Pressure Algometer Research Articles

Effects of Nature-Based Multisensory Stimulation on Pain Mechanisms in Women with Fibromyalgia Syndrome: A Randomized Double-Blind Placebo-Controlled Trial

BackgroundThe term “nature-based sensory stimuli” refers to the sensory information produced by biotic and abiotic agents from natural environments. The literature has reported the beneficial effects of these agents on various pain dimensions in non-clinical populations. AimsTo evaluate the potential analgesic effects of nature-based multisensory stimulation in women with fibromyalgia syndrome. MethodsA randomized, double-blind, placebo-controlled, parallel-group trial with a 1:1 allocation ratio was conducted. Forty-two women with fibromyalgia syndrome interacted with either different plant species with flowers, stones, and soil organic matter or their synthetic imitations for 30 minutes. Outcome measurements were performed before and after the intervention, including clinical pain intensity using the Numeric Rating Scale, cold pain thresholds using the Cold Pressor Test, mechanical hyperalgesia and wind-up using a monofilament, and pressure pain thresholds using a pressure algometer. ResultsAnalyses revealed group × time interactions for clinical pain intensity (F = 7.915, p = .008), cold-water immersion time (F = 7.271, p = .010), mechanical hyperalgesia (F = 4.701, p = .036), and pressure pain threshold (p ≤ .017). Between-group differences were found in clinical pain intensity (p = .012), cold pain thresholds (p = .002), and pressure pain thresholds (p < .05). The experimental group exhibited reduced clinical pain intensity (p = .001) and increased pressure pain thresholds (p ≤ .034). ConclusionsWomen with fibromyalgia syndrome may benefit from multisensory stimulation using biotic and abiotic agents from natural environments for 30 minutes. Interacting with flowering plants and soil components appears to induce analgesic effects.

The effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniation

Objectives. To evaluate the effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniation.Methods. This study was a prospective pre‑post single group study. Seventy‑one patients (42 male and 29 female) have been enrolled in the research with an age range of 20–60 (48 ± 13.41). During 48 hours before surgery, patients were examined by a physiotherapist. Pain intensity were measured by visual analogue scale, disability by oswestry index (Persian version) and sensitivity level using pressure algometer. Three month after laminectomy, the patients were re‑examined for mentioned outcomes again.Results. The majority of the patients (23 cases, 32.4 %) revealed 3 active trigger points of the muscles before surgery. 60 subjects (84.5 %) experienced a gradual onset of leg pain without a trauma history. Lumbar multifidus (74.9 %), medial gastrocnemius (73.2 %), soleus (70.4) gluteus medius (62 %) were the most involved muscles with trigger points before laminectomy. On the other hand, after laminectomy medial gastrocnemius (54.9 %), lateral gastrocnemius (53.5 %), soleus (50.7 %), multifidus (39.4 %) and quadratus lumborum (39.4 %) were the most involved muscles with trigger points. The existence of trigger points in longissimus thoracis (p = 0.04), quadratus lumborum (p = 0.001), gluteus maximus (p = 0.04) and tibialis anterior (p = 0.02) were decreased significantly after laminectomy. Pain, disability and pain pressure threshold revealed significant differences before and after surgery.Discussion. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively.Conclusion. The present study revealed that pain, disability, number and prevalence of trigger points decreased after lumbar laminectomy. Nevertheless, pressure pain threshold of trigger points increased after surgery. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively. In fact, current results showed that active trigger points should be considered before and after laminectomy surgery

Instrument–assisted soft tissue mobilization versus myofascial release therapy in treatment of chronic neck pain: a randomized clinical trial

ObjectiveThe purpose of this study was to investigate the effect of instrument-assisted soft tissue mobilization (IASTM) versus myofascial release therapy (MRT) on college students with chronic mechanical neck pain (CMNP).MethodsThirty-three college students with a mean age of 21.33 ± 0.98 involved in distance learning due to the Corona Virus 2019 (COVID-19) restriction were randomized to receive either IASTM on the upper trapezius and levator scapulae muscles or MRT. Researchers measured their pain with a visual analog scale (VAS), function with neck disability index (NDI), and pain pressure threshold (PPT) with a pressure algometer. The subjects received eight therapy sessions over four weeks and outcome measures were assessed pre and post-intervention. The study was registered as a clinical trial on clinicaltrials.gov (registration number: NCT05213871).ResultUnpaired t-test showed no statistical significance between the two groups post-intervention regarding improvement in pain, function, and PPT (p > 0.05).ConclusionThis study showed insignificant differences between groups. However, we did not use a control group, indicating that the improvement in outcomes may not have been caused by the intervention.Study designQuasi-experimental two groups pre-posttest clinical trial.Level of evidenceTherapy, level 2b.

Comparison of Static and Dynamic Myofascial Decompression on Gastrosoleus Muscle Power and Latent Trigger Point Pain in Normal Healthy Women

ABSTRACT Objectives: Muscle performance is an essential component of an individual that is influenced by physiological, anatomical, psychological, and biomechanical factors. It includes flexibility, muscle strength, agility, and cardiovascular and aerobic endurance. Treatment approaches like stretching and myofascial decompression help improve flexibility and thereby muscle performance. This study explores the effects of static and dynamic myofascial decompression on gastro soleus trigger point pain and power. Materials and Methods: 105 healthy normal women in the age group of 20-30 yrs were enrolled in the study. The subjects were divided into three groups by simple random sampling using the chit method. Group A received static myofascial decompression, dynamic stretching, and cryotherapy. Group B received dynamic myofascial decompression, dynamic stretching, and cryotherapy whereas Group C received dynamic stretching and cryotherapy. Lower extremity muscle power and functional performance were tested by Vertical jump height. The Gastrosoleus muscle’s myofascial trigger point pain sensitivity was measured with a pressure algometer. Statistical Analysis: Data was analyzed using SPSS. The difference in the mean Vertical jump height and pain pressure threshold values between the groups were analyzed using one-way ANOVA. Intra-group analysis was done using Repeated Measures ANOVA. Statistical significance was set at P &lt; 0.05, at a 95% confidence interval. Results: Participants in all three groups showed clinical improvement, however, the differences in the three groups were not statistically significant. In the dynamic myofascial decompression group, a significant (P &lt; 0.05) carry-over effect was seen in the vertical jump height test post 5 days of intervention. Conclusion: Static and Dynamic myofascial decompression are equally effective in reducing pain and improving gastro soleus muscle power in subjects with latent trigger points. There was a sustained carry-over effect was seen in the vertical jump height test in the dynamic myofascial decompression group after 5 days of intervention.

On determining the mechanical nociceptive threshold in pigs: a reliability study.

A pressure algometer is a valuable tool for assessing the mechanical nociceptive threshold (MNT) in clinical pain studies. Recent research has turned to large animal models of pain because of the closer anatomy and physiology to humans. Although the reliability and usefulness of the MNT have been extensively validated in humans, similar data from large animals is still sparse. Therefore, the aim of the current study was to evaluate the reliability (within- and between-session) of MNT in the forelimb of pigs using a pressure algometer. Nine animals were used (23-40 kg), and MNTs were measured at both the right and left limbs at three different sessions, with three repetitions per session. The intraclass correlation coefficient (ICC) was used as a metric for relative reliability. The standard error of measurement (SEM) and coefficient of variation (CV) was used to assess absolute reliability. Systematic bias was also evaluated. The average ICC was found to be 0.71 and 0.45 for the between-session and within-session, respectively. CV ranged from 17.9% to 20.5%, with a grand average of 19.1%. The grand average SEM was 249.5 kPa (16.6%). No systematic differences were found for the MNT between sessions, which suggests that there was no habituation to the stimulus. The reliability indices obtained in this study are comparable to results obtained in other species or anatomical regions and substantiate the use of the pressure algometer as a valuable tool to investigate the nociceptive system in pigs and translation to the human nociceptive withdrawal reflex.

Effect of myofascial cupping vs integrated neuromuscular inhibition techniques on pain and neck movement in individuals with latent trigger point in trapezius.

Pain is the most common symptom for seeking therapeutic alternative to conventional medicine. Trigger points (TrP) being the most debilitating cause of nonspecific neck pain, are found to be more prevalent in trapezius muscle. Various instrument-based and other manual therapy techniques are effective in the treatment of TrP. To compare the effect of Myofascial Cupping (MFC) and Integrated Neuromuscular Inhibition Technique (INIT) on the upper trapezius latent TrP on pain intensity, pressure pain threshold (PPT) & cervical range. A randomized trial controlled on 40 individuals aged 20-40 years, both gender with latent TrPs in upper trapezius excluding ones who have taken treatment for upper trapezius TrPs within 6 months. Participants were randomly allocated into 2 groups by chit method, one group received MFC and other INIT. Pre- and post-intervention assessment was done using NPRS, pressure algometer and goniometer. Within group, pain has significantly reduced after MFC and INIT with mean difference of and , respectively (). PPT increased in both groups () with mean difference of and , respectively. Comparison between the groups showed significant difference in pain intensity () suggesting MFC was more effective in reducing pain. However, a PPT (p=0.606) and neck lateral flexion to the contralateral side of TrP () were not significant. MFC was more effective than INITs in improving pain, however both interventions showed similar effect on PPT and neck lateral flexion on latent TrP in trapezius.

The Relationship Between Latent Myofascial Trigger Point and Range of Motion of Knee Flexor and Extensor Muscles

The study purpose was to assess the relationship between Latent Myofascial Trigger Point and range of motion in the lower limb of athletes. A lower Pain pressure threshold (&lt; 25 lbs/cm2) in muscles indicates the presence of a latent myofascial trigger point. Materials and methods. Initially, the study involved 46 male Athletes (aged 20-23 years) as participants. The pain pressure threshold was measured by the pressure algometer (FPX 25 Wagner Instruments, Greenwich, CT, USA) to detect latent myofascial trigger points on the hamstring and quadriceps muscles. Out of 46 participants, 23 tested positive with a latent myofascial trigger point, and rest of them tested negative with a latent myofascial trigger point. All the participants measured knee flexor and extensor range of motion with the Kinovea software (version 0.9.5). In descriptive statistics, mean and standard deviation were used, and Pearson correlation was used to determine the relationship between the variables. The level of significance was set at 0.05. Results. A significant correlation was found between Latent Myofascial Trigger Points and lower limb range of motion (p &lt; 0.05), and it was also observed that the magnitude of correlation coefficient was very large (0.7–0.9). Conclusions. Latent Myofascial Trigger Points impair sports performance by decreasing the range of motion of knee flexors and extensors. In light of this, Latent Myofascial Trigger Point should be considered a serious musculoskeletal disorder, and appropriate preventative measures should be taken by health professionals.

PD34-03 PRE-OPERATIVE CENTRAL SENSITIZATION AND HYPERSENSITIVITY TO PAIN IS ASSOCIATED WITH URETERAL STENT PAIN: FINDINGS FROM THE URINARY STONE DISEASE RESEARCH NETWORK (USDRN)

You have accessJournal of UrologyCME1 Apr 2023PD34-03 PRE-OPERATIVE CENTRAL SENSITIZATION AND HYPERSENSITIVITY TO PAIN IS ASSOCIATED WITH URETERAL STENT PAIN: FINDINGS FROM THE URINARY STONE DISEASE RESEARCH NETWORK (USDRN) Henry Lai, Hongqiu Yang, Jonathan Harper, Alana Desai, Gregory Tasian, Rebecca McCune, Ziya Kirkali, Hussein Al-Khalidi, Charles Scales, and Michele Curatolo Henry LaiHenry Lai More articles by this author , Hongqiu YangHongqiu Yang More articles by this author , Jonathan HarperJonathan Harper More articles by this author , Alana DesaiAlana Desai More articles by this author , Gregory TasianGregory Tasian More articles by this author , Rebecca McCuneRebecca McCune More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Hussein Al-KhalidiHussein Al-Khalidi More articles by this author , Charles ScalesCharles Scales More articles by this author , and Michele CuratoloMichele Curatolo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To examine the relationship between pre-operative central sensitization and hypersensitivity to pain, and post-operative stent pain after ureteroscopy (URS) for stones. METHODS: Adult participants enrolled in the USDRN STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) underwent quantitative sensory testing (QST) prior to URS and stent placement. Hypersensitivity to mechanical pain was assessed with pressure algometer. Participants rated their pain intensity (0-100) to 2 kg and 4 kg pressure applied to the flank and lower abdominal quadrant on the side of planned stent, and the contralateral forearm (control). Pressure pain thresholds (PPT) were also assessed. Central sensitization was assessed by applying a pinprick stimulator and calculating temporal summation (TS). Post-operative stent pain was assessed using PROMIS questionnaires for pain intensity and pain interference. Data were analyzed using repeated-measures mixed-effects models. RESULTS: Among the 412 participants with QST data, median age was 54 years, 46% were female. Higher pre-operative pain ratings to mechanical pressure to the ipsilateral flank and abdominal areas were associated with higher stent pain intensity on post-operative days 1, 3, 5, 7-9, and 30 days post-stent removal (p<0.05). Lower pre-operative PPT (i.e. higher mechanical hypersensitivity) was associated with higher post-operative pain intensity (p<0.05). Greater degree of central sensitization pre-operatively (higher TS) was associated with higher post-operative pain intensity (p<0.05). Significant correlations existed between pre-operative QST measures at the ipsilateral flank area and post-operative stent pain intensity (Table). Similar correlations were observed for ipsilateral abdominal area but not consistently for the forearm control site (data not shown). CONCLUSIONS: We have identified a physiological risk factor associated with stent pain. Preoperative central sensitization and hypersensitivity to pain were associated with post-operative stent pain. QST is a potential tool to identify patients likely to experience post-URS stent pain, which may facilitate early identification for mitigation, counseling, and management options. Source of Funding: NIH/NIDDK © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e920 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Lai More articles by this author Hongqiu Yang More articles by this author Jonathan Harper More articles by this author Alana Desai More articles by this author Gregory Tasian More articles by this author Rebecca McCune More articles by this author Ziya Kirkali More articles by this author Hussein Al-Khalidi More articles by this author Charles Scales More articles by this author Michele Curatolo More articles by this author Expand All Advertisement PDF downloadLoading ...

Chronic lateral elbow tendinopathy with a supervised graded exercise protocol

Study DesignProspective Case Series. BackgroundVariety of studies inquired the effectiveness of exercise treatment in LET (Lateral Elbow Tendinopathy). The research on the effectiveness of these approaches are still ongoing and very much needed due to the uncertainty of the subject. PurposeWe aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function. MethodsThis study is completed by 28 patients with LET and it was planned as a prospective case series. Thirty participants were included to participate in the exercise group. Basic Exercises (Grade 1) were performed for four weeks. Advanced Exercises (Grade 2) were performed for another four weeks. The VAS (Visual Analog Scale), pressure algometer, the PRTEE (Patient-Rated Tennis Elbow Evaluation) and a grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline, at the end of four weeks and at the end of eight weeks. ResultsInvestigation of the pain scores revealed that all VAS scores (p < 0.05, ES = 1.35; 0.72; 0,73 activity, rest, and night respectively) and pressure algometer results were improved both during basic (p < 0.05, ES = 0.91) and advanced exercises (p < 0.05, ES = 0,41). PRTEE scores were found to be improved in patients with LET after basic and advanced exercises (p > 0.001, ES = 1.15; p > 0.001, ES = 1.56 respectively). The grip strength only changed after basic exercises (p = 0.003, ES = 0.56). ConclusionsThe basic exercises were beneficial for both pain and function. However, advanced exercises are required for obtaining further improvements in terms of pain, function, and grip strength.

Comparative Effectiveness of Gua Sha, Cryostretch, and Positional Release Technique on Tenderness and Function in Subjects with Plantar Fasciitis: a Randomized Clinical Trial.

Plantar fasciitis (PF) can be treated effectively with manual techniques like cryostretch (CS) and the positional release technique (PRT). Although Gua Sha (GS) has been suggested in the literature for PF, its efficacy has not been studied in the research. To determine and compare the effectiveness of GS, CS, and PRT in subjects with PF in terms of pain intensity, pain pressure threshold, and foot function. Thirty-six patients with PF (n=36) were randomly allocated to three study groups (12 in each group)-group GS, group CS, and group PRT, respectively. A randomized clinical trial was conducted at physiotherapy OPD in a tertiary health center. Subjects of all genders with plantar fasciitis of the age group 20-60 years. Thirty-six subjects with plantar fasciitis out of whom 12 were males and 24 females. There were no dropouts in this study. The interventions included the Gua Sha technique (1 session), the cryostretch technique with a frozen tennis ball (3 sessions), and the positional release technique (7 sessions), along with common exercises for all three groups. Pain intensity, foot functions, and pain pressure threshold were assessed using the Numerical Pain Rating Scale, Foot Function Index, and pressure algometer, respectively, on day 1 (pre-intervention) and day 7 (post-intervention). Between-group analyses showed that group GS was more effective than CS and PRT for pain (p=.0001), group CS was more effective than GS and PRT for foot function (p=.0001) whereas group PRT was more effective than GS and CS for pain pressure threshold (p=.0001). Although all three groups showed improvement, Gua Sha was superior in terms of reducing pain, cryostretch for improving foot functions, and PRT for reducing tenderness. The interventions used in this study are cost-effective and have proved to be simple and safe techniques.

A Cross-sectional Study to Associate BMI with Pressure Pain Threshold and Pain Tolerance Among Healthy Young Individuals

Background: Although pain is common for everyone, it is a subjective sensation influenced by different variables. One factor that influences pain threshold and perception is body mass index (BMI). This study investigates the connection between BMI and pain by assessing the pressure pain threshold and tolerance on the median and ulnar nerves in the palms. Methods: The PPT and PT of 120 participants were measured with a digital pressure algometer (FPIX50; Wagner Instruments). Measurement sessions consisted of consecutive PPT and PT readings on the thenar and hypothenar eminence of the dominant and non-dominant hand. In addition, the PPT and PT were compared between BMI, thenar and hypothenar, dominant and non-dominant hand, and sexes. Results: The results have shown that the PPT and PT increased with BMI. However, only three out of the eight readings were significant (p = &lt;0.05). When comparing the thenar and hypothenar, the results revealed significantly higher PPT and PT levels in the hypothenar (p = &lt; 0.001). The results comparing the PPT and PT between the dominant and non-dominant hand revealed a significantly higher PPT in the non-dominant hand reflected across the thenar and hypothenar (t= -6.197, p= &lt;0.01) (t= -2.550, p= 0.012), respectively. In addition, males had higher PPT and PT values (p = &lt;0.05). Conclusion: The results suggest that individuals with higher BMI can tolerate more pain. They also indicate that the hypothenar eminence could withstand higher pain levels than the thenar eminence. In addition, our assessment also revealed a higher pain threshold observed in participants' nondominant hands, but the same could not be deduced for the pressure pain tolerance. Furthermore, the results have shown that males could tolerate more pain than females.

Effect of stress on contextual pain sensitivity in the preoperative period- A proof of concept study.

The importance of non-noxious contextual inputs in the interplay of pain with neurophysiologic and behavioral factors is gaining recognition. Stress of impending surgery can act as a negative context, leading to a decrease in pain threshold in patients. This study was conducted to assess the influence of stress conferred by the imminent and other contextual inputs such as anxiety, socioeconomic status, prior painful experience, and the effect of gender on modulation of pain perception in patients undergoing elective surgery. In total, 120 patients aged between 18 and 60 years of either gender posted for elective gastrointestinal surgery under general anesthesia were recruited. Data were collected on preoperative anxiety level, socioeconomic status, education, and any prior painful experience. A pressure algometer was used to measure the pressure pain thresholds and pain tolerance on the day before surgery and on the morning of surgery in the preoperative suite. There was a statistically significant decrease in both pain threshold (P < 0.0001) and pain tolerance in the immediate preoperative period in comparison to the baseline readings taken the day before surgery (P = 0.048). The magnitude of change in pain scalars was greater in females (P < 0.001), those with a high anxiety score, and a history of severe painful experience in the past. Preoperative surgical stress lowers the pain threshold and pain tolerance. Contextual modulation of pain by factors such as anxiety and memory of prior painful experience, especially in the female gender, could influence postoperative patient outcomes and warrants further research.

Effect of instrument assisted soft tissue mobilization versus kinesiotape for chronic mechanical low back pain: a randomized controlled trial

IntroductionThe primary purpose was to compare the effect of conventional program, instrument assisted soft tissue mobilization (IASTM) and kinesiotape (KT) in patients with chronic mechanical low back pain (CMLBP).Methods51 participants were randomly enrolled into three equal groups. Group A (&lt;i&gt;n&lt;/i&gt; = 17) received conventional program, Group B (&lt;i&gt;n&lt;/i&gt; = 17) received conventional program plus IASTM, and Group C (&lt;i&gt;n&lt;/i&gt; = 17) received conventional program plus KT. The participants were evaluated before and after eight sessions using the Visual Analogue Scale (VAS), pressure algometer, dual inclinometer, and Oswestry Disability Index (ODI).ResultsBetween pre-treatment and post-treatment, the three groups demonstrated a significant pain reduction (57.2%, 61.2%, and 57.77%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001), a significant increase in pain pressure threshold (PPT) [right (Rt): 56%, 53.2%, and 35.6%; left (Lt): 49%, 50.55%, and 41.36%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001], a significant improvement in the range of motion (ROM) (flexion: 38.59%, 43.55%, and 35.7%; extension: 72.4%, 88.73%, and 65.56%; Rt lateral flexion: 79.05%, 78.03%, and 55.42%; Lt lateral flexion: 85.33%, 96.37%, and 64.66%; Rt rotation 135%, 116.5%, and 188.48%; Lt rotation: 203%, 140.48%, and 224.24%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001), and a significant improvement in the functional disability index (56.8%, 49.55%, and 46.99%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001). No significant difference in pain, PPT, ROM and function was found among the three groups.ConclusionsConventional program, IASTM and KT are effective methods for improving pain, ROM and function on CMLBP.

Effects of osteopathic manipulative treatment associated with pain education and clinical hypnosis in individuals with chronic low back pain: study protocol for a randomized sham-controlled clinical trial

BackgroundPatients with chronic low back pain (CLBP) suffer with functional, social, and psychological aspects. There is a growing number of studies with multimodal approaches in the management of these patients, combining physical and behavioral therapies such as osteopathic manipulative treatment, associating pain education and clinical hypnosis. The aim of the present study will be to evaluate the effects of osteopathic manipulative treatment (OMT) associated with pain neuroscience education (PNE) and clinical hypnosis (CH) on pain and disability in participants with CLBP compared to PNE, CH, and sham therapy.MethodsA randomized controlled clinical trial will be conducted in participants aged 20–60 years with CLBP who will be divided into two groups. Group 1 will receive PNE and CH associated with OMT, and G2 will receive PNE, CH, and sham therapy. In both groups, 4 interventions of a maximum of 50 min and with an interval of 7 days will be performed. As primary outcomes, pain (numerical pain scale), pressure pain threshold (pressure algometer), and disability (Oswestry Disability Questionnaire) will be evaluated and, as a secondary outcome, global impression of improvement (Percent of Improvement Scale), central sensitization (Central Sensitization Questionnaire), biopsychosocial aspects (Start Beck Toll Questionnaire), and behavior of the autonomic nervous system (heart rate variability) will be assessed. Participants will be evaluated in the pre-intervention moments, immediately after the end of the protocol and 4 weeks after the procedures. Randomization will be created through a simple randomized sequence and the evaluator will be blinded to the allocation of intervention groups.DiscussionThe guidelines have been encouraging multimodal, biopsychosocial approaches for patients with CLBP; in this sense, the results of this study can help clinicians and researchers in the implementation of a model of treatment strategy for these patients. In addition, patients may benefit from approaches with minimal risk of deleterious effects and low cost. In addition, it will enable the addition of relevant elements to the literature, with approaches that interact and do not segment the body and brain of patients with CLBP, allowing new studies in this scenario.Trials registrationDate: September 4, 2021/Number: NCT05042115.

High-intensity laser therapy (class IV) and ibuprofen gel phonophoresis for treating knee osteoarthritis among people living in hilly terrain: a randomized, double blind, multi-centre trial protocol

INTRODUCTION: People living in hilly terrain with abnormal cyclic loading could lead to bone cartilage degeneration. High-intensity laser therapy (HILT) and Ibuprofen gel phonophoresis (IGP) have innumerable benefits for patients with knee osteoarthritis (KOA). However, it is still unclear which treatment is effective among them in rehabilitating patients with KOA. OBJECTIVE: To verify whether 8-week HILT is no worse than the IGP in treating patients with knee osteoarthritis living in hilly terrain. MATERIALS AND METHODS: A total of 108 individuals with KOA will be recruited by simple random sampling to participate in a randomized, double-blind, controlled study. Recruited individuals with KOA will be randomly divided into two groups, the HILT group (experimental group) and the IGP group (active control group). The treatment duration of HILT and IGP will be 8 minutes in one session/knee joint for each day for 3 days/week up to 8 weeks in addition to their conventional exercises for 30 minutes. The Western Ontario and McMaster Universities Osteoarthritis Index, Digitalized pain pressure algometer, and 36-Item Short-Form Health Survey questionnaire are the outcome measures that will be recorded at baseline, end of the 8-week post-intervention period. PERSPECTIVES: The results from this trial will contribute to evidence-based recommendations for the clinical implication of whether HILT is no worse than IGP, along with exercise intervention for treating individuals with KOA living in hilly terrain. Trial Registry: Clinical Trials Registry (NCT04320914)

Effect of aerobic exercises and therapeutic pain neuroscience education on disability, pain, head posture and QOL in migraine patients

Migraine is a type of primary headache with a high degree of associated disability that can present with a variety of indications and co-morbidities. The role of physical therapy treatment in migraine management is largely obscure. To investigate the combine effect of aerobic exercises and therapeutic pain neuroscience education on disability, pain pressure threshold, head posture and quality of life (QoL) in patients having migraine. Subjects were screened by using Migraine Disability Assessment (MIDAS) and after screening total sample of 50 subjects were randomly assigned into two groups: Group A (Experimental, n=25) and Group B (Control, n=25). Migraine disability assessment, pressure algometer, craniovertebral angle (CVA) and migraine specific quality of life were examined before and after 6 weeks of the intervention. Group A were given aerobic exercises and therapeutic pain neuroscience education along with conventional treatment for 45 min 3 days/week for 6 weeks, whereas participants in the Group B performed conventional exercises alone for 20 min 3 days/week for 6 weeks. Significant differences were observed in migraine disability score (P=0.003) and pain pressure threshold (P=0.039, P=0.030 and P=0.025) and improvement in forward head posture (P=0.001) between the groups after the intervention period, signifying greater improvement in the group A. QoL also improved in both the groups after intervention. Main findings of the present study suggest that the therapeutic pain neuroscience education and aerobic exercises combined with conventional treatment together maybe helpful to give better quality of life, reduced disability, increased pain pressure threshold and increased CVA to patients with migraine.

Lean Mass is Associated with, but Does Not Mediate Sex Differences in Pressure Pain Sensitivity in Healthy Adults.

Sex differences exist in pain sensitivity, however, the underlying mechanism(s) that explain these differences are not fully understood. Pain sensitivity has been shown to be influenced by body mass index, but limited data exist on the role of body composition on pain sensitivity. The purpose was to examine the influence of body composition on pain sensitivity in males and females. This cross-sectional study design used pressure pain thresholds (PPT) of 87 participants (45 female) who were assessed in the vastus lateralis (leg PPT) and brachioradialis (arm PPT) using a pressure algometer. Fat and lean tissue were assessed via dual-energy X-ray absorptiometry (DXA). A two group by two limb, repeated measured ANOVA was used to assess differences between limbs and sex. Spearman correlations and hierarchical regression analyses were employed to determine the association between body composition and PPT. Males had higher PPTs then females (P<0.05) and had higher DXA assessed lean and lower levels fat mass (P<0.05). Total body and limb specific lean mass was associated with PPTs (r≥0.34; P<0.05). Hierarchical regression analysis revealed lean mass was a significant predictor of 8% of the variance in arm PPT (P<0.006) and 18% of the variance in leg PPT (P<0.001). However, lean mass was not found to statistically mediate the observed sex differences in PPT. This finding suggests lean mass may play a previously unknown role in sex differences in pressure pain sensitivity. Future studies are needed to confirm this finding and a larger sample size is likely required to have sufficient power to perform the mediation analysis.

Pharmacokinetics and efficacy of a novel long-acting bupivacaine formulation for cornual nerve block in calves.

Local anesthetics are commonly used in farm animals to provide analgesia for painful procedures but can cause adverse effects at high systemic concentrations. The pharmacokinetics and efficacy of a long-acting sucrose acetate isobutyrate (SAIB) bupivacaine formulation following cornual nerve block in calves were compared to lidocaine. Fourteen calves were randomly assigned to one of the treatment groups (i) 5% Bupivacaine-SAIB (BUP-SAIB), n = 7; or (ii) 2% lidocaine (LID), n = 7. Cornual nerve block was performed, and duration of effective analgesia was evaluated by nociceptive threshold testing using a hand-held pressure algometer. Blood samples were collected at various time points and plasma concentrations were analyzed by HPLC. Pharmacokinetic parameters were calculated using a non-compartmental model. The mechanical nociceptive thresholds showed that the novel formulation could desensitize the skin around the horn bud for 18.77 ± 8.88 h (range 8-36 h), compared to 0.79 ± 0.34 h (range 0.5-1.5 h) with lidocaine. The mean maximum plasma concentration (Cmax) of bupivacaine was 152.03 (SD 37.34) ng/mL and its Tmax was 0.39 (SD 0.13) h. The half-life of elimination was 32.79 ± 11.00 h and the rate of clearance was 0.12 ± 0.03 L h-1. No toxicity signs were seen after treatment in either group. The novel formulation produced long-lasting analgesia of several times greater duration than that produced by lidocaine. This study showed that the safety and efficacy of the SAIB formulation justifies further studies in a larger population of animals.

A multi-center, double-blind, randomized parallel-group Phase IV study comparing the efficacy and safety of thiocolchicoside ointment versus placebo in patients with chronic mechanical low back pain and an acute muscle spasm.

This study aims to evaluate the efficacy and safety of thiocolchicoside (TCC) ointment treatment compared to placebo in patients with chronic mechanical low back pain (LBP) accompanied by acute muscle spasms. A total of 292 adult patients (106 males, 186 females; mean age: 38.5±11.2 years; range, 18 to 64 years) were randomized to TCC group (n=147) and placebo group (n=145) in 12 centers between March 2020 and March 2021. Eight patients from each group were excluded from the analysis. The primary endpoint was pressure pain threshold (PPT) on Day 3, which was measured using a pressure algometer. Secondary endpoints were PPT on Day 7, patient, and physician Visual Analog Scales-pain (VAS-pain) on Days 3 and 7, and safety. The PPT values on Day 3 was not significantly different between the treatment groups (p=0.701). Similarly, TCC and placebo group had similar VAS-pain scores over trial period (p=0.577 or higher for comparisons). Significantly higher PPT values and lower VAS-pain scores on Days 3 and 7 were observed in both groups (p<0.001 for all). In patients with a PPT value of ≥3.87, TCC arm had higher PPT on Day 3 compared to placebo (p=0.029). Three patients (two in the TCC arm and one in the placebo arm) discontinued the trial due to an adverse event. Topical TCC can be an appropriate option in a subset of patients with mild chronic LBP accompanied by muscle spasms. In a subset of patients with milder pain intensity, topical TCC may improve pain earlier. The results of this trial are compatible with the treatment approaches used in daily practice.

Changes in Circadian Variations in Blood Pressure, Pain Pressure Threshold and the Elasticity of Tissue after a Whole-Body Photobiomodulation Treatment in Patients with Fibromyalgia: A Tripled-Blinded Randomized Clinical Trial.

This study analysed circadian variation changes in blood pressure (BP), the pain pressure threshold (PPT) and the elasticity of tissue in patients with fibromyalgia (FM) after a whole-body photobiomodulation (PBM) treatment. This was a tripled-blinded randomized clinical trial including forty participants with FM. Participants using validated self-measurement BP devices attained readings that were used to calculate the circadian variation. Additionally, a standard pressure algometer of 1cm2 was used to assess 13 tender points by exerting a pressure of up to 4 kg, and strain elastography assessed the elasticity of tissue. Circadian variations in BP showed significant differences after the PBM intervention (p = 0.036). When comparing PPT between groups, statistically significant differences were found in the occiput (p = 0.039), low cervical (p = 0.035), trapezius (p = 0.037), second rib (p &lt; 0.001) and medial epicondyle points (p = 0.006). Furthermore, there were statistically significant differences in both the trapezius and the forearm at the distal dorsal third SEL values (p ≤ 0.001) when comparing groups. Whole-body PBM produces changes in circadian blood pressure, the pain pressure threshold and the elasticity of tissue after a treatment program was carried out. However, more studies are needed to corroborate our findings as well as to better understand the underlying mechanisms.