Subjective Pain Research Articles

Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review.

Complex regional pain syndrome (CRPS) is a chronic pain condition most often triggered by direct injury to an extremity that is characterized by disproportionate pain, sensory abnormalities, and autonomic dysfunction. Early research into intravenous lidocaine therapy for CRPS has demonstrated promise, but clinical evidence remains scarce. We report on 12 patients with chronic CRPS who underwent intravenous lidocaine therapy and discuss our findings in the context of the existing literature. Patients ages ranged from 25 to 64 years. Duration of CRPS ranged from 4 to 25 years. The majority of patients (8/12, 67%) reported adequate subjective pain relief with intravenous lidocaine therapy, whereas four patients reported inadequate subjective pain relief with therapy. All patients were being treated with at least one other pharmacotherapy. Three patients experienced minor side effects. Our cases, taken with existing evidence, suggest that intravenous lidocaine for the treatment of chronic CRPS is safe and may decrease the pain associated with chronic CRPS. However, this study lacks adequate sample size to make those conclusions confidently. We recommend a randomized placebo-controlled multicenter clinical trial to establish the efficacy and side effect profile of systemic intravenous lidocaine more confidently for the treatment of pain due to chronic CRPS.

Transdermal Buprenorphine Patch in the Management of Postoperative Acute Pain following Mandibular Resection and Reconstruction

BackgroundTransdermal buprenorphine is used for the management of postoperative pain. Its effectiveness for the postoperative pain management following mandibular resection and reconstruction has not been evaluated. PurposeTo evaluate the efficacy of transdermal buprenorphine patch (TBP) in managing postoperative pain after mandibular resection and reconstruction with anterior iliac crest graft. Study design, setting and sampleThis triple-blinded, randomized controlled trial included 30 subjects in the age range of 18 to 60 years with benign mandibular pathologies. Subjects visiting the Outpatient Department of Dept. of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, India were included in the study. Subjects with known allergies to any drugs, using sedatives, alcohol, pregnant and lactating mothers, and with respiratory problems were excluded. PredictorThe predictor variable was postoperative pain management and subjects were randomly assigned to TBP or a placebo patch group. Main outcome variableIt was the postoperative pain, which was measured by visual analog scale (VAS) for seven consecutive days. Secondary outcome variables were requirement of rescue analgesics and drug-related adverse effects. CovariatesAge at surgery, sex, diagnosis, duration of the operation and amount of fentanyl used during the operation were covariates. AnalysesDescriptive statistics, Mann-Whitney U, Chi-square, Repeated Measures ANOVA and post-hoc analysis (Bonferroni test) were used. A P-value <0.05 was considered as a level of statistical significance. ResultsThirty subjects were randomly allocated to TBP and control group. The mean VAS score during the study period was 0.8±2.37 and 3.49±2.37 in TBP and control group subjects respectively (P<0.001). Compared to control group, the mean VAS score in TBP group subjects was significantly less till the end of post-operative day-4 (P<0.001). The mean rescue analgesic requirement during post-operative period was 5.33±15.8mg and 47.6±37.7mg in the TBP and control group subjects (P<0.001). Nausea was most common drug-related adverse effect in both the group subjects (46.7%) (P>0.9). Conclusion and RelevanceThe highest VAS score in TBP group subjects was 1.53±0.92 on post-operative day-1 morning, whereas it was 6.47±1.3 at 6-hours after operation in control group subjects. Thus, a TBP was adequate for the management of post-operative pain following mandibular resection and reconstruction.

Lumbopelvic rhythm analysis by quartiles: Identification of differences in lumbar and pelvic contribution during trunk flexion and extension in subjects with low back pain of different origin. A case-control study.

Low back pain (LBP) can alters spinal kinematics. However, for adequate clinical care, a better understanding of lumbopelvic biomechanical behaviour according to the type of LBP is required. Our objectives were to identify differences in lumbopelvic rhythm (LPR) between subjects with acute low back pain (aLBP), axial spondyloarthritis (axSpA) and healthy subjects. As well as to identify correlations between LPR and sociodemographic and clinical data. In each group of 39 subjects, LPR total and by quartiles (Q) and metrological and clinical data were evaluated. No differences were found in relation to total flexion and LPR extension. However, study by Q showed less movement in aLBP compared to axSpA and healthy subjects at the Lumbar level in Q2 (p=0.001), Pelvis in Q3 and Q4 and Trunk in Q3 (p=<0.001). In Q4 the aLBP moved the Trunk less than axSpA exclusively [-3,64°(95% confidence interval-6.53,-0.74), p=0.011]. For the extension movement, the Pelvic motion of Q2 was lower for the aLBP group compared to axSpA group [-3,11°(-6.00,-0.22), p=0.030], and Trunk motion of Q2 and Q3 (p=0.001, p=0.007, respectively), and Lumbar mobility of Q3 were also lower compared to axSpA and control groups (p=0.031). Specific correlations were found for each group. aLBP with BMI, axSpA with metrology and Healthy subjects with age. Subjects with aLBP showed less lumbar, pelvic or trunk movement in Q2 and Q3 of trunk flexion and extension movements than axSpA and controls. RPL and its interrelationships with sociodemographic and clinical variables depend on the lumbar condition.

Initial clinical evaluation of a novel integrative bone matrix (IBM) in foot and ankle fusion procedures

BackgroundFoot and ankle arthrodesis procedures are frequently performed in concert with the utilization of bone grafts. However, the availability of autologous bone is often limited, inaccessible, or not suitable, thus there is a need for bone graft substitutes with equally effective clinical outcomes. A next generation integrative bone matrix (IBM) has been developed that has intrinsic osteogenic, osteoconductive, and osteoinductive characteristics, and is a promising solution to mitigate complications such as nonunion and reduce the need for autologous bone graft harvest.MethodsThe charts of twenty subjects undergoing foot and ankle fusion procedures with INFLUX™ SPARC, a novel IBM, were retrospectively reviewed to determine initial clinical safety and efficacy of this next generation bone graft. Endpoints included the presence of complications or surgical reintervention, fusion rates as determined by standardized radiographic films, and patient-reported outcome measures at various time points up to 24 weeks.ResultsNo major complications or surgical reinterventions were observed in this study. Complete radiographic fusion was achieved in all subjects by 24 weeks, with a mean overall fusion time of 8.5 ± 4.8 weeks. Subjective pain, function, and quality of life outcomes showed consistent improvements throughout the follow-up period, and all subjects (100%) achieved the minimum clinically significant mean improvements for all measures by week 24.ConclusionsThis study supports the use of this new IBM as a promising alternative to autologous bone grafting, offering high fusion success rates, low complications, and clinically meaningful improvements in patient-reported outcomes, particularly in higher-risk patient populations. Future investigations are needed to confirm these findings in larger and longer-term studies, and to explore the broader applications of this innovative bone graft.

Impact of equine interactions on human acute pain perception: Two cross sectional studies.

Research has demonstrated the effectiveness of Animal-Assisted Therapy, usually involving dogs, as a way to reduce pain in inpatient and outpatient populations. Here two studies investigate the effectiveness of interacting with horses for reducing human acute pain perception. In Study 1, a blood-pressure cuff was used to administer acute ischaemic pain to 70 adult participants, who were allocated to one of three groups: Equine Assisted Psychotherapy (EAP), Horse Interaction without EAP (HI), and a Control (no horses present). All participants engaged in an activity (finding a horse treat) in a large, enclosed arena. The dependent variable was the subjective pain rating (scale 0-10) of the participant in response to moderate pain induced pre- and post-activity. In Study 2, 53 adult participants were recruited and allocated to either an Equine Assisted Learning (EAL) Group or a Control Group. The same paradigm was used. Following the activity sessions, qualitative data was elicited from the participants regarding their insights and feelings. It was hypothesized that any interaction with horses would significantly reduce an individual's perception of pain. In both studies, planned paired-samples t-tests showed significant reductions in pain ratings from pre-activity to post-activity in the EAL, EAP and HI groups (large and medium effect sizes) but not the Control groups. Thematic analysis of the qualitative responses showed an overwhelmingly positive array of responses from those who interacted with the horses, for example, feeling relaxed and happy during the activity. Interactions with horses can reduce acute pain perception. Distraction, physiological changes, and positive emotions are discussed as possible underlying mechanisms. It remains to be seen how this could be more widely applied, for example, in relation to chronic pain.

Investigating the Effects of Intrinsic Foot Muscle Exercises on Dynamic Balance after Sub-Acute Ankle Sprain

Introduction: This study compares the efficacy of routine treatment plus short foot exercises (SFE) with routine treatment alone on dynamic balance and pain in subjects with sub-acute ankle sprain. Materials and Methods: A total of 32 patients (18-45 years old) with primary ankle sprain were randomly enrolled into the control group performing routine treatment alone or the SFE group performing routine treatment plus SFE. The dynamic balance was assessed using the star excursion balance test. Pain and ankle dorsiflexion range of motion were assessed using the numeric pain rating scale and a goniometer. The outcomes were evaluated at the baseline and after the end of treatment. The groups were compared using the one-way analysis of variance/analysis of covariance test. The effect sizes also were calculated to determine the efficacy of the SFE. Results: Dynamic balance in the SFE group had a significant increase in the anterior, lateral, medial, and anteromedial directions compared to the control group (P=0.001, P=0.002, P=0.014, P=0.0001). No significant differences were observed between the groups in other directions of the star excursion balance test (P&gt;0.05). Additionally, pain intensity was lower significantly in the SFE group than in the control group (P=0.0001). In the SFE group ankle dorsiflexion range was significantly more than the control group (P=0.025). The effect sizes also showed a high efficacy favoring SFE. Conclusion: The combination of routine treatment and SFE can be an effective intervention for managing ankle sprain.

Current knowledge among German physiotherapists on the subject of pain

Pain is an omnipresent symptom in the field of musculoskeletal healthcare. Person-centred care in accordance with current scientific recommendations requires comprehensive and evidence-based knowledge about pain. However, there appears to be alack of knowledge in this area both internationally and nationally. This study aimed to evaluate the pain-related knowledge and postural-structural-biomechanical (PSB) beliefs regarding pain among physiotherapists practicing in Germany. An online survey, which included the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the Essential Knowledge of Pain Questionnaire (EKPQ), was answered by n = 105 physiotherapists using SoSci Survey. Asatisfactory result is achieved when at least 90% of the participants answer at least eight of the 12questions correctly. Additionally, the possible influence of the variables 'academic degree' and 'working experience' of the participants on the questionnaire scores was investigated. The average score of the rNPQ‑D was 70.8 ± 15.4% (95% CI: 67.8-73.8%). The average score of the EKPQ was 51.4 ± 26% (95% CI: 46.4-56.4%). Neither the rNPQ‑D (69.5% of participants; n = 73) nor the EKPQ (30.6% of participants; n = 32) yielded asatisfactory result. The scores of the questionnaires correlated moderately positively and statistically significantly with each other (r = 0.47; p < 0.001). The average score of the EKPQ was significantly lower than the average score of the rNPQ‑D (p < 0.01; d = 0.84). Academically trained therapists achieved higher average scores than those non-academically trained (p < 0.05; rNPQ-D: d = 0.48, EKPQ: d = 0.42). Furthermore, participants with ≤5years of professional experience achieved significantly higher scores than participants with >5years of professional experience (p < 0.05; rNPQ-D: d = 0.75; EKPQ: d = 0.68). The knowledge among physiotherapists in Germany about pain appears to be deficient and strongly PSB-orientated. In addition, academically trained therapists seem to have amore pronounced theoretical and case-related knowledge of pain compared to graduates of vocational physiotherapy training programmes. To ensure successful and effective future treatment of individuals experiencing pain, it is imperative to systematically investigate the potential causes of such deficits. Physiotherapeutic pain care in Germany should strive for asystemic change in favour of evidence-based practice.

Complete intraureteral stent placement reduces stent-related pain in normotensive subjects and in diabetes: Subgroup analysis of a prospective randomized clinical trial

Purpose: Pain is a common symptom that is associated with ureteral stent placement, but its degree of perception might vary among individuals. Compared with conventional stent placement (C-SP), complete intraureteral stent placement (CIU-SP) has shown promise in reducing stent-associated pain. This study aimed to investigate the effect of patient characteristics and comorbidities on pain reduction after CIU-SP. Materials and methods: Patients who underwent ureteroscopic lithotripsy and stent placement were randomized into the CIU-SP and C-SP groups. Stent-associated symptoms were evaluated using the Ureteral Stent Symptom Questionnaire on day 7, immediately before stent removal. Stent-associated pain was determined by the answer to question P1 (yes or no). Subgroup analysis was conducted based on various patient characteristics and comorbidities. Results: Of the 103 randomized patients, 91 (45 in CIU-SP and 46 in C-SP) were included in the final analysis. Body pain was reported by 31 (68.9%) after CIU-SP and 41 (89.1%) after C-SP (P = 0.021). Compared with C-SP, CIU-SP significantly reduced pain in the normotensive population (66.7% versus 93.7%, P = 0.006) but not in hypertensive individuals (77.8% versus 76.9%, P = 1.000). Conversely, compared with C-SP, CIU-SP was associated with less pain in patients with diabetes (37.5% versus 88.9%, P = 0.05) but not in patients without diabetes (75.7% versus 89.2%, P = 0.221). Age, sex, stone laterality, body mass index, and smoking status did not influence the reduction of pain after CIU-SP. Conclusion: Compared with C-SP, CIU-SP was effective in reducing stent-associated pain, especially in normotensive and diabetic populations. These findings align with existing literature, which emphasized the potential impact of hypertension on decreased pain perception and highlighted the known association between diabetes and bladder hypersensitivity.

CILP-2 expression in the intervertebral discs of patients with lumbar radiculopathy

BackgroundIntervertebral disc (IVD) degeneration (IVDD) is one of the main causes of low back pain. One of the most important features of IVDD is the loss of extracellular matrix (ECM) with its structural components. Cartilage intermediate layer proteins (CILPs), minor glycoproteins residing in ECM, have been found to be increased in IVD as degeneration and aging progresses. The aim of the present study was to evaluate the expression of CILP-2 in the IVD of patients with lumbar radiculopathy.MethodsThe IVD samples were collected from 25 patients during spinal surgery (interlaminectomy, herniated disc removal). The control IVD samples were obtained from nine patients who underwent lateral corpectomies in the thoracic region. CILP-2 expression was detected by immunohistochemistry. The patients were divided into two groups – aged under or over 50 years. A standardized clinical examination with assessment of radicular signs and deficits was performed. Subjective disability and pain were assessed using the visual analogue scale and Oswestry Disability Index (ODI). The pre-operative MRI was graded for the degree of IVD degeneration by Pfirrmann grading system. IVD samples obtained during operations were subjected to the standardized histopathological analysis applying modified Boos classification. The data were analysed by t-test, Mann-Whitney U-test, and Spearman correlation test.ResultsBoth histopathology scores and Pfirrmann grades did not differ between patients’ groups. Also, no correlations were found between histopathology and Pfirrmann grades, neither were any differences seen when correlating both grades to ODI, back pain or leg pain scores. CILP-2 staining was noted in all studied samples, notably strong staining was seen around large cell clusters. However, no differences in CILP-2 staining were seen between the age groups of patients. No correlations were found between CILP-2 staining and Pfirrmann grades. Grading of CILP-2 immunostaining in nine control patient samples resulted in significantly lower values. The difference is statistically significant (P = 0.002) compared to CILP-2 staining scores of all 25 patients’ samples.ConclusionIn this study, we detected increased CILP-2 expression in the human IVD as compared to the control group patients. CILP-2 can be a possible IVDD marker; however, as knowledge about the role of CILP-2 is limited, further studies are required.

Kratom (Mitragyna speciosa) use for self-management of pain: Insights from cross-sectional and ecological momentary assessment data

Kratom (Mitragyna speciosa) is increasingly used in the US for self-management of pain, despite limited research on its efficacy and safety. To better understand how and why people use kratom for pain self-management, we analyzed baseline survey data (N = 395) and 15-day ecological momentary assessment (EMA) data (N = 357) from kratom consumers across the US. Although we recruited participants based on their kratom use, not on whether they used it for pain management, nearly half (49.1 %) met criteria for chronic pain, with many reporting substantial pain relief and high effectiveness of kratom in managing pain. A majority (69.2 %) reported difficulties in obtaining adequate pain treatment, and most indicated that these challenges impacted their decision to try kratom. Most participants did not report concerns about overuse or significant side effects. EMA data showed that, regardless of chronic-pain status, pain relief was the most frequently endorsed primary motivation for daily kratom use. There were no significant association between daily pain levels and kratom use frequency, and no difference in the daily kratom use between those with vs. without chronic pain. Recent kratom use was associated with lower current pain levels. Stronger subjective effects of kratom were associated with lower pain levels. This effect was significantly moderated by chronic-pain status: those with chronic pain showed a stronger link between subjective kratom effects and pain reduction. These findings underscore the urgent need for systematic, rigorous research on long-term implications, efficacy, and safety of kratom in pain management to guide informed clinical practices and regulatory policies. PerspectiveThis study reveals that chronic pain is common among kratom consumers, who frequently use it for pain self-management and report significant relief, as shown by ecological momentary assessment. There is an urgent need for research into kratom's safety, efficacy, and mechanisms to guide clinical practice and inform policies.

Employing the Artificial Intelligence Object Detection Tool YOLOv8 for Real-Time Pain Detection: A Feasibility Study.

Effective pain management is crucial for patient care, impacting comfort, recovery, and overall well-being. Traditional subjective pain assessment methods can be challenging, particularly in specific patient populations. This research explores an alternative approach using computer vision (CV) to detect pain through facial expressions. The study implements the YOLOv8 real-time object detection model to analyze facial expressions indicative of pain. Given four pain datasets, a dataset of pain-expressing faces was compiled, and each image was carefully labeled based on the presence of pain-associated Action Units (AUs). The labeling distinguished between two classes: pain and no pain. The pain category included specific AUs (AU4, AU6, AU7, AU9, AU10, and AU43) following the Prkachin and Solomon Pain Intensity (PSPI) scoring method. Images showing these AUs with a PSPI score above 2 were labeled as expressing pain. The manual labeling process utilized an open-source tool, makesense.ai, to ensure precise annotation. The dataset was then split into training and testing subsets, each containing a mix of pain and no-pain images. The YOLOv8 model underwent iterative training over 10 epochs. The model's performance was validated using precision, recall, and mean Average Precision (mAP) metrics, and F1 score. When considering all classes collectively, our model attained a mAP of 0.893 at a threshold of 0.5. The precision for "pain" and "nopain" detection was 0.868 and 0.919, respectively. F1 scores for the classes "pain", "nopain", and "all classes" reached a peak value of 0.80. Finally, the model was tested on the Delaware dataset and in a real-world scenario. Despite limitations, this study highlights the promise of using real-time computer vision models for pain detection, with potential applications in clinical settings. Future research will focus on evaluating the model's generalizability across diverse clinical scenarios and its integration into clinical workflows to improve patient care.

Symptom Severity and Glucocorticoid Dosing in Patients With Polymyalgia Rheumatica and Obesity.

Polymyalgia rheumatica (PMR) is an inflammatory disorder of the elderly characterized by girdle pain and stiffness. Obesity has an influence on disease activity and outcome in rheumatic diseases like osteoarthritis and rheumatoid arthritis. We aimed to investigate the relationship between high BMI and the severity and outcome of PMR, which is incompletely understood. In a post hoc analysis, 83 patients with recent-onset PMR were studied over 6 months using clinical examination, laboratory evaluation, and girdle ultrasound (US). The modified Health Assessment Questionnaire (mHAQ), 36-item Short Form Health Survey (SF-36), and PMR visual analog scale (VAS) scores, as well as prednisone therapy data, were recorded. Patients were grouped according to their BMI. At baseline, the 12 patients with obesity had significantly more shoulder pain (P = 0.03), global pain (P = 0.03), PMR VAS (P < 0.01), and fatigue (P = 0.03); higher mHAQ (P = 0.01); and lower SF-36 physical component summary (P = 0.048) and SF-36 pain index (P < 0.001). The mean initial prednisone dose was similar among groups, but patients with obesity received a lower dose/kg (1.9 [SD 0.7] mg vs 2.2 [SD 0.7] mg; P < 0.01). At 6 months, patients with obesity were being treated with higher mean daily prednisone doses (8.5 [SD 3.2] mg/d vs 6.2 [SD 5.2] mg/d; P = 0.02), and 40% of them were receiving higher daily prednisone doses than the standard protocol compared with 14% patients without obesity (P = 0.048). Clinical features, laboratory results, and US results were similar between patients with and without obesity. Obesity affects both symptom severity and prednisone utilization in patients with PMR. The reason for this may relate to different subjective pain perception rather than increased inflammation in patients with obesity. BMI should be considered when interpreting symptoms in patients with PMR and deciding their prednisone doses.

Early Detection of Left Ventricular Dysfunction With Machine Learning-Based Strain Imaging in Aortic Stenosis Patients.

Aortic stenosis (AS) is a common cardiovascular condition where early detection of left ventricular (LV) dysfunction is essential for timely intervention and optimal management. Current echocardiographic measurements, such as ejection fraction (EF), are insensitive to minor changes in LV function, and strain imaging is typically limited to the global longitudinal strain (GLS) parameter due to robustness issues. This study introduces a novel, fully automatic algorithm to enhance the detection of LV dysfunction in AS patients using multiple strain imaging parameters. We applied supervised machine-learning techniques to classify data from 82 severe AS patients, 96 chest pain subjects, and 319 healthy volunteers. Our model significantly outperformed EF and GLS in distinguishing AS patients from healthy volunteers (area under the curve [AUC] = 0.97 vs. 0.88 and 0.82, respectively). It also surpassed EF and GLS in differentiating AS patients from chest pain subjects (AUC = 0.95 vs. 0.90 and 0.55, respectively). This novel, clinically interpretable model leverages the potential of strain imaging to enhance diagnostic accuracy and guide clinical decision-making in LV dysfunction, thereby improving clinical practice.

Effectiveness of Maitland Mobilizations Along with Kinesio Taping on Reducing Pain and Disability in Subjects with Periarthritis Shoulder

Background: Frozen shoulder is a condition in which insidious and progressive pain and loss of active and passive mobility are manifested in the glenohumeral joint, presumably due to capsular contracture. Diabetes mellitus patients are more affected. Various methods were effective in treating frozen shoulder. The present study was done in frozen shoulder patients to determine the additional effect of Kinesio taping and Maitland mobilization in managing frozen shoulder. Frozen shoulder tends to develop in three phases, coming on slowly. Each stage may last several months. Method: The present study included 30 subjects with frozen shoulder. The individuals were randomly divided into 2 groups. GROUP A-experimental group, which received Maitland mobilization and Kinesiotaping treatment, while GROUP B is the control group that received only Maitland mobilization. Both groups first received hot moist packs for 20 minutes and an ultrasound for 5 minutes. Exercises were advised. Subjects received 4 weeks of intervention for 3 days/week. Before and after the intervention, SPADI outcome measures were measured. Result: There was a significant difference showing improvement in the mean of shoulder pain and disability index scale SPADI before and within the groups with p&lt;0.0001. There was a statistical difference when post-intervention means were compared between the groups. Conclusion: Maitland mobilization with Kinesiotaping reduces pain and disability in subjects with peri-arthritis shoulder. KEYWORDS: Frozen shoulder, Maitland mobilization, Kinesiotaping, Shoulder pain and disability index scale (SPADI).

Are Extracorporeal Shock Waves Just a Therapeutic Tool?

Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful sites and assess minimum (MiTI) and maximum (MaTI) pain thresholds to ESWT pressure stimuli. This topic has received limited attention in literature. This observational study describes a specific approach to using ESWT to study pain in 71 patients. The approach proposes moving the ESWT transducer head of the device over the entire joint surface, progressively increasing the energy level until the patient experiences pain. In the study, MiTI and MaTI were 0.218 ± 0.090 and 0.416 ± 0.165 mJ/mm2 in the affected joint and 0.282 ± 0.128 and 0.501 ± 0.174 mJ/mm2 in the contralateral homologous healthy joint, being significantly lower in the affected joint (MiTI: p < 0.001 and MaTI: p = 0.003, respectively). ESWT induced pain in 94.37% of the sites with the highest subjective pain and in a greater number of sites (204) than digital pressure (123) (p < 0.001). All sites with digital pressure pain also had ESWT pain. These results suggest that the ESWT device may be useful in investigating pain in musculoskeletal conditions and tailoring therapy.

Real-time biopsychosocial antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Functional neurological symptom disorder (FNSD) is a neuropsychiatric diagnosis referring to symptoms resembling those of neurological disorders, occurring without causal neuropathology. FNSD has a complex biopsychosocial aetiology but its mechanisms are poorly understood. Remote monitoring technologies (RMT) could provide critical insights into functional neurological symptoms (FNS) in real-world contexts. We examined the feasibility and acceptability of a novel RMT protocol, to identify psychobiological correlates and antecedents of FNS in everyday life. Seventeen individuals with FNS (seizures/motor) and 17 healthy controls (HC) completed ecological momentary assessments (EMA) eight times daily for 1-week, reporting FNS severity, associated physical and psychological symptoms, and subjectively significant events. Sleep quality was reported daily. Physiological variables were measured using wearable Fitbit 5 devices. Multilevel modelling examined variables associated with FNS variability. Average EMA completion rates were good in both groups (≥80%). At week-level, the FNS group reported significantly greater subjective arousal, pain, fatigue, dissociation, negative affect, daily events, stressful events, and sleep duration, compared to HC. Objective sleep disturbance and duration, and resting heartrate, were also significantly greater in the FNS sample. FNS severity correlated significantly with daily events, affect, subjective arousal, pain, fatigue and sleep disturbance, at day- or within-day levels. Daily events and negative affect were the most prominent time-lagged predictors of within-day moment-to-moment FNS severity. RMTs are feasible and acceptable tools for investigation of FNS in real-world settings, revealing daily events and negative affect as possible triggers of FNS. Interventions targeting affective reactivity and regulation might be beneficial in this group. Larger-scale, longer-term RMT studies are needed in this population.

Modulating subjective pain perception with decoded Montreal Neurological Institute-space neurofeedback: a proof-of-concept study.

Pain is a complex emotional experience that still remains challenging to manage. Previous functional magnetic resonance imaging (fMRI) studies have associated pain with distributed patterns of brain activity (i.e. brain decoders), but it is still unclear whether these observations reflect causal mechanisms. To address this question, we devised a new neurofeedback approach using real-time decoding of fMRI data to test if modulating pain-related multivoxel fMRI patterns could lead to changes in subjective pain experience. We first showed that subjective pain ratings can indeed be accurately predicted using a real-time decoding approach based on the stimulus intensity independent pain signature (SIIPS) and the neurologic pain signature (NPS). Next, we trained participants (n = 16) in a double-blinded decoded fMRI neurofeedback experiment to up- or downregulate the SIIPS. Our results indicate that participants can learn to downregulate the expression of SIIPS independently from NPS expression. Importantly, the success of this neurofeedback training was associated with the perceived intensity of painful stimulation following the intervention. Taken together, these results indicate that closed-loop brain imaging can be efficiently conducted using a priori fMRI decoders of pain, potentially opening up a new range of applications for decoded neurofeedback, both for clinical and basic science purposes. This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

Ultrasound Evaluation of Onset Core Muscle Activity in Subjects with Non-Specific Lower Back Pain and Without Lower Back Pain: An Observational Case-Control Study.

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case-control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing-abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing-contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting-contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting-voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature.

The effects of pulsed electromagnetic field therapy on muscle strength and pain in patients with end-stage knee osteoarthritis: a randomized controlled trial.

Osteoarthritis (OA) of the knee is one of the most common chronic degenerative joint conditions affecting aging population. To investigate the effectiveness of a combination of home-based exercise and pulsed electromagnetic field (PEMF) therapy to improve muscle strength, physical function, and pain. Sixty patients were randomly assigned to either home-based exercise alone (control group; n = 30) or combined with PEMF therapy (treatment group; n = 30) twice a week for eight weeks. Knee extension, flexion muscle strength, gait speed (GS), 5 time sit-to-stand test (5STS), Visual Analogue Scale (VAS) pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded at baseline and 4 and 8 weeks. Significant improvements in symptomatic knee extension muscle strength (SKE, p = 0.001), flexion strength (SKF, p = 0.011), contralateral knee extension muscle strength (CKE, p = 0.002), and flexion strength (CKF, p = 0.009) were observed for the PEMF treatment group at 8 weeks. Significant reductions in VAS pain scores were observed in both the treatment (p < 0.001, partial η2 = 0.505) and control (p < 0.001, partial η2 = 0.268) groups. Significant differences were reported between groups in the 4 (p = 0.010, partial η2 = 0.111) and 8 (p = 0.046, partial η2 = 0.068) week assessment in VAS pain. A significant time difference was found in GS and 5STS between baseline and week 8 (GS: difference 0.051, p = 0.026; 5STS: difference 2.327, p < 0.001) in the treatment group. The significant group difference at week 8 was observed in SKE (p = 0.013) in female patients while pain in male patients (p = 0.026). Patients aged over 70 years have a significantly superior improvement in SKE, SKF, and CKF after 8 weeks of PEMF therapy. The combination of PEMF therapy and home-based exercise superiorly improved knee muscle strength and reduced pain in end-stage knee OA subjects and showed a promising tendency to improve performance-based physical function. PEMF therapy was shown to preferentially benefit knee muscle strength in female patients and patients aged over 70 years, whereas male patients were more responsive to PEMF therapy in the form of pain relief. clinicalTrials.gov, NCT05550428.

Comparative Evaluation of Kanchnar Guggulu and Cystogrit Diamond in Stanagranthi (Fibroadenoma Breast)

Fibroadenoma is a benign breast tumor common in young women, affecting their daily life. Modern medicine often recommends surgical intervention, which can have physical and emotional consequences. The study explores alternative treatments through Ayurveda, which offers non-invasive and cost-effective options. This study investigates the comparative efficacy of Kanchnar Guggulu and Cystogrit Diamond in the management of Stanagranthi (Fibroadenoma breast). Sixty patients were randomly divided into two groups: Group A (treated with Kanchnar Guggulu) and Group B (treated with Cystogrit Diamond). The study assessed subjective (pain, consistency) and objective (size, number of lumps) parameters before and after a 90-day treatment period. The study aims to provide a safe, effective alternative to surgery for managing fibroadenoma, with Ayurveda offering promising non-invasive treatments. Results showed a significant reduction in pain for both groups, with Group B demonstrating a 93.24% improvement compared to Group A's 83.93%. In terms of lump size reduction, Group B also outperformed Group A, with a 42.86% decrease versus 29.85%, respectively. The average effect on consistency was higher in Group B (31.58%) compared to Group A (25%). The findings suggest that Cystogrit Diamond is more effective than Kanchnar Guggulu in managing Stanagranthi, providing a potential non-invasive, cost-effective alternative to surgery for fibroadenoma patients.