Background: Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorder... more Background: Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorders (cWAD) present a reduced ability to activate central descending nociceptive inhibition after exercise, compared to measurements before exercise. It was hypothesised that a dysfunctional motor-induced inhibition of nociception partly explains this dysfunctional exercise-induced hypoalgesia. This study investigates if engagement of the motor system during movement preparation inhibits nociception-evoked brain responses in these patients as compared to healthy controls (HC). Methods: The experiment used laser-evoked potentials (LEPs) during three conditions (no task, mental task, movement preparation) while recording brain activity with a 32-channel electroencephalogram in 21 patients with cWAD, 20 patients with CFS and 18 HC. Two-factor mixed design Analysis of variance were used to evaluate differences in LEP amplitudes and latencies. Results: No differences in N1, N2, N2P2, and P2 LEP ...
Objective Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to inves... more Objective Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs). Design Case–control study. Setting A single medical center in Belgium. Subjects The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study. Methods All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs. Results No between-group differences were found...
The Journal of orthopaedic and sports physical therapy, 2017
Study Design Controlled laboratory study. Background Chronic whiplash-associated disorder (WAD) i... more Study Design Controlled laboratory study. Background Chronic whiplash-associated disorder (WAD) is an important health issue associated with poor recovery outcomes. Sensorimotor incongruence (SMI), defined as a mismatch between the efference copy in the brain and afferent sensory feedback from the body, is proposed as a possible underlying cause of chronic pain. Objectives To determine whether SMI causes sensory disturbances or pain in people with chronic WAD and healthy controls. Methods Sixty-four participants (30 with chronic WAD and 34 healthy controls) participated in a visual feedback experiment involving the neck and a bimanual coordination experiment involving the arms. In both experimental setups, SMI was induced by modifying the visual feedback during movement. Sensory disturbances and pain were the primary outcomes. Results A statistically significant difference in perceived sensory disturbance between conditions was found in the WAD group (P<.001). Intensity scores we...
Pain practice : the official journal of World Institute of Pain, Feb 23, 2016
Whiplash-associated disorders (WAD) are a debilitating condition. In chronic WAD, sensorimotor in... more Whiplash-associated disorders (WAD) are a debilitating condition. In chronic WAD, sensorimotor incongruence exacerbates symptoms. Sensorimotor incongruence occurs when somatosensory input and predicted motor output are in conflict, which can trigger pain. On the other hand, there is evidence that visual feedback can decrease pain in certain chronic pain conditions. Therefore, the aim of this study was to examine the effect of visual feedback and sensorimotor incongruence on pain thresholds in chronic WAD. Sixty-four participants (healthy controls and patients with chronic WAD) were subjected to six experimental conditions. Participants watched correct real-time or modified visual feedback of the neck or hand (without movement as well as during repetitive neck lateroflexion). Sensorimotor incongruence was induced by manipulating visual feedback. Pressure pain thresholds were measured at baseline and during each condition. Marked between-group differences were observed. Visual feedbac...
Pain practice : the official journal of World Institute of Pain, Jan 28, 2015
Vagally mediated heart rate variability (vmHRV) is widely respected as a psychophysiological meas... more Vagally mediated heart rate variability (vmHRV) is widely respected as a psychophysiological measure of emotion regulation capacity and serves as a readily available index of executive brain areas that exert an inhibitory influence on subcortical structures. Pain catastrophizing (PC) is conceptualized as the tendency to misinterpret and exaggerate pain-related situations that may be threatening. Chronic pain patients show lower vmHRV and higher PC. Previously, no study has investigated the association of PC and vmHRV. We examined the association of PC and vmHRV in a sample of patients with chronic whiplash-associated disorders (WAD, n = 30) and healthy controls (n = 31). Patients with WAD showed lower vmHRV, indexed by high-frequency HRV (effect size, Cohen's d = 0.442), and greater PC (d = 0.815). Zero-order and partial correlations controlling for age and sex revealed that vmHRV and PC are inversely related. The results provide evidence for a psychophysiological mechanism unde...
Pain practice : the official journal of World Institute of Pain, Jan 30, 2013
Widespread sensory hypersensitivity has been observed in acute whiplash associated disorders (WAD... more Widespread sensory hypersensitivity has been observed in acute whiplash associated disorders (WAD). Changes in descending pain modulation take part in central sensitization. However, endogenous pain modulation has never been investigated in acute WAD. Altered perception of distorted visual feedback has been observed in WAD. Both mechanisms (ie, pain modulation and perception of distorted visual feedback) may be different components of one integrated system orchestrated by the brain. This study evaluated conditioned pain modulation (CPM) in acute WAD. Secondly, we investigated whether changes in CPM are associated with altered perception of distorted visual feedback. Thirty patients with acute WAD, 35 patients with chronic WAD and 31 controls were subjected to an experiment evaluating CPM and a coordination task inducing visual mediated changes between sensory feedback and motor output. A significant CPM effect was observed in acute WAD (P = 0.012 and P = 0.006), which was significan...
Journal of Manipulative and Physiological Therapeutics, 2012
The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before... more The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before and 6 months after an endurance, strength, and motor control exercise program in preprofessional dancers. This uncontrolled trial was completed at a college offering a professional bachelor degree in dance. Forty preprofessional dancers underwent a test battery before and after a 6-month lasting exercise program in addition to their regular dance lessons. Physical fitness was evaluated by means of a submaximal exercise test with continuous physiological monitoring and by a field test for explosive strength. Anthropometric measurements were taken to analyze the influence of fitness training on body composition. Musculoskeletal injury incidence and quality of life were recorded during the 6-month lasting intervention. An intention-to-treat analysis (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;last observation carried forward&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; method) was used with a Student t test for normally distributed variables. The Wilcoxon signed rank and Mann-Whitney U tests were used as nonparametric tests. Physical fitness improved after the 6 months of additional training program (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). The waist:hip ratio (P=.036) and the sum of the measured subcutaneous skin thickness (P=.001) significantly decreased. Twelve dancers developed musculoskeletal complaints, requiring temporary interruption of dancing. The combination of regular dance lessons with an additional exercise program resulted in improved physical fitness in preprofessional dancers, without affecting the aesthetical appearance. A relatively high injury rate was observed during the intervention period. These results suggest that a randomized, controlled trial should be performed to examine the effectiveness of additional exercise in dancers on physical fitness and musculoskeletal injury rate.
Transition from acute whiplash injury to either recovery or chronicity and the development of chr... more Transition from acute whiplash injury to either recovery or chronicity and the development of chronic whiplash-associated disorders (WAD) remains a challeng-ing issue for researchers and clinicians. The roles of social support and personality traits in long-term functioning ...
Journal of rehabilitation research and development, 2015
Patients with acute whiplash-associated disorder (WAD) demonstrate an inefficient endogenous pain... more Patients with acute whiplash-associated disorder (WAD) demonstrate an inefficient endogenous pain inhibition and may experience a dysfunction in autonomic nervous system reactivity to pain. This study compared the autonomic response to painful stimuli between patients with acute and chronic WAD and healthy controls. In addition, the role of the autonomic nervous system for explaining inefficient endogenous pain inhibition was examined in acute WAD. Seventeen patients with acute WAD, 30 patients with chronic WAD, and 31 healthy controls participated in an experiment evaluating the autonomic nervous system at rest and during painful stimuli. Skin conductance and heart rate variability (HRV) parameters were monitored continuously during conditioned pain modulation. A significant autonomic response to pain was present for skin conductance and two HRV parameters in all experimental groups. There was an interaction effect in the skin conductance response to pain but not in HRV responses i...
This study evaluated whether dancers with pain experience more sensory changes during an experime... more This study evaluated whether dancers with pain experience more sensory changes during an experimentally induced sensorimotor incongruent task and explored the relationship between sensorimotor incongruence and self-reported measures (e.g. Short Form 36-questionnaire (SF-36), psychosocial variables and physical activity). Forty-four dancers were subjected to a bimanual coordination test simulating sensorimotor incongruence (i.e. performing congruent and incongruent arm movements whilst viewing a whiteboard or mirror) and completed standardized questionnaires. Significantly more dancers experienced sensory changes during the performance of incongruent movements whilst viewing a mirror (p<.01), but the intensity of the reported sensations was very low. No differences were observed between dancers with and without baseline pain, but significant negative associations were found between sensorimotor incongruence and sub-scores of the SF-36. Sensorimotor incongruence can provoke small s...
The awareness is growing that central sensitization is of prime importance for the assessment and... more The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists. Designing the first set of classification criteria for the classification of central sensitization pain. A body of evidence from original research papers was used by 18 pain experts from 7 different countries to design the first classification criteria for central sensitization pain. It is proposed that the classification of central sensitization pain entails 2 major steps: the exclusion of neuropathic pain and the differential classification of nociceptive versus central sensitization pain. For the former, the International Association for the Study of Pain diagnostic criteria are available for diagnosing or excluding neuropathic pain. For the latter, clinicians are advised to screen their patients for 3 major classification criteria, and use them to complete...
Background: Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorder... more Background: Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorders (cWAD) present a reduced ability to activate central descending nociceptive inhibition after exercise, compared to measurements before exercise. It was hypothesised that a dysfunctional motor-induced inhibition of nociception partly explains this dysfunctional exercise-induced hypoalgesia. This study investigates if engagement of the motor system during movement preparation inhibits nociception-evoked brain responses in these patients as compared to healthy controls (HC). Methods: The experiment used laser-evoked potentials (LEPs) during three conditions (no task, mental task, movement preparation) while recording brain activity with a 32-channel electroencephalogram in 21 patients with cWAD, 20 patients with CFS and 18 HC. Two-factor mixed design Analysis of variance were used to evaluate differences in LEP amplitudes and latencies. Results: No differences in N1, N2, N2P2, and P2 LEP ...
Objective Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to inves... more Objective Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs). Design Case–control study. Setting A single medical center in Belgium. Subjects The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study. Methods All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs. Results No between-group differences were found...
The Journal of orthopaedic and sports physical therapy, 2017
Study Design Controlled laboratory study. Background Chronic whiplash-associated disorder (WAD) i... more Study Design Controlled laboratory study. Background Chronic whiplash-associated disorder (WAD) is an important health issue associated with poor recovery outcomes. Sensorimotor incongruence (SMI), defined as a mismatch between the efference copy in the brain and afferent sensory feedback from the body, is proposed as a possible underlying cause of chronic pain. Objectives To determine whether SMI causes sensory disturbances or pain in people with chronic WAD and healthy controls. Methods Sixty-four participants (30 with chronic WAD and 34 healthy controls) participated in a visual feedback experiment involving the neck and a bimanual coordination experiment involving the arms. In both experimental setups, SMI was induced by modifying the visual feedback during movement. Sensory disturbances and pain were the primary outcomes. Results A statistically significant difference in perceived sensory disturbance between conditions was found in the WAD group (P<.001). Intensity scores we...
Pain practice : the official journal of World Institute of Pain, Feb 23, 2016
Whiplash-associated disorders (WAD) are a debilitating condition. In chronic WAD, sensorimotor in... more Whiplash-associated disorders (WAD) are a debilitating condition. In chronic WAD, sensorimotor incongruence exacerbates symptoms. Sensorimotor incongruence occurs when somatosensory input and predicted motor output are in conflict, which can trigger pain. On the other hand, there is evidence that visual feedback can decrease pain in certain chronic pain conditions. Therefore, the aim of this study was to examine the effect of visual feedback and sensorimotor incongruence on pain thresholds in chronic WAD. Sixty-four participants (healthy controls and patients with chronic WAD) were subjected to six experimental conditions. Participants watched correct real-time or modified visual feedback of the neck or hand (without movement as well as during repetitive neck lateroflexion). Sensorimotor incongruence was induced by manipulating visual feedback. Pressure pain thresholds were measured at baseline and during each condition. Marked between-group differences were observed. Visual feedbac...
Pain practice : the official journal of World Institute of Pain, Jan 28, 2015
Vagally mediated heart rate variability (vmHRV) is widely respected as a psychophysiological meas... more Vagally mediated heart rate variability (vmHRV) is widely respected as a psychophysiological measure of emotion regulation capacity and serves as a readily available index of executive brain areas that exert an inhibitory influence on subcortical structures. Pain catastrophizing (PC) is conceptualized as the tendency to misinterpret and exaggerate pain-related situations that may be threatening. Chronic pain patients show lower vmHRV and higher PC. Previously, no study has investigated the association of PC and vmHRV. We examined the association of PC and vmHRV in a sample of patients with chronic whiplash-associated disorders (WAD, n = 30) and healthy controls (n = 31). Patients with WAD showed lower vmHRV, indexed by high-frequency HRV (effect size, Cohen's d = 0.442), and greater PC (d = 0.815). Zero-order and partial correlations controlling for age and sex revealed that vmHRV and PC are inversely related. The results provide evidence for a psychophysiological mechanism unde...
Pain practice : the official journal of World Institute of Pain, Jan 30, 2013
Widespread sensory hypersensitivity has been observed in acute whiplash associated disorders (WAD... more Widespread sensory hypersensitivity has been observed in acute whiplash associated disorders (WAD). Changes in descending pain modulation take part in central sensitization. However, endogenous pain modulation has never been investigated in acute WAD. Altered perception of distorted visual feedback has been observed in WAD. Both mechanisms (ie, pain modulation and perception of distorted visual feedback) may be different components of one integrated system orchestrated by the brain. This study evaluated conditioned pain modulation (CPM) in acute WAD. Secondly, we investigated whether changes in CPM are associated with altered perception of distorted visual feedback. Thirty patients with acute WAD, 35 patients with chronic WAD and 31 controls were subjected to an experiment evaluating CPM and a coordination task inducing visual mediated changes between sensory feedback and motor output. A significant CPM effect was observed in acute WAD (P = 0.012 and P = 0.006), which was significan...
Journal of Manipulative and Physiological Therapeutics, 2012
The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before... more The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before and 6 months after an endurance, strength, and motor control exercise program in preprofessional dancers. This uncontrolled trial was completed at a college offering a professional bachelor degree in dance. Forty preprofessional dancers underwent a test battery before and after a 6-month lasting exercise program in addition to their regular dance lessons. Physical fitness was evaluated by means of a submaximal exercise test with continuous physiological monitoring and by a field test for explosive strength. Anthropometric measurements were taken to analyze the influence of fitness training on body composition. Musculoskeletal injury incidence and quality of life were recorded during the 6-month lasting intervention. An intention-to-treat analysis (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;last observation carried forward&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; method) was used with a Student t test for normally distributed variables. The Wilcoxon signed rank and Mann-Whitney U tests were used as nonparametric tests. Physical fitness improved after the 6 months of additional training program (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). The waist:hip ratio (P=.036) and the sum of the measured subcutaneous skin thickness (P=.001) significantly decreased. Twelve dancers developed musculoskeletal complaints, requiring temporary interruption of dancing. The combination of regular dance lessons with an additional exercise program resulted in improved physical fitness in preprofessional dancers, without affecting the aesthetical appearance. A relatively high injury rate was observed during the intervention period. These results suggest that a randomized, controlled trial should be performed to examine the effectiveness of additional exercise in dancers on physical fitness and musculoskeletal injury rate.
Transition from acute whiplash injury to either recovery or chronicity and the development of chr... more Transition from acute whiplash injury to either recovery or chronicity and the development of chronic whiplash-associated disorders (WAD) remains a challeng-ing issue for researchers and clinicians. The roles of social support and personality traits in long-term functioning ...
Journal of rehabilitation research and development, 2015
Patients with acute whiplash-associated disorder (WAD) demonstrate an inefficient endogenous pain... more Patients with acute whiplash-associated disorder (WAD) demonstrate an inefficient endogenous pain inhibition and may experience a dysfunction in autonomic nervous system reactivity to pain. This study compared the autonomic response to painful stimuli between patients with acute and chronic WAD and healthy controls. In addition, the role of the autonomic nervous system for explaining inefficient endogenous pain inhibition was examined in acute WAD. Seventeen patients with acute WAD, 30 patients with chronic WAD, and 31 healthy controls participated in an experiment evaluating the autonomic nervous system at rest and during painful stimuli. Skin conductance and heart rate variability (HRV) parameters were monitored continuously during conditioned pain modulation. A significant autonomic response to pain was present for skin conductance and two HRV parameters in all experimental groups. There was an interaction effect in the skin conductance response to pain but not in HRV responses i...
This study evaluated whether dancers with pain experience more sensory changes during an experime... more This study evaluated whether dancers with pain experience more sensory changes during an experimentally induced sensorimotor incongruent task and explored the relationship between sensorimotor incongruence and self-reported measures (e.g. Short Form 36-questionnaire (SF-36), psychosocial variables and physical activity). Forty-four dancers were subjected to a bimanual coordination test simulating sensorimotor incongruence (i.e. performing congruent and incongruent arm movements whilst viewing a whiteboard or mirror) and completed standardized questionnaires. Significantly more dancers experienced sensory changes during the performance of incongruent movements whilst viewing a mirror (p<.01), but the intensity of the reported sensations was very low. No differences were observed between dancers with and without baseline pain, but significant negative associations were found between sensorimotor incongruence and sub-scores of the SF-36. Sensorimotor incongruence can provoke small s...
The awareness is growing that central sensitization is of prime importance for the assessment and... more The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists. Designing the first set of classification criteria for the classification of central sensitization pain. A body of evidence from original research papers was used by 18 pain experts from 7 different countries to design the first classification criteria for central sensitization pain. It is proposed that the classification of central sensitization pain entails 2 major steps: the exclusion of neuropathic pain and the differential classification of nociceptive versus central sensitization pain. For the former, the International Association for the Study of Pain diagnostic criteria are available for diagnosing or excluding neuropathic pain. For the latter, clinicians are advised to screen their patients for 3 major classification criteria, and use them to complete...
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