Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between −0.15 and 0.11, P ≥ 0.08; total: β between −0.27 and −0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cuto...
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p = 0.04). PPTs at the cervical spine increased following both SMT (mean +/- SE: 24.1 +/- 7.3%) and manual contact (21 +/- 8.4%) with no difference between interventions. There was n...
Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between −0.15 and 0.11, P ≥ 0.08; total: β between −0.27 and −0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many ... more Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cuto...
Introduction There is evidence of benefit for multimodal treatments including exercise in the man... more Introduction There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE. Methods Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks. Results The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures. Conclusion Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.
Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic ... more Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p = 0.04). PPTs at the cervical spine increased following both SMT (mean +/- SE: 24.1 +/- 7.3%) and manual contact (21 +/- 8.4%) with no difference between interventions. There was n...
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