The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial
Specific therapeutic exercise of the neck induces immediate local hypoalgesia.
This study compared the effect of 2 specific cervical flexor muscle exercise protocols on immediate pain relief in the cervical spine of people with chronic neck pain. In addition, the study evaluated whether these exercise protocols elicited any systemic effects by studying sympathetic nervous system (SNS) function and pain at a location distant from the cervical spine. Participants were randomly allocated into either a cranio-cervical flexion (CCF) coordination exercise group (n = 24) or a cervical flexion (CF) endurance exercise group (n = 24). Measures of pain and SNS function were recorded immediately before and after a single session of the exercise interventions. Pain measures included visual analogue scale (VAS) ratings of neck pain at rest and during active cervical motion and pressure pain threshold (PPT) and thermal pain threshold (TPT) recordings over the cervical spine and at a remote site on the leg. Measures of SNS function consisted of blood flow, skin conductance, skin temperature, heart rate, and blood pressure. Immediately after 1 session of exercise, there was a reasonably sized increase of 21% (P < .001, d = 0.88) and 7.3% (P = .03, d = 0.47) in PPT locally at the neck for the CCF exercise and the CF exercise, respectively. There were no changes in local neck TPT with either exercise. Pressure pain threshold and TPT at the leg and SNS did not change after exercise. Only the CCF exercise demonstrated a small improvement in VAS ratings during active movement (change on 10-cm VAS: CCF, 0.42 cm (P = .04). This study shows that specific CCF therapeutic exercise is likely to provide immediate change in mechanical hyperalgesia local to the neck with translation into perceived pain relief on movement in patients with chronic neck pain. ⋯ This study showed an immediate local mechanical hypoalgesic response to specific exercise of the cervical spine. Understanding the pain-relieving effects of exercise will assist the clinician in prescribing the most appropriate exercise protocols for patients with chronic neck pain.
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The aim of this systematic review was to assess the clinical evidence of external qigong as a treatment option for pain conditions. Databases were searched up to January 2007. Randomized, clinical trials (RCTs) testing external qigong in patients with pain of any origin assessing clinical outcomes were considered. Trials using any type of control group were included. The selection of studies, data extraction, and validation were performed independently by at least 2 reviewers. One hundred forty-one potentially relevant studies were identified and 5 RCTs could be included. All RCTs of external qigong demonstrated greater pain reductions in the qigong groups compared with control groups. Meta-analysis of 2 RCTs showed a significant effect of external qigong compared with general care for treating chronic pain (Pain 100 mm VAS; weighted main differences, 36.3 mm; 95% CI, 22.8 to 49.8; P < .001; heterogeneity: chi(2) = 1.79, P = .18, I(2) = 44.0%, n = 80). The evidence from RCTs testing the effectiveness of external qigong for treating pain is encouraging. Further studies are warranted. ⋯ This review of clinical studies focused on the efficacy of qigong, an energy-healing intervention used to prevent and cure ailments. A meta-analysis shows that evidence for the effectiveness of external qigong is encouraging, though further studies are warranted.
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Clinical Trial Controlled Clinical Trial
Contribution of myofascial trigger points to migraine symptoms.
This study evaluated the contribution of myofascial trigger points (TrPs) to migraine pain. Seventy-eight migraine patients with cervical active TrPs whose referred areas (RAs) coincided with migraine sites (frontal/temporal) underwent electrical pain threshold measurement in skin, subcutis, and muscle in TrPs and RAs at baseline and after 3, 10, 30, and 60 days; migraine pain assessment (number and intensity of attacks) for 60 days before and 60 days after study start. Fifty-four patients (group 1) underwent TrP anesthetic infiltration on the 3rd, 10th, 30th, and 60th day (after threshold measurement); 24 (group 2) received no treatment. Twenty normal subjects underwent threshold measurements in the same sites and time points as patients. At baseline, all patients showed lower than normal thresholds in TrPs and RAs in all tissues (P < .001). During treatment in group 1, all thresholds increased progressively in TrPs and RAs (P < .0001), with sensory normalization of skin/subcutis in RAs at the end of treatment; migraine pain decreased (P < .001). Threshold increase in RAs and migraine reduction correlated linearly (.0001 < P < .006). In group 2 and normal subjects, no changes occurred. Cervical TrPs with referred areas in migraine sites thus contribute substantially to migraine symptoms, the peripheral nociceptive input from TrPs probably enhancing the sensitization level of central sensory neurons. ⋯ This article shows the beneficial effects of local therapy of active myofascial trigger points (TrPs) on migraine symptoms in patients in whom migraine sites coincide with the referred areas of the TrPs. These results suggest that migraine pain is often contributed to by myofascial inputs that enhance the level of central neuronal excitability.
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Cognitive-behavioral models of chronic low back pain (CLBP) predict that dysfunctional assumptions about the harmfulness of activities may maintain pain-related fear and disability levels. The Photograph Series of Daily Activities (PHODA) is an instrument to determine the perceived harmfulness of daily activities in patients with CLBP. This study examined the psychometric properties of a short electronic version of the PHODA (PHODA-SeV). The results show that the PHODA-SeV measures a single factor and has a high internal consistency. The test-retest reliability and stability of the PHODA-SeV over a 2-week time interval are good, with discrepancies between 2 measurements over 20 points suggesting true change. The construct validity is supported by the finding that both self-reported pain severity and fear of movement/(re)injury were uniquely related to the PHODA-SeV. Validity is further corroborated by the finding that patients who have received exposure in vivo, that aimed to systematically reduce the perceived harmfulness of activities, had significantly lower PHODA-SeV scores after treatment than patients receiving graded activity that did not address these assumptions. The findings support the PHODA-SeV as a valid and reliable measure of the perceived harmfulness of activities in patients with CLBP. Preliminary normative data of the PHODA-SeV are presented. ⋯ This article describes a pictorial measurement tool (PHODA-SeV) for the assessment of the perceived harmfulness of activities in patients with chronic low back pain. The PHODA-SeV has good psychometric properties and can be used to elaborate on the contribution of beliefs about harmful consequences of activities to pain and disability.
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Clinical Trial Controlled Clinical Trial
Contralateral attenuation of pain after short-duration submaximal isometric exercise.
Only a small amount of research has been conducted examining whether exercise-induced hypoalgesia (EIH) occurs after isometric exercise. Thus, the purpose of this investigation was to examine whether EIH occurred in women after short-duration submaximal isometric exercise and whether the responses were restricted to the exercised hand (ipsilateral) or also occurred in the nonexercised (contralateral) hand. Fourteen healthy women (mean age = 19.5 years) completed 2 sets of submaximal (40% to 50% of max) isometric exercise consisting of squeezing a dynamometer for 2 minutes with the dominant hand. A pressure stimulus was applied to the forefinger on the dominant and nondominant hands for 2 minutes before and after isometric exercise. Participants pressed a button when the stimulus became painful, indicating pain threshold (PT), and also rated the intensity of the stimulus every 15 seconds, using a pain rating scale (PR). Results indicated that there were significant trials effects (P < .05) for PT and PR, but the main effect for hands was not significant (P > .05). PTs were found to be elevated, whereas PRs were reduced for both hands after isometric exercise. It is concluded that submaximal isometric exercise performed for 2 minutes resulted in ipsilateral and contralateral hypoalgesic responses. ⋯ The findings from the present study demonstrated that short-duration nonexhaustive isometric exercise was associated with hypoalgesic responses in the exercised and nonexercised hands. It appears that short-duration submaximal isometric exercise resulted in generalized (ie, ipsilateral and contralateral) pain-inhibitory responses in healthy young women.