Mecanismos de modulación central del dolor: revisión de la literatura / Mechanisms of central pain modulation: literature review

RESUMEN: La percepción del dolor resulta de múltiples y dinámicos mecanismos en el sistema nervioso central (SNC) y periférico que inhiben o facilitan el estímulo y respuesta nociceptiva. Sin embargo, la principal capacidad de modulación esta a cargo del SNC. Los estímulos nociceptivos son detectados por terminaciones nerviosas libres de neuronas periféricas que sinaptan con neuronas aferentes secundarias de la médula espinal. Luego estas fibras decusan para formar las vías nociceptivas ascendentes. Una vez alcanzadas las estructuras subcorticales, se activan las neuronas del tálamo, quienes envían el estímulo hacia la corteza somatosensorial, desencadenando la percepción consciente del dolor y activando el sistema inhibitorio descendente. Para que la modulación nociceptiva se realice, es necesaria la participación de diversas sustancias o neurotransmisores que conectan áreas del SNC especializadas. Por lo tanto, el objetivo de este estudio fue realizar una revisión de la literatura respecto de los mecanismos que participan en los procesos de modulación central del dolor.

SUMMARY: Pain perception results from multiple and dynamic mechanisms in the central nervous system (CNS) and peripheral nervous system that inhibit or facilitate stimulation and nociceptive response. However, neuromodulation is mainly a function of the CNS. Nociceptive stimulus is detected by peripheral neurons receptors that synapse with the secondary afferent neurons of the spinal cord. These fibers cross to conform the ascending nociceptive pathways. Once the subcortical structures are reached, the thalamus`s neurons are activated; the thalamus send the stimulus to the somatosensory cortex, triggering the conscious perception of pain and activating the descending inhibitory system. For the nociceptive modulation to be carried out, the participation of various substances or neurotransmitters that connect specialized CNS areas is necessary. Therefore, the aim of this study was to review the literature regarding the mechanisms involved in central pain modulation processes.

Calcitonin as an analgesic agent: review of mechanisms of action and clinical applications / Calcitonina como agente analgésico: revisão dos mecanismos de ação e das aplicações clínicas

Abstract Background and objectives: Calcitonin is a polypeptide hormone regulating the metabolism of calcium in the body. For many years calcitonin has been used to maintain and improve bone mineral density and to reduce the fracture rate. Many studies showed that calcitonin had analgesic role in several painful circumstances. This pain-ameliorating effect is irrelevant to its osteoclastic inhibitory effect and mechanisms like altering Na+ channel and serotonin receptor expression or hypothesis including the endorphin-mediated mechanism were used to explain this effect. In this study we performed a thorough review on the role of calcitonin as an analgesic agent in different scenarios and investigated the fact that calcitonin can be a feasible medication to relieve pain. Method: Many studies focused on the analgesic effect of calcitonin in several painful circumstances, including acute pains related to vertebral fractures, metastasis, migraine and reflex sympathetic dystrophy as well as neuropathic pains related to spinal injuries or diabetes, and phantom pain. Also, calcitonin was showed to be a useful additive to local anesthesia in the case of controlling postoperative pain or trigeminal neuralgia more effectively. However we faced some contradictory data for conditions like lumbar canal stenosis, complex regional pain syndrome, phantom pain and malignancies. Conclusion: This study showed that calcitonin could be helpful analgesic agent in different painful situations. Calcitonin can be considered an eligible treatment for acute pains related to vertebral fractures and a feasible alternative for the treatment of the acute and chronic neuropathic pains where other medications might fail.

Resumo Justificativa e objetivos: A calcitonina é um hormônio polipeptídico que regula o metabolismo do cálcio no organismo. Por muitos anos a calcitonina tem sido usada para manter e melhorar a densidade mineral óssea e reduzir a incidência de fraturas. Muitos estudos mostraram que a calcitonina teve efeito analgésico em várias condições físicas de dor. Esse efeito de melhoria da dor é irrelevante diante de seu efeito inibidor osteoclástico e de mecanismos, tais como a alteração do canal de Na+ e da expressão do receptor de serotonina, inclusive a hipótese do mecanismo mediado pela endorfina, que foram usados para explicar esse efeito. Neste estudo, fizemos uma revisão completa sobre o papel da calcitonina como agente analgésico em diferentes cenários e investigamos o fato de que a calcitonina pode ser uma medicação viável para aliviar a dor. Método: Muitos estudos centraram no efeito analgésico da calcitonina em várias condições de dor, inclusive dores agudas relacionadas a fraturas vertebrais, metástases, enxaqueca e distrofia simpática reflexa, bem como dores neuropáticas relacionadas a lesões medulares ou ao diabetes e dor fantasma. Além disso, a calcitonina mostrou ser um aditivo útil à anestesia local para o controle mais efecaz da dor pós-operatória ou neuralgia do trigêmeo. Porém, nos deparamos com alguns dados contraditórios em condições como estenose do canal lombar, síndrome complexa da dor regional, dor fantasma e malignidades. Conclusão: Este estudo mostrou que a calcitonina pode ser um analgésico útil em diferentes condições de dor. A calcitonina pode ser considerada um tratamento elegível para as dores agudas relacionadas a fraturas vertebrais e uma opção viável para o tratamento das dores neuropáticas agudas e crônicas em que outros medicamentos podem falhar.

Associação de dor crônica com força, níveis de estresse, sono e qualidade de vida em mulheres acima de 50 anos / Asociación de dolor crónico con fuerza, niveles de estrés, sueño y calidad de vida en mujeres mayores de 50 años / Association of chronic pain with strength, levels of stress, sleep and quality of life in women over 50 years

RESUMO A literatura apresenta a necessidade de investigar as dores osteoarticulares crônicas em idosos, uma vez que essas influenciam negativamente parâmetros biopsicossociais. Entender a relação entre as dimensões da dor e parâmetros de saúde dos indivíduos acometidos é necessário para melhor abordagem preventiva e terapêutica. Este trabalho tem o objetivo de identificar relações entre níveis de dores crônicas e força, qualidade de vida, estresse e sono em mulheres (as mais acometidas pelas dores osteoarticulares crônicas). Foram recrutadas participantes de um programa de educação física para idosos, com idade entre 50 e 70 anos. A dor foi avaliada por meio de um instrumento multidimensional. Foram avaliados também estado cognitivo global, nível de atividade física, qualidade de vida, estresse e sono. A força muscular das participantes foi analisada por meio do teste de sentar e levantar e do teste de flexão e extensão de cotovelo. Participaram 56 mulheres, com média de idade de 63,7±7,7 anos, e 28,7±4,7kg/m2 de índice de massa corporal (IMC). A maior parte das participantes relatou sentir dor (89,2%); 21,4% relataram dor nos membros inferiores e 67,8% relataram dor nos membros superiores. A dimensão sensorial de dor foi associada ao estresse, mas não às demais variáveis, que não se relacionaram a nenhum dos aspectos da dor. Além disso, pode haver influência da idade na interpretação da dor avaliativa.

RESUMEN La literatura presenta la necesidad de investigar los dolores osteoarticulares crónicos en ancianos, ya que estos dolores influencian negativamente parámetros biopsicosociales. Entender la relación entre las dimensiones del dolor y los parámetros de salud de los individuos afectados es necesario para un mejor enfoque preventivo y terapéutico. Este trabajo tiene el objetivo de identificar relaciones entre niveles de dolores crónicos y fuerza, calidad de vida, estrés y sueño en mujeres (las más acometidas por los dolores osteoarticulares crónicos). Se reclutaron participantes de un programa de educación física para ancianos, con edad entre 50 y 70 años. El dolor fue evaluado por medio de un instrumento multidimensional. Se evaluaron también el estado cognitivo global, el nivel de actividad física, la calidad de vida, el estrés y el sueño de las participantes. La fuerza muscular fue analizada por medio de la prueba de sentarse y levantarse y de la prueba de flexo-extensión de codos. Participaron de la investigación 56 mujeres, con media de edad de 63,7±7,7 anos, y 28,7±4,7kg/m2 de índice de masa corporal (IMC). La mayoría de las participantes relató sentir dolor (89,2%); el 21,4% relató dolor en los miembros inferiores y el 67,8% relató dolor en los miembros superiores. La dimensión sensorial del dolor se asoció al estrés, pero no a las demás variables, que no se relacionaron a ninguno de los aspectos del dolor. Además, puede haber influencia de la edad en la interpretación del dolor evaluativo.

ABSTRACT The literature presents the need for investigations related to the chronic osteoarticular pains of older adults, which are more prevalent in women, since they negatively influence biopsychosocial parameters. To understand the relationship between pain dimensions and health parameters of these individuals is necessary for a better preventive and therapeutic approach. This study aims to identify associations between levels of chronic pain and levels of strength, quality of life, stress and sleep in women. Participants were recruited from a physical education program for older adults, aged between 50 and 70 years. Pain was assessed using a multidimensional instrument on pain parameters. Global cognitive status, physical activity level, quality of life, stress and sleep were also assessed. The muscular strength of the participants was analyzed using the sit up test and the elbow flexion and extension test. The participants were 56 women, mean age 63.7±7.7 years, and 28.7±4.7 kg/m2 body mass index (BMI). Most participants reported feeling pain (89.2%), 21.4% reported lower limb pain, and 67.8% reported experiencing upper limb pain. The sensory dimension of pain was associated with stress, but not with the other variables, which were not related to any aspects of pain. In addition, there may be an influence of age in the interpretation of evaluative pain.

Relación de los factores psicoemocionales en la intensidad del dolor y la funcionalidad en usuarios adultos con lumbalgia crónica inespecífica de las comunas de Coquimbo y La Serena / Relationship of psycho-emotional factors in pain intensity and functionality in adult users with non-specific chronic low back pain in the commune of Coquimbo and La Serena

Introducción: el dolor es una experiencia multidimensional que considera los tres ejes de la salud: el biológico, el psicológico y el social. Cuando el daño estructural no es la causa esencial del dolor experimentado, tal como sucede en la lumbalgia crónica inespecífica (LCI), se hace necesario considerar los ejes no biológicos para un abordaje integral. Por lo tanto, el objetivo de este estudio es analizar la relación entre los factores psicoemocionales con la intensidad del dolor y la funcionalidad de las personas con LCI. Materiales y métodos: el tipo de estudio es no-experimental, cuantitativo y correlacional. La muestra corresponde a un n=55 usuarios de los CESFAM Sergio Aguilar, de la comuna de Coquimbo y Juan Pablo II, de la comuna de La Serena. Se aplicaron cuestionarios sobre los factores psicoemocionales: kinesofobia, catastrofismo y autoeficacia, y las variables de limitación de la funcionalidad e intensidad del dolor. Los instrumentos utilizados fueron: escala de tampa para kinesofobia (TSK 11), escala de catastrofismo del dolor (PCS), cuestionario sobre la percepción de autoeficacia, escala de funcionalidad o incapacidad por dolor lumbar Oswestry y escala visual análoga (EVA), respectivamente. Resultados: hubo una relación entre las variables catastrofismo-limitación de la funcionalidad (rho=0,537, p<0,005), catastrofismo-intensidad del dolor (rho=0,437, p=0,001), kinesofobia-limitación de la funcionalidad (rho=0,418, p=0,002) y autoeficacia-limitación de la funcionalidad (rho=-0,518, p<0,005), siendo estas correlaciones significativas estadísticamente. Discusión: los tres factores psicoemocionales se relacionan con la funcionalidad. No obstante, solo el catastrofismo se relaciona con la intensidad del dolor. Por ende, es relevante que el kinesiólogo considere en su intervención terapéutica estos factores para enfocar el posterior abordaje kinésico con una visión e interacción multidisciplinar.

Introduction: pain is a multidimensional experience that considers the three axes of health: biological, psychological and social. When structural damage is not the essential cause of the pain experienced, as it happens in non-specific chronic low back pain (NSCL), it is necessary to consider the non-biological axes for an integral approach. Therefore, the objective of this study is to analyze the relationship between psychoemotional factors with pain intensity and functionality of persons with NSCL pain. Materials and Methods: the type of study is non-experimental, quantitative and correlational. The sample corresponds to n=55 users of the CESFAM Sergio Aguilar, of the commune of Coquimbo and Juan Pablo II, of the commune La Serena. Questionnaires were applied on psychoemotional factors: kinesophobia, catastrophism and self-efficacy, and the variables of limitation of the functionality and intensity of pain. With the instruments: Tampa scale for kinesophobia (TSK 11), pain catastrophism scale (PCS), self-efficacy perception questionnaire, Oswestry functionality scale and analogous visual scale (EVA) respectively. Results: there was a relationship between the variables catastrophism - limitation of the functionality (rho=0,537, p<0,005), catastrophism - intensity of pain (rho=0,437, p=0,001), kinesophobia - limitation of the functionality (rho=0,418, p=0,002) and self-efficacy-limitation of the functionality (rho = - 0,518, p<0,005), these correlations being statistically significant (p<0,005). Discussion:tThe three psychoemotional factors are related to functionality. However, only catastrophism is related to pain intensity. Therefore, it is relevant that the physical therapist considers these factors in his therapeutic intervention, in order to focus the subsequent kinesthetic approach with a multidisciplinary vision and interaction.

Home-based exercise therapy for treating non-specific chronic low back pain

SUMMARY OBJECTIVE To evaluate pain, functional capacity, and quality of life of patients with non-specific chronic low back pain, after home-based exercise therapy with different kinds of supervision. METHOD Thirty individuals of both gender, between 18 and 65 years old, performed the proposed exercises three times a week, for eight weeks. Group A (N = 17) performed the exercises after a single supervised session. Group B (N = 13) was supervised once a week at the rehabilitation center. Both groups received a booklet with instructions, and questionnaires to evaluate pain, functional capacity and quality of life; during the initial evaluation, after four and eight weeks. RESULTS There was an improvement in pain and functional capacity between the initial evaluation and week 4, and the initial evaluation and week 8 in both groups (p <0.05). In the quality of life evaluation, the criteria for pain, functional capacity, and physical aspects had significant improvement after 8 weeks (p <0.05). There was no difference when comparing groups A and B (p >0,05). CONCLUSION Home-based exercise therapy, when performed in a period of eight weeks, using the booklet, was effective for improving level of pain, functional capacity, and quality of life in patients with non-specific chronic low back pain. The weekly supervision did not significantly influence the final outcome between the groups.

RESUMO OBJETIVO Avaliar dor, capacidade funcional e qualidade de vida de pacientes com dor lombar crônica inespecífica após terapia por exercícios domiciliares, com diferentes maneiras de supervisão. MÉTODO Trinta indivíduos de ambos os sexos, com idade entre 18 e 65 anos, apresentando dor lombar crônica inespecífica, realizaram os exercícios propostos três vezes por semana, durante oito semanas. Indivíduos do Grupo A (N=17) realizaram os exercícios após única sessão supervisionada. Já os indivíduos do Grupo B (N=13) foram supervisionados uma vez por semana no centro de reabilitação. Ambos receberam cartilha com orientações e questionários para avaliar dor, capacidade funcional e qualidade de vida; durante avaliação inicial, após quatro e oito semanas. RESULTADOS Houve melhora da dor e capacidade funcional entre as avaliações inicial e semana 4, e inicial e semana 8 nos dois grupos (p<0,05). Na avaliação de qualidade de vida (SF-36), os critérios de dor, capacidade funcional e aspectos físicos obtiveram melhora significativa após oito semanas (p<0,05). Não houve diferença significativa ao comparar os grupos (p>0,05). CONCLUSÃO A terapia por exercícios domiciliares, quando realizada num período de oito semanas, com auxílio da cartilha, foi eficaz para melhora da dor, capacidade funcional e qualidade de vida, em pacientes com dor lombar crônica inespecífica. A supervisão semanal não influenciou de forma significativa o resultado final quando comparados os grupos.

Redefiniendo dolor agudo postoperatorio: dolor incisional / Redefining acute postoperative pain: incisional pain

El adecuado manejo perioperatorio del dolor agudo y la elección de la técnica anestésica influyen en la incidencia de complicaciones a corto, mediano y largo plazo, encontrándose en este grupo el desarrollo de dolor crónico no oncológico (DCNO). Debido al aumento de la prevalencia de dolor crónico no oncológico y su relación con un manejo inadecuado o insuficiente del dolor agudo en el periodo perioperatorio, hemos realizado una revisión de su fisiopatología, los factores de riesgo y las técnicas preventivas que permitirían mitigar y/o disminuir su incidencia.

The adequate perioperative management of acute pain and the correct choice of the anesthetic technique influence the incidence of complications in the short, medium and long term, being in this group the development of chronic non-oncological pain (CNOP). Due to the increase in the prevalence of non-oncological chronic pain and its relation with an inadequate or insufficient management of acute pain in the perioperative period, we have carried out a review of its pathophysiology, risk factors and preventive techniques that would allow mitigating and/ordecrease its incidence.

Pain in Charcot-Marie-Tooth disease: an update / Dor na doença de Charcot-Marie-Tooth: atualização

ABSTRACT Charcot-Marie-Tooth (CMT) disease, the most common inherited peripheral neuropathy, has pain as one of its clinical features, yet it remains underdiagnosed and undertreated. This literature review assessed data related to pain from CMT to determine its prevalence, type and importance as a symptom, which, unlike other symptoms, is likely to be treated. The research encompassed 2007 to 2017 and included five articles that addressed pain from CMT. All of the papers concurred that pain is frequently present in CMT patients, yet its classification remains undefined as there has been no consensus in the literature about the mechanisms that cause it.

RESUMO A doença de Charcot-Marie-Tooth (CMT), a neuropatia periférica hereditária mais comum, tem a dor como uma de suas características clínicas, a qual permanece subdiagnosticada e subtratada. Essa revisão de literatura avaliou os dados relacionados à dor em CMT com objetivo de observar sua prevalência, tipo e importância como sintoma que, em detrimento de outros, é possível ser tratado. O intervalo da pesquisa foi entre 2007 e 2017, através de cinco artigos abordando a dor em CMT. Todos os artigos concordam que a dor é frequente nos pacientes com a doença de CMT e a sua classificação permanece indefinida por não haver consenso na literatura sobre os mecanismos da dor.

Trastorno depresivo, trastorno de ansiedad y dolor crónico: múltiples manifestaciones de un núcleo fisiopatológico y clínico común / Depressive Disorder, Anxiety Disorder and Chronic Pain: Multiple Manifestations of a Common Clinical and Pathophysiological Core

RESUMEN Introducción: Una alta proporción de los trastornos depresivos se acompañan de manifestaciones ansiosas, así como la depresión y la ansiedad cursan frecuentemente con dolor. En otro sentido, las manifestaciones dolorosas causan o empeoran los síntomas depresivos y ansiosos. Cada vez hay más evidencia sobre la similitud fisiopatológica, imagenológica y neurofisiológica del dolor y la depresión. Métodos: Revisión narrativa de los aspectos fisiopatológicos y clínicos de la comorbilidad depresión y dolor crónico. Se incluyen los artículos de investigación que enfatizan los elementos relevantes relacionados con la comprensión de la fisiopatología de ambas manifestaciones. Resultados: Con los más recientes avances en técnicas bioquímicas y celulares y el advenimiento de tecnologías imagenológicas de avanzada, se ha podido considerar cada vez más claramente la aproximación etiopatogénica, fisiopatológica y clínica de estos trastornos. Se sistematiza esta información en imágenes y cuadros comprensivos. Conclusiones: El reconocimiento de que el polimorfismo de los genes relacionados con la inflamación genera susceptibilidad a las manifestaciones depresivas y puede modificar la respuesta a los tratamientos antidepresivos establece que la respuesta inflamatoria no solo es un componente etiopatogénico del dolor, sino del estrés y la depresión. De igual manera, la similitud en la aproximación con imágenes corrobora la analogía no solo estructural, sino también funcional y fisiopatológica, entre la depresión y el dolor crónico. El conocimiento de la comorbilidad depresión-ansiedad-dolor crónico es importante en la búsqueda de intervenciones terapéuticas eficaces.

ABSTRACT Introduction: A high proportion of depressive disorders are accompanied by anxious manifestations, just as depression and anxiety often present with many painful manifestations, or conversely, painful manifestations cause or worsen depressive and anxious expressions. There is increasingly more evidence of the pathophysiological, and neurophysiological and technical imaging similarity of pain and depression. Methods: Narrative review of the pathophysiological and clinical aspects of depression and chronic pain comorbidity. Research articles are included that emphasise the most relevant elements related to understanding the pathophysiology of both manifestations. Results: The pathological origin, physiology and clinical approach to these disorders have been more clearly established with the latest advances in biochemical and cellular techniques, as well as the advent of imaging technologies. This information is systematised with comprehensive images and clinical pictures. Conclusions: The recognition that the polymorphism of inflammation-related genes generates susceptibility to depressive manifestations and may modify the response to antidepressant treatments establishes that the inflammatory response is not only an aetiopathogenic component of pain, but also of stress and depression. Likewise, the similarity in approach with images corroborates not only the structural, but the functional and pathophysiological analogy between depression and chronic pain. Knowledge of depression-anxiety-chronic pain comorbidity is essential in the search for effective therapeutic interventions.

Pain and temporomandibular disorders in patients with eating disorders

Abstract Orofacial pain and temporomandibular dysfunction may cause chronic facial pain, which may interfere with the emotional state and food intake of patients with eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). Sixty-four patients were assigned to four groups: Group A (AN - restricting subtype): 07; Group B (AN - purging subtype ): 19; Group C (BN): 16; and Group D (control): 22. Complaints of pain are more prevalent in individuals with eating disorders (p<0.004). There are differences between the presence of myofascial pain and the number of hospitalizations (p = 0.046) and the presence of sore throat (p=0.05). There was a higher prevalence of masticatory myofascial pain and complaints of pain in other parts of the body in ED patients; however, there was no difference between ED subgroups. There was no difference in the number of self-induced vomiting between ED patients with and without myofascial pain.

Quality of life and mastication in denture wearers and cleft lip and palate adults

Abstract The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical trial

Abstract The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

Identification of key genes and pathways involved in response to pain in goat and sheep by transcriptome sequencing

PURPOSE: This aim of this study was to investigate the key genes and pathways involved in the response to pain in goat and sheep by transcriptome sequencing. METHODS: Chronic pain was induced with the injection of the complete Freund's adjuvant (CFA) in sheep and goats. The animals were divided into four groups: CFA-treated sheep, control sheep, CFA-treated goat, and control goat groups (n = 3 in each group). The dorsal root ganglions of these animals were isolated and used for the construction of a cDNA library and transcriptome sequencing. Differentially expressed genes (DEGs) were identified in CFA-induced sheep and goats and gene ontology (GO) enrichment analysis was performed. RESULTS: In total, 1748 and 2441 DEGs were identified in CFA-treated goat and sheep, respectively. The DEGs identified in CFA-treated goats, such as C-C motif chemokine ligand 27 (CCL27), glutamate receptor 2 (GRIA2), and sodium voltage-gated channel alpha subunit 3 (SCN3A), were mainly enriched in GO functions associated with N-methyl-D-aspartate (NMDA) receptor, inflammatory response, and immune response. The DEGs identified in CFA-treated sheep, such as gamma-aminobutyric acid (GABA)-related DEGs (gamma-aminobutyric acid type A receptor gamma 3 subunit [GABRG3], GABRB2, and GABRB1), SCN9A, and transient receptor potential cation channel subfamily V member 1 (TRPV1), were mainly enriched in GO functions related to neuroactive ligand-receptor interaction, NMDA receptor, and defense response. CONCLUSIONS: Our data indicate that NMDA receptor, inflammatory response, and immune response as well as key DEGs such as CCL27, GRIA2, and SCN3A may regulate the process of pain response during chronic pain in goats. Neuroactive ligand-receptor interaction and NMDA receptor as well as GABA-related DEGs, SCN9A, and TRPV1 may modulate the process of response to pain in sheep. These DEGs may serve as drug targets for preventing chronic pain.

Relación entre el adecuado manejo del dolor agudo perioperatorio e incidencia de dolor crónico no oncológico / Relationship between the adequate management of perioperative acute pain and Incidence of non-oncologic chronic pain

El adecuado manejo perioperatorio del dolor agudo y la elección de la técnica anestésica influyen en la incidencia de complicaciones a corto, mediano y largo plazo, encontrándose en este grupo el desarrollo de dolor crónico no oncológico (DCNO). debido al aumento de la prevalencia de dolor crónico no oncológico y su relación con un manejo inadecuado o insuficiente del dolor agudo en el periodo perioperatorio, hemos realizado una revisión de su fisiopatología, los factores de riesgo y las técnicas preventivas que permitirían mitigar y/o disminuir su incidencia.

The adequate perioperative management of acute pain and the correct choice of the anesthetic technique influence the incidence of complications in the short, medium and long term, being in this group the development of chronic non-oncological pain (CNOP). due to the increase in the prevalence of non-oncological chronic pain and its relation with an inadequate or insufficient management of acute pain in the perioperative period, we have carried out a review of its pathophysiology, risk factors and preventive techniques that would allow mitigating and/or decrease its incidence.

Chronic low back pain in patients with systemic lupus erythematosus: prevalence and predictors of back muscle strength and its correlation with disability / Lombalgia crônica em pacientes com lúpus eritematoso sistêmico: prevalência e preditores da força muscular de extensão de tronco e sua correlação com a incapacidade

Abstract Objective: To determine the prevalence of Chronic Low Back Pain and predictors of Back Muscle Strength in patients with Systemic Lupus Erythematosus. Methods: Cross-sectional study. Ninety-six ambulatory patients with lupus were selected by non-probability sampling and interviewed and tested during medical consultation. The outcomes measurements were: Point prevalence of chronic low back pain, Oswestry Disability Index, Tampa Scale of Kinesiophobia, Fatigue Severity Scale and maximal voluntary isometric contractions of handgrip and of the back muscles. Correlation coefficient and multiple linear regression were used in statistical analysis. Results: Of the 96 individuals interviewed, 25 had chronic low back pain, indicating a point prevalence of 26% (92% women). The correlation between the Oswestry Index and maximal voluntary isometric contraction of the back muscles was r = −0.4, 95% CI [−0.68; −0.01] and between the maximal voluntary isometric contraction of handgrip and of the back muscles was r = 0.72, 95% CI [0.51; 0.88]. The regression model presented the highest value of R 2 being observed when maximal voluntary isometric contraction of the back muscles was tested with five independent variables (63%). In this model handgrip strength was the only predictive variable (β = 0.61, p = 0.001). Conclusions: The prevalence of chronic low back pain in individuals with systemic lupus erythematosus was 26%. The maximal voluntary isometric contraction of the back muscles was 63% predicted by five variables of interest, however, only the handgrip strength was a statistically significant predictive variable. The maximal voluntary isometric contraction of the back muscles presented a linear relation directly proportional to handgrip and inversely proportional to Oswestry Index i.e. stronger back muscles are associated with lower disability scores.

Resumo Objetivo: Determinar a prevalência de lombalgia crônica (LBC) e os preditores de força muscular nas costas (FMC) em pacientes com lúpus eritematoso sistêmico (LES). Métodos: Estudo transversal. Selecionaram-se 96 pacientes ambulatoriais com LES por amostragem não probabilística, entrevistados e testados durante consultas médicas. As medidas de desfecho foram: prevalência ocasional de LBC, Índice de Incapacidade de Oswestry, Escala Tampa para Cinesiofobia, Escala de Gravidade da Fadiga e contrações isométricas voluntárias máximas (CIVM) de preensão manual e dos músculos das costas. Usaram-se o coeficiente de correlação e a regressão linear múltipla na análise estatística. Resultados: Dos 96 indivíduos entrevistados, 25 apresentavam LBC, o que indicou uma prevalência circunstancial de 26% (92% mulheres). A correlação entre o Índice de Incapacidade de Oswestry e a contração isométrica voluntária máxima dos músculos das costas foi de r = -0,4, IC 95% [-0,68; -0,01] e entre a CIVM de preensão manual e dos músculos das costas foi de r = 0,72, IC 95% [0,51; 0,88]. O modelo de regressão apresentou o maior valor de R2 observado quando a CIVM dos músculos das costas foi testada com cinco variáveis independentes (63%). Nesse modelo, a força de preensão manual foi a única variável preditiva (ß = 0,61, p = 0,001). Conclusões: A prevalência de LBC em indivíduos com LES foi de 26%. A CIVM dos músculos das costas foi 63% prevista por cinco variáveis de interesse. No entanto, apenas a força de preensão manual foi uma variável preditiva estatisticamente significativa. A CIVM dos músculos das costas apresentou uma relação linear diretamente proporcional à força de preensão manual e inversamente proporcional ao Índice de Incapacidade de Oswestry (ou seja, músculos das costas mais fortes estão associados a menores pontuações de incapacidade).

The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies

ABSTRACT Background Longitudinal studies have shown that the symptoms of chronic low back pain (CLBP) will follow an episodic trajectory characterized by periods of high and low pain intensity that can persist for many years. There is a growing belief that the contemporary approach of limiting physical therapy to short, but intense courses of treatment for (CLBP) may be sub-optimal because these limited “windows” of clinical care are not congruent with the natural history of this condition. Recent research has suggested that people with CLBP undergo substantial, and individualized long-term variations in the neural processing of nociception over time. This has led to the concept of a “unique biosignature of pain” that may explain much of the variation in a person’s clinical picture. These and other findings have led to the reconceptualization of CLBP as an individualized, and continually evolving condition that may be more suitably managed by empowering the patient toward self-management strategies that can be modified as needed over time by the PT. Objectives The purpose of this Master Class Paper is to describe an emerging approach for the treatment of CLBP that emphasizes the formation of a long-term therapeutic alliance between the patient and the PT with an emphasis on individualized, patient-preferred approaches for activity-based self-management as an alternative to the contemporary approach of short, intense episodes of care directed toward pain reduction. Conclusion Longitudinal care using assisted self-management strategies is more congruent with the natural history of CLBP than are traditional approaches for PT intervention. This approach may empower patients to undergo lifestyle changes that will favorably influence long-term outcomes; however additional research is needed.

Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain

ABSTRACT Background Dry needling (DN) and percutaneous electrical nerve stimulation (PENS) are widely used techniques in the treatment of myofascial pain. Objective To investigate the immediate and short-term effects of the combination of DN and PENS compared to DN alone on the upper trapezius muscle. Method This is a 72-hour follow-up single-blinded randomized controlled trial. Sixty-two volunteer patients with chronic myofascial neck pain with active Myofascial Trigger Points (MTrPs) in the upper trapezius muscle were recruited. Randomization was performed, and 31 patients received DN treatment (DN group) and 31 received DN and PENS (DN+PENS group). The primary outcomes were neck disability index (NDI) and visual analog scale for pain for both post-needling soreness (PNS) and neck pain intensity (NPI). Pressure pain threshold (PPT) and cervical range of motion (CROM) were the secondary outcomes. Results We detected between-group differences in NPI and PNS in favor of the DN+PENS group immediately after treatment. No between-group differences in NDI were observed. Conclusion PENS application after dry needling treatment is more effective than dry needling alone for decreasing soreness in the short term and improving neck pain intensity immediately in patients with myofascial chronic neck pain.

Pain characterization in Duchenne muscular dystrophy / Caracterização da dor na distrofia muscular de Duchenne

ABSTRACT Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder, characterized by progressive muscle weakness. Historically, pain has not been considered to be a major symptom in DMD. Objective To investigate the relationship between DMD and pain. Methods We conducted a systematic review in Medline/PubMed and BVS (virtual library in health) databases. We searched for articles that showed the terms “Muscular Dystrophy, Duchenne” and “Pain” in all fields. All studies included boys diagnosed with DMD and the occurrence/amount of pain on this population. Results Initially, there were 175 studies. 167 articles were excluded for not meeting the inclusion criteria. The remaining eight eligible studies, involving pain assessment in DMD, were analyzed. Conclusion Pain is a frequent problem in this population and this symptom is potentially tractable. Studies conclude that pain can directly influence the quality of life of this population.

RESUMO Distrofia muscular de Duchenne (DMD) é uma doença recessiva ligada ao X, caracterizada por fraqueza muscular progressiva. Historicamente a dor não foi considerada como um dos principais sintomas em DMD. Objetivo Investigar a relação entre DMD e dor. Métodos Foi realizada uma revisão sistemática nas bases de dados Medline/PubMed e BVS (Biblioteca Virtual em Saúde). Foram incluídos na busca artigos que mostravam os termos “Distrofia Muscular de Duchenne” e “Dor” em todos os campos. Todos os estudos incluíram meninos diagnosticados com DMD e a ocorrência/intensidade da dor nesta população. Resultados Inicialmente, havia 175 estudos. 167 artigos foram excluídos por não preencherem os critérios de inclusão. Então, 8 estudos elegíveis, envolvendo a avaliação da dor em DMD, foram analisados. Conclusão A dor é um problema frequente nesta população e esse sintoma é potencialmente tratável. Estudos concluíram que a dor pode influenciar diretamente a qualidade de vida dessa população.

Musculoskeletal pain in children and adolescents

ABSTRACT Introduction Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research. Results Rates of self-reported MSK pain in adolescents are similar to those in adult populations and they are typically higher in teenage girls than boys. Epidemiological research has identified conditions such as back and neck pain as major causes of disability in adolescents, and in up to a quarter of cases there are impacts on school or physical activities. A range of physical, psychological and social factors have been shown to be associated with MSK pain report, but the strength and direction of these relationships are unclear. There are few validated instruments available to quantify the nature and severity of MSK pain in children, but some show promise. Several national surveys have shown that adolescents with MSK pain commonly seek care and use medications for their condition. Some studies have revealed a link between MSK pain in adolescents and chronic pain in adults. Conclusion Musculoskeletal pain conditions are often recurrent in nature, occurring throughout the life-course. Attempts to understand these conditions at a time close to their initial onset may offer a better chance of developing effective prevention and treatment strategies.

Reliability of new software in measuring cervical multifidus diameters and shoulder muscle strength in a synchronized way; an ultrasonographic study

OBJECTIVES: This study was conducted with the purpose of evaluating the inter-session reliability of new software to measure the diameters of the cervical multifidus muscle (CMM), both at rest and during isometric contractions of the shoulder abductors in subjects with neck pain and in healthy individuals.METHOD: In the present study, the reliability of measuring the diameters of the CMM with the Sonosynch software was evaluated by using 24 participants, including 12 subjects with chronic neck pain and 12 healthy individuals. The anterior-posterior diameter (APD) and the lateral diameter (LD) of the CMM were measured in a resting state and then repeated during isometric contraction of the shoulder abductors. Measurements were taken on separate occasions 3 to 7 days apart in order to determine inter-session reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD) were used to evaluate the relative and absolute reliability, respectively.RESULTS: The Sonosynch software has shown to be highly reliable in measuring the diameters of the CMM both in healthy subjects and in those with neck pain. The ICCs 95% CI for APD ranged from 0.84 to 0.94 in subjects with neck pain and from 0.86 to 0.94 in healthy subjects. For LD, the ICC 95% CI ranged from 0.64 to 0.95 in subjects with neck pain and from 0.82 to 0.92 in healthy subjects.CONCLUSIONS: Ultrasonographic measurement of the diameters of the CMM using Sonosynch has proved to be reliable especially for APD in healthy subjects as well as subjects with neck pain.