Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia?

There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.

Exploring the relationship between chronic pain and cortisol levels in subjects with osteoarthritis: results from a systematic review of the literature.

OBJECTIVE: Several reports in the literature have identified an association between cortisol levels and the presence of chronic pain in conditions such as rheumatoid arthritis, low back pain or whiplash. In contrast, few have examined the association of cortisol and pain in people with osteoarthritis (OA). The purpose of this systematic review was to verify the association between cortisol and pain in the OA population. DESIGN: The databases MEDLINE, CINAHL, EMBASE were searched systematically for human studies written in English up to December 2018. Two researchers screened titles and abstracts against predefined inclusion criteria; a third resolved discrepancies. Articles were included if they measured the cortisol levels in adults with pain in the OA population. Methodological quality was assessed using Methodological Index for non-randomized Studies (MINORS) score. RESULTS: Seven studies reporting on 415 patients were included in this review. The MINORS scale yielded mean scores of 8.6 of 16 and 17.5 of 24, for the cohort and case-control studies respectively. In general, the studies were of poor quality. A discrepancy of noteworthy associations between cortisol level comparison and pain was found. CONCLUSIONS: This study shows that there is a discrepancy in the relationship between cortisol and pain dependent on how and when cortisol is measured. Evidence from three low-quality studies suggest increased cortisol levels in patients with pain but the conclusions have a high risk of bias. It was not possible to make a quantitative analysis comparing the relationship between cortisol and pain in the OA population.

Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial.

BACKGROUND: Three different types of manual therapy techniques for patients with neck pain and relationship with psychological factors has not been evaluated. AIM: To compare the effectiveness high velocity and low amplitude (HVLA) manipulation vs. posteroanterior mobilization (PA mob) vs. sustain appophyseal natural glide (SNAG) in the management of patients with neck pain and to evaluate the interaction with psychological factors. STUDY DESING: Randomized clinical trial. SETTING: Primary Health Care Center. POPULATION: Patients with history of chronic neck pain over the last 3 months were recruited. METHODS: Patients were randomly assigned to receive treatment with HVLA (N.=15), with PA mob (N.=16) or with SNAG (N.=17). One session was applied. Pain intensity of neck pain, pressure pain threshold over processus spinosus of C2 (PPT_C2) and cervical range of motion (CROM) were measured pre- and post-intervention. Pain catastrophizing, depression, anxiety and kinesiophobia were assessed in baseline. ANOVAs were performed, with main effects, two-way (treatment x time) and three-way interactions (treatment x psychological variable x time) were examined. RESULTS: Fourthy-eight patients (mean±SD age, 36.5±8.7 years; 87.5% female). A significant interaction treatment x time was observed for VAS-rest in HVLA and AP mob groups (P<0.05). With more pain relief to HVLA and AP mob groups than SNAG groups but all groups improve the same in CROM. Also, a significant three-way treatment x anxiety x time interaction for VAS in Flexion/Extension was identified (P<0.01), and a trend toward significance was observed for the three way treatment x anxiety x time interaction, with respect to CROM in Lateral-Flexion movement (P<0.05). CONCLUSION: The results suggest that an HVLA and PA mob groups relieved pain at rest more than SNAG in patients with Neck pain. Among psychological factors, only trait anxiety seems interact with Manual therapy, mainly high anxiety conditions interact with the Mobilization and SNAG effects but under low anxiety conditions interact with the HVLA effects. Significant mean differences can be observed both in VAS in Flexion/Extension and in CROM in lateral-flexion movement when using mobilization under high anxiety conditions CLINICAL REHABILITATION IMPACT: The findings provide preliminary evidence to support that three different techniques have similar immediate effects over neck pain and while under high anxiety levels a better outcome is expected after mobilization intervention, under low anxiety levels a better prognosis is expected after manipulation and SNAG intervention.

The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders.

No studies have investigated the effects of the treatments directed at the cervical spine in patients with temporomandibular disorders (TMD). Our aim was to investigate the effects of joint mobilization and exercise directed at the cervical spine on pain intensity and pressure pain sensitivity in the muscles of mastication in patients with TMD. Nineteen patients (14 females), aged 19-57 years, with myofascial TMD were included. All patients received a total of 10 treatment session over a 5-week period (twice per week). Treatment included manual therapy techniques and exercise directed at the cervical spine. Outcome measures included bilateral pressure pain threshold (PPT) levels over the masseter and temporalis muscles, active pain-free mouth opening (mm) and pain (Visual Analogue Scale) and were all assessed pre-intervention, 48 h after the last treatment (post-intervention) and at 12-week follow-up period. Mixed-model anovas were used to examine the effects of the intervention on each outcome measure. Within-group effect sizes were calculated in order to assess clinical effect. The 2 x 3 mixed model anova revealed significant effect for time (F = 77.8; P < 0.001) but not for side (F = 0.2; P = 0.7) for changes in PPT over the masseter muscle and over the temporalis muscle (time: F = 66.8; P < 0.001; side: F = 0.07; P = 0.8). Post hoc revealed significant differences between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between post-intervention and follow-up period (P = 0.9) for both muscles. Within-group effect sizes were large (d > 1.0) for both follow-up periods in both muscles. The anova found a significant effect for time (F = 78.6; P < 0.001) for changes in pain intensity and active pain-free mouth opening (F = 17.1; P < 0.001). Significant differences were found between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between the post-intervention and follow-up period (P > 0.7). Within-group effect sizes were large (d > 0.8) for both post-intervention and follow-up periods. The application of treatment directed at the cervical spine may be beneficial in decreasing pain intensity, increasing PPTs over the masticatory muscles and an increasing pain-free mouth opening in patients with myofascial TMD.

Influencia de los cambios hormonales del ciclo menstrual en la percepción del dolor en las disfunciones temporomandibulares. Una revisión sistemática de la literatura médica / Infl uence of hormone changes during the menstrual cycle on pain perception in temporomandibular disorders. A systematic review of the literature

Se dispone de una extensa literatura científica que confirma que las disfunciones temporo-mandibulares (DTM) presentan una mayor incidencia en mujeres. El objetivo de esta revisión es determinar si el proceso hormonal generado mediante el ciclo menstrual influye en las DTM que presentan sintomatología dolorosa. Se realizó una búsqueda de artículos científicos en las bases datos Medline, Embase, Scielo y CINAHL, entre los años 1970y 2008. Se incluyeron estudios con diseños de cohortes y de casos y controles, donde se valoraron diversas variables del dolor durante el ciclo menstrual de personas que presentaban DTM. Dos revisores independientes valoraron la calidad de los estudios utilizando la Newcastle-Ottawa Scale. Se seleccionaron para el análisis cualitativo 4 estudios que cumplieron los criterios de inclusión propuestos. Los resultados de los estudios analizados son contradictorios, y por este motivo esta revisión no permite establecer conclusiones afirmativas en relación con el hecho que el factor hormonal femenino influye en la percepción del dolor en las DTM. Consideramos que es necesario realizar una mayor cantidad de estudios donde se investiguen los diversos aspectos del sexo femenino que puedan estar implicados en las DTM (AU)

A large body of evidence suggests that temporo mandibular joint disorders (TMJD) are much more prevalent in women than in men. The purpose of this systematic review was to examine whether hormone levels during the menstrual cycle influence TMJD when painful symptoms are present. A data extraction search strategy was performed in the Medline, Embase, Scielo and CINAHL databases from 1970 to 2008. We included cohort and case-control studies assessing several pain variables in patients with TMJD during the menstrual cycle. The quality of the studies was assessed by two independent reviewers using the Newcastle-Ottawa Scale. Four studies that met the proposed inclusion criteria were included for the qualitative analysis. The results of the studies analyzed are contradictory and consequently do not allow us to conclude that female hormone factors strongly influence pain perception in TMJD. Therefore, further studies are required to investigate the various female sex-related factors that could be involved in TMJD (AU)

Tratamiento conservador tras fractura de clavícula: análisis de un caso clínico / Conservative treatment after clavicle fracture: analysis of a clinical case

Objetivos. En el presente texto se expone un caso clínico que sufrió una no-unión del tercio distal de la clavícula. Material y métodos. Se estudió un caso clínico que sufrió una no-unión del tercio distal de la clavícula. Se desestimó, por motivos burocráticos, la operación, por lo que el paciente acudió a tratamiento de fisioterapia en clínica privada. Se midió la amplitud articular del complejo escápulo-humeral y se pasó la escala de Constant al final del tratamiento con objeto de valorar la funcionalidad al terminar el mismo. Resultados. Los resultados fueron funcionalmente aceptables según la escala de Constant después de 3 meses de tratamiento fisioterápico; sin embargo, no se pudo realizar una comparación pre-post tratamiento. Conclusiones. Se puede afirmar que la estabilidad del hombro puede obtenerse con un tratamiento fisioterápico intensivo destinado a obtener una estabilidad musculotendinosa de todo el complejo escapular (AU)

Biomecánica del síndrome de latigazo cervical y su analogía osteopática / Biomechanics of cervical whiplash syndrome and its osteopathic analogy

El tratamiento mediante manipulaciones es una terapia antigua; sin embargo, investigaciones científicas datan desde finales de la década de los 70.Las condiciones en las cuales la manipulación es aplicada, tienden al tratamiento de síntomas tales como lumbalgias agudas y crónicas, dolor radicular, cervicalgias, algunas formas de cefalea, etc. Las diferentes técnicas osteopáticas tienen como objeto liberar adherencias, suprimir fibrosis, restablecer la función articular y producir (mediante un efecto reflexógeno) un estímulo aferente con objeto de facilitar la inhibición de la hiperactividad gamma, responsable del acortamiento crónico de la musculatura profunda que fija la disfunción vertebral. El empleo de las técnicas de manipulación y movilización a nivel cervical han sido empleadas en pacientes con síndrome de latigazo cervical; sin embargo, en el aspecto clínico desarrollado por nuestro equipo de investigación, consideramos necesario la movilización y manipulación de otras zonas afectadas. El objetivo de este artículo es analizar de forma exhaustiva la biomecánica que acontece durante un impacto trasero en el interior de un vehículo (causa más frecuente de desarrollo de síndrome de latigazo cervical) y su analogía con la patomecánica osteopática (whiplash craneosacro).A través del análisis realizado en este artículo se puede observar una analogía entre las lesiones articulares demostradas en diversos estudios y las lesiones articulares definidas desde el punto de vista osteopático (AU)

Masaje de fricción transversal. Una alternativa terapéutica para el tratamiento del síndrome de dolor miofascial / Transverse friction massage. A therapeutical alternative for the treatment of the myofacial pain syndrome

El síndrome de dolor miofascial (SDM) constituye una de las principales causas de cervicalgias y cefaleas. La presencia de puntos gatillo miofasciales (PGM) en múltiples patologías ha provocado la necesidad de numerosas investigaciones acerca de las técnicas de tratamiento fisioterápico de esta entidad. Hoy en día existen muchas técnicas fisioterápicas para el tratamiento del SDM: terapia manual (compresión isquémica, técnica de Jones, masaje, técnicas de energía muscular, etc), TENS, láser, ultrasonido, termoterapia superficial, etc.Sin embargo, hemos observado que el masaje de fricción transversal, técnica empleada en numerosas ocasiones para el tratamiento fisioterápico de tendinopatías, no ha sido aplicado en el tratamiento de PGM. Objetivo: El objetivo de esta serie de casos es evaluar la efectividad inmediata de una sesión de masaje de fricción transversal en el tratamiento del SDM. Material y métodos: Se estudiaron 10 sujetos diagnosticados de PGM en las fibras superiores del músculo trapecio según los criterios de Travell y Simons. A los sujetos se les aplicó una única sesión de tratamiento mediante la aplicación de un masaje de fricción transversal. La sesión tuvo una duración de 3 minutos. Las mediciones analizadas en los pacientes fueron el umbral dolor a la presión (UDP), la escala analógica visual (EAV) durante la ejecución de la técnica, y la evocación de dolor referido durante la ejecución de la técnica. Se tomaron datos antes y después de la aplicación de la técnica. Resultados: Los resultados obtenidos muestran una mejora inmediata estadísticamente significativa (p = 0,001) en el UDP. Analizando la EAV durante la ejecución de la técnica, encontramos que la ejecución del masaje de fricción transversal es percibido como ligeramente doloroso para el paciente (EAV = 6,3).Conclusión: Los resultados obtenidos muestran que esta técnica es eficaz; sin embargo, es percibida como ligeramente dolorosa para el paciente. La escasa existencia de estudios randomizados que analicen los efectos de diferentes terapias de tratamiento en PGM y la no unanimidad en la metodología de aplicación de las mismas, hace difícil la comparación entre los resultados. Actualmente existen diferentes técnicas que se usan en el tratamiento del SDM que no han sido correctamente evidenciadas (AU)

Efectividad del tratamiento fisioterápico en las lesiones por aceleración-deceleración del raquis cervical / Effectivity of physiotherapeutic treatment in acceleration-deceleration injuries of the cervical spine

Las lesiones por aceleración-deceleración constituyen una patología con entidad propia que conlleva la necesidad de un tratamiento fisioterápico precoz e intensivo. En la actualidad no existe un protocolo determinado de actuación fisioterápica en esta patología. La necesidad de un conocimiento científico de las bases biomecánicas de la lesión y de las técnicas de tratamiento fisioterápico nos han llevado al estudio de esta entidad.En el tratamiento fisioterápico de esta patología se recurre a diferentes técnicas de terapia manual y de Fisioterapia. Estas técnicas son defendidas desde el punto de vista de la práctica clínica o, en algunos casos, con ensayos clínicos controlados. Es necesario concienciar a los fisioterapeutas la necesidad del estudio e investigación de las diferentes técnicas de Fisioterapia aplicadas en esta patología (AU)