European journal of pain : EJP
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Randomized Controlled Trial
Driving plasticity in the motor cortex in recurrent low back pain.
The sensory and motor systems can reorganise following injury and learning of new motor skills. Recently we observed adaptive changes in motor cortical organisation in patients with recurrent low back pain (LBP), which are linked to altered motor coordination. Although changes in motor coordination can be trained and are associated with improved symptoms and function, it remains unclear whether these training-induced changes are related to reorganisation of the motor cortex. ⋯ Changes were not observed following unskilled walking exercise. This is the first observation that motor training can reverse reorganisation of neuronal networks of the motor cortex in people with recurrent pain. The observed relationship between cortical reorganisation and changes in motor coordination following motor training provides unique insight into potential mechanisms that underlie recovery.
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The effects of gentle mechanical skin stimulation on reflex discharges in cardiac sympathetic nerve evoked by somatic afferent stimulation were studied in anesthetized rats. Mass discharges were recorded from cardiac sympathetic efferent nerve while somatocardiac sympathetic A- and C-reflexes were elicited by single electrical stimuli to myelinated A- and unmyelinated C-afferent fibers of the tibial nerve. Continuous touch was applied to inner thigh skin with a force of 0.12 N for 10 min periods by a soft elastomer "brush" (1.1cm in diameter with 417 microcones). ⋯ We recorded unitary afferent activity from thigh branches of the saphenous nerve and found fibers excited by touch were low-threshold mechanoreceptive Abeta, Adelta and C fibers that have rapidly or slowly adapting properties. In all units tested, average discharge rates during touch period were less than 4 Hz. The results suggest that touch-induced excitation of low threshold cutaneous mechanoreceptive fibers inhibits nociceptive transmission conveyed by C-primary-afferents, via the release of both opioid and non-opioid inhibitory mediators.
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Randomized Controlled Trial
Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear.
This investigation was an initial attempt to explore psychological factors that might help or hinder the effect of exposure in vivo for patients with musculoskeletal pain and pain-related fear. The study was based on data from a randomized-controlled trial for patients with non-specific spinal pain (Linton et al., 2008). First, catastrophizing, anxiety, and depression were studied as possible treatment moderators. ⋯ Next, patients were divided into high change participants and low change participants based on their improvement in disability after treatment in order to investigate the change in psychological variables during treatment. Descriptive data indicated that high change participants had large improvements across treatment on depression, anxiety, catastrophizing, and fear-avoidance beliefs whereas low change participants virtually did not change at all on these variables across treatment. These findings denote that catastrophizing is a moderator of treatment outcome in exposure whereas several psychological variables might be important for the treatment process.
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Previous evaluations of the 20-item Neck Pain and Disability Scale (NPAD) were indicative of excessive redundancy of the measure. The aim of this study was to develop a shortened version of the NPAD (sf-NPAD) based on results of item-to-total-score correlations and factor analysis as published by the developers of the original NPAD. Two items with the highest item-to-total score correlation were selected per factor subscale with the exception of one factor consisting of only one item. ⋯ The sf-NPAD scores of patient subgroups were significantly different showing good discriminative validity. In conclusion, the sf-NPAD demonstrated good validity and internal consistency in this general practice setting. The abbreviated version may facilitate applicability of the scale in clinical and research settings.