FMT Abstracts #2 August 11
Fibromyalgia Patients' Communication of Cues and Concerns: Interaction
Analysis of Pain Clinic Consultations
The Clinical Journal of Pain, 08/16/2011
Eide H et al. – Findings from this study highlight the importance of a patient centered communication
style to facilitate the expression of cues and concerns.
Methods
 Initial consultations between patients with fibromyalgia [n=58, 85% female, duration 30
minutes, mean age 47.8 y (SD 10.7)] and clinical nurse specialists (n=5) were videotaped.
 Patients' cues and concerns were coded using the Verona Coding Definitions of Emotional
Sequences.
 Nurses' responses to patients' cues and concerns were evaluated using the Hierarchical
Coding Scheme of Comforting Strategies.
Results
 Patients expressed more cues than concerns, mostly about pain, interpersonal relationships,
and/or emotional reactions.
 Both the lack of empathic responding and unspecific empathic responding were associated
with the expression of an increased number of cues in the consultation, whereas higher
evaluation of health was associated with less cues.
 More concerns were expressed by patients when nurses exhibited a high level of empathic
responding and when the patient entered the consultation with a higher level of negative
effect
Results: Patients expressed more cues than concerns, mostly about pain, interpersonal relationships,
and/or emotional reactions. Both the lack of empathic responding and unspecific empathic responding
were associated with the expression of an increased number of cues in the consultation, whereas
higher evaluation of health was associated with less cues. More concerns were expressed by patients
when nurses exhibited a high level of empathic responding and when the patient entered the
consultation with a higher level of negative effect.
Discussion: Findings from this study highlight the importance of a patient centered communication
style to facilitate the expression of cues and concerns.
http://journals.lww.com/clinicalpain/Abstract/2011/09000/Fibromyalgia_Patients__Communication_of_C
ues_and.6.aspx
Eide H et al. Fibromyalgia Patients' Communication of Cues and Concerns: Interaction Analysis of Pain
Clinic Consultations. The Clinical Journal of Pain. Aug 2011. (Entered August 2011)
Category: Misc Bib- Fibromyalgia
Temporomandibular Disorders Are Differentially Associated With Headache
Diagnoses: A Controlled Study
The Clinical Journal of Pain, 08/16/2011
Goncalves DAG et al. – Temporomandibular disorder (TMD), TMD subtypes, and TMD severity are
independently associated with specific headache syndromes and with headache frequency. This
differential association suggests that the presence of central facilitation of nociceptive inputs may be of
importance, as positive association was observed only when muscular TMD pain was involved.
Methods
 The sample consisted of 300 individuals.
 TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was
classified according to International Classification for Headache Disorders–2.
 Univariate and multivariate models assessed headache diagnoses and frequency as a function of
the parameters of TMD.
Results
 Relative to those without TMD, individuals with myofascial TMD were significantly more likely
to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI),
3.1–19.6], migraine (RR=4.4; 95% CI, 1.7–11.7), and episodic tension–type headache (RR=4.4;
95% CI, 1.5–12.6).
 Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine
(P<0.0001), and episodic tension–type headache (P<0.05).
 TMD severity was also associated with headache frequency.
 In multivariate analyses, TMD was associated with migraine and CDH (P=0.001).
 Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache
frequency.
Discussion: TMD, TMD subtypes, and TMD severity are independently associated with specific
headache syndromes and with headache frequency. This differential association suggests that the
presence of central facilitation of nociceptive inputs may be of importance, as positive association
was observed only when muscular TMD pain was involved.
http://journals.lww.com/clinicalpain/Abstract/2011/09000/Temporomandibular_Disorders_Are_Differenti
ally.7.aspx
Goncalves DAG et al. Temporomandibular Disorders Are Differentially Associated With Headache
Diagnoses: A Controlled Study. The Clinical Journal of Pain. Aug 2011. (Entered August 2011)
Category: Upper Quarter Bib- TMJ
Do sleep disorders contribute to pain sensitivity?
Current Rheumatology Reports, 08/16/2011 Clinical Article
Okifuji A et al. – In this review, the authors focus on one side of the relationship: Whether and how
disordered sleep adversely impacts pain.
Methods
 Discuss available evidence from epidemiologic, clinical, and human, as well as infrahuman
laboratory studies
Results
 Literature supports positive relationship between poor sleep and increased pain
 Sleep deprivation also seems to attenuate analgesic effects of medications
 Research delineating causal or associative relationship between sleep and pain is still preliminary
at this time
Abstract
Sleep disturbance is one of the most common comorbid problems for chronic pain patients. The
association between the two phenomena has long been recognized, but the nature of the relationship is not
well-understood. Many agree that the relationship is likely bidirectional. In this review, we focus on one
side of the relationship: whether and how disordered sleep adversely impacts pain. We discuss the
available evidence from the epidemiologic, clinical, and human, as well as infrahuman laboratory studies.
Generally, the literature supports the positive relationship between poor sleep and increased pain. Sleep
deprivation also seems to attenuate analgesic effects of medications. Research delineating the causal or
associative relationship between sleep and pain is still preliminary at this time. Continuing efforts in both
experimental and clinical research are needed to develop a translationally meaningful understanding of
how poor sleep impacts pain
http://www.metapress.com/content/g8m12456057869r7/
Okifuji A et al. Do sleep disorders contribute to pain sensitivity? Current Rheumatology Reports. Aug
2011. (Entered August 2011)
Category: Misc Bib- Pain
Characteristics of Response to Experimental Pain in Sexually Abused Women
The Clinical Journal of Pain, 08/16/2011
Granot M et al. – Women with a history of severe sexual abuse (SA) seem to have a paradoxical pattern
of experimental pain response, characterized by both higher pain thresholds and increased pain intensity
ratings. This pattern is associated with the personality trait of harm avoidance. Models that might account
for these findings are discussed.
Methods
 Twenty–one survivors of severe, long–lasting SA and 21 control women underwent
experimentally induced heat pain and completed psychological questionnaires.
 Pain measures included heat pain thresholds, pain intensity ratings, and pain tolerance in response
to contact heat, painful stimulation delivered to the volar forearm.
 Questionnaires included somatization (Brief Symptom Inventory), personality traits including
harm avoidance, novelty seeking, and reward dependence (Cloninger tridimensional personality
questionnaire), and levels of dissociation (Dissociative Experiences Scale).
Objectives: Women with a history of sexual abuse (SA) commonly report greater pain symptoms. It is
still unclear whether enhanced pain susceptibility is the result of altered pain processing and response.
Therefore, this pilot study aimed to explore pain sensitivity to experimentally induced pain and associated
psychology in women with a history of severe SA.
Methods: Twenty-one survivors of severe, long-lasting SA and 21 control women underwent
experimentally induced heat pain and completed psychological questionnaires. Pain measures included
heat pain thresholds, pain intensity ratings, and pain tolerance in response to contact heat, painful
stimulation delivered to the volar forearm. Questionnaires included somatization (Brief Symptom
Inventory), personality traits including harm avoidance, novelty seeking, and reward dependence
(Cloninger tridimensional personality questionnaire), and levels of dissociation (Dissociative Experiences
Scale).
Results: SA women had elevated heat pain thresholds (45.7±2.2°C vs. 43.9±3.1°C; P=0.042) and higher
pain intensity ratings (on a 0 to 100 scale: 80.0±26.6 vs. 51.2±27.7; P=0.001). In addition, they had lower
tolerability to painful tonic stimulation, greater somatization, and larger harm avoidance scores.
Regression analyses showed that higher pain intensity ratings in SA women associated with greater
tendency for harm avoidance but not with levels of dissociation.
Discussion: Women with a history of severe SA seem to have a paradoxical pattern of experimental pain
response, characterized by both higher pain thresholds and increased pain intensity ratings. This pattern is
associated with the personality trait of harm avoidance. Models that might account for these findings are
discussed.
http://journals.lww.com/clinicalpain/Abstract/2011/09000/Characteristics_of_Response_to_Experimental
_Pain.8.aspx
Granot M et al. Characteristics of Response to Experimental Pain in Sexually Abused Women. The
Clinical Journal of Pain. Aug 2011. (Entered August 2011)
Category: Misc Bib- Pain
Role of Patent Foramen Ovale in Migraine Etiology and Treatment: A
Review
Echocardiography, 08/17/2011
Sharma A et al. – An increased prevalence between patent formen ovale (PFOs) and migraine exists but
there is conflicting data regarding causal relationship between these two conditions. This review seeks to
summarize the current literature on this association and studies that have investigated PFO closure in this
population
An increased prevalence between patent formen ovale (PFOs) and migraine exists but there is conflicting
data regarding causal relationship between these two conditions. It is controversial whether cardiac
screening and intervention like PFO closure provides any benefit in this population and so this area still
remains under intense investigation. The management of migraine lies at the intersection between the
practice of primary care physicians, neurologists, and cardiologists. There is no consensus as to what is
the best practice for the evaluation of these patients with difficult to control migraine given the millions of
dollars spent on physician visits and pharmacotherapy. This review seeks to summarize the current
literature on this association and studies that have investigated PFO closure in this population.
(Echocardiography, 2011;**:1-5)
http://onlinelibrary.wiley.com/doi/10.1111/j.15408175.2011.01460.x/abstract;jsessionid=17FC46C43D07764DFDE36036C357E906.d03t03
Sharma A et al. Role of Patent Foramen Ovale in Migraine Etiology and Treatment: A Review.
Echocardiography. Aug 2011. (Entered August 2011)
Category: Upper Quarter Bib- Headache
Phantom Limb Pain: Mechanisms and Treatment Approaches
Pain Research and Treatment, 08/17/2011
Subedi B et al. – Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed
results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary
measures. This paper attempts to review and summarize recent research relative to the proposed
mechanisms of and treatments for phantom limb pain
The vast amount of research over the past decades has significantly added to our knowledge of phantom
limb pain. Multiple factors including site of amputation or presence of preamputation pain have been
found to have a positive correlation with the development of phantom limb pain. The paradigms of
proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and
central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the
brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have
been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain
is considered a neuropathic pain, and most treatment recommendations are based on recommendations for
neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb
pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include
multidisciplinary measures. This paper attempts to review and summarize recent research relative to the
proposed mechanisms of and treatments for phantom limb pain.
http://www.hindawi.com/journals/prt/2011/864605/
Subedi B et al. Phantom Limb Pain: Mechanisms and Treatment Approaches. Pain Research and
Treatment. Aug 2011. (Entered August 2011)
Category: Misc Bib- Pain
Clinical Predictors of Foot Orthoses Efficacy in Individuals with
Patellofemoral Pain
Medicine and Science in Sports and Exercise, 08/18/2011 Clinical Article
Barton CJ et al. – Individuals with patellofemoral pain syndrome (PFPS) who wear less supportive
footwear, report lower levels of pain, exhibit less ankle dorsiflexion range of motion, and report an
immediate reduction in pain with foot orthoses when performing a single–leg squat are more likely to
benefit from foot orthoses.
Methods
 A total of 60 individuals with PFPS were issued with noncustomized prefabricated foot orthoses
containing built–in arch supports and 4° rear foot varus wedging.
 Patient–reported level of improvement was documented at 12 wk.
 Potential baseline predictor variables of interest included patient demographics, pain
characteristics, footwear motion control properties, foot and ankle characteristics, and
functional performance measures.
Results
 Fourteen (25%) participants reported marked improvement at 12 wk.
 The number of participants with marked improvement increased to 78% if three of the following
four criteria were met: footwear motion control properties score of <5.0 (indicative of less
supportive footwear), usual pain <22.0 mm, ankle dorsiflexion range of motion (knee flexed)
<41°, and reduced single–leg squat pain when wearing the orthoses.
Purpose: There is emerging evidence that foot orthoses are effective in the management of
patellofemoral pain syndrome (PFPS). However, the identification of those most likely to benefit
from foot orthoses has not been adequately explored. The aim of this study was to develop a
preliminary clinical prediction rule to help identify individuals with PFPS who are most likely to
benefit from foot orthoses.
Methods: A total of 60 individuals with PFPS were issued with noncustomized prefabricated foot
orthoses containing built-in arch supports and 4° rear foot varus wedging. Patient-reported level of
improvement was documented at 12 wk. Potential baseline predictor variables of interest included
patient demographics, pain characteristics, footwear motion control properties, foot and ankle
characteristics, and functional performance measures.
Results: Fourteen (25%) participants reported marked improvement at 12 wk. The number of
participants with marked improvement increased to 78% if three of the following four criteria were
met: footwear motion control properties score of <5.0 (indicative of less supportive footwear), usual
pain <22.0 mm, ankle dorsiflexion range of motion (knee flexed) <41°, and reduced single-leg squat
pain when wearing the orthoses.
Conclusions: Individuals with PFPS who wear less supportive footwear, report lower levels of pain,
exhibit less ankle dorsiflexion range of motion, and report an immediate reduction in pain with foot
orthoses when performing a single-leg squat are more likely to benefit from foot orthoses.
http://journals.lww.com/acsmmsse/Abstract/2011/09000/Clinical_Predictors_of_Foot_Orthoses_Efficacy
_in.1.aspx
Barton CJ et al. Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain.
Medicine and Science in Sports and Exercise. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Patellofemoral Pain
Are Modic changes prognostic for recovery in a cohort of patients with nonspecific low back pain
European Spine Journal, 08/18/2011
Keller A et al. - Modic changes did not influence the clinical course of back pain and were not prognostic
factors for recovery. Education was strongly associated with recovery.
Methods
 Prospective clinical cohort study, with a 1-year follow-up. The treatment consisted of brief
intervention and instruction in stretching.
 Two hundred and sixty-nine patients with chronic low back pain.
 Socio-demographic variables, education, profession, self-reported measures, degenerative
changes on MRI.
 Linear growth model and Cox regression analysis.
Results
 Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes.
 Modic changes were not significant covariates for the clinical course of pain, function or fear
avoidance beliefs.
 Education was a strong prognostic factor for recovery.
http://www.springerlink.com/content/1m00542564742k03/
Keller A et al. Are Modic changes prognostic for recovery in a cohort of patients with non-specific low
back pain. European Spine Journal. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Low Back Pain
The influence of a series of five dry cupping treatments on pain and
mechanical thresholds in patients with chronic non-specific neck pain- a
randomised controlled pilot study
BMC Complementary and Alternative Medicine, 08/19/2011
Background
In this preliminary trial we investigated the effects of dry cupping, an ancient method for treating pain
syndromes, on patients with chronic non-specific neck pain. Sensory mechanical thresholds and the
participants' self-reported outcome measures of pain and quality of life were evaluated.
Methods
Fifty patients (50.5 +/- 11.9 years) were randomised to a treatment group (TG) or a waiting-list control
group (WL). Patients in the TG received a series of 5 cupping treatments over a period of 2 weeks; the
control group did not. Self-reported outcome measures before and after the cupping series included the
following: Pain at rest (PR) and maximal pain related to movement (PM) on a 100-mm visual analogue
scale (VAS), pain diary (PD) data on a 0-10 numeric rating scale (NRS), Neck Disability Index (NDI),
and health-related quality of life (SF-36). In addition, the mechanical-detection thresholds (MDT),
vibration-detection thresholds (VDT), and pressure-pain thresholds (PPT) were determined at pain-related
and control areas.
Results
Patients of the TG had significantly less pain after cupping therapy than patients of the WL group (PR: 22.5 mm, p=0.00002; PM: -17.8 mm, p=0.01). Pain diaries (PD) revealed that neck pain decreased
gradually in the TG patients and that pain reported by the two groups differed significantly after the fifth
cupping session (-1.1, p=0.001). There were also significant differences in the SF-36 subscales for bodily
pain (13.8, p=0.006) and vitality (10.2, p=0.006). Group differences in PPT were significant at painrelated and control areas (all p<0.05), but were not significant for MDT or VDT.
Conclusions
A series of five dry cupping treatments appeared to be effective in relieving chronic non-specific neck
pain. Not only subjective measures improved, but also mechanical pain sensitivity differed significantly
between the two groups, suggesting that cupping has an influence on functional pain processing. Trial
registration: The trial was registered at clinicaltrials.gov (NCT01289964).
http://www.biomedcentral.com/1472-6882/11/63
The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients
with chronic non-specific neck pain- a randomised controlled pilot study. BMC Complementary and
Alternative Medicine. Aug 2011. (Entered August 2011)
Category: Misc Bib- Cupping
Topical capsaicin for pain management: therapeutic potential and
mechanisms of action of the new high-concentration capsaicin 8% patch
British Journal of Anesthesia, 08/19/2011
Anand P et al. – Evidence suggests that the utility of topical capsaicin may extend beyond painful
peripheral neuropathies.
 Topical capsaicin formulations are used for pain management.
 Safety and modest efficacy of low–concentration capsaicin formulations, which require repeated
daily self–administration, are supported by meta–analyses of numerous studies.
 A high–concentration capsaicin 8% patch (Qutenz) was recently approved in the EU and USA.
 A single 60–min application in patients with neuropathic pain produced effective pain relief for
up to 12 weeks.
 Advantages of the high–concentration capsaicin patch include longer duration of effect, patient
compliance, and low risk for systemic effects or drug–drug interactions.
 The mechanism of action of topical capsaicin has been ascribed to depletion of substance P.
 Experimental and clinical studies show that depletion of substance P from nociceptors is only a
correlate of capsaicin treatment and has little, if any, causative role in pain relief.
 Topical capsaicin acts in the skin to attenuate cutaneous hypersensitivity and reduce pain by a
process best described as ‘defunctionalization’ of nociceptor fibres.
 Defunctionalization is due to a number of effects that include temporary loss of membrane
potential, inability to transport neurotrophic factors leading to altered phenotype, and reversible
retraction of epidermal and dermal nerve fibre terminals.
 Peripheral neuropathic hypersensitivity is mediated by diverse mechanisms, including altered
expression of the capsaicin receptor TRPV1 or other key ion channels in affected or intact
adjacent peripheral nociceptive nerve fibres, aberrant re–innervation, and collateral sprouting,
all of which are defunctionalized by topical capsaicin.
http://bja.oxfordjournals.org/content/early/2011/08/17/bja.aer260.abstract
Anand P et al. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of
the new high-concentration capsaicin 8% patch. British Journal of Anesthesia. Aug 2011. (Entered
August 2011)
Category: Misc Bib- Pain
Effects of physiotherapy on pain and functional activities after cesarean
delivery
Archives of Gynecology and Obstetrics, 08/19/2011
Karakaya IC et al. – Findings revealed the effectiveness of a physiotherapy program in the early post–
cesarean period in a wider perspective than the current literature, and are considered to be valuable for
increasing the quality and productivity of the postnatal care, therefore improving well–being after
childbirth.
Methods
 Fifty women were evaluated after Cesarean operation with regard to times of ambulation and
return of bowel activity, intensity of incision pain, difficulty in functional activities and number
of analgesics required additional to routine pain control procedure.
 Twenty–four women received only routine nursing care, and a physiotherapy program was
applied to the study group (n = 26), additionally.
Results
 Postoperative ambulation and return of bowel activity were earlier in the study group (p < 0.05).
 Incision pain and difficulty in functional activities decreased significantly within 2 days in both
groups, and the values were lower in the study group (p < 0.05).
 Study group needed less medication for pain control (p < 0.05).
Abstract
Purpose
To investigate the effects of a physiotherapy program on incision pain and functional activities in the
early post-cesarean period.
Methods
Fifty women were evaluated after Cesarean operation with regard to times of ambulation and return of
bowel activity, intensity of incision pain, difficulty in functional activities and number of analgesics
required additional to routine pain control procedure. Twenty-four women received only routine nursing
care, and a physiotherapy program was applied to the study group (n = 26), additionally.
Results
Postoperative ambulation and return of bowel activity were earlier in the study group (p < 0.05). Incision
pain and difficulty in functional activities decreased significantly within 2 days in both groups, and the
values were lower in the study group (p < 0.05). Study group needed less medication for pain control
(p < 0.05).
Conclusions
Findings revealed the effectiveness of a physiotherapy program in the early post-cesarean period in a
wider perspective than the current literature, and are considered to be valuable for increasing the quality
and productivity of the postnatal care, therefore improving well-being after childbirth.
http://www.springerlink.com/content/h4268g624772m888/
Karakaya IC et al. Effects of physiotherapy on pain and functional activities after cesarean delivery.
Archives of Gynecology and Obstetrics. Aug 2011. (Entered August 2011)
Category: Misc Bib- Physical Therapy
Is there altered activity of the extensor muscles in chronic mechanical neck
pain? A functional magnetic resonance imaging study.
O'Leary S, Cagnie B, Reeve A, Jull G, Elliott JM
Archives of Phys Med Issue: 6, 929-34
OBJECTIVE: To compare the pattern of neck extensor muscle use in participants with chronic
mechanical neck pain to that of healthy controls during 2 different extension exercises by use of muscle
functional magnetic resonance imaging (mfMRI).
DESIGN: Cross-sectional.
SETTING: University laboratory.
PARTICIPANTS: Data recorded from subjects with chronic mechanical neck pain (n=12; 10 women, 2
men) were compared with previously recorded data from healthy subjects (n=11; 7 men, 4 women).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: mfMRI measures of shifts in T2 relaxation were made for the
multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis muscles, at C2-3, C5-6, and
C7-T1 levels, prior and immediately after 2 different exercises: cervical extension in craniocervical
neutral (CCN) and cervical extension in craniocervical extension. T2 shift values (difference between preand postexercise T2 relaxation values) for each muscle and exercise condition were used for analysis.
RESULTS: While there were observed differences in differential activation of the extensor muscles in
participants with mechanical neck pain compared with controls, these differences were only evident for
the CCN exercise condition and were only observed for 3 out of the 7 muscle regions of interest during
this exercise.
CONCLUSIONS: Results of this study suggest some alteration in the differential activation of the
cervical extensors in patients with mechanical neck pain and indicate that further investigation of this
muscle group in mechanical neck pain disorders is warranted.
PMID: 21529779
http://www.medinfonow.com/min/secure/articles/articledetail.aspx?qs=12DA967C166E0E282AAD1196
1009DE1FC4C9A34D9450AFBDF09A6852DBEFAF1411367D0E62DB7C190FA8FB914B81CBA55C
C86712B39FC9F8288641977CF4A6D88D4E72C0972DD0A108E727B8E9575ECF8648592125E09534
70A66B05665BF69B
O’Leary S, Cagnie B, Reeve A, Jull G, Elliott JM. Is there altered activity of the extensor muscles in
chronic mechanical neck pain? A functional magnetic resonance imaging study. Archives of Phys Med.
6:929-934. (Entered August 2011)
Category: Upper Quarter Bib- Cervical Spine
Comparing biofeedback with active exercise and passive treatment for the
management of work-related neck and shoulder pain: a randomized
controlled trial.
Ma C, Szeto GP, Yan T, Wu S, Lin C, Li L
Archives of physical medicine and rehabilitation 20110692(6):849OBJECTIVES: To compare the effects of biofeedback with those of active exercise and passive
treatment in treating work-related neck and shoulder pain.
DESIGN: A randomized controlled trial with 3 intervention groups and a control group.
SETTING: Participants were recruited from outpatient physiotherapy clinics and a local hospital.
PARTICIPANTS: All participants reported consistent neck and shoulder pain related to computer use
for more than 3 months in the past year and no severe trauma or serious pathology. A total of 72 potential
participants were recruited initially, of whom a smaller group of individuals (n=60) completed the
randomized controlled trial.
INTERVENTIONS: The 3 interventions were applied for 6 weeks. In the biofeedback group,
participants were instructed to use a biofeedback machine on the bilateral upper trapezius (UT) muscles
daily while performing computer work. Participants in the exercise group performed a standardized
exercise program daily on their own. In the passive treatment group, interferential therapy and hot packs
were applied to the participants' necks and shoulders. The control group was given an education booklet
on office ergonomics.
MAIN OUTCOME MEASURES: Pain (visual analog scale), neck disability index (NDI), and surface
electromyography were assessed preintervention and postintervention. Pain and NDI were reassessed
after 6 months.
RESULTS: Postintervention, average pain and NDI scores were reduced significantly more in the
biofeedback group than in the other 3 groups, and this was maintained at 6 months. Cervical erector
spinae muscle activity showed significant reductions postintervention in the biofeedback group, and there
were consistent trends of reductions in the UT muscle activity.
CONCLUSIONS: Six weeks of biofeedback training produced more favorable outcomes in reducing
pain and improving muscle activation of neck muscles in patients with work-related neck and shoulder
pain.
PMID: 21621660
http://www.medinfonow.com/MIN/secure/articles/articledetail.aspx?qs=BB89137F607CB4C301A929CB
E3471BD0B8753CEE6EF6110DBE78612CA7AD981C665BC0705F5638175B16C2EB272307BD2E79
A7DC9852C3411D189B39762781A002F93E2341246A7A61EF3D4CB9166E5DAE8EB27664DA4AE4
8E1DD1FBA61E74CF
Ma C, Szeto GP, Yan T, Wu S, Lin C, Li L. Comparing biofeedback with active exercise and passive
treatment for the management of work-related neck and shoulder pain: a randomized controlled trial.
Archives of Physical Medicine and Rehabilitation. Jun 2011;92(6):849. (Entered August 2011)
Category: Upper Quarter Bib- Cervical Spine
Feet/types - Need to integrate into the FM II.
Copyright © 2002, National Athletic Trainers' Association, Inc.
Differences in Postural Control During Single-Leg Stance Among Healthy
Individuals With Different Foot Types
Jay Hertel, Michael R. Gay, and Craig R. Denegar
Pennsylvania State University, University Park, PA
Objective: To identify differences in postural control among healthy individuals with different
architectural foot types.
Design and Setting: We compared postural control during single-leg stance in healthy individuals with
cavus, rectus, and planus foot types in our athletic training research laboratory.
Subjects: Thirty healthy, young adults (15 men, 15 women; age, 21.9 ± 2.0 years; mass, 71.6 ± 16.7 kg;
height, 168.4 ± 13.6 cm) had their feet categorized based on rearfoot and forefoot alignment measures.
The right and left feet of a subject could be classified into different categories, and each foot was treated
as a subject. There were 19 cavus, 23 rectus, and 18 planus feet.
Measurements: Subjects performed three 10-second trials of single-leg stance on each leg with eyes open
while standing on a force platform. Dependent measures were center-of-pressure (COP) excursion area
and velocity.
Results: Subjects with cavus feet used significantly larger COP excursion areas than did subjects with
rectus feet. However, COP excursion velocities were not significantly different among foot types.
Conclusions: Clinicians and researchers assessing postural control in single-leg stance with measures of
COP excursion area must be cognizant of preexisting differences among foot types. If individuals' foot
types are not taken into account, the results of clinical and research investigations assessing COP
excursion area after injury may be confounded.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164334/#B15
Hertel J, Gay MR, Denegar CR. Differences in Postural Control During Single-Leg Stance Among
Healthy Individuals With Different Foot Types. J Athl Train. Apr-Jun 2002;37(2):129-132. (Entered
August 2011)
Category: Lower Quarter Bib- Foot
Connective Tissue – Interesting concepts that would explain many of the changes we see in the clinic.
See the article I sent out on IPA Google group.
Connective tissue: A body-wide signaling network?
Helene M. Langevin * Medical Hypotheses (2007) 68, 74–80
Department of Neurology, University of Vermont, College of Medicine, Given C423,
89 Beaumont Avenue, Burlington, VT 05405, United States
Received 12 December 2005; accepted 14 December 2005
Summary Unspecialized ‘‘loose’’ connective tissue forms an anatomical network throughout the body.
This paper presents the hypothesis that, in addition, connective tissue functions as a body-wide
mechanosensitive signaling network. Three categories of signals are discussed: electrical, cellular and
tissue remodeling, each potentially responsive to mechanical forces over different time scales. It is
proposed that these types of signals generate dynamic, evolving patterns that interact with one another.
Such connective tissue signaling would be affected by changes in movement and posture, and may be
altered in pathological conditions (e.g. local decreased mobility due to injury or pain). Connective tissue
thus may function as a previously unrecognized whole body communication system. Since connective
tissue is intimately associated with all other tissues (e.g. lung, intestine), connective tissue signaling may
coherently influence (and be influenced by) the normal or pathological function of a wide variety of organ
systems. Demonstrating the existence of a connective signaling network therefore may profoundly
influence our understanding of health and disease.
_c 2006 Elsevier Ltd. All rights reserved.
Lanegevin HM. Connective tissue: A body-wide signaling network? Medical Hypotheses. 2007;68:74-80.
(Entered August 2011)
Category: Misc Bib- Connective Tissue
Connective Tissue/LBP – May be an important theory that will support everything that we see from STM.
Pathophysiological model for chronic low back pain integrating connective
tissue and nervous system mechanisms
Helene M. Langevin a,*, Karen J. Sherman b Medical Hypotheses (2007) 68, 74–80
a Department of Neurology, Given C423, University of Vermont, Burlington, VT 05405, United States
b Center for Health Studies, Group Health Cooperative, Seattle, WA, United States
Received 21 June 2006; accepted 22 June 2006
Summary Although chronic low back pain (cLBP) is increasingly recognized as a complex syndrome
with multifactorial etiology, the pathogenic mechanisms leading to the development of chronic pain in
this condition remain poorly understood. This article presents a new, testable pathophysiological model
integrating connective tissue plasticity mechanisms with several well-developed areas of research on
cLBP (pain psychology, postural control, neuroplasticity). We hypothesize that pain-related fear leads to a
cycle of decreased movement, connective tissue remodeling, inflammation, nervous system sensitization
and further decreased mobility. In addition to providing a new, testable framework for future mechanistic
studies of cLBP, the integration of connective tissue and nervous system plasticity into the model will
potentially illuminate the mechanisms of a variety of treatments that may reverse these abnormalities by
applying mechanical forces to soft tissues (e.g. physical therapy, massage, chiropractic manipulation,
acupuncture), by changing specific movement patterns (e.g. movement therapies, yoga) or more generally
by increasing activity levels (e.g. recreational exercise). Non-invasive measures of connective tissue
remodeling may eventually become important tools to evaluate and follow patients with cLBP in research
and clinical practice. An integrative mechanistic model incorporating behavioral and structural aspects of
cLBP will strengthen the rationale for a multidisciplinary treatment approach including direct mechanical
tissue stimulation, movement reeducation, psychosocial intervention and pharmacological treatment to
address this common and debilitating condition.
_c 2006 Elsevier Ltd. All rights reserved.
Langevin HM, Sherman KJ. Pathophysiological model for chronic low back pain integrating connective
tissue and nervous system mechanisms. Medical Hypotheses. 2007;68:74-80. (Entered August 2011)
Category: Misc Bib- Connective Tissue
Knee – May be important for FMLQ and II weight bearing treatment
A three-dimensional MRI analysis of knee kinematics
Vikas V. Patel a,b, Katherine Hall b, Michael Ries a, Jeff Lotz a, Eugene Ozhinsky b, Colleen Lindsey b,
Ying Lu c, Sharmila Majumdar b,* Journal of Orthopaedic Research 22 (2004) 283–292
Purpose: To quantify normal, in vivo tibio-femoral knee joint kinematics in multiple weight bearing
positions using non-invasive, high-resolution MRI and discuss the potential of developing future
kinematic methods to assess patients with abnormal joint pathologies.
Methods: Ten volunteers with clinically normal knees pushed inferiorly on the footplate of a weight
bearing apparatus inside the MR scanner. The volunteers held the weight (133 N) for five scans as the
knee motion was evaluated from 0_ to 60_ of flexion. Full extension was set as the zero point for all
measured parameters. Using 3D reconstructions, tibia motion relative to the femur and flexion angle was
measured as varus–valgus angle, axial rotation, anterior–posterior translation, and medial–lateral
translation. Medial and lateral compartment tibio-femoral contact areas were examined and centroids of
the contract areas were calculated.
Results: Tibial internal rotation averaged 4.8_ at 40_ of flexion and then decreased. Tibial valgus
increased by 8_ at 60_ of flexion. Femoral roll back also increased to 18.5 mm average at 60_ of flexion,
while the tibia translated medially 2.5 mm. Medial compartment femoro-tibial contact area started at 374
mm2 and decreased to 308 mm2 with flexion of 60_, while lateral compartment contact area did not
change significantly from 276 mm2.
Conclusions: Results correlate with previous studies of knee kinematics while providing greater threedimensional detail. MR imaging allows excellent non-invasive evaluation of knee joint kinematics with
weight bearing. This tool may potentially be used for assessing knee kinematics in patients with knee
pathology.
_ 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.
Keywords: Knee joint; Biomechanics; MRI; Kinematics
Patel VV, Hall K, Ries M, Lotz J, Ozhinsky E, Lindsey C, Lu Y, Majumdar S. A three-dimensional MRI
analysis of knee kinematics. Journal of Orthopaedic Research. 2004;22:283-292. (Entered August 2011)
Category: Lower Quarter Bib- Knee
Knee mechanics – Interesting study on mechanics
In vivo tibiofemoral contact analysis using 3D MRI-based knee models
Louis E. DeFratea,b, Hao Suna, Thomas J. Gilla, Harry E. Rubasha, Guoan Lia,*
Journal of Biomechanics 37 (2004) 1499–1504
Abstract
This paper quantified the motion of the tibiofemoral contact points duringin vivo weight bearing flexion
using MRI- based 3D knee models and two orthogonal fluoroscopic images. The contact points on the
medial and lateral tibial plateau were calculated by finding the centroid of the intersection of the tibial and
femoral cartilage layers and by using the bony geometry alone. Our results indicate that the medial
femoral condyle remains in the central portion of the tibial plateau and the lateral condyle translates
posteriorly with increasing flexion. Using the bony contact model increased the total translation of the
medial and lateral condyles by 250 and 55%, respectively, compared to the cartilage contact model. These
results suggest that using the bony geometry alone may not accurately represent the articular surfaces of
the knee. Articular cartilage geometry may have to be used to accurately quantify tibiofemoral contact.
\r 2004 Elsevier Ltd. All rights reserved.
Keywords: In vivo knee kinematics; Cartilage contact; Soft tissue biomechanics; Magnetic Resonance
Imaging; Imaging
DeFratea LE, Suna H, Gilla TJ, Rubasha HE, Lia G. In vivo tibiofemoral contact analysis using 3D MRIbased knee models. Journal of Biomechanics. 2004;37:1499-1504. (Entered August 2011)
Category: Lower Quarter Bib- Knee
Foot and Ankle/ Important information for evaluation traumatic ankle injuries
The Spring Ligament Recess of the Talocalcaneonavicular Joint: Depiction on
MR Images With Cadaveric and Histologic Correlation
Kapil R. Desai1,2,3 Luis S. Beltran1 Jenny T. Bencardino1 Zehava S. Rosenberg1 Catherine Petchprapa1
German Steiner1,2 AJR:196, May 2011
OBJECTIVE. The objective of this study was to describe the anatomy and MR appearance
of the spring ligament recess of the talocalcaneonavicular joint.
SUBJECTS AND METHODS. Forty-nine MR examinations of the ankle with a
spring ligament recess were prospectively collected. The size of the recess was measured.
The presence of the following variables was recorded: talocalcaneonavicular joint effusion,
ankle joint effusion, talar head impaction, acute lateral ankle sprain, chronic lateral ankle
sprain, spring ligament tear, sinus tarsi ligament tear, talar dome osteochondral injury, and
talonavicular osteoarthrosis. The Fisher exact test was performed to quantify the association
of the talocalcaneonavicular effusion with the other variables. MR arthrography and dissection
with histologic analysis were performed in two cadaveric ankles.
RESULTS. Twenty-four men and 25 women (average age, 39 years; range, 21–77 years)
were included in the study. The average size of the fluid collection was 0.4 × 0.8 cm (range,
0.2–0.9 × 0.4–1.5 cm). The prevalence of the measured variables was talocalcaneonavicular
joint effusion, 67.3%; ankle joint effusion, 61.2%; talar head impaction, 32.7%; acute lateral
ankle sprain, 28.6%; chronic lateral ankle sprain, 59.2%; spring ligament tear, 14.3%; sinus
tarsi ligament tear, 12.2%; talar dome osteochondral lesion, 20.4%; and talonavicular osteoarthrosis,
18.4%. There was a higher prevalence of talar head impaction among individuals
with talocalcaneonavicular joint effusion (p = 0.0522). Cadaveric study revealed communication
between the talocalcaneonavicular joint and the spring ligament recess.
CONCLUSION. The spring ligament recess is a synovium-lined, fluid-filled space that
communicates with the talocalcaneonavicular joint. The recess should be distinguished from
a tear of the plantar components of the spring ligament.JT,
Desai KR, Beltran LS, Bencardinol JT, Rosenberg ZS, Petchprapa C, Steiner G. The Spring Ligament
Recess of the Talocalcaneonavicular Joint: Depiction on MR Images With Cadaveric and Histologic
Correlation. AJR. May 2011;196. (Entered August 2011)
Category: Lower Quarter Bib- Foot
Knee/ Important information for our meniscus rx in flexion
Tibiofemoral movement 2: the loaded and unloaded living knee studied by
MRI
P. F. Hill, V. Vedi, A. Williams, H. Iwaki, V. Pinskerova,
M. A. R. Freeman
From St. Mary’s Hospital, London and the Royal Hospital, Haslar, England
In 13 unloaded living knees we confirmed the findings previously obtained in the unloaded cadaver knee
during flexion and external rotation/internal rotation using MRI. In seven loaded living knees with the
subjects squatting, the relative tibiofemoral movements were similar to those in the unloaded knee except
that the medial femoral condyle tended to move about 4 mm forwards with flexion. Four of the seven
loaded knees were studied during flexion in external and internal rotation. As predicted, flexion
(squatting) with the tibia in external rotation suppressed the internal rotation of the tibia which had
been observed during unloaded flexion.
J Bone Joint Surg [Br] 2000;82-B:1196-8.
Received 29 October 1999; Accepted 7 January 2000
Hill PF, Williams VVA, Iwaki H, Pinskerova V, Freeman MAR. Tibiofemoral movement 2: the loaded
and unloaded living knee studied by MRI. J Bone Joint Surg. 2000;82:1196-1198. (Entered August 2011)
Category: Lower Quarter Bib- Knee
LBP/Research/ Important for us to recognize multiple options are best.
A randomized controlled trial of the effects of muscle stretching, manual
therapy and steroid injections in addition to stay active care on health-related
quality of life in acute or subacute low back pain
Clinical Rehabilitation, 08/22/2011 Clinical Article
Grunnesjo MI et al. – The effects on health–related quality of life were greater the larger the number of
treatment modalities available. The 'stay active' treatment group, with the most restricted number of
modalities, had the most modest health–related quality of life improvement, while group 4 with the most
generous choice of treatment modalities, had the greatest improvement.
Methods
 A randomized, controlled trial during 10 weeks with four treatment groups.
 Nine primary health care and one outpatient orthopaedic hospital department.
 160 patients with acute or subacute low back pain.
 Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or
'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching,
manual therapy and steroid injections (group 4).
 The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score.
Results
 In a multivariate analysis adjusted for possible outcome affecting variables other than the
treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in
groups 1-4, respectively (P for trend <0.05).
 There were significant trends for the well-being components patience (P < 0.005), energy (P <
0.05), mood (P < 0.05) and family situation (P < 0.05).
 The remaining two components and Complaint score showed a non-significant trend towards
improvement.
Conclusion: The effects on health-related quality of life were greater the larger the number of treatment
modalities available. The ‘stay active’ treatment group, with the most restricted number of modalities, had
the most modest health-related quality of life improvement, while group 4 with the most generous choice
of treatment modalities, had the greatest improvement.
Grunnesjo MI et al. A randomized controlled trial of the effects of muscle stretching, manual therapy and
steroid injections in addition to stay active care on health-related quality of life in acute or subacute low
back pain. Clinical Rehabilitation. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Low Back Pain
LBP/Exercise - not exactly great news for Pilates advocates. Get rid of the drawn in maneuver and
function may be enhanced!
Comparing the Pilates method with no exercise or lumbar stabilization for
pain and functionality in patients with chronic low back pain: Systematic
review and meta-analysis
Clinical Rehabilitation, 08/22/2011 Evidence Based Medicine Clinical Article
Pereira LM et al. – The Pilates method did not improve functionality and pain in patients who have low
back pain when compared with control and lumbar stabilization exercise groups.
Methods
 The search was performed in the following databases: Medline, Embase, AMED, Cinahl, Lilacs,
Scielo, SportDiscus, ProQuest, Web of Science, PEDro, Academic Search Premier and the
Cochrane Central Register of Controlled Trials from 1950 to 2011; the following keywords were
used: ‘Pilates’, ‘Pilates–based’, ‘back exercises’, ‘exercise therapy’, ‘low back pain’, ‘back pain’
and ‘backache.’
 The inclusion criteria were studies that assessed the effects of the Pilates method on patients with
chronic low back pain.
Results
 Five studies met the inclusion criteria.
 The total number of patients was 71 in the Pilates group and 68 in the control group.
 Pilates exercise did not improve functionality (standardized mean difference (SMD = –1.34; 95%
confidence interval (CI) –2.80, 0.11; P = 0.07) or pain between Pilates and control groups (SMD
= –1.99; 95% CI –4.35, 0.37; P = 0.10).
 Pilates and lumbar stabilization exercises presented no significant difference in functionality
(mean difference (MD) = –0.31; 95% CI –1.02, 0.40; P = 0.39) or pain (MD = –0.31; 95% CI –
1.02, 0.40; P = 0.39).
Results: Five studies met the inclusion criteria. The total number of patients was 71 in the Pilates
group and 68 in the control group. Pilates exercise did not improve functionality (standardized mean
difference (SMD = –1.34; 95% confidence interval (CI) –2.80, 0.11; P = 0.07) or pain between
Pilates and control groups (SMD = –1.99; 95% CI –4.35, 0.37; P = 0.10). Pilates and lumbar
stabilization exercises presented no significant difference in functionality (mean difference (MD) = –
0.31; 95% CI –1.02, 0.40; P = 0.39) or pain (MD = –0.31; 95% CI –1.02, 0.40; P = 0.39).
Conclusion: The Pilates method did not improve functionality and pain in patients who have low back
pain when compared with control and lumbar stabilization exercise groups.
Pereira LM et al. Comparing the Pilates method with no exercise or lumbar stabilization for pain and
functionality in patients with chronic low back pain: Systematic review and meta-analysis. Clinical
Rehabilitation. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- LBP Exercise
Fibromyalgia/HA – What we have been seeing in the clinic for years
Clinical features of headache patients with fibromyalgia comorbidity
The Journal of Headache and Pain, 08/22/2011
de Tommaso M et al. – A phenotypic profile where headache frequency concurs with anxiety, sleep
disturbance, and pericranial tenderness should be individuated to detect the development of diffuse pain
in headache patients.
Methods
 A consecutive sample of 1,123 patients was screened.
 Frequency of FM in the main groups and types of primary headaches; discriminating factor for
FM comorbidity derived from headache frequency and duration, age, anxiety, depression,
headache disability, allodynia, pericranial tenderness, fatigue, quality of life and sleep, and
probability of FM membership in groups; and types of primary headaches were assessed.
Results
 FM was present in 174 among a total of 889 included patients.
 It prevailed in the tension–type headache main group (35%, p < 0.0001) and chronic tension–type
headache subtype (44.3%, p < 0.0001).
 Headache frequency, anxiety, pericranial tenderness, poor sleep quality, and physical disability
were the best discriminating variables for FM comorbidity, with 81.2% sensitivity.
 Patients presenting with chronic migraine and chronic tension–type headache had a higher
probability of sharing the FM profile (Bonferroni test, p < 0.01).
Our previous study assessed the prevalence of fibromyalgia (FM) syndrome in migraine and tension-type
headache. We aimed to update our previous results, considering a larger cohort of primary headache
patients who came for the first time at our tertiary headache ambulatory. A consecutive sample of 1,123
patients was screened. Frequency of FM in the main groups and types of primary headaches;
discriminating factor for FM comorbidity derived from headache frequency and duration, age, anxiety,
depression, headache disability, allodynia, pericranial tenderness, fatigue, quality of life and sleep, and
probability of FM membership in groups; and types of primary headaches were assessed. FM was present
in 174 among a total of 889 included patients. It prevailed in the tension-type headache main group
(35%,p < 0.0001) and chronic tension-type headache subtype (44.3%, p < 0.0001). Headache frequency,
anxiety, pericranial tenderness, poor sleep quality, and physical disability were the best discriminating
variables for FM comorbidity, with 81.2% sensitivity. Patients presenting with chronic migraine and
chronic tension-type headache had a higher probability of sharing the FM profile (Bonferroni
test, p < 0.01). A phenotypic profile where headache frequency concurs with anxiety, sleep disturbance,
and pericranial tenderness should be individuated to detect the development of diffuse pain in headache
patients.
De Tommaso M et al. Clinical features of headache patients with fibromyalgia comorbidity. The Journal
of Headache and Pain. Aug 2011. (Entered August 2011)
Category: Misc Bib- Fibromyalgia
Less known non-infectious and neuromusculoskeletal system-originated
anterolateral neck and craniofacial pain disorders
European Archives of Oto-Rhino-Laryngology, 08/22/2011
Aydil U et al. –
Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on
head and neck area. As a result, most of the patients with these syndromes are either overlooked without
having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as
dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face
region or entities related to neuromusculoskeletal system may result in more appropriate and effective
management of such conditions while avoiding unnecessary medical and surgical treatments. In this
review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known
craniofacial and neck pain entities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia,
superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal
tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.
Aydil U et al. Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck
and craniofacial pain disorders. European Archives of Oto-Rhino-Laryngology. Aug 2011. (Entered
August 2011)
Category: Upper Quarter Bib- Cervical Spine
LBP – Very important study to outline the role just pain plays on disability.
The Impact of Fear-Avoidance Model Variables on Disability in Patients With
Specific or Nonspecific Chronic Low Back Pain
Spine, 08/24/2011
Lundberg M et al. – The authors conclude that persistent musculoskeletal pain affects the individual in a
similar manner, regardless of the cause of the pain. In clinical terms, this means that pain must be
analyzed and treated as a parallel process to searching for the cause of the pain.
Results. Both groups (specific and nonspecific CLBP) presented elevated values on the fear-avoidance
model variables. All the independent fear-avoidance variables contributed in a statistically significant
manner to predict disability in patients with specific CLBP, 67.0%, F(5, 59) = 24.46, P < 0.000. In
patients with nonspecific CLBP, all variables except kinesiophobia predicted disability in a statistically
significant manner, 63.0%, F (5, 59) = 22.64, P < 0.000.
Conclusion. We conclude that persistent musculoskeletal pain affects the individual in a similar manner,
regardless of the cause of the pain. In clinical terms, this means that pain must be analyzed and treated as
a parallel process to searching for the cause of the pain.
Lundberg M et al. The Impact of Fear-Avoidance Model Variables on Disability in Patients With Specific
or Nonspecific Chronic Low Back Pain. Spine. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Low Back Pain
Pathophysiology of the Spreading of Complex Regional Pain Syndrome
Revisited: A Case Report
Neuromodulation, 08/24/2011
Azari P et al. – Definite knowledge of the pathophysiology of complex regional pain syndrome would
allow better identification of risk factors for the development of this condition after trauma. This patient is
at higher risk of developing complex regional pain syndrome and should avoid surgeries (such as knee
and wrist surgeries) and high risk physical activities
Results: This patient was successfully treated with a spinal cord stimulator implantation with bilateral
lead placement at thoracic spine (T9) stimulating her lower extremities in addition to the leads that had
already been placed in her cervical spine for her upper extremities.
Conclusion: Definite knowledge of the pathophysiology of complex regional pain syndrome would
allow better identification of risk factors for the development of this condition after trauma. This patient is
at higher risk of developing complex regional pain syndrome and should avoid surgeries (such as knee
and wrist surgeries) and high risk physical activities.
http://onlinelibrary.wiley.com/doi/10.1111/j.15251403.2011.00385.x/abstract;jsessionid=3979EBFD0436DDC54098C8733C969051.d01t01
Azari P et al. Pathophysiology of the Spreading of Complex Regional Pain Syndrome Revisited: A Case
Report. Neuromodulation. Aug 2011. (Entered August 2011)
Category: Misc Bib- Complex Regional Pain Syndrome
Physical therapy for chronic pain conditions-A novel approach using mindbody connection
Techniques in Regional Anesthesia and Pain Management, 08/25/2011
Wenzel AM – There is evidence that patients with chronic pain conditions have altered motor control that
may be influencing reoccurrences and possible flares of pain condition. Guiding patients through
ritualistic body awareness and posture corrections and gentle reactivation activity may be 1 way to
improve motor control and build the patient's confidence to make decisions about daily activity based on
knowledge of their body not based on fear of movement or reinjury.
The treatment of chronic pain conditions continue to present a challenge to the medical field. Physical
therapy treatment needs to approach the management of chronic pain differently than the approach used
to resolve acute pain. Patients with chronic pain often have many factors that have perpetuated the pain
condition. These factors, as well as pain itself, influence their ability to reactivate and perform functional
daily activities. Physical therapists can begin to address some of the factors, including fear and
deconditioning, by building confidence and body awareness in a self-care model including a slow
graduated reactivation program. There is evidence that patients with chronic pain conditions have altered
motor control that may be influencing reoccurrences and possible flares of pain condition. Guiding
patients through ritualistic body awareness and posture corrections and gentle reactivation activity may be
1 way to improve motor control and build the patient's confidence to make decisions about daily activity
based on knowledge of their body not based on fear of movement or reinjury.
Wenzel AM. Physical therapy for chronic pain conditions-A novel approach using mind-body connection.
Techniques in Regional Anesthesia and Pain Management. Aug 2011. (Entered August 2011)
Category: Misc Bib- Physical Therapy
Regenerative medicine in the field of pain medicine: Prolotherapy, plateletrich plasma therapy, and stem cell therapy-Theory and evidence
Techniques in Regional Anesthesia and Pain Management, 08/26/2011
DeChellis DM et al. – The expansion of different regenerative medicine (RM) treatments has lead to its
increase in the application for ligament and tendon injuries, muscle defects, as well as pain associated
with osteoarthritis and degenerative disks. Recently, the use of ultrasound has been added to these
therapies to guide the solution to the exact site of injury
he concept of “regenerative medicine” (RM) has been applied to musculoskeletal injuries dating back to
the 1930s. Currently, RM is an umbrella term that has been used to encompass several therapies, namely
prolotherapy, platelet-rich plasma therapy (PRP), and stem cell therapy, which are being used to treat
musculoskeletal injuries. Although the specific treatments share similar concepts, the mechanism behind
their reparative properties differs. Recently, treatments that possess a regenerative quality are resurfacing
and expanding into the musculoskeletal field as potential therapeutic treatment modalities. RM, in the
form of prolotherapy, was first used to treat tendon and ligament injuries. With the advancement of
technology, RM has expanded to PRP and stem cell therapy. The expansion of different RM treatments
has lead to its increase in the application for ligament and tendon injuries, muscle defects, as well as pain
associated with osteoarthritis and degenerative disks. Recently, the use of ultrasound has been added to
these therapies to guide the solution to the exact site of injury. We review 3 forms of RM injection:
prolotherapy, PRP therapy, and stem cell therapy.
DeChellis DM et al. Regenerative medicine in the field of pain medicine: Prolotherapy, platelet-rich
plasma therapy, and stem cell therapy-Theory and evidence. Techniques in Regional Anesthesia and Pain
Management. Aug 2011. (Entered August 2011)
Category: Misc Bib- Prolotherapy
Pain sensitivity and modulation in primary insomnia
European Journal of Pain, 08/26/2011
Haack M et al. – Authors propose that pain–inhibitory circuits in patients with insomnia are in a state of
constant activation to compensate for ongoing subclinical pain. This constant activation ultimately may
result in a ceiling effect of pain–inhibitory efforts, as indicated by the inability of the system to adequately
function during challenge.
Results
 Primary insomnia subjects reported experiencing spontaneous pain on twice as many days as
healthy controls during the at–home recording phase (p<0.05).
 During laboratory testing, primary insomnia subjects had lower pain thresholds than healthy
controls (p<0.05 for heat pain detection threshold, p<0.08 for pressure pain detection threshold).
 Unexpectedly, pain facilitation, as assessed with temporal summation of pain responses, was
reduced in primary insomnia compared to healthy controls (p<0.05).
 Pain inhibition, as assessed with the diffuse noxious inhibitory control paradigm (DNIC), was
attenuated in insomnia subjects when compared to controls (p<0.05)
Sleep of good quantity and quality is considered a biologically important resource necessary to maintain
homeostasis of pain-regulatory processes. To assess the role of chronic sleep disturbances in pain
processing, we conducted laboratory pain testing in subjects with primary insomnia.
Seventeen participants with primary insomnia (mean ± SEM 22.6 ± 0.9 yrs, 11 women) were
individually matched with 17 healthy participants. All participants wore an actigraph device over a 2week period and completed daily sleep and pain diaries. Laboratory pain testing was conducted in a
controlled environment and included (1) warmth detection threshold testing, (2) pain sensitivity testing
(threshold detection for heat and pressure pain), and (3) tests to access pain modulatory mechanisms
(pain facilitation and inhibition).
Primary insomnia subjects reported experiencing spontaneous pain on twice as many days as healthy
controls during the at-home recording phase (p < 0.05). During laboratory testing, primary insomnia
subjects had lower pain thresholds than healthy controls (p < 0.05 for heat pain detection threshold, p <
0.08 for pressure pain detection threshold). Unexpectedly, pain facilitation, as assessed with temporal
summation of pain responses, was reduced in primary insomnia compared to healthy controls (p <
0.05). Pain inhibition, as assessed with the diffuse noxious inhibitory control paradigm (DNIC), was
attenuated in insomnia subjects when compared to controls (p < 0.05).
Based on these findings, we propose that pain-inhibitory circuits in patients with insomnia are in a state
of constant activation to compensate for ongoing subclinical pain. This constant activation ultimately
may result in a ceiling effect of pain-inhibitory efforts, as indicated by the inability of the system to
adequately function during challenge.
http://www.europeanjournalpain.com/article/PIIS1090380111001844/abstract?rss=yes
Haack M et al. Pain sensitivity and modulation in primary insomnia. European Journal of Pain. Aug
2011. (Entered August 2011)
Category: Misc Bib- Pain
Migraine headaches among university students using ID migraine test as a
screening tool
BMC Neurology, 08/29/2011
Oztora S et al. – With a prevalence similar to adults, primary care physicians should be aware of the
probability of migraine headaches in university students in order to maintain a successful school
performance.
Methods
 In this cross-sectional and descriptive study, study population was composed of students
registered to Trakya University in the academic year of 2008-2009.
 Out of these, 3694 of them accepted to participate.
 Participants who had two or more headaches in the last 3 months formed the headache group.
 Afterwards, two preliminary questions were applied to the headache group and participants with
at least one affirmative response were asked to perform the validated ID-MigraineTM test.
Results
 The mean age of 3694 students participated in the study was 19.23 +/- 1.84 (17-39 years), with
adolescents:adult ratio being 2.5:1. 1613 students (43.7%) did have at least two headaches in the
last three months.
 Migraine-type headache was detected in 266 subjects (7.2%) based on the ID-MigraineTM test.
 Of the migraine group, 72 were male (27.1%) and 194 were female (72.9%).
 There was no significant difference in migraine prevalence between adolescent and adult age
groups.
Results
The mean age of 3694 students participated in the study was 19.23 +/- 1.84 (17-39 years), with
adolescents:adult ratio being 2.5:1. 1613 students (43.7%) did have at least two headaches in the last three
months. Migraine-type headache was detected in 266 subjects (7.2%) based on the ID-MigraineTM test.
Of the migraine group, 72 were male (27.1%) and 194 were female (72.9%). There was no significant
difference in migraine prevalence between adolescent and adult age groups.
Conclusions
With a prevalence similar to adults, primary care physicians should be aware of the probability of
migraine headaches in university students in order to maintain a successful school performance.
http://www.biomedcentral.com/1471-2377/11/103
Oztora S et al. Migraine headaches among university students using ID migraine test as a screening tool.
BMC Neurology. Aug 2011. (Entered August 2011)
Category: Upper Quarter Bib- Headache
Prevalence and demographic characteristics of vulvodynia in a populationbased sample
American Journal of Obstetrics and Gynecology, 08/29/2011
Reed BD et al. - Vulvodynia is common, although rarely diagnosed. Prevalence remains high among
sexually active women of any age.
Methods
 A population-based study of adult women was conducted, using telephone recruitment and
completion of a self-administered survey.
 Weighted estimates of vulvodynia prevalence and characteristics were determined.
Results
 Over a year, 2542 women were recruited and 2269 (89.3%) completed the self-administered
survey.
 The weighted prevalence of vulvodynia was 8.3% (95% CI=7.0, 9.8) or approximately 101,000
women in the targeted population.
 Prevalence remained stable through age 70, and thereafter declined.
 Among sexually active women, prevalence was similar at all ages.
 Of 208 women meeting vulvodynia criteria, 101 (48.6%) had sought treatment, and only 3 (1.4%)
had been diagnosed with vulvodynia (unweighted values).
 Previous vulvodynia symptoms had resolved in 384 (16.9%) women after a mean duration of 12.5
years.
Results
Over a year, 2542 women were recruited and 2269 (89.3%) completed the self-administered survey. The
weighted prevalence of vulvodynia was 8.3% (95% CI=7.0, 9.8) or approximately 101,000 women in the
targeted population. Prevalence remained stable through age 70, and thereafter declined. Among sexually
active women, prevalence was similar at all ages. Of 208 women meeting vulvodynia criteria, 101
(48.6%) had sought treatment, and only 3 (1.4%) had been diagnosed with vulvodynia (unweighted
values). Previous vulvodynia symptoms had resolved in 384 (16.9%) women after a mean duration of
12.5 years.
Conclusions
Vulvodynia is common, although rarely diagnosed. Prevalence remains high among sexually active
women of any age.
http://www.ajog.org/article/PIIS0002937811010611/abstract?rss=yes
Reed BD et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample.
American Journal of Obstetrics and Gynecology. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Pelvic Floor
Pain – Always important to recognize the importance of patient reactions to their condition.
The effect of catastrophizing and depression on chronic pain- a prospective
cohort study of temporomandibular muscle and joint pain disorders
Pain, 08/29/2011
Velly AM et al. – Results indicate that catastrophizing and depression contribute to the progression of
chronic temporomandibular muscle and joint disorders (TMJD) pain and disability, and therefore should
be considered as important factors when evaluating and developing treatment plans for patients with
TMJD
Abstract
Although most cases of temporomandibular muscle and joint disorders (TMJD) are mild and selflimiting, about 10% of TMJD patients develop severe disorders associated with chronic pain and
disability. It has been suggested that depression and catastrophizing contributes to TMJD chronicity. This
article assesses the effects of catastrophizing and depression on clinically significant TMJD pain (Graded
Chronic Pain Scale [GCPS] II–IV). Four hundred eighty participants, recruited from the Minneapolis/St.
Paul area through media advertisements and local dentists, received examinations and completed the
GCPS at baseline and at 18-month follow-up. In a multivariable analysis including gender, age, and worst
pain intensity, baseline catastrophizing (β 3.79, P < 0.0001) and pain intensity at baseline (β 0.39, P <
0.0001) were positively associated with characteristic of pain intensity at the 18th month. Disability at the
18-month follow-up was positively related to catastrophizing (β 0.38, P < 0.0001) and depression (β
0.17, P = 0.02). In addition, in the multivariable analysis adjusted by the same covariates previously
described, the onset of clinically significant pain (GCPS II–IV) at the 18-month follow-up was associated
with catastrophizing (odds ratio [OR] 1.72, P = 0.02). Progression of clinically significant pain was
related to catastrophizing (OR 2.16, P < 0.0001) and widespread pain at baseline (OR 1.78, P = 0.048).
Results indicate that catastrophizing and depression contribute to the progression of chronic TMJD pain
and disability, and therefore should be considered as important factors when evaluating and developing
treatment plans for patients with TMJD.
http://www.painjournalonline.com/article/PIIS0304395911004441/abstract?rss=yes
Velly AM et al. The effect of catastrophizing and depression on chronic pain- a prospective cohort study
of temporomandibular muscle and joint pain disorders. Pain. Aug 2011. (Entered August 2011)
Category: Misc Bib- Pain
Tension-type Headache and Systemic Medical Disorders
Current Pain and Headache Reports, 08/29/2011
Sacco S et al. – Most of the headaches that present in the context of medical disorders (e.g.,
hypothyroidism, sleep disorders, and hypertensive crisis) have clinical features overlapping with those of
TTH; medical history and specific features of the systemic disorder are usually the clues to establish a
correct diagnosis. Some medical disorders may worsen a preexisting TTH, and is also possible the
comorbidity of TTH with psychiatric disorders and fibromyalgia.
Abstract
Tension-type headache (TTH) is the most common form of headache in the general population. Diagnosis
of TTH is based merely on clinical features and on careful exclusion of all possible causes of headache.
Most of the headaches that present in the context of medical disorders (e.g., hypothyroidism, sleep
disorders, and hypertensive crisis) have clinical features overlapping with those of TTH; medical history
and specific features of the systemic disorder are usually the clues to establish a correct diagnosis. Some
medical disorders may worsen a preexisting TTH, and is also possible the comorbidity of TTH with
psychiatric disorders and fibromyalgia.
http://www.springerlink.com/content/c080tn81j4xm3171/
Sacco S et al. Tension-type Headache and Systemic Medical Disorders. Current Pain and Headache
Reports. Aug 2011. (Entered August 2011)
Category: Upper Quarter Bib- Headache
Interacting Effects of Trait Anger and Acute Anger Arousal on Pain: The
Role of Endogenous Opioids
Psychosomatic Medicine, 08/29/2011
Bruehl S et al. – Results indicate that hyperalgesic effects of TRANG are most prominent when acute
anger is aroused and suggest that endogenous opioid mechanisms contribute.
Methods
 Ninety–four chronic low back pain (LBP) participants and 85 healthy controls received opioid
blockade (8 mg of naloxone) or placebo in a randomized, counterbalanced order in separate
sessions.
 Participants were randomly assigned to undergo either a 5–minute anger recall interview (ARI) or
a neutral control interview across both drug conditions.
 Immediately after the assigned interview, participants engaged sequentially in finger pressure and
ischemic forearm pain tasks.
 Opioid blockade effects were derived (blockade minus placebo condition pain ratings) to index
opioid antinociceptive function.
Results
 Placebo condition TRANG by interview interactions indicated that TRANG was hyperalgesic
only in the context of acute anger arousal.
 Blockade effect analyses suggested that these hyperalgesic effects were related to deficient opioid
analgesia.
 Significant TRANG by interview interactions (p values < .05) for both pain tasks indicated that
elevated TRANG was associated with smaller blockade effects (less endogenous opioid
analgesia) only in the ARI condition.
 Results for ischemic task visual analog scale intensity blockade effects suggested that
associations between TRANG and impaired opioid function were most evident in LBP
participants when experiencing anger.
Results Placebo condition TRANG by interview interactions (p values < .05) indicated that TRANG
was hyperalgesic only in the context of acute anger arousal (ARI condition; p values < .05). Blockade
effect analyses suggested that these hyperalgesic effects were related to deficient opioid analgesia.
Significant TRANG by interview interactions (p values < .05) for both pain tasks indicated that
elevated TRANG was associated with smaller blockade effects (less endogenous opioid analgesia)
only in the ARI condition (p values < .05). Results for ischemic task visual analog scale intensity
blockade effects suggested that associations between TRANG and impaired opioid function were
most evident in LBP participants when experiencing anger (type by interview by TRANG
interaction; p < .05).
Conclusions Results indicate that hyperalgesic effects of TRANG are most prominent when acute anger
is aroused and suggest that endogenous opioid mechanisms contribute.
http://www.psychosomaticmedicine.org/content/early/2011/08/07/PSY.0b013e318227cb88.abstract
Bruehl S et al. Interacting Effects of Trait Anger and Acute Anger Arousal on Pain: The Role of
Endogenous Opioids. Psychosomatic Medicine. Aug 2011. (Entered August 2011)
Category: Misc Bib- Pain
Complementary and Alternative Medicine in the Treatment of Pain in
Fibromyalgia: A Systematic Review of Randomized Controlled Trials
Journal of Manipulative and Physiological Therapeutics, 08/31/2011 Evidence Based Medicine Clinical
Article
Terhorst L et al. - Most of these studies identified were preliminary or pilot studies, thus had small sample
sizes and were likely underpowered. Two complementary and alternative medicine (CAM) categories
showed the most promising findings, balneotherapy and mind-body therapies. Most of the other CAM
categories showed a trend favoring the treatment group. It appears that several CAM therapies show some
preliminary treatment effect for fibromyalgia (FM) pain, but larger trials that are more adequately
powered are needed.
Results
 The literature search yielded 1722 results; 102 abstracts were selected as potential articles for
inclusion.
 Sixty studies met criteria and were rated by 2 reviewers; 18 were rated as good quality; 20,
moderate; 18, low; and 4, very low.
 Synthesis of information for CAM categories represented by more than 5 studies revealed that
balneotherapy and mind-body therapies were effective in treating FM pain.
 This study analyzed recent studies and focused exclusively on randomized controlled trials.
 Despite common use of manual therapies such as massage and manipulation to treat patients with
FM, there is a paucity of quality clinical trials investigating these particular CAM categories.
Results
The literature search yielded 1722 results; 102 abstracts were selected as potential articles for inclusion.
Sixty studies met criteria and were rated by 2 reviewers; 18 were rated as good quality; 20, moderate; 18,
low; and 4, very low. Synthesis of information for CAM categories represented by more than 5 studies
revealed that balneotherapy and mind-body therapies were effective in treating FM pain. This study
analyzed recent studies and focused exclusively on randomized controlled trials. Despite common use of
manual therapies such as massage and manipulation to treat patients with FM, there is a paucity of quality
clinical trials investigating these particular CAM categories.
Conclusion
Most of these studies identified were preliminary or pilot studies, thus had small sample sizes and were
likely underpowered. Two CAM categories showed the most promising findings, balneotherapy and
mind-body therapies. Most of the other CAM categories showed a trend favoring the treatment group. It
appears that several CAM therapies show some preliminary treatment effect for FM pain, but larger trials
that are more adequately powered are needed.
http://www.jmptonline.org/article/PIIS0161475411000959/abstract?rss=yes
Terhorst L et al. Complementary and Alternative Medicine in the Treatment of Pain in Fibromyalgia: A
Systematic Review of Randomized Controlled Trials. Journal of Manipulative and Physiological
Therapeutics. Aug 2011. (Entered August 2011)
Category: Misc Bib- Fibromyalgia
Evaluation of outcome measures for use in clinical practice for adults with
musculoskeletal conditions of the knee: A systematic review
Manual Therapy , 08/31/2011
Howe TE et al. – Despite the widespread use of some outcome measures in clinical practice and primary
research, data on the clinimetric properties were available for only 37 and of these only 10 had adequate
supporting evidence for use in this population. However, before a core set of outcome measures can be
recommended use in clinical practice, for adults with musculoskeletal conditions of the knee, consensus
should be obtained on 'feasibility' in terms of burden on the clinician and the participant.
Methods
 A systematic search was performed in Medline, EMBASE, Cinahl and AMED to identify studies
examining the clinimetric properties of outcome measures for adults undergoing conservative
treatment of ligament injuries, meniscal lesions, patellofemoral pain and osteoarthritis of the
knee.
 Outcomes measures taking less than 20 min to administer and requiring minimal equipment and
space were included.
 Pairs of authors used a checklist to record the characteristics of the outcome measures, their
reported clinimetric properties and the demographics of the study populations.
 The OMERACT filters of 'truth' and 'discrimination' were applied to the data for each outcome
measure by an expert panel.
Results
 47 studies were included evaluating 37 outcome measures.
 Ten outcome measures had adequate supporting evidence for 'truth' and 'discrimination': AAOS,
AKPS, goniometer measurement, IKDC, KOOS, LEFS, Lysholm, Tegner, WOMAC and
WOMET.
 However none of the outcome measures had been comprehensively tested across all clinimetric
properties.
Conclusion
Despite the widespread use of some outcome measures in clinical practice and primary research, data on
the clinimetric properties were available for only 37 and of these only 10 had adequate supporting
evidence for use in this population. However, before a core set of outcome measures can be recommended
use in clinical practice, for adults with musculoskeletal conditions of the knee, consensus should be
obtained on ‘feasibility’ in terms of burden on the clinician and the participant.
http://www.manualtherapyjournal.com/article/PIIS1356689X11001159/abstract?rss=yes
Howe TE et al. Evaluation of outcome measures for use in clinical practice for adults with
musculoskeletal conditions of the knee: A systematic review. Manual Therapy. Aug 2011. (Entered
August 2011)
Category: Lower Quarter Bib- Knee
Neuroticism Influences Brain Activity During the Experience of Visceral Pain
Gastroenterology, 08/31/2011
Coen SJ et al. – This study provides novel data suggesting higher neuroticism is associated with
engagement of brain regions responsible for emotional and cognitive appraisal during anticipation of pain
but reduced activity in these regions during pain. This may reflect a maladaptive mechanism in those with
higher neuroticism that promotes overarousal during anticipation and avoidance coping during pain.
Methods
 31 healthy volunteers (15 male; age range, 22–38 years) participated in the study.
 The Eysenck Personality Questionnaire was used to assess neuroticism.
 Skin conductance level, pain ratings, and functional magnetic resonance imaging data were
acquired during anticipation of pain and painful esophageal distention.
 The effect of neuroticism was assessed using correlation analysis.
Results
 There was a wide spread of neuroticism scores (range, 0–22) but no influence of neuroticism on
skin conductance level and pain tolerance or pain ratings.
 However, a positive correlation between brain activity and neuroticism during anticipation was
found in regions associated with emotional and cognitive pain processing, including the
parahippocampus, insula, thalamus, and anterior cingulate cortex.
 These regions showed a negative correlation with neuroticism during pain (P < .001).
Conclusions
This study provides novel data suggesting higher neuroticism is associated with engagement of brain
regions responsible for emotional and cognitive appraisal during anticipation of pain but reduced activity
in these regions during pain. This may reflect a maladaptive mechanism in those with higher neuroticism
that promotes overarousal during anticipation and avoidance coping during pain.
http://www.gastrojournal.org/article/PIIS0016508511007657/abstract?rss=yes
Coen SJ et al. Neuroticism Influences Brain Activity During the Experience of Visceral Pain.
Gastroenterology. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Viscera
Examination of Motor and Hypoalgesic Effects of Cervical vs Thoracic Spine
Manipulation in Patients With Lateral Epicondylalgia: A Clinical Trial
Journal of Manipulative and Physiological Therapeutics, 08/31/2011
Fernández–Carnero J et al. – Cervical spine manipulation produced greater changes in pressure pain
threshold (PPT) than thoracic spine manipulation in patients with lateral epicondylalgia (LE). No
differences between groups were identified for pain–free grip
Results
The analysis of variance detected a significant interaction between group and time (F = 31.7, P < .000) for
PPT levels. Post hoc testing revealed that the cervical spine manipulation produced a greater increase of
PPT in both sides compared with thoracic spine manipulation (P < .001). For pain-free grip strength, no
interaction between group and time (F = .66, P = .42) existed.
Conclusions
Cervical spine manipulation produced greater changes in PPT than thoracic spine manipulation in patients
with LE. No differences between groups were identified for pain-free grip. Future studies with larger
sample sizes are required to further examine the effects of manipulation on mechanisms of pain and motor
control in upper extremity conditions.
http://www.jmptonline.org/article/PIIS0161475411001278/abstract?rss=yes
Fernandez-Carnero J et al. Examination of Motor and Hypoalgesic Effects of Cervical vs Thoracic Spine
Manipulation in Patients With Lateral Epicondylalgia: A Clinical Trial. Journal of Manipulative and
Physiological Therapeutics. Aug 2011. (Entered August 2011)
Category: Upper Quarter Bib- Elbow
Foot biomechanics and initial effects of infrapatellar strap on gait parameters
in patients with unilateral patellofemoral pain syndrome
The Foot, 08/31/2011
Bek N et al. – It is not clear whether patellofemoral pain syndrome (PFPS) is a cause or effect of
abnormal gait. Further research is warranted to investigate the long–term effects of wearing an
infrapatellar strap and associated altered foot biomechanics due to PFPS
Abstract
Background
There is limited information on the relationship between plantar foot pressure and patellofemoral pain
syndrome (PFPS). In addition, there is not enough research on the effects of an infrapatellar strap on
PFPS.
Objective: The aim of this study was to evaluate the immediate effects of an infrapatellar strap on
dynamic pedabarography in patients with unilateral PFPS.
Methods: Clinical case control study design. 18 females subjects with unilateral PFPS were included
in the study. Gait parameters were tested using pedabarography during barefoot walking with and
without an infrapatellar strap.
Results: There were no statistically significant differences in gait trials comparing infrapatellar
strap to no strap (P > 0.05). In addition, a significant difference (P = 0.043) in the % forefoot
surface on the involved side demonstrated that body weight is transferred to medial aspect of the
foot.
Discussion: Although our results show a difference between the forefoot surface % of the affected
and unaffected sides of subjects with PFPS there was no indication that an infrapatellar strap had
any immediate effect on this parameter.
Conclusion:It is not clear whether PFPS is a cause or effect of abnormal gait. Further research is
warranted to investigate the long-term effects of wearing an infrapatellar strap and associated
altered foot biomechanics due to PFPS.
http://www.thefootjournal.com/article/PIIS0958259210000842/abstract?rss=yes
Bek N et al. Foot biomechanics and initial effects of infrapatellar strap on gait parameters in patients with
unilateral patellofemoral pain syndrome. The Foot. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Foot
Postural balance in low back pain patients: criterion-related validity of centre
of pressure assessed on a portable force platform
European Spine Journal, 08/31/2011
Maribo T et al. – This first study of concurrent and predictive validity of postural balance in low back
pain patients revealed no association between Centre of Pressure measures and pain, fear of pain, and
physical function
Abstract
Introduction
Altered postural control has been observed in low back pain (LBP) patients. They seem to be more
dependent on vision when standing. The objective of the study was to determine concurrent and
predictive validity of measures of postural stability in LBP patients.
Materials and methods
Centre of Pressure (CoP) measurements were tested against pain, fear of pain, and physical function.
Velocity, anterior–posterior displacement, and the Romberg Ratio obtained on a portable force platform
were used as measures of postural stability.
Results
Baseline and 12-week follow-up results of 97 LBP patients were evaluated. The correlations between CoP
measurements and pain, fear of pain, and physical function were poor. There were no significant
differences in CoP measurements between patients with no change or deterioration and patients with
improvement in pain and back-specific function.
Conclusion
This first study of concurrent and predictive validity of postural balance in LBP patients revealed no
association between CoP measures and pain, fear of pain, and physical function.
http://www.springerlink.com/content/p1781t23r806h462/
Maribo T et al. Postural balance in low back pain patients: criterion-related validity of centre of pressure
assessed on a portable force platform. European Spine Journal. Aug 2011. (Entered August 2011)
Category: Lower Quarter Bib- Posture
Is radiology a determinant of pain, stiffness, and functional disability in knee
osteoarthritis? A cross-sectional study
Journal of Orthopaedic Science, 08/30/2011
Sanghi D et al. – When the radiological features were extended beyond those included in KL grades, pain,
stiffness, and disability correlated well with radiography; articular incongruity with pain and stiffness; and
juxta–articular osteopenia with physical disability and clinical severity.
Methods
 180 patients with knee osteoarthritis were enrolled as per the American College of Rheumatology
(ACR) guidelines.
 Visual analog scale (VAS) for knee pain and the knee-specific Western Ontario Mac University
(WOMAC) index for pain, stiffness, and disability were recorded.
 Five additional radiological features apart from those in the Kellgren-Lawrence (KL)
classification grading system were recorded by two authors who were blinded to the clinical
diagnosis.
 The variables significantly associated were analyzed by linear regression model.
Results
 Pain was significantly associated with increasing KL grades; physical function was nearly
significant and stiffness was not.
 On analysis of individual radiological features, WOMAC pain was significant with subchondral
sclerosis, joint space width, and tibiofemoral alignment although the correlation was week.
 VAS pain was significant with the latter two and with articular incongruity.
 Functional disability was associated with medial joint-space narrowing, tibiofemoral alignment,
loose bodies, and juxta-articular osteopenia.
 However, in the linear regression model, pain and stiffness were significantly associated with
articular incongruity and functional disability and total clinical scores with juxta-articular
osteopenia
Results
Pain was significantly associated with increasing KL grades; physical function was nearly significant and
stiffness was not. On analysis of individual radiological features, WOMAC pain was significant with
subchondral sclerosis, joint space width, and tibiofemoral alignment although the correlation was week.
VAS pain was significant with the latter two and with articular incongruity. Functional disability was
associated with medial joint-space narrowing, tibiofemoral alignment, loose bodies, and juxta-articular
osteopenia. However, in the linear regression model, pain and stiffness were significantly associated with
articular incongruity and functional disability and total clinical scores with juxta-articular osteopenia.
Conclusion
When the radiological features were extended beyond those included in KL grades, pain, stiffness, and
disability correlated well with radiography; articular incongruity with pain and stiffness; and juxtaarticular osteopenia with physical disability and clinical severity.
http://www.springerlink.com/content/50058107763j98h0/
Sanghi D et al. Is radiology a determinant of pain, stiffness, and functional disability in knee
osteoarthritis? A cross-sectional study. Journal of Orthopaedic Science. Aug 2011. (Entered August
2011)
Category: Lower Quarter Bib- Knee Osteoarthritis
Sagittal spino-pelvic alignment in chronic low back pain
Chaleat–Valayer E et al. – Sagittal spino-pelvic alignment was different between patients with chronic
LBP and controls. In particular, there was a greater proportion of chronic low back pain (LBP) patients
with low sacral slope (SS), low lumbar lordosis (LL) and small pelvic incidence (PI), suggesting the
relationship between this specific pattern and the presence of chronic LBP.
Methods
 To compare the sagittal spino-pelvic alignment of patients with chronic LBP with a cohort of
asymptomatic adults.
 Sagittal spino-pelvic alignment was evaluated in prospective cohorts of 198 patients with chronic
LBP and 709 normal subjects.
 The two cohorts were compared with respect to the sacral slope (SS), pelvic tilt (PT), pelvic
incidence (PI), lumbar lordosis (LL), lumbar tilt (LT), lordotic levels, thoracic kyphosis (TK),
thoracic tilt (TT), kyphotic levels, and lumbosacral joint angle (LSA).
 Correlations between parameters were also assessed.
Results
 Sagittal spino-pelvic alignment is significantly different in chronic LBP with respect to SS, PI,
LT, lordotic levels, TK, TT and LSA, but not PT, LL, and kyphotic levels.
 Correlations between parameters were similar for the two cohorts.
 As compared to normal adults, a greater proportion of patients with LBP presented low SS and
LL associated with a small PI, while a greater proportion of normal subjects presented normal or
high SS associated with normal or high PI
The differences in sagittal spino-pelvic alignment between adults with chronic low back pain (LBP) and
the normal population are still poorly understood. In particular, it is still unknown if particular patterns of
sagittal spino-pelvic alignment are more prevalent in chronic LBP. The current study helps to better
understand the relationship between sagittal alignment and low back pain.
Results
Sagittal spino-pelvic alignment is significantly different in chronic LBP with respect to SS, PI, LT,
lordotic levels, TK, TT and LSA, but not PT, LL, and kyphotic levels. Correlations between parameters
were similar for the two cohorts. As compared to normal adults, a greater proportion of patients with LBP
presented low SS and LL associated with a small PI, while a greater proportion of normal subjects
presented normal or high SS associated with normal or high PI.
Conclusion
Sagittal spino-pelvic alignment was different between patients with chronic LBP and controls. In
particular, there was a greater proportion of chronic LBP patients with low SS, low LL and small PI,
suggesting the relationship between this specific pattern and the presence of chronic LBP.
http://www.springerlink.com/content/9647x24837hm3x6h/
Chaleat-Valayer E et al. Sagittal spino-pelvic alignment in chronic low back pain. European Spine
Journal. Aug 2011;20(5):634-640. (Entered August 2011)
Category: Lower Quarter Bib- Low Back Pain
Emotional Intelligence and Acute Pain: The Mediating Effect of Negative
Affect
The Journal of Pain, 08/25/2011
Ruiz–Aranda D et al. – Emotional intelligence is an important element in the processing of emotional
information during an experience of acute pain since it reduces the level of negative affect generated by
the experimental task
Abstract
Emotional abilities are predictive variables of lower perceived pain. However, no studies have been
published investigating the relationship between emotional intelligence (EI), which refers to the ability to
accurately perceive, appraise, understand, communicate and regulate emotions, and pain. The objective of
the present study was to analyze the influence of EI, measured using the Mayer-Salovey-Caruso
Emotional Intelligence Test (MSCEIT), on the level of sensory and affective pain generated by an
experimental cold pressor task (CPT). In addition, we examined the influence of negative affect, as
measured through the Positive and Negative Affect Schedule (PANAS), on the relationship between EI
and pain. Healthy college students (N = 67) completed measures of EI before the CPT, during which they
submerged their nondominant hand into ice water, and they completed measures of negative emotional
state before and after the CPT. Participants with higher EI rated pain as less intense and perceived it as
less unpleasant. Greater emotional intelligence predicted less pain in this experimental paradigm, and the
effects seemed to be mediated by the lower NA reactivity associated with greater EI.
Perspective
Emotional intelligence is an important element in the processing of emotional information during an
experience of acute pain since it reduces the level of negative affect generated by the experimental task.
http://www.jpain.org/article/PIIS1526590011006626/abstract?rss=yes
Ruiz-Aranda D et al. Emotional Intelligence and Acute Pain: The Mediating Effect of Negative Affect.
The Journal of Pain. Aug 2011. (Entered August 2011)
Category: Misc Bib- Pain
Pain complaints as risk factor for mental distress: a three-year follow-up
study
European Child and Adolescent Psychiatry, 08/24/2011
Lien L et al. – There is a strong association between pain at 15/16 years and mental distress at 18/19 years
of age. Clinicians should therefore take pain complaints among adolescents seriously and be aware of
comorbid and later development of mental health problems.
Methods
 The authors included adolescents from two longitudinal studies of 18/19 years of age with two
corresponding cross–sectional baseline studies at age 15/16.
 A total of 5750 were invited for the baseline study, and they have 3–year follow–up data for 3316
(57.8% follow–up rate). All information is based on self–report.
 The questions of pain are asking for severe pain the past year.
 Mental distress is measured by Hopkins Symptoms Check List (HSCL–10).
 Number of pain sites increased among girls and decreased among boys from baseline to follow–
up.
Results
 There was a cross–sectional dose–response association between number of pain sites and mental
distress at both time points.
 Also, in the follow–up study, there was dose–response relationship between numbers of pain sites
at baseline and mental distress at follow–up even after controlling for possible confounding
factors.
 They found no effect of mental distress at baseline on pain reports at follow–up.
The main aim of this study was to investigate the effect of pain complaints at baseline and mental distress
at follow-up. We included adolescents from two longitudinal studies of 18/19 years of age with two
corresponding cross-sectional baseline studies at age 15/16. A total of 5750 were invited for the baseline
study, and we have 3-year follow-up data for 3316 (57.8% follow-up rate). All information is based on
self-report. The questions of pain are asking for severe pain the past year. Mental distress is measured by
Hopkins Symptoms Check List (HSCL-10). Number of pain sites increased among girls and decreased
among boys from baseline to follow-up. There was a cross-sectional dose–response association between
number of pain sites and mental distress at both time points. Also, in the follow-up study, there was dose–
response relationship between numbers of pain sites at baseline and mental distress at follow-up even
after controlling for possible confounding factors. We found no effect of mental distress at baseline on
pain reports at follow-up. There is a strong association between pain at 15/16 years and mental distress at
18/19 years of age. Clinicians should therefore take pain complaints among adolescents seriously and be
aware of comorbid and later development of mental health problems.
http://www.springerlink.com/content/t482557547102240/
Lien L et al. Pain complaints as risk factor for mental distress: a three-year follow-up study. European
Child and Adolescent Psychiatry. Aug 2011. (Entered August 2011)
Category: Misc Bib- Pain
Evaluation of the fear-avoidance model with health care workers experiencing
acute/subacute pain
Pain, 08/25/2011
Corbiere M et al. – The results indicated that adjustments to the fear–avoidance model were required for
people experiencing acute/subacute pain, where fear–avoidance beliefs and depressive symptoms were
concurrent rather than sequential. The catastrophizing concept was most closely associated with
depressive symptoms, while pain self–efficacy was directly associated with fear–avoidance beliefs and
indirectly to work outcomes. Assessing and modifying pain self–efficacy in acute/subacute pain patients
is important for interventions aiming to decrease fear–avoidance and improve work outcomes
Studies in the literature do not show clear evidence supporting the relationship between pain and
depressive symptoms in individuals experiencing acute/subacute pain compared to those experiencing
chronic pain. However, more information is needed about which variables act as mediators in the paindepression relationship in people having acute/subacute pain, before pain becomes chronic. Our
objectives were to test the suitability of the fear-avoidance model in a sample of 110 health care workers
experiencing acute/subacute pain using path analyses, to improve the model as needed, and to examine a
model involving both pain catastrophizing and pain self-efficacy with work status as a final outcome.
Overall, the results indicated that adjustments to the fear-avoidance model were required for people
experiencing acute/subacute pain, where fear-avoidance beliefs and depressive symptoms were
concurrent rather than sequential. The catastrophizing concept was most closely associated with
depressive symptoms, while pain self-efficacy was directly associated with fear-avoidance beliefs and
indirectly to work outcomes. Assessing and modifying pain self-efficacy in acute/subacute pain patients is
important for interventions aiming to decrease fear-avoidance and improve work outcomes.
http://www.painjournalonline.com/article/PIIS0304395911004830/abstract?rss=yes
Corbiere M et al. Evaluation of the fear-avoidance model with health care workers experiencing
acute/subacute pain. Pain. Aug 2011. (Entered August 2011)
Category: Misc Bib- Pain
Physiological and clinical changes after therapeutic massage of the neck and
shoulders
Manual Therapy 16 (5); 487-494 October 2011
Little is known regarding the physiological and clinical effects of therapeutic massage (TM) even though
it is often prescribed for musculoskeletal complaints such as chronic neck pain. This study investigated
the influence of a standardized clinical neck/shoulder TM intervention on physiological measures
assessing α-motoneurone pool excitability, muscle activity; and the clinical measure of range of motion
(ROM) compared to a light touch and control intervention. Flexor carpi radialis (FCR) α-motoneurone
pool excitability (Hoffmann reflex), electromyography (EMG) signal amplitude of the upper trapezius
during maximal muscle activity, and cervical ROM were used to assess possible physiological changes
and clinical effects of TM. Sixteen healthy adults participated in three, 20 min interventions: control (C),
light touch (LT) and therapeutic massage (TM). Analysis of Covariance indicated a de-crease in FCR αmotoneurone pool excitability after TM, compared to both the LT (p = 0.0003) or C (p = 0.0007)
interventions. EMG signal amplitude decreased after TM by 13%, when compared to the control, and
12% as compared to LT intervention. The TM intervention produced increases in cervical ROM in all
directions assessed: flexion, lateral flexion, extension, and rotation. TM of the neck/shoulders reduced the
α-motoneurone pool excitability of the flexor carpi radialis after TM, but not after the LT or C
interventions. Moreover, decreases in the normalized EMG amplitude during MVIC of the upper
trapezius muscle; and increases in cervical ROM in all directions assessed occurred after TM, but not
after the LT or C interventions.
Physiological and clinical changes after therapeutic massage of the neck and shoulders. Manual Therapy.
Oct 2011;16(5):487-494. (Entered August 2011)
Category: Misc Bib- Massage
Occupational and Other Predictors of Herniated Lumbar Disc Disease—A 33Year Follow-up in The Copenhagen Male Study
Spine; 01 September 2011 - Volume 36 - Issue 19 - p 1541–1546
Heavy physical workload is considered a risk factor for herniated lumbar disc disease (HLDD), but the
issue is not definitively settled.
Methods: The Copenhagen Male Study is a prospective cohort study established in 1970 to 1971. At
baseline, 5245 men answered a questionnaire about history of back disease and physical workload.
Psychosocial working conditions, lifestyle, social class, and measured height and weight were included as
potential confounders. Information about hospitalization due to HLDD was obtained from the National
Hospital Register covering the period from 1977 to 2003. Hazard ratios were calculated by Cox
proportional hazard regression model.
Results: Among 3833 men without back disease history at baseline, the strongest predictor of
hospitalization for HLDD was frequent strenuous physical activity at work; compared with unexposed,
the hazard ratio with 95% confidence interval was 3.90. Also, body height was a significant predictor,
whereas body weight was only insignificantly associated with HLDD.
Conclusion: Among men without history of back disease reporting of frequent exposure to strenuous
physical activity at work was a strong risk factor for later hospitalization due to HLDD.
Occupational and Other Predictors of Herniated Lumbar Disc Disease—A 33-Year Follow-up in The
Copenhagen Male Study. Spine. Sep 2011;36(19):1541-1546. (Entered August 2011)
Category: Lower Quarter Bib- Low Back Pain
Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to
treat calcific and non-calcific rotator cuff tendinosis – A systematic review
Manual Therapy 16 (5); 419-433 October 2011
Extracorporeal shock-wave therapy (ESWT) is suggested as a treatment alternative for calcific and noncalcific rotator cuff tendinosis (RC-tendinosis), which may decrease the need for surgery. In this study we
assessed the evidence for effective-ness of ESWT for these disorders. The Cochrane Library, Pub-Med,
Embase, Pedro, and Cinahl were searched for relevant systematic reviews and RCTs. Two reviewers
independently extracted data and assessed the methodological quality.
Seventeen RCTs (11 calcific, 6 non-calcific) were included. For calcific RC-tendinosis, strong evidence
was found for effectiveness in favour of high-ESWT versus low-ESWT in short-term. Moderate evidence
was found in favour of high-ESWT versus placebo in short-, mid- and long-term and versus low-ESWT
in mid- and long-term. Moreover, high-ESWT was more effective (moderate evidence) with focus on calcific deposit versus focus on tuberculum major in short- and long-term. RSWT was more effective
(moderate evidence) than placebo in mid-term.
For non-calcific RC-tendinosis, no strong or moderate evidence was found in favour of low-, mid- or
high-ESWT versus placebo, each other, or other treatments.
This review shows that only high-ESWT is effective for treating calcific RC-tendinosis. No evidence was
found for the effectiveness of ESWT to treat non-calcific RC-tendinosis.
Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and noncalcific rotator cuff tendinosis – A systematic review. Manual Therapy. Oct 2011;16(5):419-433.
(Entered August 2011)
Category: Upper Quarter Bib- Rotator Cuff
The Effect of Fear of Movement Beliefs on Pain and Disability After Surgery
for Lumbar and Cervical Degenerative Conditions
Spine; 01 September 2011 - Volume 36 - Issue 19 - p 1554–1562
Consistent evidence supports the relationship between fear of movement and higher levels of pain and
disability in various chronic pain populations. Fear of movement among patients undergoing spinal
surgery for chronic pain has received little attention in the literature.
Methods: Participants were 141 patients treated with surgery for lumbar and cervical
degenerativeconditions. Assessments were conduct-ed before surgery and 6 weeks and 3 months after
hospitalization. Fear of movement was measured with the Tampa Scale for Kinesiophobia and outcomes
were measured with the Brief Pain Inventory, Oswestry or Neck Disability Index, and 12-Item Short
Form Health Survey (SF-12).
Results: Follow-up rates were 91% and 87% for 6 weeks and 3 months, respectively. Fear of movement
beliefs improved after surgery, but 49% of patients continued to have high fear of movement at 6-week
follow-up and 39% at 3-month follow-up. Patients with higher levels of fear of movement had poorer
postoperative outcomes. Multilevel linear regression analyses found that postoperative fear of movement
was independently associated with postoperative pain intensity, pain interference, disability, and physical
health, after controlling for depression, age, sex, education, race, comorbidities, type and area of surgery,
prior surgeries, and baseline outcome score. Preoperative fear of movement was not predictive of poorer
surgical outcomes.
Conclusion: Results demonstrate that postoperative but not preoperative fear of movement beliefs
explain unique and significant variance in postoperative pain, disability, and physical health. Clinicians
interested in improving surgical outcomes should address postoperative fear of movement along with
other traditional clinical and medical risk factors. Recommendations include postoperative screening for
high fear of movement beliefs and incorporating cognitive-behavioral techniques into postoperative
rehabilitation for at-risk surgical spine patients.
The Effect of Fear of Movement Beliefs on Pain and Disability After Surgery for Lumbar and Cervical
Degenerative Conditions. Spine. Sep 2011;36(19):1554-1562. (Entered August 2011)
Category: Misc Bib- Post Surgical
Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low
Back Pain Result in Better Long-Term Outcome?
Spine; 15 August 2011 - Volume 36 - Issue 18 - p 1427–1437
Objective: To assess the effectiveness of spinal manipulation therapy (SMT) for the management of
chronic nonspecific low back pain (LBP) and to determine the effectiveness of maintenance SMT in longterm reduction of pain and disability levels associated with chronic low back conditions after an initial
phase of treatments.
SMT is a common treatment option for LBP. Numerous clinical trials have attempted to evaluate its
effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in
chronic non-specific LBP has not been studied.
Methods: Sixty patients, with chronic, nonspecific LBP lasting at least 6 months, were randomized to
receive either (1) 12 treatments of sham SMT over a 1-month period, (2) 12 treatments, consisting of
SMT over a 1-month period, but no treatments for the subsequent 9 months, or (3) 12 treatments over a 1month period, along with “maintenance spinal manipulation” every 2 weeks for the following 9 months.
To determine any difference among therapies, we measured pain and disability scores, generic health
status, and back-specific patient satisfaction at baseline and at 1-, 4-, 7-, and 10-month intervals.
Results: Patients in second and third groups experienced significantly lower pain and disability scores
than first group at the end of 1-month period. However, only the third group that was given spinal
manipulations (SM) during the follow-up period showed more improvement in pain and disability scores
at the 10-month evaluation. In the non-maintained SMT group, however, the mean pain and disability
scores returned back near to their pretreatment level.
Conclusion: SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term
benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.
Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better
Long-Term Outcome? Spine. Aug 2011;36(18):1427-1437. (Entered August 2011)
Category: Lower Quarter Bib- Lumbar Manipulation
Morphology and kinematics of the atlanto-axial joints and their interaction
during manual cervical rotation mobilization
Manual Therapy 16 (5); 481-486 October 2011
At present little data are available on the relationship between spinal anatomy and kinematics. No studies
have verified the relationship between atlanto-axial kinematics during manual mobilization and the spatial
features of the atlanto-axial ligaments and the lateral joints.
Materials and methods: Twenty un-embalmed cervical spine specimens (9 male and 11 female; 80±11
years) were studied. Atlanto-axial kinematics were registered during manual axial rotation mobilization
using an ultrasound-based motion tracking system. Anatomical landmarks were digitized and spatial
features of the lateral atlanto-axial joint surfaces and alar ligaments were extracted. The relationship
between the anatomical features and the spinal kinematics was analyzed using statistical regression
analysis.
Results: Only the range of motion of the coupled flexion–extension motion component, the ratio and the
time shift between main axial rotation and coupled lateral bending motion components could be predicted
for about 52%, 49% and 73%, respectively, by a selected set of anatomical features.
Conclusion: Supposed relationships between anatomical features and joint kinematics are only partially
confirmed. The results indicate that the kinematics of the atlanto-axial joint during manual regional axial
mobilization are not completely predetermined by the specimens‟ specific anatomy.
Morphology and kinematics of the atlanto-axial joints and their interaction during manual cervical
rotation mobilization. Manual Therapy. Oct 2011;16(5):481-486. (Entered August 2011)
Category: Upper Quarter Bib- Upper Cervical Spine
How to explain central sensitization to patients with ‘unexplained’ chronic
musculoskeletal pain: Practice guidelines
Manual Therapy 16 (5); 413-418 October 2011
Central sensitization provides an evidence-based explanation for many cases of „unexplained‟ chronic
musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change
maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualize pain. This can
be accomplished by patient education about central sensitization and its role in chronic pain, a strategy
known as pain physiology education. Pain physiology education is indicated when: 1) the clinical picture
is characterized and dominated by central sensitization; and 2) maladaptive illness perceptions are
present. Both are prerequisites for commencing pain physiology education.
Face-to-face sessions of pain physiology education, in conjunction with written educational material, are
effective for changing pain cognitions and improving health status in patients with various chronic
musculoskeletal pain disorders. These include patients with chronic low back pain, chronic whiplash,
fibromyalgia and chronic fatigue syndrome. After biopsychosocial assessment pain physiology education
comprises of a first face-to-face session explaining basic pain physiology and contrasting acute
nociception versus chronic pain (Session 1). Written information about pain physiology should be
provided as homework in between session 1 and 2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain
physiology education is a continuous process initiated during the educational sessions and continued
within both the active treatment and during the longer term rehabilitation pro-gram.
How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice
guidelines. Manual Therapy. Oct 2011;16(5):413-418. (Entered August 2011)
Category: Misc Bib- Central Sensitization
Is Behavioral Graded Activity Cost-Effective in Comparison With Manual
Therapy for Patients With Subacute Neck Pain?: An Economic Evaluation
Alongside a Randomized Clinical Trial
Spine; 15 August 2011 - Volume 36 - Issue 18 - p E1179–E1186
Objective: To evaluate the cost-effectiveness of behavioral graded activity (BGA) in comparison with
manual therapy (MT) for patients with subacute neck pain from a societal perspective.
Neck pain is common and poses an important socioeconomic burden to society. Data on the costeffectiveness of treatments for neck pain are scarce.
Methods: A randomized clinical trial was conducted, involving 146 patients with subacute nonspecific
neck pain. The BGA program can be described as a time-contingent increase in activities from baseline
toward predetermined goals. MT consists of specific spinal mobilization techniques and exercises.
Clinical outcomes included recovery, pain, disability, and quality-adjusted life-years (QALYs). Costs
were measured from a societal perspective using cost diaries. The follow-up period was 52 weeks.
Multiple imputation was used for missing cost and effect data. Uncertainty surrounding cost differences
and incremental cost-effectiveness ratios was estimated using boot-strapping. Cost-effectiveness planes
and cost-effectiveness acceptability (CEA) curves were estimated.
Results: BGA had no significant effect on recovery or QALYs gained in comparison with MT but pain
and disability did improve significantly in the BGA group in comparison with the MT group. Total
societal costs in the BGA group were nonsignificantly higher than in the MT group. Cost-effectiveness
analyses showed that BGA is not cost-effective in comparison with MT for recovery and QALYs gained.
Substantial investments are needed to reach a 0.95 probability that BGA is cost-effective in comparison
with MT for pain and disability.
Conclusion: On the basis of the data presented, we consider BGA not cost-effective in comparison with
MT.
Is Behavioral Graded Activity Cost-Effective in Comparison With Manual Therapy for Patients With
Subacute Neck Pain?: An Economic Evaluation Alongside a Randomized Clinical Trial. Spine. Aug
2011;36(18):E1179-E1186. (Entered August 2011)
Category: Misc Bib- Manual Therapy
Altered muscular activation during prone hip extension in women with and
without low back pain
Chiropractic & Osteopathy , 09/01/2011
Arab AM et al. – The findings of this study demonstrated altered activation pattern of the lumbo–pelvic
muscles during PHE in the women with chronic low back pain (LBP). This information is important for
investigators using prone hip extension (PHE) as either an evaluation tool or a rehabilitation exercise.
Background
Altered movement pattern has been associated with the development of low back pain (LBP). The
purpose of this study was to investigate the activity pattern of the ipsilateral erector spinae (IES) and
contralateral erectorspinae (CES), gluteus maximus (GM) and hamstring (HAM) muscles during prone
hip extension (PHE) test in women with and without LBP. A cross-sectional non-experimental design was
used.
Methods
Convenience sample of 20 female participated in the study. Subjects were categorized into two groups:
with LBP (n = 10) and without LBP (n = 10). The electromyography (EMG) signal amplitude of the
tested muscles during PHE (normalized to maximum voluntary electrical activity (MVE)) was measured
in the dominant lower extremity in all subjects.
Results
Statistical analysis revealed greater normalized EMG signal amplitude in women with LBP compared to
non-LBP women. There was significant difference in EMG activity of the IES (P = 0.03) and CES (P =
0.03) between two groups. However, no significant difference was found in EMG signals of the GM (P =
0.11) and HAM (P = 0.14) among two groups.
Conclusion
The findings of this study demonstrated altered activation pattern of the lumbo-pelvic muscles during
PHE in the women with chronic LBP. This information is important for investigators using PHE as either
an evaluation tool or a rehabilitation exercise.
http://chiromt.com/content/19/1/18
Arab AM et al. Altered muscular activation during prone hip extension in women with and without low
back pain. Chiropractic & Osteopathy. Sep 2011. (Entered Aug 2011)
Category: Lower Quarter Bib- Low Back Pain
Diagnosis and treatment of sacroiliac joint pain
Current Orthopaedic Practice , 09/01/2011
Sembrano JN et al. – Studies have shown that the sacroiliac joint is the cause in approximately 15% of
patients with low back pain. The exact pattern is complex. Provocative physical examination maneuvers
may help provide a presumptive sacroiliac joint pain diagnosis. Confirmatory diagnosis is achieved with
diagnostic injection. For disabling pain that fails to respond to nonoperative treatment, surgical fusion
may be necessary; different fusion approaches have been described and are presented
http://journals.lww.com/corthopaedicpractice/Abstract/2011/07000/Diagnosis_and_treatment_of_sacroili
ac_joint_pain.12.aspx
Diagnosis and treatment of sacroiliac joint pain. Current Orthopaedic Practice. Sep 2011. (Entered
August 2011)
Category: Lower Quarter Bib- Sacroiliac Joint Pain