scholarly journals Association between Physiological and Subjective Aspects of Pain and Disability in Post-Stroke Patients with Shoulder Pain: A Cross-Sectional Study

2019 ◽  
Vol 8 (8) ◽  
pp. 1093 ◽  
Author(s):  
Martín-Martín ◽  
Membrilla-Mesa ◽  
Lozano-Lozano ◽  
Galiano-Castillo ◽  
Fernández-Lao ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Tibialis Anterior ◽  
Pain Perception ◽  
Stroke Patients ◽  
Pressure Pain ◽  
Negatively Associated ◽  
Post Stroke ◽  
Upper Trapezius ◽  
Pain Disability ◽  
Pressure Pain Thresholds

Background: Patients often experience pain as a result of a stroke. However, the mechanism of this pain remains uncertain. Our aim was to investigate the relationship between pressure pain thresholds (PPTs) and disability pain in patients with hemiplegic shoulder pain (HSP). Methods: Twenty-six post-stroke patients (age 53.35 ± 13.09 years) and healthy controls (54.35 ± 12.37 years) participated. We investigated spontaneous shoulder pain, disability pain perception through the shoulder pain and disability index (SPADI), and the PPTs over joint C5–C6, upper trapezius, deltoid, epicondyle, second metacarpal, and tibialis anterior, bilaterally. Results: The analysis of variance (ANOVA) showed significant differences in pain between groups (p < 0.001) and differences in the SPADI (p < 0.001) between groups but not between sides for PPTs over deltoid (group: p = 0.007; side: p = 0.750), epicondyle (group: p = 0.001; side: p = 0.848), and tibialis anterior (group: p < 0.001; side: p = 0.932). Pain in the affected arm was negatively associated with PPTs over the affected epicondyle (p = 0.003) and affected tibialis anterior (p = 0.009). Pain (SPADI) appeared negatively correlated with PPTs over the affected epicondyle (p = 0.047), and disability (SPADI) was negatively associated with PPTs over the affected tibialis anterior (p = 0.041). Conclusions: Post-stroke patients showed a relationship between widespread pressure pain hypersensitivity with lower PPT levels and pain disability perception, suggesting a central sensitization mediated by bilateral and symmetric pain patterns.

Bilateral, wide-spread, mechanical pain sensitivity in children with frequent episodic tension-type headache suggesting impairment in central nociceptive processing

Cephalalgia ◽  
2010 ◽  
Vol 30 (9) ◽  
pp. 1049-1055 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
Daniel M Fernández-Mayoralas ◽  
Ricardo Ortega-Santiago ◽  
Silvia Ambite-Quesada ◽  
Antonio Gil-Crujera ◽  
...  
Keyword(s):  
Tibialis Anterior ◽  
Trapezius Muscle ◽  
Tension Type Headache ◽  
Healthy Children ◽  
Wide Spread ◽  
Pressure Pain ◽  
Upper Trapezius ◽  
Pressure Pain Thresholds ◽  
Upper Trapezius Muscle ◽  
Type Headache

Introduction: The aim was to investigate bilateral, wide-spread pressure pain hyperalgesia in symptomatic (trigeminocervical) and non-symptomatic (pain-free distant) regions in children with frequent episodic tension-type headache (FETTH). Methods: Twenty-five children, 6 boys and 19 girls (mean age, 8.9 ± 1.8 years) with FETTH and 50 age- and sex-matched healthy children (12 boys, 38 girls; mean age: 8.8 ± 1.7 years) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over temporalis muscle, upper trapezius muscle, second metacarpal and tibialis anterior muscles in a blinded design. Results: The results showed that PPT levels were significantly decreased bilaterally over the temporalis, upper trapezius and tibialis muscles, and the second metacarpal in children with FETTH as compared to controls (all sites, P < 0.001). No significant differences in the magnitude of PPT decrease between the upper trapezius muscle, second metacarpal and tibialis anterior muscles were found. PPT over both upper trapezius muscles were negatively correlated with the history and intensity of headache (rs = −0.415; P = 0.045). Conclusions: The findings revealed bilateral, wide-spread pressure pain hypersensitivity in children with FETTH suggesting that wide-spread central sensitisation is involved in children with this headache pain condition.

Association between pain, disability, widespread pressure pain hypersensitivity and trigger points in subjects with neck pain

2017 ◽  
Vol 16 (1) ◽  
pp. 167-168 ◽  
Author(s):  
Matteo Castaldo ◽  
Antonella Catena ◽  
Alessandro Chiarotto ◽  
Jorge Hugo Villafañe ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Tibialis Anterior ◽  
Trigger Points ◽  
Pressure Pain ◽  
Pain Hypersensitivity ◽  
Upper Trapezius ◽  
Pain Disability ◽  
Neck Disability ◽  
Pain Patients

AbstractAimsMechanical neck pain (MNP) and whiplash-associated disorders (WAD) represents two groups of subjects with a different pathogenesis, since current evidence supports that WAD subjects presents greater sensitization than MNP. Nevertheless, it is still unclear the relationship between neck pain, neck disability, widespread pressure pain hypersensitivity (sign of sensitization) and trigger points (TrPs) in these two groups of neck pain subjects. The aim of the current study was to investigate these associations in MNP and WAD subjects.MethodsForty-six MNP and fifty-one WAD subjects underwent the following examination: pressure pain thresholds (PPTs) in the upper trapezius and tibialis anterior muscles, TrP examination in the upper trapezius, and collection of neck disability and neck pain intensity. The examination was performed by an assessor blinded to subjects’ condition.ResultsA significant positive association between pain and disability (P < 0.003), pain and PPT in the upper trapezius (P < 0.041), pain and PPT in tibialis anterior (P < 0.038), disability and PPT in upper trapezius (P = 0.006) was found in both groups. Subjects with MNP showed significantly negative association between disability and PPT in the tibialis anterior (P = 0.003). Subjects with active TrPs in the upper trapezius exhibited significantly higher neck pain intensity and neck disability and lower PPTs (all, P < 0.015), than those with latent TrPs in both groups.ConclusionsOur results suggest that the association between pain, disability, and PPTs is similar in subjects with neck pain and not influenced by the origin of neck pain. The presence of active TrPs in upper trapezius in neck pain patients was related to higher pain intensity, related-disability and lower PPTs, compared to neck pain patients with latent TrPs in upper trapezius. Future studies are needed to determine the clinical role of these associations.

scholarly journals Similar effects of fatigue induced by a repetitive pointing task on local and remote light touch and pain perception in men and women

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244321
Author(s):  
Jason Bouffard ◽  
Zachary Weber ◽  
Lyndsey Pearsall ◽  
Kim Emery ◽  
Julie N. Côté
Keyword(s):  
Sex Differences ◽  
Musculoskeletal Disorders ◽  
Upper Limb ◽  
Tibialis Anterior ◽  
Light Touch ◽  
Pressure Pain ◽  
Upper Trapezius ◽  
Pressure Pain Thresholds ◽  
Pointing Task ◽  
Anterior Deltoid

Background Women involved in repetitive, fatiguing, jobs develop more neck and/or shoulder musculoskeletal disorders than men. Sex differences in the pain response to exercise could contribute to the higher prevalence of neck/shoulder musculoskeletal disorders in women. The objective of this study was to assess sex differences in pain sensitivity following a fatiguing upper limb task. Relationships between measures of fatigue and of the sensitivity to nociceptive and to non-nociceptive stimulations were also explored. Methods Thirty healthy adults (15 women) performed a fatiguing repetitive pointing task with their dominant arm. Upper limb electromyography was recorded from the dominant upper trapezius, anterior deltoid and bicep brachii and from the contralateral tibialis anterior. Before and immediately after the repetitive pointing task, pressure pain and light touch sensitivity thresholds were measured over the same muscles. Results Electromyographic signs of fatigue were observed only in the anterior deltoid and biceps brachii muscles. Pressure pain thresholds over both muscles increased slightly (effect size ≤ 0.34), but no changes occurred over the upper trapezius and the tibialis anterior. Light touch thresholds increased moderately to importantly after the repetitive pointing task over all four muscles (effect sizes = 0.58 to 0.87). No sex differences were observed in any sensory variable. Moreover, no or weak correlations (r = -0.27 to 0.39) were observed between electromyographical signs of fatigue, light touch threshold and pressure pain threshold variables. Conclusions We observed sex-independent effects of a repetitive upper limb task on the sensitivity to painful and to nonpainful stimuli. Moreover, the hypoalgesia induced by the repetitive pointing task was weak and localized, and did not directly correlate with the induced muscle fatigue. Results suggest that fatigue-related changes in the sensitivity to noxious and innocuous stimuli could not explain women’s greater prevalence of neck/shoulder musculoskeletal disorders.

Eccentric Training Changes the Pressure Pain and Stiffness Maps of the Upper Trapezius in Females with Chronic Neck-Shoulder Pain: A Preliminary Study

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1936-1946 ◽  
Author(s):  
Alberto Marcos Heredia-Rizo ◽  
Kristian Kjær Petersen ◽  
Lars Arendt-Nielsen ◽  
Pascal Madeleine
Keyword(s):  
Shoulder Pain ◽  
Pain Sensitivity ◽  
Muscle Stiffness ◽  
Eccentric Training ◽  
Muscle Belly ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Upper Trapezius ◽  
Pressure Pain Thresholds ◽  
Shoulder Elevation

Abstract Objective Between 50% and 67% of adults suffer from neck-shoulder pain, which may be associated with increased stiffness of neck muscles. We assessed pressure pain sensitivity and muscle stiffness maps of the upper trapezius in female computer users with and without chronic neck-shoulder pain and investigated the effects of eccentric training on females with neck-shoulder pain. Design Cross-sectional (part 1) and open-label (part 2) study. Setting University. Subjects Twenty females with neck-shoulder pain were compared with 20 controls (part 1). In part 2, neck-shoulder pain participants followed a five-week unilateral upper trapezius eccentric training program. Methods Topographical maps of pressure pain thresholds (pressure algometer) and muscle stiffness (myotonometer), using a 15-point grid covering myotendinous and muscle belly sites, and shoulder elevation force and range of elevation (dynamometer) were assessed at baseline and after training. Results There were no differences in pressure pain thresholds between sites (P = 0.243) or groups (P = 0.068), and there were significant differences in stiffness between myotendinous and muscle belly sites (P &lt; 0.001) but not groups (P = 0.273). After training, pressure pain thresholds increased, stiffness decreased (P &lt; 0.005), and shoulder elevation force and range of elevation improved (P &lt; 0.001). Conclusions The lack of differences in upper trapezius pressure pain sensitivity and stiffness between females with or without neck-shoulder pain confirms no clear etiology among computer users reporting neck-shoulder pain. A five-week eccentric training protocol showed positive effects on pressure pain sensitivity, stiffness, shoulder force, and range of motion.

scholarly journals Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain

Pain Medicine ◽  
2019 ◽  
Vol 20 (7) ◽  
pp. 1379-1386 ◽  
Author(s):  
Ricardo Ortega-Santiago ◽  
Maite Maestre-Lerga ◽  
César Fernández-de-las-Peñas ◽  
Joshua A Cleland ◽  
Gustavo Plaza-Manzano
Keyword(s):  
Thoracic Spine ◽  
Pain Sensitivity ◽  
Trigger Points ◽  
Pressure Pain ◽  
Upper Thoracic Spine ◽  
Upper Trapezius ◽  
Spine Pain ◽  
Pressure Pain Thresholds ◽  
Upper Thoracic ◽  
Thoracic Spine Pain

Abstract Objectives The presence of trigger points (MTrPs) and pressure pain sensitivity has been well documented in subjects with neck and back pain; however, it has yet to be examined in people with upper thoracic spine pain. The purpose of this study was to investigate the presence of MTrPs and mechanical pain sensitivity in individuals with upper thoracic spine pain. Methods Seventeen subjects with upper thoracic spine pain and 17 pain-free controls without spine pain participated. MTrPs were examined bilaterally in the upper trapezius, rhomboid, iliocostalis thoracic, levator scapulae, infraspinatus, and anterior and middle scalene muscles. Pressure pain thresholds (PPTs) were assessed over T2, the C5-C6 zygapophyseal joint, the second metacarpal, and the tibialis anterior. Results The numbers of MTrPs between both groups were significantly different (P < 0.001) between patients and controls. The number of MTrPs for each patient with upper thoracic spine pain was 12.4 ± 2.8 (5.7 ± 4.0 active TrPs, 6.7 ± 3.4 latent TrPs). The distribution of MTrPs was significantly different between groups, and active MTrPs within the rhomboid (75%), anterior scalene (65%), and middle scalene (47%) were the most prevalent in patients with upper thoracic spine pain. A higher number of active MTrPs was associated with greater pain intensity and longer duration of pain history. Conclusions This study identified active MTrPs and widespread pain hypersensitivity in subjects with upper thoracic spine pain compared with asymptomatic people. Identifying proper treatment strategies might be able to reduce pain and improve function in individuals with upper thoracic spine pain. However, future studies are needed to examine this.

scholarly journals The Use of Wearable Sensors for the Movement Assessment on Muscle Contraction Sequences in Post-Stroke Patients during Sit-to-Stand

Sensors ◽  
2019 ◽  
Vol 19 (3) ◽  
pp. 657 ◽  
Author(s):  
Wei-Chun Hsu ◽  
Chao-Chin Chang ◽  
Yi-Jia Lin ◽  
Fu-Chi Yang ◽  
Li-Fong Lin ◽  
...  
Keyword(s):  
Muscle Contraction ◽  
Tibialis Anterior ◽  
Sagittal Plane ◽  
Balance Control ◽  
Wearable Sensors ◽  
Postural Adjustment ◽  
Stroke Patients ◽  
Post Stroke ◽  
Sit To Stand ◽  
Therapeutic Exercises

Electromyography (EMG) sensors have been used to study the sequence of muscle contractions during sit-to-stand (STS) in post-stroke patients. However, the majority of the studies used wired sensors with a limited number of placements. Using the latest improved wearable technology with 16 sensors, the current study was a thorough investigation to evaluate the contraction sequences of eight key muscles on the trunk and bilateral limbs during STS in post-stroke patients, as it became feasible. Multiple wearable sensors for the detection of muscle contraction sequences showed that the post-stroke patients performed STS with abnormal firing sequences, not only in the primary mover on the sagittal plane during raising, but also in the tibialis anterior, which may affect anticipatory postural adjustment in the gluteus medius, which may affect balance control. The abnormal tibialis anterior contraction until the early ascending phase and the delayed firing of the gluteus muscles highlight the importance of whole-kinetic-chain monitoring of contraction sequences using wearable sensors. The findings can be helpful for the design of therapeutic exercises.

Association between widespread pressure pain hypersensitivity, health history, and trigger points in subjects with neck pain

2017 ◽  
Vol 16 (1) ◽  
pp. 168-168
Author(s):  
Matteo Castaldo ◽  
Antonella Catena ◽  
César Fernández-de-las-Peñas ◽  
Lars Arendt-Nielsen
Keyword(s):  
Neck Pain ◽  
Tibialis Anterior ◽  
Trapezius Muscle ◽  
Trigger Points ◽  
Pressure Pain ◽  
Pain Hypersensitivity ◽  
Health History ◽  
Upper Trapezius ◽  
Upper Trapezius Muscle ◽  
Extensor Carpi Radialis

Abstract Aims Health history (medical conditions, comorbid musculoskeletal pain, surgical operation, long term intake of medications) may contribute to central sensitization. The duration and the number of the peripheral nociceptive input seem to play a crucial role in the development and maintenance of sensitization. No study has previously investigated these relationships. Our aim was to investigate the association between pressure pain thresholds (PPTs) and health history in patients with neck pain, and the role of active trigger points (TrPs) on PPTs. Methods Thirty-four subjects with mechanical neck pain and 34 with whiplash-associated neck pain participated. They underwent an assessment of PPTs over upper trapezius, extensor carpi radialis longus, and tibialis anterior muscles, and were screened for the presence of active TrPs in upper trapezius muscle. Further, patients fulfilled a questionnaire investigating health history outcomes number and duration. Results Significant negative correlations between all PPTs and the duration of health history outcomes were found in both groups (all, P < 0.02), with no correlations between PPTs and the number of health history outcomes (all, P > 0.15). Significant lower PPTs over upper trapezius, extensor carpi radialis longus, and tibialis anterior (all, P < 0.01) muscles were found in subjects with active TrPs as compared to those with latent TrPs. Conclusions Widespread pressure pain hypersensitivity was associated with the duration, but not the number, of health history outcomes suggesting that long-lasting health complains may act as triggering factor driving sensitization in individuals with neck pain regardless the origin of neck pain. Patients with active TrPs in the upper trapezius muscle showed higher widespread pressure sensitivity than those with latent TrPs. These data should be included in the assessment of neck pain subjects, as they may be useful for planning the management of their symptoms.

scholarly journals Local and Widespread Pressure Pain Hyperalgesia Is Not Side Specific in Females with Unilateral Neck Pain that Can Be Reproduced during Passive Neck Rotation

2019 ◽  
Vol 8 (8) ◽  
pp. 1246 ◽  
Author(s):  
Fernando Piña-Pozo ◽  
Alberto Marcos Heredia-Rizo ◽  
Pascal Madeleine ◽  
Isabel Escobio-Prieto ◽  
Antonio Luque-Carrasco ◽  
...  
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Tibialis Anterior ◽  
Pain Sensitivity ◽  
Specific Effect ◽  
Current Evidence ◽  
Pressure Pain ◽  
Pain Location ◽  
Pressure Pain Thresholds ◽  
Neck Rotation

Current evidence for widespread hyperalgesia in non-specific neck pain (NSNP) is unclear. It is currently recommended to group NSNP patients according to pain-provoking movements. The aim of this study was to investigate local and widespread pain sensitivity in females with unilateral NSNP that is reproducible during passive neck rotation compared with matched controls, and to compare the side specific effect of pain location on pressure pain sensitivity among females with unilateral NSNP. Thirty-six females with unilateral NSNP evoked during passive ipsilateral (n = 20) or contralateral (n = 16) rotation toward the painful side were compared with 20 controls. Participants reported their pain intensity at rest and during passive neck rotation and completed the Neck Disability Index. Pressure pain thresholds (PPTs) were assessed bilaterally over the anterior scalene; the sternocleidomastoid; the levator scapulae; lateral to the spinous process of C6; the median, ulnar, and radial nerves; and the tibialis anterior. The ANOVA revealed lower PPTs in females with unilateral NSNP compared with the controls (all at p < 0.001), but no differences were found between the sides, nor was there any Group × side interaction. Among females with NSNP, those with higher pain intensity during ipsilateral rotation toward the painful side showed lower PPTs over the anterior scalene, median nerve, ulnar nerve, and tibialis anterior (all, p < 0.05) than females with higher pain intensity during contralateral rotation toward the painful side. These findings demonstrated bilateral local and widespread pressure pain hyperalgesia in females with unilateral NSNP that was reproducible during passive neck rotation compared with controls. There was no side specific effect of pain location on PPTs among females with unilateral NSNP.

Deep tissue hyperalgesia after computer work

2012 ◽  
Vol 3 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Vegard Strøm ◽  
Cecilie Røe ◽  
Dagfinn Matre ◽  
Stein Knardahl
Keyword(s):  
Neck Pain ◽  
Time Pressure ◽  
Computer Work ◽  
Office Work ◽  
Deep Tissue ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Upper Trapezius ◽  
Shoulder And Neck Pain ◽  
Pressure Pain Thresholds

AbstractBackground and purposeA growing number of people are using computers. Shoulder and neck pain occur commonly during computer work. Peripheral and central sensitization may play a major role in establishing and maintaining several chronic pain conditions. We have previously reported that a 90 min simulated computer office-work induced substantial pain in the shoulders and neck. We hypothesized that the development of pain during the computer work may be related to sensitization. The aim of the present study was to examine if the 90 min computer work induced deep tissue muscle hyperalgesia manifested as altered pressure pain thresholds (PPTs).MethodsTwenty-two subjects with chronic shoulder and neck pain (pain group) and 26 healthy and pain free subjects (reference group) performed a standardized computer office-work task with use of a computer-mouse and with time pressure and high precision demands continuously for 90 min. The pressure pain threshold was measured with a pressure algometer in shoulder and forearm muscles (bilaterally in upper trapezius and extensor carpi radialis), and at sternum, before and 15 min and 30 min after the computer work task.ResultsThe PPTs before starting the computer work were not different between the groups at any of the five locations. In both groups, the PPTs in the active and inactive side of the upper trapezius as well as in the extensor carpi radialis of the forearm operating the computer mouse were significantly reduced after the 90 min computer work compared with the pre-work levels. In the pain group, also the PPT in the inactive resting forearm was significantly reduced. The changes seen in PPTs from pre-to post-work were not significantly different between the groups, except for the inactive resting forearm where the groups exhibited different time course.ConclusionA decrease in pressure pain thresholds of involved muscles suggests that computer office-work can induce deep tissue hyperalgesia within 90 min. The development of pain during the computer work indicates peripheral sensitization as the predominant mechanism. Decreased pressure pain thresholds also in sites distant from pain areas may indicate a contribution from central sensitization in the subjects with chronic shoulder and neck pain.ImplicationsThe lasting pain after work and the reduced PPTs both in involved and distant musculature may indicate need for frequent pauses during computer work, especially when performed with time pressure and high precision demands, in order to avoid pain to increase and sustain after work, and thus to prevent the possibility of pain to become chronic.

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