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Clinical Rehabilitation Apr 2023To analyse the effectiveness of exercise therapy in improving pain and active or passive maximum mouth opening in patients with temporomandibular disorders. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To analyse the effectiveness of exercise therapy in improving pain and active or passive maximum mouth opening in patients with temporomandibular disorders.
DATA SOURCES
PubMed Medline, Web of Science, Scopus, CINAHL Complete and Physiotherapy Evidence Database, until April 2022, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
REVIEW METHODS
We included randomized controlled trials evaluating the effect of exercise therapy on pain and on active and passive maximum mouth opening in patients with temporomandibular disorders. Effect size was calculated using Cohen's standardized mean difference (SMD) and their 95% confidence interval (95% CI) in a random-effects model.
RESULTS
A total of 16 studies with 812 participants were included. Exercise therapy is effective in reducing pain (SMD: -0.58; 95% CI: -1.01 to -0.12) and increasing the pain pressure threshold (SMD: 0.45; 95% CI: 0.14-0.76), active and passive maximum mouth opening (SMD: 0.43; 95% CI: 0.14-0.71 and SMD: 0.4; 95% CI: 0.06-0.75, respectively). Subgroup analyses showed more effect of exercise therapy more splints versus splints on pain (SMD: -0.5; 95% CI: -0.73 to -0.26), active and passive maximum mouth opening (SMD: 1.14; 95% CI: 0.22-2.07 and SMD: 0.56; 95% CI: 0.06-1.06, respectively). On pain pressure threshold, exercise therapy was better than physiotherapy approach (manual therapy and electrotherapy) (SMD: 0.48; 95% CI: 0.09-0.87).
CONCLUSIONS
Therapeutic exercise is an effective therapy to reduce pain and increase pain pressure threshold and active and passive maximum mouth opening in patients with temporomandibular disorders.
Topics: Humans; Exercise Therapy; Pain; Temporomandibular Joint Disorders; Physical Therapy Modalities; Musculoskeletal Manipulations
PubMed: 36263523
DOI: 10.1177/02692155221133523 -
American Journal of Physical Medicine &... Jul 2021In chronic pain conditions, the pressure pain threshold has been used to investigate the presence of central sensitization. (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
In chronic pain conditions, the pressure pain threshold has been used to investigate the presence of central sensitization.
METHODS
A systematic review and meta-analysis were conducted to compare the threshold in chronic pain patients and healthy individuals. Ovid MEDLINE and Embase up to July 2019 were used to conduct the search. Search strategy included terms and sets of terms that describe the concepts "sensory testing" and "pain measurement."
RESULTS
The included studies consisted of 24 were case-control studies and 12 cross-sectional studies. The pooled total sample size was 1280 cases of patients with different diagnoses of chronic pain and 1463 healthy controls. Among the included studies, 32 reported a significant decrease of the pressure pain threshold among patients compared with the controls and four reported no statistically significant difference. The pooled pressure pain threshold mean difference was -1.17 (95% confidence interval = -1.45 to -0.90). There was, however, evidence of significant heterogeneity across the studies (I2 = 87.42%, P < 0.001).
CONCLUSIONS
Patients who experience chronic pain have a significantly lower pressure pain threshold compared with healthy controls. Future research is needed to elucidate factors attributed to the change in pressure pain threshold among patients with chronic pain, as well as the time that the central sensitization occurs.
Topics: Central Nervous System Sensitization; Chronic Pain; Humans; Pain Measurement; Pain Threshold
PubMed: 33002911
DOI: 10.1097/PHM.0000000000001603 -
Obesity Surgery Mar 2016Pain is an integral part of life and has an important protective function. Pain perception has been shown to differ between subjects and changes with gender, race, and... (Review)
Review
Pain is an integral part of life and has an important protective function. Pain perception has been shown to differ between subjects and changes with gender, race, and culture. In addition, it has been suggested that obesity influences pain perception and that obesity can be a risk factor for increased pain thresholds. The aim of this systematic review was to examine pain thresholds in obese subjects compared to non-obese subjects. The electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE were searched using combinations of terms for obese, pain measurement, visual analog scale, quantitative sensory testing, and pain perception. Studies without comparison as well as cross-sectional studies, case series, and case reports were excluded. The search was conducted without restrictions on language or date of publication. From a total of 1818 identified studies, seven studies fulfilled the inclusion criteria, whereby only one study tested the pain threshold difference between obese and non-obese and also before and after body weight loss surgery. Two studies showed a lower pain threshold and four studies a higher pain threshold in obese subjects compared to non-obese subjects. Two studies showed no difference in pain threshold before and after substantial body weight loss due to surgery. Weight loss after surgery was not identified as a factor for higher pain thresholds in obese subjects. In view of the heterogeneity of the studies, the variability of the subjects and differences in methodological quality, a meta-analysis could not be performed. From the available literature, there is a tendency towards higher pain thresholds in obese subjects. Neither substantial weight loss, nor gender, were factors explaining difference in threshold. Future randomized, controlled trials should explore demographic variables that could influence pain perception or pain thresholds in obese individuals, and multimodal pain testing is necessary for better understanding of the apparent differences in pain thresholds in obese individuals.
Topics: Bariatric Surgery; Humans; Obesity; Pain; Pain Measurement; Pain Perception; Pain Threshold
PubMed: 26661107
DOI: 10.1007/s11695-015-2008-9 -
Journal of Pain Research 2017Primary dysmenorrhea (PD) has been the focus of a number of experimental pain studies. Although a number of reviews exist, few have critically evaluated the existing... (Review)
Review
Primary dysmenorrhea (PD) has been the focus of a number of experimental pain studies. Although a number of reviews exist, few have critically evaluated the existing body of research on PD and experimental and procedural pain. Data from 19 published research articles that include women with PD and responses to an experimental or procedural pain stimulus (or stimuli) suggest that women with PD may have elevated pain reactivity, as compared to women without PD. This pattern appears to be true across different phases of the menstrual cycle. However, there is an abundance of conflicting findings, which may be due to significant methodological issues such as inconsistent definitions of PD, wide variation in experimental pain methodologies, and inaccurate assessment of the menstrual cycle. Future research should focus on identifying specific symptoms (i.e., pain threshold ratings) to more clearly define what constitutes PD, establish reliable and valid laboratory testing protocols, and assess the menstrual cycle with greater precision.
PubMed: 29066929
DOI: 10.2147/JPR.S143512 -
PloS One 2023Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of... (Meta-Analysis)
Meta-Analysis
Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.
Topics: Adult; Humans; Fructose; Blood Pressure; Fruit; Sugars; Hypertension
PubMed: 37582096
DOI: 10.1371/journal.pone.0264802 -
Principles and Practice of Clinical... Sep 2020The use of exercise is a potential treatment option to modulate pain (exercise-induced hypoalgesia). The pain threshold (PT) response is a measure of pain sensitivity...
BACKGROUND
The use of exercise is a potential treatment option to modulate pain (exercise-induced hypoalgesia). The pain threshold (PT) response is a measure of pain sensitivity that may be a useful marker to assess the effect of physical exercise on pain modulation.
AIM
The aim of this systematic review and meta-analysis is to evaluate the PT response to exercise in healthy subjects.
METHODS
We searched in MEDLINE, EMBASE, Web of Science, Lilacs, and Scopus using a search strategy with the following search terms: "exercise" OR "physical activity" AND "Pain Threshold" from inception to December 2nd, 2019. As criteria for inclusion of appropriate studies: randomized controlled trials or quasi-experimental studies that enrolled healthy subjects; performed an exercise intervention; assessed PT. Hedge's effect sizes of PT response and their 95% confidence intervals were calculated, and random-effects meta-analyses were performed.
RESULTS
For the final analysis, thirty-six studies were included (n=1326). From this we found a significant and homogenous increase in PT in healthy subjects (ES=0.19, 95% CI= 0.11 to 0.27, I2=7.5%). According to subgroup analysis the effect was higher in studies: with women (ES=0.36); performing strength exercise (ES=0.34), and with moderate intensity (ES=0.27), and no differences by age were found. Confirmed by the meta-regression analysis.
CONCLUSION
This meta-analysis provides evidence of small to moderate effects of exercise on PT in healthy subjects, being even higher for moderate strength exercise and in women. These results support the idea of modulation of the endogenous pain system due to exercise and highlight the need of clinical translation to chronic pain population.
PubMed: 33409362
DOI: 10.21801/ppcrj.2020.63.2 -
Haemophilia : the Official Journal of... May 2023Although strength exercise is often prescribed for people with haemophilia (PWH), it remains unknown how exercise variables and pain thresholds are used to prescribe... (Review)
Review
INTRODUCTION
Although strength exercise is often prescribed for people with haemophilia (PWH), it remains unknown how exercise variables and pain thresholds are used to prescribe strength training in PWH.
AIM
To analyse how strength exercise variables and pain thresholds have been used to prescribe strength training in PWH.
METHODS
A systematic search was conducted in PubMed, Embase, Web of Science, CENTRAL and CINAHL databases from inception to 7 September 2022. Studies whose intervention included strengthening training in adults with haemophilia were included. Two independent reviewers were involved in study selection, data extraction and risk of bias assessment.
RESULTS
Eighteen studies were included. The least reported variables among the studies were: prophylactic factor coverage (11.1%), pain threshold/tolerability (5.6%), intensity (50%), total or partial range of motion (27.8%), time under tension (27.8%), attentional focus modality (0%), therapist experience in haemophilia (33.3%) and adherence assessment (50%). In contrast, weekly frequency (94.4%), duration (weeks) (100%), number of sets/repetitions (88.9%), repetitions to failure/not to failure (77.8%), types of contraction (77.8%), rest duration (55.6%), progression (55.6%), supervision (77.8%), exercise equipment (72.2%) and adverse event record (77.8%) had a higher percentage of reported (>50% of studies).
CONCLUSION
Future research on strength training for PWH should improve information on pain threshold and other important variables such as prophylactic factor coverage, intensity, range of motion, time under tension, attentional focus modality, therapist experience in haemophilia and adherence assessment. This could improve clinical practice and comparison of different protocols.
Topics: Adult; Humans; Exercise; Exercise Therapy; Hemophilia A; Pain Threshold; Resistance Training
PubMed: 36752329
DOI: 10.1111/hae.14753 -
Clinical Neurophysiology : Official... Apr 2023Several types of electrical neuromodulation (such as transcranial direct current stimulation, tDCS; transcutaneous electrical nerve stimulation) have been applied in the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Several types of electrical neuromodulation (such as transcranial direct current stimulation, tDCS; transcutaneous electrical nerve stimulation) have been applied in the treatment of fibromyalgia. These trials had different outcome measurements, such as subjective pain, pain threshold, depression, anxiety, and functioning. We intended to integrate data from different trials into a meta-analysis to clearly present the clinical value of electrical neuromodulation in fibromyalgia.
METHODS
A systematic review and meta-analysis of randomized controlled trials comparing the effect of all types of electrical neuromodulation in patients with fibromyalgia was conducted. The main outcome was subjective pain; the secondary outcomes included depression, anxiety, and functioning.
RESULTS
Twenty-five studies and 1061 fibromyalgia patients were included in the quantitative analysis. Active electrical neuromodulation and active tDCS both showed significant effects on subjective pain, depression, and functioning. For different anode tDCS electrode positions, only F3-F4 revealed a significant effect on depression. Meta-regression tDCS effects on depression were significantly associated with age.
CONCLUSIONS
Electrical neuromodulation is significantly effective in treating pain, depression, and functioning in patients with fibromyalgia.
SIGNIFICANCE
The results may help clinicians to arrange effective treatment plans for patients with fibromyalgia, especially in those patients who reveal limited response to pharmacotherapy and psychotherapy.
Topics: Humans; Fibromyalgia; Transcranial Direct Current Stimulation; Transcutaneous Electric Nerve Stimulation; Transcranial Magnetic Stimulation; Pain
PubMed: 36774784
DOI: 10.1016/j.clinph.2023.01.011 -
The Journal of Headache and Pain Dec 2023Migraine is the world's second most common disabling disorder, affecting 15% of UK adults and costing the UK over £1.5 billion per year. Several costly new drugs have... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Migraine is the world's second most common disabling disorder, affecting 15% of UK adults and costing the UK over £1.5 billion per year. Several costly new drugs have been approved by National Institute for Health and Care Excellence.
AIM
To assess the cost-effectiveness of drugs used to treat adults with chronic migraine.
METHODS
We did a systematic review of placebo-controlled trials of preventive drugs for chronic migraine. We then assessed the cost-effectiveness of the currently prescribable drugs included in the review: Onabotulinum toxin A (BTA), Eptinezumab (100mg or 300mg), Fremanezumab (monthly or quarterly dose), Galcanezumab or Topiramate, each compared to placebo, and we evaluated them jointly. We developed a Markov (state-transition) model with a three-month cycle length to estimate the costs and quality-adjusted life years (QALYs) for the different medications from a UK NHS and Personal Social Services perspective. We used a two-year time horizon with a starting age of 30 years for the patient cohort. We estimated transition probabilities based on monthly headache days using a network meta-analysis (NMA) developed by us, and from published literature. We obtained costs from published sources and applied discount rates of 3.5% to both costs and outcomes.
RESULTS
Deterministic results suggest Topiramate was the least costly option and generated slightly more QALYs than the placebo, whereas Eptinezumab 300mg was the more costly option and generated the most QALYs. After excluding dominated options, the incremental cost-effectiveness ratio (ICER) between BTA and Topiramate was £68,000 per QALY gained and the ICER between Eptinezumab 300mg and BTA was not within plausible cost-effectiveness thresholds. The cost-effectiveness acceptability frontier showed that Topiramate is the most cost-effective medication for any amount the decision maker is willing-to-pay per QALY.
CONCLUSIONS
Among the various prophylactic medications for managing chronic migraine, only Topiramate was within typical cost-effectiveness threshold ranges. Further research is needed, ideally an economic evaluation alongside a randomised trial, to compare these newer, expensive CGRP MAbs with the cheaper oral medications.
Topics: Adult; Humans; Topiramate; Migraine Disorders; Headache; Cost-Benefit Analysis; Decision Making; Quality-Adjusted Life Years
PubMed: 38053051
DOI: 10.1186/s10194-023-01686-y -
European Spine Journal : Official... Jan 2022We sought to systematically assess and summarize the available literature on outcomes following coccygectomy for refractory coccygodynia. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We sought to systematically assess and summarize the available literature on outcomes following coccygectomy for refractory coccygodynia.
METHODS
PubMed, Scopus, and Cochrane Library databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data concerning patient demographics, validated patient reported outcome measures (PROMs) for pain relief, disability outcomes, complications, and reoperation rates were extracted and analyzed.
RESULTS
A total of 21 studies (18 retrospective and 3 prospective) were included in the quantitative analysis. A total of 826 patients (females = 75%) received coccygectomy (720 total and 106 partial) for refractory coccygodynia. Trauma was reported as the most common etiology of coccygodynia (56%; n = 375), followed by idiopathic causes (33%; n = 221). The pooled mean difference (MD) in pain scores from baseline on a 0-10 scale was 5.03 (95% confidence interval [CI]: 4.35 to 6.86) at a 6-12 month follow-up (FU); 5.02 (95% CI: 3.47 to 6.57) at > 12-36 months FU; and 5.41 (95% CI: 4.33 to 6.48) at > 36 months FU. The MCID threshold for pain relief was surpassed at each follow-up. Oswestry Disability Index scores significantly improved postoperatively, with a pooled MD from baseline of - 23.49 (95% CI: - 31.51 to - 15.46), surpassing the MCID threshold. The pooled incidence of complications following coccygectomy was 8% (95% CI: 5% to 12%), the most frequent of which were surgical site infections and wound dehiscence. The pooled incidence of reoperations was 3% (95% CI: 1% to 5%).
CONCLUSION
Coccygectomy represents a viable treatment option in patients with refractory coccygodynia.
Topics: Coccyx; Female; Humans; Low Back Pain; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 34694498
DOI: 10.1007/s00586-021-07041-6