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Archives of Physical Medicine and... Nov 2023To evaluate the effectiveness of "Physio-EndEA", a multimodal nine-week supervised exercise intervention, on quality of life, pain, and lumbopelvic impairments in women... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of a Multimodal Supervised Therapeutic Exercise Program on Quality of Life, Pain, and Lumbopelvic Impairments in Women With Endometriosis Unresponsive to Conventional Therapy: A Randomized Controlled Trial.
OBJECTIVE
To evaluate the effectiveness of "Physio-EndEA", a multimodal nine-week supervised exercise intervention, on quality of life, pain, and lumbopelvic impairments in women with endometriosis unresponsive to conventional therapy.
DESIGN
Parallel-group randomized controlled trial. Outcomes were measured at baseline, post-intervention, and at 1 year.
SETTING
Two Public University Hospitals.
PARTICIPANTS
This trial included 31 women with endometriosis (N=31) randomly allocated to "Physio-EndEA" group (n=16) or control group (n=15). Four participants dropped out of the study for causes unrelated to the intervention.
INTERVENTIONS
The "Physio-EndEA" program consisted of a 1-week lumbopelvic stabilization learning phase followed by an 8-week phase of stretching, aerobic, and resistance exercises focused on the lumbopelvic area. It was sequentially instructed and supervised by a trained physiotherapist (with volume and intensity progression) and adapted daily to the potential of each participant. Control group received the usual treatment stipulated by their gynecologist.
MAIN OUTCOME MEASURES
The primary outcome was quality of life. Secondary outcomes were pain intensity, pressure pain thresholds, pain-related catastrophic thoughts, abdominal and back strength, lumbopelvic stability, and muscle architecture.
RESULTS
Adherence rate was 90.6% and mean (±standard deviation) satisfaction was 9.44±0.73 out of 10. No remarkable health problems were reported during the trial. In comparison with controls, the quality of life was improved post-intervention and at 1 year in the Physio-EndEA group with large effect sizes (d>0.80). This group also evidenced: a reduced intensity of dyspareunia, catastrophic thoughts; an increase in pelvic, lumbar, and distal pressure pain thresholds; increases in abdominal and back strength and lumbopelvic stability; and increased thickness of transversus abdominis (right side) and width of lumbar multifidus (left side).
CONCLUSION
A 9-week program of multimodal supervised therapeutic exercise is a feasible and effective intervention to improve QoL in women with endometriosis. This program also offers benefits in terms of pain/sensitization and lumbopelvic impairments.
Topics: Humans; Female; Quality of Life; Endometriosis; Exercise Therapy; Exercise; Low Back Pain
PubMed: 37467936
DOI: 10.1016/j.apmr.2023.06.020 -
Journal of Clinical Medicine Nov 2023Endometriosis is a chronic inflammatory disease where endometrial-like lesions settle outside the uterus, resulting in extensive inflammatory reactions. It is a complex... (Review)
Review
Endometriosis is a chronic inflammatory disease where endometrial-like lesions settle outside the uterus, resulting in extensive inflammatory reactions. It is a complex disease that presents with a range of symptoms, with pain and infertility being the most common. Along with severe dysmenorrhea, cyclic and acyclic lower abdominal pain, cyclic dysuria and dyschezia, dyspareunia, and infertility, there are also nonspecific complaints that can cause confusion and make endometriosis the chameleon among gynecological diseases. These symptoms include unspecific intestinal complaints, cyclic diarrhea, but also constipation, nausea, vomiting, and stomach complaints. It appears that in addition to general bowel symptoms, there are also specific symptoms related to endometriosis such as cyclic bloating of the abdomen, known as endo belly. During the second half of the menstrual cycle leading up to menstruation, the abdomen becomes increasingly bloated causing discomfort and pain due to elevated sensitivity of the intestinal wall. Patients with endometriosis exhibit a reduced stretch pain threshold of the intestinal wall. Here, we review the endo belly, for the first time, pathophysiology and the influence of other diseases (such as irritable bowel syndrome-IBS), microbiome, hormonal levels, inflammation, and diet on the presentation of this condition.
PubMed: 38002788
DOI: 10.3390/jcm12227176 -
Musculoskeletal Science & Practice Aug 2023Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and... (Review)
Review
INTRODUCTION
Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls.
PURPOSE
This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH.
IMPLICATIONS
The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment.
Topics: Humans; Headache; Migraine Disorders; Neck Pain; Pain Threshold; Tension-Type Headache
PubMed: 37394323
DOI: 10.1016/j.msksp.2023.102804 -
BioRxiv : the Preprint Server For... Aug 2023Women develop chronic pain during their reproductive years more often than men, and estrogen and progesterone regulate this susceptibility. We tested whether brain...
Women develop chronic pain during their reproductive years more often than men, and estrogen and progesterone regulate this susceptibility. We tested whether brain progesterone receptor (PR) signaling regulates pain susceptibility. During the estrous cycle, animals were more sensitive to pain during the estrus stage than in the diestrus stage, suggesting a role for reproductive hormones, estrogen, and progesterone. We measured the pain threshold daily for four days in ovariectomized, estrogen-primed animals treated with progesterone. The pain threshold was lower 2 days later and stayed that way for the duration of the testing. A specific progesterone-receptor (PR) agonist, segesterone, promoted pain, and mice lacking PR in the brain (PRKO) did not experience lowered pain threshold when treated with progesterone or segesterone. PR activation increased the cold sensitivity but did not affect the heat sensitivity and had a small effect on light sensitivity. Finally, we evaluated whether PR activation altered experimental migraine. Segesterone and nitroglycerin (NTG) when administered sequentially, reduced pain threshold but not separately. These studies have uncovered a pain-regulating function of PRs. Targeting PRs may provide a novel therapeutic avenue to treat chronic pain in women.
PubMed: 37609239
DOI: 10.1101/2023.08.04.552037 -
Advances in Neurobiology 2024Beta-endorphin is secreted from the hypothalamus and pituitary in both mother and newborn. The placenta produces numerous pituitary hormones from the third month of...
Beta-endorphin is secreted from the hypothalamus and pituitary in both mother and newborn. The placenta produces numerous pituitary hormones from the third month of pregnancy, one of which is βE. It has been suggested that βE has a role in the appetitive and precopulatory phase of sexual behavior in animals. An increase in endorphin levels during sexual activity in humans may contribute to attachment and bonding between partners, but contradictory reports in the literature question the association between sexuality and βE levels. The level of βE also increases during pregnancy, rises in early labor, peaks in late labor, and drops in the postpartum period. This fluctuation provides natural analgesia, raises the pain threshold, decreases the sensation of pain, or suppresses pain, and decreases fear levels during labor and birth. Beta-endorphin also protects the fetus from hypoxia during labor and birth and potential neural damage by aiding blood flow to the brain under hypoxic conditions. It has been suggested that a variety of pharmacologic and nonpharmacologic complementary therapies, when used in pregnancy, labor, and birth, activate the opioid receptors in the CNS and alter the sensation of pain during labor and birth, affect the mother-child attachment and affect sexual function. These studies report contradictory results that will be discussed in this chapter.
Topics: Animals; Female; Humans; Pregnancy; beta-Endorphin; Endorphins; Reproduction; Sexual Behavior; Sexuality
PubMed: 38874734
DOI: 10.1007/978-3-031-45493-6_20 -
Brazilian Dental Journal 2023In this study, we aimed to evaluate the halitosis and pain threshold of the peri-implant soft tissues in individuals rehabilitated with implant-supported prostheses.... (Observational Study)
Observational Study
In this study, we aimed to evaluate the halitosis and pain threshold of the peri-implant soft tissues in individuals rehabilitated with implant-supported prostheses. Forty-eight subjects were divided into four groups (n = 12) according to their prosthetic rehabilitation: single-tooth fixed prosthesis, multi-tooth fixed prosthesis, overdentures, and the Brånemark protocol. Halitosis was measured using a halimeter, whereas the pain threshold was measured using Von Frey monofilaments. Measurements were taken before (t0) and 30 days after (t1) placement of healing caps, and at the time of (t2) and 30 days after (t3) prosthetic placement. Halitosis data were analyzed using the chi-square test and Bonferroni correction (p < 0.05). Two-way ANOVA and Tukey's test (p < 0.05) were used to analyze pain threshold data. We noted an association between halitosis and time for the Brånemark protocol [X2(6) = 18.471; p = 0.005] and overdenture groups [X2(6) = 17.732; p = 0.007], and between halitosis and type of prosthesis only at t0 [X2(6) = 12.894; p = 0.045]. The interaction between time and the type of prosthesis significantly interfered with the mean pain threshold values (p = 0.001). At most time points, the majority of participants in each group had clinically unacceptable halitosis. After 30 days of using the prostheses, the overdenture group had a lower pain threshold compared to the Brånemark protocol group.
Topics: Humans; Dental Implants; Halitosis; Pain Threshold; Cohort Studies; Tooth; Dental Prosthesis, Implant-Supported
PubMed: 38133082
DOI: 10.1590/0103-6440202305527 -
Psychiatry Research Jan 2024It has been hypothesized that individuals less sensitive to pain could be at higher risk of suicide. However, data on pain sensitivity in suicide attempters (SA)... (Meta-Analysis)
Meta-Analysis Review
It has been hypothesized that individuals less sensitive to pain could be at higher risk of suicide. However, data on pain sensitivity in suicide attempters (SA) obtained using experimental procedures are heterogeneous. The aim of this systematic review and meta-analysis was to investigate and compare pain tolerance and threshold in SA (patients with lifetime history of suicide attempt), non-attempters (psychiatric controls, PC), and healthy controls (HC). A random effects meta-analysis was used to estimate the standardized mean differences using data from 16 studies that compared physical pain tolerance and threshold in SA and PC or HC. Pain tolerance and threshold were not significantly different in SA and PC. However, pain tolerance, but not threshold, was higher in SA than HC. Our findings do not support the hypothesis of an altered pain perception related as a trait for suicidal vulnerability, but rather suggest altered pain perception related to psychiatric vulnerability.
Topics: Humans; Suicide, Attempted; Suicidal Ideation; Pain Threshold; Pain; Pain Perception
PubMed: 38071878
DOI: 10.1016/j.psychres.2023.115618 -
International Immunopharmacology Oct 2023As a common clinical disease, neuropathic pain is difficult to be cured with drugs. The occurrence and progression of pain is closely related to the response of spinal...
As a common clinical disease, neuropathic pain is difficult to be cured with drugs. The occurrence and progression of pain is closely related to the response of spinal microglia. Aspartof the regulation of microglialactivity,PD-L1 playsacriticalrole. Loss of PD-L1 promoted the polarization of M1-like microglia. Increased expression of PD-L1 promoted M2-like polarization. Electroacupuncture has a significant analgesic effect in clinical practice, but its specific mechanism remains to be further explored. In this study, we verified the role of PD-L1 in EA analgesia and the underlying molecular mechanism through spinal nerve ligation (SNL) in rats and lipopolysaccharide (LPS)-treated BV2 microglial cells. Forbehavioralstudiesofrats,mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured, and spinal cord neuros were examined under transmission electron microscopyto determine changes to their myelin structure. The expression levels of PD-L1 and M1/M2-specific markers in rat spinal cord and BV2 microglial cells were measured by enzyme-linked immunosorbent assay, flow cytometry, immunofluorescence staining and Western blot analysis. Our study showed that EA increased the pain threshold, reduced the destruction of myelin structure, promoted the expression of PD-L1 and PD-1, inhibited the MAPK signaling pathway, and promoted the conversion of microglial polarization from the M1 phenotype to the M2 phenotype in SNL rats. PD-L1 knockdown reversed these effects of EA. In addition, PD-L1 knockdown activated the MAPK signaling pathway, promoted microglial polarization to the M1 phenotype, decreased the expression of anti-inflammatory mediators and increased the expression of proinflammatory factors in LPS-stimulated BV2 microglial cells. Our results showed that EA may regulate the excitability of primary afferent neurons through PD-L1 and then inhibit the MAPK signaling pathway to promote the transformation of activated M1 microglia into M2 microglia, reduce inflammatory reactions, and finally achieve analgesic effects. A therapy targeting PD-L1 may be an effective strategy for treating neuropathic pain.
Topics: Rats; Animals; Microglia; Electroacupuncture; Lipopolysaccharides; B7-H1 Antigen; Spinal Nerves; Neuralgia; Analgesics
PubMed: 37573685
DOI: 10.1016/j.intimp.2023.110764 -
Somatosensory & Motor Research Sep 2023Few studies have demonstrated the effects of smartphone use on grip strength and upper extremity function. The present study was purposed to compare smartphone users'...
PURPOSE/AIM OF THE STUDY
Few studies have demonstrated the effects of smartphone use on grip strength and upper extremity function. The present study was purposed to compare smartphone users' grip/lateral pinch strength, pain threshold/tolerance and upper limb function.
MATERIALS AND METHODS
A prospective cross-sectional study was conducted with 241 individuals. Participants were divided into three groups with the cut-off values of the Smartphone Addiction Scale (SAS). The Edinburgh Handedness Inventory (EHI) was used to determine the dominant side. Thumb pain threshold and tolerance were evaluated with the algometer. A hand dynamometer measured the grip and lateral pinch strength. Upper extremity functions were evaluated with the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Quick-DASH).
RESULTS
Handgrip strength of the dominant/non-dominant extremities and Quick-DASH scores were higher in low-level smartphone users ( < 0.05). There was no significant difference between the groups on lateral pinch strength and pain threshold/tolerance ( > 0.05). Smartphone usage significantly affected dominant and non-dominant hand grip strength (Standardized = -0.15, = -0.15, < 0.05). In addition, the smartphone use level negatively affected dominant lateral pinch strength (Standardized = -0.12, = 0.05). On the other hand, smartphone use positively affected upper extremity function (Standardized = 0.17, < 0.05).
CONCLUSIONS
As smartphone addiction increases, standard handgrip strength and functionality decrease. Pain threshold/tolerance is not affected by smartphone use. Future studies should focus on fine motor skills to present a more comprehensive upper limb function evaluation.
Topics: Humans; Hand Strength; Pain Threshold; Smartphone; Prospective Studies; Cross-Sectional Studies; Pain
PubMed: 36908251
DOI: 10.1080/08990220.2023.2186392