Laura A. Frey Law

Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial.

UNLABELLEDnMassage is a common conservative intervention used to treat myalgia. Although subjective reports have supported the premise that massage decreases pain, few studies have systematically investigated the dose response characteristics of massage relative to a control group. The purpose of this study was to perform a double-blinded, randomized controlled trial of the effects of massage on mechanical hyperalgesia (pressure pain thresholds, PPT) and perceived pain using delayed onset muscle soreness (DOMS) as an endogenous model of myalgia. Participants were randomly assigned to a no-treatment control, superficial touch, or deep-tissue massage group. Eccentric wrist extension exercises were performed at visit 1 to induce DOMS 48 hours later at visit 2. Pain, assessed using visual analog scales (VAS), and PPTs were measured at baseline, after exercise, before treatment, and after treatment. Deep massage decreased pain (48.4% DOMS reversal) during muscle stretch. Mechanical hyperalgesia was reduced (27.5% reversal) after both the deep massage and superficial touch groups relative to control (increased hyperalgesia by 38.4%). Resting pain did not vary between treatment groups.nnnPERSPECTIVEnThis randomized, controlled trial suggests that massage is capable of reducing myalgia symptoms by approximately 25% to 50%, varying with assessment technique. Thus, potential analgesia may depend on the pain assessment used. This information may assist clinicians in determining conservative treatment options for patients with myalgia.

A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment

UNLABELLEDnThis study compared a new transient sham transcutaneous electrical nerve stimulation (TENS) that delivers current for 45 seconds to an inactive sham and active TENS to determine the degree of blinding and influence on pain reduction. Pressure-pain thresholds (PPT), heat-pain thresholds (HPT), and pain intensities to tonic heat and pressure were measured in 69 healthy adults before and after randomization. Allocation investigators and subjects were asked to identify the treatment administered. The transient sham blinded investigators 100% of the time and 40% of subjects compared to the inactive sham that blinded investigators 0% of the time and 21% of subjects. Investigators and subjects were blinded only 7% and 13% of the time, respectively, with active TENS. Neither placebo treatment resulted in significant changes in PPT, HPT, or pain intensities. Subjects using higher active TENS amplitudes (> or =17 mAs) had significantly higher PPTs and lower pain intensities to tonic pressure than subjects using lower amplitudes (<17 mAs). HPTs and pain intensities to tonic heat were not significantly changed. The transient TENS completely blinds investigators to treatment and does not reduce pain, thereby providing a true placebo treatment.nnnPERSPECTIVEnThis article presents the benefits of a new transient sham TENS device for use in prospective, randomized, clinical trials. This device facilitates blinding of subjects and investigators to eliminate expectation bias and determine the true efficacy of TENS for use in clinical populations.

Endurance time is joint-specific: a modelling and meta-analysis investigation.

Static task intensity–endurance time (ET) relationships (e.g. Rohmerts curve) were first reported decades ago. However, a comprehensive meta-analysis to compare experimentally-observed ETs across bodily regions has not been reported. We performed a systematic literature review of ETs for static contractions, developed joint-specific power and exponential models of the intensity–ET relationships, and compared these models between each joint (ankle, trunk, hand/grip, elbow, knee, and shoulder) and the pooled data (generalised curve). 194 publications were found, representing a total of 369 data points. The power model provided the best fit to the experimental data. Significant intensity-dependent ET differences were predicted between each pair of joints. Overall, the ankle was most fatigue-resistant, followed by the trunk, hand/grip, elbow, knee and finally the shoulder was most fatigable. We conclude ET varies systematically between joints, in some cases with large effect sizes. Thus, a single generalised ET model does not adequately represent fatigue across joints. Statement of Relevance: Rohmert curves have been used in ergonomic analyses of fatigue, as there are limited tools available to accurately predict force decrements. This study provides updated endurance time–intensity curves using a large meta-analysis of fatigue data. Specific models derived for five distinct joint regions should further increase prediction accuracy.

Acidic buffer induced muscle pain evokes referred pain and mechanical hyperalgesia in humans

Abstract While tissue acidosis causes local deep‐tissue pain, its effect on referred pain and mechanical muscle hyperalgesia is unknown. The aim of this study was to investigate a human experimental acidic muscle pain model using a randomized, controlled, single‐blinded study design. Seventy‐two subjects (36 female) participated in three visits, each involving one 15 min intramuscular infusion into the anterior tibialis muscle: acidic phosphate buffer (pH 5.2) at 40 ml/h (N = 69) or 20 ml/h (N = 54), normal phosphate buffer (pH 7.3) at 40 ml/h (N = 70), or isotonic saline at 40 ml/h (N = 19). Pain ratings and pressure sensitivity of superficial and deep tissues were assessed before, during, and 20 min after infusion. Acidic buffer produced light to moderate, rate‐dependent, muscle pain (not sex‐dependent) compared to the control infusions, that referred pain to the ankle in 80% of women and 40% of men. Pain did not vary across self‐reported menstrual phases. Pressure pain thresholds (PPTs) were reduced over the infused muscle with acidic infusion, defined as primary mechanical hyperalgesia. PPTs decreased at the ankle in those with referred pain in response to acidic buffer, i.e. referred mechanical hyperalgesia, but not at the foot. No pain or changes in PPTs occurred in the contralateral leg. These results demonstrate muscle acidosis can lead to local and referred pain and hyperalgesia, with significant sex differences in development of referred pain.

Age-Related Differences in Muscle Fatigue Vary by Contraction Type: A Meta-analysis

Background During senescence, despite the loss of strength (force-generating capability) associated with sarcopenia, muscle endurance may improve for isometric contractions. Purpose The purpose of this study was to perform a systematic meta-analysis of young versus older adults, considering likely moderators (ie, contraction type, joint, sex, activity level, and task intensity). Data Sources A 2-stage systematic review identified potential studies from PubMed, CINAHL, PEDro, EBSCOhost: ERIC, EBSCOhost: Sportdiscus, and The Cochrane Library. Study Selection Studies reporting fatigue tasks (voluntary activation) performed at a relative intensity in both young (18–45 years of age) and old (≥55 years of age) adults who were healthy were considered. Data Extraction Sample size, mean and variance outcome data (ie, fatigue index or endurance time), joint, contraction type, task intensity (percentage of maximum), sex, and activity levels were extracted. Data Synthesis Effect sizes were (1) computed for all data points; (2) subgrouped by contraction type, sex, joint or muscle group, intensity, or activity level; and (3) further subgrouped between contraction type and the remaining moderators. Out of 3,457 potential studies, 46 publications (with 78 distinct effect size data points) met all inclusion criteria. Limitations A lack of available data limited subgroup analyses (ie, sex, intensity, joint), as did a disproportionate spread of data (most intensities ≥50% of maximum voluntary contraction). Conclusions Overall, older adults were able to sustain relative-intensity tasks significantly longer or with less force decay than younger adults (effect size=0.49). However, this age-related difference was present only for sustained and intermittent isometric contractions, whereas this age-related advantage was lost for dynamic tasks. When controlling for contraction type, the additional modifiers played minor roles. Identifying muscle endurance capabilities in the older adult may provide an avenue to improve functional capabilities, despite a clearly established decrement in peak torque.

A theoretical approach for modeling peripheral muscle fatigue and recovery

A three-compartment model is presented to describe muscle activation, fatigue, and recovery under a variety of loading conditions. Muscle is considered to be in one of three states: resting (M(R)), activated (M(A)), or fatigued (M(F)). A bounded proportional controller represents muscle activation-deactivation, the transfer between M(R) and M(A). The fatigue and recovery rates determine the transfer to/from M(F) state. The model qualitatively demonstrates empirically based fatigue behavior, known as Rohmerts curves, with isometric loading conditions. An expanded version of the model utilizes the properties of three muscle fiber types and a last-in-first-out stack mechanism to represent the known muscle recruitment hierarchy. Additionally, a novel yet practical approach is introduced to quantitatively evaluate task-related muscle fatigue for complex and/or dynamic movements at the joint level, encompassing the nonlinear influences of joint angle and velocity. This approach may have potential for digital human modeling, ergonomics, and other real-time applications due to its computational efficiency.

Electrically induced muscle contractions influence bone density decline after spinal cord injury

Study Design. Longitudinal repeated-measures; within-subject control. Objective. We examined the extent to which an isometric plantar flexion training protocol attenuates bone loss longitudinally after SCI. Summary of Background Data. After spinal cord injury (SCI), bone mineral density (BMD) of paralyzed extremities rapidly declines, likely because of loss of mechanical loading of bone via muscle contractions. Methods. Six individuals with complete paralysis began a 3-year unilateral plantar flexor muscle activation program within 4.5 months after SCI. The opposite limb served as a control. Compliance with recommended dose was >80%. Tibia compressive force was >140% of body weight. Results. Bilateral hip and untrained tibia BMD declined significantly over the course of the training. Lumbar spine BMD showed minimal change. Percent decline in BMD (from the baseline condition) for the trained tibia (∼10%) was significantly less than the untrained tibia (∼25%) (P < 0.05). Trained limb percent decline in BMD remained steady over the first 1.5 years of the study (P < 0.05). Conclusions. Compressive loads of ∼1 to 2 times body weight, induced by muscle contractions, partially prevent the loss of BMD after SCI. Future studies should establish dose-response curves for attenuation of bone loss after SCI.

Association of joint inflammation with pain sensitization in knee osteoarthritis: the Multicenter Osteoarthritis Study

Pain sensitization is associated with pain severity in knee osteoarthritis (OA), but its cause in humans is not well understood. We examined whether inflammation, assessed as synovitis and effusion on magnetic resonance imaging (MRI), or mechanical load, assessed as bone marrow lesions (BMLs), was associated with sensitization in knee OA.

Lower-Order Pain-Related Constructs Are More Predictive of Cold Pressor Pain Ratings than Higher-Order Personality Traits

UNLABELLEDnPain is a debilitating condition affecting millions each year, yet what predisposes certain individuals to be more sensitive to pain remains relatively unknown. Several psychological factors have been associated with pain perception, but the structural relations between multiple higher- and lower-order constructs and pain are not well understood. Thus, we aimed to examine the associations between pain perception using the cold pressor task (CPT), higher-order personality traits (neuroticism, negative affectivity, trait anxiety, extraversion, positive affectivity, psychoticism), and lower-order pain-related psychological constructs (pain catastrophizing [pre- and post-], fear of pain, anxiety sensitivity, somatosensory amplification, hypochondriasis) in 66 pain-free adults. Factor analysis revealed 3 latent psychological variables: pain- or body-sensitivity, negative affect/neuroticism, and positive affect/extraversion. Similarly, pain responses factored into 3 domains: intensity, quality, and tolerance. Regression and correlation analyses demonstrated that: 1) all the lower-order pain constructs (fear, catastrophizing, and hypochondriasis) are related through a single underlying latent factor that is partially related to the higher-order negative-valence personality traits; 2) pain- or body-sensitivity was more strongly predictive of pain quality than higher-order traits; and 3) the form of pain assessment is important-only qualitative pain ratings were significantly predicted by the psychological factors.nnnPERSPECTIVEnConsistent with the biopsychosocial model, these results suggest multiple pain-related psychological measures likely assess a common underlying factor, which is more predictive of qualitative than intensity pain ratings. This information may be useful for the development and advancement of pain assessments and treatments while considering the multidimensional nature of pain.

Sex differences in fatigue resistance are muscle group dependent.

PURPOSEnWomen are often reported to be generally more resistant to fatigue than men for relative-intensity tasks. This has been observed repeatedly for elbow flexors, whereas at the ankle, sex differences appear less robust, suggesting localized rather than systemic influences. Thus, the purpose of this study was to examine sex differences in fatigue resistance at muscle groups in a single cohort and which factors, if any, predict endurance time.nnnMETHODSnThirty-two young adults (age = 19-44 yr, 16 women) performed sustained isometric contractions at 50% maximum voluntary isometric contraction to failure for elbow flexion and ankle dorsiflexion. Pain, exertion, and muscle EMG were assessed throughout. Self-reported baseline activity was measured using the International Physical Activity Questionnaire.nnnRESULTSnWomen were significantly more resistant to fatigue than men at the elbow (112.3 ± 6.2 vs 80.3 ± 5.8 s, P = 0.001) but not at the ankle (140.6 ± 10.7 vs 129.2 ± 10.5 s, P = 0.45). Peak torque was greater in men than that in women (P < 0.0001) at the ankle (45.0 ± 1.7 vs 30.1 ± 1.0 N·m) and at the elbow (75.7 ± 3.1 vs 34.4 ± 2.2 N·m). Peak torque was significantly related to endurance time at the elbow (R2= 0.30) but not at the ankle (R2 = 0.03). Peak pain, rate of pain increase, peak exertion, EMG, and baseline physical activity did not differ between sexes.nnnCONCLUSIONSnSex differences in fatigue resistance are muscle group specific. Women were more fatigue resistant at the elbow but not at the ankle during a sustained isometric contraction. Further, factors that may contribute to fatigue resistance for one muscle group (e.g., sex, peak torque) may not be critical at another.