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In people with nonspecific chronic spinal pain (nCSP), disability and quality of life are associated with clinical, cognitive, psychophysical, and demographic variables. However, evidence regarding the interactions between these variables is only limited to this population. Therefore, this study aims to explore path models explaining the multivariate contributions of such variables to disability and quality of life in people with nCSP. This secondary analysis uses baseline data from a randomized controlled trial including 120 participants with nCSP. Structural equation modeling was used to explore path models for the Pain Disability Index (PDI), the Short Form 36-item physical (SF-36 PC), and mental (SF-36 MC) component scores. All models included sex, pain catastrophizing, kinesiophobia, hypervigilance, and pain intensity. Additionally, the PDI and SF-36 PC models included pressure pain thresholds (PPTs) at the dominant pain site (ie, neck or low back). Significant associations were found between sex, pain cognitions, pain intensity, and PPTs. Only pain catastrophizing significantly directly influenced the PDI (P ≤ .001) and SF-36 MC (P = .014), while the direct effects on the SF-36 PC from kinesiophobia (P = .008) and pain intensity (P = .006) were also significant. However, only the combined effect of all pain cognitions on the SF-36 PC was mediated by pain intensity (P = .019). Our findings indicate that patients’ pain-related cognitions have an adverse effect on their physical health-related quality of life via a negative influence on their pain intensity in people with nCSP.

Carpal tunnel syndrome (CTS) may lead to significant work limitations, especially in female manual workers. There is scarce evidence on the perspective of female manual workers with CTS.

Background/objective: Since, to our knowledge, the effects of dry needling (DN) on active myofascial trigger point (MTrP) stiffness have not been analyzed previously with shear wave elastography (SWE), our aim was to compare the effects of a single session of DN and sham DN applied to the most active MTrP located in the upper trapezius muscle on clinical outcomes.Methods: A randomized, double-blinded sham-controlled trial was conducted; 60 patients were randomized into an experimental (DN) or sham (sham DN) group. Baseline data including sociodemographic and clinical characteristics were collected. SWE and pain pressure thresholds (PPTs) at the MTrP and a control point located 3 cm laterally were the main outcomes assessed before and 10 min after the interventions.Results: Patients receiving DN interventions experienced greater increases in the control point PPTs immediately after receiving the intervention compared with sham DN (p< 0.05), but no differences were found for the MTrP (p> 0.05). Post-intervention PPT improvements were found at both locations for both groups (p< 0.01). No significant changes for either MTrP or control locations were found for SWE outcomes in either group (all ps > 0.05). No significant within-group SWE differences were found in the DN or sham DN groups (p> 0.05).Conclusion: A single session of DN or sham DN applied to active MTrPs located in the upper trapezius muscle produced no detectable changes in stiffness at the MTrP or control locations. Real DN induced an immediate analgesic response at both MTrP and control locations, while sham DN induced an immediate MTrP response.Trial registration number: NCT04832074 (ClinicalTrials.gov).

•A theoretical model proposes a relationship of psycho-physical and psychological factors in TTH.•A data-driven model associates poor sleep, psychological factors, and chronicity of headache.•This data-driven model could be leveraged in clinical trials investigating treatment of TTH.

Objective: To compare the clinical effects of needling interventions eliciting local twitch responses (LTRs) versus needling without eliciting LTRs when applied to muscle trigger points (TrPs) associated with spinal pain of musculoskeletal origin.Databases and data treatment: Electronic databases were searched for randomized or non-randomized clinical trials where one group received needling intervention where LTRs were elicited and was compared with another group receiving the same intervention without elicitation of LTRs in spinal pain disorders associated with TrPs. Outcomes included pain intensity, pain-related disability, and pressure pain thresholds. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool or ROBINS-I tool, methodological quality was assessed with the PEDro score, and quality of evidence was evaluated using the GRADE approach.Results: Six trials were included. The application of a needling intervention eliciting LTRs was associated with a significant reduction in pain intensity immediately after treatment (mean difference (MD): −2.03 points, 95% confidence interval (CI): −3.77 to −0.29; standardized MD (SMD): −1.35, 95% CI: −2.32 to −0.38, p= 0.02) when compared to the same needling intervention without elicitation of LTRs. No effect at short-term follow-up (MD: −0.20 points, 95% CI: −1.46 to 1.06, p= 0.75) was observed. No significant differences based on elicitation or non-elicitation of LTRs were found in related disability (SMD: −0.05, 95% CI: −0.41 to 0.30, p= 0.77) or pressure pain thresholds (MD: 23.39 kPa, 95% CI: −13.68 to 60.47, p= 0.22).Discussion: Low-level evidence suggests an immediate effect of obtaining LTRs during needling interventions on pain intensity, with no significant effects on related disability or pressure pain sensitivity in spinal pain disorders associated with muscle TrPs.Registration number: OSF Registry—https://doi.org/10.17605/OSF.IO/5ZX9N

Objective: The aim of this study was to evaluate the effect of acupuncture/electroacupuncture, alone or combined with other interventions, on pain intensity, pain-related disability, and strength in lateral epicondylalgia (LE) of musculoskeletal origin.Databases and data treatment: Electronic databases were searched for randomized clinical trials, where at least one group received acupuncture or electroacupuncture for LE of musculoskeletal origin. To be eligible, trials had to include humans and collect outcomes on pain intensity or pain-related disability in LE. Data were extracted by two reviewers. The risk of bias (RoB) of the trials was assessed using the Cochrane RoB tool, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the level of evidence was summarized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) using random effects were calculated.Results: A total of 14 trials (10 acupuncture) were included. The meta-analysis found a moderate effect size of acupuncture (SMD = −0.66, 95% confidence interval (CI) = −1.22 to −0.10), but not electroacupuncture (SMD = −0.08, 95% CI = −0.99 to 0.83), in the reduction of elbow pain as compared to a comparative group. Acupuncture exhibited a significant moderate effect size (SMD = −0.51, 95% CI = −0.91 to −0.11) in the improvement of related-disability. Acupuncture (SMD = 0.36, 95% CI = 0.16 to 0.57), but not electroacupuncture (SMD = 0.34, 95% CI = −0.29 to 0.98), exhibited a significant but small effect size on strength. Most significant effects were in the short term. The RoB was low but the heterogeneity of trial results led to a downgrading of the GRADE evidence level.Conclusion: Low-level evidence suggests positive effects of acupuncture, but not electroacupuncture, for pain, related-disability, and strength, in LE of musculoskeletal origin, in the short term.

This population-based study investigated the prevalence of de novo, multitype,post-coronavirus disease (COVID) pain and its associated risk factors in previously hospitalized coronavirus disease 2019 (COVID-19) survivors. The nationwide, cross-sectional study included a cohort of Danish residents previously hospitalized due to severe acute respiratory syndrome coronavirus-2 infection between March 2020 and December 2021. Demographic data, preexisting medical comorbidities, previous pain-related symptoms, medication use for pain management, pain intensity (4-point scale), and development of de novo, multitype,post-COVID pain were collected by a self-reported survey distributed via e-Boks (a secured national digital mail system used in Denmark to provide public information to residents). The sample comprised 4,712 previously hospitalized COVID-19 survivors (48.6% women, mean age: 60.1 ± 15.6 years). At the time of the study (21 ± 6 months after hospitalization), 18.0% (847) reported the presence of de novo, multitype,post-COVID pain, and 38.6% of any pain. A multivariate analysis revealed that female sex (Odds Ratio (OR) 1.711, 95% Confidence Interval (CI) 1.444–2.023), higher body mass index (OR 1.032, 95% CI 1.019–1.045), intensive care unit admission (OR 1.597, 95% CI 1.324–1.926), previous history of whiplash (OR 2.471, 95% CI 1.004–6.081), anxiety (OR 3.626, 95% CI 1.335–9.708), and younger age (OR .982, 95% CI .976–.987) were factors associated with development of de novo, multitype,post-COVID pain. High income (OR .635, 95% CI .494–.817) and high educational level (OR .774, 95% CI .609–.984) were protective factors. In conclusion, multitype pain as a de novopost-COVID symptom was present in 18.0% of previously hospitalized COVID-19 survivors more than 1 year after hospital discharge and as such can be considered as adding to the global burden of chronic pain.

The aims of this study were to phenotype pain in patients with interstitial lung disease (ILD) by investigating the association between sensitization-associated symptoms with quality of life, anxiety/depression, pain catastrophizing, and kinesiophobia levels and identifying those risk factors explaining the variance of quality of life in individuals with ILD and pain. One hundred and thirty-two (38.6% women, mean age: 70, standard deviation: 10.5 years) patients with ILD completed clinical (age, sex, height, weight), psychological (Hospital Anxiety and Depression Scale [HADS] and the Pittsburgh Sleep Quality Index), and health-related quality of life (EQ-5D-5L) variables, as well as the Central Sensitization Inventory (CSI), the Self-Report Leeds Assessment of Neuropathic Symptoms (S-LANSS), Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia (TSK-11) questionnaires. The prevalence of sensitization-associated symptomatology (CSI), neuropathic-like features (S-LANSS), anxiety symptoms, depressive symptoms, or poor sleep was 20.5%, 23.5%, 23.6%, 22.9%, or 51.6%. Significant associations between CSI, S-LANSS, HADS-A, HADS-D, Pain Catastrophizing Scale, TSK-11, and EQ-5D-5L (.220 < r < .716) were found. The regression analysis revealed that CSI, TSK-11, and HADS-D explained 44.8% of the variance of EQ-5D-5L (r2adjusted: .448). This study found the presence of sensitization-associated and neuropathic-like symptoms as well as other central nervous system-derived symptoms, such as anxiety, depression, poor sleep, pain catastrophizing, and kinesiophobia in 25% of ILD patients with pain. Sensitization-associated symptoms, depression, and kinesiophobia were associated with a worse quality of life. These findings would support that individuals with ILD can exhibit different pain phenotypes, including nociplastic-like pain phenotype based on self-reported measurements.

•C1/C2 hypomobility is an important finding in women with migraine and is related to migraine chronicity.•Mobility of the C1/C2 segment is influenced by neck pain related-disability.•Chronic migraine patients have a reduced global cervical range of motion.

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Objective: The aim of this study was to compare the effects of dry needling (DN) versus pressure release over scalene muscle trigger points (TrPs) on pain, related disability, and inspiratory vital capacity in individuals with neck pain.Methods: In this randomized, single-blind trial, 30 patients with mechanical neck pain and active TrPs in the scalene musculature were randomly allocated to trigger point dry needling (TrP-DN; n = 15) or pressure release (n = 15) groups. The DN group received a single session of DN of active TrPs in the anterior scalene muscles, and the pressure release group received a single session of TrP pressure release over the same muscle lasting 30 s. The primary outcome was pain intensity as assessed by a numerical pain rate scale (NPRS, 0–10). Secondary outcomes included disability (neck disability index, NDI) and inspiratory vital capacity. Outcomes were assessed at baseline and 1 day (immediately post), 1 week, and 1 month after the treatment session. Data were expressed as mean score difference (Δ) and standardized mean difference (SMD).Results: Patients receiving DN exhibited a greater decrease in pain intensity than those receiving TrP pressure release at 1 month (Δ 1.2 (95% CI–1.8, –0.6), p = 0.01), but not immediately (1 day) or 1 week after. Patients in the DN group exhibited a greater increase in inspiratory vital capacity at all follow-up time points (Δ 281 mm (95% CI 130, 432) immediately after, Δ 358 mm (95% CI 227, 489) 1 week after, and Δ 310 mm (95% CI 180, 440) 1 month after treatment) than those in the pressure release group (p = 0.006). Between-group effect sizes were large at all follow-up time points (1.1 > SMD > 1.3) in favor of DN.Conclusion: This trial suggests that a single session of DN over active TrPs in the scalene muscles could be effective at reducing pain and increasing inspiratory vital capacity in individuals with mechanical neck pain. Future studies are needed to further confirm these results.

No study to our knowledge has investigated the effects longer than 1 year of manual therapy in carpal tunnel syndrome (CTS). The purpose of this study was to investigate the effects of manual therapy versus surgery at 4-year follow-up and to compare the post-study surgery rate in CTS.

We investigated if dynamic pressure pain sensitivity in the symptomatic area is associated with pressure sensitivity in local and distant pain-free areas in cluster headache (CH). A pressure algometry set consisting of 8 rollers with fixed pressure levels ranging from 500 to 5300 g was used to assess dynamic pressure pain sensitivity in men with episodic CH. Each roller was moved from an anterior-to-posterior direction over the temporalis muscle. The load level of the first painful roller was considered the dynamic pain threshold (DPT). Further, pain elicited during DPT (roller evoked pain) was also assessed. We used a pressure algometer to determine pressure pain thresholds (PPTs) over the temporalis muscle, C5/C6 joint, second metacarpal, and tibialis anterior. Patients were assessed in an asymptomatic (remission) phase, at least 6 months after their last cluster period and without taking pharmacological treatment. Forty men with episodic CH (mean age 42 years) were included. Both outcomes, DPTs (r= 0.781, P< 0.001) and roller-evoked pain (r= 0.586; P< 0.001) were bilaterally correlated. Further, DPT, but not roller-evoked pain, was moderately associated with PPTs measured at the symptomatic (temporalis: r= 0.665, P< 0.001) and distant pain-free (C5–C6 joint: r= 0.389, P= 0.013; second metacarpal: r= 0.551, P< 0.001; and, tibialis anterior: r= 0.308, P= 0.035) points. Dynamic pressure sensitivity in the trigeminal area was correlated to pressure pain sensitivity at both symptomatic and distant pain-free areas in men with CH supporting the use of roller pressure algometry. Dynamic pressure algometry may be a new tool for assessing the status of sensitization in primary headaches.

•Wheelchair basketball players with shoulder pain get localized pain sensitivity.•Basketball players without shoulder pain had similar pressure pain sensitivity.•Elite wheelchair basketball players with shoulder pain get active trigger points.•The referred pain elicited by active trigger points reproduced shoulder pain.•Basketball players without shoulder pain get similar latent trigger points.

Objectives: To determine the presence of post-needling induced pain in subjects who had suffered a stroke and received trigger point (TrP) dry needling (DN), and to investigate the effects of including TrP-DN into a rehabilitation program for shoulder pain in this population.Methods: A randomized clinical trial was conducted. Sixteen patients who had suffered a stroke and presented with shoulder pain were randomly assigned to receive rehabilitation alone or rehabilitation combined with DN. Both groups received a neurorehabilitation session including modulatory interventions targeting the central nervous system. Patients in the DN group also received a single session of DN over active TrPs in the shoulder musculature. A numerical pain rating scale (NPRS, 0–10) was used to asses post-needling induced pain at 1 min, 24 h, and 72 h after needling. Shoulder pain (NPRS, 0–10) was assessed at baseline, and 3 and 7 days after DN in both groups.Results: Five (62%) patients receiving TrP-DN reported post-needling induced pain. Post hoc analysis found that post-needling induced pain decreased significantly at 24 and 72 h (both p < 0.001) after DN. Patients receiving TrP-DN plus rehabilitation exhibited greater decreases in shoulder pain intensity at 3 days (Δ = −4.2, 95% confidence interval (CI) = −5.8 to −2.6) and 7 days (Δ = −4.3, 95% CI = −5.9 to −2.7) after the intervention compared with those receiving rehabilitation alone (all p < 0.001).Conclusion: This trial found that 50% of stroke patients receiving DN experienced post-needling induced pain, a side effect that almost disappeared 72 h after the intervention without any additional therapeutic action. In addition, the inclusion of TrP-DN into a rehabilitation session was effective at decreasing shoulder pain in these patients.

Objective To determine the effects of inclusion of deep dry needling into a treatment session following the Bobath concept on spasticity, motor function and postural control after a stroke.Methods 26 patients who had suffered a stroke were randomly assigned to one of two treatment groups: Bobath only, or Bobath plus dry needling. Both groups received a session including strengthening, stretching and reconditioning exercises following the principles of the Bobath concept. Patients in the Bobath plus dry needling group also received a single session of ultrasound-guided dry needling of the tibialis posterior. Spasticity (Modified Modified Ashworth Scale), function (Fugl-Meyer Scale) and stability limits (computerised dynamic posturography using the SMART EquiTest System) were collected before and 10?min after treatment by a blinded assessor. The parameters of the stability limits included movement velocity (MVL), maximum excursion (MXE), end-point excursion (EPE) and directional control (DCL).Results A greater number of individuals receiving Bobath plus dry needling exhibited a decrease in spasticity after treatment (P<0.001). Analysis of covariance (ANCOVA) showed that patients receiving Bobath plus dry needling exhibited greater improvements in the balance (0.8, 95%?CI 0.2 to 1.4), sensory (1.7, 95%?CI 0.7 to 2.7) and range of motion (3.2, 95%?CI 2.0 to 4.4) domains of the Fugl-Meyer Scale than those receiving Bobath only. ANCOVA also found that subjects receiving dry needling showed a greater increase in MVL non-affected forward direction, EPE non-affected direction, MXE backward and MXE affected/non-affected, DCL backward and DCL affected backward direction, than those who did not receive it.Conclusions The inclusion of deep dry needling into a treatment session following the Bobath concept was effective at decreasing spasticity and improving balance, range of motion and the accuracy of maintaining stability in patients who had experienced a stroke.Trial registration number NCT02579291.

Objective To compare the effectiveness of trigger point dry needling (TrP-DN) versus placebo needling, relative to an untreated control group, on pain and quality of life in primary dysmenorrhoea.Methods In this randomised, single blind, parallel-group trial, 56 females with primary dysmenorrhoea were randomly allocated to TrP-DN (n=19), placebo needling (n=18) or no treatment (n=19). Patients in both groups were asked to undertake a stretching exercise of the rectus abdominis daily. The needling group received a single session of TrP-DN to trigger points (TrPs) in the rectus abdominis, and the placebo group received placebo needling. The primary outcome was pain intensity (visual analogue scale). Secondary outcomes were quality of life, use of non-steroidal anti-inflammatory drugs, the number of days with pain, and self-perceived improvement, measured using a Global Rate of Change. Outcomes were assessed at baseline, and 1 and 2 months after the treatment.Results Females receiving TrP-DN exhibited greater decreases (P<0.001) in pain than those receiving placebo (1?month: ?-19.8 mm, 25.9 to -13.7; 2 months: ?-26.0 mm, -33.1 to -18.9) or assigned to the untreated control group (1?month: ?-26.0mm, -32.5 to -19.5; 2 months: ?-20.1 mm, -26.4 to -13.8). Females in the TrP-DN group also exhibited a greater decrease in the amount of medications (P<0.001). No differences in the number of days with pain or quality of life were found (all P>0.1).Conclusions This trial suggests that a single session of TrP-DN of the rectus abdominis combined with stretching was more effective than placebo needling and stretching alone at reducing pain and the amount of medication used in primary dysmenorrhoea.Trial registration number ACTRN12616000170426.

ObjectiveTo determine the effects of inclusion of deep dry needling into a treatment session following the Bobath concept on spasticity, motor function and postural control after a stroke.Methods26 patients who had suffered a stroke were randomly assigned to one of two treatment groups: Bobath only, or Bobath plus dry needling. Both groups received a session including strengthening, stretching and reconditioning exercises following the principles of the Bobath concept. Patients in the Bobath plus dry needling group also received a single session of ultrasound-guided dry needling of the tibialis posterior. Spasticity (Modified Modified Ashworth Scale), function (Fugl-Meyer Scale) and stability limits (computerised dynamic posturography using the SMART EquiTest System) were collected before and 10 min after treatment by a blinded assessor. The parameters of the stability limits included movement velocity (MVL), maximum excursion (MXE), end-point excursion (EPE) and directional control (DCL).ResultsA greater number of individuals receiving Bobath plus dry needling exhibited a decrease in spasticity after treatment (P<0.001). Analysis of covariance (ANCOVA) showed that patients receiving Bobath plus dry needling exhibited greater improvements in the balance (0.8, 95% CI 0.2 to 1.4), sensory (1.7, 95% CI 0.7 to 2.7) and range of motion (3.2, 95% CI 2.0 to 4.4) domains of the Fugl-Meyer Scale than those receiving Bobath only. ANCOVA also found that subjects receiving dry needling showed a greater increase in MVL non-affected forward direction, EPE non-affected direction, MXE backward and MXE affected/non-affected, DCL backward and DCL affected backward direction, than those who did not receive it.ConclusionsThe inclusion of deep dry needling into a treatment session following the Bobath concept was effective at decreasing spasticity and improving balance, range of motion and the accuracy of maintaining stability in patients who had experienced a stroke.Trial registration numberNCT02579291.

ObjectiveTo compare the effectiveness of trigger point dry needling (TrP-DN) versus placebo needling, relative to an untreated control group, on pain and quality of life in primary dysmenorrhoea.MethodsIn this randomised, single blind, parallel-group trial, 56 females with primary dysmenorrhoea were randomly allocated to TrP-DN (n=19), placebo needling (n=18) or no treatment (n=19). Patients in both groups were asked to undertake a stretching exercise of the rectus abdominis daily. The needling group received a single session of TrP-DN to trigger points (TrPs) in the rectus abdominis, and the placebo group received placebo needling. The primary outcome was pain intensity (visual analogue scale). Secondary outcomes were quality of life, use of non-steroidal anti-inflammatory drugs, the number of days with pain, and self-perceived improvement, measured using a Global Rate of Change. Outcomes were assessed at baseline, and 1 and 2 months after the treatment.ResultsFemales receiving TrP-DN exhibited greater decreases (P<0.001) in pain than those receiving placebo (1 month: Δ−19.8 mm, 25.9 to −13.7; 2 months: Δ−26.0 mm, −33.1 to −18.9) or assigned to the untreated control group (1 month: Δ−26.0mm, −32.5 to −19.5; 2 months: Δ−20.1 mm, −26.4 to −13.8). Females in the TrP-DN group also exhibited a greater decrease in the amount of medications (P<0.001). No differences in the number of days with pain or quality of life were found (all P>0.1).ConclusionsThis trial suggests that a single session of TrP-DN of the rectus abdominis combined with stretching was more effective than placebo needling and stretching alone at reducing pain and the amount of medication used in primary dysmenorrhoea.Trial registration numberACTRN12616000170426 .

This survey investigated the prevalence of de novo widespread musculoskeletal post-COVID pain and risk factors for its development in nonhospitalized COVID-19 survivors. A nationwide exploratory cross-sectional study was conducted, including a cohort of 593,741 Danish residents who had suffered from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from March 2020 to December 2021. A questionnaire was distributed to the Danish population via the digital mail system (e-Boks). Self-reported demographic data, previous medical comorbidities (diagnosed), socioeconomic data, time of infection, prior chronic pain conditions (diagnosed), development of de novo widespread pain after infection, pain medication, and pain intensity information were collected. Responders consisted of 130,443 nonhospitalized participants (58.2% women; mean age: 50.2 years). At a mean of 14.4 (standard deviation 6.0) months after infection, 6,875 (5.3%) patients reported the presence of de novo widespread musculoskeletal post-COVID pain. Almost 75% of the patients reported a moderate to severe intensity of the pain. In conclusion, de novo widespread post-COVID pain was present in 5.3% of nonhospitalized COVID-19 survivors 1 year after infection (14.4 ± 6.0 months). Older age, female sex, higher BMI, and history of migraine, whiplash, stress, type-2 diabetes, neurological disorders, and lower socioeconomic status were risk factors associated with the development of de novo widespread post-COVID pain in nonhospitalized patients. As de novo widespread pain is considered a sign of sensitization, this group will require specialized pain management attention.

•Digital physical therapy may be a solution for continuity during lockdown, yet its development appears complex.•Implementation difficulties seem to relate to physical, attentional, and training factors.•Technological accessibility, adaptation of the therapist and involvement of the whole family appear to be facilitators.•Future possibilities may support a better follow-up with fluid communication between families and therapists.

ObjectivesTo analyze the effect of weight on psychological and functional outcomes in multiple sclerosis (MS) patients, including self-perception, depression, functional level, fatigue, and self-rated health status.MethodsOne hundred and one (n= 101) patients with MS participated in this cross-sectional study. Outcomes were scores in the Beck Depression Inventory, NEO Five-Factor Inventory (NEOFFI), Functional Assessment of Multiple Sclerosis (FAMS), Fatigue Impact Scale, and Quality Short-Form Health Survey 36 (SF-36). Patients were classified as normal weight (18.5 < BMI < 24.9 kg/m2) or overweight (25.0 > BMI > 29.9 kg/m2). One-way analysis of covariance was conducted with gender, age, and years with disease as covariates.ResultsDepression levels were significantly higher in overweight versus normal-weight MS patients (F= 6.381; P= 0.013). NEOFFI scores were significantly higher in overweight versus normal-weight MS patients for extraversion (F= 6.331; P= 0.014), conscientiousness (F= 4.794; P= 0.034), and neuroticism (F= 5.422; P= 0.022) but not for openness (F= 2.174; P= 0.109) or agreeableness (F= 0.047; P= 0.829). The two groups did not significantly differ in fatigue (P> 00.5). Scores in general (F= 4.708; P= 0.032) and mental health (F= 4.583; P= 0.035) SF-36 domains were significantly lower in overweight versus normal-weight patients. Scores for FAMS domains of emotional well-being (F= 8.050; P= 0.006), general contentment (F= 7.967; P= 0.006), and family/social well-being (F= 7.662; P= 0.007) were significantly lower in overweight versus normal-weight patients.ConclusionsOverweight MS patients evidenced higher depression levels, lower functional capacity, and worse self-rated health status in comparison to normal-weight MS patients. These results suggest that weight control programs should be incorporated into the management of patients with MS.

ObjectivesTo analyze psychological distress, comorbidity, and medication consumption among subjects suffering from disabling migraine compared to non-migraineurs controls and to identify those factors associated with psychological distress in migraine adults.MethodsA case–control study was conducted with data obtained from adults aged 16 years or older [N = 29,478] who participated in the 2006 Spanish National Health Survey. We analyzed socio-demographic characteristics, self-perceived health status, lifestyle habits, presence of concomitant chronic disease, and medication consumption in subjects with disabling migraine the previous two weeks. The 12-item Global Health Questionnaire was used to assess psychological distress.ResultsThe prevalence of disabling migraine among Spanish adults was 2.2 percent [95 percent confidence interval [CI] 2.04–2.37]. Migraine was more prevalent in women [77.5 percent] than men [22.5 percent]. Migraine sufferers showed 1.57 [95 percent CI 1.12–2.19] and 3.68 [95 percent CI 2.54–5.33] times more psychological distress as compared to non-migraineurs. Migraineurs consumed analgesics [odds ratio [OR] 8.28, 95 percent CI 6.30–10.89], tranquilizers [OR 3.34, 95 percent CI 2.61–4.28], antidepressants [OR 3.82, 95 percent CI 2.85–5.12], and alternative medicines [OR 1.72, 95 percent CI 1.22–2.44] more frequently than non-migraineurs. Depression [OR 2.49, 95 percent CI 1.66–3.74], chronic bronchitis [OR 2.25, 95 percent CI 1.13–2.47], musculoskeletal pain [OR 1.59, 95 percent CI 1.11–2.28], and worse self-report health status [1.73, 95 percent CI 1.16–2.58] were related to a higher psychological distress.ConclusionThis population-based survey revealed that individuals suffering from disabling migraine had greater psychological distress as compared to non-migraineurs. Psychological distress was related to a greater consumption of medications, a worse self-reported health status, depression, and other comorbid conditions. Clinicians should be aware of these conditions to improve the management of these patients.

Our aim was to investigate the relationship between Val158Met polymorphisms, headache, and pressure hypersensitivity in children with chronic tension-type headache (CTTH). A case–control study with blinded assessor was conducted. Seventy children with CTTH associated with pericranial tenderness and 70 healthy children participated. After amplifying Val158Met polymorphism by polymerase chain reactions, we assessed genotype frequencies and allele distributions. We classified children according to their Val158Met polymorphism: Val/Val, Val/Met, Met/Met. Pressure pain thresholds (PPT) were bilaterally assessed over the temporalis, upper trapezius, second metacarpal, and tibialis anterior muscles. The distribution of Val158Met genotypes was not significantly different (p = 0.335), between children with CTTH and healthy children, and between boys and girls (p = 0.872). Children with CTTH with the Met/Met genotype showed a longer headache history compared with those with Met/Val (p = 0.001) or Val/Val (p = 0.002) genotype. Children with CTTH with Met/Met genotype showed lower PPT over upper trapezius and temporalis muscles than children with CTTH with Met/Val or Val/Val genotype (p < 0.01). The Val158Met catechol-O-methyltransferase (COMT) polymorphism does not appear to be involved in predisposition to suffer from CTTH in children; nevertheless, this genetic factor may be involved in the phenotypic expression, as pressure hypersensitivity was greater in those CTTH children with the Met/Met genotype.

Our aim was to investigate the relationship between Val158Met polymorphisms, headache, and pressure hypersensitivity in children with chronic tension-type headache (CTTH). A case–control study with blinded assessor was conducted. Seventy children with CTTH associated with pericranial tenderness and 70 healthy children participated. After amplifying Val158Met polymorphism by polymerase chain reactions, we assessed genotype frequencies and allele distributions. We classified children according to their Val158Met polymorphism: Val/Val, Val/Met, Met/Met. Pressure pain thresholds (PPT) were bilaterally assessed over the temporalis, upper trapezius, second metacarpal, and tibialis anterior muscles. The distribution of Val158Met genotypes was not significantly different (p0.335), between children with CTTH and healthy children, and between boys and girls (p0.872). Children with CTTH with the Met/Met genotype showed a longer headache history compared with those with Met/Val (p0.001) or Val/Val (p0.002) genotype. Children with CTTH with Met/Met genotype showed lower PPT over upper trapezius and temporalis muscles than children with CTTH with Met/Val or Val/Val genotype (p< 0.01). The Val158Met catechol-O-methyltransferase (COMT) polymorphism does not appear to be involved in predisposition to suffer from CTTH in children; nevertheless, this genetic factor may be involved in the phenotypic expression, as pressure hypersensitivity was greater in those CTTH children with the Met/Met genotype.

ABSTRACTObjective: To review current evidence for trigger point TrP involvement in tension-type headache TTH.Findings: It seems that mechanical pain sensitivity is a consequence and not a causative factor for TTH. Recent evidence modifying previous knowledge about relationships between muscle tissues and chronic tension-type headache, suggests a potential role of myofascial TrPs in the genesis of the pain. In fact, active TrPs reproducing the headache attacks are present in both episodic and chronic TTH in a similar percentage, supporting an etiological role of active TrPs in TTH. Further, spatial and temporal summation of TrP activity is present in TTH. An updated pain model suggests that headache perception can be explained by referred pain from TrPs in the craniocervical muscles, mediated through the spinal cord and the trigeminal nucleus caudalis rather than tenderness of the muscles themselves. Different therapeutic strategies, i.e., pharmacological, physical therapy, psychological, and acupuncture, are generally used for the management of TTH. All these therapeutic interventions are also targeted to inactivating TrP activity.Conclusions: Although there is an increasing comprehension of the role of active TrPs in TTH, future studies investigating the effectiveness of inactivation of TrPs into the evolution of TTH are urgently needed.

This review discusses current data on nosological boundaries related to diagnosis, pathophysiology and therapeutic strategies in chronic tension-type headache (CTTH).

The presence of altered nociceptive pain processing in patients with upper extremity tendinopathy/overuse injury is conflicting. Our aim was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas between patients with upper extremity tendinopathy/overuse injury and controls.

Objective. To evaluate the effects of combining dry needling with other physical therapy interventions versus the application of the other interventions or dry needling alone applied over trigger points (TrPs) associated to neck pain. Databases and Data Treatment. Electronic databases were searched for randomized controlled trials where at least one group received dry needling combined with other interventions for TrPs associated with neck pain. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool, methodological quality was assessed with PEDro score, and the quality of evidence was assessed by using the GRADE approach. Between-groups mean differences (MD) and standardized mean difference (SMD) were calculated. Results. Eight trials were included. Dry needling combined with other interventions reduced pain intensity at short-term (SMD −1.46, 95% CI −2.25 to −0.67) and midterm (SMD −0.38, 95% CI −0.74 to −0.03) but not immediately after or at long-term compared with the other interventions alone. A small effect on pain-related disability was observed at short-term (SMD −0.45, 95% CI −0.87 to −0.03) but not at midterm or long-term. The inclusion of dry needling was also effective for improving pressure pain thresholds only at short-term (MD 112.02 kPa, 95% CI 27.99 to 196.06). No significant effects on cervical range of motion or pain catastrophism were observed. Conclusion. Low-to-moderate evidence suggests a positive effect to the combination of dry needling with other interventions for improving pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion in people with neck pain associated with TrPs at short-term. No midterm or long-term effects were observed.

A peripheral mechanism has been proposed for nummular headache; however, there have been descriptions of atypical features resembling migraine. The authors describe a case in which algometry assessment facilitated the discrimination between atypical nummular headache and circumscribed migraine. A 21-year-old woman presented with a history of focal episodic pain in a circumscribed area on the left frontal region. The algometry study showed a unilateral and diffuse decrease of the pain pressure thresholds with frontal predominance, as has been proposed for migraine patients. This result led the authors to introduce a more specific preventive therapy with topiramate, with significant relief. In conclusion, cartographic investigation of pressure pain sensitivity is a simple tool that can help to differentiate between nummular headache and migraine. Further confirmatory investigations are needed.

Background. Hamstring injuries continue to affect active individuals and although inadequate muscle extensibility remains a commonly accepted factor, little is known about the most effective method to improve flexibility. Purpose. To determine if an isolated neurodynamic sciatic sliding technique would improve hamstring flexibility to a greater degree than stretching or a placebo intervention in asymptomatic subjects with short hamstring syndrome (SHS). Study Design. Randomized double-blinded controlled trial. Methods. One hundred and twenty subjects with SHS were randomized to 1 of 3 groups: neurodynamic sliding, hamstring stretching, and placebo control. Each subject’s dominant leg was measured for straight leg raise (SLR) range of motion (ROM) before and after interventions. Data were analyzed with a 3×2 mixed model ANOVA followed by simple main effects analyses. Results. At the end of the study, more ROM was observed in the Neurodynamic and Stretching groups compared to the Control group and more ROM in the Neurodynamic group compared to Stretching group. Conclusion. Findings suggest that a neurodynamic sliding technique will increase hamstring flexibility to a greater degree than static hamstring stretching in healthy subjects with SHS. Clinical Relevance. The use of neurodynamic sliding techniques to improve hamstring flexibility in sports may lead to a decreased incidence in injuries; however, this needs to be formally tested.

The article discusses "The Influence of Patient Attitude Toward Massage on Pressure and Pain Sensitivity and Immune System after Application of Myofascial Release in Breast Cancer Survivors: A Randomized, Controlled Crossover Study," a study which showed that myofascial release led to increased immune function among those subjects with a positive attitude toward massage. Another key outcome measure was the pressure pain threshold (PPT) of the breast-cancer survivors.

Introduction: It has previously been reported that local and referred pain from active myofascial trigger points (MTPs) in the neck and shoulder region contribute to fibromyalgia (FM) pain and that the pain pattern induced from active MTPs can reproduce parts of the spontaneous clinical FM pain pattern. The current study investigated whether the overall spontaneous FM pain pattern can be reproduced by local and referred pain from active MTPs located in different muscles. Methods: A spontaneous pain pattern in FM was recorded in 30 FM patients and 30 healthy subjects served as controls. Local and referred pain patterns induced from active (patients) and latent (controls) MTPs were recorded following manual stimulation. The existence of MTPs was confirmed by intramuscular electromyographical registration of spontaneous electrical activity. Results: Local and referred pain areas induced from key active MTPs in FM were larger than pain areas from latent MTPs in healthy controls (P&lt; 0.001), but were similar to the overall spontaneous FM pain area in FM (P> 0.05). The induced pain area was positively associated with current spontaneous pain intensity in FM (P&lt; 0.01). The locations of key active MTPs in FM patients were found to have latent MTPs in healthy subjects. The muscles containing key active MTPs in FM are often observed in the muscles of extensor digitorum, trapezius, infraspinatus in the upper part of the body and of quadratus lumborum, gluteus medius in the lower part of the body. Conclusions: The overall spontaneous FM pain pattern can be reproduced by mechanical stimulation of active MTPs located in different muscles, suggesting that fibromyalgia pain is largely composed of pain arising from muscle pain and spasm. Targeting active MTPs and related perpetuating factors may be an important strategy in FM pain control. Trial registration: ISRCTN ISRCTN43167547.