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Objective: To assess the effectiveness of different dosages of local twitch responses (LTRs) elicited by deep dry needling (DDN) in relation to pain intensity, pressure pain threshold (PPT), cervical range of movement (CROM), and disability degree in cervical myofascial pain patients. Design: A randomized, double-blind clinical trial. Participants: Eighty-four patients (21 males, 63 females; 27.18 ± 10.91 yrs) with cervical pain. Interventions: DDN in active myofascial trigger points (MTrPs) in the upper trapezius. Patients were randomly divided into four groups: (a)no LTRs elicited, (b) four LTRs elicited, (c)six LTRs elicited, and (d) needling until no more LTRs were elicited. Outcome Measures: Pain intensity, PPT, CROM, and disability degree were assessed before treatment, post-immediate, 48 hrs, 72 hrs, and 1 wk after treatment. Results: Significant differences were found in the time factor for all the variables (P < 0.005), but no significant changes were found in the group-time interaction (P > 0.05). Conclusions: DDN in the upper trapezius MTrP improved pain at a 1-wk follow-up, but improvements were not significantly different among DDN dosages. A higher number of patients with neck pain improvements superior to the moderate clinically important differences were observed when eliciting 6 LTRs and LTRs until exhaustion compared with not eliciting LTRs. [ABSTRACT FROM AUTHOR]

Objectives The main aim was to determine the effects of percutaneous electrical nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS) on endogenous pain mechanisms in patients with musculoskeletal pain. Design A systematic review and meta-analysis. Methods The search was conducted on March 1, 2022, in the EMBASE, CINAHL, PubMed, PEDro, Cochrane Library, Web of Science, Medline, and SCOPUS databases. Randomized controlled trials comparing the use of transcutaneous or percutaneous electrostimulation with a placebo, control group, or standard treatment in patients with musculoskeletal pain were included. Outcome measurements were quantitative sensory testing somatosensory variables like pressure pain threshold (PPT), conditioned pain modulation, and temporal summation of pain. The pooled data were evaluated in Review Manager 5.4. Results Twenty-four randomized controlled trials (n = 24) were included in the qualitative analysis and 23 in the meta-analysis. The immediate effects of PENS and TENS on local PPTs were significant, with a moderate effect size (standardized mean difference [SMD] 0.53; 95% confidence interval [CI]: 0.34 to 0.72; P  < 0.00001). When only studies with a lower risk of bias were analyzed, the heterogeneity decreased from I 2 = 58% (P  < 0.00001) to I 2 = 15% (P  = 0.01), and a decrease in the overall effect was observed (SMD 0.33; 95% CI: 0.7 to 0.58). The short-term effects on local PPTs were not significant when compared with the control group (P  = 0.13). The mid-term effects on local PPTs were significant, showing a large effect size (SMD 0.55; 95% CI: 0.9 to 1.00; P  = 0.02). The immediate effects on conditioned pain modulation were significant, with a large effect size (SMD 0.94; 95% CI: 0.48 to 1.41; P  < 0.0001). Conclusion PENS and TENS have a mild–moderate immediate effect on local mechanical hyperalgesia in patients with musculoskeletal pain. It appears that these effects are not sustained over time. Analyses suggest an effect on central pain mechanisms producing a moderate increase in remote PPT, an increase in conditioned pain modulation, but further studies are needed to draw clearer conclusions. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of a therapeutic patient education (TPE) intervention based on a biobehavioral approach combined with manual therapy (MT) to reduce pain in patients with chronic nonspecific neck pain (CNSNP). In addition, this study intended to assess the effectiveness of a multimodal physiotherapy program including TPE to reduce pain in patients with CNSNP. Design: Single-blind randomized controlled trial. Interventions: A total of 47 patients with CNSNP were randomized into three groups: (1) MT (control group); (2) MT plus TPE based on a biobehavioral approach (Exp1); and (3) MT plus TPE based on a biobehavioral approach, and therapeutic exercise (Exp2). Main Outcome Measurements: The clinical outcomes were recorded at baseline and at 1 and 4 months after the initiation of treatment. The primary outcome was pain intensity (Visual Analog Scale), and the secondary outcomes were pain catastrophizing (Pain Catastrophizing Scale), illness severity and global improvement (Clinical Global Impression Scale), and mechanosensitivity of the median nerve (Upper Limb Neural Test) and the cervical region (Modified Passive Neck Flexion Test). Results: Statistically significant differences in pain intensity were found when Exp2 was compared with Exp1 and the control group at 4 months (p = 0.015 and p = 0.001, respectively), but no difference was found between Exp1 and the control group at the same follow-up period (p = 0.86). Exp2 showed statistically significant differences in all of the secondary outcomes except for pain catastrophizing when compared with the control group at 4 months. Conclusions: The Exp2 group was more effective than Exp1 and the control group in terms of reducing pain intensity at 4 months; at post-treatment, only Exp2 was more effective than the control group. [ABSTRACT FROM AUTHOR]

Objective: The aim of this umbrella review with meta-meta-analysis was to assess the effectiveness of orthopedic manual therapy in isolation on pain sensitization in patients with chronic musculoskeletal pain. Design: A systematic search was performed in different databases including systematic reviews with or without meta-analysis. The outcome measures included were pressure pain threshold, temporal summation, and conditioned pain modulation. The results of the different reviews were statistically synthesized through a random-effect meta-analysis, of all standardized mean differences and the corresponding 95% confidence interval reported by each study. Results: For mechanical hyperalgesia, the meta-meta-analysis of three meta-analyses revealed a statistically significant small-moderate effect of orthopedic manual therapy, with no evidence of heterogeneity and moderate-quality evidence. In terms of temporal summation, one meta-analysis revealed a statistically significant small effect of orthopedic manual therapy intervention, with moderate heterogeneity and low quality of evidence. Finally, one review without meta-analysis found that orthopedic manual therapy improved endogenous analgesia with low-quality evidence. Conclusion: Orthopedic manual therapy in isolation improved mechanical hyperalgesia with moderate-quality evidence, as well as temporal summation and conditioned pain modulation with low-quality evidence. However, its effects are limited only to immediate and short-term. [ABSTRACT FROM AUTHOR]

Objective. To assess differences in neural mechanosensitivity between patients with chronic nonspecific neck pain with and without neuropathic features (NF and No-NF, respectively). Design. Descriptive, cross-sectional study. Setting. A primary care center, a hospital physiotherapy outpatient department, and a university campus. Subjects. Chronic nonspecific neck pain patients classified by the self-completed leeds assessment of neuropathic symptoms and signs pain scale (SLANSS; 49 patients with NF [S-LANSS ⩾ 12] and 50 patients with No-NF [S-LANSS < 12]) and a healthy control group (n=48). Methods. The primary measurements were the mechanosensitivity of the median nerve and cervical region, specifically the assessment of the onset of symptoms and submaximal pain intensity according to the upper limb neural test 1 (ULNT1) for the median nerve and the modified passive neck flexion test (MPNFT) for the cervical region; secondary measurements included pain intensity, neck disability, kinesiophobia, and pain catastrophizing. Results. Statistically significant differences between the NF and No-NF groups were found with respect to the onset of symptoms of ULNT1 (-15.11 [-23.19 to -7.03]) and MPNFT (-6.58 [-11.54 to -1.62]), as well as the outcomes of the visual analogue scale (Mean difference [95% Confidence Interval]; 7.12 [1.81-12.42]) and neck disability index (3.72 [1.72-5.71]). Both chronic nonspecific neck pain groups showed statistically significant differences compared with the control group for all outcomes assessed (P< 0.01) except for the onset of symptoms of ULNT1 in the No-NF group. Conclusions. The findings of this study suggest that chronic nonspecific neck pain patients with NF have greater neural mechanosensitivity, pain intensity, and neck disability than those with No-NF. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to assess the current evidence for the effects of neural mobilization (NM) treatments. Methods Three umbrella reviews with meta–meta-analyses were conducted to determine the effects of NM on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in participants who were asymptomatic. The study used the grading criteria proposed by the Physical Activity Guidelines Advisory Committee to assess the quality of evidence. Results One meta–meta-analysis revealed a statistically significant moderate effect on pain intensity (standardized mean difference [SMD] = −0.75, 95% CI = −1.12 to −0.38) but with evidence of heterogeneity (Q  = 14.13; I2 = 65%). The study found a significantly large effect of NM on disability (SMD = −1.22, 95% CI = −2.19 to −0.26), again with evidence of heterogeneity (Q  = 31.57; I2 = 87%). The third meta–meta-analysis showed a statistically significant moderate effect of NM on mechanosensitivity (SMD = 0.96, 95% CI = 0.35 to 1.57), with no evidence of heterogeneity (Q  = 2.73; I2 = 63%). For all examined outcomes, the quality of evidence was limited. Conclusion Overall, the results indicated that although NM treatment had a moderate to large beneficial clinical effect on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in individuals who were asymptomatic, the quality of evidence was limited. Impact Neural mobilization treatments showed positive results on the pain intensity and disability in individuals with musculoskeletal conditions. Neural mobilization could be integrated into the physical therapy management, although more research is needed. [ABSTRACT FROM AUTHOR]

Objective. To compare patients with chronic migraine (CM) and chronic temporomandibular disorders (TMD) on disability, pain, and fear avoidance factors and to associate these variables within groups. Design. Descriptive, cross-sectional study. Settings. A neurology department and a temporomandibular disorders consult in a tertiary care center. Subjects. A total of 50 patients with CM and 51 patients with chronic TMD, classified by international criteria classifications. Methods. The variables evaluated included pain intensity (visual analog scale [VAS]), neck disability (NDI), craniofacial pain and disability (CF-PDI), headache impact (HIT-6), pain catastrophizing (PCS), and kinesiophobia (TSK-11). Results. Statistically significant differences were found between the CM group and the chronic TMD group in CF-PDI (P < 0.001), PCS (P = 0.03), and HIT-6 (P < 0.001); however, there were no differences between the CM group and the VAS, NDI, and TSK-11 groups (P > 0.05). For the chronic TMD group, the combination of NDI and TSK-11 was a significant covariate model of CF-PDI (adjusted R² = 0.34). In the CM group, the regression model showed that NDI was a significant predictive factor for HIT-6 (adjusted R² = 0.19). Conclusions. Differences between the CM group and the chronic TMD group were found in craniofacial pain and disability, pain catastrophizing, and headache impact, but they were similar for pain intensity, neck disability, and kinesiophobia. Neck disability and kinesiophobia were covariates of craniofacial pain and disability (34% of variance) for chronic TMD. In the CM group, neck disability was a predictive factor for headache impact (19.3% of variance). [ABSTRACT FROM AUTHOR]

Objective. Insufficient evidence exists to compare widespread pain (WP), pain sensibility, and psychological factors that occur in patients presenting with chronic neck pain (CNP) or a combination of temporomandibular disorder (TMD) and other complaints. The present study compared the pain sensibility and psychological factors of subjects with CNP with those with TMD1CNP. Design. Cross-sectional study. Setting. Local community. Subjects. A nonprobabilistic convenience sample of 86 persons with CNP or TMD was recruited into three groups: CNP, TMD with myofascial pain in masticatory muscles with cocomitant CNP (TMD1CNP), and asymptomatic control groups consisted of 27, 29, and 30 participants, respectively. Methods. Participants underwent a clinical examination to evaluate WP with computerized assessment based on the pain drawing, pressure pain thresholds (PPT), and psychological factors, which were evaluated using the pain catastrophizing scale (PCS) and the state-trait anxiety inventory (STAI). Results. Statistically significant differences were observed between participants with CNP and TMD1CNP for WP (t 5 -2.80, P< 0.01, d 5-1.06). Post hoc analyses only revealed significant differences between TMD1CNP participants and asymptomatic controls for PPT at extratrigeminal areas. Pearson correlation analyses showed a moderate positive association between symptomatic groups within the WP and STAI (P< 0.05) and a moderate negative association between PCS and PPT (P< 0.05) at the right tibialis muscle. Conclusion. TMD1CNP participants had more areas of pain and also showed widespread pain hyperalgesia. Both groups of participants had psychological factors positively associated with STAI and WP; further, PCS and the PPT at the extratrigeminal region were negatively associated with each other in both groups, except for the left tibialis in the TMD1CNP group. [ABSTRACT FROM AUTHOR]

Background: The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). Methods: A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). Results: A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability ( p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability ( p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache ( p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache ( p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (β = 0.40; p < 0.001) and kinesiophobia (β = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability. Conclusion: Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain. [ABSTRACT FROM AUTHOR]