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Introduction: Chronic Whiplash Associated Disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. Methods: 72 CWAD patients and 55 healthy controls underwent electrical stimuli-based quantitative sensory testing (QST). Detection and pain thresholds (EPT), temporal summation (TS) and conditioned pain modulation (CPM) were examined. Spearman correlations and linear mixed models analyses were performed to assess respectively the hypothesized associations with and group differences in QST. Results: The Pain Catastrophizing magnification subscale correlated with left wrist EPT (r = -0.332; p = 0.004), and the Pain Anxiety Symptom Scale-20 with left wrist (r = -0.325; p = 0.005) and ankle (r = -0.330; p = 0.005) EPT. TS at the ankle correlated with the CS Inventory (r = 0.303; p = 0.010), Short Form 36 pain subscale (r = -0.325; p = 0.005), and Illness Perception Questionnaire revised consequences subscale (r = 0.325; p = 0.005). EPTs of left (p = 0.011) and right wrist (p = 0.023) were lower in the CWAD group, but CPM and TS did not differ between groups. Discussion: QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in CWAD patients, but no differences in endogenous pain facilitation nor inhibition. Process evaluation: Both CWAD patients reporting unilateral as bilateral neck pain were included, which complicated the interpretation of distal hyperalgesia. [ABSTRACT FROM AUTHOR]

Introduction: Prayer is the most common therapy used in alternative medicine1. The objective of this study was to explore the effect of prayers on endogenous pain modulation, pain intensity, and sensitivity in healthy religious participants. Methods: Two hundred and eight healthy religious participants were enrolled in this study and randomly distributed into two groups, a prayer group (n = 156) and a poem reading or control group (n = 52). Participants from the prayer group were allocated to either an active prayer group (n = 94) receiving an active type of praying or to a passive prayer group (n = 62) receiving a passive type of praying. Pain assessments were performed prior to and following the prayer or poem reading interventions and included pressure pain threshold assessment, conditioned pain modulation, and a numerical pain rating scale for perceived pain intensity. Results: A significant group-by-time interaction for PPT (p = 0.014) indicated post-intervention increases in PPT in the prayer group but not in the poem reading control group. Also, a significant group-by-time interaction for PPT (p = 0.005) indicated that these effects were greater in the active prayer group than in the passive prayer group. Participants experienced a decrease in CPM efficacy (p = 0.030) and an increase in pain intensity (p < 0.001) following the interventions, independent of their group allocation. Discussion: The results showed that prayer, irrespective to type, can positively affect pain sensitivity and intensity, but does not influence endogenous pain inhibition. Process evaluation: Future research should focus on understanding the mechanism behind "prayer induced analgesia". [ABSTRACT FROM AUTHOR]

Introduction: Recent fMRI studies have revealed altered activations in key regions for threat and affective processing of pain in motor imagination tasks. Yet, research in this vein is still lacking in people with chronic whiplash (CWAD). Methods: Sixty CWAD and 32 pain-free participants were included. In the scanner, participants were presented with pictures divided into 3 categories (5 weight bearing, 5 non-weight bearing and 5 neutral pictures) taken from the Pictorial Fear of Activity Scale-Cervical***questionnaire (jittered event-related design). After the scanning, participants were asked to rate each picture in terms of worry, desire to avoidance, anxiety, expected pain. SPM software was used for pre-processing and analysis of the fMRI data. Results: Whole brain analysis revealed greater activation in CWAD for the contrast weight bearing versus neutral pictures in planum temporale/parietal operculum, post/pre-central gyrus, frontal pole, precuneus and posterior cingulate. CWAD have greater activation in precuneus and cerebellum in the non-weight bearing versus neutral contrast. CWAD scored pictures higher than controls, but no correlation between scores and the identified clusters was found. Discussion: The results from this study allow for a better understanding of the maladaptive pain cognitions associated with CWAD by investigating the underlying neural activity alterations. Process evaluation: Several challenges were encountered along the way (data collection and analyses) as this was my first fMRI study. [ABSTRACT FROM AUTHOR]

Introduction: Migraine is conceptualized as a continuum, with at the one hand episodic migraine and at the other hand chronic migraine (CM) which is more frequent1. Recent studies support the presence of central sensitization (CS) in migraine patients2,3, but controversial evidence exists about where in the continuum exactly CS appears and which mechanisms are underlying. Therefore this study aims to determine the occurrence and mechanisms of CS within the migraine continuum. Methods: Self-reported and psychophysiological data will be collected from 30 migraine patients and 30 healthy controls. Pain sensitivity will be evaluated using Quantitative Sensory Testing including mechanical and thermal thresholds. Pain facilitation and inhibition will be assessed by using respectively temporal summation and conditioned pain modulation paradigms. Assessments are performed unilateral at the painful side and interictally. Results: Widespread pain and impaired pain facilitation and inhibition are expected to be more pronounced in patients with more migraine days (further along the continuum) than in those with less migraine days. Discussion: This research will show whether signs of CS are present in migraine patients, where in the migraine continuum these symptoms are appearing, and whether impaired pain inhibition and/or facilitation underlie these symptoms. Process evaluation: Data collection is currently going on. Testing patients with CM interictally is a challenge. [ABSTRACT FROM AUTHOR]

Introduction: There is growing acknowledgement of the benefits of incorporating a bio-psychosocial model of understanding pain within physical therapist practice1. Consequently this has led to an increasing interest in interventions such Pain neuroscience education (PNE). However, pain management strategies developed by clinicians in one culture may not necessarily be understood, appropriate, or effective in another culture2 Methods: This study is part of a broader research in the development of culturally sensitive pain neuroscience education for the Lebanese population. Therefore, the purpose of this paper is to first gain an in-depth understanding of the Lebanese physiotherapists' perceptions towards the management of chronic low back pain as well as the knowledge regarding PNE. A qualitative one-to-one semi-structured interviews with 10 practicing physical therapists were conducted. The transcribed text from the interviews was analyzed using inductive thematic analysis. Results: Several themes were generated, identified, and constructed by the researchers: (1) physiotherapists use of a biomechanical approach. (2) Poor knowledge about the bio-psychosocial approach or PNE. (3) Barrier and facilitation for the implementation of PNE. Discussion: The preliminary results showed a limited knowledge of the bio-psychosocial approach, or PNE, and that the Lebanese physical therapist use more a biomechanical approach in the treatment and assessment of people with chronic low back pain. Process evaluation: The results showed that training is needed for physiotherapists to deliver a broader model of care, and that future research should focus on developing a culturally sensitive PNE material. [ABSTRACT FROM AUTHOR]

Introduction: Whiplash injuries typically occur from a motor vehicle collision and lead to chronic whiplash associated disorders (CWAD) in 20-50% of cases. Changes in neurotransmission, metabolism and networks seem to play a role in the pathogenic mechanisms of CWAD. Methods: This case-control study (CWAD patients/healthy controls (HC):50/50), investigated ankle and wrist electrical pain thresholds (EPT) and the amplitude and latency of event-related potentials (ERPs) resulting from 20 electrical stimuli at the intensity of 1,4xEPT. Linear mixed effect models were applied to detect group differences in EPTs and ERP characteristics. Correlations between ERP characteristics, EPT, self-reported pain, disability, pain catastrophizing and symptoms of central sensitisation (CS) were investigated. Results: In CWAD patients, left wrist P3 latency (t = -2.283; p = 0.023) was prolonged, and their ankle EPT correlated with ankle P1 (ρs = 0.293; p = 0.044) and P3 amplitude (ρs = 0.306; p = 0.033), and left wrist P3 amplitude (ρs = 0.343; p = 0.017). Symptoms of CS correlated with right wrist P3 amplitude (ρs = 0.308; p = 0.030) and latency (ρs = -0.341; p = 0.015), and the worst pain during the week before the assessment correlated with left wrist P1 latency (ρs = 0.319; p = 0.029). Discussion: CWAD patients did not show signs of hypersensitivity, but their ERP characteristics seemed to be related to the intensity of the stimulus, self-reported symptoms of CS, and worst pain during the week before the assessment. Process evaluation: Self-reported disability had changed between time of inclusion and baseline assessment, resulting in the inclusion of 8 CWAD patients with low disability at baseline. [ABSTRACT FROM AUTHOR]

Objective: Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care., Methods: Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated., Results: Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21-0.57) and varied considerably between pairs of physical therapists (κ = 0.14-1.00)., Conclusion: The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment., Impact: The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Purpose: Examining whether socio-demographic variables, pain or functionality are related to the degree of clinic-based therapy adherence in patients suffering from nonspecific chronic spinal pain (nCSP)., Design: Secondary analysis of a randomized clinical trial., Setting: University hospital of Ghent and Brussels., Methods: Dutch speakers, 18-65 years old, experiencing nCSP for at least 3 months. 120 participants were randomly allocated to two interventional groups, of which 94 completed all therapy sessions., Main Outcome Measures: Degree of clinic-based adherence, defined as the amount of completed therapy sessions., Results: Demographic data (sex, age or education) were not significantly associated with adherence in the total sample or the neuroscience group. For the traditional physiotherapy group, educational level was associated with attendance of at least 50% of the therapy sessions. Regarding pain-, belief- and function-related measures, only the association between change in kinesiophobia and adherence was significant for the traditional physiotherapy group., Conclusions: Factors related to therapy adherence in the total group or the neuroscience group could not be found. Educational level and change in kinesiophobia were however related to therapy adherence in the traditional physiotherapy group., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Neck pain is a common problem in F-16 pilots. A cross-sectional survey was used to determine the self-reported 1-yr prevalence of neck pain and to compare individual, work-related, and flight-related characteristics in F-16 pilots with and without neck pain., Method: There were 90 male F-16 pilots of the Belgian Air Force and The Royal Netherlands Air Force who voluntarily completed an anonymous survey., Results: The 1-yr prevalence of neck pain was 18.9%. Pilots were divided into two groups: healthy (HG) and neck pain group (NPG). This study could not identify individual or specific flight-related differences between these two groups. High force demands, often sitting for a long time, frequently holding the neck in a forward bent posture, and being physically tired were all physical work-related factors that were reported significantly more often in the NPG. The NPG also reported significantly more psychosocial factors, such as being mentally tired at the end of the day and being annoyed by others at the workplace., Discussion: Since the specific flight-related factors were not significantly different between the HG and the NPG, physical and psychosocial factors could have been important factors in the development or maintenance of neck pain in F-16 pilots., Conclusion: The results of this study highlight for the first time that, in addition to flight-related issues, other aspects must be considered in analyzing neck pain. These other aspects stress the importance of a broader approach when considering neck pain, even in this population that is exposed to very high loads during flight.