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Recently, there has been interest in lysergic acid diethylamide (LSD) and psilocybin for depression, anxiety and fear of death in terminal illness. The aim of this review is to discuss the potential use of LSD and psilocybin for patients with persistent pain. LSD and psilocybin are 5-hydroxytryptamine receptor agonists and may interact with nociceptive and antinociceptive processing. Tentative evidence from a systematic review suggests that LSD (7 studies, 323 participants) and psilocybin (3 studies, 92 participants) may be beneficial for depression and anxiety associated with distress in life-threatening diseases. LSD and psilocybin are generally safe if administered by a healthcare professional, although further investigations are needed to assess their utility for patients with persistent pain, especially associated with terminal illness

Tensiomyography (TMG) can estimate the intrinsic contractile potential of a muscle using data between 10 and 90% of the displacement-time curve. However, it is yet to be determined whether this data represents the greatest rate of displacement i.e. the most valid estimate of the maximal shortening velocity of a muscle. The aim of this secondary analysis of data gathered from 10 participants who had maximal displacement (Dm) of the rectus femoris assessed using TMG, was to compare the rate of displacement using data from 0 – 100% of Dm; 10 – 90% of Dm and the most linear phase of the displacement-time curve. One-way analysis of variance (ANOVA) indicated that rate of displacement increased as data bands narrowed towards the most linear phase of the displacement-time curve (P

Mirror visual feedback is used for reducing pain and visually distorting the size of the reflection may improve efficacy. The findings of studies investigating size distortion are inconsistent. The influence of the size of the reflected hand on embodiment of the mirror reflection is not known. The aim of this study was to compare the effect of magnifying and minifying mirror reflections of the hand on embodiment measured using an eight-item questionnaire and on proprioceptive drift. During the experiment, participants (n = 45) placed their right hand behind a mirror and their left hand in front of a mirror. Participants watched a normal-sized, a magnified and a minified reflection of the left hand while performing synchronised finger movements for 3 min (adaptive phase). Measurements of embodiment were taken before (pre) and after (post) synchronous movements of the fingers of both hands (embodiment adaptive phase). Results revealed larger proprioceptive drift post-adaptive phase (p = 0.001). Participants agreed more strongly with questionnaire items associated with location, ownership and agency of the reflection of the hand post-adaptive phase (p

Non-specific low back pain (LBP) is a symptom of unknown cause affecting one third of the UK adult population, accounting for more than 15 million lost work days and an estimated annual cost of £12.3 billion. Pilates based exercise is becoming increasingly incorporated in to spinal rehabilitation, yet there is limited evidence on the efficacy of the technique. The aim of this study was to evaluate the effect of a 6-week Pilates based exercise programme on perceived functional disability, pain, local muscular endurance and lumbar range of motion in patients with non-specific chronic low back pain. Participants (n=13) with chronic non-specific LBP (>12-weeks) were recruited to a pre-post intervention trial. All participants were assigned to a 6-week control period. Subsequently, participants undertook one hour of a Pilates based exercise intervention twice per week for 6-weeks. Perceived functional disability and pain were assessed using the Oswestry functional disability questionnaire (ODQ) and visual analogue scale (VAS) respectively. Local muscular endurance (CE) and lumbar range of motion (LF) were assessed using the core endurance test and the fingertip to floor distance (FFD) respectively. Functional disability (ODQ), pain (VAS), local muscular endurance and lumbar flexion (FFD) improved after the intervention period (P0.05). The results of this pre-post intervention trial suggest that Pilates based exercise can be administered safely and is well tolerated by the majority of patients with nonspecific chronic LBP.

BACKGROUND: The aim of this study was to investigate the influence of body fat percentage and its distribution on sensory detection and pain sensitivity responses to experimentally induced noxious stimuli in otherwise pain-free individuals. METHODS: Seventy-two participants were divided into three equal groups according to their body mass index (BMI: normal, overweight and obese). Percentage body fat was estimated using a four-site skinfold method. Measurements of cold pressor pain threshold, tolerance and intensity; contact thermal sensory detection and heat pain threshold and tolerance (TSA-II - NeuroSensory Analyzer, Medoc); and blunt pressure pain threshold (algometer, Somedic SenseLab AB) were taken at the waist and thenar eminence. RESULTS: Mean ± SD pressure pain threshold of the obese group (620.72 ± 423.81 kPa) was significantly lower than normal (1154.70 ± 847.18 kPa) and overweight (1285.14 ± 998.89 kPa) groups. Repeated measures ANOVA found significant effects for site for cold detection threshold (F1,68 = 8.3, p = 0.005) and warm detection threshold (F1,68 = 38.69, p = 0.001) with waist having lower sensory detection thresholds than thenar eminence. For heat pain threshold, there were significant effects for site (F1,68 = 4.868, p = 0.031) which was lower for waist compared with thenar eminence (mean difference = 0.89 °C). CONCLUSION: Obese individuals were more sensitive than non-obese individuals to pressure pain but not to thermal pain. Body sites may vary in their response to different types and intensities of stimuli. The inconsistency of findings within and between research studies should catalyse further research in this field. SIGNIFICANCE: This study provided evidence that body mass index and distribution of body fat can influence sensory detection and pain sensitivity. Obese individuals were more sensitive than normal range body mass index individuals to pressure pain but not to thermal pain. Pain response varied according to subcutaneous body fat at different body sites. These findings strengthen arguments that weight loss should be a significant aspect of a pain management programme for obese pain patients.

Tensiomyography is used to measure skeletal muscle contractile properties, most notably muscle displacement (Dm) and contraction time (Tc). Professional football medical departments are currently using the equipment to profile the muscle function of their squad and subsequently evaluate change due to injury or intervention. However, at present there are no published standardised operating procedures for identifying probe position for muscle assessment. In this technical report we propose standardised operating procedures for the identification of precise probe position as part of an on-going study in male professional footballers.

Neurological conditions are associated with pain, anxiety and depression which are known to diminish the quality of life. Guidelines for the treatment of specific neurological conditions often give little consideration to pain. This may be because pain is not as visible as functional impairment and treatment tends to focus on curing or slowing disease progression and improving functional outcome.

OBJECTIVE: The aim of this study was to compare the effectiveness of transcutaneous electrical nerve stimulation and interferential therapy (IFT) both in combination with hot pack, myofascial release, active range of motion exercise, and a home exercise program on myofascial pain syndrome patients with upper trapezius myofascial trigger point. DESIGN: A total of 105 patients with an upper trapezius myofascial trigger point were recruited to this single-blind randomized controlled trial. Following random allocation of patients to three groups, three therapeutic regimens-control-standard care (hot pack, active range of motion exercises, myofascial release, and a home exercise program with postural advice), transcutaneous electrical nerve stimulation-standard care and IFT-standard care-were administered eight times during 4 wks at regular intervals. Pain intensity and cervical range of motions (cervical extension, lateral flexion to the contralateral side, and rotation to the ipsilateral side) were measured at baseline, immediately after the first treatment, before the eighth treatment, and 1 wk after the eighth treatment. RESULTS: Immediate and short-term improvements were marked in the transcutaneous electrical nerve stimulation group (n = 35) compared with the IFT group (n = 35) and the control group (n = 35) with respect to pain intensity and cervical range of motions (P < 0.05). The IFT group showed significant improvement on these outcome measurements than the control group did (P < 0.05). CONCLUSION: Transcutaneous electrical nerve stimulation with standard care facilitates recovery better than IFT does in the same combination.

Objectives: The Short-Form McGill Pain Questionnaire (SF-MPQ) is an English language based tool used to assess sensory, affective and evaluative aspects of pain. The aim of this study was to develop a culturally valid version of SF-MPQ for use in Libya for pain patients. Setting: Data was collected at the Ibn Sina Hospital, Sirt, Libya. Design: The SF-MPQ was translated and back-translated into Arabic by 4 university teachers and 8 university students fluent in Arabic and English to generate an Arabic version of the SF-MPQ. A Libyan dialect equivalent was created following discussion with 4 physicians and 6 pain patients. A group of 40 pain patients (mean age 35.3 years) attending an outpatient Physiotherapy clinic in Sirt City completed the Libyan SF-MPQ. Results: It was found that the Libyan SF-MPQ scored 0.15 for Cronbach's alpha indicating poor internal reliability. SFMPQ descriptors "Shooting" and "Gnawing" were problematic during translation and only three words "Throbbing", "Cramping" and "Tiring-Exhausting" met criterion for content validity. Intensity scores for sensory descriptors of pain chosen by the 40 patients was high and scores for affective descriptors low. Conclusions: The Libyan SF-MPQ had poor internal reliability suggesting that further development of the tool is needed. Nevertheless, this first version of the Libyan SF-MPQ will be of value for health care professionals, especially as the intensity of pain in the population of Libyan patients was high. The findings of this research emphasise the need for sociallyoriented research on cultural attitudes towards reporting of pain.

REVIEW QUESTION/OBJECTIVE: The objective of this mixed methods review is to develop an aggregated synthesis of qualitative and quantitative data on weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision making.The objective of the quantitative component of this review is to quantify the effectiveness of weight-loss interventions on weight, pain and physical and/or psychosocial function in overweight/obese adults with chronic musculoskeletal pain.The objectives of the qualitative component of this review are to explore the perceptions and experiences of overweight/obese adults with chronic musculoskeletal pain of the link between their weight and pain, and the effectiveness and appropriateness of weight-loss interventions and sustainability of weight-loss efforts.

Painful conditions such as complex regional pain syndrome, phantom limb pain and low back pain may change the sense of body image, so that body parts are perceived as large, swollen, heavy or stuck in one position [1]. In 1995, Ramachandran et al. [2] reported that phantom limb pain could be relieved by creating a visual illusion whereby the amputated limb appeared to be wholly intact by reflecting a nonpainful intact limb in a mirror (i.e., using mirror visual feedback). Randomized, sham-controlled clinical trials of mirror visual feedback have confirmed the potential utility of the technique. For example, Chan et al. [3] assigned 22 patients with phantom limb pain to a 4-week course of one of the following interventions: viewing a reflected image of their intact foot in a mirror; viewing a covered mirror; or mental visualization. All patients receiving mirror visual feedback reported a decrease in pain (n = 6) compared with only one patient in the covered mirror group and two in the mental visualization group. Three patients reported worsening pain in the covered mirror group and four patients reported worsening pain in the mental visualization group. Nowadays, mirror visual feedback, often termed mirror box therapy, has been incorporated within therapeutic programs to treat painful conditions associated with alterations of body image resulting from neuropathy [4], complex regional pain syndrome [5], fibromyalgia [6] and nonspecific mechanical back pain [7].

OBJECTIVE: The aim of this study was to investigate the strength of perceptual embodiment achieved during an adapted version of the rubber hand illusion (RHI) in response to a series of modified transcutaneous electrical nerve stimulation (TENS) pulse patterns with dynamic temporal and spatial characteristics which are more akin to the mechanical brush stroke in the original RHI. MATERIALS AND METHODS: A repeated-measures counterbalanced experimental study was conducted where each participant was exposed to four TENS interventions: continuous pattern TENS; burst pattern TENS (fixed frequency of 2 bursts per second of 100 pulses per second); amplitude-modulated pattern TENS (intensity increasing from zero to a preset level, then back to zero again in a cyclical fashion); and sham (no current) TENS. Participants rated the intensity of the RHI using a three-item numerical rating scale (each item was ranked from 0 to 10). Friedman's analysis of ranks (one-factor repeated measure) was used to test the differences in perceptual embodiment between TENS innervations; alpha was set at p ≤ 0.05. RESULTS: There were statistically significant differences in the intensity of misattribution and perceptual embodiment between sham and active TENS interventions, but no significant differences between the three active TENS conditions (amplitude-modulated TENS, burst TENS, and continuous TENS). Amplitude-modulated and burst TENS produced significantly higher intensity scores for misattribution sensation and perceptual embodiment compared with sham (no current) TENS, whereas continuous TENS did not. CONCLUSION: The findings provide tentative, but not definitive, evidence that TENS parameters with dynamic spatial and temporal characteristics may produce more intense misattribution sensations and intense perceptual embodiment than parameters with static characteristics (e.g., continuous pulse patterns).

Background The aim of this article is to report the findings of a secondary analysis of a previous injury study to consider previous injury as a risk factor for reinjury in rock climbing.\ud \ud Methods We completed a secondary analysis of 201 questionnaires that were gathered as part of a retrospective cross-sectional cohort survey that investigated the epidemiology of injuries in a representative sample of British rock climbers. Participants had actively engaged in rock climbing over the previous 12-month period and were recruited from six indoor climbing centres and five outdoor climbing venues (men n=163, mean±SD, age=35.2±11.8 years, participating in rock climbing=13.88+11.77 years; women n=38, mean±SD, age=35.1±10.7 years, participating in rock climbing=11.62+9.19 years).\ud \ud Results Of the 101 participants who sustained a previous injury, 36 were found to have sustained at least one reinjury. The total number of reinjuries was 82, with the average probability of sustaining at least one reinjury being 35.6% (95% CI 34.71% to 36.8%; p

Background and aims: Obese individuals have increased concentrations of pro-inflammatory cytokines and some other markers of inflammationand an increased risk of metabolic disorders. The relationship between obesity, pro-inflammatory cytokines and pain sensitivity response is not fully understood. Aim of the Study:To investigate associations between body fat distribution, C reactive protein (CRP), interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-a), leptin and pain sensitivity in adults. Methods: 38 adults (n=18 women) were grouped as normal weight(n=22) or obese (n=16), based on body mass index (BMI).Measurements of pressure pain and cold pressor pain sensitivity response, biomarkers (venous blood), and body composition (dual X-ray absorptiometry) were evaluated for each participant. Results: Pressure pain threshold was significantly lower in obese(mean+SD=340.93±93.58 kpa)compared to the normal weight group(447.45±203.72 kpa, p=0.039, t-test). Forward regression suggested that high gynoid fat (g)was associated with lower pressure pain thresholds (ß=-0.383, p=0.028), high lower limb fat (g) was associated with lower cold pain thresholds (ß=-0.495, p=0.003)and high IL-6 predicted higher cold pain tolerance (ß=0.345, p = 0.049). Women were more sensitive to pressure pain (P=0.03). Conclusion: Gynoid and lower limb fat content correlated with pain sensitivity response in adults, whereby those with greater fat content were more sensitive to pain. However, this may be a reflection of the sex differences in pain sensitivity as women have greater gynoid and leg fat contents.

Background: This is a second update of a Cochrane Review originally published in Issue 2, 2009. Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological agent, based on delivering low voltage electrical currents to the skin. TENS is used by people to treat a variety of pain conditions. Objectives: To assess the analgesic effectiveness of TENS, as a sole treatment, for acute pain in adults. Search methods: We searched the following databases up to 3 December 2014: the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; EMBASE; CINAHL; and AMED. We also checked the reference lists of included trials. Selection criteria: We included randomised controlled trials (RCTs) of adults with acute pain (< 12 weeks) if they examined TENS given as a sole treatment and assessed pain with subjective pain scales. Trials were eligible if they compared TENS to placebo TENS, no treatment controls, pharmacological interventions or non-pharmacological interventions. We excluded trials on experimental pain, case reports, clinical observations, letters, abstracts or reviews. Also we excluded trials investigating the effect of TENS on pain during childbirth (labour), primary dysmenorrhoea or dental procedures. Studies where TENS was given with another treatment as part of the formal trial design were excluded. We did not restrict any articles based on language of publication. Data collection and analysis Two review authors independently assessed study eligibility and carried out study selection, data extraction, 'Risk of bias' assessment and analyses of data. We extracted data on the following: types of participants and pain condition, trial design and methods, treatment parameters, adverse effects, and outcome measures. We contacted trial authors for additional information if necessary. Main results: We included 12 trials in the original review (2009) and included no further trials in the first update (2011). An additional seven new trials met the inclusion criteria in this second update. In total, we included 19 RCTs involving 1346 participants at entry, with 11 trials awaiting classification either because the full text was unavailable or information in the full text failed to clarify eligibility. We excluded most trials because TENS was given in combination with another treatment as part of the formal study design or TENS was not delivered using appropriate TENS technique. The types of acute pain included in this Cochrane Review were procedural pain, e.g. cervical laser treatment, venepuncture, screening flexible sigmoidoscopy and non-procedural pain, e.g. postpartum uterine contractions and rib fractures. We pooled data for pain intensity for six trials (seven comparisons) comparing TENS with placebo but the I2 statistic suggested substantial heterogeneity. Mean difference (MD) with 95% confidence intervals (CIs) on a visual analogue scale (VAS, 100 mm) was -24.62 mm (95% CI -31.79 to -17.46) in favour of TENS. Data for the proportion of participants achieving ≥ 50% reduction in pain was pooled for four trials (seven comparisons) and relative risk was 3.91 (95% CI 2.42 to 6.32) in favour of TENS over placebo. We pooled data for pain intensity from five trials (seven comparisons) but the I2 statistic suggested considerable heterogeneity. MD was -19.05 mm (95% CI -27.30 to -10.79) in favour of TENS using a random-effects model. It was not possible to pool other data. There was a high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions. Seven trials reported minor adverse effects, such as mild erythema and itching underneath the electrodes and participants disliking TENS sensation. Authors' conclusions: This Cochrane Review update includes seven new trials, in addition to the 12 trials reviewed in the first update in 2011. The analysis provides tentative evidence that TENS reduces pain intensity over and above that seen with placebo (no current) TENS when administered as a stand-alone treatment for acute pain in adults. The high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions makes definitive conclusions impossible. There was incomplete reporting of treatment in many reports making replication of trials impossible.