Acute muscle pain alters corticomotor output of the affected muscle stronger than a synergistic, ipsilateral muscle

2017 ◽  
Vol 16 (1) ◽  
pp. 177-177
Author(s):  
Dennis Boye Larsen ◽  
Thomas Graven-Nielsen ◽  
Rogerio Pessoto Hirata ◽  
Shellie A. Boudreau
Keyword(s):  
Pain Intensity ◽  
Muscle Pain ◽  
Repeated Measures ◽  
Cortical Excitability ◽  
Motor Evoked Potentials ◽  
Post Injection ◽  
Repeated Measures Analysis ◽  
Resting Motor Threshold ◽  
First Dorsal Interosseus ◽  
Extensor Carpi Radialis

Abstract Aims Muscle pain affects corticomotor areas representing the affected muscle, by changing the size of representation and reduces the corticospinal output as assessed by transcranial magnetic stimulation (TMS). Less work has been done to understand how pain in one muscle group may affect synergistic ipsilateral muscles distal to the pain. This study aimed to explore the effects of acute extensor carpi radialis (ECR) muscle pain on TMS motor-evoked potentials (MEPs) of the ECR and the first dorsal interosseus (FDI) muscle, which are known to strongly overlap within the corticomotor area. Methods Eight healthy volunteers (1 woman) were injected with hypertonic saline (5.8%, 0.5 mL) into the ECR muscle. Pain intensity was assessed by the visual analogue scale (VAS) every minute for 10 min. TMS was applied at 120% of ECR resting motor threshold, and MEPs were acquired from the ECR and the FDI muscles. At baseline, 10 TMS pulses were delivered. Temporal mapping of ECR and FDI MEPs over 10 min duration was performed by delivering 100 single-pulses of TMS, at 6 s interstimulus-interval. The MEPs for each muscle were averaged at baseline, peak-pain (1 –2 min epoch), and 10 min post-injection Results Pain intensity reduced significantly at 10 min postinjection as compared to peak-pain (P = 0.011). Further, one-way repeated measures analysis of variance revealed that ECR MEPs were altered at peak-pain compared to baseline (P > 0.05), but not 10 min post-injection (P > 0.05). Baseline and 10 min post-injection of ECR MEPs did not differ significantly (P = 0.67). The MEPs of the FDI muscle did not show a similar alteration over time (P = 0.1). Conclusions Despite the overlap between ECR and FDI representations, acute muscle pain of the ECR only significantly altered cortical excitability of the ECR muscle representation.

scholarly journals Differential Corticomotor Excitability Responses to Hypertonic Saline-Induced Muscle Pain in Forearm and Hand Muscles

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Dennis B. Larsen ◽  
Thomas Graven-Nielsen ◽  
Rogerio P. Hirata ◽  
Shellie A. Boudreau
Keyword(s):  
Pain Intensity ◽  
Hypertonic Saline ◽  
Muscle Pain ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Corticomotor Excitability ◽  
Hand Muscles ◽  
First Dorsal Interosseus ◽  
Extensor Carpi Radialis ◽  
Cortical Representations

Experimental muscle pain inhibits corticomotor excitability (CE) of upper limb muscles. It is unknown if this inhibition affects overlapping muscle representations within the primary motor cortex to the same degree. This study explored CE changes of the first dorsal interosseus (FDI) and extensor carpi radialis (ECR) muscles in response to muscle pain. Participants (n=13) attended two sessions (≥48 hours in-between). Hypertonic saline was injected in the ECR (session one) or the FDI (session two) muscle. CE, assessed by transcranial magnetic stimulation (TMS) motor-evoked potentials (MEPs), was recorded at baseline, during pain, and twenty minutes postinjection together with pain intensity ratings. Pain intensity ratings did not differ between the two pain sites (p=0.19). In response to FDI muscle pain, the MEPs of the FDI muscle were reduced at 2 and 4 min postinjection (p≤0.03), but not after ECR muscle pain. No significant MEP change was detected for the ECR muscle (p=0.62). No associations between MEPs and pain intensity were found (p>0.2). The present results indicate that the output from overlapping cortical representations of two muscles differentially adapts to acute muscle pain.

Effect of an early mobilisation programme on pain intensity after laparoscopic surgery: a randomised clinical trial

2020 ◽  
pp. bmjspcare-2020-002618
Author(s):  
Azam Dehghani ◽  
Ali Hajibagheri ◽  
Ismail Azizi-Fini ◽  
Fatemeh Atoof ◽  
Noushin Mousavi
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Surgery ◽  
Pain Intensity ◽  
Repeated Measures ◽  
Intervention Group ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Early Mobilisation ◽  
Repeated Measures Analysis ◽  
The Mean

BackgroundPain is a common complication after laparoscopic surgery. This study aimed to examine the effect of an early mobilisation programme on postoperative pain intensity after laparoscopic surgery.MethodsA randomised controlled clinical trial was conducted on 80 patients who underwent laparoscopic surgery in Shahid Beheshti Hospital in Kashan, Iran. The patients were randomly allocated to intervention (n=40) and a control (n=40) group. In the intervention group, an early mobilisation programme was implemented in two rounds. The patient’s perceived pain was assessed using a Visual Analogue Scale 15 min before and 30 min after each round of early mobilisation. Data were analysed through the independent samples t, χ2 and Fisher’s exact tests and the repeated measures analysis.ResultsThe repeated measures analysis showed that the mean pain scores have been decreased over time (F=98.88, p<0.001). Considering the observed interaction between time and the intervention, the t test was used for pairwise comparisons and showed that the mean pain score was not significantly different between the two groups in 15 min before the first round of early mobilisation (p=0.95). However, the mean pain in the intervention group was significantly less than the control group in all subsequent measurements (p<0.05).ConclusionEarly mobilisation programmes such as the one implemented in the current study are easy and inexpensive and can be implemented safely for the reduction of pain after laparoscopic surgeries.

scholarly journals Evaluation of intra-articular injection of bupivacaine with morphine or methylprednisolone or alone on pain after knee arthroscopy

2020 ◽  
pp. 314-322
Keyword(s):  
Side Effects ◽  
Pain Intensity ◽  
Repeated Measures ◽  
Knee Arthroscopy ◽  
Sedative Effect ◽  
Visual Analog Scales ◽  
Repeated Measures Analysis ◽  
Recorded Data ◽  
Spss Software ◽  
Over Time

Background and Aim: Knee arthroscopy is used to diagnose and treat intra-articular lesions. Controlling acute pain after arthroscopy requires the use of a method with the least side effects and the most efficiency. The aim of this study was to compare the sedative effect after intra-articular injection of bupivacaine combination with morphine or methylprednisolone or alone in knee arthroscopy. Materials and Methods: In this study clinical-randomized three-blind trial, 99 volunteer patients with knee arthroscopy were randomly divided into three groups: 1. Bupivacaine (0.5%), 2. Morphine (5 mg)+ bupivacaine (0.5%) and 3. Methylprednisolone (40 mg) + bupivacaine (0.5%). At the end of the operation, drugs were injected intra-articular and the amount of postoperative pain was evaluated and recorded based on visual analog scales 6, 12, 18, and 24 hours after injection. Also, receiving the injected analgesic within 24 hours, was recorded. Data were analyzed using SPSS software and repeated measures analysis of variance. Results: In all three groups, the pain intensity decreased significantly over time. The pain intensity of the methylprednisolone + bupivacaine and morphine+bupivacaine group was the similar, at different postoperative periods, but the pain intensity of these groups was significantly lower than the control. Also, consumption of the analgesics was significantly reduced in methylprednisolone+bupivacaine group compared to the two other groups. Conclusion: The results of this study showed that intra-articular injection of methylprednisolone + bupivacaine and morphine+bupivacaine was more effective than bupivacaine alone in reducing pain and the need for injectable analgesia.

scholarly journals Inhibiting corticospinal excitability by entraining ongoing mu-alpha rhythm in motor cortex

2020 ◽  
Author(s):  
Elina Zmeykina ◽  
Zsolt Turi ◽  
Andrea Antal ◽  
Walter Paulus
Keyword(s):  
Electric Fields ◽  
Alpha Rhythm ◽  
Cortical Excitability ◽  
Motor Evoked Potentials ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Corticospinal Excitability ◽  
List Type ◽  
Beta Power ◽  
Resting Motor Threshold ◽  
Alpha Beta

AbstractsSensorimotor mu-alpha rhythm reflects the state of cortical excitability. Repetitive transcranial magnetic stimulation (rTMS) can modulate neural synchrony by inducing periodic electric fields (E-fields) in the cortical networks. We hypothesized that the increased synchronization of mu-alpha rhythm would inhibit the corticospinal excitability reflected by decreased motor evoked potentials (MEP). In seventeen healthy participants, we applied rhythmic, arrhythmic, and sham rTMS over the left M1. The stimulation intensity was individually adapted to 35 mV/mm using prospective E-field estimation. This intensity corresponded to ca. 40% of the resting motor threshold. We found that rhythmic rTMS increased the synchronization of mu-alpha rhythm, increased mu-alpha/beta power, and reduced MEPs. On the other hand, arrhythmic rTMS did not change the ongoing mu-alpha synchronization or MEPs, though it increased the alpha/beta power. We concluded that low intensity, rhythmic rTMS can synchronize mu-alpha rhythm and modulate the corticospinal excitability in M1.HighlightsWe studied the effect of rhythmic rTMS induced E-field at 35 mV/mm in the M1Prospective electric field modeling guided the individualized rTMS intensitiesRhyhtmic rTMS entrained mu-alpha rhythm and modulated mu-alpha/beta powerArrhythmic rTMS did not synchronize ongoing activity though increased mu-alpha/beta power.Rhythmic but not arrhythmic or sham rTMS inhibited the cortical excitability in M1

scholarly journals Clinically significant acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients: A TMS study

2019 ◽  
Author(s):  
Marianne Jodoin ◽  
Dominique M. Rouleau ◽  
Audrey Bellemare ◽  
Catherine Provost ◽  
Camille Larson-Dupuis ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Severe Pain ◽  
Cortical Excitability ◽  
Intracortical Inhibition ◽  
Cortical Inhibition ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Resting Motor Threshold ◽  
Clinically Significant ◽  
Intracortical Inhibition And Facilitation

AbstractObjectivePrimary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper limb fracture (IULF) in relation to pain intensity.MethodsEighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls) performed a single transcranial magnetic stimulation (TMS) session over M1 (resting motor threshold (rMT); short-intracortical inhibition (SICI); intracortical facilitation (ICF); long-interval cortical inhibition (LICI)). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain).ResultsReduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures.DiscussionThese findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.

Abstract TMP43: Differential Cortical Effect Modulated by Anodal, Cathodal and Bihemispheric Transcranial Direct Current Stimulation (tDCS) in Patients With Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pratik Y Chhatbar ◽  
William DeVries ◽  
Emily Grattan ◽  
Steven A Kautz ◽  
Wuwei Feng
Keyword(s):  
Ischemic Stroke ◽  
Cortical Excitability ◽  
Motor Evoked Potentials ◽  
Single Pulse ◽  
Intracortical Inhibition ◽  
Motor Threshold ◽  
Stroke Patients ◽  
Intracortical Facilitation ◽  
Abductor Pollicis Brevis ◽  
Resting Motor Threshold

Introduction: The differential brain modulatory effects across hemispheres from different montages in stroke patients is not well established. We aimed to investigate the cortical excitability on lesional and contra-lesional hemisphere modulated by anodal, cathodal and bihemispheric montage at 4 mA tDCS strengths. Hypothesis: Bihemispheric tDCS montage induces more cortical excitability on the lesional hemisphere. Methods: Eighteen aging stroke patients with unilateral ischemic stroke of 6 or more months and inducible motor evoked potentials (MEP) underwent 3 sessions of 30 minutes 4 mA tDCS combined with occupational therapy. Each session was at least 2 days apart and consisted of one of the 3 different montages: anodal (Anode: lesional C3/C4, Cathode: non-lesional FP1/FP2), cathodal (Anode: lesional FP1/FP2, Cathode: non-lesional C3/C4), or bihemispheric (Anode: lesional C3/C4, Cathode: non-lesional C3/C4). We collected MEP size, short intracortical inhibition (SICI, 3 ms) and intracortical facilitation (ICF, 15 ms) on bilateral abductor pollicis brevis (APB) muscles using single or paired pulse TMS at 5 timepoints (baseline and four post-tDCS 12 minutes apart sessions). Results: All 18 subjects had comparable resting motor threshold (rMT) across 3 montages (see A). Bihemispheric tDCS montage offered significantly larger peak-to-peak MEP responses on the lesioned cortex (ANOVA, F=8.97, P<0.01) but not on the non-lesioned cortex (ANOVA, F=0.86, P=0.42). These differences were apparent in single pulse, SICI and ICF (see B). Conclusion: Our findings support that bihemispheric montage is better suited in post-stroke motor recovery tDCS applications.

A single bout of aerobic exercise promotes motor cortical neuroplasticity

2013 ◽  
Vol 114 (9) ◽  
pp. 1174-1182 ◽  
Author(s):  
Michelle N. McDonnell ◽  
Jonathan D. Buckley ◽  
George M. Opie ◽  
Michael C. Ridding ◽  
John G. Semmler
Keyword(s):  
Motor Cortex ◽  
Evoked Potentials ◽  
Aerobic Exercise ◽  
Neurotrophic Factor ◽  
Cortical Excitability ◽  
Motor Evoked Potentials ◽  
Moderate Intensity ◽  
Single Session ◽  
Low Intensity ◽  
First Dorsal Interosseus

Regular physical activity is associated with enhanced plasticity in the motor cortex, but the effect of a single session of aerobic exercise on neuroplasticity is unknown. The aim of this study was to compare corticospinal excitability and plasticity in the upper limb cortical representation following a single session of lower limb cycling at either low or moderate intensity, or a control condition. We recruited 25 healthy adults to take part in three experimental sessions. Cortical excitability was examined using transcranial magnetic stimulation to elicit motor-evoked potentials in the right first dorsal interosseus muscle. Levels of serum brain-derived neurotrophic factor and cortisol were assessed throughout the experiments. Following baseline testing, participants cycled on a stationary bike at a workload equivalent to 57% (low intensity, 30 min) or 77% age-predicted maximal heart rate (moderate intensity, 15 min), or a seated control condition. Neuroplasticity within the primary motor cortex was then examined using a continuous theta burst stimulation (cTBS) paradigm. We found that exercise did not alter cortical excitability. Following cTBS, there was a transient inhibition of first dorsal interosseus motor-evoked potentials during control and low-intensity conditions, but this was only significantly different following the low-intensity state. Moderate-intensity exercise alone increased serum cortisol levels, but brain-derived neurotrophic factor levels did not increase across any condition. In summary, low-intensity cycling promoted the neuroplastic response to cTBS within the motor cortex of healthy adults. These findings suggest that light exercise has the potential to enhance the effectiveness of motor learning or recovery following brain damage.

scholarly journals Effects of Reflexology on the Pain Intensity among Patients with Depression after Receiving Electroconvulsive Therapy: A Randomized Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 129-136
Author(s):  
Maryam Aliashraf Jodat ◽  
Leyla Alilu ◽  
Sohila Ahangarzadeh Rezayee ◽  
Rasool Gharaaghaji Asl
Keyword(s):  
Pain Intensity ◽  
Health Care Providers ◽  
Electroconvulsive Therapy ◽  
Muscle Pain ◽  
Repeated Measures ◽  
Intervention Group ◽  
Control Group ◽  
Care Providers ◽  
Significant Difference ◽  
The Mean

Introduction: High prevalence of psychiatric disorders and the high effectiveness of electroconvulsive therapy (ECT) have made this treatment a useful intervention. Memory impairment, headache, and muscle pain are the most important complications after ECT. This research aimed to determine the effect of reflexology on the headache and muscle pain intensity of patients after receiving ECT. Methods: This randomized controlled trial was conducted in Razi teaching hospital of Urmia, Iran. A total of 56 patients with depression receiving ECT were randomly assigned into two equal groups of control (n=28) and intervention (n=28). In the intervention group, reflexology was performed for 20 minutes at reflex points and, in the control group, only the conventional measures were taken. Pain intensity was measured with visual analogue scale (VAS) before and 1, 6, and 24 hours after the intervention. Data were analyzed using the SPSS software version 13. Furthermore, chi-square, Mann-Whitney, Wilcoxon, and repeated-measures tests were performed. Results: The mean difference in the severity of headache and muscle pain in the intervention group was significantly reduced compared to the control group. Moreover, the results demonstrated a significant difference between the mean headache and muscle pain in the two groups after the intervention. Conclusion: The results of this study showed the positive effect of reflexology on reducing the intensity of pain in patients receiving ECT. Thus, it is recommended that nurses, health care providers, and caregivers use reflexology to reduce pain in patients with depression receiving ECT.

scholarly journals Effects of Ultrasound-Guided Administration of Botulinum Toxin (IncobotulinumtoxinA) in Patients with Lateral Epicondylitis

Toxins ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 46 ◽  
Author(s):  
Antonio Galván Ruiz ◽  
Gloria Vergara Díaz ◽  
Beatriz Rendón Fernández ◽  
Carmen Echevarría Ruiz De Vargas
Keyword(s):  
Adverse Events ◽  
Repeated Measures ◽  
Patient Population ◽  
Lateral Epicondylitis ◽  
Ultrasound Guided ◽  
Repeated Measures Analysis ◽  
Secondary Analyses ◽  
Males And Females ◽  
Post Hoc ◽  
Extensor Carpi Radialis

How effective and safe are incobotulinumtoxinA injections in adult patients with lateral epicondylitis refractory to other treatments? In this experimental study, ultrasound-guided incobotulinumtoxinA 10–30 U/muscle was injected into extensor carpi ulnaris, extensor digiti minimi, extensor digitorum longus and extensor carpi radialis brevis muscles. Pain (visual analogue scale [VAS], 0 to 10 [no pain to severe pain]) and upper-limb functionality (QuickDASH scale, 0 to 100 [best to worst]), assessed at baseline, 1, 3 and 6 months post-treatment, were analysed using repeated-measures analysis of variance (ANOVA) and Tukey post-hoc tests. Secondary analyses stratifying patient population by sex and baseline VAS were performed. Adverse events were reported. Twenty-four patients (mean [standard deviation] age 46.8 years) were included. Compared with baseline, mean VAS and QuickDASH scores improved at all follow-ups (p < 0.001 and p = 0.001, respectively; repeated-measures ANOVA). Secondary analyses revealed significant differences between baseline and all follow-ups in the group with baseline VAS ≥ 6 and in males and females (all p < 0.05, Tukey post-hoc test). No adverse events, except for the expected third finger weakness, were reported. In conclusion, ultrasound-guided incobotulinumtoxinA injections may be an effective treatment for lateral epicondylitis in the appropriate patient population.

scholarly journals Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Karen Lei ◽  
Alphonsa Kunnel ◽  
Valerie Metzger-Smith ◽  
Shahrokh Golshan ◽  
Jennifer Javors ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Repeated Measures ◽  
Cortical Excitability ◽  
Single Pulse ◽  
Gulf War ◽  
Gulf War Illness ◽  
Corticomotor Excitability ◽  
Body Pain ◽  
Resting Motor Threshold ◽  
The Impact

Abstract Chronic diffuse body pain is unequivocally highly prevalent in Veterans who served in the 1990–91 Persian Gulf War and diagnosed with Gulf War Illness (GWI). Diminished motor cortical excitability, as a measurement of increased resting motor threshold (RMT) with transcranial magnetic stimulation (TMS), is known to be associated with chronic pain conditions. This study compared RMT in Veterans with GWI related diffuse body pain including headache, muscle and joint pain with their military counterparts without GWI related diffuse body pain. Single pulse TMS was administered over the left motor cortex, using anatomical scans of each subject to guide the TMS coil, starting at 25% of maximum stimulator output (MSO) and increasing in steps of 2% until a motor response with a 50 µV peak to peak amplitude, defined as the RMT, was evoked at the contralateral flexor pollicis brevis muscle. RMT was then analyzed using Repeated Measures Analysis of Variance (RM-ANOVA). Veterans with GWI related chronic headaches and body pain (N = 20, all males) had a significantly (P < 0.001) higher average RMT (% ± SD) of 77.2% ± 16.7% compared to age and gender matched military controls (N = 20, all males), whose average was 55.6% ± 8.8%. Veterans with GWI related diffuse body pain demonstrated a state of diminished corticomotor excitability, suggesting a maladaptive supraspinal pain modulatory state. The impact of this observed supraspinal functional impairment on other GWI related symptoms and the potential use of TMS in rectifying this abnormality and providing relief for pain and co-morbid symptoms requires further investigation. Trial registration: This study was registered on January 25, 2017, on ClinicalTrials.gov with the identifier: NCT03030794. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03030794.

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