The dosing of aerobic exercise therapy on experimentally-induced pain in healthy female participants

Abstract Knowledge of efficacious dosing respective to exercise type and pain condition is extremely limited in the literature. This study aimed to determine the impact of dose of moderate intensity treadmill walking on experimentally-induced pain in healthy human participants. Forty females were divided into 4 groups: control (no exercise), low dose exercise (3×/wk), moderate dose exercise (5×/wk) or high dose exercise (10×/wk). Over a 7-day period, subjects performed treadmill walking during assigned exercise days. Both qualitative and quantitative measures of pain were measured at baseline, during the trial, and 24 hrs post-final intervention session via sensitivity thresholds to painful thermal and painful pressure stimulation. Significant effects of treatment were found post-intervention for constant pressure pain intensity (p = 0.0016) and pain unpleasantness ratings (p = 0.0014). Post-hoc tests revealed significant differences between control and moderate and control and high dose groups for constant pressure pain intensity (p = 0.0015), (p = 0.0094), respectively and constant pressure pain unpleasantness (p = 0.0040), (p = 0.0040), respectively. Moderate and high dose groups had the greatest reductions in ratings of pain, suggesting that our lowest dose of exercise was not sufficient to reduce pain and that the moderate dose of exercise may be a sufficient starting dose for exercise-based adjuvant pain therapy.

Download Full-text

Impact of treatment dose on patient outcomes after Interdisciplinary Multimodal Pain Therapy

10.21203/rs.3.rs-514829/v1 ◽

2021 ◽

Author(s):

Philipp Baumbach ◽

Maria Richter ◽

Johannes Schneider ◽

Ulrich Christian Smolenski ◽

Thomas Weiss ◽

...

Keyword(s):

Pain Intensity ◽

Pain Therapy ◽

Low Dose ◽

High Dose ◽

Multimodal Pain Therapy ◽

Average Pain Intensity ◽

Average Pain ◽

Interdisciplinary Multimodal Pain Therapy ◽

The Impact

Abstract Objectives The impact of duration and intensity on outcomes after Interdisciplinary Multimodal Pain Therapy (IMPT) is poorly researched. The aim of this study was to compare the effects of low dose (LD, avg. 25 hours) and high dose IMPT (HD, avg. 110 hours).Methods Patients completed pain-related questionnaires at the beginning (T1), at the end of therapy (T2) and at 3-month follow-up (T3) and were matched according to age, sex, presence of back-pain and pain-related disability at T1, resulting in 32 patients per group. Primary endpoint was the difference in pain-related disability and average pain intensity at T3 between both groups. In addition, early treatment effects and group differences at T2 were analyzed.Results Both groups showed significant improvements in pain-related disability and average pain intensity between T1 and T2. These positive effects persisted in the HD group until the 3-month follow-up, whereas outcomes in the LD group patients deteriorated and were significantly poorer compared to HD at T3.Discussion Within a widely comparable therapeutic setting, high-dose IMPT was associated with longer lasting improvements compared to low-dose IMPT in chronic pain patients, indicating that the “dose” of therapy is a relevant factor for clinical outcomes and should be further investigated.

Download Full-text

Effect of expectation on pain assessment of lower- and higher-intensity stimuli

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.09.013 ◽

2017 ◽

Vol 14 (1) ◽

pp. 9-14 ◽

Cited By ~ 4

Author(s):

Valentina Ružić ◽

Dragutin Ivanec ◽

Koraljka Modić Stanke

Keyword(s):

Pain Intensity ◽

Pain Perception ◽

Pain Modulation ◽

The Other ◽

Moderate Intensity ◽

Lower Intensity ◽

Intensity Assessment ◽

Potential Benefits ◽

Electrical Stimuli ◽

Experimentally Induced

AbstractBackground and aimsPain modulation via expectation is a well-documented phenomenon. So far it has been shown that expectations about effectiveness of a certain treatment enhance the effectiveness of different analgesics and of drug-free pain treatments. Also, studies demonstrate that people assess same-intensity stimuli differently, depending on the experimentally induced expectations regarding the characteristics of the stimuli. Prolonged effect of expectation on pain perception and possible symmetry in conditions of lower- and higher-intensity stimuli is yet to be studied. Aim of this study is to determine the effect of expectation on the perception of pain experimentally induced by the series of higher- and lower-intensity stimuli.Methods192 healthy participants were assigned to four experimental groups differing by expectations regarding the intensity of painful stimuli series. Expectations of two groups were congruent with actual stimuli; one group expected and received lower-intensity stimuli and the other expected and received higher-intensity stimuli. Expectations of the remaining two groups were not congruent with actual stimuli; one group expected higher-intensity stimuli, but actually received lower-intensity stimuli while the other group expected lower-intensity stimuli, but in fact received higher-intensity ones. Each group received a series of 24 varied-intensity electrical stimuli rated by the participants on a 30° intensity scale.ResultsExpectation manipulation had statistically significant effect on pain intensity assessment. When expecting lower-intensity stimuli, the participants underestimated pain intensity and when expecting higher-intensity stimuli, they overestimated pain intensity. The effect size of expectations upon pain intensity assessment was equal for both lower- and higher-intensity stimuli.ConclusionThe obtained results imply that expectation manipulation can achieve the desired effect of decreasing or increasing both slight and more severe pain for a longer period of time. Manipulation via expectation before the stimuli series was proven to be effective for pain modulation in the entire series of stimuli which lasted around 10 min. The results suggest a potential benefit of manipulating expectations to alleviate emerging pain, since the obtained effects are moderate to large.ImplicationsIt seems that expectation effect is strong enough to “overcome” even the direct effect of stimulus intensity (at least in the low to moderate intensity range), which suggests potential benefits of verbal instructions even in rather painful stimuli.

Download Full-text

Guided relaxation-based virtual reality versus distraction-based virtual reality or passive control for postoperative pain management in children and adolescents undergoing Nuss repair of pectus excavatum: protocol for a prospective, randomised, controlled trial (FOREVR Peds trial)

BMJ Open ◽

10.1136/bmjopen-2020-040295 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040295

Author(s):

Vanessa A Olbrecht ◽

Sara E Williams ◽

Keith T O’Conor ◽

Chloe O Boehmer ◽

Gilbert W Marchant ◽

...

Keyword(s):

Virtual Reality ◽

Pain Management ◽

Pain Intensity ◽

Pectus Excavatum ◽

Passive Control ◽

Controlled Trial ◽

Novel Therapy ◽

The Impact ◽

Guided Relaxation ◽

Pain Unpleasantness

IntroductionVirtual reality (VR) offers an innovative method to deliver non-pharmacological pain management. Distraction-based VR (VR-D) using immersive games to redirect attention has shown short-term pain reductions in various settings. To create lasting pain reduction, VR-based strategies must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates pain-relieving mind–body based guided relaxation with VR, a novel therapy delivery mechanism. The primary aim of this study is to assess the impact of daily VR-GR, VR-D and 360 video (passive control) on pain intensity. We will also assess the impact of these interventions on pain unpleasantness, anxiety and opioid and benzodiazepine consumption. The secondary aim of this study will assess the impact of psychological factors (anxiety sensitivity and pain catastrophising) on pain following VR.Methods and analysisThis is a single centre, prospective, randomised, clinical trial. Ninety children/adolescents, aged 8–18 years, presenting for Nuss repair of pectus excavatum will be randomised to 1 of 3 study arms (VR-GR, VR-D and 360 video). Patients will use the Starlight Xperience (Google Daydream) VR suite for 10 min. Patients randomised to VR-GR (n=30) will engage in guided relaxation/mindfulness with the Aurora application. Patients randomised to VR-D (n=30) will play 1 of 3 distraction-based games, and those randomised to the 360 video (n=30) will watch the Aurora application without audio instructions or sound. Primary outcome is pain intensity. Secondary outcomes include pain unpleasantness, anxiety and opioid and benzodiazepine consumption.Ethics and disseminationThis study follows Standard Protocol Items: Recommendations for Interventional Trials guidelines. The protocol was approved by the Cincinnati Children’s Hospital Medical Center’s institutional review board. Patient recruitment began in July 2020. Written informed consent will be obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals.Trial registration numberNCT04351776.

Download Full-text

The Impact of Moderate-Dose Acetylsalicylic Acid in the Reduction of Inflammatory Cytokine and Prevention of Complication in Acute Phase of Kawasaki Disease: The Benefit of Moderate-Dose Acetylsalicylic Acid

Children ◽

10.3390/children7100185 ◽

2020 ◽

Vol 7 (10) ◽

pp. 185

Author(s):

Jung Eun Kwon ◽

Da Eun Roh ◽

Yeo Hyang Kim

Keyword(s):

Kawasaki Disease ◽

Acetylsalicylic Acid ◽

Acute Phase ◽

Transforming Growth Factor ◽

High Dose ◽

Reye Syndrome ◽

Moderate Dose ◽

Number Of Patients ◽

The Impact ◽

Different Doses

Background: Acetylsalicylic acid (ASA) is part of the recommended treatment of Kawasaki disease (KD). Controversies remain regarding the optimal dose of ASA. We aimed to evaluate the impact of different doses of ASA on inflammation control while minimizing adverse effects in the acute phase treatment of KD. Methods: The enrolled 323 patients with KD were divided into three groups according to ASA dose: moderate-dose (30–50 mg/kg/day), high-dose (80–100 mg/kg/day), and non-ASA. Results: High-dose ASA group showed a significantly shorter duration of fever from the start of treatment to remission than other groups. Baseline level and delta score of interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-α, and transforming growth factor β were not statistically different among the groups. The number of patients who received additional treatments in the non-ASA group was more than other groups. Coronary artery dilatation was not significantly different among the groups. One patient with high-dose ASA was diagnosed with Reye syndrome. Conclusion: Different doses of ASA did not show any differences in changes of inflammatory bio-makers and cytokines. However, high-dose ASA showed occurrence of Reye syndrome, and non-ASA showed intravenous immunoglobulin refractoriness. We suggest that moderate-dose ASA may be beneficial for the treatment of patients in the acute phase of KD.

Download Full-text

Abstract P028: The Influence of Exercise Dose, Exercise Intensity, and Weight Loss on C-reactive Protein in Sedentary Overweight Women

Circulation ◽

10.1161/circ.127.suppl_12.ap028 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Patricia K Tuite ◽

Lora E Burke ◽

Paul M Coen ◽

Richard Henker ◽

John M Jakicic

Keyword(s):

Weight Loss ◽

Energy Expenditure ◽

Moderate Intensity ◽

High Dose ◽

Obese Women ◽

Behavioral Weight Loss ◽

Moderate Dose ◽

Inflammatory State ◽

Vigorous Intensity ◽

Hs Crp

Background: Obesity is a modifiable risk factor associated with heart disease and an increased inflammatory state. Reducing weight and increasing physical activity have been shown to decrease heart disease risk. There is increasing evidence that weight loss leads to a reduced inflammatory state; however, there is less evidence on the combined role of weight loss and different doses of exercise. Objective: The purpose of the study was to examine the effect of exercise on change in high sensitivity C-reactive protein (hs-CRP) in overweight and obese women in a 6-month behavioral weight loss program. Methods: The parent study was a randomized trial testing different doses of exercise in a behavioral weight loss program. The sample (N = 182) consisted of sedentary overweight women with a mean (SD) age of 37.5 (±5.7) years and a baseline body mass index (BMI) of 32.7 (±4.2) kg/m 2 . Participants were randomly assigned to 1 of 4 exercise groups based on energy expenditure (1000 kcal/week or 2000 kcal/week) and intensity (vigorous vs. moderate). Groups included: vigorous intensity/high dose; vigorous intensity/moderate dose; moderate intensity/moderate dose; and moderate intensity/high dose. The dietary component included an energy restricted diet of 1200 kcal/day or 1500 kcal/day based on weight at baseline; daily fat intake recommendation was 20%-30% of total energy intake. Results: There were no statistically significant differences in hs-CRP levels between dose of exercise, moderate vs. high, (F=0.330, p=0.58) or level of intensity, moderate vs. vigorous (F=0.118, p=0.731). However, there was a significant decrease in hs-CRP from baseline to 6 months (F=25.553, p<0.0004). There was a significant 3 way interaction between energy expenditure, intensity, and time (baseline to 6-month) (F=4.035, p=0.035); post hoc analysis revealed a significant decrease in hs-CRP in the moderate/high (p<0.0004) and vigorous/moderate groups (p=0.004). The results were unchanged after controlling for the change in body weight, body fatness, or body distribution. The change in hs-CRP was not significantly correlated with the change in body weight, percent body fat, waist circumference, or self-reported physical activity. The hs-CRP at 6 months was correlated with 6-month measures of weight, BMI, percent body fat, and fat distribution (p<0.0004). Conclusions: The level of hs-CRP was reduced in overweight and obese women in response to a 6-month weight loss intervention that included a prescribed increase in energy expenditure and reduction in energy intake. We observed a significant reduction in the moderate intensity/high dose and vigorous intensity/moderate dose exercise groups, suggesting that at least a moderate level of exercise is needed to affect hs-CRP levels. Further research is needed to better determine the dose of exercise needed to reduce markers of inflammation.

Download Full-text

The impact of gender of the examiner on orofacial pain perception and pain reporting among healthy volunteers

Clinical Oral Investigations ◽

10.1007/s00784-021-04286-9 ◽

2021 ◽

Author(s):

A. Lövgren ◽

B. Häggman-Henrikson ◽

A. Fjellman-Wiklund ◽

A. Begic ◽

H. Landgren ◽

...

Keyword(s):

Pain Intensity ◽

Pain Perception ◽

Rating Scale ◽

Orofacial Pain ◽

Multivariable Analysis ◽

Pressure Pain Threshold ◽

Pain Tolerance ◽

Pressure Pain ◽

Pain Reporting ◽

The Impact

Abstract Objectives Pain on palpation of jaw muscles is a commonly used diagnostic criterion when examining patients with orofacial pain. It is not known, however, if pain reports are affected by the gender of the examiner. Our aim was to investigate if pressure pain threshold (PPT), pressure pain tolerance (PTol), and pain intensity assessed over the masseter muscles in healthy individuals are affected by the gender of the examiner. Materials and methods Healthy, pain-free individuals were recruited on a voluntary basis. PPT and PTol were assessed using pressure algometry. At the PTol level, participants also rated pain intensity on a 0–10 numeric rating scale. Assessments of PPT and PTol were conducted with six repeated measurements performed twice, separately by one female and one male examiner, on each participant. Results In total, 84 participants (43 women; median age 24, IQR 6) were included. With a female examiner, women reported higher pain intensity than men (Mann Whitney U, p = 0.005). In the multivariable analysis, significantly higher PTol was predicted by male examiner. Also, a higher ratio between PTol and reported pain intensity was predicted by male examiner. Conclusions The gender of the examiner influences pain reporting and perception in an experimental setting. This effect on pain perception related to gender of the examiner is probably related to normative gender behaviors rather than to biological alterations within the examined individual. Clinical relevance In clinical and experimental settings, gender of the examiner may affect not only pain perception but also pain reporting, with potential implications for diagnostics in patients with pain.

Download Full-text

Guided relaxation-based virtual reality versus distraction-based virtual reality or passive control for postoperative pain management in children and adolescents undergoing Nuss repair of pectus excavatum: protocol for a prospective, randomized, controlled trial (FOREVR Peds trial)

10.1101/2020.09.11.20192708 ◽

2020 ◽

Author(s):

Vanessa Anne Olbrecht ◽

Sara E Williams ◽

Keith T O'Conor ◽

Chloe O Boehmer ◽

Gilbert W Marchant ◽

...

Keyword(s):

Virtual Reality ◽

Pain Management ◽

Pain Intensity ◽

Pectus Excavatum ◽

Passive Control ◽

Pain Catastrophizing ◽

Opioid Consumption ◽

The Impact ◽

Guided Relaxation ◽

Pain Unpleasantness

Introduction: Virtual reality (VR) offers an innovative method to deliver nonpharmacological pain management. Distraction-based VR (VR-D) using immersive games to redirect attention has shown short-term pain reductions in various settings. To create lasting pain reduction, VR-based strategies must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates pain-relieving mind-body based guided relaxation with VR, a novel therapy delivery mechanism. The primary aim of this study is to assess the impact of daily VR-GR, VR-D, and 360 video (passive control) on pain intensity and opioid consumption. We will also assess the impact of these interventions on pain unpleasantness, anxiety, and benzodiazepine consumption. The secondary aim of this study will assess the impact of psychological factors (anxiety sensitivity, pain catastrophizing) on pain following VR. Methods and analysis: This is a single center, prospective, randomized, clinical trial. Ninety children/adolescents, ages 8 to 18 years, presenting for Nuss repair of pectus excavatum will be randomized to 1 of 3 study arms (VR-GR, VR-D, 360 video). Patients will use the Starlight Xperience (Google Daydream) VR suite for 10-minutes. Patients randomized to VR-GR (n=30) will engage in guided relaxation/mindfulness with the Aurora application. Patients randomized to VR-D (n=30) will play 1 of 3 distraction-based games, and those randomized to the 360 video (n=30) will watch the Aurora application without audio instructions or sound. Primary outcomes are pain intensity and opioid consumption. Secondary outcomes include pain unpleasantness, anxiety, and benzodiazepine consumption. Ethics and dissemination: This study follows SPIRIT guidelines. The protocol was approved by the Cincinnati Childrens Hospital Medical Center Institutional Review Board. The trial has not yet begun recruiting (recruitment to begin July 2020). Written informed consent will be obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals. Trial registration number: ClinicalTrials.gov NCT04351776, registered April 3, 2020.

Download Full-text

Using an App to monitor postoperative pain at home in pediatric patients

Journal of Child Health Care ◽

10.1177/1367493520919313 ◽

2021 ◽

pp. 136749352091931

Author(s):

Emanuela Tiozzo ◽

Valentina Biagioli ◽

Matilde Brancaccio ◽

Riccardo Ricci ◽

Anna Marchetti ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Health Professionals ◽

Pediatric Patients ◽

Pain Scale ◽

Factors Associated ◽

Prospective Comparative Study ◽

Paper And Pencil ◽

The Impact ◽

At Home

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

Download Full-text

Effect of Adherence to Physical Exercise on Cardiometabolic Profile in Postmenopausal Women

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020656 ◽

2021 ◽

Vol 18 (2) ◽

pp. 656

Author(s):

Valentina Bucciarelli ◽

Francesco Bianco ◽

Francesco Mucedola ◽

Andrea Di Blasio ◽

Pascal Izzicupo ◽

...

Keyword(s):

Physical Exercise ◽

Diastolic Function ◽

Postmenopausal Women ◽

Serum Glucose ◽

Moderate Intensity ◽

Adherence Rate ◽

Before And After ◽

Estrogen Depletion ◽

The Impact ◽

Cardiometabolic Profile

Background: Menopause is associated with negative cardiovascular adaptations related to estrogen depletion, which could be counteracted by physical exercise (PhE). However, the impact of total adherence-rate (TA) to PhE and sedentary time (SedT) on cardiometabolic profile in this population has not been elucidated. Methods: For 13-weeks, 43 women (57.1 ± 4.7 years) participated in a 4-days-a-week moderate-intensity walking training. They underwent laboratory, anthropometric and echocardiographic assessment, before and after training (T0–T1). Spontaneous physical activity (PhA) was assessed with a portable multisensory device. The sample was divided according to TA to PhE program: <70% (n = 17) and ≥70% (n = 26). Results: TA ≥ 70% group experienced a significant T1 improvement of relative wall thickness (RWT), diastolic function, VO2max, cortisol, cortisol/dehydroandrostenedione-sulphate ratio and serum glucose. After adjusting for SedT and 10-min bouts of spontaneous moderate-to-vigorous PhA, TA ≥ 70% showed the most significant absolute change of RWT and diastolic function, body mass index, weight and cortisol. TA ≥ 70% was major predictor of RWT and cortisol improvement. Conclusions: In a group of untrained, postmenopausal women, a high TA to a 13-weeks aerobic PhE program confers a better improvement in cardiometabolic profile, regardless of SedT and PhA levels.

Download Full-text

The Antioxidant Effect of Curcumin and Rutin on Oxidative Stress Biomarkers in Experimentally Induced Periodontitis in Hyperglycemic Wistar Rats

Molecules ◽

10.3390/molecules26051332 ◽

2021 ◽

Vol 26 (5) ◽

pp. 1332

Author(s):

Gilda M. Iova ◽

Horia Calniceanu ◽

Adelina Popa ◽

Camelia A. Szuhanek ◽

Olivia Marcu ◽

...

Keyword(s):

Oxidative Stress ◽

Diabetes Mellitus ◽

Diabetic Rats ◽

Gingival Tissue ◽

Control Group ◽

Albino Rats ◽

Oxidative Stress Biomarkers ◽

Significant Difference ◽

The Impact ◽

Experimentally Induced

Background: There is a growing interest in the correlation between antioxidants and periodontal disease. In this study, we aimed to investigate the effect of oxidative stress and the impact of two antioxidants, curcumin and rutin, respectively, in the etiopathology of experimentally induced periodontitis in diabetic rats. Methods: Fifty Wistar albino rats were randomly divided into five groups and were induced with diabetes mellitus and periodontitis: (1) (CONTROL)—control group, (2) (DPP)—experimentally induced diabetes mellitus and periodontitis, (3) (DPC)—experimentally induced diabetes mellitus and periodontitis treated with curcumin (C), (4) (DPR)—experimentally induced diabetes mellitus and periodontitis treated with rutin (R) and (5) (DPCR)—experimentally induced diabetes mellitus and periodontitis treated with C and R. We evaluated malondialdehyde (MDA) as a biomarker of oxidative stress and reduced glutathione (GSH), oxidized glutathione (GSSG), GSH/GSSG and catalase (CAT) as biomarkers of the antioxidant capacity in blood harvested from the animals we tested. The MDA levels and CAT activities were also evaluated in the gingival tissue. Results: The control group effect was statistically significantly different from any other groups, regardless of whether or not the treatment was applied. There was also a significant difference between the untreated group and the three treatment groups for variables MDA, GSH, GSSG, GSH/GSSG and CAT. There was no significant difference in the mean effect for the MDA, GSH, GSSG, GSH/GSSG and CAT variables in the treated groups of rats with curcumin, rutin and the combination of curcumin and rutin. Conclusions: The oral administration of curcumin and rutin, single or combined, could reduce the oxidative stress and enhance the antioxidant status in hyperglycemic periodontitis rats.

Download Full-text