AN OBSERVATIONAL STUDY ON ASSESSMENT OF PAIN THRESHOLD IN TRIVIDHA SATWABALA

Introduction: ‘Purusha’ the sentient being in Ayurveda is formed by the combination of Satwa (Mind), Atma (Soul) and Shareera (Body). Among these, paramount importance has been given to the role of the mind in both health and diseased states. In the present study, the term Satwa has been used to denote Satwabala or the psychic strength of an individual. The assessment of Satwabala is an important part in examination of the patient and while planning the treatment. The interrelationship of mind and body is well explained in Ayurveda. The pain inflicted on one's body has influence on his mind. Some people feel pain more intensely than others and some tolerate it so much more than others. Thus, quantification of pain with reference to psychic strength is essential for diagnostic and pain monitoring purposes in clinical practice. Aim and Objectives: The study was carried out with an aim to assess the Pain threshold in the form of Pressure Pain Threshold [PPT] and the Pain intensity in the form of the Visual Analog Scale [VAS] in three types of Satwabala. It was hypothesised that there could be a positive relation between Satwabala and Pain threshold. Methods: For the objective assessment of Pressure Pain Threshold a simple handheld pressure Algometer has been used. For the subjective measurement of experimental pain, Visual Analog Scale was used. Further, the Satwa of participants was assessed using a standard questionnaire. Results: The resultssuggested that in people between the age group of 18-40 years, there exist a statistically highly significant positive correlation between Satwabala and Pain threshold with P< 0.01. Keywords: Satwa, Satwabala, Pain threshold, Pressure Pain Threshold, Visual Analog Scale.

The Effect of Hamstring Relaxation Program on Headache, Pressure Pain Threshold, and Range of Motion in Patients with Tension Headache: A Randomized Controlled Trial

The purpose of this study was to determine if the severity of headache is reduced by decreasing hamstring tension in patients with tension headache. Thirty patients participated in this study. The participants were randomly allocated to two groups: hamstring relaxation program (HR) group (n = 15) and control group (n = 15). The participants in the HR group participated in a HR program for 25 min per day, three times per week, for a period of 4 weeks, and the control group participated in an electrotherapy for 25 min per day, three times per week, for a period of 4 weeks. Both groups participated in a self-myofacial release for 5 min per day, three times per week, for a period of 4 weeks. Headache was evaluated using the headache impact test (HIT-6) and visual analog scale (VAS). The pain pressure threshold (PPT) was evaluated using a digital pressure algometer. The range of motion (ROM) was evaluated using a goniometer and two special tests: straight leg raise test (SLRT) and popliteal angle test (PAT). The two groups showed no significant differences in terms of age, sex, height, and weight. The VAS and HIT-6 scores (p < 0.05) and neck and hamstring PPT showed significant improvements (p < 0.05). Neck flexion ROM and SLRT and PAT scores showed significant improvements (p < 0.05) in both groups, and the HR group showed significantly more improvements than the control group. This study confirmed that the HR program has positive effects on tension headache and is a good intervention for alleviating headaches in patients with tension headache.

Tenderness of the knee is associated with thinning of the articular cartilage evaluated with ultrasonography in a community-based cohort: The Nagahama study

ABSTRACT Objectives This study aimed to elucidate the association between joint line tenderness (JLT) of the knee and knee joint structural changes evaluated with ultrasonography (US) for the early diagnosis of knee osteoarthritis (KOA). Methods This cross-sectional study included 121 participants (age 71.7 ± 5.8 years, 75 women) from a community-based population. Bilateral structural changes in the knee joint were evaluated with US, and the presence or absence of JLT was evaluated using a pressure algometer. Logistic regression analysis was performed to evaluate the odds ratios (ORs) of US findings for the presence of JLT. Moreover, when the analysis was limited to knees with pre-/early radiographic KOA, the ORs were also calculated using logistic regression analysis. Results Among the 242 knees, 38 had medial JLT, which was significantly associated with female sex (OR 11.87) and loss of cartilage thickness of the distal medial femoral condyle (CTh-MFC) (OR 0.12). Among 96 knees with Kellgren–Lawrence grade ≤ 2, 18 knees had medial JLT, which was also significantly associated with loss of CTh-MFC (OR 0.07) and medial osteophytes (OR 2.01). Conclusions JLT is significantly associated with thinning of the femoral cartilage and larger osteophytes in elderly patients, even in those with pre-/early radiographic KOA.

Pressure pain thresholds in individuals with knee pain: a cross-sectional study

Background Knee osteoarthritis (KOA), chronic widespread pain (CWP) and overweight/obesity are public health problems that often coincide, and there is a multifactorial and unclear relationship between them. The study aimed to (1) investigate pain sensitivity, assessed by pressure pain thresholds (PPTs), among women and men with knee pain and (2) associations with, respectively, radiographic KOA (rKOA), CWP, and overweight/obesity. Methods Baseline data from an ongoing longitudinal study involving 280 individuals with knee pain in the 30–60 age group. Pain sensitivity was assessed by PPTs on eight different tender points using a pressure algometer. The participants’ knees were x-rayed. Self-reported CWP and number of pain sites were assessed with a pain figure, and overweight/obesity was measured using body mass index (BMI), visceral fat area (VFA), and body fat percentage, assessed with a bioimpedance. Associations were analysed using regression analyses. Results Women reported lower PPTs than men (p < 0.001), but no PPTs differences were found between those with and without rKOA. Low PPTs was associated with female sex, more pain sites, CWP, and a higher VFA and body fat percentage. The tender points second rib and the knees were most affected. The prevalence of CWP was 38 %. Conclusions The modifiable factors, increased VFA, and body fat could be associated with increased pain sensitivity among individuals with knee pain. Longitudinal studies are needed to further investigate the associations.

A novel metric of reliability in pressure pain threshold measurement

The inter-session Intraclass Correlation Coefficient (ICC) is a commonly investigated and clinically important metric of reliability for pressure pain threshold (PPT) measurement. However, current investigations do not account for inter-repetition variability when calculating inter-session ICC, even though a PPT measurement taken at different sessions must also imply different repetitions. The primary aim was to evaluate and report a novel metric of reliability in PPT measurement: the inter-session-repetition ICC. One rater recorded ten repetitions of PPT measurement over the lumbar region bilaterally at two sessions in twenty healthy adults using a pressure algometer. Variance components were computed using linear mixed-models and used to construct ICCs; most notably inter-session ICC and inter-session-repetition ICC. At 70.1% of the total variance, the source of greatest variability was between subjects ($${\sigma }_{subj}^{2}$$ σ subj 2 = 222.28 N2), whereas the source of least variability (1.5% total variance) was between sessions ($${\sigma }_{sess}^{2}$$ σ sess 2 = 4.83 N2). Derived inter-session and inter-session-repetition ICCs were 0.88 (95%CI: 0.77 to 0.94) and 0.73 (95%CI: 0.53 to 0.84) respectively. Inter-session-repetition ICC provides a more conservative estimate of reliability than inter-session ICC, with the magnitude of difference being clinically meaningful. Quantifying individual sources of variability enables ICC construction to be reflective of individual testing protocols.

Mechanical Nociceptive Threshold, Tissue Alterations and Horn Growth in Calves after Injection of Isoeugenol or Clove Oil under the Horn Bud

Disbudding of calves is a common, painful intervention. Due to cytotoxic and anesthetic properties, the injection of clove oil or its component isoeugenol may be less detrimental to animal welfare. We investigated mechanical nociceptive threshold (MNT), possible tissue alterations and horn growth for up to 12 weeks after injection of 1.5 mL clove oil (CLOV), isoeugenol (ISO) or saline (CON) or after hot-iron disbudding (BURN; with local anesthesia and sedation, n = 10/treatment). MNT was measured using von Frey filaments and a pressure algometer at four locations around the horn bud. There was a treatment*time point interaction (linear mixed model, p < 0.05). MNT decreased most strongly and for the longest time for BURN in most calves at least for 3 weeks. For ISO, the decrease was less distinct and most calves’ values returned to baseline after 1–2 weeks. MNT in CLOV was intermediate, with decreased values up to 3 weeks in some animals. 12 weeks after the treatment, horn growth was prevented in about 50% of the horns in CLOV and ISO. Tissue alterations such as swellings of the eyelids often occurred in CLOV, but less so in ISO. Our results suggest that injection of isoeugenol causes less pain and thus seems to be beneficial compared to hot-iron disbudding, while clove oil was not advantageous. Regarding the effectiveness of isoeugenol to prevent horn growth, more studies are needed.

Bell’s Palsy—Retroauricular Pain Threshold

Background and objectives: Non-motor symptoms in the form of increased sensitivity are often associated with the onset of idiopathic Bell’s palsy (IBP). The aims were to determine whether the pain threshold in the retroauricular regions (RAR) in IBP patients and the time of its occurrence is related to IBP severity. Materials and Methods: The study was conducted among 220 respondents (142 IBP patients, 78 healthy subjects (HS)). The degree of IBP was graded using the House–Brackmann and Sunnybrook Grading Scales (II—mild dysfunction, VI—total paralysis), whereas the pain thresholds were measured using the digital pressure algometer. Results: We found no difference in the degree of the pain threshold between the right and left RAR in the HS group. IBP patients belonging to groups II, III, IV, and V had lower pain thresholds in both RARs than HS and IBP patients belonging to group VI. There was no difference in the degree of pain threshold in RAR between the affected and unaffected side in IBP patients. The incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups II and III of IBP patients is noticeably lower and the incidence of retroauricular pain that occurred only after the onset of paralysis is more frequent. Also, we found that the incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups V and VI of IBP patients was more frequent. Conclusions: The degree of pain threshold lowering in RAR (bilaterally) is inversely related to the severity of IBP. We suggest that the occurrence of retroauricular pain before the onset of facial weakness is associated with higher severity of IBP while the occurrence after the onset is associated with lower severity of IBP.

Biomechanical Model of Human Index Finger During Examination

We have developed a mathematical model based on the Hunt-Crossley’s viscoelastic contact formulation for predicting the contact forces in the upper-body. The simulations were carried out in OpenSim software package and the simulations results were compared to experimentally recorded contact forces measured using a pressure algometer for assessing pressure pain sensitivity in the pelvic region 1. We observed a very good agreement between the model prediction and algometer data. Our simulation revealed that by pressing down on the tissue both normal and frictional contact forces increase up to a point- ceiling effect. Moreover, viscoelastic properties of the examinee’s tissue were associated with force; specifically, as the stiffness of the tissue declined both normal and frictional contact forces similarly declined albeit in a different way. Once the contact force reaches a peak point (irrespective of the baseline stiffness of the tissue) additional pressure application by the examiner was associated with incremental decrease in both normal and frictional (wasted) contact force.

Effects of Different Ischemic Preconditioning Occlusion Pressures on Muscle Damage Induced by Eccentric Exercise: A Study Protocol for a Randomized Controlled Placebo Clinical Trial

Introduction: due to its mechanical advantage and less metabolic demand, eccentric exercise (EE) has been widely used in rehabilitation and for improving physical fitness. However, EE can induce muscle damage, leading to structural alterations and reduced muscle function, making it necessary to seek alternatives to reduce this damage caused by stress. Thus, ischemic preconditioning (IPC) could represent an aid to reduce the damage caused by EE, because it can mitigate the ischemia-reperfusion injury, and can be used to accelerate the post-exercise recovery process. Objectives: to compare the effects of IPC, using different occlusion pressures, on the acute and delayed responses of perceptual outcomes and on the markers of muscle damage, in addition to verifying whether the technique causes deleterious effects on performance in recovery after eccentric exercise. Methods: a randomized controlled placebo clinical trial will be carried out with 80 healthy men aged 18 to 35 years who will be randomly divided into four groups: IPC using total occlusion pressure (TOP), IPC with 40% more than TOP, placebo (10 mmHg), and control. The IPC protocol will consist of four cycles of ischemia and reperfusion of five minutes each. All groups will perform an EE protocol, and assessments will be carried out before, immediately after, and 24, 48, 72, and 96 hours after the end of the EE to evaluate creatine kinase (CK), blood lactate, perception of recovery using the Likert scale, being sequentially evaluated, pain by the visual analog scale (VAS), pain threshold using a pressure algometer, muscle thickness by ultrasound, muscle tone, stiffness and elasticity by myotonometry, vectors of cell integrity through electrical bioimpedance (BIA), and maximal voluntary isometric contraction (MVIC) using the isokinetic dynamometer. The trial was registered at ClinicalTrials.gov (NCT04420819). Discussion: the present study aims to present an alternative technique to reduce muscle damage caused by EE, which is easy to apply and low cost. If the benefits are proven, IPC could be used in any clinical practice that aims to minimize the damage caused by exercise, presenting an advance in the prescription of EE and directly impacting on the results of post-exercise recovery.Trial registration number: ClinicalTrials.gov, (30765020.3.0000.5402). Registered on 19 May 2020.