Angular gyrus connectivity at alpha and beta oscillations is reduced during tonic pain - Differential effect of eye state

The angular gyrus (AG) is a common hub in the pain networks. The role of the AG during pain perception, however, is still unclear. This crossover study examined the effect of tonic pain on resting state functional connectivity (rsFC) of the AG under eyes closed (EC) and eyes open (EO). It included two sessions (placebo/pain) separated by 24 hours. Pain was induced using topical capsaicin (or placebo as control) on the right forearm. Electroencephalographic rsFC assessed by Granger causality was acquired from 28 healthy participants (14 women) before (baseline) and 1-hour following the application of placebo/capsaicin. Subjects were randomly assigned and balanced to groups of recording sequence (EC-EO, EO-EC). Decreased rsFC at alpha-1 and beta, but not alpha-2, oscillations was found during pain compared to baseline during EC only. For alpha-1, EC-EO group showed a pain-induced decrease only among connections between the right AG and each of the posterior cingulate cortex (PCC, P = 0.002), medial prefrontal cortex (mPFC, P = 0.005), and the left AG (P = 0.023). For beta rsFC, the EC-EO group showed a bilateral decrease in rsFC spanning the connections between the right AG and mPFC (P = 0.015) and between the left AG and each of PCC (P = 0.004) and mPFC (P = 0.026). In contrast, the EO-EC group showed an increase in beta rsFC only among connections between the left AG and each of PCC (P = 0.012) and mPFC (P = 0.036). No significant change in the AG rsFC was found during EO. These results provide insight into the involvement of the AG in pain perception and reveal methodological considerations when assessing rsFC during EO and EC

Injuries and pain associated with goalkeeping in football— review of the literature

Knowledge and research about football goalkeeper (GK) injuries are scarce, which prevents the development of evidence-based injury prevention programs. Fortunately, progress is evident in injury prevention strategies in outfield football players. However, a GK fulfills a unique role, and an injured GK can substantially impact a team. Thus, there is a need to clarify and summarize current knowledge concerning football goalkeeper pain and injuries. This narrative review aims to present the best-evidence synthesis of knowledge about football GK injuries and pain, their type, location, and incidence. A secondary aim is to contrast these findings with outfield players and identify knowledge gaps. Scientific databases were searched for the following indexed terms: goalkeeper, injury, soccer, and football. Original papers, including case studies and systematic reviews published from August 1994 to March 2021, were screened for relevance using a priori criteria and reviewed. Commonly described injuries are fractures, luxation and dislocations in the fingers, hand and wrist. The quadriceps femoris and forearms muscles are the most frequently described muscle and tendon injuries. Further, football GK injuries differ in type, location, and incidence compared to outfield players. Whether GKs suffer fewer injuries than players in other positions, whether GK suffer more injuries in training than matches, and whether they sustain more upper limb injuries comparing to field players is still unclear and controversial. Few studies assess pain, and current data point to the development of hip and groin, thigh, knee, arm and forearm pain resulting from training and match play. Due to the crucial role of GK in the football team, it is recommended to use the injury burden as a parameter considering the number and time-loss of injuries in future studies

Pain-free default mode network connectivity contributes to tonic experimental pain intensity beyond the role of negative mood and other pain-related factors

Alterations in the default mode network (DMN) connectivity across pain stages suggest a possible DMN involvement in the transition to persistent pain. This study examined whether pain-free DMN connectivity at lower alpha oscillations (8-10 Hz) accounts for a unique variation in experimental peak pain intensity beyond the contribution of factors known to influence pain intensity. Pain-free DMN connectivity was measured with electroencephalography prior to 1 h of capsaicin-evoked pain using a topical capsaicin patch on the right forearm. Pain intensity was assessed on a (0-10) numerical rating scale and the association between peak pain intensity and baseline measurements was examined using hierarchical multiple regression in 52 healthy volunteers (26 women). The baseline measurements consisted of catastrophizing (helplessness, rumination, magnification), vigilance, depression, negative and positive affect, sex, age, sleep, fatigue, thermal and mechanical pain thresholds and DMN connectivity (medial prefrontal cortex [mPFC]-posterior cingulate cortex [PCC], mPFC-right angular gyrus [rAG], mPFC-left Angular gyrus [lAG], rAG-mPFC and rAG-PCC). Pain-free DMN connectivity increased the explained variance in peak pain intensity beyond the contribution of other factors (ΔR  = 0.10, p = 0.003), with the final model explaining 66% of the variation (R  = 0.66, ANOVA: p < 0.001). In this model, negative affect (β = 0.51, p < 0.001), helplessness (β = 0.49, p = 0.007), pain-free mPFC-lAG connectivity (β = 0.36, p = 0.003) and depression (β = -0.39, p = 0.009) correlated significantly with peak pain intensity. Interestingly, negative affect and depression, albeit both being negative mood indices, showed opposing relationships with peak pain intensity. This work suggests that pain-free mPFC-lAG connectivity (at lower alpha) may contribute to individual variations in pain-related vulnerability. These findings could potentially lead the way for investigations in which DMN connectivity is used in identifying individuals more likely to develop chronic pain

Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain:A Longitudinal Study

Objectives: To longitudinally investigate the relationships between neck/arm disability and pain profile measures in individuals with chronic nonspecific neck pain (NSNP) at baseline, one month, and six months after a standardized physiotherapy intervention. A secondary aim was to compare pain sensitivity of individuals with chronic NSNP at baseline to healthy controls. Methods: A total of sixty-eight individuals with chronic NSNP and healthy controls were recruited. Neck disability index (NDI), the 11-item disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), temporal summation (TS), pressure pain thresholds (PPTs), pain intensity and pain extent were assessed in individuals with chronic NSNP. For the cross-sectional assessment, TS and PPTs were compared to healthy controls. Results: After following a standardized physiotherapy intervention, local and distal PPTs to the neck region decreased at one and six month follow-ups, respectively. Pain extent decreased at one and six months. Furthermore, a positive correlation between neck/arm disability and pain intensity was found at baseline, whereas moderate positive correlations (e.g., between NDI and pain extent) at baseline, one and six month follow-ups and negative correlations at six months (e.g., between arm disability and PPTs) were found. Discussion: Overall, these findings indicate that pain sensitivity can worsen following treatment despite reduced pain extent and unchanged neck disability and pain intensity scores over a six-month period in individuals with chronic NSNP

Digital body mapping of pain quality and distribution in athletes with longstanding groin pain

Groin pain is common in athletes, but remains a challenge to diagnose. Self-reported pain quality distribution may facilitate differential diagnoses. We included 167 athletes with groin pain (≥ 4 weeks). All athletes received a standardized clinical examination. Athletes could choose multiple quality descriptors and intensity, and drew these on a digital body map. Overlay images were created to assess distribution and area visually. Intensity, duration, and qualities were compared between each clinical entity and multiple entities. Top three quality descriptors were electric (22%), pain (19%), and dull/aching (15%). There were no differences in the frequencies of quality descriptors (p = 0.893) between clinical entities. Areas of the mapped qualities were similar between the single clinical entities (χ(2)(3) = 0.143, p = 0.986) and independent of symptom duration (ρ = 0.004, p = 0.958). Despite a considerable overlap, the mapped pain qualities’ distributions appear to differ visually between single clinical entities and align with the defined clinical entities of adductor-related, inguinal-related, and pubic-related groin. In iliopsoas-related groin pain, pain extended more medially. The overlap between the drawn areas underscores a challenge in differentiating groin pain classifications based only on self-reported pain. The prevalence of pain quality descriptors varied and individually do not associate with one particular clinical entity of groin pain

Do gender-specific and high-resolution three dimensional body charts facilitate the communication of pain for women?:A quantitative and qualitative study

BACKGROUND: Chronic pain is more prevalent among women; however, the majority of standardized pain drawings are often collected using male-like androgynous body representations. OBJECTIVE: The purpose of this study was to assess whether gender-specific and high-resolution three-dimensional (3D) body charts facilitate the communication of pain for women. METHODS: Using mixed-methods and a cross-over design, female patients with chronic pain were asked to provide detailed drawings of their current pain on masculine and feminine two-dimensional (2D) body schemas (N=41, Part I) or on female 2D and 3D high-resolution body schemas (N=41, Part II) on a computer tablet. The consistency of the drawings between body charts were assessed by intraclass correlation coefficient (ICC) and Bland-Altman plots. Semistructured interviews and a preference questionnaire were then used to obtain qualitative and quantitative responses of the drawing experience. RESULTS: The consistency between body charts were high (Part I: ICC=0.980, Part II: ICC=0.994). The preference ratio for the masculine to feminine body schemas were 6:35 and 18:23 for the 2D to 3D female body charts. Patients reported that the 3D body chart enabled a more accurate expression of their pain due to the detailed contours of the musculature and bone structure, however, patients also reported the 3D body chart was too human and believed that skin-like appearance limited ‘deep pain’ expressions. CONCLUSIONS: Providing gender-specific body charts may facilitate the communication of pain and the level of detail (2D vs 3D body charts) should be used according to patients’ needs