Chronic diabetic peripheral neuropathic pain: psychometric properties of pain and physical function outcome measures

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Background: Diabetic peripheral neuropathy (DPN) not only produces severe pain, tingling, and numbness sensation in the involved limbs, but also limits physical function due to loss of sensation. There are no recommended methods for clinical situations to measure these signs and symptoms. Studies with high methodological quality use the modified Brief Pain Inventory for Diabetic Peripheral Neuropathic pain (mBPI-DPN) scale and the short form Screening of Activity Limitations and Safety Awareness (sSALSA) scale for measuring these symptoms in DPN population. In order to capture a real change in the variables of interest, the psychometric properties of that measure should be within acceptable limits. As these two measures were not assessed for all of the psychometric properties, there was a need for further evaluation. Methods: Data were collected (n = 38 patients) in a longitudinal cohort study. Test–retest reliability (0–4 weeks) and Responsiveness- Minimal Clinically Important Difference (MCID) (0–12 weeks) were calculated between two sessions. Convergent validity was assessed (between mBPI-DPN pain interference and sSALSA scale). Results: Both measures demonstrated acceptable test–retest reliability (mBPI-DPN scale: ICC = 0.61, SEM = 12.92; the sSALSA scale: ICC = 0.81, SEM = 4.88) and convergent validity (Spearman’s correlation coefficient r = 0.62). The computational methods used in different methodologies to calculate MCID for the mBPI-DPN and the sSALSA scale were varied, hence the magnitude of derived MCID scores also varied. Conclusions: Our study have provided evidence to add to the scientific basis surrounding the use of mBPI-DPN and sSALSA scales in DPN population, but standardization of these measures in a larger population is required

Structural Modifications of the Brain in Acclimatization to High-Altitude

Adaptive changes in respiratory and cardiovascular responses at high altitude (HA) have been well clarified. However, the central mechanisms underlying HA acclimatization remain unclear. Using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) with fractional anisotropy (FA) calculation, we investigated 28 Han immigrant residents (17–22 yr) born and raised at HA of 2616–4200 m in Qinghai-Tibetan Plateau for at least 17 years and who currently attended college at sea-level (SL). Their family migrated from SL to HA 2–3 generations ago and has resided at HA ever since. Control subjects were matched SL residents. HA residents (vs. SL) showed decreased grey matter volume in the bilateral anterior insula, right anterior cingulate cortex, bilateral prefrontal cortex, left precentral cortex, and right lingual cortex. HA residents (vs. SL) had significantly higher FA mainly in the bilateral anterior limb of internal capsule, bilateral superior and inferior longitudinal fasciculus, corpus callosum, bilateral superior corona radiata, bilateral anterior external capsule, right posterior cingulum, and right corticospinal tract. Higher FA values in those regions were associated with decreased or unchanged radial diffusivity coinciding with no change of longitudinal diffusivity in HA vs. SL group. Conversely, HA residents had lower FA in the left optic radiation and left superior longitudinal fasciculus. Our data demonstrates that HA acclimatization is associated with brain structural modifications, including the loss of regional cortical grey matter accompanied by changes in the white matter, which may underlie the physiological adaptation of residents at HA

Transcutaneous electrical nerve stimulation reduces exercise-induced perceived pain and improves endurance exercise performance

Purpose. Muscle pain is a natural consequence of intense and prolonged exercise and has been suggested to be a limiter of performance. Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) have been shown to reduce both chronic and acute pain in a variety of conditions. This study sought to ascertain whether TENS and IFC could reduce exercise-induced pain (EIP) and whether this would affect exercise performance. It was hypothesised that TENS and IFC would reduce EIP and result in an improved exercise performance. Methods. In two parts, 18 (Part I) and 22 (Part II) healthy male and female participants completed an isometric contraction of the dominant bicep until exhaustion (Part I) and a 16.1 km cycling time trial as quickly as they could (Part II) whilst receiving TENS, IFC and a SHAM placebo in a repeated measures, randomized cross-over, and placebo controlled design. Perceived EIP was recorded in both tasks using a validated subjective scale. Results. In Part I, TENS significantly reduced perceived EIP (mean reduction of 12%) during the isometric contraction (P = 0.006) and significantly improved participants’ time to exhaustion by a mean of 38% (P = 0.02). In Part II, TENS significantly improved (P = 0.003) participants’ time trial completion time (~2% improvement) through an increased mean power output. Conclusion. These findings demonstrate that TENS can attenuate perceived EIP in a healthy population and that doing so significantly improves endurance performance in both submaximal isometric single limb exercise and whole-body dynamic exercise

Dose-specific effects of transcutaneous electrical nerve stimulation (TENS) on experimental pain: a systematic review.

Objective To determine the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) parameter combinations on experimental models in healthy humans. Methods Searches were performed using the electronic databases Ovid MEDLINE, CINAHL, AMED, and Web of Science (from inception to December 2009). Manual searches of journals and reference lists of retrieved trials were also performed. Randomized controlled trials (RCTs) were included in the review if they compared the hypoalgesic effect of TENS relative with placebo and control, using an experimental pain model in healthy human participants. Two reviewers independently selected the trials, assessed their methodologic quality and extracted data. Results Forty-three RCTs were eligible for inclusion. A best evidence synthesis revealed: Overall “conflicting” (inconsistent findings in multiple RCTs) evidence of TENS efficacy on experimental pain irrespective of TENS parameters used. Overall intense TENS has “moderate” evidence of efficacy (1 high-quality and 2 low-quality trials). Conventional TENS has overall conflicting evidence of efficacy, this is derived from “strong” evidence of efficacy (generally consistent findings in multiple high-quality RCTs) on pressure pain but strong evidence of inefficacy on other pain models. “Limited” evidence (positive findings from 1 RCT) of hypoalgesia exists for some novel parameters. Low-intensity, low-frequency, local TENS has strong evidence of inefficacy. Inappropriate TENS (using “barely perceptible” intensities) has moderate evidence of inefficacy. Discussion The level of hypoalgesic efficacy of TENS is clearly dependent on TENS parameter combination selection (defined in terms of intensity, frequency, and stimulation site) and experimental pain model. Future clinical RCTs may consider these TENS dose responses

Clinical assessment of balance using BBS and SARAbal in cerebellar ataxia : synthesis of findings of a psychometric property analysis

2017-2018 > Academic research: refereed > Publication in refereed journal201806 bcrcVersion of RecordSelf-fundedPublishe

Pain and Physical Functioning in Neuropathic Pain: A Systematic Review of Psychometric Properties of Various Outcome Measures.

INTRODUCTION: A range of outcome measures across various domains are used to evaluate change following an intervention in clinical trials on chronic neuropathic pain (NeP). However, to capture a real change in the variable of interest, the psychometric properties of a particular measure should demonstrate appropriate methodological quality. Various outcome measures in the domains of pain and physical functioning have been used in the literature for NeP, for which individual properties (eg, reliability/validity) have been reported. To date, there is no definitive synthesis of evidence on the psychometric properties of those outcome measures; thus, the aim of this systematic review was to evaluate the methodological quality [COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines] of studies that evaluated psychometric properties of pain and physical functioning outcome measures used for NeP. METHODS: Specific MeSH/keywords related to 3 areas (pain and/or physical functioning, psychometric properties, and NeP) were used to retrieve relevant studies (English language) in key electronic databases (MEDLINE (Ovid), CINAHL (EBSCO), Scopus, AMED, and Web of Science) from database inception-July 2012. Articles retrieval/screening and quality analysis (COSMIN) were carried out by 2 independent reviewers. RESULTS: Twenty-four pain and thirty-seven physical functioning outcome measures were identified, varying in methodological quality from poor-excellent. CONCLUSION: Although a variety of pain and physical functioning outcome measures have been reported in the literature, few have demonstrate methodologically strong psychometric properties. Thus, future research is required to further investigate the psychometric properties of existing pain and physical functioning outcome measures used for clinical and research purposes

Cutaneous vasoconstriction as a measure of incipient autonomic dysreflexia during penile vibratory stimulation in spinal cord injury

Measurement of haemodynamic responses, cutaneous blood flow and sweat release during penile vibratory stimulation (PVS) in spinal cord-injured men. To assess the validity of using markers of sympathetic activity (cutaneous blood flow and sweat release) as a measure of incipient autonomic dysreflexia during PVS in spinal cord-injured men. Prince of Wales Medical Research Institute, Australia. Ten spinal cord-injured men with injuries ranging from C3 to T6. Continuous arterial pressure, intermittent auscultation, heart rate (HR), respiration, cutaneous blood flow and sweat release from both finger and toe were recorded during PVS. Vibration of the penis caused immediate cutaneous vasoconstriction, but negligible sweat release, in the hands and feet of the quadriplegics and the feet of the paraplegics. Systolic blood pressure (BP) increased by up to 90 mm Hg, and a compensatory vagal bradycardia was observed in five of the six quadriplegics and two of the four paraplegic subjects. Given that there was-in general-an inverse relationship between BP and skin blood flow, we conclude that continuous measurements of skin blood flow above and below the lesion can provide important information on the state of the sympathetic nervous system and early identification of reflexly evoked increases in sympathetic vasoconstrictor drive, below a spinal lesion. Coupled with a decrease in HR, this cutaneous vasoconstriction infers an increased BP