Pain inhibition is not affected by exercise-induced pain

Introduction: Offset analgesia (OA) and conditioned pain modulation (CPM) are frequently used paradigms to assess the descending pain modulation system. Recently, it was shown that both paradigms are reduced in chronic pain, but the influence of acute pain has not yet been adequately examined. Objectives: The aim of this study is to investigate OA and CPM after exercise-induced pain to evaluate whether these tests can be influenced by delayed-onset muscle soreness (DOMS) at a local or remote body site. Methods: Forty-two healthy adults were invited to 3 separate examination days: a baseline appointment, the consecutive day, and 7 days later. Participants were randomly divided into a rest (n 5 21) and an exercise group (n 5 21). The latter performed a single intensive exercise for the lower back. Before, immediately after, and on the following examination days, OA and CPM were measured at the forearm and the lower back by blinded assessor. Results: The exercise provoked a moderate pain perception and a mild delayed-onset muscle soreness on the following day. Repeatedmeasurements analysis of variance showed no statistically significantmaineffect for eitherOAorCPMat the forearmor lower back (P.0.05). Conclusion: Delayed-onset muscle soreness was shown to have no effect on the inhibitory pain modulation system neither locally (at the painful body part), nor remotely. Thus, OA and CPM are robust test paradigms that probably require more intense, different, or prolonged pain to be modulated

Vrijwillig kinderloze vrouwen : verkenningen rond een keuze

This research on voluntarily childless married women was carried out by the direction of the "Netionaal Programma Demografisch Onderzoek (NPDO) (National Program for Demographic Research). To all appearances, the percentage of voluntarily childless married couples is increasing in various western countries, including the Netherlands. This makes this relatively new topic of research extra interesting.The problem-definition of the research was as follows:- Which factors influence the choice for voluntary childlessness? How does the decision-making process around this choice take place?- What role does women's emancipation play?- As the number of women who do not conform with traditional sex-roles increases, will the number of voluntarily childless women also increase?In the research design I tried to link the findings of research abroad (Bram, 1974; Veevers, 1973b) and my own observations on the role of women in society with the Fishbein theoretical model on behavioral intention (Fishbein & Ajzen, 1975).The sample was drawn from the 90,000 inhabitants of a city in the western part of the country. All the women who had been married for at least 3 years, were under age 35 and who had no children were sampled (about 1200). A control group of 100 mothers with the same characteristics, but with one child no more than 2 years old, was also drawn from this population. These preliminary subjects received a letter of introduction and a small screening questionnaire. As a result of these questionnaires four groups of women were selected (N=170). Because of the non-normal distribution of the voluntarily childless in the general population, the childless sample was supplemented by subjects chosen in a purposive manner. A lengthy (2-4 hours) personal interview was conducted with open-ended and pre-coded questions. (Material collected in 1978). A total of 158 of the respondents was used in the final analysis, the four groups are:1- Voluntary childless WC): 65 women who ware sure that they wanted to be permanently childless;2- Hesitators (H): 43 women who were (very much) in doubt whether they wanted to have children;3- Delays (D): 23 women who were delaying having children;4- Mothers (M): 29 women who had one child age 2 or younger.The research report comprises 14 chapters.In chapter 1 it is established that no reliable data on the numbers of VC within a population are available. This is partly due to incorrect interrogation during fertility surveys and other such research, where the desire for children was always presumed. This also holds true for the Netherlands: considerably more material concerning voluntary childlessness could have been available if the right questions had been asked in earlier research. On account of the predicted massive increase in the percentage of VC among recently contracted marriages in the Netherlands (an expected 18 to 20% of marriages contracted in 1980 and later (among others: CBS, 1976; Frinking & Niphuis-Nell, 1979)), a change in the way of thinking around motherhood can be established.In chapter 2, the results of research done recently in the Netherlands and abroad concerning the backgrounds of the VC are reviewed. The fact that the VC are under considerable social pressure to conform with the pronatalist norm also comes up for discussion; although according to the results of national opinion polls, the VC are less disapproved of than some 15 years ago.In chapter 3, the choice of Fishbein's theoretical model is accounted for. This model emphasizes the importance of two basic social-psychological concepts that were traditionally treated independently - the "attitude concept" and the "concept of social norm". This theoretical model provides a bridge between these two approaches to the study of human behavior. In addition, Veevers' decision-making typology for the VC (1973b) is described; this was tested during this research. A schedule was constructed in order to clarify the notion of sex-roles. A description of the sex-role socialization is given, in the course of which it is made clear that girls are still "programmed" for motherhood.In chapter 4 an account is given of the criteria which were required of the population to be investigated and the recruit ment and other technical details of the preliminary stage of the field work and the field work itself are discussed.In the subsequent chapters, the research results are presented. Chapter 5 is one of the central chapters of the report as it comprises the results of measurements using the Fishbein model. The attitude-items for the model were derived from questionnaires. used during the "Nationaal Onderzoek Vruchtbaarheids- en Ouderschapsmotivatie" (NOVOM) (National Research on Fertility and Parenthood Motivation) and those used by Bram (1974). These in turn were based on Arnold & Fawcett's "Value of Children scale" (Niphuis-Nell, 1976) and Hoffman & Hoffman's model of the values and costs of children (Bram, 1974) respectively. Both attitude and subjective norm components appeared to be good predictors of behavioral intention. The multiple correlation of attitude (Σb.e) and subjective norm (ΣNB.MC) with the behavioral intention was .74 (pTwenty of the thirty-nine attitude-items which were taken into account showed significant differences between the four groups; the differences between VC and M being the most obvious. The VC saw fewer satisfactions and more "costs" as consequences of having children than the other groups. It is remarkable that the scores of the H were very often near those of the VC, and the scones of the D near those of the M. Personal freedom, the opportunity to work outdoors and to do things spontaneously with one's spouse were very important for the VC.As far as the normative component is concerned, the following can be mentioned: in four of the nine subjective norm-items significant differences between the groups could be established. The respondents did not care much about the opinion of others (referents) with regard to having children. An exception was the husband, who was the most important referent for all four groups, but the "motivation to comply" of the VC was significant ly lower.The attitude and subjective norm components together formed 54% of accounted for variance of behavioral intention. A detailed reconstruction of the course of the decision-making process of the VC brought to light that Veevers' decision-making typology is only applicable to very few of the VC in this research. (This conforms with the experiences of the VC in the NOVOM-research). Veevers' notion that first "delaying" VC would, to a large extent, implicitly decide to remain voluntarily childless also appeared not to apply to these VC respondents: nearly 75% of them said that they had made an explicit decision (chapter 61. All this could be a consequence of the phenomenon of voluntary childlessness becoming better known and more discussable in the Netherlands in the second half of the seventies.In answering open-ended questions on consequences of having children and on the respondents' motivation "to parent or not to parent", freedom again is a very important consideration for the VC. Many of them were worried about the chances children would have in this world (because of over-population, pollution, danger of war and the like).The motives which were mentioned turned out to link up well with the scores of the various groups on the attitude-items of the Fishbein model (chapter 7).In chapter 8 the social pressure to procreate, which 60% of the respondents said they were under, is described. Parents and in-laws were mentioned most as the source of this pressure (68% of those mentioned). The reaction of the respondents in actual and hypothetical social pressure situations was usually said to be rejective. This tallies with the scores on the normative component of the Fishbein model, where a minimal motivation to comply emerged. In general the VC appeared to be the most sensitive in pronatal pressure situations.Nearly all the respondents turned out to have either a positive or a neutral opinion of VC (they think that those concerned should decide for themselves).The VC were highly dedicated to upholding their childfree lifestyle. Almost one third of them reported their own or their spouse's sterilization, and most others ware inclined to be sterilized in the (near) future (chapter 9).In chapters 10, 11 and 12 the results of a number of questions concerning childhood background variables, demographic variables and situational variables are described. As was mentioned earlier, the contents of these questions were partly inspired by the results of foreign research on VC. With the aid of the chi-square test, the question of whether VC differed on all these points from other groups of respondents was looked into. Not many significant differences were found hare. The childhood situation of the VC were pretty much the same as those of other respondents and the social-demographic characteristics hardly differed either. The only fact worth mentioning is that a significantly higher percentage of M felt religously bound. The differences which manifested themselves in the situational variables can be mainly attributed to the differences in situation of all the (still) childless on the one hand and M on the other (among others: less opportunities to work outdoors, lower family income, more household duties etc.) . One outcome which seems interesting at first sight, viz. the lack of difference in the average educational level between the groups, will be cancelled when those who are currently following some form of higher education complete their studies: then the M will fall behind. (However, it was established that within the group of respondents there was an unintentional over-representation of women with a higher educational level compared to the national percentages which may be expected for women with the same demographic characteristics).Chapter 13 mentions first of all that measurements with the aid of existing scales of personality characteristics such as self-esteem, assertiveness and sensitivity towards criticism, brought no significant differences to light. However, other points did result in interesting differences. During the investigation, it was supposed that the more a woman perceives the existing sex-roles and the resulting positional distribution in society as traditional and restrictive for women (and especially for mothers), while she herself has a modern sex~ role conception, the more she will consider the consequences of motherhood more seriously than a woman with a traditional sex-role conception. The latter will see motherhood as a must in order to prove herself as a woman and feel content. Two scales constructed during this research in order to map the sex-role perception and sex-role conception of the respondents yield remarkable differences between the groups. In accordance with expectations, the sex-role perception of the VC was the most traditional and the sex-role conception of the VC (and the H) the most modern. The discrepancy between sex-role perception and sex- role conception was greatest within the group of VC. The VC were more positive towards women's lib than the M.In chapter 14, the connection is made between the Fishbein model and the "external" variables described in chapters 10, 11, 12 and 13. The results of the correlation of relevant external variables with behavioral intention are given. The correlations were generally weak: From the research results, it can be established that socialpsychological factors have the most influence on the forming of behavioral intention to remain VC and that the VC cannot be distinguished in any obvious way from the other groups of women as far as social-demographic, situational characteristics and childhood background are concerned.A distinction between "primary" and "secondary" VC is proposed. Primary VC will stick by their decision under all circumstances, secondary VC, however, could reconsider their decision (e.g. because of a lack of employment opportunities or social changes which meant that bringing up and caring for children would not be the sole responsibility of the woman). The research results support predictions of an increase in the percentage of marriages remaining VC, where women's lib seems to be an important condition.</p

Het ontstaan van de wijk Angsteloord

Geschiedenis van het uitbreidingsplan van 1950 voor de gemeente Abcoude. Zo is de wijk Angsteloord ontstaan

Pain mechanisms in low back pain: a systematic review and meta-analysis of mechanical quantitative sensory testing outcomes in people with non-specific low back pain

Study Design Systematic review and meta-analysis. Background Quantitative mechanical sensory testing (QST) assesses sensory functioning and detects functional changes in (central) nociceptive processing. In the current low back pain literature it has been hypothesized that these functional changes might be apparent in people with non-specific low back pain (NSLBP), although the results are mixed. Objective The aim of this systematic review/meta-analysis was to appraise and summarize the literature about QST outcomes in people with subacute and chronic NSLBP and healthy controls (HC). Methods This systematic review and meta-analysis was reported using PRISMA guidelines. Five databases were searched for relevant literature. Studies comparing mechanical QST-measures involving people with subacute and chronic low back pain and HC were included if 1) pressure pain thresholds (PPTs), 2) temporal summation (TS) and/or 3) conditioned pain modulation (CPM) were reported. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale (NOS). If possible, the results from different studies were pooled. Results Twenty-four studies were included. NOS scores varied between one and six points. Meta-analysis showed that people with NSLBP, compared to HC have significantly lower PPTs at remote sites and increased TS at the lower back. For example, PPTs measured at the scapula, were significantly lower in patients with NSLBP than in HC (pooled mean difference (MD): 119.2, 95% confidence interval (CI): (91.8, 146.6), P<0.00001. Conclusion This meta-analysis found that overall PPT measurements at remote body parts are significantly lower in the group with NSLBP compared with HC. TS and CPM measurements demonstrated mixed outcomes. Level of Evidence Therapy, level 3a. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2019.887

Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis

BACKGROUND: A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined. OBJECTIVES: The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain. METHODS: For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain. CONCLUSIONS: Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain

In the spine or in the brain?: recent advances in pain neuroscience applied in the intervention for low back pain

Conservative, surgical and pharmacological strategies for chronic low back pain (CLBP) management offer at best modest effect sizes in reducing pain and related disability, indicating a need for improvement. Such improvement may be derived from applying contemporary pain neuroscience to the management of CLBP. Current interventions for people with CLBP are often based entirely on a “biomedical” or “psychological” model without consideration of information concerning underlying pain mechanisms and contemporary pain neuroscience. Here we update readers with our current understanding of pain in people with CLBP, showing that CLBP is not limited to spinal impairments, but is also characterised by brain changes, including functional connectivity reorganisation in several brain regions and increased activation in brain regions of the so-called ‘pain matrix’ (or ‘pain connectome’). Indeed, in a subgroup of the CLBP population brain changes associated with the presence of central sensitisation are seen. Understanding the role of these brain changes in CLBP improves our understanding not only of pain symptoms, but also of prevalent CLBP associated comorbidities such as sleep disturbances and fear avoidance behaviour. Applying contemporary pain neuroscience to improve care for people with CLBP includes identifying relevant pain mechanisms to steer intervention, addressing sleep problems and optimising exercise and activity interventions. This approach includes cognitively preparing patients for exercise therapy using (therapeutic) pain neuroscience education, followed by cognition-targeted functional exercise therapy