Effect of TENS on pain in relation to central sensitization in patients with osteoarthritis of the knee: study protocol of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Central sensitization has recently been documented in patients with knee osteoarthritis (OAk). So far, the presence of central sensitization has not been considered as a confounding factor in studies assessing the pain inhibitory effect of tens on osteoarthritis of the knee. The purpose of this study is to explore the pain inhibitory effect of burst tens in OAk patients and to explore the prognostic value of central sensitization on the pain inhibitory effect of tens in OAk patients.</p> <p>Methods</p> <p>Patients with knee pain due to OAk will be recruited through advertisements in local media. Temporal summation, before and after a heterotopic noxious conditioning stimulation, will be measured. In addition, pain on a numeric rating score, WOMAC subscores for pain and function and global perceived effect will be assessed. Patients will be randomly allocated to one of two treatment groups (tens, sham tens). Follow-up measurements will be scheduled after a period of 6 and 12 weeks.</p> <p>Discussion</p> <p>Tens influences pain through the electrical stimulation of low-threshold A-beta cutaneous fibers. The responsiveness of central pain-signaling neurons of centrally sensitized OAk patients may be augmented to the input of these electrical stimuli. This would encompass an adverse therapy effect of tens. To increase treatment effectiveness it might be interesting to identify a subgroup of symptomatic OAk patients, i.e., non-sensitized patients, who are likely to benefit from burst tens.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01390285">NCT01390285</a></p

Central modulation in cluster headache patients treated with occipital nerve stimulation: an FDG-PET study

Peer reviewe

Differential Effects of Painful and Non-Painful Stimulation on Tactile Processing in Fibromyalgia Syndrome and Subjects with Masochistic Behaviour

BACKGROUND: In healthy subjects repeated tactile stimulation in a conditioning test stimulation paradigm yields attenuation of primary (S1) and secondary (S2) somatosensory cortical activation, whereas a preceding painful stimulus results in facilitation. METHODOLOGY/PRINCIPAL FINDINGS: Since previous data suggest that cognitive processes might affect somatosensory processing in S1, the present study aims at investigating to what extent cortical reactivity is altered by the subjective estimation of pain. To this end, the effect of painful and tactile stimulation on processing of subsequently applied tactile stimuli was investigated in patients with fibromyalgia syndrome (FMS) and in subjects with masochistic behaviour (MB) by means of a 122-channel whole-head magnetoencephalography (MEG) system. Ten patients fulfilling the criteria for the diagnosis of FMS, 10 subjects with MB and 20 control subjects matched with respect to age, gender and handedness participated in the present study. Tactile or brief painful cutaneous laser stimuli were applied as conditioning stimulus (CS) followed by a tactile test stimulus (TS) 500 ms later. While in FMS patients significant attenuation following conditioning tactile stimulation was evident, no facilitation following painful stimulation was found. By contrast, in subjects with MB no attenuation but significant facilitation occurred. Attenuation as well as facilitation applied to cortical responses occurring at about 70 ms but not to early S1 or S2 responses. Additionally, in FMS patients the amount of attenuation was inversely correlated with catastrophizing tendency. CONCLUSION: The present results imply altered cortical reactivity of the primary somatosensory cortex in FMS patients and MB possibly reflecting differences of individual pain experience

Effect of dance on lower-limb range of motion in young people with cerebral palsy: a blinded randomized controlled clinical trial

Lavinia Teixeira-Machado,1 Josimari M DeSantana2 1Education in Health Department, Federal University of Sergipe, Lagarto, SE, Brazil; 2Department of Physical Therapy, Graduate Program Physiological Sciences, Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brasil Purpose: One of the most limiting conditions in cerebral palsy (CP) is the impairment in musculoskeletal mobility. CP may impair the ability to perform efficient movements. The aim of this trial was to investigate the effect of dance on the range of motion (ROM) of lower limbs in young people with CP. Patients and methods: the randomized clinical trial consisted of two groups: dance group (DG) and control group (CG). Both of them underwent a 1-hour treatment, twice a week, for 2 months. Sanny&reg; pendulum fleximeter was used to measure ROM in pre- and posttreatment. The applied procedures in both groups were conducted at suitable locations. Twenty-six participants were allocated to these two groups of study. Results: In DG, the sampling variances showed improvements in all lower limb joints and axes of movements (P&lt;0.05). In CG, there was increase in passive ROM in some lower limb joints (P&le;0.05). Conclusion: Physical intervention is imperative to improve ROM. It seems dance practice can contribute to CP corporal mobility in a positive way. Clinical trial number: N&ordm; CAAE-06154012.4.0000.0058-12, number 98.993. Keywords: dance, physical therapy, cerebral palsy, range of motio

Management and Treatment of WAD Patients : Conclusive Remarks

Whiplash-associated disorder (WAD) represents a significant public health problem, resulting in a substantial socioeconomic burden throughout the industrialised world, wherever costs are documented