Chronic Pain Following Musculoskeletal Injuries: Where Do Familial Factors, Depression, and Distress Fit in?

Background: Currently, there is a paucity of effective therapeutic options for chronic pain. A better understanding of the factors that can contribute to chronic pain development and maintenance can lead to more informed prevention and management strategies. Purpose: The driving force for this thesis comes from the biopsychosocial model of pain. The main purpose was to investigate the contribution of various psychosocial factors to chronic pain with the following objectives: 1) to systematically review the literature on the existence of a familial sub-type of complex regional pain syndrome (fCRPS); 2) CRPS can follow injuries such as distal radius fractures (DRFs), therefore the second objective was to assess recovery trajectories of patients following DRFs and assess the contribution of various characteristics; 3) to examine the effect of post-trauma distress on pain one year following musculoskeletal injuries. Results: There is a potential (\u3c25%) for the existence of fCRPS. People with this sub-type may suffer from more severe symptoms and earlier age at onset. Following DRFs, a significantly higher proportion of people with depression were found in the non-recovery group (24%) compared to the slow-recovery (16%, p=0.04) and the rapid-recovery group (8%, p=0.03). Following musculoskeletal injuries, a subset of people continue to have persisting pain. In this subset of people, higher levels of distress were associated with higher levels of pain 12 months later. Conclusion: Familial factors, depression, and post-trauma distress all have the potential to contribute to chronic pain development and maintenance. The results of this thesis provide further evidence for the biopsychosocial model of chronic pain. Keywords Chronic pain; musculoskeletal injuries; biopsychosocial; familial; depression; distres

Depression Affects Recovery Following Distal Radius Fracture: A Latent Class Analysis

Background: Most people recover within six months following distal radius fractures (DRFs) but some experience pain and disability for one year or longer. Therefore, it is important to understand the factors that can help predict recovery. According to the biopsychosocial model of pain, psychological aspects of a condition can play important roles in explaining recovery. Objectives: To identify the recovery trajectories of patients with DRFs and to determine the degree to which depression affects these trajectories. Methods: Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding the single item pertaining to depression were extracted. Latent class analysis was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. Results: The latent class analysis revealed three trajectories: rapid-recovery, slow-recovery, and non-recovery as the best fit to the data. The proportion of people that had depression was significantly greater in the non-recovery class (24%) compared to the rapid-recovery (8%) and slow-recovery classes (16%) (p Discussion: Patients who appear to be in the non-recovery class may require additional assessments, closer monitoring, supervised therapy, or other interventions to improve outcomes

Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review

Background: People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia. Objective: To review gait parameters and characteristics associated with falls in people with dementia. Methods: Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia. Results: Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson’s Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia. Conclusion: This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population

CaMKII mediates input-specific early odor preference learning in rats

The synaptic tagging hypothesis explains how input specificity is preserved in long-term potentiation of synapses. This phenomenon requires new proteins that are synthesized in the nuclei and shipped cell wide, to be captured by a tag at synapses that signal a prior synaptic activity. One specific molecule called calcium/calmodulin Kinase II (CaMKII) plays a major role and has been postulated to function as a synaptic tag due to its unique properties. The behavioral relevance of synaptic tagging has not been extensively studied. Using an early odor-preference learning model, which occurs in a week-old rat pup when a novel odor is paired with a reward, we tested the hypothesis that CaMKII activation is critical for short and long-term memories as well as for inputspecificity of the odor learning. Using behavioral pharmacology, we first tested whether blocking CaMKII with KN-62 infusion in the olfactory bulb blocks short-term (tested at 3 hr) and long-term memories (tested at 24 hr). Our results show that both memories were blocked. To test the role of CaMKII in input specificity of long-term memory, we used a PKA agonist, Sp-cAMP, to induce 24 hr memory and tested whether blocking CaMKII at the same time affects memories for the learned odor (peppermint) as well as a control odor (vanillin). Co-infusion of Sp-cAMP with KN-62 did not impair 24 hr memory for peppermint; however, the input specificity was lost since animals also showed preference to vanillin. Immunohistochemistry results show that phosphorylated CaMKII is primarily expressed in mitral cell dendrites of olfactory bulbs. These experiments help us understand the specific role of CaMKII in short and long-term odor memories, its role as a synaptic tag, and its role in memory specificity

Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis.

© 2019 Background: Distal radius fractures (DRFs) are common and can lead to substantial pain and disability. Most people recover in six months, but some experience persistent pain and disability for one year or longer after injury. Therefore, it is important to understand the factors that can help predict poor recovery. Objective: To identify recovery trajectories in DRF patients and to determine the factors that can help predict poor recovery. Methods: Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding depression were extracted. Latent growth curve analysis (LGCA) was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. Results: The LGCA revealed three distinct trajectories (rapid-recovery: (69%), slow-recovery: (23%), and non-recovery: (8%) as the best fit to the data. The proportion of people with depression was significantly greater in the non-recovery class (24%) compared to the slow (16%, p = 0.04) and rapid-recovery (8%, p = 0.03) classes. Additionally, the proportion of females were significantly lower in the non-recovery (64%, p = 0.03) compared to the slow (85%, p = 0.03) and the rapid-recovery classes (81%, p = 0.048). Conclusion: Recovery from DRF was best described using three different trajectories. Greater self-reported depression and a lower proportion of females in the non-recovery class were distinguishing factors between the classes. Patients who appear to be in slow-recovery or non-recovery classes may be followed more closely

Measurement Properties of a 2-Dimensional Movement Analysis System: A Systematic Review and Meta-analysis

© 2020 American Congress of Rehabilitation Medicine Objectives: To critically appraise, compare, and summarize the quality of the measurement properties of the Dartfish software across various populations and motion tasks. Data Sources: Systematic electronic searches were performed in the PsychInfo, Embase, Medline@Ovid, CINAHL, and Google Scholar databases from January 1999 to January 2020. Study Selection: Prospective measurement studies published in English peer-reviewed journals that reported on at least 1 psychometric property (reliability, validity, measurement error) using Dartfish were included. An independent reviewer performed searches and identified studies. Data Extraction: We followed the COnsensus-based Standards for the selection of health Measurement INstruments 2018 guideline for abstracting and assessing data quality. Independent extraction was performed by 2 individual authors. The extracted data involved the author, year, study population, setting, sample size, and measurement properties, as well as information on camera positions, analyzed movement variables, and the corresponding strategy for addressing perspective error. Data Synthesis: In total, 23 studies were included in this review. Studies were pooled to examine inter-rater reliability estimates for different tasks: single-leg squat angle (2 studies, 115 participants; intra-class correlation coefficient [ICC], 0.94; 95% confidence interval [CI], 0.62-0.99), single-leg vertical drop jump angle (2 studies, 94 participants; ICC, 0.92; 95% CI, 0.20-0.99), and vertical drop jump angle (2 studies, 100 participants; ICC, 0.88; 95% CI, 0.83-0.92). Concurrent validity (2-dimensional Dartfish vs 3-dimensional Vicon) was established using the push and release task, single leg stance, and single leg stance with acutely induced dizziness in 45 healthy Parkinson patients. A correlation of 0.59 to 0.98 was reported. For tracking angles across various movements, a measurement error of approximately 10° retest variation was reported in 3 studies. Conclusion: Dartfish is a reliable software for assessing a variety of tasks across multiple contexts of assessments. Evidence suggests that the estimates of motion obtained with Dartfish are valid for single plane movements

Feasibility of pain informed movement program for people with knee osteoarthritis

Objective: To establish the feasibility of an intervention consisting of neuromuscular exercise, mind-body techniques, and pain neuroscience education (PNE), referred to as Pain Informed Movement in people with knee Osteoarthritis (KOA). This program has the potential to improve our understanding of intrinsic pain modulation and its role in the management of chronic pain. Methods: This was a single-arm feasibility trial with a nested qualitative component. Primary outcome: complete follow-up. Inclusion criteria: age ≥40 years, KOA clinical diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10. The program consisted of 8-week in-person and at-home exercise sessions. PNE and mind-body techniques were provided as videos and integrated into the exercise sessions. Participants completed questionnaires and physical assessments including blood draws at baseline and program completion. Secondary feasibility outcomes: acceptability of the intervention, burden, rates of recruitment, compliance and adherence, and adverse events. A priori success criteria were identified. Participants were invited to an online focus group. Results: 19 participants were enrolled, with a complete follow-up rate of 74% (mean age 63.3 years (SD 10.5), 73% female), indicating modifications were necessary to proceed. All other success criteria were met. The focus groups revealed that the video content pertaining to the mind-body techniques would benefit from on screen demonstrations. Conclusion: The Pain Informed Movement program is deemed feasible, with minor modifications needed to proceed. A pilot two-arm RCT will be conducted to establish the feasibility and explore potential effects of Pain Informed Movement compared to conventional neuromuscular exercise and standard OA education

Pain Informed Movement for people with knee osteoarthritis: Protocol for a pilot randomized controlled trial

Objective: Conservative pain management strategies for knee osteoarthritis (KOA) have limited effectiveness and do not employ a pain-mechanism informed approach. Pain Informed Movement is a novel intervention combining mind-body techniques with neuromuscular exercise and pain neuroscience education (PNE), aimed at improving endogenous pain modulation. While the feasibility and acceptability of this program has been previously established, it now requires further evaluation in comparison to standard KOA care. Design: This protocol describes the design of a pilot two-arm randomized controlled trial (RCT) with an embedded qualitative component. The primary outcome is complete follow-up rate. With an allocation ratio of 1:1, 66 participants (33/arm) (age ≥40 years, KOA diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10), will be randomly allocated to two groups that will both receive 8 weeks of twice weekly in-person exercise sessions. Those randomized to Pain Informed Movement will receive PNE and mind-body technique instruction provided initially as videos and integrated into exercise sessions. The control arm will receive neuromuscular exercise and standard OA education. Assessment will include clinical questionnaires, physical and psychophysical tests, and blood draws at baseline and program completion. Secondary outcomes are program acceptability, burden, rate of recruitment, compliance and adherence, and adverse events. Participants will be invited to an online focus group at program completion. Conclusion: The results of this pilot RCT will serve as the basis for a larger multi-site RCT aimed at determining the program's effectiveness with the primary outcome of assessing the mediating effects of descending modulation on changes in pain