Bement, Marie K. Hoeger

Hunter, Sandra K.

Weyer, Andy

Yoon, Tejin

English

epublications@Marquette

Marquette Universitye-Publications@MarquettePhysical Therapy Faculty Research and Publications Health Sciences, College of4-1-2012Corticomotor Excitability During a NoxiousStimulus and Following Exercise in Women withFibromyalgiaMarie K. Hoeger BementMarquette University, mariehoeger.bement@marquette.eduAndy WeyerMarquette UniversityTejin YoonMarquette University, tejin.yoon@marquette.eduSandra K. HunterMarquette University, sandra.hunter@marquette.eduAmerican Pain Society 31st Annual Scientific Meeting. Honolulu, HI. May 16-19, 2012.Abstracted in The Journal of Pain, Vol. 13, No. 4, Supplement (April 2012): S94. © 2016 Elsevier,2012. Used with permission.G03 Rehabilitation Medicine(472) Does rehabilitation dose predict functional recovery aftertotal knee replacement?J Lee, B Rakel, T Johnston,W Angstrom, N Logsden-Sackett, Y Perkhounkova,X Yang, C Clark, N Noiseux, J Callaghan, and K Sluka; University of Iowa, IowaCity, IATotal knee replacement (TKR) is a cost-effective treatment, with benefits of im-proved pain, function and quality of life. Considerable rehabilitation is neededto maximize recovery speed post-TKR, yet how rehabilitation dose influencesfunctional recovery is not well-understood. The aim of this study was to deter-minewhether exercise dose or general activity predict functional improvement6weeks following TKR. On postoperative day 2 (POD2) and at 6weeks, 151 par-ticipants (61.369.6yrs) completed 4 knee function tasks (extension, extensorlag, flexion, walking speed), and rated their pain on a 21-point numeric scale.They also completed home record logs for 6 weeks, including daily minutes of(1)exercise dose (physical therapy, home exercises), and (2)other activity(housework, gardening), and pain with each task. Prescribed exercise was sig-nificantly higher in weeks 1 and 2 (45.7619.2), and 3 and 4 (46.8621.9) com-pared to 5 and 6 (38.9620.8)(Wilcoxon test, p’s < .001). Function improvedsignificantly for all tasks from POD2 to 6 weeks (p’s < .001). Walking speed im-provement was positively associated with prescribed rehabilitation dose dur-ing weeks 3 and 4 (multiple regression; b = 4.48, p < .01). Exercise dose wasnot associatedwith function change for the other tasks. A POD2walking speedby sex interaction was observed for walking speed (b = -0.82, p = .01): maleswith lower POD2 speeds had greater improvements than males with higherPOD2 speeds. Pain at 6 weeks was associated with less improvement for alltasks, and age was associated with poorer walking speed and flexion change-s(p’s > .01). These results suggest exercise dose translates to better functionalimprovement, and people with higher pain and who are older have poorerfunctional recovery. Our study is the first to examine whether physical rehabil-itation dose affects functional recovery after TKR and shows that dose is impor-tant for improvement in function. Funding: NINR R01 NR009844.(473) Corticomotor excitability during a noxious stimulus andfollowing exercise in women with fibromyalgiaM Bement, A Weyer, T Yoon, and S Hunter; Marquette University, Milwaukee,WIIn young healthy adults, application of a noxious stimulus increases corticomo-tor excitability (motor evoked potentials, MEP) to the contralateral limb. Imme-diately following a sustained isometric contraction, the pain-induced increasein corticomotor excitability decreases in parallel with a decrease in pain re-ports. The purpose of this study was to assess corticomotor excitability duringa noxious stimulus before and after isometric exercise in women with fibro-myalgia. Fifteen women with fibromyalgia (53.769.9 years) participated inthree research sessions: one familiarization and two randomized experimental.The experimental sessions involved measurement of pain perception and mo-tor evoked potentials (MEPS) of the biceps brachii before and after 1) 30 min-utes of quiet rest or 2) a fatiguing submaximal isometric contraction with theelbow flexor muscles. Corticomotor excitability was quantified as the ampli-tude of theMEP evoked at rest in the elbowflexormuscles in response to trans-cranial magnetic stimulation. Pain perception, measured as pain threshold andpain ratings, was assessed with a custom-made pressure pain device placed onthe contralateral index finger for two minutes. Pain ratings were recorded ev-ery 20 seconds using a 0-10 numerical rating scale. In contrast to healthy sub-jects, women with fibromyalgia did not experience a pain-induced increasein corticomotor excitability (p>0.05). Furthermore, following the submaximalisometric contraction, there was no change in pain reports or MEP amplitudecompared with the quiet rest session (p>0.05). Thus, corticomotor excitabilityduring a noxious stimulus and following exercise is very different for womenwith fibromyalgia compared with healthy adults. Supported by a grant fromthe Arthritis Foundation.(474) Wearable long-duration ultrasound treatment of chronictrapezius myalgiaG Lewis, S Guarino, and R Ortiz; Cayuga Medical Center, Ithaca, NYRecent research suggests that Traditional ultrasound therapy (TUS) is most clin-ically effective on pain treatment when administered daily. However, owing tothe patient costs and inconvenience of regular TUS, it is not considered a self-pain management approach to pain therapy. The purpose of this study was toevaluate if a novel wearable low intensity therapeutic ultrasound (LITUS) de-vice could reduce patient’s pain, be easily self-applied at home, and if dailyLITUS had an overall therapeutic benefit to treating chronic trapezius myalgia.The wearable LITUS device is about the size of an iPod and provides 5 to 6hours of 2.75 MHz ultrasound therapy at 90mW/cm2 on a single charge. Thewide-beam device treats a softball size volume and is attached to the bodywith ultrasound gel and tegaderm bandage. The LITUS device was evaluatedin a double-blinded placebo-controlled study under CayugaMedical Center In-stitutional Review Board approval. The patient population consisted of 30 sub-jects, 40-60 years of age, with starting daily-pain ratings of <7 on the visualanalog scale (VAS), and medically diagnosed with chronic trapezius myalgia.Each subject logged a daily 1 hour treatment session for 10-12 consecutivedays at the onset of trapezius spasm, and recorded VAS and GROC scores intheir user diary. On average subjects reported a 2x VAS pain reduction over pla-cebo. Placebo users had a 6.54% pain reduction, female and male active usershad a 11.76% and 15.02%pain reduction, respectively. For the GROC, the aver-age improvement over placebo was 3x. Placebo users had a 12.75% improve-ment, female and male active users had a 28.68% and 47.98% improvement,respectively. In almost all treatment sessions, the wearable LITUS device pro-vided improved pain reduction over placebo, and no adverse events were re-ported during or after the study.(475) High intensity TENS reduces pain during dressingchanges on open wounds: a proof of concept studyL Malloy, E Borhart, S Gardner, N Petsas, N Logsden-Sackett, and B Rakel;University of Iowa, Iowa City, IADressing changes on openwounds causemoderate to severe pain in 50-80%ofpatients, which interferes with wound care. Effective interventions withoutsignificant side effects are lacking to control this procedure-evoked woundpain. The effect of high intensity transcutaneous electrical nerve stimulation(HI-TENS) for reducing procedure-evokedwound pain during dressing changeson open wounds was examined using a pre-post pilot study of 24 subjects. In-patients reporting a pain intensity$ 4 on a 0-10 NRS during a screening dress-ing change of both acute and chronic open wounds were enrolled. Subjects’were primarily female (62.5%) and had a mean age of 49.3 6 13.9 years. HI-TENS was applied 20 minutes prior to the intervention dressing change usingfour electrodes placed the top and bottom of both sides of the wound dressingat points of least resistance. Subjects controlled increases in amplitude to pro-mote acceptance of sensation resulting in amean amplitude of 48.66 10.6mA.Four of the 24 subjects received preventive or procedural analgesia during theHI-TENS dressing change beyond what they received during their screeningdressing change so were eliminated from the analyses. The mean reductionin pain intensity with HI-TENS for the remaining 20 subjects was 2.3, goingfrom an average pain intensity of 7.05 6 1.97 without HI-TENS to 4.7 6 2.55with HI-TENS. This effect is similar in magnitude to that demonstrated withpharmacologic strategies for this purpose and HI-TENS far fewer side effectsthan opioids, such as sedation and nociceptor sensitization. Therefore, HI-TENS represents a preventive intervention for procedure-evoked wound painthat deserves further study in a large randomized clinical trial. If HI-TENS isshown to be effective, the positive impact would be improved wound out-comes because reduced procedure-evoked pain will lead to more thoroughwound care, decreased infection, and better wound healing.S94 The Journal of Pain Abstracts

Corticomotor Excitability During a Noxious Stimulus and Following Exercise in Women with Fibromyalgia

https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1086&amp;context=phys_therapy_fac

Corticomotor Excitability During a Noxious Stimulus and Following Exercise in Women with Fibromyalgia

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