Pressure-induced referred pain is expanded by persistent soreness

Doménech-García, Víctor; Palsson, Thorvaldur Skuli; Herrero, Pablo; Graven‐Nielsen, Thomas

doi:10.1097/j.pain.0000000000000497

Cited by 37 publications

(85 citation statements)

References 52 publications

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“…It is well known in clinical practice 2,5,9,26,35 and reproducible in experimental settings 34,37 . The hypertonic saline model caused a more extensive pain referral than tonic pressure, similar to previous findings 8 and may relate to differences in pain intensity. Painful pressure results in a timerelated increase in pain area 13 which may indicate that the participants in this study were understimulated by only receiving a 60s stimulation with PPT+20%.…”

Section: Increased Pain Referral and The Sensitized Pain Systemsupporting

confidence: 86%

Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study

Palsson

Boudreau

Krebs

et al. 2018

The Journal of Pain

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Section: Increased Pain Referral and The Sensitized Pain Systemsupporting

confidence: 86%

Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study

Palsson

Boudreau

Krebs

et al. 2018

The Journal of Pain

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“…Recent evidence, however, indicate that the neurotrophic factors are essential in DOMS (Mizumura and Taguchi, 2016). Although the underlying mechanisms are not well covered, exercises will influence the somatosensory system resulting in sensitization of peripheral and central mechanisms as previously observed with DOMS in, for example, the wrist extensors (Slater et al, 2003) and m. infraspinatus (Domenech-Garcia et al, 2016). The DOMS model thereby evoked mechanical hyperalgesia (Gibson et al, 2006) as we observed in the decreased PPT values and a subsequent change in the pain quality and perception could be expected (Reddy et al, 2012).…”

Section: The Experimental Low Back Pain Modelmentioning

confidence: 97%

Pain‐evoked trunk muscle activity changes during fatigue and DOMS

Larsen

Hirata

Graven‐Nielsen

2017

European Journal of Pain

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Background Muscle pain may reorganize trunk muscle activity but interactions with exercise‐related muscle fatigue and delayed onset muscle soreness (DOMS) is to be clarified. Methods In 19 healthy participants, the trunk muscle activity during 20 multi‐directional unpredictable surface perturbations were recorded after bilateral isotonic saline injections (control) and during unilateral and bilateral hypertonic saline‐induced low back pain (LBP) in conditions of back muscle fatigue (Day‐1) and DOMS (Day‐2). Pain intensity and distribution were assessed by visual analogue scale (VAS) scores and pain drawings. The degree of fatigue and DOMS were assessed by Likert scale scores. Root‐mean‐square electromyographic (RMS‐EMG) signals were recorded post‐perturbation from six bilateral trunk muscles and the difference from baseline conditions (Delta‐RMS‐EMG) was extracted and averaged across abdominal and back muscles. Results In DOMS, peak VAS scores were higher during bilateral control and bilateral saline‐induced pain than fatigue (p < 0.001) and during bilateral compared with unilateral pain (p < 0.001). The saline‐induced pain areas were larger during DOMS than fatigue (p < 0.01). In response to surface perturbations during fatigue and DOMS, the back muscle Delta‐RMS‐EMG increased during bilateral compared with unilateral pain and control injections (p < 0.001) and decreased during unilateral pain compared with control injections (p < 0.04). In DOMS compared with fatigue, the post‐perturbation Delta‐RMS‐EMG in back muscles was higher during bilateral pain and lower during unilateral pain (p < 0.001). The abdominal Delta‐RMS‐EMG was not significantly affected. Conclusion Facilitated and attenuated back muscle responses to surface perturbations in bilateral and unilateral LBP, respectively, was more expressed during exercise‐induced back muscle soreness compared with fatigue. Significance Back muscle activity decreased during unilateral and increased during bilateral pain after unpredictable surface perturbations during muscle fatigue and DOMS. Accumulation effects of DOMS on pain intensity and spreading and trunk muscle activity after pain‐induction.

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“…For data analysis, areas of referred pain and areas for "other sensations" were assessed separately and body chart was subdivided in 15 different regions ( Fig. 2) and the frequencies of referred symptoms in these regions were extracted [18]. Expansion of pain beyond the stimulation location, was considered referred pain [24].…”

Section: Pressure-induced Referred Painmentioning

confidence: 99%

“…This was performed on the affected side (previous history of fracture) for the fracture group and on the dominant side for the control group with the objective to produce delayed onset muscle soreness (DOMS) on Day-1. The exercise consisted of externally rotating the shoulder against a resistance from a heavy elastic band (Black or Silver TheraBand™), performing four sets of as many times possible until failure, with 1 minute of rest between each set [18]. In short, the subject was in sitting position, resting the elbow 90º flexed on a table, maintaining the glenohumeral joint between 70º to 80º of flexion.…”

Section: Persistent Pain Modelmentioning

confidence: 99%

“…It has been demonstrated in healthy individuals that referred pain from back muscles can be felt in the shoulder region [18], where pain from proximal humerus is also felt [12]. Interestingly, a stimulus applied to the maxillary sinus induced a pain experience at the site of a prior dental procedure [32], raising the possibility that subsequent to a strong nociceptive stimulus, the perceived location of referred pain may shift towards a recent locus of pain.…”

Section: Introductionmentioning

confidence: 99%

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Pressure-induced referred pain areas are more expansive in individuals with a recovered fracture

Doménech-García¹,

Palsson

Boudreau

et al. 2018

Pain

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Musculoskeletal trauma and pain can sensitize central pain mechanisms, but whether these normalize on recovery is unknown. This study compared the extent of pain referral in individuals recovered from a musculoskeletal trauma and healthy controls. Twenty pain-free participants recovered from a shoulder fracture and 20 age-/sex-matched controls participated in 2 experimental sessions (day-0 and day-1) separated by 24 hours. On both days, pressure pain thresholds were measured bilaterally at infraspinatus, supraspinatus, trapezius, and gastrocnemius muscles. Referred pain towards the shoulder region was induced by a 60-second pressure stimulation (pressure pain threshold + 20%) at the infraspinatus muscle and recorded on an electronic body chart. After day-0 assessments, delayed onset muscle soreness (DOMS) was induced to challenge the pain systems by exercising the external rotators of the recovered/dominant shoulder. The size of pressure-induced pain referral on day-0 did not differ between groups, although there was a tendency for a smaller referred pain area in recovered group. Pressure pain thresholds at the infraspinatus muscle on the DOMS side were reduced on day-1 in both groups (P = 0.03). An expansion of pressure-induced pain referral was found in both groups following the DOMS protocol on day-1 (P = 0.05) with a relatively larger expansion (P = 0.05) and higher frequency of pain in the shoulder (P = 0.04) in the recovered pain group. After complete recovery and absence of pain symptoms after a fracture, central pain mechanisms seem to normalize in the region of the trauma after recovery but when sensitized a heightened response can emerge. Such mechanisms could be important for recurrence of pain conditions.

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Pressure-induced referred pain is expanded by persistent soreness

Cited by 37 publications

References 52 publications

Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study

Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study

Pain‐evoked trunk muscle activity changes during fatigue and DOMS

Pressure-induced referred pain areas are more expansive in individuals with a recovered fracture

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