The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Sanderson, A. J. R.; Wang, Shuwfen F; Cancino, Edith Elgueta; Martinez‐Valdes, Eduardo; Sanchís-Sánchez, Enrique; Liew, Bernard X. W.; Falla, Deborah

doi:10.1002/ejp.1789

Cited by 23 publications

(24 citation statements)

References 93 publications

(251 reference statements)

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“…Previous investigations [ 12 , 13 ] with AAS patients found neither change nor a relationship for the effects of swelling on spinal reflex excitability. In this regard, our current findings, along with previous studies [ 12 , 13 , 43 ], indicate that underlying neural mechanism associated with AAS symptom severity does not appear to be directly related to alterations in spinal reflex excitability.…”

Section: Discussionsupporting

confidence: 71%

“…However, the current study did not confirm any links between neural changes and severity of acute symptoms. The lack of associations may be supported by a recent systematic review, concluding that the presence of clinical pain does not influence H-reflex responses [ 43 ]. With regards to the effects of ankle swelling on spinal reflex excitability, a previous investigation [ 15 ] using simulated ankle joint effusion model showed alterations in H-reflex measures of ankle stabilizing muscles.…”

Section: Discussionmentioning

confidence: 99%

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Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability

Kim

Chang

et al. 2022

Healthcare

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Neural changes in the ankle stabilizing muscles following ankle sprains are thought to be one contributing factor to persistent ankle dysfunction. However, empirical evidence is limited. Therefore, we aimed to examine spinal reflex excitability of lower leg muscles following acute ankle sprains (AAS). We performed a case-control study with 2 groups consisting of 30 young adults with AAS and 30 aged-matched uninjured controls. Hoffmann reflex (H-reflex) testing was performed to estimate spinal reflex excitability of lower leg muscles: soleus, fibularis longus (FL), tibialis anterior (TA). Maximal H-reflex (Hmax) and motor responses (Mmax) were determined by delivering a series of electrical stimuli at the sciatic nerve. Hmax/Mmax ratios were calculated to represent normalized spinal reflex excitability. Separate group-by-limb analyses of variance (ANOVA) with repeated measures found there were no significant interactions for any of the muscles (SL: F1,56 = 0.95, p = 0.33, FL: F1,51 = 0.65, p = 0.42, TA: F1,51 = 1.87, p = 0.18), but there was a significant main effect of group in the soleus (F1,56 = 6.56, p = 0.013), indicating the Hmax/Mmax ratio of soleus in the AAS group was significantly lower bilaterally (AAS = 0.56 ± 0.19, control = 0.68 ± 0.17, p = 0.013), with no significant group differences in the other muscles (FL: F1,51 = 0.26, p = 0.61, TA: F1,51 = 0.93, p = 0.34). The bilateral inhibition of the soleus spinal reflex excitability following AAS may be significant in that it may explain bilateral sensorimotor deficits (postural control deficits) following unilateral injury, and provide insights into additional therapies aimed at the neural change.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability

Kim

Chang

et al. 2022

Healthcare

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“…On the other hand, as experimental pain could alter the motor output in target and not target muscles (48)(49)(50)(51), the migraine attack could constitute a nociceptive input able to alter the motor control of neck muscles leading to a reduction in cervical mobility. As the effect of clinical pain on motor output is less consistent (51)(52)(53), and no study that we are aware of ever assessed the effect of migraine-like pain on cervical motor output, future studies should assess the mechanisms by which migraine-like pain affects the cervical motor output. Even if changes in mechanical behaviors occurring during acute pain could have a short-term benefit, they often cause long-term mechanical consequences, as increased muscle stiffness and reduced movement variability (54).…”

Section: Discussionmentioning

confidence: 99%

Cervical musculoskeletal impairments in the 4 phases of the migraine cycle in episodic migraine patients

et al. 2022

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Objective To assess cervical musculoskeletal impairments during the 4 phases of a migraine cycle in episodic migraine patients, controlling for the presence of concomitant neck pain. Methods Differences in cervical musculoskeletal impairments were assessed during the 4 migraine phases in episodic migraine patients and compared with healthy controls controlling for concomitant neck pain. Cervical musculoskeletal impairments were assessed as follow: cervical active range of motion; flexion rotation test; craniocervical flexion test and calculation of activation pressure score; the total number of myofascial trigger points in head/neck muscles; the number of positivevertebral segments (headache’s reproduction) during passive accessory intervertebral movement; pressure pain thresholds over C1, C2, C4, C6 vertebral segments bilaterally, trigeminal area, hand, and leg. Signs of pain sensitization were assessed by evaluating mechanical pain threshold over trigeminal area and hand, pressure pain thresholds, and the wind-up ratio. The Bonferroni-corrected p-value (05/4 = 0.013) was adopted to assess the difference between groups, while a p-value of 0.05 was considered significant for the correlation analysis. Results A total of 159 patients and 52 controls were included. Flexion rotation test and craniocervical flexion test were reduced in all 4 phases of the migraine cycle versus healthy controls (p < 0.001). The number of myofascial trigger points and positive vertebral segments was increased in all 4 phases of the migraine cycle versus healthy controls (p < 0.001). Flexion, extension, and total cervical active range of motion and cervical pressure pain thresholds were reduced in episodic migraine in the ictal phase versus controls (p < 0.007) with no other significant differences. Outside the ictal phase, the total cervical active range of motion was positively correlated with trigeminal and leg pressure pain threshold (p < 0.026), the number of active myofascial trigger points and positive positive vertebral segments were positively correlated with higher headache frequency (p=0.045), longer headache duration (p < 0.008), and with headache-related disability (p = 0.031). Cervical pressure pain thresholds were positively correlated with trigeminal, hand, and leg pressure pain threshold (p < 0.001), and trigeminal and leg mechanical pain thresholds (p < 0.005), and negatively correlated with the wind-up ratio (p < 0.004). Conclusion In all phases of the migraine cycle, independent of the presence of concomitant neck pain, episodic migraine patients showed reduced flexion rotation test and craniocervical flexion test and an increased number of myofascial trigger points and passive accessory vertebral segments. These impairments are correlated with enhanced headache duration, headache-related disability, and signs of widespread pain sensitization. Reduction in active cervical movement and increased mechanical hyperalgesia of the cervical was consistent in ictal episodic migraine patients and the subgroups of episodic migraine patients with more pronounced widespread sensitization.

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“…These findings contrast with the findings of this study which found no consistent evidence that experimental pain inhibits cortical changes associated with motor learning. Sub-grouping analysis performed by Sanderson et al [ 71 ] suggests that the impact of pain on cortical excitability may be dependent on the specific pain paradigm or tissue stimulated. The authors reported increased cortical excitability when hypertonic saline was injected into non-contractile tissue and a decrease when injected into contractile tissue.…”

Section: Discussionmentioning

confidence: 99%

Exploring pain interference with motor skill learning in humans: A systematic review

et al. 2022

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Motor learning underpins successful motor skill acquisition. Although it is well known that pain changes the way we move, it’s impact on motor learning is less clear. The aim of this systematic review was to synthesize evidence on the impact of experimental and clinical pain on task performance and activity-dependent plasticity measures across learning and explore these findings in relation to different pain and motor learning paradigms. Five databases were searched: Web of Science, Scopus, MEDLINE, Embase and CINAHL. Two reviewers independently screened the studies, extracted data, and assessed risk of bias using the Cochrane ROB2 and ROBIN-I. The overall strength of evidence was rated using the GRADE guidelines. Due to the heterogeneity of study methodologies a narrative synthesis was employed. Twenty studies were included in the review: fifteen experimental pain and five clinical pain studies, covering multiple motor paradigms. GRADE scores for all outcome measures suggested limited confidence in the reported effect for experimental pain and clinical pain, on motor learning. There was no impact of pain on any of the task performance measures following acquisition except for ‘accuracy’ during a tongue protrusion visuomotor task and ‘timing of errors’ during a motor adaptation locomotion task. Task performance measures at retention, and activity dependent measures at both acquisition and retention showed conflicting results. This review delivers a detailed synthesis of research studies exploring the impact of pain on motor learning. This is despite the challenges provided by the heterogeneity of motor learning paradigms, outcome measures and pain paradigms employed in these studies. The results highlight important questions for further research with the goal of strengthening the confidence of findings in this area.

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The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 23 publications

References 93 publications

Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability

Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability

Cervical musculoskeletal impairments in the 4 phases of the migraine cycle in episodic migraine patients

Exploring pain interference with motor skill learning in humans: A systematic review

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