Spine pain of musculoskeletal origin can affect the cervical, thoracic, or lumbar regions. Its duration may range from an acute episode of a few days or weeks to chronicity over several years (Borghouts et al., 1998;Urits et al., 2019). Low back pain (LBP) is the leading contributor to disability, followed closely by neck pain (NP;James et al., 2018;Urits et al., 2019). Together, back pain and NP are responsible for more than 10% of the total years lived with disability worldwide (James et al., 2018). Spine pain can originate from myofascial tissues, facet joints, intervertebral discs, spinal ligaments and other less common causes (Urits et al., 2019;Vlaeyen et al., 2018). However, it remains challenging to identify the source of pain in individual cases
Language processing involves other cognitive domains, including Working Memory (WM). Much detail about the neural correlates of language and WM interaction remains unclear. This review summarizes the evidence for the interaction between WM and language obtained via functional Magnetic Resonance Imaging (fMRI) in the past two decades. The search was limited to PubMed, Google Scholar, Science direct and Neurosynth for working memory, language, fMRI, neuroimaging, cognition, attention, network, connectome keywords. The exclusion criteria consisted of studies including children, older adults, bilingual or multilingual population, clinical cases, music, sign language, speech, motor processing, review papers, meta-analyses, electroencephalography/event-related potential, and positron emission tomography. A total of 20 articles were included and discussed in four categories: language comprehension, language production, syntax, and networks. Studies on neural correlates of WM and language interaction are rare. Language tasks that involve WM activate common neural systems. Activated areas can be associated with cognitive concepts proposed by Baddeley and Hitch (1974), including the phonological loop of WM (mainly Broca and Wernicke's areas), other prefrontal cortex and right hemispheric regions linked to the visuospatial sketchpad. There is a clear, dynamic interaction between language and WM, reflected in the involvement of subcortical structures, particularly the basal ganglia (caudate), and of widespread right hemispheric regions. WM involvement is levered by cognitive demand in response to task complexity. High WM capacity readers draw upon buffer memory systems in midline cortical areas to decrease the WM demands for efficiency. Different dynamic networks are involved in WM and language interaction in response to the task in hand for an ultimate brain function efficiency, modulated by language modality and attention.
Background and aimsLow back pain is the leading cause of years lived with disability worldwide. Chiropractors employ different interventions to treat low back pain, including spinal manipulative therapy, although the mechanisms through which chiropractic care improves low back pain are still unclear. Clinical research and animal models suggest that spinal manipulation might modulate plasma levels of inflammatory cytokines, which have been involved in different stages of low back pain. More specifically, serum levels of Tumor Necrosis Factor-alpha (TNF-α) have been found to be elevated in patients with chronic low back pain. We aimed to investigate whether urine from chronic low back pain patients could be an appropriate medium to measure concentrations of TNF-α and to examine possible changes in its levels associated to chiropractic care.MethodsUrine samples were collected from 24 patients with chronic low back pain and TNF-α levels were analyzed by ELISA before and after 4–6 weeks of care compared to a reference value obtained from 5 healthy control subjects, by means of a Welch’s t-test. Simultaneously, pain intensity and disability were also evaluated before and after care. Paired t-tests were used to compare mean pre and post urinary concentrations of TNF-α and clinical outcomes.ResultsSignificantly higher baseline levels of urinary TNF-α were observed in chronic low back pain patients when compared to our reference value (p < 0.001), which were significantly lower after the period of chiropractic treatment (p = 0.03). Moreover, these changes were accompanied by a significant reduction in pain and disability (both p < 0.001). However, levels of urinary TNF-α were not correlated with pain intensity nor disability.ConclusionThese results suggest that urine could be a good milieu to assess TNF-α changes, with potential clinical implications for the management of chronic low back pain.
Background and Aims: Spinal manipulation (SM) is currently recommended for the management of back pain. Experimental studies indicate that the hypoalgesic mechanisms of SM may rely on inhibition of segmental processes related to temporal summation of pain and, possibly, on central sensitization, although this remains unclear. The aim of this study was to determine whether experimental back pain, secondary hyperalgesia, and pain-related brain activity induced by capsaicin are decreased by segmental SM.Methods: Seventy-three healthy volunteers were randomly allocated to one of four experimental groups: SM at T5 vertebral level (segmental), SM at T9 vertebral level (heterosegmental), placebo intervention at T5 vertebral level, or no intervention. Topical capsaicin was applied to the area of T5 vertebra for 40 min. After 20 min, the interventions were administered. Pressure pain thresholds (PPTs) were assessed outside the area of capsaicin application at 0 and 40 min to examine secondary hyperalgesia. Capsaicin pain intensity and unpleasantness were reported every 4 min. Frontal high-gamma oscillations were also measured with electroencephalography.Results: Pain ratings and brain activity were not significantly different between groups over time (p > 0.5). However, PPTs were significantly decreased in the placebo and control groups (p < 0.01), indicative of secondary hyperalgesia, while no hyperalgesia was observed for groups receiving SM (p = 1.0). This effect was independent of expectations and greater than placebo for segmental (p < 0.01) but not heterosegmental SM (p = 1.0).Conclusions: These results indicate that segmental SM can prevent secondary hyperalgesia, independently of expectations. This has implications for the management of back pain, particularly when central sensitization is involved.
The aim of this study was to examine the mechanisms underlying hypoalgesia induced by spinal manipulation (SM). Eighty-two healthy volunteers were assigned to one of the four intervention groups: no intervention, SM at T4 (homosegmental to pain), SM at T8 (heterosegmental to pain) or light mechanical stimulus at T4 (placebo). Eighty laser stimuli were applied on back skin at T4 to evoke pain and brain activity related to Aδ- and C-fibers activation. The intervention was performed after 40 stimuli. Laser pain was decreased by SM at T4 (p = 0.028) but not T8 (p = 0.13), compared with placebo. However, brain activity related to Aδ-fibers activation was not significantly modulated (all p > 0.05), while C-fiber activity could not be measured reliably. This indicates that SM produces segmental hypoalgesia through inhibition of nociceptive processes that are independent of Aδ fibers. It remains to be clarified whether the effect is mediated by the inhibition of C-fiber activity.
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