Baseline Pain Intensity Is a Predictor of Chronic Pain in Individuals With Distal Radius Fracture

Mehta, Saurabh P.; MacDermid, Joy C.; Richardson, Julie; MacIntyre, Norma J.; Grewal, Ruby

doi:10.2519/jospt.2015.5129

Cited by 58 publications

(48 citation statements)

References 26 publications

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“…This is particularly interesting as results from the current study showed that patients with higher pain levels also reported greater functional disability. Therefore, study findings are not only consistent with the notion that high initial pain is a good predictor for chronic pain, but it also argues that altered cortical excitability of M1 could contribute to underlying mechanisms of pain chronification following a fracture [75, 76].…”

Section: Discussionsupporting

confidence: 82%

Clinically significant acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients: A TMS study

Jodoin

Rouleau

Bellemare

et al. 2019

Preprint

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30 Objective: Primary motor (M1) cortical excitability alterations are involved in the 31 development and maintenance of chronic pain. Less is known about M1-cortical 32 excitability implications in the acute phase of an orthopedic trauma. This study aims to 33 assess acute M1-cortical excitability in patients with an isolated upper limb fracture 34 (IULF) in relation to pain intensity.35 Methods: Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls) 36 performed a single transcranial magnetic stimulation (TMS) session over M1 (resting 37 motor threshold (rMT); short-intracortical inhibition (SICI); intracortical facilitation 38 (ICF); long-interval cortical inhibition (LICI)). IULF patients were divided into two 39 subgroups according to pain intensity (mild versus moderate to severe pain). 40 Results: Reduced SICI and ICF were found in IULF patients with moderate to severe 41 pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since 42 the accident had no influence on TMS measures. 43 Discussion: These findings show altered M1 in the context of acute moderate to severe 44 pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic 45 facilitatory activities. 46 47 48 65 [8,9]. More specifically, this non-invasive technique has made it possible to shed light on 66 the activity of the inhibitory and facilitatory interneuronal circuits of various targeted 67 systems [8,9]. In chronic pain studies, the primary motor cortex (M1) commonly serves 68 as the targeted brain region due to its connections with the nociceptive system and the 69 known effect of pain on motor function [10,11]. An added value of stimulating M1 is the 70 ability to establish a causal relationship between the administered stimulus (excitation or 71 inhibition) and the recorded output response (i.e. motor evoked potentials). Despite some 4 72 variability across TMS studies, there is extensive evidence of an altered balance between 73 inhibitory and facilitatory circuits of M1 in various chronic pain conditions (i.e. 74 fibromyalgia, neuropathic pain, complex regional pain syndrome, phantom limb pain, 75 chronic orofacial pain). These results highlight maladaptive plasticity within the motor 76 system, a consequence closely linked to central sensitization [12,13]. More precisely, a 77 state of disinhibition in M1 has been identified, mainly corresponding to a deficiency in 78 the GABAergic inhibition system as well as an upregulation of N-methyl-D-aspartate 79 (NMDA) receptors, glutamate receptors closely involved in facilitating peripheral and 80 central sensitization [14][15][16][17][18][19]. M1-cortical excitability alterations have been associated 81 with the severity of the clinical symptoms such as pain intensity, hyperalgesia, and 82 allodynia [20,21], pointing to the value of TMS as an objective tool that reflects 83 functional alterations. Moreover, cortical excitability restoration through repetitive TMS 84 (rTMS), a technique known to induce lasting modulation effec...

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Section: Discussionsupporting

confidence: 82%

Clinically significant acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients: A TMS study

Jodoin

Rouleau

Bellemare

et al. 2019

Preprint

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show abstract

“…85 A lower rate of 8.3% was reported by Beerthuizen and Stronks 86 for a cohort of patients managed either operatively or nonoperatively. Given that chronic pain and functional disability are commonly characterized adverse outcomes after DRF, 82 there is an important need for risk stratification and preventive strategies, which may assist hand therapists to identify who are likely to develop chronic pain and disability after DRF.…”

Section: Pain and Disability In The Hand And Wrist At The Time Of Injurymentioning

confidence: 99%

“…Pain significantly predicted disability at the 2-year pain subscale score at baseline regardless of how the injury was treated. 82 Chronic pain and functional decline are ongoing problems for some people who have sustained a DRF. A study from the United Kingdom reported that 63% of patients with DRF had some degree of pain and 11% had severe pain 1 year after a DRF.…”

Section: Pain and Disability In The Hand And Wrist At The Time Of Injurymentioning

confidence: 99%

Epidemiology of distal radius fractures and factors predicting risk and prognosis

MacIntyre

Dewan

2016

Journal of Hand Therapy

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258

190

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“…4,7 Pain is one of the major risk factors inhibiting recovery, thereby resulting in poor functional outcomes in patients with DRFx. 4,8 The pain intensity score during the acute stage postinjury determines the patient's profile for rehabilitation and recovery. 4 Therefore, pain control at the early stages of rehabilitation is considered to be important for reducing the patient's long-term disability level.…”

Section: Introductionmentioning

confidence: 99%

“…22 As pain is a major obstacle to recovery of motion and function after DRFx, pain management is an important goal throughout the rehabilitation process. 4,8,9 Although evidence supports the view that GMI is appropriate for chronic pain, as far as we know, there is no study revealing the effectiveness of GMI in pain control in the early phase of rehabilitation. However, many studies have shown that therapy methods including visualization approaches help to reduce pain relief at the early stage.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial

Dilek

Ayhan

Yağcı

et al. 2018

Journal of Hand Therapy

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Baseline Pain Intensity Is a Predictor of Chronic Pain in Individuals With Distal Radius Fracture

Cited by 58 publications

References 26 publications

Clinically significant acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients: A TMS study

Clinically significant acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients: A TMS study

Epidemiology of distal radius fractures and factors predicting risk and prognosis

Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial

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