The effect of maximal exercise on temporal summation of second pain (windup) in patients with fibromyalgia syndrome

Vierck, Charles J.; Staud, Roland; Price, Donald D.; Cannon, Richard L.; Mauderli, André P.; Martin, A. Daniel

doi:10.1054/jpai.2001.25533

Cited by 151 publications

(120 citation statements)

References 49 publications

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“…In contrast, an increased pressure pain sensitivity was observed in the FM study group. Vierck et al [12] reported similar findings.…”

Section: Pain and Physical Load In Fmmentioning

confidence: 59%

Exercise Induced Autonomic Disengagement and Pain in Women Presenting FM and Healthy Women: Analgesia and Blood Pressure

Wentz¹,

Archer²

2017

Clin Exp Psychol

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Objective: The aim of the present analysis was to examine physiological adaptation to a sub-maximal test by measuring blood pressure (BPR) from the perspective of the fibromyalgia (FM) pain experience.Method: Twenty-four women presenting FM and twenty-six healthy women were education-and age-matched. In their homes, all women completed questionnaires regarding background and health related quality of life (SF-36).All the women performed a stepwise load increment submaximal exercise test on a cycle ergometer to the severe perceived exertion level. Blood pressure was recorded before, during and after the test.Result: Women presenting FM showed higher baseline resting systolic BPR (SBPR) and diastolic BPR (DBPR) with higher SBPR and DBPR during the recovery phase. In both groups SBPR and DBPR were correlated at base line. Women presenting FM contrasted to healthy women by BPR measures more frequently correlating during workload. In women with FM the correlative relationship between the SBPR and DBPR during recovery was pronouncedly higher. Clinical pain correlated four times more often with BPR measures in the FM study group as compared to the group of controls. In FM higher clinical pain was linked to lower BPR. Conclusion:In the context of the FM condition, the tests depict a physiologically perseverative pattern concerning SBPR and SBPR measurements. This pattern was pronounced during recovery. A higher level of clinical pain BP corresponded to lower SBPR and SBPR before and after the test confirming an inverse relationship between blood pressure and pain sensitivity in the condition of FM. Parallel, in FM the analgesic effect from BPR was insufficient due to lowered pain thresholds. Pain thresholds linked to dysregulated sympathetic and parasympathetic functions together with psychological functioning and higher levels of brain functioning need further examination.

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“…In contrast, an increased pressure pain sensitivity was observed in the FM study group. Vierck et al [12] reported similar findings.…”

Section: Pain and Physical Load In Fmmentioning

confidence: 59%

Exercise Induced Autonomic Disengagement and Pain in Women Presenting FM and Healthy Women: Analgesia and Blood Pressure

Wentz¹,

Archer²

2017

Clin Exp Psychol

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“…A prescrição de exercícios para o tratamento da dor crônica é defendida há mais de 20 anos pela literatura científica (16) Embora a atividade física seja a mais comum dentre as modalidades dos tratamentos multidisciplinares, o efeito analgésico do exercício ainda é contraditório. Enquanto alguns estudos clínicos demonstram a redução da dor após a atividade física (17) , outros relatam a ausência de efeitos do exercícios sob a percepção da dor (18,19) e ainda há aqueles que apontam exacerbação da dor após o exercício físico (20) , sobretudo após exercícios de resistência (21,22) . Essas contradições podem ser devidas a características metodológicas das pesquisas.…”

Section: Introductionunclassified

Poderia a atividade física induzir analgesia em pacientes com dor crônica?

Souza¹

2009

Rev Bras Med Esporte

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A dor crônica caracteriza-se pela persistência do sintoma além do período fisiológico de recuperação do tecido lesado. Essas dores causam incapacidade física e redução da performance cognitiva, reduzem a qualidade de vida e o bem-estar dos pacientes, cujo tratamento proposto contradiz o clássico binômio da terapia da dor aguda (repouso e fármacos). Para a dor crônica prescrevem-se exercícios físicos e sugerem-se tratamentos multidisciplinares. Embora a atividade física seja prescrita há mais de 20 anos, os mecanismos neurofisiológicos envolvidos ainda não são compreendidos. Descrevemos brevemente os mecanismos endógenos de controle da dor crônica e evidências da literatura científica que defendem o sistema opioide como mecanismo de ação na analgesia induzida pelo exercício em indivíduos sadios e atletas. Esse mecanismo também parece agir na população com dor crônica, embora haja controvérsias. Finalizamos o artigo com considerações clínicas para a prescrição do exercício para a população com dor crônica.Palavras-chave: dor crônica, atividade física, mecanismos endógenos de controle da dor. ABSTRACTChronic pain is defined as persistent pain beyond normal tissue healing time. Chronic pain syndromes have a considerable impact on functional capacity, resulting in disrupted work and social activities; therefore, the impact of these syndromes affect the society at large and at a high economic cost. In contrast to rest and pharmacological treatment, multidisciplinary programs with exercises have shown to improve pain and function in chronic pain patients. A number of studies reported analgesia induced by exercise; however, the neurological mechanisms involved are not known yet. To explore this phenomenon, we describe endogenous pain control relating some studies on general population and chronic pain subjects, and we conclude this paper with some clinical consideration to determine optimal intensity of exercise to produce hypoalgesia. Keywords INTRODUÇÃOA dor é uma percepção subjetiva, desagradável e vital. A interpretação do estímulo nocivo protege o organismo através desse sinal de alarme denominado dor (1) . Num contexto temporal, a dor pode ser classificada como aguda ou crônica. A dor aguda está associada a lesão do organismo, é de curta duração e desaparece com a cicatrização dessa lesão, por exemplo dor pós-operatória. A dor crônica, por sua vez, é persistente ou recorrente e não está necessariamente associada a uma lesão no organismo. A cronificação da dor pode ser de causa desconhecida. Em sua classificação, consideram-se crônicas aquelas em que o sintoma se mantém além do tempo fisiológico de cicatrização de determinada lesão, ou por permanecer por mais de três meses (2)(3)(4) , por exemplo, as síndromes dolorosas como lombalgias crônicas ou fibromialgia.Estima-se que, mundialmente, 80% das consultas médicas devamse à presença da dor (5) . Um recente estudo brasileiro demonstra que 75% dos pacientes que consultam serviços públicos de saúde relatam a presença de dor crônica (6) . A alta prevalência da dor crô...

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“…56,60 Pain is increased during and after exercise in people with fibromyalgia and chronic fatigue syndrome. 20,48,54,55 Similarly, muscle fatigue is increased in people with chronic fatigue syndrome. 3,10,23 To assess mechanisms of chronic widespread pain, we developed an animal model that mimics the clinical symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…However, in people with musculoskeletal pain or chronic fatigue syndrome there is decreased muscle force compared with normal subjects, 3,10,23 and there is commonly pain on or after exercise. 20,48,54,55 Clearly, exercise is an effective treatment for people with musculoskeletal pain conditions such as fibromyalgia and chronic fatigue syndrome 6,14 decreasing pain, fatigue, and/or improving function. This exercise, however, must be carefully monitored to avoid worsening of symptoms.…”

mentioning

confidence: 99%

Muscle Fatigue Increases the Probability of Developing Hyperalgesia in Mice

Yokoyama

Lisi

Moore

et al. 2007

The Journal of Pain

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Chronic muscle pain is a major clinical problem that is often associated with fatigue. Conversely, chronic fatigue conditions are commonly associated with muscle pain. We tested the hypothesis that muscle fatigue enhances hyperalgesia associated with injection of acidic saline into muscle. We evaluated mechanical sensitivity of the paw (von Frey) in mice after 2 intramuscular injections of saline (20 µL; pH 4, pH 5, pH 6, pH 7.2) in a fatigue and a control group. To induce fatigue, mice were run for 2 h/day for 2 days prior to the first injection and 2 h/day for 2 days prior to the second injection. Muscle lactate, pCO 2 , pO 2 , creatinine kinase, phosphate, and histology were examined after the fatigue task and compared to a control group. Grip force was significantly decreased after 2 h of running indicating fatigue. The fatigue task did not induce muscle damage as there was no difference in muscle lactate, pCO 2 , pO 2 , creatinine kinase, phosphate, or histology. The fatigue task altered the dose-response relationship to intramuscular acidic saline injections. Mechanical hyperalgesia was observed in both fatigue and control groups after intramuscular injection of pH 4.0, but only the fatigue group after injection of pH 5. Neither the fatigue nor the control group developed hyperalgesia in response to intramuscular injection of pH 6 or pH 7.2. In conclusion, fatigue modified the susceptibility of mice to acid injection of pH 5.0 to result in mechanical hyperalgesia after 2 injections of pH 5.0. The fatigue task did not produce measurable changes in the muscle tissue suggesting a central mechanism mediating the enhancement of hyperalgesia.Perspective-These data therefore show that muscle fatigue can enhance the likelihood that one develops pain to a mild insult. Clinically, this could relate to the development of pain from such conditions as repetitive strain injury, and may relate to the interrelationship between chronic pain and fatigue. KeywordsFatigue; exercise; acid; protons; low-pH saline Pain arising from musculoskeletal disorders is a major clinical problem globally, 58 and fibromyalgia affects 2% of population in the United States. 57 As high as 76% of people with chronic widespread musculoskeletal pain conditions, such as fibromyalgia and arthritis, also report fatigue. 26 Conversely, as high as 94% of people with chronic fatigue syndrome report musculoskeletal pain and approximately half of the population has chronic widespread musculoskeletal pain. 56,60 Pain is increased during and after exercise in people with fibromyalgia and chronic fatigue syndrome. 20,48,54,55 Similarly, muscle fatigue is increased in people with chronic fatigue syndrome. 3,10,23 To assess mechanisms of chronic widespread pain, we developed an animal model that mimics the clinical symptoms. Two injections of acidic saline (pH 4.0), 5 days apart, into 1 muscle results in bilateral long-lasting hyperalgesia of the paw, 41 muscle,59 and the viscera28 without muscle tissue damage.41 The intramuscular pH decreases to a p...

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The effect of maximal exercise on temporal summation of second pain (windup) in patients with fibromyalgia syndrome

Cited by 151 publications

References 49 publications

Exercise Induced Autonomic Disengagement and Pain in Women Presenting FM and Healthy Women: Analgesia and Blood Pressure

Exercise Induced Autonomic Disengagement and Pain in Women Presenting FM and Healthy Women: Analgesia and Blood Pressure

Poderia a atividade física induzir analgesia em pacientes com dor crônica?

Muscle Fatigue Increases the Probability of Developing Hyperalgesia in Mice

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