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      Fatiguing Trunk Flexor Exercise Decreases Pain Sensitivity in Postpartum Women

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          Abstract

          Background

          Low back pain (LBP) is common in the general population and among postpartum women. Abdominal muscle exercise is often used to treat LBP, but it is unknown if fatiguing abdominal muscle exercise can produce exercise-induced hypoalgesia (EIH).

          Objectives

          To assess pressure pain thresholds (PPTs) at rest and following fatiguing trunk flexor exercise (EIH) in (1) nulligravid and postpartum women to evaluate the impact of pregnancy and childbirth and (2) nulligravid women and men to examine sex differences.

          Methods

          Seventy healthy adults (31 postpartum women, 23 nulligravid women, 16 men) participated. Postpartum and nulligravid women were tested twice (16–18 weeks apart) to identify changes in EIH with postpartum recovery. PPTs were measured at the nailbed and superior rectus abdominis before and after exercise to investigate systemic and local EIH, respectively. Rectus abdominis muscle thickness was assessed with ultrasound.

          Results

          Postpartum women reported lower PPTs than nulligravid women at the abdomen ( p < 0.05) whereas postpartum women had lower PPTs at the nailbed during the first session only. Men reported higher nailbed PPTs ( p = 0.047) and similar PPTs at the abdomen than women ( p = 0.294). All groups demonstrated EIH at the abdomen ( p < 0.05). Systemic EIH was absent in postpartum and nulligravid women ( p > 0.05), while men demonstrated hyperalgesia. Local EIH was positively associated with muscle thickness for men and women, which was not significant at the second timepoint.

          Limitations

          Acute exercise response may not reflect changes that occur with exercise training.

          Conclusion

          Fatiguing trunk flexor exercise produced local EIH for all groups including postpartum and nulligravid women. Clinically, trunk exercises may be useful for acute pain relief for clinical populations that are characterized by pain and/or weakness in the abdominal region muscles in populations with abdominal pain syndromes.

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          Most cited references33

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          The short-form McGill Pain Questionnaire.

          A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
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            Factor structure, reliability, and validity of the Pain Catastrophizing Scale.

            The Pain Catastrophizing Scale (PCS; Sullivan et al., Psychol. Assess. 7, 524-532, 1995) has recently been developed to assess three components of catastrophizing: rumination, magnification, and helplessness. We conducted three studies to evaluate the factor structure, reliability, and validity of the PCS. In Study I, we conducted principal-components analysis with oblique rotation to replicate the three factors of the PCS. Gender differences on the original PCS subscales were also analyzed. In Study II, we conducted confirmatory factor analyses to evaluate the adequacy of fit of four alternative models. We also evaluated evidence for concurrent and discriminant validity. In Study III, we evaluated the ability of the PCS and subscales to differentiate between the responses of clinic (students seeking treatment) and nonclinic undergraduate samples. Also, in the clinic sample, we evaluated evidence of concurrent and predictive validity for the PCS. The internal consistency reliability indices for the total PCS and subscales were examined in all three studies. Limitations and future directions are discussed.
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              A systematic literature review of 10 years of research on sex/gender and experimental pain perception - part 1: are there really differences between women and men?

              The purpose of this systematic review was to summarize and critically appraise the results of 10 years of human laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian and conducted in multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The first set of results (122 articles), which is presented in this paper, examined sex difference in the perception of laboratory-induced thermal, pressure, ischemic, muscle, electrical, chemical, and visceral pain in healthy subjects. This review suggests that females (F) and males (M) have comparable thresholds for cold and ischemic pain, while pressure pain thresholds are lower in F than M. There is strong evidence that F tolerate less thermal (heat, cold) and pressure pain than M but it is not the case for tolerance to ischemic pain, which is comparable in both sexes. The majority of the studies that measured pain intensity and unpleasantness showed no sex difference in many pain modalities. In summary, 10 years of laboratory research have not been successful in producing a clear and consistent pattern of sex differences in human pain sensitivity, even with the use of deep, tonic, long-lasting stimuli, which are known to better mimic clinical pain. Whether laboratory studies in healthy subjects are the best paradigm to investigate sex differences in pain perception is open to question and should be discussed with a view to enhancing the clinical relevance of these experiments and developing new research avenues. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Front Physiol
                Front Physiol
                Front. Physiol.
                Frontiers in Physiology
                Frontiers Media S.A.
                1664-042X
                26 March 2019
                2019
                : 10
                : 315
                Affiliations
                [1] 1Department of Physical Therapy, Marquette University , Milwaukee, WI, United States
                [2] 2William S. Middleton Veterans Hospital , Madison, WI, United States
                [3] 3Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison , Madison, WI, United States
                [4] 4Department of Obstetrics and Gynecology, Medical College of Wisconsin , Milwaukee, WI, United States
                Author notes

                Edited by: Gary Iwamoto, University of Illinois at Urbana-Champaign, United States

                Reviewed by: Jennifer Joy Hamner, University of Texas Southwestern Medical Center, United States; Adam Hare, University of Texas Southwestern Medical Center, United States

                This article was submitted to Exercise Physiology, a section of the journal Frontiers in Physiology

                Article
                10.3389/fphys.2019.00315
                6445131
                e43cd210-85e3-4191-b94c-e77141a429e5
                Copyright © 2019 Deering, Pashibin, Cruz, Hunter and Hoeger Bement.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 30 October 2018
                : 07 March 2019
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 50, Pages: 9, Words: 0
                Funding
                Funded by: Medical College of Wisconsin 10.13039/100008980
                Funded by: American Association of University Women 10.13039/100005280
                Funded by: National Center for Advancing Translational Sciences 10.13039/100006108
                Award ID: UL1TR001436
                Award ID: 1TL1TR001437
                Categories
                Physiology
                Original Research

                Anatomy & Physiology
                exercise-induced hypoalgesia,pregnancy,pressure pain thresholds,muscle thickness,sex differences

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