Goodman Lee-Ran, Carlesso Lisa, Tang Ada, Macedo Luciana
School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Br J Pain. 2025 Aug 3:20494637251365688. doi: 10.1177/20494637251365688.
OBJECTIVES: A significant driver of low back pain (LBP) is adaptations to endogenous pain modulation (EPM). Exercise modulates pain through various mechanisms, however, there is a lack of information on its relation to EPM. The objective of this study was to evaluate the feasibility of a protocol investigating if changes in EPM occurs after exercise therapy. METHODS: Participants were recruited from an ongoing randomized controlled trial comparing graded activity to motor control exercises. Participants attended 2 in person sessions pre and post intervention to assess pain pressure threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM) and exercise induced hypoalgesia (EIH). Feasibility outcomes included attrition, recruitment rate, exercise adherence, protocol burden and consistency. In total, 36 (53%) eligible participants enrolled and completed baseline assessments. RESULTS: A-priori thresholds for feasibility were met for attrition 32/36 (89%), recruitment rate (53% of eligible participant enrolled and 36 recruited in 6 months), exercise adherence (93.8%) and satisfaction with assessment protocols (bothersome 88.9%, future participation 97.2%), apart from discomfort with assessment (58.3%). Participants reported that the CPM caused the most discomfort. There was a trend for an increase in low back PPT, no change in TS, and a decrease in CPM and thumbnail PPT at follow up. The results demonstrated that the protocol is feasible for all pre-specified outcomes. DISCUSSION: This article presents a protocol for EPM using PPT, TS, CPM and EIH that is feasible in a clinical trial for LBP. A future study is needed to further investigate EPM changes after exercise therapy in this population.
目的:下腰痛(LBP)的一个重要驱动因素是内源性疼痛调制(EPM)的适应性变化。运动通过多种机制调节疼痛,然而,关于运动与EPM之间关系的信息却很匮乏。本研究的目的是评估一项探究运动疗法后EPM是否发生变化的方案的可行性。 方法:参与者来自一项正在进行的随机对照试验,该试验比较了分级活动与运动控制练习。参与者在干预前后参加了2次面对面的会议,以评估疼痛压力阈值(PPT)、时间总和(TS)、条件性疼痛调制(CPM)和运动诱导的痛觉减退(EIH)。可行性结果包括损耗率、招募率、运动依从性、方案负担和一致性。共有36名(53%)符合条件的参与者登记并完成了基线评估。 结果:除了评估时的不适感(58.3%)外,损耗率32/36(89%)、招募率(6个月内53%符合条件的参与者登记并招募了36名)、运动依从性(93.8%)和对评估方案的满意度(麻烦程度88.9%,未来参与意愿97.2%)均达到了预先设定的可行性阈值。参与者报告称CPM带来的不适感最强。随访时,下背部PPT有增加趋势,TS无变化,CPM和拇指甲PPT有下降趋势。结果表明,该方案对于所有预先指定的结果都是可行的。 讨论:本文介绍了一种使用PPT、TS、CPM和EIH来评估EPM的方案,该方案在腰痛的临床试验中是可行的。未来需要进一步研究该人群运动疗法后EPM的变化情况。
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