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Objective Previous neuroimaging studies have shown that patients with chronic pain display altered functional connectivity across distributed brain areas involved in the processing of nociceptive stimuli. The aim of the present study was to investigate how pain chronification modulates whole-brain functional connectivity during evoked clinical and tonic pain. Methods Patients with osteoarthritis of the hip (n  = 87) were classified into 3 stages of pain chronification (Grades I–III, Mainz Pain Staging System). Electroencephalograms were recorded during 3 conditions: baseline, evoked clinical hip pain, and tonic cold pain (cold pressor test). The effects of both factors (recording condition and pain chronification stage) on the phase-lag index, as a measure of neuronal connectivity, were examined for different frequency bands. Results In women, we found increasing functional connectivity in the low-frequency range (delta, 0.5–4 Hz) across pain chronification stages during evoked clinical hip pain and tonic cold pain stimulation. In men, elevated functional connectivity in the delta frequency range was observed in only the tonic cold pain condition. Conclusions Across pain chronification stages, we found that widespread cortical networks increase their synchronization of delta oscillations in response to clinical and experimental nociceptive stimuli. In view of previous studies relating delta oscillations to salience detection and other basic motivational processes, our results hint at these mechanisms playing an important role in pain chronification, mainly in women. [ABSTRACT FROM AUTHOR]

Objective To compare the effects of dry needling or manual pressure release on an active trigger point in the upper trapezius on craniocervical flexion test performance, pressure pain thresholds, and cervical range of motion in chronic neck pain. Design A parallel randomized clinical trial. Setting Physical therapy service. Subjects Individuals with chronic neck pain. Methods Subjects were randomized to receive dry needling (n = 25) or manual trigger point pressure release (n = 25) on upper trapezius active trigger points. Surface electromyography from the upper trapezius, splenius capitis, sternocleidomastoid, and scalene muscles during performance of the craniocervical flexion test was assessed before and immediately after the intervention as the primary outcome. Neck pain intensity, range of motion, and pressure pain thresholds were the secondary outcomes. Results A decrease in sternocleidomastoid activity at all stages of the craniocervical flexion test (time effect, P  < 0.001) was found in both groups after the interventions, with no significant between-group difference. Pressure pain thresholds measured over the cervical spine and second metacarpal increased after dry needling when compared with manual trigger point pressure release (P  < 0.05). Pain intensity decreased immediately after both treatments with moderate to large effect sizes, whereas cervical range of motion increased for both groups but with small effect sizes. Conclusion A single session of dry needling or manual pressure release over upper trapezius active trigger points promotes limited effects on muscle performance during the craniocervical flexion test, pressure pain thresholds, and cervical range of motion in patients with chronic neck pain. [ABSTRACT FROM AUTHOR]

Background Several factors such as neck pain intensity, disability, anxiety, depression, female sex, or a previous history of headache are associated with post-whiplash headache. However, the possible role of psychosocial factors contributing to the presence of headache or worsening of headache after a whiplash trauma remains unclear. To address this gap in knowledge, there is the need to assess psychosocial factors concerning headache shortly after a whiplash injury. Objective To evaluate psychological features, pain and disability in people with acute whiplash associated disorders (WAD) and compare these features between those with and without headache. Design Case-control study. Setting A secondary care traumatology center. Methods Forty-seven people with acute WAD were recruited; 28 with headache, and 19 without. All participants completed self-reported questionnaires including Visual Analogue Scale (VAS) for neck pain intensity, the Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia-11 (TSK-11), and State-Trait Anxiety Inventory. Results Neck pain intensity (P  < .001), neck disability (P  < 0.001), pain catastrophizing (P  < .001), kinesiophobia (P  < .001), and anxiety state (P  = .007) and trait (P  = .05) were higher in those with headache when compared to those without. In addition, high levels of neck pain (P  = .025), moderate levels of neck disability (P  < .001), moderate levels of pain catastrophizing (P  = .015), and moderate (P  = .002) and severe (P  = .016) levels of kinesiophobia were related to the presence of headache. Conclusions The level of neck pain intensity and disability, kinesiophobia, catastrophizing, and anxiety were all greater in people with acute WAD who presented with a headache compared to those without headache. [ABSTRACT FROM AUTHOR]