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The present study examined the activity levels of the thoracic and lumbar extensor muscles during different extension exercise modalities in healthy individuals. Therefore, 14 subjects performed four different types of extension exercises in prone position: dynamic trunk extension, dynamic-static trunk extension, dynamic leg extension, and dynamic-static leg extension. Pre- and post-exercise muscle functional magnetic resonance imaging scans from the latissimus dorsi, the thoracic and lumbar parts of the longissimus, iliocostalis, and multifidus were performed. Differences in water relaxation values ( T2-relaxation) before and after exercise were calculated ( T2-shift) as a measure of muscle activity and compared between extension modalities. Linear mixed-model analysis revealed higher lumbar extensor activity during trunk extension compared with leg extension ( T2-shift of 5.01 ms and 3.55 ms, respectively) and during the dynamic-static exercise performance compared with the dynamic exercise performance ( T2-shift of 4.77 ms and 3.55 ms, respectively). No significant differences in the thoracic extensor activity between the exercises could be demonstrated. During all extension exercises, the latissimus dorsi was the least activated compared with the paraspinal muscles. While all extension exercises are equivalent effective to train the thoracic muscles, trunk extension exercises performed in a dynamic-static way are the most appropriate to enhance lumbar muscle strength. [ABSTRACT FROM AUTHOR]

Van Oosterwijck J, Nijs J, Meeus M, Lefever I, Huybrechts L, Lambrecht L, Paul L (Vrije Universiteit Brussel, Brussels; Artesis University College Antwerp, Antwerp; University Hospital Brussels, Brussels; Private Practice For Internal Medicine, Ghent/Aalst; CVS Contactgroep, Bruges; Belgium; and University of Glasgow, Glasgow, UK). Pain inhibition and postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome. J Intern Med 2010; 268: 265–278. Objectives. To examine the efficacy of the pain inhibitory systems in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) during two different types of exercise and to examine whether the (mal)functioning of pain inhibitory systems is associated with symptom increases following exercise. Design. A controlled experimental study. Setting and subjects. Twenty-two women with ME/CFS and 22 healthy sedentary controls were studied at the Department of Human Physiology, Vrije Universiteit Brussel. Interventions. All subjects performed a submaximal exercise test and a self-paced, physiologically limited exercise test on a cycle ergometer. The exercise tests were undertaken with continuous cardiorespiratory monitoring. Before and after the exercise bouts, subjects filled out questionnaires to assess health status, and underwent pressure pain threshold measurements. Throughout the study, subjects’ activity levels were assessed using accelerometry. Results. In patients with ME/CFS, pain thresholds decreased following both types of exercise, whereas they increased in healthy subjects. This was accompanied by a worsening of the ME/CFS symptom complex post-exercise. Decreased pressure thresholds during submaximal exercise were associated with postexertional fatigue in the ME/CFS group ( r = 0.454; P = 0.034). Conclusions. These observations indicate the presence of abnormal central pain processing during exercise in patients with ME/CFS and demonstrate that both submaximal exercise and self-paced, physiologically limited exercise trigger postexertional malaise in these patients. Further study is required to identify specific modes and intensity of exercise that can be performed in people with ME/CFS without exacerbating symptoms. [ABSTRACT FROM AUTHOR]

Abstract. Nijs J, Van Oosterwijck J, Meeus M, Lambrecht L, Metzger K, Frémont M, Paul L (Vrije Universiteit Brussel, Brussels; University College Antwerp, Antwerp; University Hospital Brussels, Brussels; Private Practice for Internal Medicine, Gent/Aalst; and RED Laboratories N.V., Zellik; Belgium, and University of Glasgow, Glasgow, UK). Unravelling the nature of postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: the role of elastase, complement C4a and interleukin-1beta. J Intern Med 2010; 267: 418-435. Objectives. Too vigorous exercise or activity increase frequently triggers postexertional malaise in people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a primary characteristic evident in up to 95% of people with ME/CFS. The present study aimed at examining whether two different types of exercise results in changes in health status, circulating elastase activity, interleukin (IL)-1beta and complement C4a levels. Design. Comparative experimental design. Setting. University. Subjects. Twenty-two women with ME/CFS and 22 healthy sedentary controls Interventions: participants were subjected to a submaximal exercise (day 8) and a self-paced, physiologically limited exercise (day 16). Each bout of exercise was preceded and followed by blood sampling, actigraphy and assessment of their health status. Results. Both submaximal exercise and self-paced, physiologically limited exercise resulted in postexertional malaise in people with ME/CFS. However, neither exercise bout altered elastase activity, IL-1beta or complement C4a split product levels in people with ME/CFS or healthy sedentary control subjects (P > 0.05). Postexercise complement C4a level was identified as a clinically important biomarker for postexertional malaise in people with ME/CFS. Conclusions. Submaximal exercise as well as self-paced, physiologically limited exercise triggers postexertional malaise in people with ME/CFS, but neither types of exercise alter acute circulating levels of IL-1beta, complement C4a split product or elastase activity. Further studying of immune alterations in relation to postexertional malaise in people with ME/CFS using multiple measurement points postexercise is required. [ABSTRACT FROM AUTHOR]

Nijs J, Van Oosterwijck J, Meeus M, Lambrecht L, Metzger K, Frémont M, Paul L (Vrije Universiteit Brussel, Brussels; University College Antwerp, Antwerp; University Hospital Brussels, Brussels; Private Practice for Internal Medicine, Gent/Aalst; and RED Laboratories N.V., Zellik; Belgium, and University of Glasgow, Glasgow, UK). Unravelling the nature of postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: the role of elastase, complement C4a and interleukin-1β. J Intern Med 2010; 267: 418–435. Objectives. Too vigorous exercise or activity increase frequently triggers postexertional malaise in people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a primary characteristic evident in up to 95% of people with ME/CFS. The present study aimed at examining whether two different types of exercise results in changes in health status, circulating elastase activity, interleukin (IL)-1β and complement C4a levels. Design. Comparative experimental design. Setting. University. Subjects. Twenty-two women with ME/CFS and 22 healthy sedentary controls Interventions: participants were subjected to a submaximal exercise (day 8) and a self-paced, physiologically limited exercise (day 16). Each bout of exercise was preceded and followed by blood sampling, actigraphy and assessment of their health status. Results. Both submaximal exercise and self-paced, physiologically limited exercise resulted in postexertional malaise in people with ME/CFS. However, neither exercise bout altered elastase activity, IL-1β or complement C4a split product levels in people with ME/CFS or healthy sedentary control subjects ( P > 0.05). Postexercise complement C4a level was identified as a clinically important biomarker for postexertional malaise in people with ME/CFS. Conclusions. Submaximal exercise as well as self-paced, physiologically limited exercise triggers postexertional malaise in people with ME/CFS, but neither types of exercise alter acute circulating levels of IL-1β, complement C4a split product or elastase activity. Further studying of immune alterations in relation to postexertional malaise in people with ME/CFS using multiple measurement points postexercise is required. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThis paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage.Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0).The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain.This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.The exploration of patients’ pain perception may provide an opportunity to better develop and design culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The rehabilitation process should incorporate a balanced biopsychosocial approach, addressing both physical and psychosocial elements of pain, to provide more effective care and outcomes for Lebanese patients who predominantly attribute chronic low back pain to biomedical factors.Lebanese healthcare professionals need to improve communication with Lebanese patients regarding the nature of chronic low back pain, using clear communication to help dispel misconceptions and enhance rehabilitation outcomes.The exploration of patients’ pain perception may provide an opportunity to better develop and design culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The rehabilitation process should incorporate a balanced biopsychosocial approach, addressing both physical and psychosocial elements of pain, to provide more effective care and outcomes for Lebanese patients who predominantly attribute chronic low back pain to biomedical factors.Lebanese healthcare professionals need to improve communication with Lebanese patients regarding the nature of chronic low back pain, using clear communication to help dispel misconceptions and enhance rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability. A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis. Two topics were generated and constructed by the researchers: (1) "barriers to the implementation of pain neuroscience education, with subthemes including (a) "current health care approach," (b) "basic curriculum and continuing education," (c) "patients' barriers"; (2) "facilitators to the implementation of pain neuroscience education," with subthemes containing (a) "interest in the BPS model, (b) "therapeutic alliance," and (c) "motivation for future training on BPS approach." The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach. The exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists. The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management. The most important barriers were the dominant characteristic of the Lebanese physical therapist's health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective. [ABSTRACT FROM AUTHOR]

Introduction: Up to 37% of lumbar radiculopathy patients experience residual pain and disability following lumbar discectomy. Although it is assumed that dysfunctional pain processing may play a mechanistic role in symptom persistence, research in this area is lacking. Therefore, this study will evaluate pain processing in lumbar radiculopathy patients prior to and 3 months following lumbar discectomy. Methods: Lumbar radiculopathy patients (n = 122) scheduled for discectomy will be recruited through Flemish hospitals. At follow-up, patients with =1.5/10 average pain intensity on a visual analogue scale and <20% improvement on the Oswestry Disability Index will be categorized as having residual complaints. These will be compared to matched patients without residual complaints and pain-free controls. Pain sensitivity will be evaluated using Quantitative Sensory Testing including thermal, mechanical, and electrical perception and pain thresholds. Spinal modulation will be assessed using nociceptive flexion reflex thresholds; pain facilitation by the presence of psychocognitive factors through questionnaires and temporal summation of mechanical stimuli and the NFR; and pain inhibition using a conditioned pain modulation paradigm. Results: Not applicable. Discussion: We hypothesize that pre-operative pain characteristics are predictive of residual complaints and that patients with residual complaints exhibit dysfunctional pain processing compared to individuals without residual complaints as expressed by impaired pain inhibition and enhanced spinal modulation, pain sensitivity and facilitation. The findings will provide the potential to identify patients at risk of poor surgical outcome and explore treatment strategies according to dysfunctions in pain processing. Process evaluation: Currently recruiting and completing ethical committee applications for multicentric recruitment. [ABSTRACT FROM AUTHOR]

Introduction: Although a positive correlation between patients' expectations and outcome after surgery appears evident, evidence is rather conflicting. This can be attributed to the lack of uniform, validated, and reliable methods to assess patients' expectations. A valid and reliable questionnaire to assess patients' expectations of lumbar spine surgery is not yet available in Dutch. Methods: The forward-backward translation method will be applied to the original Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey [1]. The translations will be revised by an expert committee, including translators, methodologist, spinal surgery experts and psychology experts. The pre-final Dutch survey will be piloted in a sample (n = 50) of patients scheduled for lumbar surgery. Based on these results, the expert committee will improve the survey. The final survey will then be administered in a sample (n = 300) of patients twice before their spinal surgery. Based on the acquired data, validity (i.e. content, construct, and discriminative validity) and reliability (i.e. internal consistency and test-retest reliability) will determined. Results: Not applicable. Discussion: A Dutch validated survey for assessment of expectations of lumbar surgery patients may assist clinicians in determining the quality of spinal surgical care and any discrepancies that might exist between clinician and patient. Researchers will benefit as well, as uniform and valid surveys are essential to unravel the relation between pre-surgical patients' expectations and satisfaction following spinal surgery. Process evaluation: The study is currently in the backward-translation stage. Finding translators with the appropriate requirements according to the WHO guidelines proves to be challenging. [ABSTRACT FROM AUTHOR]

Introduction: Despite the considerable amount of research performed on conditioned pain modulation (CPM), there are still uncertainties concerning the influence of cognitive mechanisms on CPM efficacy.1 This study aimed to investigate whether the CPM effect is influenced by attention and expectations in healthy adults. Methods: Seventy-two healthy pain-free adults participated in this cross-sectional study undergoing CPM evaluation (i.e. pain pressure threshold (PPT) assessment (= test stimulus (TS)) in response to hot water hand submersion (=conditioning stimulus (CS)) during three experimental protocols administered in randomized order, i.e. (1) a sequential 'neutral' protocol, (2) a 'focus' protocol during which attention was focused on the CS, and (3) a 'distraction' protocol during which attention was directed away from the CS using a distraction task. Participants their pain expectations were recorded before each of the three protocols. Results: Compared to the other protocols, focusing the attention on the CS resulted in smaller CPM magnitudes (p < 0.001), and the distraction protocol resulted in lower NRS ratings for the CS (p < 0.001). A priori expectations accounted for 6.6% of the CPM effect of the neutral protocol (p = 0.035), with expectations of analgesia predicting more efficient CPM. Discussion: It is recommended to rate CS-related pain intensity after CS completion rather than during CS to prevent a reduction of the inhibitory effects by the CPM paradigm. Participants' a priori expectations should be registered as these can influence the induced CPM magnitude. Process evaluation: Building the appropriate statistical models, which took into account confounding factors as well as randomization sequence, was challenging. [ABSTRACT FROM AUTHOR]

Introduction: Prayer is the most common therapy used in alternative medicine1. The objective of this study was to explore the effect of prayers on endogenous pain modulation, pain intensity, and sensitivity in healthy religious participants. Methods: Two hundred and eight healthy religious participants were enrolled in this study and randomly distributed into two groups, a prayer group (n = 156) and a poem reading or control group (n = 52). Participants from the prayer group were allocated to either an active prayer group (n = 94) receiving an active type of praying or to a passive prayer group (n = 62) receiving a passive type of praying. Pain assessments were performed prior to and following the prayer or poem reading interventions and included pressure pain threshold assessment, conditioned pain modulation, and a numerical pain rating scale for perceived pain intensity. Results: A significant group-by-time interaction for PPT (p = 0.014) indicated post-intervention increases in PPT in the prayer group but not in the poem reading control group. Also, a significant group-by-time interaction for PPT (p = 0.005) indicated that these effects were greater in the active prayer group than in the passive prayer group. Participants experienced a decrease in CPM efficacy (p = 0.030) and an increase in pain intensity (p < 0.001) following the interventions, independent of their group allocation. Discussion: The results showed that prayer, irrespective to type, can positively affect pain sensitivity and intensity, but does not influence endogenous pain inhibition. Process evaluation: Future research should focus on understanding the mechanism behind "prayer induced analgesia". [ABSTRACT FROM AUTHOR]

Introduction: There is abundant evidence for compromised movement performance in non-specific low back pain (NSLBP)1,2. It has been proposed that not only pain severity, but also cognitive-affective factors such as attention might influence movement3. The objective of this study is to review current knowledge concerning the effects of attention on movement-related outcomes in NSLBP. Methods: A systematic search was performed and reported following the PRISMA-guidelines. A comprehensive search strategy was used by using five electronic databases. Possible risk-of-bias was evaluated by using the adjusted version of the Newcastle-Ottawa Scale. Levels of evidence and conclusion were assigned according to guidelines of the Dutch Institute for Healthcare Improvement. Results: Twenty-two articles were included (ROB 18.2% -72.7%), the majority (77%) performed in chronic LBP.Limited evidence indicated attentional suppression (measured with coping strategy questionnaire) to be negatively associated with activity of the trunk muscles in acute NSLBP. Furthermore, limited evidence indicated that when attention is divided over tasks (i.e. dual-tasks) this results in lower variability of postural strategies in recurrent NSLBP and lower/delayed anticipatory trunk muscle activation in chronic NSLBP. Discussion: Ignoring pain effects trunk muscle activity in acute NSLBP. When attention is divided (i.e. dual-tasks), individuals with recurrent/chronic NSLBP are less capable to control their trunk muscles. Process evaluation: The different possibilities to operationalize 'attention' posed a difficulty. Included studies used two main operationalizations: 'attentional control of pain' (i.e. attention focus, attentional suppression/distraction) and 'attention as a capacity' (i.e. cognitive load of pain competes for available attentional resources for postural control). [ABSTRACT FROM AUTHOR]

Introduction: There is growing acknowledgement of the benefits of incorporating a bio-psychosocial model of understanding pain within physical therapist practice1. Consequently this has led to an increasing interest in interventions such Pain neuroscience education (PNE). However, pain management strategies developed by clinicians in one culture may not necessarily be understood, appropriate, or effective in another culture2 Methods: This study is part of a broader research in the development of culturally sensitive pain neuroscience education for the Lebanese population. Therefore, the purpose of this paper is to first gain an in-depth understanding of the Lebanese physiotherapists' perceptions towards the management of chronic low back pain as well as the knowledge regarding PNE. A qualitative one-to-one semi-structured interviews with 10 practicing physical therapists were conducted. The transcribed text from the interviews was analyzed using inductive thematic analysis. Results: Several themes were generated, identified, and constructed by the researchers: (1) physiotherapists use of a biomechanical approach. (2) Poor knowledge about the bio-psychosocial approach or PNE. (3) Barrier and facilitation for the implementation of PNE. Discussion: The preliminary results showed a limited knowledge of the bio-psychosocial approach, or PNE, and that the Lebanese physical therapist use more a biomechanical approach in the treatment and assessment of people with chronic low back pain. Process evaluation: The results showed that training is needed for physiotherapists to deliver a broader model of care, and that future research should focus on developing a culturally sensitive PNE material. [ABSTRACT FROM AUTHOR]

Introduction: Migraine is conceptualized as a continuum, with at the one hand episodic migraine and at the other hand chronic migraine (CM) which is more frequent1. Recent studies support the presence of central sensitization (CS) in migraine patients2,3, but controversial evidence exists about where in the continuum exactly CS appears and which mechanisms are underlying. Therefore this study aims to determine the occurrence and mechanisms of CS within the migraine continuum. Methods: Self-reported and psychophysiological data will be collected from 30 migraine patients and 30 healthy controls. Pain sensitivity will be evaluated using Quantitative Sensory Testing including mechanical and thermal thresholds. Pain facilitation and inhibition will be assessed by using respectively temporal summation and conditioned pain modulation paradigms. Assessments are performed unilateral at the painful side and interictally. Results: Widespread pain and impaired pain facilitation and inhibition are expected to be more pronounced in patients with more migraine days (further along the continuum) than in those with less migraine days. Discussion: This research will show whether signs of CS are present in migraine patients, where in the migraine continuum these symptoms are appearing, and whether impaired pain inhibition and/or facilitation underlie these symptoms. Process evaluation: Data collection is currently going on. Testing patients with CM interictally is a challenge. [ABSTRACT FROM AUTHOR]

Introduction: Although the cause of persistent non-specific low back pain (NSLBP) remains unknown, structural and functional alterations of the brain1 and paravertebral muscles2 have been proposed as underlying mechanisms. To date, it is unknown if improvements through exercise therapy may be attributed to measurable changes in the muscles and/or adaptations in the brain. Therefore, the objective is to examine short and long-term effects of specific skilled motor control training versus unspecific general exercise training. Methods: In this double-blind, randomized controlled clinical trial, 62 recurrent NSLBP patients will be randomly allocated (1:1) to receive either skilled motor training or general exercise training. The primary outcome is LBP-related disability. Secondary measures include: brain structure, structural/functional connectivity, muscle structure, muscle function, and proprioception. Results: We expect changes only after skilled motor training for: brain function (i.e. increased functional connectivity in default mode network and sensory-motor regions), thoracolumbar dissociation and proprioception. In addition, for brain structure (i.e. changed structural connectivity between parieto-and (pre)motor areas and motor cortex reorganization), muscle function (i.e. timing/amplitude of anticipatory/compensatory postural adjustments) and muscle structure (i.e. muscle/fat index, cross-sectional area) we expect changes for both groups, but more pronounced after skilled motor training. More specifically, we expect that changes in muscle structure are training unspecific for superficial trunk muscles, but more pronounced for deep segmental muscles after skilled motor training. Process evaluation: Learning the necessary skills for MRI acquisition and recognizing artefacts took more time than expected. Several MRI sequence alterations were necessary to ensure sufficient image quality. References: 1. Kregel J, Meeus M, Malfliet A, et al. Structural and functional brain abnormalities in chronic low back pain: A systematic review. Seminars in Arthritis and Rheumatism 2015; 45(2), 229-237. 2. Goubert D, Meeus M. Willems T, et al. The association between back muscle characteristics and pressure pain sensitivity in low back pain patients. Scandinavian Journal of Pain 2018; 18(2), 281-293. Keywords: Low back pain; motor control; exercise; randomized controlled trial; brain 15332500, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/papr.13128 by EBSCO SUBSCRIPTION SERVICES - Journal Digital Lic, Wiley Online Library on [19/10/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License is LBP-related disability. Secondary measures include: brain structure, structural/functional connectivity, muscle structure, muscle function, and proprioception. Results: We expect changes only after skilled motor training for: brain function (i.e. increased functional connectivity in default mode network and sensory-motor regions), thoracolumbar dissociation and proprioception. In addition, for brain structure (i.e. changed structural connectivity between parieto-and (pre)motor areas and motor cortex reorganization), muscle function (i.e. timing/amplitude of anticipatory/compensatory postural adjustments) and muscle structure (i.e. muscle/fat index, cross-sectional area) we expect changes for both groups, but more pronounced after skilled motor training. More specifically, we expect that changes in muscle structure are training unspecific for superficial trunk muscles, but more pronounced for deep segmental muscles after skilled motor training. Process evaluation: Learning the necessary skills for MRI acquisition and recognizing artefacts took more time than expected. Several MRI sequence alterations were necessary to ensure sufficient image quality. [ABSTRACT FROM AUTHOR]