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Chronic pain is one of the most common symptoms of temporomandibular disorders (TMD). Although its pathophysiology is still a challenge, TMD has been associated with changes in central nervous system activity related to pain modulatory capacity. This study was conducted to examine the cortical activity of patients with temporomandibular disorders and chronic pain of myofascial origin using quantitative electroencephalography (qEEG). Individuals with TMD and chronic pain and healthy controls were evaluated using qEEG in four consecutive conditions, all with closed eyes: 1) initial resting condition; 2) non-painful motor imagery task of hand movement; 3) painful motor imagery task of clenching the teeth; 4) final resting condition. Participants with TMD and chronic pain overall presented decreased alpha power density during baseline at rest, and non-painful and painful motor imagery tasks when compared to healthy controls. Furthermore, functional brain connectivity was distinct between groups, with TMD and chronic pain showing lower small-world values for the delta (all conditions), theta (eyes closed, painful and non-painful motor imagery task), and alpha bands (painful motor imagery task), and an increase in the beta band (all conditions). These results suggest that TMD and related chronic pain is associated with maladaptive plasticity in the brain, which may correspond to a reduced ability to modify brain activity during different mental tasks, including painful and non-painful imagery. These changes can be detected by qEEG, a method which may be very important because of its characteristics of good temporal resolution and the possibility to be performed in naturalistic setups.

Introducción: La biopsia percutánea guiada por tomografía computarizada (BPGTC) es un procedimiento ampliamente utilizado para el diagnóstico de masas pulmonares. El conocimiento de sus complicaciones y la relación de las mismas con variables individuales es vital a la hora de realizar el abordaje. Objetivo: Describir las complicaciones de la BPGTC y cómo éstas se relacionan con características propias de los pacientes, los tipos de lesiones y la vía de abordaje utilizada en nuestra institución. Materiales y métodos: Estudio observacional retrospectivo descriptivo que incluyó 84 pacientes a los que se les realizó BPGTC entre enero de 2016 y abril de 2019 en el Departamento de Radiología de la Clínica CES, en Medellín. Resultados: 17 pacientes presentaron complicaciones, de las cuales el neumotórax fue la más común, 13,1 % (11/17), seguida de la hemorragia alveolar, 7,1 % (6/17) y la hemoptisis, 4,8 % (4/17). Uno de los pacientes falleció durante el procedimiento. Los pacientes con comorbilidades pulmonares, especialmente enfisema, lesiones de pequeño tamaño, sin adherencia a la pleura, en el lóbulo inferior derecho y con mayor recorrido de la aguja tuvieron un mayor número de complicaciones. Conclusiones: En nuestra institución hay pocas complicaciones derivadas de la BPGTC, y las más comunes son el neumotórax, la hemorragia alveolar y la hemoptisis con porcentajes del 13 %, 7 % y 4,8 % respectivamente, las cuales se encuentran por debajo de los estudios internacionales conocidos.

Carolina Sitges,1,2 Olga Velasco-Roldán,1,3 Jaume Crespí,1 Nuria García-Dopico,1 Joan Segur-Ferrer,1 Ana María González-Roldán,1,2 Pedro Montoya1,2 1Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain; 2Departament of Psychology, UIB, Palma, Spain; 3Departament of Nursing and Physiotherapy, UIB, Palma, SpainCorrespondence: Carolina SitgesResearch Institute of Health Sciences (IUNICS), University of Balearic Islands (UIB), Carretera de Valldemossa km 7.5, Palma, 07122, SpainTel +34 971-259-885Fax +34 971259501Email carol.sitges@uib.esBackground: Evidence-based clinical guidelines consider physical exercise one of the best nonpharmacological interventions for low-back pain (LBP), but it is necessary to clarify the exercise-induced hypoalgesia effect of different modalities of exercise in chronic pain populations.Purpose: This study focused on exploring acute changes in tactile and pressure-pain perception and lumbar strength and flexibility in patients with nonspecific chronic LBP (NSCLBP) after performing one of three 20-minute physical exercise modalities.Methods: A total of 81 patients with NSCLBP were pseudorandomly distributed into three groups of 20-minute physical exercise — 1) aerobic (n=21, mean age 42± 9.72 years, nine men), 2) stretching (n=21, mean age 40± 11.37 years, ten men), and 3) strengthening (n=20, mean age 35.80± 11.56 years, ten men) — and 4) a control group (n=19, mean age 38.64± 10.24 years, eight men), and completed self-reported questionnaires during the same period. Tactile and pressure-pain thresholds and isometric lumbar muscle endurance and flexibility were assessed before and after this brief exercise-based intervention.Results: All groups were comparable in terms of sociodemographic and clinical data, cardiovascular capacity, and self-reported data onphysical disability, mood, motivation, psychological response to stimulus properties of physical exercise, and physical activity enjoyment. Our analyses revealed higher tactile sensitivity (p< 0.001) and pressure-pain thresholds (p< 0.001) at the forefinger than other body locations. We also found lower pain sensitivity (p=0.010) and pressure pain–intensity ratings (p=0.001) and higher lumbar flexibility (p< 0.001) after intervention. After calculation of absolute pre–post differences, higher tactile sensitivity was observed at the gluteus medius muscle than the erector spinal muscle only after aerobic intervention (p=0.046).Conclusion: These results add some evidence about different modalities of exercise-induced hypoalgesia in NSCLBP. However, the fact that we also found improvements in the control group limits our conclusions.Keywords: low-back pain, exercise therapy, aerobic exercise, flexibility

Emotion knowledge has not been explored in children with cerebral palsy (CP). To evaluate differences in emotion knowledge between children with CP and their typically developing peers (TDP), and explore its associations with affective regulation and behavioral psychopathology. 36 Children with CP and 45 TDP completed the Emotion Matching Task (emotion knowledge); their parents completed the Emotion Regulation Checklist and Child Behavior Checklist (emotional regulation and lability; psychopathological behaviors). Children with CP made more mistakes in emotion knowledge tasks, had lower emotional regulation and higher behavioral problems than their TDP. Emotion knowledge showed a positive correlation with emotional regulation and a negative correlation with behavioral problems, predicting psychopathological behaviors. Greater attention to emotion knowledge in children with CP could improve adjustment at social and behavioral functioning.

To compare differences in postural balance, pain and depression in patients with chronic and acute low back pain, twenty patients with chronic and twenty patients with acute low back pain from the Edward Francis Small Hospital (Banjul, Gambia), as well as 20 age-matched healthy controls participated in the study. A modified Romberg test was used to assess postural balance during one minute with closed eyes. Body sway in the anteroposterior and mediolateral axes was video-recorded during test performance and further analyzed with an open source software for movement analyses (CvMob). Pain sensitivity was assessed by means of pressure pain thresholds and depression by a self-report questionnaire (PHQ-9). As results, patients with chronic low back pain displayed higher body sway in the anteroposterior and mediolateral axes, as well as faster body sway than patients with acute low back pain and healthy controls. Nevertheless, group differences disappeared when depression was introduced as a covariate, indicating a major role of depression in postural balance deficits of patients with pain disorders. As conclusions, the assessment of postural balance and depression should be implemented in the clinical routine for the design of tailored interventions in pain conditions.

Most pain studies have focused on only two aspects of pain: the influence of pain on attentional processing and the modulation of pain perception by affective stimuli. However, the influence of tonic pain on the attentional processing of affective stimuli has not been studied. In this study, we investigated the effects of tonic pain on the attentional processing of affective stimuli, focusing on autonomic responses and their relationship with both EEG power and functional connectivity. Forty participants (20 men and 20 women) received tonically painful and nonpainful thermal stimulation while viewing blocks of pleasant, unpleasant, or neutral images. The galvanic skin conductance response (SCR), electrocardiographic activity, and electroencephalographic (EEG) activity in the delta and theta bands were recorded. Participants rated the unpleasantness of the pain at the end of each block. Typical affective SCR and heart rate (HR) patterns were found in the no-pain condition, but when the pain was delivered, these patterns disappeared. EEG power and functional connectivity results showed that tonic pain affected the delta band in the central region during pleasant and unpleasant image blocks. Our findings suggest that tonic pain captured attentional focus and reduced the cognitive resources available for processing affective stimuli, altering the emotional experience associated with pain.

Many individuals with cerebral palsy (CP) suffer from pain and must develop pain-coping strategies, although the factors determining them are unknown. This observational study aims at exploring the association between different pain-coping strategies and factors such as age, sex, pain, health status, sleep or motor and cognitive function in individuals with cerebral palsy (CP) and typically developing peers (TD). Main caregivers of 94 individuals with CP (age range = 6–69 years, mean age = 17.78 (10.05)) and the closest relative of 145 individuals with TD (age range = 6–51 years, mean age = 19.13 (12.87)) completed questionnaires on the previous topics (Parent Report of the PEDsQL Pediatric Coping Inventory, the Health Utility Index HUI-3, Epworth Sleepiness Score and the Pittsburgh Sleep Quality Index). Pain presence, duration, intensity, location and ratings of current and worst pain in the last week in an 11-point numerical rating scale were assessed in an interview. Global health was the best predictor the of use of any type of pain-coping strategy, including cognitive self-instruction, problem-solving, distraction, seeking social support and catastrophizing, in both individuals with CP and individuals with TD. However, different health attributes predicted their use in each population. Emotional health was the best predictor in individuals with CP, whereas cognition and pain were the best predictors in individuals with TD. Speech ability was a predictor in both groups. In conclusion, the assessment of health attributes such as emotional health and speech may help design specific interventions for enhancing self-efficacy and adaptive pain coping skills.

Fibromyalgia syndrome (FMS) is a chronic pain condition accompanied by affective symptoms and cognitive impairments. This study investigated central nervous correlates of attentional and emotional processing in FMS. Therefore, event-related potentials were recorded in 26 FMS patients and 26 healthy controls during a dot probe task, which required participants to decide which side of the screen an asterisk was displayed on; the asterisk was immediately preceded by a facial expression (anger, pain, happiness, neutral) on the left or right side. Comorbid depression was also assessed. In patients, N170 amplitude was smaller for anger and pain expressions than for happy expressions, and P2 was greater for pain expressions than for happy expressions. N170 and P2 were unaffected by emotional expressions in controls. LPC was smaller overall in patients than controls. Though reaction times were longer overall in patients than controls, no behavioral effects of emotional stimuli arose in these groups. In contrast, FMS patients with comorbid depression showed less attentional interference due to emotional expressions, and less difficulty disengaging from these stimuli than patients without depression. While the observations concerning N170 suggested facilitated encoding of facial features representing negative rather than positive emotions in FMS and more automatized processing of pain expressions, those for P2 indicated increased attentional resource allocation to pain-related information. Reduced LPC reflects nonspecific deficits in sustained attention in FMS, which is in line with the longer reaction times. Behavioral data suggest lower processing depth of emotional information in patients with comorbid depression.

Phantom limb (PLP) as well as residual limb pain (RLP) are still a very significant problem after amputation and their causes are only partially known. Here we tested whether the predisposition for the frequency, duration and intensity of PLP and RLP is shared with other prior chronic pains and/or the presence of postamputation subacute pain. A week preoperatively we collected data using validated questionnaires, a pain diary and interviews on past chronic pain conditions, acute pain, depression, anxiety, pain interference, life control, social support and affective distress and pain ratings one day before the amputation in 52 patients scheduled for limb amputation. In the week postamputation and again three and 12 months thereafter, we collected data on postoperative wound pain, PLP, RLP and non-painful phantom sensation (PLS). Phantom and residual limb pain indices were calculated per patient, integrating the intensity, frequency and duration of past chronic pain, PLP, RLP and PLS into a single value to index the overall burden of pain. We report that acute and chronic pain long before but not on the day before the amputation and subacute pain postamputation significantly predicted up to half of the variance in the incidence and severity of PLP, RLP and PLS 12 months postamputation. Moreover, the severity of these painful sensations at 12 months postamputation was partially predicted by preamputation scores of depression and anxiety. These findings corroborate the hypothesis that chronic pain and non-painful sensations following limb amputation are strongly related to longstanding preoperative chronic pain and to subacute postoperative pain as well as to psychological factors before the amputation that may be inherited and/or acquired (learning- and memory-related). Furthermore, we also confirm that subacute pain postamputation comprises an additional risk factor for long-term painful sensations postamputation. Our results suggest that timely interventions might prevent the development of chronic pain.

This study aimed to present a narrative review regarding androgen production, androgens' role in folliculogenesis, and the available therapeutic approaches for androgen supplementation, and to perform a systematic review and meta-analysis regarding the impact of androgens (dehydroepiandrosterone/testosterone) compared with placebo or no treatment on ovarian response and pregnancy outcomes in patients with diminished ovarian reserve and/or poor ovarian responders.An electronic search of MEDLINE, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials, Scopus, ClinicalTrials.gov, the ISRCTN registry, and the World Health Organization International Clinical Trials Registry, was conducted for studies published until September 2021.Randomized controlled trials that compared ovarian response and/or pregnancy outcomes between the different in vitro fertilization protocols using androgens (ie, dehydroepiandrosterone and testosterone) and conventional in vitro fertilization stimulation in patients with diminished ovarian reserve and/or poor ovarian responders were included.The quality of each study was evaluated with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The meta-analysis used random-effects models. All results were interpreted on the basis of intention-to-treat analysis (defined as the inclusion of all randomized patients in the denominator). Risk ratios and 95% confidence intervals were used and combined for meta-analysis.No significant differences were found regarding the number of oocytes retrieved (mean difference, 0.76; 95% confidence interval, -0.35 to 1.88), mature oocytes retrieved (mean difference, 0.25; 95% confidence interval, -0.27 to 0.76), clinical pregnancy rate (risk ratio, 1.17; 95% confidence interval, 0.87-1.57), live-birth rate (risk ratio, 0.97; 95% confidence interval, 0.47-2.01), or miscarriage rate (risk ratio, 0.80; 95% confidence interval, 0.29-2.22) when dehydroepiandrosterone priming was compared with placebo or no treatment. Testosterone pretreatment yielded a higher number of oocytes retrieved (mean difference, 0.94; 95% confidence interval, 0.46-1.42), a higher clinical pregnancy rate (risk ratio, 2.07; 95% confidence interval, 1.33-3.20), and higher live-birth rate (risk ratio, 2.09; 95% confidence interval, 1.11-3.95).Although dehydroepiandrosterone did not present a clear effect on outcomes of assisted reproductive techniques, we found a potentially beneficial effect of testosterone priming on ovarian response and pregnancy outcomes. However, results should be interpreted with caution, taking into account the low to moderate quality of the available evidence.

Alterations in the affective component of pain perception are related to the development of chronic pain and may contribute to the increased vulnerability to pain observed in aging. The present study analyzed age-related changes in resting-state brain activity and their possible relation to an increased pain perception in older adults. For this purpose, we compared EEG current source density and fMRI functional-connectivity at rest in older (n = 20, 66.21 ± 3.08 years) and younger adults (n = 21, 20.71 ± 2.30 years) and correlated those brain activity parameters with pain intensity and unpleasantness ratings elicited by painful stimulation. We found an age-related increase in beta2 and beta3 activity in temporal, frontal, and limbic areas, and a decrease in alpha activity in frontal areas. Moreover, older participants displayed increased functional connectivity in the anterior cingulate cortex (ACC) and the insula with precentral and postcentral gyrus. Finally, ACC beta3 activity was positively correlated with pain intensity and unpleasantness ratings in older, and ACC-precentral/postcentral gyrus connectivity was positively correlated with unpleasantness ratings in older and younger participants. These results reveal that ACC resting-state hyperactivity is a stable trait of brain aging and may underlie their characteristic altered pain perception.

Objectives: Neurofeedback can induce long-term changes in brain functional connectivity, but its influence on the connectivity between different physiological systems is unknown. The present paper is an ancillary study of a previous paper that confirmed the effect of neurofeedback on brain connectivity associated with chronic pain. We analysed the influence of neurofeedback on the connectivity between the electroencephalograph (EEG) and heart rate (HR). Methods: Seventeen patients diagnosed with fibromyalgia were divided into three groups: good sensorimotor rhythm (SMR) training responders (n = 4), bad SMR responders (n = 5) and fake training (SHAM, n = 8). Training consisted of six sessions in which participants learned to synchronize and desynchronize SMR power. Before the first training (pre-resting state) and sixth training (post-resting state) session, open-eye resting-state EEG and electrocardiograph signals were recorded. Results: Good responders reduced pain ratings after SMR neurofeedback training. This improvement in fibromyalgia symptoms was associated with a reduction of the connectivity between the central area and HR, between central and frontal areas, within the central area itself, and between central and occipital areas. The sham group and poor responders experienced no changes in their fibromyalgia symptoms. Conclusions: Our results provide new evidence that neurofeedback is a promising tool that can be used to treat of chronic pain syndromes and to obtain a better understanding of the interactions between physiological networks. These findings are preliminary, but they may pave the way for future studies that are more methodologically robust. In addition, new research questions are raised: what is the role of the central-peripheral network in chronic pain and what is the effect of neurofeedback on this network., Spanish Government PSI2014-57231-R

BACKGROUND Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. OBJECTIVE The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. METHODS A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). RESULTS After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; PP=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance. CONCLUSIONS Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention. CLINICALTRIAL ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611

Background Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. Objective The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. Methods A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). Results After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P Conclusions Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention. Trial Registration ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611

Aim: Children with cerebral palsy (CP) have increased pain sensitivity and recurrent pain episodes; however, pain is underreported in children with intellectual impairment. Cardiac autonomic regula...

Whole body vibration has been proven to improve the health status of patients with fibromyalgia, providing an activation of the neuromuscular spindles, which are responsible for muscle contraction. The present study aimed to compare the effectiveness of two types of whole body vibrating platforms (vertical and rotational) during a 12-week training program. Sixty fibromyalgia patients (90% were women) were randomly assigned to one of the following groups: group A (n = 20), who performed the vibration training with a vertical platform, group B (n = 20), who did rotational platform training, or a control group C (n = 20), who did not do any training. Sensitivity measures (pressure pain and vibration thresholds), quality of life (Quality of Life Index), motor function tasks (Berg Scale, six-minute walking test, isometric back muscle strength), and static and dynamic balance (Romberg test and gait analysis) were assessed before, immediately after, and three months after the therapy program. Although both types of vibration appeared to have beneficial effects with respect to the control group, the training was more effective with the rotational than with vertical platform in some parameters, such as vibration thresholds (p &lt, 0.001), motor function tasks (p &lt, 0.001), mediolateral sway (p &lt, 0.001), and gait speed (p &lt, 0.05). Nevertheless, improvements disappeared in the follow-up in both types of vibration. Our study points out greater benefits with the use of rotational rather than vertical whole body vibration. The use of the rotational modality is recommended in the standard therapy program for patients with fibromyalgia. Due to the fact that the positive effects of both types of vibration disappeared during the follow-up, continuous or intermittent use is recommended.

Background Pain expectation and controllability can modulate pain processing. However, little is known about age-related effects on these cognitive factors involved in pain control. This study assessed age-related brain changes associated with pain expectation and controllability. Methods 17 healthy older adults (9 men; 65.65 ± 4.34 years) and 18 healthy younger adults (8 men; 20.56 ± 5.56 years) participated in the study. Pain evoked potentials and pain ratings were recorded while participants received painful electrical stimuli under two different conditions of pain controllability over the intensity of the stimulation (self-controlled vs. computer controlled) and two conditions of pain expectations (high vs. low pain). Results Although the intensity of the painful stimulation was kept constant, all participants showed reduced pain perception in the controllable and low pain expectancy conditions. However, older participants showed reduced amplitudes of pain evoked potentials in the time window between 150 and 500 ms after stimulus onset as compared to younger participants. Moreover, younger participants showed greater negative amplitudes from 80 to 150 ms after stimulus onset for uncontrollable versus controllable pain. Conclusions These results suggest that although cognitive pain modulation is preserved during ageing, neural processing of pain is reduced in older adults. Significance This research describes the impact of age on cognitive pain modulation evoked by the manipulation of pain controllability and pain expectations. Our findings constitute a first step in the understanding of the greater vulnerability of older individuals to chronic pain. Moreover, we show that older adults can benefit from cognitive pain control mechanisms to increase the efficacy of pain treatments.

To determine if patients with a DC respond similarly to ovarian stimulation when compared to patients without a DC. Infertility patients with a DC that underwent IVF between January 2009 and Decemb...

Controlled ovarian hyperstimulation (COH) is a key part of assisted reproductive technologies (ART) that resulted in a substantial increase in pregnancy rates from in vitro fertilization (IVF). However, in spite of the clear benefit of COH on an increase in the number of follicles and the number of oocytes retrieved, allowing for extended embryo culture and enabling the selection of the best quality embryo for transfer, several reports has shown that the supraphysiological hormonal levels may indeed have a detrimental effect on the endometrial level. The current article revises the pathophysiological mechanisms through which ovarian stimulation may negatively affect endometrial receptivity. In addition, the evidence is analyzed explaining how segmentation of IVF treatment may allow us to overcome the deleterious effects of hyperstimulation on endometrial receptivity. Deferred embryo transfer may be performed in a more physiologic uterine environment in a subsequent cycle, improve endometrial receptivity, decrease uterine contractility, diminishes the impact of premature luteinization and allow individualized stimulation according to the level of response.

This work aimed, to determine the characteristics of activity series from fractal geometry concepts application, in addition to evaluate the possibility of identifying individuals with fibromyalgia. Activity level data were collected from 27 healthy subjects and 27 fibromyalgia patients, with the use of clock-like devices equipped with accelerometers, for about four weeks, all day long. The activity series were evaluated through fractal and multifractal methods. Hurst exponent analysis exhibited values according to other studies ($H>0.5$) for both groups ($H=0.98\pm0.04$ for healthy subjects and $H=0.97\pm0.03$ for fibromyalgia patients), however, it is not possible to distinguish between the two groups by such analysis. Activity time series also exhibited a multifractal pattern. A paired analysis of the spectra indices for the sleep and awake states revealed differences between healthy subjects and fibromyalgia patients. The individuals feature differences between awake and sleep states, having statistically significant differences for $\alpha_{q-} - \alpha_{0}$ in healthy subjects ($p = 0.014$) and $D_{0}$ for patients with fibromyalgia ($p = 0.013$). The approach has proven to be an option on the characterisation of such kind of signals and was able to differ between both healthy and fibromyalgia groups. This outcome suggests changes in the physiologic mechanisms of movement control., Comment: Preprint accepted for publication at Physica A: Statistical Mechanics and its Applications

Background Previous research has demonstrated the efficacy of cognitive engagement in reducing concurrent pain. However, little is known about the role of individual differences in inhibitory control abilities and negative pain-related cognitions in modulating the magnitude of this type of distraction from pain. Methods In a pain distraction paradigm, 41 participants completed a working memory task with both a demanding high load condition (2-back) and an easy low load condition (0-back), while receiving warm or painful thermal stimuli to their left forearm. To control for individual differences in sensitivity to pain and perceived task difficulty, nociceptive stimulus intensity and task speed were individually calibrated. Additionally, participants completed a set of cognitive inhibition tasks (flanker, go/nogo, Stroop) and questionnaires about negative pain-related cognitions (fear of pain, pain catastrophizing) prior to the distraction paradigm. Results As expected, engaging in the high load condition significantly reduced perceived intensity and unpleasantness of nociceptive stimuli, compared to the low load condition. The size of the distraction effect correlated significantly with better cognitive inhibition and selective attention abilities, as measured by the flanker task. A moderation analysis revealed a significant interaction between pain catastrophizing and performance in the flanker task in predicting the distraction effect size: Participants who performed well on the flanker task showed more pain reduction, but only when they were average to high pain catastrophizers. Conclusions Selective attention abilities and pain catastrophizing seem to be important factors in explaining individual differences in the size of the analgesic response to a distractive task. Significance Understanding which factors influence the effectiveness of cognitive engagement in distracting from pain could help to optimize its therapeutic application in patient care. This study shows that a complex interplay of cognitive inhibition abilities, specifically selective attention, and negative pain-related cognitions, such as pain catastrophizing, modulate the magnitude of the distraction effect., This work was supported by the Luxembourg National Research Fund [C16/BM/11266318].

Background: Chronic pain is the main reason for medical consultation, as well as one of the main burdens of the health system in the developed world. However, current therapies are still inadequate for certain types of chronic pain, as in the case of fibromyalgia syndrome, or cause intolerable side effects (such as opioids). Understanding the neurophysiological and psychobiological bases of chronic pain is crucial to develop adequate and efficient strategies for the multidisciplinary evaluation and treatment of pain. Objective: The aim of this work is to provide a brief summary of the current state of the art to clarify the most effective strategies for the treatment of chronic pain. Methods: Narrative literature study developed in a reference world center to study of chronic pain. Results: In the last decades, it has been demonstrated that the plastic changes that occur in the brain are key for understanding the maintenance of pain over time. Research has provided evidence that patients with chronic pain displayed abnormal brain processing of body information and that negative emotional states can significantly alter brain functioning and amplify the suffering associated with pain. On the other hand, it has been suggested that strengthening emotional regulation skills through cognitive reassessment and suppression as used in cognitive-behavioral therapy or mindfulness can help regulate pain and emotion in patients with chronic pain. However, the brain mechanisms involved in these regulatory processes must still be elucidated, before being transferred to clinical practice. Conclusion: Cognitive and affective neuroscience is fundamental to physiotherapists understanding chronic pain.

Children with autism spectrum disorders (ASD) often present with somatosensory dysfunction including an abnormal reactivity to tactile stimuli and altered pain perception. A therapy based on somatosensory stimuli has shown effectiveness in reducing pain sensitivity among adults with cerebral palsy. The present study aims at exploring the influence of somatosensory therapy on somatosensory parameters in children with ASD. Children with high-functioning ASD were randomly assigned to either the intervention (n = 29) or the control group (n = 30). The intervention group received a somatosensory therapy consisting of four types of exercises (touch, proprioception, vibration, stereognosis). Somatosensory function (pressure pain thresholds, tactile thresholds, stereognosis, proprioception) was assessed before and immediately after the therapy. Children in the intervention group showed a significant reduction of pain sensitivity and increase of tactile sensitivity after treatment, whereas children in the control group displayed increased pain sensitivity in the absence of changes of tactile sensitivity. No changes were observed for proprioception or stereognosis. The repetitive somatosensory stimulation therapy led to a decrease of pain sensitivity and an increase of tactile sensitivity. These findings may have important research and clinical implications, as promoting early tactile interventions in children with ASD may lead to a more adequate development of somatosensory processing and less somatosensory abnormalities upon adult life.

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology and have a considerable impact on patients’ daily activities and quality of life. The main objective of this study was to compare pain impact, somatosensory sensitivity, motor functionality, and balance among 60 patients with FM, 60 patients with CLBP, and 60 pain-free controls aged between 30 and 65 years. It is essential to know the possible differences existing in symptomatology of two of the major chronic pain processes that most affect the population, such as FM and CLBP. The fact of establishing possible differences in sensory thresholds, motor function, and proprioceptive measures among patients with FM and CLBP could bring us closer to a greater knowledge of the chronic pain process. Through an observational study, a comparison was made between the three groups (FM, CLBP, and pain-free controls) evaluating functional performance, postural balance, kinematic gait parameters, strength, depression, fatigue, and sensitivity to pain and vibration. Patients with chronic pain showed worse somatosensory sensitivity (p &lt, 0.001) and motor function (p &lt, 0.001) than pain-free controls. Moreover, patients with FM showed greater pain impact (p &lt, 0.001) and bigger somatosensory (p &lt, 0.001) and motor deficiencies (p &lt, 0.001) than patients with CLBP. Further research should explore the possible reasons for the greater deterioration in patients with FM in comparison with other chronic pain conditions. Our results, showing the multiple areas susceptible of deterioration, make it necessary to adopt interdisciplinary interventions focused both on physical and emotional dysfunction.

Despite considerable research on experience-dependent neuroplasticity in professional musicians, detailed understanding of an involvement of the insula is only now beginning to emerge. We investigated the effects of musical training on intrinsic insula-based connectivity in professional classical musicians relative to nonmusicians using resting-state functional MRI. Following a tripartite scheme of insula subdivisions, coactivation profiles were analyzed for the posterior, ventral anterior, and dorsal anterior insula in both hemispheres. While whole-brain connectivity across all participants confirmed previously reported patterns, between-group comparisons revealed increased insular connectivity in musicians relative to nonmusicians. Coactivated regions encompassed constituents of large-scale networks involved in salience detection (e.g., anterior and middle cingulate cortex), affective processing (e.g., orbitofrontal cortex and temporal pole), and higher order cognition (e.g., dorsolateral prefrontal cortex and the temporoparietal junction), whereas no differences were found for the reversed group contrast. Importantly, these connectivity patterns were stronger in musicians who experienced more years of musical practice, including also sensorimotor regions involved in music performance (M1 hand area, S1, A1, and SMA). We conclude that musical training triggers significant reorganization in insula-based networks, potentially facilitating high-level cognitive and affective functions associated with the fast integration of multisensory information in the context of music performance. Hum Brain Mapp 38:4834-4849, 2017. © 2017 Wiley Periodicals, Inc.

Neuroimaging studies have demonstrated that altered activity in somatosensory and motor cortices play a key role in pain chronification. Neurofeedback training of sensorimotor rhythm (SMR) is a tool which allow individuals to self-modulate their brain activity and to produce significant changes over somatomotor brain areas. Several studies have further shown that neurofeedback training may reduce pain and other pain-related symptoms in chronic pain patients. The goal of the present study was to analyze changes in SMR power and brain functional connectivity of the somatosensory and motor cortices elicited by neurofeedback task designed to both synchronize and desynchronize the SMR power over motor and somatosensory areas in fibromyalgia patients. Seventeen patients were randomly assigned to the SMR training (n = 9) or to a sham protocol (n = 8). All participants were trained during 6 sessions, and fMRI and EEG power elicited by synchronization and desynchronization trials were analyzed. In the SMR training group, four patients achieved the objective of SMR modulation in more than 70% of the trials from the second training session (good responders), while five patients performed the task at the chance level (bad responders). Good responders to the neurofeedback training significantly reduced pain and increased both SMR power modulation and functional connectivity of motor and somatosensory related areas during the last neurofeedback training session, whereas no changes in brain activity or pain were observed in bad responders or participants in the sham group. In addition, we observed that good responders were characterized by reduced impact of fibromyalgia and pain symptoms, as well as by increased levels of health-related quality of life during the pre-training sessions. In summary, the present study revealed that neurofeedback training of SMR elicited significant brain changes in somatomotor areas leading to a significant reduction of pain in fibromyalgia patients. In this sense, our research provide evidence that neurofeedback training is a promising tool for a better understanding of brain mechanisms involved in pain chronification., This work was supported by the grants from PSI2017-88388-C4-1-R (AEI/FEDER, UE), PSI2017-88388-C4-3-R (AEI/FEDER, UE), and the Spanish Ministerio de Economia, Industria y Competitividad (ref: PSI2013-48260-C3-1-R and PSI2014-57231-R).

Congenital Mullerian anomalies (CMA) are the result of a developmental anomaly of the Mullerian ducts because of a failure during the fusion. The estimated prevalence of CMA in the general population is around 6.7%, whereas in the infertile population is about 7.3% and 16.7% in those women with recurrent miscarriage. Arcuate and septate uteri are the most common forms of anomalies both in fertile and infertile patients. The European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE) created the Congenital Uterine Anomalies Group (CONUTA). The American Society for Reproductive Medicine (ASRM) proposed their classification in 1988. The reason for infertility, although not fully understood, lies in the altered characteristics of the endometrium lining in the malformed uteri, ending in low implantation rates. Hysteroscopy remains the gold standard method for the evaluation of the uterine cavity, so it is of paramount importance to correctly diagnose these alterations and treat them when appropriate.

Objective: To study the time course of the electrocortical activity evoked by gains and losses in the Iowa Gambling Task (IGT), the brain sources of this electrical activity, and its association with behavioral parameters of task performance in order to achieve a better knowledge of decision-making processes. Method: Event-related potentials (ERPs) were obtained from a 64-channel EEG in 25 participants when performing the IGT. Brain source localization analyses of the ERP components were also assessed. Results: ERP amplitudes were sensitive to gains and losses. An early fronto-central negativity was elicited when feedback was provided for both gains and losses, and correlated with the number of gains at FCz and with the number of both gains and losses at Cz. The P200 component had larger amplitudes to losses and correlated positively with the number of losses. Feedback related negativity (FRN) was higher at frontal, temporal and occipital electrodes in trials with monetary losses. In addition, trials with monetary losses elicited larger P300 magnitudes than trials with monetary gains at all electrode localizations. Conclusions: All ERP components (except P300) were related to participants’ performance in the IGT. Amplitudes of P200 and P300 were associated with the conscious recognition of the error during the decision-making. Performance data and source analysis underline the importance of the medial prefrontal cortex when processing feedback about monetary losses in the IGT., This research was supported by grants from the Spanish Ministry of Science and Innovation (Ministerio de Ciencia y Tecnología), European Regional Development Funds (ERDF) and Ministry of Economy, Industry and Competitiveness (Ministerio de Economía, Industria y Competitividad, Gobierno de España). References: PSI2008-04394, PSI2017-88388-C4-1-R and PSI2017-88388-C4-3-R.

Purpose of reviewThe purpose of this review is to provide an overview of androgen supplementation in ART with the most updated evidence, from animal studies to its clinical applications in poor ovarian responders (POR) and the future studies to be published.Recent findingsAnimal studies, has shown that testosterone supplementation, can be an option to increase the recruitable follicular pool in POR. However, the potential mechanism of action, dose, and duration of treatment is still under investigation. Early studies in humans reported promising results in favor of androgens [dehydroepiandrosterone (DHEA) or testosterone] in POR. Nevertheless, recent evidence does not appear to follow the initial results, whereas the type, dose, and duration of testosterone administration appear to be crucial for treatment effect.SummaryTestosterone seems to play an essential role in regulating ovarian function. However, it is worrisome that androgens are used off-label, despite that the available evidence is weak. Although testosterone supplementation may be beneficial in POR, published studies have used inconsistent doses and duration of administration. An ongoing trial (T-TRANSPORT trial) for the first time aims to provide conclusive evidence on whether transdermal testosterone administration can improve the reproductive outcomes in patients undergoing IVF/ICSI.

Objective Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain accompanied by symptoms like fatigue, insomnia, depression, anxiety and cognitive impairments. In addition to central nervous pain sensitization, emotional dysregulation may be involved in FMS pathogenesis. This study investigated central nervous correlates of affective and attentional processing in FMS using an implicit task. Methods Event-related potentials (ERPs) of the EEG were recorded in 25 FMS patients and 37 healthy controls while they had to name the frame color of pictures displaying emotional expressions (angry, painful, happy, neutral). The actual picture had to be ingored. Symptoms of pain, depression and anxiety were also assessed. Results Patients exhibited smaller P2 and late positive potential (LPP) amplitudes, and a greater N250 amplitude, than controls. The N250 amplitude varied according to the emotional expressions displayed in patients, but not in controls. No group differences arose for the P1 or N170 amplitudes. Patients had longer reaction times and made more errors on the task; task performance was more closely related to pain severity than to other symptoms. Conclusion The reduced P2 and LPP amplitudes indicate deficient short-term mobilization of attentional resources and sustained attention in FMS; the greater N250 amplitude may reflect greater engagement in the decoding of complex facial features, which is necessary to compensate for attentional impairments. Affective modulation of the N250 suggests that the neural mechanisms underlying complex visual processes are particularly susceptible to emotional influences in FMS. The behavioral data confirm attentional deficits in the disorder and implicate clinical pain therein.

Pain and abnormal somatosensory processing are important associated conditions in children and adolescents with cerebral palsy (CP). Perceived social support is highly relevant for pain perception and coping. Aim: The aim of the present study was to assess the influence of social support on pain sensitivity in children and adolescents with cerebral palsy and healthy peers. Design: Cross-sectional study. Methods: Pressure pain thresholds were assessed in 42 children and adolescents with CP and 190 healthy peers during three different conditions: alone, with their mother and with a stranger. Results: Children with CP reported lower pain sensitivity when they were with their mother than being alone or with a stranger, whereas healthy peers did not experience different pain sensitivity related to the social condition. Sex or clinical characteristics did not affect the relationship between pain perception and social support. Conclusion: The present study shows how children with CP are highly affected by social and contextual influences for regulating pain sensitivity. Solicitous parental support may enhance pain perception in children with CP. Further research on the topic is warranted in order to attain well-founded conclusions for clinical practice Ministerio de Economía y Competitividad, #PSI2017-88388-C4-1-R

Background and aims While social interactions like verbal support and physical touch have repeatedly been shown to reduce experimental pain, analgesic effects of passive social support, i.e. the sole physical presence of a supportive other, remain unclear. Moreover, little is known about individual factors influencing the extent of pain attenuation during social support. This study investigated analgesic effects of passive support by a romantic partner and the role of partner empathy therein. Methods In 48 heterosexual couples, sensitivity to pressure pain was assessed; each participant was tested alone and in the passive presence of his/her partner. Dispositional empathy was quantified by a questionnaire. Results In the presence, as compared to absence, of their partners men and women exhibited higher pain threshold and tolerance, as well as lower sensory and affective pain ratings on constant pressure stimuli. Partner empathy was positively associated with pain tolerance and inversely associated with sensory pain experience. Conclusions The results confirm the analgesic effects of social support, which may even occur without verbal or physical contact. Partner empathy may buffer affective distress during pain exposure, thereby reducing pain sensitivity and promoting pain coping. These processes may occur solely due to a partner’s physical presence and do not necessarily require direct empathetic feedback.

To determine if patients with a DC respond similarly to ovarian stimulation when compared to patients without a DC. Infertility patients with a DC that underwent IVF between January 2009 and December 2016 were included. A cystic mass with mixed echogenicity, internal echoes similar to thick bands, fatty-fluid level, or an echogenic tubercle with acoustic shadow (Rokitansky nodule) within two years of the cycle characterized the diagnosis. The z-score compared the standard deviations (SDs) in patients with/without a DC and were compared to a nomogram (expected oocytes minus oocytes obtained divided by the SD), adjusted for age and number of oocytes retrieved, built utilizing cycles from noninfertile female patients. Thirty-nine patients with DC and 7839 patients without DC were identified. The mean number of oocytes (8.6 ± 5.8 vs. 8.5 ± 7.7

Background Children with cerebral palsy (CP) perform less physical activity than their typically developing peers (TDP). Pain, important comorbidity in children with CP, restrains levels of physical activity. Objective This study aims at exploring the influence of chronic pain in physical activity of children with CP and TDP. Methods 24-hour heart rate was registered in four groups of children: children with CP and TDP, with and without chronic pain. Heart rate based indexes of physical activity (MET percentages, energy expenditure) were computed. A self-reported diary of activities rated activities pain and fatigue intensity. Results Children with CP and chronic pain reported more painful activities and higher pain than their TDP with chronic pain. Moreover, children with CP and chronic pain presented higher time and periods of light activity and less sedentary activity than their TDP with chronic pain. No differences were found between CP and TDP without chronic pain. Conclusion Children with CP regulate physical activity differently than TD children in the presence of chronic pain. The maintenance of light levels of physical activity in children with CP may suggest efficient pain coping strategies and perseverance in participation. These findings encourage the implementation of programs to improve fitness in this population.

Objectives Comorbid symptoms in fibromyalgia (FM) syndrome, such as mood disorders and cognitive dysfunction, may lead to greater functional impairment than pain itself. This study aimed to unravel the modulating role of depression in response execution and inhibition in FM using an emotional go/no-go task. Materials and methods In total, 17 FM patients with low depression, 18 FM patients with high depression, and 18 pain-free controls were included. Pain, happy, and neutral faces were pseudorandomly presented, and participants were asked to respond to male faces (go trials) by pressing a button, and to inhibit their responses if female faces were presented (no-go trials). Results FM patients with high depression showed lower positive affect scores, higher negative affect and pain vigilance scores, and slower reaction times, than FM patients with low depression and pain-free controls. Both subgroups of FM patients also rated pain faces as more arousing than pain-free controls. The lack of group differences in our electrophysiological data, neither in N200 nor in P300 amplitudes, seems to indicate that there was no significant impairment in response execution in response inhibition due to pain. Discussion Taken together, these results add evidence to the notion that depression is associated with higher affective dysregulation and deficit of information-processing speed in FM. Furthermore, our data suggest that pain induces a bias to pain-related information, but the absence of significant group differences in event-related potential amplitudes, calculated with analyses of covariance (ANCOVA) (with pain intensity), seem to show that pain intensity is not a predictor for cognitive dysfunctions.

Background This randomized controlled trial explored the practicality and effectiveness of a novel tool-assisted self-help device, one that combines vibrational oscillation, leverage, and the shearing effect from the edges, for promoting meaningful changes in key biomechanical tissue indices and related parameters. Methods One hundred and thirteen male breakdancers were randomized to an intervention or control group. Individuals assigned to the intervention group performed the self-help treatment on the quadriceps and the iliotibial band of their right thighs for 8 min, while individuals assigned to the control condition merely sat quietly during this period. Various primary outcome measures (e.g., elasticity, stiffness, range of motion, pain pressure threshold sensitization, and blood flow) were assessed before and after the intervention for each participant, with position and posture being standardized throughout. Subjective sensations and a measure selected to assess for potential experimental demand effects, serving as secondary measures, were also administered pre- to post-treatment. Results Stiffness was significantly reduced for both structures (p

There are an increasing number of neuroimaging studies that allow a better understanding of symptoms, neural correlates and associated conditions of fibromyalgia. However, the results of these studies are difficult to compare, as they include a heterogeneous group of patients, use different stimulation paradigms, tasks, and the statistical evaluation of neuroimaging data shows high variability. Therefore, this meta-analytic approach aimed at evaluating potential alterations in neuronal brain activity or structure related to pain processing in fibromyalgia syndrome (FMS) patients, using quantitative coordinate-based "activation likelihood estimation" (ALE) meta-analysis. 37 FMS papers met the inclusion criteria for an ALE analysis (1,264 subjects, 274 activation foci). A pooled ALE analysis of different modalities of neuroimaging and additional analyses according functional and structural changes indicated differences between FMS patients and controls in the insula, amygdala, anterior/mid cingulate cortex, superior temporal gyrus, the primary and secondary somatosensory cortex, and lingual gyrus. Our analysis showed consistent results across FMS studies with potential abnormalities especially in pain-related brain areas. Given that similar alterations have already been demonstrated in patients with other chronic pain conditions and the lack of adequate control groups of chronic pain subjects in most FMS studies, it is not clear however, whether these findings are associated with chronic pain in general or are unique features of patients with FMS. Hum Brain Mapp 37:1749-1758, 2016. © 2016 Wiley Periodicals, Inc.

The major aim of this work was to propose a new association method known as Motif-Synchronization. This method was developed to provide information about the synchronization degree and direction between two nodes of a network by counting the number of occurrences of some patterns between any two time series. The second objective of this work was to present a new methodology for the analysis of dynamic brain networks, by combining the Time-Varying Graph (TVG) method with a directional association method. We further applied the new algorithms to a set of human electroencephalogram (EEG) signals to perform a dynamic analysis of the brain functional networks (BFN).

[EN] Neurofeedback is a self-regulation technique that can be applied to learn to voluntarily control cerebral activity in specific brain regions. In this work, a Transcranial Doppler-based configurable neurofeedback system is proposed and described. The hardware configuration is based on the Red Pitaya board, which gives great flexibility and processing power to the system. The parameter to be trained can be selected between several temporal, spectral, or complexity features from the cerebral blood flow velocity signal in different vessels. As previous studies have found alterations in these parameters in chronic pain patients, the system could be applied to help them to voluntarily control these parameters. Two protocols based on different temporal lengths of the training periods have been proposed and tested with six healthy subjects that were randomly assigned to one of the protocols at the beginning of the procedure. For the purposes of the testing, the trained parameter was the mean cerebral blood flow velocity in the aggregated data from the two anterior cerebral arteries. Results show that, using the proposed neurofeedback system, the two groups of healthy volunteers can learn to self-regulate a parameter from their brain activity in a reduced number of training sessions., This research was funded by Ministerio de Economia y Competitividad, Spain, grant number PSI2013-48260-C3-2-R. The APC was funded by Ministerio de Economia y Competitividad, Spain, grant number PSI2013-48260-C3-2-R.

Pain assessment is difficult in individuals with cerebral palsy (CP). This is of particular relevance in children with communication difficulties, when non-verbal pain behaviors could be essential for appropriate pain recognition. Parents are considered good proxies in the recognition of pain in their children; however, health professionals also need a good understanding of their patients' pain experience. This study aims at analyzing the agreement between parents' and physiotherapists' assessments of verbal and non-verbal pain behaviors in individuals with CP. A written survey about pain characteristics and non-verbal pain expression of 96 persons with CP (45 classified as communicative, and 51 as non-communicative individuals) was performed. Parents and physiotherapists displayed a high agreement in their estimations of the presence of chronic pain, healthcare seeking, pain intensity and pain interference, as well as in non-verbal pain behaviors. Physiotherapists and parents can recognize pain behaviors in individuals with CP regardless of communication disabilities.

It is widely known that an adequate growth of the endometrium is indispensable for implantation and successful pregnancy. However, there is no clear agreement on what proper growth is. When reviewing the literature, it is accepted that an endometrial thickness of less than 7 mm would be considered as a refractory endometrium (or thin endometrium) and that would entail to altered pregnancy and live birth rates [1, 2]. It has been long tried to define the optimal characteristics of that “ideal” endometrium in which to transfer the best possible embryo. Investigators have sought to determine it using ultrasonography regarding its thickness and its pattern, but no explicit agreement has been established to date. Moreover, pregnancies and live births have been documented both with thinner and normal endometrium [3]. Therefore, because of the difficulties in defining diagnostic criteria, it is challenging to calculate its true prevalence, although some researchers estimate it around 2.42% (260/10724 women) [4].

Background Knee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA. Methods Patients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention. Discussion The motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. Trial registration: Brazilian Registry on Clinical Trials (ReBEC) – Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B. Trial registration ID: RBR-9D7C7B. Registered on 29 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2332-6) contains supplementary material, which is available to authorized users.

Brain-derived neurotrophic factor (BDNF) levels in dopaminergic (DA) cells within the ventral tegmental area (VTA)/nucleus accumbens (NAc) circuitry appear to be a candidate mechanism for the neuroadaptive changes that follow stress and reward responses in animal models. However, the role of theBDNFgene variants in responses to salient cues through DA neurotransmission in humans remains unexplored. Here, we studied the effect of the common functionalBDNFVal66Met (rs6265) polymorphism on rewarding experiences in the striatum and DA-mediated responses to stress. Seventy-two healthy controls were genotyped for theBDNFVal66Met polymorphism and underwent the monetary incentive delay task during an functional magnetic resonance imaging (fMRI) session. Forty-nine of them also underwent a sustained pain challenge with and without placebo administration with potential analgesic properties during PET measures of DA D2/3-receptor-mediated neurotransmission. Neuroimaging results revealed a significant effect ofBDNF(Met66carriers > Val/Val) on brain responses during the anticipation of monetary losses, baseline D2/3receptor availability, and pain-stress-induced DA release in the NAc. Conversely, BDNF Met66carriers showed no activation in response to monetary gains and a blunted DA response to the analgesic placebo in the NAc. These results provide initial human evidence regarding the effect of theBDNFVal66Met polymorphism on DA-mediated responses to stress, its cognitive regulation by positive expectations, and the anticipatory responses to monetary gains and losses in the VTA-NAc pathway. Our results are of relevance to the neurobiology of stress and reward interactions and the pathophysiology of stress-related disorders.

Objective In addition to central nervous sensitization, affect dysregulation constitutes an important factor in the pathogenesis of fibromyalgia syndrome (FMS). The present study is concerned with emotional influences on information processing in FMS. The hypothesis of attentional bias, i.e., selective processing of negatively connoted stimuli, was tested. Methods Twenty-seven female FMS patients and 34 healthy women undertook an emotional modification of the Stroop task. Subjects had to decide whether the colors of positive, negative, and neutral adjectives accorded with color words presented in black. Attentional bias was defined as delay in color naming of emotional words relative to neutral words. Affective and anxiety disorders, pain severity, as well as medication were considered as possible factors mediating the expected interference. Results Patients showed marked attentional bias, manifested in a greater response delay due to negative words compared with the control group. Among the clinical features, pain severity was most closely associated with the extent of the interference. While depression played only a subordinate role, anxiety and medication were without effect. Conclusions The study provides evidence of emotionally driven selective attention in FMS. Attentional bias to negative information may play an important role in the vicious circle between negative affective state and pain augmentation. In the management of FMS pain, strategies aiming at conscious direction of attention may be helpful, e.g., imagery techniques or mindfulness training.

Recent resting-state fMRI studies associated extensive musical training with increased insula-based connectivity in large-scale networks involved in salience, emotion, and higher-order cognitive processes. Similar changes have also been found in chronic pain patients, suggesting that both types of experiences can have comparable effects on insula circuitries. Based on these observations, the current study asked the question whether, and if so in what way, different forms of experience-dependent neuroplasticity may interact. Here we assessed insula-based connectivity during fMRI resting-state between musicians and non-musicians both with and without chronic pain, and correlated the results with clinical pain duration and intensity. As expected, insula connectivity was increased in chronic pain non-musicians relative to healthy non-musicians (with cingulate cortex and supplementary motor area), yet no differences were found between chronic pain non-musicians and healthy musicians. In contrast, musicians with chronic pain showed decreased insula connectivity relative to both healthy musicians (with sensorimotor and memory regions) and chronic pain non-musicians (with the hippocampus, inferior temporal gyrus, and orbitofrontal cortex), as well as lower pain-related inferences with daily activities. Pain duration correlated positively with insula connectivity only in non-musicians, whereas pain intensity exhibited distinct relationships across groups. We conclude that although music-related sensorimotor training and chronic pain, taken in isolation, can lead to increased insula-based connectivity, their combination may lead to higher-order plasticity (metaplasticity) in chronic pain musicians, engaging brain mechanisms that can modulate the consequences of maladaptive experience-dependent neural reorganization (i.e., pain chronification).

Sensory and cognitive deficits are common comorbidities in children with cerebral palsy. This observational study examines if brain processing of affective information is also altered in children with cerebral palsy (CP) in comparison with typically developing peers (TDP).Evoked-related potentials were recorded in 15 children with CP (age = 11.27 ± 4.53 yr, 6 girls) and 14 TDP (age = 10.14 ± 4.29 yr, 5 girls) when viewing pleasant, unpleasant and neutral pictures. The subjective perception of valence and arousal of each one of the pictures was examined.Children with CP showed a significant amplitude reduction of evoked potentials in the occipital region to the affective stimuli in early brain processing latencies (P100 and N200; all F 2.9, all p .05). Children with CP rated pictures with affective content (pleasant and unpleasant) as less arousing (F(2.25) = 46.71, p .001), and neutral pictures as more pleasant, than their TDP (F(2.25) = 75.56, p .001).The pictures with emotional content produce less activation, both at the behavioral and brain processing levels in children with CP. These differences were found in early latencies of brain processing which could be related to alterations in the detection of emotionally relevant stimuli.

Facial expression provides information for an accurate estimation of others' pain. Nevertheless, little is known about psychophysiological responses to pain faces in chronic pain. Event-related potentials and brain oscillations, corrugator activity, and heart rate were recorded in 20 fibromyalgia patients and 20 pain-free controls when viewing pain, anger, happy, and neutral faces. Pain and anger faces elicited greater unpleasantness and arousal than happy and neutral faces, and pain faces evoked greater corrugator response than the rest of faces in all participants. Fibromyalgia patients displayed greater cardiac deceleration to all facial expressions than pain-free controls, and enhanced N100 amplitudes to pain and anger faces in comparison with neutral faces. Pain-free controls were characterized by enhanced N100 amplitudes to happy faces as compared to patients, and by more positive event-related potential amplitudes to happy than to other faces in the time window of 200 to 300 ms. Fibromyalgia patients showed greater theta power in response to pain and anger faces, as well as more reduced alpha power than pain-free controls to all faces. These findings suggest that information processing in fibromyalgia might be characterized by enhanced defensive reactions and increased mobilization of attention resources to pain and anger faces, and by reduced allocation of attention to happy faces. Perspective Our findings suggest that brain and cardiac activity elicited by viewing facial expressions of pain and anger in others is altered in fibromyalgia patients. This cognitive bias toward negative emotions could be used in clinical settings as a psychobiological marker during the assessment and treatment of fibromyalgia.

Objectives Increased cerebral blood flow during processing of acute pain has repeatedly been observed in fibromyalgia syndrome. The study investigated the time dynamics of the pain-related hemodynamic response in fibromyalgia using transcranial Doppler sonography. Methods In 25 women with fibromyalgia and 25 healthy participants, blood flow velocities in the anterior and middle cerebral arteries of both hemispheres were recorded, while heat stimuli of 45°C were applied to their forearms. Thermal pain threshold and subjective pain experience during stimulation were assessed, and the participants completed the McGill Pain Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory. Results The early component of the blood flow response in both anterior cerebral arteries, that is, the steep flow increase during the initial stimulation period, was more pronounced in the patients than in the controls (mean [standard deviation] = 1.28% [1.85%] versus 0.24% [1.58%], p = .04). The patients showed lower pain threshold (p = .018), stronger sensory and affective pain experience (p Conclusions The increased blood flow response in the anterior cerebral arteries reflects hyperactivity of medial structures of the neuromatrix of nociception, structures involved in the processing of affective and cognitive aspects of pain. Aberrances in cerebral blood flow related to fibromyalgia and its clinical characteristics become particularly apparent in the enhancement of the initial component of the hemodynamic response. Abbreviations FMS = fibromyalgia syndrome Abbreviations fMRI = functional magnetic resonance imaging Abbreviations fTCD = functional transcranial Doppler sonography Abbreviations ACAs = anterior cerebral arteries Abbreviations MCAs = middle cerebral arteries Abbreviations SCID = Structured Clinical Interview for Axis I Disorders Abbreviations MPQ = McGill Pain Questionnaire Abbreviations BDI = Beck Depression Inventory Abbreviations STAI = State-Trait Anxiety Inventory Abbreviations VAS = visual analog scale Abbreviations VIF = variance inflation factor Abbreviations BOLD = blood oxygen level dependent Abbreviations EEG = electroencephalography