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Purpose: To evaluate exercise-induced analgesia (EIA) effectiveness in healthy adolescent males and to investigate possible associations between EIA and physiological/psychological variables. Methods: Twenty-eight healthy adolescent males (14–17 y) participated in this study. EIA was evaluated by comparing perceptions of heat pain stimulations before and after an increasing maximal load test on a cycle ergometer (VO2max). Results: Pain intensity for mild and strong heat pain stimulations significantly decreased following physical exercise (mild: EIA = 28.6%; 95% confidence interval, 0.9–1.9; P <.001 and strong: EIA = 11.3%; 95% confidence interval, 0.3–1.4; P =.002). The number of physical activity hours per week was positively correlated with the effectiveness of EIA for mild and strong pain intensity (r =.41, P =.03 and r =.43, P =.02, respectively). Conclusions: Intense physical exercise decreases perception of intensity of experimental heat pain in healthy adolescent males. The least physically active adolescents have reduced EIA effectiveness to experimental heat pain stimulations compared with physically active ones. Adolescents adopting an active lifestyle have more endogenous pain inhibition and could, therefore, potentially be less disposed to suffer from chronic pain later in life. [ABSTRACT FROM AUTHOR]

Introduction: Self-reported levels of disability in individuals with low back pain (LBP) have not improved in the last decade. A broader perspective and a more comprehensive management framework may improve disability outcomes. We recently developed and validated the Low Back Pain and Disability Drivers Management (PDDM) model, which aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the applicability of the PDDM model to a LBP population and the feasibility of conducting a pragmatic trial, as well as to explore clinicians' perceived acceptability of the PDDM model's use in clinical settings. Methods: This study was an one-arm prospective feasibility trial. Participants included physiotherapists working with a population suffering from LBP and their patients aged 18 years or older presenting with a primary complaint of LBP that sought a new referral and deemed fit for rehabilitation from private and public clinical settings. Clinicians participated in a one-day workshop on the integration of the PDDM model into their clinical practice, and were asked to report various LBP-related outcomes via self-reported questionnaires (i.e., impact of pain on physical function, nervous system dysfunctions, cognitive-emotional factors, work disabilities) at baseline and at six-week follow-up. Physiotherapists' acceptability of the use of the PDDM model and appreciation of the training were assessed via semi-structured phone interviews. Analyses focused on a description of the model's applicability to a LBP population, feasibility outcomes and acceptability measures. Results: Applicablity of the PDDM model was confirmed since it successfully established the profile of patients according to the elements of each categories, and each of the 5 domains of the model was represented among the study sample. Trial was deemed feasible contingent upon few modifications as our predefined success criteria for the feasibility outcomes were met but feasibility issues pertaining to data collection were highlighted. Twenty-four (24) clinicians and 61 patients were recruited within the study's timeframe. Patient's attrition rate (29%) and clinicians' compliance to the study protocol were adequate. Clinicians' perceived acceptability of the use of the model in clinical settings and their appreciation of the training and online resources were both positive. Recommendations to improve the model's integration in clinical practice, content of the workshop and feasibility of data collection methods were identified for future studies. A positive effect for all patients' reported outcome measures were also observed. All outcome measures except for the PainDetect questionnaire showed a statistically significant reduction post-intervention (p<0.05). Conclusion: These findings provide preliminary evidence of the potential of the PDDM model to optimize LBP management as well as conducting a future larger-scale pragmatic trial to determine its effectiveness. Trial registration: Clinicaltrial.gov: NCT03949179. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify which averaging methods most accurately measures peak cardiorespiratory fitness (CRF) parameters [peak O2 uptake (VO2), peak O2pulse and peak respiratory exchange ratio (RER)] in a sample of healthy children and adolescents. In this cross-sectional multicenter study, we recruited 278 healthy children aged 12–17 years. We compared the mean peak value of three CRF parameters using the recommended averaging methods (30-second block average) with alternative averaging methods such as moving averages or shorter smoothing periods. We also assessed averaging methods for accuracy by individually reviewing breath-by-breath scatter plots. The 30-second block average method resulted in a lower mean peak VO2 and in an increased proportion of underestimated peak values. Using a 30-second moving average significantly increased mean peak values which increased accuracy. Similar results were found for peak RER and peak O2pulse. In conclusion, the currently recommended averaging method (30-second block average) increased the risk of misinterpretation of peak CRF values in children. Using a moving average approach decreased misinterpretation and increased accuracy. [ABSTRACT FROM AUTHOR]

Background and aims: Chronic pain is affecting a growing number of individuals including adolescents. Different endogenous pain inhibitory systems could confer protection against development of chronic pain. Decreased pain perception can be observed following intense pain (i.e. conditioned pain modulation – CPM) or after physical exercise (i.e. exercise-induced analgesia – EIA). Reduced effectiveness of pain inhibitory mechanisms have been reported in several chronic pain conditions. However, the extent of these dysfunctions has not been thoroughly investigated in adolescents suffering from chronic pain. Our hypothesis was that adolescents suffering from chronic pain have less effective CPM and EIA than pain-free teenagers. Methods: Twenty-five healthy adolescent girls and 16 teenage girls with chronic pain participated in this study. Only girls were included in this investigation, since chronic pain is more prevalent in females. The effectiveness of CPM was assessed by comparing heat pain stimulations (individually adapted to induce mild pain intensity) performed with a thermode before and after a cold pressor test (CPT; 2 min, 10 °C). EIA was evaluated by comparing pain intensity produced by an ice cube placed on the forearm before and after a graded exercise test on a cycle ergometer. Results: Pain intensity produced by heat pain stimulations decreased following CPT in healthy (p<0.05), but not in chronic pain adolescent girls (p=0.4). Pain intensity induced by the ice cube was reduced after exercise in healthy (p<0.05), but not in chronic pain adolescents (p=0.9). The effectiveness of CPM and EIA was inferior in teenage girls suffering from chronic pain compared to healthy participants (p<0.05). Conclusions: Endogenous pain inhibitory mechanisms triggered by intense pain or by physical exercise are effective in healthy adolescent girls. Teenage girls living with chronic pain do not show diminished pain perception after a CPT or a graded exercise test. These results suggest that pain inhibitory mechanisms such as CPM and EIA are ineffective in adolescent girls suffering from chronic pain. Implications: In a wider context, the findings of the present research could help understand better the mechanisms involved in the development of chronic pain. Improved comprehension of this subject might help prevent chronic pain conditions and thus, reduce the negative impacts of this burden. [ABSTRACT FROM AUTHOR]

Preterm birth is associated with painful procedures during the neonatal intensive care unit (NICU) stay. Full-term newborns can also experience pain, following surgery. These procedures can have long-lasting consequences. It has been shown that children born preterm show pain responses and cardiac alterations. This study aimed to explore the heart rate reactivity to pain in 107 subjects born either pretermor full-termwho were between 7 and 25 years old at testing. We also evaluated the effect of pain experienced at birth, as represented by a longer NICU stay, time under ventilation, and surgery at birth. Participants were asked to immerse their right forearm in 10°c water for 2 minutes. Electrocardiograms were recorded at baseline and during the immersion procedure. Fullterm subjects showed a stable increase in heart rate throughout the procedure, whereas preterm ones showed a strong increase at the beginning, which decreased over time. Also, preterm and full-term subjects who experienced pain at birth showed higher resting heart rate, stronger sympathetic activity, and lower cardiac vagal activity. Our study demonstrated a long-term impact of a long NICU stay and surgery at birth on cardiac autonomic activity. This could lead to impaired reactions to pain or stress in later life. [ABSTRACT FROM AUTHOR]

AbstractPlacebo effects are well-known phenomena in medicine and biology. In fact, placebos are used as control conditions in randomized cross-over clinical trials to validate new treatments. Only recently, however, has it become apparent that the conditioning and/or expectation effects provided by the experience of placebos can influence the results of clinical trials. It seems that combining shams and sequences has prejudiced the conclusions provided by cross-over designs. Frighteningly, this bias is always in the same direction, namely to increase the risk of rejecting potentially valid treatments. New models for clinical trials should be encouraged if we wish to market new and truly valid treatments. [ABSTRACT FROM AUTHOR]

Sedation and/or analgesia are standard of care for pediatric patients during painful intervention or medical imaging requiring immobility. Physician availability is frequently insufficient to allow for all procedural sedation. A nurse-led sedation program was created at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) to address this problem. Objective. To evaluate the effectiveness and the safety of our program. Methods. A retrospective study of all the procedural sedations done over one year was performed. Complications were separated in four categories: (1) major complications (call for help; unexpected admission, aspiration, and code); (2) reportable sedation events (oxygen saturation <90%, bradycardia (more than 2 SD below normal for the age of the child), and hypotension (more than 2 SD below normal for the age of the child); (3) difficult sedation (agitation, inadequate sedation, and failure to perform the procedure), (4) minor complications. Results. 448 patients, 249 boys and 199 girls; received sedation for 555 procedures. Overall, 78% (432) of interventions were successfully accomplished: 0% of major complications, 8% of reportable sedation events; 5% of difficult sedation; 9% of minor complications. Conclusion. Our nurse-led sedation program compares favorably to other similar systems. [ABSTRACT FROM AUTHOR]

Introduction: Tonsillectomy is usually done as day surgery, transferring to the parents most of the postoperative care. They often feel alone and incompetent in front of a child in pain. We developed a guide to help parents for both the evaluation and the management of postoperative pain. Objective: To improve pediatric posttonsillectomy pain management with the implementation of a parental guide and treatment algorithm. Methods: Eighty children (5-17 years) were recruited in this randomized clinical trial. Parents and children were assigned to one of the research groups: control or experimental. All received an identical prescription for acetaminophen (15 mg/kg) and morphine (0.3 mg/kg), information about the medication, a visual analogue scale (VAS), and index cards to be filled at home. The experimental group also received a treatment algorithm associating pain scores with analgesics. Results: Pain scores for the control group and the experimental group were 5.3 and 4.7 on the day of surgery, 4.0 and 3.6 the next day, 2.2 and 2.3 3 days later, and 1.6 and 1.4 1 week after the intervention, respectively. The side effects and the analgesics given were comparable for both groups. Conclusion: No significant difference was demonstrated for the studied parameters, probably because the majority of the parents followed the prescriptions well. The guide was much appreciated. The children understood the VAS easily and liked using it. The combination of acetaminophen-morphine needs to be revisited since pain remains problematic. [ABSTRACT FROM AUTHOR]

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