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To compare the presence of allodynia, pain catastrophizing, and the impact of headaches on patients with cluster headache (CH) and healthy individuals. Our second aim was to analyze the relationship between catastrophism, psychological comorbidities, and the impact in CH. We designed this cross-sectional study to compare various factors among 47 patients diagnosed with CH and 40 healthy controls, and then focus on catastrophism, anxiety, depression, and impact in the CH group. There were statistically significant differences between CH and the asymptomatic group in Allodynia Symptom Checklist (ASC) (p < 0.001), Pain Catastrophizing Scale (p < 0.001), and HIT-6 (p < 0.001) scores. We found a correlation among ASC, PCS, anxiety-depression, EuroQoL, and HIT-6 for the CH group. In this group, we observed a strong positive correlation between PCS and anxiety (rho = 0.69; p < 0.001), PCS and depression (rho = 0.62; p < 0.001) and depression and EuroQoL (rho = − 0.68; p < 0.001). The regression model showed that the combination of anxiety and HIT-6 was a significant predictor of PCS (adjusted R2 = 0.52). Our findings reveal significant differences regarding allodynia, pain catastrophism, and impact in CH group compared with controls. We found a significant relationship between psychological comorbidity, pain catastrophism, and quality of life in CH patients. Anxiety and HIT-6 were a predictor (adjusted R2 = 52%) of pain catastrophism. Screening for these comorbidities should be implemented through a multidisciplinary approach.

ObjectiveTo summarize the cervical physical examination characteristics in subjects with chronic primary headache and compare those with a healthy population and a population with episodic primary headache.DesignSystematic review and meta-analysis.SubjectsHumans ≥18 years old. At least one of the study groups should be constituted by subjects diagnosed with one of the chronic primary headache subtypes according to the International Classification of Headache Disorders, 3rd Edition.ComparisonNeck physical examination outcomes of subjects with chronic primary headache compared with a healthy population or subjects with episodic primary headache.OutcomesForward head posture (FHP), cervical range of movement, motor control, neck muscle activity, and reproduction and resolution of symptoms.MethodsTwo reviewers assessed independently the MEDLINE, EMBASE, WOS, MEDES, PEDro, and CINAHL databases to select observational studies. First, both implemented an agreement for a search strategy. Then, they screened independently for duplicates, titles, abstracts, and full-text information. A meta-analysis was conducted to compare measures between groups.ResultsTwelve studies (N = 1,083) with moderate quality (mean ± SD = 7.75 ± 1.48 on the Newcastle Ottawa Scale) were selected for the qualitative analysis. The meta-analysis showed that patients with chronic primary headache presented greater forward head posture than asymptomatic participants (N = 275, Hg = 0.68, 95% CI = 0.25–1.1, Z = 3.14, P ConclusionsThere is moderate to strong evidence that patients with chronic primary headache present greater FHP than asymptomatic individuals and moderate evidence that patients with chronic primary headache present greater forward head posture than those with episodic primary headache.

generating kinesthetic and visual motor imagery. Objectives: The main aim of this study was to determine whether the ability to generate mental motor imagery (MIab) influences psychological, motor, and disability variables in patients with NCLBP. The secondary aim was to determine whether an approach based on therapeutic exercise (TE) and therapeutic education (TEd) could improve the MIab in those patients with less ability to perform it. Study Design: Cross-sectional and quasiexperimental study. Setting: Physical Therapy Unit of primary health care center in Madrid, Spain. Methods: A total of 68 patients were divided into 2 groups according to a greater (n = 34) or lesser (n = 34) MIab. Treatment was based on TEd and TE for the group with less ability to generate kinesthetic and visual motor imagery. The outcome measures were imagery requested time, self-efficacy, disability, pain intensity, lumbar strength, psychological variables, and MIab. Results: The group with lesser MIab showed lower levels of self-efficacy (P = 0.04; d, −0.47) and lower levels of lumbar strength and extension strength (P = 0.04; d, −0.46 and P = 0.02; d, −0.52, respectively). After the intervention with TE and TEd, MIab (both kinesthetic and visual) improved significantly, with a moderate to large effect size (P ≤ 0.01; d, −0.80 and P ≤ 0.01; d, −0.76, respectively), as did pain intensity, lumbar strength, disability, and psychological variables (P < 0.05), but not levels of self-efficacy (P > 0.05). Based on the results, the patients with NCLBP with lesser MIab achieved lower levels of self-efficacy and lower strength levels. Limitations: The results of this study should be interpreted with caution because of its quasiexperimental design and a bias selection. Conclusions: A clinical TE approach, coupled with a TEd program, resulted in significant improvement in MIab (both kinesthetic and visual), reduced pain intensity, increased lumbar strength, reduced disability, and improved psychological variables, but it did not significantly improve self-efficacy levels in the patients with NCLBP. Key words: Chronic low back pain, motor imagery, disability, lumbar strength

There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain. Ministerio de Economia, Industria y Competitividad, Gobierno de España (under Grant PSI2010-21888) 3.104 JCR (2020) Q2, 23/53 Behavioral Sciences 0.896 SJR (2020) Q2, 177/537 Psychiatry and Mental Health No data IDR 2020 UEM

13 pags., 5 figs., 3 tabs., Background: Clinical presentation is the key to the diagnosis of patients with migraine and tension-type headache, but features may overlap when both become chronic. Psychophysical parameters may distinguish both conditions. We aimed to compare psychophysical aspects of patients with chronic migraine, chronic tension-type headache and headache-free controls, and to determine whether these can predict headache frequency. Methods: An examiner blinded to the diagnosis assessed 100 participants (chronic migraine (n = 38), chronic tension-type headache (n = 31) and controls (n = 31)). Assessed variables included painful area, pressure pain thresholds, temporal summation, cervical range of motion, neck posture, headache and neck impact, quality of life, and kinesiophobia. Comparison between groups was performed with one-way ANOVA and multiple linear regression was used to assess the headache frequency predictors. Results: We found differences of both headache groups compared to controls (p < 0.01), but not between headache groups. Neck disability was a significant predictor of headache frequency for chronic tension-type headache (adjusted R = 0.14; β = 0.43; p = 0.03) and chronic migraine (adjusted R = 0.18; β = 0.51; p < 0.01). Conclusions: Chronic tension-type headache and chronic migraine showed similar psychophysical results, but were significantly worse when compared to controls. The psychophysical examination did not discriminate between headache types. The variable best explaining headache frequency for both headache types was neck disability.

Introduction: Facial paralysis (FP) is a neuromuscular disorder caused by facial nerve injury. There are two main types of FP (which can be either primary or secondary): central and peripheral; Procedure of cases: This case series presents five patients with facial paralysis with different etiologies. In all cases, we assessed the facial disability index and a clinical test registering the electromyographic activity, with and without biofeedback generated by Specular Face, a new software program; Discussion: After performing the appropriate tests, we checked the patients’ ability to change certain expressions when the Specular Face program was added. We can confirm that the mirror visual feedback therapy changes the behavior of synkinesis and the muscle function in these patients; Conclusion: The use of mirror therapy using a computerized treatment system of facial images yields promising results in modulating the muscle activity of patients with FP.

Patients with temporomandibular disorders (TMD) can become very complex. This article aims to highlight the importance of the multimodal and multidisciplinary approach in this type of patients to improve clinical outcomes. At present we have innumerable techniques and tools to approach this type of patients from a biopsychosocial model where active and adaptive type treatments are fundamental. There are various health professions that have competence in the treatment of TMD, however, although in the most complex cases should be treated simultaneously, still too many patients receive unique treatments and only from one point of view. This review exposes the treatments available from a clinical-scientific perspective and also emphasizes the importance of working in specialized units with those professionals who have competencies on the different conditions that may occur.

Objective To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain. Methods A single-blind randomized controlled trial. Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. Both groups completed a total of eight sessions, with a frequency of two sessions per week. The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment. Results In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. There were no significant differences between groups in intensity or frequency of pain, with a large effect size (>0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. There were also no significant differences between groups in the secondary variables during the same follow-up period. Conclusions The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.

ObjectiveTo investigate central sensitization (CS) in cluster headache (CH) and to evaluate its relationship with disease characteristics and psychological comorbidities.DesignCross-sectional study.SettingsWhether CS occurs in CH, as it does in other primary headaches, is a subject of debate. Few studies have evaluated the presence of CS and its relationship with psychological comorbidities in patients with CH.SubjectsTwenty patients with episodic or chronic CH and 16 healthy controls were recruited.MethodsThe variables evaluated included frequency, intensity and duration of headache attacks, pressure pain thresholds (PPTs) and wind-up (WU) ratios of pain bilaterally measured over trigeminal and extratrigeminal areas, and results of questionnaires regarding anxiety and depression (Hospital Anxiety and Depression Scale [HADS], Beck Depression Inventory [BDI], State-Trait Anxiety Inventory [STAI]), quality of life (Short Form-36 [SF-36]), headache impact (Headache Impact Test [HIT-6]), and allodynia (Allodynia Symptom Checklist [ASC]).ResultsPPT levels were significantly lower in the CH group compared with the healthy participants (all tested points, P < 0.001). No differences were found in WU ratios between groups. However, differences in HADS (P < 0.01), BDI (P < 0.01), STAI (P < 0.01), SF-36 (P < 0.01), HIT-6 (P < 0.001), and ASC (P < 0.01) were observed between groups. The healthy group showed a moderate negative correlation between SF-36 and BDI (rho = –0.59, P = 0.03). Likewise, the CH group showed a moderate negative correlation between frequency and BDI (rho = –0.52, P = 0.03), a strong positive correlation between duration and HADS (rho = 0.86, P < 0.01), and a moderate negative correlation between intensity and PPT over symptomatic V1 (rho = –0.66, P < 0.01) and over asymptomatic V1 (rho = –0.65, P < 0.01). The CH group also showed a moderate negative correlation between SF-36 and anxiety and depression variables.ConclusionsOur findings show that patients with CH have lower PPT levels at cranial and extracranial points, suggesting, as in other primary headaches, the presence of CS. We have also found a high prevalence of psychiatric comorbidities that correlate with the length and frequency of attacks. These findings highlight the importance of a multidisciplinary approach to the treatment of patients with CH.

Background Cancer involves numerous physical, psychological and emotional changes and has a negative impact on patients. Although there are a wide variety of questionnaires for general use in patients with cancer, very few are available that assess the pain, disability and craniomandibular functionality of patients with head and neck cancer (HNC) in a more specific manner. The purpose of this study is to present the preliminary behavior of the CF-PDI in its reduced version adapted for patients with HNC. Material and Methods A total of 61 patients with HNC were included in a study to preliminarily analyze the internal consistency of the instrument, the convergent validity and the floor and ceiling effects. All the patients completed the informed consent document and a battery of 5 questionnaires: The Numerical Rating Scale (NRS), the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), the Pain Catastrophizing Scale (PCS), the Quality of Life Questionnaire in patients with HNC (QLQ-HN) and the reduced version of the Craniofacial Pain and Disability Inventory (CF-PDI-11). Patients also performed 2 physical tests: measurements of the pain threshold on the masseter muscle and on the distal phalanx of the first finger; and the maximum mouth opening in neutral head position. Results Cronbach's α coefficient showed a very high internal consistency of 0.92. In terms of convergent validity, a statistically significant correlation was found between the CF-PDI-11 and the following variables: NRS, TSK-TMD, PCS, QLQ-HN, the threshold of pain in the distal phalanx of the first finger and the maximum interincisal opening. However, 21.3% of patients obtained the lowest possible score. The strongest correlation was found between the CF-PDI-11 and the QLQ-HN (r = 0.85, p

Occipital nerve stimulation (ONS) is a surgical treatment proposed for drug-resistant chronic cluster headache (drCCH). Long-term series assessing its efficacy are scarce. We designed a retrospective observational study with consecutive sampling, evaluating the follow-up of 17 drCCH patients who underwent ONS. Our main endpoint was the reduction the rate of attacks per week. We also evaluated the pain intensity through the Visual Analogue Scale (VAS), patient overall perceived improvement and decrease in oral medication intake. After a median follow-up of 6.0 years (4.5-9.0), patients decreased from a median of 30 weekly attacks to 22.5 (5.6-37.5, p = 0.012), 7.5 at 1 year (p = 0.006) and 15.0 at the end of follow-up (p = 0.041). The VAS decreased from a median of 10.0 to 8.0 (p = 0.011) at three months, to 7.0 (p = 0.008) at twelve months and 7.0 (p = 0.003) at the end of the follow-up. A total of 23.5% had an overall perceived improvement of ≥ 70% at 3 months, 41.2% at 1 year and 27.8% at the end of follow-up. Reducing prophylactic oral medication was possible in 76,5% and it was stopped in 17.7%. Triptan use decreased in all the responder patients and 17.7% stopped its intake. A total of 41.2% presented mild adverse events. In conclusion, our long-term experience suggests that ONS could be an interesting option for drCCH-selected patients, as it is a beneficial and minimally invasive procedure with no serious adverse events, Publication costs and financial support for medical writing were provided by Boston Scientific. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication

To compare the presence of allodynia, pain catastrophizing, and the impact of headaches on patients with cluster headache (CH) and healthy individuals. Our second aim was to analyze the relationship between catastrophism, psychological comorbidities, and the impact in CH.We designed this cross-sectional study to compare various factors among 47 patients diagnosed with CH and 40 healthy controls, and then focus on catastrophism, anxiety, depression, and impact in the CH group.There were statistically significant differences between CH and the asymptomatic group in Allodynia Symptom Checklist (ASC) (p0.001), Pain Catastrophizing Scale (p0.001), and HIT-6 (p0.001) scores. We found a correlation among ASC, PCS, anxiety-depression, EuroQoL, and HIT-6 for the CH group. In this group, we observed a strong positive correlation between PCS and anxiety (rho = 0.69; p0.001), PCS and depression (rho = 0.62; p0.001) and depression and EuroQoL (rho = - 0.68; p0.001). The regression model showed that the combination of anxiety and HIT-6 was a significant predictor of PCS (adjusted ROur findings reveal significant differences regarding allodynia, pain catastrophism, and impact in CH group compared with controls. We found a significant relationship between psychological comorbidity, pain catastrophism, and quality of life in CH patients. Anxiety and HIT-6 were a predictor (adjusted R

Background: Virtual reality (VR) applied to patients with neck pain is a promising intervention to produce positive effects when used alone or combined with exercise. Therefore, the objective of this manuscript is to compare the effects of VR versus exercise treatment on pain intensity, conditioned pain modulation (CPM), temporal summation (TS) and functional and somatosensory outcomes in patients with non-specific chronic neck pain (NS-CNP). Methods: A single-blinded, randomized clinical trial was carried out. A total sample of 44 patients with NS-CNP was randomized into a VR treatment group or neck exercises group. The intervention consisted of two treatment sessions per week, for four weeks and eight sessions. Four measurement moments (at baseline, immediately, 1 month, and 3 months after intervention) were considered. Pain intensity, CPM, TS, functional and somatosensory outcomes were measured. Results: Statistically significant differences were revealed for time factor (F = 16.40, p &lt, 0.01, &eta, p2 = 0.28) and group*time interaction for kinesiophobia (F = 3.89, p = 0.01, &eta, p2 = 0.08) showing post-hoc differences in favor of the VR group at 3 months (p &lt, 0.05, d = 0.65). Significant effects were shown for time factor (p &lt, 0.05) but not for the group*time interaction (p &gt, 0.05) for pain intensity, rotation range of motion (ROM), Neck Disability Index, pain catastrophizing, fear-avoidance beliefs, left side pressure pain threshold (PPT) and anxiety. Statistically significant differences were not found for time factor (p &gt, 0.05) and neither in group*time interaction (p &gt, 0.05) for CPM, TS, right side PPT, flexo-extension and lateral-flexion ROM. Conclusions: Kinesiophobia was the only outcome that showed differences between VR and exercise at 3 months. Nevertheless, pain intensity, CPM, TS, ROM, neck disability, pain catastrophizing, fear-avoidance beliefs, PPT and anxiety did not show differences between both interventions.

Background Chronic pain from temporomandibular disorders (TMDs) is caused by a somatosensory disturbance due to sustained activation of central nervous system nociceptive pathways, which can induce changes in neuroplasticity in the thalamus, basal ganglia and limbic system, as well as disturbances in the somatosensory, prefrontal and orbitofrontal cortex and cognitive impairment. The main objective of this study was to determine the discrimination capacity of mandibular and tongue laterality between women with chronic TMDs and asymptomatic women. Material and Methods This descriptive-comparative study examined 2 groups with a total of 30 women. All participants were between the ages of 23 and 66 years and were assigned to the chronic TMD group or the asymptomatic group according to the inclusion criteria. We employed a mobile application developed specifically for this study to measure the accuracy and reaction time (RT) of mandibular and tongue laterality discrimination. Results The chronic TMD group had a lower success rate in laterality discrimination (mean mandibular accuracy of 40% and mean tongue accuracy of 67%) than the asymptomatic group (mean mandibular accuracy of 61% and mean tongue accuracy of 90%). These results showed statistically significant differences between the groups for mandibular laterality discrimination (d, 1.14; p

Resumen: Introducción: La escala autoadministrada de Evaluación de Signos y Síntomas Neuropáticos de Leeds (S-LANSS) es un instrumento diseñado para identificar a pacientes con dolor de características neuropáticas. Objetivo: Evaluar la validez y fiabilidad de la versión española del S-LANSS. Métodos: Se incluyó un total de 182 pacientes con dolor crónico para evaluar la validez discriminante y convergente del S-LANSS, incrementándose la muestra hasta 321 pacientes para valorar la validez de constructo y la fiabilidad de la escala. Se utilizó como variable criterio la versión validada al español del ID-Pain. Todos los participantes cumplimentaron el cuestionario ID-Pain, el S-LANSS, y la Escala Numérica del Dolor. La validez discriminante se evaluó mediante el análisis del área bajo la curva de características operativas para el receptor, y la sensibilidad y especificidad. La validez de constructo se evaluó mediante un análisis factorial y mediante el análisis del odds-ratio de cada ítem del S-LANSS respecto a la puntuación total. La validez convergente y la fiabilidad se valoraron con la R de Pearson y el alfa de Cronbach respectivamente. Resultados: El punto de corte óptimo del S-LANSS fue ≥ 12 puntos (área bajo la curva = 0,89; sensibilidad = 88,7; especificidad = 76,6). El S-LANSS presentó un factor y, además, cada ítem contribuyó significativamente a la puntuación total positiva del S-LANSS (p

Objetivo: Valorar la influencia del ejercicio terapéutico (ET) sobre la calidad de vida de pacientes con cáncer (Ca) de pulmón. Asimismo, por su relación con la calidad de vida, se ha analizado la influencia que el ejercicio tiene sobre la tolerancia al esfuerzo y la fuerza..Métodos: Se realizó una búsqueda de ensayos clínicos aleatorizados (ECA) en la base de datos electrónica de MEDLINE (Pubmed). Los criterios de inclusión fueron: ECA realizados en pacientes con cáncer de pulmón, bien tras intervención quirúrgica (IQ), durante o tras el tratamiento con quimioterapia, donde la intervención fuera ejercicio terapéutico, publicados en cualquier idioma. Dos revisores independientes realizaron el análisis de la calidad metodológica mediante la escala PEDro, y un tercer revisor intervino en los casos de desacuerdo.Resultados: Se seleccionaron 8 ECA, de los cuales 4 presentaron una calidad metodológica buena, por encima de 6, en la escala PEDro. Se ha encontrado evidencia fuerte de la influencia del ET en la mejora de la calidad de vida de los pacientes con Ca de pulmón, así como en el aumento de la tolerancia al ejercicio.Conclusión: El ET es un tratamiento que presenta beneficios en la calidad de vida de los pacientes con Ca de pulmón. Estos beneficios no son superiores al tratamiento con fisioterapia activa convencional, terapia manual, fisioterapia respiratoria o relajación progresiva.

Objetivo: Evaluar cómo las expectativas, inducidas de forma escrita, influyen en la fuerza de prensión manual, en la intensidad de dolor y en variables somato-sensoriales.Diseño: Ensayo piloto controlado y aleatorizado a simple ciegoMarco: Campus Universitario.Participantes: Los criterios de inclusión fueron: sujetos sanos, sin dolor y en edades comprendidas entre 18 y 30 años. Una muestra total de 39 sujetos sanos participaron en el presente estudio piloto y fueron asignados aleatoriamente en tres grupos según la expectativa, la cual podía ser positiva, negativa o neutra, dada por escritoIntervenciones: Tras asignar la muestra de manera aleatoria a los tres grupos de expectativas, se les aplicó una corriente de neuro-estimulación eléctrica transcutánea (TENS) de corta duración y sin efecto terapéutico.Variables: La variable principal fue la fuerza de prensión manual. Las variables secundarias fueron la intensidad de dolor, los umbrales de dolor a la presión y la sumación temporal en zona epicondilar. En primer lugar, se recogieron los valores pre-intervención y tras la intervención, se recogieron los datos de las variables de interés en dos tiempos. Primero, inmediatamente después de la intervención y segundo, a los 5 minutos de la misma.Resultados: No se encontraron diferencias estadísticamente significativas en relación a la influencia de las expectativas con el cambio de la fuerza de prensión manual (p > 0,05). No se encontraron diferencias estadísticamente significativas en la sumación temporal, ni en los umbrales de dolor a la presión. El dolor post-intervención fue mayor en el grupo de expectativas negativas y este fue el único grupo que mantuvo el dolor a los 5 minutos tras finalizar la intervención.Conclusión: A pesar de las tendencias observadas, no se encontraron influencias estadísticamente significativas de las expectativas sobre la fuerza muscular de prensión manual, ni en la intensidad de dolor, ni en variables somato-sensoriales. Las expectativas negativas influyeron en el dolor post-intervención.

Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild-moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multi-modal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.

espanolRESUMEN Objetivos: El dolor es un aspecto de amplia repercusion en la calidad de vida de los pacientes y se ha propuesto incluirlo entre las constantes o signos vitales para que sea siempre recogido en la evaluacion del paciente hospitalizado. El objetivo principal del presente estudio fue evaluar las constantes vitales en funcion de la intensidad de dolor en pacientes agudos hospitalizados, y el objetivo secundario fue observar si existen posibles asociaciones entre la intensidad del dolor y las constantes vitales. Material y metodos: El presente estudio fue un estudio transversal realizado en diferentes areas de hospitalizacion aguda en el Hospital Universitario La Paz. La variable principal fue la intensidad de dolor y las variables secundarias fueron las constantes vitales: temperatura corporal, tension arterial sistolica, tension arterial diastolica, tension arterial media, frecuencia cardiaca, glucemia capilar y saturacion de oxigeno. Se utilizo la prueba t de Student para comparacion entre grupos. El tamano del efecto se midio mediante la d de Cohen y el tamano de asociacion mediante la r de Pearson. Resultados: Se incluyeron un total de 180 pacientes. No se encontraron diferencias estadisticamente significativas para ninguna de las constantes vitales en funcion a los niveles de intensidad de dolor (p > 0,05) divididos en 2 grupos. Tampoco se hallaron diferencias estadisticamente significativas entre las constantes vitales en funcion de la intensidad de dolor en el turno de manana, tarde y noche (p > 0,05). No se hallaron asociaciones estadisticamente significativas entre la intensidad de dolor y las constantes vitales, excepto una asociacion debil y negativa entre la tension arterial diastolica y la intensidad de dolor percibido por los pacientes (r = -0,219; p = 0,032). Conclusiones: En base a los resultados obtenidos en el presente estudio, no existen diferencias entre las constantes vitales en funcion la intensidad de dolor. Las variaciones de las constantes vitales parecen no ser una buena estimacion de la intensidad de dolor en pacientes con dolor leve y dolor moderado-severo. Son necesarios analisis prospectivos en muestras de mayor tamano para confirmar estos resultados. EnglishABSTRACT Objectives: A relevant aspect in hospitalized patient is pain intensity measurement. The objectives were firstly the identification of associated variables to pain and secondly if there was any association between the intensity of pain and the modification of the vital signs. Materials and methods: The present research was a cross-sectional study was carried out in different areas of acute hospitalization in the University Hospital La Paz. Main variable was intensity of pain measured with numeric verbal scale, and secondary variables were vital signs, body temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, capillary blood glucose and oxygen saturation from the data obtained in the hospital monitoring instruments. The Student's T test was used for comparison between groups. The effect size was measured by the Cohen d and the association size by the Pearson r. Results: A total of 180 patients were included. No statistically significant differences were found for any of the vital signs according to pain intensity levels (p > 0.05) divide in two groups. No statistically significant differences were found between vital signs as a function of pain intensity and the moment to collect measurements (morning/afternoon/evening) (p > 0.05). No statistically significant associations were found between pain intensity and vital signs except a statistically significant weak and negative association was observed between the diastolic blood pressure and the patients pain intensity (r = -0.219; p = 0.032). Conclusions: Our results suggest that there are no differences between the vital signs according to the pain intensity and there are not associations between them.

The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n=14) and an ineffective-movement group (n=14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pres-sure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P=0.042; Cohen d=0.81) and after 10 min (P=0.019; Cohen d=0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P=0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5-C6 as the pre to post (P=0.010) as the pre to 10-min post (P=0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately.

Resumen Objetivo Evaluar la relacion entre la percepcion del dolor tras una artroscopia de rodilla por cirugia mayor ambulatoria medida a las 24 h y los comportamientos de miedo y ansiedad prequirurgicos. Metodos Estudio observacional de tipo transversal, realizado a 40 sujetos adultos sometidos a artroscopia de rodilla en el area quirurgica del Hospital de Cantoblanco (Hospital Universitario La Paz) de Madrid. Las conductas de miedo y ansiedad se evaluaron mediante los cuestionarios validados de catastrofizacion ante el dolor, kinesiofobia y ansiedad. El dolor pre y posquirurgico, asi como la discapacidad percibida prequirurgica, se valoraron mediante la escala verbal numerica. Resultados La edad media de la muestra (22 hombres y 18 mujeres) fue de 52,85 ± 14,21, sin que hubiese diferencias significativas entre genero. No se encontraron datos estadisticamente significativos para la asociacion entre las variables de kinesiofobia, ansiedad y catastrofismo ante el dolor con la intensidad del dolor percibido por el paciente posquirurgico de artroscopia de rodilla. La duracion de la cirugia tiene, segun nuestro estudio, una correlacion con el dolor posquirurgico inmediato (r = 0,468; p = 0,002), asi como existe una relacion entre la edad y la intensidad del dolor a las 24 h (r = −0,329; p = 0,038), y entre la edad y la discapacidad percibida (r = −0,314; p = 0,049). Se obtiene asi mismo una asociacion entre la escala de catastrofismo y la de kinesiofobia (r = 0,337; p = 0,033). Conclusiones Los factores de miedo y ansiedad prequirurgicos, asi como el catastrofismo y la kinesiofobia, no han resultado estar asociados con el dolor posquirurgico en nuestro estudio. La duracion de la intervencion muestra una correlacion con el dolor posquirurgico.

espanolObjetivo Adaptar la Escala de gradacion del dolor cronico en pacientes de Atencion Primaria en Espana y evaluar sus propiedades psicometricas. Metodos Estudio observacional de medicion clinica de una escala de magnitud del dolor cronico. Se realizo un proceso de traduccion-retrotraduccion siguiendo las guias internacionales. Setenta y cinco sujetos con dolor lumbar de mas de 6 meses de evolucion derivados a las unidades de fisioterapia en Atencion Primaria participaron en el estudio. Se analizaron: la consistencia interna, la validez del constructo, la fiabilidad test-retest, los efectos techo y suelo, y la capacidad de respuesta. Resultados La Escala de gradacion del dolor cronico posee una alta consistencia interna, el α de Cronbach fue de 0,87, similar al que presentan las versiones en otros idiomas, y el coeficiente de correlacion intraclase fue 0,81. En cuanto a la validez del constructo, se extrajeron 2 factores que consiguieron explicar el 72,37% de la varianza. La validez convergente muestra una correlacion positiva moderada con la escala visual analogica, la subescala de evitacion de actividad de la Escala Tampa de kinesiofobia, la Escala del catastrofismo para el dolor, el Cuestionario de discapacidad por dolor lumbar de Roland-Morris, y el Cuestionario de conductas de miedo-evitacion, y una correlacion negativa moderada con el Cuestionario de autoeficacia en el dolor cronico. El tiempo medio de administracion fue de 2 min y 28 s. Conclusiones La version espanola de la Escala de gradacion del dolor cronico parece ser un instrumento valido, fiable y util para medir de forma precoz el dolor cronico en la practica clinica en Atencion Primaria en Espana. EnglishObjective To adapt the Graded Chronic Pain Scale for use in Primary care patients in Spain, and to assess its psychometric properties. Methods Clinical measures observational study investigating the severity of chronic pain. The methodology included a process of translation and back-translation following the international guidelines. Study participants were 75 patients who experienced lower back pain for more than six months and were sent to Primary Care physiotherapy units. Internal consistency, construct validity, test-retest reliability, floor and ceiling effects, and answering capacity were analysed. Results The Spanish version of the Graded Chronic Pain Scale had a high internal consistency, with a Cronbach's alpha of 0.87 and intraclass correlation coefficient of 0.81. Regarding construct validity, it was identified that two factors explained 72.37% of the variance. Convergent validity showed a moderate positive correlation with the Visual Analogue Scale, the activity avoidance subscale of the Tampa Scale of Kinesophobia, the Pain Catastrophizing Scale, the Roland-Morris Low Back Pain and Disability Questionnaire, and the FearAvoidance Beliefs Questionnaire. A moderate negative correlation was identified with the Chronic Pain Self-Efficacy Scale. The mean time of questionnaire administration was 2 minutes and 28 seconds. Conclusions The Spanish version of the Graded Chronic Pain Scale appears to be a valid, reliable, and useful tool for measuring chronic pain at an early stage in Primary Care settings in Spain.

Objective To adapt the Graded Chronic Pain Scale for use in primary care patients in Spain, and to assess its psychometric properties. Methods Clinical measures observational study investigating the severity of chronic pain. The methodology included a process of translation and back-translation following the international guidelines. Study participants were 75 patients who experienced lower back pain for more than six months and were sent to primary care physiotherapy units. Internal consistency, construct validity, test–retest reliability, floor and ceiling effects, and answering capacity were analyzed. Results The Spanish version of the Graded Chronic Pain Scale had a high internal consistency, with a Cronbach's α of 0.87 and intraclass correlation coefficient of 0.81. Regarding construct validity, it was identified that two factors explained 72.37% of the variance. Convergent validity showed a moderate positive correlation with the Visual Analog Scale, the activity avoidance subscale of the Tampa Scale of Kinesophobia, the Pain Catastrophizing Scale, the Roland-Morris Low Back Pain and Disability Questionnaire, and the Fear Avoidance Beliefs Questionnaire. A moderate negative correlation was identified with the Chronic Pain Self-Efficacy Scale. The mean time of questionnaire administration was 2 min and 28 s. Conclusions The Spanish version of the Graded Chronic Pain Scale appears to be a valid, reliable, and useful tool for measuring chronic pain at an early stage in primary care settings in Spain.

The main aim of this study was to evaluate the perceived level of difficulty and fear of movement among patients with chronic low back pain (CLBP) compared with asymptomatic subjects when they visualized motor control therapeutic exercises (MCTEs) commonly used in physiotherapy. Our secondary objective was to analyse the correlation between fear of MCTEs and other psychological and disability variables. Thirty patients with CLBP comprised the treatment group, and 30 asymptomatic subjects comprised the control group. The procedure consisted of showing photographs and videos of seven MCTEs and having the participants rate their perceived difficulty and fear. Participants then answered a series of psychological self-report measures. Differences were found between groups in perceived difficulty of the MCTEs shown in videos (F=21.06, P

ObjectivesLow back pain (LBP) is the most prevalent musculoskeletal problem, which implies a high rate of chronicity. The chronicity of symptoms can lead to pain expansion. The main objective of this study was to assess whether there were differences between patients with nonspecific chronic LBP (CLBP) who sought healthcare compared to those who did not in terms of pain expansion.MethodsNinety individuals participated in the study and were divided into three groups: 30 patients who sought care; 30 patients who did not seek care; and 30 asymptomatic individuals. The primary variable analyzed was pain expansion. Secondary physical and psychological variables were assessed later, and a regression analysis was performed.ResultsPatients who sought help showed significant differences in pain expansion and pain intensity compared with the group who did not seek help, with a medium effect size (0.50–0.79). The regression model for the care-seeking group showed that dynamic balance with the left leg and depression were predictors of percentage pain surface area (34.6%). The combination of dynamic balance, range of movement in flexoextension and depression were predictors of widespread pain (48.5%).ConclusionPatients who soughtcare presented greater pain expansion than patients whodidnot. A combination of functional and psychological variables can significantly predict pain expansion in patients with nonspecific CLBP who seek help.

Hector Beltran-Alacreu,1,2 Ibai López-de-Uralde-Villanueva,1,2 César Calvo-Lobo,3 Roy La Touche,1,2,4 Roberto Cano-de-la-Cuerda,5 Alfonso Gil-Martínez,1,2,4 David Fernández-Ayuso,6 Josué Fernández-Carnero2,4,5 1Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain; 2Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Spain; 3Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain; 4Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain; 5Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; 6“San Juan de Dios” School of Nursing and Physiotherapy, Pontifica de Comillas University, Madrid, Spain Purpose: The main aim of the study was to predict the health-related quality of life (HRQoL) based on physical, functional, and psychological measures in patients with different types of neck pain (NP). Materials and methods: This cross-sectional study included 202 patients from a primary health center and the physiotherapy outpatient department of a hospital. Patients were divided into four groups according to their NP characteristics: chronic (CNP), acute whiplash (WHIP), chronic NP associated with temporomandibular dysfunction (NP-TMD), or chronic NP associated with chronic primary headache (NP-PH). The following measures were performed: Short Form-12 Health Survey (SF-12), Neck Disability Index (NDI), visual analog scale (VAS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BECK), and cervical range of movement (CROM). Results: The regression models based on the SF-12 total HRQoL for CNP and NP-TMD groups showed that only NDI was a significant predictor of the worst HRQoL (48.9% and 48.4% of the variance, respectively). In the WHIP group, the regression model showed that BECK was the only significant predictor variable for the worst HRQoL (31.7% of the variance). Finally, in the NP-PH group, the regression showed that the BECK, STAI, and VAS model predicted the worst HRQoL (75.1% of the variance). Conclusion: Chronic nonspecific NP and chronic NP associated with temporomandibular dysfunction were the main predictors of neck disability. In addition, depression, anxiety, and pain were the main predictors of WHIP or primary headache associated with CNP. Keywords: quality of life, neck pain, disability, depression, anxiety

To compare patients with chronic migraine (CM) and chronic temporomandibular disorders (TMD) on disability, pain, and fear avoidance factors and to associate these variables within groups.Descriptive, cross-sectional study.A neurology department and a temporomandibular disorders consult in a tertiary care center.A total of 50 patients with CM and 51 patients with chronic TMD, classified by international criteria classifications.The variables evaluated included pain intensity (visual analog scale [VAS]), neck disability (NDI), craniofacial pain and disability (CF-PDI), headache impact (HIT-6), pain catastrophizing (PCS), and kinesiophobia (TSK-11).Statistically significant differences were found between the CM group and the chronic TMD group in CF-PDI (P 0.001), PCS (P = 0.03), and HIT-6 (P 0.001); however, there were no differences between the CM group and the VAS, NDI, and TSK-11 groups (P 0.05). For the chronic TMD group, the combination of NDI and TSK-11 was a significant covariate model of CF-PDI (adjusted R2 = 0.34). In the CM group, the regression model showed that NDI was a significant predictive factor for HIT-6 (adjusted R2 = 0.19).Differences between the CM group and the chronic TMD group were found in craniofacial pain and disability, pain catastrophizing, and headache impact, but they were similar for pain intensity, neck disability, and kinesiophobia. Neck disability and kinesiophobia were covariates of craniofacial pain and disability (34% of variance) for chronic TMD. In the CM group, neck disability was a predictive factor for headache impact (19.3% of variance).

The aim of this study was to determine the influence of expectations plus mobilization with movement (MWM) in kinesiophobia, perceived disability and sensorimotor variables in patients with lateral epicondylalgia. A pilot randomized controlled trial in 24 patients with lateral epicondylalgia was conducted. Perceived pain, pain-free grip strength, pressure pain detection threshold, kinesiophobia measured with the short version of Tampa Scale of Kinesiophobia, perceived disability of the upper limb measured with disability of the arm, hand and shoulder questionnaire, and perceived disability specifically for the elbow joint measured with patient-rating tennis elbow evaluation, and also satisfaction were assessed. Participants were randomized to receive written instructions in order to create positive expectations regarding the technique in one group (n=12) or neutral expectations in the other one (n=12). All patients were treated for three sessions with the MWM technique. Measures were recorded before and after treatment. The effect size was calculated by Rosenthal "r" for nonparametrical tests. There were no significant statistical differences (P>0.05) between groups after receiving the treatment for none of the physical analyzed variables. The Wilcoxon test showed statistically significant changes in kinesiophobia (Z=-2.278, r=0.47, P=0.023) and perceived disability (Z= -2.934, r=0.61, P=0.003) within positive expectations group. In conclusion this pilot study shows that a positive expectation almost given in a sealed envelope before treatment plus MWM produced changes in kinesiophobia and perceived disability in the immediate term, in patients with lateral epicondylalgia.

Objective Our aim was to systematically review and meta-analyze the effectiveness of therapeutic patient education for migraine. Methods A literature search of multiple electronic databases (MEDLINE, EMBASE, PEDro, CINAHL, and PsychINFO) was conducted to identify randomized control trials (RCTs) published in the English and Spanish languages up to and including May 2013. Two reviewers independently selected the studies, conducted the quality assessment (Delphi list), and extracted the results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used throughout the systematic review and meta-analysis. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated for relevant outcome measures (headache frequency, headache disability, self-efficacy, depressive symptoms, and quality of life) and pooled in a meta-analysis using the random effects model. Results Fourteen RCTs were included in the systematic review. Only nine studies were included in the meta-analysis. The median quality score was 6.14 ± 1.29 (range: 5–9). There was strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education on headache frequency (five studies: N = 940, SMD = −0.24, 95% CI of −0.48 to −0.01, P = 0.03), headache disability (four studies: N = 799, SMD = −1.02, 95% CI of −1.95 to −0.08, P = 0.03), and quality of life (three studies: N = 674, SMD = 0.36, 95% CI of 0.05–0.67, P = 0.02). There was no evidence for either short-term or intermediate-term effectiveness of therapeutic patient education on self-efficacy or depressive symptoms. Conclusion This systematic review revealed strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education for migraine. Further high-quality RCTs are required for conclusive determination of its effectiveness.

Objective: The aim of this paper is to describe the progressive changes of chronic cluster headaches (CHs) in a patient who is being treated by a multimodal approach, using pharmacology, neurostimulation and physiotherapy. Subject: A male patient, 42 years of age was diagnosed with left-sided refractory chronic CH by a neurologist in November 2009. In June 2014, the patient underwent a surgical intervention in which a bilateral occipital nerve neurostimulator was implanted as a treatment for headache. Methods: Case report. Results: Primary findings included a decreased frequency of CH which lasted up to 2 months and sometimes even without pain. Besides this, there were decreased levels of anxiety, helplessness (PCS subscale) and a decreased impact of headache (HIT-6 scale). Bilateral pressure pain thresholds (PPTs) were improved along with an increase in strength and motor control of the neck muscles. These improvements were present at the conclusion of the treatment and maintained up to 4 months after the treatment. Conclusions: A multimodal approach, including pharmacology, neurostimulation and physiotherapy may be beneficial for patients with chronic CHs. Further studies such as case series and clinical trials are needed to confirm these results.

Background The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). Methods A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). Results A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p

Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P>0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P>0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.

Introduccion. La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa mas frecuente. La tecnologia de realidad virtual (RV) ha adquirido una gran relevancia en la rehabilitacion en pacientes de origen neurologico. El objetivo es analizar la efectividad terapeutica de la RV en pacientes con EP en variables motoras, calidad de vida y cognicion. Pacientes y metodos. La busqueda de articulos se realizo utilizando bases de datos electronicas: Medline, EMBASE, PEDro, CINAHL y Cochrane. Los criterios de inclusion fueron estudios clinicos aleatorizados (ECA) en pacientes con EP donde al menos una intervencion terapeutica estuviera basada en programas de RV. Se seleccionaron cuatro ECA con calidad metodologica buena. La concordancia entre los evaluadores fue moderada-alta. En los cuatro ECA se realizo inmersion de RV como principal tratamiento. Resultados. Dos de los ECA revelaron que la RV es superior frente al tratamiento de fisioterapia convencional para la mejora del equilibrio. Dos de los ECA revelaron que la RV no es superior frente al tratamiento convencional en la mejora del equilibrio. Existe evidencia contradictoria de que los programas para la mejora del equilibrio basados en RV son mas eficaces que los basados en fisioterapia convencional. Las variables no motoras medidas en los diferentes ECA no se vieron mejoradas en los grupos tratados con RV frente a los tratados con fisioterapia convencional. Conclusiones. No se ha podido demostrar que la efectividad terapeutica de los sistemas de RV sea superior a los programas de fisioterapia convencional en pacientes con EP en variables motoras y psicosociales.

The aim of this study was to investigate the short-term (24hours) association between postoperative pain and preoperative psychological variables (anxiety, pain catastrophizing and kinesiophobia) in a sample of knee arthroscopy ambulatory surgery.Observational cross-sectional study, conducted with 40 adult subjects who underwent knee arthroscopy in the surgical area of Cantoblanco Hospital (Hospital Universitario La Paz) in Madrid. The fear-avoidance beliefs and anxiety were assessed using validated questionnaires of pain catastrophizing, kinesiophobia and anxiety. Pre and post-surgical pain and perceived disability were evaluated by the Verbal Numeric Scale.Mean age of the sample (22 men and 18 women) was 52.85±14.21 without significant differences between gender. No statistically significant data for the association between variables of kinesiofobia, anxiety and pain catastrophizing and the intensity of perceived pain by the postoperative knee arthroscopy patient were found. Length of surgery in our study has a correlation with the immediate post-surgical pain (r=0.468; P=.002) and there is a relationship between age and pain intensity at 24hours (r=-0.329; P=.038), and between age and perceived disability (r=-0.314; P=.049). An association between catastrophizing and kinesiophobia scales (r=0.337; P=.033) is obtained likewise.In conclusion, preoperative fear-avoidance beliefs like pain anxiety or pain catastrophizing and kinesiophobia were not associated with acute postoperative pain in our study. Analyses of secondary pain related outcomes, however, indicated that reduced time of surgery may contribute to enhance clinical postoperative pain. If confirmed and replicated in larger samples, this may potentially enable clinicians to improve postoperative pain management in future patients.

Motor control therapeutic exercise (MCTE) for the neck is a motor relearning program that emphasizes the coordination and contraction of specific neck flexor, extensor, and shoulder girdle muscles. Because motor imagery (MI) improves sensorimotor function and it improves several motor aspects, such as motor learning, neuromotor control, and acquisition of motor skills, the authors hypothesized that a combination of MCTE and MI would improve the sensorimotor function of the cervical spine more effectively than a MCTE program alone.The purpose of this study was to investigate the influence of MI combined with a MCTE program on sensorimotor function of the craniocervical region in asymptomatic subjects.This study was a single-blinded randomized controlled trial.Forty asymptomatic subjects were assigned to a MCTE group or a MCTE+MI group. Both groups received the same MCTE program for the cervical region (60 minutes), but the MCTE+MI group received an additional intervention based on MI (15 minutes). The primary outcomes assessed were craniocervical neuromotor control (activation pressure value and highest pressure value), cervical kinesthetic sense (joint position error [JPE]), and the subjective perception of fatigue after effort.Intra-group significant differences were obtained between pre- and post interventions for all evaluated variables (p0.01) in the MCTE+MI and MCTE groups, except for craniocervical neuromotor control and the subjective perception of fatigue after effort in the MCTE group. In the MCTE+MI group a large effect size was found for craniocervical neuromotor control (d between -0.94 and -1.41), cervical kinesthetic sense (d between 0.97 and 2.14), neck flexor muscle endurance test (d = -1.50), and subjective perception of fatigue after effort (d = 0.79). There were significant inter-group differences for the highest pressure value, joint position error (JPE) extension, JPE left rotation, and subjective perception of fatigue after effort.The combined MI and MCTE intervention produced statistically significant changes in sensorimotor function variables of the craniocervical region (highest pressure value, JPE extension and JPE left rotation) and the perception of subjective fatigue compared to MCTE alone. Both groups showed statistically significant changes in all variables measured, except for craniocervical neuromotor control and the subjective perception of fatigue after effort in the MCTE group.1b.