Background Expanded distribution of pain is considered a sign of central sensitization (CS). The relationship between recording of symptoms and CS in people with knee osteoarthritis (OA) has been poorly investigated. Objective To examine whether the area of pain assessed using pain drawings relates to CS and clinical symptoms in people with knee OA. Design Cross-sectional study. Methods Fifty-three subjects with knee OA scheduled to undergo primary total knee arthroplasty were studied. All participants completed pain drawings using a novel digital device, self-administration questionnaires and were assessed by quantitative sensory testing. Pain frequency maps were generated separately for women and men. Spearman's correlation coefficients were computed to reveal possible correlations between the area of pain and quantitative sensory testing and clinical symptoms. Results Pain frequency maps revealed enlarged areas of pain, especially in women. Enlarged areas of pain were associated with higher knee pain severity (rs= .325, P < 0.05) and stiffness (rs=.341, P < 0.05), lower pressure pain thresholds at the knee (rs=-.306, P < 0.05) and epicondyle (rs=-.308, P < 0.05) and higher scores with the Central Sensitization Inventory (rs=.456, P < 0.01). No significant associations were observed between the area of pain and the remaining clinical symptoms and measures of CS. Limitations Firm conclusions about the predictive role of pain drawings cannot be drawn. Further evaluation of the reliability and validity of pain area extracted from pain drawings in people with knee OA is required. Conclusion Expanded distribution of pain was correlated with some measures of CS in individuals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is required.

Article: Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis - European Journal of Physical and Rehabilitation Medicine 2017 August;53(4):603-10 - Minerva Medica - Journals

Purpose of review: Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this critical review will summarize recent findings concerning the clinical evaluation and the treatment of myofascial trigger points. Recent findings: The clinical features of myofascial trigger points and their contribution to the patient pain and disability have been detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to identify MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments have been proposed and positive effects on pain and function demonstrated. Summary: The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to consider the contribution of myofascial trigger points to the patient's pain and disability through a careful medical history and a specific manual examination. Patients with myofascial trigger points will benefit from a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved.

Background: Tecar therapy (TT) is an endogenous thermotherapy used to generate warming up of superficial and deep tissues. TT capability to affect the blood flow is commonly considered to be the primary mechanism to promote tissue healing processes. Despite some preliminary evidence about its clinical efficacy, knowledge on the physiologic responses induced by TT is lacking. Objective: The aim of this quantitative randomized pilot study was to determinate if TT, delivered in two modes (resistive and capacitive), affects the perfusion of the skin microcirculation (PSMC) and intramuscular blood flow (IMBF). Design: A randomized controlled pilot feasibility study. Subjects: Ten healthy volunteers (n = 4 females, n = 6 males; mean age 35.9 ± 10.7 years) from a university population were recruited and completed the study. Intervention: All subjects received three different TT applications (resistive, capacitive, and placebo) for a period of 8 min. Outcome measures: PSMC, IMBF, and the skin temperature (ST) were measured pre- and post-TT application using power Doppler sonography, laser speckle contrast imaging (LSCI), and infrared thermography. Results: Compared with placebo application, statistically significant differences in PSMC resulted after both the resistive (p = 0.0001) and the capacitive (p = 0.0001) TT applications, while only the resistive modality compared with the placebo was capable to induce a significant change of IMBF (p = 0.013) and ST (p = 0.0001). Conclusions: The use of power Doppler sonography and LSCI enabled us to evaluate differences in PSMC and IMBF induced by TT application.