Pain in Motion

ABSTRACT Muscle stiffness is a critical biomechanical property that influences joint function and neuromuscular control, with deviations often indicating underlying pathology. Two‐dimensional shear wave elastography (2D‐SWE) is a non‐invasive imaging technique that quantifies muscle stiffness and shows clinical promise in musculoskeletal assessment. The pectoralis major and minor muscles are of interest due to their roles in shoulder function and their susceptibility to treatment‐related changes, especially in breast cancer populations. Despite its potential, no systematic review has yet evaluated the reliability and validity of 2D‐SWE for assessing stiffness in these muscles. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, using PubMed and Web of Science to identify relevant studies. The Consensus‐Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used to assess methodological quality. Five studies met inclusion criteria, all evaluating the reliability of 2D‐SWE for pectoralis muscle stiffness. Intra‐rater reliability ranged from moderate to excellent (ICC = 0.57–0.99), while inter‐rater reliability was consistently good (ICC = 0.85–0.89). No studies assessed validity, and most had doubtful or inadequate quality in key COSMIN domains. This review emphasizes that 2D‐SWE demonstrates moderate to excellent intra‐ and inter‐rater reliability for assessing stiffness of the pectoralis major and minor muscles in healthy individuals. However, the validity of SWE for these muscles has not been established. Given limited demographic diversity, future research should focus on validation in broader populations and protocol standardization to support clinical applicability.

This study aimed to evaluate the presence of human assumed central sensitization in interictal episodic and chronic migraine patients. A comprehensive literature search was conducted in September 2024 across three databases. Studies evaluating human assumed central sensitization using static or dynamic quantitative sensory testing in adults with interictal migraine were included. Two independent, blinded reviewers performed study selection, data extraction, and assessments of risk of bias and evidence quality. Meta-analyses were conducted using Review Manager. Sixty-two studies were included in the qualitative synthesis, with 37 contributing to the meta-analysis. Findings, categorized by headache frequency and testing modality, revealed reduced pressure pain thresholds in trigeminal, extra-trigeminal, and pain-free areas in episodic and chronic migraine patients. Other static sensory testing outcomes were inconsistent. Altered defensive reflexes were observed in both groups. No significant differences were found between episodic and chronic migraine regardless of testing method used. These findings support the presence of human assumed central sensitization in interictal episodic and chronic migraine, highlighting the potential benefit of multimodal treatment approaches aimed at central nervous system desensitization. Although different quantitative sensory testing profiles may influence the development of human assumed central sensitization, headache frequency appears to have a limited impact.

This study evaluated the feasibility of two minimally equipped, blended supervised and tele-supported exercise programs, a moderate intensity training (MIT) and high intensity training (HIT) program, in healthy sedentary adults, and explored signals of efficacy on central pain processing. Participants were randomized to a 10-week MIT or HIT program, each comprising one supervised group session and two tele-supported home-based sessions per week. MIT involved a Start-to-Run protocol at 60-70% of heart rate reserve, while HIT involved strength exercises at > 80% of predicted maximum heart rate. Feasibility outcomes included recruitment, retention, adherence, and acceptability. Quantitative sensory testing (QST) assessed central pain processing pre- and post-intervention. Eighteen participants were enrolled (8 MIT, 10 HIT). Retention was lower in the MIT group (5 completed) than the HIT group (11 completed), with high adherence in both. Participants appreciated the blended format but noted challenges with digital tools, and suggested refinements. No significant differences in QST outcomes were observed, likely due to small sample size and inter-individual variability. Individual responses suggested reduced pain inhibition following MIT and enhanced inhibition after HIT. Both programs were feasible, supporting a larger-scale study to optimize implementation and confirm effects. ClinicalTrails.gov (ID: NCT06207422).

Purpose: Multicomponent physical activity programmes can prevent frailty in older adults but remain underutilised. To increase adoption, healthcare policy must prioritise research on preventive strategies. Although randomised controlled trials (RCTs) and clinical trials (CTs) are essential, recruitment challenges often lead to underpowered studies, wasted resources, and unexpected costs. Transparent and comprehensive reporting on recruitment is rare. This study aimed to develop effective strategies for engaging frail older adults in trials by analysing recruitment efforts and outcomes from the ACTIVE-AGE@home trial. Method: A mixed-method study was conducted to evaluate recruitment strategies at three levels: macro (broad-scale), meso (community-level), and micro (individual-level). Quantitative analysis assessed the effectiveness of these strategies, while qualitative data – field notes documenting researchers’ recruitment experiences – were analysed using thematic analysis (TA) following Braun and Clarke’s approach. Both a deductive TA, guided by the TIBaR model (Trust, Incentives, Barriers, and Responsiveness), and an inductive approach were employed to explore motivations for long-term engagement, adherence, and maintenance. Results: Over six months, researchers contacted 49 macro-, 112 meso-, and 1,001 micro-level recruitment partners. Of these, 30 meso- and 44 micro-level partners referred frail older adults. Micro-level referrals were most effective, yielding 23 eligible participants, compared to six via meso-level. Thematic analysis identified four key themes: 1) Be appealing – Make the study unique, accessible, and approachable. 2) Foster reciprocal relationships – Build trust and shared ownership with recruitment partners. 3) Understand identity – Consider the identities of both recruitment partners and potential participants. 4) Gear trial requirements – Align study design with recruitment realities and identity needs. Conclusion: Micro-level strategies, particularly personal contact and warm referrals through local healthcare and welfare professionals, are critical for recruiting frail older adults. Macro- and meso-level strategies should support these efforts. The BRIDGE model emerged from this analysis, offering a reflective tool balancing recruitment, identity, and trial demands. As rigid RCT designs present recruitment barriers, more flexible trial designs should be explored. Transparent reporting of both successes and challenges is essential to improve future intervention research. Support/Funding Source: This work is supported by Research Foundation Flanders, under Applied Biomedical Research with a Primary Social finality (Grant Number: T002322N).

Background/Objectives: Biopsychosocial pain neuroscience education (PNE) has recently gained attention in preparing patients for surgery. PNE is expected to influence pain coping strategies and descending nociceptive inhibition. The goal of this study was to compare cortical evoked responses during experimental pain processing using a conditioned pain modulation (CPM) paradigm between patients receiving perioperative PNE (PPNE) or perioperative biomedical back school education (PBSE). Methods: This predefined EEG subgroup analysis included only participants with complete EEG recordings at baseline and 6 weeks. Of these, twenty-three patients with low back-related leg pain, scheduled for lumbar spine surgery, were randomized to either two sessions of PPNE or two sessions of PBSE. All patients were stimulated electrically at the median nerve of the symptomatic side and the sural nerve of the symptomatic and non-symptomatic side before and 6 weeks after the educational sessions, while evoked potentials were recorded by electroencephalography (EEG). Subsequently, this protocol was repeated during the application of the CPM paradigm by immersing the hand contralateral to the symptomatic side into cold water. Results: A significant decrease in the amplitude of the waveforms during CPM was found compared to the waveforms before CPM at the non-symptomatic sural nerve. No significant differences were found at the other test locations. For the waveforms of the CPM effect (subtracted waveforms), no significant treatment effects were revealed between the PPNE and PBSE groups. Conclusions: These exploratory findings suggest that PPNE was not associated with differential modulation of EEG evoked potentials during CPM compared with PBSE at 6 weeks post-surgery.

Abstract Background Young informal caregivers (YICs) are individuals under 25 years who provide care for a family member with a chronic illness or disability while managing other responsibilities, such as education. This study focuses on caregiving students in HBO5 (associate degree) programs in Flanders (Belgium), aged 18-25, to assess their caregiving burden, emotional wellbeing and support needs. Methods Between 2018 and 2020, cross-sectional surveys were conducted in five Flemish HBO5 schools, targeting 428 students. Of these, 88 (21%) identified as young informal caregivers. The surveys captured demographic information, caregiving activities, perceived burden, and mental wellbeing, utilizing validated tools like MACA YC-18, PANOC-YC20, and WEMWBS. Ethical approval was obtained from SMEC, University of Leuven, Belgium. Results Most YICs were female (95%), and caregiving tasks ranged from providing emotional support (30%) to physical and administrative tasks. The average mental wellbeing score (WEMWBS) was 49/70, with variations depending on caregiving hours. While caregiving provided positive feelings of pride and usefulness, significant challenges included stress (31%) and emotional exhaustion (20%). Schoolwork was less frequently affected but included concentration difficulties (41%). Notably, 80% of students reported that their caregiving role was unknown to the school (staff). Conclusions Young informal caregivers (YIC) face complex challenges balancing care and education. While many derive fulfillment from their caregiving role, substantial emotional and practical support is needed to mitigate stress and promote wellbeing in YICs. Schools should adopt ‘carer-friendly’ practices and education, such as planning support and raising awareness, to better accommodate YICs’ unique needs. Key messages • Young informal caregivers in higher education face significant stress and emotional exhaustion, highlighting the need for better support and awareness in schools. • Despite deriving pride from caregiving, young informal caregivers need substantial emotional and practical support to balance their education and caregiving roles.