Thesis (Ph.D.)--University of Delaware, 2009. / Principal faculty advisor: Irene S. Davis, Dept. of Physical Therapy. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1981.

M.Tech. / Purpose: The cervical facet joints have attracted relatively little attention as possible sources of neck pain and referred pain. Multiple authors have described the management of cervical facet joint pain but not the cause (Manchikanti et al., 2002). Method: This study consisted of one group of 100 participants. The participants were between the ages of 18 and 40 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. All the participants received a cervical spine adjustment. Objective and subjective readings were taken. Procedure: The participants were seen only once. The Visual Analogue Scale was completed by each participant before treatment. Algometer readings were taken over the most restricted cervical spine facet joint and cervical spine range of motion (CROM) machine readings were taken measuring the ranges of motion of the cervical spine. The participants received an adjustment to the most restricted cervical spine facet joint as determined by motion palpation. The CROM machine and algometer readings were taken again immediately after the adjustment and the algometer readings were taken again 10 minutes later. Results: In terms of subjective measurements based on the Visual Analogue Scale, all participants experienced clinically significant pain before starting the trial.In terms of objective measurements based on algometer readings, a clinically significant difference was found as the pressure pain threshold increases over a period of time. In terms of the CROM machine readings there was a clinical improvement from the pretreatment ranges of motion to the post-treatment ranges of motion. The algometer and CROM readings were statistically incomparable to begin with. Conclusion: The results proved that there was a statistical significant noted immediately after the adjustment and 10 minutes later, however, this does not mean much as thegroups were not comparable to begin with. A statistically significant difference was noted for all ranges of cervical spine motion (flexion, extension, right and left lateral flexion and rotation), thus showing that the cervical spine adjustment was successfully delivered to the restricted segments.

Disfunções temporomandibulares são secundárias à inflamação e dor. Estudos mostram a participação da ET na nocicepção. Investigamos o papel da ET1 na sinovite induzida pela injeção de CGN na ATM de ratos. Injeções intra-articulares de CGN, ET1 ou do agonista do receptor ETB BQ3020 foram realizadas na ATM. Após 4h, a hiperalgesia foi avaliada usando um analgesímetro digital e as cavidades articulares foram lavadas para contagem total e diferencial de leucócitos. Antagonistas dos receptores ETA e ETB foram co-injetados com CGN e ET1, e o antagonista de TRPV1 capsazepina com a ET1. A ET1, o BQ3020 e a CGN induziram hiperalgesia que foi inibida pela injeção simultânea (mas não individual) dos antagonistas ETA e ETB. A capsazepina não afetou o efeito nociceptivo da ET1. Nem a ET1, o BQ3020 nem os antagonistas dos receptores da ET afetaram a infiltração de leucócitos. Com base nestes resultados concluímos que a ET1 induz hiperalgesia e está envolvida na nocicepção induzida por CGN através dos receptores ETA e ETB, sem qualquer efeito sobre a migração de leucócitos. / Temporomandibular disorders are secondary to inflammation and pain. Studies show the involvement of ET in nociception. Weve investigated the role of ET1 in synovitis induced by CGN injection on the rats TMJ. Intra-articular injections of CGN, ET1 or ETB receptor agonist BQ3020 were performed at the TMJ. After 4h, hyperalgesia was assessed using a digital analgesimeter and the joint cavities were washed for total and differential leukocyte counting. ETA and ETB receptors antagonists were co-injected with CGN and ET1, and the TRPV1 antagonist capsazepine with ET1. ET1, BQ3020 and CGN induced hyperalgesia, which was inhibited by simultaneous (but not single) antagonists ETA and ETB injection. The capsazepine did not affect the ET1 nociceptive effect. Neither ET1, BQ3020 nor antagonists of ET receptors affect leukocyte infiltration. Based on these results we conclude that the ET1 induces hyperalgesia and its involved in CGN induced nociception through ETA and ETB receptors, without any effect on the leukocytes migration.

Introduction: Chronic joint (CJ) pain is the foremost osteoarthritis (OA) symptom that affects older African Americans’ (AAs) functional ability. Every effort should be made to reduce the development of high-impact chronic pain. One way to effectively do this is for older AAs to consistently engage in self-management utilizing the recommended OA treatments. Recommended behaviors include land-based exercise, water-based exercise, strength (muscle and endurance) training and stretching, self-management education, analgesic medications, thermal (warm/cool) modalities, and use of assistive and/or orthotic devices. However, evidence suggests these core behaviors of chronic pain self-management are not optimally utilized in older AAs. Methods: A convergent, parallel mixed-methods study explored patterns, preferences, and predictors of stage of engagement (pre-contemplation, preparation, or action) in recommended OA and CJ self-management behaviors. One hundred ten AAs aged 50 and older from communities in north Louisiana completed quantitative surveys, and a subset of 18 participated in audio-recorded qualitative interviews. Using SPSS, multinomial and binomial regression were used to build predictive models to determine which contextual and cognitive factors predict stage of engagement in each recommended and complementary OA self-management behaviors. A qualitative descriptive approach underscored a conventional content analysis of qualitative data. Results: Older AAs were “dealin’ with it [pain]” in a variety of ways, and their experience of having OA and CJ pain was based on their ability and willingness to bear the pain, understand the nature of OA pain, and experience life with daily pain. These dimensions of dealin’ with pain acted as a catalyst for engagement in complementary and recommended behaviors. In addition, participants’ and providers’ cultural receptivity may limit or enable engagement in certain recommended evidence-based OA behaviors. Specifically, each recommended OA self-management behavior was associated with different predictors of engagement. Confidence to manage pain was a predictor for land-based exercise, while there were no factors associated with water-based exercise. The most reasonable explanation for this finding of lack of participation in water-based exercise is likely due to inability to swim and lack of access to a personal or community pool. Engagement in strength training was significantly associated with confidence, knowledge of strength training recommendation, motivation, pain interference, and spirituality. For self-management education, only knowledge of self-management education recommendation was a predictor. Most AA older adults were unaware that this was recommended or didn’t have access to a self-management program; subsequently the majority had never participated in such but were in the preparation stage. Predictors for medication use included confidence, knowledge, and pain interference. Almost all AAs were using either over-the-counter or prescribed medications. Use of thermal modalities was predicted by pain interference. Lastly, using assistive and/or orthotic devices was significantly associated with employment status, OA pain severity, pain interference, and perceived social support. Assistive and/or orthotic device use was evenly split between users and non-users. Pain interference emerged as the most salient factor predicting stage of engagement in any of the recommended behaviors. Depending on the specific behaviors, pain interference prevented or motivated engagement. Conclusion: OA and CJ pain is a significant symptom in older AAs. This study’s mixed method approach uncovered what older AAs do to manage pain. More specifically, these results illuminate the daily patterns and preferences for self-management. We identified specific barriers and motivators that influence engagement in OA self-management behaviors, and determined the most relevant predictors for each stage of engagement. In addition, we were able to develop a model of OA and CJ pain self-management based on the predictors.

ABSTRACT BACKGROUND: Arthritis is increasingly becoming a public health concern as it is the leading cause of disability. Glucosamine and chondroitin, which are alternative dietary supplements, are commonly marketed for persons with joint pain. The purpose of this study is to examine if self-reported 12-month and past 30-day use of glucosamine and/or chondroitin among persons with any arthritis, unspecified arthritis, and rheumatoid arthritis is associated with reports of past 12-month improved health and reports of past 30-day joint pain, aching, and stiffness, respectively. METHODS: The 2012 National Health Interview Survey (NHIS), a nationally representative cross-sectional household interview survey, was used for this study. The adult sample consisted of 34,525. Subgroup analyses were conducted on 7,654 respondents with any arthritis, 6,016 with unspecified arthritis, and 898 with rheumatoid arthritis. The independent variables were defined as the use of glucosamine only, chondroitin only, or glucosamine and chondroitin one or more times in the past 12 months and past 30 days. The dependent variables were defined as self-reported past 12 month improved health and past 30 day joint pain, aching, and stiffness. Descriptive, bivariate, and multivariate analyses were conducted using SAS 9.4 accounting for the complex survey design, computing missing values as missing completely at random for variance estimation. All multivariate logistic regression models included sociodemographics, use of other observed alternative therapies, and other chronic conditions. RESULTS: Approximately 21.8% of U.S adults had any arthritis, 17.0% had unspecified arthritis and 2.5% had rheumatoid arthritis. Among persons with any arthritis, approximately 3.7% used glucosamine, 0.4% used chondroitin, and 3.4% used both glucosamine and chondroitin within the past 12 months while approximately 5.1% used glucosamine, 0.6% used chondroitin, and 0.4% used both glucosamine and chondroitin within the past 30 days. Among persons with unspecified arthritis, approximately 3.7% used glucosamine, 0.5% used chondroitin, and 3.8% used both glucosamine and chondroitin within the past 12 months while 5.5% used glucosamine, 0.5% used chondroitin, and 0.4% used both glucosamine and chondroitin within the past 30 days. Among persons with rheumatoid arthritis, approximately 2.4% used glucosamine, 0.3% used chondroitin, and 2.1% used both glucosamine and chondroitin within the past 12 months while approximately 2.9% used glucosamine, 0.7% used chondroitin, and 0.5% used both glucosamine and chondroitin within the past 30 days. Women used more of all supplements (past 12 months and past 30 days) except past 12 month use of chondroitin among persons with any arthritis. Persons 56 to 70 years old had the highest proportion of past 12 month and 30 day supplement use among persons with unspecified arthritis. After adjusting for sex, age, race, BMI, poverty level, other health conditions, and other CAM therapies (acupuncture, energy, mind-body, and chiropractic/osteopathic therapies), the use of chondroitin only (adjusted OR= 0.6; p= <0.01) and the use of both glucosamine and chondroitin (adjusted OR= 5.7; p= <0.01) during the past 30 days was associated with self-reported past 30 day joint pain, aching, and stiffness among persons with any arthritis. After adjusting for age, BMI, poverty level, region, other health conditions, and other CAM therapies (acupuncture, energy, mind-body, and chiropractic/osteopathic therapies), the use of chondroitin only was also associated with past 30 day joint pain, aching, and stiffness among persons with unspecified arthritis (adjusted OR= 0.5; p= 0.02). CONCLUSION: Chondroitin alone was associated reports of past 30 day joint pain, aching, and stiffness among persons with any arthritis and unspecified arthritis highlighting a potential effective role and use for this supplement. In addition, the use of both glucosamine and chondroitin were associated with reports of past 30 day joint pain, aching, and stiffness among persons with any arthritis. Marketing may play a role in these relationships and should be further examined.

Disfunções temporomandibulares são secundárias à inflamação e dor. Estudos mostram a participação da ET na nocicepção. Investigamos o papel da ET1 na sinovite induzida pela injeção de CGN na ATM de ratos. Injeções intra-articulares de CGN, ET1 ou do agonista do receptor ETB BQ3020 foram realizadas na ATM. Após 4h, a hiperalgesia foi avaliada usando um analgesímetro digital e as cavidades articulares foram lavadas para contagem total e diferencial de leucócitos. Antagonistas dos receptores ETA e ETB foram co-injetados com CGN e ET1, e o antagonista de TRPV1 capsazepina com a ET1. A ET1, o BQ3020 e a CGN induziram hiperalgesia que foi inibida pela injeção simultânea (mas não individual) dos antagonistas ETA e ETB. A capsazepina não afetou o efeito nociceptivo da ET1. Nem a ET1, o BQ3020 nem os antagonistas dos receptores da ET afetaram a infiltração de leucócitos. Com base nestes resultados concluímos que a ET1 induz hiperalgesia e está envolvida na nocicepção induzida por CGN através dos receptores ETA e ETB, sem qualquer efeito sobre a migração de leucócitos. / Temporomandibular disorders are secondary to inflammation and pain. Studies show the involvement of ET in nociception. Weve investigated the role of ET1 in synovitis induced by CGN injection on the rats TMJ. Intra-articular injections of CGN, ET1 or ETB receptor agonist BQ3020 were performed at the TMJ. After 4h, hyperalgesia was assessed using a digital analgesimeter and the joint cavities were washed for total and differential leukocyte counting. ETA and ETB receptors antagonists were co-injected with CGN and ET1, and the TRPV1 antagonist capsazepine with ET1. ET1, BQ3020 and CGN induced hyperalgesia, which was inhibited by simultaneous (but not single) antagonists ETA and ETB injection. The capsazepine did not affect the ET1 nociceptive effect. Neither ET1, BQ3020 nor antagonists of ET receptors affect leukocyte infiltration. Based on these results we conclude that the ET1 induces hyperalgesia and its involved in CGN induced nociception through ETA and ETB receptors, without any effect on the leukocytes migration.

Aktualumas. Kelio sąnario skausmas yra dažna aktyviai gyvenančių vyrų ir moterų problema. Neretai skausmo priežasties nepavyksta nustatyti, tačiau dėl raumenų silpnumo ir kojų asimetrijos biomechanikos pokyčių skausmai yra dažnesni. Todėl šiame darbe iškėlėme hipotezę, kad po kineziterapijos padidės blauzdos lenkiamųjų ir tiesiamųjų raumenų jėga, sumažės kojų raumenų asimetrija bei išnyks kelio sąnario skausmas. Darbo tikslas — nustatyti blauzdos tiesiamųjų ir lenkiamųjų raumenų jėgos pokyčius taikant KT sportuojantiesiems ir nesportuojantiesiems. Buvo atliktas tyrimas, kuriame dalyvavo 29 tiriamieji: 15 sportuojančių asmenų (3 vyrai ir 12 moterų, amžiaus vidurkis 24,1±3,7 metai) ir 14 nesportuojančių asmenų (4 vyrai ir 10 moterų, amžiaus vidurkis 26,5±6,5 metai). Kineziterapija buvo atliekama Lietuvos Olimpiniame Sporto Centre (LOSC) masažo kabinete. Biodex Medikai System (Biodex Medikai System 3 PRO Sertifikuota ISO 9001 EN 46001) aparatūra buvo registruojama raumenų jėga, kai kampinis greitis buvo 60 l/s, 180 l/s ir 360 l/s. Buvo vertinta kairės ir dešinės blauzdos lenkiamujų ir tiesiamųjų raumenų maksimali jėga, galingumas ir maksimali jėga atitinkanti kūno masę. Gauti duomenys parodė, kad didžiausia raumenų jėga pasiekiama tada, kai sportuojančiųjų ir nesportuojančiųjų kampinis greitis yra mažiausias — 60 l/s. Sportuojančiųjų ir nesportuojančiųjų blauzdos tiesiamieji raumenys yra stipresni už lenkiamuosius esant visiems trims kampiniams greičiams. Kineziterapija labiau... [toliau žr. visą tekstą] / Actuality. The problem of the knee joint pain is frequent among women as well as men who lead an active way of life. Unfortunately, causative factors are difficult to state although muscle weaknesses, asymmetry, biomechanical changes with leg pain are frequent. The hypothesis of this work is that due to physical therapy the power of shin flexion and extension increases while their asymmetry decreases and the knee joint pain disappears. The aim of the work is to define the shin flexion and extension muscle power changes while put up into physical therapy among those who are both sport active and sport passive ones. The research work with 29 participants was done; 15 of them were sport active (3 men and 12 women, the average age of them was 24, 1=3,7years old) the rest 14 sport passive ones (4 men and 10 women, the average age of them was 26, 5= 6, 5 years old). Physical therapy exercises took place at Lithuanian Sport Centre in the massage room. The Biodex Medical System (Biodex Medical System 3PRO Certificated ISO 9001 EN 46001) was registered under the power of 60 l/s, 180 l/s and 360 l/s corner speed. The left and the right shin flexion and extension maximal power of participants were evaluated in comparison with their maximal body mass power. The final results reveal that the strongest power is reached under the low 60 l/s corner speed among people who are sport active as well as sport passive. Physical therapy strengthens more shin flexion muscles among sport active... [to full text]

No description available.

La douleur articulaire associée à l’arthrose est un problème clinique majeur, spécialement chez les personnes âgées. L’intensité de la douleur est souvent amplifiée lors de mouvement de l’articulation et principalement lors du soutien de la charge corporelle sur le membre lésé. Malheureusement, les traitements pharmacologiques proposés sont trop souvent associés à des effets secondaires néfastes et à une inefficacité pour le soulagement de la douleur à long terme. Divers modèles murins sont utilisés en laboratoire de recherche pour des études précliniques de molécules aux propriétés analgésiques. Une évaluation comparative de la réponse comportementale douloureuse des animaux d’un modèle d’instabilité articulaire induit par le sectionnement du ligament croisé antérieur accompagné d’une méniscectomie partielle (le modèle ACLT+pMMx) et d’un modèle de dégénérescence articulaire induite par le monoiodoacetate (le modèle MIA) a permis de sélectionner un modèle approprié pour la continuité du projet. Les deux modèles ont démontré des lésions tissulaires, mais le modèle MIA a démontré une réponse douloureuse plus prononcée que le modèle ACLT+pMMx. Par l’analyse de la démarche, le modèle MIA a démontré une boiterie claire dans le patron de la démarche des animaux qui est associée à une lésion unilatérale. Le modèle MIA a donc été choisi pour la suite du projet. La problématique principale dans la recherche sur la douleur associée à l’arthrose est une compréhension incomplète des mécanismes de douleur responsables de l’induction et du maintien de l’état de douleur. Il devient donc nécessaire d’améliorer nos connaissances de ces mécanismes en effectuant une caractérisation plus approfondie des modèles animaux employés pour l’évaluation de stratégies pharmacologiques analgésiantes. Afin de bien comprendre le modèle MIA, une caractérisation des événements moléculaires centraux lors de la progression du processus dégénératif des structures articulaires de ce modèle s’est effectuée aux jours 3, 7, 14, 21 et 28 post injection. Des mécanismes hétérogènes qui modulent l’information nociceptive en fonction de la progression temporelle de la pathologie ont été observés. Les changements du contenu i spinal des neuropeptides sélectionnés (substance P, CGRP, dynorphine A et Big dynorphine) ont débuté sept jours suivant l’injection de MIA. L’observation histologique a démontré que les dommages structuraux les plus importants surviennent entre les jours 14 et 21. C’est entre les jours 7 et 21 que les lésions démontrent le plus de similarités à la pathologie humaine. Cela suggère que lors d’une évaluation préclinique d’un traitement pharmacologique pour pallier la douleur articulaire utilisant le modèle MIA, l’étude doit tenir compte de ces événements afin de maximiser l’évaluation de son efficacité. Puisque les traitements pharmacologiques conventionnels proposés pour le soulagement de la douleur ne font pas l’unanimité en terme d’efficacité, d’effets non désirés et de coûts monétaires parfois onéreux, les molécules de dérivés de plante deviennent une alternative intéressante. L’eugénol, le principal constituant de l’huile de clou de girofle, a été administré oralement pour une période de 28 jours chez des rats ayant reçu l’injection intra-articulaire de MIA afin d’évaluer son efficacité pour le traitement de la douleur articulaire. L’eugénol à une dose de 40 mg/kg s’est révélé efficace pour l’amélioration du patron de la démarche des animaux ainsi que pour la diminution de l’allodynie mécanique secondaire. De plus, les concentrations spinales de neuropeptides pronocicepteurs ont diminué chez les animaux traités. Par une évaluation histopathologique, l’eugénol n’a démontré aucune évidence d’effets toxiques suite à une administration per os quotidienne pour une période prolongée. Ces résultats suggèrent le potentiel thérapeutique complémentaire de la molécule d’eugénol pour le traitement de la douleur articulaire. / Pain is the most predominant clinical symptom associated with osteoarthritis (OA), mostly among older people. Joint movement and weight bearing often increase the pain intensity. Unfortunately, the proposed pharmacological treatments are frequently associated with side effects and ineffective for pain alleviation for long time periods. Many murine models are used in laboratories for preclinical studies evaluating analgesic compounds. A comparative evaluation of the behavioral pain responses of animals with a joint instability model induced by the transection of the anterior cruciate ligament followed by a partial menisectomy (the ACLT+pMMx model) and of an articular degenerative model induced by an intra-articular injection of monoiodoacetate (the MIA model) was conducted to select an appropriate model for the continuation of the project. Both models demonstrated articular lésions, however the MIA model demonstrated a clearer behavioral pain response over the ACLT+pMMx model. The gait pattern of the MIA model revealed a clear limping gait similar to that observed with unilateral OA in humans. The MIA model was chosen for the subsequent studies. An unresolved issue in pain OA research is the lack of understanding of the pain mechanisms responsible for the induction and maintenance of the pain. Therefore, there is an urgent clinical need to improve the characterization of animal models to effectively discover novel pain relief pharmacological treatment stratégies for OA patients. A characterization of the spinal pain molecular events during the progression of the joint degenerative process in the MIA model was performed on days 3, 7, 14, 21 and 28 post injection. Heterogeneous nociceptive central molecular events were observed in respect to the time course of the pathology’s progression. Changes in selected spinal neuropeptide content (substance P, CGRP, dynorphin A, Big dynorphin) began 7 days following the MIA injection. Most severe joint structural damage on histology occured between days 14 and 21 post injection. These results suggest that preclinical drug evaluation employing this model should be conducted between 7 and 21 days post injection when the lesions resemble most those of human OA. iii As current pharmacological therapy for the alleviation of joint pain does not achieve the unanimity in respect to efficacy, side effects and cost, plant derivate compounds are now interesting alternatives to improve the situation. Eugenol, the main constituent of clove oil, was evaluated for its efficacy for alleviation of joint pain in rats who previously received an intra-articular injection of mono-iodoacetate to induce the MIA model. Eugenol, administered orally for 28 consecutive days at a dose of 40 mg/kg, improved gait pattern and reduced secondary mechanical allodynia. Furthermore, spinal concentrations of pronociceptive neuropeptides were also decreased in the treated animals. No toxic effects of the compoud were identified on histopathological assessment of the various tissues. These results suggest that eugenol could be a potential therapeutic option for alleviating OA joint pain.