A paper submitted to The University of Arizona College of Medicine - Phoenix, History of Medicine course.

Dissertation presented in partial fulfilment of the requirements for the Master's Diploma in Technology: Chiropractic, Technikon Natal, 1994. / The efficacy of myofascial trigger point therapy in treatment of myofasciitis was evaluated in a single blind, randomised, placebo controlled trial. The patient population consisted of twenty individuals who presented with one of the following: upper-back pain, shoulder pain, and neck-pain and or headaches and who were diagnosed as having myofasciitis. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2004. / The purpose of this study was to investigate the association between the role of Myofascial Trigger Points of the lower extremity to the clinical presentation of lIiotibialband Friction syndrome / M

Ce travail questionne la place du féminin dans l’expérience subjective des personnes atteintes de fibromyalgie, maladie touchant majoritairement des femmes et dont la douleur et la fatigue chroniques occupent le devant de la scène. Notre hypothèse principale nous conduit à investiguer l’existence d’un trouble primaire du féminin chez les personnes qui en sont atteintes. Ce trouble serait lié à un échec de l’accès à la voie passive. Le modèle identificatoire serait celui de la mère des premiers soins, mal différenciée, mais représentant un idéal de toute-puissance narcissique. Dans ce contexte, les éprouvés douloureux de la passivité primaire laisseraient la place à une difficulté majeure face à la position passive, comprise comme une défense contre l’emprise maternelle. Des travaux de recherche proposent de considérer cette maladie comme étant une manifestation moderne de l’hystérie de conversion. Nous mettons cette hypothèse à l’épreuve à travers les cas cliniques étudiés. Nous investiguons également la question de la dépression en suivant l’idée que la fatigue chez les fibromyalgiques pourrait être interprétée comme une forme de dépression, non réactionnelle, préexistante à la maladie et caractérisée par une susceptibilité mélancolique. Les douleurs éprouvées constitueraient ainsi la composante mélancolique de cette dépression. Notre travail s’appuie sur le cadre théorique de la psychopathologie psychanalytique et sur des outils d’investigation qui sont les entretiens cliniques de recherche et les épreuves projectives (Rorschach et TAT). / This work questions the place of the feminine in the subjective experience of people suffering from fibromyalgia, a disease that mostly affects women and which chronic pain and fatigue occupy center stage. Our main hypothesis leads us to investigate the existence of a primary disorder of the feminine in people suffering from this disease. This disorder would be linked to a failure of reaching the passive way. The role model would be the first care mother, poorly differentiated, but which represents an omnipotent narcissistic ideal. In this context, the pain felt in primary passivity would leave room for a major difficulty regarding the passive position which is seen as a defense against the mother’s control. Some research intends to consider this disease as a modern expression of conversion hysteria. We challenge this hypothesis through the clinical cases that we studied. We also investigate the question of depression by following the idea that the fatigue of fibromyalgic people could be interpreted as a form of depression, non-reactive, pre-existing from the disease and characterized by a melancholic susceptibility. Then, the pain would consist in the melancholic component of the depression. Our work is based on the theoretical framework of psychoanalytical psychology and on investigation tools which are clinical research interviews and projective tests (Rorschach and TAT).

The specific purpose of the study was to determine the differential efficacy of three different multicompetent cognitive strategies in the control of an induced pain. An exploratory investigation was also conducted to determine the relationship of health locus of control, expectancy, compliance, and anxiety ratings with the variables of pain tolerance and subjective pain ratings.

The purpose of this unblinded, controlled pilot study was to compare the effectiveness of Spinal Manipulative Therapy and a shoulder rehabilitation program, focussing on improving muscular and postural imbalances, verses Spinal Manipulative Therapy alone in the treatment of sub-acute and chronic shoulder impingement syndrome found in swimmers. In executing the comparison, it was anticipated that both treatment protocols would be effective, but the combined therapy of Spinal Manipulative Therapy and rehabilitation would be the most effective in treating sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol focused on correcting the biomechanical dysfunction in the cervical spine and thoracic spine coupled with a rehabilitation program to stretch anterior musculature, strengthen posterior musculature and strengthen the shoulder in external rotation. These muscular and postural imbalances are a contributing factor in perpetuating the pathomechanics causing sub-acute and chronic shoulder impingement syndrome found in swimmers. Shoulder impingement syndrome of this kind in swimmers is known as Swimmer’s shoulder. Thirty swimmers between the ages of 18 and 60 with subacute and chronic shoulder pain were recruited by advertising in the local newspapers. Two groups of fifteen patients were created. Patients were randomly assigned to one of the groups as they enrolled for participation. Group A underwent Spinal Manipulative Therapy of the thoracic and cervical spines in conjunction with shoulder strengthening and postural corrective exercises. Group B underwent Spinal Manipulative Therapy of the thoracic and cervical spines. Each patient was treated nine times in three weeks. A Saunders Digital Inclinometer was used to record objective glenohumeral ranges of motion and a painful arc was determined as positive between 45 and 120 degrees. The Supraspinatus Test was performed which was recorded as positive or negative. Subjective findings were measured with the use of the Visual Analogue Pain Scale and a questionnaire modified from Athletic Shoulder Outcome Rating Scale and American Shoulder and Elbow Surgeons’ Shoulder Evaluation Form. Data was collected prior to the first, fourth, seventh and ninth visit. III The results indicated that both groups were effective in treating Swimmer’s shoulder. Group A showed the most positive results in terms of objective and subjective clinical findings. In conclusion, Group A (Spinal Manipulative Therapy and Rehabilitation) was the most effective treatment protocol for the management of sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol had a greater benefit with regard to improvement of shoulder abduction range of motion, painful arc, Supraspinatus Test and Visual Analogue Pain Scale than Group B (Spinal Manipulative Therapy only). / Dr. B. Losco Dr. C. Lyons

A dissertation submitted in partial compliance with the requirements for the Master's in Technology: Chiropractic, Durban Institute of Technology, 2004. / Mechanical neck pain is defined as a restriction of movement of the neck, which frequently refers pain to the occiput, shoulders, nuchal muscles, interscapular region and anterior chest wall, and is usually due to a history of trauma or awkward posture of the cervical spine / M

There is a great need for new analgesics. The current problem in treatment of severe pain is that side effects limit the effectiveness of therapy. Glycine receptors are important in modulation of nociception, suggesting a novel class of analgesics. Previous studies in rats show that intrathecal administration of glycine agonists and amino acids structurally similar to glycine have antinociceptive effects. The effects of isovaline, a unique, non-proteogenic glycine-like aminoacid, have not been studied. Isovaline is absorbed from the gut and transported across the blood-brain-barrier. We examined the hypothesis that isovaline produces antinociception in mice. Administration of strychnine, an antagonist at glycine receptors, into the cisterna magna or lumbar intrathecal space resulted in allodynia, localized to the somatotopic distribution of the trigeminal and lumbar nerves. These findings provided a basis for models of lumbar and trigeminal neuralgia. Racemic isovaline blocked strychnine induced allodynia in both models without apparent side effects. We next investigated the antinociceptive effects of glycine-like amino acids in formalin foot assay, a conventional rodent model of acute and chronic pain. Antinociceptive effects were demonstrated on intrathecal administration of glycine, beta-alanine, and isovaline. Intravenous isovaline produced significant antinociceptive effects in the formalin foot model. The toxicity of isovaline and related amino acids were determined. Exploratory behavior, gait, and responses to stimuli were used to assess sedation. The rotarod test was used to examine central nervous system (CNS) and neuromuscular toxicities of intravenous isovaline. Lumbar administration of glycine and beta-alanine caused scratching and/or lower body weakness. Isovaline at 7-times intrathecal ED50 produced lower body weakness in some animals. None of the amino acids produced sedation comparable to morphine. At 6-times ED50, beta-alanine produced weakness. Both glycine (ED50) and beta-alanine (3x ED50) but not isovaline produced local nerve irritation. Intracisternal injection of glycine did not reverse allodynia and resulted in death. Neither R nor S enantiomers of isovaline impaired performance on the rotarod test. Isovaline has significant antinociceptive properties. Given the absence of apparent CNS or motor toxicity, isovaline has potential as a clinical analgesic. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

Pharmacological treatments for pain show limited analgesic benefits when compared with placebo. Neuro-modulatory approaches, such as mindfulness meditation and neurofeedback training show more promising effects, but are time consuming and difficult to complete. Neural entrainment provides an almost instantaneous increase in EEG power of the stimulated frequency, achieved with minimal effort through visual flicker stimuli or auditory binaural beats. EEG recorded alpha power displays a reproducible inverse relationship with pain perception. Hence, the main objective of this PhD thesis was to develop an analgesic alpha entrainment intervention: increasing alpha power with the aim to reduce the perception of acute pain in healthy volunteers and chronic pain patients. Prior to attempting to modulate pain, pilot work assessing the ability to entrain alpha power is reported in Chapter 3. A checkerboard stimulus was used to visually entrain frequencies across the alpha band from 7Hz – 14Hz, resulting in a significant power increase at 10Hz and 11Hz. With the goal to reduce behavioural and electrophysiological responses to a moderately painful stimulus, EEG alpha entrainment at 8Hz, 10Hz and 12Hz through auditory binaural beats (in Chapters 4 and 5), and visual flashing LED goggles (in Chapters 4, 6 and 7) was then attempted. A significant reduction of pain ratings was found following both the visual and the auditory alpha stimulation across all three frequencies in Chapters 4,5 and 6. Chapter 5 revealed a significant alpha power increase following 10Hz and 12Hz auditory stimulation. The laser-evoked potential’s (LEP) N2 peak reduced significantly following 10Hz auditory entrainment and the P2 peak reduced significantly across all auditory entrainment conditions. In Chapter 6, alpha power entrained significantly at 8Hz and 10Hz. The P2 peak reduced significantly following the 10Hz visual stimulation. Source analysis showed the precuneus and posterior cingulate cortex might mediate alpha entrainment-induced reductions in LEPs and pain ratings. The paradigm used in Chapter 6 was repeated in osteoarthritic patients in Chapter 7. Significant reductions in pain ratings were observed following all three alpha stimulation sessions, despite a lack of alpha power increase. A significantly reduced response in the P2 peak was also observed following the 12Hz visual stimulation. Decreases in P2 source activity in the posterior insula suggest a functional role in the reduction of pain intensity triggered by alpha stimulation. A significant reduction in the electrophysiological response and the perception of moderately painful stimuli can be achieved through visual or auditory entrainment across the alpha band range, in both healthy volunteers and osteoarthritic patients. The findings from this PhD thesis provide a solid foundation for further investigation of alpha based neuro-modulation as an analgesic intervention.

Nonverbal indices of pain are some of the least researched sources of data for assessing pain. The extensive literature on the communicative functions of nonverbal facial expressions suggests that there is potentially much information to be gained in studying facial expressions associated with pain. Results from two studies support the position that facial expressions related to pain may indeed be a source of information for pain assessment. A review of the literature found several studies indicating that judges could make discriminations amongst levels of discomfort from viewing a person's facial expressions. Other studies found that the occurrence of a small set of facial movements could be used to discriminate amongst several levels of self-reported discomfort. However, there was no research directly addressing the question of whether judges ratings would vary in response to different patterns of the identified facial movements. Issues regarding the facial cues used by naive judges in making ratings of another person's discomfort were investigated. Four hypotheses were developed. From prior research using the Facial Action Coding System (FACS) (Ekman S. Friesen, 1978) a small set of facial muscle movements, termed Action Units (AUs), were found to be the best facial movements for discriminating amongst different levels of pain. The first hypothesis was that increasing the number of AUs per expression would lead to increased ratings of discomfort. The second hypothesis was that video segments with the AUs portrayed simultaneously would be rated higher than segments with the same AUs portrayed in a sequential configuration. Four encoders portrayed all configurations. The configurations were randomly editted onto video tape and presented to the judges. The judges used the scale of affective discomfort developed by Gracely, McGrath, and Dubner (1978). Twenty-five male and 25 female university students volunteered as judges. The results supported both hypotheses. Increasing the number of AUs per expression led to a sharp rise in judges' ratings. Video segments of overlapping AU configurations were rated higher than segments with non-averlapping configurations. Female judges always rated higher than male judges. The second study was methodologically similar to the first study. The major hypothesis was that expressions with only upper face AUs would be rated as more often indicating attempts to hide an expression than lower face expressions. This study contained a subset of expressions that were identical to ones used in the first study. This allowed for testing of the fourth hypothesis which stated that the ratings of this subset of expressions would differ between the studies due to the differences in the judgment conditions. Both hypotheses were again supported. Upper face expressions were more often judged as portraying attempts by the encoders to hide their expressions. Analysis of the fourth hypothesis revealed that the expressions were rated higher in study 2 than study 1. A sex of judge X judgment condition interaction indicated that females rated higher in study 1 but males rated higher in study 2. The results from these studies indicated that the nonverbal communication of facial expressions of pain was defined by a number of parameters which led judges to alter their ratings depending on the parameters of the facial expressions being viewed. While studies of the micro-behavioral aspects of facial expressions are new, the present studies suggest that such research is integral to understanding the complex communication functions of nonverbal facial expressions. / Arts, Faculty of / Psychology, Department of / Graduate