Leeds Pallium Research Group

Leeds, United Kingdom

Leeds Pallium Research Group

Leeds, United Kingdom

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Alabas O.A.,Leeds Beckett University | Alabas O.A.,Leeds Pallium Research Group | Tashani O.A.,Leeds Beckett University | Tashani O.A.,Leeds Pallium Research Group | And 4 more authors.
European Journal of Pain (United Kingdom) | Year: 2012

Gender role refers to the culturally and socially constructed meanings that describe how women and men should behave in certain situations according to feminine and masculine roles learned throughout life. The aim of this meta-analysis was to evaluate the relationship between gender role and experimental pain responses in healthy human participants. We searched computerized databases for studies published between January 1950 and May 2011 that had measured gender role in healthy human adults and pain response to noxious stimuli. Studies were entered into a meta-analysis if they calculated a correlation coefficient (r) for gender role and experimental pain. Searches yielded 4465 'hits' and 13 studies were eligible for review. Sample sizes were 67-235 participants and the proportion of female participants was 45-67%. Eight types of gender role instrument were used. Meta-analysis of six studies (406 men and 539 women) found a significant positive correlation between masculine and feminine personality traits and pain threshold and tolerance, with a small effect size (r = 0.17, p = 0.01). Meta-analysis of four studies (263 men and 297 women) found a significant negative correlation between gender stereotypes specific to pain and pain threshold and tolerance, with a moderate effect size (r = -0.41, p < 0.001). In conclusion, individuals who considered themselves more masculine and less sensitive to pain than the typical man showed higher pain thresholds and tolerances. Gender stereotypes specific to pain scales showed stronger associations with sex differences in pain sensitivity response than masculine and feminine personality trait scales. © 2012 European Federation of International Association for the Study of Pain Chapters.


Kolen A.F.,HIGH-TECH | De Nijs R.N.J.,Elkerliek Hospital | Wagemakers F.M.,HIGH-TECH | Meier A.J.L.,Maxima Medical Center | And 2 more authors.
Pain | Year: 2012

A novel device was developed that measured local electrical skin resistance and generated pulsed local electrical currents that were delivered across the skin around the knee for patients with osteoarthritis (termed eBrace TENS). Currents were delivered using an electrode array of 16 small circular electrode elements so that stimulation could be spatially targeted. The aim of this study was to investigate the effects of spatially targeted transcutaneous electrical nerve stimulation (TENS) to points of low skin resistance on pain relief and mobility in osteoarthritis of the knee (OAK). A randomised, controlled, 3-arm, parallel-group trial was designed that compared pain and function following a 30 to 45 minute intervention of TENS at specific locations depending on the local electrical skin resistance. Pain intensity by the visual analogue scale (VAS), 6-minute walk test, maximum voluntary contraction (MVC), and range-of-motion (ROM) were the primary outcomes. Lowest-resistance TENS reduced pain intensity during walking relative to resting baseline compared with random TENS (95% confidence interval of the difference: -20.8 mm, -1.26 mm). There were no statistically significant differences between groups in distance during the walk test, maximum voluntary contraction (MVC) or range-of-motion (ROM) measures or WOMAC scores. In conclusion, we provide evidence that use of a matrix electrode that spatially targets strong nonpainful TENS for 30 to 45 minutes at sites of low resistance can reduce pain intensity at rest and during walking. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


Chen C.,Leeds Beckett University | Chen C.,Leeds Pallium Research Group | Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group
Clinical Physiology and Functional Imaging | Year: 2010

Summary: Electrophysiological studies suggest that there are differential frequency effects during TENS. The aim of this experimental study was to assess the effects of strong non-painful TENS administered at 3 pulses per second (pps) and 80 pps on cold-pressor pain in healthy human participants. A repeated measure design was used with participants receiving TENS at 3 pps and 80 pps in the same experiment. There were six cold-pressor pain tests conducted on the hand with each type of TENS delivered via four electrodes on the ipsilateral forearm for 20 min. Outcomes were differences in pain threshold (s) and intensity (VAS) after 5 and 15 min of TENS. A 2 × 3 factorial repeated measure ANOVA was performed on data. Thirty-five participants completed the experiment. Statistically significant effects were detected for condition, time and interactions between time × condition for both threshold and intensity. There were statistically higher pain thresholds and lower pain intensities for 3 pps when compared to 80 pps after 5 and 15 min of TENS. The differences after 15 min of TENS were 1·70 s to 3·70 s (95% CI) for threshold and 6·63-15·5 mm (95% CI) for pain intensity. In conclusion, strong non-painful TENS at 3 pps was superior to 80 pps at reducing experimentally induced cold-pressor pain. The implications of these findings are discussed. © 2010 The Authors. Journal compilation © 2010 Scandinavian Society of Clinical Physiology and Nuclear Medicine.


Konopinski M.D.,Leeds Beckett University | Jones G.J.,Leeds Beckett University | Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group
American Journal of Sports Medicine | Year: 2012

Background: A recent meta-analysis found that generalized joint hypermobility is a risk factor for knee injuries during contact sports. The effect of hypermobility on the incidence of injuries in elite-level professional soccer players is not known.Purpose: To compare the incidence of injury between hypermobile and nonhypermobile elite-level male professional soccer players.Study Design: Cohort study; Level of evidence, 2.Methods: Fifty-four players from an English Premier League soccer club were assessed for hypermobility, using the 9-point Beighton scale (threshold, 4 points or above), at the start of the 2009-2010 season. Time-loss injuries and individual exposure times were recorded during all club training sessions and matches throughout the entire season.Results: Mean ± standard deviation incidence of injuries was 11.52 ± 11.39 injuries/1000 h, and the prevalence of hypermobility was 33.3% (18 of 54 players). There were 133 injuries during 13 897.5 hours of exposure. During the season, hypermobile participants had a higher incidence of injuries (mean [95% confidence interval] difference, 15.65 [9.18-22.13] injuries/1000 h; P =.001) and were more likely to experience at least 1 injury, a reinjury, and a severe injury compared with nonhypermobile participants. There were 9 severe knee injuries in hypermobile participants, of which 6 were cartilage injuries.Conclusion: There was an increased incidence of injury in hypermobile elite-level professional soccer players from an English Premier League club, resulting in more missed days from training and match play. These findings suggest a need for routine screening for hypermobility in professional soccer. © 2012 The Author(s).


Chen C.-C.,Leeds Beckett University | Chen C.-C.,Leeds Pallium Research Group | Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group
Clinical Journal of Pain | Year: 2011

INTRODUCTION: Electrophysiological studies show frequency-dependent effects of transcutaneous electrical nerve stimulation (TENS) in animal models of hyperalgesia. Evidence of frequency-dependent effects of TENS in humans is conflicting. Objective: To assess the effects of low-frequency and high-frequency TENS at a strong nonpainful intensity on experimentally induced ischemic pain. Methods: Submaximal effort tourniquet tests were carried out on 48 healthy human participants before (baseline) and during TENS at 3 pulsed currents per second (pps), 80 pps, and no current (placebo). TENS was switched on for 20 minutes and a submaximal effort tourniquet test was carried out during the final 5 minutes of the intervention. There was a 30-minute washout, with TENS switched off, between the interventions. Results: Repeated measure analysis of variance detected significant effects for pain intensity [100 mm Visual Analog Scale (VAS)] for condition (P<0.001), time (P<0.001), and time×condition (P=0.039). When compared with pre-TENS lower VAS scores were detected for placebo TENS (P=0.026) and 80 pps (P<0.001), but not for 3 pps (P=0.19). There were lower VAS scores for 80 pps than placebo (mean difference, 13.29 mm; 95% CI, 9.71, 16.87; P<0.001) and 3 pps (mean difference, 19.88 mm; 95% CI, 17.20-22.55; P<0.001), yet 3 pps scores were higher than placebo (mean difference, 6.58 mm; 95% CI 3.45, 9.72; P<0.001). There were significantly lower scores for sensory dimensions of the short-form McGill Pain Questionnaire for both 3 pps and 80 pps when compared with the placebo (P<0.001; P=0.005, respectively), but no significant differences between TENS at 80 and 3 pps (P=1.0). There were no significant effects detected for condition (P=0.217) or for condition×sequence interaction (P=0.800) for affective dimensions. Conclusions: Strong nonpainful TENS delivered at 80 pps reduced experimentally induced ischemic pain when compared with TENS delivered at 3 pps. Copyright © 2011 by Lippincott Williams & Wilkins.


Moran F.,University of Ulster | Leonard T.,University of Ulster | Hawthorne S.,University of Ulster | Hughes C.M.,University of Ulster | And 6 more authors.
Journal of Pain | Year: 2011

Transcutaneous electrical nerve stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naïve healthy individuals (18-64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset to 0 mA. Pressure pain thresholds (PPT) were recorded from 2 points on the hand and forearm before and after TENS to measure hypoalgesia. There were significant differences between groups at both the hand and forearm (ANOVA; P =.005 and.002). At 30 minutes, there was a significant hypoalgesic effect in the Strong Non Painful TENS group compared to: Below Sensory Threshold TENS, No Current Placebo TENS and Transient Placebo TENS groups (P <.0001) at the forearm; Transient Placebo TENS and No Current Placebo TENS groups at the hand (P =.001). There was no significant difference between Strong Non Painful TENS and Sensory Threshold TENS groups. The area under the curve for the changes in PPT significantly correlated with the current amplitude (r 2 =.33, P =.003). These data therefore show that there is a dose-response effect of TENS with the largest effect occurring with the highest current amplitudes. Perspective: This study shows a dose response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief. © 2011 by the American Pain Society.


Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group | Gohil M.,Leeds Beckett University
Scandinavian Journal of Pain | Year: 2016

Background and aims: Mirror visual feedback may be a useful clinical tool for reducing pain. Research suggests that reducing the size of a non-painful reflected hand can alleviate complex regional pain syndrome in the affected hand that is out of view. In contrast, research on healthy humans exposed to experimentally induced pain suggests that reducing the appearance of the size of a reflected body part can increase pain. The aim of this study was to investigate the effect of enlarging and reducing the visual appearance of the size of a hand using mirror visual feedback on pain threshold, intensity and tolerance in healthy human participants exposed to cold-pressor pain. Methods: Participants were a convenience sample of 20 unpaid, healthy pain free volunteers aged 18 years or above. Each participant took part in one experiment where they completed cold-pressor pain tests whilst observing normal, enlarged and reduced size reflections of a hand congruent to a hand immersed in the ice cold water. A 4. ×. 2 factorial repeated measures analysis of variance (ANOVA) was performed on time to pain threshold and pain tolerance, and pain intensity with Condition (four levels: no reflection, reduced reflection, normal reflection, enlarged reflection) being the within-subject factors and Sex (two levels: female, male) between-subject factors. Results: There were no significant effects for Condition, Sex, or Condition. ×. Sex interaction for pain threshold, intensity or tolerance (p> 0.05). There were no significant differences between the 3 mirror reflection conditions for agreement with the statements: "It felt like I was looking directly at my hand rather than at a mirror image"; "It felt like the hand I was looking at was my hand"; and "Did it seem like the hand you saw was a right hand or a left hand?". Conclusion: Enlarging or reducing the size of a hand using mirror visual feedback did not alter pain perception in healthy human participants exposed to cold-pressor pain. The different sizes of hands generated by mirror visual feedback created an illusion of looking at their own hand but this was not as strong as looking directly at the hand. Implications: In future, investigators and clinicians using mirror visual feedback may consider including an adaptive phase to ensure the reflection has been perceptually embodied. Reasons for the lack of effects are explored to inspire further research in the field. © 2015 Scandinavian Association for the Study of Pain.


Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group | Bjordal J.M.,Bergen University College | Bjordal J.M.,University of Bergen
Expert Review of Neurotherapeutics | Year: 2011

The management of neuropathic pain is challenging, with medication being the first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is used as an adjunct to medication. Clinical experience suggests that TENS is beneficial providing it is administered at a sufficiently strong intensity, close to the site of pain. At present, there are too few randomized controlled trials on TENS for neuropathic pain to judge effectiveness. The findings of systematic reviews of TENS for other pain syndromes are inconclusive because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration. The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future. © 2011 Expert Reviews Ltd.


Elzahaf R.A.,Leeds Beckett University | Elzahaf R.A.,Leeds Pallium Research Group | Tashani O.A.,Leeds Beckett University | Tashani O.A.,Leeds Pallium Research Group | And 3 more authors.
Current Medical Research and Opinion | Year: 2012

Background: To date, there are no systematic reviews of epidemiological studies of chronic pain in the developing world. Aim: To estimate the prevalence of chronic pain worldwide paying particular attention to data from countries with a Human Development Index (HDI) of less than 0.9. Methods: A literature search was conducted for cross-sectional surveys of chronic pain (≥3 months) in the adult general population using Medline, Embase, CINAHL, SportDiscus, Sciencedirect, CAS ILLUMINA, Academic search complete, PsycINFO and AMED. Forty-eight studies were identified and 29 of these were excluded because they surveyed children, the elderly or were longitudinal studies. Results: Weighted mean±SD prevalence of chronic pain worldwide was 30.3±11.7 (19 studies, 65 surveys, 34 countries, 182,019 respondents). There was no correlation between HDI and prevalence. In countries with a HDI<0.9 prevalence was 33.9±14.5 and significantly higher than prevalence in countries with a HDI of ≥0.9 (29.9±12.7), although removal of a large study that may have included a sample of individuals with comorbidities reduced the worldwide estimate to 28.0±11.8 (47 surveys, 33 countries, 139,770 participants). Interestingly, the estimate of countries with a HDI<0.9 to 24.8±8.9 (7 surveys, 7 countries, 6122 participants) became significantly lower than the estimate of countries with a HDI≥0.9 which was 28.1±11.6 (40 surveys, 21 countries, 133,648 participants). Conclusion: The review provides further evidence that the prevalence of chronic pain in the general population is high. However, there was insufficient reliable data to estimate with any certainty the prevalence of chronic pain in countries with an HDI<0.9 with variability in estimates between surveys being of concern. Subtle differences in review and survey methodology appeared to impact markedly on estimates. There is a need for epidemiological studies that estimate the prevalence of chronic pain in developing countries to determine the scale of the problem. © 2012 Informa UK Ltd.


Radford H.,Leeds Beckett University | Radford H.,The Leeds Teaching Hospitals NHS Trust | Radford H.,Leeds Pallium Research Group | Fitzgerald P.,Leeds Beckett University | And 3 more authors.
British Journal of Pain | Year: 2016

Introduction: Chronic pain is often managed using co-prescription of analgesics and adjuvants, with concomitant medication prescribed for comorbidities. Patients may have suboptimal response to some analgesics or be at risk of drug interactions or adverse drug reactions (ADRs) due to polypharmacy affecting CYP2D6 enzyme activity. The aim of the service improvement project was to determine the proportion of patients referred to a specialist pain service in the UK National Health Service (NHS) by general practitioners (GPs) who may be at risk of suboptimal analgesic response or ADRs due to CYP2D6 inhibition through polypharmacy. This was achieved by reviewing clinical prescribing information provided by GPs at time of referral. It was hoped that the findings could be used to aid clinical and prescribing decisions without conducting CYP2D6 genotyping or phenotyping. Methods: A review of letters from 250 patients referred to an NHS hospital pain service from GPs over a 3-month period was undertaken. Information about current and concomitant medications was analysed to identify the potential for CYP2D6 inhibition and adverse events. Results: Letters failed to provide information about current pain medication for 20 (8%) patients or non-pain concomitant medication for 54 (21.6%) patients. Of 176 patients, 52 (29.5%) patients with information about non-pain concomitant medication had been prescribed at least one known CYP2D6 inhibitor. A total of 35 (19.9%) patients were identified as being at risk of an adverse drug reaction and 33 (18.75%) patients at risk of suboptimal analgesic response due to co-administration of CYP2D6 inhibitors. Conclusion: The review revealed the need for improved detail in GP referral letters used to transfer care to UK NHS hospital pain clinics. There is a need to consider an individual’s CYP2D6 phenotype when prescribing analgesic prodrugs to manage persistent pain. Caution is needed when patients are co-prescribed codeine or tramadol with selective serotonin reuptake inhibitors (SSRIs). © 2016, © The British Pain Society 2016.

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