Effect of two contrasting types of physical exercise on chronic neck muscle pain. Assessing chronic pain in general practice: Are guidelines relevant? A cluster randomized controlled trial A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol Design of clinical trials for biomarker research in oncology.
OBJECTIVE The prevalence of neck muscle pain has steadily increased and especially pain from the descending part of the trapezius muscle has been associated with monotonous work tasks such as computer work . Physical exercise is generally recommended as treatment , but it is unclear which type of training is most effective . Our objective was to determine the effectiveness of specific strength training of the painful muscle versus general fitness training without direct involvement of the painful muscle ( leg bicycling ) on work-related neck muscle pain . METHODS We conducted a r and omized controlled trial and recruited subjects from 7 workplaces characterized by monotonous jobs ( e.g. , computer-intensive work ) . Forty-eight employed women with chronic neck muscle pain ( defined as a clinical diagnosis of trapezius myalgia ) were r and omly assigned to 10 weeks of specific strength training locally for the affected muscle , general fitness training performed as leg bicycling with relaxed shoulders , or a reference intervention without physical activity . The main outcome measure was an acute and prolonged change in intensity of neck muscle pain ( 100-mm visual analog scale [ VAS ] ) . RESULTS A decrease of 35 mm ( approximately 79 % ; P<0.001 ) in the worst VAS pain score over a 10-week period was seen with specific strength training , whereas an acute and transient decrease in pain ( 5 mm ; P<0.05 ) was found with general fitness training . CONCLUSION Specific strength training had high clinical relevance and led to marked prolonged relief in neck muscle pain .  General fitness training showed only a small yet statistically significant acute pain reduction Objectives : To evaluate the impact of using pain assessment scales on the management of musculoskeletal chronic pain . Methods : Cluster-r and omized controlled multicentre trial in French general practice setting s. Practice s were r and omized by region before patient recruitment . The inclusion concerned patients suffering from musculoskeletal chronic pain . General practitioners assigned to the scale group used two vali date d assessment instruments ; those assigned to the control group cared for their patients according to their usual practice . The primary end-point was the level of relief obtained and the secondary changes in prescription of painkilling modalities . Results : A total of 155 general practitioners included 772 successive patients suffering from musculoskeletal chronic pain . The control group reported a mean level of relief of 50.7 % compared with one of 41.1 % in the scale group ( p<0.0001 ) . In the intervention group , physicians decreased significantly their prescription of  level two painkillers .  Conclusions . In general practice , the use of pain assessment scales is not associated with greater pain relief . The lesser level of pain relief obtained in the scale group does provide evidence that using pain assessment scales does not enhance the relief of chronic pain in patients in primary care . Guidelines which recommend the systematic use of scales for the assessment and monitoring of chronic pain are not tailored to either the context or the patients encountered in the primary care setting Purpose There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome . However , what is unclear are the parameters underpinning this intervention . This has led to uncertainty when operationalizing exercises for patients with patellofemoral pain syndrome in clinical practice . The aim of this review was to evaluate the parameters of exercise programs reported in primary research , to provide clinicians with evidence -based recommendations for exercise prescription for patellofemoral pain . Methods A systematic review of r and omized controlled trials was undertaken . Only trials that identified exercise to be effective in treating patellofemoral pain were included . Appropriate data bases and reference lists were search ed using established keywords . Data relating to common exercise parameters such as the type of exercise , length , and frequency of intervention , intensity , repetitions , sets , and specific technique were extracted , along with details of co- interventions that may have been used . Results A total of ten r and omized controlled trials were included in this review and from these trials 14 interventions arms were evaluated . All 14 interventions focused on active exercises , all but two of which also included a passive stretching component . The current body of evidence demonstrates positive results with exercise interventions such as  knee extension , squats , stationary cycling , static quadriceps , active straight leg raise , leg press , and step-up and down exercises  for patients with patellofemoral pain syndrome . A progressive regime of daily exercises of two to four sets of ten or more repetitions over an intervention period of 6 weeks or more , combined with exercises to address flexibility of the lower limb musculature was commonly used . Conclusion Currently , the primary research on this topic supports the use of closed kinetic chain , strengthening exercises for musculature of the lower limb , combined with flexibility options . The current evidence base supports a prescription of daily exercises of two – four sets of ten or more repetitions over a period of 6 weeks or more Background Knee osteoarthritis ( OA ) is a prevalent chronic musculoskeletal condition with no cure . Pain is the primary symptom and results from a complex interaction between structural changes , physical impairments and psychological factors . Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population . There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training ( PCST ) particularly in other chronic pain conditions . Though typically provided separately , there are symptom , re source and personnel advantages of exercise and PCST being delivered together by a single healthcare professional . Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management . No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population . The primary aim of this multisite r and omised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA . Methods / design This will be an assessor-blinded , 3-arm r and omised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice . Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and r and omized into one of three groups : exercise alone , PCST alone , or integrated PCST and exercise .  R and omisation will be stratified by city ( Melbourne or Brisbane ) and gender . Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale . Secondary outcomes include global rating of change , muscle strength , functional performance , physical activity levels , health related quality of life and psychological factors . Measurements will be taken at baseline and immediately following the intervention ( 12 weeks ) as well as at 32 weeks and 52 weeks to examine maintenance of any intervention effects . Specific assessment of adherence to the treatment program will also be made at weeks 22 and 42 . Relative cost-effectiveness will be determined from health service usage and outcome data . Discussion The findings from this r and omised controlled trial will provide evidence for the efficacy of an integrated PCST and exercise program delivered by physiotherapists in the management of painful and functionally limiting knee OA compared to either program alone . Trial registration Australian New Zeal and Clinical Trials Registry reference number : The developmental pathway from discovery to clinical practice for biomarkers and biomarker-directed therapies is complex . While several issues need careful consideration , two critical issues that surround the validation of biomarkers are the choice of clinical trial design ( which is based on the strength of the preliminary evidence and marker prevalence ) and the biomarker assay related issues surrounding the marker assessment methods such as the reliability and reproducibility of the assay . This review focuses on trial design s for marker validation , both in the setting of early phase trials for initial validation , as well as in the context of larger definitive trials . Design s for biomarker validation are broadly classified as retrospective ( i.e. , using data from previously well-conducted , r and omized , controlled trials ) or prospect i ve ( enrichment , allcomers or adaptive ) . We believe that the systematic evaluation and implementation of these design strategies are essential to accelerate the clinical validation of biomarker-guided therapy , thereby taking us a step closer to the goal of personalized medicine
Inflammatory markers were most commonly measured followed by neurotransmitter-related genes and metabolite-detecting genes .
After exercise interventions , changes in biomarkers involved in neurotransmission and inflammation suggest a hypoalgesic exercise effect .
Significant biomarker associations were found with pain intensity , fatigue , depression , anxiety , and quality of life .
Discussion : It remains a question whether biomarkers can be used as objective measures for risk assessment , diagnosis , or evaluation or as surrogate endpoints in chronic pain .
Regardless , the potential translational value of biomarkers in chronic pain is evident .
Background : Chronic pain is highly prevalent .
Current management is challenged by lack of vali date d objective measures like biological markers .
Clinical pain studies employing exercise interventions have evaluated biomarkers ; however , it is unclear how exercise impacts biomarkers involved in pain pathways and whether these markers are associated with relevant pain-related outcomes .
This systematic review evaluates data from clinical studies employing exercise interventions in chronic musculoskeletal nonmalignant pain conditions in which biomarkers in pain pathways were measured .