Abstract
Study design
Case series
Objectives
The temporal relationships between exercise, neuropathic pain and affect are not well understood. The purpose of this study was to utilize ecological momentary assessment to measure intra-individual diurnal variations in neuropathic pain and affect on exercise and non-exercise days. This study aimed to provide a deeper understanding of how neuropathic pain and affect change from pre- to post-exercise, and over time.
Setting
Community.
Methods
Six physically active men with SCI participated in a 6-day protocol (Mage = 39.33 ± 8.24; 83.3% tetraplegics; years post injury = 6–17 years). Using their Smartphones, participants completed the Feeling Scale, Felt Arousal Scale, and Neuropathic Pain Scale in response to six daily prompts, and before and after exercise. Paired samples t-tests were conducted on changes in neuropathic pain and affect from pre to post-exercise. Bivariate Pearson’s correlational analyses were computed between time of day, neuropathic pain and affect.
Results
Participants experienced a significant decrease in neuropathic pain (t(5) = 3.93; p = 0.01) following completion of at least one bout of exercise. A large, but non-significant increase (Hgav = 0.76) in Feeling Scale scores occurred following one bout of exercise. Time of day, neuropathic pain and affect were significantly correlated for two participants.
Conclusions
Overall, results suggest exercise can reduce neuropathic pain, and may also increase feelings of pleasure. Given the inconsistent pattern of results across participants, further research is needed to look at both individual characteristics, and characteristics of exercise that may moderate changes in neuropathic pain and affect for adults with SCI.
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References
Finnerup NB, Jensen MP, Norrbrink C, Trok K, Johannesen IL, Jensen TS, et al. A prospective study of pain and psychological functioning following traumatic spinal cord injury. Spinal Cord. 2016;54:816–21.
Burke D, Fullen BM, Stokes D, Lennon O. Neuropathic pain prevalence following spinal cord injury: A systematic review and meta‐analysis. Eur J Pain. 2017;21:29–44.
IASP. IASP taxonomy. 2012. . http://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698&navItemNumber=576. Accessed Date April 4, 2018
Anson CA, Shepherd C. Incidence of secondary complications in spinal cord injury. International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Rev Int De Rech De Readapt. 1995;19:55–66.
Backonja MM, Stacey B. Neuropathic pain symptoms relative to overall pain rating. J Pain. 2004;5:491–7.
Cruz-Almeida Y, Felix ER, Martinez-Arizala A, Widerström-Noga EG. Pain symptom profiles in persons with spinal cord injury. Pain Med. 2009;10:1246–59.
Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms. Lancet Neurol. 2014;13:924–35.
Guy SD, Mehta S, Casalino A, Côté I, Kras-Dupuis A, Moulin DE, et al. The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord: recommendations for treatment. Spinal Cord. 2016;54(S1):S14.
Ragnarsson K. Management of pain in persons with spinal cord injury. J Spinal Cord Med. 1997;20:187–99.
Warms CA, Turner JA, Marshall HM, Cardenas DD. Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful. Clin J Pain. 2002;18:154–63.
Hutchinson KJ, Gómez‐Pinilla F, Crowe MJ, Ying Z, Basso DM. Three exercise paradigms differentially improve sensory recovery after spinal cord contusion in rats. Brain. 2004;127:1403–14.
Boldt I, Eriks-Hoogland I, Brinkhof MW, de Bie R, Joggi D, von Elm E. Non-pharmacological interventions for chronic pain in people with spinal cord injury. Cochrane Database Syst Rev. 2014;11:69–74.
Crane DA, Hoffman JM, Reyes MR. Benefits of an exercise wellness program after spinal cord injury. J Spinal Cord Med. 2015;25:1–5.
Hicks AL, Martin KA, Ditor DS, Latimer AE, Craven C, Bugaresti J, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord. 2003;41:34–43.
Martin Ginis KA, Latimer AE, McKecknie K, Ditor DS, McCartney N, Hicks AL. Using exercise to enhance subjective wellbeing among people with spinal cord injury: the mediating influences of stress and pain. Rehabil Psychol. 2003;48:157–64.
Norrbrink C, Lindberg T, Wahman K, Bjerkefors A. Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury—results from a seated double-poling ergometer study. Spinal Cord. 2012;50:457–61.
Celik EC, Erhan B, Lakse E. The clinical characteristics of neuropathic pain in patients with spinal cord injury. Spinal Cord. 2012;50:585–9.
Kratz AL, Ehde DM, Bombardier CH, Kalpakjian CZ, Hanks RA. Pain acceptance decouples the momentary associations between pain, pain interference, and physical activity in the daily lives of people with chronic pain and spinal cord injury. J Pain. 2017;18:319–31.
Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol. 2008;4:1–32.
May M, Junghaenel DU, Ono M, Stone AA, Schneider S. Ecological momentary assessment methodology in chronic pain research: a systematic review. J Pain. 2018;19:699–716.
Ekkekakis P. The measurement of affect, mood, and emotion: a guide for health-behavioral research. Cambridge; Cambridge University Press; 2013.
Rodrigues D, Tran Y, Wijesuriya N, Guest R, Middleton J, Craig A. Pain intensity and its association with negative mood States in patients with spinal cord injury. Pain Ther. 2013;2:113–9.
Hagglund KJ, Haley WE, Reveille JD, Alarcon GS. Predicting individual differences in pain and functional impairment among patients with rheumatoid arthritis. Arthritis Rheum. 1989;32:851–8.
Smedstad LM, Mourn T, Vaglum P, Kvien TK. The impact of early rheumatoid arthritis on psychological distress. Scand J Rheumatol. 1996;25:377–82.
Dua JK. The role of negative affect and positive affect in stress, depression, self-esteem, assertiveness, type A behaviors, psychological health, and physical health. J Soc Psychol. 1993;119:515–52.
Ginis KM, Latimer AE. The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury. Spinal Cord. 2007;45:112–5.
Bani MA, Arazpour M, Farahmand F, Kashani RV, Mousavi ME, Hutchins SW. Comparison of new medial linkage reciprocating gait orthosis and isocentric reciprocating gait orthosis on energy consumption in paraplegic patients: a case series. Spinal Cord Ser Cases. 2015;1:15012.
Grassner L, Geuther M, Mach O, Bühren V, Vastmans J, Maier D. Charcot spinal arthropathy: an increasing long-term sequel after spinal cord injury with no straightforward management. Spinal Cord Ser Cases. 2015;1:15022.
Jayaraman A, Shah P, Gregory C, Bowden M, Stevens J, Bishop M, et al. Locomotor training and muscle function after incomplete spinal cord injury: case series. J Spinal Cord Med. 2008;31:185–93.
Kumru H, Albu S, Vidal J, Barrio M, Santamaria J. Dopaminergic treatment of restless legs syndrome in spinal cord injury patients with neuropathic pain. Spinal Cord Ser Cases. 2016;2:16022.
Pandey S, Holla VV, Rizvi I, Qavi A, Shukla R. Can vitamin B12 deficiency manifest with acute posterolateral or posterior cord syndrome? Spinal Cord Ser Cases. 2016;2:16006.
Ginis KM, Hicks AL, Latimer AE, Warburton DE, Bourne C, Ditor DS, et al. The development of evidence-informed physical activity guidelines for adults with spinal cord injury. Spinal Cord. 2011;49:1088–96.
Tuomenoksa, M. Ilumivu: ecological momentary assessment. 2013. http://www.ilumivu.com/index.php?section=41&chapter=54. Accessed Date April 4, 2018
Tsang KL, Yong HJR, Ding D. Measuring heart rate in manual wheelchair users during exercise and free-living activity with the latest Fitbit surge monitor. conference: rehabilitation engineering and assistive technology society of North America. 2016.
Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain The Neuropathic Pain Scale. Neurology. 1997;48:332–8.
Hardy CJ, Rejeski WJ. Not what, but how one feels: the measurement of affect during exercise. J Sport Exerc Psychol. 1989;11:304–17.
Svebak S, Murgatroyd S. Metamotivational dominance: a multimethod validation of reversal theory constructs. J Pers Soc Psychol. 1985;48:107–16.
Watson D, Clark LA. Measurement and mismeasurement of mood: recurrent and emergent issues. J Pers Assess. 1997;8:267–96.
Focht BC, Ewing V, Gauvin L, Rejeski WJ. The unique and transient impact of acute exercise on pain perception in older, overweight, or obese adults with knee osteoarthritis. Ann Behav Med. 2002;24:201–10.
Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863.
Cohen J. Statistical power analysis for the behavioural sciences (Revised edition). Academic Press; New York;1989. p. 7.
Farrar JT, Young Jr JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58.
Field A. Discovering statistics using IBM SPSS statistics. Cambridge;Sage; 2013.
Ditor DS, Kamath MV, MacDonald MJ, Bugaresti J, McCartney N, Hicks AL. Effects of body weight-supported treadmill training on heart rate variability and blood pressure variability in individuals with spinal cord injury. J Appl Physiol. 2005;98:1519–25.
Grigorean VT, Sandu AM, Popescu M, Iacobini MA, Stoian R, Neascu C, et al. Cardiac dysfunctions following spinal cord injury. J Med Life. 2009;2:133.
Elkington TJ, Cassar S, Nelson AR, Levinger I. Psychological responses to acute aerobic, resistance, or combined exercise in healthy and overweight individuals: a systematic review. Clin Med Insights Cardiol. 2017;11:1–23.
Ekkekakis P, Hall EE, Petruzzello SJ. Variation and homogeneity in affective responses to physical activity of varying intensities: an alternative perspective on dose–response based on evolutionary considerations. J Sports Sci Med. 2005;23:477–500.
Strian F, Lautenbacher S, Galfe G, Hölzl R. Diurnal variations in pain perception and thermal sensitivity. Pain. 1989;36:125–31.
Rolstad S, Adler J, Rydén A. Response burden and questionnaire length: is shorter better? A review and meta-analysis. Value Health. 2011;14:1101–8.
Widerström-Noga E, Biering-Sørensen F, Bryce TN, Cardenas DD, Finnerup NB, Jensen MP, et al. The international spinal cord injury pain basic data set (version 2.0). Spinal Cord. 2014;52:282–6.
Authors contributions
KMG supervised the project and provided assistance with design of the research study, measurement selection, obtaining ethics approval, analysis and interpretation of the data, and manuscript preparation. KT was responsible for authoring the ethics application that was submitted to the BREB at UBC (Okanagan), as well as the design of the research study. Furthermore, she selected which measures would be used, and was the sole investigator responsible for participant recruitment, participant contact and training participants how to utilize the apparatus. Last, KT was responsible for all data collection, input and analysis.
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Todd, K.R., Martin Ginis, K.A. An examination of diurnal variations in neuropathic pain and affect, on exercise and non-exercise days, in adults with spinal cord injury. Spinal Cord Ser Cases 4, 94 (2018). https://doi.org/10.1038/s41394-018-0130-3
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DOI: https://doi.org/10.1038/s41394-018-0130-3
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