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Homberg TJW1, Gallego-Sendarrubias G2, Voogt LP1,3
1Rotterdam University of Applied Sciences, Department of Physical Therapy Studies, Rotterdam, Netherlands, 2Camilo José Cela University, Physiotherapy Department, Madrid, Spain, 3Pain in Motion International Research Group, Brussels, Belgium
Background: Verbal messages shared in physical therapy practice carry meanings that can either be interpreted as reassuring or threatening. Research has shown that verbal messages can have effect on self-reported pain. However, the concrete effect of verbal messages in physical therapy practice is scarce and deserves more attention.
Purpose: A randomised controlled trial was conducted in order to determine the effect of a verbal message on exercise-induced pain and (local and remote) pain pressure thresholds in healthy adolescents.
Methods: A double-blind randomized study was executed including 42 healthy participants (aged between 18 - 22). Participants were allocated in either an intervention group or a control group using a computerised random number generator performing blocked randomisation, blinding the interventions with a 1:1 allocation ratio. Exercise induced pain was created in both groups following a Delayed Onset Muscle Soreness (DOMS) protocol to induce muscle pain in the biceps brachii muscle. In the intervention group, a verbal message (''as a result of this training program you can get severe muscle pain in the forthcoming days'') was given three times during the session (before the start of the intervention, directly after and after the intervention ended) in the intervention group. In the control group, nothing was said about pain or other detrimental effects as a consequence of the exercise. Measurements and interventions were executed by four senior-year students physical therapy.
Outcome measurement consisted of pain intensity (VAS) and local (left and right mm. biceps brachii) and remote (right m. triceps surae) Pain Pressure Threshold measurements (PPT). PPT measurements were taken before the start of the intervention, directly after and after forty-eight hours. Self-reported pain intensity was measured after 48-hours. Measurements were taken by assessors blinded for group allocation.
Data-analysis was carried out using a mixed-ANOVA (for PPT's) and independent T-test (for self-reported pain).
Ethical approval was provided by the institutional ethical committee. Informed consent was obtained prior to the start of the study.
Results: Results of the study reveal a significant difference in pain intensity between both groups (higher in intervention group) at follow-up (mean difference: 2.33, p .001). Local (ipsi- and contralateral PPT's) and remote PPT's (lower leg) showed all significant differences in both groups (F(2,80) = 20.65, P .001 (right M. biceps humeri), F(2,80) = 16.62, P .001 (left M. biceps humeri), F(2,36) = 8.58, p = .001(right M. triceps surae)). PPT's were lower at both local and remote locations after the exercise bout.
Conclusion(s): A verbal message has a significant effect on exercise-induced pain intensity. Participants that were warned to expect pain, reported more self-reported pain then participants in the control group. Besides that, not only local PPT's, but also PPT's on the contralateral side and PPT's on the leg were lower following the exercise bout. This points to central effects of the execution of a DOMS-protocol in healthy adolescents.
Implications: The results of this study show the potential effect of verbal messages in physical therapy practice. Further studies in a clinical population are warranted.
Keywords: Verbal messages, Pain intensity, Pressure pain thresholds
Funding acknowledgements: None.
Purpose: A randomised controlled trial was conducted in order to determine the effect of a verbal message on exercise-induced pain and (local and remote) pain pressure thresholds in healthy adolescents.
Methods: A double-blind randomized study was executed including 42 healthy participants (aged between 18 - 22). Participants were allocated in either an intervention group or a control group using a computerised random number generator performing blocked randomisation, blinding the interventions with a 1:1 allocation ratio. Exercise induced pain was created in both groups following a Delayed Onset Muscle Soreness (DOMS) protocol to induce muscle pain in the biceps brachii muscle. In the intervention group, a verbal message (''as a result of this training program you can get severe muscle pain in the forthcoming days'') was given three times during the session (before the start of the intervention, directly after and after the intervention ended) in the intervention group. In the control group, nothing was said about pain or other detrimental effects as a consequence of the exercise. Measurements and interventions were executed by four senior-year students physical therapy.
Outcome measurement consisted of pain intensity (VAS) and local (left and right mm. biceps brachii) and remote (right m. triceps surae) Pain Pressure Threshold measurements (PPT). PPT measurements were taken before the start of the intervention, directly after and after forty-eight hours. Self-reported pain intensity was measured after 48-hours. Measurements were taken by assessors blinded for group allocation.
Data-analysis was carried out using a mixed-ANOVA (for PPT's) and independent T-test (for self-reported pain).
Ethical approval was provided by the institutional ethical committee. Informed consent was obtained prior to the start of the study.
Results: Results of the study reveal a significant difference in pain intensity between both groups (higher in intervention group) at follow-up (mean difference: 2.33, p .001). Local (ipsi- and contralateral PPT's) and remote PPT's (lower leg) showed all significant differences in both groups (F(2,80) = 20.65, P .001 (right M. biceps humeri), F(2,80) = 16.62, P .001 (left M. biceps humeri), F(2,36) = 8.58, p = .001(right M. triceps surae)). PPT's were lower at both local and remote locations after the exercise bout.
Conclusion(s): A verbal message has a significant effect on exercise-induced pain intensity. Participants that were warned to expect pain, reported more self-reported pain then participants in the control group. Besides that, not only local PPT's, but also PPT's on the contralateral side and PPT's on the leg were lower following the exercise bout. This points to central effects of the execution of a DOMS-protocol in healthy adolescents.
Implications: The results of this study show the potential effect of verbal messages in physical therapy practice. Further studies in a clinical population are warranted.
Keywords: Verbal messages, Pain intensity, Pressure pain thresholds
Funding acknowledgements: None.
Topic: Pain & pain management
Ethics approval required: Yes
Institution: Department of Physical Therapy Studies, Rotterdam University of applied sciences
Ethics committee: Institutional ethical committee
Ethics number: The ethical committee didn’t provide a number
All authors, affiliations and abstracts have been published as submitted.
