ORCID Profile
0000-0003-4339-3687
Current Organisation
Université Laval
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Publisher: The Journal of Rheumatology
Date: 12-2011
Abstract: To assess the effect of intramuscular botulinum toxin type A (BoNT-A) injections on pain, function/disability, global perceived effect, and quality of life (QOL) in adults with neck pain (NP). We searched Central, Medline, and Embase databases up to June 2010. A minimum of 2 authors independently selected articles, abstracted data, and assessed risk of bias and clinical applicability. We estimated standard mean differences (SMD) with 95% CI, relative risks (RR), and performed metaanalyses (SMD p ) using a random-effects model for nonheterogeneous data. The approach of the Grading of Recommendations Assessment, Development, and Evaluation working group summarizes the quality of evidence. We selected 14 trials. High-quality evidence suggested BoNT-A was no better than saline at 4 weeks [4 trials/183 participants SMD p −0.21 (95% CI −0.50 to 0.07)] and 6 months for chronic NP. Moderate-quality evidence showed a similar effect for subacute/chronic whiplash-associated disorder (WAD) on pain [4 trials/122 participants SMD p −0.21 (95% CI −0.57 to 0.15)], disability, and QOL. Very low-quality evidence indicated BoNT-A combined with exercise and analgesics was not significant for chronic NP reduction at 4 weeks [3 trials/114 participants SMD p −0.08 (95% CI −0.45 to 0.29)] but was at 6 months [2 trials/43 participants SMD p −0.66 (95% CI −1.29 to −0.04)]. Current evidence does not confirm a clinically or statistically significant benefit of BoNT-A used alone on chronic NP in the short term or on subacute/chronic WAD pain, disability, and QOL. Larger trials, subgroups, and predictors of responses defined a priori (to facilitate selection of patients most likely to benefit) and factorial designs to explore BoNT as an adjunct treatment to physiotherapeutic exercise and analgesics are needed.
Publisher: Wiley
Date: 21-05-2015
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.MATH.2016.04.005
Abstract: Neck pain (NP) is disabling and costly. To assess the effectiveness of exercise on pain, disability, function, patient satisfaction, quality of life (QoL) and global perceived effect (GPE) in adults with NP. We searched computerised databases up to May 2014 for randomized controlled trials (RCTs) comparing exercise to a control in adults with NP with/without cervicogenic headache (CGH) or radiculopathy. Two reviewers independently conducted selection, data abstraction and assessed risk of bias. Meta-analyses were performed to establish pooled standardised mean differences (SMDp). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) was used to summarise the body of evidence. The following exercises (27 trials) were supported by 'Moderate GRADE' evidence: For chronic NP, 1) cervico-scapulothoracic and upper extremity (UE) strengthening for moderate to large pain reduction immediately post treatment (IP) and at short-term (ST) follow-up 2) scapulothoracic and UE endurance training for a small pain reduction (IP/ST) 3) cervical, shoulder and scapulothoracic strengthening and stretching exercise for a small to large pain reduction in the long-term (LT) (SMDp -0.45 [95%CI: -0.72 to -0.18]) and function improvement 4) cervico-scapulothoracic strengthening/stabilisation exercises for pain and function at intermediate-term (IT) (SMDp -14.90 [95%CI: -22.40 to -7.39]). 5) mindfulness exercises (Qigong) for minor improved function but not GPE (ST). For chronic CGH, cervico-scapulothoracic strengthening and endurance exercises including pressure biofeedback for small/moderate improvement of pain, function and GPE (IP/LT). Specific strengthening exercises of the neck, scapulothoracic and shoulder for chronic NP and chronic CGH are beneficial. Future research should explore optimal dosage.
Publisher: Mary Ann Liebert Inc
Date: 04-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-06-2020
Publisher: Wiley
Date: 23-09-2015
Publisher: Informa UK Limited
Date: 19-07-2023
Publisher: Wiley
Date: 12-12-2022
DOI: 10.1111/PAPR.13189
Abstract: Exercise is the most recommended treatment for chronic low back pain (CLBP) and is effective in reducing pain, but the mechanisms underlying its effects remain poorly understood. Exercise‐induced hypoalgesia (EIH) may play a role and is thought to be driven by central pain modulation mechanisms. However, EIH appears to be disrupted in many chronic pain conditions and its presence in people with CLBP remains unclear. As people suffering from chronic pain often exhibit psychological factors and central sensitization symptoms influencing pain perception, EIH might be associated with these factors. The aim of this study is to compare the level of EIH between participants with and without CLBP following back and wrist exercises and to assess the associations between EIH, psychological factors, and symptoms of central sensitization (using the central sensitization inventory ‐ CSI) in CLBP. Twenty‐eight participants with CLBP and 23 without pain were recruited. Pressure pain thresholds (PPT) were measured at 4 sites (2 bony sites = capitate, S1|2 muscle sites = wrist flexors, lumbar erector spinae) before and after each of two exercises (wrist flexion and lumbar extension). Exercise‐induced hypoalgesia was defined as percent change in PPT from pre‐ to post‐exercise. Participants with CLBP also completed questionnaires to measure psychological factors (e.g., kinesiophobia, catastrophizing, anxiety, and self‐efficacy) and symptoms of central sensitization (CSI), and correlations with EIH were calculated. After wrist exercise, EIH measured at the muscle sites was lower in the CLBP group compared with the pain‐free group ( p = 0.047) but no differences were found at bony sites ( p = 0.49). No significant differences for EIH were observed following back exercise at muscle sites ( p = 0.14) or at bony sites ( p = 0.65). Exercise‐induced hypoalgesia was not correlated with any psychological factors or with the CSI score. The lower EIH following wrist exercises may represent an alteration in pain modulation control in CLBP. However, psychological factors and central sensitization symptoms may not explain the differences observed.
No related grants have been discovered for Pierre Langevin.