Influence of Expectations on Change in Pain Perception After a 3 Min Wallsquat Exercise.

NCT ID: NCT03678662

Last Updated: 2018-11-26

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 83 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-09-19
• Study Completion Date: 2018-11-22

Brief Summary

The purpose of this study is to investigate how expectations induced by information given prior to exercise influence the magnitude of exercise-induced hypoalgesia after a 3 min wallsquat exercise in healthy subjects. The study is a double blinded (participant, investigator) randomized controlled trial The results from the study may be of great importance to the understanding of exercise-induced hypoalgesia, and whether the information related to exercise as pain relief can be used in practice for patients with pain.

The subjects are randomized to 1 in 3 groups. Hypoalgesia expectation, hyperalgesia expectation, neutral expectation. Each group (besides the neutral group) is given different information of what to expect on pain ratings after a 3 minutes wallsquat.

Detailed Description

Painful conditions are a major societal and economic problem and in Denmark, almost every fifth person suffers from long-lasting pain. Effective treatment of these conditions is vital not only to alleviate the pain but also to prevent repeated episodes of personal disorder and impaired work ability. Based on the hypothesis that physical activity and exercise lead to a change in pain perception, Pain Center South, Odense University Hospital has conducted a series of research projects which have investigated the immediate effect of various types of acute exercise on the pain sensitivity of both healthy subjects, patients with chronic pain in the knee and in patients with more 'complex' chronic pain who were referred to treatment at the Pain Center. The results showed that healthy subjects achieved a reduced overall pain sensitivity after both high intensity aerobic exercise (cycling) and low and high intensity isometric training (strength-like exercise on the arm and leg). This phenomenon is called 'exercise-induced hypoalgesia' or 'training-induced pain relief'. A recently published study from Australia has also shown that the effect of exercise can be positively influenced by the information given prior to exercise, indicating that some of the experience of exercise may be related to expectations of the effect. This may be one of the reasons why patients with chronic pain do not experience a positive effect, as opposed to healthy people, as chronic pain patients may previously have experienced no effect of exercise or perhaps even worsening / flareup in post-workout pain.

The purpose of this study is to investigate how expectations induced by information given prior to exercise influence the magnitude of exercise-induced hypoalgesia after a 3 min wallsquat exercise in healthy subjects. The pain sensitivity of the deep structures is investigated with two different pressure-gauges for the testing of mechanical pressure pain sensitivity. Pain sensitivity is examined on the leg and arm before and after the exercise. Pressure-sensitivity is evaluated using a handheld pressure-algometer for testing mechanical pressure pain-threshold in the deeper musculoskeletal structures. The pain-threshold is evaluated on the thigh and shoulder.

To investigate additional facets of pain-sensitivity, computer-controlled cuff geometry is used. The computer-controlled cuff algorithm is less affected by local differences in pain sensitivity to the handheld pressure algometer and the cuff algorithm can also affect a larger portion of the deep tissue than the pressure algometer can.

The cuff gauge consists of a blood pressure cuff placed around one lower leg and then slowly inflated. The pain response is registered continuously and the stimulus response function can then be established. The cuff algorithm has a maximum pressure that ensures no tissue damage to the subject and the device is automatically stopped at 100 kPa. Both the handheld pressure gauge and the cuff algorithm have proven to be a valid and reliable techniques for investigating the pain-sensitivity of healthy subjects.

The person performing the measurements before and after the exercise is blinded to what information the subject has received, likewise the patient is blinded to the group randomization.

Conditions

Pain; Physical Activity

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: DOUBLE

Study Groups

hyperalgesia expectation

In this group the subjects will be told that the 3 minutes wall squat will have pain-enhancing effects.

Group Type: EXPERIMENTAL

Neutral

Intervention Type: OTHER

"Soon you are going to do a training exercise in a squat position up against the wall for 3 min. Following the squat exercise, we will repeat the measurement of how you experience pressure pain with the 2 devices you have just become acquainted with. While doing the squat exercise you will be asked to indicate pain in the thigh muscles."

hypoalgesia expectation

In this group the subjects will be told that the 3 minutes wall squat will have pain-diminishing effects.

Group Type: EXPERIMENTAL

Hypoalgesia expectation

Intervention Type: OTHER

"Before and after the squat exercise, assessment of how you experience pressure pain with the 2 devices you have just become acquainted with will be repeated. While doing the squat exercise you will be asked to indicate pain in the thigh muscles.

What we currently know about the effect of exercise on the experience of pressure pain is that after eg. cycling or walking, more pressure can be applied before the pressure starts to hurt and more pressure is required before you can't withstand anymore.

Whether this applies to a squat exercise, as the one you are about to perform, has not yet been investigated, but we expect that the same applies here, namely, that more pressure is required before you feel the pressure begins to hurt you and you will be able to endure a greater pressure."

Supported by visual information.

Neutral

In this group the subjects expectations are not manipulated

Group Type: ACTIVE_COMPARATOR

Hyperalgesia expectation

Intervention Type: OTHER

"Before and after the squat exercise, assessment of how you experience pressure pain with the 2 devices you have just become acquainted with will be repeated. While doing the squat exercise you will be asked to indicate pain in the thigh muscles.

What we currently know is that exercise can cause muscle pain, both during and after training. You may have experienced muscle soreness yourself in relation to training? We expect that the same will apply here. Namely, after performing this squat exercise, which will likely hurt your thigh muscles while doing it, you will experience that the pressure applied afterwards, with the two devices you have just become acquainted with, should be less before it starts to hurt and that you can endure less pressure."

Supported by visual information.

Interventions

Hypoalgesia expectation

"Before and after the squat exercise, assessment of how you experience pressure pain with the 2 devices you have just become acquainted with will be repeated. While doing the squat exercise you will be asked to indicate pain in the thigh muscles.

What we currently know about the effect of exercise on the experience of pressure pain is that after eg. cycling or walking, more pressure can be applied before the pressure starts to hurt and more pressure is required before you can't withstand anymore.

Whether this applies to a squat exercise, as the one you are about to perform, has not yet been investigated, but we expect that the same applies here, namely, that more pressure is required before you feel the pressure begins to hurt you and you will be able to endure a greater pressure."

Supported by visual information.

Intervention Type: OTHER

Hyperalgesia expectation

"Before and after the squat exercise, assessment of how you experience pressure pain with the 2 devices you have just become acquainted with will be repeated. While doing the squat exercise you will be asked to indicate pain in the thigh muscles.

What we currently know is that exercise can cause muscle pain, both during and after training. You may have experienced muscle soreness yourself in relation to training? We expect that the same will apply here. Namely, after performing this squat exercise, which will likely hurt your thigh muscles while doing it, you will experience that the pressure applied afterwards, with the two devices you have just become acquainted with, should be less before it starts to hurt and that you can endure less pressure."

Supported by visual information.

Intervention Type: OTHER

Neutral

"Soon you are going to do a training exercise in a squat position up against the wall for 3 min. Following the squat exercise, we will repeat the measurement of how you experience pressure pain with the 2 devices you have just become acquainted with. While doing the squat exercise you will be asked to indicate pain in the thigh muscles."

Intervention Type: OTHER

Other Intervention Names

Randomization group a; Randomization group b; Randomization group c

Eligibility Criteria

Inclusion Criteria

• Healthy subjects without current recurrent or prolonged painful diseases.
• The subjects should speak and understand Danish.

Exclusion Criteria

• Pregnancy
• Previous addictive behavior defined as abuse of hash, opioids or other euphoric substances.
• Previous painful or mental illnesses, neurological or circulatory diseases in the form of heart or lung disease.
• Lack of co-operation.
• Subjects who perform elite sports.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Southern Denmark

OTHER

Sponsor Role: collaborator

Odense University Hospital

OTHER

Sponsor Role: lead

Responsible Party

Peter Thinggaard

Stud. M.Sc. Physiotherapy

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Gitte Handberg, MD

Role: STUDY_DIRECTOR

Pain Center, OUH

Locations

Pain Center South

Odense, Fyn, Denmark

Countries

Denmark

References

Vaegter HB, Thinggaard P, Madsen CH, Hasenbring M, Thorlund JB. Power of Words: Influence of Preexercise Information on Hypoalgesia after Exercise-Randomized Controlled Trial. Med Sci Sports Exerc. 2020 Nov;52(11):2373-2379. doi: 10.1249/MSS.0000000000002396.

Reference Type: DERIVED

PMID: 32366799 (View on PubMed)

Other Identifiers

62039

Identifier Type: -

Identifier Source: org_study_id