Purpose: This preliminary study aimed to determine the intrarater reliability of the quantitative tests for the study of non-specific low back pain.Methods: Test-retest reliability of the measurements of ratio data was determined by an intraclass correlation coefficient (ICC), standard error of measurements (SEMs), coefficient of variation (CV), and one-way repeated measures ANOVA using the values collected from 13 young individuals (25.8±6.2 years) with chronic non-specific low back pain on two occasions separated by 2 days. Percent agreement of the ordinal data was also determined by Cohen’s Kappa statistics (kappa). The measures consisted of tissue blood flow (BF), average pain visual analog scales (VAS), Pressure pain threshold (PPT), cold pain threshold (CPT), heat pain threshold (HPT) and lumbo-pelvic stability test (LPST). An acceptable reliability was determined as the ICC values of greater than 0.85, SEMs less than 5%, CV less than 15%, the kappa scores of greater than 80% and no evidence of systematic error (ANOVA, P>0.05).Results: ICC of all measures in the lumbo-sacral area were greater than 0.87. The kappa was also greater than 83%. Most measures demonstrated a minimal error of measurements and less potential of systemic error in nature.Only the SEMs and the CV of the CPT exceeded the acceptable level.Conclusions: It is concluded that most of the quantitative measurements are reliable for the study of non-specific low back pain, however the CPT should be applied with care as it has a great variation among individuals and potential of measurement error.

Purpose: The purpose of the present study was to evaluate the association of ultrasonography findings with pain, range of motion, disability, and Pressure pain threshold in patients with upper trapezius myofascial pain syndrome.Methods: A total of 60 subjects with upper trapezius myofascial pain syndrome (mean age: 25.90±4.47 y; mean weight: 63.53±7.76 kg; mean height: 166.55±5.65 cm; and pain duration: 9.75±6.04 month) were selected with nonprobability convenient sampling method and examined. After methodological study, all participants were evaluated regarding their pain, cervical range of motion, functional disability, Pressure pain threshold (PPT), maximum muscle and fascia thickness as well as strain ratio by the following instruments, respectively: visual analogue scale, goniometry, neck disability index, algometer, sonography, and sonoelastography.Results: The ICC values for intra- and inter-examiner reliability of variables were high to very high (0.72-0.96). The correlation coefficients between pain (r=0.22), range of motion (r=0.11), disability (r=0.13), PPT (r=0.32), and maximum thickness of muscle were moderate. The correlation coefficients between pain (r=0.13), range of motion (r=0.23), disability (r=0.17), PPT (r=0.23) and maximum thickness of fascia were low. The correlation coefficients between pain (r=-0.65), range of motion (r=-0.23), disability (r=-0.41), PPT (r=0.71) were high. Values of β for strain ratio and pain were -0.35 (P=0.01), range of motion, -0.14, (P=0.03); disability, -0.19, (P=0.03); and PPT, 0.41 (P<0.001).Conclusion: Strain ratio of upper trapezius muscle in subjects with myofascial pain syndrome has strong correlation with pain, disability, and PPT. However, maximum muscle thickness and fascia of the upper trapezius are correlated with these variables poorly. PPT is the highly correlated factor with strain ratio.

Introduction: The number of diabetics has progressively increased in recent decades. pain is reported as one of the main complaints of these patients. On the other hand, in case of resistance exercises, there is no sufficient evidence on pain relief. Accordingly, the purpose of this study was to investigate the effect of resistance exercise on pain threshold and blood Pressure in patients with diabetes mellitus.Methods: 11 overweight diabetic male patients (45-50 years) were selected through purposeful random sampling, but 3 of them refused to continue collaboration. After measuring one repetition maximum (1RM), they completed three sets of strength exercise with intensity of 80% 1RM. pain threshold and blood Pressure was measured by special devices in active arm and finally data were analyzed using paired t-test and the correlation coefficient.Results: Increased pain threshold and diastolic and systolic blood Pressure was observed immediately after the resistance exercise (P£0.05), but the relationship between diastolic blood Pressure and pain threshold was not significant.Conclusions: The results revealed contrast interaction between blood Pressure and pain threshold that suggests the central mechanisms of pain may engage in diabetic people.

2Background: The main purpose of this study was to investigate the effects of dry needling on pain and pain Pressure threshold (PPT) in patients with non-specific chronic low back pain (NSCLBP). Methods: 29 patients with NSCLBP were randomly allocated into two experimental (N=14) and control (N=15) groups. The dry needling intervention was considered for quadratus lumborum, gluteus medius, and lumbar multifidus, in 6 sessions, and subjects of the control group followed their routine lifestyle. The measurements included pain and PPT, which were evaluated in the pre-test, post-test, and follow-up periods. The pain was a variable that had a three-month follow-up assessment. Analysis of variance of combined measurement with repeated measurement and Benferoni's post hoc test were used to investigate the effect of the intervention on the outcome measurements. Results: Three sessions of trigger point dry needling did not lead to a significant change in pain. However, after five sessions of dry needling, a significant decrease in pain was observed (p<0.05), and the positive changes significantly remained until one and three months after the end of the intervention (p<0.05). Furthermore; significant changes in PPT scores were detected following five sessions of trigger point dry needling treatment (p<0.05). These changes remained constant in the one-month follow-up assessment (p<0.05). Conclusion: Dry needling for the trigger points of the QL, GM, and LM muscles can improve pain intensity and PPT in patients with NSLBP.

Introduction: Myofascial pain syndrome is one of the most common disorders of the musculoskeletal system with skeletal muscle origin. It is characterized by the presence of trigger points, which are very sensitive points in the muscle and are often found in the tight band of skeletal muscle,they are sensitive to stimulation (Pressure or use of dry needles) and create a referral pain in an area far from that points. The prevalence of trigger points is higher in the postural muscles of the upper quarter, especially the trapezius muscle. The aim of this study was to compare the short-term effects of transcutaneous electrical nerve stimulation (TENS) with dry needling on pain, disability, and Pressure pain threshold in subjects with trigger points in upper trapezius muscle. Materials and Methods: In this clinical trial, 45 patients with upper trapezius muscle trigger points were randomly divided into three groups: TENS and stretching exercise (group A), dry needling and stretching exercise (group B), and stretching exercise alone (group C, control). The joint program between the three groups was to perform trapezius muscle stretching exercises at home for two weeks. In addition to stretching exercise training, group A was treated with TENS for ten sessions during two weeks (5 days a week). Group B, besides stretching exercise training, was treated with three sessions of dry needling for two weeks. Group C was the control group and was trained only in stretching exercises. The outcomes were pain intensity, disability, and Pressure pain threshold that were measured using Visual Analog Scale (VAS), Neck Disability Index (NDI), and digital algometer. Paired t-test was used to compare before and after treatment in each group and one-way analysis of variance (ANOVA) test was used to compare mean changes between the three groups. Results: After treatment, significant improvement was seen in pain intensity and NDI in all three groups (P < 0. 001), but there was no significant difference in Pressure pain threshold in any of the three groups before and after the intervention (P > 0. 05). Moreover, there was no significant difference between the three groups in mean changes of pain, Pressure pain threshold, and NDI scores after the intervention compared to before the intervention (P > 0. 05). Conclusion: Although the use of TENS and dry needling along with stretching exercises in subjects with upper trapezius muscle trigger points helps to reduce pain and disability, but it has no additional effect and only stretching exercise in these patients helps to reduce pain and disability to the same extent.

Clonidine, the α 2-adrenergic agonist, is usually used as an antihypertensive drug. Dextromethorphan is a non-competitive NMDA antagonist which is routinely prescribed to suppress cough. However, there are not confidential documents regarding their analgesic effects. Due to the controversies over the analgesic properties of these two drugs, this study was designed to evaluate cold pain threshold changes following their administration. This study was conducted to assess the impact of oral clonidine and dextromethorphan on ice-water immersion tolerance. Four closed sachets labeled with codes were dedicated to each participant. Each of these four sachets contained placebo, 0. 3 mg/kg dextromethorphan, 0. 2 mg clonidine or both of the previous drugs randomly. The cold pain threshold was measured five times for each participant, once before taking any drug (T1) and the next four times (T2-T5) after taking each of the four sachets. 35 volunteers (15 men and 20 women) participated in the study. The study showed that cold pain threshold was higher in men than women (P=0. 004) and also in participants above 30 than those under 30-year-old (P=0. 007). Moreover, the pain threshold did not change significantly after the administration of clonidine (P=0. 33) or dextromethorphan (P=0. 21), but the threshold significantly increased after receiving a combination of dextromethorphan and clonidine compared with placebo overall (P=0. 001). Cold pain threshold was higher in men and individuals over than 30-year-old and decreased significantly after administration of clonidine and dextromethorphan conjointly. Body mass index has no relation with changes in cold pain threshold by taking mentioned medications.