Publications by authors named "Stella Fuensalida-Novo"

11 Publications

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Myalgia as a symptom at hospital admission by SARS-CoV-2 infection is associated to persistent musculoskeletal pain as long-term post-COVID sequelae: a case-control study.

Pain 2021 Apr 8. Epub 2021 Apr 8.

Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain. Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark Department of Neurology, Hospital Clínico San Carlos. Madrid, Spain Department of Public Health, Universidad Rey Juan Carlos (URJC), Madrid. Spain.

Abstract: This study investigated the association between COVID-related myalgia experienced by patients at hospital admission and the presence of post-COVID symptoms. A case-control study including patients hospitalised due to COVID-19 between February 20 and May 31, 2020 was conducted. Patients reporting myalgia and patients without myalgia at hospital admission were scheduled for a telephone interview 7 months after hospital discharge. Hospitalisation and clinical data were collected from medical records. A list of post-COVID symptoms with attention to musculoskeletal pain was evaluated. Anxiety and depressive symptoms, and sleep quality were likewise assessed. From a total 1,200 hospitalised COVID-19 patients, 369 with and 369 without myalgia at hospital admission were assessed 7.2 months (SD 0.6) after hospital discharge. A greater proportion (P=0.03) of patients with myalgia at hospital admission (20%) showed ≥3 post-COVID symptoms when compared with individuals without myalgia (13%). A higher proportion of patients presenting myalgia (OR1.41, 95%CI 1.04-1.90) exhibited musculoskeletal post-COVID pain when compared to those without myalgia. The prevalence of musculoskeletal post-COVID pain in the total sample was 38%. Fifty percent of individuals with pre-existing musculoskeletal pain experienced a worsening of their symptoms after COVID-19. No differences in fatigue, dyspnoea, anxiety/depressive levels or sleep quality were observed between myalgia and non-myalgia groups. The presence of myalgia at hospital admission was associated with pre-existing history of musculoskeletal pain (OR1.62, 95%CI 1.10-2.40). In conclusion, myalgia at the acute phase was associated with musculoskeletal pain as long-term post-COVID sequelae. Additionally, half of patients with pre-existing pain conditions experienced a persistent exacerbation of their previous syndromes.
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http://dx.doi.org/10.1097/j.pain.0000000000002306DOI Listing
April 2021

In episodic cluster headache, pain extent is not related to widespread pressure pain sensitivity, psychological outcomes, or clinical outcomes.

Physiother Theory Pract 2020 Oct 5:1-6. Epub 2020 Oct 5.

Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland , Manno, Switzerland.

Background: Sensitization mechanisms are thought to play a role in the perception of pain in people with cluster headache. No study has investigated the relation between the spatial extent of pain in cluster headache and measures of sensitization or other clinical features. : Our aim was to investigate if the size of the painful area in people with cluster headache relates to widespread pressure sensitivity, headache features, and psychological outcomes. : Forty men with episodic cluster headache reported their symptoms on a digital body chart and pain extent was calculated. Pressure pain thresholds were assessed locally over the temporalis muscle and the C5-C6 joint and at a remote site over the tibialis anterior to assess widespread pressure sensitivity. Clinical features of headache attacks, and anxiety/depressive levels were also assessed. Patients were assessed during a period of remission 6 months after their last pain attack and after treatment discontinuation. : Thirty-two (80%) and thirty (75%) patients reported their headaches in the orbital and the frontal areas, respectively. No significant associations (rho values ranging from -0.228 to 0.187, values ranging from 0.157 to 0.861) were found between pain extent and pressure pain thresholds in trigeminal, extra-trigeminal, and distant pain-free areas, headache clinical features, and anxiety and depressive levels. : Pain extent in the trigemino-cervical area was not related to the degree of pressure pain sensitivity or headache features in men with episodic cluster headache during a period of remission.
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http://dx.doi.org/10.1080/09593985.2020.1827468DOI Listing
October 2020

Current perspectives on sex differences in tension-type headache.

Expert Rev Neurother 2020 07 18;20(7):659-666. Epub 2020 Jun 18.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos , Alcorcón, Spain.

Introduction: Clinical and experimental evidence supports the presence of several gender differences in the pain experience.

Areas Covered: The current paper discusses biological, psychological, emotional, and social differences according to gender and their relevance to TTH. Gender differences have also been observed in men and women with tension-type headache and they should be considered by clinicians managing this condition. It appears that multimodal treatment approaches lead to better outcomes in people with tension-type headache; however, management of tension-type headache should consider these potential gender differences. Different studies have observed the presence of complex interactions between tension-type headache, emotional stress, sleep, and burden and that these interactions are different between men and women.

Expert Opinion: Based on current results, the authors hypothesize that treatment of men with tension-type headache should focus on the improvement of sleep quality and the level of depression whereas treatment of women with TTH should focus on nociceptive mechanisms and emotional/stressful factors. Future trials should investigate the proposed hypotheses.
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http://dx.doi.org/10.1080/14737175.2020.1780121DOI Listing
July 2020

Effects of Kinesio Taping on Post-Needling Induced Pain After Dry Needling of Active Trigger Point in Individuals With Mechanical Neck Pain.

J Manipulative Physiol Ther 2020 01 13;43(1):32-42. Epub 2020 Feb 13.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain. Electronic address:

Objective: The purpose of this study was to assess the effectiveness of the application of kinesio taping in reducing induced pain after dry needling of active trigger points (TrPs) to the upper trapezius muscle.

Methods: Consecutive patients had mechanical neck pain (n = 34, 44% female) with active TrPs in the upper trapezius muscle. All participants received dry needling into upper trapezius active TrPs. Then, they were randomly divided into a kinesio taping group, which received an adhesive tape (Kinesio Tex), and a control group, which did not receive the taping. The numeric pain rating scale was assessed (0-10) at post-needling; immediately after; and 24 hours, 48 hours, and 72 hours after needling. Neck- and shoulder-related disability was assessed before and 72 hours after needling with the Neck Disability Index (NDI) and the Shoulder Pain and Disability Index, respectively. The pressure pain threshold (PPT) over the TrP was also assessed post-needling, immediately post-intervention, and 72 hours after needling.

Results: The analysis of covariance did not find a significant group × time interaction (P = .26) for post-needling soreness: both groups exhibited similar changes in post-needling induced pain (P < .001). No significant group × time interactions were observed for changes in NDI (P = .62), SPADI (P = .41), or PPTs (P = .52): similar improvements were found after the needling procedure for the NDI (P < .001), Shoulder Pain and Disability Index (P < .001), and PPT (P < .001). The number of local twitch responses and sex (all, P > .30) did not influence the effect for any outcome.

Conclusion: The application of kinesio taping after dry needling of active TrPs in the upper trapezius muscle was not effective for reducing post-needling induced pain in people with mechanical neck pain. Further, the application of kinesio taping as a post-needling intervention did not influence short-term changes in disability.
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http://dx.doi.org/10.1016/j.jmpt.2019.02.011DOI Listing
January 2020

Gender differences in clinical and psychological variables associated with the burden of headache in tension-type headache.

Women Health 2020 07 3;60(6):652-663. Epub 2019 Dec 3.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos , Alcorcón, Spain.

Our aim was to assess gender differences in variables associated with the emotional and physical burdens of tension-type headache (TTH). Participants with TTH diagnosed according to the ICHD-III were recruited from three university-based hospitals (in Spain, Italy, Denmark) between January 2015 and June 2017. The physical/emotional headache burden was assessed with the Headache Disability Inventory (HDI-P/HDI-E, respectively). Headache features were collected with a four-week diary. Sleep quality was assessed with Pittsburgh Sleep Quality Index. The Hospital Anxiety and Depression Scale evaluated anxiety and depressive symptom levels. Trait and state anxiety levels were evaluated with the State-Trait Anxiety Inventory. Two hundred and twelve (28% men) participants (aged 41-48 years old) participated. Multiple regression models revealed that sleep quality explained 36.7% of the variance of HDI-E and 31.1% of the variance of HDI-P in men, whereas headache intensity, depressive levels, and younger age explained 37.5% of the variance of HDI-E and 32.8% of the variance of HDI-P in women (all < .001). This study observed gender differences in variables associated with headache burden in TTH. Management of men with TTH should focus on interventions targeting sleep quality, whereas the management of women with TTH should combine psychological approaches and interventions targeting pain mechanisms.
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http://dx.doi.org/10.1080/03630242.2019.1696440DOI Listing
July 2020

Spatial Distribution of Temporalis Pressure Pain Sensitivity in Men with Episodic Cluster Headache.

Int J Environ Res Public Health 2019 11 1;16(21). Epub 2019 Nov 1.

Headache Unit, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain.

(1) Background: Spatial changes in pressure sensitivity have been described in migraine and tension-type headaches. Our aim was to determine differences in the spatial distribution of pressure pain sensitivity of the temporalis muscle between cluster headache (CH) patients and headache-free controls; (2) Methods: Pressure pain thresholds (PPTs) were determined over nine points covering the temporalis muscle in 40 men with episodic CH and 40 matched headache-free controls in a blinded fashion. Topographical pressure pain sensitivity maps were constructed based on interpolation of the PPTs. Patients were evaluated in a pain-free period (remission phase), at least 3 months from the last attack and without medication; (3) Results: The analysis of covariance (ANCOVA) found significant difference between points (F = 21.887; P < 0.001) and groups (F = 24.416; P = 0.602), but not between sides (F = 0.440; P = 0.508). No effect of depression (F = 0.014; P = 0.907) or anxiety (F = 0.696; F = 0.407) was observed. A post-hoc analysis revealed: 1) lower PPTs at all points in patients than in controls, 2) an anterior-to-posterior gradient in patients but not in controls, with lower PPTs located in the anterior column. Large between-groups effects were shown in all points (standardized mean difference, SMD > 0.8); (4) Conclusions: Bilateral pressure pain hypersensitivity to pressure pain in the temporalis muscle and an anterior-to-posterior gradient to pressure pain was observed in men with episodic CH.
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http://dx.doi.org/10.3390/ijerph16214239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861990PMC
November 2019

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety.

Pain Pract 2020 02 16;20(2):147-153. Epub 2019 Oct 16.

Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.

Background: Diminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods.

Objective: To investigate if men with episodic CH in a long-lasting remission phase exhibit widespread pressure pain hypersensitivity.

Methods: Forty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra-trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6 months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed-model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates.

Results: PPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100 kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80 kPa), second metacarpal (mean difference: 65 to 90 kPa), and tibialis anterior muscle (mean difference: 135 to 155 kPa) in patients with CH when compared to headache-free subjects (all, P < 0.001). No effect of anxiety or depression levels was found.

Conclusions: Patients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long-lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.
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http://dx.doi.org/10.1111/papr.12839DOI Listing
February 2020

Active Trigger Points Are Associated With Anxiety and Widespread Pressure Pain Sensitivity in Women, but not Men, With Tension Type Headache.

Pain Pract 2019 06 12;19(5):522-529. Epub 2019 Mar 12.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.

Background: A better understanding of gender differences can assist clinicians in further developing therapeutic programs in tension type headache (TTH).

Objective: To evaluate gender differences in the presence of trigger points (TrPs) in the head, neck, and shoulder muscles and their relationship with headache features, pressure pain sensitivity, and anxiety in people with TTH.

Methods: Two hundred and ten (59 men, 151 women) patients with TTH participated. TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, splenius capitis, and sternocleidomastoid muscles. Headache features were collected using a 4-week headache diary. Trait and state anxiety levels were assessed using the State-Trait Anxiety Inventory. Pressure pain thresholds (PPTs) over the temporalis, C5/C6 joint, second metacarpal, and tibialis anterior were assessed.

Results: Women with TTH exhibited a significantly higher number of total (P = 0.027) and active (P = 0.030), but similar number of latent (P = 0.461), TrPs than men with TTH. Active TrPs in the temporalis, suboccipital, and splenius capitis muscles were the most prevalent in both men and women with TTH. The number of active TrPs was associated with anxiety levels (r = 0.217; P = 0.045) in women, but not in men (P = 0.453): the higher the number of active TrPs, the more the trait levels of anxiety. Women exhibited lower PPTs than men (all, P < 0.001). In men, the number of active, but not latent, TrPs was negatively associated with localized PPTs (all, P < 0.05), whereas in women, the number of active and latent TrPs was negatively associated with PPTs in all points (all, P < 0.01): the higher the number of TrPs, the lower the widespread PPTs.

Conclusions: This study described gender differences in the presence of TrPs in TTH. Women with TTH showed lower PPTs than men. The association between TrPs, anxiety levels, and pressure pain hyperalgesia seems to be more pronounced in women than in men with TTH.
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http://dx.doi.org/10.1111/papr.12775DOI Listing
June 2019

The burden of headache is associated to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study.

J Headache Pain 2017 Dec 28;18(1):119. Epub 2017 Dec 28.

Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Facultad de Ciencias de la Salud, University Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.

Background: To investigate variables associated at one year (longitudinal design) with the physical or emotional component of burden in chronic tension type headache (CTTH).

Methods: One hundred and thirty (n = 130) individuals with CTTH participated in this longitudinal study. Clinical features were collected with a 4-weeks headache diary at baseline and 1-year follow-up. The burden of headache was assessed at baseline and one -year follow-up with the Headache Disability Inventory (HDI), physical (HDI-P) or emotional (HDI-E) component. Sleep quality (Pittsburgh Sleep Quality Index), anxiety and depression (Hospital Anxiety and Depression Scale-HADS), and quality of life (SF-36) were also assessed at baseline. Hierarchical regression analyses were conducted to determine the associations between the baseline variables and the headache burden at 1-year. Simple mediation models were also applied to determine the potential mediation effect of any intermediary variable.

Results: Regression analyses revealed that baseline pain interference and depression explained 32% of the variance in the emotional burden of headache, whereas baseline emotional burden of the headache, pain interference, and headache duration explained 51% of the variance in the physical burden of headache (P < .01) at 1-year. The mediation models observed that the effect of baseline pain interference on emotional burden of headache at 1-year was mediated through baseline depression, whereas the effect of baseline pain interference on the physical burden of headache at 1-year was mediated through baseline emotional burden of headache (both P < .05).

Conclusions: The current study found a longitudinal interaction between pain interference and depression with the burden of headache in individuals with CTTH.
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http://dx.doi.org/10.1186/s10194-017-0829-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745374PMC
December 2017

Perceived Pain Extent is Not Associated With Widespread Pressure Pain Sensitivity, Clinical Features, Related Disability, Anxiety, or Depression in Women With Episodic Migraine.

Clin J Pain 2018 03;34(3):217-221

Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory 2rLab, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.

Objective: People with migraine present with varying pain extent and an expanded distribution of perceived pain may reflect central sensitization. The relationship between pain extent and clinical features, psychological outcomes, related disability, and pressure pain sensitivity in migraine has been poorly investigated. Our aim was to investigate whether the perceived pain extent, assessed from pain drawings, relates to measures of pressure pain sensitivity, clinical, psychological outcomes, and related disability in women with episodic migraine.

Methods: A total of 72 women with episodic migraine completed pain drawings, which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine-related disability (migraine disability assessment questionnaire [MIDAS]), and anxiety and depression (Hospital Anxiety-Depression Scale [HADS]) were also assessed. Spearman ρ correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes.

Results: No significant associations were observed between pain extent and pressure pain thresholds in trigeminal, extratrigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression, and migraine-related disability.

Conclusions: Pain extent within the trigeminocervical area was not associated with any of the measured clinical outcomes and not related to the degree of pressure pain sensitization in women with episodic migraine. Further research is needed to determine if the presence of expanded pain areas outside of the trigeminal area can play a relevant role in the sensitization processes in migraine.
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http://dx.doi.org/10.1097/AJP.0000000000000537DOI Listing
March 2018

The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial.

J Orthop Sports Phys Ther 2017 Mar 3;47(3):151-161. Epub 2017 Feb 3.

Study Design Randomized parallel-group trial. Background Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. Objective To compare the effectiveness of manual therapy versus surgery for improving self-reported function, cervical range of motion, and pinch-tip grip force in women with CTS. Methods In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n = 50) or a surgery (n = 50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire. Patients were assessed at baseline and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat, with mixed analyses of covariance adjusted for baseline scores. Results At 12 months, 94 women completed the follow-up. Analyses showed statistically significant differences in favor of manual therapy at 1 month for self-reported function (mean change, -0.8; 95% confidence interval [CI]: -1.1, -0.5) and pinch-tip grip force on the symptomatic side (thumb-index finger: mean change, 2.0; 95% CI: 1.1, 2.9 and thumb-little finger: mean change, 1.0; 95% CI: 0.5, 1.5). Improvements in self-reported function and pinch grip force were similar between the groups at 3, 6, and 12 months. Both groups reported improvements in symptom severity that were not significantly different at all follow-up periods. No significant changes were observed in pinch-tip grip force on the less symptomatic side and in cervical range of motion in either group. Conclusion Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion. Level of Evidence Therapy, level 1b. Prospectively registered September 3, 2014 at www.clinicaltrials.gov (NCT02233660). J Orthop Sports Phys Ther 2017;47(3):151-161. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090.
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http://dx.doi.org/10.2519/jospt.2017.7090DOI Listing
March 2017