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Article ; Online: Spinal kinematic variability is increased in people with chronic low back pain during a repetitive lifting task.

Alsubaie, Amal M / Sanderson, Andy / Cabral, Hélio V / Martinez-Valdes, Eduardo / Falla, Deborah

Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology

2023 Volume 73, Page(s) 102832

Abstract: Changes in spinal kinematic variability have been observed in people with chronic non-specific LBP (CNSLBP) during the performance of various repetitive functional tasks. However, the direction of these changes (i.e., less or more kinematic variability) ... ...

Abstract	Changes in spinal kinematic variability have been observed in people with chronic non-specific LBP (CNSLBP) during the performance of various repetitive functional tasks. However, the direction of these changes (i.e., less or more kinematic variability) is not consistent. This study aimed to assess differences in kinematic variability of the 3D angular displacement of thoracic and lumbar spinal segments in people with CNSLBP compared to asymptomatic individuals during a repetitive lifting task. Eleven people with CNSLBP and 11 asymptomatic volunteers performed 10 cycles of multi-planar lifting movements while spinal kinematics were recorded. For the three planes of motion, point-by-point standard deviations (SDs) were computed across all cycles of lifting and the average was calculated as a measure of kinematic variability for both segments. People with CNSLBP displayed higher thoracic (F = 8.00, p = 0.010, ηp
MeSH term(s)	Humans ; Low Back Pain ; Lifting ; Biomechanical Phenomena ; Muscle, Skeletal ; Spine ; Range of Motion, Articular/physiology ; Lumbar Vertebrae
Language	English
Publishing date	2023-10-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1073161-1
ISSN	1873-5711 ; 1050-6411
ISSN (online)	1873-5711
ISSN	1050-6411
DOI	10.1016/j.jelekin.2023.102832
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Article ; Online: Microscopic changes in the spinal extensor musculature in patients experiencing chronic spinal pain: protocol for a systematic review.

Purushotham, Shilpa / Stephenson, Robert Stanley / Sanderson, Andy / Falla, Deborah

BMJ open

2021 Volume 11, Issue 2, Page(s) e042729

Abstract: Introduction: Chronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have ...

Abstract	Introduction: Chronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have focused on the lumbar region only and the results have been inconclusive. Therefore, in this protocol, we aim to assess microscopic changes in the extensor muscles of all spinal regions, investigating regionally specific changes in muscle fibre types of the spinal extensor muscles in patients with non-specific CSP. Methods/analysis: This protocol was designed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will use the following databases: MEDLINE, Embase, PubMed, CINAHL Plus and Web of Science along with relevant grey literature searches. Two reviewers will conduct the searches, perform data extraction, apply inclusion criteria and conduct risk of bias assessment using Newcastle-Ottawa Scale. Data will be synthesised and analysed independently. If there is sufficient homogeneity, then meta-analysis will be conducted by the reviewers jointly. If not, meta-synthesis or narrative reporting will be performed. The quality of the evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Ethics and dissemination: The results of this study will be submitted for publication to a peer-reviewed journal and will be presented at conferences. Ethical approval for this systematic review was not required due to no patient data being collated. Prospero registration number: CRD42020198087.
MeSH term(s)	Chronic Pain ; Humans ; Meta-Analysis as Topic ; Muscle, Skeletal ; Research Design
Language	English
Publishing date	2021-02-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-042729
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Article ; Online: Does pain influence force steadiness? A protocol for a systematic review.

Arvanitidis, Michail / Falla, Deborah / Sanderson, Andy / Martinez-Valdes, Eduardo

BMJ open

2021 Volume 11, Issue 1, Page(s) e042525

Abstract: Introduction: Performing contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of ... ...

Abstract	Introduction: Performing contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of experimental or clinical musculoskeletal pain on force steadiness but with conflicting findings. The aim of this systematic review is to summarise the current literature to determine whether pain, whether it be clinical or experimental, influences force steadiness. Methods and analysis: This protocol for a systematic review was informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Handbook for Systematic Reviews of Interventions. Key databases will be searched from inception to 31 August 2020, including MEDLINE, EMBASE, PubMed, CINAHL Plus, ZETOC and Web of Science. Grey literature and key journals will be also reviewed. Risk of bias will be assessed with the Newcastle-Ottawa tool, and the quality of the cumulative evidence assessed with the Grading of Recommendations, Assessment, Development and Evaluation guidelines. If homogeneity exists between groups of studies, meta-analysis will be conducted. Otherwise, a narrative synthesis approach and a vote-counting method will be used, while the results will be presented as net increases or decreases of force steadiness. Ethics and dissemination: The findings will be presented at conferences and the review will be also submitted for publication in a refereed journal. No ethical approval was required. Prospero registration number: CRD42020196479.
MeSH term(s)	Humans ; Meta-Analysis as Topic ; Musculoskeletal Pain ; Research Design ; Systematic Reviews as Topic
Language	English
Publishing date	2021-01-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-042525
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Article ; Online: Effects of the menstrual cycle phase on anterior cruciate ligament neuromuscular and biomechanical injury risk surrogates in eumenorrheic and naturally menstruating women: A systematic review.

Dos'Santos, Thomas / Stebbings, Georgina K / Morse, Christopher / Shashidharan, Medha / Daniels, Katherine A J / Sanderson, Andy

PloS one

2023 Volume 18, Issue 1, Page(s) e0280800

Abstract: Background: Eumenorrheic women experience cyclic variations in sex hormones attributed to the menstrual cycle (MC) which can impact anterior cruciate ligament (ACL) properties, knee laxity, and neuromuscular function. This systematic review aimed to ... ...

Abstract	Background: Eumenorrheic women experience cyclic variations in sex hormones attributed to the menstrual cycle (MC) which can impact anterior cruciate ligament (ACL) properties, knee laxity, and neuromuscular function. This systematic review aimed to examine the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates during dynamic tasks, to establish whether a particular MC phase predisposes women to greater ACL injury risk. Methods: PubMed, Medline, SPORTDiscus, and Web of Science were searched (May-July 2021) for studies that investigated the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates. Inclusion criteria were: 1) injury-free women (18-40 years); 2) verified MC phases via biochemical analysis and/or ovulation kits; 3) examined neuromuscular and/or biomechanical injury risk surrogates during dynamic tasks; 4) compared ≥1 outcome measure across ≥2 defined MC phases. Results: Seven of 418 articles were included. Four studies reported no significant differences in ACL injury risk surrogates between MC phases. Two studies showed evidence the mid-luteal phase may predispose women to greater risk of non-contact ACL injury. Three studies reported knee laxity fluctuated across the MC; two of which demonstrated MC attributed changes in knee laxity were associated with changes in knee joint loading (KJL). Study quality (Modified Downs and Black Checklist score: 7-9) and quality of evidence were low to very low (Grading of Recommendations Assessment Development and Evaluation: very low). Conclusion: It is inconclusive whether a particular MC phase predisposes women to greater non-contact ACL injury risk based on neuromuscular and biomechanical surrogates. Practitioners should be cautious manipulating their physical preparation, injury mitigation, and screening practises based on current evidence. Although variable (i.e., magnitude and direction), MC attributed changes in knee laxity were associated with changes in potentially hazardous KJLs. Monitoring knee laxity could therefore be a viable strategy to infer possible ACL injury risk.
MeSH term(s)	Humans ; Female ; Anterior Cruciate Ligament ; Anterior Cruciate Ligament Injuries ; Menstruation ; Joint Instability ; Knee Joint ; Menstrual Cycle ; Biomechanical Phenomena
Language	English
Publishing date	2023-01-26
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0280800
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Article ; Online: Microscopic changes in the spinal extensor musculature in people with chronic spinal pain: a systematic review.

Purushotham, Shilpa / Stephenson, Rob S / Sanderson, Andy / Abichandani, Deepa / Greig, Carolyn / Gardner, Adrian / Falla, Deborah

The spine journal : official journal of the North American Spine Society

2022 Volume 22, Issue 7, Page(s) 1205–1221

Abstract: Background context: Chronic spinal pain is one the most common musculoskeletal disorders. Previous studies have observed microscopic structural changes in the spinal extensor muscles in people with chronic spinal pain. This systematic review synthesizes ...

Abstract	Background context: Chronic spinal pain is one the most common musculoskeletal disorders. Previous studies have observed microscopic structural changes in the spinal extensor muscles in people with chronic spinal pain. This systematic review synthesizes and analyzes all the existing evidence of muscle microscopic changes in people with chronic spinal pain. Purpose: To assess the microscopy of spinal extensor muscles including the fiber type composition, the area occupied by fiber types, fiber size/cross sectional area (CSA), and narrow diameter (ND) in people with and without chronic spinal pain. Further, to compare these outcome measures across different regions of the spine in people with chronic neck, thoracic and low back pain. Study design: Systematic review with meta-analysis. Methods: MEDLINE (Ovid Interface), Embase, PubMed, CINAHL Plus, and Web of Science were searched from inception to October 2020. Key journals, conference proceedings, grey literature and hand searching of reference lists from eligible studies were also searched. Two independent reviewers were involved in the selection process. Only studies examining the muscle microscopy of the spinal extensor muscles (erector spinae [ES] and/or multifidus [MF]) between people with and without chronic spinal pain were selected. The risk of bias from the studies was assessed using modified Newcastle Ottawa Scale and the level of evidence was established using the GRADE approach. Data were synthesized based on homogeneity on the methodology and outcome measures of the studies for ES and MF muscles and only four studies were eligible for analysis. Results: All the five studies included were related to chronic low back pain (CLBP). Meta-analysis (inverse variance method for random effect to calculate mean difference and 95% CI) was performed for the ES fiber type composition by numbers for both type I and type II fibers (I Conclusions: For the ES muscle, there was no difference in fiber type composition and fiber CSA between people with and without CLBP and no conclusions could be drawn for ND for the ES. For the MF, no conclusions could be drawn for any of the muscle microscopy outcome measures. Overall, the quality of evidence is very low and there is very low evidence that there are no differences in microscopic muscle features between people with and without CLBP.
MeSH term(s)	Chronic Pain ; Humans ; Low Back Pain ; Paraspinal Muscles ; Spine
Language	English
Publishing date	2022-02-05
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2022.01.023
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Zs.A 5898: Show issues

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Article ; Online: The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review.

Sanderson, Andy / Wang, Shuwfen F / Elgueta-Cancino, Edith / Martinez-Valdes, Eduardo / Sanchis-Sanchez, Enrique / Liew, Bernard / Falla, Deborah

European journal of pain (London, England)

2021 Volume 25, Issue 8, Page(s) 1668–1701

Abstract: Background and objective: Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review ... ...

Abstract	Background and objective: Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties. Databases and data treatment: MeSH terms and preselected keywords relating to the H-reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool; a narrative synthesis and three meta-analyses were performed. Results: Sixty-one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H-reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting individual adaptations to chronic symptoms. Significance: This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.
MeSH term(s)	Chronic Pain ; Evoked Potentials, Motor ; Humans ; Motor Neurons ; Musculoskeletal Pain ; Patient Discharge
Language	English
Publishing date	2021-06-25
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	1390424-3
ISSN	1532-2149 ; 1090-3801
ISSN (online)	1532-2149
ISSN	1090-3801
DOI	10.1002/ejp.1789
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Article ; Online: The effect of chronic, non-specific low back pain on superficial lumbar muscle activity: a protocol for a systematic review and meta-analysis.

Sanderson, Andy / Rushton, Alison B / Martinez Valdes, Eduardo / Heneghan, Nicola R / Gallina, Alessio / Falla, Deborah

BMJ open

2019 Volume 9, Issue 10, Page(s) e029850

Abstract: Introduction: Chronic, non-specific low back pain is a major global cause of disability. One factor which might potentially contribute to ongoing pain is maladaptive variation in the level of activity in the lumbar musculature. Several studies have ... ...

Abstract	Introduction: Chronic, non-specific low back pain is a major global cause of disability. One factor which might potentially contribute to ongoing pain is maladaptive variation in the level of activity in the lumbar musculature. Several studies have investigated this activity using surface electromyography, in varied muscles and during a number of functional activities. Due to differences in the applied methodology, the results have been difficult to compare, and previous reviews have been limited in scope. In this protocol, we aim to perform a comprehensive review of the effect of chronic low back pain on lumbar muscle activity. Methods and analysis: This protocol was informed by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and results will be reported in line with the PRISMA. Searches will be conducted on the Web of Science, PubMed, MEDLINE, EMBASE, ZETOC and CINAHL databases, along with a comprehensive review of grey literature and key journals. One reviewer will conduct the searches, but two independent reviewers will screen potential studies and assess the risk of bias within studies which meet the inclusion criteria. The Newcastle-Ottawa risk of bias tool, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used to assess the quality of the data. Meta-analysis will be conducted where appropriate on groups of studies with homogenous methodology. Where studies are too heterogeneous to allow for meta-analysis, meta-synthesis will instead be completed, comparing results in terms of net increases or decreases of activity. Ethics and dissemination: This review aims to identify common adaptations of muscle activity in people with low back pain and it is expected that the results will influence future research directions and future rehabilitation approaches. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. Prospero registration number: CRD42019125156.
MeSH term(s)	Humans ; Chronic Pain/physiopathology ; Electromyography ; Low Back Pain/physiopathology ; Lumbar Vertebrae ; Superficial Back Muscles/physiopathology ; Meta-Analysis as Topic ; Systematic Reviews as Topic
Language	English
Publishing date	2019-10-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2019-029850
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Article ; Online: Variation in the spatial distribution of erector spinae activity during a lumbar endurance task in people with low back pain.

Sanderson, Andy / Martinez-Valdes, Eduardo / Heneghan, Nicola R / Murillo, Carlos / Rushton, Alison / Falla, Deborah

Journal of anatomy

2019 Volume 234, Issue 4, Page(s) 532–542

Abstract: This study aimed to investigate the spatial distribution and redistribution of lumbar erector spinae (ES) activity during a lumbar extension endurance task in pain-free participants and how this is modified in people with low back pain (LBP). High ... ...

Abstract	This study aimed to investigate the spatial distribution and redistribution of lumbar erector spinae (ES) activity during a lumbar extension endurance task in pain-free participants and how this is modified in people with low back pain (LBP). High density surface electromyography (HDEMG) was recorded using 13 × 5 electrode grids placed over the lumbar ES in 13 LBP and 13 control participants while completing an Ito test to task failure. The root mean square of the HDEMG signals was computed, a topographical map of the EMG amplitude generated and the centre of the activity (centroid) determined throughout the task. The centroid of the EMG amplitude map was systematically more cranial (F = 6.09, P = 0.022) for the LBP participants compared with the control subjects. Regression analysis showed that the extent of redistribution of ES activity was associated with longer endurance. These results show that LBP participants utilised a different motor strategy to perform the endurance task, characterised by greater activation of more cranial regions of the ES and less redistribution of ES activity throughout the task. This study provides new insight into the functional activation of the lumbar ES and how it is modified when people have pain.
MeSH term(s)	Adult ; Case-Control Studies ; Cross-Sectional Studies ; Electromyography ; Female ; Humans ; Low Back Pain/physiopathology ; Lumbosacral Region/physiopathology ; Male ; Middle Aged ; Paraspinal Muscles/physiopathology ; Physical Endurance ; Young Adult
Language	English
Publishing date	2019-01-21
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2955-5
ISSN	1469-7580 ; 0021-8782
ISSN (online)	1469-7580
ISSN	0021-8782
DOI	10.1111/joa.12935
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Article ; Online: Shear wave elastography investigation of multifidus stiffness in individuals with low back pain.

Murillo, Carlos / Falla, Deborah / Rushton, Alison / Sanderson, Andy / Heneghan, Nicola R

Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology

2019 Volume 47, Page(s) 19–24

Abstract: The purpose of this study was to investigate differences in passive muscular stiffness between the superficial multifidus (SM) and deep multifidus (DM), and to compare their passive and active stiffness in individuals with low back pain (LBP) and ... ...

Abstract	The purpose of this study was to investigate differences in passive muscular stiffness between the superficial multifidus (SM) and deep multifidus (DM), and to compare their passive and active stiffness in individuals with low back pain (LBP) and asymptomatic individuals. Fifteen LBP individuals and 15 asymptomatic individuals were recruited. Passive stiffness of the SM and DM was measured bilaterally using shear wave elastography (SWE) with participants lying prone. Active stiffness was measured for the SM during trunk extension, and the contraction ratio was calculated. DM displayed higher passive muscular stiffness than SM in both the asymptomatic and LBP groups (14.41 ± 2.62 and 15.40 ± 2.77 kPa respectively; p < 0.001). Individuals with LBP exhibited higher passive muscular stiffness of SM (LBP: 10.15 ± 4.21, asymptomatic: 6.84 ± 1.69 kPa; p < 0.005) and a lower contraction ratio (LBP: 1.54 ± 0.47, asymptomatic: 2.65 ± 1.36 kPa; p < 0.003) compared to the asymptomatic group. The findings support a differentiation in passive muscular stiffness between SM and DM and provide evidence for an alteration in muscular stiffness at rest in individuals with LBP. The lower increase of muscular stiffness with contraction observed for those with LBP may reflect a deficit in activation of the multifidus.
MeSH term(s)	Adult ; Biomechanical Phenomena ; Elasticity Imaging Techniques/methods ; Female ; Humans ; Low Back Pain/diagnostic imaging ; Low Back Pain/physiopathology ; Male ; Paraspinal Muscles/diagnostic imaging ; Paraspinal Muscles/physiopathology ; Young Adult
Language	English
Publishing date	2019-05-03
Publishing country	England
Document type	Journal Article
ZDB-ID	1073161-1
ISSN	1873-5711 ; 1050-6411
ISSN (online)	1873-5711
ISSN	1050-6411
DOI	10.1016/j.jelekin.2019.05.004
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Zs.A 3218: Show issues

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Article ; Online: Lack of Exercise-Induced Hypoalgesia to Repetitive Back Movement in People with Chronic Low Back Pain.

Kuithan, Pauline / Heneghan, Nicola R / Rushton, Alison / Sanderson, Andy / Falla, Deborah

Pain practice : the official journal of World Institute of Pain

2019 Volume 19, Issue 7, Page(s) 740–750

Abstract: Purpose: To investigate whether people with chronic low back pain (LBP) show dysfunctional exercise-induced hypoalgesia (EIH) in response to repeated contractions of their back muscles during a lifting task.: Methods: In this cross-sectional ... ...

Abstract	Purpose: To investigate whether people with chronic low back pain (LBP) show dysfunctional exercise-induced hypoalgesia (EIH) in response to repeated contractions of their back muscles during a lifting task. Methods: In this cross-sectional observational study conducted on asymptomatic participants (n = 18) and participants with chronic LBP (n = 21), quantitative sensory testing (QST) was applied extensively over the lumbar region and a remote area before and after a repeated task that involved lifting a 5-kg box for ~7 minutes. QST included pressure pain thresholds (PPTs), thermal detection, pain thresholds, and measures of temporal summation. Topographical maps of the percentage change in PPT detected at 16 locations over the lumbar region were generated to explore regional differences and compared between groups. Results: Mean (standard deviation) PPTs measured from 16 sites over the lower back changed significantly in asymptomatic participants (+29.78 kPa [41.4]) following task completion, indicative of EIH, whereas no significant change was observed for the low back pain (LBP) group (-14.87 kPa [61.2]). No changes were detected at the remote site for either group. No changes were revealed for the thermal tests. Temporal summation data revealed decreasing pain sensitivity as the test progressed, but the test response did not change after the exercise for either group. Conclusion(s): Unlike asymptomatic individuals, participants with LBP lacked EIH over the lumbar erector spinae muscles following repeated lifting. Although these results should be considered in relation to the study limitations, particularly the absence of a control group, the findings support impaired EIH in patients with LBP.
MeSH term(s)	Adult ; Back Muscles ; Cross-Sectional Studies ; Exercise/physiology ; Female ; Humans ; Hypesthesia/etiology ; Low Back Pain/physiopathology ; Lumbosacral Region/anatomy & histology ; Male ; Middle Aged ; Pain Threshold/physiology
Language	English
Publishing date	2019-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2151272-3
ISSN	1533-2500 ; 1530-7085
ISSN (online)	1533-2500
ISSN	1530-7085
DOI	10.1111/papr.12804
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