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Papers by Britt Larsson

European Journal of Pain, 2009

Journal of Electromyography and Kinesiology, 2003

The aim of this study was to investigate the reliability of peak torque and surface electromyogra... more The aim of this study was to investigate the reliability of peak torque and surface electromyography (EMG) variable's root mean square (RMS) and mean frequency (MNF) during an endurance test consisting of repetitive maximum concentric knee extensions. Muscle fatigue has been quantified in several ways, and in isokinetic testing it is based on a set of repetitive contractions. To assess test-retest reliability, two sets of 100 dynamic maximum concentric knee extensions were performed using an isokinetic dynamometer. The two series were separated by 7-8 days. The subjects relaxed during the passive flexion phase. Twenty (10 men and 10 women) clinically healthy subjects volunteered.

European Journal of Pain Supplements, 2011

With a repeated measures manova the changes over time were investigated. Effect sizes were calcul... more With a repeated measures manova the changes over time were investigated. Effect sizes were calculated using Cohen's d. Clinical relevance was determined by using the minimal clinical important difference (MCID). Results: Of the 107 participants, with a baseline average pain duration of 11 years, 90 (84%) completed the 1-year and 85 (79%) the 2-year follow-up. For all outcomes improvement immediately after the program was maintained. Effect sizes at 2-year followup for functioning (d = 1.6) and QoL (d = 1.4) were large, and more than 65% reached preset MCID. Healthcare use reduced: at baseline all patients consulted their general practitioner (GP) and medical specialist (MS) at least once, whereas at 2-year followup 73% reported having consulted neither a GP nor a MS during the previous year. Furthermore, analgesics decreased, and work participation increased to 81%. Conclusions: Patients who participated in this short, intensive intervention have learned to manage CLBP. The clinical relevant results were maintained two years later. In addition, healthcare use decreased substantially and most of the patients are at work.

European Journal of Pain, 2009

Pain, 2000

The association of cytochrome c oxidase negative ®bres (COX-negative) and ragged-red ®bres (RR-®b... more The association of cytochrome c oxidase negative ®bres (COX-negative) and ragged-red ®bres (RR-®bres) with work related trapezius myalgia has been proposed. Hitherto studies have been small or without control groups. The aim of the present study was to investigate the prevalences of RR-®bres and COX-negative ®bres in female cleaners with (n 25) and without (n 23) trapezius myalgia and in clinically healthy female teachers (n 21). The cleaners did mainly¯oor cleaning requiring monotonous loading on the trapezius muscle. A questionnaire covering background data and aspects of pain (prevalence, duration, intensity and in¯uence on daily living) was answered. Biopsies were obtained from the trapezius muscle by an open surgical technique. The three groups did not differ in prevalence of COXnegative or COX-superpositive (i.e. type-I ®bres with extremely strong brownish reaction in both the COX and SDH/COX stainings) ®bres. The prevalence of COX-negative ®bres was age dependent. Two subgroups of RR-®bres were present when stained for COX; COX-negative (73%) and COX-superpositive (26%) ®bres. Forty-two percent of the COX-negative ®bres were RR-®bres and 79% of the COX-superpositive were RR-®bres. A signi®cantly (P 0:002) higher proportion of the COX-superpositive ®bres in the cleaners were RR-®bres compared to the teachers. Multivariate regression analysis revealed that age, occupation as cleaner and a tender point in the trapezius were signi®cantly associated with increased prevalences of RR-®bres; a cleaner with a tender point had a 4.35 higher prevalence of RR-®bres compared to a teacher without a tender point. No correlations between other pain related variables and prevalence of RR-®bres were noted. In conclusion, RR-®bres but not COX-negative or COX-superpositive ®bres were correlated with cleaning work tasks and with a tender point in the trapezius. q 2000 International Association for the Study of Pain. Published by Elsevier Science B.V.

European Journal of Pain, 2009

Journal of pain research, 2014

Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult popu... more Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain), which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for s...

Journal of Muscle Research and Cell Motility, 2002

Decreased estrogen production is associated with changes in the skeletal, cardiovascular and musc... more Decreased estrogen production is associated with changes in the skeletal, cardiovascular and muscular systems. At the level of skeletal muscles, it has been shown that a reduction in force production occurs at menopause but the underlying mechanisms are still unknown. The aim of the study was to investigate the effects of ovariectomy on myosin heavy chain (MyHC) composition. Additionally, we studied the effects of physical activity and the combined effects of physical activity and estrogen treatment on MyHC content in ovariectomised (OX) animals. Twenty-five rats were randomly assigned to five different groups: controls, runners, OX, ovariectomised runners and ovariectomised runners receiving estrogen. Exercise consisted of voluntary running for 5 weeks. Two muscles were analysed: m. extensor digitorum longus, EDL, (fast muscle) and m. soleus (slow muscle). MyHC content was analysed on 8% gel electrophoresis. The level of running activity is reduced in OX animals and estrogen administration is associated with the normalisation of the level of physical activity. Ovariectomy induces a shift from fast to slow MyHC isoforms in both the soleus and EDL. When OX animals are allowed to run, alterations in MyHC isoforms are still observed in the EDL but not in the soleus. When physical activity is combined with estrogen treatment no alterations are observed in both muscles. In conclusion, this study shows that ovariectomy induces alterations in the contractile properties of skeletal muscles and that physical activity in combination with estrogen treatment are associated with the maintenance of slow and fast muscle characteristics.

PLoS ONE, 2011

Background: N-acylethanolamines (NAEs) are endogenous compounds that regulate inflammation and pa... more Background: N-acylethanolamines (NAEs) are endogenous compounds that regulate inflammation and pain. These include the cannabinoid ligand anandamide (AEA) and the peroxisome proliferator-activated receptor-a ligand palmitoylethanolamide (PEA). Little is known as to the levels of NAEs in pain states in human, particularly in the skeletal muscle. The aim of this study was to investigate the levels of these lipid mediators in muscle dialysate from women with chronic neck-/shoulder pain compared to healthy controls.

Pain, 2004

Local metabolic changes are suggested to be involved in muscle pain development in humans. Ninete... more Local metabolic changes are suggested to be involved in muscle pain development in humans. Nineteen women with chronic work-related trapezius myalgia (TM) and 20 healthy female controls (CON) were studied during baseline rest, 20 min repetitive low-force exercise, and 120 min recovery. Interstitial serotonin (5-HT), glutamate, lactate, pyruvate, and blood flow were determined by microdialysis in the trapezius muscle. Baseline pressure pain threshold (PPT) was lower (143+/-18 (TM) vs. 269+/-17 (CON)kPa) (mean+/-SEM), pain intensity (visual analogue scale, VAS) higher (33+/-5 vs. 2+/-1mm), muscle 5-HT higher (22.9+/-6.7 vs. 3.8+/-1.3 nmol/l), and glutamate higher (47+/-3 vs. 36+/-4 micromol/l) in TM than in CON (all P<0.05), whereas muscle blood flow was similar in groups. Furthermore, muscle pyruvate was higher (180+/-15 vs. 135+/-12 micromol/l) and lactate higher (4.4+/-0.3 vs. 3.1+/-0.3 mmol/l) in TM than in CON (P<0.001). In response to exercise, VAS and glutamate increased in both TM and CON (all P<0.05). In TM only, lactate and pyruvate increased significantly (P<0.02), whereas blood flow increased to similar levels in both groups. During the initial 20 min recovery period, blood flow remained increased in TM (P<0.005) whereas it decreased to baseline levels in CON. In conclusion, patients with chronic work-related TM have increased levels of muscle 5-HT and glutamate that were correlated to pain intensity (r=0.55, P<0.001) and PPT (r=-0.47, P<0.001), respectively. In addition, TM was associated with increased anaerobic metabolism, whereas a normal rise in blood flow was seen with exercise. These findings indicate that peripheral nociceptive processes are active in work-related TM.

Pain, 2005

The mechanisms behind the development of work-related trapezius pain are suggested to involve bot... more The mechanisms behind the development of work-related trapezius pain are suggested to involve both peripheral and central components, but the specific contribution of alterations in muscle nociceptive and other substances is not clear. Female patients with chronic trapezius myalgia (N=19; TM) and female controls (N=20; CON) were studied at rest, during 20 min repetitive low-force exercise and recovery, and had their interstitial concentrations of potassium (K(+)), lactate dehydrogenase (LDH), interleukin-6 (IL-6) and collagen turnover determined in the trapezius muscle by the microdialysis technique. K(+) levels were at all time points higher in TM than in CON (P<0.0001). Baseline levels of LDH and IL-6 were similar in both groups. In response to exercise pain intensity, rated perceived exertion, and the concentrations of K(+), LDH and IL-6 increased significantly in both groups. [K(+)] immediately decreased to baseline levels in CON but remained elevated during the first 20 min of recovery in TM (P<0.01) whereafter it returned to baseline level. In all subjects taken together mean [K(+)] correlated negatively with pressure pain threshold of trapezius (P<0.001), positively with mean pain intensity VAS (P<0.001) and mean perceived exertion (P<0.001). Rises in muscle LDH and IL-6 as well as the anabolic ratio for collagen type I was not significantly different between groups. In conclusion, patients with chronic pain in the trapezius muscle had increased levels of interstitial potassium. This finding could be causally related to myalgia or secondary to pain due to deconditioned muscle or altered muscle activity pattern.

PAIN, 2008

The origins of chronic muscle pain development and maintenance are debated regarding the relative... more The origins of chronic muscle pain development and maintenance are debated regarding the relative contributions of peripheral nociception and central pain processing. Bradykinin (BKN) and kallidin (KAL) have been suggested to be algesic kinins involved in muscle pain. This in vivo study investigates whether there were significant differences in interstitial muscle concentrations of BKN and KAL between chronic work-related trapezius myalgia (TM), chronic whiplash associated disorders (WAD), and healthy controls (CON). These subjects were studied at rest, during a 20-min repetitive low-force exercise and recovery. The interstitial concentrations of BKN and KAL of trapezius were determined using the microdialysis technique. The interstitial concentration of KAL was overall significantly higher in TM than in CON.

Journal of Rehabilitation Medicine, 2010

The aim of this study was to compare the interstitial concentrations of pyruvate, lactate and glu... more The aim of this study was to compare the interstitial concentrations of pyruvate, lactate and glutamate in the trapezius muscle between patients with fibromyalgia syndrome and healthy controls. Comparative cross-sectional study. Patients with fibromyalgia (n = 19) and healthy controls (n = 19); all women. Subjects answered a questionnaire about different aspects of pain. Pressure pain thresholds over the trapezius and tibialis anterior muscles were determined. The inter-stitial concentrations of pyruvate, lactate and glutamate were determined in the resting trapezius muscle by the microdialysis technique, with samples collected every hour for 5 consecutive hours. Pain intensity was also rated. Significantly higher interstitial concentrations of pyruvate and lactate were found in patients with fibromyalgia- syndrome. The multivariate regression analyses of group membership and pressure pain thresholds of the trapezius confirmed the importance of pyruvate and lactate. Different mechanisms that may increase pyruvate and lactate in patients with fibromyalgia syndrome are discussed. Improved understanding of peripheral muscle alterations in patients with fibromyalgia syndrome could lead to mechanism-based rehabilitation.

European Journal of Pain, 2005

Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis a... more Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis anterior muscle and overlying skin in healthy subjects (HS) and patients with fibromyalgia (FM). The aim of the present study was to examine the effect of needle stimulation on local blood flow in the trapezius muscle and overlying skin in HS and two groups of patients suffering from chronic pain in the trapezius muscle, i.e., FM and work-related trapezius myalgia (TM) patients. Two modes of needling, deep muscle stimulation (Deep) and subcutaneous needle insertion (SC), were performed at the upper part of the shoulder and blood flow was monitored for 60 min post-stimulation. Blood flow changes were measured non-invasively by using a new application of photoplethysmography. Increased blood flow in the trapezius muscle and overlying skin was found in all three groups following both Deep and SC. In HS, Deep was superior to SC in increasing skin and muscle blood flow, whereas in FM, SC was as effective as, or even more effective, than Deep. In the severely affected TM patients, no differences were found between the stimuli, and generally, a lesser blood flow response to the stimuli was found. At Deep, the muscle blood flow increase was significantly larger in HS, compared to the two patient groups. Positive correlations were found between muscle blood flow at Deep and pressure pain threshold in the trapezius muscle, neck movement and pain experienced at the stimulation, and negative correlations were found with spontaneous pain-related variables, symptom duration and age, pointing to less favorable results with worsening of symptoms, and to the importance of nociceptor activation in blood flow increase. It was hypothesized that the different patterns of muscle blood flow response to the needling may mirror a state of increased sympathetic activity and a generalized hypersensitivity in the patients. The intensity of stimulation should be taken into consideration when applying local needle stimulation (acupuncture) in order to increase the trapezius muscle blood flow in chronic pain conditions.

European Journal of Pain, 2008

The mechanisms behind the development of chronic trapezius myalgia in patients with whiplash asso... more The mechanisms behind the development of chronic trapezius myalgia in patients with whiplash associated disorders (WAD) appear to involve both peripheral and central components, but the specific contribution of alterations in muscle is not clear. Female patients with WAD and involvement of trapezius (N = 22) and female controls (N = 20; CON) were studied during an experiment compromised of rest (baseline), 20 min repetitive low-force exercise and 120 min recovery. Their interstitial concentrations of serotonin (5-HT), glutamate, lactate, pyruvate, potassium, interleukin-6 (IL-6), and blood flow were determined in the trapezius muscle using a microdialysis technique. Pressure pain thresholds (PPT) over trapezius and tibialis anterior muscles were also assessed. In WAD, we found signs of generalized hypersensitivity according to PPT. The WAD group had significantly higher interstitial [IL-6] and in the trapezius than the CON. [Pyruvate] was overall significantly lower in WAD, and with lactate it showed another time-pattern throughout the test. In the multivariate regression analysis of pain intensity [5-HT] was the strongest regressor and positively correlated with pain intensity in WAD. In addition, blood flow, [pyruvate], and [potassium] influenced the pain intensity in a complex time dependent way. These findings may indicate that peripheral nociceptive processes are activated in WAD with generalized hypersensitivity for pressure and they are not identical with those reported in chronic work-related trapezius myalgia, which could indicate different pain mechanisms.

European Journal of Applied Physiology, 2010

The aim of this investigation was to study female workers active in the labour market for differe... more The aim of this investigation was to study female workers active in the labour market for differences between those with trapezius myalgia (MYA) and without (CON) during repetitive pegboard (PEG) and stress (STR) tasks regarding (1) relative muscle load, (2) trapezius muscle blood flow, (3) metabolite accumulation, (4) oxygenation, and (5) pain development. Among 812 female employees (age 30-60 years) at 7 companies with high prevalence of neck/shoulder complaints, clinical examination identified 43 MYA and 19 CON. At rest, during PEG, and STR the trapezius muscle was measured using (1) EMG and MMG, (2) microdialysis, and (3) NIRS. Further, subjective pain ratings were scored (VAS). EMGrms in %MVE (Maximal Voluntary EMG-activity), was significantly higher among MYA than CON during PEG (11.74 +/- 9.09 vs. 7.42 +/- 5.56%MVE) and STR (5.47 +/- 5.00 vs. 3.28 +/- 1.94%MVE). MANOVA showed a group and time effect regarding data from the microdialysis: for MYA versus CON group differences demonstrated lower muscle blood flow and higher lactate and pyruvate concentrations. Potassium and glucose only showed time effects. NIRS showed similar initial decreases in oxygenation with PEG in both groups, but only in CON a significant increase back to baseline during PEG. VAS score at rest was highest among MYA and increased during PEG, but not for CON. The results showed significant differences between CON and MYA regarding muscle metabolism at rest and with PEG and STR. Higher relative muscle load during PEG and STR, insufficient muscle blood flow and oxygenation may account for the higher lactate, pyruvate and pain responses among MYA versus CON.

European Journal of Applied Physiology, 2002

The present study had two aims: (1) to investigate potential differences in proportion of myosin ... more The present study had two aims: (1) to investigate potential differences in proportion of myosin heavy chain isoforms in the trapezius muscle between female cleaners with and without trapezius myalgia and healthy teachers, and (2) to elucidate if myosin heavy chain composition and surface electromyogram (EMG) during an isokinetic endurance test of shoulder flexors are significantly related. The subjects were divided into three groups: (1) 25 female cleaners with diagnosed work-related trapezius myalgia; (2) 25 female cleaners without work-related trapezius myalgia; (3) a control group of 21 healthy female teachers who were not exposed to repetitive or static muscle work. All subjects performed a test involving150 forward flexions using an isokinetic dynamometer. During the test surface EMG was recorded from the trapezius muscle. Muscle samples were obtained from the descending part of the trapezius muscle. The fibre type area percentage based on ATPase staining and the proportions of different MHC isoforms as determined by gel electrophoresis. The trapezius was dominated by MHC I (71%), followed by MHC IIA (22-24%), and MHC IIX (5-7%); no significant differences between the three groups of subjects were found. The proportion of MHC I correlated negatively with MHC IIA ( r=-0.78; P<0.001) and MHC IIX ( r=-0.53; P<0.001). Significant correlations existed between the proportion of the MHC isoforms and the corresponding proportion of the fibre type area; 27-45% of the variance was explained. The multivariate analysis of the three groups of subjects revealed that MHC variables showed intercorrelations with EMG (both amplitude and frequency variables). However, the directions of the relationships differed among the three groups; the cleaners with myalgia and the teachers showed the greatest similarities in patterns. Intrinsic muscle properties appear to influence the frequency content of the EMG, which is in contrast to some of the theoretical models of the EMG. Our data could suggest that monotonous work such as professional cleaning can change the relationships between muscle structure and the frequency content of the EMG.

European Journal of Applied Physiology, 2003

Surface electromyography (sEMG) is an important tool to estimate muscular activity at work. There... more Surface electromyography (sEMG) is an important tool to estimate muscular activity at work. There is, however, a great inter-individual variation, even in carefully standardized work tasks. The sEMG signal is attenuated in the subcutaneous tissues, differently for each subject, which requires normalization. This is commonly made in relation to a reference contraction, which by itself, however, introduces a variance. A normalization method that is independent of individual motivation, motor control and pain inhibition would be desirable. The aim of the study was to explore the influence of the subcutaneous tissue thickness on sEMG amplitude. Ultrasound measurements of the muscle to skin surface distance were made bilaterally over the trapezius muscle in 12 females. Skinfold caliper measurements from these sites, as well as from four other sites, were made, body mass index (BMI) was recorded, and sEMG was recorded at maximal and submaximal contractions. The muscle-electrode distance, as measured by ultrasound, explained 33% and 31% (on the dominant and non-dominant sides respectively) of the variance of the sEMG activity at a standardized submaximal contraction (average between the sides, 46%); for maximal contractions the explained variance was 21%. Trapezius skinfold measurements showed poor correlations with sEMG. Instead, the mean of skinfold measurements from other sites explained as much as 68% (submaximal contraction). The corresponding figure for BMI was 67%. In conclusion, skinfold thickness explains a major part of the inter-individual variance in sEMG amplitude, and normalization to this measure is a possibility worth further evaluation.

Ergonomics, 1992

EMG was recorded with surface electrodes from the trapezius and deltoid muscles during a static e... more EMG was recorded with surface electrodes from the trapezius and deltoid muscles during a static endurance test at approximately 20% of maximal voluntary contraction. Objective parameters for localized muscular fatigue were derived from the time course of the root mean square (RMS) and mean power frequency (MPF) of the EMG recordings. Isotonic regression is introduced as a tool for assessment of such parameters. The most pronounced sign of fatigue for trapezius was an increase in the RMS values, while for deltoid it was a decrease in the MPF values. This could be explained by the different functions of the two muscles. The endurance time for a group of 11 women in industrial work with repetitive short-cycled work tasks who were diagnosed with neck/shoulder disorders (tension neck) was significantly shorter (p less than 0.05) than for a group with the same work, but without neck/shoulder disorders (n = 11), and shorter than for a control group (n = 11). Regarding the EMG fatigue measures, there were no significant differences between the three groups. We did not find any relationships between endurance time and the EMG parameters. The results indicate that neck/shoulder disorders were not associated with divergent mechanisms for developing fatigue in the muscles, as recorded with surface EMG.

The Clinical Journal of Pain, 2013

Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent... more Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent negative consequences. CWP has been associated with alterations in the central processing of nociception. Whereas some researchers consider CWP/FM as a central hyperexcitability pain condition, others suggest that the central alterations are maintained by peripheral nociceptive input. Microdialysis can be used in vivo to study muscle alterations in chronic myalgia. : The aim of the study was to investigate the plasma and interstitial concentrations of metabolites and algesics in the trapezius muscle of women with CWP and in pain-free women (CON). Seventeen women with CWP and 24 CON went through a clinical examination and completed a questionnaire; the pressure pain thresholds in the upper and lower extremities were registered. Microdialysis was conducted in the trapezius muscle, and a blood sample was drawn. Muscle blood flow, interstitial muscle concentrations, and plasma concentrations of lactate, pyruvate, glutamate, glucose, and glycerol (not in the plasma) were determined. CWP patients had significantly increased interstitial muscle (P=0.02 to 0.001) and plasma (P=0.026 to 0.017) concentrations of lactate and glutamate. No significant differences existed in blood flow between CWP and CON. The interstitial concentrations-but not the plasma levels-of glutamate and lactate correlated significantly with aspects of pain such as pressure pain thresholds of the trapezius (R=0.22) and tibialis anterior (R=0.18) and the mean pain intensity (R=0.10) in CWP but not in CON. The present study supports the suggestion that aspects of pain and central alterations in CWP/FM are influenced by peripheral tissue alterations.

European Journal of Pain, 2009

Journal of Electromyography and Kinesiology, 2003

The aim of this study was to investigate the reliability of peak torque and surface electromyogra... more The aim of this study was to investigate the reliability of peak torque and surface electromyography (EMG) variable's root mean square (RMS) and mean frequency (MNF) during an endurance test consisting of repetitive maximum concentric knee extensions. Muscle fatigue has been quantified in several ways, and in isokinetic testing it is based on a set of repetitive contractions. To assess test-retest reliability, two sets of 100 dynamic maximum concentric knee extensions were performed using an isokinetic dynamometer. The two series were separated by 7-8 days. The subjects relaxed during the passive flexion phase. Twenty (10 men and 10 women) clinically healthy subjects volunteered.

European Journal of Pain Supplements, 2011

With a repeated measures manova the changes over time were investigated. Effect sizes were calcul... more With a repeated measures manova the changes over time were investigated. Effect sizes were calculated using Cohen's d. Clinical relevance was determined by using the minimal clinical important difference (MCID). Results: Of the 107 participants, with a baseline average pain duration of 11 years, 90 (84%) completed the 1-year and 85 (79%) the 2-year follow-up. For all outcomes improvement immediately after the program was maintained. Effect sizes at 2-year followup for functioning (d = 1.6) and QoL (d = 1.4) were large, and more than 65% reached preset MCID. Healthcare use reduced: at baseline all patients consulted their general practitioner (GP) and medical specialist (MS) at least once, whereas at 2-year followup 73% reported having consulted neither a GP nor a MS during the previous year. Furthermore, analgesics decreased, and work participation increased to 81%. Conclusions: Patients who participated in this short, intensive intervention have learned to manage CLBP. The clinical relevant results were maintained two years later. In addition, healthcare use decreased substantially and most of the patients are at work.

European Journal of Pain, 2009

Pain, 2000

The association of cytochrome c oxidase negative ®bres (COX-negative) and ragged-red ®bres (RR-®b... more The association of cytochrome c oxidase negative ®bres (COX-negative) and ragged-red ®bres (RR-®bres) with work related trapezius myalgia has been proposed. Hitherto studies have been small or without control groups. The aim of the present study was to investigate the prevalences of RR-®bres and COX-negative ®bres in female cleaners with (n 25) and without (n 23) trapezius myalgia and in clinically healthy female teachers (n 21). The cleaners did mainly¯oor cleaning requiring monotonous loading on the trapezius muscle. A questionnaire covering background data and aspects of pain (prevalence, duration, intensity and in¯uence on daily living) was answered. Biopsies were obtained from the trapezius muscle by an open surgical technique. The three groups did not differ in prevalence of COXnegative or COX-superpositive (i.e. type-I ®bres with extremely strong brownish reaction in both the COX and SDH/COX stainings) ®bres. The prevalence of COX-negative ®bres was age dependent. Two subgroups of RR-®bres were present when stained for COX; COX-negative (73%) and COX-superpositive (26%) ®bres. Forty-two percent of the COX-negative ®bres were RR-®bres and 79% of the COX-superpositive were RR-®bres. A signi®cantly (P 0:002) higher proportion of the COX-superpositive ®bres in the cleaners were RR-®bres compared to the teachers. Multivariate regression analysis revealed that age, occupation as cleaner and a tender point in the trapezius were signi®cantly associated with increased prevalences of RR-®bres; a cleaner with a tender point had a 4.35 higher prevalence of RR-®bres compared to a teacher without a tender point. No correlations between other pain related variables and prevalence of RR-®bres were noted. In conclusion, RR-®bres but not COX-negative or COX-superpositive ®bres were correlated with cleaning work tasks and with a tender point in the trapezius. q 2000 International Association for the Study of Pain. Published by Elsevier Science B.V.

European Journal of Pain, 2009

Journal of pain research, 2014

Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult popu... more Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain), which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for s...

Journal of Muscle Research and Cell Motility, 2002

Decreased estrogen production is associated with changes in the skeletal, cardiovascular and musc... more Decreased estrogen production is associated with changes in the skeletal, cardiovascular and muscular systems. At the level of skeletal muscles, it has been shown that a reduction in force production occurs at menopause but the underlying mechanisms are still unknown. The aim of the study was to investigate the effects of ovariectomy on myosin heavy chain (MyHC) composition. Additionally, we studied the effects of physical activity and the combined effects of physical activity and estrogen treatment on MyHC content in ovariectomised (OX) animals. Twenty-five rats were randomly assigned to five different groups: controls, runners, OX, ovariectomised runners and ovariectomised runners receiving estrogen. Exercise consisted of voluntary running for 5 weeks. Two muscles were analysed: m. extensor digitorum longus, EDL, (fast muscle) and m. soleus (slow muscle). MyHC content was analysed on 8% gel electrophoresis. The level of running activity is reduced in OX animals and estrogen administration is associated with the normalisation of the level of physical activity. Ovariectomy induces a shift from fast to slow MyHC isoforms in both the soleus and EDL. When OX animals are allowed to run, alterations in MyHC isoforms are still observed in the EDL but not in the soleus. When physical activity is combined with estrogen treatment no alterations are observed in both muscles. In conclusion, this study shows that ovariectomy induces alterations in the contractile properties of skeletal muscles and that physical activity in combination with estrogen treatment are associated with the maintenance of slow and fast muscle characteristics.

PLoS ONE, 2011

Background: N-acylethanolamines (NAEs) are endogenous compounds that regulate inflammation and pa... more Background: N-acylethanolamines (NAEs) are endogenous compounds that regulate inflammation and pain. These include the cannabinoid ligand anandamide (AEA) and the peroxisome proliferator-activated receptor-a ligand palmitoylethanolamide (PEA). Little is known as to the levels of NAEs in pain states in human, particularly in the skeletal muscle. The aim of this study was to investigate the levels of these lipid mediators in muscle dialysate from women with chronic neck-/shoulder pain compared to healthy controls.

Pain, 2004

Local metabolic changes are suggested to be involved in muscle pain development in humans. Ninete... more Local metabolic changes are suggested to be involved in muscle pain development in humans. Nineteen women with chronic work-related trapezius myalgia (TM) and 20 healthy female controls (CON) were studied during baseline rest, 20 min repetitive low-force exercise, and 120 min recovery. Interstitial serotonin (5-HT), glutamate, lactate, pyruvate, and blood flow were determined by microdialysis in the trapezius muscle. Baseline pressure pain threshold (PPT) was lower (143+/-18 (TM) vs. 269+/-17 (CON)kPa) (mean+/-SEM), pain intensity (visual analogue scale, VAS) higher (33+/-5 vs. 2+/-1mm), muscle 5-HT higher (22.9+/-6.7 vs. 3.8+/-1.3 nmol/l), and glutamate higher (47+/-3 vs. 36+/-4 micromol/l) in TM than in CON (all P<0.05), whereas muscle blood flow was similar in groups. Furthermore, muscle pyruvate was higher (180+/-15 vs. 135+/-12 micromol/l) and lactate higher (4.4+/-0.3 vs. 3.1+/-0.3 mmol/l) in TM than in CON (P<0.001). In response to exercise, VAS and glutamate increased in both TM and CON (all P<0.05). In TM only, lactate and pyruvate increased significantly (P<0.02), whereas blood flow increased to similar levels in both groups. During the initial 20 min recovery period, blood flow remained increased in TM (P<0.005) whereas it decreased to baseline levels in CON. In conclusion, patients with chronic work-related TM have increased levels of muscle 5-HT and glutamate that were correlated to pain intensity (r=0.55, P<0.001) and PPT (r=-0.47, P<0.001), respectively. In addition, TM was associated with increased anaerobic metabolism, whereas a normal rise in blood flow was seen with exercise. These findings indicate that peripheral nociceptive processes are active in work-related TM.

Pain, 2005

The mechanisms behind the development of work-related trapezius pain are suggested to involve bot... more The mechanisms behind the development of work-related trapezius pain are suggested to involve both peripheral and central components, but the specific contribution of alterations in muscle nociceptive and other substances is not clear. Female patients with chronic trapezius myalgia (N=19; TM) and female controls (N=20; CON) were studied at rest, during 20 min repetitive low-force exercise and recovery, and had their interstitial concentrations of potassium (K(+)), lactate dehydrogenase (LDH), interleukin-6 (IL-6) and collagen turnover determined in the trapezius muscle by the microdialysis technique. K(+) levels were at all time points higher in TM than in CON (P<0.0001). Baseline levels of LDH and IL-6 were similar in both groups. In response to exercise pain intensity, rated perceived exertion, and the concentrations of K(+), LDH and IL-6 increased significantly in both groups. [K(+)] immediately decreased to baseline levels in CON but remained elevated during the first 20 min of recovery in TM (P<0.01) whereafter it returned to baseline level. In all subjects taken together mean [K(+)] correlated negatively with pressure pain threshold of trapezius (P<0.001), positively with mean pain intensity VAS (P<0.001) and mean perceived exertion (P<0.001). Rises in muscle LDH and IL-6 as well as the anabolic ratio for collagen type I was not significantly different between groups. In conclusion, patients with chronic pain in the trapezius muscle had increased levels of interstitial potassium. This finding could be causally related to myalgia or secondary to pain due to deconditioned muscle or altered muscle activity pattern.

PAIN, 2008

The origins of chronic muscle pain development and maintenance are debated regarding the relative... more The origins of chronic muscle pain development and maintenance are debated regarding the relative contributions of peripheral nociception and central pain processing. Bradykinin (BKN) and kallidin (KAL) have been suggested to be algesic kinins involved in muscle pain. This in vivo study investigates whether there were significant differences in interstitial muscle concentrations of BKN and KAL between chronic work-related trapezius myalgia (TM), chronic whiplash associated disorders (WAD), and healthy controls (CON). These subjects were studied at rest, during a 20-min repetitive low-force exercise and recovery. The interstitial concentrations of BKN and KAL of trapezius were determined using the microdialysis technique. The interstitial concentration of KAL was overall significantly higher in TM than in CON.

Journal of Rehabilitation Medicine, 2010

The aim of this study was to compare the interstitial concentrations of pyruvate, lactate and glu... more The aim of this study was to compare the interstitial concentrations of pyruvate, lactate and glutamate in the trapezius muscle between patients with fibromyalgia syndrome and healthy controls. Comparative cross-sectional study. Patients with fibromyalgia (n = 19) and healthy controls (n = 19); all women. Subjects answered a questionnaire about different aspects of pain. Pressure pain thresholds over the trapezius and tibialis anterior muscles were determined. The inter-stitial concentrations of pyruvate, lactate and glutamate were determined in the resting trapezius muscle by the microdialysis technique, with samples collected every hour for 5 consecutive hours. Pain intensity was also rated. Significantly higher interstitial concentrations of pyruvate and lactate were found in patients with fibromyalgia- syndrome. The multivariate regression analyses of group membership and pressure pain thresholds of the trapezius confirmed the importance of pyruvate and lactate. Different mechanisms that may increase pyruvate and lactate in patients with fibromyalgia syndrome are discussed. Improved understanding of peripheral muscle alterations in patients with fibromyalgia syndrome could lead to mechanism-based rehabilitation.

European Journal of Pain, 2005

Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis a... more Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis anterior muscle and overlying skin in healthy subjects (HS) and patients with fibromyalgia (FM). The aim of the present study was to examine the effect of needle stimulation on local blood flow in the trapezius muscle and overlying skin in HS and two groups of patients suffering from chronic pain in the trapezius muscle, i.e., FM and work-related trapezius myalgia (TM) patients. Two modes of needling, deep muscle stimulation (Deep) and subcutaneous needle insertion (SC), were performed at the upper part of the shoulder and blood flow was monitored for 60 min post-stimulation. Blood flow changes were measured non-invasively by using a new application of photoplethysmography. Increased blood flow in the trapezius muscle and overlying skin was found in all three groups following both Deep and SC. In HS, Deep was superior to SC in increasing skin and muscle blood flow, whereas in FM, SC was as effective as, or even more effective, than Deep. In the severely affected TM patients, no differences were found between the stimuli, and generally, a lesser blood flow response to the stimuli was found. At Deep, the muscle blood flow increase was significantly larger in HS, compared to the two patient groups. Positive correlations were found between muscle blood flow at Deep and pressure pain threshold in the trapezius muscle, neck movement and pain experienced at the stimulation, and negative correlations were found with spontaneous pain-related variables, symptom duration and age, pointing to less favorable results with worsening of symptoms, and to the importance of nociceptor activation in blood flow increase. It was hypothesized that the different patterns of muscle blood flow response to the needling may mirror a state of increased sympathetic activity and a generalized hypersensitivity in the patients. The intensity of stimulation should be taken into consideration when applying local needle stimulation (acupuncture) in order to increase the trapezius muscle blood flow in chronic pain conditions.

European Journal of Pain, 2008

The mechanisms behind the development of chronic trapezius myalgia in patients with whiplash asso... more The mechanisms behind the development of chronic trapezius myalgia in patients with whiplash associated disorders (WAD) appear to involve both peripheral and central components, but the specific contribution of alterations in muscle is not clear. Female patients with WAD and involvement of trapezius (N = 22) and female controls (N = 20; CON) were studied during an experiment compromised of rest (baseline), 20 min repetitive low-force exercise and 120 min recovery. Their interstitial concentrations of serotonin (5-HT), glutamate, lactate, pyruvate, potassium, interleukin-6 (IL-6), and blood flow were determined in the trapezius muscle using a microdialysis technique. Pressure pain thresholds (PPT) over trapezius and tibialis anterior muscles were also assessed. In WAD, we found signs of generalized hypersensitivity according to PPT. The WAD group had significantly higher interstitial [IL-6] and in the trapezius than the CON. [Pyruvate] was overall significantly lower in WAD, and with lactate it showed another time-pattern throughout the test. In the multivariate regression analysis of pain intensity [5-HT] was the strongest regressor and positively correlated with pain intensity in WAD. In addition, blood flow, [pyruvate], and [potassium] influenced the pain intensity in a complex time dependent way. These findings may indicate that peripheral nociceptive processes are activated in WAD with generalized hypersensitivity for pressure and they are not identical with those reported in chronic work-related trapezius myalgia, which could indicate different pain mechanisms.

European Journal of Applied Physiology, 2010

The aim of this investigation was to study female workers active in the labour market for differe... more The aim of this investigation was to study female workers active in the labour market for differences between those with trapezius myalgia (MYA) and without (CON) during repetitive pegboard (PEG) and stress (STR) tasks regarding (1) relative muscle load, (2) trapezius muscle blood flow, (3) metabolite accumulation, (4) oxygenation, and (5) pain development. Among 812 female employees (age 30-60 years) at 7 companies with high prevalence of neck/shoulder complaints, clinical examination identified 43 MYA and 19 CON. At rest, during PEG, and STR the trapezius muscle was measured using (1) EMG and MMG, (2) microdialysis, and (3) NIRS. Further, subjective pain ratings were scored (VAS). EMGrms in %MVE (Maximal Voluntary EMG-activity), was significantly higher among MYA than CON during PEG (11.74 +/- 9.09 vs. 7.42 +/- 5.56%MVE) and STR (5.47 +/- 5.00 vs. 3.28 +/- 1.94%MVE). MANOVA showed a group and time effect regarding data from the microdialysis: for MYA versus CON group differences demonstrated lower muscle blood flow and higher lactate and pyruvate concentrations. Potassium and glucose only showed time effects. NIRS showed similar initial decreases in oxygenation with PEG in both groups, but only in CON a significant increase back to baseline during PEG. VAS score at rest was highest among MYA and increased during PEG, but not for CON. The results showed significant differences between CON and MYA regarding muscle metabolism at rest and with PEG and STR. Higher relative muscle load during PEG and STR, insufficient muscle blood flow and oxygenation may account for the higher lactate, pyruvate and pain responses among MYA versus CON.

European Journal of Applied Physiology, 2002

The present study had two aims: (1) to investigate potential differences in proportion of myosin ... more The present study had two aims: (1) to investigate potential differences in proportion of myosin heavy chain isoforms in the trapezius muscle between female cleaners with and without trapezius myalgia and healthy teachers, and (2) to elucidate if myosin heavy chain composition and surface electromyogram (EMG) during an isokinetic endurance test of shoulder flexors are significantly related. The subjects were divided into three groups: (1) 25 female cleaners with diagnosed work-related trapezius myalgia; (2) 25 female cleaners without work-related trapezius myalgia; (3) a control group of 21 healthy female teachers who were not exposed to repetitive or static muscle work. All subjects performed a test involving150 forward flexions using an isokinetic dynamometer. During the test surface EMG was recorded from the trapezius muscle. Muscle samples were obtained from the descending part of the trapezius muscle. The fibre type area percentage based on ATPase staining and the proportions of different MHC isoforms as determined by gel electrophoresis. The trapezius was dominated by MHC I (71%), followed by MHC IIA (22-24%), and MHC IIX (5-7%); no significant differences between the three groups of subjects were found. The proportion of MHC I correlated negatively with MHC IIA ( r=-0.78; P<0.001) and MHC IIX ( r=-0.53; P<0.001). Significant correlations existed between the proportion of the MHC isoforms and the corresponding proportion of the fibre type area; 27-45% of the variance was explained. The multivariate analysis of the three groups of subjects revealed that MHC variables showed intercorrelations with EMG (both amplitude and frequency variables). However, the directions of the relationships differed among the three groups; the cleaners with myalgia and the teachers showed the greatest similarities in patterns. Intrinsic muscle properties appear to influence the frequency content of the EMG, which is in contrast to some of the theoretical models of the EMG. Our data could suggest that monotonous work such as professional cleaning can change the relationships between muscle structure and the frequency content of the EMG.

European Journal of Applied Physiology, 2003

Surface electromyography (sEMG) is an important tool to estimate muscular activity at work. There... more Surface electromyography (sEMG) is an important tool to estimate muscular activity at work. There is, however, a great inter-individual variation, even in carefully standardized work tasks. The sEMG signal is attenuated in the subcutaneous tissues, differently for each subject, which requires normalization. This is commonly made in relation to a reference contraction, which by itself, however, introduces a variance. A normalization method that is independent of individual motivation, motor control and pain inhibition would be desirable. The aim of the study was to explore the influence of the subcutaneous tissue thickness on sEMG amplitude. Ultrasound measurements of the muscle to skin surface distance were made bilaterally over the trapezius muscle in 12 females. Skinfold caliper measurements from these sites, as well as from four other sites, were made, body mass index (BMI) was recorded, and sEMG was recorded at maximal and submaximal contractions. The muscle-electrode distance, as measured by ultrasound, explained 33% and 31% (on the dominant and non-dominant sides respectively) of the variance of the sEMG activity at a standardized submaximal contraction (average between the sides, 46%); for maximal contractions the explained variance was 21%. Trapezius skinfold measurements showed poor correlations with sEMG. Instead, the mean of skinfold measurements from other sites explained as much as 68% (submaximal contraction). The corresponding figure for BMI was 67%. In conclusion, skinfold thickness explains a major part of the inter-individual variance in sEMG amplitude, and normalization to this measure is a possibility worth further evaluation.

Ergonomics, 1992

EMG was recorded with surface electrodes from the trapezius and deltoid muscles during a static e... more EMG was recorded with surface electrodes from the trapezius and deltoid muscles during a static endurance test at approximately 20% of maximal voluntary contraction. Objective parameters for localized muscular fatigue were derived from the time course of the root mean square (RMS) and mean power frequency (MPF) of the EMG recordings. Isotonic regression is introduced as a tool for assessment of such parameters. The most pronounced sign of fatigue for trapezius was an increase in the RMS values, while for deltoid it was a decrease in the MPF values. This could be explained by the different functions of the two muscles. The endurance time for a group of 11 women in industrial work with repetitive short-cycled work tasks who were diagnosed with neck/shoulder disorders (tension neck) was significantly shorter (p less than 0.05) than for a group with the same work, but without neck/shoulder disorders (n = 11), and shorter than for a control group (n = 11). Regarding the EMG fatigue measures, there were no significant differences between the three groups. We did not find any relationships between endurance time and the EMG parameters. The results indicate that neck/shoulder disorders were not associated with divergent mechanisms for developing fatigue in the muscles, as recorded with surface EMG.

The Clinical Journal of Pain, 2013

Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent... more Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent negative consequences. CWP has been associated with alterations in the central processing of nociception. Whereas some researchers consider CWP/FM as a central hyperexcitability pain condition, others suggest that the central alterations are maintained by peripheral nociceptive input. Microdialysis can be used in vivo to study muscle alterations in chronic myalgia. : The aim of the study was to investigate the plasma and interstitial concentrations of metabolites and algesics in the trapezius muscle of women with CWP and in pain-free women (CON). Seventeen women with CWP and 24 CON went through a clinical examination and completed a questionnaire; the pressure pain thresholds in the upper and lower extremities were registered. Microdialysis was conducted in the trapezius muscle, and a blood sample was drawn. Muscle blood flow, interstitial muscle concentrations, and plasma concentrations of lactate, pyruvate, glutamate, glucose, and glycerol (not in the plasma) were determined. CWP patients had significantly increased interstitial muscle (P=0.02 to 0.001) and plasma (P=0.026 to 0.017) concentrations of lactate and glutamate. No significant differences existed in blood flow between CWP and CON. The interstitial concentrations-but not the plasma levels-of glutamate and lactate correlated significantly with aspects of pain such as pressure pain thresholds of the trapezius (R=0.22) and tibialis anterior (R=0.18) and the mean pain intensity (R=0.10) in CWP but not in CON. The present study supports the suggestion that aspects of pain and central alterations in CWP/FM are influenced by peripheral tissue alterations.