Thread by @laurarathbone

@LePubScientifiq with @ksluka0101 on NOW!

Joined by @paintoolkit2 and @AdamMeakins and Le Pubbers @timbeames and @Pijninfo
#LePubHB

We've known for 100years that exercise is a helpful option for pain care, but it still is not part of first line treatment. #LePubHB

But yet within the community of people living with Fibromyalgia the opposite was shown. That exercise increases the experience of pain.
But why?
#LePubHB

@ksluka0101 has been using animal studies to knock out certain mechanisms of excitability to reduce the reported experience of pain.
#LePubHB

Fatigue metabolites may also contribute to pain behaviour by activated macrophages during muscular contraction. So they eliminated macrophages within animal studies and thwre was no evidence of pain behaviour.
#neuroimmune
#LePubHB

So great to get an insight into how the mind of a basic scientist works!
@ksluka0101 "i dont just ask, does it do this? I also ask - why does it or doesnt it"
#LePubHB
Dr Sluka is so passionate and excited by her work. Its so inspiring.

Inactivity is a problem for pain, and higher levels of activity can be preventative for the development of persistent pain.
Check out the HUNT study.
#LePubHB

When rodents run for 8 weeks they show reduced hyperalgesia and pain behaviours compared to sedentary rodents

Exercise is not PART of multi-modal treatment, it is IN ITSELF a multi-modal treatment!
#LePubHB

Exercise induces the release of endogenous opiods (made by the body)
#LePubHB

The chat box on @LePubScientifiq is one of my favourite things about Le Pub!
#LePubHB
The old fashioned @AdamMeakins
@bannister_lab avec beer 🍻

A change in connectivity between areas of the brain and the spinal cord, suggesting there is less excitability between those two regions in rodents that regualr exercised vs those who didnt. And this was confirmed in humans.
#LePubHB

Back to the neuroimmune system now with the formidable @ksluka0101
I think we all want to become basic scientists now....
#LePubHB

The involvement of the neuroimmune system has been confirmed in human subjects, and in people with fibromyalgia there is evidence showing changes in immune mechanisms that may be conteibuting to thwir experience of pain.
#LePubHB

Physical activity and exercise under pain conditions, we have increased facilitation and less inhibition...but...when exercise vecomes regular we move to an inti-inflammatory state, with increased inhibition and reduced faciltation.
#LePubHB

Everytime a study puts 2 types of exercises against each other they almost always come out as equally effective for people with persistent pain.
So exercise choice should probably depend on patient preference, therapist training and safety.
#LePubHB

@BethDarnall 's recent study suggests there is an interraction between catastrophisation and physical activity levels.

So what will improve adherence?

Because the most important thing is that people do the exercises...when pain is the biggest obstacle for most people

#LePubHB

Is this a role for TENS-based on the mechanisms of inhibition.

Check out the FAST study.

Not to suggest that TENS has any curative action, but may help with movement induced pain when it is on (and probably only when it is on), which may promote adherence to exercise.
#LePubHB

Numbers needed to treat is as effective as medical options, and numbers needed to harm is waar above medical interventions (usually around 10 people for 1 person harmed, with this its around 25 people before harm - like skin irritation from the electeodes)
#LePubHB

The BEST study (@ksluka0101)partnered with the university of Iowa clinics to try and improve the implementation of exercise in primary care.

#LePubHB

This has been amazing, insightful and really translational.
Phew and now into the panelist session and then on to the QandA.
Im gonna sit back and relax now!
#LePubHB

If you are going to have a MANEL, have one like this....
@LePubScientifiq
@AdamMeakins
@paintoolkit2
@ksluka0101
#LePubHB