L Arendt-Nielsen

Aalborg University, Ålborg, North Denmark, Denmark

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Publications (395)1087.19 Total impact

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    ABSTRACT: Objectives: This study focused on the biomechanical implications of knee osteoarthritis (OA) and the association with pain. The plantar loading force distribution of the foot was determined and correlated to degenerative knee changes, function, pain intensity, and pain sensitization. Method: Knee OA patients (n = 34) with moderate and mild knee pain were characterized and compared to matched controls (n = 16). The Plantar Foot Posture Index (FPI) and mean maximum plantar forces were determined by pressure-sensitive insoles. Pain intensity and function were assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Brief Pain Inventory (BPI). Local knee pain sensitization was assessed by pressure pain thresholds (PPTs) from eight knee locations. Spreading sensitization was assessed by PPTs from two extra-segmental test sites. Temporal summation to repeated pressure stimulation (knee and extra-segmental stimulation) and conditioning pain modulation (CPM) were assessed, representing central pain mechanisms. Results: The maximum force (MF) applied by the medial forefoot correlated to knee PPTs (r = 0.524, p < 0.001), CPM potency (r = 0.532, p < 0.001), and BPI (r = -0.325, p < 0.05) and WOMAC scores (pain r = -0.425, p < 0.01; stiffness r = -0.386, p < 0.01; function r = -0.378, p < 0.05). The MF applied by the medial hindfoot correlated negatively to scores on the FPI (r = -0.394, p < 0.01) and the Kellgren-Lawrence (K-L) grading scale (r = -0.330, p < 0.05). The MF applied by the medial forefoot correlated to extra-segmental PPTs (r = 0.554, p < 0.001) and the potency of CPM (r = 0.561, p < 0.0001). The MF applied by the lateral hindfoot correlated negatively to the PPT assessed extra-segmentally (r = -0.367, p < 0.05) and positively to CPM potency (r = 0.322, p < 0.05). Conclusions: This study shows that mean maximum plantar foot force distribution in patients with painful knee OA is associated with specific pain mechanisms, function, radiological findings, and pain intensity.
    Scandinavian journal of rheumatology. 10/2014;
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    ABSTRACT: Osteoarthritis (OA) is the most common degenerative joint disease, of which the pathogenesis is inadequately understood. Hypertrophy-like changes have been observed as part of the progression of OA. The aim of the study was to develop and characterize a novel biomarker of chondrocytes hypertrophy and investigate how this marker was associated with cartilage degradation and inflammation in patients with various degrees of OA.
    BMC Musculoskeletal Disorders 09/2014; 15(1):309. · 1.88 Impact Factor
  • Jesper Elberling, Lars Arendt-Nielsen
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    ABSTRACT: Chronic itch is an annoying and disabling symptom that severely affects patients' quality of life in several dermatological as well as non-dermatological disorders. Chronic itch may be maintained and even aggravated by sensitization of peripheral and central neuronal structures. The possibilities to effectively relieve chronic itch are often limited and the need of more specific, effective and quick-acting treatment options is huge. This review summarizes the fundamental aspects of itch, the neuronal transmission and modulation of itch, and discusses new treatment opportunities.
    Ugeskrift for laeger 08/2014; 176(32).
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    ABSTRACT: Generalized hyperalgesia, a widespread increased sensitivity to painful stimuli, has been demonstrated in a range of chronic pain conditions including low-back pain. The evidence suggests, that generalized hyperalgesia may be an important factor in the development of chronicity, but it is not commonly assessed in clinical practice. Whereas a range of tools and procedures for the quantitative sensory testing of pain sensitivity is available for laboratory pain research, most experimental pain stimuli are not well suited for clinical practice. In the current study, a simple and inexpensive mechanical spring-clamp was tested as a potential experimental pain stimulus.
    Chiropractic & Manual Therapies. 08/2014; 22(1):30.
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    ABSTRACT: Activation of TRPM8 and TRPA1 receptors generates cold and cold pain sensations, respectively, and is presumably important in clinical pain manifestations, such as cold hyperalgesia. This study investigated the interaction between TRPM8 and TRPA1 receptors through stimulation of glabrous human skin (volar forearm) by topical administration of 40% L-menthol and 10% trans-cinnamaldehyde (CA), individually and in combination. Sensory manifestations were assessed in 10 healthy volunteers via a platform of 11 quantitative sensory (thermal and mechanical stimuli) and vasomotor tests (skin temperature, perfusion and axon-reflex-flare) in a double-blinded randomized crossover design. Cold pain threshold was increased (p < 0.01, cold allodynia) by L-menthol alone and L-menthol + CA in combination but unaffected by CA. Mechanical pain threshold was significantly decreased (mechanical hyperalgesia) by all three substances (p < 0.01), with a significant intergroup difference found between CA alone and the less decreased L-menthol + CA (p < 0.05). Application of CA alone and L-menthol + CA in combination showed an increase in skin temperature and perfusion significantly larger than that induced by L-menthol alone (p < 0.05). An axon-reflex-flare was present after CA administration, but was significantly reduced upon addition of L-menthol (p < 0.01). This study elucidates the potential of L-menthol as a counter-irritant to secondary neurogenic inflammation and provides evidence of an intricate interplay between cold receptors TRPA1 and TRPM8, warranting further investigation of the neural coding of cold pain perception.
    European journal of pain (London, England) 03/2014; · 3.37 Impact Factor
  • Lars Arendt-Nielsen, Thomas Arendt Nielsen, Parisa Gazerani
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    ABSTRACT: Translation of the analgesic efficacy of investigational neurotherapeutics from pre-clinical pain models into clinical trial phases is associated with a high risk of failure. Application of human pain biomarkers in early stages of clinical trials can potentially enhance the rate of successful translation, which would eventually reduce both length and costs of drug development after the pre-clinical stage. Human pain biomarkers are based on the standardized activation of pain pathways followed by the assessment of ongoing and paroxysmal pain, plus evoked responses which can be applied to healthy individuals and patients prior to and after pharmacological interventions. This review discusses the rationality and feasibility of advanced human pain biomarkers in early phases of drug development for pain management which is still an unmet medical need.
    Expert Review of Neurotherapeutics 02/2014; · 2.96 Impact Factor
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    ABSTRACT: Hip disorder patients typically present with extensive pain referral and hyperalgesia. To better understand underlying mechanisms an experimental hip pain model was established where pain referrals and hyperalgesia could be studied under standardized conditions. In sixteen healthy subjects, pain was induced by hypertonic saline injection into the gluteus medius tendon (GMT), addutor longus tendon (ALT), or gluteus medius muscle (GMM). Isotonic saline was injected contralaterally as control. Pain intensity was assessed on a visual analogue scale (VAS) and subjects mapped the pain distribution. Before, during and after injections, passive hip joint pain provocation tests were completed together with quantitative sensory testing: Pressure pain thresholds (PPTs), cuff algometry pain thresholds (cuff-PPTs), cutaneous pin-prick sensitivity, and thermal pain thresholds. Hypertonic saline injected into the GMT caused higher VAS scores than hypertonic injections into the ALT and GMM (P<0.05). Referred pain areas spread to larger parts of the leg after GMT and GMM injections compared with more regionalized pain pattern after ALT injections (P<0.05). PPTs at the injection site were decreased after hypertonic saline injections into GMT and GMM compared with baseline, ALT injections, and isotonic saline. Cuff-PPTs from the thigh were decreased after hypertonic saline injections into the ALT compared with baseline, GMT injections, and isotonic saline (P<0.05). More subjects had positive joint pain provocation tests after hypertonic compared with isotonic saline injections (P<0.05) indicating that this provocation test also assess hyperalgesia in extra-articular soft tissues. The experimental models may open for better understanding of pain mechanisms associated with painful hip disorders.
    Pain 01/2014; · 5.64 Impact Factor
  • Ann G Hayes, Lars Arendt-Nielsen, Simon Tate
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    ABSTRACT: Recent advances in understanding the pathophysiology of pain have led to a wealth of molecular targets for novel analgesic drugs and many clinical drug trials. There have been successes, like the gabapentinoids for neuropathic pain and calcium channel blockers for otherwise intractable pain states; and drugs which show promise in clinical trials, like nerve growth factor inhibitors and p38 kinase inhibitors. Unfortunately there have also been a number of failures. We suggest factors which might predispose to success, for example some clinical precedence for the mechanism in pain or a genetic link for the mechanism, for example a mutation linked to a pain syndrome. We also stress the importance of demonstrating molecular target engagement with a novel compound and suggest pain biomarkers which can be used for mechanistic drug profiling.
    Current Opinion in Pharmacology 01/2014; 14:11–17. · 5.44 Impact Factor
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    Lars Arendt-Nielsen, Brian Edwin Cairns
    The Lancet Neurology 01/2014; 13(1):22-23. · 23.92 Impact Factor
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    ABSTRACT: In the trigeminal ganglion (TG), satellite glial cells (SGCs) form a functional unit with neurons. It has been proposed that SGCs participate in regulating extracellular glutamate levels and that dysfunction of this SGC capacity can impact nociceptive transmission in craniofacial pain conditions. This study investigated whether SGCs release glutamate and whether elevation of TG glutamate concentration alters response properties of trigeminal afferent fibers. Immunohistochemistry was used to assess glutamate content and the expression of excitatory amino acid transporter (EAAT)1 and EAAT2 in TG sections. SGCs contained glutamate and expressed EAAT1 and EAAT2. Potassium chloride (10 mM) was used to evoke glutamate release from cultured rat SGCs treated with the EAAT1/2 inhibitor (3S)-3-[[3-[[4-(trifluoromethyl)ben zoyl]amino]phenyl]methoxy]-l-aspartic acid (TFB-TBOA) or control. Treatment with TFB-TBOA (1 and 10 μM) significantly reduced the glutamate concentration from 10.6 ± 1.1 to 5.8 ± 1.4 μM and 3.0 ± 0.8 μM, respectively (p < 0.05). Electrophysiology experiments were conducted in anaesthetized rats to determine the effect of intraganglionic injections of glutamate on the response properties of ganglion neurons that innervated either the temporalis or masseter muscle. Intraganglionic injection of glutamate (500 mM, 3 μl) evoked afferent discharge and significantly reduced muscle afferent mechanical threshold. Glutamate-evoked discharge was attenuated by the N-methyl-d-aspartate receptor antagonist 2-amino-5-phosphonovalerate (APV) and increased by TFB-TBOA, whereas mechanical sensitization was only sensitive to APV. Antidromic invasion of muscle afferent fibers by electrical stimulation of the caudal brainstem (10 Hz) or local anesthesia of the brainstem with lidocaine did not alter glutamate-induced mechanical sensitization. These findings provide a novel mechanism whereby dysfunctional trigeminal SGCs could contribute to cranial muscle tenderness in craniofacial pain conditions such as migraine headache.
    Neuroscience 01/2014; 256:23–35. · 3.12 Impact Factor
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    ABSTRACT: Around 20% of patients with osteoarthritis (OA) have chronic post-operative pain after total knee arthroplasty (TKA) and often undergo revision surgery with unfavourable pain outcome. This study compared sensitization in pain patients with knee OA and after revision TKA (re-TKA). Median pressure pain thresholds (PPTs) assessed from the most affected knee (localized sensitization) were used to subgroup 53 patients with OA pain and 20 patients with pain after re-TKA: group 1: OA and high-knee PPT; group 2: OA and low-knee PPT; group 3: re-TKA and high-knee PPT; group 4: re-TKA and low-knee PPT. Clinical pain intensity was assessed using a visual analogue scale (VAS). Bilateral PPTs were measured from the lower leg and forearm (spreading sensitization). Furthermore, the pain intensities evoked by 10 repeated pressure pain stimuli (temporal summation) at the knee and lower leg were assessed on an electronic VAS. The mean clinical pain intensity was not significantly different between groups. The PPTs from both lower leg and forearm were significantly lower in group 4 compared to groups 1, 2, and 3 and in groups 2 and 3 compared to group 1 (p < 0.05). Temporal summations from the knee and lower leg were significantly facilitated in groups 3 and 4 compared to groups 1 and 2 (p < 0.05). Despite similar pain intensities, facilitated temporal summation is worse in re-TKA than in OA and patients with high local knee hyperalgesia show more prominent spreading sensitization. The study suggests that sensitization should be considered in knee OA especially before re-TKA.
    European journal of pain (London, England) 12/2013; · 3.37 Impact Factor
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    ABSTRACT: Osteoarthritis (OA) is a degenerative disease with a subset of patients experiencing joint inflammation, but C-reactive protein (CRP) has shown limited use in OA as a diagnostic marker. The aim was to identify subpopulations of patients with high or low levels of acute (hsCRP) and/or matrix metalloproteinase (MMP) derived inflammation (CRPM) and investigate the subpopulations' association with biomarkers of collagen degradation and Kellgren-Lawrence score (KL). hsCRP, CRPM and MMP-degraded type I, II and III collagen (C1M, C2M and C3M) were quantified by ELISA in serum of 342 patients with symptomatic knee OA of which 60 underwent total knee replacement (TKR). KL was obtained. Patients were divided into quartiles by hsCRP and CRPM levels, where Q1 and Q4 were low or high in both. The biomarker levels of healthy adults provided in the ELISA kits were used as reference level. hsCRP was elevated in TKR (5.9(3.6-8.2 95% CI)μg/mL) compared to reference level (3μg/mL), while CRPM was highly elevated with OA independent of KL (10-14ng/mL) compared to reference level (5ng/mL). Q4 had higher KL than Q1 (P<0.001), Q2 (P=0.017) and Q3 (P<0.001). C1M, C2M and C3M were lowest in Q1. C1M was elevated in Q3 compared to Q2 (P<0.001), whereas C3M was lower (P=0.019). A bigger proportion of patients were elevated in CRPM compared to hsCRP, indicating MMP-derived inflammation as a component of OA. Moreover, the levels of MMP-degraded collagens differed between the subgroups segregated by inflammation, indicating distinctively different subpopulation selected by inflammation.
    Osteoarthritis and Cartilage 11/2013; · 4.26 Impact Factor
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    Dataset: Fulltext p9
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    ABSTRACT: Ethnic differences in pain experiences have been widely assessed in various pathological and experimental conditions. However, limited sensory modalities have been described in previous research, and the affective-motivational factors have so far been estimated to be the main mediator for the ethnic differences. This study aimed to detect the ethnic differences of oro-facial somatosensory profiles related to the sensory-discriminative dimension in healthy volunteers. The standardised quantitative sensory testing battery developed by the German Research Network on Neuropathic Pain was performed bilaterally in the infraorbital and mental regions on age- and gender-matched healthy Chinese and Danes, 29 participants each group. The influences of ethnicity, gender and test site on the somatosensory profile were evaluated by three-way anova. The ethnic disparities were also presented by Z-scores. Compared to Danes, Chinese were more sensitive to thermal detection, thermal pain, mechanical deep pain and mechanical pain rating parameters (P < 0·002) related to small fibre functions. However, the inverse results were observed for mechanical tactile modality related to large fibre function (P < 0·001) and wind-up ratio (P = 0·006). Women presented higher sensitivity compared to men. The mean Z-scores of all the parameters from Chinese group were in the normal zone created by Danish Caucasians' means and SDs. The ethnic disparities in somatosensory profile illustrated the necessity of establishing the reference data for different ethnic groups and possibly individual pain management strategies for the different ethnic groups.
    Journal of Oral Rehabilitation 08/2013; · 2.34 Impact Factor
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    ABSTRACT: Cold allodynia and cold hyperalgesia are both elusive features of neuropathic pain, particularly in patients with various polyneuropathies. Numerous studies have suggested that topical application of L-menthol causes temporary cold hypersensitivity and thus acts as a proxy for associated symptoms. This review summarizes studies on L-menthol-induced nociception, cold allodynia and cold hyperalgesia in vitro, in animals and in humans. A comprehensive literature search was performed using the PubMed and Google Scholar databases until February 2013. Obtained manuscripts were reviewed for relevancy and reference lists of the retrieved articles were cross-checked for additional important studies. Solely the literature regarding topical application of L-menthol in humans was attained systematically. Of the total identified studies (96), 10 met the inclusion criteria being controlled studies applying L-menthol at a concentration of ≥30%. The extracted data are meticulously compared and presented with emphasis on clarity and transparency. In seven animal studies, cold allodynia or hyperalgesia was successfully established utilizing various methods. Eight studies in healthy volunteers unanimously reported a significant increase in cold pain threshold, representing cold allodynia and increased supra-threshold cold pain sensitivity, thus demonstrating cold hyperalgesia. Topical high-concentration L-menthol consistently induces cold hypersensitivity in animals and humans, thus constituting a predictable surrogate model of cold allodynia and hyperalgesia. Understanding translational features of this model and its underlying mechanisms could be valuable in preclinical and human phases of drug development and in improving current treatment of patients with polyneuropathy.
    European journal of pain (London, England) 08/2013; · 3.37 Impact Factor
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    ABSTRACT: Multiple chemical sensitivity (MCS) is a chronic condition of unknown etiology. MCS is characterized by recurrent nonspecific symptoms from multiple organ systems in response to chemical exposures in concentrations that are normally tolerated by the majority of the population. The symptoms may have severe impact on patients' lives, but an evidence-based treatment for the condition is nonexisting. The pathophysiology is unclarified, but several indicators point towards abnormal processing of sensory signals in the central nervous system. Pulsed electromagnetic fields (PEMF) offer a promising new treatment for refractory depression and can be targeted at the brain, thereby activating biochemical cell processes. In a parallel, randomized, double-blind, placebo-controlled trial conducted at the Danish Research Centre for Chemical Sensitivities, the effects of PEMF in MCS patients will be assessed using the Re5 Independent System. Based on sample size estimation, 40 participants will be randomized to either PEMF therapy or placebo. The allocation sequence will be generated by computer. All involved parties (that is, participants, investigators, the research nurse, and the statistician) will be blinded to group allocation. The participants will receive PEMF therapy or placebo applied transcranially 30 minutes twice a day for 7 days a week over 6 consecutive weeks. Outcomes will be measured at baseline, once weekly during treatment, post treatment, and at 2.5-month and 4.5-month follow-up according to a predefined timetable. The primary outcome will be a measurement of the impact of MCS on everyday life. The secondary outcomes will be measurements of MCS symptoms, psychological distress (stress, anxiety or depressive symptoms), capsaicin-induced secondary punctate hyperalgesia, immunological markers in serum, and quality of life. This trial will assess the effects of PEMF therapy for MCS. Currently, there is no treatment with a documented effect on MCS, and in terms of healthcare there is very little to offer these patients. There is thus a great need for well-conducted randomized trials aimed at assessing possible treatment effects. A positive outcome will pave the way for improved healthcare and understanding of this very disabling and overlooked condition.Trial registration: ClinicalTrials.gov: NCT01834781, www.clinicaltrials.gov/ct2/show/NCT01834781.
    Trials 08/2013; 14(1):256. · 2.21 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the effect of repeated bouts of eccentric exercise on the nociceptive withdrawal reflex (NWR) threshold, a measure of sensitivity in the spinal nociceptive system. Sixteen healthy students (age 25.7 ± 0.6 years, BMI 24.8 ± 1 kg m(-2)) participated in this randomized, controlled, crossover study. Two identical bouts of high-intensity eccentric exercises were performed on the tibialis anterior muscle 7 days apart. Control sessions involving no exercise were performed 4 weeks apart the exercise sessions. Pressure pain thresholds (PPT) and the NWR threshold were recorded before, immediately after, and 1 day after both bouts of exercise. Pressure pain thresholds decreased significantly at two of the muscle belly sites on the day after initial bout compared with baseline. NWR threshold decreased by 25 ± 4 % immediately after initial bout and by 30 ± 5 % the next day (p < 0.05) as an indication of generalized pain hypersensitivity. On the contrary, no changes were found in both pain thresholds after second bout of eccentric exercise indicating that both localized and generalized pain sensitivity were normalized. In conclusion, this study for the first time documented that an initial bout of unaccustomed high-intensity eccentric exercise, which results in muscle soreness can induce central sensitization. A repeated bout of exercise, however, facilitates inherent protective spinal mechanisms against the development of muscle soreness.
    Arbeitsphysiologie 08/2013; · 2.66 Impact Factor
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    ABSTRACT: Computer users often report musculoskeletal complaints and pain in the upper extremities and the neck-shoulder region. However, recent epidemiological studies do not report a relationship between the extent of computer use and work-related musculoskeletal disorders (WMSD).The aim of this study was to conduct an explorative analysis on short and long-term pain complaints and work-related variables in a cohort of Danish computer users. A structured web-based questionnaire including questions related to musculoskeletal pain, anthropometrics, work-related variables, work ability, productivity, health-related parameters, lifestyle variables as well as physical activity during leisure time was designed. Six hundred and ninety office workers completed the questionnaire responding to an announcement posted in a union magazine. The questionnaire outcomes, i.e., pain intensity, duration and locations as well as anthropometrics, work-related variables, work ability, productivity, and level of physical activity, were stratified by gender and correlations were obtained. Women reported higher pain intensity, longer pain duration as well as more locations with pain than men (P < 0.05). In parallel, women scored poorer work ability and ability to fulfil the requirements on productivity than men (P < 0.05). Strong positive correlations were found between pain intensity and pain duration for the forearm, elbow, neck and shoulder (P < 0.001). Moderate negative correlations were seen between pain intensity and work ability/productivity (P < 0.001). The present results provide new key information on pain characteristics in office workers. The differences in pain characteristics, i.e., higher intensity, longer duration and more pain locations as well as poorer work ability reported by women workers relate to their higher risk of contracting WMSD. Overall, this investigation confirmed the complex interplay between anthropometrics, work ability, productivity, and pain perception among computer users.
    BMC Musculoskeletal Disorders 08/2013; 14(1):226. · 1.88 Impact Factor
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    ABSTRACT: Our aim was to investigate whether migraine adolescents with pain directed inside (imploding pain - IP) and outside (exploding pain - EP) the head may have different levels of cortical excitability underlying their migraineous syndrome. Ten migraine children referring prevalent EP (mean age 14.5±1.4 years, 3 girls, 7 boys), 10 patients with IP (mean age 14.1±2.2 years, 4 girls, 6 boys), and 13 control subjects (mean age 13±1.8 years, 6 males, 7 females) participated to the study. The recovery cycle of the somatosensory evoked potentials to electrical median nerve stimuli at interstimulus intervals of 5, 20, and 40ms was measured. Anger expression, anxiety, and somatic concerns were investigated in migraine patients. Overall, SEP recovery cycle was shorter in migraineurs than in healthy controls. The recovery cycle of the frontal N30 SEP component was significantly shorter in IP than in EP patients. While among the EP patients those with faster N30 recovery cycle had higher trait-anger score, the opposite was found among the IP patients. Our results suggest that the inhibitory mechanisms within the somatosensory cortex are more impaired in IP than in EP migraine adolescents. The pathophysiological difference between IP and EP migraineurs was strengthened also by the opposite correlations between the brain excitability and the anger expression.
    Neuroscience Research 07/2013; · 2.20 Impact Factor
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    ABSTRACT: We evaluated the effect of Creatine (Cr) supplementation on muscle fatigue and physiological indices after intermittent swimming bouts in trained swimmers. Sixteen healthy non-elite swimmers (19±4 years, 75±12 kg) were randomly assigned into two groups of either Cr supplementation or placebo and performed six repeated sprints swimming bouts of 50-m departing every 120 seconds. The Cr group was supplemented 4 times a day for 6 days. Blood lactate, Creatine Kinase (CK), creatinine, heart rate, best repeated sprint (RSb) and mean repeated sprint (RSm) times, and percentage of speed decrement (%Dec) were measured at the various phases of swimming bouts. Repeated measure ANOVA and independent t-student tests showed CK and blood lactate concentration increased gradually after the third and sixth swimming bouts. % Dec in Cr group was significantly lower after 3rd swimming bout, also heart rate in Cr group was associated with lower increase in HR mean (P<0.05) compared to placebo. These results suggest that Cr supplementation may improve swimming performance and reduce increased blood lactate levels following intermittent sprint swimming bouts. In conclusion Cr supplementation in trained swimmers may improve anaerobic performance and heart rate variations independent of the effect of intensive sprint swimming bouts.
    The Journal of sports medicine and physical fitness 06/2013; 53(3):232-239. · 0.73 Impact Factor

Publication Stats

10k Citations
1,087.19 Total Impact Points

Institutions

  • 1987–2014
    • Aalborg University
      • • Department of Health Science and Technology
      • • Department of Electronic Systems
      Ålborg, North Denmark, Denmark
  • 2013
    • Peking University
      Peping, Beijing, China
    • University of Mazandaran
      Meshed-i-Sar, Māzandarān, Iran
  • 2012
    • Tokyo Medical and Dental University
      • Division of Oral Health Sciences
      Edo, Tōkyō, Japan
  • 2011
    • Macquarie University
      • Macquarie Centre for Cognitive Science (MACCS)
      Sydney, New South Wales, Australia
  • 2010
    • Regionspsykiatrien Viborg-Skive
      Viborg, Central Jutland, Denmark
  • 2001–2010
    • University of Toronto
      • Faculty of Dentistry
      Toronto, Ontario, Canada
    • Universität Bern
      Berna, Bern, Switzerland
    • Politecnico di Torino
      • DET - Department of Electronics and Telecommunications
      Torino, Piedmont, Italy
    • University of Southern Denmark
      • Institute of Public Health
      Copenhagen, Capital Region, Denmark
  • 1989–2010
    • Aarhus University
      • • Department of Dentistry
      • • Department of Neurology
      • • Department of Anaesthesiology
      • • Royal Dental College
      Aars, Region North Jutland, Denmark
  • 2009
    • Academisch Centrum Tandheelkunde Amsterdam
      Amsterdamo, North Holland, Netherlands
    • Hospital Clínico San Carlos
      Madrid, Madrid, Spain
  • 2007–2009
    • King Juan Carlos University
      • Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física
      Móstoles, Madrid, Spain
    • University School of Physical Education
      Posen, Greater Poland Voivodeship, Poland
  • 2004–2009
    • Fourth Military Medical University
      • • School of Stomatology
      • • Institute of Neurosciences
      Xi’an, Liaoning, China
    • RWTH Aachen University
      • Institute of Biotechnology (Bio VI)
      Aachen, North Rhine-Westphalia, Germany
  • 1995–2009
    • Aalborg University Hospital
      • • Department of Gastroenterology and Hepatology
      • • Department of Neurology
      Ålborg, North Denmark, Denmark
  • 2008
    • The Royal Marsden NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2006–2007
    • University of British Columbia - Vancouver
      • Faculty of Pharmaceutical Sciences
      Vancouver, British Columbia, Canada
    • Sapienza University of Rome
      • Department of Anatomical, Histological, Forensic Medicine and Orthopedic Science
      Roma, Latium, Italy
  • 2005–2006
    • University of Haifa
      • Faculty of Social Welfare and Health Sciences
      H̱efa, Haifa District, Israel
    • Ospedale Pediatrico Bambino Gesù
      • Division of Neurology
      Roma, Latium, Italy
    • Otto-Friedrich-Universität Bamberg
      Bamberg, Bavaria, Germany
  • 1998–2003
    • Inselspital, Universitätsspital Bern
      • Department of Anesthesiology and Pain Therapy
      Bern, BE, Switzerland
    • Johannes Gutenberg-Universität Mainz
      • Institut für Physiologie und Pathophysiologie
      Mainz, Rhineland-Palatinate, Germany
    • University Hospital Linköping
      • Department of Anaesthesiology
      Linköping, Östergötland, Sweden
  • 2002
    • Curtin University Australia
      • School of Physiotherapy
      Bentley, Western Australia, Australia
  • 1992–2002
    • Aarhus University Hospital
      • • Department of Neurology
      • • Department of Anaesthesiology
      Århus, Central Jutland, Denmark
    • Royal Australasian College of Dental Surgeons
      Денмарк, Western Australia, Australia
  • 2000
    • Catholic University of the Sacred Heart
      • Institute of Neurology
      Roma, Latium, Italy
  • 1999
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      Erlangen, Bavaria, Germany
  • 1996–1997
    • Odense University Hospital
      • Department of Neurology - N
      Odense, South Denmark, Denmark
    • Danish Pain Research Center
      Aarhus, Central Jutland, Denmark
  • 1988
    • University of Groningen
      • Department of Neurology
      Groningen, Province of Groningen, Netherlands