JOURNAL WATCH Journal Watch

LAUGHTER, HUMOUR AND PAIN PERCEPTION IN CHILDREN: A PILOT STUDY. Stuber M, Sherry DH et al. Evidence-Based Complimentary and Alternative Medicine 2009;6(2):271–276.

Eighteen children aged 7–16 years watched humorous videotapes before, during and after a standardised pain task that involved placing a hand in cold water. Pain appraisal (rating

of pain severity) and pain tolerance (submersion time) were recorded and examined in relation to humour indicators (the number of laughs or smiles observed during each video plus child ratings of how funny the video was). The humour indicators were not significantly associated with pain appraisal or pain tolerance, but the children did show significantly greater pain tolerance while they were watching funny videos than when they viewed them immediately before or after the cold-water task.

sportEX comment We love humour research. Any paper that uses the number of laughs and smiles as an outcome measure should be treated seriously. We are not so sure about asking kids to be subjected to inflicted pain but maybe the ends justify the means if it proves that distraction is useful for helping children and adolescents (and adults for that matter) tolerate painful procedures.

NOVEL APPLICATIONS OF ULTRASOUND TECHNOLOGY TO VISUALIZE AND CHARACTERIZE MYOFASCIAL TRIGGER POINTS AND SURROUNDING SOFT TISSUE. Sikdar S, Shah JP et

al. Archives of Physical Medicine and Rehabilitation 2009;90(11):1829–1838.

Nine participants were selected who met Travell and Simons’ criteria for myofascial trigger points (MTrPs) in a taut band in the upper trapezius. The MTrPs were evaluated by (i) physical examination, (ii) pressure algometry, and (iii) three types of ultrasound imaging, namely gray-scale two-dimensional ultrasound, vibration sonoelastography (VSE) and Doppler ultrasound. Four sites on each patient were labelled, based on physical examination, as active which were spontaneously painful, latent which were non-painful or normal myofascial tissue. Ultrasound examination was carried out with a transducer of approximately 5 MHz. VSE was performed by colour Doppler variance imaging while simultaneously inducing vibrations (approximately 92 Hz) with a hand-

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that the trigger points appeared as focal, hypoechoic regions on two-dimensional ultrasound, indicating local changes in tissue echogenicity, and they appeared as focal regions of reduced vibration amplitude on VSE, indicating a localised, stiff nodule. MTrPs were elliptical, with a size of 0.16 ± 0.11 cm2

. There were no significant differences

held massage vibrator. Each site was assigned a tissue imaging score as follows: 0 for uniform echogenicity and stiffness; 1 for focal hypoechoic region with stiff nodule; and 2 for multiple hypoechoic regions with stiff nodules. Blood flow in the neighbourhood of the trigger points was assessed using Doppler imaging. Each site was assigned a blood flow waveform score as follows: 0 for normal arterial flow in muscle; 1 for elevated diastolic flow; and 2 for a high-resistance flow waveform with retrograde diastolic flow. The results showed

in size between active and latent MTrPs. Sites containing trigger points were more likely to have a higher tissue imaging score compared with normal myofascial tissue. Small arteries (or enlarged arterioles) near active MTrPs showed retrograde flow in diastole, indicating a highly resistive vascular bed. Active sites were more likely to have a higher blood flow score compared with latent ones.

sportEX comment This is a major breakthrough in

proving exactly what it is that a therapist is feeling with his or her hands. It is a basis for further research for comparing the images pre- and post-treatment as a guide to what works and what doesn’t.

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