On the Threshold of Adolescence


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Eighty-seven did not answer the phone. Sixty-six would have liked to participate, but 42 were not available at the time of the PPT measurements. A total of 24 agreed to participate, but 2 did not show up for the examinations. Thus, the comparison group consisted of 22 female adolescents without musculoskeletal pain.

Demographic data indicated that the female adolescents without musculoskeletal pain were similar to the adolescents with PFPS in age, height, weight, and body mass index TABLE 1. Adolescents with PFPS had symptoms lasting, on average, 34 months.

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The majority had bilateral pain with a peripatellar pain localization and a diffuse pain distribution TABLE 2. Abbreviation: VAS, visual analog scale. There was a significant interaction between PPT site and group F 3. Abbreviation: PFPS, patellofemoral pain syndrome.


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Positive values indicate lower pressure pain threshold for the group with PFPS. The univariate analysis showed that symptom duration was significantly associated with PPT on the knee an average of the 4 sites on the knee as well as on the tibialis anterior TABLES 4 and 5.

References

The multivariate model indicated that longer symptom duration was significantly associated with a higher PPT on and around the knee and a higher PPT on the tibialis anterior. Adjusted coefficients show the results from the multivariate analysis. There was a significant interaction between pain distribution and PPT site F 5. This study showed that female adolescents diagnosed with PFPS had lower PPTs compared with those without musculoskeletal pain, indicating both localized and distal hyperalgesia.

Contrary to our hypothesis, the analysis showed an association between a longer symptom duration and higher PPT. As hypothesized, we observed a lower PPT on all 4 sites around the knee and on the tibialis anterior. These findings are consistent with previous studies of PPT performed on individuals with osteo arthritic knee pain.

Local pain may develop to cover a larger area of hyperalgesia as time and severity increase. This could reflect that where pain covers a larger area of the knee, there is an associated increase in localized hyperalgesia. However, as there was no additional decrease in PPT among those with diffuse knee pain, an alternative interpretation is that the variation in PPT between local and regional pain distribution may represent 2 different underlying causes of PFPS.

Increased anxiety has previously been shown to lower pain thresholds. Contrary to our hypothesis, symptom duration was positively associated with PPT, indicating that adolescents with the longest symptom duration had higher PPTs. Earlier studies on older patients showed that a long symptom duration was associated with lower PPT. At least 5 years of symptoms are needed for rheumatoid arthritis, 18 whereas central sensitization may occur within the first month after injury in subjects with whiplash.

Previous research on adolescents failed to show an association between symptom duration and PPT. Earlier research has reported an association between pain severity and PPT among older adult patients with knee osteoarthritis, 3 as well as several other pain conditions. The strength of our study is that all the participants were recruited from a large, well-defined, population-based cohort. Recruitment of a population-based sample suggests that our data may be generalizable to the female adolescent population.

However, our sample may not be generalizable to female adolescents currently under medical treatment, as we excluded these from the sample. Even though we excluded female adolescents who were currently under medical treatment, the baseline demographics of worst pain last week and symptom duration showed that our sample of female adolescents with PFPS was comparable to previous patient-based studies in slightly older patients of mixed genders.

The investigation of the association between symptom duration and localized and distal hyperalgesia may be limited, as the PFPS in the current study represented a chronic pain condition, defined as PFPS more than 3 months in duration. None of the adolescents had a symptom duration less than 3 months, even though 1 of our inclusion criteria was pain for more than 6 weeks. To obtain spatial information, PPT was assessed at 4 sites around the knee and 1 site on the tibialis anterior.

Due to the limited time available for each examination, it was unfortunately not possible to measure PPT from the upper extremity. This would have allowed us to investigate whether the distal hyperalgesia was generalized. During exercise and physiotherapy interventions in PFPS, we should take into consideration facilitated pain reactions due to hyperalgesia, as patients may experience more pain than expected. Within the area of musculoskeletal pain, clinicians often underestimate pain that may result from sensitization. Lower thresholds were found around the knee as an indicator for localized hyperalgesia and remote from the knee as an indicator for distal hyperalgesia, as seen in other conditions like knee osteoarthritis.

PPTs were poorly correlated with self-reported pain and duration of symptoms, indicating the necessity for future studies to include both self-reporting and pressure pain testing to further elucidate the nature of pain in adolescents with PFPS. Female adolescents diagnosed with PFPS have lower mechanical PPTs compared with female adolescents without musculoskeletal pain, which suggests both localized and distal hyperalgesia. These findings indicate that both peripheral and central mechanisms may be driving pain in adolescent females with PFPS.

Research Report. Rathleff, PT 1 , 2 , Ewa M. Roos, PhD 3 , Jens L.


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Study Design. J Orthop Sports Phys Ther ;41 8 J Orthop Sports Phys Ther ;42 6 J Orthop Sports Phys Ther ;41 3 J Orthop Sports Phys Ther ;40 11 J Orthop Sports Phys Ther ;41 9 J Orthop Sports Phys Ther ;47 10 Epub 4 Sep Volume 43, Issue 6 June Pages: - Related Articles Articles citing this article: Google Scholar.

Related Articles In: PubMed. Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish knee ligament register. Am J Sports Med. Translational musculoskeletal pain research. Best Pract Res Clin Rheumatol. Sensitization in patients with painful knee osteoarthritis. Reactivity to superficial and deep stimuli in patients with chronic musculoskeletal pain. Cathcart S , Pritchard D.

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Reliability of pain threshold measurement in young adults. J Headache Pain. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. Predictors of short and long term outcome in patellofemoral pain syndrome: a prospective longitudinal study. BMC Mus-culoskelet Disord. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial.

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Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg Br. Bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder: evidence of impairment in central nociceptive processing. J Pain. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol.

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Decreased pain threshold in children with growing pains. J Rheumatol. Hosmer DW , Jr.

Hoboken, NJ : Wiley ; Is pain in patellofemoral pain syndrome neuropathic? Clin J Pain. Reduced cold pressor pain tolerance in non-recovered whiplash patients: a 1-year prospective study. Eur J Pain. Kosek E , Ordeberg G. Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain. Somatosensory perception and function of diffuse noxious inhibitory controls DNIC in patients suffering from rheumatoid arthritis.

Prediction of persistent pain after total knee replacement for osteoarthritis. Mense S. Nociception from skeletal muscle in relation to clinical muscle pain.

Who exactly counts as an adolescent?

Those social roles vary widely by culture and era, opening up the definition to a range of interpretations. But in many societies today, the conventional markers of adulthood are slipping to later in life. Young people spend more years at school, live with their parents for longer, and delay marriage and parenthood. Marriage, in particular, has historically been a key marker for adulthood in many cultures, says anthropologist Alice Schlegel at the University of Arizona in Tucson.

The average age of women at first marriage has risen by two years globally over the past two decades, according to the United Nations. The prefrontal cortex, considered the seat of executive functioning and responsible for the ability to plan ahead and to resist impulses, typically does not come fully online until the early twenties — or later 7. But if not then, when? The World Health Organization set its boundaries at ages 10 and 19, but Susan Sawyer, chair of adolescent health at the University of Melbourne in Australia, and her colleagues have argued 8 that this upper boundary should be raised to In , New Zealand revised its regulations regarding children in protective care: rather than sending them out on their own at the age of 18, the government continues to provide support into their twenties.

The change came in response to reports that the adolescents were not coping well with independence at younger ages. As helpful as it would be to have a fixed, biological end point to adolescence, neuroscientists are unlikely to derive one, says Blakemore. Ultimately, the end point of adolescence is a social construct, she says, with large differences between cultures. And there is so much variation in brain function and structure from person to person that it may not be possible to nail down a suitable biological end point. That can confound research by making it difficult to compare and interpret results across studies.

And it complicates social policies by yielding a patchwork of inconsistent guidelines. But Beatriz Luna, who studies neurocognitive development at the University of Pittsburgh in Pennsylvania, sees the differing definitions as a reminder of the complicated and gradual changes that occur in the brain as it specializes for adult modes of action — a process that continues into adulthood.

At 16, Laver simply left to take a job, later attending a technical college before embarking on a career in the Royal Air Force. But twice, some of the older students stumbled across them in a nursing magazine. Black bars obscured much of the faces in the photos, but Laver easily recognized some of his classmates.

Many physicians are unaware of the full history of the Tanner scale, says Roberts, who has written about the growth study. The standards of child care were different back then, he says. And participation in the study was voluntary — sort of. Aksglaede, L. Pediatrics , e—e Zhai, L. Lee, J. Pediatrics , e Johansson, T. Goddings, A. NeuroImage 88 , — Rubia, K. Sawyer, S. Lancet Child Adolesc. Health 2, — Download references. Sign up for the daily Nature Briefing email newsletter. Stay up to date with what matters in science and why, handpicked from Nature and other publications worldwide.

Sign Up. Advanced search. PDF version. Illustration by Eric Nyquist. References 1. Tanner, J. PubMed Article Google Scholar 3. PubMed Article Google Scholar 5. PubMed Article Google Scholar 6. PubMed Article Google Scholar 7. Article Google Scholar Download references. Nature Briefing. Sign up for the daily Nature Briefing email newsletter Stay up to date with what matters in science and why, handpicked from Nature and other publications worldwide.

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