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How Does Extensive Sensorimotor Training Influence Pain?

woman playing a piano

Musicians perform a high volume of repetitive movements (>1000 movements per minute for some experts). While the volume is beneficial for skill training, motor learning, and adaptive brain plasticity, it may increase the prevalence of pain (>80% in some studies). This study

assessed whether extensive multisensory training influences pain sensitivity and the cortical responses to noxious and non-noxious stimuli during the development of prolonged experimental pain.

The study included 39 healthy participants, of which 19 were musicians (9 amateurs averaging 1.3 hours of practice daily and 10 conservatory-trained instrumentalists averaging 3.9 hours of practice daily). The 20 controls had no formal or informal music training.

The experiment involved 3 sessions (days 1, 3, and 8) over 8 days, and daily diaries about muscle soreness completed up to day 14. At the end of Day 1, all participants received an injection of NGF into the right first dorsal interosseous (FDI) muscle to induce prolonged muscle pain for several days. At the beginning of Day 3 and Day 8, participants reported their state anxiety (STAI), current pain ratings (NRS), the extent and distribution of the NGF-induced pain, and the qualitative characteristics (McGill Questionnaire). On Day 8, participants reported pain ratings for the worst, least, and average NGF- induced pain during the last 7 days. All neurophysiological testing (nociceptive and non-nociceptive electrical stimulations), pain sensitivity assessments (electric detection thresholds and pressure pain thresholds), and reaction times were registered on Day 1 (before the NGF injection), Day 3, and Day 8.

The distribution of NGF-induced muscle pain was similar in both groups. The pain area reduced in all participants from Day 3 to Day 8 but the magnitude was greater for musicians. NGF-induced pain intensity scores were significantly lower in the musician group, but muscle soreness did not differ. Musicians with higher weekly training reported lower pain ratings. Musicians showed secondary hyperalgesia to electrical stimulation on Day3 to Day8 (p<0.004) and reduced nociceptive P200 ERP amplitudes on Day8 (p<0.005)

The data highlights a couple of key points. Individuals who complete repetitive sensorimotor practice may be more susceptible to secondary hyperalgesia, potentially increasing their risk for chronic pain. Subjectively, musicians may adapt to the pain and form new baselines for tolerance. High level musicians will continue to practice, despite experiencing pain (I can personally attest to this as my brother is a jazz pianist). This data can help us program rehabilitation and educate patients on individual variations in pain experiences.

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