The PAIVM techniques have been described previously.[3] In brief, this involves applying thumb pressure to the AO or C2-3 spinal segments. All participants were examined in the supine position in 2 sessions. Each session comprised 5 trials that were 90 seconds long and separated by 30 seconds. The nBR was recorded during the first trial of each session, but no manual pressure was applied. Thereafter, manual pressure was applied to either the ipsilateral common extensor origin (lateral epicondyle of the humerus) of the arm or the AO or C2-3 segments and was sustained for the length of each trial. www.selleckchem.com/products/poziotinib-hm781-36b.html The order of the examination (ie, cervical vs arm) alternated from 1 participant to the next. Participants
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reproduction of head pain with “yes” or “no” and rated the intensity of head pain on a scale of 0-10, where 0 = “no pain” and 10 = “intolerable pain.” Participants also rated the intensity of applied pressure where 0 = “pressure but no pain” and 10 = “intolerable pain. To study trigeminal brainstem nociception and transmission, the nBR was elicited ipsilaterally using a custom-made planar concentric electrode. The electrode comprised a central wire cathode (diameter 0.5 mm), an isolation insert and an external anode ring, both 5 mm in diameter providing a stimulation area of 235.5 mm.[2] The electrode was placed on the forehead 10 mm above the supraorbital groove, and the nBR was recorded by 2 surface electrodes attached below the lower eyelid and 2-3 cm laterally.[18] Current intensity (monopolar square wave pulses, 0.3 ms duration) was 2.3 mA. Main outcome variables were the number of recorded blinks, and AUC and latencies of the R2 component of the nBR. The nBR was recorded during both sessions, which were separated by 30 minutes. Each session comprised 5 trials of 8 stimuli; the interstimulus interval varied between 12 and 18 seconds. The intertrial interval was 30
seconds. After subtracting background noise from raw blink reflex data, latencies were established for each blink. Blinks were identified individually by inspecting each blink in the raw data files and were defined as present if the AUC was greater than background noise. Areas under the curve were assessed in the time window 27-87 ms after the stimulus.[28, Florfenicol 29] Data were analyzed using SPSS Version 16 software (SPSS, Inc., Chicago, IL, USA). Local tenderness ratings were investigated in a 2 × 4 × 2 (site [arm, neck]) × trial [trials 1-4] × time [start, end of each trial]) analysis of variance. Similar analyses were computed for supraorbital pain ratings, head pain referral, number of blinks, and R2 latency and AUC. P < .05 was considered to be statistically significant in all analyses, and tests of statistical significance were 2-tailed. Where appropriate, the Huynh–Feldt correction was used to correct for violation of the sphericity assumption.