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Kalezic, Nebojsa
Publications (6 of 6) Show all publications
Kalezic, N., Noborisaka, Y., Nakata, M., Crenshaw, A. G., Karlsson, S., Lyskov, E. & Eriksson, P.-O. (2010). Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD). Archives of Oral Biology, 55(6), 447-453
Open this publication in new window or tab >>Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD)
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2010 (English)In: Archives of Oral Biology, ISSN 0003-9969, E-ISSN 1879-1506, Vol. 55, no 6, p. 447-453Article in journal (Refereed) Published
Abstract [en]

Objective. The present study aimed to elucidate possible physiological mechanisms behind impaired endurance during chewing as previously reported in WAD. We tested the hypothesis of a stronger autonomic reaction in WAD than in healthy subjects in response to dynamic loading of the jaw-neck motor system. Design. Cardiovascular reactivity, muscle fatigue indicies of EMG, and perceptions of fatigue, exhaustion and pain were assessed during standardised chewing. Twenty-one WAD subjects and a gender/age matched control group participated. Baseline recordings were followed by two sessions of alternating unilateral chewing of a bolus of gum with each session followed by a rest period. Results. More than half of the WAD subjects terminated the test prematurely due to exhaustion and pain. In line with our hypothesis the chewing evoked an increased autonomic response in WAD exhibited as a higher increase in heart rate as compared to controls. Furthermore, we saw consistently higher values of arterial blood pressure for WAD than for controls across all stages of the experiment. Masseter EMG did not indicate muscle fatigue nor were there group differences in amplitude and mean power frequency. Pain in the WAD group increased during the first session and remained increased, whereas no pain was reported for the controls. Conclusion. More intense response to chewing in WAD might indicate pronounced vulnerability to dynamic loading of the jaw-neck motor system with increased autonomic reactivity to the test. Premature termination and autonomic involvement without EMG signs of muscle fatigue may indicate central mechanisms behind insufficient endurance during chewing.

Keywords
Jaw-neck pain, chewing, autonomic reactivity, endurance, fatigue, Whiplash Associated Disorder
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-6556 (URN)10.1016/j.archoralbio.2010.03.015 (DOI)000279100100008 ()20413105 (PubMedID)2-s2.0-77955431603 (Scopus ID)
Available from: 2010-03-19 Created: 2010-03-19 Last updated: 2018-12-03Bibliographically approved
Kalezic, N. (2006). Autonomic reactivity in muscle pain: clinical and experimental assessment. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Autonomic reactivity in muscle pain: clinical and experimental assessment
2006 (English)Doctoral thesis, monograph (Other scientific)
Abstract [en]

There are numerous indications of possible involvement of the autonomic nervous system in the genesis of chronic pain. The possibility exists that sympathetic activation is related to motor dysfunction and changes in sensory processing, which have otherwise been implicated in musculoskeletal disorders.

The primary aim of the thesis has been to investigate autonomic regulation at rest and in response to laboratory tests of autonomic function in subjects suffering from chronic pain in different localisations (lower back, neck-shoulder and neck-jaw), as well as to study the relations between autonomic regulation, proprioceptive acuity and clinical data. Secondary aim has been to assess autonomic regulation in fit, pain-free subjects in response to experimentally induced pain and in occupationally relevant settings.

A total of 194 subjects suffering from chronic pain participated [low back pain (LBP) n=93; non-traumatic neck pain (NT) n=40, Whiplash associated disorder (WAD) n=40, Whiplash with temporomandibular dysfunction (WADj) n=21]. Each chronic pain group was subjected to a battery of autonomic function tests combining cognitive (Stroop Colour-Word conflict tests), physical (handgrip), sensory (unpleasant sound) and motor tasks (chewing tests) as well as the activation of reflex pathways (paced breathing and the orthostatic test) and compared to an age- and gender balanced control group. Autonomic regulation was also assessed in exposure to experimentally induced muscle pain in healthy subjects (n=24) in order to describe acute pain reaction. Further assessment was carried out during monotonous repetitive work and dynamic work in healthy subjects (n=10) and in a three-day monitoring of ambulance personnel (n=26) in occupational settings.

Autonomic regulation was evaluated using cardiovascular (heart rate and heart rate variability, local blood flow and blood pressure), respiratory (breathing rate) electrodermal (skin conductance), muscular (trapezius and masseter EMG) and biochemical (insulin, cortisol, catecholamines) variables. Proprioceptive acuity was assessed using active-active repositioning tests. Pain levels were assessed using Visual-analogue or Numerical Rating scales. General health was evaluated through the Short-Form SF-36 Health Related Quality of Life questionnaire and Self-Efficacy Score questionnaires, whereas dysfunction was evaluated using the Oswestry Low Back Pain questionnaire, Pain Disability and Neck Disability Index questionnaires, the McKenzie evaluation and primary healthcare diagnoses. Self-reports of pain, stress and exertion were acquired prior to, during and post-testing.

Chronic pain subjects were characterised by increased sympathetic and decreased parasympathetic activity as reflected in heart rate (LBP, WAD, WADj), heart rate variability (LBP, WAD, WADj), blood pressure (WADj) and electrodermal activity (LBP). In general, WAD showed more pain and dysfunction than NT, with lower self-efficacy and health-related quality of life. Differential reactivity was observed only in WAD, with increased responsiveness to sensory stimuli (heart rate variability, electrodermal activity), and motor tasks (heart rate) and a decreased response to cognitive challenge (heart rate variability, electrodermal activity). A significant part of WADj subjects showed sensorimotor impairment and low endurance in chewing tests, concomitant with a cardiovascular response that correlated with pain levels. Proprioceptive acuity was not found to be impaired among subjects suffering from chronic pain, and there were no indications of significant individual response specificity. Response to experimentally induced muscle pain in healthy subjects was also characterised by a prominent cardiovascular component. In simulated occupational settings autonomic activation and transient insulin resistance were detected in healthy subjects following monotonous repetitive work, with no similar effects following dynamic exercise. Modest deviations in circadian heart rate variability patterns during workdays were detected in ambulance personnel reporting more pronounced musculoskeletal symptoms, with no such effects on work-free days.

Autonomic balance observed in chronic pain subjects was characterised by a trend towards increased sympathetic activity in comparison with pain-free controls. Moderate signs of affected reactivity to autonomic function tests were observed in patients with WAD, however no specific reaction patterns have been observed in any chronic pain group. Correspondence between the intensity of pain and autonomic activity was observed in acute pain and in chronic pain groups characterised by higher pain levels. As indicated by autonomic and neurohormonal changes in the recovery from real and simulated work, further studies with physiological monitoring of the effects of work-related stress are warranted for better understanding of the mechanism of musculoskeletal disorders

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2006. p. 62
Series
Umeå University Medical Dissertations, ISSN 0346-6612 ; 1061
Keywords
autonomic reactivity, stress, chronic pain, experimental pain, back, shoulder, neck
National Category
Physiology
Identifiers
urn:nbn:se:hig:diva-1238 (URN)91-7264-144-4 (ISBN)
Public defence
(English)
Available from: 2008-01-23 Created: 2008-01-23 Last updated: 2018-03-13Bibliographically approved
Wilén, J., Johansson, A., Kalezic, N., Lyskov, E. & Sandström, M. (2006). Psychophysiological tests and provocation of subjects with mobile phone related symptoms. Bioelectromagnetics, 27(3), 204-214
Open this publication in new window or tab >>Psychophysiological tests and provocation of subjects with mobile phone related symptoms
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2006 (English)In: Bioelectromagnetics, ISSN 0197-8462, E-ISSN 1521-186X, Vol. 27, no 3, p. 204-214Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to investigate the effect of exposure to a mobile phone-like radiofrequency (RF) electromagnetic field on persons experiencing subjective symptoms when using mobile phones (MP). Twenty subjects with MP-related symptoms were recruited and matched with 20 controls without MP-related symptoms. Each subject participated in two experimental sessions, one with true exposure and one with sham exposure, in random order. In the true exposure condition, the test subjects were exposed for 30 min to an RF field generating a maximum SAR(1g) in the head of 1 W/kg through an indoor base station antenna attached to a 900 MHz GSM MP. The following physiological and cognitive parameters were measured during the experiment: heart rate and heart rate variability (HRV), respiration, local blood flow, electrodermal activity, critical flicker fusion threshold (CFFT), short-term memory, and reaction time. No significant differences related to RF exposure conditions were detected. Also no differences in baseline data were found between subject groups, except for the reaction time, which was significantly longer among the cases than among the controls the first time the test was performed. This difference disappeared when the test was repeated. However, the cases differed significantly from the controls with respect to HRV as measured in the frequency domain. The cases displayed a shift in low/high frequency ratio towards a sympathetic dominance in the autonomous nervous system during the CFFT and memory tests, regardless of exposure condition. This might be interpreted as a sign of differences in the autonomous nervous system regulation between persons with MP related subjective symptoms and persons with no such symptoms.

Keywords
Adult, Aged, Cellular Phone, Cognition radiation effects, Cognition Disorders diagnosis etiology physiopathology, Female, Humans, Male, Microwaves adverse effects, Middle Aged, Neuropsychological Tests, Psychophysiologic Disorders diagnosis etiology physiopathology, Questionnaires, Risk Assessment methods, Risk Factors
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-2875 (URN)10.1002/bem.20195 (DOI)000236411600005 ()16304699 (PubMedID)2-s2.0-33645743537 (Scopus ID)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2018-03-13Bibliographically approved
Aasa, U., Kalezic, N., Lyskov, E., Ängquist, K.-A. & Barnekow-Bergkvist, M. (2006). Stress monitoring of ambulance personnel during work and leisure time. International Archives of Occupational and Environmental Health, 80(1), 51-59
Open this publication in new window or tab >>Stress monitoring of ambulance personnel during work and leisure time
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2006 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 80, no 1, p. 51-59Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of the present study was to assess physiological and subjective stress markers during a 24-h ambulance work shift and during the next two work-free days, and relate these parameters to self-reported health complaints. Methods: Twenty-six ambulance personnel were followed during a 24-h work shift and during the next two work-free days with electrocardiogram, cortisol assessments and diary notes. The ambulance personnel also performed tests of autonomic reactivity before and at the end of the work shift. The subjects were categorized into two groups according to their number of health complaints. Results: In general, stress markers did not show differences between the work shift and leisure time. However, a modest deviation in heart rate variability pattern and higher morning cortisol values during work in comparison with work-free days were observed in personnel with many health complaints. Conclusions: Subjective and physiological characteristics of ambulance personnel did not indicate distinctive stress during the 24-h work shift. Relationships between frequent health complaints and specific work-related factors require further prospective studies.

Keywords
Adult, Ambulances manpower, Blood Pressure physiology, Cross-Sectional Studies, Emergency Medical Technicians psychology, Energy Metabolism physiology, Female, Heart Rate physiology, Humans, Hydrocortisone analysis, Leisure Activities, Male, Medical Records, Monitoring Physiologic, Occupational Diseases diagnosis epidemiology psychology, Personnel Staffing Scheduling, Questionnaires, Stress diagnosis epidemiology, Stress Psychological diagnosis epidemiology, Time Factors, Work Schedule Tolerance
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-2809 (URN)10.1007/s00420-006-0103-x (DOI)000240854500006 ()16680487 (PubMedID)2-s2.0-33749332522 (Scopus ID)
Available from: 2007-11-21 Created: 2007-11-21 Last updated: 2018-03-13Bibliographically approved
Lyskov, E., Kalezic, N., Markov, M., Mild, K. H., Thunberg, J. & Johansson, H. (2005). Low frequency therapeutic EMF differently influences experimental muscle pain in female and male subjects.. Bioelectromagnetics, 26(4), 299-304
Open this publication in new window or tab >>Low frequency therapeutic EMF differently influences experimental muscle pain in female and male subjects.
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2005 (English)In: Bioelectromagnetics, ISSN 0197-8462, E-ISSN 1521-186X, Vol. 26, no 4, p. 299-304Article in journal (Refereed) Published
Abstract [en]

Effects of a pulsating, half sine wave magnetic field (MF) with a frequency of 100 pps and 15 mT rms flux density, generated by the MD TEMF device (EMF Therapeutics, Inc., Chattanooga), on subjective pain rating, heart rate, and arterial blood pressure were tested in a double blind, crossover design study employing experimental muscle pain. Each of 24 healthy volunteers (12 females and 12 males, 24.7 +/- 3.2 years of age) received painful stimulation induced by the infusion of 5% hypertonic saline (HS) into the erector spinae muscle during real and sham MF exposure, in counterbalanced order. Exposure to MF differently affects subjective pain estimates in females and males. MF exposure increased averaged pain level and time integral of pain ratings in females, whereas no statistically significant difference for these characteristics was found in males. Pain related elevation of systolic and diastolic blood pressure was observed during both real and sham EMF exposure in female and male subjects.

Keywords
Adult, Cross-Over Studies, Double-Blind Method, Electric Stimulation Therapy methods, Electromagnetic Fields, Female, Humans, Male, Myofascial Pain Syndromes chemically induced diagnosis therapy, Pain Measurement, Prognosis, Radiation Dosage, Saline Solution, Hypertonic, Sex Factors, Treatment Outcome
Identifiers
urn:nbn:se:hig:diva-2880 (URN)10.1002/bem.20092 (DOI)000228616100007 ()15832331 (PubMedID)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2018-03-13Bibliographically approved
Bergfors, M., Barnekow-Bergkvist, M., Kalezic, N., Lyskov, E. & Eriksson, J. W. (2005). Short-term effects of repetitive arm work and dynamic exercise on glucose metabolism and insulin sensitivity.. Acta Physiologica Scandinavica, 183(4), 345-356
Open this publication in new window or tab >>Short-term effects of repetitive arm work and dynamic exercise on glucose metabolism and insulin sensitivity.
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2005 (English)In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 183, no 4, p. 345-356Article in journal (Refereed) Published
Abstract [en]

Aim: To detennine whether repetitive ann work, with a large component of static muscle contraction alters glucose metabolism and insulin sensitivity.

Methad: Euglycemic clamps (2h) were started in ten healthy individuals 15 minutes after 37 minute periods of: 1) repetitive ann work in a simulated occupational setting; 2) dynamic concentric exercise on a cycle ergometer at 60% OfVO2 max and 3) a resting regime as a control. During the experimental periods, blood samples were collected, blood pressure was measured repeatedly and electrocardiogram (ECG) wasrecorded continuously. During the clamps, euglycemia was maintained at 5 mmo1/l and insulin was infused at 56 mU/m2/min for 120 min.

Results: The insulin-mediated glucose disposal rate (M-value) for the steady state period (60- 120 min) of the clamp, tended to be lower following ann work than for both cycling and resting regimes. When dividing the steady state period into 20-minute intervals, the insulin sensitivity index, (ISI) was significantly lower for ann work compared with the resting control situation between 60-80 minutes (p=0.04) and 80-100 minutes (p=0.01) respectively.

Catecholamines increased significantly for ann work and cycling compared with resting regime. .Data from heart rate variability (HRV) me asurements indicated significant sympathetic activation during repetitive ann work test.

Canelusian: The results indicate that repetitive ann work might acutely promote insulin resistance, whereas no such effect on insulin resistance was produced by dynamic concentric exercise.

Keywords
Adult, Arm, Blood Glucose analysis, Blood Pressure physiology, Epinephrine blood, Ergometry methods, Exercise physiology, Fatty Acids, Nonesterified blood, Glucose metabolism, Heart Rate physiology, Humans, Hydrocortisone blood, Insulin blood metabolism, Insulin Resistancephysiology, Interleukin-6 blood, Lactates blood, Leptin blood, Male, Muscle Contraction physiology, Muscle, Skeletal physiology, Norepinephrine blood, Tumor Necrosis Factor-alpha analysis
Identifiers
urn:nbn:se:hig:diva-2767 (URN)10.1111/j.1365-201X.2005.01407.x (DOI)000227969300002 ()15799771 (PubMedID)
Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2018-03-13Bibliographically approved
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