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Amorim-Barbosa T, Catelas D, Pereira C, Sousa A, Amorim JM, Rodrigues-Pinto R, Neves P. Is preoperative fat infiltration in lumbar spine muscles associated with worse clinical outcomes after lumbar interbody fusion? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022. [PMID: 35723839 DOI: 10.1007/s00590-022-03311-110.1007/s00590-022-03311-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE Lumbar musculature has a fundamental role in spine stability and spinal balance. Muscle atrophy and fat infiltration play an important role in pain pathophysiology. Accordingly, the preoperative condition of lumbar muscles may influence clinical outcomes after surgical treatment. In this context, the aim of this study was to evaluate the association between preoperative lumbar paravertebral muscle fat infiltration and clinical outcomes after lumbar interbody fusion. METHODS A retrospective study of patients with lumbar pathology submitted to lumbar transforaminal (TLIF) or posterior interbody fusion (PLIF) was performed, with a minimum of two years of follow-up. Preoperative lumbar magnetic resonance imaging (MRI) images were classified for fat infiltration in lumbar multifidus muscle and correlated with clinical outcomes. RESULTS Seventy-five patients were included: 24 submitted to PLIF and 51 to TLIF. Most patients underwent surgery for spondylolisthesis (67%). Higher degrees of fat infiltration were associated with more advanced age (54.8 vs. 49.1 years old, p = 0.04) and more leg pain after surgery (p = 0.04). No statistically significant differences in other clinical outcomes such as Oswestry Disability Index, visual analogue scale for back and leg pain, self-reported back pain relief, return to work and overall satisfaction were found between different groups of fat infiltration. The improvement in leg pain was associated with improvement in self-reported lumbar pain (p < 0.001). CONCLUSION Age and preoperative degree of fat infiltration may be important to predict improvement in leg pain after lumbar interbody fusion. The absence of solid literature on this topic and universal assessment methodologies reinforce the need for further studies.
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Affiliation(s)
- Tiago Amorim-Barbosa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Diogo Catelas
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Catarina Pereira
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Arnaldo Sousa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | | | - Ricardo Rodrigues-Pinto
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Neves
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
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2
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Amorim-Barbosa T, Catelas D, Pereira C, Sousa A, Amorim JM, Rodrigues-Pinto R, Neves P. Is preoperative fat infiltration in lumbar spine muscles associated with worse clinical outcomes after lumbar interbody fusion? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022:10.1007/s00590-022-03311-1. [PMID: 35723839 DOI: 10.1007/s00590-022-03311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/31/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Lumbar musculature has a fundamental role in spine stability and spinal balance. Muscle atrophy and fat infiltration play an important role in pain pathophysiology. Accordingly, the preoperative condition of lumbar muscles may influence clinical outcomes after surgical treatment. In this context, the aim of this study was to evaluate the association between preoperative lumbar paravertebral muscle fat infiltration and clinical outcomes after lumbar interbody fusion. METHODS A retrospective study of patients with lumbar pathology submitted to lumbar transforaminal (TLIF) or posterior interbody fusion (PLIF) was performed, with a minimum of two years of follow-up. Preoperative lumbar magnetic resonance imaging (MRI) images were classified for fat infiltration in lumbar multifidus muscle and correlated with clinical outcomes. RESULTS Seventy-five patients were included: 24 submitted to PLIF and 51 to TLIF. Most patients underwent surgery for spondylolisthesis (67%). Higher degrees of fat infiltration were associated with more advanced age (54.8 vs. 49.1 years old, p = 0.04) and more leg pain after surgery (p = 0.04). No statistically significant differences in other clinical outcomes such as Oswestry Disability Index, visual analogue scale for back and leg pain, self-reported back pain relief, return to work and overall satisfaction were found between different groups of fat infiltration. The improvement in leg pain was associated with improvement in self-reported lumbar pain (p < 0.001). CONCLUSION Age and preoperative degree of fat infiltration may be important to predict improvement in leg pain after lumbar interbody fusion. The absence of solid literature on this topic and universal assessment methodologies reinforce the need for further studies.
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Affiliation(s)
- Tiago Amorim-Barbosa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Diogo Catelas
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Catarina Pereira
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Arnaldo Sousa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | | | - Ricardo Rodrigues-Pinto
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Neves
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
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Vulfsons S, Minerbi A. The Case for Comorbid Myofascial Pain-A Qualitative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145188. [PMID: 32709141 PMCID: PMC7400256 DOI: 10.3390/ijerph17145188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Abstract
Myofascial pain syndrome is widely considered to be among the most prevalent pain conditions, both in the community and in specialized pain clinics. While myofascial pain often arises in otherwise healthy individuals, evidence is mounting that its prevalence may be even higher in individuals with various comorbidities. Comorbid myofascial pain has been observed in a wide variety of medical conditions, including malignant tumors, osteoarthritis, neurological conditions, and mental health conditions. Here, we review the evidence of comorbid myofascial pain and discuss the diagnostic and therapeutic implications of its recognition.
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Affiliation(s)
- Simon Vulfsons
- Correspondence: ; Tel.: +972-47772234; Fax: +972-47773505
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Finta R, Nagy E, Bender T. The effect of diaphragm training on lumbar stabilizer muscles: a new concept for improving segmental stability in the case of low back pain. J Pain Res 2018; 11:3031-3045. [PMID: 30568484 PMCID: PMC6276912 DOI: 10.2147/jpr.s181610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of this study was to assess the effects of diaphragm training on low back pain and thickness of stabilizer muscles of the lumbar spine. PATIENTS AND METHODS Fifty-two individuals were recruited with a history of chronic low back pain in our randomized controlled trial. The participants were divided randomly into two groups. One of the groups took part in a complex training program and completed with diaphragm training (DT group, n=26). The control (C) group took part only in the complex training (n=21). The thickness of transversus abdominis, diaphragm, and lumbar multifidus muscle was measured with ultrasonography in two positions: lying and sitting. All muscles were assessed in relaxed and in contracted state in the lying position and in a relatively relaxed (calm sitting) and relatively contracted state (during weightlifting) in the sitting position. RESULTS After the training, severity of the pain was significantly reduced in both the groups. Regarding the thickness of the muscles, there were no changes in group C. The thickness of transversus abdominis increased significantly in relaxed and in relatively relaxed state, but there were no changes in contracted and relatively contracted state in group DT. As for the diaphragm muscle, there were significant increase in the state of supine position and in relatively contracted state, but there was no notable change in relatively relaxed state. With regard to the thickness of lumbar multifidus, a significant increase was only found in the left-sided muscle in relaxed, relatively relaxed, and relatively contracted state and in case of the right-sided one in relatively contracted state in group DT. CONCLUSION Our results suggest that diaphragm training has an effect also on the thickness of other active stabilizers of the lumbar spine, such as transversus abdominis and lumbar multifidus muscles.
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Affiliation(s)
- Regina Finta
- Department of Physiotherapy, Faculty of Health Sciences, University of Szeged, Szeged, Hungary,
| | - Edit Nagy
- Department of Physiotherapy, Faculty of Health Sciences, University of Szeged, Szeged, Hungary,
| | - Tamás Bender
- Department of Orthopedics, Faculty of Medicine, Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
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Abstract
More than 100 million adults in the United States have chronic pain conditions, costing more than $500 billion annually in medical care and lost productivity. They are the most common reason for seeking health care, for disability and addiction, and the highest driver of health care costs. Myofascial pain is the most common condition causing chronic pain and can be diagnosed through identifying clinical characteristics and muscle palpation. Management is focused on integrating patient training in changing lifestyle risk factors with evidence-based treatment. Understanding the cause, diagnosis, and management of myopain conditions will help prevent the impact of chronic pain.
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Affiliation(s)
- James Fricton
- HealthPartners Institute for Education and Research, University of Minnesota School of Dentistry, 4700 Dale Drive, Edina, MN 55424, USA.
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Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford) 2014; 54:392-9. [PMID: 25477053 DOI: 10.1093/rheumatology/keu471] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore, the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced.
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Affiliation(s)
- John L Quintner
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Geoffrey M Bove
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Milton L Cohen
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
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Nguyen BM. Trigger point therapy and plantar heel pain: A case report. Foot (Edinb) 2010; 20:158-62. [PMID: 21030246 DOI: 10.1016/j.foot.2010.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 09/15/2010] [Accepted: 09/27/2010] [Indexed: 02/04/2023]
Abstract
The cause of plantar heel pain and fasciitis has continued to be a diagnostic challenge even though it is one of the most common musculoskeletal disorders of the foot and ankle. The subject has evoked strong emotions and sparked intense debate regarding the likely causes and effective treatment options. Myofascial trigger point as a treatment option for plantar heel pain and fasciitis has been inconspicuous. The full extent of its significance and potential is largely unexplored in podiatric literature and medicine. Myofascial trigger point may offer an alternative explanation of the etiology of plantar heel pain and fasciitis.
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Affiliation(s)
- Bang M Nguyen
- Darebin Community Health Service, Victoria, Australia.
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Lucas KR, Rich PA, Polus BI. How Common Are Latent Myofascial Trigger Points in the Scapular Positioning Muscles? ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450802479800] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gemmell H, Bagust J. Can surface electromyography differentiate muscle activity between upper trapezius muscles with active versus latent trigger points? ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.clch.2009.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gemmell H, Allen A. Relative immediate effect of ischaemic compression and activator trigger point therapy on active upper trapezius trigger points: A randomised trial. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.clch.2009.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Referred pain from disorders of the cervical spine can be perceived as headache. The mechanism is convergence between trigeminal afferents and afferents of the upper three cervical nerves in the trigeminocervical nucleus. Cervicogenic headache cannot be diagnosed on clinical grounds alone. The definitive criterion is complete relief of pain after controlled diagnostic blocks of cervical structures or their nerve supply. The most rigorously studied example of cervicogenic headache is third occipital headache.
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Affiliation(s)
- Nikolai Bogduk
- University of Newcastle, Department of Clinical Research, Royal Newcastle Hospital, Newcastle, NSW 2300, Australia.
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Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 2000; 55:145-9. [PMID: 10657162 DOI: 10.1053/crad.1999.0340] [Citation(s) in RCA: 305] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In the assessment of the lumbar spine by magnetic resonance imaging (MRI), changes in the paraspinal muscles are frequently overlooked. In this study, our objective was to investigate the relationships between lumbar multifidus (MF) muscle atrophy and low back pain (LBP), leg pain and intevertebral disc degeneration. METHODS A retrospective study of 78 patients (aged 17-72) with LBP presenting with back pain with or without associated leg pain was undertaken. Their MR images were visually analysed for signs of lumbar MF muscle atrophy, disc degeneration and nerve root compression. The clinical history in each case was obtained from their case notes and pain drawing charts. RESULTS MF muscle atrophy was present in 80% of the patients with LBP. The correlation between MF muscle atrophy and leg pain was found to be significant (P < 0.01). However, the relationships between muscle atrophy and radiculopathy symptoms, nerve root compression, herniated nucleus pulposus and number of degenerated discs were statistically not significant. CONCLUSION Examination of the paraspinal muscles looking for atrophy of MF muscle should be considered when assessing MR images of lumbar spine. This may explain the referred leg pain in the absence of other MR abnormalities.
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Affiliation(s)
- D F Kader
- Department of Radiology, Woodend Hospital, Eday Road, Aberdeen, AB15 6XS, U.K
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Abstract
Masticatory myofascial pain is a relatively frequent occurrence in patients seen by the orthodontist. Thus it is important to understand the management of this condition. Treatment is generally directed toward the restoration of a more physiological state in the muscles of mastication and involves medications, appliances, various forms of behavioral modification, as well as the use of muscle exercises and trigger point therapy. This article focuses on the role of the latter modalities in the management of myofascial pain and dysfunction.
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Affiliation(s)
- J R Fricton
- Department of Diagnostic and Surgical Sciences, University of Minnesota, Minneapolis 55455, USA
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18
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Abstract
MFP is a regional muscle pain disorder characterized by localized muscle tenderness and pain and is the most common cause of persistent regional pain. The affected muscles may also display an increased fatiguability, stiffness, subjective weakness, pain on movement and slightly restricted range of motion that is unrelated to joint restriction. MFP is frequently overlooked as a diagnosis because it is often accompanied by signs and symptoms in addition to pain, coincidental pathological conditions, and behavioural and psychosocial problems. Chronic pain characteristics often precede or follow the development of MFP. Evaluation of MFP includes locating the trigger points and muscles involved as well as recognition of the contributing factors. Management of the syndrome naturally follows with muscle exercises, therapy to the trigger points, and reduction of all the contributing factors. The short-term goal is to restore the muscle to normal length and posture and full joint range of motion with exercises and trigger point therapy. The long-term goals include reducing the symptoms and their negative effects while helping the patient return to normal function without the need for future health care. The difficulty in managing MFP lies in the critical need to match the level of complexity of the management programme with the complexity of the patient's situation. Failure to address the entire problem, through a team approach if needed, may lead to failure to resolve the pain and perpetuation of a chronic pain syndrome.
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Affiliation(s)
- J R Fricton
- School of Dentistry, University of Minnesota, Minneapolis 55455
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Byrn C, Olsson I, Falkheden L, Lindh M, Hösterey U, Fogelberg M, Linder LE, Bunketorp O. Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries. Lancet 1993; 341:449-52. [PMID: 8094485 DOI: 10.1016/0140-6736(93)90204-t] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In many cases of whiplash injury symptoms persist and do not respond to treatment. There is uncontrolled evidence to suggest that intracutaneous injections of sterile water might help. Since that route may be unacceptable to patients the subcutaneous route is used in the randomised trial reported here. 40 patients with whiplash syndrome, mean age 46 years (24-73) were given subcutaneous injections of 0.3-0.5 ml sterile water or saline over tender and trigger points in the neck and shoulder. A maximum of three treatments were given during the first two months of the study and the patients were followed up for 8 months. The accidents had occurred 4-6 years previously. X-ray examinations revealed no traumatic spinal lesions. Neck mobility and pain levels were evaluated by a physiotherapist immediately before and after the first treatment and after 1, 3, and 8 months. After 3 months, the mean total mobility of the cervical spine had increased by 39 degrees in the sterile water group and 6 degrees in the saline group (p < 0.05). Minimum and maximum levels of pain in the weeks just before treatment were evaluated by a visual analogue scale from 0 to 10. After 3 months the minimum pain level had fallen from 2.2 to 1.4 in the sterile water group but was not reduced in the saline group (p < 0.02); the maximum had fallen from 8.1 to 3.8 in the sterile water group and from 8.3 to 7.5 in the saline group (p < 0.001). After 3 months, 19 of 20 patients in the sterile water group assessed their condition as generally improved but only 6 in the saline group felt that they had got better. After 8 months there were still significant differences for minimum pain score and for mobility but not for maximum pain or for self-assessment of improvement.
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Affiliation(s)
- C Byrn
- Department of Anaesthesia, Sahlgrenska Hospital, University of Gothenburg, Sweden
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Antonelli MA, Vawter RL. Nonarticular pain syndromes. Differentiating generalized, regional, and localized disorders. Postgrad Med 1992; 91:95-8, 103-4. [PMID: 1738752 DOI: 10.1080/00325481.1992.11701197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nonarticular pain syndromes, although not inherently crippling, can have significant impact on patients' comfort, daily activities, and job performance. These syndromes include fibromyalgia, bursitis, tendinitis, and localized myofascial pain syndromes. Although differentiating these conditions from one another may be difficult, early diagnosis and follow-up are important for determining appropriate treatment. Depending on the diagnosis, treatment may include use of nonsteroidal anti-inflammatory drugs, analgesics, or corticosteroid injections; trigger-point desensitization therapy; physical therapy; and patient education.
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Affiliation(s)
- M A Antonelli
- Section of Rheumatology, West Virginia University School of Medicine, Morgantown
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Albright GL, Fischer AA. Effects of warming imagery aimed at trigger-point sites on tissue compliance, skin temperature, and pain sensitivity in biofeedback-trained patients with chronic pain: a preliminary study. Percept Mot Skills 1990; 71:1163-70. [PMID: 2150881 DOI: 10.2466/pms.1990.71.3f.1163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
13 subjects were trained in biofeedback and self-regulation strategies for reducing chronic pain. Upon demonstrating ability to hand warm, subjects were exposed to an imagery exercise designed to increase skin temperature at trigger-point sites, which are small tender irritative foci located in the soft tissue. Skin temperature, tissue compliance, and pressure-pain sensitivity were recorded before and after imagery intervention. Subjects showed significant increases in skin temperature and muscle relaxation at trigger-point sites and decreases in pressure-pain sensitivity. This suggests that localized trigger-point warming may be an effective adjunct in treating chronic pain.
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Affiliation(s)
- G L Albright
- Baruch College City University of New York, Psychophysiology Laboratory, New York 10010
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22
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Margoles MS. Clinical assessment and interpretation of abnormal illness behaviour in low back pain, G. Waddell, I. Pilowsky and M. Bond, Pain, 39 (1989) 41-53. Pain 1990; 42:258-259. [PMID: 2147236 DOI: 10.1016/0304-3959(90)91172-f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Clark GT, Adachi NY, Dornan MR. Physical medicine procedures affect temporomandibular disorders: a review. J Am Dent Assoc 1990; 121:151-62. [PMID: 2196298 DOI: 10.14219/jada.archive.1990.0140] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article reviews the literature on the effectiveness of physical medicine procedures for treatment of temporomandibular disorders (TMD). Brief descriptions of some commonly used dental appliances, and pharmacological and surgical treatment methods are provided.
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Affiliation(s)
- G T Clark
- Dental Research Institute, UCLA School of Dentistry 90024
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Cram JR. Surface EMG recordings and pain-related disorders: a diagnostic framework. BIOFEEDBACK AND SELF-REGULATION 1988; 13:123-38. [PMID: 3207765 DOI: 10.1007/bf01001496] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Surface electromyography provides a very valuable set of information when used diagnostically with pain-related disorders. Unfortunately, most researchers and clinicians limit their investigation to only one level of diagnostic information available concerning the neuromuscular system. This article develops and encourages the clinician/researcher to consider three levels of diagnostic information: emotional, organ-related, and postural aspects. The theoretical background and diagnostic procedures used to investigate each is presented. Differential treatment considerations, given differential diagnostic findings, are discussed.
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Affiliation(s)
- J R Cram
- Biofeedback Institute, Seattle, Washington 98104
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Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1985; 60:615-23. [PMID: 3865133 DOI: 10.1016/0030-4220(85)90364-0] [Citation(s) in RCA: 218] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Myofascial pain syndrome (MPS) is a common but misunderstood muscular pain disorder involving pain referred from small, tender trigger points within myofascial structures in or distant from the area of pain. Misdiagnosis or inadequate management of this disorder after onset may lead to development of a complex chronic pain syndrome. A review of the clinical characteristics of 164 patients whose chief complaints led to the diagnosis of MPS revealed that these patients had (1) tenderness at points in firm bands of skeletal muscle that were consistent with past reports, (2) specific patterns of pain referral associated with each trigger point, (3) frequent emotional, postural, and behavioral contributing factors, and (4) frequent associated symptoms and concomitant diagnoses.
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Abstract
This study compared the pain-relieving effects of shortwave diathermy and moist heat on trigger points. Patients with trigger points on the neck or back were randomly assigned one of these treatments. The sensitivity of each trigger point was measured with a pressure algometer before treatment, 5 minutes after treatment, and 30 minutes after treatment. Sensitive trigger points, at which 2000 grams of force or less caused pain, were more responsive to treatment than moderate trigger points (painful only at 2000 grams or greater force). Both treatments were effective in relieving the pain of sensitive trigger points but shortwave diathermy was more effective at decreasing the sensitivity of both sensitive and moderate trigger points (P > 0.0581). The pressure algometer was shown to be a useful device for objectively measuring pain and may be useful in selecting the most effective type of treatment for trigger points.J Orthop Sports Phys Ther 1984;5(4):175-178.
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Abstract
Pain in the shoulder girdle and the arm is often referred pain from a remote trigger point, ie, the myofascial pain syndrome. Once initiated, this definite disease entity perpetuates itself through various feedback loops. Treatment consists of interrupting the pain cycle. Local block of the trigger point with 1% lidocaine (Xylocaine), to which a short- or long-acting steroid may or may not be added, has proved to be most effective.
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Graham MM, Buxbaum J, Staling LM. A study of occlusal relationships and the incidence of myofacial pain. J Prosthet Dent 1982; 47:549-55. [PMID: 6953240 DOI: 10.1016/0022-3913(82)90308-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A survey of 123 subjects (dental students) was performed to evaluate quantitative data that may be of value in the incidence and treatment of myofacial pain. Social statistics, subjective and objective symptoms, and the influence of occlusal interferences on these symptoms were quantitated and recorded. The data indicated that, 123 subjects, 26% had maximum intercuspation of the teeth at terminal hinge closure, 42% had maximum intercuspation of the teeth with the condyles located symmetrically anterior to terminal hinge, and 32.5% had maximum intercuspation of the teeth with assymmetric variations of the condyles anterior to terminal hinge. Averages were obtained for the maximum intercuspal open, the condylar inclination, and the distance anterior from the terminal hinge of both condyles in symmetrical and asymmetrical variations. The location of the transverse (terminal hinge) axis from the external auditory meatus was measured on the ala-tragus line. These latter averages indicate that a significant occlusal discrepancy can result from prevailing techniques of locating an arbitrary hinge axis 10 to 13 mm anterior from the external auditory meatus. The results showed that most subjects demonstrated, both subjectively and clinically, symptoms of neuromuscular dysfunction without occlusal interferences. Therefore, it may be concluded that treatment modalities considered within the first 6 weeks should be conservative and reversible to eliminate or decrease myofascial trigger zones and their areas of referred pain. Alteration of the existing occlusion and maxillomandibular relations may be adjusted with caution, if necessary.
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Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 1981; 11:151-71. [PMID: 6944796 DOI: 10.1016/0049-0172(81)90096-2] [Citation(s) in RCA: 659] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Detailed clinical study of 50 patients with primary fibromyalgia and 50 normal matched controls has shown a characteristic syndrome. Primary fibromyalgia patients are usually females, aged 25-40 yr, who complain of diffuse musculoskeletal aches, pains or stiffness associated with tiredness, anxiety, poor sleep, headaches, irritable bowel syndrome, subjective swelling in the articular and periarticular areas and numbness. Physical examination is characterized by presence of multiple tender points at specific sites and absence of joint swelling. Symptoms are influenced by weather and activities, as well as by time of day(worse in the morning and the evening). In contrast, symptoms of psychogenic rheumatism patients have little fluctuation, if any, and are modulated by emotional rather than physical factors. In psychogenic rheumatism, there is diffuse tenderness rather than tender points at specific sites. Laboratory tests and roentgenologic findings in primary fibromyalgia are normal or negative. Primary fibromyalgia should be suspected by the presence of its own characteristic features, and not diagnosed just by the absence of other recognizable conditions. This study has also shown that primary fibromyalgia is a poorly recognized condition. Patients were usually seen by many physicians who failed to provide a definite diagnosis despite frequent unnecessary investigations. A guideline for diagnosis of primary fibromyalgia, based upon our observations, is suggested. Management is usually gratifying in these frustrated patients. The most important aspects are a definite diagnosis, explanation of the various possible mechanisms responsible for the symptoms, and reassurance regarding the benign nature of this condition. A combination of reassurance, nonsteroidal antiinflammatory drugs, good sleep, local tender point injections, and various modes of physical therapy is successful in most cases.
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Abstract
Low back pain, referred pain in the lower limbs, and spasm of the back, gluteal, and hamstring muscles are clinical features which can be induced in normal volunteers by stimulating structures which are innervated by the lumbar dorsal rami. Conversely, they can be relieved in certain patients by selective interruption of conduction along dorsal rami. These facts permit the definition of a lumbar dorsal ramus syndrome, which can be distinguished from the intervertebral disc syndrome and other forms of low back pain. The distinguishing feature is that, in lumbar dorsal ramus syndrome, all the clinical features are exclusively mediated by dorsal rami and do not arise from nerve-root compression. The pathophysiology, pathology, and treatment of this syndrome are described. Recognition of this syndrome, and its treatment with relatively minor procedures, can obviate the need for major surgery which might otherwise be undertaken.
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Sheon RP. Regional soft tissue rheumatic pain syndromes: a common challenge in daily practice. Postgrad Med 1980; 68:143-7, 150-4, 156-7. [PMID: 6968897 DOI: 10.1080/00325481.1980.11715598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Soft tissue pain syndromes, problematic in themselves, may aggravate other underlying disorders. The physician who is familiar with the characteristic features of each of the many syndromes may more readily recognize them in practice. Treatment should be tailored to the individual and based on a home exercise program. Success of treatment corroborates the diagnosis and may prevent a state of chronic incapacitating pain.
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Scott DS, Gregg JM. Myofascial pain of the temporomandibular joint: a review of the behavioral-relaxation therapies. Pain 1980; 9:231-241. [PMID: 7005828 DOI: 10.1016/0304-3959(80)90010-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This paper reviews the behavioral-relaxation treatments of myofascial pain-dysfunction syndrome. The evidence indicates that this pain (located around the oral cavity) is due to muscle hyperactivity, most commonly of the lateral pterygoids. Research concerning relaxation techniques (i.e. progressive muscle relaxation and electromyographic feedback) has indicated the following: (a) in analogue research, normal healthy controls can learn to relax their muscles of mastication profoundly even during stress, and (b) in case reports, relaxation treatments are helpful clinical interventions, especially for pain patients who are not depressed, and who have not had the pain for more than a few years. Well controlled research is the next, essential step.
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Affiliation(s)
- Donald S Scott
- U.N.C. Pain Clinic, Dental Research Center, University of North Carolina, Chapel Hill, N.C. 27514 U.S.A
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THERAPY WITH CONTINUOUS WAVE ULTRASOUND. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 1978. [DOI: 10.1016/b978-0-444-41641-4.50007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Grieder A, Vinton PW, Cinotti WR, Kangur TT. An evaluation of ultrasonic therapy for temporomandibular joint dysfunction. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1971; 31:25-31. [PMID: 5275501 DOI: 10.1016/0030-4220(71)90029-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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