Experimental muscle pain does not cause long-lasting increases in resting electromyographic activity

Is there an association between EMG activity and temporomandibular disorders during orthotic mandibular advancement in sleep apnea patients undergoing DISE?

OBJECTIVE

To detect whether myotatic reflex activation of masticatory muscles during drug-induced sleep endoscopy (DISE) can be an indirect marker for temporomandibular disorder (TMD) in patients suffering from obstructive sleep apnea (OSA).

METHODS

OSA patients were prospectively recruited and underwent a complete TMD examination prior to undergoing DISE with the addition of electrodes applied over masticatory muscles. A positive activation of myotatic reflex was considered in case of an increase in muscle tone of at least 50%.

RESULTS

Of the 41 patients included, 48.8% presented activation of myotatic reflex. Of these patients, 45% presented a TMD diagnosis, 40% presented pain at masticatory muscles palpation, and 15% did not report pain during clinical examination.

CONCLUSION

An increase in EMG activity during mandibular advancement is not associated with TMD presence, but it can be an indirect marker of pain in the orofacial area in OSA patients.

Effects of Chronic and Experimental Acute Masseter Pain on Precision Biting Behavior in Humans

Chronic pain in the orofacial region is common worldwide. Pain seems to affect the jaw motor control. Hence, temporomandibular disorders (TMD) are often accompanied by pain upon chewing, restricted mouth opening and impaired maximal bite forces. However, little is known on the effects of pain, in particular the effects of chronic jaw muscle pain on precision biting. The aim of the study was to investigate the effect of chronic and acute jaw muscle pain on oral motor control during precision biting in humans. Eighteen patients with chronic masseter muscle pain and 18 healthy participants completed the experiment. All participants were examined according to the Diagnostic Criteria for TMD. Experimental acute pain was induced by bilateral, simultaneous sterile hypertonic saline infusions into the healthy masseter muscles. A standardized hold and split biting task was used to assess the precision biting. The data was analyzed with non-parametric statistical tests. The results showed no significant differences in the hold forces, split forces, durations of split or peak split rates within or between the pain and pain-free conditions. The mean split rate increased significantly compared to baseline values both in the chronic patients and the pain-free condition. However, this increase was not evident in the experimental acute pain condition. Further, there were no significant differences in the mean split rates between the conditions. The data suggest that jaw muscle pain does not seem to alter precision biting in humans, however, the possibility that a nociceptive modulation of spindle afferent activity might have occurred but compensated for cannot be ruled out.

Effect of a brief episode of experimental muscle pain on jaw movement and jaw-muscle activity during chewing

The aims of this study were to determine whether: (i) the jaw motor system develops a new pattern of jaw movement and/or jaw-muscle activity after resolution of an acute episode of jaw-muscle pain; and (ii) if jaw-muscle activity and jaw-movement features change progressively with repetition of a chewing sequence. Jaw movement and jaw muscle (masseter, anterior temporalis, and digastric) activity were recorded during free and rate-standardized chewing in eight asymptomatic participants (pain infusion group), before and at three time blocks up to 45 min after a single 0.2-ml bolus infusion of 5% hypertonic saline into the right masseter muscle. The same procedure, without infusion, was performed in another eight participants (control group). There were no significant main effects of group on jaw movement and muscle activity, suggesting that there were no persistent post-pain effects on chewing. Across groups, repetitions of free and unstandardized chewing movements were associated with progressive increases in velocity and amplitude of jaw movement and masseter and temporalis electromyographic (EMG) activity. These findings suggest that factors unrelated to pain, such as practice effects, may be playing a role in the changes in jaw movement and jaw-muscle activity observed after resolution of an acute episode of jaw-muscle pain.

The Design of Non-Occlusal Intraoral Appliances on Hard Palate and Their Effect on Masseter Muscle Activity During Sleep

This study aimed to reveal whether masseter muscle activity during sleep is affected by the difference in design of non-occlusal intraoral appliances on hard palate. Eight healthy Japanese participants were selected and wore each of the four types of appliances (horse shoe, thin, thick and medium thick) during sleep for one week with a one week interval without appliance during sleep. A masseter muscle electromyograph (EMG) was recorded during sleep. The EMG activities were analyzed by calculating the number of bursts per hour, episodes per hour, and bursts per episode. The EMG parameters with the thick type appliance were significantly lower than the baseline condition without appliance. In this study, it is suggested that a thick type appliance has an active effect on suppression of masseter muscle activity.

On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck-shoulder region

BACKGROUND

Occupations characterized by a static low load and by repetitive actions show a high prevalence of work-related musculoskeletal disorders (WMSD) in the neck-shoulder region. Moreover, muscle fatigue and discomfort are reported to play a relevant initiating role in WMSD.

AIMS

To investigate relationships between altered sensory information, i.e. localized muscle fatigue, discomfort and pain and their associations to changes in motor control patterns.

MATERIALS & METHODS

In total 101 subjects participated. Questionnaires, subjective assessments of perceived exertion and pain intensity as well as surface electromyography (SEMG), mechanomyography (MMG), force and kinematics recordings were performed.

RESULTS

Multi-channel SEMG and MMG revealed that the degree of heterogeneity of the trapezius muscle activation increased with fatigue. Further, the spatial organization of trapezius muscle activity changed in a dynamic manner during sustained contraction with acute experimental pain. A graduation of the motor changes in relation to the pain stage (acute, subchronic and chronic) and work experience were also found. The duration of the work task was shorter in presence of acute and chronic pain. Acute pain resulted in decreased activity of the painful muscle while in subchronic and chronic pain, a more static muscle activation was found. Posture and movement changed in the presence of neck-shoulder pain. Larger and smaller sizes of arm and trunk movement variability were respectively found in acute pain and subchronic/chronic pain. The size and structure of kinematics variability decreased also in the region of discomfort. Motor variability was higher in workers with high experience. Moreover, the pattern of activation of the upper trapezius muscle changed when receiving SEMG/MMG biofeedback during computer work.

DISCUSSION

SEMG and MMG changes underlie functional mechanisms for the maintenance of force during fatiguing contraction and acute pain that may lead to the widespread pain seen in WMSD. A lack of harmonious muscle recruitment/derecruitment may play a role in pain transition. Motor behavior changed in shoulder pain conditions underlining that motor variability may play a role in the WMSD development as corroborated by the changes in kinematics variability seen with discomfort. This prognostic hypothesis was further, supported by the increased motor variability among workers with high experience.

CONCLUSION

Quantitative assessments of the functional motor adaptations can be a way to benchmark the pain status and help to indentify signs indicating WMSD development. Motor variability is an important characteristic in ergonomic situations. Future studies will investigate the potential benefit of inducing motor variability in occupational settings.

The adaptive response of jaw muscles to varying functional demands

Jaw muscles are versatile entities that are able to adapt their anatomical characteristics, such as size, cross-sectional area, and fibre properties, to altered functional demands. The dynamic nature of muscle fibres allows them to change their phenotype to optimize the required contractile function while minimizing energy use. Changes in these anatomical parameters are associated with changes in neuromuscular activity as the pattern of muscle activation by the central nervous system plays an important role in the modulation of muscle properties. This review summarizes the adaptive response of jaw muscles to various stimuli or perturbations in the orofacial system and addresses general changes in muscles as they adapt, specific adaptive changes in jaw muscles under various physiologic and pathologic conditions, and their adaptive response to non-surgical and surgical therapeutic interventions. Although the jaw muscles are used concertedly in the masticatory system, their adaptive changes are not always uniform and vary with the nature, intensity, and duration of the stimulus. In general, stretch, increases neuromuscular activity, and resistance training result in hypertrophy, elicits increases in mitochondrial content and cross-sectional area of the fibres, and may change the fibre-type composition of the muscle towards a larger percentage of slow-type fibres. In contrast, changes in the opposite direction occur when neuromuscular activity is reduced, the muscle is immobilized in a shortened position, or paralysed. The broad range of stimuli that affect the properties of jaw muscles might help explain the large variability in the anatomical and physiological characteristics found among individuals, muscles, and muscle portions.

The electromyographic activity of masseter and anterior temporalis during orofacial symptoms induced by experimental occlusal highspot

The aim of the present study was to investigate the short-term impact of an occlusal highspot on the occurrence of orofacial symptoms by collecting self-evaluation and using electromyography (EMG) evaluation. A rigid unilateral intercuspal occlusal highspot (A cast onlay of 0.5 mm) was placed on the right lower first molar of six adult volunteers (three males, three females), and remained for 6 days. Continuously all the induced orofacial symptoms were collected and the subjects scored the orofacial pain on a 10-cm visual analogue scale (VAS) during the placement of onlay. The surface EMG was recorded before the placement of onlay, during (on the 3rd and 6th day) and after the onlay was removed. Then the contractile symmetry of bilateral masseter (MAL, MAR) and anterior temporalis (TAL, TAR) was measured by using an asymmetry index. On the 3rd day of the placement of the occlusal highspot, all subjects complained of headache in right temporal region (mean VAS +/- s.d.=3.7+/-0.5); the activity of TAR at rest position of mandible increased significantly (P=0.027). In addition, on the 3rd and 6th day with the highspot the EMG activity of the tested muscles during maximal voluntary contraction (MVC) was significantly reduced; the asymmetry index of bilateral anterior temporalis during MVC was increased significantly (P(3rd)=0.028; P(6th)=0.046). A unilateral occlusal highspot may make the ipsilateral anterior temporalis become tenser at rest position. Furthermore, the activity of bilateral anterior temporalis becomes more unsymmetrical during MVC although there are inter-individual differences between subjects. The changes in muscular activity may have some relationship with the occurrence of tension-type headache in temporal region.

The effects of experimental muscle and skin pain on the static stretch sensitivity of human muscle spindles in relaxed leg muscles

Animal studies have shown that noxious inputs onto gamma-motoneurons can cause an increase in the activity of muscle spindles, and it has been proposed that this causes a fusimotor-driven increase in muscle stiffness that is believed to underlie many chronic pain syndromes. To test whether experimental pain also acts on the fusimotor system in humans, unitary recordings were made from 19 spindle afferents (12 Ia, 7 II) located in the ankle and toe extensors or peronei muscles of awake human subjects. Muscle pain was induced by bolus intramuscular injection of 0.5 ml 5% hypertonic saline into tibialis anterior (TA); skin pain was induced by 0.2 ml injection into the overlying skin. Changes in fusimotor drive to the muscle spindles were inferred from changes in the mean discharge frequency and discharge variability of spindle endings in relaxed muscle. During muscle pain no afferents increased their discharge activity: seven afferents (5 Ia, 2 II) showed a decrease and six (4 Ia, 2 II) afferents were not affected. During skin pain of 13 afferents discharge rate increased in one (Ia) and decreased in two (1 Ia, 1 II). On average, the overall discharge rate decreased during muscle pain by 6.1% (P < 0.05; Wilcoxon), but remained essentially the same during skin pain. There was no detectable correlation between subjective pain level and the small change in discharge rate of muscle spindles. Irrespective of the type of pain, discharge variability parameters were not influenced (P > 0.05; Wilcoxon). We conclude that, contrary to the 'vicious cycle' hypothesis, acute activation of muscle or skin nociceptors does not cause a reflex increase in fusimotor drive in humans. Rather, our results are more aligned with the pain adaptation model, based on clinical studies predicting pain-induced reductions of agonist muscle activity.

Experimental muscle pain decreases the frequency threshold of electrically elicited muscle cramps

This study in humans tested the hypothesis that nociceptive muscle afferent input facilitates the occurrence of muscle cramps. In 13 healthy adults, muscle cramps were experimentally induced in the foot by stimulating the tibialis posterior nerve at the ankle with 2-s bursts of stimuli separated by 30 s, with stimulation frequency increasing by 2-Hz increments from 10 Hz until the cramp appeared. The minimum stimulation frequency that induced the cramp was defined "cramp frequency threshold". In 2 days, elicitation of the cramp was performed in the two-feet with and without (baseline condition) injection of hypertonic (painful condition) or isotonic (control condition) saline into the deep midportion of the flexor hallucis brevis muscle, from where surface EMG signals were recorded. The cramp frequency threshold was lower for the painful condition with respect to its baseline (mean +/- SE, hypertonic saline: 25.7 +/- 2.1 Hz, corresponding baseline: 31.2 +/- 2.8 Hz; P < 0.01) while there was no difference between the threshold with isotonic injection with respect to baseline. EMG average rectified value and power spectral frequency were higher during the cramp than immediately before the stimulation that elicited the cramp (pre-cramp: 13.9 +/- 1.6 muV and 75.4 +/- 3.8 Hz, respectively; post-cramp: 19.9 +/- 3.2 muV and 101.6 +/- 6.0 Hz; P < 0.05). The results suggest that nociceptive muscle afferent activity induced by injection of hypertonic saline facilitates the generation of electrically elicited muscle cramps.

Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition

Chronic musculoskeletal pain has biological, psychological and social components. This review deals with the biological factors, with emphasis on the fibromyalgia syndrome (FMS). Studies on central sensitization of pain-transmitting neurons, changes in endogenous pain modulation that give rise to pain disinhibition, referred pain, pain-related decrease in muscle strength and endurance, and pain generators in deep tissues are reviewed. In FMS there is strong scientific support for the statement that the biological part of the syndrome is a longstanding or permanent change in the function of the nociceptive nervous system that can be equated with a disease. Further research is necessary in order to determine which methods are best for diagnosis of the pain hypersensitivity in clinical practice. FMS may be the far end of a continuum that starts with chronic localized/regional musculoskeletal pain and ends with widespread chronic disabling pain.

What can human experimental pain models teach us about clinical TMD?

Human experimental pain (HEP) models applied to the orofacial area have been widely used over the last decades and several reviews are available on the interaction between HEP and jaw-motor function. In this selective review some of the possibilities and limitations with HEP models are discussed based on the current experience with HEP models. For example, it is appropriate to consider how closely HEP models may mimic the clinical phenomenon, i.e., do they represent a reasonable "proxy" of temporomandibular disorders (TMD) and what can HEP models offer for the understanding of jaw-motor function in relation to painful TMD conditions. Finally, are there any clinical implications of the knowledge derived from HEP studies? This present review suggests that HEP models, indeed, are valuable and can provide clinically relevant information by serving as a bridge between basic animal experiments and studies in pain populations; however, there are several caveats to this suggestion which needs to be acknowledged.

Experimental muscle pain changes the spatial distribution of upper trapezius muscle activity during sustained contraction

OBJECTIVE

To investigate the effect of local excitation of nociceptive muscle afferents on the spatial distribution of muscle activity.

METHODS

Surface electromyographic (EMG) signals were recorded from the upper trapezius muscle of 10 healthy volunteers with a 5 x 13 electrode grid during 90-s isometric contractions before, during, 15 and 30 min after intramuscular injection of hypertonic (painful) or isotonic (non-painful) saline. From the multi-channel EMG recordings, two-dimensional maps of root mean square and mean power frequency were obtained. The centre of gravity of the root mean square map was used to quantify global changes in the spatial distribution of muscle activity.

RESULTS

During sustained contractions, average root mean square increased, average mean frequency decreased and the centre of gravity moved cranially. During experimental muscle pain, compared to before injection, the average root mean square decreased and there was a caudal shift of the centre of gravity. Fifteen minutes after the painful injection the centre of gravity returned to its original position.

CONCLUSIONS

Short-term dynamic reorganization of the spatial distribution of muscle activity occurred in response to nociceptive afferent input.

SIGNIFICANCE

The study furnishes an extension of the pain adaptation model indicating heterogeneous inhibition of muscle activity.

Masticatory muscle pain and disordered jaw motor behaviour: Literature review over the past decade

The clinically important relationship between masticatory muscle pain (MMP) and disordered jaw motor behaviour is subject of this concise, evidence-based review of the literature that was published during the past 10 years. Mainly based on studies that used some sort of experimental MMP (e.g., the intramuscular injection of noxious substances like hypertonic saline), it was concluded that MMP has pronounced effects on jaw motor functions like maximal clenching and mastication. The pain-related modulation of oral reflexes further illustrated the effects of MMP on masticatory motor control. Protecting the painful muscle tissues against further damage and allowing for time to heal the damaged tissues by immobilization of the masticatory system seem to be the key outcomes of these effects. Further, MMP was shown to influence the cervical motor system, which may partly explain the mechanism behind the frequently observed co-occurrence of pain in the neck and the jaw. Finally, it was concluded that, even though the evidence is not yet conclusive, also remote pain (non-MMP) can modulate jaw motor behaviour, which indicates the involvement of central mechanisms in this modulation.

Quantitative analysis of surface EMG activity of cranial and leg muscles across sleep stages in human

OBJECTIVE

The aim of this study was to make a quantitative analysis of the changes in cranial and limb muscle activity from wakefulness to light and deep sleep stages and during rapid eye movement (REM) sleep of normal subjects.

METHODS

Polysomnographic recordings were made of the sleep of 9 healthy human subjects, including electromyograms of the suprahyoid, temporalis and masseter cranial muscles and the anterior tibialis limb muscle. Quantitative assessments of EMG activity were carried out with root mean square (RMS) and frequency-spectral analysis (FSA) methods.

RESULTS

From wakefulness to sleep, a significant reduction (-25.2 to -71.2%; P < 0.01) was observed in EMG activity (for both RMS and FSA) of the 3 cranial muscles using both methods of analysis. The EMG activity of suprahyoid muscle further decreased from non-REM to REM sleep (-17.8 to -43.0%; P < 0.01). In contrast, the EMG activity of the anterior tibialis muscle was only slightly reduced across sleep stages and did not further reduce during REM sleep. During REM sleep, all the 4 muscles maintained minimal activity.

CONCLUSIONS

The maintenance of muscle activity during REM sleep suggests that a minimal level of activity is required to preserve physiological functions (e.g. airway patency, posture) related to homeostasis and bodily protection.

SIGNIFICANCE

This study suggests that quantitative sleep EMG analysis is important for understanding the mechanisms of sleep-related movement disorders or when objective assessment of changes in EMG activity are needed for diagnostic purposes or for the assessment of drug efficiency.

Pathophysiology of upper extremity muscle disorders

A review of the literature on the pathophysiology of upper extremity muscle disorders (UEMDs) was performed. An overview is given of clinical findings and hypotheses on the pathogenesis of UEMDs. The literature indicates that disorders of muscle cells and limitations of the local circulation underlie UEMDs. However, these disorders identified do not necessarily lead to symptoms. The following mechanisms have been proposed in the literature: (1) selective recruitment and overloading of type I (Cinderella) motor units; (2) intra-cellular Ca(2+) accumulation; (3) impaired blood flow; (3b) reperfusion injury; (3.3c) blood vessel-nociceptor interaction; (4a) myofascial force transmission; (4b) intramuscular shear forces; (5) trigger points; (6) impaired heat shock response. The results of the review indicate that there are multiple possible mechanisms, but none of the hypotheses forms a complete explanation and is sufficiently supported by empirical data. Overall, the literature indicates that: (1) sustained muscle activity, especially of type I motor units, may be a primary cause of UEMDs; (2) in UEMDs skeletal muscle may show changes in morphology, blood flow, and muscle activity; (3) accumulation of Ca(2+) in the sarcoplasm may be the cause of muscle cell damage; (4) it seems plausible that suboptimal blood flow plays a role in pathogenesis of UEMDs; (5) since the presence of fiber disorders is not a sufficient condition for the development of UEMSDs additional mechanisms, such as sensitization, are assumed to play a role.

Activity of masticatory muscles in subjects with different orofacial pain conditions

The existence of a pathophysiological link between tonic muscle activity and chronic muscle pain is still being debated. The purpose of this retrospective, controlled study was to evaluate the electromyographic (EMG) activity of masticatory muscles in subjects with different orofacial pain conditions. The temporal and masseter EMG activity at rest and the masseteric reflex were recorded in two groups of patients with either myofascial pain (n=33) or neuropathic pain (n=20), one group of non-pain patients with disc derangement disorders (n=27) and one control group of healthy, asymptomatic subjects (n=32). The EMG activities of both muscles at rest were significantly higher in the pain patient groups compared to the asymptomatic control group. There was no significant difference between the disc derangement disorder group and the control group. The masseteric reflex amplitude was reduced in all patient groups when compared with the control group. In pain patient groups, the increased EMG activity at rest and the reduction of the masseteric reflex amplitude were equally distributed in the pain and non-pain sides. In addition, subjects presenting with bilateral pain showed higher EMG activity at rest than those with unilateral pain. These results suggested that the modulation of muscle activity was not the direct consequence of a peripheral nociceptive mechanism and seemed to indicate that a central mechanism was at work. The contrast between the increased EMG activity at rest and the reduction of the masseteric reflex amplitude may reflect modulations of motoneurones that differed in tonic versus phasic conditions in chronic pain patients.

Long-term potentiation of orofacial sensorimotor processing by noxious input from the semispinal neck muscle in mice

Tension-type headache is the most common type of primary headaches but no conclusive concept of pathophysiology exists. This may be due to a lack of an appropriate animal model. This study addressed the hypothesis that noxious neck muscle input induces central sensitization of orofacial sensorimotor processing. The effect of hypertonic saline injection into the semispinal neck muscle on the jaw-opening reflex (JOR) was investigated in anaesthetized mice (n = 11). Hypertonic saline injection into the neck muscle facilitated the JOR for at least one hour: integral (+94.5%) and duration (+18.7%) increased, latency decreased (-7.5%). The reflex threshold decreased to 61% after injection. Isotonic saline injection into the neck muscle (n = 11) or hypertonic saline injection into a hindpaw muscle (n = 10) did neither change the reflex integral nor the threshold. Long-term potentiation of the JOR by noxious neck muscle input may be an appropriate model to investigate tension-type headache pathophysiology.

Experimental muscle pain increases mechanomyographic signal activity during sub-maximal isometric contractions

This study was designed to investigate the local effect of experimental muscle pain on the MMG and the surface EMG during a range of sub-maximal isometric contractions. Muscle pain was induced by injections of hypertonic saline into the biceps brachii muscle in 12 subjects. Injections of isotonic saline served as a control. Pain intensity and location, MMG and surface EMG from the biceps brachii were assessed during static isometric (0%, 10%, 30%, 50% and, 70% of the maximal voluntary contraction) and ramp isometric (0-50% of the maximal voluntary contraction) elbow flexions. MMG and surface EMG signals were analyzed in the time and frequency domain. Experimentally induced muscle pain induced an increase in root mean square values of the MMG signal while no changes were observed in the surface EMG. Most likely this increase reflects changes in the mechanical contractile properties of the muscle and indicates compensatory mechanisms, i.e. decreased firing rate and increased twitch force to maintain a constant force output in presence of experimental muscle pain. Under well-controlled conditions, MMG recordings may be more sensitive than surface EMG recordings and clinically useful for detecting non-invasively increased muscle mechanical contributions during muscle pain conditions.

Beeinflussung muskul�rer Gesichtsschmerzen durch Botulinumtoxin�A

OBJECTIVE

Can chronic pain of the masticatory muscles be positively affected by low dose injection of botulinum toxin (BTX-A)?

METHODS

Twenty patients suffering chronic myofacial pain were questioned and examined after injection of 25-50 U Dysport into the affected muscles over a period of 8 weeks.

RESULTS

Four weeks after injection of BTX-A patients reported a significant reduction of pain (p <0.001, paired t-test. Power of performed test with alpha 0.050:1.000). Then the pain remained constant over the next 4 weeks. Concurrently a significant increase of mandubular range of movement was observed (p <0,05, Wilcoxon signed rank test).

CONCLUSIONS

Even though lacking placebo control the findings suggest that patients suffering chronic myofacial pain may benefit from injection of low dose BTX-A into the affected muscles.

Paraspinal muscles and intervertebral dysfunction: part two

BACKGROUND

One of the diagnostic characteristics of the manipulable spinal lesion--a musculoskeletal disturbance that is claimed to be detected with manual palpation and corrected with manipulation--is said to be altered segmental tissue texture. Little evidence for the nature of abnormal paraspinal tissue texture exists, but indirect evidence from experimental studies supports the plausibility of the concept of protective muscle spasm, although investigations of increased paraspinal electromyography (EMG) associated with low back pain suggests complex changes in motor control rather than simple protective reflexes.

OBJECTIVES

To review the literature for evidence that may support or refute proposed explanations for clinically observed altered paraspinal tissue texture associated with the manipulable spinal lesion. This review aims to highlight areas that require further research and make recommendations for future studies. Data Source MEDLINE and CINAHL databases were searched using various combinations of the keywords paraspinal, muscle, palpation, EMG, spine, low back pain, pain, myofascial, hardness, manipulation, reliability, and somatic dysfunction, along with searching the bibliographies of selected articles and textbooks. Data Extraction All relevant data were used.

RESULTS

Decreased paraspinal muscle activity and strength associated with low back pain is well established, and there is evidence of changes in muscle fiber composition and localized selective multifidus atrophy. Disturbances in microcirculation have been implicated in nonparaspinal muscle pain. The effect of spinal manipulation on paraspinal EMG activity is inconclusive but promising.

CONCLUSION

Little direct evidence exists to support the existence or nature of paraspinal tissue texture change that is claimed to be detected with palpation. The proposal of segmental reflex paraspinal muscle contraction was not supported, at least in association with low back pain. There appears to be a complex relationship between deep paraspinal muscle inhibition during dynamic activity and nonvoluntary guarding behavior during static activity. The relationship between these findings and palpable tissue change is speculative, but increased activity, decreased activity, or both may be responsible for paraspinal tissues detected as abnormal with palpation. Recommendations are outlined for future research.

Associations between pain and neuromuscular activity in the human jaw and neck muscles

The aim of this study was to test the effects of glutamate-evoked jaw or neck muscle pain on electromyographic (EMG) activity of jaw and neck muscles in humans. EMG recordings were made from left (MAL) and right (MAR) masseter muscles, and right sternocleidomastoid (SCM) and splenius (SP) muscles in three different head positions (head rest, head back, head right) or during maximal jaw clenching in 19 men. Glutamate (1 M) or isotonic saline was injected into MAR or SP, and induced pain was recorded on visual analogue scales. EMG activity in MAL and MAR was increased in the head back position compared to head rest and head right positions, whereas EMG activity in SCM and SP was progressively increased as the head was moved from rest position to head back to head right positions. Glutamate-evoked MAR pain was associated with increases in EMG activity in MAR, SCM and SP at rest but not in the head back or head right positions. Glutamate-evoked SP pain was associated with an increase in SP EMG activity at rest and a decrease in SCM EMG activity in the head right position. Decreases in jaw clench-related EMG activity were observed in MAL, MAR and SCM muscles only during glutamate-evoked MAR pain. Isotonic saline injections induced no pain or EMG changes. In conclusion, experimental neck pain is not associated with tonic increases in jaw EMG activity although jaw muscle pain can be linked to increases in neck EMG activity with the head and jaw at rest.

Effect of load level and muscle pain intensity on the motor control of elbow-flexion movements

This study assessed interactions between mild/moderate muscle pain and inertial load on the control of human elbow-flexion movements. It is hypothesized that high inertial load combined with moderate muscle pain intensity affect the motor control more than for low inertial-load combined with low-intensity pain. Fifteen subjects performed horizontal pointing movements (70 degree range) under three load conditions: 0, 4, and 10 kg. Pain was induced by injection of 0.5 ml and 1.5 ml hypertonic saline into the biceps muscle. Subjects scored the muscle pain intensity on a visual analogue scale (VAS). Elbow joint position, VAS, and the electromyograms (EMG, m. biceps brachii, m. triceps brachii, m. brachioradialis, and m. trapezius) were recorded. Mild and moderate muscle pain attenuated acceleration profiles [6.1(0.9)%], effective movement amplitude [3.2 (0.7)%], peak velocity [5.8 (0.9)%] and prolonged the reaction time [21 (5)%]. No interaction between muscle pain intensity and inertial load was found for the kinematic parameters. EMG profiles from m. biceps brachii, m. triceps brachii, and m. brachioradialis were similarly attenuated [10.2 (0.80)%] by mild and moderate muscle pain in all inertial load conditions. For high inertial load, the initial agonist EMG burst activity was more attenuated [50 (5.3)%] by moderate muscle pain compared with mild muscle pain [34 (4.2)%]. These data suggest that for high effort-demanding tasks muscle pain differently affects the motor planning according to the pain-intensity level. Perturbations of motor planning lead to changes on movement strategies, which might be a potential cause of musculoskeletal problems.

Comparative EEG activation to skin pain and muscle pain induced by capsaicin injection

Skin pain differs from muscle pain in quality and affective dimension, but it is unknown how the brain processes the nociceptive inputs from skin and muscle differently. To delineate the differential effects of nociceptive inputs from skin and muscle, the EEG topography and power spectra were analysed on the basis of two databases acquired from two separate studies regarding skin (Neurosci. Lett. 305 (2001b) 49) and muscle pain (Exp. Brain Res. 141 (2001c) 195). The same experimental protocol was applied to the same subject-group in the two separate experiments. In the two independent experiments, skin pain and muscle pain were, respectively, induced by intracutaneous and intramuscular injection of capsaicin in the left forearm. Visual analogue scale (VAS) and EEG data acquired before, during the vehicle and capsaicin injections were quantitatively compared. The results showed that the VAS profiles for skin and muscle pain are highly similar in spite of distinct qualities perceived. Skin pain produced a similar but not identical EEG topographic pattern as muscle evoked. Muscle pain induced a significant increase of beta-2 activity in the extensive frontal, parietal and occipital areas compared to skin pain. No difference was found between the vehicle-induced non-painful sensations in skin and muscle. These results implicate that the nociceptive inputs from muscle and skin are processed differently in the similar neural matrix of the brain.

The effect of muscle pain on elbow flexion and coactivation tasks

The effects of muscle pain on movement can easily be observed in daily life routines. However, the influence of muscle pain on motor control strategies has not been fully clarified. In this human experimental study it was hypothesized that muscle pain affects the motor control of elbow flexion movements, in different combinations of range of motion and target size, by decreased agonistic muscle activity and increased antagonistic muscle activity with consequent implications on kinematic parameters. The effects of experimentally induced muscle pain on movement strategy for: (1) small and large range of motion (ROM) elbow flexion movements towards a wide target, (2) large ROM flexion movements towards a narrow and wide target, and (3) subsequent coactivation of agonistic and antagonistic muscles to elbow flexion were assessed. Muscle pain induced by injections of hypertonic saline (1 ml, 5.8%) in either m. biceps brachii or m. triceps brachii caused similar effects on the movements. For low accurate movements the initial (100 ms) integrated electromyographic (EMG) activity of m. biceps brachii was decreased during muscle pain. In contrast, integrated EMG of the entire m. biceps brachii burst was decreased by muscle pain only for small ROM at a low accuracy, which also showed decreased EMG activity of m. triceps brachii and m. brachioradialis, together with increased activity of m. trapezius. Finally, high accurate movements and post-movement coactivation were generally not modulated by muscle pain. In summary, the present study shows that acute muscle pain can perturb the motor control strategy, which might be highly important in occupational settings where such a change may need compensatory actions from other muscles and thereby eventually contribute to the development of musculoskeletal pain problems.

Trunk muscle activation in low-back pain patients, an analysis of the literature

This paper provides an analysis of the literature on trunk muscle recruitment in low-back pain patients. Two models proposed in the literature, the pain-spasm-pain model and the pain adaptation model, yield conflicting predictions on how low- back pain would affect trunk muscle recruitment in various activities. The two models are outlined and evidence for the two from neurophsysiological studies is reviewed. Subsequently, specific predictions with respect to changes in activation of the lumbar extensor musculature are derived from both models. These predictions are compared to the results from 30 clinical studies and three induced pain studies retrieved in a comprehensive literature search. Neither of the two models is unequivocally supported by the literature. These data and further data on timing of muscle activity and load sharing between muscles suggest an alternative model to explain the alterations of trunk muscle recruitment due to low-back pain. It is proposed that motor control changes in patients are functional in that they enhance spinal stability.

Psychophysical and EEG responses to repeated experimental muscle pain in humans: pain intensity encodes EEG activity

Clinical pain is often characterized by repetitive and persistent occurrence in deep structures, but few studies investigated repetitive tonic pain in humans. To determine cerebral responses to repetitive tonic pain, psychophysical responses, and electroencephalographic (EEG) activation to five trials of repeated tonic muscle pain induced by hypertonic saline were examined and analyzed in 13 male subjects. The study was composed of two experimental sessions performed in separate days. Five sequential injections of hypertonic saline (5.8%) were used to induce repeated muscle pain in the left forearm, and five sequential injections of isotonic saline (0.9%) acted as control. Visual analogue scales (VAS) for pain intensity and 32-channels EEG activities were recorded simultaneously. Five trials of relatively stable muscle pain were induced by intramuscular injections of hypertonic saline, but no evident pain was induced by the injections of isotonic saline. Significant decreases in alpha-1 and -2 activities in posterior part of the head were found during repeated muscle pain in comparison with non-pain. In comparison with baseline, alpha-1 and -2 activities reduced significantly during the first two trials, and gradually resumed in the following three trials of muscle pain. However, beta-2 activity increased consistently throughout the five trials of muscle pain compared to baseline. Alpha-1 activity was negatively, but beta-2 activity was positively correlated to the pain intensity and pain area on the skin. Throughout five injections, the reduction of alpha-1 activity was contrary to the changes of pain intensity. These results indicates that pain-related EEG activities were encoded by the pain intensity. The thalamo-cortical system and descending inhibitory neuronal networks may be involved in the regulation of pain intensity.

Botulinum toxin for the treatment of musculoskeletal pain and spasm

The impressive pain relief experienced by sufferers of dystonia and spasticity from intramuscular injections of botulinum toxin suggested that patients with other chronic, musculoskeletal pain conditions also may benefit. However, there have been relatively few placebo-controlled studies of botulinum toxin in such non-neurologic conditions as myofascial pain syndrome, chronic neck and low back pain, and fibromyalgia; the results of these studies have not been impressive. One explanation for the lack of positive findings may be the lack of clinically evident muscle spasms (overactivity), despite the presence of muscle tenderness, tightness, or trigger points. Clinical observations of pain relief from injections of botulinum toxin for dystonia and spasticity and its apparent efficacy in treating migraine suggest an anti-nociceptive action independent of its neuromuscular junction-blocking action. Evidence from animal experiments supports this notion, and other data provide plausible physiologic mechanisms in the periphery and central nervous systems. These involve modulation of the activity of the neurotransmitters glutamate, substance P, calcitonin gene-related peptide, enkephalins, and others. However, even if botulinum toxin is firmly established as an analgesic, there is insufficient clinical evidence of its efficacy in treating non-neurologic, chronic, musculoskeletal pain conditions.

Effects of experimental muscle pain on electromyographic activity of masticatory muscles in the rat

The aim of the present study was to investigate the effects of noxious chemical stimulation of a jaw muscle on postural electromyographic (EMG) activity from several masticatory muscles in lightly anesthetized rats. Unilateral injection of a substance known to induce acute muscle pain (5% NaCl) or longer duration of pain with inflammation (mustard oil) was made into the masseter muscle. The changes in EMG activity following the injection were recorded from the injected and contralateral masseter muscles and the ipsilateral digastric muscle. The algesic chemicals produced a significant but transient increase in EMG activity in all three muscles. The data from the present study and similar observations from clinical and experimental human studies suggest that increased activity from muscle nociceptors is not sufficient to produce a prolonged increase in postural EMG activity. Therefore, the development and maintenance of chronic jaw muscle pain does not appear to result from a feedback cycle mechanism.

Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study

Hypertonic saline effectively excites muscle nociceptors. Muscle hyperalgesia was assessed in osteoarthritis (OA) by intramuscular infusion of 0.5 ml hypertonic saline (6%) into the tibialis anterior muscle in humans. Patients (n=14) with OA in the lower extremities were compared with an equal number of age- and sex-matched healthy controls. Ten of the 14 OA patients had pain in the knee joint as the most common presenting complaint. Visual analogue scale (VAS) pain intensity and assessment of pain areas were recorded before infusion and immediately, 2, 5, 10 and 20 min after infusion, and then every 10 min, until the pain vanished. The mean pain offset time in OA patients (11.3+/-7.9 min) was larger as compared with the control subjects (6.04+/-2.1 min) (P=0.025). OA patients had increased pain intensity VAS after the infusion in the right leg compared with controls (P<0.05). Referred and radiating pain areas at 2 min post-infusion increased in OA patients and not in controls as compared with the local pain areas (P<0.05). It is concluded that muscle hyperalgesia and extended pain areas might be due to central sensitization caused by painful osteoarthritis.

The effect of musculoskeletal pain on motor activity and control

Aberrant movement patterns and postures are obvious to clinicians managing patients with musculoskeletal pain. However, some changes in motor function that occur in the presence of pain are less apparent. Clinical and basic science investigations have provided evidence of the effects of nociception on aspects of motor function. Both increases and decreases in muscle activity have been shown, along with alterations in neuronal control mechanisms, proprioception, and local muscle morphology. Various models have been proposed in an attempt to provide an explanation for some of these changes. These include the vicious cycle and pain adaptation models. Recent research has seen the emergence of a new model in which patterns of muscle activation and recruitment are altered in the presence of pain (neuromuscular activation model). These changes seem to particularly affect the ability of muscles to perform synergistic functions related to maintaining joint stability and control. These changes are believed to persist into the period of chronicity. This review shows current knowledge of the effect of musculoskeletal pain on the motor system and presents the various proposed models, in addition to other shown effects not covered by these models. The relevance of these models to both acute and chronic pain is considered. It is apparent that people experiencing musculoskeletal pain exhibit complex motor responses that may show some variation with the time course of the disorder.

The relationship between selective sleep deprivation, nocturnal jaw-muscle activity and pain in healthy men

The relationship between nocturnal jaw-muscle activity and temporomandibular disorders (TMD) is still controversial. The aim of this study was to investigate the effect of selective slow wave sleep (SWS = non-rapid-eye-movement (NREM) stage 3 + 4) deprivation on jaw-muscle activity using a new automatic system. Ten healthy men without signs of symptoms of TMD participated. The subjects slept in the laboratory for six continuous nights including one adjustment night, one baseline night, three nights with experimental sleep deprivation and one recovery night. Polysomnographic recordings of electroencephalography (EEG) and electromyography (EMG) were obtained for recognition of sleep stages and masseter muscle activity. During the three experimental nights, computer-controlled sound stimulation (60--90 dB(A), 1000 Hz) were given as long as the subjects were in SWS. Maximum voluntary occlusal force (MVOF), pain pressure threshold (PPT) and visual analogue scales (VAS) were used to assess the state of the masseter muscles every morning and evening during the study period. The results showed that the time spent in SWS was significantly decreased during the first sleep deprivation night, but there were no significant effects on nocturnal EMG activity (i.e. the numbers of bruxism episodes per hour of sleep, bruxism bursts per episodes bruxism bursts per hour of sleep), MVOF, VAS or PPT. Furthermore, the automatic system only deprived the SWS in five subjects for the following two nights although the sound stimulation was given at the maximum intensity. These results suggest that deprivation of SWS may not interact immediately with nocturnal jaw-muscle activity and jaw-muscle pain.