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Puntumetakul R, Neubert MS, Karukunchit U, Buranruk O, Boucaut R. Knee musculoskeletal impairments and associated pain factors among rice farmers. J Back Musculoskelet Rehabil 2019; 31:1111-1117. [PMID: 30010097 DOI: 10.3233/bmr-170845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rice farming is done using manual methods and involves strenuous labour, which can lead to musculoskeletal disorders. OBJECTIVE To identify the factors associated with knee musculoskeletal impairments and related pain among rice farmers complaining of knee pain. METHODS The study employed a community-based, cross-sectional design. Full-time rice farmers (n= 201) were surveyed. A questionnaire was used to record demographics and details of farm work; followed by a physical examination of knee structures impairments. RESULTS The prevalence of knee impairment was highest among farmers with joint dysfunction (79.6%), followed by those with dysfunctional hamstring muscles (52.74%), quadriceps muscles (44.28%), neural tissue (38.81%), and ligaments (1.99%). It was lowest among farmers with meniscus dysfunction (1.49%). Stooping with twisting was strongly associated with knee joint and quadricep muscle impairment. Stooping with twisting and carrying loads were associated with hamstring muscle impairment. Stooping while twisting and being overweight was associated with neural tissue impairment. Being overweight was significantly associated with ligament impairment. There were no factors significantly associated with meniscus dysfunction. CONCLUSIONS Knee musculoskeletal impairments is common among Thai rice farmers. Joint dysfunction was common. The factors associated with knee musculoskeletal impairments included being overweight, stooping while twisting and carrying heavy weight.
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Affiliation(s)
- Rungthip Puntumetakul
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand.,School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Manida Swangnetr Neubert
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand.,Department of Production Technology, Faculty of Technology, Khon Kaen University, Thailand
| | - Usa Karukunchit
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand.,Faculty of Physical Therapy, Saint Louis College, Thailand
| | - Orawan Buranruk
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand.,School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Rose Boucaut
- School of Health Sciences (Physiotherapy), iCAHE, Sansom Institute for Health Research, University of South Australia, Australia
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Ayhan C, Tanrıkulu S, Leblebicioglu G. Scapholunate interosseous ligament dysfunction as a source of elbow pain syndromes: Possible mechanisms and implications for hand surgeons and therapists. Med Hypotheses 2018; 110:125-131. [PMID: 29317055 DOI: 10.1016/j.mehy.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/02/2017] [Accepted: 12/03/2017] [Indexed: 12/01/2022]
Abstract
Elbow pain syndromes are common upper extremity musculoskeletal disorders, and they are usually associated with repetitive occupational exposure. Ligaments are often one of the sources of musculoskeletal disorders because of their mechanical and neurological properties. The wrist ligaments are some of the ligaments most vulnerable to occupational exposure. Since most occupational tasks require wrist extension for handling tools and loading, the scapholunate interosseous ligament (SLIL) bears greater strain during loading, which results in creep deformation and hysteresis. Ligamentous creep may result in diminished ability to detect signal changes during joint movements, which impairs neuromuscular control established by ligamentomuscular reflex arcs elicited from mechanoreceptors in the ligaments. Changes in muscle activation patterns of forearm muscles due to diminished ligamentomuscular reflexes may initiate a positive feedback loop, leading to musculoskeletal pain syndromes. The relationship between elbow pain syndromes and SLIL injury will be presented through two hypotheses and relevant pain mechanisms: 1. Repetitive tasks may cause creep deformation of the SLIL, which then impairs ligamentomuscular reflexes, leading to elbow pain disorders. 2. Lateral epicondylalgia may increase the risk of SLIL injury through the compensation of the lower extensor carpi radialis muscle activity by higher extensor carpi ulnaris muscle activity, which may alter carpal kinematics, leading to SLIL degeneration over time. The differential diagnosis is usually complicated in musculoskeletal pain disorders. The failure of treatment methods is one of the issues of concern for many researchers. A key element in developing treatment strategies is to understand the source of the disorder and the nature of the injury. We proposed that the differential diagnosis include SLIL injuries when describing elbow pain syndromes, particularly, lateral epicondylalgia.
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Affiliation(s)
- Cigdem Ayhan
- Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey.
| | - Seval Tanrıkulu
- Koc University, Faculty of Medicine, Orthopedics and Traumatology Department, Hand Surgery Unit, İstanbul, Turkey
| | - Gursel Leblebicioglu
- Hacettepe University, Faculty of Medicine, Orthopaedics and Traumatology Department, Hand Surgery Unit, Ankara, Turkey
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Nebel K, Stude P, Lüdecke C, Wiese H, Diener HC, Keidel M. Prospective PC-interactive Pressure Algesimetry of Post-Traumatic Neck pain after Whiplash Injury. Cephalalgia 2016; 25:205-13. [PMID: 15689196 DOI: 10.1111/j.1468-2982.2004.00842.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cervical pain is a prominent symptom in both acute whiplash injury and late whiplash syndrome. However, no systematic analysis of post-traumatic pain development covering several weeks has yet been performed in whiplash patients. It was the aim of the present study to analyse the duration and course of post-traumatic muscle pain due to whiplash injury in a prospective follow-up examination with short investigation intervals. A recovery of initially increased muscle pain after whiplash injury within 1 month was hypothesized. Pressure pain of the splenius and trapezius muscles was recorded using PC-interactive pressure algesimetry. Whiplash patients were investigated during the acute injury stage and after 3, 4, and 6 weeks and compared with matched controls. We found significantly increased pressure pain of the splenius and trapezius muscles in the acute stage of whiplash injury. After 4 weeks patients' scores of pain parameters were comparable to those of healthy control subjects. Within the patient group the first changes of pressure pain were observed within 3 (splenius) and 4 weeks (trapezius). For most patients the recovery dynamics lasted 4-6 weeks. A minority of patients did not show any improvement after 6 weeks. The present study shows that the dynamics of pressure pain due to whiplash injury can be quantified by means of PC-interactive pressure algesimetry. Our results confirm the clinical experience that the acute post-traumatic cervical syndrome normally subsides within weeks.
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Affiliation(s)
- K Nebel
- Department of Neurology, University of Essen, Essen, Germany.
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Vidor LP, Torres ILS, Medeiros LF, Dussán-Sarria JA, Dall'agnol L, Deitos A, Brietzke A, Laste G, Rozisky JR, Fregni F, Caumo W. Association of anxiety with intracortical inhibition and descending pain modulation in chronic myofascial pain syndrome. BMC Neurosci 2014; 15:42. [PMID: 24645677 PMCID: PMC3995110 DOI: 10.1186/1471-2202-15-42] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/12/2014] [Indexed: 01/03/2023] Open
Abstract
Background This study aimed to answer three questions related to chronic myofascial pain syndrome (MPS): 1) Is the motor cortex excitability, as assessed by transcranial magnetic stimulation parameters (TMS), related to state-trait anxiety? 2) Does anxiety modulate corticospinal excitability changes after evoked pain by Quantitative Sensory Testing (QST)? 3) Does the state-trait anxiety predict the response to pain evoked by QST if simultaneously receiving a heterotopic stimulus [Conditional Pain Modulation (CPM)]? We included females with chronic MPS (n = 47) and healthy controls (n = 11), aged 19 to 65 years. Motor cortex excitability was assessed by TMS, and anxiety was assessed based on the State-Trait Anxiety Inventory. The disability related to pain (DRP) was assessed by the Profile of Chronic Pain scale for the Brazilian population (B:PCP:S), and the psychophysical pain measurements were measured by the QST and CPM. Results In patients, trait-anxiety was positively correlated to intracortical facilitation (ICF) at baseline and after QST evoked pain (β = 0.05 and β = 0.04, respectively) and negatively correlated to the cortical silent period (CSP) (β = -1.17 and β = -1.23, respectively) (P <0.05 for all comparisons). After QST evoked pain, the DRP was positively correlated to ICF (β = 0.02) (P < 0.05). Pain scores during CPM were positively correlated with trait-anxiety when it was concurrently with high DRP (β = 0.39; P = 0.02). Controls’ cortical excitability remained unchanged after QST. Conclusions These findings suggest that, in chronic MPS, the imbalance between excitatory and inhibitory descending systems of the corticospinal tract is associated with higher trait-anxiety concurrent with higher DRP.
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Affiliation(s)
| | - Iraci L S Torres
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Gerhardt A, Hartmann M, Tesarz J, Janke S, Leisner S, Seidler G, Eich W. Subgroups of musculoskeletal pain patients and their psychobiological patterns - the LOGIN study protocol. BMC Musculoskelet Disord 2012; 13:136. [PMID: 22862787 PMCID: PMC3476389 DOI: 10.1186/1471-2474-13-136] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain conditions of the musculoskeletal system are very common and have tremendous socioeconomic impact. Despite its high prevalence, musculoskeletal pain remains poorly understood and predominantly non-specifically and insufficiently treated.The group of chronic musculoskeletal pain patients is supposed to be heterogeneous, due to a multitude of mechanisms involved in chronic pain. Psychological variables, psychophysiological processes, and neuroendocrine alterations are expected to be involved. Thus far, studies on musculoskeletal pain have predominantly focused on the general aspects of pain processing, thus neglecting the heterogeneity of patients with musculoskeletal pain. Consequently, there is a need for studies that comprise a multitude of mechanisms that are potentially involved in the chronicity and spread of pain. This need might foster research and facilitate a better pathophysiological understanding of the condition, thereby promoting the development of specific mechanism-based treatments for chronic pain. Therefore, the objectives of this study are as follows: 1) identify and describe subgroups of patients with musculoskeletal pain with regard to clinical manifestations (including mental co-morbidity) and 2) investigate whether distinct sensory profiles or 3) distinct plasma levels of pain-related parameters due to different underlying mechanisms can be distinguished in various subgroups of pain patients. METHODS/DESIGN We will examine a population-based chronic pain sample (n = 100), a clinical tertiary care sample (n = 100) and pain-free patients with depression or post-traumatic stress disorder and pain-free healthy controls (each n = 30, respectively). The samples will be pain localisation matched by sex and age to the population-based sample. Patients will undergo physical examination and thorough assessments of mental co-morbidity (including psychological trauma), perceptual and central sensitisation (quantitative sensory testing), descending inhibition (conditioned pain modulation, the diffuse noxious inhibitory control-like effect), as well as measurement of the plasma levels of nerve growth factor and endocannabinoids. DISCUSSION The identification of the underlying pathophysiologic mechanisms in different subgroups of chronic musculoskeletal pain patients will contribute to a mechanism-based subgroup classification. This will foster the development of mechanism-based treatments and holds promise to treat patients more sufficient.
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Affiliation(s)
- Andreas Gerhardt
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.
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Abstract
UNLABELLED BACKGROUND The mechanisms subserving deep spinal pain have not been studied as well as those related to the skin and to deep pain in peripheral limb structures. The clinical phenomenology of deep spinal pain presents unique features which call for investigations which can explain these at a mechanistic level. METHODS Targeted searches of the literature were conducted and the relevant materials reviewed for applicability to the thesis that deep spinal pain is distinctive from deep pain in the peripheral limb structures. Topics related to the neuroanatomy and neurophysiology of deep spinal pain were organized in a hierarchical format for content review. RESULTS Since the 1980's the innervation characteristics of the spinal joints and deep muscles have been elucidated. Afferent connections subserving pain have been identified in a distinctive somatotopic organization within the spinal cord whereby afferents from deep spinal tissues terminate primarily in the lateral dorsal horn while those from deep peripheral tissues terminate primarily in the medial dorsal horn. Mechanisms underlying the clinical phenomena of referred pain from the spine, poor localization of spinal pain and chronicity of spine pain have emerged from the literature and are reviewed here, especially emphasizing the somatotopic organization and hyperconvergence of dorsal horn "low back (spinal) neurons". Taken together, these findings provide preliminary support for the hypothesis that deep spine pain is different from deep pain arising from peripheral limb structures. CONCLUSIONS This thesis addressed the question "what is different about spine pain?" Neuroanatomic and neurophysiologic findings from studies in the last twenty years provide preliminary support for the thesis that deep spine pain is different from deep pain arising from peripheral limb structures.
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Affiliation(s)
- Howard Vernon
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
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Sjörs A, Larsson B, Persson AL, Gerdle B. An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain. BMC Musculoskelet Disord 2011; 12:230. [PMID: 21992460 PMCID: PMC3204274 DOI: 10.1186/1471-2474-12-230] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/12/2011] [Indexed: 11/10/2022] Open
Abstract
Background Neck-shoulder pain conditions, e.g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance). Methods Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study. Results NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. Conclusion These results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.
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Affiliation(s)
- Anna Sjörs
- Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden
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Chopra K, Kuhad A, Arora V. Neoteric pharmacotherapeutic targets in fibromyalgia. Expert Opin Ther Targets 2011; 15:1267-81. [DOI: 10.1517/14728222.2011.617366] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Andersen LL, Hansen K, Mortensen OS, Zebis MK. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. BMC Musculoskelet Disord 2011; 12:169. [PMID: 21777478 PMCID: PMC3161919 DOI: 10.1186/1471-2474-12-169] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 07/22/2011] [Indexed: 11/26/2022] Open
Abstract
Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809
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Affiliation(s)
- Lars L Andersen
- National Research Centre for the Working Environment, Lersø Parkalle 105, DK 2100 Copenhagen Ø, Denmark.
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Nielsen PK, Andersen LL, Olsen HB, Rosendal L, Sjøgaard G, Søgaard K. Effect of physical training on pain sensitivity and trapezius muscle morphology. Muscle Nerve 2010; 41:836-44. [DOI: 10.1002/mus.21577] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Chronic widespread pain (CWP) is very prevalent in the general population (5%-10%) and is characterized by pain in all four body quadrants, the neck, and back. CWP differs from localized pain not only in its distribution but also in the way it affects lives. Multiple pain sites are associated with higher pain intensity, longer pain duration, and greater disability. Anxiety and depression are more common in CWP patients than among those with localized pain and pain-free controls. Fibromyalgia (FM) has been classified as CWP of more than a 3-month duration, with mechanical hyperalgesia at > or = 11 tender-point sites. FM has been found in 2% to 4% of community subjects and represents the extreme of CWP. This article compares pain characteristics, quality of life, consequences for daily living, and psychosocial status between FM patients and individuals with CWP. Available evidence shows that FM is associated with more severe symptoms and consequences for daily life and higher pain-severity compared with CWP.
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Freeman MD, Nystrom A, Centeno C. Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation. J Brachial Plex Peripher Nerve Inj 2009; 4:2. [PMID: 19389231 PMCID: PMC2680858 DOI: 10.1186/1749-7221-4-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 04/23/2009] [Indexed: 11/11/2022] Open
Abstract
Objective it has been established that chronic neck pain following whiplash is associated with the phenomenon of central sensitization, in which injured and uninjured parts of the body exhibit lowered pain thresholds due to an alteration in central pain processing. it has furthermore been hypothesized that peripheral sources of nociception in the muscles may perpetuate central sensitization in chronic whiplash. the hypothesis explored in the present study was whether myofascial trigger points serve as a modulator of central sensitization in subjects with chronic neck pain. Design controlled case series. Setting outpatient chronic pain clinic. Subjects seventeen patients with chronic and intractable neck pain and 10 healthy controls without complaints of neck pain. Intervention symptomatic subjects received anesthetic infiltration of myofascial trigger points in the upper trapezius muscles and controls received the anesthetic in the thigh. Outcome measures: pre and post injection cervical range of motion, pressure pain thresholds (ppt) over the infraspinatus, wrist extensor, and tibialis anterior muscles. sensitivity to light (photophobia) and subjects' perception of pain using a visual analog scale (vas) were also evaluated before and after injections. only the ppt was evaluated in the asymptomatic controls. Results immediate (within 1 minute) alterations in cervical range of motion and pressure pain thresholds were observed following an average of 3.8 injections with 1–2 cc of 1% lidocaine into carefully identified trigger points. cervical range of motion increased by an average of 49% (p = 0.000) in flexion and 44% (p = 0.001) in extension, 47% (p = 0.000) and 28% (p < 0.016) in right and left lateral flexion, and a 27% (p = 0.002) and 45% (p = 0.000) in right and left rotation. ppt were found increased by 68% over the infraspinatus (p = 0.000), by 78% over the wrist extensors (p = 0.000), and by 64% over the tibialis anterior (p = 0.002). among 11 subjects with photophobia, only 2 remained sensitive to light after the trigger point injections (p = 0.033). average vas dropped by 57%, from 6.1 to 2.6 (p = 0.000). no significant changes in ppt were observed in the control group following lidocaine infiltration of the thigh. Conclusion the present data suggest that myofascial trigger points serve to perpetuate lowered pain thresholds in uninjured tissues. additionally, it appears that lowered pain thresholds associated with central sensitization can be immediately reversed, even when associated with long standing chronic neck pain. although the effects resulting from anesthesia of trigger points in the present study were temporary, it is possible that surgical excision or ablation of the same trigger points may offer more permanent solutions for chronic neck pain patients. further study is needed to evaluate these and other options for such patients.
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Affiliation(s)
- Michael D Freeman
- Department of Public Health and Preventive Medicine, Oregon Health and Science University School of Medicine, Portland, Oregon, USA.
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Borg-Stein J. Treatment of Fibromyalgia, Myofascial Pain, and Related Disorders. Phys Med Rehabil Clin N Am 2006; 17:491-510, viii. [PMID: 16616279 DOI: 10.1016/j.pmr.2005.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic muscle pain is a common complaint among patients who seek care for musculoskeletal disorders. A spectrum of clinical presentations exists, ranging from focal or regional complaints that usually represent myofascial pain syndromes to more wide spread pain that may meet criteria for a diagnosis of fibromyalgia. This article addresses the epidemiology, pathophysiology, and clinical management of myofascial pain syndrome and fibromyalgia. These conditions are challenging to treat and require physiatrists to be aware of the wide range of pharmacologic, rehabilitative,and psychosocial interventions that can be helpful.
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Affiliation(s)
- Joanne Borg-Stein
- Rehabilitation Center, Spaulding Newton-Wellesley Rehabilitation Hospital, 65 Walnut Street, Wellesley, MA 02481, USA.
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Christidis N, Kopp S, Ernberg M. The effect on mechanical pain threshold over human muscles by oral administration of granisetron and diclofenac-sodium. Pain 2005; 113:265-270. [PMID: 15661432 DOI: 10.1016/j.pain.2004.10.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Revised: 10/06/2004] [Accepted: 10/18/2004] [Indexed: 11/26/2022]
Abstract
Previous studies indicate that plasma levels of serotonin (5-HT) and intramuscular prostaglandin E2 (PGE2) participate in determining the mechanical pain threshold and tolerance level to pressure applied on the skin over healthy muscles. Other studies reported gender differences regarding responses to noxious stimuli. The present study aimed to determine whether the mechanical pain threshold of healthy muscles is influenced by oral administration of 5-HT3 or PGE2-inhibitors and if there are any gender differences in this respect. Ten healthy female subjects and 10 age-matched healthy male subjects participated in the study, which was randomized and double blind with crossover design. Granisetron (5-HT3-antagonist), diclofenac-sodium (PGE2-antagonist) and placebo were administered for 3 days. The pressure pain threshold (PPT) was recorded bilaterally with an algometer over certain orofacial, trunk, and limb muscles before and after administration of the antagonists. The PPT over all muscles combined increased after administration of granisetron. There was no change after administration of placebo. The difference between granisetron and placebo was significant for the trapezius and tibialis anterior muscles. Diclofenac-sodium did not influence the PPT and there was no difference compared to placebo. Although the basal PPT values were lower in females, the PPT response to granisetron differed significantly between genders only in the tibialis anterior muscle. In conclusion, the results of this study showed that oral administration of the 5-HT3-antagonist granisetron increased the PPT over healthy trunk and limb muscles but not over orofacial muscles, and that the response in the limb muscles was greater in males.
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Affiliation(s)
- Nikolaos Christidis
- Department of Clinical Oral Physiology, Institute of Odontology, Karolinska Institutet, Box 4064, SE-141 04 Huddinge, Sweden
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