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Sago T, Costa YM, Ferreira DM, Svensson P, Exposto FG. Referred sensations in the orofacial region are associated with a decreased descending pain inhibition and modulated by remote noxious stimuli and local anesthesia. Pain 2023; 164:2228-2238. [PMID: 37289580 DOI: 10.1097/j.pain.0000000000002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/03/2023] [Indexed: 06/10/2023]
Abstract
ABSTRACT Referred sensation (RS) as a specific clinical phenomenon has been known for a long time, although the underlying mechanisms remain unclear. The aims of this study were to assess if (1) healthy individuals who experienced RS had a less active endogenous pain system when compared with those who did not; (2) activation of descending pain inhibition mechanisms can modulate RS parameters; and finally, (3) a transient decrease in peripheral afferent input because of a local anesthetic (LA) block in the masseter muscle can modulate RS parameters. To assess these, 50 healthy participants were assessed in 3 different sessions. In the first session, conditioned pain modulation (CPM) as well as mechanical sensitivity and RS at the masseter muscle were assessed. In the same session, participants who experienced RS had their mechanical sensitivity and RS assessed again while undergoing a CPM protocol. In the second and third sessions, participants had their mechanical sensitivity and RS assessed before and after receiving an injection of 2 mL of LA and isotonic saline into the masseter muscle. The main findings of this study were (1) participants who experienced RS during standardized palpation exhibited increased mechanical sensitivity ( P < 0.05, Tukey post hoc test) and decreased CPM ( P < 0.05, Tukey post hoc test) when compared with those who did not; RS incidence ( P < 0.05, Cochran Q test), frequency ( P < 0.05; Friedman test), intensity ( P < 0.05, Tukey post hoc test), and area ( P < 0.05, Tukey post hoc test) were all significantly reduced when assessed (2) during a painful conditioning stimulus and (3) after LA block. These novel findings highlight that RS in the orofacial region are strongly modified by both peripheral and central nervous system factors.
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Affiliation(s)
- Teppei Sago
- Division of Dental Anesthesiology, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan
| | - Yuri M Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Dyna M Ferreira
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
- Faculty of Odontology, Malmo University, Malmo, Sweden
| | - Fernando G Exposto
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
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Martínez‐Jiménez EM, Losa‐Iglesias ME, Mazoteras‐Pardo V, López‐López D, Pereiro‐Buceta H, Calvo‐Lobo C, Rodríguez‐Sanz D, Becerro‐de‐Bengoa‐Vallejo R, Navarro‐Flores E. Dry needling of the flexor digitorum brevis muscle reduces postural control in standing: A pre-post stabilometric study. J Anat 2023; 243:545-554. [PMID: 36924312 PMCID: PMC10439377 DOI: 10.1111/joa.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
There are studies that show the better balance after dry needling in lumbar pain. However, the postural control effects after foot dry needling are unknown. Our objective was to check if dry needling reduces postural control. Eighteen subjects with flexor digitorum brevis (FDB) muscle Myofascial trigger point were evaluated pre- and post-deep dry needling. We measured stabilometric variables in a pre-post study. We have found significant differences in three stabilometric variables: surface with eyes closed (29.36-53.21 mm2 ) (p = 0.000), medium speed of the laterolateral displacement with eyes closed (1.42-1.64 mm/s) (p = 0.004), and medium speed of the anteroposterior displacement with eyes closed (1.30-1.53 mm/s) (p = 0.025). Dry needling therapy application in FDB muscle reduces standing postural control with eyes closed.
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Affiliation(s)
| | - Marta Elena Losa‐Iglesias
- Nursing and Stomatology Department, Faculty of Health SciencesUniversidad Rey Juan CarlosMadridSpain
| | - Victoria Mazoteras‐Pardo
- Grupo de Investigación ENDOCU, Departamento Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Fisioterapia y Enfermería de ToledoUniversidad de Castilla‐La ManchaCiudad RealSpain
| | - Daniel López‐López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and PodiatryUniversidade da CoruñaIndustrial Campus of FerrolFerrol, Spain
| | - Héctor Pereiro‐Buceta
- Departamento de Enfermería y Fisioterapia, Facultad de Ciencias de la SaludUniversidad de LeónPonferradaSpain
| | - César Calvo‐Lobo
- Facultad de enfermería Fisioterapia y PodologíaUniversidad Complutense de MadridMadridSpain
| | - David Rodríguez‐Sanz
- Facultad de enfermería Fisioterapia y PodologíaUniversidad Complutense de MadridMadridSpain
| | | | - Emmanuel Navarro‐Flores
- Frailty Research Organized Group (FROG), Department of Nursing, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
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Fernández-de-las-Peñas C, Nijs J, Cagnie B, Gerwin RD, Plaza-Manzano G, Valera-Calero JA, Arendt-Nielsen L. Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain. Life (Basel) 2023; 13:life13030694. [PMID: 36983849 PMCID: PMC10059732 DOI: 10.3390/life13030694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Madrid, Spain
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Correspondence:
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Jette, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Robert D. Gerwin
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
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Martínez-Jiménez EM, Losa-Iglesias ME, Antolín-Gil MS, López-López D, Romero-Morales C, Benito-de-Pedro M, Calvo-Lobo C, Becerro-de-Bengoa-Vallejo R. Flexor Digitorum Brevis Muscle Dry Needling Changes Surface and Plantar Pressures: A Pre-Post Study. Life (Basel) 2021; 11:life11010048. [PMID: 33451013 PMCID: PMC7830844 DOI: 10.3390/life11010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The effects of the dry needling technique and pain reduction have been demonstrated in numerous quality studies. However, the mechanical effects of dry needling are largely unknown. METHODS A total of 18 subjects with flexor digitorum brevis muscle myofascial trigger point were evaluated pre- and post-deep dry needling. We measured static footprint variables in a pre-post study. MAIN FINDINGS We found differences in rearfoot maximum pressure (119.22-111.63 KPa; p = 0.025), midfoot maximum pressure (13.68-17.26 KPa; p = 0.077), midfoot medium pressure (4.75-6.24 KPa; p = 0.035) and forefoot surface (86.58-81.75 cm2; p = 0.020). All variables with significant differences decrease, with the exception of forefoot surface which showed an increase. CONCLUSIONS After flexor digitorum brevis muscle dry needling, midfoot plantar pressures (maximum and medium) and forefoot surface were increased, and rearfoot maximum pressure was decreased.
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Affiliation(s)
| | - Marta Elena Losa-Iglesias
- Nursing and Stomatology Department, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | | | - Daniel López-López
- Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
| | - Carlos Romero-Morales
- Villaviciosa de Odón Campus, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Correspondence:
| | - María Benito-de-Pedro
- Facultad de enfermería Fisioterapiay Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.B.-d.-P.); (C.C.-L.); (R.B.-d.-B.-V.)
| | - César Calvo-Lobo
- Facultad de enfermería Fisioterapiay Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.B.-d.-P.); (C.C.-L.); (R.B.-d.-B.-V.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de enfermería Fisioterapiay Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.B.-d.-P.); (C.C.-L.); (R.B.-d.-B.-V.)
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Ford B, Halaki M, Diong J, Ginn KA. Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review. Scand J Pain 2020; 21:217-237. [PMID: 34387953 DOI: 10.1515/sjpain-2020-0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Experimental pain is a commonly used method to draw conclusions about the motor response to clinical musculoskeletal pain. A systematic review was performed to determine if current models of acute experimental pain validly replicate the clinical experience of appendicular musculoskeletal pain with respect to the distribution and quality of pain and the pain response to provocation testing. METHODS A structured search of Medline, Scopus and Embase databases was conducted from database inception to August 2020 using the following key terms: "experimental muscle pain" OR "experimental pain" OR "pain induced" OR "induced pain" OR "muscle hyperalgesia" OR ("Pain model" AND "muscle"). Studies in English were included if investigators induced experimental musculoskeletal pain into a limb (including the sacroiliac joint) in humans, and if they measured and reported the distribution of pain, quality of pain or response to a provocation manoeuvre performed passively or actively. Studies were excluded if they involved prolonged or delayed experimental pain, if temporomandibular, orofacial, lumbar, thoracic or cervical spine pain were investigated, if a full text of the study was not available or if they were systematic reviews. Two investigators independently screened each title and abstract and each full text paper to determine inclusion in the review. Disagreements were resolved by consensus with a third investigator. RESULTS Data from 57 experimental pain studies were included in this review. Forty-six of these studies reported pain distribution, 41 reported pain quality and six detailed the pain response to provocation testing. Hypertonic saline injection was the most common mechanism used to induce pain with 43 studies employing this method. The next most common methods were capsaicin injection (5 studies) and electrical stimulation, injection of acidic solution and ischaemia with three studies each. The distribution of experimental pain was similar to the area of pain reported in clinical appendicular musculoskeletal conditions. The quality of appendicular musculoskeletal pain was not replicated with the affective component of the McGill Pain Questionnaire consistently lower than that typically reported by musculoskeletal pain patients. The response to provocation testing was rarely investigated following experimental pain induction. Based on the limited available data, the increase in pain experienced in clinical populations during provocative maneuvers was not consistently replicated. CONCLUSIONS Current acute experimental pain models replicate the distribution but not the quality of chronic clinical appendicular musculoskeletal pain. Limited evidence also indicates that experimentally induced acute pain does not consistently increase with tests known to provoke pain in patients with appendicular musculoskeletal pain. The results of this review question the validity of conclusions drawn from acute experimental pain studies regarding changes in muscle behaviour in response to pain in the clinical setting.
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Affiliation(s)
- Brendon Ford
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
| | - Mark Halaki
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSWAustralia
| | - Joanna Diong
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
| | - Karen A Ginn
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
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6
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Local anaesthesia decreases nerve growth factor induced masseter hyperalgesia. Sci Rep 2020; 10:15458. [PMID: 32963266 PMCID: PMC7508842 DOI: 10.1038/s41598-020-71620-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/13/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.
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7
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Abstract
Background The trigeminal nerve theory has been proposed as a pathophysiological mechanism of migraine; however, its association with the triggers of migraine remains unclear. Cervical disability such as neck pain and restricted cervical rotation, have been associated with not only cervicogenic headaches but also migraine. The presence of cervical disability could worsen of the migraine, and also the response to pharmacologic treatment may be reduced. The aim in this review is to highlight the involvement of cervical disability in migraine, considering contributing factors. Findings In recent years, evidence of neck pain complaints in migraine has been increasing. In addition, there is some recent evidence of cervical musculoskeletal impairments in migraine, as detected by physical assessment. However, the main question of whether neck pain or an associated cervical disability can act as an initial factor leading to migraine attacks still remains. Daily life imposes heavy loads on cervical structures (i.e. muscles, joints and ligaments), for instance, in the forward head position. The repetitive nociceptive stimulation initiating those cervical skeletal muscle positions may amplify the susceptibility to central migraine and contribute to chronicity via the trigeminal cervical complex. Conclusion Further studies are needed to explain the association between cervical disability as a source of pain and the development of migraine. However, evidence suggests that cervical disability needs to be considered in the prevention and treatment of migraine.
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Affiliation(s)
- Naoki Aoyama
- Department of Neurosurgery, JCHO Yokohama Central Hospital, Yokohama, Japan
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8
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Palsson TS, Boudreau SA, Krebs HJ, Graven-Nielsen T. Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study. THE JOURNAL OF PAIN 2018; 19:1189-1200. [DOI: 10.1016/j.jpain.2018.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022]
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9
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Rajasekar S, Marchand AM. Fascial Manipulation ® for persistent knee pain following ACL and meniscus repair. J Bodyw Mov Ther 2016; 21:452-458. [PMID: 28532890 DOI: 10.1016/j.jbmt.2016.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/23/2016] [Accepted: 08/21/2016] [Indexed: 11/20/2022]
Abstract
Fascial Manipulation® (FM) is a manual therapy approach for the treatment of musculoskeletal pain. Anomalous fascial tension is common following surgery due to surgical scar, inadequate mobility and fear of movement. Fascial tension may result in pain and loss of mobility. This case report aims at investigating the effectiveness of FM® on pain and function in a patient following knee surgery. A 32 years old male patient, with persisting knee pain following anterior cruciate ligament reconstruction (hamstring graft) and meniscal repair, underwent the systematic FM® assessment process, the selected centers of coordination of myofascial units were treated. Knee Injury Osteoarthritis Outcome Score (KOOS) questionnaire was obtained prior treatment and after 4 treatment sessions. Results showed clinically significant improvements in all subscales of KOOS after 4 weeks, the effect was maintained in subsequent follow-ups at 3 months, 6 months, one year and two years.
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Affiliation(s)
- Sannasi Rajasekar
- Srinivas College of Physiotherapy and Research Centre, Mangalore, Karnataka, 575 001, India
| | - Aurélie Marie Marchand
- Clinical Lecturer, Anglo-European College of Chiropractic, 13-15 Parkwood Road, BH5 2DF Bournemouth, United Kingdom.
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Hitomi S, Ono K, Yamaguchi K, Terawaki K, Imai R, Kubota K, Omiya Y, Hattori T, Kase Y, Inenaga K. The traditional Japanese medicine hangeshashinto alleviates oral ulcer-induced pain in a rat model. Arch Oral Biol 2016; 66:30-7. [PMID: 26878477 DOI: 10.1016/j.archoralbio.2016.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 12/15/2015] [Accepted: 02/01/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Recent studies have demonstrated that mouthwash made with the traditional Japanese medicine hangeshashinto exhibits anti-inflammatory action and alleviates oral mucositis scores, including pain complaints, in patients undergoing chemoradiotherapy. However, no study has demonstrated the mechanism underlying how hangeshashinto provides pain relief in oral ulcers. DESIGN The analgesic effects on pain-related behaviors following the topical application of hangeshashinto were evaluated in an oral ulcer rat model treated with acetic acid using recently developed methods. Indomethacin, the representative anti-inflammatory agent, was intraperitoneally administered. The tissue permeability of the oral mucosa was histologically evaluated after applying the fluorescent substance FluoroGold. RESULTS The topical application of hangeshashinto in ulcerative oral mucosa suppressed mechanical pain hypersensitivity over 60 min, without any effects on healthy mucosa. The same drug application also inhibited oral ulcer-induced spontaneous pain. Indomethacin administration failed to block the mechanical pain hypersensitivity, though it did largely block spontaneous pain. Topical anesthesia with lidocaine showed hyposensitivity to mechanical stimulation in healthy mucosa. In the ulcer regions in which the oral epithelial barrier was destroyed, deep parenchyma was stained with FluoroGold, in contrast to healthy oral mucosa, in which staining was limiting to the superficial site. CONCLUSIONS Hangeshashinto leads to long-lasting analgesic effects, specifically in the ulcer region by destroying the epithelial barrier. Hangeshashinto alleviates oral ulcer-induced pain in inflammation-dependent and/or independent manner.
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Affiliation(s)
- Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Kentaro Ono
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan.
| | - Kiichiro Yamaguchi
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan; Division of Dental Anesthesiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Kiyoshi Terawaki
- Tsumura Research Laboratories, Kampo Scientific Strategies Division, Tsumura & Co., 3586 Yoshihara, Amicho, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Ryota Imai
- Tsumura Research Laboratories, Kampo Scientific Strategies Division, Tsumura & Co., 3586 Yoshihara, Amicho, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Kunitsugu Kubota
- Tsumura Research Laboratories, Kampo Scientific Strategies Division, Tsumura & Co., 3586 Yoshihara, Amicho, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Yuji Omiya
- Tsumura Research Laboratories, Kampo Scientific Strategies Division, Tsumura & Co., 3586 Yoshihara, Amicho, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Tomohisa Hattori
- Tsumura Research Laboratories, Kampo Scientific Strategies Division, Tsumura & Co., 3586 Yoshihara, Amicho, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Yoshio Kase
- Tsumura Research Laboratories, Kampo Scientific Strategies Division, Tsumura & Co., 3586 Yoshihara, Amicho, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Kiyotoshi Inenaga
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
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11
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Tolerability of hypertonic injectables. Int J Pharm 2015; 490:308-15. [DOI: 10.1016/j.ijpharm.2015.05.069] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/21/2022]
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12
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Experimental orofacial pain and sensory deprivation lead to perceptual distortion of the face in healthy volunteers. Exp Brain Res 2015; 233:2597-606. [DOI: 10.1007/s00221-015-4330-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 05/14/2015] [Indexed: 12/29/2022]
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13
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Dommerholt J, Layton M, Hooks T, Grieve R. A critical overview of current myofascial pain literature – March 2015. J Bodyw Mov Ther 2015; 19:337-49. [DOI: 10.1016/j.jbmt.2015.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Arendt-Nielsen L, Castaldo M. MTPs are a Peripheral Source of Nociception. PAIN MEDICINE 2015; 16:625-7. [DOI: 10.1111/pme.12714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Dommerholt J, Gerwin RD. A critical evaluation of Quintner et al: missing the point. J Bodyw Mov Ther 2015; 19:193-204. [PMID: 25892372 DOI: 10.1016/j.jbmt.2015.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 02/03/2023]
Abstract
The objective of this article is to critically analyze a recent publication by Quinter, Bove and Cohen, published in Rheumatology, about myofascial pain syndrome and trigger points (Quintner et al., 2014). The authors concluded that the leading trigger point hypothesis is flawed in reasoning and in science. They claimed to have refuted the trigger point hypothesis. The current paper demonstrates that the Quintner et al. paper is a biased review of the literature replete with unsupported opinions and accusations. In summary, Quintner et al. have not presented any convincing evidence to believe that the Integrated TrP Hypothesis should be laid to rest.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; PhysioFitness, Rockville, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Robert D Gerwin
- Myopain Seminars, Bethesda, MD, USA; Johns Hopkins University, Baltimore, MD, USA; Pain & Rehabilitation Medicine, Bethesda, MD, USA.
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16
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The interactions between cutaneous and deep pain. Scand J Pain 2014; 5:256-257. [DOI: 10.1016/j.sjpain.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fernández-de-las-Peñas C, Dommerholt J. Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep 2014; 16:395. [PMID: 24264721 DOI: 10.1007/s11926-013-0395-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Trigger points (TrP) are hyperirritable spots in a taut band of a skeletal muscle, which usually have referred pain. There is controversy over whether TrP are a peripheral or central nervous system phenomenon. Referred pain, the most characteristic sign of TrP, is a central phenomenon initiated and activated by peripheral sensitization, whereby the peripheral nociceptive input from the muscle can sensitize dorsal horn neurons that were previously silent. TrP are a peripheral source of nociception, and act as ongoing nociceptive stimuli contributing to pain propagation and widespread pain. Several studies support the hypothesis that TrP can induce central sensitization, and appropriate TrP treatment reduces central sensitization. In contrast, preliminary evidence suggests that central sensitization can also promote TrP activity, although further studies are needed. Proper TrP management may prevent and reverse the development of pain propagation in chronic pain conditions, because inactivation of TrP attenuates central sensitization.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain,
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Rubin TK, Lake S, van der Kooi S, Lucas NP, Mahns DA, Henderson LA, Macefield VG. Predicting the spatiotemporal expression of local and referred acute muscle pain in individual subjects. Exp Brain Res 2012; 223:11-8. [DOI: 10.1007/s00221-012-3236-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/17/2012] [Indexed: 11/29/2022]
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Spatial pain propagation over time following painful glutamate activation of latent myofascial trigger points in humans. THE JOURNAL OF PAIN 2012; 13:537-45. [PMID: 22537561 DOI: 10.1016/j.jpain.2012.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/26/2012] [Accepted: 03/01/2012] [Indexed: 11/22/2022]
Abstract
UNLABELLED The aim of this present study was to test the hypothesis that tonic nociceptive stimulation of latent myofascial trigger points (MTPs) may induce a spatially enlarged area of pressure pain hyperalgesia. Painful glutamate (.2 mL, 1M) stimulation of latent MTPs and non-MTPs in the forearm was achieved by an electromyography-guided procedure. Pain intensity (as rated on the visual analog scale [VAS]) and referred pain area following glutamate injections were recorded. Pressure pain threshold (PPT) was measured over 12 points in the forearm muscles and at the mid-point of tibialis anterior muscle before and at .5 hour, 1 hour, and 24 hours after glutamate injections. The results showed that maximal pain intensity, the area under the VAS curve, and referred pain area were significantly higher and larger following glutamate injection into latent MTPs than non-MTPs (all, P < .05). A significantly lower PPT level was detected over time after glutamate injection into latent MTPs at .5 hour (at 4 points), 1 hour (at 7 points), and 24 hours (at 6 points) in the forearm muscles. However, a significantly lower PPT was observed only at 24 hours after glutamate injection into non-MTPs in the forearm muscles (at 4 points, P < .05) when compared to the pre-injection PPT. PPT at the mid-point of the tibialis anterior was significantly decreased at 1 hour only as compared to the pre-injection PPT in both groups (< .05). The results of the present study indicate that nociceptive stimulation of latent MTPs is associated with an early onset of locally enlarged area of mechanical hyperalgesia. PERSPECTIVE This study shows that MTPs are associated with an early occurrence of a locally enlarged area of pressure hyperalgesia associated with spreading central sensitization. Inactivation of MTPs may prevent spatial pain propagation.
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Variation of pain and vasomotor responses evoked by intramuscular infusion of hypertonic saline in human subjects: Influence of gender and its potential neural mechanisms. Brain Res Bull 2012; 87:564-70. [DOI: 10.1016/j.brainresbull.2011.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 10/27/2011] [Accepted: 11/03/2011] [Indexed: 11/20/2022]
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Ge HY, Fernández-de-Las-Peñas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med 2011; 6:13. [PMID: 21439050 PMCID: PMC3070691 DOI: 10.1186/1749-8546-6-13] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/25/2011] [Indexed: 11/10/2022] Open
Abstract
Active myofascial trigger points are one of the major peripheral pain generators for regional and generalized musculoskeletal pain conditions. Myofascial trigger points are also the targets for acupuncture and/or dry needling therapies. Recent evidence in the understanding of the pathophysiology of myofascial trigger points supports The Integrated Hypothesis for the trigger point formation; however unanswered questions remain. Current evidence shows that spontaneous electrical activity at myofascial trigger point originates from the extrafusal motor endplate. The spontaneous electrical activity represents focal muscle fiber contraction and/or muscle cramp potentials depending on trigger point sensitivity. Local pain and tenderness at myofascial trigger points are largely due to nociceptor sensitization with a lesser contribution from non-nociceptor sensitization. Nociceptor and non-nociceptor sensitization at myofascial trigger points may be part of the process of muscle ischemia associated with sustained focal muscle contraction and/or muscle cramps. Referred pain is dependent on the sensitivity of myofascial trigger points. Active myofascial trigger points may play an important role in the transition from localized pain to generalized pain conditions via the enhanced central sensitization, decreased descending inhibition and dysfunctional motor control strategy.
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Affiliation(s)
- Hong-You Ge
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg DK-9220, Denmark.
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Morimoto Y, Kondo Y, Shimosako J, Kozu R, Kataoka H, Sakamoto J, Nakano J, Okita M. Investigation of Pain in Hip Disease Patients before and after Arthroplasty. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Yasutaka Kondo
- Department of Rehabilitation, The Japanese Red Cross Nagasaki Genbaku Hospital
- Department of Physical Therapy Science, Unit of Physical and Occupational Therapy, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Ryo Kozu
- Department of Rehabilitation, Nagasaki University Hospital
| | - Hideki Kataoka
- Department of Rehabilitation, Nagasaki Memorial Hospital
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Junya Sakamoto
- Department of Physical Therapy Science, Unit of Physical and Occupational Therapy, Nagasaki University Graduate School of Biomedical Sciences
| | - Jiro Nakano
- Department of Physical Therapy Science, Unit of Physical and Occupational Therapy, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Okita
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences
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Rubin TK, Henderson LA, Macefield VG. Changes in the Spatiotemporal Expression of Local and Referred Pain Following Repeated Intramuscular Injections of Hypertonic Saline: A Longitudinal Study. THE JOURNAL OF PAIN 2010; 11:737-45. [DOI: 10.1016/j.jpain.2009.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 10/17/2009] [Accepted: 11/09/2009] [Indexed: 11/30/2022]
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Lujan HL, Palani G, Peduzzi JD, DiCarlo SE. Targeted ablation of mesenteric projecting sympathetic neurons reduces the hemodynamic response to pain in conscious, spinal cord-transected rats. Am J Physiol Regul Integr Comp Physiol 2010; 298:R1358-65. [PMID: 20219868 PMCID: PMC2867526 DOI: 10.1152/ajpregu.00755.2009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 03/05/2010] [Indexed: 11/22/2022]
Abstract
Individuals with spinal cord injuries above thoracic level 6 (T(6)) experience episodic bouts of life-threatening hypertension as part of a condition termed autonomic dysreflexia. The paroxysmal hypertension can be caused by a painful stimulus below the level of the injury. Targeted ablation of mesenteric projecting sympathetic neurons may reduce the severity of autonomic dysreflexia by reducing sympathetic activity. Therefore, cholera toxin B subunit (CTB) conjugated to saporin (SAP; a ribosomal inactivating protein that binds to and inactivates ribosomes) was injected into the celiac ganglion to test the hypothesis that targeted ablation of mesenteric projecting sympathetic neurons reduces the pressor response to pain in conscious, spinal cord-transected rats. Nine Sprague-Dawley male rats underwent a spinal cord transection between thoracic vertebrae 4 and 5. Following recovery (5 wk), all rats were instrumented with a radio telemetry device for recording arterial pressure and bilateral catheters in the gluteus maximus muscles for the infusion of hypertonic saline (hNa(+)Cl(-)). Subsequently, the hemodynamic responses to intramuscular injection of hNa(+)Cl(-) (100 microl and 250 microl, in random order) were determined. Following the experiments in the no celiac ganglia injected condition (NGI), rats received injections of CTB-SAP (n = 5) or CTB (n = 3) into the celiac ganglia. CTB-SAP rats, compared with NGI and CTB rats, had reduced pressor responses to hNa(+)Cl(-). Furthermore, the number of stained neurons in the celiac ganglia and spinal cord (segments T(6)-T(12)), was reduced in CTB-SAP rats. Thus, CTB-SAP retrogradely transported from the celiac ganglia is effective at ablating mesenteric projecting sympathetic neurons and reducing the pressor response to pain in spinal cord-transected rats.
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MESH Headings
- Animals
- Autonomic Dysreflexia/etiology
- Autonomic Dysreflexia/physiopathology
- Autonomic Dysreflexia/therapy
- Blood Pressure/drug effects
- Blood Pressure/physiology
- Cholera Toxin/pharmacology
- Consciousness
- Disease Models, Animal
- Ganglia, Spinal/drug effects
- Ganglia, Spinal/physiology
- Ganglia, Sympathetic/drug effects
- Ganglia, Sympathetic/physiopathology
- Heart Rate/drug effects
- Heart Rate/physiology
- Injections, Intramuscular
- Male
- Pain/complications
- Pain/physiopathology
- Rats
- Rats, Sprague-Dawley
- Ribosome Inactivating Proteins, Type 1/pharmacology
- Saline Solution, Hypertonic/pharmacology
- Saporins
- Spinal Cord Injuries/complications
- Spinal Cord Injuries/physiopathology
- Sympathectomy, Chemical
- Thoracic Vertebrae
- Visceral Afferents/drug effects
- Visceral Afferents/physiology
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Affiliation(s)
- Heidi L Lujan
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield Ave., Detroit, MI 48201, USA
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