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Bingölbali Ö, Taşkaya C, Alkan H, Altındağ Ö. The effectiveness of deep tissue massage on pain, trigger point, disability, range of motion and quality of life in individuals with myofascial pain syndrome. Somatosens Mot Res 2024; 41:11-17. [PMID: 36645811 DOI: 10.1080/08990220.2023.2165054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aims to examine the effect of deep tissue massage (DTM) on the myofascial trigger point (MTrP) number, neck range of motion (ROM), pain, disability and quality of life in patients with Myofacial pain syndrome (MPS). METHODS The study involved patients with MPS between the ages of 20-57. The patients were randomly divided into two groups: the control group (n = 40) and the study group (n = 40). Transcutaneous Electrical Neuromuscular Stimulation (TENS), hotpack and ultrasound were applied to 40 patients in the control group. The study group was also administered DTM for 12 sessions in addition to TENS, hotpack and ultrasound applications. Neck pain and disability scale (NPDS) for a neck disability, universal goniometer for neck ROM, MTrP count using manual palpation, Short Form 36 (SF-36) for quality of life and severity of neck pain were evaluated using a visual analog scale (VAS). All patients were evaluated before and after treatment. RESULTS It was found that the DTM group has statistically more improvement than the control group for VAS, NPDS and SF-36. Moreover, although there was a significant improvement in favour of the study group for extension, lateral flexion, right rotation and left rotation in the neck ROM, there was no significant difference in flexion measurements between the study and control group. CONCLUSION In addition to the traditional rehabilitation program, DTM is effective on neck ROM, pain, disability and quality of life. Therefore, DTM treatment is a safe and inexpensive treatment method that can be applied in patients with MPS.
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Affiliation(s)
- Ömer Bingölbali
- Department of Health Care Services, Health Services Vocational School, Muş Alparslan University, Muş, Turkey
| | - Cengiz Taşkaya
- Department of Health Care Services, Health Services Vocational School, Muş Alparslan University, Muş, Turkey
| | - Halil Alkan
- Department of Physiotherapy and Rehabilitation, Muş Alparslan University, Muş, Turkey
| | - Özlem Altındağ
- Department of Physical Medicine and Rehabilitation Gaziantep, Gaziantep University, Gaziantep, Turkey
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Navarro-Ledesma S, Aguilar-García M, González-Muñoz A, Casas-Barragán A, Tapia-Haro RM. Association between elasticity of tissue and pain pressure threshold in the tender points present in subjects with fibromyalgia: a cross-sectional study. Sci Rep 2023; 13:22003. [PMID: 38086996 PMCID: PMC10716166 DOI: 10.1038/s41598-023-49550-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/09/2023] [Indexed: 12/18/2023] Open
Abstract
Fibromyalgia (FM) is a multicomponent illness and despite its worldwide prevalence, a complete understanding of its aetiology and pathogenesis remains unclear. The goal of the study is to analyze the level of association between elastic properties of tissue measured by strain elastography (SEL) and pain pressure threshold (PPT) in the characteristic painful points described in patients suffering from FM. This was a cross-sectional, observational study. A sample comprised of 42 subjects with FM was recruited from a private care centre. The occiput, low cervical, trapezius, supraspinatus, paraspinous, lateral pectoral, second rib, lateral epicondyle, medial epicondyle, gluteus, greater trochanter, knee, and anterior tibial PPTs were bilaterally assessed using a standard pressure algometer and elastic properties of tissue were evaluated by SEL. Linear regression analysis showed significant associations between SEL and dominant trapezius PPT (β = 0.487, 95% CI [0.045, 0.930], p = 0.032) after adjustments for the age, body mass index, and menopause status (higher SEL and higher pain sensitivity). No significant associations between SEL and the other PPTs variables were found in women diagnosed with FM. The PPT of the dominant trapezius is associated with SEL measurements in subjects suffering from FM. More studies are required to fully explain the underlying mechanisms.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | - María Aguilar-García
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
- Biomedicine PhD Program, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, 18071, Granada, Spain
| | - Ana González-Muñoz
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, 18071, Granada, Spain
- Clinica Ana Gonzalez, Malaga, Spain
| | - Antonio Casas-Barragán
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
- Faculty of Health Sciencies, University of Granada (UGR), Ave. de la Ilustración, 60, 18016, Granada, Spain.
| | - Rosa María Tapia-Haro
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Faculty of Health Sciencies, University of Granada (UGR), Ave. de la Ilustración, 60, 18016, Granada, Spain
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Murphy AE, Minhas D, Clauw DJ, Lee YC. Identifying and Managing Nociplastic Pain in Individuals With Rheumatic Diseases: A Narrative Review. Arthritis Care Res (Hoboken) 2023; 75:2215-2222. [PMID: 36785994 PMCID: PMC11210328 DOI: 10.1002/acr.25104] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/15/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
Chronic pain is a burdensome and prevalent symptom in individuals with rheumatic disease. The International Association for the Study of Pain classifies pain into 3 descriptive categories: nociceptive, neuropathic, and nociplastic. These categories are intended to provide information about the mechanisms underlying the pain, which can then serve as targets for drug or non-drug treatments. This review describes the 3 types of pain as they relate to patients seen by rheumatology health care providers. The focus is on identifying individuals with nociplastic pain, which can either occur in isolation as in fibromyalgia, or as a comorbidity in individuals with primary autoimmune conditions, such as rheumatoid arthritis and systemic lupus erythematosus. Practical information about how rheumatology health care providers can approach and manage chronic pain is also provided.
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Affiliation(s)
| | - Deeba Minhas
- University of Michigan Medical School, Ann Arbor
| | | | - Yvonne C Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abstract
Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Many interventional procedures can be performed in both an acute and chronic pain setting to address myofascial pain syndromes. Trigger point injections can be performed with or without imaging guidance such as fluoroscopy and ultrasound; however, the use of imaging in years past has been recommended to improve patient outcome and safety. Injections can be performed using no injectate (dry needling), or can involve the administration of local anesthetics, botulinum toxin, or corticosteroids.
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Tuckey B, Srbely J, Rigney G, Vythilingam M, Shah J. Impaired Lymphatic Drainage and Interstitial Inflammatory Stasis in Chronic Musculoskeletal and Idiopathic Pain Syndromes: Exploring a Novel Mechanism. FRONTIERS IN PAIN RESEARCH 2021; 2:691740. [PMID: 35295453 PMCID: PMC8915610 DOI: 10.3389/fpain.2021.691740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
A normal functioning lymphatic pump mechanism and unimpaired venous drainage are required for the body to remove inflammatory mediators from the extracellular compartment. Impaired vascular perfusion and/or lymphatic drainage may result in the accumulation of inflammatory substances in the interstitium, creating continuous nociceptor activation and related pathophysiological states including central sensitization and neuroinflammation. We hypothesize that following trauma and/or immune responses, inflammatory mediators may become entrapped in the recently discovered interstitial, pre-lymphatic pathways and/or initial lymphatic vessels. The ensuing interstitial inflammatory stasis is a pathophysiological state, created by specific pro-inflammatory cytokine secretion including tumor necrosis factor alpha, interleukin 6, and interleukin 1b. These cytokines can disable the local lymphatic pump mechanism, impair vascular perfusion via sympathetic activation and, following transforming growth factor beta 1 expression, may lead to additional stasis through direct fascial compression of pre-lymphatic pathways. These mechanisms, when combined with other known pathophysiological processes, enable us to describe a persistent feed-forward loop capable of creating and maintaining chronic pain syndromes. The potential for concomitant visceral and/or vascular dysfunction, initiated and maintained by the same feed-forward inflammatory mechanism, is also described.
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Affiliation(s)
- Brian Tuckey
- Department of Physical Therapy, Tuckey and Associates Physical Therapy, Frederick, MD, United States
| | - John Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, ON, Canada
| | - Grant Rigney
- Department of Psychiatry, Oxford University, Oxford, United Kingdom
| | - Meena Vythilingam
- Department of Health and Human Services, Center for Health Innovation, Office of the Assistant Secretary for Health, Washington, DC, United States
| | - Jay Shah
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
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Scarola R, Montemurro N, Ferrara E, Corsalini M, Converti I, Rapone B. Temporomandibular Disorders and Fibromyalgia: A Narrative Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Temporomandibular disorder (TMD) and fibromyalgia (FM) have some clinical characteristics in common, for instance the chronic evolution, the pathophysiology incompletely understood and a multifactorial genesis. The incidence and the relationship between TMD and FM patients are the aims of this review. A MEDLINE and Pubmed search was performed for the key words “temporomandibular disorder” AND “fibromyalgia” from 2000 to present. A total of 19 papers were included in our review, accounting for 5449 patients. Ten studies, reporting a total of 4945 patients with TMD, showed that only 16.5% of these patients had diagnosis of FM, whereas 12 studies, reporting a total of 504 patients with FM, demonstrated that 77.0% of these patients had diagnosis of TMD. A comorbid relationship exists between TMD and FM. The complexity of both diseases shows the importance of a multimodal and interdisciplinary.
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de Souza RCV, de Sousa ET, Scudine KGO, Meira UM, de Oliveira E Silva EM, Gomes ACA, Limeira-Junior FA. Low-level laser therapy and anesthetic infiltration for orofacial pain in patients with fibromyalgia: a randomized clinical trial. Med Oral Patol Oral Cir Bucal 2018; 23:e65-e71. [PMID: 29274162 PMCID: PMC5822542 DOI: 10.4317/medoral.21965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/27/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To compare the analgesic effect of anesthetic infiltration of lidocaine 2% and low-level laser therapy (LLLT) by GaAlAs into tender points of patients with orofacial pain and fibromyalgia (FM). MATERIAL AND METHODS A randomized clinical trial was performed with adults (N=66) that were allocated into two groups (1:1): Group A received LLLT irradiation by Diode Laser GaAlAs (780nm) with expositions twice a week during six weeks and Group B was treated with anesthetic infiltration of lidocaine 2% without vasoconstrictor once a week for four weeks. The pain assessment included the Visual Analogic Scale (VAS) and tenderness to palpation. RESULTS No dropout and adverse effect was observed during the study. The pain decreased significantly in each group after the treatment (p=0.0001, β=1.0), even though no statistical difference was found between both treatments (p=0.46, β= 0.82). The presence of tender points decreased after both treatments, with responsively in some types of masticatory muscles (p<0.05) except posterior temporalis muscle. The patients perception showed that both treatments were effective and a few patients reported that the treatment did not improve welfare. CONCLUSIONS The LLLT by GaAlAs and anesthetic infiltration of lidocaine 2% were equally effective to control orofacial pain in FM individuals.
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Affiliation(s)
- R-C-V de Souza
- 901 Limeira Avenue, Areiao- Piracicaba-SP/Brazil, 13414-903,
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Abstract
OBJECTIVE To determine the feasibility of a detailed pain sensitivity assessment using body-wide musculoskeletal tender points (TPs) in women with different types of chronic pelvic pain (CPP) and compare phenotypic differences. MATERIALS AND METHODS Seventy women with CPP and 35 pain-free women underwent musculoskeletal evaluation of TPs in the pelvic floor, abdomen, groin, inner thigh, and all 18 fibromyalgia TPs. Patients scored elicited pain on a numeric rating scale. TP pain scores were used for intergroup comparison and intragroup correlation. RESULTS Women with CPP were grouped as having either bladder pain syndrome (BPS, n=24) or myofascial pelvic pain (MPP, n=11) singularly or both concomitantly (BPS+MPP, n=35). TP pain scores for all evaluations were higher in women with CPP compared with healthy women (P<0.001). Women with BPS+MPP had elevated TP pain for each evaluation compared with women with BPS alone. Pelvic floor and fibromyalgia TP scores correlated strongly in the MPP group, moderately in the BPS+MPP group, and weakly in the BPS alone group. Although some moderate and strong correlations between different body locations were present in all 3 groups, only the BPS+MPP group showed moderate to strong correlations between all body TPs. CONCLUSIONS Detailed musculoskeletal evaluation of women with CPP is feasible and well tolerated. Careful phenotyping differentiated BPS, MPP, and BPS+MPP groups. Attending to the differences between these groups clinically may lead to more effective treatment strategies and improved outcomes for patients with CPP.
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Muro-Culebras A, Cuesta-Vargas AI. Sono-myography and sono-myoelastography of the tender points of women with fibromyalgia. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1951-1957. [PMID: 23932269 DOI: 10.1016/j.ultrasmedbio.2013.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 04/24/2013] [Accepted: 05/09/2013] [Indexed: 06/02/2023]
Abstract
Sono-myography and sono-myoelastography have been found useful in the investigation of myofascial trigger points. The objective of this study was to use the same techniques to investigate the morphology, stiffness and blood flow of tender points in women with fibromyalgia and to compare the results with those for samples from healthy patients. Algometry tests indicated significant differences between groups (p < 0.001). Elliptical and hypoechoic areas were observed in the ultrasound images of the upper trapezius in both groups. No differences between groups were found in the number of hypoechoic areas (p = 0.167, t = 1.008); blood flow also did not differ between the groups. Larger hypoechoic areas were found in the fibromyalgia group (p = 0.139, t = 1.317). Sono-myoelastography did not reveal greater stiffness in these areas compared with the rest of the muscle. These results lead us to believe that sono-myoelastography and sono-myography, used in the diagnosis of myofascial trigger points, may not be able to discriminate tender points.
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10
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Lewis C, Sterling M, Souvlis T. Digitally tender points: their significance in physiotherapy. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x252109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Desai MJ, Shkolnikova T, Nava A, Inwald D. A critical appraisal of the evidence for botulinum toxin type A in the treatment for cervico-thoracic myofascial pain syndrome. Pain Pract 2013; 14:185-95. [PMID: 23692187 DOI: 10.1111/papr.12074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/12/2013] [Indexed: 11/28/2022]
Abstract
Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence-based medicine to the treatment for cervico-thoracic MPS. A search was conducted through MEDLINE (PubMed, OVID, MDConsult), EMBASE, SCOPUS and the Cochrane database for the period 1966 to 2012 using the following keywords: myofascial pain, muscle pain, botulinum toxin, trigger points, and injections. A total of 7 trials satisfied our inclusion criteria and were evaluated in this review. Although the majority of studies found negative results, our analysis identified Gobel et al.'s as the highest quality study among these prospectively randomized investigations. This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality.
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Affiliation(s)
- Mehul J Desai
- The George Washington University Spine & Pain Center, Washington, District of Columbia, U.S.A
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Myofasziale Triggerpunkte. MANUELLE MEDIZIN 2013. [DOI: 10.1007/s00337-013-1019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bennett RM, Goldenberg DL. Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping? Arthritis Res Ther 2011; 13:117. [PMID: 21722339 PMCID: PMC3218900 DOI: 10.1186/ar3357] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Myofascial trigger points (MTPs) have long been a contentious issue in relation to fibromyalgia, and poorly defined pain complaints in general. Can MTPs be reproducibly identified? Do MTPs have valid objective findings, such as spontaneous electromyographic activity, muscle microdialysis evidence for an inflammatory milieu or visualization with newer ultrasound techniques? Is fibromyalgia a syndrome of multiple MTPs, or is focal muscle tenderness a manifestation of central sensitization? These issues are discussed with relevance to a recent paper reporting that manual palpation of active MTPs elicits the spontaneous pain experienced by fibromyalgia patients.
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Hains G, Descarreaux M, Hains F. Chronic shoulder pain of myofascial origin: a randomized clinical trial using ischemic compression therapy. J Manipulative Physiol Ther 2010; 33:362-9. [PMID: 20605555 DOI: 10.1016/j.jmpt.2010.05.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 11/27/2009] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this clinical trial was to evaluate the effect of 15 myofascial therapy treatments using ischemic compression on shoulder trigger points in patients with chronic shoulder pain. METHODS Forty-one patients received 15 experimental treatments, which consisted of ischemic compressions on trigger points located in the supraspinatus muscle, the infraspinatus muscle, the deltoid muscle, and the biceps tendon. Eighteen patients received the control treatment involving 15 ischemic compression treatments of trigger points located in cervical and upper thoracic areas. Of the 18 patients forming the control group, 16 went on to receive 15 experimental treatments after having received their initial control treatments. Outcome measures included a validated 13-question questionnaire measuring shoulder pain and functional impairment. A second questionnaire was used to assess patients' perceived amelioration, using a scale from 0% to 100%. Outcome measure evaluation was completed for both groups at baseline after 15 treatments, 30 days after the last treatment, and finally for the experimental group only, 6 months later. RESULTS A significant group x time interval interaction was observed after the first 15 treatments, indicating that the experimental group had a significant reduction in their Shoulder Pain and Disability Index (SPADI) score compared with the control group (62% vs 18% amelioration). Moreover, the patients perceived percentages of amelioration were higher in the experimental group after 15 treatments (75% vs 29%). Finally, the control group subjects significantly reduced their SPADI scores after crossover (55%). CONCLUSION The results of this study suggest that myofascial therapy using ischemic compression on shoulder trigger points may reduce the symptoms of patients experiencing chronic shoulder pain.
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Affiliation(s)
- Guy Hains
- Private practice, Trois-Rivières, Côte Richelieu, Trois-Rivières, Québec, Canada.
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Bracco P, Debernardi C, Piancino MG, Cirigliano MF, Salvetti G, Bazzichi L, De Feo F, Bosco M. Evaluation of the stomatognathic system in patients with rheumatoid arthritis according to the research diagnostic criteria for temporomandibular disorders. Cranio 2010; 28:181-6. [PMID: 20806736 DOI: 10.1179/crn.2010.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to investigate the clinical features of stomatognathic dysfunction in patients with rheumatoid arthritis (RA). The study sample consisted of 40 patients with RA (34 female, 6 male), mean age 44 years, recruited at the Rheumatology Division of the Department of Internal Medicine, University of Pisa, Italy. The inclusion criteria were diagnosis of RA according to the criteria of the American Rheumatism Association (ARA). In the study, 82.5% (n=33) of patients affected by RA satisfied at least the criteria of one diagnosis of temporomandibular disorders (TMD), according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The results are in agreement with the literature and the prevalence of such involvement ranges between 53% and 94% of patients. Several studies reported an involvement of the stomatognathic system in RA. In fact, RA can affect the temporomandibular joint as much as any other synovial joint. A more thorough analysis is required for a multidisciplinary approach to gnathological patients, including assessment by a rheumatologist. This issue and its epidemiologic relevance need further scientific research. Dentistry has a fundamental role in this process since patients who present with a systemic disease such as RA can be recognized and intercepted and referred to medical specialists, i.e., rheumatologists, to provide a diagnosis and therapy.
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Affiliation(s)
- Pietro Bracco
- Dept. of Orthodontics and Gnathology, Dental School, University of Turin, Via Nizza 230, 10126 Torino, Italy.
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Hains G, Hains F. Patellofemoral pain syndrome managed by ischemic compression to the trigger points located in the peri-patellar and retro-patellar areas: A randomized clinical trial. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.clch.2010.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tender Point Injections Are Beneficial in Fibromyalgia Syndrome: A Descriptive, Open Study. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v08n04_03] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Comorbidity of fibromyalgia and cervical myofascial pain syndrome. Clin Rheumatol 2010; 29:405-11. [DOI: 10.1007/s10067-009-1342-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 12/08/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
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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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Scott NA, Guo B, Barton PM, Gerwin RD. Trigger Point Injections for Chronic Non-Malignant Musculoskeletal Pain: A Systematic Review. PAIN MEDICINE 2009; 10:54-69. [DOI: 10.1111/j.1526-4637.2008.00526.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT
Objective. This systematic review assessed the available published evidence on the efficacy and safety of using trigger point injection (TPI) to treat patients with chronic non-malignant musculoskeletal pain that had persisted for at least 3 months.
Methods. All published systematic reviews or randomized controlled trials detailing the use of TPI in patients with chronic, non-malignant musculoskeletal pain (persisting for >3 months) were identified by systematically searching literature databases and the Websites of various health technology assessment agencies, research registers, and guidelines sites up to July 2006.
Results. Although no systematic reviews were identified, 15 peer-reviewed randomized controlled trials met the inclusion criteria. However, deficiencies in reporting, small sample sizes, and marked inter-study heterogeneity precluded a definitive synthesis of the data. TPI is a safe procedure when used by clinicians with appropriate expertise and training. It relieved symptoms when used as a sole treatment for patients with chronic head, neck, shoulder, and back pain or whiplash syndrome, regardless of the injectant used, and may be a useful adjunct to intra-articular injection in the treatment of osteoarthritis pain. Although the addition of TPI to stretching exercises augments treatment outcomes, this was also true of other therapies such as ultrasound and laser.
Conclusion. The efficacy of TPI is no more certain than it was a decade ago as, overall, there is no clear evidence of either benefit or ineffectiveness. The only advantage of injecting anesthetic into trigger points may be to reduce the pain of the needling process, which may not be an insignificant benefit.
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Affiliation(s)
| | - Bing Guo
- Institute of Health Economics, Edmonton
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Perreault A, Kelln B, Hertel J, Pugh K, Saliba S. Short-Term Effects of Strain Counterstrain in Reducing Pain in Upper Trapezius Tender PointsA Pilot Study. ACTA ACUST UNITED AC 2009. [DOI: 10.3928/19425864-20090826-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Sinha D, Thomson AJ. Botulinum toxin for pelvic pain in women. WOMEN'S HEALTH (LONDON, ENGLAND) 2008; 4:173-81. [PMID: 19072519 DOI: 10.2217/17455057.4.2.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic pain is a common disorder in women, causing significant morbidity. Often the etiology is not clear as it results from a complex interaction between neurologic, musculoskeletal and endocrine systems that is further influenced by behavioral and psychological factors. A comprehensive approach to the problem requires recognition of the multiple organ systems that may be involved. A thorough history and physical examination, followed by selected laboratory and imaging studies, is essential in evaluation of these patients. Medical and surgical management improves or controls the symptoms in the majority of cases, but there remains a group of women who are difficult to treat. Botulinum toxin is a presynaptic neuromuscular blocking agent inducing selective and reversible muscle weakness that lasts several months when injected intramuscularly. It has been shown to be effective in treating pain caused by muscular spasm in conditions other than pelvic pain caused by muscular hypertonicity. Evidence or literature related to treatment of pelvic pain with botulinum toxin is discussed in this review.
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Affiliation(s)
- Deepali Sinha
- Worcestershire Royal Hospital, Charles Hastings Way, Worcester WR51DD, UK.
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Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2008; 13:3-10. [PMID: 18395479 DOI: 10.1016/j.ejpain.2008.02.006] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 01/17/2008] [Accepted: 02/19/2008] [Indexed: 12/15/2022]
Abstract
Pain from myofascial trigger points is often treated by needling, with or without injection, although evidence is inconclusive on whether this is effective. We aimed to review the current evidence on needling without injection, by conducting a systematic literature review. We searched electronic databases to identify relevant randomised controlled trials, and included studies where at least one group were treated by needling directly into the myofascial trigger points, and where the control was either no treatment, or usual care; indirect local dry needling or some form of placebo intervention. We extracted data on pain, using VAS scores as the standard. Seven studies were included. One study concluded that direct dry needling was superior to no intervention. Two studies, comparing direct dry needling to needling elsewhere in the muscle, produced contradictory results. Four studies used a placebo control and were included in a meta-analysis. Combining these studies (n=134), needling was not found to be significantly superior to placebo (standardised mean difference, 14.9 [95%CI, -5.81 to 33.99]), however marked statistical heterogeneity was present (I(2)=88%). In conclusion, there is limited evidence deriving from one study that deep needling directly into myofascial trigger points has an overall treatment effect when compared with standardised care. Whilst the result of the meta-analysis of needling compared with placebo controls does not attain statistically significant, the overall direction could be compatible with a treatment effect of dry needling on myofascial trigger point pain. However, the limited sample size and poor quality of these studies highlights and supports the need for large scale, good quality placebo controlled trials in this area.
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Affiliation(s)
- Elizabeth A Tough
- Primary Care, Peninsula Medical School, Universities of Exeter and Plymouth, ITTC Building, Tamar Science Park, Plymouth PL6 8BX, UK.
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Buchmann J, Blümel G, Beyer L. Objektivierbare apparative Messung der Gewebespannung mittels Tissue Tensiometer (TTM). MANUELLE MEDIZIN 2007. [DOI: 10.1007/s00337-007-0504-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maquet D, Demoulin C, Croisier JL, Crielaard JM. Benefits of physical training in fibromyalgia and related syndromes. ACTA ACUST UNITED AC 2007; 50:363-8, 356-62. [PMID: 17467103 DOI: 10.1016/j.annrmp.2007.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 03/20/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the published information on physical training for fibromyalgia (FM) and related syndromes. METHODS A search of Medline literature (via Ovid and PubMed) with the following keywords: FM, chronic fatigue syndrome, therapy, rehabilitation, aerobic, exercise, and cognitive behavioral therapy. The reference lists of articles were examined for additional related articles. RESULTS Several studies investigated the benefits of graded exercise therapy for patients with FM or related syndromes. Although some systematic reviews have not established an unequivocal benefit of physical training, most authors report a benefit for patients with chronic pain or fatigue. Ideally, such a therapy should be a part of multidisciplinary program. Muscular rehabilitation is reserved for preventing the deconditioning syndrome often reported in patients and the vicious cycle of pain, avoidance and inactivity behaviors, or even kinesiophobia, deconditioning, incapacity and psychological distress. CONCLUSION This review emphasizes the relevance of graded physical training for treating FM and related syndromes. The development of rehabilitation centers, with experts able to propose a relevant therapy to patients with chronic pain or fatigue, should help alleviate this public health problem.
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Affiliation(s)
- D Maquet
- Department of Motricity Sciences, University of Liege, ISEPK, B21, allée des sports 4, 4000 Liege, Belgium.
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Maquet D, Demoulin C, Croisier JL, Crielaard JM. Intérêts du réentraînement à l'effort dans la fibromyalgie et autres syndromes apparentés. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Salvetti G, Manfredini D, Bazzichi L, Bosco M. Clinical features of the stomatognathic involvement in fibromyalgia syndrome: a comparison with temporomandibular disorders patients. Cranio 2007; 25:127-33. [PMID: 17508633 DOI: 10.1179/crn.2007.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Several studies have reported an involvement of the stomatognathic system in the course of fibromyalgia (FM) similar to that which characterizes temporomandibular disorders (TMD). The aim of this study was to investigate and compare the clinical features of stomatognathic dysfunction in patients with FM and TMD. Ninety-three FM patients underwent an assessment according to the RDC/TMD guidelines. Prevalence of the different RDC/TMD diagnoses and some clinical parameters of FM patients were compared with those of 181 patients affected by TMD. Seventy-four (79.6%) FM patients presented at least one RDC/TMD diagnosis and showed lower mean maximum voluntary and passive mouth opening values than TMD patients. Moreover, 34 FM patients presented with trigger and/or tender points. Results of the present study confirm the high rate of involvement of the stomatognathic system in the course of FM and support the need for a careful multidisciplinary approach to patients with TMD, including the rheumatologist.
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Affiliation(s)
- Giovanni Salvetti
- Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy.
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García-Leiva JM, Hidalgo J, Rico-Villademoros F, Moreno V, Calandre EP. Effectiveness of ropivacaine trigger points inactivation in the prophylactic management of patients with severe migraine. PAIN MEDICINE 2007; 8:65-70. [PMID: 17244105 DOI: 10.1111/j.1526-4637.2007.00251.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Tenderness and referred pain have been described in migraine and involved in its pathogenesis. The present study was performed to evaluate the prophylactic effectiveness of ropivacaine injections during a 12-week period. INTERVENTIONS A total of 52 patients agreed to participate in the study. Trigger points were explored by manual palpation and injected weekly with 10 mg ropivacaine. The frequencies of migraine attacks were recorded from 4 weeks before the beginning of injections until 4 weeks after the last one, and a Clinical Global Impression improvement scale was completed in the final visit. RESULTS All of the subjects had one or more trigger points, located in temporal and/or suboccipital areas in most of the cases. In nine (17.3%) patients the frequency of attacks was reduced >or=50%, and in 19 (36.5%) cases the reduction was comprised between 11% and 49%. A total of 31 (59.6%) patients reported to be much or very much improved after finishing the injection period. In 11 cases rescue medication intake was reduced >or=50% in comparison with baseline period, and the attacks of severe intensity decreased significantly. Eight (26.6%) out of 30 patients suffering chronic migraine reverted to episodic migraine. Local pain in injection sites was reported by 14 patients, and 13 subjects (25.5%) experienced postinjection soreness. CONCLUSIONS Trigger points inactivation can be an effective palliative measure in the prophylactic management of severe refractory migraine.
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Abstract
This article summarizes the evidence for two major clinical syndromes of muscle pain: fibromyalgia and myofascial pain syndrome. The evidence for diagnostic and treatment approaches is reviewed.
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Affiliation(s)
- Harden R Norman
- Center for Pain Studies, Rehabilitation Institute of Chicago, 446 E. Ontario St, Suite 1011, Chicago, IL 60611, USA
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Tough EA, White AR, Richards S, Campbell J. Variability of Criteria Used to Diagnose Myofascial Trigger Point Pain Syndrome—Evidence From a Review of the Literature. Clin J Pain 2007; 23:278-86. [PMID: 17314589 DOI: 10.1097/ajp.0b013e31802fda7c] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the literature review was to investigate the criteria adopted by "experts" to diagnose myofascial trigger point (MTrP) pain syndrome. Experts were defined as being either researchers investigating MTrP pain syndrome or the "authority" the researchers cited as a source of reference for MTrP pain syndrome diagnosis. METHODS We searched electronic databases to identify relevant empirical research (excluding studies not in English and those relating to dental pathology). Of 607 possibly relevant publications 93 met our inclusion criteria. We recorded (1) the individual criterion and criteria combinations used to diagnose MTrP pain syndrome; (2) the cited "authoritative" publications and (3) the criteria recommended by the authoritative publications as being essential for MTrP pain syndrome diagnosis. RESULTS The review identified 19 different diagnostic criteria. The 4 most commonly applied criteria were: "tender spot in a taut band" of skeletal muscle, "patient pain recognition," "predicted pain referral pattern," and "local twitch response." There was no consistent pattern to the choice of specific diagnostic criteria or their combinations. However, one pair of criteria "tender point in a taut band" and "predicted or recognized pain referral" were used by over half the studies. The great majority of studies cited publications by Travell and more recently Simons as a principal authoritative source for MTrP pain syndrome diagnosis, yet most of these studies failed to apply the diagnostic criteria as described by these authorities. DISCUSSION We conclude that there is as yet limited consensus on case definition in respect of MTrP pain syndrome. Further research is needed to test the reliability and validity of diagnostic criteria. Until reliable diagnostic criteria have been established, there is a need for greater transparency in research papers on how a case of MTrP pain syndrome is defined, and claims for effective interventions in treating the condition should be viewed with caution.
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Calandre EP, Hidalgo J, García-Leiva JM, Rico-Villademoros F. Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition? Eur J Neurol 2006; 13:244-9. [PMID: 16618340 DOI: 10.1111/j.1468-1331.2006.01181.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although migraine is a neurovascular disorder, both scalp tenderness and referred pain have been observed in migraine patients. The present study was carried out to investigate the presence of trigger points eliciting referred pain in 98 migraine patients and in 32 healthy subjects. Trigger points were found in 92 (93.9%) migraineurs and in nine (29%) controls (P < 0.0001). The number of individual migraine trigger points varied from zero to 14 (modal number: 4), and was found to be related to both the frequency of migraine attacks (P < 0.0001), and the duration of the disease (P = 0.017). About 74% of the total detected trigger points were found in temporal and/or suboccipital areas; other locations were mainly found in patients showing more than four trigger points. Trigger point palpation provoked a migraine attack in 30 (30.6%) patients. Pericraneal allodynia was found in 15 (15.3%) patients. These data indicate that nociceptive peripheral sensitization is a usual finding in migraine, and that central sensitization can develop in patients with frequent attacks and long-lasting disease. Trigger points' detection in migraine patients could be useful when applying therapies like acupuncture, needling or botulinum toxin injections directed to reduce peripheral sensitization.
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Affiliation(s)
- E P Calandre
- Instituto de Neurociencias, Universidad de Granada, Granada, Spain.
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Facco E, Ceccherelli F. Myofascial pain mimicking radicular syndromes. ACTA NEUROCHIRURGICA. SUPPLEMENT 2005; 92:147-50. [PMID: 15830988 DOI: 10.1007/3-211-27458-8_32] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Myofascial pain is very often underscored and misunderstood in clinical practice. In many cases the localization of myofascial pain may resemble other diseases, such as radicular syndromes (e.g., low back pain from herniated disc) and even diseases of internal organs (e.g., angina pectoris, bowel diseases or gynaecological disturbances). In pain clinics one can routinely see patients with myofascial painful disorders showing a radicular topography and normal CT and MRI: as a consequence, when vertebral abnormalities are present on CT or MRI, it should be checked whether the cause of pain is radicular, myofascial, or both. On the other hand, the conventional approach to painful disorders may lead to errors and wrong diagnosis, depending on several factors: a) pain is often considered a symptom of an organic disease; b) the diagnosis is usually directed towards the structural cause of pain only; c) the functional components of the suffering patient are underscored; d) the site of pain may introduce some bias. When the latter is concerned, it is usually admitted that a neck pain may depend on muscle contraction (e.g. torticollis), while such a cause is less commonly admitted for leg, where the attention is first directed towards the sciatic nerve; myofascial origin of pain is even less considered in abdominal or pelvic painful disorders, where patients with no structural detectable diseases are often considered as neurotic and referred to the psychiatrist. The reason for this topographical dependence of diagnosis lies in the conventional attitude to focus on the most relevant and frequent organic diseases, thus introducing a bias with relevant epistemological implications.
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Affiliation(s)
- E Facco
- Department of Pharmacology and Anesthesiology, University of Padua, Padua, Italy.
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35
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Shin HD, Yoon KB, Yoon DM, Kim WO, Lee YK, Kim WJ, Kim SH. The Effect of Acupotomy in Trapezius Myofascial Pain Syndrome. Korean J Pain 2004. [DOI: 10.3344/jkps.2004.17.2.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyun Dong Shin
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Mi Yoon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Oak Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Kyung Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ju Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Affiliation(s)
- Jae Chol Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea
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Abstract
Myofascial pain syndrome (MPS) and fibromyalgia (FM) are complex conditions and pose significant challenges to clinicians and patients. This chapter explores available treatments for MPS and FM in the context of pathophysiology, clinical evidence, and experimental support. This information may prove to be helpful in designing individualized treatment for patients with these complex syndromes. New treatments should be critically and carefully evaluated as they appear.
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Affiliation(s)
- Nathan J Rudin
- Department of Orthopedics and Rehabilitation, University of Wisconsin Medical School, 5249 East Terrace Drive, Mail Code 9950, Madison, WI 53718-8339, USA.
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Abstract
UNLABELLED Chronic pelvic pain affects upward of 15% of women and is a frustrating condition for both patients and physicians. Chronic pelvic pain is not a disease, but a syndrome that results from a complex interaction between neurologic, musculoskeletal, and endocrine systems that is further influenced by behavioral and psychologic factors. Traditional approaches to this disorder have been surgical, although long-term success rates have been disappointing. Placebo response to surgery is common, and many conditions that contribute to the pain cannot be identified or treated with a surgical approach. Many patients will require a combination of both pharmacologic and nonpharmacologic treatments in addition to various types of invasive procedures. It is now recognized that many disorders contribute to the chronic pelvic pain symptom complex; thus, an integrated multidisciplinary approach to diagnosis and treatment is essential to achieve the greatest success. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader will be able to describe the pathophysiology of chronic pelvic pain, to outline the evaluation of a patient with chronic pelvic pain, and to explain the treatment options for patients with chronic pelvic pain.
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Affiliation(s)
- Jennifer Gunter
- Department of Obstetrics and Gynecology, The University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, Colorado 80262, USA.
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39
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Comment on, Pain elicited by blunt pressure: neurobiological basis and clinical relevance. Treede et al., (Pain 98 (2002) 235). Pain 2003. [DOI: 10.1016/s0304-3959(03)00162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Meyer HP. Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome. Curr Pain Headache Rep 2002; 6:274-83. [PMID: 12095462 DOI: 10.1007/s11916-002-0048-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myofascial pain syndrome is a chronic muscle pain disorder in one or more muscles or groups of muscles accompanied by local and referred pain, decreased range of motion, weakness, and often autonomic phenomena. Patients are readily recognized by their history of muscle pain and the presence of myofascial trigger points, which are specific areas of hyperirritability in a muscle that cause local and referred pain on palpation. Failure to recognize MPS often leads to over-investigation, unnecessary medical intervention, and iatrogenic harm with serious cost implications. The purpose of this review is to present clinically relevant data regarding myofascial pain syndrome and to discuss its possible role in the pathophysiology and optimal treatment of fibromyalgia syndrome.
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Affiliation(s)
- Helgard P Meyer
- University of Pretoria, Private Bag X 396, Pretoria 0001, South Africa.
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Abstract
Despite disappointing results when subjected to randomized clinical trials, pharmacologic agents remain an important component of FM management. Addressing the main symptoms of pain, disturbed sleep, mood disturbances, fatigue, and associated conditions is essential to improve patient functioning and enhanced quality of life. However, much work remains to design clinical trials which address the complexity of FM, while satisfying evidence based medicine paradigms.
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Affiliation(s)
- André Barkhuizen
- Department of Medicine, Oregon Health and Science University, Portland VA Medical Center, Portland, OR, USA.
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42
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Royal MA. The Use of Botulinum Toxins in the Management of Pain and Headache. Pain Pract 2001. [DOI: 10.1111/j.1533-2500.2001.01024.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- M A Royal
- Pain Evaluation and Treatment, 5801 East 41st, #1000, Tulsa, OK 74135-5618, USA
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Abstract
Fibromyalgia is a chronic syndrome characterized by widespread pain, unrefreshed sleep, disturbed mood, and fatigue. Until such time as we have a clearer understanding of the trigger and/or pathophysiologic mechanisms producing these symptoms, pharmacologic treatment should be aimed at individual symptoms. Such treatment should ideally be offered as part of a multidisciplinary treatment program using both pharmacologic and nonpharmacologic treatment modalities. Critical components of any successful fibromyalgia treatment program include addressing physical fitness, work and other functional activities, and mental health, in addition to symptom-specific therapies. The main symptoms that should be addressed include pain, sleep disturbances including restless leg syndrome, mood disturbances, and fatigue. Pharmacologic therapy should also be considered for syndromes commonly associated with fibromyalgia including irritable bowel syndrome, interstitial cystitis, migraine headaches, temporomandibular joint dysfunction, dysequilibrium including neurally mediated hypotension, sicca syndrome, and growth hormone deficiency. This article provides general guidelines in initiating a successful pharmacologic treatment program for fibromyalgia.
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Affiliation(s)
- A Barkhuizen
- Department of Medicine (L329A), Oregon Health Sciences University and Portland VA Medical Center, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA
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Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 2001; 82:986-92. [PMID: 11441390 DOI: 10.1053/apmr.2001.24023] [Citation(s) in RCA: 251] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To establish whether there is evidence for or against the efficacy of needling as a treatment approach for myofascial trigger point pain. DATA SOURCES PubMed, Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, AMED, and CISCOM databases, searched from inception to July 999. STUDY SELECTION Randomized, controlled trials in which some form of needling therapy was used to treat myofascial pain. DATA EXTRACTION Two reviewers independently extracted data concerning trial methods, quality, and outcomes. DATA SYNTHESIS Twenty-three papers were included. No trials were of sufficient quality or design to test the efficacy of any needling technique beyond placebo in the treatment of myofascial pain. Eight of the 10 trials comparing injection of different substances and all 7 higher quality trials found that the effect was independent of the injected substance. All 3 trials that compared dry needling with injection found no difference in effect. CONCLUSIONS Direct needling of myofascial trigger points appears to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor refuted by the evidence from clinical trials. Any effect of these therapies is likely because of the needle or placebo rather than the injection of either saline or active drug. Controlled trials are needed to investigate whether needling has an effect beyond placebo on myofascial trigger point pain.
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Affiliation(s)
- T M Cummings
- British Medical Acupuncture Society, London, England.
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Raphael KG, Marbach JJ. Comorbid fibromyalgia accounts for reduced fecundity in women with myofascial face pain. Clin J Pain 2000; 16:29-36. [PMID: 10741816 DOI: 10.1097/00002508-200003000-00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined factors related to reduced fecundity among women with myofascial face pain (MFP) arising from hypotheses concerning the role of neurohormonal factors in MFP and associated conditions. DESIGN Fecundity rates among 162 MFP cases and 173 demographically equivalent acquaintance female controls were compared. OUTCOME MEASURES Fecundity indicators and factors underlying differential fecundity rates were investigated. RESULTS It was determined that female cases with MFP had significantly fewer children and were more likely to have never been pregnant. Although women with MFP were more likely than controls to indicate that volitional factors related to their health discouraged them from any or additional pregnancies, these factors did not account for lower rates of fecundity. MFP cases also did not differ from controls on self-reported indicators of infertility. Moreover, we show that reduced fecundity was restricted to the subgroup of MFP cases who reported a history of fibromyalgia. CONCLUSIONS Reduced fecundity in women with MFP is restricted to those who self-report a history of fibromyalgia. Possible mechanisms for reduced fecundity in fibromyalgia are discussed. These findings highlight the need to screen for widespread pain among women with regional myofascial pain syndromes.
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Affiliation(s)
- K G Raphael
- Department of Psychiatry, New Jersey Medical School, and School of Oral Biology, Pathology, and Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark 07107, USA.
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Block SR. On the nature of rheumatism. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1999; 12:129-38. [PMID: 10513501 DOI: 10.1002/1529-0131(199904)12:2<129::aid-art8>3.0.co;2-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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49
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Abstract
Despite significant efforts devoted to understanding the etiopathogenesis of fibromyalgia, its treatment still presents a challenge to practicing clinicians, who must recognize the disorder and quantify the different symptoms in order to treat it. This article discusses recent research to identify sensitive and reliable measures for determining response to treatment among patients with FM, and the elements of therapeutic programs (pharmacologic and nonpharmacologic) for patients with FM along with the empirical or theoretical basis for their use. Future directions, including the need for systematic, controlled outcome studies of therapies and evaluation of variables which may mediate the effects of treatment, as well as demonstration that the effects produced in outcome studies generalize to settings beyond those in which the studies are initially conducted, are also discussed.
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Affiliation(s)
- G S Alarcón
- Division of Clinical Immunology and Rheumatology and the Multipurpose Arthritis and Musculoskeletal Diseases Center, The University of Alabama at Birmingham, 35294, USA.
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