July 2013 References for Research Update  Devin J. Starlanyl   for http://www.sover.net/~devstar

Ablin JN, Buskila D. 2013. Fibromyalgia syndrome – novel therapeutic targets. Maturitas [June 3 Epub ahead of print].  “Fibromyalgia is a syndrome characterized by the presence of chronic widespread pain, representing sensitization of the central nervous system. The pathophysiology of fibromyalgia is complex and remains in evolution, encompassing diverse issues such as disturbed patterns of sleep, altered processing and decreased conditioned pain modulation at the spinal level, as well as increased connectivity between various pain-processing areas of the brain. This evolution is continuously uncovering potential novel therapeutic targets. Treatment of fibromyalgia is a multi-faceted endeavor, inevitably combining pharmacological as well as non-pharmacological approaches. Certain specific ligands and selective nor-epinephrine-serotonin reuptake inhibitors are the current mainstays of pharmacological treatment. Novel reuptake inhibitors targeting both nor-epinephrine and dopamine are potential additions to this armamentarium as are substance P antagonists. Opioid antagonism is another intriguing possibility. Cannabinoid agonists hold promise in the treatment of fibromyalgia although current evidence is incomplete. Sodium Oxybate is a unique sleep-promoting medication while drugs that promote arousals such as modafilnil are also under investigation. In the current review, current and emerging therapeutic options for the syndrome of fibromyalgia are covered.”

Akdogan S, Ayhan Ff, Yildirim S et al. 2013. Impact of fatigue on cognitive functioning among premenopausal women with fibromyalgia syndrome and rheumatoid arthritis. J Musculoskel Pain 21(2):135-146. Women with fibromyalgia, rheumatoid arthritis, and healthy controls were compared for fatigue and cognitive impairment. “After adjustment for age, education level and possible related factors...test data were found to correlate with pain, fatigue, anxiety, depression, dizziness, forgetfulness and sleeplessness.... Fatigue was the predictor of attentional impairment....”

Ban R, Matsuo K, Ban M et al. 2013. Eyebrow ptosis after blowout fracture indicates impairment of trigeminal proprioceptive evocation that induces reflex contraction of the frontalis muscle. Eplasty. 13:e33. “Objective: The mixed levator and frontalis muscles lack the interior muscle spindles normally required to induce involuntary contraction of their slow-twitch fibers. To involuntarily move the eyelid and eyebrow, voluntary contraction of the levator nonskeletal fast-twitch muscle fibers stretches the mechanoreceptors in Muller's muscle to evoke trigeminal proprioception, which then induces reflex contraction of the levator and frontalis skeletal slow-twitch muscle fibers. The trigeminal proprioceptive nerve has a long intraorbital course from the mechanoreceptors in Müller's muscle to the superior orbital fissure. Since external force to the globe may cause impairment of trigeminal proprioceptive evocation, we confirmed how unilateral blowout fracture due to a hydraulic mechanism affects ipsilateral eyebrow movement as compared with unilateral zygomatic fracture. Methods: In 16 unilateral blowout fracture patients, eyebrow heights were measured on noninjured and injured sides in primary and 60° upward gaze and statistically compared. Eyebrow heights were also measured in primary gaze in 24 unilateral zygomatic fracture patients and statistically compared. Results: In the blowout fracture patients, eyebrow heights on the injured side were significantly smaller than on the noninjured side in both gaze. In the zygomatic fracture patients, eyebrow heights on the injured side were significantly larger than on the noninjured side in primary gaze. Conclusion: Since 60° upward gaze did not recover the eyebrow ptosis observed in primary gaze in blowout fracture patients, such ptosis indicated impairment of trigeminal proprioceptive evocation and the presence of a hydraulic mechanism that may require ophthalmic examination.”  [Although this study did not mention the presence of trigger points, their involvement is intuitively obvious to the trained reader.  Trauma can cause TrPs, and TrPs can cause proprioceptive dysfunction, droopy and/or asymmetrical eyelids.  We need more clinical and research physicians and other health care who are trained in trigger point diagnosis and treatment. DJS]

Bhatti MI, Hollingworth P, Leach P. 2013. Significant improvement of fibromyalgia symptoms after excision of large meningioma – a case report. Br J Neurosurg. [June 14 Epub ahead of print]. “We report a very unusual case of a 42-year-old patient with confirmed fibromyalgia and juvenile onset arthritis whose symptoms dramatically improved after surgical excision of a large, dominant hemisphere, parafalcine meningioma.”

Bodes-Pardo G, Pecos-Martin D, Gallego-Izquierdo T et al. 2013. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. J Manipulative Physiol Ther. [July 8 Epub ahead of print].  Twenty patients. “The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective  for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors, PPT (pressure-pain threshold), and active CROM (cervical range of motion) in individuals with CeH (cervicogenic headache) showing active TrPs in this muscle. Studies including greater sample sizes and examining long-term effects are needed. “

Bouman EA, Theunissen M , Bons SA et al. 2013. Reduced Incidence of Chronic Postsurgical Pain after Epidural Analgesia for Abdominal Surgery. Pain Pract. [Jun 12 Epub ahead of print]. “Chronic postsurgical pain (CPSP) is a common complication of surgery with high impact on quality of life. Peripheral and central sensitization caused by enhanced and prolonged afferent nociceptive input are considered important mechanisms for the development of CPSP. This case-control study investigated whether epidural analgesia is associated with a reduced incidence of CPSP after open abdominal surgery….METHODS: Six months after surgery, Short-Form-36 Health Survey (SF-36) pain scores, possible predictors of chronic pain, and quality of life were assessed. Patients treated with epidural analgesia in combination with general anesthesia (epidural group, N = 51) were compared to patients undergoing matched surgical procedures receiving general anesthesia alone….Patients with CPSP reported a significantly lower quality of life compared to patients without CPSP….Chronic postsurgical pain occurs in a significant number of patients 6 months after open abdominal surgery. Postoperative epidural analgesia is associated with a reduced incidence of CPSP after abdominal surgery.”

Bruno A, Mico U, Lorusso S et al. 2013. Agomelatine in the treatment of fibromyalgia: a 12-week, open-label, uncontrolled preliminary study J Clin Psychopharmacol. 33(4):507-511. Agomelatine was given to women with FM who were not on any other medications. The patients’ pain, depression, and anxiety improved.  [These patients were not assessed for coexisting trigger points. DJS]

Buyukbese MA, Pamuk ON, Yurekli OA et al. 2013. Effect of fibromyalgia on bone mineral density in patients with fibromyalgia and rheumatoid arthritis. J Postgrad Med. 59(2):106-109. “FM does not cause a decrease in BMD (bone mineral density). The presence of FM in RA (rheumatoid arthritis) patients does not result in a change in BMD.”

Cagnie B, Dewitte V, Barbe T et al. 2013. Physiologic effects of dry needling. Curr Pain Headache Rep. 17(8):348. “During the past decades, worldwide clinical and scientific interest in dry needling (DN) therapy has grown exponentially. Various clinical effects have been credited to dry needling, but rigorous evidence about its potential physiological mechanisms of actions and effects is still lacking. Research identifying these exact mechanisms of dry needling action is sparse and studies performed in an acupuncture setting do not necessarily apply to DN. The studies of potential effects of DN are reviewed in reference to the different aspects involved in the pathophysiology of myofascial trigger points: the taut band, local ischemia and hypoxia, peripheral and central sensitization. This article aims to provide the physiotherapist with a greater understanding of the contemporary data available: what effects could be attributed to dry needling and what are their potential underlying mechanisms of action, and also indicate some directions at which future research could be aimed to fill current voids.”

Celik D, Mutlu EK. 2013. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 17(8):353. Latent TrPs are important clinically. They still cause dysfunction, and cause pain on pressure. Latent TrPs may be found in many pain-free muscles, and can be activated by “continuous detrimental stimuli. This review highlights the importance of LTrPs.”

Chiarotto A, Fernandez-de-Las-Penas C, Castaldo M et al. 2013. Bilateral Pressure Pain Hypersensitivity over the Hand as Potential Sign of Sensitization Mechanisms in Individuals with Thumb Carpometacarpal Osteoarthritis. Pain Med. [Jun 26 Epub ahead of print].  “OBJECTIVE: To investigate whether bilateral deep tissue pressure hyperalgesia exists in individuals with unilateral thumb carpometacarpal osteoarthritis (CMC OA). METHODS: A total of 32 patients with CMC OA (29 females and 3 males, aged 69-90 years old) and 32 healthy matched controls (29 females and 3 males, aged 70-90 years) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over the first CMC joint, the hamate bone and the lateral epicondyle in a blinded design. Mixed models analyses of variance were conducted to determine the differences in pressure pain sensitivity between groups and sides….DISCUSSION: This study revealed bilateral localized pressure pain hypersensitivity over the hand in individuals with unilateral thumb CMC OA, suggesting spinal cord sensitization mechanisms in this population. Future studies should analyze the presence of widespread pressure pain sensitivity in patients with thumb CMC OA to further determine the presence of central sensitization mechanisms.”

Clark P, Paiva ES, Ginovker A et al. 2013. A patient and physician survey of fibromyalgia across Latin America and Europe. BMC Musculoskel Disord. 14:188. “Patient- and physician-rated disease perception and impact was often higher in LA (Latin America) than in Europe. Patient and physician perspective concerning FM impact and disruption were often misaligned within the same region. Our observations may be representative of cultural differences in stoicism, expression, beliefs, and attitudes to pain perception and management. Better understanding of these complexities could help targeted educational/training programs, incorporating cultural differences, to improve chronic care.”

Costantini A, Pala MI, Tundo S et al. 2013. High-dose thiamine improves the symptoms of fibromyalgia. BMJ Case Rep.  [May 20 Epub ahead of print]. This very small study (3 patients) indicated that FM symptoms improved with high doses of thiamine. [This agrees with the earlier work of JB Eisinger. DJS]

Elliott R, Burkett B. 2013. Massage therapy as an effective treatment for carpal tunnel syndrome. J Bodyw Mov Ther. 17(3):332-338. “Carpal tunnel syndrome is a common entrapment that causes neuralgia in the median nerve distribution of the hand. The primary aim of this study was to evaluate the efficacy of massage therapy as a treatment for carpal tunnel syndrome. Within this process, the locations of trigger points that refer neuropathy to the hand were identified. The creation of massage pressure tables provides a means of treatment reproducibility. Twenty-one participants received 30 min. of massage, twice a week, for six weeks. Carpal tunnel questionnaires, the Phalen, Tinel, and two-point discrimination tests provided outcome assessment. The results demonstrated significant…change in symptom severity and functional status from two weeks. Based on this study, the combination of massage and trigger-point therapy is a viable treatment option for carpal tunnel syndrome and offers a new treatment approach.”  [This is yet another study showing that surgery is not to be considered for CTS until all other options have been tried. DJS]

Ericsson A, Bremell T, Mannerkorpi K. 2013. Usefulness of multiple dimensions of fatigue in fibromyalgia. J Rehabil Med. [Jun 24 Epub ahead of print]. “Dimensions of fatigue, assessed by the MFI-20 (Multidimensional Fatigue Inventory), appear to be valuable in studies of employment, pain intensity, sleep, distress and physical function in women with fibromyalgia. The patients reported higher levels on all fatigue dimensions in comparison with healthy women.”

Eva-Maj M, Hans W, Per-Anders F et al. 2013. Experimentally induced deep cervical muscle pain distorts head on trunk orientation. Eur J Appl Physiol. [Jun 29 Epub ahead of print].

“PURPOSE: We wanted to explore the specific proprioceptive effect of cervical pain on sensorimotor control. Sensorimotor control comprises proprioceptive feedback, central integration and subsequent muscular response. Pain might be one cause of previously reported disturbances in joint kinematics, head on trunk orientation and postural control. However, the causal relationship between the impact of cervical pain on proprioception and thus on sensorimotor control has to be established. METHODS: Eleven healthy subjects were examined in their ability to reproduce two different head on trunk targets, neutral head position (NHP) and 30° target position, with a 3D motion analyzer before, directly after and 15 min. after experimentally induced neck pain. Pain was induced by hypertonic saline infusion at C2/3 level in the splenius capitis muscle on one side (referred to as "injected side")….A sensory mismatch appeared in some subjects, who experienced dizziness.  CONCLUSIONS: Acute cervical pain distorts sensorimotor control with side-specific changes, but also has more complex effects that appear when pain has waned.” [Myofascial trigger points can and do cause these effects.  Many are only evident after the pain has eased, and the TrPs have become latent. DJS]

Feng J, Zhang Z, Wu X et al. 2013. Discovery of potential new gene variants and inflammatory cytokine associations with fibromyalgia syndrome by whole genome sequencing. PLoS One. [June 10 Epub ahead of print]. This is an article on the complete exome sequencing on a subset of fibromyalgia patients from 150 nuclear families. Their conclusions “…implicate an inflammatory basis for FMS, as well as specific cytokine dysregulation, in at least 35% of our FMS cohort.  “Among 9 patients bearing more than one of the variants we have described, 4 had onset of symptoms between the ages of 10 and 18.  The subset with the C11orf40 mutation had elevated plasma levels of the inflammatory cytokine, IL-12, compared with unaffected controls or FMS patients with the wild-type allele.” [We do not know if these patients had co-existing inflammatory processes, but in that one subset of FM patients they did find 35% with inflammatory findings. Linda Watkins’ team also found pro-inflammatory cytokines elevated in FM, but that was considered a prelude to fractalkine and interthecal (dural tube) glial cell activation. DJS]

Ferrari R, Russell AS. 2013. A questionnaire using the Modified 2010 American College of Rheumatology criteria for fibromyalgia: specificity and sensitivity in clinical practice. J Rheumatol. [Jul 1 Epub ahead of print]. “The Modified ACR (American College of Rheumatology) 2010 criteria questionnaire can be used in primary care as a tool to assist physicians in the diagnosis of FM with high specificity and sensitivity. Calculating the total score on a Modified ACR 2010 criteria questionnaire, and setting the value of  > 13 as the cutoff for a diagnosis of FM appears to be the most effective approach. The Modified ACR 2010 criteria may reduce the need for rheumatology referral simply for the diagnosis of FM.”

Fitzcharles MA, Ste-Marie PA, Goldenberg DL et al. 2013. Canadian Pain Society and Canadian Rheumatology Association recommendations for rational care of persons with fibromyalgia. A summary report. J Rheumatol. [Jul 1 Epub ahead of print]. “These guidelines should provide the health community with reassurance for the global care of patients with FM with the aim of improving patient outcome by reducing symptoms and maintaining function.”

Fitzcharles MA, Ste-Marie PA, Goldenberg DL et al. 2013. Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag. 18(3):119-126.

Flammer J, Konieczka K, Flammer AJ. 2013. The primary vascular dysregulation syndrome: implications for eye diseases. EPMA J. 4(1):14. “Subjects with PVD (primary vascular dysregulation) tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.”

Gerber LH, Sikdar S, Armstrong K et al. 2013. A Systematic Comparison Between Subjects with No Pain and Pain Associated with Active Myofascial Trigger Points. PM R. [Jun 27 Epub ahead of print]. “We evaluated adults with MPS and active (painful) MTrPs and those without pain. Subjects in the "Active" ('A') group had at least one active MTrP with spontaneous pain which was persistent, lasted more than 3 months and had characteristic pain on palpation. Subjects in the "No pain" ('Np') group had no spontaneous pain. However, some had discomfort on MTrP palpation (latent MTrP) while others in the Np group had no discomfort on palpation of nodules or had no nodules….Each participant underwent range of motion (ROM) measurement, 10-point manual muscle test, and manual and algometric palpation. The latter determined the pain/pressure threshold using an algometer of 4 pre-determined anatomical sites along the upper trapezius. Participants rated pain using a verbal analogue scale (0-10); completed the Brief Pain Inventory and Oswestry Disability Scale (ODS), which included a sleep sub-scale; Short Form 36(SF36) and the Profile of Mood States (POMS)….There were 24 in the 'A' group (mean 36yrs, 16 women) and 26 in the 'Np' group (mean 26yrs, 12 women). Subjects in group 'A' differed from 'Np' in number of latent MTrPs…; asymmetrical cervical ROM…; in all pain reports…; algometry…; POMS…; SF36…and ODS….A systematic musculoskeletal evaluation of people with MPS reliably distinguishes them from subjects with no pain. The two groups are significantly different in their physical findings and self-reports of pain, sleep disturbance, disability, health status and mood. These findings support the view that a "local" pain syndrome has significant associations with mood, health-related quality of life and function.”

Giggins OM, Persson UM, Caulfield, B. 2013. [June 18 Epub ahead of print]. [This is a review of the use of many types of biofeedback now being used in many conditions, including fibromyalgia. DJS]

Grieve R, Barnett S, Coghill N et al. 2013. Myofascial trigger point therapy for triceps surae dysfunction: A case series. Man Ther. [June 4 Epub ahead of print]. Four women and 6 men with triceps surae dysfunction (“triceps surae” is an anatomical term for the combination of gastrocnemius and soleus muscles) were evaluated for myofascial trigger points. All participants had active and latent myofascial TrPs on assessment.  A program of trigger point pressure release, self-TrP release and home stretching was instituted.  Ankle dorsiflexion, pain scale, function scale improve, and improvement was still evident 6 weeks later.  “This case series suggests that a brief course of multimodal MTrP therapy would be helpful for some patients with sub-acute or chronic calf pain.”

Gurbuzler L, Unanir, Yelken K et al. 2013. Voice disorder in patients with fibromyalgia. Auris Nasus Larynx [May 30 Epub ahead of print]. Thirty fibromyalgia patients were analyzed with laryngostroboscopy, acoustic analysis, aerodynamic measurements and perceptual analysis and compared to control subjects.  [The authors concluded that FM impairs voice quality in patient self-evaluation or clinical evaluation, but they did not assess for co-existing TrPs that can cause these same results. It would help greatly if patients had assessment for area TrPs in future studies. DJS]

Hamaue Y, Nakano J, Sekino Y et al. 2013. Immobilization-induced hypersensitivity associated with spinal cord sensitization during cast immobilization and after cast removal in rats. J Physiol Sci. [Jul 2 Epub ahead of print]. “This study examined mechanical and thermal hypersensitivity in the rat hind paw during cast immobilization of the hind limbs for 4 or 8 weeks and following cast removal. Blood flow, skin temperature, and volume of the rat hind paw were assessed in order to determine peripheral circulation of the hind limbs. Sensitization was analyzed by measuring the expression of the calcitonin gene-related peptide (CGRP) in the spinal dorsal horn following cast immobilization. Two weeks post immobilization, mechanical and thermal sensitivities increased significantly in all rats; however, peripheral circulation was not affected by immobilization. Cast immobilization for 8 weeks induced more serious hypersensitivity compared to cast immobilization for 4 weeks. Moreover, CGRP expression in the deeper lamina layer of the spinal dorsal horn increased in the rats immobilized for 8 weeks but not in those immobilized for 4 weeks. These findings suggest that immobilization-induced hypersensitivity develops during the immobilization period without affecting peripheral circulation. Our results also highlight the possibility that prolonged immobilization induces central sensitization in the spinal cord.” [Although trigger points were not mentioned in this study, prolonged immobility in humans can cause trigger points that can cause the central sensitization noted here in rats.  The omission points to the need for more TrP training among researchers. DJS]

Hauser W, Burgmer M, Kollner V et al. 2013. [Fibromyalgia syndrome as a psychosomatic disorder - Diagnosis and therapy according to current evidence-based guidelines. Z Psychosom Med Psychother. 59(2):32-152. [German]. [The lead author is a known “debunker” of fibromyalgia. He seems unaware or disregarding of the research dismissing the usefulness of terms such as “somatoform” or the inappropriate use of “psychosomatic” in relation to fibromyalgia.  As research piles up about the importance of peripheral pain driving the central sensitization of FM, these authors remain oblivious.  They also seem unaware of the works as from Drs. Feng J, Zhang Z, Wu X et al. 2013, or Oaklander AL, Herzog ZD, Downs H et al 2013.  The team also seems unaware of the medical vow, “Do no harm”, as in my opinion, by publishing this erroneous article, they certainly are.  DJS]

Jesus CA, Feder D, Peres MF. 2013. The role of vitamin D in pathophysiology and treatment of fibromyalgia. Curr Pain Headache Rep. 17(8):355. “The association between fibromyalgia and vitamin D deficiency is very controversial in the literature with conflicting studies and methodological problems, which leads to more questions than answers. The purpose of this article is to raise questions about the association of hypovitaminosis D with fibromyalgia considering causal relationships, treatment, and pathophysiological explanations.”

Kamping S, Bomba IC, Kanske P et al. 2013. Deficient modulation of pain by a positive emotional context in fibromyalgia patients. Pain [Epub ahead of print]. This study used painful stimuli to the hand in conjunction with positive, negative or neutral pictures. The conclusion was that the FM patients “…are less efficient in modulating pain...” than healthy controls. [They may have been distracted by the pain. Also, none of the patients were assessed for coexisting trigger points.  DJS]

Kietrys DM, Palombaro KM, Azzaretto E et al. 2013. Effectiveness of Dry Needling for Upper Quarter Myofascial Pain: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. [Jun 11 Epub ahead of print]. “Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points (MTrPs). When palpated, active MTrPs cause local or referred symptoms, including pain. Dry needling involves inserting an acupuncture-like needle into a MTrP with the goal of reducing pain and restoring range of motion. OBJECTIVE: To explore the evidence regarding the effectiveness of DN in reducing pain for patients with MPS of the upper quarter. METHODS: An electronic literature search was performed using the keyword "dry needling." Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trials (RCTs), dry needling intervention group, and MPS involving the upper quarter.…RESULTS:…

Findings of 3 studies that compared dry needling to sham or placebo treatment provide evidence that dry needling can immediately decrease pain in patients with upper quarter MPS, with an overall effect favoring dry needling. Findings of 2 studies that compared dry needling to sham or placebo treatment provide evidence that dry needling can decrease pain after 4 weeks in patients with upper quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There is evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. CONCLUSIONS: Based on the best current available evidence, we recommend (Grade A) dry needling, compared to sham or placebo, for decreasing pain (immediately after treatment and at 4 weeks) in patients with upper quarter MPS. Due to the small number of high quality RCTs published to date, additional well-designed studies are needed to inform future evolution of this recommendation.”

Kim SH, Moon IS, Park IS. 2013. Unique hippocampal changes and allodynia in a model of chronic stress. J Korean Med Sci. 28(6):946-950. Chronic stress may bring about central sensitization and hippocampal changes in rats.

Konczak J, Abbruzzese G. 2013. Focal dystonia in musicians: linking motor symptoms to somatosensory dysfunction. Front Hum Neurosci. 7:297. “Musician's dystonia (MD) is a neurological motor disorder characterized by involuntary contractions of those muscles involved in the play of a musical instrument. It is task-specific and initially only impairs the voluntary control of highly practiced musical motor skills. MD can lead to a severe decrement in a musician's ability to perform. While the etiology and the neurological pathomechanism of the disease remain unknown, it is known that MD like others forms of focal dystonia is associated with somatosensory deficits, specifically a decreased precision of tactile and proprioceptive perception. The sensory component of the disease becomes also evident by the patients' use of "sensory tricks" such as touching dystonic muscles to alleviate motor symptoms. The central premise of this paper is that the motor symptoms of MD have a somatosensory origin and are not fully explained as a problem of motor execution. We outline how altered proprioceptive feedback ultimately leads to a loss of voluntary motor control and propose two scenarios that explain why sensory tricks are effective. They are effective, because the sensorimotor system either recruits neural resources normally involved in tactile-proprioceptive (sensory) integration, or utilizes a fully functioning motor efference copy mechanism to align experienced with expected sensory feedback. We argue that an enhanced understanding of how a primary sensory deficit interacts with mechanisms of sensorimotor integration in MD provides helpful insights for the design of more effective behavioral therapies. “[Myofascial trigger points can and do cause the symptoms here described, but are not mentioned in this study. DJS]

Korakakis V, Giakas G. 2013. Spinal repositioning deficit. The effect of prolonged flexed posture. Br J Sports Med. 47(10):e3. “Flexed sitting posture is commonly adopted in daily sitting activities and when sustained has been proposed to affect biological properties of spinal tissues and act detrimentally on proprioception. The objective of this study by using an optoelectronic motion analysis system was to assess sitting posture regarding the head, spine and pelvis, in healthy individuals; the time effect of flexed posture (FSP) on proprioception and the impact of an MDT (Mechanical Diagnosis and Therapy) procedure on proprioceptive deficit. …Postural repositioning error showed significant differences for LU (lumbar) and HE (head) angles. The findings suggest that healthy individuals habitually sit in more flexed posture than SPOP (optimal sitting posture) and IOSP (instructed sitting posture). Postural education can be actualized in a reliable way and subjects can adopt an educated posture. Furthermore FSP (habitual sitting posture) challenged postural proprioception, but SOP increased proprioceptive accuracy.”  [Immobility in this flexed posture could activate myofascial trigger points, causing the effects noted here, but they were not mentioned.  DJS]

Lewis GK Jr., Langer MD, Henderson CR Jr. et al. 2013. Design and Evaluation of a Wearable Self-Applied Therapeutic Ultrasound Device for Chronic Myofascial Pain. Ultrasound Med Biol. [Jun 3 Epub ahead of print]. “Ultrasound therapy for pain and healing is a versatile treatment modality for musculoskeletal conditions that is used daily in rehabilitation clinics around the world. Our group designed and constructed a wearable, battery-operated, low-intensity therapeutic ultrasound (LITUS) device that patients could self-apply and operate during daily activity for up to 6 h. Thirty patients with chronic trapezius myofascial pain evaluated the LITUS system in a double-blind, placebo-controlled, 10-d study under institutional review board approval. While continuing their prescribed medication regimen, patients with the active device reported on average 1.94× reduction in pain and 1.58× improvement in health relative to placebo devices after 1 h of treatment. Both of these results were statistically significant …for the first 2 d of the study. Male patients reported the majority of benefit…. The study indicates that wearable, long-duration LITUS technology improves mobile access to drug-free pain relief.”

Liptan G, Mist S, Wright C et al. 2013. A pilot study of myofascial release therapy compared to Swedish massage in fibromyalgia. J Bodw Mov Ther. 17(3):365-370. This small study, with 8 women with FM having myofascial release and 4 having Swedish massage, 90 minutes each for four weeks, indicates that localized pain areas that can lead to central sensitization improved more with myofascial release. This can be important as research indicates that peripheral pain generators are responsible for FM central sensitization. As the study states, larger and more varied studies are needed. [It would be good to compare myofascial release with specific trigger point myotherapy, and with them both used in conjunction.  It has been my experience that Swedish massage can help calm the central sensitization, and works well in combination with the other two techniques. We need to work to get these covered by insurance. DJS]

Liu YP, Liu S. 2013. Electrical nerve stimulation and the relief of chronic pain through regulation of the accumulation of synaptic Arc protein. Med Hypotheses. [Jun 3 Epub ahead of print]. “Electrical nerve stimulation (ENS) is used in clinical settings for the treatment of chronic pain, but the mechanism underlying its effects remains unknown. ENS has been found to mimic neural activity, inducing the accumulation of Arc in synapses. Activity-dependent synaptic accumulation of Arc protein has been shown to reduce synaptic strength by promoting endocytosis of the AMPA receptors in the synaptic membrane. These receptors play a decisive role in central sensitization, which is one of the main mechanisms underlying chronic pain. It is here hypothesized that ENS induces Arc expression in synapses, where Arc promotes endocytosis of membrane AMPARs that are up-regulated during chronic pain. High frequency and high intensity are characteristics of ENS, which may be effective in the treatment of chronic pain. Stimulation-site of ENS may also influence the outcome of ENS.”

Manfredini D, Cocilovo F, Stellini E et al. 2013. Surface Electromyography Findings in Unilateral Myofascial Pain Patients: Comparison of Painful vs. Non Painful Sides. Pain Med. [Jun 7 Epub ahead of print]. OBJECTIVES: To answer the clinical research question: in patients with myofascial pain, are there any differences in the surface electromyography (sEMG) activity of muscles of the painful and nonpainful sides that can be detected by commercially available devices?  RESULTS: At the study population level, differences between the sEMG values of muscles of the painful and nonpainful sides were not significant in any conditions, viz., either at rest or during clenching tasks. At the individual level, the difference between the sEMG activity of painful and nonpainful sides was very variable.  CONCLUSIONS: The above findings were not supportive of the existence of any detectable difference in sEMG activity between jaw muscles of the painful and nonpainful sides in patients with unilateral myofascial pain. Centrally mediated mechanism for pain adaptation may explain these findings, and the role of sEMG as a diagnostic tool for muscle pain needs to be carefully reconceptualized.

Martinez MP, Miro E, Sanchez AI et al. 2013. Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J Behav Med. [Jun 7 Epub ahead of print]. “The CBT-I (cognitive-behavioral therapy for insomnia) group reported significant improvements at post-treatment in several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression. The SH (sleep hygiene) group only improved significantly in subjective sleep quality. Patients in the CBT-I group showed significantly greater changes than those in the SH group in most outcome measures. The findings underscore the usefulness of CBT-I in the multidisciplinary management of FM.”

Mehling WE, Daubenmier J, Price CJ et al. 2013. Self-reported interoceptive awareness in primary care patients with past or current low back pain. J Pain Res. 6:403-418. “Mind-body interactions play a major role in the prognosis of chronic pain, and mind-body therapies such as meditation, yoga, Tai Chi, and Feldenkrais presumably provide benefits for pain patients. The Multidimensional Assessment of Interoceptive Awareness (MAIA) scales, designed to measure key aspects of mind-body interaction, were developed and validated with individuals practicing mind-body therapies, but have never been used in pain patients. METHODS: We administered the MAIA to primary care patients with past or current low back pain and explored differences in the performance of the MAIA scales between this and the original validation sample. We compared scale means, exploratory item cluster and confirmatory factor analyses, scale-scale correlations, and internal-consistency reliability between the two samples and explored correlations with validity measures. RESULTS: Responses were analyzed from 435 patients, of whom 40% reported current pain. Cross-sectional comparison between the two groups showed marked differences in eight aspects of interoceptive awareness. Factor and cluster analyses generally confirmed the conceptual model with its eight dimensions in a pain population. Correlations with validity measures were in the expected direction. Internal-consistency reliability was good for six of eight MAIA scales. We provided specific suggestions for their further development. CONCLUSION: Self-reported aspects of interoceptive awareness differ between primary care patients with past or current low back pain and mind-body trained individuals, suggesting further research is warranted on the question whether mind-body therapies can alter interoceptive attentional styles with pain. The MAIA may be useful in assessing changes in aspects of interoceptive awareness and in exploring the mechanism of action in trials of mind-body interventions in pain patients.”

Miletic G, Lippitt JA, Sullivan KM et al. 2013. Loss of calcineurin in the spinal dorsal horn contributes to neuropathic pain, and intrathecal administration of the phosphatase provides prolonged analgesia.  Pain. [Jun 15 Epub ahead of print]. “Calcineurin (protein phosphatase 3) regulates synaptic plasticity in the brain. The development of neuropathic pain appears dependent on some of the same mechanisms that underlie brain synaptic plasticity. In this study, we examined whether calcineurin regulates chronic constriction injury (CCI)-elicited plasticity in the spinal dorsal horn. CCI animals exhibited mechanical and thermal hypersensitivity 7days after ligation of the sciatic nerve. Neither control uninjured nor sham-operated animals exhibited pain behavior. Calcineurin activity and content of its Aα isoform were significantly decreased in the ipsilateral postsynaptic density (PSD) of dorsal horn neurons in CCI animals. Calcineurin activity and content in the contralateral PSD of CCI animals or either side of the dorsal horn in sham animals were not modified. The pain behavior in CCI animals was attenuated by intrathecal application of exogenous calcineurin. The treatment was long-lasting as a single injection provided analgesia for 4days by restoring the phosphatase's activity and Aα content in the PSD. No signs of toxicity were detected up to 14days after the single intrathecal injection. Intrathecal application of the calcineurin inhibitor FK-506 elicited pain behavior in control uninjured animals and significantly reduced calcineurin activity in the PSD. CCI may elicit neuropathic pain at least in part as a result of the loss of calcineurin-mediated dephosphorylation in the dorsal horn. Addition of the phosphatase by intrathecal injection reverses the injury-elicited loss and provides prolonged pain relief. Clinical therapy with calcineurin may prove to be a novel, effective, and safe approach in the management of well-established neuropathic pain.”

Morris G, Anderson G, Berk M et al. 2013. Coenzyme Q10 depletion in medical and neuropsychiatric disorders: potential repercussions and therapeutic implications. Mol Neurobiol. [Jun 13 Epub ahead of print]. “Coenzyme Q10 (CoQ10) is an antioxidant, a membrane stabilizer, and a vital cofactor in the mitochondrial electron transport chain, enabling the generation of adenosine triphosphate. It additionally regulates gene expression and apoptosis; is an essential cofactor of uncoupling proteins; and has anti-inflammatory, redox modulatory, and neuroprotective effects.” “Administration of CoQ10 improves hyperalgesia and quality of life in patients with fibromyalgia. The evidence base for the effectiveness of treatment with CoQ10 may be explained via its ability to ameliorate oxidative stress and protect mitochondria.”

Natelson BH. 2013. Brain dysfunction as one cause of CFS symptoms including difficulty with attention and concentration. Front Physiol. 4:109. “We have been able to reduce substantially patient pool heterogeneity by identifying phenotypic markers that allow the researcher to stratify chronic fatigue syndrome (CFS) patients into subgroups. To date, we have shown that stratifying based on the presence or absence of comorbid psychiatric diagnosis leads to a group with evidence of neurological dysfunction across a number of spheres. We have also found that stratifying based on the presence or absence of comorbid fibromyalgia leads to information that would not have been found on analyzing the entire, unstratified patient group. Objective evidence of orthostatic intolerance (OI) may be another important variable for stratification and may define a group with episodic cerebral hypoxia leading to symptoms. We hope that this review will encourage other researchers to collect data on discrete phenotypes in CFS to allow this work to continue more broadly. Finding subgroups of CFS suggests different underlying pathophysiological processes responsible for the symptoms seen. Understanding those processes is the first step toward developing discrete treatments for each.”

Nazarian A, Tenayuca JM, Almasarweh F et al. 2013. Sex differences in formalin-evoked primary afferent release of substance P. Eur J Pain. [Jun 10 Epub ahead of print]. “Sex differences in pain have been well documented; however, the mechanisms involved remain to be elucidated. The present study examined whether sex differences exist in the functioning of primary afferent fibres by assessing formalin-evoked release of substance P by way of neurokinin 1 receptor (NK1r) internalization. The study also investigated whether the observed effects would be oestradiol-sensitive….These findings suggest that oestradiol mediates sex differences in formalin-evoked substance P release, which may contribute to a differential development of central sensitization and pain behaviors in males and females.”

Neziri AY, Limacher A, Juni P et al. 2013. Ranking of Tests for Pain Hypersensitivity According to Their Discriminative Ability in Chronic Neck Pain.  Reg Anesth Pain Med. 38(4):308-320. “Quantitative sensory testing (QST) is widely used to investigate peripheral and central sensitization. However, the comparative performance of different QST for diagnostic or prognostic purposes is unclear. We explored the discriminative ability of different quantitative sensory tests in distinguishing between patients with chronic neck pain and pain-free control subjects and ranked these tests according to the extent of their association with pain hypersensitivity….Pressure stimulation at the site of the most severe pain and parameters of electrical stimulation were the most appropriate QST to distinguish between patients with chronic neck pain and asymptomatic control subjects. These findings may be used to select the tests in future diagnostic and longitudinal prognostic studies on patients with neck pain and to optimize the assessment of localized and spreading sensitization in chronic pain patients.”

Oaklander AL, Herzog ZD, Downs H et al. 2013. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. [Jun 5 Epub ahead of print.]  “Fibromyalgia is a common, disabling syndrome that includes chronic widespread pain plus other diverse symptoms….In contrast, small-fiber polyneuropathy (SFPN), despite causing similar symptoms, is definitely a disease caused by dysfunction and degeneration of peripheral small-fiber neurons…..41% of skin biopsies from fibromyalgia subjects vs. 3% of biopsies from control subjects were diagnostic for SFPN, and MNSI (Michigan Neuropathy Screening Instrument) and UENS (Utah Early Neuropathy Scale) scores were higher among fibromyalgia than control subjects…. Abnormal AFT (Autonomic Function Testing) was equally prevalent suggesting that fibromyalgia-associated SFPN is primarily somatic. Blood tests from all 13 fibromyalgia subjects with SFPN-diagnostic skin biopsies provided insights into etiologies. All glucose tolerance tests were normal, but eight subjects had dysimmune markers, 2 had hepatitis C serologies, and one family had apparent genetic causality. These findings suggest that some patients with chronic pain labeled as “fibromyalgia” have unrecognized small-fiber polyneuropathy, a distinct disease that can be objectively tested for an sometimes definitively treated.” 

Oliveira-Campelo NM, de Melo CA, Alburquerque-Sendín F et al. 2013. Short- and Medium-Term Effects of Manual Therapy on Cervical Active Range of Motion and Pressure Pain Sensitivity in Latent Myofascial Pain of the Upper Trapezius Muscle: A Randomized Controlled Trial. J Manipulative Physiol Ther. [Jun 11 Epub ahead of print]. “Manual techniques on upper trapezius with latent trigger point seemed to improve the cervical range of motion and the pressure pain sensitivity. These effects persist after 1 week in the IC (ischemic compression) group.”

Pergolizzi J, Ahlbeck K, Aldington D et al. 2013. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin. [Jul 3 Epub ahead of print]. “Chronic pain is currently under-diagnosed and under-treated, partly because doctors' training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain.”

Queiroz LP. 2013. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep. 17(8):356. “This article reviews the prevalence and incidence studies done in the general population, in several countries/continents, the prevalence of FM in special groups/settings, the association of FM with some sociodemographic characteristics of the population, and the comorbidity of FM with others’ disorders, especially with headaches.”

Rahn EJ, Guzman-Karlsson MC, David Sweatt J. 2013. Cellular, molecular, and epigenetic mechanisms in non-associative conditioning: Implications for pain and memory.  Neurobiol Learn Mem. [Jun 22 Epub ahead of print]. “Sensitization is a form of non-associative conditioning in which amplification of behavioral responses can occur following presentation of an aversive or noxious stimulus. Understanding the cellular and molecular underpinnings of sensitization has been an overarching theme spanning the field of learning and memory as well as that of pain research. In this review we examine how sensitization, both in the context of learning as well as pain processing, shares evolutionarily conserved behavioral, cellular/synaptic, and epigenetic mechanisms across phyla. First, we characterize the behavioral phenomenon of sensitization both in invertebrates and vertebrates. Particular emphasis is placed on long-term sensitization (LTS) of withdrawal reflexes in Aplysia following aversive stimulation or injury, although additional invertebrate models are also covered. In the context of vertebrates, sensitization of mammalian hyperarousal in a model of post-traumatic stress disorder (PTSD), as well as mammalian models of inflammatory and neuropathic pain is characterized. Second, we investigate the cellular and synaptic mechanisms underlying these behaviors. We focus our discussion on serotonin-mediated long-term facilitation (LTF) and axotomy-mediated long-term hyperexcitability (LTH) in reduced Aplysia systems, as well as mammalian spinal plasticity mechanisms of central sensitization. Third, we explore recent evidence implicating epigenetic mechanisms in learning- and pain-related sensitization. This review illustrates the fundamental and functional overlay of the learning and memory field with the pain field which argues for homologous persistent plasticity mechanisms in response to sensitizing stimuli or injury across phyla.”

Robinson RL, Kroenke K, Williams DA et al. 2013.  Longitudinal observation of treatment patterns and outcomes for patients with fibromyalgia: 12-month findings from the REFLECTIONS study. Pain Med. [June 11 Epub ahead of print].  This was a study using data from 1700 patients based on subjective inventories by patients on pregabalin (12%) duloxetine (15.5%), minilcipran (7.9%) or tricyclic antidepressants (3.9%). The focus was on “unique drugs for fibromyalgia” with over 75% of the patients taking over two or more medications, but not necessarily those medications. Duloxene and minilcipran patients had fewer outpatient visits than the others, and patients reported satisfaction with their treatment and “their fibromyalgia medication”. [Bold lettering is theirs.]  In the conclusions, ALL of the fibromyalgia patients had “modest improvements, high resources, and medication use, and were satisfied with the care they received.”  Authors admitted that it was difficult to tell the difference among the groups of patients due to the “high rates of drub discontinuation and concomitant medication over the 12 month period” of the study. The study was financed by Eli Lilly and Company.  [This study is included in annotated references because it is easy to see how it could be misconstrued and perhaps misused.  When quoting studies, often the sponsors of the studies and their relation to the medications are not given. DJS]

Roussel NA, Nijs J, Meeus M et al. 2013. Central Sensitization and Altered Central Pain Processing in Chronic Low Back Pain: Fact or Myth? Clin J Pain. 29(7):625-638. “Results of studies examining the responsiveness to various stimuli in patients with chronic LBP (low back pain) are conflicting. Some studies in patients with chronic LBP have demonstrated exaggerated pain responses after sensory stimulation of locations outside the painful region, while other studies report no differences between patients and healthy subjects. Studies examining the integrity of the endogenous pain inhibitory systems report unaltered activity of this descending inhibitory system. In contrast, studies analyzing brain structure and function in relation to (experimentally induced) pain provide preliminary evidence for altered central nociceptive processing in patients with chronic LBP. Finally, also psychosocial characteristics, such as inappropriate beliefs about pain, pain catastrophizing, and/or depression may contribute to the mechanisms of central sensitization. …It tempting to speculate that ongoing nociception is associated with cortical and subcortical reorganization and may play an important role in the process of the chronification of LBP. Future prospective research should explore to what extent these changes are reversible and if this reversibility is associated with improved functioning of patients.”

Sanchez AI, Valenza MC, Martinez MP et al. 2013. Gender differences in pain experience and physical activity of fibromyalgia syndrome patients. J Musculoskel Pain. 21(2):147-155. Abnormal pain processing in FM patients is similar in males as in females, with lower pain thresholds and higher pain levels. “In women with FMS, only sleep quality was significantly correlated with physical activity.”

Sberly JZ, Vernon H, Lee D et al. 2013. Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults.   J Manipulative Physiol Ther. [July 3 Epub ahead of print]. This study used patients with TRPs in the infraspinatus and gluteus medius muscles. Spinal manipulation therapy (SMT) to the C5-C6 spine significantly improved pressure pain thresholds short-term (15 minutes) in the test infraspinatus muscle in healthy young adults. No significant increases were found in control infraspinatus and gluteus medius muscles of patients who received sham SMT.

Shadmehr A, Jafarian Z, Tavakol K et al. 2013. Effect of pelvic compression on the stability of pelvis and relief of sacroiliac joint pain in women: A case series. J Musculoskel Pain. 21(1):31-36.  “Pelvic compression significantly reduced the EMG (electromyographic) activity from six muscles....pelvic compression can improve both the motor control and stability of the pelvis, while reducing joint pain in women suffering from sacroiliac symptoms.” 

Sharan D, Ajeesh PS, Rameshkumar R et al. 2012. Risk factors, clinical features, and outcome of treatment of work related musculoskeletal disorders in on-site clinics among IT companies in India. Work. Suppl 1:5702-5704.  This study focused on the IT (information technology) profession and workplace risk in India.  It found poor office ergonomics; lack of keyboard and/or mouse tray and foot rest; and improper monitor height to be the most common risk factors. The most common musculoskeletal disorders were myofascial pain syndrome (49.2%), thoracic outlet syndrome (25%), and fibromyalgia (8.5%). The body regions affected mostly were neck (64.9%), shoulder 42.1%), lower back (56.5%), and thigh (34.2%). The patients were treated with the RECOUP protocol designed by Dr. Sharan, and the patients were satisfied with their progress.

Sharan D, Jacob BN, Ajeesh PS et al. 2011. The effect of cetylated fatty esters and physical therapy on myofascial pain syndrome of the neck. J Bodyw Mov Ther. 15(3):363-374.  Myofascial pain patients were treated with either a combination of cetylated fatty ester complex (CFEC) and 1.5% menthol or a control cream of 1.5% menthol.  The patients treated with the compound containing the CFEC experienced significantly improved symptoms compared with those who used the menthol cream. [Patients on guaifenesin should be aware that the cream available in the USA, Celadrin, has significant peppermint oil and would be contraindicated due to the salicylates in it. DJS]

Soyupek F, Guney M, Kaplan O et al. 2013. Is fibromyalgia syndrome common in the patients with primary dysmenorrhea? J Musculoskel Pain 21(2):156-160. Fibromyalgia was more frequent in primary dysmenorrhea patients, especially symptomatic ones. [These patients were not checked for co-existing chronic myofascial pain.  Since trigger points can cause dysmenorrhea and drive FM central sensitization, these patients may have had primary myofascial pain due to trigger points that caused the dysmenorrhea and subsequently, the FM. DJS]

Stecco A, Gesi M, Stecco C et al. 2013. Fascial components of the myofascial pain syndrome. Curr Pain Headache Rep. 17(8):352.  “Myofascial pain syndrome (MPS) is described as the muscle, sensory, motor, and autonomic nervous system symptoms caused by stimulation of myofascial trigger points (MTP). The participation of fascia in this syndrome has often been neglected. Several manual and physical approaches have been proposed to improve myofascial function after traumatic injuries, but the processes that induce pathological modifications of myofascial tissue after trauma remain unclear. Alterations in collagen fiber composition, in fibroblasts or in extracellular matrix composition have been postulated. We summarize here recent developments in the biology of fascia, and in particular, its associated hyaluronan (HA)-rich matrix that address the issue of MPS.”


Thomas K, Shankar H. 2013. Targeting myofascial taut bands by ultrasound. Curr Pain Headache Rep. 17(7):349. “Myofascial pain syndrome (MPS) is a frequent diagnosis in chronic pain and is characterized by tender, taut bands known as trigger points. The trigger points are painful areas in skeletal muscle that are associated with a palpable nodule within a taut band of muscle fibers. Despite the prevalence of myofascial pain syndrome, diagnosis is based on clinical criteria alone. A growing body of evidence that suggests that taut bands are readily visualized under ultrasound-guided exam, especially when results are correlated with elastography, multidimensional imaging, and physical exam findings such as local twitch response.”

Tsuchie H, Miyakoshi N, Kasukawa Y et al. 2013. High prevalence of abdominal aortic aneurysm in patients with chronic low back pain. Tohoku J Exp Med. 230(2):83-86. “The prevalence of LBP (low back pain) is high in AAA (abdominal aortic aneurysm) patients, and doctors who treat chronic LBP should be aware of AAA as a potential cause of LBP.” [This study is included here to alert readers that abdominal aortic aneurysm is common in low back pain patients and must be assessed and can mimic symptoms of spinal or myofascial pain. DJS]  

Uemoto L, Antonio C Garcia M, Vinicius D et al. 2013. Laser therapy and needling in myofascial trigger point deactivation. J Oral Sci. 55(2):175-181. Twenty-one women patients with bilateral masseter TrPs were divided into groups to receive either laser therapy, needling with local anesthetic or no treatment (control). The laser and needling groups experienced a significant decrease of pain by visual analogue scale.  A significant decrease in pressure pain threshold was experienced by the local anesthetic needling group only. This study indicates that four sessions of needling with 2% lidocaine without vasoconstrictor, with intervals between 48 and 72 hours between treatments, or laser therapy at a dose of 4 J/cm2, effectively deactivated the TrPs.

Villalon P, Arzola JF, Valdivia J et al. 2013. The occlusal appliance effect on myofascial pain. Cranio. 31(2):84-91. “There are limited studies about the effects of occlusal appliance (OA) after three months of use. This study aimed to compare myofascial pain (MP) according to RDC/TMD, craniocervical relationships (CR) and masseter and temporalis bilateral electromyographic (EMG) activity, before and after three months of occlusal appliance use. Nineteen patients participated in this study. Cephalometric and RDC/TMD diagnostics were performed previously (baseline) and at the end of the study period (three months). EMG recordings at clinical mandibular rest position (MRP), during swallowing of saliva (SW) and during maximum voluntary clenching (MVC) were performed as follows: after one hour of use of an OA; after three months of using the OA for a minimum of 16 hours each day; and immediately after removal from the mouth. MP was relieved in all patients at the end of the study period. CR did not change significantly between baseline and after removal of the OA at the end of the study period. EMG activity during MRP, SW, and MVC decreased in both muscles after one hour using the OA and maintained the same level for the three-month period. When comparing baseline versus final EMG activity without OA, a significant decrease was only observed in the masseter muscle. The results observed in the present study are relevant to clinicians because they imply that the therapeutic effect of OA does not significantly affect the homeostasis of the craniocervical system.”

Volz MS, Medeiros LF, Tarrago MD et al. 2013.  The Relationship between Cortical Excitability and Pain Catastrophizing in Myofascial Pain. J Pain. [Jun 27 Epub ahead of print]. “Pain catastrophizing regularly occurs in chronic pain patients. ….this study explored the relationship between a neurophysiological marker of cortical excitability, as assessed by transcranial magnetic stimulation, and catastrophizing, as assessed by the Brazilian Portuguese Pain Catastrophizing Scale, in patients with chronic myofascial pain syndrome. …Our results did not suggest that these findings were influenced by other factors, such as age or medication use. Furthermore, short intracortical inhibition showed a significant association with pressure pain threshold….This study highlights the relationship between cortical excitability and catastrophizing. Cortical measures may illuminate how catastrophizing responses may be related to neurophysiological mechanisms associated with chronic pain.”

Weifen W, Muheremu A, Chaohui C et al. 2013. Effectiveness of tai chi practice for non-specific chronic low back pain on retired athletes: a Randomized controlled study. J Musculoskel Pain 21(1):37-45. “Tai chi has better efficacy than certain other sports on the treatment of non-specific chronic LBP.”

Weimer MB, Macey TA, Nicolaidis C et al. 2013. Sex differences in the medical care of VA patients with chronic non-cancer pain. [Epub ahead of print]. Female VA patients moderate to severe chronic non-cancer pain are more likely to be diagnosed with two or more conditions. These more often included fibromyalgia, low back pain, inflammatory bowel disease, migraines, neck or joint pain, and/or arthritis. “After adjustment for demographic characteristics, pain diagnoses, mental health diagnoses, substance use disorders, and medical comorbidity, women had lower odds of being prescribed chronic opioid therapy…greater odds of visiting an emergency department for a pain related complaint… and greater odds of receiving physical therapy….Primary are utilization was not significantly different between sexes.”

Wolfe F, Walitt B. 2013. Culture, science and the changing nature of fibromyalgia. Nat Rev Rheumatol. [Jul 2 Epub ahead of print]. [The lead author is a known “debunker” of the reality of FM.  These authors would have us believe that the fibromyalgia diagnoses are harmful to patients, in spite of research to the contrary.  They also infer that FM is a mythical entity that is supported only because of those who would benefit from it, such as pharmaceutical companies and patient organizations. This flies in the face of research that the central sensitization of FM is caused by peripheral pain generators, and other research specifying genetic links, biochemical and skin differences, and other objective changes of FM.  The research is there to be examined. It is left to the reader to decide why such an experienced and well-known researcher such as Dr. Wolfe ignores it. DJS]

Yokota S, Kikuchi M, Miyamae T. 2013. Juvenile fibromyalgia: Guidance for its management. Pediatr Int. [June 13 Epub ahead of print].  In Japan, the exact number of children with FM is unknown. Pediatric rheumatologists see children with a wide variety of musculoskeletal conditions. This provides guidelines for diagnosis and treatment. [It is not known if this paper differentiates between myofascial trigger points and FM.  DJS]

Zammurrad S, Munir W, Farooqi. 2013. Disease activity score in rheumatoid arthritis with or without secondary fibromyalgia. J Coll Physicians Surg Pak. 23(6):413-417. “DAS-28 (disease activity score) is a useful tool for assessing rheumatoid arthritis disease status in outpatient setting; however, increased disease activity must be assessed for possible co-existence of fibromyalgia which can spuriously give high DAS value and adversely affect treatment decision.”

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