March 2013 References    Devin J. Starlanyl   for

Batheja S, Nields JA, Landa A et al. 2013. Post-Treatment Lyme Syndrome and Central Sensitization. J Neuropsychiatry Clin Neurosci. [Feb 27 Epub ahead of print]. “Central sensitization is a process that links a variety of chronic pain disorders that are characterized by hypersensitivity to noxious stimuli and pain in response to non-noxious stimuli. Among these disorders, treatments that act centrally may have greater efficacy than treatments acting peripherally. Because many individuals with post-treatment Lyme syndrome (PTLS) have a similar symptom cluster, central sensitization may be a process mediating or exacerbating their sensory processing. This article reviews central sensitization, reports new data on sensory hyper arousal in PTLS, explores the potential role of central sensitization in symptom chronicity, and suggests new directions for neurophysiologic and treatment research.”

Camerini L, Schulz PJ, Nakamoto K. 2012. Differential effects of health knowledge and health empowerment over patients’ self-management and health outcomes: a cross-sectional evaluation. Patient Educ Couns. 89(2):337-344. “Results from this study suggest that health interventions targeted to chronic patients should focus simultaneously on knowledge and empowerment, rather than favoring one of these individual constructs.”

Deere KC, Clinch J, Holliday K et al. 2012. Obesity is a risk factor for musculoskeletal pain in adolescents: findings from a population-based cohort. Pain. 153(9):1932-1938. “Obese adolescents were more likely to report musculoskeletal pain, including knee pain and CRP (chronic regional pain). Moreover, obese adolescents with knee pain and CRP had relatively high pain scores, suggesting a more severe phenotype with worse prognosis.”

Fornasari D. 2012. Pain mechanisms in patients with chronic pain. Clin Drug Investig. 32 Suppl 1:45-52. “The mechanisms involved in the development of chronic pain are varied and complex. Pain processes are plastic and unrelieved pain may lead to changes in the neural structure involved in pain generation. Nociceptive pain announces the presence of a potentially damaging stimulus that occurs when noxious stimuli activate primary afferent neurons. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system resulting from trauma, infection, ischemia, cancer or other causes such as chemotherapy. The exact mechanisms involved in the pathophysiology of chronic pain are not well understood, but rapid and long-term changes are thought to occur in parts of the central nervous system that are involved in the transmission and modulation of pain following injury. Peripheral and central sensitization of sensory nerve fibres are the primary reasons for hypersensitivity to pain after injury, and mainly occur in inflammatory and neuropathic pain. During these processes the sensation of pain is enhanced as a result of changes in the environment, the nerve fibres and modifications of the functional properties and the genetic program of primary and secondary afferent neurons. Non-steroidal anti-inflammatory drugs and opioid analgesics are two of the most common classes of drugs used for the treatment of pain. Response to drug treatment shows significant inter-individual variability and can lead to side effects. The neurobiological mechanisms that cause pain may account for the different types of pain observed. Identification of these mechanisms may allow us to move from an empirical therapeutic approach to one that it is specifically targeted at the particular mechanisms of the type of pain experienced by an individual patient.”

Gleberzon B, Stuber K. 2013. Frequency of use of diagnostic and manual therapeutic procedures of the spine taught at the Canadian Memorial Chiropractic Collage:  preliminary survey of Ontario chiropractors. Part 1undefinedpractice characteristics and demographic profiles. J Can Chiropr Assoc 57(1):32-41. This study got a low response rate, but those responding reported highest use for “diversified technique” with specific trigger point therapy in second.

Han L, Ma C, Liu Q et al.  2013. A subpopulation of nociceptors specifically linked to itch.  Nat Neurosci 16(2):174-182. This team has found a new itch-specific type of neuron in mice. This is a big first step in developing itch-specific therapies that will stop itching that anti-histamines don’t help.

Hauser W, Urrutia G, Tort S et al. 2013. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database Syst Rev. 1:CD010292. “The SNRIs duloxetine and milnacipran provided a small incremental benefit over placebo in reducing pain. The superiority of duloxetine and milnacipran over placebo in reducing fatigue and limitations of QOL (quality of life) was not substantial. Duloxetine and milnacipran were not superior to placebo in reducing sleep problems. The dropout rates due to adverse events were higher for duloxetine and milnacipran than for placebo. The most frequently reported symptoms leading to stopping medication were nausea, dry mouth, constipation, headache, somnolence/dizziness and insomnia. Rare complications of both drugs may include suicidality, liver damage, abnormal bleeding, elevated blood pressure and urinary hesitation.”

Iannuccelli C, Spinelli FR, Guzzo MP et al. 2012. Fatigue and widespread pain in systemic lupus erythematosus and Sjogren’s syndrome: symptoms of the inflammatory disease or associated fibromyalgia? Clin Exp Rheumatol. 30(6 Suppl 74):117-121. “FM seems to contribute to constitutional symptoms more in SLE than in pSS, suggesting a different underlying cause of fatigue and widespread pain in these two different connective tissue diseases.”

Illes JD, Maola CJ. 2012. Chiropractic management of low back pain in a patient with a transfemoral amputation. J Chiropr Med. 11(3):179-185. “Chiropractic management included manipulative therapy to the lumbar spine and pelvis, trigger point therapy of hypertonic musculature, and strengthening of pelvic musculature. In addition, the patient's prosthetist shortened her new prosthetic device. After 18 treatments, LBP (low back pain) severity was resolved (0/10); and there was an overall improvement with gait biomechanics….This case illustrates the importance of considering leg length inequality in patients with amputations as a possible cause of lower back pain, and that proper management may include adjusting the length of the prosthetic device and strengthening of the hip flexors and abductors, in addition to trigger point therapy and chiropractic manipulation.”

Kashikar-Zuck S, Zafar M, Barnett KA et al. 2013. Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia. Clin J Pain. [Feb 26 Epub ahead of print]. “Chronic pain in children is associated with significant negative impact on social, emotional and school functioning.” “Youth with JFM (juvenile fibromyalgia) had significantly higher anxiety and depressive symptoms, and lower quality of life in all domains. Among children with CM (chronic migraine), overall functioning was higher but school functioning was a specific area of concern….Results indicate important differences in subgroups of pediatric pain patients and point to the need for more intensive multidisciplinary intervention for JFM patients.”

Kucuksen S, Genc E, Yilmaz H et al. 2013. The prevalence of fibromyalgia and its relation with headache characteristics in episodic migraine. Clin Rheumatol. [Feb 27 Epub ahead of print]. “This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain.”

Lee SJ, Kim DY, Chun MH et al. 2012. The effect of repetitive transcranial magnetic stimulation on fibromyalgia: a randomized sham-controlled trial with 1-month follow-up. Am J Phys Med Rehabil. 91(12):1077-1085. “Low-frequency rTMS may play a role in the long-term treatment of fibromyalgia. Notably, the findings of this study are the first to show that the right dorsolateral prefrontal cortex or the left motor cortex rTMS could have an antidepressive and pain-modulating effect in patients with fibromyalgia.”

Mannerkorpi K, Gard G. 2012. Hinders for continued work among persons with fibromyalgia. BMC Musculoskel Disord. 13:96. “Limited physical capacity and an increased need of rest made it difficult for these women to manage the physical, psychosocial and organizational work demands. Adjustment of the work tasks and work environment were the main factors influencing whether the women with FM could work or not.”

Martin KL, Blizzard L, Srikanth VK et al. 2013. Cognitive Function Modifies the Effect of Physiological Function on the Risk of Multiple Falls--A Population-Based Study. J Gerontol A Biol Sci Med Sci. [Feb 14 Epub ahead of print]. “A range of cognitive (executive function/attention, memory, processing speed, and visuospatial ability) and physiological functions (vision, proprioception, sway, leg strength, reaction time) were measured using standardized tests in 386 randomly selected adults aged 60-86. Incident falls were recorded over 12 months….Preventing falls due to physiological impairments in community-dwelling older people  may need to be tailored based on cognitive impairment, a key factor in their inability to compensate for physical decline.”

Mork P, Nilsson J, Loras H et al. 2013. Heart rate variability in fibromyalgia patients and healthy controls during non-REM and REM sleep: a case-control study. Scand J Rheumatol. [Feb 20 Epub ahead of print]. “RMSSD (root mean square successive difference), indicative of parasympathetic predominance, is attenuated in FM patients compared to HCs (healthy controls) during N2 (non-REM stage 2) sleep and REM sleep. This difference was not present for the HF component. HRV (heart rate variability) during sleep in FM patients is moderately and positively associated with sleep quality and moderately and negatively associated with neck/shoulder pain.”

Nijs J, Kosek E, Van Oosterwijck J et al. 2012. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician. 15(3 Suppl):ES205-213. “A dysfunctional response of patients with chronic pain and aberrations in central pain modulation to exercise has been shown, indicating that exercise therapy should be individually tailored with emphasis on prevention of symptom flares.”

Reed BD, Harlow SD, Sen A et al. 2012. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet Gynecol. 120(1):145-151. “Chronic pain conditions are common, and a subgroup of women with vulvodynia is more likely than those without vulvodynia to have one or more of the three other chronic pain conditions (interstitial cystitis, fibromyalgia, and irritable bowel syndrome) evaluated.”

Torma LM, Houck GM, Wagnild GM et al. 2013. Growing old with fibromyalgia: factors that predict physical function. Nurs Res. 62(1):16-24. “Resilience, a novel variable in fibromyalgia research, was a unique predictor of physical function. Further research is needed to learn more about the relationships between resilience, fibromyalgia impact, and the aging process….Resilience was not a moderator of fibromyalgia pain and physical function; resilience did contribute uniquely to physical function variance.”

Uceyler N, Zeller D, Kahn AK et al. 2013. Small fibre pathology in patients with fibromyalgia syndrome. Brain. [Epub Mar 9]This case control study of 25 patients investigated shape and function of small nerve fibers through punch biopsies of the upper thigh and lower leg, plus patient neurological assessment. FM patients had increased  neuropathic findings in questionnaires. Compared with healthy controls and patients with depression, FM patients had impaired small fiber function with increased cold and warm sensation thresholds and increased reaction to touch/pain stimuli.  There were a smaller number of unmyelinated nerve fiber bundles in the skin of FM patients compared to the others, although mylinated nerve fibers were equal in all groups. This study indicates that pain in FM has a neuropathic nature.[These patients were not screened for co-existing myofascial trigger points and related microcirculation abnormalities and nerve entrapment. DJS]

Willigenburg NW, Kingma I, Hoozemans MJ et al. 2013. Precision control of trunk movement in low back pain patients. Hum Mov Sci. [Feb 19 Epub ahead of print]. “Motor control is challenged in tasks with high precision demands. In such tasks, signal-dependent neuromuscular noise causes errors and proprioceptive feedback is required for optimal performance. Pain may affect proprioception, muscle activation patterns and resulting kinematics. Therefore, we investigated precision control of trunk movement in

18 low back pain (LBP) patients and 13 healthy control subjects. …These results suggest that reduced precision in LBP patients might be explained by proprioceptive deficits. Ratios of antagonistic over agonistic muscle activation were similar between groups. Tracking errors increased trunk inclination, but no significant relation between tracking error and agonistic muscle activation was found. Tracking errors did not decrease when antagonistic muscle activation increased, so, neither healthy subjects nor LBP patients appear to counteract trunk movement errors by increasing co-contraction.”


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