March 2014 References  Devin J. Starlanyl   for

Andrell P, Schultz T, Mannerkorpi K et al. 2014. Health-related quality of life in fibromyalgia and refractory angina pectoris: A comparison between two chronic non-malignant pain disorders. J Rehabil Med. [Feb 14 Epub ahead of print.] “Patients with fibromyalgia experience greater impairment in health-related quality of life compared with the normal population than do patients with refractory angina pectoris, despite the fact that the latter have a potentially life-threatening disease. The great impairment in health- related quality of life in patients with fibromyalgia should be taken into consideration when planning rehabilitation.”

Arnstein PM. 2013. The future of topical analgesics.  Postgrad Med. 125(4 Suppl 1):34-41. “Before modem pharmaceuticals became readily available, mud-based emollients, salves, cold therapies, and other natural remedies were often used. Now we have effective therapies and are developing advanced topical analgesics as we learn more about the physiology and pathophysiology of pain. The use of topical analgesics may be associated with fewer patient systemic side effects than are seen with oral, parenteral, or transdermally administered agents, making the topical route of administration attractive to prescribers and patients. With further refinement of existing drugs and the development of novel agents, topical analgesics may offer relief for treating patient pain conditions that are currently challenging to treat, such as pain resulting from burns, wound debridement, and pressure ulcers. Recognizing the value of a multimodal approach, topical analgesics may offer a therapeutic option that can become part of a comprehensive treatment plan for the patient. With continued advancements in targeted drug-delivery systems, topical analgesics may be able to provide a method to prevent or reverse the phenomena of peripheral and central sensitization, or the neuroplastic changes believed to be responsible for the transition from acute to chronic pain states in patients. For those patients at risk for developing chronic pain states, such as complex regional pain syndrome, the combination of cutaneous stimulation (achieved through rubbing during application) and analgesic effects produced by the drug itself may prevent the disabling pain that often emerges during the subacute phase of disease. In summary, better utilization of currently available topical analgesics and continued research promise to ensure that topical analgesics are, and will continue to be, important tools in the treatment of patients with resistant pain.”

Bedaiwy MA, Patterson B, Mahajan S. 2013. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med. 58(11-12):504-510. “A retrospective chart review was performed on all women who presented to our facility between January 2005 and December 2007. Those diagnosed with myofascial pelvic pain and referred for transvaginal pelvic floor physical therapy over this 3-year period were evaluated. Participants with an initial pain score of > or = 4, myofascial pelvic pain on examination, and who attended 2 or more physician visits were included in the analysis. Patient physical examination findings, symptoms, and verbal pain ratings were reviewed….In all, 146 (13.2%) of 1,106 initially screened patients were diagnosed with myofascial pain. Seventy-five (51%) of the 146 patients who were referred for physical therapy were included, and 75% had an initial pain score of > or = 7. Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement….Transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain.”

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.”

Davis MC, Thummala K, Zautra AJ et al. 2014. Stress-related clinical pain and mood in women with chronic pain: Moderating effects of depression and positive mood induction. Ann Behav Med. [Feb 15 Epub ahead of print.]  “Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions.”

Dubrovsky B, Raphael KG, Lavigne GJ et al. 2014. Polysomnographic investigation of sleep and respiratory parameters in women with temporomandibular pain disorders. J Clin Sleep Med. 10(2):195-201. “Myofascial pain in TMD is associated with mild elevation in sleep fragmentation and increased frequency of RERA (respiratory effort related arousals events). Further research is required to evaluate the clinical significance of these findings.”

Fernandez-de-Las-Penas C, Ortega-Santiago R, Ortíz-Gutierrez R et al. 2014. Widespread Pressure Pain Hypersensitivity in Patients with Multiple Sclerosis with and Without Pain as Sign of Central Sensitization. Clin J Pain. [Feb 12 Epub ahead of print.] “Our study found widespread pressure pain hyperalgesia in individuals with MS as compared to healthy controls. No differences existed between MS patients with pain and those without pain in the presence of widespread pressure sensitivity. Current results suggest that MS is associated with sensory hyper-excitability of the central nervous system or dysfunction in endogenous pain modulatory systems.”

Fernandez-de-Las-Penas C, Penacoba-Puente C, Cigaran-Mendez M et al. 2014. Has catechol-O-methyltransferase genotype (Val158Met) an influence on endocrine, sympathetic nervous and humoral immune systems in women with fibromyalgia syndrome? Clin J Pain. 30(3):199-204.

“Stress can play an important role in etiology of fibromyalgia syndrome (FMS) by activating the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic nervous system (SNS), and altering the immune system. The current study examined the influence of catechol-O-methyltransferase (COMT) Val158Met genotypes on salivary markers of HPA axis (cortisol), SNS (α-amylase), and immune (IgA) systems in women with FMS….The results suggest that women with FMS with the Met/Met genotype exhibit greater disturbed activity of the SNS and humoral immune system. These results provide initial evidence of a link between Val158Met polymorphism and dysfunctions in the SNS and humoral immune system in women with FMS.”

Garza-Villarreal EA, Wilson AD, Vase L et al. 2014. Music reduces pain and increases functional mobility in fibromyalgia. Front Psychol. 5:90. “Twenty-two FM patients were passively exposed to (1) self-chosen, relaxing, pleasant music, and to (2) a control auditory condition (pink noise). They rated pain and performed the "timed-up & go task (TUG)" to measure functional mobility after each auditory condition. Listening to relaxing, pleasant, self-chosen music reduced pain and increased functional mobility significantly in our FM patients. The music-induced analgesia was significantly correlated with the TUG scores; thereby suggesting that the reduction in pain unpleasantness increased functional mobility. Notably, this mobility improvement was obtained with music played prior to the motor task (not during), therefore the effect cannot be explained merely by motor entrainment to a fast rhythm. Cognitive and emotional mechanisms seem to be central to music-induced analgesia. Our findings encourage the use of music as a treatment adjuvant to reduce chronic pain in FM and increase functional mobility thereby reducing the risk of disability.”

Gilbert JW, Vogt M, Windsor RE et al. 2014. Vestibular dysfunction in patients with chronic pain or underlying neurologic disorders. J Am Osteopath Assoc.114(3):172-178. “Individuals with vestibular dysfunction are at increased risk for falling. In addition, vestibular dysfunction is associated with chronic pain, which could present a serious public health concern as approximately 43% of US adults have chronic pain.”  Using a retrospective review of records, the authors found that: “Patients being treated with medications for chronic, noncancer pain or other underlying neurologic disorders may have a higher-than-average incidence of vestibular dysfunction. Baseline assessment and monitoring of the vestibular apparatus may be indicated for these patients.

Haliloglu S, Carlioglu A, Sahiner E et al. 2014. Mean platelet volume in patients with fibromyalgia. Z Rheumatol.  [Feb 20 Epub ahead of print.] “These results suggest that an early atherosclerosis marker, mean platelet volume, is elevated in patients with fibromyalgia. This indicates increased platelet activation and therefore a higher risk of future cardiovascular disease.”

Hoeger Bement MK, Weyer AD, Yoon T et al. 2014. Corticomotor excitability during a noxious stimulus before and after exercise in women with fibromyalgia. J Clin Neurophysiol. 31(1):94-98. “The purposes of this study were to assess corticomotor excitability in people with fibromyalgia during a noxious stimulus before and after fatiguing exercise and examine associations with pain perception. Fifteen women with fibromyalgia completed three sessions: one familiarization and two experimental. The experimental sessions were randomized and involved measurement of pain perception and motor evoked potentials before and after (1) quiet rest and (2) isometric contraction of the elbow flexor muscles. Motor evoked potential amplitude of brachioradialis muscle was measured following transcranial magnetic stimulation delivered before, during, and after a noxious mechanical stimulus. After quiet rest, there was no change in pain perception. After the submaximal contraction, there was considerable variability in the pain response. Based on the changes in the experimental pain, subjects were divided into three groups (increase, decrease, and no change in pain). There was an interaction between pain response and the pain-induced change in motor evoked potentials. Those individuals who had an increase in motor evoked potentials during the pain test had an increase in pain after exercise. Thus, women with fibromyalgia were classified based on their pain response to exercise, and this response was associated with the change in corticomotor excitability during the application of a noxious stimulus.”

Holey LA, Dixon J. 2014. Connective tissue manipulation: A review of theory and clinical evidence. J Bodyw Move Ther. 18:112-118. “Connective tissue manipulation or connective tissue massage (bindegewebsmassage) is a manual reflex therapy in that it is applied with the therapist’s hands which are in contact with the patient’s skin. The assessment of the patient and the clinical decision-making that directs treatment is based on a theoretical model that assumes a reflex effect on the autonomic nervous system which is induced by manipulating the fascial layers within and beneath the skin to stimulate cutaneo-visceral reflexes. This paper reviews the literature and current research findings to establish the theoretical framework for CTM and the evidence for its clinical effects. The rationale for the principles of treatment is discussed and the evidence for the clinical effectiveness assessed through an analytical review of the clinical research.” [This paper indicates to me that CTM would be an excellent therapy option for chronic myofascial pain.  If fibromyalgia central sensitization were also involved, therapy would, as always, require modification.  DJS]

Jiao J, Vincent A, Cha SS et al. 2014. Relation of age with symptom severity and quality of life in patients with fibromyalgia. Mayo Clin Proc. 89(2):199-206.  “Our study shows that symptom severity and QOL differ across age groups in patients with fibromyalgia, with young and middle-aged patients having poorer QOL and worse fibromyalgia symptoms than do older patients. QOL in physical health was reduced more than in mental health, particularly in young patients, compared with the general population.” [Possibly due to myofascial trigger points, the symptom generators, becoming latent. DJS]

Kashikar-Zuck S, Cunningham N, Sil S et al. 2014. Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics. [Feb 24 Epub ahead of print.]

“Adolescent patients with JFM have a high likelihood of continued fibromyalgia symptoms into young adulthood. Those who met criteria for fibromyalgia in adulthood exhibited the highest levels of physical and emotional impairment. Emerging differences in educational attainment and marital status were also found in the JFM group. JFM is likely to be a long-term condition for many patients, and this study for the first time describes the wide-ranging impact of JFM on a variety of physical and psychosocial outcomes that seem to diverge from their same-age peers.”

Lapane KL, Quilliam BJ, Benson C et al. 2014. Impact of noncancer pain on health-related quality of life. Pain Pract. [Feb 27 Epub ahead of print.]  “Among outpatients with various underlying causes of pain, the negative impact of pain on physical and mental health-related quality of life is significant.”

Mason JS, Tansey KA, Westrick RB. 2014. Treatment of subacute posterior knee pain in an adolescent ballet dancer utilizing trigger point dry needling: a case report. Int J Sports Phys Ther. 9(1):116-124. “The subject was a 16-year-old female competitive ballet dancer referred to physical therapy with a two month history of right posterior knee pain. Palpation identified MTPs which reproduced the patient's primary symptoms. In addition to an exercise program promoting lower extremity flexibility and hip stability, the subject was treated with DN to the right gastrocnemius, soleus, and popliteus muscles….The patient was able to return to high level dance training and competition without physical limitations and resumed pre-injury dynamic movement activities including dancing, running, jumping, and pivoting without pain. DN can be an effective and efficient intervention to assist patients in decreasing pain and returning to high intensity physical activity. Additional research is needed to determine if DN is effective for other body regions and has long-term positive outcomes.”

Ma W, Quirion R. 2014.  Targeting cell surface trafficking of pain-facilitating receptors to treat chronic pain conditions. Expert Opin Ther Targets. [Feb 10 Epub ahead of print.] “Pain mediators stimulate forward surface trafficking of their own and/or other pain-facilitating receptors to amplify pain intensity and duration. Enhancing surface abundance of pain-facilitating receptors in nociceptors and dorsal horn neurons is an important mechanism underpinning chronic pain states. Targeting specific trafficking events of pain-facilitating receptors may open a novel therapeutic avenue to more efficiently treat chronic pain conditions.”

McBeth J, Lacey RJ, Wilkie R. 2014. Predictors of new-onset widespread pain in older adults: Results from a population-based prospective cohort study in the UK. Arthritis Rheumatol. 66(3):757-767. “This study sought to identify factors associated with an increased risk of developing WP in adults age ≥50 years….A population-based prospective study was conducted. A baseline questionnaire was administered to subjects to collect data on pain, psychological status, lifestyle and health behaviors, and sociodemographic and clinical factors. Participants free of WP (as defined by the American College of Rheumatology 1990 criteria for fibromyalgia) were followed up for 3 years, and those with new-onset WP at follow-up were identified. …Of the factors measured in this study, nonrestorative sleep was the strongest independent predictor of new-onset WP.”

Mejuto-Vazquez MJ, Salom-Moreno J, Ortega-Santiago R et al. 2014. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: A randomized clinical trial. J Orthop Sports Phys Ther. [Feb 25 Epub ahead of print.] “The results of the current randomized clinical trial suggest that a single session of TrP-DN decreases neck pain intensity and widespread pressure sensitivity, and also increases active cervical range of motion in patients with acute mechanical neck pain. Changes in pain, PPT, and cervical range of motion surpassed their respective minimal detectable change values supporting clinically relevant treatment effects.”   

Myers T. 2014. Spatial medicine – A call to ‘arms’. J Bodyw Mov Ther. 18:94-98. “A comprehensive and coherent approach to spatial patterning in human posture and movement is visible on the horizon. Advances in the study of fascia, neural plasticity, and epigenetics allow an overarching theory to unite all who work in human movement from osteopaths to personal trainers. Trainers, rehab specialists, manual therapists and physical educators are joining to embrace and develop this unifying construct to help our growing children meet the demands of the 21st century electronic environment.”

Pitcher GM, Ritchie J, Henry JL. 2013. Peripheral neuropathy induces cutaneous hypersensitivity in chronically spinalized rats. Pain Med. 14(7):1057-1071. “Our findings demonstrate an aberrant peripheral/spinal mechanism that induces and maintains thermal and to a greater degree tactile cutaneous hypersensitivity in the cuff model of neuropathic pain, and raise the prospect that altered peripheral/spinal nociceptive mechanisms in humans with peripheral neuropathy may have a pathologically relevant role in both inducing and sustaining neuropathic pain.”

Rossi DM, Morcelli MH, Marques NR et al. 2014. Antagonist coactivation of trunk stabilizer muscles during Pilates exercises. J Bodyw Mov Ther. 18:34-41.  Pilates practitioners must be aware that some of their strategies could make some patients worse.  One must be aware of compensatory muscle recruitment and other adjustments the body has made. [This is often due to trigger points.] “This suggests that the exercises of Skilled Modern Pilates only should be performed after appropriate learning and correct execution of all principles, mainly the Centering Principle.”

Salaffi F, De Angelis R, Carotti M et al. 2014. Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatol Int. [Feb 8 Epub ahead of print.]  “FM is common in axial-SpA and more prevalent in female patients. Our findings suggest that ASDAS (Ankylosing Spondylitis Disease Activity Score) is better than BASDAI (Bath Ankylosing Spondylitis Activity Disease Activity Index) in distinguishing patients with disease activity from those with functional impairment. The use of ASDAS may be very useful in clinical practice as it allows treating patients with the most appropriate therapy.”

Salomons TV, Moayedi M, Erpelding N et al. 2014. A brief cognitive-behavioral intervention for pain reduces secondary hyperalgesia.  Pain. [Feb 22 Epub ahead of print.] “Repeated exposure to pain can result in sensitization of the central nervous system enhancing subsequent pain and potentially leading to chronicity. The ability to reverse this sensitization in a top-down manner would be of tremendous clinical benefit but the degree that this can be accomplished volitionally   remains unknown(intervention could modify pain perception and reduce central sensitization (as reflected by secondary hyperalgesia). In each of eight sessions, two groups of healthy human subjects received a series of painful thermal stimuli that resulted in secondary hyperalgesia. One group ("Regulate") was given brief pain-focused cognitive training at each session while the other group ("Control") received a non-pain focused intervention. The intervention selectively reduced pain unpleasantness but not pain intensity in the Regulate group. Furthermore, secondary hyperalgesia was significantly reduced in the Regulate group compared with the Control group. Reduction in secondary hyperalgesia was associated with reduced pain catastrophizing, suggesting that changes in central sensitization are related to changes in pain-related cognitions. Thus, we demonstrate that central sensitization can be modified volitionally by altering pain-related thoughts.”

Schwaller F, Fitzgerald M. 2014. The consequences of pain in early life: injury-induced plasticity in developing pain pathways. Eur J Neurosci. 39(3):344-352.  “Pain in infancy influences pain reactivity in later life, but how and why this occurs is poorly understood. Here we review the evidence for developmental plasticity of nociceptive pathways in animal models and discuss the peripheral and central mechanisms that underlie this plasticity. Adults who have experienced neonatal injury display increased pain and injury-induced hyperalgesia in the affected region but mild injury can also induce widespread baseline hyposensitivity across the rest of the body surface, suggesting the involvement of several underlying mechanisms, depending upon the type of early life experience. Peripheral nerve sprouting and dorsal horn central sensitization, disinhibition and neuroimmune priming are discussed in relation to the increased pain and hyperalgesia, while altered descending pain control systems driven, in part, by changes in the stress/HPA axis are discussed in relation to the widespread hypoalgesia. Finally, it is proposed that the endocannabinoid system deserves further attention in the search for mechanisms underlying injury-induced changes in pain processing in infants and children.”

Sheth T, Pitchumoni CS, Das KM. 2014. Musculoskeletal manifestations in inflammatory bowel disease: A revisit in search of immunopathophysiological mechanisms. J Clin Gastroenterol. [Jan 31 Epub ahead of print.] “Inflammatory bowel diseases are chronic inflammatory disorders of multiple organ systems, primarily involving the gut, with chronic relapsing and remitting course. Musculoskeletal involvement is the most common extraintestinal manifestation. Distinct cell-mediated and humoral immunopathophysiological mechanisms have been identified underlying gut and joint inflammation in patients with inflammatory bowel disease and arthritis. Genetic polymorphisms in genes coding for NOD2 and IL12/IL23 complex lead to impaired antigenic handling in the gut and local immune dysregulation. The gut-synovial axis hypothesis implicates both environmental and host factors acting as triggers to initiate inflammation in genetically predisposed individuals, leading to priming of Th1 and Th17 lymphocytes in the gut and subsequent homing to the synovial tissue. Similar to gut, antibody-dependent cell-mediated cytotoxicity and complement-mediated cell lysis may also contribute to the joint damage. Involvement of peripheral joints occurs in 2 distinct manners, one being oligoarticular asymmetric arthritis associated with active disease and the other being polyarticular symmetric involvement of small joints. The axial involvement may include asymptomatic sacroiliitis, inflammatory back pain, and ankylosing spondylitis, running an independent clinical course. Noninflammatory involvement of the musculoskeletal system may present as osteopenia, osteonecrosis, fibromyalgia, or myopathies, leading to significant impact on quality of life.”


Staud R, Weyl EE, Riley JL 3rd et al. 2014. Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients. PLoS One. 9(2):e89086.  “In healthy individuals slow temporal summation of pain or wind-up (WU) can be evoked by repetitive heat-pulses at frequencies of ≥.33 Hz. Previous WU studies have used various stimulus frequencies and intensities to characterize central sensitization of human subjects including fibromyalgia (FM) patients. However, many trials demonstrated considerable WU-variability including zero WU or even wind-down (WD) at stimulus intensities sufficient for activating C-nociceptors. Additionally, few WU-protocols have controlled for contributions of individual pain sensitivity to WU-magnitude, which is critical for WU-comparisons. ….Slope of WU-RF, which is representative of central pain sensitivity, was significantly steeper in FM patients than NC (normal controls) ....Compared to single WU series, WU-RFs integrate individuals' pain sensitivity as well as WU and WD. Slope of WU-RFs was significantly different between FM patients and NC. Therefore WU-RF may be useful for assessing central sensitization of chronic pain patients in research and clinical practice.”  Free PMC Article

Streit RS. 2014. NTOS symptoms and mobility: A case study on neurogenic thoracic outlet syndrome involving massage therapy. J Bodyw Mov Ther. 18:42-48. “Neurogenic thoracic outlet syndrome (NTOS) is a neuromuscular condition affecting brachial plexus functionality. NTOS is characterized by paresthesia, pain muscle fatigue, and restricted mobility in the upper extremity. This study quantified massage therapy’s possible contribution to treatment of NTOS. A 24-year-old female with NTOS received eight treatments over 35 days. Treatment included myofascial release, trigger point therapy, cross fiber friction, muscle stripping, and gentle passive stretching. Abduction and lateral rotation at the glenohumeral (GH joint) assessments measured range of motion (ROM). A resisted muscle test evaluated upper extremity strength. The client rated symptoms daily via a visual analog scale (VAS). Findings showed improvement in ROM at the GH joint. VAS ratings revealed a reduction in muscle weakness, pain, numbness, and ‘paresthesia’. Results suggest massage may be useful as part of a broad approach to managing NTOS symptoms and improving mobility.”


Tanriverdi O. 2014. Is a new perspective for definition and diagnostic criteria of fibromyalgia in early stage cancer patients necessary? Med Hypotheses. [Jan 27 Epub ahead of print.]  “Fibromyalgia is a most common pain syndrome characterized by the presence of chronic widespread pain and tenderness with manual palpation. However there is not enough data about frequency of fibromyalgia syndrome in patients with cancer. How often FM is being used in oncological practice and how are we managing this case by medical oncologists. Widespread pain index and symptom severity scale are not clear enough in patients with cancer when ACR-2010 diagnostic criteria for FM are considered. In conclusion, there is it may more prevalence of fibromyalgia in patients with cancer. For the diagnosis of fibromyalgia, (there may need to) be new diagnostic criteria for early-stage cancer patients.”

Ullrich A, Hauer J, Farin E. 2014. Communication preferences in patients with fibromyalgia syndrome: descriptive results and patient characteristics as predictors. Patient Prefer Adherence. 8:135-145. “Communication with patients with fibromyalgia syndrome (FMS) is often considered difficult. The primary objective of this explorative study was to describe the communication preferences of FMS patients in comparison with other chronic diseases, and the secondary objective was to identify patient-related predictors of those communication preferences….Health care providers who communicate with FMS patients should employ an open and patient-centered communication style, and affective communication components should be adapted to accommodate each patient.”

Vincent A, Clauw D, Oh TH et al. 2014. Decreased physical activity attributable to higher body mass index influences fibromyalgia symptoms. PM R. [Feb 14 Epub ahead of print.] “The relationship between BMI and fibromyalgia impact was almost fully accounted for by physical factors and not psychological factors….Despite patient report that pain hinders physical activity, clinicians who encounter patients with fibromyalgia, particularly patients with increased BMI, should be cognizant to invest time and resources to counsel patients on physical factors (i.e., physical activity) that could improve the patient's symptom experience.”

Wang D, Couture R, Hong Y. 2014.  Activated microglia in the spinal cord underlies diabetic neuropathic pain. Eur J Pharmacol. [Feb 6 Epub ahead of print.] “Diabetes mellitus is an increasingly common chronic medical condition. Approximately 30% of diabetic patients develop neuropathic pain, manifested as spontaneous pain, hyperalgesia and allodynia. Hyperglycemia induces metabolic changes in peripheral tissues and enhances oxidative stress in nerve fibers. The damages and subsequent reactive inflammation affect structural properties of Schwann cells and axons leading to the release of neuropoietic mediators, such as pro-inflammatory cytokines and pro-nociceptive mediators. Therefore, diabetic neuropathic pain (DNP) shares some histological features and underlying mechanisms with traumatic neuropathy. DNP displays, however, other distinct features; for instance, sensory input to the spinal cord decreases rather than increasing in diabetic patients. Consequently, development of central sensitization in DNP involves mechanisms that are distinct from traumatic neuropathic pain. In DNP, the contribution of spinal cord microglia activation to central sensitization and pain processes is emerging as a new concept. Besides inflammation in the periphery, hyperglycemia and the resulting production of reactive oxygen species affect the local microenvironment in the spinal cord. All these alterations could trigger resting and sessile microglia to the activated phenotype. In turn, microglia synthesize and release pro-inflammatory cytokines and neuroactive molecules capable of inducing hyperactivity of spinal nociceptive neurons. Hence, it is imperative to elucidate glial mechanisms underlying DNP for the development of effective therapeutic agents. The present review highlights the recent developments regarding the contribution of spinal microglia as compelling target for the treatment of DNP.”

Wassinger CA, McKinney H, Roane S et al. 2014. The influence of upper body fatigue on dynamic standing balance. Int J Sports Phys Ther. 9(1):40-46. “Physical therapists should be aware of the adverse influence distant fatigue may exhibit on neuromuscular control in muscles not actively involved in the fatiguing exercise. The balance deficits noted may indicate an increased risk of injury with muscle fatigue in muscles not directly contributing to standing balance.”

Wilhelmsen K, Kvale A. 2014. Individuals with unilateral vestibular damage--examination and treatment with focus on the musculoskeletal system: A case series. Phys Ther. [Feb 20 Epub ahead of print.] “The purpose of this case series is to address the examination and treatment of musculoskeletal dysfunction seen in patients with unilateral vestibular hypofunction (UVH).Case Description: The musculoskeletal system was evaluated with the Global Physiotherapy Examination, dynamic balance was measured during walking using tri-axial accelerometers positioned on the lower and upper trunk, symptoms and functional limitations were assessed with standardized self-report measures. “The four patients had symptoms of severe dizziness lasting more than a year after the onset of the vestibular dysfunction with moderate level of perceived disability. Musculoskeletal abnormalities typically included postural misalignment, restricted abdominal respiration, restricted trunk movements and tense muscles of the upper trunk and neck. The patients participated in a modified vestibular rehabilitation program consisting of body awareness exercises addressing posture, movements and respiration….Following intervention self-reported symptoms and perception of disability improved. Improvements in mobility and positive physical changes were particularly found in the upper trunk and in respiratory movements. The attenuation of medio-lateral accelerations in the upper trunk changed; a relatively more stable upper and concomitantly more flexible lower trunk was identified during walking in three patients….The recovery process is possibly influenced by self-inflicted rigid body movements and behavior strategies that prevent compensation. By addressing physical dysfunctions and enhancing body awareness directly, and dizziness indirectly, it may be possible to break a self-sustaining circle of dizziness and musculoskeletal problems in patients with UVH. Considering the body as a functional unit and including both the musculoskeletal and vestibular systems in the examination and treatment may be important.”


Wolfe F, Walitt BT, Katz RS et al. 2014. Symptoms, the nature of fibromyalgia, and diagnostic and statistical Manual 5 (DSM-5) defined mental illness in patients with rheumatoid arthritis and fibromyalgia. PLoS One. 9(2):e88740. “All patients with fibromyalgia will satisfy the DSM-5 "A" criterion for distressing somatic symptoms, and most would seem to satisfy DSM-5 "B" criterion because symptom impact is life-disturbing or associated with substantial impairment of function and quality of life. But the "B" designation requires special knowledge that symptoms are "disproportionate" or "excessive," something that is uncertain and controversial. The reliability and validity of DSM-5 criteria in this population is likely to be low.”


Wolfe F, Walitt BT, Katz RS et al. 2014. Social security work disability and its predictors in patients with fibromyalgia. Arthritis Care Res (Hoboken). [Feb 10 Epub ahead of print.]  “The prevalence of SSD is high in fibromyalgia, but not higher than in RA and OA patients who satisfy fibromyalgia criteria. The best predictors of work disability are functional status variables. “

Younger J, Parkitny L, McLain D. 2014. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clin Rheumatol. [Feb 15 Epub ahead of print.]  “Low-dose naltrexone (LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn's disease, multiple sclerosis, and complex regional pain syndrome. We review the evidence that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on opioid receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated. Despite initial promise of efficacy, the use of LDN for chronic disorders is still highly experimental. Published trials have low sample sizes, and few replications have been performed. We cover the typical usage of LDN in clinical trials, caveats to using the medication, and recommendations for future research and clinical work. LDN may represent one of the first glial cell modulators to be used for the management of chronic pain disorders.”



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