May 2013 References  Devin J. Starlanyl   for

Adams K, Gregory WT, Osmundsen B et al. 2013. Levator myalgia: why bother? Int Urogynecol J. [Apr 11 Epub ahead of print].  “Levator myalgia is a prevalent condition in urogynecology practice, and is associated with approximately 50 % greater bother in urinary, defecatory, and prolapse symptoms.” [Levator myalgia is a description given to the pain and dysfunction commonly caused by levator ani and other pelvic floor trigger points. DJS]

Bettoni L, Bonomi FG, Zani V et al. 2013. Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin Rheumatol. [May 2 Epub ahead of print]. “Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life, in comparison with the non-cryo treated fibromyalgic subjects, as indicated by the scores of the qualitative indexes and sub-indexes that are widely recognized tools to assess the overall health status and the effect of the treatments. We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain.”

Braz AS, Morais LC, Paula AP et al. 2013. Effects of Panax ginseng extract in patients with fibromyalgia: a 12-week, randomized, double-blind, placebo-controlled trial. Rev Bras Psiquiatr. 35(1):21-28. “The purpose of the study was to evaluate the efficacy of an extract of Panax ginseng in patients with fibromyalgia. A randomized, double-blind, controlled clinical trial was carried out over 12 weeks to compare the effects of P. ginseng (100 mg/d) with amitriptyline (25 mg/d) and placebo in 38 patients with fibromyalgia…. The beneficial effects experienced by patients for all parameters suggest a need for further studies to be performed on the tolerability and efficacy of this phytotherapic as a complementary therapy for fibromyalgia.”

Casanueva B, Rivas P, Rodero B et al. 2013. Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatol Int. [Apr 23 Epub ahead of print]. “…patients severely affected by fibromyalgia can obtain short-term improvements following weekly dry needling for 6 weeks.”  [It is suspected that these researchers are actually treating co-existing myofascial trigger points, but since the researchers did not assess for TrPs, this is only speculation. DJS}

Castro-Marrero J, Cordero MD, Saez-Francas N et al. 2013. Could mitochondrial dysfunction be a differentiating marker between Chronic Fatigue Syndrome and Fibromyalgia? Antioxid Redox Signal. [Apr 22 Epub ahead of print]. “…mitochondrial dysfunction-dependent events could be a marker of differentiation between CFS and FM indicating the mitochondria as a new potential therapeutic target for these conditions.”

Couto C, de Souza IC, Torres IL et al. 2013. Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: A randomized sham-controlled clinical trial. Clin J Pain. [Apr 25 Epub ahead of print]. “This study highlighted the greater efficacy of MDIMST (multiple deep intramuscular stimulation therapy) over the placebo-sham and (LTrP-I TrP lidocaine injection) and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities.”

Drummond PD, Willox M. 2013. Painful effects of auditory startle, forehead cooling and psychological stress in patients with fibromyalgia or rheumatoid arthritis. J Psychosom Res. 74(5):378-383. “These findings suggest that processes linked with individual differences in distress aggravate pain in rheumatoid arthritis, whereas some other mechanism (e.g., failure of stress-related pain modulation processes or an aberrant interaction between nociceptive afferent and sympathetic efferent fibers) triggers stress-induced pain in fibromyalgia.”

Gonzalez-Roldan AM, Munoz MA, Cifre I et al. 2013. Altered psychophysiological responses to the view of others' pain and anger faces in fibromyalgia patients. J Pain. [Apr 25 Epub ahead of print].  “Our findings suggest that brain and cardiac activity elicited by viewing facial expressions of pain and anger in others is altered in fibromyalgia patients. This cognitive bias toward negative emotions could be used in clinical settings as a psychobiological marker during the assessment and treatment of fibromyalgia.”

Gui MS, Pedroni CR, Aquino LM et al. 2013. Facial pain associated with fibromyalgia can be marked by abnormal neuromuscular control: A cross-sectional study. Phys Ther. [Apr 18 Epub ahead of print].  “Altered neuromuscular control in masticatory muscles may be correlated with perceived facial pain in patients with FMS.”  [This altered neuromuscular control is probably due to co-existing trigger points. FM researchers must learn to recognize TrPs. DJS]

May research update: Hackshaw KV, Rodriguez-Saona L, Plans M et al. 2013. A bloodspot-based diagnostic test for fibromyalgia syndrome and related disorders. Analyst. [Apr 17 Epub ahead of print]. “The aim of this study was to investigate the ability of a rapid biomarker-based method for diagnosis of fibromyalgia syndrome (FM) using mid-infrared microspectroscopy (IRMS) to differentiate patients with FM from those with osteoarthritis (OA) and rheumatoid arthritis (RA), and to identify molecular species associated with the spectral patterns….Metabolomic analysis revealed that RA and OA groups were metabolically similar, whereas biochemical differences were identified in the FM that were quite distinctive from those found in the other two groups. Both IRMS and metabolomic analysis identified changes in tryptophan catabolism pathway that differentiated patients with FM from those with RA or OA.”

Hampson JP, Reed BD, Clauw DJ et al. 2013. Augmented Central Pain Processing in Vulvodynia. J Pain. pii: S1526-5900(13)00805-5. “Vulvodynia (VVD) is a chronic pain disorder wherein women display sensitivity to evoked stimuli at the vulva and/or spontaneous vulvar pain. Our previous work suggests generalized hyperalgesia in this population; however, little is known about central neurobiological factors that may influence pain in VVD…..The presence of augmented brain responses to pressure stimuli remote from the vulva was observed in vulvodynia patients. These findings may guide treatment decisions for better response, as brain mechanisms may be a factor in some VVD patients.” [Researchers must learn to consider the causes of the pain, including trigger points, and the causes of hyperalgesia (or FM).  DJS]

Hsu RY, Bariteau J. 2013. Management of ankle fractures. R I Med J. 96(5):23-27. “Ankle fractures are a common injury across all age groups. Management may be operative or nonoperative, depending on the severity of the injury and the patient's overall health and functional status. Although imaging defines the nature of the fracture, a careful history and physical also helps determine the patient's plan of care. Initial management is focused on adequate alignment and safe immobilization of the injury. Definitive management must provide anatomic alignment of the joint as well as consideration of the surrounding soft tissues. Rehabilitation after either operative or nonoperative treatment aims at restoring range of motion, strength, proprioception, and function.” [Often it is the imagery that is treatedundefinedthe MRI, X-ray or whatever, rather than the patient. The soft tissue is immobilized (and usually untreated) while the bone is in a cast. We must remember the importance of soft tissue. DJS]

Itza F, Zarza D, Salinas J et al. 2013. Anal stretching device for patients with chronic prostatitis and chronic pelvic pain syndrome. Arch Esp Urol. 66(2):201-205. [Article in English, Spanish].  “Chronic pelvic pain syndrome (CPPS) is a poorly understood and ill-treated condition. It is accompanied by the shortening and increase in tone of the pelvic floor muscles and is closely related to myofascial pain syndrome (MPS). This study aims to evaluate the utility of an anal stretching device (ASD) for improving the pain manifestations of chronic prostatitis (CP) and CPPS….ASD appears to be a safe and useful tool to treat the pain manifestations of CPPS without notable side effects.” [One must address the cause of muscle shortening and increased tone; myofascial trigger points. DJS]

Jung E, Erbsloh-Moller B, Gesmann M et al. 2013. [Are members of fibromyalgia syndrome self-help groups "different"?: Demographic and clinical characteristics of members and non-members of fibromyalgia syndrome self-help groups.] Z Rheumatol. [Apr 13 Epub ahead of print]. [Article in German]. “Members of FMS self-help groups…were older and reported a longer duration of chronic widespread pain, less anxiety and depression and a more frequent current use of aerobic exercise, relaxation training and complementary alternative medication than participants not affiliated with FMS self-help groups….Membership in FMS self-help groups was associated with less psychological distress and a more frequent use of active self-management strategies.”

Liu T, Ji RR. 2013. New insights into the mechanisms of itch: are pain and itch controlled by distinct mechanisms? Pflugers Arch. [May 1 Epub ahead of print]. “Itch and pain are closely related but distinct sensations. They share largely overlapping mediators and receptors, and itch-responding neurons are also sensitive to pain stimuli….Chronic itch results from dysfunction of the immune and nervous system and can manifest as neural plasticity despite the fact that chronic itch is often treated by dermatologists. While differences between acute pain and acute itch are striking, chronic itch and chronic pain share many similar mechanisms, including peripheral sensitization (increased responses of primary sensory neurons to itch and pain mediators), central sensitization (hyperactivity of spinal projection neurons and excitatory interneurons), loss of inhibitory control in the spinal cord, and neuro-immune and neuro-glial interactions. Notably, painful stimuli can elicit itch in some chronic conditions (e.g., atopic dermatitis), and some drugs for treating chronic pain are also effective in chronic itch.”

Manor B, Lipsitz LA, Wayne PM et al. 2013. Complexity-based measures inform tai chi's impact on standing postural control in older adults with peripheral neuropathy. BMC Complement Altern Med. 13:87. Subjects of the Tai Chi program exhibited increased complexity of standing COP (control of posture) dynamics. These increases were associated with improved plantar sensation and physical function. Although more research is needed, results of this non-controlled pilot study suggest that complexity-based COP measures may inform the study of complex mind-body interventions, like Tai Chi, on postural control in those with peripheral neuropathy or other age-related balance disorders.

Mayoral O, Salvat I, Martín MT et al. 2013. Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Evid Based Complement Alternat Med. 2013:694941. A single treatment of dry needling myofascial trigger points after anesthesia, before surgery for total knee arthroplasty, helped prevent residual pain.  The pain was less for patients who had dry needling in the first month after surgery, and remained so at 6 month follow-up.

McLeod D, Nelson K. 2013. The role of the emergency department in the acute management of chronic or recurrent pain. Australas Emerg Nurs J. 16(1):30-36. “It is evident that the ED is not the ideal setting for managing patients with chronic pain; however, it is the last resort for many who do present, and who will continue to present should their pain persist. It is time to ensure that the ED provides a consistently supportive, cohesive and integrated approach to managing patients with chronic pain syndromes.”

Mist SD, Firestone KA, Jones KD. 2013. Complementary and alternative exercise for fibromyalgia: a meta-analysis. J Pain Res. 6:247-260. “Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management.”

Muscolino JE. 2013. Abdominal wall trigger point case study. J Bodyw Mov Ther. 17(2):151-156. “Myofascial trigger points (TrPs) are posited to be an element in the etiology of both musculoskeletal and visceral pain. However, the recognition of TrPs as a causative factor in a patient's pain presentation varies amongst physicians and therapists. When myofascial pain syndrome is responsible for a patient's condition and is not recognized by the patient's medical advisors, the patient may be put through a plethora of testing procedures to find the cause of the patient's pain, and prescribed medications in an effort to treat the patient's symptoms. The case review presented here involves a patient with severe anterior abdominal pain, with a history of Crohn's disease, who experienced a long and difficult medical process before a diagnosis of myofascial pain syndrome was made.”

Nguyen BM. 2013. Myofascial trigger point, falls in the elderly, idiopathic knee pain and osteoarthritis: An alternative concept. Med Hypothesis. [April 5 Epub ahead of print]. Currently, most of the medical establishment believes that knee misalignment and other forces create reflex arthrogenous muscle inhibition that causes osteoarthritis. It’s logical that myofascial trigger points initiate the processes causing misalignment that result in osteoarthritis of the knee.  The trigger point concept is “…more sensitive and advanced in the early detection of neuromuscular impairment and pathological changes, allowing early intervention, prevention of falls in the elderly and idiopathic knee osteoarthritis.”

Nguyen RH, Veasley C, Smolenski D. 2013. Latent class analysis of comorbidity patterns among women with generalized and localized vulvodynia: preliminary findings. J Pain Res. 6:303-309. “The pattern and extent of clustering of comorbid pain conditions with vulvodynia is largely unknown. However, elucidating such patterns may improve our understanding of the underlying mechanisms involved in these common causes of chronic pain….This novel work provides insight into potential shared mechanisms of vulvodynia by describing that a prominent comorbidity pattern involves having both irritable bowel syndrome and fibromyalgia. In addition, the prevalence of a multiple comorbidity class pattern increases with increasing severity of vulvar pain.” [Until the medical world understands that many symptoms often labeled generalized and localized vulvodynia or fibromyalgia are actually due to or sustained by myofascial trigger points, and that those TrPs are the critical generating co-existing condition, researchers are going to miss the critical (trigger) point. DJS]

Olsen MN, Sherry DD, Boyne K et al. 2013. Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome. SLEEP 36(4):509-516. Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS (alpha-delta sleep), nor do they support causal relationships between ADS and chronic pain or subjective sleep quality.

Rainey CE. 2013. The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report. Int J Sports Phys Ther. 8(2):145-161.This female patient with low back and posterolateral hip pain was able to return to full active military duty after successful trigger point therapy including dry needling and intramuscular electrical stimulation.

Scheidt CE, Mueller-Becsangele J, Hiller K et al. 2013. Self-reported symptoms of pain and depression in primary fibromyalgia syndrome and rheumatoid arthritis. Nord J Psychiatry. [Apr 16 Epub ahead of print]. “FMS patients in tertiary referral centers suffer from higher levels of pain intensity than RA patients. Depression predicts levels of pain in FMS but not in RA and is therefore an important target of intervention.”

Romanello S, Spiri D, Mancuzzi E et al. 2013 309(15):1607-1612. Association between childhood migraine and history of infantile colic. JAMA. Infant with colic have a grater chance of developing migraines between 6 and 18 years old. The association between these types of pain is yet unknown to these researchers. [Janet Travell long ago documented that trigger points causing colic can be relieved by vapocoolant spray, and other researchers have documented the connection of trigger point cause or contribution to migraines.  The great Czech doctor Karel Lewit MD has observed that colic is an early indication that trigger points will develop later, and that migraines (and menstrual pain) are adolescent signs that trigger points will be part of the diagnoses.  Perhaps that is the connection for which these researchers search, and perhaps early detection and treatment of the TrPs would prevent chronic myofascial pain from developing.  It certainly would be worth trying.  DJS]

Vierck CJ Wong F, King CD et al. 2013. Characteristics of Sensitization Associated With Chronic Pain Conditions. Clin J Pain. [Apr 25 Epub ahead of print]. “The widespread sensitization for irritable bowel syndrome and TMD participants does not rely on mechanisms of spatial and temporal summation often invoked to explain widespread hyperalgesia associated with chronic pain. Increased sensitivity during descending series of stimulation of an arm or leg but not the face indicates a propensity for sensitization of nociceptive input to the spinal cord. Abnormally prolonged sensitization for FM participants reveals a unique influence of widespread chronic pain referred to deep somatic tissues.”

Wallden M. 2013. The primal nature of core function: In rehabilitation & performance conditioning. J Bodyw Mov Ther. 17(2):239-248. “In this editorial, what is understood of the definition and function of the human core is discussed; presented in the context of evolution and holistic human modeling. It appears likely from this understanding of neural phenomena such as central sensitization, neural facilitation/inhibition, tonic and phasic motoneuron excitatory thresholds and viscerosomatic convergence that, very simply, for effective core function, optimal visceral function is a pre-requisite and may be a commonly overlooked aspect of patient rehabilitation. Furthermore, not only is core function key for optimal expression of forces through the appendicular skeleton, but since it is the tonic motoneurons most readily inhibited by nociceptive (including viscerosomatic) phenomena, this will likely affect the tonic components of peripheral musculature directly; impairing both local motor control and performance at peripheral joints.” [Core muscle dysfunctions are often at the base of peripheral muscle symptoms. The peripheral muscles try to compensate when the core is weakened by trigger points, causing the peripheral muscles to become overloaded and develop their own trigger points (and the pain and dysfunction they cause). Too often this valuable insight is ignored. DJS]

Wei GX, Xu T, Fan FM et al. 2013. Can tai chi reshape the brain? A brain morphometry study. PLoS One. 8(4):e61038. “These findings indicate that long-term TCC (t’ai chi chuan) practice could induce regional structural change and also suggest TCC might share similar patterns of neural correlates with meditation and aerobic exercise.”

Yan JH, Guo YZ, Yao HM et al. 2013. Effects of tai chi in patients with chronic obstructive pulmonary disease: preliminary evidence. PLoS One. 8(4):e61806. “Findings suggest that TC may provide an effective alternative means to achieve results similar to those reported following participation in pulmonary rehabilitation programs. Further studies are needed to substantiate the preliminary findings and investigate the long-term effects of TC.” [Anything that inhibits oxygen from reaching the soft tissue can be an initiating or perpetuating factor to the development of trigger points. T’ai chi may be helpful preventative medicine. DJS]

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