May 2014 References  Devin J. Starlanyl   for

Arendt-Nielsen L, Madsen H, Jarrell J et al.  2014. Pain evoked by distension of the uterine cervix in women with dysmenorrhea: Evidence for central sensitization. Acta Obstet Gynecol Scand. [Apr 29 Epub ahead of print.]  Many women have intense abdominal pain during menstruation. This study found: “Pain sensitization (temporal summation, i.e. increase in pain during prolonged stimulation, and facilitation of referred pain areas as an indicator of central nervous system changes) is present in women with dysmenorrhea.” [Studies done by R. Doggweiler indicate that this prolonged pain stimulation from distension may be caused by trigger points. DJS]

Behnam A, Mahyar S, Ezzati K et al. 2014. The use of dry needling and myofascial meridians in a case of plantar fasciitis. J Chiropr Med. 13(1):43-48. “A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity…..Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient's pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient…. Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis.”

Blom D, Thomaes S, Bijlsma JW et al. 2014. Embitterment in patients with a rheumatic disease after a disability pension examination: occurrence and potential determinants. Clin Exp Rheumatol. [Apr 7 Epub ahead of print.] “Our results suggest that, after a disability pension examination, embitterment is present in about one out of five patients with a rheumatic disease. This is problematic insofar as embitterment limits well-being, functioning, and the potential to reintegrate to work. To the extent that helplessness and invalidation at work are causal determinants of embitterment, interventions targeting these aspects may be key to reducing embitterment.”

Borg-Stein J, Iaccarino MA. 2014. Myofascial Pain Syndrome Treatments. Phys Med Rehabil Clin N Am. 25(2):357-374. “Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms.”

Caro XJ, Winter EF. 2014. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: Clinical and immunologic implications. Arthritis Rheumatol. [Apr 9 Epub ahead of print.]

“A subset of fibromyalgia (FM) patients exhibits a large fiber, demyelinating peripheral polyneuropathy, akin to that seen in chronic inflammatory demyelinating polyneuropathy (CIDP). It has been suggested that this demyelinating process is likely to be immune mediated. Since it is known that similar, large fiber neuropathic lesions may be associated with a cutaneous small fiber neuropathy (SFN), we sought to determine the prevalence of SFN, as measured by epidermal nerve fiber density (ENFD), in a series of FM patients and clinically healthy controls. Conclusion: Calf and thigh ENFD in FM are significantly diminished compared to controls. Advancing age, alone, can not explain this finding. Calf ENFD correlated, though weakly, in an inverse fashion with serum IL-2R …. These findings suggest that SFN is likely to contribute to FM pain complaints; that pain in this disorder arises, in part, from a peripheral immune mediated process; and that measurement of ENFD may be a useful clinical tool in FM.” [The authors need to take into consideration that the nerve fiber density in FM may possibly be higher due to co-existing myofascial trigger points entrapping nerves and corollary nerve fiber development may occur.  Differing collagen deposition and mast cell deposition in the skin of FM has also been observed by researchers, and this might affect the conclusion as well. DJS]

Check JH, Cohen R. 2014. Marked improvement of pain from long-term fibromyalgia with dextroamphetamine sulfate in a woman who failed to improve with conventional pharmacologic treatment. Clin Exp Obstet Gynecol. 41(1):90-92. “Dextroamphetamine sulfate extended release capsules once daily was gradually increased to 25 mg per day in a woman with treatment resistant fibromyalgia of 20 years duration….Within a short time, the woman experienced dramatic relief of pain. Furthermore, her edema improved resulting in a 27 pound weight loss and her chronic fatigue improved….Fibromyalgia can be effectively treated with an innocuous dose of dextroamphetamine sulfate.”  [This ONE person responded, and there was no assessment for any comorbidities.  Fibromyalgia is heterogenous.  More research needed here, and the general conclusion given, IMO, is unwarranted. DJS]

Chiarella G, Tognini S, Nacci A et al. 2014. Vestibular disorders in euthyroid patients with Hashimoto's thyroiditis: role of thyroid autoimmunity. Clin Endocrinol (Oxf). [Apr 16 Epub ahead of print.] “This finding suggests that circulating anti-thyroid autoantibodies may represent a risk factor for developing vestibular dysfunction. An accurate vestibular evaluation of HT patients with or without symptoms is therefore warranted.”

Choi JI. 2014. Chicken and egg: peripheral nerve entrapment or myofascial trigger point? 

Korean J Pain. 27(2):186-188. In this letter, the author is commenting on the case report “Successful treatment of abdominal cutaneous entrapment syndrome (ACES) using ultrasound guided injections,” written by WV Applegate.  Dr. Choi calls attention to the fact that abdominal cutaneous entrapment syndrome is usually caused by trigger points, which are found by palpation, and yet myofascial pain syndrome was not mentioned in the article.  The original author missed the point that the radiculopathy is often caused by trigger points as well. [I certainly am glad that Dr. Choi wrote this letter, and agree with him heartily.  DJS]

Fan YH, Lin AT, Lu SH et al. 2014. Non-bladder conditions in female Taiwanese patients with interstitial cystitis/hypersensitive bladder syndrome. Int J Urol. [Apr 13 Epub ahead of print.]

“Interstitial cystitis/hypersensitive bladder syndrome patients are more likely to have multiple non-bladder conditions. These conditions correlate with the severity of interstitial cystitis/hypersensitive bladder syndrome symptoms.”

Fredheim OM, Mahic M, Skurtveit S et al. 2014. Chronic pain and use of opioids: A population-based pharmacoepidemiological study from the Norwegian prescription database and the Nord-Trondelag health study. Pain. [Mar 15 Epub ahead of print.] “The study showed that most people having chronic nonmalignant pain are not using opioids, even if the pain is strong or very strong. However, the vast majority of patients with persistent opioid use report strong or very strong pain in spite of opioid treatment.”  [This should not be interpreted to mean that opioids do not help chronic pain.  In this increasingly wary culture, many chronic pain patients are denied access to adequate opioid pain medications.  Opioids should not be used as the only treatment, but can be a logical part of the management of some chronic pain treatment plans.  Efforts also must be made to treat the cause of the pain, such as myofascial trigger points, and the perpetuating factors of that cause.  Doctors and other care providers who are involved in any pain management must be trained in the diagnosis and treatment of the most common cause of musculoskeletal pain; myofascial trigger points. DJS]

Gerwin RD. 2014.  Diagnosis of Myofascial Pain Syndrome. Phys Med Rehabil Clin N Am. 25(2):341-355. “Myofascial pain is one of the most common causes of pain. The diagnosis of myofascial pain syndrome (MPS) is made by muscle palpation. The source of the pain in MPS is the myofascial trigger point, a very localized region of tender, contracted muscle that is readily identified by palpation. The trigger point has well-described electrophysiologic properties and is associated with a derangement of the local biochemical milieu of the muscle. A proper diagnosis of MPS includes evaluation of muscle as a cause of pain, and assessment of associated conditions that have an impact on MPS.”

Graff-Radford SB, Bassiur JP. 2014. Temporomandibular Disorders and Headaches. Neurol Clin. 32(2):525-537. “Headache and temporomandibular disorders should be treated together but separately. If there is marked limitation of opening, imaging of the joint may be necessary. The treatment should then include education regarding limiting jaw function, appliance therapy, instruction in jaw posture, and stretching exercises, as well as medications to reduce inflammation and relax the muscles. The use of physical therapies, such as spray and stretch and trigger point injections, is helpful if there is myofascial pain.”

Hagenfeld D, Schulz T, Ehling P et al.  2010. Depolarization of the membrane potential by hyaluronan. J Cell Biochem. 111(4):858-864. “Depolarization of the plasma membrane by hyaluronan (hyaluronic acid) represents an additional pathway of signal transduction to the classical CD44 signal transduction pathway, which links the extracellular matrix to intracellular metabolism.”  [This research meshes well with the studies we did on geloid masses inpatients with FM and CMP, and indicates that patients with FM and CMP may need to be very careful using any product with hyaluronic acid.  That is a component in many cosmetics, body lotions, and anti-aging formulas.  DJS]

Iatridou K, Mandalidis D, Chronopoulos E et al. 2014. Static and dynamic body balance following provocation of the visual and vestibular systems in females with and without joint hypermobility syndrome. J Bodyw Mov Ther. 18(2):159-164. “Joint hypermobility syndrome (JHS) is a heritable disorder of the connective tissue characterized by excessive joint movement, musculoskeletal pain and neurophysiological deficits (i.e. decreased proprioceptive acuity, altered neuromuscular reflexes). Such deficits may affect body balance thus increasing the risk of injury. The present study aimed at examining static and dynamic body balance following challenge of the visual and vestibular systems in individuals with JHS…. Poor static balance following challenge of the vestibular system may be justified by vestibular deficiency and/or insufficient proprioceptive capabilities of the neck. Impairments of dynamic balance in individuals with JHS may be attributed to proprioceptive deficits, which can alter feed forward and feedback mechanisms.”

Inanir A, Karakus N, Ates O. 2014. Clinical symptoms in fibromyalgia are associated to catechol-O-methyltransferase (COMT) gene Val158Met polymorphism. Xenobiotica. [Apr 24 Epub ahead of print.] “Fibromyalgia syndrome (FMS) is a common chronic widespread pain syndrome mainly affecting women. The aim of this study was to explore the frequency and clinical significance of catechol-O-methyltransferase (COMT) gene Val158Met polymorphism in a large cohort of Turkish patients with FMS. 2. The study included 379 FMS patients and 290 controls….The results of this study suggested that COMT gene Val158Met polymorphism is positively associated with FMS and play a relevant role in the clinical symptoms of the disease.”

Isasi C, Colmenero I, Casco F et al. 2014. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int. [Apr 12 Epub ahead of print.]

“Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5-31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome.”  [The authors have found one common perpetuating factor for at least one subgroup of patients with FM. DJS]

Itoh K, Saito S, Sahara S et al. 2014. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study. J Acupunct Meridian Stud. 7(2):59-64. “We compared the effect of trigger point acupuncture (TrP), with that of sham (SH) acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. The participants were 18 patients (15 women, 3 men; aged 42-65 years) with nonradiating shoulder pain for at least 6 months and normal neurological findings. The participants were randomized into two groups, each receiving five treatment sessions. The TrP group received treatment at trigger points for the muscle, while the other group received SH acupuncture treatment on the same muscle…. Compared with SH acupuncture therapy, TrP therapy appears more effective for chronic shoulder pain.”

Jimenez-Rodríguez, Garcia-Leiva JM, Jimenez-Rodriguez BM et al. 2014. Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain. Neuropsychiatr Dis Treat. 10:625-630. “Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances….Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia…. The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls…. The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide.” [How much of this is associated with feelings of helplessness, hopelessness, and lack of support from family, companions and medical team we can only guess. DJS]

Joerges J, Schulz T, Wegner J et al. 2012. Regulation of cell volume by glycosaminoglycans. J Cell Biochem. 13(1):340-348. “Hyaluronidase treatment of inhibition of hyaluronan transport led to cell shrinkage indicating that the hyaluronan (hyaluronic acid) coat maintained fibroblasts (the most common type of connective tissue cell) in a swollen state.”  [This research meshes well with the studies we did on geloid masses inpatients with FM and CMP, and indicates that patients with FM and CMP may need to be very careful using any product with hyaluronic acid.  That is a component in many cosmetics, body lotions, and anti-aging formulas.  DJS]

Kathagen N, Prehm P. 2013. Regulation of intracellular pH by glycosaminoglycans. J Cell Physiol. 228(10):2071-2075. Addition of hyaluronan (hyaluronic acid), hyaluronan oligosaccharides, chondroitin sulfate, or heparin to culture medium of fibroblasts caused intracellular acidification from pH 7.2 to 6.7 in a concentration dependent manner.  Acidification is associated with disease states.  Hyaluronidase treatment or hyaluronidase export inhibition (with xanthhohumol) resulted in intracellular alkalization.  This indicates that glycosaminoglycans participate in some way in intracellular pH regulation.  [This research meshes well with the studies we did on geloid masses inpatients with FM and CMP, and indicates that patients with FM and CMP may need to be very careful using any product with hyaluronic acid.  HA is a component in many cosmetics, body lotions, and anti-aging formulas.  DJS]

Liu Z, Cappola AR, Crofford LJ et al. 2014. Modeling Bivariate Longitudinal Hormone Profiles by Hierarchical State Space Models. J Am Stat Assoc. 109(505):108-118. “The hypothalamic-pituitary-adrenal (HPA) axis is crucial in coping with stress and maintaining homeostasis. Hormones produced by the HPA axis exhibit both complex univariate longitudinal profiles and complex relationships among different hormones. Consequently, modeling these multivariate longitudinal hormone profiles is a challenging task.” These authors propose a model to deal with interactive hormone balances.  “Application of the proposed method to a study of chronic fatigue syndrome and fibromyalgia reveals that the relationships between adrenocorticotropic hormone and cortisol in the patient group are weaker than in healthy controls”.

Matilainen V, Laakso M, Hirsso P. 2013. Hair loss, insulin resistance, and heredity in middle-age women.  A population-based study.  J Cardiovasc Risk. 10(3):227-231. Insulin resistance is associated with “…large waist and neck circumferences, abdominal obesity by waist to hip ration, mean insulin concentration or urinary albumin to creatinine ratio.  Although extensive hair loss has been linked to men with insulin resistance, this study found it is present in women too.  Female hair loss has been linked to hyper-androgenism, hirsutism, and polycystic ovary syndrome. These researchers found a 31.2% presence of extensive hair loss in patients with insulin resistance.  Women in the highest percentiles of waist and neck circumference had greater risk of hair loss”.

Meran S, Martin J, Luo DD et al. 2013. Interleukin-1beta induces hyaluronan and CD44-dependent cell protrusions that facilitate fibroblast-monocyte binding. Am J Path. 182(6):2223-2240. This study concerns the possible mechanisms behind persistent inflammation as a determinant of progressive tissue fibrosis.  These authors found that if they stimulated fibroblasts, the most common type of connective tissue cell, with interleukin 1-beta, the hyaluronic acid within the fibroblast relocates to the outer cell membrane, forming protrusions.  They conclude that their study suggests that the interleukin beta-1 generated hyaluronic acid (hyaluronan) is involved in fibroblast immune activation, which may sequester monocytes in the inflamed tissues, resulting in a state of chronic inflammation. [This research meshes well with the studies we did on geloid masses inpatients with FM and CMP, and indicates that patients with FM and CMP may need to be very careful using any product with hyaluronic acid.  HA is a component in many cosmetics, body lotions, and anti-aging formulas.  DJS]

Moeller-Bertram T, Strigo IA, Simmons AN et al. 2014. Evidence for Acute Central Sensitization to Prolonged Experimental Pain in Posttraumatic Stress Disorder. Pain Med. [Apr 16 Epub ahead of print.] “Post-traumatic stress disorder (PTSD) and pain have a well-documented high comorbidity; however, the underlying mechanisms of this comorbidity are currently poorly understood.” This study found: “… a significantly higher degree of acute central sensitization in individuals with PTSD. Increased acute central sensitization may underlie increased vulnerability for developing pain-related conditions following combat trauma.”

Petra AI, Panagiotidou S, Stewart JM et al. 2014. Spectrum of mast cell activation disorders. Expert Rev Clin Immunol. [May 1 Epub ahead of print.] “Mast cell (MC) activation disorders present with multiple symptoms including flushing, pruritus, hypotension, gastrointestinal complaints, irritability, headaches, concentration/memory loss and neuropsychiatric issues. These disorders are classified as: cutaneous and systemic mastocytosis with a c-kit mutation and clonal MC activation disorder, allergies, urticarias and inflammatory disorders and mast cell activation syndrome (MCAS), idiopathic urticaria and angioedema. MCs are activated by IgE, but also by cytokines, environmental, food, infectious, drug and stress triggers, leading to secretion of multiple mediators. The symptom profile and comorbidities associated with these disorders, such as chronic fatigue syndrome and fibromyalgia, are confusing. We propose the use of the term 'spectrum' and highlight the main symptoms, useful diagnostic tests and treatment approaches.”  [These interactive conditions may be much more common than now suspected. DJS]

Prehm P. 2013. Curcumin analogue identified as hyaluronan export inhibitor by virtual docking to the ABC transporter MRP5. Food Chem Toxicol. 62:76-81. Hyaluronan (hyaluronic acid) is produced in excess in many disease states, including metastatic cancers, inflammation, or insufficient blood flow (such as the energy crisis in trigger point areas). Fibroblasts are the most common type of connective tissue cell, and they form hyaluronic acid. Fibroblasts synthesize the extra cellular matrix, collagen, and stroma, which make up the connective tissue framework.  Fibroblasts play a critical role in cellular healing.   The multidrug resistance associated protein 5 (MRPS 5) transports the hyaluronic acid from the fibroblasts.  MRPS 5 is inhibited by the plant phenols curcumin or xanthohumol.  The best plant phenol to inhibit hyaluronic acid is hylin.  Hylin is found in natural curcumin extracts, such as turmeric. “Since curcumin itself is unstable under physiological conditions, the active component for many cell biological and pharmaceutical effects of natural curcumin preparations could be that hylin that acts by hylauronan inhibition.”  [This research meshes well with the studies we did on geloid masses in patients with FM and CMP, and indicates that patients with FM and CMP may need to be very careful using any product with hyaluronic acid.  HA is a component in many cosmetics, body lotions, and anti-aging formulas.  DJS]

Shin HJ, Shin JC, Kim WS et al. 2014. Application of ultrasound-guided trigger point injection for myofascial trigger points in the subscapularis and pectoralis muscles to post-mastectomy patients: a pilot study. Yonsei Med J. 55(3):792-799. “In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.”

von Kanel R, Muller-Hartmannsgruber V, Kokinogenis G et al. 2014. Vitamin D and Central Hypersensitivity in Patients with Chronic Pain. Pain Med. [Apr 14 Epub ahead of print.]

“The findings suggest a role of low vitamin D levels for heightened central sensitivity, particularly augmented pain processing upon mechanical stimulation in chronic pain patients. Vitamin D seems comparably less important for self-reports of spontaneous chronic pain.”

Wiffen PJ, Derry S, Moore RA et al. 2014. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 4:CD005451. “This is an update of a Cochrane review entitled 'Carbamazepine for acute and chronic pain in adults' published in Issue 1, 2011. Some antiepileptic medicines have a place in the treatment of neuropathic pain (pain due to nerve damage). This updated review considers the treatment of chronic neuropathic pain and fibromyalgia only, and adds no new studies. The update uses higher standards of evidence than the earlier review, which results in the exclusion of five studies that were previously included….. Carbamazepine is probably effective in some people with chronic neuropathic pain, but with caveats. No trial was longer than four weeks, had good reporting quality, nor used outcomes equivalent to substantial clinical benefit. In these circumstances, caution is needed in interpretation, and meaningful comparison with other interventions is not possible.”  [The authors warn us to beware jumping to conclusions based on little research.  That seems to happen often in the medical field.  DJS]

Ziaeifar M, Arab AM, Karimi N et al. 2014.The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle.  J Bodyw Mov Ther. 18(2):298-305. “DN (dry needling) produces an improvement in pain intensity, PPT (pressure pain thresholds) and DASH (disability of Arm, hand and Shoulder) and may be prescribed for subjects with TrP in UT muscles especially when pain relief is the goal of the treatment.”


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