October 2012 References  Devin J. Starlanyl   for http://www.sover.net/~devstar

Ahn S, Song R. 2012. Effects of Tai Chi Exercise on Glucose Control, Neuropathy Scores, Balance, and Quality of Life in Patients with Type 2 Diabetes and Neuropathy. J Altern Complement Med. [Sep 17 Epub ahead of print]. “Tai Chi improved glucose control, balance, neuropathic symptoms, and some dimensions of quality of life in diabetic patients with neuropathy. Further studies with larger samples and long-term follow-up are needed to confirm the effects of Tai Chi on the management of diabetic neuropathy, which may have an impact on fall prevention in this population.”


Atzeni F, Sallì S, Benucci M et al. 2012. Fibromyalgia and arthritides. Reumatismo. 64(4):286-292. “Fibromyalgia (FM) is a chronic pain syndrome that affects at least 2% of the adult population. It is characterized by widespread pain, fatigue, sleep alterations and distress, and emerging evidence suggests a central nervous system (CNS) malfunction that increases pain transmission and perception. FM is often associated with other diseases that act as confounding and aggravating factors, such as rheumatoid arthritis (RA), spondyloarthritides (SpA), osteoarthritis (OA) and thyroid disease. Mechanism-based FM management should consider both peripheral and central pain, including effects due to cerebral input and that come from the descending inhibitory pathways. Rheumatologists should be able to distinguish primary and secondary FM, and need new guidelines and instruments to avoid making mistakes, bearing in mind that the diffuse pain of arthritides compromises the patients' quality of life.”

Auvinet B, Chaleil D. 2012. Identification of subgroups among fibromyalgia patients. Reumatismo. 64(4):250-260. “This paper presents some hypotheses concerning the identification of homogeneous subgroups among fibromyalgia (FM) patients in order to improve the management of the disease. It also reviews the available literature about this subject. Three methods for subgrouping are discussed according to clinical features, biomarkers, and gait analysis.... Biomarkers in FM, which is a neurobiological disease, are of promising interest, nevertheless currently, none of them can be used to subgroup FM patients. Due to the fact that cortical and subcortical mechanisms of gait control share some cognitive functions which are involved in FM, gait markers have been proposed to evaluate and to subgroup FM patients, in clinical settings. Three out of 4 core FM symptoms are linked to gait markers. Kinesia measured by means of cranio-caudal power is correlated to pain, and could be proposed to assess pain behavior (kinesiophobia). Stride frequency, which is linked to physical component, allows the identification of a hyperkinetic subgroup. Moreover, SF has been correlated to fatigue during the 6 minute walking test. Stride regularity, which expresses the unsteadiness of gait, is correlated to cognitive dysfunction in FM. Decreased stride regularity allows the recognition of a homogeneous subgroup characterized by an increased anxiety and depression, and decreased cognitive functions. [Unfortunately, the authors did not recognize that most if not all fibromyalgia patients also have myofascial trigger points, and many of these trigger points can profoundly affect gait. Until researchers realize that many of the symptoms caused by trigger points are being attributed to fibromyalgia, the FM research will be flawed.  DJS] 

Bachasson D, Guinot M, Wuyam B et al. 2012. Neuromuscular fatigue and exercise capacity in fibromyalgia syndrome. Arthritis Care Res (Hoboken). [Sep 10 Epub ahead of print]. “Larger impairment in muscle contractility is associated with enhanced perception of exertion and reduced maximal exercise capacity in FMS patients. Neuromuscular impairments should be considered as an important factor underlying functional limitations in FMS patients.” [It is highly likely that at least some of the results reflect the action of co-existing myofascial trigger points, and it would be very helpful to know this extent in future studies.  DJS]

Bardal EM, Roeleveld K, Okkenhaug Johansen T et al. 2012. Upper limb position control in fibromyalgia. BMC Musculoskel Disord. 13(1):186. “FM patients exhibit an altered neuromuscular strategy for upper limb position control compared to HCs. The predominance of low-frequency limb oscillations among FM patients may indicate a sensory deficit.” [Or may actually indicate the presence of co-existing myofascial trigger points, which are known to affect limb position control. DJS]

Bazzichi L, Giacomelli C, Rossi A. 2012. Fibromyalgia and sexual problems. Reumatismo. 64(4):261-267. “The aim of this review was to describe the recent literature concerning sexual dysfunction in fibromyalgia patients....The major findings observed were related to a decreased sexual desire and arousal, decreased experience of orgasm, and in some studies an increase in genital pain. The psychological aspects, together with the stress related to the constant presence of chronic widespread pain, fatigue and sleep disturbances, are certainly a major factor that adversely affects the sexuality of the patient with FM. Moreover, the drugs most commonly used in these cases may interfere negatively on the sexuality and sexual function of these patients. [It is most unfortunate that the authors of the papers reviewed did not understand that fibromyalgia patients have co-existing myofascial trigger points causing most if not all of these sexual pains and dysfunctions.  This review is a good example of how bad research begets more bad research. DJS]

Bote ME, García JJ, Hinchado MD et al. 2012. Inflammatory/Stress Feedback Dysregulation in Women with Fibromyalgia. Neuroimmunomodulation. 19(6):343-351. “Although one of the current hypotheses of the aetiology of fibromyalgia (FM) syndrome involves inflammatory and neuroendocrine disorders, its biophysiology still remains unclear. The purpose of the present investigation was to study the systemic inflammatory and stress responses, as well as the innate response mediated by monocytes and neutrophils in FM patients....FM patients showed an inflammatory state accompanied by an altered stress response....An inflammatory/stress feedback dysregulation underlies FM. Whether dysregulation of the stress response is the cause of the inflammatory dysregulation or vice versa is also discussed.

Bron C, de Gast A, Dommerholt J et al. 2011. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial.  A 12-week trial of weekly manual trigger point compression, manual stretching, and intermittent cold with stretching in addition to home muscle stretching, relaxation exercises and ergonomic and postural correction reduced symptoms and improved function for patients with chronic shoulder pain.

Bron C, Dommerholt J. 2012. Etiology of myofascial trigger points. Curr Pain Rep. 16(5):439-444. “Myofascial pain syndrome (MPS) is described as the sensory, motor, and autonomic symptoms caused by myofascial trigger points (TrPs). Knowing the potential causes of TrPs is important to prevent their development and recurrence, but also to inactivate and eliminate existing TrPs. There is general agreement that muscle overuse or direct trauma to the muscle can lead to the development of TrPs. Muscle overload is hypothesized to be the result of sustained or repetitive low-level muscle contractions, eccentric muscle contractions, and maximal or submaximal concentric muscle contractions. TrPs may develop during occupational, recreational, or sports activities when muscle use exceeds muscle capacity and normal recovery is disturbed.”  Trigger points are common in athletes, and anyone subjected to restrictions of blood flow to the muscle in which they develop. The lack of blood flow leads to a lowered pH and release of pro-inflammatory biochemicals.  There is still disagreement if overuse mechanisms or chronic pain are the initiating factor.

Bron C, Dommerholt J, Stegenga B et al. 2011. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskel Disord. 12:139. If patients have chronic non-traumatic shoulder pain, it is likely that they have active and latent myofascial trigger points.

Camerini L, Schultz 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. [Sep 4 Epub ahead of print]. “The role of health knowledge and empowerment in explaining behavioral and health outcomes was treated in depth in the literature, but the combined effect of these constructs has been somehow neglected. This study presents an empirical, a priori, cross-sectional evaluation of the differential effects of health knowledge and empowerment on patients' self-management and health outcomes. Knowledge and three empowerment dimensions were found to positively impact health outcomes. However, these relationships were not mediated by self-management. Self-management, operationalized in terms of physical exercise and drug intake, was found to be a strong predictor of health outcomes....Despite the lack of support for the mediating role of self-management, a strong impact of knowledge and empowerment over health outcomes was observed. Theories of health literacy and empowerment may benefit from this result by integrating both dimensions in an overall model of behavioral and health outcomes change....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.”

Can SS, Gencay Can A. 2012. Assessment of cognitive function in patients with fibromyalgia using the clock drawing test. J Musculoskel Pain. 20(3):177-182.  The clock drawing test indicated fibromyalgia patients had impaired cognitive function related to advanced age and high pain intensity.

Chamani G, Zarei MR, Momenzadeh A et al. 2012. Prevalence of musculoskeletal disorders among dentists in Kerman, Iran. J Musculoskel Pain. 20(3):202-207. We need to identify risk factors of developing musculoskeletal disorders, including static postures. Knowledge of ergonomics and preventative measures must be part of undergraduate education.

Chrednichenko G, Zhang R, Bannister RA et al. 2012. Triclosan impairs excitation-contraction coupling and Ca2+ dynamics in striated muscle.  Proc Natl Acad Sci USA. 109(35):14158-14163. Triclosan, a commonly used antibacterial agent found in many hand soaps, dish detergents and other over-the-counter products, is a “priority pollutant” and “...acutely depresses hemodynamics and grip strength in mice....” It affects ryanodine binding, which is a calcium ion-channel receptor that has been suggested may be involved in myofascial trigger points. Triclosan “...weakens cardiac and skeletal muscle contractility in a manner that may negatively impact muscle health, especially in susceptible populations.”

Daenen L, Nijs J, Roussel N et al. 2012. “Dysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study. Clin Rheumatol. [Sep 16 Epub ahead of print]. Inefficient endogenous pain inhibition, in particular impaired conditioned pain modulation (CPM), may disturb central pain processing in patients with chronic whiplash-associated disorders (WAD). Previous studies revealed that abnormal central pain processing is responsible for a wide range of symptoms in patients with chronic WAD. Hence, the present study aimed at examining the functioning of descending pain inhibitory pathways, and in particular CPM, in patients with chronic WAD. Thirty-five patients with chronic WAD and 31 healthy controls were subjected to an experiment evaluating CPM. CPM was induced by an inflated occlusion cuff and evaluated by comparing temporal summation (TS) of pressure pain prior to and during cuff inflation. Temporal summation was provoked by means of 10 consecutive pressure pulses at upper and lower limb location. Pain intensity of first, fifth, and 10th pressure pulse was rated. During heterotopic noxious conditioning stimulation, TS of pressure pain was significantly depleted among healthy controls. In contrast, TS was quite similar prior to and during cuff inflation in chronic WAD, providing evidence for dysfunctional CPM in patients with chronic WAD. The present study demonstrates a lack of endogenous pain inhibitory pathways, and in particularly CPM, in patients with chronic WAD, and hence provides additional evidence for the presence of central sensitization in chronic WAD.”

Dee SW, Kao MJ, Hong CZ et al. 2012. Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature. Neuropsychiatr Dis Treat. 8:399-403. This patient presented with shoulder pain on one side, and was given conservative treatment for 13 months, including trigger point injection.  Eventually, a rare case of thymic carcinoma was discovered to be the cause of the pain. Pain can come from many sources, and if trigger points aren’t relieved by usual treatment, the perpetuating factor(s) must be identified.

de Oliveira RA, Ciampi de Andrade D, McHado AG et al. 2012. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome. BMC Neurol. 12(1):89. Myofascial pain syndrome is a common co-morbid condition with central post-stroke pain.

Diochot S, Baron A, Salinas M et al. 2012. Black mamba venom peptides target acid-sensing ion channels to abolish pain. Nature. [Oct 3 Epub ahead of print]. Acid sensing ion channels (ACIC) are generally thought of as playing a main role in the pain pathways. A new class of peptides, called mambalgins, derived from the black mamba snake venom can abolish ACIC pain in either peripheral or central neurons. Their analgesic effect can be as strong as morphine without the respiratory distress caused by morphine, indicating a possible promising pain control option for the future.  

Duschek S, Mannhart T, Winkelmann A et al. 2012. Cerebral blood flow dynamics during pain processing in patients with fibromyalgia syndrome. Psychosom Med. 74(8):802-809.  “Objectives Increased cerebral blood flow during processing of acute pain has repeatedly been observed in fibromyalgia syndrome....The increased blood flow response in the anterior cerebral arteries reflects hyperactivity of medial structures of the neuromatrix of nociception, structures involved in the processing of affective and cognitive aspects of pain. Aberrances in cerebral blood flow related to fibromyalgia and its clinical characteristics become particularly apparent in the enhancement of the initial component of the hemodynamic response.”

Egli M, Koob GF, Edwards S. 2012. Alcohol dependence as a chronic pain disorder. Neurosci Biobehav Rev. [Sep 11 Epub ahead of print]. “Dysregulation of pain neurocircuitry and neurochemistry has been increasingly recognized as playing a critical role in a diverse spectrum of diseases including migraine, fibromyalgia, depression, and PTSD. Evidence presented here supports the hypothesis that alcohol dependence is among the pathologies arising from aberrant neurobiological substrates of pain. In this review, we explore the possible influence of alcohol analgesia and hyperalgesia in promoting alcohol misuse and dependence. We examine evidence that neuroanatomical sites involved in the negative emotional states of alcohol dependence also play an important role in pain transmission and may be functionally altered under chronic pain conditions. We also consider possible genetic links between pain transmission and alcohol dependence. We propose an allostatic load model in which episodes of alcohol intoxication and withdrawal, traumatic stressors, and injury are each capable of dysregulating an overlapping set of neural substrates to engender sensory and affective pain states that are integral to alcohol dependence and comorbid conditions such as anxiety, depression, and chronic pain.”

Elder NC, Simmons T, Regan S et al. 2012. Care for Patients with Chronic Nonmalignant Pain with and without Chronic Opioid Prescriptions: A Report from the Cincinnati Area Research Group (CARinG) Network. J Am Board Fam Med. 25(5):652-660. “The use of chronic opioids for patients with chronic nonmalignant pain (CNMP) is a common problem for family physicians, yet little is known about the management of CNMP in family medicine offices....Physicians described suspicion of patients as a primary difficulty in prescribing or considering chronic opioids; they also expressed interest in practicing evidence-based CNMP care, but there was little teamwork between physicians and medical assistants caring for patients with CNMP who were taking chronic opioids....Chronic opioids are frequently prescribed to patients with CNMP. Although patients taking opioids have better documentation of pain assessments and management, care for all patients with CNMP fell short of evidence-based guidelines and was primarily performed by the physician alone.

Fais A, Cacace E, Corda M et al. 2012. Purine metabolites in fibromyalgia syndrome. Clin Biochem. [Sep 18 Epub ahead of print]. “Study results suggest that purines, in particular adenosine and inosine, may be involved in pain transmission in fibromyalgia.”

Fernández-de-Las-Peñas C, Ambite-Quesada S, Gil-Crujera A et al. 2012. Catechol-O-Methyltransferase Val158Met Polymorphism Influences Anxiety, Depression, and Disability, but not Pressure Pain Sensitivity, in Women with Fibromyalgia Syndrome. J Pain. [Sep 28 Epub ahead of print]. “Our aim was to assess the relationship of the Val158 Met polymorphism to pain, anxiety, depression, functional ability, and pressure pain sensitivity in women with fibromyalgia (FMS)....  This study suggests that the Val158Met COMT polymorphism modulated some psychological variables but not pressure pain sensitivity in FMS because women with FMS carrying the Met/Met genotype exhibit higher disability, depression, and anxiety than but similar PPTs to those with Val/Met and Val/Val genotypes. This study provides further evidence of potential genetic factors that predispose women with FMS to exhibit the disease more severely.”

Guarda-Mardini L, Stecco A, Stecco C et al. 2012. Myofascial pain if the jaw muscles; comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. As a comparison of single session botulinum injections and multiple session fascial manipulation: “The two treatments seem to be almost equally effective, fascial manipulation being slightly superior to reduce subjective pain perception, and botulinum toxin injections being slightly superior to increase jaw range of motion.  Differences between the two treatment protocols aw to changes in the outcome parameters at the three-months follow-up were not relevant clinically.”

Hassett AL, Epel E, Clauw DJ et al. 2012. Pain is associated with short leukocyte telomere length in women with fibromyalgia. J Pain. 13(10):959-969. “Telomere length, considered a measure of biological aging, is linked to morbidity and mortality. Psychosocial factors associated with shortened telomeres are also common in chronic pain; yet, little is known about telomere length in pain populations. Leukocyte telomere length was evaluated in 66 women with fibromyalgia and 22 healthy female controls....Our findings support a link between premature cellular aging and chronic pain. These preliminary data imply that chronic pain is a more serious condition than has typically been recognized in terms of bodily aging.”

Hegarty D, Shorten G. 2012. Multivariate prognostic modeling of persistent pain following lumbar discectomy.  Pain Physician. 15(5):421-434. “Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined....We demonstrated that the occurrence of PPSP can be predicted using a small set of variables easily obtained at the preoperative visit. This is a prediction rule that could further optimize perioperative pain treatment and reduce attendant complications by allowing the preoperative classification of surgical patients according to their risk of developing PPSP.”

Henry R, Cahill CM, Wood g et al. 2012. Myofascial pain in patients waitlisted for total knee arthroplasty. Pain Res Manag 17(5):321-327. “Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA)....Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8 ...Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility...All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA.”  

Howell ER. 2012. Conservative management of a 31 year old male with left sided low back and leg pain: a case report. J Can Chiropr Assoc. 56(3):225-232. “This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation....A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting....The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit....Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral.”

Iliff JJ, Wang M, Liao Y et al. 2012. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amaloid beta. Sci Transi Med. 4(147):147ra111. The brain does not have a lymph system. It needs another way to clear extra cellular proteins and drain excess interstitial fluid and other waste materials. Material dissolves in the cerebrospinal fluid (CSF), and then “...a substantial portion of subarachnoid CSF cycles through the brain interstitial space....” and then cleared though paravenous drainage pathways. “ clearance through paravenous flow may also regulate extracellular levels of proteins involved with neurogenerative conditions, its impairment perhaps contributing to the mis-accumulation of soluble proteins.” [This may also be involved in traumatic brain injury, Parkinson’s disease, Alzheimer’s disease, and glial cell interactions that may affect cognitive dysfunctions in FM. DJS]

Kannan P. 2012. Management of Myofascial Pain of Upper Trapezius: A Three Group Comparison Study. Glob J Health Sci. 4(5):46-52. “We conclude that laser can be used as an effective treatment regimen in the management of myofascial trigger points thereby reducing disability caused due to musculoskeletal pathology.”

Karakus N, Yigit S, Inanir A et al. 2012. Association between sequence variations of the Mediterranean fever gene and fibromyalgia syndrome in a cohort of Turkish patients. Clin Chim Acta. 414C:36-40. “The results of this study suggest that MEFV gene mutations and polymorphism are positively associated with predisposition to develop FMS. Further studies with larger populations will be required to confirm these findings.”

Karper WB. 2012. Exercise Effects on Two Men with Fibromyalgia Syndrome: An Update. Am J Mens Health. [Sep 6 Epub ahead of print]. “In 2007, an article was published in this journal about the effects of exercise on two older men with fibromyalgia syndrome (FMS). This new article is an update on how exercise has affected them during a 4-year period since 2007. Results suggest that both these men still function at approximately the same levels (physically and psychosocially) as reported in 2007. This is viewed as a positive finding, because even with all of their FMS symptoms, these two men managed to maintain their functional capacity. It is hard for most older people without FMS to remain motivated enough to accomplish this. Because it is difficult to find specifically published data on men (vs. women) with FMS, this long-term information on these two men is important for professionals who are involved in exercise programming for men with FMS and for those interested in studying exercise effects on men with FMS.”

Kim SK, Kim SH, Lee CK et al. 2012. Effect of fibromyalgia syndrome on the health-related quality of life and economic burden in Korea. Rheumatology (Oxford). [Sep 28 Epub ahead of print]. “Patients with FMS experience a decline in their HRQOL and constitute a significant economic burden on health-service utilization. The improvement in health-related costs and HRQOL after a diagnosis of FMS demonstrates a need for early diagnosis and treatment of FMS to reduce costs and enhance HRQOL.”

Kodama Y, Seo K, Hayashi T et al. 2012. Orofacial pain related to traumatic neuroma in a patient with multiple TMJ operations. Cranio. 30(3):183-187. “The diagnosis of orofacial pain associated with temporomandibular disorders after repeated temporomandibular joint (TMJ) surgeries can be quite difficult. This case report describes a 52-year-old woman who had previously undergone five TMJ surgeries and developed divergent pain caused by a trigger point in the left preauricular area. Computed tomography and magnetic resonance imaging could not be used to identify a lesion because of metallic artifacts from a TMJ prosthesis. However, sonography indicated the location of the suspected lesion. Moreover, a neurological examination performed with local anesthesia was clinically effective in ruling out other diagnoses of orofacial pain. Ultimately, a histopathological examination of a biopsy specimen from the painful site confirmed the lesion to be a traumatic neuroma. This case report suggests the value of including traumatic neuroma in the differential diagnosis of patients with a history of previous TMJ surgery who present with orofacial pain in the region of the TMJ.”

Leddy JJ, Sandhu H, Sodhi V et al. 2012. Rehabilitation of concussion and post-concussion syndrome. Sports Health. 4(2):147-154. “Prolonged symptoms after concussion are called post-concussion syndrome (PCS), which is a controversial disorder with a wide differential diagnosis....Treatment approaches depend on the clinician's ability to differentiate among the various conditions associated with PCS. Early education, cognitive behavioral therapy, and aerobic exercise therapy have shown efficacy in certain patients but have limitations of study design. An algorithm is presented to aid clinicians in the evaluation and treatment of concussion and PCS and in the return-to-activity decision.”

Malhotra D, Saxena AK, Dar A+SA, et al. 2012. Evaluation of cytokine levels in fibromyalgia syndrome patients and its relationship to the severity of chronic pain. J Musculoskel Pain.  20(3):164-169. [Elevated levels of cytokines and other pro-inflammatory substances have been implicated in fibromyalgia. This study indicates that Interleukin-6, a pro-inflammatory substance, may be active in the process of increased pain in fibromyalgia.  This indicates a possible role of inflammation in fibromyalgia. While not an inflammatory disease per se, IL-6, a pro-inflammatory cytokine, does affect glial cells as shown in the research of Dr. Linda Watkins and her team. [see Wieseler-Frank J, Maier SF, Watkins LR. 2005. Immune-to-brain communication dynamically modulates pain: physiological and pathological consequences. Brain Behav Immun. 19(2):104-111.] Pro-inflammatory cytokines can cause diffuse muscle aches, fatigue, hyperalgesia, depressed mood, and may other symptoms associated with FM.  The authors urge large multicenter investigations, and explain that the exact role of inflammation in FM is not fully established. We hope for more research to follow up this excellent article. DJS]

Malin K, Littlejohn GO. 2012. Personality and fibromyalgia syndrome. Open Rheumatol J.  6:273-285. “No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person's response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism.”

Molnar DS, Flett G, Sadava SW et al. 2012.  Perfectionism and health functioning in women with fibromyalgia. J Psychosom Res. 73(4):295-300. “Collectively, these findings clarify that overall levels of perfectionism are not elevated among women with fibromyalgia (emphasis mine DJS), but those women who are exceptionally high in levels of self-oriented perfectionism or high in socially prescribed perfectionism are particularly likely to suffer lower health functioning. These results suggest that perfectionism should be specifically assessed and targeted for intervention among women with fibromyalgia and there should be a particular emphasis on the pressure to meet perceived or actual expectations imposed on the self.”

Moraska AF, Hickner RC, Kohrt WM et al. 2012. Changes in blood flow and cellular metabolism at a myofascial trigger point with trigger point release (ischemic compression): a proof-of-principle pilot study. Arch Phys Med Rehabil. [Sep 10 Epub ahead of print]. “Identifying physiological constituents of MTrPs following intervention is an important step toward understanding pathophysiology and resolution of myofascial pain. The present study forwards that aim by showing proof-of-concept for collection of interstitial fluid from an MTrP before and after intervention can be accomplished using microdialysis, thus providing methodological insight toward treatment mechanism and pain resolution. Of the biomarkers measured in this study, lactate may be the most relevant for detection and treatment of abnormalities in the MTrP.”

Nijs J, Crombez G, Meeus M et al. 2012. Pain in patients with chronic fatigue syndrome: time for specific pain treatment? Pain Physician. 15(5):E677-686. “Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers....From the available literature....Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. [This study was simply a review of other studies, all of which totally ignored the possibility that CFS patients could have pain from co-existing myofascial trigger points or other local sources. It is a fine example of how bad research can lead to further bad research. DJS] 

Nijs J, Van Cauwenbergh D, De Kooning M et al. 2012. Time-contingent pacing and exercise therapy accounting for postexertional malaise and central sensitization in chronic fatigue (central sensitivity) syndrome. Eur J Clin Invest. [Sep 7 Epub ahead of print]. 

Patel SB, Kumar SK. 2012. Myofascial pain secondary to medication-induced bruxism. J Am Dent Assoc. 143(10):e67-69.

Perrot S. 2012. If fibromyalgia did not exist, we should have invented it. A short history of a controversial syndrome. Reumatismo. 64(4):186-193. “Fibromyalgia is a recent disease, and some physicians remain doubtful about its reality. The history of fibromyalgia is a story of controversies: the fight between subjectivity and cartesianism, and between old mind and body concepts. Fibromyalgia represents the emblematic condition of unexplained medical symptoms, far from well-defined diseases with objective biomarkers. In this review we will follow the fibromyalgia story along the ages and sciences to better understand this complex pain disorder, between soma and psyche, and between medicine and psycho-sociology and to demonstrate that fibromyalgia exists; we have not invented it.”

Pedrelli A, Stecco C, Day JA. 2009. treating patellar tendinopathy with fascial manipulation. J Bodyw Mov Ther 13(1):73-80.  Trigger points in quadriceps muscles can cause kneecap pain with motor incoordination.  Fascial manipulation technique of the quadriceps may relieve kneecap pain and dysfunction, and thus the focus of therapy may need to be the anterior thigh.

Picelli A, Ledro G, Turrina A et al. 2011. effects of myofascial technique in patients with subacute whiplash associated disorders: a pilot study. Eur J Phys Rehabil Med 47(4):561-568. “Myofascial techniques may be useful for improving treatment of subacute whiplash associated disorders also reducing their economic burden.”

Schjerning Olsen AM, Fosbel EL, Lindhardsen J. 2012. Long-term cardiovascular risk of

NSAID use according to time passed after first-time myocardial infarction: A nationwide cohort study. Circulation. [Sept 10 Epub ahead of print]. “The use of NSAIDS is associated with persistently increased coronary risk regardless of time elapsed after first-time MI.  We advise long-term caution in using NSAIDS for patients after MI.”

Schleip R, Jäger H, Klingler W et al. 2012. What is 'fascia'? A review of different nomenclatures.

J Bodyw Mov Ther. 16(4):496-502.

Stecco C, Gagey O, Belloni A et al. 2007. Anatomy of the deep fascia of the upper limb. Second part: study of innervation. Morphologie 91(292):38-43.  This study indicates that the flexor retinaculum has more proprioceptive functions, whereas the tendons were primarily mechanical in function. “…the fascia is a membrane that extends throughout the whole body and numerous muscular expansions maintain it in a basal tension.  During a muscular contraction these expansions could also transmit the effect of the stretch to a specific area of the fascia, stimulating the proprioceptors in that area.”  

Stecco C, Macchi V, Porzionato A et al. 2010. The ankle retinacula: morphological evidence of the proprioceptive role of the fascial system. Cells Tissues Organs 192(3):200-210. “The retinacula are not static structures for joint stabilization, like the ligaments, but a specialization of the fascia for local spatial proprioception of the movements of the foot and ankle.  Their anatomical variations and accessory bundles may be viewed as morphological evidence of the integrative role of the fascial system in peripheral control of articular motility.”

Stecco C, Stern R, Prozionato A et al. 2011.  Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat 33(10):891-896.   This study focused on hyaluronic acid in the fascial layers. “The HA within the deep fascia facilitates the free sliding of two adjacent fibrous fascial layers, thus promoting the normal function associated with the deep fascia.  If the HA assumes a more packed confirmation, or more generally, if the loose connective tissue inside the fascia alters its density, the behavior of the entire deep fascia and the underlying muscle would be compromised,  This, we predict, may be the basis of the common phenomenon known as “myofascial pain.” This study describes the fascial reservoir as a “…reservoir of water and ions for surrounding tissues. It may also function as a reservoir to accumulate and remove various degradation products and toxic substances…A fundamental element of the loose connective tissue (ground substance) is the HA, and its concentration determines, together with the temperature and other physical parameters, the density of the matrix. “  The study proposes the mechanism of increasing viscosity of ground substance, and proposes a new type of cell they call the “fasciacyte.” [This study confirms increased hyaluronic acid in myofascial pain areas  (what we found in the geloid mass over areas of resistant TrPs), and gives new anatomical fascial insights and a new direction in what may be a promising way to relieve and even reverse myofascial pain. DJS]

Tampin B, Slater H, Hall T. 2012. Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain. Pain. [Sep 11 Epub ahead of print]. The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM)....Despite commonalities in pain characteristics between the two neck-arm pain groups, distinct sensory profiles were demonstrated for each group. [It would be extremely helpful to discover what percentage of these patients had co-existing myofascial trigger points referring to the upper limb and/or neck.  DJS]

Tobbackx Y, Meeus M, Wauters L. 2012. Does acupuncture activate endogenous analgesia in chronic whiplash-associated disorders? A randomized crossover trial. Eur J Pain. [Sep 11 Epub ahead of print]. “It was shown that one session of acupuncture treatment results in acute improvements in pressure pain sensitivity in the neck and calf of patients with chronic WAD. Acupuncture had no effect on conditioned pain modulation or temporal summation of pressure pain. Both acupuncture and relaxation appear to be well-tolerated treatments for people with chronic WAD. These findings suggest that acupuncture treatment activates endogenous analgesia in patients with chronic WAD.”

Tugnet N, Williams R. 2012. “My bones hurt.” An unusual cause of fibromyalgia syndrome. J Musculoskel Pain 20(3):208-221.  This excellent case report documents fibromyalgia caused by multiple bony hemangiomatosis. [This is a good reminder that when the central nervous system is sensitized, it has been sensitized by something.  One must look for the cause. DJS]


Turkyilmaz AK, Kurt EE, Capkin E et al. 2012. Assessment of neuropathic pain in patients with fibromyalgia syndrome: A pilot study. J Musculoskel Pain. 20(3):170-176. [This study indicated that many patients with fibromyalgia have neuropathic pain syndromes that are associated with pain severity. Since many if not all fibromyalgia patients also have myofascial trigger points, and trigger points can cause nerve entrapment and these symptoms, it is to be hoped that future studies will include co-existing trigger points as a possible cause of these symptoms. DJS]

Van Oosterwijck J, Nijs J, Meeus M et al. 2012. Evidence for central sensitization in chronic whiplash: A systematic literature review. Eur J Pain. [Sep 25 Epub ahead of print]. “It has been suggested that sensitization of the central nervous system plays an important role in the development and maintenance of chronic (pain) complaints experienced by whiplash patients. According to the PRISMA guidelines, a systematic review was performed to screen and evaluate the existing clinical evidence for the presence of central sensitization in chronic whiplash....These studies evaluated the sensitivity to different types of stimuli (mechanical, thermal, electrical). Findings suggest that although different central mechanisms seem to be involved in sustaining the pain complaints in whiplash patients, hypersensitivity of the central nervous system plays a significant role.....international guidelines for the definition, clinical recognition, assessment and treatment of central sensitization are warranted.”

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