September 2014 References  Devin J. Starlanyl   for http://www.sover.net/~devstar

Brady S, McEvoy J, Dommerholt J et al. 2014. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther. 22(3):134-140.

“Trigger point dry needling (TrP-DN) is commonly used to treat persons with myofascial pain, but no studies currently exist investigating its safety. The aim of this study was to determine the incidence of Adverse Events (AEs) associated with the use of TrP-DN by a sample of physiotherapists in Ireland….A prospective survey was undertaken consisting of two forms recording mild and significant AEs. Physiotherapists who had completed TrP-DN training with the David G Simons Academy (DGSA) were eligible to take part in the study. Data were collected over a ten-month period….In the study, 39 physiotherapists participated and 1463 (19.18%) mild AEs were reported in 7629 treatments with TrP-DN. No significant AEs were reported giving an estimated upper risk rate for significant AEs of less than or equal to 0.04%. Common AEs included bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19%). Uncommon AEs were aggravation of symptoms (0.88%), drowsiness (0.26%), headache (0.14%), and nausea (0.13%). Rare AEs were fatigue (0.04%), altered emotions (0.04%), shaking, itching, claustrophobia, and numbness, all 0.01%....While mild AEs were very commonly reported in this study of TrP-DN, no significant AEs occurred. For the physiotherapists surveyed, TrP-DN appeared to be a safe treatment.”

Bravo D, Ibarra P, Retamal J. 2014. Pannexin 1: A novel participant in neuropathic pain signaling in the rat spinal cord. Pain. [Aug 4 Epub ahead of print.] “Pannexin 1 (panx1) is a large-pore membrane channel expressed in many tissues of mammals, including neurons and glial cells. Panx1 channels are highly permeable to calcium and adenosine triphosphatase (ATP); on the other hand, they can be opened by ATP and glutamate, two crucial molecules for acute and chronic pain signaling in the spinal cord dorsal horn, thus suggesting that panx1 could be a key component for the generation of central sensitization during persistent pain. In this study, we examined the effect of three panx1 blockers, namely, 10panx peptide, carbenoxolone, and probenecid, on C-reflex wind-up activity and mechanical nociceptive behavior in a spared nerve injury neuropathic rat model involving sural nerve transection. In addition, the expression of panx1 protein in the dorsal horn of the ipsilateral lumbar spinal cord was measured in sural nerve-transected and sham-operated control rats. Sural nerve transection resulted in a lower threshold for C-reflex activation by electric stimulation of the injured hindpaw, together with persistent mechanical hypersensitivity to pressure stimuli applied to the paw. Intrathecal administration of the panx1 blockers significantly depressed the spinal C-reflex wind-up activity in both neuropathic and sham control rats, and decreased mechanical hyperalgesia in neuropathic rats without affecting the nociceptive threshold in sham animals. Western blotting showed that panx1 was similarly expressed in the dorsal horn of lumbar spinal cord from neuropathic and sham rats. The present results constitute the first evidence that panx1 channels play a significant role in the mechanisms underlying central sensitization in neuropathic pain.”

Burri A, Lachance G, Williams FM. 2014. Prevalence and Risk Factors of Sexual Problems and Sexual Distress in a Sample of Women Suffering from Chronic Widespread Pain. J Sex Med. [Aug 7 Epub ahead of print.]  “CWP patients report more sexual pain and sexual distress compared with controls. Assessment of sexual problems should therefore be added to routine care of patients with CWP.”

Field T. Massage therapy research review. Complement Ther Clin Pract. 2014 [Aug 1 Epub ahead of print.]  “When moderate and light pressure massage have been compared in laboratory studies, moderate pressure massage reduced depression, anxiety and heart rate, and it altered EEG patterns, as in a relaxation response. Moderate pressure massage has also led to increased vagal activity and decreased cortisol levels. Functional magnetic resonance imaging data have suggested that moderate pressure massage was represented in several brain regions including the amygdala, the hypothalamus and the anterior cingulate cortex, all areas involved in stress and emotion regulation. Further research is needed to identify underlying neurophysiological and biochemical mechanisms associated with moderate pressure massage.”

Hartmann D, Sarton J. 2014. Chronic pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol. [Jul 17 Epub ahead of print.] “The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vulvar pain and sexual dysfunction. Though the studies have yet to prove a specific protocol, physical therapists trained in pelvic dysfunction are reporting success with restoring tissue normalcy and reducing vulvar and sexual pain. A review of pelvic anatomy and common findings are presented along with suggested physical therapy management.”

Havas M. 2006. Electromagnetic hypersensitivity: biological effects of dirty electricity with emphasis on diabetes and multiple sclerosis. Electromagn Biol Med 25(4):259-268. This article has several case studies and anecdotal inforamtin on sick building syndrome remediation by Graham/Stetzer filters to reduce dirty electricity, that is, electrical fields from wires and electrical devices causing sick building syndrome.  This article infers that the increase in rates of disorders such as fibromyalgia, asthma, chronic fatigue, MS, ADD/ADHD, and diabetes might have a contributor in rising “electromagnetic pollution in the form of dirty electricity, ground current, and radio frequency from wireless devices,” and urges that more research be done on this and on finding the number of people who are affected.

Homma M, Ishikawa H, Kiuchi T. 2014. Association of physicians' illness perception of fibromyalgia with frustration and resistance to accepting patients: a cross-sectional study. Clin Rheumatol. [Aug 3 Epub ahead of print.] “The aim of this study was to elucidate whether physicians' illness perceptions correlate with their frustration or resistance to accepting patients with fibromyalgia (FM). In this cross-sectional postal survey, questionnaires were sent to member physicians of the Japan College of Rheumatology and Japan Rheumatism Foundation. Measures collected included the Brief Illness Perception Questionnaire with Causal Attribution, the Illness Invalidation Inventory, and the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10). Multiple logistic regression was performed to examine associations between the DDPRQ-10 and resistance to accepting patients with FM for treatment. We analyzed data from 233 physicians who had experience in consulting with patients with FM. Only 44.2 % answered that they wanted to accept additional patients with FM. Physicians' frustration was associated with difficulty controlling symptoms, patients' emotional responses, and causal attribution of FM to patient internal factors. Conversely, lower levels of frustration were associated with causal attributions to biological factors and uncontrollable external factors. However, the ‘difficult patient’ perception did not correlate with resistance to accepting patients with FM. Difficulty controlling symptoms with treatment was the one factor common to both physicians' frustration and resistance to accepting patients with FM. Physicians may hesitate to accept patients with FM not because of the stigmatic image of the ‘difficult patient,’ but instead because of the difficulty in controlling the symptoms of FM. Thus, to improve the quality of consultation, physicians must continuously receive new information about the treatments and causes of FM.”

             

Huang JT, Chen HY, Hong CZ et al. 2014. Lumbar facet injection for the treatment of chronic piriformis myofascial pain syndrome: 52 case studies. Patient Prefer Adherence. 8:1105-1111.

“It is important to identify the possible cause of piriformis myofascial pain syndrome. If this pain is related to lumbar facet lesions, lumbar facet joint injection can immediately suppress piriformis myofascial pain symptoms. This effectiveness may last for at least 6 months in most patients. This study further supports the importance of eliminating the underlying etiological lesion for complete and effective relief of myofascial pain syndrome.”

Iglesias-Gonzalez JJ, Munoz-García MT, Rodrigues-de-Souza DP et al. 2013. Pain Med. 14(12):1964-1970. Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain. Forty-two patients with nonspecific LBP (50% women), aged 23-55 years old, and 42 age- and sex-matched controls participated…. TrPs were bilaterally explored within the quadratus lumborum, iliocostalis lumborum, psoas, piriformis, gluteus minimus, and gluteus medius muscles in a blinded design. TrPs were considered active if the subject recognized the local and referred pain as familiar symptoms, and TrPs were considered latent if the pain was not recognized as a familiar symptom…. The local and referred pain elicited by active TrPs in the back and hip muscles contributes to pain symptoms in nonspecific LBP. Patients had higher disability and worse sleep quality than controls. The number of active TrPs was associated with pain intensity and sleep quality. It is possible that a complex interaction among these factors is present in patients with nonspecific LBP.

Jeffery DD, Bulathsinhala L, Kroc M et al. 2014. Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010. Mil Med 179(9):1021-1029. “Although cause and effect cannot be established, the advent of federally approved drugs for FMS in concert with pharmaceutical industry marketing of these drugs coincide with the observed changes in prevalence, health care utilization, and costs of FMS relative to IBS and CFS.”

Jiao J, Vincent A, Cha SS et al. 2014. Association of abuse history with symptom severity and quality of life in patients with fibromyalgia. Rheumatol Int. [Aug 18 Epub ahead of print.]

This study from the Mayo Clinic indicates that “…abuse history in patients with fibromyalgia was associated with worse symptoms and QOL compared with those patients without abuse history. Future studies are needed to assess whether additional tailored interventions as part of fibromyalgia treatment are helpful for patients with a history of abuse.”

Juuso P, Skar L, Olsson M et al. 2014. Meanings of Being Received and Met by Others as Experienced by Women with Fibromyalgia. Qual Health Res. [Aug 21 Epub ahead of print.]

“Fibromyalgia (FM) is a common chronic pain syndrome that mostly affects middle-aged women. Our aim with this study was to elucidate meanings of being received and met by others as experienced by women with FM. Interviews with a narrative approach were conducted with 9 women. We analyzed the transcribed interviews with a phenomenological hermeneutical interpretation. The findings revealed two themes: being seen as a malingerer and being acknowledged. Meanings of being received and met by others, as experienced by women with FM, can be understood as a movement between the two perspectives. When they were acknowledged, their feelings of security and trust increased, but the women could not rely on this because others received and met them in such an unpredictable manner.”

Kovacic K, Chelimsky TC, Sood MR. 2014. Joint Hypermobility: A Common Association with Complex Functional Gastrointestinal Disorders. J Pediatr. [Aug 20 Epub ahead of print.]

Comorbid conditions were common, including sleep disturbances (77%), chronic fatigue (93%), dizziness (94%), migraines (94%), chronic nausea (93%), and fibromyalgia (24%)….JH (joint hypermobility) and other comorbid symptoms, including fibromyalgia, occur commonly in children and young adults with complex FGIDs (functional gastrointestinal disorders). POTS is prevalent in FGIDs but is not associated with hypermobility. We recommend screening patients with complex FGIDs for JH, fibromyalgia, and comorbid symptoms such as sleep disturbances, migraines, and autonomic dysfunction.

Li G, Yuan H, Zhang W. 2014. Effects of Tai Chi on health related quality of life in patients with chronic conditions: A systematic review of randomized controlled trials. Complement Ther Med. 22(4):743-755. “One of the characters of chronic illness is life-long condition with the deterioration in health related quality of life. Tai Chi has become a popular mind-body exercise and self-management strategy for patients with chronic conditions regarding its various physical and psychological effects…. Tai Chi appears to be safe and has positive effects on health related quality of life in patients with chronic conditions, especially for patients with disorders in Cardio-cerebrovascular and respiratory systems, and musculoskeletal system. However, as the delivery mood of Tai Chi provides multiply benefits, which part of the group provides the most benefit in improving quality of life is unclear. Due to the design limitations of previous studies, more larger and well-designed RCTs are needed to confirm the effects. And qualitative researches are warranted to explore how Tai Chi may work exactly from patients' own perspectives.”

Macerollo AA, Mack DO, Oza R et al. 2014. Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain. J Opioid Manag. 10(4):255-261. “This study was part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance omnibus survey of active academic US family physicians….Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription.”

McLennan MT. 2014. Interstitial Cystitis: Epidemiology, Pathophysiology, and Clinical Presentation. Obstet Gynecol Clin North Am. 41(3):385-395. “Interstitial cystitis, or painful bladder syndrome, can present with lower abdominal pain/discomfort and dyspareunia, and pain in any distribution of lower spinal nerves. Patients with this condition experience some additional symptoms referable to the bladder, such as frequency, urgency, or nocturia. It can occur across all age groups, although the specific additional symptoms can vary in prevalence depending on patient age. It should be considered in patients who have other chronic pain conditions such as fibromyalgia, chronic fatigue, irritable bowel, and vulvodynia. The cause is still largely not understood, although there are several postulated mechanisms.”

Miller AH, Jones JF, Drake DF et al. 2014. Decreased basal ganglia activation in subjects with chronic fatigue syndrome: Association with symptoms of fatigue. PLoS One 23(5):398 156. The information presented suggests that “symptoms of fatigue in CFS subjects were associated with reduced responsitivity of the basal ganglia, possibly involving the disruption of projections from the globus palladus to thalamic and cortical networks.

Mohandas M, Sharan D, Ranganathan R et al. 2014. Co-morbidities of myofascial neck pain among information technology professionals. Ann Occ Env Med. 26:21. This study was done with 71% males using laptop and/or desktop computers at occupational health clinics in India. Neck pain was the most common symptom, followed by low back, shoulder, and arm pain. Neck pain among females was significantly higher than in males. Myofascial pain syndrome was the commonest musculoskeletal disorder leading to pain in males and females. Thoracic Outlet Syndrome, Fibromyalgia, and eye strain were also common.

Montoro CI, Duschek S, Munoz Ladron de Guevara C et al. 2014. Aberrant Cerebral Blood Flow Responses during Cognition: Implications for the Understanding of Cognitive Deficits in Fibromyalgia.  Neuropsychology. [Aug 25 Epub ahead of print.]  “There is ample evidence for cognitive deficits in fibromyalgia syndrome (FMS). The present study investigated cerebral blood flow responses during arithmetic processing in FMS patients and its relationship with performance. The influence of clinical factors on performance and blood flow responses were also analyzed.…Forty-five FMS patients and 32 matched healthy controls completed a mental arithmetic task while cerebral blood flow velocities in the middle (MCA) and anterior (ACA) cerebral arteries were measured bilaterally using functional transcranial Doppler sonography (fTCD)…Patients' cognitive processing speeds were slower versus healthy controls. In contrast to patients, healthy controls showed a pronounced early blood flow response (during seconds 4-6 after the warning signal) in all assessed arteries. MCA blood flow modulation during this period was correlated with task performance. This early blood flow response component was markedly less pronounced in FMS patients in both MCAs. Furthermore, patients displayed an aberrant pattern of lateralization, with right hemispheric dominance especially observed in the ACA. Severity of clinical pain in FMS patients was correlated with cognitive performance and cerebral blood flow responses…. Cognitive impairment in FMS is associated with alterations in cerebral blood flow responses during cognitive processing. These results suggest a potential physiological pathway through which psychosocial and clinical factors may affect cognition.”

Perrot S, Russell IJ. 2014. More ubiquitous effects from non-pharmacologic than from pharmacologic treatments for fibromyalgia syndrome: A meta-analysis examining six core symptoms. Eur J Pain. 18(8):1067-1080.  “Very few drugs in well-designed clinical trials have demonstrated significant relief for multiple FM symptom domains, whereas non-pharmacologic treatments with weaker study designs have demonstrated multidimensional effects. Future therapeutic trials for FM should prospectively examine each of the core domains and should attempt to combine pharmacologic and non-pharmacologic therapies in well-designed clinical trials.”

Powell J. 2014. The Approach to Chronic Pelvic Pain in the Adolescent. Obstet Gynecol Clin North Am. 41(3):343-355. “Adolescents present to outpatient and acute care settings commonly for evaluation and treatment of chronic pelvic pain (CPP). Primary care providers, gynecologists, pediatric and general surgeons, emergency department providers, and other specialists should be familiar with both gynecologic and nongynecologic causes of CPP so as to avoid delayed diagnoses and potential adverse sequelae. Treatment may include medications, surgery, physical therapy, trigger-point injections, psychological counseling, and complementary/alternative medicine. Additional challenges arise in caring for this patient population because of issues of confidentiality, embarrassment surrounding the history or examination, and combined parent-child decision making.”

Robbins MS, Kuruvilla D, Blumenfeld A et al. 2014. Trigger Point Injections for Headache Disorders: Expert Consensus Methodology and Narrative Review. Headache. [Aug 28 Epub ahead of print.] “Indications for TPIs (trigger point injections) may include many types of episodic and chronic primary and secondary headache disorders, with the presence of active trigger points (TPs) on physical examination. Contraindications may include infection, a local open skull defect, or an anesthetic allergy, and precautions are necessary in the setting of anticoagulant use, pregnancy, and obesity with unclear anatomical landmarks. The most common muscles selected for TPIs include the trapezius, sternocleidomastoid, and temporalis, with bupivacaine and lidocaine the agents used most frequently. Adverse effects are typically mild with careful patient and procedural selection, though pneumothorax and other serious adverse events have been infrequently reported….When performed in the appropriate setting and with the proper expertise, TPIs seem to have a role in the adjunctive treatment of the most common headache disorders. We hope our effort to characterize the methodology of TPIs by expert opinion in the context of published data motivates the performance of evidence-based and standardized treatment protocols.”

Sharan D, Manjula M, Urmi D et al. 2014. Effect of yoga on the myofascial pain sydnroe of neck. Int J Yoga. 7(1):54-59.  Pysiotherapists can often develop chronic myofascial pain due to trigger points due to their static posture, the repetitive nature of the work, and other perpetuating factors. This pilot study was done on eight physiotherapists at a tertiary facility who had at least six months of experience. And tested positive with Simons’ criteria for trigger points.  After 4 weeks of a program of Hatha Yoga specific to the cervical region and including pranayama, asanas, and meditation for one hour a day, the subjects had improved quality of life, enhanced range of motion, less pressure pain sensitivity, greater range of motion, greater grip strength, , and less disability.

Sharan D, Mohandoss M, Ranganathan R et al. 2014. Musculoskeletal disorders of the upper extremities due to excessive usage of hand held devices. Ann Occ Env Med. 26:22.   This retrospective study from India was held on 70 subjects with upper extremity MSD from handheld devices. “All of the subjects reported pain in the thumb and forearm with associated burning, numbness and tingling around the thenar aspect of the hand, and stiffness of wrist and hand.  43 subjects had symptoms on the right side; 9 on the left and 18n had bilateral symptoms.…All the subjects were diagnosed to have tendinosis of the extensor pollicis longus and myofascial pain syndrome affecting the 1^st interossei, thenar group of muscles and extensor digitorum communis….All subjects recovered completely following the rehabilitation.”

Sharan D, Rajkumar JS, Mohandoss M. 2014. Myofascial low back pain treatment. Curr Pain Headache Rep.18(9):449. “Myofascial pain is a common musculoskeletal problem, with the low back being one of the commonest affected regions. Several treatments have been used for myofascial low back pain through physical therapies, pharmacologic agents, injections, and other such therapies. This review will provide an update based on recently published literature in the field of myofascial low back pain along with a brief description of a sequenced, multidisciplinary treatment protocol called Skilled Hands-on Approach for the Release of myofascia, Articular, Neural and Soft tissue mobilization (SHARANS) protocol. A comprehensive multidisciplinary approach is recommended for the successful management of individuals with myofascial low back pain.”

Spitznagle TM, McCurdy Robinson C. 2014. Myofascial Pelvic Pain. Obstet Gynecol Clin North Am. 41(3):409-432. “Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination.”

Wolfe F, Hauser W, Walitt BT et al. 2014. Fibromyalgia and Physical Trauma: The Concepts We Invent. J Rheumatol. [Aug 1 Epub ahead of print.] “Despite weak to nonexistent evidence regarding the causal association of trauma and fibromyalgia (FM), literature and court testimony continue to point out the association as if it were a strong and true association. The only data that appear unequivocally to support the notion that trauma causes FM are case reports, cases series, and studies that rely on patients' recall and attribution - very low-quality data that do not constitute scientific evidence. Five research studies have contributed evidence to the FM-trauma association. There is no scientific support for the idea that trauma overall causes FM, and evidence in regard to an effect of motor vehicle accidents on FM is weak or null. In some instances effect may be seen to precede cause. Alternative causal models that propose that trauma causes "stress" that leads to FM are unfalsifiable and immeasurable.” [These authors, known for their debunking of fibromyalgia, seem oblivious to the relationship between fibromyalgia and myofascial trigger points, and the numerous studies linking whiplash associated trauma to trigger points and fibromyalgia central sensitization. DJS]

Wolf LD, Davis MC. 2014. Loneliness, daily pain, and perceptions of interpersonal events in adults with fibromyalgia. Health Psychol. 33(9):929-937. Chronic and transient episodes of loneliness are associated with more negative daily social relations and pain. However, boosts in positive events yield greater boosts in day-to-day enjoyment of social relations for lonely versus non-lonely individuals, and during loneliness episodes, a finding that can inform future interventions for individuals with chronic pain.