September2013 References  Devin J. Starlanyl   for

Agrawal Y, Davalos-Bichara M, Zuniga MG et al. 2013. Head impulse test abnormalities and influence on gait speed and falls in older individuals. Otol Neurotol. [Aug 6 Epub ahead of print]. In a tertiary care center, among patients 70 years of age and older, this study found that “…half of the community-dwelling older individuals in our study had evidence of vestibular dysfunction, which was significantly associated with gait speed and fall risk in adjusted analyses. Screening for vestibular impairment using the simple HIT (head impulse test) and directing targeted vestibular therapy may be important to reduce gait impairment and fall risk in older individuals.” [Vestibular dysfunction has been observed to be a common co-existing condition with fibromyalgia. DJS]

Cagnie B, Dewitte V, Coppieters I et al. 2013. Effect of ischemic compression on trigger points in the neck and shoulder muscles in office workers: A cohort study. J Manipulative Physiol Ther. [Aug 28 Epub ahead of print]. Nineteen office workers with “mildly severe chronic” neck and shoulder pain and dysfunction each had their 4 most painful trigger points treated with ischemic compression during 8 sessions within a 4 week period. They had significant decrease in pain from all 4 trigger points treated, with significant increase in mobility and muscle strength.  These positive outcomes were maintained at a 6-month follow-up. 

Covelli E, Attanasio G, Viccaro M et al. 2013. A 9-year-old boy with atypical retroauricular pain: A case report. Am J Otolaryngol. [Aug 12 Epub ahead of print]. “We present a 9-year-old child who suffered from atypical retroauricular pain resistant to conventional treatment. After excluding any other cause of retroauricular pain, a nerve block was performed with a 0.3ml lidocaine 1% injection into the trigger point. We believe that this case report is important because in the literature there are no similar cases described in children”.  [People of all ages can have pain behind the ears that is generated by trigger points in the clavicular sternocleidomastoid muscle, the suboccipital muscles, the posterior occipitalis or the obliquus capitis superior.  It’s good to see this documented. DJS]

Domany E, Gilad O, Shwarz M et al. 2013. Imperforate hymen presenting as chronic low back pain. Pediatrics. 132(3):e768-770. In some women, the hymen has an insufficient opening to allow the menses to flow.  This case report is from the Pediatrics Dept. of B. Schneider Children’s Medical Center of Israel. “Imperforate hymen in an adolescent usually presents with cyclic abdominal pain or with pelvic mass associated with primary amenorrhea. We present a 13-year-old girl with chronic lower back pain of 6 months' duration as the only complaint. On physical examination, multiple trigger points were detected in the quadratus lumborum and gluteus medius muscles bilaterally….Hymenectomy was performed, with complete resolution of the back pain. Myofascial pain syndrome with a viscerosomatic reflex is a possible explanation for the clinical presentation of our patient.”

Huang QM, Ye G, Zhao ZY et al. 2013. Myoelectrical activity and muscle morphology in a rat model of myofascial trigger points induced by blunt trauma to the vastus medialis. Acupunct Med. 31(1):65-73. “A total of 24 male SD rats were randomly divided into a control group (group A) and model group (group B). A blunt striking injury and eccentric exercise were applied to the vastus medialis (VM) of rats in group B for 8 weeks. Later, the palpable taut band (TB), local twitch response, myoelectrical activities and morphology in the two groups were examined….An average of 2.5 (30/12) palpable TBs were detected in the VM in group B compared with none in group A. The MTrPs had two types of abnormal potential. Their amplitudes were significantly higher than those in the control group…but their durations showed no significant differences. A series of reflex contractions appeared in groups A and B in response to external stimulation to the ear. Their amplitude and duration in group B were significantly lower than those in group A. A series of lower fibrillation potentials repeatedly occurred in model MTrPs in group B. The morphology of MTrPs showed abnormal muscle fibres with large round or ellipse shapes in cross-section and enlarged tapering shapes in longitudinal section….Active MTrPs can be provoked by repeated blunt injury. Active MTrPs are a group of muscle fibres with abnormal shapes and abnormal myoelectrical potentials. External stimulation provokes low-voltage responses in MTrPs, which is different from the response of normal muscle fibres.

Iglesias-Gonzalez JJ, Munoz-García MT, Rodrigues-de-Souza DP et al. 2013. Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain Med. [Aug 15 Epub ahead of print]. “Forty-two patients with nonspecific LBP (low back pain) (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. Pain measures were collected with a numerical pain rate scale, disability was assessed with the Roland-Morris questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index….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.”

Iida K, Oguma Y. 2013. Relationships between flow experience, IKIGAI, and sense of coherence in tai chi practitioners. Holist Nurs Pract. 27(5):260-267. “The purpose of this study was to examine the mental health effects of Tai chi on regular practitioners by investigating the relationships between flow experience, IKIGAI (Japanese: "Life worth living"), and sense of coherence. The results indicated that flow experience may influence IKIGAI and IKIGAI may influence sense of coherence; this suggests that IKIGAI may act as an intermediary between flow experience and sense of coherence. The results also indicated that the longer the Tai chi experience, the higher was the flow experience.”

Kim MH, Nahm FS, Kim TK et al. 2013. Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty: clinical evidence of enhanced pain sensitivity following surgical injury. Pain. [Aug 29 Epub ahead of print]. “Staged bilateral total knee arthroplasty (TKA) may provide an ideal clinical model for the study of central sensitization. In staged TKA, hyperalgesia may be induced due to repeated surgical injury possibly via central sensitization, which can decrease functional outcomes. Therefore, we hypothesized that in staged bilateral TKA, patients would have greater pain in the second operated knee than in the first.”  This study confirmed that hypothesis.  “…patients undergoing staged bilateral TKA suffer greater postoperative pain in the second operated knee than the first. This suggests extension of hyperalgesia beyond the initially injured site to remote regions following surgical injury, in which central sensitization may be involved. Therapeutic approaches to reduce such hyperalgesia induced in the course of staged operations are required.”

Kim SA, Oh KY, Choi WH et al. 2013. Ischemic compression after trigger point injection affect the treatment of myofascial trigger points. Ann Rehabil Med. 37(4):541-546. This team from Soonchunhyang University College of Medicine in Korea divided 60 patients with active TrPs into 3 groups.  Group 1 received trigger point injections only, group 2 received TrP injections with 30 seconds of ischemic compression and group 3 received the TrP injections with 60 seconds of ischemic compression.  Significant improvement was found in all groups, although the groups receiving the additional ischemic compression had more improvement, no matter the time of compression. “This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point.”

Lago-Rizzardi CD, de Siqueira JT, de Siqueira SR. 2013. Spirituality of chronic orofacial pain patients: Case-control study. J Relig Health. [Aug 29 Epub ahead of print]. This study was from the Neurology Department, University of Sao Paulo Brazil Medical School. “The objective of this study was to investigate spirituality and blood parameters associated with stress in patients with facial musculoskeletal pain. Twenty-four women with chronic facial musculoskeletal pain (CFMP) and 24 healthy women were evaluated with a protocol for orofacial characteristics, research diagnostic criteria for temporomandibular disorders and the Spiritual Perspective Scale. Blood samples were collected to analyze blood count, cortisol, ACTH, C3, C4, thyroid hormones, total immunoglobulin, C-reactive protein and rheumatoid factor. The study group was more spiritualized than control group. Individuals with a high score of spirituality had less myofascial pain, less bruxism and fewer complaints. They also had lower levels of ACTH and IgE. Spirituality was higher in the study group and can be considered an important tool for coping with CFMP”.

McMakin CR, Oschman JL. 2013. Visceral and somatic disorders: tissue softening with frequency-specific microcurrent. J Altern Complement Med. 19(2):170-177. “Frequency-specific microcurrent (FSM) is an emerging technique for treating many health conditions. Pairs of frequencies of microampere-level electrical stimulation are applied to particular places on the skin of a patient via combinations of conductive graphite gloves, moistened towels, or gel electrode patches. A consistent finding is a profound and palpable tissue softening and warming within seconds of applying frequencies appropriate for treating particular conditions. Similar phenomena are often observed with successful acupuncture, cranial-sacral, and other energy-based techniques. This article explores possible mechanisms involved in tissue softening. In the 1970s, neuroscientist and osteopathic researcher Irvin Korr developed a "γ-loop hypothesis" to explain the persistence of increased systemic muscle tone associated with various somatic dysfunctions. This article summarizes how physiologists, neuroscientists, osteopaths, chiropractors, and fascial researchers have expanded on Korr's ideas by exploring various mechanisms by which injury or disease increase local muscle tension or systemic muscle tone. Following on Korr's hypothesis, it is suggested that most patients actually present with elevated muscle tone or tense areas due to prior traumas or other disorders, and that tissue softening indicates that FSM or other methods are affecting the cause of their pathophysiology. The authors believe this concept and the research it has led to will be of interest to a wide range of energetic, bodywork, and movement therapists.”

Rahman W, Dickenson AH. 2013. Voltage gated sodium and calcium channel blockers for the treatment of chronic inflammatory pain. Neurosci Lett. [Aug 11 Epub ahead of print]. “The inflammatory response is a natural response of the body that occurs immediately following tissue damage, which may be due to injury, infection or disease. The acute inflammatory response is an essential mechanism that promotes healing and a key aspect is the ensuing pain, which warns the subject to protect the site of injury. Thus, it is common to see a zone of primary sensitization as well as consequential central sensitization that generally, is maintained by a peripheral drive from the zone of tissue injury. Inflammation associated with chronic pain states, such as rheumatoid and osteoarthritis, cancer and migraine etc. is deleterious to health and often debilitating for the patient. Thus there is a large unmet clinical need. The mechanisms underlying both acute and chronic inflammatory pain are extensive and complex, involving a diversity of cell types, receptors and proteins. Among these the contribution of voltage gated sodium and calcium channels on peripheral nociceptors is critical for nociceptive transmission beyond the peripheral transducers and changes in their distribution, accumulation, clustering and functional activities have been linked to both inflammatory and neuropathic pain. The latter has been the main area for trials and use of drugs that modulate ion channels such as carbamazepine and gabapentin, but given the large peripheral drive that follows tissue damage, there is a clear rationale for blocking voltage gated sodium and calcium channels in these pain states. It has been hypothesized that pain of inflammatory origin may evolve into a condition that resembles neuropathic pain, but mixed pains such as low back pain and cancer pain often include elements of both pain states. This review considers the therapeutic potential for sodium and calcium channel blockers for the treatment of chronic inflammatory pain states.” [This paper confirms the role of peripheral pain generation in initiating the central sensitization state. It is very interesting, considering the idea that trigger points may be associated with a calcium channelopathy.  DJS]

Weijenborg PW, Bredenoord AJ. 2013. How reflux causes symptoms: Reflux perception in gastroesophageal reflux disease. Best Pract Res Clin Gastroenterol. 27(3):353-364. Gastroesophageal reflux occurs in everyone, but in the vast majority of the population it remains asymptomatic.  This review considers factors affecting symptomology of GERD, including central sensitization, leaky gut, enzymatic factors, acidity, and genetic tendencies, as well as treatments. 

Zhang RX, Ren K, Dubner R. 2013. Osteoarthritis pain mechanisms: basic studies in animal models. Osteoarthritis Cartilage. 21(9):1308-1315. This study, from the Center for Integrative Medicine, School of Medicine, University of Maryland, was done in rats, but may hold clues pertaining to human osteoarthritic development.  “Conditioned place preference tests demonstrate that OA pain induces aversive behaviors, suggesting the involvement of brain. During OA, brain functional connectivity is enhanced, but at present it is unclear how this change is related to OA pain….Animal studies demonstrate that peripheral and central sensitization contributes to OA pain, involving inflammatory cytokines, neuropeptides, and a variety of chemical mediators. Interestingly, brainstem descending facilitation of 5-HT/5-HT3 receptors plays a role in OA pain.”

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