September 2011 References   Devin J. Starlanyl   for


Boelens OB, Scheltinga MR, Houterman S et al. 2011. Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients. Ann Surg. [Aug 30 Epub ahead of print]. “A regimen of consecutive local trigger point injections is effective in one-third of patients with ACNES (anterior cutaneous nerve entrapment syndrome). Surgical neurectomy is effective in about two-thirds of the injection regimen refractory patients. Eighty percent of the entire ACNES population reports total or substantial pain relief on the long term.” [All too often, surgery is considered because the treating clinician does not know how to diagnose or treat trigger points. Much surgery can be prevented. DJS]


Boisgontier MP, Olivier I, Chenu O et al. 2011. Presbypropria: the effects of physiological ageing on proprioceptive control. Age (Dordr). [Aug 18 Epub ahead of print]. “Results showed that proprioceptive control was as accurate and as consistent in older as in young adults for a single proprioceptive task. However, performing a secondary cognitive task and increasing the difficulty of this secondary task evidenced both a decreased matching performance and/or an increased attentional cost of proprioceptive control in older adults as compared to young ones. These results advocated for an impaired proprioception in physiological ageing.” [This may be similar to what occurs due to TrPs in FM. The braion can only handle so much, and when confronted with multiple proprioceptive TrP dysfunction as well as the pain stimuli, cognitive dysfunction results. DJS]


Clauw DJ, Arnold LM, McCarberg BH. 2011. The Science of Fibromyalgia. Mayo Clin Proc. 86(9):907-911. “Fibromyalgia (FM) is a common chronic widespread pain disorder. Our understanding of FM has increased substantially in recent years with extensive research suggesting a neurogenic origin for the most prominent symptom of FM, chronic widespread pain. Neurochemical imbalances in the central nervous system are associated with central amplification of pain perception characterized by allodynia (a heightened sensitivity to stimuli that are not normally painful) and hyperalgesia (an increased response to painful stimuli). Despite this increased awareness and understanding, FM remains undiagnosed in an estimated 75% of people with the disorder. Clinicians could more effectively diagnose and manage FM if they better understood its underlying mechanisms. Fibromyalgia is a disorder of pain processing. Evidence suggests that both the ascending and descending pain pathways operate abnormally, resulting in central amplification of pain signals, analogous to the "volume control setting" being turned up too high. Patients with FM also exhibit changes in the levels of neurotransmitters that cause augmented central nervous system pain processing; levels of several neurotransmitters that facilitate pain transmission are elevated in the cerebrospinal fluid and brain, and levels of several neurotransmitters known to inhibit pain transmission are decreased. Pharmacological agents that act centrally in ascending and/or descending pain processing pathways, such as medications with approved indications for FM, are effective in many patients with FM as well as other conditions involving central pain amplification. Research is ongoing to determine the role of analogous central nervous system factors in the other cardinal symptoms of FM, such as fatigue, nonrestorative sleep, and cognitive dysfunction.”


de Tommaso M, Federici A, Serpino C et al. 2011. Clinical features of headache patients with fibromyalgia comorbidity. J Headache Pain. [Aug 17 Epub ahead of print]. “Our previous study assessed the prevalence of fibromyalgia (FM) syndrome in migraine and tension-type headache. We aimed to update our previous results, considering a larger cohort of primary headache patients who came for the first time at our tertiary headache ambulatory. A consecutive sample of 1,123 patients was screened. Frequency of FM in the main groups and types of primary headaches; discriminating factor for FM comorbidity derived from headache frequency and duration, age, anxiety, depression, headache disability, allodynia, pericranial tenderness, fatigue, quality of life and sleep, and probability of FM membership in groups; and types of primary headaches were assessed. FM was present in 174 among a total of 889 included patients.... Headache frequency, anxiety, pericranial tenderness, poor sleep quality, and physical disability were the best discriminating variables for FM comorbidity, with 81.2% sensitivity. Patients presenting with chronic migraine and chronic tension-type headache had a higher probability of sharing the FM profile..... A phenotypic profile where headache frequency concurs with anxiety, sleep disturbance, and pericranial tenderness should be individuated to detect the development of diffuse pain in headache patients.” [It is very likely that the headaches and localized tenderness, and perhaps some of the other symptoms as well,  were due to co-existing myofascial TrPs rather than FM. The FM simply amplified the symptoms. DJS]


Ermis MN, Yildirim D, Durakbasa MO et al. 2011. Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors. J Back Musculoskel Rehabil. 24(3):137-144. “The ultrasonographic examination detected a paravertebral hypoechogenic globular-shaped muscle disorganization associated with lipomatous degeneration exclusively localized to the trigger point in the study group…This prospective study depicts the etiologic factors, ultrasonographic features and treatment protocol of MSCNE (medical superior cluneal nerve entrapment) which is usually an underestimated cause of the low back pain.”  This is yet another study documenting key TrP involvement in chronic low back pain and nerve entrapment. DJS]


Moldofsky H, Harris HW, Archambault WT et al. 2011. Effects of Bedtime Very Low Dose Cyclobenzaprine on Symptoms and Sleep Physiology in Patients with Fibromyalgia Syndrome: A Double-blind Randomized Placebo-controlled Study. J Rheumatol. [Sep 1 Epub ahead of print]. “Bedtime VLD( very low dose) CBP (cyclobenzaprine) treatment improved core FM symptoms.” 


Ozkan F, Cakir Ozkan N, Ekorkmaz U. 2011. Trigger point injection therapy in the management of myofascial temporomandibular pain. Agri 23(3):119-125.  “Myofascial pain is the most common temporomandibular disorder.....Our results indicate that trigger point injection therapy combined with splint therapy is effective in the management of myofascial TMD pain. “ Further research is needed. [One must be careful with splint use in TrPs, as immobility is a perpetuating factor of TrPs. One needs to treat all the TrPs affecting the TMJ, including the soleus.  Unless one knows all TrPs, one may not know to check the calf for TrPs that can affect the jaw. DJS]


Rha DW, Shin JC, Kim YK et al. 2011. Detecting local twitch responses of myofascial trigger points in the lower back muscles using ultrasonography. Arch Phys Med Rehabil. [Aug 11 Epub ahead of print]. “These findings suggest that ultrasonography was useful for detecting LTRs (local twitch responses) of MTrPs, especially for LTRs in the deep muscles. Ultrasound guidance may improve the therapeutic efficacy of trigger point injection for treating MTrPs in the deep muscles.”


Rodriguez-Fernandez AL, Garrido-Santofimia V, Gueita-Rodriguez J et al. 2011. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 92(9):1353-1358. “A 10-minute application of burst-type TENS (transcutaneous electrical nerve stimulation) increases in a small but statistically significant manner the RPPT (referred pressure pain threshold) over upper trapezius latent MTrPs and the ipsilateral cervical range of motion.”


Schaefer C, Chandran A, Hufstader M et al. 2011. The Comparative Burden of Mild, Moderate and Severe Fibromyalgia: Results from a Cross-Sectional Survey in the United States. Health Qual Life Outcomes. 9(1):71. “FM imposes a substantial humanistic burden on patients in the United States, and leads to substantial productivity loss, despite treatment. This burden is higher among subjects with worse FM severity.”


Staud R. 2011. Evidence for Shared Pain Mechanisms in Osteoarthritis, Low Back Pain, and Fibromyalgia. Curr Rheumatol Rep. [Aug 11 Epub ahead of print]. “Osteoarthritis (OA), low back pain (LBP), and fibromyalgia (FM) are common chronic pain disorders that occur frequently in the general population. They are a significant cause of dysfunction and disability. Why some of these chronic pain disorders remain localized to few body areas (OA and LBP), whereas others become widespread (FM), is unclear at this time. Genetic, environmental, and psychosocial factors likely play an important role...... Ineffective endogenous pain control and central sensitization are important features of OA, LBP, and FM patients.”   



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