June 2011 References   Devin J. Starlanyl   for http://www.sover.net/~devstar


Anderson R, Wise D, Sawyer T et al. 2011. Safety and effectiveness of an internal pelvic trigger point wand to urologic chronic pelvic pain syndrome. Clin J Pain [May 25 Epub ahead of print]. “This research has found that pelvic TrPs can be safely and effectively treated in a carefully monitored self-treatment home program.  They have a device that is a therapeutic wand; almost a back-knob device for the pelvis. It is attached to a batter driven monitor for checking pressure at the tip of the wand. TrPs are mapped for the patient and the patient is carefully instructed and supervised in self-therapy.  This study was done from a pelvic clinic that has a variety of practitioners familiar with internal work on TrPs.  Most of these patients, 93%, were male.” [It is to be hoped that future studies will include more female patients with chronic pelvic pain. It is also to be hoped that more practitioners will become aware of the presence of TrPs in chronic pelvic pain. This device is at present not sold in the USA. DJS]   


Apte G, Nelson P, Brismee JM et al. 2011. Chronic Female Pelvic Pain-Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region. Pain Pract. [May 26 Epub ahead of print].        “Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction. [TrPs will be part of almost every chronic pelvic pain condition.  One must treat them, but must find and control the perpetuating factors. DJS]


Chang CW, Chang KY, Chen YR et al. 2011. Electrophysiologic evidence of spinal accessory neuropathy in patients with cervical myofascial pain syndrome. Arch Phys Med Rehabil. 92(6):935-940. “This study demonstrates electrophysiologic evidence of neuroaxonal degeneration and neuromuscular transmission disorder in a significant proportion of patients with cervical MFPS. We suggest that spinal accessory neuropathy may be associated with cervical MFPS.”  


Ge HY, Arendt-Nielsen L. 2011. Latent Myofascial Trigger Points. Curr Pain Headache Rep. [May 11 Epub ahead of print]. “Treating latent MTPs in patients with musculoskeletal pain may not only decrease pain sensitivity and improve motor functions, but also prevent latent MTPs from transforming into active MTPs, and hence, prevent the development of myofascial pain syndrome.”


Hardy JK, Crofford LJ, Segerstrom SC. 2011. Goal conflict, distress, and pain in women with fibromyalgia: A daily diary study. J Psychosom Res. 70(6):534-540. “A chronic illness such as fibromyalgia can interfere with daily activities and goals by limiting available resources, including time and energy. This leads to competition between goals, known as goal conflict. The purpose of this study was to determine if goal conflict increases symptoms in women with fibromyalgia and whether symptoms lead to perceptions of goal conflict.....Goal pursuit may deplete psychological and physical resources in this vulnerable population, resulting in higher pain. Conversely, emotional distress may affect perception of goal conflict, resulting in less ambitious goal pursuit. Understanding the dynamic relationship between goal conflict and fibromyalgia symptoms may lead to more effective management of limited resources and pursuit of daily goals with fibromyalgia.”


Harker KT, Klein RM, Dick B et al. 2011. Exploring attentional disruption in fibromyalgia using the attentional blink. Psychol Health. [Jan 1 Epub ahead of print]. “Our findings suggest that attentional disruption in individuals with FMS is associated with deficits in the early allocation of attentional resources during the completion of tasks with higher attentional demand.”


Roizenblatt S, Neto NS, Tufik S. 2011. Sleep Disorders and Fibromyalgia. Curr Pain Headache Rep. [May 20 Epub ahead of print]. “Disordered sleep is such a prominent symptom in fibromyalgia that the American College of Rheumatology included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia in the 2010 diagnostic criteria for fibromyalgia. Even though sleep recording is not part of the routine evaluation, polysomnography may disclose primary sleep disorders in patients with fibromyalgia, including obstructive sleep apnea and restless leg syndrome. In addition, genetic background and environmental susceptibility link fibromyalgia and further sleep disorders. Among nonpharmacological treatment proposed for sleep disturbance in fibromyalgia, positive results have been obtained with sleep hygiene and cognitive-behavioral therapy. The effect of exercise is contradictory, but overweight or obese patients with fibromyalgia should be encouraged to lose weight. Regarding the approved antidepressants, amitriptyline proved to be superior to duloxetine and milnacipran for sleep disturbances. New perspectives remain on the narcolepsy drug sodium oxybate, which recently was approved for sleep management in fibromyalgia.” [This research was written in Brazil.  As of this date, sodium oxybate is not approved for FM in the USA. DJS]


Slevin KA, Ashburn MA. 2011. Primary care physician opinion survey on FDA opioid risk evaluation and mitigation strategies. J Opioid Manag. 7(2):109-115. “In response to disturbing rises in prescription opioid abuse, the Food and Drug Administration (FDA) has proposed the implementation of aggressive Risk Evaluation and Mitigation Strategies (REMS) that will require prescribers to obtain mandatory education, provide mandatory patient education, register patients into registries, and so forth before prescribing certain opioids.....The results suggest that 50 percent of the responding physicians would be willing to comply with the mandatory education component of REMS, including the requirement to provide education to patients. For some REMS components, willingness to continue to prescribe despite the restriction was higher (up to 90 percent). However, this leaves a substantial proportion of physicians who would not be willing to prescribe opioids controlled by the new REMS, which could have the unintended effect of decreasing access to these medications for legitimate medical purposes.”


Zhang Z, Zolnoun DA, Francisco EM et al. 2011. Altered Central Sensitization in Subgroups of Women With Vulvodynia. Clin J Pain. [May 17 Epub ahead of print]. “Chronic pain is thought to lead to altered central sensitization, and adaptation is a centrally mediated process that is sensitive to this condition. This report suggests that similar alterations exist in a subgroup of vulvodynia patients.” [Vulvodynia almost always has a myofascial TrP component.  This and other pain generators must be brought under control before one has a chance to deal with the central sensitization. DJS]


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