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


Berstad A, Undseth R, Lind R et al. 2012. Functional bowel symptoms, fibromyalgia and fatigue: A food-induced triad? Scand J Gastroenterol. [May 18 Epub ahead of print]. “Abstract Objective. Patients with perceived food hypersensitivity typically present with multiple health complaints. We aimed to assess the severity of their intestinal and extra-intestinal symptoms....All but one patient were diagnosed with IBS, 58% with severe symptoms. Extra-intestinal symptoms suggestive of chronic fatigue and fibromyalgia were demonstrated in 85% and 71%, respectively. Neither IgE-mediated food allergy nor organic pathology could explain the patients' symptoms. Nevertheless, malabsorption of fat was demonstrated in 10 of 38 subjects. Conclusions: Perceived food hypersensitivity may be associated with severe, debilitating illness. The comorbid triad of IBS, chronic fatigue, and musculoskeletal pain is striking and may point to a common underlying cause.”


Charles E. 2011. [No title available] J Chiropr Med. 10(4):301-305. “This case report describes a patient with right arm paralysis after nerve entrapment release surgery who had a diagnosis of Parsonage-Turner syndrome. The patient had right arm contracture, muscle atrophy, and weakness with a 6-week general paralysis of the forearm and index finger. The patient responded to chiropractic care including high-velocity/low-amplitude spinal manipulation, trigger point therapy, specific exercises and stretching. After 8 treatments the patient was able to fully straighten his arm, and his arm was fully functional and pain-free 3 years later with a return to mountain climbing.”


de-la-Llave-Rincon AI, Puentedura EJ, Fernandez-de-Las-Penas C. 2012. New advances in the mechanisms and etiology of carpal tunnel syndrome. Discov Med. 13(72):343-348. “Some studies have demonstrated that patients with CTS exhibit sensory symptoms not only within the areas innervated by the median nerve but also in extra-median regions, i.e., forearm or shoulder. It has also been demonstrated that patients with CTS may exhibit widespread pressure hypersensitivity and generalized thermal hyperalgesia, but not hypoesthesia, which is not related to electro-diagnostic findings. In addition, fine motor control and pinch grip force disturbances have been found to be commonly observed in this patient population. All these data suggest that central sensitization mechanisms are involved in the somato-sensory and motor disturbances found in CTS, probably related to cortical plastic changes. The presence of sensitization mechanisms could play an important role in the development of bilateral sensory symptoms in CTS and also can determine the therapeutic strategies for this condition. We propose that therapeutic interventions applied to individuals with CTS should include approaches that would modulate nociceptive barrage into the central nervous system.”


Jarrell J. 2011. Endometriosis and abdominal myofascial pain n adults and adolescents. Curr Pain Headache Rep 15(5):368-376. This comprehensive review explains the interconnection of endometriosis and myofascial TrPs and provides management options.


Jarrell J, Giambarardino MA, Robert M et al.  2011. Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain. Pain Res Treat 2011:692102.  “Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.” 


Jarrell J 2009. Demonstration of cutaneous allodynia in association with chronic pelvic pain. J Vis Exp 23(28).pii 1232. doi 10.3791/1232. This shows how episodic pelvic pain from painful menstrual periods, or chronic pain from endometriosis, can result in chronic pelvic pain with central sensitization hallmarks such as allodynia (pain from normally non-painful stimuli).  Abdominal wall tenderness and dyspareunia (pain with intercourse) are common at that stage. By the time signs of a central sensitization state have occurred, this pain can persist after medical or surgical treatment of the initial cause as part of a viscero-somatic reflex.  At this state, surgical intervention is not usually necessary, as the presence of abdominal wall and other area TrPs may be maintaining this heightened central pain state


Jones KD, Sherman CA, Mist SD et al. 2012. A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clin Rheumatol. [May 13 Epub ahead of print]. This study used an FM-modified 8-form Yang style tai chi compared to those that had education only.  Small groups of patients met twice a week for 90 minutes, over 12 weeks, with a goal of self-reported symptom reduction. The patients in the tai chi groups had better results in pain, sleep, function, and other parameters than the group that was provided with education only. “Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients.”


Napadow V, Edwards RR, Cahalan CM et al. 2012. Evoked Pain Analgesia in Chronic Pelvic Pain Patients Using Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation. Pain Med. [May 8 Epub ahead of print]. “Objective: Previous vagus nerve stimulation (VNS) studies have demonstrated antinociceptive effects, and recent noninvasive approaches, termed transcutaneous-vagus nerve stimulation (t-VNS), have utilized stimulation of the auricular branch of the vagus nerve in the ear. The dorsal medullary vagal system operates in tune with respiration, and we propose that supplying vagal afferent stimulation gated to the exhalation phase of respiration can optimize t-VNS.. RAVANS (respiratory-gated auricular vagal afferent nerve stimulation) produced promising antinociceptive effects (in CPP patients) for quantitative sensory testing (QST) outcomes reflective of the noted hyperalgesia and central sensitization in this patient population.”


Park SC, Kim KH. 2012. Effect of adding cervical facet joint injections in a multimodal treatment program for long-standing cervical myofascial pain syndrome with referral pain patterns of cervical facet joint syndrome. J Anesth. [May 31 Epub ahead of print]. Addition of therapeutic CFJ (cervical facet joint) injections to a multimodal treatment program is a useful therapeutic modality for patients, especially young patients, suffering from long-standing MPS with referral pain of CFJ syndrome.


Peng PW. 2012. Tai Chi and Chronic Pain. Reg Anesth Pain Med. [May 17 Epub ahead of print].

Most tai chi studies were found to be of low quality. “Only 5 pain conditions were reviewed: osteoarthritis, fibromyalgia, rheumatoid arthritis, low back pain, and headache. Of these, Tai Chi seems to be an effective intervention in osteoarthritis, low back pain, and fibromyalgia.”     


Rivera J, Vallejo MA, Esteve-Vives J. 2012. Drug prescription strategies in the treatment of patients with fibromyalgia. Reumatol Clin. [May 17 Epub ahead of print]. [Article in English, Spanish]. “The introduction of anticonvulsants or antidepressants, in an isolated or combined form, produces a significant clinical improvement in FM patients. The most effective drug strategy is the introduction of both drugs at the same time. The least effective strategy is not to change the number of drug prescriptions.”


Romero-Zurita A, Carbonell-Baeza A, Aparicio VA et al. 2012. Effectiveness of a tai-chi training and detraining on functional capacity, symptomatology and psychological outcomes in women with fibromyalgia. Evid Based Complement Alternat Med. 2012:614196 [May 9 Epub ahead of print]. “A 28-week Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female FM patients.”


Sari H, Akarirmak U, Uludag M. 2012. Active myofascial trigger points might be more frequent in patients with cervical radiculopathy. Eur J Phys Rehabil Med. 48(2):237-244. “Patients with cervical radiculopathy confirmed by MRI were assessed for trigger points. 51.2% had at least one active TrP in the upper trapezius, multifidus, splenius capitis, levator scapulae, rhomboid major or minor, or deep paraspinals. Latent TrPs were found I both the control and the radiculopathy group, but the radiculopathy group had a significantly higher percent of active TrPs. Treatment of cervical radiculopathy might be improved by treating active TrPs in the mentioned muscles.”


Veldhuijzen DS, Sondaal SF, Oosterman JM. 2012. Intact cognitive inhibition in patients with fibromyalgia but evidence of declined processing speed. J Pain. 13(5):507-515. “Patients with fibromyalgia frequently report cognitive complaints. In this study we examined performance on 2 cognitive inhibition tests, the Stroop Color-Word Test (SCWT) and the Multi-Source Interference Test (MSIT), in 35 female patients with fibromyalgia and 35 age-matched healthy female controls....For patients, pain ...correlated significantly to several indices of cognition. Psychosocial variables were not related to cognitive test performance. Fibromyalgia patients performed worse on both tests but to a similar extent for the neutral condition and the interference condition, indicating that there is no specific problem in cognitive inhibition. Evidence of decreased mental processing and/or psychomotor speed was found in patients with fibromyalgia. PERSPECTIVE: Fibromyalgia patients performed worse on interference tests, but no specific problem in cognitive inhibition was found. Decreased reaction time performance may instead point to an underlying problem of psychomotor or mental processing speed in fibromyalgia. Future studies should examine potential deficits in psychomotor function in fibromyalgia patients in more detail.”


Vulfsons S, Ratmansky M, Kalichman L. 2012. Trigger Point Needling: Techniques and Outcome. Curr Pain Headache Rep. [May 18 Epub ahead of print]. “In a patient with too much pain to be treated directly, dry needling distal to the TrP may be helpful because it may reduce noxious inhibitory control.” [Dry needling may be too painful for some patients, especially if they have central sensitization such as fibromyalgia as well as TrPs. The use of local anesthetics with standard TrP injection may be very helpful. Dry needling may cause added pain and thus increase central sensitization. DJS]   

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