March 2012 References   Devin J. Starlanyl   for


Abdullah M, Vishwanath S, Elbalkhi A et al. 2012. Mitochondrial myopathy presenting as fibromyalgia: a case report. J Med Case Reports. 6(1):55. “This case demonstrates that adults diagnosed with fibromyalgia may have their symptom complex related to an adult onset mitochondrial myopathy. This is an important finding since treatment of mitochondrial myopathy resulted in resolution of symptoms.”


Akkaya N, Atalay NS, Selcuk ST et al. 2012. Frequency of fibromyalgia syndrome in breast cancer patients. Int J Clin Oncol. [Feb 10 Epub ahead of print]. “We note that the frequency of FM in the operated breast cancer patients in this study was higher than that reported in normal populations in the literature. Also, we found that the presence of FM had negative effects on the quality of life of the breast cancer patients. Accordingly, in the evaluation of widespread pain and complaints of fatigue in long-surviving breast cancer patients, after metastatic disease is excluded, the probability of FM should be kept in mind, so that appropriate treatment can be initiated to improve their functional status and quality of life.”


Alonso-Blanco C, de-la-Llave-Rincon AI, Fernandez-de-las-Penas C. 2012. Muscle trigger point therapy in tension-type headache. Expert Rev Neurother. 12(3):315-322. “Recent evidence suggests that active trigger points (TrPs) in neck and shoulder muscles contribute to tension-type headache. Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms. It seems that the pain profile of this headache may be provoked by referred pain from active TrPs in the posterior cervical, head and shoulder muscles. In fact, the presence of active TrPs has been related to a higher degree of sensitization in tension-type headache. Different therapeutic approaches are proposed for proper TrP management. Preliminary evidence indicates that inactivation of TrPs may be effective for the management of tension-type headache, particularly in a subgroup of patients who may respond positively to this approach. Different treatment approaches targeted to TrP inactivation are discussed in the current paper, focusing on tension-type headache. New studies are needed to further delineate the relationship between muscle TrP inactivation and tension-type headache.”


Anaya-Terroba L, Arroyo-Morales M, Fernandez-de-las-Penas C et al. 2010. Effects of ice massage on pressure pain thresholds and electromyography activity post exercise: a randomized controlled crossover study. J Manipulative Physiol Ther. 33(3):212-219. “Ice massage after isokinetic exercise produced an immediate increase of PPT (pressure pain threshold) over the VL (vastus lateralis) and VM (vastus medialis) and EMG (electromyography) activity over the VL muscle in recreational athletes, suggesting that ice massage may result in a hypoalgesic effect and improvements in EMG activity.” [Ice massage can rapidly “diffuse” tightness, and thus pain due to the tightness, in some muscles with TrPs.  This may be what is occurring here. DJS]


Anderson RJ, McCrae CS, Staud R et al. 2012. Predictors of Clinical Pain in Fibromyalgia: Examining the Role of Sleep. J Pain. [Feb 29 Epub ahead of print]. “Understanding individual differences in the variability of fibromyalgia pain can help elucidate etiological mechanisms and treatment targets. Past research has shown that spatial extent of pain, negative mood, and after sensation (pain ratings taken after experimental induction of pain) accounts for 40 to 50% of the variance in clinical pain. Poor sleep is hypothesized to have a reciprocal relationship with pain, and over 75% of individuals with fibromyalgia report disturbed sleep. We hypothesized that measures of sleep would increase the predictive ability of the clinical pain model. Measures of usual pain, spatial extent of pain, negative mood, and pain after sensation were taken from 74 adults with fibromyalgia. Objective (actigraph) and subjective (diary) measures of sleep duration and nightly wake time were also obtained from the participants over 14 days.... Results replicate previous research and suggest that spatial extent of pain, pain after sensation, and negative mood play important roles in clinical pain, but sleep disturbance did not aid in its prediction.... Fibromyalgia patients may benefit from a 3-pronged approach to pain management: reducing pain's spatial extent, normalization of central nervous system hypersensitivity, and psychobehavioral therapies for negative mood.”


Becker A. 2012. Health Economics of Interdisciplinary Rehabilitation for Chronic Pain: Does it Support or Invalidate the Outcomes Research of These Programs? Curr Pain Headache Rep. [Feb 5 Epub ahead of print]. “Interdisciplinary rehabilitation has been shown to be effective for treatment of patients suffering from chronic nonmalignant pain with respect to activity level, pain intensity, function, or days of sick leave. However, effects in clinical outcome do not necessarily imply a superiority of the intervention from an economic point of view.....there is still a long way to go to understand the economic implications of interdisciplinary rehabilitation from the perspectives of society, the health insurers, and the patients.”


Bican O, Jacovides C, Pulido L et al. 2011. Total knee arthroplasty inpatients with fibromyalgia. J Knee Surg. 24(4):265-271. “We matched 59 patients (90 knees) who underwent primary TKA (total knee arthroplasty) with a diagnosis of fibromyalgia to control patients who underwent the same surgery. Postoperative satisfaction and functional outcomes were assessed using a Likert scale and the SF-36 survey, respectively. At 3.4 years’ follow-up, fibromyalgia patients were less satisfied with TKA than control patients, and had lower preoperative and postoperative SF-36 scores. They demonstrated improvement comparable to that of controls following TKA, however. Fibromyalgia patients appear to show improvement comparable to that of controls following surgery. This syndrome should not be considered a contraindication for surgery.”


Cordero MD, Santos-Garcia R, Bermejo-Jover D et al. 2012. Coenzyme Q (10) in salivary cells correlate with blood cells in fibromyalgia: Improvement in clinical and biochemical parameter after oral treatment. Clin Biochem. [Feb 10 Epub ahead of print]. “Patients with FM showed an important dysfunction in CoQ(10) levels and might benefit from oral supplementation.”


Crane JD, Ogborn DI, Cupido C et al. 2012. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med 4(119):119ra13.  “To assess the effects of massage, we administered either massage therapy or no treatment to separate quadriceps of 11 young male participants after exercise-induced muscle damage. Muscle biopsies were acquired from the quadriceps (vastus lateralis) at baseline, immediately after 10 min of massage treatment, and after a 2.5-hour period of recovery. We found that massage activated the mechanotrans-duction signaling pathways focal adhesion kinase (FAK) and extracellular signal-regulated kinase 1/2 (ERK1/2), potentiated mitochondrial biogenesis signaling [nuclear peroxisome proliferator-activated receptor ( coactivator 1" (PGC-1")], and mitigated the rise in nuclear factor 6B (NF6B) (p65) nuclear accumulation caused by exercise-induced muscle trauma. Moreover, despite having no effect on muscle metabolites (glycogen, lactate), massage attenuated the production of the inflammatory cytokines tumor necrosis factor-" (TNF-") and interleukin-6 (IL-6) and reduced heat shock protein 27 (HSP27) phosphorylation, thereby mitigating cellular stress resulting from myofiber injury. In summary, when administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis.”  This indicates that massage enhances tissue repair and promote the healing process.


D’Apuzzo MR, Cabanela ME, Trousdale RT et al. 2012. Primary total knee arthroplasty inpatients with fibromyalgia. Orthopedics. 35(2):e175-e178. “Survivorship free from revision at 7 years was 89% for cruciate retaining knees and 98% for posterior stabilized knees. Patients with fibromyalgia undergoing primary TKA (total knee arthroplasty) have a high prevalence of complications and pain. Despite continued pain, the majority of patients were satisfied with the results and reported improvements after TKA. This data should be used to counsel patients with fibromyalgia preoperatively regarding limited goals with respect to pain relief and suggests that a multimodal individualized treatment program may be necessary to achieve optimal outcomes in patients with fibromyalgia.” [The FM is amplifying the pain from the TKA and TrPs from the knee dysfunction and the TKA itself. The TrP-related pain might be successfully treated with targeted therapy. DJS.]  


De-la-Llave-Rincon AI, Fernandez-de-las-Penas C, Laguarta-Val S et al. 2011. Women with carpal tunnel syndrome show restricted cervical range of motion. J Orthop Sports Phys Ther. 41(5):305-310. “Women with minimal, mild/moderate or severe CTS (carpal tunnel syndrome) exhibited less cervical range of motion compared to women of a similar age, suggesting that restricted cervical range of motion may be a common feature in individuals with CTS, independent of severity subgroups, as defined by electrodiagnosis. Future research should investigate cervical range of motion as a possible consequence or causative factor of CTS and related symptoms.”  [Inter-related TrPs in the neck, shoulder and arm must be investigated before surgery is considered, as must potential interactions of discs and facets that could be moderated with less invasive techniques. DJS]


De-la-Llave-Rincon AI, Fernandez-de-las-Penas C, Palacios-Cena D et al. 2009. Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome. J Orthop Sports Phys Ther. 39(9):658-664. “Patients with mild/moderate CTS (carpal tunnel syndrome) exhibited a greater FHP (forward head posture) and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion.” [Nerve entrapment by TrPs can exist all along the median nerve.  Forward head posture is a perpetuating factor of TrPs. DJS.]


Fernandez-de-las-Penas C. 2009. Interaction between trigger points and joint hypomobility: a clinical perspective. J Man Manip Ther. 17(2):74-77. “Reduction of joint mobility appears related to local muscles innervated from the segment, which suggests that muscle and joint impairments may be indivisible and related disorders in pain patients. …There is scientific evidence showing change in muscle sensitivity in muscle TrP after spinal manipulation, which suggests that clinicians should include treatment of joint hypomobility in the management of TrPs. Nevertheless, the order in which these muscle and joint impairments should be treated is not known and requires further investigation.” [The intriguing hypotheses mentioned here did not include the possibility that muscle contracture caused by TrPs can torque the joint, provoking hypermobility in the opposite direction.  It is to be hoped that more investigations on this interrelationship will be forthcoming. DJS]


Fernandez-de-las-Penas C, Fernandez-Mayoralas DM, Ortega-Santiago R et al. 2011. Referred pain from myofascial trigger points in head, neck and shoulder muscles reproduces head pain features in children with chronic tension type headache. J Headache Pain. 12(1):35-43. TrPs are a common cause of chronic tension type headaches in children.  [Pediatricians must become aware of this fact, and be trained in diagnosis and treatment of TrPs. DJS]


Gleitz M, Hornig K. 2012. [Trigger points - Diagnosis and treatment concepts with special reference to extracorporeal shockwaves]. Orthopade. 41(2):113-125. [German]  “The 70-year-old trigger point theory has experienced a growing scientific confirmation and clinical significance as a consequence of recent muscle pain research....The most effective conventional forms of treatment are aimed at a direct mechanical manipulation of the trigger point as are new forms of therapy with focused and radial shockwaves. By using high pressures the focused shockwaves in particular are suitable to provoke local and referred pain and thus simplify the trigger point diagnosis....Overall, the shockwave therapy on muscles represents a confirmation and extension of the existing trigger point therapy. It seems to be suitable for treating functional muscular disorders and myofascial pain syndromes within the locomotor system.”


Kool MD, Geenen R. 2012. Loneliness in patients with rheumatic diseases: the significance of invalidation and lack of social support. J Psychol. 146(1-2):229-241. “Patients with fibromyalgia experienced significantly more loneliness than patients with ankylosing spondylitis and patients with rheumatoid arthritis. Besides being younger, having lower education, and not working, in multiple regression analyses both lack of social support and invalidation were independently correlated with loneliness. This suggests that to decrease loneliness, therapeutic attention should be given to both increasing social support as well as decreasing invalidation in patients with rheumatic diseases, especially in patients with fibromyalgia.”


Kool MB, Van Middendorp H, Lumley M et al. 2012. Social Support and Invalidation by Others Contribute Uniquely to the Understanding of Physical and Mental Health of Patients with Rheumatic Diseases. J Health Psychol. [Feb 23 Epub ahead of print]. “This study examined whether social support and invalidation (lack of understanding and discounting by others) are differently associated with physical and mental health. Participants were 1455 patients with fibromyalgia, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, or another rheumatic disease....Social support correlated negatively with discounting responses of others (moderately) and lack of understanding (strongly). Both invalidation and social support were additively associated with patients' mental health, but only discounting was significantly associated with patients' physical health.” 


Li RM, Franks RH, Dimmitt SG et al. 2011. Ideas and innovations: inclusion of pharmacists in chronic pain management services in a primary care practice. J Opioid Manag. 7(6):484-487. “Nonmalignant chronic pain management involves an ongoing process of complex evaluations including proper patient selection, proper prescribing, and careful monitoring. In the Pain Management Refill Clinic, patients are stabilized on an opioid regimen by either a pain specialist or a primary care physician (PCP). The PCP assumes long-term prescription of the regimen and proper follow-up. The inclusion of pharmacists in the management of patients suffering from chronic pain has allowed the physicians to improve opioid prescribing, documentation, and monitoring in accordance with chronic nonmalignant pain guidelines.”


Moseley GL, Flor H. 2012. Targeting Cortical Representations in the Treatment of Chronic Pain: A Review. Neurorehabil Neural Repair. [Feb 13 Epub ahead of print]. “Recent neuroscientific evidence has confirmed the important role of cognitive and behavioral factors in the development and treatment of chronic pain. Neuropathic and musculoskeletal pain are associated with substantial reorganization of the primary somatosensory and motor cortices as well as regions such as the anterior cingulate cortex and insula. What is more, in patients with chronic low back pain and fibromyalgia, the amount of reorganizational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes, cortical reorganization correlates with the magnitude of pain. These findings have implications for both our understanding of chronic pain and its prevention and treatment. For example, central alterations may be viewed as pain memories that modulate the processing of both noxious and non-noxious input to the somatosensory system and outputs of the motor and other response systems. The cortical plasticity that is clearly important in chronic pain states also offers potential targets for rehabilitation. The authors review the cortical changes that are associated with chronic pain and the therapeutic approaches that have been shown to normalize representational changes and decrease pain and discuss future directions to train the brain to reduce chronic pain.”


Nguyen RH, Ecklund AM, Maclehose RF et al. 2012. Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia. Psychol Health Med. [Feb 13 Epub ahead of print]. “Having a co-morbid condition with vulvodynia, as well as having an increasing number of co-morbid conditions with vulvodynia, was significantly associated with the presence of feeling both invalidated and isolated. Chronic fatigue syndrome was the co-morbidity most strongly associated with feelings invalidation and isolation. One or more co-morbid pain conditions in addition to vulvodynia were significantly associated with psychosocial wellbeing.... future studies should explore the utility of promoting validation of women's pain conditions and reducing social isolation for women with chronic pain. [It is most unfortunate that the co-existing condition most interactive with and often causative of vulvodynia, chronic myofascial pain, was not considered among these conditions. DJS]


Perrot S, Schaefer C, Knight T et al. 2012. Societal and individual burden of illness among fibromyalgia patients in France: Association between disease severity and OMERACT core domains. BMC Musculoskel Disord. 13(1):22. “In a sample of 88 patients with FM from France, we found that FM poses a substantial economic and human burden on patients and society. FM severity level was significantly associated with patients' health status and core symptom domains.”


Rakovski C, Zettel-Watson L, Rutledge D. 2012. Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia. Disabil Rehabil. [Feb 12 Epub ahead of print]. “Work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation.”  [To do these modifications adequately, one must take into consideration the peripheral pain generators that are causing and/or maintaining the central sensitization of FM. Controlling the perpetuating factors of the peripheral pain generators can substantially help in the management of FM. DJS]


Reyes Del Paso GA, Pulgar A, Duschek S et al. 2011. Cognitive impairment in fibromyalgia syndrome: The impact of cardiovascular regulation, pain, emotional disorders and medication.

Eur J Pain. [Dec 19 Epub ahead of print]. “Thirty-five patients with FMS and 29 matched healthy controls completed a neuropsychological test measuring attention and arithmetic processing. As possible factors underlying the expected cognitive impairment, clinical pain intensity, co-morbid depression and anxiety disorders, sleep complaints, medication use, as well as blood pressure parameters were investigated. The patients' test performance was substantially reduced, particularly in terms of lower speed of cognitive processing and restricted improvement of performance in the course of the task. While the extent of depression, anxiety, fatigue and sleep complaints was unrelated to test performance, better performance was observed in patients showing lower pain ratings and those using opiate medication. The data corroborate the presence of substantial cognitive impairment in FMS. While the experience of chronic pain is crucial in mediating the deficits, co-morbid depression, anxiety, fatigue and sleep complaints play only a subordinate role. In the control group, but not in the patients, blood pressure was inversely associated with mental performance. This finding is in line with the well known cognitive impairment in hypertension. The lack of this association in FMS confirms previous research showing aberrances in the interaction between blood pressure and central nervous function in the affected 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. [Jan 17 Epub ahead of print].  This study considers cervical root compression as the initiator or maintainer of active TrPs in the upper trapezius, multifidi, splenius capitis, levator scapulae, rhomboid major and minor and deep paraspinals.


Talebian S, Otadi K, Ansari NN et al. 2012. Postural control in women with myofascial neck pain. J Musculoskel Pain. 20(1):25-30.Patients with myofascial TrPs in the neck area had difficulty standing on foam flooring, both with one-foot standing and bipedal standing. Foam flooring affected both the control group and the patient group, but the patients had a faster sway velocity and significantly greater displacement distance. The study revealed that patients with cervical TrPs have standing deficits in standing balance with the eyes open or closed. Postural impairments could be from proprioceptor dysfunction associated with neck TrPs. The use of foam flooring as a standing surface significantly worsened postural control, both during one-legged and bipedal stances. The foam disrupts the sensory information from cutaneous mechanoreceptors on the soles of the feet, contributing to postural instability that increased with TrP-related neck pain. Patients did recruit the ankle tissues in an attempt to compensate for the postural imbalance, stressing those muscles. [This has direct application for those patients who exercise on foam matted surfaces, for t’ai chi chuan, yoga and other forms in which postural balance is of importance. DJS.]


Valenza MC, Rodenstein DO, Fernandez-de-las-Penas C. 2011. Consideration of sleep dysfunction in rehabilitation. J Bodyw Mov Ther. 15(3):262-267.  Patients with whiplash commonly have neck pain that is contributory to sleep disturbance.  There is a direct relationship between pain intensity and worsening sleep quality.  It is essential to treat both the causes of the pain and the sleep dysfunction components as part of management of these patients.


Valenza MC, Valenza G, Gonzalez-Jimenez E et al. 2011. Alteration in sleep quality in patients with mechanical insidious neck pain and whiplash-associated neck pain. Am J Phys Med Rehabil. [Dec 14 Epub ahead of print]. “Sleep disturbances are a common finding in individuals with neck pain and are associated with the intensity of ongoing pain in WAD (whiplash).”  Inadequate sleep quality and quantity can contribute to multi-system effects.  “It seems essential to address the ongoing cycle of pain and sleep disturbances as an integral part of the treatment of patients with neck pain.”  


van Wilgen CP, Keizer D. 2012. The sensitization model to explain how chronic pain exists without tissue damage. Pain Manag Nurs. 13(1):60-65. “The interaction of nurses with chronic pain patients is often difficult. One of the reasons is that chronic pain is difficult to explain, because no obvious anatomic defect or tissue damage is present. There is now enough evidence available indicating that chronic pain syndromes such as low back pain, whiplash, and fibromyalgia share the same pathogenesis, namely, sensitization of pain modulating systems in the central nervous system. Sensitization is a neuropathic pain mechanism in which neurophysiologic changes may be as important as behavioral, psychological, and environmental mechanisms. The sensitization model provides nurses with an opportunity to explain pain as a physical cause related to changes in the nervous system. This explanation may improve the patient's motivation to discuss the importance of psychosocial factors that contribute to the maintenance of chronic pain. In this article, sensitization is described as a model that can be used for the explanation of the existence of chronic pain. The sensitization model is described using a metaphor. The sensitization model is a useful tool for nurses in their communication and education toward patients.”


Vargas-Alarcon G, Alvarez-Leon E, Fragoso JM et al. 2012. A SCN9A gene-encoded dorsal root ganglia sodium channel polymorphism associated with severe fibromyalgia. BMC Musculoskel Disord. 13(1):23. “A consistent line of investigation suggests that autonomic nervous system dysfunction may explain the multi-system features of fibromyalgia (FM); and that FM is a sympathetically maintained neuropathic pain syndrome....The aim of this study was to search for an association between fibromyalgia and several SCN9A sodium channels gene polymorphisms....We studied 73 Mexican women suffering from FM and 48 age-matched women who considered themselves healthy....In this ethnic group; a disabling form of FM is associated to a particular SCN9A sodium channel gene variant. These preliminary results raise the possibility that some patients with severe FM may have a dorsal root ganglia sodium channelopathy.”     


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