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



Anderson R, Wise D, Sawyer T et al. 2011.6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. J Urol 185(4):1294-1299.  This study showed that men with chronic pelvic pain and “abacterial prostatitis” due to TrPs can benefit significantly from intensive myofascial TrP therapy and paradoxical relaxation training. Much pelvic pain and dysfunction is caused by short and tight pelvic floor musculature due to TrPs.  Intense patient  training for a short period of time can provide long-term symptom relief.


Anderson R, Wise D, Sawyer T et al. 2011. Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome. Clin J Pain 27(9):764-768. The pelvic wand is a device that enables safe patient self-treatment for internal trigger points. [It does, however, require that patients have care providers who can diagnose and treat the TrPs, and train the patients in the use of the wand. DJS]


Ballyns J, Shah JP, Hammond J et al. 2011. Objective sonographic measures for characterizing myofascial trigger points. J Ultrasound Med 30(10):1331-1340.”...myofascial trigger points may be classified by area using sonoelastography. Furthermore, monitoring the trigger point area and pulsatility index may be useful in evaluating the natural history of myofascial pain syndrome.” [This is very useful research, but sonoelastography is for research institution benefit only.  There is no short-cut around good history taking and palpation exam for the diagnosis of TrPs. DJS]


Bosch OG, Quednow BB, Seifritz E et al. 2011. Reconsidering GHB: orphan drug or new model antidepressant? J Psychopharmacol. [Sep 17 Epub ahead of print]. “For six decades, the principal mode of action of antidepressant drugs is the inhibition of monoamine re-uptake from the synaptic cleft. Tricyclic antidepressants, selective serotonin re-uptake inhibitors (SSRIs) and the new generation of dual antidepressants all exert their antidepressant effects by this mechanism. In the early days of the monoaminergic era, other efforts have been made to ameliorate the symptoms of depression by pharmacological means. The gamma-aminobutyric acid (GABA) system was and possibly still is one of the main alternative drug targets. Gammahydroxybutyrate (GHB) was developed as an orally active GABA analogue.... The effects on sleep, agitation, anhedonia and depression were promising. However, the rise of benzodiazepines and tricyclic antidepressants brought GHB out of the scope of possible treatment alternatives. GHB is a GABA(B) and GHB receptor agonist with a unique spectrum of behavioral, neuroendocrine and sleep effects, and improves daytime sleepiness in various disorders such as narcolepsy, Parkinson's disease and fibromyalgia. Although it was banned from the US market at the end of the 1990s because of its abuse and overdose potential, it later was approved for the treatment of narcolepsy. New research methods and an extended view on other neurotransmitter systems as possible treatment targets of antidepressant treatment brought GHB back to the scene. This article discusses the unique neurobiological effects of GHB, its misuse potential and possible role as a model substance for the development of novel pharmacological treatment strategies in depressive disorders.”

Chopra K, Kuhad A, Arora V. 2011. Neoteric pharmacotherapeutic targets in fibromyalgia.

Expert Opin Ther Targets. [Sep 10 Epub ahead of print]. “Fibromyalgia is a debilitating, chronic pain disorder typically present with allodynia and hyperalgesia. Estimates from the USA suggest that fibromyalgia affects about 5% of women, and is the third most common rheumatic disorder after lower back pain and osteoarthritis....  Despite progress in understanding of fibromyalgia and the long-awaited introduction of three medications for treating it, fibromyalgia continues to pose a significantly unmet medical need, negatively affecting the lives of millions of individuals worldwide in all ethnic groups and all economic classes....Current research on novel sedative-hypnotics, anti-epileptic medications, various reuptake inhibitors, growth hormone agonists, cannabinoid agonists, non-opiate analgesics and 5-HT(3) antagonists offers hope for the next generation of therapeutic options for fibromyalgia. With regards to the development of novel pharmacotherapies, there seem to be grounds for increased optimism regarding prospective treatments of the disorder.”


Foerster BR, Petrou M, Edden RA et al. 2011. Reduced insular gamma-aminobutyric acid in fibromyalgia. Arthritis Rheum. [Sep 13 Epub ahead of print]. “Diminished inhibitory neurotransmission resulting from lower concentrations of GABA within the right anterior insula may play a role in the pathophysiology of FM and other central pain syndromes.”      


Glass JM, Williams DA, Fernandez-Sanchez ML et al. 2011. Executive Function in Chronic Pain Patients and Healthy Controls: Different Cortical Activation During Response Inhibition in Fibromyalgia. J Pain. [Sep 24 Epub ahead of print]. “Neural activation (fMRI) during response inhibition was measured in fibromyalgia patients and controls. FM patients show lower activation in the inhibition and attention networks and increased activation in other areas. Inhibition and pain perception may use overlapping networks: resources taken up by pain processing may be unavailable for other processes.”  The brain can be so occupied dealing with pain input that it can’t handle other tasks. Multitasking can only go so far, especially if the brain is handling pain from multiple sources.


Hayashi K, Ozaki N, Kawakita K et al. 2011. Involvement of NGF in the rat model of persistent muscle pain associated with taut band. J Pain. 12(10):1059-1068.  In rats, the taut band associated with myofascial TrPs can be affected by the administration of nerve growth factor (NGF). Mice that received the NGF receptor (TrkA) inhibitor K252a had significantly decreased hyperalgesia related to taut bands. “...NGF expressed in regenerating muscle cells is involved in persistent muscular mechanical hyperalgesia. NGF-TrkA signaling in primary muscle afferent neurons may be one of the most important and promising targets for MPS.”


Jabbari B, Machado D. 2011. Treatment of Refractory Pain with Botulinum Toxins-An Evidence-Based Review. Pain Med. [Sep 29 Epub ahead of print]. “Evidence-based data indicate that administration of botulinum toxin in several human conditions can alleviate refractory pain. The problems with some study designs and toxin dosage are critically reviewed.”


Matthana MH. 2011. The relation between Vitamin D deficiency and fibromyalgia syndrome in women. Saudi Med J. 32(9):925-929. “Vitamin D deficiency has to be considered in the management of fibromyalgia syndrome.”


Rayegani S, Bahrami M, Samadi B et al. 2011. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. Eur J Phys Rehabil Med. 47(3):381-389. “Myofascial pain syndrome (MPS) is one of the most prevalent musculoskeletal diseases.  MPS impaired quality of life in the patients. There is a lot of controversy about different treatment options which include medical treatments, physical therapy, injections, ultrasound and laser....  This study introduces laser as one of the preferred treatments of myofascial pain syndrome in shoulder.” [It is a sad commentary on the state of medical care that most care providers are unaware that this common cause of musculoskeletal pain even exists.  DJS]


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. 9:71. “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.”


Schrier M, Amital D, Arnson Y et al. 2011. Association of fibromyalgia characteristics in patients with non-metastatic breast cancer and the protective role of resilience. Rheumatol Int. [Sep 8 Epub ahead of print]. “Women with breast cancer tend to develop chronic widespread pain syndromes more often than do healthy women.”


Spaeth M. 2011. [Fibromyalgia]. Z Rheumatol. 70(7):573-587. [German]. “Although chronic musculoskeletal pain represents the main symptom of fibromyalgia, those affected usually experience many and various accompanying symptoms of differing frequency and extent. While symptoms such as non-restful sleep, daytime fatigue, impaired memory and concentration, morning stiffness, as well as digestive and urination disorders help to establish the diagnosis, they represent a particular disease burden on patients, those around them and on the social system. Pathogenetic research is focused increasingly on a central dysregulation in pain perception and pain processing, leading to the concept of ‘central sensitization’ as a final common pathway for fibromyalgia and similar syndromes. This supports the recommendations for prompt multimodal therapy based on pharmaco-, functional and behavioral therapy.”


Wong CS, Wong SH. 2012. A new look at trigger point injections. Anesthesiol Res Pract [Epub Sept 29, 2011.] This article is a new look at TrP injections, from the perception of nerve entrapment and associated TrPs. “The advent of ultrasound technology in the non-invasive real-time imaging of soft-tissues sheds new light on visualization of trigger points, explaining the effect of trigger point injection by blockade of peripheral nerves, and minimizing the complications of blind injection.” [Although the specific ultrasound technique required is expensive and limited to universities and other research settings, it may be helpful in exact placement of pudendal nerve entrapment and other deep injections, such as the iliopsoas. DJS]

Wuytack F, Miller P. 2011. The lived experience of fibromyalgia in female patients, a phenomenological study. Chiropr Man Therap. 19(1):22. “Fibromyalgia pervaded all aspects of life. Four main themes arose from data analysis, namely; the impact of fibromyalgia on patients' occupational and personal life, the impact on their future and aspects of social interaction. Nearly all participants had stopped working, giving rise to feelings of uselessness and loss of identity. Leisure activities were also greatly affected. Fibromyalgia was said to alter family bonds, some of which were reinforced, others were broken. The diagnosis was seen as a relief, marking an end to a period of uncertainty. Participants reported ambivalence in interaction. Despite some positive encounters, frustration arising from perceived incomprehension dominated. Consequently patients preferred not to share their experiences.... The study revealed the negative impact of fibromyalgia on patients' lives as comprising of great complexity and individuality. Several implications for health care practitioners can be extrapolated, including the need of a more efficient diagnostic process and increased education about the fibromyalgia experience. Further studies are required to better clarify the multifaceted nature of living with the condition.”












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