August 2011 References   Devin J. Starlanyl   for


Aparicio VA, Ortega FB, Heredia JM et al. 2011. [Analysis of the body composition of Spanish women with fibromyalgia]. Reumatol Clin. 7(1):7-12. [Spanish] “The results suggest that obesity is a common condition in women diagnosed with FM, its prevalence in this population being higher than the national reference values. This study provides detailed information about the body composition characteristics of women with FM.” [Investigation for FM co-existing conditions such as insulin resistance would be very useful. DJS]


Bendtsen L, Fernandez-de-las-Penas C. 2011. The Role of Muscles in Tension-Type Headache.  Curr Pain Headache Rep. [Jul 7 Epub ahead of print]. “The tenderness of pericranial myofascial tissues and number of myofascial trigger points are considerably increased in patients with tension-type headache (TTH). Mechanisms responsible for the increased myofascial pain sensitivity have been studied extensively. Peripheral activation or sensitization of myofascial nociceptors could play a role in causing increased pain sensitivity, but firm evidence for a peripheral abnormality still is lacking. Peripheral mechanisms are most likely of major importance in episodic TTH. Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from pericranial myofascial tissues seem to be responsible for the conversion of episodic to chronic TTH. Treatment directed toward muscular factors include electromyography biofeedback, which has a documented effect in patients with TTH, as well as physiotherapy and muscle relaxation therapy, which are most likely effective. Future studies should aim to identify the source of peripheral nociception.”


Besteiro Gonzales JL, Suarez Fernandex TV, Arboleya Rodriguez L et al. 2011. Sleep architecture in patients with fibromyalgia. Psicothema. 23(3):368-373. “The results support that fibromyalgia patients present an increase of superficial sleep at the expense of deep sleep and also an increase of periodic leg movements, which could have a pathogenic effect, facilitating the onset of the illness.”


Brummett CM, Clauw DJ. 2011. Fibromyalgia: a primer for the anesthesia community. Curr Opin Anaesthesiol. [Jul 27 Epub ahead of print]. “Research continues to demonstrate that fibromyalgia patients have neurophysiologic abnormalities that alter sensory perception, including lower levels of central neurotransmitters associated with the inhibition of pain and higher levels those that facilitate pain. While comorbid mood disorders are more common in fibromyalgia patients, studies have shown that fibromyalgia symptoms are not explained by depression alone. In the last year, the American College of Rheumatology established a new self-report questionnaire for the diagnosis of fibromyalgia in lieu of the previously required tender point examination plus self-report questionnaire. This questionnaire allows for the study of the severity of sensitivity and symptomatology on a continuum, which is termed 'fibromyalgianess'. Some new concepts in the treatment have been proposed, including sodium oxybate, transcranial magnetic stimulation, and web-based cognitive behavioral therapy.....The impact of fibromyalgia on anesthesia care is not known. Years of quality research have clearly demonstrated multiple pathophysiologic changes that could impact anesthesia care and future study is needed.” [Myofascial pain awareness is necessary as well.  The addition of a Bier’s block during IV anesthesia using an irritating substance could prevent a trigger point cascade and an exacerbation of FM, for example.]

Calandre EP, Vilchez JS, Molina-Barea R et al. 2011. Suicide attempts and risk of suicide in patients with fibromyalgia: a survey in Spanish patients. Rheumatology (Oxford). [Jul 12 Epub ahead of print]. “Pain, poor sleep quality, anxiety and depression were positively correlated with suicide risk. Conclusions: FM is associated with an increased risk of suicide and suicide attempts. Suicidal behavior seems to be related with the global severity of the disease.” [If they would look closely, I believe that they would find that the risk of suicide increases with the lack of symptom control, especially pain. When patients feel helpless and hopeless, suicide may appear to be an option. When patients understand their conditions, especially coexisting myofascial trigger points, other pain generators, and perpetuating factors, patients realize that they have some control over their symptoms.  They have hope when they are working with their care providers on better symptom control.  DJS]


Coaccioli S, Varrassi G. 2011. Chronic degenerative pain: an update on abdominal pain in comparison to rheumatic diseases. J Clin Gastroenterol. S94-S97. “Extra-articular syndromes, notably fibromyalgia, can be a lifelong rheumatic condition characterized by widespread musculoskeletal pain and functional impairment, without any known structural or inflammatory cause. Irritable bowel syndrome (IBS) occurs in around half of patients with fibromyalgia raising the possibility of a possible overlapping or underlying pathophysiology. The dysfunction of bidirectional neural pathways and viscerovisceral cross-interactions within the central nervous system has been proposed as a possible central hypersensitization disorder responsible for the extraintestinal manifestations of IBS. Common inflammatory and molecular pathways may also be present in which a dysregulation of the immune system leads to a chronic inflammatory response. Given that the treatment of degenerative chronic pain remains suboptimal, these findings may suggest new treatment strategies.” [These authors deserve commendation for recognition of the interactive aspect of these two conditions.  They both have central sensitization components. They would do well to include myofascial trigger points, which also are co-existing to both conditions, in future research.  DJS]


Crawford BK, Piault EC, Lai C et al. 2011. Assessing fibromyalgia-related fatigue: content validity and psychometric performance of the Fatigue Visual Analog Scale in adult patients with fibromyalgia. Clin Exp Rheumatol. [Jul 14 Epub ahead of print]. “Previous studies have confirmed that fatigue is a major component of the fibromyalgia experience. This current study reports that fibromyalgia patients spontaneously rated fatigue as a highly significant feature of their illness, and supports the use of the Fatigue VAS as a valid questionnaire in fibromyalgia clinical trials.”


Feraco P, Bacci A, Pedrabissi F et al. 2011. Metabolic Abnormalities in Pain-Processing Regions of Patients with Fibromyalgia: A 3T MR Spectroscopy Study. AJNR Am J Neuroradiol. [Jul 28 Epub ahead of print]. “The presence of elevated Glu/Cr levels in VLPFC strengthens the opinion that a complex neurophysiologic imbalance of different brain areas involved in pain processing underlies FM. These data may be useful in the diagnosis and development of more effective pharmacologic treatments.”


Furuta A, Suzuki Y, Honda M et al. 2011. Time-dependent changes in bladder function and plantar sensitivity in a rat model of fibromyalgia syndrome induced by hydrochloric acid injection into the gluteus. BJU Int. [Aug 2 Epub ahead of print]. “HCl injection (pH 4.0) into the gluteus can induce plantar hypersensitivity and urinary frequency (in the rat) for up to 2 weeks after the injection, suggesting that somatic (gluteus)-to-visceral (bladder) cross-sensitization might underlie bladder hypersensitivity in patients with FMS. Moreover, intervention at specific tender points outside the bladder could be effective in treating urinary frequency because lidocaine injection into the gluteus normalized bladder function in FMS rats for up to 2 weeks.”


Gryfe Saperia NJ, Swartzman LC. 2011. Openness to psychological explanations and treatment among people with Fibromyalgia versus Rheumatoid Arthritis. Psychol Health. [Jul 26 Epub ahead of print]. “The classic perspective in the psychosomatic literature is that patients with medically unexplained syndromes do not acknowledge psychologically-based causes for their conditions and will not engage in psychological treatments. These assumptions were tested by contrasting the illness models and reported treatment experiences of individuals with fibromyalgia (FM), a syndrome with a currently unknown organic origin, with those of individuals with rheumatoid arthritis (RA), a 'legitimate' (i.e. organic) condition.... Contrary to prediction, compared to patients with RA, patients with FM were more likely to endorse psychological causes for their condition and reported having used more psychological management approaches. Moreover, patients with FM considered psychological approaches to be more effective than narcotics....These findings indicate that patients with FM do not react defensively to the implication of psychogenic causes. Rather, as a group, they tend to acknowledge both the psychosocial influences on and the effectiveness of psychological management approaches for their condition.” [The study is interesting, although some of the wording is unfortunate and one can only guess the authors intent.  They should be aware, however, that FM is organic, although different causes may institute the biochemical cascades that result in central sensitization. It might be interesting if co-existing TrPs were included in this mix, as they maintain most cases of central sensitization. First, however, one must have researchers and patients aware of these co-existent and ubiquitous pain generators. For now, much research focuses on the pain amplifier, FM, instead. DJS]


Hamnes B, Hauge MI, Kjeken I et al. 2011. 'I have come here to learn how to cope with my illness, not to be cured': A Qualitative Study of Patient Expectations Prior to a One-Week Self-Management Program. Musculoskeletal Care. [Jul 20 Epub ahead of print]. “Self-management programs (SMPs) have been developed to help patients with chronic rheumatic diseases to manage their health problems. Patients' expectations prior to treatment are important determinants of outcomes, and should therefore be identified, to ensure that interventions meet the participants' needs. The aim of the present study was to determine participant expectations with respect to a one-week inpatient SMP for those with fibromyalgia (FM) and rheumatoid arthritis (RA).....The findings show that the participants expected the SMP to be a turning point towards a better future and to empower them to assume more responsibility for their own health and self-care. They also expected the SMP to facilitate acceptance, help them to gain new knowledge and be a forum in which to share their experience. Participants who were employed assumed that participation in the SMP would help to ensure that they would continue in their jobs.....This qualitative study indicated that identifying expectations prior to an SMP provides important information which has implications for the program's implementation. Additional themes, such as acceptance of the illness and management of work, should also be included in the programs and they should focus more on sharing experience.”


Harrington MG, Chekmenev EY, Schepkin V et al. 2011. Sodium MRI in a rat migraine model and a NEURON simulation study support a role for sodium in migraine. Cephalalgia. [Aug 4 Epub ahead of print]. During a migraine-like state in rats, “...sodium rises to levels that increase neuronal excitability. We propose that rising sodium in CSF (cerebrospinal fluid) surrounding trigeminal nociceptors increases their excitability and causes pain and that rising sodium in vitreous humor increases retinal neuronal excitability and causes photosensitivity.”


Hoffman D. 2011. Understanding Multisymptom Presentations in Chronic Pelvic Pain: The Inter-relationships between the Viscera and Myofascial Pelvic Floor Dysfunction. Curr Pain Headache Rep. [Jul 8 Epub ahead of print]. “Patients presenting with chronic pelvic pain frequently complain of multiple symptoms that appear to involve more than one organ system, creating diagnostic confusion. The multisymptom presentation of chronic pelvic pain has been frequently described. This article describes four proposed explanations for the clinical observation of multisymptom presentations of patients with chronic pelvic pain. These include the concepts of viscerovisceral convergence; viscerosomatic convergence; hypertonicity of pelvic floor muscles creating visceral symptoms along with somatovisceral convergence; and central sensitization with expansion of receptive fields.”


Huang YT, Lin SY, Neoh CA et al. 2011. Dry needling for myofascial pain: prognostic factors. J Altern Complement Med. 17(8):755-762. “Dry needling is an effective treatment for reducing pain and pain interference. However, long pain duration, high pain intensity, poor quality of sleep, and repetitive stress are associated with poor outcomes. Treatment outcome depends not only on the dry needling protocol, but also on disease characteristics and patient demographic profile.” [Outcome would also depend on the proper identification of the myofascial trigger points involved, as well as the training and skill of the practitioner. DJS]


Jarrell J. 2011. Endometriosis and Abdominal Myofascial Pain in Adults and Adolescents. Curr Pain Headache Rep. [Jul 14 Epub ahead of print]. “Endometriosis and myofascial pain are common disorders with significant impact on quality of life. Increasingly, these conditions are being recognized as highly interconnected through processes that have been described for more than a century. [Emphasis DJS] This review is directed to this interconnection through a description of the relationships of endometriosis to proposed mechanisms of pain and chronic pain physiology; the clinical assessment of myofascial representations of this pain; and an approach to the management of these interconnected disorders.”


Jones KD, King LA, Mist SD et al. 2011. Postural control deficits in people with fibromyalgia: a pilot study. Arthritis Res Ther. 13(4):R127. “Postural instability and falls are increasingly recognized problems in fibromyalgia (FM). The purpose of this study was to determine if FM patients, compared to age-matched controls, had differences in dynamic posturography, including sensory, motor, and limits of stability. We further sought to determine if postural instability was associated with strength, proprioception and lower extremity myofascial trigger points (MTPs), FM symptoms and physical function, dyscognition, balance confidence and medication usage. Lastly, we evaluated self-report of falls over the past six months....This study reports that middle-aged FM patients have: consistent objective sensory deficits on dynamic posturography, despite having a normal clinical neurological exam. Further study is needed to determine prospective fall rates and the significance of lower extremity MTPs. The development of interventions to improve balance and reduce falls in FM patients may need to combine balance training with exercise and cognitive training.” [It is good that TrPs are considered in FM studies, but it would be helpful to include upper body TrPs in future studies, as dizziness and imbalance are often associated with sternocleidomastoid and other upper body TrPs. The inclusion of a diagnostic check for vestibular dysfunction, a common co-existing condition of FM, would also be helpful. DJS]


Juuso P, Skar L, Olsson M et al. 2011. Living with a double burden: meanings of pain for women with fibromyalgia. Int J Qual Stud Halth Well-being. 6(3). “The findings show that meanings of pain for women with FM can be understood as living with a double burden; living with an aggressive, unpredictable pain and being doubted by others in relation to the invisible pain. The ever-present pain was described as unbearable, overwhelming, and dominated the women’s whole existence. Nevertheless, all the women tried to normalize life by doing daily chores in an attempt to alleviate the pain. In order to support the women’s needs and help them to feel well despite their pain, it is important that nurses and health care personnel acknowledge and understand women with FM and their pain experiences.”


Lange G, Janal MN, Maniker A et al. 2011. Safety and Efficacy of Vagus Nerve Stimulation in Fibromyalgia: A Phase I/II Proof of Concept Trial. Pain Med. [Aug 3 Epub ahead of print]. “Side effects and tolerability were similar to those found in disorders currently treated with VNS (vagus nerve stimulation.)  Preliminary outcome measures suggested that VNS may be a useful adjunct treatment for FM patients resistant to conventional therapeutic management, but further research is required to better understand its actual role in the treatment of FM.”


Mitchell MD, Mannino DM, Steinke DT et al. 2011. Association of smoking and chronic pain syndromes in Kentucky women. J Pain. 12(8):892-899. “Data was analyzed on 6,092 women over 18 years of age who responded to survey questions on pain and smoking. The chronic pain syndromes included in the analysis were fibromyalgia, sciatica, chronic neck pain, chronic back pain, joint pain, chronic head pain, nerve problems, and pain all over the body. Analyses controlled for age, body mass index, and Appalachian versus non-Appalachian county of residence.”  “This study provides evidence of an association between chronic pain and cigarette smoking that is reduced in former smokers. PERSPECTIVE: This paper presents the association between smoking and musculoskeletal pain syndromes among Kentucky women. This finding may provide additional opportunities for intervention in patients with chronic pain.”


Moriatis Wolf J, Cameron KL, Owens BD. 2011. Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg. 19(8):463-471. “Excessive joint laxity, or hypermobility, is a common finding of clinical importance in the management of musculoskeletal conditions. Hypermobility is common in young patients and in general is associated with an increased incidence of musculoskeletal injury. Hypermobility has been implicated in ankle sprains, anterior cruciate ligament injury, shoulder instability, and osteoarthritis of the hand. Patients with hypermobility and musculoskeletal injuries often seek care for diffuse musculoskeletal pain and injuries with no specific inciting event. Orthopaedic surgeons and other healthcare providers should be aware of the underlying relationship between hypermobility and musculoskeletal injury to avoid unnecessary diagnostic tests and inappropriate management. Prolonged therapy and general conditioning are typically required, with special emphasis on improving strength and proprioception to address symptoms and prevent future injury. Orthopaedic surgeons must recognize the implications of joint mobility syndromes in the management and rehabilitation of several musculoskeletal injuries and orthopaedic disorders.”

Wen YR, Tan PH, Cheng JK et al. 2011. Microglia: a promising target for treating neuropathic and postoperative pain, and morphine tolerance. J Formos Med Assoc. 110(8):487-494.

“...targeting microglial signaling might lead to more effective treatments for devastating chronic pain after diabetic neuropathy, viral infection, cancer, and major surgeries, partly via improving the analgesic efficacy of opioids.”