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Patients &
trained Companions

Doctors & Other
Care Providers



Fibromyalgia (FM) and
Chronic Myofascial Pain (CMP)
For Doctors and 
Other Health Care Providers

annotated by Devin J. Starlanyl



References for Research Purposes

On This Page
A  B  C 


F-H       I-K

L-N       O-R

S-V       W-Z

NOTE:  New Nomenclature

All material written by me after October 1, 2007, will have the following changes in nomenclature.  I regret any confusion caused by this change, but deem it necessary due to the changes in our current understanding of the conditions involved.

The abbreviation for myofascial trigger point, "TrP," is replaced by "MTP." 
The term Myofascial Pain Syndrome (MPS) will no longer be used, as current research shows it is not a syndrome but a true myopathy, and thus a true disease.  
There are acute MTPs and chronic myofascial pain (CMP) due to MTPs.  Where applicable, CMP will be separated into CMP Stage 1 (without central sensitization) and CMP Stage 2 (with central sensitization).
Fibromyalgia (FM) will replace the former term fibromyalgia syndrome (FMS).


Aarflot, T. and D. Bruusgaard.  1996.  Association between chronic widespread musculoskeletal complaints and thyroid autoimmunity.  Results from a community survey.  Scand J Prim Health Care 14(2):111-115.  

Abajo, F.J., Rodriguex L.A.G., Montero, D. 1999. Association between selective serotonin reuptake inhibitors in gastrointestinal bleeding: population based control study. The concomitant use of NSAIDs or aspirin with SSRIs poses a significantly increased risk of GI bleeding.  The possible etiological mechanism is the lower level of platelet serotonin in patients on SSRIs.

Abbasi, F., T. McLaughlin, C. Lamendola and G. M. Reaven.  2000.  Insulin regulation of plasma free fatty acid concentrations is abnormal in healthy subjects with muscle insulin resistance.  Metabolism 49(2):151-4.

Abbott RB, Hui KK, Hays RD et al. 2007.  A randomized controlled trial of Tai Chi for tension headaches.  Evid Based Complement Alternat Med. 4(1):107-113.  “A 15 week intervention of Tai Chi practice was effective in reducing headache impact and also effective in improving perceptions of some aspects of physical and mental health.”

Abboud J, Marchand AA, Sorra K et al. 2013. Musculoskeletal physical outcome measures in individuals with tension-type headache: a scoping review. Cephalalgia. 33(16):1319-1336. "Individuals with tension-type headache (TTH), in addition to headache pain, typically suffer from pericranial muscle tenderness and increased cervical muscle tone.… Musculoskeletal outcomes, such as trigger points, pressure pain threshold and forward head posture should inform TTH pathophysiology, diagnosis and interdisciplinary patient care."

Abdel-Moty E, Khalil T, Rosomoff H. 1999.  The effects of the Aqua-PT on myofascial pain.  Paper presented at the 18th Annual Scientific Meeting of the American Pain Society, Oct 21-24, Greater Fort Lauderdale/Broward County Convention Center.  This paper, studying 123 patients with myofascial pain as a primary diagnosis, indicates that 15 minute therapy sessions on an aqua massage unit may provide some relief from myofascial pain.

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."

Abeles AM, Pillinger MH, Solitar BM et al. 2007.  Narrative review: the pathophysiology of fibromyalgia.  Ann Intern Med. 146(10):726-734.

Abitbol, J., P. Abitbol and B. Abitbol.  1999.  Sex hormones and the female voice.  J Voice 13(3):424-46.

Ablin JN, Buskila D. 2013. Fibromyalgia syndrome – novel therapeutic targets. Maturitas [June 3 Epub ahead of print]. "Fibromyalgia is a syndrome characterized by the presence of chronic widespread pain, representing sensitization of the central nervous system. The pathophysiology of fibromyalgia is complex and remains in evolution, encompassing diverse issues such as disturbed patterns of sleep, altered processing and decreased conditioned pain modulation at the spinal level, as well as increased connectivity between various pain-processing areas of the brain. This evolution is continuously uncovering potential novel therapeutic targets. Treatment of fibromyalgia is a multi-faceted endeavor, inevitably combining pharmacological as well as non-pharmacological approaches. Certain specific ligands and selective nor-epinephrine-serotonin reuptake inhibitors are the current mainstays of pharmacological treatment. Novel reuptake inhibitors targeting both nor-epinephrine and dopamine are potential additions to this armamentarium as are substance P antagonists. Opioid antagonism is another intriguing possibility. Cannabinoid agonists hold promise in the treatment of fibromyalgia although current evidence is incomplete. Sodium Oxybate is a unique sleep-promoting medication while drugs that promote arousals such as modafilnil are also under investigation. In the current review, current and emerging therapeutic options for the syndrome of fibromyalgia are covered."

Ablin JN, Clauw DJ, Lyden AK et al. 2013. Effects of sleep restriction and exercise deprivation on somatic symptoms and mood in healthy adults. Clin Exp Rheumatol. 31(6 Suppl 79):53-59. "This study supports previous research suggesting that both sleep and exercise are critical in 'preventing' somatic symptoms among some individuals. Furthermore, to our knowledge, this is the first time there is data to suggest that women are much more sensitive to decrements in routine sleep and exercise than are men."

Ablin JN, Cohen H, Clauw DJ et al. 2010. A tale of two cities - the effect of low intensity conflict on prevalence and characteristic s of musculoskeletal pain and somatic symptoms associated with chronic stress. Clin Exp Rheumatol. [Nov 23 Epub ahead of print]. "Although both acute and chronic stress leads to pain, the precise characteristics of this association have not been well defined. Sderot is an Israeli town exposed to repeated missile attacks. Ofakim, a town of similar demographic and socioeconomic characteristics, had not been targeted, as of the period of our study....One thousand and twenty-four individuals in Sderot and 1006 in Ofakim were interviewed regarding pain, somatic symptoms, mood, trauma-exposure, and general health status....Similar to previous studies that have suggested that chronic stress is associated with chronic pain, this study demonstrates significantly increased rates of somatic complaints, including pain, fatigue and IBS-like symptoms, among individuals in Sderot compared with Ofakim, as well as significantly higher rates of trauma-related symptoms. Thus, a fibromyalgia-like symptoms cluster was more likely to be found in Sderot compared with Ofakim. Widespread pain was reported as being significantly more frequent by inhabitants of Sderot compared with Ofakim. These results have relevance to both the general population and for populations enduring chronic stress."

Ablin JN, Cohen H, Eisinger M et al. 2010. Holocaust survivors: the pain behind the agony. Increased prevalence of fibromyalgia among Holocaust survivors. Clin Exp Rheumatol. 28(6 Suppl 63):S51-56. "The results indicate a significantly increased prevalence of fibromyalgia among Holocaust survivors six decades after the end of the Second World War."

Ablin JN, Oren A, Cohen S et al. 2012. Prevalence of fibromyalgia in the Israeli population: a population-based study to estimate the prevalence of fibromyalgia in the Israeli population using the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ). Clin Exp Rheumatol. [Nov 21 Epub ahead of print]. "Fibromyalgia represents the tip of the iceberg of chronic pain in the general population. We have attempted to estimate the prevalence of fibromyalgia in the Israeli population, using the London Fibromyalgia Epidemiology....The prevalence of the fibromyalgia syndrome in the Israeli population is considerable and constitutes a significant health care issue. The prevalence is similar to that observed in other western populations. Based on this tool, over 25% of fibromyalgia cases appear to be among males, a proportion higher than generally appreciated." [This is the same proportion of male FM patients I encountered. DJS]

Abramowicz S, Kim S, Susarla HK et al. 2013. Differentiating Arthritic from Myofascial Pain in Children with Juvenile Idiopathic Arthritis: Preliminary Report. J Oral Maxillofac Surg. S0278-2391(12)01617-5. To differentiate between temporomandibular joint (TMJ) inflammation and myofascial pain (MPD) in children with juvenile idiopathic arthritis (JIA). "The results of this study indicate that in patients with JIA and jaw signs/symptoms, there is an overlap in diagnoses between arthritis and MPD. This has considerable implications for patient management." [Patients with jaw pain must be assessed for the presence of myofascial pain due to trigger points, and these TrPs treated ASAP. This may prevent or slow the progress of the OA. DJS]

Abu-Samra M, Gawad OA, Agha M. 2011. The outcomes for nasal contact point surgeries in patients with unsatisfactory response to chronic daily headache medication. Eur Arch Otorhinolaryngol. Apr 3 [Epub ahead of print.] Chronic headache can be caused by or contributed to by trigger areas inside the nose.

Acasuso-Diaz, M. and E. Collantes-Estevez.  1998.  Joint hypermobility in patients with fibromyalgia syndrome.  Arthritis Care Res 11(1):39-42.

Achermann, J. C. and J. L. Jameson.  1999. Fertility and infertility: genetic contributions from the hypothalamic-pituitary-gonadal axis. Mol Endocrinology. 13(6):812-8.

Acheson DW, Luccioli S. 2004.  Microbial-gut interactions in health and disease.  Mucosal immune responses. Best Pract Res Clin Gastroenterol 18(2):387-404.  This is a good review, including functions of the GI mucosal barrier and permeable membrane, or Leaky Gut Syndrome.

Adak B, Tekeoglu I, Ediz L et al. 2005.  Fibromyalgia frequency in hepatitis B carriers.  J Clin Rheumatol. 11(3):157-159.  “The present study suggests that chronic hepatitis B carriage appears to increase the risk of FM and many of the typically associated symptoms.”

Adam TC, Epel ES. 2007.  Stress, eating and the reward system.  Physiol Behav. 91(4):449-458.   Chronic stress may be worsening the obesity epidemic due to the loss of glucocorticoid regulation by insulin and leptin.

Adams K, Gregory WT, Osmundsen B et al. 2013. Levator myalgia: why bother? Int Urogynecol J. [Apr 11 Epub ahead of print]. "Levator myalgia is a prevalent condition in urogynecology practice, and is associated with approximately 50 % greater bother in urinary, defecatory, and prolapse symptoms." [Levator myalgia is a description given to the pain and dysfunction commonly caused by levator ani and other pelvic floor trigger points. DJS]

Adams PJ, Snutch TP. 2007.  Calcium channelopathies: voltage-gated calcium channels.  Subcell Biochem. 45:215-251.  Genetically caused minute changes in calcium ion channels can have a wide spectrum affect on “...mammalian developmental, physiological and behavioral functions.”  Agents that act on selective calcium channel activity may be important medications for the future.

Adams, W. R., K. J. Spolnik and J. E. Bouquot.  1999.  Maxillofacial osteonecrosis in a patient with multiple “idiopathic” facial points.  J Oral Pathol Med 28(9):423-32. Called NICO (neuralgia-inducing cavitational osteonecrosis). The underlying problem is vascular insufficiency.

Adcock KG, Kyle PB, Deaton JS et al. 2007.  Pharmacokinetics of intranasal and intratracheal pentoxifylline in rabbits.  Pharmacotherapy. 27(2):200-206.  “The pharmacokinetic profiles after intranasal and intratracheal administration of pentoxifylline appear similar to those after intravenous administration.”  [Since intrathecal glial cell modulation works well in rats to diminish or relieve central sensitization, this use of intranasal pentoxifylline may have potential for FMS. DJS]

Adelmanesh F, Jalali A, Shooshtari SM et al. 2015. Is there an association between lumbosacral radiculopathy and painful gluteal trigger points? A cross-sectional study. Am J Phys Med Rehabil. [Mar 12 Epub ahead of print.] Trigger points in the gluteal areas were rare in healthy controls, but most patients with lumbosacral radiculopathy had gluteal trigger points on the same side as that radiculopathy.

Adelowo A, Hacker MR, Shapiro A et al. 2013. Botulinum toxin type A (BOTOX) for refractory myofascial pelvic pain. Female Pelvic Med Reconstr Surg. 19(5):288-292. "Intralevator injection of Botox demonstrates effectiveness in women with refractory myofascial pelvic pain with few self-limiting adverse effects".

Adiguzel O, Kaptanoglu E, Turgut B et al.  2004.  The possible effect of clinical recovery on regional cerebral blood flow deficits in fibromyalgia: a prospective study with semi-quantitative SPECT.  South Med J. 97(7):651-655.  “...these findings could indicate that deficits in cerebral blood flow in fibromyalgia improve parallel to clinical recovery.”

Adkisson CD, Yip L, Armstrong MJ et al. 2014. Fibromyalgia symptoms and medication requirements respond to parathyroidectomy. Surgery. 156(6):1614-1621. "FM is common in patients operated on for sporadic PHP (primary hyperparathyroidism). Of those with both conditions, after PTX (parathyroidectomy) 89% appreciate symptom response and 77% and 21% had a decrease in or discontinuation or medications, respectively. Before diagnosing FM, providers should exclude PHP, which is surgically correctable".

Adler GK, Geenen R. 2005.  Hypothalamic-pituitary-adrenal and autonomic nervous system functioning in fibromyalgia.  Rheum Dis Clin North Am 31(1):187-202.  “In general, there seems to be a reduction in some neuroendocrine and autonomic nervous system (ANS) responses to applied stresses in individuals who have fibromyalgia.”

Adler GK, Manfredsdottir VF, Creskoff KW. 2002. Neuroendocrine abnormalities in fibromyalgia.  Curr Pain Headache Rep 6(4): 289-98. "A combination of multiple, mild impaired responses may lead to more profound physiologic and clinical consequences as compared with a defect in only one system, and could contribute to the symptoms of fibromyalgia."

Adler, G. K., B. T. Kinsley, S. Hurwitz, C. J. Mossey and D. L. Goldenberg.  1999.  Reduced hypothalamic pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome.  Am J Med 106(5):534-43.

Adler MW, Rogers TJ. 2005.  Are chemokines the third major system in the brain?  J Leukoc Biol. [Oct 4 Epub ahead of print]  The authors propose that the endogenous chemokine system in the brain interacts with the neurotransmitter and neuropeptide systems to govern brain function.  [There are abundant chemokine receptors in the glial cells, and activated intrathecal glia have been implicated in the inception and maintenance of chronic pain states.  Imbalance of specific  neuopeptides, and neurotransmitters and cytokines have been implicated in fibromyalgia, and biochemicals belonging to these systems are released during myofascial trigger point twitch. DJS] 

Adriaensen H, Vissers K, Noorduin H et al. 2003. Opioid tolerance and dependence: an inevitable consequence of chronic treatment?  Acta Anaesthesiol Belg. 54(1):37-47.  “Although opioids provide effective analgesia, largely unsubstantiated concern about opioid-induced tolerance, physical dependence and addiction have limited their appropriate use.  As a consequence, many patients receive inadequate treatment for both malignant and non-malignant pain. However, it has been shown that analgesic tolerance develops less frequently during chronic opioid administration in a clinical context than in animal experiments.”

Afari N, Ahumada SM, Wright LJ et al. 2013. Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosom Med. [Dec 12 Epub ahead of print.] "Findings highlight the limitations of the existing literature and emphasize the importance of conducting prospective studies, further examining the potential similarities and differences of these conditions and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes." [If the authors really want to understand the meaningful connections, they need to include myofascial trigger points. DJS]

Affaitati G, Fabrizio A, Savini A et al. 2009.  A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds.  Clin Ther. 31(4):705-720.  The lidocaine patch seems effective and acceptable to patients with myofascial pain.   [This may be useful in sports therapy, or very early detection of single TrPs.  The patch in the study was applied to THE trigger point.  For those of us with chronic myofascial pain, having dozens or even hundreds of TrPs, lidocaine patch therapy may not be helpful. DJS]

Aftimos, S. 1989. Myofascial pain in children. N Z Med J 102(874):440-441.

Agargun, M. Y. , I. Tekeoglu, A. Gunes, B. Adak, H. Kara and M. Ercan. 1999. Sleep quality and pain threshold in patients with fibromyalgia. Compr Psychiatry 40(3):226-8.

Aggarwal A, Keluskar V. 2012. Physiotherapy as an adjuvant therapy for treatment of TMJ disorders. Gen Dent. 60(2):e119-122. "Physiotherapy has long been used to cure joint and muscle diseases. It has also been used to treat various diseases without inflicting mental trauma or the pain of surgery. This adjunctive therapeutic modality is widely used for patients with orofacial disorders, especially in the prevention or treatment of temporomandibular joint (TMJ) disorder, hypomobility, or ankylosis. Physiotherapy has a particular importance in the treatment of TMJ disorders such as myofascial pain and internal derangement. This review article highlights the importance of physiotherapy as an emerging adjuvant therapy in the treatment of TMJ disorders."

Aggarwal SK, Carter GT, Sullivan MD et al. 2009.  Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington StateJ Opioid Manag. 5(5):257-286.  This interesting study on the use of medical cannabis is one of the first of its kind, including 139 patients, most of whom were male.  “Myofascial pain was the most common diagnosis….”  Other conditions included fibromyalgia, neuropathic pain, cancer, arthritis, and other chronic pain conditions.  Males and females used the medical cannabis at the same rate.  “In 51 (31%) patients, there were documented instances of major hurdles related to accessing MC (medical cannabis), including prior physicians unwilling to authorize use, legal problems relating to MC use, and difficulties in finding an affordable and consistent supply of MC…..  Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain.”

Agrawal Y, Davalos-Bichara M, Zuniga MG et al. 2013. Head impulse test abnormalities and influence on gait speed and falls in older individuals. Otol Neurotol. [Aug 6 Epub ahead of print]. In a tertiary care center, among patients 70 years of age and older, this study found that "…half of the community-dwelling older individuals in our study had evidence of vestibular dysfunction, which was significantly associated with gait speed and fall risk in adjusted analyses. Screening for vestibular impairment using the simple HIT (head impulse test) and directing targeted vestibular therapy may be important to reduce gait impairment and fall risk in older individuals." [Vestibular dysfunction has been observed to be a common co-existing condition with fibromyalgia. DJS]

Aguidelo LZ, Femenia T, Orhan F et al. 2014. Skeletal muscle PGC-1alpha1 modulates kynurenine metabolism and mediates resilience to stress-induced depression. Cell 159(1)33-45. Physical exercise has been shown to reduce depression in some people. This study indicates that one mechanism by which it does this is by suppressing kynurenine, a neurotoxic substance. Exercise activates a specific pathway, changing kynruenin metabolism and reducing depression. [This is important for the subset of people with fibromyalgia who utilize the kynurenine pathway. In these people, 5-HTP is metabolized into kynurenine instead of serotonin. So if taking 5-HTP, L-tryptophan, or eating foods high in tryptophan cause you to feel worse, your body may be utilizing this pathway. This research is giving you hope that exercise may help. DJS See: Schwartz M.J., Offenbacher M., Neumeister A. et al. 2002. Evidence for an altered tryptophan metabolism in fibromyalgia. Neurobiol Dis 11(3):434-442. This study shows an altered tryptophan metabolism in a subgroup of fibromyalgia patients.

Ahmad J, Blumen H, Tagoe CE. 2015. Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis. Rheumatol Int. [May 15 Epub ahead of print.] "There may be a positive association between the ATD antibody TPOAb, and fibromyalgia syndrome and CWP in patients with established RA."

Ahmad J, Tagoe CE. 2014. Fibromyalgia and chronic widespread pain in autoimmune thyroid disease. Clin Rheumatol. [Jan 18 Epub ahead of print.] "Fibromyalgia and chronic widespread pain syndromes are among the commonest diseases seen in rheumatology practice. Despite advances in the management of these conditions, they remain significant causes of morbidity and disability. Autoimmune thyroid disease is the most prevalent autoimmune disorder, affecting about 10% of the population, and is a recognized cause of fibromyalgia and chronic widespread pain. Recent reports are shedding light on the mechanisms of pain generation in autoimmune thyroid disease-associated pain syndromes including the role of inflammatory mediators, small-fiber polyneuropathy, and central sensitization. The gradual elucidation of these pain pathways is allowing the rational use of pharmacotherapy in the management of chronic widespread pain in autoimmune thyroid disease."

Ahmadpour, S. and U. M. Kabadi.  1997.  Pancreatic alpha-cell function in idiopathic reactive hypoglycemia.  Metabolism 46(6):639-643.   

Ahn S, Song R. 2012. Effects of Tai Chi Exercise on Glucose Control, Neuropathy Scores, Balance, and Quality of Life in Patients with Type 2 Diabetes and Neuropathy. J Altern Complement Med. [Sep 17 Epub ahead of print]. "Tai Chi improved glucose control, balance, neuropathic symptoms, and some dimensions of quality of life in diabetic patients with neuropathy. Further studies with larger samples and long-term follow-up are needed to confirm the effects of Tai Chi on the management of diabetic neuropathy, which may have an impact on fall prevention in this population."

Aikins, Murphy P.  1998.  Alternative therapies for nausea and vomiting of pregnancy.  Obstet Gynecol 91(1):149-155.  

Airaksinen, O. and P. J. Pontinen.  1992.  Effects of electrical stimulation of myofascial trigger points with tension headache.  Acupunct Electrother Res 17(4):285-290.

Akassoglou K., Strickland S. 2002. Fibrin inhibits nerve regeneration by arresting schwann cell differentiation. Glia (Suppl 1):S42 [Abstract]. “These results provide the first indication that fibrin, a blood-derived protein, which becomes a component of the extracellular matrix of the nervous system in pathological states, can affect repair by negatively regulating myalination. Dysregulation of fibrin clearance and/or deposition could play a role in traumatic injuries of the nervous system, as well as in demyelinating diseases such as multiple sclerosis.”

Akdeniz S, Kelsaka E, Guldogus F. 2013. [Retrospective evaluation of the patients with chronic pain admitted to the algology polyclinic between 2000-2010.] Agri. 25(3):115-122 [Article in Turkish]. Patients in this pain clinic during the 11-year period between January 2000 and December 2010 were evaluated as to the cause of their pain. These 6647 patients included those with malignancies as well as non-cancer conditions. "66.9% of the patients were between the ages of 19 and 64. There was no significant difference between genders. The most common causes of pain were myofascial pain, neuropathic pain, low back pain and headache. Among malignancy related cases the most common sources were gastrointestinal system, lung and breast regions. In 83.4% of patients, pharmacological and invasive treatments were utilized. The most common invasive treatment modalities were, trigger point injection, dry needle application and epidural catheter application. Conclusion: In conclusion, pain treatments with multidisciplinary approach applied by the increasing number of pain clinics provide favorable results and patients quality of life is also increased. We hope our retrospective study may provide helpful data for future studies on chronic pain with its comprehensive base of patient data which covers an eleven years period."

Akdogan S, Ayhan Ff, Yildirim S et al. 2013. Impact of fatigue on cognitive functioning among premenopausal women with fibromyalgia syndrome and rheumatoid arthritis. J Musculoskel Pain 21(2):135-146. Women with fibromyalgia, rheumatoid arthritis, and healthy controls were compared for fatigue and cognitive impairment. "After adjustment for age, education level and possible related factors...test data were found to correlate with pain, fatigue, anxiety, depression, dizziness, forgetfulness and sleeplessness.... Fatigue was the predictor of attentional impairment...."

Akkasilpa S, Goldman D, Magder LS et al. 2005.  Number of fibromyalgia tender points is associated with health status in patients with systemic lupus erythematosus.  J Rheumatol. 32(1):48-50.  “A strong association between the number of FM TPs and health status was found in patients with SLE. The number of TPs, and not just the presence/absence of FM, is associated with health status in SLE.”

Akkaya N, Akkaya S, Atalay NS et al. 2012. Assessment of the relationship between postural stability and sleep quality in patients with fibromyalgia. Clin Rheumatol. [Nov 21 Epub ahead of print]. "Worse postural performance and fall risk found in the fibromyalgia patients compared to controls were related with the sleep quality in the last 24 h and level of fatigue."

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."

Akyol Y, Tander B, Goktepe AS et al. 2012. The relationship of fibromyalgia syndrome with neuropathic pain, quality of life and emotional status in male traumatic lower limb amputees. J Musculoskel Pain. 20(2):87-94. Men with traumatic amputation may have co-existing fibromyalgia, resulting in enhanced nerve pain, lower quality of life and greater anxiety than in amputees without FM. [As Dr. Carol McMakin teaches, patients are entitled to more than one diagnosis. The central sensitization of FM is, apparently, often missed in these patients. It would have been interesting to assess these patients for yet another condition, co-existing myofascial trigger points, as these have been known to cause phantom limb pain and often exist in stump tissue. DJS]

Al-Alawi A, Mulgrew A, Tench E et al. 2006.  Prevalence, risk factors and impact on daytime sleepiness and hypertension of periodic leg movements with arousals in patients with obstructive sleep apnea.   J Clin Sleep Med. 2(3):281-287.  “Risk factors for PLMS include preexisting medical conditions -- particularly depression, fibromyalgia, and diabetes mellitus -- increasing age, predisposing medications, obesity and OSA.”

Al Saif AA, Al Senany S. 2015. Determine the effect of neck muscle fatigue on dynamic visual acuity in healthy young adults. J Phys Ther Sci. 27(1):259-263. "The results of this study suggest that neck muscle fatigue negatively impacts dynamic visual acuity."

Al-Shenqiti AM, Oldham JA. 2005.  Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis.  Clin Rehabil. 19(5):482-487.  “The presence or absence of the taut band, spot tenderness, jump sign and pain recognition was highly reliable between sessions. Referred pain and local twitch response reliability varied depending on the muscle being studied.” [Again, both training and experience are vital to reliably diagnose and treat TrPs. DJS]


Alanoglu E, Ulas UH, Ozdag F. et al. 2004. Auditory event-related brain potentials in fibromyalgia syndrome.  Rheumatol Int. [Epub Feb 21 ahead of print].  “...FM affects quality of life and dysfunction in cognitive abilities can be determined by brain event-related potentials.”

Alarcon, G. S., and L. A. Bradley. 1998. Advances in the treatment of fibromyalgia: current status and future directions. Am J Med Sci 315 (6):397-404.

Albright, G. L. and A. A. Fischer.  1990.  Effects of warming imagery aimed at trigger-point sites on tissue compliance, skin temperature, and pain sensitivity in biofeedback-trained patients with chronic pain: a preliminary study.  Percept Mot Skills 71(3 Pt 2):1163-70. 

Album D, Westin S. 2007.  Do diseases have a prestige hierarchy?  A survey among physicians and medical students. Soc Sci Med. [Sep 10 Epub ahead of print]  Medical specialties and illnesses are considered to have a ranking among doctors and medical students.  “Myocardial infarction, leukemia and brain tumor were among the highest ranked, and fibromyalgia and anxiety neurosis were among the lowest.”  “Low prestige scores are given to diseases and specialties associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.”  [It seems we have a lot of educating to do, and it is no wonder FM patients are considered to have a self-esteem problem.  See: “Bennett RM. 2007.  Do patients’ perceptions of negative physician attitudes influence fibromyalgia symptoms and status?”  This would seem to  indicate that some doctors could be major perpetuating factors.  DJS.]

Alburquerque-García A, Rodrigues-de-Souza DP, Fernandez-de-Las-Penas C et al. 2015. Association between Muscle Trigger Points, Ongoing Pain, Function, and Sleep Quality in Elderly Women with Bilateral Painful Knee Osteoarthritis. J Manipulative Physiol Ther. [Apr 25 Epub ahead of print.] "OBJECTIVE: The objectives of this study were to investigate if referred pain elicited by active trigger points (TrPs) reproduced the symptoms in individuals with painful knee osteoarthritis (OA) and to determine the relationship between the presence of active TrPs, intensity of ongoing pain, function, quality of life, and sleep quality in individuals with painful knee OA....CONCLUSIONS: The referred pain elicited by active TrPs in the lower extremity muscles contributed to pain symptoms in painful knee OA. A higher number of active TrPs was associated with higher intensity of ongoing knee pain." [Some of the pain and perhaps other symptoms often attributed to OA may be due to co-existing trigger points. DJS]

Alburquerque-Sendín F, Camargo PR, Vieira A et al. 2013. Bilateral myofascial trigger points and pressure pain thresholds in the shoulder muscles in patients with unilateral shoulder impingement syndrome: A Blinded, Controlled Study. Clin J Pain. [Jan 16 Epub ahead of print]. "To identify the presence of myofascial trigger points (TrPs) and pressure pain threshold (PPT) levels in the shoulder muscles of both involved and uninvolved sides in patients with unilateral shoulder impingement syndrome (SIS)... SIS group showed a greater number of TrPs…than the control group. The muscles of the uninvolved side of the SIS group also presented some active TrPs…. The muscle PPTs of the patients presenting TrPs in each muscle of the involved side were lower than the PPTs of the patients without TrPs in the same muscle for both involved and uninvolved sides with few significant differences….The high number of TrPs in the involved side of patients with SIS suggests the presence of peripheral sensitization. The results reject the presence of central alterations. Finally, the patients with unilateral SIS may present bilateral deficits related to myofascial pain."

Alcocer-Gomez E, Garrido-Maraver J, Bullon P, et al. 2015. Metformin and caloric restriction induce an AMPK-dependent restoration of mitochondrial dysfunction in fibroblasts from fibromyalgia patients. Biochim Biophys Acta. 1852(7):1257-1267. "Impaired AMPK is associated with a wide spectrum of clinical and pathological conditions, ranging from obesity, altered responses to exercise or metabolic syndrome, to inflammation, disturbed mitochondrial biogenesis and defective response to energy stress. Fibromyalgia (FM) is a world-wide diffused musculoskeletal chronic pain condition that affects up to 5% of the general population and comprises all the above mentioned pathophysiological states. Here, we tested the involvement of AMPK activation in fibroblasts derived from FM patients. AMPK was not phosphorylated in fibroblasts from FM patients and was associated with decreased mitochondrial biogenesis, reduced oxygen consumption, decreased antioxidant enzymes expression levels and mitochondrial dysfunction. However, mtDNA sequencing analysis did not show any important alterations which could justify the mitochondrial defects. AMPK activation in FM fibroblast was impaired in response to moderate oxidative stress. In contrast, AMPK activation by metformin or incubation with serum from caloric restricted mice improved the response to moderate oxidative stress and mitochondrial metabolism in FM fibroblasts. These results suggest that AMPK plays an essential role in FM pathophysiology and could represent the basis for a valuable new therapeutic target/strategy. Furthermore, both metformin and caloric restriction could be an interesting therapeutic approach in FM."

Aldridge, R., E. B. Cady, D. A. Jones and G. Obletter.  1986.  Muscle pain after exercise is linked with an inorganic phosphate increase as shown by 31P NMR. Biosci Rep 6(7):663-7.

Alexander RE. 2013. Clinical effectiveness of electroacupuncture in meralgia paresthetica: a case series. Acupunct Med. [Oct 23 Epub ahead of print]. "Meralgia paresthetica is a fairly common condition resulting from entrapment of the lateral femoral cutaneous nerve. I have found that acupuncture produces a rapid improvement, sometimes affecting a cure, after only one or two treatments. I therefore invited referrals in order to collect a case series….A series of 10 patients, which included two who had refused surgery, but excluded those with significant lumbar spine problems, were treated. Visual Analogue Scale pain scores and analgesic intake were recorded weekly, starting before treatment. Four patients were receiving high doses of analgesics and the average period of symptoms was 3-4 years. Acupuncture points used were BL25, GB30, GB34, GB31, GB32, Huatuojiaji and ah shi points of the buttock and thigh, up to a depth of 7.5 cm. Electroacupuncture was normally given from the second treatment….Without exception, patients were specifically tender over GB31 before they started treatment. Most were also tender over the upper lumbar spine. An average of four to five sessions of acupuncture was given. The pain scores for all 10 patients improved by at least 50%, including that of a patient with a 20-year history. At follow-up (varying from 3 to 36 months), improvement was nearly 100%. Most patients were able to stop their analgesics. Meralgia paresthetica appears to respond rapidly to electroacupuncture. A significant trigger point at GB31 was universally present, which may aid diagnosis, although the reason for this is unclear. Further controlled studies are justified." [All of these acupuncture point locations can be trigger points. Meralgia paresthetica can also be successfully treated with trigger point injection or dry needling in the quadriceps TrPs at that point, but must include palpation for and treatment of associated hip and thigh TrPs and identification and control of all perpetuating factors. If all the relevant TrPs are treated and the perpetuating factors brought under control, this usually takes one treatment. DJS]

Alexander, R. W. , L. A. Bradley, G. S. Alarcon, M. Triana-Alexander, L. A. Aaron, K. R. Alberts, M. Y. Martin and K. E. Stewart.  1998. Sexual and physical abuse in women with fibromyalgia: association with outpatients health care utilization and pain medication usage.  Arthritis Care Res 11(2):102-15.

Alford, F. P., F. L. Hew, M. C. Christopher and C. Rantzau.  1999.  Insulin sensitivity in growth hormone (GH)-deficient adults and effect of GH replacement therapy.  J Endocrinol Invest 22(5 Suppl):28-32.  

Alix ME, Bates DK. 1999.  A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle.  J Manipulative Physiol Ther. 22(8):534-539.  This study found bridges formed of connective tissue at the atlanto-occipital junction between the rectus capitis posterior and the dorsal spinal dura.  Tightness of these connections may be associated with headache.  “The dura-muscular, dura-ligamentous connections in the upper cervical spine and occipital areas may provide anatomic and physiologic answers to the cause of the cervicogenic headache.”

Aliyev R, Vieth T, Geiger G. 2010. Traditional Chinese medicine in diagnosis and treatment of fibromyalgia syndrome. Georgian Med News. (188):38-45. "Fibromyalgia Syndrome (FS) is known for the difficulties arising from classification. The accompanying pain in skeletal muscles, myofascial peri-articular structures and a number of polymorphic symptoms cannot be separated into complexes of symptoms. The application of principles of Traditional Chinese Medicine (TCM) helps in analyzing the symptoms of FS to detect a leading syndrome and thereby establish an individual therapy. Medical histories and objective examinations of 25 patients with FS and 22 patients with vertebrogenic pain syndromes were analyzed according to TCM. A questionnaire was used to determine the leading constitutional type according to the 5-elements-theory. Analyses of the results showed that 83% of patients with FS were of constitutional type of the element earth. The following syndromes were found to be important in FS: 1) liver-Qi-stagnation, 2) Yin and blood deficiency of the liver, 3) Yang-weakness of the spleen and kidney, 4) Yin-weakness of the kidney. Applying TCM for FS allows for separating a group of symptoms and thus individual therapy. The determination of the constitutional type according to the 5-elements-theory may be used for a better understanding of the disharmony pattern."

Alkherayf F, Agbi C. 2009.  Cigarette smoking and chronic low back pain in the adult population.  Clin Invest Med. 32(5):E360-367.  “Daily smoking increases the risk of LBP (low back pain) among young adults, and this effect seems to be dose-dependent.  Back pain treatment programs may benefit from integrating smoking habit modification.”  [Chronic low back pain is often due to myofascial TrPs, and smoking is a preventable perpetuating factor. DJS]

Allcock N, McGarry J, Elkan R. 2002.  Management of pain in older people within the nursing home: a preliminary study.  Health Soc Care Comm. 10(6):464-471.  “It has been estimated that approximately two-thirds of people aged 65 years and over experience chronic pain, and that the prevalence of chronic pain in nursing home residents is between 45% and 80%.  Overall, 37% of nursing home residents were identified as experiencing chronic non-malignant pain.”

Allegrante, J. P.  1996.  The role of adjunctive therapy in the management of chronic nonmalignant pain.  Am J Med 101(1A):33S-39S.

Allen, G., B. S. Galer and L. Schwartz.  1999.  Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients.  Pain 80(3):539-44

Almeida, TF, Roizenblatt, S, Benedito, Silva AA, et al. 2003.  The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia.  Pain 104(3):665-672. Combined therapy with pulsed ultrasound and interferential current can be an effective therapy for pain and sleep dysfunction in fibromyalgia patients.

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."

Alonso-Blanco C, Fernández-de-Las-Penas C, de-la-Llave-Rincón AI et al. 2012. Characteristics of referred muscle pain to the head from active trigger points in women with myofascial temporomandibular pain and fibromyalgia syndrome. J Headache Pain. [Aug 31 Epub ahead of print]. "Women with FMS had larger referred pain areas than those with TMD for sternocleidomastoid and suboccipital muscles.... Significant differences within COG coordinates of TrP referred pain areas were found in TMD, the referred pain was more pronounced in the orofacial region, whereas the referred pain in FMS was more pronounced in the cervical spine. This study showed that the referred pain elicited from active TrPs shared similar patterns as usual pain symptoms in women with TMD or FMS, but that distinct differences in TrP prevalence and location of the referred pain areas could be observed. Differences in location of referred pain areas may help clinicians to determine the most relevant TrPs for each pain syndrome in spite of overlaps in pain areas."

Alonso-Blanco C, Fernandez-de-Las-Penas C, Morales-Cabezas M et al. 2011. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. [Feb 28 Epub ahead of print]. "The local and referred pain elicited from widespread active MTrPs fully reproduced the overall spontaneous clinical pain area in patients with FMS. Widespread mechanical pain hypersensitivity was related to a greater number of active MTrPs. This study suggests that nociceptive inputs from active MTrPs may contribute to central sensitization in FMS."

Alonso-Ruiz, A., A. De la Hoz-Martinez and A. C. Zea-Mendoza. 1985. Fibromyalgia syndrome as a late complication of toxic-oil syndrome. J Rheumatol 12(6):1207-1208.

Al-Shenqiti AM, Oldham JA. 2009. Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis.  Clin Rehabil. 19(5):482-487.  “The presence or absence of the taut band, spot tenderness, jump sign and pain recognition was highly reliable between sessions.  Referred pain and local twitch response reliability varied depending on the muscle being studied.”

Altan L, Korkmaz N, Bingol U et al. 2009.  Effect of Pilates training on people with fibromyalgia syndrome: a pilot study. Arch Phys Med Rehabil. 90(12):1983-1988.  Pilates may help some FM patients.  [Studies are needed to identify what specific Pilates exercises help FM and what help co-existing TrPs, and to identify what Pilates exercises could worsen specific TrPs.   Otherwise the research could become increasingly confused.  DJS]

Altindag O, Gur A, Calgan N et al. 2007. Paraoxonase and arylesterase activities in fibromyalgia.  Redox Rep. 12(3):134-138.   “Patients with fibromyalgia might be prone to development of atherosclerosis with reduced paraoxonase and arylesterase activities.”

Altindag O, Celik H. 2006.  Total antioxidant capacity and the severity of the pain in patients with fibromyalgia.  Redox Rep. 11(3):131-135.   “Increased oxidative stress may play a role in the etiopathogenesis of the disease.”  Antioxidant supplements may be a useful part of therapy.

Alvarez DJ, Rockwell PG. 2002.  Trigger points: diagnosis and management.  Am Fam Physician 65(4):653-660.  “Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle.  They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders.  Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points.  Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles.  These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle.  Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain.  Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point.  Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response.  Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points.  Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.”

Alvarez, L. B. , J Teran, J. L. Alonso, J. Alegre, I. Arroyo and J. L. Viejo. 1992.  Lack of association between fibromyalgia and sleep apnea syndrome. Ann Rheum Dis 51(1):108-11. 

Alvarez TL, Kim EH, Vicci VR et al. 2012. Concurrent vision dysfunctions in convergence insufficiency with traumatic brain injury. Optom Vis Sci. 89(12):1740-1751. "Convergence insufficiency without simultaneous visual or vestibular dysfunctions was observed in about 9% of the visually symptomatic TBI (traumatic brain injury) civilian population studied. A thorough visual and vestibular examination is recommended for all TBI patients."

Aly T.A., Tahaka Y., Aizawa T. et al. 2002. Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases. Tohoku J Exp Med 197(4):229-31. Nerve entrapment causing pain radiating down the low back may be caused by myofascial trigger points, but these are often misdiagnosed.  These two patients completely recovered after trigger point therapy, even though they had been misdiagnosed and in pain for a long time.

Amador NJ, Shivers K, Weiner J et al.  Program 51.16/M8.  Estrus cycle effects on behavioral and physiological responses to formalin-induced inflammatory pain.  Georgia World Congress Center Atlanta, GA.  Society for Neuroscience, Presentation.: Oct 14, 2006.  Both physiological and behavioral changes to inflammatory pain can vary significantly with the estrus cycle in rats.   Hormones may physically affect perceptions of pain.

Ambalavanar R, Moutanni A, Dessem D. 2006.  Inflammation of craniofacial muscle induces widespread mechanical allodynia.  Neurosci Lett. [Feb 27 Epub ahead of print]

Ambrogio, N., J. Cuttiford, S. Lineker and L. Li. 1998. A comparison of three types of neck support in fibromyalgia patients. Arthritis Care Res 11(5):405-10.

Ames BN, Elson-Schwab I, Silver EA. 2002.  High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): relevance to genetic disease and polymorphisms.  Am J Clin Nutr. 75(4):616-658.  This article concerns increasing developments in the science of genomics.  They have already found over 50 genetic diseases that can be helped by high doses of the vitamin component of coenzymes, restoring metabolic paths.  [From what we have learned in the study of genomics and epigenomics, each human being has significantly different nutrient requirements, and this may be profoundly affected by differences in intestinal permeability.  The use of healthy food and supplements as medicine may become more accepted as research unfolds. DJS]

Amital D, Fostik L, Polliack ML et al. 2006.  Posttraumatic stress disorder, tenderness, and fibromyalgia syndrome: are they different entities?  J Psychosom Res. 61(5):663-669.  This study concerned comorbidity of FMS in male patients with PTSD that occurred after an intensive, initial combat-related traumatic event.  [In these patients, and not necessarily all male patients as the study concluded, the occurrence, degree and impact of PTSD is often significantly related to co-existing FMS.  FMS may be amplifying more than pain. DJS]

Ammer, K. and P. Melnizky.  1999. [Medicinal baths for treatment of generalized fibromyalgia.] Forsch Komplementarmed 6(2):80-5. [German] .

Amris K, Jespersen A. 2010. [Fibromyalgia as a neuropathic pain condition]. Ugeskr Laeger. 172(24):1832-1835. [Danish]. "Fibromyalgia is characterized by chronic widespread pain and mechanical hyperalgesia. It is associated with a higher pain intensity, fewer pain-free intervals and more pronounced pain-related interference in function than other musculoskeletal pain conditions. Increasing evidence supports an underlying augmented central pain processing which includes sensitization of pain-transmitting neurons and dysfunction of pain inhibitory pathways. If this permanent change in the function of the nociceptive system is shown to equal fibromyalgia, the condition may be considered a neuropathic pain condition."

Amutio A, Franco C, Perez-Fuentes Mde C et al. 2015. Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. Front Psychol. 5:1572. "Fibromyalgia is a disabling syndrome. Results obtained with different therapies are very limited to date. The goal of this study was to verify whether the application of a mindfulness-based training program was effective in modifying anger, anxiety, and depression levels in a group of women diagnosed with fibromyalgia. This study is an experimental trial that employed a waiting list control group. Measures were taken at three different times: pretest, posttest, and follow-up. The statistical analyses revealed a significant reduction of anger (trait) levels, internal expression of anger, state anxiety, and depression in the experimental group as compared to the control group, as well as a significant increase in internal control of anger. It can be concluded that the mindfulness-based treatment was effective after 7 weeks. These results were maintained 3 months after the end of the intervention." Free PMC Article

Anand KJ. 2000.  Pain, plasticity, and premature birth: a prescription for permanent suffering?  Nat Med 6(9):971-973.  Premature infants and other children requiring medical procedures require adequate pain control.  Failure to provide it not only causes needless acute suffering but can change the central nervous system and cause predisposition to chronic pain.

Anand P, Aziz Q, Willert R et al. 2007.  Peripheral and central mechanisms of visceral sensitization in man.  Neurogastroenterol Motil. 19(1 Suppl):29-46.

Anandkumar S. 2014. Effect of Pain Neuroscience Education and dry needling on chronic elbow pain as a result of cyberchondria: a case report. Physiother Theory Pract. Dec 9:1-7. [Epub ahead of print.] "This case report describes a 31-year-old male who presented with complaints of chronic pain in his right elbow. Detailed subjective examination revealed that the patient had searched Google for extensive online information relating to his pain, ultimately self-labeling with various diagnoses. After researching in YouTube, the patient self-treated with ice, exercises, neural mobilization, self-massage and taping, all resulting in a failed outcome. Clinical findings revealed trigger points in his right brachioradialis muscle with added symptoms of central pain. This is a potential first-time description of physical therapy management of brachioradialis myofascial pain syndrome with superadded central pain caused as a result of cyberchondria where the patient used the Internet for arriving at a wrong self-diagnosis and incorrect self-treatment with failed or worsening pain outcomes leading to pain sustenance or chronicity. Physical therapy consisted of Pain Neuroscience Education, dry needling and Exercise Therapy. The patient was completely pain free and fully functional at the end of the sixth session, which was maintained at a one-month follow-up." [Although the assumption of a type of hypochondria is unfortunate, as the patient did have the real medical condition of trigger points, it is a lesson that trigger points can mimic many other conditions. Many doctors and other care providers as well as patients often mistake pain and/or dysfunction from myofascial trigger points to be something else, resulting in much unnecessary pain and waste of resources. DJS]

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]

Ancoli-Israel, S. and T. Roth.  1999.  Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I.  Sleep 22 Suppl 2:S347-53.

Anderberg, UM, 2001.[Stress-related syndromes-contemporary illnesses.] Lakartidningen Dec;98(51-52):5860-3.[Swedish] The diagnoses of burnout, chronic fatigue syndrome and fibromyalgia syndrome may represent reactions to an overwhelming situation.  The new diagnoses may indicate preliminary stages of more serious diseases such as angina pectoris or myocardial infarction. Other causes of death may be related to stress.  "These circumstances reflect not only considerable suffering on the part of individuals, but also a substantial economic burden for society".

Anderberg, U. M., Z. Liu, L Berglund and F. Nyberg.  1999.  Elevated plasma levels of neuro-peptide Y in female fibromyalgia patients.  Eur J Pain 3(1):19-30.

Anderberg, U. M. , I. Marteinsdottir, J. Hallman and T. Backstrom. 1998. Variablility in cyclicity affects pain and other symptoms in female fibromyalgia syndrome patients. J Musculoskel Pain 6(4):5-22.

Andersen, S. and G. Leikersfeldt.  1996.  Management of chronic non-malignant pain.  Br J Clin Pract 50(6):324-330.

Anderson H, Arendt-Nielsen L, Svensson P et al. 2007.  Spatial and temporal muscle hyperalgesia induced by nerve growth factor in humans.  J Musculoskel Pain 15 (Supp 13):13 item 16.  [Myopain 2007 Poster]  “NGF intramuscular injection causes a time-dependent enlargement of the hyperalgesic area that is most prominent 24 hours after injection.  The expansion of hyperalgesia locally and in distinct area innervated by the same nerve indicates that both peripheral and central mechanisms are involved in the NGF-induced sensitization.  These findings may add to the current knowledge of the development of chronic pain conditions.”

Anderson, K. and J. M. Silver.  1998.  Modulation of Anger and Aggression.  Semin Clin Neuropsychiatry 3(3):232-242.

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]

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."

Anderson RU, Harvey RH, Wise D et al. 2015. Chronic pelvic pain syndrome: Reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand. Appl Psychophysiol Biofeedback. [Feb 24 Epub ahead of print.] "This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion." Of these patients, 79.7% were male. At the beginning of the study, 63.6% used medications. After 6 months, 40.1% used medications, with a general reduction in total symptoms.

Anderson RU, Sawyer T, Wise D et al. 2009.  Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome.  J Urol. [Oct 16 Epub ahead of print].  “This report shows relationships between myofascial trigger points and reported painful sites in men with chronic prostatitis/chronic pelvic pain syndrome.  Identifying the site of clusters of trigger points inside and outside the pelvic floor may assist in understanding the role of muscles in this disorder and provide focused therapeutic approaches.” 


Anderson RU, Wise D, Sawyer T et al. 2006.  Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training.  J Urol. 176(4 Pt 1):1534-1538.  “Sexual dysfunction is common in men with refractory chronic pelvic pain syndrome but it is unexpected in the mid fifth decade of life.  Application of the trigger point release/paradoxical relaxation training protocol was associated with significant improvement in pelvic pain, urinary symptoms, libido, ejaculatory pain, and erectile and ejaculatory dysfunction.”  Men as well as women deal with chronic pain due to TrPs.  So much of the suffering is needless.  It is important for physicians to be trained in diagnosis and treatment of TrPs. DJS]


Anderson RU, Wise D, Sawyer T et al. 2005. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 174(1):155-160. “This case study analysis indicates that MFRT (myofascial trigger point assessment and release therapy) combined with PRT (paradoxical relaxation therapy) represents an effective therapeutic approach for the management of CP/CPPS (chronic prostatitis/chronic pelvic pain syndrome), providing pain and urinary symptom relief superior to that of traditional therapy.” [One must wonder how much of our health care resources are wasted because of the lack of myofascial medicine training. DJS]

Anderson RU, Wise D, Sawyer T et al. 2005.  Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men.  J Urol. 174(1):155-160.  Myofascial release of trigger points combined with paradoxical relaxation training can provide pain relief superior to traditional therapy.

Anderson, R. A.  1992.  Chromium, glucose tolerance, and diabetes.  Biol Trace Elem Res 32:19-24.

Anderson, R. C. and J. H. Anderson.  1999.  Sensory irritation and multiple chemical sensitivity. Toxicol Ind Health 15(3-4):339-45.  

Anderson, R. C. and J. H. Anderson.  1998.  Acute toxic effects of fragrance products.  Arch Environ Health 53(2):138-46.

Andersson HI. 2004.  The course of non-malignant chronic pain: a 12-year follow-up of a cohort from the general population.  Eur J Pain 8(1):47-53. “Mortality was significantly higher in the group initially reporting widespread pain compared with the other groups.  The chronicity of widespread chronic pain supports early and intense intervention among individuals with located pain.  The association between chronic widespread pain and increased mortality needs further investigation but may deepen the view of chronic pain as a public health problem.”

Andersson HI. 2004.  The course of non-malignant chronic pain: a 12-year follow-up of a cohort from the general population.  Eur J Pain 8(1):47-53.  “Mortality was significantly higher in the group initially reporting widespread pain compared with the other groups.  The chronicity of widespread chronic pain supports early and intense intervention among individuals with located pain.  The association between chronic widespread pain and increased mortality needs further investigation but may deepen the view of chronic pain as a public health problem.”

Andersson, M., J. R. Bagby, L. Dyrehag and C. Gottfries.  1998.  Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome.  Eur J Pain 2(2):133-142.

Andersson, M., J. R. Bagby, L. E. Dyrehag and C. G. Gottfries.  1999.  Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome.  Eur J Pain 2(2):133-142.

Andrell P, Schultz T, Mannerkorpi K et al. 2014. Health-related quality of life in fibromyalgia and refractory angina pectoris: A comparison between two chronic non-malignant pain disorders. J Rehabil Med. [Feb 14 Epub ahead of print.] "Patients with fibromyalgia experience greater impairment in health-related quality of life compared with the normal population than do patients with refractory angina pectoris, despite the fact that the latter have a potentially life-threatening disease. The great impairment in health- related quality of life in patients with fibromyalgia should be taken into consideration when planning rehabilitation."

Andresson ML, Svensson B, Bergman S. 2013. Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years. J Rheumatol [Nov 1 Epub ahead of print.] Chronic widespread pain is common in RA and is more often related to pain intensity and other pain qualities rather than inflammation indicators, such as the number of swollen joints and inflammatory markers. It is important to identify the chronic widespread pain (FM) component of the patient's illness so that can be treated adequately and taken into account. [It is also important to identify the pain generators, such as myofascial trigger points, that are most likely the reason that the pain intensity and the inflammation are not related. I don't know what it will take for people to understand this. At least this research indicates that there is "something else" other than RA inflammation influencing "RA" pain and causing/affecting the chronic widespread pain (FM). They must become aware of co-existing trigger points. DJS]

Andreu JL, Sanz J. 2005.  [Fibromyalgia and its diagnosis.]  Rev Clin Esp. 205(7):333-336.  [Spanish]  “Although the fibromyalgia classification criteria of the American College of Rheumatology are not diagnostic criteria, they have been extensively used to diagnose FMS in patients with chronic diffuse arthromyalgias.  Fibromyalgia diagnosis reduces the patient’s anxiety, avoiding complementary expensive and unnecessary tests and it allows the patient to share his/her fears, illnesses and expectations with other human beings who suffer the same problem.”

Andrews R.C., Herlihy O., Livingstone D.E. 2002.  Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance.  J Clin Endocrinol Metab 87(12):5587-93.  “ patients with glucose intolerance, cortisol secretion, although normal, is inappropriately high given enhanced central and peripheral sensitivity to glucocorticoids....altered cortisol action occurs not only in obesity and hypertension but also in glucose intolerance, and could therefore contribute to the link between these multiple cardiovascular risk factors.”

Andrews,  R. C. and B. R. Walker.  1999.  Glucocorticoids and insulin resistance: old hormones, new targets.  Clin Sci (Colch) 96(5):513-523.

Ang DC, Chakr R, France CR et al. 2010. Association of Nociceptive Responsivity with Clinical Pain and the Moderating Effect of Depression. J Pain. [Nov 24 Epub ahead of print]. "....higher level of clinical pain intensity correlated with greater nociceptive responsivity, and that depression moderated this association....Given that clinical pain correlated with nociceptive responsiveness, our findings support the mechanistic role of CS (central sensitization) in fibromyalgia." [The central sensitization is often caused by TrPs and/or arthritis and other peripheral pain sources. DJS]

Angarola, R. T.  1990.  National and international regulation of opioid drugs: purpose, structures, benefits and risks.  J Pain Symptom Manage 5(1 Suppl):S6-S11.  

Angsuwarangsee T, Morrison M. 2002.  Extrinsic laryngeal muscular tension in patients with voice disorders.  J Voice 16(3):333-343.  “A strong relationship was found between thyrohyoid muscle tension and both gastroesophageal reflux (GER) and muscle misuse dysphonia (MMD).”  [These patients were not checked for TrPs.  TrPs may cause muscle tension.  This may be an important connection between reflux as a perpetuating factor of myofascial TrPs. DJS]

Annaswamy TM, De Luigi AJ, O'Neill BJ et al. 2011. Emerging Concepts in the Treatment of Myofascial Pain: A Review of Medications, Modalities, and Needle-based Interventions. PM R. 3(10):940-961. "The purpose of this review is to provide the clinician with a better understanding of emerging concepts in the interventions used for myofascial pain syndromes."

Annemans L, Le Lay K, Taieb C. 2009.  Societal and patient burden of fibromyalgia syndrome.  Pharmacoeconomics 27(7):547-559.  “…the patient burden of fibromyalgia is very high in comparison with many other conditions.  The burden to healthcare payers and society is important as well, and can be mostly explained by factors not directly related to the treatment of FMS.  Data suggest that the cost before diagnosis may even be higher than the cost after diagnosis.  It is very likely that the combination of symptoms not only complicates the recognition and treatment of FMS, but also magnifies the burden of FMS.”

Antoin H, Beasley RD. 2004.  Opioids for chronic noncancer pain.  Tailoring therapy to fit the patient and the pain.  Postgrad Med. 116(3)37-40, 43-44.  “…opioids can be a viable option today for successful therapy for chronic non-cancer pain.”

Anuradha, C. V. and S. D. Balakrishnan. 1999. Taurine attenuates hypertension and improves insulin sensitivity in the fructose-fed rat, and animal model of insulin resistance. Can J Physiol Pharmacol 77(10:749-54. 

Aoki M, Sakaida Y, Tanaka K et al. 2011. Evidence for vestibular dysfunction in orthostatic hypotension. Exp Brain Res. [Dec 29 Epub ahead of print]. "Our results suggest that vestibular disorders due to the dysfunction of otolith organs provoke OH." [Orthostatic hypotension is common in FM, as is vestibular dysfunction. Could some of the "fibromyalgia" OH actually be caused by co-existing vestibular disorders? DJS"

Aparicio VA, Carbonell-Baeza A, Ortega FB et al. 2010. Handgrip strength in men with fibromyalgia. Clin Exp Rheumatol. 28(6 Suppl 63):S78-81. "HGs (handgrip strength test) is reduced in male FM patients and is inversely related to FM severity and symptomatology. HGs testing could be used as a complementary tool in the assessment and monitoring of FM."

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]

Aparicio VA, Ortega FB, Heredia JM et al. 2011. Handgrip strength test as a complementary tool in the assessment of fibromyalgia severity in women. Arch Phys Med Rehabil. 92(1):83-88. "Handgrip strength is reduced in women with FM as well as those with severe FM from their peers with moderate FM. Identification of women who fail to meet the suggested standards can be a helpful and informative tool for clinician." [As trigger points are known to cause grip strength failure and also to co-exist with FM, it is most likely that the failure of handgrip strength had nothing or little to do with FM, and was probably caused by coexisting TrPs. DJS]

Apkarian AV, Sosa Y, Krauss BR et al. 2004.  Chronic pain patients are impaired on an emotional decision-making task.  Pain 108(1-2):129-136.  “Performance on an emotional decision-making task may be impaired in chronic pain since human brain imaging studies show that brain regions critical for this ability are also involved in chronic pain.  Our evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact everyday behavior especially in risky, emotionally laden situations.”

Apkarian AV, Sosa Y, Sonty S et al. 2004.  Chronic back pain is associated with decreased prefrontal and thalamic gray matter density.  J Neurosci. 24(46):10410-10415.  “Patients with CBP showed 5-11% less neocortical gray matter volume than control subjects.  The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging.  The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain.  Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.”

Appelboom, T. and A. Schoutens. 1990.  High bone turnover in fibromyalgia. Calcif Tissue Int 46(5):314-317.

Aranha MF, Alves MC, Berzin F et al. 2011. Efficacy of electroacupuncture for myofascial pain in the upper trapezius muscle: a case series. Rev Bras Fisioter. [Oct 14 Epub ahead of print]. "The EA (electroacupuncture) showed to be a reliable method for myofascial pain relief." [This study was done on 20 women. It is hoped that there will be larger studies on a variety of subjects with TrPs in multiple muscles. DJS]

Aranha MF, Müller CE, Gaviao MB (Brazil). 2015. Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial. Braz J Phys Ther. 19(1):34-43. "The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control….EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly." Free Article

Arciero, P. J., M. D. Vukovich, J. O. Holloszy, S. B. Racette and W. M. Kohrt.  1999.  Comparison of short-term diet and exercise on insulin action in individuals with abnormal glucose tolerance.  J Appl Physiol 86(6):1930-5.

Arden Pope III, C., R. L. Verrier, E. G. Lovett, A. C. Larson, M. E. Raizenne, R. E. Kanner, J. Schwartz, G. M. Villegas, D. R. Gold and D. W. Dockery.  1999.  Heart rate variability associated with particulate air pollution.  Am Heart J 138(5):890-899.

Ardic F, Gokharman D, Atsu S et al. 2006.  The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis.  Aust Dent J. 51(1):23-28.  “...the myofascial pain of the temporomandibular system is an important cause of pain in rheumatoid arthritis...”

Arendt-Nielsen L. 2007.  Measuring muscle pain.  J Musculoskel Pain 15 (Supp 13):9 item 11.  [Myopain 2007 Poster]  “Referred muscle pain [and the possible related hyperalgesia] is manifested in somatic structures [skin, muscles, joints, tendons].  These manifestations are of significant clinical importance for the diagnosis of pain pathologies.”   “Recently we have found that patients suffering from chronic musculoskeletal pains have significantly larger referred pain areas to experimentally induced muscle pain intramuscular injection of hypertonic saline, and at the same time they show manifestations of muscle sensitization.  Furthermore they show facilitated responses to a variety of other stimuli.”

Arendt-Nielsen L, Fernández-de-las-Penas C, Graven-Nielsen T. 2011. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther.i> 19(4):186-193. "The transition from acute to chronic musculoskeletal pain is not well understood. To understand this transition, it is important to know how peripheral and central sensitization are manifested and how they can be assessed. A variety of human pain biomarkers have been developed to quantify localized and widespread musculoskeletal pain. In addition, human surrogate models may be used to induce sensitization in otherwise healthy volunteers. Pain can arise from different musculoskeletal structures (e.g. muscles, joints, ligaments, or tendons), and differentiating the origin of pain from those different structures is a challenge. Tissue specific pain biomarkers can be used to tease these different aspects. Chronic musculoskeletal pain patients in general show signs of local/central sensitization and spread of pain to degrees which correlate to pain intensity and duration. From a management perspective, it is therefore highly important to reduce pain intensity and try to minimize the duration of pain."

Arendt-Nielsen, L, Graven-Neilsen, T. 2003.  Central sensitization in fibromyalgia and other musculoskeletal disorders.  Curr Pain Headache Rep. 7(5):355-361.  Tenderness and referred chronic musculoskeletal pain may be due to peripheral and central sensitization.  This sensitization may be part of what changes acute pain into chronic pain.

Arendt-Nielsen, L., T. Graven-Nielson. 2002. Deep tissue Hyperalgesia. J Musculoskel Pain 10(1/2):97-119.  "increased muscle sensitivity is present in musculoskeletal pain conditions and may play a role for chronification of pain, and interventions should take this aspect into consideration".

Arendt-Nielsen, L., T. Graven-Nielsen and P. Svensson. 1999. Assessment of muscle pain in humans–clinical and experimental aspects. J Musculoskel Pain 7(1-2):25-41.

Arendt-Nielsen L, Madsen H, Jarrell J et al. 2014. Pain evoked by distension of the uterine cervix in women with dysmenorrhea: Evidence for central sensitization. Acta Obstet Gynecol Scand. [Apr 29 Epub ahead of print.] Many women have intense abdominal pain during menstruation. This study found: "Pain sensitization (temporal summation, i.e. increase in pain during prolonged stimulation, and facilitation of referred pain areas as an indicator of central nervous system changes) is present in women with dysmenorrhea." [Studies done by R. Doggweiler indicate that this prolonged pain stimulation from distension may be caused by trigger points. DJS]

Arendt-Nielsen L, Mense S, Graven-Nielsen T. 2003.  [Assessment of muscle pain and hyperalgesia.  Experimental and clinical findings] [German] Schmerz 17(6):445-449.  “ An important part of the manifestation of pain in chronic musculoskeletal disorders may be due to peripheral and central sensitization processes, which are also involved in the transition from acute to chronic pain.  Knowledge of these processes has expanded enormously in recent years; it should be utilized when new intervention strategies are designed.”

Arendt-Nielsen L, Nie H, Laursen MB et al. 2010. Sensitization in patients with painful knee osteoarthritis. Pain. [Apr 23 Epub ahead of print]. Central sensitization was found to be a significant factor in patients with knee pain from osteoarthritis. [This meshes well with the work of R. Staud and HY Ge and others who have shown that central sensitization is maintained by peripheral pain generators.  What is now needed is a follow-up study to see how many patients with arthritis also have TrPs.  From observation plus information from R. Gerwin, DG Simons and others, a significant amount of pain from osteoarthritis may actually be due to associated TrPs, with the TrPs perpetuating the OA and the OA perpetuating the TrPs in a spiral feedback loop. DJS.]

Arendt-Nielsen L, Nielsen TA, Gazerani P. 2014. Translational pain biomarkers in the early development of new neurotherapeutics for pain management. Expert Rev Neurother. 14(3):241-254. "Translation of the analgesic efficacy of investigational neurotherapeutics from pre-clinical pain models into clinical trial phases is associated with a high risk of failure. Application of human pain biomarkers in early stages of clinical trials can potentially enhance the rate of successful translation, which would eventually reduce both length and costs of drug development after the pre-clinical stage. Human pain biomarkers are based on the standardized activation of pain pathways followed by the assessment of ongoing and paroxysmal pain, plus evoked responses which can be applied to healthy individuals and patients prior to and after pharmacological interventions. This review discusses the rationality and feasibility of advanced human pain biomarkers in early phases of drug development for pain management which is still an unmet medical need."

Argoff, C. E. 2002. A review of the use of topical analgesics for myofascial pain. Curr Pain Headache Rep 6(5):375-8.

Argoff CE, Clair A, Emir B et al. 2015. Prior Opioid Use Does Not Impact the Response to Pregabalin in Patients With Fibromyalgia. Clin J Pain. [Mar 7 Epub ahead of print.] "FM patients respond to treatment with pregabalin with significant improvements in pain scores irrespective of prior opioid use. These data could inform treatment decisions for FM patients currently taking opioids." [This study is associated with Pfizer Pharmaceuticals. DJS]

Arguelles LM, Afari N, Buchwald DS et al. 2006.  A twin study of posttraumatic stress disorder symptoms and chronic widespread pain.  Pain [May 13 Epub ahead of print]  “Our findings suggest that PTSD (posttraumatic stress disorder) symptoms, as measured by IES (Impact Events Scale), are strongly linked to CWP (chronic widespread pain), but this association is not explained by a common familial or genetic vulnerability to both conditions. Future research is needed.

Ariji Y, Sakuma S, Izumi M et al. 2004.  Ultrasonographic features of the masseter muscle in female patients with temporomandibular disorder associated with myofascial pain.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98(3):337-341.  Masseter muscle pain in TMD might be associated with muscle edema.

Ariji Y, Sakuma S, Izumi M et al. 2004. Ultrasonographic features of the masseter muscle in female patients with temporomandibular disorder associated with myofascial pain.  Oral Surg. 98(3):337-341.  [I found it very interesting that the myofascial pain in patients in this study was associated with muscle edema. DJS]

Arnold LM, Chatamra K, Hirsch I et al. 2010. Safety and efficacy of esreboxetine in patients with fibromyalgia: An 8-week, multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. 32(9):1618-1632. "Esreboxetine is an investigational, highly selective norepinephrine reuptake inhibitor that has been reported to have antinociceptive effects in preclinical pain models.... In this 8-week trial in patients with fibromyalgia, esreboxetine was associated with significant reductions in pain scores compared with placebo. It was also associated with improvements in outcomes relevant to fibromyalgia, including the PGIC, function, and fatigue."

Arnold LM, Clauw DJ, McCarberg BH. 2011. Improving the Recognition and Diagnosis of Fibromyalgia. Mayo Clin Proc. 86(5):457-464. "Fibromyalgia (FM) is a chronic widespread pain disorder often seen in primary care practices. Advances in the understanding of FM pathophysiology and clinical presentation have improved the recognition and diagnosis of FM in clinical practice. Fibromyalgia is a clinical diagnosis based on signs and symptoms and is appropriate for primary care practitioners to make. The hallmark symptoms used to identify FM are chronic widespread pain, fatigue, and sleep disturbances. Awareness of common mimics of FM and comorbid disorders will increase confidence in establishing a diagnosis of FM."

Arnold LM, Crofford LJ, Martin SA et al. 2007.  The effect of anxiety and depression on improvements in pain in a randomized, controlled trial of pregabalin for treatment of fibromyalgia.  Pain Med. 8(8):633-638.  “The pain treatment effect of pregabalin did not depend on baseline anxiety or depressive symptoms, suggesting pregabalin improves pain in patients with or without these symptoms.  Much of the pain reduction appears to be independent of improvements in anxiety or mood symptoms.”

Arnold LM, Fan J, Russell IJ et al. 2012. The fibromyalgia family study: A genome-scan linkage study. Arthritis Rheum. [Dec 28 Epub ahead of print]. "We genotyped members of 116 families from the Fibromyalgia Family Study and performed a model-free genome-wide linkage analysis of fibromyalgia with 341 microsatellite markers, using the Haseman-Elston regression approach….The estimated sibling recurrence risk ratio suggests a strong genetic component of fibromyalgia. This is the first study to report genome-wide suggestive linkage of fibromyalgia to the chromosome 17p11.2-q11.2 region. Further investigation of these multi-case families from the Fibromyalgia Family Study is warranted to identify potential causal risk variants for fibromyalgia."

Arnold LM, Leon T, Whalen E et al. 2010. Relationships among pain and depressive and anxiety symptoms in clinical trials of pregabalin in fibromyalgia. Psychosomatics. 51(6):489-497. "Changes in the level of anxiety or depression had a low-to-moderate impact on pain reduction. Pain reduction with pregabalin treatment appeared to result mostly from a direct treatment effect, rather than an indirect effect mediated through improvement in anxiety or depressive symptoms."

Arnold LM, Pritchett YL, D’Souza DN et al. 2007.  Duloxetine for the treatment of fibromyalgia in women: pooled results from two randomized, placebo-controlled clinical trials.  J Womens Health 16(8):1145-1156.  “…duloxetine is a safe and efficacious treatment for both the pain and functional impairment associated with fibromyalgia in female patients, while significantly improving quality of life.”

Arnold L, Duan W, Young, Jr. J et al. 2007.  Efficacy of pregabalin monotherapy for relief of pain associated with fibromyalgia syndrome: time course and durability of pain results of a 14-week, double-blind, placebo-controlled trial.  J Musculoskel Pain 15 (Supp 13):41 item 71.  [Myopain 2007 Poster]  “Pregabalin was associated with relief of FMS pain.”

Arnold L, Russell IJ, Duan R et al. 2007.  Pregabalin monotherapy for relief of symptoms of fibromyalgia syndrome: two double-blind, randomized, controlled trials.  J Musculoskel Pain 15 (Supp 13):41 item 72.  [Myopain 2007 Poster]  “Pregabalin 300, 450, and 600mg/d [BID] therapy was associated with significant and clinically relevant reduction of pain associated with FMS.”

Arnold LM, Emir B, Pauer L et al. 2014. Time to Improvement of Pain and Sleep Quality in Clinical Trials of Pregabalin for the Treatment of Fibromyalgia. Pain Med. [Dec 19 Epub ahead of print.] "Both immediate and sustained clinical improvements in pain and sleep quality occurred faster with pregabalin vs. placebo."

Arnold LM, Goldenberg DL, Stanford SB et al. 2007.  Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial.  Arthritis Rheum. 56(4):1336-1344.  “Gabapentin (1,200-2,400 mg/day) is safe and efficacious for the treatment of pain and other symptoms associated with fibromyalgia.”  [It would be interesting to see a comparison of the effectiveness and side-effect profile of Gabapentin and Lyrica. DJS]

Arnson Y, Amital D, Fostick L et al. 2007.  Physical activity protects male patients with post-traumatic stress disorder from developing severe fibromyalgia.  Clin Exp Rheumatol. 25(4):529-533.  “Physical exercise in male patients with combat-related PTSD provides protection from the future development of fibromyalgia and is related in this group of patients to a better perception of their quality of life.”

Arnstein, P., M. Caudill, C. L. Mandle, A. Norris and R. Beasley.  1999.  Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients.  Pain 80(3):483-91. 

Arnstein PM. 2013. The future of topical analgesics. Postgrad Med. 125(4 Suppl 1):34-41. "Before modem pharmaceuticals became readily available, mud-based emollients, salves, cold therapies, and other natural remedies were often used. Now we have effective therapies and are developing advanced topical analgesics as we learn more about the physiology and pathophysiology of pain. The use of topical analgesics may be associated with fewer patient systemic side effects than are seen with oral, parenteral, or transdermally administered agents, making the topical route of administration attractive to prescribers and patients. With further refinement of existing drugs and the development of novel agents, topical analgesics may offer relief for treating patient pain conditions that are currently challenging to treat, such as pain resulting from burns, wound debridement, and pressure ulcers. Recognizing the value of a multimodal approach, topical analgesics may offer a therapeutic option that can become part of a comprehensive treatment plan for the patient. With continued advancements in targeted drug-delivery systems, topical analgesics may be able to provide a method to prevent or reverse the phenomena of peripheral and central sensitization, or the neuroplastic changes believed to be responsible for the transition from acute to chronic pain states in patients. For those patients at risk for developing chronic pain states, such as complex regional pain syndrome, the combination of cutaneous stimulation (achieved through rubbing during application) and analgesic effects produced by the drug itself may prevent the disabling pain that often emerges during the subacute phase of disease. In summary, better utilization of currently available topical analgesics and continued research promise to ensure that topical analgesics are, and will continue to be, important tools in the treatment of patients with resistant pain."

Arnstein, P. M.  1997.  The neuroplastic phenomenon: a physiologic link between chronic pain and learning.  J Neurosci Nurs 29(3):179-186.

Arlt, W., F. Callies, J. C. van Vlijmen, I. Koehler, M. Reincke, M. Bidlingmaier, D. Huebler, M. Oettel, M. Ernst, H. M. Schulte and B. Allolio.  1999. Dehydroepiandrosterone replacement in women with adrenal insufficiency.  N Engl J Med 341(14):1013-20.

Arreola R, Becerril-Villanueva E, Cruz-Fuentes C et al. 2015. Immunomodulatory Effects Mediated by Serotonin. J Immunol Res. [Apr 19 Epub ahead of print]. "Serotonin (5-HT) induces concentration-dependent metabolic effects in diverse cell types, including neurons, entherochromaffin cells, adipocytes, pancreatic beta-cells, fibroblasts, smooth muscle cells, epithelial cells, and leukocytes. Three classes of genes regulating 5-HT function are constitutively expressed or induced in these cells: (a) membrane proteins that regulate the response to 5-HT, such as SERT, 5HTR-GPCR, and the 5HT3-ion channels; (b) downstream signaling transduction proteins; and (c) enzymes controlling 5-HT metabolism, such as IDO and MAO, which can generate biologically active catabolites, including melatonin, kynurenines, and kynurenamines. This review covers the clinical and experimental mechanisms involved in 5-HT-induced immunomodulation. These mechanisms are cell-specific and depend on the expression of serotonergic components in immune cells. Consequently, 5-HT can modulate several immunological events, such as chemotaxis, leukocyte activation, proliferation, cytokine secretion, anergy, and apoptosis. The effects of 5-HT on immune cells may be relevant in the clinical outcome of pathologies with an inflammatory component. Major depression, fibromyalgia, Alzheimer disease, psoriasis, arthritis, allergies, and asthma are all associated with changes in the serotonergic system associated with leukocytes. Thus, pharmacological regulation of the serotonergic system may modulate immune function and provide therapeutic alternatives for these diseases." Free PMC Article

Arshad A, Ool KK. 2007.  Awareness and perceptions of fibromyalgia syndrome: a survey of Southeast Asian rheumatologists.  J Clin Rheumatol. 13(2):59-62.

Arshad A, Kong KO. 2007.  Awareness and perceptions of fibromyalgia syndrome: a survey of Malaysian and Singaporean rheumatologists.  Singapore Med J. 48(1):25-30.  “This study confirmed that there was a variation of perceptions and knowledge of FMS among rheumatologists from Malaysia and Singapore.”  [It is unfortunate that neither the rheumatologists surveyed nor the authors themselves understand that fibromyalgia is not a diagnosis of exclusion, and that FMS is often present as a condition interacting with other diagnoses. DJS]

Arvoid DS, Odean MJ, Dornfeld MP et al. 2009.  Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial.  Endocr Pract. 15(3):203-212.  “Compared with participants in the placebo group, patients in the treatment group showed mild short-term improvement in the overall fibromyalgia impact score, but did not show significant improvement in most musculoskeletal symptoms or in activities of daily living.”  [This study might have been much more helpful had it taken into account co-existing myofascial trigger points. DJS]

Asa, P. B., Y. Cao and R. F. Garry.  2000.  Antibodies to squalene in Gulf War syndrome. Exp Mol Pathol 68(1):55-64. 

Asaki S, Sekikawa M, Kim YT. 2006.  Sensory innervation of temporomandibular joint disk.  J Orthop Surg. 14(1):3-8.  “Free nerve endings and sensory nerve end organs are present in the disk parenchyma of the human temporomandibular joint and are associated with sensation and proprioception, just as they are in the acetabular labrum, glenoid labrum, triangular fibrocartilage complex, and meniscus.”

Asbill S, Sweitzer SM, Spigener S et al. 2014. Compounded pain formulations: what is the evidence? Int J Pharm Compd. 18(4):278-286. "Pain syndromes are among the most widespread, costly, and debilitating of all neurological disorders. The number of patients living with chronic pain is expected to increase with the aging population and with the rise in obesity and diabetes across the nation. This type of pain is often insensitive to the traditional pain pharmacopeia or surgical intervention. Over the last 10 years the number of prescriptions that have been compounded by pharmacists has increased dramatically. There are a number of drugs in the area of pain management that have been formulated and compounded by pharmacists to treat conditions such as diabetic neuropathy, fibromyalgia, postherpetic neuralgia, joint pain, arthritis, and a variety of other conditions. A significant portion of these compounded analgesic preparations is made up of topical/transdermal dosage forms such as gels and creams. While the efficacy and doses of these drugs in systemic dosage forms have been widely established, little is known about the permeation and efficacy of these compounds from topical/transdermal gels. This review will provide an overview of chronic pain as a disease, the mechanisms of chronic pain, current treatment approaches to chronic pain, and a discussion of the drugs that are typically compounded into these topical formulations and studied in clinical trials."

Asbring P, Narvanen AL. 2003.  Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia.  Soc Sci Med 57(4):711-720.  “The results suggest that there is a discrepancy between the ideal role of the physician and reality in the everyday work in interaction with these patients.”  “The results also illuminate the physician’s interpretations of patients in moralising terms.  Conditions given the status of illness were regarded, for example, as less serious by the physicians than those with disease status.  Skepticism was expressed regarding especially CFS, but also fibromyalgia. Moreover, it is shown how the patients are characterized by the physicians as ambitious, active, illness focused, demanding and medicalising.  The patients in question do not always gain full access to the sick-role, in part as a consequence of the conditions not being defined as diseases.”  [It is a sad reflection on the state of medical practice that many practitioners do not understand that syndromes can be every bit as serious and life-altering as diseases.  Just because we do not understand the total mechanisms behind the illness does not mean the patients with these illnesses do not deserve the care given to patients who have illnesses that we do understand.  DJS]

Asbring, PJ, Chronic Illness-A Disruption in Life: Identity-Transformation Among Women with Chronic Fatigue Syndrome and Fibromyalgia. Adv Nurs 34(3):312-319, 2001.  FMS can profoundly affect personal identity, particularly in relation to work and social life.  Some of the change was positive. The first step toward successful therapy is often the acceptance of diagnosis.  

Ashburn, M. A. and P. S. Staats.  1999.  Management of chronic pain.  Lancet 353(9167):1865-9.

Ashby, E.C. 1994. Chronic obscure groin pain is commonly caused by enthesopathy: 'tennis elbow' of the groin. Br J. Surg 81(11):1632-4.  Groin pain may be caused by myofascial trigger points in the groin ligaments.


Ashina S, Bendtsen L, Ashina M. 2005.  Pathophysiology of tension-type headache. Curr Pain Headache Rep. 9(6):415-422.  “Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial input may be responsible for the transformation of episodic tension-type headache into the chronic form.  Studies of nitric oxide (NO) mechanisms suggest that NO may play a key role in the pathophysiology of tension-type headache and that the antinociceptive effect of nitric oxide synthase inhibitors may become a novel principle in the future treatment of chronic headache.”   [Nitric oxide is a focus of chronic pain research, and would give another pathway to treat it. DJS]


Asmundson, G. J., P. J. Norton and G. R. Norton.  1999.  Beyond pain: the role of fear and avoidance in chronicity.  Clin Psych Rev 19(1):97-119.  

Assefi, N.P., Coy, T.V., Uslan, D. et al.  Financial, occupational, and personal consequences of disability patients with chronic fatigue syndrome and fibromyalgia compared to other fatiguing conditions.  J Rheumatol 30(4):804-8.  Patient evaluation at a chronic fatigue clinic indicated that the patients with the most extensive loss of support by friends, family, and loss of job, possessions, and recreational abilities were those with FMS alone or with CFS, and yet there were “ reliable difference between groups in use of disability benefits.”  The authors recommend “Employers and personal relations of patients with chronic fatigue should make a greater effort to accommodate the illness-related limitations of these conditions, especially for those with FMS and CFS.

Assimos, D. G., P. Langenstroer, R. F. Leinbach, N. S. Mandel, J. M. Stern and R. P. Holmes. 1999.  Guaifenesin- and ephedrine-induced stones. J Endourol 13(9):665-7.

Attal, N., L. Brasseur, F. Parker, M. Chauvin and D. Bouhassira.  1998. Effects of gabapentin on the different components of peripheral and central neuropathic pain syndromes: a pilot study. Eur Neurol 40(4):191-200. 

Atzeni F, Sallì S, Benucci M et al. 2012. Fibromyalgia and arthritides. Reumatismo. 64(4):286-292. "Fibromyalgia (FM) is a chronic pain syndrome that affects at least 2% of the adult population. It is characterized by widespread pain, fatigue, sleep alterations and distress, and emerging evidence suggests a central nervous system (CNS) malfunction that increases pain transmission and perception. FM is often associated with other diseases that act as confounding and aggravating factors, such as rheumatoid arthritis (RA), spondyloarthritides (SpA), osteoarthritis (OA) and thyroid disease. Mechanism-based FM management should consider both peripheral and central pain, including effects due to cerebral input and that come from the descending inhibitory pathways. Rheumatologists should be able to distinguish primary and secondary FM, and need new guidelines and instruments to avoid making mistakes, bearing in mind that the diffuse pain of arthritides compromises the patients' quality of life."

Audette JF, Wang F, Smith H. 2004.  Bilateral activation of motor unit potentials with unilateral needle stimulation of active myofascial trigger points.  Am J Phys Med Rehabil. 83(5):368-374.   TrPs on the contralateral side of the body exhibited a local twitch response after dry needling TrPs.  The group with active TrPs had motor unit potentials (MUPs) activated in a specific muscle on both sides of the body when the TrP on one side was needled.  This did not happen if the TrP was latent.  [If there are active TrPs on one side of the body, the corresponding muscles should be checked for latent TrPs and if those TrPs are present, they may need to be treated. DJS] 

Audette JF, Ryan AH. 2004.  The role of acupuncture in pain management.  Phys Med Rehabil Clin N Am. 15(4):749-772.

Audette JF, Blinder RA. 2003.  Acupuncture in the management of myofascial pain and headache. Curr Pain Headache Rep. 7(5):395-401.  Many practitioners and patients have reported benefits from the treatment of myofascial pain and headache by acupuncture.

Audette JF, Wang F, Smith H  2004.  Bilateral activation of motor unit potentials with unilateral needle stimulation of active myofascial trigger points.  Am J Phys Med Rehabil. 83(5):368-374.  “...perception of pain and muscle dysfunction in active MTrPs may be related to abnormal central nervous system processing of sensory input at the level of the spinal cord.”

Auleciems, L. M.  1995.  Myofascial pain syndrome: a multidisciplinary approach.  Nurs Pract 20(4):18. 

Austin, James H. 1999.  Zen and the Brain.  MIT Press: Cambridge MA.

Auvenshine, R. C.  1997.  Psychoneuroimmunology and its relationship to the differential diagnosis of temporomandibular disorders.  Dent Clin North Am 41(2):279-296.

Auvinet B, Bileckot R, Alix AS et al. 2006.  Gait disorders in patients with fibromyalgia.  Joint Bone Spine. [Mar 15 Epub ahead of print]  “Gait during stable walking was severely altered in the patients.  Walking speed was significantly diminished as a result of reductions in stride length and cycle frequency.  The resulting bradykinesia was the best factor for separating the two groups.  Regularity was affected in the patients; this variable is interesting because it is independent of age and sex in healthy, active adults.  Measuring the variables that characterize relaxed walking provides useful quantitative data in patients with fibromyalgia.”  [Unfortunately, these patients were not evaluated for co-existing myofascial TrPs which are often the cause of gait disturbance. DJS]

Auvinet B, Chaleil D. 2012. Identification of subgroups among fibromyalgia patients. Reumatismo. 64(4):250-260. "This paper presents some hypotheses concerning the identification of homogeneous subgroups among fibromyalgia (FM) patients in order to improve the management of the disease. It also reviews the available literature about this subject. Three methods for subgrouping are discussed according to clinical features, biomarkers, and gait analysis.... Biomarkers in FM, which is a neurobiological disease, are of promising interest, nevertheless currently, none of them can be used to subgroup FM patients. Due to the fact that cortical and subcortical mechanisms of gait control share some cognitive functions which are involved in FM, gait markers have been proposed to evaluate and to subgroup FM patients, in clinical settings. Three out of 4 core FM symptoms are linked to gait markers. Kinesia measured by means of cranio-caudal power is correlated to pain, and could be proposed to assess pain behavior (kinesiophobia). Stride frequency, which is linked to physical component, allows the identification of a hyperkinetic subgroup. Moreover, SF has been correlated to fatigue during the 6 minute walking test. Stride regularity, which expresses the unsteadiness of gait, is correlated to cognitive dysfunction in FM. Decreased stride regularity allows the recognition of a homogeneous subgroup characterized by an increased anxiety and depression, and decreased cognitive functions. [Unfortunately, the authors did not recognize that most if not all fibromyalgia patients also have myofascial trigger points, and many of these trigger points can profoundly affect gait. Until researchers realize that many of the symptoms caused by trigger points are being attributed to fibromyalgia, the FM research will be flawed. DJS]

Avendano-Coy J, Gomez-Soriano J, Valencia M et al. 2014. Botulinum toxin type A and myofascial pain syndrome: A retrospective study of 301 patients. J Back Musculoskelet Rehabil. [May 27 Epub ahead of print.] BTX-A injections and physiotherapy is an alternative to conventional treatment which should be considered when treating refractory MPS. Nonetheless, the differences in effectiveness based on diagnosis suggest the need to clarify the criteria used to select patients with MPS in future clinical trials and applications.

Avery, D. H., K. Dahl, M. V. Savage, G. L. Brengelmann, L. H. Larsen, M. A. Kenny, D. N. Eder, M. V. Vitiello and P. N. Prinz.  1997.  Circadian temperature and cortisol rhythms during a constant routine are phase-delayed in hypersomnic winter depression.  Biol Psychiatry 41(11): 1109-1123.

Avila LA, de Araujo Filho GM, Guimaraes EF et al. 2014. [Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center]. Rev Bras Reumatol. 54(5):409-413. [Article in Portuguese] "Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients' approach and treatment" Free Article

Avrahami D, Hammond A, Higgins C et al. 2012. A randomized, placebo-controlled double-blinded comparative clinical study of five over-the-counter non-pharmacological topical analgesics for myofascial pain: single session findings. Chiropr Man Therap. 20(1):7. "120 subjects were entered into the study (63 females; ages 16-82); 20 subjects randomly allocated into each group.....With regards to pressure threshold, PTMC (Professional Therapy MuscleCare Roll-on), BG (Ben-Gay Ultra Strength Muscle Pain Ointment) and MM (Motion Medicine Cream) showed significant increases in pain threshold tolerance after a short-term application on a trigger points located in the trapezius muscle. PTMC roll-on and BG were both shown to be superior vs. placebo while PTMC was also shown to be superior to IH (Icy Hot Extra Strength Cream) in patients with trigger points located in the trapezius muscle on a single application."

Ay S, Doğan SK, Evcik D et al. 2010. Comparison of the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int. [Mar 31 Epub ahead of print].  “Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS.  Phonophoresis was not found to be superior over ultrasound therapy.”  [It is usually wise to take the most efficient and simplest way to achieve the desired result. DJS]

Ay S, Evcik D, Tur BS. 2009.  Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial.  Clin Rheumatol. [Oct 20 Epub ahead of print].  “Our study indicated that exercise associated with local anesthetic and dry needling injections were effective in decrease of pain level in MPS (myofascial pain syndrome) as well as increase of cervical ROM (range of motion) and decrease of depressive mood levels of individuals.” [Dry needling may be as effective, but needling without topical anesthetic should not be used for patients with central sensitization as it causes increased pain during and after injection. DJS]

Aydemir K, Duman I, Tugcu I et al. 2010. Piriformis syndrome presenting with foot drop diagnosed with magnetic resonance imaging: a case report. J Musculoskel Pain. 18(3).261-264. "Piriformis syndrome can cause foot drop. Magnetic resonance imaging can help earlier diagnosis and treatment." Piriformis syndrome is a description, not a diagnoses. The authors did not note that myofascial TrPs are the most common cause of this condition, and can cause foot drop as noted in Travell and Simons Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol II. Trigger points were not mentioned, although the authors noted the palpable mass that responded to steroid injection into the mass, resulting in resolution of the syndrome. It would have been interesting to see if the "mass" responded to TrP injection of local anesthetic. Steroids are undesirable and unhelpful in most TrP injections. DJS]

Azad SC, Huge V, Schops P et al. 2005.  [Endogenous cannabinoid system.  Effect on neuronal plasticity and pain memory] Schmerz 19(6):521-527. [German]  “The endogenous cannabinoid system is involved in the control of neuroplasticity as part of pain processing.  Cannabinoids prevent the formation of LTP (long-term potentiation) in the amygdala via activation of CBI receptors.”

Azadeh H, Dehghani M, Zarezadeh A. 2010. Incidence of trapezius myofascial trigger points in patients with the possible carpal tunnel syndrome. J Res Med Sci. 15(5):250-255. "The findings of this study imply the significant correlation between occurrence of CTS (carpal tunnel syndrome) and MTP (myofascial trigger points) suggested that clinicians consider the probability of existence of MTP in patients referred for diagnosis of CTS."

Azuma, J., T. Kishi, R. H. Williams and K. Folkers. 1976.  Apparent deficiency of Vitamin B6 in typical individuals who commonly serve as normal controls. Res Commun Chem Pathol Pharmacol 14(2):343-66

Babu AS, Mathew E, Danda D et al. 2007.  Management of patients with fibromyalgia using biofeedback: a randomized control trial.  Indian J Med Sci. 61(8):455-461.  “Biofeedback as a treatment modality reduces pain in patients with FMS, along with improvements in FIQ (fibromyalgia impact questionnaire), SMWT (six-minute walk test) and the number of tender points.”

Bach GL, Clement DB. 2007.  Efficacy of Farabloc as an analgesic in primary fibromyalgia. [Jan 11 Epub ahead or print] Clin Rheumatol.  This single-blind study suggests that Farabloc, an electromagnetic shielding fabric, if used as material for night clothes for fibromyalgia patients, has analgesic properties.

Bachasson D, Guinot M, Wuyam B et al. 2012. Neuromuscular fatigue and exercise capacity in fibromyalgia syndrome. Arthritis Care Res (Hoboken). [Sep 10 Epub ahead of print]. "Larger impairment in muscle contractility is associated with enhanced perception of exertion and reduced maximal exercise capacity in FMS patients. Neuromuscular impairments should be considered as an important factor underlying functional limitations in FMS patients." [It is highly likely that at least some of the results reflect the action of co-existing myofascial trigger points, and it would be very helpful to know this extent in future studies. DJS]

Bachmann, G. A. 1999.  Vasomotor flushes in menopausal women.  Am J Obstet Gynecol 180(3):312-6.

Baconnier, S., S. B. Lang, M. Polomska et al. Calcite microcrystals in the pineal gland of the human brain: First physical and chemical studies. Bioelectromagnetics 23(7):488-495. A new form of crystallization that is separate and different from the hydroxyapatite concretions often described has been found in the pineal gland. This calcium, carbon and oxygen crystallization may have piezoelectric properties. Tests are in progress to determine function and formation of these crystals. 

Bae Y. 2014. Change the myofascial pain and range of motion of the temporomandibular joint following kinesio taping of latent myofascial trigger points in the sternocleidomastoid muscle. J Phys Ther Sci. 26(9):1321-1324. "The purpose of this study was to identify the changes in the myofascial pain and range of the motion of temporomandibular joint when Kinesio taping is applied to patients with latent myofascial trigger points of the sternocleidomastoid muscle… In the experimental group, it was found that pain in the SCM was relieved, as the VAS and PPT score decrease significantly and range of motion of temporomandibular joint increase significantly. In comparison between the groups, significant differences were shown in the VAS and PPT scores and in the range of motion of the temporomandibular joint….Kinesio taping is thought to be an intervention method that can be applied to latent myofascial trigger points."

Bagge, E., B. A. Bengtsson, L. Carlsson and J. Carlsson. 1998. Low growth hormone secretion in patients with fibromyalgia-a preliminary report on 10 patients and 10 controls. J Rheumatol 25(1):145-148.

Bagis S, Karabiber M, As I et al. 2012. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. [Jan 22 Epub ahead of print]. "Sixty premenopausal women diagnosed with fibromyalgia according to the ACR criteria and 20 healthy women whose age and weight matched the premenopausal women were evaluated. Pain intensity, pain threshold, the number of tender points, the tender point index, the fibromyalgia impact questionnaire (FIQ), the Beck depression and Beck anxiety scores and patient symptoms were evaluated in all the women. Serum and erythrocyte magnesium levels were also measured. The patients were divided into three groups. The magnesium citrate (300 mg/day) was given to the first group.... amitriptyline (10 mg/day) was given to the second group....,and magnesium citrate (300 mg/day) + amitriptyline (10 mg/day) treatment was given to the third group....After the 8 weeks of treatment.... serum and erythrocyte magnesium levels were significantly lower in patients with fibromyalgia than in the controls. Also there was a negative correlation between the magnesium levels and fibromyalgia symptoms. The number of tender points, tender point index, FIQ and Beck depression scores decreased significantly with the magnesium citrate treatment. The combined amitriptyline + magnesium citrate treatment proved effective on all parameters except numbness..... The magnesium citrate treatment was only effective tender points and the intensity of fibromyalgia. However, it was effective on all parameters when used in combination with amitriptyline."

Bagis S., Tamer L., Sahin G. et al. 2003.  Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder?  Rheumatol Int. [Epub Dec 20 ahead of print].  This study indicates that free radical levels may cause FMS.

Bahadir C, Dayan VY, Ocak F et al. 2010. Efficacy of immediate rewarming with moist heat after conventional vapocoolant spray therapy in myofascial pain syndrome. J Musculoskel Pain 18(2):147-152. Rewarming is a significant step in the use of vapocoolant spray and stretch therapy in women with TrPs of less than six months in duration, increasing benefits of the therapy. [It would be good to know if this is also true for patients with CMP, and for male patients in both categories. DJS]

Baik, H. W. and R. M. Russell.  1999.  Vitamin B12 deficiency in the elderly.  Annu Rev Nutr 19:357-77.  

Bajaj P, Bajaj P, Madsen H et al. 2003.  Endometriosis is associated with central sensitization: a psychophysical controlled study.  J Pain 4(7):372-380.

Baker, B. A.  1986.  The muscle trigger: evidence of overload injury.  J Neuro Ortho Med Surg 7(1):35-44.  ISSN 0271-1575/86-0701.

Baker K, Barkhuizen A. 2006.  Pharmacologic treatment of fibromyalgia.  Curr Psychiatry Rep. 8(6):464-469.  “Fibromyalgia is a syndrome of widespread pain, non-restorative sleep, disturbed mood, and fatigue.  Optimal treatment involves a multidisciplinary approach with a team of health care providers using pharmacologic and nonpharmacologic treatment.  Because of the heterogeneity of the illness, management should be individualized for the patient.  Pharmacologic treatment should address issues of pain control, sleep disturbance, fatigue and any underlying coexisting mood disorder.  Nonpharmacologic treatment should include patient education, a regular exercise and stretching program, and cognitive behavioral therapy.  All of these are essential to improving functional capacity and quality of life.  This review provides general guidelines in initiating a successful pharmacologic treatment program for patients with fibromyalgia.”

Baker NA, Rubinstein EN, Rogers JC. 2012. Problems and Accommodation Strategies Reported by Computer Users with Rheumatoid Arthritis or Fibromyalgia. J Occup Rehabil. [Jan 24 Epub ahead of print]. The number of problems during computer use was substantial in our sample, and our respondents with RA and FM may not implement the most effective strategies to deal with their chair, keyboard, or mouse problems. This study suggests that workers with RA and FM might potentially benefit from education and interventions to assist with the development of accommodation strategies to reduce problems related to computer use."

Bakker, S. J., J. C. ter Maaten, C. Popp-Snijders, R. J. Heine and R. O. Gans. 1999.  Triiodo-thyronine:   a link between the insulin resistance syndrome and blood pressure?  J Hypertens 17(12 Pt 1):1725-30.

Bal S, Celiker R. 2009.  Health-related quality of life in patients with myofascial pain syndrome: a controlled clinical study.  J Musculoskel Pain. 17(2):173-177.  “There was a correlation between NHP (Nottingham Health Profile) pain score and number of trigger points.  However, no correlation was found between the NHP scores and other clinical parameters, such as age, duration of pain, and visual analog scale scores.”  “The results of this study suggest that MPS affects many aspects of HRQOL (health-related quality of life).  Besides the clinical and laboratory evaluation, the emotional and physiological parameters should also be considered to define the health status of the patients and plan the appropriate treatment.”

Balasubramaniam R, Laudenbach JM, Stoopler ET. 2007.  Fibromyalgia: an update for oral health care providers.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 104(5):589-602.  “Oral health care providers may be the first to recognize signs and symptoms of this complex disorder and are often consulted to participate in the management of FM patients.”  “This review will also highlight issues that are important to the oral health care provider, including orofacial manifestations and dental considerations for patients with FM.”  [Many dentists and oral hygienists have no idea how much their work can impact the life of their FM patients.  They don’t understand central sensitization and can cause significant needless pain that can last for weeks or longer.  Many dentists are also unaware of MTPs, and thus unaware of the impact MTPs can have on equilibration.  If the bite is off due to MTPs, or there is dental pain or sensitivity to pressure or cold, etc., due to MTPs, errors in “correcting” the bite can ruin the patient’s mouth, cause needless dental work, and amount to malpractice.   Information has been available for a long time, and there is no excuse for dentists (nor other care providers) “not wanting to know.” DJS]

Balasubramanian V, Adalarasu K. 2007.  EMG-based analysis of change in muscle activity during simulated driving.  J Bodywork Move Ther. 11, 151-158.  “Extensive usage of computers could cause fatigue and even lead to musculo-skeletal injuries.”

Baldacci F, Vedovello M, Ulivi M et al. 2012. Triggers in Allodynic and Non-Allodynic Migraineurs. A Clinic Setting Study. Headache. [Dec 26 Epub ahead of print]. "Allodynia is considered a phenomenon of central sensitization that may lead to migraine transformation, lowering the attack threshold. Migraine triggers are factors that may induce headache attacks in susceptible individuals. We hypothesize that because allodynia decreases the migraine-attack threshold, allodynic migraineurs are more susceptible to triggers than the non-allodynic ones….CONCLUSIONS: Migraineurs with moderate/severe allodynia had more triggers than those with no/mild allodynia. It is unknown if those with moderate/severe allodynia are more susceptible to triggers, or repetitive stimulation of the trigeminal system by triggers resulted in moderate/severe allodynia."

Baldry P. 2002.  Management of myofascial trigger point pain.  Acupunct Med. 20(1):2-10.  “Successful management of myofascial trigger point (MTrP) pain depends on the practitioner finding all of the MTrPs from which the pain is emanating, and then deactivating them by one of several currently used methods.”  “Following MTrP deactivation, correction of any postural disorder likely to cause MTrP reactivation is essential, as is the need to teach the patient how to carry out appropriate muscle stretching exercises.  It is also important that the practitioner excludes certain biochemical disorders.”  [Dry needling is not the treatment of choice when there is co-existing fibromyalgia.  Local anesthetic must be used to avoid further central sensitization.  DJS]

Baldry P. 2002.  Superficial versus deep dry needling.  Acupunct Med. 20(2-3):78-81.  This article compares the pain level between superficial and dry needling.  Some muscles are deep, however, and those TrPs are deep as well.  TrPs can occur at any level.  In those cases, with the use of proper positioning and local anesthetic, deep TrP injections done properly with range of motion stretching according to the Travell and Simons guidelines can provide relief.  See Alvarez DJ, Rockwell PG. 2002. DJS]

Baldweg, S. E., A. Golay, A. Natali, B. Balkau, S. Del Prato and S. W. Coppack.  2000.  Insulin resistance, lipid and fatty acid concentrations in 867 healthy Europeans.  Eur J Clin Invest 30(1):45-52.

Baldwin, C. M., I. R. Bell and M. K. O’Rourke.  1999.  Odor sensitivity and respiratory complaint profiles in a community-based sample of asthma, hay fever, and chemical odor intolerance.  Toxicol Ind Health 15(3-4):403-9.

Baliki MN, Geha PY, Apkarian AV. 2007.  Spontaneous pain and brain activity in neuropathic pain: functional MRI and pharmacologic functional MRI studies.  Curr Pain Headache Rep 11(3):171-177.  Functional MRI may be a valid method for studying clinical pain.  “...the latest results using this approach imply that distinct clinical chronic pain conditions seem to involve specific brain circuitry, which is also distinct from the brain activity commonly observed in acute pain.”

Baliki MN, Chialvo DR, Geha PY. 2006.  Chronic pain and the emotional brain: Specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain.  Chronic pain seems to activate different areas of the brain than are activated during acute pain.  Chronic pain is associated with the insula, an area of the brain that also is associated with negative emotions, response conflict, emotional memories and self-image.  Chronic back pain may influence a person’s sense of being and may trigger emotional distress of itself.

Balint G. 2002.  Buprenorphine treatment of patients with non-malignant musculoskeletal diseases.  Clin Rheumatol 21 Duppl 1:S17-S18. “When simple analgesics are not sufficient, the use of opioid-type analgesics is justified.  Buprenorphine transdermal therapeutic system (TDS) is a novel formulation of a well-tolerated and highly effective drug for satisfactory pain control that can also be used in patients with chronic non-malignant pain (CNMP) due to musculoskeletal diseases.”

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]

Balousek S, Plane MB, Fleming M. 2007.  Prevalence of interpersonal abuse in primary care patients prescribed opioids for chronic pain.  J Gen Intern Med. [Jul 20 Epub ahead of print].  This study, contrary to many others, reported abuse of opioids in chronic pain patients.  A large percentage of these patients, however, had suffered lifetime physical abuse and suicide attempts.  The study concludes that understanding of patients' needs may be better met by screening patients taking opioids for chronic pain for a history of interpersonal abuse, and addressing those needs specifically.

Ban R, Matsuo K, Ban M et al. 2013. Eyebrow ptosis after blowout fracture indicates impairment of trigeminal proprioceptive evocation that induces reflex contraction of the frontalis muscle. Eplasty. 13:e33. "Objective: The mixed levator and frontalis muscles lack the interior muscle spindles normally required to induce involuntary contraction of their slow-twitch fibers. To involuntarily move the eyelid and eyebrow, voluntary contraction of the levator nonskeletal fast-twitch muscle fibers stretches the mechanoreceptors in Muller's muscle to evoke trigeminal proprioception, which then induces reflex contraction of the levator and frontalis skeletal slow-twitch muscle fibers. The trigeminal proprioceptive nerve has a long intraorbital course from the mechanoreceptors in Müller's muscle to the superior orbital fissure. Since external force to the globe may cause impairment of trigeminal proprioceptive evocation, we confirmed how unilateral blowout fracture due to a hydraulic mechanism affects ipsilateral eyebrow movement as compared with unilateral zygomatic fracture. Methods: In 16 unilateral blowout fracture patients, eyebrow heights were measured on noninjured and injured sides in primary and 60° upward gaze and statistically compared. Eyebrow heights were also measured in primary gaze in 24 unilateral zygomatic fracture patients and statistically compared. Results: In the blowout fracture patients, eyebrow heights on the injured side were significantly smaller than on the noninjured side in both gaze. In the zygomatic fracture patients, eyebrow heights on the injured side were significantly larger than on the noninjured side in primary gaze. Conclusion: Since 60° upward gaze did not recover the eyebrow ptosis observed in primary gaze in blowout fracture patients, such ptosis indicated impairment of trigeminal proprioceptive evocation and the presence of a hydraulic mechanism that may require ophthalmic examination." [Although this study did not mention the presence of trigger points, their involvement is intuitively obvious to the trained reader. Trauma can cause TrPs, and TrPs can cause proprioceptive dysfunction, droopy and/or asymmetrical eyelids. We need more clinical and research physicians and other health care who are trained in trigger point diagnosis and treatment. DJS]

Banahan, B. F. 3rd and E. M. Kolassa.  1997. A physician survey on generic drugs and substitution of critical dose medications.  Arch Intern Med 157(18):2080-2088.

Bandak E, Amris K, Bliddal H et al. 2012. Muscle fatigue in fibromyalgia is in the brain, not in the muscles: a case-control study of perceived versus objective muscle fatigue. Ann Rheum Dis. [Dec 8 Epub ahead of print]. "Women with FM and HC completed an isometric muscle exhaustion task at 90° shoulder abduction. Surface electromyographic (EMG) activity in the deltoid muscle was recorded together with self-reported level of muscle fatigue….Participants with FM did not exhibit the same level of objective signs of muscle fatigue, seen as fewer changes in the EMG activity, as the HC during the exhaustion task. The task did not provoke pain in the HC, while participants with FM reported a doubling of pain….Women with FM had shorter exhaustion times and showed fewer objective signs of muscle fatigue during an exhausting isometric shoulder abduction compared with younger HC. This indicates that perceived muscle fatigue may be of central origin and supports the notion of central nervous dysfunction as basic pathological changes in FM." [Although it is likely that co-existing trigger points caused or contributed significantly to the fatigue, patients were not assessed for co-existing TrPs. DJS]

Bani, D., L. Ballati, E. Masini, M. Bigazzi and T. B. Sacchi.  1997.  Relaxin counteracts asthma-like reaction indused by inhaled antigen in sensitized guinea pigs.  Endocrinology 138(5): 1909-1915.

Bani, D. 1997. Relaxin: a pleiotropic hormone. Gen Pharmacol 28(1):13-22.

Banic B, Petersen-Felix S, Andersen OK et al. 2004.  Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia.  Pain 107(1-2):7-15.  This study gives evidence for spinal cord hyperexcitability with hyperalgesia and allodynia in fibromyalgia patients and in post-whiplash patients with chronic pain, in spite of the absence of tissue damage.

Banisadr G, Rostene W, Kitabgi P et al. 2005.  Chemokines and brain functions.  Curr Drug Targets Inflamm Allergy 4(3):387-399.  “Chemokines are small secreted proteins that chemoattract and activate immune and non-immune cells both in vivo and in vitro.  Besides their well-established role in the immune system, several recent reports have suggested that chemokines and their receptors may also play a role in the central nervous system.  These proteins regulate the leukocyte infiltration in the brain during inflammatory and infectious diseases.  Chemokines and their receptors are constitutively expressed by glial and neuronal cells in the CNS, where they are involved in intercellular communication.  The implication of chemokines in cellular communication could allow: i) to identify a new pathway for neuron-neuron and/or glia-glia and/or neuron-glia communications that are relevant to both normal brain function and neuroinflammatory and neurodegenerative diseases; ii) to develop new therapeutic approaches for still untreatable diseases further.”

Bank PJ, Peper CL, Marinus J et al. 2013. Motor dysfunction of complex regional pain syndrome is related to impaired central processing of proprioceptive information. J Pain. 14(11):1460-1474. "Our understanding of proprioceptive deficits in complex regional pain syndrome (CRPS) and its potential contribution to impaired motor function is still limited. To gain more insight into these issues, we evaluated accuracy and precision of joint position sense over a range of flexion-extension angles of the wrist of the affected and unaffected sides in 25 chronic CRPS patients and in 50 healthy controls. The results revealed proprioceptive impairment at both the patients' affected and unaffected sides, characterized predominantly by overestimation of wrist extension angles. Precision of the position estimates was more prominently reduced at the affected side. Importantly, group differences in proprioceptive performance were observed not only for tests at identical percentages of each individual's range of wrist motion but also when controls were tested at wrist angles that corresponded to those of the patient's affected side. More severe motor impairment of the affected side was associated with poorer proprioceptive performance. Based on additional sensory tests, variations in proprioceptive performance over the range of wrist angles, and comparisons between active and passive displacements, the disturbances of proprioceptive performance most likely resulted from altered processing of afferent (and not efferent) information and its subsequent interpretation in the context of a distorted "body schema….The present results point at a significant role for impaired central processing of proprioceptive information in the motor dysfunction of CRPS and suggest that therapeutic strategies aimed at identification of proprioceptive impairments and their restoration may promote the recovery of motor function in CRPS patients."

Bannwarth, B.  1999.  Risk-benefit assessment of opioids in chronic noncancer pain.  Drug Saf 21(4):283-96.

Banovac, K., K. Renfree, A. L. Makowski, L. L. Latta and R. D. Altman.  1995. Fracture healing and mast cells.  J Orthop Trauma 9(6):482-90. 

Baran, H., K. Jellinger and L. Deecke.  1999.  Kynurenine metabolism in Alzheimer’s disease. J Neural Transm 106(2):165-81.  Blockade of NMDA receptors by KYNA may be responsible for impaired memory, learning and cognition in AD patients.

Baraniuk JN, Casado B, Maibach H. 2005.  A chronic fatigue syndrome-related proteome in human cerebrospinal fluid.  BMC Neurol Dec 1:5(1):22.  “This pilot study detected an identical set of central nervous system, innate immune and amyloidogenic proteins in cerebrospinal fluids from two independent cohorts of subjects with overlapping CFS (chronic fatigue syndrome), PGI (Persian Gulf War Illness) and fibromyalgia.”  The conditions are different, but they may share the proteome and pathological mechanism.  This study also gives an objective neuropathophysiology shared by each of these conditions.  [Dr. Baraniuk stated that his research “ …provides initial evidence that chronic fatigue syndrome and its family of illnesses (i.e., FMS and GWI) may be legitimate, neurological diseases and that at least part of the pathology involves the central nervous system.”  Georgetown University Medical Center public press release 12/1/05. ]

Baraniuk JN, Whalen G, Cunningham J et al. 2004.  Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain.  BMC Musculoskel Disord 5(1):48.  “Central nervous system opioid dysfunction may contribute to pain in fibromyalgia.”


Baraniuk JN, Petrie KN, Le U et al. 2004.  Neuropathology in Rhinosinusitis. Am J Respir Crit Care Med [Epub]

Baraniuk, J. N. , D. Clauw, A. Yuta, M. Ali, E. Gaumond, N. Upadhyayula, K. Fujita and T. Shimizu. 1998.  Nasal secretion analysis in allergic rhinitis, cystic fibrosis, and nonallergic fibromyalgia/chronic fatigue syndrome subjects. Am J Rhinol 12(6):435-40.

Baraniuk JN, Zheng Y. 2010. Relationships among rhinitis, fibromyalgia, and chronic fatigue. Allergy Asthma Proc. 31(3):169-178. CFIDS patients have a high percentage of nonallergic rhinitis. My work showed a high percentage of the same in patients with FM and CMP. It would be extremely interesting if these CFIDS patients were assessed for those myofascial TrPs that are known to cause rhinitis. DJS]

Barbara G, Stanghellini V, DeGiorgio R et al. 2004.  Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome.  Gastroenterology 126(3):693-702.  The pain of IBS may be in part provoked by release of mast cells in the colon.

Barber JB, Gibson SJ. 2009.  Treatment of chronic non-malignant pain in the elderly: safety considerations.  Drug Saf. 32(6):457-474.  “Non-malignant pain in the elderly is frequently under-treated, with physicians appearing to be uncertain concerning how best to achieve optimum management of this common problem in individual cases.  The aim of this review is to provide a brief overview and discuss the variety of interacting factors that contribute to the continuing under-treatment of chronic non-malignant pain in the older population.  The central objective is to encourage safer and more effective pain management in a population that is highly vulnerable to painful conditions and to the consequences of poorly treated pain.... Used appropriately, analgesic and adjuvant treatments can and should be employed to relieve persistent pain in the expanding elderly population.”

Barbero M, Bertoli P, Cescon C et al. 2012. Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle. J Man Manip Ther. 20(4):171-177. "The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle….Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values." The study showed that: "An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol." [Again, it has been shown that inter-rater reliability locating trigger points requires good training and experience. Failure of any previous study demonstrated not the reliability of trigger points, but rather a failure on the part of training and experience of those who are palpating. Doctors and other care providers, including pain researchers, MUST be proficient in palpation to accurately identify, assess and treat TrPs. The presence (or absence) of initials after a name has no relation to the ability to palpate, and hence to diagnose and treat, trigger points. DJS]

Barbero M, Cescon C, Tettamanti A et al. 2013. Myofascial trigger points and innervation zone locations in upper trapezius muscles. BMC Musculoskelet Disord. 14:179. "Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology…. we conclude that IZ (innervation zone) and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped."

Bardal E, Olsen T, Ettema G et al. 2013. Metabolic rate, cardiac response, and aerobic capacity in fibromyalgia: a case-control study. Scand J Rheumatol. [Mar 26 Epub ahead of print]. "The current study indicates that patients with fibromyalgia (FM) have similar metabolic and cardiovascular responses to submaximal exercise as healthy controls (HCs). However, these patients have reduced ability to reach maximal oxygen consumption (VO2max) and a possible deficit in the metabolic system when exercising above the anaerobic threshold (AT)."

Bardal EM, Roeleveld K, Okkenhaug Johansen T et al. 2012. Upper limb position control in fibromyalgia. BMC Musculoskel Disord. 13(1):186. "FM patients exhibit an altered neuromuscular strategy for upper limb position control compared to HCs. The predominance of low-frequency limb oscillations among FM patients may indicate a sensory deficit." [Or may actually indicate the presence of co-existing myofascial trigger points, which are known to affect limb position control. DJS]

Bardin L, Tarayre JP, Malfetes N et al. 2003.  Profound, non-opioid analgesia produced by the high-efficacy 5-HT(1A) agonist F 13640 in the formalin model of tonic nociceptive pain.  Pharmacology 67(4):182-194.  “These results help to establish large-magnitude 5-HT(1A) receptor activation as a new molecular mechanism of profound, central analgesia and suggest that F 13640 may be particularly effective against pain arising from severe tonic nociceptive stimulation.”  [Although these studies are in early phases in rats, they provide hope that a new type of medication for chronic pain will become available that may be helpful for FMS.  DJS]

Bardoni R, Ghirri A, Zonta M et al. 2010. Glutamate-mediated astrocyte-to-neuron signaling in the rat dorsal horn. J Physiol. [Jan 18 Epub ahead of print]. The results of this study indicated that “…NMDAR-mediated astrocyte-to-neuron signaling thus represents a novel pathway that may contribute to the control of central sensitization in pathological pain.”

Barkhuizen A. 2002.  Rational and targeted pharmacologic treatment of fibromyalgia.  Rheum Dis Clin North Am 28(2):261-90. "Pharmacologic agents remain an important component of FM management.  Addressing the main symptoms of pain, disturbed sleep, mood disturbances, fatigue, and associated conditions is essential to improve patient functioning and enhanced quality of life."

Barlow KM. 2014. Postconcussion Syndrome: A Review. J Child Neurol. Oct 20. [Epub ahead of print] "Postconcussion syndrome is a symptom complex with a wide range of somatic, cognitive, sleep, and affective features, and is the most common consequence of traumatic brain injury. Between 14% and 29% of children with mild traumatic brain injury will continue to have postconcussion symptoms at 3 months, but the pathophysiological mechanisms driving this is poorly understood. The relative contribution of injury factors to postconcussion syndrome decreases over time and, instead, premorbid factors become important predictors of symptom persistence by 3 to 6 months postinjury. The differential diagnoses include headache disorder, cervical injury, anxiety, depression, somatization, vestibular dysfunction, and visual dysfunction. The long-term outcome for most children is good, although there is significant morbidity in the short term. Management strategies target problematic symptoms such as headaches, sleep and mood disturbances, and cognitive complaints."

Barnes, J. 1996. Myofascial release for craniomandibular pain and dysfunction.  Int J Orofascial Myology 22:20-22.

Barnes, J. 1990. Myofascial Release. MFR Seminars, 10 S. Leopard Road, Suite One, Paoli, PA. 19301.

Baron EP, Cherian N, Tepper SJ. 2011. Role of greater occipital nerve blocks and trigger point injections for patients with dizziness and headache. Neurologist. 17(6):312-317.

Baron R, Hans G, Dickenson A. 2013. Peripheral input and its importance for central sensitization. Ann Neurol. [Sep 10 Epub ahead of print]. "Many pain states begin with damage to tissue and/or nerves in the periphery, leading to enhanced transmitter release within the spinal cord and central sensitization. Manifestations of this central sensitization are wind-up and long-term potentiation. Hyperexcitable spinal neurons show reduced thresholds, greater evoked responses, increased receptive field sizes and ongoing stimulus-independent activity; these changes probably underlie the allodynia, hyperalgesia and spontaneous pain seen in patients. Central sensitization is maintained by continuing input from the periphery, but also modulated by descending controls, both inhibitory and facilitatory, from the midbrain and brainstem. The projections of sensitized spinal neurons to the brain, in turn, alter the processing of painful messages by higher centers. Several mechanisms contribute to central sensitization. Repetitive activation of primary afferent C-fibers leads to a synaptic strengthening of nociceptive transmission. It may also induce facilitation of non-nociceptive Aβ-fibers and nociceptive Aδ-fibers, giving rise to dynamic mechanical allodynia and mechanical hyperalgesia. In post-herpetic neuralgia and complex regional pain syndrome, for example, these symptoms are maintained and modulated by peripheral nociceptive input. Diagnosing central sensitization can be particularly difficult. In addition to the medical history, quantitative sensory testing and functional magnetic resonance imaging may be useful, but diagnostic criteria which include both subjective and objective measures of central augmentation are needed. Mounting evidence indicates that treatment strategies which desensitize the peripheral and central nervous systems are required. These should generally involve a multimodal approach, so that therapies may target the peripheral drivers of central sensitization and/or the central consequences."

Barsante Santos AM, Burti JS, Lopes JB et al. 2010. Prevalence of fibromyalgia and chronic widespread pain in community-dwelling elderly subjects living in Sao Paulo, Brazil. Maturitas. [Aug 11 Epub ahead of print]. "In our elderly subjects, the prevalence of FM was slightly higher compared to previously reported studies, and CWP was around 14%. The spectrum of problems related to chronic pain was more severe in FM followed by CWP, strongly suggesting that these conditions should be diagnosed and adequately treated in older individuals."

Bartels EM, Dreyer L, Jacobsen S et al. 2009.  [Fibromyalgia, diagnosis and prevalence.  Are gender differences explainable?]  Ugeskr Laeger 171(49):3588-3592. [Danish]  “Most non-inflammatory musculoskeletal diseases are more common in women than in men.  Fibromyalgia is characterized by chronic generalized muscle pain.  The male:female ratio is 1:9.  Interacting factors including genetic, hormonal, environmental and behavioral elements may cause this condition, and there are possibly subgroups of which one has shown to be treatable.  A different pathogenetic appearance in the two sexes may also be present.  The gender difference may partly be explained by the fact that pressure pain test in tender points forms part of the diagnosis.  This may leave some male fibromyalgia patients unrecognized.”  [It is unfortunate that co-existing TrPs were not considered in this article, as one cannot be sure what symptoms are FM and what were due to co-existing TrPs.  DJS]

Barton, A., B. Pal, P. J. Whorwell and D. Marshall.  1999.  Increased prevalence of sicca complex and fibromyalgia in patients with irritable bowel syndrome. Am J Gastroenterol 94(7):1898-901.

Barzilai, N., L. She, B. Q. Liu, P. Vuguin, P. Cohen, J. Wang and L. Rossetti.  1999.  Surgical removal of visceral fat reverses hepatic insulin resistance.  Diabetes 48(1):94-8.  

Barzilai, N., J. Wang, D. Massilon, P. Vuguin, M. Hawkins and L. Rossetti. 1997. Leptin selectively decreases visceral adiposity and enhances insulin action. J Clin Invest 100(12):3105-3110.

Basford JR, An KN. 2009.  New techniques for the quantification of fibromyalgia and myofascial pain.  Curr Pain Headache Rep. 13(5):376-378.  Fibromyalgia and myofascial pain are different but share some common features.  Until recently, the lack of objective and quantifiable findings have undermined the acceptance of the importance of these conditions by the medical community.  This is a review of objective findings of these conditions, focusing more on myofascial pain.

Bashir A, Lipton RB, Ashina S et al. 2013. Migraine and structural changes in the brain: A systematic review and meta-analysis. Neurology. 81(14):1260-1268. "This review and meta-analysis was conducted: "To evaluate the association between migraine without aura (MO) and migraine with aura (MA) and 3 types of structural brain abnormalities detected by MRI: white matter abnormalities (WMAs), infarct-like lesions (ILLs), and volumetric changes in gray and white matter (GM, WM) regions….These data suggest that migraine may be a risk factor for structural changes in the brain. Additional longitudinal studies are needed to determine the differential influence of migraine without and with aura, to better characterize the effects of attack frequency, and to assess longitudinal changes in brain structure and function."

Basner M, Babisch W, Davis A et al. 2014. Auditory and non-auditory effects of noise on health. Lancet 383(9925):1325-1332. Noise-induced hearing loss is the most predominant health effect of noise, but there are other problems caused by unwanted noise in occupational and other settings. Research has found that noise induced nerve damage has increased, and non-auditory effects of noise include annoyance and other mood disturbances, sleep disturbance, daytime sleepiness, healing rates in hospitals, hypertension, and cognitive dysfunction.

Bassaly R, Tidwell N, Bertolino S et al. 2010. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct. Oct 26 [Epub ahead of print]. Pain from myofascial trigger points is common among interstitial cystitis pain patients. IC patients should be assessed for TrPs, especially pelvic floor TrPs.

Bassoe, C. F. 1995.  The skinache syndrome.  J R Soc Med 88:565-569.

Bastos JL, Pires ED, Silva ML et al. 2013. Effect of acupuncture at tender points for the management of fibromyalgia syndrome: a case series. J Acupunct Meridian Stud. 6(3):163-168. Dry needling with acupuncture needles once a week for 2 months was done at 5 tender points (occiput, trapezius, rhomboid, upper chest and lateral epicondyle) on 8 female fibromyalgia patients. There was a reduction in pain sensitivity and improvement in anxiety and depression and quality of life with the Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the Beck Anxiety inventory, but not the Health Assessment Questionnaire.

Batheja S, Nields JA, Landa A et al. 2013. Post-treatment Lyme syndrome and central sensitization. J Neuropsychiatry Clin Neurosci. 25(3):176-186. "Central sensitization is a process that links a variety of chronic pain disorders that are characterized by hypersensitivity to noxious stimuli and pain in response to non-noxious stimuli. Among these disorders, treatments that act centrally may have greater efficacy than treatments acting peripherally. Because many individuals with post-treatment Lyme Syndrome (PTLS) have a similar symptom cluster, central sensitization may be a process mediating or exacerbating their sensory processing. This article reviews central sensitization, reports new data on sensory hyperarousal in PTLS, explores the potential role of central sensitization in symptom chronicity, and suggests new directions for neurophysiologic and treatment research."

Batterman S.D., Batterman S.C. 2002. Delta-V, spinal trauma, and the myth of the minimal damage accident.  J Whiplash and Rel Dis 1(1):41-52.

Bayazit YA, Celenk F, Gunduz AG et al. 2010. Vestibular evoked myogenic potentials in patients with fibromyalgia syndrome. J Laryngol Otol. [Feb 22 Epub ahead of print].  “…it is possible to detect abnormalities on vestibular evoked myogenic potential testing in such patients, indicating dysfunction in the vestibulospinal pathway, possibly in the saccule. Elongation of the n23 latency and of the interpeak latency of waves p13-n23, during vestibular evoked myogenic potential testing, may be a useful, objective indicator demonstrating neurotological involvement in fibromyalgia syndrome patients. Future research investigating the mechanisms of this latency elongation may help increase understanding of the pathogenesis of fibromyalgia syndrome.” [Vestibular dysfunction is a frequent yet often unrecognized co-existing condition for fibromyalgia, and I believe that some of the symptoms attributed to FM may, in some patients, be due to this condition. DJS]

Bazzichi L, Ciregia F, Giusti L et al. 2009. Detection of potential markers of primary fibromyalgia syndrome in human saliva. Proteomics Clin Appl. 3(11):1296-1304. "In the last few years, many attempts have been carried out for the research of specific biological biomarkers in fibromyalgia (FM) since, so far, no laboratory tests have been appropriately validated for the diagnosis and the prognostic stratification of the disease. In our study for the first time, we carried out a proteomic analysis of the whole saliva of FM patients in order to evaluate salivary biomarkers. Twenty-two FM patients with all fulfilling the American College of Rheumathology diagnostic criteria for FM and 26 sex-and age-matched healthy subjects were enrolled in the study....The most relevant observation which emerged from the data analysis was the exclusive and significant over-expression of transaldolase and phosphoglycerate mutase I. These findings were validated by Western blot analysis and the total optical density confirmed the significant up-regulation of transaldolase and phosphoglycerate mutase I in FM samples with respect to healthy subjects. It was noteworthy that seven further salivary proteins resulted differentially expressed, namely: calgranulin A, calgranulin C, cyclophilin A, profilin 1, Rho GDP-dissociation inhibitor 2, proteasome subunit-Î"-type-2 and haptoglobin-related protein precursor. These preliminary results demonstrated the utility of salivary proteomic analysis in the identification of salivary biomarkers in FM patients and in clarifying some of the pathogenetic aspects of the disease."

Bazzichi L, Giacomelli C, Rossi A. 2012. Fibromyalgia and sexual problems. Reumatismo. 64(4):261-267. "The aim of this review was to describe the recent literature concerning sexual dysfunction in fibromyalgia patients....The major findings observed were related to a decreased sexual desire and arousal, decreased experience of orgasm, and in some studies an increase in genital pain. The psychological aspects, together with the stress related to the constant presence of chronic widespread pain, fatigue and sleep disturbances, are certainly a major factor that adversely affects the sexuality of the patient with FM. Moreover, the drugs most commonly used in these cases may interfere negatively on the sexuality and sexual function of these patients. [It is most unfortunate that the authors of the papers reviewed did not understand that fibromyalgia patients have co-existing myofascial trigger points causing most if not all of these sexual pains and dysfunctions. This review is a good example of how bad research begets more bad research. DJS]

Bazzichi L, Giannaccini G, Betti L et al. 2006.  Alteration of serotonin transporter density and activity in fibromyalgia.  Arthritis Res Ther. 8(4):R99.  “A change in SERT (specific serotonin transporter, and serotonin uptake) seems to occur in fibromyalgia patients, and it seems to be related to the severity of fibromyalgic symptoms.”

Bazzichi L, Rossi A, Massimetti G et al. 2007.  Cytokine patterns in fibromyalgia and their correlation with clinical manifestations.  Clin Exp Rheumatol. 25(2):225-230.  “The higher levels of cytokines found in FM patients suggest the presence of an inflammatory response system (IRS) and highlight a parallel between the clinical symptoms and biochemical data.  They support the hypothesis that cytokines may play a role in the clinical features of fibromyalgia.  In addition, the similar cytokine patterns found in FM patients with different psychiatric profiles suggests that IRS impairment may play a specific role in the disease.”

Bazzichi L, Rossi A, Giuliano T et al. 2007.  Association between thyroid autoimmunity and fibromyalgic disease severity.  Clin Rheumatol. [May 9 Epub ahead of print].  “...autoimmune thyroiditis is present in an elevated percentage of FM patients…”

Bazzichi L, Rossi A, Zirafa C et al. 2010. Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia? Rheumatol Int. [Nov 18 Epub ahead of print]. "In particular, FM comorbidity in HT (Hashimoto's Thyroiditis) patients without SCH (subclinical hypothyroid) was 33.3% and in HT patients with SCH was 28.5%. Based on our data, we speculate that maybe there is more than a hypothesis regarding the cause-effect relation between thyroid autoimmunity and the presence of FM, thus suggesting a hypothetical role of thyroid autoimmunity in FM pathogenesis." [Hashimoto's Thyroiditis and hypothyroid are perpetuating factors of both FM and TrPs. DJS]

Beal, M. W.  1998. Women’s use of complementary and alternative therapies in reproductive health care.  J Nurse Midwifery 43(3):224-34.

Beard, J. L., M. J. Borel and J. Derr.  1990.  Impaired thermoregulation and thyroid function in iron-deficiency anemia.  Am J Clin Nutr 52(5):813-9.

Beauchet O, Annweiler C, Verghese J et al. 2011. Biology of gait control: Vitamin D involvement. Neurology. [Apr 6 Epub ahead of print]. "Low levels of vitamin D may be associated with disturbed gait control."

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."

Becker, N., A. B. Thomsen, A. K. Olsen, P. Sjogren, P. Bech and J. Erikson.  1998. [No title available]. Ugeskr Laeger 160(47):6816-9. [Danish].  

Becker, N., A. Bondegaard Thomsen, A. K. Olsen, P. Sjogren, P. Bech and J. Erikson.  1997. Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to as Danish multidisciplinary pain center.  Pain 73(3):393-400.

Becker, N., P. Sjogren, P. Bech, A. K. Olsen and J. Eriksen.  2000.  Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain center compared to general practice: a randomized controlled trial.  Pain 84(2):203-11.

Becker PM, Novak M. 2014. Diagnosis, Comorbidities, and Management of Restless Legs Syndrome. Curr Med Res Opin. [May 7 Epub ahead of print.] "Although clinical diagnosis of RLS can be straightforward, diagnostic challenges may arise when patients present with comorbid conditions. Comorbidities of RLS include insomnia, depressive and anxiety disorders, and pain disorders. Differential diagnosis is particularly important, as some of the medications used to treat insomnia and depression may exacerbate RLS symptoms. Appropriate diagnosis and management of RLS symptoms may benefit patient well-being and, in some cases, may lessen comorbid disease burden. Therefore, it is important that physicians are aware of the presence of RLS when treating patients with conditions that commonly co-occur with the disorder."

Bedaiwy MA, Patterson B, Mahajan S. 2013. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med. 58(11-12):504-510. "A retrospective chart review was performed on all women who presented to our facility between January 2005 and December 2007. Those diagnosed with myofascial pelvic pain and referred for transvaginal pelvic floor physical therapy over this 3-year period were evaluated. Participants with an initial pain score of > or = 4, myofascial pelvic pain on examination, and who attended 2 or more physician visits were included in the analysis. Patient physical examination findings, symptoms, and verbal pain ratings were reviewed….In all, 146 (13.2%) of 1,106 initially screened patients were diagnosed with myofascial pain. Seventy-five (51%) of the 146 patients who were referred for physical therapy were included, and 75% had an initial pain score of > or = 7. Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement….Transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain."

Beebe FA, Barkin RL, Barkin S. 2005.  A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions.  Am J Ther. 12(2):151-171.

Behm FG, Gavin IM, Karpenko O et al. 2012. Unique immunologic patterns in fibromyalgia. BMC Clin Pathol. 12(1):25. "Fibromyalgia (FM) is a clinical syndrome characterized by chronic pain and allodynia. The diagnosis of FM has been one of exclusion as a test to confirm the diagnosis is lacking. Recent data highlight the role of the immune system in FM. Aberrant expressions of immune mediators, such as cytokines, have been linked to the pathogenesis and traits of FM. We therefore determined whether cytokine production by immune cells is altered in FM patients by comparing the cellular responses to mitogenic activators of stimulated blood mononuclear cells of a large number of patients with FM to those of healthy matched individuals…..The cytokine responses to mitogenic activators of PBMC isolated from patients with FM were significantly lower than those of healthy individuals, implying that cell-mediated immunity is impaired in FM patients."

Behnam A, Mahyar S, Ezzati K et al. 2014. The use of dry needling and myofascial meridians in a case of plantar fasciitis. J Chiropr Med. 13(1):43-48. "A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity…..Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient's pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient…. Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis."

Bell IR, Lewis DA 2nd, Lewis SE et al. 2004.  EEG alpha sensitization in individualized homeopathic treatment of fibromyalgia.  Int J Neurosci. 114(9):1195-1220.  

Bell IR, Lewis II DA, Brooks AJ et al.  2004. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo. Rheumatology (Oxford) 43(5):577-582.  This double-blind, randomized, parallel-group, placebo-controlled study indicates that “...individualized homeopathy is significantly better than placebo in lessening tender point pain and improving the quality of life and global health of persons with fibromyalgia.”

Bell, I. R., C. M. Baldwin, M. Fernandez and G. E. Schwartz.  1999.  Neural sensitization model for multiple chemical sensitivity: overview of theory and empirical evidence.  Toxicol Ind Health 15(3-4):295-304.

Bell, I. R., M. J. Szarek, D. R. Dicenso, C. M. Baldwin, G. E. Schwartz and R. R. Bootzin.  1999. Patterns of waking EEG spectral power in chemically intolerant individuals during repeated chemical exposures.  Int J Neurosci 97(1):41-59.

Bell, I. R., C. M. Baldwin and G. E. Schwartz.  1998.  Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia.  Am J Med 105(3A):74S-82S. 

Bell, I. R., C. M. Baldwin, L. G. Russek, G. E. Schwartz and E. E. Hardin. 1998.  Early life stress, negative paternal relationships, and chemical intolerance in middle-aged women: support for a neural sensitization model.  J Womens Health 7(9):1135-47.

Bell J. 2008.  Massage therapy helps to increase range of motion, decrease pain and assist in healing a client with low back pain and sciatica symptoms.  J Bodyw Mov Ther. 12(3):281-289.

Bellamy N, Sothern RB, Campbell J. 2004.  Aspects of diurnal rhythmicity in pain, stiffness, and fatigue in patients with fibromyalgia.  J Rheumatol 31(2):379-89.  This study indicates that there are indications that pain, stiffness and fatigue show daily and possibly weekly patterns.  The awareness of these patterns can be useful for scheduling activities, measurement in clinical trials, and perhaps timing administration of medications for when they are most needed.

Bellastella, A., G. Pisano, S. Iorio, D. Pasquali, F. Orio, T. Venditto and A. A. Sinisi.  1998. Endocrine secretions under abnormal light-dark cycles and in the blind.  Horm Res 49(3-4):153-7. 

Bendiksen A, McGehee E, Handberg G. 2007.  [The use of methadone in the treatment of chronic non-malignant pain in an out-patient setting]  Ugeskr Laeger 169(17):1568-1572. [Danish]  “Opioid treated chronic pain patients with insufficient pain relief may benefit from conversion to methadone, as 59% in our analysis achieved better pain relief, while the rotation was generally opioid-saving at the same time.  The method used was safe and acceptable to the patients.  The analyses did not result in any fundamental changes to the procedure.”  Methodone may be a viable option for insufficiently relieved pain in chronic non-malignant pain patients. 

Bendtsen L. 2000.  Central sensitization in tension-type headache—possible pathophysiological mechanisms.  Cephalalgia 20(5):486-508.  “The stimulus-response function for palpation pressure vs. pain was found to be qualitatively altered in chronic tension-type headache patients compared with controls.  The stimulus-response function was found to be qualitatively altered also in patients with fibromyalgia.  It was concluded that the qualitatively altered nociception was probably due to central sensitization at the level of the spinal dorsal horn/trigeminal nucleus.  Future basic and clinical research should aim at identifying the source of peripheral nociception in order to prevent the development of central sensitization and at ways of reducing established sensitization.  This may lead to a much needed improvement in the treatment of chronic tension-type headache and other chronic myofascial pain conditions.”

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."

Bendtsen, L., J. Norregaard, B. Jensen and J. Olesen.1997. Evidence of qualitatively altered nociception in patients with fibromyalgia. J Rheumatol 40(1):98-102.  

Benecke R., Dressler D, Kunesch E et al. 2003.  [No Title Given] Schmertz 17(6):450-458.  Pain relief for myofascial pain has been reported with botox injections, but “in fibromyalgia, there seems to be no analgesic effect.”

Bengtsson, A., J. Ernerudh, M. Vrethem and T. Skogh. 1990. Absence of autoantibodies in primary fibromyalgia. J Rheumatol 17(12:1682-3. 

Bengtsson, A. and K. G. Henriksson. 1989. The muscle in fibromyalgia–a review of Swedish studies. J Rheumatol Suppl Nov;(19)144-149.

Bengtsson, A. and M. Bengtsson. 1988. Regional sympathetic blockade in primary fibromyalgia.  Pain 33(2):161-7.

Bengtsson A., Henriksson KG, Larsson J.  1986. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia.  Arthritis Rheum. 29:817-21.

Benjamin M, Toumi H, Ralphs JR et al. 2006.  Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load.  J Anat. 208(4):471-490.   “Entheses (insertion sites, osteotendinous junctions, osteoligamentous junctions) are sites of stress concentration at the region where tendons and ligaments attach to bone.  Consequently, they are commonly subject to overuse injuries (enthesopathies) that are well documented in a number of sports.”  [These areas are often sites of attachment TrPs and these TrPs are frequently overlooked by orthopedic and surgical consultants.  DJS]

Benjamin, S., Morris, S., McBeth, J., MacFarland, G.J., Silman, A.J.. 2000. The association between chronic widespread pain and mental disorder: A Population Study. Epidemiological group has tended towards viewing FMS as a somatization disorder.  It was therefore important in this study that they only found three cases of somatoform disorders and came to the conclusion that somatoform disorders were uncommon in people with chronic widespread pain.

Bennett GJ. 2000.  Update on the neurophysiology of pain transmission and modulation: focus on the NMDA-receptor.  J Pain Symptom Manage 19(1 Suppl):S2-S6.  “NMDA-receptor activation not only increases the cell’s response to pain stimuli, it also decreases neuronal sensitivity to opioid receptor agonists.  In addition to preventing central sensitization, co-administration of NMDA-receptor antagonists with an opioid may prevent tolerance to opioid analgesia.”

Bennett, G. J.  2000.  Update on the neurophysiology of pain transmission and modulation: focus on the NMDA-receptor.  J Pain Symptom Manage 19(1 Suppl):S2-6.

Bennett R. 2007.  Myofascial pain syndromes and their evaluation.  Best Pract Res Clin Rheum 21(3):427-445.  This outstanding summary of MTPs is a comprehensive, clearly written overview of myofascial medicine.  It explains why it is necessary for doctors to be trained in diagnosis of MTPs, and that they frequently occur in the presence of other conditions but, although they are exceedingly common, are often undiagnosed or misdiagnosed.  [Severe CMP with central sensitization and multiple conditions are not explored, but the treatments suggested are often adequate for mild cases.  It is significant that an article on MTPs written by such a respected scientist and clinician has appeared in a rheumatology journal.  It is hoped that it is as well-read as it is well-written. DJS]

Bennett RM. 2007.  Do patients’ perceptions of negative physician attitudes influence fibromyalgia symptoms and status?  J Musculoskel Pain 15 (Supp 13):42 item 74.  [Myopain 2007 Poster]   “Current physicians were perceived to take the diagnosis of FMS more seriously, which in turn was related to improved FMS symptomatology.  Perception that current or past physicians didn’t take FMS seriously was associated with increased anxiety.  Patients may improve both physically and psychologically under the care of a physician who takes their illness seriously, whereas a negative past attitude continues to adversely influence their psychological health.”  [Doctors can be serious perpetuating factors.  Use care in choosing your health care team. DJS]

Bennett R. 2007.  Myofascial pain syndromes and their evaluation.  Best Pract Res Clin Rheumatol. 21(3):427-445.  “Myofascial pain refers to a specific form of soft tissue rheumatism that results from irritable foci (trigger points) within skeletal muscles and their ligamentous junctions.  It must be distinguished from bursitis, tendonitis, hypermobility syndromes, fibromyalgia and fasciitis.  On the other hand it often exists as part of a clinical complex that includes these other soft tissue conditions, i.e., it is not a diagnosis of exclusion.”

Bennett RM. 2004.  Diagnostic criteria and differential diagnosis of the fibromyalgia syndrome.  J Musculoskeletal Pain 12(3/4):59-64.  This article explains some of the difficulties arising from the use of 1990 ACR FMS Criteria for research as diagnostic criteria, the need for clarification of terms and training in differential diagnosis and treatment.


Bennett RM. 2004.  Three years later: presidential address to MYOPAIN ’04.  J Musculoskeletal Pain 12(3/4):1-12.  [This is an excellent overview on some of the current developments in FMS and myofascial pain, including a summary of the reasons central sensitization is a key to FMS, and a clear look at the increase in morbidity and mortality for those with chronic pain. DJS]


Bennett R. 2005.  The fibromyalgia impact questionnaire (FIQ): a review of its development, current version, operating characteristics and uses.  Clin Exp Rheumatol. 23(5 Suppl 39):S154-162.   The latest version of the Fibromyalgia Impact Questionnaire can be found at


Bennett RM, Schein J, Kosinski MR et al. 2005.  Impact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen.  Arthritis Rheum. 53(4):519-527.  “Moderate-to-severe fibromyalgia pain significantly impairs HRQOL [health-related quality of life], and effective pain relief in these patients significantly increases HRQOL.”


Bennett R. 2004.  Fibromyalgia: present to future. Curr pain Headache Rep. 8(5):379-384.  A review of the understanding of FMS, including emerging clues and predictions on future developments. 

Bennett RM. 2002. Adult growth hormone deficiency in patients with fibromyalgia.  Curr Rheumatol Rep 4(4):306-12. "There is evidence that GH deficiency as defined in terms of a low insulin-like growth factor-1 (IGF-1) level occurs in approximately 30% of patients with fibromyalgia and is probably the cause of some morbidity.  It seems most likely that impaired GH secretion in fibromyalgia is related to a physiologic dysregulation of the hypothalamic-pituitary-adrenal axis (HPA) with a resulting increase in hypothalamic somatostatin tone.  The severe GH deficiency that occurs in a subset of patients with fibromyalgia is of clinical relevance because it is a treatable disorder with demonstrated benefits to patients."

Bennett RM. 2002. The rational management of fibromyalgia patients.  Rheum Dis Clin North Am 2002. 28(2):181-99.  "The exponential increase in pain research over the last 10 years has established fibromyalgia (FM) as a common chronic pain syndrome with similar neurophysiologic aberrations to other chronic pain states.  As such, the pathogenesis is considered to involve an interaction of augmented sensory processing (central sensitization) and peripheral pain generators.  The notion, the FM symptomatology results from an amplification of incoming sensory impulses, has revolutionized the contemporary understanding of this enigmatic problem and provided a more rational approach to treatment."

Bennett, R. M.  1999.  Fibromyalgia Review.  J Musculoskeletal Pain 7(4):85. 

Bennett,  R. M. 1999. Emerging concepts in the neural biology of chronic pain: evidence of abnormal sensory processing in fibromyalgia.. Mayo Clin Proc 74(4):385-98.

Bennett,  R. M. 1998. Disordered growth hormone secretion and fibromyalgia: a review of recent findings and a hypothesized etiology. Z Rheumatol 57 Suppl 2:72-6.

Bennett, R. M., S. C. Clark and J. Walczyk.  1998.  A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia.  A J Med 104(3):227-231. 

Bennett, R. M. , D. M. Cook, S. R. Clark, C. S. Burckhardt and S. M. Campbell. 1997. Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia. J Rheumatol 24(7):1384-1389.

Bennett, R. M. 1995. Fibromyalgia: The commonest cause of widespread pain. Frontiers 21(6):269-275.

Bennett, R. M. And S. Jacobsen. 1994.  Muscle function and origin of pain in fibromyalgia. Ballieres Clin Rheumatol 8(4):721-746.

Bennett, R. M., S. R. Clark, S. M. Campbell and C. S. Burckhardt.  1992. Low levels of somatomedin C in patients with the fibromyalgia syndrome: a possible link between sleep and muscle pain. Arthritis Rheum 35(10):1113-6.

Bennett, R. M., S. R. Clark, S. M. Campbell, S. B. Ingram, C. S. Burckhardt, D. L. Nelson and J. M. Porter. 1991. Symptoms of Raynaud’s syndrome in patients with fibromyalgia. Arthritis Rheum 34(3):264-9.

Bennett, R.M., R. A. Gatter, S. M. Campbell, R. P. Andrews, S. R. Clark and J. A. Scarola.  1988.  A comparison of cyclobenzaprine and placebo in the management of fibrositis.  Arthritis Rheum 31(12):1535-1542.

Bennett RM, Goldenberg DL. 2011. Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping? Bennett and Goldenberg Arthritis Research & Therapy. 13:117. [This study is fascinating due to its authors, one of whom knows both FM and TrPs (Bennett) and the other (Goldenberg) who appears to have a vested interest in claiming TrPs do not exist, as he does not understand them. I know said author has been confronted with these pesky critters, because we have shared patients who have plunked my book on his desk and asked him "Why don't you know this?" Nothing I could write can top the commentary on this article by Dr. Jan Dommerholt on page 239 of The Journal of Musculoskeletal Pain Vol. 19 #4: "Apparently, Dr. Goldenberg still has not learned to palpate TrPs and appreciate their value, as he considers localized TrPs to be a belief system. He either is not aware of current research or elects to discard many recent TrP studies....We can only hope that the next generation of physicians with an interest in FMS will start to incorporate TrPs into their thinking and evidence-based practice." Amen, Dr. Dommerholt. What ever happened to "Do no harm," Dr. Goldenberg? DJS

Bennett RM, Russell JI, Cappelleri JC et al. 2010. Identification of symptom and functional domains that fibromyalgia patients would like to see improved: a cluster analysis. BMC Musculoskelet Disord. 11(1):134. "The purpose of this study was to determine whether some of the clinical features of fibromyalgia (FM) that patients would like to see improved aggregate into definable clusters. CONCLUSION: Common clinical features of FM could be grouped into 6 clusters (Pain, Fatigue, Domestic, Impairment, Affective, and Social) based on patient perception of relevance to treatment. Furthermore, these 6 clusters could be charted in the 2 dimensions of Status and Setting, thus providing a unique perspective for interpretation of FM symptomatology."

Benyamina A, Reynaud M. 2014. [Therapeutic use of cannabis derivatives.] Rev Prat. 64(2):165-168. [Article in French] "The therapeutic use of cannabis has generated a lot of interest in the past years, leading to a better understanding of its mechanisms of action. Countries like the United States and Canada have modified their laws in order to make cannabinoid use legal in the medical context. It's also the case in France now, where a recent decree was issued, authorizing the prescription of medication containing "therapeutic cannabis" (decree no. 2013-473, June 5, 2013). Cannabinoids such as dronabinol, Sativex and nabilone have been tested for the treatment of acute and chronic pain. These agents are most promising to relieve chronic pain associated with cancer, with human immunodeficiency virus infection and with multiple sclerosis. However, longer-term studies are required to determine potential long-term adverse effects and risks of misuse and addiction."

Berga, S. L. 1998. Hypothalamus pituitary gonadal axis: stress-induced gonadal compromise. J Musculoskel Pain 6(3):61-70.

Berger A, Dukes E, Martin S et al. 2007.  Characteristics and healthcare costs of patients with fibromyalgia syndrome.  Int J Clin Pract. [Jul 26 Epub ahead of print].  “Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.”  [Researchers are realizing that FM patients often have multiple conditions.  What they do not yet understand is that many of these conditions are interactive. DJS]

Berggren-Clive, K.  1998.  Out of the darkness and into the light: women’s experiences with depression after childbirth.  Can J Commun Ment Health 17(1):103-20.

Bergholm U, Johansson BH. 2003.  [No title given] Lakartidningen 100(47):3842-3847.  [Swedish]  “The late onset of symptoms can now be explained by the functional stenosis of the spinal cord and brainstem due to scar formation around the dens axis after injury.  Modern neurophysiology can now explain the background of the generalized and complex picture of chronic pain and muscular and cognitive dysfunction.  This new knowledge has prepared the way for more specific therapy in patients suffering from craniocervical instability symptoms and pain from disks and facet joints in the cervical spine after whiplash trauma.”

Berman, B. M., J. P. Swyers and J. Ezzo.  2000.  The evidence for acupuncture as a treatment for rheumatologic conditions.  Rheum Dis Clin North Am 26(1):103-15, ix-x.

Berman, B. M. and J. P. Swyers.  1999.  Complementary medicine treatments for fibromyalgia syndrome.  Baillieres Best Pract Res Clin Rheumatol 13(3):487-92.

Berman, B. M, B. B. Singh, S. M. Hartnoll, B. K. Singh and D. Reilly.  1998.  Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns. J Am Board Fam Pract 11(4):272-81.

Berman, B. M. and J. P. Swyers.  1997. Establishing as research agenda for investigating alternative medical interventions for chronic pain.  Prim Care 24(4):743-758.

Berman SM, Naliboff BD, Suyenobu B et al. 2008.  Reduced brainstem inhibition during anticipated pelvic visceral pain correlates with enhanced brain response to the visceral stimulus in women with irritable bowel syndrome.  J Neurosci. 28(2):349-359.

Bernardes AT, dos Santos RM. 1997.  Immune network at the edge of chaos.  J Theor Biol. 186(2):173-187.  Chaos system, used in mathematics, corresponds in many ways to the state of ill health, especially chronic illness.   

Bernardis, L. L. and P. J. Davis.  1996.  Aging and the hypothalamus: research perspectives. Physiol Behav 59(3):523-36.

Bernatsky S, Dobkin P, DeCivita M et al. 2005.  Co-morbidity and physician use in fibromyalgia.  Swiss Med Wkly 135(5-6):76-81.  “Reported co-morbidity was classified into 4 categories: medical, psychiatric, ‘functional’ and unknown.  The category for ‘functional’ conditions included disorders that have been classified by previous authors as medically unexplained symptoms such as the irritable bowel and chronic fatigue syndromes.  Co-morbidity with other disorders, both functional and medical, was high in this sample.  Medical and psychiatric co-morbidity were stronger determinants of high physician use than ‘functional’ co-morbidity.”  [It is illogical to classify conditions together merely because medical science, or the authors, cannot explain them. DJS]

Bernik M, Sampaio TP, Gandarela L. 2013. Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Curr Pain Headache Rep. 17(9):358. "Fibromyalgia is associated with high level of pain and suffering. Lack of diagnosis leads to onerous indirect economic costs. Recent data indicate that fibromyalgia; anxiety disorders, and depression tend to occur as comorbid conditions. They also share some common neurochemical dysfunctions and central nervous system alterations such as hypofunctional serotonergic system and altered reactivity of the hypothalamic-pituitary-adrenal axis. Conversely, functional neuroimaging findings point to different patterns of altered pain processing mechanisms between fibromyalgia and depression. There is no cure for fibromyalgia, and treatment response effect size is usually small to moderate. Treatment should be based on drugs that also target the comorbid psychiatric condition. Combined pharmacotherapy and cognitive-behavior therapy should ideally be offered to all patients. Lifestyle changes, such as physical exercise should be encouraged. The message to patients should be that all forms of pain are true medical conditions and deserve proper care."

Bernstein CD, Albrecht KL, Marcus DA. 2013. Milnacipran for fibromyalgia: a useful addition to the treatment armamentarium. Expert Opin Pharmacother. [Mar 19 Epub ahead of print]. "Milnacipran provides modest fibromyalgia pain relief and is best used as part of a multidisciplinary treatment approach. While milnacipran was not studied in fibromyalgia patients with major depression, it may be a wise choice for fibromyalgia patients with depressive symptoms and patients for whom sedation, dizziness, edema or weight gain with gabapentin and pregabalin is a problem. Milnacipran has been found to be beneficial for treating some troublesome fibromyalgia-associated symptoms, including fatigue and cognitive dysfunction."

Bernstein J, Alonso DR, DiCaprio M et al. 2003.  Curricular reform in musculoskeletal medicine: needs, opportunities and solutions.  Clin Orthop Relat Res. (415):302-308.  “Musculoskeletal medicine is not taught adequately in American medical schools and the predictable consequences are seen.  Students cannot show cognitive mastery of the subject and lack confidence in this topic.”   “…although inadequate education is neither new nor necessarily unique among disciplines, the coming year or two, the beginning of the Bone and Joint decade, was seen to be a particularly auspicious time for attempting curricular reform.”

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."

Berthelot JM, Delecrin J, Maugars Y et al. 1996.  A potentially under-recognized and treatable cause of chronic back pain: entrapment neuropathy of the cluneal nerves.  J Rheumatol. 23(12):2179-2181.  “We describe a case of longstanding low back pain related to entrapment neuropathy of the L1-L2 dorsal ramus over the iliac crest.  As 3 local anesthetic pain blocks (at the trigger point, 7 cm left of the L5 spine process and just above the iliac crest) were successful for 3 weeks each, a surgical procedure was performed.  This corrected patient stricture of a voluminous dorsal ramus within a rigid osteofibrous orifice between the upper rim of the iliac crest and the thoracolumbar fascia.  Pain decreased dramatically the same day and disappeared completely within less than a week.”  [One may wonder what might have been the outcome had the patient been treated for myofascial TrPs throughout the body, including the control of perpetuating factors.  Is surgery necessary? DJS]


Berthold U, Johansson BH. 2003.  [No title given]  Lakartidingen 100(47):3842-3847.  [Swedish]  Late symptom onset may be due to scar formation around the dens axis after whiplash injury. Functional magnetic resonance imaging (fMRI) may be a valuable source of documentation in whiplash injuries. This may be causing central pain, and muscular and cognitive dysfunctions. [Narrowing of the spinal cord and brainstem area may also be due to constricting muscles due to TrP contracture. DJS

Bertin PM. 2014. Liposome bupivacaine for postsurgical pain in an obese woman with chronic pain undergoing laparoscopic gastrectomy: a case report. J Med Case Rep. 8(1):21. "Liposome bupivacaine use in this morbidly obese patient undergoing laparoscopic sleeve gastrectomy provided analgesic efficacy and limited postsurgical opioids to a level comparable with her baseline opioid regimen for chronic pain. Given her complex medical history and previous issues with acute and chronic pain, we consider these results highly successful and continue to use liposome bupivacaine as part of a multimodal analgesic regimen in an effort to optimize postsurgical pain management."

Bertolucci PH, de Oliveira FF. 2013. Cognitive impairment in fibromyalgia. Curr Pain Headache Rep. 17(7):344. "Cognitive and behavioral impairments are core manifestations of fibromyalgia and may be more disabling than pain itself. Involvement of the central nervous system is ascertained by the fact that frontoparietal and limbic cortices are often functionally and structurally affected along the course of this disease. Even though neuroimaging has brought some experimental evidence to support such network disruption, there are currently no clinically effective biomarkers that detect and quantify cognitive and behavioral disturbances in fibromyalgia; thus, traditional scales and tests of neuropsychiatric assessment remain the most important diagnostic tools. This review addresses the most common cognitive and behavioral impairments in people with fibromyalgia, while explaining their pathophysiological basis and currently available therapeutic options."

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."

Bettoni L, Bonomi FG, Zani V et al. 2013. Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin Rheumatol. [May 2 Epub ahead of print]. "Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life, in comparison with the non-cryo treated fibromyalgic subjects, as indicated by the scores of the qualitative indexes and sub-indexes that are widely recognized tools to assess the overall health status and the effect of the treatments. We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain."

Bezerra Rocha CA, Sanchez TG, Tesseroli de Siqueira JT. 2007.  Myofascial trigger point: a possible way of modulating tinnitus.  Audiol Neurootol. 13(3):153-160.  “Temporary modulation of tinnitus was frequently observed (55.9%) during digital pressure, mainly in the masseter.”  “An association between tinnitus and the presence of myofascial trigger points was observed, as well as a laterality association between the ear with the worst tinnitus and the side of the body with more myofascial trigger points.  Thus, this relationship could be explained not only by somatosensory-auditory system interactions but also by the influence of the sympathetic system.”

Bezov D, Ashina S, Jensen R et al. 2010. Pain Perception Studies in Tension-Type Headache. Headache. [Oct 1 Epub ahead of print]. "Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. ... Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders." [The number of TrPs and duration of TrPs are two important variable in reversibility. Pharmaceutical and other pain therapies may be able to reverse some central sensitization, especially if it is new, if the pain control method is effective. The cause of the pain and the perpetuating factors must also be brought under control. Since most FM researchers are as yet not considering the peripheral cause of the pain and other symptoms, trigger points, vast shadows are being cast on current fibromyalgia research. DJS]

Bhatti MI, Hollingworth P, Leach P. 2013. Significant improvement of fibromyalgia symptoms after excision of large meningioma – a case report. Br J Neurosurg. [June 14 Epub ahead of print]. "We report a very unusual case of a 42-year-old patient with confirmed fibromyalgia and juvenile onset arthritis whose symptoms dramatically improved after surgical excision of a large, dominant hemisphere, parafalcine meningioma."

Biasi G, Di Sabatino V, Ghizzani A et al. 2014. Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia. Reumatismo. 66(1):87-91. "Chronic pelvic pain (CPP) is a common condition that has a major impact on the quality of life of both men and women. Male CPP is usually attributable to well-defined urogenital conditions (most frequently infectious/non infectious prostatic diseases) or musculoskeletal or bowel diseases, whereas the features of female CPP are much more complex and are of particular clinical and epidemiological importance. It is a multifactorial syndrome that can be due to diseases of the urogenital, gastrointestinal, or musculoskeletal systems, or to neurological or neuropsychiatric disorders. It is not always easy to identify its predominant pathogenesis, although it often occurs as a central sensitization syndrome triggered by an initial stimulus which is no longer detectable and only manifests itself clinically through pain. In this respect, there are some very interesting relationships between vulvodynia and fibromyalgic syndrome, as identified in a preliminary study of women with chronic musculoskeletal pain in which it was demonstrated that vulvar pain plays an important role, although it is often overlooked and undiagnosed." [Myofascial trigger points are often responsible for or contribute to chronic pelvic pain and/or vulvodynia. There are excellent research articles on this. See Doggweiler R. DJS]

Biasi, G., A. Fioravani, A. Franci and R. Marcolongo. 1994. [The role computerized telethermography in the diagnosis of fibromyalgia syndrome.]  Minerva Med 85(9):451-4. [Italian]

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."

Bidari A, Ghavidel-Parsa B, Ghalehbaghi B. 2009.  Reliability of ACR criteria over time to differentiate classic fibromyalgia from nonspecific widespread pain syndrome: a 6-month prospective cohort study.  Mod Rheumatol. [Sep 4 Epub ahead of print].  “This study showed the ACR 1990 criteria was not able to consistently classify affected patients with FM syndrome within a group of patients having nonspecific body pain and multiple tender points over 6 months of follow-up.”

Bieber C, Muller KG, Blumenstiel K et al. 2008.  A shared decision-making communication training program for physicians treating fibromyalgia patients: effects of a randomized controlled trial.  J Psychosom Res. 64(1):13-20.  “SDM (shared decision making) with FMS patients might be a possible means to achieve a positive quality of physician-patient interaction.  A specific SDM communication training program teaches physicians to perform SDM and reduces frustration in patients.”

Bieber C, Muller KG, Blumenstiel K et al. 2006. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia: A qualitative and quantitative 1-year follow-up of a randomized controlled trial.  Patient Educ Couns. [Jul 25 Epub ahead of print]  Shared decision making can be a critical step in producing both doctor and patient satisfaction in fibromyalgia care. 

Billiard M, Bentley A. 2004.  Is insomnia best categorized as a symptom or a disease?  Sleep Med. 5 Suppl 1:S35-40.  It is important to discover if co-existing conditions are causing the insomnia, or simply co-existing.  If co-existing, it is important to discover the cause of the insomnia and get that under control. 

Binhi VN. 2005.  Stochastic dynamics of magnetosomes and a mechanism of biological orientation in the geomagnetic field.  Bioelectromagnetics [Nov 10 Epub ahead of print].   Magnetosomes embedded in the cytoskeleton (skeletal structure of the cells) may be what allows migratory animals to orient themselves.  They are sensitive to the Earth’s magnetic field.  [The possibility of magnetosomes in cytoskeletons of those people electromagnetically sensitive or electromagnetically sensible exists. DJS]

Birch, S. 2003.  Trigger point–acupuncture point correlations revisited.  J Altern Complement Med 9(1):91-103.  Earlier research (Melzack et al 1977) claimed 71% correspondence of trigger points to traditional acupuncture points.  This study finds that result is “conceptually not possible,” and that there is no more than a 40% correlation and more likely 18% to 19% correlation between the two.  The author did find that another class of acupuncture points, “a she” points, had a very high correlation to trigger points.

Birch, S. and R. N. Jamison.  1998.  Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment.  Clin J Pain 14(3):248-55. 

Birdsall, T. C.  1998.  5-Hydroxytryptophan: a clinically-effective serotonin precursor.  Altern Med Rev 3(4):271-80.

Birkmayer W. and P. Riederer. 1989. Understanding the Neurotransmitters: Key to the Workings of the Brain. Translated from German by Karl Blau. NY: Springerer-Verlag.

Birketvedt, G. S. , J. Florholmen, J. Sundsfjord, B. Osterud, D. Dinges, W. Bilker and A. Stunkard. 1999. Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA 282(7):657-63.  

Birley T, Goebel A. 2014. Widespread pain in patients with complex regional pain syndrome. Pain Pract. 14(6):526-531. "In this systematic assessment of the incidence of widespread pain in a large cohort of patients with CRPS, important widespread pain affected >10% of patients. Our data support the inclusion of routine enquiries about additional pains in the clinical assessment of patients with CRPS."

Bisdorff A. 2014. Migraine and dizziness. Curr Opin Neurol. 27(1):105-110. "The further refinement and wider acceptance of the diagnostic entity of vestibular migraine is an important development as it is one the most common vestibular disorders. But the relationship between migraine and vestibular dysfunction is complex and has many aspects beyond vestibular migraine."

Bishnoi, A., H. E. Carlson, B. L. Gruber, L. D. Kaufman, J. L. Bock and K. Lidonnici. 1994. Effects of commonly prescribed nonsteroidal anti-inflammatory drugs on thyroid hormone measurements. Am J Med 96(3):235-8.

Bismil Q, Bismil M. 2013. Myofascial-entheseal dysfunction in chronic whiplash injury: an observational study. JRSM Short Rep. 3(8):57. "1025 consecutive patients with chronic whiplash with neck pain and reduced cervical spine range of motion and trapezius trigger points were seen in this large orthopedic practice seen during a 4-year period. They all had trapezius-associated enthesopathy. This observational paper proposes a change of the definition of chronic whiplash associated disorder to "a painful syndrome following acceleration-deceleration injury with neck stiffness; and myofascial-entheal dysfunction". [Dysfunction of the enthesis, or attachment area, can be a critical part of any injury involving the joint area. DJS]

Biurrun Manresa JA, Mørch CD, Andersen OK. 2010. Long-term facilitation of nociceptive withdrawal reflexes following low-frequency conditioning electrical stimulation: a new model for central sensitization in humans. Eur J Pain. [Jan 26 Epub ahead of print]. “Central sensitization is believed to be one of the key mechanisms behind chronic pain conditions, and several models have been developed in order to characterize this phenomenon in humans. One of these models relies on conditioning electrical stimulation to elicit long-lasting effects on the nociceptive system. The aim of this study was to evaluate these effects using an objective electrophysiological measurement, the nociceptive withdrawal reflex (NWR). Long-term changes in spinal nociception after high- and low-frequency conditioning electrical stimulation were assessed in 13 healthy volunteers…These findings suggest that activity-dependent central sensitization can be elicited using conditioning electrical stimulation with a stimulation frequency that lies within the physiological firing range of primary afferents, and that it can be objectively assessed in humans using the NWR.”  

Bjersing JL, Bokarewa MI, Mannerkorpi K. 2014. Profile of circulating microRNAs in fibromyalgia and their relation to symptom severity: an exploratory study. Rheumatol Int. [Sep 28 Epub ahead of print.] "To our knowledge, this is the first study of circulating microRNAs in FM. Levels of several microRNAs differed significantly in FM compared to healthy women. Three microRNAs were associated with pain or pain threshold in FM."

Bjornsdottir S, Jonsson S, Valdimarsdottir U. 2014. Mental health indicators and quality of life among individuals with musculoskeletal chronic pain: a nationwide study in Iceland. Scand J Rheumatol. 12:1-15. "Musculoskeletal chronic pain is a costly public health threat. The aim of our study was to investigate mental health indicators, including self-reported symptoms of depression, sleep disruption, stress, well-being, and quality of life (QoL), among men and women with musculoskeletal chronic pain in a general population…Our data indicate that individuals with musculoskeletal chronic pain have increased risk of poor mental health and diminished QoL. Further studies are needed on treatment and preventative measures of a decline in mental health among individuals with chronic pain."

Bjorntorp P. 2001. Do Stress reactions cause abdominal obesity and comorbidities?  Obes Rev 2(2):73-86. Long-term activation of the Hypothalamus-Pituitary Adrenal (HPA) Axis and sympathetic nervous system [commonly part of FMS DJS] may be the prelude to many serious illnesses.  This includes Metabolic Syndrome.  It is important to prevent and/or treat abnormal stress activation.  " is suggested that environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abnormal abdominal obesity with its associated comorbidities."

Bjorntorp, P., G. Holm and R. Rosamund. 1999. Hypothalamus arousal, insulin resistance and Type 2 diabetes mellitus. Diabet Med 16(5):373-83.

Bjurstrom MF, Giron SE, Griffis CA. 2014. Cerebrospinal Fluid Cytokines and Neurotrophic Factors in Human Chronic Pain Populations: A Comprehensive Review. Pain Pract. Oct 29. [Epub ahead of print] "Chronic pain is a prevalent and debilitating condition, conveying immense human burden. Suffering is caused not only by painful symptoms, but also through psychopathological and detrimental physical consequences, generating enormous societal costs. The current treatment armamentarium often fails to achieve satisfying pain relief; thus, research directed toward elucidating the complex pathophysiological mechanisms underlying chronic pain syndromes is imperative. Central neuroimmune activation and neuroinflammation have emerged as driving forces in the transition from acute to chronic pain, leading to central sensitization and decreased opioid efficacy, through processes in which glia have been highlighted as key contributors. Under normal conditions, glia exert a protective role, but in different pathological states, a deleterious role is evident-directly and indirectly modulating and enhancing pain transmission properties of neurons, and shaping synaptic plasticity in a dysfunctional manner. Cytokines and neurotrophic factors have been identified as pivotal mediators involved in neuroimmune activation pathways and cascades in various preclinical chronic pain models. Research confirming these findings in humans has so far been scarce, but this comprehensive review provides coherent data supporting the clear association of a mechanistic role of altered central cytokines and neurotrophic factors in a number of chronic pain states despite varying etiologies. Given the importance of these factors in neuropathic and inflammatory chronic pain states, prospective therapeutic strategies, and directions for future research in this emerging field, are outlined."

Black, D. W., B. N. Doebbeling, M. D. Voelker, W. R. Clarke, R. F. Woolson, D. H. Barrett and D. A. Schwartz.  1999.  Quality of life and health-services utilization in a population-based sample of military personnel reporting multiple chemical sensitivities.  J Occup Environ Med 41(10):928-33.

Black, K. M., P. McClure and M. Polansky.  1996.  The influence of different sitting positions on cervical and lumbar posture.  Spine 21(1):65-70.

Blackman, J. D., V. L. Towle, G. F. Lewis, J. P. Spire and K. S. Polonsky.  1990.  Hypoglycemic thresholds for cognitive dysfunction in humans.  Diabetes 39(7):828-835.  

Blacksher E. 2002.  On being poor and feeling poor: low socioeconomic status and the moral self. Theor Med Bioeth. 23(6):455-470.  “Persons of low socioeconomic status generally experience worse health and shorter lives than their better off counterparts.  They also suffer a greater incidence of adverse psychosocial characteristics, such as low self-esteem, self-efficacy, and self-mastery and increased cynicism and hostility.  Chronic socioeconomic deprivation can create environments that undermine the development of self and capacities constitutive to moral agency — i.e., the capacity for self-determination and crafting a life of one’s own.  This moral harm is particularly salient in modern Western societies, especially in the United States, where success and failure is attributed to the individual, with little notice of the larger social and political realities that inform an individual’s circumstances and choices.”

Blanco I, Beritze N, Arguelles M et al. 2010. Abnormal over expression of mastocytes in skin biopsies of fibromyalgia patients. Clin Rheumatol. [Apr 30 Epub ahead of print]. “Formalin-fixed, paraffin-embedded skin tissue sections were collected from a matched cohort of 63 fibromyalgia syndrome (FMS) patients and 49 volunteers from the general population with both alpha1-antitrypsin (AAT) normal and deficiency variants. These tissues were examined for the expression of the broad-spectrum inhibitor AAT, the serine proteinases elastase and tryptase, the proinflammatory cytokines MCP-1 and TNFalpha, the endothelium biomarker VEGF, and the inflammation/nociception-related receptor PAR(2). The most relevant finding of the study was a significantly increased number of mast cells (MCs) in the papillary dermis of all FMS patients (greater than or equal to five to 14 per microscopic high power field) compared to zero to one in controls (p < 0.001). MCs strongly stained with tryptase, AAT and PAR(2) antibodies, exhibited a spindle-like shape and were uniformly distributed around blood vessels and appendages. MCP-1 and VEGF expressed weak/moderate positivity in most samples, with a higher expression in controls than in FMS patients (p < 0.001 and 0.051, respectively). No differences in elastase and TNFalpha were found between both groups. Moreover, no histological differences were found between samples from AAT deficiency and normal AAT phenotypes. Our results indicate that FMS is a MC-associated condition. MCs are present in skin and mucosal surfaces throughout the human body, and are easily stimulated by a number of physical, psychological, and chemical triggers to degranulate, releasing several proinflammatory products which are able to generate nervous peripheral stimuli causing CNS hypersensitivity, local, and systemic symptoms. Our findings open new avenues of research on FMS mechanisms and will benefit the diagnosis of patients and the development of therapeutics.” [Other studies have indicated that the skin of fibromyalgia patients differs in collagen depositions, mast cell amounts,  and in other ways. Myofascial trigger point practitioners have indicated the special feel of “fibroskin” is unique.  Histamine is a neurotransmitter that can become imbalanced early in FM, and its overabundance can be a perpetuating factor for both FM and CMP and may be a key to some interactive conditions. DJS]


Blanco I, Janciauskiene S, Nita I et al. 2009.  Low plasma levels of monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha (TNFalpha), and vascular endothelial growth factor (VEGF) in patients with alpha1-antitrypsin deficiency-related fibromyalgia.  Clin Rheumatol. [Nov 19 Epub ahead of print]   This research found that the hypothesis of FM “…as an inflammatory condition related to high levels of inflammatory biomarkers cannot be supported.”

Blanco I, Arbesu D, Al Kassam D et al. 2006.  Alphal-antitrypsin polymorphism in fibromyalgia syndrome patients from the Asturias province in northern Spain: a significantly higher prevalence of the PI*Z deficiency allele in patients than in the general population.  J Musculoskel Pain 14(3):5-12.  A gene has been found that is twice as high in FMS patients as in this general population.  The gene is associated with AT, an anti-inflammatory substance, and may indicate that “ least a subset of FMS subjects could suffer from an inflammatory process, mediated by cytokines, proteases, and inflammation mediators normally inhibited by AT.”  [This study indicates that if there is a triggering event that causes inflammation in the extra cellular matrix and the patient lacks these anti-inflammatory modulators due to genetics, the central sensitization process of FMS could begin. DJS]

Blankenfield A. 2013. Kynurenine pathway pathologies: Do nicotinamide and other pathway co-factors have a therapeutic role in reduction of symptom severity, including chronic fatigue syndrome (CFS) and fibromyalgia (FM). Int J Tryptophan Res. 6(Suppl 1):39-45. "The up-regulation of the kynurenine pathway by physical illness can cause neuropathic and immunological disorders associated with secondary neuropsychiatric symptoms. Tryptophan and nicotinamide deficiencies fall within the protein energy malnutrition (PEM) spectrum. They can arise if the kynurenine pathway is stressed by primary or secondary inflammatory conditions and the consequent imbalance of available catabolic/anabolic substrates may adversely influence convalescent phase efficiency. The replacement of depleted or reduced NAD+ levels and other cofactors can perhaps improve the clinical management of these disorders. Chronic fatigue syndrome (CFS) and fibromyalgia (FM) appear to meet the criteria of a tryptophan-kynurenine pathway disorder with potential neuroimunological sequelae." [Actually, FM and CFS have been shown to be different conditions. A subset of FM patients does utilize the kynurenine alternative metabolic pathway, producing the neurotoxic quinolinic acid rather than serotonin. The release of this neurotoxin may be more causative of symptoms than what is here proposed. DJS]

Blashki G, McMichael T, Karoly DJ. 2007.  Climate change and primary health care. 36(12):986-989.  “Climate change has substantial potential health effects.  These include heat stress related to heat waves; injuries related to extreme weather events such as storms, fires and floods; infectious disease outbreaks due to changing patterns of mosquito borne and water borne diseases; poor nutrition from reduced food availability and affordability; the psychosocial impact of drought; and the displacement of communities.  Primary health care has an important role in preparing for and responding to these climate change related threats to human health.”  [Patients with weather-reactive health conditions should be environmental activists.  We are the canaries in the mines.  Sensitivity to pollution in all its forms has made us the first to be aware, but we will not be the last to be affected. DJS]

Blazquez A, Ruiz E, Aliste L et al. 2013. The impact of fatigue and fibromyalgia on sexual dysfunction in women with chronic fatigue syndrome. J Sex Marital Ther. [Nov 25 Epub ahead of print]. "Sexual dysfunction in patients with chronic fatigue syndrome (CFS) is attracting growing interest but has been analyzed by few studies to date. For this reason we evaluate sexual dysfunction in women with CFS (GRISS) and explore correlations with fatigue and other symptoms. Sexual dysfunction was greater in CFS patients… with a higher number of cognitive, neurological, and neurovegetative symptoms, concomitant fibromyalgia, Sjogren's syndrome, or myofascial pain syndrome, and more intense fatigue…."

Bliddal H, Danneskiold-Samsoe B. 2007.  Chronic widespread pain in the spectrum of rheumatological diseases.  Best Pract Res Clin Rheumatol. 21(3):391-402.  “Evidence points to central sensitization as an important neurophysiological aberration in the development of FMS.  Importantly, these neurological changes may result from inadequately treated chronic focal pain problems such as osteoarthritis or myofascial pain.”  “Fibromyalgia patients need recognition of their pain syndrome if they are to comply with treatment.  Lack of empathy and understanding by healthcare professionals often leads to patient frustration and inappropriate illness behavior, often associated with some exaggeration of symptoms in an effort to gain some legitimacy for their problem.”

Block C, Cianfrini L. 2013. Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia. NeuroRehabilitation. 33(2):343-366. "To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations."

Blom D, Thomaes S, Bijlsma JW et al. 2014. Embitterment in patients with a rheumatic disease after a disability pension examination: occurrence and potential determinants. Clin Exp Rheumatol. [Apr 7 Epub ahead of print.] "Our results suggest that, after a disability pension examination, embitterment is present in about one out of five patients with a rheumatic disease. This is problematic insofar as embitterment limits well-being, functioning, and the potential to reintegrate to work. To the extent that helplessness and invalidation at work are causal determinants of embitterment, interventions targeting these aspects may be key to reducing embitterment."

Blunz, K. L., M. H. Rajwani and R. C. Guerriero.  1997.  The effectiveness of chiropractic management of fibromyalgia patients: a pilot study.  J Manipulative Physiol Ther 20(6):389-399.

Blyth FM, March LM, Brnabic AJ et al. 2004. Chronic pain and frequent use of health care.  Pain 111(1-2):51-58.  “There was a strong association between pain-related disability and greater use of services.”

Bodes-Pardo G, Pecos-Martin D, Gallego-Izquierdo T et al. 2013. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. J Manipulative Physiol Ther. [July 8 Epub ahead of print]. Twenty patients. "The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors, PPT (pressure-pain threshold), and active CROM (cervical range of motion) in individuals with CeH (cervicogenic headache) showing active TrPs in this muscle. Studies including greater sample sizes and examining long-term effects are needed. "

Boehm A, Eisenberg E, Lampel S. 2010. The Contribution of Social Capital and Coping Strategies to Functioning and Quality of Life of Patients with Fibromyalgia. Clin J Pain. [Dec 20 Epub ahead of print]. "Bonding social capital, problem-solving coping strategies, and the duration of FM contribute positively to functioning and QoL (quality of life) of FM patients; whereas, emotional-focused coping strategies do the opposite. Further research to test the effects of strengthened social capital and enhanced problem-solving rather than emotion-focused coping strategies on functioning and QoL of FM patients is warranted."

Boelens OB, Scheltinga MR, Houterman S et al. 2012. Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome. Br J Surg. [Nov 23 Epub ahead of print]. "Entrapped branches of intercostal nerves may contribute to the clinical picture in some patients with chronic abdominal pain. Pain reduction following local infiltration in these patients was based on an anesthetic mechanism and not on a placebo or a mechanical (volume) effect."

Boelens OB, Scheltinga MR, Houterman S et al. 2011. Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients. Ann Surg. [Aug 30 Epub ahead of print]. "A regimen of consecutive local trigger point injections is effective in one-third of patients with ACNES (anterior cutaneous nerve entrapment syndrome). Surgical neurectomy is effective in about two-thirds of the injection regimen refractory patients. Eighty percent of the entire ACNES population reports total or substantial pain relief on the long term." [All too often, surgery is considered because the treating clinician does not know how to diagnose or treat trigger points. Much surgery can be prevented. DJS]

Boggero IA, Kniffin TC, de Leeuw R et al. 2014. Fatigue mediates the relationship between pain interference and distress in patients with persistent orofacial pain. J Oral Facial Pain Headache. 28(1):38-45. "These results suggest that interventions targeted specifically at fatigue symptoms may be helpful for reducing interference and improving quality of life in patients with persistent orofacial pain."

Bohme K. 2002.  Buprenorphine in a transdermal therapeutic system — a new option.  Clin Rheumatol 21 Suppl 1:S13-S16.  “Typical opioid-related adverse events were reported with a low incidence and mild intensity.  Clinical benefit, coupled with a high level of patient compliance and improved quality of life, substantiate the usefulness of buprenorphine TDS in a practical setting.”

Boisgontier MP, Olivier I, Chenu O et al. 2011. Presbypropria: the effects of physiological ageing on proprioceptive control. Age (Dordr). [Aug 18 Epub ahead of print]. "Results showed that proprioceptive control was as accurate and as consistent in older as in young adults for a single proprioceptive task. However, performing a secondary cognitive task and increasing the difficulty of this secondary task evidenced both a decreased matching performance and/or an increased attentional cost of proprioceptive control in older adults as compared to young ones. These results advocated for an impaired proprioception in physiological ageing." [This may be similar to what occurs due to TrPs in FM. The braion can only handle so much, and when confronted with multiple proprioceptive TrP dysfunction as well as the pain stimuli, cognitive dysfunction results. DJS]

Bokarewa MI, Erlandsson MC, Bjersing J et al. 2014. Smoking is associated with reduced leptin and neuropeptide Y levels and higher pain experience in patients with fibromyalgia. Mediators Inflamm. 2014:627041. "Smoking deregulates neuroendocrine responses to pain supporting production of neuropeptide Y (NpY) by direct stimulation of nicotinic receptors or by inhibiting adipokine leptin….This study shows that patients with FM have no increase of NpY levels in response to smoking despite the low levels of leptin. Deregulation of the balance between leptin and neuropeptide Y may be one of the essential mechanisms of chronic pain in FM."

Boldingh MI, Ljostad U, Mygland A et al. 2013. Comparison of interictal vestibular function in vestibular migraine vs. migraine without vertigo. Headache. [May 15 Epub ahead of print]. This study found vestibular abnormalities in all migraine patients tested.

Bolgla LA, Malone TR. 2004.  Plantar fasciitis and the Windlass Mechanism: A biochemical link to clinical practice.  J Alth Train 39(1):77-82.  “This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between conditions and their treatments.  [This article is relevant to and can be useful in the treatment of myofascial TrPs, and would have benefitted by their inclusion. DJS]

Bolton PS, Hammam E, Macefield VG. 2014. Neck proprioceptors contribute to the modulation of muscle sympathetic nerve activity to the lower limbs of humans. Exp Brain Res. 232(7):2263-2271. "These data suggest that dynamic, but not static, neck movements can modulate MSNA (muscle sympathetic nerve activity), presumably via projections of muscle spindle afferents to the vestibular nuclei, and may thus contribute to the regulation of blood pressure during orthostatic challenges." [Trigger points in the neck could be contributing to or causing the orthostatic hypotension often found in FM. DJS]

Bonadonna R.  Meditation’s impact on chronic illness.  Holistic Nurs Pract 17(6):309-319.  This article points out that more research needs to be done on the effect of living mindfully on chronic illness and urges the practice of meditation as part of treatment regimens.

Bongers, K. M., J. P. ter Bruggen and C. L. Franke.  1991. [The exploding head syndrome]. Ned Tijdschr Geneeskd 135(14):617-618. [Dutch] 

Bonifazi M, Lisa Suman A, Cambiaggi C et al. 2006.  Changes in salivary cortisol and corticosteroid receptor-alpha mRNA expression following a 3-week multidisciplinary treatment program in patients with fibromyalgia.  Psychoneuroendocrinology 31(9):1076-1086.   “One of the active mechanisms underlying the effects of our treatment is an improvement of HPA axis function, consisting in increased resiliency and sensitivity of the stress system probably related to stimulation of GR-alpha synthesis by the components of the treatment.”

Boninger M.L., Cooper R.A., Fitzgerald S.G. et al. 2003. Investigating neck pain in wheelchair users. Am J Phys Med Rehabil 82(3):197-202. Palpation for trigger points (TrPs) reproduced pain in 54% of the wheelchair user patients who had experienced recent neck pain.  Myofascial TrPs may be a significant contributor to neck pain in wheelchair users.  [Not only neck pain.  Janet Travell mentioned how much the wheelchair was “vexing” the TrPs in her legs, and indicated that the use of the chair, although she was generally able to get up and about for specific needs, could be a perpetuating factor for many TrPs.  DJS]

Bonneau, R. H., P. Mormede, G. P. Vogler, G. E. McClearn and B. C. Jones.  1998.  A genetic basis for neuroendocrine-immune interactions.  Brain Behav Immun 12(2):83-9.

Booth, F. W., S. E. Gordon, C. J. Carlson and M. T. Hamilton.  2000.  Waging war on modern chronic diseases: primary prevention though exercise biology.  J Appl Physiol 88(2):774-787.

Boquet J, Boismare F, Payenneville G et al. 1989.  Lateralization of headache: possible role of an upper cervical trigger point.  Cephalalgia. 9(1):15-24.  “An ipsilateral upper neck trigger point was found in 21 of 24 patients with unilateral headache.  During the prodromic period this trigger point was detected as a tender protrusion on neck palpation.  In 18 out of 24 patients it was also found during the headache-free period.  On standard roentgenogram, this protrusion seemed to be a laterally developed C2 spinous process.  The EMG study showed latest trapezius hypertonicity on the side of the headache, even during the headache-free period.  The association of the painful protrusion and trapezius hypertonicity could create an autoreinforcing nociceptive loop, which in turn could be the cause of lateralization of the pain.”

Borenstein, D. 1995. Prevalence and treatment outcome of primary and secondary fibromyalgia in patients with spinal pain. Spine. 20(7):796-800.

Borg-Stein J. 2006.  Treatment of fibromyalgia, myofascial pain, and related disorders.  Phys Med Rehabil Clin N Am. 17(2):491-510.  This is an overview of treatment considerations for these patients.

Borg-Stein J. 2002.  Cervical myofascial pain and headache. Curr Pain Headache Rep 6(4):324-30. Myofascial pain from trigger points is a treatable component or cause of many headaches.

Borg-Stein J. 2002. Management of peripheral pain generators in fibromyalgia. Rheum Dis Clin North Am 28(2):305-17. "Fibromyalgia is a widespread chronic pain disorder that is characterized in part by central sensitization and increased pain response to peripheral nociceptive and non-nociceptive stimuli.  Part of the comprehensive pain management of patients with fibromyalgia should include a thoughtful evaluation and search for peripheral pain generators that either are associated with fibromyalgia or are coincidentally present.  The identification and treatment of these pain generators lessens the total pain burden, facilitates rehabilitation and decreases the stimuli for ongoing central sensitization."

Borg-Stein J, Iaccarino MA. 2014. Myofascial Pain Syndrome Treatments. Phys Med Rehabil Clin N Am. 25(2):357-374. "Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms."

Borg-Stein, J. and Stein, J. 1996.  Trigger points and tender points.  Rheum Disease Clin North Am 22(2):305-22.

Borg-Stein J, Wilkins A. 2006.  Soft tissue determinants of low back pain.  Curr Pain Headache Rep. 10(5):339-344.  Low back pain patients are often incorrectly labeled.  It is important to recognize and treat the soft tissue cause of the low back pain.  These conditions may be found alone or in combination:  ligamentous, non ligamentous, discogenic and facet.  All contributing causes must be evaluated and treated.

Borman, P. and Celiker, R.  1999.  A comparative analysis of quality of life in rheumatoid arthritis and fibromyalgia.  J Musculoskeletal Pain 7(4).

Borman, P., R. Celiker and Z. Hascelik.  1999.  Muscle performance in fibromyalgia syndrome. Rhematol Int 19(1-2):27-30.

Borsbo B, Peolsson M, Gerdie B. 2009.  The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability.  Disabil Rehabil. 31(19):1605-1613.

Borsook D, Kussman BD, George E et al. 2012. Surgically Induced Neuropathic Pain: Understanding the Perioperative Process. Ann Surg. [Oct 10 Epub ahead of print]. "Nerve damage takes place during surgery. As a consequence, significant numbers (10%-40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in "peripheral and central sensitization," with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients, these initial events produce chemical, structural, and functional changes in the peripheral and central nervous systems (CNS). The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state-allodynia, sensory loss, shooting pains, etc, that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed "centralization of pain" and affect sensory, emotional, and other (e.g., cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (e.g., depression). Currently there are no objective measures of nociception and pain in the perioperative period. As such, intermittent or continuous pain may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition, appear to provide initial opportunities for decreasing the burden of SNPP, until treatments with high efficacy and low adverse effects that either prevent or treat pain are discovered."

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."

Bossema ER, Kool MB, Cornet D et al. 2011. Characteristics of suitable work from the perspective of patients with fibromyalgia. Rheumatology (Oxford). [Oct 22 Epub ahead of print]. "Our aim was to investigate the characteristics of suitable work from the perspective of patients with FM.... According to patients with FM, suitable work is paced in such a way that one can perform the job well and with satisfaction while keeping energy for home and free time and having acknowledgement and help from management and colleagues. The brief suitable work checklist that is provided can help patients with FM to negotiate with employers and job professionals to improve the match between job demands and capabilities. [FM is heterogeneous. Much of the ability to work specific jobs may depend on the severity of the FM, the perpetuating factors, and co-existing conditions (especially myofascial TrPs.) DJS]

Bote ME, García JJ, Hinchado MD et al. 2012. Inflammatory/Stress Feedback Dysregulation in Women with Fibromyalgia. Neuroimmunomodulation. 19(6):343-351. "Although one of the current hypotheses of the aetiology of fibromyalgia (FM) syndrome involves inflammatory and neuroendocrine disorders, its biophysiology still remains unclear. The purpose of the present investigation was to study the systemic inflammatory and stress responses, as well as the innate response mediated by monocytes and neutrophils in FM patients....FM patients showed an inflammatory state accompanied by an altered stress response....An inflammatory/stress feedback dysregulation underlies FM. Whether dysregulation of the stress response is the cause of the inflammatory dysregulation or vice versa is also discussed.

Botwin KP, Patel BC. 2007.  Electromyographically guided trigger point injections in the cervicothoracic musculature of obese patients: a new and unreported technique.  Pain Physician 10(6):753-756.  “This technique helps confirm proper needle placement within the cervicothoracic musculature in an obese patient in whom the musculature is not readily palpated.  This, thus, reduces the potential for a pneumothorax by an improperly placed injection.”

Bou-Holaigah, I., H. Calkins, J. A. Flynn, C. Tunin, H. C. Chang, J. S. Kan and P. C. Rowe. 1997.  Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia.  Clin Exp Rheumatol 15(3):239-246.

Bou-Holaigah, I., P. C. Rowe, J. Kan and H. Calkins.  1995. The relationship between neurally mediated hypotension and the chronic fatigue syndrome.  JAMA 274(12):961-967. 

Bouman EA, Theunissen M , Bons SA et al. 2013. Reduced Incidence of Chronic Postsurgical Pain after Epidural Analgesia for Abdominal Surgery. Pain Pract. [Jun 12 Epub ahead of print]. "Chronic postsurgical pain (CPSP) is a common complication of surgery with high impact on quality of life. Peripheral and central sensitization caused by enhanced and prolonged afferent nociceptive input are considered important mechanisms for the development of CPSP. This case-control study investigated whether epidural analgesia is associated with a reduced incidence of CPSP after open abdominal surgery….METHODS: Six months after surgery, Short-Form-36 Health Survey (SF-36) pain scores, possible predictors of chronic pain, and quality of life were assessed. Patients treated with epidural analgesia in combination with general anesthesia (epidural group, N = 51) were compared to patients undergoing matched surgical procedures receiving general anesthesia alone….Patients with CPSP reported a significantly lower quality of life compared to patients without CPSP….Chronic postsurgical pain occurs in a significant number of patients 6 months after open abdominal surgery. Postoperative epidural analgesia is associated with a reduced incidence of CPSP after abdominal surgery."

Bourdette DN, McCauley LA, Barkhuizen A, Johnston W, Wynn M, Joos SK, Storzbach D, Shuell T, Sticker D. 2001. Symptom factor analysis, clinical findings, and functional status in a population-based case control study of Gulf War unexplained illness. J Occup Environ Med Dec;43(12):1026-40.  More than half of the veterans with unexplained musculoskeletal pain met the criteria for fibromyalgia. Many with unexplained fatigue met the criteria for chronic fatigue syndrome.

Bourke J. 2015. Fibromyalgia and chronic fatigue syndrome: management issues. Adv Psychosom Med. 34:78-91. "Fibromyalgia and chronic fatigue syndrome represent two of the most commonly encountered functional somatic syndromes in clinical practice. Both have been contentious diagnoses in the past, and this diagnostic dispute has resulted in a therapeutic nihilism that has been of great detriment to their management and to alleviation of the intense suffering and disability that they have caused their innumerable sufferers. A new age has dawned in terms of a better understanding of these syndromes' physiology and improved approaches to their management. Here, the diagnosis and management of these closely related disorders are discussed, with particular reference to the recent empirical evidence that has come to light as a consequence of neurophysiological insights and robustly designed randomized clinical trials. Much work remains to be done in this vein, but we are better placed to facilitate recovery from these disorders than we have been previously. Whilst remission should always be a goal, complete symptom resolution is not the norm, but 'moderate' improvements are certainly attainable with appropriate management."

Bovaira M, Penarrocha M, Penarrocha M. et al. 2012. Radiofrequency treatment of cervicogenic headache. Med Oral Patol Cir Bucal. [Dec 10 Epub ahead of print]. This study revealed three areas of severe facial pain originating in other locations: one each in cervical roots C2 and C3 and one from an atlantoaxial joint level trigger point.  They were all treated with pulsed radiofrequency The first two patients had 30-50% relief versus baseline after one year, the third had complete pain relief for 5 months, after which the pain returned. [Nothing was done to correct the perpetuating factors. DJS]

Bowyer, S. L. and J. R. Hollister.  1984.  Limb pain in childhood.  Pediatr Clin North Am 31(5):1053-1081.

Boychuk DG, Goddard G, Mauro G et al. 2015. The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. J Oral Facial Pain Headache. 29(1):7-14. "Cannabis-based medicinal extracts used in different populations of chronic nonmalignant neuropathic pain patients may provide effective analgesia in conditions that are refractory to other treatments. Further high-quality studies are needed to assess the impact of the duration of the treatment as well as the best form of drug delivery."

Boyer N, Dallel R, Artola A et al. 2014. General trigeminospinal central sensitization and impaired descending pain inhibitory controls contribute to migraine progression. Pain. [Mar 12 Epub ahead of print.] "Migraine is a chronic disease with episodic manifestations. In a subgroup, attack frequency increases over time, leading to chronic migraine. One of the most important risk factors for migraine progression is frequency of headache attacks at baseline…. We investigated the behavioral, anatomical, and electrophysiological changes induced by repeated low- and high-intensity stimulation of meningeal nociceptor by injecting an inflammatory soup in rats. Single high-intensity, but not low-intensity, stimulation produces a reversible cephalic allodynia. Upon repetition, however, low-intensity stimulation, too, induces a reversible cephalic allodynia, and high-intensity, reversible cephalic and extracephalic allodynia. Moreover, cephalic allodynia becomes, in part, persistent upon repeated high-intensity stimulation. Fos expression reveals that a single high-intensity stimulation already leads to widespread, trigeminal, and spinal central sensitization, and that such general central sensitization potentiates upon repetition. Trigeminovascular nociceptive neurons become persistently sensitized and their diffuse noxious inhibitory controls (DNIC) concomitantly impaired. Thus, compared with single stimulation, repeated dural nociceptor activation specifically leads to: 1) a gradual worsening of cutaneous hypersensitivity and general neuronal hyperexcitability and 2) spreading of cutaneous hypersensitivity superimposed on 3) persistent cephalic cutaneous hypersensitivity and trigeminal central sensitization. Such repetition-induced development of central sensitization and its consequence, cutaneous allodynia, may arise from both the general neuronal hyperexcitability that results from DNIC impairment and hyperexcitability that likely develops in trigeminal nociceptive neurons in response to their repetitive activation. These neuronal changes may in turn elevate the risk for developing chronic migraine."

Boyum, A., P. Wiik, E. Gustavsson, O. P. Veiby, J. Reseland, A. H. Haugen and P. K. Opstad. 1996. The effect of strenuous exercise, calorie deficiency and sleep deprivation on white blood cells, plasma immunoglobulins and cytokines.  Scand J Immunol 43(2):228-235.

Bradesi S. 2010. Role of spinal cord glia in the central processing of peripheral pain perception. Neurogastroenterol Motil. [Mar 16 Epub ahead of print]. “The discovery that glial activation plays a critical role in the modulation of neuronal functions and affects the spinal processing of nociceptive signaling has brought new understanding on the mechanisms underlying central sensitization involved in chronic pain facilitation. Spinal glial activation is now considered an important component in the development and maintenance of allodynia and hyperalgesia in various models of chronic pain, including neuropathic pain and pain associated with peripheral inflammation. In addition, spinal glial activation is also involved in some forms of visceral hyperalgesia….We discuss the signaling pathways engaged in central glial activation, including stress pathways, and the neuron-glia bidirectional relationships involved in the modulation of synaptic activity and pain facilitation. In this expanding field of research, the characterization of the mechanisms by which glia affect spinal neuro-transmission will increase our understanding of central pain facilitation, and has the potential for the development of new therapeutic agents for common chronic pain conditions.”  [Now all we need to do is have the energy and funds now directed at neuron research to be directed to glial research. Then we may have a better chance to find specific ways to neutralize central sensitization.  DJS]

Bradley LA, McKendree-Smith NL.  Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches.  Curr Opin Rheumatol Jan;14(1):45-51,2002.  The neuromatrix is a construct that helps in understanding the interaction between physiologic mechanisms and psychosocial factors in the development and maintenance of chronic pain. The efficacy of cognitive-behavioral interventions for patients with fibromyalgia has not been established.  Cognitive-behavior therapy will benefit some patients but not others.

Bradley, LA, A. Sotolongo, KR Alberts, G. S. Alarcon, J. M. Mountz, H-G Liu, et al. 1999. Abnormal regional cerebral blood flow in the caudate nucleus among fibromyalgia patients and non-patients os associated with insidious symptom onset. J Musculoskel Pain 7(1-2):285-292. 

Bradley, L. A. and K. R. Alberts. 1998. Psychological and behavioral approaches to pain management for patients with rheumatic disease.  Rheum Dis Clin North Am 25(1):215-32, viii. 

Brady, C., D. Taylor and M. O'Brien. 1993. Whiplash and temporomandibular joint dysfunction. J Ir Dent Assoc 39(3):69-72. 

Brady S, McEvoy J, Dommerholt J et al. 2014. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther. 22(3):134-140. "Trigger point dry needling (TrP-DN) is commonly used to treat persons with myofascial pain, but no studies currently exist investigating its safety. The aim of this study was to determine the incidence of Adverse Events (AEs) associated with the use of TrP-DN by a sample of physiotherapists in Ireland….A prospective survey was undertaken consisting of two forms recording mild and significant AEs. Physiotherapists who had completed TrP-DN training with the David G Simons Academy (DGSA) were eligible to take part in the study. Data were collected over a ten-month period….In the study, 39 physiotherapists participated and 1463 (19.18%) mild AEs were reported in 7629 treatments with TrP-DN. No significant AEs were reported giving an estimated upper risk rate for significant AEs of less than or equal to 0.04%. Common AEs included bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19%). Uncommon AEs were aggravation of symptoms (0.88%), drowsiness (0.26%), headache (0.14%), and nausea (0.13%). Rare AEs were fatigue (0.04%), altered emotions (0.04%), shaking, itching, claustrophobia, and numbness, all 0.01%....While mild AEs were very commonly reported in this study of TrP-DN, no significant AEs occurred. For the physiotherapists surveyed, TrP-DN appeared to be a safe treatment."

Brage S, Ihlebaek C, Natvig B et al. 2010. [Musculoskeletal disorders as causes of sick leave and disability benefits] Tidsskr Nor Laegeforen. 130(23):2369-2370. [Norwegian] "Of the musculoskeletal disorders, low back conditions are the most frequent causes of sick leave and disability benefits, and account for 11 and 9% respectively. Neck and shoulder disorders are also common causes of sick leave, while osteoarthritis and fibromyalgia are common causes of disability benefits and each account for 5% of all new cases….The labor and welfare administration should continue to focus on musculoskeletal disorders to prevent long-term sick leave and permanent absence from work."

Brainard GC, Hanifin JP. 2005.  Photons, clocks and consciousness.  J Biol Rhythms 20(4):314-325.  “Light profoundly impacts human consciousness through the stimulation of the visual system and powerfully regulates the human circadian system, which, in turn, has a broad regulatory impact on virtually all tissues in the body.”  This includes the neuroendocrine system.   The use of specific wavelength light at specific times of the day may be very helpful in resetting biological clocks.

Branco, J., A. Atalaia and T. Paiva. 1994.  Sleep cycles and alpha-delta sleep in fibromyalgia syndrome. J Rheumatol 21(6):1113-1117.

Branco, J. C. , V. Tavares, I. Abreu and R. L. Humbel.  1994. [Viral infection and fibromyalgia.] J Rheumatol 7(6):337-341. [Portugese]

Brand-Miller, J. C. and S. Colagiuri.  1999.  Evolutionary aspects of diet and insulin resistance. World Rev Nutr Diet Basel, Karger.  84:74-105.

Brandenburg JE, Eby SF, Song P et al. 2014. Ultrasound Elastography: The New Frontier in Direct Measurement of Muscle Stiffness. Arch Phys Med Rehabil. [Jul 23 Epub ahead of print.] "The use of brightness-mode ultrasound and Doppler ultrasound in physical medicine and rehabilitation has increased dramatically. The continuing evolution of ultrasound technology has also produced ultrasound elastography, a cutting-edge technology that can directly measure the mechanical properties of tissue, including muscle stiffness. Its real-time and direct measurements of muscle stiffness can aid the diagnosis and rehabilitation of acute musculoskeletal injuries and chronic myofascial pain. It can also help monitor outcomes of interventions affecting muscle in neuromuscular and musculoskeletal diseases, and it can better inform the functional prognosis. This technology has implications for even broader use of ultrasound in physical medicine and rehabilitation practice, but more knowledge about its uses and limitations is essential to its appropriate clinical implementation. In this review, we describe different ultrasound elastography techniques for studying muscle stiffness, including strain elastography, acoustic radiation force impulse imaging, and shear-wave elastography. We discuss the basic principles of these techniques, including the strengths and limitations of their measurement capabilities. We review the current muscle research, discuss physiatric clinical applications of these techniques, and note directions for future research." This is from the Mayo Clinic.

Brattberg, G.  1999.  Connective tissue massage in the treatment of fibromyalgia.  Eur J Pain 3(3):235-244.

Brault JR, Siegmund GP, Wheeler JB. 2000.  Cervical muscle response during whiplash: evidence of a lengthening muscle contraction.  Clin Biomech 15(6):426-435.  “The cervical muscles contract rapidly in response to impact and the potential exists for muscle injury due to lengthening contractions.  The clinician should recognize the role of cervical retraction in the mechanism of whiplash injury and avoid aggressive motion in that plane during diagnosis and treatment.”

Brault, J. R., G. P. Siegmund and J. B. Wheeler.  2000.  Cervical muscle response during whiplash: evidence of a lengthening muscle contraction.  Clin Biomech (Bristol, Avon) 15(6):426-435.

Braus DF. 2004.  [Neurobiology of learning – the basis of an alteration process.] 31 (Suppl 2):215-223. [German] “...there is now increasing evidence that the plasticity of the human brain, i.e. its remarkable ability to adapt to and change with experience, is, under normal conditions, a lifelong phenomenon.”  “The capability to modify the biochemistry of synapses as well as the growth and change in terms of rewiring of synapses, dendritic branching and glial cell proliferation via the dialogue of synapses and genes, results in specific changes in neuronal connectivity and function.”  “...neurotransmitter systems modulate neuronal plasticity on the neuronal level; on the behavioral level they influence affect, emotion, positive motivation and the correct evaluation of environmental stimuli.  Experience, action as well as learning and memory are influenced by these systems.”  [Superb paper with great significance in FMS. DJS]

Bravo D, Ibarra P, Retamal J. 2014. Pannexin 1: A novel participant in neuropathic pain signaling in the rat spinal cord. Pain. [Aug 4 Epub ahead of print.] "Pannexin 1 (panx1) is a large-pore membrane channel expressed in many tissues of mammals, including neurons and glial cells. Panx1 channels are highly permeable to calcium and adenosine triphosphatase (ATP); on the other hand, they can be opened by ATP and glutamate, two crucial molecules for acute and chronic pain signaling in the spinal cord dorsal horn, thus suggesting that panx1 could be a key component for the generation of central sensitization during persistent pain. In this study, we examined the effect of three panx1 blockers, namely, 10panx peptide, carbenoxolone, and probenecid, on C-reflex wind-up activity and mechanical nociceptive behavior in a spared nerve injury neuropathic rat model involving sural nerve transection. In addition, the expression of panx1 protein in the dorsal horn of the ipsilateral lumbar spinal cord was measured in sural nerve-transected and sham-operated control rats. Sural nerve transection resulted in a lower threshold for C-reflex activation by electric stimulation of the injured hindpaw, together with persistent mechanical hypersensitivity to pressure stimuli applied to the paw. Intrathecal administration of the panx1 blockers significantly depressed the spinal C-reflex wind-up activity in both neuropathic and sham control rats, and decreased mechanical hyperalgesia in neuropathic rats without affecting the nociceptive threshold in sham animals. Western blotting showed that panx1 was similarly expressed in the dorsal horn of lumbar spinal cord from neuropathic and sham rats. The present results constitute the first evidence that panx1 channels play a significant role in the mechanisms underlying central sensitization in neuropathic pain."

Bravo JF. 2009. [Ehlers-Danlos syndrome, with special emphasis in the joint hypermobility syndrome]. Rev Med Chil. 137(11):1488-1497. [Spanish] “There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome (JHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research.”

Braz AS, Morais LC, Paula AP et al. 2013. Effects of Panax ginseng extract in patients with fibromyalgia: a 12-week, randomized, double-blind, placebo-controlled trial. Rev Bras Psiquiatr. 35(1):21-28. "The purpose of the study was to evaluate the efficacy of an extract of Panax ginseng in patients with fibromyalgia. A randomized, double-blind, controlled clinical trial was carried out over 12 weeks to compare the effects of P. ginseng (100 mg/d) with amitriptyline (25 mg/d) and placebo in 38 patients with fibromyalgia…. The beneficial effects experienced by patients for all parameters suggest a need for further studies to be performed on the tolerability and efficacy of this phytotherapic as a complementary therapy for fibromyalgia."

Breau, L. M., P. J. McGrath and L. H. Ju.  1999.  Review of juvenile primary fibromyalgia and chronic fatigue syndrome.  J Dev Behav Pediatr 20(4):278-88. 

Brecher LS, Cymet TC.  A practical approach to fibromyalgia. 2001.  J Am Osteopath Assoc (4 Suppl Pt 2):S12-7. "The term fibromyalgia refers to a collection of symptoms with no clear physiologic cause, but the symptoms together constitute a clearly recognizable and distinct pathologic entity.  Diagnostic criteria serve as guidelines for diagnosis, not as absolute requirements.  Treatment of fibromyalgia, which is an ongoing process, remains individualized.  It is goal-oriented, directed at helping patients get restorative sleep, alleviating the somatic pains, keeping patients productive, and regulating schedules.  Because fibromyalgia is chronic and may affect all areas of an individual's functioning, the physician needs to also evaluate the social support systems of patients with fibromyalgia."

Brenne, E., K. van der Hagen, E. Maehlum and S. Husebo.   1997. [Treatment of chronic pain with amitriptyline.  A double-blind dosage study with determination of serum levels].  Tidsskr Nor Laegeforen 117(24):3491-3494 [Norwegian].

Brietzke, S. E., Mair, E. A. 2001.  Injection snoreplasty: how to treat snoring without all the pain and expense.  Otolaryngol Head Neck Surg 124(5):503-10.  Injection of a sclerotherapy agent, Sotradecol, into the soft palate, reduces or eliminates palatal flutter snoring.  It is a simple, safe and effective office treatment for primary snoring.

Briley M. 2003.  New hope in the treatment of painful symptoms in depression.  Curr Opin Investig Drugs 4(1):42-45.  “Recent, principally open, trials with members of the new select serotonin and norepinephrine reuptake inhibitor class of antidepressants such as venlafaxine, milnacipran and duloxetine...suggest that these compounds may be effective in relieving pain both associated with, and independent of, depression.”

Brisby H. 2006.  Pathology and possible mechanisms of nervous system response to disc degeneration.  J Bone Joint Surg Am. 88 Suppl 2:68-71.  “Disc deterioration and/or degeneration may influence the nervous system by stimulation of nociceptors in the anulus fibrosus, causing nociceptive pain that is often referred to as discogenic pain.  The stimulation of the nociceptors may be of mechanical or inflammatory origin.  Deterioration of a disc with loss of normal structure and weight-bearing properties may lead to abnormal motions that cause mechanical stimulation.”  “A large number of inflammatory and signaling substances, such as tumor necrosis factor and interleukins (interleukin-1beta, interleukin-6, and interleukin-8) may also play a role in the development of back pain.  Independent of stimulus of the nociceptors, the pain impulses are conducted through myelinated A delta fibers and unmyelinated C fibers to the dorsal root ganglion and continue by way of the spinothalamic tract to the thalamus and the somatosensory cortex.”  “Disc deterioration also influences other spinal structures, such as facet joints, ligaments, and muscles, which can also become pain generators.  Thus, disc degeneration may be responsible for the development of chronic low-back pain without being the actual pain focus.”  “The altered magnitude of perceived pain is often referred to as neural plasticity and is considered to play a critical role in the evolution of chronic pain.”

Brisby H. 2006.  Pathology and possible mechanisms of nervous system response to disc degeneration.  J Bone Joint Surg Am. 88 Suppl 2:68-71.  “Deterioration of a disc with loss of normal structure and weight-bearing properties may lead to abnormal motions that cause mechanical stimulation.  This theory is supported by the fact that patients commonly experience an increase in pain with weight-bearing and certain movements.”  “A large number of inflammatory and signaling substances, such as tumor necrosis factor and interleukins (interleukin-1beta, interleukin-6, and interleukin-8), may also play a role in the development of back pain.”  “Disc deterioration also influences other spinal structures, such as facet joints, ligaments, and muscles, which can also become pain generators.  Thus, disc degeneration may be responsible for the development of chronic low-back pain without being the actual pain focus.  Both nociceptive and neuropathic pain can be modulated at higher centers, both at the spinal and the supraspinal levels (central sensitization).  The altered magnitude of perceived pain is often referred to as neural plasticity and is considered to play a critical role in the evolution of chronic pain.”

Brockow T, Wagner A, Franke A et al. 2007.  A randomized controlled trial on the effectiveness of mild water-filtered near infrared whole-body hyperthermia as an adjunct to a standard multimodal rehabilitation in the treatment of fibromyalgia.  Clin J Pain. 23(1):67-75.  “The study indicates that NI-WBH (whole body hyperthermia) is a worthwhile adjunct to MR (multimodal rehabilitation) in the treatment of FM.”  [It would be useful to compare the efficacy of this type of hyperthermia with a warm water bath of the same temperature. DJS]

Broderick JE, Gold MS, Amin MM et al. 2014. The association of somatic arousal with the symptoms of upper airway resistance syndrome. Sleep Med. [Feb 15 Epub ahead of print.] "We tested the hypothesis that the symptoms of upper airway resistance syndrome (UARS) are manifestations of chronic stress. …Our findings suggest that UARS patients have increased levels of the stress component, somatic arousal, proportionate to the severity of their symptoms."

Broderick JE, Junghaenel DU, Turk DC. 2004.  Stability of patient adaptation classifications on the multidimensional pain inventory. Pain 109(1-2):94-102. “The implications of this study is that for a sizable number of chronic pain patients, MPI classifications may not be stable, trait-like characterizations.” [This agrees with my observation in the 2nd edition Survival Manual. Chronic pain can often cause patients to answer in a way that may indicate antisocial or other psychological characteristics in a healthy person. For example, you often leave a party early because you are in pain, not because you want to avoid contact.]

Brodin P, Jojic V, Gao T et al. 2015.Variation in the human immune system is largely driven by non-heritable influences. Cell 160(1-2):37-47. The environment may affect the immune system response more than genetic influences. This effect grows stronger as we age. This study was done on healthy twins, but the results may be even more important to those with inherited autoimmune disorders. There is a brief article more understandable to the lay person in Science News, February 21, 2015, page 9. "Environment steers the immune system", by Tina Hesman Saey. (This highlights the importance of perpetuating factors that we can change. DJS)

Broekmans S, Dobbels F, Milisen K et al. 2009.  Medication adherence in patients with chronic non-malignant pain: is there a problem?  Eur J Pain 13(2):115-123.

Broide, R. S. and F. M. Leslie.  1999.  The alpha 7 nicotinic acetylcholine receptor in neuronal plasticity.  Mol Neurobiol 20(1):1-16. 

Bromberg MH, Schechter NL, Nurko S et al. 2014. Persistent pain in chronically ill children without detectable disease activity. Pain Manag. 4(3):211-219. "Children with organic diseases may experience persistent pain in the presence of controlled disease, as evidenced by little or no measurable disease activity or inflammation. Historically, dualistic definitions of pain have informed standard diagnostic approaches to persistent pain; aggressive investigation and treatment targeting underlying disease, even in the absence of evidence indicating disease escalation. Evidence across disease populations, in children with inflammatory bowel disease, sickle cell disease, and juvenile idiopathic arthritis indicates that persistent pain in these conditions may be better conceptualized as functional in nature, potentially resulting from disordered somatosensory processing including central sensitization. Applying a biopsychosocial understanding of persistent pain and multidisciplinary functional pain management strategies may lead to improved health outcomes."

Bron C, de Gast A, Dommerholt J et al. 2011. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Jan 24;9:8. A 12-week trial of weekly manual trigger point compression, manual stretching, and intermittent cold with stretching in addition to home muscle stretching, relaxation exercises and ergonomic and postural correction reduced symptoms and improved function for patients with chronic shoulder pain.

Bron C, Dommerholt J. 2012. Etiology of myofascial trigger points. Curr Pain Rep. 16(5):439-444. "Myofascial pain syndrome (MPS) is described as the sensory, motor, and autonomic symptoms caused by myofascial trigger points (TrPs). Knowing the potential causes of TrPs is important to prevent their development and recurrence, but also to inactivate and eliminate existing TrPs. There is general agreement that muscle overuse or direct trauma to the muscle can lead to the development of TrPs. Muscle overload is hypothesized to be the result of sustained or repetitive low-level muscle contractions, eccentric muscle contractions, and maximal or submaximal concentric muscle contractions. TrPs may develop during occupational, recreational, or sports activities when muscle use exceeds muscle capacity and normal recovery is disturbed." Trigger points are common in athletes, and anyone subjected to restrictions of blood flow to the muscle in which they develop. The lack of blood flow leads to a lowered pH and release of pro-inflammatory biochemicals. There is still disagreement if overuse mechanisms or chronic pain are the initiating factor.

Bron C, Dommerholt JD. 2012. Etiology of Myofascial Trigger Points. Curr Pain Headache Rep. [Jul 27 Epub ahead of print]. "Myofascial pain syndrome (MPS) is described as the sensory, motor, and autonomic symptoms caused by myofascial trigger points (TrPs). Knowing the potential causes of TrPs is important to prevent their development and recurrence, but also to inactivate and eliminate existing TrPs. There is general agreement that muscle overuse or direct trauma to the muscle can lead to the development of TrPs. Muscle overload is hypothesized to be the result of sustained or repetitive low-level muscle contractions, eccentric muscle contractions, and maximal or submaximal concentric muscle contractions. TrPs may develop during occupational, recreational, or sports activities when muscle use exceeds muscle capacity and normal recovery is disturbed."

Bron C, Dommerholt J, Stegenga B et al. 2011. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskel Disord. 12:139. If patients have chronic non-traumatic shoulder pain, it is likely that they have active and latent myofascial trigger points.

Brooks JC, Kong Y, Lee MC et al. 2012. Stimulus Site and Modality Dependence of Functional Activity within the Human Spinal Cord. J Neurosci. 32(18):6231-6239. "We have investigated the functional response in the cervical spinal cord of 18 healthy human subjects (aged 22-40 years) to noxious thermal and non-noxious tactile stimulation of the left and right forearms. Physiological noise, which is a significant source of signal variability in the spinal cord, was accounted for in the general linear model….Nonpainful punctate stimulation of the thenar eminence provoked more diffuse activity but was still ipsilateral to the side of stimulation. These results present the first noninvasive evidence for a lateralized response to noxious and non-noxious stimuli in the human spinal cord. The development of these techniques opens the path to understanding, at a subject-specific level, central sensitization processes that contribute to chronic pain states.

Brown, C. S., N. Parker, F. Ling and J. Wan.  2000.  Effects of magnets on chronic pelvic pain. Obstet Gynecol 95(4 Suppl 1):S29. 

Brown, C. R.  1996.  Pain management NICO.  The Implant Report 8(9):916.

Brown MM, Jason LA. 2007.  Functioning in individuals with chronic fatigue syndrome: increased impairment with co-occurring multiple chemical sensitivity and fibromyalgia.  Dyn Med. 6(1):6.  “…having more than one illness exacerbates one’s disability beyond CFS alone.”


Brown SL, Duggiraia HJ, Pennello G. 2002. An Association of Silicone-gel Breast Implant Rupture and Fibromyalgia.  Curr Rheumatol Rep 4(4):293-8. "Silicone-gel breast implant rupture is common.  Silicone-gel from ruptured implants may escape the scar capsule that forms around breast implants and become 'extracapsular silicone'.  Our previously published study found that women with extracapsular silicone-gel were at higher risk of reporting that they were diagnosed with fibromyalgia."

Bruce, E. 1995 Myofascial pain syndrome: early recognition and comprehensive management. AAOHN  J 43(9):469-474. 

Bruehl S, Chung OY. 2004.  Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain.  Neurosci Biobehav Rev. 28(4):395-414.  Theoretical possibilities and clinical implications are discussed in this article.

Bruehl S, Chung OY, Ward P et al. 2004. Endogenous opioids and chronic pain intensity: interactions with level of disability.  Clin J Pain 20(5):283-292.  Among more disabled chronic pain patients, endogenous opioid system dysfunction may contribute to hyperalgesia.  Among less disabled patients, chronic pain itself may initiate central sensitization.  [Even chronic pain from TrPs. DJS]

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.]

Brummett CM, Urquhart AG, Hassett AL et al. 2015. Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Arthritis Rheumatol. [Mar 13 Epub ahead of print.] "The fibromyalgia survey score was a robust predictor of poorer arthroplasty outcomes, even among individuals who fell well below the threshold for the categorical diagnosis of fibromyalgia."

Brunner E.J., Hemingway H., Walker B.R. et al. 2002. Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: nested case-control study. Circulation 106(21):2659-65. “Neuroendocrine stress axes are activated in MS [Metabolic Syndrome].  There is relative cardiac sympathetic predominance.  The neuroendocrine changes may be reversible.  This case-control study provides the first evidence that chronic stress may be a cause of MS.”

Bruno A, Mico U, Lorusso S et al. 2013. Agomelatine in the treatment of fibromyalgia: a 12-week, open-label, uncontrolled preliminary study J Clin Psychopharmacol. 33(4):507-511. Agomelatine was given to women with FM who were not on any other medications. The patients' pain, depression, and anxiety improved. [These patients were not assessed for coexisting trigger points. DJS]

Bruno, R. L.  1998. Abnormal movements in sleep as a post-polio sequelae.  Am J Phys Med Rehabil 77(4):339-43.

Bruno, R. L., S. J. Creange and N. M. Frick.  1998.  Parallels between post-polio fatigue and chronic fatigue syndrome: a common pathophysiology?  Am J Med 105(3A):66S-73S.  

Brunson KL, Kramar E, Lin B et al. 2005.  Mechanisms of late-onset cognitive decline after early-life stress.  Jour of Neuro. 25(41):9328-9338.  “A short period of stress early in life can lead to delayed, progressive impairments of synaptic and behavioral measures of hippocampal function, with potential implications to the basis of age-related cognitive disorders in humans.”  [This may explain at least part of why some of a subset of FMS patients have greater cognitive impairment when they reach middle age.  This may be very significant, and an initiating factor that can be prevented. DJS]

Bryant, R. A. and A. G. Harvey.  1999.  Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury.  J Nerv Ment Dis 187(5):302-5.

Buchgreitz L, Lyngberg AC, Bendtsen L et al. 2007.  Increased pain sensitivity is not a risk factor but a consequence of frequent headache: a population-based follow-up study.  Pain. [Nov 29 Epub ahead of print].  “…increased pain sensitivity is a consequence of frequent tension-type headache, not a risk factor, and support that central sensitization plays an important role or the chronification of tension-type headache.”

Buchgreitz L, Lyngberg A, Bendtsen L et al. 2007.  Increased prevalence of tension-type headache over a 12-year period is related to increased pain sensitivity.  A population study.  Cephalalgia. 27(2):145-152.  Tension-type headache in women may be one cause of central sensitization.

Buchmann J, Neustadt B, Buchmann-Barthel K et al. 2014. Objective measurement of tissue tension in myofascial trigger point areas before and during the administration of anesthesia with complete blocking of neuromuscular transmission Clin J Pain. 2014 Mar;30(3):191-8. "An increased muscle tension in MTPs, and not a primary local inflammation with enhanced viscoelasticity, was the main result of our investigation. We interpret this increased muscular tension in the taut band with an MTP as increased spinal segmental excitability. In line with this, we assume a predominant, but not unique, impact of increased spinal excitability resulting in an augmented tension of segmental-associated muscle fibers for the etiology of MTP." [This study found that it was not local inflammation, but rather increased muscle tension, that is associated with the irritation of trigger points.]

Buchner RL, Snyder AZ, Shannon BJ et al. 2005.  Molecular, structural, and functional characterization of Alzheimer’s Disease; Evidence for a relationship between default activity, amyloid, and memory.  J Neurosci 25(34):7709-7717.  Chronically activated areas of the brain produce more amyloid beta.  That is the substance implicated in Alzheimer’s.  [What this means for patients with FMS who have rapid-fire synapses, if anything, remains to be seen, but it is an area of research to watch. DJS]

Buckalew N, Haut MW, Aizenstein H et al. 2010. Differences in brain structure and function in older adults with self-reported disabling and non-disabling chronic low back pain. Pain Med. 11(8):1183-1197. "Brain structure and function is different in older adults with disabling CLBP compared with those with non-disabling CLBP. Deficits in brain morphology combining groups are associated with pain duration and poor physical function. Our findings suggest brain structure and function may play a key role in chronic pain related disability and may be important treatment targets."

Buckelew, S. P., R. Conway, J. Parker, W. E. Deuser, J. Read, T. E. Witty, J. E. Hewett, M.  Minor, J. C. Johnson, L. Van Male, M. J. McIntosh, M. Nigh and D. R. Kay.  1998.  Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res 11(3);196-209.

Buckwalter, J. A. and N. E. Lane.  1997.  Athletics and osteoarthritis.  Am J Sports Med 25(6): 873-81.  

Bueno, L., J. Fioramonti, M. Delvaux and J. Frexinos.  1997.  Mediators and pharmacology of visceral sensitivity: from basic to clinical investigations.  Gastroenterology 112(5):1714-1743.

Bugajski, J., A. Gadek-Michalska, A. Olowska, J. Borycz and R. Glod.  1996. Central histaminergic mechanisms mediate the vasopressin-induced pituitary adrenocortical stimulation. J Physiol Pharmacol 47(4):649-659.

Bugajski, J.  1996.  Role of prostaglandins in the stimulation of the hypothalamic-pituitary-adrenal axis by adrenergic and neurohormone systems.  J Physiol Pharmacol 47(4):559-575.

Bunevicius, R. G. Kazanavicius, R. Zalinkevicius and A. J. Prange, Jr.  1999. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med 340(6):424-9.

Burchard, J. F., D. H. Nguyen and E. Block.  1999.  Macro- and trace element concentrations in blood plasma and cerebrospinal fluid of dairy cows exposed to electric and magnetic fields. Bioelectromagnetics 20(6):358-64.  

Burchard, J. F., D. H. Nguyen, L. Richard, S. N. Young, M. P. Heyes and E. Block.  1998. Effects of electromagnetic fields on the levels of biogenic amine metabolites, quinolinic acid, and beta-endorphin in the cerebrospinal fluid of dairy cows.  Neurochem Res 23(12):1527-31.

Burckhardt CS. 2004.  Fibromyalgia: novel therapeutic aspects.  J Musculoskeletal Pain 12(3/4):65-72.  “Overall, there is moderate to strong evidence of the effectiveness of some nonpharmacologic approaches to fibromyalgia treatment.  Novel treatments from a wide group of practitioners and health perspectives are beginning to emerge as legitimate strategies.  An individualized approach that incorporates patient’s abilities, preferences, physical and psychological characteristics is critical to the success of treatment.”

Burckhardt CS, Clark SR, Bennett RM. 2005.  Long-term follow-up of fibromyalgia patients who completed a structured treatment program versus patients in routine treatment.  J Musculoskeletal Pain 13(1).  “Patients treated in a comprehensive program had consistently lower FMS impact, depression, pain, and fatigue scores over time.  Patients who did not enter or complete the program were as likely to take sleep medication, exercise or use self-management techniques over time but did not perceive themselves to be doing as well as those who completed the program.”

Burckhardt CS. 2005.  Educating patients: self-management approaches.  Disabil Rehabil. 27(12):703-709.  “Programs that combine education with cognitive-behavioral techniques and exercise are most effective in enhancing self-efficacy and decreasing symptoms of FMS.”

Burckhardt, C. S. , S. R. Clark and R. M. Bennett. 1993. Fibromyalgia and quality of life: a comparative analysis. .J Rheumatol 20(3):475-9.

Burgess, J. A. D. A. Kolbinson, P. T. Lee and J. B. Epstein. 1996. Motor vehicle accidents and TMDS: assessing the relationship. J Am Dent Assoc 127(12):1767-72.

Burghy CA, Stodola DE, Ruttle PL et al. 2012. Developmental pathways to amygdala-prefrontal function and internalizing symptoms of adolescence. Nat Neurosci 15(12):1736-1741.Early life stress and activation of the hypothalamus-pituitary –adrenal axis in females (such as during the first year of life or even earlier) can result in higher stress hormone production resulting in depression and anxiety in adolescence. The same cortisol response was not present in males.

Burgmer M, Pogatzi-Zahn E, Gaubitz M et al. 2009.  Fibromyalgia unique temporal brain activation during experimental pain: a controlled fMRI Study.  J Neural Transm. [Nov 25 Epub ahead of print]  “We observed a FMS-unique temporal brain activation of the frontal cortex in patients with FMS.  Moreover, areas of the motor cortex and the cingulated cortex presented a FMS-specific relation between brain activity during pain anticipation and the magnitude of the subsequent pain experience.  Our results support the hypothesis that central mechanisms of pain processing in the frontal cortex and cingulated cortex may play an important role in patients with FMS.”

Burgunder, J. M. 1998. Pathophysiology of akinetic movement disorders: a paradigm for studies in fibromyalgia? Z Rheumatol Suppl 57(2):27-30.

Burke SM, Shorten GD. 2010. Perioperative pregabalin improves pain and functional outcomes three months after lumbar discectomy. Anesth Analg. [Jan 26 Epub ahead of print]. “Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain …Pregabalin administration was associated with greater pain tolerance thresholds in both lower limbs compared with placebo at 24 hours postoperatively. Conclusion: Perioperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy.”

Burns, J. W., B. J. Johnson, J. Devine, N. Mahoney and R. Pawl.  1998.  Anger management style and the prediction of treatment outcome among male and female chronic pain patients. Behav Res Ther 36(11):1051-62.

Burri A, Lachance G, Williams FM. 2014. Prevalence and Risk Factors of Sexual Problems and Sexual Distress in a Sample of Women Suffering from Chronic Widespread Pain. J Sex Med. [Aug 7 Epub ahead of print.] "CWP patients report more sexual pain and sexual distress compared with controls. Assessment of sexual problems should therefore be added to routine care of patients with CWP."

Burstein R, Yarnitsky D, Goor-Aryeh I et al. 2000.  An association between migraine and cutaneous allodynia. Ann Neurol 47(5):614-624.

Burston JJ, Sagar DR, Shao P et al. 2013. Cannabinoid CB2 receptors regulate central sensitization and pain responses associated with osteoarthritis of the knee joint. PLoS One. 8(11):e80440. "Osteoarthritis (OA) of the joint is a prevalent disease accompanied by chronic, debilitating pain. Recent clinical evidence has demonstrated that central sensitization contributes to OA pain. An improved understanding of how OA joint pathology impacts upon the central processing of pain is crucial for the identification of novel analgesic targets/new therapeutic strategies. Inhibitory cannabinoid 2 (CB2) receptors attenuate peripheral immune cell function and modulate central neuro-immune responses in models of neurodegeneration. Systemic administration of the CB2 receptor agonist JWH133 attenuated OA-induced pain behavior, and the changes in circulating pro- and anti-inflammatory cytokines exhibited in this model. Electrophysiological studies revealed that spinal administration of JWH133 inhibited noxious-evoked responses of spinal neurones in the model of OA pain, but not in control rats, indicating a novel spinal role of this target. We further demonstrate dynamic changes in spinal CB2 receptor mRNA and protein expression in an OA pain model. The expression of CB2 receptor protein by both neurones and microglia in the spinal cord was significantly increased in the model of OA…. These data provide new clinically relevant evidence that joint damage and spinal CB2 receptor expression are correlated combined with converging pre-clinical evidence that activation of CB2 receptors inhibits central sensitization and its contribution to the manifestation of chronic OA pain. These findings suggest that targeting CB2 receptors may have therapeutic potential for treating OA pain."

Burton, A. K., R. D. Clarke, T. D. McClune and K. M. Tillotson.  1996.  The natural history of low back pain in adolescents.  Spine 21(20):2323-8. 

Burwinkle T, Robinson JP, Turk DC. 2005.

Fear of movement: factor structure of the Tampa Scale of Kinesiophobia in patients with fibromyalgia syndrome.  J Pain 6(6):384-391.  The Tampa Scale of Kinesiophobia may not be applicable to fibromyalgia patients, and its assessment measurement properties are “problematic.”  [It may be even less applicable for myofascial pain patients. DJS.]


Bushnell, M. C., C. Villemure, I Strigo et al. 2001. Imaging pain in the brain: The role of the cerebral cortex in pain perception and modulation. J Musculoskel Pain 10(1/2):59-72. Fibromyalgia may involve dysfunctional pain processing in the forebrain. "…activity in this network can be modulated by cognitive state, as well as by pharmaceutical treatments", resulting in pain control.


Buskila D, Ablin JN, Ben-Zion I et al. 2009. A painful train of events: increased prevalence of fibromyalgia in survivors of a major train crash. Clin Exp Rheumatol. 27(5 Suppl 56):S79-85. “Fibromyalgia was found to be highly prevalent, three years after a major train crash, among individuals exposed to the combination of physical injury and extreme stress. This finding is in accordance with previous data regarding the association of fibromyalgia with both physical and emotional trauma and calls attention to studying the underlying susceptibility factors which may partake in this association.”


Buskila D. 2009.  Developments in the scientific and clinical understanding of fibromyalgia.  Arthritis Res Ther. 11(5):242.  “As our understanding of the biological basis and the genetic underpinning of FM increases, we hope to gain a better understanding of the true nature of the disorder, to better classify patients and to attain more rational therapeutic modalities.”


Buskila D, Sarzi-Puttini P, Ablin JN. 2007.  The genetics of fibromyalgia syndrome.  Pharmacogenomics 8(1):67-74.  “The mode of inheritance in FMS is unknown, but it is most probably polygenic.  Recognition of these gene polymorphisms may help to better subgroup FMS patients and to guide a more rational pharmacological approach.”


Buskila D, Press J, Abu-Shakra M. 2003.  Fibromyalgia in systemic lupus erythamatosus: prevalence and clinical implications.  Clin Rev Allergy Immunol Aug:25(1):25-8.  “Fibromyalgia (FM) is common in SLE patients, and is the source of many of the symptoms and much of the disability in these patients.”


Buskila D., Neumann L., 2000. Musculoskeletal Injury as a Trigger for Fibromyalgia/Post-traumatic Fibromyalgia. Curr Rheumatol Rep 2(2):104-108. Soft tissue trauma to the neck can result in an increased incidence of FM compared with other injuries.

Buskila, D, Neumann L, Odes LR, et al. 2001. The prevalence of musculoskeletal pain and fibromyalgia in patients hospitalized on internal medicine wards.  Semin Arthritis Rheum 30(6):411-7. Pain syndromes and related symptoms are prevalent among hospitalized patients on the medicine wards.  Care providers need to be aware of these syndromes, regardless of the reason for the patient's hospitalization.

Buskila, D.  1999.  Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol 11(2):119-26.

Buskila, D., L. R. Odes, L. Neumann and H. S. Odes.  1999.  Fibromyalgia in inflammatory bowel disease.  J Rheumatol 26(5):1167-71.

Buskila, D., L. Neumann, D. Sibirski and P. Shvartzman.  1997.  Awareness of diagnostic and clinical features in fibromyalgia among family physicians.  Fam Pract 14(3):238-241.

Buskila, D. and L. Neumann.  1997.  Fibromyalgia syndrome (FM) and nonarticular tenderness in relatives of patients with FM.  J Rheumatol 24(5):941-944. 

Buskila, D., L Neumann, G. Vaisberg, D. Alkalay and F. Wolfe. 1997. Increased rates of fibromyalgia following cervical spine injury.  A controlled study of 161 cases of traumatic injury. Arthritis Rheum 40(3):446-452.  

Buskila, D., A. Shnaider, I. Neumann, D. Zilberman, N. Hilzenrat and E. Sikuler.  1997. Fibromyalgia in hepatitis C virus infection.  Another infectious disease relationship. Arch Intern Med 157(21):2497-500.

Buskila, D., L. Neumann, I. Hazanov and R. Carmi.  1996.  Familial aggregation in the fibromyalgia syndrome.  Semin Arthritis Rheum 26(3):605-611.

Buskila, D., L. Neumann, E. Hershman, A. Gedalia, J. Press and S. Sukenik. 1995.  Fibromyalgia syndrome in children–an outcome study.  J Rheumatol 22(3):525-528.  

Buskila, D., J. Press, A. Gedalia, M. Klein, L. Newman, R. Boehm and S. Sukenik.  1993. Assessment of nonarticular tenderness and prevalence of fibromyalgia in children. J Rheumatol 20(2):368-70.

Buskila, D., D. D. Gladman, K.V. Straaton P. Langevitz, S.Urowicz and H. A. Smythe. 1990. Fibromyalgia in human immunodeficiency syndrome virus infection. J Rheumatol 17(9):1202-12-6.

Butrick CW. 2009.  Pelvic floor hypertonic disorders: identification and management.  Obstet Bynecol Clin North Am. 36(3):707-722.  “Patients with hypertonic pelvic floor disorders can present with pelvic pain or dysfunction.  Each of the various syndromes will be discussed including elimination disorders, bladder pain syndrome/interstitial cystitis (BPS/IC), vulvodynia, vaginismus, and chronic pelvic pain.  The symptoms and objective findings on physical examination and various diagnostic studies will be reviewed.  Therapeutic options including physical therapy, pharmacologic management, and trigger point injections, as well as botulinum toxin injections…” are reviewed in detail in this article. [It is interesting that more and more research indicates that pelvic floor problems are often caused by TrPs, and yet many clinicians seem unaware of the fact.  It is to be hoped that training programs are under way.  DJS]

Butkevich I.P., Vershinina E.A. 2003.  Maternal stress differently alters nociceptive behaviors in the formalin test in adult female and male rats. Brain Res 961(1):159-65. Prenatal stress alters pain receptor behaviors in offspring. 

Butt AM, Hamilton N, Hubbard P et al. 2005.  Synantocytes: the fifth element.  J Anat. 207(6):695-706.  There is a possible form of glial cells apart from the astrocytes, oligodendrocytes and microglia.  It expressed the NG2 chondroitin sulphate proteoglycan (CSPG).  The majority of the NG-2-expressing glial cells in the adult CNS is a specific cell the authors name syantocytes, and they are an integral part of the tripartite synapse, integrating commmunication between the neuron and glial cell.  “Neuronal activity, glutamate and adenosine triphosphate (ATP) act on synatocyte receptors and evoke raised intracellular calcium.  This may affect ion channels and receptor profiles, and their activation may result in glial scar formation.  [This may be an important factor in FMS and CMP interconnection. DJS] 

Buyukbese MA, Pamuk ON, Yurekli OA et al. 2013. Effect of fibromyalgia on bone mineral density in patients with fibromyalgia and rheumatoid arthritis. J Postgrad Med. 59(2):106-109. "FM does not cause a decrease in BMD (bone mineral density). The presence of FM in RA (rheumatoid arthritis) patients does not result in a change in BMD."


Cabral GA, Marciano-Cabral F. 2005.  Cannabinoid receptors in microglia of the central nervous system: immune functional relevance.  J Leukoc Biol. [Oct 4 Epub ahead of print]  “The recognition that microglia express cannabinoid receptors and that their activation results in modulation of select cellular activities suggests that they may be amenable to therapeutic manipulation for ablating untoward inflammatory responses in the central nervous system.”

Cady RJ, Hirst JJ, Durham PL. 2010. Dietary grape seed polyphenols repress neuron and glia activation in trigeminal ganglion and trigeminal nucleus caudalis. Mol Pain. 6:91. "Results from our study provide evidence that grape seed extract may be beneficial as a natural therapeutic option for temporomandibular joint disorders by suppressing development of peripheral and central sensitization."

Cagnie B, Dewitte V, Barbe T et al. 2013. Physiologic effects of dry needling. Curr Pain Headache Rep. 17(8):348. "During the past decades, worldwide clinical and scientific interest in dry needling (DN) therapy has grown exponentially. Various clinical effects have been credited to dry needling, but rigorous evidence about its potential physiological mechanisms of actions and effects is still lacking. Research identifying these exact mechanisms of dry needling action is sparse and studies performed in an acupuncture setting do not necessarily apply to DN. The studies of potential effects of DN are reviewed in reference to the different aspects involved in the pathophysiology of myofascial trigger points: the taut band, local ischemia and hypoxia, peripheral and central sensitization. This article aims to provide the physiotherapist with a greater understanding of the contemporary data available: what effects could be attributed to dry needling and what are their potential underlying mechanisms of action, and also indicate some directions at which future research could be aimed to fill current voids."

Cagnie B, Dewitte V, Coppieters I et al. 2013. Effect of ischemic compression on trigger points in the neck and shoulder muscles in office workers: A cohort study. J Manipulative Physiol Ther. 36(8):482-489. Nineteen office workers with "mildly severe chronic" neck and shoulder pain and dysfunction each had their 4 most painful trigger points treated with ischemic compression during 8 sessions within a 4 week period. They had significant decrease in pain from all 4 trigger points treated, with significant increase in mobility and muscle strength. These positive outcomes were maintained at a 6-month follow-up.

Caidahl, K., M. Lurie, B. Bake, G. Johannson and H. Wetterqvist.  1989. Dyspnoea in chronic primary fibromyalgia. J Intern Med 226(4):265-270.

Cairns BE. 2007.  The role of peripheral glutamate and glutamate receptors in muscle pain.  J Musculoskel Pain 15 (Supp 13):8 item 10.  [Myopain 2007 Poster]  “These findings suggest that elevations of interstitial glutamate concentration alter musculoskeletal pain sensitivity in a sex-related manner through activation of peripheral NMDA receptors.” 

Cairns V, Godwin J. 2005.  Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms.  Int J Epidemiol. [Epub ahead of print July 22]   “This meta-analysis provides strong evidence that some patients with LB have fatigue, musculoskeletal pain, and neurocognitive difficulties that may last for years despite antibiotic treatment.”

Caixeta GC, Dona F, Gazzola JM. 2012. Cognitive processing and body balance in elderly subjects with vestibular dysfunction. Braz J Otorhinolaryngol. 78(2):87-95. [English, Portuguese]. "Elderly patients with chronic peripheral vestibular disease and worse performance in body balance tests have functional impairment in cognitive skills." [Patients with balance failures must be assessed for trigger points, vestibular dysfunction, cognitive impairment, and metabolic and nutritional imbalances, among other possible causes. DJS]

Cakit BD, Taskin S, Nacir B et al. 2010. Comorbidity of fibromyalgia and cervical myofascial pain syndrome. Clin Rheumatol. [Jan 12 Epub ahead of print]. “The aims of this study are to determine the frequency of fibromyalgia syndrome (FMS) in patients with chronic cervical myofascial pain (CMP) and to investigate the FMS characteristics in CMP patients….Of the 93 CMP subjects, 22 (23.6%) patients fulfilled the classification criteria for FMS…. There were statistically significant differences between regional CMP patients and comorbid CMP and FMS patients regarding presence of fatigue (p = 0.0) and irritable bowel syndrome (p = 0.022)…..In conclusion, we found that nearly a quarter of CMP patients were comorbid with FMS, and psychological and comorbid symptoms were more prominent in comorbid patients. We thought that these two syndromes might be overlapping conditions and as a peripheral pain generator or inducer of central sensitization, MPS might lead to FMS or precipitate and worsen the FMS symptoms.”

Calabro, JJ. 1986.  Fibromyalgia (fibrositis) in children. Am J Med 81(3A):57-59.

Calandre EP, Hidalgo J, Garcia-Leiva JM et al. 2006.  Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?  Eur J Neural. 13(3):244-249.  “Trigger point palpation provoked a migraine attack in 30 (30.6%) patients.  Pericraneal allodynia was found in 15 (15.3%) patients.  These data indicate that nociceptive peripheral sensitization is a usual finding in migraine, and that central sensitization can develop in patients with frequent attacks and long-lasting disease.  Trigger points’ detection in migraine patients could be useful when applying therapies like acupuncture, needling or botulinum toxin injections directed to reduce peripheral sensitization.”

Calandre EP, Hidalgo J, Garcia-Leiva JM et al. 2006.  Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?  Eur J Neurol. 13(3):244-249.  “Trigger points were found in 92 (93.9%) migraineurs and in nine (29%) controls.”  “These data indicate that nociceptive peripheral sensitization is a usual finding in migraine, and that central sensitization can develop in patients with frequent attacks and long-lasting disease.  Trigger points’ detection in migraine patients could be useful when applying therapies like acupuncture, needling or botulinum toxin injections directed to reduce peripheral sensitization.”  [This may be another indication wherein the central sensitization found in FMS acts synergically with the peripheral pain stimuli from trigger points.  DJS]

Calandre EP, Hidalgo J, Garcia-Leiva JM et al. 2006.  Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?  Eur J Neurol. 13(3):244-249.  “These data indicate that nociceptive peripheral sensitization is a usual finding in migraine, and that central sensitization can develop in patients with frequent attacks and long-lasting disease.  Trigger points’ detection in migraine patients could be useful.”  [This may indicate another connection with central sensitization of FMS and TrPs. DJS]

Calandre EP, Morillas-Arques P, Rodriguez-Lopez CM et al. 2007.  Pregabalin augmentation of quetiapine therapy in the treatment of fibromyalgia: an open-label, prospective trial.  Pharmacopsychiatry 40(2):68-71.  “...the use of pregabalin can be a useful augmentation strategy in fibromyalgia patients partially responding to quetiapine.”

Calandre EP, Navajas-Rojas MA, Ballesteros J et al. 2014. Suicidal Ideation in Patients with Fibromyalgia: A Cross-Sectional Study. Pain Pract. [Jan 17 Epub ahead of print.] "Chronic pain, sleep disturbances, and depression, which are relevant symptoms of fibromyalgia syndrome, have been demonstrated to be associated with an increased likelihood of suicidal behaviors. Mortality from suicide has been shown to be greater among patients with fibromyalgia. This study aimed to assess the prevalence of suicidal ideation among a sample of patients with fibromyalgia and to evaluate its relationship with the clinical symptomatology of fibromyalgia….Suicidal ideation was markedly associated with depression, anxiety, sleep quality, and global mental health, whereas only weak relationships were observed between suicidal ideation and both pain and general physical health."

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]

Caldarella MP, Giamberardino MA, Sacco F et al. 2006.  Sensitivity disturbances in patients with irritable bowel syndrome and fibromyalgia.  Am J Gastroenterol. 101(12):2782-2789.  “Our observations seem to indicate that, although sharing a common hypersensitivity background, multiple mechanisms may modulate perceptual somatic and visceral responses in patients with IBS and FM.”  

Calder, AA.  1994.  Prostaglandins and biological control of cervical function.  Aust N Z Obstet Gynaecol 34(3):347-51.  

Calis M, Gokee C, Ates F et al. 2004.  Investigation of the hypothalamo-pituitary-adrenal axis (HPA) by 1 microg ACTH test and metyrapone test in patients with primary fibromyalgia syndrome.  J Endocrinol Invest 27(1):42-46.  This study indicated that the HPA axis is underactivated in primary FMS patients.  [The disparity of this conclusion with other researchers’ findings could be that there are several phases of HPA activation, and once the system has been stressed for a period of time, the imbalance causes a decreased response. We don’t know.  DJS]

Calvo MS, Whiting SJ. 2003.  Prevalence of vitamin D insufficiency in Canada and the United States: importance to health status and efficacy of current food fortification and dietary supplement use.  Nutr Rev. 61(3):107-113.  “Several recent studies have identified a surprisingly high prevalence of vitamin insufficiency in otherwise healthy adults living in Canada and the United States.  Dietary Vitamin D is not reaching the population in greatest need, nor is it very protective against insufficiency.”

Camargo, Jr, J. N.  and A. Nucci. 1997. Saphenous nerve entrapment manifested as proximal cruralgia. Rev Paul Med 115(5):1553-4.

Cambron JA, Dexheimer J, Coe P. 2006.  Changes in blood pressure after various forms of therapeutic massage: a preliminary study.  J Altern Complement Med. 12(1):65-70.  “Increases in BP were noted for potentially painful massage techniques, including trigger point therapy.”  [There are a lot of different TrP massage therapy techniques and they were not differentiated here.  TrP therapists must be careful to keep the pain level low to prevent the possibility of central sensitization.  This paper shows that there may be other possible effects of painful therapies.  DJS]

Camerini L, Schultz PJ, Nakamoto K. 2012. Differential effects of health knowledge and health empowerment over patients' self-management and health outcomes: A cross-sectional evaluation. Patient Educ Couns. 89(2):337-344. "The role of health knowledge and empowerment in explaining behavioral and health outcomes was treated in depth in the literature, but the combined effect of these constructs has been somehow neglected. This study presents an empirical, a priori, cross-sectional evaluation of the differential effects of health knowledge and empowerment on patients' self-management and health outcomes. Knowledge and three empowerment dimensions were found to positively impact health outcomes. However, these relationships were not mediated by self-management. Self-management, operationalized in terms of physical exercise and drug intake, was found to be a strong predictor of health outcomes....Despite the lack of support for the mediating role of self-management, a strong impact of knowledge and empowerment over health outcomes was observed. Theories of health literacy and empowerment may benefit from this result by integrating both dimensions in an overall model of behavioral and health outcomes change....Results from this study suggest that health interventions targeted to chronic patients should focus simultaneously on knowledge and empowerment, rather than favoring one of these individual constructs."

Camparis CM, Formigoni G, Teixeira MJ et al. 2006.  Sleep bruxism and temporomandibular disorder: clinical and polysomnographic evaluation.  Arch Oral Biol. [Apr 1 Epub ahead of print].  “The polysomnographic characteristics of patients with sleep bruxism, with and without orofacial pain, are similar.  More studies are necessary to clarify the reasons why some sleep bruxism patients develop chronic (facial) myofascial pain, and others do not.”

Camparis CM, Formigoni G, Teixeira MJ et al. 2005.  Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics.  J Oral Rehabil. 32(11):808-814.  “Tinnitus frequency was higher in patients with sleep bruxism and chronic facial pain.  Myofascial pain, numbers of areas painful to palpation in the masticatory and cervical muscles, higher levels of depression and tooth absence without prosthetic replacement were more frequent in the group with tinnitus.”

Campos RP, Vazquez MI. 2012. The impact of fibromyalgia on health-related quality of life in patients according to age. Rheumatol Int. [Nov 15 Epub ahead of print]. "Previous studies show controversial results regarding the influence of age on health-related quality of life (HRQOL) in patients with Fibromyalgia (FM).... it is important to control age effect on HRQOL to determine the specific impact of FM. Controlling the age effect on the HRQOL with standardized scores, elderly (over 60) women with FM have less impact of the disease on the physical and social dimensions of the HRQOL than younger patients".

Can SS, Gencay Can A. 2012. Assessment of cognitive function in patients with fibromyalgia using the clock drawing test. J Musculoskel Pain. 20(3):177-182. The clock drawing test indicated fibromyalgia patients had impaired cognitive function related to advanced age and high pain intensity.

Cannon DE, Dillingham TR, Miao H et al. 2007.  Musculoskeletal disorders in referrals for suspected cervical radiculopathy.  Arch Phys Med Rehabil. 88(10):1256-1259.  “Musculoskeletal disorders are common in patients with suspected cervical radiculopathy.”  “The presence of musculoskeletal disorders should not preclude electrodiagnostic testing when otherwise indicated.”

Canovas R, Leon I, Roldan MD et al. 2009.  Virtual reality tasks disclose spatial memory alterations in fibromyalgia.  Rheumatology [Aug 4 Epub ahead of print].  “These results are the first to demonstrate that there is a spatial learning deficit in people with FM, which suggest that the hippocampal system can be disturbed in this syndrome.”  [It may be difficult to separate causes of spatial dysfunction.  Patients with FM usually have TrPs, and TrPs can cause proprioceptive dysfunction.  They also may have vestibular dysfunction or TBI.  These patients were not screened for co-existing TrPs, so we cannot be sure what caused the spatial alterations, and it is very important to discover what cause or causes there may be. DJS]

Cantini, F., F. Bellandi, L. Niccoli and O. Di Munno.  1994.  Fluoxetin combined with cyclo-benzaprine in the treatment of fibromyalgia.  Minerva Med 85(3):97-100 [Italian]. 

Cantu, Robert L. and Alan J. Grodin. 1992. Myofascial Manipupation: Theory and Clinical Application. Aspen Publishers Inc: Gaithersburg MD. 

Cao DY, Pickar JG. 2010. Lengthening but not shortening history of paraspinal muscle spindles in the low back alters their dynamic sensitivity. J Neurophysiol. [Nov 3 Epub ahead of print]. "Proprioception is considered important for maintaining spinal stability and for controlling posture and movement in the low back. Previous studies demonstrate the presence of thixotropic properties in lumbar muscle spindles wherein a vertebra's positional history alters spindle responsiveness to position and movement. This study (in cats) investigated whether a vertebra's movement-history affects the velocity sensitivity of paraspinal muscle spindles in the low back. In conclusion, only movement-histories which stretch but not shorten muscle spindles alter their velocity sensitivity. In the low back, forward flexion and lateral bending postures would likely be the most provocative."

Capo-Juan MA. 2015. [Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment] An Sist Sanit Navar. 38(1):105-115. [Article in Spanish] "Pain is a complex and multifactorial phenomenon that depends on the interaction of biopsychosocial factors. Between 15-25% of adults suffer from chronic pain at some point in their lives. Cervical chronic pain is considered a public health problem affecting 9.6% men and 21.9% women, according to the latest National Health Survey 2011-12. A high percentage of medical consultations due to muscle pain turn out to be myofascial pain syndrome (MPS). Its existence implies the presence of myofascial trigger points which can be latent or active throughout the whole population. The aim of this review is to update knowledge in the various therapies applied by the physiotherapist in the treatment of this syndrome at cervical level. From the review it appears that some of the most used techniques that may be useful in the short or medium term are: ischemic compression and/or trigger point pressure release and dry needling. Furthermore, various combinations of treatment modalities are used to treat this syndrome, taking other aspects into account, such as education." Free Article

Caraco Y, Sheller J, Wood AJ. 1996.  Pharmacogenetic determination of the effects of codeine and prediction of drug interactions.  J Pharmacol Exp Ther. 278(3):1165-1174.  Codeine, hydrocodone, and oxycodone are dependent on metabolism by CYP2D6.  Patients who lack the enzyme CYP2D6 or have inhibited CYP2D6 are not candidates for these medications.  Patients on these medications should not be put on medications that inhibit this enzyme.  [Lack of phenotyping test subjects and avoidance of inhibitors may have resulted in incorrect conclusions in some opioid trials for chronic pain.  Metabolic testing may be a valuable tool to help decide which patients will find opioids more effective in controlling pain. DJS] 


Caraco Y, Sheller J, Wood AJ. 1999.  Impact of ethnic origin and quinidine coadministration on codeine’s disposition and pharmacodynamic effects.  J Pharmacol Exp Ther. 290(1):413-422.  Chinese patients varied greatly from Caucasian patients in CYP2D6 activity.  “..Chinese patients produce less morphine from codeine, exhibit reduced sensitivity to that morphine, and therefore might experience reduced analgesic effect in response to codeine. Quinidine-induced inhibition of codeine metabolism is ethnically dependent as well.  The reduction is significantly greater in Caucasians.  [Clinicians need to be aware that different ethnic populations may react differently to medications. DJS] 

Carames J, Carvalhao F, Real Dias MC. 2009.  [Myofascial trigger point disease – a multidisciplinary disorder] Acta Reumatol Port. 34(1):38-43.  [Portuguese]  “The articles and texts reviewed underline the need for an early diagnosis of this disease in order to treat its aetiology and avoid the chronicity of symptoms.”

Carbonell-Baeza A, Aparicio VA, Martins-Pereira CM et al. 2010. Efficacy of Biodanza for Treating Women with Fibromyalgia. J Altern Complement Med. [Oct 27 Epub ahead of print]. "The objective of this study was to determine the effects of a 3-month Biodanza intervention in women with fibromyalgia (FM)..... Biodanza intervention shows improvements on pain, body composition, and FM impact in female patients."

Cardenal, A., I. Masuda, W. Ono, A. L. Haas, L. M. Ryan, D. Trotter and D. J. McCarty.  1998. Serum nucleotide pyrophosphohydrolase activity; elevated levels in osteoarthritis, calcium pyrophosphate cyrstal {NOTE EDITOR, “CRYSTAL” IS MISSPELLED IN ARTICLE} deposition disease, scleroderma, and fibromyalgia. J Rheumatol 25(11):2175-80.

Cardoso LR, Rizzo CC, de Oliveira CZ et al. 2014. Myofascial pain syndrome after head and neck cancer treatment: Prevalence, risk factors and influence on quality of life. Head Neck. [Jul 2 Epub ahead of print.] "Background: Patients undergoing treatment for head and neck cancer (HNC) might develop myofascial pain syndrome (MPS) as sequelae. The aim of this study was to determine the prevalence, risk factors and quality of life related to MPS….Conclusions: MPS was observed in 1 out of 9 patients after HNC treatment and a worse QOL was observed among them. Tumor site and neck dissection were found to be risk factors for MPS."

Carette, S., M. J. Bell, W. J. Reynolds, B. Haraoui, G. A. McCain, V. P. Bykerk, S. M. Edworthy, M. Baron, B. E. Koehler, A.G. Fam et al.  1994.  Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia.  A randomized, double-blind clinical trial.  Arthritis Rheum 37(1):32-40.

Carli G., Suman A.L., Biasi G. et al. 2002.  Reactivity to superficial and deep stimuli in patients with chronic musculoskeletal pain.  Pain 100(3):259-69.  Even when patients who have pain in many regions of the body do not have 11 of 18 tender points required for the technical diagnosis of fibromyalgia, the nociceptive system is already dysfunctional.  The dysfunction becomes more severe as the tender points increase, and becomes greatest in patients who have fibromyalgia.  [This study indicates that patients who do not yet have the 11 of 18 tender points may benefit from aggressive pain control to prevent further central sensitization. DJS]

Carlson CR, Okeson JP, Falace DA et al. 1993.  Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.  Pain 55(3):397-400.  “Sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.”

Carmona L. 2002.  More evidence on the dysautonomic nature of fibromyalgia: The association with short stature.  Arthritis Rheum 46(1):1415-1416.  This is especially interesting in that the author found a significant correlation with FMS and short women.

Caro XJ, Winter EF. 2014. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: Clinical and immunologic implications. Arthritis Rheumatol. [Apr 9 Epub ahead of print.] "A subset of fibromyalgia (FM) patients exhibits a large fiber, demyelinating peripheral polyneuropathy, akin to that seen in chronic inflammatory demyelinating polyneuropathy (CIDP). It has been suggested that this demyelinating process is likely to be immune mediated. Since it is known that similar, large fiber neuropathic lesions may be associated with a cutaneous small fiber neuropathy (SFN), we sought to determine the prevalence of SFN, as measured by epidermal nerve fiber density (ENFD), in a series of FM patients and clinically healthy controls. Conclusion: Calf and thigh ENFD in FM are significantly diminished compared to controls. Advancing age, alone, can not explain this finding. Calf ENFD correlated, though weakly, in an inverse fashion with serum IL-2R …. These findings suggest that SFN is likely to contribute to FM pain complaints; that pain in this disorder arises, in part, from a peripheral immune mediated process; and that measurement of ENFD may be a useful clinical tool in FM." [The authors need to take into consideration that the nerve fiber density in FM may possibly be higher due to co-existing myofascial trigger points entrapping nerves and corollary nerve fiber development may occur. Differing collagen deposition and mast cell deposition in the skin of FM has also been observed by researchers, and this might affect the conclusion as well. DJS]

Caro XJ, Winter EF, Dumas AJ. 2008.  A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg.  Rheumatology 47(2):208-211.  “A significant subset of FMS subjects have clinical and EDX (electrodiagnostic) findings suggestive of CIDP.  IVIg (intravenous immunoglobin) treatment shows promise in treating this subset.”

Caro, X. J. , F. Wolfe, W. H. Johnston and A. L. Smith. 1986. A controlled and blinded study of immune L. reactive deposition at the dermal-epidermal junction of patients with primary fibrositis syndrome.  J. Rheumatol 13(6):1086-1092.

Carrasco TG, Guerisoli LD, Guerisoli DM et al. 2009.  Evaluation of low intensity laser therapy in myofascial pain syndrome.  Cranio. 27(4):243-247.

Carrillo-de-la-Peña MT, Triñanes Y, González-Villar A et al. 2014. Filtering out repetitive auditory stimuli in fibromyalgia: A study of P50 sensory gating. Eur J Pain. [Nov 28 Epub ahead of print.] "It has been suggested that fibromyalgia (FM) patients show increased sensory processing of nociceptive and non-nociceptive stimuli and also reduced habituation. Although this pattern of increased reactivity has been established for the somatosensory modality, its generalization to other sensory modalities remains controversial." This study from Spain found: "The results indicate that FM patients do not present significant deficits in early sensory gating when processing auditory stimuli, and therefore challenge the 'generalized hypersensitivity' hypothesis of FM."

Carrillo-de-la-Pena MT, Vallet M, Perez MI et al. 2006.  Intensity dependence of auditory-evoked cortical potentials in fibromyalgia patients: a test of the generalized hypervigilance hypothesis.  J Pain 7(7):480-487.  “Defects in an inhibitory system protecting against overstimulation may be a crucial factor in the pathophysiology of FM.”  FMS patients may have hypersensitivity to stimuli, especially loud noise.  [This study suggests mechanisms which may explain part of the auditory segment of allodynia often associated with FMS. DJS]

Carter, J. E.  1999.  A systematic history for the patient with chronic pelvic pain.  JSLS 3(4); 245-52. 

Carter, J. E. 1998.  Surgical treatment for chronic pelvic pain.  J Soc Laparoendosc Surg 2(2):129-39.

Cartwright, R., A. Luten, M. Young, P. Mercer and M. Bears.  1998.  Role of REM sleep and dream affect in overnight mood regulation: a study of normal volunteers.  Psychiatry Res 81(1):1-8. 

Cartwright, R. D. and E. Wood.  1991.  Adjustment disorders of sleep: the sleep effects of a major stressful event and its resolution.  Psychiatry Res 39(3):199-209.

Casale R, Rainoldi A. 2011. Fatigue and fibromyalgia syndrome: Clinical and neurophysiologic pattern. Best Pract Res Clin Rheumatol. 25(2):241-247. "The concept of 'fatigue' is strictly related to parameters of the setting in which fatigue is measured. Therefore, it is mandatory to provide a definition of fatigue and the modalities of its use. This is of pivotal importance with regard to the fibromyalgia (FM) syndrome, where fatigue is the most invalidating symptom and where, paradoxically, no clear and widely accepted definition of fatigue is available in the literature as yet. In the clinical setting, fatigue can be measured by different methods of various complexities. The simplest technique to assess fatigue involves the use of a visual analogue scale (VAS); however, a number of scales with differing levels of complexity are available for use. It is, often, difficult to detach the term 'fatigue' from tiredness and task failure, which correspond to two completely distinguished forms of fatigue: one with central origin (tiredness) and another which is localized within the muscle (peripheral muscle fatigue). The former is related to changes in motor-unit-recruitment strategies, whereas the latter is attributed to changes in membrane properties. To extensively assess fatigue and, partially, to avoid confusion among the types of fatigue described above, a number of laboratory tests have been developed; among these, there are multichannel surface electromyography (EMG) recordings. Using this type of an approach, it is possible the estimation of motor unit location within the muscle, the decomposition of the surface EMG (sEMG) interference signal into constituent trains of motor unit action potentials (MUAPs) and the analysis of single unit properties." [One must take into consideration co-existing conditions such as myofascial trigger points, which could impact any conclusion considerably. DJS]

Casanueva B, Rivas P, Rodero B et al. 2013. Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatol Int. [Apr 23 Epub ahead of print]. "…patients severely affected by fibromyalgia can obtain short-term improvements following weekly dry needling for 6 weeks." [It is suspected that these researchers are actually treating co-existing myofascial trigger points, but since the researchers did not assess for TrPs, this is only speculation. DJS]

Cash E, Salmon P, Weissbecker I et al. 2014. Mindfulness Meditation Alleviates Fibromyalgia Symptoms in Women: Results of a Randomized Clinical Trial. Ann Behav Med. [Nov 26 Epub ahead of print.] "MBSR (Mindfulness-Based Stress Reduction) ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden. Further exploration of MBSR effects on physiological stress responses is warranted. These results support use of MBSR as a complementary treatment for women with fibromyalgia."

Cashman GE, Mortenson WB, Gilbart MK. 2014. Myofascial treatment for patients with acetabular labral tears: a single-subject research design study. J Orthop Sports Phys Ther. 44(8):604-614. "Study Design Single-subject research design using 4 consecutive patients. Objective To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. Background Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. Methods This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. Results All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. Conclusion Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles."

Cassidy, C. M.  1998.  Chinese medicine users in the United States.  Part I: Utilization, satisfaction, medical plurality.  J Altern Complement Med 4(1):17-27.

Cassisi G, Sarzi-Puttini P, Casale R et al. 2014. Pain in fibromyalgia and related conditions. Reumatismo. 66(1):72-86. "Pain is the hallmark symptom of fibromyalgia (FM) and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as 'central pain', 'neuropathic pain', 'nonnociceptive pain' or 'central sensitivity syndromes'. The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions are caused by central nervous system hypersensitivity and abnormalities."

Castaldo M, Ge HY, Chiarotto A et al. 2014. Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Med. 15(5):842-849. "Active MTPs are more prominent in WAD (whiplash associated disorders) than MNP and related to current pain intensity and size of the spontaneous pain distribution in whiplash patients. This may underlie a lower degree of sensitization in MNP than in WAD." [We must get physicians and other care providers to recognize the myofascial trigger points that are causing the pain, and train them to treat these pain generators adequately. DJS]

Castori M. 2013. Joint hypermobility syndrome (a.k.a. Ehlers-Danlos Syndrome, Hypermobility Type): an updated critique. G Ital Dermatol Venereol. 148(1):13-36. This review covers every system that could be affected in this common, underdiagnosed and often missed condition, as well as management strategies.

Castori M. 2012. Ehlers-Danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN Dermatol [Nov 22 Epub ahead of print.] EDS, hypermobility type, is a common and often missed hereditary condition. It may have relatively few skin and joint manifestations, and may be missed among common co-existing conditions such as fibromyalgia, carpal tunnel syndrome, chronic low back pain, or chronic regional pain syndrome. When there is hyperextensible or smooth, velvety skin and generalized joint hypermobility, EDS should be among the interactive diagnoses considered. [Many of the common co-morbidities mentioned commonly have co-existing myofascial trigger points as well, and EDS is certainly an initiating and perpetuating factor for trigger points. DJS]

Castori M, Morino S, Celletti C et al. 2013. Am J Med Genet A. 161(12):2989-3004. This paper focuses on fatigue and headache in EDS (Ehlers-Danlos Syndrome) hypermobility type, and its co-existence with chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and similar conditions.

Castori M, Morlino S, Ghibellini G et al. 2015. Connective tissue, Ehlers-Danlos syndrome(s), and head and cervical pain. Am J Med Genet C Semin Med Genet. [Feb 5 Epub ahead of print.] "Ehlers-Danlos syndrome (EDS) is an umbrella term for a growing group of hereditary disorders of the connective tissue mainly manifesting with generalized joint hypermobility, skin hyperextensibility, and vascular and internal organ fragility….Headache is reported in no less than 1/3 of the patients. Migraine results the most common type in the hypermobility type of EDS. Other possibly related headache disorders include tension-type headache, new daily persistent headache, headache attributed to spontaneous cerebrospinal fluid leakage, headache secondary to Chiari malformation, cervicogenic headache and neck-tongue syndrome, whose association still lacks of reliable prevalence studies. The underlying pathogenesis seems complex and variably associated with cardiovascular dysautonomia, cervical spine and temporomandibular joint instability/dysfunction, meningeal fragility, poor sleep quality, pain-killer drugs overuse and central sensitization."

Castro-Marrero J, Cordero MD, Saez-Francas N et al. 2013. Could mitochondrial dysfunction be a differentiating marker between Chronic Fatigue Syndrome and Fibromyalgia? Antioxid Redox Signal. [Apr 22 Epub ahead of print]. "…mitochondrial dysfunction-dependent events could be a marker of differentiation between CFS and FM indicating the mitochondria as a new potential therapeutic target for these conditions."

Castro-Sanchez AM, Aguilar-Ferrandiz ME, Mataran-Penarrocha GA et al. 2013. Short-term effects of a manual therapy protocol on pain, physical function, quality of sleep, depressive symptoms and pressure sensitivity in women and men with fibromyalgia syndrome: A randomized controlled trial. Clin J Pain. [Nov 25 Epub ahead of print]. "Manual therapy protocol was effective for improving pain intensity, widespread pressure pain sensitivity, impact of FMS symptoms, sleep quality and depressive symptoms. In addition, sex differences were observed in response to treatment: women and men get similar improvements in quality of sleep and tender point count, whereas women showed a greater reduction in pain and impact of FMS symptoms than men, but men reported higher decreases in depressive symptoms and pressure hypersensitivity than women."

Castro-Sanchez AM, Mataran-Penarrocha GA, Granero-Molina J et al. 2011. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011:561753. "Myofascial release techniques improved pain and quality of life in patients with fibromyalgia." [Myofascial pain is a common co-existing condition with fibromyalgia, and techniques that can ease myofascial pain will help relieve the central sensitization state of FM. DJS]

Castro-Sanchez AM, Mataran-Penarrocha GA, Lopez-Rodriguez MM et al. 2012. Gender Differences in Pain Severity, Disability, Depression, and Widespread Pressure Pain Sensitivity in Patients with Fibromyalgia Syndrome without Comorbid Conditions. Pain Med. [Nov 21 Epub ahead of print]. "To determine the differences in pain, disability, depression, and pressure sensitivity between men and women with fibromyalgia syndrome (FMS), and to analyze the relationship between pain and pressure sensitivity in FMS.....Women with FMS showed higher pain severity and lower PPT than men, whereas men exhibited longer duration of symptoms and disability. In men with FMS, the intensity of ongoing pain was positively correlated to pressure hyperalgesia over the neck. This study suggests that FMS could show a different phenotype in women and men and confirm that women exhibit lower PPT than men." [No check for TrPs.]

Castro-Sanchez AM, Mataran-Penarrocha GA, Sanchez-Labraca N, et al. 2010. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil. [Aug 11 Epub ahead of print]. "Craniosacral therapy improved medium-term pain symptoms in patients with fibromyalgia."

Cavriani G, Domingos HV, Oliveira-Filho RM et al. 2007.  Lymphatic thoracic duct ligation modulates the serum levels of IL-1beta and IL-10 after intestinal ischemia/reperfusion in rats with the involvement of tumor necrosis factor alpha and nitric oxide.  Shock. 27(2):209-213.  [This study may be relevant to glial cell research and central sensitization. DJS]

Cayea D, Perera S, Weiner DK. 2006.  Chronic low back pain in older adults: what physicians know, what they think they know, and what they should be taught.  J Am Geriatr Soc. 54(11):1772-1777.   “PCPs did not feel ‘very confident’ in their ability to diagnose any of the contributors of CLBP listed (most items <40%).  PCPs felt most confident in detecting scoliosis and least confident detecting myofascial pain of the piriformis muscle.”  “The results point to a need for more PCP education about CLBP in older adults.  It also suggests that accurate needs assessment should not rely on physician confidence ratings alone.”

Cazzola M, Atzeni F, Salaffi F et al. 2010. Which kind of exercise is best in fibromyalgia therapeutic programs? A practical review. Clin Exp Rheumatol. 28(6 Suppl 63):S117-124. "...the latest findings concerning the neurophysiology of nociception indicate the fundamental importance of assigning workloads that do not exacerbate post-exercise pain."

Cedraschi C, Desmeules J, Rapiti E et al. 2004.  Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management.  Ann Rheum Dis 63(3):290-296. Appropriate 6 week pool-based exercise and education resulted in sustained (at least 6 months) improved quality of life for FMS patients.  These patients were not screened for co-existing chronic myofascial pain.

Cedraschi C, Girard E, Piguet V et al. 2014. Assessing the affective load in the narratives of women suffering from fibromyalgia: the clinicians' appraisal. Health Expect. [Dec 10 Epub ahead of print.] "The affective load in the narratives of these patients with fibromyalgia was high and had a negative undertone when considered from the clinicians' perspective. This study highlights the importance of considering the affective resonance in the context of therapeutic relationships that are often emotionally laden and highly challenging for the clinician."

Celik D, Kaya Mutlu E. 2012. The relationship between latent trigger points and depression levels in healthy subjects. Clin Rheumatol 31(6):907-911. This study from Turkey found a "…close relationship between the presence of LTrPs (latent trigger points) and depression levels I healthy people." 

Celik D, Mutlu EK. 2013. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 17(8):353. Latent TrPs are important clinically. They still cause dysfunction, and cause pain on pressure. Latent TrPs may be found in many pain-free muscles, and can be activated by "continuous detrimental stimuli. This review highlights the importance of LTrPs."

Celik D, Yeldan I. 2011. The relationship between latent trigger point and muscle strength in healthy subjects: A double-blind study. J Back Musculoskel Rehabil. 24(4):251-256. "Latent TrPs can cause significant muscle weakness."

Cenevic C, Maloney G, Mehta N. 2006.  Myofascial pain may mimic trigeminal neuralgia.  Cephalalgia 26:899-901.

Cerda-Olmedo G, Mena-Duran AV, Monsalve V et al. 2015. Identification of a microRNA signature for the diagnosis of fibromyalgia. PLoS One. 10(3):e0121903. "We propose a signature of five strikingly downregulated miRNAs (hsa-miR223-3p, hsa-miR451a, hsa-miR338-3p, hsa-miR143-3p and hsa-miR145-5p) to be used as biomarkers of FM. Validation in larger study groups is required before the results can be transferred to the clinic." Free Article [I believe that this is one of the most promising studies on genetic ID of FM. DJS]

Ceru-Bjork C, Andersson I, Rossner S. 2001.  Night eating and nocturnal eating – two different or similar syndromes among obese patients?  Int J Obes Relat Metab Disord. 25(3):365-372.  “The main objective of this study was to identify subjects with (1) night eating syndrome (defined as morning anorexia, evening hyperphagia and insomnia) and (2) nocturnal eating syndrome (defined as eating at night after having gone to bed.)...Fourteen percent of the patients at our obesity unit met the criteria for night eating and/or nocturnal eating syndrome.”

Cervero, F. and J. M. Laird. 1996. Mechanisms of touch-evoked pain (allodynia): a new model.  Pain 1996 68(1):13-23.  

Cervero, F.  1995.  Visceral pain: mechanisms of peripheral and central sensitization. Ann Med 27(2):235-9. 

Cervigni M, Natale F. 2014. Gynecological disorders in bladder pain syndrome/interstitial cystitis patients. Int J Urol. 21 Suppl 1:85-88. "Bladder pain syndrome/interstitial cystitis is a complex pathology often associated with vulvodynia, endometriosis and pelvic floor dysfunctions. Therefore, it is of utmost importance to obtain an accurate evaluation ruling out confusable disease, such as pudendal neuropathy. The optimal approach is a combined treatment oriented not only to treat the bladder, but also the other components responsible for the pain disorder."

Cevikbas F, Steinhoff M, Ikoma A. 2010. Role of Spinal Neurotransmitter Receptors in Itch: New Insights into Therapies and Drug Development. CNS Neurosci Ther. [Oct 15 Epub ahead of print]. "Targets for antipruritic therapies are now expanding from the skin to the central nervous system. Recent studies demonstrate that various neuronal receptors in the spinal cord are involved in pruritus. The spinal opioid receptor is one of the best-known examples. Spinal administration of morphine is frequently accompanied by segmental pruritus. In addition to mu-opioid receptor antagonists, kappa-opioid receptor agonists have recently come into usage as novel antipruritic drugs, and are expected to suppress certain subtypes of itch such as hemodialysis- and cholestasis-associated itch that are difficult to treat with antihistamines. The gastrin-releasing peptide receptor in the superficial dorsal horn of the spinal cord has also received recent attention as a novel pathway of itch-selective neural transmission. The NMDA glutamate receptor appears to be another potential target for the treatment of itch, especially in terms of central sensitization. The development of NMDA receptor antagonists with less undesirable side effects on the central nervous system might be beneficial for antipruritic therapies. Drugs suppressing presynaptic glutamate-release such as gabapentin and pregabalin also reportedly inhibit certain subtypes of itch such as brachioradial pruritus. Spinal receptors of other neuromediators such as bradykinin, substance P, serotonin, and histamine may also be potential targets for antipruritic therapies, given that most of these molecules interfere not only with pain, but also with itch transmission or regulation. Thus, the identification of itch-specific receptors and understanding itch-related circuits in the spinal cord may be innovative strategies for the development of novel antipruritic drugs." [C-fiber activation involvement in itch may be part of low-level TrP activation. Itch, especially when it follows a pattern, might benefit from TrP assessment and treatments. DJS]

Ceylan Y, Hizmetli S, Silig Y. 2004.  The effects of infrared laser and medical treatments on pain and serotonin degradation products in patients with myofascial pain syndrome.  A controlled trial.  Rheumatol Int. 24(5):260-263.  IR laser may be highly effective for pain reduction in MPS patients.

Ceylan Y., Hizmetli S., Silig Y. 2003.  The effects of infrared laser and medical treatments on pain and serotonin degradation products in patients with myofascial pain syndrome.  A controlled trial. Rheumatol Int. [Epub Nov 20 ahead of print].  This study indicates that infrared laser treatment is effective for myofascial pain.

Chaitow L. 1998.  Raymond L Nimmo and the evolution of trigger point therapy, 1929-1986.  J Manipulative Physiol Ther. 21(8):575.  [Dr. Raymond Nimmo was responsible for much basic TrP therapy technique development.  He taught the concept that bones follow muscles – a concept that is still lacking in much medical training.  I have found anything written by Leon Chaitow to be well worth reading. This is no exception. DJS]

Chaitow L. 2007.  Chronic pelvic pain: Pelvic floor problems, sacroiliac dysfunction and the trigger point connection.  J Bodywork Move Ther 11(4):327-339.  This review is packed with information.  Chronic pelvic pain is poorly understood and may have far-reaching connections including breathing dysfunction and sacroiliac and urethral instability.   This review includes excellent illustrations, clear explanations of the connections of specific links between symptoms and often unsuspected causes, and methods of examination and treatment.  The importance of pelvic muscle tone is often greatly underestimated, and often much can be done to relieve symptoms often thought of as untreatable.

Chalaye P, Lafrenaye S, Goffaux P et al. 2013. The role of cardiovascular activity in fibromyalgia and conditioned pain modulation. Pain. [Dec 14 Epub ahead of print.] "Patients with FM had higher heart rate than HS at baseline and during CPT. Higher heart rate was related with higher pain intensity during the CPT (cold presser test). Blood pressure increments during CPT were weaker in the FM group. CPM (conditioned pain modulation) was less effective in FM patients than HS. Importantly, systolic blood pressure responses during CPT were positively related to CPM effectiveness, suggesting that reduced blood pressure response during the conditioning stimulus could be involved in CPM dysfunction in the FM group. Higher heart rate could be implicated in the greater sensitivity to cold pain in FM. Patients with FM have reduced blood pressure response to a painful CPT Reduced cardiovascular reactivity to pain could have important involvement in diminished endogenous pain inhibition efficacy and FM pathophysiology."

Chamani G, Zarei MR, Momenzadeh A et al. 2012. Prevalence of musculoskeletal disorders among dentists in Kerman, Iran. J Musculoskel Pain. 20(3):202-207. We need to identify risk factors of developing musculoskeletal disorders, including static postures. Knowledge of ergonomics and preventative measures must be part of undergraduate education.

Chan AW, Lee A, Suen LK et al. 2011. Tai chi Qigong improves lung functions and activity tolerance in COPD clients: A single-blind, randomized controlled trial. Complement Ther Med. 19(1):3-11. "Results of repeated measures of analysis of covariance demonstrated that there were significant interaction effects between time and group in forced vital capacity... forced expiratory volume... and exacerbation 3 months. Improvements were noted in the TCQ group. No changes were observed in the exercise group, while a decline in lung functions was noticed in the control group..... Tai chi Qigong was able to improve respiratory functions and activity tolerance level in COPD clients. The breathing and walking exercise helped maintain lung functions and slow down disease progression." [This is of critical importance to patients with FM and CMP, as both conditions are marked by enr4gy crisis in the tissues, and lack of oxygen. This study indicates that tai chi chuan can improve oxygenation of the tissues. Also, COPD has been shown to directly affect oxygenation of muscle fibers, and thus susceptibility to TrPs. DJS]

Chan K, Qin L, Lau M et al.  2004.  A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women.  Arch Phys Med Rehabil. 85(5):717-722.  The practice of t’ai chi chuan may retard some bone loss.

Chan R, Lee M, Lee S. 2007.  Needle electrical intramuscular stimulation for MPS: the VAS change of pain perception.  J Musculoskel Pain 15 (Supp 13):14 item 18.  [Myopain 2007 Poster]   “NEIMS yield a good immediate pain relief [VAS drop about 2 scales] to the MPS patients.  The effect can last for around one week.  There is no treatment-tolerance after multiple NEIMS treatments.”

Chan YC, Wang TJ, Chang CC et al. 2015. Short-term effects of self-massage combined with home exercise on pain, daily activity, and autonomic function in patients with myofascial pain dysfunction syndrome. J Phys Ther Sci. 27(1):217-221. "The aim of the present was to investigate the short-term effects of a program combining self-massage and home exercise for patients with myofascial pain dysfunction syndrome (MPDS)….In this retrospective study, 63 patients were allocated to the experimental…and control…groups. Both groups received 6 sessions of treatment with physical modalities over the course of two weeks. The experimental group completed an additional program with a combination of self-massage and home exercise. The outcome measurements included a pain scale, pressure pain threshold (PPT), neck disability index (NDI), patient-specific functional scales (PSFS), and heart rate variability (HRV). The interactions between the groups and over time were analyzed using two-way repeated measures ANOVA….Only the experimental group demonstrated significant improvements in the pain scale with varying conditions. The PPTs of the trigger points increased significantly in the experimental group, and significant functional improvements in NDI and PSFS were observed in the same group. There were significant increases in high-frequency HRV and high-frequency % in the experimental group.… Treatment with physical modalities plus combination of self-massage and home exercise is more effective than the physical modalities treatment alone." Free PMC Article

Chandler TJ, Kibler WB. 1993.  A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis.  Sports Med 15(5):344-352.  [Understanding biomechanics of the foot may help treat and reduce recurrence of plantar fasciitis.  This article would have benefitted greatly by inclusion of data concerning myofascial TrPs. DJS]

Chandra, S. and R. K. Chandra. 1986. Nutrition, immune response, and outcome. Prog Food Nutr Sci 10(1-2):1-65.

Chang CC, Chang ST. 2009.  Excessive yawning induced by stimulation of myofascial trigger point-case report.  Eur J Neurol. 16(6):e118-119.

Chang CW, Chen YR, Chang KF. 2008.  Evidence of neuroaxonal degeneration in myofascial pain syndrome: a study of neuromuscular jitter by axonal microstimulation.  Eur J Pain. 12(8):1026-1030.  “The present study with axonal microstimulation and SFEMG (single-fiber electromyography) demonstrates a prominent evidence of neuroaxonal degeneration and neuromuscular transmission disorders in the trigger point muscles of MPS patients.  The mechanism of MPS is possible implicated with the degeneration of motor neurons.”

Chang FY, Lu CL. 2013. Irritable bowel syndrome and migraine: bystanders or partners? J Neurogastroenterol Motil. 19(3):301-311. "Irritable bowel syndrome (IBS) and migraine are distinct clinical disorders. Apart from the characteristics of chronic and recurrent pain in nature, these pain-related disorders apparently share many similarities. For example, IBS is female predominant with community prevalence about 5-10%, whereas that of migraine is 1-3% also showing female predominance. They are often associated with many somatic and psychiatric comorbidities in terms of fibromyalgia, chronic fatigue syndrome, interstitial cystitis, insomnia and depression etc., even the IBS subjects may have coexisted migraine with an estimated odds ratio of 2.66. They similarly reduce the quality of life of victims leading to the social, medical and economic burdens. Their pathogeneses have been somewhat addressed in relation to biopsychosocial dysfunction, heredity, genetic polymorphism, central/visceral hypersensitivity, somatic/cutaneous allodynia, neurolimbic pain network, gonadal hormones and abuses etc. Both disorders are diagnosed according to the symptomatically based criteria. Multidisciplinary managements such as receptor target new drugs, melatonin, antispasmodics, and psychological drugs and measures, complementary and alternatives etc. are recommended to treat them although the used agents may not be necessarily the same. Finally, the prognosis of IBS is pretty good, whereas that of migraine is less fair since suicide attempt and stroke are at risk. In conclusion, both distinct chronic pain disorders to share many similarities among various aspects probably suggest that they may locate within the same spectrum of a pain-centered disorder such as central sensitization syndromes."

Chang L, Berman S, Mayer EA, 2003.  Brain responses to visceral and somatic stimuli in patients with irritable bowel syndrome with and without fibromyalgia.  Am J. Gastroenterol 98(6):1354-1361. Irritable bowel syndrome and fibromyalgia may have similar central pathophysiologic mechanisms.

Chang YP, Compton P. 2013. Management of chronic pain with chronic opioid therapy in patients with substance use disorders. Addict Sci Clin Pract. 8(1):21. "Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life."

Chao J. 2005.  Retrospective analysis of kadian (morphine sulfate sustained-release capsules) in patients with chronic, nonmalignant pain.  Pain Med. 6(3):262-265.  “Kadian® use did not result in escalation of dose strength or frequency, and was safe and efficacious regardless of patient age.”

Chao JD, Memmel HC, Redding JF. 2002.  Reduction mammaplasty is a functional operation, improving quality of life in symptomatic women: a prospective, single-center breast reduction outcome study.  Plast Reconstr Surg. 110(7):1644-1652.  “Reduction for symptomatic breast hypertrophy can effect a statistically significant improvement in these objective measures of pain, disability, muscle weakness and poor posture.”

Chao Y.F., Chen S.Y., Lan C. et al. 2002.  The cardiorespiratory response and energy expenditure of “Tai-Chi-Qui-Gong.  Am J Chin Med 30(4):451-461.  T’ai chi is a low intensity valid alternative exercise program for cardiopulmonary rehabilitation.

Chaplan, S. R., F. W. Bach, S. L. Shafer and T. L. Yaksh.  1995.  Prolonged alleviation of tactile allodynia by intravenous lidocaine in neuropathic rats.  Anesthesiology 83(4):775-785.

Chapman CR, Bradshaw DH. 2013. Only modest long-term opioid dose escalation occurs over time in chronic nonmalignant pain management. J Pain Palliat Care Pharmacother. [Oct 21 Epub ahead of print]. "Clinical experience and the literature increasingly support differentiating chronic pain associated with malignant disease from chronic pain associated with nonmalignant conditions when defining optimal pharmacotherapy. The use of opioids for chronic nonmalignant pain has grown steadily despite the lack of a strong evidence base that can guide practice. A fundamental question is whether patients develop tolerance and need repeated dose escalations to sustain pain control. We examined opioid prescribing data from United Kingdom Clinical Practice Research Datalink longitudinal database of general practice records and tracked dose changes but not pain reports in a sample of 4035 patients who received oral or transdermal-extended release opioids for chronic nonmalignant pain. The median number of days on opioid pharmacotherapy for all patients was 311. Thirty percent of patients never changed doses during the course of treatment. In patients who never changed medications, the mean morphine equivalent 24-hour dose increased from beginning to end of opioid pharmacotherapy only by 1.4 fold…and was independent of both age and gender. Comparison across extended release morphine, oxycodone, and fentanyl revealed that it was significantly greatest for patients using fentanyl and least for those using morphine."

Chapman, C. R. and J. Gavrin.  1999.  Suffering: the contributions of persistent pain.  Lancet 353(9171):2233-7. 

Chappell AS, Littlejohn G, Kajdasz DK et al. 2009.  A 1-year safety and efficacy study of duloxetine in patients with fibromyalgia. Clin J Pain. 25(5):365-375.

Charles A. 2012. The Evolution of a Migraine Attack - A Review of Recent Evidence. Headache. [Dec 20 Epub ahead of print]. "A migraine attack is an extraordinarily complex brain event that takes place over hours to days. This review focuses on recent human studies that shed light on the evolution of a migraine attack. It begins with a constellation of premonitory symptoms that are associated with activation of the hypothalamus and may involve the neurotransmitter dopamine. Even in the premonitory phase, patients experience sensitivity to sensory stimuli, indicating that central sensitization is a primary phenomenon. The migraine attack progresses to a phase that in some patients includes aura, which involves changes in cortical function, blood flow, and neurovascular coupling. The aura phase overlaps with the headache phase, which is associated with further changes in blood flow and function of the brainstem, thalamus, hypothalamus, and cortex. Serotonin receptors, nitric oxide, calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide, and prostanoids are demonstrated specific chemical mediators of migraine based on therapeutic and triggered migraine studies. A number of migraine symptoms persist beyond resolution of headache into a postdromal phase, accompanied by persistent blood flow changes in several brain regions. Although these phases of migraine have substantial temporal, neurochemical, and anatomical overlap, each represents an important window onto the pathophysiology of migraine as well as a target for therapeutic intervention. A comprehensive approach to migraine requires an understanding of the entire range of mechanisms and resultant symptoms that occur throughout the evolution of an attack."

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."

Chau KW, Mao DW. 2006.  The characteristics of foot movements in Tai Chi Chuan.  Res Sports Med. 14(1):19-28.  “The movements classified are shown to simulate balance, flexibility and proprioception, and functional training.  The findings partially explain the relationship between practicing TCC (t’ai chi chuan) and its health benefits.”

Chaves TC, Nagamine HM, de Sousa LM et al. 2013. Differences in pain perception in children reporting joint and orofacial muscle pain. J Clin Pediatr Dent. 37(3):321-327. "MP (myofascial pain) more accurately differentiated symptomatic subjects from symptom-free TMD (temporomandibular dysfunction) subjects, and PPT (pressure point threshold) values were more sensitive to the discrimination of pain in the orofacial sites assessed. In addition, the changes in perception at a larger number of sites among children reporting mixed pain may suggest the presence of a possible mechanism of central sensitization."

Chawla PS, Kochar MS. 1999.  Effect of pain and nonsteroidal analgesics on blood pressure.  WMJ 98(5):22-25, 29.  “NSAIDs antagonize the antihypertensive effect of diuretics, beta-blockers and ACE inhibitors more than that of calcium-channel blockers.  The elderly and those with salt-sensitive hypertension experience greater rise in blood pressure with NSAIDs.  Physicians should avoid NSAIDs and instead use alternative analgesics such as acetaminophen and physical therapy for control of pain.  Since both pain and hypertension are common, it is important that their relationship be well understood by the primary care physicians.”

Check JH, Cohen R. 2014. Marked improvement of pain from long-term fibromyalgia with dextroamphetamine sulfate in a woman who failed to improve with conventional pharmacologic treatment. Clin Exp Obstet Gynecol. 41(1):90-92. "Dextroamphetamine sulfate extended release capsules once daily was gradually increased to 25 mg per day in a woman with treatment resistant fibromyalgia of 20 years duration….Within a short time, the woman experienced dramatic relief of pain. Furthermore, her edema improved resulting in a 27 pound weight loss and her chronic fatigue improved….Fibromyalgia can be effectively treated with an innocuous dose of dextroamphetamine sulfate." [This ONE person responded, and there was no assessment for any comorbidities. Fibromyalgia is heterogenous. More research needed here, and the general conclusion given, IMO, is unwarranted. DJS]

Check JH, Katsoff B, Citerone T et al. 2005.  A novel highly effective treatment of interstitial cystitis causing chronic pelvic pain of bladder origin: case reports.  Clin Exp Obstet Gynecol 32(4):247-249.  Dextroamphetamine sulfate seems to be helpful for this condition.

Check JH, Katsoff D, Kaplan H et al. 2007.  A disorder of sympathomimetic amines leading to increased vascular permeability may be the etiologic factor in various treatment refractory health problems in women.  Med Hypotheses.  [Aug 30 Epub ahead of print]  “There is an evidence that increased capillary permeability in the standing position is related to a deficit in the sympathetic nervous system.”  “One of the most common manifestations is the inability to lose weight despite proper dieting.  A randomized study comparing the efficacy of a diuretic, a converting enzyme inhibitor, spironolactone and a sympathomimetic amine on weight loss in diet refractory women found that only the latter in the form of dextroamphetamine sulfate demonstrated significant weight reduction over a six month time span.”  “The diagnosis of a deficit in sympathomimetic amines is established by demonstrating an abnormal clearance of a water load in the erect position and exclusion of other conditions that are associated with an abnormal free water clearance, e.g., hypothyroidism, renal or liver disease or congestive heart failure.”  “There are several conditions that have proven refractory to conventional theory that respond quickly and effectively to sympathomimetic amines.  There have been many anecdotal reports of relieving intractable pain syndromes quickly and efficiently with sympathomimetic amine theory, despite failure with a multitude of other therapies.  These include interstitial cystitis and pelvic pain that was attributed to endometriosis, gastrointestinal pain including esophagitis and gastroparesis, headaches, joint pain, fibromyalgia, and carpal tunnel syndrome.  It is not clear if the improvement in pain is related to a decrease in fluid retention or a direct effect of the sympathomimetic amines on the sympathetic nervous system.”  “These studies strongly suggest that physicians be aware of this condition involving a deficit in the sympathetic nervous system when faced with various enigmatic complaints especially if standard therapy has not proven effective.”  [This review has made connections that may explain why an FM subset of patients and those with other conditions respond to some stimulants and other medications in this class. DJS]

Check JH, Shanis BS, Shapse D et al. 1995.  A randomized comparison of the effect of two diuretics, a converting enzyme inhibitor, and a sympathomimetic amine on weight loss in diet-refractory patients.  “...the results suggest that some women who are recalcitrant to dietary weight loss may have a mild type of water retention that is refractory to diuretics but responsive to amphetamines.”

Check,  J. H. , H. g. Adelson and C. H. Wu. 1982. Improvement of cervical factor with guaifenesin. Fertil Steril 37(5):707-708.

Chee EK, Walton H. 1986.  Treatment of trigger points with microamperage transcutaneous electrical nerve stimulation (TENS) – (the Electro-Acuscope 80).  J Manipulative Physiol Ther. 9(2):131-134.  “Results indicate that the subjects who received treatment had a higher change of trigger-point indicators compared to those receiving the placebo treatment.”

Chelimsky G, Heller E, Buffington C et al. 2012. Co-morbidities of interstitial cystitis. Front Neurosci. 6:114. Introduction: This study aimed to estimate the proportion of patients with interstitial cystitis/painful bladder syndrome (IC/BPS) with systemic dysfunction associated co-morbidities such as irritable bowel syndrome (IBS) and fibromyalgia (FM)....Co-morbid complaints in the IC/BPS groups included gastrointestinal symptoms suggestive of IBS and dyspepsia, sleep abnormalities with delayed onset of sleep, feeling poorly refreshed in the morning, waking up before needed, snoring, severe chronic fatigue and chronic generalized pain, migraines, and syncope....Our findings mirror those of others in regard to IBS, symptoms suggestive of FM, chronic pain, and migraine. High rates of syncope and functional dyspepsia found in the IC/BPS groups merit further study to determine if IC/BPS is part of a diffuse disorder of central, autonomic, and sensory processing affecting multiple organs outside the bladder.[It is most unfortunate that myofascial trigger points, one of the main co-existing conditions of irritable bladder and bowel, as well as one of the main causes, was not included in this study. DJS]

Chen AT. 2012. Information Seeking over the Course of Illness: The Experience of People with Fibromyalgia. Musculoskeletal Care. [Jun 27 Epub ahead of print]. "Although there is literature addressing the fibromyalgia illness experience, there has been limited work concerning how people with fibromyalgia utilize health information. The aim of this study was therefore to investigate the information needs and information-seeking patterns of such individuals, and how these might change over time....Respondents used the internet most frequently, but also placed great value on information from others, including healthcare practitioners, family and friends. Among the online sources, organization websites, health portals and health-related social networking sites were most frequently used. Topics of interest to people with fibromyalgia vary as they move from an initial stage of confusion, to diagnosis and eventually to a stage of equilibrium in which they are satisfied with their management of their condition. Aside from symptoms and treatments, topics often reflect a need to understand the meaning of their condition and coping skills.

Chen CL, Robert JJ, Orr WC. 2008.  Sleep symptoms and gastroesophageal reflux.  J Clin Gastroenterol. 42(1):13-17.  “Nighttime heartburn together with sleep complaints is associated with excessive gastroesophageal reflux.”

Chen CL, Broom DC, Liu Y et al. 2006.  Runx1 determines nociceptive sensory neuron phenotype and is required for thermal and neuropathic pain. Neuron. 49(3):365-377.  “In mammals, the perception of pain is initiated by the transduction of noxious stimuli through specialized ion channels and receptors expressed by nociceptive sensory neurons.”  “Thus, Runx1, a Runt domain transcription factor, coordinates the phenotype of a large cohort of nociceptors, a finding with implications for pain therapy.”

Chen CS, Ingber DE. 1999.  Tensegrity and mechanoregulation: from skeleton to cytoskeleton.  Osteoarthritis Cartilage. 7(1):81-94.  This article explains how factors affecting one portion of the body can affect the whole, down to the molecular level.

Chen I, Kurz J, Pasanen M et al. 2005.  Racial differences in opioid use for chronic nonmalignant pain.  J Gen Intern Med. 20(7):593-598.  “Equal treatment by race occurs in nonopioid-related therapies, but white patients are more likely than black patients to be treated with opioids.”

Chen JJ, Wang JY, Chang YM et al. 2007.  Regional cerebral blood flow between primary and concomitant fibromyalgia patients: a possible way to differentiate concomitant fibromyalgia from the primary disease.  Scand J Rheumatol. 36(3):226-232.  “Reduced rCBF at cortical regions, in addition to previously reported areas at the thalamus and the subcortical nucleus, in FM patients was demonstrated in this study.  The perfusion deficit areas were similar between primary and concomitant FM when the underlying disease activity was quiescent.  The feasibility of using this neuroimaging rheumatoid arthritis (RA)-associated depression and neuropsychiatric lupus, should be considered.”

Chen JT, Chung KC, Hou CR et al. 2001.  Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle.  Am J Phys Med Rehabil. 80(10):729-735.  “Dry needling of the myofascial trigger spot is effective in diminishing SEA (spontaneous electrical activity) if local twitch responses are elicited.  The local twitch response elicitation, other than trauma effects of needling, seems to be the primary inhibitory factor on SEA during dry needling.”

Chen, J. T. S. M. Chen, T. S. Kuan, K. C. Chung and C. Z. Hong. 1998. Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle. Arch Phys Med Rehabil 79(7):790-4.

Chen K, Hong C, Hsu H et al. 2010. Dose-dependent and ceiling effects of therapeutic laser on myofascial trigger spots in rabbit skeletal muscles. J Musculoskel Pain 18(3).235-245. Low-level laser treatment seems to be effective in quieting endplate noise in rabbits. Irritability of TrPs, indicated by endplate noise, was affected differently with different dosage. Further studies are needed, and human studies, before significance of this finding can be understood, but it does offer hope of another potential TrP treatment.

Chen KH, Hong CZ, Kuo FC et al. 2007.  Electrophysiological effects of therapeutic laser on trigger spots of rabbit skeletal muscles.  J Musculoskel Pain 15 (Supp 13):24 item 38.  [Myopain 2007 Poster]

Chen KH, Hsiao KY, Lin CH et al. 2013. Remote effect of lower limb acupuncture on latent myofascial trigger point of upper trapezius muscle: a pilot study. Evid Based Complement Alternat Med. [Apr 28 Epub ahead of print]. "To demonstrate the use of acupuncture in the lower limbs to treat myofascial pain of the upper trapezius muscles via a remote effect…Five adults with latent myofascial trigger points (MTrPs) of bilateral upper trapezius muscles received acupuncture at Weizhong (UB40) and Yanglingquan (GB34) points in the lower limbs. Modified acupuncture was applied at these points on a randomly selected ipsilateral lower limb (experimental side) versus sham needling on the contralateral lower limb (control side) in each subject. Each subject received two treatments within a one-week interval. To evaluate the remote effect of acupuncture, the range of motion (ROM) upon bending the contralateral side of the cervical spine was assessed before and after each treatment….There was significant improvement in cervical ROM after the second treatment (P = 0.03) in the experimental group, and the increased ROM on the modified acupuncture side was greater compared to the sham needling side (P = 0.036). Conclusions: A remote effect of acupuncture was demonstrated in this pilot study. Using modified acupuncture needling at remote acupuncture points in the ipsilateral lower limb, our treatments released tightness due to latent MTrPs of the upper trapezius muscle."

Chen KW, Hassett AL, Hou F et al. 2006.  A pilot study of external qigong therapy for patients with fibromyalgia.  J Altern Complement Med. 12(9):851-856.  “Treatment with EQT resulting in complete recovery for some FMS patients suggests that TCM may be very effective for treating pain and the multiplicity of symptoms associated with FMS.  Larger controlled trials of this promising intervention are urgently needed.”

Chen Q, Basford J, An KN. 2008. Ability of magnetic resonance elastography to assess taut bands. Clin Biomech (Bristol, Avon) 23(5):623-629. "Using magnetic resonance elastography, the Mayo clinic was able to image the taut bands of trigger points. There is now objective evidence of the existence of TrPs." [It is expensive and not available in most localities. It does prove their existence, however, and their importance cannot be disputed. Care providers must rely on the palpation techniques and their information-gathering senses including eyes, fingers and brains to locate TrPs. Those who are untrained in diagnosis and treatment of myofascial TrPs, one of the leading causes of musculoskeletal pain, and many other symptoms, must consider carefully the ethics of taking money for pain management. They might also hasten to learn these skills from a reputable myofascial TrP school such as Myopain. DJS]

Chen Q, Bensamoun S, Basford JR et al. 2007. Identification and quantification of myofascial taut bands with magnetic resonance elastography.  Arch Phys Med Rehabil. 88(12):1658-1661.  “Our findings suggest that MRE can quantitate asymmetries in muscle tone that could previously only be identified subjectively by examination.”   This includes myofascial trigger points

Chen, S. M., J. T. Chen, T. S. Kuan and C. Z. Hong.  1998.  Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve.  Arch Phys Med Rehabil 79(3):336-338.

Chen WK, Liu IY , Chang YT et al. 2010. Cav3.2 T-Type Ca2+ Channel-Dependent Activation of ERK in Paraventricular Thalamus Modulates Acid-Induced Chronic Muscle Pain. J Neurosci. 30(31):10360-10368. "Treatments for chronic musculoskeletal pain, such as lower back pain, fibromyalgia, and myofascial pain syndrome, remain inadequate because of our poor understanding of the mechanisms that underlie these conditions. Although T-type Ca(2+) channels (T-channels) have been implicated in peripheral and central pain sensory pathways, their role in chronic musculoskeletal pain is still unclear....Our findings suggest that Ca(v)3.2 T-channel-dependent activation of ERK in PVA is required for the development of acid-induced chronic mechanical hyperalgesia." [This is especially interesting due to the hypothesis that myofascial TrPs are caused by a calcium channelopathy, and that FM central sensitization may be caused by myofascial TrPs. DJS]

Chen WN, Lee CH, Lin SH et al. 2014. Roles of ASIC3, TRPV1, and NaV1.8 in the transition from acute to chronic pain in a mouse model of fibromyalgia. Mol Pain. 10(1):40. "Tissue acidosis is effective in causing chronic muscle pain. However, how muscle nociceptors contribute to the transition from acute to chronic pain is largely unknown….Here we showed that a single intramuscular acid injection induced a priming effect on muscle nociceptors of mice. The primed muscle nociceptors were plastic and permitted the development of long-lasting chronic hyperalgesia induced by a second acid insult. The plastic changes of muscle nociceptors were modality-specific and required the activation of acid-sensing ion channel 3 (ASIC3) or transient receptor potential cation channel V1 (TRPV1). Activation of ASIC3 was associated with increased activity of tetrodotoxin (TTX)-sensitive voltage-gated sodium channels but not protein kinase Cepsilon (PKCepsilon) in isolectin B4 (IB4)-negative muscle nociceptors. In contrast, increased activity of TTX-resistant voltage-gated sodium channels with ASIC3 or TRPV1 activation in NaV1.8-positive muscle nociceptors was required for the development of chronic hyperalgesia. Accordingly, compared to wild type mice, NaV1.8-null mice showed briefer acid-induced hyperalgesia (5 days vs. >27 days)…..ASIC3 activation may manifest a new type of nociceptor priming in IB4-negative muscle nociceptors. The activation of ASIC3 and TRPV1 as well as enhanced NaV1.8 activity is essential for the development of long-lasting hyperalgesia in acid-induced, chronic, widespread muscle pain." Free Article

Cheng J, Abdi S. 2007.  Complications of joint, tendon, and muscle injections.  Tech Reg Anesth Pain Manag. 11(3):141-147.  “We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the procedural techniques with a clear understanding of the relevant anatomies.”  [TrP injections must be done according to procedure specified by Travell and Simons, including aseptic technique (preferably first using a non-alcohol agent on the skin, as alcohol toughens the skin with time), proper positioning, and including range of motion stretching, to ensure optimum efficiency. DJS]

Cheng ST, Chow PK, Song YQ et al. 2012. Mental and Physical Activities Delay Cognitive Decline in Older Persons with Dementia. Am J Geriatr Psychiatry. [Nov 5 Epub ahead of print]. "Mahjong and TC can preserve functioning or delay decline in certain cognitive domains, even in those with significant cognitive impairment."

Cheng XF, Tan J, Tan KL. 2005.  [Clinical analysis of six cases with juvenile primary fibromyalgia syndrome.]  Zhonghua Er Ke Za Zhi 43(11):863-865. [Chinese]  “Juvenile primary FMS may not be a rare disease and the clinicians should pay more attention to it for avoiding misdiagnosis.”

Cheras, P. A., A. N. Whitaker, E. A. Blackwell, T. J. Sinton, M. D. Chapman and K. A. Peacock. 1997. Hypercoagulability and hypofibrinolysis in primary osteoarthritis.  Clin Orthop (334):57-67.

Cherkin DC, Sherman KJ, Kahn J et al. 2011. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med 155(1):1-9). This study compared structural, relaxation massage and usual care for chronic low back pain patients. The findings: "Massage therapy may be effective for treatment of chronic low back pain, with benefits lasting at least 6 months." Both massage varieties were equally effective.

Cherry BJ, Weiss J, Barakat BK et al. 2009. Physical performance as a predictor of attention and processing speed in fibromyalgia.  Arch Phys Med Rehabil. 90(12):2066-2073.  “…as the physical performance level decreased, cognitive performance levels decreased.”  “Findings suggest that research is needed to determine whether patterns of physical activity participation through their effects on physical fitness and performance can enhance cognitive performance in persons with FM.  Physiologic changes in specific brain regions in FM (e.g., hippocampus, neural pain regions) suggest that further research is also warranted in determining specific relationships between biomarkers and cognitive performance in persons with FM.”   [One must also consider that physical performance often decreases in regard to pain level, and pain has considerable effect on cognitive performance.  Adequate pain control may have much to do with ability and desire to exercise. DJS]

Cherry BJ, Zettel-Watson L, Shimizu R et al. 2012. Cognitive Performance in Women Aged 50 Years and Older With and Without Fibromyalgia. J Gerontol B Psychol Sci Soc Sci. [Dec 28 Epub ahead of print]. "Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding)…..Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted."

Cheshire, W. P., S. W. Abashian and J. D. Mann.  1994.  Botulinum toxin in the treatment of myofascial pain syndrome.  Pain 59(1):65-9.

Chevlen, E.  2000.  Morphine with dextromethorphan; conversion from other opioid analgesics. J Pain Symptom Manage 19(1 Suppl):S42-9.  MS:DM appears safe and effective in treating moderate to severe chronic pain.

Chiang CY, Li Z, Dostrovsky JO, Sessle BJ. 2010. Central sensitization in medullary dorsal horn involves gap junctions and hemichannels. Neuroreport. 21(3):233-237.  “Central sensitization is a fundamental mechanism contributing to acute and chronic pain conditions. Our previous studies have documented a glutamatergic, purinergic and glial-dependent central sensitization that can be induced in rat medullary dorsal horn nociceptive neurons by mustard oil application to the tooth pulp. This study showed that carbenoxolone, a potent gap junction and hemichannel blocker, completely blocked all parameters of mustard oil-induced central sensitization tested in functionally identified medullary dorsal horn nociceptive neurons. These results represent the first evidence suggesting that gap junctions and hemichannels may have a critical role in mediating central sensitization in dorsal horn nociceptive neurons and may account for the spread as well as development of central sensitization.”

Chiarella G, Tognini S, Nacci A et al. 2014. Vestibular disorders in euthyroid patients with Hashimoto's thyroiditis: role of thyroid autoimmunity. Clin Endocrinol (Oxf). [Apr 16 Epub ahead of print.] "This finding suggests that circulating anti-thyroid autoantibodies may represent a risk factor for developing vestibular dysfunction. An accurate vestibular evaluation of HT patients with or without symptoms is therefore warranted."

Chiarotto A, Fernandez-de-Las-Penas C, Castaldo M et al. 2013. Bilateral Pressure Pain Hypersensitivity over the Hand as Potential Sign of Sensitization Mechanisms in Individuals with Thumb Carpometacarpal Osteoarthritis. Pain Med. [Jun 26 Epub ahead of print]. "OBJECTIVE: To investigate whether bilateral deep tissue pressure hyperalgesia exists in individuals with unilateral thumb carpometacarpal osteoarthritis (CMC OA). METHODS: A total of 32 patients with CMC OA (29 females and 3 males, aged 69-90 years old) and 32 healthy matched controls (29 females and 3 males, aged 70-90 years) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over the first CMC joint, the hamate bone and the lateral epicondyle in a blinded design. Mixed models analyses of variance were conducted to determine the differences in pressure pain sensitivity between groups and sides….DISCUSSION: This study revealed bilateral localized pressure pain hypersensitivity over the hand in individuals with unilateral thumb CMC OA, suggesting spinal cord sensitization mechanisms in this population. Future studies should analyze the presence of widespread pressure pain sensitivity in patients with thumb CMC OA to further determine the presence of central sensitization mechanisms."

Chiel HJ, Ting LH, Ekeberg O et al. 2009.  The brain in its body: motor control and sensing in a biomechanical context. J Neurosci. 29(41):12807-12814.  “These studies illustrate that control may be shared between the nervous system and the periphery, that neural activity organizes degrees of freedom into biomechanically meaningful subsets, that mechanics alone may play crucial roles in enforcing gait patterns, and that mechanics of sensors is crucial for their function.

Chim D, Brodsky M, Hui KK. 2007.  Teaching medical students trigger point techniques.  Fam Med. (1):8.  “Myofascial pain is underemphasized in medical education and underrecognized in clinical practice.”

Chiu, H. F., T. Leung, L. C. Lam, Y. K. Wing, D. W. Chung, S. W. Li,  I. Chi, W. T. Law and K. W. Boey.  1999. Sleep problems in Chinese elderly in Hong Kong. Sleep 22(6):717-26.

Chiu KC, Chu A, Go VLW et al. 2004.  Hypovitaminosis D is associated with insulin resistance and B cell dysfunction.  Amer Jour Clinical Nut. 79(5):820-825.  This may be very pertinent as I have observed insulin resistance to be a common perpetuating factor for both FMS and CMP, and vitamin D insufficiency is implicated as one cause of musculoskeletal pain.

Cho JW, Chu K, Jeon BS. 2001.  Case of essential palatal tremor: atypical features and remarkable benefit from botulinum toxin injection.  Mov Disord. 16(4):779-782.  An injection of Botox into the tensor veli palatini muscles cured essential palatal tremor.  [The patient had some control over the tremor before treatment.  Could there have been myofascial TrPs?  DJS. 

Cho KI, Lee JH, Kim SM et al. 2010. Assessment of endothelial function in patients with fibromyalgia-cardiac ultrasound study. Clin Rheumatol. [Oct 19 Epub ahead of print]. "In patients with fibromyalgia (FM) syndrome, stress and pain may chronically enhance sympathetic activity, altering cardiovascular response and inducing endothelial dysfunction. We investigated endothelial function in FM patients using echocardiography and analyzed whether endothelial function was affected by the clinical parameters of FM.... Pain exerts a negative effect on endothelial function in FM patients, and that effect was significantly different according to the FIQ (fibromyalgia impact questionnaire) score."

Cho KI, Lee JH, Lee HG et al. 2010. Assessment of myocardial function in patients with fibromyalgia and the relationship to chronic emotional and physical stress. Korean Circ J. 40(2):74-80. “An association between emotional or physical stressful triggers and adverse cardiovascular events, such as death and myocardial infarction, has been recognized for many years. The clinical features of transient left apical ballooning syndrome have been clearly described, but the effect of chronic stress on the myocardium is unknown. Our objective was to assess left ventricular (LV) function in patients with fibromyalgia (FM) with chronic emotional and physical stress….Global and segmental LV strains were negatively associated with fatigue, tender point count, and FIQ score. However, there was no significant association between depression and LV strain. This study demonstrated that chronic emotional or physical stress in FM patients might reduce myocardial longitudinal deformation.” [This connection between fibromyalgia and a transient heart condition needs follow-up, and may lead to preciously unknown consequences.  With the variety of metabolic cascades that can occur in FM, such intermittent or difficult to specify co-existing conditions are not unexpected.  I hope to see more research on this. DJS]

Cho, Z. H., S. C. Chung, J. P. Jones, J. B. Park, H. J. Park, H. J. Lee, E. K. Wong and B. I. Min. 1998.  New findings of the correlation between acupoints and corresponding brain cortices using function MRI. Proc Natl Acad Sci U S A 95(5):2670-2673.

Choi JI. 2014. Chicken and egg: peripheral nerve entrapment or myofascial trigger point? Korean J Pain. 27(2):186-188. In this letter, the author is commenting on the case report "Successful treatment of abdominal cutaneous entrapment syndrome (ACES) using ultrasound guided injections," written by WV Applegate. Dr. Choi calls attention to the fact that abdominal cutaneous entrapment syndrome is usually caused by trigger points, which are found by palpation, and yet myofascial pain syndrome was not mentioned in the article. The original author missed the point that the radiculopathy is often caused by trigger points as well. [I certainly am glad that Dr. Choi wrote this letter, and agree with him heartily. DJS]

Choi W 1, Lim M, Kim JS et al. 2014. Impaired pre-attentive auditory processing in fibromyalgia: A mismatch negativity (MMN) study. Clin Neurophysiol. [Oct 18 Epub ahead of print.] "Fibromyalgia (FM) patients often show deficits in cognitive functions such as attention and working memory. We assumed that pre-attentive information processing, a crucial element in human perception and cognition, would be altered in FM patients…. This study provided neurophysiological evidence of impaired pre-attentive sensory change detection in FM."

Choi YH, Jung SJ, Lee CH et al. 2014. Additional effects of transcranial direct-current stimulation and trigger-point injection for treatment of myofascial pain syndrome: A pilot study with randomized, single-blinded trial. J Altern Complement Med. [Aug 1 Epub ahead of print.] "Chronic pain caused by myofascial pain syndrome (MPS) results in generalized and debilitating conditions. Trigger-point injection (TPI) is the mainstay of MPS management to reduce acute and localized pain. Other adjunctive intervention to modulate the central pain pathway might be helpful if they are combined with TPI. Transcranial direct-current stimulation (tDCS), which is a form of neurostimulation, has been reported to be safe and effective in treating chronic pain by changing cortical excitability. Objectives: To determine whether there is an additional effect of tDCS and TPI to reduce pain in patients with MPS. Patients: Twenty-one patients with newly diagnosed MPS of shoulder girdle muscles. Interventions: Patients were randomly assigned into 1 of 3 groups (2 active and 1 sham stimulation groups) and received TPI. Immediately after TPI, tDCS (2 mA for 20 minutes on 5 consecutive days) was administered. For the active stimulation groups, tDCS was applied over 2 different locations (primary motor cortex and dorsolateral prefrontal cortex [DLPFC]). Outcome Measures: Visual analogue scale (VAS), Pain Threshold Test, and short form of the McGill Pain Questionnaire were measured before and immediately after stimulation for 5 consecutive days. Results: The mean VAS values were decreased in all three groups after 5 days. There was a significant change between before and after stimulation only in the DLPFC group. The significant change in the mean VAS value was shown from after the second stimulation session (p=0.031), and this remained significant until the last stimulation session (p=0.027). Conclusion: This study suggests that tDCS over DLPFC may have additional effects with TPI to reduce pain in patients with MPS. tDCS over DLPFC can be used to reverse central pain pathway by modulating cortical plasticity."

Choileain NN, Redmond HP. 2006.  Cell response to surgery.  Arch Surg. 141(11):1132-1140.   “Surgical trauma produces profound immunological dysfunction.  Therapeutic strategies directed at restoring immune homeostasis should aim to redress the physiological proinflammatory-anti-inflammatory cell imbalance associated with major surgery.”

Chong YY, Ng BY. 2009. Clinical aspects and management of fibromyalgia syndrome. Ann Acad Med Singapore. 38(11):967-973.  “Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pituitary-adrenal axis stress response system.  With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome.  This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS.  The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia – pregabalin, duloxetine and milnacipran.  Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioral therapy to be most effective.  Overall, management of FMS requires a multi-disciplinary approach.”

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."

Chopra P, Cooper MS. 2013. Treatment of Complex Regional Pain Syndrome (CRPS) Using Low Dose Naltrexone (LDN). J Neuroimmune Pharmacol. [Apr 2 Epub ahead of print]. "Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms."

Chou KC. 2004.  Insights from modeling three-dimensional structures of the human potassium and sodium channels.  J Proteome Res. 3(4):856-861.  Research in ion channel dysfunction may be revealing new strategies for treatment of chronic pain.

Chou LW, Hsieh YL, Chen HS et al. 2011. Remote therapeutic effectiveness of acupuncture in treating myofascial trigger point of the upper trapezius muscle. Am J Phys Med Rehabil. [Oct 20 Epub ahead of print]. This study used a modified rapid screw in and out acupuncture needle technique that elicited the myofascial local twitch response.

Chou LW, Hsieh YL, Kao MJ et al. 2009.  Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle.  Arch Phys Med Rehabil. 90(6):905-912.  “The change in the pain intensity was significantly correlated with the change of EPN amplitude (r=0.685).  Conclusions: Both subjective changes in the pain intensity and objective changes of the EPN (endplate noise) amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points.  This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control.”

Chou LW, Kao MJ, Lin JG. 2012. Probable mechanisms of needling therapies for myofascial pain control. Evid Based Complement Alternat Med. 2012:705327. "Myofascial pain syndrome (MPS) has been defined as a regional pain syndrome characterized by muscle pain caused by myofascial trigger points (MTrPs) clinically. MTrP is defined as the hyperirritable spot in a palpable taut band of skeletal muscle fibers. Appropriate treatment to MTrPs can effectively relieve the clinical pain of MPS. Needling therapies, such as MTrP injection, dry needling, or acupuncture (AcP) can effectively eliminate pain immediately. AcP is probably the first reported technique in treating MPS patients with dry needling based on the Traditional Chinese Medicine (TCM) theory…. There are several principles for selection of acupoints based on the TCM principles: "Ah-Shi" point, proximal or remote acupoints on the meridian, and extra-meridian acupoints. Correlations between acupoints and MTrPs are discussed. Some clinical and animal studies of remote AcP for MTrPs and the possible mechanisms of remote effectiveness are reviewed and discussed."

Chou LW, Hsieh YL, Kuan TS et al. 2014. Needling therapy for myofascial pain: recommended technique with multiple rapid needle insertion. Biomedicine (Taipei). 4:13. [Aug 2 Epub ahead of print.] "Myofascial trigger point (MTrP) is a major cause of muscle pain, characterized with a hyperirritable spot due to accumulation of sensitized nociceptors in skeletal muscle fibers. Many needling therapy techniques for MTrP inactivation exist. Based on prior human and animal studies, multiple insertions can almost completely eliminate the MTrP pain forthwith. It is an attempt to stimulate many sensitive loci (nociceptors) in the MTrP region to induce sharp pain, referred pain or local twitch response. Suggested mechanisms of needling analgesia include effects related to immune, hormonal or nervous system. Compared to slow-acting biochemical effects involving immune or hormonal system, neurological effects can act faster to provide immediate and complete pain relief. Most likely mechanism of multiple needle insertion therapy for MTrP inactivation is to encounter sensitive nociceptors with the high-pressure stimulation of a sharp needle tip to activate a descending pain inhibitory system. This technique is strongly recommended for myofascial pain therapy in order to resume patient's normal life rapidly, thus saving medical and social resources."

Chow DH, Leung KT, Holmes AD. 2007.  Changes in spinal curvature and proprioception of schoolboys carrying different weights of backpack.  Ergonomics. [Sep 19 Epub ahead of print].  “Carriage of a loaded backpack causes immediate changes in spinal curvature and appears to have a direct effect on the repositioning consistency.”   Patents and teachers must be made aware of the dangers posed to the youth of our country by carrying heavy backpacks.

Chow RT, Barnsley L, Heller GZ et al. 2004.  A pilot study of low-power laser therapy in the management of chronic neck pain.  Musculoskel Pain 12(2):71-81.

Chow R, Barnsley L, Heller GZ et al. 2003.  Efficacy of 300 mW, 830 nm laser in the treatment of chronic neck pain: a survey in a general practice setting.  J Musculoskel Pain 11(3):13-21.  “Low level laser therapy using this wavelength and power of infrared laser may provide a non-drug, non-invasive option for the management of neck pain.”

Choy E, Richards S, Bowrin K et al. 2010. Cost effectiveness of pregabalin in the treatment of fibromyalgia from a UK perspective. Curr Med Res Opin. [Feb 23 Epub ahead of print]  “Fibromyalgia is a chronic condition associated with widespread pain, sleep disturbance and disability.  Disease related costs are high and effective treatment options few….This model found pregabalin 300 mg and 450 mg to be cost effective compared with placebo and, within the limits of available evidence, against duloxetine using standard UK criteria in patients with fibromyalgia experiencing severe pain.”  [Unfortunately, it does not work on all patients, and some patients cannot tolerate it.  Co-existing conditions must still be brought under control and one must discover why and how the central sensitization occurred and bring that cause (or those causes) under control.  The temptation is to take the easy route and throw a pill at the patient.  In complex conditions such as FM, cookbook medicine does not apply.  Each patient is very different. DJS]

Choy E, Richards S, Bowrin K et al. 2010. Cost effectiveness of pregabalin in the treatment of fibromyalgia from a UK perspective. Curr Med Res Opin. [Feb 23 Epub ahead of print]  “Fibromyalgia is a chronic condition associated with widespread pain, sleep disturbance and disability. Disease related costs are high and effective treatment options few….This model found pregabalin 300 mg and 450 mg to be cost effective compared with placebo and, within the limits of available evidence, against duloxetine using standard UK criteria in patients with fibromyalgia experiencing severe pain.” [Unfortunately, it does not work on all patients, and some patients cannot tolerate it. Co-existing conditions must still be brought under control and one must discover why and how the central sensitization occurred and bring that cause (or those causes) under control. The temptation is to take the easy route and throw a pill at the patient. In complex conditions such as FM, cookbook medicine does not apply. Each patient is very different. DJS]

Choy EH. 2015. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. [Apr 28 Epub ahead of print.] "Fibromyalgia is a common cause of chronic widespread pain, characterized by reduced pressure pain thresholds with hyperalgesia and allodynia. In addition to pain, common symptoms include nonrestorative sleep, fatigue, cognitive dysfunction, stiffness and mood disturbances. The latest research indicates that the dominant pathophysiology in fibromyalgia is abnormal pain processing and central sensitization. Neuroimaging studies have shown that patients with fibromyalgia have similar neural activation to healthy age-matched and gender-matched individuals; however, they have a lower pressure-pain threshold. Polysomnography data has demonstrated that these patients have reduced short-wave sleep and abnormal α-rhythms, suggestive of wakefulness during non-REM (rapid eye movement) sleep. Sleep deprivation in healthy individuals can cause symptoms of fibromyalgia, including myalgia, tenderness and fatigue, suggesting that sleep dysfunction might be not only a consequence of pain, but also pathogenic. Epidemiological studies indicate that poor sleep quality is a risk factor for the development of chronic widespread pain among an otherwise healthy population. Mechanistically, sleep deprivation impairs descending pain-inhibition pathways that are important in controlling and coping with pain. Clinical trials of pharmacological and nonpharmacological therapies have shown that improving sleep quality can reduce pain and fatigue, further supporting the hypothesis that sleep dysfunction is a pathogenic stimulus of fibromyalgia." [Another study showing that an in-lab sleep study is one of the first tests to set up for any patient with fatigue and fibromyalgia. DJS]


Choy EH, Arnold LM, Clauw DJ et al. 2009.  Content and criterion validity of the preliminary core dataset for clinical trials in fibromyalgia syndrome.  J Rheumatol. 36(10):2330-2334.  [It is necessary to establish criteria, but as long as the criteria do not acknowledge that most if not all fibromyalgia patients have myofascial trigger points and that these trigger points may be the source of many of the symptoms, any criteria will be invalid and any research using it will be suspect.  Fibromyalgia is the amplifier, the central sensitization.  Trigger points and other peripheral sources are the pain and other symptom generators. DJS]

Chrednichenko G, Zhang R, Bannister RA et al. 2012. Triclosan impairs excitation-contraction coupling and Ca2+ dynamics in striated muscle. Proc Natl Acad Sci USA. 109(35):14158-14163. Triclosan, a commonly used antibacterial agent found in many hand soaps, dish detergents and other over-the-counter products, is a "priority pollutant" and "...acutely depresses hemodynamics and grip strength in mice...." It affects ryanodine binding, which is a calcium ion-channel receptor that has been suggested may be involved in myofascial trigger points. Triclosan "...weakens cardiac and skeletal muscle contractility in a manner that may negatively impact muscle health, especially in susceptible populations."

Chu J. 2000.  Twitch-obtaining intramuscular stimulation (TOIMS): long term observations in the management of chronic partial cervical radiculopathy.  Electromyogr Clin Neurophysiol 40(8):503-510.  “Observations suggest TOIMS to have potential value in the long-term management of partial cervical radiculopathy related myofascial pain.”

Chu J, Takehara I, Li TC et al. 2004.  Electrical twitch obtaining intramuscular stimulation (ETOIMS) myofascial pain syndrome in a football player.  Br J Sports Med. 38(5):E25.  ETOIMS may be helpful in reducing pain and increasing and maintaining range of motion in MPS.

Chugh, D. K., T. E. Weaver and D. F. Dinges.  1996.  Neurobehavioral consequences of arousals. Sleep 19(10 Suppl):S198-201.

Chung M, Wang C. 2013. Can alcohol consumption be an alternative treatment for fibromyalgia? Arthritis Res Ther. 15(6):126. "Treatment of chronic pain conditions such as fibromyalgia is challenging due to limitations of drug therapies. An initial exploration into the relationships between self-reported alcohol consumption, symptom severity, and quality of life for individuals with fibromyalgia sheds new light on plausible hypotheses and potential mechanisms of action for future research. Evidence suggests that alcohol consumption may improve social and psychological factors because of activity in the ascending and descending pain pathways in modulating gamma-aminobutyric acid neurotransmission. Further methodologically rigorous studies in this field to improve well-being of individuals with fibromyalgia are warranted." (From Tufts University School of Medicine)

Chung SD, Lin CC, Liu SP et al. 2013. Obstructive Sleep Apnea Increases the Risk of Bladder Pain Syndrome/Interstitial Cystitis: A Population-Based Matched-Cohort Study. Neurourol Urodyn. [Mar 28 Epub ahead of print]. "Previous studies indicated a possible association between bladder pain syndrome/interstitial cystitis (BPS/IC) and sleep disorders including sleep abnormalities with delayed onset of sleep, waking up before needed, and snoring. Nevertheless, no previous study has reported the association between obstructive sleep apnea (OSA) and BPS/IC....This study provides epidemiological evidence of a link between OSA and a subsequent BPS/IC diagnosis. We suggest that clinical practitioners treating subjects with OSA be alert to urinary complaints in this population."

Chwieduk CM, McCormack PL. 2010.  Milnacipran: in fibromyalgia.  Drugs. 70(1):99-108.  “In adults, milnacipran was generally effective in the treatment of fibromyalgia in four well designed trials of 3 or 6 months’ duration.”  “The benefits of milnacipran therapy were sustained in a 6-month extension of an initial double-blind trial.”  “Milnacipran was generally well tolerated in adults with fibromyalgia with most adverse events being mild to moderate in severity.  Nausea was the most common adverse event reported in milnacipran recipients.”

Ciappuccini R, Ansemant T, Maillefert JF et al. 2010. Aspartame-induced fibromyalgia, an unusual but curable cause of chronic pain. Clin Exp Rheumatol. 28(6 Suppl 63):S131-133. "We report for the first time an unusual musculoskeletal adverse effect of aspartame in two patients. A 50-year-old woman had been suffering from widespread pain and fatigue for more than 10 years leading to the diagnosis of fibromyalgia. During a vacation in a foreign country, she did not suffer from painful symptoms since she had forgotten to take her aspartame. All of the symptoms reappeared in the days following her return when she reintroduced aspartame into her daily diet. Thus, aspartame was definitively excluded from her diet, resulting in a complete regression of the fibromyalgia symptoms. A 43-year-old man consulted for a 3-year history of bilateral forearm, wrist, and hand and cervical pain with various unsuccessful treatments. A detailed questioning allowed to find out that he had been taking aspartame for three years. The removal of aspartame was followed by a complete regression of pain, without recurrence. We believe that these patients' chronic pain was due to the ingestion of aspartame, a potent flavoring agent, widely used in food as a calorie-saver. The benefit/ risk ratio of considering the diagnosis of aspartame-induced chronic pain is obvious: the potential benefit is to cure a disabling chronic disease, to spare numerous laboratory and imaging investigations, and to avoid potentially harmful therapies; the potential risk is to temporarily change the patient's diet. Thus, practitioners should ask patients suffering from fibromyalgia about their intake of aspartame. In some cases, this simple question might lead to the resolution of a disabling chronic disease." [Excitotoxins are perpetuating factors for FM and CMP. We now have indications excitotoxins, including aspartame and MSG, as initiating factors for FM. DJS]

Ciccone DS, Elliott DK, Chandler HK et al. 2005.  Sexual and physical abuse in women with fibromyalgia syndrome: a test of the trauma hypothesis.  Clin J Pain 21(5):378-386.  "With the exception of rape, no self-reported sexual or physical abuse event was associated with FMS in this community sample. [Emphasis mine. DJS]  In accord with the trauma hypothesis, however, posttraumatic stress disorder was more prevalent in the FMS group.  Chronic stress in the form of posttraumatic stress disorder but not major depressive disorder may mediate the relationship between rape and FMS.”

Ciccone DS, Just N, Bandilla EB et al. 2000.  Psychological correlates of opioid use in patients with chronic nonmalignant pain.  A preliminary test of the downhill spiral hypothesis.  J Pain Symptom Manage 20(3):180-192.  “There was no evidence that higher levels of opioid use were associated with higher levels of disability or depression.”

Cimbiz A, Beydemir F, Manisaligil U. 2006.  Evaluation of trigger points in young subjects.  J Musculoskel Pain 14(4):27-35.  It is necessary to diagnose and treat myofascial TrPs promptly in young patients, as they can become chronic and worsen with time.

Cimbiz A, Bayazit V, Hallaceli H et al. 2005.  The effect of combined therapy (spa and physical therapy) on pain in various chronic diseases.  Complement Ther Med. 13(4):244-250.  “The patients with ankle arthrosis, fibromyalgia and cervical disc herniation reported the highest VAS (Visual Analog Scale) score before treatment program.  After the therapy program, VAS scores were seen to decrease compared to before treatment.”  “To decrease pain and high blood pressure without hemodynamic risk, a combined spa and physical therapy program may help to decrease pain and improve hemodynamic response in patients with irreversible pathologies.”

Cimen A, Celik M, Erdine S. 2004.  Myofascial pain syndrome in the differential diagnosis of chronic abdominal pain.  Agri. 16(3):45-47.  MPS may be misdiagnosed as visceral disease if the clinician is not trained in its diagnosis.

Cinar, Y., G. Demir, M. Pac and A. B. Cinar.  1999.  Effect of hematocrit on blood pressure via hyperviscosity.  Am J Hypertens 12(7):739-43. 

Cioni B, Meglio M. 2007.  Motor cortex stimulation for chronic non-malignant pain: current state and future prospects.  Acta Neurochir Suppl. 97(Pt 2):45-49.  “MCS may act by rebalancing the control of non-nociceptive sensory inputs over nociceptive afferents at cortical, thalamic, brainstem and spinal level.  In addition, it may interfere with the emotional component of nociceptive perception.”   MCS may be a promising new therapy for chronic pain.

Cisler TA. 1994.  Whiplash as a total-body injury.  J Am Osteopath Assoc 94(2):145-148.  “Physicians must recognize whiplash injury as a manifestation of total-body trauma and treat accordingly, with particular emphasis on alleviating abnormal tension of the fascia.  Precise description of the accident, followed by healing methods tailored to well-defined bodily injury, aids in effective management.”

Citak-Karakaya I, Akbayrak T, Demirturk F et al. 2006.  Short- and long-term results of connective tissue manipulation and combined ultrasound therapy in patients with fibromyalgia.  Manipulative Psysiol Ther. 29(7):524-528.  “Methods used in this study seemed to be helpful in improving pain intensity, complaints of nonrestorative sleep, and impact on functional activities in patients with FM.”

Citera, G., M. A. Arias, J. A. Maldonado-Cocco, M. A. Lazaro, M. G. Rosemffet, L. I. Brusco, E. J. Scheines and D. P. Carinalli. 2000.  The effect of melatonin in patients with fibromyalgia: a pilot study.  Clin Rheumatol 19(1):9-13.  

Civelek GM, Ciftkaya PO, Karatas M. 2014. Evaluation of restless legs syndrome in fibromyalgia syndrome: An analysis of quality of sleep and life. Back Musculoskelet Rehabil. [May 27 Epub ahead of print.] "Presence of RLS should be investigated in every patient with FMS and treatment plans should also cover RLS in case of coexistance with FMS. Prospective cohort studies are needed for better explanation of FMS and RLS coexistance."

Clark, F., S. P. Azen, R. Zemke, J. Jackson, M. Carlson, D. Mandel, J. Hay, K. Josephson, B. Cherry, C. Hessel, J. Palmer and L. Lipson.  1997.  Occupational therapy for independent-living older adults.  A randomized controlled trial.  JAMA 278(16):1321-6.  Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains.  Preventive health programs based on OT may mitigate against the health risks of older adulthood.

Clark, F. J., R. C. Burgess, J. W. Chapin and W. T. Lipscomb.  1985.  Role of intramuscular receptors in the awareness of limb position.  J Neurophysiol 54(6):1529-40.

Clark, H. W. and K. L. Sees.  1993.  Opioids, chronic pain, and the law.  J Pain Sympt Manage 8(5):297-305.

Clark NC, Roijezon U, Treleaven J. 2015. Proprioception in musculoskeletal rehabilitation. Part 2: Clinical assessment and intervention. Man Ther. [Jan 29 Epub ahead of print.] "Clinical assessment of proprioception can be performed using goniometers, inclinometers, laser-pointers, and pressure sensors. Manual therapy, taping, and bracing can immediately enhance proprioception and should be used to prepare for exercise interventions. Various types of exercise (active joint repositioning, force sense, co-ordination, muscle performance, balance/unstable surface, plyometric, and vibration training) should be employed for long-term enhancement of proprioception." [This should be coupled with an assessment and treatment of the cause of proprioception disturbance, which is often the myofascial trigger point. DJS]

Clark, P., R. Burgos-Vargas, C. Medina-Palma, P. Lavielle and F. F. Marina.  1998.  Prevalence of fibromyalgia in children: a clinical study of Mexican children.  J Rheumatol 25(10):2009-14.

Clark P, Paiva ES, Ginovker A et al. 2013. A patient and physician survey of fibromyalgia across Latin America and Europe. BMC Musculoskel Disord. 14:188. "Patient- and physician-rated disease perception and impact was often higher in LA (Latin America) than in Europe. Patient and physician perspective concerning FM impact and disruption were often misaligned within the same region. Our observations may be representative of cultural differences in stoicism, expression, beliefs, and attitudes to pain perception and management. Better understanding of these complexities could help targeted educational/training programs, incorporating cultural differences, to improve chronic care."

Clauw DJ. 2015. Fibromyalgia and Related Conditions. Mayo Clin Proc. 90(5):680-692. "Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified. Earlier there was some doubt about whether there was an "organic basis" for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients. The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing. This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (e.g., irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (e.g., autoimmune disorders and osteoarthritis). In the latter instance, the term centralized pain connotes the fact that in addition to the pain that might be caused by peripheral factors, there is superimposed pain augmentation occurring in the central nervous system. It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies."

Clauw DJ. 2014. Fibromyalgia: a clinical review. JAMA 311(15):1547-1555. "Fibromyalgia and other "centralized" pain states are much better understood now than ever before. Fibromyalgia may be considered a discrete diagnosis or as a constellation of symptoms characterized by central nervous system pain amplification with concomitant fatigue, memory problems, and sleep and mood disturbances. Effective treatment for fibromyalgia is now possible." [This review might have been made even better with the inclusion of some of the articles dealing with the peripheral source of pain causing central sensitization states, including myofascial trigger points and arthritis. Controlling the pain generated by these states is a critical part of managing fibromyalgia. DJS]

Clauw DJ. 2007.  Clinical studies and their implications for the management of fibromyalgia syndrome.  J Musculoskel Pain 15 (Supp 13):6 item 7.  [Myopain 2007 Poster]  Possibly the most common association in FM studies is the amplification of sensory stimuli, including pressure, pain, heat, electricity and noise.  Regional pain conditions that often occur with FM and are associated with central sensitization, such as IBS, have similar amplification, with “...augmented central processing of pain as a finding common to all of these conditions.”  [Many of the conditions mentioned, such as tension headache, TMD and low back pain have myofascial components. DJS] There is one or more dysfunctions in the descending pain pathway in FM.  Indications are that there may be genetic defects involved in the metabolism of pro-nociceptive or anti-nociceptive biochemicals.  “Drugs that decrease the release of pro-nociceptive substances (e.g. pregabalin) may be acting via this mechanism to ‘decrease the volume’ setting in FMS.”  “...studies suggest that the biological basis for the effectiveness of cognitive behavioral approaches can be objectively measured using functional imaging.”  Research suggests that decreasing restorative sleep and exercise may help initiate or worsen FM, and focusing on restoring these areas may help restore function and reduce pain.

Clauw DJ, Arnold LM, McCarberg BH. 2011. The Science of Fibromyalgia. Mayo Clin Proc. 86(9):907-911. "Fibromyalgia (FM) is a common chronic widespread pain disorder. Our understanding of FM has increased substantially in recent years with extensive research suggesting a neurogenic origin for the most prominent symptom of FM, chronic widespread pain. Neurochemical imbalances in the central nervous system are associated with central amplification of pain perception characterized by allodynia (a heightened sensitivity to stimuli that are not normally painful) and hyperalgesia (an increased response to painful stimuli). Despite this increased awareness and understanding, FM remains undiagnosed in an estimated 75% of people with the disorder. Clinicians could more effectively diagnose and manage FM if they better understood its underlying mechanisms. Fibromyalgia is a disorder of pain processing. Evidence suggests that both the ascending and descending pain pathways operate abnormally, resulting in central amplification of pain signals, analogous to the "volume control setting" being turned up too high. Patients with FM also exhibit changes in the levels of neurotransmitters that cause augmented central nervous system pain processing; levels of several neurotransmitters that facilitate pain transmission are elevated in the cerebrospinal fluid and brain, and levels of several neurotransmitters known to inhibit pain transmission are decreased. Pharmacological agents that act centrally in ascending and/or descending pain processing pathways, such as medications with approved indications for FM, are effective in many patients with FM as well as other conditions involving central pain amplification. Research is ongoing to determine the role of analogous central nervous system factors in the other cardinal symptoms of FM, such as fatigue, nonrestorative sleep, and cognitive dysfunction."

Clauw DJ, Crofford LJ. 2003.  Chronic widespread pain and fibromyalgia: what we know, and what we need to know.  Best Pract Res Clin Rheumatol. 17(4):685-701.  “These conditions respond best to a combination of symptom-based pharmacological therapies, and non-pharmacological therapies such as exercise and cognitive behavioral therapy.  In contrast to drugs that work for peripheral pain due to damage or inflammation, neuroactive compounds [especially those that raise central levels of noradrenaline (norepinephrine) or serotonin] are most effective for treating central pain.”

Clauw, D. 2002. Fibromyalgia associated syndromes. J Musculoskel Pain 10(1/2)201-214. " …chronic multisystem illnesses such as fibromyalgia are extremely common. Hallmarks of these syndromes include non-nociceptive pain, fatigue, memory difficulties, and dysfunction of visceral organs". 

Clauw, D. J. and G. P. Chousos. 1997. Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms.  Neuroimmunomodulation 4(3):134-53.

Clauw, D. J. , M. Schmidt, D. Radulovic, A. Singer, P. Katz, and J. Bresettte..1997.  The relationship between fibromyalgia and interstitial cystitis. J Psychiatr Res 31(1):125-31.

Clemenzi A, Pompa A, Casillo P. 2014. Chronic pain in multiple sclerosis: is there also fibromyalgia? An observational study. Med Sci Monit. 20:758-766. "In our sample of MS patients we found a high prevalence of chronic pain, with those patients displaying a higher disability and a more severe depression. Moreover, FM frequency, significantly higher than that observed in the general population, was detected among the MS patients with chronic pain. FM occurrence was associated with a stronger impact on patients' QoL (quality of life)." Free PMC Article.

Cleveland, C. H.  Jr., R. H. Fisher, E. P. Brestel, J. D. Esinhart and W. J. Metzger. 1992. Chronic rhinitis: an underrecognized association with fibromyalgia. Allergy Proc 13(5):263-267. 

Clewley D, Flynn TW, Koppenhaver S. 2013. Trigger point dry needling as an adjunct treatment for a patient with adhesive capsulitis of the shoulder. J Orthop Sports Phys Ther. [Nov 21 Epub ahead of print]. "Prognosis for adhesive capsulitis has been described as self-limiting and can persist for 1-3 years. Conservative treatment including physical therapy is commonly advised…. The patient was a 54 year old female with primary symptoms of shoulder pain and loss of motion consistent with adhesive capsulitis. Manual physical therapy intervention initially consisted of joint mobilizations of the shoulder region and thrust manipulation of the cervicothoracic region. Although manual techniques seemed to cause some early functional improvement, continued progression was limited by pain. Subsequent examination identified trigger points in the upper trapezius, levator scapula, deltoid and infraspinatus muscles that were treated with dry needling to decrease pain and allow for higher grades of manual intervention. Outcomes: The patient was treated for a total of 13 visits over a 6 weeks period. After trigger point dry needling was introduced on the third visit, improvements in pain-free shoulder range of motion and functional outcome measures…exceeded the minimal clinically important difference after 2 treatment sessions. At discharge the patient had achieved significant improvements in shoulder range of motion in all planes and outcome measures were significantly improved….This case report describes the clinical reasoning behind the use of trigger point dry needling in the treatment of a patient with adhesive capsulitis. The rapid improvement seen in this patient following the initiation of dry needling to the upper trapezius, levator scapula, deltoid and infraspinatus muscles suggests that surrounding muscles may be a significant source of pain in this condition."

Climent JM, Kuan TS, Fenollosa P et al. 2013. Botulinum toxin for the treatment of myofascial pain syndromes involving the neck and back: a review from a clinical perspective. Evid Based Complement Alternat Med. [Feb 19 Epub ahead of print]. "Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results....Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies."

Close J. 2012. Are stress responses to geomagnetic storms mediated by the cryptochrome compass system? Proc Biol Sci 279(1736):2081-2090. The cryptochrome compass system may be at least one of the geomagnetic response systems. This system may affect hypothalamic-pituitary-adrenal (HPA) axis responses, including changes in circadian cycle, to the geomagnetic field. The magnetosence is mediated by the HPA axis in migratory animals. Vestibular system derived gravitational cues interact with the magnetosence to help migrating animals. When the vestibular system is hyperstimulated, it stimulates a corresponding an acute stress response across the HPA axis. In rats, this also disturbs spatial sense. Humans were nomadic, migrating animals. If the geomagnetic sense can interact with hormonal systems, it could provoke a general stress response. Geomagnetic effects are complex, and integrated with multiple response systems. The cryptochrome acts as geomagnetic compass in migrating animals, as well as modulator of circadian oscillation. Several studies have revealed a relationship between light exposure and geomagnetic and human-generated magnetic fields. [We do not yet know the effects of geomagnetic storms on humans, especially those with disrupted HPA axes, such as FM patients. If these patients also have vestibular dysfunction and optic dysfunction, the effects could be significant. The interactions would be extremely complex, with a wide number of variables, and we as yet cannot test for this. 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]

Coderre, T. J. and J. Katz. 1997. Peripheral and central hyperexcitability: differential signs and symptoms in persistent pain. Behav Brain Sci 20(3):404-19.

Cogan J, Camus M, Saucier JF et al. 2006.  A new application of sound resonance technology therapy for the treatment of fibromyalgia: a retrospective analysis.  Complement Ther Clin Pract. 12(3):206-212.  “Conclusions: This retrospective analysis suggests considerable and rapid relief of the symptoms of fibromyalgia following the use of the three-phase SRTT treatment protocol, which appears to be maintained over several years.  Although these results are not conclusive, they are remarkable as no other therapy reported in the scientific literature seems as efficacious for fibromyalgia.  A follow-up study using an RCT design is warranted.”

Cohen AH. 2013. Vision rehabilitation for visual-vestibular dysfunction: The role of the neuro-optometrist. NeuroRehabilitation. 32(3):483-492. "Dizziness, balance problems and the sensation that the space world is moving (vertigo) are one of the most commonly reported problems in general medical practice. Persons with a central nervous system injury or other idiopathic causes of visual processing problems or who have functional vision problems that are not adequately managed, often experience extreme difficulty with balance and movement, as well as with their perception of space. Consequently, the patient often experiences difficulty functioning in an environment with excessive visual stimulation such as a grocery store or shopping mall….The combination of neuro-optometric rehabilitative therapy and balance therapy will result is an effective treatment for reducing or resolving these symptoms."

Cohen H, Neumann L, Glazer Y et al. 2009. The relationship between a common catechol-O-methyltransferase (COMT) polymorphism val(158) met and fibromyalgia. Clin Exp Rheumatol. 27(5 Suppl 56):S51-56. “Our results are consistent with carriers of the COMT met/met genotype showing increased sensitivity to pain as one mechanism for the role of this gene in conferring risk for FM. We suggest that the reduced frequency of the met allele in the non-affected relatives acts as a 'protective' allele in this group and prevents the development of clinical FM.”

Cohen, H., L. Neumann, Y. Haiman et al. 2002. Prevalence of post-traumatic stress disorder in fibromyalgia patients: Overlapping syndromes or post-traumatic fibromyalgia syndrome? Semin Arthritis Rheum 23(1):38-50.  In this study, 57% of the FMS patients tested had significant levels of PTSD symptoms. 

Cohen, H., L. Neumann, M. Shore, M. Amir, Y. Cassuto and  D. Buskila. 2000.  Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum 2000 Feb;29(4):217-27.

Cohen JH, Gibbons RW. 1998.  Raymond L. Nimmo and the evolution of trigger point therapy, 1929-1986.  J Manipulative Physiol Ther. 21(3):167-172.

Cohen, S., E. Frank, W. J. Doyle, D. P. Skoner, B. S. Rabin and J. M. Gwaltney, Jr.  1998.  Types of stressors that increase susceptibility to the common cold in healthy adults.  Health Psychol 17(3):214-23.

Cohen, S., W. J. Doyle, D. P. Skoner, B. S. Rabin and J. M. Gwaltney, Jr.  1997.  Social ties and susceptibility to the common cold.  JAMA 277(24):1940-4. 

Cole JA, Rothman KJ, Cabral HJ et al. 2006.  Migraine, fibromyalgia and depression among people with IBS: a prevalence study.  BMC Gastroenterol. 6:26.  “People in the IBS cohort had a 40% to 80% higher prevalence odds of migraine, fibromyalgia and depression.”

Coluzzi F, Valensise H, Sacco M et al. 2013. Chronic pain management in pregnancy and lactation. Minerva Anestesiol. [Jul 15 Epub ahead of print]. "During pregnancy, most women will experience some kind of pain, either as a result of a pre-existing condition (low back pain, headache, fibromyalgia, and rheumatoid arthritis) or as a direct consequence of pregnancy (weight gain, postural changes, pelvic floor dysfunction, hormonal factors). However, chronic pain management during pregnancy and lactation remains a challenge for clinicians and pregnant women are at risk of undertreatment for painful conditions, because of fear about use of drugs during pregnancy. Few analgesic drugs have been demonstrated to be absolutely contraindicated during pregnancy and breastfeeding, but studies in pregnant women are not available for most of pain medications. The aim of this paper is to review the safety profile in pregnancy or lactation of the commonly prescribed pain medications and non-pharmacological treatments."

Cook DB, Nagelkirk PR, Poluri A et al. 2006.  The influence of aerobic fitness and fibromyalgia on cardiorespiratory and perceptual responses to exercise in patients with chronic fatigue syndrome.  Arthritis Rheum. 54(10):3351-3362.  “These results suggest that aerobic fitness and a concurrent diagnosis of FM are likely explanations for currently conflicting data and challenge ideas implicating metabolic disease in the pathogenesis of CFS.”

Cook DB, Lange G, Ciccone DS et al. 2004.  Functional imaging of pain in patients with primary fibromyalgia.  J Rheumatol 31(2):364-78.  This study provides “...further evidence for a physiological explanation for FM pain.”

Covelli, V., A. B. Maffione, C. Nacci, E. Tato and E. Jirillo.  1998.  Stress, neuropsychiatric disorders and immunological effects exerted by benzodiazepines.  Immunopharmacol Immunotoxicol 20(2):199-209.

Colborn, T., M. J. Smolen and R. Rolland.  1998.  Environmental neurotoxic effects: the search for new protocols in functional teratology.  Toxicol Ind Health 14(1-2):9-23.  

Colborn, T.  1994.  The wildlife/human connection: modernizing risk decisions.  Environ Health Perspect 102 Suppl 12:55-9.

Colborn, T., F. S. vom Saal and A. M. Soto.  1993.  Development effects of endocrine-disrupting chemicals in wildlife and humans.  Environ Health Perspect 101(5):378-84.

Colburn KK, Rambharose JA, Malto MC et al. 2006.  Abnormally low antibody markers of elastin synthesis in patients with fibromyalgia syndrome.  J Musculoskel Pain. 14(3):13-19.  This study showed altered elastin metabolism in FMS patients.  This alteration, if significant, could affect elastic tissue in areas such as the lungs and other organs, skin, and blood vessels.  [These patients were not screened for co-existing myofascial TrPs. DJS]

Colcombe SJ, Kramer AF, Erickson KI et al. 2004. Cardiovascular fitness, cortical plasticity and aging. Proc Natl Acad Sci U S A 101(9):3316-3321.  Brain function in sedentary seniors can be improved with moderate regular walking exercise.

Collop N. 2007.  The effect of obstructive sleep apnea on chronic medical disorders.  Cleve Clin J Med. 74(1):72-78.  “Evidence is mounting that obstructive sleep apnea causes or contributes to many chronic medical diseases, and that treatment with continuous positive airway pressure (CPAP) often improves concomitant diseases.”  [This can be beneficial for some chronic pain patients, as OSA is often a perpetuating factor or interactive diagnosis. DJS]

Comeche Moreno MI, Ortega Pardo J, Rodríguez Munoz MF et al. 2012. [Structure and adequacy of the Beck Depression Inventory in patients with fibromyalgia.] Psicothema. 24(4):668-673. [Spanish] "The Beck Depression inventory is a widely used instrument for the measurement of depression in chronic pain....These results indicate that there are differences between the depressive manifestations of this type of patients and those with chronic pain. In addition, the peculiar structure of the BDI in this sample of patients seems to indicate an overlap between some depressive symptoms and the symptoms of fibromyalgia, which could lead to an overestimation of the occurrence of depression when measured with the BDI, a bias that should be assessed and modified."

Conigliaro, D. A.  1996.  Opioids for chronic non-malignant pain.  J Fla Med Assoc 83(10):708-711.

Connelly M, Hoffart C, Schikler K et al. 2014. A84: Changes over Time in Symptoms and Treatment of Juvenile Primary Fibromyalgia Syndrome. Arthritis Rheumatol. 66 Suppl 11:S117. "Children with JPFS exhibit worsening pain and quality of life over time regardless of treatment modality recommendations or patient compliance to therapy. Patients returning for follow-up visits may be those whose symptoms are most refractory. Additional studies are needed to identify barriers to improvement in this patient population and to determine effective treatment approaches to improve health outcomes." [If the focus shifts to identifying the cause of the symptoms, including myofascial trigger points and their perpetuating factors, and then bring them under control, the prognosis of these patients may improve considerably. DJS]

Conte, PM, Walco, GA, Kimura, Y. 2003.  Temperament and stress response in children with juvenile primary fibromyalgia syndrome.  Arthritis Rheum 48(10):2923-30.  This article may help care providers recognize children who are at risk for development of a chronic pain condition and may be a valuable tool in helping to prevent that from happening.

Converse AK, Ahlers EO, Travers EG et al. 2014. Tai chi training reduces self-report of inattention in healthy young adults. Front Hum Neurosci. 8:13. "In this study of healthy young adults, we measured the effects of training in tai chi, which involves mindful attention to the body during movement. Using a non-randomized, controlled, parallel design, students in a 15-week introductory tai chi course…and control participants…were tested for ADHD indicators and cognitive function at three points over the course of the 15-weeks. The tai chi students' self-report of attention, but not hyperactivity-impulsivity, improved compared to controls. At baseline, inattention correlated positively with reaction time variability in an affective go/no-go task across all participants, and improvements in attention correlated with reductions in reaction time variability across the tai chi students…These results converge to suggest that tai chi training may help improve attention in healthy young adults. Further studies are needed to confirm these results and to evaluate tai chi as therapy for individuals with ADHD."

Cook DB, Stegner AJ, Ellingson LD. 2010. Exercise alters pain sensitivity in Gulf War veterans with Chronic Musculoskeletal Pain. J Pain. [Mar 23 Epub ahead of print]. “Since returning from the Persian Gulf, nearly 100,000 veterans of the first Gulf War (GVs) have reported numerous symptoms with no apparent medical explanation. A primary complaint of these individuals is chronic musculoskeletal pain (CMP). CMP symptoms in GVs are similar to those reported by patients with fibromyalgia (FM), but have not received equivalent scientific attention. Exercise research in CMP patients suggests that acute exercise may exacerbate pain while chronic exercise can reduce pain and improve other symptoms….Gulf War veterans with CMP perceive exercise as more painful and effortful than healthy GVs and experience increased pain sensitivity following exercise. These results suggest that similar abnormalities in central nervous system processing of nociceptive information documented in FM may also be occurring in GVs with CMP.”  

Cook, I. A., A. F. Leuchter, M. Morgan et al. 2002. Early changes in prefrontal activity characterize clinical responders to antidepressants. Neuropsychopharmacology 27(1):120-31. Quantatative EEG (QEEG) of the prefrontal region of the brain may be a valuable tool that might indicate which patients are responding to a specific antidepressant within 48 hours to 1 week after beginning therapy. 

Coplan, J. D., H. Tamir, D. Calaprice, M. DeJesus, M. de la Nuez, D. Pine, L. A. Papp, D. F. Klein and J. M. Gorman.  1999.  Plasma anti-serotonin and serotonin anti-idiotypic antibodies are elevated in panic disorder. Neuropsychopharmacology 20(4):386-91.

Corbel V, Stankiewicz M, Pennetier C et al. 2009. Evidence for inhibition of cholinesterases in insect and mammalian nervous systems by the insect repellent deet. BMC Biol. 7:47.   This research shows that the common insect repellant, DEET, can significantly inhibit acetylcholinesterase.  [Our current model for the formation and perpetuating of myofascial trigger points includes the release of excess acetylcholine (ACl) at the motor end plate.  Anything that promotes that release or inhibits acetlylcholinesterase, the enzyme that breaks down ACl, could then increase the possibility of TrP formation and maintenance.    The extra aches and pain from that walk in the woods may be due to more than the extra exercise.  DJS]

Cordero MD, Alcocer-Gomez E, Cano-García FJ et al. 2013. Clinical symptoms in fibromyalgia are associated to overweight and lipid profile. Rheumatol Int. [Jan 3 Epub ahead of print]. "The number of tender points showed significantly positive correlation with higher BMI…. A total of 57.9 % of patients showed increased levels of total cholesterol, 63.4 % increased levels of LDL cholesterol and 19.9 % high levels of triglycerides. BMI, total cholesterol and triglycerides showed high association with some clinical parameters. Overweight and lipid profile could be associated with fibromyalgia symptoms. A treatment program with weight loss strategies, and control in diet and increased physical activity is advised to patients."

Cordero MD, Alcocer-Gomez E, Cano-Garcia FJ et al. 2010. [Low levels of serotonin in serum correlates with severity of fibromyalgia.] Med Clin (Barc). [Jun 28 Epub ahead of print]. [Spanish] "The aim of the present study was to assess the correlation levels between low levels of serotonin and severity of symptoms in FM…..Serotonin levels were decreased by 45% compared to healthy individual. An important correlation was observed between serotonin levels and predetermined parameters of pain, depression, FIQ and age…. Serotonin levels are correlated with severity of FM. In addition, there is an interesting correlation between serotonin levels and age of patients."

Cordero MD, Alcocer-Gomez E, Culic O et al. 2013. NLRP3 Inflammasome is activated in Fibromyalgia: the effect of Coenzyme Q10. Antioxid Redox Signal. [Jul 25 Epub ahead of print]. "These results show an important role for the NLRP3 inflammasome in the pathogenesis of FM, and the capacity of CoQ10 in the control of inflammasome. Conclusions: These findings provide new insights into the pathogenesis of FM and suggest that NLRP3 inflammasome inhibition represents a new therapeutic intervention for the disease."

Cordero MD, Miguel MD, Carmona-Lapez I et al. 2010. Oxidative stress and mitochondrial dysfunction in Fibromyalgia. MINIREVIEW. Neuro Endocrinol Lett. 31(2):169-173. “Fibromyalgia (FM) is a chronic pain syndrome with unknown etiology and pathophysiology. Recent studies have shown some evidence demonstrating that oxidative stress may have a role in the pathophysiology of FM. Furthermore, it is controversial the role of mitochondria in the oxidant imbalance documented in FM. Signs and symptoms associated with muscular alteration and mitochondrial dysfunction, including oxidative stress, have been observed in patients with FM. To this respect, Coenzyme Q10 (CoQ10) deficiency, an essential electron carrier in the mitochondrial respiratory chain and a strong antioxidant, alters mitochondria function and mitochondrial respiratory complexes organization and leading to increased ROS generation. Recently have been showed CoQ10 deficiency in blood mononuclear cells in FM patients, so if the hypothesis that mitochondrial dysfunction is the origin of oxidative stress in FM patients is demonstrated, could help to understand the complex pathophysiology of this disorder and may lead to development of new therapeutic strategies for prevention and treatment of this disease.”

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."

Correa A, Miro E, Martinez MP et al. 2010. Temporal preparation and inhibitory deficit in fibromyalgia syndrome. Brain Cogn. [Dec 10 Epub ahead of print]. "Cognitive deficits in fibromyalgia may be specifically related to controlled processes, such as those measured by working memory or executive function tasks. This hypothesis was tested here by measuring controlled temporal preparation (temporal orienting) during a response inhibition (go no-go) task. Temporal orienting effects (faster reaction times for targets appearing at temporally attended vs. unattended moments) and response inhibition were impaired in fibromyalgia compared to the control group. It is concluded that frontal networks underlying attentional control (temporal orienting and response inhibition) can be a dysfunctional neurocognitive mechanism in fibromyalgia."

Corujeira Rivera MC, Carregal Rañó A, Diz Gómez JC et al. 2010. [Evaluation of 2 invasive techniques for treating myofascial pain] Rev Esp Anestesiol Reanim. 57(2):86-90. [Spanish]  “Both acupuncture and lidocaine infiltration of trigger points were effective in reducing pain intensity after treatment and in improving quality of life. One method could not be shown to be better than the other for treating myofascial pain.”

Corvo G, Tartaro G, Giudice A et al. 2003.  Distribution of craniomandibular disorders, occlusal factors and oral parafunctions in a paediatric population.  Eur J Paediatr Dent. 4(2):84-88.   Early diagnosis and correction of muscle dysfunctions are critical to avoid later TMJD.  [Myofascial TrPs are a very common and generally unrecognized cause of many of these dysfunctions DJS.]

Costantini A, Pala MI, Tundo S et al. 2013. High-dose thiamine improves the symptoms of fibromyalgia. BMJ Case Rep. [May 20 Epub ahead of print]. This very small study (3 patients) indicated that FM symptoms improved with high doses of thiamine. [This agrees with the earlier work of JB Eisinger. DJS]

Cotchett MP, Landorf KB, Munteanu SE et al. 2011. Effectiveness of trigger point dry needling for plantar heel pain study protocol for a randomized controlled trial. J Foot Ankle Res. Jan 23; 4:5. [This is only a trial for a study protocol, but it indicates the understanding by the authors that plantar heel pain is commonly caused by myofascial TrPs. Dry needling can be a tough remedy, however, as foot and hand TrPs are especially painful, and the use of local anesthetic such as lidocaine or procaine can prevent some patient discomfort and may help prevent central sensitization. DJS]

Cotchett MP, Landorf KB, Munteanu SE. 2010. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain; a systematic review. J Foot Ankle Res 3(1):18. This review found available studies to be of poor quality. [Many investigators do not understand that plantar fasciitis can be caused by TrPs. Injection of the foot area is extremely painful and that must also be taken into consideration. It would be interesting to see a study on plantar fasciitis and/or heel pain due to TrPs, rather than a review, done by researchers proficient in a variety of myofascial therapy. DJS]

Cotchett MP, Munteanu SE, Landorf KB. 2014. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys Ther. 94(8):1083-1094. "Dry needling provided statistically significant reductions in plantar heel pain…"

Cote, K. A. and H. Moldofsky. 1997. Sleep, daytime symptoms, and cognitive performance in patients with fibromyalgia  J Rheumatol 24:2014-2023.

Coull JA, Beggs S, Boudreau D et al. 2005.  BDNF from microglia causes the shift in neuronal anion gradient underlying neuropathic pain.  Nature 438(7070):1017-1021.  “...BDNF is a crucial signaling molecule between microglia and neurons.  Blocking this microglia-neuron signaling pathway may represent a therapeutic strategy for treating neuropathic pain.”

Couppe C, Torelli P, Fugisang-Frederiksen A et al. 2007.  Myofascial trigger points are very prevalent in patients with chronic tension-type headache: a double-blinded controlled study.  Clin J Pain. 23(1):23-27.  “These findings suggest that active TrPs are much more frequent in CTTH (chronic tension type headaches) than in controls and the number and pain intensity of TrPs may be used to distinguish between the two groups.”

Courtney CA, Clark JD, Duncombe AM et al. 2011. Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions. J Man Manip Ther. 19(4):212-222. "Chronic lower quadrant injuries constitute a significant percentage of the musculoskeletal cases seen by clinicians. While impairments may vary, pain is often the factor that compels the patient to seek medical attention. Traumatic injury from sport is one cause of progressive chronic joint pain, particularly in the lower quarter. Recent studies have demonstrated the presence of peripheral and central sensitization mechanisms in different lower quadrant pain syndromes, such as lumbar spine related leg pain, osteoarthritis of the knee, and following acute injuries such as lateral ankle sprain and anterior cruciate ligament rupture. Proper management of lower quarter conditions should include assessment of balance and gait as increasing pain and chronicity may lead to altered gait patterns and falls. In addition, quantitative sensory testing may provide insight into pain mechanisms which affect management and prognosis of musculoskeletal conditions. Studies have demonstrated analgesic effects and modulation of spinal excitability with use of manual therapy techniques, with clinical outcomes of improved gait and functional ability. This paper will discuss the evidence which supports the use of manual therapy for lower quarter musculoskeletal dysfunction."

Courtney CA, O'Hearn MA, Hornby TG. 2012. Neuromuscular Function in Painful Knee Osteoarthritis. Curr Pain Headache Rep. [Sep 29 Epub ahead of print]. "Pain is a major cause of impaired mobility in elderly patients with chronic osteoarthritis (OA) of the knee. Central sensitization and impaired nociceptive inhibitory mechanisms have both been identified as contributing factors to heightened pain in this patient population. While central sensitization has been shown to produce enhanced pain responses and spread of pain to adjacent and remote body regions, conditioned pain modulation has also been shown to be adversely affected, and may be characteristic of those patients with chronic pain. Alterations of quantitative sensory testing measures have been demonstrated in patients with knee OA, and may serve as a clinical means of staging chronic musculoskeletal pain, including assessment of hyperalgesia and hypoesthesia. In addition, pain and altered somatosensation commonly associated with OA may be correlated with functional deficits."

Couto C, de Souza IC, Torres IL et al. 2013. Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: A randomized sham-controlled clinical trial. Clin J Pain. [Apr 25 Epub ahead of print]. "This study highlighted the greater efficacy of MDIMST (multiple deep intramuscular stimulation therapy) over the placebo-sham and (LTrP-I TrP lidocaine injection) and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities."

Covelli E, Attanasio G, Viccaro M et al. 2013. A 9-year-old boy with atypical retroauricular pain: A case report. Am J Otolaryngol. [Aug 12 Epub ahead of print]. "We present a 9-year-old child who suffered from atypical retroauricular pain resistant to conventional treatment. After excluding any other cause of retroauricular pain, a nerve block was performed with a 0.3ml lidocaine 1% injection into the trigger point. We believe that this case report is important because in the literature there are no similar cases described in children". [People of all ages can have pain behind the ears that is generated by trigger points in the clavicular sternocleidomastoid muscle, the suboccipital muscles, the posterior occipitalis or the obliquus capitis superior. It's good to see this documented. DJS]

Cox GR, Barish RA. 1991.  Delayed presentation of unstable cervical spine injury with minimal symptoms.  J Emerg Med 9(3):123-127.  “Physicians must aggressively search for injuries whenever a history of neck pain is present or a strong mechanism of injury exists, even if the patient has been ambulatory for days or weeks following the injury."

Cox JJ, Reimann F, Nicholas AK. 2006.  An SCN9A channelopathy causes congenital inability to experience pain.  Nature 444:894-898.  A genetic mutation can cause the inability to feel pain through a sodium channelopathy.  Studying this may offer insights into chronic pain.  [Myofascial pain may also be a channelopathy. DJS]

Craft JM, Ridgeway JL, Vickers KS et al. 2014. Unique Barriers and Needs in Weight Management for Obese Women with Fibromyalgia. Explore (NY). [Oct 23 Epub ahead of print.] "Obesity appears in higher rates in women with fibromyalgia compared to the population at large, and no study to date has taken a qualitative approach to better understand how these women view weight management in relation to their disease and vice versa….Women with FM identify unique barriers to weight management, including the complex interrelationships between symptoms of FM and health behaviors, such as diet and exercise. They prefer a weight management program for women with FM that consists of an in-person, group-based approach with a leader but are open to a tailored conventional weight management program. Feasibility may be one of the biggest barriers to such a program both from an institutional and individual perspective."

Crago BR, Gray MR, Nelson LA et al. 2003. Psychological, neuropsychological, and electrocortical effects of mixed mold exposure. Arch Environ Health 58(8):452-463.  Mold exposure can lead to “ dysregulation of emotions and cognitive functioning as a result of toxic or metabolic encephalopathy...”  Abnormalities in the frontal and prefrontal lobes of the brain were “...significantly and consistently related to deficits in cognitive functioning and mold-exposure measures.”  “Patients reported a loss of their sense of self, of their usual ways of doing things, and even of their personality.  They were painfully aware of their deficits and were constantly frustrated by their loss of cognitive efficiency and frequent mistakes.”

Craig, AD. 2003.  Interoception: the sense of the physiological condition of the body.  Curr Opin Neurobiol  13:500-505.  Both fibromyalgia and chronic myofascial trigger points may be associated with autonomic symptoms.  There may be mechanoreceptive and proprioceptive dysfunction.  This article discusses the interoceptive system, which includes vasomotor activity, hunger, thirst and internal sensations.  “These findings explain the distinct nature of pain, temperature, itch, sensual touch and other bodily feelings from cutaneous mechanoreception (somatosensory touch) and they identify the long-missing peripheral and central afferent complement to the efferent autonomic nervous system.  I agree with the author that this study may have profound clinical significance.

Craig KD, Lilley CM, Gilbert CA. 1996.  Social barriers to optimal pain management in infants and children.  Clin J Pain 12(3):232-242.  Care providers need to be aware that infants and children need adequate pain control.

Crain, D. A., N. Noriega, P. M. Vonier, S. F. Arnold, J. A. McLachlan and L. J. Guillette, Jr. 1998. Cellular bioavailability of natural hormones and environmental contaminants as a function of serum and cytosolic binding factors.  Toxicol Ind Health 14(1-2):261-73.

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 γ coactivator 1α(PGC-1α)], and mitigated the rise in nuclear factor κB (NFκB) (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-α (TNF-α) 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.

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."

Crettaz B, Marziniak M, Willeke P et al. 2013. Stress-induced allodynia-evidence of increased pain sensitivity in healthy humans and patients with chronic pain after experimentally induced psychosocial stress. PLoS One. 8(8):e69460. This study provides: "…evidence for stress-induced allodynia/hyperalgesia in humans for the first time and suggest differential underlying mechanisms determining response to stressors in healthy subjects and patients suffering from chronic pain."

Crinnion, W. J.  2000.  Environmental medicine, Part one: the human burden of environmental toxins and their common health effects.  Altern Med Rev 5(1):52-63.

Criscuolo CM. 2001.  Interventional approaches to the management of myofascial pain syndrome.  Curr Pain Headache Rep. 5(5):407-411.  “This article describes current interventional therapies that are employed in treating myofascial pain syndromes.  The mainstay of injection therapies, the myofascial trigger point injection, is emphasized.”

Crofford L, Simpson S, Young, Jr. J et al. 2007.  Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief [freedom] trial: dose-specific results of a 6-month discontinuation trial of pregabalin for the pain of fibromyalgia syndrome.  J Musculoskel Pain 15 (Supp 13):43 item 75.  [Myopain 2007 Poster]  “Pregabalin therapy at a dose range of 300 to 600 mg/day demonstrated superior durability of efficacy in FMS response in this 32-week treatment study.” 

Crofford LJ, Rowbotham MC, Mease PJ et al. 2005.  Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial.  Arthritis Rheum. 52(4):1264-1273.  “Conclusion: Pregabalin at 450 mg/day was efficacious for the treatment of FMS, reducing symptoms of pain, disturbed sleep, and fatigue compared with placebo.  Pregabalin was well tolerated and improved global measures and health-related quality of life.”

Crofford LJ.  2004.  Pharmaceutical treatment options for fibromyalgia.  Curr Rheumatol Rep. 6(4):274-280.  There are multiple mechanisms causing a wide variety of fibromyalgia symptoms. “Understanding specific etiologic factors and pathogenic mechanisms in individual patients will allow clinicians to determine treatments that are most effective for a given patient.”  [Look for the perpetuating factors. DJS]

Crawford, LJ. 1998.  Neuroendocrine findings and patients with fibromyalgia. J Musculoskel Pain 6(3):69.

Crofford, L. J. 1998. Neuroendocrine abnormalities in fibromyalgia and related disorders. Am J Med Sci 315(6):359-366.

Crofford,  L. J, and M. A. Demitrack. 1996. Evidence that abnormalities of central neurohormonal systems are key to understanding fibromyalgia and chronic fatigue syndrome. Rheum Dis Clin North Am 22:267-84.

Crompton, R, Clifton, VL, Bisits, AT et al. 2003. Corticotropin-releasing hormone causes vasodilation in human skin via mast cell-dependent pathways.  J Clin Endocrinol Metab 88(11):5427-5432.  This study may explain some of the sensitive allergic skin symptoms of fibromyalgia.  Histamine may be a principal neurotransmitter mediator.

Crook, J., H. Moldofsky and H. Shannon.  1998. Determinants of disability after a work related musculoskeletal injury.  J Rheumatol 25(8):1570-7. 

Crooks VA. 2015. "Because everything changes that day; you don't do the routine": Alterations and activities chronically ill women undertake on days with health care provider appointments. Chronic Illn. [Feb 23 Epub ahead of print.] "Research points to the importance of interactions with health care providers for chronically ill patients. Meanwhile, we know little about how visits to providers' offices are accommodated in these patients' lives. This analysis identifies the full scope of routine alterations and preparatory activities that require chronically ill women's time and energy specifically on appointment days….Two trajectories are identified: (1) alterations to daily routines on appointment days; and (2) activities to prepare for the provider-patient interaction. Factors such as wanting to minimize symptom exacerbation, desires to come across as informed patients, limited time afforded to interactions, and access to transportation explain why these particular routine alterations and preparatory activities were undertaken.….Findings demonstrate that the health care provider-patient interaction does not start or end in the space of the provider's office but is, rather, an event that is part of a larger process primarily focused on its successful negotiation. This suggests that the boundaries of the appointment need to be reconsidered, which holds implications for appointment-focused interventions aimed at chronically ill patients."

Crosignani P.G., Vegetti W., Columbo M. et al. 2002.  Resumption of fertility with diet in overweight women.  Reprod Biomed Online 5(1):60-4.  “...being overweight lowers the concentration of sex hormone binding globulin and increases androgen and insulin secretion and insulin resistance....appropriate counselling about weight reduction through diets and exercise can restore both health and fertility, avoiding much frustration, and saving time and money.”

Crotti FM, Carai A, Carai M et al. 2005.  TOS pathophysiology and clinical features.  Acta Neurochir Suppl. 92:7-12.  “In all patients neurological, vascular and myofascial pain symptoms were observed before the operation.  Neurological and vascular pain disappeared after surgery, while the myofascial pain remained.  In TOS, therefore, there is a pain loop that cannot be resolved by surgical therapy alone.  The connection between myofascial pain syndrome and TOS might explain the many controversial opinions regarding frequency, results and surgical possibilities of this lesion.”   [Thoracic Outlet Syndrome is a description, not a diagnosis.  Clinicians must learn to look for the reasons for constriction.  It is often caused by muscles contractured due to myofascial TrPs.  The sooner the TrPs are treated the less the chance for fibrosis or calcification. DJS]    

Crotti FM, Carai A, Carai M et al. 2005.  Entrapment of crural branches of the common peroneal nerve.  Acta Neurochir 92:69-70.  “Failed back surgery syndrome (FBSS) occurs in 30% of operated patients and represents a heavy problem both regarding disability and costs in first world countries.  Among FBSS we found the possibility of a double crush syndrome: a disco-radicular conflict and a peripheral nerve entrapment.  The latter, disguised by root compression symptoms, becomes evident only after spinal surgery.  We found peroneal nerve crural branches entrapped where they crossed the fascia to reach the subcutaneous layer.  Most of the patients were found to have myofascial pain syndrome (MPS).”   [Again, myofascial TrPs are often the cause of nerve entrapment.  Clinicians (and insurance companies) need to be aware of this.  Doctors need to be trained in diagnosis and treatment of TrPs to help minimize the pain and costs of chronic care.  DJS]

Crow T, Kasper D. 2006.  A myofascial trigger point on the skull: treatment improves peak flow values in acute asthma patients.  AAOJ 16(1):23-25.  Nine chronic asthma patients, varying from mild to severe cases, were given manual therapy of an MTP on the left parietal eminence.  The air flow rate of 5 patients was restored to from 96-108%, and the other 4 restored to between 66 and 88% expected flow amount based on body size.  [This is an early study, lacking much specific data, but it does imply that it is worth checking asthma patients for MTPs in the skull and treating any that are found. DJS] 

Cruz-Almeida Y, King CD, Goodin BR et al. 2013. Psychological profiles and pain characteristics of older adults with knee osteoarthritis. Arthritis Care Res (Hoboken). [Jul 16 Epub ahead of print]. "The main objectives were to identify psychological profiles in persons with knee osteoarthritis (OA) and to determine the relationship between these profiles and specific pain and sensory characteristics including temporal summation and conditioned pain modulation. Methods: Individuals with knee OA (n=194) completed psychological, health and sensory assessments. Hierarchical cluster analysis was used to derive psychological profiles that were compared across several clinical pain/disability and experimental pain responses. Results: Cluster 1 had high optimism with low negative affect, pain vigilance, anger and depression along with the lowest self-reported pain/disability and the lowest sensitivity to mechanical, pressure and thermal pain…. Cluster 2 had low positive affect with high somatic reactivity while Cluster 3 showed high pain vigilance with low optimism. Clusters 2 and 3 had intermediate levels of self-reported pain/disability and Cluster 3 experienced central sensitization to mechanical stimuli. Participants in Cluster 3 also displayed significant pain facilitation…. Cluster 4 exhibited the lowest positive affect with the highest pain vigilance, reactivity, negative affect, anger and depression. These individuals experienced the highest self-reported pain/disability including widespread pain…. Cluster 4 was most sensitive to mechanical, pressure and thermal stimuli and showed significant central sensitization to mechanical and thermal stimuli…. Conclusion: Our findings demonstrate the existence of homogeneous psychological profiles displaying unique sets of clinical and somatosensory characteristics. Multidisciplinary treatment approaches consistent with the biopsychosocial model of pain should provide significant advantages if targeted to profiles such as those in our OA sample."

Cryer, P.E.1999.  Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia on awareness. Endocrinol Metab Clin North Am 28(3):495-500, v-vi.  

Cryer, P. E.  1993.  Adrenaline: a physiological metabolic regulatory hormone in humans? Int J Obes Relat Metab Disord 17 (Suppl 3):S43-S46.

Csaba G, Kovacs P, Tothfalusi L et al. 2005.  Prolonged effect of stress (water and food deprivation) at weaning or in adult age on the triiodothyronine and histamine content of immune cells.  Horm Metab Res. 37(11):711-715.  “Not only fetal or neonatal stress has long-lasting consequences, but also stress events in later periods of life in cells (organs) that are continuously differentiating.”  A significant change in rat T3 metabolism due to neonatal stress was evident.  The histamine content of granulocytes was also changed significantly. [Similar changes have been noted in adult FMS patients. DJS.]

Csako G, McGriff NJ, Rotman-Pikielny P, Sarlis NJ, Pucino F. 2001. Exaggerated levothyroxine malabsorption due to calcium carbonate supplementation in gastrointestinal disorders. Ann Pharmacother Dec:35(12):1578-83.  Calcium carbonate can decrease absorption of levothyroxine especially if the patient has a preexisting malabsorption disorder.

Cuatrecasas G, Gonzalez MJ, Alegre C et al. 2010. High Prevalence of Growth Hormone Deficiency in Severe Fibromyalgia Syndromes. J Clin Endocrinol Metab. [Jul 14 Epub ahead of print]. "FM patients show a high prevalence of GH axis dysfunction. A significant number of patients show biochemical patterns of GH deficiency as well as some degree of GH resistance and might be potential candidates for substitution treatment." [It would be interesting to see if these patients also had insulin resistance and thyroid resistance. The concept of GH resistance is very relevant. It would also be good to discover if these patients were unable to get restorative sleep. If so, the use of sodium oxybate to restore deep level sleep might be considered. DJS]

Cubukcu S, Alimoglu MK, Samanci N et al. 2007.  Isokinetic and isometric muscle strength of the knee flexors and extensors in patients with the fibromyalgia syndrome and chronic myofascial pain syndrome.  J Musculoskel Pain 15(3):49-55.  “Muscular performance in both of FMS and MPS patients groups was low compared to HNCs (healthy normal controls].  The FMS patients showed lower isokinetic flexion and isometric extension strength than the MPS patients at some particular speeds.”  [The MTP patient’s muscle weakness may be due to latent MTPs in the area. DJS]

Cueco RT, Salvat I, Montull S et al. 2007.  Evaluation of the skin rolling procedure as a diagnostic test for fibromyalgia syndrome.  J Musculoskel Pain 15 (Supp 13):44 item 77.  [Myopain 2007 Poster]  “Toughness and stiffness felt in the application of the SRP (skin rolling procedure) is not a valuable diagnostic tool in FMS and cannot be used as a diagnostic test.”  [This “test” can be exceedingly painful to patients with CMP and central sensitization.  They may have tissue adhesed from skin to the bone, and releasing stuck fascia by this method may increase central sensitization. DJS]

Culpepper L. 2010. Pharmacologic therapy for fibromyalgia. J Clin Psychiatry. 71(12):e34. "While nonpharmacologic strategies can help patients understand and accept the diagnosis of fibromyalgia, pharmacologic therapy can provide important additional symptom relief and improvement in functioning. Pharmacologic therapy must be individualized based on a comprehensive evaluation of the patient and continued assessment of symptoms and response to treatment. Patient symptoms and impairments related to each of the dimensions of the 'fibromyalgia triad' (pain, sleep dysfunction, and mood disorders) as well as any other comorbidities, past experiences with treatment, and patient preferences should guide therapy selection."

Culpepper L. 2010. Recognizing and diagnosing fibromyalgia. J Clin Psychiatry. 71(11):e30. "Fibromyalgia affects an estimated 2% of the American population. Current understanding explains it as a neurologic disorder of central pain processing that causes the perception of pain in response to stimuli that in healthy individuals would not be painful. The recognition of fibromyalgia can lead to effective treatment with significant improvement in functioning. Unfortunately, because of the chronic nature of the pain condition and associated counterproductive behaviors and disability, patients and physicians may rapidly become frustrated with each other and abandon the pursuit of adequate diagnosis and treatment. If the physician instead recognizes the diagnostic pattern of pain and appreciates the real nature of the underlying pathology, then he or she can be of great benefit to patients and their families in managing this chronic disease."

Cummings M. 2003.  Myofascial pain from pectoralis major following trans-axillary surgery.  Acupunct Med. 21(3):105-107.  “This is the first reported description, to the author’s knowledge, of myofascial pain occurring at a surgical drain site.  The patient consulted a medical acupuncturist after suffering five months of continuous chest and arm pain associated with ‘tingling’ in the forearm and hand.  She had undergone trans-axillary resection of the first left rib following a left axillary vein thrombosis 18 months previously.  Her symptoms had been principally attributed to nerve traction at surgery or nerve root entrapment from scar tissue.  However, the drain passed through the free border of pectoralis major, and the myofascial trigger point that appeared to develop as a result of the muscle trauma, or the pain at that site, presented as a chronic and complex post-surgical pain problem.  The pain and tingling resolved completely after two sessions of dry needling at a single myofascial trigger point in the free border of the left pectoralis major muscle.”

Cummings M, Baldry P. 2007.  Regional myofascial pain: diagnosis and management.  Best Pract Res Clin Rheumatol. 21(2):367-387. 

Cummings M. 2003.  Myofascial pain from pectoralis major following trans-axillary surgery.  Acupuncture Med 21(3):105-107.  Myofascial referred pain and nerve entrapment symptoms can occur at a post-surgical drain site.

Cummings, M. 2003.  Referred knee pain treated with electroacupuncture to iliopsoas.  Acupunct Med 21(1-2):32-35. This is a showcase of what can happen when care providers don’t understand myofascial medicine.  The patient developed knee pain after standing for a prolonged time.  Tests indicated arthritis and left hip dysplasia, but no knee abnormalities.  After multiple surgical techniques, including femoral osteotomy, lateral shaft graft and total hip replacement, the knee pain was still present on follow-up.  After two treatments with electroacupuncture to the iliopsoas muscle, the knee pain was gone.  How might the practice of medicine, and the costs of same, be changed if the care providers were trained in the diagnosis and treatment of myofascial trigger points?

Cummings TM, White AR. 2001.  Needling therapies in the management of myofascial trigger point pain: a systematic review.  Arch Phys Med Rehabil. 82(7):986-992.

Cunali PA, Almeida FR, Santos CD et al. 2009.  Prevalence of temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy.  J Orofac Pain. 23(4):339-344.  “The most common TMD (temporomandibular disorders) diagnosis was myofascial pain with and without limited mouth opening and arthralgia (50%).  Conclusion: The high prevalence of TMD in the current study indicates that patients with OSAS (obstructive sleep apnea syndrome) referred for oral appliance therapy require specific evaluation related to TMD.”  [The dental world often looks at the term “myofascial pain” as meaning the same as “TMD.”  Appliances may make symptoms due to myofascial trigger points worse, or at best, cause them to become latent.  The solution to myofascial trigger point pain is to treat the TrPs, and to bring the perpetuating factors under control.  DJS]

Curatolo M, Arendt-Nielsen L, Petersen-Felix S. 2004.  Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury.  Clin J Pain 20(6):469-476.  “Central hypersensitivity may explain exaggerated pain in the presence of minimal nociceptive input arising from minimally damaged tissue.  This could account for pain and disability in the absence of objective signs of damage in patients with whiplash.  Central hypersensitivity may provide a neurobiological framework for the integration of peripheral and supraspinal mechanisms in the pathophysiology of chronic pain after whiplash.”

Curl DD. 1989.  Discovery of a myofascial trigger point in the buccinator muscle: a case report.  Cranio. 7(4):339-345.

Custodio L, Carlson CR, Upton B et al. 2015. The impact of cigarette smoking on sleep quality of patients with masticatory myofascial pain. J Oral Facial Pain Headache. 29(1):15-23. "Cigarette smoking is associated with numerous adverse health outcomes, including pain severity, alterations in mood, and disrupted sleep, and seems to be a significant predictor of sleep quality in patients with masticatory myofascial pain."

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