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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
   D  E   

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).


Da Costa D, Abrahamowicz M, Lowensteyn I et al. 2005.  A randomized clinical trial of an individualized home-based exercise program for women with fibromyalgia.  Rheumatology (Oxford) [Epub ahead of print July 19]  “Home-based exercise, a relatively low-cost treatment modality, has the potential to improve important health outcomes in FM.”

Da Costa, D., P. L. Dobkin, M. A. Fitzcharles, P. R. Fortin, A. Beaulieu, M. Zummer, J. L. Senecal, J. R. Goulet, E. Rich, D. Choquette and A. E. Clark.  2000. Determinants of health status in fibromyalgia: a comparative study with systemic lupus erythematosus.  J Rheumatol 27(2):365-72.

Daali Y, Cherkaoui S, Doffey-Lazeyras F et al. 2008.  Development and validation of a chemical hydrolysis method for dextromethorphan and dextrophan determination in urine samples: application to the assessment of CYP2D6 activity in fibromyalgia patients.  J Chromatogr B Analyt Technol Biomed Life Sci. 861(1):56-63  

D’Adamo PJ, Kelly GS. 2001.  Metabolic and immunologic consequences of ABH secretor and Lewis subtype status.  Altern Med Rev. 6(4):390-405.  “Determining ABH secretor phenotype and/or Lewis (Le) blood group status can be useful to the metabolically-oriented clinician.  Lewis typing is one genetic marker which might help identify subpopulations of individuals genetically prone to insulin resistance, autoimmunity and heart disease.”  ABH secretor status and Lewis blood groups may provide some clues that insulin resistance or other metabolic abnormalities may be present.

Daenen L, Nijs J, Roussel N et al. 2012. "Dysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study. Clin Rheumatol. [Sep 16 Epub ahead of print]. Inefficient endogenous pain inhibition, in particular impaired conditioned pain modulation (CPM), may disturb central pain processing in patients with chronic whiplash-associated disorders (WAD). Previous studies revealed that abnormal central pain processing is responsible for a wide range of symptoms in patients with chronic WAD. Hence, the present study aimed at examining the functioning of descending pain inhibitory pathways, and in particular CPM, in patients with chronic WAD. Thirty-five patients with chronic WAD and 31 healthy controls were subjected to an experiment evaluating CPM. CPM was induced by an inflated occlusion cuff and evaluated by comparing temporal summation (TS) of pressure pain prior to and during cuff inflation. Temporal summation was provoked by means of 10 consecutive pressure pulses at upper and lower limb location. Pain intensity of first, fifth, and 10th pressure pulse was rated. During heterotopic noxious conditioning stimulation, TS of pressure pain was significantly depleted among healthy controls. In contrast, TS was quite similar prior to and during cuff inflation in chronic WAD, providing evidence for dysfunctional CPM in patients with chronic WAD. The present study demonstrates a lack of endogenous pain inhibitory pathways, and in particularly CPM, in patients with chronic WAD, and hence provides additional evidence for the presence of central sensitization in chronic WAD."

Dailey DL, Keffala VJ, Sluka KA. 2014. Cognitive and physical fatigue tasks enhance pain, cognitive fatigue and physical fatigue in people with fibromyalgia. Arthritis Care Res (Hoboken). [Jul 29 Epub ahead of print.] People with fibromyalgia had significantly higher increases in pain, cognitive fatigue and physical fatigue when compared to healthy controls after completion of a cognitive fatigue task, a physical fatigue task, or a dual fatigue task (p<0.01). People with fibromyalgia performed equivalently on measures of physical performance and cognitive performance on the physical and cognitive fatigue tasks, respectively. Conclusions: These data show that people with fibromyalgia show larger increases in pain, perceived cognitive fatigue and perceived physical fatigue to both cognitive and physical fatigue tasks compared to healthy controls. The increases in pain and fatigue during cognitive and physical fatigue tasks could influence subject participation in daily activities and rehabilitation.

Dainoff MJ, Cohen BG, Dainoff MH. 2005.  The effect of an ergonomic intervention on musculoskeletal, psychosocial, and visual strain of VDT data entry work: the United States part of the international study.  Int J Occuip Saf Ergon. 11(1):49-63.  “...extensive, intensive and relatively expensive ergonomic intervention and training...” can prevent further injury, improve health, and avoid further costs to the company.  “The cost of this intervention was estimated as $2,200 per employee, while the cost of a single worker’s compensation case could be as high as $75,000.” [The problem now is to get the employers and 3rd party insurance payers to realize that preventative ergonomic medicine is cost effective.  DJS]

Dalla-Bona D, Shackleton T, Clark G et al. 2015. Unilateral ear fullness and temporary hearing loss diagnosed and successfully managed as a temporomandibular disorder: A case report. J Am Dent Assoc. 146(3):192-194. "A 73-year-old woman had a 4-month history of debilitating left-sided otic fullness, hearing loss, and a watery sensation in her ear without obvious cause. She had consulted with an otolaryngologist who cleared the ear of all middle ear pathology and then placed ventilation tubes in the tympanic membrane to relieve her symptoms of ear fullness. The ventilation tubes did not produce long-lasting relief so she was referred to the dental clinic….A diagnosis of localized osteoarthritis (OA) of the TMJ (TMJ-OA) and masticatory myofascial pain was given. The authors provided 3 months of treatment that included self-applied physical therapy (stretch and thermal packs), full-arch stabilization splint, trigger point injection, and a TMJ injection using triamcinolone acetonide (20 milligrams).….Diagnosis and management of TMJ dysfunction (pain on palpation, OA, and limitation of motion) should be considered when patients have symptoms of unexplained ear fullness and have been cleared for ear infection or other ear-related pathology."

Dall’Alba PT, Sterling MM, Treleaven JM et al. 2001.  Cervical range of motion discriminates between asymptomatic persons and those with whiplash.  Spine 26(19):2090-2094.  “Range of motion was reduced in all primary movements in patients with persistent whiplash-associated disorder.”  [Decreased range of motion is often caused by myofascial trigger points. DJS]

Dalmau-Carolà J. 2010. Myofascial Pain Syndrome Affecting the Quadratus Femoris. Pain Pract. [Feb 11 Epub ahead of print]. The quadratus femoris is an external rotator of the hip.  Quadratus femoris injury can accompany damage to the surrounding muscles.  Guided by the clinical symptoms, the injection technique described here can facilitate accurate diagnosis in selected cases.

Dalmau-Carolà J. 2010. Myofascial Pain Syndrome Affecting the Quadratus Femoris.  Pain Pract. [Feb 11 Epub ahead of print]. The quadratus femoris is an external rotator of the hip. Quadratus femoris injury can accompany damage to the surrounding muscles. Guided by the clinical symptoms, the injection technique described here can facilitate accurate diagnosis in selected cases.

Dalmau-Carola J. 2005.  Myofascial pain syndrome affecting the piriformis and the obturator internus muscle.  Pain Pract. 5(4):361-363.  “The obturator internus muscle is an external rotator of the hip.  Obturator internus injury may occur and be hidden by the piriformis syndrome.  Clinical symptoms may offer some clues to the clinician.  The selective injection technique described here facilitates precise diagnosis.”

Dalpiaz AS, Lordon SP, Lipman AG. 2004.  Topical lidocaine patch therapy for myofascial pain.  J Pain Palliat Care Pharmacother 18(3):15-34. 

Dalpiaz AS, Dodds TA. 2002.  Myofascial pain response to topical lidocaine patch therapy: case report.  J Pain Palliat Care Pharmacother.  In the case described, pain was decreased and function improved with the use of lidocaine patch.

D'Ambrogi E, Giacomozzi C, Macellari V et al. 2005.  Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism. Diabetic Med 22(12):1713-1719.  “Increased thickness of Achilles tendon and plantar fascia, more evident in the presence of neuropathy...might play a significant role in the overall alteration of the biomechanics of the foot-ankle complex.”  [Diabetic neuropathy might be a significant perpetuating factor to myofascial TrPs. DJS] 

Damian M, Zalpour C. 2011. Trigger point treatment with radial shock waves in musicians with nonspecific shoulder-neck pain: data from a special physio outpatient clinic for musicians. Med Probl Perform Art. 26(4):211-217. "Radial shockwave treatment plus physical therapy can bring temporary relief from shoulder and neck trigger points in professional musicians."

Danadian, K., G. Balasekaran, V. Lewy, M. P. Meza, R. Robertson and S. A. Arslanian.  1999. Insulin sensitivity in African-American children with and without family history of type 2 diabetes.  Diabetes Care 22(8):1325-9.

D’Andrea, J. A.  1999.  Behavioral evaluation of microwave irradiation.  Bioelectromagnetics Suppl 4:64-74.

Daniels M., Brown D. R. 2002.  Astrocytic regulation of NMDA receptor subunit composition affects neuronal sensitivity to glutamate toxicity. Glia (Suppl 1):S32 [Abstract].  “These results imply that astrocytes regulate the expression of NMDA receptor subunit subtypes which influence neuronal sensitivity to glutamate toxicity.”

Danneels L, Beernaert A, DeCorte K et al. 2011. A didactical approach for musculoskeletal physiotherapy: the planetary model. J Musculoskel Pain. 19(4):218-224. This is a nice study that incorporates a different model for approaching bodywork. With myofascial, articular and neurogenic components circling a sensorimotor core in the realm of movement dysfunction, and outlying orbit of pain mechanisms, structural impairment and tissue mechanisms, psychosocial factors and activity restriction. Neat.

Danneskiold-Samsøe B, Bartels EM, Genefke I. 2007.  Treatment of torture victims – a longitudinal clinical study.  Torture. 17(1):11-7.   “A high percentage of the torture victims in our study suffered from fibromyalgia prior to treatment.  A multidisciplinary treatment involving individualized physiotherapy and psychotherapy had a significant effect on musculoskeletal pain in torture victims.  Following nine months of treatment, only one torture victim in our study could be classified as suffering from fibromyalgia when applying the fibrositis index.”

Danneskiold-Samsøe, B, Bartels EM. 2004.  Idiopathic low back pain: classification and differential diagnosis.  J Musculoskeletal Pain 12(3/4):93-99.  “Although acute back pain is often viewed as a benign and reversible condition, it can develop into a chronic condition if not correctly diagnosed and treated accordingly.”

Danneskiold-Samsøe, E. Christiansen and R. B. Andersen.  1986.  Myofascial pain and the role of myoglobin.  Scand J Rheumatol 15:174-178.

Danneskiold-Samsøe, B., E. Christiansen, B. Lund and R. B. Andersen.  1982.  Regional muscle tension and pain (“fibrositis”).  Scand J Rehab Med 15:17-20.  

Danto JB. 2003.  Review of integrated neuromusculoskeletal release and the novel application of a segmental anterior/posterior approach in the thoracic, lumbar and sacral regions.  J Am Osteopath Assoc 103(12):583-96.

Dao, T., T. K. Knight and V. Ton-That. 1998. Modulation of myofascial pain by the reproductive hormones: a preliminary report. J Prosthet Dent 79(6):663-670.

Dao, T. T. , W. J. Reynolds and H. C. Tenenbaum. 1997. Co morbidity between myofascial pain of the masticatory muscles and fibromyalgia. J Orofac Pain 11(3):232-241.

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

Dardano A, Bazzichi L, Bombardieri S et al. 2011. Symptoms in Euthyroid Hashimoto's Thyroiditis: Is There a Role for Autoimmunity Itself? Thyroid. [Dec 22 Epub ahead of print]. "...FM comorbidity resulted in almost one third of patients (all females) suffering from HT with or without mild hypothyroidism (SCH). Moreover, the prevalence of fibromyalgia was slightly higher in euthyroid HT patients (33.3%) than in those suffering also from SCH (28.5%). In this setting, it is noteworthy that SCH patients without autoimmunity did not show any clinical symptom consistent with FM. Therefore, our data support the hypothesis that thyroid autoimmunity per se plays a role in the development of FM comorbidity, although the specific underlying mechanism is still not completely known."

Dargaud J, Lamotte C, Dainotti JP et al. 2001.  [Venous drainage and innervation of the maxillary sinus] Morphologie 85(270):11-13. [French]  Although not mentioning myofascial TrPs specifically, this study indicates how maxillary sinus congestion could be caused by blood vessel entrapment by pterygoid TrPs.

Da Silva GD, Lorenzi-Filho G, Lage LV. 2007. Effects of yoga and the addition of tui na in patients with fibromyalgia.  J Altern Complement Med. 13(10):1107-1114.  Some yoga techniques may be helpful for some FM patients.  Patients who experienced a type of soft tissue masssage, tui na, reported less pain than patients who took part in yoga, but the patients with yoga improved more over the long term.  [This study did not screen patients for co-existing MTPs, but may indicate that while massage may ease the pain, stretching and breathing properly may be a better alternative than passive treatment if one has to choose between the two. DJS]

da Silva LA, Kazyiama HH, de Siqueira JT et al. 2012. High prevalence of orofacial complaints in patients with fibromyalgia: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol. [Aug 17 Epub ahead of print]. "Orofacial complaints including TMD may be present either as symptoms of FS or as a comorbidity associated with this condition. A comprehensive evaluation of patients with FS is necessary to identify the need for specific treatments for orofacial complaints. Future studies, especially those with longitudinal design, should clarify whether a cause-effect relationship exists between orofacial complaints and fibromyalgia. [It is most unfortunate that myofascial trigger points, one of the main co-existing conditions of TMJ, as well as one of the main causes, was not included in this study. DJS]

da Silva SG, Sarni RO, de Souza FI et al. 2012. Assessment of nutritional status and eating disorders in female adolescents with fibromyalgia. J Adolesc Health. 51(5):524-527. CONCLUSIONS: This study verified an absence of nutritional and eating disorders in adolescents recently diagnosed with fibromyalgia that, in addition to the correlation between adiposity indexes and KEDS total score, emphasizes the importance of nutritional and body composition assessment, allowing an early and adequate nutritional intervention.

Daub CW. 2007.  A case report of a patient with upper extremity symptoms: differentiating radicular and referred pain.  Chiropr Osteopat. 15(1):10.  “During the first episode the patient was diagnosed with a cervical radiculopathy.”   “Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms.  Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle.  A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition.”  “Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain.”  [We will never know how much surgery and other invasive procedures are unnecessary until we start assessing soft tissue pain generators such as myofascial trigger points. DJS]


Davalos D, Grutzendler J, Yang G et al. 2005.  ATP mediates rapid microglial response to local brain injury in vivo.  Nat Neurosci. 8(6):752-758.   “Extracellular ATP regulates microglial branch dynamics in the intact brain, and its release from the damaged tissue and surrounding astrocytes mediates a rapid microglial response towards injury.”

David, J., S. Modi, A. A. Aluko, C. Robertshaw and J. Farebrother.  1998.  Chronic neck pain: a comparison of acupuncture treatment and physiotherapy.  J Rheumatol 37(10):1118-22.  

Davidhizar, R.  1991.  Liabilities of competence.  Adv Clin Care 6(1):44-6. 

Davidoff, R. A.  1998.  Trigger points and myofascial pain: toward understanding how they affect headaches.  Cephalalgia 18:436-48.

Davidson RJ, Kabat-Zinn J, Schumacher J, et al. 2003.  Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 65:564-570.  Meditation may positively affect brain and immune function.

Davies, H. T., I. K. Crombie, J. H. Brown and C. Martin.  1997.  Diminishing returns or appropriate treatment strategy?–an analysis of short-term outcomes after pain clinic treatment. Pain 70(2-3):203-208.

Davis, A. E.1996. Primary care management of chronic musculoskeletal pain. Nurse Pract 21(8):72.

Davis CG. 2000.  Injury threshold: whiplash-associated disorders.  J Manipulative Physiol Ther 23(6):420-427.  “To make a competent assessment of injury, it is important to evaluate each patient individually. The same collision may cause injury to some individuals and leave others unaffected.  With the variability of human postures, tensile strength of the ligaments between individuals, body positions in the vehicle, collagen fibers in the same specimen segment, the amount of muscle activation and inhibition of muscles, the size of the spinal canals, and the excitability of the nervous system, one specific threshold is not possible.  How individuals react to a stimulus varies widely, and it is evident peripheral stimulation has effects on the central nervous system.  It is also clear that the somatosensory system of the neck, in addition to signaling nociception, may influence the control of neck, eyes, limbs, respiratory muscles, and some preganglionic sympathetic nerves.”

Davis, G. G. and C. B. Alexander.  1998.  A review of carisoprodol deaths in Jefferson County, Alabama.  South Med J 91(8):726-730.

Davis MC, Thummala K, Zautra AJ et al. 2014. Stress-related clinical pain and mood in women with chronic pain: Moderating effects of depression and positive mood induction. Ann Behav Med. [Feb 15 Epub ahead of print.] "Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions."

Davis MC, Zautra AJ. 2013. An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: Results of a randomized controlled trial. Ann Behav Med. [May 14 Epub ahead of print]. "FM patients experience increases in self-efficacy for coping with pain and positive engagement in relationships, marginal increases in positive affect, and decreases in relationship stress from an automated online intervention that targets socioemotional regulation skills. Findings highlight the potential utility of widely accessible, low-cost intervention methods for fibromyalgia."

Davis MP, Dickerson ED, Pappagallo M et al. 2001. Mirtazepine: heir apparent to amitriptyline?  Am J Hosp Palliat Care 18(1):42-46.  Mirtazepine “… is an atypical anti-depressant, which has both noradrenergic and specific serotonergic receptor antagonism (NaSSa), and a unique pharmacological profile.”

Davis, S. R.  1999.   Androgen treatment in women.  Med J Aust 170(11):545-9.

Davis, S.  1999.  Androgen replacement in women: a commentary.  J Clin Endocrinol Metab 84(6):1886-91.

Davison, J. M.  1997.  Edema in pregnancy.  Kidney Int Suppl 59:S90-6.  de Aloysio, D. and P. Penacchioni. 1992. Morning sickness control in early pregnancy by neuguan point acupressure. Obstet Gyn 80 (5):852-854.

Day JT, Lichtwark GA, Cresswell AG. 2013. Tibialis anterior muscle fascicle dynamics adequately represent postural sway during standing balance. J Appl Physiol (1985). 115(12):1742-1750. "As previously suggested, through reciprocal inhibition, afferent information from TA could help to regulate plantar flexor torque at relevant phases of the sway cycle. The proprioceptive role of TA appears to become complicated during more challenging conditions."

de Abreu Freitas RP, Lemos TM, Spyrides MH et al. 2012. Influence of cortisol and DHEA-S on pain and other symptoms in post menopausal women with fibromyalgia. J Back Musculoskel Rehabil. 25(4):245-252. "There seems to be a connection between decreased levels of DHEA-S and increased pain sensitivity in post-menopausal women with FM."

Deakon RT. 2012. Chronic musculoskeletal conditions associated with the cycling segment of the triathlon; prevention and treatment with an emphasis on proper bicycle fitting. Sports Med Arthrosc. 20(4):200-205. "Cycling-related injuries account for 20% of all injuries occurring during triathlons. Traumatic injuries caused by falls or accidents are thankfully rare but can be highly variable and very serious in nature. The best approach to these injuries is prevention. The majority of complaints arising from cycling are due to overuse or poor technique. The knee joint, lower back, neck, and Achilles tendon are the most frequently affected anatomic sites. Anterior knee pain, lower back and neck myofascial pain, iliotibial band friction syndrome, and Achilles tendonitis are the most common diagnoses. Initial treatment should always use rest, ice, compression, and elevation. Muscle strengthening and stretching as well as other physical modalities are helpful in the subacute setting. The need for surgery is rare. Improper bike fit contributes to the causation of a significant number of these conditions. Bike geometry may also be altered to alleviate symptoms."

DeCarvalho LT. 2010. Important missing links in the treatment of chronic low back pain patients. J Musculoskel Pain. 18(1). “Findings of this study indicate that there is an increased positive association between CLBP (chronic low back pain) patients’ level of pain severity and symptoms reported of PTSD (post-traumatic stress disorder). Findings highlight the need for pain specialists to assess not only pain severity levels, but also anxiety symptoms. Very vital links, which should not be missed when treating these patients, are to provide treatments that target their physical condition and emotional distress or anxiety and that increase their sense of control over their pain experience and treatments.”

Decharms RC, Maeda F, Glover GH et al. 2005.  Control over brain activation and pain learned by using real-time functional MRI.  Proc Natl Acad Sci. U S A 102(51):18626-18631.  “These findings show that individuals can gain voluntary control over activation in a specific brain region given appropriate training, that voluntary control over activation in rACC (the rostral anterior cingulate cortex) leads to control over pain perception, and that these effects were powerful enough to impact severe, chronic clinical pain.”

Dechene, L.  1993.  Chronic fatigue syndrome: influence of histamine, hormones and electrolytes.  Med Hypotheses 40(1):55-60.  

Decker MW, Meyer MD, Sullivan JP. 2001.  The therapeutic potential of nicotinic acetylcholine receptor agonists for pain control.  Expert Opin Investig Drugs 10(10):1819-1830.  “Preclinical findings suggest that nAChR agonists have the potential to be highly efficacious treatments in a variety of pain states.”

Dedert EA, Studts JL, Weissbecker I et al.  2004.  Religiosity may help preserve the cortisol rhythm in women with stress-related illness.  Int J Psychiatry Med. 34(1):61-77.  “...religiosity may have a protective effect on the physiological effects of stress among women with fibromyalgia.”

Dee SW, Kao MJ, Hong CZ et al. 2012. Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature. Neuropsychiatr Dis Treat. 8:399-403. This patient presented with shoulder pain on one side, and was given conservative treatment for 13 months, including trigger point injection. Eventually, a rare case of thymic carcinoma was discovered to be the cause of the pain. Pain can come from many sources, and if trigger points aren't relieved by usual treatment, the perpetuating factor(s) must be identified.

Deere KC, Clinch J, Holliday K et al. 2012. Obesity is a risk factor for musculoskeletal pain in adolescents: Findings from a population-based cohort. Pain. 153(9):1932-1938. "Obesity is a risk factor for fibromyalgia in adults, but whether a similar relationship exists in children is uncertain. This study examined whether obesity is associated with reporting of musculoskeletal pain, including chronic regional pain (CRP) and chronic widespread pain (CWP), in adolescents, in a population-based setting....Compared with non obese participants, those with any pain, knee pain, and CRP reported more severe average pain (P<.01). Obese adolescents were more likely to report musculoskeletal pain, including knee pain and CRP. Moreover, obese adolescents with knee pain and CRP had relatively high pain scores, suggesting a more severe phenotype with worse prognosis."

Defalque, R. J. 1982.  Painful trigger points in surgical scars. Anesth Analg 61(6):518-20.

Defrin R, Lurie R. 2012. Indications for Peripheral and Central Sensitization in Patients with Chronic Scalp Pain (Trichodynia). Clin J Pain. [Dec 14 Epub ahead of print]. "The underlying mechanism of trichodynia (scalp/hair pain, is unknown). The aim of this study was to characterize chronic trichodynia and to conduct, for the first time, sensory testing in patients with trichodynia to learn about possible underlying mechanisms. METHODS: Participants were 16 trichodynia patients and 19 healthy controls. Participants underwent testing of touch and pressure-pain threshold as well as allodynia in painful and pain-free scalp sites and in the hands (intact remote region). A trichogram (hair test) was conducted on painful and pain-free scalp sites to evaluate hair cycle abnormalities. The chronic pain was characterized as well…. The cranial hyperalgesia and allodynia, the generalized hyperalgesia, and the correlation between hyperalgesia and chronic pain suggest that trichodynia is related with both peripheral and central sensitization, respectively. The coexistence of hair cycle abnormalities and chronic pain might suggest a common denominator for both phenomena, possibly mediated by proinflammatory agents. Clinical implications are discussed." [These patients were not assessed for co-existing trigger points that could have been the cause of the pain. DJS]

de Girolamo, G. 1991. Epidemiology and social costs of low back pain and fibromyalgia. Clin J Pain 7 Suppl 1: S1-7. 

Degotardi PJ, Klass ES, Rosenberg BS et al. 2005.  Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia.  J Pediatr Psychol. [August 24 Epub ahead of print]  “Children with fibromyalgia can be taught CBT strategies that help them effectively manage this chronic and disabling musculoskeletal pain disorder.”

Deitmer, J. W. 2002.  The role of acid/base transport for metabolic shuttling between glial cells and neurons.  Glia (Suppl 1):S4 [Abstract].

Deitos A, Dussan-Sarria JA, Medeiros L et al. 2014. Clinical Value of Serum Neuroplasticity Mediators in Identifying the Central Sensitivity Syndrome in Patients with Chronic Pain with and Without Structural Pathology. Clin J Pain. [Dec 30 Epub ahead of print.] "Central sensitivity syndrome (CSS) encompasses disorders with overlapping symptoms in a spectrum of structural pathology from persistent somatic nociception [e.g. Osteoarthritis (OA)] to absence of tissue injury such as in fibromyalgia, chronic tension-type headache (CTTH), and myofascial pain syndrome (MPS)." This study found that: "Neuroplasticity mediators could play a role as screening tools for pain clinicians, and as validation of the complex and diffuse symptoms of these patients."

Dejung B. 1994.  [Manual trigger point treatment in chronic lumbosacral pain].  Schweiz Med Wochenschr Suppl. 62:82-87. [German]  “We believe that lumbosacral pain of unknown origin is frequently caused by muscular trigger points in the muscles of the trunk.  We present a new manual therapy for management of this muscular pathology.”

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

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

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

Delaney J.P., Leong K. S., Watkins A. et al. 2002.  The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects.  J Adv Nurs 27(4):364-71.  TrP massage to the head, neck and shoulder increased cardiac parasympathetic activity and improved relaxation even in healthy individuals.

de Las Penas CF, Cuadrado ML, Gerwin RD et al. 2005.  Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle.  Headache 45(6):731-737.  This blinded, controlled study indicates that myofascial trigger points in the superior oblique muscle may cause or contribute to typical tension headache pain.  [This study confirms the presence of myofascial trigger points in at least one of the extrinsic eye muscles, as per the 2nd edition of “Fibromyalgia and Chronic Myofascial Pain: A Survival Manual.  TrPs in the extrinsic eye muscles may be diagnosed and treated by use of eye exercises in that book.]

Delavierre D, Rigaud J, Sibert L et al. 2010 [Symptomatic approach to referred chronic pelvic and perineal pain and posterior ramus syndrome.] Prog Urol 20(12):990-994. [French] Referred pain is common in the pelvis. Posterior ramus syndrome [a description, not a diagnosis DJS] can be responsible for "...pseudovisceral lower abdominal pain, fibromyalgia, pseudotendinitis, and painful bands in a given dermatome. The usual cause of posterior ramus syndrome is minor intervertebral dysfunction involving a posterior facet joint, usually at T12-L1. Only a thorough physical examination can demonstrate the painful vertebral segment." [The facet syndrome itself may be caused or be interacting with TrPs in the paraspinals. DJS]

DeLeo JA, Tanga FY, Tawfik VL. 2004.  Neuroimmune activation and neuroinflammation in chronic pain and opioid tolerance/hyperalgesia.  Neuroscientist 10(1):40-52. Modulation of central nervous system glial cells and 
proinflammatory cytokines may not only contribute to central sensitization but also decrease the effectiveness of opioids. The role of neuroinflammation and interstitial swelling can be integral parts of central sensitization.  “…there is now increasing evidence suggesting that the CNS mounts an organized innate immune response during systemic infection and neuronal injury.”  Also interesting is the observation of cellular adhesion molecules in the lumbar spinal cord following peripheral inflammatory stimuli.  This may indicate a similar process occurring in the central nervous system similar to the myofascial cellular adhesion in response to mechanical or biochemical trauma.

DeLeo JA, Tanga FY, Tawfik VL. 2004.  Neuroimmune activation and neuroinflammation in chronic pain and opioid tolerance/hyperalgesia.  Neuroscientist 10(1):40-52.   Modulation of central nervous system glial cells and   pro-inflammatory cytokines may not only contribute to central sensitization but also decrease the effectiveness of opioids.  The role of neuroinflammation and interstitial swelling can be integral parts of central sensitization.  " …there is now increasing evidence suggesting that the CNS mounts an organized innate immune response during systemic infection and neuronal injury."  Also interesting is the observation of cellular adhesion molecules in the lumbar spinal cord following peripheral inflammatory stimuli.  This may indicate a similar process occurring in the central nervous system similar to the myofascial cellular adhesion in response to mechanical or biochemical trauma. 

Dellon AL, Shookster LA, Maloney CT Jr et al. 2003.  Diagnosis of compressive neuropathies in patients with fibromyalgia.  J Hand Surg [Am] 28(6):894-7.  This article suggests that the Tinel sign may be a valid tool for identification of arm peripheral nerve compression in fibromyalgia.  It neglects to screen patients for myofascial trigger points, which may be the cause of such nerve entrapment.

Dell'Osso L, Carmassi C, Consoli G et al. 2011. Lifetime post-traumatic stress symptoms are related to the health-related quality of life and severity of pain/fatigue in patients with fibromyalgia. Clin Exp Rheumatol. 29(6 Suppl 69):S73-78. "Our results corroborate the presence of a relationship between the lifetime exposure to potentially traumatic events, in particular loss events, and lifetime post-traumatic stress symptoms and the severity of illness and HRQoL (health-related quality of life) in patients with FM."

Delorme T, Boureau F, Eymard B et al. 2004.  Clinical study of chronic pain in hereditary myopathies.  Eur J Pain 8(1):55-61. This study of 68 consecutive and unselected adult patients at a multidiciplinary consultation for hereditary myopathies found that 46 of them had chronic pain, mostly musculoskeletal.  50% had symptoms of myofascial pain and 26% had symptoms of fibromyalgia.  [It would be interesting to study how many of the relatives with hereditary myopathies also had these co-existing conditions.  Clinicians must become aware that these illness are frequent companions to other chronic illnesses, and that prompt diagnosis, recognition, and treatment of the individual TrPs and central sensitization may considerably improve the patient=s quality of life. DJS]

DeLuca, J., S. K. Johnson, S. P. Ellis and B. H. Natelson.  1997.  Cognitive functioning is impaired in patients with chronic fatigue syndrome devoid of psychiatric disease.  J Neurol Neurosurg Psychiatry 62(2):151-155.

Deluze, C., L. Bosia, A. Zirbs, A. Chantraine and T. L. Vischer. 1992. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 305(6864)1249-1252. 

DeMaria Jr. S, Hassett AL, Sigal LH. 2007.  N-methyl-D-aspartate receptor-mediated chronic pain: new approaches to fibromyalgia syndrome etiology and therapy.  J Musculoskel Pain 15(2):33-39.  NMDA receptors are good targets for FMS pharmaceutical chronic pain remediation.  NMDA receptor modulation shows more promise than blockade.   Dextromethorphan, ifenprodil, memantine and other low-affinity NMDA antagonists show promise. 

Demco L. 2004.  Pain mapping of adhesions.  J Am Assoc Gynecol Laparosc. 11(2):181-183.  [This is an interesting study.  I would like such a study in which the tissue (and surrounding tissue) was also examined for evidence of TrPs. DJS]

De Meirleir K., Bisbal C., Campine I., De Becker P., Salehzada T., Demettre, D., Lebleu B. 2000.  A 37 kDa 2-5A binding protein as a potential biochemical marker for chronic fatigue syndrome. Am J Med 108(2):99-105. There may be a way to distinguish chronic fatigue syndrome patients from patients with fibromyalgia or depression with a biochemical marker.

DeMeo DL, Zanobetti A, Litonjua AA et al. 2004.  Ambient air pollution and oxygen saturation.  Am J Respir Crit Care Med. 170(4):383-387.  Air pollution can cause reduced oxygen saturation in the body.  This study discusses possible mechanisms.  [Anything that reduces oxygen availability is a perpetuating factor for both FMS and CMP. DJS]

DeMeo MT, Mutlu EA, Keshavarzian A et al. 2002.  Intestinal permeation and gastrointestinal disease.  J Clin Castroenterol. 34(4):385-396.  “The gastrointestinal tract constitutes one of the largest sites of exposure to the outside environment.  The function of the gastrointestinal tract in monitoring and sealing the host interior from intruders is called the gut barrier.”  “Disruptions in the gut barrier follow injury from various causes including nonsteroidal anti-inflammatory drugs and oxidant stress, and involve mechanisms such as adenosine triphosphate depletion and damage to epithelial cell cytoskeletons that regulate tight junctions.  Ample evidence links gut barrier dysfunction to multiorgan system failure in sepsis and immune dysregulation.”  [More information is coming out concerning the relationship between permeable bowel and chronic illness.  What can be done to heal the bowel is to remove irritants, replace lost enzymes, reinnoculate healthy organisms with probiotics, and repair the mucosa.  Detailed information can be found in the Textbook of Functional Medicine, (see Galland, L. and  DJS.]

Demeter P, Vardi VK, Magyar P. 2004.  [Study on connection between gastroesophageal reflux disease and obstructive sleep apnea]  Orv Hetil. 145(37):1897-1901. [Hungarian]  “The study reveals that in patients with severe obstructive sleep apnea, erosive reflux disease is more frequent and a positive correlation can be found between severity of reflux disease and sleep apnea as well.”

Demeter P, Pap A. 2004.  The relationship between gastroesophageal reflux disease and obstructive sleep apnea.  Gastroenterol 39(9):815-820.   Reflux is more likely to occur during sleep.  Also,  “...the transdiaphragmatic pressure increases in parallel with the growing intrathoracic pressure generated during obstructive apnea episodes.”

Demeter P, Vardi VK, Magyar P. 2004.  [Study of connection between gastroesophageal reflux disease and obstructive sleep apnea] Orv Hetil. 145(37):1897-1901. [Hungarian]  “The study reveals that in patients with severe obstructive sleep apnea, erosive reflux disease is more frequent and a positive correlation can be found between severity of reflux disease and sleep apnea as well.”

Demitrack,  M. A. and L. J. Crofford. 1998. Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann NY Acad Sci 840:(684-697.

Dengler-Crish CM, Bruehl S,Walker LS. 2011. Increased wind-up to heat pain in women with a childhood history of functional abdominal pain. Pain. [Jan 29 Epub ahead of print]. "Young women with a childhood history of functional abdominal pain may have a long-term vulnerability to pain that is associated with enhanced responses of the central nervous system to pain stimuli." [According to Dr. Karel Lewit, in his book "Manipulative Therapy: Musculoskeletal Medicine (Churchill Livingstone Elsevier 2010), such "functional" pain, such as abdominal or menstrual pain beginning at the first period, may be an early sign of spinal dysfunction that may not show up on MRI until many years later. This is a critical clue, the significance of which is missed in the education of many care providers. These "functional" conditions ("functional" being a medical term for "we don't know the cause") could be indications of the early forms of initiating factors for central sensitization. They need to be pounced upon as a good mouser cat pounced on its prey. They are part of the practice of preventative medicine, and not symptoms to be dismissed. DJS]

Denko CW, Malemud CJ.  2004.  Serum growth hormone and insulin but not insulin-like growth factor-1 levels are elevated in patients with fibromyalgia syndrome.  [Jul 24 Epub ahead of print]  “Basal serum GH and fasting serum insulin levels appear to be valuable surrogate markers in clinically active, normoglycemic fibromyalgia patients.”  [These may be associated with perpetuating factors of insulin resistance and lack of restorative sleep. DJS]

Dennis NL, Larkin M, Derbyshire SW. 2013. 'A giant mess' - making sense of complexity in the accounts of people with fibromyalgia. Br J Health Psychol. [Jan 24 Epub ahead of print]. "Twenty people with fibromyalgia participated in email interviews exploring their experiences, history and diagnosis…. Participants described enduring the course of a 'giant mess' of unpleasant symptoms, some of which were understood to be symptoms of fibromyalgia and some the interactive or parallel effects of comorbid illness. The respondents also demonstrated their considerable efforts at imposing order and sense on complexity and multiplicity, in terms of the instability of their symptoms. They expressed ambivalence towards diagnosis, doctors and medication, and we noted that each of the above areas appeared to come together to create a context of relational uncertainty, which undermined the security of connections to family, friends, colleagues and the workplace….Three key issues were discussed. First, there was not one overall symptom (e.g., pain) driving the unpleasantness of fibromyalgia; second, participants spent excessive time and energy trying to manage forces outside their control; third, because there is no definitive 'fibromyalgia experience', each diagnosis is unique, and our participants often appeared to be struggling to understand the course of their illness. [While I disagree with the authors' contention that FM is a diagnosis of exclusion, I agree that co-existing conditions cause a lot of the confusion concerning FM, and there are many interesting points in this paper. DJS]

De Noronha M, Refshauge KM, Herbert RD et al. 2006.  Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain?  Br J Sports Med. 40(10):824-828.  “...people with reduced ankle dorsiflexion range may be at increased risk of ankle sprain.” [The reduced ROM is often due to TrPs. DJS]

Deodhar, A. A. , R. A. Fisher, C. V. Blacker and A. D. Woolf. 1994. Fluid retention syndrome and fibromyalgia. Br J Rheumatol 33(6):576-582.

de Oliveira RA, Ciampi de Andrade D, McHado AG et al. 2012. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome. BMC Neurol. 12(1):89. Myofascial pain syndrome is a common co-morbid condition with central post-stroke pain.

DePedro JA, Perez-Caballer AJ, Dominguez J et al. 2005.  Pulsed electromagnetic fields induce peripheral nerve regeneration and endplate enzymatic changes.  Bioelectromagnetics 26(1):20-27.  This study on the ability of electromagnetic field ability to induce changes in the endplate enzymes may be significant, as that is where the central TrPs occur.

DePedro JA, Perez-Caballer AJ, Dominguez J et al. 2005.  Pulsed electromagnetic fields induce peripheral nerve regeneration and endplate enzymatic changes.  Bioelectromagnetics 26(1):20-27.  This study demonstrated effects of pulsed electromagnetic fields on motor endplates.  Since motor endplates are the areas of dysfunction implicated in the formation and perpetuation of myofascial TrPs, this study may suggest some mechanisms involved in the benefits of some types of specific electronic therapies.

DeQuervain, D.J., Roozendaal, B., Nitsch, R.M., McGaugh, J.L., Hock, C. 2000. Acute cortisone administration impairs retrieval of long term declarative memory in humans. Most patients with FMS and other chronic pain syndromes report more stress in their lives. The major endocrine manifestation of stress is increased secretion of cortisol.  Could this, in part, be an explanation for so-called "fibro fog" - the impaired memory problems described by many FMS patients?  In this study, cortisol had a selective effect of interfering with delayed recall, but not immediate recall or recognition memory.  This study is also relevant to the cognitive defects often described by lupus patients who are often treated with intermittently high doses of corticosteroids.

De Renzi, E., F. Lucchelli, S. Muggia and H. Spinnler. 1995. Persistent retrograde amnesia following a minor trauma. Cortex 31(3):531-542 .

de Ridder, D., M. Depla, P. Severens and M. Malsch.  1997.  Beliefs on coping with illness: a consumer’s perspective.  Soc Sci Med 44(5):553-9.

Deroo BJ, Korach KS. 2006.  Estrogen receptors and human disease.  J Clin Invest. 116(3):561-570.  “Estrogens influence many physiological processes in mammals, including but not limited to reproduction, cardiovascular health, bone integrity, cognition, and behavior.  Given this widespread role for estrogen in human physiology, it is not surprising that estrogen is also implicated in the development or progression of numerous diseases, which include but are not limited to various types of cancer (breast, ovarian, colorectal, prostate, endometrial), osteoporosis, neurodegenerative diseases, cardiovascular disease, insulin resistance, lupus erythematosus, endometriosis, and obesity.  In many of these diseases, estrogen mediates its effects through the estrogen receptor (ER), which serves as the basis for many therapeutic interventions.”  Now that we are aware of the 2nd estrogen receptor and its differences, new medications may be specifically tailored to estrogen receptor beta.  More tools are being developed for preventative medicine.

Dertwinkel, R., A. Wiebalck, M. Zenz and M. Strumpf.  1996. [Oral opioids for long-term treatment of chronic non-cancer pain].  Anaesthesist 45(6):495-505 [German].

Desai MJ, Shkolnikova T, Nava A et al. 2013. A critical appraisal of the evidence for botulinum toxin Type A in the treatment for cervico-thoracic myofascial pain syndrome. Pain Pract. [May 21 Epub ahead of print]. "Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence-based medicine to the treatment for cervico-thoracic MPS. A search was conducted through MEDLINE (PubMed, OVID, MDConsult), EMBASE, SCOPUS and the Cochrane database for the period 1966 to 2012 using the following keywords: myofascial pain, muscle pain, botulinum toxin, trigger points, and injections. A total of 7 trials satisfied our inclusion criteria and were evaluated in this review. Although the majority of studies found negative results, our analysis identified Gobel et al's as the highest quality study among these prospectively randomized investigations. This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality." [This study pointed out that there is a lot of sloppy research out there. A study of myofascial trigger points must define criteria used to identify those TrPs. DJS]

de Sa Pinto AL, de Barros Holanda PM, Radu AS et al. 2006.  Musculoskeletal findings in obese children.  J Paediatr Child Health 42(6):341-4.  “The present data suggest that obesity has a negative impact on osteoarticular health by promoting biomechanical changes in the lumbar spine and lower extremities.”  [This research would suggest that other factors that cause biomechanical changes in the lumbar spine and lower extremities, such as muscle contracture due to TrPs, could also contribute to OA.  DJS]

Desmeules J, Chabert J, Rebsamen M et al. 2013. Central Pain Sensitization, COMT Val158Met Polymorphism, and Emotional Factors in Fibromyalgia. J Pain. [Oct 20 Epub ahead of print.] "Neurobiological evidence points to altered central nervous system processing of nociceptive stimuli in fibromyalgia. Enzymes like catechol-O-methyl-transferase (COMT) are involved in the elimination of catecholamines playing a possible role in central sensitization and pain. We used quantitative sensory testing to evidence central sensitization in fibromyalgia patients and test whether COMTVal158Met polymorphism, associated with a reduction in enzyme activity, plays a role in sensitized patients. Pain evaluation and quantitative sensory testing were performed including the spinal nociceptive flexion reflex, a physiologic correlate for the evaluation of central nociceptive pathways." The study found: "The association between COMT p.Val158Met polymorphism and central sensitization in fibromyalgia is essential as it refers to the severity of central sensitization and may be a risk factor for treatment outcome."

de Souza Nascimento S, Desantana JM, Nampo FK et al. 2013. Efficacy and safety of medicinal plants or related natural products for fibromyalgia: a systematic review. Evid Based Complement Alternat Med. [Jun 4 Epub ahead of print.] "To assess the effects of medicinal plants (MPs) or related natural products (RNPs) on fibromyalgia (FM) patients, we evaluate the possible benefits and advantages of MP or RNP for the treatment of FM based on eight randomized placebo-controlled trials (RCTs) involving 475 patients. The methodological quality of all studies included was determined according to JADAD and "Risk of Bias" with the criteria in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Evidence suggests significant benefits of MP or RNP in sleep disruption, pain, depression, joint stiffness, anxiety, physical function, and quality of life. Our results demonstrated that MP or RNP had significant effects on improving the symptoms of FM compared to conventional drug or placebo; longer tests are required to determine the duration of the treatment and characterize the long-term safety of using MP, thus suggesting effective alternative therapies in the treatment of pain with minimized side effects. "

Despres JP, Golay A, Sjostrom L et al. 2005.  Effects of rimonabant on metabolic risk factors in overweight patients with dyslipidemia.  N Engl J Med. 353(20):2121-2134.  [This medication may be a promising one for patients with Metabolic Syndrome. DJS]

de Tommaso M, Delussi M, Vecchio E et al. 2014. Sleep features and central sensitization symptoms in primary headache patients. J Headache Pain. 15(1):64. "Association between sleep disorders and headache is largely known. The aim of the present study was to evaluate sleep quality and quantity in a large cohort of primary headache patients, in order to correlate these scores with symptoms of central sensitization as allodynia, pericranial tenderness and comorbidity with diffuse muscle-skeletal pain….One thousand six hundreds and seventy primary headache out patients were submitted to the Medical Outcomes Study (MOS) within a clinical assessment, consisting of evaluation of frequency of headache, pericranial tenderness, allodynia and coexistence of fibromyalgia syndrome (FM)….Self reported duration of sleep seems a useful index to be correlated with allodynia, pericranial tenderness and chronic headache as a therapeutic target to be assessed in forthcoming studies aiming to prevent central sensitization symptoms development." Free Article

de Tommaso M, Federici A, Serpino C et al. 2011. Clinical features of headache patients with fibromyalgia comorbidity. J Headache Pain. [Aug 17 Epub ahead of print]. "Our previous study assessed the prevalence of fibromyalgia (FM) syndrome in migraine and tension-type headache. We aimed to update our previous results, considering a larger cohort of primary headache patients who came for the first time at our tertiary headache ambulatory. A consecutive sample of 1,123 patients was screened. Frequency of FM in the main groups and types of primary headaches; discriminating factor for FM comorbidity derived from headache frequency and duration, age, anxiety, depression, headache disability, allodynia, pericranial tenderness, fatigue, quality of life and sleep, and probability of FM membership in groups; and types of primary headaches were assessed. FM was present in 174 among a total of 889 included patients.... Headache frequency, anxiety, pericranial tenderness, poor sleep quality, and physical disability were the best discriminating variables for FM comorbidity, with 81.2% sensitivity. Patients presenting with chronic migraine and chronic tension-type headache had a higher probability of sharing the FM profile..... A phenotypic profile where headache frequency concurs with anxiety, sleep disturbance, and pericranial tenderness should be individuated to detect the development of diffuse pain in headache patients." [It is very likely that the headaches and localized tenderness, and perhaps some of the other symptoms as well, were due to co-existing myofascial TrPs rather than FM. The FM simply amplified the symptoms. DJS]

de Tommaso M, Nolano M, Iannone F et al. 2013. Update on laser-evoked potential findings in fibromyalgia patients in light of clinical and skin biopsy features. J Neurol. [Dec 24 Epub ahead of print.] "In fibromyalgia (FM), reduced habituation of laser-evoked potentials (LEPs) suggests a dysfunction of pain processing at a central level. In this study, we aimed to further examine the nociceptive pathways at the peripheral to the central level in a large group of FM patients by means of LEPs and skin biopsy, in light of healthy controls findings and main clinical features. One hundred and ninety-nine FM patients and 109 age- and sex-matched controls were submitted to LEPs by the dorsum of the right hand and the skin over the right chest and knee tender point stimulation. Skin biopsy was performed in 21 randomly selected FM patients and 60 age- and sex-matched controls. The mean N2-P2 amplitude was reduced in the whole FM group, with normal or even increased values in patients with migraine as comorbidity and reduced values in other patients including those presenting with distal sensory deficits. All patients had reduced N2-P2 habituation in respect to controls. In the FM group, LEPs habituation was correlated with pain at tender points and bad quality of life. Epidermal fiber density was significantly reduced in FM patients versus controls, and correlated with N2-P2 amplitude by the hand and chest tender-point stimulation. Dysfunction in the nociceptive system at both the central and peripheral levels may concur to explain phenotypical eterogeneity and clinical symptom complexity in fibromyalgia."

Deval E, Gasull X, Noel J et al. 2010. Acid-Sensing Ion Channels (ASICs): pharmacology and implication in pain. Pharmacol Ther. [Aug 28 Epub ahead of print]. "Tissue acidosis is a common feature of many painful conditions. Protons are indeed among the first factors released by injured tissues, inducing a local pH fall that depolarizes peripheral free terminals of nociceptors and leads to pain. ASICs are excitatory cation channels directly gated by extracellular protons that are expressed in the nervous system. In sensory neurons, they act as "chemo-electrical" transducers and are involved in somatic and visceral nociception. Two highly specific inhibitory peptides isolated from animal venoms have considerably helped in the understanding of the physiological roles of these channels in pain. At the peripheral level, ASIC3 is important for inflammatory pain. Its expression and its activity are potentiated by several pain mediators present in the "inflammatory soup" that sensitize nociceptors. ASICs have also been involved in some aspects of mechanosensation and mechanonociception, notably in the gastrointestinal tract, but the underlying mechanisms remain to be determined. At the central level, ASIC1a is largely expressed in spinal cord neurons where it has been proposed to participate in the processing of noxious stimuli and in central sensitization. Blocking ASIC1a in the spinal cord also produces a potent analgesia in a broad range of pain conditions through activation of the opiate system. Targeting ASIC channels at different levels of the nervous system could therefore be an interesting strategy for the relief of pain." [The investigation of ion channelopathies in chronic musculoskeletal pain is expanding. This study may be another indication that myofascial TrPs are due to calcium channelopathy, and that chronic pain conditions have a myofascial component. DJS]

Devor M. 2006.  Sodium channels and mechanisms of neuropathic pain.  J Pain 7 Suppl 1:S3-S12.  “Neuropathic pain is a complex outcome of multiple pathophysiological changes that develop in the peripheral nervous system (PNS) and the central nervous system (CNS) following nerve injury or disease.  All or most of the CNS changes are thought to be due to abnormal signaling from the PNS, notably electrical hyperexcitability of peripheral sensory neurons.  Because hyperexcitability is associated with abnormal sodium channel regulation, this process is a prime target for therapeutic intervention.”

Devulder J, Jacobs A, Richarz U et al. 2009.  Impact of opioids rescue medication for breakthrough pain on the efficacy and tolerability of long-acting opioids in patients with chronic non-malignant pain.  Br J Anaesth. [Sep 6 Epub ahead of print].  “We found no evidence that rescue medication with short-acting opioids for breakthrough pain affects analgesic efficacy of long-acting opioids or the incidence of common opioids-related side effects among chronic non-malignant pain patients.”

Deyo RA. 1996.  Drug therapy for back pain.  Which drugs help which patients?  Spine. 21(24):2840-2849.

de Zanette SA, Vercelino R, Laste G et al. 2014. Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial. BMC Pharmacol Toxicol. 15(1):40. "Central disinhibition is a mechanism involved in the physiopathology of fibromyalgia. Melatonin can improve sleep quality, pain and pain threshold. We hypothesized that treatment with melatonin alone or in combination with amitriptyline would be superior to amitriptyline alone in modifying the endogenous pain-modulating system (PMS) as quantified by conditional pain modulation (CPM), and this change in CPM could be associated with serum brain-derived neurotrophic factor (BDNF). We also tested whether melatonin improves the clinical symptoms of pain, pain threshold and sleep quality….Melatonin increased the inhibitory endogenous pain-modulating system as assessed by the reduction on NPS(0-10) during the CPM-TASK. Melatonin alone or associated with amitriptyline was better than amitriptyline alone in improving pain on the VAS, whereas its association with amitriptyline produced only marginal additional clinical effects on FIQ and PPT." Free Article

Dhein, S., R. Gerwin, U. Ziskoven, M. Schott, A. F. Rump, Y. Zhao, A. Salameh and W. Klaus. 1993.  Propranolol unmasks class III like electrophysiological properties of norepinephrine. Naunyn Schmiedebergs Arch Pharmacol 348(6):643-649.  

Dhir V, Lawrence A, Aggarwai A et al. 2009.  Fibromyalgia is common and adversely affects pain and fatigue perception in North Indian patients with rheumatoid arthritis.  J Rheumatol. 36(11):2443-2448.  “FM is more common in North Indian patients with RA (rheumatoid arthritis) compared to controls.  It adversely affects the pain and fatigue felt by RA patients.  Disease activity and FM influence each other.”

Diakow PR. 1992.  Differentiation of active and latent trigger points by thermography. J Manipulative Physiol Ther. 15(7):439-441.  “Thermography may be a useful tool in distinguishing active from latent trigger points, but the thermal imaging of spinal joint dysfunction may be a compounding factor.”

Diatchenko L, Fillingim RB, Smith SB et al. 2013. The phenotypic and genetic signatures of common musculoskeletal pain conditions. Nat Rev Rheumatol. [Apr 2 Epub ahead of print]. "Musculoskeletal pain conditions, such as fibromyalgia and low back pain, tend to coexist in affected individuals and are characterized by a report of pain greater than expected based on the results of a standard physical evaluation. The pathophysiology of these conditions is largely unknown, we lack biological markers for accurate diagnosis, and conventional therapeutics have limited effectiveness. Growing evidence suggests that chronic pain conditions are associated with both physical and psychological triggers, which initiate pain amplification and psychological distress; thus, susceptibility is dictated by complex interactions between genetic and environmental factors. Herein, we review phenotypic and genetic markers of common musculoskeletal pain conditions, selected based on their association with musculoskeletal pain in previous research. The phenotypic markers of greatest interest include measures of pain amplification and 'psychological' measures (such as emotional distress, somatic awareness, psychosocial stress and catastrophizing). Genetic polymorphisms reproducibly linked with musculoskeletal pain are found in genes contributing to serotonergic and adrenergic pathways. Elucidation of the biological mechanisms by which these markers contribute to the perception of pain in these patients will enable the development of novel effective drugs and methodologies that permit better diagnoses and approaches to personalized medicine."

Diaz, J. H. and H. J. Gould 3rd.  1999.  Management of post-thoracotomy pseudoangina and myofascial pain with botulinum toxin.  Anesthesiology 91(3):877-9.  Diaz: Louisiana State University Medical Center, Multidisciplinary Pain Mastery Center, New Orleans 70112.

Diaz-Piedra C, Catena A, Miro E et al. 2013. The impact of pain on anxiety and depression is mediated by objective and subjective sleep characteristics in fibromyalgia patients. Clin J Pain. [Nov 25 Epub ahead of print]. "Subjective poor sleep quality was found in all patients. Pain correlated with subjective and objective sleep parameters, self-efficacy, anxiety, and, marginally, with depression. The mediated regression analysis suggested that the best models to explain the impact of pain on anxiety and depression included, as mediators, subjective sleep quality, objective sleep efficiency and self-efficacy….objective sleep efficiency being the mediator with the highest influence….These findings show a high prevalence of sleep problems in patients with FMS and suggest that they play a role in the relationship between pain and anxiety and depression. In fact, the impact of chronic pain on the later emotional variables was mediated, not only by self-efficacy, but also by subjective sleep quality and, especially, by objective sleep efficiency."

Dick BD, Rashiq S. 2007. Disruption of attention and working memory traces in individuals with chronic pain.  Anesth Analg 104(5):1223-1229.  This research indicates that the maintenance of memory trace is affected by chronic pain.  Spatial memory was particularly affected.  "...pain may disrupt the maintenance of the memory trace that is required to hold information for processing and to later retain it for storage in longer-term memory stores.”

Dickenson AH, Carpenter K, Suzuki R. 1999.  Pain relief.  IDrugs 2(11):1130-1132.  “…excitability blockers acting on sodium and calcium channels, progress in drugs acting at glutamate receptors, cannabinoid receptors, capsaicin analogs, novel opioids acting at receptors other than the mu receptor for morphine, substance P antagonists and cyclooxygenase (COX)-2 inhibitors as being of particular interest.”  [Cannabinoids seem to be of increasing interest for the control of chronic pain. DJS]

Dickenson, A. H.  1997.  NMDA receptor antagonists: interactions with opioids.  Acta Anaesthesiol Scan 41(1 Pt 2):112-115.

Dickman R, Feroze H, Fass R. 2006.  Gastroesophageal reflux disease and irritable bowel syndrome: a common overlap syndrome.  Curr Gastroenterol Rep 8(4):261-265.  GERD patients with IBS are less likely to respond to anti-reflux medications than patients without IBS and also perceive their symptoms to be more severe.  [The latter could be due to the central sensitization aspects of IBS.  DJS]

Dickstein, J. B., H. Moldofsky, F. A. Lue and J. B. Hay.  1999.  Intracerebroventricular injection of TNF-alpha promotes sleep and is recovered in cervical lymph.  Am J Physiol 276(4 Pt 2):

Diercks RL. 2014. [Practice guideline 'Diagnosis and treatment of the subacromial pain syndrome']. Ned Tijdschr Geneeskd. 158:A6985. [Dutch] In shoulder pain there is often no direct relationship between the symptoms and the anatomical substrate; for this reason, the term 'subacromial pain syndrome' (SAPS) is better than 'impingement'. The diagnosis of SAPS can only be made using a combination of tests. Imaging diagnostics, preferably ultrasound, can be carried out if conservative treatment does not give the required result. Acute pain is treated by giving advice and if necessary analgesics; a subacromial injection of glucocorticoids is indicated if symptoms recur or are persistent. Exercise therapy should be specific, of low intensity and high frequency, including eccentric training, scapula stabilization and trigger point massage. Rehabilitation in a specialized unit may be considered if pain maintaining behavior is playing a role. There is no convincing evidence that surgical treatment is more effective than conservative management and there is no indication for the surgical treatment of asymptomatic rotator cuff tears.

Dietz GP, Valbuena PC, Dietz B et al. 2006.  Application of a blood-brain-barrier-penetrating form of GDNF in a mouse model for Parkinson’s disease.  Brain Res. 1082(1):61-66.  [Although this is a rat study, it is an important step in finding a biochemical that can cross the blood-brain barrier and perhaps influence the development of central sensitization.  DJS]

Di Franco M, Iannuccelli C, Atzeni F et al. 2010. Pharmacological treatment of fibromyalgia. Clin Exp Rheumatol. 28(6 Suppl 63):S110-116. "Various drugs currently are available to control the complex and different symptoms reported by patients. Only three drugs (duloxetine, milnacipram, pregabalin) are approved by the American Food and Drug Administration (FDA) and none by the European Medicines Agency (EMEA), consequently, off-label use is habitual in Europe. Most of the drugs improve only one or two symptoms; no drug capable of overall symptom control is yet available. Furthermore, different classes of drugs with different mechanisms of action are used off-label, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), opioids, non-steroidal anti-inflammatory drugs (NSAIDs), growth hormone, corticosteroids and sedative hypnotics. As no single drug fully manages FM symptoms, multicomponent therapy should be used from the beginning. Various pharmacological treatments have been used to treat FM with inconclusive results, and gradually increasing low doses is suggested in order to maximize efficacy. The best treatment should be individualized and combined with patient education and non-pharmacological therapy." [It is strongly suggested that all co-existing conditions, including chronic myofascial pain, be identified and treated to decrease pain stimuli and symptom burden. All perpetuating factors of all conditions must be brought under control as much as possible. DJS]

Di Girolamo S, Pisani V, Di Girolamo M et al. 2013. Atypical facial pain secondary to an unusual iatrogenic endonasal "contact point". Pain Med. 14(1):167-168.

Dijk DJ. 2008.  Slow-wave sleep, diabetes, and the sympathetic nervous system.  Proc Natl Acad Sci U S A. 105(4):1107-1108.  Slow wave (delta) sleep has a profound impact on brain regulatory functions, including glucose regulation and the development of insulin resistance.  [It is becoming more recognized that preventative medicine must include assurance of restorative sleep. DJS]

DiLorenzo L, Traballesi M, Morelli D et al. 2004.  Hemiparetic shoulder pain syndrome treated with deep dry needling during early rehabilitation: a prospective, open-label, randomized investigation.  J Musculoskel Pain 12(2):25-34.  Deep dry needling was associated with significant reduction of pain during sleep and physiotherapy.

Dimitrov EL, Kuo J, Kohno K et al. 2013. Neuropathic and inflammatory pain is modulated by tuberoinfundibular peptide of 39 residues. Proc Natl Acad Sci USA. [Jul 22 Epub ahead of print]. "Nociceptive information is modulated by a large number of endogenous signaling agents that change over the course of recovery from injury. This plasticity makes understanding regulatory mechanisms involved in descending inhibition of pain scientifically and clinically important. Neurons that synthesize the neuropeptide TIP39 project to many areas that modulate nociceptive information. These areas are enriched in its receptor, the parathyroid hormone 2 receptor (PTH2R). We previously found that TIP39 affects several acute nociceptive responses, leading us to now investigate its potential role in chronic pain…. These results suggest that TIP39 signaling modulates sensory thresholds via effects on glutamatergic transmission to brainstem GABAergic interneurons that innervate noradrenergic neurons. TIP39's normal role may be to inhibit release of hypoalgesic amounts of norepinephrine during chronic pain. The neuropeptide may help maintain central sensitization, which could serve to enhance guarding behavior."

Dimitrova S, Stoilova I, Cholakov I.  2004.  Influence of local geomagnetic storms on arterial blood pressure.  Bioelectromagnetics 25(6):408-414.  “Arterial bp was found to increase with the increase of the GMA level, and systolic and diastolic bp were found to increase significantly from the day before till the second day after the geomagnetic storm.  These effects were present irrespective of sex and medication.”  [FMS hypersensitivity to stimuli may cause greater sensitivity to geomagnetic effects. DJS.]

Dinerman, H. D. L. Goldenberg and D. T. Felson.  1986.  A prospective evaluation of 118 patients with the fibromyalgia syndrome: prevalence of Raynaud’s phenomenon, sicca symptoms, ANA, low complement, and Ig deposition at the dermal-epidermal junction.  J Rheumatol 13(2):368-73.

Dinier M, Diracoglu D, Kasikcioglu E et al. 2009.  Effect of aerobic exercise training on oxygen uptake and kinetics in patients with fibromyalgia.  Rheumatol Int. [Sep 26 Epub ahead of print].  “The results of the study suggest that cardiopulmonary system in charge of delivering oxygen to whole body and muscular microcirculation may have dysfunction in patients with FMS.” [This may affect FM and co-existing myofascial TrPs. DJS]

Dinges, D. F., M. T. Orne, W. G. Whitehouse and E. C. Orne.  1987.  Temporal placement of a nap for alertness: contributions of circadian phase and prior wakefulness.  Sleep 10(4):313-29.

Diochot S, Baron A, Salinas M et al. 2012. Black mamba venom peptides target acid-sensing ion channels to abolish pain. Nature. [Oct 3 Epub ahead of print]. Acid sensing ion channels (ACIC) are generally thought of as playing a main role in the pain pathways. A new class of peptides, called mambalgins, derived from the black mamba snake venom can abolish ACIC pain in either peripheral or central neurons. Their analgesic effect can be as strong as morphine without the respiratory distress caused by morphine, indicating a possible promising pain control option for the future.

Diraçoglu D, Vural M, Karan A et al. 2012. Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: A double-blind, randomized, placebo controlled study. J Back Musculoskel Rehabil. 25(4):285-290. "Dry needling appears to be an effective treatment method in relieving the pain and tenderness of myofascial trigger points."

Dirckx M, Groeneweg G, van Daele PL et al. 2013. Mast Cells: A New Target in the Treatment of Complex Regional Pain Syndrome? Pain Pract. [Mar 14 Epub ahead of print]. "There is convincing evidence that inflammation plays a pivotal role in the pathophysiology of complex regional pain syndrome (CRPS). Besides inflammation, central sensitization is also an important phenomenon. Mast cells are known to be involved in the inflammatory process of CRPS and also play a role (at least partially) in the process of central sensitization. In the development of a more mechanism-based treatment, influencing the activity of mast cells might be important in the treatment of CRPS. We describe the rationale for using medication that counteracts the effects of mast cells in the treatment of CRPS."

Dirlewanger, M., P. H. Schneiter, N. Paquot, E. Jequier, V. Ray and L. Tappy.  2000.  Effects of glucocorticoids on hepatic sensitivity to insulin and glucagon in man.  Clin Nutr 19(1):29-34.

Di Stefano, G. and B. P. Radanov. 1995. Course of attention and memory after common whiplash: 82-year prospective study with age, education and gender pair-matched patients. Acta Neurol Scand 91(5):346-352.

Di Tella M, Castelli L, Colonna F. 2015. Theory of Mind and emotional functioning in fibromyalgia syndrome: An investigation of the relationship between social cognition and executive function. PLoS One. 10(1):e0116542. "Patients with FM have impairments both in the regulation of their own affect and in the recognition of other's emotions, as well as in representing other people's mental states. No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analyzed….The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice." Free PMC Article

Djouhri L, Koutsikou S, Fang X et al. 2006.  Spontaneous pain, both neuropathic and inflammatory, is related to frequency of spontaneous firing in intact C-fiber nociceptors.  “Spontaneous pain is a poorly understood aspect of human neuropathic pain.”  “Some types of spontaneous pain after nerve injury may result from cumulative neuroinflammation.”

Dobkin PL, Sita A, Sewitch MJ. 2006.  Predictors of adherence to treatment in women with fibromyalgia.  Clin J Pain. 22(3):286-294.   “Adherence is influenced by both clinical (patient-physician discordance and pain) and psychological (distress) factors in women with FM.  Improvements in these domains may improve adherence in FM.”

Dobkin PL, Abrahamowicz M, Fitzcharles MA et al. 2005.  Maintenance of exercise in women with fibromyalgia.  Arthritis Rheum. 53(5):724-731.  “The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress, pain, barriers to exercise, and disability.”

Doggweiler-Wiygul R. 2004.  Urologic myofascial pain syndromes.  Curr Pain Headache Rep. 8(6):445-451.  “Treatment of pain of urogenital origin, chronic pelvic pain syndrome, can be frustrating for patients and physicians.  The usual approaches do not always produce the desired results.  Visceral pain from pelvic organs and myofascial pain from muscle trigger points share common characteristics.  Referred pain from myofascial trigger points can mimic visceral pain syndromes and visceral pain syndromes can induce trigger point development and myofascial pain and dysfunction.  The referred pain syndrome can long outlast the initial event, making diagnosis difficult.”

Doggweiler-Wiygul R, 2004.  Urological myofascial pain syndromes.  Curr Pain Headache Rep 8(6):445-451.  It can be difficult to distinguish pain from visceral organs and pain due to myofascial  trigger points that refer to the same areas.  Visceral pain can also be a perpetuating factor of TrPs, although the TrPs themselves can perpetuate the pain and other symptoms long after the visceral problem is under control.

Doggweiler-Wiygul R., Wiygul J.P.  Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients.  World J Urol 20(5):310-4.  “Referred pain and motor activity to the pelvic floor muscles (sphincters), as well as to the pelvic organs, can be the sole cause of IC, IPP, and irritative voiding dysfunction...”

Dohrenbusch, R., H. Sodhi , J. Lamprecht and E. Genth. 1997. Fibromyalgia as a disorder of perceptual organization? An analysis of acoustic stimulus processing in patients with widespread pain. Z Rheumatol 56(6):334-341.

Domany E, Gilad O, Shwarz M et al. 2013. Imperforate hymen presenting as chronic low back pain. Pediatrics. 132(3):e768-770. In some women, the hymen has an insufficient opening to allow the menses to flow. This case report is from the Pediatrics Dept. of B. Schneider Children's Medical Center of Israel. "Imperforate hymen in an adolescent usually presents with cyclic abdominal pain or with pelvic mass associated with primary amenorrhea. We present a 13-year-old girl with chronic lower back pain of 6 months' duration as the only complaint. On physical examination, multiple trigger points were detected in the quadratus lumborum and gluteus medius muscles bilaterally….Hymenectomy was performed, with complete resolution of the back pain. Myofascial pain syndrome with a viscerosomatic reflex is a possible explanation for the clinical presentation of our patient."

Domingo T, Blasi J, Casals M et al. 2011. Is interfascial block with ultrasound-guided puncture useful treatment of myofascial pain of the trapezius muscle. Clin J Pain Feb 11 [Epub ahead of print] Interfascial diffusion of local anesthetic may be useful for treating trapezius myofascial pain. Patients experienced significant relief with guided local anesthetic injection into this area. The authors did a cadaver study and found that numerous nerve structures in the interfascial space could be a significant part of pain generation in some patients. [Myofascial TrPs take a while to form. This study may the first using injection of local anesthetic to treat the interfascial area to relieve pain. DJS]

Domire ZJ, McCullough MD, Chen Q et al. 2009. Feasibility of using magnetic resonance elastography to study the effect of aging on shear modulus of skeletal muscle. J Appl Biomech. 25(1):93-93. Stiffening of muscles is commonly associated with aging. MRE might be a promising way to study age-related changes in muscle tissue and to evaluate treatments.

Dommerholt J. 2011. Dry needling – peripheral and central considerations. J Man Manipul Ther. 19(4):223-237. This interesting review was prepared by someone I know and respect as a master of both dry needling and trigger points. I have had discussions on this topic with my co-author, John Sharkey, who fits both of these descriptions as well. This review clarifies many points. One of these is points is that the active or latent status of a TrPs at least partially depends on any degree of co-existing central sensitization. Readers are cautioned that new ultrasound and magnetic resonance elastographic techniques that have proven the existence of TrPs are not available for clinical use, and explains the importance of carefully checking anatomic landmarks to avoid damage of other tissues. Included is a fine overview of the current controversy on dry needling between acupuncturists and physical therapists. It is true that there are some physical therapists who have managed to go through school without learning about TrPs, just as there are acupuncturists who have done the same. Perhaps we are looking too much at titles and too little at specific training. Certainly, an MD, DO or any other title after a name does not qualify someone to perform a TrP injection, although many do. This article contains much food for thought, offered by an eminently qualified writer. DJS

Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part II–examination. J Bodyw Mov Ther 14(1):65-72. This second in the series article illustrates how to follow the clues given in the medical history and translate them into the examination.

Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part III-Case histories. J Bodyw Mov Ther 13(4):311-319. This last in the series article gives 3 case histories of musicians with hand pain. The clues given in the history and exam (part I and II) lead to specific diagnoses, followed with individual treatment plans and control of perpetuating factors.  


Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part II–examination. J Bodyw Mov Ther 14(1):65-72. This second in the series article illustrates how to follow the clues given in the medical history and translate them into the examination.


Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part III-Case histories. J Bodyw Mov Ther 13(4):311-319.  This last in the series article gives 3 case histories of musicians with hand pain.  The clues given in the history and exam (part I and II) lead to specific diagnoses, followed with individual treatment plans and control of perpetuating factors. 

Dommerholt J. 2009.  Performing arts medicine-instrumentalist musicians part I-general considerations. J Bodyw Mov Ther 13(4):311-319.  This is an excellent paper illustrating the importance of history taking to the discovery of the total pattern of accommodation and altered function that can occur in instrumental musicians.  It has lessons for all care providers who must assess chronic pain conditions.  These patients arrived with incorrect diagnoses and a lot of pain and dysfunction, but found hope and a chance of resuming their careers.

Dommerholt J. 2009. Performing arts medicine-instrumentalist musicians part I-general considerations. J Bodyw Mov Ther 13(4):311-319.  This is an excellent paper illustrating the importance of history taking to the discovery of the total pattern of accommodation and altered function that can occur in instrumental musicians. It has lessons for all care providers who must assess chronic pain conditions.  These patients arrived with incorrect diagnoses and a lot of pain and dysfunction, but found hope and a chance of resuming their careers.

Dommerholt J, Bron C, Frannsen J. 2006.  Myofascial trigger points: An evidence-informed review.  J Man Manip Ther 14(4):203-221.  This excellent review includes history, examination procedures, and a good overview of the evidence-based material on MTPs.  Although it is written for manual therapists, it is worthy reading for all care providers, including physicians. 

Dommerholt, Jan, 2000. Fibromyalgia: time to consider a new taxonomy?  Persons with fibromyalgia have altered nociception, hyperalgesia, allodynia, and hypervigilance. The term "fibromyalgia" does not describe the etiology of the syndrome adequately.

Dommerholt J, Gerwin RD. 2015. A critical evaluation of Quintner et al: Missing the point. J Bodyw Mov Ther. 19(2):193-204. "The objective of this article is to critically analyze a recent publication by Quinter, Bove and Cohen, published in Rheumatology, about myofascial pain syndrome and trigger points (Quintner et al., 2014). The authors concluded that the leading trigger point hypothesis is flawed in reasoning and in science. They claimed to have refuted the trigger point hypothesis. The current paper demonstrates that the Quintner et al. paper is a biased review of the literature replete with unsupported opinions and accusations. In summary, Quintner et al. have not presented any convincing evidence to believe that the Integrated TrP Hypothesis should be laid to rest." [This article proves that the article written by Quintner and company "debunking trigger points", to put it politely, is total nonsense. I wonder how the flawed article by Quintner and co. was published at all. DJS]

Dommerholt J, Grieve R, Layton M et al. 2015. An evidence-informed review of the current myofascial pain literature - January 2015. J Bodyw Mov Ther. 19(1):126-137. "This article provides an up-to-date review of the most recent publications about myofascial pain, trigger points (TrPs) and other related topics. We have added some commentaries where indicated with supporting references. In the Basic Research section, we reviewed the work by Danish researchers about the influence of latent TrPs and a second study of the presence and distribution of both active and latent TrPs in whiplash-associated disorders. The section on Soft Tissue Approaches considered multiple studies and case reports of the efficacy of myofascial release (MFR), classic and deep muscle massage, fascial techniques, and connective tissue massage. Dry needling (DN) is becoming a common approach and we included multiple studies, reviews, and case reports, while the section on Injection Techniques features an article on TrP injections following mastectomy and several articles about the utilization of botulinum toxin. Lastly, we review several articles on modalities and other clinical approaches."

Dommerholt J, Layton M, Hooks T et al. 2015. A critical overview of current myofascial pain literature - March 2015. J Bodyw Mov Ther. 19(2):337-349. "The second article in this review series considers multiple recent publications about myofascial pain, trigger points (TrPs) and other related topics. The article is divided into several sections, including a Basic Research section (4 articles), a section on Soft Tissue Approaches (5 articles), a Dry Needling and Acupuncture section (7 articles), an Injection section (2 articles), a section on. Modalities (1 article), Other Clinical Approaches (3 articles) and finally a Reviews section (7 articles). The thirty publications reviewed in this article originated in all corners of the world."

Donahue, R. P. , R. J. Prineas, R. DeCarlo Donahue, P. Zimmet, J. A. Bean, M. De Courten, G. Collier, R. B. Goldberg, J. S. Skyler and N. Schneiderman. 1999. Is fasting leptin associated with insulin resistance among nondiabetic individuals?  The Miami Community Health Study. Diabetes Care 22(7):1092-6.

Donaldson CCS, Nelson DV, Schulz R. 1998.  Disinhibition in the gamma motoneuron circuitry: a neglected mechanism for understanding myofascial pain syndromes?  Applied Psycho Biofeedback 23(1):43-57.

Donaldson, C. C. , D. V., Nelson and R. Schulz. 1998. Disinhibition in the gamma motoneuron circuitry: a neglected mechanism for understanding myofascial pain syndromes? Appl Psychophysiol Biofeedback 23(1):43-57.

Donaldson, C.C.S., G. E. Sella and H. H. Mueller.  1998.  Fibromyalgia: a retrospective study of 252 consecutive referrals.  Can J Clin Med 5(6):1-10.

Donaldson IM. 2000.  The functions of the proprioceptors of the eye muscles.  Philos Trans R Soc Lond B Sci. 355(1404):1685-1754.  “...there are excellent grounds for believing that the receptors in the extraocular muscles are indeed proprioceptors...”

Donnelly JM, Palubinskas L. 2007.  Prevalence and inter-rater reliability of trigger points.  J Musculoskel Pain 15 (Supp 13):16 item 21.  [Myopain 2007 Poster]  This research not only confirmed that practitioners skilled in palpation had excellent inter-rater reliability for MTPs, but also found that many healthy college students had taut bands and MTPs.  [It would be interesting to follow these students and find out if these latent MTPs caused restricted range of motion, if there were one or more perpetuating factors, and if they activated at a later time. DJS]

Donnelly, J. M. 2002. Physical therapy approach to fibromyalgia with myofascial trigger points: a case report. J Musculoskel Pain 10(1/2)177-190.  This report indicates that a well educated and function-oriented patient coupled with a care provider who is well-trained in the recognition of fibromyalgia and myofascial trigger points can work as a team to significantly improve the patient’s quality of life, improving function and decreasing pain level.

Doorenbos AZ, Gordon DB, Tauben D et al. 2013. A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain. 14(12):1533-1538. "Findings confirm the paucity of pain education across the health sciences curriculum in a CoEPE that serves a large region of the United States. The data provide a pain curriculum blueprint that can be used to recommend added pain content tin health sciences programs across the country."

Dorey G, Speakman M, Feneley R et al. 2004. Randomized controlled trial of pelvic floor muscle exdercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract 54(508):819-825. Research indicates that pelvic floor exercises and manometric biofeedback are as effective as Viagra for erectile dysfunction.

Doron Y, Peleg R, Peleg A et al.  2004.  The clinical and economic burden of fibromyalgia compared with diabetes mellitus and hypertension among Bedouin women in the Negev.  Fam Pract. 21(4):415-419.  “Conclusions: FM patients consume health care resources to a similar extent to patients with other chronic diseases such as diabetes mellitus and hypertension, but the latter usually receive much more attention from the health care system.  Greater awareness of this disorder can improve management and facilitate planning of health care resources, thus improving quality of care.”

Dorsher PT. 2009.  Myofascial referred-pain data provide physiologic evidence of acupuncture meridians. J Pain. [Apr 29 Epub ahead of print].  “This article demonstrates that myofascial referred-pain data provide independent physiologic evidence of acupuncture meridians.  The acupuncture tradition provides pain practitioners with millennia of accumulated clinical experience treating pain (and visceral) disorders and offers the potential for novel pain treatment approaches and understanding of pain neurophysiology.”

Dorsher PT. 2007.  Subcutaneous trigger point causing radiating post-surgical pain.  J Musculoskel Pain 15 (Supp 13):16 item 22.  [Myopain 2007 Poster]  A visible subcutaneous trigger point overlying the latissimus dorsi muscle was difficult to anesthetize.  It produced referred arm and back pain, but range of motion was normal.  The pain improved with a mild opioid, Flexeril, physical therapy including massage and exercises.  [Subcutaneous trigger points are not well known or documented.  Much research is needed on trigger points in nonmyofascial tissues. DJS]

Draper DO, Mahaffey C, Kaiser D et al. 2010. Thermal ultrasound decreases tissue stiffness of trigger points in upper trapezius muscles. Physiother Theory Pract. 26(3):167-172. “Thermal ultrasound over latent trigger points is comfortable and can decrease stiffness of a trigger point.” [Since latent TrPs have been shown to decrease range of motion and cause weakness and contribute to muscle imbalance even though they don’t cause pain all the time, they do need to be treated.  The patient should be educated that such treatment can activate the TrPs, producing a temporary increase in symptoms, but that such treatment may help in restoring function.  Post-treatment symptoms can be minimized by a warm bath with bath salts and stretching after. DJS] 

Dreon, D. M., H. A. Fernstrom, P. T. Williams and R. M. Krauss.  1999.  A very low-fat diet is not associated with improved lipoprotein profiles in men with a predominance of large, low-density lipoproteins.  Am J Clin Nutr 69(3):411-8.  

Dressler D. 2012. Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system. J Neurol. [Aug 10 Epub ahead of print]. Botulinum toxin (BoNT) has been used for a number of non-muscular conditions including: achalasia, gastroparesis, sphincter of Oddi spasms, and unspecific esophageal spasms in gastroenterology and prostate disorders in urology, various forms of bladder dysfunction (detrusor sphincter dyssynergia, idiopathic detrusor overactivity, neurogenic detrusor overactivity, urinary retention and bladder pain syndrome), pelvic floor disorders (pelvic floor spasms and anal fissures), hyperhidrosis (axillary, palmar, and plantar hyperhidrosis, diffuse sweating, Frey's syndrome) and hypersalivation (hypersalivation in Parkinsonian syndromes, motor neuron disease, neuroleptic use, and cerebral palsy). [Some of these conditions, such as many chronic pelvic complaints, can be relieved by trigger point injection. It is unknown how many of the papers reviewed were actually dealing with that BoTox TrP therapy. DJS]

Drewes, A. M. , K. D. Kielson, S. J. Taagholt, K. Bjerregard, L. Svendsen and J. Gade. 1995. Sleep intensity in fibromyalgia: focus on the micro-structure of the sleep process. Br J Rheumatol 34(7):629-635.

Dreyer L, Kendall S, Danneskiold-Samsoe B et al. 2010. Mortality in a cohort of Danish patients with fibromyalgia - increased suicide, liver disease and cerebrovascular disease. Arthritis Rheum. [Jun 25 Epub ahead of print]. "Among the 1269 female patients, an increased risk of death from suicide SMR=10.5[95%CI: 4.5-20.7], liver cirrhosis/biliary tract disease SMR=6.4[95%CI:2.3-13.9], and cerebrovascular disease SMR=3.1[95%CI:1.1-6.8] was observed. Suicide risk was increased at time of diagnosis and remained after 5 years….No increased cause-specific mortality was observed in the 84 male patients…..The causes of markedly increased rate of suicide in female FM are at present unknown, but may be related to increased rates of lifetime depression, anxiety, and psychiatric disorders. Risk factors for suicide should be sought at time of diagnosis and at follow up. The results also suggest that risk factors for liver disease and cerebrovascular disease should be evaluated in FM patients."

Dreyer L, Mellemkjaer L, Kendall S et al. 2007.  Increased cancer risk in patients referred to hospital with suspected fibromyalgia.  J Rheumatol. 34(1):201-206.  This study found no association between these two conditions.  [Any chronic unrelieved pain, or any other chronic or sufficiently acute central nervous system stimulation, might provoke central sensitization and FMS. DJS]

Dromey C, Nissen SL, Roy N et al. 2008.  Acticulatory changes following treatment of muscle tension dysphonia: preliminary acoustic evidence.  J Speech Lang Hear Res. 51(1):196-208.  [This work indicates that manual therapy in the laryngeal muscles may be helpful in vocal dysfunction.  I believe that these authors have been working on trigger points in the laryngeal muscles without knowing it. DJS]

Drummond PD, Willox M. 2013. Painful effects of auditory startle, forehead cooling and psychological stress in patients with fibromyalgia or rheumatoid arthritis. J Psychosom Res. 74(5):378-383. "These findings suggest that processes linked with individual differences in distress aggravate pain in rheumatoid arthritis, whereas some other mechanism (e.g., failure of stress-related pain modulation processes or an aberrant interaction between nociceptive afferent and sympathetic efferent fibers) triggers stress-induced pain in fibromyalgia."

Duan B, Cheng L, Bourane S. 2014. Identification of spinal circuits transmitting and gating mechanical pain. Cell 159(6):1417-1432. This study from the Salk Institute for Biological Studies and Harvard indicates that peripheral mechanical pain sources and a type of mechanoreceptor, along with spinal excitatory and inhibitory neurons can create and modulate mechanical pain signals to and from the brain. This nerve circuit may be part of the phantom limb pain, or fibromyalgia central sensitization pain, causing pain from only touch or other normally non-painful stimuli.

Duan B, Wu LJ, Yu YQ et al. 2007.  Upregulation of acid-sensing ion channel ASIC1a in spinal dorsal horn neurons contributes to inflammatory pain hypersensitivity.  J Neurosci. 27(41):11139-11148.  “Specific blockade of Ca2+-permeable ASIC1a channels thus may have antinociceptive effect by reducing or preventing the development of central sensitization induced by inflammation.”  [This is another indication of calcium ion channel dysfunction affecting the chronic pain state, and may lead to new avenues of prevention and treatment of same. DJS]

Dubner, R. 1991. Basic mechanisms of pain associated with deep tissues. Can J Physiol Pharmacol 69(5):607-609.

Dubner, R. and K. M. Hargreaves. 1989. The neurobiology of pain and its modulation.  Clin J Pain 5(Suppl 2):S1-S4.

Dubousset J. 2003.  [Spinal instrumentation, source of progress, but also revealing pitfalls.]  Bull Acad Natl Med 187(3):523-533. [French]  Most surgeons do not check their patients presurgically for the presence of biomechanical or soft tissue dysfunctions.  Even bone evaluations are rarely done except supine views.  Computer simulation may help to remedy this lack, and may reduce needless surgery and minimize failed surgeries.

Dubrovsky B, Raphael KG, Lavigne GJ et al. 2014. Polysomnographic investigation of sleep and respiratory parameters in women with temporomandibular pain disorders. J Clin Sleep Med. 10(2):195-201. "Myofascial pain in TMD is associated with mild elevation in sleep fragmentation and increased frequency of RERA (respiratory effort related arousals events). Further research is required to evaluate the clinical significance of these findings."

Duclos M, Gatta B, Corcuff JB et al. 2001.  Fat distribution in obese women is associated with subtle alterations of the hypothalamic-pituitary-adrenal axis activity and sensitivity to glucocorticoids.  Clin Endocrinol 55(4):447-454. [This study shows another connection between HPA axis dysfunction and abdominal obesity.  Insulin resistance, abdominal obesity and other pieces of the metabolic syndrome are perpetuating factors of both FMS and myofascial TrPs. DJS]

Dulloo, A. G., C. Duret, D. Rohrer, L. Girardier, N. Mensi, M. Fathi, P. Chantre and J. Vandermander.  1999.  Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans. Am J Clin Nutr 70(6):1040-5.

Dummer JS, Dinges DF. 2005.  Neurocognitive consequences of sleep deprivation.  Semin Neurol. 25(1):117-129.  “Recent chronic partial sleep deprivation experiments, which more closely replicate sleep loss in society, demonstrate that profound neurocognitive deficits accumulate over time in the face of subjective adaptation to the sensation of sleepiness.  Sleep deprivation associated with disease-related sleep fragmentation also results in neurocognitive performance decrements similar to those seen in sleep restriction studies.”

Duncan B, White A, Rahman A. 2007.  Acupuncture in the treatment of fibromyalgia in tertiary care – a case series.  Acupunct Med. 25(4):137-147.  “Acupuncture appears to offer symptomatic improvement to some patients with fibromyalgia in a tertiary clinic who have failed to respond to other treatments.  In view of its safety, further acupuncture research is justified in this population.”

Dunn D. 2000.  Chronic regional pain syndrome, type 1: Part I.  AORN J. 72(3):422-432, 435-449.  Although this article is on chronic regional pain syndrome, it includes trigger point injections and other trigger point therapies, indicating the author’s understanding that TrPs are contributors to many cases of CRPS.  DJS]

Dunnett AJ, Roy D, Stewart A et al. 2007.  The diagnosis of fibromyalgia in women may be influenced by menstrual cycle phase.  J Bodywork Move Ther. 11, 99-105.  “…sensitivity to pressure and pain varies over the course of the menstrual cycle, requiring clinical adjustments in palpation-based diagnostic models and treatment modalities.”

Dunteman, E., M. S. Turner and R. Swarm. 1996. Pseudo--spinal headache. Reg Anesth 21(4):358-360.

DuPont, J. S. Jr. DDS. 1999. Trigger Point Identification and Treatment with Microcurrent. J Craniomandib Pract 17(4):293-296.

Durand M, Mach N. 2013. [Alpha lipoic acid and its antioxidant against cancer and diseases of central sensitization.] Nutr Hosp. 28(4):1031-1038. [Article in Spanish]. "The ALA (alpha lipoic acid) plays a significant role as antioxidant and prooxidant in cancer and central sensitization diseases, although more extensive studies are required to determine the clinical significance in humans."

Duric V, McCarson KE. 2006.  Persistent pain produces stress-like alterations in hippocampal neurogenesis and gene expression.  J Pain 7(8):544-555.  “Persistent pain induces stress-like damaging modulatory effects in the hippocampus, which is one of the limbic regions involved in the pathophysiology of depression.  Targeting these mechanisms (which are potential contributors to the emotional impact of pain) may provide novel therapeutic approaches for relieving depression-like aspects of chronic pain.”

Duschek S, Mannhart T, Winkelmann A et al. 2012. Cerebral blood flow dynamics during pain processing in patients with fibromyalgia syndrome. Psychosom Med. 74(8):802-809. "Objectives Increased cerebral blood flow during processing of acute pain has repeatedly been observed in fibromyalgia syndrome....The increased blood flow response in the anterior cerebral arteries reflects hyperactivity of medial structures of the neuromatrix of nociception, structures involved in the processing of affective and cognitive aspects of pain. Aberrances in cerebral blood flow related to fibromyalgia and its clinical characteristics become particularly apparent in the enhancement of the initial component of the hemodynamic response."

Duschek S, Werner NS, Limbert N et al. 2014. Attentional Bias toward Negative Information in Patients with Fibromyalgia Syndrome. Pain Med. [Jan 21 Epub ahead of print.] "In addition to central nervous sensitization, affect dysregulation constitutes an important factor in the pathogenesis of fibromyalgia syndrome (FMS). The present study is concerned with emotional influences on information processing in FMS. The hypothesis of attentional bias, i.e., selective processing of negatively connoted stimuli, was tested….Twenty-seven female FMS patients and 34 healthy women undertook an emotional modification of the Stroop task. Subjects had to decide whether the colors of positive, negative, and neutral adjectives accorded with color words presented in black. Attentional bias was defined as delay in color naming of emotional words relative to neutral words. Affective and anxiety disorders, pain severity, as well as medication were considered as possible factors mediating the expected interference….Patients showed marked attentional bias, manifested in a greater response delay due to negative words compared with the control group. Among the clinical features, pain severity was most closely associated with the extent of the interference. While depression played only a subordinate role, anxiety and medication were without effect….The study provides evidence of emotionally driven selective attention in FMS. Attentional bias to negative information may play an important role in the vicious circle between negative affective state and pain augmentation. In the management of FMS pain, strategies aiming at conscious direction of attention may be helpful, e.g., imagery techniques or mindfulness training."

Duschek S, Werner NS, Winkelmann A et al. 2013. Implicit memory function in fibromyalgia syndrome. Behav Med. 39(1):11-16. "The study investigated implicit memory function in fibromyalgia syndrome (FMS) and its association with clinical parameters. Implicit memory refers to the influence of past experience on current behavior without conscious awareness of these experiences. Eighteen FMS patients and 25 healthy individuals accomplished a word-stem completion task. As possible factors mediating the expected impairment, pain severity, emotional disorders, and medication were taken into the expected impairment, pain severity, emotional disorders, and medication were taken into account. The patients displayed markedly reduced task performance and higher levels of depression and anxiety. Among the clinical features, pain severity was most closely associated with performance, whereas depression, anxiety, and medication showed only a minor impact. The study documented reduced implicit memory function in FMS. In contrast to former findings on impaired performance of FMS patients on classical memory tests, lower implicit memory function cannot be ascribed to motivational deficits. Instead, the aberrances may relate to functional inference between central nervous nociceptive activity and cognitive processing."

Dutra EH, Maruo H, Vianna-Lara MS. 2006.  Electromyographic activity evaluation and comparison of the orbicularis oris (lower fascicle) and mentalis muscles in predominantly nose- or mouth-breathing subjects.  Am J Orthod Dentofacial Orthop. 129(6):722.e1-9.  [Although TrPs were not specifically mentioned, this study indicated that mouth breathing influences EMG activity of specific muscles, and that could increase the chance of TrP formation. DJS]

Duyur Cakit B, Genc H, Altuntas V et al. 2009.  Disability and related factors in patients with chronic cervical myofascial pain.  Clin Rheumatol. 28(6):647-654.  “The aim of this study is to detect whether cervical myofascial pain leads to disability and to determine factors associated with disability in patients with chronic cervical myofascial pain.”  “In the patient group, the total Neck Pain and Disability scale scores were significantly correlated with the pain pressure threshold values of the trapezius and levator scapula muscles and Beck Depression Inventory scores.”  “Cervical myofascial pain is a reason for disability in chronic neck pain population.  Disease duration was found as the strongest predictor of disability.”

Dwarswaard J, Bakker EJ, van Staa A et al. 2015. Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies. Health Expect. [Jan 26 Epub ahead of print.] "Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support….Patients do not self-manage on their own. Patients expect health-care professionals to fulfill a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs."

Dwight, M. M., L. M. Arnold, H. O’Brien, R. Metzger, E. Morris-Park and P. E. Peck Jr.  1998. An open clinical trial of venlafaxine treatment of fibromyalgia.  Psychosomatics 39(1):14-17.

Dyer L, Venton K, Forrester M. 2013. Home electroacupuncture for persistent postsurgical pain: a patient's report. Acupunct Med. 31(4):425-429. "A 30-year-woman presented with iatrogenic myofascial facial pain of 12 months' duration after surgical treatment for bilateral temporomandibular joint dysfunction….Home electroacupuncture seems to be safe, acceptable and practicable as a maintenance treatment for patients with persistent postsurgical pain of myofascial origin."

Dykman, K. D., C. Tone, C. Ford and R. A. Dykman. 1998. The effects of nutritional supplements on the symptoms of fibromyalgia and chronic fatigue syndrome. Integr Physiol Behav Sci 33(1):61-71.

Easton V, Bale P, Bacon H et al. 2014. A89: the relationship between benign joint hypermobility syndrome and developmental coordination disorders in children. Arthritis Rheumatol. 66 Suppl 11:S124. "The purpose of this study was to examine baseline data from an interventional study of BJHS in childhood to assess the relationship between joint hypermobility and motor control. …The study subjects included 119 children between the ages of 5 and 16 years. All had documented joint hypermobility (assessed by a pediatric rheumatologist) and musculoskeletal pain or dysfunction. …Movement difficulty is a common independent component of BJHS in childhood. An evaluation of motor function needs to be included as part of the assessment of all children with BJHS and may merit targeted intervention as its presence represents a lower quality of functioning. Further research is needed into children with BJHS and movement difficulty, who may benefit from targeted interventions." [It would be very useful if these children were assessed for trigger points that could be affecting their coordination. DJS]

Ebener, M. K.  1999.  Older adults living with chronic pain: an opportunity for improvement. J Nurs Care Qual 13(4):1-7.

Edwards J. 2005.  The importance of postural habits in perpetuating myofascial trigger point pain.  Acupunct In Med. 23(2):77-82.  This article is a collection of examples indicating how bracing arms or knees, leg crossing and side-leaning, arm crossing, sitting with legs tucked sideways, habitual undesirable sleeping positions, and “...any habitual posture that gives rise to [prolonged contraction of muscle fibres may cause motor endplate dysfunction and the development of an MTrP...”  [ The author believes that habitual dysfunctional postures may occur without other perpetuating factors and may be often untreated and correctable perpetuating factors.  We both believe that this knowledge would be very empowering to TrP patients and should be part of the educational process. DJS]

Edwards J, Knowles N. 2003.  Superficial dry needling and active stretching in the treatment of myofascial pain — a randomized controlled trial.  Acupunct Med 21(3):80-86.  “SDN followed by active stretching is more effective than stretching alone in deactivating TrPs (reducing their sensitivity to pressure), and more effective than no treatment in reducing subjective pain.  Stretching without prior deactivation may increase TrP sensitivity

Edwards R, Augustson E, Fillingim R. 2003.  Differential relationships between anxiety and treatment-associated pain reduction among male and female chronic pain patients.  Clin J Pain. 19(4):208-216.  “These findings suggest differential relationships between anxiety and pain relief as a function of sex.  While we are unable to identify a mechanism for this effect, higher anxiety may have predicted more pain relief among males and less pain relief among females due to sex differences in coping strategies or placebo effects.”

Edwards RR, Bingham CO 3rd, Bathon J et al. 2006.  Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases.  Arthritis Rheum. 55(2):325-332.  “There appear to be multiple mechanisms by which catastrophizing exerts its harmful effects, from maladaptive influences on the social environment to direct amplification of the central nervous system’s processing of pain.”  “Catastrophizing is a critically important variable in understanding the experience of pain in rheumatologic disorders as well as other chronic pain conditions.  Pain-related catastrophizing may be an important target for both psychosocial and pharmacologic treatment of pain.”

Edwards RR, Calahan C, Mensing G et al. 2011. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol. [Feb 1 Epub ahead of print]. "Depression and catastrophizing are consistently associated with the reported severity of pain, sensitivity to pain, physical disability, poor treatment outcomes, and inflammatory disease activity, and potentially with early mortality. A variety of pathways, from cognitive to behavioral to neurophysiological, seem to mediate these deleterious effects. Collectively, depression and catastrophizing are critically important variables in understanding the experience of pain in patients with rheumatologic disorders. Pain, depression, and catastrophizing might all be uniquely important therapeutic targets in the multimodal management of a range of such conditions." [It should go without saying (but it cannot as many clinicians seem not to understand this) that the physical reasons for the pain must also be identified and treated. This often takes persistence and a thorough understanding of pain generators and perpetuating factors. DJS]

Eftekhar-Sadat B, BabaeiGhazani A, Zeinolabedinzadeh V. 2012. Evaluation of dry needling in patients with chronic heel pain due to plantar fasciitis. Foot (Edinb). [Nov 28 Epub ahead of print]. This study from Iran found that although dry needling did not seem to improve range of motion of ankle joint in dorsiflexion or plantar extension, it helped improve pain significantly and should be tried before more invasive forms of treatment are attempted. [Other TrPs could have been involved in the Ankle ROM, including TrPs in the tibialis anterior, anterior gluteus minimus, peroneus muscles and ankle retinaculua. All involved muscles must all be treated with manual therapy, electoceutical modalities such as ultrasound, stretch and spray and other noninvasive alternatives and perpetuating factors brought under control before anything more invasive is considered. DJS]

Egli M, Koob GF, Edwards S. 2012. Alcohol dependence as a chronic pain disorder. Neurosci Biobehav Rev. [Sep 11 Epub ahead of print]. "Dysregulation of pain neurocircuitry and neurochemistry has been increasingly recognized as playing a critical role in a diverse spectrum of diseases including migraine, fibromyalgia, depression, and PTSD. Evidence presented here supports the hypothesis that alcohol dependence is among the pathologies arising from aberrant neurobiological substrates of pain. In this review, we explore the possible influence of alcohol analgesia and hyperalgesia in promoting alcohol misuse and dependence. We examine evidence that neuroanatomical sites involved in the negative emotional states of alcohol dependence also play an important role in pain transmission and may be functionally altered under chronic pain conditions. We also consider possible genetic links between pain transmission and alcohol dependence. We propose an allostatic load model in which episodes of alcohol intoxication and withdrawal, traumatic stressors, and injury are each capable of dysregulating an overlapping set of neural substrates to engender sensory and affective pain states that are integral to alcohol dependence and comorbid conditions such as anxiety, depression, and chronic pain."

Ehrenberg R. 2012. Hurt Blocker: The next big pain drug may soothe sensory firestorms without side effects. Science 181(13):22-25. A small group of Pakistani families with inability to feel pain have mutations in a gene that controls access to nerve cells through sodium ion channels. These sodium channels may be a target area for future specific pain control medications. Other sodium channel blockers, such as lidocaine, block whole classes of sodium channels, producing side-effects. The same is true for calcium channel blockers such as Lyrica, which may cause dizziness, sleepiness and related problems. Opioids also affect multiple systems in the body, and carry dangers of addiction. The specific sodium ion channel mutation found in the Pakistanis can affect the sense of smell, but does offer future promise for pain control because it targets a sodium channel used predominantly by peripheral nerves.

Eichling PS, Sahni J. 2005.  Menopause related sleep disorders.  J Clin Sleep Med. 1(3):291-300.  “The ‘domino theory’ of sleep disruption leading to insomnia followed by depression has the most scientific support.  Estrogen itself may also have an antidepressant as well as a direct sleep effect.  Treatment of insomnia in responsive individuals may be a major remaining indication for hormone therapy.”  “Due to the general under-recognition of SDB, health care providers should not assume sleep complaints are due to vasomotor related insomnia/depression without considering SDB.” “Sleep complaints are almost universal in FM.  There are associated polysomnogram (PSG) findings.”  “Treatment of sleep itself seems to improve, if not resolve FM.  Menopausal sleep disruption can exacerbate other pre-existing sleep disorders including RLS and circadian disorders.”

Eilertsen G, Ormstad H, Kirkevold M et al. 2015. Similarities and differences in the experience of fatigue among people living with fibromyalgia, multiple sclerosis, ankylosing spondylitis and stroke. J Clin Nurs. [Feb 7 Epub ahead of print.] "Fatigue is common to many long-term illnesses, but it has been studied mainly within the context of a single illness; qualitative studies comparing the experience and its impact on daily life across different long-term illnesses are lacking….Fatigue is commonly expressed by patients with long-term illnesses. Variations in experience are related to the type of diagnosis. The disparity between experiences influences how patients managed and adjusted to the conditions of everyday life. The illness-specific characteristics of fatigue warrant increased clinical awareness and may allow professionals to offer adequate information and establish effective methods of managing the condition. The feeling of invisibility and difficulty describing the experience of fatigue in particular highlights this need."

Einarson, A. and G. Koren.  1999.  Dextromethorphan.  Extrapolation of findings from reproductive studies in animals to humans.  Can Fam Physician 45:2309-10.

Eisen SA, Kang HK, Murphy FM et al. 2005.  Gulf War veterans’ health: medical evaluation of a U.S. cohort.  Ann Intern Med. 142(11):881-890.  “Gulf War deployment is associated with an increased risk for fibromyalgia, the chronic fatigue syndrome, skin conditions, dyspepsia, and a clinically insignificant decrease in the SF-36 physical component score.”

Eisinger J, Ayavou T, Zakarian H et al. 2007. Fibromyalgia [FMS], Nitric Oxide [NO] and Insulin: Probable links between metabolic changes, inflammation and apoptosis: Taxonomy and description.  J Musculoskel Pain 15 (Supp 13):45 item 78.  Insulin modulates inflammation [TNF, cytokines], vasodilatation [NO], vasoconstriction [ET], energy metabolism, ROS and aptosis.  Its role in FM is probably underestimated.

Eisinger J. 2007.  Dysautonomia, fibromyalgia and reflex dystrophy.  Arthritis Res Ther. 9(4):105.   “Fibromyalgia could be a generalized sympathetic dystrophy since both conditions are activated by trauma and partly linked to sympathetic mechanisms.  Yet they differ on several points: hormonal and neurochemical abnormalities are observed in fibromyalgia whereas activation by peripheral trauma and hyperosteolysis are observed in reflex sympathetic dystrophy.”

Eisinger J. 2006. Fibromyalgia: terra incognita.  J Musculoskel Pain 14(4):5-9.  This perceptive editorial provides charts that may be valuable tools for indicating subsets of FMS, as well as possible treatment options.

Eisinger, J. 2003.  [Clinical evaluation of fibromyalgia] Rev Med Interne 24(4):237-42. [French].  The use of blood pressure tensiometetry is a new, easier and alternative way to screen for fibromyalgia. 

Eisinger J, Milliat M, Garnier R, Starlanyl D. 2000. [Commentaries sur un questionnaire "fibromyalgie" detaille.] Myalgies 1(3):1-3 insert. [French].

Eisinger J, Starlanyl D, Blotman F, Bueno L et al. 2000. [Protocole d’informations anonyme sure les fibromyalgiques.] Med du Sud-Est 1:9-13. [French].

Eisinger, J. B. 1999. Hypothyroidism treatment: one hormone or two?  Myalgies 2(Suppl 2):1-3. [French]

Eisinger, J.  1998.  Place du syndrome polymyalgies-hypothryroïdie instable dans le cadre des manifestations musculaires des hypothyroïdiens traités.  Lyon Méditerranée Médical - Médecine du Sud-est 34(5,6):4-6. 

Eisinger, J. B. 1998. Alcohol, thiamin and fibromyalgia. J Am Col Nutri 17(3):300-303.

Eisinger, J., A. Plantamura and T. Ayavou. 1994. Glycolosis abnormalities in fibromyalgia.. J Am Col Nutri 13(2) 144-148.

Eisinger, J., A. Plantamura, P. A. Marie and T. Ayavou. 1994. Selenium and magnesium status and fibromyalgia. Magnes Res 7(3-4):285-8.

Eken C, Durmaz D, Erol B. 2009.  Successful treatment of a persistent renal colic with trigger point injection.  Am J Emerg. Med. 27(2):252.e3-4.  “We present a case of renal colic successfully treated by trigger point injection that was refractory to 150 microg fentanyl and 5 mg morphine.”

Elder NC, Simmons T, Regan S et al. 2012. Care for Patients with Chronic Nonmalignant Pain with and without Chronic Opioid Prescriptions: A Report from the Cincinnati Area Research Group (CARinG) Network. J Am Board Fam Med. 25(5):652-660. "The use of chronic opioids for patients with chronic nonmalignant pain (CNMP) is a common problem for family physicians, yet little is known about the management of CNMP in family medicine offices....Physicians described suspicion of patients as a primary difficulty in prescribing or considering chronic opioids; they also expressed interest in practicing evidence-based CNMP care, but there was little teamwork between physicians and medical assistants caring for patients with CNMP who were taking chronic opioids....Chronic opioids are frequently prescribed to patients with CNMP. Although patients taking opioids have better documentation of pain assessments and management, care for all patients with CNMP fell short of evidence-based guidelines and was primarily performed by the physician alone.

Elert J, Kendall SA, Larsson B et al. 2001.  Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders.  J Rheumatol 28(6):1361-1368.  Some “… groups of patients with chronic pain have increased muscle tension and decreased output during dynamic activity compared to pain-free controls.  However, the results indicated there is heterogeneity within groups of patients with the same chronic pain disorder and that not all patients with chronic pain have increased muscle tension.”

Elias M. 1994.  Cervical epidural abscess following trigger point injection.  J Pain Symptom Manage. 9(2):71-72.  [This can be avoided by following aseptic injection procedure. DJS]

Elie, R., E. Ruther, I. Farr, G. Emilien and E. Salinas.  1999. Sleep latency is shortened during 4 weeks of treatment with zaleplon, a novel nonbenzodiazepine hypnotic.  Zaleplon Clinical Study Group.  J Clin Psychiatry 60(8):536-44.

Elliott R, Burkett B. 2013. Massage therapy as an effective treatment for carpal tunnel syndrome. J Bodyw Mov Ther. 17(3):332-338. "Carpal tunnel syndrome is a common entrapment that causes neuralgia in the median nerve distribution of the hand. The primary aim of this study was to evaluate the efficacy of massage therapy as a treatment for carpal tunnel syndrome. Within this process, the locations of trigger points that refer neuropathy to the hand were identified. The creation of massage pressure tables provides a means of treatment reproducibility. Twenty-one participants received 30 min. of massage, twice a week, for six weeks. Carpal tunnel questionnaires, the Phalen, Tinel, and two-point discrimination tests provided outcome assessment. The results demonstrated significant…change in symptom severity and functional status from two weeks. Based on this study, the combination of massage and trigger-point therapy is a viable treatment option for carpal tunnel syndrome and offers a new treatment approach." [This is yet another study showing that surgery is not to be considered for CTS until all other options have been tried. DJS]

El Maghraoui A, Tellal S, Achemial L et al. 2006.  Bone turnover and hormonal perturbations in patients with fibromyalgia.  Clin Exp Rheumatol. 24(4):428-431.  “Our study showed that patients with FM had low bone resorption and normal bone formation compared to a control group.  This was not related to several hormonal perturbations observed in these patients and may reflect functional impairment as suggested in previous studies.”

Eltiti S, Wallace D, Zougkou K et al. 2006.  Development and evaluation of the electromagnetic hypersensitivity questionnaire.  Bioelectromagnetics. [Sep 29 Epub ahead of print]  The electromagnetic sensitivity questionnaire was developed with eight subscales: neurovegetative, skin, auditory, headache, cardiorespiratory, cold related, locomotor and allergy.  This scale provides “ index of the type and intensity of the symptoms commonly experienced by people believing themselves to be EHS and a screening tool that researchers can use to pre-select the most sensitive individuals...”

Elvin A, Siosteen AK, Nilsson A et al. 2006. Decreased muscle blood flow in fibromyalgia patients during standardized muscle exercise: a contrast media enhanced color doppler study.  Eur J Pain 10(2):137-144.  “…muscle ischemia can contribute to pain in FM, possibly by maintaining the central nervous changes such as central sensitization/disinhibition.  US with contrast can be a new valuable approach to assess muscle perfusion in pain patients during standardized exercise.”

Emir B, Murphy TK, Petersel DL et al. 2010. Treatment response to pregabalin in fibromyalgia pain: effect of patient baseline characteristics. Expert Opin Pharmacother. [Sep 3 Epub ahead of print]. The magnitude of response to pregabalin in terms of changes in pain may depend on age, pain, and sleep levels at baseline in patients with fibromyalgia. [Note: the lead author in this study is director of statistics at Pfizer Pharmaceuticals. DJS]

Enestrom, S., A. Bengtsson, and T. Frodin. 1997. Dermal IgG deposits and increase of mast cells in patients with fibromyalgia–relevant findings or epiphenomena? Scand J Rheumatol 26(4):308-313.

Enge, C. C. Jr. 2002. Caring for medically unexplained physical symptoms after toxic environmental exposures: effects of contested causation. Environ Health Perspect 110(Suppl 4):641-7.  Contested causation may have serious deletory effects on the patient, and on the patient-care provider relationship. 

Engel CC Jr. 2002.  Caring for medically unexplained physical symptoms after toxic environmental exposures: effects of contested causation.  Environ Health Perspect 110 Suppl 4:641-647.  The adversarial experience when outside parties refuse to believe that patients have become ill after toxic exposure may be toxic in itself.  Medically unexplained physical symptoms, [or care providers who do not understand the cause or mechanisms of the symptoms  DJS] “…may erode patient-provider trust, test the provider’s issues of compensation, reparation and blame.  These issues may distract patients and providers from therapeutic goals.” 

English B. 2014. Neural and Psychosocial Mechanisms of Pain Sensitivity in Fibromyalgia. Pain Manag Nurs. 15(2):530-538. "Fibromyalgia is a chronic musculoskeletal pain disorder that affects an estimated 5 million adults in the US. The hallmark is burning, searing, tingling, shooting, stabbing, deep aching, or sharp pain. Fibromyalgia is generally considered to be a 'central sensitivity syndrome' where central sensitization is regarded as the cause of pain in its own right. Nonetheless, the case continues to be made that all central and spatially distributed peripheral components of fibromyalgia pain would fade if the peripheral generators could be silenced….The aim of this review is to examine four mechanisms responsible for heightened pain sensitivity in fibromyalgia: peripheral sensitization, central sensitization, cognitive-emotional sensitization, and interpersonal sensitization. The purpose of framing the review in terms of pain sensitivity in fibromyalgia is to highlight that different mechanisms of sensitization are appropriately regarded as intervening variables when it comes to understanding individual differences in the experience of pain."

Epstein, S. A. , G. Kay, D. Clauw, R. Heaton, D. Kelin, L. Krupp, J. Kuck, V. Leslie, D. Masur, M. Wagner, R. Waid and S. Zisook. 1999. Psychiatric disorders in patients with fibromyalgia.  A multicenter investigation. Psychosomatics 40(1):57-63.  

Eraso RM, Bradford NJ, Fontenot CN et al. 2007. Fibromyalgia syndrome in young children: onset at age 10 years and younger.  Clin Exp Rheumatol. 25(4):639-644.  “FMS in young children of 10 years old and younger is frequently under-recognized.  As compared with the older group, stiffness, subjective joint swelling, abdominal pain, initial presentation on wheelchair and a higher mean count of tender points at diagnosis were significantly more common in the younger age group.  However, the type of medications used and outcome were similar in both groups.”  [We have to stop believing that FM is an illness that presents predominantly in middle aged women.  Men, children of both genders and the elderly can have FM too, and these groups are often undiagnosed or misdiagnosed. DJS]

Erdem HR, Cakit BD, Ozdemirel AE et al. 2012. Fear of falling in patients with cervical myofascial pain syndrome. J Musculoskel Pain. 20(4):257-262. "Patients with cervical MPS suffer from FOF (fear of falling) probably due to balance problems and dizziness." Fear of falling is common in the elderly, and can cause limitations and psychological stress. Vestibular rehabilitation and balance exercises are recommended in myofascial pain patients. [Falling can have serious consequences. TrPs in the cervical area can adversely affect balance and proprioception, so are important to assess and treat, especially in the elderly, as well as possible co-existing vestibular and ocular dysfunctions. DJS]

Ericsson A, Bremell T, Mannerkorpi K. 2013. Usefulness of multiple dimensions of fatigue in fibromyalgia. J Rehabil Med. [Jun 24 Epub ahead of print]. "Dimensions of fatigue, assessed by the MFI-20 (Multidimensional Fatigue Inventory), appear to be valuable in studies of employment, pain intensity, sleep, distress and physical function in women with fibromyalgia. The patients reported higher levels on all fatigue dimensions in comparison with healthy women."

Erikstrup C, Pedersen LM, Heickendorff L, et al. 2001. Production of hyaluronan and chondroitin sulphate proteoglyucans from human arterial smooth muscle- the effect of glucose, insulin, IGF-I or growth hormone. Eur J Endocrinol 145(2):193-8.Chondroitin sulphate proteoglycan CSPG.  Insulin and hGH can influence the accumulation of hyaluronan and CSPG.

Ermis MN, Yildirim D, Durakbasa MO et al. 2011. Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors. J Back Musculoskel Rehabil. 24(3):137-144. "The ultrasonographic examination detected a paravertebral hypoechogenic globular-shaped muscle disorganization associated with lipomatous degeneration exclusively localized to the trigger point in the study group…This prospective study depicts the etiologic factors, ultrasonographic features and treatment protocol of MSCNE (medical superior cluneal nerve entrapment) which is usually an underestimated cause of the low back pain." This is yet another study documenting key TrP involvement in chronic low back pain and nerve entrapment. DJS]

Ernberg M, Lundeberg T, Kopp S. 2000.  Pain and allodynia/hyperalgesia induced by intramuscular injection of serotonin in patients with fibromyalgia and healthy individuals.  Pain 85(1-2):31-39.  “5-HT injected into the masseter muscle of healthy female subjects elicits pain and allodynia/hyperalgesia, while no such responses occur in patients with fibromyalgia.”

Ernst E. 2011. Herbal medicine in the treatment of rheumatic diseases. Rheum Dis Clin North Am. 37(1):95-102. "This article provides a brief overview of the evidence on herbal medicines for 4 common rheumatic conditions: back pain, fibromyalgia, osteoarthritis, and rheumatoid arthritis."

Ernst, E.  1998.  Does post-exercise massage treatment reduce delayed onset muscle soreness?  A systematic review.  Br J Sports Med 32(3):212-4.

Escalante, A. and M. Fischbach.  1998.  Musculoskeletal manifestations, pain, and quality of life in Persian Gulf War veterans referred for rheumatologic evaluation.  J Rheumatol 25(11):2228-35. .

Escalante Pulido, J. M. and M. Alpizar Salazar.  1999.  Changes in insulin sensitivity, secretion and glucose effectiveness during menstrual cycle.  Arch Med Res 30(1):19-22.

Escobar PL, Ballesteros J. 1988.  Teres minor.  Source of symptoms resembling ulnar neuropathy or C8 radiculopathy.  Am J Phys Med Rehabil. 67(3):120-122.  “Numbness and tingling in the ring and little fingers (fourth and fifth digits) is usually associated with a radiculopathy (C8) or compromise of a peripheral nerve (ulnar).  The presence of a trigger point in the teres minor muscle may produce similar symptoms.  Early diagnosis and appropriate treatment will save the patient unnecessary discomfort and reduce the use of sophisticated diagnostic testing.”

Esenyel M, Caglar N, Aldemir T. 2000.  Treatment of myofascial pain.  Am J Phys Med Rehabil. 79(1):48-52.  “When combined with neck stretching exercises, ultrasound treatment and trigger point injections were found to be equally effective.”


Esenyel M, Walsh K, Walden JG et al. 2003.  Kinetics of high-heeled gait.  J Am Podiatr Med Assoc. 93(1):27-32.  “Reduced effectiveness of the ankle plantar flexors during late stance results in a compensatory enhanced hip flexor “pull-off” that assists in limb advancement during the stance-to-swing transition.  Larger muscle moments and increased work occur at the hip and knee, which may predispose long-term wearers of high-heeled shoes to musculoskeletal pain.”  [Janet Travell indicated high heeled shoes, and any non-flexible soled shoe, can be perpetuating factors of many TrPs. DJS]

Esposito K, Pontillo A, Giugliano F. et al. 2003.  Association of low interleukin-10 levels with the metabolic syndrome in obese women.  J Clin Endocrinol Metab 88(3):1055-1058.  Circulating levels of the anti-inflammatory cytokine IL-10 are elevated in obese and non-obese women compared with obese women who had metabolic syndrome.  [This may be significant in chronic pain states, especially if metabolic syndrome is a perpetuating factor.  DJS]

Estivill, E. and V. de la Fuente.  1999. [No title available].  Rev Neurol 28(10):962-3.  Ropinirol, treatment of initial phase of Parkinson’s disease.  Restless legs syndrome.

Esty, ML. 2006.  Reflections on FMS treatment, research and neurotherapy: Cautionary tales.  (see Kravitz HM, Esty ML, Karz RS et al. 2006.)  J Neurother 10(2/3):63-68.

Etminan M, Sadatsafavi M, Jafari S et al. 2009.  Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis.  Chest. 136(5):1316-1323.  Acetaminophen is often recommended freely due to its availability and low cost.  This review indicates that acetaminophen use is linked to asthma and wheezing in both children and adults.

Ettlin T. 2004.  Trigger point injection treatment with the 5-HT3 receptor antagonist tropisetron in patients with late whiplash-associated disorder.  First results of a multiple case study.  Scand J Rheumatol Suppl (119):49-50.  “The study demonstrated more than 50% pain relief for more than two weeks in 52% of the 73 treatment sessions.  The duration of effectiveness of the injections showed great intraindividual and interindividual variation.”

Eva-Maj M, Hans W, Per-Anders F et al. 2013. Experimentally induced deep cervical muscle pain distorts head on trunk orientation. Eur J Appl Physiol. [Jun 29 Epub ahead of print]. "PURPOSE: We wanted to explore the specific proprioceptive effect of cervical pain on sensorimotor control. Sensorimotor control comprises proprioceptive feedback, central integration and subsequent muscular response. Pain might be one cause of previously reported disturbances in joint kinematics, head on trunk orientation and postural control. However, the causal relationship between the impact of cervical pain on proprioception and thus on sensorimotor control has to be established. METHODS: Eleven healthy subjects were examined in their ability to reproduce two different head on trunk targets, neutral head position (NHP) and 30° target position, with a 3D motion analyzer before, directly after and 15 min. after experimentally induced neck pain. Pain was induced by hypertonic saline infusion at C2/3 level in the splenius capitis muscle on one side (referred to as "injected side")….A sensory mismatch appeared in some subjects, who experienced dizziness. CONCLUSIONS: Acute cervical pain distorts sensorimotor control with side-specific changes, but also has more complex effects that appear when pain has waned." [Myofascial trigger points can and do cause these effects. Many are only evident after the pain has eased, and the TrPs have become latent. DJS]

Evans, R. W. 1992. Some observations on whiplash injuries. Neurol Clin 10(4):975-997.

Evans RW, de Tommaso M. 2011. Migraine and fibromyalgia. Headache. 51(2):295-299.

Evans, R. W., R. I. Evans and M. J. Sharp.  1994.  The physician survey on the post-concussion and whiplash syndromes.  Headache 34(5):268-274.

Evans S, Taub R, Tsao JC et al. 2010. Sociodemographic factors in a pediatric chronic pain clinic: The roles of age, sex and minority status in pain and health characteristics. J Pain Manag. 3(3):273-281. "Little is known about how sociodemographic factors relate to children's chronic pain. This paper describes the pain, health, and sociodemographic characteristics of a cohort of children presenting to an urban tertiary chronic pain clinic and documents the role of age, sex and minority status on pain-related characteristics. A multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Two hundred and nineteen patients and their parents were given questionnaire packets to fill out prior to their intake appointment which included demographic information, clinical information, Child Health Questionnaire - Parent Report, Functional Disability Index - Parent Report, Child Somatization Index - Parent Report, and a Pain Intensity Scale. Additional clinical information was obtained from patients' medical records via chart review. This clinical sample exhibited compromised functioning in a number of domains, including school attendance, bodily pain, and health compared to normative data. Patients also exhibited high levels of functional disability. Minority children evidenced decreased sleep, increased somatization, higher levels of functional disability, and increased pain intensity compared to Caucasians. Caucasians were more likely to endorse headaches than minorities, and girls were more likely than boys to present with fibromyalgia. Younger children reported better functioning than did teens. The results indicate that sociodemographic factors are significantly associated with several pain-related characteristics in children with chronic pain. Further research must address potential mechanisms of these relationships and applications for treatment."

Evans TH, Schiller LR. 2012. Chronic vestibular dysfunction as an unappreciated cause of chronic nausea and vomiting. Proc (Bayl Univ Med Cent). 25(3):214-217. "In patients with chronic nausea and/or vomiting, gastroparesis is frequently diagnosed, often on the basis of abnormal gastric emptying scintigraphy (GES). When typical treatments fail, patients may be referred to a referral center. This retrospective study evaluated the diagnoses made in patients referred for chronic nausea and vomiting and appraised the GES utilized to assess these patients....The most common specific diagnosis in the entire group was chronic vestibular dysfunction (CVD, 64 patients, 26%) made by abnormal modified Fukuda stepping test, nystagmus, or abnormal Romberg test. CVD patients did not typically report a history of an inner-ear disorder or vertigo. Eighty-nine percent of CVD patients were given trials of antivertiginous medications; of the 39 followed for a median of 5 months, improvement occurred in two thirds. Diagnosis of gastroparesis should not be based on a nonstandardized GES. In our referred patients, gastroparesis was infrequent, while CVD was much more likely. Treatment for CVD may mitigate the nausea and vomiting." [Vestibular dysfunction is a frequent co-existing condition to both FM and CMP and is often unrecognized. DJS]

Evengard, B., C. G. Nilsson, G. Lindh, L. Lindquist, P. Eneroth, S. Fredrikson, L. Terenius and K. G. Henriksson.  1998.  Chronic fatigue syndrome differs from fibromyalgia.  No evidence for elevated substance P levels in cerebrospinal fluid of patients with chronic fatigue syndrome. Pain 78(2):153-5.

Everett CF, Morice AH. 2004.  Gastroesophageal reflux and chronic cough.  Minerva Gastroenterol Dietol. 50(3):205-213.  “Gastroesophageal reflux (GOR) disease is one of the 3 commonest causes of chronic cough.  It can be difficult to diagnose as the traditionally recognized symptoms of GOR, such as heartburn an acid regurgitation, are often absent.”  [GERD is an important perpetuating factor of myofascial TrPs.  Without the typical presenting symptoms, it may be missed. DJS]

Everson, M. P., S. D. Kotler and W. D. Blackburn, Jr.  1999.  Stress and immune dysfunction in Gulf War veterans.  Ann N Y Acad Sci 876:413-8.

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