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Patients &
trained Companions

Doctors & Other
Care Providers



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

annotated by Devin J. Starlanyl



References for Research Purposes

A-C       D-E


On This Page
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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).




Iannuccelli C, Spinelli FR, Guzzo MP et al. 2012. Fatigue and widespread pain in systemic lupus erythematosus and Sjogren's syndrome: symptoms of the inflammatory disease or associated fibromyalgia? Clin Exp Rheumatol. 30(6 Suppl 74):117-121. "FM seems to contribute to constitutional symptoms more in SLE than in pSS, suggesting a different underlying cause of fatigue and widespread pain in these two different connective tissue diseases."

Iatridou K, Mandalidis D, Chronopoulos E et al. 2014. Static and dynamic body balance following provocation of the visual and vestibular systems in females with and without joint hypermobility syndrome. J Bodyw Mov Ther. 18(2):159-164. "Joint hypermobility syndrome (JHS) is a heritable disorder of the connective tissue characterized by excessive joint movement, musculoskeletal pain and neurophysiological deficits (i.e. decreased proprioceptive acuity, altered neuromuscular reflexes). Such deficits may affect body balance thus increasing the risk of injury. The present study aimed at examining static and dynamic body balance following challenge of the visual and vestibular systems in individuals with JHS…. Poor static balance following challenge of the vestibular system may be justified by vestibular deficiency and/or insufficient proprioceptive capabilities of the neck. Impairments of dynamic balance in individuals with JHS may be attributed to proprioceptive deficits, which can alter feed forward and feedback mechanisms."

Ibarra JM, Ge HY, Wang C et al. 2011. Latent Myofascial Trigger Points are Associated with an Increased Antagonistic Muscle Activity during Agonist Muscle Contraction. J Pain. [Nov 9 Epub ahead of print]. "The current study provides the first evidence that increased motor unit excitability is associated with reduced antagonist reciprocal inhibition." Even with latent TrPs, this inhibition existed. This "may contribute to the delayed and incomplete muscle relaxation following exercise. Disordered fine movement control, and unbalanced muscle activation. Elimination of latent MTrPs and/or prevention of latent MTrPs from becoming active may improve motor functions."

Ichesco E, Bhavsar R, Clauw DJ et al. 2014. Altered resting state connectivity of the insular cortex in individuals with fibromyalgia. J Pain. [May 7 Epub ahead of print.] "The insular (IC) and cingulate cortices (CC) are critically involved in pain perception. Previously we demonstrated that fibromyalgia (FM) patients have greater connectivity between the insula and Default Mode Network at rest, and that changes in the degree of this connectivity were associated with changes in the intensity of ongoing clinical pain. Here we more thoroughly evaluate the degree of resting state connectivity to multiple regions of the IC in individuals with FM and healthy controls (HC). We also investigated the relationship between connectivity, experimental pain and current clinical chronic pain. Functional connectivity was assessed using resting state functional magnetic resonance imaging in 18 FM patients and 18 age- and sex-matched HC using pre-defined seed regions in the anterior, middle and posterior IC. FM patients exhibited greater connectivity between: (1) right mid IC and right mid/posterior CC and right mid IC; (2) right posterior IC and the left CC; and (3) right anterior IC and left superior temporal gyrus. HCs displayed greater connectivity between: left anterior IC and the bilateral medial frontal gyrus/ACC; and left posterior IC and the right superior frontal gyrus. Within the FM group, greater connectivity between the IC and CC was associated with decreased pressure-pain thresholds.… These data provide further support for altered resting-state connectivity between the IC and other brain regions known to participate in pain perception/modulation playing a pathogenic role in conditions such as FM. We speculate that altered IC connectivity is associated with the experience of chronic pain in individuals with fibromyalgia."

Ickmans K, Meeus M, De Kooning M et al. 2013. Recovery of upper limb muscle function in chronic fatigue syndrome with and without fibromyalgia. Eur J Clin Invest. [Nov 11 Epub ahead of print.] "This study reveals, for the first time, delayed recovery of upper limb muscle function in CFS+FM, but not in CFS-only patients. The results underline that CFS is a heterogeneous disorder suggesting that reducing the heterogeneity of the disorder in future research is important to make progress towards a better understanding and uncovering of mechanisms regarding the nature of divers impairments in these patients."

Igaz P, Novak I, Lazaar E et al. 2001.  Bidirectional communication between histamine and cytokines.  Inflamm Res. 50(3):123-128.  “Histamine plays fundamental roles in numerous immune reactions.  In addition to its well-characterized effects in the acute inflammatory and allergic responses, histamine also influences the expression and actions of several cytokines.  Because antihistamines are widely used in the treatment of various human diseases, this complex interaction could have general medical relevance too.”

Iglesias-Gonzalez JJ, Munoz-García MT, Rodrigues-de-Souza DP et al. 2013. Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain Med. [Aug 15 Epub ahead of print]. "Forty-two patients with nonspecific LBP (low back pain) (50% women), aged 23-55 years old, and 42 age- and sex-matched controls participated….TrPs were bilaterally explored within the quadratus lumborum, iliocostalis lumborum, psoas, piriformis, gluteus minimus, and gluteus medius muscles in a blinded design. TrPs were considered active if the subject recognized the local and referred pain as familiar symptoms, and TrPs were considered latent if the pain was not recognized as a familiar symptom. Pain measures were collected with a numerical pain rate scale, disability was assessed with the Roland-Morris questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index….The local and referred pain elicited by active TrPs in the back and hip muscles contributes to pain symptoms in nonspecific LBP. Patients had higher disability and worse sleep quality than controls. The number of active TrPs was associated with pain intensity and sleep quality. It is possible that a complex interaction among these factors is present in patients with nonspecific LBP."

Ignatowski TA, Spengler RN. 2004.  Tumor necrosis factor-alpha quantification and expression by insitu hybridization.  Methods Mol Biol 196:85-96.  Antidepressants may work as pain relievers by inhibiting production of the inflammatory protein tumor necrosis factor in the brain.

Iguchi M., Katoh Y., Koike H. et al. 2002.  Randomized trial of trigger point injection for renal colic.  Int J Urol 9(9):475-479.  “Trigger point injection, in our experience, is an easy, safe and effective method for the amelioration of renal colic."

Iida K, Oguma Y. 2013. Relationships between flow experience, IKIGAI, and sense of coherence in tai chi practitioners. Holist Nurs Pract. 27(5):260-267. "The purpose of this study was to examine the mental health effects of Tai chi on regular practitioners by investigating the relationships between flow experience, IKIGAI (Japanese: "Life worth living"), and sense of coherence. The results indicated that flow experience may influence IKIGAI and IKIGAI may influence sense of coherence; this suggests that IKIGAI may act as an intermediary between flow experience and sense of coherence. The results also indicated that the longer the Tai chi experience, the higher was the flow experience."

Ikeda H, Murase K. 2004.  Glial nitric oxide-mediated long-term presynaptic facilitation revealed by optical imaging in rat spinal dorsal horn.  J Neurosci. 24(44):9888-9896.  “Activity-dependent LTP of nociceptive afferent synaptic transmission the spinal cord is believed to underlie central sensitization after inflammation nerve injury. This glial NO-mediated control of presynaptic excitation may contribute to the induction at least in part.”

Ikegami S, Kamimura M, Uchiyama S et al. 2010. Anti-nociceptive effects of elcatonin injection for postmenopausal women with back pain: a randomized controlled trial. Open Orthop J. 4:132-136. “Thirty-six women aged >/=50 years with acute lower back pain participated in this study. They were randomly divided into two treatment groups according to whether they received a placebo or a weekly trigger point injection of elcatonin (20 units).” “There were no statistically significant differences in the mean VAS scores for motion pain in the elcatonin group were significantly lower than those in the placebo group at the third, fifth and sixth weeks. Conclusions: Elcatonin injection (20 units) significantly relieved motion pain in the lower back in postmenopausal women after three weeks of treatment. This analgesic effect continued for the subsequent 3 weeks.” [ It would be interesting to see how the elcatonin trigger point injections for back pain compared to injections of procaine, lidocaine, and dry needling. DJS]

Ilbuldu E, Cakmak A, Disci R et al. 2004. Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome.  Photomed Laser Surg. 22(4):306-311.  “Laser therapy could be useful as a treatment modality in myofascial pain syndrome because of its noninvasiveness, ease, and short-term application.”

Iliff JJ, Wang M, Liao Y et al. 2012. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amaloid beta. Sci Transi Med. 4(147):147ra111. The brain does not have a lymph system. It needs another way to clear extra cellular proteins and drain excess interstitial fluid and other waste materials. Material dissolves in the cerebrospinal fluid (CSF), and then "...a substantial portion of subarachnoid CSF cycles through the brain interstitial space...." and then cleared though paravenous drainage pathways. " clearance through paravenous flow may also regulate extracellular levels of proteins involved with neurogenerative conditions, its impairment perhaps contributing to the mis-accumulation of soluble proteins." [This may also be involved in traumatic brain injury, Parkinson's disease, Alzheimer's disease, and glial cell interactions that may affect cognitive dysfunctions in FM. DJS]

Ilkjaer, S., J. Dirks, J. Brennum, M. Wernberg and J. B. Dahl.  1997.  Effect of systemicN-methyl-D-aspartate receptor antagonist (dextromethorphan) on primary and secondary hyperalgesia in humans.  Br J Anaesth 79(5):600-605.

Illes JD, Maola CJ. 2012. Chiropractic management of low back pain in a patient with a transfemoral amputation. J Chiropr Med. 11(3):179-185. "Chiropractic management included manipulative therapy to the lumbar spine and pelvis, trigger point therapy of hypertonic musculature, and strengthening of pelvic musculature. In addition, the patient's prosthetist shortened her new prosthetic device. After 18 treatments, LBP (low back pain) severity was resolved (0/10); and there was an overall improvement with gait biomechanics….This case illustrates the importance of considering leg length inequality in patients with amputations as a possible cause of lower back pain, and that proper management may include adjusting the length of the prosthetic device and strengthening of the hip flexors and abductors, in addition to trigger point therapy and chiropractic manipulation."

Ilter L, Dilek B, Batmaz I et al. 2014. Efficacy of pulsed and continuous therapeutic ultrasound in myofascial pain syndrome: A randomized controlled study. Am J Phys Med Rehabil. Oct 8. [Epub ahead of print] "This study aimed to compare continuous and pulsed ultrasound therapy with sham ultrasound in terms of pain, severity of muscle spasm, function, depression, and quality of life in patients with myofascial pain syndrome….Continuous ultrasound therapy is more efficient in reducing pain at rest for myofascial pain syndrome patients than is sham or pulsed ultrasound therapy."

Im SH, Han EY. 2013. Improvement in anxiety and pain after whole body whirlpool hydrotherapy among patients with myofascial pain syndrome. Ann Rehabil Med. 37(4):534-540. This study found whirlpool therapy to be more effective than conventional hydrocollator packs for the treatment of myofascial pain.

Imamura M, Hsing WT, Kaziyama H et al. 2007.  Hyperalgesia of central origin in patients with severe osteoarthritis of the knee.  J Musculoskel Pain 15 (Supp 13):25 item 40.  [Myopain 2007 Poster]   “There is a significant deficit in the PPT in all spinal levels studied.  CS (central sensitization) needs to be addressed as part of the treatment.”  [Central sensitization is often unacknowledged and untreated in osteoarthritis, as are co-existing MTPs.  Peripheral pain can cause and maintain central sensitization, but the hypersensitive central nervous system must be treated to enable the peripheral areas to better respond to their treatment. DJS]

Imamura M, Kaziyama HHS, Hsing WT et al. 2007.  Efficacy of a segmental neuromyotherapy approach to improve pain pressure threshold in patients with severe osteoarthritis of the knee.  J Musculoskel Pain 15 (Supp 13):25 item 39.  [Myopain 2007 Poster]   “Segmental neuromyotherapy improved PPT immediately and after three months of treatment.” [Sclerodermal hyperalgesia of the supraspinous ligaments in addition to MTPs are often a vital yet unacknowledged and untreated component of osteoarthritic pain.  DJS]

Imamura M, Targino RA, Hsing WT et al. 2014. Concentration of cytokines in patients with osteoarthritis of the knee and fibromyalgia. Clin Interv Aging. 9:939-944. "Patients with knee osteoarthritis and fibromyalgia with the same duration and intensity of pain demonstrate similar concentrations of cytokines. Aging may play a role in cytokine profile, a finding not so extensively addressed in the literature and one that should be further investigated."

Imamura, S.T., T.Y. Lin, M.J. Yriyrits, S.S. Fischer, R.J. Azze, L. A. Rosgano and R. Mahar. 1997. The importance of myofascial pain syndrome in reflex sympathetic dystrophy. Phys Med Rehab Clinics of North Am 8:207-211.

Imbierowicz K., Egle U.T. 2003.  Childhood adversities in patients with fibromyalgia and somatoform pain disorder.  Eur J Pain 7(2):113-9.  This study in primary FMS found that “The FM patients show the highest score of childhood adversities.  In addition to sexual and physical maltreatment, the FM patients more frequently reported a poor emotional relationship with both parents, a lack of physical affection, experiences of the parent’s physical quarrels, as well as alcohol or other problems of addiction in the mother, separation, and a poor financial situation before the age of 7.”

Inanici F, Yunus MB. 2004.  History of fibromyalgia: past to present.  Curr Pain Headache Rep. 8(5):369-378.  ”Fibromyalgia syndrome (FMS) is now a recognized clinical entity causing chronic and disabling pain.” 

Inanir A, Karakus N, Ates O. 2014. Clinical symptoms in fibromyalgia are associated to catechol-O-methyltransferase (COMT) gene Val158Met polymorphism. Xenobiotica. [Apr 24 Epub ahead of print.] "Fibromyalgia syndrome (FMS) is a common chronic widespread pain syndrome mainly affecting women. The aim of this study was to explore the frequency and clinical significance of catechol-O-methyltransferase (COMT) gene Val158Met polymorphism in a large cohort of Turkish patients with FMS. 2. The study included 379 FMS patients and 290 controls….The results of this study suggested that COMT gene Val158Met polymorphism is positively associated with FMS and play a relevant role in the clinical symptoms of the disease."

Inanir A, Yigit S, Tekcan A. 2015. Angiotensin converting enzyme and methylenetetrahydrofolate reductase gene variations in fibromyalgia syndrome. Gene. [Mar 28 Epub ahead of print.] "Fibromyalgia syndrome (FM) is a common disease characterized by generalized body pain, sensitivity in certain physical areas (sensitive points), lowered pain threshold, sleep disorder, and fatigue. The study aimed to determine the effects ACE I/D and MTHFR C677T gene polymorphisms in Turkish patients with FM and evaluate if there was an association with clinical features….Our findings showed that there are associations of ACE I/D polymorphism with susceptibility of a person for development of fibromyalgia syndrome. Also, it is determined an association between MTHFR C677T polymorphism and feeling of stiffness and dry eye which are among the clinical characteristics of FM. Our study is the first report of ACE I/D and MTHFR C677T polymorphisms in fibromyalgia syndrome."

Ingber RS. 2000.  Shoulder impingement in tennis/racquetball players treated with subscapularis myofascial treatments.  Arch Phys Med Rehabil. 81(5):679-682.  “Conservative care of the athlete with shoulder impingement includes activity modification, application of ice, nonsteroidal anti-inflammatory drugs, subacromial corticosteroid injections, and physiotherapy.  This case report describes the clinical treatment and outcome of three patients with shoulder impingement syndrome who did not respond to traditional treatment.  Two of the three were previously referred for arthroscopic surgery.  All three were treated with subscapularis trigger point dry needling and therapeutic stretching.  They responded to treatment and had returned to painless function at follow-up 2 years later.”

Ingber, R. S.  1989.  Iliopsoas myofascial dysfunction: a treatable cause of “failed” low back syndrome.  Arch Phys Med Rehabil 70(5):382-6.  

Ingebrigtsen, T., B.  Romner, K. Waterloo and J. H. Trumpy. 1996. [Minor head injuries in sport. Occurrence, management, sequelae and prevention.] Tidsskr Nor Laegeforen 116(30):3594-3597. [Norwegian].

Ingman T, Nieminen T, Hurmerinta K. 2004.  Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions.  Eur J Orthod 26(3):321-326.  “The present results suggest that OSA patients are prone to significant narrowing of their oropharyngeal, but not of their naso- or hypopharyngeal, airways in the supine position.  Thus, treatment of OSA and UARS patients should mainly be aimed at preventing further oropharyngeal airway narrowing as a result of supine-dependent sleep.”

Innes, K. E. and J. H. Wimsatt.  1999.  Pregnancy-induced hypertension and insulin resistance: evidence for a connection.  Acta Obstet Gynecol Scand 78(4):263-84.

Inoue K, Tsuda M, Koizumi S. 2004.  Chronic pain and microglia: the role of ATP.  Novartis Found Symp. 261:55-64.

Inturrisi, C. E., W. A. Colburn, R. F. Kaiko, R. W. Houde and K. M. Foley.  1987. Pharmacokinetics and pharmacodynamics of methadone in patients with chronic pain.  Clin Pharmacol Ther 41(4):392-401.

Ionescu-Tirgoviste, C.  1998.  Proposal for a new classification of diabetes mellitus. Rom J Intern Med 36(1-2):121-34. 

Irwin MR, Olmstead R, Oxman MN. 2007.  Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of tai chi.  J Am Geriatr Soc. 55(4):511-517.  “Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.”  Regular practice of t’ai chi boosted cell-mediated immunity in immunized patients.

Irwin, M., J. McClintick, C. Costlow, M. Fortner, J. White and J. C. Gillin. 1996. Partial night sleep deprivation reduces natural killer and cellular immune responses in humans.  FASEB J10(5):643-653.

Irwin RS, Madison JM. 2000.  Anatomical diagnostic protocol in evaluating chronic cough with specific reference to gastroesophageal reflux disease.  Am J Med. 108 Suppl 4a:126S-130S.  “Gastroesophageal reflux disease (GERD), along with postnasal drip syndrome (PNDS) and asthma, is one of the three most common causes of chronic cough in all age groups.  When GERD is the cause of chronic cough, there may be no gastrointestinal (GI) symptoms up to 75% of the time, and, in these cases, the term ‘silent GERD’ is used.”

Irwin RW, Zuhosky JP, Sullivan WJ et al. 2007.  Industrial medicine and acute musculoskeletal rehabilitation.  4. Interventional procedures for work-related cervical spine conditions.  Arch Phys Med Rehabil. 88(3 Suppl 1):S18-S21.  An overview, including myofascial pain.

Isabel de-la-Llave-Rincón A, Puentedura EJ, Fernández-de-Las-Penas C. 2011. Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions. J Man Manip Ther. 19(4):201-211. We've learned much recently about the causes of upper quadrant pain. A treatment based classification of these causes has been developed. Patients grouped and treated according to this classification have better outcomes. The cervical and thoracic spine is often involved. "Spinal manipulation has been found to be effective for patients with elbow pain, neck pain, or cervicobrachial pain. Additionally, it is known that spinal manipulative therapy exerts neurophysiological effects that can activate pain modulation mechanisms. This paper exposes some manual therapies for upper quadrant pain syndromes, based on a nociceptive pain rationale for modulating central nervous system including trigger point therapy, dry needling, mobilization or manipulation, and cognitive pain approaches."

Isasi C, Colmenero I, Casco F et al. 2014. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int. [Apr 12 Epub ahead of print.] "Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5-31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome." [The authors have found one common perpetuating factor for at least one subgroup of patients with FM. DJS]

Isasi C, Tejerina E, Moran LM. 2015. Non-celiac gluten sensitivity and rheumatologic diseases. Reumatol Clin. [May 5 Epub ahead of print.] [Article in English, Spanish] "Celiac disease is an autoimmune systemic disease having among its clinical manifestations frequent symptoms common to rheumatologic diseases such as musculoskeletal pain, asthenia, and cognitive fatigue. It is associated with other autoimmune diseases like Sjögren disease. It is a well-characterized disease with specific diagnostic tests. Non-celiac gluten sensitivity is an emerging entity with symptoms similar to celiac disease, but without specific diagnostic tests. The concept of non-celiac gluten sensitivity and its diagnostic problems are reviewed, and the hypothesis of its association with fibromyalgia, spondyloarthritis, and autoimmune conditions is proposed. Clinical observations supporting the hypothesis are described, highlighting the benefit of treating non-celiac gluten sensitivity." Free Article

Isomaa B. 2003.  A major health hazard: the metabolic syndrome.  Life Sci 73(19):2395-2411.  “The metabolic syndrome seems to result from a collision between susceptible ‘thrifty genes’ and a society characterized by an increased prevalence of obesity and a sedentary lifestyle.”  “The metabolic syndrome constitutes a major challenge for public health…since more than 40 million U.S. adults seem to be affected….  Lifestyle changes could have a profound influence on the syndrome and its development.”

Israel HA, Ward JD. Horrell B, et al. 2003.  Oral and maxillofacial surgery in patients with chronic orofacial pain.  J Oral Maxillofac Surg 61(6):662-7.  “Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain ..... surgical treatment was rarely indicated as a treatment for pain relief ..... and it exacerbated and perpetuated pain symptoms in some of them.”

Isomaa B. 2003. A major health hazard: the metabolic syndrome. Life Sci 73(19):2395-2411. “The metabolic syndrome seems to result from a collision between susceptible ‘thrifty genes’ and a society characterized by an increased prevalence of obesity and a sedentary lifestyle.” “The metabolic syndrome constitutes a major challenge for public health…since more than 40 million U.S. adults seem to be affected…. Lifestyle changes could have a profound influence on the syndrome and its development.”

Itoh K, Okada K. 2007.  Influence of ovariectomy on development of delayed onset muscle soreness in female rates.  J Musculoskel Pain 15 (Supp 13):26 item 42.  [Myopain 2007 Poster]  “In the present study, the muscle pain thresholds were influenced by the estrus cycle in the intact control female rates.  The delay of development of muscular hyperalgesia was also detected in the OVX rats.  These results suggest that the change of estrogen content might be a possible influence on the sensitivity of nociceptive process.”  [This meshes well with other research that suggests that changes in estrogen may be involved in pain modulation. DJS]

Itoh K, Katsumi Y, Hirota S et al. 2006.  Effects of trigger point acupuncture on chronic low back pain in elderly patients – a sham-controlled randomized trial.  Acupunct Med. 24(1):5-12.  “These results suggest that trigger point acupuncture may have greater short term effects on low back pain in elderly patients than sham acupuncture.”

Itoh K, Saito S, Sahara S et al. 2014. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study. J Acupunct Meridian Stud. 7(2):59-64. "We compared the effect of trigger point acupuncture (TrP), with that of sham (SH) acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. The participants were 18 patients (15 women, 3 men; aged 42-65 years) with nonradiating shoulder pain for at least 6 months and normal neurological findings. The participants were randomized into two groups, each receiving five treatment sessions. The TrP group received treatment at trigger points for the muscle, while the other group received SH acupuncture treatment on the same muscle…. Compared with SH acupuncture therapy, TrP therapy appears more effective for chronic shoulder pain."

Itoh, Y, T Igarashi, N Tatsuma, T Imai, J Yoshida, M Tsuchiya, M Murakami and Y Fukunaga. 1999.  [Autoimmune fatigue syndrome and fibromyalgia syndrome.]  Nippon Ika Daigaku Zasshi 66(4):239-44.

Itza F, Zarza D, Salinas JC et al. 2015. Turn-amplitude analysis as a diagnostic test for myofascial syndrome in patients with chronic pelvic pain. Pain Res Manag. 20(2):96-100. "Background: Myofascial pain syndrome of the pelvic floor (MPSPF) is a common disease in the context of chronic pelvic pain (CPP); however, there is currently no gold-standard test to diagnose it. Objective: To validate the turns-amplitude analysis (TAA) as a diagnostic test for MPSPF in patients with CPP. Methods:...The same operator conducted all tests. Electromyography of the TAA is based on the collection of motor unit potentials that measure the number of changes in the signal and the mean amplitude of the changes. The electromyogram transfers the data to a graphical point cloud, which enables the patient's results to be compared with the results of the healthy subjects. Results: In patients and control subjects, the sensitivity and specificity of the proposed diagnostic test showed a marked clinical significance: the sensitivity was 83%, and the specificity was 100%....Conclusion: TAA is a reliable diagnostic test to detect MPSPF. Further studies are needed to reproduce these results." Free PMC Article

Itza F, Zarza D, Salinas J et al. 2013. Anal stretching device for patients with chronic prostatitis and chronic pelvic pain syndrome. Arch Esp Urol. 66(2):201-205. [Article in English, Spanish]. "Chronic pelvic pain syndrome (CPPS) is a poorly understood and ill-treated condition. It is accompanied by the shortening and increase in tone of the pelvic floor muscles and is closely related to myofascial pain syndrome (MPS). This study aims to evaluate the utility of an anal stretching device (ASD) for improving the pain manifestations of chronic prostatitis (CP) and CPPS….ASD appears to be a safe and useful tool to treat the pain manifestations of CPPS without notable side effects." [One must address the cause of muscle shortening and increased tone; myofascial trigger points. DJS]

Itza F, Zarza D, Serra L et al. 2010. [Myofascial pain syndrome in the pelvic floor: a common urological condition]. Actas Urol Esp. 34(4):318-326. [Spanish] “It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.” [What these authors say is true, but it is also true that these tools are not often used and that many patients with myofascial TrPs are undiagnosed, misdiagnosed and untreated.  This must change. DJS]

Iverson L. 2004.  GABA pharmacology–what prospects for the future?  Biochem Pharmacol 68(8):1537-1540.  Gaboxadol (THIP) is one of the new non-benzodiazepine hypnotics that acts on GABA A receptors.  This type of medication shows promise as a more specific type of sleep medication.

Iwama H, Akama Y. 2000.  The superiority of water-diluted 0.25% to neat 1% lidocaine for trigger-point injections in myofascial pain syndrome: a prospective, randomized, double-blinded trial.  Anesth Analg. 91(2):408-409.  “Trigger-point injection with a mixture of commercially available 1% lidocaine in sterile distilled water at a ratio of 1:3 compared with 1% lidocaine alone resulted in better efficacy and less injection pain.  This simple procedure may be suitable for treatments of a wide range of myofascial pain syndromes.”  [How I wish that all care providers who do TrP injections would read this and take it to heart.  Perhaps some of their patients will get this abstract and take it to their care providers so that they can avoid having more toxic and unnecessary substances injected into them. DJS]

Iwama H, Ohmori S, Kaneko T et al. 2001.  Water-diluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: evaluation of types of local anesthetic and concentrations in water.  Reg Anesth Pain Med. 26(4):333-336.  “The suitable type of local anesthetic may be lidocaine or mepivacaine, and the most effective water-diluted concentration is considered to be 0.2% to 0.25%.  [How I wish that all care providers who do TrP injections would read this and take it to heart. Perhaps some of their patients will get this abstract and take it to their care providers, so that they can avoid having more toxic and unnecessary substances injected into them. DJS]

Iwama H, Akama Y. 2000.  The superiority of water-diluted 0.25% to neat 1% lidocaine for trigger-point injections in myofascial pain syndrome: a prospective, randomized, double-blinded trial.  Anesth Analg 91(2):408-409.  “Trigger-point injection with a mixture of commercially available 1% lidocaine in sterile distilled water at a ratio of 1:3 compared with 1% lidocaine alone resulted in better efficacy and less injection pain.”  [Travell and Simons also reported better effects with diluted local anesthetic. DJS]

Iwasaka, M., Ueno, S. 2003.  Detection of intracellular macromolecule behavior under strong magnetic fields by linearly polarized light.  Bioelectromagnetics 24(8):564-70.  Strong static magnetic fields caused behavioral changes in cell components that corresponded to changes in polarized light.  The intracellular macromolecular arrangement may be affected by these fields.

Izumi M, Petersen KK, Arendt-Nielsen L et al. 2014. Pain referral and regional deep tissue hyperalgesia in experimental human hip pain models. Pain. 155(4):792-800. Hip pain and hyperalgesia was produced experimentally in health individuals by injecting them with hypertonic saline solution in the gluteus medius tendon, adductor longus tendon, or gluteus medius muscle. [This experiment basically created referred pain patterns and hyperalgesia, such as occurs with myofascial trigger points in these muscles and tendons. DJS]

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

Jackson MJ. 2005.  Use of microdialysis to study interstitial nitric oxide and other reactive oxygen and nitrogen species in skeletal muscle.  Methods Enzymol. 396:514-525.

Jacob L, Jacob T, Jacob B. 2007.  Escitaloproan for fibromyalgia and multiple chemical sensitivity syndrome: Tolerable efficacy.  J Musculoskel Pain 15(Suppl 13):50. item 87.  Escitalopran (Lexapro) seems to help FM pain even if patients don't have MCS, and it appears to be well tolerated and have few side-effects. 

Jacobs CA, Christensen CP, Karthikeyan T. 2015. Chronic Non-Orthopedic Conditions More Common in Patients with Less Severe Degenerative Changes That Have Elected to Undergo Total Knee Arthroplasty. J Arthroplasty. [Feb 7 Epub ahead of print.] "The purpose of this study was to determine whether the prevalence of chronic non-orthopedic conditions that may play a role in an abnormal pain response differs between patients based on the severity of degenerative changes at the time of surgery. Of 1020 OA knees that had undergone primary TKA with a minimum 2year follow-up, we identified 117 (11.5%) that had less severe degenerative changes. The prevalence of dissatisfaction was significantly greater in less severe group compared to those with moderate or severe changes... Chronic non-orthopedic conditions were significantly more prevalent in the less severe group with 41.9% reporting depression/anxiety, 30.8% with fibromyalgia or low back pathology, and 12.8% with a prior traumatic brain injury or stroke."

Jacobson BC, Somers SC, Fuchs CS et al. 2006.  Body-mass index and symptoms of gastroesophageal reflux in women.  N Engl J Med. 354(22):2340-2348.  “BMI is associated with symptoms of gastroesophageal reflux disease in both normal-weight and overweight women.  Even moderate weight gain among persons of normal weight may cause or exacerbate symptoms of reflux.”  [Obesity, or even overweight, may be an important perpetuating factor for GERD, which itself is an important perpetuating factor for sleep apnea, fibromyalgia and some myofascial TrPs.  DJS]

Jacobson PL, Mann JD. 2003. Evolving role of the neurologist in the diagnosis and treatment of chronic noncancer pain. Mayo Clin Proc 78(1):80-84. “The neurologist has become increasingly involved in the multidisciplinary treatment of patients with chronic noncancer pain. Informed regulatory agencies and professional organizations such as the American Academy of Neurology recognize the undertreatment of patients with CNP and provide clear recommendations to help neurologists in the ethical and effective treatment of patients with pain. Improved education of neurologists, other health care professionals, patients, and the media about evolving standards of pain care and therapy will produce a more supportive environment for the compassionate and ethical treatment of patients with CNP."

Jacobson PL, Mann JD. 2003.  Evolving role of the neurologist in the diagnosis and treatment of chronic noncancer pain.  Mayo Clin Proc. 78(1):80-84.  “Informed regulatory agencies and professional organizations such as the American Academy of Neurology recognize the undertreatment of patients with CNP and provide clear recommendations to help neurologists in the ethical and effective treatment of patients with pain.  Improved education of neurologists, other health care professionals, patients, and the media about evolving standards of pain care and therapy will produce a more supportive environment for the compassionate and ethical treatment of patients with CNP.”

Jacobsen, S., I.S. Petersen and B. Danneskiold-Samsoe. 1993.Clinical features in patients with chronic muscle pain-with special reference to fibromyalgia. Scand J Rheumatol 22(2):69-76. 

Jacobsen, S. and B. Danneskiold-Samsoe. 1992. Dynamic muscular endurance in primary fibromyalgia compared with chronic myofascial pain syndrome. Arch Phys Med Rehab 73(2):170-173.

Jacobsen, S., M. Hoyer-Madsen, B. Danneskiold-Samsoe and A. Wiik. 1990.  Screening for autoantibodies in patients with primary fibromyalgia syndrome and a matched controlled group. APMIS 98(7):655-8.

Jacobsen, S. 1998.  Physical biodynamics and performance capacities of muscle in patients with fibromyalgia syndrome.  Z Rheumatol Suppl 57 (2):43-6.

Jacobson SA, Simpson RG, Lubahn C et al. 2014. Characterization of fibromyalgia symptoms in patients 55-95 years old: a longitudinal study showing symptom persistence with suboptimal treatment. Aging Clin Exp Res. [May 25 Epub ahead of print.] "In this cohort of elders with suboptimally treated FM, substantial persistence of symptoms was seen over time. In general, recommended treatments were either not used or not tolerated…. Age-appropriate treatments as well as education of primary care providers are needed to improve treatment of FM in the older population."

Jaeger B. 2013. Myofascial trigger point pain. Alpha Omegan. 106(1-2):14-22. "Myofascial trigger point pain is an extremely prevalent cause of persistent pain disorders in all parts of the body, not just the head, neck, and face. Features include deep aching pain in any structure, referred from focally tender points in taut bands of skeletal muscle (the trigger points). Diagnosis depends on accurate palpation with 2-4 kg/cm2 of pressure for 10 to 20 seconds over the suspected trigger point to allow the referred pain pattern to develop. In the head and neck region, cervical muscle trigger points (key trigger points) often incite and perpetuate trigger points (satellite trigger points) and referred pain from masticatory muscles. Management requires identification and control of as many perpetuating factors as possible (posture, body mechanics, psychological stress or depression, poor sleep or nutrition). Trigger point therapies such as spray and stretch or trigger point injections are best used as adjunctive therapy."

Jaeger B. 1989. Are “cervicogenic” headaches due to myofascial pain and cervical spine dysfunction?  Cephalalgia 9(3):157-164.  “Eleven patients with cervicogenic headaches were systematically examined for myofascial trigger points and cervical spine dysfunction.  All patients had at least three myofascial trigger points on the symptomatic side.  In eight of these patients, trigger point palpation clearly reproduced their headache.  There were 70 myofascial trigger points (35 ‘very tender’, 35 ‘tender’) and 17 non-myofascial tender points on the symptomatic side, compared to 22 myofascial trigger points (one ‘very tender’, 21 ‘tender’) and 19 non-myofascial tender points on the asymptomatic side.”  “Treated patients reported a significant decrease in the frequency and intensity of their headaches during a median two-year follow-up.  It is concluded that myofascial trigger points may be an important pain producing mechanism in cervicogenic headache and that segmental cervical dysfunction is a common feature in such patients.  Conservative, non-surgical treatment appears to be effective in reducing the frequency and intensity of cervicogenic headache.  These data suggest that surgical approaches should be reserved only for those patients who fail conservative therapy.”  [This study did not include non-cervical TrPs that refer pain to the head.  If extrinsic eye TrPs, posterior tongue TrPs, upper trapezius TrPs and the many other TrP sites that do exactly that were well known and considered, the need for surgery, and the rate of “failed” surgery, would drop even more dramatically.  DJS]

Jaeger B, Reeves JL. 1986.  Quantification of changes in myofascial trigger point sensitivity with the pressure algometer following passive stretch.  Pain. 27(2):203-210.  “In order to determine the relationship between trigger point sensitivity and the referred symptoms of myofascial pain, VAS ratings of referred pain intensity and pressure algometer measures of myofascial trigger point sensitivity were taken pre- and post-treatment of the muscle containing the trigger point with passive stretch.  The results in 20 subjects, experiencing unilateral or bilateral myofascial head and neck pain, showed that myofascial trigger point sensitivity decreases in response to passive stretch as assessed by the pressure algometer, and that trigger point sensitivity and intensity of referred pain are related.”

Jafri MS. 2014. Mechanisms of myofascial pain. Int Sch Res Notices. 2014;2014. pii: 523924. "Myofascial pain syndrome is an important health problem. It affects a majority of the general population, impairs mobility, causes pain, and reduces the overall sense of well-being. Underlying this syndrome is the existence of painful taut bands of muscle that contain discrete, hypersensitive foci called myofascial trigger points. In spite of the significant impact on public health, a clear mechanistic understanding of the disorder does not exist. This is likely due to the complex nature of the disorder which involves the integration of cellular signaling, excitation-contraction coupling, neuromuscular inputs, local circulation, and energy metabolism. The difficulties are further exacerbated by the lack of an animal model for myofascial pain to test mechanistic hypothesis. In this review, current theories for myofascial pain are presented and their relative strengths and weaknesses are discussed. Based on new findings linking mechanoactivation of reactive oxygen species signaling to destabilized calcium signaling, we put forth a novel mechanistic hypothesis for the initiation and maintenance of myofascial trigger points. It is hoped that this lays a new foundation for understanding myofascial pain syndrome and how current therapies work, and gives key insights that will lead to the improvement of therapies for its treatment."

Jaggi AS, Singh N. 2011. Role of different brain areas in peripheral nerve injury-induced neuropathic pain. Brain Res. [Jan 14 Epub ahead of print]. "Neuropathic pain has been described as the "most terrible of all tortures which a nerve wound may inflict" and arises as a consequence of nerve injury either of the peripheral or central nervous system. Following peripheral nerve injury, a cascade of events in the primary afferents leads to peripheral sensitization resulting in spontaneous nociceptor activity, decreased threshold and increased response to supra-threshold stimuli. A series of molecular changes in spinal cord and brain centers are associated with central sensitization which is responsible for the pain to non-injured extra-territory regions (extraterritorial pain) and contralateral parts (mirror-image pain). The peripheral nerve injury has been reported to induce neuroplastic changes in different brain regions including the anterior cingulate cortex, insular cortex, ventrolateral orbitofrontal area, amygdala, striatum, thalamus, hypothalamus, rostral ventromedial medulla, periaqueductal gray, pons (locus coeruleus), red nucleus, and medulla oblongata. The present review article discusses the involvement of these different brain areas in the development of peripheral nerve injury-induced neuropathic pain." [Although this is a rat study, it may be profoundly applicable to humans. DJS]

Jain AK, Carruthers BM, van de Sande MI, Barron SR, Donaldson CCS, Dunne JV, Gingrich E, Heffez DS, Leung FYK, Malone DG, Romano TJ, Russell IJ, Saul D, Seibel DG.  2003.  Fibromyalgia syndrome: Canadian clinical working case definition, diagnostic and treatment protocols – a consensus document.  J Musculoskel Pain 11(4):3-107.

Jalil NA, Prateepavanich P, Chaudakshetrin P. 2010. Atypical chest pain from myofascial pain syndrome of the subscapularis muscle. J Musculoskel Pain 18(2):173-179. This is a first-time report of subscapularis TrPs causing chest pain in two case reports. Both patients had restricted range of motion demonstrated by the Mouth Wraparound Test. Care providers should be aware of this presentation, in addition to the common subscapularis frozen shoulder and associated referral pain.

James G., Butt A.M. 2002.  P2Y and P2X purinoceptor medicated Ca (2+) signaling in glial cell pathology in the central nervous system.  Eur J Pharmacol 447(2-3):247-60.  This research suggests that ATP is a primary glial cell signal molecule in response to central nervous system injury, and that the named receptors are involved with this response.

Jamison, J.  1999.  Stress: the chiropractic patients’ self-perceptions.  J Manipulative Physiol Ther 22(6):395-8.

Jamison, R. N.  1996.  Comprehensive pretreatment and outcome assessment for chronic opioid therapy in nonmalignant pain.  J Pain Symptom Manage 11(4):231-241.  

Jamison, R. N., K. O. Anderson and M. A. Slater.  1995.  Weather changes and pain: perceived influence of local climate on pain complaint in chronic pain patients.  Pain 61(2):309-315.

Jamison, R. N., K. O. Anderson, C. Peeters-Asdourian and F. M. Ferrante.  1994.  Survey of opioid use in chronic nonmalignant pain patients.  Reg Anesth 19(4):225-230. 

Jan, J. E., M. B. Connolly, D. Hamilton, R. D. Freeman and M. Laudon.  1999.  Melatonin treatment of non-epileptic myoclonus in children.  Dev Med Child Neurol 41(4):255-9.

Janal MN, Ciccone DS, Natelson BH. 2006.  Sub-typing CFS patients on the basis of ‘minor’ symptoms.  Biol Psychol.  [Feb 9 Epub ahead of print]  “In 161 women meeting 1994 criteria for CFS, principal components analysis of the ten ‘minor’ symptoms of CFS produced three factors interpreted to indicate musculoskeletal, infectious and neurological subtypes.  Extreme scores on one or more of these factors characterized about 2/3 of the sample.”  “Results suggest that subtypes of CFS may be identified from reports of the minor diagnostic symptoms, and that these subtypes demonstrate construct validity.”

Janda AM, As-Sanie S, Tsodikov A et al. 2015. Fibromyalgia Survey Criteria Is Associated with Increased Postoperative Opioid Consumption in Women Undergoing Hysterectomy. Anesthesiology. [Mar 12 Epub ahead of print.] "As was previously demonstrated in a total knee and hip arthroplasty cohort, this study demonstrated that increased fibromyalgia survey scores were predictive of postoperative opioid consumption in the posthysterectomy surgical population during their hospital stay. By demonstrating the generalizability in a second surgical cohort, these data suggest that patients with fibromyalgia-like characteristics may require a tailored perioperative analgesic regimen." [In summary, patients with amplified pain (FM) require more pain medication. This surprises? DJS]

Janig, W., H. Blumberg, R. A. Boas et al. 1991.  The reflex sympathetic dystrophy syndrome: consensus statement and general recommendations for diagnosis and clinical research.  In Bond, M. R., J. E. Charleton and C. J. Woolf (eds): Proceedings of the VI th World Congress on Pain. Elsevier, Amsterdam, 1991, pp. 373-376.

Janis JE, Dhanik A, Howard JH. 2011. Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression. Plast Reconstr Surg. 128(1):123-131. [Although less invasive treatments are often successful, this article is of interest in that it confirms a nasal TrP. DJS]

Janis JE, Hatef DA, Ducic I et al. 2010. Anatomy of the auriculotemporal nerve: variations in its relationship to the superficial temporal artery and implications for the treatment of migraine headaches. Plast Reconstr Surg. 125(5):1422-1428. “In an effort to better understand potential etiologies for failure of treatment, an investigation was performed to determine whether or not vascular-mediated peripheral trigger points exist that have heretofore been undescribed that may be contributing to persistent symptomatology. One such potential trigger point is the superficial temporal artery’s interaction with the auriculotemporal nerve.” “The auriculotemporal nerve and superficial temporal artery run together in the superficial soft tissue in the preauricular and temple regions. A contiguous relationship between the two was found in 17 hemiheads (34.0 percent). ”These variations may serve as an anatomical explanation for this point as a source of migraine headaches in some patients.”

Janis JE, Hatef DA, Ducic I et al. 2010. Anatomy of the auriculotemporal nerve: variations in its relationship to the superficial temporal artery and implications for the treatment of migraine headaches. Plast Reconstructr Surg 125(5):1422-1428. This study of 25 cadaver heads found a 34.0% occurrence of a contiguous relationship between the ariculotemporal nerve and the superficial temporal artery that may be a potential vascular-mediated TrP and possible migraine instigator.

Janis JE, Hatef DA, Reece EM et al. 2010. Neurovascular compression of the greater occipital nerve: implications for migraine headaches. Plast Reconstr Surg. 126(6):1996-2001. [The greater occipital nerve can be entrapped by TrPs in the semispinalis capitis muscle. Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual Vol I ed 2 page 126.]

Jankovic D, van Zundert A. 2006.  The frozen shoulder syndrome.  Description of a new technique and five case reports using the subscapular nerve block and subscapularis trigger point infiltration.  Acta Anaesthesiol Belg. 57(2):137-143.

Janssens KA, Zijlema WL, Joustra ML et al. 2015. Mood and anxiety disorders in chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome: Results from the LifeLines Cohort Study. Psychosom Med. [Mar 12 Epub ahead of print.] "Mood and anxiety disorders are more prevalent in individuals with FSSs, and particularly CFS, than in individuals without FSSs. However, most individuals with FSSs do not have mood or anxiety disorders."

Janssens L, Brumagne S, McConnell AK. 2013. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One. 8(3):e57949. "Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls. These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability. Further research is required to determine whether interventions such as proprioceptive training and inspiratory muscle training improve postural balance and reduce the fall risk in individuals with COPD."

Jaracz J, Rybakowski J. 2005.  [Depression and pain: novel clinical, neurobiological and psychopharmacological data]  Psychiatr Pol. 39(5):937-950.  [Polish]  “In the pathogenesis of both depression and pain symptoms, an important role has been attributed to disturbances of serotonergic and noradrenergic neurotransmission as well as to neuropeptides such as opioids and substance P.  In mood regulation as well as in the perception and emotional dimension of pain stimuli, such brain structures as the amygdala, anterior cingulate cortex and prefrontal cortex are of main significance.  The action of antidepressant drugs results in a normalization of the activity of those neurotransmitter systems an brain structures.  It was found that dual action antidepressants (i.e., influencing both serotonergic and noradrenergic system) such as tricyclic antidepressants and new generation drugs (venlafaxine, milnacipram, duloxetine, mirtazapine) exert a stronger antidepressant effect and possess a broader therapeutic spectrum, including also an effect on pain symptoms.” 

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

Jarrell J. 2010. Myofascial pain in the adolescent. Curr Opin Obstet Gynecol. 22(5):393-8. "Pain associated with myofascial dysfunction is common in the adolescent female. Pain in this group of women has been shown to extend into adulthood. Although there has been attention directed to the management of endometriosis through laparoscopic surgical approaches, these are seen as limiting. Myofascial dysfunction is now regarded as an important factor in the evaluation of adolescent pain. One of the most important approaches to the reduction of severe pain in the adolescent is the complete menstrual suppression through use of continuous oral contraceptives or contraceptive rings. Operative laparoscopy has been heavily utilized but there are increasing concerns about the overutilization of this procedure.... Alternative approaches to myofascial pain include multidisciplinary care with a rehabilitative perspective." [It is vital that care providers learn prompt diagnosis and treatment of myofascial trigger points. Procedures such as laparoscopy can both activate and perpetuate TrPs. DJS]

Jarrell J 2009. Demonstration of cutaneous allodynia in association with chronic pelvic pain. J Vis Exp 23(28).pii 1232. doi 10.3791/1232. This shows how episodic pelvic pain from painful menstrual periods, or chronic pain from endometriosis, can result in chronic pelvic pain with central sensitization hallmarks such as allodynia (pain from normally non-painful stimuli). Abdominal wall tenderness and dyspareunia (pain with intercourse) are common at that stage. By the time signs of a central sensitization state have occurred, this pain can persist after medical or surgical treatment of the initial cause as part of a viscero-somatic reflex. At this state, surgical intervention is not usually necessary, as the presence of abdominal wall and other area TrPs may be maintaining this heightened central pain state.

Jarrell J. 2007.  Gynecological pain and the viscero-somatic connection.  J Musculoskel Pain 15 (Supp 13):3 item 3.  [Myopain 2007 Poster]  “Myofascial dysfunction is common in the presence of endometriosis and visceral disease.  There is an interesting relationship of the number of reported laparoscopies and the number of areas of myofascial dysfunction.  This may reflect the severity of the visceral disease being treated at laparoscopy but also raises the possibility that laparoscopy may in some way exacerbate the viscero-somatic appreciation of pain physiology.” 

Jarrell J. 2004.  Myofascial dysfunction in the pelvis.  Curr Pain Headache Rep 8:452-456.  Between 25% and 40% of all laparoscopy for pelvic pain finds no cause.  Myofascial pain due to TrPs may be a significant and unrecognized cause of much pelvic pain.   

Jarrell J, Giambarardino MA, Robert M et al. 2011. Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain. Pain Res Treat 2011:692102. "Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain."

Jarrell JF, Vilos GA, Allaire C et al. 2005.  Consensus guidelines for the management of chronic pelvic pain.  J Obstet Gynaecol Can. 27(8):781-826.  Myofascial pain must be taken into account when looking for possible causes of chronic pelvic pain.

Jason LA, Taylor RR, Kennedy CL. 2000.  Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities in a community-based sample of persons with chronic fatigue syndrome-like symptoms.  Psychosom Med. 62(5):655-663.  “People with CFS, MCS or FM endure significant disability in terms of physical, occupational and social functioning, and those with more than one of these diagnoses also report greater severity of physical and mental fatigue.”

Jaspers, J. P.  1998.  Whiplash and post-traumatic stress disorder.  Disabil Rehabil 20(11):397-404.

Jaspersen D, Leodolter A. 2005.  [Sleep disorders associated with gastroesophageal reflux.]  Dtsch Med Wochenschr. 130(48):2779-2782. [German]  “Individuals with clinical sleep disorders have a greatly impaired quality of life.  The causes for sleeping disorders are complex, but evidence has recently come from different trials supporting a causal relationship between gastroesophageal reflux disease (GERD) and sleep disorders in some patients.  The majority of patients with GERD report reflux symptoms during the night.  It is well known that especially at night reflux is characterized by prolonged esophageal acid exposure.  Sleep disorders significantly improve while on efficacious antisecretory treatment.  In patients with sleep disorders but no previously known GERD, the search for it is recommended and should be followed by adequate antisecretory treatment.  In other severe diseases associated with sleep, like the obstructive sleep apnoea syndrome (OSAS), an association with esophageal acid exposure has been proven.  The sleep apnea-associated reflux has probably a multifactorial etiology: in cases with other predisposing conditions for gastro-esophageal reflux, OSAS promotes the development of reflux."

Jayaseelan DJ, Moats, N, Ricardo CR. 2013. Rehabilitation of proximal hamstring tendinopathy utilizing eccentric traoning, lumbopelvic stabilization, and trigger point dry needling: 2 case reports. J Orthop Sports Phys Ther. Nov 21 [Epub ahead of print]. Two runners with proximal hamstring tendinopathy were treated with a specific exercise program and dry needling. Both patients were seen for 8-9 visits over 8-10 weeks, and returned to sitting and running without symptoms.

Jeal, W. and P. Benfield. 1997.  Transdermal fentanyl.  A review of its pharmacological properties and therapeutic efficacy in pain control.  Drugs 53(1):109-138.

Jeffery DD, Bulathsinhala L, Kroc M et al. 2014. Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010. Mil Med 179(9):1021-1029. "Although cause and effect cannot be established, the advent of federally approved drugs for FMS in concert with pharmaceutical industry marketing of these drugs coincide with the observed changes in prevalence, health care utilization, and costs of FMS relative to IBS and CFS."

Jenewein J, Moergeli H, Sprott H et al. 2013. Fear-learning deficits in subjects with fibromyalgia syndrome? Eur J Pain. [Mar 7 Epub ahead of print]. "Contingency learning deficits represent a potentially promising and specific, but largely unstudied, psychopathological factor in FMS. Deficits in contingency learning may increase anxiety and, consequently, pain sensation. These findings have the potential to contribute to the development of novel therapeutic approaches for FMS."

Jennings, JR, Muldoon MF, Hall M et al. 2007.  Self-reported sleep quality is associated with the metabolic syndrome.  Sleep. 30(2):219-223.

Jennum, P., A. M. Drewes, A. Andreasen and K. D. Nielsen. 1993. Sleep and other symptoms in primary fibromyalgia and in healthy controls.  J. Rheumatol 20(10):1756-1759.

Jensen B, Wittrup IH, Wiik A et al. 2004.  Antipolymer antibodies in Danish fibromyalgia patients.  Clin Exp Rheumatol 22(2):227-229.  Although FMS patients in this study had slightly higher APA levels than healthy people, the levels declined with age.

Jensen B, Wittrup IH, Bliddal H et al. 2003.  Bone mineral density in fibromyalgia patients – correlation to disease activity. 32(3):146-150.  “...the severity of FM might have a negative impact on bone mass.”

Jensen, K. A., S. K. Christensen, E. M. Nielsen, L. K. Bunemann, K. Therkelsen and F. Knudsen.1997. [Cerebral blood flow and indomethacin.  The effect of different doses administered as continuous intravenous infusions or as suppositories in healthy adults]. Ugeskr Laeger 159(27):4257-4260 [Danish].

Jensen KB, Kosek E, Petzke F et al. 2009.  Evidence of dysfunctional pain inhibition in fibromyalgia reflected in rACC during provoked pain.  Pain. [Apr 30 Epub ahead of print].  

Jensen KB, Loitoile R, Kosek E et al. 2012. Patients with Fibromyalgia Display less Functional Connectivity in the Brain's Pain Inhibitory Network. Mol Pain. 8(1):32. "Patients with FM displayed less connectivity within the brain's pain inhibitory network during calibrated pressure pain, compared to healthy controls. The present study provides brain-imaging evidence on how brain regions involved in homeostatic control of pain are less connected in FM patients. It is possible that the dysfunction of the descending pain modulatory network plays an important role in maintenance of FM pain and our results may translate into clinical implications by using the functional connectivity of the pain modulatory network as an objective measure of pain dysregulation."

Jensen KB, Sriniasan P, Spaeth R et al. 2013. Overlapping structural and functional brain changes in patients with long-term exposure to fibromyalgia. Arthritis Rheum. [Aug 27 Epub ahead of print]. "FM patients displayed a distinct overlap between decreased cortical thickness, brain volumes and measures of functional regional coherence in the rostral anterior cingulate cortex. The morphometric changes were more pronounced with longer exposure to FM pain. In addition, we found associations between structural and functional changes in the mesolimbic areas of the brain and comorbid depressive symptoms in FM patients. Conclusion: The combined integration of structural and functional measures allowed for a unique characterization of the impact of FM pain on the brain. Our data may lead to the identification of early structural and functional brain alterations in response to pain, which could be used to develop markers to predict the development of FM and other pain disorders."

Jensen MP, Nielson WR, Turner JA et al. 2004.  Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping.  Pain 111(1-2):84-95.

Jeon JH, Jung YJ, Lee JY et al. 2012. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Ann Rehabil Med. 36(5):665-674. "The ESWT (extracorporeal shock wave therapy) in patients with MPS (myofascial pain syndrome) in trapezius muscle are as effective as TPI (trigger point injections) and TENS (transcutaneous electrical nerve stimulation) for the purpose of pain relief and improving cervical range of motion."

Jeong SH, Oh SY, Kim HJ et al. 2009.  Vestibular dysfunction in migraine: effects of associated vertigo and motion sickness.  J Neurol. [Dec 30 Epub ahead of print]  “Innate hypersensitivity of the vestibular system may be an underlying mechanism of motion sickness and increased TC (time constant) in MD/MV (migrainous dizziness/vestibular migraine).  The increased tilt suppression may be an adaptive cerebellar mechanism to suppress the hyperactive vestibular system in migraineurs.”  [Vestibular dysfunction, migraines, FM and TrPs often occur in the same patient, and it can be difficult to figure out what symptoms are from which source.  Since TrPs are treatable, it may help to treat them and then see what remains. DJS]

Jerosch J, Sohling M. 2012. Open-label, multicenter, randomized study investigating the efficacy and safety of botulinum toxin type A in the treatment of myofascial pain syndrome in the neck and shoulder girdle. J Musculoskel Pain. 20(2):95-99. "Both doses (25 U/TrP and 40 U/TrP) provided effective relief from chronic MPS; benefits were maintained for at least three months." In this preliminary study, Botox was safe and effective for longer term relief for TrPs. The side-effects were injection-site soreness and muscle weakness in some patients, but were largely well-tolerated and allowed patients to continue with other rehabilitation therapies. [Note: This research was supported by the pharmaceutical company involved,]

Jerschow E, McGinn AP, de Vos G. et al. 2012. Dichlorophenol-containing pesticides and allergies: results from the US National Health and Nutrition Examination Survey 2005-2006. Ann Allergy Asthma Immunol. 109(6):420-425. "High urine levels of dichlorophenols are associated with the presence of sensitization to foods in a US population. Excessive use of dichlorophenols may contribute to the increasing incidence of food allergies in westernized societies. [We must be diligent about being more aware and concerned about our environment. As we pollute it, it pollutes us. DJS]

Jespersen A, Dreyer L, Kendall S et al. 2007.  Computerized cuff pressure algometry: a new method to assess deep-tissue hypersensitivity in fibromyalgia.  Pain. [Jan 24 Epub ahead of print]  This is yet another study confirming Dr. J. B. Eisinger’s development of FMS diagnostic testing using tensiometry, or blood pressure cuff tension.  I believe that this article would have benefitted by inclusion of Dr. Eisinger’s work. DJS]

Jesus CA, Feder D, Peres MF. 2013. The role of vitamin D in pathophysiology and treatment of fibromyalgia. Curr Pain Headache Rep. 17(8):355. "The association between fibromyalgia and vitamin D deficiency is very controversial in the literature with conflicting studies and methodological problems, which leads to more questions than answers. The purpose of this article is to raise questions about the association of hypovitaminosis D with fibromyalgia considering causal relationships, treatment, and pathophysiological explanations."

Jevning, R., I. Wells, A. F. Wilson and S. Guich.  1987.  Plasma thyroid hormones, thyroid stimulating hormone, and insulin during acute hypometabolic states in man.  Physiol Behav 40(5):603-6.

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Jevning, R., A. F. Wilson and W. R. Smith.  1978.  The transcendental meditation technique, adrenocortical activity, and implications for stress.  Experientia 34(5):618-9.  

Jevning, R., A. F. Wilson, H. Pirkle, J. P. O’Halloran and R. N. Walsh.  1983.  Metabolic control in a state of decreased activation: modulation of red cell metabolism.  Am J Physiol 245(5 Pt 1):C457-61.

Jezova, D., Jurankova E., Mosnarova A., M. Kriska and I Skultetyova. 1996.  Neuroendocrine response during stress with relation to gender differences. Acta Neurobiol Exp (Warsz) 56(3):779-985.

Ji HM, Kim HJ, Han SJ. 2012. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius. Ann Rehabil Med. 36(5):675-680. "ESWT (extracorporeal shock wave therapy) in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males."

Ji RR, Berta T, Nedergaard M. 2013. Glia and pain: Is chronic pain a gliopathy? Pain. Jun 20. [Epub ahead of print] "Activation of glial cells and neuro-glial interactions are emerging as key mechanisms underlying chronic pain. Accumulating evidence has implicated 3 types of glial cells in the development and maintenance of chronic pain: microglia and astrocytes of the central nervous system (CNS), and satellite glial cells of the dorsal root and trigeminal ganglia. Painful syndromes are associated with different glial activation states: (1) glial reaction (ie, upregulation of glial markers such as IBA1 and glial fibrillary acidic protein (GFAP) and/or morphological changes, including hypertrophy, proliferation, and modifications of glial networks); (2) phosphorylation of mitogen-activated protein kinase signaling pathways; (3) upregulation of adenosine triphosphate and chemokine receptors and hemichannels and downregulation of glutamate transporters; and (4) synthesis and release of glial mediators (eg, cytokines, chemokines, growth factors, and proteases) to the extracellular space. Although widely detected in chronic pain resulting from nerve trauma, inflammation, cancer, and chemotherapy in rodents, and more recently, human immunodeficiency virus-associated neuropathy in human beings, glial reaction (activation state 1) is not thought to mediate pain sensitivity directly. Instead, activation states 2 to 4 have been demonstrated to enhance pain sensitivity via a number of synergistic neuro-glial interactions. Glial mediators have been shown to powerfully modulate excitatory and inhibitory synaptic transmission at presynaptic, postsynaptic, and extrasynaptic sites. Glial activation also occurs in acute pain conditions, and acute opioid treatment activates peripheral glia to mask opioid analgesia. Thus, chronic pain could be a result of "gliopathy," that is, dysregulation of glial functions in the central and peripheral nervous system. In this review, we provide an update on recent advances and discuss remaining questions."

Jiang CF, Lin YC, Yu NY. 2013. Multi-scale surface electromyography modeling to identify changes in neuromuscular activation with myofascial pain. IEEE Trans Neural Syst Rehabil Eng. 21(1):88-95. "To solve the limitations in using the conventional parametric measures to define myofascial pain, a 3-D multi-scale wavelet energy variation graph is proposed as a way to inspect the pattern of surface electromyography (SEMG) variation between the dominant and nondominant sides at different frequency scales during a muscle contraction cycle and the associated changes with the upper-back myofascial pain. The model was developed based on the property of the wavelet energy of the SEMG signal revealing the degree of correspondence between the shape of the motor unit action potential and the wavelet waveform at a certain scale in terms of the frequency band. The characteristic pattern of the graph for each group (30 normal and 26 patient subjects) was first derived and revealed the dominant-hand effect and the changes with myofascial pain. Through comparison of individual graphs across subjects, we found that the graph pattern reveals a sensitivity of 53.85% at a specificity of 83.33% in the identification of myofascial pain. The changes in these patterns provide insight into the transformation between different fiber recruitment, which cannot be explored using conventional SEMG features. Therefore, this multi-scale analysis model could provide a reliable SEMG features to identify myofascial pain."

Jiang GM, Lin MD, Wang LY. 2013. [Comparative study on effect of acupuncture and lidocaine block for lumbar myofascial pain syndrome]. Zhongguo Zhen Jiu. 33(3):223-226. [Article in Chinese] "To observe the clinical efficacy of acupuncture at Jiaji (EX-B 2) points mainly for lumbar myofascial pain syndrome (MPS)….Sixty-six cases of MPS were randomized into an acupuncture group and a lidocaine group, 33 cases in each group. The acupuncture group was treated with acupuncture at Jiaji (EX-B 2) points combined with needling local myofascial trigger points (MTrP), and the lidocaine group was treated with local block at trigger points with lidocaine injection. The treatment was given once every 2 days. After three and five times of the treatment, the simplified McGill scale, Oswestry disability index (ODI) and pressure-pain threshold were assessed to compare the therapeutic effects between the two groups…Acupuncture at Jiaji (EX-B 2) points combined with needling MTrP is an effective and safe therapy for lumbar MPS, the therapeutic effect is equal to lidocaine block."

Jiao J, Vincent A, Cha SS et al. 2014. Association of abuse history with symptom severity and quality of life in patients with fibromyalgia. Rheumatol Int. [Aug 18 Epub ahead of print.] This study from the Mayo Clinic indicates that "…abuse history in patients with fibromyalgia was associated with worse symptoms and QOL compared with those patients without abuse history. Future studies are needed to assess whether additional tailored interventions as part of fibromyalgia treatment are helpful for patients with a history of abuse."

Jiao J, Vincent A, Cha SS et al. 2014. Relation of age with symptom severity and quality of life in patients with fibromyalgia. Mayo Clin Proc. 89(2):199-206. "Our study shows that symptom severity and QOL differ across age groups in patients with fibromyalgia, with young and middle-aged patients having poorer QOL and worse fibromyalgia symptoms than do older patients. QOL in physical health was reduced more than in mental health, particularly in young patients, compared with the general population." [Possibly due to myofascial trigger points, the symptom generators, becoming latent. DJS]

Jimenez-Rodríguez I, Garcia-Leiva JM, Jimenez-Rodriguez BM et al. 2014. Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain. Neuropsychiatr Dis Treat. 10:625-630. "Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances….Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia…. The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls…. The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide." [How much of this is associated with feelings of helplessness, hopelessness, and lack of support from family, companions and medical team we can only guess. DJS]

Jimenez-Sanchez S, Jimenez-Garcia R, Hernandez-Barrera V et al. 2011. Invalidating musculoskeletal pain is associated with psychological distress and drug consumption: a Spanish population case-control study. J Musculoskel Pain. 19(2):76-86. "The IMP (invalidating musculoskeletal pain) subjects showed two times more probability of presenting psychological distress compared to those without pain. Women with IMP had more probability of suffering from psychological distress than men. Finally, psychological distress was related to a greater consumption of tranquilizers." Educating care providers and companions of peopel with TrPs is a key to their psychological health.

Joergensen TS, Henriksen M, Danneskiold-Samsoe B et al. 2013. Experimental knee pain evokes spreading hyperalgesia and facilitated temporal summation of pain. Pain Med 14(6):874-883. Why hypertonic saline was injected into the infrapatellar knee pad in healthy individuals, hyperalgesia and facilitated temporal summation (wind-up) resulted. When isotonic saline was injected into the same area of each patient on the other knee, no changes were noted. "Acute knee joint pain leads to hyperalgesia and facilitated temporal summation in the infrapatellar fat pad and in muscles located distant to the injection site, in subjects with no history of knee pain."

Joerges J, Schulz T, Wegner J et al. 2012. Regulation of cell volume by glycosaminoglycans. J Cell Biochem. 13(1):340-348. "Hyaluronidase treatment of inhibition of hyaluronan transport led to cell shrinkage indicating that the hyaluronan (hyaluronic acid) coat maintained fibroblasts (the most common type of connective tissue cell) in a swollen state." [This research meshes well with the studies we did on geloid masses inpatients with FM and CMP, and indicates that patients with FM and CMP may need to be very careful using any product with hyaluronic acid. That is a component in many cosmetics, body lotions, and anti-aging formulas. DJS]

Johannesson U, de Boussard CN, Brodda Jansen G et al. 2006.  Evidence of diffuse noxious inhibitory controls (DNIC) elicited by cold noxious stimulation in patients with provoked vestibulodynia.  Pain [Dec 12 Epub ahead of print]

Johanson E, Brumagne S, Janssens L et al. 2011. The effect of acute back muscle fatigue on postural control strategy in people with and without recurrent low back pain. Eur Spine J. [May 1 Epub ahead of print]. "...these findings suggest that impaired back muscle function, as a result of acute muscle fatigue or pain, may lead to an inability to adapt postural control strategies to the prevailing conditions." When we are hurt or fatigued, we are less able to control our gross motor function and posture, and more likely to be injured.

Johansson, G., J. Risberg, U. Rosenhall, G. Orndahl, L. Svennerholm and S. Nystrom. 1995. Cerebral dysfunction in fibromyalgia; evidence from regional cerebral blood flow measurements, otoneurological tests and cerebrospinal fluid analysis. Acta Psychiatr Scand 91(2):86-94.

Johansson O, Gangi S, Liang Y, Yoshimura K, Jing C, Liu PY. 2001. Cutaneous mast cells are altered in normal healthy volunteers sitting in from of ordinary TVs/PCsBresults from open-field provocation experiments. J Cutan Pathol Nov;28(10):513-9. Normal cutaneous mast cells can be altered by exposure to television or personal computer screens.  The number of skin mast cells increase in exposed skin in many patients after such an exposure.  After 24 hours, the number of mast cells returns to normal. [This may be significant to FMS patients with skin allergy symptoms. DJS]

  1. Johnson EO, Kostandi M, Moutsopoulos HM. 2006.  Hypothalamic-pituitary-adrenal axis function in Sjogren’s syndrome: mechanisms of neuroendocrine and immune system homeostasis.  Ann N Y Acad Sci. 1088:41-51.  “These findings suggest not only adrenal axis hypoactivity in SS and FM patients, but also that varying patterns of adrenal and thyroid axes dysfunction may exist in patients with different rheumatic diseases.”

Johnson JD, O’Connor KA, Deak T et al. 2002.  Prior stressor exposure primes the HPA axis.  Psychoneuroendocrinology 27(3):353-365. 

Johnson JD, O’Connor KA, Deak T et al.  Psychoneuroendocrinology. 27(3):353-365.  The stress response in rats is changed after an initial HPA activation.  Neural plasticity is affected by stress, at least in rats.

Johnson KM, Bradley KA, Bush K et al. 2006.  Frequency of mastalgia among women veterans.  Association with psychiatric conditions and unexplained pain syndromes.  J Gen Intern Med. 21 Suppl 3:S70-75.  “Like other unexplained pain syndromes, frequent mastalgia is strongly associated with PTSD and other psychiatric conditions.  Clinicians seeing patients with frequent mastalgia should inquire about anxiety, depression, alcohol misuse, and trauma history.”  [Unfortunately, these patients were not evaluated for pectoral TrPs which may cause pain called mastalgia. DJS]

Johnson M, Collett B, Castro-Lopes JM. 2013. The challenges of pain management in primary care: a pan-European survey. J Pain Res. 6:393-401. "A survey was conducted to assess the challenges of chronic nonmalignant pain (CNMP) management in primary care in Europe, focusing particularly on pain assessment, opioid therapy, and educational needs….These findings reveal that PCPs (Primary Care Physicians) in Europe find CNMP a challenge to treat. Areas to address with training include underuse of pain assessment tools and lack of confidence in use of opioid therapy. Guidelines on CNMP management in primary care would be welcomed."

Johnston SS, Udall M, Alvir J et al. 2014. Characteristics, Treatment, and Health Care Expenditures of Medicare Supplemental-Insured Patients with Painful Diabetic Peripheral Neuropathy, Post-Herpetic Neuralgia, or Fibromyalgia. Pain Med. [Jan 16 Epub ahead of print.] "Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009….The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: $1,632, $24,740 for pDPN; $1,403, $16,579 for PHN; and $1,635, $18,320 for fibromyalgia. In age-stratified analyses, pain-related health care expenditures decreased as age increased….The numerous comorbidities, polypharmacy, and magnitude of expenditures in this sample of Medicare supplemental-insured patients with pDPN, PHN, or fibromyalgia underscore the complexity and importance of appropriate management of these chronic pain patients."

Jones AY, Dean E, Scudds RJ. 2005.  Effectiveness of a community-based Tai Chi program and implications for public health initiatives.  Arch Phys Med Rehabil. 86(4):619-625.  “A community-based Tai Chi program produces beneficial effects comparable to those reported from experimental laboratory trials of Tai Chi; therefore, it should be considered as a public health strategy.”  The regular practice of t’ai chi improves handgrip strength, resting heart rate, and flexibility.


Jones CJ, Rutledge DN, Aquino J. 2010. Predictors of physical performance and functional ability in people 50+ with and without fibromyalgia. J Aging Phys Act. 18(3):353-368. "The purposes of this study were to determine whether people with and without fibromyalgia (FM) age 50 yr and above showed differences in physical performance and perceived functional ability and to determine whether age, gender, depression, and physical activity level altered the impact of FM status on these factors.... Results indicated significant differences between adults with and without FM on all physical-performance measures and perceived function. Linear-regression models showed that the contribution of significant predictors was in expected directions. All regression models were significant, accounting for 16-65% of variance in the dependent variables."

Jones GT, Atzeni F, Beasley M et al. 2014. The prevalence of fibromyalgia in the general population - a comparison of the American College of Rheumatology 1990, 2010 and modified 2010 classification criteria. Arthritis Rheumatol. Oct 16. "Fibromyalgia prevalence varies with the different classification criteria - specifically, prevalence is higher, and a greater proportion of men are identified, with the modified 2010 criteria, compared to those requiring clinician input. This has important implications for the use of the new criteria both in research and in clinical practice."

Jones GT, Nicholl BI, McBeth J et al. 2011. Road traffic accidents, but not other physically traumatic events, predict the onset of chronic widespread pain: Results from the EpiFunD study. Arthritis Care Res (Hoboken). [Mar 21 Epub ahead of print]. "This study provides support to the 'at risk' phenotype hypothesis, where individuals characterized by poorer health and psychological variables may be predisposed to develop CWP following a traumatic trigger. However, while this has been seen with road traffic accidents it is not the case with other events. Future research should examine what is peculiar about an accident - or about one's reaction to it - that confers this increase in the risk of CWP onset."

Jones GT, Silman AJ, Macfarlane GJ. 2003.  Predicting the onset of widespread body pain among children.  Arthritis Rheum. 48(9):2402-2405.  This English study indicates that children who have behavioral problems or “common childhood somatic symptoms” are at risk for developing widespread pain.  [I would love to see these children examined for developing FMS, sleep disturbances, and myofascial TrPs. DJS]

Jones KD, Deodhar P, Lorentzen A et al. 2007.  Growth hormone perturbations in fibromyalgia: a review.  Semin Arthritis Rheum. [Jan 12 Epub ahead of print]  This study indicates normal pituitary function in FMS patients, and that dysfunction of the HP-GH-IGF-1 axis is most likely hypothalamic in origin, but notes that more research is required.

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

Jones KD, Mist SD, Bennett RM et al. 2010. Computerized dynamic posturography reveals balance deficits in fibromyalgia patients comparable to healthy persons in their eighth decade. International Myopain Society Eighth Clinical Meeting Oct 3-7, 2010. Toledo, Spain. Abstract No. 48. "FM patients, compared to controls, are more likely to experience falls and have poor balance related to impaired use of visual, vestibular and somatosensory inputs. Deficits are related to FM severity, an elevated BMI and impaired cognition." [FM patients often have co-existing TrPs with concomitant proprioceptive deficits, FM chemical traumatic brain impairments such as those due to quinolinic acid production, co-existing traumatic brain injury and/or vestibular dysfunction as well as visual impairments. All of these and other forms of balance impairments (many TrPs are significantly linked to balance and gait irregularities) must be identified and treated vigorously. This could save countless hip replacement and other surgeries, other injuries and hospitalizations, and even deaths. DJS]

Jones KD, Sherman CA, Mist SD et al. 2012. A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clin Rheumatol. [May 13 Epub ahead of print]. This study used an FM-modified 8-form Yang style tai chi compared to those that had education only. Small groups of patients met twice a week for 90 minutes, over 12 weeks, with a goal of self-reported symptom reduction. The patients in the tai chi groups had better results in pain, sleep, function, and other parameters than the group that was provided with education only. "Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients."

Joranson DE, Gilson AM. 2001.  Pharmacists’ knowledge of and attitudes toward opioid pain medications in relation to federal and state policies.  J Am Pharm Assoc 41(2):213-220.  “Pharmacists play a pivotal role in ensuring patient access to medications.  Our findings suggest that the incorrect knowledge and inappropriate attitudes of some pharmacists could contribute to a failure to dispense valid prescriptions for opioid analgesics to patients in pain.”  [This is a very sad yet accurate commentary on one more hurdle that some chronic pain patients must overcome to gain access to adequate pain control.]

Joranson DE, Ryan KM, Gilson AM et al. 2000.  Trends in medical use and abuse of opioid analgesics.  JAMA 283(13):1710-1714.  “The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse.”

Joranson, D. E. and A. M. Gilson.  1998.  Regulatory barriers to pain management.  Semin Oncol Nurs 14(2):158-63.

Joranson, D. E.  1994.  Are health-care reimbursement policies a barrier to acute and cancer pain management?  J Pain Symptom Manage 9(4):244-53.  

Joranson, D. E.  1990.  Federal and state regulation of opioids.  J Pain Symptom Manage5(1 Suppl):S12-S23.

Jorge LL, Amaro E Jr. 2012. Brain Imaging in Fibromyalgia. Curr Pain Headache Rep. [Jun 21 Epub ahead of print]. "Fibromyalgia is a primary brain disorder or a result of peripheral dysfunctions inducing brain alterations, with underlying mechanisms that partially overlap with other painful conditions. Although there are methodologic variations, neuroimaging studies propose neural correlations to clinical findings of abnormal pain modulation in fibromyalgia. Growing evidences of specific differences of brain activations in resting states and pain-evoked conditions confirm clinical hyperalgesia and impaired inhibitory descending systems, and also demonstrate cognitive-affective influences on painful experiences, leading to augmented pain-processing. Functional data of neural activation abnormalities parallel structural findings of gray matter atrophy, alterations of intrinsic connectivity networks, and variations in metabolites levels along multiple pathways. Data from positron-emission tomography, single-photon-emission-computed tomography, blood-oxygen-level-dependent, voxel-based morphometry, diffusion tensor imaging, default mode network analysis, and spectroscopy enable the understanding of fibromyalgia pathophysiology, and favor the future establishment of more tailored treatments."

Joyce, E., S. Blumentahl and S. Wessely. 1996.  Memory, attention and executive function in chronic fatigue syndrome.  J Neurol Neurosurg Psychiatry 60(5):459-503.

Joyce, P. and C. Clark.  1996.  The use of CranioSacral Therapy to treat gastroesophageal reflux in infants.  Inf Young Children 9(2):51-58. 

Juhl GI, Jensen TS, Norholt SE et al. 2007.  Central sensitization phenomena after third molar surgery: a quantitative sensory testing study.  Eur J Pain. [Jun 4 Epub ahead of print]  “Even a minor orofacial surgical procedure may be sufficient to evoke signs of both central and peripheral sensitization, which may play a role in the transition from acute to chronic pain in susceptible individuals.” 

Julien N, Goffaux P, Arsenault P et al. 2005.  Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition.  Pain 114(1-2):295-302.  “These data support a deficit of endogenous pain inhibitory systems in fibromyalgia but not in chronic low back pain.  The treatments proposed to fibromyalgia patients should aim at stimulating the activity of those endogenous systems.”  [This indicates that treatment of FMS should focus on central nervous system modulation. DJS]

Jung, A. C., T. Staiger and M. Sullivan.  1997.  The efficacy of selective serotonin reuptake inhibitors for the management of chronic pain.  J Gen Intern Med 12(6):384-389. 

Jung E, Erbsloh-Moller B, Gesmann M et al. 2013. [Are members of fibromyalgia syndrome self-help groups "different"?: Demographic and clinical characteristics of members and non-members of fibromyalgia syndrome self-help groups.] Z Rheumatol. [Apr 13 Epub ahead of print]. [Article in German]. "Members of FMS self-help groups…were older and reported a longer duration of chronic widespread pain, less anxiety and depression and a more frequent current use of aerobic exercise, relaxation training and complementary alternative medication than participants not affiliated with FMS self-help groups….Membership in FMS self-help groups was associated with less psychological distress and a more frequent use of active self-management strategies."

Jurgens TP, Sawatzki A, Henrich F et al. 2014. An improved model of heat-induced hyperalgesia--repetitive phasic heat pain causing primary hyperalgesia to heat and secondary hyperalgesia to pinprick and light touch. PLoS One. 9(6):e99507. "This study tested a modified experimental model of heat-induced hyperalgesia, which improves the efficacy to induce primary and secondary hyperalgesia and the efficacy-to-safety ratio reducing the risk of tissue damage seen in other heat pain models. Quantitative sensory testing was done in eighteen healthy volunteers before and after repetitive heat pain stimuli (60 stimuli of 48°C for 6 s) to assess the impact of repetitive heat on somatosensory function in conditioned skin (primary hyperalgesia area) and in adjacent skin (secondary hyperalgesia area) as compared to an unconditioned mirror image control site. Additionally, areas of flare and secondary hyperalgesia were mapped, and time course of hyperalgesia determined. After repetitive heat pain conditioning we found significant primary hyperalgesia to heat, and primary and secondary hyperalgesia to pinprick and to light touch (dynamic mechanical allodynia). Acetaminophen (800 mg) reduced pain to heat or pinpricks only marginally by 11% and 8%, respectively (n.s.), and had no effect on heat hyperalgesia. In contrast, the areas of flare (-31%) and in particular of secondary hyperalgesia (-59%) as well as the magnitude of hyperalgesia (-59%) were significantly reduced…. Thus, repetitive heat pain induces significant peripheral sensitization (primary hyperalgesia to heat) and central sensitization (punctate hyperalgesia and dynamic mechanical allodynia). These findings are relevant to further studies using this model of experimental heat pain as it combines pronounced peripheral and central sensitization, which makes a convenient model for combined pharmacological testing of analgesia and anti-hyperalgesia mechanisms related to thermal and mechanical input."

Juul-Kristensen B, Lund H, Hanses K et al. 2007.  Poorer elbow proprioception in patients with lateral epicondylitis than in healthy controls: a cross-sectional study.  J Shoulder Elbow Surg. [Nov 22 Epub ahead of print].  “Proprioception be poorer in elbows with lateral epicondylitis elbows than in the controls’ elbows.  This needs to be taken into consideration in the management of lateral epicondylitis.”  [This could be due to co-existing MTPs. DJS]

Juuso P, Skar L, Olsson M et al. 2014. Meanings of Being Received and Met by Others as Experienced by Women with Fibromyalgia. Qual Health Res. [Aug 21 Epub ahead of print.] "Fibromyalgia (FM) is a common chronic pain syndrome that mostly affects middle-aged women. Our aim with this study was to elucidate meanings of being received and met by others as experienced by women with FM. Interviews with a narrative approach were conducted with 9 women. We analyzed the transcribed interviews with a phenomenological hermeneutical interpretation. The findings revealed two themes: being seen as a malingerer and being acknowledged. Meanings of being received and met by others, as experienced by women with FM, can be understood as a movement between the two perspectives. When they were acknowledged, their feelings of security and trust increased, but the women could not rely on this because others received and met them in such an unpredictable manner."

Juuso P, Skar L, Olsson M et al. 2012. Meanings of Feeling Well for Women with Fibromyalgia. Health Care Women Int. [Nov 8 Epub ahead of print]. "Our interpretation of the findings shows that for women with FM meanings of feeling well can be understood as having strength to be involved. The women's experiences of feeling well meant being in control, having power, finding one's own pace, and experiencing feelings of belonging."

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

Juuso P, Soderberg S, Olsson M et al. 2013. The significance of FM associations for women with FM. Disabil Rehabil. [Dec 18 Epub ahead of print.] "Living with fibromyalgia (FM) means living with a long-term pain syndrome that is invisible to others. Support and understanding from others seem to be important to managing the affected daily life….The findings show that women experienced associations for people with FM as important as they gave access to contacts with others with similar experiences. Their need of togetherness was fulfilled at the association and they described being strengthened by the support received. Because of the lack of information and knowledge about FM, the association was described as an important venue for getting and mediating information about the illness. ….At the association the women seem to be empowered, which increases their ability to manage their daily lives despite the limitations imposed by FM. Healthcare personnel could not satisfy the women's needs and to manage to support women with FM. There is a need for communication based on a shared understanding between the women and healthcare personnel. Implications for Rehabilitation This study highlighted the need for communication based on a shared understanding between people with chronic illness and healthcare personnel to support and strengthen women with FM in their daily lives. The FM associations meet the needs for togetherness, confirmation, and information that the women with FM in this study described and healthcare personnel could not satisfy. Healthcare personnel can learn from FM associations how to empower women with FM in their everyday lives."

Kabongo, M. L. and A. W. Bedell.  1987.  Nail signs of systemic conditions.  AFP 36(4):109-116.

Kadetoff D, Lampa J, Westman M et al. 2011. Evidence of central inflammation in fibromyalgia - Increased cerebrospinal fluid interleukin-8 levels. J Neuroimmunol. [Nov 27 Epub ahead of print]. "Activation of glia cells resulting in intrathecal elevation of cytokines and chemokines has been hypothesized in chronic pain syndromes such as fibromyalgia. To our knowledge, this is the first study assessing intrathecal concentrations of pro-inflammatory substances in fibromyalgia. We report elevated cerebrospinal fluid and serum concentrations of interleukin-8, but not interleukin-1beta, in FM patients. This profile is in accordance with FM symptoms being mediated by sympathetic activity rather than dependent on prostaglandin associated mechanisms and supports the hypothesis of glia cell activation in response to pain mechanisms."

Kahan M, Srivastava A, Wilson L et al. 2006.  Opioids for managing chronic non-malignant pain: safe and effective prescribing.  Can Fam Physician. 52(9):1091-1096.  When pain control with other medications have failed, titration to find the lowest dose opioids that might be effective is the next logical step.  “Most patients with chronic non-malignant pain can be managed with <300 mg/d of morphine (or equivalent).  Opioids are safe and effective for managing chronic pain.”  [Non-medicinal pain relief methods should be part of any pain control program. DJS]   

Kakojic, D., V. Demarin, M. Kadojic, I. Mihaljevic and B. Barac.  1999.  Influence of prolonged stress on risk factors for cerebrovascular disease.  Coll Antropol 23(1):213-9.

Kalichman L. 2010. Massage therapy for fibromyalgia symptoms. Rheumatol Int. [Mar 20 Epub ahead of print]. Massage therapy is widely used by patients with fibromyalgia seeking symptom relief. We performed a review of all available studies with an emphasis on randomized controlled trials to determine whether massage therapy can be a viable treatment of fibromyalgia symptoms…..PubMed, PsychInfo, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2009) were searched for the key words "massage", "massotherapy", "self-massage", "soft tissue manipulation", "soft tissue mobilization", "complementary medicine", "fibromyalgia" "fibrositis", and "myofascial pain". ….The effects of massage on fibromyalgia symptoms have been examined in two single-arm studies and six randomized controlled trials. All reviewed studies showed short-term benefits of massage, and only one single-arm study demonstrated long-term benefits. All reviewed studies had methodological problems. The existing literature provides modest support for use of massage therapy in treating fibromyalgia. Additional rigorous research is needed in order to establish massage therapy as a safe and effective intervention for fibromyalgia. In massage therapy of fibromyalgia, we suggest that massage will be painless, its intensity should be increased gradually from session to session, in accordance with patient's symptoms; and the sessions should be performed at least 1-2 times a week. [Many of the terms used to as being former terms for fibromyalgia were describing myofascial trigger points in research many papers.  There may be a major confusion between fibromyalgia and myofascial pain on the part of the authors of  these papers, so that it is impossible to use those papers to ascertain whether the treatments being evaluated helped the FM or the co-existing myofascial component of the patients’ symptoms.  WE now know that patients with FM often if not always have TrPs generating the symptoms that FM amplifies.  Care must be taken in using the conclusions drawn by these papers to extrapolate further conclusions.  What is clear is that massage is beneficial at least on short term to patients who have both FM and CMP, and is a helpful part of the treatment tool box.  DJS]

Kalichman L, Vulfsons S. 2010. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 23(5):640-646. "Myofascial pain is a common syndrome seen by family practitioners worldwide. It can affect up to 10% of the adult population and can account for acute and chronic pain complaints. In this clinical narrative review we have attempted to introduce dry needling, a relatively new method for the management of musculoskeletal pain, to the general medical community. Different methods of dry needling, its effectiveness, and physiologic and adverse effects are discussed. Dry needling is a treatment modality that is minimally invasive, cheap, easy to learn with appropriate training, and carries a low risk. Its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews. The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial trigger points. However, over areas with potential risk of significant adverse events, such as lungs and large blood vessels, we suggest using the superficial technique, which has also been shown to be effective, albeit to a lesser extent. Additional studies are needed to evaluate the effectiveness of dry needling. There also is a great need for further investigation into the development of pain at myofascial trigger points."

Kallenberg LA, Hermens HJ. 2004.  Motor unit action potential rate and motor unit action potential shape properties in subjects with work-related chronic pain.  Eur J Appl Physiol. [Epub ahead of print.]  “...more high-threshold Mus contribute to low-level computer work-related tasks in chronic pain cases. Additionally, the results suggest that the input of the central nervous system to the muscle is higher in the cases with chronic pain.”

Kalmer, J. M. and E. Cafarelli1999. Effects of caffeine on neuromuscular function. A Appl Physiol 87(2):801-808.

Kamanli A, Kaya A, Ardicoglu O et al. 2004.  Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome.  Rheumatol Int. [Epub ahead of print.]  Lidocaine injection appears to offer the best results of the three according to this study, as it causes less problems than the dry needling and is less expensive than BTX-A.  BTX-A may be the treatment of choice in patients with resistant TrPs.  [Perpetuating factors must always be identified and brought under control.  DJS.]

Kamping S, Bomba IC, Kanske P et al. 2013. Deficient modulation of pain by a positive emotional context in fibromyalgia patients. Pain [Epub ahead of print]. This study used painful stimuli to the hand in conjunction with positive, negative or neutral pictures. The conclusion was that the FM patients "…are less efficient in modulating pain..." than healthy controls. [They may have been distracted by the pain. Also, none of the patients were assessed for coexisting trigger points. DJS]

Kandt RS, Daniel FL. 1986.  Glossopharyngeal neuralgia in a child.  A diagnostic and therapeutic dilemma.  Arch Neurol 43(3):301-302.  Symptoms were caused by TrPs in the right tonsil area.

Kang W, Hong HJ, Guan J et al. 2012. Reservatrol improves insulin signaling in a tissue-specific manner under insulin-resistant conditions only: in vitro and in vivo experiments in rodents. Metabolism 61(3):424-433. This study showed that in mice, reservatrol enhanced insulin action and normalized metabolism only under insulin-resistant conditions. It may act differently or not at all, depending on what type tissue is being targeted and whether or not the metabolic state is insulin-resistant or not.

Kang Y, Yi Y, Kim J. 2007.  Pain drawings of the phantom pain of the patients with amputation.  J Musculoskel Pain 15 (Supp 13):27 item 43.  [Myopain 2007 Poster]  “The patterns of phantom pain were very similar to the referred pain patterns of the MPS.  A new assumption would be possible: that ‘phantom pain in MPS’s clothing’ like ‘sheep in wolf’s clothing’.” [This finding agrees with other research and observation that indicates phantom limb (and breast, uterine and ovarian) pain may be due to MTPs or other tissue TrPs. DJS]

Kankaanpaa, M. S. Taimela, D. Laaksonen, O. Hanninen and O. Airaksinen.  1998.  Back and hip extensor fatigability in chronic low back pain patients and controls.  Arch Phys Med Rehabil 79(4):412-7.

Kanlayananaphotporn R. 2014. Changes in sitting posture affect shoulder range of motion. J Bodyw Move Ther. 18(2):239-243. A slight, comfortable slouch can significantly affect shoulder range of motion. Even slight changes in the curve of the thoracic spine can affect shoulder range of motion, and must be taken into account during assessment.

Kannan P. 2012. Management of Myofascial Pain of Upper Trapezius: A Three Group Comparison Study. Glob J Health Sci. 4(5):46-52. "We conclude that laser can be used as an effective treatment regimen in the management of myofascial trigger points thereby reducing disability caused due to musculoskeletal pathology."

Kao MJ, Han TI, Chou LW et al. 2010. Development of myofascial trigger points in children. International Myopain Society Eighth Clinical Meeting Oct 3-7, 2010. Toledo, Spain. Abstract No. 8. "It was concluded that children began to develop an MTrP and an A-TrP at the brachioradialis muscle since at the age of 6 years, with the A-TrP becomes more irritable than in the MTrP since at the age of 7 years. These findings are not related to the activity levels." [Young people have TrPs, both attachment TrPs (ATrPs in tendons and ligaments) and MTrPs (myofascial TrPs.) They are a common source of growing pain, and they are treatable. They must be treated promptly (and gently), to prevent scoliosis and other bone deformities from developing, to prevent gait irregularities from causing further problems, and to prevent chronicity and central sensitization from developing. DJS]

Kao MJ, Hsieh YL, Kuo FJ et al. 2006. Electrophysiological assessment of acupuncture points.  Am J Phys Med Rehabil. 85(5):443-448.   “Similar to the distribution of EPN loci in an MTrP region, significantly more EPN (end plate noise) loci can be identified in an AcP (acupuncture point) region of Stomach-36 than in a nearby non-AcP site.  This study provides additional support to the hypothesis that some AcPs are also myofascial trigger points.”

Kaplan, R. M., S. M. Schmidt and T. A. Cronan.  2000.  Quality of well being in patients with fibromyalgia.  J Rheumatol 27(3):785-9. 

Kapreli E, Vourazanis E, Strimpakos N. 2007.  Neck pain causes respiratory dysfunction.  Med Hypotheses [Oct 22 Epub ahead of print].  “The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction.  The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects, notably patient assessment, rehabilitation and pharmacological prescription.”

Kaput J, Perlina A, Hatipoglu B et al. 2007.  Nutrigenomics: concepts and applications to pharmacogenomics and clinical medicine.  Pharmacogenomics. 8(4):369-390. “The maintenance of health and the prevention and treatment of chronic diseases are influenced by naturally occurring chemicals in foods.  In addition to supplying the substrates for producing energy, a large number of dietary chemicals are bioactive -- that is, they alter the regulation of biological processes and, either directly or indirectly, the expression of genetic information.  Nutrients and bioactives may produce different physiological phenotypes among individuals because of genetic variability and not only alter health, but also disease initiation, progression and severity.  The study and application of gene-nutrient interactions is called nutritional genomics or nutrigenomics.  Nutrigenomic concepts, research strategies and clinical implementation are similar to and overlap those of pharmacogenomics, and both are fundamental to the treatment of disease and maintenance of optimal health.”

Kaput J, Rodriguez RL. 2004.  Nutritional genomics: the next frontier in the post genomic era.  Physiol Genomics. 16(2):166-177. “…dietary intervention based on knowledge of nutritional requirement, nutritional status, and genotype (i.e., ‘individualized nutrition’) can be used to prevent, mitigate, or cure chronic disease.”

Kar, A., B. K. Choudhary and N. G. Bandyopadhyay. 1999. Preliminary studies on the inorganic constituents of some indigenous hypoglycaemic herbs on oral glucose tolerance test. J Ethnopharmacol 64(2):179-84.

Karadas O, Gul HL, Inan LE. 2013. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain. 14:44. "Local lidocaine injections into the myofascial TPs located in the pericranial muscles could be considered as an effective alternative treatment for ETTH (episodic tension-type headache)."

Karakus N, Yigit S, Inanir A et al. 2012. Association between sequence variations of the Mediterranean fever gene and fibromyalgia syndrome in a cohort of Turkish patients. Clin Chim Acta. 414C:36-40. "The results of this study suggest that MEFV gene mutations and polymorphism are positively associated with predisposition to develop FMS. Further studies with larger populations will be required to confirm these findings."

Karalis, K. P., E. Kontopoulos, L. J. Muglia and J. A. Majzoub.  1999.  Corticotropin-releasing hormone deficiency unmask the proinflammatory effect of epinephrine.  Proc Natl Acad Sci U S A 96(12):7093-7.   

Karavis MY, Argyra E, Segredos V et al. 2015. Acupuncture-induced haemothorax: a rare iatrogenic complication of acupuncture. Acupunct Med. [Mar 19 Epub ahead of print.] "This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection….To maximize the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques."

Karim MR, Fann AV, Gray RP et al. 2005.  Enthesitis of biceps brachii short head and coracobrachialis at the coracoid process: a generator of shoulder and neck pain.  Am J Phys Med Rehabil. 84(5):376-380.  [This study used Marcaine and DepoMedrol for anterior shoulder pain and MPS, with a diagnosis of enthesitis.  It would be interesting to know what would have happened if the patients had been examined for attachment trigger points and injected with procaine or lidocaine.  A less toxic local anesthetic may often be effective for enthesiopathy caused by attachment trigger points.  DJS]

Karmakar MK, Ho AM. 2004.  Postthoracotomy pain syndrome.  Thorac Surg. Clin. 14(3):345-352.  About 30% of posthoracotomy patients experience chronic pain as a result.  The authors advocate aggressive pain control before incision, but neglect to mention the possibility of TrPs.

Karper WB. 2012. Exercise Effects on Two Men with Fibromyalgia Syndrome: An Update. Am J Mens Health. [Sep 6 Epub ahead of print]. "In 2007, an article was published in this journal about the effects of exercise on two older men with fibromyalgia syndrome (FMS). This new article is an update on how exercise has affected them during a 4-year period since 2007. Results suggest that both these men still function at approximately the same levels (physically and psychosocially) as reported in 2007. This is viewed as a positive finding, because even with all of their FMS symptoms, these two men managed to maintain their functional capacity. It is hard for most older people without FMS to remain motivated enough to accomplish this. Because it is difficult to find specifically published data on men (vs. women) with FMS, this long-term information on these two men is important for professionals who are involved in exercise programming for men with FMS and for those interested in studying exercise effects on men with FMS."

Karsdorp PA, Vlaeyen JW. 2009.  Active avoidance but not activity pacing is associated with disability in fibromyalgia.  Pain [Aug 26 Epub ahead of print].

Kashikar-Zuck S, Cunningham N, Sil S et al. 2014. Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics. [Feb 24 Epub ahead of print.] "Adolescent patients with JFM have a high likelihood of continued fibromyalgia symptoms into young adulthood. Those who met criteria for fibromyalgia in adulthood exhibited the highest levels of physical and emotional impairment. Emerging differences in educational attainment and marital status were also found in the JFM group. JFM is likely to be a long-term condition for many patients, and this study for the first time describes the wide-ranging impact of JFM on a variety of physical and psychosocial outcomes that seem to diverge from their same-age peers."

Kashikar-Zuck S, Flowers SR, Verkamp E et al. 2010. Actigraphy-based physical activity monitoring in adolescents with juvenile primary fibromyalgia syndrome. J Pain. [Apr 23 Epub ahead of print].“Juvenile primary fibromyalgia syndrome (JPFS) is a chronic pain condition associated with significant impairment in physical functioning, but no studies have used newer technologies such as actigraphy to document objective physical activity levels in JPFS. This is the first study to objectively describe physical activity in JPFS patients and examine the relationship of pain, perceived functional impairment, and depressive symptoms on physical activity. One hundred four clinically referred adolescents with JPFS (ages 11 to 18 years) wore a hip-mounted actigraph for 1 week. Data on pain intensity, functional disability, depressive symptoms, and psychiatric diagnoses were obtained using self- and parent-report measures and a standardized psychiatric interview. Results showed that younger patients were more active....Actigraphy provides a unique source of information about physical functioning which is distinct from adolescents' self-report of physical functioning in JPFS....Results indicate that actigraphy provides a unique source of objective information that can advance our understanding of physical disability in JPFS and the factors associated with physical impairment.” [It would be helpful if these patients were assessed for co-existing myofascial trigger points, as much of the activity level might be due to the presence of those pain generators. Treatment of the TrPs at this stage might prevent serious conditions such as osteoarthritis from developing later. DJS]

Kashikar-Zuck S, Johnston M, Ting TV et al. 2010. Relationship between school absenteeism and depressive symptoms among adolescents with juvenile fibromyalgia. J Pediatr Psychol. [Apr 1 Epub ahead of print]. “Over 12% of adolescents with JPFS (juvenile primary fibromyalgia syndrome) were home schooled. Those enrolled in regular school missed 2.9 days per month on average, with one-third of participants missing more than 3 days per month. Pain and maternal pain history were not related to school absenteeism. However, depressive symptoms were significantly associated with school absences. Conclusion: Many adolescents with JPFS experience difficulties with regular school attendance.”  [This conclusion is not unexpected yet the study is needed.  It is hoped that teachers will learn basic signs of both fibromyalgia and myofascial trigger points.  These common conditions can directly affect the ability of the student to learn, and there are many things that can be done to improve the learning experience for these students.  The sooner early warning signs of these conditions such as unrestorative sleep and growing pains are caught, the better the prognosis for the patient and the more efficient the education efforts can be. DJS]

Kashikar-Zuck S, Lynch AM, Graham TB et al. 2007.  Social functioning and peer relationships of adolescents with juvenile fibromyalgia syndrome.  Arthritis Rheum. 57(3):474-480.  “Adolescents with JPFS were perceived (by peer and self reports) as being more isolated and withdrawn and less popular.  Adolescents with JPFS were less well liked, were selected less often as a best friend, and had fewer reciprocated friendships.”  “Given the central role that peer relationships play in psychological development of children, and because peer rejection and isolation have been associated with subsequent adjustment problems, these findings are concerning.”  [This is a significant study and indicates a great need for more attention to the support systems of adolescents with FM. DJS]

Kashikar-Zuck S, Parkins IS, Ting TV et al. 2010. Controlled follow-up study of physical and psychosocial functioning of adolescents with juvenile primary fibromyalgia syndrome. Rheumatology (Oxford). [Aug 5 Epub ahead of print]. "The results of this controlled follow-up study demonstrate that symptoms of FM appear to be chronic in a majority of clinically referred JPFS patients and the associated physical and emotional impairment can also be persistent."

Kashikar-Zuck S, Vaught MH, Goldschneider KR et al. 2002. Depression, coping, and functional disability in juvenile primary fibromyalgia syndrome.  J Pain 3(5):412-419.  In this study, children with juvenile primary fibromyalgia syndrome (JPFS) and nonmalignant chronic back pain (CBP) were compared.  “...both JPFS and CBP groups reported significant disruption in functional abilities and school attendance as a result of chronic pain....  The JPFS group had suffered from pain for significantly longer than the CBP group before being referred for specialty care...  The JPFS group reported somewhat more school absences.”

Kashikar-Zuck S, Zafar M, Barnett KA et al. 2013. Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia. Clin J Pain. [Feb 26 Epub ahead of print]. "Chronic pain in children is associated with significant negative impact on social, emotional and school functioning." "Youth with JFM (juvenile fibromyalgia) had significantly higher anxiety and depressive symptoms, and lower quality of life in all domains. Among children with CM (chronic migraine), overall functioning was higher but school functioning was a specific area of concern….Results indicate important differences in subgroups of pediatric pain patients and point to the need for more intensive multidisciplinary intervention for JFM patients."

Kashima, K., O. I. Rahman, S. Sakoda and R. Shiba.  1999.  Increased pain sensitivity of the upper extremities of TMD patients with myalgia to experimentally-evoked noxious stimulation: possibility of worsened endogenous opioid systems.  Cranio 17(4):241-6.

Kasikcioglu E, Dinler M, Berker E. 2006.  Reduced tolerance of exercise in fibromyalgia may be a consequence of impaired microcirculation initiated by deficient action of nitric oxide.  Med. Hypotheses [Jan 9 Epub ahead of print].

Kassirer,  J. P. 1997. Federal foolishness and marijuana.  N Engl J Med 366(5):336-7.

Kasteleijn-Nolst Trenite, D. G., A. M. da Silva, S. Ricci, C. D. Binnie, G. Rubboli, C. A. Tassinari and J. P. Segers.  1999.  Video-game epilepsy: a European study.  Epilepsia 40 (Suppl 4):70-4.

Kasunich NJ. 2003.  Changes in low back pain in a long distance runner after stretching the iliotibial band.  J Chiropr Med. 2(1):37-40.  “This case report describes a long distance runner with low-back pain and sacroiliac pain and proposes iliotibial band tightness as a possible causative factor.  Clinical Features: A 38-year-old female amateur runner experienced an exacerbation of right-sided lower back and sacroiliac pain, which she had experienced for several months.”  “Trigger points were found in the gluteus maximus, gluteus medius, and tensor fascia lata muscles.”  “A patient had low back and sacroiliac pain that seemed to originate from a dysfunctional iliotibial band.  This case illustrates that it is important to consider iliotibial band tightness as a possible cause of low back and sacroiliac pain and that proper management may need to include stretching of the iliotibial band along with trigger point therapy and chiropractic manipulation.”  [TrPs in the iliotibial band are a frequently overlooked source of referred pain. DJS]

Kathagen N, Prehm P. 2013. Regulation of intracellular pH by glycosaminoglycans. J Cell Physiol. 228(10):2071-2075. Addition of hyaluronan (hyaluronic acid), hyaluronan oligosaccharides, chondroitin sulfate, or heparin to culture medium of fibroblasts caused intracellular acidification from pH 7.2 to 6.7 in a concentration dependent manner. Acidification is associated with disease states. Hyaluronidase treatment or hyaluronidase export inhibition (with xanthhohumol) resulted in intracellular alkalization. This indicates that glycosaminoglycans participate in some way in intracellular pH regulation. [This research meshes well with the studies we did on geloid masses inpatients with FM and CMP, and indicates that patients with FM and CMP may need to be very careful using any product with hyaluronic acid. HA is a component in many cosmetics, body lotions, and anti-aging formulas. DJS]

Kato K, Sullivan PF, Evengard B et al. 2006.  Importance of genetic influences on chronic widespread pain.  Arthritis Rheum. 54(5):1682-1686.  “Individual differences in the likelihood of developing chronic widespread pain reflect modest genetic influences.  There are no significant sex differences in the type or expression of the genes responsible for chronic widespread pain or in the magnitude of the relative importance of these influences on chronic widespread pain.”

Kato T, Rompre P, Montplaisir JY et al. 2001.  Sleep bruxism: an oromotor activity secondary to micro-arousal.  J Dent Res. 80(10):1940-1944.  “A clear sequence of cortical to autonomic-cardiac activation precedes jaw motor activity in SB [sleep bruxism] patients.  This suggests that SB is a powerful oromotor manifestation secondary to micro-arousal.”  [This is contrary to the belief that jaw clenching and grinding is primarily caused by stress. It indicates that care providers should be checking sleep quality. DJS]

Kato T, Montplaisir JY, Guitard F et al. 2003.  Evidence that experimentally induced sleep bruxism is a consequence of transient arousal.  J Dent Res. 82(4):284-288.

Katz JD, Mamyrova G, Guzhva O et al. 2010. Gender bias in diagnosing fibromyalgia. Gend Med. 7(1):19-27. “This study provides insight into the diagnostic thought processes of rheumatologists. A minority of practitioners relied solely on the published ACR classification criteria for the diagnosis of FM. We also report gender bias with regard to disease classification, because rheumatologists were more likely to require a physical finding to support a diagnostic conclusion in male patients.” [It comes as no surprise that many physicians in general still expect more male patients to have a “real” reason for their symptoms. DJS]

Katz J, McCartney CJ. 2002.  Current status of pre-emptive analgesia.  Curr Opin Anaesthesiol. 15(4):435-441.  “The application of preventive perioperative analgesia (not necessarily preincisional) is associated with a significant reduction in pain beyond the clinical duration of action of the analgesic agent, in particular for the N-methyl-D-aspartate antagonists.”

Katz J, Cohen L, Schmid R, et al. 2003.  Postoperative morphine use and hyperalgesia are reduced by preoperative but not intraoperative epidural analgesia: implications for preemptive analgesia and the prevention of central sensitization.  Anesthesiology 98(6):144-1460. 

Katz, N. P.  2000.  MorphiDex (MS:DM) double-blind, multiple-dose studies in chronic pain patients.  J Pain Symptom Manage 19(1 Suppl):S37-41.

Katz RS. P956: Learning disability in fibromyalgia patients: FMS patients report more language and spatial difficulties. Presented at: American College of Rheumatology 2012 Annual Meeting; Nov 10-14, Washington.  Fibromyalgia patients report more learning disability symptoms than patients with rheumatoid arthritis. Patients with FM, RA, systemic lupus erythematosus and healthy controls were compared in a survey of reading, writing, body awareness/spatial relationships and oral expressive language. Patients with FM had worse reading and oral expressive language scores than controls, and worse scores in all areas than RA and SLE groups.  They made mistakes such as skipping words or lines; in remembering what they read; understanding the main concept or details of the story; in grammar or punctuation; with tendency to be clumsy or uncoordinated; with hand-eye coordination; in finding the right words to say in a conversation; or in getting to the point of a conversation. This can make it very challenging to learn, especially in a school situation, or in a job.  [This can make life difficult in general.  It is good to understand that this is part of the problem. The spatial manifestations may be part of the use if the alternate kynurenine metabolic pathway and quinolinic acid production in FM.  The clumsiness and hand-eye coordination may be associated with myofascial trigger point proprioceptive concomitants. Patients were not screened for co-existing TrPs. DJS]

Katz RS, Heard AR, Mills M et al. 2004.  The prevalence and clinical impact of reported cognitive difficulties (fibrofog) in patients with rheumatic disease with and without fibromyalgia.  J Clin Rheumatol. 10(2):53-58.  “Memory decline and mental confusion were coupled more often in patients with FMS (50.9-8.8%).  Patients with FMS with this combination of cognitive problems reported more pain (76.0-45.4%), stiffness (79.7-43.7%), fatigue (79.6-52.6%) and disturbed sleep (59.2-36.6%) compared with patients with FMS with memory problems alone.  Patients with rheumatic disease substantially differ in cognitive vulnerability, with patients with FMS at considerably higher risk for cognitive difficulty.  More importantly, the prevalence of a combined disturbance in memory and mental clarity is high and closely associated with the perception of increased illness severity and diminished mental health in FMS.  That this linkage has the possibility of having a great deal to do with an important clinical variant of FMS underscores the need for greater clinical recognition of this underrecognized pattern and for further research.”

Kaufman MB, Choy M. 2012. Pregabalin and simvastatin: first report of a case of rhabdomyolysis. P T. 37(10):579-595. This study concerns a 70-year-old man who arrived at the emergency department with multiple conditions. He was taking multiple medications. His rhabdomyolysis was found to be caused by simvastatin and perhaps also pregabalin. "It is not well known that pregabalin can cause rhabdomyolysis, and there is only one published report on pregabalin-induced hepatotoxicity. When different therapies are combined, the risk of rhabdomyolysis may be increased. The cause of rhabdomyolysis in our patient might be related to decreased renal elimination of both pregabalin and simvastatin (e.g., renal tubular reabsorption). It is important to be aware of this potentially serious and possibly life-threatening reaction especially when medication doses are increased or combined with other agents with similar safety issues."

Kaufmann, H. 1997. Neurally mediated syncope and syncope due to autonomic failure: differences and similarities.  J Clin Neurophysiol 14(3):183-196.

Kauppila, T., X. J. Xu, W. Yu and Z Wiesenfeld-Hallin.  1998.  Dextromethorphan potentiates the effect of morphine in rats with peripheral neuropathy.  Neuroreport 9(6):1071-1074.

Kavlock, R. J.  1999.  Overview of endocrine disruptor research activity in the United States. Chemosphere 39(8):1227-36.

Kawakita K, Itoh K, Okada K. 2007.  Experimental model of trigger points using eccentric exercise.  J Musculoskel Pain 15 (Supp 13):4 item 4.  [Myopain 2007 Poster]  “The tissue injuries and subsequent inflammation processes produced by the REC play an important role in the development of TrP, and ischemic condition could induce synaptic changes in the spinal cord.  Sensitization of peripheral sensory could induce synaptic changes in the spinal cord.  Sensitization of peripheral sensory receptors presumably polymodal receptors of the fascia and central sensitization might be a possible underlying mechanism of the TrP formation and referred pain phenomena.”

Kawakita K, Okada K. 2006.  Mechanisms of action of acupuncture for chronic pain relief – polymodal receptors are the key candidates.  Acupunct Med. 24 Suppl:S58-S66.

Kawamata, T., K. Omote, M. Kawamata and A. Namiki.  1998.  Premedication with oral dextromethorphan reduces postoperative pain after tonsillectomy.  Anesth Analg 86(3):594-597.

Kawase T, Maki A, Takata Y et al. 2010. Effects of neck muscle vibration on subjective visual vertical: comparative analysis with effects on nystagmus. Eur Arch Otorhinolaryngol. [Dec 23 Epub ahead of print]. "In patients with unilateral vestibular dysfunction, vibratory stimulation to the neck muscles not only induces shift of the subjective visual vertical (SVV), but also enhances the generation of nystagmus. In the present study, the effects of neck vibration on the SVV were compared with those on nystagmus in patients with unilateral vestibular schwannoma (14 patients; 6 males and 8 females, mean age 54.2 years). The results indicated that the presence of nystagmus and magnitude of the SVV were generally correlated, neck vibration significantly increased the abnormal shift of the SVV and the presence of nystagmus, and the effects of vibration to the ipsilateral dorsal neck were significantly larger than those to the contralateral dorsal neck on the SVV, whereas no significant difference was observed in slow phase velocity of nystagmus. The present study suggests that both SVV and nystagmus induced by vibration have many similar clinical features and may be important in assessing the unilateral vestibular dysfunction." [Vestibular dysfunction is a common but often undiagnosed co-existing disorder of FM and CMP. DJS]

Kay, G.G. and A. G. Harris.  1999.  Loratadine [Note: Claritin]: a non-sedating antihistamine. Review of its effects on cognition, psychomotor performance, mood and sedation.  Clin Exp Allergy 29(S3):147-150.

Kaya A, Kamanii A, Ardicoglu O et al. 2009.  Direct current therapy with/without lidocaine iontophoresis in myofascial pain syndrome.  Bratisi Lek Listy 110(3):185-191.  “Direct current therapy with/without lidocaine iontophoresis were determined to be effective treatment modalities in TrP management.”   [It would be interesting to see how patients with more than a few TrPs reacted to this method of treatment.  Is it possible to treat body-wide TrPs with this sort of therapy? DJS]

Kaya S, Hermans L, Willems T et al. 2013. Central sensitization in urogynecological chronic pelvic pain: a systematic literature review. Pain Physician. 16(4):291-308. "Although the majority of the literature provides evidence for the presence of CS (central sensitization) in urogynecological CPP (chronic pelvic pain) with changes in brain morphology/function and sensory function, it is unclear whether these changes in central pain processing are secondary or primary to CPP, especially since evidence regarding the function of endogenous pain inhibition and the role of psychosocial pain facilitation is scarce. Further studies with good methodological quality are needed in order to clarify exact mechanisms."

Kazennikov OV, Wiesendanger M. 2005.  Goal synchronization of bimanual skills depends on proprioception.  Neurosci Lett. [Epub ahead of print Jul 20]  Proprioceptive feedback is necessary for the brain to monitor, correct and coordinate bimanual movements.  [Proprioceptive dysfunction associated with myofascial TrPs may contribute to much more disability or dysfunction than is recognized.]

Keel, P.  1999.  Pain management strategies and team approach.  Baillieres Best Pract Res Clin Rheumatol 13(3):493-506.

Keel, P.J., C. Bodoky, U. Gerhard and W. Muller. 1998. Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clin J Pain 14(3):232-8.

Keitel, W. 1999. [Occupational therapy in the diseases of the locomotor system]. Z Arztl Fortbild Qualitatssich 93(5):335-40 [German].

Keitel, W. 1999. [ No title available] Fortschr Med 117(5):32-6. [German]

Kelly G.S. 2000. Insulin resistance: lifestyle and nutritional interventions. Altern Med Rev 5(2):109-32. Insulin resistance seems to be common and contributes to several frequent health problems including sleep apnea, obesity, and type 2 diabetes.  Possible perpetuating factors include diet, exercise, smoking and stress.

Kemeny, M. E. and T. L. Gruenewald.  1999.  Psychoneuroimmunology update.  Semin Gastrointest Dis 10(1):20-9.

Kempermann G, Neumann H. 2003.  Neuroscience.  Microglia: the enemy within?  Science 302(5651):1689-1690.  Microglia "...may be central players in repairing brain tissue and maintaining its integrity...and also...contribute to the rearrangement of neural connections and hence to the plasticity of normal brain tissue."  [Microglia may be part of the cause and the cure of central sensitization. DJS]

Kendall, SA, Henriksson, KG, Hurtig, I et al. 2003.  Differences in sensory thresholds in the skin of women with fibromyalgia syndrome: a comparison between ketamine responders and ketamine non-responders.  J Muscoloskel Pain 11(2):3-9.  This is another study indicating that subsets of patients with FMS have different pain processing dysfunctions. 

Kengen Traska T, Rutledge DN, Mouttapa M et al. 2011. Strategies used for managing symptoms by women with fibromyalgia. J Clin Nurs. [Feb 15 Epub ahead of print]. "Study findings demonstrate that women with fibromyalgia can develop strategies that enable them to cope with a life encumbered with chronic pain and fatigue.....Further research is needed on risks/benefits of these and other self-management strategies used by women with fibromyalgia."

Kern, W., E. F. Stange, H. L. Fehm and H. H. Klein.  1999. [No title available].  Z Gastroenterol Suppl 1 (13):36-42 [German]. 

Kerns RD, Rosenberg R. 2000.  Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model.  Pain 84(1):49-55.  “These findings suggest that increased commitment to a self-management approach to chronic pain may serve as a mediator or moderator of successful treatment.”

Kerr, S. J. , P. J. Armati and B. J. Brew.  1995. Neurocytotoxity of quinolinic acid in human brain cultures. J Neurovirol 1(5-6):375-380.

Ketenci A, Basat H, Esmaeilzadeh S. 2009.  The efficacy of topical thiocolchicoside (Muscoril) in the treatment of acute cervical myofascial pain syndrome: a single-blind, randomized, prospective, phase IV clinical study.  Agri. 21(3):95-103.  “Thiocolchicoside can be used in the treatment of myofascial pain syndrome.  The ointment form may be a good alternative, particularly in patients who cannot receive injections.”

Ketenci A, Basat H, Esmaeizadeh S. 2009.  The efficacy of topical thiocolchicoside (Muscoril) in the treatment of acute cervical myofascial pain syndrome: a single-blind, randomized, prospective, phase IV clinical study.  Agri. 21(3):95-103.  “Thiocolchicoside can be used in the treatment of myofascial pain syndrome.  The ointment form may be a good alternative, particularly in patients who cannot receive injections.”  [This study was done with acute TrPs, and not in chronic TrPs.  It is hoped that future studies will include patients with CMP, using the ointment on some of the worst TrPs.  In all chronic cases, any perpetuating factors will have to be brought under control as well. DJS]

Ketroser DB 2000.  Whiplash, chronic neck pain, and zygapophyseal joint disorders. A selective review. Minn Med  83(2):51-4

Keverne, E. B.  1999.  The Vomeronasal Organ.  Science 286(5440):716-720.

Khaki AM. 2006.  Pain clinic experience in a teaching hospital in Western Saudi Arabia.  Relationship of patient’s age and gender to various types of pain.  Saudi Med J. 27(12):1882-1886.  “Various types of chronic pain managed in the pain clinic (required) full understanding of pain neurophysiology as well as familiarity with contributing factors to the prevalence of pain.”

Khalsa PS. 2004. Biomechanics of musculoskeletal pain: dynamics of the neuromatrix.  J Electromyogr Kinesiol. 14(1):109-120.  “Mammals in general, and humans in particular, have evolved a highly sophisticated system of pain perception, which is characterized in humans by complementary but distinct neural processing of the intensity and location of a noxious stimulus, and a motivational/emotional or affective response to the stimulus.  The peripheral and central neurons that comprise this system, which has been called the 'neuromatrix', dynamically (temporally) respond and adapt to noxious biomechanical stimuli.  However, phenotypic variability of the neuromatrix can be large, which can result in a host of musculoskeletal conditions that are characterized by altered pain perception, which can and often does alter the course of the condition.  This neural plasticity has been well recognized in the central nervous system, but it has only more recently become known that peripheral nociceptors also adapt to their altered extracellular matrix environment.  This work reviews the biomechanics of pain focusing on the relevant stimulus that initiates responses by nociceptors to the cognitive perception of pain.”  [It is becoming increasingly evident that each of us is indeed unique, including in response to medications and to just about everything else.  One size does not fit all, and, especially in complex medical conditions, tailoring the medications and therapies to the individual is vital to success. DJS]

Khan MA, Lichtensteiger CA, Faroon O, Mumtaz M, Schaeffer DJ, Hansen LG. The hypothalamo-pituitary-thyroid (HPT) axis: a target of nonpersistent ortho-substituted PCB congeners.2002. Toxicol Sci Jan;65(1):52-61.

Khasar SG, Green PG, Levine JD. 2005.  Repeated sound stress enhances inflammatory pain in the rat.  Pain 116(1-2):79-86.  “Stress-induced enhancement of inflammatory hyperalgesia is associated with a change in mechanism by which bradykinin induces hyperalgesia, from being sympathetically mediated to being sympathetically independent.  This sympathetic-independent enhancement of mechanical hyperalgesia is mediated by the stress-induced release of epinephrine from the adrenal medulla.”

Kharkevich, D. A. and V. V. Churukanov.  1999.  Pharmacological regulation of descending cortical control of the nociceptive processing.  Eur J Pharmacol 375(1-3):121-31.

Khasar SG, Dina OA, Green PG et al. 2009.  Sound stress-induced long-term enhancement of mechanical hyperalgesia in rats is maintained by sympathoadrenal catecholamines.  J Pain. [Jul 1 Epub ahead of print].  “We present data showing mechanical hyperalgesia persisting for up to 28 days after exposure to sound stress, with evidence that the sympathoadrenal axis mediator epinephrine plays a major role.  These findings could have clinical implications with regard to novel potential treatments for chronic widespread pain syndromes, such as fibromyalgia.”  As many of us with FM know, noise can create a major stressor to the central nervous system.  This article provides some proof, and an indication of how long the effects can last.

Kidd, P. M.  1999.  A review of nutrients and botanicals in the integrative management of cognitive dysfunction.  Altern Med Rev 4(3);144-61.

Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Emotions, Morbidity, and Mortality: New Perspectives from Psychoneuroimmunology. 2002. Annu Rev Psychol 53:83-107.

Kiers H 1, van Dieën JH, Brumagne S et al. 2014. Postural sway and integration of proprioceptive signals in subjects with LBP. Hum Mov Sci. 39C:109-120. "Patients with non-specific low back pain (LBP) may use postural control strategies that differ from healthy subjects….This model suggests that subjects with LBP use more co-contraction and less cognitive control, to maintain a standing balance when compared to subjects without LBP. In addition, a reduced weighting of proprioceptive signals in subjects with LBP is suggested as an explanation for the findings in this study."

Kietrys DM, Palombaro KM, Azzaretto E et al. 2013. Effectiveness of Dry Needling for Upper Quarter Myofascial Pain: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. [Jun 11 Epub ahead of print]. "Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points (MTrPs). When palpated, active MTrPs cause local or referred symptoms, including pain. Dry needling involves inserting an acupuncture-like needle into a MTrP with the goal of reducing pain and restoring range of motion. OBJECTIVE: To explore the evidence regarding the effectiveness of DN in reducing pain for patients with MPS of the upper quarter. METHODS: An electronic literature search was performed using the keyword "dry needling." Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trials (RCTs), dry needling intervention group, and MPS involving the upper quarter.…RESULTS:… Findings of 3 studies that compared dry needling to sham or placebo treatment provide evidence that dry needling can immediately decrease pain in patients with upper quarter MPS, with an overall effect favoring dry needling. Findings of 2 studies that compared dry needling to sham or placebo treatment provide evidence that dry needling can decrease pain after 4 weeks in patients with upper quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There is evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. CONCLUSIONS: Based on the best current available evidence, we recommend (Grade A) dry needling, compared to sham or placebo, for decreasing pain (immediately after treatment and at 4 weeks) in patients with upper quarter MPS. Due to the small number of high quality RCTs published to date, additional well-designed studies are needed to inform future evolution of this recommendation."

Kietrys DM, Palombaro KM, Mannheimer JS. 2014. Dry needling for management of pain in the upper quarter and craniofacial region. Curr Pain Headache Rep. 18(8):437. "Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling."

Kim CH, Vincent A, Clauw DJ et al. 2013. Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia. Arthritis Res Ther. 15(2):R42. "Our study demonstrates that low and moderate alcohol consumption was associated with lower fibromyalgia symptoms and better quality of life (QOL) compared to no alcohol consumption. The reasons for these results are unclear. Since recent studies have demonstrated that gamma-Aminobutyric Acid (GABA) levels are low in fibromyalgia, and alcohol is known to be a GABA-agonist, future studies should examine whether alcohol could have a salutary effect on pain and other symptoms in fibromyalgia."

Kim DH, Yoon DM, Yoon KB. 2015. The effects of myofascial trigger point injections on nocturnal calf cramps. J Am Board Fam Med. 28(1):21-27. "The purpose of this study was to elucidate the effects of injection at trigger points on pain and sleep disturbance in patients with nocturnal calf cramps (NCCs)…. Patients with NCCs that occurred at least once per week and who had myofascial trigger points (MTrPs) on the gastrocnemius muscles were enrolled in the study for 9 months…. These preliminary data show that injection at MTrPs in patients with NCCs not only alleviated pain and reduced the frequency of cramps but also lessened the severity of insomnia as measured by the ISI. A larger randomized controlled trial is needed to confirm these findings and determine whether the effect lasts over the long term." Free Article

Kim DS, Jeong TY, Kim YK 2013. Usefulness of a myofascial trigger point injection for groin pain in patients with chronic prostatitis/chronic pelvic pain syndrome: a pilot study. Arch Phys Med Rehab 94(5):930-936. "in patients with CP/CPPS, US-guided trigger point injections of the iliopsoas, hip adductor, and abdominal muscles are safe and effective for both diagnosis and treatment when the cause of groin pain is suspected to originate in from muscles. In particular, the iliopsoas muscle was affected in all patients (N=21) in this study.

Kim J, Loggia ML, Edwards RR et al. 2013. Sustained deep-tissue pain alters functional brain connectivity. Pain. [Apr 11 Epub ahead of print]. "Recent functional brain connectivity studies have contributed to our understanding of the neurocircuitry supporting pain perception. However, evoked-pain connectivity studies have employed cutaneous and/or brief stimuli, which induce sensations that differ appreciably from the clinical pain experience. Sustained myofascial pain evoked by pressure cuff affords an excellent opportunity to evaluate functional connectivity change to more clinically relevant sustained deep-tissue pain. Connectivity in specific networks known to be modulated by evoked pain (sensorimotor, salience, dorsal attention, frontoparietal control, and default mode networks: SMN, SLN, DAN, FCN, and DMN) was evaluated with functional-connectivity magnetic resonance imaging, both at rest and during a sustained (6-minute) pain state in healthy adults. We found that pain was stable, with no significant changes of subjects' pain ratings over the stimulation period. Sustained pain reduced connectivity between the SMN and the contralateral leg primary sensorimotor (S1/M1) representation. Such SMN-S1/M1 connectivity decreases were also accompanied by and correlated with increased SLN-S1/M1 connectivity, suggesting recruitment of activated S1/M1 from SMN to SLN. Sustained pain also increased DAN connectivity to pain processing regions such as mid-cingulate cortex, posterior insula, and putamen. Moreover, greater connectivity during pain between contralateral S1/M1 and posterior insula, thalamus, putamen, and amygdala was associated with lower cuff pressures needed to reach the targeted pain sensation. These results demonstrate that sustained pain disrupts resting S1/M1 connectivity by shifting it to a network known to process stimulus salience. Furthermore, increased connectivity between S1/M1 and both sensory and affective processing areas may be an important contribution to interindividual differences in pain sensitivity."

Kim JY, Kim SH, Seo J et al. 2013. Increased power spectral density in resting-state pain-related brain networks in fibromyalgia. Pain. 154(9):1792-1797. "Fibromyalgia (FM), characterized by chronic widespread pain, is known to be associated with heightened responses to painful stimuli and atypical resting-state functional connectivity among pain-related regions of the brain. Previous studies of FM using resting-state functional magnetic resonance imaging (rs-fMRI) have focused on intrinsic functional connectivity, which maps the spatial distribution of temporal correlations among spontaneous low-frequency fluctuation in functional MRI (fMRI) resting-state data. In the current study, using rs-fMRI data in the frequency domain, we investigated the possible alteration of power spectral density (PSD) of low-frequency fluctuation in brain regions associated with central pain processing in patients with FM. rsfMRI data were obtained from 19 patients with FM and 20 age-matched healthy female control subjects. For each subject, the PSDs for each brain region identified from functional connectivity maps were computed for the frequency band of 0.01 to 0.25Hz. For each group, the average PSD was determined for each brain region and a 2-sample t test was performed to determine the difference in power between the two groups. According to the results, patients with FM exhibited significantly increased frequency power in the primary somatosensory cortex (S1), supplementary motor area (SMA), dorsolateral prefrontal cortex, and amygdale. In patients with FM, the increase in PSD did not show an association with depression or anxiety. Therefore, our findings of atypical increased frequency power during the resting state in pain-related brain regions may implicate the enhanced resting-state baseline neural activity in several brain regions associated with pain processing in FM."

Kim MH, Nahm FS, Kim TK et al. 2013. Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty: clinical evidence of enhanced pain sensitivity following surgical injury. Pain. [Aug 29 Epub ahead of print]. "Staged bilateral total knee arthroplasty (TKA) may provide an ideal clinical model for the study of central sensitization. In staged TKA, hyperalgesia may be induced due to repeated surgical injury possibly via central sensitization, which can decrease functional outcomes. Therefore, we hypothesized that in staged bilateral TKA, patients would have greater pain in the second operated knee than in the first." This study confirmed that hypothesis. "…patients undergoing staged bilateral TKA suffer greater postoperative pain in the second operated knee than the first. This suggests extension of hyperalgesia beyond the initially injured site to remote regions following surgical injury, in which central sensitization may be involved. Therapeutic approaches to reduce such hyperalgesia induced in the course of staged operations are required."

Kim, J. Y. L. A. Nolte, P. A. Hansen, D. H. Hanm, K. Kawanaka and J. O. Holloszy. 1999. Insulin resistance of muscle glucose transport in male and female rats fed a high-sucrose diet. Am J Physiol 276(3 Pt 2): R665-R672.

Kim PS. 2002. Role of injection therapy: review of indications for trigger point injections, regional blocks, facet joint injections, and intra-articular injections. Curr Opin Rheumatol Jan;14(1):52-7. Multidiciplinary therapies for many chronic pain patients may often include injection therapies as part of effective pain management.

Kim SA, Oh KY, Choi WH et al. 2013. Ischemic compression after trigger point injection affect the treatment of myofascial trigger points. Ann Rehabil Med. 37(4):541-546. This team from Soonchunhyang University College of Medicine in Korea divided 60 patients with active TrPs into 3 groups. Group 1 received trigger point injections only, group 2 received TrP injections with 30 seconds of ischemic compression and group 3 received the TrP injections with 60 seconds of ischemic compression. Significant improvement was found in all groups, although the groups receiving the additional ischemic compression had more improvement, no matter the time of compression. "This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point."

Kim SC, Landon JE, Solomon DH. 2013. Clinical characteristics and medication uses among fibromyalgia patients newly prescribed amitriptyline, duloxetine, gabapentin or pregabalin. Arthritis Care Res (Hoboken). [Jul 16 Epub ahead of print]. "Fibromyalgia is a common chronic pain disorder with unclear etiology. No definitive treatment is available for fibromyalgia and treatment with antidepressants or antiepileptics is often used for symptom management …. Back pain was the most frequent comorbidity in all four groups (48%-64%) and hypertension, headache, depression, and sleep disorder were also common. Median daily dose at the start of follow-up was 25mg for amitriptyline, 60mg for duloxetine, 300mg for gabapentin, and 75mg for pregabalin and more than 60% of patients remained on the same dose throughout the follow-up period. Only one fifth of patients continued the treatment started for at least one year. The mean number of different prescription drugs at baseline ranged from 8 to 10 across the groups. More than a half of patients used opioids and a third used benzodiazepines, sleep disorder drugs and muscle relaxants….Patients who started one of the four common drugs for fibromyalgia similarly had multiple comorbidities and other fibromyalgia-related drug use, but continued the treatment only for a short time. The dose of the four drugs was not increased in most patients during the follow-up."

Kim SH. 2007.  Skin biopsy findings: implications for the pathophysiology of fibromyalgia.  Med Hypotheses [Jan 8 Epub ahead of print]  Skin abnormalities in FMS patients may be significant.

Kim SH, Jang TJ, Moon IS. 2006.  Increased expression of N-Methyl-D-Aspartate Receptor Subunit 2D in the skin of patients with fibromyalgia.  J Rheumatol. 33(4):785-788.  “The increased expression of NMDAR found in FM skin could be indicative of a more generalized increase in other peripheral nerves.  This suggests that NR2D-selective antagonists may have implications in the treatment of allodynia in patients with FM.”

Kim SH, Kim DH, Yoon KB et al. 2013. Clinical effectiveness of the obturator externus muscle injection in chronic pelvic pain patients. Nov 5. [Epub ahead of print]. Obturator externus injection, in this study of 23 patients fluoroscopy-guided, reduced symptoms greatly, and may be "…a valuable therpeutic option for a select group of chronic pelvic patients who present with localized tenderness in the OE muscle that is accompanied by groin, antromedial thigh, or hip pain."

Kim SH, Kim SH, Kim SK et al. 2011. Spatial versus verbal memory impairments in patients with fibromyalgia. Rheumatol Int. [Jan 19 Epub ahead of print]. "Mounting evidence suggests that individuals with fibromyalgia (FM) have impairments in general cognitive functions. However, few studies have explored the possibility of dissociation between verbal and visulospatial memory impairments in FM. Therefore, the purpose of this study was to investigate the asymmetrical impairment of cognitive functions between verbal and visulospatial memory and between short-term and long-term memory. Neuropsychological assessments were carried out on 23 female patients with FM and 24 healthy female controls....These findings suggest that spatial memory abilities may be more impaired than verbal memory abilities in patients with FM." [This agrees with what I have observed and experienced. DJS]

Kim SH, Moon IS, Park IS. 2013. Unique hippocampal changes and allodynia in a model of chronic stress. J Korean Med Sci. 28(6):946-950. Chronic stress may bring about central sensitization and hippocampal changes in rats.

Kim SH, Won SJ, Mao XO et al. 2005.  Molecular mechanisms of cannabinoid protection from neuronal excitotoxicity.  Mol Pharmacol. [Nov 18 Epub ahead of print].  “Cannabinoids appear to protect neurons against NMDA toxicity at least partly by activation of CB1R and downstream inhibition of PKA signaling and NO generation.”

Kim SK, Kim SH, Lee CK et al. 2012. Effect of fibromyalgia syndrome on the health-related quality of life and economic burden in Korea. Rheumatology (Oxford). [Sep 28 Epub ahead of print]. "Patients with FMS experience a decline in their HRQOL and constitute a significant economic burden on health-service utilization. The improvement in health-related costs and HRQOL after a diagnosis of FMS demonstrates a need for early diagnosis and treatment of FMS to reduce costs and enhance HRQOL."

Kim Y, Kim J, Shim JK et al. 2014. The hypoalgesic effect of remote tactile sensory modulation on the mechanical sensitivity of trigger points: A randomized controlled study. Neuro Rehabilitation. [Sep 23 Epub ahead of print.] "MTrP sensitivity is more strongly affected by interventions at remote ipsilateral sites in the same spinal segment than by stimulation of extra-segmental sites."

Kim Y, Yang HR, Lee JW et al. 2014. Effects of the high-power pain threshold ultrasound technique in the elderly with latent myofascial trigger points: a double-blind randomized study. J Back Musculoskelet Rehabil. 27(1):17-23. "The high-power pain threshold ultrasound (HPPTUS) technique has been introduced as a novel treatment method in patients with myofascial trigger points (MTrPs)…. The results indicate that the HPPTUS technique in same manner as treatment of active MTrPs is not superior to the conventional ultrasound technique in the treatment of the elderly patients with the latent MTrPs."

Kim YS. 2011. Why should gastroenterologists know about fibromyalgia? Common pathogenesis and clinical implications. J Neurogastroenterol Motil. 17(1):1-3.

Kimmelberg H.K., Zhou M. 2002.  Hippocampal astrocytes show heterogeneity of swelling activated anion currents.  Glia (Suppl 1):S55 [Abstract]. 

Kindler LL, Bennett RM, Jones KD. 2011. Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs. 12(1):15-24. "'Central sensitivity syndromes' denotes an emerging nomenclature that could be embraced by researchers investigating each of these disorders. Moreover, a shared paradigm would be useful in promoting cross-fertilization between researchers. Scientists and clinicians could most effectively forward the understanding and treatment of fibromyalgia and other common chronic pain disorders through an appreciation of their shared pathophysiology."

King, D. E. and B. Bushwick.  1994.  Beliefs and attitudes of hospital inpatients about faith healing and prayer.  J Fam Pract 39(4):349-52.

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Kinsley, C. H.., L. Madonia, G. W. Gifford, K. Tureski, G. R. Griffin, C. Lowry, J. Williams, J. Collins, H. McLearie and K. G. Lambert. 1999. Motherhood improves learning and memory. Nature 402(6758):137-8. 

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Kirchheiner J, Brockmoller J. 2005.  Clinical consequences of cytochrome P450 2C9 polymorphisms.  Clin Pharmacol Ther. 77(1):1-16.   This is a good review of the current knowledge of the effects of genetic variations on drug metabolism.   Phenotyping has potential use indicating both potential drug effectiveness and potential toxicity, but the knowledge needs to be developed.

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Kiser RS, Cohen HM, Freedenfeld RN et al. 2001.  Olanzapine for the treatment of fibromyalgia symptoms.  J Pain Symptom Manage 22(2):704-708.  This is a potential medication for FMS with few serious side effects found thus far.

Kishi A, Natelson BH, Togo F et al. 2011. Sleep-stage dynamics in patients with chronic fatigue syndrome with or without fibromyalgia. SLEEP 34(11):1551-1560. Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are medically unexplained conditions that often have overlapping symptoms, including sleep-related complaints. However, differences between the 2 conditions have been reported, and we hypothesized that dynamic aspects of sleep would be different in the 2 groups of patients....We studied transition probabilities and rates between sleep stages (waking, rapid eye movement [REM] sleep, stage 1 [S1], stage 2 [S2], and slow-wave sleep [SWS]) and duration distributions of each sleep stage. We found that the probability of transition from REM sleep to waking was significantly greater in subjects with CFS alone than in control subjects, which may be the specific sleep problem for people with CFS alone. Probabilities of (a) transitions from waking, REM sleep, and S1 to S2 and (b) those from SWS to waking and S1 were significantly greater in subjects with CFS+FM than in control subjects; in addition, rates of these transitions were also significantly increased in subjects with CFS+FM. Result (a) might indicate increased sleep pressure in subjects with CFS+FM whereas result (b) may be the specific sleep problem of subjects with CFS+FM. We also found that shorter durations of S2 sleep are specific to patients with CFS+FM, not to CFS alone....These results suggest that CFS and FM may be different illnesses associated with different problems of sleep regulation."

Kishi A, Natelson BH, Togo F et al. 2010. Sleep stage transitions in chronic fatigue syndrome patients with or without fibromyalgia. Conf Proc IEEE Eng Med Biol Soc. 1:5391-5394. "Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are medically unexplained conditions that share considerable overlapping symptoms, including sleep-related complaints. However, differences between the two conditions have been reported, and we hypothesized that dynamic aspects of sleep, recently attracting scientific interests, would be different in the two groups of patients. We thus study transition probabilities between sleep stages of CFS patients with or without FM. Subjects were 26 healthy controls, 14 CFS patients without FM (CFS alone) and 12 CFS patients with FM (CFS+FM) - all women. We studied transition probabilities between sleep stages (waking, REM sleep and Stage I, Stage II and slow-wave sleep (Stage III+IV)). We found that probabilities of transition from REM sleep to waking were significantly greater in CFS alone than in controls; we have reported previously this sleep disruption as the specific sleep problem for CFS alone [Kishi et al., 2008]. Probabilities of transitions from waking, REM sleep and Stage I to Stage II, and those from slow-wave sleep to Stage I, were significantly greater in CFS+FM than in controls; the former might indicate increased sleep pressure in CFS+FM and the latter may be the specific sleep problem of CFS+FM. These results suggest that CFS and FM are different illnesses associated with different problems of sleep regulation."

Kitagawa Y, Kimura K, Yoshida S. 2014. Spectral analysis of heart rate variability during trigger point acupuncture. Acupunct Med. [Mar 7 Epub ahead of print.] "These data suggest that acupuncture stimulation of trigger points of the tibialis anterior muscle transiently increases parasympathetic nerve activity." [This study may indicate that trigger point bodywork can be helpful to rebalance the sympathetic imbalance in fibromyalgia. DJS]

Kitahara M, Kojima K, Hanada M et al. 2009.  [Effectiveness of oral tramadol hydrochloride for chronic non-malignant pain]  Masui. 58(8):971-975. [Japanese]  “Tramadol is a useful option to treat non-malignant chronic pain, especially considering its very low abuse potential and a more acceptable side effect profile compared to non-steroidal anti-inflammatory drugs and opioids.”  [Sometimes there are formidable side effects that exclude use, and these may be delayed. DJS]

Kivimaki M, Leino-Arjas P, Kaila-Kangas L et al. 2006.  Increased sickness absence among employees with fibromyalgia.  Ann Rheum Dis June 22 [Epub ahead of print].  “FM is associated with a substantially increased risk of medically certified sickness absence...”

Klaver-Krol EG, Rasker JJ, Henriquez NR. 2012. Muscle fiber velocity and electromyographic signs of fatigue in fibromyalgia. Muscle Nerve. 46(5):738-745. "We investigated possible differences in surface electromyography (sEMG) in clinically unaffected muscle between patients with FM and controls....sEMG was performed on the biceps brachii muscle of 13 women with FM and 14 matched healthy controls during prolonged dynamic exercises, unloaded, and loaded up to 20% of maximum voluntary contraction. The sEMG parameters were: muscle fiber conduction velocity (CV); skewness of motor unit potential (peak) velocities; peak frequency (PF) (number of peaks per second); and average rectified voltage (ARV). Results: There was significantly higher CV in the FM group. Although the FM group performed the tests equally well, their electromyographic fatigue was significantly less expressed compared with controls (in CV, PF, and ARV)....In the patients with FM, we clearly showed functional abnormalities of the muscle membrane, which led to high conduction velocity and resistance to fatigue in electromyography. [It would be very interesting to check these patients for co-existing myofascial trigger points in those muscles. The unsuspected TrPs could be the actual cause of the symptoms noted. DJS]

Klaver-Krol EG, Zwarts MJ, Ten Klooster PM et al. 2012. Abnormal muscle membrane function in fibromyalgia patients and its relationship to the number of tender points. Clin Exp Rheumatol. [Nov 22 Epub ahead of print]. "Fibromyalgia (FM) is a disorder characterized by chronic widespread pain in soft tissues, especially in muscles. Previous research has demonstrated a higher muscle fibre conduction velocity (CV) in painful muscles of FM patients. The primary goal of this study was to investigate whether there is also a difference in CV in non-painful, non-tender point (TP) related muscles between FM patients and controls. The secondary goal was to explore associations between the CV, the number of TPs and the complaints in FM....The results demonstrate abnormally high muscle membrane conduction velocity in FM, even in non-TP muscles. In addition, a relationship has been found between the high membrane velocity and the number of TPs. [These authors considered tender points and trigger points to be the same. DJS]

Kleier DJ. 1985.  Referred pain from a myofascial trigger point mimicking pain of endodontic origin.  J Endod. 11(9):408-411.  [Many a healthy tooth has been mishandled due to TrPs that can refer pain and sensitivity to the teeth.  Dentists must learn myofascial pain to avoid harming patients. DJS]

Klein, R., and P. A. Berg. 1995. High incidence of antibodies 5-hydroxytryptamine, gangliosides, and phospholipids in patients with chronic fatigue and fibromyalgia syndrome and their relatives: evidence for a clinical entity of both disorders. Eur J Med Res 1(1):21-6.

Klein, R. , M. Bansch and P. A. Berg. 1992. Clinical relevance of antibodies against serotonin and gangliosides in patients with primary fibromyalgia syndrome. Psychoneuroimmunology 17(6):593-8.

Kleinman N, Harnett J, Melkonian A et al 2009.  Burden of fibromyalgia and comparisons with osteoarthritis in the workforce.  J Occup Environ Med. [Nov 25 Epub ahead of print]  “FM places a significant cost, absence, and productivity burden on employers.”   [The conclusion of this report is that: “FM places a significant cost, absence, and productivity burden on employers.”  It also shows that the cost is not as high as osteoarthritis, but this is not stated in the conclusion.  What the study does not take into account is the cost to the employees due to the failure of employers to accommodate the employees, and the failure of the medical profession to promptly diagnose and treat the FM and accompanying CMP and other co-existing conditions.  Jobs themselves are frequently prime perpetuating factors of TrPs, just as TrPs are prime perpetuating factors of FM.  (see: Ge HY, Wang Y, Danneskiold-Samsoe B et al. 2009.)  Most jobs can be changed to accommodate the worker without greatly increasing the cost, at the same time greatly increasing productivity and lessening absence.  The pain must be brought under control and the conditions diagnosed and treated.


Klekner A, Felszeghy S, Tammi R et al. 2005.  Quantitative determination of hyaluronan content in cerebral aneurysms by digital densitometry.  Zentralbl Neurochir. 66(4):207-212.  “Results suggest that an elevated hyaluronan level in the extracellular matrix may affect the cerebral arterial wall architecture.  It is reasonable to suppose that the increased hyaluronan content creates a viscoelastic ECM which might improve the biomechanical resistance of the thinned vessel wall.”  [This seemingly unrelated piece of research may provide clues to the higher viscosity of the extracellular matrix of a subset of patients with both FMS and CMP, especially in relation to the geloid mass.  DJS]

Knadler MP, Lobo E, Chappell J et al. 2011. Duloxetine: Clinical Pharmacokinetics and Drug Interactions. Clin Pharmacokinet. [Mar 2 Epub ahead of print]. "Pharmacokinetic results from drug interaction studies show that activated charcoal decreases duloxetine exposure, and that CYP1A2 inhibition increases duloxetine exposure to a clinically significant degree..... The exposure of duloxetine with CYP2D6 inhibitors or in CYP2D6 poor metabolizers is increased to a lesser extent than that observed with CYP1A2 inhibition and does not require a dose adjustment. In addition, duloxetine increases the exposure of drugs that are metabolized by CYP2D6, but not CYP1A2. Pharmacodynamic study results indicate that duloxetine may enhance the effects of benzodiazepines, but not alcohol or warfarin. An increase in gastric pH produced by histamine H(2)-receptor antagonists or antacids did not impact the absorption of is important to be knowledgeable about the potential for pharmacokinetic interactions between duloxetine and drugs that inhibit CYP1A2 or drugs that are metabolized by CYP2D6 enzymes." [Note: This study was done in connection with Eli Lilly and Company. DJS]

Knardahl, S., M. Elam, B. Olausson and B. G. Wallin.  1998.  Sympathetic nerve activity after acupuncture in humans.   Pain 75(1):19-25.

Knobler, H. A. Schattner, T. Zhornicki, S. D. Malnick, D. Keter, N. Sokolovskaya, Y. Lurie and D. D. Bass. 1999. Fatty liver-and additional and treatable feature of the insulin resistance syndrome. QMJ 9(2):73-9.

Knockaert DC, D’Heygere FG, Bobbaers HJ. 1989.  Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain.  Postgrad Med J. 65(767):632-635.  “The ilioinguinal nerve entrapment syndrome is an abdominal muscular pain syndrome, characterized by the clinical triad of muscular type iliac fossa pain with a characteristic radiation pattern, an altered sensory perception in the ilioinguinal nerve cutaneous innervation area, and a well-circumscribed trigger point medial and below the anterosuperior iliac spine.  Relief of pain by infiltration of a local anaesthetic confirms the diagnosis.  This report describes retrospectively the clinical picture of ilioinguinal nerve entrapment in 32 mainly non-surgical patients.  In 14 cases a definite diagnosis was established and in 18 patients the diagnosis was considered probable.  The mean delay in diagnosis was 12.8 months. Better knowledge of this syndrome may avoid invasive investigations and be cost saving.”

Knoll, R, Hoshijima, M, Chien, K. 2003.  Cardiac mechanotransduction and implications for heart disease.  Oct 9 [Epub ahead of print.]  This article concerns mechanotransduction, which includes the translation of mechanoreception to proprioception.  The authors ask some interesting questions concerning conversion of stimuli to electrochemical signaling and cover recent research in cardiac cytoskeleton structure.  Fascia is everywhere, and my heart tells me that the authors should be aware of myofascial medicine and the possible permutations that may be involved.

Ko GD, Nowacki NB, Arseneau L et al. 2010. Omega-3 fatty acids for neuropathic pain: case series. Clin J Pain. 26(2):168-172.  “Objective: The aim of this case series study was to investigate and report on patients with neuropathic pain who responded to treatment with omega-3 fatty acids. Methods: Five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, burn injury were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA). This first-ever reported case series suggests that omega-3 fatty acids may be of benefit in the management of patients with neuropathic pain.”    

Kobesova A, Lewit K. 2000.  A case of a pathogenic active scar.  Australas Chiropr Osteopathy. 9(1):17-19.  Scars are like icebergs.  Their surface is only a small indication of the amount of disruption that they can be causing.  The example is an appendectomy scar in a person with abdominal and low back pain.  Extensive and expensive testing remained negative, and the pain persisted.  When the scar was treated with barrier release mobilizing the tissue and treating related TrPs, the symptoms were relieved.

Kobesova A, Morris CE, Lewit K et al. 2007. Twenty-year-old pathogenic “active” postsurgical scar: a case study of a patient with persistent right lower quadrant pain.  J Manipulative Physiol Ther. 30(3):234-238.  Even after decades without adequate diagnosis and treatment, trigger points in scar tissue may be effectively treated with tissue mobilization.  [This gives pain patients hope, but also leads one to wonder how many people are living with unnecessary pain. DJS]

Koca I, Tutoglu A, Boyacı A. 2014. An evaluation of oxidative stress and antioxidant capacity in patients with myofascial pain syndrome. Mod Rheumatol. [Mar 26 Epub ahead of print.] "The results of this study determined that the oxidant/antioxidant balance was impaired in MPS patients and thus MPS can be considered to be related to an increase in oxidative stress."

Koca I, Tutoglu A, Boyacı A et al. 2013. A comparison of the effectiveness of low-, moderate- and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome. Mod Rheumatol. [Dec 11 Epub ahead of print.] "This study aimed to compare and evaluate the effects of ultrasound (US) treatment applied at low-, medium- and high-power-pain threshold (HPPT) doses to trigger points in the treatment of myofascial pain syndrome (MPS). Methods: The study comprised 61 (40 female and 21 male) patients diagnosed with MPS, aged between 18 and 60 years. The patients were randomly allocated to three groups for the US application at different dosages. Group I patients received treatment of medium-dose US (1.5 Watt/cm2), Group II received HPPT US, and Group III received low-dose US (0.5 W/cm2). The patients were evaluated pre-treatment and 3 weeks after treatment in respect of visual analogue scale (VAS) scores, number of trigger points (NTP), pressure pain threshold (PPT), Range of Tragus-Acromioclavicular joint (RT-AJ) and neck pain disability scores (NPDS). Results: A significant improvement was determined after treatment in all scores except PPT in Group I, in all scores in Group II, and only in the VAS score in Group III. When the groups were compared post-treatment in respect of improvement in NTP, VAS, RT-AJ and NPDS scores, Group II showed significant superiority over Group I, and Group I was determined to have significant superiority over Group III in respect of VAS, RT-AJ and NPDS scores (p < 0.05).… In the treatment of MPS, US therapy at HPPT dose can be considered as an alternative therapy method, which is more economical and more effective than low-dose and conventional US therapy."

Koch, K. L.  1999.  Illusory self-motion and motion sickness: a model for brain-gut interactions and nausea.  Dig Dis Sci 44(8 Suppl):53S-57S.

Kodama Y, Seo K, Hayashi T et al. 2012. Orofacial pain related to traumatic neuroma in a patient with multiple TMJ operations. Cranio. 30(3):183-187. "The diagnosis of orofacial pain associated with temporomandibular disorders after repeated temporomandibular joint (TMJ) surgeries can be quite difficult. This case report describes a 52-year-old woman who had previously undergone five TMJ surgeries and developed divergent pain caused by a trigger point in the left preauricular area. Computed tomography and magnetic resonance imaging could not be used to identify a lesion because of metallic artifacts from a TMJ prosthesis. However, sonography indicated the location of the suspected lesion. Moreover, a neurological examination performed with local anesthesia was clinically effective in ruling out other diagnoses of orofacial pain. Ultimately, a histopathological examination of a biopsy specimen from the painful site confirmed the lesion to be a traumatic neuroma. This case report suggests the value of including traumatic neuroma in the differential diagnosis of patients with a history of previous TMJ surgery who present with orofacial pain in the region of the TMJ."

Koelback Johnson, M., T. Graven Nielsen, A. Schou Olesen and L. Arendt-Nielsen. 1999. Generalized muscular hyperalgesia in chronic whiplash syndrome. Pain 83(2):229-234.

Koenig, H. G., J. C. Hays, D. B. Larson, L. K. George, H. J. Cohen, M. E. McCullough, K. G. Meador and D. G. Blazer.  1999.  Does religious attendance prolong survival?  A six-year follow-up study of 3,968 older adults.  J Gerontol A Biol Sci Med Sci 54(7):M370-6.  

Koenig, H. G., L. K. George and B. L. Peterson.  1998.  Religiosity and remission of depression in medically ill older patients.  Am J Psychiatry 155(4):536-542.  

Koenig, H. G., H. J. Cohen, L. K. George, J. C. Hays, D. B. Larson and D. G. Blazer.  1997. Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults.  Int J Psychiatry Med 27(3):233-50.

Koenig M, Cathebras P, Guy C et al. 2005.  [Pentoxiphylline: a cheap substitute for anti-TNFalpha agents?]  Rev Med Interne. [Nov 8 Epub ahead of print] [French]   [This medication may be a useful agent for use in chronic pain states. DJS]

Kofler M, Halder W. 2013. Alterations in excitatory and inhibitory brainstem interneuronal circuits in fibromyalgia: Evidence of brainstem dysfunction. Clin Neurophysiol. [Sept 21 Epub ahead of print]. In this small study—10 women with fibromyalgia and 26 healthy controls—found the blink reflex to be the same in FM patients and healthy controls. The blink reflex excitability recovery was enhanced in FM, and the blink reflex prepulse inhibition reduced. This is suggestive of brainstem functional changes in FM patients. Reduced blink reflex prepulse inhibition is common in patients with altered sensory gating, suggesting that FM patients have dysfunctional ability to filter stimuli. This can lead to sensory overload.

Kojima C, Fujishima I, Ohkuma R et al. 2002.  Jaw opening and swallow triggering method for bilateral-brain-damaged patients: K-point stimulation.  Dysphagia. 17(4):273-277.  “The trigger point lies on the mucosa lateral to the palatoglossal arch and medial to the pterygomandibular fold at the height of the postretromolar pad.”  “Stimulating the trigger point was useful for opening the mouth and facilitating swallowing in pseudobulbar palsy patients and that this technique may be of help in these patients in terms of oral health care and feeding.”

Kohnen R, Farber L, Spath M. 2004.  The assessment of vegetative and functional symptoms in fibromyalgia patients: the tropisetron experience.  Scand J Rheumatol Suppl. (119):67-71.  Tropisetron, in general, helped sleep dysfunction but worsened gastrointestinal function in these FMS patients.

Kohlmann T. 2003.  [Musculoskeletal pain in the population] [German]  Schmerz. 17(6):405-411.  This review indicates that about 16% of the German population has severe musculoskeletal pain.

Kojic Z, Stojanovic D. 2013. Pathophysiology of migraine--from molecular to personalized medicine. Med Pregl. 66(1-2):53-57. "Understanding of migraine pathophysiology has substantially improved over the last two decades. As a result, migraine is now mainly considered to be a disorder of the brain, rather than one of the vasculature or the meninges....Although it remains speculative how exactly they relate to each other, the following three processes are important in migraine: 1. Cortical spreading depression is a wave of intense depolarization, it starts in the occipital lobe, propagates through the brain and is followed by a period of suppressed activity. 2. Activation of the trigemonovascular system causes the release of neuropeptides (e.g. calcitonin gene-related peptide, substance P) from the peripheral trigeminal nerve endings. These neuropeptides are thought to play a role in causing and maintaining headache. 3. Sensitization of peripheral and central brain areas, it is thought that pulsating quality of migraine headache is caused by a process of peripheral sensitization. Cutaneous allodynia is a marker of central sensitization....The view that the aura is caused by cortical spreading depression has become generally accepted, and the same is true for the view that activation of the trigemonovascular system underlies migraine headache. However, the relationship between the aura and the activation of the trigemonovascular system and the start of headache remains elusive....One of the most important aspects of the pathophysiology of migraine is the hereditary nature of the disorder....Identification of polymorphisms and genetic biomarkers should help us to understand migraine pathophysiology better and thus enable the development of specific, effective 'individually-tailored treatment' for each particular migraine patient (personalized medicine)."

Kolar P, Sulc J, Kynci M et al. 2010. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol. 109(4):1064-1071. "Significant involvement of the diaphragm in the limb postural activities was found." [The implications are that contractured muscles due to myofascial TrPs can significantly impair breathing. DJS]

Kolbinson, D. A. , J. B. Epstein, A. Senthilselvan and J. A. Burgess. 1998. Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod  85(6):665-73.  

Kole AK, Roy R, Kole DC. 2013. Musculoskeletal and rheumatological disorders in HIV infection: Experience in a tertiary referral center. Indian J Sex Transm Dis. 34(2):107-112. "Musculoskeletal involvement was common in HIV patients causing increased morbidity, so early detection and timely intervention is essential to improve quality of life."

Komaroff, A. L. and D. S. Buchwald.  1998.  Chronic fatigue syndrome: an update.  Annu Rev Med 49:1-13.  

Komiyama, O., M. Kawara, M. Arai, T. Asano and K. Kobayashi.  1999.  Posture correction as part of behavioral therapy in treatment of myofascial pain with limited opening.  J Oral Rehabil26(5):428-35.

Konczak J, Abbruzzese G. 2013. Focal dystonia in musicians: linking motor symptoms to somatosensory dysfunction. Front Hum Neurosci. 7:297. "Musician's dystonia (MD) is a neurological motor disorder characterized by involuntary contractions of those muscles involved in the play of a musical instrument. It is task-specific and initially only impairs the voluntary control of highly practiced musical motor skills. MD can lead to a severe decrement in a musician's ability to perform. While the etiology and the neurological pathomechanism of the disease remain unknown, it is known that MD like others forms of focal dystonia is associated with somatosensory deficits, specifically a decreased precision of tactile and proprioceptive perception. The sensory component of the disease becomes also evident by the patients' use of "sensory tricks" such as touching dystonic muscles to alleviate motor symptoms. The central premise of this paper is that the motor symptoms of MD have a somatosensory origin and are not fully explained as a problem of motor execution. We outline how altered proprioceptive feedback ultimately leads to a loss of voluntary motor control and propose two scenarios that explain why sensory tricks are effective. They are effective, because the sensorimotor system either recruits neural resources normally involved in tactile-proprioceptive (sensory) integration, or utilizes a fully functioning motor efference copy mechanism to align experienced with expected sensory feedback. We argue that an enhanced understanding of how a primary sensory deficit interacts with mechanisms of sensorimotor integration in MD provides helpful insights for the design of more effective behavioral therapies. "[Myofascial trigger points can and do cause the symptoms here described, but are not mentioned in this study. DJS]

Kool MB, van Middendorp H, Boeije HR et al. 2009.  Understanding the lack of understanding: invalidation from the perspective of the patient with fibromyalgia. Arthritis Rheum. 61(12):1650-1656.  “Invalidation as perceived by patients with fibromyalgia includes active negative social responses (denying, lecturing, and overprotecting) as well as a lack of positive social responses (supporting and acknowledging) with respect to the patient and the condition of the patient.”  One of the key perpetuating factors of FM is the lack of support of spouse, other family members, co-workers or classmates and friends.  This can come in the form of patronizing, dismissing, and other types of abuse, and more research is needed on how this negative attitude affects people with invisible illnesses.  

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

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

Koolstra JH, van Eijden TM. 2005.  Combined finite-element and rigid-body analysis of human jaw joint dynamics.  J Biomech 38(12):2431-2439.  The (jaw) joint is subjected to loading which causes tensions and deformations in its cartilaginous structures.  These are assumed to be a major determinant for development, maintenance, and also degeneration of the joint...It was demonstrated that joint loads increase with muscle activation, irrespective of the external loads..”

Kop WJ, Lyden A, Berlin AA et al. 2005.  Ambulatory monitoring of physical activity and symptoms in fibromyalgia and chronic fatigue syndrome.  Arthritis Rheum. 52(1):296-303.  “Patients with FM and/or CFS engaged in less high-intensity physical activities than that recorded for sedentary control subjects.  This reduced peak activity was correlated with measures of poor physical function.  Activity levels appear to be contingent on, rather than predictive of, symptoms.”


Kopf A, Janson W, Stein C. 2003.  [Opioid therapy in chronic non-malignant pain] [German]  Anaesthesist. 52(2):103-114.  Therapeutic recommendations from the DGSS consensus conference include a validated indication for the use of opioids for chronic nonmalignant pain.


Koppert W. 2005.  [Opioid-induced analgesia and hyperalgesia]  Schmerz [Aug 12 Epub ahead of print] [German]  “Successful strategies that may decrease or prevent opioid-induced hyperalgesia include the concomitant administration of drugs such as NMDA antagonists, alpha(2)-agonists, or nonsteroidal anti-inflammatory drugs (NSAID), opioid rotation, or combinations of opioids with different receptor selectivity.”

Koppert W, Weigand M, Neumann F et al. 2004.  Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery.  Anesth Analg 98(4):1050-1055.

Koppert, W., S. Zeck, R. Sittl, R. Likar, R. Knoll and M. Schmelz. 1998. Low-dose lidocaine suppresses experimentally induced hyperalgesia in humans. Anesthesiology 89(6):1345-53. 

Koppert, W., P. W. Reeh and H. O. Handwerker. 1993. Conditioning of history mind by bradykinen alters responses of wrapped nociceptors and human itch sensation. Neurosci Lett 152(1-2):117-20.

Korakakis V, Giakas G. 2013. Spinal repositioning deficit. The effect of prolonged flexed posture. Br J Sports Med. 47(10):e3. "Flexed sitting posture is commonly adopted in daily sitting activities and when sustained has been proposed to affect biological properties of spinal tissues and act detrimentally on proprioception. The objective of this study by using an optoelectronic motion analysis system was to assess sitting posture regarding the head, spine and pelvis, in healthy individuals; the time effect of flexed posture (FSP) on proprioception and the impact of an MDT (Mechanical Diagnosis and Therapy) procedure on proprioceptive deficit. …Postural repositioning error showed significant differences for LU (lumbar) and HE (head) angles. The findings suggest that healthy individuals habitually sit in more flexed posture than SPOP (optimal sitting posture) and IOSP (instructed sitting posture). Postural education can be actualized in a reliable way and subjects can adopt an educated posture. Furthermore FSP (habitual sitting posture) challenged postural proprioception, but SOP increased proprioceptive accuracy." [Immobility in this flexed posture could activate myofascial trigger points, causing the effects noted here, but they were not mentioned. DJS]

Korneyev, A. Y.  1997.  The role of the hypothalamic-pituitary-adrenocortical axis in memory-related effects of anxiolytics.  Neurobiol Learn Mem 67(1):1-13.

Kornick CA, Santiago-Palma J, Moryl N et al. 2003.  Benefit-risk assessment of transdermal fentanyl for the treatment of chronic pain.  Drug Saf 26(13):951-973.  “Transdermal fentanyl is effective and well tolerated for the treatment of chronic pain caused by malignancy and non-malignant conditions when administered according to the manufacturer’s recommendations.  Compared with oral opioids, advantages of transdermal fentanyl include a lower incidence and impact of adverse effects (constipation, nausea and vomiting, and daytime drowsiness), higher degree of patient satisfaction, improved quality of life, improved convenience and compliance resulting from administration every 72 hours, and decreased use of rescue medication.”

Kornstein, S. G. 1998. Gender differences in depression: implications for treatment. J Clin Psychiatry 58 Suppl 15:12-8.

Korszun, A., L. Sackett-Lundeen, E. Papadopoulos, C. Brucksch, L. Masterson, N. C. Engelberg, E. Haus, M. A. Demitrack and L. Crofford.  1999.  Melatonin levels in women with fibromyalgia and chronic fatigue syndrome.  J Rheumatol 26(12):2675-80.

Kosek E, Altawil R, Kadetoff D et al. 2015. Evidence of different mediators of central inflammation in dysfunctional and inflammatory pain - Interleukin-8 in fibromyalgia and interleukin-1beta in rheumatoid arthritis. J Neuroimmunol. 280:49-55. "The purpose of this study was to relate central inflammation to autonomic activity (heart rate variability (HRV)) in patients with rheumatoid arthritis (RA) and fibromyalgia (FM)….we found different profiles of central cytokines, i.e., elevated IL-1beta in inflammatory pain (RA) and elevated IL-8 in dysfunctional pain (FM)." Free PMC Article

Kosek, E., J. Ekholm and P. Hansson. 1996.  “Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms.”  Pain 68 (2-3): 375-383.

Kosek E, Kadetoff D. 2010. Evidence of reduced sympatho-adrenal and hypothalamic-pituitary activity during static muscular work in patients with fibromyalgia. J Rehabil Med. 42(8):765-772. "Patients with fibromyalgia exhibited a hypoactive sympathoadrenal system as well as a hypo-reactive hypothalamic-pituitary axis during static exercise."

Kosharskyy B, Almonte W, Shaparin N et al. 2013. Intravenous infusions in chronic pain management. Pain Physician. 16(3):231-249. "In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. …This article will focus on non-opiate intravenous infusions (lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates) that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries."

Kosmidis ML, Koutsogeorgopoulou L, Alexopoulos H et al. 2014. Reduction of Intraepidermal Nerve Fiber Density (IENFD) in the skin biopsies of patients with fibromyalgia: A controlled study. J Neurol Sci. Sep 28. [Epub ahead of print] "This is one of the largest series of FM patients demonstrating a significant reduction of IENFD (Intraepidermal Nerve Fiber Density) in their skin biopsies. The findings indicate that in a subset of FM patients, the pain syndrome is, at least partially, of neuropathic origin. Skin biopsy may prove a useful tool and a potential biomarker in future studies of FM patients."

Kostopoulos D. 2007.  Reduction of spontaneous electrical activity and pain perception of trigger points in the upper trapezius muscle through trigger point compression and passive stretching.  J Musculoskel Pain 15 (Supp 13):27 item 44.  [Myopain 2007 Poster]  “Although each technique significantly reduced pain perception and SEA (spontaneous electrical activity) the combination of Ic (ischemic compression) and PS (passive stretching) was superior, apparently because of the complementary nature of the therapeutic interventions.”

Kotarinos R. 2012. Myofascial pelvic pain. Curr Pain Headache Rep. 16(5):433-438. "Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings."

Kotarinos RK. 2003.  Pelvic floor physical therapy in urogynecologic disorders.  Curr Womens Health Rep. 3(4):334-339.

Kothari DJ, Davis MC, Yeung EW et al. 2015. Positive affect and pain: mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia. Pain. 156(3):540-546. "Fibromyalgia (FM) is a chronic pain condition often resulting in functional impairments.... Results showed that pain and positive affect mediated the relation between sleep quality and activity interference. Early-morning reports of poor sleep quality last night predicted elevated levels of pain and lower levels of positive affect at late-morning, which, in turn, predicted elevated end-of-day activity interference. Of note, positive affect was a stronger mediator than pain and negative affect was not a significant mediator. In summary, the findings identify 2 parallel mechanisms, pain and positive affect, through which the prior night's sleep quality predicts disability the next day in patients with FM. Furthermore, results highlight the potential utility of boosting positive affect after a poor night's sleep as one means of preserving daily function in FM."

Kotter I, Neuscheler D, Gunaydin I et al. 2007.  Is there a predisposition for the development of autoimmune diseases in patients with fibromyalgia?  Retrospective analysis with long term follow-up.  Rheumatol Int. [Jul 20 Epub ahead of print].  “The risk of CTD (connective tissue disease) is not increased in FM.  The detection of ANA (antinuclear antibodies) does not predict the development of CTD.”

Kovacevic-Ristanovic, R., R. D. Cartwright and S. Lloyd.  1991.  Nonpharmacologic treatment of period leg movements in sleep.  Arch Phys Med Rehabil 72(6):385-9.

Kovacic K, Chelimsky TC, Sood MR. 2014. Joint Hypermobility: A Common Association with Complex Functional Gastrointestinal Disorders. J Pediatr. [Aug 20 Epub ahead of print.] Comorbid conditions were common, including sleep disturbances (77%), chronic fatigue (93%), dizziness (94%), migraines (94%), chronic nausea (93%), and fibromyalgia (24%)….JH (joint hypermobility) and other comorbid symptoms, including fibromyalgia, occur commonly in children and young adults with complex FGIDs (functional gastrointestinal disorders). POTS is prevalent in FGIDs but is not associated with hypermobility. We recommend screening patients with complex FGIDs for JH, fibromyalgia, and comorbid symptoms such as sleep disturbances, migraines, and autonomic dysfunction.

Kovacs, F. M., V. Abraira, F. Pozo, D. G. Kleinbaum, J. Beltran, I. Mateo, C. Perez de Ayala, A. Pena, A. Zea, M. Gonzalez-Lanza and L. Morillas.  1997.  Local and remote sustained trigger point therapy for exacerbations of chronic low back pain.  A randomized, double-blind, controlled, multicenter trial.  Spine 22(7):786-797.

Kraegen EW, Cooney GJ, Ye J, et al. 2001. Triglycerides, fatty acids and insulin resistance B hyperinsulinemia.  Exp Clin Enocrinol Diabetes 109(4):S516-26. "A key issue for development of insulin resistance is skeletal muscle.  At least some of the lipid accumulation is inside the muscle cell (myocyte).  Unless there is significant weight loss, short or medium term dietary manipulation does not alter insulin sensitivity.  Evidence is growing that excess muscle and liver lipid accumulation causes or exacerbates insulin resistance."

Krag, N. J. , J. Norregaard, J. K. Larsen, B. Danneskiold-Samsoe. 1994. A blinded, controlled evaluation of anxiety and depressive symptoms in patients with fibromyalgia, as measured by standardized psychometric interview scales. Acta Psychiatr Scand 89(6):370-5. 

Kramis, R. C., W. J. Roberts and R. G. Gillette. 1996. Non-nociceptive aspects of persistent musculoskeletal pain. J Orthop Sports Phys Ther 24(4):255-267.

Kratz AL, Davis MC, Zautra AJ. 2007.  Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients.  Ann Behav Med. 33(3):291-301.  “These findings suggest that pain patients with greater capacity to accept pain may be emotionally resilient in managing their condition.”

Kratz AL, Schilling S, Goesling J et al. 2015. Development and Initial Validation of a Brief Self-Report Measure of Cognitive Dysfunction in Fibromyalgia. J Pain. [Mar 4 Epub ahead of print.] "This paper presents the Multidimensional Inventory of Subjective Cognitive Impairment (MISCI), a 10-item measure of cognitive dysfunction in fibromyalgia, developed through classical test theory and item response theory. This brief but comprehensive measure shows evidence of excellent construct validity through large correlations with a lengthy legacy measure of cognitive functioning." [This important diagnostic list, coupled with the understanding brought to light by recent research that the cognitive impairments of FM do not lead to Alzheimer's, may bring peace of mind to many FM patients. DJS]

Kraus, H. and A. A. Fischer.  1991.  Diagnosis and treatment of myofascial pain.  Mt Sinai J Med58(3):235-9

Krause, K-H, J. Krause, I. Magyarosy, E. Ernst and D. Pongratz. 1998. Fibromyalgia syndrome and attention deficit hyperactivity disorder: is there a co morbidity and are their consequences for the therapy of fibromyalgia syndrome. J Musculoskel Pain 6(4): 111-116.

Kravitz HM, Esty ML, Karz RS et al. 2006.  Treatment of fibromyalgia syndrome using low-intensity neurofeedback with the Flexyx Neurotherapy System: A randomized controlled clinical trial.  J Neurother 10(2/3):41-46.

Kravitz HM, Katz RS. 2015. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int. [Jan 13 Epub ahead of print.] "Patients with fibromyalgia often report forgetfulness as well as declines in cognitive function, memory, and mental alertness-symptoms that have been termed 'fibrofog' in popular and electronic media as well as in professional literature. 'Fibrofog' is the subjectively experienced cognitive dysfunction associated with fibromyalgia and is a clinically important yet comparatively less well-studied aspect of the disorder; it includes loss of mental clarity (mental fogginess) as well as attention and memory impairment. Although until recently cognitive symptoms have been largely ignored, these symptoms can be more disturbing than the widespread pain and can change these patients' lives, sometimes dramatically so. Whereas widespread musculoskeletal pain, tenderness, and fatigue may be the hallmark symptoms of fibromyalgia, patients rank cognitive dysfunction highly in terms of disease impact. This review addresses (1) the prevalence of self-reported cognitive disturbances in fibromyalgia, (2) the clinical presentation of fibrofog, (3) neuropsychological test performance, with particular attention to discrepancies between self-report and test results, (3) clinical correlates of impaired cognitive function in fibromyalgia, (4) neurobiology relevant to cognitive disturbances in fibromyalgia, and (5) clinical management of fibrofog. Although the pathophysiology of fibromyalgia remains an enigma, evidence suggests that it may be a brain disorder, with cognitive deficits ('fibrofog') reflecting disturbed centrally mediated processes."

Kreczy, A., M. Kofler and A. Gschwendtner. 1999.  Underestimated health hazard: proposal for an ergonomic microscope workstation.  Lancet 354:1701-1702.

Krishman SK, Benzon HT, Siddiqui T et al. 2000.  Pain on intramuscular injection of bupivacaine, ropivacaine, with and without dexamethasone.  Reg Anesth Pain Med 25(6):615-619.  “The pain on intramuscular injection of bupivacaine is significantly more intense than with ropivacaine.”  Yet another study documenting that Marcaine is not acceptable for TrP injections.


Krishnaswamy G, Ajitawi O, Chi DS. 2005.  The human mast cell: an overview.  Methods Mol Biol. 315:13-34.  “Mast cells may be capable of regulating inflammation, host defense, and innate immunity.  After activation, mast cells express histamine, leukotrienes, and prostanoids, as well as proteases, and many cytokines and chemokines.  These mediators may be pivotal to the genesis of an inflammatory response.  By virtue of their location and mediator expression, mast cells may play an active role in many diseases.  Recent data also suggest that mast cells play a vital role in host defense against pathogens by elaboration of tumor necrosis factor alpha.  Mast cells also express the Toll-like receptor, which may further accentuate their role in the immune-inflammatory response.”

Kroboth, P. D., F. S. Salek, A. L. Pittenger, T. J. Fabian and R. F. Frye.  1999.  DHEA and DHEA-S: a review.  J Clin Pharmacol 39(4):327-48.

Kross E, Berman MG, Mischel W et al. 2011. Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci USA [Mar 28 Epub ahead of print]. "These results give new meaning to the idea that rejection 'hurts'. They demonstrate that rejection and physical pain are similar not only in that they are both distressing – they share a common somatosensory representation as well."[This may be how emotional pain contributes to central pain states such as fibromyalgia. DJS]

Kruger, L. R., W. J. Van Der Linden and P. E. Cleaton-Jones.  1998.  Transcutaneous electrical nerve stimulation in the treatment or myofascial pain dysfunction.  S Afr J Surg 36(1):35-38.

Kruse RA Jr, Christiansen JA. 1992.  Thermographic imaging of myofascial trigger points: a follow-up study.  Arch Phys Med Rehabil. 73(9):819-823.  “Asymmetric thermal patterns were observed at all trigger points in the sensory referral area and distal to the referred area before compression.  The thermal referral areas showed a reduction in temperature from precompression levels during compression.  When similar but asymptomatic areas were compressed, no significant changes in temperature were noted at distal sites.”  

Kuan LC, Li YT, Chen FM et al. 2006.  Efficacy of treating abdominal wall pain by local injection.  Taiwan J Obstet Gynecol. 45(3):239-243.  “Local injection for selective abdominal wall pain patients produces significant pain relief.  The diagnosis of abdominal wall pain is an important component in avoiding unnecessary operations in patients with abdominal pain.”

Kuan TS. 2009.  Current studies on myofascial pain syndrome.  Curr Pain Headache Rep. 13(5):365-369.

Kuan TS, Chen JT, Chen SM, Chien CH, Hong CZ. 2002. Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle.  Am J Phys Med Rehabil 81(7):512-20.  This study confirms the association of excess acetylcholine in the motor endplates as part of the pathogenesis of myofascial trigger points.

Kuan TS, Hong CZ, Chen JT et al. 2007.  The spinal cord connections of the myofascial trigger spots.  Eur J Pain 11(6):624-634.  “Background: Recent electrophysiological studies revealed that endplate noise (EPN) could be specifically recorded from a myofascial trigger point (MTrP) region.  EPN has been considered as the focal graded potentials due to excessive acetycholine release in neuromuscular junction.”  “The spinal cord connections of an MTrS (myofascial trigger spot) are basically similar to that for a normal tissue region.  The motor neurons related to MTrS tended to be smaller in their diameters.  The findings in this study further supported the previously proposed hypotheses for the pathogenesis of an MTrP.”

Kuan TS, Hong CZ, Chen SM et al. 2012. Myofascial pain syndrome: correlation between the irritability of trigger points and the prevalence of local twitch responses during trigger point injection. J Musculoskel Pain. 20(4):250-256. The local twitch response appears to be a reflex contraction of muscle fiber within the TrP taut band. The LTR occurs when the nociceptors in the taut band are stimulated, such as during TrP injection or dry needling "This study supports the hypothesis that in MPS there are multiple sensitized loci nociceptors in TrP regions and that the Local Twitch Response is related to the irritability of the TrP." This study found a high correlation of LTR during injection and intensity of pain or pressure pain threshold before injection. We don't yet know why it is so critical for pain relief to elicit an LTR during injection. The prevalence of LTR seems to be highly associated with the LTR. The amount of pain relief was in proportion to the LTR only when the mean intensity of pain was very high before injection.

Kuan TS, Hsieh YL, Chen SM et al. 2007.  The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise.  Am J Phys Med Rehabil. 86(3):183-189.  “The irritability of an MTrP is highly correlated with the prevalence of EPN in the MTrP region of the upper trapezius muscle.  The assessment of EPN prevalence in an MTrP region may be applied to evaluate the irritability of that MTrP.”

Kuch, K., B. J. Cox and R. J. Evans. 1996. Posttraumatic stress disorder and motor vehicle accidents: a multidisciplinary overview. Can J Psychiatry 41(7):429-434.

Kuch, K., B. Cox, R. J. Evans,  P. C. Watson and C. Bubela. 1993. To what extent do anxiety and depression interact with chronic pain? Can J Psychiatry 38(1):38(1):36-38.

Kuchinad A, Schweinhardt P, Seminowicz DA et al. 2007.  Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain?  J Neurosci. 27(15):4004-4007.  “…fibromyalgia patients had significantly less total gray matter volume and showed a 3.3 times greater age-associated decrease in gray matter than healthy controls.  The longer the individuals had had fibromyalgia, the greater the gray matter loss, with each year of fibromyalgia being equivalent to 9.5 times the loss in normal aging.  In addition, fibromyalgia patients demonstrated significantly less gray matter density than healthy controls in several brain regions, including the cingulate, insular and medical frontal cortices, and parahippocampal gyri.”   “...fibromyalgia appears to be associated with an acceleration of age-related changes in the very substance of the brain.  Moreover, the regions in which we demonstrate objective changes may be functionally linked to core features of the disorder including affective disturbances and chronic widespread pain.”

Kucuksen S, Genc E, Yilmaz H et al. 2013. The prevalence of fibromyalgia and its relation with headache characteristics in episodic migraine. Clin Rheumatol. [Feb 27 Epub ahead of print]. "This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain."

Kudo, Y. 1997. [Ca2+dynamics in glial cells]. Nippon Yakurigaku Zasshi 109(3):111-7. 

Kuhajda, M. C., B. E. Thorn and M. R. Klinger.  1998.  The effect of pain on memory for affective words.  Ann Behav Med 20(1):31-5.

Kuiper, G. G., J. G. Lemmen, B. Carlsson, J. C. Corton, S. H. Safe, P. T. van der Saag and B. van der Burg.  1998.  Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta.  Endocrinology 139(10):4252-63.

Kujala, U. M., S. Taimela and T. Viljanen.  1999.  Leisure physical activity and various pain symptoms among adolescents.  Br J Sports Med 33(5):325-8.

Kulcu DG, Akbas B, Bicakcigil M et al. 2010. The reliability and validity of the Turkish version of the Fibrofatigue Scale. J Musculoskel Pain 18(2):2010. This study showed the scale to be reliable and valid. A copy of the questionnaire is included in the article.

Kumar S, Ferrari R, Narayan Y. 2004.  Cervical muscle response to posterolateral impacts — effect of head rotation.  Clin Biomech 19(9):899-905.  “Head rotation in a right posterolateral impact modifies the cervical response mainly by generating an asymmetry in the paired sternocleidomastoid electromyograms.  This may asymmetrically affect the risk of injury to the sternocleidomastoids “  

Kumar S, Ferrari R, Narayan Y. 2004.  Electromyographic and kinematic exploration of whiplash-type rear impacts: effect of left offset impact.  Spine J. 4(6):656-665.  “When a rear impact is offset to the subject’s left, it results in not only increased electromyographic generation in both sternocleidomastoids, but the splenius capitis contralateral to the direction of impact offset also bears part of the force of the neck perturbation.  Expecting or being aware of imminent impact also plays a role in reducing muscle responses in low-velocity offset rear impacts.”  [It is an interesting reflection that while some researchers are working to understand the mechanisms of whiplash and thus benefiting patients and care providers, and perhaps preventing further injury, there are  doctors  (primarily under the pay and/or influence of insurance companies) who still refuse to believe whiplash exists. DJS]

Kumar S, Narayan Y, Amell T. 2002. An electromyographic study of low-velocity rear-end impacts. Spine 27(10):1044-1055. “Muscle responses were greater with higher levels of acceleration. Because the muscular component of the head-neck complex plays a central role in the abatement of higher acceleration levels, it may be a primary site of injury in the whiplash phenomenon.”

Kuncewicz E, Samborski W. 2009. [Tender points and trigger points--differences and similarities]. Chir Narzadow Ruchu Ortop Pol. 74(6):367-71. [Polish] Two main types of myalgia that are not inflammatory are fibromyalgia (FM) and myofasical pain (MFP). In both of them during diagnosing tender points (characteristic for fibromyalgia) and trigger points (MTrP--characteristic for myofasical pain) are of key importance. A great degree of similarity together with the inability to differentiate between those points result in wrong diagnosis and, as a consequence, failure of therapy. Additional difficulties are caused by the lack of unity in nomenclature, as in literature the term tender point and trigger point are used interchangeably. Moreover, some centres question the existence of fibromyalgia and myofascial pain as separate pain entities. [It is sad that anyone, especially anyone writing papers and working in the field, considers myofascial pain due to trigger points as a type of fibromyalgia.  It is not.  Sadly, there are far too many examples of this.  It does not make them any more correct.  This lack of knowledge among so many in medicine is part of the reason for the confusion between FM and CMP. DJS]

Kundermann B, Krieg JC, Schreiber W et al. 2004.  The effect of sleep deprivation on pain.  Pain Res Manag. 9(1):25-32.  “Chronic pain syndromes are associated with alterations in sleep continuity and sleep architecture.  One perspective of this relationship, which has not received much attention to date, is that disturbances of sleep affect pain.  Sleep deprivation produces hyperalgesic changes.  Sleep deprivation can counteract analgesic effects of pharmacological treatments involving opioidergic and serotoninergic mechanisms of action.”

Kuo LE, Kitlinska JB, Tilan JU et al. 2007.  Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome.  Nat Med. 13(7):803-811.

Kung YY, Chen FP, Chaung HL et al. 2001.  Evaluation of acupuncture effect to chronic myofascial pain syndrome in the cervical and upper back regions by the concept of Meridians.  Acupunct Electrother Res. 26(3):195-202.  “Acupuncture is a somewhat effective method for pain relief of patients with chronic MPS in the cervical and upper back regions.  The effect of acupuncture with the concept of meridians on MPS is insidious and the duration of the relief is not long enough.”

Kupers RC, Svensson P, Jensen TS. 2004.  Central representation of muscle pain and mechanical hyperesthesia in the orofacial region: a positron emission tomography study.  Pain 108(3):284-293. s “Cerebral processing of jaw-muscle pain may differ from the processing of cutaneous pain and that mechanical hyperesthesia, which often is encountered in clinical cases, has a unique representation in the brain.”

Kuramoto AM. 2006.  Therapeutic benefits of Tai Chi exercise: research review.  WMJ 105(7):42-46.

Kurland JE, Coyle WJ, Winkler A et al. 2006.  Prevalence of irritable bowel syndrome and depression in fibromyalgia.  Dig Dis Sci. 51(3):454-460.  “The prevalence of IBS and depressive symptoms was higher in FM patients compared to the control population.”

Kurosinski P, Gotz J. 2002.  Glial cells under physiologic and pathologic conditions.  Arch Nerol 59(10):1524-8. Glial cell loss may contribute to cognitive deficits such as memory impairment.

Kurtze, N., K. T. Gundersen and S. Svebak.  1999.  Quality of life, functional disability and lifestyle among subgroups of fibromyalgia patients: the significance of anxiety and depression. Br J Med Psychol 72 (Pt 4):471-84.   

Kurtze, N., K. T. Gundersen and S. Svebak.  1998.  The role of anxiety and depression in fatigue and patterns of pain among subgroups of fibromyalgia patients.  Br J Med Psychol 71(Pt 2):185-194.

Kvale A, Skouen JS, Ljunggren, AE. 2003.  Discriminative validity of the global physiotherapy examination-52 in patients with long lasting musculoskeletal pain versus healthy persons.  J Musculoskel Pain 11(3):23-35.  This study separated patients into subgroups, comparing healthy patients, patients with long-standing musculoskeletal pain, men and women.  The physical therapy evaluations were separated into 5 domains: Posture, Respiration, Movement, Muscle and Skin.  They found significant variations, especially in Movement and Muscle groups, and also differences dependent on gender and pain distribution.

Kwan CL, Diamant NE, Pope G et al. 2005.  Abnormal forebrain activity in functional bowel disorder patients with chronic pain.  Neurology 65(8):1268-1277.  Abnormal brain responses in IBS may cause many sensory symptoms including pain, dysfunction and dysfunctional processing of visceromotor stimuli. 

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