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."
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.
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
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."
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, 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."
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
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]
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 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.
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
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
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.
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.
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capacities of muscle in patients with fibromyalgia syndrome. Z Rheumatol Suppl 57
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.”
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
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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
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cell signal molecule in response to central nervous system injury, and that
the named receptors are involved with this response.
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these factors characterized about 2/3 of the sample.” “Results suggest that
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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.
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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
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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.]
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"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."
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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
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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.”
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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.
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"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."
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Changes in readiness to self-manage pain are associated with improvement
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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."
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“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.
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]
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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."
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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. 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)
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vestibulodynia. Pain [Dec 12 Epub ahead of print]
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Johansson, G., J. Risberg, U. Rosenhall, G. Orndahl, L.
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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]
- 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.
O’Connor KA, Deak T et al. Psychoneuroendocrinology.
27(3):353-365. The stress response in rats is changed after an
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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
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, 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
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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."
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Joyce, P. and C. Clark. 1996. The use of
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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."
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 seems...to 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. 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."
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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.
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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
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
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.”
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.
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]
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.
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."
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
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.
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
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.
Katz, N. P. 2000. MorphiDex (MS:DM)
double-blind, multiple-dose studies in chronic pain patients. J Pain Symptom
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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
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
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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.
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Kay, G.G. and A. G. Harris. 1999. Loratadine
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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."
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bimanual skills depends on proprioception. Neurosci Lett. [Epub
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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.]
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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.
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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
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
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Kerns RD, Rosenberg R. 2000.
Predicting responses to self-management treatments for chronic pain:
application of the pain stages of change model. Pain
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a self-management approach to chronic pain may serve as a mediator or
moderator of successful treatment.”
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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
Ketroser DB 2000. Whiplash, chronic neck pain, and
zygapophyseal joint disorders. A selective review. Minn Med 83(2):51-4
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Pain clinic experience in a teaching hospital in Western Saudi Arabia.
Relationship of patient’s age and gender to various types of pain.
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managed in the pain clinic (required) full understanding of pain
neurophysiology as well as familiarity with contributing factors to the
prevalence of pain.”
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]
Lichtensteiger CA, Faroon O, Mumtaz M, Schaeffer DJ, Hansen LG.
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“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.
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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
Kiecolt-Glaser JK, McGuire L, Robles TF,
Glaser R. Emotions, Morbidity, and Mortality: New Perspectives
from Psychoneuroimmunology. 2002. Annu Rev Psychol
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."
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 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.
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 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
Kipen, H. M., W. Hallman, H. Kang, N. Fiedler and B. H.
Natelson. 1999. Prevalence of chronic fatigue and chemical sensitivities in
Gulf Registry Veterans. Arch Environ Health 54(5):313-8.
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.
Kiraly, S. J., R. J. Ancill and G. Dimitrova.
1997. The relationship of endogenous cortisol to psychiatric disorder: a
review. Can J Psychiatry 42(4):415-420.
Kirchgessner ,A. L., and M. Liu. 1999. Orexin
synthesis and response in the gut. Neuron. 24(4):941-51
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
Kischka, U. T. Ettlin, S. Heim and G. Schmid. 1991.
Cerebral symptoms following whiplash injury. Eur Neurol 31(3):136-140.
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]
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 duloxetine.....it 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]
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1998. Sympathetic nerve activity after acupuncture in humans. Pain
Knobler, H. A. Schattner, T. Zhornicki, S. D. Malnick, D.
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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
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
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opening the mouth and facilitating swallowing in pseudobulbar palsy patients
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"Musculoskeletal involvement was common in HIV patients causing increased morbidity, so early detection and timely intervention is essential to improve quality of life."
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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
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."
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of the external loads..”
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that recorded for sedentary control subjects. This reduced
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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
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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."
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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.”
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"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."
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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
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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.”
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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
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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.”
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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
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."
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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]
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