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Patients &
trained Companions

Doctors & Other
Care Providers



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

annotated by Devin J. Starlanyl



References for Research Purposes

A-C       D-E

F-H       I-K

On This Page
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NOTE:  New Nomenclature

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

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


Labat JJ, Guerineau M, Delavierre D et al. 2010. [Symptomatic approach to musculoskeletal dysfunction and chronic pelvic and perineal pain.] Prog Urol 20(12):982-989. [French] "Musculoskeletal pain is certainly underestimated in the management of chronic pelvic and perineal pain."

Labat JJ, Ribert R, Delavierre D et al. 2010. [Symptomatic approach to chronic neuropathic somatic pelvic and perineal pain] Prog Urol 20(12):973-981. Chronic pelvic and perineal pain must include assessment and treatment of entrapped nerves and trigger points in scars, facet joint pain and multiple other factors. [French]

Lachaine J, Beauchemin C, Landry PA. 2010. Clinical and economic characteristics of patients with fibromyalgia syndrome. Clin J Pain. 26(4):284-290. “Results of this analysis of the RAMQ (Quebec provincial health plans) database illustrate the high prevalence of comorbidities among patients with a diagnosis of FMS and strongly indicate that the economic burden of FMS is substantial.” [It is vital to discover the initiating cause of the central sensitization of FM, and even more, the comorbidities and other factors that are maintaining it. DJS]

Lachapelle DL, Lavoie S, Higgins NC et al. 2014. Attractiveness, Diagnostic Ambiguity, and Disability Cues Impact Perceptions of Women with Pain. Rehabil Psychol. [Mar 10 Epub ahead of print.] "This experimental study investigated how physical attractiveness, disability cue, and diagnostic ambiguity stereotypes impact perceptions of a patient's pain/disability and personality…. After viewing photographs of women pictured with or without a cane, accompanied by descriptions of the women's diagnosis (fibromyalgia or rheumatoid arthritis), 147 university students rated the women's pain/disability and personality…. Analyses revealed that more attractive women received lower ratings on pain/disability and higher ratings (more positive) on personality. Moreover, those pictured with a disability cue got higher ratings on both pain/disability and personality, and those with medical evidence of pathology (less ambiguity) got higher ratings on pain/disability and lower ratings on personality. Examination of the 3 stereotypes in a single study enabled an evaluation of their interactions. An Attractiveness × Disability Cue × Diagnostic Ambiguity interaction for ratings of pain/disability revealed that the presence of both medical evidence and a disability cue were needed to override the strong "beautiful is healthy" stereotype. Significant 2-way interactions for ratings of personality indicated that the impact of the disability stereotype tends to be overshadowed by the attractiveness stereotype…. The results indicate that these stereotypes have a large effect on perceptions of women with chronic pain and that attractiveness, a contextual variable unrelated to the pain experience, exerts an even stronger effect when there is less objective information available. This could have clinical ramifications for assessment and treatment of patients with chronic pain, which often occurs in the absence of "objective" medical evidence or any external cues of disability."

LaCroix-Fralish ML, Tawfik VL, DeLeo JA. 2005.  The organizational and activational effects of sex hormones on tactile and thermal hypersensitivity following lumbar nerve root injury in male an female rates.  Pain 114(1-2):71-80.  “Manipulation of gonadal hormones may be a potential source for novel therapies for chronic pain in women.”

Lafargue, A. L., L. B. Cabrales, R. M. Larramendi. 2002. Bioelectrical parameters of the whole human body obtained through bioelectrical impedance analysis. 2002. 23(6):450-454.

Lago-Rizzardi CD, de Siqueira JT, de Siqueira SR. 2013. Spirituality of chronic orofacial pain patients: Case-control study. J Relig Health. [Aug 29 Epub ahead of print]. This study was from the Neurology Department, University of Sao Paulo Brazil Medical School. "The objective of this study was to investigate spirituality and blood parameters associated with stress in patients with facial musculoskeletal pain. Twenty-four women with chronic facial musculoskeletal pain (CFMP) and 24 healthy women were evaluated with a protocol for orofacial characteristics, research diagnostic criteria for temporomandibular disorders and the Spiritual Perspective Scale. Blood samples were collected to analyze blood count, cortisol, ACTH, C3, C4, thyroid hormones, total immunoglobulin, C-reactive protein and rheumatoid factor. The study group was more spiritualized than control group. Individuals with a high score of spirituality had less myofascial pain, less bruxism and fewer complaints. They also had lower levels of ACTH and IgE. Spirituality was higher in the study group and can be considered an important tool for coping with CFMP".

Lahita, R. G.  1998. Collagen disease: the enemy within.  Int J Fertil Womens Med 43(5):229-34.

Lai, H. and M. Carino.  1999.  60 Hz magnetic fields and central cholinergic activity: effects of exposure intensity and duration.  Bioelectromagnetics 20(5):284-9.

Laird RA, Gilbert J, Kent P et al. 2014. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 15(1):229. "On average, people with LBP have reduced lumbar ROM and proprioception, and move more slowly compared to people without LBP. Whether these deficits exist prior to LBP onset is unknown." [Trigger points often cause low back pain, and can be the initial cause and maintainer of that pain. DJS]

Lake, D. A.  1992.  Neuromuscular electrical stimulation.  An overview and its application in the treatment of sports injuries.  Sports Med 13(5):320-336.

Lai HH, Gardner V, Ness TJ et al. 2013. Segmental Hyperalgesia to Mechanical Stimulus in Interstitial Cystitis/Bladder Pain Syndrome - Evidence of Central Sensitization. J Urol. [Dec 5 Epub ahead of print.] "Female subjects with IC/BPS showed segmental hyperalgesia to mechanical pressure stimulation in the suprapubic area (T10-T12). This segmental hyperalgesia may be explained in part by spinal central sensitization."

Lakhan SE, Avramut M, Tepper SJ. 2012. Structural and Functional Neuroimaging in Migraine: Insights from 3 Decades of Research. Headache. [Oct 23 Epub ahead of print]. "Modern imaging methods provide unprecedented insights into brain structure, perfusion, metabolism, and neurochemistry, both during and between migraine attacks. Neuroimaging investigations conducted in recent decades bring us closer to uncovering migraine as a multifaceted, primarily central nervous system disorder. Three main categories of structural and functional brain changes are described in this review, corresponding to the migrainous aura, ictal headache, and interictal states. These changes greatly advance our understanding of multiple pathophysiologic underpinnings of migraine, from central "migraine generating" loci, to cortical spreading depression, intimate mechanisms underlying activation of neuronal pain pathways in vulnerable patients, central sensitization, and chronification. Structural imaging begins to explain the complex connections between migraine and cerebral vascular events, white matter lesions, grey matter density alterations, iron deposition, and microstructural brain damage. Selected structural and functional alterations of brain structures, as identified with imaging methods, may represent the foundation of new diagnostic strategies and serve as markers of therapeutic efficacy."

Lakomek HJ, Lakomek M, Bosquet-Nahrwold K. 2007.  [Fibromyalgia. Diagnostics – disease approach – therapy]  Med Klin (Munich) 102(1):23-29. [German]  “The importance of fibromyalgia has been recognized within the German health system by creating the new ICD code M79.70 and by assigning fibromyalgia its own rheumatologic DRG (I79Z).

Lamotte M, Maugars Y, Le Lay K. 2010. Health economic evaluation of outpatient management of fibromyalgia patients and the costs avoided by diagnosing fibromyalgia in France. Clin Exp Rheumatol. 28(6 Suppl 63):S64-70. "…in France, early diagnosis of fibromyalgia leads to a decrease in resource use and health care costs."

Lan C, Chen SY, Lai JS et al. 2013. Tai chi chuan in medicine and health promotion. Evid Based Complement Alternat Med. 2013:502131. "Tai chi chuan (Tai Chi) is a Chinese traditional mind-body exercise, and recently, it becomes popular worldwide. During the practice of Tai Chi, deep diaphragmatic breathing is integrated into body motions to achieve a harmonious balance between body and mind and to facilitate the flow of internal energy (Qi). Participants can choose to perform a complete set of Tai Chi or selected movements according to their needs. Previous research substantiates that Tai Chi has significant benefits to health promotion, and regularly practicing Tai Chi improves aerobic capacity, muscular strength, balance, health-related quality of life, and psychological well-being. Recent studies also prove that Tai Chi is safe and effective for patients with neurological diseases (e.g., stroke, Parkinson's disease, traumatic brain injury, multiple sclerosis, cognitive dysfunction), rheumatological disease (e.g., rheumatoid arthritis, ankylosing spondylitis, and fibromyalgia), orthopedic diseases (e.g., osteoarthritis, osteoporosis, low-back pain, and musculoskeletal disorder), cardiovascular diseases (e.g., acute myocardial infarction, coronary artery bypass grafting surgery, and heart failure), chronic obstructive pulmonary diseases, and breast cancers. Tai Chi is an aerobic exercise with mild-to-moderate intensity and is appropriate for implementation in the community. This paper reviews the existing literature on Tai Chi and introduces its health-promotion effect and the potential clinical applications."

Lan C., S. Y. Chen, J. S. Lai et al. 2001. Heart rate responses and oxygen consumption during Tai Chi Chuan practice. Am J Chin Med 29(3-4):403-10. T'ai chi chuan is a moderate intensity aerobic exercise.   

Landis CA, Lentz MJ, Rothermel J et al.  2004.  Decreased sleep spindles and spindle activity in midlife women with fibromyalgia and pain.  Sleep 27(4):741-750.  There may be impaired thalamocortical spindle generation mechanisms associated with FMS in women.

Lane, J. D. , B. G. Phillips-Bute and C. F. Piper.  1998. Caffeine raises blood pressure at work. 1998.  Psychosom Med  60(3):327-330. 

Lane RD, Hsu CH, Locke DE et al. 2015. Role of theory of mind in emotional awareness and alexithymia: Implications for conceptualization and measurement. Conscious Cogn. 33:398-405. The goal of this study was to determine whether alexithymia, which is characterized by difficulty in recognizing and describing emotions, is associated with impairments in the ability to mentally represent emotional states. We studied 89 outpatients including 29 conversion disorder patients, 30 functional somatic syndrome [e.g. fibromyalgia] patients and 30 medical controls. Groups did not differ on affective or cognitive Theory of Mind (ToM) measures, the Levels of Emotional Awareness Scale (LEAS) or the Twenty-Item Toronto Alexithymia Scale (TAS-20) after adjusting for Positive and Negative Affect Scale (PANAS) variables. Across all patients, LEAS but not TAS-20 correlated positively with affective and cognitive ToM measures after adjusting for PANAS scores. Impairments in ToM functioning influence LEAS performance but not TAS-20 scores. These findings support the distinction between a milder "anomia" form of alexithymia associated with impaired emotion naming and a more severe "agnosia" form associated with impaired mental representation of emotion.

Landolt, H.P., C. Roth, D. J. Dijk and A. A. Borbely.  1996.  Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men.  J Clin Psychopharmacol 16(6):428-36.

Landolt, H. P. , E. Werth, A. A. Borbely and D,. J. Dijk 1995. Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain Res 675(1-2):67-74.  

Landro, N. I., T. C. Stiles and H. Sletvold. Memory functioning in patients with primary fibromyalgia and depression on healthy controls. 1997. J Psychosomatic Research. 42(3):297-306.

Lang, AM. 2003.  A preliminary comparison of the efficacy and tolerability of botulinum toxin serotypes A and B in the treatment of myofascial pain syndrome: a retrospective, open-label chart review.  Clin Ther 25(8):2268-78.  Myofascial pain patients treated with BTX-A “...reported significantly greater reductions in pain for longer durations...” than BTX-B, and there were no “severe systemic adverse effects,” which was not the case with BTX-B.

Lang, A. M. 2002. Botulinum toxin therapy for myofascial pain disorders. Curr Pain Headache Rep 6(5):355-60.

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

Lange M, Karpinski N, Krohn-Grimberghe B et al. 2009.  [Fibromyalgia: influence of depressive symptoms in coping with pain]  Rehabilitation (Stuttg). 48(5):306-311. [German]  “Comparison of the groups shows significantly lower means for the fibromyalgia patients with depressive symptoms concerning ‘perceived self-competence’, ‘cognitive restructuring’, and ‘countertraded activity’.  The same results can be observed for ‘self-efficacy’.  Analysis of the motivation for therapy in the ‘carefreeness’ scale shows significantly higher means in the fibromyalgia patients with depressive symptoms.  In the ‘maintenance’ scale, however, lower means are observed in this patient group.  As fibromyalgia patients with depressive symptoms show greater strain on account of their psychosomatic symptoms, depressive symptoms should be dealt with during treatment.”  [No consideration was made for the effects of living with an invisible illness that had little understanding and little support among care providers and companions alike.  It is very difficult to be “carefree” when you are living with a bewildering number of symptoms, often caused by a multitude of co-existing conditions, many of which are unrecognized by care providers.  This situation lends itself toward fostering an attitude of hopelessness and helplessness, underscored by often enhanced by inadequately treated pain.  Perhaps when care providers become more educated, patients will as well, and become less depressed as their symptoms are more adequately managed. DJS]

Langevin HM. 2006.  Connective tissue: a body-wide signaling network?  Med Hypotheses. 66(6):1074-1077.  “Unspecialized ‘loose’ connective tissue forms an anatomical network throughout the body.  This paper presents the hypothesis that, in addition, connective tissue functions as a body-wide mechanosensitive signaling network.”   “Demonstrating the existence of a connective signaling network therefore may profoundly influence our understanding of health and disease.”  [This concept is increasingly important due to the finding of trigger points in so many types of tissue, and that at least MTPs have part in central sensitization.  DJS]

Langevin HM, Nedergaard M, Howe AK. 2013. Cellular control of connective tissue matrix tension. J Cell Biochem. Aug;114(8):1714-9. "The biomechanical behavior of connective tissue in response to stretching is generally attributed to the molecular composition and organization of its extracellular matrix. It also is becoming apparent that fibroblasts play an active role in regulating connective tissue tension. In response to static stretching of the tissue, fibroblasts expand within minutes by actively remodeling their cytoskeleton. This dynamic change in fibroblast shape contributes to the drop in tissue tension that occurs during viscoelastic relaxation. We propose that this response of fibroblasts plays a role in regulating extracellular fluid flow into the tissue, and protects against swelling when the matrix is stretched. This article reviews the evidence supporting possible mechanisms underlying this response including autocrine purinergic signaling. We also discuss fibroblast regulation of connective tissue tension with respect to lymphatic flow, immune function, and cancer."

Langevin HM, Sherman KJ. 2007.  Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms.  Med Hypotheses. 68(1):74-80.  [Most chronic low back pain includes MTPs, and the MTPs can cause central sensitization.  Since pain at the end of range of motion is due to MTPs and the MTPs can cause central sensitization contributing to chronic pain (see Niddam et al 2008), the myofascial component must be diagnosed and treated for the therapies mentioned in this article to be successful.  DJS.]

Langford CF, Udvari Nagy S, Ghoniem GM. 2007.  Levator ani trigger point injections: an underutilized treatment for chronic pelvic pain.  Neurourol Urodyn 26(1):59-62.  “In the management of CPP, a non-surgical office-based therapy such as trigger point injections can be effective in selected patients.”

Langley, P.  1997.  Scapular instability associated with brachial plexus irritation: a proposed causative relationship with treatment implications.  J Hand Ther 10(1):35-40.  

Laniosz V, Wetter DA, Godar DA. 2014. Dermatologic manifestations of fibromyalgia. Clin Rheumatol. [Jan 14 Epub ahead of print.] "Among these (over 800) Mayo Clinic fibromyalgia patients, various dermatologic conditions and cutaneous problems were identified, including hyperhidrosis in 270 (32.0 %), burning sensation of the skin or mucous membranes in 29 (3.4 %), and various unusual cutaneous sensations in 14 (1.7 %). Pruritus without identified cause was noted by 28 patients (3.3 %), with another 16 patients (1.9 %) reporting neurotic excoriations, prurigo nodules, or lichen simplex chronicus. Some form of dermatitis other than neurodermatitis was found in 77 patients (9.1 %). Patients with fibromyalgia may have skin-related symptoms associated with their fibromyalgia. No single dermatologic diagnosis appears to be overrepresented in this population, with the exception of a subjective increase in sweating."

Lantz, M. S., E. Buchalter and V. Giambanco.  1999.  St. John’s wort and antidepressant drug interactions in the elderly.  J Geriatr Psychiatry Neurol 12(1):   

Lanza. F. L., J. R. Codispoti and E. B. Nelson.  1998.  An endoscopic comparison of gastro-duodenal injury with over-the-counter doses of ketoprofen and acetaminophen.  Am J Gastro-enterol 93(7):1051-4.

Lapane KL, Quilliam BJ, Benson C et al. 2014. Impact of noncancer pain on health-related quality of life. Pain Pract. [Feb 27 Epub ahead of print.] "Among outpatients with various underlying causes of pain, the negative impact of pain on physical and mental health-related quality of life is significant."

Lapatki BG, Oostenveld R, Van Dijk JP et al. 2006.  Topographical characteristics of motor units of the lower facial musculature revealed by means of high-density surface EMG.  J Neurophysiol. 95(1):342-354.

Lapin, I. P., S. M. Mirzaev, I. V. Ryzov and G. F. Oxenkrug.  1998.  Anticonvulsant activity of melatonin against seizures induced by quinolinate, kainate, glutamate, NMDA, and pentylenetetrazole in mice.  J Pineal Res 24(4):215-218.

Lara NA Jr, Teixeira MJ, Fonoff ET. 2011. Long Term Intrathecal Infusion of Opiates for Treatment of Failed Back Surgery Syndrome. Acta Neurochir Suppl. 108:41-47. "Failed Back Surgery Syndrome (FBSS) is a multidimensional painful condition and its treatment remains a challenge for the surgeons. Prolonged intrathecal infusion of opiates for treatment of noncancer pain also remains a controversial issue. (In this study it) was concluded that intrathecal infusion of morphine is a useful and safe tool for long-term treatment of chronic nonmalignant pain."["Failed back syndrome" is a description, not a diagnosis, and is often due to myofascial TrPs. One must always start with the least invasive therapies. DJS]

Lark SD, McCarthy PW. 2007.  Cervical range of motion and proprioception in rugby players versus non-rugby players.  J Sports Sci. 25(8):887-894.  “The active cervical range of motion of rugby forwards is similar to that of whiplash patients, suggesting that participation in rugby can have an effect on neck range of motion that is equivalent to chronic disability.  Reduced active cervical range of motion could also increase the likelihood of injury and exacerbate age-related neck problems.”  [This study may have significant relevance to many sports. DJS]

Larsen, L. B. and R. Holm.  2000. [Prolonged neck pain following automobile accidents.  Gender and age related risk calculated on basis of data from an emergency department].  Ugeskr Laeger 162(2):178-81 [Danish].  

Larson AA, Pardo JV, Pasley JD. 2013. Review of Overlap between Thermoregulation and Pain Modulation in Fibromyalgia. Clin J Pain. [Jul 24 Epub ahead of print]. "Fibromyalgia (FM) syndrome is characterized by widespread pain that is exacerbated by cold and stress but relieved by warmth. We review the points along thermal and pain pathways where temperature may influence pain. We also present evidence addressing the possibility that brown adipose tissue activity is linked to the pain of FM given that cold initiates thermogenesis in brown adipose tissue through adrenergic activity, whereas warmth suspends thermogenesis. Although females have a higher incidence of FM and more resting thermogenesis, they are less able to recruit brown adipose tissue in response to chronic stress than males. In addition, conditions that are frequently comorbid with FM compromise brown adipose activity making it less responsive to sympathetic stimulation. This results in lower body temperatures, lower metabolic rates, and lower circulating cortisol/corticosterone in response to stress-characteristics of FM. In the periphery, sympathetic nerves to brown adipose also project to surrounding tissues, including tender points characterizing FM. As a result, the musculoskeletal hyperalgesia associated with conditions such as FM may result from referred pain in the adjacent muscle and skin."

Larson, B., Bjork, J., Henriksson, K.J., Gerdle, B., Lindman, R. 2000. The prevalence of cytochrome oxidase negative and super-positive fibers and ragged red fibers in the trapezius muscle of female cleaners with and without myalgia and/or female healthy controls. Peripheral pain input from injuries, inflammation, or chronic work-related myalgia are probable sources of persistent nociceptive impulses could lead to a central sensitization.  Furthermore, once central sensitization develops, peripheral pain generators, such as myofascial trigger points, may lead to perpetuation and aggravation of central sensitization.

Lartigue AM. 2009.  Patient education and self-advocacy.  Myofascial pain syndrome: treatments.  J Pain Palliat Care Pharmacother. 23(2):169-170.

La Rubia M, Rus A, Molina F et al. 2013. Is fibromyalgia-related oxidative stress implicated in the decline of physical and mental health status? Clin Exp Rheumatol. 31(6 Suppl 79):121-127. "These findings reveal an imbalance between oxidants and antioxidants in FM patients. The lower antioxidant enzyme activities may lead to oxidative stress through the oxidation of DNA and proteins, which may affect the health status of FM patients."

Laske C, Stransky E, Eschweiler GW et al. 2006.  Increased BDNF serum concentration in fibromyalgia with or without depression or antidepressants.  J Psychiatr Res.  [Apr 3 Epub ahead of print]   “Fibromyalgia (FM) is still often viewed as a psychosomatic disorder.  However, the increased pain sensitivity to stimuli in FM patients is not an ‘imagined’ histrionic phenomena.  Pain, which is consistently felt in the musculature, is related to specific abnormalities in the CNS pain matrix.  Brain-derived neurotrophic factor (BDNF) is an endogenous protein involved in neuronal survival and synaptic plasticity of the central and peripheral nervous system (CNS and PNS).  Several lines of evidence converged to indicate that BDNF also participates in structural and functional plasticity of nociceptive pathways in the CNS and within the dorsal root ganglia and spinal cord.  In the latter, release of BDNF appears to modulate or even mediate nociceptive sensory inputs and pain hypersensitivity.  We were interested if BDNF serum concentration may be altered in FM.”  “The results from our study indicate that BDNF may be involved in the pathophysiology of pain in FM.  Nevertheless, how BDNF increases susceptibility to pain is still not known.”

Latina R, Sansoni J, D'Angelo D et al. 2013. [Etiology and prevalence of chronic pain in adults: a Narrative Review.] Prof Inferm. 66(3):151-158. [Article in Italian] "The chronic nonmalignant pain is an underestimated epidemiologic health problem. It is a disease in its own right. It is one of the major reasons because patients use health service. The magnitude of chronic pain is in terms of human suffering and costs to society. The aim of this review is to identify the diagnosis and the prevalence of nonmalignant chronic pain in the adults….Excluding topics of headache, pain for pediatric and geriatric groups, cancer pain and disease-specific items. … We have obtained 7 articles. These epidemiological studies conducted in different part of the world, reported prevalence rates of chronic pain ranging from 16-53%. They show a high heterogeneity of results concerning diagnosis and methods. Although limited the number of articles, show the high complexity of the phenomenon."

Laurent, D. D., and H. R.  Holman. 1999.   Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.  Med Care 37(1):5-14.

Lauretti GR. 2008.  Mechanisms of analgesia of intravenous lidocaine.  Rev Bras Anestesiol. 58(3):280-286.  “The final analgesic action of intravenous lidocaine is a reflection of its multifactorial action.  It has been suggested that its central sensitization is secondary to a peripheral anti-hyperalgic action on somatic pain and central on neuropathic pain, which result in the blockade of central hyperexcitability.  The intravenous dose should not exceed the toxic plasma concentration of 5 microg mL(-1); doses smaller than 5 mg kg(-1), administered slowly (30 minutes), under monitoring, are considered safe.”

Laursen JC, Cairns BE, Kumar U et al. 2013. Nitric oxide release from trigeminal satellite glial cells is attenuated by glial modulators and glutamate. Int J Physiol Pathophysiol Pharmacol. 5(4):228-238. "…these findings suggest that targeting SGCs (satellite glial cells) may provide a novel therapeutic approach for management of craniofacial pain conditions such as migraine in the future."

Lautenbacher S. 2012. Experimental approaches in the study of pain in the elderly. Pain Med. 13 Suppl 2:S44-50. "The present review summarizes experimental data on age-related changes in pain processing. These data suggest an increase in pain threshold and a decrease in tolerance threshold, which both are dependent on the physical nature of the stressor, as well as a developing deficiency in endogenous pain inhibition, which might be paralleled by an enhanced disposition to central sensitization (stronger temporal summation). These findings are arranged in a model that allows for explaining the two seemingly divergent perspectives: age both dulls the pain sense and increases the prevalence of pain complaints. This model is based on the assumption that both excitatory and inhibitory processes are dampened with age but that the later processes age at a faster rate, leading to increasingly unbalanced pain excitation."

Lautenbacher S, Kunz M, Strata P et al. 2005.  Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain.  “...somatosensory thresholds for non-noxious stimuli increase with age whereas pressure pain thresholds decrease and heat pain thresholds show no age-related changes.”

Lautenbacher S, Rollman GB, McCain GA. 1994.  Multi-method assessment of experimental and clinical pain in patients with fibromyalgia.  Pain 59(1):45-53.  There is increased pain responsiveness for any noxious stimuli in FM patients, including cold, heat, and electronic stimulation, although the latter was noted in the tender point regions.


Lavand’homme P, De Kock M. 2006.  The use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery.  Acta Anaesthesiol Belg. 57(4):373-379.  Blocking nociceptive stimuli with multimodal analgesia on the surgical incision site may prevent or at least minimize central sensitization after abdominal procedures. 

Lavand’homme P. 2006.  Perioperative pain.  Curr Opin Anaesthesiol. 19(5):556-561.  “Effective perioperative block of nociceptive inputs from the wound as well as use of antihyperalgesic and analgesic drugs in combination seem the best way to control postoperative pain and specifically to prevent central sensitization.”

Lavaque E, Sierra A, Azcoitia I et al. 2005.  Steroidogenic acute regulatory protein in the brain. Neuroscience [Dec. 6 Epub ahead of print]  “The nervous system synthesizes steroids that regulate the development and function of neurons and glia, and have neuroprotective properties.  The first step in steroidogenesis involves the delivery of free cholesterol to the inner mitochondrial membrane where it can be converted into pregnenolone by the enzyme cytochrome P450side chain cleavage.  The peripheral-type benzodiazepine receptor and the steroidogenic acute regulatory protein are involved in this process and appear to function in a coordinated manner.”  “Steroidogenic acute regulatory protein is regulated in the nervous system by different physiological and pathological conditions and may play an important role during brain development, aging and after injury.”

Lavelle ED, Lavelle W, Smith HS. 2007.  Myofascial trigger points.  Anesthesiol Clin. 25(4):841-851.


Lavergne MR, Cole DC, Kerr K et al. 2010. Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity. Can Fam Physician. 56(2):e57-65.  “The patient population was predominantly female (86.7%), with a mean age of 44.6 years. Seventy-eight patients had discrete diagnoses of 1 of MCS, CFS, or FM, while the remainder had 2 or 3 overlapping diagnoses. Most (68.8%) had stopped work, and on average this had occurred 3 years after symptom onset. On every Short Form-36 subscale, patients had markedly lower functional scores than population average values, more so when they had 2 or 3 of these diagnoses. Having FM, younger age at onset, and lower socioeconomic status were most consistently associated with poor function. CONCLUSION: Patients seen at the EHC demonstrated marked functional impairment, consistent with their reported difficulties working and caring for their homes and families during what should be their peak productive years. Early comprehensive assessment, medical management, and social and financial support might avoid the deterioration of function associated with prolonged illness. Education and information resources are required for health care professionals and the public, along with further etiologic and prognostic research.” [The loss to society, as well as to the patients and their families, is tremendous. More care must be taken to prevent these conditions and avoid these perpetuating factors.  Beginning symptoms must be pounced upon as a cat on a mouse, and care must be taken to avoid worsening of the conditions. DJS]

Lavin, R. A., M. Pappagallo and K. V. Kuhlemeier. 1997.  Cervical pain: a comparison of three pillows.  Arch Phys Med Rehabil 78(2):193-8.

Lawrence RC, Felson DT, Helmick CG et al. 2007.  Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II.  Arthritis Rheum. 58(1):26-35.  “Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population.  This report provides the best available prevalence estimates for the US, but for most specific conditions more studies generalizable to the US or addressing understudied populations are needed.”  [This study estimated that among US adults, 5 million have FM.  They also mentioned 59 million with low back pain and 30.1 million with neck pain, but did not specify MTPs.  Since most of the conditions they counted often do have a myofascial component, the numbers of people with MTPs is staggering.  So is the fact that they ignored this in this NIH study. DJS]

Lawrence, W. F., S. S. Smith, T. B. Baker and M. C. Fiore.  1998.  Does over-the-counter nicotine replacement therapy improve smokers’ life expectancy?  Tob Control 7(4):364-8.

Lawson GE, Hung LY, Ko GD et al. 2011. A case of pseudo-angina pectoris from a pectoralis minor trigger point caused by cross-country skiing. J Chiropr Med. 10(3):173-178. "This case demonstrates the importance of differential diagnosis and mechanism of injury in regard to chest pain and that chiropractic management can be successful when addressing patients with chest wall pain of musculoskeletal origin."

Le H, Tfelt-Hansen P, Russell MB et al. 2010. Co-morbidity of migraine with somatic disease in a large population-based study. Cephalalgia. [Jun 2 Epub ahead of print]. "The aim of this study was to determine sex specific co-morbidity of migraine and its subtypes migraine without aura (MO) and migraine with aura (MA) with a number of common somatic diseases..... Co-morbid diseases included previously documented diseases: asthma, epilepsy and stroke as well as new conditions: kidney stone, psoriasis, rheumatoid arthritis and fibromyalgia. MA had more co-morbidities than MO and females more than males.... Migraine occurs in 20-30% of several medical conditions. It should be diagnosed and treated along with the primary disease."

Leach, M. W., D. W. Frank, M. R. Berardi, E. W. Evans, R. C. Johnson, D. G. Schuessler and E. Radwanski.  1999.  Renal changes associated with naproxen sodium administration in cynomolgus monkey.  Toxicol Pathol 27(3):295-306.  

Leal-Cerro, A., J. Povedano, R. Astorga, M. Gonzalez, H. Silva, F. Garcia-Pesquera, F. F. Casanueva and C. Dieguez.  1999. The growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in patients with fibromyalgia syndrome.  J Clin Endocrinol Metab 84(9):3378-81.

Lean ME. 2000. Obesity: burdens of illness and strategies for prevention or management.  Drugs Today (Barc) 36(11):773-784.  Obesity is implicated as a perpetuating factor in low back pain, hypertension, metabolic syndrome, fatigue, dyspnea, and obstructive sleep apnea.

Leavitt F, Katz RS. 2015. Cross-sectional Neurocognitive Data Do Not Support a Transition From Fibrofog to Alzheimer Disease in Fibromyalgia Patients. J Clin Rheumatol. 21(2):81-85. Got fibrofog? From the Department of Behavioral Sciences and Section of Rheumatology, Department of Internal Medicine, Rush Medical College, Chicago, IL, comes welcome and comforting research. "The cognitive pattern of fibromyalgia appears distinct from that of Alzheimer's disease. Fibrofog is not associated with either episodic memory loss on standard tests of episodic memory or progressive cognitive decline. Patients with fibrofog remember personally experienced events termed episodic memory at a normal rate in quiet, distraction-free conditions. Patients with Alzheimer's disease do not. They forget the essential elements of short stories just read to them in environments free of distractions. In Alzheimer's disease, the brain mechanisms responsible for encoding personally experienced events into memory are irreversibly impaired. In fibrofog, the encoding mechanisms are intact. At the heart of memory loss in fibromyalgia is the inability to appropriately filter out relevant distractions. Encoding mechanisms that otherwise operate normally in forming episodic memories for everyday events in fibromyalgia appear to malfunction when 2 streams of information operate concurrently (relevant information and a source of distraction overlap). The findings should allay the worries of many with fibromyalgia who fear that fibrofog is the start of a dementing process."

Leavitt F, Katz RS. 2014. Cognitive dysfunction in fibromyalgia: Slow access to the mental lexicon. Psychol Rep. [Dec 24 Epub ahead of print.] "Lexical access speed, the time needed for the brain to access the catalogue of words in long-term memory, is assumed to provide a foundation for a broad array of cognitive operations. It was hypothesized that deficits in lexical speed are likely to play a central role in deficiencies in cognitive performance of patients with fibromyalgia, who as a group show deficits in lexical speed. This was tested in a sample of 209 patients with fibromyalgia and in 72 control patients with memory deficits…. Deficit in lexical access speed occurred at approximately twice the frequency (48.3% vs. 25.0%) in fibromyalgia. The average delay in speed of lexical access was 171 msec. in fibromyalgia and 163 msec. in controls….The premise that lexical access speed is disproportionately present in fibromyalgia and serves as a foundation for a wide array of cognitive operations is supported."

Leavitt F, Katz RS. 2012. Lexical memory deficit in fibromyalgia syndrome. J Musculoskel Pain. 20(2):82-86. "Abnormalities in naming speed and phonemic verbal fluency are prominent clinical features of FMS and appear closely linked. Inferences derived from these abnormalities have the potential to transform our picture of how cognition in FMS dysfunctions. Deficits in lexical memory may signal a core area of cognitive deficiency in FMS." These authors have called attention to yet another variety of cognitive deficit that is common to FM patients.

Leavitt F, Katz RS. 2011. Development of the Mental Clutter Scale. Psychol Rep. 109(2):445-452. "Mental fog is a core symptom of fibromyalgia. Its definition and measurement are central to an understanding of fibromyalgia-related cognitive disability. The Mental Clutter Scale was designed to measure mental fogginess. In an exploratory factor analysis of two different samples (n=128 and n=170), cognitive symptoms of fibromyalgia loaded on 2 dimensions: cognition and mental clarity. The mental clarity factor comprised 8 items with factor loadings greater than .60 and was named the Mental Clutter Scale. The factor stability of the new scale was good, internal consistency was .95, and test-retest reliability over a median of 5 days was .92. The 8-item scale is a quick measure of mental fog that provides clinicians with information about cognitive functioning in fibromyalgia."

Leavitt F, Katz RS. 2009.  Normalizing memory recall in fibromyalgia with rehearsal: a distraction-counteracting effect.  Arthritis Rheum. 61(6):740-744.  “In the absence of rehearsal, a source of distraction added to unrefreshed information signals a remarkable level of cognitive deficit in FMS that goes undetected by conventionally relied-upon neurocognitive measures.”

Leavitt F, Katz RS, Mills M et al. 2002.  Cognitive and dissociative manifestations in fibromyalgia.  J Clin Rheumatol. 8(2):77-84.  “These findings suggest that dissociation may play a role in FM symptom amplification and may aid in comprehending the regularity of cognitive symptoms.  Separating cases of fibrofog from cognitive conditions with actual brain damage is important.  It may be prudent to add a test of dissociation as an adjunct to the evaluation of FM patients in cases of suspected fibrofog.  Otherwise, test results may prove normal even in patients with disabling cognitive symptoms.”

Leavitt F, Katz RS. 2006.  Distraction as a key determinant of impaired memory in patients with fibromyalgia.  J Rheumatol. 33(1):127-132.  “The findings validate the perception of failing memory in patients with FM and are the first psychometric based evidence to our knowledge of short-term memory problems in FM linked to interference from a source of distraction.  Adding a source of distraction caused the majority of FM patients to retain new information poorly and may be integral to an understanding of FM memory problems.”

Lebiebici B, Pektas ZO, Ortancil O et al. 2006.  Coexistence of fibromyalgia, temporomandibular disorder, and masticatory myofascial pain syndromes.  [Nov 10 Epub ahead of print]  Rheumatol Int  “Our results indicate that coexistence of FM and TMD with MMP is high.  Pain and tenderness in the masticatory muscles appear to be an important element in FM, so in some patients it may be the leading complaint.”

Lebovits, A. H., I. Florence, R. Bathina, V. Hunko, M. T. Fox and C. Y. Bramble.  1997.  Pain knowledge and attitudes of healthcare providers: practice characteristic differences.  Clin J Pain 13(3):237-243.  

Leddy JJ, Sandhu H, Sodhi V et al. 2012. Rehabilitation of concussion and post-concussion syndrome. Sports Health. 4(2):147-154. "Prolonged symptoms after concussion are called post-concussion syndrome (PCS), which is a controversial disorder with a wide differential diagnosis....Treatment approaches depend on the clinician's ability to differentiate among the various conditions associated with PCS. Early education, cognitive behavioral therapy, and aerobic exercise therapy have shown efficacy in certain patients but have limitations of study design. An algorithm is presented to aid clinicians in the evaluation and treatment of concussion and PCS and in the return-to-activity decision."

Lee, J. R.  1991.  Is natural progesterone the missing link in osteoporosis prevention and treatment?  Med Hypotheses 35(4):316-8.

Lee JW, Park HS. 2015. Relation of the factor to menstrual pain and musculoskeletal pain. J Exerc Rehabil. 11(2):108-111. "The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods.... The area of musculoskeletal pain and menstrual pain were found to be the same." Free PMC Article

Lee KJ, Kim JH, Cho SW. 2005.  Gabapentin reduces rectal mechanosensitivity and increases rectal compliance in patients with diarrhea-predominant irritable bowel syndrome.  Aliment Pharmacol Ther. 22(10):981-988.  “Our results show that gabapetin reduces rectal sensory thresholds through attenuating rectal sensitivity to distension and enhancing rectal compliance in diarrhea-predominant irritable bowel syndrome patients.”   [This meshes with findings of central sensitization in IBS patients. DJS]

Lee MC, Wanigasekera V, Tracey I. 2013. Imaging opioid analgesia in the human brain and its potential relevance for understanding opioid use in chronic pain. Neuropharmacology. [Jul 25 Epub ahead of print]. "Opioids play an important role for the management of acute pain and in palliative care. The role of long-term opioid therapy in chronic non-malignant pain remains unclear and is the focus of much clinical research. There are concerns regarding analgesic tolerance, paradoxical pain and issues with dependence that can occur with chronic opioid use in the susceptible patient. In this review, we discuss how far human neuroimaging research has come in providing a mechanistic understanding of pain relief provided by opioids, and suggest avenues for further studies that are relevant to the management of chronic pain with opioids."

Lee MJ, Chung YS. 2013. Spinal subarachnoid hematoma as a complication of an intramuscular stimulation: case report and a review of literatures. J Korean Neurosurg Soc. 54(1):58-60. "Intramuscular stimulation (IMS) is widely used to treat myofascial pain syndrome. IMS is a safe procedure but several complications have been described. To our knowledge, spinal subarachnoid hematoma has never been reported as a complication of an IMS. The authors have experienced a case of spinal subarachnoid hematoma occurring after an IMS, which was tentatively diagnosed as intracranial subarachnoid hemorrhage because of severe headache. Patient was successfully treated with surgery."

Lee MY, Lee HY, Yong MS. 2014. Characteristics of Cervical Position Sense in Subjects with Forward Head Posture. J Phys Ther Sci. 26(11):1741-1743. "The purpose of this study was to investigate the effect of forward head posture (FHP) on proprioception by determining the cervical position-reposition error. [Subjects and Methods]….This result implies that the change in the muscle length caused by FHP decreases the joint position sense. Also, proprioception becomes worse as FHP becomes more severe."

Lee SH, Lu WA, Lee CS et al. 2014. The therapeutic effect of collateral meridian therapy is comparable to acupoint pressure therapy in treating myofascial pain syndrome. Complement Ther Clin Pract. [Oct 18 Epub ahead of print.] "Both APT (traditional acupoint pressure therapy) and CMT (collateral meridian therapy) have comparable therapeutic efficacy in the treatment of unilateral upper back pain with active myofascial trigger points in the upper trapezius muscle."

Lee SJ, Kim DY, Chun MH et al. 2012. The effect of repetitive transcranial magnetic stimulation on fibromyalgia: a randomized sham-controlled trial with 1-mo follow-up. Am J Phys Med Rehabil. 91(12):1077-1085. "In the low-frequency group, the Beck Depression Inventory scores significantly decreased from baseline to 1 mo after rTMS. The visual analog scale and Korean version of the Fibromyalgia Impact Questionnaire scores significantly decreased immediately after rTMS. In the high-frequency group, the visual analog scale and Beck Depression Inventory scores were significantly decreased immediately after rTMS.... Low-frequency rTMS may play a role in the long-term treatment of fibromyalgia. Notably, the findings of this study are the first to show that the right dorsolateral prefrontal cortex or the left motor cortex rTMS could have an antidepressive and pain-modulating effect in patients with fibromyalgia."

Lee SS, Yoon HJ, Chang HK et al. 2005.  Fibromyalgia in Behcet’s disease is associated with anxiety and depression, and not with disease activity.  Clin Exp Rheumatol. 23(4 Suppl 38):S15-19.  “FM (fibromyalgia) was very common among BD (Behcet’s Disease) patients and was associated with the presence of anxiety and depression, and not with disease activity.”  [Multiple invisible illnesses (especially if one or more is undiscovered and untreated for a number of years and causes a chronic pain state) have a greater chance to cause depression, and this must be taken into account. DJS]

Lee YC. 2013. Effect and treatment of chronic pain in inflammatory arthritis. Curr Rheumatol Rep. 15(1):300. "Pain is the most common reason patients with inflammatory arthritis see a rheumatologist. Patients consistently rate pain as one of their highest priorities, and pain is the single most important determinant of patient global assessment of disease activity. Although pain is commonly interpreted as a marker of inflammation, the correlation between pain intensity and measures of peripheral inflammation is imperfect. The prevalence of chronic, non-inflammatory pain syndromes such as fibromyalgia is higher among patients with inflammatory arthritis than in the general population. Inflammatory arthritis patients with fibromyalgia have higher measures of disease activity and lower quality of life than inflammatory patients who do not have fibromyalgia. This review article focuses on current literature involving the effects of pain on disease assessment and quality of life for patients with inflammatory arthritis. It also reviews non-pharmacologic and pharmacologic options for treatment of pain for patients with inflammatory arthritis, focusing on the implications of comorbidities and concurrent disease-modifying antirheumatic drug therapy."

Lee YH, Kim JH, Song GG. 2014. Association between the COMT Val158Met polymorphism and fibromyalgia susceptibility and fibromyalgia impact questionnaire score: a meta-analysis. Rheumatol Int. [Jun 21 Epub ahead of print.] "The aim of this study was to explore whether the catechol-O-methyltransferase (COMT) Val158Met polymorphism is associated with susceptibility to fibromyalgia and fibromyalgia impact questionnaire (FIQ) score in fibromyalgia patients. We conducted a meta-analysis of the associations of the COMT Val158Met polymorphism with fibromyalgia risk as well as FIQ score in fibromyalgia patients. A total of 993 fibromyalgia patients and 778 controls from 10 studies on the COMT Val158Met polymorphism and 538 fibromyalgia patients from 5 studies on the COMT Val158Met polymorphism and FIQ score were included in this meta-analysis. The meta-analysis revealed an association between fibromyalgia and the COMT Met/Met + Val/Met genotype in all study subjects (odds ratio (OR) 1.635, 95 % confidence interval (CI) 1.029-2.597, p = 0.037). However, stratification by ethnicity indicated no association between the Met/Met + Val/Met genotype and fibromyalgia in the European and Turkish populations (OR 1.202, 95 % CI 0.876-1.649, p = 0.255; OR 2.132, 95 % CI 0.764-5.949, p = 0.148, respectively). Analysis using other genetic models showed no association between the COMT Val158Met polymorphism and fibromyalgia. The meta-analysis also revealed that the FIQ score was significantly higher in individuals with the COMT Met/Met genotype than in those with the Val/Val genotype…and the Val/Met genotype... This meta-analysis identified an association between fibromyalgia risk and the COMT Val158Met polymorphism as well as the FIQ score in fibromyalgia patients."

Leeb BF, Andel I, Sautner J et al.  2004.  The DAS28 in rheumatoid arthritis and fibromyalgia patients.  [Epub]  “Conclusion: The DAS28, as expected, proved to be inappropriate to express disease activity in FM patients.  DAS28 values for expressing disease activity in RA patients may be flawed by coexisting FM and should therefore be regarded with caution as high pain levels more than impaired mood may lead to higher total scores.”

Lefebvre, P. J. and A. J. Scheen. 1999. Glucose metabolism and the postprandial state. Eur J Clin Invest 29(S2):1-6.

Legier L. 2005.  Treatment of chronic low back pain incorporating active patient participation and chiropractic: a retrospective case report.  J Chiropr Med. 4(4):200-205.  “A 43-year-old female experienced severe right lumbar, right sacrum, and right acetabular pain and muscle spasms occurring after playing a vigorous tennis match 16 years earlier.”  “By the time of presentation she also experienced right arm and right upper back pain.  A lumbar MRI scan showed an L4/5 disc bulge.  Patrick’s, Yeoman’s and Kemp’s tests were positive on her right side.  She had an asymmetrical gait pattern with a right hip hike, lateral shift and rotation of the pelvis.  Weakness of the left gluteus maximus, gluteus medius, and right erector spinae muscles was present.  Motion palpation revealed several fixations.  There was tenderness to palpation of the right psoas muscle and a trigger point in the right iliacus muscle.”  “Incorporation of active patient participation seemed to be a significant factor in the resolution of the patient’s low back pain.  Active patient participation improved the quality of life for this patient.”  [It is a sad commentary that the patient had to endure so many years of pain and dysfunction before finding a care provider who could properly address the cause of her symptoms. DJS]

Legrain V, Mancini F, Sambo CF et al. 2012. Cognitive aspects of nociception and pain. Bridging neurophysiology with cognitive psychology. Neurophysiol Clin. 42(5):325-336. "The event-related brain potentials (ERPs) elicited by nociceptive stimuli are largely influenced by vigilance, emotion, alertness, and attention. Studies that specifically investigated the effects of cognition on nociceptive ERPs support the idea that most of these ERP components can be regarded as the neurophysiological indexes of the processes underlying detection and orientation of attention toward the eliciting stimulus. Such detection is determined both by the salience of the stimulus that makes it pop out from the environmental context (bottom-up capture of attention) and by its relevance according to the subject's goals and motivation (top-down attentional control). The fact that nociceptive ERPs are largely influenced by information from other sensory modalities such as vision and proprioception, as well as from motor preparation, suggests that these ERPs reflect a cortical system involved in the detection of potentially meaningful stimuli for the body, with the purpose to respond adequately to potential threats. In such a theoretical framework, pain is seen as an epiphenomenon of warning processes, encoded in multimodal and multiframe representations of the body, well suited to guide defensive actions. The findings here reviewed highlight that the ERPs elicited by selective activation of nociceptors may reflect an attentional gain apt to bridge a coherent perception of salient sensory events with action selection processes."

Leitgeb N, Schrottner J. 2003.  Electrosensitibity and electromagnetic hypersensitivity.  Bioelectromagnetics 24(6):387-394.  Both electromagnetic hypersensitivity (developing health symptoms due to exposure of environmental electromagnetic fields) and electromagnetic sensibility (the ability to perceive electric and electromagnetic exposure) have been scientifically documented.  People with electromagnetic sensibility do not necessarily have electromagnetic hypersensitivity.

Lemming D, Graven-Nielsen T, Sörensen,Arendt-Nielsen L et al. 2012. Widespread pain hypersensitivity and facilitated temporal summation of deep tissue pain in whiplash associated disorder: An explorative study of women. J Rehabil Med. 44(8):648-657. "Widespread deep tissue pain hyperalgesia was evaluated in women with chronic whiplash associated disorder ...and controls ...using computerized cuff pressure algometry and hypertonic saline infusion.... The results indicated widespread hyperalgesia in chronic whiplash associated disorder and facilitated temporal summation outside the primary pain area, suggesting involvement of central sensitization."

Lempiainen, P., L. Mykkanen, K. Pyorala, M. Laakso and J. Kuusisto.  1999.  Insulin resistance syndrome predicts coronary heart disease events in elderly non-diabetic men. Circulation 100(2):123-128.  

Lentz, M. J. , C. a. Landis, J. Rothermel and J. L. Shaver. 1999. Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. J Rheumatol 26(7):1586-92 

Leon, J., F. Vives, E. Crespo, E. Camacho, A. Espinosa, M. A. Gallo, G. Escames and D. Acuna-Castroviejo.  1998.  Modification of nitric oxide synthase activity and neuronal response in rat striatum by melatonin and kynurenine derivatives.  J Neuroendocrinol 10(4):297-302. 

Leung AK, Lemay JF. 2004.  The limping child.  J Pediatr Health Care 18(5):219-223.  This paper on the causes of limping in children stresses trauma as the most important cause, but that “...awareness of other potential causes is important.”  Yet it neglects one of the most common and easily treated; the myofascial TrP.

Levene R, Gunther O, Rothkötter HJ et al. 2014. [Treatment of myofascial lumbar dorsal pain: Effective clinical diagnostics and therapy]. Schmerz. 28(6):573-583. [Article in German] "The results indicate that targeted treatment of muscles and fascia in patients with chronic back pain can lead to a reduction of pain symptoms. The consideration of the myofascial systems, particularly in relation to nonspecific back pain, could contribute to improving the treatment of pain and contribute to lowering costs."

Levine JD, Reichling DB. 2005.  Fibromyalgia: the nerve of that disease.  J Rheumatol Suppl. 75:29-37.  This paper categorizes FMS as “...a common, often debilitating and intractable, chronic, generalized pain condition.”  The authors suggest that there is altered activity in the subdiaphramatic vagus nerve that may be an integral part of this condition.  [This would mesh well with the findings of Linda Watkins and her research team regarding the development of central sensitization. DJS]

Levine TD, Saperstein DS. 2014. Routine use of punch biopsy to diagnose small fiber neuropathy in fibromyalgia patients. Clin Rheumatol. [Dec 24 Epub ahead of print.]"Fibromyalgia is a clinical syndrome that currently does not have any specific pathological finding to aid in diagnosis. Therefore, fibromyalgia is most likely a heterogeneous group of diseases with similar symptoms. Identifying and understanding the pathological basis of fibromyalgia will allow physicians to better categorize patients, increasing prospective treatment options, and improving potential therapeutic endeavors. Recent work has demonstrated that approximately 50 % of patients diagnosed with fibromyalgia have damage to their small unmyelinated nerve fibers. A skin punch biopsy is a sensitive and specific diagnostic test for this damage as a reduction in nerve fiber density allows for the diagnosis of small fiber neuropathy. Small fiber neuropathy is a disease with symptoms similar to fibromyalgia, but it often has a definable etiology. Identifying small fiber neuropathy and its underlying cause in fibromyalgia patients provides them with a succinct diagnosis, increases treatment options, and facilitates more specific studies for future therapeutics." [This is of concern, as fibromyalgia research indicates FM is a central nervous system dysfunction. This "test" may be indicative of myofascial trigger points or other co-existing condition. We need more research taking into consideration common co-existing illnesses that may be interfering with microcirculation. DJS]

Lewandowski AS, Palermo TM, Stinson J et al. 2010. Systematic review of family functioning in families of children and adolescents with chronic pain. J Pain. 11(11):1027-1038.

Lewin, D. S. and R. E. Dahl.  1999.  Importance of sleep in the management of pediatric pain. J Dev Behav Pediatr 20(4):244-52.

Lewis GK Jr., Langer MD, Henderson CR Jr. et al. 2013. Design and Evaluation of a Wearable Self-Applied Therapeutic Ultrasound Device for Chronic Myofascial Pain. Ultrasound Med Biol. [Jun 3 Epub ahead of print]. "Ultrasound therapy for pain and healing is a versatile treatment modality for musculoskeletal conditions that is used daily in rehabilitation clinics around the world. Our group designed and constructed a wearable, battery-operated, low-intensity therapeutic ultrasound (LITUS) device that patients could self-apply and operate during daily activity for up to 6 h. Thirty patients with chronic trapezius myofascial pain evaluated the LITUS system in a double-blind, placebo-controlled, 10-d study under institutional review board approval. While continuing their prescribed medication regimen, patients with the active device reported on average 1.94× reduction in pain and 1.58× improvement in health relative to placebo devices after 1 h of treatment. Both of these results were statistically significant …for the first 2 d of the study. Male patients reported the majority of benefit…. The study indicates that wearable, long-duration LITUS technology improves mobile access to drug-free pain relief."

Lewis JD, Wassermann EM, Chao W et al. Central sensitization as a component of post-deployment syndrome. NeuroRehabilitation. 31(4):367-372. "Many service members and veterans report chronic unexplained symptoms such as pain, fatigue and memory complaints, which have most recently been characterized as post-deployment syndrome (PDS). Chronic widespread pain is a component of this syndrome, producing significant disability and considerable health care costs. The similarity between the nature of these complaints and other medically unexplained illnesses such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome suggest that they may share a common mechanism. Here, we provide support for PDS as a consequence of pain and sensory amplification secondary to neuroplastic changes within the central nervous system, a phenomenon often termed central sensitization. We also discuss how factors such as stress and genetics may promote chronic widespread pain in veterans and service members who develop PDS." [These patients were not examined for chronic myofascial pain. DJS]

Lewis, K. S.  1998.  Emotional adjustment to a chronic illness.  Lippincotts Prim Care Pract 2(1):38-51.  

Lewis, P. J. 1996. A review of prayer within the role of the holistic nurse.  J Holist Nurs 14(4):308-315..

Lewis RF, Haburcakova C, Gong W et al. 2013. Electrical stimulation of semicircular canal afferents affects the perception of head orientation. J Neurosci. 33(22):9530-9535. "Patients with vestibular dysfunction have visual, perceptual, and postural deficits. ...These results demonstrate that electrical stimulation of canal afferents affects the perception of head orientation, and therefore suggest that motion-modulated stimulation of canal afferents by a vestibular prosthesis could potentially improve vestibular percepts in patients lacking normal vestibular function." [Note: this small study was done in rhesus monkeys. DJS]

Lewit K, Olsanska S. 2004.  Clinical importance of active scars: abnormal scars as a cause of myofascial pain.  J Manipulative Physiol Ther. 27(6):399-402.  “The treatment of active scars can be of importance in a great number of cases; untreated, active scars are an important cause of therapeutic failure.  Treatment also widens the scope of manipulative therapy."

Lewit, K. and D. G. Simons.  1984.  Myofascial pain: relief by post-isometric relaxation. Arch Phys Med Rehabil 65(8):452-6. 

L'Heureux-Lebeau B, Godbout A, Berbiche D et al. 2014. Evaluation of paraclinical tests in the diagnosis of cervicogenic dizziness. Otol Neurotol. [Jul 23 Epub ahead of print.] "Twenty-five subjects with cervicogenic dizziness and 25 subjects with benign paroxysmal positional vertigo….This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups." [The cervicogenic dizziness is probably related to trigger point proprioceptive problems, and patients should be assessed. DJS]

Li, C. M., H. Chiang, Y. D. Fu, B. J. Shao, J. R. Shi and G. D. Yao.  1999. Effects of 50 Hz magnetic fields on gap junctional intercellular communication.  Bioelectromagnetics 20(5):290-4. 

Li G, Yuan H, Zhang W. 2014. Effects of Tai Chi on health related quality of life in patients with chronic conditions: A systematic review of randomized controlled trials. Complement Ther Med. 22(4):743-755. "One of the characters of chronic illness is life-long condition with the deterioration in health related quality of life. Tai Chi has become a popular mind-body exercise and self-management strategy for patients with chronic conditions regarding its various physical and psychological effects…. Tai Chi appears to be safe and has positive effects on health related quality of life in patients with chronic conditions, especially for patients with disorders in Cardio-cerebrovascular and respiratory systems, and musculoskeletal system. However, as the delivery mood of Tai Chi provides multiply benefits, which part of the group provides the most benefit in improving quality of life is unclear. Due to the design limitations of previous studies, more larger and well-designed RCTs are needed to confirm the effects. And qualitative researches are warranted to explore how Tai Chi may work exactly from patients' own perspectives."

Li, J., D. A. Simone and A. A. Larson.  1999.  Windup leads to characteristics of central sensitization.  Pain 79(1):75-82.

Li RM, Franks RH, Dimmitt SG et al. 2011. Ideas and innovations: inclusion of pharmacists in chronic pain management services in a primary care practice. J Opioid Manag. 7(6):484-487. "Nonmalignant chronic pain management involves an ongoing process of complex evaluations including proper patient selection, proper prescribing, and careful monitoring. In the Pain Management Refill Clinic, patients are stabilized on an opioid regimen by either a pain specialist or a primary care physician (PCP). The PCP assumes long-term prescription of the regimen and proper follow-up. The inclusion of pharmacists in the management of patients suffering from chronic pain has allowed the physicians to improve opioid prescribing, documentation, and monitoring in accordance with chronic nonmalignant pain guidelines."

Li S, Micheletti R. 2011. Role of diet in rheumatic disease. Rheum Dis Clin North Am. 37(1):119-133. "Millions of people suffer from rheumatic diseases such as gout, fibromyalgia, osteoarthritis, and rheumatoid arthritis. These can be incapacitating and detrimental to quality of life. Diet, nutrition, and weight loss have shown promise in alleviating some of this disease burden. These lifestyle changes may give patients a feeling of control and ownership over their disease as well as a nonpharmacologic means of treatment. This article reviews the available research on the effects of diet and nutrition on rheumatoid disease."

Li, S. L., H. Goko, Z. D. Xu, G. Kimura, Y. Sun, M. H. Kawachi, T. G. Wilson, S. Wilczynski and Y. Fujita-Yamaguchi.  1998.  Expression of insulin-like growth factor (IGF)-II in human prostate, breast, bladder, and paraganglioma tumors.  Cell Tissue Res 291(3):469-479.

Li W.W., Le Goascogne C., Ramauge M.  Deiodinases of thyroid hormones: induction in the sciatic nerve after injury.  Glia (Suppl 1):S89 [Abstract].

Li YH, Wang FY, Feng CQ et al. 2014. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 9(2):e89304. "Massage therapy with duration ≥5 weeks had beneficial immediate effects on improving pain, anxiety, and depression in patients with FM. Massage therapy should be one of the viable complementary and alternative treatments for FM. However, given fewer eligible studies in subgroup meta-analyses and no evidence on follow-up effects, large-scale randomized controlled trials with long follow-up are warrant to confirm the current findings."

Liao, S. J. and M. K. Liao.  1985.  Acupuncture and tele-electronic infra-red thermography. Acupunct Electrother Res 10(1-2):41-66.

Liboff A.R., Cherng S., Jenrow K.A. et al. 2003. Calmodulin-dependent cyclic nucleotide phosphodiesterase activity is altered by a 20 &mgr; T magnetostatic fields. Bioelectromagnetics 24(1):32-38.  “Calmodulin activation may be functionally sensitive to the geomagnetic field.”

Liedberg GM, Björk M. 2013. Symptoms of subordinated importance in fibromyalgia when differentiating working from non-working women. Work. [Mar 26 Epub ahead of print]. "The non-working (NW) women reported a significantly higher severity of symptoms compared with the working (W) women. The most important variable when differentiating the W from the NW women was social support from colleagues and employers. ...To change prevailing attitudes and values towards persons with a work disability, a process of active intervention involving staff is needed. Educating employers as to how a disability may influence a work situation, and the importance of social support, can be improved." [In the case of women who have such severe pain and other disabling pain and dysfunctions that they cannot work, is it necessary to find another reason that such women who aren't working have greater pain? Where is the logic here? DJS]

Liedberg GM, Henriksson CM.2002.  Factors of importance for work disability in women with fibromyalgia: An interview study.  Arthritis Rheum 15:47(3):266-74. "The ability to remain at work depends not only on limitation in work capacity, but also on the capacity of society to adjust work environments and work tasks.  More individual solutions are needed to allow women with fibromyalgia to maintain work roles."

Liedtke, W. 2006. Transient receptor potential vanilloid channels functioning in transduction of osmotic stimuli.  J Endocrinol 191(3):515-523.  This study suggests that ion channels play a part in mechanosensation, including proprioception.  [Although this was done in invertebrates, it may have implications as myofascial pain is investigated as a possible channelopathy.  It may provide clues as to how proprioception is affected by myofascial TrPs. DJS]

Lienbacher K, Horn AK. 2012. Palisade endings and proprioception in extraocular muscles: a comparison with skeletal muscles. Biol Cybern. [Oct 10 Epub ahead of print]. "This article describes current views on motor and sensory control of extraocular muscles (EOMs) based on anatomical data. The special morphology of EOMs, including their motor innervation, is described in comparison to classical skeletal limb and trunk muscles. The presence of proprioceptive organs is reviewed with emphasis on the palisade endings (PEs), which are unique to EOMs, but the function of which is still debated. In consideration of the current new anatomical data about the location of cell bodies of PEs, a hypothesis on the function of PEs in EOMs and the multiply innervated muscle fibres they are attached to is put forward." [Imagine the effects of TrPs in these muscles. DJS]

Light KC, Bragdon EE, Grewen KM et al. 2009.  Adrenergic dysregulation and pain with and without acute beta-blockade in women with fibromyalgia and temporomandibular disorder.  J Pain. 10(5):542-552.  “These findings support the hypothesis that both FMS and TMD may frequently involve dysregulation of beta-adrenergic activity that contributes to altered cardiovascular and catecholamine responses and to severity of clinical pain.  Acute treatment with low-dose propranolol led to short-term improvement in all these domains.”  [This study adds to the data available on the biochemical inter-relationship between FM and TMD, concluding that dysregulated adrenergic function is associated in females with FM, TMD, or both conditions.  Future studies would benefit by the inclusion of myofascial pain due to TrPs in this mix, using the Travell and Simons criteria, as they often co-exist and interact. DJS]

Lightfoot, R.W. Jr, B. J. Luft, D. W. Rahn, A. C. Steere, L. H. Sigal, D. C. Zoschke, P. Gardner, M. C. Britton and R .L. Kaufman. 1993. Empiric parenteral antibiotic treatment of patients with fibromyalgia and fatigue and a positive serologic result for Lyme disease.  A cost-effectiveness analysis. Ann Intern Med 119(6):503-9.

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Lillefjell M, Haugan T, Martinussen P et al. 2013. Non-ketogenic, low carbohydrate diet predicts lower affective distress, higher energy levels and decreased fibromyalgia symptoms in middle aged females with fibromyalgia syndrome as compared to the western pattern diet. J Musculoskel Pain 21(4):311-319. The non-ketogenic, low-carbohydrate diet improved mood, energy levels and confusional states and other symptoms in patients with fibromyalgia syndrome. [Although the authors mentioned this diet as improvement of "functional" and "affective" symptoms, they may be treating co-existing insulin resistance. DJS]

Lim EC, Seet RC. 2007. Can botulinum toxin put the restless legs syndrome to rest?  Med Hypotheses [Mar 13 Epub ahead of print].  “We postulate that BTX can be injected subcutaneously to the lower limbs to effect amelioration of the symptoms of RLS.”  [This would indicate that the RLS may be caused by MTrPs.  It would be of interest to see if other MTrP treatment would be effective. DJS]

Lin CP, Kang KH, Lin TH et al. 2015. Role of spinal CXCL1 (GRO alpha) in opioid tolerance: A Human-to-rodent translational study. Anesthesiology 122(3):3:666-676. These researches wanted to see if opioid-tolerant patients with cancer had been modified by glial cell activation in the dural tube (the tube holding the spinal cord) by up-regulated cytokines. This process had been found in rats, but not verified in humans. They found that the cytokine "…CXCL1 is up-regulated in both opioid-tolerant patients and rodents." This may be a new avenue for treating opioid tolerance in chronic pain.

Lin MT, Chen HS, Chou LW et al. 2011. Treatment of attachment trigger points in the gluteal muscles to cure chronic gluteal pain: a case report. J Musculoskel Pain. 19(1):31-34. "Chronic myofascial pain syndrome in the gluteal region can be caused by both lumbar facet joint lesion and attachment TrPs of the involved muscles. It is necessary to eliminate the underlying etiological lesions appropriately in order to provide long-term relief of myofascial pain." [A significant number of patients diagnosed with fibromyalgia and/or chronic myofascial pain who have severe pain in spite of strong medication probably have spinal pathomorphologies. There are a number of non-surgical treatments to relieve the pain and decrease central sensitization, such as facet injection and epidural injection. These treatments can buy time, because frequency specific microcurrent can treat these spinal pathomorpholgies once the severe central pain is relieved. This would eliminate a lot of pain, and save a lot of money in disability and surgery. In an ideal world, these would have been prevented. Right now, we must treat what we have, and it is good to have documentation of facet injection helping associated TrPs. DJS]

Lin SY, Neoh CA, Huang YT et al. 2010. Educational program for myofascial pain syndrome. J Altern Complement Med. 16(6):633-640. "Sixty-two (62) patients with a 3-month or longer history of MPS… were randomized to an experimental group (n = 32) or a control group (n = 30). Both groups underwent trigger-point dry needling and muscle-stretch exercise regimen for passively stretching the affected muscles to their normal lengths; the experimental group then watched an 8-minute multimedia instructional video about MPS with supplemental handouts…..Compared to the control group, the experimental group had significantly less interference of pain, lower intensity of present pain, and least pain (p < 0.05)….The findings emphasize the importance of including patient education programs in MPS intervention."'

Lin, T. Y. , M. J. Teixeira, A. A. Fischer, F. G. Barboza, S. T. Immura, R. Mattar Jr.1997. Work-related musculoskeletal disorders. Phys Med Rehab Clin N Am (Philadelphia): ****113-117.

Lin YC, Kuan TS, Hsieh PC et al. 2012. Therapeutic Effects of Lidocaine Patch on Myofascial Pain Syndrome of the Upper Trapezius: A Randomized, Double-Blind, Placebo-Controlled Study. Am J Phys Med Rehabil. [Jul 30 Epub ahead of print]. "The 5% lidocaine patch may be helpful for relieving pain and reducing associated neck disability for a period of longer than one wk for treating patients with trigger points in the upper trapezius."

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Lind BK, Lafferty WE, Tyree PT et al. 2010. Comparison of health care expenditures among insured users and nonusers of complementary and alternative medicine in Washington State: a cost minimization analysis. J Altern Complement Med.16(4):411-417. “This analysis indicates that among insured patients with back pain, fibromyalgia, and menopause symptoms, after minimizing selection bias by matching patients who use CAM providers to those who do not, those who use CAM (complementary and alternative medicine) will have lower insurance expenditures than those who do not use CAM.”

Lind BK, Lafferty WE, Tyree PT et al. 2007.  Use of complementary and alternative medicine providers by fibromyalgia patients under insurance coverage.  Arthritis Rheum. 57(1):71-76.  Even though there were an increased number of health care visits with more CAM use by the most ill patients, the use of CAM was not associated with higher overall cost.  “Until a cure for FMS is found, CAM (complementary and alternative medicines) providers may offer an economic alternative for patients with FMS seeking symptomatic relief.”

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Lindheim, S. R. , S. C. Presser, E. C. Ditkoff, M. A. Vijod, F. Z. Stanczyk and R. A. Lobo. 1993. A possible bimodal effect of estrogen on insulin sensitivity in post menopausal women and the attenuating effect of added progestin. Fertil Steril 60(4):664-7.

Lindsetmo RO, Stulberg J. 2009.  Chronic abdominal wall pain – a diagnostic challenge for the surgeon.  Am J Surg. 198(1):129-134.  Chronic abdominal wall pain is common, occurring in about 30% of patients with chronic abdominal pain.  It is frequently caused by trigger points in the fascia, but is usually misdiagnosed, leading to unnecessary testing and procedures, even surgery.

Ling, F.W. and J. C. Slocumb.  1993.  Use of trigger point injections in chronic pelvic pain. Obstet Gynecol Clin North Am 20(4):809-815.

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Lipkovich IA, Choy EH, Van Wambeke P et al. 2014. Typology of patients with fibromyalgia: cluster analysis of duloxetine study patients. BMC Musculoskelet Disord. 15(1):450. "FM patients are heterogeneous and can be classified into distinct subgroups by simple descriptive rules derived from only 3 variables, which may guide individual patient management. Duloxetine showed higher improvement rates than placebo and had a sustained effect beyond 12 weeks." Free Article

Lipman, A. G.  1987.  Effects of smoking on drug therapy.  Modern Medicine 55:185-186.  The impact of smoking on drug absorption, metabolism, and action.

Liptan G, Mist S, Wright C et al. 2013. A pilot study of myofascial release therapy compared to Swedish massage in fibromyalgia. J Bodw Mov Ther. 17(3):365-370. This small study, with 8 women with FM having myofascial release and 4 having Swedish massage, 90 minutes each for four weeks, indicates that localized pain areas that can lead to central sensitization improved more with myofascial release. This can be important as research indicates that peripheral pain generators are responsible for FM central sensitization. As the study states, larger and more varied studies are needed. [It would be good to compare myofascial release with specific trigger point myotherapy, and with them both used in conjunction. It has been my experience that Swedish massage can help calm the central sensitization, and works well in combination with the other two techniques. We need to work to get these covered by insurance. DJS]

Liptan GL. 2010.  Fascia: a missing link in our understanding of the pathology of fibromyalgia.  J Bodyw Mov Ther. 14(1):3-12.  This is a very interesting study and a promising one.  Until quite recently, FM researchers were unaware of myofascial TrPs and myofascial practitioners were largely unaware of the central sensitization of FM and the need to modify therapies to accommodate it when it occurs in their patients.  FM is the amplifier.  TrPs are the pain generators.  There may be other pain generators, but the TrPs in the fascia (myofascia and other wise) are there and generating symptoms.  There are many of us patients with FM and CMP, and our needs cannot be met until researchers understand the complexity that both of these conditions together can create.  It is refreshing to see that the bridge is finally being built. DJS]

Lipworth L, Holmich LR, McLaughlin JK. 2011. Silicone breast implants and connective tissue disease: no association. Semin Immunopathol. [Jan 10 Epub ahead of print]. "...cosmetic breast implants are not associated with a subsequent increased occurrence of individual CTDs (connective tissue diseases) or all CTDs combined, including fibromyalgia. Moreover, there is no credible evidence for the conjectured excess of 'atypical' CTD among women with cosmetic breast implants, or of a rheumatic symptom profile unique to these women. No increased risk of CTDs is evident in women with extracapsular ruptures in two studies, which evaluated risk by implant rupture status, and no consistent association has been observed between silicone breast implants and a variety of serologic markers or autoantibodies."

Lisboa LL, Sonehara E, Oliveira KC et al. 2015. [Kinesiotherapy effect on quality of life, sexual function and climacteric symptoms in women with fibromyalgia]. Rev Bras Reumatol. [Apr 24 Epub ahead of print.] [Article in Portuguese] "The pelvic floor kinesiotherapy promotes a positive effect in the domains of quality of life, sexual function and climacteric symptoms in women with and without fibromyalgia in the climacteric period; however, fibromyalgia seems to be a limiting factor to achieve better results in some of the aspects evaluated." Free Article [The subjects were not evaluated for co-existing TrPs. DJS]

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Liston MB, Bamiou DE, Martin F et al. 2013. Peripheral vestibular dysfunction is prevalent in older adults experiencing multiple non-syncopal falls versus age-matched non-fallers: a pilot study. Age Ageing. [Sep 15 Epub ahead of print]. "Vestibular dysfunction is significantly more prevalent in older adult fallers versus non-fallers. Individuals referred to a falls clinic are older, more impaired and report more falls than those referred to a neuro-otology department. A greater awareness of vestibular impairments may lead to more effective management and treatment for older adult fallers."

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Liu J, Wang XQ, Zheng JJ et al. 2012. Effects of Tai Chi versus Proprioception Exercise Program on Neuromuscular Function of the Ankle in Elderly People: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2012:265486. "Tai Chi is a traditional Chinese medicine exercise used for improving neuromuscular function. This study aimed to investigate the effects of Tai Chi versus proprioception exercise program on neuromuscular function of the ankle in elderly people...Sixty elderly subjects were randomly allocated into three groups of 20 subjects per group. For 16 consecutive weeks, subjects participated in Tai Chi, proprioception exercise, or no structured exercise. Primary outcome measures included joint position sense and muscle strength of ankle…Results: (1) Both Tai Chi group and proprioception exercise group were significantly better than control group in joint position sense of ankle, and there were no significant differences in joint position sense of ankle between TC group and PE group. (2) There were no significant differences in muscle strength of ankle among groups. (3) Subjects expressed more satisfaction with Tai Chi than with proprioception exercise program…. None of the outcome measures on neuromuscular function at the ankle showed significant change post training in the two structured exercise groups. However, the subjects expressed more interest in and satisfaction with Tai Chi than proprioception exercise."

Liu T, Ji RR. 2013. New insights into the mechanisms of itch: are pain and itch controlled by distinct mechanisms? Pflugers Arch. [May 1 Epub ahead of print]. "Itch and pain are closely related but distinct sensations. They share largely overlapping mediators and receptors, and itch-responding neurons are also sensitive to pain stimuli….Chronic itch results from dysfunction of the immune and nervous system and can manifest as neural plasticity despite the fact that chronic itch is often treated by dermatologists. While differences between acute pain and acute itch are striking, chronic itch and chronic pain share many similar mechanisms, including peripheral sensitization (increased responses of primary sensory neurons to itch and pain mediators), central sensitization (hyperactivity of spinal projection neurons and excitatory interneurons), loss of inhibitory control in the spinal cord, and neuro-immune and neuro-glial interactions. Notably, painful stimuli can elicit itch in some chronic conditions (e.g., atopic dermatitis), and some drugs for treating chronic pain are also effective in chronic itch."

Liu X, Miller YD, Burton NW et al. 2012. The effect of Tai Chi on health-related quality of life in people with elevated blood glucose or diabetes: a randomized controlled trial. Qual Life Res. [Nov 10 Epub ahead of print]. "The aim was to assess the effects of a Tai Chi-based program on health-related quality of life (HR-QOL) in people with elevated blood glucose or diabetes who were not on medication for glucose control." "The findings show that this Tai Chi program improved indicators of HR-QOL including physical functioning, role physical, bodily pain and vitality in people with elevated blood glucose or diabetes who were not on diabetes medication."

Liu YP, Liu S. 2013. Electrical nerve stimulation and the relief of chronic pain through regulation of the accumulation of synaptic Arc protein. Med Hypotheses. [Jun 3 Epub ahead of print]. "Electrical nerve stimulation (ENS) is used in clinical settings for the treatment of chronic pain, but the mechanism underlying its effects remains unknown. ENS has been found to mimic neural activity, inducing the accumulation of Arc in synapses. Activity-dependent synaptic accumulation of Arc protein has been shown to reduce synaptic strength by promoting endocytosis of the AMPA receptors in the synaptic membrane. These receptors play a decisive role in central sensitization, which is one of the main mechanisms underlying chronic pain. It is here hypothesized that ENS induces Arc expression in synapses, where Arc promotes endocytosis of membrane AMPARs that are up-regulated during chronic pain. High frequency and high intensity are characteristics of ENS, which may be effective in the treatment of chronic pain. Stimulation-site of ENS may also influence the outcome of ENS."

Liu Z, Cappola AR, Crofford LJ et al. 2014. Modeling Bivariate Longitudinal Hormone Profiles by Hierarchical State Space Models. J Am Stat Assoc. 109(505):108-118. "The hypothalamic-pituitary-adrenal (HPA) axis is crucial in coping with stress and maintaining homeostasis. Hormones produced by the HPA axis exhibit both complex univariate longitudinal profiles and complex relationships among different hormones. Consequently, modeling these multivariate longitudinal hormone profiles is a challenging task." These authors propose a model to deal with interactive hormone balances. "Application of the proposed method to a study of chronic fatigue syndrome and fibromyalgia reveals that the relationships between adrenocorticotropic hormone and cortisol in the patient group are weaker than in healthy controls".

Liu ZJ, Yamagata K, Kuroe K et al. 2000.  Morphological and positional assessment of TMJ components and lateral pterygoid muscle in relation to symptoms and occlusion of patients with temporomandibular disorders.  J Oral Rehabil 27(10):860-874.  “These findings suggest that TMJ internal derangements are more related to the positional changes or spatial relationships of TMJ components but less to the individual morphologies of TMJ osseous structures, disc and LP (lateral pterygoid), as well as specific clinical symptoms and occlusal factors...” 

Ljoranson, D., Ryan, K.M., Gilson, A.M., Dahl, J.L. 2000. Trends in medical use and abuse of opioid analgesics. Between 1990-1996 the use of all agents, with the exception of meperidine, increased from between 19% and 59%.  Drug abuse due to opioids and narcotics increased by only 6.6%.  As a proportion of all drug abuse, narcotic abuse decreased by 2% in the same period.  Specifically, abuse of meperidine decreased by 39%, oxycodeine by 29%, fentanyl by 59%, and hydromorphine by 15%.  There was a 3% increase in drug abuse related to morphine.

Llamas-Ramos R, Pecos-Martin D, Gallego-Izquierdo T et al. 2014. Comparison of the Short-Term Outcomes between Trigger Point Dry Needling Versus Trigger Point Manual Therapy for the Management of Chronic Mechanical Neck Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 30:1-34. "The results of this clinical trial suggest that 2 sessions of TrP-DN and TrP manual therapy resulted in similar outcomes in terms of pain, disability and cervical range of motion. Those in the TrP-DN group experienced greater improvements in PPT (pressure pain thresholds) over the cervical spine."

Lobbezoo F, Visscher CM, Naeije M. 2004.  Impaired health status, sleep disorders, and pain in the craniomandibular and cervical spinal regions.  Eur J Pain 8(1):23-30.  “Both musculoskeletal pain in the trigemino-cervical area and widespread body pain are associated with an increased impairment of health status.  Also, sleep disorders are frequently found in patients with chronic pain in the craniomandibular and cervical spinal regions as well as in patients with widespread pain.  The more painful areas there are, the likelier it is that sleep disorders are present.”

Lobo CP, Pfalzgraf AR, Giannetti V et al. 2014. Impact of invalidation and trust in physicians on health outcomes in fibromyalgia patients. Prim Care Companion CNS Disord. 16(5). "Patients with fibromyalgia have reported experiencing discouragement, rejection, suspicion, and stigma during their encounters with health care professionals.… The aim of this study was to assess fibromyalgia patients' self-reported quality of life (QoL) and pain based on the following: perceptions of physician attitudes, trust in physicians, perceptions of medical professionals, type of treatment, and various demographic variables….Invalidation, trust in physician, and use of complementary medicine can have significant impact on QoL and pain in fibromyalgia. Further research in more representative fibromyalgia samples may help confirm findings." Free PMC Article

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Loeser JD. 2005.  Quo Vadis. Poena.  J Musculoskeletal Pain 13(3).  This editorial pinpoints some problems in the development of the field of chronic pain management.  One is the use of pain clinics as dumping grounds for complex cases.  Much of chronic pain is preventable, but it is not being prevented.  “Chronic illness will become the major health care issue in the 21st century, as the population ages and infectious diseases are better treated.”  “...we will need pain managements who have a broad overview of the diagnostic and therapeutic strategies that will provide the best possible outcomes.”  “Payers and providers will need to recognize that chronic pain is like diabetes: cure is not the goal.  Instead, management with the goal of minimizing morbidity, improving function, and containing costs is the optimal outcome.”

Loeser JD, Cahana A. 2013. Pain medicine versus pain management: ethical dilemmas created by contemporary medicine and business. Clin J Pain. 29(4):31-316. "The world of health care and the world of business have fundamentally different ethical standards. In the past decades, business principles have progressively invaded medical territories, leading to often unanticipated consequences for both patient and providers. Multidisciplinary pain management has been shown to be more effective than all other forms of health care for chronic pain patient; yet, fewer and fewer multidisciplinary pain management facilities are available in the United States.…We call for increased pin educational experiences for all types of health care providers and the separation of business concepts from pain-related health care." "Despite the talk about evidence-based medicine…the primary driving force behind changes in health care has become economics. …Chronic pain management has not done well in such an environment….chronic pain patients suffer from this more than most other patient groups."

Loeser, RF, Shakoor, N. 2003.  Aging or osteoarthritis: which is the problem?  Rheum Dis Clin North Am 29(4):653-673.  These authors realize that OA is not an inevitable part of getting old, and that the progression of structural deterioration in OA may be prevented by improving neuromuscular function.  Structural damage does not always correspond to joint deterioration, and proprioception is often involved, as is muscle weakness and lack of balance.  What is missing in this article is often at the heart of these things: myofascial trigger points.

Loevinger BL, Muller D, Alonso C et al. 2007.  Metabolic syndrome in women with chronic pain.  Metabolism 56(1):87-93.  “Women with chronic pain from fibromyalgia are at an increased risk for metabolic syndrome...”

Loggia ML, Berna C, Kim J et al. 2014. Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia. Arthritis Rheum. 66(1):203-12. "In this study we investigate potential dysregulation of the neural circuitry underlying cognitive and hedonic aspects of the subjective experience of pain such as anticipation of pain and of pain relief….FMRI was performed on 31 FM patients and 14 controls while they received cuff pressure pain stimuli on their leg, calibrated to elicit a pain rating of ~50/100. During the scan, subjects also received visual cues informing them of impending pain onset (pain anticipation) and pain offset (relief anticipation)….Patients exhibited less robust activations during both anticipation of pain and anticipation of relief within regions commonly thought to be involved in sensory, affective, cognitive and pain-modulatory processes. In healthy controls, direct searches and region-of-interest analyses in the ventral tegmental area (VTA) revealed a pattern of activity compatible with the encoding of punishment: activation during pain anticipation and pain stimulation, but deactivation during relief anticipation. In FM patients, however, VTA activity during pain and anticipation (of both pain and relief) periods was dramatically reduced or abolished….FM patients exhibit disrupted brain responses to reward/punishment. The VTA is a source for reward-linked dopaminergic/GABAergic neurotransmission in the brain and our observations are compatible with reports of altered dopaminergic/GABAergic neurotransmission in FM. Reduced reward/punishment signaling in FM may relate to the augmented central processing of pain and reduced efficacy of opioid treatments in these patients."

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Lombard L., Augustyn M.N., Ascott-Evans B.H.  The metabolic syndrome — pathogenesis, clinical features and management.  Cardiovasc J S Afr 13(4):181-6.  “The metabolic syndrome is a highly prevalent clinical entity, which is often overlooked and may have far-reaching health implications to the patient.  Up to 80% of patients with the metabolic syndrome die as a result of cardiovascular complications.  Insulin resistance is the central component of this complex syndrome and should be appropriately addressed to ensure the best possible outcome for our patients.”

Lommel K, Kapoor S, Bamford J et al. 2009. Juvenile primary fibromyalgia syndrome in an inpatient adolescent psychiatric population. Int J Adolesc Med Health. 21(4):571-579. “Juvenile primary fibromyalgia is highly prevalent in an adolescent inpatient psychiatric unit. This possibility should be taken into consideration when chronic complaints of pain are expressed by patients in this setting, especially in those who have conduct-related issues. The connection between JPFS and abuse history requires further investigation.” [It is hoped that more studies will be done on identifying early warning signs of fibromyalgia and chronic myofascial pain.  If awareness of the importance of symptoms such as unrestorative sleep and growing pain becomes recognized, perhaps we can keep some of these patients from developing chronic pain conditions. DJS]

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Lopez-Rodríguez MM , Fernandez-Martínez M, Mataran-Penarrocha GA et al. 2012. [Effectiveness of aquatic biodance on sleep quality, anxiety and other symptoms in patients with fibromyalgia.] Med Clin (Barc). [Dec 12 Epub ahead of print]. [Spanish] "Aquatic biodance contributed to improvements in sleep quality, anxiety, pain and other fibromyalgia symptoms."

Lopez-Sola M, Pujol J, Wager TD et al. 2014. Altered fMRI responses to non-painful sensory stimulation in fibromyalgia patients. Arthritis Rheumatol. [Sep 15 Epub ahead of print.] "Patients reported increased subjective sensitivity (increased unpleasantness) in response to multisensory stimulation in daily life. FMRI revealed that patients showed reduced task-evoked activation in primary/secondary visual and auditory areas and augmented responses in the insula and anterior lingual gyrus. Reduced responses in visual and auditory areas were correlated with subjective sensory hyper-sensitivity and clinical severity measures….FM patients showed strong attenuation of brain responses to non-painful events in early sensory cortices, accompanied by an amplified response at later stages of sensory integration in the insula. These abnormalities are associated with core fibromyalgia symptoms, suggesting that they may be part of the pathophysiology of the disease."

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Lorduy KM, Liegey-Dougall A, Haggard R et al. 2013. The Prevalence of Comorbid Symptoms of Central Sensitization Syndrome among Three Different Groups of Temporomandibular Disorder Patients. Pain Pract. [Jan 22 Epub ahead of print]. "Myofascial TMD is characterized by a high degree of comorbidity of symptoms of CSS and associated emotional distress." [Patients with TMD should be assessed for myofascial pain due to trigger points, fibromyalgia, and other possible co-existing conditions, and distinction must be made between a general use of the term "myofascial pain" to mean TMJ and myofascial pain due to trigger points. DJS]

Lorenz, J., H. Beck and B. Bromm.  1997.  Cognitive performance, mood and experimental pain before and during morphine-induced analgesia in patients with chronic non-malignant pain. Pain 73(3):369-375.

Loretan S, Duvoisin B, Scolozzi P. 2011. Unusual fatal petrositis presenting as myofascial pain and dysfunction of the temporal muscle. Quintessence Int. 42(5):419-422. "Petrositis is a rare and severe complication of acute otitis media and mastoiditis.... We report here the unusual case of an 86-year-old man who presented with a handicapping myofascial pain and dysfunction syndrome of the right temporal muscle as a heralding manifestation of an unusual form of petrositis. The patient progressively developed a retropharyngeal abscess, a right sphenoid sinusitis, and fatal meningitis..... This case demonstrated that (1) myofascial pain and dysfunction syndrome that does not respond to conventional treatments may suggest an unusual etiology and warrant further medical investigations and a detailed medical history and that (2) petrositis can manifest itself with atypical clinical symptoms and radiologic signs."

Lorton D, Lubahn CL, Estus C et al. 2006.  Bidirectional communication between the brain and the immune system: implications for physiological sleep and disorders with disrupted sleep.  Neuroimmunomodulation. 13(5-6):357-374.  “The central nervous system (CNS) modulates immune function by signaling target cells of the immune system through autonomic and neuroendocrine pathways.  Neurotransmitters and hormones produced and released by these pathways interact with immune cells to alter immune functions, including cytokine production.  Cytokines produced by cells of the immune and nervous systems regulate sleep.  Cytokines released by immune cells, particularly interleukin-1beta and tumor necrosis factor-alpha, signal neuroendocrine, autonomic, limbic and cortical areas of the CNS to affect neural activity and modify behaviors (including sleep), hormone release and autonomic function.  In this manner, immune cells function as a sense organ, informing the CNS of peripheral events related to infection and injury.  Equally important, homeostatic mechanisms, involving all levels of the neuroaxis, are needed, not only to turn off the immune response after a pathogen is cleared or tissue repair is completed, but also to restore and regulate natural diurnal fluctuations in cytokine production and sleep.”  [This shows the interactivity of sleep dysfunction and immune dysfunction, common interactive diagnoses in patients with FM and CMP.  DJS]

Lotaif AC, Mitrirattanakul S, Clark GT. 2006.  Orofacial muscle pain: new advances in concept and therapy.  J Calif Dent Assoc. 34(8):625-630.  “The probable mechanisms underlying chronic myogenous pains and trigger points phenomena are discussed.  Treatment options of the myogenous masticatory pain conditions including physical medicine modalities, as well as several types of pharmacologic agents, are presented.”    

Loth, S., B, Petruson, G. Lindstedt and B. A. Bengtsson.  1998.  Improved nasal breathing in snorers increases nocturnal growth hormone secretion and serum concentrations of insulin-like growth factor 1 subsequently.  Rhinology 36(4):179-83.   

Lotsch J, Geisslinger G, Tegeder I. 2009.  Genetic modulaton of the pharmacological treatment of pain.  Pharmacol Ther. [Jul 15 Epub ahead of print].  “Inadequately treated acute and chronic pain remains a major cause of suffering and dissatisfaction in pain therapy.  A cause for the variable success of pharmacologic pain therapy is the different genetic disposition of patients to develop pain or to respond to analgesics.  The patient’s phenotype may be regarded as the result of synergistic or antagonistic effects of several genetic variants concomitantly present in an individual.  Variants modulate the risk of developing painful disease or its clinical course (e.g., migraine, fibromyalgia, low back pain).  Other variants modulate the perception of pain….”  “Other polymorphisms alter pharmacokinetic mechanisms controlling the local availability of active analgesic molecules at their effector sites (e.g., decreased CYP2D6 related prodrug activation of codeine to morphine).  In addition, genetic variants may alter pharmacodynamic mechanisms controlling the interaction of the analgesic molecules with their target structures (e.g., opioids receptor mutations).  Finally, opioids dosage requirements may be increased depending on the risk of drug addiction….”  [This information is important for care providers and for patients to understand.  It may explain much of the variance of response to medications.  Sadly, genetics are not often taken into consideration when drawing up treatment plans.  This can not only increase long-term cost, it can greatly add to the possibility of multiple drug treatment failures.  DJS]

Lotsch J, Skarke C, Liefhold J et al. 2004.  Genetic predictors of the clinical response to opioid analgesics: clinical utility and future perspectives.  Clin Pharmacokinet. 43(14):983-1013.  Genetics can affect analgesic response to opioids (some patients may need higher doses to achieve the desired analgesia), affect metabolism of opioids, or cause drug reactions. 


Loucks TM, De Nil LF. 2006.  Anomalous sensorimotor integration in adults who stutter: a tendon vibration study.  Neurosci Lett. [May 11 Epub ahead of print]  “AWS (adults who stutter) use proprioceptive information less efficiently than normal speakers, which could interfere with sensorimotor integration during speech production.”  [This study did not evaluate patients for myofascial TrPs, which can often cause proprioceptive dysfunction, although it does mention that movement dysfunction is often associated with stuttering.  Some cases of stuttering may be related to myofascial TrPs, but studies are needed on this.  DJS]

Loudon, J. K., M. Ruhl and E. Field. 1997. Ability to reproduce head position after whiplash injury.  Spine. 22(8):865-8.

Lourenco S, Costa L, Rodrigues AM et al. 2015. Gender and psychosocial context as determinants of fibromyalgia symptoms (fibromyalgia research criteria) in young adults from the general population. Rheumatology (Oxford). [May 14 Epub ahead of print.] "In young adulthood, psychological distress was particularly consistent in predicting SSS (symptom severity score) and may become useful as a red flag for the establishment of clinical disease."

Louter MA, Bosker JE, van Oosterhout WP et al. 2013. Cutaneous allodynia as a predictor of migraine chronification. Brain. [Sep 29 Epub ahead of print]. "Cutaneous allodynia is a risk factor for migraine chronification and may warrant preventive treatment strategies."

Lovati C, Mariotti C, Giani L et al. 2013. Central sensitization in photophobic and non-photophobic migraineurs: possible role of retino nuclear way in the central sensitization process. Neurol Sci. 34 Suppl 1:133-135. "Overall, these findings suggest that light stimulation may contribute to central sensitization of pain pathways in migraineurs, possibly contributing to progression into chronic forms. The possible connections underlying this type of sensitization are offered by the recently published data on a non-image-forming visual retino-thalamo-cortical pathway which may allow photic signals to converge on a thalamic region which is selectively activated during migraine headache."

Lovy, M. R., G. Starkebaum and S. Uberoi. 1996. Hepatitis C infection presenting with rheumatic manifestations: a mimic of rheumatoid arthritis. J Rheumatol 23(6):979-983.

Low LA, Schweinhardt P. 2012. Early Life Adversity as a Risk Factor for Fibromyalgia in Later Life. Pain Res Treat. 2012:140832. "This paper discusses risk factors from early life that may increase the occurrence or severity of FM in later life: pain experience during neonatal life causes long-lasting changes in nociceptive circuitry and increases pain sensitivity in the older organism; premature birth and related stressor exposure cause lasting changes in stress responsitivity; maternal deprivation affects anxiety-like behaviors that may be partially mediated by epigenetic modulation of the genome-all these adult phenotypes are strikingly similar to symptoms displayed by FM sufferers. In addition, childhood trauma and exposure to substances of abuse may cause lasting changes in developing neurotransmitter and endocrine circuits that are linked to anxiety and stress responses."

Lowe JC, Yellin J, Honeyman-Lowe G. 2006.  Female fibromyalgia patients: lower resting metabolic rates than matched healthy controls.  Med Sci Monit. 12(7):CR282-289.  This study indicates that FMS patients have a low metabolic rate, adjusted for patient fat percentage differential.  The study also reiterates what other research has found: that TSH, FT(4) and FT(3) values are not reliable indicators in FMS patients.


Lowe, J.C., Honeyman-Lowe, G. 1999. Ultrasound treatment of trigger points: differences in technique for myofascial pain syndrome and fibromyalgia patients.  This is a report of clinical experience described in terms of an experimental approach without presentation of hard data. The details of treatment depend strongly on what the patient feels.  The caveat that FMS patients are prone to be hyperreactive to ultrasound therapy and need to be treated less vigorously is consistent with their strong reaction to other treatments and life experiences.  It takes much more skill and gentleness to successfully treat MTrPs of FMS patients than uncomplicated MTrPs.

Lowe, J. C. and G. Honeyman-Lowe.  1998.  Facilitating the decrease in fibromyalgic pain during metabolic rehabilitation: an essential role for soft tissue therapies.  J Bodywork &Movement Therapies 2(4):208-217.

Lowe, J. C., M .E. Cullum, L. H. Graf Jr., J. Yellin. 1997.  Mutations in the c-erbA beta gene: do they underlie euthyroid fibromyalgia?  Med Hypo 48 (2): 125-135.

Lu X, Hui-Chan CW, Tsang WW. 2012. Tai Chi, arterial compliance, and muscle strength in older adults. Eur J Prev Cardiol. [Apr 4 Epub ahead of print]. "Aerobic exercise can alleviate the declines in arterial compliance common in older adults. However, when combined with strength training, aerobic exercise may not reduce arterial compliance….Tai Chi practitioners showed significantly better haemodynamic parameters than the controls as indexed by larger and small artery compliance. They also demonstrated greater eccentric muscle strength in both knee extensors and flexors….The findings of better muscle strength without jeopardizing arterial compliance suggests that Tai Chi could be a suitable exercise for older persons to improve both cardiovascular function and muscle strength."

Lubiatowski P, Romanowski L, Kruczynski J et al. 2003.  Proprioception in pathophysiology and treatment of shoulder instability.  Ortop Traumatol Rehabil. 5(4):421-425.  “Restoration of joint proprioception and neuromuscular control seems to be an essential part of treatment in shoulder instability.”  [This may be accomplished, at least in part, by treatment of co-existing MTPs. DJS]

Lucas KR, Rich PA, Polus BI. 2010. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: The effects of Latent Myofascial Trigger Points. Clin Biomech (Bristol, Avon). [Jul 26 Epub ahead of print]. Latent myofascial trigger points can cause major dysfunction and must be taken seriously.

Lucas KR, Rich PA, Polus BI. 2007.  Do latent trigger points affect muscle activation patterns?  J Musculoskel Pain 15 (Supp 13):30 item 49.  [Myopain 2007 Poster]  “LTrPs (latent trigger points) alter the timing of muscle activation in common movement patterns suggesting that they should be treated.  Mechanisms that might mediate the effects observed are proposed.”  [Latent MTPs cause muscle dysfunction and restriction of range of motion, and may affect the way muscle function groups work together.  Care must be taken not to equate MTPs only with pain.  The dysfunction caused must be taken as seriously. DJS]

Lucas N, Macaskill P, Irwig L et al. 2009.  Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature.  Clin J Pain. 25(1):80-89.  This article was based on review of literature.  Myofascial medicine takes time, training and experience.  Most care providers do not have these.   This must change. DJS]

Ludwig DS. 2003. Diet and development of the insulin resistance syndrome.  Asia Pac J Clin Nutr 12 Suppl:S4.  “Among modifiable factors including weight loss and exercise, dietary composition appears to have an important effect on development of IRS.  The available evidence suggests that IRS, and therefore diabetes and cardiovascular disease, can be prevented by a high fiber/low glycemic index diet containing dairy products and a higher amount of unsaturated fat than currently recommended.”

Ludwig, DS, JA Majzoub, A Al-Zahrani, GE Dallal, I Blanco and SB Roberts.  1999.  High glycemic index foods, overeating, and obesity.  Pediatrics 103(3):E26.

Lumley, M., J. Smith, D. Longo. 2002. The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain. Comparisons with self-efficacy, catastrophizing, and depression. Difficulty in recognizing, accepting and describing emotional reactions to myofascial pain symptoms and their impact correlates with the suffering component of the illness, independent of self-efficacy or catastrophizing.

Lund, B. C., K. A. Bever-Stille and P. J. Perry.  1999.  Testosterone and andropause: the feasibility of testosterone replacement therapy in elderly men.  Pharmacotherapy 19(8):951-6.

Lund E, Kendall SA, Janerot-Sjoberg B et al. 2003.  Muscle metabolism in fibromyalgia studied by P-31 magnetic resonance spectroscopy during aerobic and anaerobic exercise.  Scand J Rheumatol 32(3):138-145.  “Fibromyalgia patients seem to utilize less of the energy rich phosphorus metabolites at maximal work despite pH reduction.  They seemed to be less aerobically fit and reached the anaerobic threshold earlier than the controls.”

Lund N, Bengtsson A, Thorborg P. 1986.  Muscle tissue oxygen pressure in primary fibromyalgia.  Scand j Rheumatol. 15(2):165-173.  “The conclusion is that in patients with primary fibromyalgia, the muscle oxygenation is abnormal or low, at least in the trigger point area of the muscles.”  [These findings may have been due to co-existing myofascial TrPs creating microcirculation problems and energy crises.  They must learn that trigger points are NOT part of fibromyalgia but are rather part of myofascial pain, a totally different condition.  Researchers must consider co-existing TrPs as possible cause of what they are attributing to FM, or their conclusions will remain faulty and suspect and generate more faulty research based upon them. DJS]

Lundberg G, Anderberg UM, Gerdle B. 2009.  Personality features in female fibromyalgia syndrome.  J Musculoskel Pain. 17(2):117-130.

Lundberg M, Larsson M, Ostlund H et al. 2006.  Kinesiophobia among patients with musculoskeletal pain in primary healthcare.  J Rehabil Med. 38(1):37-43.  “…factors that seemed to be associated with kinesiophobia were interference, disability, pain severity, pain intensity, life control, affective distress, depressed mood and solicitous response.  The multiple logistic regression analysis showed no significant associations.”  “Kinesiophobia is a commonly seen factor among patients with musculoskeletal pain, which ought to be taken into consideration when designing and performing rehabilitation programs.”  [It is also important to understand that myofascial TrPs cause pain at the end of the range of motion, and it is logical for the patient to avoid range of motion when there is pain at the end of that range of motion.  The TrPs must be treated and the range of motion restored as much as possible so that the reason for the fear is removed.  Only then can remaining fear be considered as true kinesiophobia.  DJS]

Lundeberg, T., K. Uvnas-Moberg, G. Agren and G. Bruzelius.  1994.  Anti-nociceptive effects of oxytocin in rats and mice.  Neurosci Lett 170(1):153-157.

Luomala T, Pihlman M Heiskanen J et al. 2014. Case study: Could ultrasound and elastography visualize densified areas inside the deep fascia? J Bodyw Mov Ther. 18(3):462-468. "Many manual techniques describe palpable changes in the subcutaneous tissue. Many manual therapists have perceived palpable tissue stiffness and how it changes after treatment. No clear demonstration exists of the presence of specific alterations in the subcutaneous tissue and even less a visualization of their changes following manual therapy. This case study visualizes by ultrasound and elastography an alteration of the deep fascia in a 40-year-old male with subacute pain in the calf area. Ultrasound and elastography permits visualization of gliding, echogenicity and elasticity of deep fascia and their changes, after manual therapy (Fascial Manipulation(©)). This study suggests the possible use of the ultrasound and elastography to furnish a more objective picture of the "sensations" that are commonly reported by manual therapists, and which supports clinicians in the diagnosis of the myofascial pain."

Luoto, S., S. Taimela, H. Hurri and H. Alaranta.  1999.  Mechanisms explaining the association between low back trouble and deficits in information processing.  A controlled study with follow-up.  Spine 24(3):255-61.  

Luoto, S., H. Aalto, S. Taimela, H. Hurri, I. Pyykko and H. Alaranta.  1998.  One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy subjects.  A controlled study with follow-up.  Spine 23(19):2089-90.

Lupien, S. J., S. Gaudreau, B. M. Tchiteya, F. Maheu, S. Sharma, N. P. Nair, R. L. Hauger, B. S. McEwen and M. J. Meaney.  1997.  Stress-induced declarative memory impairment in healthy elderly subjects: relationship to cortisol reactivity.  J Clin Endocrinol Metab 82(7):2070-5. 

Lupien, S. J. and McEwen B. S. 1997. The acute effects of corticosteroids on cognition: integration of animal and human model studies.  Brain Res Brain Res Rev 24(1): 1-27. 

Lupien, S.J., N. P. Nair, S. Briere, F. Maheu, M. T. Tu, M. Lemay, B. S. McEwen, M. J. Meaney. 1999. Increased cortisol levels and impaired cognition in human aging: implication for depression and dementia in later life. Rev Neurosci 10(2):17-39.

Lurie, M. , K. Caidahl , G. Johansson and B. Bake. 1990. Respiratory function in chronic primary fibromyalgia. Scand J Rehabil Med 22(3):151-5.

Lutz J, Schelling G, Stahl R et al.  Diffuse Tensor Imaging (DTI) danisotropic changes in the brain associated with chronic low back pain.  Radiological Society of North America Conference 29 Nov 2006.  Chicago IL.  (Conf. Nov 26-Dec 1)  “...chronification of lower back pain is associated with cortical and subcortical microstructural anisotropy changes .... these results argue for plastic changes of the cingulate gyrus, postcentral gyrus and the prefrontal cortex in chronic pain processing.”  There are microstructural changes in the brains of chronic pain patients, and DTI may explain and map some of what is happening in chronic pain.

Lyketsos, C. G., E. Garrett, K. Y. Liang and J. C. Anthony.  1999.  Cannabis use and cognitive decline in persons under 65 years of age.  Am J Epidemiol 149(9):794-800.

Lynch JJ 3rd, Wade CL, Mikusa JP et al. 2005.  ABT-594 (a nicotinic acetylcholine agonist): anti-allodynia in a rat chemotherapy-induced pain model.  Eur J Pharmacol. 509(1):43-48.  ABT-594 ((R)-5-(2-azetidinylmethoxy)-2-chloropyridine is in a new class of pain relievers.  They work mainly by activating nicotinic acetylcholine receptors in the neurons.  This medication blocks the main pain transmitter receptors (acute and chronic pain) and also affects local pain signaling that can contribute to central sensitization, without toxic side effects.  [Phase II human trials for acute and chronic pain are about to begin on this medication which is a synthetic variation of Epibatidine without the toxicity of that compound. DJS]

Lynch ME, Campbell F. 2011. Cannabinoids for Treatment of Chronic Non-Cancer Pain; a Systematic Review of Randomized Trials. Br J Clin Pharmacol. [Mar 23 Epub ahead of print]. "Chronic non-cancer pain conditions included neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Overall the quality of trials was excellent. Fifteen of the eighteen trials that met inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared to placebo, several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases. Overall there is evidence that cannabinoids are safe and modestly effective in neuropathic pain with preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. The context of the need for additional treatments for chronic pain is reviewed. Further large studies of longer duration examining specific cannabinoids in homogeneous populations are required."

Lyons KS, Jones KD, Bennett RM et al. 2013. Couple perceptions of fibromyalgia symptoms: The role of communication. Pain. [Jul 18 Epub ahead of print]. "The objectives of the current study were to 1) describe fibromyalgia patient-spouse incongruence regarding patient pain, fatigue, and physical function and 2) examine the associations of individual and interpersonal factors with patient-spouse incongruence. Two hundred four fibromyalgia patients and their co-residing partners rated the patient's symptoms and function. Multilevel modeling revealed that spouses, on average, rated patient fatigue significantly lower than patients. Couple incongruence was not significantly different from zero, on average, for pain severity, interference, or physical function. However, there was significant variability across couples in how they rated the severity of symptoms and function, and how much incongruence existed within couples. Controlling for individual factors, patient and spouse reports of communication problems were significantly associated with levels of couple incongruence regarding patient fatigue and physical function, albeit in opposing directions. Across couples, incongruence was high when patients rated communication problems as high; incongruence was low when spouses rated communication problems as high. An important within-couple interaction was found for pain interference suggesting couples who are similar on level of communication problems experience low incongruence; those with disparate ratings of communication problems experience high incongruence. Findings suggest the important roles of spouse response and the patient's perception of how well the couple is communicating. Couple-level interventions targeting communication or other interpersonal factors may help to decrease incongruence and lead to better patient outcomes."


Ma C, Wu S, Li G et al. 2010. Comparison of miniscalpel-needle release, acupuncture needling, and stretching exercise to trigger point in myofascial pain syndrome. Clin J Pain. 26(3):251-7.  “Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. Several methods have been recommended for the inactivation of trigger points (TrPs). We carried out this study to investigate the effectiveness of miniscalpel-needle (MSN) release and acupuncture needling and self neck-stretching exercises on myofascial TrPs of the upper trapezius muscle.” This study found “the effectiveness of MSN release for MPS is superior to that of acupuncture needling treatment or self neck-stretching exercises alone. The MSN release is also safe, without severe side effects in treatment of MPS.” [The comparison may look good, but there are numerous techniques that may be at least as effective. Stretching alone is not an adequate treatment for TrPs in my opinion, and I would like to see this technique compared with the Travell and Simons’ technique (incorporating  proper positioning and full range of moti) of TrP injection with procaine or lidocaine, barrier release and spray and stretch. It is important to remember that no matter what the technique employed, control of perpetuating factors is critical to lasting treatment effect. DJS] 

Ma W, Quirion R. 2014. Targeting cell surface trafficking of pain-facilitating receptors to treat chronic pain conditions. Expert Opin Ther Targets. [Feb 10 Epub ahead of print.] "Pain mediators stimulate forward surface trafficking of their own and/or other pain-facilitating receptors to amplify pain intensity and duration. Enhancing surface abundance of pain-facilitating receptors in nociceptors and dorsal horn neurons is an important mechanism underpinning chronic pain states. Targeting specific trafficking events of pain-facilitating receptors may open a novel therapeutic avenue to more efficiently treat chronic pain conditions."

Ma Y, Bu H, Jia JR et al. 2012. [Progress of research on acupuncture at trigger point for myofascial pain syndrome] 32(6):573-576. [Chinese]. This literature review covered acupuncture used on TrPs, taking into consideration both Traditional Chinese Medicine and modern clinical research applications. This review indicates that acupuncture on specific myofascial TrPs can significantly affect myofascial pain, but that results could be influenced by a number of variables including needle size and needling technique. Existing studies are insufficient and inconsistent, with inadequate use of clinical diagnostic standards. Good studies are needed.

Mabry, R. L. and C. S. Mabry. 2000.  Allergic fungal sinusitis: the role of immunotherapy Otolaryngol Clin North Am 33(2):433-440.

MacDougall HG, Moore ST, Black RA et al. 2009.  On-road assessment of driving performance in bilateral vestibular-deficient patients.  Ann N Y Acad Sci. 1164:413-418.  “This has important implications for driver licensing, road-safety policy, and for the potential successful rehabilitation of vestibular patients.  Patients with unilateral vestibular dysfunction may have more difficulty driving than their bilateral counterparts.”  [This can be critical, as many patients with FM may have co-existing vestibular dysfunction. DJS]

Macedo JA, Hesse J, Turner JD et al. 2007.  Adhesion molecules and cytokine expression in fibromyalgia patients: increased L-selectin on monocytes and neutrophils.  J Neuroimmunol.  [Jun 27 Epub ahead of print]  “This study shows a slight disturbance in the innate immune system of FM patients and suggests an enhanced adhesion and recruitment of leukocytes to inflammatory sites.”

Macerollo AA, Mack DO, Oza R et al. 2014. Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain. J Opioid Manag. 10(4):255-261. "This study was part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance omnibus survey of active academic US family physicians….Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription."

Macgregor J, von Schweinitz DG. 2006.  Needle electromyographic activity of myofascial trigger points and control sites in equine cleidobrachialis muscle – an observational study.  Acupunct Med. 24(2):61-70.  “Equine myofascial trigger points can be identified and have similar objective signs and electrophysiological properties to those documented in human and rabbit skeletal muscle tissue.  The important differences from findings in human studies are that referred pain patterns and the reproduction of pain profile cannot be determined in animals."

Madeleine P, Vangsgaard S, Hviid Andersen J et al. 2013. Computer work and self-reported variables on anthropometrics, computer usage, work ability, productivity, pain and physical activity. BMC Musculoskel Disord 14:226. "The differences in pain characteristics, i.e., higher intensity, longer duration and more pain locations as well as poorer work ability reported by women workers relate to their higher risk of contracting WMSD (work-related musculoskeletal disorders). Overall, this investigation confirmed the complex interplay between anthropometrics, work ability, productivity, and pain perception among computer workers."

Madill SJ, McLean L. 2010. Intravaginal pressure generated during voluntary pelvic floor muscle contractions and during coughing: the affect of age and continence status. Neurolog Urodyn 29(3):437-442. As they age, women often recruit pelvic floor muscles to compensate for weakness in the urethral sphincter or fascia. [This can lead to increasing symptoms, as tight pelvic floor muscles due to TrPs are a common cause of stress incontinence. DJS]

Maekawa K, Clark GT, Kuboki T. 2002.  Intramuscular hypoperfusion, adrenergic receptors, and chronic muscular pain. Aug 3(4):251-260.  This review focuses on the sympathetic connection between fibromyalgia and myofascial pain.  The authors state “What cannot be done at this time and is needed in the future is to compare and contrast to what degree the regional muscle pain disorder (myofascial) is similar or different from the more generalized disorder (fibromyalgia.)”  I agree that it must be done.  I also think that it can be.

Maes, M., I. Libbrecht, F. Van Hunsel, A. H. Lin, L. De Clerck, W. Stevens, G. Kenis, R. de Jongh, E. Bosmans and H. Neels. 1999. The immune-inflammatory pathophysiology of fibromyalgia: increased serum soluble gp130, the common signal transducer protein of various neurotrophic cytokines.

Maes, M., A. Lin, S. Bonaccorso, F. Van Hunsel, A. Van Gastel, L. Delmeire, M. Biondi, E. Bosmans, G. Kenis and S. Scharpe. 1998. Increased 24-hour urinary cortisol excretion in patients with post-traumatic stress disorder and patients with major depression, but not in patients with fibromyalgia. Acta Psychiatr Scand 98(4):328-35.

Maes M, Twisk FN, Johnson C. 2012. Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and Chronic Fatigue (CF) are distinguished accurately: Results of supervised learning techniques applied on clinical and inflammatory data. Psychiatry Res. [Apr 20 Epub ahead of print]. "There is much debate on the diagnostic classification of Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) and chronic fatigue (CF). Post-exertional malaise (PEM) is stressed as a key feature. This study examines whether CF and CFS, with and without PEM, are distinct diagnostic categories. Fukuda's criteria were used to diagnose 144 patients with chronic fatigue and identify patients with CFS and CF, i.e. those not fulfilling the Fukuda's criteria. PEM was rated by means of a scale with defined scale steps between 0 and 6. CFS patients were divided into those with PEM lasting more than 24h (labeled: ME) and without PEM (labeled: CFS). The 12-item Fibromyalgia and Chronic Fatigue Syndrome (FF) Rating Scale was used to measure severity of illness. Plasma interleukin-1 (IL-1), tumor necrosis factor (TNF)α , and lysozyme, and serum neopterin were employed as external validating criteria. Using fatigue, a subjective feeling of infection and PEM we found that ME, CFS, and CF were distinct categories. Patients with ME had significantly higher scores on concentration difficulties and a subjective experience of infection, and higher levels of IL-1, TNFα, and neopterin than patients with CFS. These biomarkers were significantly higher in ME and CFS than in CF patients. PEM loaded highly on the first two factors subtracted from the data set, i.e. "malaise-sickness" and "malaise-hyperalgesia". Fukuda's criteria are adequate to make a distinction between ME/CFS and CF, but ME/CFS patients should be subdivided into ME (with PEM) and CFS (without PEM)."

Maeshima E, Furukawa K. 2012. A case of fibromyalgia syndrome with anaphylaxis induced by intradermal injection of purified protein derivative. Mod Rheumatol. [Jun 10 Epub ahead of print]. "When a 36-year-old woman with fibromyalgia syndrome (FMS) underwent the tuberculin test, urticaria developed on her trunk at 30 min after intradermal injection of purified protein derivative. Although the urticaria resolved, fever, facial edema, and generalized urticaria occurred after 8 h. A patient with FMS who developed a systemic allergic reaction after an intradermal skin test has not been reported. We should pay attention to anaphylactic reactions after intradermal injection in patients with FMS."

Magaldi M, Moltoni L, Biasi G, Marcolongo R. 2000. Role of intracellular calcium ions in the physiopathology of fibromyalgia syndrome. Boll Soc Ital Biol Sper (1-2:)1-4. "In fibromyalgia patients the intracellular calcium concentration is significantly reduced in comparison to that of healthy controls: the reduced intracellular calcium concentration seems to be a peculiar characteristic of fibromyalgia patients and may be potentially responsible for muscular hypertonus."

Maggi RG, Mozayeni BR, Pultorak EL et al. 2012. Bartonella spp. Bacteremia and Rheumatic Symptoms in Patients from Lyme Disease-endemic Region. Emerg Infect Dis. 18(5):783-791. "Bartonella spp. infection has been reported in association with an expanding spectrum of symptoms and lesions. Among 296 patients examined by a rheumatologist, prevalence of antibodies against Bartonella henselae, B. koehlerae, or B. vinsonii subsp. berkhoffii (185 [62%]) and Bartonella spp. bacteremia (122 [41.1%]) was high. Conditions diagnosed before referral included Lyme disease (46.6%), arthralgia/arthritis (20.6%), chronic fatigue (19.6%), and fibromyalgia (6.1%). B. henselae bacteremia was significantly associated with prior referral to a neurologist, most often for blurred vision, subcortical neurologic deficits, or numbness in the extremities, whereas B. koehlerae bacteremia was associated with examination by an infectious disease physician. This cross-sectional study cannot establish a causal link between Bartonella spp. infection and the high frequency of neurologic symptoms, myalgia, joint pain, or progressive arthropathy in this population; however, the contribution of Bartonella spp. infection, if any, to these symptoms should be systematically investigated."

Magnusson, M. L., M. H. Pope, L. Hasselquist, K. M. Bolte, M. Ross, V. K. Goel, J. S. Lee, K. Spratt, C. R. Clark and D. G. Wilder. 1999. Cervical electromyographic activity during low-speed rear impact. Eur Spine J 8(2):118-25.

Magnussen, T. 1994. Extra cervical symptoms after whiplash trauma. Cephalalgia 14(3):223-227.

Magrey MN, Antonelli M, James N et al. 2013. High frequency of fibromyalgia in patients with psoriatic arthritis: a pilot study. Arthritis. [Feb 14 Epub ahead of print]. "FMS-associated pain and fatigue are significantly more frequent in patients with PsA compared to controls."

Mahakkanukrauh P, Surin P, Vaidhayakam P. 2005. Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament. Clin Anat 18(3):200-205. The pudendal nerve can be entrapped in a variety of places. "Eight of fifteen rectal nerves pierced through the sacrospinous ligament, perhaps making it prone for entrapment." [Deep ligaments may be the site of TrP nerve entrapment. DJS]

Maher, J. 2000. Report investigating the importance of head restraint positioning in reducing neck injury in rear impact. Accid Anal Prev 32(2):299-305.

Maher RM, Hayes DM, Shinohara, M. 2013. Quantification of dry needling and posture effects on myofascial trigger points using ultrasound shear-wave elastography. Arch Phys Med Rehabil. 94(11):2146-2150. "The shear modulus measured with ultrasound SWE (shear-wave elastography) reduced after DN (dry needling) and in the prone position compared with sitting, in agreement with reductions in palpable stiffness. These findings suggest that DN and posture have significant effects on the shear modulus of MTrPs, and that shear modulus measurement with ultrasound SWE may be sensitive enough to detect these effects."

Mahowald ML, Singh JA, Majeski P. 2005.  Opioid use by patients in an orthopedics spine clinic.  Arthritis Rheum. 52(1):312-321.  “This study provides clinical evidence to support and protect physicians treating patients with chronic musculoskeletal diseases, who may be reluctant to prescribe opioids because of possible sanctions from regulatory agencies.  More important, it will benefit patients by permitting them to receive these effective, safe medications.

Maiese K, Chong ZZ, Li F. 2005.  Driving cellular plasticity and survival through the signal transduction pathways of metabotropic glutamate receptors.  Curr Neurovasc Res. 2(5):425-446.  “Metabotropic glutamate receptor (mGluRs)…system impacts upon neuronal, vascular, and glial cell function and is activated by a wide variety of stimuli that includes neurotransmitters, peptides, hormones, growth factors, ions, lipids, and light.  Employing signal transduction pathways that can modulate both excitatory and inhibitory responses, the mGluR system drives a spectrum of cellular pathways that involve protein kinases, endonucleases, cellular acidity, energy metabolism, mitochrondrial membrane potential, caspases, and specific mitogen-activated protein kinases.  Ultimately these pathways can converge to regulate genomic DNA degradation, membrane phosphatidylserine (PS) residue exposure, and inflammatory microglial activation.”

Maigne JY, Doursounian L. 1997.  Entrapment neuropathy of the medial superior cluneal nerve.  Nineteen cases surgically treated, with a minimum of 2 years’ follow-up.  Spine 22(10):1156-1159. “Nineteen patients suffering from unilateral low back pain projecting in the territory of the medial superior cluneal nerve, with a trigger point at the posterior iliac crest and with a positive block test at this level, underwent surgery.  Results: Results were excellent in 13 cases (7 of which had suffered from severe compression), and unsatisfactory in 6 cases (including 4 cases in whom no compression could be demonstrated).  Conclusion: Entrapment neuropathy of the medial superior cluneal nerve is a rare and easily treatable cause of unilateral low back pain.”

Maigne JY, Maigne R. 1991.  Trigger point of the posterior iliac crest: painful iliolumbar ligament insertion or cutaneous dorsal ramus pain?  An anatomic study.  Arch Phys Med Rehabil. 72(10):734-737.  “A trigger point is frequently found over the iliac crest at 7 to 8 cm from the midline in low-back-pain syndromes.”  “The iliac insertion of the iliolumbar ligament is inaccessible to palpation, being shielded by the iliac crest.”  “The authors conclude that the trigger point sometimes localized over the iliac crest at 7 cm from the midline likely corresponds to elicited pain from a cutaneous dorsal ramus originating from the thoracolumbar junction rather than from the iliac insertion of the iliolumbar ligament.”

Maigne, R. 1997. Pain syndromes of the thoracolumbar junction. Myofascial Pain–Update in Diagnosis and Treatment. Phys Med Rehab Clin North Am 8(1):87-100.

Mailis A, Papagapiou M, Umana M, Cohodarevic T, Nowak J, Nicholson K.  Unexplainable nondermatomal somatosensory deficits in patients with chronic nonmalignant pain in the context of litigation/compensation: a role for involvement of central factors? J Rheumatol 2001 28(6):1385-93. Nondermatomal somatosensory deficits (NDSD), commonly associated with chronic pain conditions, may often be associated with impairment of vibration, reduced strength, dexterity of movement, and extreme sensitivity to superficial skin palpation or profound insensitivity to deep pain. Spatial, temporal, qualitative, and evolutionary patterns of NDSD emerged associated with cognitive/affective symptoms.

Maitre M, Humbert JP, Kemmel V et al. 2005.  [A mechanism for gamma-hydroxybutyrate (GHB) as a drug and a substance of abuse.]  Med Sci (Paris) 21(3):284-289. [French]  “Gamma-hydroxybutyrate (GHB) increases slow-wave deep sleep and the secretion of growth hormone and besides its role in anesthesia, it is used in several therapeutic indications including alcohol withdrawal, control of daytime sleep attacks and cataplexy in narcoleptic patients and is proposed for the treatment of fibromyalgia.”


Maizels M, McCarberg B. 2005.  Antidepressants and antiepileptic drugs for chronic non-cancer pain.  Am Fam Physician 71(3):483-490.  “The development of newer classes of antidepressants and second-generation antiepileptic drugs has created unprecedented opportunities for the treatment of chronic pain.  These drugs modulate pain transmission by interacting with specific neurotransmitters and ion channels...  Tricyclic antidepressants have documented (although limited) efficacy in the treatment of fibromyalgia and chronic low back pain.  Recent evidence suggests that duloxetine and pregabalin have modest efficacy in patients with fibromyalgia.”


Majlesi J, Unalan H. 2004.  High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double blind, case-control study.  Arch Phys Med Rehabil 85:833-836.  This study found that high-power ultrasound, using a specific technique, can quickly find and treat TrPs.  [There was no significant change in range of motion, which may indicate that the TrPs were simply rendered latent, but the pain levels were reduced significantly.  This therapy shows promise, although there are some areas in which it cannot be utilized.  DJS]


Majlesi J, uNalan H.  2004.  High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points:  A randomized, double-blind, case-control study.  Arch Phys Med Rehabil. 85(5):833-836.  This technique was more effective than conventional ultrasound.

Mak, M.K., Ng, P.L. 2003.  Mediolateral sway in single-leg stance is the best discriminator of balance performance for T’ai-Chi practitioners.  Arch Phys Med Rehabil 84(5):683-686.  “T’ai-chi practitioners performed better both in clinical and laboratory tests when compared with subjects who did not practice T'ai Chi. More T'ai-Chi experience was associated with better postural control.  [It may be helpful for patients with myofascial TrPs who are t’ai chi players (and their medical team) to remember this, persevere, and concentrate on TrPs that affect mediolateral sway balance. DJS]

Makolkin, V.I., Podzolkov V.I., Napalkov D.A. 2002. [Metabolic syndrome from the point of view of a cardiologist: diagnosis, non drug and drug treatment.] Kardiologiia 42(12:91-7.  [Russian]  “Timely diagnosis and treatment of metabolic syndrome is important because of high prevalence of this pathology....For correction of metabolic changes metformin is used in addition to non drug methods which include diet and exercise.  Treatment with metformin allows to decrease insulin resistance and thus severity of derangements of metabolism.  [Metformin is an inexpensive and useful part of control of metabolic syndrome. DJS]

Malanga G, Wolff E. 2008.  Evidence-informed management of chronic low back pain with trigger point injections.  Spine J. 8(1):243-252.  “The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden.  Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers.”  [Stakeholders?  Why are “stakeholders” making medical decisions?  Shouldn’t medical decisions be based on what is best for the patient?  The vast majority of chronic low back pain has been shown to be due to myofascial TrPs.  Training in diagnosis and treatment of same would go far to relieve patient symptom and financial burden, and actually help those stakeholders as proper myofascial education would go far to relieving socioeconomic burden and prevent future chronicity.  Care providers, and “stakeholders,” need to be educated in myofascial pain. DJS]


Malanga GA, Cruz Colon EJ. 2010. Myofascial low back pain: a review. Phys Med Rehabil Clin N Am. 21(4):711-724. Myofascia pain is common, found in up to 95% of chronic pain patients. TrPs can occur in muscle, fascia or tendons, and are often caused by muscle imbalance. [Often they are the cause of muscle imbalance DJS] There is a wide variety of treatment options, but steroids should not be used for TrP injection therapy.

Malanga GA, Gwynn MW, Smith R et al. 2002.  Tizanidine is effective in the treatment of myofascial pain syndrome.  Pain Physician 5(4):422-432.

Malhotra D, Saxena AK, Dar A+SA, et al. 2012. Evaluation of cytokine levels in fibromyalgia syndrome patients and its relationship to the severity of chronic pain. J Musculoskel Pain. 20(3):164-169. [Elevated levels of cytokines and other pro-inflammatory substances have been implicated in fibromyalgia. This study indicates that Interleukin-6, a pro-inflammatory substance, may be active in the process of increased pain in fibromyalgia. This indicates a possible role of inflammation in fibromyalgia. While not an inflammatory disease per se, IL-6, a pro-inflammatory cytokine, does affect glial cells as shown in the research of Dr. Linda Watkins and her team. [see Wieseler-Frank J, Maier SF, Watkins LR. 2005. Immune-to-brain communication dynamically modulates pain: physiological and pathological consequences. Brain Behav Immun. 19(2):104-111.] Pro-inflammatory cytokines can cause diffuse muscle aches, fatigue, hyperalgesia, depressed mood, and may other symptoms associated with FM. The authors urge large multicenter investigations, and explain that the exact role of inflammation in FM is not fully established. We hope for more research to follow up this excellent article. DJS]

Malin K, Littlejohn GO. 2012. Personality and fibromyalgia syndrome. Open Rheumatol J. 6:273-285. "No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person's response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism."

Malin K, Littlejohn GO. 2012. Psychological control is a key modulator of fibromyalgia symptoms and comorbidities. J Pain Res. 5:463-471. "FM patients use significantly different control styles compared with healthy individuals. Levels and type of psychological control buffer mood, stress, fatigue, and pain in FM. Control appears to be an important "up-stream" process in FM mechanisms and is amenable to intervention."

Malleson, P. N., M. al-Matar and R. E. Petty. 1992. Idiopathic musculoskeletal pain syndromes in children. J Rheumatol 19(11):1786-1789.

Mallinson, A. I. and N. S. Longridge. 1998. Dizziness from whiplash and head injury: differences between whiplash and head injury. Am J Otol 19(6):814-8.

Mallorquí-Bague N, Bulbena A, Roe-Vellve N et al. 2015. Emotion processing in joint hypermobility: A potential link to the neural bases of anxiety and related somatic symptoms in collagen anomalies. Eur Psychiatry. [Feb 12 Epub ahead of print.] This article from Spain found: "Joint hypermobility syndrome (JHS) has repeatedly been associated with anxiety and anxiety disorders, fibromyalgia, irritable bowel syndrome and temporomandibular joint disorder. However, the neural underpinnings of these associations still remain unclear. This study explored brain responses to facial visual stimuli with emotional cues using fMRI techniques in general population with different ranges of hypermobility….Hypermobility scores are associated with trait anxiety and higher brain responses to emotional faces in emotion processing brain areas (including hippocampus) described to be linked to anxiety and somatic symptoms. These findings increase our understanding of emotion processing in people bearing this heritable variant of collagen and the mechanisms through which vulnerability to anxiety and somatic symptoms arise in this population." [This is an article in a psychiatry journal; the authors looked at this condition through that lens. DJS]

Malmberg, A. B., C. Chen, S. Tonegawa and A.I. Basbaum. 1997. Preserved acute pain and reduced neuropathic pain in mice lacking PKCgamma. Science 278(5336):279-83.

Malmstrom EM, Karlberg M, Holmstrom E et al. 2010. Influence of prolonged unilateral cervical muscle contraction on head repositioning - decreased overshoot after a 5-min. static muscle contraction task. Man Ther. [Jan 16 Epub ahead of print].  “The ability to reproduce a specified head-on-trunk position can be an indirect test of cervical proprioception. This ability is affected in subjects with neck pain, but it is unclear whether and how much pain or continuous muscle contraction factors contribute to this effect…..  After contraction, the “…increased accuracy was most pronounced for movements directed towards the activated side. Hence, prolonged unilateral neck muscle contraction may increase the sensitivity of cervical proprioceptors.”  [It is known that prolonged contraction can activate TrPs, and that they are associated with proprioceptor dysfunction. DJS]

Mamelak M. 2000.  The motor vehicle collision injury syndrome.  Neuropsychiatry Neuropsychol Behav Neurol. 13(2):125-135.  “Occupants of motor vehicles involved in a collision often develop a disabling syndrome consisting of head, neck and back pain; impaired short-term memory and concentration; fatigue and a loss of stamina; poor balance; and a change in personality.  Injury victims experience a loss of motivation, emotional lability, and a decrease in libido.  It is hypothesized that the collision impact produces an inertial strain injury to the anterior regions of the brain which depresses the functions of the frontotemporal lobes, at the same time, sensitizing somatosensory neural afferent systems.  Damage to the orbital surfaces of the frontotemporal lobes, in particular, impairs the gating mechanisms that normally limit sensory input to the brain and further promotes central sensitization.  Early intervention to arrest the injury-induced metabolic cascade, and treatment with agents that activate cerebral metabolism may mitigate the symptoms of this injury syndrome.”

Manber, R. and R. Armitage. 1999. Sex, steroids, and sleep: a review. Sleep 22(5):540-55.

Manchikanti L. 2004.  The growth of interventional pain management in the new millennium: a critical analysis of utilization in the Medicare population.  Pain Physician. 7(4):465-482.  “It is estimated that among Medicare recipients, the frequency of interventional procedures, which includes epidural, spinal neurolysis, and adhesiolysis procedures; facet joint interventions and sacroiliac joint blocks; and other types of nerve blocks excluding continuous epidurals, implantables, disc procedures, intraarticular injections, trigger point and ligament injections, had increased by 95% from 1998 to 2003.”  [The “bottom line” seems to be the new criteria for medical management.  Certainly, wiser decisions must be made in the field of chronic pain.  This can best happen by education in interactive diagnoses rather than reliance on differential diagnosis, and the inclusion of myofascial pain and chronic pain management in all medical fields. DJS]

Manco, M., G. Mingrone, A. V. Greco, E. Capristo, D. Gniuli, A. De Gaetano and G. Gasbarrini.2000. Insulin resistance directly correlates with increased saturated fatty acids in skeletal muscle triglycerides. Metabolism 49(2):220-4.

Mandal, A. C. 1984. The correct height of school furniture. Physiotherapy 70(2):48-53.

Mander BA, Rao V, Lu B et al. 2013. Prefrontal atrophy, disrupted NREM slow waves and impaired hippocampal-dependent memory in aging. Nat Neurosci. [Jan 27 Epub ahead of print]. "…findings suggest that sleep disruption in the elderly, mediated by structural brain changes, represents a contributing factor to age-related cognitive decline in later life." It is critical that quality as well a quantity of sleep be monitored in older adults, as quality of sleep directly relates to cognitive function. [A sleep study may uncover hidden reasons for (or contributions to) cognitive decline that may be treatable. DJS]

Manfredini D, Cocilovo F, Stellini E et al. 2013. Surface Electromyography Findings in Unilateral Myofascial Pain Patients: Comparison of Painful vs. Non Painful Sides. Pain Med. [Jun 7 Epub ahead of print]. OBJECTIVES: To answer the clinical research question: in patients with myofascial pain, are there any differences in the surface electromyography (sEMG) activity of muscles of the painful and nonpainful sides that can be detected by commercially available devices? RESULTS: At the study population level, differences between the sEMG values of muscles of the painful and nonpainful sides were not significant in any conditions, viz., either at rest or during clenching tasks. At the individual level, the difference between the sEMG activity of painful and nonpainful sides was very variable. CONCLUSIONS: The above findings were not supportive of the existence of any detectable difference in sEMG activity between jaw muscles of the painful and nonpainful sides in patients with unilateral myofascial pain. Centrally mediated mechanism for pain adaptation may explain these findings, and the role of sEMG as a diagnostic tool for muscle pain needs to be carefully reconceptualized.

Manfredini D, Tognini F, Montagnani G et al. 2004.  Comparison of masticatory dysfunction in temporomandibular disorders and fibromyalgia.  Minerva Stomatol. 53(11-12):641-650.  “Most patients with fibromyalgia (86.7%) report signs and symptoms localized at the stomatognathic system; by contrast, only a minority of patients with temporomandibular disorders (10%) are actually affected by fibromyalgia.”

Manfredini D, Cantini E, Romagnoli M et al. 2003.  Prevalence of bruxism in patients with different research diagnostic criteria for temporomandibular disorders (RDC/TMD) diagnoses.  Cranio 21(4):279-285.  Bruxism has a stronger association with muscle dysfunction than with disc and joint dysfunctions.  Patients with bruxism should be investigated for the presence of muscle dysfunctions.

Mani N, Jun HW, Beach JW et al. 2003.  Solubility of guaifenesin in the presence of common pharmaceutical additives.  Pharm Dev Technol 8(4):385-96.  Common additives can change the aqueous solubility of guaifenesin.  This indicates that all compounds of guaifenesin may not have equal solubility and possibly may not be equivalent in bioavailability as well. 

Mann, J. J., K. M. Malone, D. A. Nielsen, D. Goldman, J. Erdos and J. Gelernter. 1997. Possible association of a polymorphism of the tryptophan hydroxylase gene with suicidal behavior in depressed patients. Am J Psychiatry 154(10):1451-1453.

Mannerkorpi K, Gard G. 2012. Hinders for continued work among persons with fibromyalgia. BMC Musculoskelet Disord. 13(1):96. "Work disability is common among women with fibromyalgia (FM). The aim of the study was to investigate what health problems and work-related difficulties lead to hinders for continued work among women with FM.....Health problems and work-related demands were identified. Limited physical capacity, increased stress and an increased need of rest were the major health problems, while physical, psychosocial and work organizational demands were the main work-related problems. Personal factors and factors related to family influenced the strategies used to manage the imbalance between the health problems and work-related demands.....Limited physical capacity and an increased need of rest made it difficult for these women to manage the physical, psychosocial and organizational work demands. Adjustment of the work tasks and work environment were the main factors influencing whether the women with FM could work or not."

Mannerkorpi K, Nordeman L, Ericsson A et al. 2009.  Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses.  J Rehabil Med. 41(9):751-760.  “The exercise-education program showed significant, but small, improvement in health status in patients with fibromyalgia and chronic widespread pain, compared with education only.  Patients with milder symptoms improved most with this treatment.”


Mannerkorpi K. 2005.  Exercise in fibromyalgia. Curr Opin Rheumatol. 17(2):190-194.  “The recent studies support existing literature on the benefits of exercise for patients with fibromyalgia.  The outcomes appear to be related to the program design and the characteristics of the populations studied.  As the patients with fibromyalgia form a heterogeneous population, more research is required to identify the characteristics of patients who benefit from specific modes of exercise.  Moreover, long-term planning is needed to motivate the patients to continue regular exercise.”


Mannerkorpi K, Gard G. 2003.  Physiotherapy group treatment for patients with fibromyalgia – an embodied learning process. Disabil Rehabil 25(24):1372-1380.  This study found that “Interactions between the co-participants promoted the process of creating new patterns of thinking and acting in the social world” that were beneficial to patients with fibromyalgia.  A good, positive support group may provide the same thing to some degree.


Mannerkorpi K., Ahlmen M., Ekdahl C. 2002.  Six- and 24-month follow-up of pool exercise therapy and education for patients with fibromyalgia.  Scand J Rheumatol 31(5):306-10.  This study showed lasting improvements even 24 months after the completion of the therapy.  [It would be valuable to evaluate the use of pool therapy in patients with both fibromyalgia and chronic myofascial pain, and to specify which pool temperatures are most effective. DJS]

Mannerkorpi, K., T. Kroksmark and C. Ekdahl. 1999. How patients with fibromyalgia experience their symptoms in everyday life. Physiother Res Int 4(2):110-22.

Manor B, Lipsitz LA, Wayne PM et al. 2013. Complexity-based measures inform tai chi's impact on standing postural control in older adults with peripheral neuropathy. BMC Complement Altern Med. 13:87. Subjects of the Tai Chi program exhibited increased complexity of standing COP (control of posture) dynamics. These increases were associated with improved plantar sensation and physical function. Although more research is needed, results of this non-controlled pilot study suggest that complexity-based COP measures may inform the study of complex mind-body interventions, like Tai Chi, on postural control in those with peripheral neuropathy or other age-related balance disorders.

Manson J, Rotondi M, Jamnik V et al. 2013. Effect of tai chi on musculoskeletal health-related fitness and self-reported physical health changes in low income, multiple ethnicity mid to older adults. BMC Geriatr. 13(1):114. "Two hundred and nine ethnically diverse mid to older community dwelling Canadian adults residing in low income neighborhoods were enrolled in a 16 week Yang style TC program. Body Mass Index and select musculoskeletal fitness measures including upper and lower body strength, low back flexibility and self-reported physical health measured by SF 36 were collected pre and post the TC program. Determinants of health such as age, sex, marital status, education, income, ethnicity of origin, multi-morbidity conditions, weekly physical activity, previous TC experience as well as program adherence were examined as possible musculoskeletal health-related fitness change predictors….These results reveal that TC has the potential of having a beneficial influence on musculoskeletal health-related fitness and self-reported physical health in a mid to older low socioeconomic, ethnically diverse sample."

Mao J, Gold MS, Backonja MM. 2010. Combination Drug Therapy for Chronic Pain: A Call for More Clinical Studies. J Pain. [Sep 16 Epub ahead of print]. "Chronic pain is a debilitating clinical condition associated with a variety of disease entities including diabetic neuropathy, postherpetic neuralgia, low back pathology, fibromyalgia, and neurological disorders. For many general practitioners and specialists, managing chronic pain has become a daunting challenge. As a modality of multidisciplinary chronic pain management, medications are often prescribed in combinations, an approach referred to as combination drug therapy (CDT). However, many medications for pain therapy, including antidepressants and opioid analgesics, have significant side effects that can compound when used in combination and impact the effectiveness of CDT. To date, clinical practice of CDT for chronic pain has been based largely on clinical experiences. In this article, we will focus on (1) the scientific basis and rationales for CDT, (2) current clinical data on CDT, and (3) the need for more clinical studies to establish a framework for the use of CDT. ....More preclinical, clinical, and translational studies are needed to improve the efficacy of combination drug therapy that is an integral part of a comprehensive approach to the management of chronic pain." [Many of the conditions mentioned have as a common pain generator myofascial trigger points. Many TrP therapies are themselves painful. It is greatly to be hoped that, as we uncover the mechanisms of TrPs, useful medication regimens for chronic myofascial pain will be developed. DJS]

Maquet D, Croisier JL, Dupont C et al. 2010. Fibromyalgia and related conditions: Electromyogram profile during isometric muscle contraction. Joint Bone Spine. [Apr 21 Epub ahead of print]. “OBJECTIVES: To evaluate electromyogram (EMG) profiles in patients with three related conditions: fibromyalgia, chronic fatigue syndrome, and depression. METHODS: We studied 44 healthy volunteers, 22 patients with fibromyalgia, 11 patients with chronic fatigue syndrome, and 10 patients admitted for depression. The trapezius electromyogram was recorded during maximally sustained, bilateral, 90 degrees abduction of the shoulders. EMG signal frequency and amplitude were measured throughout the test. RESULTS: In the fibromyalgia group, isometric contraction duration was significantly shorter than in the other two patient groups (P<0.001) and the EMG frequency and amplitude pattern indicated premature discontinuation of the muscle contraction. Findings in the chronic fatigue patients were similar to those in the healthy controls. The patients with depression had a distinctive EMG profile characterized by excessive initial motor-unit recruitment with a shift in the frequency spectrum. CONCLUSIONS: Fibromyalgia was associated with a specific EMG pattern indicating premature discontinuation of the muscle contraction. Therefore, maximal voluntary muscle contraction tests may be of limited value for assessing function in fibromyalgia patients. Chronic fatigue syndrome patients had similar EMG findings to those in the healthy controls. The EMG alterations in the patients with depression were consistent with manifestations of psychomotor retardation.” [There is a great likelihood that this study had nothing to do with FM and everything to do with co-existing myofascial trapezius TrPs in these FM patients.  Studies of FM patients such as this one must include assessment of TrPs to make any conclusions meaningful. DJS]

Maquet D, Croisier JL, Renard C, Crielaard JM. 2002. Muscle performance in patients with fibromyalgia. Joint Bone Spine 69(3):293-9. "This study of the three pathways supplying energy to muscle confirms that muscle function is globally impaired in FMS patients.  The results suggest that the impairment predominated on aerobic processes."

Marchettini, P., F. Formaglio and M. Lacerenza. 1999. Clinical interpretations of intraneural muscle nociceptors recordings in humans. J Musculoskel Pain 7(1-2):55-59.

Marchioni D, Ghidini A, Daari S et al. 2005.  The normal-weight snorer: polysomnographic study and correlation with upper airway morphological alterations.  Ann Otol Rhinol Laryngol. 114(2):144-146.  “The major risk factor for developing OSAS in normal-weight snorers appears to be anatomic abnormalities.  The normal-weight snorer needs to be thoroughly investigated because of the significant risk of developing OSAS and for the detection of multiple concomitant sites of obstruction.”  [This paper does not discuss muscle contracture due to TrPs, but it could be a variable factor as well, and the presence of TrPs in some muscle may indicate the need for automatically adjusting CPAP set to maximum high equal to that of the sleep study need of the patient.]

Marcus DA. 2009.  Fibromyalgia: diagnosis and treatment options.  Gend Med. 6 Suppl 2:139-151.  “Physicians diagnose fibromyalgia in women at an approximately 3- to 6-fold rate compared with men.”  “Fibromyalgia is a common, disabling, chronic pain condition that predominantly affects women.  Symptoms can be effectively treated using both drug and nondrug therapies.  In general, treatment benefits in fibromyalgia appear largely independent of patient sex.”

Marcus DA. 2006.  A review of perinatal acute pain: treating perinatal pain to reduce adult chronic pain.  J Headache Pain 7(1):3-8.  “Over the last decade, studies have suggested that exposure to repeated painful procedures during the early perinatal period results in profound changes in sensitivity of nociceptive pathways.  Both animal and human studies show that early pain experiences increase pain responses beyond the period of infancy.  These data suggest a need to increase implementation of guidelines for minimizing pain exposures during infancy.”

Marcus, D. A. 2000. Treatment of nonmalignant chronic pain. Am Fam Physician 61(5):1331-8, 1345-6.

Marcus DA, Bernstein CD, Constantin JM et al. 2012. Impact of Animal-Assisted Therapy for Outpatients with Fibromyalgia. Pain Med. [Nov 21 Epub ahead of print]. "Animal-assisted therapy using dogs trained to be calm and provide comfort to strangers has been used as a complementary therapy for a range of medical conditions. This study was designed to evaluate the effects of brief therapy dog visits for fibromyalgia patients attending a tertiary outpatient pain management facility compared with time spent in a waiting room. Brief therapy dog visits may provide a valuable complementary therapy for fibromyalgia outpatients."

Marcus DA, Bernstein CD, Haq A. 2013. Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment. Musculoskeletal Care. [Jul 23 Epub ahead of print]. "Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ (Fibromyalgia Impact Questionnaire), more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness."

Marcus DA, Richards KL, Chambers JF et al. 2012. Fibromyalgia Family and Relationship Impact Exploratory Survey. Musculoskeletal Care. [Nov 21 Epub ahead of print]. Fibromyalgia is frequently associated with impairments in activities of daily living and work disability. Limited data have investigated the impact of fibromyalgia on relationships with family and friends.....Half of participants endorsed that fibromyalgia had mildly to moderately damaged relationship(s) with their spouse(s)/partner(s) or contributed to a break-up with a spouse or partner. Half of participants scored as not being satisfied with their current spouse/partner relationship, with satisfaction negatively affected by the presence of mood disturbance symptoms and higher fibromyalgia severity. Relationships with children and close friends were also negatively impacted for a substantial minority of participants....In addition to physical impairments that are well documented among individuals with fibromyalgia, fibromyalgia can result in a substantial negative impact on important relationships with family and close friends.

Marcus NJ, Shrikhande AA, McCarberg B et al. 2013. A preliminary study to determine if a muscle pain protocol can produce long-term relief in chronic back pain patients. Pain Med. [May 20 Epub ahead of print]. This study was done on patients with neuraxal low back pain, testing before and after invasive treatments. They used an electrical device to find possible sources of pain, rather than palpation. The study found that identifying and treating painful muscles produced significantly lasting reductions in pain as well as function improvement. Some patients cancelled their surgeries. Others had failed back surgery, failed epidural steroid injections, and/or TrP injections. With treatment of muscle and tendon pain generator, their pain was significantly relieved using this muscle protocol. Both the muscles and their tendon attachments were critical pain generators.

Margoles M. 1983.  Stress neuromyelopathic pain syndrome (SNPS): Report of 333 patients.  J Neuro Ortho Surg 4(4):317-322.  This is an older but very important study using the term “stress neuromyelopathic pain syndrome” for what Travell and Simons describe in their later texts as “post-traumatic hyperirritability syndrome.”  The authors agree that these are the same conditions.  This condition can be caused by severe or repeated trauma especially to the head, neck and back, but can also be caused by biochemical trauma. This author found that patients with this condition often have low levels of B vitamins but may not respond to oral supplements, and 30-50% of these patients have abnormally high vitamin A.  Eating foods high in vitamin A could lead to a flaring of symptoms.  This condition often starts locally but can spread to overlapping pain patterns.  Clinical findings are clearly specified, and the fact that this can often be mistakenly diagnosed as neuropathy caused by disc problem when the disc is not the cause at all, but the metabolic changes that this syndrome has brought about.  [After extensive discussion with Drs. Michael S. Margoles and David G. Simons, I am convinced that these are early descriptions of what can happen when early myofascial trigger points and fibromyalgia are not treated promptly and aggressively.  This paper clearly describes in detail a scenario of the unfolding of this condition.  I advise any clinician to get a copy of this important paper. DJS]

Maria G, Cadeddu F, Brisinda D et al. 2005.  Management of bladder, prostatic and pelvic floor disorders with botulinum neurotoxin.  Curr Med Chem. 12(3):247-265.  “Botulinum toxin (BoNT) has been increasingly used in the interventional treatment of several other disorders characterized by excessive or inappropriate muscle contractions.  BoNT is being investigated for the control of the pain, and for the management of tension or migraine headaches and myofascial pain syndrome.  This paper presents current data on the use of BoNT to treat pelvic floor disorders.”

Marin, P., and S. Arver. 1998. Androgens and abdominal obesity. Ballieres Clin Endocrinol Metab 12(3):441-51.

Markkula R, Kalso E, Huunan-Sepp** et al. 2011. The burden of symptoms predicts early retirement: a twin cohort study on fibromyalgia-associated symptoms. Eur J Pain. [Feb 10 Epub ahead of print]. "…the high symptom class…had a 43%...increased overall mortality risk, which was fully accounted for by adjustment for lifestyle factors, mainly smoking." "Symptoms associated with FM strongly correlate with early disability retirement. Lifestyle problems associated with high symptom load need prompt management to avoid increased risk of mortality."

Markotic F, Cerni Obrdalj E, Zalihic A et al. 2013. Adherence to pharmacological treatment of chronic nonmalignant pain in individuals aged 65 and older. Pain Med. [Jan 31 Epub ahead of print]. "According to their own statements, 57% of the patients were nonadherent, while 84% exhibited some form of nonadherence …The most common deviation from the prescribed therapy was self-adjustment of the dose and medical regimen based on the severity of pain. Polymedication correlated positively with nonadherence. Nonsteroidal anti-inflammatory drugs were the most frequently prescribed medications. The majority of the participants (59%) believed that higher pain intensity indicates progression of the disease, and half of the participants believed that one can easily become addicted to pain medications. Nonadherence was associated with patient attitudes about addiction to analgesics and ability of analgesics to control pain….High pain intensity and nonadherence found in this study suggest that physicians should monitor older patients with chronic nonmalignant pain more closely and pay more attention to patients' beliefs regarding analgesics to ensure better adherence to pharmacological therapy." [Many patients have incorrect understanding of medications, and may fail to use sufficient medication to control their symptoms due to fear of addiction DJS]

Marqulis RK, Borrero M. 2010. Distant surgery scar points and fascial adhesions perpetuate pectoralis minor trigger points in two cases of severe chronic palmar pain. International Myopain Society Eighth Clinical Meeting Oct 3-7, 2010. Toledo, Spain. Abstract No. 91. "In these cases, the distant scar points and fascial adhesions on acupuncture channels acted as trigger point perpetuating factors: when these factors were successfully treated, the trigger points resolved and did not return. This is believed to be the first report of scar points and fascial adhesions as distant trigger point perpetuating factors." [Actually, previous significant research has been published on the topic of scars and TrPs by both Dr. Karl Lewit and Dr.Alena Kobesova. DJS]

Marshall R, Paul L, McFadyen AK et al. 2010. Pain characteristics of people with chronic fatigue syndrome. J Musculoskel Pain 18(2):127-137. People with chronic fatigue syndrome often have significant pain issues, and these must be treated by pain management strategies. Research has been focused on the fatigue, although five of the eight other symptoms commonly reported are pain-related. [Patients reported pain symptoms, including muscle tightness, associated with myofascial TrPs and nerve entrapment. It would be of great importance to find out the percentage of chronic fatigue syndrome patients who also have co-existing myofascial TrPs. Myofascial pain may be an important and treatable interactive condition contributing not only to the pain but also to the fatigue. DJS]

Martin DP, Sletten CD, Williams BA et al. 2006.  Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial.  Mayo Clin Proc. 81(6):749-757.  “We found that acupuncture significantly improved symptoms of fibromyalgia.  Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety.”  [The subset of FMs patients who have anxiety and fatigue may benefit from specific acupuncture therapy.  DJS]

Martín J, Torre F, Padierna A et al. 2013. Interdisciplinary treatment of patients with fibromyalgia: Improvement of their health-related quality of life. Pain Pract. [Nov 27 Epub ahead of print]. "This interdisciplinary intervention has shown effectiveness in improving the HRQoL of this sample of patients with FM. The number of physical illnesses was identified as a predictor of that improvement."

Martin KL, Blizzard L, Srikanth VK et al. 2013. Cognitive Function Modifies the Effect of Physiological Function on the Risk of Multiple Falls--A Population-Based Study. J Gerontol A Biol Sci Med Sci. [Feb 14 Epub ahead of print]. "A range of cognitive (executive function/attention, memory, processing speed, and visuospatial ability) and physiological functions (vision, proprioception, sway, leg strength, reaction time) were measured using standardized tests in 386 randomly selected adults aged 60-86. Incident falls were recorded over 12 months….Preventing falls due to physiological impairments in community-dwelling older people may need to be tailored based on cognitive impairment, a key factor in their inability to compensate for physical decline."

Martin S, Chandran A, Zografos L et al. 2009.  Evaluation of the impact of fibromyalgia on patients’ sleep and the content validity of two sleep scales.  Health Qual Life Outcomes. 7(1):64.  “This study demonstrates the significant impact that FM has on patients’ lives, particularly sleep.”  [A sleep study is an important part of FM evaluation, and may uncover several treatable perpetuating factors that are impacting the patient’s quality of life. DJS]

Martin, W. J., A. B. Malmberg and A. I. Basbaum. 1998. Pain: nocistatin spells relief. Curr Biol 8(15):R525-7.

Martinez MP, Miro E, Sanchez AI et al. 2013. Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J Behav Med. [Jun 7 Epub ahead of print]. "The CBT-I (cognitive-behavioral therapy for insomnia) group reported significant improvements at post-treatment in several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression. The SH (sleep hygiene) group only improved significantly in subjective sleep quality. Patients in the CBT-I group showed significantly greater changes than those in the SH group in most outcome measures. The findings underscore the usefulness of CBT-I in the multidisciplinary management of FM."

Martínez MP, Sanchez AI, Miro E et al. 2015. Relationships between physical symptoms, emotional distress, and pain appraisal in fibromyalgia: the moderator effect of alexithymia. J Psychol. 149(2):115-140. "Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed."

Martinez-Jauand M, Sitges C, Femenia J et al. 2013. Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia. Clin Rheumatol. 32(7):975-981. "Fibromyalgia (FM) is a chronic pain condition characterized by high prevalence in women. In particular, estrogen deficit has been considered as a potentially promoting factor of FM symptoms. This study was aimed to examine the relationship between age-of-onset of menopause and pain sensitivity in FM. For this purpose, pain sensitivity was assessed in 74 FM and 32 pain-free control women. All participants were postmenopausal and underwent a detailed semi-structured clinical interview, including data about menopause transition, previous history of hysterectomy or ovariectomy, and menses time. Participants were divided into two groups depending on age-of-onset of menopause: early menopause [<49 years] vs. late menopause [>49 years]. Pain and non-pain thresholds were assessed by using cold, heat, mechanical, and electrical stimulation. FM women showed higher overall pain sensitivity as compared with healthy subjects. FM women with early age-of-onset of menopause displayed greater pain and non-pain sensitivity than women with late age-of-onset of menopause, whereas no differences were observed in healthy women due to age-of-onset of menopause. These results suggest that an early transition to menopause (shortening the time of exposure to estrogens) may influence pain hypersensitivity and could be related to aggravation of FM symptoms."

Martinez-Jauand M, Sitges C, Rodriguez V et al. 2012. Pain sensitivity in fibromyalgia is associated with catechol-O-methyltransferase (COMT) gene. Eur J Pain. [Apr 24 Epub ahead of print]. "Recent evidence suggests that genetic factors might contribute to individual differences in pain sensitivity, risk for developing clinical pain conditions and efficacy of pain treatments. The purpose of the present study was to investigate the relationship of three common haplotypes of COMT gene affecting the metabolism of catecholamines on pain sensitivity in patients with fibromyalgia (FM)….According with previous research, our findings revealed that haplotypes of the COMT gene and genotypes of the Val158Met polymorphism play a key role on pain sensitivity in FM patients."

Martinez-Lavin M. 2014. Fibromyalgia-like illness in 2 girls after human papillomavirus vaccination. J Clin Rheumatol 20(7):392-393.

Martinez-Lavin M. 2012. Fibromyalgia: When Distress Becomes (Un)sympathetic Pain. Pain Res Treat. 2012:981565. [Epub 2011 Sep 19] " fibromyalgia, distress could be converted into pain through forced hyperactivity of the sympathetic component of the stress response system."

Martinez-Lavin M. 2004.  Fibromyalgia as a sympathetically maintained pain syndrome.  Curr Pain Headache Rep. 8(5):385-389.  “...patients with FM display signs of relentless sympathetic hyperalgesia...”


Martinez-Lavin, M. 2002. The autonomic nervous system, and fibromyalgia. J Musculoskel Pain 10(1/2):221-228.  Fibromyalgia is a multisystem illness. Many researchers have found indications that fibromyalgia is a form of autonomic nervous system dysfunction. 


Martinez-Lavin, M. 2002. Management of dysautonomia in fibromyalgia. Rheum Dis Clin North Am 28(2):379-87. "The realization of dysautonomia in FM has opened the possibility for new and different therapeutic interventions.  Much more research is needed to better define the role of ANS in the pathogenesis of FM.  If this research supports current hypotheses, therapeutic trials with disciplines and substances intended to correct autonomic dysfunction will be indicated."

Martinez-Lavin, M., A. G. Hermosillo, M. Rosas and M. E. Soto. 1998. Circadian studies of autonomic nervous balance in patients with fibromyalgia: a heart rate variability analysis. Arthritis Rheum 41(11):1966-71.

Martinez-Lavin, M., A. G. Hermosillo, C. Mendoza, R. Ortiz, J. C. Cajigas, C. Pineda, A. Nava, and M. Vallejo. 1997. Orthostatic sympathetic derangement in subjects with fibromyalgia. J Rheumatol 24(4): 714-718.

Martino, A. M. 1998. In search of a new ethic for treating patients with chronic pain: What can medical boards do? J Law, Medicine & Ethics 26(4):332-49.

Martin-Pintado-Zugasti A, Pecos-Martin D, Rodriguez-Fernandez AL et al. 2015. Ischemic compression after dry needling of a latent myofascial trigger point reduces post-needling soreness intensity and duration. PM R. [Mar 30 Epub ahead of print.] "IC can potentially be added immediately after dry needling of MTrPs in the upper trapezius muscle because it has the effect of reducing postneedling soreness intensity and duration. The combination of dry needling and IC seems to improve CROM (cervical range of motion) in homolateral and contralateral cervical rotation movements." [The subjects in this study did not have chronic pain. DJS]

Marwick, C. 1999. New advocates of adequate treatment say have no fear of pain or of prosecution. JAMA 281:406-407.

Masand, P. S. and S. Gupta. 1999. Selective serotonin-reuptake inhibitors: an update. Harv Rev Psychiatry 7(2):69-84.

Mascia P, Brown BR, Friedman S. 2003.  Toothache of nonodontogenic origin: a case report.  J Endod. 29(9):608-610.  “This article describes the diagnosis and treatment of a patient exhibiting nonodontogenic tooth pain.  A 25-year-old female patient presented to postgraduate endodontics, SUNY at Stony Brook, for evaluation and treatment of pain associated with the upper and lower left quadrants.  After thorough intraoral and extraoral examinations, it was determined that the pain was referred to the dentition from a trigger point in the masseter muscle.  An extraoral injection of 3% Carbocaine was administered into the trigger point, and the pain abated within 5 minutes.  The patient has experienced no recurrence of this pain for 12 months.  Consideration of nonodontogenic dental pain should be included in a differential diagnosis.”

Mascia P, Brown BR, Friedman S. 2003.  Toothache of nonodontogenic origin: a case report.  J Endod 29(9):608-10. These authors found that a masseter trigger point was the source of tooth pain in this patient.  The patient had immediate relief after trigger point injection, with no recurrence of the pain. Dental practitioners need myofascial medicine as part of their training and their differential diagnosis.   

Mason JS, Tansey KA, Westrick RB. 2014. Treatment of subacute posterior knee pain in an adolescent ballet dancer utilizing trigger point dry needling: a case report. Int J Sports Phys Ther. 9(1):116-124. "The subject was a 16-year-old female competitive ballet dancer referred to physical therapy with a two month history of right posterior knee pain. Palpation identified MTPs which reproduced the patient's primary symptoms. In addition to an exercise program promoting lower extremity flexibility and hip stability, the subject was treated with DN to the right gastrocnemius, soleus, and popliteus muscles….The patient was able to return to high level dance training and competition without physical limitations and resumed pre-injury dynamic movement activities including dancing, running, jumping, and pivoting without pain. DN can be an effective and efficient intervention to assist patients in decreasing pain and returning to high intensity physical activity. Additional research is needed to determine if DN is effective for other body regions and has long-term positive outcomes."

Masood, K., C. Wu, U. Brauneis and F. F. Weight. 1994. Differential ethanol sensitivity ofrecombinant N-methyl-D-aspartate receptor subunits. Mol Pharmacol 45(2):324-329.

Masralla, M., J. Haier and G. L. Nicolson. 1999. Multiple mycoplasmal infections detected in blood of patients with chronic fatigue syndrome and/or fibromyalgia syndrome. Eur J ClinMicrobiol Infect Dis 18(12):859-65.

Massa F, Storr M, Lutz B. 2005.  The endocannabinoid system in the physiology and pathophysiology of the gastrointestinal tract.  J Mol Med. [August 26 Epub ahead of print ]  “The endocannabinoid system may serve as a potentially promising therapeutic target against different GI disorders, including frankly inflammatory bowel diseases (e.g., Crohn’s disease), functional bowel diseases (e.g., irritable bowel syndrome) and secretion- and motility-related disorders.”

Massey PB. 2007.  Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial.  Altern Ther Health Med. 13(3):32-34.  “IVNT appears to be safe to reduce FM symptoms.”  The patients in this study had FM for at least 8 years and had no significant, lasting relief with conventional therapies.

Mataran-Penarrocha GA, Castro-Sanchez AM, Garcia GC et al. 2009.  Influence of craniosacral therapy on anxiety, depression and quality of life in patients with fibromyalgia.  Evid Based Complement Alternat Med. [Sep 3 Epub ahead of print].  “Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients.”  [Craniosacral therapy can be a good way to integrate other therapies and calm the sympathetic nervous system. DJS]

Mathias S, Zihl J, Steiger A et al. 2004.  Effect of repeated gaboxadol administration on night sleep and next-day performance in healthy elderly subjects.  Neuropsychopharmacology Dec 15 [Epub ahead of print]  Gaboxadol improved sleep quality in healthy elderly subjects without side-effects.

Mathieson L, Hirani SP, Epstein R et al. 2009.  Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia.  J Voice. 23(3):353-366.  Manual therapy can often relieve what is called “muscle tension dysphonia.”  [This indicates that a significant portion of the problem may be due to the presence of TrPs in the laryngeal and related muscles.  People working in this field must be made aware of this situation.  It would be a win/win scenario for all concerned.  DJS]

Mathieu N. 2009. [Somatic comorbidities in irritable bowel syndrome: fibromyalgia, chronic fatigue syndrome, and interstitial cystitis]  Gastroenterol Clin Biol. 33 Suppl 1:S17-25. [French]  “Fibromyalgia, chronic fatigue syndrome, and interstitial cystitis frequently overlap with irritable bowel syndrome (IBS).  There is a positive correlation between the incidence of these comorbidities and increased health care seeking, reduction in quality of life, and higher levels of mood disorders, which raises the question of a common underlying pathophysiology.  A possible central hypersensitization disorder seems to be particularly involved in the dysfunction of bidirectional neural pathways and viscerovisceral cross-interactions within the CNS, thus explaining these many extraintestinal manifestations in IBS.”

Matilainen V, Laakso M, Hirsso P. 2013. Hair loss, insulin resistance, and heredity in middle-age women. A population-based study. J Cardiovasc Risk. 10(3):227-231. Insulin resistance is associated with "…large waist and neck circumferences, abdominal obesity by waist to hip ration, mean insulin concentration or urinary albumin to creatinine ratio. Although extensive hair loss has been linked to men with insulin resistance, this study found it is present in women too. Female hair loss has been linked to hyper-androgenism, hirsutism, and polycystic ovary syndrome. These researchers found a 31.2% presence of extensive hair loss in patients with insulin resistance. Women in the highest percentiles of waist and neck circumference had greater risk of hair loss".

Matsuda JB, Barbosa FR, Morel LJ et al. 2010. [Serotonin receptor (5-HT 2A) and catechol-O-methyltransferase (COMT) gene polymorphisms: Triggers of fibromyalgia?] Rev Bras Reumatol. 50(2):141-145. [Portuguese] "The L/L genotype was more frequent among fibromyalgia patients. Though considering a polygenic situation and environmental factors, the molecular study of the rs4680 SNP of the COMT gene may be helpful to the identification of susceptible individuals."

Matsuda M, Imaoka T, Vomachka AJ et al. 2004.  Serotonin regulates mammary gland development via an autocrine-paracrine loop.  Dev Cell 6(2):193-203.  Dysfunctional serotonin signaling may be part of the reason some women with FMS experience problems nursing.  Nursing may begin normally, but the milk [production] hesitates or stops.

Matsumoto, Y. 1999. [Fibromyalgia syndrome]. Nippon Ronsho 57(2):364-9.[Japanese]

Matsutani LA, Marques AP, Ferreira EA et al. 2007.  Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia.  Clin Exp Rheumatol. 25(3):410-415.  “Laser therapy has not shown advantages when added to muscle stretching exercises.”

Matthana MH. 2011. The relation between Vitamin D deficiency and fibromyalgia syndrome in women. Saudi Med J. 32(9):925-929. "Vitamin D deficiency has to be considered in the management of fibromyalgia syndrome."

Matthews, D. A. , M. E. McCullough, D. B. Larson, H. G. Koenig, J. P. Swyers and M. G. Milano. 1998. Religious committment and health status: a review of the research and implications for family medicine. Arch Fam Med 7(2):118-124.

Mattozzi I. 2015. [Conservative treatment of cervical radiculopathy with 5% lidocaine medicated plaster.] Minerva Med. 105(1):1-7.[Article in Italian] Cervical radiculopathy is a mixed pain syndrome characterized by neuropathic, skeletal and myofascial pain….A retrospective study was carried out on 60 patients, of which 30 were treated with mesotherapy and 30 were treated with 5% lidocaine medicated plaster. Data for a total of 30 days observation were collected from the patient medical records. In particular, besides medical history, intensity of pain, intensity of allodynia and pain were considered….For all analyzed parameters, both treatments were effective, but patients treated with 5% lidocaine medicated plaster showed faster control of the painful symptoms, an essential condition for an earlier rehabilitative treatment.

Mau, W. and H. Zeidler. 1999. [No title available]. Versicherungsmedizin 51(2):59-65 [German].

Mawe GM, Coates MD, Moses PL. 2006.  Review article: intestinal serotonin signaling in irritable bowel syndrome.  Aliment Pharmacol Ther. 23(8):1067-1076.  “Both genetic and epigenetic factors could contribute to decreased serotonin-selective reuptake transporter in irritable bowel syndrome.  A serotonin-selective reuptake transporter gene promoter polymorphism may cause a genetic predisposition, and inflammatory mediators can induce serotonin-selective transporter downregulation.  While a psychiatric co-morbidity exists with IBS, changes in mucosal serotonin handling support the concept that there is a gastrointestinal component to the aetiology of irritable bowel syndrome.”  [There are many patients with IBS and without a “psychiatric component” except for the general depression that one gets when one is given that “It’s All In Your Head” diagnoses.  Current research indicates that chronic illness often has intestinal permeability as a contributor.  When patients have invisible illnesses causing chronic pain and are given or take aspirin and NSAID that can contribute to intestinal permeability (see Galland, L. and, IBS is a logical consequence.  It is nice to know that some researchers are finally discovering the GI component, but they are still stuck in the mindset that IBS is a basically psychological dysfunction. DJS]

May A. 2009. [Chronic pain alters the structure of the brain.] Schmerz. [Oct 17 Epub ahead of print] [German]  “Local morphologic alterations of the brain in areas ascribable to the transmission of pain were recently detected in patients suffering from phantom pain, chronic back pain, irritable bowel syndrome, fibromyalgia and frequent headaches.  These alterations were different for each pain syndrome, but overlapped in the cingulated cortex, the orbit frontal cortex, the insula and dorsal pons. As it seems that chronic pain patients have a common ‘brain signature’ in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronic pain.  The in vivo demonstration of a loss of brain gray matter in patients suffering from chronic pain compared to age and sex-matched healthy controls could represent the heavily discussed neuroanatomical substrate for pain memory.”

May. K. P. , S. G. West, M. R. Baker and D. W. Everett. 1993. Sleep apnea in male patients with the fibromyalgia syndrome. Am J Med 94(5):505-508.

Mayer, E. A., R. Fass and S. Fullerton. 1998. Intestinal and extraintestinal symptoms in

Mayer-Davis, E. J. , R. D’Agostino Jr., A. J. Karter, S. M. Haffner, M. J. Rewers, M. Saad and R. N. Bergman.1998. Intensity and amount of physical activity on relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. JAMA 279(9):669-74.

Mayoral O, Salvat I, Martín MT et al. 2013. Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Evid Based Complement Alternat Med. 2013:694941. A single treatment of dry needling myofascial trigger points after anesthesia, before surgery for total knee arthroplasty, helped prevent residual pain. The pain was less for patients who had dry needling in the first month after surgery, and remained so at 6 month follow-up.

Mayoral del Moral O. 2010. Dry needling treatments for myofascial trigger points. J Musculoskel Pain. 18(4):411-416. "There exist different dry needling techniques that can be used in the treatment of trigger points. These techniques seem to be effective in treating this condition. There seems to be an increasing number of indications of these techniques within the context of myofascial pain syndrome. Dry needling techniques are rapidly expanding among healthcare providers. More research is needed to know the mechanisms of dry needling in order to improve its efficiency and the patients' tolerance of the techniques." There are multiple dry needling techniques, and all require training and experience.

McAdam, B. F., F. Catella-Lawson, I. A. Mardini, S. Kapoor, J. A. Lawson and G. A. FitzGerald. 1999. Systemic biosynthesis of prostacyclin by cyclooxygenase (COX)-2: the human pharmacology of a selective inhibitor of COX-2. Proc Natl Acad Sci U S A 96(10):5890.

McAllister SJ, Vincent A, Hassett AL et al. 2013. Psychological Resilience, Affective Mechanisms and Symptom Burden in a Tertiary-care Sample of Patients with Fibromyalgia. Stress Health. [Dec 26 Epub ahead of print.] "Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden."

McAuley JH, Stanton TR, Kamper SJ et al. 2011. Psychological approaches have not been demonstrated to be effective for fibromyalgia. Pain. [Feb 10 Epub ahead of print].

McBeth J, Chiu YH, Silman AJ et al. 2005.  Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.  Arthritis Res Ther. 7(5):R992-R1000.  “This is the first population study to demonstrate that those with established, and those psychologically at risk of, chronic widespread pain demonstrate abnormalities of HPA axis function, which are more marked in the former group.”  “We conclude that the occurrence of HPA abnormality in persons with chronic widespread pain is not fully explained by the accompanying psychological stress.”

McBeth J, Lacey RJ, Wilkie R. 2014. Predictors of new-onset widespread pain in older adults: Results from a population-based prospective cohort study in the UK. Arthritis Rheumatol. 66(3):757-767. "This study sought to identify factors associated with an increased risk of developing WP in adults age ≥ 50 years….A population-based prospective study was conducted. A baseline questionnaire was administered to subjects to collect data on pain, psychological status, lifestyle and health behaviors, and sociodemographic and clinical factors. Participants free of WP (as defined by the American College of Rheumatology 1990 criteria for fibromyalgia) were followed up for 3 years, and those with new-onset WP at follow-up were identified. …Of the factors measured in this study, nonrestorative sleep was the strongest independent predictor of new-onset WP."

McBeth, J., G. J. Macfarlane, S. Benjamin, S. Morris and A. J. Silman. 1999. The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum 42(7):1397-404.

McBride, J. L. , G. Arthur, R. Brooks and L. Pilkington. 1998. The relationship between a patient’s spirituality and health experiences. Fam Med 30(2):122-126.

McCabe CS, Cohen H, Hall J et al. 2009.  Somatosensory conflicts in complex regional pain syndrome type 1 and fibromyalgia syndrome.  Curr Rheumatol Rep. 11(6):461-465.  “The somatosensory system is an integral component of the motor control system that facilitates the recognition of location and experience of peripheral stimuli, as well as body part position and differentiation.  In chronic pain, this system may be disrupted by alterations in peripheral and cortical processing.  Clinical symptoms that accompany such changes can be difficult for patients to describe and health care practitioners to comprehend.  Patients with chronic pain conditions such as complex regional pain syndrome or fibromyalgia typically describe a diverse range of somatosensory changes.  This article describes how sensory information processing can become disturbed in fibromyalgia syndrome and complex regional pain syndrome and how symptoms can potentially be explained by the mechanisms that generate them.”  [This is a good study, and it is to be hoped that future studies will include myofascial TrPs. DJS]

McCabe CS, Cohen H, Blake DR. 2007. Somaesthetic disturbances in fibromyalgia are exaggerated by sensory motor conflict: implications for chronicity of the disease?  Rheumatology [Sep 1 Epub ahead of print]  “New perceptions included disorientation, pain, perceived changes in temperature, limb weight or body image.  Conclusions: Our findings support the hypothesis that motor-sensory conflict can exacerbate pain and sensory perceptions in those with FMS to a greater extent than in Hvs. [healthy volunteers]”

McCain, G. A. 1999. Treatment of fibromyalgia syndrome. J Musculoskel Pain 7(1-2):193-208.

McCall-Hosenfeld, J. S., Goldenberg, D.L., Hurwitz, S. et al. 2003. Growth Hormone and Insulin-Like Growth Factor-1 Concentrations in Women with Fibromyalgia.  J Rheumatol 30(4):809-14.  If the body mass index is taken into consideration, there is no significant association between premenopausal FMS patients and healthy controls with regard to average peak growth hormone.  The authors indicate that increase in age and obesity are both strongly linked to the GH-IGF-1 axis, and are factors that must be considered in research concerning FMS and the GH-IGF-1 axis.

McClaflin, R. R. 1994. Myofascial pain syndrome. Primary care strategies for early intervention. Postgrad Med 96(2):56-59.

McConaghy, P. M., P. McSorley, W. McCaughey and W. I. Campbell. 1998. Dextromethorphan and pain after total abdominal hysterectomy. Br J Anaesth 81(5):731-6.

McCoy JG, Tartar JL Bebis AC et al. 2007.  Experimental sleep fragmentation impairs attentional set-shifting in rats.  Sleep 30(1):52-60.  “24 hour SI (sleep interruption) produced impairment in an attentional set shifting that is comparable to the executive function and cognitive deficits observed in humans with sleep apnea or after a night of experimental sleep fragmentation.”

McCracken, L. M. 1998. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 74(1):21-27.

McCrae CS, O'Shea AM, Boissoneault J et al. 2015. Fibromyalgia patients have reduced hippocampal volume compared with healthy controls. J Pain Res. 8:47-52. "Fibromyalgia patients frequently report cognitive abnormalities. As the hippocampus plays an important role in learning and memory, we determined whether individuals with fibromyalgia had smaller hippocampal volume compared with healthy control participants….Potential mechanisms for reduced hippocampal volume in fibromyalgia include abnormal glutamate excitatory neurotransmission and glucocorticoid dysfunction; these factors can lead to neuronal atrophy, through excitotoxicity, and disrupt neurogenesis in the hippocampus. Hippocampal atrophy may play a role in memory and cognitive complaints among fibromyalgia patients." Free PMC Article

McCray RE, Patton NJ. 1984.  Pain relief at trigger points: a comparison of moist heat and shortwave diathermy.  J Orthop Sports Phys Ther. 5(4):175-178.  “Both treatments were effective in relieving the pain of sensitive trigger points but shortwave diathermy was more effective at decreasing the sensitivity of both sensitive and moderate trigger points (P>0.0581).  The pressure algometer was shown to be a useful device for objectively measuring pain and may be useful in selecting the most effective type of treatment for trigger points.”

McCrimmon, R. J., I. J. Deary, B. J. P. Huntly, K. J .MacLeod and B. M. Frier. 1996. Visual information processing during controlled hypoglycaemia in humans. Brain 119(4):1277-1287.

McDaniel WW. 2003.  Electroconvulsive therapy in complex regional pain syndromes.  J ETC 19(4):226-229.  “In one of the cases, concomitant fibromyalgia was not relieved during 2 separate series of ETC.”

McDermott BE, Feldman MD. 2007.  Malingering in the medical setting.  Psychiatr Clin North Am. 30(4):645-662.  “…the physician should generally suspect malingering when there are tangible incentives and when reported symptoms do not match the physical examination or no organic basis for the physical complaints is found.”  [The authors take for granted that their readers, psychiatrists, can diagnose ALL diseases with standard tests and examinations.  Shame on them.  Whatever happened to the oath to “Do no harm?”  This paper is food for lawyers to deny patients care.  Intelligent and trained lawyers can make mincemeat out of it once they understand that many physicians are untrained in diagnosis of MTPs, and there are documented changes in FM patients that are not practical for the physician to perform.  [see: Harris RE, Clauw DJ, Scott DJ et al. 2007 and countless other references in this section.  DJS]

McEwen BS, Kalia M. 2010. The role of corticosteroids and stress in chronic pain conditions. Metabolism. 59 Suppl 1:S9-15. "The relationship between corticosteroids (endogenous and exogenous) and stress is well known, as is the use of steroids as concomitant treatment in pain management during acute inflammation. In the past, steroids have not been considered the first line of treatment in pain management. In this review, we examine new scientific and clinical evidence that demonstrates the direct role that steroids play in the generation and clinical management of chronic pain."

McFadden, S. A. 1996. Phenotypic variation in xenobiotic metabolism and adverse environmental response: focus on sulfur-dependent detoxification pathways. Toxicology 111(1-3):43-65.

McGreevy K, Bottros MM, Raja SN. 2011. Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and their Efficacy. Eur J Pain Suppl. 5(2):365-372. This paper from Johns Hopkins states: "Chronic pain is the leading cause of disability in the United States. The transition from acute to persistent pain is thought to arise from maladaptive neuroplastic mechanisms involving three intertwined processes, peripheral sensitization, central sensitization, and descending modulation. Strategies aimed at preventing persistent pain may target such processes. Models for studying preventive strategies include persistent post-surgical pain (PPP), persistent post-trauma pain (PTP) and post-herpetic neuralgia (PHN). Such entities allow a more defined acute onset of tissue injury after which study of the long-term effects is more easily examined. In this review, we examine the pathophysiology, epidemiology, risk factors, and treatment strategies for the prevention of chronic pain using these models. Both pharmacological and interventional approaches are described, as well as a discussion of preventive strategies on the horizon."

McInnis OA, Matheson K, Anisman H. 2014. Living with the unexplained: Coping, distress, and depression among women with chronic fatigue syndrome (CFS) and/or fibromyalgia compared to an autoimmune disorder. Anxiety Stress Coping. [Jan 30 Epub ahead of print.] "Chronic fatigue syndrome (CFS) and fibromyalgia are disabling conditions without objective diagnostic tests, clear-cut treatments, or established etiologies. Those with the disorders are viewed suspiciously, and claims of malingering are common, thus promoting further distress…. High problem-focused coping was associated with low levels of depression and perceived distress in those with an autoimmune condition. In contrast, although CFS/fibromyalgia was also accompanied by higher depression scores and higher perceived distress, this occurred irrespective of problem-focused coping. It is suggested that because the veracity of ambiguous illnesses is often questioned, this might represent a potent stressor in women with such illnesses, and even coping methods typically thought to be useful in other conditions, are not associated with diminished distress among those with CFS/fibromyalgia."

McInnis OA, McQuaid RJ, Bombay A et al. 2014. Finding benefit in stressful uncertain circumstances: relations to social support and stigma among women with unexplained illnesses. Stress. Dec 29:1-32. [Epub ahead of print.] "Living with a chronic illness can be challenging, but the ability to derive benefits and grow from this experience may enhance well-being. However, the possibility of obtaining such benefits may be dependent on the levels of stigmatization and lack of social support experienced by an individual as a result of the illness. Chronic fatigue syndrome (CFS) and fibromyalgia are chronic conditions that remain largely unexplained and those with these conditions must often contend with stigma and skepticism from others. Individuals with CFS/fibromyalgia often display stress-related biological alterations and the experience of stressful life events have been associated with illness development. The present study demonstrated that women with CFS/fibromyalgia (n=40) as well as community participants who were depressed/anxious (n=37), reported higher stigma levels than healthy women (n=33). Moreover, women with CFS/fibromyalgia and those with depression/anxiety also reported greater levels of stigma than women with a chronic yet more widely accepted condition (n=35; rheumatoid arthritis, osteoarthritis, and multiple sclerosis). Secrecy related to stigma among those with CFS/fibromyalgia declined with increased social support, but this was not apparent among those with other chronic conditions. In addition, posttraumatic growth was lower among women with CFS/fibromyalgia compared to those with other chronic conditions. Qualitative analysis examining both negative impacts and positive changes stemming from illness experience revealed many similarities between women with CFS/fibromyalgia and those with other chronic conditions, including elevated appreciation for life, personal growth, and compassion for others. However, women with CFS/fibromyalgia tended to report less positive change regarding interpersonal relationships compared to women with other chronic conditions. In general, unexplained illnesses were also accompanied by stigmatization which might ultimately contribute to women's lower ability to derive positive growth from their illness experience."

McIver KL, Evans C, Kraus RM et al. 2005.  NO-mediated alterations in skeletal muscle nutritive blood flow and lactate metabolism in fibromyalgia.  Pain [Dec 20 Epub Ahead of Print]  “FM may be more sensitive than HC (healthy women) to the suppressive effect of nitric oxide on oxidative phosphorylation.”

McKee, D. D. and J. N. Chappel. 1992. Spirituality and medical practice. J Fam Pract 35(2):201.

McKeever TM, Lewis SA, Smit HA et al. 2005.  The association of acetaminophen, aspirin, and ibuprofen with respiratory disease and lung function.  Am J Respir Crit Care Med. 171(9):966-971.  “Use of acetaminophen [but not aspirin or ibuprofen] is associated with an increased risk of asthma and COPD [chronic obstructive pulmonary disease], and with decreased lung function.”

McKnite AM, Perez-Munoz ME, Lu L et al. 2012. Murine gut microbiota is defined by host genetics and modulates variation of metabolic traits. PLoS One. 7(6):e39191. "The gastrointestinal tract harbors a complex and diverse microbiota that has an important role in host metabolism. Microbial diversity is influenced by a combination of environmental and host genetic factors and is associated with several polygenic diseases. In this study we combined next-generation sequencing, genetic mapping, and a set of physiological traits of the BXD mouse population to explore genetic factors that explain differences in gut microbiota and its impact on metabolic traits. Molecular profiling of the gut microbiota revealed important quantitative differences in microbial composition among BXD strains. These differences in gut microbial composition are influenced by host-genetics, which is complex and involves many loci. Linkage analysis defined Quantitative Trait Loci (QTLs) restricted to a particular taxon, branch or that influenced the variation of taxa across phyla. Gene expression within the gastrointestinal tract and sequence analysis of the parental genomes in the QTL regions uncovered candidate genes with potential to alter gut immunological profiles and impact the balance between gut microbial communities. A QTL region on Chr 4 that overlaps several interferon genes modulates the population of Bacteroides, and potentially Bacteroidetes and Firmicutes-the predominant BXD gut phyla. Irak4, a signaling molecule in the Toll-like receptor pathways is a candidate for the QTL on Chr15 that modulates Rikenellaceae, whereas Tgfb3, a cytokine modulating the barrier function of the intestine and tolerance to commensal bacteria, overlaps a QTL on Chr 12 that influence Prevotellaceae. Relationships between gut microflora, morphological and metabolic traits were uncovered, some potentially a result of common genetic sources of variation. Gut microorganisms may largely be determined by genetics."


McLean SA, Williams DA, Harris RE et al. 2005.  Momentary relationship between cortisol secretion and symptoms in patients with fibromyalgia.  Arthritis Rheum. 52(11):3660-3669.  “Among women with FM, pain symptoms early in the day are associated with variations in function of the hypothalamic-pituitary-adrenal axis.”

McLean SA, Clauw DJ. 2005.  Biomedical models of fibromyalgia.  Disabil Rehabil. 27(12):659-665.  “The tender point criteria for FM have resulted in the common misconception among health care professionals that this spectrum of disorders is limited to women with high degrees of psychological distress.  A hallmark of FM is the presence of non-nociceptive, central pain.  There is evidence of centrally augmented pain processing, which can be detected both with sensory testing and by more objective measures (e.g., evoked potentials, functional neuroimaging).  An appreciation of the neurobiological basis for these disorders, and an understanding of some of the abnormalities of pain processing present in patients with FM, will hopefully provide greater understanding of these patients.  It may also serve to decrease the level of frustration and improve the care experience of both chronic pain patients and physicians.”

McLean SA, Williams DA, Clauw DJ. 2005.  Fibromyalgia after motor vehicle collision: evidence and implications.  Traffic Inj Prev. 6(2):97-104.  “The evidence that MVC trauma may trigger FM meets established criteria for determining causality, and has a number of important implications, both for patient care, and for research into the pathophysiology and treatment of these disorders.”

McLennan MT. 2014. Interstitial Cystitis: Epidemiology, Pathophysiology, and Clinical Presentation. Obstet Gynecol Clin North Am. 41(3):385-395. "Interstitial cystitis, or painful bladder syndrome, can present with lower abdominal pain/discomfort and dyspareunia, and pain in any distribution of lower spinal nerves. Patients with this condition experience some additional symptoms referable to the bladder, such as frequency, urgency, or nocturia. It can occur across all age groups, although the specific additional symptoms can vary in prevalence depending on patient age. It should be considered in patients who have other chronic pain conditions such as fibromyalgia, chronic fatigue, irritable bowel, and vulvodynia. The cause is still largely not understood, although there are several postulated mechanisms."

McLeod D, Nelson K. 2013. The role of the emergency department in the acute management of chronic or recurrent pain. Australas Emerg Nurs J. 16(1):30-36. "It is evident that the ED is not the ideal setting for managing patients with chronic pain; however, it is the last resort for many who do present, and who will continue to present should their pain persist. It is time to ensure that the ED provides a consistently supportive, cohesive and integrated approach to managing patients with chronic pain syndromes."

McMahon M, Stiller K, Trott P. 2006.  The prevalence of thumb problems in Australian physiotherapists is high: an observational study.  Aust J Physiother. 52(4):287-292.  “The prevalence of thumb problems in Australian physiotherapists appears to be high and can be of sufficient severity to impact on careers.”  Myofascial trigger point therapists and other manual therapists are greatly needed, and will become more so as the rest of the medical world discovers them for the treasures that they are.  The loss of even one of them is too much.  There are alternative options to TrP care that are not as difficult on the thumbs and other parts of the anatomy.  It is to be holed that the therapists search out their own perpetuating factors and look into barrier release method, frequency specific microcurrent and other methods to effectively perform manual medicine.  DJS]

McMakin CR, Oschman JL. 2013. Visceral and somatic disorders: tissue softening with frequency-specific microcurrent. J Altern Complement Med. 19(2):170-177. "Frequency-specific microcurrent (FSM) is an emerging technique for treating many health conditions. Pairs of frequencies of microampere-level electrical stimulation are applied to particular places on the skin of a patient via combinations of conductive graphite gloves, moistened towels, or gel electrode patches. A consistent finding is a profound and palpable tissue softening and warming within seconds of applying frequencies appropriate for treating particular conditions. Similar phenomena are often observed with successful acupuncture, cranial-sacral, and other energy-based techniques. This article explores possible mechanisms involved in tissue softening. In the 1970s, neuroscientist and osteopathic researcher Irvin Korr developed a "γ-loop hypothesis" to explain the persistence of increased systemic muscle tone associated with various somatic dysfunctions. This article summarizes how physiologists, neuroscientists, osteopaths, chiropractors, and fascial researchers have expanded on Korr's ideas by exploring various mechanisms by which injury or disease increase local muscle tension or systemic muscle tone. Following on Korr's hypothesis, it is suggested that most patients actually present with elevated muscle tone or tense areas due to prior traumas or other disorders, and that tissue softening indicates that FSM or other methods are affecting the cause of their pathophysiology. The authors believe this concept and the research it has led to will be of interest to a wide range of energetic, bodywork, and movement therapists."

McMillan AS, Blasberg B. 1994. Pain-pressure threshold in painful jaw muscles following trigger point injection.  J Orofac Pain. 8(4):384-390.  “The pain-pressure threshold was significantly lower in myofascial pain subjects than in control subjects at all recording sites.  Pain-pressure thresholds increased minimally in the masseter after trigger-point injection, whereas the temporal region was relatively unaffected.”  “Although local anesthetic injection acts peripherally at the painful site and centrally where pain is sustained, pain-pressure thresholds were not dramatically increased in myofascial pain subjects, in contrast to controls.  This suggests that in subjects with myofascial pain, there was continued excitability in peripheral tissues and/or central neural areas which may have contributed to the persistence of jaw muscle tenderness.”

McNett M, Goldenberg D, Schaefer C et al. 2011. Treatment patterns among physician specialities in the management of fibromyalgia: results of a cross-sectional study in the United States. Curr Med Res Opin. 27(3):673-683. "Fibromyalgia (FM) is characterized by persistent and widespread pain and often associated with other symptoms and comorbidities. Thus, FM patients seek care from multiple physician specialties." "Patient characteristics were similar across specialties, except with regards to Comorbidity burden. This study noted significant differences among physician specialties in HRU (healthcare resource use) and treatment patterns among medications, diagnostics, and outpatient visits. Consistent with other studies, this study did not identify a dominant strategy for FM management across physician specialties as overall per patient medical costs and subject-reported treatment satisfaction were similar. Future research to better characterize differences among physician specialties in FM management, as well as the reasons for these differences, would be useful."

McNicholas WT, Bonsignore MR. 2007.  Sleep Apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities.  Eur Respir J. 29(1):156-178.  “Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death.  The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism.”

McPartland JM, Giuffrida A, King J et al. 2005.  Cannabimimetic effects of osteopathic manipulative treatment.  J Am Osteopath Assoc. 105(6):283-291.  “Healing modalities popularly associated with changes in the endorphin system, such as OMT [osteopathic manipulative treatment], may actually be mediated by the endocannabinoid system.”

McPartland JM, Guy GW, Di Marzo V. 2014. Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid System. PLoS One. 9(3):e89566. "Evidence indicates that several classes of pharmaceuticals upregulate the eCB system, including analgesics (acetaminophen, non-steroidal anti-inflammatory drugs, opioids, glucocorticoids), antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Clinical interventions characterized as "complementary and alternative medicine" also upregulate the eCB system: massage and manipulation, acupuncture, dietary supplements, and herbal medicines. Lifestyle modification (diet, weight control, exercise, and the use of psychoactive substances-alcohol, tobacco, coffee, cannabis) also modulate the eCB system….Few clinical trials have assessed interventions that upregulate the eCB system. Many preclinical studies point to other potential approaches; human trials are needed to explore these promising interventions."

McPartland JM.  2004.  Travell trigger points – molecular and osteopathic perspectives.  JAOA 104(6):244-249.

McQuay, H. 1999. Opioids in pain management. Lancet 353(9171):2229-32.

McRae A, Ling EA, Schubert P et al. 1998.  Properties of activated microglia and pharmacologic interference by propentofylline.  Alzheimer Dis Assoc Disord 12 Suppl 2:S15-S20.  This study indicates that propentofylline can down regulate spinal glial cells.  This indicates it may be a useful medication for central sensitization.

McSherry, J. A. 1989. Cognitive impairment after head injury. Am Fam Physician 40(4):186-190. Cognitive impairment is common after head injury, even when the injury has been minor.

McVeigh GE, Cohn JN. 2003.  Endothelial dysfunction and the metabolic syndrome. Curr Diab Rep 3(1):87-92.  “The metabolic syndrome is a highly prevalent multifaceted clinical entity produced through the interaction of genetic, hormonal, and lifestyle factors.  A distinctive constellation of abnormalities precedes and predicts the accelerated development of inflammation and coagulation represent emerging risk contributors associated with obesity and insulin resistance, central components of the metabolic syndrome, which act in concert with traditional abnormalities to increase cardiovascular risk.”

McVeigh JG, Finch MB, Hurley DA et al. 2007.  Tender point count and total myalgic score in fibromyalgia: changes over a 28-day period.  Rheumatol Int. [Jul 20 Epub ahead of print].

McWhorter, J. H. and R. B. Davis. 1998. Cherokee prescriptions for accupressure and massage. NCMJ 59(6):368.

Meana M, Cho R, DesMeules M. 2004.  Chronic pain: the extra burden on Canadian women.  BMC Womens Health 4 Suppl 1:S17.  This paper indicates that 18% of Canadian women and 14% of Canadian men have chronic pain, with a higher prevalence of Asians in the over 65 year age group and a higher prevalence of Aboriginal Canadians in the under 65 group.  Of the 125,574 people represented, age, income and education seemed to make the difference in the percentage between men and woman.  The authors stress early identification of pain disorders and note an urgent need for the development of patient education and self-management programs, as the population is aging.

Mease P, Arnold LM, Chow EH et al. 2009.  Fibromyalgia syndrome module at OMERACT 9: domain construct.  J Rheumatol. 36(10):2318-2329.  [It is very disheartening that these authors did not include the critical step of acknowledging that co-existing myofascial and other trigger points MUST be taken into consideration, as many of the symptoms that they ascribe to FM can be caused by TrPs.  Recent research indicates that every FM patients has co-existing TrPs.  It is to be hoped that this fatal flaw in this criteria will be corrected before it encourages even more flawed FM research with suspect conclusions.

Mease P. 2005.  Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment.  J Rheumatol Suppl. 75:6-21.  “Although the etiology of FM is not completely understood, the syndrome is thought to arise from influencing factors such as stress, medical illness, and a variety of pain conditions in some, but not all patients, in conjunction with a variety of neurotransmitter and neuroendocrine disturbances. These include reduced levels of biogenic amines, increased concentrations of excitatory neurotransmitters, including substance P, and dysregulation of the hypothalamic-pituitary-adrenal axis.  A unifying hypothesis is that FM results from sensitization of the central nervous system.  Establishing diagnosis and evaluating effects of therapy in patients with FM may be difficult because of the multifaceted nature of the syndrome and overlap with other chronically painful conditions.  Diagnostic criteria need further refinement.  The multifaceted nature of FM suggests that multimodal individualized treatment programs may be necessary to achieve optimal outcomes in patients with this syndrome.”

Mease PJ, Clauw DJ, Trugman JM et al. 2014. Efficacy of long-term milnacipran treatment in patients meeting different thresholds of clinically relevant pain relief: subgroup analysis of a randomized, double-blind, placebo-controlled withdrawal study. J Pain Res. 7:679-687. "Fibromyalgia patients from a long-term, open-label study of milnacipran (50-200 mg/day) were eligible to participate in a 12-week, randomized, placebo-controlled withdrawal study. The withdrawal study evaluated loss of therapeutic response in patients who achieved ≥50% pain improvements after receiving up to 3.25 years of milnacipran. This post-hoc analysis investigated whether patients who met lower thresholds of pain improvement also experienced worsening of fibromyalgia symptoms upon treatment withdrawal….Patients who experienced ≥30% to <50% pain reduction with long-term milnacipran had significant worsening of fibromyalgia symptoms after treatment withdrawal. These results suggest that the conventional ≥30% pain responder cutoff may be adequate to demonstrate efficacy in randomized withdrawal studies of fibromyalgia. Patients in the <30% pain reduction subgroup had worsening scores on the FIQR and other multidimensional measures after treatment withdrawal, indicating the importance of identifying and managing the multiple symptoms of fibromyalgia." Free Article

Mease PJ, Farmer MV, Palmer RH et al. 2013. Milnacipran combined with pregabalin in fibromyalgia: a randomized, open-label study evaluating the safety and efficacy of adding milnacipran in patients with incomplete response to pregabalin. Ther Adv Musculoskelet Dis. 5(3):113-126. "In this exploratory, open-label study, adding milnacipran to pregabalin improved global status, pain, and other symptoms in patients with fibromyalgia with an incomplete response to pregabalin treatment." [See: Huskey AM, Thomas CC, Waddell JA. 2013. Occurrence of milnacipran-associated morbilliform rash and serotonin toxicity. Ann Pharmacother. 47(7-8):e32. Look at the peripheral pain generators, and treat those. DJS]

Mediati RD, Vellucci R, Dodaro L. 2014. Pathogenesis and clinical aspects of pain in patients with osteoporosis. Clin Cases Miner Bone Metab. 11(3):169-172. "Bone pain is one of the most frequent kinds of chronic pain, mainly in elderly patients. It causes a significant worsening of functional capacity and deterioration in the quality of life in people affected. Mechanisms of pain in osteoporosis are poorly known and often extrapolated by other pathologies or other experimental model. One of principal causes would be a 'hyper-remodeling' of bone that involves osteoclasts activity and pathological modifications of bone innervation. Several studies show that osteoclasts play a significant role in bone pain etiology. Pain in osteoporosis is mainly nociceptive, if it becomes persistent a sensitization of peripheral and central nervous system can occur, so underlining the transition to a chronic pain syndrome…A balanced and early multimodal pain therapy including opioids as necessary, even in cases of acute pain, improve the functional capacity of patients and helps to prevent neurological alterations that seems to contribute in significant way in causing irreversible pain chronic syndromes." Free PMC Article

Meerlo P, Koehl M, van der Borght K et al. 2002.  Sleep restriction alters the hypothalamic-pituitary-adrenal response to stress.  J Neuroendocrinol 14(5):397-402.

Meeus M, Goubert D, De Backer F et al. 2013. Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: A systematic review. Semin Arthritis Rheum. [Jul 6 Epub ahead of print]. "FM patients show more HRV (heart rate variability) aberrances and indices of increased sympathetic activity. Increased sympathetic activity is only present in CFS patients at night. Since direct comparisons are lacking and some confounders have to be taken into account, further research is warranted. The role of pain and causality can be subject of further research, as well as therapy studies directed to reduced HRV."

Meeus M , Ickmans K, Struyf F et al. 2014. What is in a name? Comparing diagnostic criteria for chronic fatigue syndrome with or without fibromyalgia. Clin Rheumatol. Oct 14. [Epub ahead of print] "Based on the present study, fulfillment of the ME or Canadian criteria did not seem to give a clinically different picture, whereas a diagnosis of comorbid FM selected symptomatically worse and more disabled patients."

Meeus M, Ickmans K, Struyf F et al. 2013. Does Acetaminophen Activate Endogenous Pain Inhibition in Chronic Fatigue Syndrome/Fibromyalgia and Rheumatoid Arthritis? A Double-Blind Randomized Controlled Cross-over Trial. Pain Physician. 16(2):E61-70. "Although enhanced temporal summation (TS) and conditioned pain modulation (CPM), as characteristic for central sensitization, has been proved to be impaired in different chronic pain populations, the exact nature is still unknown....We examined differences in TS and CPM in 2 chronic pain populations, patients with both chronic fatigue syndrome (CFS) and comorbid fibromyalgia (FM) and patients with rheumatoid arthritis (RA), and in sedentary, healthy controls, and evaluated whether activation of serotonergic descending pathways by acetaminophen improves central pain processing....After intake of acetaminophen, pain thresholds increased slightly in CFS/FM patients, and decreased in the RA and the control group. Temporal summation was reduced in the 3 groups and CPM at the shoulder was better overall, however only statistically significant for the RA group....This is the first study comparing the influence of acetaminophen on central pain processing in healthy controls and patients with CFS/FM and RA. It seems that CFS/FM patients present more central pain processing abnormalities than RA patients, and that acetaminophen may have a limited positive effect on central pain inhibition, but other contributors have to be identified and evaluated."

Meeus M, Nijs J, Hermans L et al. 2013. The role of mitochondrial dysfunctions due to oxidative and nitrosative stress in the chronic pain or chronic fatigue syndromes and fibromyalgia patients: peripheral and central mechanisms as therapeutic targets? Expert Opin Ther Targets. 17(9):1081-1089. "Introduction: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are characterized by persistent pain and fatigue. It is hypothesized that reactive oxygen species (ROS), caused by oxidative and nitrosative stress, by inhibiting mitochondrial function can be involved in muscle pain and central sensitization as typically seen in these patients. Areas covered: The current evidence regarding oxidative and nitrosative stress and mitochondrial dysfunction in CFS and FM is presented in relation to chronic widespread pain. Mitochondrial dysfunction has been shown in leukocytes of CFS patients and in muscle cells of FM patients, which could explain the muscle pain. Additionally, if mitochondrial dysfunction is also present in central neural cells, this could result in lowered ATP pools in neural cells, leading to generalized hypersensitivity and chronic widespread pain. Expert opinion: increased ROS in CFS and FM, resulting in impaired mitochondrial function and reduced ATP in muscle and neural cells, might lead to chronic widespread pain in these patients. Therefore, targeting increased ROS by antioxidants and targeting the mitochondrial biogenesis could offer a solution for the chronic pain in these patients. The role of exercise therapy in restoring mitochondrial dysfunction remains to be explored, and provides important avenues for future research in this area."

Mehl-Madrona, L. E. 1999. Comparison of ketorolac-chlorpromazine with meperidine-promethazine for treatment of exacerbations of chronic pain. J Am Board Fam Pract 12(3):188-94.

Mehling WE, Daubenmier J, Price CJ et al. 2013. Self-reported interoceptive awareness in primary care patients with past or current low back pain. J Pain Res. 6:403-418. "Mind-body interactions play a major role in the prognosis of chronic pain, and mind-body therapies such as meditation, yoga, Tai Chi, and Feldenkrais presumably provide benefits for pain patients. The Multidimensional Assessment of Interoceptive Awareness (MAIA) scales, designed to measure key aspects of mind-body interaction, were developed and validated with individuals practicing mind-body therapies, but have never been used in pain patients. METHODS: We administered the MAIA to primary care patients with past or current low back pain and explored differences in the performance of the MAIA scales between this and the original validation sample. We compared scale means, exploratory item cluster and confirmatory factor analyses, scale-scale correlations, and internal-consistency reliability between the two samples and explored correlations with validity measures. RESULTS: Responses were analyzed from 435 patients, of whom 40% reported current pain. Cross-sectional comparison between the two groups showed marked differences in eight aspects of interoceptive awareness. Factor and cluster analyses generally confirmed the conceptual model with its eight dimensions in a pain population. Correlations with validity measures were in the expected direction. Internal-consistency reliability was good for six of eight MAIA scales. We provided specific suggestions for their further development. CONCLUSION: Self-reported aspects of interoceptive awareness differ between primary care patients with past or current low back pain and mind-body trained individuals, suggesting further research is warranted on the question whether mind-body therapies can alter interoceptive attentional styles with pain. The MAIA may be useful in assessing changes in aspects of interoceptive awareness and in exploring the mechanism of action in trials of mind-body interventions in pain patients."

Mehling WE, Hamel KA, Acree M et al. 2005.  Randomized, controlled trial of breath therapy for patients with chronic low-back pain.  Altern Ther Health Med. 11(4):44-52.  Patients with chronic low back pain improved significantly with breath therapy.  [Although myofascial trigger points were not mentioned in this article, it is very possible that the prevention of paradoxical breathing, a common perpetuating factor in many TrPs that can contribute to or cause low back pain, may have been part of this process. DJS]

Meigs, J. B. 2002. Epidemiology of the metabolic syndrome. Am J Manag Care 8(Suppl):S283-92. "Primary care physicians must recognize that the co-occurrence of risk factors for type 2 diabetes and CVD represents an extremely adverse metabolic state warranting aggressive risk factor intervention."

Meilinger A, Burger M, Peter HH. 2015. [Heterozygote forms of familial Mediterranean fever can be manifested in adults as myofascial pain syndrome.] Z Rheumatol. [Jan 22 Epub ahead of print.] [Article in German] Familial Mediterranean fever (FMF) is a disease characterized by recurrent fever, serositis, arthritis and unspecific myalgia. It is prevalent among Mediterranean people and has been shown to be associated with mutations in the Mediterranean fever (MEFV) gene…. As heterozygous mutations in MEFV can be associated with only mild inflammatory symptoms, such as arthralgia or chronic fibromyalgic pain, FMF may be underdiagnosed in the current diagnostic work-up of musculoskeletal diseases….This article presents evidence that 9 out of 12 Mediterranean patients with recurrent myofascial pain syndrome and mild inflammation revealed heterozygote mutations in the MEFV gene and 7 of these patients benefitted from treatment with colchicine. As colchicine treatment not only improved the myofascial pain but also prevented FMF-associated amyloidosis and nephropathy, differential diagnosis of fibromyalgia in patients of Mediterranean origin should include FMF and a genetic screening of the MEFV locus.

Meireles SA, Antero DC, Kulczycki MM et al. 2014. Prevalence of falls in fibromyalgia patients. Acta Ortop Bras. 22(3):163-166. "FM patients fall more often than RA patients and control individuals." [These patients were not assessed for CMP. So this could be due to FM, or could be due to symptoms of some specific co-existing trigger points. DJS]

Meisinger C, Heier M, Loewel H: MONICA:KORA Augsburg Cohort Study. 2005.  Sleep disturbance as a predictor of type 2 diabetes mellitus in men and women from the general population.  Diabetologia 48(2):235-241.  Sleep disturbance may be associated with both insulin resistance and chronic low-grade systemic inflammation.

Meisler, J. G. 1999. Chronic pain conditions in women. J Womens Health 8(3):313-20.

Meites, J. 1991. Role of hypothalamic catecholamines in aging processes. Acta Endocrinol (Copenh) 125 Suppl 1:98-103.

Mejuto-Vazquez MJ, Salom-Moreno J, Ortega-Santiago R et al. 2014. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: A randomized clinical trial. J Orthop Sports Phys Ther. [Feb 25 Epub ahead of print.] "The results of the current randomized clinical trial suggest that a single session of TrP-DN decreases neck pain intensity and widespread pressure sensitivity, and also increases active cervical range of motion in patients with acute mechanical neck pain. Changes in pain, PPT, and cervical range of motion surpassed their respective minimal detectable change values supporting clinically relevant treatment effects."

Melamede RJ. 2005.  Cannabis and tobacco smoke are not equally carcinogenic.  Harm Reduct J. 2(1):21  “Available scientific data that examines the carcinogenic properties of inhaling smoke and its biological consequences suggests reasons why tobacco smoke, but not cannabis smoke, may result in lung cancer.”

Meleger AL, Krivickas LS. 2007.  Neck and back pain: musculoskeletal disorders.  Neurol Clin. 25(2):419-438.  Review of many non-neurological causes of neck and back pain, including myofascial pain and fibromyalgia.

Melikoglu M, Melikoglu MA. 2012. The prevalence of fibromyalgia in patients with Behçet's disease and its relation with disease activity. Rheumatol Int. [Sep 28 Epub ahead of print]. "FM is a common and important clinical problem that may represent an additional factor that worsens pain and physical limitations in patients with BD. The higher prevalence of FM in patients with BD seems to be affected by BD itself, rather than its severity." [This study makes an important point. Many conditions have interactive diagnoses, and we need to look for them. DJS]

Mellick GA, Mellick LB. 2003.  Regional head and face pain relief following lower cervical intramuscular anesthetic injection.  Lower cervical intramuscular injection of local anesthetic relieved hyperalgesia and allodynia of the face and scalp associated with migraine headache, as well as associated nausea, photophobia and phonophobia.

Mellin, G. 1998. Correlations of hip mobility with degree of back pain and lumbar spinal mobility in chronic low-back pain patients. Spine 13(6):668-70.

Melnick MD, Harrison BR, Park S et al. 2013. A strong interactive link between sensory discriminations and intelligence. Curr Biol. [May 22 Epub ahead of print]. This study linked intelligence (IQ) with the ability to filter out less relevant low-level stimuli. "We conjecture that the ability to suppress irrelevant and rapidly process relevant information fundamentally constrains both sensory discriminations and intelligence, providing an information-processing basis for the observed link." [Fibromyalgia has been shown in research to suppress the normal filtering of information. This contributes to what amounts to constant sensory overload. The central nervous system is overwhelmed by stimuli, keeping the CNS hypersensitized and preoccupied. DJS]

Melzack, R., McGill University. 1993. Pain: past, present and future. Can J Exper Psych 47(4):615-629.

Menachem A, Kaplan O, Dekel S. 1993.  Levator scapulae syndrome: an anatomic-clinical study.  Bull Hosp Jt Dis. 53(1):21-24.  “Twenty-two patients, all young females, presenting with a common clinical picture of pain over the upper medial angle of the scapula were studied.  The dominant shoulder was the most commonly involved (82%).  Pain radiated to the neck and shoulder, but rarely to the arm. Movements that stretched the levator scapulae on the affected side aggravated symptoms.”  “Anatomic dissections of 30 cadaveric shoulders showed great variability in the insertion of the levator.  A bursa was found between the scapula, the serratus, and the levator in more than 50% of the shoulders.  This study suggests that this syndrome, leading to bursitis and pain, may be caused by anatomic variations of the insertion of the levator scapulae and origin of the serratus anterior.  This may explain the constant trigger point and crepitation as well as the increased heat emission found on thermography.  Local steroid injections relieved symptoms partially in 75% of those patients who underwent treatment.” 

Menant JC, Wong A, Sturnieks DL et al. 2013. Pain and Anxiety Mediate the Relationship Between Dizziness and Falls in Older People. J Am Geriatr Soc. [Jan 25 Epub ahead of print]. "Suffering from neck and back pain and anxiety were mediators of the relationship between dizziness and falls after controlling for poor sensorimotor function and balance. Older people with dizziness might benefit from interventions targeting these mediators such as pain management and cognitive behavioral therapy." [This should include an assessment for TrPs. DJS]

Mendell, L. M., K. M. Albers and B. M. Davis. 1999. Neurotrophins, nociceptors, and pain. Microsc Res Tech 45(4-5):252-61.

Mendelson, W. B. 1996. Are periodic leg movements associated with clinical sleep disturbance? Sleep 19(3):219-23.

Mendez-Sanchez R, Gonzalez-Iglesias J, Puente-Gonzalez AS et al. 2011. Effects of manual therapy of craniofacial pain in patients with chronic rhinosinusitis: a case series. J Manipulative Physiol Ther. [Oct 27 Epub ahead of print]. This interesting study found that patients with craniofascial pain and "chronic rhinosinusitis" could get relief with manual therapy. This is indicative of possible myofascial trigger point origins of the symptoms. Myofascial TrPs can cause runny nose, craniofascial pain, congestion and other sinus symptoms. DJS]

Mendy A, Vieira ER, Albatineh AN, et al. 2013. Low bone mineral density is associated with balance and hearing impairments. Ann Epidemiol Oct 29 [Epub ahead of print]. "Low BMD is associated with balance and hearing impairments, especially in older adults."

Mengshoel AM. 2007.  What is important to ease the life with fibromyalgia syndrome – review of qualitative studies.  J Musculoskel Pain 15 (Supp 13):55 item 97.  [Myopain 2007 Poster]  “The patients considered that the following were important for easing their lives: 1. Getting a diagnosis for validating illness and helping to focus their further search of information about explanations and management possibilities; 2. Learning strategies to cope with FMS by not overdoing.  This implies accepting the situation, adapting to the boundaries set by illness, and adjusting to everyday life situations and social obligations; 3. Support and recognition from health professionals, family and others.”

Mengshoel AM, Heggen K. 2004. Recovery from fibromyalgia – previous patients’ own experiences.  Disabil Rehabil 26(1):46-53.  This small study of 5 women found that they had been able to “...alter life goals and everyday obligations...”, while “...maintaining a social role they considered to be consistent with their self-image.”  It suggests that some patients with FMS may become symptom free if their perpetuating factors can be controlled.

Mengshoel, A. M. 1996. [Effect of physical exercise in fibromyalgia]. Tidsskr Nor Laegeforen 116(6):746-748 [Norwegian].

Mengshoel, A. M., O. Forre and H. B. Komnaes. 1990. Muscle strength and aerobic capacity in primary fibromyalgia. Clin Exp Rheumatol 8(5):475-479.

Mense S. 2011. [Differences between myofascial trigger points and tender points.] Schmerz. 25(1):93-104 [German]. "The article describes and compares the characteristics of myofascial trigger points (MTrPs) of the myofascial pain syndrome and the tender points (TePs) of the fibromyalgia syndrome. Many statements are hypothetical, because not all aspects of the disorders have been clarified in solid studies. Signs and symptoms of MTrPs: (1) palpable nodule, often located close to the muscle belly, (2) often single, (3) allodynia and hyperalgesia at the MTrP, (4) referral of the MTrP pain, (5) normal pain sensitivity outside the MTrPs, (6) local twitch response, (7) local contracture in biopsy material, (8) peripheral mechanism probable. Signs and symptoms of TePs: (1) no palpable nodule, (2) location often close to the muscle attachments, (3) multiple by definition, (4) allodynia and hyperalgesia also outside the TePs, (5) enhanced pain under psychic stress, (6) unspecific histological changes in biopsy material, (7) central nervous mechanism probable. The multitude of differences speaks against a common aetiology and pathophysiology."

Mense S. 2010. How do muscle lesions such as latent and active trigger points influence central nociceptive neurons? J Musculoskel Pain. 18(4):348-353. "Spontaneous pain is mainly due to ongoing activity in nociceptive neurons in the spinal cord. Allodynia and hyperalgesia can be explained by a sensitization of central nociceptive neurons (central sensitization). One mechanism of central sensitization is the release of substance P together with glutamate from presynaptic terminals of nociceptive fibers from muscle. Other steps of sensitization are the opening of N-methyl-d-aspartate channels on postsynaptic neurons and the de novo synthesis of ion channels. The current concept of pain referral assumes that the efficacy of synaptic connections of central dorsal horn neurons can change under the influence of a nociceptive input. Thus, ineffective synaptic connections can become effective. Pain referral appears to reflect the formation of new effective central nervous connections." "Myofascial TrPs are not merely a peripheral phenomenon, the input from TrPs leads to hyperexcitability of central neurons that manifests itself in allodynia, hyperalgesia, and pain referral. These central changes are mainly based on an increase in the synaptic efficacy of central connections induced by nociceptive input." "Allodynia (pain evoked by stimuli that are not normally painful) and hyperalgesia (stronger than usual pain evoked by a painful stimulus) can be explained by a sensitization of central nociceptive neurons (central sensitization)." "One mechanism of central sensitization is the release of the neuromodulator SP together with glutamate from presynaptic terminals of nociceptive fibers from muscle." [This article explains how TrPs can cause central sensitization states such as FM, and that glial cell activation is a critical part of this process. DJS]

Mense S. 2004. Neurobiological basis for the use of botulinum toxin in pain therapy. J Neurol 251(Suppl 1):1/1-1/7.  Botulinum toxin interferes with the release of acetylcholine from cholinergic nerve endings, and thus interferes with the probable mechanism of TrP formation. Botulinum toxin interferes with this process, thus acting upon the pain cause, rather than just offering symptomatic relief.

Mense S, Hoheisel U. 2004.  Central nervous sequelae of local muscle pain.  J Musculoskeletal Pain 12(3/4):101-109.  This excellent overview explains how the body and mind work to handle acute pain, and how some of these very changes can backfire in some patients to promote chronic pain.  There are mechanisms in place to prevent this, but there are many variables in both series of processes.  Research in chronic pain mechanisms, especially involving glial cells, offer hope for answers in the near future.

Mense SS. 2004.  [Functional neuroanatomy for pain stimuli.  Reception, transmission and processing] [German] Schmerz 18(3):225-237.

Mense S. 2004.  Neurobiological basis for the use of botulinum toxin in pain therapy.  J Neurol. 251 Suppl 1:I1-7.  “During chronic pain conditions, at all levels massive neuroplastic changes take place that lead to rewiring of connections and structural alterations in the nuclei of the nociceptive pathways.  In chronic pain patients the neuroanatomy of pain probably differs from that of healthy people.”

Mense S. 1999.  [Neurobiological basis of muscle pain] [German] Schmerz. 13(1):3-17.  “The central sensitization can explain the hyperalgesia and spread of pain in patients.  Chronic spontaneous muscle pain, however, appears to be due to a lack of NO [nitric oxide].  The final step in the transition from acute to chronic pain involves structural changes that perpetuate the functional changes.  In rat experiments employing nerve lesions or muscle inflammation, such morphological changes become apparent within a few hours after the lesion.”  [Research into the development of chronic pain has the potential to lead to new understanding and new therapies and medications to prevent and treat it. DJS] 


Mense S. 2004.  [Mechanisms of transition from acute to chronic muscle pain] [German] Orthopade 33(5):525-532.  “Norepinephrine is known to increase cases of chronic pain, and is a stimulant of muscle nociceptors.  If BoNT inhibits the release of these transmitters, it could be analgesic in cases of sympathetically maintained pain including the complex regional pain syndrome.”

Mense S. 2003.  What is different about muscle pain?  Schmertz 17(6):459-463.  This article calls attention to the fact that most of the studies on pain are done on pain arising from the skin, and yet it is deeper pains, from fascia, muscle, tendon and joint that are more clinically significant.  Research indicates that the mechanisms of cutaneous pain and pain originating elsewhere are different, and suggest dysfunction in descending pain-modulating pathways could lead to the type of pain associated with fibromyalgia. [German]


Mense S. 2003.  The pathogenesis of muscle pain.  Curr Pain Headache Rep 7(6):419-415.  This excellent article brings out many fine points that are often missed in the study of central sensitization and muscle pain.  Low pH can sensitize receptors, and a low local pH is common in ischemia and inflammation and other conditions and can be part of the neuroplastic changes leading to central sensitization, causing spontaneous pain and hyperalgesia and allodynia.  This paper also brings attention to the fact that once central sensitization has taken place, it takes time to normalize the body.  This does not mean it is impossible to do so, just that the patient and the clinicians must try to restore the body balances carefully.  All perpetuating factors must be addressed and the body given a chance to reestablish balance.  There is no quick fix.  It takes time. 

Mense, S., Simons, D.G., Hoheisel, U., et al. 2003.  Lesions of rat skeletal muscle following local block of acetylcholinesterase and neuromuscular stimulation.  J Appl Physiol [***epub ahead of print].  “The results support the assumption that a dysfunctional endplate exhibiting increased release of [acetylcholine] may be the starting point for regional abnormal contractions which are thought to be essential for the formation of myofascial trigger points.”

Mense, S. 1999. New Developments in the Understanding of the Pathophysiology of Muscle Pain. J Musculoskel Pain 7(1-2):13-24.

Mense, S. 1998. Descending antinociception and fibromyalgia. Z Rheumatol 57 Suppl 2:23-6.

Menzies V, Lyon DE, Archer KJ et al. 2013. Epigenetic alterations and an increased frequency of micronuclei in women with fibromyalgia. Nurs Res Pract. [Aug 22 Epub ahead of print]. The frequency of spontaneously occurring micronuclei and genome-wide methylation patterns in 10 women with FM were compared. There were significant alterations in methylation patterns at 69 sites compared with those in 42 healthy controls of similar ages. "Genes associated with DM (differently methylated) sites whose function has particular relevance to FM included BDNF, NAT15, HDAC4, PPKCA, RTN1, and PRKG1."

Menzies V, Taylor AG, Bourguignon C. 2006.  Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia.  J Altern Complement Med. 12(1):23-30.  “This study demonstrated the effectiveness of guided imagery in improving functional status and sense of self-efficacy for managing pain and other symptoms of FM.  However, participants’ reports of pain did not change.”

Meran S, Martin J, Luo DD et al. 2013. Interleukin-1beta induces hyaluronan and CD44-dependent cell protrusions that facilitate fibroblast-monocyte binding. Am J Path. 182(6):2223-2240. This study concerns the possible mechanisms behind persistent inflammation as a determinant of progressive tissue fibrosis. These authors found that if they stimulated fibroblasts, the most common type of connective tissue cell, with interleukin 1-beta, the hyaluronic acid within the fibroblast relocates to the outer cell membrane, forming protrusions. They conclude that their study suggests that the interleukin beta-1 generated hyaluronic acid (hyaluronan) is involved in fibroblast immune activation, which may sequester monocytes in the inflamed tissues, resulting in a state of chronic inflammation. [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]

Meria A, Ciuffolo F, D’Attillo M et al. 2004.  Functional infrared imaging in the diagnosis of the myofascial pain.  Conf Proc IEEE Eng Med Biol Soc. 2:1188-1191.  “Functional infrared imaging seems to distinguish healthy subjects from the patients suffering myofascial pain in almost all the investigated sites.”

Merkes M. 2010. Mindfulness-based stress reduction for people with chronic diseases. Aust J Prim Health. 16(3):200-210. "Chronic diseases are associated with a range of unwelcome psychological and physical consequences. Participation in an MBSR (mindfulness-based stress reduction) program is likely to result in coping better with symptoms, improved overall well-being and quality of life, and enhanced health outcomes. As an adjunct to standard care, MBSR has potential for much wider application in Australian primary care settings."

Mesiano, S., S. L. Katz, J. Y. Lee and R. B. Jaffe. 1999. Phytoestrogens alter adrenocortical function: genistein and daidzein suppress glucocorticoid and stimulate androgen production by cultured adrenal cortical cells. J Clin Endocrinol Metab 84(7):2443-8.

Mesplie N, Kerautret J, Leoni-Mesplie S et al. 2010. [Central toxic keratopathy and fibromyalgia: a case report.] J Fr Ophtalmol. [Jul 29 Epub ahead of print]. [French] "Diffuse lamellar keratitis (DLK) is a sterile inflammation after laser in situ keratomileusis. Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The cause of central toxic keratopathy is unknown. Fibromyalgia is a widespread, chronic pain disorder that includes a complex constellation of somatic and emotional symptoms. Patients often complain of dry eye sensations. Recent studies have highlighted a reduced corneal sensitivity in patients with fibromyalgia. There could be a relation between fibromyalgia, diffuse lamellar keratitis, and central toxic keratopathy. Some precautions may be used before LASIK in patients with fibromyalgia."

Metzger, L. J., S. P. Orr, N. J. Berry, C. E. Ahern, N. B. Lasko and R. K. Pitman. 1999. Physiologic reactivity to startling tones in women with posttraumatic stress disorder. J Abnorm Psychol 108(2):347-52.

Meyer HP. 2002.  Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome. Curr Pain Headache Rep 6(4):274-83. Failure on the part of care providers to recognize myofascial pain from trigger points often leads to costly and unnecessary tests and  procedures. This failure to diagnose can result in harm to the patients.


Meyer UA, Zanger UM. 1997.  Molecular mechanisms of genetic polymorphisms of drug metabolism.  Annu Rev Pharmacol Toxicol. 37:269-296.  Yet another study of how genetics can influence metabolism of drugs.  Some patients are ultra-rapid metabolizers, and some are slow metabolizers.

Mhalla A, de Andrade DC, Baudic S et al. 2010. Alteration of cortical excitability in patients with fibromyalgia. Pain. [Mar 30 Epub ahead of print]. “…fibromyalgia is associated with deficits in intracortical modulation involving both GABAergic and glutamatergic mechanisms, possibly related to certain aspects of the pathophysiology of this chronic pain syndrome. Our data add to the growing body of evidence for objective and quantifiable changes in brain function in fibromyalgia.”  [Evidence continues to be gathered that fibromyalgia is not “all in the mind” nor even in the muscles, but in the central nervous system. DJS]

Mhalla A, Baudic S, de Andrade DC et al. 2011. Long-term maintenance of the analgesic effects of transcranial magnetic stimulation in fibromyalgia. Pain. [Mar 10 Epub ahead of print]. "…these results suggest that TMS (transcranial magnetic stimulation) may be a valuable and safe new therapeutic option in patients with fibromyalgia. The analgesic effects induced by repetitive transcranial magnetic stimulation of the motor cortex can be maintained over 6 months in patients with fibromyalgia, using monthly stimulation."

Mhyre AJ, Dorsa DM. 2005.  Estrogen activates rapid signaling in the brain: role of estrogen receptor alpha and estrogen receptor beta in neurons and glia.  Neuroscience [Dec 9 Epub ahead of print].

Michael DM, Warren GL. 2007.  Effect of trigger point treatment on muscle activation patterns in hip extension movement.  J Musculoskel Pain 15 (Supp 13):32 item 54.  [Myopain 2007 Poster]  “Treatment of TrPs may improve lumbopelvic function.”

Michalsen A, Riegert M, Ludtke R et al. 2005.  Mediterranean diet or extended fasting’s influence of changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study.  BMC Complement Altern Med. 5:22.  Neither extended fasting for the Mediterranean diet changed the intestinal microflora.  [These patients were not screened for co-existing conditions or perpetuating factors such as permeable gut or insulin resistance.  Diet in patients with heterogenous and/or multiple conditions must be carefully and individually tailored to meet the requirements of the patient. DJS]

Michna E, Blonsky ER, Schulman S et al. 2011. Subcutaneous Methylnaltrexone for Treatment of Opioid-Induced Constipation in Patients with Chronic, Nonmalignant Pain: A Randomized Controlled Study. J Pain. [Mar 21 Epub ahead of print]. "We present data demonstrating that subcutaneous methylnaltrexone 12 mg given once daily (QD) or every other day provides significant relief of OIC and was generally well tolerated in patients with chronic, nonmalignant pain. These results expand on prior effectiveness observed for the treatment of OIC in advanced illness patients to a broader population."

Miernik M, Wieckiewicz M, Paradowska A. 2012. Massage therapy in myofascial TMD pain management. Adv Clin Exp Med. 21(5):681-685. Myofascial pain located in the area of the head is a very common disease of the stomatognathic system. The fact that the mechanism of its development is very complex may cause a variety of problems in diagnosis and therapy. Patients diagnosed with this type of affliction usually need a variety of different therapies. Massage therapy can be a significant method of treatment of myofascial pain. That kind of therapy is clinically useful as it improves the subjective and objective health status of the patient and is easy to follow. The aim of this paper is to show the physiological effect and different massage techniques applied in myofascial pain treatment. The authors would also like to present the protocol for dealing with patients who demand that kind of therapy for masseter and temporal muscles.

Mifflin KA, Kerr BJ. 2013. The transition from acute to chronic pain: understanding how different biological systems interact. Can J Anaesth. [Nov 26 Epub ahead of print]. "Although pain is an adaptive sensory experience necessary to prevent further bodily harm, the transition from acute to chronic pain is not adaptive and results in the development of a chronic clinical condition. How this transition occurs has been the focus of intense study for some time. The focus of the current review is on changes in neuronal plasticity as well as the role of immune cells and glia in the development of chronic pain from acute tissue injury and pain….Our understanding of the complex pathways that mediate the transition from acute to chronic pain continues to increase. Work in this area has already revealed the complex interactions between the nervous and immune system that result in both peripheral and central sensitization, essential components to the development of chronic pain. Taken together, a thorough characterization of the cellular mechanisms that generate chronic pain states is essential for the development of new therapies and treatments."

Migliardi, J. R., J. J. Armellino, M Friedman, D. B. Gillings and W. T. Beaver. 1994. Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 56(5):576-86.

Miholic J, Hoffman M, Hoist JJ et al. 2007.  Gastric emptying of glucose solution and associated plasma concentrations of GLP-1, GIP, and PYY before and after fundoplication.  Surg Endosc. [Jan 2 Epub ahead of print]  Fundoplication is implicated as a perpetuating factor in hypoglycemia, which is itself a perpetuating factor for FMS and CMP.

Mika J, Osikowicz M, Makuch W et al. 2007.  Minocycline and pentoxifylline attenuate allodynia and hyperalgesia and potentiate the effects of morphine in rat and mouse models of neuropathic pain.  Eur J Pharmacol. 560(2-3):142-149.  “…preemptive and repeated administration of glial inhibitors suppresses development of allodynia and hyperalgesia and potentiates effects of morphine in rat and mouse models of neuropathic pain.”  [The action of the glial cell modulator pentoxifylline, which can be compounded in topical or intranasal form, seems to have many medicinal applications.  It is a known cytokine modulator.  Research by Myrianthefs PM, Batistaki C in J BUON indicates it is not only an immunmodulator, but also may be helpful to prevent/treat cachexia in cancer patients.  Whether this might imply appetite increase in noncancer patients is something to be considered. DJS]

Mikhailidis, D. P., J. A. Papadakis and E. S. Ganotakis. 1998. Smoking, diabetes and hyperlipidaemia. J R Soc Health 118(2):91-3.

Mikkelsson M, Latikka P, Kautiainen H et al. 1992.  Muscle and bone pressure pain threshold and pain tolerance in fibromyalgia patients and controls.  Arch Phys Med Rehabil. 73(9):814-818.  “…patients with primary fibromyalgia have a generalized amplification of pain sensitivity, a sign that might be useful in the diagnosis of fibromyalgia.”

Mikkelson, M. 1999. One year outcome of preadolescents with fibromyalgia. J Rheumatol 26(3):674-82.

Mikkelsson, M., A. Sourander, J. Piha and J. J. Salminen. 1997. Psychiatric symptoms in preadolescents with musculoskeletal pain and fibromyalgia. Pediatrics 100(2):220-7.

Mikkelsson, M., J. J. Salminen and H. Kautiainen. 1997. Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain 73(1):29-35.

Miletic G, Lippitt JA, Sullivan KM et al. 2013. Loss of calcineurin in the spinal dorsal horn contributes to neuropathic pain, and intrathecal administration of the phosphatase provides prolonged analgesia. Pain. [Jun 15 Epub ahead of print]. "Calcineurin (protein phosphatase 3) regulates synaptic plasticity in the brain. The development of neuropathic pain appears dependent on some of the same mechanisms that underlie brain synaptic plasticity. In this study, we examined whether calcineurin regulates chronic constriction injury (CCI)-elicited plasticity in the spinal dorsal horn. CCI animals exhibited mechanical and thermal hypersensitivity 7days after ligation of the sciatic nerve. Neither control uninjured nor sham-operated animals exhibited pain behavior. Calcineurin activity and content of its Aα isoform were significantly decreased in the ipsilateral postsynaptic density (PSD) of dorsal horn neurons in CCI animals. Calcineurin activity and content in the contralateral PSD of CCI animals or either side of the dorsal horn in sham animals were not modified. The pain behavior in CCI animals was attenuated by intrathecal application of exogenous calcineurin. The treatment was long-lasting as a single injection provided analgesia for 4days by restoring the phosphatase's activity and A? content in the PSD. No signs of toxicity were detected up to 14days after the single intrathecal injection. Intrathecal application of the calcineurin inhibitor FK-506 elicited pain behavior in control uninjured animals and significantly reduced calcineurin activity in the PSD. CCI may elicit neuropathic pain at least in part as a result of the loss of calcineurin-mediated dephosphorylation in the dorsal horn. Addition of the phosphatase by intrathecal injection reverses the injury-elicited loss and provides prolonged pain relief. Clinical therapy with calcineurin may prove to be a novel, effective, and safe approach in the management of well-established neuropathic pain."

Milham, S., J. B. Hatfield and R. Tell. 1999. Magnetic fields from steel-belted radial tires: implications for epidemiologic studies. Bioelectromagnetics 1999 Oct;20(7):440-5

Millan, M. J. 1999. The induction of pain: an integrative review. Prog Neurobiol 57(1):1-164.

Millecamps M, Centeno MV, Berra HH et al. 2007.  Pain Apr 10 [Epub ahead of print]  d-Cycloserine may reduce central sensitization and associated chronic neuropathic pain mechanisms in rats.

Miller AH, Jones JF, Drake DF et al. 2014. Decreased basal ganglia activation in subjects with chronic fatigue syndrome: Association with symptoms of fatigue. PLoS One 23(5):398 156. The information presented suggests that "symptoms of fatigue in CFS subjects were associated with reduced responsitivity of the basal ganglia, possibly involving the disruption of projections from the globus palladus to thalamic and cortical networks.

Miller, A. W., J. J. Sims, A. Canavan, T. Tsu and M. R. Ujhelyi. 1999. Impaired vagal reflex activity in insulin-resistant rats. J Cardiovasc Pharmacol 33(5):698-702.

Miller, C. S. 1999. Are we on the threshold of a new theory of disease? Toxicant-induced loss of tolerance and its relationship to addiction and abdiction. Toxicol Ind Health 15(3-4):284-94.

Miller G. 2005.  The dark side of glia.  Science 308:778-781.  Glial cell activation is a promising target for chronic pain medication.  Glial cells direct neurons to release neurotransmitters, and regulate synaptic traffic.  This involves them in memory and learning processes.  Glia may be involved in the origin of MS, neuropathic pain, chronic pain, and some types of seizures.  Medications already available may work on overexcited glia, but they haven’t been tested for this yet.  Now that more researchers are aware of the pathological properties of some types of activated glia, new avenues for treatment will be developed.

Miller GE, Chen E, Parker KJ. 2011. Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving towards a model of behavioral and biological mechanisms. Psychol Bull. 137(6):959-997. People who are exposed to major psychological stressors in early life have a susceptibility to chronic diseases associated with aging. The altered responses to the endocrine and autonomic systems can amplify the proinflammatory environment, adding to the tendency toward developing chronic diseases.

Miller PL, Ernst AA. 2004.  Sex differences in analgesia: a randomized trial of mu versus kappa opioid agonists.  South Med J 97(1):35-41.  Kappa opioids such as butorphanol may work better for pain in women than mu opioids such as morphine. 

Milligan E, Zapata V, Schoeniger D et al. 2005.  An initial investigation of spinal mechanisms underlying pain enhancement induced by fractalkine, a neuronally released chemokine.  Eur J Neurosci. 22(11):2775-2782.  “These data support that neuronally released fractalkine enhances pain via activation of spinal cord glia.  Thus, fractalkine may be a neuron-to-glia signal triggering pain facilitation.”


Milligan ED, Zapata V, Chacur M et al. 2004.  Evidence that exogenous and endogenous Fractalkine can induce spinal nociceptive facilitation in rats.  Eur J Neurosci 20(9):2294-2302.  The chemokine fractalkine may be a key player in the development of central sensitization.

Mills, K. R., D. J. Newham and R. H. Edwards. 1982. Severe muscle cramps relieved by transcutaneous nerve stimulation: a case report. J Neurol Neurosurg Psychiatry 45(6):539-42.

Min KB, Lee KJ, Park JB et al. 2012. Lead, Cadmium, and Balance and Vestibular Dysfunction Among Adult Participants in the National Health and Nutrition Examination Survey 1999-2004. Environ Health Perspect. [Jan 3 Epub ahead of print]. "Our findings suggest that blood lead and cadmium levels may be associated with balance/vestibular dysfunction in a general sample of U.S. adults." [Vestibular dysfunction is a common co-existing condition with FM and TrPs. This study indicates another possible perpetuating factor. DJS]

Minami, T., E. Okuda-Ashitaka, Y. Nishiuchi, T. Kimura, S. Tachibana, H. Mori and S. Ito. 1998. Anti-nociceptive responses produced by human putative counterpart of nocistatin. Br J Pharmacol 124(6):1016-8.

Minehira K., Tappy L. 2002.  Dietary and lifestyle interventions in the management of the metabolic syndrome: present and future perspective.  Eur J Clin Nutr 56(12):1264-9.  “Future research, in particular the genetic basis of the metabolic syndrome and the interorgan interactions responsible for insulin resistance, is needed to improve therapeutic strategies for the metabolic syndrome.” [As more clinicians become aware of the role of metabolic syndrome as a perpetuating factor in many other conditions such as fibromyalgia and chronic myofascial pain, this research will become more obviously vital to the health of many. The interorgan interactions are already important in fibromyalgia, as so many informational substances are imbalanced.  The addition of metabolic syndrome further complicates the diagnosis and treatment. DJS]

Mingdong Y, Na X, Mingyang G et al. 2012. Acupuncture at the back-pain-acupoints for chronic low back pain of peacekeepers in Lebanon: a randomized controlled trial. J Musculoskel Pain. 20(2):107-115. "Both acupuncture groups have beneficial and persistent effectiveness against CLBP compared with the usual care group. Back-pain-acupoints acupuncture is significantly more effective than standardized acupuncture." Myofascial trigger points have been found to be in ashi acupuncture points. This study found that where there is pain, there is an ashi acupuncture point. Patients with other disabling chronic conditions, including fibromyalgia, were disqualified from this study.

Minich DM, Bland JS. 2007.  Acid-alkaline balance: role in chronic disease and detoxification.  Altern Ther Health Med. 13(4):62-65.  “The increasing dietary acid load in the contemporary diet can lead to a disruption in acid-alkaline homeostasis in various body compartments and eventually result in chronic disease through repeated borrowing of the body’s alkaline reserves.”

Mira E, Martanez MP, Sanchez AI et al. 2011. When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self-efficacy and sleep quality. Br J Health Psychol. 16(4):799-814. "Sleep dysfunction is importantly related to FM symptoms and deserves more attention in both research and clinical practice. Our results suggest that, in addition to the usual treatment of FM, improving sleep could optimize the current management of the syndrome." [This agrees with other research that have shown that polysomnography (sleep studies) are a necessary part of all fibromyalgia work-ups when fatigue or non-restorative sleep is part of the symptoms. If the patient is tired when they wake up, it's time to find out why. DJS]

Miranda, A. F., R. J. Boegman, R. J. Beninger and K. Jhamandas. 1997. Protection against quinolinic acid-mediated excitotoxicity in nigrostriatal dopaminergic neurons by endogenous kynurenic acid. Neuroscience 78(4):967-975.

Miranda LC, Parente M, Silva C et al. 2007.  [Perceived pain and weather changes in rheumatic patients.] Acta Reumatol Port. 32(4):351-361. [Portuguese]  “In our study as well as in literature we found that a high percentage of patients, 70, perceived that weather conditions influenced their pain and disease.  Fibromyalgia patients seemed to be strongly influenced by weather changes.  Our study confirms that patients’ perception on the influence of climate on pain and therefore their disease is an important clinical factor and it should be considered when evaluating rheumatic patients.” 

Miro E, Lupianez J, Hita E et al. 2011. Attentional deficits in fibromyalgia and its relationships with pain, emotional distress and sleep dysfunction complaints. Psychol Health. 3:1-16. "Cognitive complaints are common among subject with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints."

Miro E, Martinez MP, Sanchez AI et al. 2014. Men and women with fibromyalgia: Relation between attentional function and clinical symptoms. Br J Health Psychol. [Dec 29 Epub ahead of print.] "Control men were faster than control women, but FM eliminated sex differences. In addition, attention deficit was associated with worse daily functioning in women but not in men with FM. Emotional distress and sleep disruption seemed to contribute differently to these cognitive alterations in both sexes….Therapy strategies aimed at reducing emotional distress and sleep disruption are likely to improve cognitive function by enhancing vigilance. Therapies aimed at reducing emotional distress seem to improve attentional function more in women than in men; those aimed at improving sleep quality are likely to reduce a vigilance/alertness deficit in women and executive problems in men."

Misirlioglu TO, Akgun K, Palamar D et al. 2015. Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study. Pain Physician. 18(2):163-171. The object of this study was to "… investigate the differences between local anesthetic (LA) and LA + corticosteroid (CS) injections in the treatment of PS (piriformis syndrome)." The study found no difference in outcome with the addition of steroids. [Steroids are myotoxic. This is yet another study showing no benefit to the use of steroids in trigger point injection. DJS] Free Article

Mist SD, Firestone KA, Jones KD. 2013. Complementary and alternative exercise for fibromyalgia: a meta-analysis. J Pain Res. 6:247-260. "Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management."

Mist SD, Wright CL, Jones KD et al. 2011. Traditional Chinese medicine diagnoses in a sample of women with fibromyalgia. Acupunct Med. [Oct 25 Epub ahead of print]. "Three primary TCM (traditional Chinese medicine) diagnoses were found in the population (women with fibromyalgia): Qi and Blood Deficiency (46.4%, CI 33.0% to 60.36%), Qi and Blood Stagnation (26.8%, CI 15.8% to 40.3%), and Liver Qi Stagnation (19.6%, CI 10.2% to 32.4%).... It is likely that previous studies of FM were treating a heterogeneous study population where variable results might be expected. Future acupuncture studies should either control for TCM diagnosis or consider its usefulness as an inclusion/exclusion criterion."

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

Miyakoshi N, Shimada Y, Kasukawa Y et al. 2007.  Total dorsal ramus block for the treatment of chronic low back pain: a preliminary study.  Joint Bone Spine. [Mar 7 Epub ahead of print].

Miyawaki S, Tanimoto Y, Araki Y et al. 2004.  Relationships among nocturnal jaw muscle acitivites, decreased esophageal pH, and sleep positions.  Am J Orthod Dentofacial Orthop 126(5):615-619.  GERD episodes that occur while sleeping on the back can trigger jaw muscle activities, including bruxism.

Mizumura K, Murase S, Taguchi T. 2010. Animal models of myofascial trigger points. J Musculoskel Pain. 18(4):361-366. "The sensitization of muscle nociceptors to mechanical stimulation by NGF up-regulated in the muscle after LC is considered to be a mechanism for mechanical hyperalgesia after exercise. Determining whether there is any difference in expression of NGF or sensitivity of muscle nociceptors in the TrP and in other areas will be an important key for clarifying the mechanism of TrPs." This article also explains mechanisms involved in delayed onset muscle soreness.

Modell, W. J. Travell and J Kraus et al. 1952. Relief of pain by ethyl chloride spray. NY State Med 52;1550-1558.

Mody R, Bolge SC, Kannan H et al. 2009.  Effects of gastro-esophageal reflux disease on sleep and outcomes.  Clin Gastroenterol Hepatol. [Apr 15 Epub ahead of print].  “Nighttime GERD symptoms are associated with interruption of sleep induction and maintenance and result in considerable economic burden and reduction in HRQOL (health-related quality of life).”

Moeller-Bertram T, Strigo IA, Simmons AN et al. 2014. Evidence for Acute Central Sensitization to Prolonged Experimental Pain in Posttraumatic Stress Disorder. Pain Med. [Apr 16 Epub ahead of print.] "Post-traumatic stress disorder (PTSD) and pain have a well-documented high comorbidity; however, the underlying mechanisms of this comorbidity are currently poorly understood." This study found: "… a significantly higher degree of acute central sensitization in individuals with PTSD. Increased acute central sensitization may underlie increased vulnerability for developing pain-related conditions following combat trauma."

Mogil, J. S., S. P. Richards, L. A. O’Toole, M. L. Helms, S. R. Mitchell, B. Kest and J. K. Belknap. 1997. Identification of a sex-specific quantitative trait locus mediating nonopioid stress-induced analgesia in female mice. J Neurosci 17(20):7995-8002.

Mohammad A, Carey JJ, Storan E et al. 2012. High Prevalence of Fibromyalgia in Patients with HFE-related Hereditary Hemochromatosis. J Clin Gastroenterol. [Nov 21 Epub ahead of print]. "This study reveals a high prevalence of FMS (43%) among subjects with HFE-related hemochromatosis. Prospective studies are needed to better understand the risk factors for FMS in such patients."

Mohammad A, Carey JJ, Storan E et al. 2012. Prevalence of fibromyalgia among patients with chronic hepatitis C infection: relationship to viral characteristics and quality of life. J Clin Gastroenterol. 46(5):407-412. "This study reveals a high prevalence of FMS (57%) among subjects with chronic HCV infection, one third of whom reported some degree of functional impairment. Recognition and management of this condition in such patients will help improve their quality of life."

Mohandas M, Sharan D, Ranganathan R et al. 2014. Co-morbidities of myofascial neck pain among information technology professionals. Ann Occ Env Med. 26:21. This study was done with 71% males using laptop and/or desktop computers at occupational health clinics in India. Neck pain was the most common symptom, followed by low back, shoulder, and arm pain. Neck pain among females was significantly higher than in males. Myofascial pain syndrome was the commonest musculoskeletal disorder leading to pain in males and females. Thoracic Outlet Syndrome, Fibromyalgia, and eye strain were also common.

Mohanty AF, Muthukutty A, Carter ME et al. 2015. Chronic multisymptom illness among female veterans deployed to Iraq and Afghanistan. Med Care. 53(4 Suppl 1):S143-148. "CMI-related diagnoses were more prevalent among female OEF/OIF/OND Veterans compared with all female Veterans who currently access VHA. Future studies of the role of mental health diagnoses as confounders or mediators of the association of OEF/OIF/OND deployment and CMI are warranted. These and other factors associated with CMI may provide a basis for enhanced screening to facilitate recognition of these conditions. Further work should evaluate models of care and healthcare utilization related to CMI in female Veterans."

Mohr Drewes A, Pedersen J, Reddy H et al. 2006. Central sensitization in patients with non-cardiac chest pain: a clinical experimental study.  Scand J Gastroenterol. 41(6):640-649.  “NCCP patients showed facilitated central pain mechanisms (temporal summation and visceral hyperalgesia after sensitization.  [Non-cardiac chest pain is often caused by myofascial TrPs.  These patients were not tested for scalene, pectoral, sternalis, paraspinal, intercostal or other potential chest-pain causing  TrPs.  These patients did have FMS-associated symptoms.  It is to be hoped that future studies document both TrPs and FMS, which would considerably add to the value of the studies.  DJS]

Moldofsky H. 2010.  Rheumatic manifestations of sleep disorders.  Curr Opin Rheumatol. 22(1):59-63.  “The determination of how disordered sleep affects musculoskeletal pain, fatigue, mood, and behavior is important in the assessment and management of patients with rheumatic illness.  The high prevalence of obstructive sleep apnea and restless legs syndromes requires more research to determine whether treatments of these sleep disorders will benefit the symptoms of rheumatic diseases.”  [This lovely paper by the master of sleep disorders is of vital importance.  The impact of unrestorative sleep cannot be overestimated, and there are many components to sleep disturbances.  Unrestorative sleep must be considered not only as a perpetuating factor but as an interactive diagnosis with many other illnesses, including those associated with musculoskeletal pain.  Thank you, Dr. Moldofsky.]

Moldofsky H. 2009.  The significance of dysfunctions of the sleeping/waking brain to the pathogenesis and treatment of fibromyalgia syndrome.  Rheum Dis Clin North Am. 35(2):275-283.  “This article reviews how functional disturbances of the sleeping-waking brain are involved in pathogenesis of the widespread pain, unrefreshing sleep, fatigue, and impaired quality of life of patients who have fibromyalgia syndrome.”  One of the most common perpetuating factors for FM is lack of restorative sleep.  There are pharmaceutical and physical agents that can help pain and  fatigue while regaining restorative sleep.


Moldofsky H. 2007.  The assessment and significance of the sleep/waking brain in patients with chronic widespread musculoskeletal pain and fatigue syndromes.  J Musculoskel Pain 15 (Supp 13):4 item 5.  [Myopain 2007 Poster]  “Psychophysiological studies demonstrate that total, partial and rapid eye movement [REM] sleep deprivations decrease pain threshold.  Pain stimuli disturb sleep, and non-painful stimuli [e.g. noise] that disrupt sleep [e.g. slow wave sleep] cause unrefreshing sleep, myalgia and fatigue.”  “In clinical studies of FMS and chronic fatigue syndrome, unrefreshing sleep is associated with frequent periodic electroencephalogram arousals from sleep, i.e. the cyclical alternating pattern, sleep apneas, and periodic limb movements.”  “Preliminary studies of novel treatments that aim to facilitate restorative sleep suggest a rationale for better management of FMS and related illnesses.”  [This information indicates that many sleep dysfunctions are interactive with FM and other disorders.]


Moldofsky, H. 2002. Management of sleep disorders in fibromyalgia.  Rheum Dis Clin North Am 28(2):353-65. "In summary, the treatment of patients with FM requires a proper assessment of the reason for the unrefreshing sleep, which is an important component of the FM syndrome."

Moldofsky, H. 1995. Sleep and the immune system. Int J Immunopharmacol 17(8):649-654.

Moldofsky H, Harris HW, Archambault WT et al. 2011. Effects of Bedtime Very Low Dose Cyclobenzaprine on Symptoms and Sleep Physiology in Patients with Fibromyalgia Syndrome: A Double-blind Randomized Placebo-controlled Study. J Rheumatol. [Sep 1 Epub ahead of print]. "Bedtime VLD( very low dose) CBP (cyclobenzaprine) treatment improved core FM symptoms."

Moldofsky H, Inhaber NH, Guinta DR et al. 2010. Effects of Sodium Oxybate on Sleep Physiology and Sleep/Wake-related Symptoms in Patients with Fibromyalgia Syndrome: A Double-blind, Randomized, Placebo-controlled Study. J Rheumatol. [Aug 3 Epub ahead of print]. "This large cohort of patients with FM demonstrated that SXB treatment improved EEG sleep physiology and sleep-related FM symptoms." [Sodium oxybate does restore deep sleep, the area of sleep wherein neurotransmitters, hormones and other informational substances are balanced. It is most unfortunate for FM patient that the fear diversion to illegal use has caused the FDA to deny its use for FM patients. DJS]

Moldofsky, H. and A. Lue. 1980. The relationship of alpha delta EEG frequencies to pain and mood in "fibrositis" patients with chlorpromazine and L-tryptophan. Electroencephalogr Clin Neurophysiol. 50(1-2):71-80.

Moldwin RM, Fariello JY. 2013. Myofascial trigger points of the pelvic floor; Associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep Aug 14.[Epub ahead of print] "Myofascial trigger points (MTrP), or muscle 'contraction knots', of the pelvic floor may be identified in as many as 85% of patients suffering from urological, colorectal and gynecological pelvic pain syndromes; and can be responsible for some, if not all, symptoms related to these syndromes. Identification and conservative treatment of MTrPs in these populations has often been associated with impressive clinical improvements. In refractory cases, more 'aggressive' therapy with varied trigger point needling techniques, including dry needling, anesthetic injections, or botulinum toxin A injections m, may be used, in combination with conservative therapies."

Molina J, Dos Santos FH, Terreri MT et al. 2012. Sleep, stress, neurocognitive profile and health-related quality of life in adolescents with idiopathic musculoskeletal pain. Clinics (Sao Paulo). 67(10):1139-1144. Adolescents with idiopathic musculoskeletal pain did not exhibit cognitive impairments. However, adolescents with idiopathic musculoskeletal pain did experience intermediate to advanced psychological distress and lower health-related quality of life, which may increase their risk of cognitive dysfunction in the future.

Moller DE 2001. New drug targets for type 2 diabetes and the metabolic syndrome.  Nature Dec 13;414(6865):821-7.  Obesity, insulin resistance and dyslipidaemia have worked together to produce a worldwide epidemic of type 2 insulin-resistant diabetes mellitus. As we learn the mechanisms of development of metabolic syndrome, new medicinal therapies are being developed.

Moller-Levet CS, Archer SN, Bucca G et al. 2013. Effects of insufficient sleep on circadian rhythmicity and expression amplitude of the human blood transcritome. Proc Natl Acad Sci USA. 110(12):E1132-1141. "…insufficient sleep affects the human blood transcriptome, disrupts its circadian regulation, and intensifies the effects of acute total sleep deprivation. The identified biological processes may be involved with the negative effects of sleep loss on health, and highlight the interrelatedness of sleep homeostasis, circadian rhythmicity, and metabolism." The change from 8 hours a night to 6 hours a night of sleep for even one week can cause drastic genetic effects. After one week of the 6 hour a night sleep regimen, tests of the formerly healthy subjects showed that 711 of their genes had changed, including ones that regulate the immune system.

Molnar DS, Flett G, Sadava SW et al. 2012. Perfectionism and health functioning in women with fibromyalgia. J Psychosom Res. 73(4):295-300. "Collectively, these findings clarify that overall levels of perfectionism are not elevated among women with fibromyalgia (emphasis mine DJS), but those women who are exceptionally high in levels of self-oriented perfectionism or high in socially prescribed perfectionism are particularly likely to suffer lower health functioning. These results suggest that perfectionism should be specifically assessed and targeted for intervention among women with fibromyalgia and there should be a particular emphasis on the pressure to meet perceived or actual expectations imposed on the self."

Monga, T. N., G. Tan, H. J. Ostermann, U. Monga and M. Grabois. 1998. Sexuality and sexual adjustment of patients with chronic pain. Disabil Rehabil 20(9):317-29.

Monsivais D, Engebretson JC. 2012. I'm Just Not That Sick: Pain Medication and Identity in Mexican American Women with Chronic Pain. J Holist Nurs. [Jun 19 Epub ahead of print]. "To describe the beliefs and attitudes about self-identity and pain medication in a sample of Mexican American women with chronic pain living in the El Paso, Texas, area. The findings are drawn from a larger qualitative study of 15 women describing the expression and communication of chronic pain symptoms, pain-related cultural beliefs, decision making, and treatment preferences of chronic pain....A shared central theme was controlling the use of pain medications to control perceived negative associations with pain medication. The negative associations resulted in women rejecting use of medication to preserve their legitimate identity. This perception can be destructive and can lead to poor pain control....Providing patients with anticipatory guidance about common barriers to taking pain medication may allow medication use consistent with improved pain control.

Montagna, P. E. Lugaresi and G. Plazzi. 1997. Motor disorders in sleep. Eur Neurol 38(3):190-7.

Montanez-Aguilera FJ, Valtuena-Gimeno N, Pecos-Martin D et al. 2010. Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy. J Back Musculoskelet Rehabil. 23(2):101-104. This article describes the improvement of one patient who had neck pain for at least four months. After one session of ischemic compression on the left trapezius, range of motion increased, electromyography improved and pain decreased.

Montenegro ML, Gomide LB, Mateus-Vasconcelos EL et al.  2009. Abdominal myofascial pain syndrome must be considered in the differential diagnosis of chronic pelvic pain.  Eur J Obstet Gynecol Reprod Biol. [Jul 21 Epub ahead of print].  “Abdominal myofascial pain syndrome is a highly prevalent disease associated with CPP (chronic pelvic pain), and because of this physicians should get used to making a precise and early diagnosis in order to avoid additional and unnecessary investigation.”  [Yet another study showing that myofascial trigger points are extremely common and that much pain could be saved by myofascial trigger point assessment.  This requires adequate training for care providers in the diagnosis of TrPs, which would save enormous amounts of money and avoid many procedures and testing in the long term.  DJS]

Montes Milina, R., A. Galen Tabernero and M. S. Martin Garcia. 1997. Spectral electromyographic changes during a muscular strengthening training based on electrical stimulation. Electromyogr Clin Neurophysiol 37(5):287-295.

Montoro CI, Duschek S, Munoz Ladron de Guevara C et al. 2014. Aberrant Cerebral Blood Flow Responses during Cognition: Implications for the Understanding of Cognitive Deficits in Fibromyalgia. Neuropsychology. [Aug 25 Epub ahead of print.] "There is ample evidence for cognitive deficits in fibromyalgia syndrome (FMS). The present study investigated cerebral blood flow responses during arithmetic processing in FMS patients and its relationship with performance. The influence of clinical factors on performance and blood flow responses were also analyzed.…Forty-five FMS patients and 32 matched healthy controls completed a mental arithmetic task while cerebral blood flow velocities in the middle (MCA) and anterior (ACA) cerebral arteries were measured bilaterally using functional transcranial Doppler sonography (fTCD)…Patients' cognitive processing speeds were slower versus healthy controls. In contrast to patients, healthy controls showed a pronounced early blood flow response (during seconds 4-6 after the warning signal) in all assessed arteries. MCA blood flow modulation during this period was correlated with task performance. This early blood flow response component was markedly less pronounced in FMS patients in both MCAs. Furthermore, patients displayed an aberrant pattern of lateralization, with right hemispheric dominance especially observed in the ACA. Severity of clinical pain in FMS patients was correlated with cognitive performance and cerebral blood flow responses…. Cognitive impairment in FMS is associated with alterations in cerebral blood flow responses during cognitive processing. These results suggest a potential physiological pathway through which psychosocial and clinical factors may affect cognition."

Montoya P, Larbig W, Braun C et al. 2004.  Influence of social support and emotional context on pain processing and magnetic brain responses in fibromyalgia.  Arthritis Rheum. 50(12):4035-4044.  “…social support through the presence of a significant other can influence pain processing at the subjective-behavioral level as well as the central nervous system level.”

Monti, D. A. and E. J. S. Kunkel. 1998. Management of chronic pain among elderly patients.Psychiatr Serv 49(12):1537-1539.

Montoya P, Sitges C, Garcia-Herrera M et al. 2006.  Reduced brain habituation to somatosensory stimulation in patients with fibromyalgia.  Arthritis Rheum. 54(6):1995-2003.  “Our findings suggest that in FM patients, there is abnormal information processing, which may be characterized by a lack of inhibitory control to repetitive non-painful somatosensory information during stimulus coding and cognitive evaluation.”

Montoya P, Sitges C, Garcia-Herrera M et al. 2005.  Abnormal affective modulation of somatosensory brain processing among patients with fibromyalgia.  Psychosom Med. 67(6):957-963.  “Our data suggest an abnormal processing of nonpainful somatosensory information in FM, especially when somatic signals are arising from the body within an aversive stimulus context.  These findings provide further support for the use of biopsychosocial models for understanding FM and other chronic pain states.”  [These patients were not screened for co-existing myofascial pain. DJS]

Moore MK. 2004.  Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther. 27(6):414-420.  A patient with one-sided headache radiating to the eye was found to have bilateral myofascial trigger points in the pectoralis major, levator scapulae, upper trapezius and supraspinatus muscles.  Appropriate therapy relieved the headache and its perpetuating factors.

Moore RA, Straube S, Paine J et al. 2010. Fibromyalgia: Moderate and substantial pain intensity reduction predicts improvement in other outcomes and substantial quality of life gain. Pain. [Mar 25 Epub ahead of print]. “Chronic pain is associated with a range of other problems, including disturbed sleep, depression, anxiety, fatigue, reduced quality of life, and an inability to work or socialize. We investigated whether good symptom control of pain (using definitions of moderate and substantial benefit) is associated with improvement in other symptoms. Individual patient data from four randomized trials in fibromyalgia (2575 patients) lasting 8-14weeks were used to calculate percentage pain reduction for each completing patient (1858), divided into one of five groups according to pain reduction, irrespective of treatment: substantial benefit - 50% pain reduction; moderate - 30% to <50%; minimal - 15% to <30%; marginal - 0% to <15%; worse - <0% (increased pain intensity). We then calculated change from baseline to end of trial for measures of fatigue, function, sleep, depression, anxiety, ability to work, general health status, and quality-adjusted life year (QALY) gain over a 12-month period. Substantial and moderate pain intensity reductions were associated with statistically significant reduction from baseline by end of trial in all measures, with values by trial end at or approaching normative values. Substantial pain intensity reduction resulted in 0.11 QALYs gained, and moderate pain intensity reduction in 0.07 QALYs gained over a 12-month period. Substantial and moderate pain intensity reduction predicts broad beneficial outcomes and improved quality of life that do not occur without pain relief. Pain intensity reduction is a simple and effective predictor of which patients should continue treatment, and which should discontinue and try an alternative therapy."

Moore SK, Black K. 2005.  Fibromyalgia and pregnancy: what nurses need to know and do.  AWHONN Lifelines 9(3):228-235.

Moraska AF, Hickner RC, Kohrt WM et al. 2012. Changes in blood flow and cellular metabolism at a myofascial trigger point with trigger point release (ischemic compression): a proof-of-principle pilot study. Arch Phys Med Rehabil. [Sep 10 Epub ahead of print]. "Identifying physiological constituents of MTrPs following intervention is an important step toward understanding pathophysiology and resolution of myofascial pain. The present study forwards that aim by showing proof-of-concept for collection of interstitial fluid from an MTrP before and after intervention can be accomplished using microdialysis, thus providing methodological insight toward treatment mechanism and pain resolution. Of the biomarkers measured in this study, lactate may be the most relevant for detection and treatment of abnormalities in the MTrP."

Moraska AF, Stenerson L, Butryn N et al. 2014. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: A randomized, placebo-controlled clinical trial. Clin J Pain. 2014 Oct 17. [Epub ahead of print] "(1) MTrPs (myofascial trigger points) are important components in the treatment of TTH (tension-type headaches), and (2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on headache that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention."

Morf S, Amann-Vesti B, Forster A et al. 2005.  Microcirculation abnormalities in patients with fibromyalgia – measured by capillary microscopy and laser fluxmetry.  Arthritis Res Ther. 7(2):R209-216.  “...the peripheral blood flow in FM patients was much less than in healthy controls but did not differ from that of SSc [systemic scleroderma] patients.  The data suggest that functional disturbances of microcirculation are present in FM patients and that morphological abnormalities may also influence their microcirculation.”

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

Morillas-Arques P, Rodriguez-Lopez CM, Molina-Barea R et al. 2010. Trazodone for the treatment of fibromyalgia: an open-label, 12-week study. BMC Musculoskel Disord. 10;11:204. "Trazodone markedly improved sleep quality, with large effect sizes in total PSQI (Pittsburgh Sleep Quality Index) score as well on sleep quality, sleep duration and sleep efficiency. Significant improvement, although with moderate effect sizes, were also observed in total FIQ scores, anxiety and depression scores...and pain interference with daily activities. Unexpectedly, the most frequent and severe side effect associated with trazodone in our sample was tachycardia, which was reported by 14 (21.2%) patients....In doses higher than those usually prescribed as hypnotic, the utility of trazodone in fibromyalgia management surpasses its hypnotic activity. However, the emergence of tachycardia should be closely monitored."

Moriwaki K, Uesugi F, Kusunoki S et al. 2000.  [Pain management for patients with cancer—current problems in a pain clinic] Masui. 49(6):680-685. [Japanese]  A large proportion of cancer patients were given some amount of pain relief by treatment of trigger points and/or nerve block.  Assessment of cancer and other chronic pain patients for co-existing trigger points would seem a basic part of standard adequate medical care.

Moriwaki, K. and O. Yuge. 1999. Topographical features of cutaneous tactile hypoesthetic and hyperesthetic abnormalities in chronic pain. Pain 81:1-6.

Morjaria JB, Lakshminarayana UB, Liu-Shiu-Cheong P et al. 2014. Pneumothorax: a tale of pain or spontaneity. Ther Adv Chronic Dis. 5(6):269-273. Of these two case studies, one of them considers a mastectomy patient with multiple conditions that had pneumothorax secondary to trigger point injection. That case did not require surgical procedure, and the other did. Free Article

Mork, H., Ashina, M., Bendtsen, L. et al. 2003.  Experimental muscle pain and tenderness following infusion of endogenous substances in humans.  Eur J Pain 7(2):145-53.  This study attempts to “...develop a clinically relevant model of prolonged human myofascial pain....”

Mork P, Nilsson J, Loras H et al. 2013. Heart rate variability in fibromyalgia patients and healthy controls during non-REM and REM sleep: a case-control study. Scand J Rheumatol. [Feb 20 Epub ahead of print]. "RMSSD (root mean square successive difference), indicative of parasympathetic predominance, is attenuated in FM patients compared to HCs (healthy controls) during N2 (non-REM stage 2) sleep and REM sleep. This difference was not present for the HF component. HRV (heart rate variability) during sleep in FM patients is moderately and positively associated with sleep quality and moderately and negatively associated with neck/shoulder pain."

Mork PJ, Vasseljen O, Nilsen TI. 2010. The association between physical exercise, body mass index, and risk of fibromyalgia: Longitudinal data from the Norwegian HUNT study. Arthritis Care Res (Hoboken). [Jan 29 Epub ahead of print]  “Overweight and obesity was associated with an increased risk of FM, especially among women who also reported low levels of physical exercise. Community based measures aimed at reducing the incidence of FM should emphasize the importance of regular exercise and maintenance of normal body weight.” [Obesity is in itself a perpetuating factor of both FM and CMP, and conditions such as hypothyroid and insulin resistance may be some initiating factors common in some patients.   There is a substantial subset of FM patients, however, who were athletic when they developed FM.  Overweight can also be caused by chronic pain.  One must look at the whole story of each individual. DJS]

Moroni, F. 1999. Tryptophan metabolism and brain function: focus on kynurenine and other indole metabolites. Eur J Pharmacol 375(1-3):87-100.

Morris, C. E. 1999. Chiropractic rehabilitation if a patient with S1 radiculopathy associated with a large lumbar disk herniation. J Manupulative Physiol Ther 22(1):38-44.

Morris G, Anderson G, Berk M et al. 2013. Coenzyme Q10 depletion in medical and neuropsychiatric disorders: potential repercussions and therapeutic implications. Mol Neurobiol. [Jun 13 Epub ahead of print]. "Coenzyme Q10 (CoQ10) is an antioxidant, a membrane stabilizer, and a vital cofactor in the mitochondrial electron transport chain, enabling the generation of adenosine triphosphate. It additionally regulates gene expression and apoptosis; is an essential cofactor of uncoupling proteins; and has anti-inflammatory, redox modulatory, and neuroprotective effects." "Administration of CoQ10 improves hyperalgesia and quality of life in patients with fibromyalgia. The evidence base for the effectiveness of treatment with CoQ10 may be explained via its ability to ameliorate oxidative stress and protect mitochondria."

Morris, V., S. Cruwys and B. Kidd. 1998. Increased capsaicin-induced secondary hyperalgesia as a marker of abnormal sensory activity in patients with fibromyalgia. Neurosci Lett 250(3):205-207

Morrow, L. A., M. B. O’Brien, D. E. Moller, J. S. Flier and A. C. Moses. 1994. Recombinant human insulin-like growth factor-I therapy improves glycemic control and insulin action in the type A syndrome of severe insulin resistance. J Clin Endocrinol Metab 79(1):205-10.

Morse CA, Quan SF, Mays MZ et al. 2004.  Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?  Clin Gastroenterol Hepatol. 2(9):761-768.  “Subjective reports of sleep quality were affected by GERD severity, but an objective correlation between OSA and GERD was lacking. This may suggest that GERD and OSA are common entities that share similar risk factors, but appear not to be causally linked.”

Mosca F, Persi A, Stracqualursi A et al. 2004.  [The abdominal wall: an overlooked cause of pain]  G Chir 25(6-7):245-250.  Abdominal wall TrPs are often overlooked causes of pain and other symptoms often misdiagnosed as visceral in origin.  It is strongly suggested that patients be assessed for TrPs.  If they are treated and the TrPs return, perpetuating factors may then be identified and brought under control.  A visceral-TrP loop may be the problem, but identification and prompt treatment of abdominal and other TrPs can often avoid “... inappropriate diagnostic tests, unsatisfactory treatment and high costs.”

Mosca F, Persi A, Stracqualursi A et al. 2004.  [The abdominal wall: an overlooked cause of pain.]  G Chir 25(6-7):245-250.  [Italian]  Pain from abdominal wall trigger points is frequently misdiagnosed.

Moseley GL, Flor H. 2012. Targeting Cortical Representations in the Treatment of Chronic Pain: A Review. Neurorehabil Neural Repair. [Feb 13 Epub ahead of print]. "Recent neuroscientific evidence has confirmed the important role of cognitive and behavioral factors in the development and treatment of chronic pain. Neuropathic and musculoskeletal pain are associated with substantial reorganization of the primary somatosensory and motor cortices as well as regions such as the anterior cingulate cortex and insula. What is more, in patients with chronic low back pain and fibromyalgia, the amount of reorganizational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes, cortical reorganization correlates with the magnitude of pain. These findings have implications for both our understanding of chronic pain and its prevention and treatment. For example, central alterations may be viewed as pain memories that modulate the processing of both noxious and non-noxious input to the somatosensory system and outputs of the motor and other response systems. The cortical plasticity that is clearly important in chronic pain states also offers potential targets for rehabilitation. The authors review the cortical changes that are associated with chronic pain and the therapeutic approaches that have been shown to normalize representational changes and decrease pain and discuss future directions to train the brain to reduce chronic pain."

Moseley GL, Gallagher L, Gallace A. 2012. Neglect-like tactile dysfunction in chronic back pain. Neurology 79(4):327-332. Patients who have chronic low back pain demonstrated a "…spatially defined disruption of tactile processing." [How much of this is due to TrP proprioception and/or latent TrP activation in the contralateral side and/or facilitated segments is not known, as patients were not assessed for TrPs. DJS]

Motivala SJ, Sollers J, Thayer J et al. 2006.  Tai chi chih acutely decreases sympathetic nervous system activity in older adults.  J Gerontol A Biol Sci Med Sci. 61(11):1177-1180.  “TCC performance led to acute decreases in sympathetic activity, which could not be explained by physical activity alone.”  [As FMS is associated with up-regulation of the sympathetic nervous system, t’ai chi chuan may be helpful for FMS. DJS]

Motley CP, Maxwell ML. 2010. Fibromyalgia: helping your patient while maintaining your sanity. Prim Care. 37(4):743-755. "In caring for the patient with fibromyalgia, the primary care provider benefits from an understanding of fibromyalgia as a distinct entity. Evidence-based diagnostic criteria for fibromyalgia can be used in all individuals who present with multiple site pain, fatigue, and poor sleep. Planning therapy for individuals with fibromyalgia often involves using both pharmacologic and nonpharmacologic treatment in the primary care setting." [The multiple site pain is generally caused by myofascial trigger points. One can't understand and treat FM without understanding the co-existing conditions that often cause it. DJs]

Mountz, J. M. , L. A. Bradley and G. S. Alarcon. 1998. Abnormal functional activity of the central nervous system in fibromyalgia syndrome. Am J Med Sci 315(6):385-396.

Mu R, Li C, Zhu JX et al. 2013. National survey of knowledge, attitude and practice of fibromyalgia among rheumatologists in China. Int J Rheum Dis. 16(3):258-263. "The awareness and perception of FM are still low among Chinese rheumatologists. Continuing medical education on FM is needed for improving the quality of health care in China." [Much the same could be said of all countries. DJS]

Mueller HH, Donaldson CC, Nelson DV, Layman M. 2001.  Treatment of fibromyalgia incorporating EEG-Driven stimulation: A clinical outcomes study.  J Clin Psychol 57(7):933-52. "Electroencephalograph (EEG)-driven stimulation or EDS. Patients were initially treated with EDS until they reported noticeable improvements in mental clarity, mood, and sleep.  Self-reported pain, then, having changed from vaguely diffuse to more specifically localized, was treated with very modest amounts of physically oriented therapies."


Muller HW, Klapka N, Hermanns S. 2002.  Glial scarring as impediment for axon regeneration in the CNS-getting across.  Glia (Suppl 1):S91 [Abstract].


Muller KG, Richter A, Bieber C et al.  2004.  [no title given].  Z Arztl Fortbild Qualitatssich 98(2):95-100. [German].  “Conditions affecting the musculoskeletal system are the cause of approximately 25% of absenteeism from work...The physician-patient relationship is burdened with resignation and frustration on both sides....The patient’s active involvement in the decision making process is expected to improve the physician-patient relationship.  One aspect of this shared decision- making process is the evaluation and possibly modification of treatment decisions.”

Muller KG, Richter A, Bieber C et al. 2004.  The process of shared decision making in chronic pain patients: Evaluation and modification of treatment decisions.  Z Arztl Fortbild Qualitatssich 98(2):95-100. [German].

Muller W, Fiebich BL, Stratz T. 2006.  New treatment options using 5-HT3 receptor antagonists in rheumatic diseases.  Curr Top Med Chem. 6(18):2035-2042.  “Clinical trials have provided evidence of pain reduction in a subgroup of fibromyalgia syndrome and, moreover, have demonstrated that tropisetron injected locally for insertion tendinoses and myofascial syndromes with associated trigger points leads to an alleviation of pain that is comparable to injections with the combination of corticosteroids and local anesthetics.”


Muller W, J Kelemen and T Stratz. 1998.  The spinal factors in the generation of fibromyalgia syndrome.  Z Rheumatol 57 Suppl 2:36-42.

Muller-Ehrenberg H, Thorwesten L. 2007.  Frequency and importance of trigger points in the case of sports-related shoulder pain.  J Musculoskel Pain 15 (Supp 13):33 item 55.  [Myopain 2007 Poster]  “Trigger points [TrPs] can often be diagnosed when patients complain about sports-related shoulder pain, and they contribute considerably to the symptoms.  Including the examination for TrP will therefore broaden the understanding of the cause of shoulder pain.”

Muller-Ehrenberg H, Thorwesten L. 2007.  Improvement of sports-related shoulder pain after treatment of trigger points using focused extracorporeal shock wave therapy regarding static and dynamic force development, pain relief and sensomotoric performance.  J Musculoskel Pain 15 (Supp 13):33 item 56.  [Myopain 2007 Poster]  “The treatment of trigger points using focused ESWT (extracorporeal shock wave therapy) significantly improves the pain symptoms as well as the performance of athletes suffering from acute or chronic shoulder pain.”  This study used piezoelectric shock waves, with significant reduction in pain and return to healthier movement.

Muls, E and G Vansant. 1999.  Clinical approaches to healthier diet modifications.  Acta Cardiol 54(3):159-61.

Munguia-Izquierdo D, Legaz-Arrese A. 2007. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia.  Clin Exp Rheumatol. 25(6):823-830.  “An exercise therapy three times per week for 16 weeks in a warm-water pool is an adequate treatment to decrease the pain and severity of FM well as to improve cognitive function in previously unfit women with FM and heightened painful symptomatology.”

Mur, E., A. Drexler, J. Gruber, F. Hartig and V. Gunther. 1999. [No title available]. Wien MedWochenschr 149(19-20):561-3 [German].

Muratani T, Doi Y, Nishimura W et al. 2005.  Preemptive analgesia by zaltoprofen that inhibits bradykinin action and cyclooxygenase in a post-operative pain model.  Neurosci Res. 51(4):427-433.  “The post-operative pain state results from a barrage of primary afferent inputs exposed to products of tissue damage such as bradykinin and prostaglandins and the central sensitization by the continuing inputs.  This provides the rationale for preemptive analgesia, whereby the blockade of primary afferent inputs prior to injury may result in a reduction of post-operative pain.  These results suggest that zaltoprofen produces the preemptive analgesic effect peripherally by clocking the B(2) pathway.”

Murayama RA, Stuginski-Barbosa J, Moraes NP et al. 2009.  Toothache referred from auriculotemporal neuralgia: case report. Int Endod J. 42(9):845-851.  This is yet another case report demonstrating that TrPs can cause toothache that does not originate from the tooth, but is instead a referral pain from the TrPs.

Murner, J. 2002.  Brain injury as a result of whiplash injury: a controversy.  J Whiplash and Rel Dis 1(1):77-84.  “Despite disagreements, it is clear from the literature that brain injury can result from whiplash.”

Murphy SL, Phillips K, Williams DA et al. 2012. The role of the central nervous system in osteoarthritis pain and implications for rehabilitation. Curr Rheumatol Rep. [Aug 10 Epub ahead of print]. It has been known for some time that central nervous system (CNS) pain amplification is present in some individuals with osteoarthritis; the implications of this involvement, however, are just starting to be realized....This review article focuses on current literature describing CNS amplification in osteoarthritis by discussing peripheral sensitization, central sensitization, and central augmentation, and the clinical manifestation of central augmentation referred to as centralized pain, and offers considerations for rehabilitation treatment and future directions for research.

Murray B, Yashar BM, Uhlmann WR et al. 2013. Ehlers-Danlos syndrome, hypermobility type: A characterization of the patients' lived experience. Am J Med Genet A. 161(12):2981-2988. "Hypermobility type Ehlers-Danlos syndrome (EDS-HT) is an inherited connective tissue disorder clinically diagnosed by the presence of significant joint hypermobility and associated skin manifestations. This article presents a large-scale study that reports the lived experience of EDS-HT patients, the broad range of symptoms that individuals with EDS-HT experience, and the impact these symptoms have on daily functioning. A 237-item online survey, including validated questions regarding pain and depression, was developed. Four hundred sixty-six (466) adults (90% female, 52% college or higher degree) with a self-reported diagnosis of EDS-HT made in a clinic or hospital were included. The most frequently reported symptoms were joint pain (99%), hypermobility (99%), and limb pain (91%). They also reported a high frequency of other conditions including chronic fatigue (82%), anxiety (73%), depression (69%), and fibromyalgia (42%). Forty-six percent of respondents reported constant pain often described as aching and tiring/exhausting. Despite multiple interventions and therapies, many individuals (53%) indicated that their diagnosis negatively affected their ability to work or attend school. Our results show that individuals with EDS-HT can experience a wide array of symptoms and co-morbid conditions. The degree of constant pain and disability experienced by the majority of EDS-HT respondents is striking and illustrates the impact this disorder has on quality of life as well as the clinical challenges inherent in managing this complex connective tissue disorder."

Muscolino JE. 2013. Abdominal wall triggerpoint case study. J Bodyw Mov Ther 17(2):151-156. "When myofascial pain syndrome is responsible for a patient's condition and is not recognized by the patient's medical advisors, the patient may be put through a plethora of testing procedures to find the cause of the patient's pain, and prescribed medications in an effort to treat the patient's symptoms, The case review presented here involves a patient with severe anterior abdominal pain, with a history of Crohn's disease, who experienced a long and difficult medical process before a diagnosis of myofascial pain syndrome was made."

Mustian KM, Katula JA, Zhao H. 2006.  A pilot study to assess the influence of tai chi chuan on functional capacity among breast cancer survivors.  J Support Oncol. 4(3):139-145.  “The TCC (t’ai chi chuan) group demonstrated significant improvement in functional capacity (specifically aerobic capacity, muscular strength, and flexibility) whereas the PST group showed significant improvement in flexibility only.  These data suggest that TCC may be an efficacious intervention for enhancing functional capacity among breast cancer survivors.”

Muzammil S, Cooper HC. 2011. Acute pancreatitis and fibromyalgia: Cytokine link. N Am J Med Sci. 3(4):206-208. [Case Report] "There is a known increase in levels of cytokines in patients with fibromyalgia. Part of the pathophysiology of acute pancreatitis is related to raised cytokines and immune deregulations. We hypothesize that elevated levels of cytokines in fibromyalgia has led to acute pancreatitis in our patient. Further epidemiological research on the incidence of pancreatitis in cytokine mediated conditions such as fibromyalgia is required."

Myburgh C, Lauridsen HH, Hartvigsen J. 2010. Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility. Man Ther. [Aug 31 Epub ahead of print]. "Identification of clinically relevant TrPs of the upper trapezius musculature is reproducible when performed by two experienced clinicians...." [This study conforms what has been found before. Myofascial TrP diagnosis by palpation is repeatable with trained, experienced care providers. It takes a concerted effort to get that experience. DJS]

Myers JB, Guskiewicz KM, Schneider RA et al. 1999.  Proprioception and neuromuscular control of the shoulder after muscle fatigue.  J Athl Train. 34(4):362-367.  “Fatigue of the internal and external rotators of the shoulder decreased proprioception of the shoulder, while having no significant effect on neuromuscular control.”

Myers T. 2014. Spatial medicine – A call to 'arms'. J Bodyw Mov Ther. 18:94-98. "A comprehensive and coherent approach to spatial patterning in human posture and movement is visible on the horizon. Advances in the study of fascia, neural plasticity, and epigenetics allow an overarching theory to unite all who work in human movement from osteopaths to personal trainers. Trainers, rehab specialists, manual therapists and physical educators are joining to embrace and develop this unifying construct to help our growing children meet the demands of the 21st century electronic environment."

Myers T. 2007. Treatment approaches for three shoulder “tethers.”   J Bodywork Movement Ther 1(11):3-8.  This excellent article offers an in depth look at three common “sticking points” in the shoulder complex (subclavious, pectoralis minor, and teres minor) and how to treat them.

Nabekura T, Morishima S, Cover T.L. et al. 2003.  Recovery from lactacidosis-induced glial cell swelling with aid of exogenous anion channels.  Glia 41(3):247-59. Cerebral edema associated with lactacidosis or head trauma may be associated with swelling in astrocytes, and may be treated by introducing anion channel activity. [This may be relevant to some of the cerebral swelling and cognitive dysfunction noted in fibromyalgia. DJS]

Nacir B, Genc H, Duyur Cakit B et al. 2012. Evaluation of Upper Extremity Nerve Conduction Velocities and the Relationship between Fibromyalgia and Carpal Tunnel Syndrome. Arch Med Res. [Jul 24 Epub ahead of print]. "We determined an increased rate of CTS (carpal tunnel syndrome) and decreased NCV (nerve conduction velocities) in the upper extremities in patients with FS. We should consider that complaints of paresthesia and pain in hands, increasing especially at night, observed in FS may mask that CTS can be an associated illness."

Nadler SF, Feinberg JH, Reisman S, Stitik TP, DePrince ML, Hengehold D, Weingand K. 2001.  Effect of topical heat on electromyographic power density spectrum in subjects with myofascial pain and normal controls: a pilot study. Am J Phys Med Rehabil Nov;80(11):809-15.  Myofascial pain patients responded differently to exercise and heat challenge.  This may indicate a difference in muscle physiology.

Nagai T, Abt JP, Sell TC et al. 2014. Neck proprioception, strength, flexibility, and posture in pilots with and without neck pain history. Aviat Space Environ Med. 85(5):529-535. CONCLUSION: The results demonstrate less neck active ROM (range of motion) in pilots with a history of NP (neck pain). Operating a helicopter with limited neck ROM or NP may negatively impact flight safety and force readiness. Continued research is warranted.

Naja ZM, Al-Tannir MA, Zeidan A et al. 2007.  Nerve stimulator-guided repetitive paravertebral block for thoracic myofascial pain syndrome.  Pain Pract. 7(4):348-351.  [This treatment may be useful for chronic MTPs resistant to standard treatments]

Nakagawa T, Kaneko S. 2010. Spinal Astrocytes as Therapeutic Targets for Pathological Pain. J Pharmacol Sci. [Nov 11 Epub ahead of print]. "Development of next-generation analgesics requires a better understanding of the molecular and cellular mechanisms underlying pathological pain. Accumulating evidence suggests that the activation of glia contributes to the central sensitization of pain signaling in the spinal cord. The role of microglia in pathological pain has been well documented, while that of astrocytes still remains unclear. After peripheral nerve inflammation or injury, spinal microglia are initially activated and subsequently sustained activation of astrocytes is precipitated, which are implicated in the induction and maintenance of pathological pain. Astrocytic activation is caused by the production of diffusible factors from primary afferent neurons (neuron-to-astrocyte signals) and activated microglia (microglia-to-astrocyte signals). Although astrocyte-to-neuron signals implicated in pathological pain is poorly understood, activated astrocytes, as well as microglia, produce proinflammatory cytokines and chemokines, which lead to adaptation of the dorsal horn neurons. Furthermore, it has been suggested that glial glutamate transporters in the spinal astrocytes are down-regulated in pathological pain and that up-regulation or functional enhancement of these transporters prevents pathological pain. This review will briefly discuss novel findings on the role of spinal astrocytes in pathological pain and their potential as a therapeutic target for novel analgesics."

Nakamura I, Nishioka K, Usui C et al. An Epidemiological Internet Survey of Fibromyalgia and Chronic Pain in Japan. Arthritis Care Res (Hoboken). [Jan 8 Epub ahead of print.] "Because FM usually presents with more severe and more widely distributed pain, as well as more non-painful symptoms than CP, our results suggest that FM is a different clinical phenotype of CP."

Naliboff BD, Wu SM, Schieffer B et al. 2010. A Randomized Trial of Two Prescription Strategies for Opioid Treatment of Chronic Nonmalignant Pain. J Pain. [Nov 24 Epub ahead of print]. "The results of this study demonstrate that even in carefully selected patients there is a significant risk of problematic opioid misuse. Although in general there were no statistically significant differences in the primary outcomes between groups, the escalating dose strategy did lead to small improvements in self-reported acute relief from medications without an increase in opioid misuse, compared to the stable dose strategy."

Nam TS, Choi SY, Park DJ et al. 2014. The Overlap between Fibromyalgia Syndrome and Myotonia Congenita. J Clin Neurol. [Nov 11 Epub ahead of print.] "Fibromyalgia syndrome (FMS) is a complex disorder characterized by chronic widespread pain (CWP), multiple areas of tenderness, sleep disturbance, fatigue, and mood or cognitive dysfunction. Myotonia congenita (MC) is an inherited myopathic disorder that is caused by mutations in the gene encoding the skeletal muscle chloride channel, which can infrequently manifest as generalized muscle cramps or myalgia….The first case was a 33-year-old woman who complained of CWP and chronic headache occurring during pregnancy, and the second case was a 37-year-old man with CWP and depression who suffered from cold-induced muscle cramps. These two patients were initially diagnosed with FMS by rheumatologists, based on CWP of longer than 3 months duration and mechanical tenderness in specific body regions. However, these two FMS patients were subsequently also diagnosed with MC….These two cases are the first report of an overlap of CWP between FMS and MC." Free Article [This study from Korea highlights two cases of this co-morbidity. I have seen one, and that person also had myofascial trigger points. I suspect that congenital frequently has these co-morbidities, as do most chronic conditions. DJS]

Nantz E, Liu-Seifert H, Skijarevski V. 2009.  Predictors of premature discontinuation of treatment in multiple disease states.  Patient Prefer Adherence. 3:31-43.  "Contrary to the conventional belief that premature treatment discontinuation is primarily related to adverse events, our findings suggest lack of therapeutic response also plays a significant role in patient attrition.  This research highlights the importance of systematic monitoring of therapeutic response in clinical practice as a measure to prevent patients’ discontinuation from pharmacological treatments."

Napadow V, Edwards RR, Cahalan CM et al. 2012. Evoked Pain Analgesia in Chronic Pelvic Pain Patients Using Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation. Pain Med. [May 8 Epub ahead of print]. "Objective: Previous vagus nerve stimulation (VNS) studies have demonstrated antinociceptive effects, and recent noninvasive approaches, termed transcutaneous-vagus nerve stimulation (t-VNS), have utilized stimulation of the auricular branch of the vagus nerve in the ear. The dorsal medullary vagal system operates in tune with respiration, and we propose that supplying vagal afferent stimulation gated to the exhalation phase of respiration can optimize t-VNS.. RAVANS (respiratory-gated auricular vagal afferent nerve stimulation) produced promising antinociceptive effects (in CPP patients) for quantitative sensory testing (QST) outcomes reflective of the noted hyperalgesia and central sensitization in this patient population."

Napadow V, Harris RE. 2014. What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management of 'centralized' pain? Arthritis Res Ther. 16(5):425. "Research suggests that fibromyalgia is a central, widespread pain syndrome supported by a generalized disturbance in central nervous system pain processing…. In recent years, brain neuroimaging techniques have heralded a revolution in our understanding of chronic pain, as they have allowed researchers to non-invasively (or minimally invasively) evaluate human patients suffering from various pain disorders. This review will outline recent applications of the complementary imaging techniques - fcMRI and 1H-MRS - to improve our understanding of fibromyalgia pathophysiology and how pharmacological and non-pharmacological therapies contribute to analgesia in these patients. A better understanding of the brain in chronic pain, with specific linkage as to which neural processes relate to spontaneous pain perception and hyperalgesia, will greatly improve our ability to develop novel therapeutics. Neuroimaging will play a growing role in the translational research approaches needed to make this a reality."


Napadow V, Lacount L, Park K et al. 2010. Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity. Arthritis Rheum. [Apr 6 Epub ahead of print]. “Our findings indicated that resting brain activity within multiple networks is associated with spontaneous clinical pain in FM. These findings may also have broader implications for how subjective experiences such as pain from a complex interplay amongst multiple brain networks.” [As synaptic junctions are under the control of neurotransmitters, and that many neurotransmitters may be dysregulated in central sensitization states such as FM, this is a logical finding. DJS]

Naschitz JE, Rozenbaum M, Fields MC et al. 2005.  Cardiovascular reactivity in fibromyalgia: evidence for pathogenic heterogeneity.  J Rheumatol. 32(2):335-339.  “Patients with FM represent a heterogenous group with respect to their pattern of cardiovascular reactivity.”

Naschitz JE, Rosner I, Rozenbaum M et al. 2003.  The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome.  QJM 96(2):133-142.  The particular dysautonomia in CFS is different from that occurring in fibromyalgia and other illnesses, and this difference can be measured with objective testing.

Naschitz JE, Rozenbaum M, Rosner I, Sabo E, Priselac RM, Shaviv N, Ahdoot A, Ahdoot M, Gaitini L, Eldar S, Yeshurun D. 2001. Cardiovascular response to upright tilt in fibromyalgia differs from that in chronic fatigue syndrome.  J Rheumatol 28(6):1356-60.

Nascimento SS, Camargo EA, DeSantana JM et al. 2014. Linalool and linalool complexed in β-cyclodextrin produce anti-hyperalgesic activity and increase Fos protein expression in animal model for fibromyalgia. Naunyn Schmiedebergs Arch Pharmacol. [Jun 24 Epub ahead of print.] "The analgesic activity of (-)-linalool (LIN), a monoterpene present in essential oils of Lamiaceae species, has been previously demonstrated in rodents. However, its possible use in the treatment of fibromyalgia (FM) was never demonstrated. Additionally, as a short half-life is a limitation for the LIN medicinal application, the employment of drug delivery systems has been used to improve pharmaceutical properties of this compound. We investigated the anti-nociceptive effect of LIN, isolated or in β-cyclodextrin complex (LIN-CD), in an animal model of chronic non-inflammatory muscle pain (a FM animal model), as well as its effect on the central nervous system (CNS)….our results suggest that LIN-CD improved analgesic profile of LIN, with a probable involvement of descending pain pathways and the anti-nociceptive effect of linalool in an animal model of chronic non-inflammatory muscle pain. So far, only the investigations in animal models of inflammatory pain and supraspinatus were published." [Linolool is an aromatic compound found in many herbs, including coriander, basil, cinnamon, lavender, and mints. DJS]

Nasir SM, Ostry DJ. 2006.  Somatosensory precision in speech production.  Curr Biol. 16(19):1918-1923. This study indicates that somatosensory feedback is necessary for vocal precision.  [This has implications for TrP and associated proprioception involvement in speech dysfunction. DJS.]

Natelson BH. 2013. Brain dysfunction as one cause of CFS symptoms including difficulty with attention and concentration. Front Physiol. 4:109. "We have been able to reduce substantially patient pool heterogeneity by identifying phenotypic markers that allow the researcher to stratify chronic fatigue syndrome (CFS) patients into subgroups. To date, we have shown that stratifying based on the presence or absence of comorbid psychiatric diagnosis leads to a group with evidence of neurological dysfunction across a number of spheres. We have also found that stratifying based on the presence or absence of comorbid fibromyalgia leads to information that would not have been found on analyzing the entire, unstratified patient group. Objective evidence of orthostatic intolerance (OI) may be another important variable for stratification and may define a group with episodic cerebral hypoxia leading to symptoms. We hope that this review will encourage other researchers to collect data on discrete phenotypes in CFS to allow this work to continue more broadly. Finding subgroups of CFS suggests different underlying pathophysiological processes responsible for the symptoms seen. Understanding those processes is the first step toward developing discrete treatments for each."

Navarrete M, Araque A. 2008.  Endocannabinoids mediate neuron-astrocyte communication. Neuron. 57(6):883-893.  This study has “...indicated the existence of an endocannabinoid-mediated neuron-astrocyte communication, revealing that astrocytes (a type of glial cell) are targets of cannabinoids.”  These glial cells might participate in cannabinoid addiction, but might also be a “...bridge for nonsynaptic interneuronal communication.”  As aggravated glial cells have been implicated in central sensitization, a dysfunction in the endocannabinoid system may be part of the problems in the cognitive deficits found in FM, as has been indicated by other research.  DJS]

Navarro RP. 2009. Contemporary management strategies for fibromyalgia. Am J Manag Care. 15(7 Suppl):S197-218.  “A roundtable meeting that comprised clinical, patient advocacy, and managed care experts discussed issues regarding the diagnosis and management of fibromyalgia.  The panel agreed that earlier diagnosis and treatment, additional education for the medical community, and appropriate management by health plans, including patient access to US Food and Drug Administration-approved fibromyalgia medications, are needed.  In addition, physicians, payers, and patient advocates must work to improve clinical, economic, and quality-of-life outcomes for fibromyalgia patients.  Finally, treatment and diagnostic guidelines must be updated as advances in disease management are made (including approvals of three new pharmacologic agents), and development of a therapeutic category for “fibromyalgia” on payer formularies is needed.”  [This is a fine paper, and it must be done for myofascial pain as well, as these two diagnoses often occur in the same patients. DJS]

Nawa, H., M. Saito and T. Nagano. 1997. Neurotrophic factors in brain synaptic plasticity.Crit Rev Neurobiol 11(1):91-100.

Nazarian A, Tenayuca JM, Almasarweh F et al. 2013. Sex differences in formalin-evoked primary afferent release of substance P. Eur J Pain. [Jun 10 Epub ahead of print]. "Sex differences in pain have been well documented; however, the mechanisms involved remain to be elucidated. The present study examined whether sex differences exist in the functioning of primary afferent fibres by assessing formalin-evoked release of substance P by way of neurokinin 1 receptor (NK1r) internalization. The study also investigated whether the observed effects would be oestradiol-sensitive….These findings suggest that oestradiol mediates sex differences in formalin-evoked substance P release, which may contribute to a differential development of central sensitization and pain behaviors in males and females."

Nebel MB, Gracely RH. 2009. Neuroimaging of fibromyalgia.  Rheum Dis Clin North Am. 35(2):313-327.  “Using a wide array of techniques, these studies have found differences in opioid receptor binding, in the concentration of metabolites associated with neural processing in pain-related regions, in functional brain networks, and in regional brain volume and white matter tracks.  A common theme of all of these methods is that they provide information that may be pertinent to the otherwise unobservable and poorly treated symptoms of persistent widespread chronic pain.”  [There may be many ways in which pain is uncontrolled in FM.  FM is real, even though there are no easy and widely available tests for it.  It is to be hoped that those doctors and other professionals who “don’t believe in FM,” as if it were on par with a horoscope, will read good studies such as this and become educated.  FM is not a faith-based belief, it is medical and scientific fact. DJS]

Neblett R, Cohen H, Choi Y et al. 2013. The Central Sensitization Inventory (CSI): Establishing Clinically-Significant Values for Identifying Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample. J Pain. [Mar 9 Epub ahead of print]. "Central sensitization (CS) is a proposed physiological phenomenon in which central nervous system neurons become hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli. The term central sensitivity syndrome (CSS) describes a group of medically indistinct (or nonspecific) disorders, such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome, for which CS may be a common etiology. In a previous study, the central sensitization inventory (CSI) was introduced as a screening instrument for clinicians to help identify patients with a CSS…. The CSI is a new self-report screening instrument to help identify patients with CSSs, including fibromyalgia. The present study investigated CSI scores in a heterogeneous pain population, with a large percentage of CSSs, and a normative nonclinical sample to determine a clinically relevant cutoff value."

Nedergaard M. 2013. Neuroscience. Garbage truck of the grain. Science 340 (6140):1529-1530. [This article focuses predominantly on neurodegenerative diseases, but the effect of the proposed glial cell network in clearing excess interstitial fluid from the brain is, I believe, very relevant to patients with fibromyalgia. During or after the process of neurodegeneration, abnormal proteins can be difficult to process and remove from the brain. This is the case in Alzheimer's disease, wherein tau and beta-amyloid can accumulate. Cytosolic proteins may be released into the brain's interstitial space, indicating that there may be a pathway for extracellular disposal of these neurotoxic wastes. (This may also be a possibility for quinolinic acid, which can be produced instead of serotonin in the tryptophan kynurenine alternative metabolic pathway found in some fibromyalgia patients.) There are aquaporin 4 (AQP4) channels on the vascular endfeet of astrocytes, a type of glial cell, that facilitate the flow from around the outsides of the arteries to the interstitial space. The cerebrospinal fluid exchanges with the interstitial fluid, driving waste products from the arteries to the veins. The interstitial fluid flows around the veins to the lymphatic system in the neck area, and the material in the interstitial fluid eventually finds its way into the lymph system. Up to 80% of the large proteins and soluble wastes and metabolic by-products in the brain are removed by this system of glial cells and lymph vessels working through the interstitial space. Dr. Nedergaard calls this system in the brain the "glymphatic system". When AQP4 is dysfunctional or inappropriately located, as can occur after trauma or stroke (or perhaps exposure to quinolinic acid if the kynurenine metabolic pathway is in use) this can result in excess proteins, solutes and perhaps fluid accumulation. Perhaps defects in the glymphatic system could be part of the cause of fibrofog and cerebral fluid accumulation in fibromyalgia patients. Excess interstitial fluid in the body has been observed in some fibromyalgia and insulin-resistant patients. It is extremely difficult to rid the interstitial space of accumulated fluid. The research being done by Dr. Nedergaard and others may offer insight and hope to some of us who have diffuse interstitial swelling and confusional states. DJS]

Neeck G. 2004.  Pain and the neuroendocrine system.  J Musculoskeletal Pain 12(3/4):45.  This brief summary explains the relation of the HPA-axis activation and the stress system to acute and chronic pain.

Neeck, G. and W. Riedel. 1999 Hormonal perturbations in fibromyalgia syndrome. Ann NY Acad Sci 22:876:325-38.

Neeck, G. and W. Reidel. 1994. Neuromediator and hormonal perturbations in fibromyalgia syndrome: results of chronic stress? Ballieres Clin Rheumatol 8(4):763-775.

Neeck, G. and W. Riedel. 1992. Thyroid function in patients with fibromyalgia syndrome.J Rheumatol 19(7):1120-2.

Negrini, S. 2000. Operation overload: kids’ backpacks. Science News 157(2):31.

Negrini, S., R. Carabalona and P. Sibilla. 1999. Backpack as a daily load for children. Lancet354 (9194):1974.

Nelson, D. V. and D. M. Novy. 1996. Psychological characteristics of reflex sympathetic dystrophy versus myofascial pain syndromes. Reg Anesth 21(3):202-208.

Nelson LS, Hoffman RS. 1998.  Intrathecal injection: unusual complication of trigger-point injection therapy.  Ann Emerg Med. 32(4):506-508.  “Trigger-point injection therapy is a common procedure in primary care medicine and emergency medicine and is generally considered safe.  A 28-year-old woman experienced respiratory depression and hemiplegia after the injection of a superficial trapezius trigger point.  The patient required emergency tracheal intubation for ventilatory support.  Computed tomography of her head revealed pneumocephalus.  She recovered fully over the course of 24 hours.  Intrathecal injection during a trigger-point injection is a previously unreported complication of trigger-point injection therapy.”

Neubauer, D. N. 1999. Sleep problems in the elderly. Am Fam Physician 59(9):2551-8, 2559-60.

Neumann DJ. 2014. July 2014 book reviews. Orthop Sports Phys Ther. 44(7):542-546. JOSPT offers invited reviews of current titles. The July 2014 column includes 6 reviews of the following books: Physical Therapy Management of Patients With Spinal Pain: An Evidence-Based Approach; Traumatology for the Physical Therapist; Evidence-Based Rehabilitation: A Guide to Practice, Third Edition; Healing Through Trigger Point Therapy: A Guide to Fibromyalgia, Myofascial Pain, and Dysfunction; Your Headache Isn't All in Your Head: Neuroscience Education for Patients With Headache Pain; and Disorders of the Shoulder: Diagnosis and Management Package, Third Edition.

Neumann, L. and D. Buskila. 1998. Ethnocultural and educational differences in Israeli women correlate with pain perception in fibromyalgia. J Rheumatol 25(7):1369-73.

Neville CE, Fitzgerald CM, Mallinson T et al. 2012. A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: a blind study of examination findings. J Bodyw Mov Ther. 16(1):50-56. "Abdominal findings on musculoskeletal exam are more common in women with self-reported CPP. Women with CPP might benefit from a faster time to diagnose and improved treatment outcomes if a musculoskeletal contribution to CPP was identified earlier."

Newcomb LW, Koltyn KF, Morgan WP et al. 2010. The Influence of Preferred versus Prescribed Exercise on Pain in Fibromyalgia. Med Sci Sports Exerc. [Nov 11 Epub ahead of print]. "It is concluded that the women with FM who participated in this study experienced significant improvements in pain following exercise. The results from this study are novel and indicate that recommendations for exercise prescription for individuals with FM should consider the preferred intensity exercise model as a strategy to reduce pain."

Newcomer, J. W., G. Selke, A. K. Melson, T. Hershey, S. Craft, K. Richards and A. L. Alderson.1999. Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry 56(6):527-33.

Newham, D. J., K. R. Mills, B. M. Quigley and R. H. Edwards. 1983. Pain and fatigue after concentric and eccentric muscle contractions. Clin Sci 64(1):55-62.

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Newman E.A. 2003.  Glial cell inhibition of neurons by release of ATP.  J Neurosci 23(5):1659-66.  “The results lend support to the hypothesis that glial cells play an active role in information processing in the CNS.”

Neyal M, Yimenicioglu F, Aydeniz A et al. 2012. Plasma nitrite levels, total antioxidant status, total oxidant status, and oxidative stress index in patients with tension-type headache and fibromyalgia. Clin Neurol Neurosurg. [Oct 11 Epub ahead of print]. "Tension-type headache (TTH) and fibromyalgia syndrome (FM) are worldwide seen chronic pain syndromes of unknown etiology. Despite the growing body of data on pathophysiology and generation mechanisms of pain, our knowledge on pain....These results (from Turkey) indicated that FM and TTH patients revealed higher oxidative stress index and lower total nitrite levels than healthy controls. We conclude that oxidative stress may have a role in the pathophysiological mechanisms of TTH and FM, although whether it is the cause or the consequence is not clear."

Neziri AY, Bersinger NA, Andersen OK et al. 2014. Correlation between altered central pain processing and concentration of peritoneal fluid inflammatory cytokines in endometriosis patients with chronic pelvic pain. Reg Anesth Pain Med. [Apr 1 Epub ahead of print.] "The results suggest that inflammatory mechanisms may be important in the pathophysiology of altered central pain processes and that cytokines produced in the environment of endometriosis could act as mediators between the peripheral lesion and changes in central nociceptive processes."

Neziri AY, Limacher A, Juni P et al. 2013. Ranking of Tests for Pain Hypersensitivity According to Their Discriminative Ability in Chronic Neck Pain. Reg Anesth Pain Med. 38(4):308-320. "Quantitative sensory testing (QST) is widely used to investigate peripheral and central sensitization. However, the comparative performance of different QST for diagnostic or prognostic purposes is unclear. We explored the discriminative ability of different quantitative sensory tests in distinguishing between patients with chronic neck pain and pain-free control subjects and ranked these tests according to the extent of their association with pain hypersensitivity….Pressure stimulation at the site of the most severe pain and parameters of electrical stimulation were the most appropriate QST to distinguish between patients with chronic neck pain and asymptomatic control subjects. These findings may be used to select the tests in future diagnostic and longitudinal prognostic studies on patients with neck pain and to optimize the assessment of localized and spreading sensitization in chronic pain patients."

Ng, E.H., C. Y. Ji, P. H. Tan, V. Lin, K. C. Soo and K. O. Lee. 1998. Altered serum levels of insulin-like growth-factor binding proteins in breast cancer patients. Ann Surg Oncol 5(2):194-201.

Ng S.Y. 1999. Hair calcium and magnesium levels in patients with fibromyalgia: a case center study. J Manipulative Physiol Ther 22(9):586-93. Calcium and magnesium supplements may be indicated as an adjunctive treatment of fibromyalgia.

Nguyen BM. 2013. Myofascial trigger point falls in the elderly, idiopathic knee pain and osteoarthritis: An alternative concept. Med Hypotheses. [April 5 Epub ahead of print]. "Knee alignment and associated pathological abnormal forces transmitted through the knee is thought to provoke joint protective mechanism in reflex arthrogenic muscle inhibition (AMI) and the start of the idiopathic knee osteoarthritic process. The current prevailing hypothesis is AMI initiates quadriceps muscle weakness, cause aberrant loading of the knee joint and focal cartilage destruction. This paper investigates for evidence in the literature if this conceptual framework is consistent with the clinical evidence, and if there is an alternative explanation to AMI hypothesis for the pathogenesis of idiopathic knee osteoarthritis. One crucial question yet to be answered by the AMI hypothesis is; where are the initial aggravating factors of reflex AMI emanate from? AMI hypothesis relies on joint damage and changes in joint homeostasis to provoke a reflex arthrogenous response which can be found late in the development of knee OA. Myofascial trigger point (MTrP) hypothesis only relies on muscle tightness, pain and weakness to detect early pathological neuromuscular changes including knee instability and falls in the elderly. AMI is implicated in the knee OA pathological process but much later on when there are changes in joint homeostasis and joint cartilage damage have occurred. Falls in the elderly are a result of early pathological neuromuscular changes. The MTrP hypothesis is more sensitive and advanced in the early detection of neuromuscular impairment and pathological changes, allowing early intervention, prevention of falls in the elderly and idiopathic knee osteoarthritis." [Researchers are discovering that bones follow muscles, and that it is the muscle contracture by TrPs causing the wear and tear on bony areas of joints that leads to osteoarthritis. DJS]

Nguyen BM. 2010. Trigger point therapy and plantar heel pain: A case report. Foot (Edinb). [Oct 26 Epub ahead of print]. Myofascial trigger points are a common cause of the condition often called plantar fasciitis. Trigger point therapy for plantar fasciitis has been neglected in medicine. [We can not afford to describe a set of symptoms and call that a diagnosis. We must look at the cause and treat the cause. DJS]

Nguyen MH, Kruse A. 2012. A randomized controlled trial of Tai chi for balance, sleep quality and cognitive performance in elderly Vietnamese. Clin Interv Aging. 7:185-90. "Tai chi is beneficial to improve balance, sleep quality, and cognitive performance of the elderly."

Nguyen RH, Ecklund AM, Maclehose RF et al. 2012. Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia. Psychol Health Med. [Feb 13 Epub ahead of print]. "Having a co-morbid condition with vulvodynia, as well as having an increasing number of co-morbid conditions with vulvodynia, was significantly associated with the presence of feeling both invalidated and isolated. Chronic fatigue syndrome was the co-morbidity most strongly associated with feelings invalidation and isolation. One or more co-morbid pain conditions in addition to vulvodynia were significantly associated with psychosocial wellbeing.... future studies should explore the utility of promoting validation of women's pain conditions and reducing social isolation for women with chronic pain. [It is most unfortunate that the co-existing condition most interactive with and often causative of vulvodynia, chronic myofascial pain, was not considered among these conditions. DJS]

Nguyen RH, Veasley C, Smolenski D. 2013. Latent class analysis of comorbidity patterns among women with generalized and localized vulvodynia: preliminary findings. J Pain Res. 6:303-309. "The pattern and extent of clustering of comorbid pain conditions with vulvodynia is largely unknown. However, elucidating such patterns may improve our understanding of the underlying mechanisms involved in these common causes of chronic pain….This novel work provides insight into potential shared mechanisms of vulvodynia by describing that a prominent comorbidity pattern involves having both irritable bowel syndrome and fibromyalgia. In addition, the prevalence of a multiple comorbidity class pattern increases with increasing severity of vulvar pain." [Until the medical world understands that many symptoms often labeled generalized and localized vulvodynia or fibromyalgia are actually due to or sustained by myofascial trigger points, and that those TrPs are the critical generating co-existing condition, researchers are going to miss the critical (trigger) point. DJS]

Nicassio PM, Schuman CC. 2005.  The prediction of fatigue in fibromyalgia.  J Musculoskeletal Pain 13(1).  “The data demonstrated that passive coping contributed to a dysfunctional cycle characterized by heightened pain and depressive symptomatology, leading to greater fatigue.  The continued effort to develop effective interventions to reduce maladaptive coping efforts in FMS is warranted by these findings.”

Nicassio P.M., Moxham E.G., Schuman C.E. et al. 2002.  The contribution of pain, reported sleep quality, and depressive symptoms to fatigue in fibromyalgia.  Pain 100(3):271-9. The study indicates that the fatigue of fibromyalgia is due to poor sleep quality. Lack of restorative sleep is a perpetuating factor that must be addressed to alleviate patient’s fatigue.

Nichols TW Jr, Gaiteri C. 2014. Morton's foot and pyridoxal 5'-phosphate deficiency: Genetically linked traits. Med Hypotheses. 83(6):644-648. Vitamin B6 is an essential vitamin needed for many chemical reactions in the human body. It exists as several vitamins forms but pyridoxal 5'-phosphate (PLP) is the phosphorylated form needed for transamination, deamination, and decarboxylation. PLP is important in the production of neurotransmitters, acts as a Schiff base and is essential in the metabolism of homocysteine, a toxic amino acid involved in cardiovascular disease, stroke, thrombotic and Alzheimer's disease. This report announces the connection between a deficit of PLP with a genetically linked physical foot form known as the Morton's foot. Morton's foot has been associated with fibromyalgia/myofascial pain syndrome. Another gene mutation methylenetetrahydrofolate reductase (MTHFr) is now being recognized much commonly than previous with chronic fatigue, chronic Lyme diseases and as "the missing link" in other chronic diseases. PLP deficiency also plays a role in impaired glucose tolerance and may play a much bigger role in the obesity, diabetes, fatty liver and metabolic syndrome. Without the Schiff-base of PLP acting as an electron sink, storing electrons and dispensing them in the mitochondria, free radical damage occurs! The recognition that a phenotypical expression (Morton's foot) of a gene resulting in deficiency of an important cofactor enzyme pyridoxal 5'-phosphate will hopefully alert physicians and nutritionists to these phenomena. Supplementation with PLP, L5-MTHF, B12 and trimethylglycine should be used in those patients with hyperhomocysteinemia and/or MTHFR gene mutation.

Nicol AL, Wu II, Ferrante FM. 2014. Botulinum toxin type A injections for cervical and shoulder girdle myofascial pain using an enriched protocol design. Anesth Analg. 118(6):1326-1335. BoNT-A injected directly into painful muscle groups improves average pain scores and certain aspects of quality of life in patients experiencing severe cervical and shoulder girdle myofascial pain.

Nicolaidis C. 2011. Police Officer, Deal-Maker, or Health Care Provider? Moving to a Patient-Centered Framework for Chronic Opioid Management. Pain Med. [May 3 Epub ahead of print]. "How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be nonjudgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or a judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the American Pain Society/American Academy of Pain Medicine guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This article discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic nonmalignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm."

Nicolodi, M., A. R. Volpe and F. Sicuteri. 1998. Fibromyalgia and headache. Failure of serotonergic analgesia and N-methyl-D-aspartate-mediated neuronal plasticity: their common clues. Cephalalgia 18 (Suppl 21):41-44.

Nichols, M. L., B. J. Allen, S. D. Rogers, J. R. Ghilardi, P. Honore, N. M. Luger, M. P. Finke,J. Li, D. A. Lappi, D. A. Simone and P. W. Mantyh. 1999. Transmission of chronic nociception by spinal neurons expressing the substance P receptor. Science 286(5444):1558-61.

Niddam DM, Chan RC, Lee SH et al. 2007.  Central modulation of pain evoked from myofascial trigger point.  Clin J Pain. 23(5):440-448.  “Low-intensity low-frequency electrostimulation delivered within a myofascial trigger point (MTP) has been used as intervention to deactivate MTPs.”  “The applied intervention most likely involves supraspinal pain control mechanisms related to both antinociception and regulation of pain affect.”

Niddim DM, Chan Rc, Lee SH et al. 2008.  Central representation of hyperalgesia from myofascial trigger point.  NeuroImage. 39:1299-1306.  Using functional MRI, imaging regions that are dysfunctional in FM patients, researchers used a needle electrode or pressure to stimulate MTPs.  Both stimulations produced a higher pain response than normal controls, with “significantly enhanced somatosensory activity (SI, SII, inferior pareital, mid insula) and limbic (anterior insula) activity and suppressed right dorsal hippocampal activity in patients compared with controls.”  The results show that the hyperalgesic state in MTP patients is associated with abnormal brain activity in the areas that process stimulus activity and negative affect.  [This study indicates that MTPs may contribute significantly to central sensitization. DJS]

Nielsen LA, Henriksson KG. 2007.  Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition.  Best Pract Res Clin Rheumatol. 21(3):465-480.  “In FMS there is strong scientific support for the statement that the biological part of the syndrome is a longstanding or permanent change in the function of the nociceptive nervous system that can be equated with a disease.”  “FMS may be the far end of a continuum that starts with chronic localized/regional musculoskeletal pain and ends with widespread chronic disabling pain.”

Nielson WR, Merskey H.2001.  Psychosocial aspects of fibromyalgia. Curr Pain Headache Rep 5(4):330-7. The opinion that fibromyalgia syndrome (FMS) is a psychiatric disorder or can be caused by stress or abuse is unproven and can be of potential harm to patients. Care providers should be aware of "possible undue influences on medical opinion by agencies providing health care and research funding".

Nijs J, Crombez G, Meeus M et al. 2012. Pain in patients with chronic fatigue syndrome: time for specific pain treatment? Pain Physician. 15(5):E677-686. "Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers....From the available literature....Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. [This study was simply a review of other studies, all of which totally ignored the possibility that CFS patients could have pain from co-existing myofascial trigger points or other local sources. It is a fine example of how bad research can lead to further bad research. DJS]

Nijs J, Daenen L, Cras P et al. 2011. Nociception Affects Motor Output: A Review on Sensory-motor Interaction with Focus on Clinical Implications. Clin J Pain. [Jun 27 Epub ahead of print]. "Nociception-induced motor inhibition might prevent effective motor retraining. In addition, the sympathetic nervous system responds to chronic nociception with enhanced sympathetic activation. Not only motor and sympathetic output pathways are affected by nociceptive input, afferent pathways (proprioception, somatosensory processing) are influenced by tonic muscle nociception as well.... The clinical consequence of the shift in thinking is to stop trying to restore normal motor control in case of chronic nociception. Activation of central nociceptive inhibitory mechanisms, by decreasing nociceptive input, might address nociception-motor interactions."

Nijs J, Kosek E, Van Oosterwijck J et al. 2012. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician. 15(3 Suppl):ES205-213. "Exercise is an effective treatment for various chronic pain disorders, including fibromyalgia, chronic neck pain, osteoarthritis, rheumatoid arthritis, and chronic low back pain. Although the clinical benefits of exercise therapy in these populations are well established (i.e., evidence based), it is currently unclear whether exercise has positive effects on the processes involved in chronic pain (e.g., central pain modulation). A dysfunctional response of patients with chronic pain and aberrations in central pain modulation to exercise has been shown, indicating that exercise therapy should be individually tailored with emphasis on prevention of symptom flares. The paper discusses the translation of these findings to rehabilitation practice together with future research avenues."

Nijs J, Malfliet A, Ickmans K et al. 2014. Treatment of central sensitization in patients with 'unexplained' chronic pain: an update. Expert Opin Pharmacother. 15:1-13. "Central sensitization (CS) is present in a variety of chronic pain disorders, including whiplash, temporomandibular disorders, low back pain, osteoarthritis, fibromyalgia, headache, lateral epicondylalgia among others. In spite of our increased understanding of the mechanisms involved in CS pain, its treatment remains a challenging issue. Areas covered: An overview of the treatment options we have for desensitizing the CNS in patients with CS pain is provided. These include strategies for eliminating peripheral sources of nociception, as well as pharmacotherapy and conservative interventions that primarily address top-down (i.e., brain-orchestrated) mechanisms. Expert opinion: A combination of different strategies, each targeting a different 'desensitizing' mechanism, might prove superior over monotherapies. Such combined therapy may include both bottom-up and top-down (e.g., opioids, combined ?-opioid receptor agonist and noradrenaline reuptake inhibitor drugs) strategies. Topically applied analgesic therapies have strong potential for (temporally) decreasing peripheral nociceptive input (bottom-up approach). Targeting metabolic (e.g., ketogenic diets) and neurotrophic factors (e.g., decreasing brain-derived neurotrophic factor) are promising new avenues for diminishing hyperexcitability of the CNS in central sensitization pain patients. Addressing conservative treatments, pain neuroscience education, cognitive behavioral therapy and exercise therapy are promising treatments for CS pain."

Nijs J, Meeus M, Oosterwijck JV et al. 2011. Treatment of central sensitization in patients with 'unexplained' chronic pain: what options do we have? Expert Opin Pharmacother. [Jan 22 Epub ahead of print]. "Acetaminophen, serotonin-reuptake inhibitor drugs, selective and balanced serotonin and norepinephrine-reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, N-methyl-d-aspartate (NMDA)-receptor antagonists, calcium-channel alpha(2)delta (a2î) ligands, transcranial magnetic stimulation, transcutaneous electric nerve stimulation (TENS), manual therapy and stress management each target central pain processing mechanisms in animals that - theoretically - desensitize the CNS in humans. To provide a comprehensive treatment for 'unexplained' chronic pain disorders characterized by central sensitization, it is advocated to combine the best evidence available with treatment modalities known to target central sensitization." [This is not a sufficient way to treat central pain. One must also identify and bring under maximum control all pain generating factors. For example, if there are morphological pain generators in the spine such as tears in the disc or facet joint inflammation, if there is visceral disease, if there is cancer, if there are myofascial trigger points, one must find the perpetuating factor–and all of its perpetuating factors–and bring them under control. Only then can central pain be successfully treated, and not just masked. DJS]

Nijs J, Torres-Cueco R, van Wilgen CP et al. 2014. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Pain Physician. 17(5):447-457. "It is proposed that the classification of central sensitization pain entails 2 major steps: the exclusion of neuropathic pain and the differential classification of nociceptive versus central sensitization pain. For the former, the International Association for the Study of Pain diagnostic criteria are available for diagnosing or excluding neuropathic pain. For the latter, clinicians are advised to screen their patients for 3 major classification criteria, and use them to complete the classification algorithm for each individual patient with chronic pain. The first and obligatory criterion entails disproportionate pain, implying that the severity of pain and related reported or perceived disability are disproportionate to the nature and extent of injury or pathology (i.e., tissue damage or structural impairments). The 2 remaining criteria are 1) the presence of diffuse pain distribution, allodynia, and hyperalgesia; and 2) hypersensitivity of senses unrelated to the musculoskeletal system (defined as a score of at least 40 on the Central Sensitization Inventory….Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain." Free Article

Nijs J, Van Cauwenbergh D, De Kooning M et al. 2012. Time-contingent pacing and exercise therapy accounting for postexertional malaise and central sensitization in chronic fatigue (central sensitivity) syndrome. Eur J Clin Invest. [Sep 7 Epub ahead of print].

Nijs J, Van Houdenhove B, Oostendorp RA. 2009.  Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice.  Man Ther. [Dec 23 Epub ahead of print] "The diagnosis/assessment of central sensitization in individual patients with musculoskeletal pain is not straightforward; however, manual therapists can use information obtained from the medical diagnosis, combined with the medical history of the patient, as well as the clinical examination and the analysis of the treatment response in order to recognize central sensitization.  The clinical examination used to recognize central sensitization entails the distinction between primary and secondary hyperalgesia."

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Nilsen KB, Sand T, Westgaard RH et al. 2007.  Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients.  Eur J Pain. [Jan 13 Epub ahead of print]  [This study might have yielded more information if the subjects had been checked for co-existing shoulder and neck myofascial trigger points. DJS]

Nilsen KB, Westgaard RH, Stovner LJ et al. 2005.  Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography. Eur J Pain [Nov 18 Epub ahead of print].  “Muscular activity did not explain the pain which developed during the stressful task for either group. Pain lasted longer during recovery in both FMS and SNP (shoulder/neck pain) patients compared to healthy controls, possibly a result of disease-related sensitization in pain pathways."  [These patients were not screened for co-existing myofascial pain. DJS]

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Nourmoussavi M, Bodmer-Roy S, Mui J et al. 2014. Bladder Base Tenderness in the Etiology of Deep Dyspareunia. J Sex Med. [Sep 21 Epub ahead of print.] "Bladder base tenderness is present in one-third of women with pelvic pain, and contributes specifically to the symptom of deep dyspareunia. Bladder base tenderness was also associated with the presence of an abdominal wall trigger point and with pelvic floor tenderness, suggesting a myofascial etiology and/or nervous system sensitization."

Nye BL, Thadani VM. 2015. Migraine and epilepsy: review of the literature. Headache. 55(3):359-380. "Migraine and epilepsy are disorders that are common, paroxysmal, and chronic. In many ways they are clearly different diseases, yet there are some pathophysiological overlaps, and overlaps in clinical symptomatology, particularly with regard to visual and other sensory disturbances, pain, and alterations of consciousness. Epidemiological studies have revealed that the two diseases are comorbid in a number of individuals….In epilepsy, neuronal overactivity leads to the recruitment of larger populations of neurons firing in a rhythmic manner that constitutes an epileptic seizure. Migraine aura and headaches may act as a trigger for epileptic seizures. Epilepsy is not infrequently accompanied by preictal, ictal, and postictal headaches that often have migrainous features. Genetic links are also apparent between the two disorders, and are particularly evident in the familial hemiplegic migraine syndromes where different mutations can produce either migraine, epilepsy, or both. Also, various medications are found to be effective for both migraine and epilepsy, again pointing to a commonality and overlap between the two disorders."

Nymdelger S, Nieber K. 2007.  [Pregabalin – a neuromodulator for the treatment of neuropathic pain, generalized anxiety disorders and fibromyalgia syndrome] Med Monatsschr Pharm. 30(11):396-400. [German]

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