O’Shaughnessy, T. 1994. Craniomandibular/temporomandibular/cervical implications of a forced hyper-extension/hyper-flexion episode (ie., whiplash). Funct Orthod 11(2):5-10, 12.

Ostensen, M., A. Rugelsjoen and S. H. Wigers. 1997. The effect of reproductive events and alterations of sex hormone levels on the symptoms of fibromyalgia. Scand J Rheumatol 26(5):355-360.

Otis J, Rothman M. 2006.  A Phase III study to assess the clinical utility of low-dose fentanyl transdermal system in patients with chronic nonmalignant pain.  Curr Med Res Opin. 22(8):1493-1501.  This lower-dose fentanyl may be of benefit to opioid-naive patients and the elderly.  It had a beneficial therapeutic effectiveness with a lessened drop out rate.

Ouyang A, Wrzos HF. 2006.  Contribution of gender to pathophysiology and clinical presentation of IBS: should management be different in women?  Am J Gastroenterol. 101 Suppl 3:S602-609.

Overlie, I., M. H. Moen, L. Morkrid, J. S. Skjaeraasen, and A. Holte.1999. The endocrine transition around menopause-a five-year prospective study with profiles of gonadotropins, estrogens, androgens, and SHBG among healthy women. Acta Obstet Gynecol Scand 78(7):643-7.

Ozgocmen S, Ozyurt H., Sogut S et al. 2005.  Antioxidant status, lipid peroxidation, and nitric oxide in fibromyalgia: etiologic and therapeutic concerns.  Rheumatol Int. Nov 10:1-10.  [Epub ahead of print]  This article offers several possible therapeutic avenues for fibromyalgia treatment by indicating possible metabolic subsets.

Ozgocmen, S., Yoldas, T., Kamanli, A. et al. 2003.  Auditory P300 event related potentials and serotonin reuptake inhibitor treatment in patients with fibromyalgia.  Ann Rheum Dis 62(6):551-5.  P300 amplitude components of auditory event potentials, as measured by scalp electrodes, are associated with attention allocation, information and cognitive processing, and maintenance of working memory.  In fibromyalgia patients, P300 amplitudes are reduced.

Ozgocmen, S, Ardicoglu O, Lipid Profile in Patients with Fibromyalgia and Myofascial Pain Syndromes, Yonsei Medical Journal 41(5):541-545, 2000. Significant changes to the lipid profile seems to be part of the myofascial component rather than the fibromyalgia component when these conditions occur together.

Ozkan F, Cakir Ozkan N, Ekorkmaz U. 2011. Trigger point injection therapy in the management of myofascial temporomandibular pain. Agri 23(3):119-125. "Myofascial pain is the most common temporomandibular disorder.....Our results indicate that trigger point injection therapy combined with splint therapy is effective in the management of myofascial TMD pain. " Further research is needed. [One must be careful with splint use in TrPs, as immobility is a perpetuating factor of TrPs. One needs to treat all the TrPs affecting the TMJ, including the soleus. Unless one knows all TrPs, one may not know to check the calf for TrPs that can affect the jaw. DJS]

Oztürk O, Tek M, Seven H. 2012. Temporomandibular disorders in scuba divers - an increased risk during diving certification training. J Craniofac Surg. 23(6):1825-1829. The design and fit of a mouthpiece on SCUBA can increase the risk of developing TMJD and TrPs as the diver is constantly struggling to attain mouthpiece stability.

Packard C., Nunn A., Hobbs R. et al. 2002.  High density lipoprotein: guardian of the vascular system?  Int J Clin Pract 56(10):761-71.  “Patients with low HDL-C levels often have central obesity, insulin resistance and other features of the metabolic syndrome.  This syndrome is both increasingly common and strongly implicated in the growing worldwide epidemic of type 2 diabetes . . . . Although current guidelines are beginning to recognize the protective role of HDL-C level in preventing coronary events, HDL-C should be adopted soon as a target for intervention in its own right.”

Padamsee M, Mehta N, White GE. 1987.  Trigger point injection: a neglected modality in the treatment of TMJ dysfunction.  J Pedod. 12(1):72-92.

Pagotto U, Marsicano G, Cota D et al. 2005.  The emerging role of the endocannabinoid system in endocrine regulation and energy balance.  Endocr Rev. [Nov 23 Epub ahead of print]   [The role of the endocannabinoid system includes the modulation of all the endocrine hypothalamic-peripheral endocrine axes, control of reproduction and sexual behavior, control of appetite and energy balance and other  metabolic areas that are often imbalanced in FMS. DJS]

Painter JT, Crofford LJ, Talbert J. 2013. Geographic variation of chronic opioid use in fibromyalgia. Clin Ther. 35(3):303-311. "Opioid use for the treatment of chronic nonmalignant pain has increased drastically over the past decade. Although no evidence of efficacy exists supporting the treatment of fibromyalgia (FM) with chronic opioid therapy, a large number of patients are receiving this therapy....Geographic variation in chronic opioid use among patients with FM exists at rates similar to those seen in other studies examining opioid use. This large level of geographic variation suggests that the prescribing decision is not based solely on physician-patient interaction but also on contextual and structural factors at the state level. The level of physician and condition prevalence suggest that information dissemination and peer-to-peer interaction may play a key role in adopting evidence-based medicine for the treatment of patients suffering from FM and related conditions. Level of diagnosis prevalence as a predictor of evidence-based practice has not been reported in the literature and is an important contribution to research on geographic variation."

Paira, S. O. 1994. Fibromyalgia associated with female and urethral syndrome. Clin Rheumatol 13(1):88-89.

Pal JS, Desai J, Bajwa Z. 2007.  Superior oblique muscle deinnervation: implications for differential innervation of myofascial trigger points.  J Musculoskel Pain 15 (Supp 13):66 item 117.  [Myopain 2007 Poster]  “SOM (superior oblique muscle) TrPs may be a cause, as opposed to a consequence, of headache.”  “Eye movement disorders increase risk for headache due to awkward head tilts and double vision.”

Palestini P, Calvi C, Conforti E et al. 2003.  Compositional changes in lipid microdomains of air-blood barrier plasma membranes in pulmonary interstitial edema.  J Appl Physiol 95(4):1446-1452.

Palm HG, Laufer C, von Luebken F et al. 2010. [Do meniscus injuries affect postural stability?] Orthopade. [Jan 20 Epub ahead of print]. [German]  Background: Meniscal lesions are known to cause a loss of proprioception, which plays an important role in the regulation of postural stability.  This study showed that in spite of  “…the presence of an arthroscopically confirmed meniscal lesion, none of the stability indexes that we calculated revealed significant differences in postural stability between the injured and uninjured sides…..It was surprising to note that the loss of proprioception in patients with meniscus injuries did not influence postural stability. Patients with functional knee instability must therefore be examined for the presence of further injuries because a meniscal lesion alone cannot explain instability symptoms.” [It is suggested the authors look for myofascial trigger points in the regions of the meniscal lesions in future research, as TrP are often associated with proprioceptor dysfunction. DJS]

Palomino RA, Nicassio PM, Greenberg MA et al. 2007.  Helplessness and loss as mediators between pain and depressive symptoms in fibromyalgia.  Pain. [Feb 28 Epub ahead of print]  “The findings confirm the importance of helplessness and demonstrate that the cognitive meaning of having FM plays a more central role in predicting depressive symptomatology than illness-related stressors, such as pain or disability.”

Palstam A, Gard G, Mannerkorpi K. 2013. Factors promoting sustainable work in women with fibromyalgia. Disabil Rehabil. [Jan 22 Epub ahead of print]. "Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM… Working women with FM appear to have developed advanced well-functioning individual strategies to enhance their work ability. The development of individual strategies should be supported by health-care professionals as well as employers to promote sustainable work and health in women with FM."

Pang, S. F., L. Li, E. A. Ayre, C. S. Pang, P. P. Lee, R. K. Xu, P. H. Chow, Z. H. Yu and S. Y. Shiu. 1998. Neuroendocrinology of melatonin in reproduction: recent developments. J Chem Neuroanat 14(3-4):157-66.

Panton L, Simonavice E, Williams K et al. 2012. Effects of Class IV Laser Therapy on Fibromyalgia Impact and Function in Women with Fibromyalgia. J Altern Complement Med. [Nov 23 Epub ahead of print]. "This study provides evidence that LHT (laser heat therapy) may be a beneficial modality for women with FM in order to improve pain and upper body range of motion, ultimately reducing the impact of FM."

Panton LB, Kingsley JD, Toole T et al. 2006.  A comparison of physical functional performance and strength in women with fibromyalgia, age- and weight-matched controls, and older women who are healthy.  Phys Ther. 86(11):1479-1488.  “This study demonstrated that women with FM and older women who are healthy have similar lower-body strength and functionality, potentially enhancing the risk for premature age-associated disability.”

Paolisso, G., M. R. Tagliamonte, M. R. Rizzo and D. Giugliano. 1999. Advancing age and insulin resistance: new facts about an ancient history. Eur J Clin Invest 29(9):758-769.

Pappagallo, M. and L. J. Heinberg. 1997. Ethical issues in the management of chronic nonmalignant pain. Semin Neurol 17(3):203-211.

Pappagallo, M. 1998. Aggressive pharmacologic treatment of pain. Rheum Dis Clin North Am25(1):193-213, vii.

Paradies, G., F. M. Ruggiero and P. Dinoi. 1991.  The influence of hypothyroidism on the transport of phosphate and on the lipid composition in rat-liver mitochondria.  Biochim Biophys Acta 1070(1):180-186.

Park AJ, Paraiso MF. 2009.  Successful use of botulinum toxin type A in the treatment of refractory postoperative dyspareunia.  Obstet Gynecol. 114(2 Pt 2):484-487.  “Refractory dyspareunia presents a challenging therapeutic dilemma.  Case: A woman with defecatory dysfunction and dysparenuria presented with stage 2 prolapse.  She underwent laparoscopic and vaginal pelvic floor reconstruction with excision of endometriosis.  The patient experienced increased dysparenuria and de novo vaginismus postoperatively that were refractory to trigger point injections, physical therapy, and medical and surgical management.  She underwent botulinum toxin type A injections into her levator ani muscles, which allowed her to have sexual intercourse again after 2 years of apareunia with no recurrence of pain for 12 months.  Conclusion: Injecting botulinum toxin into the levator ani muscles shows promise for postoperative patients who develop vaginismus and do not respond to conservative therapy.”  [Men and women with sexual dysfunction must be assessed for myofascial TrPs in the pelvic floor, including perineum, plus low abdominal wall and rectal and vaginal TrPs.   There is so much unnecessary misery (and cost) due to lack of training on the part of practitioners. DJS] 

Park CH, Huh BK, Lee SH et al. 2011. Efficacy of oblique fluoroscopic approach for stellate ganglion block. J Musculoskel Pain. 19(2):101-104. "The C7 oblique approach SGB (stellate ganglion block) showed the same SGB effects compared with the C7 anterior approach SGB, and did not cause hoarseness. We concluded that the C7 oblique approach SGB may be a beneficial method for patients." Spinal pathology is a frequent perpetuating factor for TrPs in CMP. It is good to have the safest options for controlling spinal pain. DJS]

Park CH, Lee YW, Kim YC et al. 2012. Treatment experience of pulsed radiofrequency under ultrasound guided to the trapezius muscle at myofascial pain syndrome - a case report. Korean J Pain. 25(1):52-54. "Trigger point injection treatment is an effective and widely applied treatment for myofascial pain syndrome. The trapezius muscle frequently causes myofascial pain in neck area. We herein report a case in which direct pulsed radio frequency (RF) treatment was applied to the trapezius muscle. .... RF treatment produced continuous pain relief when the effective duration of trigger point injection was temporary in myofascial pain."

Park HJ, Moon DE. 2010. Pharmacologic management of chronic pain. Korean J Pain. 23(2):99-108. "This article provides a mechanism- and evidence-based approach to improve the outcome for pharmacologic management of chronic pain. The usual approach to treat mild to moderate pain is to start with a nonopioid analgesic. If this is inadequate, and if there is an element of sleep deprivation, then it is reasonable to add an antidepressant with analgesic qualities. If there is a component of neuropathic pain or fibromyalgia, then a trial with one of the gabapentinoids is appropriate. If these steps are inadequate, then an opioid analgesic may be added. For moderate to severe pain, one would initiate an earlier trial of a long term opioid. Skeletal muscle relaxants and topicals may also be appropriate as single agents or in combination. Meanwhile, the steps of pharmacologic treatments for neuropathic pain include (1) certain antidepressants (tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors), calcium channel alpha(2)-delta ligands (gabapentin and pregabalin) and topical lidocaine, (2) opioid analgesics and tramadol (for first-line use in selected clinical circumstances) and (3) certain other antidepressant and antiepileptic medications (topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists). It is essential to have a thorough understanding about the different pain mechanisms of chronic pain and evidence-based multi-mechanistic treatment. It is also essential to increase the individualization of treatment."

Park, J. H., P. Phothiamat, C. T. Oates, M. Hernanz-Schulman and N. J. Olsen. 1998.  Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia.  Arth Rheum 41(3):406-413.

Park SC, Kim KH. 2012. Effect of adding cervical facet joint injections in a multimodal treatment program for long-standing cervical myofascial pain syndrome with referral pain patterns of cervical facet joint syndrome. J Anesth. [May 31 Epub ahead of print]. Addition of therapeutic CFJ (cervical facet joint) injections to a multimodal treatment program is a useful therapeutic modality for patients, especially young patients, suffering from long-standing MPS with referral pain of CFJ syndrome.

Park TJ, Comer C, Carol A et al. 2003.  Somatosensory organization and behavior in naked mole-rats: I - Peripheral structures, innervation, and selective lack of neuropeptides associated with thermoregulation and pain.  J Comp Neurol 465(1):104-20.  The naked mole-rat may be a lab model for fibromyalgia. 

Parr, T. 1996.  Insulin exposure controls the rate of mammalian aging.  Mech Ageing Dev 88(1-2):75-82.

Parrott, Tom. 1999.  Using opioid analgesics to manage chronic noncancer pain in primary care.  J Am Board Fam Pract 12:293-306.

Partanen JV, Ojala TA, Arokoski JP. 2009.  Myofascial syndrome and pain: a neurophysiological approach.  Pathophysiology. [Jun 3 Epub ahead of print].  This study indicates that TrPs are related to muscle spindles in the taut bands.

Partonen, T. 1999.  Melatonin-dependent infertility.  Med Hypotheses 52(3):269-70.

Pascarelli, E. F. and J. J. Kella. 1993.  Soft-tissue injuries related to the use of the computer keyboard.  A clinical study of 53 severely injured persons.  J Occup Med 35(5):522-532.

Pasquini, J. M. and A. M. Adamo. 1994. Thyroid hormones and the central nervous system.Dev Neurosci 16(1-2):1-8.

Passard A, Attal N, Benadhira R et al. 2007.  Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia.  Brain. 130(Pt 10):2661-2670.  “…unilateral rTMS of the motor cortex induces a long-lasting decrease in chronic widespread pain and may therefore constitute an effective alternative analgesic treatment for fibromyalgia.”

Passik SD, Kirsh KL, Whitcomb L et al. 2004.  A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy.  Clin Ther 26(4):552-561.  “In this study, the PADT appeared to be a useful tool for clinicians to guide the evaluation of several important outcomes during opioid therapy and provide a simple means of documenting patient care.”

Pastore EA, Katzman WB. 2012. Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain. J Obstet Gynecol Neonatal Nurs. 2012 Aug 3. [Epub ahead of print] "Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP."

Patel SB, Kumar SK. 2012. Myofascial pain secondary to medication-induced bruxism. J Am Dent Assoc. 143(10):e67-69.

Patkar AA, Masand PS, Krulewicz S et al. 2007.  A randomized, controlled trial of controlled release paroxetine in fibromyalgia.  Am J Med. 120(5):448-454.  “Paroxetine controlled release appears to be well-tolerated and improves the overall symptomatology in patients with fibromyalgia without current mood or anxiety disorders.  However, its effect on pain measures seems to be less robust.”

Patucchi, E, Fatati G, Puxeddu A. et al. 2003.  [Prevalence of fibromyalgia in diabetes mellitus and obesity.]  Recenti Prog Med 94(4):163-5.  [Italian] This study indicates that the association between obesity, diabetes mellitus and fibromyalgia is a significant one.  [Perhaps as common perpetuating factors for FMS? DJS]

Paul TM , Hoo JS, Chae J et al. 2012. Central Hypersensitivity in Patients with Subacromial Impingement Syndrome. Arch Phys Med Rehabil. [Jul 9 Epub ahead of print]. "This study provides further evidence that SIS (secondary hyperalgesia) patients have significantly lower PPTs (pain-pressure thresholds) than controls in both local and distal areas from their affected arm consistent with primary and secondary hyperalgesia, respectively. Data suggest the presence of central sensitization among subjects with chronic SIS."

Paulson, M., A. Norberg, E. Danielson. 2002. Men living with fibromyalgia-type pain: experiences as patients in the Swedish health care system. J Adv Nurs 40(1):87-95. Men with chronic diffuse pain waited a long time to be referred to a specialty clinic.  If the staff was interested and well-trained, the men experienced well-being in spite of the recognition that there was no cure. Lack of respect from the staff caused the patients to feel neglected, even if they had otherwise adequate care.

Pavlou M, Quinn C, Murray K et al. 2010. The effect of repeated visual motion stimuli on visual dependence and postural control in normal subjects. Gait Posture. [Dec 6 Epub ahead of print]. "Patients with vestibular dysfunction, migraine and/or anxiety may experience visual vertigo (VV), whereby symptoms are provoked by disorienting visual environments (e.g., supermarkets). Patients with VV over rely on vision for balance (i.e., visually dependent). Visual vertigo significantly improves when vestibular rehabilitation incorporates exposure to optokinetic stimulation (OKS). However, whether OKS exposure induces a reduction in visual dependency is unknown. This study investigated this issue by measuring visual dependency before and after repeated OKS exposure. Twenty-six healthy subjects (10 males; mean age 29.8 years, range 20-42 years) were randomly allocated into an OKS group who underwent graded OKS exposure for five consecutive days, or a no intervention control group. Assessment included the 'Rod and Frame' and 'Rod and Disc' tests where subjects set the subjective visual vertical in darkness, facing a tilted luminous frame or luminous rotating disc, respectively. Postural sway measures were obtained with eyes open, closed and facing the rotating disc. Results showed significant reductions in subjective vertical tilt with the frame and rotating disc for the OKS group only.... Total sway path and mean deviation induced by the rotating stimulus decreased significantly only for the OKS group (p<0.01), as did the Kinetic Quotient (disc rotation/eyes open sway path ratio; p=0.04). The Romberg Quotient (eyes closed/eyes open ratio) showed no change. Findings suggest visual dependency, both at a perceptual and a postural level, can be reduced with short-term graded OKS exposure in healthy subjects. This has important implications for treatment of patients with VV and balance disorders."

Paxton SE. 2011. Perioperative care of the patient with fibromyalgia. AORN J. 93(3):380-389.

Payne RJ, Kost KM, Frenkiel S, et al. 2006.  Otolaryngeal inflammation assessed using the reflux finding score in obstructive sleep apnea. 134(5):836-842.  Laryngeal inflammation is prevalent among OSA patients and correlates with laryngeal sensory dysfunction, attenuation of the LAR (laryngeal adductor reflex), and apnea severity.  [GERD may activate laryngeal TrPs. DJS]

Pedrelli A, Stecco C, Day JA. 2009. treating patellar tendinopathy with fascial manipulation. J Bodyw Mov Ther 13(1):73-80. Trigger points in quadriceps muscles can cause kneecap pain with motor incoordination. Fascial manipulation technique of the quadriceps may relieve kneecap pain and dysfunction, and thus the focus of therapy may need to be the anterior thigh.

Pedretti, Lorraine Williams, ed. April 1996. Occupational Therapy: Practice Skills for PhysicalDisfunction. Mosby-Year Book. Chap. 21. Pope-Davis, S. A.

Pelin Z, Karadeniz D, Ozturk L et al. 2003.  The role of mean inspiratory effort on daytime sleepiness.  Eur Respir J 21(4):688-694.  “The data from this study indicate the possible important role of average inspiratory effort in determining subjective sleepiness in both obstructive sleep apnoea syndrome and upper airway resistance syndrome patients.”

Pellegrino, M. J., G. W. Waylonis and A. Sommer. 1989. Familial occurrence of primaryfibromyalgia. Arch Phys Med Rehabil 70(1):61-63.

Pellegrino, M. J., D. Van Fossen, C. Gordon, J. M. Ryan and G.W. Waylonis. 1989.

Peng PW. 2012. Tai Chi and Chronic Pain. Reg Anesth Pain Med. [May 17 Epub ahead of print]. Most tai chi studies were found to be of low quality. "Only 5 pain conditions were reviewed: osteoarthritis, fibromyalgia, rheumatoid arthritis, low back pain, and headache. Of these, Tai Chi seems to be an effective intervention in osteoarthritis, low back pain, and fibromyalgia."

Peng PW, Castano ED. 2005.  Survey of chronic pain practice by anesthesiologists in Canada.  Can J Anaesth. 52(4):383-389.  “While 38% of responding anesthesiologists were involved in CPP (chronic pain practice), in the majority of cases, this accounted for less than 20% of their clinical time.  Thirty percent of those involved in CPP had previous training in pain management.  The types of CPP included nerve blocks (84%) and pharmacological treatment (60%) in non-cancer pain (85%) and cancer pain (50%) patients.”  “Approximately one-third of anesthesiologists surveyed incorporate chronic pain in their practice and their pattern of practice is widely diversified.”  Only 30% of these anesthesiologists had previous training in chronic pain management.  Trigger point injections were responsible for 70% of this work.  [One must wonder how many of the patients had proper placement and range of motion stretching for their injections, and how much was done to identify and control the perpetuating factors–both minimal and necessary parts of proper treatment of TrPs. DJS]

Peng ZF. 2008.  [Comparison between western trigger point of acupuncture and traditional acupoints]  Zhongguo Zhen Jiu. 28(5):349-352.  “Trigger point theory as the soul of western acupuncture is very similar to acupoint theory of traditional acupuncture and moxibustion science.  After comparison, it is found that over 92% of trigger points (235/255) is corresponding to acupoints in anatomy, and the local pain treated by 79.5% acupoints are similar to corresponding myofascial trigger point.  Both of them can induce similar linear propagation of needling response, with complete uniform or basically complete uniform of 76%, and a part uniform of 14%; next, both of them can treat symptoms of internal organs such as diarrhea, constipation, dysmenorrheal, etc.  Therefore, they are very similar in anatomic location, clinical indications, and the linear propagation of needling response induced by acupuncture, etc.

Pennacchio, E. A., J. Borg-Stein and D. A. Keith. 1998. The incidence of pain in the muscles of mastication in patients with fibromyalgia. J Mass Dent Soc 47(3):8-12.

Peres JF, Goncalves AL, Peres MF. 2009.  Psychological trauma in chronic pain: implications of PTSD for fibromyalgia and headache disorders.  Curr Pain Headache Rep. 13(5):350-357.  “The association of traumatic exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known.  Patients with chronic pain, particularly headache disorders and fibromyalgia (FM), associated with psychological traumas need a special management strategy.  Diagnosis of headache disorders and FM in traumatized patients and collecting the clinical history of a traumatic event or diagnosing PTSD in chronic pain patients is of great importance.  Psychotherapy and pharmacotherapeutic options should be started on patients with comorbid PTSD and headache disorders and/or FM.”  [This article would have been well-served if the authors had included myofascial TrPs as part of the picture, as they so obviously are.  Recent research abound in which headaches are part of myofascial pain rather than FM. DJS]

Peres M, Zukerman E, Senne Soares et al. 2004. Cerebrospinal fluid glutamate levels in chronic migraine.  Cephalalgia 24(9):735-739.  This study indicates that patients with both FMS and migraines may have a more severe central sensitization process than patients with FMS who do not have migraines.  The headache intensity of the chronic migraine patients correlated with cerebrospinal glutamate levels.

Perez-de-Heredia-Torres M, Martínez-Piedrola RM et al. 2013. Bilateral deficits in fine motor control ability and manual dexterity in women with fibromyalgia syndrome. Exp Brain Res. [Jan 26 Epub ahead of print]. "Our findings revealed bilateral deficits in fine motor control ability and manual dexterity in patients with FMS without symptoms in the upper extremity. These deficits are not related to the clinical features of the symptoms supporting an underlying central mechanism of altered motor control." [These patients should be assessed for the presence of latent TrPs, as they are known (or should be) to co-exist with FM, and can cause deficits in fine motor control and manual dexterity. DJS]

Perez-Palomares S, Olivan-Blazquez B, Magallon-Botaya R et al. 2010. Percutaneous electrical nerve stimulation versus dry needling: effectiveness in the treatment of chronic low back pain. J Musculoskel Pain. 18(1). “At least one TrP was found in all patients, most commonly situated in the quadratus lumborum muscle [97.6 percent]. The improvement achieved for both treatment groups was similar in all the measured variables, although the DN (dry needling) group carried out fewer sessions than the PENS (percutaneous electrical nerve stimulation) group.”  [The term “chronic low back pain” is a description, not a diagnosis, and our reimbursement system must be set up to reflect this.  Quadratus lumborum TrPs are potentially disabling and can cause tremendous amount of pain and dysfunction, and must be part of the assessment for causes of chronic low back pain.  DJS]

Perneger, T. V., P. K. Whelton and M. J. Klag. Risk of kidney failure associated with the use ofacetominophen, aspirin, and nonsteroidal anti-inflammatory drugs. N Engl J Med 331(25):1675-9.

Perrot S. 2012. If fibromyalgia did not exist, we should have invented it. A short history of a controversial syndrome. Reumatismo. 64(4):186-193. "Fibromyalgia is a recent disease, and some physicians remain doubtful about its reality. The history of fibromyalgia is a story of controversies: the fight between subjectivity and cartesianism, and between old mind and body concepts. Fibromyalgia represents the emblematic condition of unexplained medical symptoms, far from well-defined diseases with objective biomarkers. In this review we will follow the fibromyalgia story along the ages and sciences to better understand this complex pain disorder, between soma and psyche, and between medicine and psycho-sociology and to demonstrate that fibromyalgia exists; we have not invented it."

Perrot S, Choy E, Petersel D et al. 2012. Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia. BMC Health Serv Res. 12(1):356. "Fibromyalgia (FM) is a condition characterized by widespread pain and is estimated to affect 0.5-5% of the general population. Historically, it has been classified as a rheumatologic disorder, but patients consult physicians from a variety of specialties in seeking diagnosis and ultimately treatment. Patients report considerable delay in receiving a diagnosis after initial presentation, suggesting diagnosis and management of FM might be a challenge to physicians....A questionnaire survey of 1622 physicians in six European countries, Mexico and South Korea was conducted. Specialties surveyed included primary care physicians (PCPs; n=809) and equal numbers of rheumatologists, neurologists, psychiatrists and pain specialists. The sample included experienced doctors, with an expected clinical caseload for their specialty. Most (>80%) had seen a patient with FM in the last 2 years. Overall, 53% of physicians reported difficulty with diagnosing FM, 54% reported their training in FM was inadequate, and 32% considered themselves not knowledgeable about FM. Awareness of American College of Rheumatology classification criteria ranged from 32% for psychiatrists to 83% for rheumatologists. Sixty-four percent agreed patients found it difficult to communicate FM symptoms, and 79% said they needed to spend more time to identify FM. Thirty-eight percent were not confident in recognizing the symptoms of FM, and 48% were not confident in differentiating FM from conditions with similar symptoms. Thirty-seven percent were not confident developing an FM treatment plan, and 37% were not confident managing FM patients long-term. In general, rheumatologists reported least difficulties/greatest confidence, and PCPs and psychiatrists reported greatest difficulties/least confidence....Diagnosis and managing FM is challenging for physicians, especially PCPs and psychiatrists, but other specialties, including rheumatologists, also express difficulties. Improved training in FM and initiatives to improve patient-doctor communication are needed and may help the management of this condition. [This free article is available on the Internet, and confirms what many patients know all too well. DJS]

Perrot S, Schaefer C, Knight T et al. 2012. Societal and individual burden of illness among fibromyalgia patients in France: Association between disease severity and OMERACT core domains. BMC Musculoskel Disord. 13(1):22. "In a sample of 88 patients with FM from France, we found that FM poses a substantial economic and human burden on patients and society. FM severity level was significantly associated with patients' health status and core symptom domains."

Perry, F., P. H. Heller, J. Kamiya and J. D. Levine. 1989. Altered autonomic function in patients with arthritis or with chronic myofascial pain. Pain 39(1):77-84.

Persinger, M. A., S. G. Tiller and S. A. Koren. 1999. Background sound pressure fluctuations(5DB) from overhead ventilation systems increase subjective fatigue of university students during three-hour lectures. Percept Mot Skills 88(2):451-6.

Pert, C. B., H. E. Dreher and M. R. Ruff. 1998. The psychosomatic network: foundations of mind-body medicine. Altern Ther Health Med 4(4):30-41.

Peters A, Schweiger U, Fruhwald-Schultes B et al. 2002.  The neuroendocrine control of glucose allocation.  Exp Clin Endocrinol Diabetes 110(5):199-211.  “The concept of glucose allocation presented here challenges the common opinion of ‘blood glucose’ being the main parameter controlled.  The concept of glucose allocation would predict that weight gain — with abundance of glucose in muscle and fat — increases feedback to the brain (via hyperleptinemia) which in turn results in HPA-axis and SNS overdrive, impaired insulin secretion, and insulin resistance.  HPA-axis overdrive would account for metabolic abnormalities such as central adiposity, hyperglycemia, dyslipidemia, and hypertension that are well known clinical aspects of the metabolic syndrome.  This novel viewpoint of ‘brain glucose’ control may shed new light on the pathogenesis of the metabolic syndrome and type 2 diabetes.”

Petzke F, Harris RE, Williams DA et al. 2005.  Differences in unpleasantness induced by experimental pressure pain between patients with fibromyalgia and healthy controls.  Eur J Pain 9(3):325-335.  “Patients with FM unexpectedly display less relative unpleasantness than healthy controls in response to random noxious pressure stimuli.  These results are consistent with the concept that chronic pain may reduce the relative unpleasantness of evoked pain sensations.”  Sensitivity to pain and pain tolerance are different.  Patients may have hyperalgesia, a heightened sensitivity toward pain, but still have a greater tolerance to pain.  This difference has not been specified in most previous research.

Peyron, R., L. Garcia-Larrea, M. C. Gregoire, N. Costes, P. Convers, F. Lavenne, F. Mauguiere, D. Michel and B. Laurent. 1999. Haemodynamic brain responses to acute pain in humans:sensory and attentional networks. Brain 122(Pt 9):1765-1780. .

Pezet, S. B. Ont niente, G. Grannec and B. Calvino. 1999. Chronic pain is associated with increased TrkA immunoreactivity in spinoreticular neurons. J Neurosci 19(13):5482-92.

Pfau DB, Rolke R, Nickel R et al. 2009.  Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and fibromyalgia syndrome.  [Sep 18 Epub ahead of print]

Phillips, S.M. and B.B. Sherwin. 1992. Effects of estrogen on memory function in surgically menopausal women. Psychoneuroendocrinology 17(5):485-95.

Phillips, S. M. and B. B. Sherwin. 1992. Variations in memory function and sex steroid hormones across the menstrual cycle. Psychoneuroendocrinology 17(5):497-506.

Pierson MJ. 2011. Changes in temporomandibular joint dysfunction symptoms following massage therapy: a case report. Int J Ther Massage Bodywork. 4(4):37-47. "Ten 45-minute massage therapy treatments were administered over a five-week period. The client's progress was monitored by an initial, midway, and final assessment, using range of motion testing, personal interview, an orthopedic test, and postural analysis.....The client participated in a home care routine consisting of stretches, self-massage, postural training, a proprioception exercise, and hydrotherapy.....Results include an increase in maximal opening from 3.1 cm to 3.8 cm, an overall increase in neck range of motion, a decrease in muscle hypertonicity using the Wendy Nickel's Scale, a decrease in pain from 7/10 to 3/10 on a numerical pain scale, and a decline in stress. [TMJD is often due to TrPs, and this combination of therapies deserves further study. DJS]

Pimentel M, Park S, Mirocha J et al. 2006.  The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial.  Ann Intern Med. 145(8):557-563.  “Rifaximin [Xifaxan] improves IBS symptoms for up to 10 weeks after the discontinuation of therapy.”

Pincus T, Castrejón I, Bergman MJ et al. 2012. Treat-to-target: not as simple as it appears. Clin Exp Rheumatol. [Oct 16 Epub ahead of print]. "Treat-to-target as a strategy for rheumatoid arthritis (RA) is now widely advocated based on strong evidence. Nonetheless, implementation of treat-to-target raises caveats, as is the case with all clinical care strategies. The target of remission or even low disease activity does not apply to all individual patients, some of whom are affected by concomitant fibromyalgia, other comorbidities, joint damage, and/or who simply prefer to maintain current status and avoid risks of more aggressive therapies. No single universal 'target' measure or index exists for all individual RA patients. An emphasis in most studies on radiographic progression, rather than physical function or mortality, as the most important outcome to document the value of treat-to-target may be inappropriate. Many reports imply that the only limitation to treating all RA patients with biological agents involves costs, ignoring effective results in most patients with methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs) and adverse events associated with biological agents. Indeed, the best outcomes in reported RA clinical trials result from tight control with DMARDs, rather than from biological agents, as does better overall status of RA patients at this time compared to previous decades. Pharmacoeconomic reports may ignore that RA patients are older, less educated, and have more comorbidities than the general population, as well as critical differences in patient status according to the gross domestic product of different countries. While treating to a target of remission or low disease activity, including with biological agents, is appropriate for many patients, awareness of these concerns could improve implementation of treat-to-target for optimal care of all RA patients." [Many patients have RA, FM and CMP and other conditions as well. Improvement of one condition often improves quality of life, although it may not affect the radiological images. Clinicians must learn to treat the patients and not the diagnostic images. DJS]

Pinquart M, Shen Y. 2010. Depressive Symptoms in Children and Adolescents with Chronic Physical Illness: An Updated Meta-Analysis. J Pediatr Psychol. [Nov 18 Epub ahead of print]. "Pediatricians and others working with children with chronic illnesses should screen children with chronic physical illness for symptoms of psychological distress and make appropriate referrals for mental health services, when needed."[All co-existing conditions should be screened for, and psychologists must be aware that co-existing conditions such as vestibular dysfunction, fibromyalgia and myofascial pain may have some symptoms that may be mistaken for psychological. Lack of support for chronic invisible illnesses can often lead to psychological distress. DJS]

Pioro-Boisset, M., J. M. Esdaile and M. A. Fitzcharles. 1996. Alternative medicine use in fibromyalgia syndrome. Arth Care Res 9(1):13-17.

Piotrowski, C. 1997. Hypoglycemia as a mitigating factor in vehicular accidents. Perceptual Motor Skills 84(3 pt 2):1241-1242.

Pipereit K, Bock O, Vercher JL. 2006.  The contribution of proprioceptive feedback to sensorimotor adaptation.  Exp Brain Res. [Mar 10 Epub ahead of print]  “Intact proprioception is needed for mechanical but not for visual adaptation, which implies that the underlying mechanisms are at least partly distinct.”

Pittman, D. M. and M. J. Belgrade. 1997. Complex regional pain syndrome. Am Fam Physician56(9):2265-70, 2275-6.

Pizzigallo, E., D. Racciatti and J. Vecchiet.1999. Clinical and path of physiological aspects of chronic fatigue syndrome. J Musculoskel Pain 7(1-2):217-224.

Ploghaus, A., I. Tracey, J. S. Gati, S. Clare, R. S. Menon, P. M. Matthews and J. N. Rawlings.1999. Dissociating pain from its anticipation in the human brain. Science 284(5422):1979-81.

Plotnikoff GA. 2003.  Food as medicine – cost-effective health care?  The example of omega-3 fatty acids.  Minn Med 86(11):41-5.  This very interesting article notes that the US spends over half of the amount of money spent on pharmaceuticals in the world, yet our health care is not the best in many areas.  It proposes that it is in the best interest to look first at non-pharmaceutical methods to promote health, such as healthy food.

Plotnikoff GA, Quigley JM. 2003.  Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.  Mayo Clin Proc 78(12):1463-1470.  This study showed that vitamin D deficiency was present in 93% of consecutive patients with nonspecific muscle pain, no matter the season.

Plotsky, O. M. 1998. Stress system plasticity: neural adaptations to neonatal pain and stress. J Musculoskel Pain 6(3):57-60.

Plouffe, L. Jr., and J. A. Simon. 1998. Androgens effects on the central nervous system in the post menopausal woman. Semin Reprod Endocrinol 16(2):135-43.

Poelmans J, Feenstra L, Tack J. 2005.  The role of (duodeno)gastroesophagopharyngeal reflux in unexplained excessive throat phlegm.  Dig Dis Sci. 50(5):824-832.  “Unexplained excessive throat phlegm is a sign suggestive of GER and GEPR, and unexplained yellow throat phlegm a sign suggestive of duodenogastroesophagopharyngeal reflux (DGEPR).”

Pogatzki-Zahn EM, Englbrecht JS, Schug SA. 2009.  Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes.  Curr Opin Anaesthesiol. [Jul 13 Epub ahead of print].  Adequate pain management of acute pain is of vital necessity for patients with the central sensitization of FM.  [It is also of vital necessity for others to help prevent FM central sensitization. DJS]

Polat A, Ekinci O, Terzioglu B et al. 2011. Treatment of lateral epicondylitis using betahistine dihydrochloride. J Musculoskel Pain. 19(4):201-206. The description of lateral epicondylitis is often given to pain in the area caused by myofascial TrPs, and TrP twitch causes excess histamine at the motor endplate. Betahistadine is a histamine agonist. Interesting. DJS]

Polkinghorn, B. S. 1998. Treatment of cervical disc protrusions via instrumental chiropractic adjustment. J Manipulative Physiol Ther 21(2):114-121.

Pokorny, J. 1996. [Mechanisms of neuroplasticity]. Cesk Fysiol 45(1):21-28 [Czech].

Pongratz D, Spath M. 2001.  [What helps in back pain? Guideline for symptomatic therapy] MMW Fortschr Med. 143(18):26-29. [German]  “Both in acute and chronic, unspecific back pain, the myofascial pain syndrome resulting in muscular dysbalance is a major factor.  For the differential diagnosis, however, consideration must always be given to concomitant symptoms (neurological deficits, general symptoms, signs of osteopathy).  Pathophysiologically, the active trigger point corresponds to a contraction in the muscle fibers that forms in the region of the a neuromuscular endplate, and leads, via biochemical processes, to the stimulation of mesochymal nociceptors.  Symptomatic treatment of acute and chronic back pain may be broken down into a) physical measures, b) local therapeutic regimens, and c) systemic pharmacotherapy.  As medication, non-steroidal anti-inflammatory drugs, non-opioid analgesics, opioids analgesics, muscle relaxants, and antidepressives are available, and are dose-matched to the severity and stage of the condition.  The spectrum of therapeutic options is outlined.”

Pongratz DE, Spath M. 1998.  [Myofascial pain syndrome – frequent occurrence and often misdiagnosed]  Fortschr Med. 116(27):24-29.  “The difference between trigger points (MPS) and tender points (fibromyalgia) is of central importance – not merely in a linguistic sense.  Knowledge of the signs and symptoms typically associated with a trigger point often obviates the need for time-consuming and expensive technical diagnostic measures.  The assumption that many cases of unspecific complaints affecting the musculoskeletal system may be ascribed to MPS makes clear the scope for the saving of costs.”

Pongratz DE, Vorgerd M, Schoser BGH. 2004.  Scientific aspects and clinical signs of muscle pain.  J Musculoskeletal Pain 12(3/4):121-128.  This article highlights painful muscle disorders, including the myopathological aspects of inflammatory and metabolic conditions.  Exercise intolerance is a common symptom of many of them, due to their impact on muscle energy metabolism.  MPS due to TrPs is a more common cause of muscle pain, with morphological changes noted as contraction discs often located in the motor endplate area.  [Due to the localized energy depletion of these states, including TrPs, it is logical that the impact of TrPs would be especially devastating in a patient who had a co-existing condition that already depleted the energy state, such as the mitochondrial ATP affect of FMS.  DJS]

Pongratz, D. E, and M. Spath. 1997.  Morphologic aspects of muscle pain syndromes: a critical review. Myofascial pain–update in diagnosis and treatment.  Phys Med Rehab Clin North Am 8(1): 55-68.

Porter, F. L., R. E. Grunau and K. J. Anand. 1999.  Long-term effects of pain in infants.  J Dev Behav Pediatr 20(4):253-61.

Porter, F. L., C. M. Wolf and J. P. Miller. 1999. Procedural pain in newborn infants: the influence of intensity and development.  Pediatrics 104(1):e13.

Porter, R. J., B. S. Lunn, L. L. Walker, J. M. Gray, C. G. Ballard and J. T. O'Brien JT 2000.  Cognitive Deficit Induced by Acute Tryptophan Depletion in Patients With Alzheimer's Disease.  Am J Psychiatry. 157(4):638-640.

Post, L. F., J. Blustein, E. Gordon and N. N. Dubler. 1996. Pain: ethics, culture, and informed consent to relief. J Law Med & Ethics 24(4):348-59.

Potenzieri C, Undem BJ. 2011. Basic mechanisms of itch. Clin Exp Allergy. [Jun 6. doi: 10.1111/j.1365-2222.2011.03791.x. Epub ahead of print]. "Studies have demonstrated that both peripheral and central sensitization to pruritogenic stimuli occur during chronic itch."

Potts J, Payne RE. 2007.  Prostatitis: infection, neuromuscular disorder, or pain syndrome?  Proper patient classification is key.  Cleve Clin J Med. 74 Suppl 3:S63-71. “Prostatitis is a broad term used to describe inflammation of the prostate that may be associated with a myriad of lower urinary tract symptoms of sexual discomfort and dysfunction.”  “Prostatitis is classified into four categories, including acute and chronic bacterial forms, a chronic abacterial form, and an asymptomatic form.”  “Chronic abacterial prostatitis (also known as chronic pelvic pain syndrome) is both the most prevalent form and also the least understood and the most challenging to evaluate and treat.  This form of prostatitis may respond to non-prostate-centered treatment strategies such as physical therapy, myofascial trigger point release, and relaxation techniques. Because the various forms of prostatitis call for vastly different treatment approaches, appropriate evaluation, testing, and differential diagnosis are crucial to effective management.”

Potts JM. 2009.  Nonpharmacological approaches for the treatment of urological chronic pelvic pain syndromes in men.  Curr Urol Rep. 10(4):289-294.  “Chronic nonbacterial prostatitis, or urological chronic pelvic pain syndrome (UCPPS), remains a common and often challenging disorder to evaluate and treat.  Employing a more holistic approach, including urological therapy, physical therapy, and psychosocial perspectives, may be more appropriate for most patients.  Growing evidence supports the use of biofeedback, myofascial trigger point release, prescribed exercise regimens, relaxation techniques, and supportive counseling to treat men with UCPPS.”  [What is causing the pain?  As the work by Dr. Ragi Doggweiler-Wiygul explains, “nonbacterial Prostatitis” may often be a way the non-myofascial trained practitioner describes pain caused by some myofascial TrPs.  DJS]

Potvin S, Larouche A, Normand E et al. 2009.  DRD3 Ser9Gly polymorphism is related to thermal pain perception and modulation in chronic widespread pain patients and healthy controls.  J Pain. [May 21 Epub ahead of print].  “This experimental study is the first to relate DNIC (diffuse noxious inhibitory controls) and TPTs (thermal pain thresholds) to a functional polymorphism of limbic dopamine-D3 receptors.  As lowered pain thresholds and deficient pain inhibition are two core features of fibromyalgia, these preliminary results may help identify a subgroup of FM patients who require closer medical attention.”

Poulletier de Gannes F., Lagroye I., Haro E et al. 2002. Effects of radio frequencies emitted by mobile phone on CNS cell cultures.  Glia (Suppl 1):S51-52 [Abstract]. Mobile phones at 900 MHz could induce CNS response on the cellular level.

Prasanna, A. 1993. Myofascial pain as postoperative complication. J Pain Sympt Manage8(7):450-451.

Prateepavanich, P., V. Kupniratsaikul and T. Charoensak. 1999. The relationship between myofascial trigger points of gastrocnemius muscle and nocturnal calf cramps. J Med Assoc Thai82(5):451-9.

Prato, F. S., J. J. Carson, K. P. Ossenkopp, and M. Kavaliers. 1995. Possible mechanisms by which extremely low frequency magnetic fields affect opioid function. FASEB J 9(9):807-14.

Press, J., M. Phillip, L. Neumann, R. Barak, Y. Segev, M. Abu-Shakra and D. Buskila. Normal melatonin levels in patients with fibromyalgia syndrome. J Rheumatol 25(3):551-555.

Preuss HG, Bagchi D, Bagchi M. 2002.  Protective effects of a novel niacin-bound chromium complex and a grape seed proanthocyanidin extract on advancing age and various aspects of syndrome X.  Ann N Y Acad Sci. 957:250-259.  Chronium or grape seed supplementation may be helpful to control insulin resistance and age-related conditions.

Prevalence of mitral valve prolapse in primary fibromyalgia: a pilot investigation.  Arch Phys Med Rehabil 70(7):541-543.

Price DD, Zhou Q, Moshiree B et al. 2006.  Peripheral and central contributions to hyperalgesia in irritable bowel syndrome.  J Pain 7(8):529-535.  “Pain in irritable bowel syndrome is likely to be at least partly maintained by peripheral impulse input from the colon/rectum and central sensitization.”  Central sensitization contributes to IBS and is at least partly maintained by peripheral pain stimuli and is in this way similar to FMS.

Price, D. D., G. N. Verne. 2002. Brain mechanisms of persistent pain states. J Musculoskel Pain 10(1/2):73-83. Central sensitization involves increased activity in the same areas and along the same paths as acute pain, but there are additional areas involved, and some of these may be part of psychological factors that occur in chronic pain.

Prince PB, Rapaport AM, Sheftell FD et al. 2004.  The effect of weather on headache.  Headache 44(6):596-602.  This study supports the influence of weather changes on headache.

Prist V, De Wilde VA, Masquelier E. 2012. Ann Phys Rehabil Med 55(3):174-189. This case report presents a 49-year old woman suffering from widespread pain since 2002. Her gait pattern included hip adduction, flexed hips and knees and bilateral equines hip deformity. She was diagnosed by several clinicians, but each had a different idea of what she had: fibromyalgia with dystonia, CNS injury, Little's disease, intramedullary spinal cord tumor, or multiple sclerosis. The authors conclude that the logical diagnosis is fibromyalgia with dystonia; the dystonia being due to generalized analgesic protective attitude. [The patient was not assessed for myofascial trigger points. If she had been, by someone well-trained in myofascial medicine, the diagnosis might have been different. Other diagnoses may be involved, and central sensitization is certainly part of this patient's cause of misery, but as to what the cause behind the descriptions are, the TrP assessment and postural analysis must be done to complete the picture. DJS].

Procacci, P., M. Maresca and P. Gepetti. 1999. Neurogenic inflammation and muscle pain. J Musculoskel Pain 7(1-2):5-12.

Proctor SL, Estroff TW, Empting LD et al. 2012. Prevalence of Substance Use and Psychiatric Disorders in a Highly Select Chronic Pain Population. J Addict Med. [Nov 5 Epub ahead of print]. "Certain populations of patients with complex nociceptive, neuropathic, and myofascial pain syndromes may have a lower prevalence of substance use disorders than the general population. They also have concurrent psychiatric disorders, which should be evaluated and treated concomitantly as part of their chronic pain treatment. Despite the low prevalence of substance use disorders, these patients must be continuously monitored for abuse, misuse, and diversion of their medication. The low prevalence may be attributable to the severity of their illness, the patients' inability to achieve pain relief and obtain pain medications easily, and their persistence in pursuing accurate diagnoses and treatment. A major limitation of this study was that it relied on self-report and there were no urine drug screens to report."

Proske U, Gandevia SC. 2012. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev. 92(4):1651-1697. Proprioceptive senses "...include the senses of position and movement of our limbs and trunk, the sense of effort, the sense of force, and the sense of heaviness. Receptors involved in proprioception are located in skin, muscles, and joints. Information about limb position and movement is not generated by individual receptors, but by populations of afferents. Afferent signals generated during a movement are processed to code for endpoint position of a limb. The afferent input is referred to a central body map to determine the location of the limbs in space. Experimental phantom limbs, produced by blocking peripheral nerves, have shown that motor areas in the brain are able to generate conscious sensations of limb displacement and movement in the absence of any sensory input. In the normal limb tendon organs and possibly also muscle spindles contribute to the senses of force and heaviness. Exercise can disturb proprioception, and this has implications for musculoskeletal injuries. Proprioceptive senses, particularly of limb position and movement, deteriorate with age and are associated with an increased risk of falls in the elderly. [Trigger points can cause proprioceptive dysfunction, so this information is very important. DJS]

Proudfoot CJ, Garry EM, Cottrell DF et al. 2006. Analgesia mediated by the TRPM8 cold receptor in chronic neuropathic pain.  Curr Biol. 16(16):1591-1605.  A synthetic with the same properties as mint oil may be an effective analgesic for some chronic pain when applied topically.

Przeklasa-Muszynska A, Nosek-Kozdra K, Muszynski T et al. 2006.  [Preemptive analgesia in postoperative pain for children in otolaryngological department]  Przegl Lek. 63(11):1168-1172. [Polish]  “Although much more about the safe and effective management of pain in children is now known, this knowledge has not been widely or effectively translated into routine clinical practice.” [This is very disturbing as inadequate acute pain management can predispose to chronic pain. DJS]

Pujol J, Lopez-Sola M, Ortiz H et al. 2009.  Mapping brain response to pain in fibromyalgia patients using temporal analysis of FMRI.  PloS ONE. 4(4):e5224. “The results suggest that data-driven fMRI assessments may complement conventional neuroimaging for characterizing pain responses and that enhancement of brain activation in fibromyalgia patients may be particularly relevant in emotion-related regions.”

Punjabi NM, Shahar E, Redline S et al. 2004.  Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study.  Am J Epidemiol. 160(6):521-530.  “Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass and waist circumference.  The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and lead to type 2 diabetes mellitus.”

Puretic MB, Demarin V. 2012. Neuroplasticity mechanisms in the pathophysiology of chronic pain. Clin Croat. 51(3):425-429. "Chronic pain is a widespread healthcare problem with great impact on mental health, professional and family life of the patient. It can be a consequence of many disorders; however, its pathogenesis has not yet been fully understood. Neuroplasticity is the ability of the nervous system to adapt to different changes and it is present throughout life, not only in prenatal period, infancy and childhood. However, in the pathophysiology of chronic pain, neuroplasticity shows its 'dark side'. Due to the central sensitization process, noxious stimuli can produce chronic pain or misinterpretation of non-noxious stimuli (secondary hyperalgesia and allodynia). These changes occur at the level of brain cortex as well at peripheral nerves and receptors. This review summarizes a significant portion of literature dealing with neuroplasticity processes in well known chronic pain conditions such as migraine, chronic posttraumatic headache, low back pain, fibromyalgia, and others." [This review from Croatia is well-thought-out and well-done. It is to be hoped that in the future, these researchers will include papers dealing with central sensitization generating TrPs in their research. DJS]

Putignano, P., G. A. Kaltsas, M. A. Satta and A. B. Grossman. 1998. The effects of anti-convulsant drugs on adrenal function. Horm Metab Res 30(6-7):389-97.

Przekop P, Haviland MG, Morton KR et al. 2010. Correlates of Perceived Pain-Related Restrictions among Women with Fibromyalgia. Pain Med. 11(11):1698-1706. "Women with fibromyalgia reporting the more severe pain-related restrictions were those who had experienced trauma accompanied by physical pain, were older, less educated, more depressed, more hostile, had high BMI (body mass index) scores, and had been treated for fibromyalgia in the last 12 months. Predictors in women with osteoarthritis were age, BMI, treatment in the last 12 months, experience of a major life stressor, and greater depression symptom severity. ....In both groups, age, BMI, treatment in the last 12 months, and depression predicted pain-related restrictions. Experience of a traumatic event with physical pain was the strongest predictor in the fibromyalgia group. These findings may be useful in constructing novel treatments and prevention strategies for pain-related morbidity in fibromyalgia patients." [One can always tell when the researchers are psychologist and/or psychiatrists. The BMI is usually an indication of co-existing insulin resistance, and one can only suspect that the hostility and depression have a lot to do with the failure of the doctors to address the myofascial trigger points causing the symptoms and maintaining central sensitization. DJS]

Przekop P, Haviland MG, Zhao Y et al. 2012. Self-reported physical health, mental health, and comorbid diseases among women with irritable bowel syndrome, fibromyalgia, or both compared with healthy control respondents. J Am Osteopath Assoc. 112(11):726-735. "Physicians often encounter patients with functional pain disorders such as irritable bowel syndrome (IBS), fibromyalgia (FM), and their co-occurrence.... Respondents with IBS reported fewer traumatic and major life stressors and better health (ratings and comorbidity data) than respondents with FM or respondents with IBS plus FM. Overall, respondents with both diseases reported the worst stressors and physical-mental health profiles and reported more diagnosed medical, pain, and psychiatric comorbidities....The results revealed statistically significant, relatively large differences in perceptions of quality of life measures and health profiles among the respondents in the control group and the 3 clinical groups."

Quintner J, Buchanan D, Cohen M et al. 2003.  Signification and pain: a semiotic reading of fibromyalgia.  Theor Med Bioeth 24(4):345-354.  These authors contend that fibromyalgia does not exist.  I wonder if they have read any of the articles in this reference section.  While some researchers are zeroing in on causes and treatments options for patients with fibromyalgia, there are still a few who spend their time creating fodder for lawyers bent on denying benefits and care to patients with this condition.  They are part of the problem instead of part of the solution and seem determined to ignore the ever-mounting evidence that fibromyalgia is real and very treatable, and thus deny early interventions that may in many cases help prevent full-blown fibromyalgia from developing.

Rachlin, E. S. ed. 1994. Myofascial Pain and Fibromyalgia Trigger Point Management Mosby: St. Louis. Radanov, B. P., I. Bicik, J. Dvorak, J Antinnes, G. K. von Schulthess and A. Buck. 1999.Relation between neuropsychological and neuroimaging findings in patients with late whiplash syndrome. J Neurol Neurosurg Psychiatry 66(4):485-9.

Radanov BP, Sturzenegger M, Di Stefano G. 1995.  Long-term outcome after whiplash injury.  A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings.  Medicine 74(5):281-297.  “Symptomatic patients were older, had higher incidence of rotated or inclined head position at the time of impact, had higher prevalence of pretraumatic headache, showed higher intensity of initial neck pain and headache, complained of a greater number of symptoms, had a higher incidence of symptoms of radicular deficit and higher average scores on a multiple symptom analysis, and displayed more degenerative signs on X-ray.  Symptomatic patients scored higher with regard to impaired well-being and performed worse on tasks of attentional functioning and showed more concern with regard to long-term suffering and disability.”

Radanov, B. P., S. Begre, M. Sturzeneggar and K. F. Augustiny. 1996. Course of psychological variables in whiplash injury--a 2-year follow-up with age, gender and education pair-matched patients. Pain 64(3):429-434.

Radhakrishnan R, Sluka KA. 2009.  Increased glutamate and decreased glycine release in the rostral ventromedial medulla during induction of a pre-clinical model of chronic widespread muscle pain.  Neurosci Lett. 457(3):141-145.  “We hypothesize that increased release of excitatory neurotransmitters in the RVM (rostroventromedial medulla) drives the release of excitatory neurotransmitters in the spinal cord, central sensitization and the consequent hyperalgesia.”

Rafols, A., J. A. Garcia Vicente, M. Farre and M. Mas. 1999. [Dextromethorphan-induced sexual dysfunction]. Aten Primaria 24(8):495-7 [Spanish].

Ragab A, Clement P, Vincken W. 2004.  Objective assessment of lower airway involvement in chronic rhinosinusitis.  Am J Rhinol. 18(1):15-21.  Sixty percent of chronic rhinosinusitis patients have lower airway involvement, 24 % had asthma and 36% had small airway disease.  These may often be unsuspected.

Raghavendra V, Tanga FY, DeLeo JA. 2004.  Complete Freunds adjuvant-induced peripheral inflammation evokes glial activation and proinflammatory cytokine expression in the CNS.  Eur J Neurosci 20(2):467-473.  Proinflammatory cytokines can result from hyperactivation of glial cells, producing central sensitization.

Raghavendra V, Tanga FY, DeLeo JA. 2004.  Attenuation of morphine tolerance, withdrawal-induced hyperalgesia, and associated spinal inflammatory immune responses by propentofylline in rats.  Neuropsychopharmacology 29(2):327-334.  This study indicates that propentopylline, a glial cell modulator and anti-inflammatory agent, can restore the analgesic efficacy of morpihine.  “These results further support the hypothesis that spinal glia and proinflammatory cytokines contribute to the mechanisms of morphine tolerance and associated abnormal pain sensitivity.”

Raikkonen K., Matthews K.A., Kuller L.H. 2002.  The relationship between psychological risk attributes and the metabolic syndrome in healthy women: Antecedent or consequence?  Metabolism 51(12):1573-1577.  “The metabolic syndrome is an important risk factor for major chronic diseases in women....Psychological risk factors affect the development of the metabolic syndrome.  The association between anger and the metabolic syndrome is reciprocal.  Reduction in the level of psychological distress may prevent the development of the metabolic syndrome in women.”

Rainey CE. 2013. The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report. Int J Sports Phys Ther 8(2):145-161. The subject of this case report is a 30 year old female on active military duty, who developed low back and right posteriolateral hip pain after a lumbar flexion injury from picking up a barbell. Exam revealed a multi-segmental flexion movement pattern dysfunction, with TrPs in the right gluteus maximus and medius. Dry needling of the trigger points and intramuscular stimulation coupled with a home program of core stability exercises helped the patient return to full military duty without pain.

Rainsford KD. 2006.  Influenza (“Bird Flu”), inflammation and anti-inflammatory/analgesic drugs.  Inflammopharmacology 14(1-2):2-9.  This study is related to fibromyalgia in that avian flu may cause a pro-inflammatory cytokine storm to kill its victims, and FMS patients may already be in a cytokine storm, or at least at a high level of pro-inflammatory cytokine activity.  A number of potential medications are listed, among which are pentoxifylline, macrolide antibiotics, reservatrol, flavenoids and EPA.  [Reduced anti-inflammatory cytokines may also be part of the problem.  (See Uceyler N et al 2006 et al.)  Statins are also mentioned, but there is concern due to their potential adverse affects on co-existing myofascial TrPs.]

Rainville P, Bushnell MC, Duncan GH. 2001.  Representation of acute and persistent pain in the human CNS: potential implications for chemical intolerance.  Ann N Y Acad Sci. 933:130-141.  CNS neuroplasticity involved in chronic pain may share similarities with environmental chemical sensitivity.

Raison CL, Capuron L, Miller AH. 2005.  Cytokines sing the blues: inflammation and the pathogenesis of depression.  Trends Immunol. [Nov 26 Epub ahead of print]  “Depression might be a behavioral byproduct of early adaptive advantages conferred by genes that promote inflammation.  These findings suggest that targeting proinflammatory cytokines and their signaling pathways might represent a novel strategy to treat depression.”  [This may be a helpful treatment strategy for patients with both depression and FMS. DJS]

Rakovski C, Zettel-Watson L, Rutledge D. 2012. Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia. Disabil Rehabil. [Feb 12 Epub ahead of print]. "Work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation." [To do these modifications adequately, one must take into consideration the peripheral pain generators that are causing and/or maintaining the central sensitization of FM. Controlling the perpetuating factors of the peripheral pain generators can substantially help in the management of FM. DJS]

Raloff, J. 2000. More Waters Test Positive for Drugs. Sci News157(14):212.

Ramanathan S, Panksepp J, Johnson B. 2012. Is Fibromyalgia An Endocrine/Endorphin Deficit Disorder? Is Low Dose Naltrexone a New Treatment Option? Psychosomatics. [Apr 3 Epub ahead of print].

Raouf R, Quick K, Wood JN. 2010. Pain as a channelopathy. J Clin Invest. 120(11):3745-3752. "Mendelian heritable pain disorders have provided insights into human pain mechanisms and suggested new analgesic drug targets. Interestingly, many of the heritable monogenic pain disorders have been mapped to mutations in genes encoding ion channels. Studies in transgenic mice have also implicated many ion channels in damage sensing and pain modulation. It seems likely that aberrant peripheral or central ion channel activity underlies or initiates many pathological pain conditions. Understanding the mechanistic basis of ion channel malfunction in terms of trafficking, localization, biophysics, and consequences for neurotransmission is a potential route to new pain therapies." [This is interesting in that the most likely current hypothesis for the cause of myofascial TrPs is a calcium channelopathy. DJS]

Raphael, J., J. Southall, G. Treharne et al. 2002. Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome. BMC Musculoskel Disord 3(1):21. IV lidocaine may be a safe and beneficial therapy for fibromyalgia.

Raphael K.G., Natelson B.H., Janal M.N. et al. 2002.  A community-based survey of fibromyalgia-like pain complaints following the World Trade Center terrorist attacks.  Pain 100(1-2):131-9.  “The failure to detect a significant increase in symptoms consistent with a diagnosis of fibromyalgia and the failure of new onsets of such symptoms to be accounted for by exposure to major stressors or prior depressive symptoms suggests that these hypothesized risk factors are unlikely to be of major importance in the pathogenesis of fibromyalgia.”

Rashiq, S. and B. S. Galer. 1999. Proximal myofascial dysfunction in complex regional pain syndrome: a retrospective prevalence study. Clin J Pain 15(2):151-3.

Rask-Anderson, H., A. Kinnefors and R. B. Illing. 1999. On a novel type of neuron with proposed mechanoreceptor function in the human round window membrane–animmunohistochemical study. Rev Laryngol Otol Rhinol (Bord) 120(3):203-7.

Rasmussen, D. D., B. M. Boldt, C. W. Wilkinson, S. M. Yellon and A. M. Matsumoto. 1999.Daily melatonin administration at middle age suppresses male rat visceral fat, plasma leptin, and plasma insulin to youthful levels. Endocrinology 140(2):1009-12.

Rauck R, Busch M, Marriot T. 2012. Effectiveness of a heated lidocaine/tetracaine topcial patch for pain associated with myofascial trigger points: results of an open-label pilot study. Pain Pract. [Dec 10 Epub ahead of print]. "The heated lidocaine/tetracaine patch has potential utility as a noninvasive pharmacological approach for managing MTP pain. Further studies are warranted." [This may be a helpful treatment for one or two trigger points, although perpetuating factors must still be brought under control. DJS]

Ravera S, Bianco B, Cugnoli C et al. 2009.  Sinusoidal ELF magnetic fields affect acetyl cholinesterase activity in cerebellum synaptosomal membranes.  Bioelectromagnetics. [Dec 29 Epub ahead of print].  [This article is of interest in that Simons’ Integrated Hypothesis of myofascial TrP formation includes the excess amount of acetylcholine produced at the motor endplate.  Anything, even these magnetic fields that affect the metabolism of acetylcholine, might then impact TrPs and their ability to heal. DJS]

Rayegani S, Bahrami M, Samadi B et al. 2011. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. Eur J Phys Rehabil Med. 47(3):381-389. "Myofascial pain syndrome (MPS) is one of the most prevalent musculoskeletal diseases. MPS impaired quality of life in the patients. There is a lot of controversy about different treatment options which include medical treatments, physical therapy, injections, ultrasound and laser.... This study introduces laser as one of the preferred treatments of myofascial pain syndrome in shoulder." [It is a sad commentary on the state of medical care that most care providers are unaware that this common cause of musculoskeletal pain even exists. DJS]

Rea, T., J. Russo, W. Katon, R. L. Ashley and D. Buchwald. 1999. A prospective study of tender points and fibromyalgia during and after an acute viral infection. Arch Intern Med159(8):865-707.

Ready LB, Kozody R, Barsa JE et al. 1983.  Trigger point injections vs. jet injection in the treatment of myofascial pain.  Pain. 15(2):201-206.  “Trigger point injections using dilute solutions of local anesthetic agents have proved effective for many patients with myofascial pain.  The treatment itself, however, can produce severe pain and may occasionally be associated with complications.  It was determined in this study that a local anesthetic solution administered by jet injection in the area of myofascial trigger points was capable of providing short-term pain relief equal to conventional trigger point injections using a hypodermic needle and syringe.  The jet injector system produced significantly less pain during treatment than conventional trigger point injections and therefore was preferred by most subjects having the opportunity to compare both forms of treatment.”

Reddy J.M., Joyce C., Zaneveld L.J. 1980.  Role of hyaluronidase in fertilization: The antifertility activity of Myocristin, a nontoxic hyaluronidase inhibitor. J Androl 1(1):28-32.  Excess hyaluronic acid may be a factor in infertility.

Redondo JR, Justo CM, Moraleda FV et al. 2004.  Long-term efficacy of therapy in patients with fibromyalgia: A physical exercise-based program and a cognitive-behavioral approach. Arthritis Rheum 51(2):184-192.  This study showed that “improvement in self-efficacy and physical fitness are not associated with improvement in clinical manifestations.”

Redwine L, Hauger RL, Gilin JC et al. 2000.  Effects of sleep and sleep deprivation on interleukin-6, growth hormone, cortisol, and melatonin levels in humans.  J Clin Endocrinol Metab 85(10:3597-3603.  There is an association between sleep stages and IL-6 levels.  Populations with increased REM and relative loss of deep sleep [some FMS patients may fall in this category.  DJS] have elevated nighttime concentrations of IL-6.  This may signify increased inflammatory disease risk.  [It also may be a cause for chronic pain – see Focus on Pain 2003.  DJS]

Reece PH, Wyatt M, O’Flynn P. 1999.  Dercum’s disease (adiposis dolorosa).  J Laryngol Otol. 113(2):174-176.  Dercum’s disease, also called lipomtosis dolorosa and a variety of other names, is characterized by progressively painful fatty deposits.  There is at least 3 months pain in fatty deposits, and may be excessive fatigue, obesity, and mental disturbances including confusional states.  It is rare, but may be misdiagnosed as FM, or it may co-exist with FM and some of the confusional states and other symptoms may be due to co-existing conditions.  DJS]

Reed BD, Harlow SD, Sen A et al. 2012. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet Gynecol. 120(1):145-151. "To estimate the relationship among the presence of vulvodynia, fibromyalgia, interstitial cystitis, and irritable bowel syndrome. Validated questionnaire-based screening tests for the four pain conditions were completed by women with and without vulvodynia who were participating in the Michigan Woman to Woman Health Study, a longitudinal population-based survey in southeastern Michigan. Weighted population-based estimates of the prevalence and characteristics of participants with these chronic comorbid pain conditions were calculated using regression analyses....Chronic pain conditions are common, and a subgroup of women with vulvodynia is more likely than those without vulvodynia to have one or more of the three other chronic pain conditions evaluated. [It is most unfortunate that myofascial trigger points, one of the main co-existing conditions of vulvodynia as well as one of the main causes, was not included in this study. DJS]

Reeh ES, elDeeb ME. 1991.  Referred pain of muscular origin resembling endodontic involvement.  Case report. Oral Surg Oral Med Oral Pathol. 71(2):223-227.  “Referred pain is common in the orofacial region and can cause considerable difficulties in diagnosis.  Referred pain is defined as pain that is referred to a part of the body other than the site of origin, and as a result, severe pain may arise without an associated causative lesion.  A muscular trigger point that resembled a tooth with endodontic involvement is discussed.” 

Refshauge, K.M., Kilbreath, S.L., Raymond, J. 2003.  Deficits in detection of inversion and eversion movements among subjects with recurrent ankle sprains.  J Orthop Sports Phys Ther 33(4):166-173; discussion 173-6.  “Perception of passive inversion and eversion movements imposed at the ankle was impaired in subjects with recurrent ankle sprains.”  [This may have implications for spread of TrPs, involving, among other things, TrP proprioception dysfunction. DJS]

Regland, B., M. Andersson, L. Abrahamsson, J. Bagby, L. E. Dyrehag and C. G. Gottfries. 1997.Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scand J Rheumatol 26(4):301-307.

Reich JW, Olmsted ME, van Puymbroeck CM. 2006.  Illness uncertainty, partner caregiver burden and support, and relationship satisfaction in fibromyalgia and osteoarthritis patients.  Arthritis Rheum. 55(1):86-93.  “Partner caregiver burden was related to lower levels of partner supportiveness for the FMS dyads, but not for the OA dyads.”  “The results suggest that uncertainty of illness is a prominent feature affecting patients with FMS in their relationships with their partners.”

Reichling DB, Levine JD. 2009.  Critical role of nociceptors plasticity in chronic pain.  Trends Neurosci. [Sep 23 Epub ahead of print]  “The transition from acute to chronic pain states might be the most important challenge in research to improve clinical treatment of debilitating pain.  We describe a recently identified mechanism of neuronal plasticity in primary afferent nociceptive nerve fibers (nociceptors) by which an acute inflammatory insult or environmental stressor can trigger long-lasting hypersensitivity of nociceptors to inflammatory cytokines.  This phenomenon, ‘hyperalgesic priming’, depends on the epsilon isoform of protein kinase C (PKCvarepsilon) and a switch in intracellular signaling pathways that mediate cytokine-induced nociceptor hyperexcitability.  We discuss the impact of this discovery on our understanding of, and ultimately our ability to treat, a variety of enigmatic and debilitating pain conditions, including those associated with repetitive injury and generalized pain conditions, such as fibromyalgia.”

Reichmann H, Schaefer J. 2004.  Painful myopathies – metabolism of muscle cells and metabolic myopathies.  J Musculoskeletal Pain 12(3/4):75-83.   Types of myalgia considered in this article include causes of focal muscle pain such as restless leg syndrome and neurogenic pain, causes of diffuse muscle pain such as FMS, paroxysmal muscle pain such as contractures (which may be caused by TrPs) and exercise-induced muscle pain.  This excellent article on myopathies makes several points which are relevant to FMS or TrPs.  There is a clear and detailed explanation of energy metabolism in muscle mitochondria.  There is a clear explanation of muscle pain pathogenesis in myopathies.  Tissue pH importance, now found to be lowered at the TrP local twitch response (Shah et al 2005) is highlighted.   Muscle soreness caused by mechanical microrupture of the sarcomeric structures described in the article may happen in over-vigorous physical therapy, especially in patients with the combination of FMS and TrPs.  The article describes the hypersensitivity of FMS patients to normal mechanical stimuli.  A central nervous system disease may cause secondary myalgia due to spasticity or rigidity.  [Patients with chronic myofascial pain complex may have muscle tightness to the point of pain.]  Contractures are described briefly as never occurring at rest, but only after repetitive muscle contractions.  [Patients with chronic myofascial pain complex can have muscles in permanent contracture.  The muscles do not seem to be able to relax.  DJS] Disturbances in muscle metabolism can cause contractures, and among these are channelopathies.  [It has been proposed that myofascial TrPs are a type of channelopathy.  DJS] “All patients with a defect in glucose metabolism should have a protein-rich diet.”  Patients must learn to avoid overuse of their muscles, and “avoid endurance exercise with abnormalities of aerobic metabolism and to avoid brief intensive exercise with disturbances of anaerobic metabolism.”

Reid, G. J., B. A. Lang and P. J. McGrath. 1997. Primary juvenile fibromyalgia: psychological adjustment, family functioning, coping and functional disability. Arth Rheum 40(4):752-760.

Reid, W. D. and G. Dechman. 1995.  Considerations when testing and training the respiratory muscles.  Phys Ther 75(11):971-82.

Reidenberg, M. M. and R. K. Portenoy. 1994. The need for an open mind about the treatment of nonmalignant pain. Clin Pharmacol Ther 55(4):367-369.

Reiffenberger, D. H. and L. H. Amundson. 1996. Fibromyalgia syndrome: a review. Am Fam Physician 53(5):1698-712.

Reilich P, Fheodoroff K, Kern U et al. 2004.  Consensus statement: botulinum toxin in myofascial pain.  J Neurol 251(Suppl 1):1/36-1/38.  Botulinum toxin is suitable for patients with myofascial TrPs who have poor clinical outcomes after at least a month of physical therapy, including dry needling and medications.  Two techniques are explained.  It must be used with caution, and only as part of multimodal therapy.

Reilly, P. A. 1999. The differential diagnosis of generalized pain. Baillieres Best Pract ResClin Rheumatol 13(3):391-401.

Reimann F, Cox JJ, Belfer I et al. 2010 March 8 Proc Natl Acad Sci USA [Epub ahead of print.]  The gene SCN9A has been shown to be responsible for several pain disorders in human beings.  This study shows that a nucleotide polymorphism in this gene is also part of central sensitization through C-fiber activation.

Reisenauer SJ. 2012. A needle in the neck: trigger point injections as headache management in the emergency department. Adv Emerg Nurs J. 34(4):350-356. "A review of recent research suggests that the use of trigger point injections is successful in relieving the acute pain of musculoskeletal headaches. Patients with the chief complaint of headache commonly present to the emergency department (ED) and are often treated with multiple intravenous medications including narcotics....This article will address the problems of intravenous medication therapy and discuss the benefits of trigger point therapy as management for musculoskeletal headaches specifically in the ED. In addition, discussion aims to provide tools for the nurse practitioner to integrate this skill into clinical practice."

Reisine S, Fifield J, Walsh S et al. 2004.  Employment and quality of life outcomes among women with fibromyalgia compared to healthy controls.  Women Health 39(4):1-19.  “Employed women report better quality of life than those not employed, but only for the physical dimension of quality of life.  The findings regarding MCS [Mental Component Summary Scores] are intriguing in that women with FMS are not very different from controls and that employment has little effect on the mental health component of quality of life.”

Reitinger, A., H. Radner, H. Tilscher, M. Hanna, A. Windischand W. Feigl. 1996. [Morphologic study of trigger points.] Manuelle Medizin 34:256-262. [German]

Remesar, X., I Rafecas, J. A. Fernandez-Lopez and M. Alemany. 1997. Is leptin an insulin counter-regulatory hormone? FEBS Lett 402(1):9-11.

Renan-Ordine R, Alburquerque-Sendi N F, Rodrigues de Souza DP et al. 2011. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 41(2):43-50. A self-stretching program coupled with bodywork on TrPs was far superior to self-stretching alone in the relief of plantar heel pain.

Reusch, J. 2002. Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome. Am J Cardiol 90(Suppl 1):19. Insulin resistance plays a critical role in the development of cardiovascular disease. Nitric oxide-mediated vasodilation is impaired in insulin resistance. Insulin resistance may be moderated by the use of insulin sensitizing medications.

Reyes Del Paso GA, Garrido S, Pulgar A et al. 2011. Autonomic cardiovascular control and responses to experimental pain stimulation in fibromyalgia syndrome. J Psychosom Res. 70(2):125-134. "The data suggest impaired autonomic cardiovascular regulation in FMS in terms of reduced sympathetic and parasympathetic influences, as well as blunted sympathetic reactivity to acute stress. The association between baroreflex function and pain experience reflects the pain inhibition mediated by the baroreceptor system. Given the reduced baroreflex sensitivity in FMS, one may assume deficient ascending pain inhibition arising from the cardiovascular system, which may contribute to the exaggerated pain sensitivity of FMS."

Reyes Del Paso GA, Pulgar A, Duschek S et al. 2011. Cognitive impairment in fibromyalgia syndrome: The impact of cardiovascular regulation, pain, emotional disorders and medication. Eur J Pain. [Dec 19 Epub ahead of print]. "Thirty-five patients with FMS and 29 matched healthy controls completed a neuropsychological test measuring attention and arithmetic processing. As possible factors underlying the expected cognitive impairment, clinical pain intensity, co-morbid depression and anxiety disorders, sleep complaints, medication use, as well as blood pressure parameters were investigated. The patients' test performance was substantially reduced, particularly in terms of lower speed of cognitive processing and restricted improvement of performance in the course of the task. While the extent of depression, anxiety, fatigue and sleep complaints was unrelated to test performance, better performance was observed in patients showing lower pain ratings and those using opiate medication. The data corroborate the presence of substantial cognitive impairment in FMS. While the experience of chronic pain is crucial in mediating the deficits, co-morbid depression, anxiety, fatigue and sleep complaints play only a subordinate role. In the control group, but not in the patients, blood pressure was inversely associated with mental performance. This finding is in line with the well known cognitive impairment in hypertension. The lack of this association in FMS confirms previous research showing aberrances in the interaction between blood pressure and central nervous function in the affected patients."

Reynolds MD. 1981.  Myofascial trigger point syndromes in the practice of rheumatology.  Arch Phys Med Rehabil. 62(3):111-114.  “Pain referred from a muscle can mimic both pain from a joint and radicular pain associated with disease of spinal joints, leading to mistakes in diagnosis and in treatment.  When articular disease is present, it predisposes to myofascial trigger point (TP) syndromes.  With arthritis, TPs in muscles may result from decreased mobility with prolonged shortening of muscles, from abnormal mechanical stress on muscles and from stimuli arising in diseased joints.  During examination for signs of myofascial disorders, the numbers of tender points and of local twitch responses in women with rheumatoid arthritis were twice those found in women free of any rheumatic illness.  It is important to consider this high frequency of myofascial syndromes in persons with arthritis when treating pain or weakness which could be due to the muscles rather than the joints.  Conversely, it has been proposed, on theoretical and clinical grounds, that muscular TPs can cause joint disease.  This hypothesis has important implications for the treatment of arthritis.”  [Studies are linking TrPs with arthritic conditions, and have been doing so for some time.  They are going unnoticed.  ALL arthritis patients need assessment of co-existing TrPs to relieve them of unnecessary symptom burden. DJS]

Reynolds, M. D. 1984. Myofascial trigger points in persistent posttraumatic shoulder pain. South Med J 77(10):1277-1280.

Rha DW, Shin JC, Kim YK et al. 2011. Detecting local twitch responses of myofascial trigger points in the lower back muscles using ultrasonography. Arch Phys Med Rehabil. [Aug 11 Epub ahead of print]. "These findings suggest that ultrasonography was useful for detecting LTRs (local twitch responses) of MTrPs, especially for LTRs in the deep muscles. Ultrasound guidance may improve the therapeutic efficacy of trigger point injection for treating MTrPs in the deep muscles."

Richards JR, Richards IN, Ozery G et al. 2010. Droperidol Analgesia for Opioid-Tolerant Patients. J Emerg Med. [Sep 10 Epub ahead of print]. "Patients with acute and chronic pain syndromes such as migraine headache, fibromyalgia, and sickle cell disease represent a significant portion of emergency department (ED) visits. Certain patients may have tolerance to opioid analgesics and often require large doses and prolonged time in the ED to achieve satisfactory pain mitigation. Droperidol is a unique drug that has been successfully used not only as an analgesic adjuvant for the past 30 years, but also for treatment of nausea/vomiting, psychosis, agitation, sedation, and vertigo....Droperidol has myriad pharmacologic properties that may explain its efficacy as an analgesic, including: histamine antagonist, muscarinic and nicotinic cholinergic antagonist, anticholinesterase activity, sodium channel blockade similar to lidocaine, and ...opiate receptor potentiation.....Droperidol is an important adjuvant for patients who are tolerant to opioid analgesics."

Richardson K, Gonzalez Y, Crow H et al. 2012. The effect of oral motor exercises on patients with myofascial pain of masticatory system. Case series report. NY State Dent J. 78(1):32-37. "The following case series report explores the impact of oral motor exercises on the management of myofascial pain when used in conjunction with other treatment modalities. Oral motor exercises are used by speech-language pathologists to improve the strength, range of movement and coordination of the oral musculature during non-speech movements. The findings of this case series report suggest an opportunity exists for collaboration between speech-language pathologists and the 'traditional' TMD team." [It will be a new world when the speech-language pathologists discover TrPs. DJS]

Rico-Villademoros F, Calandre EP, Rodriguez-Lopez CM et al. Sexual functioning in women and men with fibromyalgia. J Sex Med. [Oct 24 Epub ahead of print]. "Our results show that sexual dysfunction is common in patients with fibromyalgia. The disease seems to deeply affect all dimensions of sexual functioning in both females and males." [Since myofascial TrPs occur in patients with FM, and these patients were not assessed for pelvic floor and other TrPs that can cause sexual dysfunction, it is suspected that at least the majority of these symptoms could be caused by co-existing TrPs. DJS]

Ridgway, K. 1999. Acupuncture as a treatment modality for back problems. Vet Clin North Am Equine Pract 15(1):211-21.

Riedel, W., H. Layka and G. Neeck. 1998. Secretory pattern of GH, TSH, thyroid hormones, ACTH, cortisol, FSH, and LH in patients with fibromyalgia syndrome following systemic injection of the relevant hypothalamic-releasing hormones. Z Rheumatol 57 Suppl 2:81-7.

Rigaud J, Delavierre D, Sibert L et al. 2010. [General principles of the diagnostic approach to chronic postoperative pelvic and perineal pain.] Prog Urol 20(12:1139-1144.[French] "The aetieological and diagnostic assessment of chronic postoperative pelvic and perineal pain requires a detailed clinical analysis based on examination of the scars and analysis of the clinical signs of muscle and nerve lesions..... A test block of a nerve or trigger point is the main test performed to determine the level of the lesion responsible for pain. " [Trigger points again as the pain generator. When will the medical world get it? DJS]

Rigaud J, Delavierre D, Sibert L et al. 2010. [Management of chronic pelvic and perineal pain after suburethral tape placement for urinary incontinence.] Prog Urol. 20(12):1166-1174. [French] The role of suburethral tape in the pathogenesis of pain is essentially based on the fact that pain occurs immediately or over the days following (suburethral surgical) tape placement. The clinical features are usually fairly nonspecific, with pelvic myofascial pain, possibly associated with direct or indirect nerve lesions (obturator nerve or pudendal nerve). Local infiltration of anaesthetic along the tape is performed for diagnostic purposes to confirm the aetiology of the pain and can also have a temporary therapeutic efficacy. Surgical removal of the tape was performed with satisfactory intermediate-term results in about two out of three cases....The frequency of chronic pelvic and perineal pain following suburethral tape placement appears to be underestimated. The diagnostic approach is based on complete clinical examination and infiltration along the tape and any nerves involved. Surgical removal of the tape provides the best intermediate-term analgesic results."

Ring, J., B. Eberlein-Konig and H. Behrendt. 1999. "Eco-syndrome" ("Multiple Chemical Sensitivity"–MCS). Zentralbl Hyg Umweltmed 202(2-4):207-18.

Rios R, Zautra AJ. 2011. Socioeconomic disparities in pain: the role of economic hardship and daily financial worry. Health Psychol. 30(1):58-66. "Economic hardship was associated not only with greater exposure to daily financial worries but also with greater vulnerability to pain on days when daily financial worries were experienced."

Riskowski JL, Mikesky AE, Bahamonde RE et al. 2005.  Proprioception, gain kinematics, and rate of leading during walking: are they related?  J Musculoskelet Neuronal Interact. 5(4):379-387.

Ristow, M., M. Vorgerd, M. Mohlig, H. Schatz and A. Pfeiffer. 1997. Deficiency ofphosphofructo-1-kinase/muscle subtype in humans impairs insulin secretion and causes insulin resistance. J Clin Invest 100(11):2833-2841.

Rivera, J., A. de Diego, M. Trinchet and A. Garcia Monforte. 1997. Fibromyalgia-associated hepatitis C virus infection. Br J Rheumatol 36(9):981-985.

Rivera J, Rejas J, Esteve-Vives J et al. 2009. Resource utilization and health care costs in patients diagnosed with fibromyalgia in Spain. Clin Exp Rheumatol. 27(5 Suppl 56):S39-45. “Fibromyalgia (FM) patients have been regarded as great utilizers of health resources, with important related costs. The aim of this study is to describe health care resource utilization and related costs of FM from the perspective of the National Health System in Spain….During the year 2006 the mean total cost per patient per year was 9,982 Euros, of which 3,245.8 (32.5%) corresponded to health care costs and 6,736.2 (67.5%) to indirect costs attributable to productivity losses. Non-drug therapies accounted for the largest proportion of the health care costs, three times greater than the drug treatment. Patients with higher total costs showed the greatest disease involvement. The variables associated to the total health care costs were functional capacity, depression, comorbidities and age. Patients with permanent working disability were the greatest resource utilizers….. FM patients with higher costs show the greatest disease involvement. Direct and indirect costs are well correlated to disease severity. The indirect costs account for most of the economic burden of FM and approximately double the health care costs. Patients with permanent working disability present more severe disease and generate greater health care costs.”

Rivera J, Rejas-Gutiérrez J, Vallejo MA et al. 2012. Prospective study of the use of healthcare resources and economic costs in patients with fibromyalgia after treatment in routine medical practice. Clin Exp Rheumatol. [Aug 4 Epub ahead of print]. "Treated patients with FM in daily practice improved their clinical status and were accompanied by a significant reduction in the cost of the illness. The extra cost of drugs is substantially compensated for by less use of other healthcare resources and fewer days off work."

Rivera J, Vallejo MA, Esteve-Vives J. 2012. Drug prescription strategies in the treatment of patients with fibromyalgia. Reumatol Clin. [May 17 Epub ahead of print]. [Article in English, Spanish]. "The introduction of anticonvulsants or antidepressants, in an isolated or combined form, produces a significant clinical improvement in FM patients. The most effective drug strategy is the introduction of both drugs at the same time. The least effective strategy is not to change the number of drug prescriptions."

Rivner MH. 2001.  The neurophysiology of myofascial pain syndrome.  Curr Pain Headache Rep. 5(5):432-440.

Roach S, Sorenson E, Headley B et al. 2012. The prevalence of myofascial trigger points in the hip in patellofemoral pain patients. Arch Phys Med Rehabil Nov 2 [Epub ahead of print] Patients with pain in the front of the knee have a much greater prevalence of trigger points bilaterally in the gluteus medius and quadratus lumborum muscles. They also had less hip abduction strength which TrP release therapy was not sufficient to increase.

Robbins, W. R., P. S. Staats, J. Levine, H. L. Fields, R. W. Allen, J. N. Campbell and M. Pappagallo. 1998. Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesth Analg 86(3):597-83.

Roberts, B. L. 1997. Soft tissue manipulation: neuromuscular and muscle energy techniques. J Neurosci Nurs 29(2):123-7.

Roberts, T. B. 1999. Do entheogen-induced mystical experiences boost the immune system? Psychedelics, peak experiences, and wellness. Adv Mind Body Med 15(2):139-47.

Robinson de Senna B, Marques LS, Franca JP et al. 2009.  Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 108(3):e117-124.

Robitaille, R., A. Castonguy, I. Rousse et al. 2002.  Glial cells are determinant of synaptic activity.  Glia (Suppl 1):S9 [Abstract].  This research indicates “that perisynaptic glial cells modulate sybaptic efficacy in a frequent dependent manner.

Rocca, P. V. 1999. Fibromyalgia: how disabling? Del Med Jrl 71(6): 263-5.

Rocha CB, Sanchez TG. 2012. [Efficacy of myofascial trigger point deactivation for tinnitus control] [Portuguese] Braz J Otorhinolaryngol 78(6):21-26. "Besides medical and audiological investigation, patients with tinnitus should also be checked for: 1) presence of myofascial pain surrounding the ear; 2) laterality between both symptoms; 3) initial decrease of tinnitus during muscle palpation. Treating this specific subgroup of tinnitus patients with myofascial trigger point release may provide better results than others described so far. [There must also be an understanding that bilateral TrPs can be interacting with tinnitus, and that TrPs in the areas of the neck and surrounding tissues may also contribute to tinnitus. DJS]

Rocha CA, Sanchez TG. 2007.  Myofascial trigger points: another way of modulating tinnitus.  Prog Brain Res. 166:209-214.  “Tinnitus is a multifaceted symptom that may have many causes…”  “Tinnitus can often be modulated by different kinds of stimuli.”  “In 56% of patients with tinnitus and MTPs, the tinnitus could be modulated by applying digital compression of such points, mainly those of the masseter muscle.”  “Compression of MTPs was most effective in patients who have had chronic pain earlier in the examined areas.”  [As tinnitus can be severe enough to cause suicidal ideation, disrupting lives significantly, it is ironic that some patients can be helped so easily, yet are not.  DJS]

Roche, H. M. 1999. Dietary carbohydrates and triacylglycerol metabolism. Proc Nutr Soc58(1):201-7.

Rodero B, Casanueva B, Garcia-Campayo J et al. 2010. Stages of chronicity in fibromyalgia and pain catastrophising: a cross-sectional study. BMC Musculoskel Disord. 11(1):251. "Fibromyalgia (FM) is a prevalent and disabling disorder characterized by widespread pain and other symptoms such as insomnia, fatigue and depression.... The present research examined the relationship among pain, catastrophic thinking and FM impact, as a function of stage of chronicity.... These findings provide preliminary evidence that stage of chronicity is an important moderator of psychological vulnerability for FM impact and should be taken into account by tailoring psychological interventions." [One can always tell when the researchers are psychologist and/or psychiatrists. The researchers must address the myofascial trigger points causing the symptoms and maintaining central sensitization. The lack of myofascial training in medical community is the greatest catastrophe of all. DJS]

Rodreguez-Andreu J, Ibanez-Bosch R, Portero-Vasquez A et al. 2009.  Cognitive impairment in patients with fibromyalgia syndrome as assessed by the Mini-Mental State Examination.  BMC Musculoskeletal Disord. 10(1):162.  “Compared with the population reference value, patients with FMS showed high frequency of cognitive impairment.”

Rodreguez MA, Afari N, Buchwald DS. 2009.  Evidence for overlap between urological and noneurological unexplained clinical conditions.  J Urol. 182(5):2123-2131.  “The literature suggests considerable comorbidity between urological and noneurological unexplained clinical conditions.  The most robust evidence for overlap was for irritable bowel syndrome and urological unexplained syndromes with some estimates of up to 79% comorbidity between chronic pelvic pain and symptoms of irritable bowel syndrome.”  [Unfortunately, myofascial pain was not considered in this article, and much of the FM-relationship could be from co-existing myofascial TrPs.  Other research certainly indicates that the pelvic symptoms stem from co-existing TrPs and not from FM, which highlights the dangers of ignoring the contributions of the TrPs as well as the TrPs themselves. DJS]

Rodriguez EM, Blazquez JL, Pastor FE et al. 2005.  Hypothalamic tanycytes: a key component of brain-endocrine interaction.  Int Rev Cytol. 247:89-164.  “Tanycytes are bipolar cells bridging the cerebrospinal fluid (CSF) to the portal capillaries and may link the CSF to neuroendocrine events.  During the perinatal period a subpopulation of radial glial cells differentiates into tanycytes...”  There are four populations of tanycytes, and each subtype expresses important “...functional molecules, such as glucose and glutamate transpoters; a series of receptors for neuropeptide and peripheral hormones; secretory molecules  such as transforming growth factors, prostaglandin E(2), and the specific protein P85; and proteins of the endocytic pathways.”  “The discovery in tanycytes of new functional molecules is opening a new field of research.  Thus, thyroxine deiodinase type II, an enzyme generating triiodothyronine T(3) from thyroxine, appears to be exclusively expressed by tanycytes, suggesting that these cells are the main source of brain T(3).”  [Other types of tanycytes are involved in glucose, and the patients who are thyroid resistant also seem to be insulin resistant. This may be a clue to why some FMS patients are T4-resistant and insulin resistant. DJS]

Rodriguez-Fernandez AL, Garrido-Santofimia V, Gueita-Rodriguez J et al. 2011. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 92(9):1353-1358. "A 10-minute application of burst-type TENS (transcutaneous electrical nerve stimulation) increases in a small but statistically significant manner the RPPT (referred pressure pain threshold) over upper trapezius latent MTrPs and the ipsilateral cervical range of motion."

Roehrs TA. 2009. Does effective management of sleep disorders improve pain symptoms? Drugs. 69 Suppl 2:5-11. “Co-morbid insomnia is a much more frequent problem than primary insomnia. In co-morbid insomnia, management of the underlying disease can improve sleep difficulty. Conversely, treating the sleep disorder may also improve the co-morbid condition. For example, patients with painful chronic illnesses are more likely to experience sleep disturbance than patients with non-painful illnesses. Moreover, there is evidence that insomnia further exacerbates pain in these illnesses. This suggests that a reciprocal relationship exists between pain and sleep, and that intervention targeted primarily at insomnia may improve pain. Treatment options for sleep disorders in the context of pain that have been assessed include cognitive behavioral therapy for insomnia and various pharmacological therapies. In randomized clinical trials, cognitive behavioral therapy significantly improved insomnia secondary to chronic pain compared with control therapy, but pain was only improved in patients in whom it was associated with pain disorders other than fibromyalgia. Of the pharmacological agents studied (zopiclone, zolpidem and triazolam), only triazolam improved both sleep and pain to a greater extent than placebo. Overall, clinical data supporting a cause-effect relationship between insomnia and pain are preliminary and are limited to several small trials. Further investigation is required to clarify the extent of the link between insomnia and pain and whether successfully managing insomnia secondary to pain improves pain symptoms. Areas of particular interest include investigation of the effect of sleep agents on analgesia and the effect of analgesics on sleep.”

Roehrs T, Diederichs C, Gillis M et al. 2012. Nocturnal sleep, daytime sleepiness and fatigue in fibromyalgia patients compared to rheumatoid arthritis patients and healthy controls: A preliminary study. Sleep Med. [Nov 10 Epub ahead of print]. "Women with FM have similar nocturnal sleep disturbance as those with RA (rheumatoid arthritis), but FM patients report greater self-rated daytime sleepiness and fatigue than RA and HC, which did not correspond to the relatively low level of objectively determined daytime sleepiness of FM patients. These findings suggest a generalized hyperarousal state in FM."

Roehrs T, Hyde M, Blaisdell B et al. 2006.  Sleep loss and REM sleep loss are hyperalgesic.  Sleep. 29(2):145-151.  “...the loss of four hours of sleep and specific REM sleep loss are hyperalgesic the following day.  Pharmacologic treatments and clinical conditions that reduce sleep and REM sleep time may increase pain.”

Roehrs T, Roth T. 2005.  Sleep and pain: interaction of two vital functions.  Semin Neurol 25(1):106-116.  “The pain sleep nexus has been modeled in healthy pain-free subjects and the studies have demonstrated the bidirectionality of the sleep-pain relation.  ...treatment must focus on alleviation of both the pain and sleep disturbance.”

Roelofs J, Sluiter JK, Frings-Dresen MH et al. 2007.  Fear of movement and (re)injury in chronic musculoskeletal pain: evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish and Canadian samples.  Pain. [Feb 19 Epub ahead of print]  [This study does not take into consideration that restriction of movement may be due to co-existing myofascial trigger points that cause pain at the end of range of motion.  Until psychologists, psychiatrists, and indeed all health care professionals are trained in the awareness of myofascial medicine, papers like this will be, at best, incomplete, and, at worst, lead to erroneous conclusions. DJS]

Rogers, N., C. van den Heuvel, and D. Dawson. 1997. Effect of melatonin and corticosteroid on in vitro cellular immune function in humans. J Pineal Res 22(2): 75-80.

Rogozhin AA, Devlikamova FI. 2007.  Inactivation of trigger points could significantly reduce radicular pain.  J Musculoskel Pain 15 (Supp 13):35 item 59.  [Myopain 2007 Poster]  “It is difficult to distinguish between radicular and MPS because trigger points [TrPs] are widely present in patients with radiculopathy.”  “We can suppose that radicular pain in patients with acute radiculopathy partly could be caused by activation of TrPs.  Inactivation of TrPs in patients with radiculopathy never leads to complete pain relief but could be useful in patients with prolonged time course of disease.”  [The patient must be treated, rather than the radiography.  This means that soft tissue problems such as MTPs must be treated rather than the current focus on the skeletal system and discs alone.  DJS.]

Roizenblatt S, Fregni F, Gimenez R et al. 2007.  Site-specific effects of transcranial direct current stimulation on sleep and pain in fibromyalgia: a randomized, sham-controlled study.  Pain Pract. 7(4):297-306.  “Our findings suggest that one possible mechanism to explain the therapeutic effects of tDCS in fibromyalgia is via sleep modulation that is specific to modulation of primary M1 (motor cortex) activity.”

Roizenblatt, S., S. Tufik, J. Goldenberg, L. R. Pinto, M. P. Hilario and D. Feldman. 1997. Juvenile fibromyalgia; clinical and polysomnographic aspects. J Rheumatol 24 (3): 579-585.

Rolland JF, DeLuca A, Burdi R et al. 2006.  Overactivity of exercise-sensitive cation channels and their impaired modulation by IGF-1 in mdx native muscle fibers: beneficial effect of pentoxifylline.  Neurobiol Dis.  [Sep 27 Epub ahead of print]  Pentoxifylline may be helpful in some channelopathies.

Romano, T. J. 1991. Fibromyalgia in children: diagnosis and treatment. W V Med J 87 (3):112-114.

Romano, T. J. 1990. Clinical experiences with post-traumatic fibromyalgia syndrome. WV Med J 86(5):198-202.

Romero-Zurita A, Carbonell-Baeza A, Aparicio VA et al. 2012. Effectiveness of a tai-chi training and detraining on functional capacity, symptomatology and psychological outcomes in women with fibromyalgia. Evid Based Complement Alternat Med. 2012:614196 [May 9 Epub ahead of print]. "A 28-week Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female FM patients."

Rooks DS. 2007.  Fibromyalgia treatment update. Curr Opin Rheumatol. 19(2):111-117.  “Treatment goals should include the improvement of symptoms, primarily pain and sleep, and the promotion of positive health behaviors with the aim of improving physical function and emotional well-being.”

Roosink M, Renzenbrink GJ, Buitenweg JR et al. 2010. Somatosensory Symptoms and Signs and Conditioned Pain Modulation in Chronic Post-Stroke Shoulder Pain. J Pain. [Dec 16 Epub ahead of print]. "Persistent shoulder pain is a common complication after stroke. Its etiology and underlying mechanisms are not well understood and treatment is generally unsatisfactory. The objective of this study was to assess the role of central sensitization and disinhibition in chronic stroke patients with chronic PSSP (n = 19), pain-free stroke patients (n = 29), and healthy controls (n = 23)….. Sensory abnormalities were more frequently observed and more severe in patients with PSSP, including positive signs such as allodynia at the affected side and generalized hyperalgesia at the unaffected side. CPM was similar in stroke patients and healthy controls. This study showed that chronic PSSP was associated with several positive and negative somatosensory signs, implicating a role for central sensitization and possibly for disinhibition. Since the causal relationship remains unclear, and may be related to either neuroplasticity induced by ongoing nociception as well as to the neuropathic brain lesion, prospective studies are warranted….The assessment of somatosensory symptoms and signs and endogenous pain modulation demonstrated a role for central sensitization and possibly for disinhibition in chronic PSSP. Prevention and treatment of PSSP could benefit from a more detailed analysis of both peripheral and central pain mechanisms." [It would be interesting to check these patients for those TrPs that cause shoulder pain. It is very likely that there are treatable myofascial components to post-stroke pain. DJS]

Roost M, Nilsson P. 2002.  [Sleep disorders — a public health problem.  Potential risk factor in the development of type 2 diabetes, hypertension, dyslipidemia and premature aging]  Lakartidningen 99(3):154-157. [Swedish]  “Sleep disorders may play a primary role in the pathophysiology of cardiovascular disease.  This has recently been documented in association with metabolic disturbances and impaired insulin action following experimental sleep deprivation.  Sleep disorders may finally prove to be part of the pathophysiological chain linking adverse psychosocial stress with the metabolic syndrome, and ultimately premature aging and early mortality.”

Rosado-Pérez J, Santiago-Osorio E, Ortiz R et al. 2012. Tai chi diminishes oxidative stress in Mexican older adults. J Nutr Health Aging. 16(7):642-646. "...the daily practice of Tai Chi is useful for reducing OxS (oxidative stress) in healthy older adults."

Rosenbaum TY. 2009.  Musculoskeletal pain and sexual function in women.  J Sex Med. [Sep 14 Epub ahead of print]  “Musculoskeletal pain (MP) that is not essentially genitally based often interferes with sex as well yet is not considered a distinct sexual dysfunction.  MP is generally addressed by physiatrists, orthopedists, and rheumatologists who are not traditionally trained in sexual medicine, and therefore, the sexual concerns of women with MP often go unaddressed.”  “Lack of mobility and MP can restrict intercourse and limit sexual activity, and gender differences are noted in response to pain.  Sexual and relationship counseling should be offered as a component of rehabilitative treatment.  Physical therapists are uniquely qualified to provide treatment to address functional activities of daily living, including sexual intercourse, and offer advice for modifications in positioning.”

Rosengren SM, Colebatch JG. 2010. Vestibular evoked myogenic potentials are intact in cervical dystonia. Mov Disord. [Oct 19 Epub ahead of print]. "Vestibular dysfunction has been reported in patients with cervical dystonia (CD), but it is still unclear whether the abnormalities occur as part of the CD syndrome or whether they arise from the abnormal posture and movement of the head..... Both cervical and ocular VEMPs (vestibular-evoked myogenic potentials) were present in the majority of patients and controls..... Our results showed that VEMPs can be reliably recorded from both the neck and extraocular muscles in patients with CD, even after long disease or treatment durations, and provide evidence for intact short-latency vestibular reflexes in CD. " [FM, TrPs and vestibular dysfunction ar often interactive co-existing conditions. DJS]

Rosenhall, U., G. Johansson and G. Orndahl. 1996. Otoneurologic and audiologic findings in fibromyalgia. Scan J Rehabil Med 28(4):225-232.

Rosenhall, U., G. Johansson and G. Orndahl. 1987. Neuroaudiological findings in primary fibromyalgia with dysesthesia. Scand J Rehabil Med 19(4):147-152.

Roskos SE, Keenum AJ, Newman LM et al. 2007.  Literacy demands and formatting characteristics of opioid contracts in chronic nonmalignant pain management.  J Pain [Mar 21 Epub ahead of print]   “Most OCs contained not only sophisticated medical language but multisyllable, nonmedical terms and vocabulary not used in typical everyday conversation.”  Opioid contracts must be understandable and clear, and this is not the case.

Rosmond, R., E. Eriksson and P. Bjorntorp. 1999. Personality disorders in relation to anthropometric, endocrine and metabolic factors. J Endocrinol Invest 22(4):279-88.

Rossetti, L., D. Massillon, N. Barzilai, P. Vuguin, W. Chen, M. Hawkins, J. Wu and J. Wang.1997. Short term effects of leptin on hepatic gluconeogenesis and in vivo insulin action. J Biol Chem 272(44):27758-63.

Rossi S, della Volpe R, Giananneschi F et al. 2003.  Early somatosensory processing during tonic muscle pain in humans: relation to loss of proprioception and motor ‘defensive’ strategies. Clin Neurophysiol 114(7):1351-1358.  Contractured, painful muscles can cause early sensory processing at the cortical level. This may be part of the mechanism of proprioception dysfunction in myofascial TrPs.

Rossini M, Di Munno O, Valentini G et al. 2007.  Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients.  Clin Exp Rheumatol. 25(2):182-188.  “LAC (acetyl l-carnitine) may be of benefit in patients with FMS, providing improvement in pain as well as the general and mental health of these patients.”

Rossy, L. A., S. P. Buckelew, N. Dorr, K. J. Hagglund, J. F. Thayer, M. J. McIntosh, J. E. Hewett and J. C. Johnson. 1999. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med 21(2):180-91.

Roth, R. S., K. Horowitz and J. E. Bachman. 1998. Chronic myofascial pain: knowledge of diagnosis and satisfaction with treatment. Arch Phys Med Rehabil 79(8):966-70.

Roth, T. and S. Ancoli-Israel. 1999. Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. II. Sleep 22 Suppl 2:S354-8.

Roussou E, Ciurtin C. 2012. Clinical overlap between fibromyalgia tender points and enthesitis sites in patients with spondyloarthritis who present with inflammatory back pain. Clin Exp Rheumatol. [Aug 30 Epub ahead of print]. "To assess the extent of coexistence of inflammatory back pain (IBP) with fibromyalgia (FM) features in patients with spondyloarthritis (SpA), and to assess the degree of overlap of FM tender points (TeP) and enthesitis sites (ES) in patients with SpA.....One third of patients with IBP fulfilled the criteria for FM. There is a significant degree of overlap between FM TeP and ES in patients with IBP.[Since many patients with FM have trigger points, and trigger points in the attachment areas cause enthesitis and enthesis, it would be helpful to know what percentage of these patients had TrPs and if the contracture from TrPs might cause the inflammation. DJS]

Rowbotham MC, Twilling L, Davies P et al. 2003.  Oral opioid therapy for chronic peripheral and central neuropathic pain.  New England Jour Med 348:1223-1232.

Roy-Byrne P, Smith WR, Goldberg J et al. 2004.  Post-traumatic stress disorder among patients with chronic pain and chronic fatigue.  Psychol Med 34(2):363-368.  "Optimal clinical care for patients with FMS should include an assessment of trauma in general, and PTSD in particular."

Rra ML, Angst F, Beck T et al. 2012. Horticultural therapy for patients with chronic musculoskeletal pain: results of a pilot study. Altern Ther Health Med. 18(2):44-50. "Seventy-nine patients with chronic musculoskeletal pain (fibromyalgia or chronic, nonspecific back pain) participated in the study….The addition of horticultural therapy to a pain management program improved participants' physical and mental health and their coping ability with respect to chronic musculoskeletal pain."

Rubenstein, S. 1990. The osteopathy alternative. East West Dec:45-49.

Rubic B. 2002.  The biofield hypothesis: its biophysical basis and role in medicine.  J Altern Complement Med 8(6):703-717.  “This paper provides a scientific foundation for the biofield: the complex extremely weak electromagnetic field of the organism hypothesized to involve electromagnetic bioinformation for regulating homeodynamics.”  This hypothesis may relate to the benefits of acupuncture, bioelectromagnetic and other complementary medicine methods.

Rudin NJ. 2003.  Evaluation of treatments for myofascial pain syndrome and fibromyalgia.  Curr Pain Headache Rep 7(6):433-442.  As the title suggests, this is a general evaluation of these conditions, although the author mentions early that there is a question of whether either of these conditions exist. Treatment options are discussed without mention of perpetuating factors, and they often are the chief clue to the tailoring of specific remedial work and treatment regimens.

Care is taken to note that treatments must be carefully tailored to the needs of the individual patient.  What is effective for some may not fill the needs of others, and some types of therapies require specific attention to protocol for success, and as the author states, no single therapeutic regimen will be successful on every patient.  There are many fine points to this article, but it is unfortunate that the difference between hypothyroid and thyroid-resistant states was not specified, and that the dismissal of guaifenesin was based on a single flawed study.

Ruhl A. 2005. Glial cells in the gut. Neurogastroenterol Motil. 17(6):777-790.  “The enteric nervous system is composed of both neurons and glia.  Recent evidence indicates that enteric glia—which vastly outnumber enteric neurons—are actively involved in the control of gastrointestinal functions: they contain neurotransmitter precursors, have the machinery for uptake and degradation of neuroligands, and express neurotransmitter-receptors which makes them well suited as intermediaries in enteric neurotransmission and information processing in the ENS.  Novel data further suggest that enteric glia have an important role in maintaining the integrity of the mucosal barrier of the gut.  Finally, enteric glia may also serve as a link between the nervous and immune systems of the gut as indicated by their potential to synthesize cytokines, present antigen and respond to inflammatory insults.”  “...it is predictable that enteric glia are involved in the etiopathogenesis of various pathological processes in the gut.”

Ruiz Moral R, Rodriguez Salvador J, Perula L et al. 2006.  [Problems and solutions in health care for chronic diseases. A qualitative study with patients and doctors.] Aten Primaria 38(9):483-489. [Spanish]  “To tackle prevalent chronic problems requires, in the view of doctors and patients, important modifications that are related mainly to the kind of relationship between the two, with new clinical responsibilities and certain organizational care delivery features.”  Presently, chronic illness is frustrating to patients and care givers.  Suggestions are given to remedy this.

Ruiz-Párraga GT, López-Martínez AE, Gómez-Pérez L. 2012. Factor structure and psychometric properties of the resilience scale in a Spanish chronic musculoskeletal pain sample. J Pain. 13(11):1090-1098. "This article presents the first resilience questionnaire (RS-18) for chronic pain patients. The instrument obtained shows good reliability and validity. The results provide health-care professionals and researchers with a measure of resilience in chronic pain patients that excludes items related to functional disability."

Ruiz-Saez M, Fernandez-de-las-Penas C, Blanco CR et al. 2007.  Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects.  J Manipulative Physiol Ther. 30(8):578-583.  “Our results suggest that a cervical spine manipulation directed at the C3 through C4 segment induced changes in pressure pain sensitivity in latent MTrPs in the upper trapezius muscle.  Different therapeutic mechanism, either segmental or central, may be involved at the same time.”

Rulh A. 2005. Glial cells in the gut.  Neurogastroenterol Motil 17(6):777-790.  [This may have relevance to central sensitization in both FMS and IBS. DJS]

Ruotolo G., Howard B.V. 2002.  Dyslipidemia of the metabolic syndrome.  Curr Cardio Rep 4(6):494-500. “...these lipoprotein defects contribute largely to the increased cardiovascular disease risk in individuals with insulin resistance.”

Rusiecki, RS. 1998.  Chest pain as result of temporomandibular disorder (TMD). Gen Dent46(4):352-5.

Russell, IJ, JE Michalek, YK Kang and AB Richards. 1999. Reduction of morning stiffness and improvement in physical function in fibromyalgia syndrome patients treated subligually with low doses of human interferon-alpha.  J Interferon Cytokine Res 19(8):961-8.

Russell, IJ , GA Vapriao, JE Michalek, FE Craig, YK Kang and AB Richards. 1999.  Lymphocyte markers and natural killer cell activity in fibromyalgia syndrome: effects of low-dose, subligually use of human interferon-alpha.  J Interferon Cytokine Res 19(8):969-78.

Russell, IJ, JE Michalek, JD Fletchas, and GE Abraham. 1995. Treatment of fibromyalgia syndrome with Super Malic; a randomized, double blind, placebo controlled, crossover pilot study.  J Rheumatol 22(5):953-958.

Russo, C. M. and W. G. Brose. 1998. Chronic pain. Annu Rev Med 49:123-33.

Rusy, L. M., S. A. Harvey and D. J. Beste. 1999. Pediatric fibromyalgia and dizziness: evaluation of vestibular function. J Dev Behav Pediatr 20(4):211-5.

Rutledge DN, Mouttapa M, Wood PB. 2009.  Symptom clusters in fibromyalgia: potential utility in patient assessment and treatment evaluation.  Nurs Res. 58(5):359-367.  “In this well-educated, primarily Caucasian sample, morning stiffness, fatigue, and not feeling rested in the morning were the symptoms with the highest severity scores.”  “The findings support the heterogeneity of the FM experience and the presence of symptom clusters within the greater spectrum of symptoms comprising the FM syndrome.  These observations suggest the possibility of tailoring interventions based upon individual patient symptomatology.”  [This article did not consider the co-existing TrPs, so many of the symptoms ascribed to FM may actually be due to TrPs.  DJS]

Ryabow S. I. 2002.  Extracellular space volume changes in the cerebral cortex evoked by repetitive peripheral stimulation.  Glia (Suppl 1):S59 [Abstract].

Ryan E, Malboeuf CM, Barnard M et al. 2006.   Cyclooxygenase-2 Inhibition attenuates antibody responses against human papillomavirus-like particles.  J Immunol 177:7811-7819.  Some common over-the counter and other pain medications might weaken vaccines.  Vaccines are give to produce a response of antibodies.  Any COX inhibitor, such as aspirin, Advil, Celebrex, etc., may attenuate this.  In people with compromised immune systems, the effect may be even more pronounced.