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PubMedDate not supplied

[The abdominal wall: an overlooked cause of pain].

Abdominal wall pain is frequently misdiagnosed as arising from visceral source, often resulting in inappropriate diagnostic tests, unsatisfactory treatment and high costs. The Authors describe the various causes of abdominal wall pain with particular regard to abdominal cutaneous nerve entrapment syndrome. They analyze the main features of abdominal wall pain: a localized tender trigger point can be frequentely identified, the Carnett's sign is positive and the local injection of an anesthetic agent into the trigger point can be diagnostic and therapeutic, while image techniques are useful when the pain results from structural conditions. At last they describe the therapeutic options.

Abdominal Pain↗
PubMed1985

Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients.

Myofascial pain syndrome (MPS) is a common but misunderstood muscular pain disorder involving pain referred from small, tender trigger points within myofascial structures in or distant from the area of pain. Misdiagnosis or inadequate management of this disorder after onset may lead to development of a complex chronic pain syndrome. A review of the clinical characteristics of 164 patients whose chief complaints led to the diagnosis of MPS revealed that these patients had (1) tenderness at points in firm bands of skeletal muscle that were consistent with past reports, (2) specific patterns of pain referral associated with each trigger point, (3) frequent emotional, postural, and behavioral contributing factors, and (4) frequent associated symptoms and concomitant diagnoses.

Adolescent↗
PubMedDate not supplied

Local injection therapy in 107 patients with myofascial pain syndrome of the head and neck.

Myofascial pain syndrome of the head and neck is a frequent cause of facial pain and is characterized by tender trigger points. In a double-blind study of 107 patients, local injection therapy using one of three solutions was applied at the trigger points by intracutaneous injection of 0.3 ml solution followed by deep infiltration of the site. Results using bupivacaine 0.25%, lignocaine 1% and saline 0.9% were compared. There was no significant difference among groups with respect to reduction of pain and overall rating by patients of the therapeutic benefits. Fifty-three patients (49%) were free of symptoms after treatment, 40 patients (38%) reported substantial relief and in 14 patients (13%) symptoms remained unchanged. The findings suggest that relief of pain is mainly due to reflex mechanisms rather than to the pharmacological effects of the injected solutions. Physiological saline solution is recommended for use in local injection therapy.

Analysis of Variance↗
PubMedDate not supplied

Simultaneous multiple-modality therapy for tension headaches and neck pain.

Eighty-one patients suffering from neck pain and tension-type headaches were treated by the application of a unique physical therapy device combining transcutaneous electrical nerve stimulation (TENS), traction, massage, vibration, and acupressure applied to the forehead, posterior cervical spine, and scapula. The device employed eight silver silicone electrodes for modality application. Its safety and effectiveness were assessed by evaluating patients before and after treatment. No complication ensued. Statistical analysis of visual analog scales for neck pain and headache yielded p values < 0.0001. Analysis of fibromyalgia neck and shoulder trigger points with three controls gave nonsignificant results. Conclusions were that 1) the device is safe and effective as judged by subjective patient input and 2) fibromyalgia trigger points are unaffected by the treatments. More objective measures are needed to provide evidence of efficacy.

Acupressure↗
PubMed2000

Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers.

OBJECTIVE: The goal of this study was to assess clinical consensus regarding whether myofascial pain syndrome (MPS) is a legitimate and distinct diagnosis as well as the signs and symptoms characterizing MPS. DESIGN: A standardized mailed survey with return postage provided. SUBJECTS: A total of 1,663 American Pain Society members in medically related disciplines listed in the 1996/1997 directory. OUTCOME MEASURES: A standardized survey assessing clinical opinion regarding whether MPS is a legitimate diagnosis, whether MPS is a clinical entity distinct from fibromyalgia, and the signs and symptoms believed to be "essential to," "associated with," or "irrelevant to" to the diagnosis of MPS. RESULTS: Of the 403 surveys returned, 88.5% respondents reported that MPS was a legitimate diagnosis, with 81% describing MPS as distinct from fibromyalgia. The only signs and symptoms described as essential to the diagnosis of MPS by greater than 50% of the sample were regional location, presence of trigger points, and a normal neurologic examination. Regarding the signs and symptoms considered to be essential or associated with MPS, more than 80% of respondents agreed on regional location, trigger points, normal neurologic examination, reduced pain with local anesthetic or "spray and stretch," taut bands, tender points, palpable nodules, muscle ropiness, decreased range of motion, pain exacerbated by stress, and regional pain described as "dull," "achy," or "deep." Sensory or reflex abnormalities, scar tissue, and most test results were considered to be irrelevant to the diagnosis of MPS by a large proportion of the respondents. CONCLUSIONS: There was general agreement across specialties that MPS is a legitimate diagnosis distinct from fibromyalgia. There was a high level of agreement regarding the signs and symptoms essential or associated with a diagnosis of MPS. Differences across specialties are discussed. This survey provides a first step toward the development of consensus-based diagnostic criteria for MPS, which can then be validated empirically.

Data Collection↗
PubMed2004

A randomized controlled study on the effect of two different treatments (FREMS AND TENS) in myofascial pain syndrome.

AIM: Myofascial pain syndrome (MPS) is a frequent cause of chronic muscoloskeletal pain. Transcutaneous electrical nerve stimulation (TENS) is one of the most frequently employed treatments in MPS. The aim of this study is to compare the short and medium-term effects of frequency modulated neural stimulation (FREMS) to those of TENS in MPS. METHODS: Forty subjects with upper trapezius MPS were randomly allocated to 1 of 2 groups, treated with either FREMS (n=19) or TENS (n=21). Each treatment consisted in 10 sessions lasting 20 min each. Patients were evaluated before treatment, at 1 week, and at 1 and 3 months after the end of treatment. Clinical evaluation included parameters for measurement of pain levels using the neck pain and disability visual analogue scale (NPDVAS) and algometry, evaluation of myofascial trigger point characteristics and measurement of the range of cervical movement (range of motion, ROM). RESULTS: The FREMS group showed a significant improvement in the NPDVAS, algometry, in myofascial trigger point characteristics, and in the ROM (homolateral rotation, controlateral rotation, bending and extension) after the end of treatment and at 1 and 3 months follow-up evaluation. The TENS group showed significant improvement in the same outcome measures except for algometry and cervical extension, but these improvements were maintained only at the 1 month follow-up evaluation. However, were not observed statistically significant differences between FREMS of TENS in many of outcome measures. CONCLUSIONS: Both FREMS and TENS have positive short-term effects on MPS. But, medium-term effects were achieved only with FREMS.

Journal Article↗
PubMedDate not supplied

Pseudo-spinal headache.

BACKGROUND AND OBJECTIVES: Myofascial trigger points are often not considered in the differential diagnosis of headaches. METHODS: A patient who presented with severe bifrontal headaches was treated by injections of the sternocleidomastoid muscle trigger points with local anesthetics. RESULTS: The patient experienced complete resolution of all symptoms, which had not reappeared after 14 months. CONCLUSIONS: Myofascial pain may mimic other disorders, and myofascial headaches can be easily treated once properly diagnosed.

Adult↗
PubMed2004

A real-world way to manage real options.

Each corporate growth project is an option, in the sense that managers face choices--push ahead or pull back--along the way. Yet many companies hesitate to apply options theory to initiatives such as R&D and geographic expansion, partly because these "real" options are highly complex. In this article, the authors make the case that the complexity of real options can be eased through the use of a binomial valuation model. Many of the problems with real-options analysis stem from the use of the Black-Scholes-Merton model, which isn't suited to real options. Binomial models, by contrast, are simpler mathematically, and you can tinker with a binomial model until it closely reflects the project you wish to value. Suppose your company is considering investing in a new plant. To use the binomial model, you must create an "event tree" to figure out the full range of possible values for the plant during the project's lifetime--next year, at the end of the design phase, upon completion. Then you work backward from the value at completion, factoring in the various investments, to determine the value of the project today. These calculations provide you with numbers for all the possible future values of the option at the various points where a decision needs to be made on whether to continue with the project. The authors also address another criticism of real options: that gaps often arise between theoretical and realized values of options of all types. Such gaps may be largely the result of managers exercising options at the wrong time. To improve the way it manages its real options, a company can look out for the decision trigger points that correspond to the nodes on a binomial decision tree. The trigger points should not only tell managers when they need to decide on exercise but also specify rules governing the exercise decisions.

Commerce↗
PubMed1983

When shoulder pain isn't bursitis. The myofascial pain syndrome.

Pain in the shoulder girdle and the arm is often referred pain from a remote trigger point, ie, the myofascial pain syndrome. Once initiated, this definite disease entity perpetuates itself through various feedback loops. Treatment consists of interrupting the pain cycle. Local block of the trigger point with 1% lidocaine (Xylocaine), to which a short- or long-acting steroid may or may not be added, has proved to be most effective.

Bupivacaine↗
PubMedDate not supplied

Comparison of masticatory dysfunction in temporomandibular disorders and fibromyalgia.

AIM: Many theories have been proposed as to the relationship between fibromyalgia (FM) and temporomandibular disorders (TMD). The aim of this study was to investigate the clinical features of the involvement of the stomatognathic system in patients with fibromyalgia, and to compare signs and symptoms of masticatory dysfunction between TMD and FM patients. METHODS: The study sample consisted of 30 subjects with fibromyalgia recruited at the Rheumatology Disease Department, University of Pisa, Italy, and of 30 with temporomandibular disorders at the Section of Prosthetic Dentistry, Department of Neurosciences, University of Pisa, Italy. Masticatory dysfunction has been compared between the 2 groups by means of a clinical assessment conducted according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients of the TMD group underwent a rheumatologic examination to investigate for the presence of previously undiagnosed fibromyalgia. RESULTS: As regards specific clinical variables and RDC/TMD diagnoses, differences between the 2 groups appear to be not relevant, with the exception of the values of mouth opening, both voluntary and passive, and the presence of trigger points. FM patients showed a decrease in both maximum voluntary and passive mouth opening which was about 2 mm worse than that recorded in TMD patients. FM patients also showed a significantly higher number of trigger points, even though muscle palpation evoked tenderness in the same number of sites in the 2 groups. CONCLUSIONS: This study showed that most patients with fibromyalgia (86.7%) report signs and symptoms localized at the stomatognathic system; by contrast, only a minority of patients with temporomandibular disorders (10%) are actually affected by fibromyalgia.

Adult↗
PubMed1999

Characteristics of postradical neck pain syndrome: a report of 25 cases.

The postradical neck pain syndrome has been briefly described in the literature, but detailed characterization has not been reported. To further define this syndrome, 25 patients with persistent pain for at least 1 month following neck dissection were evaluated. The sample consisted of 13 men and 12 women with moderate to severe pain ranging from 1 month to 27 years in duration. All patients had at least one type of neuropathic pain: spontaneous, continuous burning pain (81%), shooting pain (69%), and/or allodynia (88%). Neuropathic pain sites were within the distribution of the superficial cervical plexus (SCP). Regional myofascial pain was also common (72%). Seventeen patients agreed to undergo diagnostic local anesthetic injections. Ten of these patients had both neuropathic and somatic (myofascial) pain. Local anesthetic injection of the SCP temporarily eliminated all neuropathic pain in the 17 patients who underwent the procedure. The 10 patients who also had myofascial pain reported temporary relief of their somatic pain following myofascial trigger point injections (TPI). Criteria for the postradical neck pain syndrome are proposed: (1) persistent, nonprogressive neuropathic pain involving one or more branches of the SCP, which may be accompanied by (2) regional nonprogressive somatic pain associated with myofascial pain trigger points in head and neck muscles.

Female↗
PubMed2005

Evoked potentials during active horizontal head rotations in patients with vertigo.

OBJECTIVES: The purpose of this study was to investigate whether evoked potentials by active head rotation help to verify and topographically differentiate patients with the major symptom vertigo. METHODS: Twenty-four healthy human subjects and 43 patients with either infratentorial or supratentorial brain lesions were analysed. RESULTS: The evoked response in normal subjects was composed of six peaks, indicated by polarization and time difference from the trigger points P100, N30, P0, N50, P155 and N320. The EEG pattern was independent of the direction, type of target and whether the eyes were open or closed. In contrast, the evoked response, especially P155, was dependent on the chosen trigger point and acceleration. P155 was the most stable and significant component of the evoked potentials. Thus, we chose P155 as the reference for studying patients with vertigo. DISCUSSION: In peripheral vestibular disorders, cerebellar and diffuse supratentorial cerebral lesions and P155 latencies remain non-significantly altered. However, P155 latencies significantly increase in pontine lesions homolaterally, and space occupying tumors contralaterally. CONCLUSION: Active horizontal head rotations differentially stimulate the vestibulocortical pathways and may contribute to the analysis of vertigo.

Adult↗
PubMedDate not supplied

Myofascial pain syndromes in the upper extremity.

Myofascial pain syndromes of the upper extremity are common causes of pain that may follow trauma and are associated with acute or chronic musculoskeletal stress. The syndromes are characterized by the presence of the myofascial trigger point, a physical finding that is reliably identified by palpation. Local and referred pain are hallmarks of the syndrome, and the referred pain patterns may mimic such conditions as radiculopathy and nerve entrapment syndromes. Treatment is directed toward inactivating the myofascial trigger point, correcting underlying perpetuating factors, and restoring the normal relationships between the muscles of the affected functional motor units.

Arm↗
PubMed2003

Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation.

BACKGROUND AND OBJECTIVES: The efficacy of low level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. Our aim was to clarify the effect of LLLT in MPS by using algometry and thermography. STUDY DESIGN/MATERIALS AND METHODS: Sixty-two patients with MPS having an active trigger point in the neck or upper back region were randomly divided into two equal groups according to therapy applied (group 1: LLLT + stretching exercises, group 2: stretching exercises alone). The outcome measures were pain measured with visual analogue scale (VAS), algometry on the trigger point, algometric difference, thermographic difference, and thermal asymmetry. Comparison was made within and between the groups pre- and post-therapeutically and 3 weeks after therapy. RESULTS: Mean pain values decreased more significantly in group 1 from baseline to 3 weeks follow up (7.54-3.06) while these values were 7.03-5.19 in group 2 (P < 0.05). Group comparisons revealed significant favorable differences in group 1 patients in terms of all other parameters at the first and the second evaluation post therapeutically (P < 0.05). CONCLUSIONS: LLLT seemed to be beneficial for pain in MPS by using algometry and thermography.

Adult↗
PubMed2003

Myofascial pain from pectoralis major following trans-axillary surgery.

This is the first reported description, to the author's knowledge, of myofascial pain occurring at a surgical drain site. The patient consulted a medical acupuncturist after suffering five months of continuous chest and arm pain associated with 'tingling' in the forearm and hand. She had undergone trans-axillary resection of the first left rib following a left axillary vein thrombosis 18 months previously. Her symptoms had been principally attributed to nerve traction at surgery or nerve root entrapment from scar tissue. However, the drain passed through the free border of pectoralis major, and the myofascial trigger point that appeared to develop as a result of the muscle trauma, or the pain at that site, presented as a chronic and complex post-surgical pain problem. The pain and tingling resolved completely after two sessions of dry needling at a single myofascial trigger point in the free border of the left pectoralis major muscle.

Acupuncture Analgesia↗
PubMed1989

Iliopsoas myofascial dysfunction: a treatable cause of "failed" low back syndrome.

Most patients with low back pain experience loss of spinal and hip extension range of motion. The limitation appears to involve significant iliopsoas myofascial dysfunction manifested in tenderness, as shown by deep abdominal palpation of the psoas muscle, hip flexor contracture, pain elicited by the stretch maneuver of the spine and hip, and relative weakness of the psoas muscle when tested manually. These signs assisted in identifying the source of low back pain in six patients who had failed to respond to prior treatment. Therapy consisted of iliopsoas trigger point treatment using a dry needling technique, followed by self-administered postisometric relaxation exercise of the iliopsoas. In all cases, marked improvement of hip and spine extension, dramatic reduction of pain, and return to normal activity resulted. Given the low risk-to-benefit ratio, trigger point treatment is indicated in "failed back syndrome" and chronic low back pain after conservative therapy or surgery have been tried without success.

Abdominal Muscles↗
PubMed2002

Focused review: myofascial pain.

Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The appropriate evaluation and management of myofascial pain is an important part of musculoskeletal rehabilitation of regional axial and limb pain syndromes. This article reviews the current hypotheses regarding the pathophysiology of myofascial trigger points and muscle pain. A critical evidence-based review of the pharmacologic, nonpharmacologic, alternative medicine, and exercise treatments of myofascial pain is provided, as well as future research directions. OVERALL LEARNING OBJECTIVE: To review critically the state of the art knowledge of myofascial pain, including pathophysiology and comprehensive management. Areas of future research are identified.

Humans↗
PubMed1997

Response of pain to static magnetic fields in postpolio patients: a double-blind pilot study.

OBJECTIVE: To determine if the chronic pain frequently presented by postpolio patients can be relieved by application of magnetic fields applied directly over an identified pain trigger point. DESIGN: Double-blind randomized clinical trial. SETTING: The postpolio clinic of a large rehabilitation hospital. PATIENTS: Fifty patients with diagnosed postpolio syndrome who reported muscular or arthritic-like pain. INTERVENTION: Application of active or placebo 300 to 500 Gauss magnetic devices to the affected area for 45 minutes. MAIN OUTCOME MEASURE: Score on the McGill Pain Questionnaire. RESULTS: Patients who received the active device experienced an average pain score decrease of 4.4 +/- 3.1 (p < .0001) on a 10-point scale. Those with the placebo devices experienced a decrease of 1.1 +/- 1.6 points (p < .005). The proportion of patients in the active-device group who reported a pain score decrease greater than the average placebo effect was 76%, compared with 19% in the placebo-device group (p < .0001). CONCLUSIONS: The application of a device delivering static magnetic fields of 300 to 500 Gauss over a pain trigger point results in significant and prompt relief of pain in postpolio subjects.

Chi-Square Distribution↗