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Tuckey B, Srbely J, Rigney G, Vythilingam M, Shah J. Impaired Lymphatic Drainage and Interstitial Inflammatory Stasis in Chronic Musculoskeletal and Idiopathic Pain Syndromes: Exploring a Novel Mechanism. FRONTIERS IN PAIN RESEARCH 2021; 2:691740. [PMID: 35295453 PMCID: PMC8915610 DOI: 10.3389/fpain.2021.691740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
A normal functioning lymphatic pump mechanism and unimpaired venous drainage are required for the body to remove inflammatory mediators from the extracellular compartment. Impaired vascular perfusion and/or lymphatic drainage may result in the accumulation of inflammatory substances in the interstitium, creating continuous nociceptor activation and related pathophysiological states including central sensitization and neuroinflammation. We hypothesize that following trauma and/or immune responses, inflammatory mediators may become entrapped in the recently discovered interstitial, pre-lymphatic pathways and/or initial lymphatic vessels. The ensuing interstitial inflammatory stasis is a pathophysiological state, created by specific pro-inflammatory cytokine secretion including tumor necrosis factor alpha, interleukin 6, and interleukin 1b. These cytokines can disable the local lymphatic pump mechanism, impair vascular perfusion via sympathetic activation and, following transforming growth factor beta 1 expression, may lead to additional stasis through direct fascial compression of pre-lymphatic pathways. These mechanisms, when combined with other known pathophysiological processes, enable us to describe a persistent feed-forward loop capable of creating and maintaining chronic pain syndromes. The potential for concomitant visceral and/or vascular dysfunction, initiated and maintained by the same feed-forward inflammatory mechanism, is also described.
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Affiliation(s)
- Brian Tuckey
- Department of Physical Therapy, Tuckey and Associates Physical Therapy, Frederick, MD, United States
| | - John Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, ON, Canada
| | - Grant Rigney
- Department of Psychiatry, Oxford University, Oxford, United Kingdom
| | - Meena Vythilingam
- Department of Health and Human Services, Center for Health Innovation, Office of the Assistant Secretary for Health, Washington, DC, United States
| | - Jay Shah
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
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Ultrasound-Guided Inactivation of Trigger Points Combined with Muscle Fascia Stripping by Liquid Knife in Treatment of Postherpetic Neuralgia Complicated with Abdominal Myofascial Pain Syndrome: A Prospective and Controlled Clinical Study. Pain Res Manag 2020; 2020:4298509. [PMID: 32509046 PMCID: PMC7251458 DOI: 10.1155/2020/4298509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
Objective To evaluate ultrasound-guided inactivation of myofascial trigger points (MTrPs) combined with abdominal muscle fascia stripping by liquid knife in the treatment of postherpetic neuralgia (PHN) complicated with abdominal myofascial pain syndrome (AMPS). Methods From January 2015 to July 2018, non-head-and-neck PHN patients in the Pain Department, The First Affiliated Hospital of Soochow University, were treated with routine oral drugs and weekly paraspinal nerve block for two weeks. Patients with 2 < VAS (visual analogue scale) score < 6 were subjects of the study. They were assigned into control group 1 (C1, n = 33) including those with PHN and without myofascial pain syndrome (MPS) and control group 2 (C2, n = 33) including those with PHN complicated with MPS and observation group 1 (PL, n = 33) including those with PHN complicated with limb myofascial pain syndrome (LMPS) and observation group 2 (PA, n = 33) including those with PHN complicated with AMPS. All groups received zero-grade treatment: routine oral drugs and weekly paraspinal nerve block. PL and PA groups were also treated step by step once a week: primary ultrasound-guided inactivation of MTrPs with dry needling, secondary ultrasound-guided inactivation of MTrPs with dry and wet needling, and tertiary ultrasound-guided dry and wet needling combined with muscle fascia stripping by liquid knife. At one week after primary treatment, patients with a VAS score > 2 proceeded to secondary treatment. If the VAS score was <2, the treatment was maintained, and so on, until the end of the four treatment cycles. Pain assessment was performed by specialized nurses at one week after each treatment, including VAS score, McGill pain questionnaire (MPQ) score, pressure pain sensory threshold (PPST), and pressure pain tolerance threshold (PPTT). VAS score was used as the main index and VAS <2 indicated effective treatment. At 3 months after treatment, outpatient and/or telephone follow-up was performed. The recurrence rate was observed and VAS > 2 was regarded as recurrence. Results At one week after primary treatment, the effective rate was 66.7% in PL group, significantly higher than that in PA group (15.2%, P < 0.05). At one week after secondary treatment, the effective rate was 100% and 37.5% in PL and PA groups, respectively, with significant difference between the groups (P < 0.05). The effective rate increased to 90.6% in PA group at one week after tertiary treatment. At one week after the end of treatment cycles, the scores of VAS and MPQ were significantly lower in C1, PL, and PA groups than in C2 group (P < 0.05), while PPST and PPTT were significantly higher than in C2 group (P < 0.05). There was no significant difference between C1 group and PL group (P > 0.05). At follow-up at 3 months after treatment, the recurrence rate was low in each group, with no significant difference between the groups (P > 0.05). Conclusion About 57% of PHN patients with mild to moderate pain are complicated with MPS, and ultrasound-guided inactivation of MTrPs with dry and wet needling can effectively treat PHN patients complicated with LMPS. However, patients with PHN complicated with AMPS need to be treated with ultrasound-guided MTrPs inactivation combined with muscle fascia stripping by liquid knife as soon as possible.
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Moon DH, Park J, Kang DY, Lee HS, Lee S. Intramuscular stimulation as a novel alternative method of pain management after thoracic surgery. J Thorac Dis 2019; 11:1528-1535. [PMID: 31179096 DOI: 10.21037/jtd.2019.03.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to determine whether electrical twitch-obtaining intramuscular stimulation (ETOIMS) can be an alternative to intravenous patient-controlled analgesia (IV-PCA) for postoperative pain management in pneumothorax patients undergoing single-port video-assisted thoracoscopic surgery (VATS). Methods This preliminary prospective randomized study was conducted between March 2017 and July 2017. A total of 26 patients undergoing single-port VATS were randomly assigned to two groups: the ETOIMS group (n=12), which received intramuscular stimulation prior to chest tube insertion toward the end of procedure, and the IV-PCA group (n=14), which received continuous infusion of fentanyl with a basal rate of 10 µg/mL/h. To measure postoperative pain, visual analogue scale (VAS; range, 0-10) was used as the primary endpoint. Results Baseline characteristics were not different between the two groups. According to the linear mixed model, there was statistical difference in the serial VAS score between the two groups (P=0.007). The ETOIMS group showed a significantly lower VAS score compared with the IV-PCA group, especially at postoperatively hour 8, day 1, and day 2. Conclusions We showed that ETOIMS may be a safe, effective, and simple alternative for pain management after single-port VATS.
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Affiliation(s)
- Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Du-Young Kang
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Hong CZ. Myofascial Trigger Points: Pathophysiology and Correlation with Acupuncture Points. Acupunct Med 2018. [DOI: 10.1136/aim.18.1.41] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A review is made of recent studies on myofascial trigger points (MTrP) and their mechanism is discussed. Clinical and basic science studies have shown that there are multiple MTrP loci in a MTrP region. A MTrP locus contains a sensory component (sensitive locus) and a motor component (active locus). A sensitive locus is a point from which tenderness or pain, referred pain, and local twitch response can be elicited by mechanical stimulation. Sensitive loci (probably sensitised nociceptors) are widely distributed in the whole muscle, but are concentrated in the endplate zone. An active locus is a site from which spontaneous electrical activity can be recorded. Active loci appear to be dysfunctional endplates since spontaneous electrical activity is essentially the same as the electrical activity reported by neurophysiologists as that recorded from an abnormal endplate. A MTrP is always found in a taut band which is histologically related to contraction knots caused by excessive release of acetylcholine in abnormal endplates. Both referred pain and local twitch response are mediated through spinal cord mechanisms, as demonstrated in both human and animal studies. The pathogenesis of MTrPs appears to be related to integration in the spinal cord of response to the disturbance of nerve endings and abnormal contractile mechanism at multiple dysfunctional endplates. There are many similarities between MTrPs and acupuncture points including their location and distribution, pain and referred pain patterns, local twitch responses (de qi), and possible spinal cord mechanism.
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Affiliation(s)
- Chang-Zern Hong
- Department of Physical Medicine and Rehabilitation, University of California Irvine, Irvine, California, USA and Department of Rehabilitation Medicine, National Cheng-Kung University, Tainan, Taiwan
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Michels T, Ahmadi S, Graf N. Treatment of peripheral pain with low-dose local anesthetics by epidermal, epithelial and periosteal application. Local Reg Anesth 2018; 11:129-136. [PMID: 30588085 PMCID: PMC6294063 DOI: 10.2147/lra.s151316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The efficiency of local anesthetics (LAs) in the treatment of peripheral pain is commonly attributed to their capacity to block the axon conduction of sensory nerves. LAs even in non-blocking concentration suppress oscillations of the resting membrane potential. Spiking in sensory neurons is triggered by subthreshold membrane potential oscillations (SMPOs), which reach threshold and is maintained by depolarizing impulse after oscillations. The suppression of these oscillations abolishes sustained afferent discharge in sensory nerves without blocking the axon conduction. In a retrospective observational study, we examined if LAs in low concentration and very small quantities could reduce peripheral pain in patients. Design During a period of 2 years, a total of 127 consecutive patients, 43 with cervico-brachial, 12 with intercostal and 72 with lumbo-sciatic pain received an identical treatment, which consisted of LAs applied in 4–8 sessions on average to a fixed set of epidermal, epithelial and periosteal locations. The primary outcome was relief of symptoms measured by verbal analog scales at the end of therapy. Results At the end of therapy, 53 (41.7%) of all patients (127) had a complete remission (reduction of pain 100%). Twenty-three patients (18.1%) had a partial remission with >90% reduction of pain and 50 patients (39.4%) had a pain reduction of 30%–90%. One patient did not respond. Conclusion LAs in low concentration and small quantities proved to be highly efficient in the treatment of peripheral pain. An almost complete remission could be obtained in a majority of patients. Given the extent of pain reduction achieved, the method of application seems to be of major importance.
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Affiliation(s)
| | - Seifollah Ahmadi
- Institute of Physiology II, University of Bonn, 53115 Bonn, Germany
| | - Nicole Graf
- Graf Biostatistics, CH-8400 Winterthur, Switzerland
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Chen LK, Arai H, Chen LY, Chou MY, Djauzi S, Dong B, Kojima T, Kwon KT, Leong HN, Leung EMF, Liang CK, Liu X, Mathai D, Pan JY, Peng LN, Poblete ERS, Poi PJH, Reid S, Tantawichien T, Won CW. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific. BMC Infect Dis 2017; 17:213. [PMID: 28298208 PMCID: PMC5353949 DOI: 10.1186/s12879-017-2198-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 01/09/2017] [Indexed: 02/05/2023] Open
Abstract
Background Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region. Methods We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines. Results From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation. Conclusions Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan. .,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-340 Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan
| | - Samsuridjal Djauzi
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Salemba Raya No. 6, Jakarta, 10430, Indonesia
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Medical School/West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Renmin Nan Lu, Chengdu, Sichuan, 610041, China
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Jongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ki Tae Kwon
- Division of Infectious Diseases, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu, 710-600, Korea
| | - Hoe Nam Leong
- Rophi Clinic, 38 Irrawaddy Rd. #07-54/55, Mount Elizabeth Novena Specialist Centre, Singapore, 329563, Singapore
| | - Edward M F Leung
- Geriatric Medicine Centre (Healthy Ageing), Hong Kong Sanatorium and Hospital, 2 Village Rd. Happy Valley, Hong Kong S.A.R., China
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Xiaohong Liu
- Division of Geriatrics, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Dilip Mathai
- Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Jubilee Hills, Hyderabad, 500096, India
| | - Jiun Yit Pan
- National Skin Centre, 1 Mandalay Rd., Singapore, 308205, Singapore
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Eduardo Rommel S Poblete
- Geriatric Center, St. Luke's Medical Center, 279 E. Rodriguez Sr. Ave., Quezon City, 1102, Philippines
| | - Philip J H Poi
- Division of Geriatrics, Department of Medicine, University Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Stewart Reid
- Ropata Medical Centre, Lower Hutt, 5010, New Zealand
| | - Terapong Tantawichien
- Division of Infectious Diseases, Department of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, 1 Hoigi-dong, Dongdaemun-gu, Seoul, 130-720, Korea
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Sacramento LS, Camargo PR, Siqueira-Júnior AL, Ferreira JP, Salvini TF, Alburquerque-Sendín F. Presence of Latent Myofascial Trigger Points and Determination of Pressure Pain Thresholds of the Shoulder Girdle in Healthy Children and Young Adults: A Cross-sectional Study. J Manipulative Physiol Ther 2016; 40:31-40. [PMID: 27863792 DOI: 10.1016/j.jmpt.2016.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/06/2016] [Accepted: 10/04/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The primary objective of this study was to compare the number of myofascial trigger points (MTPs) and the pressure pain thresholds (PPTs) in the shoulder girdle, on the dominant and nondominant sides, between healthy children and adults. The secondary aim was to assess the correlations between the number of MTPs and the PPTs in these populations. METHODS A cross-sectional study was performed. Thirty-five children (aged 9.1 ± 1.7 years) and 35 adults (aged 23.4 ± 3.4 years) with no history of shoulder or cervical pathology were included. All participants were examined for MTPs in the shoulder muscles and assessed for PPTs in the neck, shoulder, and tibialis anterior. Parametric and nonparametric tests, effect sizes, and odds ratios were used to determine the differences between groups and sides. Spearman's σ test was used to assess correlations between latent MTPs (LTPs) and PPTs in each group. RESULTS Children had fewer LTPs than adults did (P = .03). The upper trapezius was the muscle with the largest number of LTPs, affecting 13 adults on the dominant side. Children had lower PPTs compared with adults (P < .05). Correlations between the number of LTPs (on both sides and in total) and PPTs were observed only in adults. CONCLUSIONS Healthy children have fewer LTPs and lower PPTs in the shoulder girdle than healthy adults. A relationship was observed between sensitivity to pressure and the presence of LTPs in adults, in whom lower PPT was associated with more LTPs. This relationship was not detected in children.
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Affiliation(s)
- Luciane S Sacramento
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula R Camargo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | | | - Jean P Ferreira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Tania F Salvini
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Francisco Alburquerque-Sendín
- Department of Nursing and Physical Therapy, University of Salamanca, Salamanca, Spain; Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.
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Kobayashi H, Shinoda Y, Ohki T, Kawano H. Intercostal neuralgia as a symptom of an osteoblastoma in thoracic spine. BMJ Case Rep 2015; 2015:bcr-2015-210720. [PMID: 26139654 DOI: 10.1136/bcr-2015-210720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An osteoblastoma is a benign bone lesion most commonly affecting the spine; it is frequently found in the posterior elements of the vertebra. When an osteoblastoma originates in the spine, it usually causes dull and localised dorsal pain, but the period between symptom development and diagnosis can be long. MRI shows intense peritumoural oedema accompanying the osteoblastoma. We present a case of a 15-year-old boy with osteoblastoma at the level of the T8-9 left laminae causing intercostal neuralgia without direct invasion to the intercostal nerve. Immediately after surgery, intercostal neuralgia was diminished. To our knowledge, this is the first case of an osteoblastoma with intercostal neuralgia, which is possibly the key symptom for diagnosing an osteoblastoma in the thoracic spine.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Orthopaedic, The University of Tokyo Hospital, Tokyo, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation, The University of Tokyo Hospital, Tokyo, Japan
| | - Takahiro Ohki
- Department of Orthopaedic, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic, The University of Tokyo Hospital, Tokyo, Japan
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Pain in chemotherapy-induced neuropathy--more than neuropathic? Pain 2013; 154:2877-2887. [PMID: 23999056 DOI: 10.1016/j.pain.2013.08.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/16/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022]
Abstract
Chemotherapy-induced neuropathy (CIN) is an adverse effect of chemotherapy. Pain in CIN might comprise neuropathic and nonneuropathic (ie, musculoskeletal) pain components, which might be characterized by pain patterns, electrophysiology, and somatosensory profiling. Included were 146 patients (100 female, 46 male; aged 56 ± 0.8 years) with CIN arising from different chemotherapy regimens. Patients were characterized clinically through nerve conduction studies (NCS) and quantitative sensory testing (QST). Questionnaires for pain (McGill) and anxiety/depression (Hospital Anxiety and Depression Scale) were supplied. Patients were followed-up after 17 days. Large- (61%) and mixed- (35%) fibre neuropathies were more frequent than small-fibre neuropathy (1.4%). The 5 major chemotherapeutic regimens impacted differently on large- but not on small-fibre function and did not predict painfulness. Chronic pain associated with CIN was reported in 41.7%. Painless and painful CIN did not differ in QST profiles or electrophysiological findings, but different somatosensory patterns were found in CIN subgroups (pain at rest [RestP], n = 25; movement-associated pain [MovP], n = 15; both pain characteristics [MovP+RestP], n = 21; or no pain [NonP], n = 85): small-fibre function (cold-detection threshold, CDT: z score: -1.46 ± 0.21, P < 0.01) was most impaired in RestP; mechanical hyperalgesia was exclusively found in MovP (z score: +0.81 ± 0.30, P < 0.05). "Anxiety" discriminated between painful and painless CIN; "CDT" and "anxiety" discriminated between patients with ongoing (RestP) and movement-associated pain (MovP) or pain components (MovP+RestP). The detrimental effect of chemotherapy on large fibres failed to differentiate painful from painless CIN. Patients stratified for musculoskeletal or neuropathic pain, however, differed in psychological and somatosensory parameters. This stratification might allow for the application of a more specific therapy.
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Dommerholt J, Bron C, Franssen J. Myofascial Trigger Points: An Evidence-Informed Review. J Man Manip Ther 2013. [DOI: 10.1179/106698106790819991] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Simons DG, Dommerholt J. Myofascial Trigger Points and Myofascial Pain Syndrome: A Critical Review of Recent Literature. J Man Manip Ther 2013. [DOI: 10.1179/jmt.2006.14.4.125e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Abstract
Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. Varicella zoster infection is almost universally prevalent, making prevention of acute herpes zoster (AHZ) infection and prompt diagnosis and aggressive management of PHN of critical importance. Despite the recent development of a herpes zoster vaccine, prevention of AHZ is not yet widespread or discussed in PHN treatment guidelines. Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. PHN pain is typically localized, unilateral and chronic, but may be constant, intermittent, spontaneous and/or evoked. PHN is likely to interfere with sleep and daily activities. First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch. Tricyclic antidepressants, gabapentinoids and strong opioids are effective but are also associated with systemic adverse events that may limit their use in many patients, most notably those with significant medical comorbidities or advanced age. Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. Given the low systemic drug exposure, adverse events with topical therapies are generally limited to application-site reactions, which are typically mild and transient with lidocaine 5 % patch, but may involve treatment-limiting discomfort with capsaicin cream or 8 % patch. Based on available clinical data, clinicians should consider administering the herpes zoster vaccine to all patients aged 60 years and older. Clinicians treating patients with PHN may consider a trial of lidocaine 5 % patch monotherapy before resorting to a systemic therapy, or alternatively, may consider administering the lidocaine 5 % patch in combination with a tricyclic antidepressant or a gabapentinoid to provide more rapid analgesic response and lower the dose requirement of systemic therapies.
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Affiliation(s)
- Srinivas Nalamachu
- International Clinical Research Institute, Inc., 8675 College Blvd, Suite 150, Overland Park, KS 66210 USA
| | - Patricia Morley-Forster
- Interdisciplinary Pain Program, University of Western Ontario, St. Josephs Hospital, Room B3-628, 268 Grosvenor Street, London, ON N6A 4V2 Canada
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Abstract
Myofascial pain syndrome presents a significant physical and financial burden to society. In view of the aging demographics, myofascial pain promises to be an even greater challenge to health care in the future. Myofascial trigger points have been identified as important anatomic and physiologic phenomena in the pathophysiology of myofascial pain. While their pathophysiologic mechanisms are still unclear, emerging research suggests that trigger points may be initiated by neurogenic mechanisms secondary to central sensitization, and not necessarily by local injury. A variety of treatments are employed in the management of trigger points, including manual therapy, electrotherapy, exercise, and needle therapy. Therapeutic ultrasound demonstrates significant potential as a safe, cost-effective, and relatively noninvasive therapeutic alternative in the treatment and management of this modern day medical enigma.
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Lin MT, Chen HS, Chou LW, Hong CZ. Treatment of Attachment Trigger Points in the Gluteal Muscles to Cure Chronic Gluteal Pain: A Case Report. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10582452.2010.538823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kang JH, Lee SK, Seo MB, Na JY, Jang JH, Kim KY. A Clinical Study of Intercostal Neuropathy after Rib Fracture. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.1.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jung-Hun Kang
- Department of Rehabilitation Medicine, College of Medicine, Chosun University
| | - Seog-Ki Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chosun University
| | - Min-Bum Seo
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chosun University
| | - Jeong-Yeop Na
- Department of Rehabilitation Medicine, College of Medicine, Chosun University
| | - Jae-Hyouk Jang
- Department of Rehabilitation Medicine, College of Medicine, Chosun University
| | - Kweon-Young Kim
- Department of Rehabilitation Medicine, College of Medicine, Chosun University
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Srbely JZ, Dickey JP, Bent LR, Lee D, Lowerison M. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. THE JOURNAL OF PAIN 2009; 11:636-43. [PMID: 20015704 DOI: 10.1016/j.jpain.2009.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 09/22/2009] [Accepted: 10/02/2009] [Indexed: 12/19/2022]
Abstract
UNLABELLED This study investigated whether inducing central sensitization evokes segmental increases in trigger point pressure sensitivity. We evoked central sensitization at the C(5) segment and validated its presence via mechanical cutaneous sensitivity (brush allodynia) testing. Trigger point pressure sensitivity was quantified using the pain pressure threshold (PPT) value. A 50 cm(2) area of the C(5) dermatome at the right lateral elbow was pretreated with 45 degrees heat for 10 minutes. Test subjects (n = 20) then received topical capsaicin cream (0.075%; Medicis, Toronto, Canada) to the C(5) dermatome, whereas control subjects (n = 20) received a topical placebo cream (Biotherm Massage, Montreal, Canada). PPT readings were recorded from the infraspinatus (C(5,6)) and gluteus medius (L(4,5)S(1)) trigger points at zero (pre-intervention), 10, 20, and 30 minutes after intervention; all PPT readings were normalized to pre-intervention (baseline) values. The difference between the PPT readings at the 2 trigger point sites represents the direct influence of segmental mechanisms on the trigger point sensitivity at the infraspinatus site (PPT(seg)). Test subjects demonstrated statistically significant increases in Total Allodynia scores and significant decreases in PPT(seg) at 10, 20, and 30 minutes after application, when compared with control subjects. These results demonstrate that increases in central sensitization evoke increases in trigger point pressure sensitivity in segmentally related muscles. PERSPECTIVE Myofascial pain is the most common form of musculoskeletal pain. Myofascial trigger points play an important role in the clinical manifestation of myofascial pain syndrome. Elucidating the role of central sensitization in the pathophysiology of trigger points is fundamental to developing optimal strategies in the management of myofascial pain syndrome.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.
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Hsieh YL, Kao MJ, Kuan TS, Chen SM, Chen JT, Hong CZ. Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. Am J Phys Med Rehabil 2007; 86:397-403. [PMID: 17449984 DOI: 10.1097/phm.0b013e31804a554d] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the changes in pressure pain threshold of the secondary (satellite) myofascial trigger points (MTrPs) after dry needling of a primary (key) active MTrP. DESIGN Single blinded within-subject design, with the same subjects serving as their own controls (randomized). Fourteen patients with bilateral shoulder pain and active MTrPs in bilateral infraspinatus muscles were involved. An MTrP in the infraspinatus muscle on a randomly selected side was dry needled, and the MTrP on the contralateral side was not (control). Shoulder pain intensity, range of motion (ROM) of shoulder internal rotation, and pressure pain threshold of the MTrPs in the infraspinatus, anterior deltoid, and extensor carpi radialis longus muscles were measured in both sides before and immediately after dry needling. RESULTS Both active and passive ROM of shoulder internal rotation, and the pressure pain threshold of MTrPs on the treated side, were significantly increased (P < 0.01), and the pain intensity of the treated shoulder was significantly reduced (P < 0.001) after dry needling. However, there were no significant changes in all parameters in the control (untreated) side. Percent changes in the data after needling were also analyzed. For every parameter, the percent change was significantly higher in the treated side than in the control side. CONCLUSIONS This study provides evidence that dry needle-evoked inactivation of a primary (key) MTrP inhibits the activity in satellite MTrPs situated in its zone of pain referral. This supports the concept that activity in a primary MTrP leads to the development of activity in satellite MTrPs and the suggested spinal cord mechanism responsible for this phenomenon.
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Affiliation(s)
- Yueh-Ling Hsieh
- Department of Physical Therapy, Hungkuang University, Salu, Taichung, Taiwan
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Abstract
OBJECTIVE To describe a series of older adult patients with postherpetic myofascial pain, a heretofore rarely described complication of herpes zoster. DESIGN Case series. SETTING Outpatient older adult pain clinic. PATIENTS Five older adults are presented with myofascial pain that developed as a complication of herpes zoster. RESULTS Pain duration at the time of presentation ranged from 4 months to 7 years. All patients reported functional impairment from pain despite oral analgesics. Myofascial pathology was diagnosed by the presence of taut bands and trigger points in the affected myotome. Upon successful treatment of the myofascial pain with nonpharmacologic modalities (e.g., physical therapy, trigger point injections, dry needling, and/or percutaneous electrical nerve stimulation), all patients reported symptomatic improvement, and four out of five were able to significantly reduce or discontinue their opioids. CONCLUSION Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon. Identification of the intrusion of a myofascial component may be worthwhile, both from the standpoint of enhanced pain relief and reduction in the need for oral analgesics. Formal exploration of this phenomenon is needed.
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Affiliation(s)
- Debra K Weiner
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15206, USA.
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Vilensky JA, Baltes M, Weikel L, Fortin JD, Fourie LJ. Serratus posterior muscles: anatomy, clinical relevance, and function. Clin Anat 2001; 14:237-41. [PMID: 11424195 DOI: 10.1002/ca.1039] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The serratus posterior superior and inferior muscles are generally considered clinically insignificant muscles that, based on attachments, probably function in respiration. Interestingly, however, there is no evidence supporting a respiratory role for these muscles. In fact, some electromyographic data refute a respiratory function for these muscles. We suggest that the serratus posterior muscles function primarily in proprioception. Further, these muscles, especially the superior, have been implicated in myofascial pain syndromes and therefore may have greater clinical relevance than commonly attributed to them.
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Affiliation(s)
- J A Vilensky
- Department of Anatomy, Indiana University School of Medicine, Fort Wayne, Indiana 46805, USA.
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