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Sample records for chronically painful muscles

  1. Future perspectives: pathogenesis of chronic muscle pain.

    Science.gov (United States)

    Staud, Roland

    2007-06-01

    Chronic painful muscle conditions include non-inflammatory and inflammatory illnesses. This review is focused on chronic non-inflammatory pain conditions such as myofascial pain syndrome (MPS) and fibromyalgia syndrome (FM), and will not discuss metabolic, genetic or inflammatory muscle diseases such as McArdle's disease, muscular dystrophy, polymyositis, dermatomyositis, or inclusion body myositis.

  2. Muscle strength in patients with chronic pain

    NARCIS (Netherlands)

    van Wilgen, C.P.; Akkerman, L.; Wieringa, J.; Dijkstra, P.U.

    2003-01-01

    Objective: To analyse the influence of chronic pain on muscle strength. Design: Muscle strength of patients with unilateral nonspecific chronic pain, in an upper or lower limb, were measured according to a standardized protocol using a hand-held dynamometer. Before and after muscle strength measurem

  3. Increased proportion of megafibers in chronically painful muscles

    DEFF Research Database (Denmark)

    Andersen, Lars L; Suetta, Charlotte; Andersen, Jesper Løvind

    2008-01-01

    Trapezius myalgia - chronic pain from the upper trapezius muscle - is frequent in female employees in monotonous stressful jobs, potentially due to chronic overload of type I muscle fibers. In this study, we investigated the intra-individual distribution of trapezius muscle fiber size, and hypoth......Trapezius myalgia - chronic pain from the upper trapezius muscle - is frequent in female employees in monotonous stressful jobs, potentially due to chronic overload of type I muscle fibers. In this study, we investigated the intra-individual distribution of trapezius muscle fiber size...

  4. Single cell morphology of muscle in patients with chronic muscle pain

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Bartels, E M; Danneskiold-Samsøe, B

    1991-01-01

    In 119 patients referred with suspected fibromyalgia, biopsies from the quadriceps muscle were analyzed for "rubber band" morphology, and isokinetic quadriceps strength was measured. Eighty-four fulfilled the criteria for fibromyalgia, 26 had chronic myofascial pain (CMP) and 9 had other diseases...... to the biopsy score. "Rubber band" morphology is seen more often in fibromyalgia patients than in CMP patients. The exact genesis of this phenomenon is still unknown but theories connected with the possible pathogenesis of the syndrome are presented....

  5. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  6. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain

    OpenAIRE

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per ...

  7. Chronic Pain

    Science.gov (United States)

    ... a problem you need to take care of. Chronic pain is different. The pain signals go on ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis ...

  8. Torque-EMG-velocity relationship in female workers with chronic neck muscle pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Nielsen, Pernille K; Søgaard, Karen

    2008-01-01

    The present study investigated the effect of chronic neck muscle pain (defined as trapezius myalgia) on neck/shoulder muscle function during concentric, eccentric and static contraction. Forty-two female office workers with trapezius myalgia (MYA) and 20 healthy matched controls (CON) participated...

  9. Effect of contrasting physical exercise interventions on rapid force capacity of chronically painful muscles

    DEFF Research Database (Denmark)

    Andersen, Lars L; Andersen, Jesper L; Suetta, Charlotte

    2009-01-01

    as neural and muscular adaptations in women with chronic neck muscle pain. A group of employed women (n = 42) with a clinical diagnosis of trapezius myalgia participated in a 10-wk randomized controlled trial; specific strength training of the neck/shoulder muscles, general fitness training performed as leg...

  10. Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain.

    Science.gov (United States)

    Ylinen, Jari; Takala, Esa-Pekka; Kautiainen, Hannu; Nykänen, Matti; Häkkinen, Arja; Pohjolainen, Timo; Karppi, Sirkka-Liisa; Airaksinen, Olavi

    2004-10-01

    Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. The outcome was assessed by the self-rating questionnaires on neck pain (visual analogue scale, Vernon's disability index, Neck pain and disability index) and by measures of the passive range of movement (ROM) and maximal isometric neck muscle strength. No statistically significant correlation was found between perceived neck pain and the disability indices and the maximal isometric neck strength and ROM measures. However, the pain values reported during the strength tests were inversely correlated with the results of strength tests (r=-0.24 to -0.46), showing that pain was associated with decreased force production. About two-thirds of the patients felt pain during test efforts. Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.

  11. Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Ge, Hong-You; Arendt-Nielsen, Lars; Cuadrado, Maria Luz; Pareja, Juan A

    2007-05-01

    Referred pain and pain characteristics evoked from the upper trapezius muscle was investigated in 20 patients with chronic tension-type headache (CTTH) and 20 age- and gender-matched controls. A headache diary was kept for 4 weeks in order to confirm the diagnosis and record the pain history. Both upper trapezius muscles were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold (PPT) were recorded. The results show that referred pain was evoked in 85% and 50% on the dominant and non-dominant sides in CTTH patients, much higher than 55% and 25% in controls (P<0.01). Referred pain spread to the posterior-lateral aspect of the neck ipsi-lateral to the stimulated muscle in both patients and controls, with additional referral to the temple in most patients, but none in controls. Nearly half of the CTTH patients (45%) recognized the referred pain as their usual headache sensation, i.e. active TrPs. CTTH patients with active TrPs in the right upper trapezius muscle showed greater headache intensity and frequency, and longer headache duration than those with latent TrPs. CTTH patients with bilateral TrPs reported significantly decreased PPT than those with unilateral TrP (P<0.01). Our results showed that manual exploration of TrPs in the upper trapezius muscle elicited referred pain patterns in both CTTH patients and healthy subjects. In CTTH patients, the evoked referred pain and its sensory characteristics shared similar patterns as their habitual headache pain, consistent with active TrPs. Our results suggest that spatial summation of perceived pain and mechanical pain sensitivity exists in CTTH patients.

  12. Chronic pelvic pain arising from dysfunctional stabilizing muscles of the hip joint and pelvis.

    Science.gov (United States)

    Lee, Dae Wook; Lim, Chang Hun; Han, Jae Young; Kim, Woong Mo

    2016-10-01

    Chronic pelvic pain in women is a very annoying condition that is responsible for substantial suffering and medical expense. But dealing with this pain can be tough, because there are numerous possible causes for the pelvic pain such as urologic, gynecologic, gastrointestinal, neurologic, or musculoskeletal problems. Of these, musculoskeletal problem may be a primary cause of chronic pelvic pain in patients with a preceding trauma to the low back, pelvis, or lower extremities. Here, we report the case of a 54-year-old female patient with severe chronic pelvic pain after a transcutaneous electrical nerve stimulation (TENS) accident that was successfully managed with image-guided trigger point injections on several pelvic stabilizing muscles.

  13. Clinical features in patients with chronic muscle pain--with special reference to fibromyalgia

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Petersen, I S; Danneskiold-Samsøe, B

    1993-01-01

    Clinical characteristics were studied in patients with chronic muscle pain, divided into three groups according to the characteristics of their pain; "fibromyalgia" (n = 23), "widespread muscle pain" (n = 21), and "regional muscle pain" (n = 28). Typical fibromyalgia features were also seen...... in the other groups of patients, but not to the same extent. In particular, sleep disturbance, subjective swelling, cold and exercise intolerance and low self-reported physical performance were significantly related to fibromyalgia. The major components of fibromyalgia were not wholly different compared...... with other European and North American studies, except for sleep disturbance and subjective swelling, which was somewhat more pronounced in this study. The most used medications in fibromyalgia patients at referral were analgesics, anxiolytic drugs and female sex hormones. Medication in fibromyalgia...

  14. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain

    DEFF Research Database (Denmark)

    Loving, S; Thomsen, Thordis; Jaszczak, Poul P.

    2014-01-01

    BACKGROUND: No current standardized set of pelvic floor muscle (PFM) outcome measures have been specifically tested for their applicability in a general female chronic pelvic pain (CPP) population. We aimed to compare PFM function between a randomly selected population-based sample of women...

  15. Short Term Effects of Mobilization Techniques on Neck Pain and Deep Neck Flexor Muscle Endurance in Patients with Mechanical Chronic Neck Pain

    OpenAIRE

    Kılınç, Hasan Erkan; Harput, Gülcan; Baltacı, Gül; İnce, Deniz İnal

    2014-01-01

    Objectives: The aim of the study was to investigate short term effects of cervical and scapular mobilization techniques on neck pain and deep cervical muscles endurance in chronical mechanical neck pain patients. Methods: 22 chronical mechanic neck pain patients four male 18 female (mean age: mean±sd 35.59± 15.85) were included. Before treatment, neck pain level (visual analog scale) and deep neck flexor muscles endurance (in supine position with digital chronometer) of all patients were eval...

  16. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain.

    Science.gov (United States)

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain.

  17. Effect of brief daily resistance training on occupational neck/shoulder muscle activity in office workers with chronic pain

    DEFF Research Database (Denmark)

    Lidegaard, Mark; Jensen, Rene B; Andersen, Christoffer H

    2013-01-01

    PURPOSE: This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain. METHODS: 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance trai...

  18. Muscle activation during selected strength exercises in women with chronic neck muscle pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Kjaer, Michael; Andersen, Christoffer H

    2008-01-01

    .6 (range=3-8) on a scale of 0 to 9. METHOD: Electromyographic activity in the trapezius and deltoid muscles was measured during the exercises (lateral raises, upright rows, shrugs, one-arm rows, and reverse flys) and normalized to EMG activity recorded during a maximal voluntary static contraction (MVC......). RESULTS: For most exercises, the level of muscle activation was relatively high (>60% of MVC), highlighting the effectiveness and specificity of the respective exercises. For the trapezius muscle, the highest level of muscle activation was found during the shrug (102+/-11% of MVC), lateral raise (97......+/-6% of MVC), and upright row (85+/-5% of MVC) exercises, but the latter 2 exercises required smaller training loads (3-10 kg) compared with the shrug exercise (20-30 kg). DISCUSSION AND CONCLUSION: The lateral raise and upright row may be suitable alternatives to shrugs during rehabilitation of chronic neck...

  19. Exercise prevents development of autonomic dysregulation and hyperalgesia in a mouse model of chronic muscle pain.

    Science.gov (United States)

    Sabharwal, Rasna; Rasmussen, Lynn; Sluka, Kathleen A; Chapleau, Mark W

    2016-02-01

    Chronic musculoskeletal pain (CMP) conditions, like fibromyalgia, are associated with widespread pain and alterations in autonomic functions. Regular physical activity prevents the development of CMP and can reduce autonomic dysfunction. We tested if there were alterations in autonomic function of sedentary mice with CMP, and whether exercise reduced the autonomic dysfunction and pain induced by CMP. Chronic musculoskeletal pain was induced by 2 intramuscular injections of pH 5.0 in combination with a single fatiguing exercise task. A running wheel was placed into cages so that the mouse had free access to it for either 5 days or 8 weeks (exercise groups) and these animals were compared to sedentary mice without running wheels. Autonomic function and nociceptive withdrawal thresholds of the paw and muscle were assessed before and after induction of CMP in exercised and sedentary mice. In sedentary mice, we show decreased baroreflex sensitivity, increased blood pressure variability, decreased heart rate variability, and decreased withdrawal thresholds of the paw and muscle 24 hours after induction of CMP. There were no sex differences after induction of the CMP in any outcome measure. We further show that both 5 days and 8 weeks of physical activity prevent the development of autonomic dysfunction and decreases in withdrawal threshold induced by CMP. Thus, this study uniquely shows the development of autonomic dysfunction in animals with chronic muscle hyperalgesia, which can be prevented with as little as 5 days of physical activity, and suggest that physical activity may prevent the development of pain and autonomic dysfunction in people with CMP.

  20. An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain

    Directory of Open Access Journals (Sweden)

    Persson Ann L

    2011-10-01

    Full Text Available Abstract Background Neck-shoulder pain conditions, e.g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance. Methods Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP and 30 age-matched pain-free female control subjects (CON participated in the study. Results NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. Conclusion These results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.

  1. Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic low-back pain patients and controls.

    Science.gov (United States)

    Cassisi, J E; Robinson, M E; O'Conner, P; MacMillan, M

    1993-02-01

    The purpose of this study was to describe trunk strength and lumbar paraspinal muscle activity across five angles of flexion during isometric exercise and rest in chronic low-back pain patients and control subjects. High muscle tension as measured by surface integrated electromyography is predicted by a muscle spasm model, and low muscle tension is predicted by a muscle deficiency model. Prior lumbar surgery had no affect on peak torque or maximum surface integrated electromyography data. Both groups produced greater torque and less surface integrated electromyography in more flexed positions. Chronic low-back pain patients exhibited lower peak torque and lower maximum surface integrated electromyography bilaterally during isometric extension effort across all angles. A muscle deficiency model of chronic low back pain was supported by these data and a muscle spasm model was not supported. Discriminant analyses indicated that monitoring maximum surface integrated electromyography of lumbar muscles during isometric effort facilitates classification of chronic low-back pain patients. Future directions are discussed in terms of applying psychophysiologic methods to pain rehabilitation.

  2. Chronic Pelvic Pain

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pelvic Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  3. Effect of two contrasting types of physical exercise on chronic neck muscle pain

    DEFF Research Database (Denmark)

    Andersen, L.L.; Kjær, Michael; Søgaard, Kirsten;

    2008-01-01

    Objective. The prevalence of neck muscle pain has steadily increased and especially pain from the descending part of the trapezius muscle has been associated with monotonous work tasks such as computer work. Physical exercise is generally recommended as treatment, but it is unclear which type...... of training is most effective. Our objective was to determine the effectiveness of specific strength training of the painful muscle versus general fitness training without direct involvement of the painful muscle (leg bicycling) on work-related neck muscle pain. Methods. We conducted a randomized controlled...

  4. Distribution of myogenic progenitor cells and myonuclei is altered in women with vs. those without chronically painful trapezius muscle

    DEFF Research Database (Denmark)

    Mackey, Abigail; Andersen, Lars L; Frandsen, Ulrik

    2010-01-01

    It is hypothesized that repeated recruitment of low-threshold motor units is an underlying cause of chronic pain in trapezius myalgia. This study investigated the distribution of satellite cells (SCs), myonuclei, and macrophages in muscle biopsies from the trapezius muscle of 42 women performing ...

  5. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

    Directory of Open Access Journals (Sweden)

    Stefan J. Friedrichsdorf

    2016-12-01

    Full Text Available Primary pain disorders (formerly “functional pain syndromes” are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1 rehabilitation; (2 integrative medicine/active mind-body techniques; (3 psychology; and (4 normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

  6. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints.

    Science.gov (United States)

    Friedrichsdorf, Stefan J; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A

    2016-12-10

    Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

  7. Effect of two contrasting types of physical exercise on chronic neck muscle pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Kjaer, Michael; Søgaard, Karen

    2008-01-01

    OBJECTIVE: The prevalence of neck muscle pain has steadily increased and especially pain from the descending part of the trapezius muscle has been associated with monotonous work tasks such as computer work. Physical exercise is generally recommended as treatment, but it is unclear which type of ...

  8. Chronic pelvic pain arising from dysfunctional stabilizing muscles of the hip joint and pelvis

    OpenAIRE

    2016-01-01

    Chronic pelvic pain in women is a very annoying condition that is responsible for substantial suffering and medical expense. But dealing with this pain can be tough, because there are numerous possible causes for the pelvic pain such as urologic, gynecologic, gastrointestinal, neurologic, or musculoskeletal problems. Of these, musculoskeletal problem may be a primary cause of chronic pelvic pain in patients with a preceding trauma to the low back, pelvis, or lower extremities. Here, we report...

  9. Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report

    DEFF Research Database (Denmark)

    Sørensen, Jens Christian Hedemann; Meier, Kaare; Perinpam, Larshan;

    Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report......Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report...

  10. Short Term Effects of Mobilization Techniques on Neck Pain and Deep Neck Flexor Muscle Endurance in Patients with Mechanical Chronic Neck Pain

    Science.gov (United States)

    Kılınç, Hasan Erkan; Harput, Gülcan; Baltacı, Gül; İnce, Deniz İnal

    2014-01-01

    Objectives: The aim of the study was to investigate short term effects of cervical and scapular mobilization techniques on neck pain and deep cervical muscles endurance in chronical mechanical neck pain patients. Methods: 22 chronical mechanic neck pain patients four male 18 female (mean age: mean±sd 35.59± 15.85) were included. Before treatment, neck pain level (visual analog scale) and deep neck flexor muscles endurance (in supine position with digital chronometer) of all patients were evaluated. Cyriax cervical mobilization for 10 minutes and scapular mobilization for 10 repetition 10 sets were performed to patients as treatment protocol. After treatment, 24 hours after and a week after evaluations of neck pain and deep cervical muscles endurance were repeated. Results: Before treatment Neck pain Visual Analog Scale scores was 5.78±1.43 point, 2.80±1.99 point after treatment, 24 hours later 3.36±2.12 point, one week later 3.91±2.24 point. This alteration was found significant statistically (p<0.01). Before treatment deep cervical flexor muscle endurance score was 27.25±17.74 sec, after treatment 39.46±25.20 sec, 24 hours later 38.67±28.43 and one week later 40.11±27.82 sec. This alteration was also found significant statistically (p=0.01). Conclusion: Initially neck pain scores in our subjects decreased quickly, after 24 hours these scores increased but last scores were below first neck pain level in a week follow-up. Deep neck cervical flexor muscles test scores also increased quickly, after 24 hours later this scores were stable along a week. Mobilization techniques are effective methods on neck pain and endurance in chronical mechanic neck pain patients.

  11. Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Pavlos Bobos

    2016-01-01

    Full Text Available Background. We need to understand more about how DNF performs in different contexts and whether it affects the pain threshold over myofascial trigger points (MTrPs. Purpose. The objectives were to investigate the effect of neck muscles training on disability and pain and on pain threshold over MTrPs in people with chronic neck pain. Methods. Patients with chronic neck pain were eligible for participation with a Neck Disability Index (NDI score of over 5/50 and having at least one MTrP on either levator scapulae, upper trapezoid, or splenius capitis muscle. Patients were randomly assigned into either DNF training, superficial neck muscle exercise, or advice group. Generalized linear model (GLM was used to detect differences in treatment groups over time. Results. Out of 67 participants, 60 (47 females, mean age: 39.45 ± 12.67 completed the study. Neck disability and neck pain were improved over time between and within groups (p<0.05. However, no differences were found within and between the therapeutic groups (p<0.05 in the tested muscles’ PPTs and in cervicothoracic angle over a 7-week period. Conclusion. All three groups improved over time. This infers that the pain pathways involved in the neck pain relief are not those involved in pain threshold.

  12. Muscle activation during selected strength exercises in women with chronic neck muscle pain

    DEFF Research Database (Denmark)

    Andersen, L.L.; Kjaer, M.; Andersen, C.H.

    2008-01-01

    contraction (MVC). Results. For most exercises, the level of muscle activation was relatively high (>60% of MVC), highlighting the effectiveness and specificity of the respective exercises. For the trapezius muscle, the highest level of muscle activation was found during the shrug (102 +/- 11% of MVC......), lateral raise (97+/-6% of MVC), and upright row (85 +/- 5% of MVC) exercises, but the latter 2 exercises required smaller training loads (3-10 kg) compared with the shrug exercise (20-30 kg). Discussion and Conclusion. The lateral raise and upright row may be suitable alternatives to shrugs during...

  13. Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures.

    Science.gov (United States)

    Miura, Takuya; Yamanaka, Masanori; Ukishiro, Kengo; Tohyama, Harukazu; Saito, Hiroshi; Samukawa, Mina; Kobayashi, Takumi; Ino, Takumi; Takeda, Naoki

    2014-12-01

    The aim of this study was to evaluate the thickness of the transversus abdominis (TrA) muscle in three basic postures in subjects with and without chronic low back pain. Subjects were classified into a chronic low back pain group (n = 27) and a healthy control group (n = 23). The thickness of the TrA muscle was measured at rest and during the abdominal drawing-in manoeuvre (ADIM) in supine, sitting and standing postures using B-mode ultrasound imaging. Contraction ratio (TrA thickness during the ADIM/TrA thickness at rest) was calculated for each posture. At rest, the TrA thickness in the sitting and standing postures was significantly greater than in the supine posture (p contraction ratio was also significantly higher in the control group than in the chronic low back pain group in all three postures. These results indicate that the automatic postural contraction of the TrA observed in the control subjects in the sitting and standing postures was not demonstrated in subjects with chronic low back pain. The present study revealed the one aspect of different response of the TrA muscle to changing posture between two groups.

  14. Changed activation, oxygenation, and pain response of chronically painful muscles to repetitive work after training interventions: a randomized controlled trial

    DEFF Research Database (Denmark)

    Søgaard, Karen; Blangsted, Anne Katrine; Nielsen, Pernille Kofoed;

    2012-01-01

    The aim of this randomized controlled trial was to assess changes in myalgic trapezius activation, muscle oxygenation, and pain intensity during repetitive and stressful work tasks in response to 10 weeks of training. In total, 39 women with a clinical diagnosis of trapezius myalgia were randomly...... assigned to: (1) general fitness training performed as leg-bicycling (GFT); (2) specific strength training of the neck/shoulder muscles (SST) or (3) reference intervention without physical exercise. Electromyographic activity (EMG), tissue oxygenation (near infrared spectroscopy), and pain intensity were...... to improved oxygenation of the painful muscles. SST lowered the overall level of pain both during rest and work, possibly due to a lowered relative exposure as evidenced by a lowered relative EMG. The results demonstrate differential adaptive mechanisms of contrasting physical exercise interventions...

  15. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.

    Science.gov (United States)

    Jeong, Ui-Cheol; Sim, Jae-Heon; Kim, Cheol-Yong; Hwang-Bo, Gak; Nam, Chan-Woo

    2015-12-01

    [Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period.

  16. Isokinetic imbalance of adductor-abductor hip muscles in professional soccer players with chronic adductor-related groin pain.

    Science.gov (United States)

    Belhaj, K; Meftah, S; Mahir, L; Lmidmani, F; Elfatimi, A

    2016-11-01

    This study aims to compare the isokinetic profile of hip abductor and adductor muscle groups between soccer players suffering from chronic adductor-related groin pain (ARGP), soccer players without ARGP and healthy volunteers from general population. Study included 36 male professional soccer players, who were randomly selected and followed-up over two years. Of the 21 soccer players eligible to participate in the study, 9 players went on to develop chronic ARGP and 12 players did not. Ten healthy male volunteers were randomly selected from the general population as a control group. Comparison between the abductor and adductor muscle peak torques for players with and without chronic ARGP found a statistically significant difference on the dominant and non-dominant sides (p muscle significantly stronger than the adductor muscle. In the group of healthy volunteers, the adductor muscle groups were significantly stronger than the abductor muscle groups on both dominant and non-dominant sides (p muscle strength was also significantly decreased on the affected side. This imbalance appears to be a risk factor for adductor-related groin injury. Therefore, restoring the correct relationship between these two agonist and antagonist hip muscles may be an important preventative measure that should be a primary concern of training and rehabilitation programmes.

  17. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.

    Science.gov (United States)

    Fernández-de-las-Peñas, César; Fernández-Mayoralas, Daniel M; Ortega-Santiago, Ricardo; Ambite-Quesada, Silvia; Palacios-Ceña, Domingo; Pareja, Juan A

    2011-02-01

    Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

  18. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies Udgivelsesdato: 2008/3...

  19. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  20. The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain.

    Science.gov (United States)

    Mohseni-Bandpei, Mohammad A; Rahmani, Nahid; Behtash, Hamid; Karimloo, Masoud

    2011-01-01

    Dysfunction of spinal stability seems to be one of the causes of low back pain (LBP). It is thought that a large number of muscles have a role in spinal stability including the pelvic floor muscle (PFM). The purpose of this study was to investigate the effect of PFM exercise in the treatment of chronic LBP. After ethical approval, a randomized controlled clinical trial was carried out on 20 women with chronic LBP. Patients were randomly allocated into two groups: an experimental and a control group. The control group was given routine treatment including electrotherapy and general exercises; and the experimental group received routine treatment and additional PFM exercise. Pain intensity, functional disability and PFM strength and endurance were measured before, immediately after intervention and at 3 months follow-up. In both groups pain and functional disability were significantly reduced following treatment (p0.05). All measurements were improved in both groups (p<0.01) although patients in the experimental group showed greater improvement in PFM strength and endurance (p<0.01). It seems that the PFM exercise combined with routine treatment was not superior to routine treatment alone in patients with chronic LBP.

  1. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain

    Energy Technology Data Exchange (ETDEWEB)

    Laasonen, E.M.

    1984-01-01

    After surgery necessitated by lumbar back pain syndromes, radiolucency verified by CT may appear in the sacrospinal muscle group on the operate side. This radiolucency represents muscular atrophy and is in its most severe form a result of the replacement of muscle tissue with adipose tissue. Such muscular atrophy appeared in the present series in 31 out of all 156 patients (19.9%) and in 29 out of 94 patients operated on because of radiating lumbar back pain (30.9%). The radiological appearance, extent, and HU values of this muscular atrophy are presented in detail. Only weak correlations with the multitude of clinical symptoms and signs were found in this retrospective study. The effects of irreversible muscular atrophy on the indications for surgery and physiotherapy are discussed.

  2. High-Intensity Strength Training Improves Function of Chronically Painful Muscles: Case-Control and RCT Studies

    Directory of Open Access Journals (Sweden)

    Lars L. Andersen

    2014-01-01

    Full Text Available Aim. This study investigates consequences of chronic neck pain on muscle function and the rehabilitating effects of contrasting interventions. Methods. Women with trapezius myalgia (MYA, n=42 and healthy controls (CON, n=20 participated in a case-control study. Subsequently MYA were randomized to 10 weeks of specific strength training (SST, n=18, general fitness training (GFT, n=16, or a reference group without physical training (REF, n=8. Participants performed tests of 100 consecutive cycles of 2 s isometric maximal voluntary contractions (MVC of shoulder elevation followed by 2 s relaxation at baseline and 10-week follow-up. Results. In the case-control study, peak force, rate of force development, and rate of force relaxation as well as EMG amplitude were lower in MYA than CON throughout all 100 MVC. Muscle fiber capillarization was not significantly different between MYA and CON. In the intervention study, SST improved all force parameters significantly more than the two other groups, to levels comparable to that of CON. This was seen along with muscle fiber hypertrophy and increased capillarization. Conclusion. Women with trapezius myalgia have lower strength capacity during repetitive MVC of the trapezius muscle than healthy controls. High-intensity strength training effectively improves strength capacity during repetitive MVC of the painful trapezius muscle.

  3. High-intensity strength training improves function of chronically painful muscles

    DEFF Research Database (Denmark)

    Andersen, Lars L; Andersen, Christoffer H; Skotte, Jørgen H

    2014-01-01

    randomized to 10 weeks of specific strength training (SST, n = 18), general fitness training (GFT, n = 16), or a reference group without physical training (REF, n = 8). Participants performed tests of 100 consecutive cycles of 2 s isometric maximal voluntary contractions (MVC) of shoulder elevation followed...... by 2 s relaxation at baseline and 10-week follow-up. RESULTS: In the case-control study, peak force, rate of force development, and rate of force relaxation as well as EMG amplitude were lower in MYA than CON throughout all 100 MVC. Muscle fiber capillarization was not significantly different between...... capacity during repetitive MVC of the trapezius muscle than healthy controls. High-intensity strength training effectively improves strength capacity during repetitive MVC of the painful trapezius muscle....

  4. The relationship between superficial muscle activity during the cranio-cervical flexion test and clinical features in patients with chronic neck pain.

    Science.gov (United States)

    O'Leary, Shaun; Falla, Deborah; Jull, Gwendolen

    2011-10-01

    Changes in motor behavior are a known feature of chronic mechanical neck pain disorders. This study examined the strength of the association between reported levels of pain and disability from 84 individuals (63 women, 21 men) with chronic mechanical neck pain and levels of electromyographic activity recorded from superficial cervical flexor (sternocleidomastoid; SCM and anterior scalene; AS) muscles during progressive stages of the cranio-cervical flexion muscle test. A significant positive association was observed between superficial muscle activity and pain intensity (P 0.5) or perceived disability (P > 0.21). The strongest relationship between pain intensity and superficial muscle activity occurred at the final increment of the cranio-cervical flexion test (inner-range test position) for both the SCM and AS muscles (R(2) = 0.16). Although a positive and significant relationship between pain intensity and superficial muscle activity was shown, the relationship was only modest (16% explained variance), indicating that multiple factors contribute to the altered motor function observed in individuals with chronic mechanical neck pain.

  5. Lumbar and abdominal muscle activity during walking in subjects with chronic low back pain: Support of the “guarding” hypothesis?

    NARCIS (Netherlands)

    Hulst, van der M.; Vollenbroek-Hutten, M.M.R.; Rietman, J.S.; Hermens, H.J.

    2010-01-01

    It has been hypothesized that changes in trunk muscle activity in chronic low back pain (CLBP) reflect an underlying “guarding” mechanism, which will manifest itself as increased superficial abdominal – and lumbar muscle activity. During a functional task like walking, it may be further provoked at

  6. [Myofascial pain syndrome--fascial muscle pain].

    Science.gov (United States)

    Partanen, Juhani; Ojala, Tuula; Arokoski, Jari P A

    2010-01-01

    Symptoms of myofascial pain syndrome, i.e. fascial muscle pain may occur in several areas of the body, particularly in the neck-shoulder region. The muscle pain symptom in the neck-shoulder region is commonly termed tension neck pain or nonspecific neck pain, but myofascial pain syndrome can also be distinguished into its own diagnosis. This review deals with the clinical picture of myofascial pain syndrome along with pathophysiological hypotheses and treatment options.

  7. The effectiveness of cervical adjustment therapy, dry needling of the levator scapulae muscle and the combination of the two in the treatment of chronic mechanical neck pain

    OpenAIRE

    2011-01-01

    M.Tech. The aim of this study was to compare the effectiveness of cervical adjustment therapy, dry needling of the levator scapulae muscle and a combination of the two in the treatment of chronic mechanical neck pain. Forty-five patients were recruited via posters and advertisements from in and around the University of Johannesburg. The participants had to present with bilateral neck pain, decreased range of motion and an active levator scapulae muscles trigger point, which was diagnosed u...

  8. Effect of physical training on function of chronically painful muscles: A randomized controlled trial

    DEFF Research Database (Denmark)

    Andersen, Lars L; Andersen, Christoffer H; Zebis, Mette K

    2008-01-01

    and electromyography (EMG) were recorded during maximal shoulder abductions in an isokinetic dynamometer at -60, 60, 0 and 180 degrees (.)s(-1). Further, a submaximal reference contraction with only the load of the arms was performed. Results: Significant changes were observed only in SST. Pain decreased 42-49% (P....01-0.05). While EMG activity of the unaffected deltoid remained unchanged during the maximal contractions, an increase in EMG amplitude (42-86%, P... during the reference contraction decreased significantly for both the trapezius and deltoid muscles (P

  9. 肌肉疲劳与慢性腰痛研究进展%Research Progress of Muscle Fatigue and Chronic Low Back Pain

    Institute of Scientific and Technical Information of China (English)

    唐能章; 陈少清; 林建平; 王诗忠

    2015-01-01

    慢性腰痛是骨科及康复学科常见的肌肉骨骼疾病,有关肌肉疲劳的研究有助于认识慢性腰痛的发病机制.腰部肌肉长期处于疲劳状态可导致慢性损伤,易疲劳性增加,肌肉耐力下降,最终可能导致腰痛.目前多采用表面肌电图研究慢性腰痛患者腰部肌肉功能的改变及慢性腰痛与肌肉疲劳之间的关系.%Chronic low back pain is a kind of common musculoskeletal disease in orthopedics department and rehabilitation subject, related study of muscle fatigue is helpful to understand pathogenesis of chronic low back pain. The long-term fatigue of waist muscles can lead to chronic injury, in-creasing fatigue and decreasing muscle endurance, which may eventually bring about low back pain. Surface electromyography is used to study the waist muscle function changes of patients with chronic low back pain and the relationship between chronic low back pain and muscle fatigue at pres-ent.

  10. Specific proteins of the trapezius muscle correlate with pain intensity and sensitivity – an explorative multivariate proteomic study of the trapezius muscle in women with chronic widespread pain

    Directory of Open Access Journals (Sweden)

    Olausson P

    2016-06-01

    Full Text Available Patrik Olausson, Bijar Ghafouri, Nazdar Ghafouri, Björn Gerdle Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Abstract: Chronic widespread pain (CWP including fibromyalgia syndrome (FMS has a high prevalence and is associated with prominent negative consequences. CWP/FMS exhibits morphological and functional alterations in the central nervous system. The importance of peripheral factors for maintaining the central alterations are under debate. In this study, the proteins from biopsies of the trapezius muscle from 18 female CWP/FMS patients and 19 healthy female controls were analyzed. Pain intensity and pressure pain thresholds (PPT over the trapezius muscles were registered. Twelve proteins representing five different groups of proteins were important regressors of pain intensity in CWP/FMS (R2=0.99; P<0.001. In the regression of PPT in CWP/FMS, it was found that 16 proteins representing six groups of proteins were significant regressors (R2=0.95, P<0.05. Many of the important proteins were stress and inflammation proteins, enzymes involved in metabolic pathways, and proteins associated with muscle damage, myopathies, and muscle recovery. The altered expression of these proteins may reflect both direct and indirect nociceptive/inflammatory processes as well as secondary changes. The relative importance of the identified proteins and central alterations in CWP need to be investigated in future research. Data from this and the previous study concerning the same cohorts give support to the suggestion that peripheral factors are of importance for maintaining pain aspects in CWP/FMS. Keywords: chronic widespread pain, proteomics, biomarkers, multivariate data analysis, pain threshold, numeric rating scale

  11. Individuals with chronic low back pain demonstrate delayed onset of the back muscle activity during prone hip extension.

    Science.gov (United States)

    Suehiro, Tadanobu; Mizutani, Masatoshi; Ishida, Hiroshi; Kobara, Kenichi; Osaka, Hiroshi; Watanabe, Susumu

    2015-08-01

    Prone hip extension (PHE) is commonly used in the evaluation of the stability of the lumbopelvic region. There is little evidence of difference in muscle activity onset timing between healthy individuals and individuals with chronic low back pain (CLBP) during PHE. The purpose of this study was to determine if individuals with and without CLBP differ in the onset time of the trunk and hip extensor muscles activity during PHE. The participants were 20 patients with CLBP and 20 healthy individuals. Electromyography data of the erector spinae, multifidus, gluteus maximus, and semitendinosus were collected during PHE using a surface electromyograph. Relative differences in the onset times between each muscle and the prime mover (i.e., the semitendinosus) were calculated. The onsets of the bilateral multifidus and contralateral erector spinae were significantly delayed in the CLBP group compared with the healthy group (pleg movement not being significantly different between the groups. The onset times of the gluteus maximus and ipsilateral erector spinae showed no significant differences between the groups. These results suggest that individuals with CLBP use an altered, and possibly inadequate, trunk muscle recruitment pattern.

  12. Chronic pain management: nonpharmacological therapies for chronic pain.

    Science.gov (United States)

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Nonpharmacologic therapies have become a vital part of managing chronic pain (CP). Although these can be used as stand-alone therapies, nonpharmacologic treatments often are used to augment and complement pharmacologic treatments (ie, multimodal therapy). Nonpharmacologic approaches can be classified as behavioral, cognitive, integrative, and physical therapies. Core principles in developing a treatment plan are explaining the nature of the CP condition, setting appropriate goals, and developing a comprehensive treatment approach and plan for adherence. Clinicians should become familiar with these interventions so that they can offer patients flexibility in the pain management approach. Effective noninvasive treatment modalities for CP include behavioral therapy for short-term pain relief; cognitive behavioral therapy for reducing long-term pain and disability; hypnosis as adjunctive therapy; guided imagery, diaphragmatic breathing, and muscle relaxation, especially for cancer-related pain; mindfulness-based stress reduction for patients with chronic low back pain; acupuncture for multiple pain conditions; combination manipulation, manual therapy, endurance exercise, stretching, and strengthening for chronic neck pain; animal-assisted therapy; and S-adenosyl-L-methionine for joint pain. Guidelines for use of these treatment modalities are based on expert panel recommendations in combination with data from randomized controlled trials.

  13. Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain--a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Romy Lauche

    Full Text Available UNLABELLED: Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0-100 mm visual analog scale; VAS after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female were randomized to cupping massage (n = 30 or progressive muscle relaxation (n = 31. After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results. TRIAL REGISTRATION: ClinicalTrials.gov NCT01500330.

  14. Effect of cycling on oxygenation of relaxed neck/shoulder muscles in women with and without chronic pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Blangsted, Anne Katrine; Nielsen, Pernille Kofoed;

    2010-01-01

    Work-related neck/shoulder muscle pain has been associated with increased anaerobic muscle metabolism. Thus, interventions to enhance oxygenation of painful muscles seem relevant. While cycling with relaxed shoulders has been shown to result in acute neck/shoulder muscle pain reduction, the effect......-maximal cycling in an upright position with relaxed shoulders. Near-infrared spectroscopy was used to measure trapezius muscle oxygenation during and 2 min after the cycling period. For both MYA and CON, oxygenation of the passive trapezius increased in a linear fashion over time, to values approximately 5 micro...... increases oxygenation of resting neck/shoulder muscles in women with and without trapezius myalgia, indicating acute positive effects of either neural or humoral factors on vascular beds of distant relaxed muscles. Although this beneficial response was observed in both groups, the post-exercise response...

  15. Altered spinal kinematics and muscle recruitment pattern of the cervical and thoracic spine in people with chronic neck pain during functional task.

    Science.gov (United States)

    Tsang, Sharon M H; Szeto, Grace P Y; Lee, Raymond Y W

    2014-02-01

    Knowledge on the spinal kinematics and muscle activation of the cervical and thoracic spine during functional task would add to our understanding of the performance and interplay of these spinal regions during dynamic condition. The purpose of this study was to examine the influence of chronic neck pain on the three-dimensional kinematics and muscle recruitment pattern of the cervical and thoracic spine during an overhead reaching task involving a light weight transfer by the upper limb. Synchronized measurements of the three-dimensional spinal kinematics and electromyographic activities of cervical and thoracic spine were acquired in thirty individuals with chronic neck pain and thirty age- and gender-matched asymptomatic controls. Neck pain group showed a significantly decreased cervical velocity and acceleration while performing the task. They also displayed with a predominantly prolonged coactivation of cervical and thoracic muscles throughout the task cycle. The current findings highlighted the importance to examine differential kinematic variables of the spine which are associated with changes in the muscle recruitment in people with chronic neck pain. The results also provide an insight to the appropriate clinical intervention to promote the recovery of the functional disability commonly reported in patients with neck pain disorders.

  16. 肌肉疲劳与慢性颈痛的研究现状%Research Status on Relation of Muscle Fatigue and Chronic Neck Pain (review)

    Institute of Scientific and Technical Information of China (English)

    潘泳鸿; 仲卫红; 张俊新; 王诗忠

    2015-01-01

    Chronic neck pain is a common chronic musculoskeletal disorder. Research on neck muscle fatigue contributed to the under-standing the pathogenesis of chronic neck pain. The influences caused by the neck muscle fatigue, such as the change of cervical propriocep-tion and balance, could easily lead to chronic injury. Changes in morphology and recruitment strategy of cervical muscle could decrease muscle endurance, which bring about further damage. Targeted therapy and training can relieve muscle fatigue, improve muscle function, and reduce the recurrence rate. Surface electromyography has unique advantages in the evaluation of cervical muscle fatigue. The assess-ment of muscle fatigue could provide for assistance to the treatment and curative effect of chronic neck pain.%慢性颈痛是一种常见的慢性肌肉骨骼疾病,有关颈部肌肉疲劳的研究有助于认识慢性颈痛的发病机制。颈肌疲劳会对颈椎本体感觉和身体平衡等产生影响,易造成慢性损伤。慢性颈痛患者肌肉组织形态学和募集策略等的改变,使颈部肌肉抗疲劳能力下降,又可能导致颈部肌肉进一步损伤。针对性地治疗和训练能够缓解肌肉疲劳,提高肌肉功能,减少慢性颈痛的复发率。表面肌电图在评价颈肌疲劳中有着独特的优势,颈肌疲劳的评估可为慢性颈痛的治疗和疗效评价提供帮助。

  17. Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain

    DEFF Research Database (Denmark)

    Juul-Kristensen, Birgit; Clausen, Brian; Ris Hansen, Inge

    2013-01-01

    To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls.......To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls....

  18. [Efficacy of levocarnitine for tyrosine kinase inhibitor-induced painful muscle cramps in patients with chronic myelogenous leukemia].

    Science.gov (United States)

    Yamada, Michiko; Kuroda, Hiroyuki; Shimoyama, Saori; Ito, Ryo; Sugama, Yusuke; Sato, Ken; Yamauchi, Natsumi; Horiguchi, Hiroto; Nakamura, Hajime; Hamaguchi, Kota; Abe, Tomoyuki; Fujii, Shigeyuki; Maeda, Masahiro; Kato, Junji

    2016-04-01

    Muscle cramps are side effects commonly associated with tyrosine kinase inhibitor (TKI) treatment. Patients suffering from muscle cramps are treated with various medications such as calcium, magnesium and vitamin supplements, but these therapies are often ineffective. We report two patients with chronic myelogenous leukemia who developed muscle cramps caused by TKI. These patients were treated successfully with levocarnitine. Both of our cases revealed the beneficial effects of levocarnitine treatment on TKI-induced muscle cramps.

  19. Changes in muscle activity determine progression of clinical symptoms in patients with chronic spine-related muscle pain. A complex clinical and neurophysiological approach.

    Science.gov (United States)

    Wytrazek, Marcin; Huber, Juliusz; Lisinski, Przemyslaw

    2011-01-01

    Spine-related muscle pain can affect muscle strength and motor unit activity. This study was undertaken to investigate whether surface electromyographic (sEMG) recordings performed during relaxation and maximal contraction reveal differences in the activity of muscles with or without trigger points (TRPs). We also analyzed the possible coexistence of characteristic spontaneous activity in needle electromyographic (eEMG) recordings with the presence of TRPs. Thirty patients with non-specific cervical and back pain were evaluated using clinical, neuroimaging and electroneurographic examinations. Muscle pain was measured using a visual analog scale (VAS), and strength using Lovett's scale; trigger points were detected by palpation. EMG was used to examine motor unit activity. Trigger points were found mainly in the trapezius muscles in thirteen patients. Their presence was accompanied by increased pain intensity, decreased muscle strength, increased resting sEMG amplitude, and decreased sEMG amplitude during muscle contraction. eEMG revealed characteristic asynchronous discharges in TRPs. The results of EMG examinations point to a complexity of muscle pain that depends on progression of the myofascial syndrome.

  20. Trunk Muscle Characteristics of the Multifidi, Erector Spinae, Psoas, and Quadratus Lumborum in Older Adults With and Without Chronic Low Back Pain.

    Science.gov (United States)

    Sions, J Megan; Elliott, James M; Pohlig, Ryan T; Hicks, Gregory E

    2017-03-01

    Study Design Cross-sectional study. Objective To determine whether there are differences in trunk muscle characteristics between older adults with and without chronic low back pain (LBP), while controlling for age, sex, and body mass index. Background Muscle support for the trunk is provided by the multifidi, erector spinae, psoas, and quadratus lumborum. Trunk muscle characteristics may be altered with aging and/or chronic LBP. To date, most trunk muscle research has been conducted among younger adults. Given age-related muscle changes, such as reduced size and increased intramuscular fat, studies are needed in older adults, including those comparing older adults with and without LBP. Methods One hundred two older adults with (n = 53) and without (n = 49) chronic LBP were included. Cross-sectional area (CSA) measurements were taken by tracing inside the fascial borders on magnetic resonance images. Pixel intensity summaries were obtained to compute muscle-to-fat indices and relative muscle CSA, that is, CSA void of fat. Right/left averages for levels L2 through L5 were determined. Mixed-design analyses of covariance were used to test for differences between groups, based on LBP presence and sex, across levels (P≤.05). Results Older adults with LBP had a greater average multifidus muscle-to-fat index (0.51 versus 0.49) and smaller average erector spinae relative muscle CSA (8.56 cm(2) versus 9.26 cm(2)) when compared to control participants without LBP. No interactions between LBP status and average muscle characteristics were found for the psoas or quadratus lumborum (P>.05). Conclusion Up to 54% of older adult trunk muscle CSA may be fat. Women have smaller muscles and greater intramuscular fat (at lower spinal levels) than men. J Orthop Sports Phys Ther 2017;47(3):173-179. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7002.

  1. Muscle Cramp - A Common Pain

    Science.gov (United States)

    ... Osteopathic Manipulative Treatment Becoming a DO Video Library Muscle Cramp – A Common Pain Page Content Has a muscle ... body’s natural tendency toward self-healing. Causes of Muscle Cramps Muscle cramps can occur anywhere, anytime to anyone. “ ...

  2. Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, J. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Department of Physical Therapy, Rueckert-Hartman School for Health Professions, Regis University, Denver, Colorado (United States); Centre for Magnetic Resonance, University of Queensland, Brisbane (Australia)], E-mail: jelltt@regis.edu; Sterling, M. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Noteboom, J.T. [Department of Physical Therapy, Rueckert-Hartman School for Health Professions, Regis University, Denver, Colorado (United States); Darnell, R. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Galloway, G. [Centre for Magnetic Resonance, University of Queensland, Brisbane (Australia); Jull, G. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia)

    2008-06-15

    Aim: To investigate the presence of fatty infiltrate in the cervical extensor musculature in patients with insidious-onset neck pain to better understand the possible pathophysiology underlying such changes in chronic whiplash-associated disorders (WAD). Materials and methods: A sample of convenience of 23 women with persistent insidious-onset neck pain (mean age 29.2 {+-} 6.9 years) was recruited for the study. Magnetic resonance imaging (MRI) was used to quantify fatty infiltration in the cervical extensor musculature. Quantitative Sensory Testing (QST; pressure and thermal pain thresholds) was performed as sensory features are present in chronic whiplash. Self-reported pain and disability, as well as psychological distress, were measured using the Neck Disability Index (NDI) and the General Health Questionnaire-28 (GHQ-28), respectively. Results: Measures were compared with those of a previous dataset of chronic whiplash patients (n = 79, mean age 29.7 {+-} 7.8 years). Using a classification tree, insidious-onset neck pain was clearly identified from whiplash (p < 0.001), based on the presence of MRI fatty infiltrate in the cervical extensor musculature (0/102 individuals) and altered temperature thresholds (cold; 3/102 individuals). Conclusion: Fatty infiltrates in the cervical extensor musculature and widespread hyperalgesia were not features of the insidious-onset neck pain group in this study; whereas these features have been identified in patients with chronic WAD. This novel finding may enable a better understanding of the underlying pathophysiological processes in patients with chronic whiplash.

  3. A study on the Efficacy of Muscle Energy Technique as compared to Conventional Therapy on Lumbar Spine Range of Motion in Chronic Low Back Pain of Sacroiliac Origin

    Directory of Open Access Journals (Sweden)

    Supreet Bindra

    2013-10-01

    Full Text Available Sacroiliac joint dysfunction is a term often used to describe pain in and around the region of the joint that is presumed to be due to biomechanical disorders of the joint. Despite of high incidence, the contribution of sacroiliac joint to low back pain has been a matter of controversy. Physical therapists routinely assess spinal range of motion in patients with low back pain and believe that spinal range of motion and disability are closely linked. The present study was aimed to determine the relative efficacy of Muscle Energy Technique as compared to Conventional Therapy on lumbar spine range of motion in chronic low back pain of Sacroiliac origin. It was found that the subjects who were treated with Muscle Energy Technique showed greater improvements in lumbar spine range of motion as compared to Conventional Therapy Group. As far as reduction in pain and disability are concerned both the groups showed almost similar results. The study concluded that sacroiliac joint dysfunction affects lumbar spine range of motion and is a significant contributor to chronic low back pain.

  4. Rapid muscle activation and force capacity in conditions of chronic musculoskeletal pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Holtermann, Andreas; Jørgensen, Marie B;

    2008-01-01

    during the stable high-force phase of maximal voluntary shoulder abduction, whereas rapid capacity was determined as the steepest slope of the torque-time and EMG-time curves, defined as rate of torque development and rate of EMG rise. Intensity of pain was registered prior to the test on a visual-analogue-scale...

  5. Effect of Brief Daily Resistance Training on Occupational Neck/Shoulder Muscle Activity in Office Workers with Chronic Pain: Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mark Lidegaard

    2013-01-01

    Full Text Available Purpose. This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain. Methods. 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day (n=15 or in control receiving weekly email-based information on general health (n=15. Electromyography (EMG from the splenius and upper trapezius was recorded during a normal workday. Results. Adherence to training and control interventions were 86% and 89%, respectively. Compared with control, training increased isometric muscle strength 6% (P<0.05 and decreased neck/shoulder pain intensity by 40% (P<0.01. The frequency of periods with complete motor unit relaxation (EMG gaps decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius. Conclusion. While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain.

  6. Pain Modulation by Lignans (Phyllanthin and Hypophyllanthin) and Tannin (Corilagin) Rich Extracts of Phyllanthus amarus in Carrageenan-induced Thermal and Mechanical Chronic Muscle Hyperalgesia.

    Science.gov (United States)

    Chopade, Atul R; Sayyad, F J

    2015-08-01

    The current study was aimed at evaluating the antihyperalgesic effects of lignans (phyllanthin and hypophyllanthin) and tannin (corilagin) rich three standardized extracts of Phyllanthus amarus in a model of chronic musculoskeletal inflammatory pain. Three percent carrageenan injected in the gastrocnemius muscle produced hyperalgesia to mechanical and heat stimuli ipsilaterally, which spreads to the contralateral side within 7 to 9 days. To investigate the effects on chronic thermal and mechanical hypersensitivity, three extracts of P. amarus in three doses (100, 200, and 400 mg/kg) were administered to animals intraperitoneally from 14th day to 22nd day after intramuscular injection of carrageenan. It was observed that intraperitoneal administrations of Phyllanthus extracts showed antihyperalgesic activity, as they elevated thermal and mechanical threshold, which was supported by histopathological observations along with reduction in prostaglandin E2 (PGE2) concentration. In conclusion, we strongly suggest that the observed antihyperalgesic and antiinflammatory effects of P. amarus in current pain model are mediated via spinal or supraspinal neuronal mechanisms, mainly by inhibition of PGE2. Modulation of chronic muscular inflammation may be due to presence of phytoconstituents like phyllanthin, hypophyllanthin, and corilagin, which offers a promising means for treatment of chronic muscle pain.

  7. Acetaminophen for Chronic Pain

    DEFF Research Database (Denmark)

    Ennis, Zandra Nymand; Dideriksen, Dorthe; Vaegter, Henrik Bjarke;

    2016-01-01

    strategies for acetaminophen use in chronic pain in both Embase and PubMed, 1,551 hits were obtained. Following cross-reference searches of both trials and 38 reviews, seven studies comparing acetaminophen in continuous dosing regimens of more than two weeks with placebo were included. The review...

  8. Preliminary study of neck muscle size and strength measurements in females with chronic non-specific neck pain and healthy control subjects.

    Science.gov (United States)

    Rezasoltani, Asghar; Ali-Reza, Ahmadipor; Khosro, Khademi-Kalantari; Abbass, Rahimi

    2010-08-01

    Neck muscle weakness and atrophy are two common causes of pain and disability among office workers. The aim of this study was to compare the strength of the neck extensor and flexor muscles and the size of the semispinalis capitis muscle (SECM) in patients with chronic non-specific neck pain (CNNP) and healthy subjects. Twenty female office workers (10 patients with CNNP and 10 healthy subjects) participated in this study. The strength of the neck extensor and flexor muscles was measured by an isometric device and the SECM size was measured by ultrasonography. Neck muscle strength, size of the SECM and the ratios of neck strength to body weight, neck extensor strength to SECM size, SECM size to body weight and neck flexor to extensor strength were all significantly lower in patients compared to controls (P neck strength, the size of the SECM and the ratio of neck muscle strength to SECM size appear to be useful parameters in appraising patients with CNNP.

  9. Myofascial Pain Syndrome in Chronic Back Pain Patients

    Science.gov (United States)

    Nizar, Abd Jalil

    2011-01-01

    Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (χ2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome. PMID:21716607

  10. [Chronic pain in geriatrics].

    Science.gov (United States)

    Kennes, B

    2001-06-01

    Pain is frequent in communicative or no-communicative, ambulatory, institutionalized or hospitalized veterans. It is associated with severe comorbidity so much more than chronic pain could be neglected and expressed of atypical manner or masked by the absence of classical symptoms in particular in case of dementia or of sensory disorders. Pain detection by clinic examination or by pain assessment's methods and adequate approach by pharmacological and non pharmacological therapies are essential for correct pain management. On pharmacological plan, the strategy of the O.M.S. landings is applicable owing to a more particular attention to secondary effects and drugs interactions. AINS must be manipulated with prudence. There are no reasons to exclude opioides from the therapeutic arsenal but with a reduction of the starting doses, a regular adaptation and a very attentive survey. In drugs of landing 2, tramadol reveals itself as efficient and better tolerated as the codeine and dextropropoxyphene has to be to avoid. The obtaining of a satisfactory result depends on a regular assessment of the pain in a context of polydisciplinar approach (physicians, nurses, paramedicals, other care givers).

  11. The Effects of Stabilization and Mckenzie Exercises on Transverse Abdominis and Multifidus Muscle Thickness, Pain, and Disability: A Randomized Controlled Trial in NonSpecific Chronic Low Back Pain.

    Science.gov (United States)

    Hosseinifar, Mohammad; Akbari, Mohammad; Behtash, Hamid; Amiri, Mohsen; Sarrafzadeh, Javad

    2013-12-01

    [Purpose] This study compared the effectiveness of stabilization and McKenzie exercises on pain, disability, and thickness of the transverse abdominis and multifidus muscles in patients with nonspecific chronic low back pain. [Subjects] Thirty patients were randomly assigned into two groups: the McKenzie and stabilization exercise groups. [Methods] Before and after intervention, pain, disability, and thickness of the transverse abdominis and multifidus muscles were evaluated by visual analogue scale, functional rating index, and sonography, respectively. The training program was 18 scheduled sessions of individual training for both groups. [Results] After interventions, the pain score decreased in both groups. The disability score decreased only in the stabilization group. The thickness of the left multifidus was significantly increased during resting and contracting states in the stabilization group. The thickness of the right transverse abdominis during the abdominal draw-in maneuver, and thickness of the left transverse abdominis during the active straight leg raising maneuver were significantly increased in the stabilization group. The intensity of pain, disability score, thickness of the right transverse abdominis during the abdominal draw-in manouver, and thickness of the left transverse abdominis during active straight leg raising in the stabilization group were greater than those on the Mackenzie. [Conclusion] Stabilization exercises are more effective than McKenzie exercises in improving the intensity of pain and function score and in increasing the thickness of the transverse abdominis muscle.

  12. Respiratory weakness in patients with chronic neck pain.

    Science.gov (United States)

    Dimitriadis, Zacharias; Kapreli, Eleni; Strimpakos, Nikolaos; Oldham, Jacqueline

    2013-06-01

    Respiratory muscle strength is one parameter that is currently proposed to be affected in patients with chronic neck pain. This study was aimed at examining whether patients with chronic neck pain have reduced respiratory strength and with which neck pain problems their respiratory strength is associated. In this controlled cross-sectional study, 45 patients with chronic neck pain and 45 healthy well-matched controls were recruited. Respiratory muscle strength was assessed through maximal mouth pressures. The subjects were additionally assessed for their pain intensity and disability, neck muscle strength, endurance of deep neck flexors, neck range of movement, forward head posture and psychological states. Paired t-tests showed that patients with chronic neck pain have reduced Maximal Inspiratory (MIP) (r = 0.35) and Maximal Expiratory Pressures (MEP) (r = 0.39) (P Neck muscle strength (r > 0.5), kinesiophobia (r neck pain and disability (r Neck muscle strength was the only predictor that remained as significant into the prediction models of MIP and MEP. It can be concluded that patients with chronic neck pain present weakness of their respiratory muscles. This weakness seems to be a result of the impaired global and local muscle system of neck pain patients, and psychological states also appear to have an additional contribution. Clinicians are advised to consider the respiratory system of patients with chronic neck pain during their usual assessment and appropriately address their treatment.

  13. Core Muscle Activity during TRX Suspension Exercises with and without Kinesiology Taping in Adults with Chronic Low Back Pain: Implications for Rehabilitation

    Directory of Open Access Journals (Sweden)

    Shirley S. M. Fong

    2015-01-01

    Full Text Available This study aimed to examine the effects of kinesiology taping (KT and different TRX suspension workouts on the amplitude of electromyographic (EMG activity in the core muscles among people with chronic low back pain (LBP. Each participant (total n=21 was exposed to two KT conditions: no taping and taping, while performing four TRX suspension exercises: (1 hamstring curl, (2 hip abduction in plank, (3 chest press, and (4 45-degree row. Right transversus abdominis/internal oblique (TrAIO, rectus abdominis (RA, external oblique (EO, and superficial lumbar multifidus (LMF activity was recorded with surface EMG and expressed as a percentage of the EMG amplitude recorded during a maximal voluntary isometric contraction of the respective muscles. Hip abduction in plank increased TrAIO, RA, and LMF EMG amplitude compared with other TRX positions (P0.05. Hip abduction in plank most effectively activated abdominal muscles, whereas the hamstring curl most effectively activated the paraspinal muscles. Applying KT conferred no immediate benefits in improving the core muscle activation during TRX training in adults with chronic LBP.

  14. TMD and chronic pain: A current view

    Science.gov (United States)

    Furquim, Bruno D'Aurea; Flamengui, Lívia Maria Sales Pinto; Conti, Paulo César Rodrigues

    2015-01-01

    This review aims at presenting a current view on the physiopathologic mechanisms associated with temporomandibular disorders (TMDs). While joint pain is characterized by a well-defined inflammatory process mediated by tumor necrosis factor-α and interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms, being considered a functional pain syndrome similar to fibromyalgia, irritable bowel syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization is the common factor unifying these conditions, and may be influenced by the autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be understood as a complex response which might get worse or improve depending on an individual's adaptation. PMID:25741834

  15. TMD and chronic pain: A current view

    Directory of Open Access Journals (Sweden)

    Bruno D'Aurea Furquim

    2015-02-01

    Full Text Available This review aims at presenting a current view on the physiopathologic mechanisms associated with temporomandibular disorders (TMDs. While joint pain is characterized by a well-defined inflammatory process mediated by tumor necrosis factor-α and interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms, being considered a functional pain syndrome similar to fibromyalgia, irritable bowel syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization is the common factor unifying these conditions, and may be influenced by the autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be understood as a complex response which might get worse or improve depending on an individual's adaptation.

  16. The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain.

    Science.gov (United States)

    Noh, Kyung-Hee; Kim, Ji-Won; Kim, Gyoung-Mo; Ha, Sung-Min; Oh, Jae-Seop

    2014-05-01

    [Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensional motion-analysis system, and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography (EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and increasing abdominal muscle activity in women with chronic low back pain.

  17. Pain perception and modulation in acute and chronic pain states

    NARCIS (Netherlands)

    Oudejans, L.C.J.

    2016-01-01

    This thesis describes the evaluation of pain perception in acute and chronic pain patients and the strength of the endogenous pain modulation system in chronic pain patients. Additionally, pain phenotypes are determined in patients with chronic pain. The ability of patients with acute pain after sur

  18. Prevalence of cervical facet joint pain in chronic neck pain.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Singh, Vijay; Rivera, Jose; Pampati, Vidyasagar

    2002-07-01

    Neck pain is considered to be one of the most common chronic pain conditions in modern society. Various structures identified as capable of transmitting pain in the cervical spine include facet joints, intervertebral discs, nerve root dura, ligaments, fascia, and muscles. The prevalence of cervical facet joint pain in patients with chronic pain after whiplash has been determined as 54% to 60%. However, the prevalence of chronic cervical facet joint pain has not yet been determined in a heterogenous population or in patients with cervical spine pain of idiopathic origin in a controlled environment. This study evaluated 160 patients seen in one interventional pain management practice in a non-university setting. Cervical facet joints were investigated with diagnostic blocks using lidocaine 1% preservative free initially, followed by bupivacaine 0.25%, usually 2 to 4 weeks apart. The study population consisted of 76 women and 30 men aged 43 +/- 13 years of age (mean +/- SD). Mode of onset of neck pain was determined as following a traumatic incident in 48% of the patients, whereas it was with gradual onset without an identifiable specific incident in the remaining 55 patients (52%). Eighty-one or 70% of the patients (70%) reported a definite response to lidocaine blocks. Confirmatory blocks with bupivacaine were performed in 81 patients with 64 patients with 60% of the total sample, or 79%, of the lidocaine-positive group reporting definite response with improvement in their pain. Thus, a prevalence rate of facet joint pain in chronic neck pain was determined to be 60% (95% CI, 50%-70%), with a false positive rate of controlled diagnostic blocks of 40% (95% CI, 34%-46%).

  19. Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics.

    Science.gov (United States)

    Malanga, Gerard; Wolff, Erin

    2008-01-01

    The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

  20. Chronic neck pain disability due to an acute whiplash injury

    NARCIS (Netherlands)

    Nederhand, Marc J.; Hermens, Hermie J.; IJzerman, Maarten J.; Turk, Dennis C.; Zilvold, Gerrit

    2003-01-01

    Several theories about musculoskeletal pain syndromes such as whiplash-associated disorder (WAD) suggest that pain and muscle activity interact and may contribute to the chronicity of symptoms. Studies using surface electromyography (sEMG) have demonstrated abnormal muscle activation patterns of the

  1. Tai chi and chronic pain.

    Science.gov (United States)

    Peng, Philip W H

    2012-01-01

    In the last 2 decades, a growing body of research aimed at investigating the health benefits of Tai Chi in various chronic health conditions has been recognized in the literature. This article reviewed the history, the philosophy, and the evidence for the role of Tai Chi in a few selected chronic pain conditions. The ancient health art of Tai Chi contributes to chronic pain management in 3 major areas: adaptive exercise, mind-body interaction, and meditation. Trials examining the health benefit of Tai Chi in chronic pain conditions are mostly 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. The limitations of the Tai Chi study design and suggestions for the direction of future research are also discussed.

  2. Management of chronic visceral pain

    DEFF Research Database (Denmark)

    Olesen, Anne E; Farmer, Adam D; Olesen, Søren S

    2016-01-01

    ' symptoms, adopting an empathic approach and taking time to educate patients. To optimize treatment and outcomes in chronic visceral pain we need to move away from approaches exclusively based on dealing with peripheral nociceptive input toward more holistic strategies, taking into account alterations......Despite marked differences in underlying pathophysiology, the current management of visceral pain largely follows the guidelines derived from the somatic pain literature. The effective management of patients with chronic visceral pain should be multifaceted, including both pharmacological...... in central pain processing....

  3. Fighting Chronic Pain

    Science.gov (United States)

    ... leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, colitis Urinary/Reproductive: Kidney stones, pelvic pain, vulvodynia, ...

  4. [Pharmacological treatment of chronic pain].

    Science.gov (United States)

    Willimann, Patrick

    2011-09-01

    The pharmacological treatment of chronic pain differs from acute pain management. In chronic non-cancer pain patients pharmacological treatment is only one element of an interdisciplinary approach. Not pain reduction only but gain in physical and social functioning is mandatory for continuation of therapy. The developpement of a strategy is the most important and difficult step toward an individual and sustained pharmacological pain treatment. Simple practical guidelines can help to find an individual therapeutic straight. Outcome parameters have to be determined. Check-ups for discontinuation of the therapy have to be done periodically. Exact documentation of effect and side effects prevents ungrateful and potential dangerous treatments. The WHO ladder remains the cornerstone of pharmacological pain treatment. Further analgesics as antidepressants and anticonvulsants are important in treatment of neuropathic or mixed pain states. Special considerations have to be done in opioid treatment of non-cancer pain regarding the lack of evidence in long term outcome and possible side effects and risks.

  5. Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

    OpenAIRE

    2015-01-01

    Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold hea...

  6. [Neurosurgical treatment of chronic pain].

    Science.gov (United States)

    Fontaine, D; Blond, S; Mertens, P; Lanteri-Minet, M

    2015-02-01

    Neurosurgical treatment of pain used two kind of techniques: 1) Lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (drezotomy, cordotomy, tractotomy…). They are indicated to treat morphine-resistant cancer pain and few cases of selected neuropathic pain. 2) Neuromodulation techniques try to decrease pain by reinforcing inhibitory and/or to limit activatory mechanisms. Chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation…) is used to treat chronic neuropathic pain. Intrathecal infusion of analgesics (morphine, ziconotide…), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, selected patients with severe and chronic pain, refractory to all other treatments. The quality of the analgesic outcome depends on the relevance of the indications.

  7. Effects of 12-wk eccentric calf muscle training on muscle-tendon glucose uptake and SEMG in patients with chronic Achilles tendon pain

    DEFF Research Database (Denmark)

    Masood, Tahir; Kalliokoski, Kari; Magnusson, S Peter

    2014-01-01

    High-load eccentric exercises have been a key component in the conservative management of chronic Achilles tendinopathy. This study investigated the effects of a 12-wk progressive, home-based eccentric rehabilitation program on ankle plantar flexors' glucose uptake (GU) and myoelectric activity....... The results indicated that the symptomatic leg was weaker (P eccentric rehabilitation. Additionally, the rehabilitation resulted in greater GU in both soleus (P ... within- or between-group differences. Eccentric rehabilitation was effective in decreasing subjective severity of Achilles tendinopathy. It also resulted in redistribution of relative electrical activity, but not metabolic activity, within the triceps surae muscle....

  8. Experimental quadriceps muscle pain impairs knee joint control during walking

    DEFF Research Database (Denmark)

    Henriksen, Marius; Alkjaer, Tine; Lund, Hans

    2007-01-01

    of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity...

  9. Multimodal Treatment of Chronic Pain.

    Science.gov (United States)

    Dale, Rebecca; Stacey, Brett

    2016-01-01

    Most patients with chronic pain receive multimodal treatment. There is scant literature to guide us, but when approaching combination pharmacotherapy, the practitioner and patient must weigh the benefits with the side effects; many medications have modest effect yet carry significant side effects that can be additive. Chronic pain often leads to depression, anxiety, and deconditioning, which are targets for treatment. Structured interdisciplinary programs are beneficial but costly. Interventions have their place in the treatment of chronic pain and should be a part of a multidisciplinary treatment plan. Further research is needed to validate many common combination treatments.

  10. Neurovascular Unit in Chronic Pain

    Science.gov (United States)

    Radu, Beatrice Mihaela; Bramanti, Placido; Osculati, Francesco; Flonta, Maria-Luisa; Radu, Mihai; Bertini, Giuseppe; Fabene, Paolo Francesco

    2013-01-01

    Chronic pain is a debilitating condition with major socioeconomic impact, whose neurobiological basis is still not clear. An involvement of the neurovascular unit (NVU) has been recently proposed. In particular, the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB), two NVU key players, may be affected during the development of chronic pain; in particular, transient permeabilization of the barrier is suggested by several inflammatory- and nerve-injury-based pain models, and we argue that the clarification of molecular BBB/BSCB permeabilization events will shed new light in understanding chronic pain mechanisms. Possible biases in experiments supporting this theory and its translational potentials are discussed. Moving beyond an exclusive focus on the role of the endothelium, we propose that our understanding of the mechanisms subserving chronic pain will benefit from the extension of research efforts to the NVU as a whole. In this view, the available evidence on the interaction between analgesic drugs and the NVU is here reviewed. Chronic pain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronic pain treatment. PMID:23840097

  11. Neurovascular Unit in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Beatrice Mihaela Radu

    2013-01-01

    Full Text Available Chronic pain is a debilitating condition with major socioeconomic impact, whose neurobiological basis is still not clear. An involvement of the neurovascular unit (NVU has been recently proposed. In particular, the blood-brain barrier (BBB and blood-spinal cord barrier (BSCB, two NVU key players, may be affected during the development of chronic pain; in particular, transient permeabilization of the barrier is suggested by several inflammatory- and nerve-injury-based pain models, and we argue that the clarification of molecular BBB/BSCB permeabilization events will shed new light in understanding chronic pain mechanisms. Possible biases in experiments supporting this theory and its translational potentials are discussed. Moving beyond an exclusive focus on the role of the endothelium, we propose that our understanding of the mechanisms subserving chronic pain will benefit from the extension of research efforts to the NVU as a whole. In this view, the available evidence on the interaction between analgesic drugs and the NVU is here reviewed. Chronic pain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronic pain treatment.

  12. Effect of acupuncture depth on muscle pain

    Directory of Open Access Journals (Sweden)

    Kitakoji Hiroshi

    2011-06-01

    Full Text Available Abstract Background While evidence supports efficacy of acupuncture and/or dry needling in treating musculoskeletal pain, it is unclear which needling method is most effective. This study aims to determine the effects of depth of needle penetration on muscle pain. Methods A total of 22 healthy volunteers performed repeated eccentric contractions to induce muscle soreness in their extensor digital muscle. Subjects were assigned randomly to four groups, namely control group, skin group (depth of 3 mm: the extensor digital muscle, muscle group (depth of 10 mm: the extensor digital muscle and non-segmental group (depth of 10 mm: the anterior tibial muscle. Pressure pain threshold and electrical pain threshold of the skin, fascia and muscle were measured at a point 20 mm distal to the maximum tender point on the second day after the exercise. Results Pressure pain thresholds of skin group (depth of 3 mm: the extensor digital muscle and muscle group (depth of 10 mm: the extensor digital muscle were significantly higher than the control group, whereas the electrical pain threshold at fascia of muscle group (depth of 10 mm: the extensor digital muscle was a significantly higher than control group; however, there was no significant difference between the control and other groups. Conclusion The present study shows that acupuncture stimulation of muscle increases the PPT and EPT of fascia. The depth of needle penetration is important for the relief of muscle pain.

  13. Chronic low back pain in housewives

    Directory of Open Access Journals (Sweden)

    Mehmet Bulut

    2011-09-01

    Full Text Available Objectives: The aim of this study is to investigate low back pain of housewives and to deteremine relationships between psychological status, education and physical health in housewives.Materials and methods: Thirty premenopausal housewives aged 33-45 years with chronic low back pain were included and the control group consisted of 30 healthy premenopausal housewives. Physical examinations were performed. Age, height, weight, educational level, number of children, consumption of cigarettes and alcohol were recorded. The body mass index (BDI was measured. The severity of back pain was measured by the Oswestry Disability Index (ODI, psychological status was evaluated by the Beck Depression Inventory (BDI and muscle strength by manual technique.Results: There was no difference between demographic data of patients and controls. BDI scores of patients were significantly higher than the controls (p<0,01. Abdominal and dorsal muscle strength were higher in the control group but different was not significant. OBAS values in the patient group, were positively correlated with BDI and BMI (p= 0.011; p= 0.001, respectively, and negatively correlated with abdominal and dorsal muscle strength (p= 0.006 and p= 0.001. Significant correlations were found between abdominal and dorsal muscle strength and the BMI, ODI and BDI scores and high educational level positively affected the ODI and the BDI scores in patients.Conclusion: The housewives with chronic back pain and do not exercise regularly limit activities of daily living. Because of higher BDI scores of patients with chronic low back pain, these patients should also undergo psychiatric examination. J Clin Exp Invest 2011; 2 (3: 295-298.

  14. Pregabalin for Pain Treatment in Chronic Pancreatitis

    DEFF Research Database (Denmark)

    Olesen, Søren Schou; Bowense, S; Wilder-Smith, Oliver

    2011-01-01

    Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution...

  15. Medicines for Pain: From Osteoarthritis to Muscle Pain

    Science.gov (United States)

    Medicines for Pain: From Osteoarthritis to Muscle Pain Do you take pain medicines to treat headaches, migraines, back aches, and even joint pain? Then this ... use these types of medicine are:  People with osteoarthritis . Osteoarthritis happens when the cartilage of the joint ...

  16. Management of chronic visceral pain.

    Science.gov (United States)

    Olesen, Anne E; Farmer, Adam D; Olesen, Søren S; Aziz, Qasim; Drewes, Asbjørn M

    2016-10-01

    Despite marked differences in underlying pathophysiology, the current management of visceral pain largely follows the guidelines derived from the somatic pain literature. The effective management of patients with chronic visceral pain should be multifaceted, including both pharmacological and psychological interventions, thereby providing a mechanism-orientated approach to treatment. Patients can frequently become disenfranchised, and subsequently disengaged, with healthcare providers leading to repeated consultations. Thus, a key aspect of management is to break this cycle by validating patients' symptoms, adopting an empathic approach and taking time to educate patients. To optimize treatment and outcomes in chronic visceral pain we need to move away from approaches exclusively based on dealing with peripheral nociceptive input toward more holistic strategies, taking into account alterations in central pain processing.

  17. Managing your chronic pain

    Science.gov (United States)

    ... hanging from above or are stored at waist height. If your back pain is worse at work, talk to your boss. It may be that ... strong. If walking is too hard for you, work with a physical therapist to develop ... decrease your risk of being overweight, which can cause back pain. ...

  18. Experimental knee pain reduces muscle strength

    DEFF Research Database (Denmark)

    Henriksen, Marius; Rosager, Sara; Aaboe, Jens

    2011-01-01

    Pain is the principal symptom in knee pathologies and reduced muscle strength is a common observation among knee patients. However, the relationship between knee joint pain and muscle strength remains to be clarified. This study aimed at investigating the changes in knee muscle strength following...... experimental knee pain in healthy volunteers, and if these changes were associated with the pain intensities. In a crossover study, 18 healthy subjects were tested on 2 different days. Using an isokinetic dynamometer, maximal muscle strength in knee extension and flexion was measured at angular velocities 0....... Knee pain reduced the muscle strength by 5 to 15% compared to the control conditions (P strength was positively correlated to the pain intensity. Experimental knee pain significantly reduced knee extension...

  19. Painful unilateral temporalis muscle enlargement: reactive masticatory muscle hypertrophy.

    Science.gov (United States)

    Katsetos, Christos D; Bianchi, Michael A; Jaffery, Fizza; Koutzaki, Sirma; Zarella, Mark; Slater, Robert

    2014-06-01

    An instance of isolated unilateral temporalis muscle hypertrophy (reactive masticatory muscle hypertrophy with fiber type 1 predominance) confirmed by muscle biopsy with histochemical fiber typing and image analysis in a 62 year-old man is reported. The patient presented with bruxism and a painful swelling of the temple. Absence of asymmetry or other abnormalities of the craniofacial skeleton was confirmed by magnetic resonance imaging and cephalometric analyses. The patient achieved symptomatic improvement only after undergoing botulinum toxin injections. Muscle biopsy is key in the diagnosis of reactive masticatory muscle hypertrophy and its distinction from masticatory muscle myopathy (hypertrophic branchial myopathy) and other non-reactive causes of painful asymmetric temporalis muscle enlargement.

  20. Fibromyalgia and Chronic Pain Syndromes

    Science.gov (United States)

    Choy, Ernest; Clauw, Daniel J.; Goldenberg, Don L.; Harris, Richard E.; Helfenstein, Milton; Jensen, Troels Staehelin; Noguchi, Koichi; Silverman, Stuart L.; Ushida, Takahiro; Wang, Guochun

    2016-01-01

    This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients’ lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general. PMID:27022674

  1. Pain management in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Cathia Gachago; Peter V Draganov

    2008-01-01

    Abdominal pain is a major clinical problem in patients with chronic pancreatitis.The cause of pain is usually multifactorial with a complex interplay of factors contributing to a varying degree to the pain in an individual patient and,therefore,a rigid standardized approach for pain control tends to lead to suboptimal results.Pain management usually proceeds in a stepwise approach beginning with general lifestyle recommendations,low fat diet,alcohol and smoking cessation are encouraged.Analgesics alone are needed in almost all patients.Maneuvers aimed at suppression of pancreatic secretion are routinely tried.Patients with ongoing symptoms may be candidates for more invasive options such as endoscopic therapy,and resective or drainage surgery.The role of pain modifying agents (antidepressants,gabapentin,peregabalin),celiac plexus block,antioxidants,octreotide and total pancreatectomy with islet cell auto transplantation remains to be determined.

  2. Masticatory muscle pain: Causes, consequences, and diagnosis

    NARCIS (Netherlands)

    Koutris, M.

    2013-01-01

    Masticatory muscle pain is known as myogenous temporomandibular disorder (TMD) pain. It has a prevalence of approximately 10% in the general population and affects women more than men. It is usually characterized by a dull, aching pain, which aggravates on function. The etiology of TMD pain is still

  3. Low back pain - chronic

    Science.gov (United States)

    ... as scoliosis or kyphosis Medical problems, such as fibromyalgia or rheumatoid arthritis Piriformis syndrome, a pain disorder ... used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed ...

  4. How is trunk muscle activity during forward bending in standing in chronic non-specific low back pain patients presenting with psychosocial characteristics such as fear avoidance beliefs, pain catastrophizing or kinesiophobia? A systematic review of the literature

    DEFF Research Database (Denmark)

    Sørensen, Brian Østergaard

    2016-01-01

    Low back pain (LBP) is the most common single reason for addressing the health care system due to musculoskeletal pain. More than 80% will experience LBP at some point in life; 6 - 10% of those experiencing LBP will develop persistent and chronic pain with great variance in level of disability...... and pain. Research indicates that LBP is multifactorial and calls for a biopsychosocial model when approaching the patient experiencing LBP. Despite this recognition LBP is poorly understood. A factor for debate has been the contribution of pain-related fear regarding maintenance of chronicity. Recently...

  5. Strength training increases the size of the satellite cell pool in type I and II fibres of chronically painful trapezius muscle in females

    DEFF Research Database (Denmark)

    Mackey, Abigail; Andersen, Lars L; Frandsen, Ulrik

    2011-01-01

    While strength training has been shown to be effective in mediating hypertrophy and reducing pain in trapezius myalgia, responses at the cellular level have not previously been studied. This study investigated the potential of strength training targeting the affected muscles (SST, n = 18) and gen......While strength training has been shown to be effective in mediating hypertrophy and reducing pain in trapezius myalgia, responses at the cellular level have not previously been studied. This study investigated the potential of strength training targeting the affected muscles (SST, n = 18...... strong support at the cellular level for the potential of SST to induce a strong myogenic response in this population....

  6. Evidence based practice of chronic pain

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2012-01-01

    Full Text Available The patients with chronic pain are increasingly reporting to the physicians for its management. Chronic pain are associated with head, neck and shoulder pain, spinal pain, pain in the joints and extremities, complex regional pain syndrome and phantom pain. The chronic pain is being managed worldwide. The different specialty of medicine is producing a lot of evidence through the published literature but the same is not being published in the field of chronic pain management. Though some evidence is being reported as to different aspects of pain management from different parts of the world but same is lacking from Indian subcontinent. This is in contrast to much done clinical work in this field as well. We present here the available evidence in relation to chronic pain management.

  7. Effects of Mindfulness Meditation on Chronic Pain

    DEFF Research Database (Denmark)

    la Cour, Peter; Petersen, Marian

    2015-01-01

    OBJECTIVE: This randomized controlled clinical trial investigated the effects of mindfulness meditation on chronic pain. DESIGN: A total of 109 patients with nonspecific chronic pain were randomized to either a standardized mindfulness meditation program (mindfulness-based stress reduction [MBSR...

  8. Managing painful chronic wounds: the Wound Pain Management Model

    DEFF Research Database (Denmark)

    Price, Patricia; Fogh, Karsten; Glynn, Chris;

    2007-01-01

    document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr......Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related...... to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions...

  9. Chronic neck pain disability due to an acute whiplash injury.

    Science.gov (United States)

    Nederhand, Marc J; Hermens, Hermie J; IJzerman, Maarten J; Turk, Dennis C; Zilvold, Gerrit

    2003-03-01

    Several theories about musculoskeletal pain syndromes such as whiplash-associated disorder (WAD) suggest that pain and muscle activity interact and may contribute to the chronicity of symptoms. Studies using surface electromyography (sEMG) have demonstrated abnormal muscle activation patterns of the upper trapezius muscles in the chronic stage of WAD (grade II). There are, however, no studies that confirm that these muscle reactions are initiated in the acute stage of WAD, nor that these muscle reactions persist in the transition from acute neck pain to chronic neck pain disability. We analyzed the muscle activation patterns of the upper trapezius muscles in a cohort of 92 subjects with acute neck pain due to a motor vehicle accident (MVA). This cohort was followed up in order to evaluate differences in muscular activation patterns between subjects who have recovered and those subjects who have not recovered following an acute WAD and developed chronic neck pain. sEMG parameters were obtained at 1, 4, 8, 12, and 24 weeks after an MVA. The level of muscle reactivity (the difference in pre- and post-exercise EMG levels) and the level of muscle activity during an isometric and a dynamic task were used as EMG parameters. The results revealed no elevated muscle reactivity either in the acute stage, or during the follow-up period. The results of both the isometric and dynamic task, showed statistically significant different EMG levels between four neck pain disability subgroups (analysis of variance reaching P-levels of 0.000), with an inverse relationship between the level of neck pain disability and EMG level. Furthermore, follow-up assessments of the EMG level during these two tasks, did not show a time related change. In conclusion, in subjects with future disability, the acute stage is characterized by a reorganization of the muscular activation of neck and shoulder muscles, possibly aimed at minimizing the use of painful muscles. This change of motor control, is in

  10. Induction and modulation of referred muscle pain in humans

    DEFF Research Database (Denmark)

    Laursen, René Johannes

    Muscle pain is a major factor in many disorders such as injuries, degenerative diseases, and cancer. The mechanisms underlying muscle pain are not fully understood. A particular problem in muscle pain is the relationship between local and referred muscle pain. Experimental pain models are useful...

  11. Comprehensive management of chronic pain in haemophilia.

    Science.gov (United States)

    Young, G; Tachdjian, R; Baumann, K; Panopoulos, G

    2014-03-01

    Chronic pain, most often due to haemophilic arthropathy, is a pervasive problem in persons with haemophilia (PWH) that adversely impacts function and quality of life. PWH with inhibitors and older PWH may be especially vulnerable to progressive arthropathy and resulting chronic pain. The development of chronic pain from acute pain involves a complex interplay of biological and psychosocial factors that may all contribute to the perpetuation of chronic pain and the outcome of therapy. In the absence of evidence-based guidelines, an individualized, multimodal approach to chronic pain management is proposed, as it is in individuals without haemophilia who have chronic pain. Pharmacological treatment is central to the management of chronic pain and must be modified based on pain intensity, ongoing response to therapy and the risk for adverse events. Non-pharmacological interventions, including physiotherapy, complementary treatments and surgical (e.g. orthopaedic) or other invasive procedures, may be integral to chronic pain management in this population. Ongoing psychosocial assessment is critical to identify those factors that may be contributing to the perpetuation of chronic pain or acting as barriers to effective management. Additional study is needed to identify optimal pharmacological treatments for chronic pain in PWH based on the unique pathophysiology of haemophilic arthropathy and on risk profile. Systematic determination of the particular psychosocial factors impacting the experience and management of chronic pain in PWH would likewise add value to the treatment of this pervasive problem.

  12. Shared genetic factors underlie chronic pain syndromes

    NARCIS (Netherlands)

    Vehof, Jelle; Zavos, Helena M. S.; Lachance, Genevieve; Hammond, Christopher J.; Williams, Frances M. K.

    2014-01-01

    Chronic pain syndromes (CPS) are highly prevalent in the general population, and increasingly the evidence points to a common etiological pathway. Using a large cohort of twins (n = 8564) characterized for chronic widespread musculoskeletal pain (CWP), chronic pelvic pain (PP), migraine (MIG), dry e

  13. Plantarflexor muscle function in healthy and chronic Achilles tendon pain subjects evaluated by the use of EMG and PET imaging

    DEFF Research Database (Denmark)

    Masood, Tahir; Kalliokoski, Kari; Bojsen-Møller, Jens;

    2014-01-01

    BACKGROUND: Achilles tendon pathologies may alter the coordinative strategies of synergistic calf muscles. We hypothesized that both surface electromyography and positron emission tomography would reveal differences between symptomatic and asymptomatic legs in Achilles tendinopathy patients...... voluntary contraction using surface electromyography and glucose uptake using positron emission tomography. Additionally, Achilles tendon glucose uptake was quantified. FINDINGS: Normalized myoelectric activity of soleus was higher (P... despite lower absolute force level maintained (PElectromyography amplitude of flexor hallucis longus was also greater on the symptomatic side compared to the healthy leg (P

  14. Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia

    Directory of Open Access Journals (Sweden)

    G. Biasi

    2014-06-01

    Full Text Available Chronic pelvic pain (CPP is a common condition that has a major impact on the quality of life of both men and women. Male CPP is usually attributable to well-defined urogenital conditions (most frequently infectious/non infectious prostatic diseases or musculoskeletal or bowel diseases, whereas the features of female CPP are much more complex and are of particular clinical and epidemiological importance. It is a multifactorial syndrome that can be due to diseases of the urogenital, gastrointestinal, or musculoskeletal systems, or to neurological or neuropsychiatric disorders. It is not always easy to identify its predominant pathogenesis, although it often occurs as a central sensitization syndrome triggered by an initial stimulus which is no longer detectable and only manifests itself clinically through pain. In this respect, there are some very interesting relationships between vulvodynia and fibromyalgic syndrome, as identified in a preliminary study of women with chronic musculoskeletal pain in which it was demonstrated that vulvar pain plays an important role, although it is often overlooked and undiagnosed.

  15. Exercise-induced muscle pain, soreness, and cramps.

    Science.gov (United States)

    Miles, M P; Clarkson, P M

    1994-09-01

    The three types of pain related to exercise are 1) pain experienced during or immediately following exercise, 2) delayed onset muscle soreness, and 3) pain induced by muscle cramps. Each is characterized by a different time course and different etiology. Pain perceived during exercise is considered to result from a combination of factors including acids, ions, proteins, and hormones. Although it is commonly believed that lactic acid is responsible for this pain, evidence suggests that it is not the only factor. However, no single factor has ever been identified. Delayed onset muscle soreness develops 24-48 hours after strenuous exercise biased toward eccentric (muscle lengthening) muscle actions or strenuous endurance events like a marathon. Soreness is accompanied by a prolonged strength loss, a reduced range of motion, and elevated levels of creatine kinase in the blood. These are taken as indirect indicators of muscle damage, and biopsy analysis has documented damage to the contractile elements. The exact cause of the soreness response is not known but thought to involve an inflammatory reaction to the damage. Muscle cramps are sudden, intense, electrically active contractions elicited by motor neuron hyperexcitability. Although it is commonly assumed that cramps during exercise are the result of fluid electrolyte imbalance induced by sweating, two studies have not supported this. Moreover, participants in occupations that require chronic use of a muscle but do not elicit profuse sweating, such as musicians, often experience cramps. Fluid electrolyte imbalance may cause cramps if there is profuse prolonged sweating such as that found in working in a hot environment. Thus, despite the common occurrence of pain associated with exercise, the exact cause of these pains remains a mystery.

  16. Chronic pain: cytokines, lymphocytes and chemokines.

    Science.gov (United States)

    de Miguel, Marcia; Kraychete, Durval Campos; Meyer Nascimento, Roberto Jose

    2014-01-01

    Chronic pain is a debilitating condition and, in most cases, difficult to treat. A prominent example of this is neuropathic pain. Understanding pathophysiological mechanisms of pain and, therefore, making this knowledge into an effective treatment is still a challenge to experts. Pain can now be considered as a neuro-immune disorder, since recent data indicate critical involvement of innate and adaptive immune responses following injury, and this interaction plays an important role in the onset and perpetuation of chronic pain. The aim of this article is to review the relationship between immune system and chronic pain, especially about neuropathic pain, and focusing on cytokines, chemokines and lymphocytes.

  17. A neural model for chronic pain and pain relief by extracorporeal shock wave treatment.

    Science.gov (United States)

    Wess, Othmar J

    2008-12-01

    The paper develops a new theory of chronic pain and pain relief by extracorporeal shock wave treatment. Chronic pain without underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reflexes are considered to be engraved memory traces linking sensory input of afferent signals with motor response of efferent signals. This feature can be described by associative memory functions of the nervous system. Some conditioned reflexes may cause inappropriate or pathological reactions. Consequently, a circulus vitiosus of pain sensation and muscle and/or vessel contraction is generated when pain becomes chronic (pain spiral). The key feature is a dedicated engram responsible for a pathological (painful) reaction. The pain memory may be explained by the concept of a holographic memory model published by several authors. According to this model it is shown how nervous systems may generate and recall memory contents. The paper shows how extracorporeal shock wave treatment may reorganize pathologic memory traces, thus giving cause to real and permanent pain relief. In a generalized manner, the idea of associative memory functions may help in the understanding of conditioning as a learning process and explain extracorporeal shock wave application as an efficient treatment concept for chronic pain. This concept may open the door for new treatment approaches to chronic pain and several other disorders of the nervous system.

  18. [Association between chronic pain and depression].

    Science.gov (United States)

    Alonso Fernández, Francisco

    2005-01-01

    The comorbidity integrated by chronic pain and depression is very common. The somatoform depressive symptoms appear often as diferent types of pain. Amon them premenstrual pain and fibromialgia are some of the most important clinical pictures. Chronic pain leads to depression as a consequence of these three kinds of factors: biomedical, psychosocial (passive attitude, disability) and pharmacological agents. Copping and acceptance of chronic pain is associated with lower pain intensity, less depression and less psychosocial disability. The appropriate use of analgesics in the management of chronic pain demands individualization. Several antidepressants have possitive effects on pain syndrom. Depression is underrecognized ad undertreated above all in patients with chronic pain. In order screening the depression seven ways are described here: personal and family history, type of the personality, clinic and evolutive aspects of somatoform symptom, search of other depressive symptoms and positive therapeutic effect determinated by an antidepressant.

  19. Chronic pain after inguinal hernia repair

    OpenAIRE

    2008-01-01

    : BACKGROUND: Chronic post herniorrhaphy groin pain is defined as pain lasting > 6 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously thought. Chronic groin pain is one of the most significant complications following inguinal hernia repair, and majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Various other factors are involved in development of...

  20. Bilateral experimental neck pain reorganize axioscapular muscle coordination and pain sensitivity

    DEFF Research Database (Denmark)

    Christensen, Steffan Wittrup; Hirata, Rogerio Pessoto; Graven-Nielsen, Thomas

    2017-01-01

    BACKGROUND: Neck pain is a large clinical problem where reorganized trunk and axioscapular muscle activities have been hypothesised contributing to pain persistence and pain hypersensitivity. This study investigated the effects of bilateral experimental neck pain on trunk and axioscapular muscle ...

  1. Experimental neck muscle pain impairs standing balance in humans

    CERN Document Server

    Vuillerme, Nicolas; 10.1007/s00221-008-1639-7

    2009-01-01

    Impaired postural control has been reported in patients with chronic neck pain of both traumatic and non-traumatic etiologies, but whether painful stimulation of neck muscle per se can affect balance control during quiet standing in humans remains unclear. The purpose of the present experiment was thus to investigate the effect of experimental neck muscle pain on standing balance in young healthy adults. To achieve this goal, 16 male university students were asked to stand upright as still as possible on a force platform with their eyes closed in two conditions of No pain and Pain of the neck muscles elicited by experimental painful electrical stimulation. Postural control and postural performance were assessed by the displacements of the center of foot pressure (CoP) and of the center of mass (CoM), respectively. The results showed increased CoP and CoM displacements variance, range, mean velocity, and mean and median frequencies in the Pain relative to the No pain condition. The present findings emphasize t...

  2. Pharmacological pain management in chronic pancreatitis

    OpenAIRE

    2013-01-01

    Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firm...

  3. Chronic widespread pain in spondyloarthritis

    Directory of Open Access Journals (Sweden)

    F. Atzeni

    2014-06-01

    Full Text Available The pain associated with spondyloarthritis (SpA can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP that characterises fibromyalgia (FM. The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.

  4. The effect of motor control exercises versus back muscle endurance training with kinesio taping on the balance indices in patients with nonspecific chronic low back Pain

    Directory of Open Access Journals (Sweden)

    Noorollahzadeh Karim

    2016-03-01

    Full Text Available Aims and Background: In patients with low back pain, postural sway is more than normal people. The aim of this study was to compare the effect of motor control exercises (MCE and back muscle endurance training with kinesio taping (BMET&KT on the on the balance indices in patients with nonspecific chronic low back Pain (NCLBP. Methods and Materials: For this single-blind randomized controlled trial, 33 patients with NCLBP were selected through convenience sampling and randomly divided into two groups of the MCE and BMET&KT. Exercises of the both groups were performed 3 times per week for 5 weeks. Before and after the treatment, overall, Anteroposterior and lateral stability indices were measured by Biodex Balance System in both static and dynamic conditions with the eyes open and closed on both legs. Paired t-test and independent sample t–tests were used for analyzing the data. Results: In the MCE group, the overall stability index(OSI and anteroposteriorior stability index(APSI in static condition with eyes closed and lateral stability index(LSI in static condition with open eyes reduced from 1.01 ±0.35 to 0.71 ± 0.36 (P = 0.003, 0.84 ± 0.35 to 0.57 ± 0.32 ( P = 0.008 and 0.14 ± 0.07 to 0.10 ± .04 (P = 0.020 respectively. In the BMET&KT group, the OSI and APSI in static condition with eyes open and LSI in dynamic condition with eyes open reduced from 0.35 ± 0.15 to 0.24 ± 0.10 (P = 0.009, 0.25 ± 0.09 to 0.18 ± 0.08 (P = 0.003 and from 0.63± 0.28 to 0.44± 0.20 (P = 0.008 respectively. Except APSI in static condition with eyes open, there wasn’t significant difference between the two groups (P > 0.05. Conclusion: The MCE were more effective on the static balance in eyes closed condition. While, BMET&KT were more effective on the static balance in the eyes open condition. But there wasn’t any difference between the two treatment methods in terms of the improvement of the postural stability

  5. The influence of experimentally induced pain on shoulder muscle activity

    DEFF Research Database (Denmark)

    Diederichsen, L.P.; Winther, A.; Dyhre-Poulsen, P.

    2009-01-01

    muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper...... in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load on the painful structures Udgivelsesdato: 2009/4...

  6. Mechanisms of chronic pain from whiplash injury.

    Science.gov (United States)

    Davis, Charles G

    2013-02-01

    This article is to provide insights into the mechanisms underlying chronic pain from whiplash injury. Studies show that injury produces plasticity changes of different neuronal structures that are responsible for amplification of nociception and exaggerated pain responses. There is consistent evidence for hypersensitivity of the central nervous system to sensory stimulation in chronic pain after whiplash injury. Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity. Different mechanisms underlie and co-exist in the chronic whiplash condition. Spinal cord hyperexcitability in patients with chronic pain after whiplash injury can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain pain in the absence of detectable tissue damage. Whiplash is a heterogeneous condition with some individuals showing features suggestive of neuropathic pain. A predominantly neuropathic pain component is related to a higher pain/disability level.

  7. Pharmacological management of pain in chronic pancreatitis.

    NARCIS (Netherlands)

    Esch, A.A.J.; Wilder-Smith, O.H.G.; Jansen, J.B.M.J.; Goor, H. van; Drenth, J.P.H.

    2006-01-01

    Pain is the major presenting symptom of chronic pancreatitis. Patients with chronic pancreatitis experience substantial impairments in health-related quality of life. Pain may be considered as the most important factor affecting the quality of life. The pathogenesis of pancreatic pain is poorly unde

  8. Chronic Pain after Inguinal Hernia Repair.

    Science.gov (United States)

    Manangi, Mallikarjuna; Shivashankar, Santhosh; Vijayakumar, Abhishek

    2014-01-01

    Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of six months. Detailed preoperative, intraoperative, and postoperative details of cases were recorded according to proforma. The postoperative pain and pain at days two and seven and at end of six months were recorded on a VAS scale. Results. Chronic pain at six-month followup was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7% of patients with preoperative pain developed chronic pain. Preemptive analgesia failed to show statistical significance in development of chronic pain (P = 0.079). Nerve injury was present in 22 of cases; it was found that nerve injury significantly affected development of chronic pain (P = 0.001). On multivariate analysis, it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, postoperative local infiltration, postoperative complication, and most importantly the early postoperative pain. Conclusions. In the present study, we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves are very important. Early diagnosis and management of chronic pain can remove suffering of the patient.

  9. Muscle histochemistry in chronic alcoholism

    Directory of Open Access Journals (Sweden)

    M. L. Ferraz

    1989-06-01

    Full Text Available Twenty-two chronic acoholic patients were assessed by neurologic examination and muscle biopsy. The patients manifested proximal muscular weakness to a variable extent. One case presented as an acute bout of myopathy, according to the Manual Muscle Test, MMT. The most prominent histologic feature observed was muscle atrophy (95.3% better evidenced through the ATPase stain with the predominance of type II A fibers (71.4%. Lack of the mosaic pattern (type grouping seen in 76% of the cases and an important mitochondrial proliferation with intrasarcoplasmatic lipid accumulation in 63% of the patients. In case of acute presentation of muscle weakness the. pathological substrate is quite different, i.e. presence of myositis mainly interstitial characterized by lymphoplasmocytic infiltrate and several spots of necrosis like Zencker degeneration. Based on histologic criteria, our data suggest that: the main determinant of muscle weakness seen in chronic alcoholic patients is neurogenic in origin (alcoholic polineuropathy; the direct toxic action of ethanol under the skeletal muscle is closely related to the mitochondrial metabolism; the so-called acute alcoholic myopathy has probably viral etiology.

  10. Painful Unilateral Temporalis Muscle Enlargement: Reactive Masticatory Muscle Hypertrophy

    OpenAIRE

    Katsetos, Christos D.; Bianchi, Michael A.; Jaffery, Fizza; Koutzaki, Sirma; Zarella, Mark; Slater, Robert

    2013-01-01

    An instance of isolated unilateral temporalis muscle hypertrophy (reactive masticatory muscle hypertrophy with fiber type 1 predominance) confirmed by muscle biopsy with histochemical fiber typing and image analysis in a 62 year-old man is reported. The patient presented with bruxism and a painful swelling of the temple. Absence of asymmetry or other abnormalities of the craniofacial skeleton was confirmed by magnetic resonance imaging and cephalometric analyses. The patient achieved symptoma...

  11. CHRONIC PAIN AFTER INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-09-01

    Full Text Available : BACKGROUND: Chronic post herniorrhaphy groin pain is defined as pain lasting > 6 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously thought. Chronic groin pain is one of the most significant complications following inguinal hernia repair, and majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Various other factors are involved in development of chronic pain. MATERIAL AND METHODS: Patients undergoing elective inguinal hernioplasty in Victoria hospital from November2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for follow up at end of six months. A detailed preoperative, intraoperative and post-operative details of cases were recorded according to proforma. The postoperative pain and pain at two, seven days and at end of six months were recorded on a VAS scale. RESULTS: Chronic pain at six month follow up was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7 % of patients with preoperative pain developed chronic pain. Patients with significant preoperative pain had higher chances of developing chronic pain (p<.0001. Preemptive analgesia failed to show statistical significance in development of chronic pain (p=0.079. Nerve injury were present in 22 of cases it was found that nerve injury significantly affected development of chronic pain (p=0.001.Post-operative infiltration of local anesthesia was practiced in 16.3 % of cases and it was found that local infiltration at incision site significantly reduced incidence of chronic pain (p=0.001.Postoperative complications in the form of hematoma, seroma or infection was present in 8.5 % of cases. It was found that post-operative complication not only increased early post-operative pain

  12. Chronic pain and invasive therapy

    Directory of Open Access Journals (Sweden)

    Alessandro Rocco

    2009-05-01

    Full Text Available The chronic pain “three-step” OMS ladder is likely to be revised, in order to introduce a “fourth step” including clinical indications for the invasive analgesic procedures. The number of patients who undergo such procedures is likely to increase, as well as modern oncology and palliative medicine development. Most of invasive approaches include central (spinal neuromodulation and peripheral (gangliar neurolysis, percutaneous vertebral reduction techniques, as well as pharmacological (opioids and adiuvants, chemical (alcohol and physical (electrical stimulation, thermic neurolysis means. Rarely effective as unique therapies, invasive procedures have to be accurately patient-selected and considered supplementary to conservative approaches, in order to minimize the adverse events deriving from a long term opioid therapy. In the near future, the development of both pain science and biomedical technology will probably be accompanied by the improvement of the knowledge regarding the recourse to invasive analgesic procedures.

  13. No release of interstitial glutamate in experimental human model of muscle pain

    DEFF Research Database (Denmark)

    Ashina, M.; Jørgensen, M.; Stallknecht, Bente;

    2005-01-01

    Glutamate may be released from muscle nociceptors and thereby contribute to mechanisms underlying acute and chronic muscle pain. In vivo concentration of glutamate during muscle pain has not previously been studied in either animals or humans. In the present study, we aimed to study the in vivo...... flow increased significantly over time in response to infusion of chemical mixture and placebo (p = 0.001). However, we found no difference in changes in muscle blood flow between chemical mixture and placebo (p > 0.05). In conclusion, the present study demonstrates no signs of increased release...... of glutamate from myofascial nociceptors during and after acute experimentally induced muscle pain and tenderness....

  14. Mindfulness, acceptance and catastrophizing in chronic pain.

    Directory of Open Access Journals (Sweden)

    Maaike J de Boer

    Full Text Available OBJECTIVES: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain. METHODS: A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center. RESULTS: The results show that general psychological acceptance (measured with the AAQ-II is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS did not predict levels of pain-related catastrophizing. DISCUSSION: Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of "acting with awareness" is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.

  15. Effects of experimental muscle pain on shoulder-abduction force steadiness and muscle activity in healthy subjects

    DEFF Research Database (Denmark)

    Bandholm, Thomas Quaade; Rasmussen, Lars; Aagaard, Per;

    2007-01-01

    We previously demonstrated that the steadiness of shoulder abduction is reduced in patients with subacromial impingement syndrome (SIS), which might be related to shoulder pain associated with the SIS. The aim of the present study was to examine the acute effects of experimental shoulder muscle p...... explanation may be that, even though the adopted experimental pain-paradigm may reflect the SIS in terms of the painful structures, it might not reflect the adaptations in the central nervous system seen with chronic pain....

  16. Beyond Acute Pain: Understanding Chronic Pain in Infancy

    Directory of Open Access Journals (Sweden)

    Miranda DiLorenzo

    2016-11-01

    Full Text Available This topical review presents the current challenges in defining chronic pain in infants, summarizes evidence from animal and human infant studies regarding the biological processes necessary for chronic pain signaling, and presents observational/experiential evidence from clinical experts. A literature search of four databases (CINAHL, EMBASE, PsycINFO, and MEDLINE was conducted, along with hand searches of reference lists. Evidence from animal studies suggest that important neurophysiological mechanisms, such as the availability of key neurotransmitters needed for maintenance of chronic pain, may be immature or absent in the developing neonate. In some cases, human infants may be significantly less likely to develop chronic pain. However, evidence also points to altered pain perception, such as allodynia and hyperalgesia, with significant injury. Moreover, clinicians and parents in pediatric intensive care settings describe groups of infants with altered behavioral responses to repeated or prolonged painful stimuli, yet agreement on a working definition of chronic pain in infancy remains elusive. While our understanding of infant chronic pain is still in the rudimentary stages, a promising avenue for the future assessment of chronic pain in infancy would be to develop a clinical tool that uses both neurophysiological approaches and clinical perceptions already presented in the literature.

  17. [Post-operative pain therapy of a chronic pain patient].

    Science.gov (United States)

    Pawlik, Michael T; Ittner, Karl Peter

    2006-11-01

    Post-operative pain therapy of chronic pain patients poses a challenge. Here we report the perioperative management of a 39-year-old male under chronic therapy with oxycodon, gabapentin and tolperison. Particular the pharmacointeractions regarding premedication and postoperative dose finding of opioids with intravenous PCIA are discussed.

  18. Chronic proctalgia and chronic pelvic pain syndromes: New etiologic insights and treatment options

    Institute of Scientific and Technical Information of China (English)

    Giuseppe Chiarioni; Corrado Asteria; William E Whitehead

    2011-01-01

    This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: A recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

  19. Pharmacological pain management in chronic pancreatitis.

    Science.gov (United States)

    Olesen, Søren S; Juel, Jacob; Graversen, Carina; Kolesnikov, Yuri; Wilder-Smith, Oliver H G; Drewes, Asbjørn M

    2013-11-14

    Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.

  20. Chronic pain after childhood groin hernia repair

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Kehlet, Henrik

    2007-01-01

    BACKGROUND: In contrast to the well-described 10% risk of chronic pain affecting daily activities after adult groin hernia repair, chronic pain after childhood groin hernia repair has never been investigated. Studies of other childhood surgery before the age of 3 months suggest a risk of increased...... pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown. METHODS: This was a nationwide detailed questionnaire study of chronic groin pain in adults having surgery for a groin hernia repair before the age of 5 years (n = 1075). RESULTS: The response...... the age of 3 months (n = 122) did not report groin pain more often or with higher intensity than other patients did. CONCLUSIONS: Groin pain in adult patients operated on for a groin hernia in childhood is uncommon and usually mild and occurs in relation to physical activity. Operation before the age of 3...

  1. Core strength training for patients with chronic low back pain.

    Science.gov (United States)

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-03-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain.

  2. The influence of experimentally induced pain on shoulder muscle activity

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul

    2009-01-01

    . EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius...... the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load on the painful structures....

  3. Chronic musculoskeletal pain: review of mechanisms and biochemical biomarkers as assessed by the microdialysis technique

    Directory of Open Access Journals (Sweden)

    Gerdle B

    2014-06-01

    Full Text Available Björn Gerdle,1,2 Bijar Ghafouri,1,3 Malin Ernberg,4 Britt Larsson1,21Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; 2Pain and Rehabilitation Centre, County Council of Östergötland, Linköping, Sweden; 3Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; 4Department of Dental Medicine, Section of Orofacial Pain and Jaw Function, Karolinska Institutet, Huddinge, SwedenAbstract: Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain, which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for studying local tissue alterations and allows for sampling of substances in the interstitium of the muscle, where nociceptor free nerve endings are found close to the muscle fibers. The extracellular matrix plays a key role in physiologic functions of cells, including the primary afferent nociceptor. The present review mainly concerns the results of microdialysis studies and how they can contribute to the understanding of activated peripheral nociceptive and pain

  4. Intravenous infusions in chronic pain management.

    Science.gov (United States)

    Kosharskyy, Boleslav; Almonte, Wilson; Shaparin, Naum; Pappagallo, Marco; Smith, Howard

    2013-01-01

    In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence.

  5. Assessment of patients with chronic pain.

    Science.gov (United States)

    Dansie, E J; Turk, D C

    2013-07-01

    Chronic pain is a public health concern affecting 20-30% of the population of Western countries. Although there have been many scientific advances in the understanding of the neurophysiology of pain, precisely assessing and diagnosing a patient's chronic pain problem is not straightforward or well-defined. How chronic pain is conceptualized influences how pain is evaluated and the factors considered when making a chronic pain diagnosis. There is no one-to-one relationship between the amount or type of organic pathology and pain intensity, but instead, the chronic pain experience is shaped by a myriad of biomedical, psychosocial (e.g. patients' beliefs, expectations, and mood), and behavioural factors (e.g. context, responses by significant others). Assessing each of these three domains through a comprehensive evaluation of the person with chronic pain is essential for treatment decisions and to facilitate optimal outcomes. This evaluation should include a thorough patient history and medical evaluation and a brief screening interview where the patient's behaviour can be observed. Further assessment to address questions identified during the initial evaluation will guide decisions as to what additional assessments, if any, may be appropriate. Standardized self-reported instruments to evaluate the patient's pain intensity, functional abilities, beliefs and expectations, and emotional distress are available, and can be administered by the physician, or a referral for in depth evaluation can be made to assist in treatment planning.

  6. Nonspecificity of Chronic Soft Tissue Pain Syndromes

    Directory of Open Access Journals (Sweden)

    Eldon Tunks

    1997-01-01

    Full Text Available Persistent (or chronic pain occurs with a prevalence of about 10% in the adult population, and chronic soft tissue pain is especially problematic. Criteria for diagnosis of these soft tissue pain disorders appear to suffer from specificity problems, even though they appear to be sensitive in distinguishing normal from soft tissue pain sufferers. A few decades ago the term 'neuraesthenia' was used as a diagnosis in individuals who now would probably be diagnosed as suffering from fibromyalgia, chronic fatigue and anxiety disorders with fatigue. Soft tissue pain provokes skepticism, especially among third-party payers, and controversy among clinicians. Recent epidemiological studies have demonstrated sex differences in the prevalence of widespread pain and multiple tender points, which are distributed variably throughout the adult population and tend to be correlated with subjective symptoms. Although there is a tendency for these syndromes to persist, follow-up studies show that they tend to vary in extent and sometimes show remissions over longer follow-up, casting doubt about the distinctions between chronic diffuse pains and localized chronic soft tissue pains. Because both accidents and soft tissue pains are relatively prevalent problems, the possibility of chance coincidence of accident and chronic soft tissue pain in an individual creates the need to be cautious in attributing these syndromes to specific accidents in medicolegal situations. At the same time, the available evidence does not support a generally dismissive attitude towards these patients.

  7. Counseling Adult Clients Experiencing Chronic Pain

    Science.gov (United States)

    Burns, Stephanie T.

    2010-01-01

    Chronic pain affects 35% to 57% of the adult population in the United States and results in billions of dollars spent annually in direct health-care costs and lost productivity. Extensive research confirms the considerable role psychological factors play in the experience and expression of chronic pain. The author discusses implications for…

  8. Pharmacological pain management in chronic pancreatitis

    NARCIS (Netherlands)

    Olesen, S.S.; Juel, J.; Graversen, C.; Kolesnikov, Y.; Wilder-Smith, O.H.G.; Drewes, A.M.

    2013-01-01

    Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles th

  9. Review of occupational therapy for people with chronic pain.

    LENUS (Irish Health Repository)

    Robinson, Katie

    2011-04-01

    Chronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.

  10. Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications.

    Science.gov (United States)

    Nijs, Jo; Meeus, Mira; De Meirleir, Kenny

    2006-08-01

    Patients with chronic fatigue syndrome (CFS) experience chronic musculoskeletal pain which is even more debilitating than fatigue. Scientific research data gathered around the world enables clinicians to understand, at least in part, chronic musculoskeletal pain in CFS patients. Generalized joint hypermobility and benign joint hypermobility syndrome appear to be highly prevalent among CFS sufferers, but they do not seem to be of any clinical importance. On the other hand, pain catastrophizing accounts for a substantial portion of musculoskeletal pain and is a predictor of exercise performance in CFS patients. The evidence concerning pain catastrophizing is supportive of the indirect evidence of a dysfunctional pain processing system in CFS patients with musculoskeletal pain. CFS sufferers respond to incremental exercise with a lengthened and accentuated oxidative stress response, explaining muscle pain, postexertional malaise, and the decrease in pain threshold following graded exercise in CFS patients. Applying the scientific evidence to the manual physiotherapy profession, pacing self-management techniques and pain neurophysiology education are indicated for the treatment of musculoskeletal pain in CFS patients. Studies examining the effectiveness of these strategies for CFS patients are warranted.

  11. Chronic Neck Pain and Cervicogenic Headaches.

    Science.gov (United States)

    Feng, Frank L.; Schofferman, Jerome

    2003-11-01

    Chronic axial neck pain and cervicogenic headache are common problems, and there have been significant advances in the understanding of the etiology and treatment of each. The severity and duration of pain drives the process. For patients who have had slight to moderate pain that has been present for less than 6 months and have no significant motor loss, strength training of anterior, posterior, and interscapular muscle groups coupled with body mechanics training is prescribed. After 8 weeks, if the patient is better, exercises are continued at home or in a gym. If the patient is not better, physical therapy is continued for up to 8 more weeks. In patients with motor loss or severe pain, radiographs and magnetic resonance imaging (MRI) should be ordered at the initial visit. In patients with slight to moderate pain who are not better by 4 to 6 months, plain radiographs of the neck and MRI should be ordered. Based on the results, a spinal injection is usually prescribed. If MRI reveals spinal stenosis of the central or lateral canal, or a disc herniation, an epidural corticosteroid injection should be ordered. If the epidural provides good relief, the patient can be referred for more aggressive physical therapy and repeat the epidural as needed up to a maximum of three times. If there is no pathology within the canal, medial branch blocks and intra-articular steroid injections can be ordered based on the joints that are most tender or where disc space narrowing is greatest, or MRI or radiographs are recommended. If there is excellent relief from the medial branch block and joint injections, repeat when the steroids wear off. If there is good relief again, but pain recurs, medial branch radiofrequency neurotomy is recommended. For patients with one or two level disc degeneration that has not responded, a psychologic evaluation and discography is recommended. If there are no significant psychologic abnormalities, and one or two (rarely three) painful discs, surgical

  12. Disposition and adjustment to chronic pain.

    Science.gov (United States)

    Ramírez-Maestre, Carmen; Esteve, Rosa

    2013-03-01

    Several empirical studies have shown that personal characteristics act as differential variables, which determine how pain is experienced and how the chronic pain patient adjusts to pain. The main aim of the present research is to review the relationships between some dispositional characteristics and pain adjustment. Taking into account the empirical literature, 6 personality traits that are relevant to the pain experience have been selected: neuroticism, anxiety sensitivity, and experiential avoidance as risk factors that increase the probability of patients experiencing a disability; and extraversion, optimism, and resilience as personal resources that increase their capacity to manage pain effectively. The results suggest that it would be useful to include an assessment of normal personality structure during the multi-dimensional evaluation of a person with chronic pain. Understanding these individual personality characteristics will aid in designing pain intervention programs and help predict possible treatment outcomes.

  13. Osteomalacia as a Cause of Chronic Pain

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1996-01-01

    Full Text Available Osteomalacia is a form of metabolic bone disease that can present as chronic pain. A 36-year-old woman presented with a three-year history of bilateral leg and back pain, and proximal leg weakness. Repeated consultations and investigations failed to discover a cause for her pain, and a diagnosis of chronic benign pain was made. She was admitted to hospital where the bone scan, laboratory investigation and bone biopsy established a diagnosis of renal phosphate-wasting adult-onset rickets (osteomalacia. Radiographs of the hip and magnetic resonance imaging revealed bilateral femoral neck fractures and segmental, avascular necrosis of the femoral heads. The patient was treated with high dose phosphate and vitamin D with marked relief of pain. Osteomalacia should be considered in unusual cases of intractable chronic pain.

  14. Muscle pain: animal and human experimental and clinical studies.

    Science.gov (United States)

    Marchettini, P

    1993-10-01

    The search for the identification of the sensory apparatus encoding muscle pain sensation in humans is recounted. Basic neurophysiologic animal studies, leading to a description of slowly conducting afferent from muscle and definition of high threshold polymodal muscle nociceptors, and pioneer psychophysic human studies together with recent microneurographic experiments in humans are described. The phenomena of muscle pain broad localization and distant referral are discussed, and clinical implications are extrapolated to interpret muscle pain as a localizing sign of mononeuropathy or radiculopathy. The identification of human muscle nociceptors has defined the scientific standard to test emerging clinical descriptions having muscle pain as a symptom.

  15. Hostility and Anger in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Lúcia Ribeiro

    2012-06-01

    Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

  16. Hostility and Anger in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Sara Oliveira

    2013-11-01

    Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

  17. Goal Pursuit in Youth with Chronic Pain

    Science.gov (United States)

    Fisher, Emma; Palermo, Tonya M.

    2016-01-01

    Children and adolescents frequently experience chronic pain that can disrupt their usual activities and lead to poor physical and emotional functioning. The fear avoidance model of pain with an emphasis on the maladaptive behaviors that lead to activity avoidance has guided research and clinical practice. However, this model does not take into consideration variability in responses to pain, in particular the active pursuit of goals despite pain. This review aims to introduce a novel conceptualization of children’s activity engagement versus avoidance using the framework of goal pursuit. We propose a new model of Goal Pursuit in Pediatric Chronic Pain, which proposes that the child’s experience of pain is modified by child factors (e.g., goal salience, motivation/energy, pain-related anxiety/fear, and self-efficacy) and parent factors (e.g., parent expectations for pain, protectiveness behaviors, and parent anxiety), which lead to specific goal pursuit behaviors. Goal pursuit is framed as engagement or avoidance of valued goals when in pain. Next, we recommend that research in youth with chronic pain should be reframed to account for the pursuit of valued goals within the context of pain and suggest directions for future research. PMID:27879686

  18. Goal Pursuit in Youth with Chronic Pain

    Directory of Open Access Journals (Sweden)

    Emma Fisher

    2016-11-01

    Full Text Available Children and adolescents frequently experience chronic pain that can disrupt their usual activities and lead to poor physical and emotional functioning. The fear avoidance model of pain with an emphasis on the maladaptive behaviors that lead to activity avoidance has guided research and clinical practice. However, this model does not take into consideration variability in responses to pain, in particular the active pursuit of goals despite pain. This review aims to introduce a novel conceptualization of children’s activity engagement versus avoidance using the framework of goal pursuit. We propose a new model of Goal Pursuit in Pediatric Chronic Pain, which proposes that the child’s experience of pain is modified by child factors (e.g., goal salience, motivation/energy, pain-related anxiety/fear, and self-efficacy and parent factors (e.g., parent expectations for pain, protectiveness behaviors, and parent anxiety, which lead to specific goal pursuit behaviors. Goal pursuit is framed as engagement or avoidance of valued goals when in pain. Next, we recommend that research in youth with chronic pain should be reframed to account for the pursuit of valued goals within the context of pain and suggest directions for future research.

  19. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.

    Science.gov (United States)

    Buskila, D

    2001-03-01

    The prevalence of chronic widespread pain in the general population in Israel was comparable with reports from the USA, UK, and Canada. Comorbidity with fibromyalgia (FM) resulted in somatic hyperalgesia in patients with irritable bowel syndrome. One sixth of the subjects with chronic widespread pain in the general population were also found to have a mental disorder. Mechanisms involved in referred pain, temporal summation, muscle hyperalgesia, and muscle pain at rest were attenuated by the N-methyl-D-aspartate (NMDA) antagonist, ketamine, in FM patients. Delayed corticotropin release, after interleukin-6 administration, in FM was shown to be consistent with a defect in hypothalamic corticotropin-releasing hormone neural function. The basal autonomic state of FM patients was characterized by increased sympathetic and decreased parasympathetic systems tones. The severity of functional impairment as assessed by the Medical Outcome Survey Short Form (SF-36) discriminated between patients with widespread pain alone and FM patients. Chronic fatigue syndrome (CFS) occurred in about 0.42% of a random community-based sample of 28,673 adults in Chicago, Illinois. A significant clinical overlap between CFS and FM was reported. Cytokine dysregulation was not found to be a singular or dominant factor in the pathogenesis of CFS. A favorable outcome of CFS in children was reported; two thirds recovered and resumed normal activities. No major therapeutic trials in FM and CFS were reported over the past year.

  20. Effects of long-term corset wearing on chronic low back pain.

    Science.gov (United States)

    Sato, Naoto; Sekiguchi, Miho; Kikuchi, Shinichi; Shishido, Hiroaki; Sato, Katsuhiko; Konno, Shinichi

    2012-01-01

    There are few studies of the therapeutic effects of long-term corset wearing in patients with chronic low back pain. The aim of this study was to evaluate the effects of long-term corset wearing on chronic low back pain and to examine the myoelectrical activities of the paravertebral muscles. Forty subjects with chronic low back pain were enrolled and randomly divided into two groups: a group wearing corsets for 6 months (CW) group and a group not wearing corsets (NW). The treatment effects were measured using the Japanese Orthopaedic Association (JOA) score. Muscle endurance was evaluated during the Biering-Sorensen test (S-test), and the degree of muscle fatigue was evaluated by the change in percent mean power frequency (%MPF) of the paravertebral muscles. Corset treatment for chronic low back pain improved low back pain and increased muscle endurance for a short period of time. Paravertebral muscle fatigue was not increased by long-term corset wearing for chronic low back pain, and weakening of the paravertebral muscles was not observed up to 6 months after the start of corset wearing.

  1. Neuroimmunological mechanisms of chronic pain syndrome

    Directory of Open Access Journals (Sweden)

    I. A. Vyshlova

    2016-01-01

    Full Text Available The article considers the mechanisms of chronic low back pain. Three pathophysiological mechanisms: nociceptive, neurogenic (neuropathic, and psychogenic are noted to be involved in the development of pain syndrome. The role of cellular and molecular changes in the posterior horn and in the somatosensory dysregulated mechanism of neuropathic pain is shown. Immunological processes, including neurohumoral (serotoninergic and hormonal (sex hormones and specific proteins ones, play an important role in the development of pain. The generalization and further study of these mechanisms are embodied in approaches to therapy for pain syndromes and hence these require analysis and further investigation. 

  2. Acute and chronic low back pain.

    Science.gov (United States)

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2014-07-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

  3. Nordic walking and chronic low back pain

    DEFF Research Database (Denmark)

    Morsø, Lars; Hartvigsen, Jan; Puggaard, Lis;

    2006-01-01

    Low Back Pain is a major public health problem all over the western world. Active approaches including exercise in the treatment of low back pain results in better outcomes for patients, but it is not known exactly which types of back exercises are most beneficial or whether general physical....... Until now no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to low back pain. The primary aim of this study is to investigate whether supervised Nordic Walking can reduce pain and improve function in a population of chronic low back pain patients...

  4. Transdermal fentanyl in chronic nonmalignant pain

    Directory of Open Access Journals (Sweden)

    Vittorio Iorno

    2006-09-01

    Full Text Available Chronic non malignant pain is always a therapeutic challenge of great significance because a inappropriate and insufficient treatment is able to reduce the life’s quality of the patients. Many therapeutic strategies were used to solve these issues, no one exhaustive. In the treatment of cancer pain, opiates use is common, is not the same for the chronic non-malignant pain. The fear of possible side effects (addiction, tolerance, respiratory depression restrain the therapist to apply this remedy. The aim of our work is to demonstrate how a correct application of the opiates in patients with chronic benign pain is not only possible but also desirable to relieving the pain and improving the quality of life.

  5. [Local invasive treatment of chronic pain].

    Science.gov (United States)

    Medvedeva, L A; Zagorul'ko, O I; Gnezdilov, A V

    2014-01-01

    The literature on methods of invasive local treatment of chronic pain was analyzed. We reviewed 14 publications including meta-analyses and systematic reviews. The use of regional anesthesia conducted by anesthesiologists in pain clinics demonstrated the evidence based efficacy of different types of peridural injections of local anesthetics with steroids in patients with root pain syndromes at cervical and lumbar levels. Therapeutic blockades of the occipital nerve is effective method of treatment of cervicogenic and cluster headache as well as occipital nerve neuralgia. There are clear indications of the efficacy of local injections in primary chronic cephalgia (migraine and headache of tension). The possibility of the abortion of the pain information flow in peripheral nociceptive pathways and, as a consequence, breaking the vicious circle is emphasized. Issues on the efficacy of local injections at trigger points in the treatment of chronic pain are highlighted.

  6. Chronic widespread pain in the spectrum of rheumatological diseases.

    Science.gov (United States)

    Bliddal, Henning; Danneskiold-Samsøe, Bente

    2007-06-01

    Chronic pain is very common in all European countries, with musculoskeletal problems predominating. About 1% of the adult population develops a syndrome of chronic muscle pain, fibromyalgia (FMS), characterized by multiple tender points, back or neck pain, and a number of associated problems from other organs, including a high frequency of fatigue. Evidence points to central sensitization as an important neurophysiological aberration in the development of FMS. Importantly, these neurological changes may result from inadequately treated chronic focal pain problems such as osteoarthritis or myofascial pain. It is important for health professionals to be aware of this syndrome and to diagnose the patients to avoid a steady increase in diagnostic tests. On the other hand, patients with chronic widespread pain have an increased risk of developing malignancies, and new or changed symptoms should be diagnosed even in FMS. In rheumatology practice it is especially important to be aware of the existence of FMS in association with immune inflammatory diseases, most commonly lupus and rheumatoid arthritis. Differential diagnoses are other causes of chronic pain, e.g. thyroid disease. The costs of this syndrome are substantial due to loss of working capability and direct expenses of medication and health-system usage. Fibromyalgia patients need recognition of their pain syndrome if they are to comply with treatment. Lack of empathy and understanding by healthcare professionals often leads to patient frustration and inappropriate illness behavior, often associated with some exaggeration of symptoms in an effort to gain some legitimacy for their problem. FMS is multifaceted, and treatment consists of both medical interventions, with emphasis on agents acting on the central nervous system, and physical exercises.

  7. The influence of experimentally induced pain on shoulder muscle activity.

    Science.gov (United States)

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul; Krogsgaard, Michael R; Nørregaard, Jesper

    2009-04-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0 degrees -105 degrees) at a speed of approximately 120 degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles. In conclusion, this study shows that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load

  8. The Efficacy of a Perceptive Rehabilitation on Postural Control in Patients with Chronic Nonspecific Low Back Pain

    Science.gov (United States)

    Paolucci, Teresa; Fusco, Augusto; Iosa, Marco; Grasso, Maria R.; Spadini, Ennio; Paolucci, Stefano; Saraceni, Vincenzo M.; Morone, Giovanni

    2012-01-01

    Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were…

  9. Interstitial Cystitis: Chronic Pelvic Pain Syndrome

    OpenAIRE

    Fatih Atuğ; Naime Canoruç

    2005-01-01

    Interstitial cystitis, is a chronic inflammatory disease of the bladder of unknown etiology characterized by urinary frequency, urgency, nocturia and suprapubic pain. The syndrome presents differently in many patients, with the unifying factor being chronic pelvic pain and disruption of daily life activities.Although there are abundance of theories, the etiology of the condition remains unclear. This review focuses on recently published literature on the epidemiology, etiology, diagnosis and ...

  10. [Physical and psychic elements in chronic pain].

    Science.gov (United States)

    Callegari, Camilla; Salvaggio, Fabio; Gerlini, Anna; Vender, Simone

    2007-04-01

    Chronic pain is a widespread problem in general medicine and in psychiatry. It consists in physical and psychic elements. The pain has a specific role, a different frequency and a different intensity in each mental illness. Medical treatments can get benefit from psychiatric drugs.

  11. Mindfulness, Acceptance and Catastrophizing in Chronic Pain

    NARCIS (Netherlands)

    de Boer, Maaike J.; Steinhagen, Hannemike E.; Versteegen, Gerbrig J.; Struys, Michel M. R. F.; Sanderman, Robbert

    2014-01-01

    Objectives: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to exami

  12. Neuroimaging revolutionizes therapeutic approaches to chronic pain

    Directory of Open Access Journals (Sweden)

    Borsook David

    2007-09-01

    Full Text Available Abstract An understanding of how the brain changes in chronic pain or responds to pharmacological or other therapeutic interventions has been significantly changed as a result of developments in neuroimaging of the CNS. These developments have occurred in 3 domains : (1 Anatomical Imaging which has demonstrated changes in brain volume in chronic pain; (2 Functional Imaging (fMRI that has demonstrated an altered state in the brain in chronic pain conditions including back pain, neuropathic pain, and complex regional pain syndromes. In addition the response of the brain to drugs has provided new insights into how these may modify normal and abnormal circuits (phMRI or pharmacological MRI; (3 Chemical Imaging (Magnetic Resonance Spectroscopy or MRS has helped our understanding of measures of chemical changes in chronic pain. Taken together these three domains have already changed the way in which we think of pain – it should now be considered an altered brain state in which there may be altered functional connections or systems and a state that has components of degenerative aspects of the CNS.

  13. Personality factors and disorders in chronic pain.

    Science.gov (United States)

    Weisberg, J N; Vaillancourt, P D

    1999-07-01

    It has long been recognized that there is a relationship between certain personality types and personality disorders (PD) and chronic nonmalignant pain (CP). The relationship, however, is far from understood and the physiological and psychological mechanisms that underlie it are unclear. Those who treat chronic pain face many challenges when dealing with individuals who have personality disorders and they often become frustrated when interacting with these patients. Patients with certain traits and personality disorders may continue to worry and ruminate about their symptoms long after the tissue pathology has resolved. Other individuals may overly rely on the clinician and assume a passive role in their treatment, thereby decreasing the likelihood for a positive outcome. Moreover, patients with personality disorders may be demanding (eg, borderline), self-absorbed (eg, narcissistic), or substance seeking (eg, antisocial, borderline). In an attempt to improve management of such patients, pain specialists have attempted to better understand the complex relationship between personality and chronic pain. In this article, we will review the predominant historical and current theories of pain and personality, discuss aspects of the gate-control theory of pain that may relate to personality, and discuss the diathesis-stress model of personality disorders in pain. Last, we will review studies of personality and personality disorders in chronic pain and their treatment implications. We conclude that, based on the underlying neurochemistry, there may be a direct or indirect link between PD and CP, but further prospective research, both on the biological and psychological relationship, should be conducted.

  14. [Hypnosis for chronic pain of children].

    Science.gov (United States)

    Célestin-Lhopiteau, Isabelle

    2014-01-01

    A child or adolescent can suffer from chronic pain. Whatever the causes, it can trap the child in a specific process whereby they focus on the pain, fearing that it will appear and experiencing anxiety. Hypno-analgesia and hypnotherapy enable them to escape this process and find within themselves the capacity to face up to the pain. Moreover, these techniques offer them an autonomy which they can use in all areas of their life.

  15. Effects of chronic neck-shoulder pain on normalized mutual information analysis of surface electromyography during functional tasks

    DEFF Research Database (Denmark)

    Madeleine, Pascal; Xie, Yanfei; Szeto, Grace P. Y.;

    2016-01-01

    OBJECTIVE: To investigate the effects neck-shoulder pain on the connectivity of surface electromyography (SEMG) signals during functional tasks. METHODS: Twenty adults suffering from chronic neck-shoulder pain and 20 healthy controls were recruited. The SEMG signals from the left and right proximal....... Moreover, NMI values in homonymous proximal muscles were higher during texting compared with computer typing with both hands. CONCLUSIONS: Our results show for the first time that chronic neck-shoulder pain affects the functional connectivity of muscle pairs. SIGNIFICANCE: The study furnishes novel...... information about the effects of chronic neck-shoulder pain on the interplay of muscle pairs during functional tasks....

  16. Mediterranean Diet May Ease Chronic Pain of Obesity

    Science.gov (United States)

    ... html Mediterranean Diet May Ease Chronic Pain of Obesity Study suggests eating fish, plant-based proteins is ... eating these foods might reduce pain associated with obesity. Because obese people with chronic pain usually also ...

  17. Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions

    OpenAIRE

    Staud,Roland

    2012-01-01

    The intensity of acute and chronic pain depends on interactions between peripheral impulse input and CNS pain mechanisms, including facilitation and inhibition. Whereas tonic pain inhibition is a characteristic of most pain-free individuals, pain facilitation can be detected in many chronic pain patients. The capability to inhibit pain is normally distributed along a wide continuum in the general population and can be used to predict chronic pain. Accumulating evidence suggests that endogenou...

  18. Analysis of scapular muscle EMG activity in patients with idiopathic neck pain: a systematic review.

    Science.gov (United States)

    Castelein, Birgit; Cools, Ann; Bostyn, Emma; Delemarre, Jolien; Lemahieu, Trees; Cagnie, Barbara

    2015-04-01

    It is proposed that altered scapular muscle function can contribute to abnormal loading of the cervical spine. However, it is not clear if patients with idiopathic neck pain show altered activity of the scapular muscles. The aim of this paper was to systematically review the literature regarding the differences or similarities in scapular muscle activity, measured by electromyography ( = EMG), between patients with chronic idiopathic neck pain compared to pain-free controls. Case-control (neck pain/healthy) studies investigating scapular muscle EMG activity (amplitude, timing and fatigue parameters) were searched in Pubmed and Web of Science. 25 articles were included in the systematic review. During rest and activities below shoulder height, no clear differences in mean Upper Trapezius ( = UT) EMG activity exist between patients with idiopathic neck pain and a healthy control group. During overhead activities, no conclusion for scapular EMG amplitude can be drawn as a large variation of results were reported. Adaptation strategies during overhead tasks are not the same between studies. Only one study investigated timing of the scapular muscles and found a delayed onset and shorter duration of the SA during elevation in patients with idiopathic neck pain. For scapular muscle fatigue, no definite conclusions can be made as a wide variation and conflicting results are reported. Further high quality EMG research on scapular muscles (broader than the UT) is necessary to understand/draw conclusions on how scapular muscles react in the presence of idiopathic neck pain.

  19. Strength Training Improves Fatigue Resistance and Self-Rated Health in Workers with Chronic Pain

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus Due; Brandt, Mikkel;

    2016-01-01

    -rated health and pain. Time to fatigue, muscle strength, hand/wrist pain, and self-rated health improved significantly more following strength training than usual care (all P ... (Spearman's rho = -0.40; P = 0.01). In conclusion, specific strength training improves muscular fatigue resistance and self-rated health and reduces pain of the hand/wrist in manual workers with chronic upper limb pain. This trial is registered with ClinicalTrials.gov NCT01671267....

  20. The Long Road of Pain: Chronic Pain Increases Perceived Distance

    Science.gov (United States)

    Witt, Jessica K.; Linkenauger, Sally A.; Bakdash, Jonathan Z.; Augustyn, Jason S.; Cook, Andrew J.; Proffitt, Dennis R.

    2011-01-01

    Spatial perception is sensitive to the energetic costs required to perform intended actions. For example, hills look steeper to people who are fatigued or burdened by a heavy load. Similarly, perceived distance is also influenced by the energy required to walk or throw to a target. Such experiments demonstrate that perception is a function, not just of optical information, but also of the perceiver’s potential to act and the energetic costs associated with the intended action. In the current paper, we expand on the notion of “cost” by examining perceived distance in patients diagnosed with chronic pain, a multifactorial disease, which is experienced while walking. We found that chronic pain patients perceive target distances to be farther away than a control group. These results indicate the physical, and perhaps emotional, costs of chronic pain affect spatial perceptions. PMID:18949471

  1. Anxiety and Related Factors in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Gordon JG Asmundson

    2002-01-01

    Full Text Available Clinicians often encounter patients who present with both chronic pain and elevated levels of anxiety. In some cases, the source of the anxiety is vague and diffuse. For others, there is an identifiable precipitating object, event or situation. For example, some patients with chronic pain are able to attribute their anxiety to the possibility of not regaining lost functional abilities, financial difficulties, feelings of social inadequacy, or uncertainty about the meaning and consequences of pain. The association between chronic pain and anxiety may not be particularly surprising when one considers that, in the acute phase, both pain and target-oriented anxiety (or fear motivate actions that serve to minimize the threat and maximize the likelihood of successful escape. As well, their neurobiology, while distinct, interacts in the reticular system (1. Evaluations of the association between chronic pain and fear-relevant constructs were initiated in the 1960s and 1970s (2,3. It has only been of late, however, that theorists and researchers have begun to focus their attention on delineating the precise nature of the relationship and its specific implications for the assessment and management of pain.

  2. Frida Kahlo: Portrait of Chronic Pain.

    Science.gov (United States)

    Courtney, Carol A; O'Hearn, Michael A; Franck, Carla C

    2016-08-25

    The Mexican artist Frida Kahlo (1907-1954) is one of the most celebrated artists of the 20th century. Although famous for her colorful self-portraits and associations with celebrities Diego Rivera and Leon Trotsky, less known is the fact that she had lifelong chronic pain. Frida Kahlo developed poliomyelitis at age 6 years, was in a horrific trolley car accident in her teens, and would eventually endure numerous failed spinal surgeries and, ultimately, limb amputation. She endured several physical, emotional, and psychological traumas in her lifetime, yet through her art, she was able to transcend a life of pain and disability. Of her work, her self-portraits are conspicuous in their capacity to convey her life experience, much of which was imbued with chronic pain. Signs and symptoms of chronic neuropathic pain and central sensitization of nociceptive pathways are evident when analyzing her paintings and medical history. This article uses a narrative approach to describe how events in the life of this artist contributed to her chronic pain. The purpose of this article is to discuss Frida Kahlo's medical history and her art from a modern pain sciences perspective, and perhaps to increase our understanding of the pain experience from the patient's perspective.

  3. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment.

    Science.gov (United States)

    Andromanakos, Nikolaos P; Kouraklis, Grigorios; Alkiviadis, Kostakis

    2011-01-01

    Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms.

  4. Craniofacial muscle pain: review of mechanisms and clinical manifestations.

    Science.gov (United States)

    Svensson, P; Graven-Nielsen, T

    2001-01-01

    Epidemiologic surveys of temporomandibular disorders (TMD) have demonstrated that a considerable proportion of the population--up to 5% or 6%--will experience persistent pain severe enough to seek treatment. Unfortunately, the current diagnostic classification of craniofacial muscle pain is based on descriptions of signs and symptoms rather than on knowledge of pain mechanisms. Furthermore, the pathophysiology and etiology of craniofacial muscle pain are not known in sufficient detail to allow causal treatment. Many hypotheses have been proposed to explain cause-effect relationships; however, it is still uncertain what may be the cause of muscle pain and what is the effect of muscle pain. This article reviews the literature in which craniofacial muscle pain has been induced by experimental techniques in animals and human volunteers and in which the effects on somatosensory and motor function have been assessed under standardized conditions. This information is compared to the clinical correlates, which can be derived from the numerous cross-sectional studies in patients with craniofacial muscle pain. The experimental literature clearly indicates that muscle pain has significant effects on both somatosensory and craniofacial motor function. Typical somatosensory manifestations of experimental muscle pain are referred pain and increased sensitivity of homotopic areas. The craniofacial motor function is inhibited mainly during experimental muscle pain, but phase-dependent excitation is also found during mastication to reduce the amplitude and velocity of jaw movements. The underlying neurobiologic mechanisms probably involve varying combinations of sensitization of peripheral afferents, hyperexcitability of central neurons, and imbalance in descending pain modulatory systems. Reflex circuits in the brain stem seem important for the adjustment of sensorimotor function in the presence of craniofacial pain. Changes in somatosensory and motor function may therefore be

  5. Chronic Abdominal Pain in Children

    NARCIS (Netherlands)

    C.F.M. Gijsbers (Carolien)

    2012-01-01

    textabstractRecurrent abdominal pain (RAP) was first defined in 1958 by Apley as “at least 3 bouts of pain, severe enough to affect activities, over a period of at least 3 months” (1). This was a landmark publication with great impact, showing, that emotional disturbances played a role in many patie

  6. Biopsychosocial model of chronic recurrent pain

    Directory of Open Access Journals (Sweden)

    Zlatka Rakovec-Felser

    2009-07-01

    Full Text Available Pain is not merely a symptom of disease but a complex independent phenomenon where psychological factors are always present (Sternberg, 1973. Especially by chronic, recurrent pain it's more constructive to think of chronic pain as a syndrome that evolves over time, involving a complex interaction of physiological/organic, psychological, and behavioural processes. Study of chronic recurrent functional pain covers tension form of headache. 50 suffering persons were accidentally chosen among those who had been seeking medical help over more than year ago. We tested their pain intensity and duration, extent of subjective experience of accommodation efforts, temperament characteristics, coping strategies, personal traits, the role of pain in intra- and interpersonal communication. At the end we compared this group with control group (without any manifest physical disorders and with analyse of variance (MANOVA. The typical person who suffers and expects medical help is mostly a woman, married, has elementary or secondary education, is about 40. Pain, seems to appear in the phase of stress-induced psychophysical fatigue, by persons with lower constitutional resistance to different influences, greater irritability and number of physiologic correlates of emotional tensions. Because of their ineffective style of coping, it seems they quickly exhausted their adaptation potential too. Through their higher level of social–field dependence, reactions of other persons (doctor, spouse could be important factors of reinforcement and social learning processes. In managing of chronic pain, especially such as tension headache is, it's very important to involve bio-psychosocial model of pain and integrative model of treatment. Intra- and inter-subjective psychological functions of pain must be recognised as soon as possible.

  7. Supporting Teens with Chronic Pain to Obtain High School Credits: Chronic Pain 35 in Alberta

    Directory of Open Access Journals (Sweden)

    Kathy Reid

    2016-11-01

    Full Text Available Chronic pain is a significant problem in children and teens, and adolescents with chronic pain often struggle to attend school on a regular basis. We present in this article a novel program we developed that integrates attendance at a group cognitive-behavioural chronic pain self-management program with earning high school credits. We collaborated with Alberta Education in the development of this course, Chronic Pain 35. Adolescents who choose to enroll are invited to demonstrate their scientific knowledge related to pain, understanding of and engagement with treatment homework, and demonstrate their creativity by completing a project, which demonstrates at least one concept. Integrating Chronic Pain 35 into an adolescent’s academic achievements is a creative strategy that facilitates the engagement of adolescents in learning and adopting pain coping techniques. It also helps teens to advocate for themselves in the school environment and improve their parents’ and teachers’ understanding of adolescent chronic pain. This is one of the first successful collaborations between a pediatric health program and provincial education leaders, aimed at integrating learning and obtaining school credit for learning about and engaging in health self-management for teens. The authors hope this paper serves as an effective reference model for any future collaborating programs aimed at supporting teens with chronic pain to obtain high school credits.

  8. Supporting Teens with Chronic Pain to Obtain High School Credits: Chronic Pain 35 in Alberta.

    Science.gov (United States)

    Reid, Kathy; Simmonds, Mark; Verrier, Michelle; Dick, Bruce

    2016-11-19

    Chronic pain is a significant problem in children and teens, and adolescents with chronic pain often struggle to attend school on a regular basis. We present in this article a novel program we developed that integrates attendance at a group cognitive-behavioural chronic pain self-management program with earning high school credits. We collaborated with Alberta Education in the development of this course, Chronic Pain 35. Adolescents who choose to enroll are invited to demonstrate their scientific knowledge related to pain, understanding of and engagement with treatment homework, and demonstrate their creativity by completing a project, which demonstrates at least one concept. Integrating Chronic Pain 35 into an adolescent's academic achievements is a creative strategy that facilitates the engagement of adolescents in learning and adopting pain coping techniques. It also helps teens to advocate for themselves in the school environment and improve their parents' and teachers' understanding of adolescent chronic pain. This is one of the first successful collaborations between a pediatric health program and provincial education leaders, aimed at integrating learning and obtaining school credit for learning about and engaging in health self-management for teens. The authors hope this paper serves as an effective reference model for any future collaborating programs aimed at supporting teens with chronic pain to obtain high school credits.

  9. Supporting Teens with Chronic Pain to Obtain High School Credits: Chronic Pain 35 in Alberta

    Science.gov (United States)

    Reid, Kathy; Simmonds, Mark; Verrier, Michelle; Dick, Bruce

    2016-01-01

    Chronic pain is a significant problem in children and teens, and adolescents with chronic pain often struggle to attend school on a regular basis. We present in this article a novel program we developed that integrates attendance at a group cognitive-behavioural chronic pain self-management program with earning high school credits. We collaborated with Alberta Education in the development of this course, Chronic Pain 35. Adolescents who choose to enroll are invited to demonstrate their scientific knowledge related to pain, understanding of and engagement with treatment homework, and demonstrate their creativity by completing a project, which demonstrates at least one concept. Integrating Chronic Pain 35 into an adolescent’s academic achievements is a creative strategy that facilitates the engagement of adolescents in learning and adopting pain coping techniques. It also helps teens to advocate for themselves in the school environment and improve their parents’ and teachers’ understanding of adolescent chronic pain. This is one of the first successful collaborations between a pediatric health program and provincial education leaders, aimed at integrating learning and obtaining school credit for learning about and engaging in health self-management for teens. The authors hope this paper serves as an effective reference model for any future collaborating programs aimed at supporting teens with chronic pain to obtain high school credits. PMID:27869766

  10. Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.

    Science.gov (United States)

    Gyang, Anthony N; Feranec, Jessica B; Patel, Rakesh C; Lamvu, Georgine M

    2014-03-01

    In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0 % and 30 % of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions.

  11. Expectations predict chronic pain treatment outcomes.

    Science.gov (United States)

    Cormier, Stéphanie; Lavigne, Geneviève L; Choinière, Manon; Rainville, Pierre

    2016-02-01

    Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.

  12. Motor unit action potential rate and motor unit action potential shape properties in subjects with work-related muscle pain

    NARCIS (Netherlands)

    Kallenberg, Laura A.C.; Hermens, Hermie J.

    2006-01-01

    The objective of this study was to investigate differences in motor control of the trapezius muscle in cases with work-related chronic pain, compared to healthy controls. Ten cases with chronic pain and 13 controls participated in the study. Electromyographic (EMG) signals were recorded from the upp

  13. Opioid Therapy for Chronic Nonmalignant Pain

    Directory of Open Access Journals (Sweden)

    Russell K Portenoy

    1996-01-01

    Full Text Available Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

  14. Mechanism for chronic pain generation

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Neuropathic pain and the other abnormalities of sensation induced by axon injury or by peripheral nerve inflammation should result from functional compensations of the injured neurons during their regeneration. Ectopic distribution of proteins related to Na+, K+ and Ca2+ channels as well as of receptors on both membranes of injured axon and its cell body becomes a main pacemaker from which spontaneous ectopic afferent of primary sensatory neurons and crosstalk between neurons occur. Abnormal ectopic afferent activities lead to disorders of the sensation, such as hyperalgesia, allodynia, spontaneous pain and paraesthesia. Administration of some ion channel agents and/or α2-adrenergic blockers has shown efficiency in preventing neuropathic pain development and in relieving neuropathic pain.

  15. Perspectives on Yoga inputs in the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Nandini Vallath

    2010-01-01

    Full Text Available Chronic pain is multi-dimensional. At the physical level itself, beyond the nociceptive pathway, there is hyper arousal state of the components of the nervous system, which negatively influences tension component of the muscles, patterns of breathing, energy levels and mindset, all of which exacerbate the distress and affect the quality of life of the individual and family. Beginning with the physical body, Yoga eventually influences all aspects of the person: vital, mental, emotional, intellectual and spiritual. It offers various levels and approaches to relax, energize, remodel and strengthen body and psyche. The asanas and pranayama harmonize the physiological system and initiate a "relaxation response" in the neuro endocrinal system. This consists of decreased metabolism, quieter breathing, stable blood pressure, reduced muscle tension, lower heart rate and slow brain wave pattern. As the neural discharge pattern gets modulated, hyper arousal of the nervous system and the static load on postural muscle come down. The function of viscera improves with the sense of relaxation and sleep gets deeper and sustained; fatigue diminishes. Several subtle level notional corrections can happen in case the subject meditates and that changes the context of the disease, pain and the meaning of life. Meditation and pranayama, along with relaxing asanas, can help individuals deal with the emotional aspects of chronic pain, reduce anxiety and depression effectively and improve the quality of life perceived.

  16. Research design considerations for chronic pain prevention clinical trials

    DEFF Research Database (Denmark)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C

    2015-01-01

    , outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues...

  17. Patterns of experimentally induced pain in pericranial muscles

    DEFF Research Database (Denmark)

    Schmidt-Hansen, Peter Thede; Svensson, Peter; Jensen, Troels Staehelin

    2006-01-01

    Nociceptive mechanisms in the craniofacial muscle tissue are poorly understood. The pain pattern in individual pericranial muscles has not been described before. Experimental muscle pain was induced by standardized infusions of 0.2 ml 1 m hypertonic saline into six craniofacial muscles (masseter....... cervically innervated dermatomes (P pain patterns and pain sensitivity in different craniofacial muscles in healthy volunteers, which may be of importance for further research on different craniofacial pain conditions......., anterior temporalis, posterior temporalis, trapezius, splenius capitis and sternocleidomastoid) in 20 healthy subjects. The pressure pain thresholds (PPTs) were determined before and after infusions. The subjects continuously reported intensity of saline-induced pain on an electronic visual analogue scale...

  18. Chronic Pain: The Impact on Academic, Social, and Emotional Functioning

    Science.gov (United States)

    Parkins, Jason M.; Gfroerer, Susan D.

    2009-01-01

    Chronic pain is persistent and recurrent pain that tends to fluctuate in severity, quality, regularity, and predictability. It can occur in a single or multiple body regions or organ systems. Some of the most frequently reported types of chronic pain include headaches, recurrent abdominal pain (RAP), and musculoskeletal pain. In contrast to acute…

  19. Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

    NARCIS (Netherlands)

    Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

    2004-01-01

    The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chro

  20. Neuromuscular adaptations predict functional disability independently of clinical pain and psychological factors in patients with chronic non-specific low back pain.

    Science.gov (United States)

    Dubois, Jean-Daniel; Abboud, Jacques; St-Pierre, Charles; Piché, Mathieu; Descarreaux, Martin

    2014-08-01

    Patients with chronic low back pain exhibit characteristics such as clinical pain, psychological symptoms and neuromuscular adaptations. The purpose of this study was to determine the independent contribution of clinical pain, psychological factors and neuromuscular adaptations to disability in patients with chronic low back pain. Clinical pain intensity, pain catastrophizing, fear-avoidance beliefs, anxiety, neuromuscular adaptations to chronic pain and neuromuscular responses to experimental pain were assessed in 52 patients with chronic low back pain. Lumbar muscle electromyographic activity was assessed during a flexion-extension task (flexion relaxation phenomenon) to assess both chronic neuromuscular adaptations and neuromuscular responses to experimental pain during the task. Multiple regressions showed that independent predictors of disability included neuromuscular adaptations to chronic pain (β=0.25, p=0.006, sr(2)=0.06), neuromuscular responses to experimental pain (β=-0.24, p=0.011, sr(2)=0.05), clinical pain intensity (β=0.28, p=0.002, sr(2)=0.08) and psychological factors (β=0.58, ppain intensity and psychological factors, and contribute to inter-individual differences in patients' disability. This suggests that disability, in chronic low back pain patients, is determined by a combination of factors, including clinical pain, psychological factors and neuromuscular adaptations.

  1. Muscle activity pattern dependent pain development and alleviation

    DEFF Research Database (Denmark)

    Sjøgaard, Gisela; Søgaard, Karen

    2014-01-01

    development if adequate recovery is granted. However, delayed muscle soreness may develop following intensive eccentric muscle activity (e.g. down-hill skiing) with peak pain levels in thigh muscles 1-2days after the exercise bout and a total recovery within 1week. This acute pain profile is in contrast......Muscle activity is for decades considered to provide health benefits irrespectively of the muscle activity pattern performed and whether it is during e.g. sports, transportation, or occupational work tasks. Accordingly, the international recommendations for public health-promoting physical activity...... of muscle pain. Focusing on muscle activity patterns and musculoskeletal health it is pertinent to elucidate the more specific aspects regarding exposure profiles and body regional pain. Static sustained muscle contraction for prolonged periods often occurs in the neck/shoulder area during occupational...

  2. Surgical treatment of pain in chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Stefanović Dejan

    2006-01-01

    Full Text Available INTRODUCTION: The principal indication for surgical intervention in chronic pancreatitis is intractable pain. Depending upon the presence of dilated pancreatic ductal system, pancreatic duct drainage procedures and different kinds of pancreatic resections are applied. OBJECTIVE: The objective of the study was to show the most appropriate procedure to gain the most possible benefits in dependence of type of pathohistological process in chronic pancreatitis. METHOD: Our study included 58 patients with intractable pain caused by chronic pancreatitis of alcoholic genesis. The first group consisted of 30 patients with dilated pancreatic ductal system more than 10 mm. The second group involved 28 patients without dilated pancreatic ductal system. Pain relief, weight gain and glucose tolerance were monitored. RESULTS: All patients of Group I (30 underwent latero-lateral pancreaticojejunal - Puestow operation. 80% of patients had no pain after 6 month, 13.6% had rare pain and 2 patients, i.e. 6.4%, who continued to consume alcohol, had strong pain. Group II consisting of 28 patients was without dilated pancreatic ductal system. This group was subjected to various types of pancreatic resections. Whipple procedure (W was done in 6 patients, pylorus preserving Whipple (PPW in 7 cases, and duodenum preserving cephalic pancreatectomy (DPCP was performed in 15 patients. Generally, 89.2% of patients had no pain 6 month after the operation. An average weight gain was 1.9 kg in W group, 2.8 kg in PPW group and 4.1 kg in DPCP group. Insulin-dependent diabetes was recorded in 66.6% in W group, 57.1% in PPW group and 0% in DPCP group. CONCLUSION: According to our opinion, DPCP may be considered the procedure of choice for surgical treatment of pain in chronic pancreatitis in patients without dilatation of pancreas ductal system because of no serious postoperative metabolic consequences.

  3. Chronic Pain after Inguinal Hernia Repair

    OpenAIRE

    2014-01-01

    Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of ...

  4. Associations between biopsychosocial factors and chronic upper limb pain among slaughterhouse workers

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Brandt, Mikkel;

    2016-01-01

    a questionnaire on work ability (work ability index), work disability (Work module of DASH questionnaire), fear avoidance, and self-rated health. Additionally, pressure pain threshold (PPT) was measured in muscles of the arm, shoulder and lower leg. RESULTS: Muscle strength and RFD (determined within time...... intervals of 30, 50, 100, and 200 ms relative to onset of contraction) was 28 % and 58-78 % lower, respectively, in workers with chronic pain compared with pain-free controls, and paralleled by reduced muscle activity (all p 

  5. Physical exercise as non-pharmacological treatment of chronic pain: Why and when.

    Science.gov (United States)

    Ambrose, Kirsten R; Golightly, Yvonne M

    2015-02-01

    Chronic pain broadly encompasses both objectively defined conditions and idiopathic conditions that lack physical findings. Despite variance in origin or pathogenesis, these conditions are similarly characterized by chronic pain, poor physical function, mobility limitations, depression, anxiety, and sleep disturbance, and they are treated alone or in combination by pharmacologic and non-pharmacologic approaches, such as physical activity (aerobic conditioning, muscle strengthening, flexibility training, and movement therapies). Physical activity improves general health, disease risk, and progression of chronic illnesses such as cardiovascular disease, type 2 diabetes, and obesity. When applied to chronic pain conditions within appropriate parameters (frequency, duration, and intensity), physical activity significantly improves pain and related symptoms. For chronic pain, strict guidelines for physical activity are lacking, but frequent movement is preferable to sedentary behavior. This gives considerable freedom in prescribing physical activity treatments, which are most successful when tailored individually, progressed slowly, and account for physical limitations, psychosocial needs, and available resources.

  6. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

    Directory of Open Access Journals (Sweden)

    Jia-Fong Jhang

    2015-06-01

    Full Text Available Chronic pelvic pain (CPP is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A, known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.

  7. Beyond pain: modeling decision-making deficits in chronic pain

    Science.gov (United States)

    Hess, Leonardo Emanuel; Haimovici, Ariel; Muñoz, Miguel Angel; Montoya, Pedro

    2014-01-01

    Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients’ behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT) is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls (HCs). In the present study, we developed a simple heuristic model to simulate individuals’ choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and HCs at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in HCs was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis. PMID:25136301

  8. Beyond pain: modeling decision-making deficits in chronic pain

    Directory of Open Access Journals (Sweden)

    Leonardo Emanuel Hess

    2014-08-01

    Full Text Available Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients’ behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls. In the present study, we developed a simple heuristic model to simulate individuals’ choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and healthy controls at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in healthy controls was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis.

  9. Acupuncture for patients with chronic neck pain.

    Science.gov (United States)

    Witt, Claudia M; Jena, Susanne; Brinkhaus, Benno; Liecker, Bodo; Wegscheider, Karl; Willich, Stefan N

    2006-11-01

    Acupuncture is widely used by patients with neck pain, but there is a lack of information about its effectiveness in routine medical care. The aim was to investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone. We performed a randomized controlled multicentre trial plus non-randomized cohort in general practices in Germany. 14,161 patients with chronic neck pain (duration >6 months). Patients were randomly allocated to an acupuncture group or a control group receiving no acupuncture. Patients in the acupuncture group received up to 15 acupuncture sessions over three months. Patients who did not consent to randomization received acupuncture treatment. All subjects were allowed to receive usual medical care in addition to study treatment. Neck pain and disability (NPAD Scale by Wheeler) after three months. Of 14,161 patients (mean age 50.9+/-13.1 years, 68% female) 1880 were randomized to acupuncture and 1886 to control, and 10,395 included into the non-randomized acupuncture group. At three months, neck pain and disability improved by 16.2 (SE: 0.4) to 38.3 (SE: 0.4); and by 3.9 (SE: 0.4) to 50.5 (SE: 0.4), difference 12.3 (pacupuncture and control group, respectively. Treatment success was essentially maintained through six months. Non-randomized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to randomized patients. Treatment with acupuncture added to routine care in patients with chronic neck pain was associated with improvements in neck pain and disability compared to treatment with routine care alone.

  10. Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis

    NARCIS (Netherlands)

    Jongsma, M.L.A.; Postma, S.A.E.; Souren, P.M.; Arns, M.W.; Gordon, E.; Vissers, K.C.P.; Wilder-Smith, O.H.G.; Rijn, C.M. van; Goor, H. van

    2011-01-01

    Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance),

  11. Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre

    DEFF Research Database (Denmark)

    Sjøgren, Per; Christrup, Lona Louring; Petersen, Morten Aa

    2005-01-01

    The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex ma...

  12. The characteristics of chronic central pain after traumatic brain injury.

    Science.gov (United States)

    Ofek, Hadas; Defrin, Ruth

    2007-10-01

    Central pain following traumatic brain injury (TBI) has not been studied in depth. Our purpose was to conduct a systematic study of patients with TBI suffering from chronic central pain, and to describe the characteristics of the central pain. Groups were TBI patients with (TBIP) and without central pain (TBINP) and healthy controls. TBI patients with other pain mechanisms were excluded from the study. Participants underwent quantitative somatosensory testing in the painful and pain-free body regions. Thresholds for warmth, cold, heat-pain, touch and graphesthesia were measured and pathologically evoked pain (allodynia, hyperpathia and wind-up pain) evaluated. Chronic pain was mapped and characterized. Chronic pain developed at a relatively late onset (6.6+/-9 months) was almost exclusively unilateral and reported as pricking, throbbing and burning. Although both TBIP and TBINP exhibited a significant reduction in thermal and tactile sensations compared to controls, thermal sensations in the painful regions of TBIP were significantly more impaired than pain-free regions in the same patients (p<0.01) and in TBINP (p<0.01). Painful regions also exhibited very high rates of allodynia, hyperpathia and exaggerated wind-up. The characteristics of the chronic pain resembled those of other central pain patients although TBIP displayed several unique features. The sensory profile indicated that damage to the pain and temperature systems is a necessary but not sufficient condition for the development of chronic central pain following TBI. Neuronal hyperexcitability may be a contributing factor to the chronic pain.

  13. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training.

    Science.gov (United States)

    Nijs, Jo; Meeus, Mira; Cagnie, Barbara; Roussel, Nathalie A; Dolphens, Mieke; Van Oosterwijck, Jessica; Danneels, Lieven

    2014-05-01

    Chronic spinal pain (CSP) is a severely disabling disorder, including nontraumatic chronic low back and neck pain, failed back surgery, and chronic whiplash-associated disorders. Much of the current therapy is focused on input mechanisms (treating peripheral elements such as muscles and joints) and output mechanisms (addressing motor control), while there is less attention to processing (central) mechanisms. In addition to the compelling evidence for impaired motor control of spinal muscles in patients with CSP, there is increasing evidence that central mechanisms (ie, hyperexcitability of the central nervous system and brain abnormalities) play a role in CSP. Hence, treatments for CSP should address not only peripheral dysfunctions but also the brain. Therefore, a modern neuroscience approach, comprising therapeutic pain neuroscience education followed by cognition-targeted motor control training, is proposed. This perspective article explains why and how such an approach to CSP can be applied in physical therapist practice.

  14. Chronic neck pain and masticatory dysfunction.

    Science.gov (United States)

    Catanzariti, Jean-François; Debuse, Thierry; Duquesnoy, Bernard

    2005-12-01

    Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD) with craniocervical asymmetry is the most common clinical picture. The pain is usually located in the suboccipital region and refractory to conventional treatment. The time pattern may be suggestive, with nocturnal arousals or triggering by temporomandibular movements. MD should be strongly suspected in patients with at least two of the following: history of treated or untreated MD, unilateral temporomandibular joint pain and clicking, lateral deviation during mouth opening, and limitation of mouth opening (less than three fingerbreadths). Rheumatologists should consider MD among causes of neck pain, most notably in patients with abnormal craniocervical posture, signs linking the neck pain to mastication, and clinical manifestations of MD. Evidence suggesting that MD may cause neck pain has been published. However, studies are needed to determine whether treatment of MD can relieve neck pain.

  15. EAU Guidelines on Chronic Pelvic Pain

    NARCIS (Netherlands)

    Fall, Magnus; Baranowski, Andrew P.; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J.; Oberpenning, Frank; Williams, Amanda C. de C.

    2010-01-01

    Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. Objective: To revise guidelines for the diagnosis,

  16. Spinal cord stimulation in chronic pain syndromes

    NARCIS (Netherlands)

    ten Vaarwerk, IAM; Staal, MJ

    1998-01-01

    Spinal cord stimulation (SCS) has been used for more than 30 years now, and although it has shown to be effective under certain well-described conditions of chronic pain, conclusive evidence on its effectiveness is still sparse. There is a need for more prospective and methodological good studies, i

  17. Performance improvement CME: managing chronic pain.

    Science.gov (United States)

    Fishman, Scott M

    2010-12-01

    Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME activity focuses on improving the safety and efficacy of treating chronic pain with opioid medications.

  18. Antioxidants for pain in chronic pancreatitis

    NARCIS (Netherlands)

    Ahmed Ali, Usama; Jens, Sjoerd; Busch, Olivier R C; Keus, Frederik; van Goor, Harry; Gooszen, Hein G; Boermeester, Marja A

    2014-01-01

    BACKGROUND: Reduced intake and absorption of antioxidants due to pain and malabsorption are probable causes of the lower levels of antioxidants observed in patients with chronic pancreatitis (CP). Improving the status of antioxidants might be effective in slowing the disease process and reducing pai

  19. Abdominal epilepsy in chronic recurrent abdominal pain

    Directory of Open Access Journals (Sweden)

    V Y Kshirsagar

    2012-01-01

    Full Text Available Background: Abdominal epilepsy (AE is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG abnormalities and favorable response to the introduction of anti-epileptic drugs (AED. We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74% children with an abnormal EEG and 39 (26% children with normal EEG. All children were subjected to AED (Oxcarbazepine and 139 (92% children responded to AED out of which 111 (74% children had an abnormal EEG and 27 (18% had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74% of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56% were females and 36 (32.43% were male, majority of children were in the age of group of 9

  20. Art Therapy for Chronic Pain: Applications and Future Directions

    Science.gov (United States)

    Angheluta, Anne-Marie; Lee, Bonnie K.

    2011-01-01

    Chronic pain is acknowledged as a phenomenological experience resulting from biological, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and biopsychosocial perspectives. One approach to treating chronic pain involves implementing…

  1. Chronic Prostatitis/Chronic Pelvic Pain Syndrome Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Cem Nedim Yuceturk

    2014-08-01

    Full Text Available Chronic prostatitis is a chronic syndrome that effects men with a wide range of age. The etiology, natural history and appropriate therapy models are still unclear. According to the classification of National Institutes of Health; 4 types of prostatitis were defined; acute bacterial prostatitis (category I, chronic bacterial prostatitis (category II, chronic nonbacterial prostatitis/chronic pelvic pain syndrome (category III and asymptomatic prostatitis (category IV.Since microorganisms can only be isolated from a small percent of patients, empiric treatment is given to the most of the men. Multidisciplinary approach to the patients with suspected chronic prostatitis will help clinicians to play an active role in the treatment and prevent unnecessary medical therapies. [Archives Medical Review Journal 2014; 23(4.000: 691-702

  2. Central Sensitization and Perceived Indoor Climate among Workers with Chronic Upper-Limb Pain

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Brandt, Mikkel;

    2015-01-01

    threshold (PPT) was measured in muscles of the arm, shoulder, and lower leg. Cross-sectional associations were determined using general linear models controlled for age, smoking, and job position. The number of indoor climate complaints was twice as high among workers with chronic pain compared with pain...... not account for musculoskeletal pain in questionnaire assessment of indoor climate may be biased. Central sensitization likely explains the present findings....

  3. Chronic Pain in Canada: Have We Improved Our Management of Chronic Noncancer Pain?

    Directory of Open Access Journals (Sweden)

    Aline Boulanger

    2007-01-01

    Full Text Available BACKGROUND: Chronic noncancer pain (CNCP is a global issue, not only affecting individual suffering, but also impacting the delivery of health care and the strength of local economies.

  4. A study on the Efficacy of Muscle Energy Technique as compared to Conventional Therapy on Lumbar Spine Range of Motion in Chronic Low Back Pain of Sacroiliac Origin

    OpenAIRE

    Supreet Bindra

    2013-01-01

    Sacroiliac joint dysfunction is a term often used to describe pain in and around the region of the joint that is presumed to be due to biomechanical disorders of the joint. Despite of high incidence, the contribution of sacroiliac joint to low back pain has been a matter of controversy. Physical therapists routinely assess spinal range of motion in patients with low back pain and believe that spinal range of motion and disability are closely linked. The present study was aimed to determine th...

  5. Fibromyalgia, chronic fatigue syndrome, and myofascial pain.

    Science.gov (United States)

    Bennett, R

    1998-03-01

    Epidemiologic studies continue to provide evidence that fibromyalgia is part of a spectrum of chronic widespread pain. The prevalence of chronic widespread pain is several times higher than fibromyalgia as defined by the 1990 American College of Rheumatology guidelines. There is now compelling evidence of a familial clustering of fibromyalgia cases in female sufferers; whether this clustering results from nature or nature remains to be elucidated. A wide spectrum of fibromyalgia-associated symptomatology and syndromes continues to be described. During the past year the association with interstitial cystitis has been explored, and neurally mediated hypotension has been documented in both fibromyalgia and chronic fatigue syndrome. Abnormalities of the growth hormone-insulin-like growth factor-1 axis have been also documented in both fibromyalgia and chronic fatigue syndrome. The commonly reported but anecdotal association of fibromyalgia with whiplash-type neck trauma was validated in a report from Israel. However, unlike North America, 100% of Israeli patients with posttraumatic fibromyalgia returned to work. Basic research in fibromyalgia continues to pinpoint abnormal sensory processing as being integral to understanding fibromyalgia pain. Drugs such as ketamine, which block N-methyl-D-aspartate receptors (which are often upregulated in central pain states) were shown to benefit fibromyalgia pain in an experimental setting. The combination of fluoxetine and amitriptyline was reported to be more beneficial than either drug alone in patients with fibromyalgia. A high prevalence of autoantibodies to cytoskeletal and nuclear envelope proteins was found in chronic fatigue syndrome, and an increased prevalence of antipolymer antibodies was found in symptomatic silicone breast implant recipients who often have fibromyalgia.

  6. Muscle function and origin of pain in fibromyalgia

    DEFF Research Database (Denmark)

    Bennett, R M; Jacobsen, Søren

    1994-01-01

    It may be concluded that both peripheral and central mechanisms may operate in the pathophysiology of both impaired muscle function and pain in FM. These mechanisms may in part be attributable to physical deconditioning and disuse of muscle secondary to the characteristic pain and fatigue so ofte...

  7. Abnormal pain processing in chronic tension-type headache: a high-density EEG brain mapping study

    DEFF Research Database (Denmark)

    Buchgreitz, L.; Egsgaard, L.L.; Jensen, R.

    2008-01-01

    Central sensitization caused by prolonged nociceptive input from muscles is considered to play an important role for chronification of tension-type headache. In the present study we used a new high-density EEG brain mapping technique to investigate spatiotemporal aspects of brain activity...... in response to muscle pain in 19 patients with chronic tension-type headache (CTTH) and 19 healthy, age- and sex-matched controls. Intramuscular electrical stimuli (single and train of five pulses delivered at 2 Hz) were applied to the trapezius muscle and somatosensory evoked potentials were recorded...... versus tonic muscle pain: P = 0.001; baseline versus post-tonic muscle pain: P = 0.002) and fifth (baseline versus tonic muscle pain: P = 0.04; baseline versus post-tonic muscle pain: P = 0.04) stimulus in the train. In contrast, there were no differences between the conditions in patients. No consistent...

  8. Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress.

    Science.gov (United States)

    Outcalt, Samantha D; Ang, Dennis C; Wu, Jingwei; Sargent, Christy; Yu, Zhangsheng; Bair, Matthew J

    2014-01-01

    Chronic pain and posttraumatic stress disorder (PTSD) co-occur at high rates, and Veterans from recent wars in Iraq and Afghanistan may be particularly vulnerable to both conditions. The objective of this study was to identify key aspects of chronic pain, cognitions, and psychological distress associated with comorbid PTSD among this sample of Veterans. Baseline data were analyzed from a randomized controlled trial testing a stepped-care intervention for chronic musculoskeletal pain. Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans with chronic pain only (n = 173) were compared with those with chronic pain and clinically significant posttraumatic stress symptoms (n = 68). Group differences on pain characteristics, pain cognitions, and psychological distress were evaluated. Results demonstrated that OIF/OEF Veterans with comorbid chronic musculoskeletal pain and PTSD experienced higher pain severity, greater pain-related disability and increased pain interference, more maladaptive pain cognitions (e.g., catastrophizing, self-efficacy, pain centrality), and higher affective distress than those with chronic pain alone. Veterans of recent military conflicts in Iraq and Afghanistan may be particularly vulnerable to the compounded adverse effects of chronic pain and PTSD. These results highlight a more intense and disabling pain and psychological experience for those with chronic pain and PTSD than for those without PTSD.

  9. Ectopic uterine tissue as a chronic pain generator.

    Science.gov (United States)

    Alvarez, P; Chen, X; Hendrich, J; Irwin, J C; Green, P G; Giudice, L C; Levine, J D

    2012-12-06

    While chronic pain is a main symptom in endometriosis, the underlying mechanisms and effective therapy remain elusive. We developed an animal model enabling the exploration of ectopic endometrium as a source of endometriosis pain. Rats were surgically implanted with autologous uterus in the gastrocnemius muscle. Within two weeks, visual inspection revealed the presence of a reddish-brown fluid-filled cystic structure at the implant site. Histology demonstrated cystic glandular structures with stromal invasion of the muscle. Immunohistochemical studies of these lesions revealed the presence of markers for nociceptor nerve fibers and neuronal sprouting. Fourteen days after surgery rats exhibited persistent mechanical hyperalgesia at the site of the ectopic endometrial lesion. Intralesional, but not contralateral, injection of progesterone was dose-dependently antihyperalgesic. Systemic administration of leuprolide also produced antihyperalgesia. In vivo electrophysiological recordings from sensory neurons innervating the lesion revealed a significant increase in their response to sustained mechanical stimulation. These results are consistent with clinical and pathological findings observed in patients with endometriosis, compatible with the ectopic endometrium as a source of pain. This model of endometriosis allows mechanistic exploration at the lesion site facilitating our understanding of endometriosis pain.

  10. Electronic momentary assessment in chronic pain (II): pain and psychological pain responses as predictors of pain disability.

    NARCIS (Netherlands)

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J.J.; Verhaak, P.F.M.; Bensing, J.M.

    2006-01-01

    Objectives and Methods: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain r

  11. Acupuncture For Severe Chronic Perineal Pain

    Institute of Scientific and Technical Information of China (English)

    W. Watere

    2004-01-01

    @@ A 42-year-old man (1.8 m, 80 kg), a postal employee, presented to our TCM-Centre, Elisabeth Hospital, Recklinghausen, Germany, with severe chronic perineal pain and hyperhidrosis, especially head, forehead, hand plains, and foot soles. Due to pain, the patient was unable to sit, unable to work for 3 months,and was depressed and fearful. He had bronchial asthma with no complaints under medication. The patient smoked 20 cigarettes daily; he reported no alcohol usage.During a 3-month period (summer 2002), he had consulted an urologist, internist, neurologist, psychiatrist, and radiologist.

  12. Psychosocial factors associated with chronic pain in adolescents.

    Science.gov (United States)

    Merlijn, Vivian P B M; Hunfeld, Joke A M; van der Wouden, Johannes C; Hazebroek-Kampschreur, Alice A J M; Koes, Bart W; Passchier, Jan

    2003-01-01

    A number of psychosocial factors have been associated with the onset, exacerbation and/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs. 127) parents. Analyses showed that adolescents with chronic pain are more vulnerable in terms of neuroticism, negative fear of failure, and (less) experienced social acceptance. Contrary to our expectations, the chronic pain group experienced less reinforcement for their pain behavior by both parents and peers than the control group. While the number of pain models was higher in the chronic pain group, no differences were found between their parents and those of the adolescents without chronic pain in pain experience, pain parameters, and pain coping. Regression analyses on the contribution of psychosocial factors to chronic pain and its parameters sustained the positive relation between vulnerability, (less) pain reinforcement, pain models and coping with pain. Furthermore, we also found evidence that gender differences have to be taken into account.

  13. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf;

    2006-01-01

    BACKGROUND: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

  14. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

  15. Chronic pain, perceived stress, and cellular aging: an exploratory study

    Directory of Open Access Journals (Sweden)

    Sibille Kimberly T

    2012-02-01

    Full Text Available Abstract Background Chronic pain conditions are characterized by significant individual variability complicating the identification of pathophysiological markers. Leukocyte telomere length (TL, a measure of cellular aging, is associated with age-related disease onset, psychosocial stress, and health-related functional decline. Psychosocial stress has been associated with the onset of chronic pain and chronic pain is experienced as a physical and psychosocial stressor. However, the utility of TL as a biological marker reflecting the burden of chronic pain and psychosocial stress has not yet been explored. Findings The relationship between chronic pain, stress, and TL was analyzed in 36 ethnically diverse, older adults, half of whom reported no chronic pain and the other half had chronic knee osteoarthritis (OA pain. Subjects completed a physical exam, radiographs, health history, and psychosocial questionnaires. Blood samples were collected and TL was measured by quantitative polymerase chain reaction (qPCR. Four groups were identified characterized by pain status and the Perceived Stress Scale scores: 1 no pain/low stress, 2 no pain/high stress, chronic pain/low stress, and 4 chronic pain/high stress. TL differed between the pain/stress groups (p = 0.01, controlling for relevant covariates. Specifically, the chronic pain/high stress group had significantly shorter TL compared to the no pain/low stress group. Age was negatively correlated with TL, particularly in the chronic pain/high stress group (p = 0.03. Conclusions Although preliminary in nature and based on a modest sample size, these findings indicate that cellular aging may be more pronounced in older adults experiencing high levels of perceived stress and chronic pain.

  16. Craniofacial pain and jaw-muscle activity during sleep.

    Science.gov (United States)

    Yachida, W; Castrillon, E E; Baad-Hansen, L; Jensen, R; Arima, T; Tomonaga, A; Ohata, N; Svensson, P

    2012-06-01

    This study compared the jaw-muscle electromyographic (EMG) activity during sleep in patients with craniofacial pain (n = 63) or no painful conditions (n = 52) and between patients with tension-type headache (TTH: n = 30) and healthy control individuals (n = 30). All participants used a portable single-channel EMG device (Medotech A/S) for four nights. There was no significant difference in EMG activity between craniofacial pain (24.5 ± 17.9 events/hr) and no painful conditions (19.7 ± 14.5), or between TTH (20.8 ± 15.0) and healthy control individuals (15.2 ± 11.6, p >.050). There were positive correlations between EMG activity and number of painful muscles (r = 0.188; p = 0.044), characteristic pain intensity (r = 0.187; p = 0.046), McGill Pain Questionnaire (r = 0.251; p = 0.008), and depression scores (r = 0.291; p = 0.002). Patients with painful conditions had significantly higher night-to-night variability compared with pain-free individuals (p craniofacial pain conditions and pain-free individuals in terms of jaw-muscle EMG activity recorded with a single-channel EMG device during sleep. However, some associations may exist between the level of EMG activity and various parameters of craniofacial pain. Longitudinal studies are warranted to further explore the relationship between sleep bruxism and craniofacial pain.

  17. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial.

    Science.gov (United States)

    Cerezo-Téllez, Ester; Torres-Lacomba, María; Fuentes-Gallardo, Isabel; Perez-Muñoz, Milagros; Mayoral-Del-Moral, Orlando; Lluch-Girbés, Enrique; Prieto-Valiente, Luis; Falla, Deborah

    2016-09-01

    Chronic neck pain attributed to a myofascial pain syndrome is characterized by the presence of muscle contractures referred to as myofascial trigger points. In this randomized, parallel-group, blinded, controlled clinical trial, we examined the effectiveness of deep dry needling (DDN) of myofascial trigger points in people with chronic nonspecific neck pain. The study was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2010 to December 2014. A total of 130 participants with nonspecific neck pain presenting with active myofascial trigger points in their cervical muscles were included. These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65]). Four sessions of treatment were applied over 2 weeks with a 6-month follow-up after treatment. Pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability were measured at baseline, after 2 sessions of intervention, after the intervention period, and 15, 30, 90, and 180 days after the intervention. Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.

  18. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus;

    2014-01-01

    , and 3, 6, and 12months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale...

  19. 'Postconcussive' symptoms in persons with chronic pain.

    Science.gov (United States)

    Iverson, G L; McCracken, L M

    1997-11-01

    The purpose of this study was to examine the base rate of cognitive and neurobehavioural complaints in patients with chronic pain (N = 170) who had not sustained a head injury. The patients completed a packet of questionnaires that contained numerous questions regarding physical, cognitive, and psychological symptoms. The 'postconcussive-like' symptoms were selected and analysed. Specific symptom endorsement rates ranged from 5% to 76.5%. Disturbed sleep, fatigue, and irritability were reported by the majority of chronic pain patients. Cognitive complaints relating to forgetfulness (29%), difficulty maintaining attention (18%), and difficulty with concentration or thinking (16.5%) were endorsed by a significant minority of patients. Most patients (80.6%) endorsed three or more symptoms from Category C of the DSM-IV Postconcussional Disorder research criteria. This study further illustrates that postconcussive-like symptoms are not unique sequelae of mild head injury, and the presence of chronic pain should be considered when interpreting patients' physical, cognitive, and psychological complaints following closed head injury.

  20. AAPT Diagnostic Criteria for Chronic Sickle Cell Disease Pain.

    Science.gov (United States)

    Dampier, Carlton; Palermo, Tonya M; Darbari, Deepika S; Hassell, Kathryn; Smith, Wally; Zempsky, William

    2017-01-05

    Pain in sickle cell disease (SCD) is associated with increased morbidity, mortality, and high health care costs. Although episodic acute pain is the hallmark of this disorder, there is an increasing awareness that chronic pain is part of the pain experience of many older adolescents and adults. A common set of criteria for classifying chronic pain associated with SCD would enhance SCD pain research efforts in epidemiology, pain mechanisms, and clinical trials of pain management interventions, and ultimately improve clinical assessment and management. As part of the collaborative effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks public-private partnership with the U.S. Food and Drug Administration and the American Pain Society, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy initiative developed the outline of an optimal diagnostic system for chronic pain conditions. Subsequently, a working group of experts in SCD pain was convened to generate core diagnostic criteria for chronic pain associated with SCD. The working group synthesized available literature to provide evidence for the dimensions of this disease-specific pain taxonomy. A single pain condition labeled chronic SCD pain was derived with 3 modifiers reflecting different clinical features. Future systematic research is needed to evaluate the feasibility, validity, and reliability of these criteria.

  1. Pain Recognition using Spatiotemporal Oriented Energy of Facial Muscles

    DEFF Research Database (Denmark)

    Irani, Ramin; Nasrollahi, Kamal; Moeslund, Thomas B.

    2015-01-01

    Pain is a critical sign in many medical situations and its automatic detection and recognition using computer vision techniques is of great importance. Utilizes this fact that pain is a spatiotemporal process, the proposed system in this paper employs steerable and separable filters to measures...... energies released by the facial muscles during the pain process. The proposed system not only detects the pain but recognizes its level. Experimental results on the publicly available pain database of UNBC show promising outcome for automatic pain detection and recognition....

  2. Pain management mini-series. Part II. Chronic opioid drug therapy: implications for perioperative anesthesia and pain management.

    Science.gov (United States)

    Fisher, Robert B; Johnson, Quinn L; Reeves-Viets, Joseph L

    2013-01-01

    In the U.S., there is a growing percentage of chronic pain patients requiring surgery. Chronic pain patients require careful evaluation and planning to achieve appropriate acute pain management. Peri-surgical pain management often requires continuation of previously prescribed chronic pain modalities and careful selection of multimodal acute pain interventions. This article will provide a broad overview of chronic pain, definitions, and current recommendations for the treatment of perioperative pain in patients maintained on opioid therapy.

  3. Current understanding of the neuropathophysiology of pain in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Amporn; Atsawarungruangkit; Supot; Pongprasobchai

    2015-01-01

    Chronic pancreatitis(CP) is a chronic inflammatory disease of the pancreas. The main symptom of patients with CP is chronic and severe abdominal pain. However, the pathophysiology of pain in CP remains obscure.Traditionally, researchers believed that the pain was caused by anatomical changes in pancreatic structure. However, treatment outcomes based on such beliefs are considered unsatisfactory. The emerging explanations of pain in CP are trending toward neurobiological theories. This article aims to review current evidence regarding the neuropathophysiology of pain in CP and its potential implications for the development of new treatments for pain in CP.

  4. Positive emotions and brain reward circuits in chronic pain.

    Science.gov (United States)

    Navratilova, Edita; Morimura, Kozo; Xie, Jennifer Y; Atcherley, Christopher W; Ossipov, Michael H; Porreca, Frank

    2016-06-01

    Chronic pain is an important public health problem that negatively impacts the quality of life of affected individuals and exacts enormous socioeconomic costs. Chronic pain is often accompanied by comorbid emotional disorders including anxiety, depression, and possibly anhedonia. The neural circuits underlying the intersection of pain and pleasure are not well understood. We summarize recent human and animal investigations and demonstrate that aversive aspects of pain are encoded in brain regions overlapping with areas processing reward and motivation. We highlight findings revealing anatomical and functional alterations of reward/motivation circuits in chronic pain. Finally, we review supporting evidence for the concept that pain relief is rewarding and activates brain reward/motivation circuits. Adaptations in brain reward circuits may be fundamental to the pathology of chronic pain. Knowledge of brain reward processing in the context of pain could lead to the development of new therapeutics for the treatment of emotional aspects of pain and comorbid conditions.

  5. Cortical plasticity as a new endpoint measurement for chronic pain

    Directory of Open Access Journals (Sweden)

    Zhuo Min

    2011-07-01

    Full Text Available Abstract Animal models of chronic pain are widely used to investigate basic mechanisms of chronic pain and to evaluate potential novel drugs for treating chronic pain. Among the different criteria used to measure chronic pain, behavioral responses are commonly used as the end point measurements. However, not all chronic pain conditions can be easily measured by behavioral responses such as the headache, phantom pain and pain related to spinal cord injury. Here I propose that cortical indexes, that indicate neuronal plastic changes in pain-related cortical areas, can be used as endpoint measurements for chronic pain. Such cortical indexes are not only useful for those chronic pain conditions where a suitable animal model is lacking, but also serve as additional screening methods for potential drugs to treat chronic pain in humans. These cortical indexes are activity-dependent immediate early genes, electrophysiological identified plastic changes and biochemical assays of signaling proteins. It can be used to evaluate novel analgesic compounds that may act at peripheral or spinal sites. I hope that these new cortical endpoint measurements will facilitate our search for new, and more effective, pain medicines, and help to reduce false lead drug targets.

  6. Cognitive function in patients with chronic pain treated with opioids

    DEFF Research Database (Denmark)

    Kurita, G P; de Mattos Pimenta, C A; Braga, P E;

    2012-01-01

    The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non-cancer pain treated...... with opioids....

  7. Jaw muscle pain and its effect on gothic arch tracings.

    Science.gov (United States)

    Obrez, A; Stohler, C S

    1996-04-01

    Perceived changes in occlusion and decreased range of motion are often expressed by patients with masticatory muscle pain. The adverse loading of craniomandibular tissues that results from an inadequate maxillomandibular relationship in combination with the coexisting dysfunction is widely regarded as the cause of pain. This study was designed to test whether pain can cause significant changes in position of the mandible and therefore form the basis for any perceived changes in the maxillomandibular relationship. A second objective was to determine whether pain can cause changes in the mandibular range of motion. Five subjects who rated pain intensity on a visual analog scale were used in a single-blind, randomized, repeated-measures study design. Tonic muscle pain was induced by infusion of 5% hypertonic saline solution into the central portion of the superficial masseter muscle. Isotonic saline solution was used as a control, with subjects blinded to the type of substance given. The effect of pain on the position of the apex of the gothic arch tracing, the direction of the lateral mandibular border movements, and the mandibular range of motion was studied in a horizontal plane with minimal occlusal separation. Pain significantly affected the position of the apex of the gothic arch tracing in anterior (F = 11.46, p = 0.03) and transverse (F = 35.0, p = 0.004) directions. Similarly, pain affected the orientation of the mandibular lateral border movements (F = 12.44, p = 0.02) and their magnitude (F = 14.97, p = 0.01). All pain-induced effects proved to be reversible. The observed effect of pain can explain the perceived change of bite that is frequently noted by patients with orofacial pain. This study provided evidence of an alternative causal relationship between pain and changes in occlusal relationship and questions occlusal therapy as treatment, directed toward the elimination of the underlying cause in patients with masticatory muscle pain.

  8. Mucosal versus muscle pain sensitivity in provoked vestibulodynia

    Directory of Open Access Journals (Sweden)

    Witzeman K

    2015-08-01

    Full Text Available Kathryn Witzeman,1 Ruby HN Nguyen,2 Alisa Eanes,3 Sawsan As-Sanie,4 Denniz Zolnoun51Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO, 2Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, 3Pelvic Pain Research Unit, Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, 4Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of Michigan, Ann Arbor, MI, 5Department of Obstetrics and Gynecology and Center for Neurosensory Disorders, University of North Carolina, Chapel Hill, NC, USABackground: An estimated 8.3%–16% of women experience vulvovaginal discomfort during their lifetime. Frequently these patients report provoked pain on contact or with attempted intercourse, commonly referred to as provoked vestibulodynia (PVD. Despite the burden of this condition, little is known about its potential etiologies including pelvic floor muscular dysfunction and mucosal components. This knowledge would be beneficial in developing targeted therapies including physical therapy.Objective: To explore the relative contribution of mucosal versus muscle pain sensitivity on pain report from intercourse among women with PVD.Design: In this proof of concept study, 54 women with PVD underwent a structured examination assessing mucosal and pelvic muscle sensitivity.Methods: We examined three mucosal sites in the upper and lower vestibule. Patients were asked to rate their pain on cotton swab palpation of the mucosa using a 10-point visual analog scale. Muscle pain was assessed using transvaginal application of pressure on right and left puborectalis, and the perineal muscle complex. The Gracely pain scale (0–100 was used to assess the severity of pain with intercourse, with women rating the lowest, average, and highest pain levels; a 100 rating the

  9. Family dysfunction: A comparison of chronic widespread pain and chronic localized pain.

    Science.gov (United States)

    Hayaki, Chie; Anno, Kozo; Shibata, Mao; Iwaki, Rie; Kawata, Hiroshi; Sudo, Nobuyuki; Hosoi, Masako

    2016-12-01

    Previous studies have shown differences in the psychosocial factors related to chronic localized pain (CLP) and chronic widespread pain (CWP). However, no studies have done an evaluation of differences between CLP and CWP from the viewpoint of family functioning. We did a cross-sectional study in a tertiary care setting to investigate possible differences in the relation of CWP and CLP to family functioning.Patients with CLP (N = 126) or CWP (N = 75) were assessed for family functioning by the Family Assessment Device (FAD) and a comparison was done. Logistic regression analysis was used to estimate associations of family functioning subscales with pain status (CWP vs CLP), controlling for demographic variables, pain variables; pain duration, pain ratings, pain disability, and psychological factors; depression, anxiety, and catastrophizing. The odds ratios (ORs) for the presence of CWP were calculated.Compared to patients with CLP, patients with CWP showed a lower functional status for Roles and Affective Involvement. The ORs for CWP were significantly higher in lower functioning Roles (OR: 2.38, 95% CI: 1.21-4.65) and Affective Involvement (OR: 2.86, 95% CI: 1.56-5.24) after adjusting for demographic variables. The significant association of CWP to Roles and Affective Involvement remained after controlling for the pain variables and psychological factors.This study shows that the families of patients with CWP have poorer family functioning than those with CLP. Our findings suggest that early identification and interventions for the family dysfunction of chronic pain patients are important to the treatment and prevention of CWP.

  10. Chronic Pain: Symptoms, Diagnosis, & Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Chronic Pain Chronic Pain: Symptoms, Diagnosis, & Treatment Past Issues / Spring 2011 Table of Contents Symptoms Chronic pain is often defined as any pain lasting ...

  11. Kinesiotherapy for quality of life, pain and muscle strength of rheumatoid arthritis and systemic lupus erythematosus patient. Case report

    OpenAIRE

    Myra,Rafaela Simon; DeMarco,Mariângela; Zanin, Caroline; Wibelinger, Lia Mara

    2015-01-01

    ABSTRACT BACKGROUND AND OBJECTIVES: Rheumatoid arthritis is an inflammatory, chronic and progressive disease. It impairs joint synovial membranes and may induce bone and cartilage destruction. Many diseases may follow rheumatoid arthritis, including systemic lupus erythematosus, an inflammatory, chronic autoimmune disease with multisystemic manifestations, with periods of remission and exacerbation. This study aimed at reporting kinesiotherapy intervention for quality of life, pain and muscle...

  12. Molecular signatures of age-associated chronic degeneration of shoulder muscles.

    Science.gov (United States)

    Raz, Yotam; Henseler, Jan Ferdinand; Kolk, Arjen; Tatum, Zuotian; Groosjohan, Niels Kuipers; Verwey, Nisha E; Arindrarto, Wibowo; Kielbasa, Szymon M; Nagels, Jochem; 't Hoen, Peter A C; Nelissen, Rob G H H; Raz, Vered

    2016-02-23

    Chronic muscle diseases are highly prevalent in the elderly causing severe mobility limitations, pain and frailty. The intrinsic molecular mechanisms are poorly understood due to multifactorial causes, slow progression with age and variations between individuals. Understanding the underlying molecular mechanisms could lead to new treatment options which are currently limited. Shoulder complaints are highly common in the elderly, and therefore, muscles of the shoulder's rotator cuff could be considered as a model for chronic age-associated muscle degeneration. Diseased shoulder muscles were characterized by muscle atrophy and fatty infiltration compared with unaffected shoulder muscles. We confirmed fatty infiltration using histochemical analysis. Additionally, fibrosis and loss of contractile myosin expression were found in diseased muscles. Most cellular features, including proliferation rate, apoptosis and cell senescence, remained unchanged and genome-wide molecular signatures were predominantly similar between diseased and intact muscles. However, we found down-regulation of a small subset of muscle function genes, and up-regulation of extracellular region genes. Myogenesis was defected in muscle cell culture from diseased muscles but was restored by elevating MyoD levels. We suggest that impaired muscle functionality in a specific environment of thickened extra-cellular matrix is crucial for the development of chronic age-associated muscle degeneration.

  13. Effect of pain neuroscience education and dry needling on chronic elbow pain as a result of cyberchondria: a case report.

    Science.gov (United States)

    Anandkumar, Sudarshan

    2015-03-01

    This case report describes a 31-year-old male who presented with complaints of chronic pain in his right elbow. Detailed subjective examination revealed that the patient had searched Google for extensive online information relating to his pain, ultimately self-labeling with various diagnoses. After researching in YouTube, the patient self-treated with ice, exercises, neural mobilization, self-massage and taping, all resulting in a failed outcome. Clinical findings revealed trigger points in his right brachioradialis muscle with added symptoms of central pain. This is a potential first-time description of physical therapy management of brachioradialis myofascial pain syndrome with superadded central pain caused as a result of cyberchondria where the patient used the Internet for arriving at a wrong self-diagnosis and incorrect self-treatment with failed or worsening pain outcomes leading to pain sustenance or chronicity. Physical therapy consisted of Pain Neuroscience Education, dry needling and exercise therapy. The patient was completely pain free and fully functional at the end of the sixth session, which was maintained at a one-month follow-up.

  14. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

    Science.gov (United States)

    Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah

    2014-01-01

    The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of

  15. Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

    OpenAIRE

    John Jarrell; Maria Adele Giamberardino; Magali Robert; Maryam Nasr-Esfahani

    2011-01-01

    Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eigh...

  16. Neural Mechanisms of Temporomandibular Joint and Masticatory Muscle Pain: A Possible Role for Peripheral Glutamate Receptor Mechanisms

    Directory of Open Access Journals (Sweden)

    David K Lam

    2005-01-01

    Full Text Available The purpose of the present review is to correlate recent knowledge of the role of peripheral ionotropic glutamate receptors in the temporomandibular joint and muscle pain from animal and human experimental pain models with findings in patients. Chronic pain is common, and many people suffer from chronic pain conditions involving deep craniofacial tissues such as temporomandibular disorders or fibromyalgia. Animal and human studies have indicated that the activation of peripheral ionotropic glutamate receptors in deep craniofacial tissues may contribute to muscle and temporomandibular joint pain and that sex differences in the activation of glutamate receptors may be involved in the female predominance in temporomandibular disorders and fibromyalgia. A peripheral mechanism involving autocrine and/or paracrine regulation of nociceptive neuronal excitability via injury or inflammation-induced release of glutamate into peripheral tissues that may contribute to the development of craniofacial pain is proposed.

  17. Altered central sensitization and pain modulation in the CNS in chronic joint pain

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Skou, Søren Thorgaard; Nielsen, Thomas Arendt

    2015-01-01

    and central pain mechanisms are not fully understood, and safe and efficient analgesic drugs are not available. The pain associated with joint pain is highly individual, and features from radiological imaging have not demonstrated robust associations with the pain manifestations. In recent years, a variety......Musculoskeletal pain disorders are the second largest contributor to global disability underlining the significance of effective treatments. However, treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the underlying peripheral...... of human quantitative pain assessment tools (quantitative sensory testing (QST)) have been developed providing new opportunities for profiling patients and reaching a greater understanding of the mechanisms involved in chronic joint pain. As joint pain is a complex interaction between many different pain...

  18. Correlates of Improvement in Multidisciplinary Treatment of Chronic Pain.

    Science.gov (United States)

    Jensen, Mark P.; And Others

    1994-01-01

    Chronic pain patients (n=94) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and three to six months after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping…

  19. Central sensitization in chronic low back pain: A narrative review.

    Science.gov (United States)

    Sanzarello, Ilaria; Merlini, Luciano; Rosa, Michele Attilio; Perrone, Mariada; Frugiuele, Jacopo; Borghi, Raffaele; Faldini, Cesare

    2016-11-21

    Low back pain is one of the four most common disorders in all regions, and the greatest contributor to disability worldwide, adding 10.7% of total years lost due to this health state. The etiology of chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon. Central sensitization has been recently recognized as a potential pathophysiological mechanism underlying a group of chronic pain conditions, and may be a contributory factor for a sub-group of patients with chronic low back pain. The purposes of this narrative review are twofold. First, to describe central sensitization and its symptoms and signs in patients with chronic pain disorders in order to allow its recognition in patients with nonspecific low back pain. Second, to provide general treatment principles of chronic low back pain with particular emphasis on pharmacotherapy targeting central sensitization.

  20. Biopsychosocial Influence on Exercise-induced Delayed Onset Muscle Soreness at the Shoulder: Pain Catastrophizing and Catechol-O-Methyltransferase (COMT) Diplotype Predict Pain Ratings

    Science.gov (United States)

    George, Steven Z.; Dover, Geoffrey C.; Wallace, Margaret R.; Sack, Brandon K.; Herbstman, Deborah M.; Aydog, Ece; Fillingim, Roger B.

    2009-01-01

    Objective The experience of pain is believed to be influenced by psychologic and genetic factors. A previous study suggested pain catastrophizing and catechol-O-methyltransferase (COMT) genotype influenced clinical pain ratings for patients seeking operative treatment of shoulder pain. This study investigated whether these same psychologic and genetic factors predicted responses to induced shoulder pain. Methods Participants (n=63) completed self-report questionnaires and had COMT genotype determined before performing a standardized fatigue protocol to induce delayed onset muscle soreness. Then, shoulder pain ratings, self-report of upper-extremity disability ratings, and muscle torque production were reassessed 24, 48, and 72 hours later. Results This cohort consisted of 35 women and 28 men, with a mean age of 20.9 years (SD=1.7). The frequency of COMT diplotypes was 42 with “high COMT enzyme activity” (low pain sensitivity group) and 21 with “low COMT enzyme activity” (average pain sensitivity/high pain sensitivity group). A hierarchical regression model indicated that an interaction between pain catastrophizing and COMT diplotype was the strongest unique predictor of 72-hour pain ratings. The same interaction was not predictive of self-report of disability or muscle torque production at 72 hours. The pain catastrophizing × COMT diplotype interaction indicated that participants with high pain catastrophizing and low COMT enzyme activity (average pain sensitivity/high pain sensitivity group) were more likely (relative risk=3.5, P=0.025) to have elevated pain intensity ratings (40/100 or higher). Discussion These findings from an experimental model converge with those from a surgical cohort and provide additional evidence that the presence of elevated pain catastrophizing and COMT diplotype indicative of low COMT enzyme activity have the potential to increase the risk of developing chronic pain syndromes. PMID:18936597

  1. Medical marijuana use for chronic pain: risks and benefits.

    Science.gov (United States)

    Greenwell, Garth T

    2012-01-01

    Questions from patients about medical marijuana use for chronic pain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions.

  2. Seniors and Chronic Pain | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... their own and 75-85 percent of the elderly in care facilities suffer from chronic pain. Yet, pain among older adults is largely undertreated, with serious health consequences, such as depression, anxiety, decreased mobility, social isolation, poor sleep, and ...

  3. Experimental knee joint pain during strength training and muscle strength gain in healthy subjects

    DEFF Research Database (Denmark)

    Sørensen, T J; Langberg, Henning; Hodges, P W;

    2012-01-01

    Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function and t...... and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals.......Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function...

  4. Epidemiology of chronic pain in Denmark: an update

    DEFF Research Database (Denmark)

    Sjøgren, Per; Ekholm, Ola; Peuckmann, Vera;

    2008-01-01

    The most recent Danish health survey of 2005 is based on a region-stratified random sample of 10.916 individuals. Data were collected via personal interviews and self-administrated questionnaires. Respondents suffering from chronic pain were identified through the question 'Do you have chronic....../long-lasting pain lasting 6 months or more?' The prevalence of chronic pain among individuals with a present or earlier cancer diagnosis was also assessed. In all, 7275 individuals (66.6%) completed a personal interview and 5552 individuals (50.9% of the original sample) completed and returned the self......-administrated questionnaire. The same questions were included in the survey in 2000 and, hence, it was possible to evaluate the trends in the past five years. In all, 20.2% of the adult Danish population has chronic pain. From year 2000-2005 the prevalence of chronic pain has remained stable. Generally, chronic pain...

  5. Over-expression of P2X7 receptors in spinal glial cells contributes to the development of chronic postsurgical pain induced by skin/muscle incision and retraction (SMIR) in rats.

    Science.gov (United States)

    Ying, Yan-Lu; Wei, Xu-Hong; Xu, Xue-Bing; She, Shou-Zhang; Zhou, Li-Jun; Lv, Jing; Li, Dai; Zheng, Bin; Liu, Xian-Guo

    2014-11-01

    Many patients suffer from chronic postsurgical pain (CPSP) following surgery, and the underlying mechanisms are poorly understood. In the present work, with use of the skin/muscle incision and retraction (SMIR) model, the role of P2X7 receptors (P2X7Rs) in spinal glial cells in the development of CPSP was evaluated. Consistent with previous reports, we found that SMIR decreased the ipsilateral 50% paw withdrawal threshold (PWT), lasting for at least 2weeks. No injury was done to L3 dorsal root ganglia (DRG) neurons and no axonal or Schwann cell damage at the retraction site in the saphenous nerve was observed 7days after SMIR. The results of immunofluorescence showed that both microglia and astrocytes were activated in the spinal dorsal horn following SMIR. In addition, both P2X7Rs and tumor necrosis factor-alpha (TNF-α) were up-regulated following SMIR. Double immunofluorescence staining revealed that the up-regulated P2X7R immunoreactivity was mainly located in microglia, and to a lesser extent in astrocytes, but not in neurons. Intrathecal delivery of specific P2X7R antagonist BBG (10μM in 10μl volume) or A438079 (10μM in 10μl volume), started 30min before the surgery and once daily thereafter for 7days, prevented the mechanical allodynia. Intrathecal injection of BBG inhibited the activation of microglia and astrocytes, and the up-regulation of TNF-α induced by SMIR. These data suggest that P2X7Rs in the spinal dorsal horn might mediate the development of CPSP via activation of glial cells and up-regulation of TNF-α.

  6. Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities.

    Science.gov (United States)

    Almoznino, Galit; Benoliel, Rafael; Sharav, Yair; Haviv, Yaron

    2017-06-01

    Chronic craniofacial pain involves the head, face and oral cavity and is associated with significant morbidity and high levels of health care utilization. A bidirectional relationship is suggested in the literature for poor sleep and pain, and craniofacial pain and sleep are reciprocally related. We review this relationship and discuss management options. Part I reviews the relationship between pain and sleep disorders in the context of four diagnostic categories of chronic craniofacial pain: 1) primary headaches: migraines, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs) and hypnic headache, 2) secondary headaches: sleep apnea headache, 3) temporomandibular joint disorders (TMD) and 4) painful cranial neuropathies: trigeminal neuralgia, post-herpetic trigeminal neuropathy, painful post-traumatic trigeminal neuropathy (PTTN) and burning mouth syndrome (BMS). Part II discusses the management of patients with chronic craniofacial pain and sleep disorders addressing the factors that modulate the pain experience as well as sleep disorders and including both non-pharmacological and pharmacological modalities.

  7. Breakthrough pain in chronic non-cancer pain: fact, fiction, or abuse.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Singh, Vijay; Caraway, David L; Benyamin, Ramsin M

    2011-01-01

    Treatment of chronic non-cancer pain with opioid therapy has escalated in recent years, resulting in exploding therapeutic use and misuse of prescription opioids and multiple adverse drug events. Breakthrough pain is defined as a transient exacerbation of pain experienced by individuals who have relatively stable and adequately controlled baseline cancer pain. Further, the definition of breakthrough pain, prevalence, characteristics, implications, and treatment modalities have been extensively described for chronic cancer pain. However, the literature for breakthrough pain in chronic non-cancer pain including its terminology, prevalence, relevance, characteristics, and treatments, have been poorly described and continue to be debated. The philosophy of breakthrough pain in chronic non-cancer pain raises multiple issues leading almost all patients to be on high dose long-acting opioids, followed by supplementing with short-acting drugs, instead of treating the patients with only short-acting drugs as required. Consequently, the subject of breakthrough pain in chronic non-cancer pain is looked at with suspicion due to the lack of evidence and inherent bias associated with its evaluation, followed by escalating use and abuse of opioids. Multiple issues related to the concept of breakthrough pain in chronic non-cancer pain evolve around extensive use, overuse, misuse, and abuse of opioids. In the era of eliminating opioids or significantly curtailing their use to only appropriate indications, the concept of breakthrough pain raises multiple questions without any scientific evidence. This review illustrates that there is no significant evidence for any type of breakthrough pain in chronic non-cancer pain based on available literature, methodology utilized, and response to opioids in chronic non-cancer pain. The advocacy for increased usage of opioids in the treatment of chronic pain dates back to the liberalization of laws governing opioid prescription for the treatment

  8. Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

    NARCIS (Netherlands)

    Nijs, J.; Crombez, G.; Meeus, M.; Knoop, H.; Damme, S.V.; Cauwenbergh, V.; Bleijenberg, G.

    2012-01-01

    BACKGROUND: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. OBJECTIVES: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as ot

  9. An update on the management of chronic lumbar discogenic pain.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2015-09-01

    Lumbar degenerative disc disease without disc herniation, also known as discogenic pain, is an elusive diagnosis of chronic low back pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar discogenic pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar discogenic pain. This review provides an updated assessment of the management of chronic lumbar discogenic pain with a critical look at the many modalities of treatments that are currently available.

  10. Commentary on the use of acupuncture in chronic pediatric pain.

    Science.gov (United States)

    Waterhouse, Michael; Tsao, Jennie C I; Zeltzer, Lonnie K

    2009-02-01

    The use of acupuncture for pain in pediatrics is a long-standing practice in Eastern cultures. Despite growing interest in the West, there has been relatively little systematic research on acupuncture for chronic pediatric pain. In particular, there is a paucity of randomized clinical trials testing the efficacy of acupuncture for chronic pain problems in pediatric populations. This commentary briefly reviews the history of acupuncture for pain and includes a summary of extant findings regarding potential mechanisms of its analgesic effects. Key areas for future research to advance the application of acupuncture to chronic pediatric pain problems are outlined.

  11. Physical Activity and Chronic Prostatitis/Chronic Pelvic Pain Syndrome

    Science.gov (United States)

    Zhang, Ran; Chomistek, Andrea K.; Dimitrakoff, Jordan D.; Giovannucci, Edward L.; Willett, Walter C.; Rosner, Bernard A.; Wu, Kana

    2014-01-01

    Purpose Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urologic disorder among men, but its etiology is still poorly understood. Our objective was to examine the relationship between physical activity and incidence of CP/CPPS in a large cohort of male health professionals. Methods We conducted a prospective cohort study among men in the Health Professionals Follow-up Study followed from 1986 to 2008. The study population included 20,918 men who completed all CP/CPPS questions on the 2008 questionnaire. Leisure-time physical activity, including type and intensity of activity, was measured by questionnaire in 1986. A National Institute of Health Chronic Prostatitis Symptom Index pain score was calculated based on the responses on the 2008 questionnaire. Participants with pain scores ≥ 8 were considered CP/CPPS cases (n=689). Results Higher leisure-time physical activity was associated with lower risk of CP/CPPS. The multivariable-adjusted odds ratio (OR) comparing >35.0 to ≤3.5 MET-h/wk of physical activity was 0.72 (95% confidence interval (CI): 0.56, 0.92, p for trend <0.001). Observed inverse associations between physical activity and CP/CPPS were similar for both moderate- and vigorous-intensity activities. Sedentary behavior, measured as time spent watching television, was not associated with risk of CP/CPPS (p for trend 0.64). Conclusions Findings from this study, the first large scale and most comprehensive study to date on this association, suggest that higher levels of leisure-time physical activity may lower risk of CP/CPPS in middle-aged and older men. PMID:25116086

  12. Cognitive processes in comorbid poor sleep and chronic pain.

    Science.gov (United States)

    Byers, Haley D; Lichstein, Kenneth L; Thorn, Beverly E

    2016-04-01

    We examined the unique and shared contributions of pain catastrophizing, cognitive pre-sleep arousal, and somatic pre-sleep arousal, to the prediction of insomnia severity in chronic pain. Forty-eight adults with chronic pain completed self-report measures of these study variables, health, and mood. Hierarchical regression showed that pain catastrophizing accounted for unique variance in insomnia severity, independent of pain intensity, depression, restless legs symptoms, and demographics. However, when cognitive and somatic pre-sleep arousal were also taken into account, the significance of cognitive pre-sleep arousal rendered pain catastrophizing non-significant. We identify research and clinical implications of this study.

  13. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    , incidence and prevalence of addiction in opioid treated pain patients, screening tools for assessing opioid addiction in chronic pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and chronic non-malignant pain...... treatment as addiction may result in poor pain control. Several screening tools were identified, but only a few were thoroughly validated with respect to validity and reliability. Most of the identified guidelines mention addiction as a potential problem. The guidelines in cancer pain management...... long-term opioid treatment, and specialised treatment facilities for pain management or addiction medicine should be consulted in these cases....

  14. [Neck pain due to tendonitis of the longus colli muscle].

    Science.gov (United States)

    Coebergh, Jan Adriaan; Koppen, Hille; van Gils, Ad P; de Bruijn, Bas F

    2010-01-01

    Two patients presented to Accidents and Emergency with severe neck pain: a 70-year-old woman with acute, severe neck pain, which had developed a few days after outpatient resection of her left lingual tonsil. The patient was suspected to have spondylodiscitis. The other patient, a 54-year-old woman, was referred with severe neck pain and suspected meningitis. In both women, the pain was diagnosed as acute calcifying tendonitis of the longus colli muscle. This benign condition can present to many different specialities. Both patients responded well to treatment with NSAIDs. Acute calcifying tendonitis of the longus colli muscle can be diagnosed using various imaging techniques, such as X-ray, CT or MRI imaging. Calcification on cervical CT or a high signal on T2-weighted MRI images of the longus colli muscle are pathognomonic of tendonitis. A correct diagnosis can prevent further invasive diagnostics and/or unnecessary treatment.

  15. Knee Muscle Forces during Walking and Running in Patellofemoral Pain Patients and Pain-Free Controls

    Science.gov (United States)

    Besier, Thor F.; Fredericson, Michael; Gold, Garry E.; Beaupré, Gary S.; Delp, Scott L.

    2009-01-01

    One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles. Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. The purpose of this study was to estimate quadriceps forces during walking and running in a group of male and female patients with patellofemoral pain (n=27, 16 female; 11 male) and compare these to pain-free controls (n=16, 8 female; 8 male). Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography (EMG) data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint. Compared to controls, the patellofemoral pain group had greater co-contraction of quadriceps and hamstrings (p=0.025) and greater normalized muscle forces during walking, even though the net knee moment was similar between groups. Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Females displayed 30-50% greater normalized hamstring and gastrocnemius muscle forces during both walking and running compared to males (pjoint contact forces and joint stresses than pain-free subjects. PMID:19268945

  16. Experimental Muscle Pain Impairs the Synergistic Modular Control of Neck Muscles.

    Directory of Open Access Journals (Sweden)

    Leonardo Gizzi

    Full Text Available A motor task can be performed via different patterns of muscle activation that show regularities that can be factorized in combinations of a reduced number of muscle groupings (also referred to as motor modules, or muscle synergies. In this study we evaluate whether an acute noxious stimulus induces a change in the way motor modules are combined to generate movement by neck muscles. The neck region was selected as it is a region with potentially high muscular redundancy. We used the motor modules framework to assess the redistribution of muscular activity of 12 muscles (6 per side in the neck region of 8 healthy individuals engaged in a head and neck aiming task, in non-painful conditions (baseline, isotonic saline injection, post pain and after the injection of hypertonic saline into the right splenius capitis muscle. The kinematics of the task was similar in the painful and control conditions. A general decrease of activity was noted for the injected muscle during the painful condition together with an increase or decrease of the activity of the other muscles. Subjects did not adopt shared control strategies (motor modules inter subject similarity at baseline 0.73±0.14; the motor modules recorded during the painful condition could not be used to reconstruct the activation patterns of the control conditions, and the painful stimulus triggered a subject-specific redistribution of muscular activation (i.e., in some subjects the activity of a given muscle increased, whereas in other subjects it decreased with pain. Alterations of afferent input (i.e., painful stimulus influenced motor control at a multi muscular level, but not kinematic output. These findings provide new insights into the motor adaptation to pain.

  17. Experimental Muscle Pain Impairs the Synergistic Modular Control of Neck Muscles.

    Science.gov (United States)

    Gizzi, Leonardo; Muceli, Silvia; Petzke, Frank; Falla, Deborah

    2015-01-01

    A motor task can be performed via different patterns of muscle activation that show regularities that can be factorized in combinations of a reduced number of muscle groupings (also referred to as motor modules, or muscle synergies). In this study we evaluate whether an acute noxious stimulus induces a change in the way motor modules are combined to generate movement by neck muscles. The neck region was selected as it is a region with potentially high muscular redundancy. We used the motor modules framework to assess the redistribution of muscular activity of 12 muscles (6 per side) in the neck region of 8 healthy individuals engaged in a head and neck aiming task, in non-painful conditions (baseline, isotonic saline injection, post pain) and after the injection of hypertonic saline into the right splenius capitis muscle. The kinematics of the task was similar in the painful and control conditions. A general decrease of activity was noted for the injected muscle during the painful condition together with an increase or decrease of the activity of the other muscles. Subjects did not adopt shared control strategies (motor modules inter subject similarity at baseline 0.73±0.14); the motor modules recorded during the painful condition could not be used to reconstruct the activation patterns of the control conditions, and the painful stimulus triggered a subject-specific redistribution of muscular activation (i.e., in some subjects the activity of a given muscle increased, whereas in other subjects it decreased with pain). Alterations of afferent input (i.e., painful stimulus) influenced motor control at a multi muscular level, but not kinematic output. These findings provide new insights into the motor adaptation to pain.

  18. Women in pain : the course and diagnostics of chronic pelvic pain

    NARCIS (Netherlands)

    Weijenborg, Philomena Theodora Maria

    2009-01-01

    The main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: 1. The clinical course of acute abdominal pain and risks of pain persistence. 2. The clinical course of chronic pelvic pain (CPP) and predictors of recovery. 3. The moderat

  19. Biofeedback therapy for chronic pelvic pain syndrome

    Institute of Scientific and Technical Information of China (English)

    Zhang-QunYE; DanCAI; Ru-ZhuLAN; Guang-HuiDU; Xiao-YiYUAN; ZhongCHEN; Yang-ZhiMA; You-MingHU; Gui-YunZENG

    2003-01-01

    Aim: To evaluate the efficacy of biofeedback therapy in patients with chronic pelvic pain syndrome(CPPS). Methods: From November 2001 to April 2002, patients visiting the Urological Outpatient Clinic of this Hospital were evaluated by means of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI)and classified by the NIH classification standard. Sixty-two patients of CPPS category Ⅲ were involved in this study. All patients had been treated by conventional approaches such as antibiotics and alpha-blockers for more than half a year without any improvement. The expressed prostatic secretion results were as follows: WBC 5 to 9/high power field, lipid +-+++ and bacterial culture negative. Their NIH-CPSI were 12-40. All the 62 cases complained of micturitional irritation (frequency, urgency, splitted stream and sense of residual urine), 32 cases, of pain or discomfort at the testicular, penile, scrotal, pelvic or rectal region and 13 cases, of white secretion-dripping. The patients were treated by the Urostym Biofeedback equipment (Laborie Co., Canada) 5 times a week for 2 weeks with a stimulus intensity of 15 mA-23 mA and duration of 20 minutes. Results: Sixty patients were significantly improved or cured, while no significant improvement in the remaining 2. No apparent side effect was observed. The NIH-CPSI dropped to 6 to 14 with an average reduction of 21 (P<0.01). In the 60 improved cases, pain was relieved after 2-3treatment courses and other symptoms disappeared after 4-5 courses. Conclusion: Biofeedback therapy is a safe and effective treatment for CPPS. Large randomized clinical trials are needed to confirm its efficacy and to explore the mechanism of action. ( Asian J Androl 2003 Jun; 5:155-158 )

  20. Basolateral amygdala lesion inhibits the development of pain chronicity in neuropathic pain rats.

    Directory of Open Access Journals (Sweden)

    Zheng Li

    Full Text Available BACKGROUND: Chronicity of pain is one of the most interesting questions in chronic pain study. Clinical and experimental data suggest that supraspinal areas responsible for negative emotions such as depression and anxiety contribute to the chronicity of pain. The amygdala is suspected to be a potential structure for the pain chronicity due to its critical role in processing negative emotions and pain information. OBJECTIVE: This study aimed to investigate whether amygdala or its subregions, the basolateral amygdala (BLA and the central medial amygdala (CeA, contributes to the pain chronicity in the spared nerve injury (SNI-induced neuropathic pain model of rats. METHODOLOGY/PRINCIPAL FINDINGS: (1 Before the establishment of the SNI-induced neuropathic pain model of rats, lesion of the amygdaloid complex with stereotaxic injection of ibotenic acid (IBO alleviated mechanical allodynia significantly at days 7 and 14, even no mechanical allodynia at day 28 after SNI; Lesion of the BLA, but not the CeA had similar effects; (2 however, 7 days after SNI when the neuropathic pain model was established, lesion of the amygdala complex or the BLA or the CeA, mechanical allodynia was not affected. CONCLUSION: These results suggest that BLA activities in the early stage after nerve injury might be crucial to the development of pain chronicity, and amygdala-related negative emotions and pain-related memories could promote pain chronicity.

  1. Association between chronic pain and the sperm motion characteristics

    DEFF Research Database (Denmark)

    Dardmeh, Fereshteh; Alipour, Hiva; Nielsen, Hans Ingolf

    2015-01-01

    valuable, prognostic indicators of successful fertilization. Maturation of sperm motility occurs during their transit through the epididymis and vas deferens regulated by androgens. As male gonadal hormones have an inhibitory, adaptive effect on the behavioral and neuronal responses to repeated nociceptive...... stimulation, it can be speculated that the observed difference in sperm kinematic parameters could be related to the alterations in serum sex hormone levels emanating from the chronic pain. Further studies are required to explain the possible mechanism of action of chronic pain on male fertility.......Sex hormones play an important role in pain in many chronic pain conditions. Relationship between chronic pain and sperm quality has not been investigated thoroughly and may provide an insight to better understanding, management and treatment of cases where chronic pain and male sub-fertility co...

  2. Observations on muscle pain in man, with particular reference to pain during needle electromyography.

    Science.gov (United States)

    Meadows, J C

    1970-08-01

    Muscle pain receptors have been studied in man. During the advance of an EMG needle pain is most regularly experienced as the muscle fascia is pierced. Further advancing the needle is usually quite painless. However, there are scantily distributed points within the muscle (`pain spots') which may give rise to pain if encountered by the advancing needle. The nature of the responsible receptors is obscure but it is likely that pain may sometimes be caused by activation of nerve fibres (presumably from these receptors) coursing through the muscle rather than by activation of the receptors themselves. Intramuscular bleeding is unlikely to contribute often to the pain of needle electromyography. Mechanically sensitive `pain spots' are more painful than other areas when stimulated electrically or injected with hypertonic (6%) saline. This suggests a common receptor. The high electrical threshold and relative invulnerability to pressure of afferent fibres from these receptors suggest that they are mainly of small diameter. These findings are discussed in relation to experimental work on pressure-pain receptors in animals.

  3. Is back pain during childhood or adolescence associated with muscle strength, muscle endurance or aerobic capacity

    DEFF Research Database (Denmark)

    Lardon, Arnaud; Leboeuf-Yde, Charlotte; Le Scanff, Christine

    2015-01-01

    BACKGROUND: Back pain is a common condition during childhood and adolescence. The causes of back pain are largely unknown but it seems plausible that some physical factors such as back muscle strength, back muscle endurance and aerobic capacity may play a role in its development, in particular...... in the early years. OBJECTIVES: The objectives of this review were to investigate in childhood and adolescence 1) if muscular strength in trunk extension is associated with back pain, 2) if muscular endurance in trunk extension is associated with back pain and 3) if aerobic capacity is associated with back...

  4. Understanding Muscle Dysfunction in Chronic Fatigue Syndrome

    Directory of Open Access Journals (Sweden)

    Gina Rutherford

    2016-01-01

    Full Text Available Introduction. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME is a debilitating disorder of unknown aetiology, characterised by severe disabling fatigue in the absence of alternative diagnosis. Historically, there has been a tendency to draw psychological explanations for the origin of fatigue; however, this model is at odds with findings that fatigue and accompanying symptoms may be explained by central and peripheral pathophysiological mechanisms, including effects of the immune, oxidative, mitochondrial, and neuronal pathways. For example, patient descriptions of their fatigue regularly cite difficulty in maintaining muscle activity due to perceived lack of energy. This narrative review examined the literature for evidence of biochemical dysfunction in CFS/ME at the skeletal muscle level. Methods. Literature was examined following searches of PUB MED, MEDLINE, and Google Scholar, using key words such as CFS/ME, immune, autoimmune, mitochondria, muscle, and acidosis. Results. Studies show evidence for skeletal muscle biochemical abnormality in CFS/ME patients, particularly in relation to bioenergetic dysfunction. Discussion. Bioenergetic muscle dysfunction is evident in CFS/ME, with a tendency towards an overutilisation of the lactate dehydrogenase pathway following low-level exercise, in addition to slowed acid clearance after exercise. Potentially, these abnormalities may lead to the perception of severe fatigue in CFS/ME.

  5. Understanding Muscle Dysfunction in Chronic Fatigue Syndrome.

    Science.gov (United States)

    Rutherford, Gina; Manning, Philip; Newton, Julia L

    2016-01-01

    Introduction. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating disorder of unknown aetiology, characterised by severe disabling fatigue in the absence of alternative diagnosis. Historically, there has been a tendency to draw psychological explanations for the origin of fatigue; however, this model is at odds with findings that fatigue and accompanying symptoms may be explained by central and peripheral pathophysiological mechanisms, including effects of the immune, oxidative, mitochondrial, and neuronal pathways. For example, patient descriptions of their fatigue regularly cite difficulty in maintaining muscle activity due to perceived lack of energy. This narrative review examined the literature for evidence of biochemical dysfunction in CFS/ME at the skeletal muscle level. Methods. Literature was examined following searches of PUB MED, MEDLINE, and Google Scholar, using key words such as CFS/ME, immune, autoimmune, mitochondria, muscle, and acidosis. Results. Studies show evidence for skeletal muscle biochemical abnormality in CFS/ME patients, particularly in relation to bioenergetic dysfunction. Discussion. Bioenergetic muscle dysfunction is evident in CFS/ME, with a tendency towards an overutilisation of the lactate dehydrogenase pathway following low-level exercise, in addition to slowed acid clearance after exercise. Potentially, these abnormalities may lead to the perception of severe fatigue in CFS/ME.

  6. Chronic Pain Following Spinal Cord Injury: The Role of Immunogenetics and Time of Injury Pain Treatment

    Science.gov (United States)

    2015-10-01

    central sensitization to nociceptive stimuli culminates in profound debilitating pain that serves no adaptive purpose for the sufferer. It is now...Award Number: W81XWH-11-1-0806 TITLE: Chronic Pain Following Spinal Cord Injury: The Role of Immunogenetics and Time of Injury Pain Treatment...29Sep2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-11-1-0806 Chronic Pain Following Spinal Cord Injury: The Role of Immunogenetics and Time

  7. Are emotion regulation skills related to adjustment among people with chronic pain, independent of pain coping?

    Science.gov (United States)

    Agar-Wilson, M; Jackson, T

    2012-01-01

    Although emotion regulation capacities have been linked to adjustment among people with chronic pain, researchers have yet to determine whether these capacities are related to functioning independent of established facets of pain coping. The present study was designed to address this gap. A sample 128 Australian adults with chronic pain (44 men, 84 women) completed self-report measures of adjustment (quality of life, negative affect, and pain-related disability), pain coping, and features of emotion regulation (emotion appraisal, perceived efficacy in emotion regulation, emotion utilization). Hierarchical multiple regression analyses indicated that efficacy in emotion regulation was related to quality of life and reduced negative affect even after statistically controlling for effects of other measures of adjustment, pain coping efficacy, and pain coping. Conversely, features of emotion regulation did not improve the prediction model for pain-related disability. Findings suggest emotion regulation capacities may have a unique role in the prediction of specific facets of adjustment among people with chronic pain.

  8. Psychosocial and Somatosensory Factors in Women with Chronic Migraine and Painful Temporomandibular Disorders

    Directory of Open Access Journals (Sweden)

    Alfonso Gil-Martínez

    2016-01-01

    Full Text Available Introduction. Psychosocial and somatosensory factors are involved in the pathophysiology of chronic migraine (CM and chronic temporomandibular disorders (TMD. Objective. To compare and assess the relationship between pain catastrophizing and kinesiophobia in patients with CM or chronic TMD. Method. Cross-sectional study of 20 women with CM, 19 with chronic TMD, and 20 healthy volunteers. Pain catastrophizing and kinesiophobia were assessed. The level of education, pain intensity, and magnitude of temporal summation of stimuli in the masseter (STM and tibialis (STT muscles were also evaluated. Results. There were significant differences between the CM and chronic TMD groups, compared with the group of asymptomatic subjects, for all variables (p<.05 except kinesiophobia when comparing patients with CM and healthy women. Moderate correlations between kinesiophobia and catastrophizing (r=0.46; p<.01 were obtained, and the strongest association was between kinesiophobia and magnification (r=0.52; p<.01. The strongest associations among physical variables were found between the STM on both sides (r=0.93; p<.01 and between the left and right STT (r=0.76; p<.01. Conclusion. No differences were observed in pain catastrophizing and kinesiophobia between women with CM and with chronic TMD. Women with CM or chronic TMD showed higher levels of pain catastrophizing than asymptomatic subjects.

  9. Psychosocial and Somatosensory Factors in Women with Chronic Migraine and Painful Temporomandibular Disorders

    Science.gov (United States)

    Grande-Alonso, Mónica; La Touche, Roy; Lara-Lara, Manuel; Fernández-Carnero, Josué

    2016-01-01

    Introduction. Psychosocial and somatosensory factors are involved in the pathophysiology of chronic migraine (CM) and chronic temporomandibular disorders (TMD). Objective. To compare and assess the relationship between pain catastrophizing and kinesiophobia in patients with CM or chronic TMD. Method. Cross-sectional study of 20 women with CM, 19 with chronic TMD, and 20 healthy volunteers. Pain catastrophizing and kinesiophobia were assessed. The level of education, pain intensity, and magnitude of temporal summation of stimuli in the masseter (STM) and tibialis (STT) muscles were also evaluated. Results. There were significant differences between the CM and chronic TMD groups, compared with the group of asymptomatic subjects, for all variables (p < .05) except kinesiophobia when comparing patients with CM and healthy women. Moderate correlations between kinesiophobia and catastrophizing (r = 0.46; p < .01) were obtained, and the strongest association was between kinesiophobia and magnification (r = 0.52; p < .01). The strongest associations among physical variables were found between the STM on both sides (r = 0.93; p < .01) and between the left and right STT (r = 0.76; p < .01). Conclusion. No differences were observed in pain catastrophizing and kinesiophobia between women with CM and with chronic TMD. Women with CM or chronic TMD showed higher levels of pain catastrophizing than asymptomatic subjects. PMID:27818609

  10. The management of chronic pain in rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Pasquale De Negri

    2010-12-01

    Full Text Available Rheumatic diseases are a group of pathologies that usually affect the joints or adjacent anatomical structures or functionally related such as bones, muscles, tendons, bursa, fascia, ligaments, and whose main symptom is the pain. Optimal pain control is a prerequisite for successful therapy of many rheumatic diseases. Many patients may present many diffi culties in terms of pain relief and therefore must be addressed at an appropriate pain treatment center.

  11. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

    Science.gov (United States)

    Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

    2015-12-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p treatment outcome (odds ratio = 0.55, p treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain.

  12. Cervical Muscle Dysfunction in Chronic Whiplash-Associated Disorder Grade 2: The Relevance of the Trauma

    NARCIS (Netherlands)

    Nederhand, Marc J.; Hermens, Hermie J.; IJzerman, Maarten J.; Turk, Dennis C.; Zilvold, Gerrit

    2002-01-01

    Study Design. Surface electromyography measurements of the upper trapezius muscles were performed in patients with a chronic whiplash-associated disorder Grade 2 and those with nonspecific neck pain. Objective. To determine the etiologic relation between acceleration–deceleration trauma and the pre

  13. Unusual fatal petrositis presenting as myofascial pain and dysfunction of the temporal muscle.

    Science.gov (United States)

    Loretan, Stefan; Duvoisin, Bernard; Scolozzi, Paolo

    2011-05-01

    Petrositis is a rare and severe complication of acute otitis media and mastoiditis. Although the extension of the inflammatory process from the petrous apex to the adjacent Meckel cave can lead to trigeminal pain, an irritation of the trigeminal nerve roots resulting in acute or chronic hyperactivity of masticatory muscles has never been reported. We report here the unusual case of an 86-year-old man who presented with a handicapping myofascial pain and dysfunction syndrome of the right temporal muscle as a heralding manifestation of an unusual form of petrositis. The patient progressively developed a retropharyngeal abscess, a right sphenoid sinusitis, and fatal meningitis. This case demonstrated that (1) myofascial pain and dysfunction syndrome that does not respond to conventional treatments may suggest an unusual etiology and warrant further medical investigations and a detailed medical history and that (2) petrositis can manifest itself with atypical clinical symptoms and radiologic signs.

  14. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

    Directory of Open Access Journals (Sweden)

    Wensing Michel

    2011-06-01

    Full Text Available Abstract Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. Methods An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72 for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ was used to test for association between variables. Results MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active

  15. Mechanism of Chronic Pain in Rodent Brain Imaging

    Science.gov (United States)

    Chang, Pei-Ching

    Chronic pain is a significant health problem that greatly impacts the quality of life of individuals and imparts high costs to society. Despite intense research effort in understanding of the mechanism of pain, chronic pain remains a clinical problem that has few effective therapies. The advent of human brain imaging research in recent years has changed the way that chronic pain is viewed. To further extend the use of human brain imaging techniques for better therapies, the adoption of imaging technique onto the animal pain models is essential, in which underlying brain mechanisms can be systematically studied using various combination of imaging and invasive techniques. The general goal of this thesis is to addresses how brain develops and maintains chronic pain in an animal model using fMRI. We demonstrate that nucleus accumbens, the central component of mesolimbic circuitry, is essential in development of chronic pain. To advance our imaging technique, we develop an innovative methodology to carry out fMRI in awake, conscious rat. Using this cutting-edge technique, we show that allodynia is assoicated with shift brain response toward neural circuits associated nucleus accumbens and prefrontal cortex that regulate affective and cognitive component of pain. Taken together, this thesis provides a deeper understanding of how brain mediates pain. It builds on the existing body of knowledge through maximizing the depth of insight into brain imaging of chronic pain.

  16. Role of Alternative Therapies for Chronic Pain Syndromes.

    Science.gov (United States)

    Thomas, Donna-Ann; Maslin, Benjamin; Legler, Aron; Springer, Erin; Asgerally, Abbas; Vadivelu, Nalini

    2016-05-01

    There is increasing interest in the use of complimentary and alternative medicine (CAM) for the treatment of chronic pain. This review examines alternative and complimentary therapies, which can be incorporated as part of a biopsychosocial approach in the treatment of chronic pain syndromes. In the present investigation, literature from articles indexed on PubMed was evaluated including topics of alternative therapies, complimentary therapies, pain psychology, biofeedback therapy, physical exercise therapies, acupuncture, natural and herbal supplements, whole-body cryotherapy, and smartphone technologies in the treatment of chronic pain syndromes. This review highlights the key role of psychology in the treatment of chronic pain. Cognitive behavior therapy appears to be the most impactful while biofeedback therapy has also been shown to be effective for chronic pain. Exercise therapy has been shown to be effective in short-, intermediate-, and long-term pain states. When compared to that in sham controls, acupuncture has shown some benefit for neck pain immediately after the procedure and in the short term and improvement has also been demonstrated in the treatment of headaches. The role of smartphones and whole-body cryotherapy are new modalities and further studies are needed. Recent literature suggests that several alternate therapies could play a role in the treatment of chronic pain, supporting the biopsychosocial model in the treatment of pain states.

  17. A study to determine the efficacy of chiropractic manipulation combined with Kinesio® taping in the treatment of chronic lower back pain

    OpenAIRE

    2012-01-01

    M.Tech. (Chiropractic) Chronic lower back pain is a very common condition affecting 60-80% of the worlds’ population at sometime in their lives. Manual therapy, including chiropractic manipulation, has been proven to be very successful in the treatment of chronic lower back pain and reduction in muscle tension. Although chiropractic treatment alone is effective in the treatment of chronic lower back pain, chiropractors often search for adjunctive modalities to enhance the positive outcomes...

  18. Muscle activation patterns in posttraumatic neck pain

    NARCIS (Netherlands)

    Nederhand, Marcus Johannes

    2003-01-01

    As an important consequence of our research, we question the relevance of the criteria of the WAD injury severity classification system. We showed that the musculoskeletal signs in WAD grade II are not characterized by muscle spasm, (i.e. increase of muscle activity), but rather by a decrease in mus

  19. The efficacy of adhesiolysis on chronic abdominal pain

    DEFF Research Database (Denmark)

    Gerner-Rasmussen, Jonas; Burcharth, Jakob; Gögenur, Ismail

    2015-01-01

    INTRODUCTION: Abdominal adhesions are a frequent reason for chronic abdominal pain. The purpose of this systematic review was to investigate the evidence of performing laparoscopic adhesiolysis as a treatment for patients with chronic abdominal pain. METHODS: Medline, Embase, and The Cochrane Cen...

  20. Classification of chronic orofacial pain using an intravenous diagnostic test

    NARCIS (Netherlands)

    Tjakkes, G. -H. E.; De Bont, L. G. M.; van Wijhe, M.; Stegenga, B.

    2009-01-01

    The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of cond

  1. Chronic pain in children and adolescents: observational studies

    NARCIS (Netherlands)

    C.W. Perquin (Christel)

    2002-01-01

    textabstractIn adults, chronic pain is by most people involved considered to be a serious disorder. Although chronic pain in adults is in general not life-threatening, a considerable amount of literature elucidates the large number of sufferers, the high cost to the person in question and to the soc

  2. Psychosocial assessment and self-management of chronic pain

    NARCIS (Netherlands)

    J.S. Voerman (Jessica)

    2015-01-01

    markdownabstractAbstract Chronic pain is prevalent in both children and adults and has major negative consequences for their daily life, e.g. reduced participation in activities and depressive and anxious feelings. Therefore, it is important to early signal and treat chronic pain. This thesis aimed

  3. EFFECTIVENESS OF MUSCLE ENERGY TECHNIQUE ON PAIN AND CERVICAL RANGE OF MOTION IN PATIENTS WITH MYOFASCIAL PAIN IN UPPER TRAPEZIUS

    Directory of Open Access Journals (Sweden)

    M. Srikanth

    2015-02-01

    Full Text Available Back ground: Myofascial trigger point (MTPt can be defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. MTPt is associated with pain on compression, the pain is typically of a referred type. MTPt symptoms, cause severe discomfort and inability to work. The pain is aggravated with activity or stress. Untreated, chronic cases might lead to symptoms like depression, fatigue and behavioural disturbances. The objective of the study is to examine the effectiveness of MET on pain with VAS and cervical ROM with inch tape method in patients with myofascial pain in upper trapezius. Methods: participants were randomized into intervention group (n =15 and control group (n = 15.The intervention group was given muscle energy technique, ischemic compression and ultrasound. The control group was given only ischemic compression and ultrasound. Ultrasound 1 MHz continuous mode, intensity 1.5W/cm2 for 5 minutes. Home exercises taught to both the groups. This program designed for daily for 1 week. Outcome measures: Pain-VAS, ROM-Inch tape method (cervical lateral flexion. Results: values within the groups were compared by using paired `t` test. According to obtained values, the pre & posttest values of pain and ROM had an significant effect on p-values 0.00 in experimental group. The difference between the pretest and posttest scores of 95% confidence intervals for each outcome variable was reported. Conclusion: After 1 week of intervention protocol, the present study concludes that MET has significant improvement in pain, ROM in intervention group.

  4. Dimensions of "unidimensional" ratings of pain and emotions in patients with chronic musculoskeletal pain.

    Science.gov (United States)

    Huber, Alexa; Suman, Anna Lisa; Rendo, Carmela Anna; Biasi, Giovanni; Marcolongo, Roberto; Carli, Giancarlo

    2007-08-01

    The use of unidimensional scales to measure pain intensity has been criticised because of the multidimensional nature of pain. We conducted multiple linear regression analyses to determine which dimensions of pain--sensory versus affective--predicted scores on unidimensional scales measuring pain intensity and emotions in 109 Italian women suffering from chronic, non-malignant musculoskeletal pain. We then compared the results with earlier findings in two groups of cancer patients suffering from acute post-operative pain and chronic cancer-related pain, respectively. Age, physical capacity and scores on the multidimensional affect and pain survey (MAPS) were used to predict patients' ratings on one visual analogue scale (VAS) and three numerical rating scales (NRS) measuring pain intensity, anxiety and depressed mood. Unidimensional pain intensity ratings were predicted better from sensory than from affective pain predictors, and the affective predictors made no unique contribution (NRS), or only a very small one (VAS). Both sensory and emotional pain aspects were unique predictors of NRS anxiety and depression. Therefore, in contrast to earlier findings in two different types of cancer patients, in subjects affected by chronic non-malignant musculoskeletal pain, the scores on unidimensional pain intensity scales mainly reflect sensory pain dimensions, supporting the discriminant validity of the NRS and VAS used. However, the patients had some difficulty in distinguishing between sensory and emotional information. For this reason, several unidimensional scales to rate pain intensity and emotions separately should be used to obtain a complete picture of the status and needs of any given patient.

  5. Diabetic Muscle Infarction: A Rare Cause of Acute Limb Pain in Dialysis Patients

    OpenAIRE

    De Vlieger, G.; B. Bammens; Claus, F; De Vos, R; Claes, K.

    2013-01-01

    Diabetic muscle infarction is a rare microangiopathic complication occurring in patients with advanced diabetes mellitus. Diabetic patients with chronic kidney disease stage Vd are prone to develop this complication. The presenting symptom is a localized painful swelling of the affected limb. Symptoms usually resolve spontaneously during the following weeks, but frequent relapse can occur and in some cases swelling may lead to compartment syndrome. Biochemical blood analyses show an elevated ...

  6. Chronic pain: the role of learning and brain plasticity.

    Science.gov (United States)

    Mansour, A R; Farmer, M A; Baliki, M N; Apkarian, A Vania

    2014-01-01

    Based on theoretical considerations and recent observations, we argue that continued suffering of chronic pain is critically dependent on the state of motivational and emotional mesolimbic-prefrontal circuitry of the brain. The plastic changes that occur within this circuitry in relation to nociceptive inputs dictate the transition to chronic pain, rendering the pain less somatic and more affective in nature. This theoretical construct is a strong departure from the traditional scientific view of pain, which has focused on encoding and representation of nociceptive signals. We argue that the definition of chronic pain can be recast, within the associative learning and valuation concept, as an inability to extinguish the associated memory trace, implying that supraspinal/cortical manipulations may be a more fruitful venue for adequately modulating suffering and related behavior for chronic pain. We briefly review the evidence generated to date for the proposed model and emphasize that the details of underlying mechanisms remain to be expounded.

  7. Control Beliefs, Coping Efforts, and Adjustment to Chronic Pain.

    Science.gov (United States)

    Jensen, Mark P.; Karoly, Paul

    1991-01-01

    Examined adaptation to chronic pain in 118 patients. Control appraisals, ignoring pain, using coping self-statements, and increasing activities were positively related to psychological functioning. Control appraisals, diverting attention, ignoring pain, and using coping self-statements were positively related to activity level for patients…

  8. Systematic mechanism-orientated approach to chronic pancreatitis pain

    NARCIS (Netherlands)

    Bouwense, S.A.W.; Vries, M. de; Schreuder, L.T.W.; Olesen, S.S.; Frokjaer, J.B.; Drewes, A.M.; Goor, H. van; Wilder-Smith, O.H.G.

    2015-01-01

    Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/

  9. Psychological Processing in Chronic Pain: A Neural Systems Approach

    Science.gov (United States)

    Simons, Laura; Elman, Igor; Borsook, David

    2014-01-01

    Our understanding of chronic pain involves complex brain circuits that include sensory, emotional, cognitive and interoceptive processing. The feed-forward interactions between physical (e.g., trauma) and emotional pain and the consequences of altered psychological status on the expression of pain have made the evaluation and treatment of chronic pain a challenge in the clinic. By understanding the neural circuits involved in psychological processes, a mechanistic approach to the implementation of psychology-based treatments may be better understood. In this review we evaluate some of the principle processes that may be altered as a consequence of chronic pain in the context of localized and integrated neural networks. These changes are ongoing, vary in their magnitude, and their hierarchical manifestations, and may be temporally and sequentially altered by treatments, and all contribute to an overall pain phenotype. Furthermore, we link altered psychological processes to specific evidence-based treatments to put forth a model of pain neuroscience psychology. PMID:24374383

  10. Chiropractic manipulative therapy combined with Kinesio Tape™ versus elastic bandage in treatment of chronic lower back pain

    OpenAIRE

    2014-01-01

    M.Tech. (Chiropractic) Chronic lower back pain (LBP) is considered as one of the most prevalent conditions in our society with 70-85% of the population experiencing pain at some point in their lives and 80% having recurrent episodes. The majority of chronic LBP is treated with conservative care, with spinal manipulation being a treatment modality shown to be beneficial resulting in restoration of normal ranges of movement, decrease of muscle spasm and there is an overall biomechanical chan...

  11. Disability and borderline personality disorder in chronic pain patients

    OpenAIRE

    2010-01-01

    BACKGROUND AND OBJECTIVE: Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients.METHODS: In a consecutive insured sample of male and female chronic pain patients (n=117), who were being initially evaluated by an outpatient pain...

  12. Investigation of Chronic Pain Following Traumatic Brain Injury

    Science.gov (United States)

    2014-03-01

    to those in other chronic pain states such as migraine and fibromyalgia when controlled for co-morbid insomnia, depression and PTSD. The study groups...to be compared for this work include patients with chronic migraine, fibromyalgia , post-traumatic pain post mTBI, asymptomatic individuals post mTBI...migraine, fibromyalgia , post-traumatic pain post mTBI, asymptomatic individuals post mTBI, and normal controls. The understanding of the

  13. A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients.

    Science.gov (United States)

    White, Hillary D; Robinson, Thomas D

    2015-08-01

    Fibromyalgia is a diffuse chronic pain condition that occurs predominantly in women and may be under-reported in men. Symptoms include a loss of feeling of well-being and generalized widespread flu-like muscle aches and pain that fail to resolve due to central sensitization of nociceptive neurons. It has commonalities with a myriad of other chronic pain conditions which include PTSD, "Gulf War Syndrome", and various stress-induced conditions caused, for example, by viral infection, emotional or physical stress, trauma, combat, accident or surgery. It is not understood why some individuals are susceptible to this condition and others are not. White et al., elsewhere in this issue, present a clinical feasibility study designed to test the hypothesis that 1) low or deficient testosterone serum levels are linked to a high risk for an inflamed nociceptive nervous system and resultant chronic pain states, and 2) a testosterone transdermal gel applied once a day by fibromyalgia patients can be an effective therapeutic against chronic pain. Here, a short profile of fibromyalgia is provided along with a brief summary of best practices currently recommended by clinical specialists. The link between testosterone and pain is then discussed, with an overview of scientific studies that lay the foundation for testosterone as a possible important additional therapeutic that has the potential to be safely administered and effective but also avoid the adverse effects of other therapeutics. Finally, novel mechanisms by which testosterone therapy is likely to down-modulate pain signaling are proposed.

  14. Chronic neck pain patients with traumatic or non-traumatic onset

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Juul-Kristensen, Birgit; Boyle, Eleanor

    2017-01-01

    tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index....... The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics...... in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p = 0.005, cranio-cervical flexion test p = 0.007, cervical extensor test p = 0.006) and cervical pressure pain threshold bilateral (p = 0...

  15. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Burns LC

    2015-01-01

    Full Text Available Lindsay C Burns,1–3 Sarah E Ritvo,1 Meaghan K Ferguson,1 Hance Clarke,3–5 Ze’ev Seltzer,3,5 Joel Katz1,3–5 1Department of Psychology, York University, Toronto, ON, Canada; 2Arthritis Research Centre of Canada, Vancouver, BC, Canada; 3Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; 4Department of Anesthesia, University of Toronto, Toronto, ON, Canada; 5Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada Background: Total knee arthroplasty (TKA is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant

  16. Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

    NARCIS (Netherlands)

    van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.

    2013-01-01

    Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain. Design Cross-sectional study. Participants Four hundred and two members of the general Dutch population, with and

  17. Medicines to Treat Muscle Spasms and Pain

    Science.gov (United States)

    ... Reports recommends methocarbamoI or chlorzoxazone . For muscle spasticity :  Baclofen If baclofen does not work well for you, then Consumer Reports recommends tizanidine . Cyclobenzaprine and baclofen are both prescription medicines. Cyclobenzaprine costs $8 to $ ...

  18. Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study

    Directory of Open Access Journals (Sweden)

    Fábio Renovato França

    2010-01-01

    Full Text Available OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA, in individuals with chronic low back pain. DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire, functional disability (Oswestry disability questionnaire, and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU. The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%. RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p<0.001. Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p<0.001, including TrA activation, where relative gains were 48.3% and -5.1%, respectively. CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.

  19. Midgut malrotation with chronic abdominal pain

    Directory of Open Access Journals (Sweden)

    Anil K Wanjari

    2012-01-01

    Full Text Available Abnormalities in midgut rotation occur during the physiological herniation of midgut between the 5 th and 10 th week of gestation. The most significant abnormality is narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period, less commonly midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 17-year-old male patient who presented with 10-year history of nonspecific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following computed tomography of abdomen. The patient was treated with a laparoscopic Ladd′s procedure and at 3 months he was gaining weight and had stopped vomiting. A laparoscopic Ladd′s procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults. Midgut malrotation is a rare congenital anomaly which may present as chronic abdominal pain. Abdominal CT is helpful for diagnosis.

  20. EFFECTS OF MUSCLE ENERGY TECHNIQUE ON PAIN AND DISABILITY IN SUBJECTS WITH SI JOINT DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    Deepali Sharma

    2014-02-01

    Full Text Available Background: Low back pain has become one of the most common, and most difficult medical problems costing $24 billion (1990 for treatment. With the consideration of costs of disability, lost workforce productivity and other related factors, the cost of society rises to $50 billion. In spite of this, disability due to low back pain has continued to rise. Aims and objectives: The incidence of lower back pain in humans parallels the incidence of the common cold, with a lifetime rate approaching 95%.Several attempts have been made to treat the chronic low back pain due to SIJ dysfunction with mobilization, manipulation and other treatment methods. Methodology: 20 men and women were recruited for the study on the basis of Unilateral back pain experiencing around or near sacral sulcus and Positive muscle length tests for piriformis, Erecter Spinae, Quadratus Lumborum. All the subjects were randomly assigned into two groups where Subjects in group A undergone MET and mobilization and Group B was treated only with mobilization of SI joint. Outcome was measured on first day and then after 1 and 2 week from each subjects pain and disability by Visual analogue scale and modified oswestry disability questionnaire (MODI Results: Paired t test was used to analyse the values of VAS and MODI within the group. ANOVA was used for between the analyses of VAS and MODI for both the groups. Conclusion: MET and mobilisation are both effective in treating chronic low back pain due to sacroiliac joint dysfunction

  1. Management of chronic pain in osteoporosis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Paolucci T

    2016-04-01

    Full Text Available Teresa Paolucci,* Vincenzo Maria Saraceni, Giulia Piccinini* Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy *These authors contributed equally to this work Abstract: Osteoporosis (OP is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP. Keywords: physical therapy, exercise, pharmacological treatment, posture and balance

  2. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study.

    Science.gov (United States)

    Itoh, Kazunori; Saito, Shingo; Sahara, Shunsaku; Naitoh, Yuki; Imai, Kenji; Kitakoji, Hiroshi

    2014-04-01

    There is evidence for the efficacy of acupuncture treatment for chronic shoulder pain, but it remains unclear which acupuncture modes are most effective. We compared the effect of trigger point acupuncture (TrP), with that of sham (SH) acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. The participants were 18 patients (15 women, 3 men; aged 42-65 years) with nonradiating shoulder pain for at least 6 months and normal neurological findings. The participants were randomized into two groups, each receiving five treatment sessions. The TrP group received treatment at trigger points for the muscle, while the other group received SH acupuncture treatment on the same muscle. Outcome measures were pain intensity (visual analogue scale, VAS) and shoulder function (Constant-Murley Score: CMS). After treatment, pain intensity between pretreatment and 5 weeks after TrP decreased significantly (pShoulder function also increased significantly between pretreatment and 5 weeks after TrP (pshoulder pain.

  3. Pain-evoked trunk muscle activity changes during fatigue and DOMS

    DEFF Research Database (Denmark)

    Larsen, Lars Henrik; Hirata, Rogerio Pessoto; Graven-Nielsen, Thomas

    2017-01-01

    abdominal and back muscles. RESULTS: In DOMS, peak VAS scores were higher during bilateral control and bilateral saline-induced pain than fatigue (p ...-perturbation Delta-RMS-EMG in back muscles was higher during bilateral pain and lower during unilateral pain (p abdominal Delta-RMS-EMG was not significantly affected. CONCLUSION: Facilitated and attenuated back muscle responses to surface perturbations in bilateral and unilateral LBP, respectively......BACKGROUND: Muscle pain may reorganize trunk muscle activity but interactions with exercise-related muscle fatigue and delayed onset muscle soreness (DOMS) is to be clarified. METHODS: In 19 healthy participants, the trunk muscle activity during 20 multi-directional unpredictable surface...

  4. Effect of experimental chewing on masticatory muscle pain onset

    Directory of Open Access Journals (Sweden)

    Paulo César Rodrigues Conti

    2011-02-01

    Full Text Available OBJECTIVES: To evaluate the effect of a chewing exercise on pain intensity and pressure-pain threshold in patients with myofascial pain. METHODS: Twenty-nine consecutive women diagnosed with myofascial pain (MFP according to the Research Diagnostic Criteria comprised the experimental group and 15 healthy age-matched female were used as controls. Subjects were asked to chew a gum stick for 9 min and to stay at rest for another 9 min afterwards. Pain intensity was rated on a visual analog scale (VAS every 3 min. At 0, 9 and 18 min, the pressure-pain threshold (PPT was measured bilaterally on the masseter and the anterior, medium, and posterior temporalis muscles. RESULTS: Patients with myofascial pain reported increase (76% and no change (24% on the pain intensity measured with the VAS. A reduction of the PPT at all muscular sites after the exercise and a non-significant recovery after rest were also observed. CONCLUSION: The following conclusions can be drawn: 1. there are at least two subtypes of patients with myofascial pain that respond differently to experimental chewing; 2. the chewing protocol had an adequate discriminative ability in distinguishing patients with myofascial pain from healthy controls.

  5. AMELOTEX IN THE TREATMENT OF CHRONIC BACK PAIN SYNDROMES

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    Irina Yuryevna Suvorova

    2010-01-01

    Full Text Available Recently there has been a considerable increase in the number of patients with lingering recurrent and chronic pain syndromes of various origin. Forty-one patients with dorsopathies were examined. Two types of pain were identified; these were vertebrogenic and nonvertebrogenic pains. The appropriateness of this identification was confirmed by instrumental studies. Treatment was performed using a selective nonsteroidal antiinflammatory drug (Amelotex. Pain syndrome relief was noted during the therapy

  6. Effect of two contrasting interventions on upper limb chronic pain and disability

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Andersen, Christoffer H;

    2014-01-01

    BACKGROUND: Chronic pain and disability of the arm, shoulder, and hand severely affect labor market participation. Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain. An alternative strategy could be to increase physical...... work. STUDY DESIGN: Examiner-blinded, parallel-group randomized controlled trial with allocation concealment. SETTING: Slaughterhouses located in Denmark, Europe. METHODS: Sixty-six adults with chronic pain in the shoulder, elbow/forearm, or hand/wrist and work disability were randomly allocated to 10...... weeks of specific resistance training for the shoulder, arm, and hand muscles for 3 x 10 minutes per week, or ergonomic training and education (usual care control group). Pain intensity (average of shoulder, arm, and hand, scale 0 - 10) was the primary outcome, and disability (Work module of DASH...

  7. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome

    OpenAIRE

    2016-01-01

    [Purpose] Patellofemoral pain syndrome is a frequent musculoskeletal disorder, which can result from core muscles instability that can lead to pain and altered dynamic balance. The objective of this study is to assess the effect of core muscle strengthening on pain and dynamic balance in female patients with patellofemoral pain syndrome. [Subjects and Methods] Twenty female patients with age ranging from 16 to 40 years with patellofemoral pain syndrome were divided into study (N=10) and contr...

  8. Comparison between children and adolescents with and without chronic benign pain: consultation rate and pain characteristics

    NARCIS (Netherlands)

    F.C. van Eekelen; C.W. Perquin (Christel); J.A.M. Hunfeld (Joke); A.A.J.M. Hazebroek-Kampschreur (Alice); L.W.A. van Suijlekom-Smit (Lisette); B.W. Koes (Bart); J. Passchier (Jan); J.C. van der Wouden (Hans)

    2002-01-01

    textabstractThe aim of the study was to determine whether children with chronic benign pain are in contact with their general practitioner (GP) more frequently than those without chronic benign pain. A random sample of children and adolescents aged between 0 and 18 years of age was

  9. Could stress contribute to pain-related fear in chronic pain?

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    Sigrid eElsenbruch

    2015-12-01

    Full Text Available Learning to predict pain based on internal or external cues constitutes a fundamental and highly adaptive process aimed at self-protection. Pain-related fear is an essential component of this response, which is formed by associative and instrumental learning processes. In chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to symptom chronicity. Pavlovian fear conditioning has proven fruitful to elucidate associative learning and extinction involving aversive stimuli, including pain, but studies in chronic pain remain scarce. Stress demonstrably exerts differential effects on emotional learning and memory processes, but this has not been transferred to pain-related fear. Within this perspective, we propose that stress could contribute to impaired pain-related associative learning and extinction processes and call for interdisciplinary research. Specifically, we suggest to test the hypotheses that (1 extinction-related phenomena inducing a re-activation of maladaptive pain-related fear (e.g., reinstatement, renewal likely occur in everyday life of chronic pain patients and may alter pain processing, impair perceptual discrimination and favour overgeneralization; (2 acute stress prior to or during acquisition of pain-related fear may facilitate the formation and/or consolidation of pain-related fear memories, (3 stress during or after extinction may impair extinction efficacy resulting in greater reinstatement or context-dependent renewal of pain-related fear; and (4 these effects could be amplified by chronic stress due to early adversity and/or psychiatric comorbidity such as depression or anxiety in patients with chronic pain.

  10. Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain

    Science.gov (United States)

    Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H. R.; Weiss, Thomas

    2016-01-01

    Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients’ current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation. PMID:27517967

  11. Effect of the spacing of backpack shoulder straps on cervical muscle activity, acromion and scapular position, and upper trapezius pain.

    Science.gov (United States)

    Kim, Min-Hee; Yoo, Won-Gyu

    2013-06-01

    [Purpose] This study investigated the effect of the spacing of backpack shoulder straps on cervical muscle activity, acromion and scapular position, and upper trapezius (UT) pain. [Subjects] Fourteen males aged 20-32 years, were recruited. [Methods] We measured the MPS (midcervical paraspinal) activity, acromial angle, scapular distance, and UT pain after gait carrying a backpack with different shoulder strap spacings. [Results] The MPS, scapular inferior distance, and UT pressure pain threshold was significantly decreased and the acromion angle was significantly increased when carrying a backpack with wide shoulder straps compared to narrow shoulder straps. [Conclusion] A backpack with wide shoulder straps may cause scapular depression syndrome and chronic UT pain.

  12. Emerging roles of microRNAs in chronic pain.

    Science.gov (United States)

    Sakai, Atsushi; Suzuki, Hidenori

    2014-11-01

    Chronic pain is a debilitating syndrome caused by a variety of disorders, and represents a major clinical problem because of the lack of adequate medication. In chronic pain, massive changes in gene expression are observed in a variety of cells, including neurons and glia, in the overall somatosensory system from the sensory ganglia to the higher central nervous system. The protein expressions of hundreds of genes are thought to be post-transcriptionally regulated by a single type of microRNA in a sequence-specific manner. Recently, critical roles of microRNAs in the pathophysiology of chronic pain have been emerging. Genome-wide screenings of microRNA expression changes have been reported in a variety of painful conditions, including peripheral nerve injury, inflammatory diseases, cancer and spinal cord injury. The data obtained suggest that a wide range of microRNAs change their expressions in individual pain conditions, although the pathological significance of individual microRNAs as causal mediators in distinct pain conditions remains to be revealed for a limited number of microRNAs. Insights into the roles of microRNAs in chronic pain will enhance our understanding of the pathophysiology of chronic pain and allow prompt therapeutic application of microRNA-related drugs against intractable persistent pain.

  13. Psychological Neuromodulatory Treatments for Young People with Chronic Pain

    Directory of Open Access Journals (Sweden)

    Jordi Miró

    2016-12-01

    Full Text Available The treatment of young people with chronic pain is a complex endeavor. Many of these youth do not obtain adequate relief from available interventions. Psychological neuromodulatory treatments have been shown to have potential benefit for adults with chronic pain. Here, we review and summarize the available information about the efficacy of three promising psychological neuromodulatory treatments—neurofeedback, meditation and hypnosis—when provided to young people with chronic pain. A total of 16 articles were identified and reviewed. The findings from these studies show that hypnotic treatments are effective in reducing pain intensity for a variety of pediatric chronic pain problems, although research suggests variability in outcomes as a function of the specific pain problem treated. There are too few studies evaluating the efficacy of neurofeedback or meditation training in young people with chronic pain to draw firm conclusions regarding their efficacy. However, preliminary data indicate that these treatments could potentially have positive effects on a variety of outcomes (e.g., pain intensity, frequency of pain episodes, physical and psychological function, at least in the short term. Clinical trials are needed to evaluate the effects of neurofeedback and meditation training, and research is needed to identify the moderators of treatment benefits as well as better understand the mechanisms underlying the efficacy of all three of these treatments. The findings from such research could enhance overall treatment efficacy by: (1 providing an empirical basis for better patient-treatment matching; and (2 identifying specific mechanisms that could be targeted with treatment.

  14. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

    Directory of Open Access Journals (Sweden)

    Pampati Vidyasagar

    2004-05-01

    Full Text Available Abstract Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine, in accordance with the criteria established by the International Association for the Study of Pain (IASP. The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%, with thoracic spine pain was 42% (95% CI, 30% – 53%, and in with lumbar spine pain was 31% (95% CI, 27% – 36%. The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72% in the cervical spine, 55% (95% CI, 39% – 78% in the thoracic spine, and 27% (95% CI, 22% – 32% in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.

  15. Improvement and care seeking for temporomandibular-pain complaints: The complexity of chronic pain

    NARCIS (Netherlands)

    Rollman, A.

    2013-01-01

    "Temporomandibular disorders" (TMD) is a collective term used to describe a group of musculoskeletal conditions occurring in the temporomandibular region. TMD shares features with other chronic musculoskeletal syndromes (such as low back pain and neck pain) including pain, limited range of motion an

  16. Multiple faces of pain : effects of chronic pain on the brain regulation of facial expression

    NARCIS (Netherlands)

    Vachon-Presseau, Etienne; Roy, Mathieu; Woo, Choong-Wan; Kunz, Miriam; Martel, Marc-Olivier; Sullivan, Michael J.; Jackson, Philip L.; Wager, Tor D.; Rainville, Pierre

    2016-01-01

    Pain behaviors are shaped by social demands and learning processes, and chronic pain has been previously suggested to affect their meaning. In this study, we combined functional magnetic resonance imaging with in-scanner video recording during thermal pain stimulations and use multilevel mediation a

  17. MECHANISMS OF CHRONIC PAIN AT OSTEOARTHROSIS OF THE KNEE

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    E. F. Turovskaya

    2014-01-01

    Full Text Available The main symptom of osteoarthritis (OA is pain. Mechanisms of chronic pain in OA have not been fully investigated yet.Objective: to study key mechanisms of chronic pain in patients with knee OA.Subjects and methods. Authors examined 80 women aged 45–65 years, with chronic pain due to OA of the knee. Clinical rheumatologic and neurologic examinations, screening for neuropathic pain (PainDETECT and DN4 questionnaires, estimation of duration and intensity of pain, WOMAC assessment and evaluation of affective disorders (HADS questionnaire were performed. X-ray and ultrasonography were used to assess destructive changes of theknee.Results. According to DN4 questionnaire, 25 (30% patients scored 4 and more, i. e. had signs of neuropathic pain, whereas 55 (70% did not (scored less than 4. Although neurologic examination did not reveal lesions of somatosensory system in neither of groups, assessment of the pain sensitivity showed hyperalgesia in 60% of cases. Patients with signs of neuropathic pain typically have secondary hyperalgesia propagating far from the damaged joint.Conclusion. 30% of patients with osteoarthritis have pain of different intensity determined by nociceptive and neuropathic mechanisms. At the same time the absence of lesions of somatosensory system does not let us to consider the pain neuropathic and indicates that it has dysfunctional nature. Signs of neuropathic pain associated with secondary hyperalgesia may be a clinical symptom of central sensitization. Due to this fact, reasonable therapy of osteoarthritis-associated chronic pain should include, besides NSAIDs, central acting drugs for neuropathic pain treatment.

  18. The effect of fear of movement on muscle activation in posttraumatic neck pain disability

    NARCIS (Netherlands)

    Nederhand, Marc J.; Hermens, Hermie J.; IJzerman, Maarten J.; Groothuis, Karin G.M.; Turk, Dennis C.

    2006-01-01

    Studies using surface electromyography have demonstrated a reorganization of muscle activation patterns of the neck and shoulder muscles in patients with posttraumatic neck pain disability. The neurophysiologically oriented "pain adaptation" model explains this reorganization as a useful adaptation

  19. Molecular Signatures of Chronic Pain Subtypes

    Science.gov (United States)

    2013-01-01

    problematic; patients experience not only nociceptive pain but also acute neuralgia and occasion- ally the immediate onset of phantom limb pain .8...post-thoracotomy pain have been initiated preoperatively.69 This preemptive effect is designed to reduce nociceptive traffic to the spinal cord and... nociceptive and inflammatory pain and has been linked to temporomandibular joint pain syndromes [50]. Even studies of COMT, however, have demonstrated

  20. Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome.

    Science.gov (United States)

    Arora, Hans C; Eng, Charis; Shoskes, Daniel A

    2017-01-01

    Analysis of the human microbiome continues to reveal new and previously unrealized associations between microbial dysbiosis and disease. Novel approaches to bacterial identification using culture-independent methods allow practitioners to discern the presence of alterations in the taxa and diversity of the microbiome and identify correlations with disease processes. While some of these diseases that have been extensively studied are well-defined in their etiology and treatment methods (colorectal cancer), others have provided much more significant challenges in both diagnosis and treatment. One such condition, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), has several etiological and potentiating contributions from infection, inflammation, central nervous system (CNS) changes, stress, and central sensitization-all factors that play important roles in the crosstalk between the human body and its microbiome. No singular cause of CP/CPPS has been identified and it is most likely a syndrome with multifactorial causes. This heterogeneity and ambiguity are sources of significant frustration for patients and providers alike. Despite multiple attempts, treatment of chronic prostatitis with monotherapy has seen limited success, which is thought to be due to its heterogeneous nature. Phenotypic approaches to both classify the disease and direct treatment for CP/CPPS have proven beneficial in these patients, but questions still remain regarding etiology. Newer microbiome research has found correlations between symptom scores and disease severity and the degree of dysbiosis in urine and gut (stool) microbiomes in these patients as compared to un-afflicted controls. These findings present potential new diagnostic and therapeutic targets in CP/CPPS patients.

  1. Somatic focus/awareness: Relationship to negative affect and pain in chronic pain patients

    OpenAIRE

    O’Brien, Erin M; Atchison, James W.; Gremillion, Henry A.; Waxenberg, Lori B.; Robinson, Michael E.

    2007-01-01

    Somatic focus refers to the tendency to notice and report physical symptoms, and has been investigated in relation to chronically painful conditions. This study investigated the relationship between somatic focus, as measured by the Pennebaker Inventory of Limbic Languidness (PILL), negative affect and pain. A secondary purpose of the present study was to examine sex differences in these relationships. Participants included 280 chronic pain patients (69.6% females, 88.9% Caucasian), who compl...

  2. Pharmacological treatment of chronic non-cancer pain in pediatric patients.

    Science.gov (United States)

    Mathew, Eapen; Kim, Eugene; Goldschneider, Kenneth R

    2014-12-01

    Chronic pain in children and young adults occurs frequently and contributes to early disability as well as personal and familial distress. A biopsychosocial approach to evaluation and treatment is recommended. Within this approach, there is a role for pharmacologic intervention. A variety of medications are used for chronic pain conditions in pediatric patients. Medication classes include anticonvulsants, muscle relaxants, antidepressants, opioids, local anesthetics, and anti-inflammatory drugs. Data is sparse, and most medications are used without condition-specific approval by national regulatory agencies such as the Food and Drug Administration in the US and the European Medicines Agency. In the absence of evidence on which to base practice, optimal drug therapy decisions rest on understanding proposed mechanisms of pain conditions, extrapolation from adult data-when such exists, and empirical and experiential knowledge. Drug delivery systems have evolved, and practitioners have to decide amongst not only medication classes, but also routes of delivery. Opioids are not recommended for use by non-pain specialists for the treatment of pediatric chronic pain, and even then the issues are more complex than can be addressed here. This article reviews the major medications used for pediatric chronic pain conditions.

  3. Validity of electrical stimulus magnitude matching in chronic pain

    DEFF Research Database (Denmark)

    Persson, Ann L; Westermark, Sofia; Merrick, Daniel

    2009-01-01

    OBJECTIVE: To examine the validity of the PainMatcher in chronic pain. DESIGN: Comparison of parallel pain estimates from visual analogue scales with electrical stimulus magnitude matching. PATIENTS: Thirty-one patients with chronic musculoskeletal pain. METHODS: Twice a day ongoing pain was rated...... on a standard 100-mm visual analogue scale, and thereafter magnitude matching was performed using a PainMatcher. The sensory threshold to electrical stimulation was tested twice on separate occasions. RESULTS: In 438 observations visual analogue scale ranged from 3 to 95 (median 41) mm, and Pain......Matcher magnitudes from 2.67 to 27.67 (median 6.67; mean 7.78) steps. There was little correlation between visual analogue scale and magnitude data (r = 0.29; p

  4. Temperament traits and chronic pain: the association of harm avoidance and pain-related anxiety.

    Directory of Open Access Journals (Sweden)

    Peter Knaster

    Full Text Available OBJECTIVE: Anxiety symptoms are common in chronic pain patients. High levels of anxiety are associated with increased pain experience and disability. Proneness to anxiety has a large interindividual variation. The aim of the study was to determine whether the anxiety-related temperament trait Harm Avoidance (HA, is associated with pain-related anxiety. METHODS: One hundred chronic pain patients in a multidisciplinary pain clinic participated in the study. The patients were assessed using the HA scale of the Temperament and Character Inventory (TCI of Cloninger and Pain Anxiety Symptoms Scale-20 (PASS-20. Both the HA total score and the four subscales of HA were analyzed. Current pain intensity was measured using the Visual Analogue Scale (VAS. The Beck Depression Inventory (BDI was used to control for the influence of depression on the personality measurement. RESULTS: The HA total score was associated with PASS-20, but the association became non-significant after controlling for depression. The HA4 Fatigability subscale was associated with the PASS scales. Depression did not influence this association. Pain intensity was not correlated with HA or the PASS scales. However, the association between HA4 Fatigability and PASS was influenced by pain intensity. Higher pain intensity was associated with stronger association between the scales. CONCLUSION: Harm Avoidance, representing temperament and trait-related anxiety, has relevance in pain-related anxiety. Assessing personality and temperament may deepen the clinician's understanding of the pain experience and behavior in chronic pain patients.

  5. Rare Case of Complete Fatty Degeneration of the Paraspinal Muscle in a Patient with Low Back Pain

    Directory of Open Access Journals (Sweden)

    Ibrahim Atci

    2014-12-01

    Full Text Available The ethiopathogenesis of low back pain cannot always be demonstrated and sometimes clinicians cannot establish a relationship between clinical symptoms and radiological examinations. Clinicians tend to focus on vertebral body, intervertebral discs, and facet joints on imaging in low back pain. However, the paravertebral muscles that play an important role in lumbar spine stabilization should not be underestimated on imaging. The increase in the amount of fat deposited in the lumbar region and the reduction of muscle mass are macroscopic findings of muscle degeneration. In this case report, we present a patient with chronic low back pain who had been reported to have no pathological findings except 2 levels of bulging on previous imaging and who was then diagnosed as having complete fatty degeneration and atrophy of the paravertebral muscles after reevaluation of her imaging results.

  6. Reorganized trunk muscle activity during multidirectional floor perturbations after experimental low back pain

    DEFF Research Database (Denmark)

    Larsen, Lars Henrik; Hirata, Rogerio Pessoto; Graven-Nielsen, Thomas

    2016-01-01

    each perturbation was extracted and averaged across perturbations. The difference (ΔRMS-EMG) and absolute difference (absolute ΔRMS-EMG) RMS from baseline conditions were extracted for each muscle during pain conditions and averaged bilaterally for back and abdominal muscle groups. Bilateral compared...... with unilateral pain induced higher VAS scores (P muscle activity during unilateral (P abdominal...... (P muscles during bilateral and decreased in the back (P abdominal (P muscles during unilateral pain. Bilateral pain caused greater absolute ΔRMS-EMG changes in the back (P abdominal (P muscle groups than unilateral pain. PERSPECTIVE: This study provided...

  7. Update on managing chronic pain in the elderly.

    Science.gov (United States)

    Malanga, Gerard; Paster, Zorba

    2007-12-01

    People aged 65 years and over make up the fastest growing demographic in the United States. By the year 2040 they will comprise approximately one fourth of the US population. The elderly patient in need of chronic pain therapy presents challenges best met with an enlightened and effective treatment strategy. Practice standards must include a thorough pain assessment and formation of a multimodal care plan, which applies knowledge of pain management in an objective and scientific manner. In this article, a patient case study illustrates how the appropriate management of chronic pain in an elderly patient can lead to better clinical outcomes.

  8. The persistence of pain behaviors in patients with chronic back pain is independent of pain and psychological factors.

    Science.gov (United States)

    Martel, M O; Thibault, P; Sullivan, M J L

    2010-11-01

    The primary purpose of the present study was to examine the temporal stability of communicative and protective pain behaviors in patients with chronic back pain. The study also examined whether the stability of pain behaviors could be accounted for by patients' levels of pain severity, catastrophizing, or fear of movement. Patients (n=70) were filmed on two separate occasions (i.e., baseline, follow-up) while performing a standardized lifting task designed to elicit pain behaviors. Consistent with previous studies, the results provided evidence for the stability of pain behaviors in patients with chronic pain. The analyses indicated that communicative and protective pain behavior scores did not change significantly from baseline to follow-up. In addition, significant test-retest correlations were found between baseline and follow-up pain behavior scores. The results of hierarchical multiple regression analyses further showed that pain behaviors remained stable over time even when accounting for patients' levels of pain severity. Regression analyses also showed that pain behaviors remained stable when accounting for patients' levels of catastrophizing and fear of movement. Discussion addresses the potential contribution of central neural mechanisms and social environmental reinforcement contingencies to the stability of pain behaviors. The discussion also addresses how treatment interventions specifically aimed at targeting pain behaviors might help to augment the overall impact of pain and disability management programs.

  9. Muscle impingement: MR imaging of a painful complication of osteochondromas

    Energy Technology Data Exchange (ETDEWEB)

    Uri, D.S. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Dalinka, M.K. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Kneeland, J.B. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States)

    1996-10-01

    The purpose of this study was to describe the magnetic resonance (MR) appearance of a newly recognized complication of osteochondromas. Two patients presented with pain and swelling over known osteochondromas. Plain radiographic studies were unrevealing. MR examinations were obtained to characterize the exostoses further and evaluate areas of palpable fullness. Increased signal was present in the muscles on T2-weighted images, which correlated with physical findings and was believed to represent muscle injury due to the osteochondroma. Pain and fullness may result from a number of osteochondroma-related complications, the most worrisome of which is malignant degeneration. Muscular impingement and injury should be considered in the differential diagnosis of pain and swelling in the region of an exostosis. MR imaging allows distinction of this entity, which may be radiographically occult and confused clinically with fracture, bursitis, or malignant degeneration. (orig.). With 2 figs.

  10. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

    DEFF Research Database (Denmark)

    Kronborg, Christian; Handberg, Gitte; Axelsen, Flemming

    2009-01-01

    This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs...... before pain onset. The majority of chronic pain patients incur the costs of alternative treatments. Chronic pain causes production losses at work, as well as impairment of non-work activities....

  11. Duloxetine in the management of chronic musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Smith EJ

    2012-06-01

    Full Text Available Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.Keywords: pain, musculoskeletal, duloxetine, osteoarthritis, low back, serotonin-norepinephrine reuptake inhibitor

  12. Estimating the prevalence of chronic pain: validation of recall against longitudinal reporting (the HUNT pain study).

    Science.gov (United States)

    Landmark, Tormod; Romundstad, Pål; Dale, Ola; Borchgrevink, Petter C; Kaasa, Stein

    2012-07-01

    Methods for classifying chronic pain in population studies are highly variable, and prevalence estimates ranges from 11% to 64%. Limited knowledge about the persistence of pain and the validity of recall questions defining chronic pain make findings difficult to interpret and compare. The primary aim of the current study was to characterize the persistence of pain in the general population and to validate recall measures against longitudinal reporting of pain. A random sample of 6419 participants from a population study (the HUNT 3 study in Norway) was invited to report pain on the SF-8 verbal pain rating scale every 3 months over a 12-month period and to report pain lasting more than 6 months at 12-month follow-up. Complete data were obtained from 3364 participants. Pain reporting was highly stable (intraclass correlation 0.66, 95% confidence interval 0.65 to 0.67), and the prevalence of chronic pain varied considerably according to level of severity and persistence: 31% reported mild pain or more, whereas 2% reported severe pain on 4 of 4 consecutive measurements. When defined as moderate pain or more on at least 3 of 4 consecutive measurements, the prevalence was 26%. Compared with the longitudinal classification, a cross-sectional measure of moderate pain or more during the last week on the SF-8 scale presented a sensitivity of 82% and a specificity of 84%, and a sensitivity of 80% and a specificity of 90% when combined with a 6-month recall question. Thus pain reporting in the general population is stable and cross-sectional measures may give valid prevalence estimates of chronic pain.

  13. Neuropathic pain as part of chronic widespread pain: environmental and genetic influences

    OpenAIRE

    Momi, Sukhleen K.; Fabiane, Stella Maris; Lachance, Genevieve; Livshits, Gregory; Williams, Frances M. K.

    2015-01-01

    Abstract Chronic widespread pain (CWP) has complex aetiology and forms part of the fibromyalgia syndrome. Recent evidence suggests a higher frequency of neuropathic pain features in those with CWP than previously thought. The aim of this study was to determine the prevalence of neuropathic pain features in individuals with CWP and to estimate the influence of genetic and environmental factors on neuropathic pain in CWP. Validated questionnaires (the London Fibromyalgia Screening Study questio...

  14. Effects of coping statements on experimental pain in chronic pain patients

    OpenAIRE

    Daniela Roditi; Robinson, Michael E.; Nola Litwins

    2009-01-01

    Daniela Roditi, Michael E Robinson, Nola LitwinsDepartment of Clinical and Health Psychology, University of Florida, Gainesville, FL, USAAbstract: The present study measured the effects of catastrophizing self-statements and positive coping self-statements on cold pressor-induced pain. Participants were 58 adult chronic pain patients with current facial pain. It was hypothesized that catastrophizing would lead to a decrease in pain endurance whereas positive coping would lead to an increase i...

  15. Chronic pain and quality of life in schizophrenic patients

    Directory of Open Access Journals (Sweden)

    Jouce Gabriela de Almeida

    2013-03-01

    Full Text Available OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia. Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001. There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. Conclusion: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.

  16. Psychological therapies for the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Sturgeon JA

    2014-04-01

    Full Text Available John A Sturgeon Department of Anesthesiology, Stanford University, Palo Alto, CA, USA Abstract: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed. Keywords: pain management, multidisciplinary pain treatment, psychological therapy

  17. Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder.

    Science.gov (United States)

    Katz, Joel; Rosenbloom, Brittany N; Fashler, Samantha

    2015-04-01

    Unlike acute pain that warns us of injury or disease, chronic or persistent pain serves no adaptive purpose. Though there is no agreed on definition of chronic pain, it is commonly referred to as pain that is without biological value, lasting longer than the typical healing time, not responsive to treatments based on specific remedies, and of a duration greater than 6 months. Chronic pain that is severe and intractable has detrimental consequences, including psychological distress, job loss, social isolation, and, not surprisingly, it is highly comorbid with depression and anxiety. Historically, pain without an apparent anatomical or neurophysiological origin was labelled as psychopathological. This approach is damaging to the patient and provider alike. It pollutes the therapeutic relationship by introducing an element of mutual distrust as well as implicit, if not explicit, blame. It is demoralizing to the patient who feels at fault, disbelieved, and alone. Moreover, many medically unexplained pains are now understood to involve an interplay between peripheral and central neurophysiological mechanisms that have gone awry. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, somatic symptom disorder overpsychologizes people with chronic pain; it has low sensitivity and specificity, and it contributes to misdiagnosis, as well as unnecessary stigma. Adjustment disorder remains the most appropriate, accurate, and acceptable diagnosis for people who are overly concerned about their pain.

  18. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life

    NARCIS (Netherlands)

    Renzenbrink, Gerbert J.; IJzerman, Maarten J.

    2004-01-01

    Objective: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Design: Prospective, open label design. Setting: The outpatient services of a large teachin

  19. Clinical study of acute and chronic pain after temporal craniotomy

    Directory of Open Access Journals (Sweden)

    WANG Cheng-wei

    2013-10-01

    Full Text Available Objective To investigate the correlation of chronic pain after surgery and acute pain within 48 h after temporal craniotomy. Methods One hundred and seventy-six patients who underwent surgery through temporal approach were divided into 3 groups and treated with morphine 30 mg (Group M, N = 57, tramadol 1000 mg (Group T, N = 60 and morphine 20 mg + flurbiprofen 200 mg (Group F, N = 59 by patient-controlled intravenous analgesia (PCIA. Postoperative acute pain (resting and movement was evaluated by Visual Analogue Scale (VAS at 4, 16, 24 and 48 h respectively. Chronic pain was measured by Short-Form McGill Pain Questionnaire (SF-MPQ 3 months after surgery. The characteristics of acute and chronic pain, the relationship between them and analgesic effect of 3 kinds of analgesic drugs were analyzed. Results The differences of observed indicators including gender, age, weight and operating time, which might affect the degree of postoperative pain between before and after surgery were not statistically significant (P > 0.05. VAS scores at different time points within 48 h after surgery in each group decreased gradually. The VAS scores in group T (2.91 ± 1.64 was significantly higher than group M (2.19 ± 1.68 and group F (1.71 ± 1.17, P 0.05. The overall incidence rate of chronic pain was 71.02% (125/176, with moderate and severe pain in 15.91% (28/176. Chronic pain and acute postoperative pain severity were positively correlated (resting: rs = 0.171, P = 0.012; movement: rs = 0.190, P = 0.006. The difference of the acute pain (VAS corresponding to SF-MPQ Ⅱ score > 0 and SF-MPQ Ⅱ score = 0 was statistically significant (P < 0.05. Conclusion The postoperative chronic pain following temporal craniotomy is related to acute pain within 48 h after operation. Effective treatment of early postoperative acute pain may reduce the incidence of chronic pain.

  20. Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculuskeletal pain patients with high pain sensitivity

    DEFF Research Database (Denmark)

    Vægter, Henrik Bjarke; Handberg, Gitte; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: In chronic pain patients, impaired conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) have been reported. No studies have compared CPM and EIH in chronic musculoskeletal pain patients with high pain sensitivity (HPS) and low pain sensitivity (LPS). MATERIALS.......005). Pain tolerance increased after the cold pressor test and exercise in both groups (PCPM and EIH were partly impaired in chronic pain patients with high versus less pain sensitivity, suggesting that the CPM and EIH responses depend on the degree of pain sensitivity. This has clinical...

  1. Depressive symptoms and pain evaluations among persons with chronic pain: catastrophizing, but not pain acceptance, shows significant effects.

    Science.gov (United States)

    Richardson, Elizabeth J; Ness, Timothy J; Doleys, Daniel M; Baños, James H; Cianfrini, Leanne; Richards, J Scott

    2009-12-15

    Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one's acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self-reports of depressive symptoms. Sixty-seven individuals with chronic back pain completed self-report measures of catastrophizing, acceptance, and depressive symptoms. In addition, participants underwent an ischemic pain induction procedure and were asked to rate the induced pain. Catastrophizing showed significant effects on sensory and intensity but not affective ratings of the induced pain. Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self-reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.

  2. Reduced acute nociception and chronic pain in Shank2-/- mice.

    Science.gov (United States)

    Ko, Hyoung-Gon; Oh, Seog-Bae; Zhuo, Min; Kaang, Bong-Kiun

    2016-01-01

    Autism spectrum disorder is a debilitating mental illness and social issue. Autism spectrum disorder patients suffer from social isolation, cognitive deficits, compulsive behavior, and sensory deficits, including hyposensitivity to pain. However, recent studies argued that autism spectrum disorder patients show physiological pain response and, in some cases, even extremely intense pain response to harmless stimulation. Recently, Shank gene family was reported as one of the genetic risk factors of autism spectrum disorder. Thus, in this study, we used Shank2(-) (/) (-) (Shank2 knock-out, KO) mice to investigate the controversial pain sensitivity issue and found that Shank2 KO mice showed reduced tactile perception and analgesia to chronic pain.

  3. [Drug therapy of acute and chronic abdominal pain].

    Science.gov (United States)

    Streitberger, Konrad; Stüber, Frank; Kipfer Buchli, Irène; Stamer, Ulrike M

    2011-08-01

    For drug therapy a differentiation of acute and chronic pain is essential. In emergency situations of acute abdominal pain a fast diagnosis is mandatory. Analgesia should be provided as soon as possible. The different groups of analgesics should be used according to their known effects, side effects and contraindications. Postoperative pain after abdominal surgery has to be considered as a special condition of acute abdominal pain. Main treatment options are non opioid analgesics and opioids. Opioids can be administered intravenously via patient controlled analgesia (PCA) devices. In major abdominal surgery neuroaxial analgesia, preferentially administered via an epidural catheter provides excellent pain relief with positive impact on gastrointestinal motility and patients' recovery. Because of difficulties to allocate chronic abdominal pain to a specific organ, causal treatment often turns out to be difficult. Peripheral and central sensitization, as well as an alteration of the endogenous pain modulation comes to the fore in these chronic pain conditions. Co-analgesics like anticonvulsants and antidepressants are utilized to reduce sensitization and improve the endogenous pain modulating system. Non drug approaches and alternative treatment options might be useful. In contrast, orally or transcutaneously administered opioids are the principal corner stone for the treatment of cancer pain.

  4. High incidence of chronic pain following surgery for pelvic fracture

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Thomsen, Camilla Højland; Rasmussen, Lars Simon

    2006-01-01

    OBJECTIVES: To determine the incidence of chronic pain after surgery for pelvic fracture using a strict definition and measures of intensity and health-related quality of life. METHODS: In April 2004, a questionnaire was sent to 221 patients who underwent surgery for pelvic fracture in the period...... 1996 to 2000. Chronic pain was defined as pain at present that related back to the pelvic fracture and was not a consequence of other disease. Health-related quality of life was measured using the 15D questionnaire. RESULTS: The response rate was 72.9% after a median follow-up of 5.6 years. Chronic...... pain was seen in 48.4% (95% confidence interval, 40.7%-56.2%). These patients had a combination of somatic nociceptive, visceral nociceptive, and neuropathic pain and had significantly lower health-related quality of life. Also, the use of opioids (14.1% vs. 4.8%) and nonsteroidal anti...

  5. Managing chronic pain in older people.

    Science.gov (United States)

    Schofield, Patricia

    This article presents the results of a collaborative project between the British Pain Society and British Geriatric Society to produce guidelines on the management of pain in older adults. The guidelines are the first of their kind in the UK and aim to provide best practice for the management of pain to all health professionals working with older adults in any care setting.

  6. Phenomenology, Hypnosis, and Chronic Pain: Steps for Clinical Understanding

    Directory of Open Access Journals (Sweden)

    Mauricio da Silva Neubern

    2014-04-01

    Full Text Available This paper proposes phenomenological notions of self-image and body schema as an explicative and clinical possibility for the relationship between hypnosis and chronic pain. It begins with a critique of the medical and nomothetic approach taken by contemporary research that does not usually address clinical issues, and then addresses a case study where a person suffering from chronic pain related both body schema and self-image is submitted to hypnotherapy. The study concludes that there is no linear relationship between such notions and that chronic pain is uniquely configured to each person. This requires a clinical and qualitative approach to access and understand chronic pain, both in terms of classic phenomenological notions of time, space, and material experiences, as well as socio-cultural dimensions that contribute to producing feelings related to the daily experiences of the subjects.

  7. A standard for terminology in chronic pelvic pain syndromes

    DEFF Research Database (Denmark)

    Doggweiler, Regula; Whitmore, Kristene E; Meijlink, Jane M

    2016-01-01

    AIMS: Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected...... by chronic pelvic pain syndromes. The standard aims to facilitate research, enhance therapy development and support healthcare delivery, for healthcare providers, and patients. This document looks at the whole person and all the domains (organ systems) in a systematic way. METHODS: A dedicated working group...... for symptoms, signs, and evaluation (diagnostic work-up) of female and male patients with chronic pelvic pain syndromes, serving as a platform for ongoing development in this field. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc....

  8. Meditation as an intervention for chronic pain: an integrative review.

    Science.gov (United States)

    Teixeira, M Elizabeth

    2008-01-01

    Chronic pain is a complex phenomenon that causes a significant disruption in the lives of those affected. Chronic pain is difficult to treat and challenges healthcare professionals' abilities to implement effective treatments. Therefore, chronic pain sufferers often seek complementary alternative medicine therapies such as meditation. Literature reviews have examined studies using mindfulness-based stress reduction program as an intervention for a variety of health problems. However, no reviews exist looking at a specific patient population's utilization of meditation-based programs. Therefore, the purpose of this integrative review is to examine studies that have investigated meditation as an intervention for chronic pain, identify gaps in the literature, and make recommendations for further research.

  9. Chronic Pain and PTSD: A Guide for Patients

    Science.gov (United States)

    ... standing in line at a grocery store, going shopping, or working. Many patients with chronic pain cannot ... Treatment can turn your life around. PTSD Coach Online Tools to help you manage stress. Search Pilots ...

  10. [18F]FDG PET/MRI of patients with chronic pain alters management: early experience

    Energy Technology Data Exchange (ETDEWEB)

    Biswal, Sandip; Behera, Deepak; Yoon, Dae Hyun; Holley, Dawn; Ith, Ma Agnes Martinez; Carroll, Ian; Smuck, Matthew; Hargreaves, Brian [Stanford University School of Medicine, California (United States)

    2015-05-18

    The chronic pain sufferer is currently faced with a lack of objective tools to identify the source of their pain. The overarching goal is to develop clinical [18F]FDG PET/MRI methods to more accurately localize sites of increased neuronal and muscular metabolism or inflammation as it relates to neurogenic sources of pain and to ultimately improve outcomes of chronic pain sufferers. The aims are to 1) correlate imaging findings with location of pain symptomology, 2) predict location of symptoms based on imaging findings alone and 3) to determine whether the imaging results affect current management decisions. Six patients suffering from chronic lower extremity neuropathic pain (4 complex regional pain syndrome, 1 chronic sciatica and 1 neuropathic pain) have been imaged with a PET/MRI system (time-of-flight PET; 3.0T bore) from mid thorax through the feet. All patients underwent PET/MR imaging one hour after a injection of 10mCi [18F]FDG. Two radiologists evaluated PET/MR images (one blinded and the other unblinded to patient exam/history). ROI analysis showed focal increased [18F]FDG uptake in affected nerves and muscle (approx 2-4 times more) over background tissue in various regions of the body in 5 of 6 patients at the site of greatest pain symptoms and other areas of the body (SUVmax of Target 0.9-4.2 vs. Background 0.2-1.2). The radiologist blind to the patient history/exam was able to correctly identify side/location of the symptoms in 5 out of 6 patients. Imaging results were reviewed with the referring physician, who then determined whether a modification in the management plan was needed: 1/6 no change, 2/6 mild modification (e.g., additional diagnostic test ordered) and 3/6 significant modification.

  11. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries opioids are increasingly used for treatment of chronic non-malignant pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria...... patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid...... are concerned with the fact that pain may be under treated because of fear of addiction, and the guidelines in management of non-malignant pain patients include warnings of addiction. According to the literature, it seems appropriate and necessary to be aware of the problems associated with addiction during...

  12. Classification of chronic orofacial pain using an intravenous diagnostic test

    OpenAIRE

    Tjakkes, G. -H. E.; de Bont, L. G. M.; Wijhe, M. van; Stegenga, B.

    2009-01-01

    The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of conducted pharmacodiagnostic tests, consisting of the consecutive intravenous administration of drugs. Visual analogue scale scores were retrieved from all patients, based on which they were classified...

  13. Effects of experimentally induced pain and fear of pain on trunk coordination and back muscle activity during walking

    NARCIS (Netherlands)

    Lamoth, Claudine J.C.; Daffertshofer, Andreas; Meijer, Onno G.; Lorimer Moseley, G.; Wuisman, Paul I.J.M.; Beek, Peter J.

    2004-01-01

    Objective. To examine the effects of experimentally induced pain and fear of pain on trunk coordination and erector spinae EMG activity during gait. Design. In 12 healthy subjects, hypertonic saline (acute pain) and isotonic saline (fear of pain) were injected into erector spinae muscle, and unpredi

  14. Effects of experimentally induced pain and fear of pain on trunk coordination and back muscle activity during walking.

    NARCIS (Netherlands)

    Lamoth, C.J.C.; Daffertshofer, A.; Meijer, O.G.; Moseley, G.; Wuisman, P.I.J.M.; Beek, P.J.

    2004-01-01

    OBJECTIVE: To examine the effects of experimentally induced pain and fear of pain on trunk coordination and erector spinae EMG activity during gait. DESIGN: In 12 healthy subjects, hypertonic saline (acute pain) and isotonic saline (fear of pain) were injected into erector spinae muscle, and unpredi

  15. Accuracy of the unassisted pain drawings by patients with chronic pain.

    Science.gov (United States)

    Cummings, G S; Routan, J L

    1987-01-01

    This investigation was conducted to test the accuracy of unassisted pain maps drawn by patients with chronic pain. Three aspects of accuracy were investigated, the accuracy of the area of pain reported, whether all existing pains were reported, and whether related symptoms were reported. Thirty-six successive new admissions to a chronic pain rehabilitation center were used as subjects. Each patient filled out the pain map prior to meeting any professional staff. During their examination the investigators completed a new pain map without seeing the patient's map. Thirty-one pairs of pain maps were compared and scored, with most maps showing several pain areas. Area of pain was accurately represented 43% of the time. Of 139 distinct pains found during examination, only 58% were reported in the pain maps. Thirtyfour percent of related symptoms were reported. It appears that unassisted pain maps are sufficiently flawed to discourage their use as an indicator of the patients symptom location J Orthop Sports Phys Ther 1987;8(8):391-396.

  16. A pilot study using Tissue Velocity Ultrasound Imaging (TVI to assess muscle activity pattern in patients with chronic trapezius myalgia

    Directory of Open Access Journals (Sweden)

    Brodin Lars-Åke

    2008-09-01

    Full Text Available Abstract Background Different research techniques indicate alterations in muscle tissue and in neuromuscular control of aching muscles in patients with chronic localized pain. Ultrasound can be used for analysis of muscle tissue dynamics in clinical practice. Aim This study introduces a new muscle tissue sensitive ultrasound technique in order to provide a new methodology for providing a description of local muscle changes. This method is applied to investigate trapezius muscle tissue response – especially with respect to specific regional deformation and deformation rates – during concentric shoulder elevation in patients with chronic trapezius myalgia and healthy controls before and after pain provocation. Methods Patients with trapezius myalgia and healthy controls were analyzed using an ultrasound system equipped with tissue velocity imaging (TVI. The patients performed a standardized 3-cm concentric shoulder elevation before and after pain provocation/exercise at a standardized elevation tempo (30 bpm. A standardized region of interest (ROI, an ellipsis with a size that captures the upper and lower fascia of the trapezius muscle (4 cm width at rest, was placed in the first frame of the loop registration of the elevation. The ROI was re-anchored frame by frame following the same anatomical landmark in the basal fascia during all frames of the concentric phase. In cardiac measurement, tissue velocities are measured in the axial projection towards and against the probe where red colour represents shortening and red lengthening. In the case of measuring the trapezius muscle, tissue deformation measurements are made orthogonally, thus, indirectly. Based on the assumption of muscle volume incompressibility, blue represents tissue contraction and red relaxation. Within the ROI, two variables were calculated as a function of time: deformation and deformation rate. Hereafter, max, mean, and quadratic mean values (RMS of each variable were

  17. Genitofemoral neuralgia: adding to the burden of chronic vulvar pain

    Directory of Open Access Journals (Sweden)

    Verstraelen H

    2015-11-01

    Full Text Available Hans Verstraelen,1 Eline De Zutter,1 Martine De Muynck2 1Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University Hospital, Ghent, Belgium; 2Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium Abstract: The vulva is a particularly common locus of chronic pain with neuropathic characteristics that occurs in women of any age, though most women with neuropathic type chronic vulvar pain will remain undiagnosed even following multiple physician visits. Here, we report on an exemplary case of a middle-aged woman who was referred to the Vulvovaginal Disease Clinic with debilitating vulvar burning and itching over the right labium majus that had been persisting for 2 years and was considered intractable. Careful history taking and clinical examination, followed by electrophysiological assessment through somatosensory evoked potentials was consistent with genitofemoral neuralgia, for which no obvious cause could be identified. Adequate pain relief was obtained with a serotonin–noradrenaline reuptake inhibitor and topical gabapentin cream. We briefly discuss the epidemiology, diagnosis, and treatment of genitofemoral neuralgia and provide a series of clues to guide clinicians in obtaining a presumptive diagnosis of specific neuropathic pain syndromes that may underlie chronic vulvar pain. We further aim to draw attention to the tremendous burden of chronic, unrecognized vulvar pain. Keywords: vulvar pain, genitofemoral nerve, neuropathic pain, vulvodynia, vulvar disease

  18. A Community Art Therapy Group for Adults with Chronic Pain

    Science.gov (United States)

    O'Neill, Aimee; Moss, Hilary

    2015-01-01

    This paper describes a community art therapy group for people living with chronic pain. Nine adults were offered 12 weekly group art therapy sessions that included art therapy activities such as guided imagery focusing on body scans followed by art responses and artistic expressions of the pain experience. This pilot group art therapy program is…

  19. Validation of the Danish-language chronic pain acceptance questionnaire

    DEFF Research Database (Denmark)

    la Cour, P; Højsted, J

    2015-01-01

    version of the CPAQ. METHODS: A total of 114 patients with chronic pain completed the questionnaire as well as other measures of pain, anxiety, depression, coping, and health-related quality of life. RESULTS: Internal consistency was satisfactory and the factorial analysis yielded a two-factor solution...

  20. Chronic Imperceptible Pain as a Cause of Addiction.

    Science.gov (United States)

    Sullivan, Arthur P.; Guglielmo, Robert

    1985-01-01

    Argues that acute, chronic pain, whether arising from environmental or psychological contexts, is a necessary condition of addiction; conditioning and neurochemical changes are assigned a catalyzing role. Inadequate self-esteem is thought to be a common source of imperceptible pain, and therefore a cause of addiction. (Author/ABL)

  1. Prognosis of chronic or recurrent abdominal pain in children

    NARCIS (Netherlands)

    Gieteling, Marieke J.; Bierma-Zeinstra, Sita M. A.; Passchier, Ban; Berger, Marjolein Y.

    2008-01-01

    Background: Chronic abdominal pain (CAP) or recurrent abdominal pain is common in childhood and is rarely associated with organic disease. With modern diagnostic technology, new organic abnormalities are found in children with CAP. Thus far a causal relation between these abnormalities and CAP has n

  2. Office management of chronic pain in the elderly.

    Science.gov (United States)

    Weiner, Debra K

    2007-04-01

    Chronic pain plagues older adults more than any other age group; thus, practitioners must be able to approach this problem with confidence and skill. This article reviews the assessment and treatment of the most common chronic nonmalignant pain conditions that affect older adults--myofascial pain, generalized osteoarthritis, chronic low back pain (CLBP), fibromyalgia syndrome, and peripheral neuropathy. Specific topics include essential components of the physical examination; how and when to use basic and advanced imaging in older adults with CLBP; a stepped care approach to treating older adults with generalized osteoarthritis and CLBP, including noninvasive and invasive management techniques; how to diagnose and treat myofascial pain; strategies to identify the older adult with fibromyalgia syndrome and avoid unnecessary "diagnostic" testing; pharmacological treatment for the older adult with peripheral neuropathy; identification and treatment of other factors such as dementia and depression that may significantly influence response to pain treatment; and when to refer the patient to a pain specialist. While common, chronic pain is not a normal part of aging, and it should be treated with an emphasis on improved physical function and quality of life.

  3. DNA methylation of SPARC and chronic low back pain

    Directory of Open Access Journals (Sweden)

    Dashwood Thomas

    2011-08-01

    Full Text Available Abstract Background The extracellular matrix protein SPARC (Secreted Protein, Acidic, Rich in Cysteine has been linked to degeneration of the intervertebral discs and chronic low back pain (LBP. In humans, SPARC protein expression is decreased as a function of age and disc degeneration. In mice, inactivation of the SPARC gene results in the development of accelerated age-dependent disc degeneration concurrent with age-dependent behavioral signs of chronic LBP. DNA methylation is the covalent modification of DNA by addition of methyl moieties to cytosines in DNA. DNA methylation plays an important role in programming of gene expression, including in the dynamic regulation of changes in gene expression in response to aging and environmental signals. We tested the hypothesis that DNA methylation down-regulates SPARC expression in chronic LBP in pre-clinical models and in patients with chronic LBP. Results Our data shows that aging mice develop anatomical and behavioral signs of disc degeneration and back pain, decreased SPARC expression and increased methylation of the SPARC promoter. In parallel, we show that human subjects with back pain exhibit signs of disc degeneration and increased methylation of the SPARC promoter. Methylation of either the human or mouse SPARC promoter silences its activity in transient transfection assays. Conclusions This study provides the first evidence that DNA methylation of a single gene plays a role in chronic pain in humans and animal models. This has important implications for understanding the mechanisms involved in chronic pain and for pain therapy.

  4. Sleep patterns in female adolescents with chronic musculoskeletal pain.

    Science.gov (United States)

    Meltzer, Lisa J; Logan, Deirdre E; Mindell, Jodi A

    2005-01-01

    This study examined sleep patterns in female adolescents with chronic musculoskeletal pain. Twenty-six participants with chronic musculoskeletal pain completed questionnaires during their clinic visit, and three 24-Hour Sleep Patterns Interviews during the following 2 weeks. Compared to normative data (Acebo & Carskadon, 2002), adolescents with chronic pain reported similar total sleep time (TST) and bedtimes. However, study participants reported significantly longer sleep onset latency, more night wakings, a later morning wake time, and more symptoms of daytime sleepiness. Pain improved after sleep for 27% of the study sample, and was associated with longer TST. Finally, depression and anxiety were related to daytime sleepiness, but not total sleep time or sleep onset latency. Female adolescents with chronic pain either may be more sensitive to the chronic sleep debt that is common in this age group, or they may experience underlying physiological sleep disrupters (e.g., periodic limb movement disorder) or sleep abnormalities (e.g., alpha-delta intrusions) not measured in this study. Additional research is needed to examine the complex relation between sleep and chronic musculoskeletal pain.

  5. Development of Viral Vectors for Gene Therapy for Chronic Pain

    Directory of Open Access Journals (Sweden)

    Yu Huang

    2011-01-01

    Full Text Available Chronic pain is a major health concern that affects millions of people. There are no adequate long-term therapies for chronic pain sufferers, leading to significant cost for both society and the individual. The most commonly used therapy for chronic pain is the application of opioid analgesics and nonsteroidal anti-inflammatory drugs, but these drugs can lead to addiction and may cause side effects. Further studies of the mechanisms of chronic pain have opened the way for development of new treatment strategies, one of which is gene therapy. The key to gene therapy is selecting safe and highly efficient gene delivery systems that can deliver therapeutic genes to overexpress or suppress relevant targets in specific cell types. Here we review several promising viral vectors that could be applied in gene transfer for the treatment of chronic pain and further discuss the possible mechanisms of genes of interest that could be delivered with viral vectors for the treatment of chronic pain.

  6. Psychiatric disorders and muscle tenderness in episodic and chronic migraine.

    Science.gov (United States)

    Mongini, Franco; Deregibus, Andrea; Rota, Eugenia

    2005-09-01

    This review first reports on the data concerning the relationship between migraine and personality traits and psychiatric disorders. The relationship between migraine and tenderness of the pericranial and cervical muscles is then discussed. In one study, a psychologic assessment was performed in 56 women with migraine, and the Minnesota Multiphase Personality Inventory (MMPI) and State Trait Anxiety Inventory were administered at baseline (T0) and after 6-7 years (T2). Frequency, severity and duration of migraine were recorded at T0, after treatment (T1) and at T2, and their relationship to the prevalence of depression, MMPI and State Trait Anxiety Inventory data were examined. Pain parameters improved in all patients in T0-1, but were higher at T2 in patients with depression at T0. The patients whose migraine improved at T2 had significantly lower MMPI and State Trait Anxiety Inventory scores at T0 and T2. Moreover, the prevalence of depression of the patients whose migraine improved at T2 was 37.5% at T0 and decreased to 12.5% at T2. The authors subsequently studied the function of the frontal lobe in 23 female patients previously treated for chronic migraine and 23 controls by applying three neuropsychologic tests (gambling task, tower of hanoi-3 and object alternation test). The patient group performed significantly worse on the tower of hanoi-3 and the object alternation test. In order to assess the extent to which muscle tenderness may relate to psychiatric disorders in patients with migraine and tension-type headache, diagnosed according International Headache Society criteria [2004], a psychologic assessment was performed and palpation tenderness scores calculated for the pericranial and cervical muscles in 459 patients. In total, 125 patients had frequent episodic migraine, 97 had chronic migraine, 82 had frequent episodic tension-type headache and chronic tension-type headache was present in 83. In a further 72 patients, both episodic migraine and

  7. Pain and Interoception Imaging Network (PAIN): A multimodal, multisite, brain-imaging repository for chronic somatic and visceral pain disorders.

    Science.gov (United States)

    Labus, Jennifer S; Naliboff, Bruce; Kilpatrick, Lisa; Liu, Cathy; Ashe-McNalley, Cody; dos Santos, Ivani R; Alaverdyan, Mher; Woodworth, Davis; Gupta, Arpana; Ellingson, Benjamin M; Tillisch, Kirsten; Mayer, Emeran A

    2016-01-01

    The Pain and Interoception Imaging Network (PAIN) repository (painrepository.org) is a newly created NIH (NIDA/NCCAM) funded neuroimaging data repository that aims to accelerate scientific discovery regarding brain mechanisms in pain and to provide more rapid benefits to pain patients through the harmonization of efforts and data sharing. The PAIN Repository consists of two components, an Archived Repository and a Standardized Repository. Similar to other 'open' imaging repositories, neuroimaging researchers can deposit any dataset of chronic pain patients and healthy controls into the Archived Repository. Scans in the Archived Repository can be very diverse in terms of scanning procedures and clinical metadata, complicating the merging of datasets for analyses. The Standardized Repository overcomes these limitations through the use of standardized scanning protocols along with a standardized set of clinical metadata, allowing an unprecedented ability to perform pooled analyses. The Archived Repository currently includes 741 scans and is rapidly growing. The Standardized Repository currently includes 433 scans. Pain conditions currently represented in the PAIN repository include: irritable bowel syndrome, vulvodynia, migraine, chronic back pain, and inflammatory bowel disease. Both the PAIN Archived and Standardized Repositories promise to be important resources in the field of chronic pain research. The enhanced ability of the Standardized Repository to combine imaging, clinical and other biological datasets from multiple sites in particular make it a unique resource for significant scientific discoveries.

  8. [Mechanisms of muscle pain : significance of trigger points and tender points].

    Science.gov (United States)

    Brezinschek, H-P

    2008-12-01

    Fibromyalgia syndrome (FMS) and myofascial pain syndrome (MPS) belong to the group of chronic non-inflammatory pain syndromes affecting muscles and tendinous insertions. Important criteria in the diagnosis of both diseases are the presence of "tender points" and "trigger points". According to ACR criteria FMS is characterized by the presence of tender points whereas trigger points are typically found in MPS.The main difference is that until now tender points could only be defined in terms of their localization, whereas trigger points can be found upon palpation which may cause a specific referred pain pattern. In addition, analysis of trigger points by microdialysis demonstrated elevated levels of pro-inflammatory substances at these sites. Moreover, local treatment of trigger points either by manipulative therapy or injection appears to be most effective for prompt relief of symptoms.

  9. Effect of Iyengar yoga therapy for chronic low back pain.

    Science.gov (United States)

    Williams, Kimberly Anne; Petronis, John; Smith, David; Goodrich, David; Wu, Juan; Ravi, Neelima; Doyle, Edward J; Gregory Juckett, R; Munoz Kolar, Maria; Gross, Richard; Steinberg, Lois

    2005-05-01

    Low back pain is a significant public health problem and one of the most commonly reported reasons for the use of Complementary Alternative Medicine. A randomized control trial was conducted in subjects with non-specific chronic low back pain comparing Iyengar yoga therapy to an educational control group. Both programs were 16 weeks long. Subjects were primarily self-referred and screened by primary care physicians for study of inclusion/exclusion criteria. The primary outcome for the study was functional disability. Secondary outcomes including present pain intensity, pain medication usage, pain-related attitudes and behaviors, and spinal range of motion were measured before and after the interventions. Subjects had low back pain for 11.2+/-1.54 years and 48% used pain medication. Overall, subjects presented with less pain and lower functional disability than subjects in other published intervention studies for chronic low back pain. Of the 60 subjects enrolled, 42 (70%) completed the study. Multivariate analyses of outcomes in the categories of medical, functional, psychological and behavioral factors indicated that significant differences between groups existed in functional and medical outcomes but not for the psychological or behavioral outcomes. Univariate analyses of medical and functional outcomes revealed significant reductions in pain intensity (64%), functional disability (77%) and pain medication usage (88%) in the yoga group at the post and 3-month follow-up assessments. These preliminary data indicate that the majority of self-referred persons with mild chronic low back pain will comply to and report improvement on medical and functional pain-related outcomes from Iyengar yoga therapy.

  10. Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

    Directory of Open Access Journals (Sweden)

    C de Roos

    2010-01-01

    Full Text Available BACKGROUND: Chronic phantom limb pain (PLP is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.

  11. Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease

    OpenAIRE

    2005-01-01

    Background: Quadriceps muscle weakness is common in chronic obstructive pulmonary disease (COPD) but is not observed in a small hand muscle (adductor pollicis). Although this could be explained by reduced activity in the quadriceps, the observation could also be explained by anatomical location of the muscle or fibre type composition. However, the abdominal muscles are of a similar anatomical and fibre type distribution to the quadriceps, although they remain active in COPD. Cough gastric pre...

  12. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice.

    Science.gov (United States)

    Nijs, Jo; Van Houdenhove, Boudewijn

    2009-02-01

    During the past decade, scientific research has provided new insight into the development from an acute, localised musculoskeletal disorder towards chronic widespread pain/fibromyalgia (FM). Chronic widespread pain/FM is characterised by sensitisation of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients. It is explained that manual therapy might be able to influence the process of chronicity in three different ways. (I) In order to prevent chronicity in (sub)acute musculoskeletal disorders, it seems crucial to limit the time course of afferent stimulation of peripheral nociceptors. (II) In the case of chronic widespread pain and established sensitisation of central pain pathways, relatively minor injuries/trauma at any locations are likely to sustain the process of central sensitisation and should be treated appropriately with manual therapy accounting for the decreased sensory threshold. Inappropriate pain beliefs should be addressed and exercise interventions should account for the process of central sensitisation. (III) However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may cause more harm then benefit to the patient by triggering or sustaining central sensitisation.

  13. HSV gene transfer in the treatment of chronic pain

    Institute of Scientific and Technical Information of China (English)

    David J. Fink; Marina Mata

    2008-01-01

    It has proven difficult to use systemic administration of small molecules to selectively modulate nociception. Over the past decade, we and others have developed non-replicating herpes simplex virus (HSV)-based vectors to treat chronic pain. Subcutaneous inoculation of an HSV vector effectively transduces sensory neurons in the dorsal root ganglion; release of transgene-coded inhibitory neurotransmitters or anti-inflammatory peptides reduces pain-related behaviors in rodent models of chronic inflammatory and neuro-pathic pain. A phase 1 trial of this therapy in patients is set to begin soon.

  14. Pacing: A Concept Analysis of a Chronic Pain Intervention

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    Kathryn Jamieson-Lega

    2013-01-01

    Full Text Available BACKGROUND: The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers’ ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain management program, outcome research is hindered by a lack of a clear and shared definition of this currently ill-defined construct.

  15. The Relationship between PTSD and Chronic Pain: Mediating Role of Coping Strategies and Depression

    OpenAIRE

    Morasco, Benjamin J.; Lovejoy, Travis I.; Lu, Mary; Turk, Dennis C.; Lewis, Lynsey; Dobscha, Steven K

    2013-01-01

    People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Veterans with chronic pain were divided into two groups, those with (n=65) and those without (n=136) concurrent PTSD. All participants completed measures...

  16. Increased muscular and cutaneous pain sensitivity in cephalic region in patients with chronic tension-type headache.

    Science.gov (United States)

    Ashina, S; Babenko, L; Jensen, R; Ashina, M; Magerl, W; Bendtsen, L

    2005-07-01

    Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial nociception may be responsible for transformation of episodic tension-type headache into chronic form. We aimed to compare mechanical and electrical (intramuscular and cutaneous) pain thresholds in trapezius and anterior tibial regions between 20 patients with chronic tension type headache and 20 healthy controls. Pain thresholds to three types of electrical stimulation (single pulse, 2 and 100 Hz) were significantly lower in patients than in controls in trapezius muscle (P tension-type headache than in healthy controls. Increased sensitivity in nociceptive pathways from cephalic region may be of importance in the pathophysiology of chronic tension type headache.

  17. Painful periostitis in the setting of chronic voriconazole therapy

    OpenAIRE

    Skaug, Margaret; Spak, Cedric; Oza, Umesh

    2014-01-01

    A 72-year-old woman on chronic voriconazole therapy for recurrent histoplasmosis developed a painful forearm mass. Laboratory and imaging findings were consistent with a diffuse periostitis. Her symptoms resolved after discontinuation of voriconazole. To our knowledge, this is the first case of voriconazole-induced periostitis to be reported in a patient with chronic histoplasmosis.

  18. Painful periostitis in the setting of chronic voriconazole therapy.

    Science.gov (United States)

    Skaug, Margaret; Spak, Cedric; Oza, Umesh

    2014-10-01

    A 72-year-old woman on chronic voriconazole therapy for recurrent histoplasmosis developed a painful forearm mass. Laboratory and imaging findings were consistent with a diffuse periostitis. Her symptoms resolved after discontinuation of voriconazole. To our knowledge, this is the first case of voriconazole-induced periostitis to be reported in a patient with chronic histoplasmosis.

  19. Risk factors for chronic postsurgical abdominal and pelvic pain

    NARCIS (Netherlands)

    Rijckevorsel, D.C.M. van; Vries, M. de; Schreuder, L.T.W.; Wilder-Smith, O.H.G.; Goor, H. van

    2015-01-01

    SUMMARY Chronic postsurgical pain (CPSP) may develop after any surgical procedure, and is a common feature after abdominal and pelvic surgery with a prevalence varying between 10 and 40%. The pathological mechanisms leading to chronic CPSP are probably inflammation, tissue and nerve damage and alter

  20. Substance P and Chronic Pain in Patients with Chronic Inflammation of Connective Tissue.

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    Barbara Lisowska

    Full Text Available Evidence suggests that substance P (SP is involved in chronic joint inflammation, such as the pathogenesis of rheumatoid arthritis and osteoarthritis. The goal of the research was to evaluate the correlation between chronic pain and changes in the SP level in patients with chronic inflammation of the connective tissue.Patients with osteoarthritis and rheumatoid arthritis were enrolled in this study. The relationship between chronic pain intensity and the serum SP concentration was evaluated in these groups of patients with osteoarthritis and rheumatoid arthritis.The results showed a positive correlation between the serum SP concentrations and chronic pain intensity.1. The SP serum concentration was significantly different between the groups of patients with OA and RA. 2. There was a positive correlation between the serum SP concentration and chronic pain intensity in OA and RA patients.

  1. Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

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    Freeman Michael D

    2009-04-01

    Full Text Available Abstract Objective it has been established that chronic neck pain following whiplash is associated with the phenomenon of central sensitization, in which injured and uninjured parts of the body exhibit lowered pain thresholds due to an alteration in central pain processing. it has furthermore been hypothesized that peripheral sources of nociception in the muscles may perpetuate central sensitization in chronic whiplash. the hypothesis explored in the present study was whether myofascial trigger points serve as a modulator of central sensitization in subjects with chronic neck pain. Design controlled case series. Setting outpatient chronic pain clinic. Subjects seventeen patients with chronic and intractable neck pain and 10 healthy controls without complaints of neck pain. Intervention symptomatic subjects received anesthetic infiltration of myofascial trigger points in the upper trapezius muscles and controls received the anesthetic in the thigh. Outcome measures: pre and post injection cervical range of motion, pressure pain thresholds (ppt over the infraspinatus, wrist extensor, and tibialis anterior muscles. sensitivity to light (photophobia and subjects' perception of pain using a visual analog scale (vas were also evaluated before and after injections. only the ppt was evaluated in the asymptomatic controls. Results immediate (within 1 minute alterations in cervical range of motion and pressure pain thresholds were observed following an average of 3.8 injections with 1–2 cc of 1% lidocaine into carefully identified trigger points. cervical range of motion increased by an average of 49% (p = 0.000 in flexion and 44% (p = 0.001 in extension, 47% (p = 0.000 and 28% (p Conclusion the present data suggest that myofascial trigger points serve to perpetuate lowered pain thresholds in uninjured tissues. additionally, it appears that lowered pain thresholds associated with central sensitization can be immediately reversed, even when associated

  2. Biochemical response to chronic shortening in unloaded soleus muscles

    Science.gov (United States)

    Jaspers, S. R.; Fagan, J. M.; Tischler, M. E.

    1985-01-01

    One leg of tail-casted suspended rats was immobilized in a plantar-flexed position to test whether chronic shortening of posterior leg muscles affected the metabolic response to unloading. The immobilized plantaris and gastrocnemius muscles of these animals showed approximately 20 percent loss of muscle mass in contrast to simply a slower growth rate with unloading. Loss of mass of the soleus muscle during suspension was not accentuated by chronic shortening. Although protein degradation in the isolated soleus muscle of the plantar-flexed limb was slightly faster than in the contralateral free limb, this difference was offset by faster synthesis of the myofibrillar protein fraction of the chronically shortened muscle. Total adenine nucleotides were 17 percent lower (P less than 0.005) in the chronically shortened soleus muscle following incubation. Glutamate, glutamine, and alanine metabolism showed little response to chronic shortening. These results suggest that, in the soleus muscle, chronic shortening did not alter significantly the metabolic responses to unloading and reduced activity.

  3. Individual and dyadic coping in chronic pain patients

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    Burri A

    2017-03-01

    Full Text Available Andrea Burri,1–3 Michèle Blank Gebre,4 Guy Bodenmann1 1Department of Psychology, University of Zurich, Zurich, Switzerland; 2Health and Rehabilitation Research Institute, Auckland University of Technology, 3Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand; 4Private Practice, Zurich, Switzerland Abstract: The purpose of the current cross-sectional study was to test the associations between individual coping responses to pain, dyadic coping, and perceived social support, with a number of pain outcomes, including pain intensity, functional disability, and pain adjustment, in a sample of N = 43 patients suffering from chronic pain in Switzerland. In contrast to previous research, we were interested not only in specific pain coping but also in more general stress coping strategies and their potential influence on pain outcomes. Analyses were performed using correlation and regression analyses. “Praying and hoping” turned out to be an independent predictor of higher pain intensity and higher anxiety levels, whereas both “coping self-instructions” and “diverting attention” were associated with higher well-being, less feelings of helplessness, and less depression and anxiety. We further found a link between “focusing on and venting emotions” and “worse pain adjustment”. No significant relationship between dyadic coping and social support with any of our pain outcomes could be observed. Overall, our results indicate that individual coping strategies outweigh the effects of social support and dyadic coping on pain-related outcomes and pain adjustment. However, results need to be interpreted with caution given the small sample size. Keywords: individual coping, dyadic coping, social support, chronic pain

  4. Individual and dyadic coping in chronic pain patients

    Science.gov (United States)

    Burri, Andrea; Blank Gebre, Michèle; Bodenmann, Guy

    2017-01-01

    The purpose of the current cross-sectional study was to test the associations between individual coping responses to pain, dyadic coping, and perceived social support, with a number of pain outcomes, including pain intensity, functional disability, and pain adjustment, in a sample of N = 43 patients suffering from chronic pain in Switzerland. In contrast to previous research, we were interested not only in specific pain coping but also in more general stress coping strategies and their potential influence on pain outcomes. Analyses were performed using correlation and regression analyses. “Praying and hoping” turned out to be an independent predictor of higher pain intensity and higher anxiety levels, whereas both “coping self-instructions” and “diverting attention” were associated with higher well-being, less feelings of helplessness, and less depression and anxiety. We further found a link between “focusing on and venting emotions” and “worse pain adjustment”. No significant relationship between dyadic coping and social support with any of our pain outcomes could be observed. Overall, our results indicate that individual coping strategies outweigh the effects of social support and dyadic coping on pain-related outcomes and pain adjustment. However, results need to be interpreted with caution given the small sample size. PMID:28331356

  5. Chronic pain: the burden of disease and treatment innovations

    Directory of Open Access Journals (Sweden)

    S. Monti

    2015-10-01

    Full Text Available Musculoskeletal conditions are the most frequent cause of chronic pain and affect around 1 in 5 adults in Europe. When chronic pain occurs, it becomes disease itself, with substantial clinical, social and economic impact. Effi cacy and tolerability problems are encountered with all therapeutic strategies available to treat musculoskeletal pain. This often limits effective analgesia and patients’ long term compliance, with the result that chronic pain is persistently underestimated and undertreated. Tapentadol is a novel, centrally acting analgesic that has been recently commercialized for the treatment of chronic pain. This new molecule, by combining two distinct mechanisms of action, μ-opioid receptor agonism (MOR and noradrenaline reuptake inhibition (NRI, introduces a new pharmacological class called MOR-NRI. Several studies demonstrated promising results in the management of both nociceptive and neuropathic pain and good tolerability profi le, particularly concerning side effects, compared to traditional opioids. This novel analgesic represents a possible therapeutic option also in the rheumatologic fi eld, particularly in the treatment of osteoarthritis and low back pain.

  6. Treating Chronic Pain with SSRIs: What Do We Know?

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    Elias Patetsos

    2016-01-01

    Full Text Available Serotonin is a monoamine neurotransmitter that plays a major role in both nociception and mood regulation. Alterations in the 5-hydroxytryptophan (5HT system have been reported in chronic pain patients. In recent years, Selective Serotonin Reuptake Inhibitors (SSRIs have been suggested as an alternative treatment for chronic pain due to the fact that they are better tolerated presenting less secondary effects than other antidepressants such as tricyclic antidepressants. Although several clinical trials have been published, the effectiveness of SSRI as treatment for pain conditions is inconclusive. This review aims to summarise what is known, regarding the effectiveness of SSRI as a treatment for chronic pain conditions in adults. A total of 36 studies involving a total of 1898 participants were included in this review. Of the 36 trials included in the review, 2 used zimelidine as treatment, 3 used escitalopram, 4 used fluvoxamine, 4 used sertraline, 6 used citalopram, 8 used paroxetine, 9 used fluoxetine, and one used both citalopram and paroxetine. Because the trials included in this review are quite heterogeneous, only qualitative analyses were performed. SSRI seems to have an effect on most of chronic pain conditions; however, further clinical trials with good methodology leading to low risk of bias are needed in order to conclude once and for all the effect of this drug class as treatment for chronic pain conditions.

  7. Neck muscle function in violinists/violists with and without neck pain.

    Science.gov (United States)

    Steinmetz, Anke; Claus, Andrew; Hodges, Paul W; Jull, Gwendolen A

    2016-04-01

    Neck pain is associated with changes in neuromuscular control of cervical muscles. Violin and viola playing requires good function of the flexor muscles to stabilize the instrument. This study investigated the flexor muscle behaviour in violin/viola players with and without neck pain using the craniocervical flexion test (CCFT). In total, 12 violin/viola players with neck pain, 21 violin/viola players without neck pain in the preceding 12 weeks and 21 pain-free non-musicians were included. Activity of the sternocleidomastoid muscles (SCM) was measured with surface electromyography (EMG) during the CCFT. Violin/viola players with neck pain displayed greater normalised SCM EMG amplitudes during CCFT than the pain-free musicians and non-musicians (P neck pain in violinists/violists is associated with altered behaviour of the superficial neck flexor muscles consistent with neck pain, despite the specific use of the deep and superficial neck flexors during violin playing.

  8. Central pain processing in chronic tension-type headache

    DEFF Research Database (Denmark)

    Lindelof, Kim; Ellrich, Jens; Jensen, Rigmor

    2009-01-01

    ) reflects neuronal excitability due to nociceptive input in the brainstem. The aim of this study was to investigate nociceptive processing at the level of the brainstem in an experimental pain model of CTTH symptoms. METHODS: The effect of conditioning pain, 5 min infusion of hypertonic saline into the neck...... muscles, was investigated in 20 patients with CTTH and 20 healthy controls. In addition, a pilot study with isotonic saline was performed with 5 subjects in each group. The BR was elicited by electrical stimuli with an intensity of four times the pain threshold, with a superficial concentric electrode. We...... measured the BR, sensibility to pressure and electrical pain scores before, during and 25 min after the saline infusion. RESULTS: The pain rating of the electrical stimuli and the pain score of the hypertonic saline infusion were significantly higher in CTTH patients than in healthy volunteers. The primary...

  9. Chronic pain, opioid prescriptions, and mortality in Denmark

    DEFF Research Database (Denmark)

    Ekholm, Ola; Kurita, Geana Paula; Højsted, Jette;

    2014-01-01

    This study aimed to investigate the risk of death, development of cancer, and hospital inpatient admissions resulting from injuries and toxicity/poisoning among opioid users with chronic noncancer pain. A population-based cohort of 13,127 adults, who have participated in the Danish Health Interview...... Surveys in 2000 or 2005 and have been followed up prospectively by registers until the end of 2011, were classified according to the absence or presence of chronic pain (ie, pain lasting ⩾6months) and long-term or short-term opioid use (individuals using at least 1 prescription per month for 6months...... in the previous year and at least 1 prescription in the previous year, respectively). The risk of all-cause mortality was 1.72 (95% confidence interval [CI]=1.23-2.41) times higher among long-term opioid users than among individuals without chronic pain. The risk of death was lower, but significantly higher than...

  10. [Personality and coping in neuropathic chronic pain: a predictable divorce].

    Science.gov (United States)

    Soriano Pastor, José F; Monsalve Dolz, Vicente; Ibáñez Guerra, Elena; Gómez Carretero, Patricia

    2010-11-01

    We approach the problem about relationships between personality dimensions and the use of coping strategies in chronic pain patients. The most frequently used theoretical model in the area of stress and its relation to pain is the transactional model, taking into account that the incorporation of personality traits improves predictions via coping in the stress process. Following the Big Five model, the relationships between personality and coping strategies in patients with chronical neuropathic pain were established. The results showed slight relationships between the Big-Five dimensions and coping. A vulnerable personality profile in patients with chronic neuropathic pain was obtained, consisting of high neuroticism, low extraversion, openness to experience and responsibility, and moderate agreeableness.

  11. Non-pharmacological treatment of chronic widespread musculoskeletal pain.

    Science.gov (United States)

    Hassett, Afton L; Williams, David A

    2011-04-01

    Individuals with chronic widespread pain, including those with fibromyalgia, pose a particular challenge to treatment, given the modest effectiveness of pharmacological agents for this condition. The growing consensus indicates that the best approach to treatment involves the combination of pharmacological and non-pharmacological interventions. Several non-pharmacological interventions, particularly exercise and cognitive-behavioural therapy (CBT), have garnered good evidence of effectiveness as stand-alone, adjunctive treatments for patients with chronic pain. In this article, evidenced-based, non-pharmacological management techniques for chronic widespread pain are described by using two broad categories, exercise and CBT. The evidence for decreasing pain, improving functioning and changing secondary symptoms is highlighted. Lastly, the methods by which exercise and CBT can be combined for a multi-component approach, which is consistent with the current evidence-based guidelines of several American and European medical societies, are addressed.

  12. Yoga and other meditative movement therapies to reduce chronic pain

    Science.gov (United States)

    Achilefu, Allison; Joshi, Kunal; Meier, Megan; McCarthy, Laine H.

    2016-01-01

    Clinical Question In adults with chronic pain, do yoga and other meditative movement therapies to improvement in chronic pain symptoms? Answer Yes. However, in each of the studies reviewed, yoga classes were included as part of the pain management regime, sometimes alone and sometimes in tandem with DVDs or audiotapes. We feel that no exercise therapy program should be undertaken without professional coaching from certified, registered and qualified instructors. Date Answer was Determined August 2014, June, 2015, August 2015. Level of Evidence for the Answer A Search Terms chronic pain, yoga, exercise therapy, meditative movement therapy Inclusion criteria Adults; meta-analyses; systematic reviews; cohort studies; randomized controlled trials; practice guidelines; articles from 2010 to present. Exclusion criteria Children younger than 18 years of age, Pilates. PMID:28190896

  13. Effects and Mechanisms of Low-Intensity Pulsed Ultrasound for Chronic Prostatitis and Chronic Pelvic Pain Syndrome.

    Science.gov (United States)

    Lin, Guiting; Reed-Maldonado, Amanda B; Lin, Maofan; Xin, Zhongcheng; Lue, Tom F

    2016-07-01

    Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is one of the most common urologic diseases, and no curative treatments have been identified. Low-intensity pulsed ultrasound (LIPUS) has been successfully used in promoting tissue healing, inhibiting inflammation and pain, differentiating stem cells, and stimulating nerve regeneration/muscle regeneration, as well as enhancing angiogenesis. Very recently, LIPUS has been proven an effective approach for CP/CPPS. This review summarizes the possible mechanisms responsible for the therapeutic effect of LIPUS for CP/CPPS. To search publications relevant to the topics of this review, the search engine for life sciences of Entrez was used. We reviewed the available evidence from 1954 through 2015 concerning LIPUS for CP/CPPS. According to the literature, both transrectal and transperineal approaches of LIPUS are effective for CP/CPPS.

  14. Effects and Mechanisms of Low-Intensity Pulsed Ultrasound for Chronic Prostatitis and Chronic Pelvic Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Guiting Lin

    2016-07-01

    Full Text Available Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS is one of the most common urologic diseases, and no curative treatments have been identified. Low-intensity pulsed ultrasound (LIPUS has been successfully used in promoting tissue healing, inhibiting inflammation and pain, differentiating stem cells, and stimulating nerve regeneration/muscle regeneration, as well as enhancing angiogenesis. Very recently, LIPUS has been proven an effective approach for CP/CPPS. This review summarizes the possible mechanisms responsible for the therapeutic effect of LIPUS for CP/CPPS. To search publications relevant to the topics of this review, the search engine for life sciences of Entrez was used. We reviewed the available evidence from 1954 through 2015 concerning LIPUS for CP/CPPS. According to the literature, both transrectal and transperineal approaches of LIPUS are effective for CP/CPPS.

  15. Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP

    Directory of Open Access Journals (Sweden)

    Jason J. Kutch

    2015-01-01

    Full Text Available Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28, as well as group of age-matched healthy male controls (N = 27, had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing.

  16. Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP

    Science.gov (United States)

    Kutch, Jason J.; Yani, Moheb S.; Asavasopon, Skulpan; Kirages, Daniel J.; Rana, Manku; Cosand, Louise; Labus, Jennifer S.; Kilpatrick, Lisa A.; Ashe-McNalley, Cody; Farmer, Melissa A.; Johnson, Kevin A.; Ness, Timothy J.; Deutsch, Georg; Harris, Richard E.; Apkarian, A. Vania; Clauw, Daniel J.; Mackey, Sean C.; Mullins, Chris; Mayer, Emeran A.

    2015-01-01

    Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28), as well as group of age-matched healthy male controls (N = 27), had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing. PMID:26106574

  17. Chronic pain and the adaptive significance of positive emotions.

    Science.gov (United States)

    Ong, Anthony D; Zautra, Alex J; Reid, M Carrington

    2015-04-01

    The February-March 2014 special issue of the American Psychologist featured articles summarizing select contributions from the field of psychology to the assessment and treatment of chronic pain. The articles examined a range of psychosocial and family factors that influence individual adjustment and contribute to disparities in pain care. The reviews also considered the psychological correlates and neurophysiological mechanisms of specific pain treatments, including cognitive-behavioral therapy, hypnosis, acceptance and commitment therapy, mindfulness, and meditation. Although a number of articles emphasized the role that negative states of mind play in pain outcomes, positive emotions were given only brief mention. Here, we provide a rationale for the inclusion of positive emotions in chronic pain research.

  18. Benzodiazepine use in patients with chronic pain in an interdisciplinary pain rehabilitation program

    Science.gov (United States)

    Cunningham, Julie L; Craner, Julia R; Evans, Michele M; Hooten, W Michael

    2017-01-01

    Objectives In the context of widespread opioid use, increased emphasis has been placed on the potentially deleterious effects of concurrent benzodiazepine (BZD) and opioid use. Although use of opioids in chronic pain has been a major focus, BZD use is equally concerning. Thus, the primary aim of this study was to determine the associations between BZD and opioid use in adults with chronic pain upon admission to an outpatient interdisciplinary pain rehabilitation (IPR) program. Methods The study cohort involved 847 consecutive patients admitted to a 3-week outpatient IPR program from January 2013 through December 2014. Study variables included baseline demographic and clinical characteristics, Center for Epidemiologic Studies-Depression Scale, Pain Catastrophizing Scale, and the pain severity subscale of the Multidimensional Pain Inventory. Results Upon admission, 248 (29%) patients were taking BZDs. Patients using BZDs were significantly more likely to use opioids and to be female. Additionally, patients using BZDs had significantly greater depression, pain catastrophizing, and pain severity scores. In univariable logistic regression analysis, opioid use, female sex, and greater scores of depression, pain catastrophizing, and pain severity were significantly associated with BZD use. In multivariable logistic regression analysis adjusted for age, sex, pain duration, opioid use, depression, pain catastrophizing, and pain severity, only female sex and greater depression scores were significantly associated with BZD use. Discussion Among patients participating in an outpatient IPR program, female sex and greater depression scores were associated with BZD use. Results identify a high prevalence of BZD use in patients with chronic pain and reinforce the need to weigh the risks versus benefits when prescribing in this patient population. PMID:28223841

  19. The "self" in pain : exploring the role of coping style in chronic pain adjustment

    OpenAIRE

    2015-01-01

    The devastating impacts of chronic pain include not only disability and emotional distress, but also challenges to patients’ sense of self. Patients experience self-discrepancy when they believe that they can no longer fulfill their hopes or responsibilities. While the impact of self-discrepancy on patients’ chronic pain adjustment has been widely examined, the underlying mechanism is still unclear. The present study therefore aimed to first examine the causal relationship between self-discre...

  20. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain?

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Søgaard, Karen; Gram, Bibi

    2016-01-01

    anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months. RESULTS: The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold...... controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, Euro......AIM: To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients. METHODS: A multicentre randomised...

  1. The role of corticosteroids and stress in chronic pain conditions.

    Science.gov (United States)

    McEwen, Bruce S; Kalia, Madhu

    2010-10-01

    The relationship between corticosteroids (endogenous and exogenous) and stress is well known, as is the use of steroids as concomitant treatment in pain management during acute inflammation. In the past, steroids have not been considered the first line of treatment in pain management. In this review, we examine new scientific and clinical evidence that demonstrates the direct role that steroids play in the generation and clinical management of chronic pain. We will discuss the new findings demonstrating the fact that steroids and related mediators produce paradoxical effects on pain such as analgesia, hyperalgesia, and even placebo analgesia. In addition, we will examine the physiologic effect of stress, high allostatic load, and idiopathic disease states such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and burnout. The recently observed positive relationship between glutaminergic activity in the insula and clinical pain will be examined in the context of understanding the central role of steroids in chronic pain. The complex role of the hypothalamic-pituitary-adrenal axis in pain will be discussed as well as other heterogeneous forms of chronic pain that involve many components of the central nervous system. Components of the hypothalamic-pituitary-adrenal axis have paradoxical effects on certain types of pain that are dependent on dose and on site (whether peripheral or central) and mode of application. Recent studies on glia have shown that they prolong a state of neuronal hypersensitization in the dorsal root ganglia by releasing growth factors and other substances that act on the immune system. We will discuss the implication of these new findings directly linking pain to steroids, stress, and key higher brain regions in the context of future therapeutic targets.

  2. Epidemiology of chronic pain in the office of a pain specialist neurologist

    Directory of Open Access Journals (Sweden)

    Karen dos Santos Ferreira

    2015-07-01

    Full Text Available Objective The objective of the present report was to describe the working experience of a pain specialist neurologist after concluding a medical residency program on neurology, area of concentration pain. Method A retrospective study was conducted for one year in the office of a pain specialist neurologist. Patients older than 18 years with chronic pain according to the criteria of the International Association for the Study of Pain, were included. Demographic data, chronic pain data and the treatments instituted were investigated. Results A total of 241 medical records were reviewed, mean patient age was 52.4 years and 79 (66.9% were women, and the mean score on a numeric pain scale was 8.69. The diagnoses were headaches (74.6%, neuropathic pain (17% and ostheomuscular pain (8.2%. We did not detect cancer pain. Patients received medication and procedures of anesthetic blockade. Conclusion This data can guide new medical residency programs on Neurology, area of concentration pain, to plan activities and studies.

  3. Emotional Status, Perceived Control of Pain, and Pain Coping Strategies in Episodic and Chronic Cluster Headache

    Directory of Open Access Journals (Sweden)

    Dominique Valade

    2012-08-01

    Full Text Available Cluster headache (CH is a chronic syndrome characterized by excruciatingly painful attacks occurring with circadian and circannual periodicity. The objectives of the present study were, in CH patients, to determine by principal component analysis the factor structure of two instruments commonly used in clinics to evaluate pain locus of control (Cancer Locus of Control Scale–CLCS and coping strategies (Coping Strategies Questionnaire–CSQ, to examine the relationship between internal pain controllability and emotional distress, and to compare psychosocial distress and coping strategies between two subsets of patients with episodic or chronic CH. Results indicate, for CLCS, a 3-factor structure (internal controllability, medical controllability, religious controllability noticeably different in CH patients from the structure reported in patients with other painful pathologies and, for CSQ, a 5-factor structure of CSQ which did not markedly diverge from the classical structure. Perceived internal controllability of pain was strongly correlated with study measures of depression (HAD depression/anhedonia subscale, Beck Depression Inventory. Comparison between subsets of patients with episodic or chronic CH of emotional status, pain locus of control, perceived social support and coping strategies did not reveal significant differences apart for the Reinterpreting pain sensations strategy which was more often used by episodic CH patients. Observed tendencies for increased anxiety and perceived social support in patients with episodic CH, and for increased depression and more frequent use of the Ignoring pain sensations strategy in patients with chronic CH, warrant confirmation in larger groups of patients.

  4. Preliminary evaluation of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain

    NARCIS (Netherlands)

    De Blecourt, A. C. E.; Schiphorst Preuper, H. R.; Van der Schans, C. P.; Groothoff, J. W.; Reneman, M. F.

    2008-01-01

    Purpose. To describe the outcome of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain. Methods. Study design: exploratory retrospective cohort study. The study sample consisted of a cohort of 70 children and adolescents ( age: 8 - 21 years) wi

  5. Dynamic pain-emotion relations in chronic pain: a theoretical review of moderation studies

    NARCIS (Netherlands)

    Dima, A.L.; Gillanders, D.T.; Power, M.J.

    2013-01-01

    Current developments in chronic pain research are changing the focus in the study of pain-emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation

  6. Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-07-01

    Full Text Available Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.Results: Based on Oswestry Disability Index (ODI and Numeric Rating Scale (NRS scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.Conclusion: This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.Keywords: chronic back pain, intense, multidisciplinary, program, outpatient

  7. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

    Science.gov (United States)

    Pastore, Elizabeth A; Katzman, Wendy B

    2012-01-01

    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.

  8. Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

    OpenAIRE

    Artner J; Kurz S; Cakir B; Reichel H; Lattig F

    2012-01-01

    Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was desi...

  9. Cognitive and emotional control of pain and its disruption in chronic pain

    OpenAIRE

    Bushnell, M. Catherine; Čeko, Marta; Low, Lucie A.

    2013-01-01

    Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind–body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states — important components of mind–body therapies. It will also examine...

  10. Is myofascial pain in temporomandibular disorder patients a manifestation of delayed-onset muscle soreness?

    NARCIS (Netherlands)

    Koutris, M.; Lobbezoo, F.; Sümer, N.C.; Atis, E.S.; Türker, K.S.; Naeije, M.

    2013-01-01

    Objective: In a study to the possible role of overuse of the jaw muscles in the pathogenesis of jaw muscle pain, we used a protocol involving concentric and eccentric muscle contractions to provoke a state of delayed-onset muscle soreness (DOMS) in the jaw muscles of healthy individuals. We tested w

  11. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education.

    Science.gov (United States)

    Wijma, Amarins J; van Wilgen, C Paul; Meeus, Mira; Nijs, Jo

    2016-07-01

    Pain neuroscience education (PNE) is increasingly used as part of a physical therapy treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how a biopsychosocial assessment should be administered. Therefore, we provided a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice. The purpose of this article is to describe the use of the Pain - Somatic factors - Cognitive factors - Emotional factors - Behavioral factors - Social factors - Motivation - model (PSCEBSM-model) during the intake, as well as a pain analysis sheet. This model attempts to clearly establish what the dominant pain mechanism is (predominant nociceptive, neuropathic, or non-neuropathic central sensitization pain), as well as to assess the provoking and perpetuating biopsychosocial factors in patients with chronic pain. Using this approach allows the clinician to specifically classify patients and tailor the plan of care, including PNE, to individual patients.

  12. Words that describe chronic musculoskeletal pain: implications for assessing pain quality across cultures

    Directory of Open Access Journals (Sweden)

    Sharma S

    2016-11-01

    Full Text Available Saurab Sharma,1 Anupa Pathak,2 Mark P Jensen3 1Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, 2Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal; 3Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA Background: People from different cultures who speak different languages may experience pain differently. This possible variability has important implications for evaluating the validity of pain quality measures that are directly translated into different languages without cultural adaptations. The aim of this study was to evaluate the impact of language and culture on the validity of pain quality measures by comparing the words that individuals with chronic pain from Nepal use to describe their pain with those used by patients from the USA. Methods: A total of 101 individuals with chronic musculoskeletal pain in Nepal were asked to describe their pain. The rates of the different pain descriptor domains and phrases used by the Nepali sample were then compared to the published rates of descriptors used by patients from the USA. The content validity of commonly used measures for assessing pain quality was then evaluated. Results: While there was some similarity between patients from Nepal and the USA in how they describe pain, there were also important differences, especially in how pain quality was described. For example, many patients from Nepal used metaphors to describe their pain. Also, the patients from Nepal often used a category of pain descriptor – which describes a physical state – not used by patients from the USA. Only the original McGill Pain Questionnaire was found to have content validity for assessing pain quality in patients from Nepal, although other existing pain quality measures could be adapted to be content valid by adding one or two additional descriptors

  13. Neurodegenerative properties of chronic pain: cognitive decline in patients with chronic pancreatitis.

    Directory of Open Access Journals (Sweden)

    Marijtje L A Jongsma

    Full Text Available Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance, use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients.

  14. Role of pain catastrophizing during pain processing in a cohort of patients with chronic and severe arthritic knee pain.

    Science.gov (United States)

    Wade, James B; Riddle, Daniel L; Price, Donald D; Dumenci, Levent

    2011-02-01

    We examined the relationship between catastrophizing and a 3-stage model of pain processing, consisting of pain sensation intensity (stage 1), pain unpleasantness (stage 2), and suffering (stage 3). We studied 310 patients with chronic and severe osteoarthritic knee pain (68.7% female) using 4 competing structural equation models. A strong relationship was found between the suffering construct and its indicators. Of the 4 theoretically plausible models, we found a model with 3 specific pathways of pain sensation leading to the final stage of pain-related suffering. A unique contribution of this study is the integration of catastrophizing into the 3 pain stages. In this model, catastrophizing mediates the relationship between pain-related unpleasantness and suffering, as well as the relationship between sensation and suffering through unpleasantness. Psychological intervention targeting catastrophizing could provide reduction of pain-related suffering that adds to the benefits of therapies directed toward the primary sensory and immediate unpleasant dimensions of pain. These results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain. Catastrophizing makes a unique contribution to suffering apart from the contribution of immediate unpleasantness. The study results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain, and the importance of psychological intervention targeting catastrophizing to reduce pain-related suffering.

  15. Central hypersensitivity in chronic musculoskeletal pain.

    Science.gov (United States)

    Curatolo, Michele; Arendt-Nielsen, Lars

    2015-05-01

    Clinical research has consistently detected alteration in central pain processing leading to hypersensitivity. Most methods used in humans are reliable and have face validity to detect widespread central hypersensitivity. However, construct validity is difficult to investigate due to lack of gold standards. Reference values in the pain-free population have been generated, but need replication. Research on pain biomarkers that reflect specific central hypersensitivity processes is warranted. Few studies have analyzed the prognostic value of central hypersensitivity. Most medications acting at central level and some non-pharmacological approaches, including psychological interventions, are likely to attenuate central hypersensitivity.

  16. Central hypersensitivity in chronic musculoskeletal pain

    DEFF Research Database (Denmark)

    Curatolo, Michele; Arendt-Nielsen, Lars

    2015-01-01

    Clinical research has consistently detected alteration in central pain processing leading to hypersensitivity. Most methods used in humans are reliable and have face validity to detect widespread central hypersensitivity. However, construct validity is difficult to investigate due to lack of gold...... standards. Reference values in the pain-free population have been generated, but need replication. Research on pain biomarkers that reflect specific central hypersensitivity processes is warranted. Few studies have analyzed the prognostic value of central hypersensitivity. Most medications acting at central...... level and some non-pharmacological approaches, including psychological interventions, are likely to attenuate central hypersensitivity....

  17. Peripheral Receptor Mechanisms Underlying Orofacial Muscle Pain and Hyperalgesia

    Science.gov (United States)

    Saloman, Jami L.

    Musculoskeletal pain conditions, particularly those associated with temporomandibular joint and muscle disorders (TMD) are severely debilitating and affect approximately 12% of the population. Identifying peripheral nociceptive mechanisms underlying mechanical hyperalgesia, a prominent feature of persistent muscle pain, could contribute to the development of new treatment strategies for the management of TMD and other muscle pain conditions. This study provides evidence of functional interactions between ligand-gated channels, P2X3 and TRPV1/TRPA1, in trigeminal sensory neurons, and proposes that these interactions underlie the development of mechanical hyperalgesia. In the masseter muscle, direct P2X3 activation, via the selective agonist αβmeATP, induced a dose- and time-dependent hyperalgesia. Importantly, the αβmeATP-induced hyperalgesia was prevented by pretreatment of the muscle with a TRPV1 antagonist, AMG9810, or the TRPA1 antagonist, AP18. P2X3 was co-expressed with both TRPV1 and TRPA1 in masseter muscle afferents confirming the possibility for intracellular interactions. Moreover, in a subpopulation of P2X3 /TRPV1 positive neurons, capsaicin-induced Ca2+ transients were significantly potentiated following P2X3 activation. Inhibition of Ca2+-dependent kinases, PKC and CaMKII, prevented P2X3-mechanical hyperalgesia whereas blockade of Ca2+-independent PKA did not. Finally, activation of P2X3 induced phosphorylation of serine, but not threonine, residues in TRPV1 in trigeminal sensory neurons. Significant phosphorylation was observed at 15 minutes, the time point at which behavioral hyperalgesia was prominent. Similar data were obtained regarding another nonselective cation channel, the NMDA receptor (NMDAR). Our data propose P2X3 and NMDARs interact with TRPV1 in a facilitatory manner, which could contribute to the peripheral sensitization underlying masseter hyperalgesia. This study offers novel mechanisms by which individual pro-nociceptive ligand

  18. Managing chronic pain in survivors of torture

    DEFF Research Database (Denmark)

    Amris, Kirstine; Williams, Amanda C de C

    2015-01-01

    All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social...... and welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive...... focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor....

  19. Daily Practice Clinic of Scientific Evidence in the Physiotherapy Management of Chronic Nonspecific Low Back Pain

    Directory of Open Access Journals (Sweden)

    María Constanza Trillos Chacón

    2015-05-01

    Full Text Available Introduction: 80 % of adults experience back pain at least once in their life. Back pain is the third leading cause of consultation in the emergency room, the fourth in general practice, the second of disability pension and the first job relocation. Objective: To compare the criteria that guide decision making of a group of physiotherapists in Bogota Colombia for the management of chronic nonspecific low back pain management criteria contained in the guide COST B13 (European Guidelines For The Management Of Chronic Non- specific Low Back Pain, 2004. Material and methods: This was a descriptive study, for which clinical practice guideline COST B13 for the management of chronic nonspecific low back pain through the AGREE tool is selected and a survey was applied to 50 physiotherapists through a convenience sample with to compare the clinical practices that are performed with the recommendations given guidance. Results: 56 % of respondents had some type of training for the management of chronic nonspecific low back pain (DLCI. 94 % of patients with DLCI served range in age from 40 to 59, with female predominance. In 80 % of respondents stated that physiotherapists diagnostic help with counting for the management of patients is the radiological image. 80 % of physiotherapists evaluated variable lumbar pain experienced by the patient and 54 % stance. Other aspects were reported in lower percentage. In the treatment of DLCI, physiotherapists reported use of stretching in 80 % of cases, the superficial thermotherapy in 70 % and isometric muscle strength in 70 %, all with favorable results.Conclusion: There are differences between clinical practice of physiotherapists and guidelines contained in the recommendations of the guide in the cost DLCI B13. Mainly in the processes of physiotherapy assessment of the surveyed population as they are often focused on observation and not always in the rigorous measurement, which makes it difficult to establish

  20. Attachment and Chronic Pain in Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Theresa J. Donnelly

    2016-10-01

    Full Text Available Although attachment theory is not new, its theoretical implications for the pediatric chronic pain context have not been thoroughly considered, and the empirical implications and potential clinical applications are worth exploring. The attachment framework broadly focuses on interactions between a child’s developing self-regulatory systems and their caregiver’s responses. These interactions are believed to create a template for how individuals will relate to others in the future, and may help account for normative and pathological patterns of emotions and behavior throughout life. This review outlines relevant aspects of the attachment framework to the pediatric chronic pain context. The theoretical and empirical literature is reviewed regarding the potential role of attachment-based constructs such as vulnerability and maintaining factors of pediatric chronic pain. The nature and targets of attachment-based pediatric interventions are considered, with particular focus on relevance for the pediatric chronic pain context. The potential role of attachment style in the transition from acute to chronic pain is considered, with further research directions outlined.

  1. Chronic low back pain patients with accompanying leg pain : The relationship between pain extent and pain intensity, disability and health status

    NARCIS (Netherlands)

    Prins, Maarten R.; van der Wurff, Peter; Groen, Gerbrand J.

    2013-01-01

    Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitat

  2. Mechanical pain sensitivity and the severity of chronic neck pain and disability are not modulated across the menstrual cycle

    OpenAIRE

    2013-01-01

    Despite the high prevalence of neck pain among women, menstrual effects on regional pain outcomes have not been investigated in this clinical population. This study evaluated menstrual effects on mechanical pain sensitivity (Pressure Pain Threshold; PPT), neck pain intensity (Numeric Pain Rating Scale; NPRS) and neck-related disability (Neck Disability Index; NDI) in 22 normally menstruating (NM) and 17 hormonal contraceptive (HC) users with chronic neck pain. Sex hormones, PPT, and NDI were ...

  3. Chronic refractory myofascial pain and denervation supersensitivity as global public health disease.

    Science.gov (United States)

    Chu, J; Bruyninckx, F; Neuhauser, D V

    2016-01-13

    Chronic pain with a 30.3% global prevalence significantly impacts universal health. Low back pain has a 9.4% prevalence worldwide causing the most widespread disability. Neck pain ranks 4th highest regarding years lived with disability with a 4.9% prevalence worldwide. The principal cause of pain in 85% of patients visiting a tertiary pain clinic has a myofascial origin. The root cause is multifocal neuromuscular ischaemia at myofascial trigger points from muscle tightening and shortening following spondylotic radiculopathy induced partial denervation. Chronic refractory myofascial pain (CRMP) is a neuromusculoskeletal disease needing management innovations. Using electrical twitch-obtaining intramuscular stimulation (eToims), we provide objective evidence of denervation supersensitivity in multiple myotomes as cause, aggravation and maintenance of CRMP. This study underscores our previous findings that eToims is safe and efficacious for long-term use in CRMP. eToims aids potential prevention (pre-rehabilitation), simultaneous diagnosis, treatment (rehabilitation) and prognosis in real time for acute and CRMP management.

  4. Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients

    Science.gov (United States)

    MAGRI, VITTORIO; MARRAS, EMANUELA; RESTELLI, ANTONELLA; WAGENLEHNER, FLORIAN M.E.; PERLETTI, GIANPAOLO

    2015-01-01

    The complex network of etiological factors, signals and tissue responses involved in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) cannot be successfully targeted by a single therapeutic agent. Multimodal approaches to the therapy of CP/CPPS have been and are currently being tested, as in the frame of complex diagnostic-therapeutic phenotypic approaches such as the urinary, psychosocial, organ-specific, infection, neurological and muscle tenderness (UPOINTS) system. In this study, the effect of combination therapy on 914 patients diagnosed, phenotyped and treated in a single specialized prostatitis clinic was analyzed. Patients received α-blockers, Serenoa repens (S. repens) extracts combined or not with supplements (lycopene and selenium) and, in the presence of documented or highly suspected infection, antibacterial agents. Combination treatment induced marked and significant improvements of National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) prostatitis symptom scores, International Index of Erectile Function (IIEF) sexual dysfunction scores, urinary peak flow rates and bladder voiding efficiency. These improvements, assessed after a 6-month course of therapy, were sustained throughout a follow-up period of 18 months. A clinically appreciable reduction of ≥6 points of the total NIH-CPSI score was achieved in 77.5% of patients subjected to combination therapy for a period of 6 months. When the patients were divided in two cohorts, depending on the diagnosis of CP/CPPS [inflammatory (IIIa) vs. non-inflammatory (IIIb) subtypes], significant improvements of all signs and symptoms of the syndrome were observed in both cohorts at the end of therapy. Intergroup comparison showed that patients affected by the IIIa sub-category of CP/CPPS showed more severe signs and symptoms (NIH-CPSI total, pain and quality of life impact scores, and Qmax) at baseline when compared with IIIb patients. However, the improvement of symptoms after

  5. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S

    2011-07-01

    Full Text Available Abstract Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%. In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%. In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809

  6. Effects of active rehabilitation therapy on muscular back strength and subjective pain degree in chronic lower back pain patients

    Science.gov (United States)

    Choi, Hea-Kyung; Gwon, Hak-ju; Kim, Seon-Rye; Park, Chan-Seok; Cho, Byung-Jun

    2016-01-01

    [Purpose] This study applied active rehabilitation therapy to muscular back strength and assessed the subjective pain degree in chronic low back pain patients. [Subjects and Methods] Subjects were randomly assigned to two groups: experimental (n=8) and control (n=8). The experimental group performed two types of rehabilitation therapy programs four times per week for eight weeks. The rehabilitation program was based on the Korea Occupational Safety and Health Agency’s program. There were several types of stretching and strengthening. Back strength was measured using the Back Muscle Dynamometer TKK-5402. The visual analog scale score, selected to measure degrees of subjective pain, was used to assess treatment efficacy. [Results] For the experimental group, muscular back strength increased from 133.90 ± 11.84 kg before exercise to 145.59 ± 14.49 kg after exercise. In the control group, muscular back strength decreased from 133.92 ± 3.84 kg before exercise to 133.90 ± 5.81 kg after exercise. In the experimental group, the visual analog scale score for subjective pain decreased from 6.63 ± 0.52 before exercise to 5.75 ± 0.46 after exercise; in the control group, it decreased from 5.61 ± 0.52 before exercise to 5.61 ± 0.52 after exercise. [Conclusion] Active rehabilitation therapy is a positive intervention that can provide relief from back pain. PMID:27821917

  7. Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample

    Science.gov (United States)

    Randolph, Mary E.; Reddy, Diane M.

    2006-01-01

    Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index…

  8. Treatment Preferences for CAM in Children with Chronic Pain

    Directory of Open Access Journals (Sweden)

    Jennie C. I. Tsao

    2007-01-01

    Full Text Available CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls (mean age = 14.5 years ± 2.4; range = 8–18 years presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80% were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy, pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.

  9. Treatment Preferences for CAM in children with chronic pain.

    Science.gov (United States)

    Tsao, Jennie C I; Meldrum, Marcia; Kim, Su C; Jacob, Margaret C; Zeltzer, Lonnie K

    2007-09-01

    CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years +/- 2.4; range = 8-18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.

  10. Relation Between Muscle Activation Pattern and Pain : An Explorative Study in a Bassists Population

    NARCIS (Netherlands)

    Woldendorp, Kees H.; van de Werk, Pieter; Boonstra, Anne M.; Stewart, Roy E.; Otten, Egbert

    2013-01-01

    Objective: To explore the muscle activation patterns in relation to pain complaints in bassists studied during a musical task. This study was based on the assumption that pain complaints are caused by increased muscle activation during playing or relaxation and/or faster onset of fatigue of muscles.

  11. Effects of coping statements on experimental pain in chronic pain patients

    Directory of Open Access Journals (Sweden)

    Daniela Roditi

    2009-08-01

    Full Text Available Daniela Roditi, Michael E Robinson, Nola LitwinsDepartment of Clinical and Health Psychology, University of Florida, Gainesville, FL, USAAbstract: The present study measured the effects of catastrophizing self-statements and positive coping self-statements on cold pressor-induced pain. Participants were 58 adult chronic pain patients with current facial pain. It was hypothesized that catastrophizing would lead to a decrease in pain endurance whereas positive coping would lead to an increase in pain endurance. It was also hypothesized that catastrophizing would lead to an increase in peak pain intensity whereas positive coping would lead to a decrease in peak pain intensity. At pretest, participants submerged their nondominant hand in the cold pressor. Pain sensitivity ranges (PSR were subsequently determined by calculating the difference between tolerance and threshold times. Ratings of peak pain intensity were measured using a pressure sensitive bladder/transducer. Participants underwent random assignment to either a catastrophizing group or a positive coping self-statement group. ANCOVA results revealed that on average, participants employing catastrophizing statements as a coping strategy experienced significantly lower PSR (M = 35.53, SD = 39.71 compared to participants employing positive coping self-statements (M = 73.70, SD = 86.14 when controlling for pretest PSR. Group assignment had no significant influence on peak pain intensity ratings. Thus, our results reveal that manipulation of coping causes changes in pain endurance.Keywords: catastrophizing, coping, expectation, pain sensitivity

  12. Experimental muscle pain decreases the frequency threshold of electrically elicited muscle cramps.

    Science.gov (United States)

    Serrao, Mariano; Arendt-Nielsen, Lars; Ge, Hong-You; Pierelli, Francesco; Sandrini, Giorgio; Farina, Dario

    2007-09-01

    This study in humans tested the hypothesis that nociceptive muscle afferent input facilitates the occurrence of muscle cramps. In 13 healthy adults, muscle cramps were experimentally induced in the foot by stimulating the tibialis posterior nerve at the ankle with 2-s bursts of stimuli separated by 30 s, with stimulation frequency increasing by 2-Hz increments from 10 Hz until the cramp appeared. The minimum stimulation frequency that induced the cramp was defined "cramp frequency threshold". In 2 days, elicitation of the cramp was performed in the two-feet with and without (baseline condition) injection of hypertonic (painful condition) or isotonic (control condition) saline into the deep midportion of the flexor hallucis brevis muscle, from where surface EMG signals were recorded. The cramp frequency threshold was lower for the painful condition with respect to its baseline (mean +/- SE, hypertonic saline: 25.7 +/- 2.1 Hz, corresponding baseline: 31.2 +/- 2.8 Hz; P cramp than immediately before the stimulation that elicited the cramp (pre-cramp: 13.9 +/- 1.6 muV and 75.4 +/- 3.8 Hz, respectively; post-cramp: 19.9 +/- 3.2 muV and 101.6 +/- 6.0 Hz; P muscle afferent activity induced by injection of hypertonic saline facilitates the generation of electrically elicited muscle cramps.

  13. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation.

    Science.gov (United States)

    Hannibal, Kara E; Bishop, Mark D

    2014-12-01

    Pain is a primary symptom driving patients to seek physical therapy, and its attenuation commonly defines a successful outcome. A large body of evidence is dedicated to elucidating the relationship between chronic stress and pain; however, stress is rarely addressed in pain rehabilitation. A physiologic stress response may be evoked by fear or perceived threat to safety, status, or well-being and elicits the secretion of sympathetic catecholamines (epinephrine and norepinepherine) and neuroendocrine hormones (cortisol) to promote survival and motivate success. Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and modulate inflammation. Cortisol also may facilitate the consolidation of fear-based memories for future survival and avoidance of danger. Although short-term stress may be adaptive, maladaptive responses (eg, magnification, rumination, helplessness) to pain or non-pain-related stressors may intensify cortisol secretion and condition a sensitized physiologic stress response that is readily recruited. Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain. Stress may be unavoidable in life, and challenges are inherent to success; however, humans have the capability to modify what they perceive as stressful and how they respond to it. Exaggerated psychological responses (eg, catastrophizing) following maladaptive cognitive appraisals of potential stressors as threatening may exacerbate cortisol secretion and facilitate the consolidation of fear-based memories of pain or non-pain-related stressors; however, coping, cognitive reappraisal, or confrontation of stressors may minimize cortisol secretion and prevent chronic, recurrent pain. Given the parallel mechanisms underlying the physiologic effects of a maladaptive response to pain and non-pain-related stressors, physical therapists should consider screening for non-pain-related stress to

  14. Sex differences between Veterans participating in interdisciplinary chronic pain rehabilitation

    Directory of Open Access Journals (Sweden)

    Jennifer L. Murphy, PhD

    2016-02-01

    Full Text Available The improved management of pain among the growing number of female Veterans receiving care through the Veterans Health Administration has been established as a priority, but studies suggest that females may respond differently to pain treatment. This study explored differences between female and male Veterans engaged in a Chronic Pain Rehabilitation Program and determined how female and male Veterans change following participation. Veterans (N = 324 in a 3 wk inpatient program completed self-report measures at admission, discharge, and 3 mo follow-up. Participants were 21% female (n = 67 and 79% male (n = 257. Compared with males, females were younger and less likely to be white or married/partnered. Females reported shorter pain duration and were more likely to have primary head or limb pain. At admission, fewer females were prescribed opioids than males and at lower doses. After opioid cessation in the program, however, there were no significant differences in use between the sexes at follow-up. Improvements in a range of domains were sustained at follow-up for both sexes, but females did not maintain gains in pain intensity or sleep while males reported more pain-related fear at discharge and follow-up. This study adds to the literature on sex-specific variations in chronic pain and implications for treatment.

  15. [NON-ONCOLOGIC CHRONIC PAIN TREATMENT WITH OPIATES].

    Science.gov (United States)

    Molas Ferrer, Glòria; Castellà Kastner, Montse; Lombraña Mencia, María

    2014-09-01

    Non-oncologic chronic pain is a very common symptom. It causes great impact on daily activities of people who suffer it. The incidence of this type of pain is rising due to the increase in life expectancy. The most affected population is geriatric population. Back pain, osteoarthritic pain and neuropathic pain are the most prevalent types of non-oncologic chronic pain. Opiates, among other analgesic drugs, are used to alleviate this type of pain. Opiates are divided into minor opiates (tramadol, codeine) and major opiates (morphine, fentanyl, oxycodone, methadone). Opiates are very effective to treat pain, but they also have important adverse effects that we must know and try to prevent. One of these adverse effects is the opiates ability to cause dependence, tolerance, addiction and other aberrant behaviors. Terminology of these concepts is sometimes confusing. It is necessary to be careful and control the patient periodically in order to avoid these aberrant behaviors. However, if health professionals take precautions to prevent these behaviors, the risk is considerably reduced. Controlling patients on opiate treatment is essential to achieve a correct use if these drugs.

  16. Diagnostic uncertainty and recall bias in chronic low back pain.

    Science.gov (United States)

    Serbic, Danijela; Pincus, Tamar

    2014-08-01

    Patients' beliefs about the origin of their pain and their cognitive processing of pain-related information have both been shown to be associated with poorer prognosis in low back pain (LBP), but the relationship between specific beliefs and specific cognitive processes is not known. The aim of this study was to examine the relationship between diagnostic uncertainty and recall bias in 2 groups of chronic LBP patients, those who were certain about their diagnosis and those who believed that their pain was due to an undiagnosed problem. Patients (N=68) endorsed and subsequently recalled pain, illness, depression, and neutral stimuli. They also provided measures of pain, diagnostic status, mood, and disability. Both groups exhibited a recall bias for pain stimuli, but only the group with diagnostic uncertainty also displayed a recall bias for illness-related stimuli. This bias remained after controlling for depression and disability. Sensitivity analyses using grouping by diagnosis/explanation received supported these findings. Higher levels of depression and disability were found in the group with diagnostic uncertainty, but levels of pain intensity did not differ between the groups. Although the methodology does not provide information on causality, the results provide evidence for a relationship between diagnostic uncertainty and recall bias for negative health-related stimuli in chronic LBP patients.

  17. Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain

    OpenAIRE

    Sudha Banth; Maryam Didehdar Ardebil

    2015-01-01

    Background and Aim: Recovery of patients with chronic low back pain (LBP) is depended on several physical and psychological factors. Therefore, the authors aimed to examine the efficacy of mindfulness based stress reduction (MBSR) as a mind-body intervention on quality of life and pain severity of female patients with nonspecific chronic LBP (NSCLBP). Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain Eighty-eight patients diagnosed a...

  18. Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

    Directory of Open Access Journals (Sweden)

    Jan Lidbeck

    2002-01-01

    Full Text Available Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

  19. Patients suffering benign chronic pain becoming acute: ER approach

    Directory of Open Access Journals (Sweden)

    Giovanni Nervetti

    2006-06-01

    Full Text Available Due to prescribing errors, to wrong therapeutic choice, to inadequate patient education, to errors in patients adherence to therapy, to social problems, to well known comorbidity between chronic pain and depression, a high number of patients, affected by chronic pain becoming acute, is in charge of the Emergency Department. But the Emergency Department is often the wrong place where to take care of such a complex condition. We present the results of a study conducted in our Emergency Department with the contribute of the Mental Health Department, concerning the evaluation of the diagnostic and therapeutic iter, the evolution of the symptoms, the customer satisfaction and the depression comorbidity, among the patients afferent to the Emergency Department because of a chronic non malignant pain becoming acute. The results of the study suggest the necessity of a more specific diagnostic and therapeutic approach to these patients, in both Emergency Hospital Department and outpatients settings.

  20. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain

    DEFF Research Database (Denmark)

    O'Neill, Søren; Manniche, Claus; Graven-Nielsen, Thomas;

    2007-01-01

    and anterior tibialis muscles. Mechanical pressure (thresholds and supra-threshold) and injection of hypertonic saline (pain intensity, duration, distribution) were used. Pain intensity to experimental stimuli was assessed on a visual analogue scale (VAS). Patients demonstrated significantly higher pain...

  1. New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures.

    Science.gov (United States)

    Grosu, Irina; de Kock, Marc

    2011-06-01

    Chronic postsurgical pain (CPSP) is a pain syndrome that has attracted attention for more than 10 years. CPSP is a pain syndrome that develops postoperatively and lasts for at least 2 months in the absence of other causes for pain (eg, recurrence of malignancy, chronic infection, and so forth). Pain continuing from a preexisting disease is not considered as CPSP. In this article, the authors discuss the etiopathogenesis of CPSP and interventions that can help prevent and treat this condition.

  2. Providing holistic care for women with chronic pelvic pain.

    Science.gov (United States)

    Abercrombie, Priscilla D; Learman, Lee A

    2012-01-01

    Chronic pelvic pain (CPP) is one of the most common pain conditions affecting women and can have a significant impact on quality of life. Assessment of women with CPP is best approached in a comprehensive, systematic manner that includes exploration of physiological and psychological causes. A range of treatment options that draw from conventional medicine and complementary and alternative modalities should be offered. The women's health nurse plays a pivotal role in all aspects of care.

  3. Craniosacral Therapy for the Treatment of Chronic Neck Pain

    OpenAIRE

    2016-01-01

    Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients. Materials and Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20)...

  4. Acupuncture for Chronic Pain in Japan: A Review

    Directory of Open Access Journals (Sweden)

    Kazunori Itoh

    2007-01-01

    Full Text Available Many Japanese reports of acupuncture and moxibustion for chronic pain are not listed in medical databases such as Medline. Therefore, they are not easily accessible to researchers outside of Japan. To complement existing reviews of acupuncture and moxibustion for chronic pain and to provide more detailed discussion and analysis, we did a literature search using ‘Igaku Chuo Zasshi Wed’ (Japana Centra Revuo Medicina and ‘Citation Information by National Institute of Information’ covering the period 1978–2006. Original articles and case reports of acupuncture and moxibustion treatment of chronic pain were included. Animal studies, surveys, and news articles were excluded. Two independent reviewers extracted data from located articles in a pre-defined structured way, and assessed the likelihood of causality in each case. We located 57 papers written in Japanese (20 full papers, 37 case reports. Conditions examined were headache (12 trials, chronic low back pain (9 trials, rheumatoid arthritis (8 trials, temporomandibular dysfunction (8 trials, katakori (8 trials and others (12 trials. While 23 were described as clinical control trials (CCTs, 11 employed a quasi-random method. Applying the 5-point Jadad quality assessment scoring system, the mean score was 1.5 ± 1.3 (SD. Eleven (52% of the CCTs were conducted to determine a more effective procedure for acupuncture; these compared a certain type of acupuncture with another type of acupuncture or specific additional points. In particular, the trigger point acupuncture was widely used to treat chronic low back pain in Japan. Many reports of chronic pain treatment by acupuncture and moxibustion are listed in Japanese databases. From the data, we conclude that there is limited evidence that acupuncture is more effective than no treatment, and inconclusive evidence that trigger point acupuncture is more effective than placebo, sham acupuncture or standard care.

  5. Effect of progressive muscle relaxation therapy on improving signs and symptoms of patients with myofacial pain dysfunction syndrome

    Directory of Open Access Journals (Sweden)

    Momen Beitollahi J.

    2009-03-01

    Full Text Available "nBackground and Aim: One of the most common causes of facial pain, is muscular pain. MPDS is one of the most important disorders of facial area that many of patients suffer from pain, tenderness of one or more masticatory muscles and limitation of movement. Psychological factors play an important role in MPDS. Anxiety and depression by increasing muscle tension, can cause myofacial pain syndrome; They can also accompany the syndrome as comorbidities or develop as sequelae of chronic pain and disability. Many approaches can be used to treat myofacial pain syndrome. The least invasive and least traumatic approach should be se.lected. Often, treatment for myofacial pain syndrome fails, because underlying problems go untreated. Progressive Muscle Relaxation (PMR is mainly used for treating anxiety and depression. The aim of this study was to evaluate the effect of PMR in improving signs and symptoms of patients with MPDS. "nMaterials and Methods: In this before and after clinical trial study, 33 patients with MPDS that had anxiety and or mild depression(were assessed by Beck Inventorywere treated by PMR in a period of a month (3 visitsand were followed up until 2 months. Analysis was done using paired t-test/ wilcoxon-sign-rank test. "nResults: The results of this study showed that variants like intensity of pain, tenderness of masticatory muscles, maximum opening of mouth with and without pain, anxiety (p<0.001 and depression (p=0.001 improved significant 16 after treatment in comparison with before treatment. "nConclusion: In conclusion, PMR is effective in improving signs and symptoms in patients with MPDS. Therefore psychological status should be considered in treatment plan of these patients.

  6. Oxytocin and the modulation of pain experience: Implications for chronic pain management.

    Science.gov (United States)

    Tracy, Lincoln M; Georgiou-Karistianis, Nellie; Gibson, Stephen J; Giummarra, Melita J

    2015-08-01

    In an acute environment pain has potential protective benefits. However when pain becomes chronic this protective effect is lost and the pain becomes an encumbrance. Previously unheralded substances are being investigated in an attempt to alleviate the burden of living with chronic pain. Oxytocin, a neuropeptide hormone, is one prospective pharmacotherapeutic agent gaining popularity. Oxytocin has the potential to modulate the pain experience due to its ubiquitous involvement in central and peripheral psychological and physiological processes, and thus offers promise as a therapeutic agent. In this review, we discuss previous effective applications of oxytocin in pain-free clinical populations and its potential use in the modulation of pain experience. We also address the slowly growing body of literature investigating the administration of oxytocin in clinical and experimentally induced pain in order to investigate the potential mechanisms of its reported analgesic actions. We conclude that oxytocin offers a potential novel avenue for modulating the experience of pain, and that further research into this area is required to map its therapeutic benefit.

  7. Why harmless sensations might hurt in individuals with chronic pain: About heightened prediction and perception of pain in the mind

    Directory of Open Access Journals (Sweden)

    Tanja Hechler

    2016-10-01

    Full Text Available In individuals with chronic pain harmless bodily sensations can elicit anticipatory fear of pain resulting in maladaptive responses such as taking pain medication. Here, we aim to broaden the perspective taking into account recent evidence that suggests that interoceptive perception is largely a construction of beliefs, which are based on past experience and that are kept in check by the actual state of the body. Taking a Bayesian perspective, we propose that individuals with chronic pain display a heightened prediction of pain (prior probability p(pain, which results in heightened pain perception (posterior probability p(pain|sensation due to an assumed link between pain and a harmless bodily sensation (p(sensation│pain. This pain perception emerges because their mind infers pain as the most likely cause for the sensation. When confronted with a mismatch between predicted pain and a (harmless bodily sensation, individuals with chronic pain try to minimize the mismatch most likely by active inference of pain or by an attentional shift. The active inference results in activities that produce a stronger sensation that will match with the prediction, allowing subsequent perceptual inference of pain. Here, we depict heightened pain perception in individuals with chronic pain by reformulating and extending the assumptions of the interoceptive predictive coding model from a Bayesian perspective. The review concludes with a research agenda and clinical considerations.

  8. Traumatization and chronic pain: a further model of interaction

    Directory of Open Access Journals (Sweden)

    Egloff N

    2013-11-01

    Full Text Available Niklaus Egloff,1 Anna Hirschi,2 Roland von Känel1 1Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, University Hospital, Bern, Switzerland; 2Outpatient Clinic for Victims of Torture and War, Swiss Red Cross, Bern-Wabern, Switzerland Abstract: Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have become the subject of increased interest over the last several years. We will give a short summary about the existing interaction models that emphasize particularly psychological and behavioral aspects of this interaction. After a synopsis of the most important psychoneurobiological mechanisms of pain in the context of traumatization, we introduce the hypermnesia–hyperarousal model, which focuses on two psychoneurobiological aspects of the physiology of learning. This hypothesis provides an answer to the hitherto open question about the origin of pain persistence and pain sensitization following a traumatic event and also provides a straightforward explanatory model for educational purposes. Keywords: posttraumatic stress disorder, chronic pain, hypermnesia, hypersensitivity, traumatization

  9. Perspectives on physiotherapy guidelines for chronic low back pain

    Directory of Open Access Journals (Sweden)

    P. Berger

    2007-02-01

    Full Text Available The prevalence of chronic low back pain presents a world widedilemma to patients, physiotherapists and clinicians. There is scant evidence for prevention and treatment however it is now acknowledged that the use of  physiotherapy in a multidimensional context has proved the more appropriate model as a vital component of the collaborative approach required for effective pain management. The following article reviews the current literature, evaluates and combines the guidelines that have been proposed from various international studies to provide a practical approach to the management of chronic back pain. This approach recognizes a broad biopsychosocial model of health and the positive role of activity in health and healing with emphasis on function, rather than impairment. Therefore the development of a patient-centred rehabilitative approach has emerged that emphasizes the restoration of normal movement and function with the addition of physical modalities where appropriate. Recent advances in neurophysiology, the modulation of pain and its perception and the fact that biological systems are known to be greatly affected by electrical treatment provide a clearer rationale for the use of physical agents for rehabilitation of patients with pain and relateddisability. The modalities used in conjunction with active exercises include thermal, massage, electrical stimulation, traction, transcutaneous electrical nerve stimulation (Tens, myofascial release, dry needling, mobilization and acupuncture. An algorithm is provided with the intention of developing protocols for breaking the pain cycle in both nociceptive and neuropathic pain states and in reducing inflammation which is a component of both peripheral and central sensitization. Pain rehabilitation is a useful and cost-effective approach to chronic pain management and makes patients’ responsible partners in their own progress. It encourages planning, pacing of activities and activity related

  10. IL-17 is not essential for inflammation and chronic pelvic pain development in an experimental model of chronic prostatitis/chronic pelvic pain syndrome.

    Science.gov (United States)

    Motrich, Ruben D; Breser, María L; Sánchez, Leonardo R; Godoy, Gloria J; Prinz, Immo; Rivero, Virginia E

    2016-03-01

    Pain and inflammation in the absence of infection are hallmarks in chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) patients. The etiology of CP/CPPS is unclear, and autoimmunity has been proposed as a cause. Experimental autoimmune prostatitis (EAP) models have long been used for studying CP/CPPS. Herein, we studied prostate inflammation induction and chronic pelvic pain development in EAP using IL-12p40-KO, IL-4-KO, IL-17-KO, and wild-type (C57BL/6) mice. Prostate antigen (PAg) immunization in C57BL/6 mice induced specific Th1 and Th17 immune responses and severe prostate inflammation and cell infiltration, mainly composed of CD4 T cells and macrophages. Moreover, chronic pelvic pain was evidenced by increased allodynia responses. In immunized IL-17-KO mice, the presence of a prominent PAg-specific Th1 immune response caused similar prostate inflammation and chronic pelvic pain. Furthermore, markedly high PAg-specific Th1 immune responses, exacerbated prostate inflammation, and chronic pelvic pain were detected in immunized IL-4-KO mice. Conversely, immunized IL-12p40-KO mice developed PAg-specific Th2 immune responses, characterized by high IL-4 secretion and neither infiltration nor damage in the prostate. As observed in wild-type control animals, IL12p40-KO mice did not evidence tactile allodynia responses. Our results suggest that, as in patients, chronic pelvic pain is a consequence of prostate inflammation. After PAg immunization, a Th1-associated immune response develops and induces prostate inflammation and chronic pelvic pain. The absence of Th1 or Th2 cytokines, respectively, diminishes or enhances EAP susceptibility. In addition, IL-17 showed not to be essential for pathology induction and chronic pelvic pain development.

  11. Psychosomatic group treatment helps women with chronic pelvic pain.

    Science.gov (United States)

    Albert, H

    1999-12-01

    This study evaluates group treatment for women suffering from chronic pelvic pain. The concept of group treatment was based on psychosomatic and physio-therapeutical principles and on cognitive and operant behavioral therapy. Each group was composed of up to six women suffering from chronic pelvic pain, and two physiotherapists. Each group treatment session lasted 2.5 h per week for a period of 10 weeks. The women completed questionnaires and pain drawings four times during the treatment period from the beginning of the period till 15 months later. During 13 group treatment periods 53 women accomplished the treatment. Before the treatment the women had experienced pain for an average period of 5 years and 9 months (ranging from 6 months to 22 years). The women's descriptions of the changes derived from group treatment were analyzed according to the Grounded Theory Method. A methodical triangulation of quantitative and qualitative data as well as analyzes of the drawings were applied. One year after the end of the treatment, 39% of the women were pain-free. The average level of pain measured according to the Visual Analog Scale was reduced from 2.8 to 0.9 (p Theory Analysis a model of the development process was elaborated. The process begins with the development of self-knowledge, followed by the woman assuming self responsibility for her own life and performing self-activeness. During the process the woman increases her feeling of self-control and personal mastery of her emotions. The women's pain drawings improved, resulting in more detailed drawings, the color intensity abating, the extent of pains declining, and the outlines blurring. In conclusion this kind of group treatment brings the women relief from their pain thus reducing the use of the National Health Service by women suffering from chronic pelvic pain. The women also experience a positive psychological development. This method of treatment, in which a synergetic combination of physical and

  12. Effects of coping statements on experimental pain in chronic pain patients.

    Science.gov (United States)

    Roditi, Daniela; Robinson, Michael E; Litwins, Nola

    2009-08-19

    The present study measured the effects of catastrophizing self-statements and positive coping self-statements on cold pressor-induced pain. Participants were 58 adult chronic pain patients with current facial pain. It was hypothesized that catastrophizing would lead to a decrease in pain endurance whereas positive coping would lead to an increase in pain endurance. It was also hypothesized that catastrophizing would lead to an increase in peak pain intensity whereas positive coping would lead to a decrease in peak pain intensity. At pretest, participants submerged their nondominant hand in the cold pressor. Pain sensitivity ranges (PSR) were subsequently determined by calculating the difference between tolerance and threshold times. Ratings of peak pain intensity were measured using a pressure sensitive bladder/transducer. Participants underwent random assignment to either a catastrophizing group or a positive coping self-statement group. ANCOVA results revealed that on average, participants employing catastrophizing statements as a coping strategy experienced significantly lower PSR (M = 35.53, SD = 39.71) compared to participants employing positive coping self-statements (M = 73.70, SD = 86.14) when controlling for pretest PSR. Group assignment had no significant influence on peak pain intensity ratings. Thus, our results reveal that manipulation of coping causes changes in pain endurance.

  13. Stereoselective pharmacokinetics of methadone in chronic pain patients

    DEFF Research Database (Denmark)

    Kristensen, K; Blemmer, T; Angelo, H R

    1996-01-01

    Ten patients with chronic pain were randomized to an open, balanced, crossover study. Each patients received two different preparations of racemic methadone, i.e., tablets and intravenous infusion. The pharmacokinetic parameters of the R- and S-enantiomers of the racemate are reported. The analge......Ten patients with chronic pain were randomized to an open, balanced, crossover study. Each patients received two different preparations of racemic methadone, i.e., tablets and intravenous infusion. The pharmacokinetic parameters of the R- and S-enantiomers of the racemate are reported...

  14. New Chronic Pain Treatments in the Outpatient Setting: Review Article.

    Science.gov (United States)

    Grandhe, R; Souzdalnitski, D; Gritsenko, K

    2016-05-01

    Chronic pain is an issue encountered by many health care providers in their routine clinical practice. In addition to generalized patient suffering, this condition has significant clinical, psychological, and socioeconomic impact due to its widespread occurrence. The landscape of chronic pain management has been changing rapidly with an array of treatment innovations, better understanding of established therapies, and care coordination across specialties. In this article, we have reviewed emerging new modalities as well as transformation of established therapies by interventional, pharmacologic, rehabilitative, psychological, complimentary, and interdisciplinary approaches.

  15. Juvenile fibromyalgia in an adolescent patient with sickle cell disease presenting with chronic pain.

    Science.gov (United States)

    Ramprakash, Stalin; Fishman, Daniel

    2015-10-01

    Juvenile fibromyalgia in children with sickle cell disease has not been reported in the literature. We report an adolescent patient with sickle cell whose pain symptoms progressed from having recurrent acute sickle cell pain crisis episodes to a chronic pain syndrome over several years. He was eventually diagnosed with juvenile fibromyalgia based on the clinical history and myofascial tender points and his pain symptoms responded better to multidisciplinary strategies for chronic fibromyalgia pain. Chronic pain in sickle cell disease is an area of poor research, and in addition there is inconsistency in the definition of chronic pain in sickle cell disease. Central sensitisation to pain is shown to occur after recurrent painful stimuli in a genetically vulnerable individual. In a chronic pain condition such as fibromyalgia central sensitisation is thought to play a key role. Fibromyalgia should be considered as one of the main differential diagnosis in any sickle cell patient with chronic pain.

  16. Critical issues on opioids in chronic non-cancer pain

    DEFF Research Database (Denmark)

    Eriksen, Jørgen; Sjøgren, Per; Bruera, Eduardo

    2006-01-01

    quality of life (SF-36), use of the health care system, functional capabilities, satisfaction with medical pain treatment and regular or continuous use of medications. Participants reporting pain were divided into opioid and non-opioid users. The analyses were adjusted for age, gender, concomitant use...... random sample of 16,684 individuals (>16 years of age), 10,066 took part in an interview and completed a self-administered questionnaire. Cancer patients were excluded. The interview and the self-administered questionnaire included questions on chronic/long-lasting pain (>6 months), health-related...

  17. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study.

    Science.gov (United States)

    Wilder-Smith, Oliver Hamilton; Schreyer, Tobias; Scheffer, Gert Jan; Arendt-Nielsen, Lars

    2010-06-01

    Chronic pain is common and undesirable after surgery. Progression from acute to chronic pain involves altered pain processing. The authors studied relationships between presence of chronic pain versus preoperative descending pain control (diffuse noxious inhibitory controls; DNICs) and postoperative persistence and spread of skin and deep tissue hyperalgesia (change in electric/pressure pain tolerance thresholds; ePTT/pPTT) up to 6 months postoperatively. In 20 patients undergoing elective major abdominal surgery under standardized anesthesia, we determined ePTT/pPTT (close to [abdomen] and distant from [leg] incision), eDNIC/pDNIC (change in ePTT/pPTT with cold pressor pain task; only preoperatively), and a 100 mm long pain visual analogue scale (VAS) (0 mm = no pain, 100 mm = worst pain imaginable), both at rest and on movement preoperatively, and 1 day and 1, 3, and 6 months postoperatively. Patients reporting chronic pain 6 months postoperatively had more abdominal and leg skin hyperalgesia over the postoperative period. More inhibitory preoperative eDNIC was associated with less late postoperative pain, without affecting skin hyperalgesia. More inhibitory pDNIC was linked to less postoperative leg deep tissue hyperalgesia, without affecting pain VAS. This pilot study for the first time links chronic pain after surgery, poorer preoperative inhibitory pain modulation (DNIC), and greater postoperative degree, persistence, and spread of hyperalgesia. If confirmed, these results support the potential clinical utility of perioperative pain processing testing.

  18. Activation of Corticostriatal Circuitry Relieves Chronic Neuropathic Pain

    Science.gov (United States)

    Lee, Michelle; Manders, Toby R.; Eberle, Sarah E.; Su, Chen; D'amour, James; Yang, Runtao; Lin, Hau Yueh; Deisseroth, Karl; Froemke, Robert C.

    2015-01-01

    Neural circuits that determine the perception and modulation of pain remain poorly understood. The prefrontal cortex (PFC) provides top-down control of sensory and affective processes. While animal and human imaging studies have shown that the PFC is involved in pain regulation, its exact role in pain states remains incompletely understood. A key output target for the PFC is the nucleus accumbens (NAc), an important component of the reward circuitry. Interestingly, recent human imaging studies suggest that the projection from the PFC to the NAc is altered in chronic pain. The function of this corticostriatal projection in pain states, however, is not known. Here we show that optogenetic activation of the PFC produces strong antinociceptive effects in a rat model (spared nerve injury model) of persistent neuropathic pain. PFC activation also reduces the affective symptoms of pain. Furthermore, we show that this pain-relieving function of the PFC is likely mediated by projections to the NAc. Thus, our results support a novel role for corticostriatal circuitry in pain regulation. PMID:25834050

  19. [Mechanisms by which acute orofacial pain becomes chronic].

    Science.gov (United States)

    Cahana, A; Forster, A

    2006-06-01

    Pain is a complex, multidimensional experience encompassing sensory-discriminative, cognitive, emotional and motivational dimensions. These dimensions in the orofacial region have particular expression since the face and mouth have special biological, emotional and psychological meaning to each individual. Orofacial pain is frequent. Epidemiological studies reveal a high prevalence of severe pain in syndromes such as temporomandibular disorders (TMD), burning mouth syndrome and toothaches, as well as an important role of psychosocial influences, contributing to the persistence of these syndromes. Many of the difficulties experienced by clinicians with the diagnosis and management of acute and chronic orofacial pain stem from a lack of recognition and understanding of these complex conditions, the various intricate bio-psycho-social interactions and the neurobiology behind the chronicisation of acute pain. This text strives to review the important advances and insights into the peripheral processes by which noxious stimuli activates or modulates nociceptive afferent input into the brainstem, the neural pathways in the brainstem and higher levels of the trigeminal (V) somatosensory system and the mechanisms involved in the plasticity of nociceptive transmission. We shall link this knowledge to clinical correlates and suggest a therapeutic approach in acute orofacial pain, in the attempt to avoid the development of chronic pain.

  20. Classification of chronic orofacial pain using an intravenous diagnostic test.

    Science.gov (United States)

    Tjakkes, G-H E; De Bont, L G M; Van Wijhe, M; Stegenga, B

    2009-07-01

    The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of conducted pharmacodiagnostic tests, consisting of the consecutive intravenous administration of drugs. Visual analogue scale scores were retrieved from all patients, based on which they were classified into different responder groups. In total, 46 pain profiles were analysed. Of these, 16 patients (35%) could be classified into one or more pain categories, while 30 patients (65%) could not be classified into any pain category. The pain duration or medication use did not influence the classification. Based on the results of this retrospective study, it seems that classification into subgroups is possible after intravenous testing in a minority of clinically unclassifiable patients. In patients where there is a substantial need for additional diagnostic information, these results may be of value. Recommendations are made for further research, which should include validation in patients with known pain mechanisms.

  1. Acupuncture for chronic neck pain--a cohort study in an NHS pain clinic.

    Science.gov (United States)

    Blossfeldt, Patrick

    2004-09-01

    The study investigates the outcome of acupuncture for chronic neck pain in a cohort of patients referred to an NHS chronic pain clinic. One hundred and seventy two patients were selected for acupuncture over a period of 6.5 years. Treatment was given by a single acupuncturist and consisted of a course of needle acupuncture for an average of seven sessions per patient. Treatment outcome was measured by an oral rating scale of improvement at the end of treatment and at follow up six months and one year after treatment. Nineteen patients were withdrawn from treatment for various reasons, two for adverse events. One hundred and fifty three patients were evaluated, of whom 68% had a successful outcome from acupuncture, reporting an improvement in pain of at least 50%. The success rate was higher in patients with a short duration of pain: 85% in patients with pain for up to three months and 78% with pain for up to six months. Long-term follow up showed that 49% of the patients who completed treatment had maintained the benefit after six months, and 40% at one year. The results indicate that acupuncture can be an effective treatment for selected patients with chronic neck pain.

  2. Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain.

    Science.gov (United States)

    Lynch-Jordan, Anne M; Sil, Soumitri; Peugh, James; Cunningham, Natoshia; Kashikar-Zuck, Susmita; Goldschneider, Kenneth R

    2014-10-01

    Patients presenting for treatment of chronic pain often believe that pain reduction must be achieved before returning to normal functioning. However, treatment programs for chronic pain typically take a rehabilitative approach, emphasizing decreasing pain-related disability first with the expectation that pain reduction will follow. This information is routinely provided to patients, yet no studies have systematically examined the actual trajectories of pain and disability in a clinical care setting. In this study of youth with chronic pain (N=94, 8 to 18 years), it was hypothesized that 1) functional disability and pain would decrease over the course of psychological treatment for chronic pain and 2) functional disability would decrease more quickly than pain intensity. Participants received cognitive behavioral therapy (CBT) for pain management (M=5.6 sessions) plus standard medical care. The Functional Disability Inventory and a Numeric Rating Scale of average pain intensity were completed by the child at every CBT session. Hierarchical linear modeling was conducted to examine the longitudinal trajectories of disability and pain. Standardized estimates of the slopes of change were obtained to test differences in rates of change between pain and disability. Results showed an overall significant decline in functional disability over time. Although pain scores reduced slightly from pretreatment to posttreatment, the longitudinal decline over treatment was not statistically significant. As expected, the rate of change of disability was significantly more rapid than pain. Evidence for variability in treatment response was noted, suggesting the need for additional research into individual trajectories of change in pediatric pain treatment.

  3. Internet interventions for chronic pain including headache: A systematic review

    Directory of Open Access Journals (Sweden)

    Monica Buhrman

    2016-05-01

    Full Text Available Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12 were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = −0.39, for pain intensity Hedge's g = −0.33, for catastrophizing Hedge's g = −0.49 and for mood variables (depression Hedge's g = −0.26.

  4. Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

    DEFF Research Database (Denmark)

    Højsted, J; Nielsen, P R; Eriksen, Jacob Gram;

    2006-01-01

    Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients refe...... referred to a pain centre and to assess the short-term effects of pain treatment.......Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients...

  5. The effects of stabilization exercise on pain, functional disability and muscle endurance in patients suspectedto lumbar segmental instability

    Directory of Open Access Journals (Sweden)

    Y. Javadian

    2008-01-01

    Full Text Available AbstractIntroduction: Lumbar segmental instability is one of the subgroups of non specific chronic low back pain and it seems that 30-40% of patients with LBP suffer from lumbar segmental instability. Pain intensity, functional disability and reduced muscle endurance are common in such patients. The aim of this study was to evaluate the effects of stabilization exercise on pain, functional disability and muscle endurance in patients suspected to lumbar segmental instability Material & methods: Following ethical approval, a randomized clinical trial was carried out on 30 patients suspected to lumbar segmental instability ranging from 18-45 years old. They were randomly divided into two groups; the first group underwent routine exercise only while the second group performed routine exercise plus stabilization training for 8 weeks. Outcome measure included pain intensity, functional disability, and flexion and extension range of motion and flexor, extensor and side support muscle endurance which were evaluated before and after treatment. Data were analyzed using paired t test and independent t test.Results: Muscle endurance and flexion range of motion increased in both groups although the increase was higher in stabilization training group (p=0.00. Pain intensity and functional disability significantly decreased in both groups (p=0.00, but decreasing of pain intensity and functional disability were more in stabilization training group (p=0.00. Conclusion: Stabilization training is more effective than routine exercise in improvement of pain intensity, functional disability, muscle endurance and range of motion in patients suspected to lumbar segmental instability. J Mazand Univ Med Sci 2008; 18(65: 63-73 (Persian

  6. Effect of brief daily resistance training on rapid force development in painful neck and shoulder muscles

    DEFF Research Database (Denmark)

    Jay, Kenneth; Schraefel, Mc; Andersen, Christoffer H

    2013-01-01

    OBJECTIVE: To determine the effect of small daily amounts of progressive resistance training on rapid force development of painful neck/shoulder muscles. METHODS: 198 generally healthy adults with frequent neck/shoulder muscle pain (mean: age 43.1 years, computer use 93% of work time, 88% women...... relationship existed between changes in rapid force development and pain (r = 0.27, Pneck/shoulder pain increases rapid force development and...

  7. Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain.

    Science.gov (United States)

    Hoffman, Martin D; Shepanski, Melissa A; Mackenzie, Sean P; Clifford, Philip S

    2005-01-01

    This study examined whether subjects with chronic low back pain demonstrate exercise-induced analgesia to experimentally induced pressure pain. We employed a repeated measures design to study eight subjects with chronic low back pain (mean +/- standard deviation age = 40 +/- 10, duration of pain = 7 +/- 4 years). Pain ratings were measured immediately before and 2 minutes and 32 minutes after 25 minutes of cycle ergometry (5 minutes at 50% peak oxygen uptake, then 20 minutes at 70% peak oxygen uptake). We based the pain ratings on subject input on a visual analog scale at 10-second intervals during the 2-minute pressure pain stimulus to the nondominant index finger. Compared with preexercise values, pain ratings were significantly (p exercise at both 2 and 32 minutes postexercise. We conclude that pressure pain perception can be reduced for more than 30 minutes following aerobic exercise from leg cycling among people with chronic low back pain.

  8. Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?

    Directory of Open Access Journals (Sweden)

    Cindy A. McGeary

    2016-06-01

    Full Text Available Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD, especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS pain rating, disability (Oswestry Disability Index; Million Visual Analog Scale, and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed.

  9. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    Science.gov (United States)

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference.

  10. Muscle activation characteristics in cross-country skiers with a history of anterior compartment pain.

    Science.gov (United States)

    Federolf, Peter; Bakker, Emily

    2012-11-01

    A large proportion of elite cross-country skiers suffer from chronic anterior compartment syndrome (CACS). This study used surface electromyograms (EMGs) to investigate whether differences existed in the activation characteristics of the tibialis anterior muscle between elite cross-country skiers with a history of anterior compartment pain (symptomatic group) and a pain-free control group. Based on self-reported pain symptoms, twelve young, national-level cross-country ski athletes were assigned to a symptomatic group (N = 5), a control group (N = 4), or analyzed individually if their diagnosis was not certain (N = 3). During skating, EMGs were recorded on five lower leg muscles. The relative increase in EMG power per step when increasing the effort level of skating was larger in the symptomatic group than in the control group for tibialis anterior (143 +/- 12% vs. 125 +/- 23%; Cohen's d = 1.17), peroneus longus (123 +/- 24% vs. 107 +/- 6%; d = 0.91), and gastrocnemius lateralis (167 +/- 51% vs. 117 +/- 12%; d = 1.64). The symptomatic group showed more power in the lower frequency bands of the tibialis anterior's EMG spectra (p 0.2). Within the step cycle, these differences appeared in the swing phase and in the gliding phase during single leg support. The observed differences in the EMG spectra may serve as an early identification of athletes who are at risk of developing CACS.

  11. Role of temporomandibular disorders (TMD) in facial pain: occlusion, muscle and TMJ pain.

    Science.gov (United States)

    Rauhala, K; Oikarinen, K S; Raustia, A M

    1999-10-01

    Temporomandibular disorders (TMD) which comprise myogenic and arthralgic components have been reported to predispose subjects to headache and facial pain. The aim of this study was to evaluate the role of these components in patients with facial pain and to investigate the influence of treatment of TMD on pain of these patients. The subject group consisted of 25 patients suffering from facial pain. The clinical stomatognathic examination was performed before conservative treatment of TMD, and one-two weeks, three months and one year after treatment. The severity of TMD was assessed using the anamnestic (AI) and clinical dysfunction (DI) indices of Helkimo. The intensity of pain was evaluated on a numerical rating scale (NRS). According to clinical findings the patients were classified to following diagnostic subgroups: TMD myo (mainly myogenic), TMD arthro (mainly arthrogenous) and TMD comb (both myogenic and arthrogenous components involved). Fifteen patients were classified in the TMD myo group, nine in the TMD comb group and one in the TMD arthro group. The DI index decreased significantly one-two weeks after treatment and remained at this level at three month and one year follow-up examinations. At the first examination the TMD myo group had the highest level of NRS index, which decreased significantly during the time of follow-up, while no significant changes were found in other groups. Bruxism reported by the patient had a positive correlation with the amount of painful muscles on the right side at first examination. The results show that facial pain combined with TMD may be mostly of myogenic origin, and myogenic pain seems to have most favorable response to conservative treatment of TMD.

  12. Orofacial pain, jaw function, and temporomandibular disorders in adult women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis

    DEFF Research Database (Denmark)

    Bakke, M.; Zak, M.; Jensen, B.L.;

    2001-01-01

    Orofacial pain, jaw function, temporomandibular disorders, adult women persistent juvenil chronic arthritis......Orofacial pain, jaw function, temporomandibular disorders, adult women persistent juvenil chronic arthritis...

  13. The Need for Knowledge Translation in Chronic Pain

    Directory of Open Access Journals (Sweden)

    James L Henry

    2008-01-01

    Full Text Available One in five Canadians suffers from some form of persistent or chronic pain. The impact on individual lives, families and friends, the health services sector and the economy is huge. Reliable evidence is available that the burden of persistent pain can be markedly reduced when available knowledge is applied. Bridging the quality chasm between chronic pain and the care process will require a unique confluence of opinion from all stakeholders committed within a focused community of practice to address the impact of pain. Various levels of success in this regard have been demonstrated when there is exchange, synthesis and ethically sound application of research findings within a complex set of interactions among researchers and knowledge users. It is now critical to accelerate the capture of the benefits of research for Canadians through improved health, more effective and responsive services and products, and a strengthened health care system to bring about health reform and health care reform across Canada as it pertains to the one in five Canadians living with chronic, disabling pain. The overarching outcome of such an initiative needs to be promoted to sustain a balanced portfolio of curiosity-and needs-based research, which along with existing knowledge, can be mobilized and applied for the benefit of Canadians, the health care system and the economy.

  14. The need for knowledge translation in chronic pain.

    Science.gov (United States)

    Henry, James L

    2008-01-01

    One in five Canadians suffers from some form of persistent or chronic pain. The impact on individual lives, families and friends, the health services sector and the economy is huge. Reliable evidence is available that the burden of persistent pain can be markedly reduced when available knowledge is applied. Bridging the quality chasm between chronic pain and the care process will require a unique confluence of opinion from all stakeholders committed within a focused community of practice to address the impact of pain. Various levels of success in this regard have been demonstrated when there is exchange, synthesis and ethically sound application of research findings within a complex set of interactions among researchers and knowledge users. It is now critical to accelerate the capture of the benefits of research for Canadians through improved health, more effective and responsive services and products, and a strengthened health care system to bring about health reform and health care reform across Canada as it pertains to the one in five Canadians living with chronic, disabling pain. The overarching outcome of such an initiative needs to be promoted to sustain a balanced portfolio of curiosity- and needs-based research, which along with existing knowledge, can be mobilized and applied for the benefit of Canadians, the health care system and the economy.

  15. Carbamazepine Withdrawal-induced Hyperalgesia in Chronic Neuropathic Pain.

    Science.gov (United States)

    Ren, Zhenyu; Yang, Bing; Yang, Bin; Shi, Le; Sun, Qing-Li; Sun, A-Ping; Lu, Lin; Liu, Xiaoguang; Zhao, Rongsheng; Zhai, Suodi

    2015-11-01

    Combined pharmacological treatments are the most used approach for neuropathic pain. Carbamazepine, an antiepileptic agent, is generally used as a third-line treatment for neuropathic pain and can be considered an option only when patients have not responded to the first- and second-line medications. In the case presented herein, a patient with neuropathic pain was treated using a combined pharmacological regimen. The patient's pain deteriorated, despite increasing the doses of opioids, when carbamazepine was discontinued, potentially because carbamazepine withdrawal disrupted the balance that was achieved by the multifaceted pharmacological regimen, thus inducing hyperalgesia. Interestingly, when carbamazepine was prescribed again, the patient's pain was successfully managed. Animal research has reported that carbamazepine can potentiate the analgesic effectiveness of morphine in rodent models of neuropathic pain and postoperative pain. This clinical case demonstrates that carbamazepine may have a synergistic effect on the analgesic effectiveness of morphine and may inhibit or postpone opioid-induced hyperalgesia. We postulate that a probable mechanism of action of carbamazepine may involve -aminobutyric acid-ergic potentiation and the interruption of glutamatergic function via N-methyl-D-aspartate receptors. Further research is warranted to clarify the analgesic action of carbamazepine and its potential use for the prevention of opioid-induced hyperalgesia in chronic neuropathic pain patients.

  16. Unconditioned and conditioned muscular responses in patients with chronic back pain and chronic tension-type headaches and in healthy controls.

    Science.gov (United States)

    Klinger, Regine; Matter, Nadia; Kothe, Ralph; Dahme, Bernhard; Hofmann, Ulrich G; Krug, Florian

    2010-07-01

    Muscular tension is assigned an important role in the development and maintenance of chronic pain syndromes. It is seen as a psychophysiological correlate of learned fear and avoidance behavior. Basic theoretical models emphasize classical conditioning of muscular responses as a mechanism of pain chronification. However, the empirical basis for this field is very small. Our aim was to investigate muscular factors in relation to unconditioned and conditioned pain stimuli. An experimental study was conducted using a differential classical conditioning paradigm with 18 patients with chronic back pain (BP) and tension-type headache (TTH), and 18 healthy controls (HC). A high-pitched sound served as the CS+, paired with an intracutaneous electric pain stimulus (US), while a neutral sound was used as the CS-. Simultaneously, integrated surface electromyograms (iEMGs) were recorded for seven muscle sites. Our hypothesis was that the pain patients would demonstrate enhanced conditionability. Baseline values between patients (TTH, BP) and HC showed no significant differences. Although the perception and pain thresholds were balanced, both patient groups revealed a higher number of significant muscular responses to the pain stimulus (UR) than the HC. All participants showed significant conditioned muscular responses, however, the patients displayed a higher number than the healthy controls. Furthermore a significant relation was found between muscular responses and the experience of pain 1day after the experiment. Muscular responses can be learned via classical conditioning. TTH and BP patients revealed a higher number of unconditioned and conditioned responses.

  17. Chronic appendicitis as a cause of chronic rigth lower quadrant abdominal pain

    OpenAIRE

    Ramírez Chacón, Jorge Luis

    2013-01-01

    Abdominal pain is a frequent problem in the medical and surgical consult. There has been written a big number of causes  of chronic abdominal pain, of which there is an estimate of 10-30% that can be explained by a structural or biochemical problems, and in the cases left (70-90%), even though the advances of diagnostic methods, will not be found an organic cause, and it defines as a functional type of abdominal pain. The chronic appendicitis it is always a topic of discussion, due to is not ...

  18. Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

    Directory of Open Access Journals (Sweden)

    John Jarrell

    2011-01-01

    Full Text Available Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA, perineal cutaneous allodynia (pCA, abdominal and perineal myofascial trigger points (aMFTP and (pMFTP, and reduced pain thresholds (RPTs. Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+ and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0, pCA-2.91 (1.19, 7.11, aMTRP-4.19 (1.46, 12.0, pMFTP-1.35 (0.86, 2.13, and RPT-1.14 (0.85, 1.52, respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.

  19. Is chronic groin pain a Bermuda triangle of sports medicine?

    Science.gov (United States)

    Šebečić, Božidar; Japjec, Mladen; Janković, Saša; Vencel Čuljak; Dojčinović, Bojan; Starešinić, Mario

    2014-12-01

    Chronic groin pain is one the most complex conditions encountered in the field of sports medicine. Conservative treatment is long lasting and the result of treatment is often uncer- tain and symptom recurrences are common, which can be very frustrating for both the patient and the physician. The complex etiology and uncertainties during treatment of chronic groin pain is the reason why some authors call it the Bermuda Triangle of sports medicine. In our prospective, 7-year study, 114 athletes with chronic groin pain resistant to conservative therapy were treated surgically. In 109 athletes with sports hernia, we performed nerve neurolysis along with resection of the genital branch of the genitofemoral nerve and we also reinforced the posterior wall of inguinal canal using a modified Shouldice technique. In 26 athletes that had concomitant adductor tendinosis and in 5 athletes with isolated tendinosis we performed tenotomy. Eighty-one of 83 patients with isolated sports hernia returned to sports within a mean of 4.4 (range, 3-16) weeks. Thirty-one athletes with adductor tenotomy returned to sports activity within a mean of 11.8 (range, 10-15) weeks. If carefully diagnosed using detailed history taking, physical examination and correct imaging techniques, chronic groin pain can be treated very successfully and quickly, so it need not be a Bermuda Triangle of sports medicine.

  20. Mexiletine for treatment of chronic painful diabetic neuropathy

    DEFF Research Database (Denmark)

    Dejgard, A; Kastrup, J; Petersen, P

    1988-01-01

    Sixteen of nineteen patients completed a randomised double-blind crossover trial to assess the effect of oral mexiletine (10 mg/kg bodyweight daily) on the symptoms and signs of chronic painful diabetic neuropathy. The median age of the sixteen patients was 50 years (range 30-64). Assessment...