Aarflot, T. and D. Bruusgaard. 1996. Association between chronic widespread musculoskeletal complaints and thyroid autoimmunity. Results from a community survey. Scand J Prim Health Care 14(2):111-115.

Abajo, F.J., Rodriguex L.A.G., Montero, D. 1999. Association between selective serotonin reuptake inhibitors in gastrointestinal bleeding: population based control study. The concomitant use of NSAIDs or aspirin with SSRIs poses a significantly increased risk of GI bleeding. The possible etiological mechanism is the lower level of platelet serotonin in patients on SSRIs.

Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S et al. 2017. Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points. J Bodyw Mov Ther. 21(1):48-52. "A sample of 20 patients (3 men, 17 women; mean age 31.7 ± 10.8) with upper trapezius MTrPs received one session of deep DN. The outcomes of neuromuscular junction response (NMJR), sympathetic skin response (SSR), pain intensity (PI) and pressure pain threshold (PPT) were measured at baseline and immediately after DN…. A single session of DN to the active upper trapezius MTrP was effective in improving pain, PPT, NMJR, and SSR in patients with myofascial trigger points."

Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S et al. 2016. Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. Acupunct Med. [Oct 3 Epub ahead of print.] "The results of this study showed that one session of DN targeting active MTrPs appears to reduce hyperactivity of the sympathetic nervous system and irritability of the motor endplate. DN seems effective at improving symptoms and deactivating active MTrPs, although further research is needed."

Abbott R, Ayres, Hui E et al. 2015. Effect of perineal self-acupressure on constipation: a randomized controlled trial. J Gen Intern Med. 30(4):434-439. Among patients with constipation, perineal self-acupressure improves self-reported assessments of quality of life, bowel function, and health and well-being relative to providing standard constipation treatment options alone. Free Article

Abbott RB, Hui KK, Hays RD et al. 2007. A randomized controlled trial of Tai Chi for tension headaches. Evid Based Complement Alternat Med. 4(1):107-113. "A 15 week intervention of Tai Chi practice was effective in reducing headache impact and also effective in improving perceptions of some aspects of physical and mental health."

Abboud J, Marchand AA, Sorra K et al. 2013. Musculoskeletal physical outcome measures in individuals with tension-type headache: a scoping review. Cephalalgia. 33(16):1319-1336. "Individuals with tension-type headache (TTH), in addition to headache pain, typically suffer from pericranial muscle tenderness and increased cervical muscle tone.... Musculoskeletal outcomes, such as trigger points, pressure pain threshold and forward head posture should inform TTH pathophysiology, diagnosis and interdisciplinary patient care."

Abdelkader NA, Mahmoud AY, Fayaz NA et al.2020. Decreased neck proprioception and postural stability after induced cervical flexor muscles fatigue. J Musculoskelet Neuronal Interact. Sep 1;20(3):421-428. "Subjects suffering from cervical muscles fatigue are vulnerable to have a significant effect on neck proprioception and postural instability as it impaired the cervical proprioception sense & postural stability. Therefore, our study provides information for the clinicians and patients to avoid overload fatigue of the cervical muscles because it affects overall postural balance, neck proprioception & righting reaction." [Trigger points were not mentored in this study from Egypt. As TrPs are treatable, can be activated by actions that cause muscle fatigue, and cervical TrPs are known to affect proprioception and postural stability in addition to causing more muscle fatigue, it would be useful to assess patients with those symptoms for TrPs. DJS]

Abdo H, Calvo-Enrique L, Lopez JM et al. Specialized cutaneous Schwann cells initiate pain sensation. Science. 2019 Aug 16;365(6454):695-699. "We discovered a specialized cutaneous glial cell type with extensive processes forming a mesh-like network in the subepidermal border of the skin that conveys noxious thermal and mechanical sensitivity. We demonstrate a direct excitatory functional connection to sensory neurons and provide evidence of a previously unknown organ that has an essential physiological role in sensing noxious stimuli. Thus, these glial cells, which are intimately associated with unmyelinated nociceptive nerves, are inherently mechanosensitive and transmit nociceptive information to the nerve." [Glial cells have already been implicated in the process of fibromyalgia central sensitization. This newly discovered type of glial cell, the cutaneous Schwann cell, initiates pain sensations, and may be a new avenue to understand and treat chronic pain conditions such as myofascial pain and dysfunction and complex regional pain syndrome.DJS]

Abdullah M, Vishwanath S, Elbalkhi A et al. 2012. Mitochondrial myopathy presenting as fibromyalgia: a case report. J Med Case Reports. 6(1):55. "This case demonstrates that adults diagnosed with fibromyalgia may have their symptom complex related to an adult onset mitochondrial myopathy. This is an important finding since treatment of mitochondrial myopathy resulted in resolution of symptoms."

Able SL, Robinson RL, Kroenke K et al. 2016. Variations in the management of fibromyalgia by physician specialty: rheumatology versus primary care. Pragmat Obs Res. 7:11-20. "Physician practice characteristics, physician attitudes, and FM patient profiles were broadly similar across specialties. The small but significant differences reported by physicians and patients across physician cohorts suggest that despite published guidelines, treatment of FM still contains important variance across specialties." Free PMC Article

Ablin JN. 2019. Fibromyalgia 2019: Myths and Realities. Isr Med Assoc J. 21(6):426-428. "Fibromyalgia syndrome (FMS), a clinical constellation of symptoms centered on chronic pain and fatigue, epitomizing the concept of pain centralization within the CNS. While struggling with the challenges of FMS, rheumatologists, as well as physicians in general, have learned a great deal regarding the nature of chronic centralized pain…. They have demonstrated how much they can gain when addressing the complaints of their patients, rather than simply assuring them that nothing is wrong because all of the test results are within the normal range. Major progress is being made through a collaboration between clinicians and neuroscientists in the effort to unravel the secrets of FMS and centralized pain in general. Nevertheless, skepticism and mistrust continue to mire the discourse between many clinicians and their FMS patients, and the lack of trust engendered by these attitudes inevitably undermines the therapeutic endeavor." Persisting FM myths included and addressed are: FM is only in women so men need not worry; FM is "all in the head"; FM patients are only depressed and need psychiatric care; There is nothing that can be done for FM anyway; FM patients are malingerers, and anyone can find FM symptoms on the Internet; This is only FM and nothing serious; FM does not really exist. The author addresses each myth, and urges clinicians to learn what they can about FM and to treat their patients with good will and respect.

Ablin JN, Aloush V, Brill A et al. 2015. Influenza vaccination is safe and effective in patients suffering from fibromyalgia syndrome. Reumatismo. 67(2):57-61. "The fibromyalgia syndrome (FMS) is considered to result from the exposure of a genetically susceptible individual to various triggers, such as physical trauma, stress, viral infections etc....Six weeks after vaccination, FMS patients showed a significant increase in geometric mean titers of HI antibody. The rates of sero-protection increased from 22.9% for H1N1 to 89.5% post-vaccination. A significant increase in HI antibody titers was also demonstrated among healthy controls. Influenza vaccination was both safe and effective in FMS patients. In view of these results, FMS patients should be encouraged to undergo influenza vaccination according to the standard WHO recommendations."

Ablin JN, Buskila D. 2015. Update on the genetics of the fibromyalgia syndrome. Best Pract Res Clin Rheumatol. 29(1):20-8. "Fibromyalgia syndrome (FMS), a condition characterized by chronic widespread pain and tenderness, is a complex condition considered to represent a paradigm of centralized pain. FMS has demonstrated a clear familial aggregation, and hence it is considered to have a genetic background. Multiple candidate-gene studies have been conducted in this field, focusing on target genes that play a role in the transmission and processing of pain. While many of these have focused in the past on markers related to neurotransmitter systems such as catecholamines (catechol-O-methyltransferase (COMT)) and serotonin, novel target genes have recently emerged. In addition, genome-wide sequencing scanning (genome-wide association study (GWAS)) is increasingly being harnessed for the study of chronic pain, including FMS. Micro RNAs are another novel field of research related to posttranscriptional inhibition of gene expression, which are currently regarding the pathogenesis of FMS."

Ablin JN, Buskila D. 2015. "Real-life" treatment of chronic pain: Targets and goals. Best Pract Res Clin Rheumatol. 29(1):111-9. Epub 2015 May 20 "Treating chronic pain is a complex challenge. While textbooks and medical education classically categorize pain as originating from peripheral (nociceptive), neuropathic, or centralized origins, in real life each and every patient may present a combination of various pain sources, types, and mechanisms. Moreover, individual patients may evolve and develop differing types of pain throughout their clinical follow-up, further emphasizing the necessity to maintain clinical diligence during the evaluation and follow-up of these patients. Rational treatment of patients suffering from chronic pain must attempt at deconstructing complex pain cases, identifying variegate pain generators, and targeting them with appropriate interventions, while incorporating both pharmacological and non-pharmacological strategies, rather than focusing on the total pain level, which represents an integral of all pain types. Failing to recognize the coexistence of different types of pain in an individual patient and escalating medications only on the basis of total pain intensity are liable to lead to both ineffective control of pain and increased untoward effects. In the current review, we outline strategies for deconstructing complex pain and therapeutic suggestions." [Some doctors are starting to recognize that chronic pain patient soften have multiple interactive diagnoses, and need to be treated accordingly. DJS]

Ablin JN, Clauw DJ, Lyden AK et al. 2013. Effects of sleep restriction and exercise deprivation on somatic symptoms and mood in healthy adults. Clin Exp Rheumatol. 31(6 Suppl 79):53-59. "This study supports previous research suggesting that both sleep and exercise are critical in 'preventing' somatic symptoms among some individuals. Furthermore, to our knowledge, this is the first time there is data to suggest that women are much more sensitive to decrements in routine sleep and exercise than are men."

Ablin JN, Cohen H, Eisinger M et al. 2010. Holocaust survivors: the pain behind the agony. Increased prevalence of fibromyalgia among Holocaust survivors. Clin Exp Rheumatol. 28(6 Suppl 63):S51-56. "The results indicate a significantly increased prevalence of fibromyalgia among Holocaust survivors six decades after the end of the Second World War."

Ablin JN, Eshed I, Berman M et al. 2016. Prevalence of axial spondyloarthropathy among patients suffering from Fibromyalgia - an MRI study with application of the ASAS classification criteria. Arthritis Care Res (Hoboken). [Jul 7 Epub ahead of print.] "These findings suggest that FMS may mask an underlying axial SpA, a diagnosis with important therapeutic implications. Physicians involved in the management of FMS should remain vigilant to the possibility of underlying inflammatory disorders and actively search for such co-morbidities." [What will it take before they start looking for trigger points and other causes of the central sensitization? DJS]

Ablin JN, Hauser W. 2016. Fibromyalgia syndrome: novel therapeutic targets. Pain Manag. 6(4):371-381. "Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread pain and tenderness, accompanied by disturbed sleep, chronic fatigue and multiple additional functional symptoms. FMS continues to pose an unmet need regarding pharmacological treatment and many patients fail to achieve sufficient relief from existing treatments. As FMS is considered to be a condition in which pain amplification occurs within the CNS, therapeutic interventions, both pharmacological and otherwise, have revolved around attempts to influence pain processing in the CNS. In the current review, we present an update on novel targets in the search for effective treatment of FMS."

Ablin JN, Oren A, Cohen S et al. 2012. Prevalence of fibromyalgia in the Israeli population: a population-based study to estimate the prevalence of fibromyalgia in the Israeli population using the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ). Clin Exp Rheumatol. [Nov 21 Epub ahead of print]. "Fibromyalgia represents the tip of the iceberg of chronic pain in the general population. We have attempted to estimate the prevalence of fibromyalgia in the Israeli population, using the London Fibromyalgia Epidemiology....The prevalence of the fibromyalgia syndrome in the Israeli population is considerable and constitutes a significant health care issue. The prevalence is similar to that observed in other western populations. Based on this tool, over 25% of fibromyalgia cases appear to be among males, a proportion higher than generally appreciated." [This is the same proportion of male FM patients I encountered. DJS]

Abraham A, Franklin E, Stecco C, et al. 2020. Integrating mental imagery and fascial tissue: A conceptualization for research into movement and cognition. Complement Ther Clin Pract. Aug;40:101193. "Mental imagery (MI) research has mainly focused to date on mechanisms of effect and performance gains associated with muscle and neural tissues. MI's potential to affect fascia has rarely been considered. This paper conceptualizes ways in which MI might mutually interact with fascial tissue to support performance and cognitive functions. Such ways acknowledge, among others, MI's positive effect on proprioception, body schema, and pain. Drawing on cellular, physiological, and functional similarities and associations between muscle and fascial tissues, we propose that MI has the potential to affect and be affected by fascial tissue. We suggest that fascia-targeted MI (fascial mental imagery; FMI) can therefore be a useful approach for scientific as well as clinical purposes. We use the example of fascial dynamic neuro-cognitive imagery (FDNI) as a codified FMI method available for scientific and therapeutic explorations into rehabilitation and prevention of fascia-related disabling conditions".

Abramowicz S, Kim S, Susarla HK et al. 2013. Differentiating Arthritic from Myofascial Pain in Children with Juvenile Idiopathic Arthritis: Preliminary Report. J Oral Maxillofac Surg. S0278-2391(12)01617-5. To differentiate between temporomandibular joint (TMJ) inflammation and myofascial pain (MPD) in children with juvenile idiopathic arthritis (JIA). "The results of this study indicate that in patients with JIA and jaw signs/symptoms, there is an overlap in diagnoses between arthritis and MPD. This has considerable implications for patient management." [Patients with jaw pain must be assessed for the presence of myofascial pain due to trigger points, and these TrPs treated ASAP. This may prevent or slow the progress of the OA. DJS]

Abu HO, Saczynski JS, Ware J et al. 2020. Impact of comorbid conditions on disease-specific quality of life in older men and women with atrial fibrillation. Qual Life Res. Jul 11. Online ahead of print. "Older persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases…. Among older persons with AF, while cardiometabolic diseases were highly prevalent, musculoskeletal conditions exerted the greatest impact on patients' disease-specific QoL. Understanding the extent of impairment in QoL due to underlying comorbidities provides an opportunity to develop interventions targeted at diseases that may cause significant impairment in QoL."

Abualnadi N, Frame B, Moore KJ, et al. 2021. Myofascial pain in hysterectomy patients. J Minim Invasive Gynecol. Jun 17;S1553-4650(21)00288-0. "All women underwent a preoperative pelvic floor exam. Myofascial pain was diagnosed as tenderness and reproduction of pain symptoms in at least 2 of 6 pelvic floor muscles…. Of the 353 women who underwent hysterectomy, the prevalence of myofascial pain was 42.7% (86.0% in patients with CPP compared to 13.7% without CPP). … Myofascial pelvic pain must be considered in the evaluation of CPP, especially in surgical candidates.

Abualruz MM, Farr S. 2020. Severe pediatric wrist joint sequelae following blunt trauma in the presence of chronic regional pain syndrome. J Hand Microsurg. Dec;12(3):212-214. "The relevance of this report is therefore to emphasize the possibility, against earlier thoughts, that well-indicated surgeries in pediatric CRPS patients may lead to prompt symptom improvement and may not be uniformly predicted to fail. With the clinical probability of a presence of an uncontrolled, symptomatic causative factor such as cartilage degeneration and chondrolysis, further early diagnostic and therapeutic interventions may be indicated to control the disease."

Abu-Samra M, Gawad OA, Agha M. 2011. The outcomes for nasal contact point surgeries in patients with unsatisfactory response to chronic daily headache medication. Eur Arch Otorhinolaryngol. Apr 3 [Epub ahead of print.] Chronic headache can be caused by or contributed to by trigger areas inside the nose.

Acar EM, Erdogan HK, Sas S, et al. 2021. Evaluation of fibromyalgia syndrome in patients with rosacea. Arch Rheumatol. Jan 14;36(2):252-257. "The frequency of FMS in rosacea patients was significantly higher than control subjects without any skin disease and there was a correlation between disability score of FMS and quality of life score of rosacea. Investigating fibromyalgia symptoms in rosacea patients may be helpful for providing patient-based therapeutic approaches where neurologically based treatments may also be beneficial for rosacea."

Acasuso-Diaz, M. and E. Collantes-Estevez. 1998. Joint hypermobility in patients with fibromyalgia syndrome. Arthritis Care Res 11(1):39-42.

Achermann, J. C. and J. L. Jameson. 1999. Fertility and infertility: genetic contributions from the hypothalamic-pituitary-gonadal axis. Mol Endocrinology. 13(6):812-8.

Acheson DW, Luccioli S. 2004. Microbial-gut interactions in health and disease. Mucosal immune responses. Best Pract Res Clin Gastroenterol 18(2):387-404. This is a good review, including functions of the GI mucosal barrier and permeable membrane, or Leaky Gut Syndrome.

Acosta-Manzano P, Segura-Jimenez V, Estevez-Lopez F et al. 2017. Do women with fibromyalgia present higher cardiovascular disease risk profile than healthy women? The al-Ándalus project. Clin Exp Rheumatol. [Apr 5 Epub ahead of print.] "Clinical data, waist circumference, body fat percentage, resting heart rate, blood pressure and cardiorespiratory fitness were assessed. Moderate-to-vigorous physical activity was objectively assessed with accelerometry. A clustering of individual cardiovascular disease risk factors was represented by the number of cigarettes/day, adiposity, mean arterial pressure, resting heart rate and cardiorespiratory fitness....Women with fibromyalgia presented higher waist circumference and body fat percentage, greater number of cigarettes/day consumption and lower levels of cardiorespiratory fitness after controlling for age, marital status, educational level, occupational status, medication for cholesterol and monthly regular menstruation (all, p<.05). Women with fibromyalgia showed higher clustered cardiovascular disease risk than control women after controlling for the potential confounders described above.... Women with fibromyalgia who did not meet moderate-to-vigorous physical activity recommendations showed increased clustered cardiovascular disease risk after adjusting for the potential confounders described above ....Women with fibromyalgia may present higher risk of cardiovascular disease than controls. Inadequate levels of moderate-to-vigorous physical activity may play a significant role as an additional predisposing factor for cardiovascular disease risk in this population." [These women were not assessed for co-existing insulin resistance, which could account for at least some of the symptoms. DJS]

Adak B, Tekeoglu I, Ediz L et al. 2005. Fibromyalgia frequency in hepatitis B carriers. J Clin Rheumatol. 11(3):157-159. "The present study suggests that chronic hepatitis B carriage appears to increase the risk of FM and many of the typically associated symptoms."

Adams EH, McElroy HJ, Udall M et al. 2016. Progression of fibromyalgia: results from a 2-year observational fibromyalgia and chronic pain study in the US. J Pain Res. 9:325-336. "A previous fibromyalgia (FM) research reports that 20%–47% of diagnosed patients may not meet the study definition of FM 1–2 years after diagnosis.... Most (76.7%) of the subjects who transitioned into/out of FM+CWP+ experienced changes in CWP, number of positive tender points, or both....The results suggest that some FM+CWP+ patients experience fluctuation in symptoms over time, which may reflect the waxing and waning nature of FM and affect diagnosis and treatment." Free PMC Article [It would be interesting to see if this fluctuation were due to trigger points. Nothing was said about them. DJS]

Adams K, Gregory WT, Osmundsen B et al. 2013. Levator myalgia: why bother? Int Urogynecol J. [Apr 11 Epub ahead of print]. "Levator myalgia is a prevalent condition in urogynecology practice, and is associated with approximately 50% greater bother in urinary, defecatory, and prolapse symptoms." [Levator myalgia is a description given to the pain and dysfunction commonly caused by levator ani and other pelvic floor trigger points. DJS]

Adams PJ, Snutch TP. 2007. Calcium channelopathies: voltage-gated calcium channels. Subcell Biochem. 45:215-251. Genetically caused minute changes in calcium ion channels can have a wide spectrum affect on "...mammalian developmental, physiological and behavioral functions." Agents that act on selective calcium channel activity may be important medications for the future.

Adams, W. R., K. J. Spolnik and J. E. Bouquot. 1999. Maxillofacial osteonecrosis in a patient with multiple "idiopathic" facial points. J Oral Pathol Med 28(9):423-32. Called NICO (neuralgia-inducing cavitational osteonecrosis). The underlying problem is vascular insufficiency.

Adelmanesh F, Jalali A, Shooshtari SM et al. 2015. Is there an association between lumbosacral radiculopathy and painful gluteal trigger points? A cross-sectional study. Am J Phys Med Rehabil. 94(10):784-791. "Although rare in the healthy volunteers, most of the patients with lumbosacral radiculopathy had gluteal trigger point, located at the painful side.

Adelowo A, Hacker MR, Shapiro A et al. 2013. Botulinum toxin type A (BOTOX) for refractory myofascial pelvic pain. Female Pelvic Med Reconstr Surg. 19(5):288-292. "Intralevator injection of Botox demonstrates effectiveness in women with refractory myofascial pelvic pain with few self-limiting adverse effects".

Adiguzel O, Kaptanoglu E, Turgut B et al. 2004. The possible effect of clinical recovery on regional cerebral blood flow deficits in fibromyalgia: a prospective study with semi-quantitative SPECT. South Med J. 97(7):651-655. "...these findings could indicate that deficits in cerebral blood flow in fibromyalgia improve parallel to clinical recovery."

Adkisson CD, Yip L, Armstrong MJ et al. 2014. Fibromyalgia symptoms and medication requirements respond to parathyroidectomy. Surgery. 156(6):1614-1621. "FM is common in patients operated on for sporadic PHP (primary hyperparathyroidism). Of those with both conditions, after PTX (parathyroidectomy) 89% appreciate symptom response and 77% and 21% had a decrease in or discontinuation or medications, respectively. Before diagnosing FM, providers should exclude PHP, which is surgically correctable".

Adler GK, Manfredsdottir VF, Creskoff KW. 2002. Neuroendocrine abnormalities in fibromyalgia. Curr Pain Headache Rep 6(4): 289-98. "A combination of multiple, mild impaired responses may lead to more profound physiologic and clinical consequences as compared with a defect in only one system, and could contribute to the symptoms of fibromyalgia."

Adler, G. K., B. T. Kinsley, S. Hurwitz, C. J. Mossey and D. L. Goldenberg. 1999. Reduced hypothalamic pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome. Am J Med 106(5):534-43.

Adler MW, Rogers TJ. 2005. Are chemokines the third major system in the brain? J Leukoc Biol. [Oct 4 Epub ahead of print] The authors propose that the endogenous chemokine system in the brain interacts with the neurotransmitter and neuropeptide systems to govern brain function. [There are abundant chemokine receptors in the glial cells, and activated intrathecal glia have been implicated in the inception and maintenance of chronic pain states. Imbalance of specific neuopeptides, and neurotransmitters and cytokines have been implicated in fibromyalgia, and biochemicals belonging to these systems are released during myofascial trigger point twitch. DJS]

Adriaensen H, Vissers K, Noorduin H et al. 2003. Opioid tolerance and dependence: an inevitable consequence of chronic treatment? Acta Anaesthesiol Belg. 54(1):37-47. "Although opioids provide effective analgesia, largely unsubstantiated concern about opioid-induced tolerance, physical dependence and addiction have limited their appropriate use. As a consequence, many patients receive inadequate treatment for both malignant and non-malignant pain. However, it has been shown that analgesic tolerance develops less frequently during chronic opioid administration in a clinical context than in animal experiments."

Affaitati G, Costantini R, Tana C et al. Co-occurrence of pain syndromes. Neural Transm (Vienna). 2019 Nov 29.[Epub ahead of print] "Many pain conditions in patients tend to co-occur, influencing the clinical expressions of each other in various ways. This paper summarizes the main concurrent pain conditions by analyzing the major interactions observed. In particular, co-occurrence will be examined in: visceral pain (especially ischemic heart disease, irritable bowel syndrome, dysmenorrhea/endometriosis and urinary pain), fibromyalgia, musculoskeletal pain and headache. Two concurrent visceral pains from internal organs sharing at least part of their central sensory projection can give rise to viscero-visceral hyperalgesia, i.e., enhancement of typical pain symptoms from both districts. Visceral pain, headache and musculoskeletal pains (myofascial pain from trigger points, joint pain) can enhance pain and hyperalgesia from fibromyalgia. Myofascial pain from trigger points can perpetuate pain symptoms from visceral pain conditions and trigger migraine attacks when located in the referred pain area from an internal organ or in cervico-facial areas, respectively. The pathophysiology of these pain associations is complex and probably multifactorial; among the possible processes underlying the mutual influence of symptoms recorded in the associations is modulation of central sensitization phenomena by nociceptive inputs from one or the other condition. A strong message in these pain syndrome co-occurrence is that effective treatment of one of the conditions can also improve symptoms from the other, thus suggesting a systematic and thorough evaluation of the pain patient for a global effective management of his/her suffering."

Affaitati G, Costantini R, Tana C et al. 2018. Effects of topical vs injection treatment of cervical myofascial trigger points on headache symptoms in migraine patients: a retrospective analysis. J Headache Pain. 19(1):104. This study (from Italy) found: "In migraine patients with cervical myofascial trigger points whose target areas coincide with migraine sites (M + cTrPs), TrP anesthetic injection reduces migraine symptoms, but the procedure often causes discomfort. This study evaluated if a topical TrP treatment with 3% nimesulide gel has similar efficacy as the injection but produces lesser discomfort with higher acceptability by the patients…. Improvement of migraine and thresholds did not differ in the two TrP-treated groups… In migraine patients, topical treatment of cervical TrPs with 5% nimesulide gel proves equally effective as TrP injection with local anesthetics but more acceptable by the patients. This treatment could be effectively associated to standard migraine prophylaxis to improve therapeutic outcomes."

Affaitati G, Fabrizio A, Savini A et al. 2009. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 31(4):705-720. The lidocaine patch seems effective and acceptable to patients with myofascial pain. [This may be useful in sports therapy, or very early detection of single TrPs. The patch in the study was applied to THE trigger point. For those of us with chronic myofascial pain, having dozens or even hundreds of TrPs, lidocaine patch therapy may not be helpful. DJS]

Affaitati G, Giamberardino MA, Lapenna D et al. 2018. Diclofenac epolamine topical patch for the treatment of pain. J Biol Regul Homeost Agents. 32(3):435-441. Topical nonsteroidal anti-inflammatory drugs have minimal systemic absorption and thus lower side effects. This review of a topical diclofenac preparation, diclofenac epolamine (DHEP) patch 1.3% or diclofenac epolamine patch with heparin as excipient (DHEP+H) showed DEEP effective for mild to moderate pain "... in numerous pain conditions, from minor soft tissue injuries to osteoarthritis and myofascial pain syndromes. Tolerability was good-to-excellent in all studies, with no serious adverse events. DHEP+H further improved efficacy without affecting tolerability. This patch is effective and safe for localized mild-to-moderate somatic pain."

Afonso J, Carvalho T, Cruz L, et al. Ultrasound-guided electroacupuncture for thoracic myofascial pain syndrome: A case report. Cureus. 2023 Mar 31;15(3):e36973. "We present a report on electroacupuncture treatment for myofascial pain syndrome using real-time ultrasound guidance, aimed at avoiding accidental puncture of the pleura when targeting deep muscle layers in the thoracic region."

Afrin LB, Fox RW, Zito SL. 2017. Successful targeted treatment of mast cell activation syndrome with tofacitinib. Eur J Haematol. [Apr 6 Epub ahead of print.] Mast cell (MC) activation syndrome (MCAS) is a collection of illnesses of inappropriate MC activation with little to no neoplastic MC proliferation, distinguishing it from mastocytosis. MCAS presents as chronic, generally inflammatory multisystem polymorbidity likely driven in most by heterogeneous patterns of constitutively activating mutations in MC regulatory elements, posing challenges for identifying optimal mutation-targeted treatment in individual patients. Targeting commonly affected downstream effectors may yield clinical benefit independent of upstream mutational profile. For example, both activated KIT and numerous cytokine receptors activate the Janus kinases (JAKs). Thus, JAK-inhibiting therapies may be useful against the downstream inflammatory effects of MCAS. The oral JAK1/JAK3 inhibitor, tofacitinib, is currently approved for rheumatoid arthritis and is in clinical trials for other chronic inflammatory disorders. Herein, we report two patients with MCAS who rapidly gained substantial symptomatic response to tofacitinib. Their improvement suggests need for further evaluation of this class of drugs in MCAS treatment.

Aftimos, S. 1989. Myofascial pain in children. N Z Med J 102(874):440-441.

Agargun, M. Y., I. Tekeoglu, A. Gunes, B. Adak, H. Kara and M. Ercan. 1999. Sleep quality and pain threshold in patients with fibromyalgia. Compr Psychiatry 40(3):226-8.

Agarwal S, Bedekar N, Shyam A, et al. 2024. Comparison between effects of instrument-assisted soft tissue mobilization and manual myofascial release on pain, range of motion and function in myofascial pain syndrome of upper trapezius - A randomized controlled trial. Hong Kong Physiother J. 2024 Jun;44(1):57-67. "Neither of the treatment options can be considered better that the other. The clinician can decide based on the availability of the instrument, training, patient's preference, and his/her comfort whether which of the two treatment methods should be used.

Agee OA, Leggit JC. Ultrasound-guided lidocaine injection as a novel predictor of response to botulinum for patients with myofascial pain syndrome: A case report. Mil Med. 2024 May 17: Online ahead of print. "Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS."

Aggarwal SK, Carter GT, Sullivan MD et al. 2009. Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State. J Opioid Manag. 5(5):257-286. This interesting study on the use of medical cannabis is one of the first of its kind, including 139 patients, most of whom were male. "Myofascial pain was the most common diagnosis...." Other conditions included fibromyalgia, neuropathic pain, cancer, arthritis, and other chronic pain conditions. Males and females used the medical cannabis at the same rate. "In 51 (31%) patients, there were documented instances of major hurdles related to accessing MC (medical cannabis), including prior physicians unwilling to authorize use, legal problems relating to MC use, and difficulties in finding an affordable and consistent supply of MC..... Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain."

Agrawal Y, Davalos-Bichara M, Zuniga MG et al. 2013. Head impulse test abnormalities and influence on gait speed and falls in older individuals. Otol Neurotol. [Aug 6 Epub ahead of print]. In a tertiary care center, among patients 70 years of age and older, this study found that "...half of the community-dwelling older individuals in our study had evidence of vestibular dysfunction, which was significantly associated with gait speed and fall risk in adjusted analyses. Screening for vestibular impairment using the simple HIT (head impulse test) and directing targeted vestibular therapy may be important to reduce gait impairment and fall risk in older individuals." [Vestibular dysfunction has been observed to be a common co-existing condition with fibromyalgia. DJS]

Aguidelo LZ, Femenia T, Orhan F et al. 2014. Skeletal muscle PGC-1alpha1 modulates kynurenine metabolism and mediates resilience to stress-induced depression. Cell 159(1)33-45. Physical exercise has been shown to reduce depression in some people. This study indicates that one mechanism by which it does this is by suppressing kynurenine, a neurotoxic substance. Exercise activates a specific pathway, changing kynruenin metabolism and reducing depression. [This is important for the subset of people with fibromyalgia who utilize the kynurenine pathway. In these people, 5-HTP is metabolized into kynurenine instead of serotonin. So if taking 5-HTP, L-tryptophan, or eating foods high in tryptophan cause you to feel worse, your body may be utilizing this pathway. This research is giving you hope that exercise may help. DJS See: Schwartz M.J., Offenbacher M., Neumeister A. et al. 2002. Evidence for an altered tryptophan metabolism in fibromyalgia. Neurobiol Dis 11(3):434-442. This study shows an altered tryptophan metabolism in a subgroup of fibromyalgia patients.]

Aguirre CC. 2016. Sleep deprivation: a mind-body approach. Curr Opin Pulm Med. 22(6):583-588. "Recent evidence indicates that sleep plays a vital role in neuro-immuno-endocrine homeostasis. Sleep loss has been linked to elevated risks for cognitive and mood disorders, underscored by impaired synaptic transmission. The glymphatic system has been shown to be modulated by sleep and implicated in neurodegenerative disorders...Interactions between sleep quality, the immune system, and neurodegenerative disease are complex and a challenge to distil. These interactions are frequently bidirectional, because of sleep's characterization as an early symptom and as a potential factor contributing to the development and progression of mood and cognitive disorders."

Ahci S, Bal B, Benbir-Senel G,et al. 2021. Polysomnographic characteristics of sleep-related bruxism: What are the determinant factors for temporomandibular disorders? Cranio. Dec 10;1-7. "This study aimed to evaluate the clinical and polysomnographic characteristics of sleep bruxism (SB) and delineate the determinant factors for temporomandibular disorders (TMD). …. Patients underwent a full-night polysomnographic recording and masseter and temporal muscle electromyographic recordings. Clinical and polysomnographic data in patients with SB were analyzed in relation to TMD. The presence of TMJ sounds was significantly correlated with the number of bruxism bursts. Intra-articular pain in the TMJ was neither correlated with clinical nor polysomnographic parameters in patients with SB. Lower sleep efficiency in patients with SB was caused by a higher number of bruxism episodes. Morning headaches were associated with the severity of SB during rapid eye movement sleep."

Ahi ED, Sirzai H. Comparison of the effectiveness of dry needling and high-intensity laser therapy in the treatment of myofascial pain syndrome: a randomized single-blind controlled study. Lasers Med Sci. 2022 Dec 20;38(1):3. "The addition of HILT and dry needling to exercises is seen as a more successful treatment option to reduce pain in MPS."

Ahiskalioglu EO, Alici HA et al. 2016. Pneumothorax after trigger point injection: A case report and review of literature. J Back Musculoskelet Rehabil. [Feb 16 Epub ahead of print]. "Myofascial pain syndrome is defined as 'pain and/or autonomic phenomena referred from active myofascial trigger points'. Trigger point injection is an effective treatment option, which is widely used to treat myofascial pain....This case report indicates there is a risk of pneumothorax during trigger point injection in the cervicothoracic regions."

Ahmad J, Blumen H, Tagoe CE. 2015. Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis. Rheumatol Int. [May 15 Epub ahead of print.] "There may be a positive association between the ATD antibody TPOAb, and fibromyalgia syndrome and CWP in patients with established RA."

Ahmad J, Tagoe CE. 2014. Fibromyalgia and chronic widespread pain in autoimmune thyroid disease. Clin Rheumatol. [Jan 18 Epub ahead of print.] "Fibromyalgia and chronic widespread pain syndromes are among the commonest diseases seen in rheumatology practice. Despite advances in the management of these conditions, they remain significant causes of morbidity and disability. Autoimmune thyroid disease is the most prevalent autoimmune disorder, affecting about 10% of the population, and is a recognized cause of fibromyalgia and chronic widespread pain."

Ahmed M, Aamir R, Jishi Z et al. 2015. The effects of milnacipran on sleep disturbance in fibromyalgia: A randomized, double-blind, placebo-controlled, two-way crossover study. J Clin Sleep Med. [Sept 14. Epub ahead of print]. "The data suggest that milnacipran is not sedating in most patients with fibromyalgia and improvements in sleep are likely a result of pain improvement."

Ahmed S, Aggarwal A, Lawrence A. 2019. Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting. Rheumatol Int. [May 17 Epub ahead of print] "The sensitivity/specificity of the ACR 2016 in tertiary settings matched those found in previous primary care-based studies. Thus, the ACR 2016 criteria are valid for use in the tertiary setting. However, patients diagnosed by only the ACR 2016 criteria (and not by the ACR 1990) have high probability of having another concomitant comorbidity."

Akassoglou K., Strickland S. 2002. Fibrin inhibits nerve regeneration by arresting schwann cell differentiation. Glia (Suppl 1):S42 [Abstract]. "These results provide the first indication that fibrin, a blood-derived protein, which becomes a component of the extracellular matrix of the nervous system in pathological states, can affect repair by negatively regulating myalination. Dysregulation of fibrin clearance and/or deposition could play a role in traumatic injuries of the nervous system, as well as in demyelinating diseases such as multiple sclerosis."

Akdogan S, Ayhan Ff, Yildirim S et al. 2013. Impact of fatigue on cognitive functioning among premenopausal women with fibromyalgia syndrome and rheumatoid arthritis. J Musculoskel Pain 21(2):135-146. Women with fibromyalgia, rheumatoid arthritis, and healthy controls were compared for fatigue and cognitive impairment. "After adjustment for age, education level and possible related factors...test data were found to correlate with pain, fatigue, anxiety, depression, dizziness, forgetfulness and sleeplessness.... Fatigue was the predictor of attentional impairment...."

Akel A, Bilal Almanasyeh B, Abo Kobaa A, et al. A cross-sectional study of fibromyalgia and post-acute COVID-19 Syndrome (PACS): Could there be a relationship? Cureus. 2023 Jul 29;15(7):e42663."Conclusion: Our data suggest that clinical features of fibromyalgia are common in patients who recovered from COVID-19 and that dyspnea and female gender increase the risk of developing post-COVID-19 fibromyalgia."

Akin Korhan E, Uyar M, Eyigor C et al. 2016. Effects of reflexology on pain in patients with fibromyalgia. Holist Nurs Pract. 30(6):351-359. "Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. "Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients."

Akkasilpa S, Goldman D, Magder LS et al. 2005. Number of fibromyalgia tender points is associated with health status in patients with systemic lupus erythematosus. J Rheumatol. 32(1):48-50. "A strong association between the number of FM TPs and health status was found in patients with SLE. The number of TPs, and not just the presence/absence of FM, is associated with health status in SLE."

Akkaya H, Güntürk EE, Kaydok E et al. 2020. Determination of the increased risk of developing atrial fibrillation in fibromyalgia syndrome. Adv Rheumatol. Jan 30;60(1):14. "Atrial fibrillation (AF) is the leading cause of ischemic stroke and is one of the most common arrhythmias… Impaired diastolic functions, an increase in Pd (P wave dispersion), and prolongation of ACT (atrial conduction times) were observed in FMS. Current disorders are thought to be associated with an increased risk of AF in FMS. The risk of developing AF (atrial fibrillation) increases with the severity of FMS and clinical progression.[It would be informative to check these subjects for TrPs known to cause arrhythmia in the pectoralis major and sternalis. DJS]

Akkaya N, Atalay NS, Selcuk ST et al. 2012. Frequency of fibromyalgia syndrome in breast cancer patients. Int J Clin Oncol. [Feb 10 Epub ahead of print]. "We note that the frequency of FM in the operated breast cancer patients in this study was higher than that reported in normal populations in the literature. Also, we found that the presence of FM had negative effects on the quality of life of the breast cancer patients. Accordingly, in the evaluation of widespread pain and complaints of fatigue in long-surviving breast cancer patients, after metastatic disease is excluded, the probability of FM should be kept in mind, so that appropriate treatment can be initiated to improve their functional status and quality of life."

Aksu E, Berk E, Sokmen A,et al. 2020. Subclinical cardiac structural and electrical abnormalities in fibromyalgia syndrome. Turk J Med Sci. Apr 14.[Epub ahead of print] "FMS found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients."

Akturk S, Kaya A, Cetintas D et al. 2018. Comparison of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study. J Phys Ther Sci. 30(3):448-453. "These results suggest that ESWT is as effective as US."

Al-Alawi A, Mulgrew A, Tench E et al. 2006. Prevalence, risk factors and impact on daytime sleepiness and hypertension of periodic leg movements with arousals in patients with obstructive sleep apnea. J Clin Sleep Med. 2(3):281-287. "Risk factors for PLMS include preexisting medical conditions -- particularly depression, fibromyalgia, and diabetes mellitus -- increasing age, predisposing medications, obesity and OSA."

Al Saif AA, Al Senany S. 2015. Determine the effect of neck muscle fatigue on dynamic visual acuity in healthy young adults. J Phys Ther Sci. 27(1):259-263. "The results of this study suggest that neck muscle fatigue negatively impacts dynamic visual acuity."

Al-Shenqiti AM, Oldham JA. 2005. Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis. Clin Rehabil. 19(5):482-487. "The presence or absence of the taut band, spot tenderness, jump sign and pain recognition was highly reliable between sessions. Referred pain and local twitch response reliability varied depending on the muscle being studied." [Again, both training and experience are vital to reliably diagnose and treat TrPs. DJS]

Alaca N. The impacts of internet addiction on depression, physical activity level and trigger point sensitivity in Turkish university students. J Back Musculoskelet Rehabil. 2019 Nov 15.[Epub ahead of print] "Internet addiction (IA), defined as excessive, time consuming, uncontrollable use of the internet, has become a widespread problem. In this study, we investigated the impact of internet addiction on depression, physical activity level, and latent trigger point sensitivity in Turkish university students.... The internet addiction rate was 24.3% in our students....IA is a growing problem. This addiction may lead to musculoskeletal problems and can have consequences involving the level of physical activity, depression, and musculoskeletal disorders, particularly in the neck."

Alanoglu E, Ulas UH, Ozdag F. et al. 2004. Auditory event-related brain potentials in fibromyalgia syndrome. Rheumatol Int. [Epub Feb 21 ahead of print]. "...FM affects quality of life and dysfunction in cognitive abilities can be determined by brain event-related potentials."

Alahmari KA, Reddy RS, Silvia P et al. 2017. Influence of chronic neck pain on cervical joint position error (JPE): Comparison between young and elderly subjects. J Back Musculoskelet Rehabil. [Aug 3 Epub ahead of print] "Cervical joint position sense is impaired in subjects with chronic neck pain."

AlAujan SS, Almalag HM, Omair MA. 2021. Prevalence of fibromyalgia in pharmacy professionals and students: A cross-sectional study. J Pain Res. Mar 31;14:837-847. "This was a cross-sectional survey conducted on members of the Saudi Pharmaceutical Society …. After adjusting for significant variables, the resulting adjusted odds ratio of developing FM was 4.86 in people working for 41-45 h weekly…5.16 in people who frequently wake up during sleep…and 12.99 in people with sleep apnea or other sleeping disorders…. FM was prevalent among pharmacy students and professionals and was much more than data reported on the general population or other healthcare workers. Traditional factors along with higher working hours were identified as significant variables." [Lack of sleep can be a significant FM initiating/perpetuating factor. DJS]

Albagieh H, Aloyouny A, Alshehri N et al. 2020. Efficacy of lidocaine versus mepivacaine in the management of myofascial pain. Saudi Pharm J. Oct;28(10):1238-1242. "No drug was superior in the long term; thus, the clinician's choice can be based on drug availability and patient medical history".

Albrecht DS, Forsberg A, Sandstrom A et al. 2018. Brain glial activation in fibromyalgia - A multi-site positron emission tomography investigation. Brain Behav Immun. [Sep 14 Epub ahead of print]. "Fibromyalgia (FM) is a poorly understood chronic condition characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties. While mounting evidence suggests a role for neuroinflammation, no study has directly provided evidence of brain glial activation in FM. In this study, we conducted a Positron Emission Tomography (PET) study using [11C]PBR28, which binds to the translocator protein (TSPO), a protein upregulated in activated microglia and astrocytes. To enhance statistical power and generalizability, we combined datasets collected independently at two separate institutions (Massachusetts General Hospital [MGH] and Karolinska Institutet [KI]). In an attempt to disentangle the contributions of different glial cell types to FM, a smaller sample was scanned at KI with [11C]-L-deprenyl-D2 PET, thought to primarily reflect astrocytic (but not microglial) signal. Thirty-one FM patients and 27 healthy controls (HC) were examined using [11C]PBR28 PET. 11 FM patients and 11 HC were scanned using [11C]-L-deprenyl-D2 PET. Standardized uptake values normalized by occipital cortex signal (SUVR) and distribution volume (VT) were computed from the [11C]PBR28 data. [11C]-L-deprenyl-D2 was quantified using?λ?k3. PET imaging metrics were compared across groups, and when differing across groups, against clinical variables. Compared to HC, FM patients demonstrated widespread cortical elevations, and no decreases, in [11C]PBR28 VT and SUVR, most pronounced in the medial and lateral walls of the frontal and parietal lobes. No regions showed significant group differences in [11C]-L-deprenyl-D2 signal, including those demonstrating elevated [11C]PBR28 signal in patients (p's?≥?0.53, uncorrected). The elevations in [11C]PBR28 VT and SUVR were correlated both spatially (i.e., were observed in overlapping regions) and, in several areas, also in terms of magnitude. In exploratory, uncorrected analyses, higher subjective ratings of fatigue in FM patients were associated with higher [11C]PBR28 SUVR in the anterior and posterior middle cingulate cortices (p's?<?0.03). SUVR was not significantly associated with any other clinical variable. Our work provides the first in vivo evidence supporting a role for glial activation in FM pathophysiology. Given that the elevations in [11C]PBR28 signal were not also accompanied by increased [11C]-L-deprenyl-D2 signal, our data suggests that microglia, but not astrocytes, may be driving the TSPO elevation in these regions. Although [11C]-L-deprenyl-D2 signal was not found to be increased in FM patients, larger studies are needed to further assess the role of possible astrocytic contributions in FM. Overall, our data support glial modulation as a potential therapeutic strategy for FM." Free Article [This is important. We now have research showing that glial cells in the brain are activated in FM patients, and before we only had research showing that glial cells are activated in the spinal cord in FM patients. I hope that researchers are finally going to focus on glial cells, rather than dedicating almost all the research dollars to neuron cells. DJS]

Albrecht DS, MacKie PJ, Kareken DA et al. 2015. Differential dopamine function in fibromyalgia. Brain Imaging Behav. [Oct 24 Epub ahead of print.] "The data suggest that abnormal DA (dopamine) function may be associated with differential processing of pain perception in FM. Further studies are needed to explore the functional significance of DA in nociception and cognitive processing in chronic pain."

Albright, G. L. and A. A. Fischer. 1990. Effects of warming imagery aimed at trigger-point sites on tissue compliance, skin temperature, and pain sensitivity in biofeedback-trained patients with chronic pain: a preliminary study. Percept Mot Skills 71(3 Pt 2):1163-70.

Album D, Westin S. 2007. Do diseases have a prestige hierarchy? A survey among physicians and medical students. Soc Sci Med. [Sep 10 Epub ahead of print] Medical specialties and illnesses are considered to have a ranking among doctors and medical students. "Myocardial infarction, leukemia and brain tumor were among the highest ranked, and fibromyalgia and anxiety neurosis were among the lowest." "Low prestige scores are given to diseases and specialties associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients." [It seems we have a lot of educating to do, and it is no wonder FM patients are considered to have a self-esteem problem. See: "Bennett RM. 2007. Do patients' perceptions of negative physician attitudes influence fibromyalgia symptoms and status?" This would seem to indicate that some doctors could be major perpetuating factors. DJS.]

Alburquerque-García A, Rodrigues-de-Souza DP, Fernandez-de-Las-Penas C et al. 2015. Association between Muscle Trigger Points, Ongoing Pain, Function, and Sleep Quality in Elderly Women with Bilateral Painful Knee Osteoarthritis. J Manipulative Physiol Ther. [Apr 25 Epub ahead of print.] "The objectives of this study were to investigate if referred pain elicited by active trigger points (TrPs) reproduced the symptoms in individuals with painful knee osteoarthritis (OA) and to determine the relationship between the presence of active TrPs, intensity of ongoing pain, function, quality of life, and sleep quality in individuals with painful knee OA....The referred pain elicited by active TrPs in the lower extremity muscles contributed to pain symptoms in painful knee OA. A higher number of active TrPs was associated with higher intensity of ongoing knee pain." [Some of the pain and perhaps other symptoms often attributed to OA may be due to co-existing trigger points. DJS]

Alburquerque-Sendín F, Camargo PR, Vieira A et al. 2013. Bilateral myofascial trigger points and pressure pain thresholds in the shoulder muscles in patients with unilateral shoulder impingement syndrome: A Blinded, Controlled Study. Clin J Pain. [Jan 16 Epub ahead of print]. "To identify the presence of myofascial trigger points (TrPs) and pressure pain threshold (PPT) levels in the shoulder muscles of both involved and uninvolved sides in patients with unilateral shoulder impingement syndrome (SIS)... SIS group showed a greater number of TrPs...than the control group. The muscles of the uninvolved side of the SIS group also presented some active TrPs.... The muscle PPTs of the patients presenting TrPs in each muscle of the involved side were lower than the PPTs of the patients without TrPs in the same muscle for both involved and uninvolved sides with few significant differences....The high number of TrPs in the involved side of patients with SIS suggests the presence of peripheral sensitization. The results reject the presence of central alterations. Finally, the patients with unilateral SIS may present bilateral deficits related to myofascial pain."

Alciati A, Atzeni F, Grassi M et al. 2017. Childhood adversities in patients with fibromyalgia: are they related to comorbid lifetime major depression? Clin Exp Rheumatol. 35 Suppl 105(3):112-118. "The results of this study suggest that there is no association between childhood adversities and comorbid lifetime major depression in patients with FM. As it would be helpful to prevent the development of FM because of the high cost and limited efficacy of therapeutic interventions, childhood adversities may offer targets for primary prevention."

Alciati A, Atzeni F, Masala IF et al. 2018. Controlled-release pregabalin in the treatment of fibromyalgia. Expert Rev Neurother. 18(8):617-623. "Together with the antidepressants duloxetine and milnacipran, the anticonvulsant pregabalin (PGB) is one of the three drugs approved by the Food and Drug Administration for the treatment of FM. The aim of this narrative review is to summarize the data relating to the efficacy and safety of the controlled-release formulation of PGB (PGB-CR) in patients with FM. Areas covered: Efforts by the pharmaceutical industry have led to the introduction of new formulations of already approved drugs to enhance treatment convenience and adherence. Expert opinion: Although there are no published studies specifically comparing PGB-CR and PGB-IR formulations in FM patients, the efficacy and safety profiles of PGB-CR seem to be similar to those of the IR formulation, and the convenience of once-daily dosing potentially enhances patient compliance. However, the amount of evidence is not sufficient to draw any definite conclusions, and further studies of larger patient samples are needed."

Alciati A, Caldirola D, Sarzi-Puttini P et al. 2016. Is panic disorder associated with clinical severity of fibromyalgia? A preliminary study in a tertiary-care centre. Clin Exp Rheumatol. 34(2 Suppl 96):99-105. "A history of PD in patients with FM increases the severity of functional impairment in performing a wide range of daily-life activities, as measured by the HAQ (Health Assessment Questionnaire) scale, with no effects on the severity of other clinical dimensions of FM. Potential underlying mechanisms and clinical implications will be discussed."

Alexander RE. 2013. Clinical effectiveness of electroacupuncture in meralgia paresthetica: a case series. Acupunct Med. [Oct 23 Epub ahead of print]. "Meralgia paresthetica is a fairly common condition resulting from entrapment of the lateral femoral cutaneous nerve. I have found that acupuncture produces a rapid improvement, sometimes affecting a cure, after only one or two treatments. ...Most patients were able to stop their analgesics. Meralgia paresthetica appears to respond rapidly to electroacupuncture. A significant trigger point at GB31 was universally present, which may aid diagnosis, although the reason for this is unclear. Further controlled studies are justified." [All of these acupuncture point locations can be trigger points. Meralgia paresthetica can also be successfully treated with trigger point injection or dry needling in the quadriceps TrPs at that point, but must include palpation for and treatment of associated hip and thigh TrPs and identification and control of all perpetuating factors. If all the relevant TrPs are treated and the perpetuating factors brought under control, this usually takes one treatment. DJS]

Alford, F. P., F. L. Hew, M. C. Christopher and C. Rantzau. 1999. Insulin sensitivity in growth hormone (GH)-deficient adults and effect of GH replacement therapy. J Endocrinol Invest 22(5 Suppl):28-32.

Alghadir AH, Iqbal A, Anwer S, et al. 2020. Efficacy of combination therapies on neck pain and muscle tenderness in male patients with upper trapezius active myofascial trigger points. Biomed Res Int. Mar 10;2020:9361405. This study divided 60 male subjects with trapezius TrPs causing neck pain into 3 groups: one group receiving muscle energy technique plus ischemic compression technique plus conventional treatment, one group receiving one group receiving muscle energy technique plus conventional treatment, and one group that only received conventional treatment. The group receiving muscle energy technique plus ischemic compression technique and conventional treatment "showed immediate and short-term (2-week follow-up) improvements in neck pain and muscle tenderness in male patients with upper trapezius active MTrPs."

Alix ME, Bates DK. 1999. A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. J Manipulative Physiol Ther. 22(8):534-539. This study found bridges formed of connective tissue at the atlanto-occipital junction between the rectus capitis posterior and the dorsal spinal dura. Tightness of these connections may be associated with headache. "The dura-muscular, dura-ligamentous connections in the upper cervical spine and occipital areas may provide anatomic and physiologic answers to the cause of the cervicogenic headache."

Ali MA, Rehman M, Saeed M. 2017. Rheumatoid arthritis masquerading as fibromyalgia. J Coll Physicians Surg Pak. 27(9):S134-S136. This study from Karachi found: "Symptoms of inflammatory arthritis such as rheumatoid arthritis (RA) can overlap with fibromyalgia syndrome (FMS). Moreover, FMS and RA can coexist. Hence, the diagnosis of low intensity, antibody-negative RA may present a challenge. Here, we present the case of a middle-aged woman thought to have FMS, osteoarthritis and osteoporosis for 4 years prior to being diagnosed as seronegative RA on musculoskeletal ultrasound (MSKUS). Targeted therapy with etanercept led to a complete clinical response and normalization of previously elevated C-reactive protein. We conclude that MSKUS is a sensitive tool for distinguishing low-intensity inflammatory arthritis from FMS with important clinical consequences." [One must always look for the cause of the central sensitization of FM. DJS]

Aliyev R, Vieth T, Geiger G. 2010. Traditional Chinese medicine in diagnosis and treatment of fibromyalgia syndrome. Georgian Med News. (188):38-45. "Fibromyalgia Syndrome (FS) is known for the difficulties arising from classification. The accompanying pain in skeletal muscles, myofascial peri-articular structures and a number of polymorphic symptoms cannot be separated into complexes of symptoms. The application of principles of Traditional Chinese Medicine (TCM) helps in analyzing the symptoms of FS to detect a leading syndrome and thereby establish an individual therapy. Medical histories and objective examinations of 25 patients with FS and 22 patients with vertebrogenic pain syndromes were analyzed according to TCM. A questionnaire was used to determine the leading constitutional type according to the 5-elements-theory. Analyses of the results showed that 83% of patients with FS were of constitutional type of the element earth. The following syndromes were found to be important in FS: 1) liver-Qi-stagnation, 2) Yin and blood deficiency of the liver, 3) Yang-weakness of the spleen and kidney, 4) Yin-weakness of the kidney. Applying TCM for FS allows for separating a group of symptoms and thus individual therapy. The determination of the constitutional type according to the 5-elements-theory may be used for a better understanding of the disharmony pattern."

Alkabbani W, Marrie RA, Bugden S et al. 2018. Pharmaceutical cannabinoid use in Manitoba, 2004/05 to 2014/15: a population-based cross-sectional study. CMAJ Open. 6(4):E637-E642. "The highest use was among older adults aged 46-64 years, females and urban area residents. One-third of incident users (1775 [35.3%]) had a diagnosis of fibromyalgia in a 2-year period before their first cannabinoid prescription. General practitioners initiated almost half (2350 [46.7%]) of first prescriptions, and anesthesiologists/pain specialists initiated one-quarter (1299 [25.8%])."

Allcock N, McGarry J, Elkan R. 2002. Management of pain in older people within the nursing home: a preliminary study. Health Soc Care Comm. 10(6):464-471. "It has been estimated that approximately two-thirds of people aged 65 years and over experience chronic pain, and that the prevalence of chronic pain in nursing home residents is between 45% and 80%. Overall, 37% of nursing home residents were identified as experiencing chronic non-malignant pain."

Allen JM, Graef DM, Ehrentraut JH et al. 2016. Sleep and pain in pediatric illness: A conceptual review. CNS Neurosci Ther. 22(11):880-893. "Sleep disruption is a common comorbidity of pediatric pain. Consequences of pain and disrupted sleep, evidence for the pain-sleep relation, and how aspects of illness, treatment, and pharmacological pain management may contribute to or exacerbate these issues are presented.... This conceptual review explored the relation between pain and sleep in children diagnosed with chronic medical or developmental conditions.... Populations reviewed include youth with intellectual and developmental disabilities (IDD), migraines, cystic fibrosis (CF), sickle cell disease (SCD), cancer, juvenile idiopathic arthritis (JIA), juvenile fibromyalgia (JFM), and functional gastrointestinal disorders (FGIDs)....Consistent evidence demonstrates that children with medical or developmental conditions are more vulnerable to experiencing pain and subjective sleep complaints than healthy peers. Objective sleep concerns are common but often under-studied. Evidence of the pain-sleep relationship exists, particularly in pediatric SCD, IDD, and JIA, with a dearth of studies directly examining this relation in pediatric cancer, JFM, CF, and FGIDs. Findings suggest that assessing and treating pain and sleep disruption is important when optimizing functional outcomes."

Almeida, TF, Roizenblatt, S, Benedito, Silva AA, et al. 2003. The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia. Pain 104(3):665-672. Combined therapy with pulsed ultrasound and interferential current can be an effective therapy for pain and sleep dysfunction in fibromyalgia patients.

Alnahhas MF, Oxentenko SC, Locke GR 3rd et al. 2015. Outcomes of ultrasound-guided trigger point injection for abdominal wall pain. Dig Dis Sci. Aug 30. [Epub ahead of print] This study from the Mayo Clinic found that about a third of the patients with abdominal wall pain could have pain significantly relieved long-term by trigger point injection.

Al-Nimer MSM, Mohammad TAM, Alsakeni RA. 2018. Serum levels of serotonin as a biomarker of newly diagnosed fibromyalgia in women: Its relation to the platelet indices. J Res Med Sci. 23:71. "This case-control study [Iraq] included 35 healthy women (Group I) served as controls and 130 women with newly diagnosed FM (Group II). The diagnosis of FM was confirmed by the diagnostic criteria of the American College of Rheumatology-10. The assessment of pain using a revised fibromyalgia impact questionnaire and tender points scoring, blood platelet indices, and serum serotonin levels were determined.... Newly diagnosed FM women have significantly low-serum serotonin levels, which does not correlate with a significant increment of the platelet activity expressed as increase MPV and platelet width distribution percentage. Therefore, this study highlighted that the correction of serum serotonin level by medicines could help the patients." Free Article

Alodiabi F, Alhowimel A, Alotaibi M et al. 2020. Knowledge, awareness, and perceptions of the diagnosis and management of fibromyalgia among physical therapists in Saudi Arabia: A cross-sectional survey. Open Access Rheumatol. Nov 30;12:293-301. "Participating physical therapists showed little awareness of or confidence in the assessment and management of patients with FM; moreover, their awareness was not supported by their adherence to recent FM guidelines. Despite the common practice of referring patients with FM for physical therapy, there are many misconceptions about FM. This study highlights the need for educational programs to provide up-to-date evidence in undergraduate and postgraduate education." [It would be interesting to discover if this lack of understanding is similar in other countries, and how much PTs are willing to adapt their therapy to adjust to the needs to patients with FM and/or MTrPs. DJS]

Alonso-Blanco C, de-la-Llave-Rincon AI, Fernandez-de-las-Penas C. 2012. Muscle trigger point therapy in tension-type headache. Expert Rev Neurother. 12(3):315-322. "Recent evidence suggests that active trigger points (TrPs) in neck and shoulder muscles contribute to tension-type headache. Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms. It seems that the pain profile of this headache may be provoked by referred pain from active TrPs in the posterior cervical, head and shoulder muscles. In fact, the presence of active TrPs has been related to a higher degree of sensitization in tension-type headache. Different therapeutic approaches are proposed for proper TrP management. Preliminary evidence indicates that inactivation of TrPs may be effective for the management of tension-type headache, particularly in a subgroup of patients who may respond positively to this approach. Different treatment approaches targeted to TrP inactivation are discussed in the current paper, focusing on tension-type headache. New studies are needed to further delineate the relationship between muscle TrP inactivation and tension-type headache."

Alonso-Blanco C, Fernández-de-Las-Penas C, de-la-Llave-Rincón AI et al. 2012. Characteristics of referred muscle pain to the head from active trigger points in women with myofascial temporomandibular pain and fibromyalgia syndrome. J Headache Pain. [Aug 31 Epub ahead of print]. "Women with FMS had larger referred pain areas than those with TMD for sternocleidomastoid and suboccipital muscles.... Significant differences within COG coordinates of TrP referred pain areas were found in TMD, the referred pain was more pronounced in the orofacial region, whereas the referred pain in FMS was more pronounced in the cervical spine. This study showed that the referred pain elicited from active TrPs shared similar patterns as usual pain symptoms in women with TMD or FMS, but that distinct differences in TrP prevalence and location of the referred pain areas could be observed. Differences in location of referred pain areas may help clinicians to determine the most relevant TrPs for each pain syndrome in spite of overlaps in pain areas."

Alonso-Blanco C, Fernandez-de-Las-Penas C, Morales-Cabezas M et al. 2011. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. [Feb 28 Epub ahead of print]. "The local and referred pain elicited from widespread active MTrPs fully reproduced the overall spontaneous clinical pain area in patients with FMS. Widespread mechanical pain hypersensitivity was related to a greater number of active MTrPs. This study suggests that nociceptive inputs from active MTrPs may contribute to central sensitization in FMS."

Alonso-Ruiz, A., A. De la Hoz-Martinez and A. C. Zea-Mendoza. 1985. Fibromyalgia syndrome as a late complication of toxic-oil syndrome. J Rheumatol 12(6):1207-1208.

Aloush V, Niv D, Ablin JN et al. 2020. Good pain, bad pain: illness perception and physician attitudes towards rheumatoid arthritis and fibromyalgia patients. Clin Exp Rheumatol. Dec 15. Online ahead of print. Forty-five rheumatologists were enrolled in the study.... Of 45 physicians included in the study, only 53% were willing to accept FM patients. FM was considered a more severe disease than RA... in terms of treatment control, understanding and emotional response generated by the disease. Doctor-patient relationship was perceived more difficult with FM patients compared to RA patients...and was significantly correlated to the patient's concern about the illness...and patient's emotional response.... Resistance to accept FM patients was largely influenced by difficult doctor-patient relationship. Higher levels of empathy were found in physicians experiencing less difficulty with FM patients.... A high proportion of physicians were reluctant to accept them because they feel emotional/psychological difficulties meeting and coping with these patients."

Al-Qadi M, Dagmar Renaud D, Meyer M 2020. ["But you've got to do something yourself as well" : Coping with fibromyalgia syndrome (FMS): perspectives of those affected and those treating them in Saarland] Schmerz. Sep 22. Online ahead of print. [Article in German] "Both FMS patients and healthcare providers noted problems with availability and accessibility of health services. In addition, some patients felt that they were not taken seriously by their healthcare providers. Care providers in turn experienced reservations about the psychosomatic component on the part of patients. Self-initiative seems to be important for a positive approach to living with FMS… Self-help groups and regionally available networks represent important support possibilities, not least with regard to the psychosomatic component of FMS. Improved coordination of care services can be achieved by promoting interdisciplinary networking. Strengthening the self-initiative of patients and promoting the work of self-help groups can help those affected to develop individual coping strategies."

Al-Shenqiti AM, Oldham JA. 2009. Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis. Clin Rehabil. 19(5):482-487. "The presence or absence of the taut band, spot tenderness, jump sign and pain recognition was highly reliable between sessions. Referred pain and local twitch response reliability varied depending on the muscle being studied."

Alvarez DJ, Rockwell PG. 2002. Trigger points: diagnosis and management. Am Fam Physician 65(4):653-660. "Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms."

Alvarez MC, Albuquerque MLL, Neiva HP. Exploring the relationship between fibromyalgia-related fatigue, Physical Activity, and Quality of Life Int J Environ Res Public Health 2022 Apr 17;19(8):4870. "Physical activity does not mediate the relationship between fatigue and quality of life. However, the results also show that the fatigue dimensions associated with fibromyalgia had a negative and significant association with physical and mental health indicators in both samples. Thus, patients with FM with higher scores on fatigue-related symptoms might suffer more from physical and mental health, both of which are related to quality of life."

Álvarez-Nemegyei J, Pacheco-Pantoja E, Olán-Centeno LJ, et al. 2022. Association between fibromyalgia syndrome clinical severity and body composition. A principal component analysis. Reumatol Clin (Engl Ed). 2022 Nov;18(9):538-545. "The results suggest that the volume of fat mass can negatively modulate the severity of FMS. We propose that the evaluation of body composition should be a basic element for the clinical approach of patients with FMS."

Aly T.A., Tahaka Y., Aizawa T. et al. 2002. Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases. Tohoku J Exp Med 197(4):229-31. Nerve entrapment causing pain radiating down the low back may be caused by myofascial trigger points, but these are often misdiagnosed. These two patients completely recovered after trigger point therapy, even though they had been misdiagnosed and in pain for a long time.

Alyanak B, Dede BT, Temel MH, et al. Re: 2024. Casting light on the overlooked trigger point of the interosseous muscles in metatarsalgia: insights and treatment strategies. Ultrasonography. 2024 Sep;43(5):393-394. "Although the literature on the use of ultrasonography (US) for diagnosing myofascial pain syndrome (MPS) is somewhat limited, there has been a notable increase in research on this topic in recent years. MPS is a prevalent condition, with estimates suggesting that among patients with chronic musculoskeletal pain, the prevalence of MPS can range from 85% to 95%. Despite its commonality, MPS is frequently overlooked by clinicians…. Typically, a myofascial trigger point appears on US imaging as a hypoechoic nodule with well-defined borders and a heterogeneous internal echotexture. Vibratory sonoelastography typically displays these nodules as hard, while Doppler imaging reveals altered blood flow patterns around MTrPs, with active MTrPs exhibiting high-resistance and retrograde diastolic flow. Additionally, US guidance improves the detection of local twitch responses in deep muscles, which are frequently overlooked by visual inspection alone.…The trigger points of the interosseous muscles are often not visualized using ultrasonography….These trigger points can be addressed using dry needling therapy, which may be performed with either a blinded or an ultrasound-guided approach." [Myofascial TrPs can entrap blood and lymph vessels as well as nerves. Please note the mention of "high-resistance and retrograde diastolic flow." I believe that this causes at least some erratic hypertension in MPS (and FM, although the TrP symptoms are too often are misdiagnosed or not diagnosed at all, and may be labeled as "catastrophizing" or otherwise psychological in nature. This all too often occurs if the care provider lacks training in myofascial medicine. DJS]

Al-Zamil M, Kulikova NG, Shnayder NA, et al. 2024. Efficiency of lidocaine intramuscular and intraosseous trigger point injections in the treatment of residual chronic pain after degenerative lumbar spinal stenosis decompression surgery. J Clin Med. 2024 Sep 13;13(18):5437. "LTPI is highly effective in the treatment of patients with residual pain after DLSS decompression surgery. High analgesic effect, significant regression of sensory deficits and gait disorders, and remarkable improvement of daily step activity and quality of life are noted not only after the end of LTPI treatment but also continue for at least 2 months after treatment."

Amador NJ, Shivers K, Weiner J et al. Program 51.16/M8. Estrus cycle effects on behavioral and physiological responses to formalin-induced inflammatory pain. Georgia World Congress Center Atlanta, GA. Society for Neuroscience, Presentation.: Oct 14, 2006. Hormones may physically affect perceptions of pain.

Aman M, Biglari B, Thielen M, et al. An algorithm for elective amputation combined with targeted muscle reinnervation in complex regional pain syndrome-A perspective. J Pers Med. 2022 Jul 19;12(7):1169. "Complex regional pain syndrome (CRPS) can result in a devastating condition. For a small number of patients, there is a non-response to any existing multimodal therapies and they ultimately request amputation. Such a drastic and final decision is not easy to take for both the patient and the surgeon and requires careful and interdisciplinary assessments and considerations. Furthermore, new surgical procedures, such as targeted muscle reinnervation (TMR) and hybrid prosthetic fitting, and multidisciplinary board advice should be included when considering amputation. In order to help other therapeutic teams in decision making for such rare but more than demanding cases, we aimed to propose an advanced algorithm for amputation indications in CRPS patients combining all these new factors. This algorithm consists of extensive pre-operative psychiatric assessment, diagnostic hybrid prosthetic fitting including fMRI analyses, multidisciplinary board advice as well as targeted muscle reinnervation and amputation procedures with final prosthetic fitting and rehabilitation." [I have observed and experienced CRPS progression along MTrP referral patterns. Perhaps if any such TrPs are considered and, if present, appropriately treated, some of these patients might not have to take this drastic step. DJS]

Ambrose KR, Golightly YM. 2015. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 29(1):120-30. "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." [This is a very wise article that articulates the need for careful and individually tailored exercise. DJS]

Amital M, Ben-Shabat N, Amital H, et al. 2021. COVID-19 associated hospitalization in 571 patients with fibromyalgia-A population-based study. PLoS One. Dec 30;16(12):e0261772. "The current population-based study revealed that FM per se was not directly associated with COVID-19 hospitalization or related mortality. Yet classical risk factors endangering the general population were also relevant among patients with FM."

Amris K, Jespersen A. 2010. [Fibromyalgia as a neuropathic pain condition]. Ugeskr Laeger. 172(24):1832-1835. [Danish]. "Fibromyalgia is characterized by chronic widespread pain and mechanical hyperalgesia. It is associated with a higher pain intensity, fewer pain-free intervals and more pronounced pain-related interference in function than other musculoskeletal pain conditions. Increasing evidence supports an underlying augmented central pain processing which includes sensitization of pain-transmitting neurons and dysfunction of pain inhibitory pathways. If this permanent change in the function of the nociceptive system is shown to equal fibromyalgia, the condition may be considered a neuropathic pain condition."

Amutio A, Franco C, Perez-Fuentes Mde C et al. 2015. Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. Front Psychol. 5:1572. "Fibromyalgia is a disabling syndrome. Results obtained with different therapies are very limited to date. The goal of this study was to verify whether the application of a mindfulness-based training program was effective in modifying anger, anxiety, and depression levels in a group of women diagnosed with fibromyalgia. This study is an experimental trial that employed a waiting list control group. Measures were taken at three different times: pretest, posttest, and follow-up. The statistical analyses revealed a significant reduction of anger (trait) levels, internal expression of anger, state anxiety, and depression in the experimental group as compared to the control group, as well as a significant increase in internal control of anger. It can be concluded that the mindfulness-based treatment was effective after 7 weeks. These results were maintained 3 months after the end of the intervention." Free PMC Article

Anand KJ. 2000. Pain, plasticity, and premature birth: a prescription for permanent suffering? Nat Med 6(9):971-973. Premature infants and other children requiring medical procedures require adequate pain control. Failure to provide it not only causes needless acute suffering but can change the central nervous system and cause predisposition to chronic pain.

Anandkumar S. 2017. Effect of dry needling on myofascial pain syndrome of the quadratus femoris: A case report. Physiother Theory Pract. 18:1-8. "This case report describes a 40-year-old male who presented with posterior thigh pain managed unsuccessfully with massage therapy, chiropractic adjustments, and physical therapy. The diagnosis of myofascial pain syndrome (MPS) involving the quadratus femoris (QF) was purely clinical, based on palpatory findings and ruling out other conditions through deductive reasoning.... Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 4-month follow-up."

Anandkumar S. 2014. Effect of Pain Neuroscience Education and dry needling on chronic elbow pain as a result of cyberchondria: a case report. Physiother Theory Pract. Dec 9:1-7. [Epub ahead of print.] "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." [Although the assumption of a type of hypochondria is unfortunate, as the patient did have the real medical condition of trigger points, it is a lesson that trigger points can mimic many other conditions. Many doctors and other care providers as well as patients often mistake pain and/or dysfunction from myofascial trigger points to be something else, resulting in much unnecessary pain and waste of resources. DJS]

Ananthan S, Kanti V, Zagury JG et al. 2019. The effect of the twin block compared with trigger point injections in patients with masticatory myofascial pain: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol. [Oct 13 Epub ahead of print] "The twin block, a novel nerve block that blocks the deep temporal and masseteric branches of the trigeminal nerve, has been shown to be effective in the short-term management of masticatory myofascial pain….. The twin block is effective in the long-term management of masticatory myofascial pain compared with trigger point injections."

Anaya-Terroba L, Arroyo-Morales M, Fernandez-de-las-Penas C et al. 2010. Effects of ice massage on pressure pain thresholds and electromyography activity post exercise: a randomized controlled crossover study. J Manipulative Physiol Ther. 33(3):212-219. "Ice massage after isokinetic exercise produced an immediate increase of PPT (pressure pain threshold) over the VL (vastus lateralis) and VM (vastus medialis) and EMG (electromyography) activity over the VL muscle in recreational athletes, suggesting that ice massage may result in a hypoalgesic effect and improvements in EMG activity." [Ice massage can rapidly "diffuse" tightness, and thus pain due to the tightness, in some muscles with TrPs. This may be what is occurring here. DJS]

Anderberg, U. M. , I. Marteinsdottir, J. Hallman and T. Backstrom. 1998. Variablility in cyclicity affects pain and other symptoms in female fibromyalgia syndrome patients. J Musculoskel Pain 6(4):5-22.

Andersen HH1, Yosipovitch G, Galor A. 2017. Neuropathic symptoms of the ocular surface: dryness, pain, and itch. Curr Opin Allergy Clin Immunol. 17(5):373-381. "Ocular dryness, pain, and itch are prevalent complaints with several of shared features. Multiple lines of evidence suggest that peripheral and central neuronal sensitization processes are involved in generating and maintaining ocular sensory symptoms."

Andersen TE, Hansen M, Ravn SL et al. 2017. Validation of the PTSD-8 Scale in chronic pain patients. Pain Med. [Jul 13 Epub ahead of print] "Overall, the results showed that the PTSD-8 is a valid short screening tool to assess possible post-traumatic stress disorder among patients with chronic pain. In addition, the PTSD-8 scale comprises all of the upcoming ICD-11 post-traumatic stress disorder symptoms within its eight items. Thus, the PTSD-8 is likely also to measure the proposed ICD-11 post-traumatic stress disorder."

Anderson AR, Holliday D. Mapping the associations of daily pain, sleep, and psychological distress in a U.S. sample. 2023. J Behav Med. 2023 Dec;46(6):973-985. "Results indicated that nightly variation in sleep quantity predicted next day psychological distress for both groups. Sleep quantity also predicted next-day pain, but only for individuals with chronic pain. Associations between pain and psychological distress were found both at the daily level and individual (between-person) level. This between-person association was stronger for those with chronic pain. The lagged associations between sleep, and both pain and psychological distress for the chronic pain group indicate that, increased quantity of sleep predicts decreased next-day pain and psychological distress."

Anderson, K. and J. M. Silver. 1998. Modulation of Anger and Aggression. Semin Clin Neuropsychiatry 3(3):232-242.

Anderson R, Wise D, Sawyer T et al. 2011. 6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. J Urol 185(4):1294-1299. This study showed that men with chronic pelvic pain and "abacterial prostatitis" due to TrPs can benefit significantly from intensive myofascial TrP therapy and paradoxical relaxation training. Much pelvic pain and dysfunction is caused by short and tight pelvic floor musculature due to TrPs. Intense patient training for a short period of time can provide long-term symptom relief.

Anderson R, Wise D, Sawyer T et al. 2011. Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome. Clin J Pain 27(9):764-768. The pelvic wand is a device that enables safe patient self-treatment for internal trigger points. [It does, however, require that patients have care providers who can diagnose and treat the TrPs, and train the patients in the use of the wand. DJS]

Anderson, R. C. and J. H. Anderson. 1998. Acute toxic effects of fragrance products. Arch Environ Health 53(2):138-46.

Anderson RJ, McCrae CS, Staud R et al. 2012. Predictors of Clinical Pain in Fibromyalgia: Examining the Role of Sleep. J Pain. [Feb 29 Epub ahead of print]. "Understanding individual differences in the variability of fibromyalgia pain can help elucidate etiological mechanisms and treatment targets. Past research has shown that spatial extent of pain, negative mood, and after sensation (pain ratings taken after experimental induction of pain) accounts for 40 to 50% of the variance in clinical pain. Poor sleep is hypothesized to have a reciprocal relationship with pain, and over 75% of individuals with fibromyalgia report disturbed sleep. We hypothesized that measures of sleep would increase the predictive ability of the clinical pain model. Measures of usual pain, spatial extent of pain, negative mood, and pain after sensation were taken from 74 adults with fibromyalgia. Objective (actigraph) and subjective (diary) measures of sleep duration and nightly wake time were also obtained from the participants over 14 days.... Results replicate previous research and suggest that spatial extent of pain, pain after sensation, and negative mood play important roles in clinical pain, but sleep disturbance did not aid in its prediction.... Fibromyalgia patients may benefit from a 3-pronged approach to pain management: reducing pain's spatial extent, normalization of central nervous system hypersensitivity, and psychobehavioral therapies for negative mood."

Anderson RU, Harvey RH, Wise D et al. 2015. Chronic pelvic pain syndrome: Reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand. Appl Psychophysiol Biofeedback. [Feb 24 Epub ahead of print.] "This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion." Of these patients, 79.7% were male. At the beginning of the study, 63.6% used medications. After 6 months, 40.1% used medications, with a general reduction in total symptoms.

Anderson RU, Sawyer T, Wise D et al. 2009. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. [Oct 16 Epub ahead of print]. "This report shows relationships between myofascial trigger points and reported painful sites in men with chronic prostatitis/chronic pelvic pain syndrome. Identifying the site of clusters of trigger points inside and outside the pelvic floor may assist in understanding the role of muscles in this disorder and provide focused therapeutic approaches."

Anderson RU, Wise D, Sawyer T et al. 2016. Equal improvement in men and women in the treatment of urologic chronic pelvic pain syndrome using a multi-modal protocol with an internal myofascial trigger point wand. Appl Psychophysiol Biofeedback. 41(2):215-224. "We conclude that men and women have similar, significant reductions in trigger point sensitivity with this protocol."

Anderson RU, Wise D, Sawyer T et al. 2015. Equal improvement in men and women in the treatment of urologic chronic pelvic pain syndrome using a multi-modal protocol with an internal myofascial trigger point wand. Appl Psychophysiol Biofeedback. [Dec 31 Epub ahead of print.] "Both men and women require treatment for urologic chronic pelvic pain syndromes (UCPPS), which includes interstitial cystitis/painful bladder syndrome, pelvic floor dysfunction, and chronic prostatitis/chronic pelvic pain syndrome. However, it is unknown if men and women respond differently to a protocol that includes specific physical therapy self-treatment using an internal trigger point wand and training in paradoxical relaxation....We conclude that men and women have similar, significant reductions in trigger point sensitivity with this protocol."

Anderson RU, Wise D, Sawyer T et al. 2006. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urol. 176(4 Pt 1):1534-1538. "Sexual dysfunction is common in men with refractory chronic pelvic pain syndrome but it is unexpected in the mid fifth decade of life. Application of the trigger point release/paradoxical relaxation training protocol was associated with significant improvement in pelvic pain, urinary symptoms, libido, ejaculatory pain, and erectile and ejaculatory dysfunction." Men as well as women deal with chronic pain due to TrPs. So much of the suffering is needless. It is important for physicians to be trained in diagnosis and treatment of TrPs. DJS]

Anderson RU, Wise D, Sawyer T et al. 2005. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 174(1):155-160. "This case study analysis indicates that MFRT (myofascial trigger point assessment and release therapy) combined with PRT (paradoxical relaxation therapy) represents an effective therapeutic approach for the management of CP/CPPS (chronic prostatitis/chronic pelvic pain syndrome), providing pain and urinary symptom relief superior to that of traditional therapy." [One must wonder how much of our health care resources are wasted because of the lack of myofascial medicine training. DJS]

Anderson RU, Wise D, Sawyer T et al. 2005. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 174(1):155-160. Myofascial release of trigger points combined with paradoxical relaxation training can provide pain relief superior to traditional therapy.

Andersson, M., J. R. Bagby, L. Dyrehag and C. Gottfries. 1998. Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome. Eur J Pain 2(2):133-142.

Andersson, M., J. R. Bagby, L. E. Dyrehag and C. G. Gottfries. 1999. Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome. Eur J Pain 2(2):133-142.

Andrade A, Vilarino GT, Sieczkowska SM et al. 2018. The relationship between sleep quality and fibromyalgia symptoms. J Health Psychol. [Jan 1 Epub ahead of print] "This study investigated the relationship between sleep quality and fibromyalgia symptoms in 326 patients. The Pittsburgh Sleep Quality Index was used to assess the presence of sleep disorders....The prevalence of sleep disorders was 92.9 percent. Patients reported generalized pain (88.3%), memory failure (78.5%), moodiness (59%), excessive anxiety (77.5%), and concentration difficulties (69.1%). Patients with more symptoms reported poor sleep quality... and the total Pittsburgh Sleep Quality Index score correlated with the number of symptoms..... Sleep quality has an important association with fibromyalgia symptoms."

Andrell P, Schultz T, Mannerkorpi K et al. 2014. Health-related quality of life in fibromyalgia and refractory angina pectoris: A comparison between two chronic non-malignant pain disorders. J Rehabil Med. [Feb 14 Epub ahead of print.] "Patients with fibromyalgia experience greater impairment in health-related quality of life compared with the normal population than do patients with refractory angina pectoris, despite the fact that the latter have a potentially life-threatening disease. The great impairment in health- related quality of life in patients with fibromyalgia should be taken into consideration when planning rehabilitation."

Andretta A, Dias Batista E, Madalozzo Schieferdecker ME et al. Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia. Adv Rheumatol. 2019 Dec 11;59(1):55. "Although women with FM had lower dietary intake of Mg and Ca, serum levels for these nutrients were not different between the groups. Low dietary intake of minerals correlated with worsened pain threshold parameters."

Andreu JL, Sanz J. 2005. [Fibromyalgia and its diagnosis.] Rev Clin Esp. 205(7):333-336. [Spanish] "Although the fibromyalgia classification criteria of the American College of Rheumatology are not diagnostic criteria, they have been extensively used to diagnose FMS in patients with chronic diffuse arthromyalgias. Fibromyalgia diagnosis reduces the patient's anxiety, avoiding complementary expensive and unnecessary tests and it allows the patient to share his/her fears, illnesses and expectations with other human beings who suffer the same problem."

Angarola, R. T. 1990. National and international regulation of opioid drugs: purpose, structures, benefits and risks. J Pain Symptom Manage 5(1 Suppl):S6-S11.

Angsuwarangsee T, Morrison M. 2002. Extrinsic laryngeal muscular tension in patients with voice disorders. J Voice 16(3):333-343. "A strong relationship was found between thyrohyoid muscle tension and both gastroesophageal reflux (GER) and muscle misuse dysphonia (MMD)." [These patients were not checked for TrPs. TrPs may cause muscle tension. This may be an important connection between reflux as a perpetuating factor of myofascial TrPs. DJS]

Annemans L, Le Lay K, Taieb C. 2009. Societal and patient burden of fibromyalgia syndrome. Pharmacoeconomics 27(7):547-559. "...the patient burden of fibromyalgia is very high in comparison with many other conditions. The burden to healthcare payers and society is important as well, and can be mostly explained by factors not directly related to the treatment of FMS. Data suggest that the cost before diagnosis may even be higher than the cost after diagnosis. It is very likely that the combination of symptoms not only complicates the recognition and treatment of FMS, but also magnifies the burden of FMS."

Antoin H, Beasley RD. 2004. Opioids for chronic noncancer pain. Tailoring therapy to fit the patient and the pain. Postgrad Med. 116(3)37-40, 43-44. "...opioids can be a viable option today for successful therapy for chronic non-cancer pain."

Antunovich D, Tuck N, Reynolds LM, et al. 2021. I don't identify with it": A qualitative analysis of people's experiences of living with complex regional pain syndrome. Pain Med. Mar 8. Online ahead of print. "The present qualitative study aimed to describe the experiences of people living with CRPS…. Three overarching themes encapsulated the data including that 1) people experience CRPS as a source of severe symptoms and emotional difficulties, 2) CRPS undermines personal and social identity, and 3) this results in: psychological responses that protect against the emotional and social impact of severe symptoms. Psychological responses include: a) searching for an explanation, b) 'nothing is my fault': emphasising a lack of personal responsibility and personal control, and c) detaching the limb from the self…. CRPS is experienced as highly threatening to physical ability, psychological state, and identity."

Anuradha, C. V. and S. D. Balakrishnan. 1999. Taurine attenuates hypertension and improves insulin sensitivity in the fructose-fed rat, and animal model of insulin resistance. Can J Physiol Pharmacol 77(10:749-54.

Anwar N, Li S, Long L, et al…2022… Combined effectiveness of extracorporeal radial shockwave therapy and ultrasound-guided trigger point injection of lidocaine in upper trapezius myofascial pain syndrome. Am J Transl Res. Jan 15;14(1):182-196. "Our study revealed that extracorporeal radial shockwave therapy combined with trigger point injection of lidocaine was more effective for decreasing pain and elastic stiffness in upper trapezius myofascial pain syndrome at four weeks."

Aoe T, Kawanaka R, Ohsone F, et al. Functional connectivity associated with attention networks differs among subgroups of fibromyalgia patients: an observational case-control study. Sci Rep. 2024 May 3;14(1):10197. "These results suggest that endogenous pain driven by top-down signals via the dorsal attention network may contribute to pain sensation in a subgroup of fibromyalgia patients with a normal pain threshold. Besides, external pain driven by bottom-up signals via the spinothalamic tract may contribute to pain sensations in another group of patients with a low pain threshold."

Aoki M, Sakaida Y, Tanaka K et al. 2011. Evidence for vestibular dysfunction in orthostatic hypotension. Exp Brain Res. [Dec 29 Epub ahead of print]. "Our results suggest that vestibular disorders due to the dysfunction of otolith organs provoke OH." [Orthostatic hypotension is common in FM, as is vestibular dysfunction. Could some of the "fibromyalgia" OH actually be caused by co-existing vestibular disorders? DJS"

Aoyagi K, He J, Clauw DJ, et al. Sleep quality in individuals with chronic low back pain and central sensitization. Physiother Res Int. 2022 Aug 7;e1968. Online ahead of print. "Sleep problems are common in individuals with chronic low back pain (CLBP). Central sensitization (CS) is present in a subgroup of individuals with CLBP. However, our knowledge about whether sleep quality varies between the subgroups of CLBP is limited. Therefore, we sought to examine whether the subgroup of CLBP with CS has poorer sleep quality than the subgroup without CS…. We found that sleep problems were more common and severe in those who exhibited signs of CS. Thus, clinicians may consider using 2011 FM survey to identify those with CS and co-existing sleep problems.

Aoyagi K, He J, Nicol AL et al. 2019. A subgroup of chronic low back pain patients with central sensitization. Clin J Pain. [Aug 12 Epub ahead of print] "Our knowledge of central sensitization (CS) in chronic low back pain (CLBP) is limited. 2011 fibromyalgia criteria and severity scales (2011 FM survey) has been used to determine FM positive as a surrogate of CS. The major features of CS including widespread hyperalgesia and dysfunction of the descending inhibitory pathways can be identified by pressure pain threshold (PPT) and conditioned pain modulation (CPM) tests.…. Our findings suggest a subgroup of CLBP patients exhibiting with signs and symptoms of CS. Associations between subjective and objective CS measures indicate that the 2011 FM survey can be utilized to identify the presence of CS in CLBP in clinical practice."

Apkarian AV, Sosa Y, Krauss BR et al. 2004. Chronic pain patients are impaired on an emotional decision-making task. Pain 108(1-2):129-136. "Performance on an emotional decision-making task may be impaired in chronic pain since human brain imaging studies show that brain regions critical for this ability are also involved in chronic pain. Our evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact everyday behavior especially in risky, emotionally laden situations."

Appelboom, T. and A. Schoutens. 1990. High bone turnover in fibromyalgia. Calcif Tissue Int 46(5):314-317.

Aquino-Jose VM, Blinder V, Johnson J, et al. 2020. Ultrasound-guided trigger point injection for piriformis syndrome in the emergency department. J Am Coll Emerg Physicians Open. 1(5):876-879. "Piriformis syndrome, a myofascial pain disorder characterized by deep gluteal pain that radiates to the ipsilateral lower back and/or posterior thigh, is an underreported cause of low back pain frequently misdiagnosed in the emergency department (ED). … This case series describes 2 patients who presented to our emergency department with low back pain and were diagnosed with piriformis syndrome. Both patients received an ultrasound-guided trigger point injection of the affected piriformis muscle with a significant reduction of pain at 15 minutes and 48 hours after the procedure." [Why aren't we training care providers to diagnose and treat TrPs? DJS]

Arakaki FH, Tufik S, Andersen ML. 2019. Naps and exercise: reinforcing a range of benefits for elderly health. Chronobiol Int. Apr 16:1-2. "According to the United Nations, in 2017, people aged 60 or over in the world, comprised 13 per cent of the global population. It is a fact that elderly people are keeping a health lifestyle, such as practicing physical exercises and avoiding excessive dosages of medications. However, this population is also more prone to have injuries while practicing exercises. Sleep architecture is physiologically different among elderly, and naps can be very beneficial to improve their mental and physical health. Thus, in this article, we encourage health professionals to recommend regular naps to this population, which could lead to an improve in their well-being and quality of life."

Arden Pope III, C., R. L. Verrier, E. G. Lovett, A. C. Larson, M. E. Raizenne, R. E. Kanner, J. Schwartz, G. M. Villegas, D. R. Gold and D. W. Dockery. 1999. Heart rate variability associated with particulate air pollution. AmHeart J 138(5):890-899.

Aredo JV, Heyrana KJ, Karp BI. 2017. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med. [Jan 3 Epub ahead of print.] "Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies target ectopic endometrial lesions, they do not directly address pain due to central sensitization of the nervous system and myofascial dysfunction, which can continue to generate pain from myofascial trigger points even after traditional treatments are optimized. This article provides a background for understanding how endometriosis facilitates remodeling of neural networks, contributing to sensitization and generation of myofascial trigger points. A framework for evaluating such sensitization and myofascial trigger points in a clinical setting is presented. Treatments that specifically address myofascial pain secondary to spontaneously painful myofascial trigger points and their putative mechanisms of action are also reviewed, including physical therapy, dry needling, anesthetic injections, and botulinum toxin injections."

Arendt-Nielsen L. 2007. Measuring muscle pain. J Musculoskel Pain 15 (Supp 13):9 item 11. [Myopain 2007 Poster] "Referred muscle pain [and the possible related hyperalgesia] is manifested in somatic structures [skin, muscles, joints, tendons]. These manifestations are of significant clinical importance for the diagnosis of pain pathologies." "Recently we have found that patients suffering from chronic musculoskeletal pains have significantly larger referred pain areas to experimentally induced muscle pain intramuscular injection of hypertonic saline, and at the same time they show manifestations of muscle sensitization. Furthermore they show facilitated responses to a variety of other stimuli."

Arendt-Nielsen L, Fernández-de-las-Penas C, Graven-Nielsen T. 2011. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther. 19(4):186-193. "The transition from acute to chronic musculoskeletal pain is not well understood. To understand this transition, it is important to know how peripheral and central sensitization are manifested and how they can be assessed. A variety of human pain biomarkers have been developed to quantify localized and widespread musculoskeletal pain. In addition, human surrogate models may be used to induce sensitization in otherwise healthy volunteers. Pain can arise from different musculoskeletal structures (e.g. muscles, joints, ligaments, or tendons), and differentiating the origin of pain from those different structures is a challenge. Tissue specific pain biomarkers can be used to tease these different aspects. Chronic musculoskeletal pain patients in general show signs of local/central sensitization and spread of pain to degrees which correlate to pain intensity and duration. From a management perspective, it is therefore highly important to reduce pain intensity and try to minimize the duration of pain."

Arendt-Nielsen, L, Graven-Neilsen, T. 2003. Central sensitization in fibromyalgia and other musculoskeletal disorders Curr Pain Headache Rep. 7(5):355-361. Tenderness and referred chronic musculoskeletal pain may be due to peripheral and central sensitization. This sensitization may be part of what changes acute pain into chronic pain.

Arendt-Nielsen L, Madsen H, Jarrell J et al. 2014. Pain evoked by distension of the uterine cervix in women with dysmenorrhea: Evidence for central sensitization. Acta Obstet Gynecol Scand. [Apr 29 Epub ahead of print.] Many women have intense abdominal pain during menstruation. This study found: "Pain sensitization (temporal summation, i.e. increase in pain during prolonged stimulation, and facilitation of referred pain areas as an indicator of central nervous system changes) is present in women with dysmenorrhea." [Studies done by R. Doggweiler indicate that this prolonged pain stimulation from distension may be caused by trigger points. DJS]

Arendt-Nielsen L, Mense S, Graven-Nielsen T. 2003. [Assessment of muscle pain and hyperalgesia. Experimental and clinical findings] [German] Schmerz 17(6):445-449. "An important part of the manifestation of pain in chronic musculoskeletal disorders may be due to peripheral and central sensitization processes, which are also involved in the transition from acute to chronic pain. Knowledge of these processes has expanded enormously in recent years; it should be utilized when new intervention strategies are designed."

Argoff, C. E. 2002. A review of the use of topical analgesics for myofascial pain. Curr Pain Headache Rep 6(5):375-8.

Argoff CE, Clair A, Emir B et al. 2015. Prior Opioid Use Does Not Impact the Response to Pregabalin in Patients With Fibromyalgia. Clin J Pain. [Mar 7 Epub ahead of print.] "FM patients respond to treatment with pregabalin with significant improvements in pain scores irrespective of prior opioid use. These data could inform treatment decisions for FM patients currently taking opioids." [This study is associated with Pfizer Pharmaceuticals. DJS]

Arias-Buría JL, Franco-Hidalgo-Chacon MM, Cleland JA et al. 2020. Effects of kinesio taping on post-needling induced pain after dry needling of active trigger points in individuals with mechanical neck pain. J Manipulative Physiol Ther.[Feb 12 Epub ahead of print] "The application of kinesio taping after dry needling of active TrPs in the upper trapezius muscle was not effective for reducing post-needling induced pain in people with mechanical neck pain. Further, the application of kinesio taping as a post-needling intervention did not influence short-term changes in disability."

Arias-Buría JL, Martín-Saborido C, Cleland J et al. 2018. Cost-effectiveness evaluation of the inclusion of dry needling into an exercise program for subacromial pain syndrome: Evidence from a randomized clinical trial. Pain Med. [Feb 22 Epub ahead of print] "The inclusion of TrP-DN into an exercise program was more cost-effective for individuals with subacromial pain syndrome than exercise alone. From a cost-benefit perspective, the inclusion of TrP-DN into multimodal management of patients with subacromial pain syndrome should be considered."

Arias-Buría JL, Monroy-Acevedo A, Fernandez-de-Las-Penas C et al. 2020. Effects of dry needling of active trigger points in the scalene muscles in individuals with mechanical neck pain: a randomized clinical trial. Acupunct Med. Mar 30:964528420912254. "This trial suggests that a single session of DN over active TrPs in the scalene muscles could be effective at reducing pain and increasing inspiratory vital capacity in individuals with mechanical neck pain."

Arıcı T, Koken IS. Results of ultrasound-guided interfascial block of the trapezius muscle for myofascial pain. Agri. 2022 Jul;34(3):187-192. "Pain relief lasting for months was achieved in most of the patients. We believe that ultrasound-guided interfascial block of the trapezius is effective for the treatment of MPS."

Arikan I, Ozyigit F. 2018. Evaluation of rational drug use knowledge level in patients with musculoskeletal disorders. J Back Musculoskelet Rehabil. [Sep 14 Epub ahead of print] "In this study [Turkey], we aimed to evaluate the Rational Drug Use Knowledge Level (RDUKL) in patients with musculoskeletal disorders and some relevant factors.... Forty-three percent of the study group was found to have Rational Drug Use Knowledge (RDUK). The patients who used medicines under family supervision had twice as much RDUK as those who did not use medicines under family supervision, and those who were university graduates had six times as much RDUK as those who had primary education or below. Scale score was found to be low in patients with fibromyalgia and high in patients with rheumatoid arthritis... RDUKL was found to be low in the group with chronic diseases and high average age. Besides training, it is important to provide patients with family support about their illness and its treatment."

Arjun MV, S Rajaseker S. Association between subscapularis trigger point and frozen shoulder: A cross sectional study.J Bodyw Mov Ther. 2021 Oct;28:406-410. "Though FS (frozen shoulder) is known as adhesive capsulitis, presence of capsular adhesions has been rebutted and the nomenclature adhesive capsulitis is debated…. Evidence also suggested that myofascial trigger points play a role in restricted range of motion….. This study concluded that there appears to be a strong association between subscapularis trigger point and frozen shoulder."

Armentor JL. 2015. Living with a contested, stigmatized illness: Experiences of managing relationships among women with fibromyalgia. Qual Health Res. [Dec 14 Epub ahead of print.] "This study focuses on the negotiation of relationships among women living with the chronic illness fibromyalgia. Twenty in-depth, semi structured interviews were conducted with women diagnosed with fibromyalgia. Drawing from interactional and constructionist perspectives, the analysis focuses on participants' approaches to communicating with others about their illness, the reactions of others to their experiences, and participants' strategies to manage stigma. Participants attempted to describe their illness experience to others through direct and educational approaches. Often, in the management of their relationships with close family and friends, there was an unspoken awareness of illness effects, and social support was offered. However, disbelief and a lack of understanding often led participants to avoid social interactions in the attempt to hide from the stigma associated with an invisible and contested illness."

Arnold LM, Choy E, Clauw DJ et al. 2016. Fibromyalgia and chronic pain syndromes: A White Paper detailing current challenges in the field. Clin J Pain. 32(9):737-746. "This manuscript, developed by a group of leading chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia and identify ongoing challenges in the field of fibromyalgia 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 fibromyalgia and related syndromes that have the potential to improve the recognition and management of patients with fibromyalgia and other conditions with fibromyalgia-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 fibromyalgia and a lack of consensus regarding the diagnosis and treatment of fibromyalgia. This paper presents a framework for future global efforts to improve the understanding and treatment of fibromyalgia 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 fibromyalgia and chronic pain in general."

Arnold LM, Fan J, Russell IJ et al. 2012. The fibromyalgia family study: A genome-scan linkage study. Arthritis Rheum. 65(4):1122-1128. "We genotyped members of 116 families from the Fibromyalgia Family Study and performed a model-free genome-wide linkage analysis of fibromyalgia with 341 microsatellite markers, using the Haseman-Elston regression approach….The estimated sibling recurrence risk ratio suggests a strong genetic component of fibromyalgia. This is the first study to report genome-wide suggestive linkage of fibromyalgia to the chromosome 17p11.2-q11.2 region. Further investigation of these multi-case families from the Fibromyalgia Family Study is warranted to identify potential causal risk variants for fibromyalgia."

Arnold LM, Whitaker S, Hsu C et al. 2019. Efficacy and safety of mirogabalin for the treatment of fibromyalgia: results from three 13-week randomized, double-blind, placebo- and active-controlled, parallel-group studies and a 52-week open-label extension study. Curr Med Res Opin. 9:1-11. "While both mirogabalin doses were well tolerated by most patients and showed potential for reducing pain associated with FM, the primary endpoint of significant pain reduction in patients on mirogabalin compared with placebo was not achieved in any of the three randomized controlled studies."

Arnson Y, Amital D, Fostick L et al. 2007. Physical activity protects male patients with post-traumatic stress disorder from developing severe fibromyalgia. Clin Exp Rheumatol. 25(4):529-533. "Physical exercise in male patients with combat-related PTSD provides protection from the future development of fibromyalgia and is related in this group of patients to a better perception of their quality of life."

Arnstein, P., M. Caudill, C. L. Mandle, A. Norris and R. Beasley. 1999. Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain 80(3):483-91.

Arnstein PM. 2013. The future of topical analgesics. Postgrad Med. 125(4 Suppl 1):34-41. "Before modem pharmaceuticals became readily available, mud-based emollients, salves, cold therapies, and other natural remedies were often used. Now we have effective therapies and are developing advanced topical analgesics as we learn more about the physiology and pathophysiology of pain. The use of topical analgesics may be associated with fewer patient systemic side effects than are seen with oral, parenteral, or transdermally administered agents, making the topical route of administration attractive to prescribers and patients. With further refinement of existing drugs and the development of novel agents, topical analgesics may offer relief for treating patient pain conditions that are currently challenging to treat, such as pain resulting from burns, wound debridement, and pressure ulcers. Recognizing the value of a multimodal approach, topical analgesics may offer a therapeutic option that can become part of a comprehensive treatment plan for the patient. With continued advancements in targeted drug-delivery systems, topical analgesics may be able to provide a method to prevent or reverse the phenomena of peripheral and central sensitization, or the neuroplastic changes believed to be responsible for the transition from acute to chronic pain states in patients. For those patients at risk for developing chronic pain states, such as complex regional pain syndrome, the combination of cutaneous stimulation (achieved through rubbing during application) and analgesic effects produced by the drug itself may prevent the disabling pain that often emerges during the subacute phase of disease. In summary, better utilization of currently available topical analgesics and continued research promise to ensure that topical analgesics are, and will continue to be, important tools in the treatment of patients with resistant pain."

Arshad Q, Roberts RE, Ahmad H et al. 2017. Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction. Clin Neurol Neurosurg. 155:17-19. "Individual THI patients typically had multiple vestibular diagnoses and unique to this group of vestibular patients, often displayed both peripheral and central vestibular dysfunction. Despite expert neuro-otological management, at two years 20% of patients still had persistent vestibular symptoms…. In summary, chronic vestibular dysfunction in THI could relate to: (i) the presence of multiple vestibular diagnoses, increasing the risk of 'missed' vestibular diagnoses leading to persisting symptoms; (ii) the impact of brain trauma which may impair brain plasticity mediated repair mechanisms. Apart from alerting physicians to the potential for multiple vestibular diagnoses in THI, future work to identify the specific deficits in brain function mediating poor recovery from post-THI vestibular dysfunction could provide the rationale for developing new therapy for head injury patients whose vestibular symptoms are resistant to treatment."

Arslan D, Unal Cevik I. Interactions between the painful disorders and the autonomic nervous system. Agri. 2022 Jul;34(3):155-165. "In this review, the anatomical, physiological and pathological aspects of ANS and pain, and laboratory tests to evaluate autonomic functions will be discussed. Pathophysiological role of ANS in migraine, trigeminal autonomic cephalgias, trigeminal neuralgia, peripheral nerve injuries, small fiber neuropathies, myofascial pain syndrome, fibromyalgia, painful joint diseases, visceral pain, phantom limb pain, complex regional pain syndrome, and spinal cord injury will be discussed."

Arthur B, Chung MK, Brobyn T et al. 2019. Successful treatment of dyspareunia with an integrative medicine approach: A case report. Integr Med (Encinitas). Dec;18(6):38-41. "A 50-year-old woman with a five-and-a-half-year history of dyspareunia was successfully treated with an integrative medicine approach, including Neural Therapy, osteopathic therapy, acupuncture, and trigger point therapy, resulting in complete resolution which has been maintained to the present day, nineteen years later."

Asbill S, Sweitzer SM, Spigener S, et al. 2024. Compounded pain formulations: What is the evidence? Int J Pharm Compd. 2024 Mar-Apr;28(2):100-109. "Pain syndromes are among the most widespread, costly, and debilitating of all neurological disorders…. This review will provide an overview of chronic pain as a disease, the mechanisms of chronic pain, current treatment approaches to chronic pain, and a discussion of the drugs that are typically compounded into these topical formulations and studied in clinical trials.

Asbring P, Narvanen AL. 2003. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Soc Sci Med 57(4):711-720. "The results suggest that there is a discrepancy between the ideal role of the physician and reality in the everyday work in interaction with these patients." "The results also illuminate the physician's interpretations of patients in moralising terms. Conditions given the status of illness were regarded, for example, as less serious by the physicians than those with disease status. Skepticism was expressed regarding especially CFS, but also fibromyalgia. Moreover, it is shown how the patients are characterized by the physicians as ambitious, active, illness focused, demanding and medicalising. The patients in question do not always gain full access to the sick-role, in part as a consequence of the conditions not being defined as diseases." [It is a sad reflection on the state of medical practice that many practitioners do not understand that syndromes can be every bit as serious and life-altering as diseases.Just because we do not understand the total mechanisms behind the illness does not mean the patients with these illnesses do not deserve the care given to patients who have illnesses that we do understand. DJS]

Ashburn, M. A. and P. S. Staats. 1999. Management of chronic pain. Lancet 353(9167):1865-9.

Ashby, E.C. 1994. Chronic obscure groin pain is commonly caused by enthesopathy: 'tennis elbow' of the groin. Br J. Surg 81(11):1632-4. Groin pain may be caused by myofascial trigger points in the groin ligaments.

Ashe S, Furness PJ, Taylor SJ et al. 2017. A qualitative exploration of the experiences of living with and being treated for fibromyalgia. Health Psychol Open. 4(2):2055102917724336. "This study explores the life and treatment experience of people in the United Kingdom with fibromyalgia in order to inform the development of treatments which are both effective and acceptable to users. Qualitative interviews were conducted with 14 participants with interpretative phenomenological analysis used as the theoretical framework and analytical method. The themes identified were as follows: Inauthenticity of fibromyalgia, An Unconventional healthcare experience, Re-creating support networks, Challenging the working identity, Threatening the family dynamic and Fighting, accepting or accommodating? The biopsychosocial impacts of fibromyalgia disrupted the identity, lifestyle, roles and relationships of our participants with such challenges further exacerbated by the contested nature of the illness." Free Article

Ashina S, Lipton RB, Bendtsen L et al. 2018. Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain: A cross-sectional population study. Eur J Pain. [Jan 19 Epub ahead of print]....Low back pain is common in the general population and in individuals with primary headaches.... Headache cases were classified into chronic.. (CH) or episodic headache days/month) (EH). A total of 495 had a pericranial total tenderness score (TTS), and 494 had cephalic and extracephalic pressure pain thresholds (PPTs) assessed....Back pain is highly frequent in individuals with CH, followed by EH and no headache. In persons with CH, back pain is associated with lower cephalic and extracephalic PPTs suggesting central sensitization may be a substrate or consequence of comorbidity....Back pain is associated with low cephalic and extracephalic PPTs in individuals with CH. Central sensitization may be a substrate or consequence of this comorbidity of back pain and CH.

Ashrafi A, Arab AM, Abdi S, et al. 2021. The association between myofascial trigger points and the incidence of chronic functional constipation. J Bodyw Mov Ther. Apr;26:201-206. "Chronic functional constipation (CFC) is the most prevalent type of constipation. Considering the proven effect of pelvic floor muscles dysfunction in these patients' symptom and the fascial connection between pelvic floor and abdominal and lumbopelvic muscles, this study aimed to examine the possible relationship between this muscles and CFC…. This study revealed that the relationship between myofascial trigger points of abdominal and lumbopelvic muscles and constipation. In addition to that, it seems that a sedentary life may influence CFC patients' condition. Moreover, it seems that the results of the dietary condition in patients could be because of conscious consumption of some certain foods."

Aslan Çİn NN, Açik M, Tertemİz OF, et al. Effect of prebiotic and probiotic supplementation on reduced pain in patients with fibromyalgia syndrome: a double-blind, placebo-controlled randomized clinical trial. Psychol Health Med. 2023 May 24;1-14. "The potential benefits of using probiotics for treatment management in FMS patients is supported by the results of the current study and might provide an important strategy to combat FMS-associated diseases."

Assefi, N.P., Coy, T.V., Uslan, D. et al. Financial, occupational, and personal consequences of disability patients with chronic fatigue syndrome and fibromyalgia compared to other fatiguing conditions. J Rheumatol 30(4):804-8. Patient evaluation at a chronic fatigue clinic indicated that the patients with the most extensive loss of support by friends, family, and loss of job, possessions, and recreational abilities were those with FMS alone or with CFS, and yet there were "...no reliable difference between groups in use of disability benefits." The authors recommend "Employers and personal relations of patients with chronic fatigue should make a greater effort to accommodate the illness-related limitations of these conditions, especially for those with FMS and CFS.

Aster HC, Evdokimov D, Braun A, et al. 2022. CNS imaging characteristics in fibromyalgia patients with and without peripheral nerve involvement. Sci Rep. Apr 25;12(1):6707. "We tested the hypothesis that reduced skin innervation in fibromyalgia syndrome is associated with specific CNS changes…. Our results suggest that the subgroup of fibromyalgia patients with pronounced pathology in the peripheral nervous system shows alterations in morphology, structural and functional connectivity also at the level of the encephalon. We propose considering these subgroups when conducting clinical trials."

Atamer Y, Şahbaz T, Aşık HK, et al. The relationship between serum leptin, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 levels and clinical parameters in primary fibromyalgia patients. Rev Assoc Med Bras (1992). 2023 Sep 25;69(10):e20230240. Our results indicate that high levels of serum leptin and low levels of serum insulin-like growth factor-1 may play a role in the physiopathogenesis of fibromyalgia and may be related to some symptoms.

Ataoglu S, Ankarali H, Samanci R et al. 2018. The relationship between serum leptin level and disease activity and inflammatory markers in fibromyalgia patients. North Clin Istanb. 5(2):102-108. "A higher serum leptin level in patients with FMS suggested that leptin may play role in the pathogenesis of FMS, yet there was no relationship between leptin and clinical and inflammatory parameters, suggesting that leptin is not an indicator of disease activity in FMS. Additional research should be performed with larger patient groups." Free Article [Leptin resistance has been suspected, alone with insulin resistance and thyroid resistance, as common perpetuating factors for trigger points and fibromyalgia. DJS]

Atasever M, Namli Kalem M, Sonmez C et al. 2016. Lower serotonin level and higher rate of fibromyalgia syndrome with advancing pregnancy. J Matern Fetal Neonatal Med. 3:1-18. "Our study has shown that serotonin levels in women with FS are lower than the control group and that serotonin levels reduce as pregnancy progresses. Anxiety and depression in pregnant women with FS are higher than the control group. The presence of depression increases the likelihood of developing FS at a statistically significant level. Serotonin impairment also increases the chance of developing FS, but this correlation has not been shown to be statistically significant."

Athnaiel O, Cantillo S, Paredes S, et al. The role of sex hormones in pain-related conditions. Int J Mol Sci. 2023 Jan 18;24(3):1866. "The purpose of this review is to explore the biochemistry of hormone replacement in transgender patients who also have other pain-related conditions such as headaches, fibromyalgia, temporomandibular myalgia, and visceral pain."

Atzeni F, Gerardi MC, Masala IF et al. 2017. An update on emerging drugs for fibromyalgia treatment. Expert Opin Emerg Drugs. 22(4):357-367. "Fibromyalgia (FM) is a chronic disorder whose symptoms of pain, fatigue, sleep disturbances and depression have a devastating effect on patients' lives as it limits their ability to engage in everyday working and social activities, and make it difficult to maintain normal relationships with family, friends and employers. None of the currently available drugs are fully effective against the whole spectrum of symptoms. The aim of this narrative review is to summarise the data relating to the new therapeutic options that have become available over the last few years. Areas covered: Increasing efforts by the pharmaceutical industry have led to the introduction of new investigational drugs and new formulations of older drugs, and studies have been carried out in order to investigate the possibility of using drugs that are currently used for other diseases. Expert opinion: Slight improvements in the health of FM patients treated with drugs targeting a range of molecular mechanisms have been observed, but there is still no single drug that is capable of offering substantial efficacy against all of the characteristic symptoms of FM. The identification of new and improved therapies for FM requires consideration of the heterogeneity of the condition, which suggests the existence of different patient subgroups, a relationship between central and peripheral aspects of the pathophysiology, and the need for combined treatment with drugs targeting multiple molecular mechanisms."

Atzeni F, Sallì S, Benucci M et al. 2012. Fibromyalgia and arthritides. Reumatismo. 64(4):286-292. "Fibromyalgia (FM) is a chronic pain syndrome that affects at least 2% of the adult population. It is characterized by widespread pain, fatigue, sleep alterations and distress, and emerging evidence suggests a central nervous system (CNS) malfunction that increases pain transmission and perception. FM is often associated with other diseases that act as confounding and aggravating factors, such as rheumatoid arthritis (RA), spondyloarthritides (SpA), osteoarthritis (OA) and thyroid disease. Mechanism-based FM management should consider both peripheral and central pain, including effects due to cerebral input and that come from the descending inhibitory pathways. Rheumatologists should be able to distinguish primary and secondary FM, and need new guidelines and instruments to avoid making mistakes, bearing in mind that the diffuse pain of arthritides compromises the patients' quality of life."

Audette JF, Blinder RA. 2003. Acupuncture in the management of myofascial pain and headache. Curr Pain Headache Rep. 7(5):395-401. Many practitioners and patients have reported benefits from the treatment of myofascial pain and headache by acupuncture.

Audette JF, Wang F, Smith H. 2004. Bilateral activation of motor unit potentials with unilateral needle stimulation of active myofascial trigger points. Am J Phys Med Rehabil. 83(5):368-374. TrPs on the contralateral side of the body exhibited a local twitch response after dry needling TrPs. The group with active TrPs had motor unit potentials (MUPs) activated in a specific muscle on both sides of the body when the TrP on one side was needled. This did not happen if the TrP was latent. [If there are active TrPs on one side of the body, the corresponding muscles should be checked for latent TrPs and if those TrPs are present, they may need to be treated. DJS]

Austin, James H. 1999. Zen and the Brain. MIT Press: Cambridge MA.

Avendano-Coy J, Gomez-Soriano J, Valencia M et al. 2014. Botulinum toxin type A and myofascial pain syndrome: A retrospective study of 301 patients. J Back Musculoskelet Rehabil. [May 27 Epub ahead of print.] BTX-A injections and physiotherapy is an alternative to conventional treatment which should be considered when treating refractory MPS. Nonetheless, the differences in effectiveness based on diagnosis suggest the need to clarify the criteria used to select patients with MPS in future clinical trials and applications.

Avery, D. H., K. Dahl, M. V. Savage, G. L. Brengelmann, L. H. Larsen, M. A. Kenny, D. N. Eder, M. V. Vitiello and P. N. Prinz. 1997. Circadian temperature and cortisol rhythms during a constant routine are phase-delayed in hypersomnic winter depression. Biol Psychiatry 41(11): 1109-1123.

Avila LA, de Araujo Filho GM, Guimaraes EF et al. 2014. [Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center]. Rev Bras Reumatol. 54(5):409-413. [Article in Portuguese] "Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients' approach and treatment" Free Article

Avrahami D, Hammond A, Higgins C et al. 2012. A randomized, placebo-controlled double-blinded comparative clinical study of five over-the-counter non-pharmacological topical analgesics for myofascial pain: single session findings. Chiropr Man Therap. 20(1):7. "120 subjects were entered into the study (63 females; ages 16-82); 20 subjects randomly allocated into each group.....With regards to pressure threshold, PTMC (Professional Therapy MuscleCare Roll-on), BG (Ben-Gay Ultra Strength Muscle Pain Ointment) and MM (Motion Medicine Cream) showed significant increases in pain threshold tolerance after a short-term application on a trigger points located in the trapezius muscle. PTMC roll-on and BG were both shown to be superior vs. placebo while PTMC was also shown to be superior to IH (Icy Hot Extra Strength Cream) in patients with trigger points located in the trapezius muscle on a single application."

Ay S, Doğan SK, Evcik D et al. 2010. Comparison of the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int. [Mar 31 Epub ahead of print]. "Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. Phonophoresis was not found to be superior over ultrasound therapy." [It is usually wise to take the most efficient and simplest way to achieve the desired result. DJS]

Ay S, Konak HE, Evcik D et al. 2017. The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome. Rev Bras Reumatol Engl Ed. 57(2):93-99. [Article in English, Portuguese] "The aim of this study was to investigate the effectiveness of Kinesio Taping and sham Kinesio Taping on pain, pressure pain threshold, cervical range of motion, and disability in cervical myofascial pain syndrome patients (MPS).... Kinesio Taping leads to improvements on pain, pressure pain threshold and cervical range of motion, but not disability in short time." Free Article

Ay S, Sonel Tur B, Karakaş M, et al. Comparison of kinesio taping, trigger point injection, and neural therapy in the treatment of acute myofascial pain syndrome: A randomized controlled study. Agri. 2023 Jul;35(3):134-141. "The results of this study show that all these three treatment methods found to be effective on pain relief and disability in acute MPS. In terms of PPT (pressure pain threshold), injection treatments seem to be superior than KT (kinesio taping)."

Ayar K, Okmen BM, Lale Altan L et al. 2020. The frequency of fibromyalgia and its relationship with disease activity in female patients with Behçet's Disease: A cross sectional study. Arch Rheumatol. Jan 8;35(3):401-408. "Disease activity is higher in female BD patients with FM than those without FM. High disease activity in female BD patients with FM may be associated with the presence of genital ulcers."

Aydemir K, Duman I, Tugcu I et al. 2010. Piriformis syndrome presenting with foot drop diagnosed with magnetic resonance imaging: a case report. J Musculoskel Pain. 18(3).261-264. "Piriformis syndrome can cause foot drop. Magnetic resonance imaging can help earlier diagnosis and treatment." Piriformis syndrome is a description, not a diagnoses. The authors did not note that myofascial TrPs are the most common cause of this condition, and can cause foot drop as noted in Travell and Simons Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol II. Trigger points were not mentioned, although the authors noted the palpable mass that responded to steroid injection into the mass, resulting in resolution of the syndrome. It would have been interesting to see if the "mass" responded to TrP injection of local anesthetic. Steroids are undesirable and unhelpful in most TrP injections. DJS]

Aydin T, Dernek B, Senturk Ege T et al. 2018. The effectiveness of dry needling and exercise therapy in patients with dizziness caused by cervical myofascial pain syndrome; Prospective randomized clinical study. Pain Med. [Apr 28 Epub ahead of print] "Both dry needling + exercise therapy and exercise therapy alone were effective in treating dizziness caused by cervical myofascial pain syndrome. However, dry needling + exercise treatment was superior to exercise treatment alone."

Azad SC, Huge V, Schops P et al. 2005. [Endogenous cannabinoid system. Effect on neuronal plasticity and pain memory] Schmerz 19(6):521-527. [German] "The endogenous cannabinoid system is involved in the control of neuroplasticity as part of pain processing. Cannabinoids prevent the formation of LTP (long-term potentiation) in the amygdala via activation of CBI receptors."

Azadeh H, Dehghani M, Zarezadeh A. 2010. Incidence of trapezius myofascial trigger points in patients with the possible carpal tunnel syndrome. J Res Med Sci. 15(5):250-255. "The findings of this study imply the significant correlation between occurrence of CTS (carpal tunnel syndrome) and MTP (myofascial trigger points) suggested that clinicians consider the probability of existence of MTP in patients referred for diagnosis of CTS."

Azarfar A, Ahmed A, Beg S. 2020. Prevalence of anxiety, depression, sleep disturbance, fibromyalgia, obesity, and gastroesophageal disease in patients with rheumatic diseases. Curr Rheumatol Rev. Dec 11. Online ahead of print. "Anxiety, depression, sleep disturbance and obesity were found to be more prevalent in patients with Sjogren's syndrome, and fibromyalgia was noted to be more prevalent in patients with more than 1 diagnosis. The presence of fibromyalgia was significantly correlated with higher RAPID3 scores in all patients except those with PsA. Significant correlation among higher BMI and greater RAPID3 scores was found for patients with rheumatoid arthritis and for patients with Sjogren's syndrome.... Our study showed increased prevalence of anxiety in patients with Sjogren's syndrome. Fibromyalgia was found to be related to higher disease activity scores. In RA and SS patients, BMI was significantly correlated with higher RAPID3 scores."

Azuma, J., T. Kishi, R. H. Williams and K. Folkers. 1976. Apparent deficiency of Vitamin B6 in typical individuals who commonly serve as normal controls. Res Commun Chem Pathol Pharmacol 14(2):343-66.

Babineau R, Alweis R. 2020. Intramuscular injection and complex regional pain syndrome development after "harmless" procedures. Cureus. Jul 25;12(7):e9393. "Complex regional pain syndrome (CRPS) is a puzzling pain condition, typically occurring after trauma. Incidents as innocent as IV injection and vaccine administration may serve as the impetus for an as yet poorly understood cascade of neuro-inflammation and somatosensory changes. A condition with variable degrees of psychological involvement, disability, and purely clinical diagnostic criteria, the diagnosis is often significantly delayed before effective treatment is begun, decreasing the likelihood of success. A 58-year-old female initially presented with painless peripheral edema of the left arm without erythema or loss of function, with later bilateral development of multiple domains of symptoms consistent with CRPS. Plausible initiation events in this instance were an IV insertion in the left cubital fossa and vaccination into the right deltoid." [Both FM and MTrPs might be risk factors for development of CRPS, so we need to be aware. DJS]

Bablis P, Pollard H, Bonello R. 2008. Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: a controlled clinical trial. Chiropr Osteopat. 16:4. "After a short course of NET treatment, measurements of visual analog scale and pressure algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly improved when compared to a control group which received a sham protocol of NET. Chronic neck pain sufferers may benefit from NET treatment in the relief of trigger point sensitivity. Further research including long-term randomized controlled trials for the effect of NET on chronic neck pain, and other chronic pain syndromes are recommended." [NeuroEmotional Technique seems to have significant benefit for patients with both FM and CMP, but considerable support be given between treatments, as the body must be given time to recover to be able to process any toxins released from the myofascia, and adequate pain control is essential during that time. DJS]

Babson KA, Sottile J, Morabito D. 2017. Cannabis, cannabinoids, and sleep: a Review of the literature. Curr Psychiatry Rep. 19(4):23. "Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with PTSD and may improve sleep among patients with chronic pain. Research on cannabis and sleep is in its infancy and has yielded mixed results. Additional controlled and longitudinal research is critical to advance our understanding of research and clinical implications."

Bachasson D, Guinot M, Wuyam B et al. 2012. Neuromuscular fatigue and exercise capacity in fibromyalgia syndrome. Arthritis Care Res (Hoboken). [Sep 10 Epub ahead of print]. "Larger impairment in muscle contractility is associated with enhanced perception of exertion and reduced maximal exercise capacity in FMS patients. Neuromuscular impairments should be considered as an important factor underlying functional limitations in FMS patients." [It is highly likely that at least some of the results reflect the action of co-existing myofascial trigger points, and it would be very helpful to know this extent in future studies. DJS]

Backryd E, Lind AL, Thulin M et al. 2017. "High levels of cerebrospinal fluid chemokines point to the presence of neuroinflammation in peripheral neuropathic pain - a cross-sectional study of two cohorts of patients compared to healthy controls. Pain. [Sep 18 Epub ahead of print] "Animal models suggest that chemokines are important mediators in the pathophysiology of neuropathic pain. Indeed, these substances have been called "gliotransmitters", a term that illustrates the close interplay between glial cells and neurons in the context of neuroinflammation and pain. However, evidence in humans is scarce. The aim of the study was to determine a comprehensive cerebrospinal fluid (CSF) inflammatory profile for neuropathic pain patients...The samples were analyzed with a multiplex proximity extension assay in which 92 inflammation-related proteins were measured simultaneously.... Univariate testing with control of false discovery rate, as well as orthogonal partial least squares - discriminant analysis, were used for statistical analyses. CSF levels of chemokines CXCL6, CXCL10, CCL8, CCL11, CCL23, as well as protein LAPTGF-beta-1, were significantly higher in both neuropathic pain cohorts compared to healthy controls, pointing to neuroinflammation in patients. These 6 proteins were also major results in a recent similar study in fibromyalgia patients. The findings need to be confirmed in larger cohorts, and the question of causality remains to be settled. Since it has been suggested that prevalent co-morbidities to chronic pain (e.g., depression, anxiety, poor sleep, and tiredness) also are associated with neuroinflammation, it will be important to determine whether neuroinflammation is a common mediator."

Bacon AM, White L. The association between adverse childhood experiences, self-silencing behaviours and symptoms in women with fibromyalgia. Psychol Health Med. 2022 Dec 21;1-11. "Women with fibromyalgia syndrome (FMS) frequently report ACEs (adverse childhood experiences) and also self-sacrificial behaviours whereby they repress their own needs and emotions to preserve personal relationships. This behavioural profile (termed self-silencing) may develop following ACEs but has not previously been considered in the context of FMS. One aspect of self-silencing, care and self-sacrifice (putting others needs before your own) mediated the association between ACEs and symptoms in the FMS group only. Externalised self-perception (judging oneself according to perceived external standards) was negatively associated with symptoms but presented no mediating effects."

Bacon AM, White L, Norman A. 2021. Coping with fibromyalgia during the COVID-19 pandemic: adjustment and wellbeing. Psychol Health. Dec 13;1-16.. "Contrary to expectations, FMS participants reported no worsening of symptoms and an increase in wellbeing over the study period. Non-FMS participants experienced worsening health symptoms and no change in wellbeing. Coping strategies involving positive reappraisal, refocusing and planning were positively associated with wellbeing in the FMS group….The unpredictable symptom profile in FMS, and the regular readjustment this necessitates, may support a form of resilience which has been adaptive during the pandemic. The results have implications for supporting people with FMS, and potentially other chronic conditions, especially at times of stress."

Baek SH, Seok HY, Koo YS et al. 2016. Lengthened cutaneous silent period in fibromyalgia suggesting central sensitization as a pathogenesis. PLoS One. 11(2):e0149248. "The pathogenesis of fibromyalgia (FM) has not been clearly elucidated, but central sensitization, which plays an important role in the development of neuropathic pain, is considered to be the main mechanism....To understand the pathophysiology of FM, we compared CSP (cutaneous silent period) patterns between patients with FM and normal healthy subjects. ...The significantly longer CSP duration in FM patients suggests central dysregulation at the spinal and supraspinal levels, rather than peripheral small fiber dysfunction." Free Article

Baeumler P, Hupe K, Irnich D. Proposal of a diagnostic algorithm for myofascial trigger points based on a multiple correspondence analysis of cross-sectional data. BMC Musculoskelet Disord. 2023 Jan 24;24(1):62. "We propose that the definite diagnosis of an MTrP requires a hypersensitive spot potentially felt as a nodule located within a taut band in addition to either referred pain, a local twitch response or at least two complementary diagnostic criteria, whereby signs of muscular dysfunction take on greater importance."

Bagcier F. 2020. Rectus abdominis muscle with different abdominal pathologies: A cite to myofascial trigger point. Turk J Obstet Gynecol. Dec;17(4):318-319. "The rectus abdominis muscle facilitates flexion of the trunk and stabilizes the pelvis. Contributing to the increased abdominal pressure with other abdominal muscles, it also plays a role in micturition, defecation, vomiting, and childbirth. MTrPs of the rectus abdominis muscle have been associated with pathologies such as pain in the abdominal wall and primary dysmenorrhea..... Primary dysmenorrhea is a frequently encountered condition that reduces the quality of life of the patient and considerably impacts the economy of the healthcare system. Primary dysmenorrhea is a recurrent, cramping pain in the lower abdomen occurring during menstruation without any pelvic pathology.... When patients cannot find a remedy for their pain, they visit various clinics for examinations, and certain patients are considered to have psychiatric disorders. In fact, MTrP of the rectus abdominis muscle causes abdominal wall pain.... The diagnosis of MTrP is under-recognized in clinical practice. On examination, the possibility of MTrP localization in each muscle should be considered."

Bagcier F, Tufanoglu FH. 2020. A new treatment modality in piriformis syndrome: Ultrasound guided dry needling treatment. Agri Aug;32(3):175-176. "Piriformis syndrome is a painful entrapment neuropathy caused by compression of the sciatic nerve under piriformis muscle for structural or acquired reasons. Myofascial pain syndrome is the most common cause. There are physical therapy modalities, stretching exercises, injection therapies and medical treatment approaches. In this case, we planned to demonstrate a different perspective to the treatment of piriformis syndrome with the ultrasound-guided dry needling treatment."

Bagcier F, Yilmaz N. 2020. The impact of extracorporeal shock wave therapy and dry needling combination on pain and functionality in the patients diagnosed with plantar fasciitis. J Foot Ankle Surg. 59(4):689-693. "Forty patients who were clinically diagnosed with plantar fasciitis were included in the study. The patients were randomly divided into 2 groups. The ESWT-DN group was applied 3 sessions of ESWT to plantar fascia and DN to the trigger points in the gastrosoleus muscles. The ESWT group was applied only ESWT treatment to plantar fascia.... In both groups, there were statistically significant improvements in VAS, pressure pain threshold, maximum painless standing time, maximum painless walking distance, and FFI's pain, disability, and activity limitation subscales scores.... ESWT and DN combination therapy in plantar fasciitis was seen to be superior in the pain scores."

Bagcier F, Yurdakul OV. 2021. Dry needling treatment of the myofascial trigger point in nocturnal calf cramp. J Am Board Fam Med. Jan-Feb; 34(1):245-246. [Free article] Dry needling can be an effective and inexpensive treatment for nocturnal leg cramps due to trigger points.

Bagcier F, Yurdakul OV, Ozduran E. 2020. Three simple rules in pectoral muscle's trigger point treatment, which may be a cause of chest pain: Position, palpation, and perpendicular needling. J Am Board Fam Med. Nov-Dec;33(6):1031.[These rules may be simple, but far too many people giving trigger point injections have not learned them. They need to do so, with attention to the proper body positioning, palpation techniques, and proper procedures outlined in Travell and Simons' medical texts. Safe and proper release of the pectorals muscles may be necessary before other area muscles such as the SCM can be fully released. DJS]

Bagcier F, Yurdakul OV, Usen A, et al. 2022. The relationship between gluteus medius latent trigger point and muscle strength in healthy subjects. J Bodyw Mov Ther. Jan;29:140-145. "Latent MTrP may cause joint movement limitation, overload by affecting motor activation patterns and reciprocal inhibition mechanisms…. It is imperative to note that the latent MTrP of gluteus medius muscle, which has a critical role in the lumbopelvic junction, should not be ignored in clinical practice, and treatment should be applied when detected.

Bagis S, Karabiber M, As I et al. 2012. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. [Jan 22 Epub ahead of print]. "The magnesium citrate (300 mg/day) was given to the first group.... amitriptyline (10 mg/day) was given to the second group....,and magnesium citrate (300 mg/day) + amitriptyline (10 mg/day) treatment was given to the third group....After the 8 weeks of treatment.... serum and erythrocyte magnesium levels were significantly lower in patients with fibromyalgia than in the controls. Also there was a negative correlation between the magnesium levels and fibromyalgia symptoms. The number of tender points, tender point index, FIQ and Beck depression scores decreased significantly with the magnesium citrate treatment. The combined amitriptyline + magnesium citrate treatment proved effective on all parameters except numbness..... The magnesium citrate treatment was only effective tender points and the intensity of fibromyalgia. However, it was effective on all parameters when used in combination with amitriptyline."

Bahadir C, Dayan VY, Ocak F et al. 2010. Efficacy of immediate rewarming with moist heat after conventional vapocoolant spray therapy in myofascial pain syndrome. J Musculoskel Pain 18(2):147-152. Rewarming is a significant step in the use of vapocoolant spray and stretch therapy in women with TrPs of less than six months in duration, increasing benefits of the therapy. [It would be good to know if this is also true for patients with CMP, and for male patients in both categories. DJS]

Baker, B. A. 1986. The muscle trigger: evidence of overload injury. J Neuro Ortho Med Surg 7(1):35-44. ISSN 0271-1575/86-0701.

Baker NA, Rubinstein EN, Rogers JC. 2012. Problems and Accommodation Strategies Reported by Computer Users with Rheumatoid Arthritis or Fibromyalgia. J Occup Rehabil. [Jan 24 Epub ahead of print]. The number of problems during computer use was substantial in our sample, and our respondents with RA and FM may not implement the most effective strategies to deal with their chair, keyboard, or mouse problems. This study suggests that workers with RA and FM might potentially benefit from education and interventions to assist with the development of accommodation strategies to reduce problems related to computer use."

Bakker, S. J., J. C. ter Maaten, C. Popp-Snijders, R. J. Heine and R. O. Gans. 1999. Triiodo-thyronine: a link between the insulin resistance syndrome and blood pressure? J Hypertens 17(12 Pt 1):1725-30.

Bal S, Celiker R. 2009. Health-related quality of life in patients with myofascial pain syndrome: a controlled clinical study. J Musculoskel Pain. 17(2):173-177. "There was a correlation between NHP (Nottingham Health Profile) pain score and number of trigger points. However, no correlation was found between the NHP scores and other clinical parameters, such as age, duration of pain, and visual analog scale scores." "The results of this study suggest that MPS affects many aspects of HRQOL (health-related quality of life). Besides the clinical and laboratory evaluation, the emotional and physiological parameters should also be considered to define the health status of the patients and plan the appropriate treatment."

Balasubramanian V, Adalarasu K. 2007. EMG-based analysis of change in muscle activity during simulated driving. J Bodywork Move Ther. 11, 151-158. "Extensive usage of computers could cause fatigue and even lead to musculo-skeletal injuries."

Baldry P. 2002. Management of myofascial trigger point pain. Acupunct Med. 20(1):2-10. "Successful management of myofascial trigger point (MTrP) pain depends on the practitioner finding all of the MTrPs from which the pain is emanating, and then deactivating them by one of several currently used methods." "Following MTrP deactivation, correction of any postural disorder likely to cause MTrP reactivation is essential, as is the need to teach the patient how to carry out appropriate muscle stretching exercises. It is also important that the practitioner excludes certain biochemical disorders."

Baldwin, C. M., I. R. Bell and M. K. O'Rourke. 1999. Odor sensitivity and respiratory complaint profiles in a community-based sample of asthma, hay fever, and chemical odor intolerance. Toxicol Ind Health 15(3-4):403-9.

Baliki MN, Chialvo DR, Geha PY. 2006. Chronic pain and the emotional brain: Specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. Chronic pain seems to activate different areas of the brain than are activated during acute pain. Chronic pain is associated with the insula, an area of the brain that also is associated with negative emotions, response conflict, emotional memories and self-image. Chronic back pain may influence a person's sense of being and may trigger emotional distress of itself.

Balint G. 2002. Buprenorphine treatment of patients with non-malignant musculoskeletal diseases. Clin Rheumatol 21 Duppl 1:S17-S18. "When simple analgesics are not sufficient, the use of opioid-type analgesics is justified. Buprenorphine transdermal therapeutic system (TDS) is a novel formulation of a well-tolerated and highly effective drug for satisfactory pain control that can also be used in patients with chronic non-malignant pain (CNMP) due to musculoskeletal diseases."

Balkarli A, Erol MK, Yucel O et al. 2017. Frequency of fibromyalgia syndrome in patients with central serous chorioretinopathy. Arq Bras Oftalmol. 80(1):4-8. "When independent risk factors were evaluated by logistic regression analysis, it was found that only the presence of familial stress was a significant risk factor for FMS....Patients with CSCR (central serous chorioretinopathy) should be assessed for the presence of FMS, and this should be taken into consideration when developing a treatment plan. Further studies with a larger sample size are needed to clarify the relationship between FMS and CSCR." Free Article [Many factors can initiate FM. There is not just one cause. DJS]

Ball A, Perreault T, Fernández-de-Las-Peñas C, Agnone M, Spennato J. 2022. Trigger Points and Contracture/Contraction Knots: What's in a Name? Reply to Dommerholt, J.; Gerwin, R.D. Contracture knots vs. trigger points. Comment on "Ball et al. ultrasound confirmation of the multiple loci hypothesis of the myofascial trigger point and the diagnostic importance of sin the elicitation of the local twitch response. Diagnostics 2022, 12, 321." Diagnostics (Basel). 2022 Sep 29;12(10):2366. "We are responding to the comment by Dommerholt and Gerwin that we have reverse-defined "myofascial trigger point" (MTrP) and "contracture/contraction knot." In attempting to maintain philosophical agreement with specific and implied aspects of their integrated hypothesis of trigger-point formation (namely a MTrP being ischemic and hypoxic), we referred to the MTrP as the Ball A, Perreault T, Fernández-de-Las-Peñas C. et al. Trigger points and contracture/contraction knots: What's in a name small hyperechoic signal rather than the larger hypoechoic (and therefore hyperperfused) structure surrounding it. It was never our intent to re-define nor contribute to confusion. In making this concession with respect to Dommerholt and Gerwin's preferred nomenclature, however, we must instead now reconcile what we image as a hypoechoic (and therefore hyperperfused) MTrP with it being concurrently hypoxic."

Ball A, Perreault T, Fernández-de-Las-Peñas C, et al.2022. "Ultrasound confirmation of the multiple loci hypothesis of the myofascial trigger point and the diagnostic importance of specificity in the elicitation of the local twitch response. Diagnostics (Basel). Jan 27;12(2):321. The literature has hypothesized that a trigger point (TrP) area consists of a hyperperfused contracture knot with smaller hypoperfused TrPs within the contracture knot. By contrast, the only published ultrasound image of a TrP has it labeled hypoechoic (i.e., hyperperfused) with no commentary regarding smaller speckles of hypoperfusion within. Furthermore, the lack of clarity in objective definition of the terms associated with the TrP (namely, the palpable "contracture knot" and smaller nonpalpable "trigger point") has led to unnecessary communication difficulties between and among clinicians and researchers. In this case series of three muscles across two patients, by using high-definition musculoskeletal ultrasound imaging technology, we present what we believe to be the first reliable capture of palpable hypoechoic (e.g., hypoperfused) contracture knots (previously mislabeled as a hypoechoic TrP), and a visual support of the multiple loci hypothesis first proposed by Hong and Simons-the first reliable confirmation of the hyperechoic (i.e., hypoperfused) TrP within. Initially proposed by a histological study and supported by microdialysis study, this case series lends further support for the multiple loci hypothesis through visual confirmation of palpable hypoechoic contracture knots, with smaller hypoechoic TrPs "speckles" within." Free article (USA, Spain) [The truth doesn't change, but our ideas of what is true evolve as we discover new things. The terms "trigger point" and "contraction knot" have previously often been used interchangeably. This study indicates that the contraction knot and the TrP are different entities, the contraction knot is hyperperfused (swollen) and the TrP is not "washed out" by liquid in the TrP injection. This is a confirmation of what some have believed. The study states: "It is possible that the mechanisms underlying TrPs are much more complex than previously realized." DJS]

Ball AM, Finnegan M, Koppenhaver S et al. 2019. The relative risk to the femoral nerve as a function of patient positioning: potential implications for trigger point dry needling of the iliacus muscle. J Man Manip Ther. Feb 20:1-10. "Although more study is needed, these results suggest that patient positioning is one of several potential variables that should be considered in the optimization of patient safety/relative risk when performing trigger point dry needling."

Ballyns J, Shah JP, Hammond J et al. 2011. Objective sonographic measures for characterizing myofascial trigger points. J Ultrasound Med 30(10):1331-1340."...myofascial trigger points may be classified by area using sonoelastography. Furthermore, monitoring the trigger point area and pulsatility index may be useful in evaluating the natural history of myofascial pain syndrome." [This is very useful research, but sonoelastography is for research institution benefit only. There is no short-cut around good history taking and palpation exam for the diagnosis of TrPs. DJS]

Balyan R, Khuba S, Gautam S et al. 2017. Abdominal wall myofascial pain: still an unrecognized clinical entity. Korean J Pain. 30(4):308-309. [LETTER] "A 37-year-old female with right upper quadrant abdominal pain was referred to our pain clinic from the urology department. The patient had been under evaluation in the urology department for the past 3 years for recurrent episodes of abdominal pain along with small sized right kidney. At the time of referral, the patient was being worked up for right side nephrectomy presuming right small kidney as the source of abdominal pain....The patient gave a history of intermittent right upper quadrant pain for the previous 3 years.... Aggravating factors for pain were prolonged sitting, standing, a right-side lateral position, forward bending, and upon getting up from a supine position. The patient also had pain in the right flank and back. There were no signs or symptoms of neuropathic pain and no history of trauma. Previously, this patient had undergone multiple evaluations and treatment under multiple specialties like urology, gastroenterology, and orthopedics, which failed to provide pain relief. There was no history of hematuria, lithuria, turbiduria, fever, or lower urinary tract symptoms. A Contrast Enhanced Computed Tomography (CECT) scan and Ultrasonography (USG) of the abdomen revealed the small scarred right kidney (size 6.6 cm) with a normal left kidney (size 10.7 cm); there was no evidence of any kidney calculus or hydronephrosis. Abdominal examination revealed a trigger point in the upper lateral part of right rectus abdominis muscle with pain increasing in severity on getting up from supine position (positive Carnett's sign). Low back examination revealed trigger points in right side iliopsoas and quadrates lumborum muscles. A provisional diagnosis of myofascial pain was made and trigger point injections in the right rectus abdominis, iliopsoas and quadrates lumborum muscles was done under USG guidance with 1% lignocaine. The patient achieved 70-80% pain relief 30 min after the procedure. The patient was given mild stretching exercises with analgesics for 3 days and was asked to follow up. After 3 days, the patient had 70% relief in pain.... So the decision to perform a right side nephrectomy was cancelled.... The trigger point injection was repeated 2 times at monthly intervals and presently the patient is having 80-90% pain relief.... A proper diagnosis and treatment of myofascial pain could save a lot of unnecessary interventions and patient morbidity. In this case we were able to save the precious kidney of the patient with a proper diagnosis...." Free Article

Banahan, B. F. 3^rd and E. M. Kolassa. 1997. A physician survey on generic drugs and substitution of critical dose medications. Arch Intern Med 157(18):2080-2088.

Bandak E, Amris K, Bliddal H et al. 2012. Muscle fatigue in fibromyalgia is in the brain, not in the muscles: a case-control study of perceived versus objective muscle fatigue. Ann Rheum Dis. [Dec 8 Epub ahead of print]. "Women with FM and HC completed an isometric muscle exhaustion task at 90° shoulder abduction. Surface electromyographic (EMG) activity in the deltoid muscle was recorded together with self-reported level of muscle fatigue....Participants with FM did not exhibit the same level of objective signs of muscle fatigue, seen as fewer changes in the EMG activity, as the HC during the exhaustion task. The task did not provoke pain in the HC, while participants with FM reported a doubling of pain....Women with FM had shorter exhaustion times and showed fewer objective signs of muscle fatigue during an exhausting isometric shoulder abduction compared with younger HC. This indicates that perceived muscle fatigue may be of central origin and supports the notion of central nervous dysfunction as basic pathological changes in FM." [Although it is likely that co-existing trigger points caused or contributed significantly to the fatigue, patients were not assessed for co-existing TrPs. DJS]

Bani, D., L. Ballati, E. Masini, M. Bigazzi and T. B. Sacchi. 1997. Relaxin counteracts asthma-like reaction indused by inhaled antigen in sensitized guinea pigs. Endocrinology 138(5): 1909-1915.

Bani, D. 1997. Relaxin: a pleiotropic hormone. Gen Pharmacol 28(1):13-22.

Banic B, Petersen-Felix S, Andersen OK et al. 2004. Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain 107(1-2):7-15. This study gives evidence for spinal cord hyperexcitability with hyperalgesia and allodynia in fibromyalgia patients and in post-whiplash patients with chronic pain, in spite of the absence of tissue damage.

Bannwarth, B. 1999. Risk-benefit assessment of opioids in chronic noncancer pain. Drug Saf 21(4):283-96.

Bao S, Qiao M, Lu Y, et al. 2022. Neuroimaging mechanism of cognitive behavioral therapy in pain management. Pain Res Manag. Feb 2;2022:6266619. "Current studies can be divided into four categories, mixed pain, fibromyalgia, migraine, and experimental pain, based on the type of disease included, with the same or different changes of brain regions after CBT intervention. According to structural and functional MRI analyses, changes of brain gray matter volume, activation and deactivation of brain regions, and intrinsic connectivity between brain regions were observed after CBT sessions. The brain regions involved mainly included some areas related to cognitive and emotional regulation. After comparison, the DLPFC, OFC, VLPFC, PCC and amygdala were found to be recurrent in multiple studies and may be key regions for CBT intervention in pain management." Free article (China)

Baraliakos X, Regel A, Kiltz U et al. 2017. Patients with fibromyalgia rarely fulfil classification criteria for axial spondyloarthritis. Rheumatology (Oxford). [Sep 6 Epub ahead of print] "FM patients only rarely fulfill classification criteria for axSpA but some axSpA patients also fulfill FM criteria. Since this was more frequent in patients with AS it may be related to the severity and duration of chronic pain in axSpA patients. Assessment instruments evaluated in axSpA are not disease-specific. The phenomenon of central pain sensitization in rheumatic diseases deserves more study."

Baran, H., K. Jellinger and L. Deecke. 1999. Kynurenine metabolism in Alzheimer's disease. J Neural Transm 106(2):165-81. Blockade of NMDA receptors by KYNA may be responsible for impaired memory, learning and cognition in AD patients.

Baraniuk JN, Whalen G, Cunningham J et al. 2004. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskel Disord 5(1):48. "Central nervous system opioid dysfunction may contribute to pain in fibromyalgia."

Baraniuk JN, Petrie KN, Le U et al. 2004. Neuropathology in Rhinosinusitis. Am J Respir Crit Care Med [Epub]

Barassi G, Bellomo RG, Di Giulio C et al. 2018. Effects of manual somatic stimulation on the autonomic nervous system and posture. Adv Exp Med Biol. [Feb 13 Epub ahead of print] "Twenty young patients with low back pain ....were randomly divided into two groups: treated with neuromuscular manual therapy performed after a specific structural evaluation and treated with back massage therapy. Both groups performed eight sessions of 30 min each, once a week for two months....The findings were that the improvement in posture and pain reduction were appreciably better in patients subjected to neuromuscular manual therapy than in those subjected to back massage therapy, with a comparable autonomic response in both groups."

Barbara G, Stanghellini V, DeGiorgio R et al. 2004. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 126(3):693-702. The pain of IBS may be in part provoked by release of mast cells in the colon.

Barbero M, Bertoli P, Cescon C et al. 2012. Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle. J Man Manip Ther. 20(4):171-177. "The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle....Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values." The study showed that: "An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol." [Again, it has been shown that inter-rater reliability locating trigger points requires good training and experience. Failure of any previous study demonstrated not the reliability of trigger points, but rather a failure on the part of training and experience of those who are palpating. Doctors and other care providers, including pain researchers, MUST be proficient in palpation to accurately identify, assess and treat TrPs. The presence (or absence) of initials after a name has no relation to the ability to palpate, and hence to diagnose and treat, trigger points. DJS]

Barbero M, Cescon C, Tettamanti A et al. 2013. Myofascial trigger points and innervation zone locations in upper trapezius muscles. BMC Musculoskelet Disord. 14:179. "Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology.... we conclude that IZ (innervation zone) and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped."

Barcelo-Martinez E, Gelves-Ospina M, Navarro Lechuga E et al. 2018. Serum cortisol levels and neuropsychological impairments in patients diagnosed with fibromyalgia. Actas Esp Psiquiatr. 46(1):1-11. "The findings show that, in patients with FM, there are neuropsychological alterations, mainly in executive functioning (cognitive flexibility) and episodic memory (evocation and storage). Likewise, executive dysfunction is related to physiological stress reciprocally and in turn are conditioned by emotional alterations such as symptoms of depression, which supports the neurophysiological model that compromises the hypothalamic-pituitary-adrenal axis and the prefrontal cortex, rich in corticosteroid receptors."

Bardal E, Olsen T, Ettema G et al. 2013. Metabolic rate, cardiac response, and aerobic capacity in fibromyalgia: a case-control study. Scand J Rheumatol. [Mar 26 Epub ahead of print]. "The current study indicates that patients with fibromyalgia (FM) have similar metabolic and cardiovascular responses to submaximal exercise as healthy controls (HCs). However, these patients have reduced ability to reach maximal oxygen consumption (VO2max) and a possible deficit in the metabolic system when exercising above the anaerobic threshold (AT)."

Barilaro G, Francesco Masala I, Parracchini R et al. 2017. The role of hyperbaric oxygen therapy in orthopedics and rheumatological diseases. Isr Med Assoc J. 19(7):429-434. "Hyperbaric oxygen therapy (HBOT) has been investigated as a primary/adjunctive treatment for a number of injuries and medical conditions including traumatic ischemia, necrotizing soft tissue injuries, non-healing ulcers and osteoradionecrosis, but the results are controversial. There is insufficient evidence to support or reject the use of HBOT to quicken healing or to treat the established nonunion of fractures. However, in patients with fibromyalgia, HBOT reduces brain activity in the posterior cortex and increases it in the frontal, cingulate, medial temporal and cerebellar cortices, thus leading to beneficial changes in brain areas that are known to function abnormally. Moreover, the amelioration of pain induced by HBOT significantly decreases the consumption of analgesic medications." Free Article [This study from Italy indicates that patients with FM may have microcirculation dysfunction. They did not check for the causes of lack of tissue oxygenation, such as myofascial TrPs. Treatment of TrPs might be a much more affordable and lasting option, especially if perpetuating factors are controlled, than use of hyperbaric chambers. DJS]

Barkhuizen A. 2002. Rational and targeted pharmacologic treatment of fibromyalgia. Rheum Dis Clin North Am 28(2):261-90. "Pharmacologic agents remain an important component of FM management. Addressing the main symptoms of pain, disturbed sleep, mood disturbances, fatigue, and associated conditions is essential to improve patient functioning and enhanced quality of life."

Barlow KM. 2014. Postconcussion Syndrome: A Review. J Child Neurol. Oct 20. [Epub ahead of print] "Postconcussion syndrome is a symptom complex with a wide range of somatic, cognitive, sleep, and affective features, and is the most common consequence of traumatic brain injury. Between 14% and 29% of children with mild traumatic brain injury will continue to have postconcussion symptoms at 3 months, but the pathophysiological mechanisms driving this is poorly understood. The relative contribution of injury factors to postconcussion syndrome decreases over time and, instead, premorbid factors become important predictors of symptom persistence by 3 to 6 months postinjury. The differential diagnoses include headache disorder, cervical injury, anxiety, depression, somatization, vestibular dysfunction, and visual dysfunction. The long-term outcome for most children is good, although there is significant morbidity in the short term. Management strategies target problematic symptoms such as headaches, sleep and mood disturbances, and cognitive complaints."

Barnes, J. 1996. Myofascial release for craniomandibular pain and dysfunction. Int J Orofascial Myology 22:20-22.

Barnes, J. 1990. Myofascial Release. MFR Seminars, 10 S. Leopard Road, Suite One, Paoli, PA. 19301.

Baron EP, Cherian N, Tepper SJ. 2011. Role of greater occipital nerve blocks and trigger point injections for patients with dizziness and headache. Neurologist. 17(6):312-317.

Baron R, Hans G, Dickenson A. 2013. Peripheral input and its importance for central sensitization. Ann Neurol. [Sep 10 Epub ahead of print]. "Many pain states begin with damage to tissue and/or nerves in the periphery, leading to enhanced transmitter release within the spinal cord and central sensitization. Manifestations of this central sensitization are wind-up and long-term potentiation. Hyperexcitable spinal neurons show reduced thresholds, greater evoked responses, increased receptive field sizes and ongoing stimulus-independent activity; these changes probably underlie the allodynia, hyperalgesia and spontaneous pain seen in patients. Central sensitization is maintained by continuing input from the periphery, but also modulated by descending controls, both inhibitory and facilitatory, from the midbrain and brainstem. The projections of sensitized spinal neurons to the brain, in turn, alter the processing of painful messages by higher centers. Several mechanisms contribute to central sensitization. Repetitive activation of primary afferent C-fibers leads to a synaptic strengthening of nociceptive transmission. It may also induce facilitation of non-nociceptive Aβ-fibers and nociceptive Aδ-fibers, giving rise to dynamic mechanical allodynia and mechanical hyperalgesia. In post-herpetic neuralgia and complex regional pain syndrome, for example, these symptoms are maintained and modulated by peripheral nociceptive input. Diagnosing central sensitization can be particularly difficult. In addition to the medical history, quantitative sensory testing and functional magnetic resonance imaging may be useful, but diagnostic criteria which include both subjective and objective measures of central augmentation are needed. Mounting evidence indicates that treatment strategies which desensitize the peripheral and central nervous systems are required. These should generally involve a multimodal approach, so that therapies may target the peripheral drivers of central sensitization and/or the central consequences."

Barros-Neto JA, Souza-Machado A, Kraychete DC et al. 2016. Selenium and zinc status in chronic myofascial pain: Serum and erythrocyte concentrations and food intake. PLoS One. 11(10):e0164302. "In this study, patients with chronic myofascial pain (due to trigger points) showed lower intracellular stores of zinc and selenium and inadequate food intake of these nutrients." Free PMC Article

Barsante Santos AM, Burti JS, Lopes JB et al. 2010. Prevalence of fibromyalgia and chronic widespread pain in community-dwelling elderly subjects living in Sao Paulo, Brazil. Maturitas. [Aug 11 Epub ahead of print]. "In our elderly subjects, the prevalence of FM was slightly higher compared to previously reported studies, and CWP was around 14%. The spectrum of problems related to chronic pain was more severe in FM followed by CWP, strongly suggesting that these conditions should be diagnosed and adequately treated in older individuals."

Barski L, Shafat T, Buskila Y et al. High prevalence of fibromyalgia syndrome among Israeli nurses. Clin Exp Rheumatol. 2019 Oct 29. [Epub ahead of print] "FM is highly prevalent among nursing staff. Our findings point towards the possibility that work-related stress and traumatic events may play a major role in the development of FM symptoms among nurses. With aging this association is more significant." [The nurses I have seen with FM (predominantly from the USA but other countries as well) have had evidence of work-induced MTrPs before development of FM, especially those doing awkward lifting or in static positions, and these nurses were not assessed for TrPs Shift work, especially rotating, was also a strong FM perpetuating factor. DJS]

Bartels EM, Dreyer L, Jacobsen S et al. 2009. [Fibromyalgia, diagnosis and prevalence. Are gender differences explainable?] Ugeskr Laeger 171(49):3588-3592. [Danish] "Most non-inflammatory musculoskeletal diseases are more common in women than in men. Fibromyalgia is characterized by chronic generalized muscle pain. The male:female ratio is 1:9. Interacting factors including genetic, hormonal, environmental and behavioral elements may cause this condition, and there are possibly subgroups of which one has shown to be treatable. A different pathogenetic appearance in the two sexes may also be present. The gender difference may partly be explained by the fact that pressure pain test in tender points forms part of the diagnosis. This may leave some male fibromyalgia patients unrecognized." [It is unfortunate that co-existing TrPs were not considered in this article, as one cannot be sure what symptoms are FM and what were due to co-existing TrPs. DJS]

Bartley EJ, Robinson ME, Staud R. 2017. Pain and fatigue variability patterns distinguish subgroups of fibromyalgia patients. J Pain. [Dec 15 Epub ahead of print] "Two hundred and fifty-six fibromyalgia (FM) patients completed daily diaries up to a period of 154 days and reported on symptoms of pain intensity, pain unpleasantness, fatigue, anxiety, and depressed mood....Higher levels of pain were associated with greater fluctuations in pain unpleasantness, fatigue, and depressed mood. Similar effects were observed for fatigue and individual variability in anxiety also emerged as a robust predictor. Three FM subgroups were revealed: low variability in symptoms (Cluster 1), high symptom variability (Cluster 2), and a mixed variability group characterized by low fluctuation in pain unpleasantness; moderate pain, fatigue, and depressed mood variability; and high anxiety variability (Cluster 3). Cluster 3 exhibited lower social functioning and higher levels of pain, compared to Cluster 1. These findings support the dynamic nature of FM pain and suggest the presence of FM subgroups based upon variation in mood and pain symptomatology.... Better understanding of the processes impacting pain variability may facilitate targeted treatments for the control of pain." [Psychological factors are only one of many possible initiating factors for FM. It would be welcome to have more studies on subgroups of FM based on physiological characteristics, including initiating factors. DJS]

Bartley J, Han E, Gupta P et al. 2018. Transvaginal trigger point injections improve pain scores in women with pelvic floor hypertonicity and pelvic pain conditions. Female Pelvic Med Reconstr Surg. [Apr 4 Epub ahead of print] "Pelvic floor muscle injections decrease pain levels in women with pelvic floor dysfunction."

Barton, A., B. Pal, P. J. Whorwell and D. Marshall. 1999. Increased prevalence of sicca complex and fibromyalgia in patients with irritable bowel syndrome. Am J Gastroenterol 94(7):1898-901.

Barton JC, Bertoli LF, Barton JC et al. 2017. Fibromyalgia in 300 adult index patients with primary immunodeficiency. Clin Exp Rheumatol. [Apr 19 Epub ahead of print.] "Fibromyalgia is common in non-Hispanic white adult index patients with primary immunodeficiency, especially women. Chronic fatigue, Sjögren's syndrome, and IC are significantly associated with fibromyalgia after adjustment for other independent variables." [It is important to note that immunodeficiency can irritate the central nervous system, causing FM. Patients with immunodeficiency often have other medical conditions that also irritate the CNS. This research should not be used to imply that FM is an immune disease. DJS]

Barulin AE, Kurushina OV, Kalinchenko BM. 2021. [Efficiency of the application of miorelaxants in lower cross myofascial syndrome] Zh Nevrol Psikhiatr Im S S Korsakova.121(9):38-43. [Article in Russian]"The effectiveness of the use of muscle relaxants in the treatment of lower cross syndrome was studied, with the identification of the most reliable and effective methods for correcting this pathology. The presented clinical study of biomechanical and statodynamic disorders of the musculoskeletal system in myofascial pain syndromes, taking into account the peculiarities of the lesion of the sanogenetic and pathogenetic region, will be useful in prescribing personalized treatment not only for neurologists, but also for primary care physicians, chiropractors, osteopaths, rheumatologists and rehabilitologists." [The use of appropriate muscle relaxants could be helpful in treatment of wide-spread MTrPs in conjunction with other medications and therapies. DJS]

Barulin AE, Kurushina OV, Kalinchenko BM. 2020. [The use of myorelaxants in the treatment of chronic non-specific pelvic pain] Zh Nevrol Psikhiatr Im S S Korsakova. 120(6):45-50. [Article in Russian] "Objective: To evaluate the efficacy of tolperisone (calmirex) in patients with chronic nonspecific pelvic pain receiving standard therapy. Myofascial and muscle-tonic reactions play a significant role in the development and maintenance of chronic nonspecific pelvic pain. At the same time, tolperisone (calmirex) together with standard therapy of chronic nonspecific pelvic pain contributes to an effective regression of pain of myofascial and muscular-tonic origin, and creates a favorable restorative background for non-drug treatment. [Muscle relaxants may play a significant part in pelvic pain and other pain conditions that include spasticity. DJS]

Barzilai, N., L. She, B. Q. Liu, P. Vuguin, P. Cohen, J. Wang and L. Rossetti. 1999. Surgical removal of visceral fat reverses hepatic insulin resistance. Diabetes 48(1):94-8.

Basford JR, An KN. 2009. New techniques for the quantification of fibromyalgia and myofascial pain. Curr Pain Headache Rep. 13(5):376-378. Fibromyalgia and myofascial pain are different but share some common features. Until recently, the lack of objective and quantifiable findings have undermined the acceptance of the importance of these conditions by the medical community. This is a review of objective findings of these conditions, focusing more on myofascial pain.

Bashir A, Lipton RB, Ashina S et al. 2013. Migraine and structural changes in the brain: A systematic review and meta-analysis. Neurology. 81(14):1260-1268. "This review and meta-analysis was conducted: "To evaluate the association between migraine without aura (MO) and migraine with aura (MA) and 3 types of structural brain abnormalities detected by MRI: white matter abnormalities (WMAs), infarct-like lesions (ILLs), and volumetric changes in gray and white matter (GM, WM) regions....These data suggest that migraine may be a risk factor for structural changes in the brain. Additional longitudinal studies are needed to determine the differential influence of migraine without and with aura, to better characterize the effects of attack frequency, and to assess longitudinal changes in brain structure and function."

Basner M, Babisch W, Davis A et al. 2014. Auditory and non-auditory effects of noise on health. Lancet 383(9925):1325-1332. Noise-induced hearing loss is the most predominant health effect of noise, but there are other problems caused by unwanted noise in occupational and other settings. Research has found that noise induced nerve damage has increased, and non-auditory effects of noise include annoyance and other mood disturbances, sleep disturbance, daytime sleepiness, healing rates in hospitals, hypertension, and cognitive dysfunction.

Bassaly R, Tidwell N, Bertolino S et al. 2010. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct. Oct 26 [Epub ahead of print]. Pain from myofascial trigger points is common among interstitial cystitis pain patients. IC patients should be assessed for TrPs, especially pelvic floor TrPs.

Bassett E, Gjekmarkaj E, Mason AM, et al. 2024. Vitamin D, chronic pain, and depression: linear and non-linear Mendelian randomization analyses. Transl Psychiatry. 2024 Jul 4;14(1):274. "Our findings suggest that population-wide vitamin D supplementation will not substantially reduce pain or depression; however, targeted supplementation of deficient individuals may reduce risk of depression."

Bassoe, C. F. 1995. The skinache syndrome. J R Soc Med 88:565-569.

Bateman L, Sarzi-Puttini P, Burbridge CL et al. 2016. Burden of illness in fibromyalgia patients with comorbid depression. Clin Exp Rheumatol. [Mar 10 Epub ahead of print.] "This study demonstrates the significant burden of FM in patients with comorbid depression treated with an antidepressant."

Batheja S, Nields JA, Landa A et al. 2013. Post-treatment Lyme syndrome and central sensitization. J Neuropsychiatry Clin Neurosci. 25(3):176-186. "Central sensitization is a process that links a variety of chronic pain disorders that are characterized by hypersensitivity to noxious stimuli and pain in response to non-noxious stimuli. Among these disorders, treatments that act centrally may have greater efficacy than treatments acting peripherally. Because many individuals with post-treatment Lyme Syndrome (PTLS) have a similar symptom cluster, central sensitization may be a process mediating or exacerbating their sensory processing. This article reviews central sensitization, reports new data on sensory hyperarousal in PTLS, explores the potential role of central sensitization in symptom chronicity, and suggests new directions for neurophysiologic and treatment research."

Batterman S.D., Batterman S.C. 2002. Delta-V, spinal trauma, and the myth of the minimal damage accident. J Whiplash and Rel Dis 1(1):41-52.

Bauer CM, Rast FM, Ernst MJ et al. 2015. Pain intensity attenuates movement control of the lumbar spine in low back pain. J Electromyogr Kinesiol. [Oct 19 Epub ahead of print.] Pain intensity attenuates muscular activity, proprioception, and tactile acuity, with consequent changes of joint kinematics. People suffering from low back pain (LBP) frequently show movement control impairments of the lumbar spine in sagittal plane. This cross-sectional, observational study investigated if the intensity of LBP attenuates lumbar movement control. The hypothesis was that lumbar movement control becomes more limited with increased pain intensity....Our results indicate changes in movement control in people suffering from LBP. Whether decreased recurrence and determinism of lumbar movement patterns are intensifiers of LBP intensity or a consequence thereof should be addressed in a future prospective study. [I have been in touch with the authors, in the hope that they will check for myofascial trigger points in the next study. DJS]

Bax K, Isackson PJ, Moore M et al. 2020. Carnitine palmitoyl transferase deficiency in a university immunology practice. Curr Rheumatol Rep. Feb 14;22(3):8. "This report describes the clinical manifestations of 35 patients sent to a University Immunology clinic with a diagnosis of fatigue and exercise intolerance who were identified to have low carnitine palmitoyl transferase activity on muscle biopsies….. All of the patients presented with fatigue and exercise intolerance and many had been diagnosed with fibromyalgia. Their symptoms responded to treatment of the metabolic disease. Associated symptoms included bloating, diarrhea, constipation, gastrointestinal reflux symptoms, recurrent infections, arthritis, dyspnea, dry eye, visual loss, and hearing loss. Associated medical conditions included Hashimoto thyroiditis, Sjogren's syndrome, seronegative arthritis, food hypersensitivities, asthma, sleep apnea, and vasculitis. This study identifies clinical features that should alert physicians to the possibility of an underlying metabolic disease. Treatment of the metabolic disease leads to symptomatic improvement." [When there is FM, there is something else causing the central sensitization. DJS]

Bayazit YA, Celenk F, Gunduz AG et al. 2010. Vestibular evoked myogenic potentials in patients with fibromyalgia syndrome. J Laryngol Otol. [Feb 22 Epub ahead of print]. "...it is possible to detect abnormalities on vestibular evoked myogenic potential testing in such patients, indicating dysfunction in the vestibulospinal pathway, possibly in the saccule. Elongation of the n23 latency and of the interpeak latency of waves p13-n23, during vestibular evoked myogenic potential testing, may be a useful, objective indicator demonstrating neurotological involvement in fibromyalgia syndrome patients. Future research investigating the mechanisms of this latency elongation may help increase understanding of the pathogenesis of fibromyalgia syndrome" [Vestibular dysfunction is a frequent yet often unrecognized co-existing condition for fibromyalgia, and I believe that some of the symptoms attributed to FM may, in some patients, be due to this condition. DJS]

Baygutalp F, Kul A. Effect of early orthopedic rehabilitation on development of complex regional pain syndrome type 1. Eurasian J Med. 2020 Jun;52(2):110-114. "Complex regional pain syndrome (CRPS) is a syndrome usually occurs in one extremity and characterized by pain, tenderness with palpation, and symptoms of autonomic nervous system dysfunction. An essential factor in the etiology of CRPS is immobilization of the extremity as a result of a fracture. Delaying the start of physical medicine and rehabilitation program after removal of the plaster or splint may increase the rates of CRPS development in patients with fractures…. As the delay time for rehabilitation in our clinic decreased, the incidence of CRPS decreased. The awareness of physicians and patients about the importance of early rehabilitation should be improved." [Research indicates that FM and/or TrPs are risk factors of CRPS. DJS]

Baykan B, Ekizoglu E Karl et al. 2015. Characterization of migraineurs having allodynia: Results of a large population-based study. Clin J Pain. [Sep 16 Epub ahead of print.] "The duration, severity and disability of migraine attacks, photophobia, phonophobia and osmophobia, as well as premonitory signs showed significant associations with allodynia in the general population. Moreover, migraineurs with aura or family history of migraine reported more often allodynia and allodynic migraineurs were more sensitive to hormonal changes. Allodynia which seems to indicate higher tendency to sensitization should be implemented in daily headache practice to predict the prognosis and high levels of migraineous involvement."

Bayrak M.2020. Metabolic syndrome, depression, and fibromyalgia syndrome prevalence in patients with irritable bowel syndrome: A case-control study. Medicine (Baltimore). 99(23):e20577. "Metabolic syndrome and obesity were significantly more frequent in IBS patients compared with controls. FMS, anxiety disorder, and depression were also more common among IBS patients."

Bazzichi L, Giacomelli C, Consensi A et al. 2016. One year in review 2016: fibromyalgia. Clin Exp Rheumatol. 34(2 Suppl 96):145-149. "Fibromyalgia (FM) syndrome is a chronic disease with unknown aetiology, characterized by widespread pain, fatigue and other functional symptoms. We reviewed the literature of the past year to underline the recent progress in the etiopathogenesis, assessment and therapies of this syndrome, evaluating the articles published between January 2015 and January 2016." Free Article

Bazzichi L, Rossi A, Giuliano T et al. 2007. Association between thyroid autoimmunity and fibromyalgic disease severity. Clin Rheumatol. [May 9 Epub ahead of print]. "...autoimmune thyroiditis is present in an elevated percentage of FM patients..."

Bazzichi L, Rossi A, Zirafa C et al. 2010. Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia? Rheumatol Int. [Nov 18 Epub ahead of print]. "In particular, FM comorbidity in HT (Hashimoto's Thyroiditis) patients without SCH (subclinical hypothyroid) was 33.3% and in HT patients with SCH was 28.5%. Based on our data, we speculate that maybe there is more than a hypothesis regarding the cause-effect relation between thyroid autoimmunity and the presence of FM, thus suggesting a hypothetical role of thyroid autoimmunity in FM pathogenesis." [Hashimoto's Thyroiditis and hypothyroid are perpetuating factors of both FM and TrPs. DJS]

Beales D, Fary R, Little C et al. 2017. Characterization of pain in people with hereditary neuropathy with liability to pressure palsy. J Neurol. [Oct 27 Epub ahead of print] Hereditary neuropathy with liability to pressure palsy (HNPP) has historically been considered a pain-free condition, though some people with HNPP also complain of pain. This study characterised persistent pain in people with HNPP....All 32 participants felt that their pain could be related to/part of their HNPP. Significant negative impact of the pain was common. Pain characterisation identified neuropathic pain and/or central sensitisation as common, potential underlying processes. Pain may plausibly be directly related to the underlying pathophysiology of HNPP. Further consideration of including pain as a primary symptom of HNPP is warranted. [This is posted as a reminder that there are many different conditions out there, and not everything is fibro or trigger points. There are all sorts of chronic pain conditions out there. DJS]

Beauchet O, Annweiler C, Verghese J et al. 2011. Biology of gait control: Vitamin D involvement. Neurology. [Apr 6 Epub ahead of print]. "Low levels of vitamin D may be associated with disturbed gait control."

Becker, N., A. B. Thomsen, A. K. Olsen, P. Sjogren, P. Bech and J. Erikson. 1998. [No title available]. Ugeskr Laeger 160(47):6816-9. [Danish].

Becker PM, Novak M. 2014. Diagnosis, Comorbidities, and Management of Restless Legs Syndrome. Curr Med Res Opin. [May 7 Epub ahead of print.] "Although clinical diagnosis of RLS can be straightforward, diagnostic challenges may arise when patients present with comorbid conditions. Comorbidities of RLS include insomnia, depressive and anxiety disorders, and pain disorders. Differential diagnosis is particularly important, as some of the medications used to treat insomnia and depression may exacerbate RLS symptoms. Appropriate diagnosis and management of RLS symptoms may benefit patient well-being and, in some cases, may lessen comorbid disease burden. Therefore, it is important that physicians are aware of the presence of RLS when treating patients with conditions that commonly co-occur with the disorder."

Bedaiwy MA, Patterson B, Mahajan S. 2013. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med. 58(11-12):504-510. "A retrospective chart review was performed on all women who presented to our facility between January 2005 and December 2007. Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement....Transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain."

Beebe FA, Barkin RL, Barkin S. 2005. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions. Am J Ther. 12(2):151-171.

Behnam A, Mahyar S, Ezzati K et al. 2014. The use of dry needling and myofascial meridians in a case of plantar fasciitis. J Chiropr Med. 13(1):43-48. "A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity.....Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient's pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient.... Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis."

Behr M, Noseworthy M, Kumbhare D. 2019. Feasibility of a support vector machine classifier for myofascial pain syndrome: Diagnostic case-control study. J Ultrasound Med. [Jan 7 Epub ahead of print] "Myofascial pain syndrome (MPS) is the most common cause of chronic pain worldwide....We propose that using a support vector machine (SVM) along with ultrasound (US) texture features can differentiate between healthy and MPS-affected skeletal muscle.... We have demonstrated that specific US texture features that have been used in other computer-aided diagnostic literature are feasible to use for the classification of healthy and MPS muscle using a binary SVM classifier."

Beiner E, Brenner Miguel S, Friederich HC, et al; PerPAIN Consortium. Elevated high sensitive C-reactive protein in fibromyalgia. Front Psychiatry. 2023 Nov 30;14:1237518. In conclusion, this study provides evidence that sub-inflammatory processes correlate with clinical symptoms, which can be partly attributed to differences in weight, but cannot be fully explained by them. Further research is needed to elucidate the mechanisms underlying the association between hsCRP and FMS and to explore the potential therapeutic implications of targeting hsCRP in the management of FMS.

Beiner E, Lucas V, Reichert J, et al. Stress biomarkers in individuals with fibromyalgia syndrome: a systematic review with meta-analysis. Pain. 2023 Jan 5. Online ahead of print. "Overall, the data are compatible with association of FMS with adrenocortical hypofunction in the presence of increased sympathetic tone. However, the data are partially contradictory, so it must be assumed that the data are highly dependent on the respective study designs, patient samples, and analytical methods and do not necessarily demonstrate an abnormal HPA-axis function in FMS."

Bell L. 2017. Bad air: Breathing pollution may harm a lot more than our lungs. Science News. Sept. 30: 18-21. Pollution can affect more than our breathing. It may contribute to diabetes, obesity, dementia, Parkinson's disease, cardiovascular disease, and could "accelerate aging in the brain. "Faster than normal cognitive decline" especially memory, occurred in more polluted areas. The cognitive deficits and other illnesses correlated to the level of air pollution.

Bell, I. R., C. M. Baldwin, M. Fernandez and G. E. Schwartz. 1999. Neural sensitization model for multiple chemical sensitivity: overview of theory and empirical evidence. Toxicol Ind Health 15(3-4):295-304.

Bell, I. R., C. M. Baldwin and G. E. Schwartz. 1998. Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. Am J Med 105(3A):74S-82S.

Bell T, Trost Z, Buelow MT et al. 2018. Meta-analysis of cognitive performance in fibromyalgia. J Clin Exp Neuropsychol. Feb 1:1-17. "Fibromyalgia is a condition with symptoms of pain, physical function difficulties, and emotional problems, but is also characterized by complaints of poor cognition (often called "FibroFog"). Over the last two decades, a number of studies have examined cognitive differences between individuals with and without fibromyalgia. The purpose of the current study was to conduct a quantitative synthesis of these differences across multiple cognitive domains....Fibromyalgia was significantly and negatively associated with performance on all domains of cognitive function. The largest effect size was found for inhibitory control..., followed by memory.... These findings support the hypothesis that the self-reported cognitive impact of fibromyalgia is also found in objective neuropsychological measures. Routine screening for cognitive dysfunction in those with fibromyalgia may be warranted in addition to assessment of the traditional fibromyalgia symptoms."

Beltran K, Wadeea R, Herbst KL. 2020. Infections preceding the development of Dercum disease. IDCases. Dec 19;19:e00682. "Dercum Disease (DD) is a rare inflammatory disease of painful subcutaneous fat masses with known alterations in lymphatic vessels. DD masses vary from pearl to walnut-size or larger and occur anywhere in body fat. Signs and symptoms of DD are similar to fibromyalgia. While the etiology of DD is unknown, metabolic, autoimmune, or autosomal genetic transmission has been proposed. This series presents 7 cases where DD followed an infection either histoplasmosis, coccidioidomycosis or Lyme disease. Known changes in fat by infectious agents are reviewed. Early diagnosis and treatment of infections may prevent further damage to fat."

Ben Simon E, Walker MP. 2018. Sleep loss causes social withdrawal and loneliness. Nat Commun. 9(1):3146. "Loneliness and social isolation markedly increase mortality risk, and are linked to numerous mental and physical comorbidities, including sleep disruption. But does sleep loss causally trigger loneliness? Here, we demonstrate that a lack of sleep leads to a neural and behavioral phenotype of social withdrawal and loneliness; one that can be perceived by other members of society, and reciprocally, makes those societal members lonelier in return. We propose a model in which sleep loss instigates a propagating, self-reinforcing cycle of social separation and withdrawal. Free Article [Yet another reason that a good in-lab sleep study be done promptly for anyone with chronic pain and fatigue, and the sleep architecture and other possible sleep dysfunctions be investigated. DJS]

Bendiksen A, McGehee E, Handberg G. 2007. [The use of methadone in the treatment of chronic non-malignant pain in an out-patient setting] Ugeskr Laeger 169(17):1568-1572. [Danish] "Opioid treated chronic pain patients with insufficient pain relief may benefit from conversion to methadone, as 59% in our analysis achieved better pain relief, while the rotation was generally opioid-saving at the same time. The method used was safe and acceptable to the patients. The analyses did not result in any fundamental changes to the procedure." Methodone may be a viable option for insufficiently relieved pain in chronic non-malignant pain patients.

Bendtsen L. 2000. Central sensitization in tension-type headache—possible pathophysiological mechanisms. Cephalalgia 20(5):486-508. "The stimulus-response function for palpation pressure vs. pain was found to be qualitatively altered in chronic tension-type headache patients compared with controls. The stimulus-response function was found to be qualitatively altered also in patients with fibromyalgia. It was concluded that the qualitatively altered nociception was probably due to central sensitization at the level of the spinal dorsal horn/trigeminal nucleus. Future basic and clinical research should aim at identifying the source of peripheral nociception in order to prevent the development of central sensitization and at ways of reducing established sensitization. This may lead to a much needed improvement in the treatment of chronic tension-type headache and other chronic myofascial pain conditions."

Bendtsen L, Fernandez-de-las-Penas C. 2011. The Role of Muscles in Tension-Type Headache. Curr Pain Headache Rep. [Jul 7 Epub ahead of print]. "The tenderness of pericranial myofascial tissues and number of myofascial trigger points are considerably increased in patients with tension-type headache (TTH). Mechanisms responsible for the increased myofascial pain sensitivity have been studied extensively. Peripheral activation or sensitization of myofascial nociceptors could play a role in causing increased pain sensitivity, but firm evidence for a peripheral abnormality still is lacking. Peripheral mechanisms are most likely of major importance in episodic TTH. Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from pericranial myofascial tissues seem to be responsible for the conversion of episodic to chronic TTH."

Benedetti MG, Zati A, Stagni SB et al. 2017. Winged scapula caused by rhomboid paralysis: a case report. Joints. 4(4):247-249."Scapular winging secondary to dorsal scapular nerve (DSN) damage is an underestimated condition. It is often caused by entrapment of the nerve due to a hypertrophic middle scalene muscle, or by stretching of the DSN during traumatic movements. The condition has also been attributed to myofascial pain syndrome of the rhomboids with entrapment of the DSN. The non-specific symptomatology reported by patients is often incorrectly diagnosed, and this can result in a high level of disability of the upper limb. A clinical case of misdiagnosed dorsal scapula entrapment is presented. Satisfactory shoulder function recovery, pain relief and reduction of disability were obtained after correct diagnosis of the condition and a comprehensive rehabilitation approach." Free Article

Bengtsson, A., J. Ernerudh, M. Vrethem and T. Skogh. 1990. Absence of autoantibodies in primary fibromyalgia. J Rheumatol 17(12:1682-3.

Bengtsson A., Henriksson KG, Larsson J. 1986. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum. 29:817-21.

Benias PC, Wells RG, Sackey-Aboagye et al. 2018. Structure and distribution of an unrecognized interstitium in human tissues. Sci Rep. 8(1):4947. Using confocal laser endomicroscopy (pCLE) techniques and fluorescein injection during endoscopy, this team was able to demonstrate real-time live imaging of a reticular pattern inside fluorescein sinuses. They froze the biopsy tissue and were able to microscopically investigate the fluid-filled interstitial space, "draining to lymph nodes and supported by a complex network of thick collagen bundles..." with "a highly unusual and extensive unlined interface between the matrix proteins of the bundles and the surrounding fluid." Similar structures were observed in a variety of tissues "that are subject to intermittent or rhythmic compression, including the submucosae of the entire gastrointestinal tract and urinary bladder, the dermis, the peri-bronchial and peri-arterial soft tissues, and fascia. These anatomic structures may be important in cancer metastasis, edema, fibrosis, and mechanical functioning of many or all tissues and organs. In sum, we describe the anatomy and histology of a previously unrecognized, though widespread, macroscopic, fluid-filled space within and between tissues, a novel expansion and specification of the concept of the human interstitium." [This research, and the interstitial space, may be profoundly important to both fibromyalgia and chronic myofascial pain and dysfunction, as well as co-existing conditions such as insulin resistance. DJS

Benites-Zapata VA, Urrunaga-Pastor D, Torres-Mallma C et al. 2017. Is free triiodothyronine important in the development of insulin resistance in healthy people? Diabetes Metab Syndr. 11 Suppl 2:S663-S667. Objective: To determine the association between thyroid hormones and insulin resistance in a population of healthy individuals…. We found no association between T4 and insulin resistance…. High levels of free triiodothyronine are associated with insulin resistance. The use of free triiodothyronine to assess insulin resistance in healthy patients should be considered. [Insulin resistance is a common co-existing condition for both FM and chronic myofascial pain and dysfunction, and yet clinicians, including endocrinologists, routinely rely on the TSH results in these patients to determine thyroid function. What must be done to educate others about the necessity of testing for insulin resistance? DJS]

Benjaboonyanupap D, Paungmali A, Pirunsan U. 2015. Effect of therapeutic sequence of hot pack and ultrasound on physiological response over trigger point of upper trapezius. Asian J Sports Med. 6(3):e23806. This study from Thailand found that the use of a combination of hot pack and ultrasound therapies was helpful in treating latent upper trapezius myofascial trigger points, a common problem in athletes. Free PMC Article

Benjamin M, Toumi H, Ralphs JR et al. 2006. Where tendons and ligaments meet bone: attachment sites ('entheses') in relation to exercise and/or mechanical load. J Anat. 208(4):471-490. "Entheses (insertion sites, osteotendinous junctions, osteoligamentous junctions) are sites of stress concentration at the region where tendons and ligaments attach to bone. Consequently, they are commonly subject to overuse injuries (enthesopathies) that are well documented in a number of sports." [These areas are often sites of attachment TrPs and these TrPs are frequently overlooked by orthopedic and surgical consultants. DJS]

Benjamin, S., Morris, S., McBeth, J., MacFarland, G.J., Silman, A.J.. 2000. The association between chronic widespread pain and mental disorder: A Population Study. Epidemiological group has tended towards viewing FMS as a somatization disorder. It was therefore important in this study that they only found three cases of somatoform disorders and came to the conclusion that somatoform disorders were uncommon in people with chronic widespread pain.

Bennett EE, Walsh KM, Thompson NR et al. 2017. Central Sensitization Inventory as a predictor of worse quality of life measures and increased length of stay following spinal fusion. World Neurosurg. [May 4 Epub ahead of print] "Preoperative CSI was associated with worse QOL (quality of life) outcomes and increased LOS (length of stay) following spinal fusions. CSI may be an additional measure in evaluating patients preoperatively to better predict successful outcomes following spinal fusion."

Bennett RM. 2016. Pain management in fibromyalgia. Pain Manag. 6(4):313-316. Free Article [This excellent overview points out some of the problems dealing with the heterogeneous condition of fibromyalgia, including the many different causes of fatigue and of sleep dysfunction, and why there is a problem in many studies. DJS]

Bennett R. 2007. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheum 21(3):427-445. This outstanding summary of MTPs is a comprehensive, clearly written overview of myofascial medicine. It explains why it is necessary for doctors to be trained in diagnosis of MTPs, and that they frequently occur in the presence of other conditions but, although they are exceedingly common, are often undiagnosed or misdiagnosed. [Severe CMP with central sensitization and multiple conditions are not explored, but the treatments suggested are often adequate for mild cases. It is significant that an article on MTPs written by such a respected scientist and clinician has appeared in a rheumatology journal. It is hoped that it is as well-read as it is well-written. DJS]

Bennett RM. 2007. Do patients' perceptions of negative physician attitudes influence fibromyalgia symptoms and status? J Musculoskel Pain 15 (Supp 13):42 item 74. [Myopain 2007 Poster] "Current physicians were perceived to take the diagnosis of FMS more seriously, which in turn was related to improved FMS symptomatology. Perception that current or past physicians didn't take FMS seriously was associated with increased anxiety. Patients may improve both physically and psychologically under the care of a physician who takes their illness seriously, whereas a negative past attitude continues to adversely influence their psychological health." [Doctors can be serious perpetuating factors. Use care in choosing your health care team. DJS]

Bennett R. 2007. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 21(3):427-445. "Myofascial pain refers to a specific form of soft tissue rheumatism that results from irritable foci (trigger points) within skeletal muscles and their ligamentous junctions. It must be distinguished from bursitis, tendonitis, hypermobility syndromes, fibromyalgia and fasciitis. On the other hand it often exists as part of a clinical complex that includes these other soft tissue conditions, i.e., it is not a diagnosis of exclusion."

Bennett RM. 2004. Diagnostic criteria and differential diagnosis of the fibromyalgia syndrome. J Musculoskeletal Pain 12(3/4):59-64. This article explains some of the difficulties arising from the use of 1990 ACR FMS Criteria for research as diagnostic criteria, the need for clarification of terms and training in differential diagnosis and treatment.

Bennett R. 2005. The fibromyalgia impact questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 23(5 Suppl 39):S154-162. The latest version of the Fibromyalgia Impact Questionnaire can be found at www.myalgia.com/FIQ/FIQ

Bennett R. 2004.  Fibromyalgia: present to future. Curr pain Headache Rep. 8(5):379-384.  A review of the understanding of FMS, including emerging clues and predictions on future developments. 

Bennett RM. 2002. The rational management of fibromyalgia patients.  Rheum Dis Clin North Am 2002. 28(2):181-99.  "The exponential increase in pain research over the last 10 years has established fibromyalgia (FM) as a common chronic pain syndrome with similar neurophysiologic aberrations to other chronic pain states.  As such, the pathogenesis is considered to involve an interaction of augmented sensory processing (central sensitization) and peripheral pain generators.  The notion, the FM symptomatology results from an amplification of incoming sensory impulses, has revolutionized the contemporary understanding of this enigmatic problem and provided a more rational approach to treatment."

Bennett, R. M. 1995. Fibromyalgia: The commonest cause of widespread pain. Frontiers 21(6):269-275.

Bennett, R. M. And S. Jacobsen. 1994.  Muscle function and origin of pain in fibromyalgia. Ballieres Clin Rheumatol 8(4):721-746.

Bennett, R. M., S. R. Clark, S. M. Campbell and C. S. Burckhardt.  1992. Low levels of somatomedin C in patients with the fibromyalgia syndrome: a possible link between sleep and muscle pain. Arthritis Rheum 35(10):1113-6.

Bennett, R. M., S. R. Clark, S. M. Campbell, S. B. Ingram, C. S. Burckhardt, D. L. Nelson and J. M. Porter. 1991. Symptoms of Raynaud’s syndrome in patients with fibromyalgia. Arthritis Rheum 34(3):264-9.

Bennett RM, Goldenberg DL. 2011. Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping? Bennett and Goldenberg Arthritis Research & Therapy. 13:117. [This study is fascinating due to its authors, one of whom knows both FM and TrPs (Bennett) and the other (Goldenberg) who appears to have a vested interest in claiming TrPs do not exist, as he does not understand them. I know said author has been confronted with these pesky critters, because we have shared patients who have plunked my book on his desk and asked him "Why don't you know this?" Nothing I could write can top the commentary on this article by Dr. Jan Dommerholt on page 239 of The Journal of Musculoskeletal Pain Vol. 19 #4: "Apparently, Dr. Goldenberg still has not learned to palpate TrPs and appreciate their value, as he considers localized TrPs to be a belief system. He either is not aware of current research or elects to discard many recent TrP studies....We can only hope that the next generation of physicians with an interest in FMS will start to incorporate TrPs into their thinking and evidence-based practice." Amen, Dr. Dommerholt. What ever happened to "Do no harm," Dr. Goldenberg? DJS

Bennett RM, Jones KD, Aebischer JH, et al. 2021. Which symptoms best distinguish fibromyalgia patients from those with other chronic pain disorders? J Eval Clin Pract. Sep 27. Online ahead of print. Comparing patient with FM and patient with pain but not FM. "…the 5 best differentiating symptoms…were: a persistent deep aching over most of my body, poor balance…, environmental sensitivity…, tenderness to touch… and pain after exercise…. Notably, VAS pain though significantly higher for FM was least discriminatory…. Our results herein suggest that clinicians may be well-served to consider symptoms in addition to those contained in current diagnostic criteria when recognizing FM in their chronic pain patients."

Bennett RM, Russell JI, Cappelleri JC et al. 2010. Identification of symptom and functional domains that fibromyalgia patients would like to see improved: a cluster analysis. BMC Musculoskelet Disord. 11(1):134. "The purpose of this study was to determine whether some of the clinical features of fibromyalgia (FM) that patients would like to see improved aggregate into definable clusters. …Common clinical features of FM could be grouped into 6 clusters (Pain, Fatigue, Domestic, Impairment, Affective, and Social) based on patient perception of relevance to treatment. Furthermore, these 6 clusters could be charted in the 2 dimensions of Status and Setting, thus providing a unique perspective for interpretation of FM symptomatology."

Benor D, Rossiter-Thornton J et al. 2016. A randomized, controlled trial of wholistic hybrid derived from eye movement desensitization and reprocessing and emotional freedom technique (WHEE) for self-treatment of pain, depression, and anxiety in chronic pain patients. J Evid Based Complementary Altern Med. [Jul 18 Epub ahead of print.] "In this pilot study, a convenience sample of 24 chronic pain patients (17 with chronic fatigue syndrome/fibromyalgia) were randomized into WHEE treatment and wait-list control groups for 6 weeks. Assessments of depression, anxiety, and pain were completed before, during, and at 1 and 3 months after treatment. Wait-listed patients then received an identical course of WHEE and assessments. WHEE decreased anxiety…and depression… compared with the control group. The wait-list-turned-WHEE assessments demonstrated decreased pain severity… and depression… but not pain interference or anxiety. WHEE appears a promising method for pain, anxiety, and depression in patients with chronic pain, compared to standard medical care alone. Though a small pilot study, the present results suggest that further research appears warranted. An incidental finding was that a majority of patients with chronic pain had suffered psychological trauma in childhood and/or adulthood."

Benyamina A, Reynaud M. 2014. [Therapeutic use of cannabis derivatives.] Rev Prat. 64(2):165-168. [Article in French] "The therapeutic use of cannabis has generated a lot of interest in the past years, leading to a better understanding of its mechanisms of action. Countries like the United States and Canada have modified their laws in order to make cannabinoid use legal in the medical context. It's also the case in France now, where a recent decree was issued, authorizing the prescription of medication containing "therapeutic cannabis" (decree no. 2013-473, June 5, 2013). Cannabinoids such as dronabinol, Sativex and nabilone have been tested for the treatment of acute and chronic pain. These agents are most promising to relieve chronic pain associated with cancer, with human immunodeficiency virus infection and with multiple sclerosis. However, longer-term studies are required to determine potential long-term adverse effects and risks of misuse and addiction."

Benzon HT, Elmofty D, Shankar H, et al. 2024. Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society. Reg Anesth Pain Med. 2024 Jul 16: Online ahead of print. "There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit….There is minimal benefit for the use of corticosteroids in trigger point injections."

Berenshteyn Y, Gibson K, Hackett GC et al. 2018. Is standing balance altered in individuals with chronic low back pain? A systematic review. Disabil Rehabil. 30:1-10. "Results suggest that balance is impaired in individuals with chronic low back pain when compared to healthy individuals.....Balance assessments should be completed for individuals with chronic low back pain."

Berga, S. L. 1998. Hypothalamus pituitary gonadal axis: stress-induced gonadal compromise. J Musculoskel Pain 6(3):61-70.

Berger A, Dukes E, Martin S et al. 2007.  Characteristics and healthcare costs of patients with fibromyalgia syndrome.  Int J Clin Pract. [Jul 26 Epub ahead of print].  “Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.”  [Researchers are realizing that FM patients often have multiple conditions.  What they do not yet understand is that many of these conditions are interactive. DJS]

Bergholm U, Johansson BH. 2003.  [No title given] Lakartidningen 100(47):3842-3847.  [Swedish]  “The late onset of symptoms can now be explained by the functional stenosis of the spinal cord and brainstem due to scar formation around the dens axis after injury.  Modern neurophysiology can now explain the background of the generalized and complex picture of chronic pain and muscular and cognitive dysfunction.  This new knowledge has prepared the way for more specific therapy in patients suffering from craniocervical instability symptoms and pain from disks and facet joints in the cervical spine after whiplash trauma.”

Berman SM, Naliboff BD, Suyenobu B et al. 2008.  Reduced brainstem inhibition during anticipated pelvic visceral pain correlates with enhanced brain response to the visceral stimulus in women with irritable bowel syndrome.  J Neurosci. 28(2):349-359.

Bernardes AT, dos Santos RM. 1997.  Immune network at the edge of chaos.  J Theor Biol. 186(2):173-187.  Chaos system, used in mathematics, corresponds in many ways to the state of ill health, especially chronic illness.   

Bernatsky S, Dobkin P, DeCivita M et al. 2005.  Co-morbidity and physician use in fibromyalgia.  Swiss Med Wkly 135(5-6):76-81.  “Reported co-morbidity was classified into 4 categories: medical, psychiatric, ‘functional’ and unknown.  The category for ‘functional’ conditions included disorders that have been classified by previous authors as medically unexplained symptoms such as the irritable bowel and chronic fatigue syndromes.  Co-morbidity with other disorders, both functional and medical, was high in this sample.  Medical and psychiatric co-morbidity were stronger determinants of high physician use than ‘functional’ co-morbidity.”  [It is illogical to classify conditions together merely because medical science, or the authors, cannot explain them. DJS]

Bernik M, Sampaio TP, Gandarela L. 2013. Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Curr Pain Headache Rep. 17(9):358. "Fibromyalgia is associated with high level of pain and suffering. Lack of diagnosis leads to onerous indirect economic costs. Recent data indicate that fibromyalgia; anxiety disorders, and depression tend to occur as comorbid conditions. They also share some common neurochemical dysfunctions and central nervous system alterations such as hypofunctional serotonergic system and altered reactivity of the hypothalamic-pituitary-adrenal axis. Conversely, functional neuroimaging findings point to different patterns of altered pain processing mechanisms between fibromyalgia and depression. There is no cure for fibromyalgia, and treatment response effect size is usually small to moderate. Treatment should be based on drugs that also target the comorbid psychiatric condition. Combined pharmacotherapy and cognitive-behavior therapy should ideally be offered to all patients. Lifestyle changes, such as physical exercise should be encouraged. The message to patients should be that all forms of pain are true medical conditions and deserve proper care."

Bernstein CD, Albrecht KL, Marcus DA. 2013. Milnacipran for fibromyalgia: a useful addition to the treatment armamentarium. Expert Opin Pharmacother. [Mar 19 Epub ahead of print]. "Milnacipran provides modest fibromyalgia pain relief and is best used as part of a multidisciplinary treatment approach. While milnacipran was not studied in fibromyalgia patients with major depression, it may be a wise choice for fibromyalgia patients with depressive symptoms and patients for whom sedation, dizziness, edema or weight gain with gabapentin and pregabalin is a problem. Milnacipran has been found to be beneficial for treating some troublesome fibromyalgia-associated symptoms, including fatigue and cognitive dysfunction."

Bernstein J, Alonso DR, DiCaprio M et al. 2003.  Curricular reform in musculoskeletal medicine: needs, opportunities and solutions.  Clin Orthop Relat Res. (415):302-308.  “Musculoskeletal medicine is not taught adequately in American medical schools and the predictable consequences are seen.  Students cannot show cognitive mastery of the subject and lack confidence in this topic.”   “…although inadequate education is neither new nor necessarily unique among disciplines, the coming year or two, the beginning of the Bone and Joint decade, was seen to be a particularly auspicious time for attempting curricular reform.”

Berrigan WA, Whitehair C, Zorowitz R. 2018. Acute spinal epidural hematoma as a complication of dry needling: A case report. PM R. [Jul 20 Epub ahead of print] "Dry needling is a procedure commonly performed for the relief of myofascial pain disorders.... This case report describes an acute spinal epidural hematoma as a complication of dry needling. It is a reminder to the performing physician or therapist to take specific precautions when placing a needle near the spine. Sudden onset of neuropathic pain post-needling therapy in and around the spine should prompt emergent assessment with possibly advanced spine imaging to evaluate the integrity of the spinal cord."

Berryman C, Wallwork SB, Heredia Rizo AM, et al. 2021. Are you listening? Facilitation of the auditory blink response in people with fibromyalgia. J Pain. Mar 20;S1526-5900(21)00182-6."Activities that decrease autonomic drive or rebalance autonomic and parasympathetic tone such as vagal stimulation might be pursued as effective interventions for people with FM…. This article presents evidence of preservation of neural circuitry that underpins response suppression and evidence of neural circuit disturbance mediated by autonomic drive in people with FM. These results are important because intact circuitry underpins the effectiveness of therapies and may be harnessed, and rebalancing autonomic drive may be indicated."

Berstad A, Undseth R, Lind R et al. 2012. Functional bowel symptoms, fibromyalgia and fatigue: A food-induced triad? Scand J Gastroenterol. [May 18 Epub ahead of print]. "Abstract Objective. Patients with perceived food hypersensitivity typically present with multiple health complaints. We aimed to assess the severity of their intestinal and extra-intestinal symptoms....All but one patient were diagnosed with IBS, 58% with severe symptoms. Extra-intestinal symptoms suggestive of chronic fatigue and fibromyalgia were demonstrated in 85% and 71%, respectively. Neither IgE-mediated food allergy nor organic pathology could explain the patients' symptoms. Nevertheless, malabsorption of fat was demonstrated in 10 of 38 subjects. Conclusions: Perceived food hypersensitivity may be associated with severe, debilitating illness. The comorbid triad of IBS, chronic fatigue, and musculoskeletal pain is striking and may point to a common underlying cause."

Berthelot JM, Delecrin J, Maugars Y et al. 1996.  A potentially under-recognized and treatable cause of chronic back pain: entrapment neuropathy of the cluneal nerves.  J Rheumatol. 23(12):2179-2181.  “We describe a case of longstanding low back pain related to entrapment neuropathy of the L1-L2 dorsal ramus over the iliac crest.  As 3 local anesthetic pain blocks (at the trigger point, 7 cm left of the L5 spine process and just above the iliac crest) were successful for 3 weeks each, a surgical procedure was performed.  This corrected patient stricture of a voluminous dorsal ramus within a rigid osteofibrous orifice between the upper rim of the iliac crest and the thoracolumbar fascia.  Pain decreased dramatically the same day and disappeared completely within less than a week.”  [One may wonder what might have been the outcome had the patient been treated for myofascial TrPs throughout the body, including the control of perpetuating factors.  Is surgery necessary? DJS]

Bertolucci PH, de Oliveira FF. 2013. Cognitive impairment in fibromyalgia. Curr Pain Headache Rep. 17(7):344. "Cognitive and behavioral impairments are core manifestations of fibromyalgia and may be more disabling than pain itself. Involvement of the central nervous system is ascertained by the fact that frontoparietal and limbic cortices are often functionally and structurally affected along the course of this disease. Even though neuroimaging has brought some experimental evidence to support such network disruption, there are currently no clinically effective biomarkers that detect and quantify cognitive and behavioral disturbances in fibromyalgia; thus, traditional scales and tests of neuropsychiatric assessment remain the most important diagnostic tools. This review addresses the most common cognitive and behavioral impairments in people with fibromyalgia, while explaining their pathophysiological basis and currently available therapeutic options."

Berwick RJ, Siew S, Andersson DA et al.2021. A systematic review into the influence of temperature on fibromyalgia pain: Meteorological atudies and quantitative sensory testing. J Pain. Jan 6;S1526-5900(20)30121-8. "We conclude that the literature provides consistent evidence for an abnormal sensitization of FMS patients' temperature-sensation systems. Additional work is required to elucidate the factors that determine why a subgroup of patients perceive low ambient temperatures as painful, and to characterize that group.... Patients often report increased pain with changes in ambient temperature; even disabling, extreme temperature sensitivity in winter. Understanding this phenomenon may help clinicians provide reassurance and advice to patients and may guide research into the everyday impact of such hypersensitivity, whilst directing future work into the pathophysiology of FMS."

Beschorner N, Nedergaard M. 2024. Glymphatic system dysfunction in neurodegenerative diseases. Curr Opin Neurol. 2024 Apr 1;37(2):182-188. Recent findings: Multiple reports have over the past decade documented that glymphatic fluid transport is broadly suppressed in neurodegenerative diseases…. It has consistently been reported that brain fluid transport is impaired in patients suffering from Alzheimer's disease compared with age-matched control subjects. Summary: An open question in the field is to define the mechanistic underpinning of why glymphatic function is suppressed. Other questions include the opportunities for using glymphatic imaging for diagnostic purposes and in treatment intended to prevent or slow Alzheimer disease progression. (Review) [Myofascial TrPs can entrap blood and lymph vessels. Might MTrPs be part of the problem? DJS]

Besteiro Gonzales JL, Suarez Fernandex TV, Arboleya Rodriguez L et al. 2011. Sleep architecture in patients with fibromyalgia. Psicothema. 23(3):368-373. "The results support that fibromyalgia patients present an increase of superficial sleep at the expense of deep sleep and also an increase of periodic leg movements, which could have a pathogenic effect, facilitating the onset of the illness."

Betsch TA, Gorodzinsky AY, Finley GA et al. 2016. What's in a name? Healthcare providers' perceptions of pediatric pain patients based on diagnostic labels. Clin J Pain. [Dec 5 Epub ahead of print.] "Responses from 58 participants were analyzed. The two groups, based on diagnostic conditions used (Fibromyalgia and Chronic Widespread Pain), did not differ significantly on general demographics and healthcare providers' perceptions of the patient. Perceived origin of the pain influenced providers' perceptions; pain of a perceived medical origin was negatively correlated with stigmatization and positively correlated with sympathy. Perceived psychological origin was positively correlated with stigmatization and providers' age…. Pain believed to be more medically based was associated with more positive reactions from providers (i.e., less stigmatization). Older providers in particular perceived the patient more negatively if they believed the pain to be psychologically based. [FM] The findings of this pediatric study replicated findings from adult literature on chronic pain, suggesting that children and adults are subject to negative perceptions from healthcare providers when the providers believe the pain to be psychological in origin."

Bettini EA, Moore K, Wang Y et al. 2018. Association between pain sensitivity, central sensitization, and functional disability in adolescents with joint hypermobility. J Pediatr Nurs. 42:34-38. "Findings implicate joint hypermobility as a possible antecedent to pain hypersensitivity and central sensitization syndromes that when recognized and addressed effectively may reduce functional disability in those affected."

Beyazal MS, Tufekci A, Kırbas S et al. 2018. The impact of fibromyalgia on disability, anxiety, depression, sleep disturbance, and quality of life in patients with migraine. Noro Psikiyatr Ars. 4;55(2):140-145. "The aim of the present study was to assess the impact of fibromyalgia (FM) comorbidity on disability, anxiety, depression, sleep disturbance, and quality of life in patients with migraine....Our study results (in Turkey) demonstrate the significant impact of FM comorbidity on anxiety, depression, sleep disturbance, and quality of life in this population. FM evaluation and treatment should be considered in the routine care of patients with migraine to globally improve the patient's quality of life."

Bezerra Rocha CA, Sanchez TG, Tesseroli de Siqueira JT. 2007.  Myofascial trigger point: a possible way of modulating tinnitus.  Audiol Neurootol. 13(3):153-160.  “Temporary modulation of tinnitus was frequently observed (55.9%) during digital pressure, mainly in the masseter.”  “An association between tinnitus and the presence of myofascial trigger points was observed, as well as a laterality association between the ear with the worst tinnitus and the side of the body with more myofascial trigger points.  Thus, this relationship could be explained not only by somatosensory-auditory system interactions but also by the influence of the sympathetic system.”

Bezov D, Ashina S, Jensen R et al. 2010. Pain Perception Studies in Tension-Type Headache. Headache. [Oct 1 Epub ahead of print]. "Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. ... Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders." [The number of TrPs and duration of TrPs are two important variable in reversibility. Pharmaceutical and other pain therapies may be able to reverse some central sensitization, especially if it is new, if the pain control method is effective. The cause of the pain and the perpetuating factors must also be brought under control. Since most FM researchers are as yet not considering the peripheral cause of the pain and other symptoms, trigger points, vast shadows are being cast on current fibromyalgia research. DJS]

Bhatti MI, Hollingworth P, Leach P. 2013. Significant improvement of fibromyalgia symptoms after excision of large meningioma - a case report. Br J Neurosurg. [June 14 Epub ahead of print]. "We report a very unusual case of a 42-year-old patient with confirmed fibromyalgia and juvenile onset arthritis whose symptoms dramatically improved after surgical excision of a large, dominant hemisphere, parafalcine meningioma."

Biasi G, Di Sabatino V, Ghizzani A et al. 2014. Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia. Reumatismo. 66(1):87-91. "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." [Myofascial trigger points are often responsible for or contribute to chronic pelvic pain and/or vulvodynia. There are excellent research articles on this. See Doggweiler R. DJS]

Biasi, G., A. Fioravani, A. Franci and R. Marcolongo. 1994. [The role computerized telethermography in the diagnosis of fibromyalgia syndrome.]  Minerva Med 85(9):451-4. [Italian]

Bican O, Jacovides C, Pulido L et al. 2011. Total knee arthroplasty inpatients with fibromyalgia. J Knee Surg. 24(4):265-271. "We matched 59 patients (90 knees) who underwent primary TKA (total knee arthroplasty) with a diagnosis of fibromyalgia to control patients who underwent the same surgery. Postoperative satisfaction and functional outcomes were assessed using a Likert scale and the SF-36 survey, respectively. At 3.4 years' follow-up, fibromyalgia patients were less satisfied with TKA than control patients, and had lower preoperative and postoperative SF-36 scores. They demonstrated improvement comparable to that of controls following TKA, however. Fibromyalgia patients appear to show improvement comparable to that of controls following surgery. This syndrome should not be considered a contraindication for surgery."

Bicket MC, Simmons C, Zheng Y. 2016. The best-laid plans of "Back Mice" and men: A case report and literature review of episacroiliac lipoma. Pain Physician. 19(3):181-188. "Firm, rubbery, mobile nodules that are located in characteristic regions of the sacroiliac, posterior superior iliac, and the lumbar paraspinal regions may represent fatty tissue that has herniated through fascial layers. When painful, these back mice may be confused with other causes of low back pain. In particular, the presence of point tenderness may mimic myofascial pain, and reports of radicular pain may imitate herniated nucleus pulposus. However, back mice may be distinguished from other entities based on findings from the history and physical examination such as absence of neurological deficit. Treatment consisting of injection of local anesthetic into the nodule with or without corticosteroid followed by repeated, direct needling has been reported to relieve pain in many case reports. The one clinical trial comparing injection of local anesthetic to normal saline, which did not include repeated needling, found only mild and transient benefit in the treatment group." Free Article

Bidari A, Ghavidel-Parsa B, Ghalehbaghi B. 2009.  Reliability of ACR criteria over time to differentiate classic fibromyalgia from nonspecific widespread pain syndrome: a 6-month prospective cohort study.  Mod Rheumatol. [Sep 4 Epub ahead of print].  “This study showed the ACR 1990 criteria was not able to consistently classify affected patients with FM syndrome within a group of patients having nonspecific body pain and multiple tender points over 6 months of follow-up.”

Bidari A, Ghavidel-Parsa B, Gharibpoor F. 2022. Comparison of the serum brain-derived neurotrophic factor (BDNF) between fibromyalgia and nociceptive pain groups; and effect of duloxetine on the BDNF level. BMC Musculoskelet Disord. May 2;23(1):411. "Non-significant BDNF level difference between FM and non-FM nociceptive pain suggested that peripheral BDNF is not a pathophysiological feature of FM. The decreased BDNF level parallel with improvement of PSD/pain scores after duloxetine treatment indicates BDNF alteration in the pain modulation process, regardless of cause and effect."

Bidwell LC, Ellingson JM, Karoly HC et al. Association of naturalistic administration of cannabis flower and concentrates with intoxication and impairment. JAMA Psychiatry. 2020 Jun 10. [Epub ahead of print]. "The rapidly growing legal cannabis market includes new and highly potent products, the effects of which, to our knowledge, have not previously been examined in biobehavioral research studies because of federal restrictions on cannabis research…. Flower users were randomly assigned to use either 16% or 24% THC flower and concentrate users were randomly assigned to use either 70% or 90% THC concentrate that they purchased from a dispensary…. Primary outcome measures included plasma cannabinoids, subjective drug intoxication, and neurobehavioral tasks testing attention, memory, inhibitory control, and balance…. Most neurobehavioral measures were not altered by short-term cannabis consumption. However, delayed verbal memory… and balance function… were impaired after use. Differing outcomes for the type of product (flower vs concentrate) or potency within products were not observed…. Short-term use of concentrates was associated with higher levels of THC exposure. Across forms of cannabis and potencies, users' domains of verbal memory and proprioception-focused postural stability were primarily associated with THC administration."

Bieber C, Muller KG, Blumenstiel K et al. 2008.  A shared decision-making communication training program for physicians treating fibromyalgia patients: effects of a randomized controlled trial.  J Psychosom Res. 64(1):13-20.  “SDM (shared decision making) with FMS patients might be a possible means to achieve a positive quality of physician-patient interaction.  A specific SDM communication training program teaches physicians to perform SDM and reduces frustration in patients.”

Bieber C, Muller KG, Blumenstiel K et al. 2006. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia: A qualitative and quantitative 1-year follow-up of a randomized controlled trial.  Patient Educ Couns. [Jul 25 Epub ahead of print]  Shared decision making can be a critical step in producing both doctor and patient satisfaction in fibromyalgia care. 

Bigelow RT, Agrawal Y. 2015. Vestibular involvement in cognition: Visuospatial ability, attention, executive function, and memory. J Vestib Res. 25(2):73-89. "A growing body of literature suggests the inner ear vestibular system has a substantial impact on cognitive function. The strongest evidence exists in connecting vestibular function to the cognitive domain of visuospatial ability, which includes spatial memory, navigation, mental rotation, and mental representation of three-dimensional space. Substantial evidence also exists suggesting the vestibular system has an impact on attention and cognitive processing ability. The cognitive domains of memory and executive function are also implicated in a number of studies."

Bijlard E, Uiterwaal L, Kouwenberg CA et al. 2017. A systematic review on the prevalence, etiology, and pathophysiology of intrinsic pain in dermal scar tissue. Pain Physician. 20(2):1-13. "Scars can cause pain, even without symptoms of underlying nerve damage. A lack of knowledge on intrinsic scar pain hampers effective treatment of these complaints…. Burn and pathologic scars often lead to high intensity pain symptoms. This pain has many characteristics of neuropathic pain that could be caused by an imbalance of C-fibers subtypes. The scar tissue itself may alter the nerve fiber distribution; the imbalance results in ongoing neuro-inflammation and pain symptoms." Free Article

Bileviciute-Ljungar I, Jan-Rickard Norrefalk I, Borg K. 2022. Pain burden in oost-COVID-19 syndrome following mild COVID-19 infection. J Clin Med. Jan 31;11(3):771. "Generalised pain was self-reported by 75 participants and was estimated in 50 participants. Diagnosis of fibromyalgia according to the 2016 criteria was suspected in 40 participants. Subgroup analyses indicated that comorbidities might play a role in the development of pain. In conclusion, a major part of sufferers from post-COVID-19 syndrome develop pain, and in addition to its many disabling symptoms, there is an urgent need for pain management in post-COVID-19 syndrome".

Bilge U, Sari YE, Balcioglu H et al. 2018. Prevalence of comorbid diseases in patients with fibromyalgia: A retrospective cross-sectional study. J Pak Med Assoc. 68(5):729-732. "Of the total, 345(67.8%) patients had at least one comorbid disease, while 164(32.2%) had no comorbid disease. The most prevalent condition was cardiovascular diseases in 187(36.7%) patients followed by endocrine diseases in 157(30.8%).... Fibromyalgia is a disease that is seen to be increasing in frequency in recent years. It is useful to evaluate fibromyalgia patients with their comorbid conditions on their follow-up." [Researchers are finding coexisting conditions in FM patients. This study from Turkey did not assess patients for TrPs, or the percentage would logically have been higher. When there is central sensitization, something is sensitizing the CNS. DJS]

Bingölbali Ö, Taşkaya C, Alkan H, et al. The effectiveness of deep tissue massage on pain, trigger point, disability, range of motion and quality of life in individuals with myofascial pain syndrome. Somatosens Mot Res. 2023 Jan 16;1-7. "In addition to the traditional rehabilitation program, DTM is effective on neck ROM, pain, disability and quality of life. Therefore, DTM treatment is a safe and inexpensive treatment method that can be applied in patients with MPS." [Deep tissue work may be too painful for those who also have FM. DJS]

Binhi VN. 2005.  Stochastic dynamics of magnetosomes and a mechanism of biological orientation in the geomagnetic field.  Bioelectromagnetics [Nov 10 Epub ahead of print].   Magnetosomes embedded in the cytoskeleton (skeletal structure of the cells) may be what allows migratory animals to orient themselves.  They are sensitive to the Earth’s magnetic field.  [The possibility of magnetosomes in cytoskeletons of those people electromagnetically sensitive or electromagnetically sensible exists. DJS]

Birch, S. 2003.  Trigger point–acupuncture point correlations revisited.  J Altern Complement Med 9(1):91-103.  Earlier research (Melzack et al 1977) claimed 71% correspondence of trigger points to traditional acupuncture points.  This study finds that result is “conceptually not possible,” and that there is no more than a 40% correlation and more likely 18% to 19% correlation between the two.  The author did find that another class of acupuncture points, “a she” points, had a very high correlation to trigger points.

Birkmayer W. and P. Riederer. 1989. Understanding the Neurotransmitters: Key to the Workings of the Brain. Translated from German by Karl Blau. NY: Springerer-Verlag.

Birketvedt, G. S. , J. Florholmen, J. Sundsfjord, B. Osterud, D. Dinges, W. Bilker and A. Stunkard. 1999. Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA 282(7):657-63.  

Birley T, Goebel A. 2014. Widespread pain in patients with complex regional pain syndrome. Pain Pract. 14(6):526-531. "In this systematic assessment of the incidence of widespread pain in a large cohort of patients with CRPS, important widespread pain affected >10% of patients. Our data support the inclusion of routine enquiries about additional pains in the clinical assessment of patients with CRPS."

Bisdorff A. 2014. Migraine and dizziness. Curr Opin Neurol. 27(1):105-110. "The further refinement and wider acceptance of the diagnostic entity of vestibular migraine is an important development as it is one the most common vestibular disorders. But the relationship between migraine and vestibular dysfunction is complex and has many aspects beyond vestibular migraine."

Bishnoi, A., H. E. Carlson, B. L. Gruber, L. D. Kaufman, J. L. Bock and K. Lidonnici. 1994. Effects of commonly prescribed nonsteroidal anti-inflammatory drugs on thyroid hormone measurements. Am J Med 96(3):235-8.

Bismil Q, Bismil M. 2013. Myofascial-entheseal dysfunction in chronic whiplash injury: an observational study. JRSM Short Rep. 3(8):57. "1025 consecutive patients with chronic whiplash with neck pain and reduced cervical spine range of motion and trapezius trigger points were seen in this large orthopedic practice seen during a 4-year period. They all had trapezius-associated enthesopathy. This observational paper proposes a change of the definition of chronic whiplash associated disorder to "a painful syndrome following acceleration-deceleration injury with neck stiffness; and myofascial-entheal dysfunction". [Dysfunction of the enthesis, or attachment area, can be a critical part of any injury involving the joint area. DJS]

Bittencourt JV, Amaral ACMM, Rodrigues PV et al. 2021. Diagnostic accuracy of the clinical indicators to identify central sensitization pain in patients with musculoskeletal pain. Arch Physiother. Jan 11;11(1):2. "Conditioned pain modulation (CPM) was assessed by the Cold Pressor Test (reference standard), which is a psychophysical test used to detect impairment of CPM..... Clinical indicators demonstrated a valuable tool for detecting the impaired CPM, which is a remarkable feature of the CS (central sensitization)-related sign and symptoms."

Bjorntorp P. 2001. Do Stress reactions cause abdominal obesity and comorbidities?  Obes Rev 2(2):73-86. Long-term activation of the Hypothalamus-Pituitary Adrenal (HPA) Axis and sympathetic nervous system [commonly part of FMS DJS] may be the prelude to many serious illnesses.  This includes Metabolic Syndrome.  It is important to prevent and/or treat abnormal stress activation.  "...it is suggested that environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abnormal abdominal obesity with its associated comorbidities."

Black, D. W., B. N. Doebbeling, M. D. Voelker, W. R. Clarke, R. F. Woolson, D. H. Barrett and D. A. Schwartz.  1999.  Quality of life and health-services utilization in a population-based sample of military personnel reporting multiple chemical sensitivities.  J Occup Environ Med 41(10):928-33.

Black, K. M., P. McClure and M. Polansky.  1996.  The influence of different sitting positions on cervical and lumbar posture.  Spine 21(1):65-70.

Black LL, Black WR, Andrea Chadwick A, et al. 2024 Investigation of patients' understanding of fibromyalgia: Results from an online qualitative survey. Patient Educ Couns. 2024 Jan 17:122:108156. "Participants in this study expressed confusion about many aspects of fibromyalgia and a desire for more understanding from others in their life about this condition."

Blacksher E. 2002.  On being poor and feeling poor: low socioeconomic status and the moral self. Theor Med Bioeth. 23(6):455-470.  “Persons of low socioeconomic status generally experience worse health and shorter lives than their better off counterparts.  They also suffer a greater incidence of adverse psychosocial characteristics, such as low self-esteem, self-efficacy, and self-mastery and increased cynicism and hostility.  Chronic socioeconomic deprivation can create environments that undermine the development of self and capacities constitutive to moral agency — i.e., the capacity for self-determination and crafting a life of one’s own.  This moral harm is particularly salient in modern Western societies, especially in the United States, where success and failure is attributed to the individual, with little notice of the larger social and political realities that inform an individual’s circumstances and choices.”

Blake P, Burstein R. 2019. Emerging evidence of occipital nerve compression in unremitting head and neck pain. J Headache Pain. 20(1):76. "Unremitting head and neck pain (UHNP) is a commonly encountered phenomenon in Headache Medicine and may be seen in the setting of many well-defined headache types… The cause of UHNP in some patients may be compression of the lesser and greater occipital nerves by the posterior cervical muscles and their fascial attachments at the occipital ridge with subsequent local perineural inflammation. The resulting pain is typically in the sub-occipital and occipital location, and, via anatomic connections between extracranial and intracranial nerves, may radiate frontally to trigeminal-innervated areas of the head. Migraine-like features of photophobia and nausea may occur with frontal radiation. Occipital allodynia is common, as is spasm of the cervical muscles. Patients with UHNP may comprise a subgroup of Chronic Migraine, as well as of Chronic Tension-Type Headache, New Daily Persistent Headache and Cervicogenic Headache. Centrally acting membrane-stabilizing agents, which are often ineffective for CM, are similarly generally ineffective for UHNP. Extracranially-directed treatments such as occipital nerve blocks, cervical trigger point injections, botulinum toxin and monoclonal antibodies directed at calcitonin gene related peptide, which act primarily in the periphery, may provide more substantial relief for UHNP; additionally, decompression of the occipital nerves from muscular and fascial compression is effective for some patients, and may result in enduring pain relief."

Blanco I, Beritze N, Arguelles M et al. 2010. Abnormal over expression of mastocytes in skin biopsies of fibromyalgia patients. Clin Rheumatol. [Apr 30 Epub ahead of print]. “Formalin-fixed, paraffin-embedded skin tissue sections were collected from a matched cohort of 63 fibromyalgia syndrome (FMS) patients and 49 volunteers from the general population with both alpha1-antitrypsin (AAT) normal and deficiency variants. These tissues were examined for the expression of the broad-spectrum inhibitor AAT, the serine proteinases elastase and tryptase, the proinflammatory cytokines MCP-1 and TNFalpha, the endothelium biomarker VEGF, and the inflammation/nociception-related receptor PAR(2). The most relevant finding of the study was a significantly increased number of mast cells (MCs) in the papillary dermis of all FMS patients (greater than or equal to five to 14 per microscopic high power field) compared to zero to one in controls (p < 0.001). MCs strongly stained with tryptase, AAT and PAR(2) antibodies, exhibited a spindle-like shape and were uniformly distributed around blood vessels and appendages. MCP-1 and VEGF expressed weak/moderate positivity in most samples, with a higher expression in controls than in FMS patients (p < 0.001 and 0.051, respectively). No differences in elastase and TNFalpha were found between both groups. Moreover, no histological differences were found between samples from AAT deficiency and normal AAT phenotypes. Our results indicate that FMS is a MC-associated condition. MCs are present in skin and mucosal surfaces throughout the human body, and are easily stimulated by a number of physical, psychological, and chemical triggers to degranulate, releasing several proinflammatory products which are able to generate nervous peripheral stimuli causing CNS hypersensitivity, local, and systemic symptoms. Our findings open new avenues of research on FMS mechanisms and will benefit the diagnosis of patients and the development of therapeutics.” [Other studies have indicated that the skin of fibromyalgia patients differs in collagen depositions, mast cell amounts,  and in other ways. Myofascial trigger point practitioners have indicated the special feel of “fibroskin” is unique.  Histamine is a neurotransmitter that can become imbalanced early in FM, and its overabundance can be a perpetuating factor for both FM and CMP and may be a key to some interactive conditions. DJS]

Blasco-Bonora PM, Martin-Pintado-Zugasti A. 2017. Effects of myofascial trigger point dry needling in patients with sleep bruxism and temporomandibular disorders: a prospective case series. Acupunct Med. 35(1):69-74. "Deep DN of active MTrPs in the masseter and temporalis in patients with myofascial TMD and SB was associated with immediate and 1-week improvements in pain, sensitivity, jaw opening and TMD-related disability."

Blashki G, McMichael T, Karoly DJ. 2007.  Climate change and primary health care. 36(12):986-989.  “Climate change has substantial potential health effects.  These include heat stress related to heat waves; injuries related to extreme weather events such as storms, fires and floods; infectious disease outbreaks due to changing patterns of mosquito borne and water borne diseases; poor nutrition from reduced food availability and affordability; the psychosocial impact of drought; and the displacement of communities.  Primary health care has an important role in preparing for and responding to these climate change related threats to human health.”  [Patients with weather-reactive health conditions should be environmental activists.  We are the canaries in the mines.  Sensitivity to pollution in all its forms has made us the first to be aware, but we will not be the last to be affected. DJS]

Blecher R, Krief S, Galili T et al. 2017. The proprioceptive system masterminds spinal alignment: Insight into the mechanism of scoliosis. Dev Cell. 42(4):388-399.e3. "These findings uncover a central role for the proprioceptive system (in mice) in maintaining spinal alignment."

Bliddal H, Danneskiold-Samsoe B. 2007.  Chronic widespread pain in the spectrum of rheumatological diseases.  Best Pract Res Clin Rheumatol. 21(3):391-402.  “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.”  “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.”

Block C, Cianfrini L. 2013. Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia. NeuroRehabilitation. 33(2):343-366. "To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations."

Bodes-Pardo G, Pecos-Martin D, Gallego-Izquierdo T et al. 2013. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. J Manipulative Physiol Ther. [July 8 Epub ahead of print]. Twenty patients. "The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors, PPT (pressure-pain threshold), and active CROM (cervical range of motion) in individuals with CeH (cervicogenic headache) showing active TrPs in this muscle. Studies including greater sample sizes and examining long-term effects are needed. "

Boehnke KF, Gagnier JJ, Matallana L, et al. 2021. Cannabidiol use for fibromyalgia: Prevalence of use and perceptions of effectiveness in a large online survey. J Pain. Jan 2;S1526-5900(20)30117-6. "This article indicates that CBD use is common among people with fibromyalgia, and the results suggest that many derive benefit from using CBD across multiple symptoms domains. Clinicians should discuss CBD use with fibromyalgia patients, and future studies are needed to rigorously assess CBD's therapeutic value for fibromyalgia symptoms."

Boelens OB, Scheltinga MR, Houterman S et al. 2012. Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome. Br J Surg. [Nov 23 Epub ahead of print]. "Entrapped branches of intercostal nerves may contribute to the clinical picture in some patients with chronic abdominal pain. Pain reduction following local infiltration in these patients was based on an anesthetic mechanism and not on a placebo or a mechanical (volume) effect."

Boelens OB, Scheltinga MR, Houterman S et al. 2011. Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients. Ann Surg. [Aug 30 Epub ahead of print]. "A regimen of consecutive local trigger point injections is effective in one-third of patients with ACNES (anterior cutaneous nerve entrapment syndrome). Surgical neurectomy is effective in about two-thirds of the injection regimen refractory patients. Eighty percent of the entire ACNES population reports total or substantial pain relief on the long term." [All too often, surgery is considered because the treating clinician does not know how to diagnose or treat trigger points. Much surgery can be prevented. DJS]

Bohme K. 2002.  Buprenorphine in a transdermal therapeutic system — a new option.  Clin Rheumatol 21 Suppl 1:S13-S16.  “Typical opioid-related adverse events were reported with a low incidence and mild intensity.  Clinical benefit, coupled with a high level of patient compliance and improved quality of life, substantiate the usefulness of buprenorphine TDS in a practical setting.”

Bohra MH, Kaushik C, Temple D et al. 2014. Weighing the balance: how analgesics used in chronic pain influence sleep. Br J Pain. 8(3):107–118."We conclude that antidepressants have both positive and negative effects on sleep, so do opioids, but in the latter case the evidence shifts towards the counterproductive side. Some anticonvulsants are sleep sparing and non-steroidal anti-inflammatory drugs (NSAIDs) are sleep neutral. Cannabinoids remain an underexplored and researched group…. Sleep deprivation leading to a decrease in the ability to focus or shift attention has been shown to affect the attentional modulation of pain. Sleep-deprived individuals have impaired ability to focus attention and then disengage from painful stimuli, which can lead to failure of cognitive-behavioral and distraction strategies used in pain management.18 Changes in mood have a profound effect on the perception of chronic pain, and sleep deprivation is closely linked to depression and elevated levels of inflammatory markers, which are positively associated with increased spontaneous pain…. It is important to recognize the strength of the impact of sleep disturbance on pain, of chronic pain on sleep and the analgesic property of sleep. Therapeutic interventions aimed to treat pain would work best if the chronic pain sufferer is sleeping well."

Boisgontier MP, Olivier I, Chenu O et al. 2011. Presbypropria: the effects of physiological ageing on proprioceptive control. Age (Dordr). [Aug 18 Epub ahead of print]. "Results showed that proprioceptive control was as accurate and as consistent in older as in young adults for a single proprioceptive task. However, performing a secondary cognitive task and increasing the difficulty of this secondary task evidenced both a decreased matching performance and/or an increased attentional cost of proprioceptive control in older adults as compared to young ones. These results advocated for an impaired proprioception in physiological ageing." [This may be similar to what occurs due to TrPs in FM. The braion can only handle so much, and when confronted with multiple proprioceptive TrP dysfunction as well as the pain stimuli, cognitive dysfunction results. DJS]

Boldingh MI, Ljostad U, Mygland A et al. 2013. Comparison of interictal vestibular function in vestibular migraine vs. migraine without vertigo. Headache. [May 15 Epub ahead of print]. This study found vestibular abnormalities in all migraine patients tested.

Bonanni E, Schirru A, Di Perri MC et al. 2019. Insomnia and hot flashes. Maturitas 126:51-54.1. "Many factors are associated with insomnia during menopause, among them: hot flashes (HF), anxiety and depression, other medical conditions, behavioral and psychosocial factors and primitive sleep patterns. The domino hypothesis connects various factors and suggests that HF disturb sleep, thereby causing insomnia, which in turn increases vulnerability to depression. Nevertheless, sleep disorders predict mood disturbances more robustly than vasomotor symptoms (VMS), indicating that sleep also influences mood via other mechanisms. The medical conditions that may compromise sleep in this age group are common; they include obesity, gastroesophageal reflux, cancer, urinary incontinence and nocturia, thyroid dysfunction, chronic pain, fibromyalgia (often starting or worsening in menopause), and hypertension…. Evidence from other populations suggests that if insomnia is not treated, it may negatively affect the outcome of comorbid conditions. Taken together, these observations suggest that insomnia should be considered a disorder requiring specific attention and treatment. Moreover, recent cross-sectional data link sleep with subclinical markers of cardiovascular risk. It should also be noted that insomnia is common in patients with mild to moderate obstructive sleep apnea syndrome (OSAS)."

Bonavita V, DeSimone R. 2015. The lesson of chronic migraine. Neurol Sci. 36 Suppl 1:101-107. "The hypothesis that central sensitization/allodynia is the common final mechanism responsible for the progression of migraine pain is supported by the possibility of tracing back to allodynic mechanisms the action of the main risk factors for chronic migraine validated by the recent literature. The comorbidity between migraine and idiopathic intracranial hypertension without papilledema is emerging as a new, commonly overlooked risk factor for migraine progression whose putative mechanism might also converge on the sensitization of central pain pathways. If headache progression always occurs at the end of a pathogenetic sequence typical of an individual susceptibility to allodynia, then the primary character of chronic migraine might be debated. Allodynia is not specific to migraine but is implied in the progressive amplification of pain after repeated stimuli, a universal adaptive phenomenon. Being largely conditioned by the individual comorbidity profile, allodynia may only in part be defined as primary in itself. Many migraine comorbid conditions, including a hidden idiopathic intracranial hypertension without papilledema, may emphasize susceptibility to allodynia and promote chronic migraine. These factors and comorbid conditions require them to be individually assessed and adequately treated to optimize the therapeutic response.

Boninger M.L., Cooper R.A., Fitzgerald S.G. et al. 2003. Investigating neck pain in wheelchair users. Am J Phys Med Rehabil 82(3):197-202. Palpation for trigger points (TrPs) reproduced pain in 54% of the wheelchair user patients who had experienced recent neck pain.  Myofascial TrPs may be a significant contributor to neck pain in wheelchair users.  [Not only neck pain.  Janet Travell mentioned how much the wheelchair was “vexing” the TrPs in her legs, and indicated that the use of the chair, although she was generally able to get up and about for specific needs, could be a perpetuating factor for many TrPs.  DJS]

Boonruab J, Damjuti W, Niempoog S et al. 2018. Effectiveness of hot herbal compress versus topical diclofenac in treating patients with myofascial pain syndrome. J Tradit Complement Med. Jun 1;9(2):163-167. (Thailand) "Myofascial pain syndrome (MPS) is a chronic pain disorder which causes musculoskeletal pain and inflammation in the body's soft tissues. Thai Traditional Medicine uses hot herbal compresses as analgesic and anti-inflammatory treatment. There are no scientifically validated follow-up studies after treatment using hot herbal compresses. Effects of hot herbal compresses as an alternative treatment for MPS in the upper trapezius muscle compared with the standard treatment (diclofenac) were examined. Sixty patients with myofascial pain syndrome in the upper trapezius muscle were randomly divided into two groups and assigned to receive either hot herbal compress or nonsteroidal anti-inflammatory drug (diclofenac) treatment for 2 weeks. [Patients in group 1 received a hot herbal compress using herbal compress balls containing Zingiber cassumunar Roxb., Tamarindus indica L., Citrus hystrix DC., Curcuma longa L., Cymbopogon citratus (DC.) Stapf., Acacia concinna (Willd.) DC., Blumea balsamifera (L.) DC. and camphor with alternating 20 min heat and surface temperature ≤45 °C for 20 min by the same therapist throughout the programme. Herbal compression was performed 6 times from the baseline (once every third day), and follow-up after 2 weeks. Patients in group 2 received nonsteroidal anti-inflammatory drugs self-administered daily as 2 mg of 1% topical diclofenac gel (Difelene™) applied on the trigger point three times a day for 2 weeks with follow-up after 2 weeks Clinical assessments included visual analogue scale (VAS) for pain score, cervical range of motion (CROM) for the neck and pressure pain threshold (PPT) tolerability before and after treatment.} Within the groups, all treatments caused significant improvement in VAS and marginally increased effectiveness in PPT; however, only hot herbal compress treatment improved CROM. Hot herbal compress was more effective than diclofenac in all tests. Results provided comparable clinical efficacy between hot herbal compress and diclofenac after 2 weeks of treatment. Hot herbal compress proved to be an effective complementary or alternative treatment for MPS in the upper trapezius muscle."

Boquet J, Boismare F, Payenneville G et al. 1989.  Lateralization of headache: possible role of an upper cervical trigger point.  Cephalalgia. 9(1):15-24.  “An ipsilateral upper neck trigger point was found in 21 of 24 patients with unilateral headache.  During the prodromic period this trigger point was detected as a tender protrusion on neck palpation.  In 18 out of 24 patients it was also found during the headache-free period.  On standard roentgenogram, this protrusion seemed to be a laterally developed C2 spinous process.  The EMG study showed latest trapezius hypertonicity on the side of the headache, even during the headache-free period.  The association of the painful protrusion and trapezius hypertonicity could create an autoreinforcing nociceptive loop, which in turn could be the cause of lateralization of the pain.”

Borenstein DG, Hassett AL, Pisetsky D. 2017. Pain management in rheumatology research, training, and practice. Clin Exp Rheumatol. 35 Suppl 107(5):2-7. "The Pain Management Task Force of the American College of Rheumatology published a report in 2010 highlighting pain management as a fundamental aspect of clinical practice, training and research. In the interim, the consideration of pain as a focus of attention of rheumatologists and rheumatology health professionals has become even more challenging than in 2010 because of the epidemic of opiate addiction and overdose death. The characterisation of categories of pain by mechanism (e.g., inflammation, joint degeneration, abnormalities of central pain processing) can help guide treatment. However, such categorisation can overlook the overlap of these processes and their interaction to create mixed pain states. Further complicating the assessment of pain, outcome measures in rheumatic disease often assess the degree of pain indirectly while concentrating on the quantification of inflammation. Non-inflammatory pain often persists despite treatment, highlighting the need for alternative analgesic therapies. Recommended therapies include acetaminophen, nonsteroidal anti-inflammatory drugs, and stimulators of the pain inhibitory pathway. Each of these non-opioid therapies has incomplete efficacy and potential toxicities that can limit their utility. Non-pharmacologic therapies can show efficacy that rivals or surpasses pharmacologic therapies in the control of pain and improving function in a variety of rheumatic disorders including chronic low back pain and fibromyalgia. A limitation of the use of these therapies is inadequate training and appreciation of their benefits. Furthermore, the supply of trained practitioners to provide non-pharmacological care and support patient efforts for self-management is often limited. Together, these considerations suggest the importance of a renewed effort to implement task force recommendations." Free Article

Borg C, Chouchou F, Dayot-Gorlero J et al. 2018. Pain and emotion as predictive factors of interoception in fibromyalgia. J Pain Res. 11:823-835. "Based on observations on the relationship between somatosensory processing and pain in FM and considering the affective symptoms of this disorder, we tested in FM three dimensions of interoception: interoceptive accuracy (IA), interoceptive awareness (IAW) and interoceptive sensibility (IS)....Multiple regression analyses showed that increased pain-related affect and reactions decrease IA in FM. When the results of each group were examined separately, such effect was found only in FM patients. On its turn, IS was predicted by emotional consciousness and pain-related affect and reactions, but these effects did not differ between FM and controls. Finally, none of the variables we used predicted IAW....Pain-related affect and reactions in FM patients can reduce their interoceptive ability." [This has relevance to any people with FM and CMPD who have menstrual pain, GERD, prostatitis, and other internal symptoms. DJS]

Borg-Stein J. 2006.  Treatment of fibromyalgia, myofascial pain, and related disorders.  Phys Med Rehabil Clin N Am. 17(2):491-510.  This is an overview of treatment considerations for these patients.

Borg-Stein J. 2002.  Cervical myofascial pain and headache. Curr Pain Headache Rep 6(4):324-30. Myofascial pain from trigger points is a treatable component or cause of many headaches.

Borg-Stein J. 2002. Management of peripheral pain generators in fibromyalgia. Rheum Dis Clin North Am 28(2):305-17. "Fibromyalgia is a widespread chronic pain disorder that is characterized in part by central sensitization and increased pain response to peripheral nociceptive and non-nociceptive stimuli.  Part of the comprehensive pain management of patients with fibromyalgia should include a thoughtful evaluation and search for peripheral pain generators that either are associated with fibromyalgia or are coincidentally present.  The identification and treatment of these pain generators lessens the total pain burden, facilitates rehabilitation and decreases the stimuli for ongoing central sensitization."

Borg-Stein J, Iaccarino MA. 2014. Myofascial Pain Syndrome Treatments. Phys Med Rehabil Clin N Am. 25(2):357-374. "Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms."

Borg-Stein, J. and Stein, J. 1996.  Trigger points and tender points.  Rheum Disease Clin North Am 22(2):305-22.

Borg-Stein J, Wilkins A. 2006.  Soft tissue determinants of low back pain.  Curr Pain Headache Rep. 10(5):339-344.  Low back pain patients are often incorrectly labeled.  It is important to recognize and treat the soft tissue cause of the low back pain.  These conditions may be found alone or in combination:  ligamentous, non ligamentous, discogenic and facet.  All contributing causes must be evaluated and treated.

Borsook D, Kussman BD, George E et al. 2012. Surgically Induced Neuropathic Pain: Understanding the Perioperative Process. Ann Surg. [Oct 10 Epub ahead of print]. "Nerve damage takes place during surgery. As a consequence, significant numbers (10%-40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in "peripheral and central sensitization," with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients, these initial events produce chemical, structural, and functional changes in the peripheral and central nervous systems (CNS). The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state-allodynia, sensory loss, shooting pains, etc, that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed "centralization of pain" and affect sensory, emotional, and other (e.g., cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (e.g., depression). Currently there are no objective measures of nociception and pain in the perioperative period. As such, intermittent or continuous pain may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition, appear to provide initial opportunities for decreasing the burden of SNPP, until treatments with high efficacy and low adverse effects that either prevent or treat pain are discovered."

Bosma RL, Mojarad EA, Leung L et al. 2016. FMRI of spinal and supra-spinal correlates of temporal pain summation in fibromyalgia patients. Hum Brain Mapp. Jan 9. [Epub ahead of print] "…FM pain is thought to rely on enhanced pain sensitivity maintained by central mechanisms. One of these mechanisms is central pain amplification, which is characterized by altered temporal summation of second pain (TSSP)…the spinal and brainstem….responses to TSSP are different between NC and FM patients, which may indicate alterations to descending pain control mechanisms suggesting contributions of these mechanisms to central sensitization and pain of FM patients."

Bosque M, Margalef R, Carvajal O, et al. Dry needling produces mild injuries irrespective to muscle stiffness and tension in ex vivo mice muscles. Pain Res Manag. 2022 Jul 5;2022:8920252."Numerous studies have suggested that the myofascial trigger points are responsible for most of the myofascial pain syndrome, so it seems reasonable that its destruction is a good therapeutic solution. The effectiveness of dry needling (DN) has been confirmed in muscles with myofascial trigger points, hypertonicity, and spasticity. The objective of this study is to analyze the need of repetitive punctures on muscles in different situations. The levator auris longus (LAL) muscle and gastrocnemius muscle from adult male Swiss mice were dissected and maintained alive, while being submerged in an oxygenated Ringer's solution…. Healthy muscles allowed the penetration of needles between fibers with minimal injuries. In muscles with contraction knots, the needle separated many muscle fibers, and several others were injured, while blood vessels and intramuscular nerves were mostly not injured. Muscles submerged in a depolarizing solution inducing sustained contraction showed more injured muscular fibers and several muscle fibers separated by the needle. Finally, the muscles submerged in Ringer solution with formalin showed a few number of injured muscular fibers and abundant muscle fibers separated by the needle. Scanning electron microscopy images confirm the optical analyses. In summary, dry needling is a technique that causes mild injury irrespective of the muscle tone."

Bossema ER, Kool MB, Cornet D et al. 2011. Characteristics of suitable work from the perspective of patients with fibromyalgia. Rheumatology (Oxford). [Oct 22 Epub ahead of print]. "Our aim was to investigate the characteristics of suitable work from the perspective of patients with FM.... According to patients with FM, suitable work is paced in such a way that one can perform the job well and with satisfaction while keeping energy for home and free time and having acknowledgement and help from management and colleagues. The brief suitable work checklist that is provided can help patients with FM to negotiate with employers and job professionals to improve the match between job demands and capabilities. [FM is heterogeneous. Much of the ability to work specific jobs may depend on the severity of the FM, the perpetuating factors, and co-existing conditions (especially myofascial TrPs.) DJS]

Botelho LM, Morales-Quezada L, Rozisky JR et al. 2016. A framework for understanding the relationship between descending pain modulation, motor corticospinal, and neuroplasticity regulation systems in chronic myofascial pain. Front Hum Neurosci. 10:308. "Recent evidence has demonstrated that three neural systems are affected in chronic pain: (i) motor corticospinal system; (ii) internal descending pain modulation system; and (iii) the system regulating neuroplasticity…. These findings suggest that the loss of net descending pain inhibition was associated with an increase in ICF, serum BDNF levels, and DRP. We propose a framework to explain the relationship and potential directionality of these factors. In this framework we hypothesize that increased central sensitization leads to a loss of descending pain inhibition that triggers compensatory mechanisms as shown by increased motor cortical excitability." Free PMC Article

Botwin KP, Patel BC. 2007.  Electromyographically guided trigger point injections in the cervicothoracic musculature of obese patients: a new and unreported technique.  Pain Physician 10(6):753-756.  “This technique helps confirm proper needle placement within the cervicothoracic musculature in an obese patient in whom the musculature is not readily palpated.  This, thus, reduces the potential for a pneumothorax by an improperly placed injection.”

Bourdette DN, McCauley LA, Barkhuizen A, Johnston W, Wynn M, Joos SK, Storzbach D, Shuell T, Sticker D. 2001. Symptom factor analysis, clinical findings, and functional status in a population-based case control study of Gulf War unexplained illness. J Occup Environ Med Dec;43(12):1026-40.  More than half of the veterans with unexplained musculoskeletal pain met the criteria for fibromyalgia. Many with unexplained fatigue met the criteria for chronic fatigue syndrome.

Bovaira M, Penarrocha M, Penarrocha M. et al. 2012. Radiofrequency treatment of cervicogenic headache. Med Oral Patol Cir Bucal. [Dec 10 Epub ahead of print]. This study revealed three areas of severe facial pain originating in other locations: one each in cervical roots C2 and C3 and one from an atlantoaxial joint level trigger point. They were all treated with pulsed radiofrequency The first two patients had 30-50% relief versus baseline after one year, the third had complete pain relief for 5 months, after which the pain returned. [Nothing was done to correct the perpetuating factors. DJS]

Bowyer, S. L. and J. R. Hollister.  1984.  Limb pain in childhood.  Pediatr Clin North Am 31(5):1053-1081.

Boyce RA, Kirpalani T, Mohan N. 2016. Updates of topical and local anesthesia agents. Dent Clin North Am. 60(2):445-471. "As described in this article, there are many advances in topical and local anesthesia. Topical and local anesthetics have played a great role in dentistry in alleviating the fears of patients, eliminating pain, and providing pain control. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. The modern-day dentist has the responsibility of knowing the variety of products on the market and should have at least references to access before, during, and after treatment. This practice ensures proper care with topical and local anesthetics for the masses of patients entering dental offices worldwide." [This is an excellent article from dental practitioners who also know trigger point injections, and includes how to pick the best anesthetics to provide dentistry that is as pain-controlled as possible. DJS]

Boyden SD, Hossain IN, Wohlfahrt et al. 2016. Non-inflammatory causes of pain in patients with rheumatoid arthritis. Curr Rheumatol Rep. 18(6):30. "Although pain in rheumatoid arthritis (RA) is frequently thought to be inflammatory in nature, the association between measures of inflammation and pain intensity is low. This observation is likely due to the multifactorial nature of pain. In addition to pain from joint inflammation, RA patients may also have pain due to structural damage or central etiologies, such as aberrancies in the central nervous system (CNS) pain regulatory pathways. These CNS pathways include mechanisms that facilitate pain, as well as mechanisms that inhibit pain. Other factors, such as sleep disturbances, depression, anxiety, and catastrophizing, may also impact the perception of pain in RA patients. Since pain is frequently used as a proxy for inflammation in the assessment of RA disease activity, it is important that patients and physicians recognize that not all pain is inflammatory, and alternative management strategies, other than escalating disease-modifying antirheumatic drug treatment, may need to be considered." [Some of the pain and other symptoms experienced by RA patients may be due to other causes, such as fibromyalgia and trigger points, and adequate treatment of these other pain sources could bring a significant percentage of relief. DJS]

Boyles R, Fowler R, Ramsey D et al. 2015. Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther. 23(5):276-293. "The majority of high-quality studies included in this review show measured benefit from TDN for MTrPs in multiple body areas, suggesting broad applicability of TDN treatment for multiple muscle groups. Further high-quality research is warranted to standardise TDN methods to determine clinical applicability."

Bradesi S. 2010. Role of spinal cord glia in the central processing of peripheral pain perception. Neurogastroenterol Motil. [Mar 16 Epub ahead of print]. “The discovery that glial activation plays a critical role in the modulation of neuronal functions and affects the spinal processing of nociceptive signaling has brought new understanding on the mechanisms underlying central sensitization involved in chronic pain facilitation. Spinal glial activation is now considered an important component in the development and maintenance of allodynia and hyperalgesia in various models of chronic pain, including neuropathic pain and pain associated with peripheral inflammation. In addition, spinal glial activation is also involved in some forms of visceral hyperalgesia….We discuss the signaling pathways engaged in central glial activation, including stress pathways, and the neuron-glia bidirectional relationships involved in the modulation of synaptic activity and pain facilitation. In this expanding field of research, the characterization of the mechanisms by which glia affect spinal neuro-transmission will increase our understanding of central pain facilitation, and has the potential for the development of new therapeutic agents for common chronic pain conditions.”  [Now all we need to do is have the energy and funds now directed at neuron research to be directed to glial research. Then we may have a better chance to find specific ways to neutralize central sensitization.  DJS]

Brady, C., D. Taylor and M. O'Brien. 1993. Whiplash and temporomandibular joint dysfunction. J Ir Dent Assoc 39(3):69-72. 

Brady S, McEvoy J, Dommerholt J et al. 2014. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther. 22(3):134-140. "Trigger point dry needling (TrP-DN) is commonly used to treat persons with myofascial pain, but no studies currently exist investigating its safety. The aim of this study was to determine the incidence of Adverse Events (AEs) associated with the use of TrP-DN by a sample of physiotherapists in Ireland….A prospective survey was undertaken consisting of two forms recording mild and significant AEs. Physiotherapists who had completed TrP-DN training with the David G Simons Academy (DGSA) were eligible to take part in the study. Data were collected over a ten-month period….In the study, 39 physiotherapists participated and 1463 (19.18%) mild AEs were reported in 7629 treatments with TrP-DN. No significant AEs were reported giving an estimated upper risk rate for significant AEs of less than or equal to 0.04%. Common AEs included bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19%). Uncommon AEs were aggravation of symptoms (0.88%), drowsiness (0.26%), headache (0.14%), and nausea (0.13%). Rare AEs were fatigue (0.04%), altered emotions (0.04%), shaking, itching, claustrophobia, and numbness, all 0.01%....While mild AEs were very commonly reported in this study of TrP-DN, no significant AEs occurred. For the physiotherapists surveyed, TrP-DN appeared to be a safe treatment."

Brage S, Ihlebaek C, Natvig B et al. 2010. [Musculoskeletal disorders as causes of sick leave and disability benefits] Tidsskr Nor Laegeforen. 130(23):2369-2370. [Norwegian] "Of the musculoskeletal disorders, low back conditions are the most frequent causes of sick leave and disability benefits, and account for 11 and 9% respectively. Neck and shoulder disorders are also common causes of sick leave, while osteoarthritis and fibromyalgia are common causes of disability benefits and each account for 5% of all new cases….The labor and welfare administration should continue to focus on musculoskeletal disorders to prevent long-term sick leave and permanent absence from work."

Brainard GC, Hanifin JP. 2005.  Photons, clocks and consciousness.  J Biol Rhythms 20(4):314-325.  “Light profoundly impacts human consciousness through the stimulation of the visual system and powerfully regulates the human circadian system, which, in turn, has a broad regulatory impact on virtually all tissues in the body.”  This includes the neuroendocrine system.   The use of specific wavelength light at specific times of the day may be very helpful in resetting biological clocks.

Branavan B, Indrakumar J. Possible complex regional pain syndrome following SARS-CoV-2 infection: Case report. SAGE Open Med Case Rep. 2022 Apr 21;10:2050313X221093111. "SARS-CoV-2 infection has various manifestations including neurological and musculoskeletal system involvement. COVID-19 infection causes peripheral nerve lesions including small fibre neuropathy…. Here, we report a 21-year-old woman presented with pain, hyperalgesia, and swelling of left upper and lower limb following SARS-CoV-2 infection managed as possible complex regional pain syndrome.

Brauer SG, Yoon JD, Curlin FA. 2017. Physician satisfaction in treating medically unexplained symptoms. South Med J. 110(5):386-391. "We surveyed a nationally representative sample of 1504 US primary care physicians. Respondents were asked how responsible patients are for two conditions with more-developed medical explanations (depression and anxiety) and two conditions with less-developed medical explanations (chronic back pain and fibromyalgia), and how much satisfaction they experienced in treating each condition…. Physicians experience less satisfaction in treating conditions characterized by medically unexplained conditions and in treating conditions for which they believe the patient is responsible.

Brault JR, Siegmund GP, Wheeler JB. 2000.  Cervical muscle response during whiplash: evidence of a lengthening muscle contraction.  Clin Biomech 15(6):426-435.  “The cervical muscles contract rapidly in response to impact and the potential exists for muscle injury due to lengthening contractions.  The clinician should recognize the role of cervical retraction in the mechanism of whiplash injury and avoid aggressive motion in that plane during diagnosis and treatment.”

Braus DF. 2004.  [Neurobiology of learning – the basis of an alteration process.] 31 (Suppl 2):215-223. [German] “...there is now increasing evidence that the plasticity of the human brain, i.e. its remarkable ability to adapt to and change with experience, is, under normal conditions, a lifelong phenomenon.”  “The capability to modify the biochemistry of synapses as well as the growth and change in terms of rewiring of synapses, dendritic branching and glial cell proliferation via the dialogue of synapses and genes, results in specific changes in neuronal connectivity and function.”  “...neurotransmitter systems modulate neuronal plasticity on the neuronal level; on the behavioral level they influence affect, emotion, positive motivation and the correct evaluation of environmental stimuli.  Experience, action as well as learning and memory are influenced by these systems.”  [Superb paper with great significance in FMS. DJS]

Bravo JF. 2009. [Ehlers-Danlos syndrome, with special emphasis in the joint hypermobility syndrome]. Rev Med Chil. 137(11):1488-1497. [Spanish] “There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome (JHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research.”

Brennan K, Elifritz KM, Comire MM et al. 2020. Rate and maintenance of improvement of myofascial pain with dry needling alone vs. dry needling with intramuscular electrical stimulation: a randomized controlled trial. J Man Manip Ther. Sep 29;1-11. "Objectives: To determine the difference in rate and maintenance of improvement of pain and disability for Dry Needling (DN) compared to Dry Needling with Intramuscular Electrical Stimulation (DN/IMES), in Myofascial Pain Syndrome (MPS)…. Conclusion: DN and DN/IMES demonstrated improvement and maintenance in disability and pain for 6 weeks. No differences in improvement of disability or pain existed between the groups at week 6 or 12."

Brennan KL, Allen BC, Maldonado YM. 2017. Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: A non-inferiority randomized clinical trial. J Orthop Sports Phys Ther. 3:1-30. "Background: Greater trochanteric pain syndrome (GTPS) is the current terminology for what was once called greater trochanteric or sub-gluteal bursitis. Cortisone (corticosteroid) injections into the lateral hip is a traditionally accepted treatment for this condition…. (Study) Conclusions: Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN."

Brewer R, Cook R, Bird G. 2016. Alexithymia: a general deficit of interoception. R Soc Open Sci. 3(10):150664. "Alexithymia is a sub-clinical construct, traditionally characterized by difficulties identifying and describing one's own emotions. Despite the clear need for interoception (interpreting physical signals from the body) when identifying one's own emotions, little research has focused on the selectivity of this impairment. While it was originally assumed that the interoceptive deficit in alexithymia is specific to emotion, recent evidence suggests that alexithymia may also be associated with difficulties perceiving some non-affective interoceptive signals, such as one's heart rate. It is therefore possible that the impairment experienced by those with alexithymia is common to all aspects of interoception, such as interpreting signals of hunger, arousal, proprioception, tiredness and temperature... ." Their findings indicate that alexthymia is a general failure or dysfunction of interoception. Free Article

Brikman S, Furer V, Wollman J et al. 2016. The effect of the presence of fibromyalgia on common clinical disease activity indices in patients with psoriatic arthritis: A cross-sectional study. J Rheumatol. [Jun 1 Epub ahead of print.] "Coexisting FM is related to worse scores on all tested measures in patients with PsA. Its influence should be taken into consideration in the treatment algorithm to avoid unnecessary upgrading of treatment."

Brinck E, Kontinen V. 2017. Ketamine in the treatment of acute pain. Duodecim. 133(9):863-868. "Ketamine is an old anesthetic agent that relieves pain by reducing central sensitization in the central nervous system. This is advantageous for patients suffering from severe pain prior to surgery or are using a strong opioid. The S enantiomer of ketamine used for anesthesia is more powerful than racemic ketamine. The ideal dose of ketamine for pain relief is not yet known, and its adverse effects on the central nervous system, including hallucinations, sedation, and diplopia have limited its use in pain management. The significance of these effects at low doses is probably less than expected, particularly if benzodiazepines or an alpha-2 agonist, such as dexmedetomidine, are administered in addition to ketamine."

Briones-Vozmediano E, Ohman A, Goicolea I et al. 2017. "The complaining women": health professionals' perceptions on patients with fibromyalgia in Spain. Disabil Rehabil. 7:1-7. PURPOSE: The aim of this study is twofold: (1) to explore health service providers' perceptions regarding fibromyalgia patients in Spain and (2) to analyze possible consequences of these perceptions in terms of how health service providers construct the disease and treat their patients. SUBJECTS/PATIENTS: Twelve health service providers (eight men, four women) involved in the care of fibromyalgia patients. Providers were from different disciplines and included general practitioners, rheumatologists, occupational doctors, psychologists, psychiatrists, physiotherapists and behavioral specialists from Spain. METHOD: We performed individual semistructured interviews, which were recorded and transcribed to conduct a qualitative content analysis supported by Atlas.ti-7. RESULTS: We identified three categories from the interviews: (1) the fibromyalgia patient prototype: the complaining woman, (2) fibromyalgia is considered a women's health issue, but male patients are a privileged minority, and (3) health professionals' attitudes toward fibromyalgia patients: are they really suffering or pretending? CONCLUSION: The uncertainty surrounding fibromyalgia together with the fact that those affected are primarily women, seem to influence professional practice in terms of lack of recognition of Fibromyalgia as a severe disease. Increased training of all health professionals is essential to improving the support and attention given to patients suffering from fibromyalgia. Implications for rehabilitation Fibromyalgia • In order to improve fibromyalgia patients' attention, health providers should learn how to assist patients without prejudices. • Training programs for health providers should include sensitization about the severity of fibromyalgia. • Health providers should be aware of the existence of stereotypes about women suffering from fibromyalgia. • Fibromyalgia protocols should give skills to health providers to avoid offering a gender-biased attention to patients.

Brisby H. 2006.  Pathology and possible mechanisms of nervous system response to disc degeneration.  J Bone Joint Surg Am. 88 Suppl 2:68-71.  “"Deterioration of a disc with loss of normal structure and weight-bearing properties may lead to abnormal motions that cause mechanical stimulation. This theory is supported by the fact that patients commonly experience an increase in pain with weight-bearing and certain movements." "Disc deterioration also influences other spinal structures, such as facet joints, ligaments, and muscles, which can also become pain generators. Thus, disc degeneration may be responsible for the development of chronic low-back pain without being the actual pain focus. Both nociceptive and neuropathic pain can be modulated at higher centers, both at the spinal and the supraspinal levels (central sensitization). The altered magnitude of perceived pain is often referred to as neural plasticity and is considered to play a critical role in the evolution of chronic pain." ”

Broderick JE, Junghaenel DU, Turk DC. 2004.  Stability of patient adaptation classifications on the multidimensional pain inventory. Pain 109(1-2):94-102. “The implications of this study is that for a sizable number of chronic pain patients, MPI classifications may not be stable, trait-like characterizations.” [This agrees with my observation in the 2nd edition Survival Manual. Chronic pain can often cause patients to answer in a way that may indicate antisocial or other psychological characteristics in a healthy person. For example, you often leave a party early because you are in pain, not because you want to avoid contact.]

Brodin P, Jojic V, Gao T et al. 2015.Variation in the human immune system is largely driven by non-heritable influences. Cell 160(1-2):37-47. The environment may affect the immune system response more than genetic influences. This effect grows stronger as we age. This study was done on healthy twins, but the results may be even more important to those with inherited autoimmune disorders. There is a brief article more understandable to the lay person in Science News, February 21, 2015, page 9. "Environment steers the immune system", by Tina Hesman Saey. (This highlights the importance of perpetuating factors that we can change. DJS)

Bromberg MH, Schechter NL, Nurko S et al. 2014. Persistent pain in chronically ill children without detectable disease activity. Pain Manag. 4(3):211-219. "Children with organic diseases may experience persistent pain in the presence of controlled disease, as evidenced by little or no measurable disease activity or inflammation. Historically, dualistic definitions of pain have informed standard diagnostic approaches to persistent pain; aggressive investigation and treatment targeting underlying disease, even in the absence of evidence indicating disease escalation. Evidence across disease populations, in children with inflammatory bowel disease, sickle cell disease, and juvenile idiopathic arthritis indicates that persistent pain in these conditions may be better conceptualized as functional in nature, potentially resulting from disordered somatosensory processing including central sensitization. Applying a biopsychosocial understanding of persistent pain and multidisciplinary functional pain management strategies may lead to improved health outcomes."

Bron C, de Gast A, Dommerholt J et al. 2011. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Jan 24;9:8. A 12-week trial of weekly manual trigger point compression, manual stretching, and intermittent cold with stretching in addition to home muscle stretching, relaxation exercises and ergonomic and postural correction reduced symptoms and improved function for patients with chronic shoulder pain.

Bron C, Dommerholt J. 2012. Etiology of myofascial trigger points. Curr Pain Rep. 16(5):439-444. "Myofascial pain syndrome (MPS) is described as the sensory, motor, and autonomic symptoms caused by myofascial trigger points (TrPs). Knowing the potential causes of TrPs is important to prevent their development and recurrence, but also to inactivate and eliminate existing TrPs. There is general agreement that muscle overuse or direct trauma to the muscle can lead to the development of TrPs. Muscle overload is hypothesized to be the result of sustained or repetitive low-level muscle contractions, eccentric muscle contractions, and maximal or submaximal concentric muscle contractions. TrPs may develop during occupational, recreational, or sports activities when muscle use exceeds muscle capacity and normal recovery is disturbed." Trigger points are common in athletes, and anyone subjected to restrictions of blood flow to the muscle in which they develop. The lack of blood flow leads to a lowered pH and release of pro-inflammatory biochemicals. There is still disagreement if overuse mechanisms or chronic pain are the initiating factor.

Bron C, Dommerholt JD. 2012. Etiology of Myofascial Trigger Points. Curr Pain Headache Rep. [Jul 27 Epub ahead of print]. "Myofascial pain syndrome (MPS) is described as the sensory, motor, and autonomic symptoms caused by myofascial trigger points (TrPs). Knowing the potential causes of TrPs is important to prevent their development and recurrence, but also to inactivate and eliminate existing TrPs. There is general agreement that muscle overuse or direct trauma to the muscle can lead to the development of TrPs. Muscle overload is hypothesized to be the result of sustained or repetitive low-level muscle contractions, eccentric muscle contractions, and maximal or submaximal concentric muscle contractions. TrPs may develop during occupational, recreational, or sports activities when muscle use exceeds muscle capacity and normal recovery is disturbed."

Bron C, Dommerholt J, Stegenga B et al. 2011. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskel Disord. 12:139. If patients have chronic non-traumatic shoulder pain, it is likely that they have active and latent myofascial trigger points.

Brooks JC, Kong Y, Lee MC et al. 2012. Stimulus Site and Modality Dependence of Functional Activity within the Human Spinal Cord. J Neurosci. 32(18):6231-6239. "We have investigated the functional response in the cervical spinal cord of 18 healthy human subjects (aged 22-40 years) to noxious thermal and non-noxious tactile stimulation of the left and right forearms. Physiological noise, which is a significant source of signal variability in the spinal cord, was accounted for in the general linear model….Nonpainful punctate stimulation of the thenar eminence provoked more diffuse activity but was still ipsilateral to the side of stimulation. These results present the first noninvasive evidence for a lateralized response to noxious and non-noxious stimuli in the human spinal cord. The development of these techniques opens the path to understanding, at a subject-specific level, central sensitization processes that contribute to chronic pain states.

Brooks JM, Muller V, Sánchez J et al. 2017. Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia. J Ment Health. Dec 22:1-7. [Epub ahead of print] "Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain."

Brooks L, Hadi J, Amber KT et al. 2015. Assessing the prevalence of autoimmune, endocrine, gynecologic, and psychiatric comorbidities in an ethnically diverse cohort of female fibromyalgia patients: does the time from hysterectomy provide a clue? J Pain Res. 2015 Aug 20;8:561-9. "This study demonstrates that autoimmune, endocrine, and gynecologic pathologies occur more commonly in women with FM than in those with CP (chronic pain), which is consistent with findings in less ethnically diverse samples. Moreover, a relationship was found between timing of pain onset and gynecologic surgery. " Free PMC Article

Brown D, Mulvey M, Cordingley L et al. 2016. The relationship between psychological distress and multiple tender points across the adult lifespan. Arch Gerontol Geriatr. 63:102-107. "Multiple tender points are common in the population and, in studies of midlife adults, are strongly associated with high levels of psychological distress…. This cross-sectional study investigated whether high levels of psychological distress would be associated with a high tender point count and whether the relationship would be moderated by age…. Psychological distress was associated with multiple tender points independent of age. Psychological distress and trouble sleeping were important, potentially modifiable factors associated with the outcome." Free PMC Article

Brown MM, Jason LA. 2007.  Functioning in individuals with chronic fatigue syndrome: increased impairment with co-occurring multiple chemical sensitivity and fibromyalgia.  Dyn Med. 6(1):6.  “…having more than one illness exacerbates one’s disability beyond CFS alone.”

Brown SL, Duggiraia HJ, Pennello G. 2002. An Association of Silicone-gel Breast Implant Rupture and Fibromyalgia.  Curr Rheumatol Rep 4(4):293-8. "Silicone-gel breast implant rupture is common.  Silicone-gel from ruptured implants may escape the scar capsule that forms around breast implants and become 'extracapsular silicone'.  Our previously published study found that women with extracapsular silicone-gel were at higher risk of reporting that they were diagnosed with fibromyalgia."

Bruce, E. 1995 Myofascial pain syndrome: early recognition and comprehensive management. AAOHN  J 43(9):469-474. 

Bruehl S, Chung OY, Ward P et al. 2004. Endogenous opioids and chronic pain intensity: interactions with level of disability.  Clin J Pain 20(5):283-292.  Among more disabled chronic pain patients, endogenous opioid system dysfunction may contribute to hyperalgesia.  Among less disabled patients, chronic pain itself may initiate central sensitization.  [Even chronic pain from TrPs. DJS]

Bruehl S, Morris MC, al'Absi M. 2022. Stress-induced analgesia: an evaluation of effects on temporal summation of pain and the role of endogenous opioid mechanisms. Pain Rep. Feb 8;7(2):e987. "Results suggest that acute stress may reduce initial ratings in temporal summation protocols via nonopioid mechanisms but does not alter the temporal summation slope commonly used to index central sensitization."

Brummett CM, Clauw DJ. 2011. Fibromyalgia: a primer for the anesthesia community. Curr Opin Anaesthesiol. [Jul 27 Epub ahead of print]. "Research continues to demonstrate that fibromyalgia patients have neurophysiologic abnormalities that alter sensory perception, including lower levels of central neurotransmitters associated with the inhibition of pain and higher levels those that facilitate pain. While comorbid mood disorders are more common in fibromyalgia patients, studies have shown that fibromyalgia symptoms are not explained by depression alone. In the last year, the American College of Rheumatology established a new self-report questionnaire for the diagnosis of fibromyalgia in lieu of the previously required tender point examination plus self-report questionnaire. This questionnaire allows for the study of the severity of sensitivity and symptomatology on a continuum, which is termed 'fibromyalgianess'. Some new concepts in the treatment have been proposed, including sodium oxybate, transcranial magnetic stimulation, and web-based cognitive behavioral therapy.....The impact of fibromyalgia on anesthesia care is not known. Years of quality research have clearly demonstrated multiple pathophysiologic changes that could impact anesthesia care and future study is needed." [Myofascial pain awareness is necessary as well. The addition of a Bier's block during IV anesthesia using an irritating substance could prevent a trigger point cascade and an exacerbation of FM, for example.]

Brummett CM, Urquhart AG, Hassett AL et al. 2015. Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Arthritis Rheumatol. [Mar 13 Epub ahead of print.] "The fibromyalgia survey score was a robust predictor of poorer arthroplasty outcomes, even among individuals who fell well below the threshold for the categorical diagnosis of fibromyalgia."

Brun C, McCabe CS, Mercier C. 2020. The contribution of motor commands to the perturbations induced by sensorimotor conflicts in fibromyalgia. Neuroscience. 434:55-65. "Individuals with pain report higher sensory disturbances during sensorimotor conflicts compared to pain-free individuals…. We assessed sensory and motor disturbances during sensory-sensory and sensory-motor conflicts using a robotized exoskeleton interfaced with a 2D virtual environment. There was a significant interaction between the group and the type of conflict…. Moreover, the increase in conflict sensitivity from sensory-sensory to sensory-motor conflicts in fibromyalgia was related to conflict-induced motor disturbances…, but did not result from a poorer proprioception…. Therefore, it appears that higher conflict sensitivity in fibromyalgia is mainly explained by a sensory-motor conflict rather by a sensory-sensory conflict. We suggest this arises due to a deficit in updating predicted sensory feedback rather than in selecting appropriate motor commands."

Bruno KA, Morales-Lara AC, Bittencourt EB, et al. Sex differences in comorbidities associated with Sjögren's disease. Front Med (Lausanne). 2022 Aug 4;9:958670." The top comorbidities in Sjögren's disease were fibromyalgia, depression, and pain. Women with Sjögren's disease had a higher relative risk of developing fibromyalgia, depression, pain, migraine, hypermobile syndrome, EDS and other rheumatic autoimmune diseases. Men with Sjögren's disease had higher risk of developing cardiovascular diseases."

Brunson KL, Kramar E, Lin B et al. 2005.  Mechanisms of late-onset cognitive decline after early-life stress.  Jour of Neuro. 25(41):9328-9338.  “A short period of stress early in life can lead to delayed, progressive impairments of synaptic and behavioral measures of hippocampal function, with potential implications to the basis of age-related cognitive disorders in humans.”  [This may explain at least part of why some of a subset of FMS patients have greater cognitive impairment when they reach middle age.  This may be very significant, and an initiating factor that can be prevented. DJS]

Bruun-Plesner K, Blichfeldt-Eckhar MR, Vaegter HBet al. 2020. Low-Dose Naltrexone for the treatment of fibromyalgia: Investigation of dose-response relationships. Pain Med. [Feb 18 Epub ahead of print] "This study is the first to explore dose-response relationships in the treatment of fibromyalgia with low-dose naltrexone. Future placebo-controlled randomized clinical trials are needed, and according to our findings, 4.5 mg, which has previously been used, seems to be a relevant test dose. We recommend that future studies include additional nonpain fibromyalgia symptoms as outcome measures."

Bruzzese V, Marrese C, P Scolieri P, et al. Efficacy of a gluten-free diet in reducing the widespread pain index and symptom severity scale in patients affected by fibromyalgia. Reumatismo. 2023 Sep 18;75(3). This study aimed to treat FM patients with a gluten-free diet (GFD), alternated with a non-restricted gluten-containing diet, followed by a rechallenge of the GFD…. A GFD (gluten-free diet) improved FM symptoms evaluated with WPI (widespread pain index) and SS (severity scale). This was confirmed for the first time, also with a rechallenge of the GFD that followed a non-restricted gluten-containing diet.

Bryant, R. A. and A. G. Harvey.  1999.  Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury.  J Nerv Ment Dis 187(5):302-5.

Buchgreitz L, Lyngberg AC, Bendtsen L et al. 2007.  Increased pain sensitivity is not a risk factor but a consequence of frequent headache: a population-based follow-up study.  Pain. [Nov 29 Epub ahead of print].  “…increased pain sensitivity is a consequence of frequent tension-type headache, not a risk factor, and support that central sensitization plays an important role or the chronification of tension-type headache.”

Buchgreitz L, Lyngberg A, Bendtsen L et al. 2007.  Increased prevalence of tension-type headache over a 12-year period is related to increased pain sensitivity.  A population study.  Cephalalgia. 27(2):145-152.  Tension-type headache in women may be one cause of central sensitization.

Buchmann J, Neustadt B, Buchmann-Barthel K et al. 2014. Objective measurement of tissue tension in myofascial trigger point areas before and during the administration of anesthesia with complete blocking of neuromuscular transmission Clin J Pain. 2014 Mar;30(3):191-8. "An increased muscle tension in MTPs, and not a primary local inflammation with enhanced viscoelasticity, was the main result of our investigation. We interpret this increased muscular tension in the taut band with an MTP as increased spinal segmental excitability. In line with this, we assume a predominant, but not unique, impact of increased spinal excitability resulting in an augmented tension of segmental-associated muscle fibers for the etiology of MTP." [This study found that it was not local inflammation, but rather increased muscle tension, that is associated with the irritation of trigger points.]

Buckalew N, Haut MW, Aizenstein H et al. 2010. Differences in brain structure and function in older adults with self-reported disabling and non-disabling chronic low back pain. Pain Med. 11(8):1183-1197. "Brain structure and function is different in older adults with disabling CLBP compared with those with non-disabling CLBP. Deficits in brain morphology combining groups are associated with pain duration and poor physical function. Our findings suggest brain structure and function may play a key role in chronic pain related disability and may be important treatment targets."

Bui R, Coffman J, Berry A et al. 2020. Complex focal pain syndrome: An unusual variant of complex regional pain syndrome. Cureus. Aug 1;12(8):e9510. Complex regional pain syndrome (CRPS) is a chronic neuropathic pain condition that is often overlooked by clinicians and typically occurs within an entire limb. There is considerable clinical variability in presentation among patients with CRPS. We report a case of extremely focal CRPS localized to the left small finger (LSF) following crush injury. A 48-year-old right-handed male presented with LSF stiffness and severe pain of three months' duration following crush injury. He endorsed severe allodynia and minimal flexion at the proximal interphalangeal and distal interphalangeal joints of the LSF. Physical examination was significant for overt shininess and edema isolated to the LSF. X-ray performed at the time of injury and three months after were devoid of any fracture or dislocation. Chronic focal pain syndrome (CFPS) may be a subset of CRPS that has yet to be documented in the literature".

Bulbul F, Koca I, Savas E et al. 2020. The comparison of the biological rhythms of patients with fibromyalgia syndrome with biological rhythms of healthy controls. Med Sci Monit. 26:e920462 "An evaluation of the relationship between FMS evaluation parameters and biological rhythm scores in patients with FMS revealed a significant positive correlation between total BRAIN and VAS, FIQ, BDI, and PSQI scores…. We consider that an evaluation of the biological rhythm of female patients with FMS, and appropriate treatment when required, would contribute significantly to the treatment and follow-up process of the patients."

Bunevicius, R. G. Kazanavicius, R. Zalinkevicius and A. J. Prange, Jr.  1999. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med 340(6):424-9.

Burghy CA, Stodola DE, Ruttle PL et al. 2012. Developmental pathways to amygdala-prefrontal function and internalizing symptoms of adolescence. Nat Neurosci 15(12):1736-1741.Early life stress and activation of the hypothalamus-pituitary-adrenal axis in females (such as during the first year of life or even earlier) can result in higher stress hormone production resulting in depression and anxiety in adolescence. The same cortisol response was not present in males.

Burke NN, Finn DP, McGuire BE et al. 2016. Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms. J Neurosci Res. [Jul 12 Epub ahead of print.] "A wealth of research over the past 2 decades has expanded our understanding of the impact of early-life adversity on physiological function and, consequently, health and wellbeing in later life. Early-life adversity increases the risk of developing a number of disorders, such as chronic pain, fibromyalgia, and irritable bowel syndrome. Although much of the research has examined the impact of physical maltreatment, an increasing number of studies have been published over the past few years examining the effect of childhood psychological stress and trauma on the development of various types of chronic pain conditions….Evidence supporting a role for certain key neurobiological substrates, including the hypothalamic-pituitary-adrenal axis; monoaminergic, opioidergic, endocannabinoid and immune systems; and epigenetic mechanisms in the association between early-life psychological stress and chronic pain, is provided. Greater understanding of the impact of early-life stress may inform the development of personalized treatments for chronic pain in later life and strategies to prevent its onset in susceptible individuals."

Burns JW1, Bruehl S, France CR et al. 2016. Psychosocial factors predict opioid analgesia via endogenous opioid function. Pain. [Nov 18 Epub ahead of print.] "Results suggest that psychosocial factors predict elevated analgesic responses to opioid-based medications, and may serve as markers to identify individuals who benefit most from opioid therapy. Results also suggest that people with greater depressive symptoms, trait anxiety, pain catastrophizing, and perceived disability may have deficits in EO (endogenous opioid) function, which may predict enhanced response to opioid analgesics."

Burstein R, Yarnitsky D, Goor-Aryeh I et al. 2000.  An association between migraine and cutaneous allodynia. Ann Neurol 47(5):614-624.

Burwinkle T, Robinson JP, Turk DC. 2005.

Fear of movement: factor structure of the Tampa Scale of Kinesiophobia in patients with fibromyalgia syndrome.  J Pain 6(6):384-391.  The Tampa Scale of Kinesiophobia may not be applicable to fibromyalgia patients, and its assessment measurement properties are “problematic.”  [It may be even less applicable for myofascial pain patients. DJS.]

Buskila D, Ablin JN, Ben-Zion I et al. 2009. A painful train of events: increased prevalence of fibromyalgia in survivors of a major train crash.Clin Exp Rheumatol. 27(5 Suppl 56):S79-85. “Fibromyalgia was found to be highly prevalent, three years after a major train crash, among individuals exposed to the combination of physical injury and extreme stress. This finding is in accordance with previous data regarding the association of fibromyalgia with both physical and emotional trauma and calls attention to studying the underlying susceptibility factors which may partake in this association.”

Buskila D. 2009.  Developments in the scientific and clinical understanding of fibromyalgia.  Arthritis Res Ther. 11(5):242.  “As our understanding of the biological basis and the genetic underpinning of FM increases, we hope to gain a better understanding of the true nature of the disorder, to better classify patients and to attain more rational therapeutic modalities.”

Buskila D, Sarzi-Puttini P, Ablin JN. 2007.  The genetics of fibromyalgia syndrome.  Pharmacogenomics 8(1):67-74.  “The mode of inheritance in FMS is unknown, but it is most probably polygenic.  Recognition of these gene polymorphisms may help to better subgroup FMS patients and to guide a more rational pharmacological approach.”

Buskila D, Press J, Abu-Shakra M. 2003.  Fibromyalgia in systemic lupus erythamatosus: prevalence and clinical implications.  Clin Rev Allergy Immunol Aug:25(1):25-8.  “Fibromyalgia (FM) is common in SLE patients, and is the source of many of the symptoms and much of the disability in these patients.”

Buskila D., Neumann L., 2000. Musculoskeletal Injury as a Trigger for Fibromyalgia/Post-traumatic Fibromyalgia. Curr Rheumatol Rep 2(2):104-108. Soft tissue trauma to the neck can result in an increased incidence of FM compared with other injuries.

Buskila, D, Neumann L, Odes LR, et al. 2001. The prevalence of musculoskeletal pain and fibromyalgia in patients hospitalized on internal medicine wards.  Semin Arthritis Rheum 30(6):411-7. Pain syndromes and related symptoms are prevalent among hospitalized patients on the medicine wards.  Care providers need to be aware of these syndromes, regardless of the reason for the patient's hospitalization.

Buskila, D., A. Shnaider, I. Neumann, D. Zilberman, N. Hilzenrat and E. Sikuler.  1997. Fibromyalgia in hepatitis C virus infection.  Another infectious disease relationship. Arch Intern Med 157(21):2497-500.

Buskila, D., L. Neumann, I. Hazanov and R. Carmi.  1996.  Familial aggregation in the fibromyalgia syndrome.  Semin Arthritis Rheum 26(3):605-611.

Buskila, D., L. Neumann, E. Hershman, A. Gedalia, J. Press and S. Sukenik. 1995.  Fibromyalgia syndrome in children–an outcome study.  J Rheumatol 22(3):525-528.  

Buskila, D., D. D. Gladman, K.V. Straaton P. Langevitz, S.Urowicz and H. A. Smythe. 1990. Fibromyalgia in human immunodeficiency syndrome virus infection. J Rheumatol 17(9):1202-12-6.

Butrick CW. 2009.  Pelvic floor hypertonic disorders: identification and management.  Obstet Bynecol Clin North Am. 36(3):707-722.  “Patients with hypertonic pelvic floor disorders can present with pelvic pain or dysfunction.  Each of the various syndromes will be discussed including elimination disorders, bladder pain syndrome/interstitial cystitis (BPS/IC), vulvodynia, vaginismus, and chronic pelvic pain.  The symptoms and objective findings on physical examination and various diagnostic studies will be reviewed.  Therapeutic options including physical therapy, pharmacologic management, and trigger point injections, as well as botulinum toxin injections…” are reviewed in detail in this article. [It is interesting that more and more research indicates that pelvic floor problems are often caused by TrPs, and yet many clinicians seem unaware of the fact.  It is to be hoped that training programs are under way.  DJS]

Butkevich I.P., Vershinina E.A. 2003.  Maternal stress differently alters nociceptive behaviors in the formalin test in adult female and male rats. Brain Res 961(1):159-65. Prenatal stress alters pain receptor behaviors in offspring.

Butt AM, Hamilton N, Hubbard P et al. 2005.  Synantocytes: the fifth element.  J Anat. 207(6):695-706.  There is a possible form of glial cells apart from the astrocytes, oligodendrocytes and microglia.  It expressed the NG2 chondroitin sulphate proteoglycan (CSPG).  The majority of the NG-2-expressing glial cells in the adult CNS is a specific cell the authors name syantocytes, and they are an integral part of the tripartite synapse, integrating commmunication between the neuron and glial cell.  “Neuronal activity, glutamate and adenosine triphosphate (ATP) act on synatocyte receptors and evoke raised intracellular calcium.  This may affect ion channels and receptor profiles, and their activation may result in glial scar formation.  [This may be an important factor in FMS and CMP interconnection. DJS] 

Buwembo J, Munson R, Rizvi SA et al. 2020. Direct sciatic nerve electrical stimulation for complex regional pain syndrome type 1. Neuromodulation. Nov 10. Online ahead of print. "Foot and leg pain in complex regional pain syndrome (CRPS) presents a challenge even with neuromodulation techniques such as spinal cord stimulation (SCS)…. Our study shows that DISNES (direct sciatic nerve electrical stimulation) helps to control the disabling foot pain in CRPS I, thus improving the quality of life, improving ambulation and decreasing disability. DISNES also alleviates autonomic features and dystonia in CRPS I. Further studies are needed to determine long-term efficacy as this study pool is limited in size and follow-up period."

Buyukkose M, Kozanoglu E, Basaran S et al. 2008. Seroprevalence of parvovirus B19 in fibromyalgia syndrome. Clin Rheumatol. [Dec 5 Epub ahead of print]. This study indicates that parvovirus may be one possible initiators of FM central sensitization. [Parvovirus infections join many others as possible initiating mechanisms. DJS]

Caamano-Barrios LH, Galan-Del-Rio F, Fernandez-de-Las-Penas C et al. 2019. Widespread pressure pain sensitivity over nerve trunk areas in women with frequent episodic tension-type headache as a sign of central sensitization. Pain Med. [Jul 22 Epub ahead of print] "Previous studies reported the presence of widespread pressure pain sensitivity in patients with tension-type headache. However, most of the studies assessed pressure pain sensitivity over muscle tissue. Our aim was to investigate the difference in pressure pain sensitivity over musculoskeletal and nerve symptomatic and distant areas between women with frequent episodic tension-type headache (FETTH) and healthy subjects…. This study found widespread pressure pain hypersensitivity over both nerve trunks and musculoskeletal structures in women with FETTH, suggesting that the presence of central altered nociceptive processing is not just restricted to musculoskeletal areas, for example, muscles, but also pain evoked from directly provoking the nerve trunks by pressure. It is also possible that nerve tissue treatment could lead to a decrease in central sensitization and headache features."

Cabral GA, Marciano-Cabral F. 2005.  Cannabinoid receptors in microglia of the central nervous system: immune functional relevance.  J Leukoc Biol. [Oct 4 Epub ahead of print]  “The recognition that microglia express cannabinoid receptors and that their activation results in modulation of select cellular activities suggests that they may be amenable to therapeutic manipulation for ablating untoward inflammatory responses in the central nervous system.”

Cachinero-Torre A, Díaz-Pulido B, Asunsolo-Del-Barco A. 2017. Relationship of the lateral rectus muscle, the supraorbital nerve, and binocular coordination with episodic tension-type headaches frequently associated with visual effort. Pain Med. [Jan 24 Epub ahead of print.] "The finding of a higher alteration of the sensitivity of the supraorbital nerve, the myofascial trigger points of the lateral rectus, binocular coordination, and the significant influence of visual effort in patients with tension-type headaches suggest a new clinical perspective for problems related to tension-type headaches." [This is another extrinsic eye muscle trigger point verified. It will also show up on the eye exercises recommended on my website in the handout for eye care providers. DJS]

Caglıyan Turk A, Ozkurt S, Dogan I, et al. Fibromyalgia syndrome and related factors in hemodialysis, peritoneal dialysis, and renal transplant patients: A cross-sectional study. Arch Rheumatol. 2021 Oct 18;37(1):67-76. "Fibromyalgia is significantly more common among hemodialysis patients than healthy individuals with a similar prevalence to the healthy individuals for peritoneal dialysis and renal transplant patients. The presence of fibromyalgia is related to depressive symptoms, anxiety, and higher impact on QoL for patients with chronic kidney disease."

Cagnie B, Dewitte V, Barbe T et al. 2013. Physiologic effects of dry needling. Curr Pain Headache Rep. 17(8):348. "During the past decades, worldwide clinical and scientific interest in dry needling (DN) therapy has grown exponentially. Various clinical effects have been credited to dry needling, but rigorous evidence about its potential physiological mechanisms of actions and effects is still lacking. Research identifying these exact mechanisms of dry needling action is sparse and studies performed in an acupuncture setting do not necessarily apply to DN. The studies of potential effects of DN are reviewed in reference to the different aspects involved in the pathophysiology of myofascial trigger points: the taut band, local ischemia and hypoxia, peripheral and central sensitization. This article aims to provide the physiotherapist with a greater understanding of the contemporary data available: what effects could be attributed to dry needling and what are their potential underlying mechanisms of action, and also indicate some directions at which future research could be aimed to fill current voids."

Cagnie B, Dewitte V, Coppieters I et al. 2013. Effect of ischemic compression on trigger points in the neck and shoulder muscles in office workers: A cohort study. J Manipulative Physiol Ther. 36(8):482-489. Nineteen office workers with "mildly severe chronic" neck and shoulder pain and dysfunction each had their 4 most painful trigger points treated with ischemic compression during 8 sessions within a 4 week period. They had significant decrease in pain from all 4 trigger points treated, with significant increase in mobility and muscle strength. These positive outcomes were maintained at a 6-month follow-up.

Cairns V, Godwin J. 2005.  Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms.  Int J Epidemiol. [Epub ahead of print July 22]   “This meta-analysis provides strong evidence that some patients with LB have fatigue, musculoskeletal pain, and neurocognitive difficulties that may last for years despite antibiotic treatment.”

Caixeta GC, Dona F, Gazzola JM. 2012. Cognitive processing and body balance in elderly subjects with vestibular dysfunction. Braz J Otorhinolaryngol. 78(2):87-95. [English, Portuguese]. "Elderly patients with chronic peripheral vestibular disease and worse performance in body balance tests have functional impairment in cognitive skills." [Patients with balance failures must be assessed for trigger points, vestibular dysfunction, cognitive impairment, and metabolic and nutritional imbalances, among other possible causes. DJS]

Cakit BD, Taskin S, Nacir B et al. 2010. Comorbidity of fibromyalgia and cervical myofascial pain syndrome. Clin Rheumatol. [Jan 12 Epub ahead of print]. “The aims of this study are to determine the frequency of fibromyalgia syndrome (FMS) in patients with chronic cervical myofascial pain (CMP) and to investigate the FMS characteristics in CMP patients….Of the 93 CMP subjects, 22 (23.6%) patients fulfilled the classification criteria for FMS…. There were statistically significant differences between regional CMP patients and comorbid CMP and FMS patients regarding presence of fatigue (p = 0.0) and irritable bowel syndrome (p = 0.022)…..In conclusion, we found that nearly a quarter of CMP patients were comorbid with FMS, and psychological and comorbid symptoms were more prominent in comorbid patients. We thought that these two syndromes might be overlapping conditions and as a peripheral pain generator or inducer of central sensitization, MPS might lead to FMS or precipitate and worsen the FMS symptoms.”

Cakit O, Gumustepe A, Cakit BD, et al. 2020. Coexistence of fibromyalgia and metabolic syndrome in females: The effects on fatigue, clinical features, pain sensitivity, urinary cortisol and norepinephrine levels: A cross-sectional study. Arch Rheumatol. Jun 25;36(1):26-37. "We found that patients with FMS had a nearly four times higher risk for MetS (metabolic syndrome) and the coexisting MetS may increase the severity of FMS. In clinical practice, when evaluating a patient with FMS, metabolic characteristics should also be evaluated." [Metabolic syndrome parameters include waist circumference greater than 40" for men and 35" for women; serum triglycerides >150 mg/dL; HDL < 40 mg/dL in men and 50 mg/dL in women, BP > 130/85 mm Hg, serum glucose level > 110 mg/dL.]

Calabro, JJ. 1986.  Fibromyalgia (fibrositis) in children. Am J Med 81(3A):57-59.

Calandre EP, Hidalgo J, Garcia-Leiva JM et al. 2006.  Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?  Eur J Neural. 13(3):244-249.  “Trigger point palpation provoked a migraine attack in 30 (30.6%) patients.  Pericraneal allodynia was found in 15 (15.3%) patients.  These data indicate that nociceptive peripheral sensitization is a usual finding in migraine, and that central sensitization can develop in patients with frequent attacks and long-lasting disease.  Trigger points’ detection in migraine patients could be useful when applying therapies like acupuncture, needling or botulinum toxin injections directed to reduce peripheral sensitization.”

Calandre EP, Hidalgo J, Garcia-Leiva JM et al. 2006.  Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?  Eur J Neurol. 13(3):244-249.  “Trigger points were found in 92 (93.9%) migraineurs and in nine (29%) controls.”  “These data indicate that nociceptive peripheral sensitization is a usual finding in migraine, and that central sensitization can develop in patients with frequent attacks and long-lasting disease.  Trigger points’ detection in migraine patients could be useful when applying therapies like acupuncture, needling or botulinum toxin injections directed to reduce peripheral sensitization.”  [This may be another indication wherein the central sensitization found in FMS acts synergically with the peripheral pain stimuli from trigger points.  DJS]

Calandre EP, Hidalgo J, Garcia-Leiva JM et al. 2006.  Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?  Eur J Neurol. 13(3):244-249.  “These data indicate that nociceptive peripheral sensitization is a usual finding in migraine, and that central sensitization can develop in patients with frequent attacks and long-lasting disease.  Trigger points’ detection in migraine patients could be useful.”  [This may indicate another connection with central sensitization of FMS and TrPs. DJS]

Calandre EP, Navajas-Rojas MA, Ballesteros J et al. 2014. Suicidal Ideation in Patients with Fibromyalgia: A Cross-Sectional Study. Pain Pract. [Jan 17 Epub ahead of print.] "Suicidal ideation was markedly associated with depression, anxiety, sleep quality, and global mental health, whereas only weak relationships were observed between suicidal ideation and both pain and general physical health."

Calandre EP, Rico-Villademoros F, Slim M. 2017. Suicidal behaviors in patients with rheumatic diseases: a narrative review. Rheumatol Int. [Dec 20 Epub ahead of print] "It was found that both suicidal ideation and completed suicide seem to be more frequent in patients experiencing systemic lupus erythematosus, fibromyalgia and arthritis. Major determinants were comorbid depression in fibromyalgia and arthritis, and neuropsychiatric disease in systemic lupus erythematosus. Based on these findings, suicide risk should be assessed in patients suffering from systemic lupus erythematosus, fibromyalgia and/or arthritis. [In this review, the ability to control symptoms sufficiently and the presence or lack of sufficient support networks were not assessed in depth. We welcome more research to ascertain why these patients consider suicide, and what can be done to prevent that set of circumstances from occurring. DJS]

Calandre EP, Vilchez JS, Molina-Barea R et al. 2011. Suicide attempts and risk of suicide in patients with fibromyalgia: a survey in Spanish patients. Rheumatology (Oxford). [Jul 12 Epub ahead of print]. "Pain, poor sleep quality, anxiety and depression were positively correlated with suicide risk. Conclusions: FM is associated with an increased risk of suicide and suicide attempts. Suicidal behavior seems to be related with the global severity of the disease." [If they would look closely, I believe that they would find that the risk of suicide increases with the lack of symptom control, especially pain. When patients feel helpless and hopeless, suicide may appear to be an option. When patients understand their conditions, especially coexisting myofascial trigger points, other pain generators, and perpetuating factors, patients realize that they have some control over their symptoms. They have hope when they are working with their care providers on better symptom control. DJS]

Caldarella MP, Giamberardino MA, Sacco F et al. 2006.  Sensitivity disturbances in patients with irritable bowel syndrome and fibromyalgia.  Am J Gastroenterol. 101(12):2782-2789.  “Our observations seem to indicate that, although sharing a common hypersensitivity background, multiple mechanisms may modulate perceptual somatic and visceral responses in patients with IBS and FM.”  

Calvo MS, Whiting SJ. 2003.  Prevalence of vitamin D insufficiency in Canada and the United States: importance to health status and efficacy of current food fortification and dietary supplement use.  Nutr Rev. 61(3):107-113.  “Several recent studies have identified a surprisingly high prevalence of vitamin insufficiency in otherwise healthy adults living in Canada and the United States.  Dietary Vitamin D is not reaching the population in greatest need, nor is it very protective against insufficiency.”

Camargo, Jr, J. N.  and A. Nucci. 1997. Saphenous nerve entrapment manifested as proximal cruralgia. Rev Paul Med 115(5):1553-4.

Cambron JA, Dexheimer J, Coe P. 2006.  Changes in blood pressure after various forms of therapeutic massage: a preliminary study.  J Altern Complement Med. 12(1):65-70.  “Increases in BP were noted for potentially painful massage techniques, including trigger point therapy.”  [There are a lot of different TrP massage therapy techniques and they were not differentiated here.  TrP therapists must be careful to keep the pain level low to prevent the possibility of central sensitization.  This paper shows that there may be other possible effects of painful therapies.  DJS]

Camerini L, Schultz PJ, Nakamoto K. 2012. Differential effects of health knowledge and health empowerment over patients' self-management and health outcomes: A cross-sectional evaluation. Patient Educ Couns. 89(2):337-344. "The role of health knowledge and empowerment in explaining behavioral and health outcomes was treated in depth in the literature, but the combined effect of these constructs has been somehow neglected. This study presents an empirical, a priori, cross-sectional evaluation of the differential effects of health knowledge and empowerment on patients' self-management and health outcomes. Knowledge and three empowerment dimensions were found to positively impact health outcomes. However, these relationships were not mediated by self-management. Self-management, operationalized in terms of physical exercise and drug intake, was found to be a strong predictor of health outcomes....Despite the lack of support for the mediating role of self-management, a strong impact of knowledge and empowerment over health outcomes was observed. Theories of health literacy and empowerment may benefit from this result by integrating both dimensions in an overall model of behavioral and health outcomes change....Results from this study suggest that health interventions targeted to chronic patients should focus simultaneously on knowledge and empowerment, rather than favoring one of these individual constructs."

Camparis CM, Formigoni G, Teixeira MJ et al. 2006.  Sleep bruxism and temporomandibular disorder: clinical and polysomnographic evaluation.  Arch Oral Biol. [Apr 1 Epub ahead of print].  “The polysomnographic characteristics of patients with sleep bruxism, with and without orofacial pain, are similar.  More studies are necessary to clarify the reasons why some sleep bruxism patients develop chronic (facial) myofascial pain, and others do not.”

Camparis CM, Formigoni G, Teixeira MJ et al. 2005.  Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics.  J Oral Rehabil. 32(11):808-814.  “Tinnitus frequency was higher in patients with sleep bruxism and chronic facial pain.  Myofascial pain, numbers of areas painful to palpation in the masticatory and cervical muscles, higher levels of depression and tooth absence without prosthetic replacement were more frequent in the group with tinnitus.”

Campi LB, Jordani PC, Tenan HL et al. 2016. Painful temporomandibular disorders and central sensitization: implications for management - a pilot study. Int J Oral Maxillofac Surg. [Aug 20 Epub ahead of print.] "The presence of depression contributed significantly to increased pain sensitivity. The presence of hyperalgesia and allodynia in both the trigeminal and extra-trigeminal regions among women with a painful TMD indicated the presence of CS. Changes involving the central nervous system should be considered during the evaluation and management of patients with a painful TMD."

Campo M, Shiyko MP, Kean MB et al. 2018. Musculoskeletal pain associated with recreational yoga participation: A prospective cohort study with 1-year follow-up. J Bodyw Mov Ther. 222(2):418-423. "The final sample included 354 participants from two suburban yoga studios. The incidence rate of pain caused by yoga was 10.7%. More than one-third of incident cases resulted in lost yoga participation time and/or symptoms lasting more than 3 months…. Yoga can cause musculoskeletal pain…. Yoga teachers should also discuss the risks for injury with their students."

Candeniz S, Çitaker S, Maraş G, et al. Comparison of the effectiveness of instrument-assisted soft tissue mobilization and extracorporeal shock wave therapy in myofascial pain syndrome. Turk J Med Sci. 2023 Oct 16;53(6):1825-1839. "Background/aim: To compare the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) used in myofascial pain syndrome (MPS) and to determine whether they are superior to conservative treatment (CT)…. All 3 of these treatments can be used to alleviate the negative effects of MPS. IASTM treatment can be preferred primarily in the creation of combined treatment programs for patients with ROM (range of motion) limitations and low PPTs (pressure pain threshold)."

Cankurtaran D, Aykın Yıüman Z, Güzel Ş, et al. The importance of myofascial trigger points in chronic neck pain: An ultrasonography preliminary study. PM R. 2023 Aug;15(8):954-964."The detection of MTPs with ultrasonography is associated with the severity of pain and disability in those with chronic NP. Features on ultrasound include hypoechoic changes within muscle and reduced muscle thickness associated with MTPs." [Other research has indicated that muscles thicken with TrPs and increasing pain. This aligns with research indicating that the myofascia becomes dense in the presence of TrPs. DJS]

Cannon DE, Dillingham TR, Miao H et al. 2007.  Musculoskeletal disorders in referrals for suspected cervical radiculopathy.  Arch Phys Med Rehabil. 88(10):1256-1259.  “Musculoskeletal disorders are common in patients with suspected cervical radiculopathy.”  “The presence of musculoskeletal disorders should not preclude electrodiagnostic testing when otherwise indicated.”

Canovas R, Leon I, Roldan MD et al. 2009.  Virtual reality tasks disclose spatial memory alterations in fibromyalgia.  Rheumatology [Aug 4 Epub ahead of print].  “These results are the first to demonstrate that there is a spatial learning deficit in people with FM, which suggest that the hippocampal system can be disturbed in this syndrome.”  [It may be difficult to separate causes of spatial dysfunction.  Patients with FM usually have TrPs, and TrPs can cause proprioceptive dysfunction.  They also may have vestibular dysfunction or TBI.  These patients were not screened for co-existing TrPs, so we cannot be sure what caused the spatial alterations, and it is very important to discover what cause or causes there may be. DJS]

Cantu, Robert L. and Alan J. Grodin. 1992. Myofascial Manipupation: Theory and Clinical Application. Aspen Publishers Inc: Gaithersburg MD. 

Cao L, Gao Y, Wu K et al. 2020. Sympathetic hyperinnervation in myofascial trigger points. Med Hypotheses. Feb 14;139:109633.. "There was sympathetic hyperinnervation in MTrPs, which could partially explain the symptoms of MTrPs and is an interesting and useful new perspective regarding the diagnosis and treatment of MPS…. The sympathetic nerves in MTrPs are remodeled, leading to sympathetic hyperinnervation. Sympathetic hyperinnervation can partially explain the symptoms of MPS. The pathological mechanism of sympathetic hyperinnervation may be a new perspective for the diagnosis and treatment of MPS." [This study may identify one reason why MTrPs are so prevalent in patients with FM; a condition characterized by a sympathetic nervous system in overdrive.]

Capo-Juan MA. 2015. [Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment] An Sist Sanit Navar. 38(1):105-115. [Article in Spanish] "A high percentage of medical consultations due to muscle pain turn out to be myofascial pain syndrome (MPS). Its existence implies the presence of myofascial trigger points which can be latent or active throughout the whole population. The aim of this review is to update knowledge in the various therapies applied by the physiotherapist in the treatment of this syndrome at cervical level. From the review it appears that some of the most used techniques that may be useful in the short or medium term are: ischemic compression and/or trigger point pressure release and dry needling. Furthermore, various combinations of treatment modalities are used to treat this syndrome, taking other aspects into account, such as education." Free Article

Caraci F, Coluzzi F, Marinangeli et al. Modulation of sensitization processes in the management of pain and the importance of descending pathways: a role for tapentadol? Curr Med Res Opin. 2020 Mar 27:1. "Solid evidence has highlighted the importance of central sensitization in the transition from acute to chronic pain…. Tapentadol is characterized by a to-date-unique mechanism of action, since it acts both as a MOR (mu-opioid receptor) agonist and as an inhibitor of NA (noradrenaline) reuptake. The synergistic interaction of these two mechanisms allows a strong analgesic effect by acting on both ascending and descending pathways. Of note, the reduced mu-load of tapentadol limits the risk of opioid-related adverse events, such as gastrointestinal disturbances and respiratory depression. Moreover, the NA component becomes predominant, at least, in some types of pain, with consequent specific clinical efficacy in the treatment of neuropathic and chronic pain…. According to these characteristics, tapentadol appears suitable in the treatment of severe uncontrolled chronic pain characterized by both a nociceptive and a neuropathic component, such as osteoarthritis or back pain."

Caraco Y, Sheller J, Wood AJ. 1996.  Pharmacogenetic determination of the effects of codeine and prediction of drug interactions.  J Pharmacol Exp Ther. 278(3):1165-1174.  Codeine, hydrocodone, and oxycodone are dependent on metabolism by CYP2D6.  Patients who lack the enzyme CYP2D6 or have inhibited CYP2D6 are not candidates for these medications.  Patients on these medications should not be put on medications that inhibit this enzyme.  [Lack of phenotyping test subjects and avoidance of inhibitors may have resulted in incorrect conclusions in some opioid trials for chronic pain.  Metabolic testing may be a valuable tool to help decide which patients will find opioids more effective in controlling pain. DJS] 

Caraco Y, Sheller J, Wood AJ. 1999.  Impact of ethnic origin and quinidine coadministration on codeine’s disposition and pharmacodynamic effects.  J Pharmacol Exp Ther. 290(1):413-422.  Chinese patients varied greatly from Caucasian patients in CYP2D6 activity.  “..Chinese patients produce less morphine from codeine, exhibit reduced sensitivity to that morphine, and therefore might experience reduced analgesic effect in response to codeine. Quinidine-induced inhibition of codeine metabolism is ethnically dependent as well.  The reduction is significantly greater in Caucasians.  [Clinicians need to be aware that different ethnic populations may react differently to medications. DJS] 

Carames J, Carvalhao F, Real Dias MC. 2009.  [Myofascial trigger point disease – a multidisciplinary disorder] Acta Reumatol Port. 34(1):38-43.  [Portuguese]  “The articles and texts reviewed underline the need for an early diagnosis of this disease in order to treat its aetiology and avoid the chronicity of symptoms.”

Cardoso LR, Rizzo CC, de Oliveira CZ et al. 2014. Myofascial pain syndrome after head and neck cancer treatment: Prevalence, risk factors and influence on quality of life. Head Neck. [Jul 2 Epub ahead of print.] "Background: Patients undergoing treatment for head and neck cancer (HNC) might develop myofascial pain syndrome (MPS) as sequelae. The aim of this study was to determine the prevalence, risk factors and quality of life related to MPS….Conclusions: MPS was observed in 1 out of 9 patients after HNC treatment and a worse QOL was observed among them. Tumor site and neck dissection were found to be risk factors for MPS."

Carlson CR, Okeson JP, Falace DA et al. 1993.  Reduction of pain in EMG activity in the masseter region by trapezius trigger point injection.  Pain 55(3):397-400.  “These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions”

Carmona L. 2002.  More evidence on the dysautonomic nature of fibromyalgia: The association with short stature.  Arthritis Rheum 46(1):1415-1416.  This is especially interesting in that the author found a significant correlation with FMS and short women.

Caro XJ, Galbraith RG, Winter EF. 2018. Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects. Eur J Rheumatol. 5(2):104-110. "Whereas small fiber neuropathy (SFN) is now a recognized part of fibromyalgia (FM), surprisingly little attention has been paid to any findings of large fiber neuropathy (LFN) in this disorder. Since 90% to 95% of FM subjects seen in our outpatient facility routinely undergo EMG and nerve conduction studies (NCS) we elected to retrospectively review the EMG/NCS results garnered from a large cohort of unselected subjects in order to describe the electrodiagnostic features of LFN in FM.... Our review of the EMG/NCS results, gleaned from the largest FM cohort yet studied with these modalities, shows that electrodiagnostic features of polyneuropathy, muscle denervation, and CIDP are common in FM. Furthermore these electrodiagnostic findings are often seen coincident with SFN, and are not significantly influenced by the presence of RA. These results, particularly when taken as a whole, suggest that EMG/NCS may be clinically useful in detecting LFN in FM and help in better understanding the etiopathogenesis of this painful disorder." Free Article [It would be interesting to see if areas of large fiber neuropathy are also areas of myofascial nerve entrapment. DJS]

Caro XJ, Winter EF. 2014. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: Clinical and immunologic implications. Arthritis Rheumatol. [Apr 9 Epub ahead of print.] "A subset of fibromyalgia (FM) patients exhibits a large fiber, demyelinating peripheral polyneuropathy, akin to that seen in chronic inflammatory demyelinating polyneuropathy (CIDP). It has been suggested that this demyelinating process is likely to be immune mediated. Since it is known that similar, large fiber neuropathic lesions may be associated with a cutaneous small fiber neuropathy (SFN), we sought to determine the prevalence of SFN, as measured by epidermal nerve fiber density (ENFD), in a series of FM patients and clinically healthy controls.…. These findings suggest that SFN is likely to contribute to FM pain complaints; that pain in this disorder arises, in part, from a peripheral immune mediated process; and that measurement of ENFD may be a useful clinical tool in FM." [The authors need to take into consideration that the nerve fiber density in FM may possibly be higher due to co-existing myofascial trigger points entrapping nerves and corollary nerve fiber development may occur. Differing collagen deposition and mast cell deposition in the skin of FM has also been observed by researchers, and this might affect the conclusion as well. DJS]

Caro XJ, Winter EF, Dumas AJ. 2008.  A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg.  Rheumatology 47(2):208-211.  “A significant subset of FMS subjects have clinical and EDX (electrodiagnostic) findings suggestive of CIDP.  IVIg (intravenous immunoglobin) treatment shows promise in treating this subset.”

Carr CM, Plastaras CT, Pingree MJ et al. 2016. Immediate adverse events in interventional pain procedures: A multi-institutional study. Pain Med. [Apr 15 Epub ahead of print.] These authors are from the Mayo Clinic, the Penn Spine Center U of PA, and Stanford University. "Immediate complication data were available for 26,061 consecutive procedures. A radiology practice performed 19,170 epidural steroid (primarily transforaminal), facet, sacroiliac, and trigger point injections (2006-2013). A physiatry practice performed 6,190 spine interventions (2004-2009). A second physiatry practice performed 701 spine procedures (2009-2010). There were no major complications (permanent neurologic deficit or clinically significant bleeding [e.g., epidural hematoma]) with any procedure. Overall complication rate was 1.9% (493/26,061). Vasovagal reactions were the most frequent event (1.1%). Nineteen patients (<0.1%) were transferred to emergency departments for allergic reactions, chest pain, symptomatic hypertension, and a vasovagal reaction….This study demonstrates that interventional pain procedures are safely performed with extremely low immediate adverse event rates when evidence-based guidelines are observed."

Carrillo-de-la-Peña MT, Triñanes Y, González-Villar A et al. 2014. Filtering out repetitive auditory stimuli in fibromyalgia: A study of P50 sensory gating. Eur J Pain. [Nov 28 Epub ahead of print.] This study from Spain found: "The results indicate that FM patients do not present significant deficits in early sensory gating when processing auditory stimuli, and therefore challenge the 'generalized hypersensitivity' hypothesis of FM."

Carrillo-de-la-Pena MT, Vallet M, Perez MI et al. 2006.  Intensity dependence of auditory-evoked cortical potentials in fibromyalgia patients: a test of the generalized hypervigilance hypothesis.  J Pain 7(7):480-487.  “Defects in an inhibitory system protecting against overstimulation may be a crucial factor in the pathophysiology of FM.”  FMS patients may have hypersensitivity to stimuli, especially loud noise.  [This study suggests mechanisms which may explain part of the auditory segment of allodynia often associated with FMS. DJS]

Carroll M, Ellis R, Kohut S, et al. Associations between gluteus medius trigger points with hip passive range of movement and muscle strength in adults with chronic nonspecific low back pain: A cross-sectional study. J Manipulative Physiol Ther. 2023 Jun 14; Online ahead of print. "Conclusion: The presence of active or latent gluteus medius trigger points was associated with hip weakness in adults with chronic nonspecific LBP. There was no association between gluteus medius trigger points and hip passive range of movement."

Carta MG, Moro MF, Pinna FL et al. 2018. The impact of fibromyalgia syndrome and the role of comorbidity with mood and post-traumatic stress disorder in worsening the quality of life. Int J Soc Psychiatry. Aug 27:20764018795211. [Epub ahead of print] "The attributable burden of FMS in worsening QoL (Quality of Life) was found comparable to that of serious chronic diseases such as multiple sclerosis.... FMS is a disorder that 'in itself' can have a devastating impact on an individual's life. The frequency of the association with major depressive and bipolar disorders increases the impact on the QoL of people with FMS. One of the causes of this association appears to be the extreme vulnerability to chronic stress that this disorder involves. The findings have important clinical significance: the physician must interpret in the right dimension and with dignity the suffering of the people with FMS."

Carter B, Rees P, Hale L et al. 2016. Association between portable screen-based media device access or use and sleep outcomes: A systematic review and meta-analysis. JAMA Pediatr. [Oct 31 Epub ahead of print.] "Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes." [These devices can be bad for sleep quality in adults, too. DJS]

Carter, J. E. 1998.  Surgical treatment for chronic pelvic pain.  J Soc Laparoendosc Surg 2(2):129-39.

Carvalho JC, Agualusa LM, Moreira LM et al. 2015. [Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve]. Rev Bras Anestesiol. [Nov 30 Epub ahead of print.] [Article in Portuguese] "Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1%-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the Chronic Pain domain were used as part of her multimodal therapeutic regimen." Free Article

Casale R, Rainoldi A. 2011. Fatigue and fibromyalgia syndrome: Clinical and neurophysiologic pattern. Best Pract Res Clin Rheumatol. 25(2):241-247. "The concept of 'fatigue' is strictly related to parameters of the setting in which fatigue is measured. Therefore, it is mandatory to provide a definition of fatigue and the modalities of its use. This is of pivotal importance with regard to the fibromyalgia (FM) syndrome, where fatigue is the most invalidating symptom and where, paradoxically, no clear and widely accepted definition of fatigue is available in the literature as yet. In the clinical setting, fatigue can be measured by different methods of various complexities. The simplest technique to assess fatigue involves the use of a visual analogue scale (VAS); however, a number of scales with differing levels of complexity are available for use. It is, often, difficult to detach the term 'fatigue' from tiredness and task failure, which correspond to two completely distinguished forms of fatigue: one with central origin (tiredness) and another which is localized within the muscle (peripheral muscle fatigue). The former is related to changes in motor-unit-recruitment strategies, whereas the latter is attributed to changes in membrane properties. To extensively assess fatigue and, partially, to avoid confusion among the types of fatigue described above, a number of laboratory tests have been developed; among these, there are multichannel surface electromyography (EMG) recordings. Using this type of an approach, it is possible the estimation of motor unit location within the muscle, the decomposition of the surface EMG (sEMG) interference signal into constituent trains of motor unit action potentials (MUAPs) and the analysis of single unit properties." [One must take into consideration co-existing conditions such as myofascial trigger points, which could impact any conclusion considerably. DJS]

Casas-Barragan A, Molina F, Tapia-Haro RM, et al. 2021. Association of core body temperature and peripheral blood flow of the hands with pain intensity, pressure pain hypersensitivity, central sensitization, and fibromyalgia symptoms. Ther Adv Chronic Dis. Mar 5;12:2040622321997253. "Our aim was to analyse body core temperature and peripheral vascular microcirculation at skin hypothenar eminence of the hands and its relationship to symptoms in fibromyalgia syndrome (FMS)…. Data highlighted that FMS women showed correlations among body core temperature and hand temperature with the clinical symptoms."

Cash E, Salmon P, Weissbecker I et al. 2014. Mindfulness Meditation Alleviates Fibromyalgia Symptoms in Women: Results of a Randomized Clinical Trial. Ann Behav Med. [Nov 26 Epub ahead of print.] "MBSR (Mindfulness-Based Stress Reduction) ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden. Further exploration of MBSR effects on physiological stress responses is warranted. These results support use of MBSR as a complementary treatment for women with fibromyalgia."

Cashman GE, Mortenson WB, Gilbart MK. 2014. Myofascial treatment for patients with acetabular labral tears: a single-subject research design study. J Orthop Sports Phys Ther. 44(8):604-614. "Study Design Single-subject research design using 4 consecutive patients. Objective To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. Background Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. Methods This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. Results All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. Conclusion Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles."

Castaldo M, Catena A2 Fernández-de-Las-Peñas C et al. 2019. Widespread Pressure Pain Hypersensitivity, Health History, and Trigger Points in Patients with Chronic Neck Pain: A Preliminary Study. Pain Med. [Mar 28 Epub ahead of print] "Widespread pressure pain hypersensitivity was associated with duration of health history conditions, suggesting that long-lasting health complaints may act as a triggering/perpetuating factor, driving sensitization in individuals with chronic neck pain. Active trigger points may be associated with higher widespread pressure hypersensitivity."

Castaldo M, Ge HY, Chiarotto A et al. 2014. Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Med. 15(5):842-849. "Active MTPs are more prominent in WAD (whiplash associated disorders) than MNP and related to current pain intensity and size of the spontaneous pain distribution in whiplash patients. This may underlie a lower degree of sensitization in MNP than in WAD." [We must get physicians and other care providers to recognize the myofascial trigger points that are causing the pain, and train them to treat these pain generators adequately. DJS]

Castori M. 2013. Joint hypermobility syndrome (a.k.a. Ehlers-Danlos Syndrome, Hypermobility Type): an updated critique. G Ital Dermatol Venereol. 148(1):13-36. This review covers every system that could be affected in this common, underdiagnosed and often missed condition, as well as management strategies.

Castori M. 2012. Ehlers-Danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN Dermatol [Nov 22 Epub ahead of print.] EDS, hypermobility type, is a common and often missed hereditary condition. It may have relatively few skin and joint manifestations, and may be missed among common co-existing conditions such as fibromyalgia, carpal tunnel syndrome, chronic low back pain, or chronic regional pain syndrome. When there is hyperextensible or smooth, velvety skin and generalized joint hypermobility, EDS should be among the interactive diagnoses considered. [Many of the common co-morbidities mentioned commonly have co-existing myofascial trigger points as well, and EDS is certainly an initiating and perpetuating factor for trigger points. DJS]

Castori M, Morino S, Celletti C et al. 2013. Am J Med Genet A. 161(12):2989-3004. This paper focuses on fatigue and headache in EDS (Ehlers-Danlos Syndrome) hypermobility type, and its co-existence with chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and similar conditions.

Castori M, Morlino S, Ghibellini G et al. 2015. Connective tissue, Ehlers-Danlos syndrome(s), and head and cervical pain. Am J Med Genet C Semin Med Genet. [Feb 5 Epub ahead of print.] "Ehlers-Danlos syndrome (EDS) is an umbrella term for a growing group of hereditary disorders of the connective tissue mainly manifesting with generalized joint hypermobility, skin hyperextensibility, and vascular and internal organ fragility….Headache is reported in no less than 1/3 of the patients. Migraine results the most common type in the hypermobility type of EDS. Other possibly related headache disorders include tension-type headache, new daily persistent headache, headache attributed to spontaneous cerebrospinal fluid leakage, headache secondary to Chiari malformation, cervicogenic headache and neck-tongue syndrome, whose association still lacks of reliable prevalence studies. The underlying pathogenesis seems complex and variably associated with cardiovascular dysautonomia, cervical spine and temporomandibular joint instability/dysfunction, meningeal fragility, poor sleep quality, pain-killer drugs overuse and central sensitization."

Castro Sanchez AM, García Lopez H, Fernandez Sanchez M et al. 2018. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. Disabil Rehabil. 23:1-12. "Sixty-four subjects with fibromyalgia were randomly assigned to a dry needling group or a myofascial release group. Pain pressure thresholds of myofascial trigger points were evaluated in the cervical muscles. In addition, quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, impact of fatigue at baseline and post treatment after four weeks of intervention were evaluated....The dry needling therapy showed higher improvements in comparison with myofascial release therapy for pain pressure thresholds, the components of quality of life of physical role, body pain, vitality and social function, as well as the total impact of FMS symptoms, quality of sleep, state and trait anxiety, hospital anxiety-depression, general pain intensity and fatigue." [Treating TrPs improve FM. DJS]

Castro-Sanchez AM, Garcia-Lopez H, Mataran-Penarrocha GA et al. 2017. Effects of dry needling on spinal mobility and trigger points in patients with fibromyalgia syndrome. Pain Physician. 20(2):37-52. "The etiology of fibromyalgia syndrome (FMS) is inconclusive, but central mechanisms are well accepted for this pain condition. Myofascial pain syndrome (MPS) is one of the most common musculoskeletal pain diseases and is characterized by myofascial trigger points (MTrPs). It has been suggested that MTrPs have an important factor in the genesis of FMS…. This study has demonstrated that dry needling therapy reduces myofascial trigger points algometry on thoracic and lumbar muscles. Dry needling and cross tape approaches reported a similar effect size for spinal mobility measures in patients with FMS." Free Article

Castro-Sanchez AM, Mataran-Penarrocha GA, Sanchez-Labraca N, et al. 2010. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil. [Aug 11 Epub ahead of print]. "Craniosacral therapy improved medium-term pain symptoms in patients with fibromyalgia."

Catalá P, Gutiérrez L, Écija C, et al. Pathological cycle between pain, insomnia, and anxiety in women with fibromyalgia and its association with disease impact. Biomedicines. 2023 Jan 6;11(1):148."Insomnia predicts higher levels of pain, which in turn predicts higher levels of anxiety, which in turn predicts a higher impact of fibromyalgia…. No significant results were found for the other interactions between the variables…. Due to the clinical and scientific relevance of the insomnia-pain-anxiety pathological cycle and given the impact it has on FM, it is especially relevant to develop programs for patients with fibromyalgia based mainly on improving sleep quality."

Cavett T, Solarczyk J. 2016. Trigger-point dry needling for the SOF Medic. J Spec Oper Med. Winter 16(4):33-39. "We propose that trigger-point dry needle (TrP-DN) therapy is an effective low-risk treatment for pain associated with myofascial trigger points (MTrP), and should be incorporated into the Special Operations Forces (SOF) Medic's scope of practice. Furthermore, TrP-DN therapy can be used as a treatment adjunct on the SOF continuum of care, providing analgesia and increased tolerance for rehabilitative therapy, thereby facilitating improved patient outcomes and faster return to operational readiness. The incidence of musculoskeletal injuries in the SOF community is discussed, as are available treatment options TrP-DN methods, a case study of a Soldier deployed to Afghanistan, the science behind the subject of MTrP and TrP-DN, and the risks associated with TrP-DN and how we can mitigate them effectively … Based on anecdotal evidence of and personal experience with the success of the therapy, as well as its growing use within both civilian and military medicine, the possible therapeutic benefit of TrP-DN is relevant for the SOF community."

Cayea D, Perera S, Weiner DK. 2006.  Chronic low back pain in older adults: what physicians know, what they think they know, and what they should be taught.  J Am Geriatr Soc. 54(11):1772-1777.   “PCPs did not feel ‘very confident’ in their ability to diagnose any of the contributors of CLBP listed (most items <40%).  PCPs felt most confident in detecting scoliosis and least confident detecting myofascial pain of the piriformis muscle.”  “The results point to a need for more PCP education about CLBP in older adults.  It also suggests that accurate needs assessment should not rely on physician confidence ratings alone.”

Cazzola M, Atzeni F, Salaffi F et al. 2010. Which kind of exercise is best in fibromyalgia therapeutic programs? A practical review. Clin Exp Rheumatol. 28(6 Suppl 63):S117-124. "...the latest findings concerning the neurophysiology of nociception indicate the fundamental importance of assigning workloads that do not exacerbate post-exercise pain."

Ce PS, Barreiro BB, Silva RB et al. 2018. Salivary levels of interleukin-1beta in temporomandibular disorders and fibromyalgia. J Oral Facial Pain Headache. [Mar 21 Epub ahead of print] Patients with TMD showed significantly higher levels of the proinflammatory cytokine interleukin-1beta than patients with fibromyalgia or controls. The latter two groups did not show significant difference.

Ceballos-Laita L, Jiménez-Del-Barrio S, Marín-Zurdo J et al. Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial. Complement Ther Med. 2020 Jun;51:102443. "Three sessions of dry needling were more effective than sham dry needling for improving pain intensity, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis in the short term." [TrPs are often a co-existing treatable condition.]

Cedraschi C, Girard E, Piguet V et al. 2014. Assessing the affective load in the narratives of women suffering from fibromyalgia: the clinicians' appraisal. Health Expect. [Dec 10 Epub ahead of print.] "The affective load in the narratives of these patients with fibromyalgia was high and had a negative undertone when considered from the clinicians' perspective. This study highlights the importance of considering the affective resonance in the context of therapeutic relationships that are often emotionally laden and highly challenging for the clinician."

Ceko M, Frangos E, Gracely J et al.2020. Dependence of changes of the default mode network in fibromyalgia patients on current clinical pain. Neuroimage. 2020 Apr 25:116877. "Differences in fMRI resting-state connectivity of the default mode network (DMN) seen in chronic pain patients are often interpreted as brain reorganization due to the chronic pain condition. Nevertheless, patients' pain at the time of fMRI might influence the DMN because pain, like cognitive stimuli, engages attentional mechanisms and cognitive engagement is known to alter DMN activity…. [This study results suggests] that transient DMN disruptions due to current clinical pain during scanning (current pain state) may be a substantial contributor to DMN connectivity disruptions observed in chronic pain patients."

Celik D, Kaya Mutlu E. 2012. The relationship between latent trigger points and depression levels in healthy subjects. Clin Rheumatol 31(6):907-911. This study from Turkey found a "…close relationship between the presence of LTrPs (latent trigger points) and depression levels I healthy people."

Celik D, Mutlu EK. 2013. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 17(8):353. Latent TrPs are important clinically. They still cause dysfunction, and cause pain on pressure. Latent TrPs may be found in many pain-free muscles, and can be activated by "continuous detrimental stimuli. This review highlights the importance of LTrPs."

Celik D, Yeldan I. 2011. The relationship between latent trigger point and muscle strength in healthy subjects: A double-blind study. J Back Musculoskel Rehabil. 24(4):251-256. "Latent TrPs can cause significant muscle weakness."

Cenevic C, Maloney G, Mehta N. 2006.  Myofascial pain may mimic trigeminal neuralgia.  Cephalalgia 26:899-901.

Cerezo-Tellez E, Torres-Lacomba M, Fuentes-Gallardo I et al. 2016. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial. Pain. 157(9):1905-1917. "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 results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain".

Cerezo-Tellez E, Torres-Lacomba M, Mayoral-Del-Moral O et al. 2018. Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial. Health Qual Life Outcomes. 16(1):207. "Chronic non-specific neck pain is related to limited cervical mobility, impaired function, neck muscles myofascial pain syndrome, and stress at work. The aforementioned factors are strongly related and may lead to a negative impact on health-related quality of life.... The purpose of the study was to examine the effectiveness of Deep Dry Needling of myofascial trigger points on health-related quality of life improvement, as a secondary analysis, in people with chronic non-specific neck pain....Deep Dry Needling plus stretching is more effective than stretching alone for Health-related quality of life improvement, especially for physical function, physical role, social function and vitality dimensions, in people with non-specific neck pain."

Cerezo-Tellez E, Torres-Lacomba M, Mayoral-Del Moral O et al. 2016. Prevalence of myofascial pain syndrome in chronic non-specific neck pain: A population-based cross-sectional descriptive study. Pain Med. 17(12):2369-2377. "Two hundred and twenty-four participants diagnosed by their family doctor with chronic non-specific neck pain…. Pain descriptions from the subjects and pain body diagrams guided the physical examination…. All participants presented with MPS. MTrPs of the trapezius muscles were the most prevalent, in 93.75% of the participants. The most prevalent active MTrPs were located right (82.1%) and left (79%) in the nearly-horizontal fibers of the upper trapezius muscle. Furthermore, active MTrPs in the levator scapulae, multifidi, and splenius cervicis muscles reached a prevalence of 82.14%, 77.68%, and 62.5%, respectively…. MPS is a common source of pain in subjects presenting chronic non-specific neck pain."

Ceru-Bjork C, Andersson I, Rossner S. 2001.  Night eating and nocturnal eating – two different or similar syndromes among obese patients?  Int J Obes Relat Metab Disord. 25(3):365-372.  “The main objective of this study was to identify subjects with (1) night eating syndrome (defined as morning anorexia, evening hyperphagia and insomnia) and (2) nocturnal eating syndrome (defined as eating at night after having gone to bed.)...Fourteen percent of the patients at our obesity unit met the criteria for night eating and/or nocturnal eating syndrome.”

Cervero, F.  1995.  Visceral pain: mechanisms of peripheral and central sensitization. Ann Med 27(2):235-9. 

Cervigni M, Natale F. 2014. Gynecological disorders in bladder pain syndrome/interstitial cystitis patients. Int J Urol. 21 Suppl 1:85-88. "Bladder pain syndrome/interstitial cystitis is a complex pathology often associated with vulvodynia, endometriosis and pelvic floor dysfunctions. Therefore, it is of utmost importance to obtain an accurate evaluation ruling out confusable disease, such as pudendal neuropathy. The optimal approach is a combined treatment oriented not only to treat the bladder, but also the other components responsible for the pain disorder."

Cervilla O, Miro E, Martínez MP et al. 2019. Sleep quality and clinical and psychological manifestations in women with mild systemic lupus erythematosus activity compared to women with fibromyalgia: a preliminary study. Mod Rheumatol. Oct 10:1-22. "Sleep deterioration is related to more pain and depressive symptoms in FM and SLE. Addressing sleep disturbances may improve not only sleep quality but also depressive symptoms and pain."

Çetin B, Sunbul EA, Toktas H et al. 2020. Comparison of sleep structure in patients with fibromyalgia and healthy controls. Sleep Breath. [Feb 25 Epub ahead of print] "Sleep disturbances such as nonrestorative sleep and nighttime awakenings play a crucial role in fibromyalgia (FMS)…. Despite similar clinical manifestations, patients with FMS should be evaluated for OSAS due to treatment differences. The role of sleep alterations in the clinical manifestation and severity of FMS suggest that effective treatments to improve sleep quality may lead to more effective management of FMS."

Cetin B1, Guleç H2, Toktas HE et al. 2018. Objective measures of sleep in fibromyalgia syndrome: Relationship to clinical, psychiatric, and immunological variables. Psychiatry Res. 263:125-129. "We aimed to investigate the changes in the objective and subjective sleep variables during painful episodes of fibromyalgia and post-episode period, and to evaluate the impact of the sleep variables on the current clinical, psychological, and immunologic parameters....The pain treatment significantly affected subjective sleep variables, psychiatric variables, clinical variables, and IL-6 levels. The subjective sleep parameters, clinical and psychiatric variables, and IL-6 levels were improved with pain treatment in fibromyalgia. The objective sleep variables, IL-1 and TNF-alpha levels were not significantly improved with the pain treatment, and they were not related to clinical presentation of patients with fibromyalgia. Subjective variability of sleep contributes to the clinical presentation, suggesting that the objective structure is trait-specific with IL-1 and TNF-alpha."

Cetin H, Turkmen C, Bal GA, et al. Factors affecting the performance of the deep cervical flexors in young people using smartphones. Cranio. 2022 May 25;1-9 Smartphone addiction and cervical superficial muscles are related to the performance of the DCFs (deep cervical flexors) in young people. Using smartphones causes impaired joint position sense in flexion, decreased DCF activity, and forward head posture.

Chaitow L. 1998.  Raymond L Nimmo and the evolution of trigger point therapy, 1929-1986.  J Manipulative Physiol Ther. 21(8):575.  [Dr. Raymond Nimmo was responsible for much basic TrP therapy technique development.  He taught the concept that bones follow muscles – a concept that is still lacking in much medical training.  I have found anything written by Leon Chaitow to be well worth reading. This is no exception. DJS]

Chaitow L. 2007.  Chronic pelvic pain: Pelvic floor problems, sacroiliac dysfunction and the trigger point connection.  J Bodywork Move Ther 11(4):327-339.  This review is packed with information.  Chronic pelvic pain is poorly understood and may have far-reaching connections including breathing dysfunction and sacroiliac and urethral instability.   This review includes excellent illustrations, clear explanations of the connections of specific links between symptoms and often unsuspected causes, and methods of examination and treatment.  The importance of pelvic muscle tone is often greatly underestimated, and often much can be done to relieve symptoms often thought of as untreatable.

Chakravarthy K, Chaudhry H, Williams K et al. 2015. Review of the uses of vagal nerve stimulation in chronic pain management. Curr Pain Headache Rep. 19(12):54. This study from Johns Hopkins found: "Recent human and animal studies provide growing evidence that vagal nerve stimulation (VNS) can deliver strong analgesic effects in addition to providing therapeutic efficacy in the treatment of refractory epilepsy and depression. Analgesia is potentially mediated by vagal afferents that inhibit spinal nociceptive reflexes and transmission and have strong anti-inflammatory properties. The purpose of this review is to provide pain practitioners with an overview of VNS technology and limitations. It specifically focuses on clinical indications of VNS for various chronic pain syndromes, including fibromyalgia, pelvic pain, and headaches."

Chalaye P, Lafrenaye S, Goffaux P et al. 2013. The role of cardiovascular activity in fibromyalgia and conditioned pain modulation. Pain. [Dec 14 Epub ahead of print.] "Patients with FM had higher heart rate than HS at baseline and during CPT. Higher heart rate was related with higher pain intensity during the CPT (cold presser test). Blood pressure increments during CPT were weaker in the FM group. CPM (conditioned pain modulation) was less effective in FM patients than HS. Importantly, systolic blood pressure responses during CPT were positively related to CPM effectiveness, suggesting that reduced blood pressure response during the conditioning stimulus could be involved in CPM dysfunction in the FM group. Higher heart rate could be implicated in the greater sensitivity to cold pain in FM. Patients with FM have reduced blood pressure response to a painful CPT Reduced cardiovascular reactivity to pain could have important involvement in diminished endogenous pain inhibition efficacy and FM pathophysiology."

Chan AW, Yu DS, Choi KC et al. 2016. Tai chi qigong as a means to improve night-time sleep quality among older adults with cognitive impairment: a pilot randomized controlled trial. Clin Interv Aging. 11:1277-1286. This pilot study indicated that: "TCQ can be considered a useful non pharmacological approach for improving sleep quality in older adults with cognitive impairment." Free PMC Article

Chan YC, Wang TJ, Chang CC et al. 2015. Short-term effects of self-massage combined with home exercise on pain, daily activity, and autonomic function in patients with myofascial pain dysfunction syndrome. J Phys Ther Sci. 27(1):217-221. "The aim of the present was to investigate the short-term effects of a program combining self-massage and home exercise for patients with myofascial pain dysfunction syndrome (MPDS)….In this retrospective study, 63 patients were allocated to the experimental…and control…groups. Both groups received 6 sessions of treatment with physical modalities over the course of two weeks. The experimental group completed an additional program with a combination of self-massage and home exercise. The outcome measurements included a pain scale, pressure pain threshold (PPT), neck disability index (NDI), patient-specific functional scales (PSFS), and heart rate variability (HRV). The interactions between the groups and over time were analyzed using two-way repeated measures ANOVA….Only the experimental group demonstrated significant improvements in the pain scale with varying conditions. The PPTs of the trigger points increased significantly in the experimental group, and significant functional improvements in NDI and PSFS were observed in the same group. There were significant increases in high-frequency HRV and high-frequency % in the experimental group.… Treatment with physical modalities plus combination of self-massage and home exercise is more effective than the physical modalities treatment alone." Free PMC Article

Chandra, S. and R. K. Chandra. 1986. Nutrition, immune response, and outcome. Prog Food Nutr Sci 10(1-2):1-65.

Chang CC, Chang ST. 2009.  Excessive yawning induced by stimulation of myofascial trigger point-case report.  Eur J Neurol. 16(6):e118-119.

Chang CW, Chen YR, Chang KF. 2008.  Evidence of neuroaxonal degeneration in myofascial pain syndrome: a study of neuromuscular jitter by axonal microstimulation.  Eur J Pain. 12(8):1026-1030.  “The present study with axonal microstimulation and SFEMG (single-fiber electromyography) demonstrates a prominent evidence of neuroaxonal degeneration and neuromuscular transmission disorders in the trigger point muscles of MPS patients.  The mechanism of MPS is possible implicated with the degeneration of motor neurons.”

Chang PJ, Asher A, Smith SR.2021. A targeted approach to post-mastectomy pain and persistent pain following breast cancer treatment. Cancers (Basel). Oct 16;13(20):5191."Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct."

Chang Y, Zhu KL, Florez ID et al. 2016. Attitudes toward the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: A qualitative study. J Opioid Manag. 12(6):377-387. "Chronic noncancer pain (CNCP) refers to all pain disorders, not due to cancer, that persist for ≥3 months. The point prevalence of CNCP in the general population of Western countries is between 19 and 33 percent. Opioids are commonly prescribed for CNCP and are associated with both benefits and harms. The Canadian Guideline for Safe and Effective Use of Opioids for CNCP was published in 2010 to provide guidance for optimal opioid prescribing in patients with CNCP…. Despite its merits, the Canadian Opioids Guideline suffers from information gaps and from limited uptake, at least in part due to suboptimal format and suboptimal dissemination."

Chang YP, Compton P. 2013. Management of chronic pain with chronic opioid therapy in patients with substance use disorders. Addict Sci Clin Pract. 8(1):21. "Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life."

Chao JD, Memmel HC, Redding JF. 2002.  Reduction mammaplasty is a functional operation, improving quality of life in symptomatic women: a prospective, single-center breast reduction outcome study.  Plast Reconstr Surg. 110(7):1644-1652.  “Reduction for symptomatic breast hypertrophy can effect a statistically significant improvement in these objective measures of pain, disability, muscle weakness and poor posture.”

Chapman CR, Bradshaw DH. 2013. Only modest long-term opioid dose escalation occurs over time in chronic nonmalignant pain management. J Pain Palliat Care Pharmacother. [Oct 21 Epub ahead of print]. "A fundamental question is whether patients develop tolerance and need repeated dose escalations to sustain pain control. We examined opioid prescribing data from United Kingdom Clinical Practice Research Datalink longitudinal database of general practice records and tracked dose changes but not pain reports in a sample of 4035 patients who received oral or transdermal-extended release opioids for chronic nonmalignant pain. The median number of days on opioid pharmacotherapy for all patients was 311. Thirty percent of patients never changed doses during the course of treatment. In patients who never changed medications, the mean morphine equivalent 24-hour dose increased from beginning to end of opioid pharmacotherapy only by 1.4 fold…and was independent of both age and gender. Comparison across extended release morphine, oxycodone, and fentanyl revealed that it was significantly greatest for patients using fentanyl and least for those using morphine."

Chapman, C. R. and J. Gavrin.  1999.  Suffering: the contributions of persistent pain.  Lancet 353(9171):2233-7. 

Charles A. 2012. The Evolution of a Migraine Attack - A Review of Recent Evidence. Headache. [Dec 20 Epub ahead of print]. "A migraine attack is an extraordinarily complex brain event that takes place over hours to days. This review focuses on recent human studies that shed light on the evolution of a migraine attack. It begins with a constellation of premonitory symptoms that are associated with activation of the hypothalamus and may involve the neurotransmitter dopamine. Even in the premonitory phase, patients experience sensitivity to sensory stimuli, indicating that central sensitization is a primary phenomenon. The migraine attack progresses to a phase that in some patients includes aura, which involves changes in cortical function, blood flow, and neurovascular coupling. The aura phase overlaps with the headache phase, which is associated with further changes in blood flow and function of the brainstem, thalamus, hypothalamus, and cortex. Serotonin receptors, nitric oxide, calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide, and prostanoids are demonstrated specific chemical mediators of migraine based on therapeutic and triggered migraine studies. A number of migraine symptoms persist beyond resolution of headache into a postdromal phase, accompanied by persistent blood flow changes in several brain regions. Although these phases of migraine have substantial temporal, neurochemical, and anatomical overlap, each represents an important window onto the pathophysiology of migraine as well as a target for therapeutic intervention. A comprehensive approach to migraine requires an understanding of the entire range of mechanisms and resultant symptoms that occur throughout the evolution of an attack."

Charles E. 2011. [No title available] J Chiropr Med. 10(4):301-305. "This case report describes a patient with right arm paralysis after nerve entrapment release surgery who had a diagnosis of Parsonage-Turner syndrome. The patient had right arm contracture, muscle atrophy, and weakness with a 6-week general paralysis of the forearm and index finger. The patient responded to chiropractic care including high-velocity/low-amplitude spinal manipulation, trigger point therapy, specific exercises and stretching. After 8 treatments the patient was able to fully straighten his arm, and his arm was fully functional and pain-free 3 years later with a return to mountain climbing."

Chaves TC, Dach F, Florencio LL et al. 2016. Concomitant migraine and temporomandibular disorders are associated with higher heat pain hyperalgesia and cephalic cutaneous allodynia. Clin J Pain. [Feb 22 Epub ahead of print]. "More pronounced levels of hyperalgesia and CA were found in patients with both TMD and migraine. Thus, it is suggested that the concomitant presence of TMD and migraine may be related to intensification of central sensitization."

Chaves TC, Nagamine HM, de Sousa LM et al. 2013. Differences in pain perception in children reporting joint and orofacial muscle pain. J Clin Pediatr Dent. 37(3):321-327. "MP (myofascial pain) more accurately differentiated symptomatic subjects from symptom-free TMD (temporomandibular dysfunction) subjects, and PPT (pressure point threshold) values were more sensitive to the discrimination of pain in the orofacial sites assessed. In addition, the changes in perception at a larger number of sites among children reporting mixed pain may suggest the presence of a possible mechanism of central sensitization."

Chawla PS, Kochar MS. 1999.  Effect of pain and nonsteroidal analgesics on blood pressure.  WMJ 98(5):22-25, 29.  “NSAIDs antagonize the antihypertensive effect of diuretics, beta-blockers and ACE inhibitors more than that of calcium-channel blockers.  The elderly and those with salt-sensitive hypertension experience greater rise in blood pressure with NSAIDs.  Physicians should avoid NSAIDs and instead use alternative analgesics such as acetaminophen and physical therapy for control of pain.  Since both pain and hypertension are common, it is important that their relationship be well understood by the primary care physicians.”

Cheatham SW, Kolber MJ, Mokha M et al. 2018. Concurrent validity of pain scales in individuals with myofascial pain and fibromyalgia. J Bodyw Mov Ther. 22(2):355-360. "Clinicians and researchers often use the numeric pain rating scale (NPRS) and visual analog scale (VAS) to measure and track pain in individuals with myofascial pain syndrome (MPS) and fibromyalgia (FM).... To date, no studies have specifically measured the concurrent validity of the NPRS and VAS in these individuals. The purpose of this investigation was to determine the concurrent validity of the NPRS when compared to the reference standard VAS in patients with MPS and FM.... The results of this study suggest that the NPRS has good concurrent validity with the referenced standard VAS among individuals with MPS and FM."

Cheatham SW, Kolber MJ, Mokha GM et al. 2018. Concurrent validation of a pressure pain threshold scale for individuals with myofascial pain syndrome and fibromyalgia. J Man Manip Ther. 26(1):25-35. Authors' conclusions: "The results provide preliminary evidence validating the PPTS for individuals with MPS and FM. Future research should further study the clinimetric properties of the PPTS with other chronic pain and orthopedic conditions." [The study used 3 groups of 28 patients, one for FM, one for myofascial pain, and one for controls with no symptoms. In actuality, the study provides preliminary evidence validating the PPTS for individuals with fibromyalgia OR myofascial pain. It would be of great interest if patients with both conditions were included in the next study. DJS]

Cheatham SW, Stull KR. 2018. Knowledge of self-myofascial release among allied health students in the United States: A descriptive survey. J Bodyw Mov Ther. Jul;22(3):713-717. "University and collegiate education of the human myofascial system is commonly taught in basic science courses such as anatomy. Allied health programs may expand upon these concepts by teaching interventions such as myofascial release in clinical education courses. Self-myofascial release (SMR) with a device such as a foam roller is an emerging intervention that has become popular among clinicians and active individuals.... The purpose of this study was to survey and document responses in the knowledge of SMR among allied health students.... A total of 502 students from the different allied health programs completed the survey..... Approximately, half of respondents...reported learning about SMR in their degree program and the other half ...report receiving no education.... A more global consensus on education for emerging therapeutic intervention such as SMR is needed in order to standardize and develop best teaching practices in allied health. This study highlighted the difference among allied health programs in the United States. This research should be a starting point for future survey research on this topic.

Cheatle MD, Foster S, Pinkett A et al. 2016. Assessing and managing sleep disturbance in patients with chronic pain. Anesthesiol Clin. 34(2):379-393. "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."

Check JH, Katsoff D, Kaplan H et al. 2007.  A disorder of sympathomimetic amines leading to increased vascular permeability may be the etiologic factor in various treatment refractory health problems in women.  Med Hypotheses.  [Aug 30 Epub ahead of print]  “There is an evidence that increased capillary permeability in the standing position is related to a deficit in the sympathetic nervous system.”  “One of the most common manifestations is the inability to lose weight despite proper dieting.  A randomized study comparing the efficacy of a diuretic, a converting enzyme inhibitor, spironolactone and a sympathomimetic amine on weight loss in diet refractory women found that only the latter in the form of dextroamphetamine sulfate demonstrated significant weight reduction over a six month time span.”  “The diagnosis of a deficit in sympathomimetic amines is established by demonstrating an abnormal clearance of a water load in the erect position and exclusion of other conditions that are associated with an abnormal free water clearance, e.g., hypothyroidism, renal or liver disease or congestive heart failure.”  “There are several conditions that have proven refractory to conventional theory that respond quickly and effectively to sympathomimetic amines.  There have been many anecdotal reports of relieving intractable pain syndromes quickly and efficiently with sympathomimetic amine theory, despite failure with a multitude of other therapies.  These include interstitial cystitis and pelvic pain that was attributed to endometriosis, gastrointestinal pain including esophagitis and gastroparesis, headaches, joint pain, fibromyalgia, and carpal tunnel syndrome.  It is not clear if the improvement in pain is related to a decrease in fluid retention or a direct effect of the sympathomimetic amines on the sympathetic nervous system.”  “These studies strongly suggest that physicians be aware of this condition involving a deficit in the sympathetic nervous system when faced with various enigmatic complaints especially if standard therapy has not proven effective.”  [This review has made connections that may explain why an FM subset of patients and those with other conditions respond to some stimulants and other medications in this class. DJS]

Chee EK, Walton H. 1986.  Treatment of trigger points with microamperage transcutaneous electrical nerve stimulation (TENS) – (the Electro-Acuscope 80).  J Manipulative Physiol Ther. 9(2):131-134.  “Results indicate that the subjects who received treatment had a higher change of trigger-point indicators compared to those receiving the placebo treatment.”

Cheema R, Chang-Miller A, Aslam F. 2019. Myalgia with elevated inflammatory markers in an obese young female: Fibromyalgia or polymyalgia rheumatica? Am J Case Rep. May 8;20:659-663. "Fibromyalgia (FM) is a common disorder of diffuse musculoskeletal pain. It is distinctly different from polymyalgia rheumatica (PMR), a disease seen in people over the age of 50 years. Hallmark features of PMR are the presence of elevated erythrocytes sedimentation rate (ESR) and/or C-reactive protein (CRP). These markers are normal in FM. Obesity in itself can be associated with elevated CRP and ESR, and when obese patients present with myalgia and elevated inflammatory markers, diagnostic confusion can ensue.... We describe a case of 38-year-old female with diffuse musculoskeletal pain and elevated ESR and CRP who was initially misdiagnosed with PMR and responded partially to steroids. She developed severe adverse effects from chronic steroid use. She was ultimately diagnosed with FM.... We highlight features to help clinicians avoid the pitfall of diagnosing PMR in young obese patients with FM and elevated inflammatory markers."

Chelimsky G, Heller E, Buffington C et al. 2012. Co-morbidities of interstitial cystitis. Front Neurosci. 6:114. Introduction: This study aimed to estimate the proportion of patients with interstitial cystitis/painful bladder syndrome (IC/BPS) with systemic dysfunction associated co-morbidities such as irritable bowel syndrome (IBS) and fibromyalgia (FM)....Co-morbid complaints in the IC/BPS groups included gastrointestinal symptoms suggestive of IBS and dyspepsia, sleep abnormalities with delayed onset of sleep, feeling poorly refreshed in the morning, waking up before needed, snoring, severe chronic fatigue and chronic generalized pain, migraines, and syncope....Our findings mirror those of others in regard to IBS, symptoms suggestive of FM, chronic pain, and migraine. High rates of syncope and functional dyspepsia found in the IC/BPS groups merit further study to determine if IC/BPS is part of a diffuse disorder of central, autonomic, and sensory processing affecting multiple organs outside the bladder.[It is most unfortunate that myofascial trigger points, one of the main co-existing conditions of irritable bladder and bowel, as well as one of the main causes, was not included in this study. DJS]

Chen AT. 2012. Information Seeking over the Course of Illness: The Experience of People with Fibromyalgia. Musculoskeletal Care. [Jun 27 Epub ahead of print]. "Although there is literature addressing the fibromyalgia illness experience, there has been limited work concerning how people with fibromyalgia utilize health information. The aim of this study was therefore to investigate the information needs and information-seeking patterns of such individuals, and how these might change over time....Respondents used the internet most frequently, but also placed great value on information from others, including healthcare practitioners, family and friends. Among the online sources, organization websites, health portals and health-related social networking sites were most frequently used. Topics of interest to people with fibromyalgia vary as they move from an initial stage of confusion, to diagnosis and eventually to a stage of equilibrium in which they are satisfied with their management of their condition. Aside from symptoms and treatments, topics often reflect a need to understand the meaning of their condition and coping skills.

Chen AV, Talin Evazyan T. Development of upper extremity complex regional pain syndrome after prolonged surgery in lithotomy position: A case report. A A Pract. 2021. Aug 23;15(8):e01507."To date, CRPS developing in a previously uninjured limb after prolonged immobilization has not yet been reported. We describe a 45-year-old man with no known preexisting injury or neuropathy to his upper extremities who developed CRPS of his right wrist and hand after prolonged colorectal surgery." (USA) [Myofascial trigger points or FM may be risk factors for developing CRPS, and may have perpetuating factors other than trauma. DJS]

Chen CH, Yang TY, Lin CL et al. 2016. Dry eye syndrome risks in patients with fibromyalgia: A national retrospective cohort study. Medicine (Baltimore). 95(4):e2607. "The coexistence of fibromyalgia (FM) and dry eye syndrome (DES) has been previously reported. However, there are few studies on how patients with FM may develop concomitant DES. Patients with chronic widespread pain, like FM, chronic fatigue syndrome, and irritable bowel syndrome (IBS), was concerned for the rheumatic or psychosomatic disorders which might adequately reflect the long-term risk of DES. We retrieved data on FM patients from the National Health Insurance Research Database of Taiwan covering the years 2000 to 2011. Our FM population consisted of 25,777 patients versus 103,108 patients in the non-FM group: the overall incidence of DES in these populations was 7.37/10,000 and 4.81/10,000, respectively. Male FM patients had a higher incidence of DES, with a 1.39-fold DES risk for males and a 1.45-fold for females after adjustment for confounding factor. Notably, FM patients aged ≤ 49 years had an elevated 80% risk of DES compared with the non-FM group. Without comorbidities, FM patients had an approximately 1.40-fold risk of DES than those without FM. The additive effects of FM and IBS or FM and sleep disturbance were pointed out that the risk for DES would be elevated when the FM patients with IBS or sleep disturbance. FM patients have a higher incidence of DES than that of non-FM patients. They carry long-term DES risks from a relatively young age, particularly those with psychiatric problems." Free Article

Chen CL, Robert JJ, Orr WC. 2008.  Sleep symptoms and gastroesophageal reflux.  J Clin Gastroenterol. 42(1):13-17.  “Nighttime heartburn together with sleep complaints is associated with excessive gastroesophageal reflux.”

Chen CS, Ingber DE. 1999.  Tensegrity and mechanoregulation: from skeleton to cytoskeleton.  Osteoarthritis Cartilage. 7(1):81-94.  This article explains how factors affecting one portion of the body can affect the whole, down to the molecular level.

Chen D, Yang G, Wang F et al. 2017. [Discussing the relationship among the ashi point, tender point and myofascial trigger point]. [Article in Chinese] Zhongguo Zhen Jiu. 37(2):212-214. "The conception and the history of ashi point, tender point and myofascial trigger point are described in the paper. All of three kinds of point are the reaction of musculoskeletal pain and visceral diseases.... Anatomically, ashi point is localized in the muscle region of meridian, on the boundary between muscles, tender point is on the muscular attachment to skeleton (the starting and ending points) and myofascial trigger point is on the motor point of neuromuscles. Pathologically, ashi point reflects the disorders of soft tissue and internal organ, tender point reflects the disorders of soft tissue and myofascial trigger point reflects the disorders of soft tissue and few disorders of internal organ. To identify the relationship among them is very significant in the target treatment with acupuncture."

Chen G, Zhang YQ, Qadri YJ et al. 2018. Microglia in pain: Detrimental and protective roles in pathogenesis and resolution of pain. Neuron. 100(6):1292-1311. "The previous decade has seen a rapid increase in microglial studies on pain, with a unique focus on microgliosis in the spinal cord after nerve injury and neuropathic pain. Numerous signaling molecules are altered in microglia and contribute to the pathogenesis of pain. Here, we discuss how microglial signaling regulates spinal cord synaptic plasticity in acute and chronic pain conditions with different degrees and variations of microgliosis. We highlight that microglial mediators such as pro- and anti-inflammatory cytokines are powerful neuromodulators that regulate synaptic transmission and pain via neuron-glial interactions. We also reveal an emerging role of microglia in the resolution of pain, in part via specialized pro-resolving mediators including resolvins, protectins, and maresins. We also discuss a possible role of microglia in chronic itch."

Chen HM, Liu MQ, Yap AU et al. 2017. Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis. J Oral Rehabil. 44(9):664-672. "Anterior repositioning splints (ARS) are used primarily for the management of temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). ... This study investigated the short and long-term effects of ARS on disc and condyle angles/positions.... MRI at 6 months after treatment (without ARS insertion) indicated that only 40.6% (13/32) of the joints were maintained in the normal disc-condyle relationship. The majority of condyles returned to their pretreatment positions, while the discs generally moved anteriorly again. The use of ARS resulted in forward and downward condyle movement, and a concurrent backward movement of the disc resulting in ideal spatial disc-condyle relationship. The stability of this relationship, however, could not be maintained in the majority of TMJs upon ARS removal. Findings explain the good short-term clinical outcomes with ARS and their relatively lower efficacy in the long term." [Some splints that are given for "myofascial pain" do not work, although they may seem to at first. They are finally documenting some of this. Dentists need to learn about TrPs. DJS]

Chen HY, Hong CZ, Hsieh YL. Assessment of the performance of ultrasonography for detecting myofascial trigger points. 2924. Sensors (Basel). 2024 Jan 23;24(3):718. "In stage 1, the MTrP of rat masseter muscle was identified through palpation and marked. Needle EMG was performed to detect the presence of EPN. When EPN was detected, ultrasound scans and indwelling needles were used to identify the nodule with a different grayscale relative to that of its surrounding tissue, and the echogenicity of the identified MTrP was determined. In stage 2, these steps were reversed. An ultrasound scan was performed to detect the nodule at the marked site, and an EMG needle was inserted into the nodule to detect EPN. There were 178 recordings in each stage, obtained from 45 rats. The stage 1 results indicate that the MTrPs in ultrasound images were hypoechoic (more dense) with a 100% sensitivity of assessment. In stage 2, the accuracy and precision of MTrP detection through ultrasonography were 89.9% and 89.2%, respectively. The results indicate that ultrasonography produces highly accurate and precise MTrP detection results.

Chen IW, Liao YT, Tseng H, et al. 2024. Pain, function and peritendinous effusion improvement after dry needling in patients with long head of biceps brachii tendinopathy: a single-blind randomized clinical trial. Ann Med. 2024 Dec;56(1):2391528.

Chen JH, Muo CH, Kao CH et al. 2016. Increased risk of new-onset fibromyalgia among chronic osteomyelitis patients: Evidence from a Taiwan cohort study. J Pain. [Nov 22 Epub ahead of print.] "Chronic inflammation, which changes the neurotransmitter metabolism and kindles neuroendocrine system dysfunction in central nervous system, might cause fibromyalgia (FM) formation. In FM patients without traditional FM risk factors, such as hypertension, hyperlipidemia, diabetes, sleep disorder, depression, and anxiety, chronic inflammatory process is a possible risk factor for FM. Thus, we investigated whether chronic osteomyelitis (COM), a disease characterized by chronic inflammation, increases FM risk….. Chronic osteomyelitis is associated with the augmented risk of developing fibromyalgia, and rigorous treatments for the chronic osteomyelitis patients might decrease the future risk of fibromyalgia formation, especially in those with relatively younger ages. [Any source of constant irritation to the CNS can cause FM central sensitization to develop in the genetically predisposed. DJS]

Chen JT, Chung KC, Hou CR et al. 2001.  Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle.  Am J Phys Med Rehabil. 80(10):729-735.  “Dry needling of the myofascial trigger spot is effective in diminishing SEA (spontaneous electrical activity) if local twitch responses are elicited.  The local twitch response elicitation, other than trauma effects of needling, seems to be the primary inhibitory factor on SEA during dry needling.”

Chen K, Hong C, Hsu H et al. 2010. Dose-dependent and ceiling effects of therapeutic laser on myofascial trigger spots in rabbit skeletal muscles. J Musculoskel Pain 18(3).235-245. Low-level laser treatment seems to be effective in quieting endplate noise in rabbits. Irritability of TrPs, indicated by endplate noise, was affected differently with different dosage. Further studies are needed, and human studies, before significance of this finding can be understood, but it does offer hope of another potential TrP treatment.

Chen KW, Hassett AL, Hou F et al. 2006.  A pilot study of external qigong therapy for patients with fibromyalgia.  J Altern Complement Med. 12(9):851-856.  “Treatment with EQT resulting in complete recovery for some FMS patients suggests that TCM may be very effective for treating pain and the multiplicity of symptoms associated with FMS.  Larger controlled trials of this promising intervention are urgently needed.”

Chen Q, Basford J, An KN. 2008. Ability of magnetic resonance elastography to assess taut bands. Clin Biomech (Bristol, Avon) 23(5):623-629. "Using magnetic resonance elastography, the Mayo clinic was able to image the taut bands of trigger points. There is now objective evidence of the existence of TrPs." [It is expensive and not available in most localities. It does prove their existence, however, and their importance cannot be disputed. Care providers must rely on the palpation techniques and their information-gathering senses including eyes, fingers and brains to locate TrPs. Those who are untrained in diagnosis and treatment of myofascial TrPs, one of the leading causes of musculoskeletal pain, and many other symptoms, must consider carefully the ethics of taking money for pain management. They might also hasten to learn these skills from a reputable myofascial TrP school such as Myopain. DJS]

Chen Q, Bensamoun S, Basford JR et al. 2007. Identification and quantification of myofascial taut bands with magnetic resonance elastography.  Arch Phys Med Rehabil. 88(12):1658-1661.  “Our findings suggest that MRE can quantitate asymmetries in muscle tone that could previously only be identified subjectively by examination.”   This includes myofascial trigger points

Chen, S. M., J. T. Chen, T. S. Kuan and C. Z. Hong.  1998.  Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve.  Arch Phys Med Rehabil 79(3):336-338.

Chen X, Qu X. 2018. Age-related differences in the relationships between lower-limb joint proprioception and postural balance. Hum Factors. Aug 21:18720818795064. [Epub ahead of print] "Impaired postural balance is reportedly one of the most common risk factors for fall accidents.... Conclusion: Declined ankle and hip proprioception could be risk factors for falls in older adults. Age-related differences in the effects of hip proprioception suggests that hip proprioception is more important for maintaining balance in older adults. Ankle proprioception contributes the most to balance maintenance. Thus, ankle proprioception enhancement exercises should be considered in fall prevention interventions." [Nothing was mentioned about myofascial trigger points; a major cause of proprioceptive dysfunction. DJS]

Chen YH, Chai HM, Shau YW et al. 2016. Increased sliding of transverse abdominis during contraction after myofascial release in patients with chronic low back pain. Man Ther. 23:69-75. "Recent evidence suggested the significance of integrity of the tension balance of the muscle-fascia corset system in spinal stability, particularly the posterior musculofascial junction which is adjacent to dorsal located paraspinal muscles joining each other at lateral raphe (LR). The purpose of this study was to compare the contraction of the transversus abdominis (TrA) at both anterior and posterior musculofascial muscle-fascia junctions in patients with low back pain (LBP) and asymptomatic participants before and immediately after a sustained manual pressure to LR….The result indicated immediately effect of sustained manual pressure on musculofascial junction of TrA and supported the concept that the possible imbalanced tension of the myofascia corset of TrA in patients with LBP."

Chen YY, Chai HM, Wang CL et al. 2018. Asymmetric thickness of oblique capitis inferior and cervical kinesthesia in patients with unilateral cervicogenic headache. J Manipulative Physiol Ther. [Epub ahead of print] "The purpose of this study was to compare the thickness of the oblique cervical inferior (OCI) and the error of the head reposition test between the painful and non painful sides of patients with cervicogenic headache (CeH) and between the patients and the asymptomatic group…. Asymmetric OCI and cervical proprioception were demonstrated in patients with CeH." [These researchers may have found evidence for oblique capitis inferior trigger points postulated in our book, "Healing through Trigger Point Therapy", pages 64-65. DJS]

Cheng CA, Chiu YW, Wu D et al. Effectiveness of Tai Chi on fibromyalgia patients: A meta-analysis of randomized controlled trials. Complement Ther Med. 2019 Oct;46:1-8. "Tai Chi exerts significantly greater effects on patients with FM than standard care; therefore, we suggest that Tai Chi can be used as an alternative treatment. However, more large-scale, high-quality, and multicenter trials are required to provide stronger evidence on the effectiveness of Tai Chi, as an alternative to aerobic exercise, compared with conventional therapeutic exercise."

Cheng J, Abdi S. 2007.  Complications of joint, tendon, and muscle injections.  Tech Reg Anesth Pain Manag. 11(3):141-147.  “We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the procedural techniques with a clear understanding of the relevant anatomies.”  [TrP injections must be done according to procedure specified by Travell and Simons, including aseptic technique (preferably first using a non-alcohol agent on the skin, as alcohol toughens the skin with time), proper positioning, and including range of motion stretching, to ensure optimum efficiency. DJS]

Cheng WM, Fan YH, Lin ATL. 2017. Urodynamic characteristics might be variable in bladder pain syndrome/interstitial cystitis patients with different non-bladder comorbid conditions. J Chin Med Assoc. [Dec 6 Epub ahead of print] "Patients with bladder pain syndrome/interstitial cystitis completed the screening questionnaires for chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, temporomandibular disorders, multiple chemical sensitivities, tension/migraine headache, and localized myofascial pain disorder. They underwent either conventional pressure-flow urodynamic studies or video-urodynamic studies. Urodynamic variables were compared between patients with and those without comorbid conditions....Bladder pain syndrome/interstitial cystitis patients, especially females, are more likely to have non-bladder comorbidities, especially tension/migraine headache and localized myofascial pain. Bladder pain syndrome/interstitial cystitis Patients with co-morbid irritable bowel syndrome are younger and more likely to have abnormal urodynamic findings." Free Article

Cheng XF, Tan J, Tan KL. 2005.  [Clinical analysis of six cases with juvenile primary fibromyalgia syndrome.]  Zhonghua Er Ke Za Zhi 43(11):863-865. [Chinese]  “Juvenile primary FMS may not be a rare disease and the clinicians should pay more attention to it for avoiding misdiagnosis.”

Cheng YC, Hsiao C, Su MI, et al. Treating fibromyalgia with electrical neuromodulation: A systematic review and meta-analysis. Clin Neurophysiol. 2023 Feb 1;148:17-28."Active electrical neuromodulation and active tDCS both showed significant effects on subjective pain, depression, and functioning. For different anode tDCS electrode positions, only F3-F4 revealed a significant effect on depression. Meta-regression tDCS effects on depression were significantly associated with age."

Cherry BJ, Weiss J, Barakat BK et al. 2009. Physical performance as a predictor of attention and processing speed in fibromyalgia.  Arch Phys Med Rehabil. 90(12):2066-2073.  “…as the physical performance level decreased, cognitive performance levels decreased.”  “Findings suggest that research is needed to determine whether patterns of physical activity participation through their effects on physical fitness and performance can enhance cognitive performance in persons with FM.  Physiologic changes in specific brain regions in FM (e.g., hippocampus, neural pain regions) suggest that further research is also warranted in determining specific relationships between biomarkers and cognitive performance in persons with FM.”   [One must also consider that physical performance often decreases in regard to pain level, and pain has considerable effect on cognitive performance.  Adequate pain control may have much to do with ability and desire to exercise. DJS]

Chiarella G, Tognini S, Nacci A et al. 2014. Vestibular disorders in euthyroid patients with Hashimoto's thyroiditis: role of thyroid autoimmunity. Clin Endocrinol (Oxf). [Apr 16 Epub ahead of print.] "This finding suggests that circulating anti-thyroid autoantibodies may represent a risk factor for developing vestibular dysfunction. An accurate vestibular evaluation of HT patients with or without symptoms is therefore warranted."

Chim D, Brodsky M, Hui KK. 2007.  Teaching medical students trigger point techniques.  Fam Med. (1):8.  “Myofascial pain is underemphasized in medical education and underrecognized in clinical practice.”

Chitneni A, Patil A, Dalal S, et al. Use of ketamine infusions for treatment of complex regional pain syndrome: A systematic review. Cureus. 2021 Oct 19;13(10):e18910. "In these studies, the dosage of ketamine infusion used ranged from 0.15 mg/kg to 7 mg/kg with the primary indication being the treatment of CRPS. In 13 of the studies, ketamine infusion resulted in a decrease in pain scores and relief of symptoms. Patients who received ketamine infusion for treatment-resistant CRPS self-reported adequate pain relief with treatment."

Chiu PE, Fu Z, Sun J, et al. Efficacy of Fu's subcutaneous needling in treating soft tissue pain of knee osteoarthritis: A randomized clinical trial. J Clin Med. 2022 Dec 2;11(23):7184. "FSN was effective in treating soft-tissue pain in degenerative knee OA in terms of alleviating pain, strengthening walking ability, and improving overall functional performance. Pain relief was the primary benefit of FSN and a significant correlation between pain relief and knee joint mobility improvement was found."

Chmiela MA, Hendrickson M, Hale J et al. 2020. Direct peripheral nerve stimulation for the treatment of complex regional pain syndrome: A 30-year review. Neuromodulation. Oct 24. Online ahead of print. "This chart review describes the use of implantable PNS systems in the treatment of CRPS of the upper and lower extremities spanning nearly three decades…. We can conclude that PNS is a useful modality to improve function and reduce long-term pain in selected patients suffering from CRPS type I and type II."

Cho IT, Cho YW, Kwak SG et al. 2017. Comparison between ultrasound-guided interfascial pulsed radiofrequency and ultrasound-guided interfascial block with local anesthetic in myofascial pain syndrome of trapezius muscle. Medicine (Baltimore). 96(5):e6019. "Myofascial pain syndrome (MPS) of the trapezius muscle (TM) is a frequently occurring musculoskeletal disorder. However, the treatment of MPS of the TM remains a challenge. We investigated the effects of ultrasound (US)-guided pulsed radiofrequency (PRF) stimulation on the interfascial area of the TM. In addition, we compared its effect with that of interfascial block (IFB) with 10?mL of 0.6% lidocaine on the interfascial area of the TM. … For the management of MPS of the TM, US-guided interfascial PRF had a better long-term effect on reducing the pain and the quality of life compared to US-guided IFB. Therefore, we think US-guided PRF stimulation on the interfascial area of the TM can be a beneficial alternative to manage the pain following MPS of the TM."

Cho SH, Kim SH. 2016. Immediate effect of stretching and ultrasound on hamstring flexibility and proprioception. J Phys Ther Sci. 28(6):1806-1808. "Self-myofascial stretching immediately increased hamstring muscle flexibility and improved hip joint proprioception, but the addition of pre-stretch ultrasound provided no further benefit." Free PMC Article

Cho SJ, Sohn JH, Bae JS et al. 2017. Fibromyalgia among patients with chronic migraine and chronic tension-type headache: A multicenter prospective cross-sectional study. Headache. [Sep 22 Epub ahead of print] "Fibromyalgia (FM) is a common comorbidity in patients with chronic headaches. CM (chronic migraine) and CTTH (chronic tension-type headache) are the two common types of chronic headaches….The frequency of FM was significantly higher among patients with CM when compared to those with CTTH…. Logistic regression analyses revealed an increased odds ratio (OR) for FM for patients with CM when compared to those with CTTH after adjustment for age, sex, anxiety, depression, and insomnia…. Furthermore, CM patients with FM had higher scores in FM Impact Questionnaire compared to CTTH patients with FM ….Comorbidity of FM was associated with increased frequency of photophobia, phonophobia, anxiety, depression, and insomnia among patients with CM. Such association was not noted among patients with CTTH….FM based on 2010 American College of Rheumatology diagnostic criteria was more prevalent among patients with CM than those with CTTH. Some clinical features and comorbidities of CM varied with the presence of FM."

Choe JY, Kim JK, Lee DE et al. 2017. Descending necrotizing mediastinitis after a trigger point injection. Clin Exp Emerg Med. 4(3):182-185. "Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection in the left upper trapezius. Chest computed tomography showed evidence of DNM, and antibiotic therapy was immediately administered intravenously. Because of the risk of sudden death, poor prognosis due to underlying disease, and his age, he declined surgical treatment and died of septic shock. Although trigger point injections are generally considered safe, caution should be used in patients with an underlying disease or in the elderly. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical management are essential to improve the prognosis." Free Article

Choe MK, Lim M, Kim JS et al. 2018. Disrupted resting state network off fibromyalgia in theta frequency. Sci Rep. 8(1):2064. "Fibromyalgia (FM), chronic widespread pain, exhibits spontaneous pain without external stimuli and is associated with altered brain activities during resting state. To understand the topological features of brain network in FM, we employed persistent homology which is a multiple scale network modeling framework not requiring thresholding....FM patients had reduced connectivity within default mode network, between middle/inferior temporal gyrus and visual cortex. The longer pain duration was correlated with reduced connectivity between inferior temporal gyrus and visual cortex. Our findings demonstrated that the aberrant resting state network could be associated with dysfunction of sensory processing in chronic pain. The spontaneous nature of FM pain may accrue to disruption of resting state network."

Choi JI. 2014. Chicken and egg: peripheral nerve entrapment or myofascial trigger point? Korean J Pain. 27(2):186-188. In this letter, the author is commenting on the case report "Successful treatment of abdominal cutaneous entrapment syndrome (ACES) using ultrasound guided injections," written by WV Applegate. Dr. Choi calls attention to the fact that abdominal cutaneous entrapment syndrome is usually caused by trigger points, which are found by palpation, and yet myofascial pain syndrome was not mentioned in the article. The original author missed the point that the radiculopathy is often caused by trigger points as well. [I certainly am glad that Dr. Choi wrote this letter, and agree with him heartily. DJS]

Choi TW, Park HJ, Lee AR et al. 2015. Referred pain patterns of the third and fourth dorsal interosseous muscles. Pain Physician. 18(3):299-304. This study investigated the referred pain patterns of the 3rd and 4th dorsal interosseous muscles. Trigger points in the 3rd dorsal interosseous muscle referred pain to the web between the 3rd and 4th fingers in 80% of the patients; the end of the 3rd and 4th fingers in 45%; and the "little finger" side of the palm in 55%. Trigger points in the 4th dorsal interosseous muscle referred to the web between the 4th and 5th fingers in 80%, the area below the base of the thumb in 65%, and the end of the 4th and 5th fingers. Some patients reported wrist pain or forearm pain on the "little finger" side. "Referred pain patterns of the third and fourth interosseous muscles resemble the pain experienced in C7 or C8 radiculopathies or the ulnar neuropathy. Thus, identification of the third and fourth interosseous muscle trigger point should be considered when patients experience pain on the ulnar aspect of the hand and wrist." Free Article

Choi W, Lim M, Kim JS et al. 2016. Habituation deficit of auditory N100m in patients with fibromyalgia. Eur J Pain. 20(10):1634-1643. "Habituation refers to the brain's inhibitory mechanism against sensory overload and its brain correlate has been investigated in the form of a well-defined event-related potential, N100 (N1). Fibromyalgia is an extensively described chronic pain syndrome with concurrent manifestations of reduced tolerance and enhanced sensation of painful and non-painful stimulation, suggesting an association with central amplification of all sensory domains…. Among diverse sensory modalities, we utilized repetitive auditory stimulation to explore the anomalous sensory information processing in fibromyalgia as evidenced by N1 habituation…. Auditory N1 was assessed in 19 fibromyalgia patients and age-, education- and gender-matched 21 healthy control subjects under the duration-deviant passive oddball paradigm and magnetoencephalography recording. The brain signal of the first standard stimulus (following each deviant) and last standard stimulus (preceding each deviant) were analyzed to identify N1 responses. N1 amplitude difference and adjusted amplitude ratio were computed as habituation indices…. Fibromyalgia patients showed lower N1 amplitude difference (left hemisphere: p = 0.004; right hemisphere: p = 0.034) and adjusted N1 amplitude ratio (left hemisphere: p = 0.001; right hemisphere: p = 0.052) than healthy control subjects, indicating deficient auditory habituation. Further, augmented N1 amplitude pattern (p = 0.029) during the stimulus repetition was observed in fibromyalgia patients…. [This explains why repetitive noises can be so very irritating in FM. DJS] Fibromyalgia patients failed to demonstrate auditory N1 habituation to repetitively presenting stimuli, which indicates their compromised early auditory information processing. Our findings provide neurophysiological evidence of inhibitory failure and cortical augmentation in fibromyalgia. WHAT'S ALREADY KNOWN ABOUT THIS TOPIC?: Fibromyalgia has been associated with altered filtering of irrelevant somatosensory input. However, whether this abnormality can extend to the auditory sensory system remains controversial. N100, an event-related potential, has been widely utilized to assess the brain's habituation capacity against sensory overload. WHAT DOES THIS STUDY ADD?: Fibromyalgia patients showed defect in N100 habituation to repetitive auditory stimuli, indicating compromised early auditory functioning. This study identified deficient inhibitory control over irrelevant auditory stimuli in fibromyalgia."

Choi W 1, Lim M, Kim JS et al. 2014. Impaired pre-attentive auditory processing in fibromyalgia: A mismatch negativity (MMN) study. Clin Neurophysiol. [Oct 18 Epub ahead of print.] "Fibromyalgia (FM) patients often show deficits in cognitive functions such as attention and working memory. We assumed that pre-attentive information processing, a crucial element in human perception and cognition, would be altered in FM patients…. This study provided neurophysiological evidence of impaired pre-attentive sensory change detection in FM."

Choileain NN, Redmond HP. 2006.  Cell response to surgery.  Arch Surg. 141(11):1132-1140.   “Surgical trauma produces profound immunological dysfunction.  Therapeutic strategies directed at restoring immune homeostasis should aim to redress the physiological proinflammatory-anti-inflammatory cell imbalance associated with major surgery.”

Chong YY, Ng BY. 2009. Clinical aspects and management of fibromyalgia syndrome. Ann Acad Med Singapore. 38(11):967-973.  “Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pituitary-adrenal axis stress response system.  With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome.  This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS.  The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia – pregabalin, duloxetine and milnacipran.  Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioral therapy to be most effective.  Overall, management of FMS requires a multi-disciplinary approach.”

Chopra P, Cooper MS. 2013. Treatment of Complex Regional Pain Syndrome (CRPS) Using Low Dose Naltrexone (LDN). J Neuroimmune Pharmacol. [Apr 2 Epub ahead of print]. "Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms."

Chopra P, Tinkle B, Hamonet C et al. 2017. Pain management in the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. [Feb 10 Epub ahead of print.] "Chronic pain in the Ehlers-Danlos syndromes (EDS) is common and may be severe. According to one study, nearly 90% of patients report some form of chronic pain. Pain, which is often one of the first symptoms to occur, may be widespread or localized to one region such as an arm or a leg. Studies on treatment modalities are few and insufficient to guide management. The following is a discussion of the evidence regarding the underlying mechanisms of pain in EDS. The causes of pain in this condition are multifactorial and include joint subluxations and dislocations, previous surgery, muscle weakness, proprioceptive disorders, and vertebral instability. Affected persons may also present with generalized body pain, fatigue, headaches, gastrointestinal pain, temporomandibular joint pain, dysmenorrhea, and vulvodynia. Pain management strategies may be focused around treating the cause of the pain (e.g., dislocation of a joint, proprioceptive disorder) and minimizing the sensation of pain. Management strategies for chronic pain in EDS includes physical therapy, medications, as well as durable medical equipment such as cushions, compressive garments, and braces. The different modalities are discussed in this paper."

Chou LW, Hsieh YL, Kuan TS et al. 2014. Needling therapy for myofascial pain: recommended technique with multiple rapid needle insertion. Biomedicine (Taipei). 4:13. "Myofascial trigger point (MTrP) is a major cause of muscle pain, characterized with a hyperirritable spot due to accumulation of sensitized nociceptors in skeletal muscle fibers. Many needling therapy techniques for MTrP inactivation exist. Based on prior human and animal studies, multiple insertions can almost completely eliminate the MTrP pain forthwith. It is an attempt to stimulate many sensitive loci (nociceptors) in the MTrP region to induce sharp pain, referred pain or local twitch response. Suggested mechanisms of needling analgesia include effects related to immune, hormonal or nervous system. Compared to slow-acting biochemical effects involving immune or hormonal system, neurological effects can act faster to provide immediate and complete pain relief. Most likely mechanism of multiple needle insertion therapy for MTrP inactivation is to encounter sensitive nociceptors with the high-pressure stimulation of a sharp needle tip to activate a descending pain inhibitory system. This technique is strongly recommended for myofascial pain therapy in order to resume patient's normal life rapidly, thus saving medical and social resources." Free PMC Article [This trigger point injection technique was developed by the fourth author, CZ Hong, and any person who does trigger point injection would do well to study this paper. DJS]

Chow DH, Leung KT, Holmes AD. 2007.  Changes in spinal curvature and proprioception of schoolboys carrying different weights of backpack.  Ergonomics. [Sep 19 Epub ahead of print].  “Carriage of a loaded backpack causes immediate changes in spinal curvature and appears to have a direct effect on the repositioning consistency.”   Patents and teachers must be made aware of the dangers posed to the youth of our country by carrying heavy backpacks.

Choy EH. 2016. Current treatments to counter sleep dysfunction as a pathogenic stimulus of fibromyalgia.Pain Manag.[Jun 17 Epub ahead of print.] "Fibromyalgia is characterized by chronic widespread pain, fatigue and nonrestorative sleep. Polysomnography showed reduced short-wave sleep and abnormal alpha rhythms during non rapid eye movement sleep in patients with fibromyalgia. However, sleep dysfunction might be pathogenic in fibromyalgia since myalgia and fatigue could be induced in healthy individuals by disrupting sleep. Poor sleep quality was a major risk factor for the subsequent development of chronic widespread pain in healthy pain-free individuals. Sleep disruption leads to impairment of the descending pain inhibition pathways. Aside from good sleep, hygiene, exercise can promote sleep. Among currently available pharmacological treatments, evidence suggests amitriptyline and pregabalin can improve sleep in fibromyalgia."

Choy EH. 2015. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. [Apr 28 Epub ahead of print.] "Fibromyalgia is a common cause of chronic widespread pain, characterized by reduced pressure pain thresholds with hyperalgesia and allodynia. In addition to pain, common symptoms include nonrestorative sleep, fatigue, cognitive dysfunction, stiffness and mood disturbances. The latest research indicates that the dominant pathophysiology in fibromyalgia is abnormal pain processing and central sensitization. Neuroimaging studies have shown that patients with fibromyalgia have similar neural activation to healthy age-matched and gender-matched individuals; however, they have a lower pressure-pain threshold. Polysomnography data has demonstrated that these patients have reduced short-wave sleep and abnormal α-rhythms, suggestive of wakefulness during non-REM (rapid eye movement) sleep. Sleep deprivation in healthy individuals can cause symptoms of fibromyalgia, including myalgia, tenderness and fatigue, suggesting that sleep dysfunction might be not only a consequence of pain, but also pathogenic. Epidemiological studies indicate that poor sleep quality is a risk factor for the development of chronic widespread pain among an otherwise healthy population. Mechanistically, sleep deprivation impairs descending pain-inhibition pathways that are important in controlling and coping with pain. Clinical trials of pharmacological and nonpharmacological therapies have shown that improving sleep quality can reduce pain and fatigue, further supporting the hypothesis that sleep dysfunction is a pathogenic stimulus of fibromyalgia." [Another study showing that an in-lab sleep study is one of the first tests to set up for any patient with fatigue and fibromyalgia. DJS]

Chrednichenko G, Zhang R, Bannister RA et al. 2012. Triclosan impairs excitation-contraction coupling and Ca2+ dynamics in striated muscle. Proc Natl Acad Sci USA. 109(35):14158-14163. Triclosan, a commonly used antibacterial agent found in many hand soaps, dish detergents and other over-the-counter products, is a "priority pollutant" and "...acutely depresses hemodynamics and grip strength in mice...." It affects ryanodine binding, which is a calcium ion-channel receptor that has been suggested may be involved in myofascial trigger points. Triclosan "...weakens cardiac and skeletal muscle contractility in a manner that may negatively impact muscle health, especially in susceptible populations."

Chrona E, Kostopanagiotou G, Damigos D et al. 2017. Anterior cutaneous nerve entrapment syndrome: management challenges. J Pain Res. 10:145-156. "Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly underdiagnosed and undertreated chronic state of pain. This syndrome is characterized by the entrapment of the cutaneous branches of the lower thoracoabdominal intercostal nerves at the lateral border of the rectus abdominis muscle, which causes severe, often refractory, chronic pain.… The presently available management strategies for ACNES include trigger point injections (diagnostic and therapeutic), ultrasound-guided blocks, chemical neurolysis, and surgical neurectomy, in combination with systemic medication, as well as some emerging techniques, such as radiofrequency ablation and neuromodulation. An increased awareness of the syndrome and the use of specific diagnostic criteria for its recognition are required to facilitate an early and successful management." Free Article

Chu J. 2000.  Twitch-obtaining intramuscular stimulation (TOIMS): long term observations in the management of chronic partial cervical radiculopathy.  Electromyogr Clin Neurophysiol 40(8):503-510.  “Observations suggest TOIMS to have potential value in the long-term management of partial cervical radiculopathy related myofascial pain.”

Chugh, D. K., T. E. Weaver and D. F. Dinges.  1996.  Neurobehavioral consequences of arousals. Sleep 19(10 Suppl):S198-201.

Chung SD, Lin CC, Liu SP et al. 2013. Obstructive Sleep Apnea Increases the Risk of Bladder Pain Syndrome/Interstitial Cystitis: A Population-Based Matched-Cohort Study. Neurourol Urodyn. [Mar 28 Epub ahead of print]. "Previous studies indicated a possible association between bladder pain syndrome/interstitial cystitis (BPS/IC) and sleep disorders including sleep abnormalities with delayed onset of sleep, waking up before needed, and snoring. Nevertheless, no previous study has reported the association between obstructive sleep apnea (OSA) and BPS/IC....This study provides epidemiological evidence of a link between OSA and a subsequent BPS/IC diagnosis. We suggest that clinical practitioners treating subjects with OSA be alert to urinary complaints in this population."

Chys M, De Meulemeester K, Greef ID, et al. Clinical effectiveness of dry needling in patients with musculoskeletal pain-An umbrella review. J Clin Med. 2023 Feb 2;12(3):1205. "Overall, DN is superior to sham/no intervention and equally effective to other interventions for pain reduction at short-term regardless of the body region…. There is a substantial need for the standardization of DN protocols to address the problem of heterogeneity and to strengthen the current evidence."

Ciampi de Andrade D, Maschietto M, Galhardoni R et al. 2017. Epigenetics insights into chronic pain: DNA hypomethylation in fibromyalgia - a controlled pilot-study. Pain. [Jun 15 Epub ahead of print] "Fibromyalgia has a hypomethylation DNA pattern, which is enriched in genes implicated in stress response and DNA repair/free radical clearance. These changes occurred parallel to changes in CE (cortical excitability) parameters. New epigenetic insights into the pathophysiology of FM may provide the basis for the development of biomarkers of this disorder."

Ciappuccini R, Ansemant T, Maillefert JF et al. 2010. Aspartame-induced fibromyalgia, an unusual but curable cause of chronic pain. Clin Exp Rheumatol. 28(6 Suppl 63):S131-133. "We report for the first time an unusual musculoskeletal adverse effect of aspartame in two patients. A 50-year-old woman had been suffering from widespread pain and fatigue for more than 10 years leading to the diagnosis of fibromyalgia. During a vacation in a foreign country, she did not suffer from painful symptoms since she had forgotten to take her aspartame. All of the symptoms reappeared in the days following her return when she reintroduced aspartame into her daily diet. Thus, aspartame was definitively excluded from her diet, resulting in a complete regression of the fibromyalgia symptoms. A 43-year-old man consulted for a 3-year history of bilateral forearm, wrist, and hand and cervical pain with various unsuccessful treatments. A detailed questioning allowed to find out that he had been taking aspartame for three years. The removal of aspartame was followed by a complete regression of pain, without recurrence. We believe that these patients' chronic pain was due to the ingestion of aspartame, a potent flavoring agent, widely used in food as a calorie-saver. The benefit/ risk ratio of considering the diagnosis of aspartame-induced chronic pain is obvious: the potential benefit is to cure a disabling chronic disease, to spare numerous laboratory and imaging investigations, and to avoid potentially harmful therapies; the potential risk is to temporarily change the patient's diet. Thus, practitioners should ask patients suffering from fibromyalgia about their intake of aspartame. In some cases, this simple question might lead to the resolution of a disabling chronic disease." [Excitotoxins are perpetuating factors for FM and CMP. We now have indications excitotoxins, including aspartame and MSG, as initiating factors for FM. DJS]

Ciccone DS, Elliott DK, Chandler HK et al. 2005.  Sexual and physical abuse in women with fibromyalgia syndrome: a test of the trauma hypothesis.  Clin J Pain 21(5):378-386.  "With the exception of rape, no self-reported sexual or physical abuse event was associated with FMS in this community sample. [Emphasis mine. DJS]  In accord with the trauma hypothesis, however, posttraumatic stress disorder was more prevalent in the FMS group.  Chronic stress in the form of posttraumatic stress disorder but not major depressive disorder may mediate the relationship between rape and FMS.”

Ciccone DS, Just N, Bandilla EB et al. 2000.  Psychological correlates of opioid use in patients with chronic nonmalignant pain.  A preliminary test of the downhill spiral hypothesis.  J Pain Symptom Manage 20(3):180-192.  “There was no evidence that higher levels of opioid use were associated with higher levels of disability or depression.”

Cichowski SB, Rogers RG, Clark EA et al. 2017. Military sexual trauma in female veterans is associated with chronic pain conditions. Mil Med. 182(9):e1895-e1899. "In the multivariable model there remained an association between MST (military sexual trauma) and chronic pain conditions including irritable bowel syndrome, chronic pelvic pain, back pain, chronic joint pain, fibromyalgia, dyspareunia, chronic abdominal pain, and headaches after adjusting for baseline differences in age, body mass index, smoking, and ethnicity. Importantly, drug abuse, and overdose were also associated with MST….In summary, we found that female veteran survivors of MST face an increased burden of chronic pain, including a broad range of pain conditions independent of the psychological effects of MST."

Cigaran-Mendez M, Ubeda-D'Ocasar E, Arias-Buría JL, et al. 2022. Pain extent is associated with Central Sensitization Inventory but not widespread pressure pain sensitivity or psychological variables in women with fibromyalgia. Scand J Rheumatol. Mar 28;1-8."This study found that larger pain extent was associated with self-reported outcomes, i.e. CSI, but not neurophysiological outcomes, i.e. PPTs (pressure pain thresholds), of sensitization in women with FMS. Older age and a longer history with pain symptoms were also associated with larger pain extent.

Cilesizoglu Yavuz N, Coluk Y. 2024. Fibromyalgia symptoms before and after septoplasty: A cross-sectional study. Medicine (Baltimore). 2024 Aug 30;103(35):e39473.

Cimen A, Celik M, Erdine S. 2004.  Myofascial pain syndrome in the differential diagnosis of chronic abdominal pain.  Agri. 16(3):45-47.  MPS may be misdiagnosed as visceral disease if the clinician is not trained in its diagnosis.

Ciregia F, Giacomelli C, Giusti L et al. 2018. Putative salivary biomarkers useful to differentiate patients with fibromyalgia. J Proteomics. [Apr 11 Epub ahead of print] "Specifically, the salivary profile of FM patients was compared with those of healthy subjects, subjects suffering migraine (model of non-inflammatory chronic pain), and patients affected by rheumatoid arthritis (model of inflammatory chronic pain). ... We defined a panel of 3 salivary proteins which could be one of the criteria to be taken into account...Actually, our future perspective foresees to develop a simple, rapid and not invasive point-of-care testing which will be of use during the diagnostic process."

Cisler TA. 1994.  Whiplash as a total-body injury.  J Am Osteopath Assoc 94(2):145-148.  “Physicians must recognize whiplash injury as a manifestation of total-body trauma and treat accordingly, with particular emphasis on alleviating abnormal tension of the fascia.  Precise description of the accident, followed by healing methods tailored to well-defined bodily injury, aids in effective management.”

Citak-Karakaya I, Akbayrak T, Demirturk F et al. 2006.  Short- and long-term results of connective tissue manipulation and combined ultrasound therapy in patients with fibromyalgia.  Manipulative Psysiol Ther. 29(7):524-528.  “Methods used in this study seemed to be helpful in improving pain intensity, complaints of nonrestorative sleep, and impact on functional activities in patients with FM.”

Civelek GM, Ciftkaya PO, Karatas M. 2014. Evaluation of restless legs syndrome in fibromyalgia syndrome: An analysis of quality of sleep and life. Back Musculoskelet Rehabil. [May 27 Epub ahead of print.] "Presence of RLS should be investigated in every patient with FMS and treatment plans should also cover RLS in case of coexistance with FMS. Prospective cohort studies are needed for better explanation of FMS and RLS coexistance."

Clark, F., S. P. Azen, R. Zemke, J. Jackson, M. Carlson, D. Mandel, J. Hay, K. Josephson, B. Cherry, C. Hessel, J. Palmer and L. Lipson.  1997.  Occupational therapy for independent-living older adults.  A randomized controlled trial.  JAMA 278(16):1321-6.  Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains.  Preventive health programs based on OT may mitigate against the health risks of older adulthood.

Clark, H. W. and K. L. Sees.  1993.  Opioids, chronic pain, and the law.  J Pain Sympt Manage 8(5):297-305.

Clauw D, Sarzi-Puttini P, Pellegrino G, et al. Is fibromyalgia an autoimmune disorder? Autoimmun Rev. 2023 Aug 25;103424. "Fibromyalgia (FM) is a multifactorial syndrome which includes not only widespread pain and stiffness, now recognized as major symptoms, but also numerous other somatic, emotional, and neuropsychic manifestation. The lack of specific validated biological and instrumental biomarkers has made FM a condition of unexplained medical significance, and its pathophysiology remains controversial and subject to debate. The current hypothesis regarding the pathogenesis of FM proposes that its development is influenced by various mechanism, including genetic predisposition, stressful life events, inflammatory processes, and cognitive-emotional factors. However, despite the extensive research conducted to date, the available data do not provide a clear understanding of the pathogenesis of FM. In this article, we report the opposing viewpoints of two leading experts who debate the question of whether FM is an autoimmune disease, based on scientific data regarding this condition. Both perspectives are discussed and the latest evidence on the pathophysiology of FM is reported to provide a comprehensive understanding of this complex syndrome."

Clauw DJ. 2015. Fibromyalgia and Related Conditions. Mayo Clin Proc. 90(5):680-692. "Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified. Earlier there was some doubt about whether there was an "organic basis" for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients. The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing. This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (e.g., irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (e.g., autoimmune disorders and osteoarthritis). In the latter instance, the term centralized pain connotes the fact that in addition to the pain that might be caused by peripheral factors, there is superimposed pain augmentation occurring in the central nervous system. It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies."

Clauw DJ. 2015. Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s). Best Pract Res Clin Rheumatol. 29(1):6-19. "Until recently, most clinicians considered chronic pain to be typically due to ongoing peripheral nociceptive input (i.e., damage or inflammation) in the region of the body where the individual is experiencing pain. Clinicians are generally aware of a few types of pain (e.g., headache and phantom limb pain) where chronic pain is not due to such causes, but most do not realize there is not a single chronic pain state where any radiographic, surgical, or pathological description of peripheral nociceptive damage has been reproducibly shown to be related to the presence or severity of pain. The primary reason for this appears to be that both the peripheral and central nervous systems play a critical role in determining which nociceptive input being detected by sensory nerves in the peripheral tissues will lead to the perception of pain in humans. This manuscript reviews some of the latest findings regarding the neural processing of pain, with a special focus on how clinicians can use information gleaned from the history and physical examination to assess which mechanisms are most likely to be responsible for pain in a given individual, and tailors therapy appropriately. A critical construct is that, within any specific diagnostic category (e.g., fibromyalgia (FM), osteoarthritis (OA), and chronic low back pain (CLBP) are specifically reviewed), individual patients may have markedly different peripheral/nociceptive and neural contributions to their pain. Thus, just as low back pain has long been acknowledged to have multiple potential mechanisms, so also is this true of all chronic pain states, wherein some individuals will have pain primarily due to peripheral nociceptive input, whereas in others peripheral (e.g., peripheral sensitization) or central nervous system factors ("central sensitization" or "centralization" of pain via augmented pain processing in spinal and brain) may be playing an equally or even more prominent role in their pain and other symptoms."

Clauw DJ. 2014. Fibromyalgia: a clinical review. JAMA 311(15):1547-1555. "Fibromyalgia and other "centralized" pain states are much better understood now than ever before. Fibromyalgia may be considered a discrete diagnosis or as a constellation of symptoms characterized by central nervous system pain amplification with concomitant fatigue, memory problems, and sleep and mood disturbances. Effective treatment for fibromyalgia is now possible." [This review might have been made even better with the inclusion of some of the articles dealing with the peripheral source of pain causing central sensitization states, including myofascial trigger points and arthritis. Controlling the pain generated by these states is a critical part of managing fibromyalgia. DJS]

Clauw DJ, Arnold LM, McCarberg BH. 2011. The Science of Fibromyalgia. Mayo Clin Proc. 86(9):907-911. "Fibromyalgia (FM) is a common chronic widespread pain disorder. Our understanding of FM has increased substantially in recent years with extensive research suggesting a neurogenic origin for the most prominent symptom of FM, chronic widespread pain. Neurochemical imbalances in the central nervous system are associated with central amplification of pain perception characterized by allodynia (a heightened sensitivity to stimuli that are not normally painful) and hyperalgesia (an increased response to painful stimuli). Despite this increased awareness and understanding, FM remains undiagnosed in an estimated 75% of people with the disorder. Clinicians could more effectively diagnose and manage FM if they better understood its underlying mechanisms. Fibromyalgia is a disorder of pain processing. Evidence suggests that both the ascending and descending pain pathways operate abnormally, resulting in central amplification of pain signals, analogous to the "volume control setting" being turned up too high. Patients with FM also exhibit changes in the levels of neurotransmitters that cause augmented central nervous system pain processing; levels of several neurotransmitters that facilitate pain transmission are elevated in the cerebrospinal fluid and brain, and levels of several neurotransmitters known to inhibit pain transmission are decreased. Pharmacological agents that act centrally in ascending and/or descending pain processing pathways, such as medications with approved indications for FM, are effective in many patients with FM as well as other conditions involving central pain amplification. Research is ongoing to determine the role of analogous central nervous system factors in the other cardinal symptoms of FM, such as fatigue, nonrestorative sleep, and cognitive dysfunction."

Clauw DJ, Crofford LJ. 2003.  Chronic widespread pain and fibromyalgia: what we know, and what we need to know.  Best Pract Res Clin Rheumatol. 17(4):685-701.  “These conditions respond best to a combination of symptom-based pharmacological therapies, and non-pharmacological therapies such as exercise and cognitive behavioral therapy.  In contrast to drugs that work for peripheral pain due to damage or inflammation, neuroactive compounds [especially those that raise central levels of noradrenaline (norepinephrine) or serotonin] are most effective for treating central pain.”

Clauw DJ, Essex MN, Pitman V et al. 2019. Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management. Postgrad Med. [Jan 31 Epub ahead of print] "Chronic pain is a common public health problem that has a detrimental impact on patient health, quality of life (QoL), and function, and poses a substantial socioeconomic burden. Evidence supports redefinition of chronic pain as a distinct disease entity, not simply a symptom of injury or illness. Chronic pain conditions are characterized by three types of pain pathophysiology - i.e., nociceptive, neuropathic, and centralized pain/central sensitization -influenced by a cluster of coexisting psychosocial factors. Negative risk/vulnerability factors, e.g., mood or sleep disturbances, and positive resilience/protective factors, e.g., social/interpersonal relationships and active coping, interact with pain neurobiology to determine patients' unique pain experience. Viewing chronic pain through a biopsychosocial lens, instead of a purely biomedical one, clinicians need to adopt a practical integrated management approach. Thorough assessment focuses on the whole patient (not just the pain), including comorbidities, cognitive/emotional/behavioral characteristics, social environment, and QoL/functional impairment. As for other complex chronic illnesses, the treatment plan for chronic pain can be developed based on pain subtype and psychosocial profile, incorporating pharmacotherapy and self-management modalities. Preferred pharmacologic treatment of conditions primarily associated with nociception (e.g., osteoarthritis) includes acetaminophen and non-steroidal anti-inflammatory drugs, whereas preferred pharmacologic treatment of conditions primarily associated with neuropathy or central sensitization (e.g., fibromyalgia) includes tricyclic compounds, serotonin norepinephrine reuptake inhibitors, and α2δ ligands. Education, exercise, cognitive behavioral therapy, and many other non-pharmacological approaches, alone or combined with pharmacotherapy, have been shown to be effective for any type of pain, although they remain underutilized due to lack of awareness of their benefits and reimbursement obstacles." [This is true, yet one must not forget to properly address those co-existing conditions, which may be many. Some may be fierce pain and other symptom generator, such as chronic myofascial pain . Cognitive therapies cannot be successfully utilized by someone who has alligators gnawing on his/her body. The alligators must first be removed, and the injuries adequately treated. So it is also for the conditions driving/maintaining the central sensitization of FM. DJS]

Clauw DJ, Hassett AL. 2017. The role of centralised pain in osteoarthritis. Clin Exp Rheumatol. 35 Suppl 107(5):79-84."In chronic pain states, central nervous system (CNS) factors often play a particularly prominent role. In many individuals with chronic pain, pain can occur with minimal or no evidence of ongoing nociceptive input. Medical subspecialties have applied a wide-range of labels to these pain conditions including fibromyalgia, irritable bowel syndrome and interstitial cystitis to name just a few. These same CNS processes can augment or magnify pain when there is ongoing nociceptive input, as in conditions such as osteoarthritis or autoimmune disorders. The hallmark of these 'centrally driven' pain conditions is a diffuse hyperalgesic state identifiable through the use of experimental sensory testing that has been corroborated by functional neuroimaging. Characteristic symptoms of these central pain conditions include multifocal pain, fatigue, poor sleep, memory complaints and frequent co-morbid mood and anxiety disorders. In contrast to acute and peripheral pain states that are responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, central pain conditions respond best to CNS neuromodulating agents, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants. While osteoarthritis is generally considered a peripherally mediated pain state, a subset of these patients also manifests centrally driven pain characteristics. Thus, osteoarthritis can also be thought of as a "mixed" pain state and this requires a more tailored approach to treatment." Free Article

Clayton HA, Jones SA, Henriques DY. 2015. Proprioceptive precision is impaired in Ehlers-Danlos syndrome. Springerplus. 4:323. "It has been suggested that people with Ehlers-Danlos syndrome (EDS), or other similar connective tissue disorders, may have proprioceptive impairments, the reason for which is still unknown. We recently found that EDS patients were less precise than healthy controls when estimating their felt hand's position relative to visible peripheral reference locations, and that this deficit was positively correlated with the severity of joint hypermobility. We further explore proprioceptive abilities in EDS by having patients localize their non-dominant left hand at a greater number of workspace locations than in our previous study. Additionally, we explore the relationship between chronic pain and proprioceptive sensitivity. We found that, although patients were just as accurate as controls, they were not as precise. Patients showed twice as much scatter than controls at all locations, but the degree of scatter did not positively correlate with chronic pain scores. This further supports the idea that a proprioceptive impairment pertaining to precision is present in EDS, but may not relate to the magnitude of chronic pain." Free PMC Article

Clemenzi A, Pompa A, Casillo P. 2014. Chronic pain in multiple sclerosis: is there also fibromyalgia? An observational study. Med Sci Monit. 20:758-766. "In our sample of MS patients we found a high prevalence of chronic pain, with those patients displaying a higher disability and a more severe depression. Moreover, FM frequency, significantly higher than that observed in the general population, was detected among the MS patients with chronic pain. FM occurrence was associated with a stronger impact on patients' QoL (quality of life)." Free PMC Article.

Cleveland, C. H.  Jr., R. H. Fisher, E. P. Brestel, J. D. Esinhart and W. J. Metzger. 1992. Chronic rhinitis: an underrecognized association with fibromyalgia. Allergy Proc 13(5):263-267. 

Clewley D, Flynn TW, Koppenhaver S. 2013. Trigger point dry needling as an adjunct treatment for a patient with adhesive capsulitis of the shoulder. J Orthop Sports Phys Ther. [Nov 21 Epub ahead of print]. "Prognosis for adhesive capsulitis has been described as self-limiting and can persist for 1-3 years. Conservative treatment including physical therapy is commonly advised…. The patient was a 54 year old female with primary symptoms of shoulder pain and loss of motion consistent with adhesive capsulitis. Manual physical therapy intervention initially consisted of joint mobilizations of the shoulder region and thrust manipulation of the cervicothoracic region. Although manual techniques seemed to cause some early functional improvement, continued progression was limited by pain. Subsequent examination identified trigger points in the upper trapezius, levator scapula, deltoid and infraspinatus muscles that were treated with dry needling to decrease pain and allow for higher grades of manual intervention. Outcomes: The patient was treated for a total of 13 visits over a 6 weeks period. After trigger point dry needling was introduced on the third visit, improvements in pain-free shoulder range of motion and functional outcome measures…exceeded the minimal clinically important difference after 2 treatment sessions. At discharge the patient had achieved significant improvements in shoulder range of motion in all planes and outcome measures were significantly improved….This case report describes the clinical reasoning behind the use of trigger point dry needling in the treatment of a patient with adhesive capsulitis. The rapid improvement seen in this patient following the initiation of dry needling to the upper trapezius, levator scapula, deltoid and infraspinatus muscles suggests that surrounding muscles may be a significant source of pain in this condition."

Climent JM, Kuan TS, Fenollosa P et al. 2013. Botulinum toxin for the treatment of myofascial pain syndromes involving the neck and back: a review from a clinical perspective. Evid Based Complement Alternat Med. [Feb 19 Epub ahead of print]. "Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results....Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies."

Clos-Garcia M, Andres-Marin N, Fernandez-Eulate G et al. 2019. Gut microbiome and serum metabolome analyses identify molecular biomarkers and altered glutamate metabolism in fibromyalgia. EBioMedicine. [Jul 18 Epub ahead of print] "We found that the diversity of bacteria is reduced in fibromyalgia patients. The abundance of the Bifidobacterium and Eubacterium genera (bacteria participating in the metabolism of neurotransmitters in the host) in these patients was significantly reduced. The serum metabolome analysis revealed altered levels of glutamate and serine, suggesting changes in neurotransmitter metabolism. The combined serum metabolomics and gut microbiome datasets showed a certain degree of correlation, reflecting the effect of the microbiome on metabolic activity. We also examined the microbiome and serum metabolites, cytokines and miRNAs as potential sources of molecular biomarkers of fibromyalgia…. Our results show that the microbiome analysis provides more significant biomarkers than the other techniques employed in the work. Gut microbiome analysis combined with serum metabolomics can shed new light onto the pathogenesis of fibromyalgia. We provide a list of bacteria whose abundance changes in this disease and propose several molecules as potential biomarkers that can be used to evaluate the current diagnostic criteria."

Close J. 2012. Are stress responses to geomagnetic storms mediated by the cryptochrome compass system? Proc Biol Sci 279(1736):2081-2090. The cryptochrome compass system may be at least one of the geomagnetic response systems. This system may affect hypothalamic-pituitary-adrenal (HPA) axis responses, including changes in circadian cycle, to the geomagnetic field. The magnetosence is mediated by the HPA axis in migratory animals. Vestibular system derived gravitational cues interact with the magnetosence to help migrating animals. When the vestibular system is hyperstimulated, it stimulates a corresponding an acute stress response across the HPA axis. In rats, this also disturbs spatial sense. Humans were nomadic, migrating animals. If the geomagnetic sense can interact with hormonal systems, it could provoke a general stress response. Geomagnetic effects are complex, and integrated with multiple response systems. The cryptochrome acts as geomagnetic compass in migrating animals, as well as modulator of circadian oscillation. Several studies have revealed a relationship between light exposure and geomagnetic and human-generated magnetic fields. [We do not yet know the effects of geomagnetic storms on humans, especially those with disrupted HPA axes, such as FM patients. If these patients also have vestibular dysfunction and optic dysfunction, the effects could be significant. The interactions would be extremely complex, with a wide number of variables, and we as yet cannot test for this. DJS]

Coaccioli S, Varrassi G. 2011. Chronic degenerative pain: an update on abdominal pain in comparison to rheumatic diseases. J Clin Gastroenterol. S94-S97. "Extra-articular syndromes, notably fibromyalgia, can be a lifelong rheumatic condition characterized by widespread musculoskeletal pain and functional impairment, without any known structural or inflammatory cause. Irritable bowel syndrome (IBS) occurs in around half of patients with fibromyalgia raising the possibility of a possible overlapping or underlying pathophysiology. The dysfunction of bidirectional neural pathways and viscerovisceral cross-interactions within the central nervous system has been proposed as a possible central hypersensitization disorder responsible for the extraintestinal manifestations of IBS. Common inflammatory and molecular pathways may also be present in which a dysregulation of the immune system leads to a chronic inflammatory response. Given that the treatment of degenerative chronic pain remains suboptimal, these findings may suggest new treatment strategies." [These authors deserve commendation for recognition of the interactive aspect of these two conditions. They both have central sensitization components. They would do well to include myofascial trigger points, which also are co-existing to both conditions, in future research. DJS]

Cobo JL, Abbate F, de Vicente JC et al. 2017. Searching for proprioceptors in human facial muscles. Neurosci Lett. 640:1-5. "Here we have investigated whether other kinds of sensory structures are present in two human facial muscles (zygomatic major and buccal). … In all the muscles analyzed, capsular corpuscle-like structures resembling elongated or round Ruffini-like corpuscles were observed. Moreover the axon profiles within these structures displayed immunoreactivity for both putative mechanoproteins. The present results demonstrate the presence of sensory structures in facial muscles that can substitute for typical muscle spindles as the source of facial proprioception."

Coderre TJ. Contribution of microvascular dysfunction to chronic pain. Front Pain Res (Lausanne). 2023 Feb 2;4:1111559. "This mini review will discuss evidence for a critical role of microvascular dysfunction or injury in pathologies that contribute to chronic pain conditions such as complex regional pain syndrome (CRPS) and fibromyalgia."

Cohen H. 2017. Controversies and challenges in fibromyalgia: a review and a proposal. Ther Adv Musculoskelet Dis. 9(5):115-127. "Fibromyalgia (FM) is the most commonly encountered chronic widespread pain (CWP) condition in rheumatology. In comparison to inflammatory arthritis (IA), it can seem ill defined with no clear understanding of the pathology and therefore no specific targeted treatment. This inevitably raises controversies and challenges. However, this is an outdated view perpetuated by poor teaching of pain at undergraduate and postgraduate levels, and the perennial problem of advances in relevant cross-speciality knowledge penetrating speciality silos. Research has provided a better understanding of the aetiopathology and FM is now regarded as a centralized pain state. Effective treatment is possible utilizing a multidisciplinary approach combining nonpharmacologic and pharmacologic treatments rooted in a biopsychosocial model. This article will provide a review of the mechanisms, diagnosis and treatment of FM, focus on some ongoing contentious issues and propose a change to the diagnostic terminology." Free Article

Cohen H, Neumann L, Glazer Y et al. 2009. The relationship between a common catechol-O-methyltransferase (COMT) polymorphism val(158) met and fibromyalgia. Clin Exp Rheumatol. 27(5 Suppl 56):S51-56. “Our results are consistent with carriers of the COMT met/met genotype showing increased sensitivity to pain as one mechanism for the role of this gene in conferring risk for FM. We suggest that the reduced frequency of the met allele in the non-affected relatives acts as a 'protective' allele in this group and prevents the development of clinical FM.”

Cohen, H., L. Neumann, Y. Haiman et al. 2002. Prevalence of post-traumatic stress disorder in fibromyalgia patients: Overlapping syndromes or post-traumatic fibromyalgia syndrome? Semin Arthritis Rheum 23(1):38-50.  In this study, 57% of the FMS patients tested had significant levels of PTSD symptoms. 

Cohen, H., L. Neumann, M. Shore, M. Amir, Y. Cassuto and  D. Buskila. 2000.  Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum 2000 Feb;29(4):217-27.

Cohen JH, Gibbons RW. 1998.  Raymond L. Nimmo and the evolution of trigger point therapy, 1929-1986.  J Manipulative Physiol Ther. 21(3):167-172.

Cohen SP, Wang EJ, Doshi TL, et al. Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies. BMJ Med. 2022 Mar 31;1(1):e000108. "This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes."

Cojocaru MC, Cojocaru IM, Voiculescu VM et al. 2015. Trigger points - ultrasound and thermal findings. J Med Life. 8(3):315-318. "Trigger points are represented by a higher temperature area surrounded by a cooler area, probably caused by a deficit in the blood flow around those points….Infrared thermography could be a great asset for the monitoring of neuromusculoskeletal disorders and their dynamics, as well as an important aid for the initial diagnosis of conditions associated with tissue temperature alterations." Free PMC Article

Colburn KK, Rambharose JA, Malto MC et al. 2006.  Abnormally low antibody markers of elastin synthesis in patients with fibromyalgia syndrome.  J Musculoskel Pain. 14(3):13-19.  This study showed altered elastin metabolism in FMS patients.  This alteration, if significant, could affect elastic tissue in areas such as the lungs and other organs, skin, and blood vessels.  [These patients were not screened for co-existing myofascial TrPs. DJS]

Colcombe SJ, Kramer AF, Erickson KI et al. 2004. Cardiovascular fitness, cortical plasticity and aging. Proc Natl Acad Sci U S A 101(9):3316-3321.  Brain function in sedentary seniors can be improved with moderate regular walking exercise.

Cole JA, Rothman KJ, Cabral HJ et al. 2006.  Migraine, fibromyalgia and depression among people with IBS: a prevalence study.  BMC Gastroenterol. 6:26.  “People in the IBS cohort had a 40% to 80% higher prevalence odds of migraine, fibromyalgia and depression.”

Collop N. 2007.  The effect of obstructive sleep apnea on chronic medical disorders.  Cleve Clin J Med. 74(1):72-78.  “Evidence is mounting that obstructive sleep apnea causes or contributes to many chronic medical diseases, and that treatment with continuous positive airway pressure (CPAP) often improves concomitant diseases.”  [This can be beneficial for some chronic pain patients, as OSA is often a perpetuating factor or interactive diagnosis. DJS]

Comeche Moreno MI, Ortega Pardo J, Rodríguez Munoz MF et al. 2012. [Structure and adequacy of the Beck Depression Inventory in patients with fibromyalgia.] Psicothema. 24(4):668-673. [Spanish] "The Beck Depression inventory is a widely used instrument for the measurement of depression in chronic pain....These results indicate that there are differences between the depressive manifestations of this type of patients and those with chronic pain. In addition, the peculiar structure of the BDI in this sample of patients seems to indicate an overlap between some depressive symptoms and the symptoms of fibromyalgia, which could lead to an overestimation of the occurrence of depression when measured with the BDI, a bias that should be assessed and modified."

Conen H, Seelmann C, Ohmann T et al.[Bilateral desensitization in CRPS with allodynia of the hand : An innovative treatment approach in ergotherapy].[Article in German] Schmerz. 2019 Nov 18.[Epub ahead of print] "This article describes the case of a female patient with symptoms of complex regional pain syndrome (CRPS) of the right wrist and forearm. Ergotherapy of the affected hand (unilateral desensitization) showed little success and became impossible with increasing environmental temperature due to excessive pain. A physiological feedback via simultaneous treatment of the unaffected healthy arm (bilateral treatment approach) ultimately led to a clear decline of all CRPS symptoms."

Conigliaro, D. A.  1996.  Opioids for chronic non-malignant pain.  J Fla Med Assoc 83(10):708-711.

Connelly M, Hoffart C, Schikler K et al. 2014. A84: Changes over Time in Symptoms and Treatment of Juvenile Primary Fibromyalgia Syndrome. Arthritis Rheumatol. 66 Suppl 11:S117. "Children with JPFS exhibit worsening pain and quality of life over time regardless of treatment modality recommendations or patient compliance to therapy. Patients returning for follow-up visits may be those whose symptoms are most refractory. Additional studies are needed to identify barriers to improvement in this patient population and to determine effective treatment approaches to improve health outcomes." [If the focus shifts to identifying the cause of the symptoms, including myofascial trigger points and their perpetuating factors, and then bring them under control, the prognosis of these patients may improve considerably. DJS]

Conte, PM, Walco, GA, Kimura, Y. 2003.  Temperament and stress response in children with juvenile primary fibromyalgia syndrome.  Arthritis Rheum 48(10):2923-30.  This article may help care providers recognize children who are at risk for development of a chronic pain condition and may be a valuable tool in helping to prevent that from happening.

Conti P, Gallenga CE, Caraffa A et al. Impact of mast cells in fibromyalgia and low-grade chronic inflammation: Can IL-37 play a role? Dermatol Ther. 2019 Dec 14:e13191."In FM, neurotransmission and glial activation can occur with an increase in inflammatory cytokines and involvement of mast cells (MCs) in the skin. FM skin biopsies show an increase in the number of MCs, as well as the production of corticotropin releasing hormone and substance P (SP) by the neurons, which in turn activate MCs to release neurosensitizing proinflammatory substances, such as cytokines, secreted preformed mediators, and lipids, which can exacerbate low-grade inflammation. In fact, certain proinflammatory cytokines are higher in FM and mediate muscle pain, the mechanism of which is not yet clear. MC-derived tumor necrosis factor (TNF) induces nerve growth factor (NGF) and participates in nerve fiber elongation in skin hypersensitivity. IL-37 is an inhibitor of proinflammatory IL-1 family members, which are generated and released by MCs. The goal of this article is to demonstrate that inflammatory cytokines and MC (mast cells) products play a role in FM and that inflammation may be inhibited by IL-37. Here, we propose IL-37 as a cytokine that contributes to improve the pathogenesis of FM by blocking IL-1 family members."

Cook A, Ghanavatian S, Jowza M. 2020. Spontaneous spread of limb complex regional pain syndrome to the ipsilateral face with ultimate corneal abrasion: A case report. A A Pract Aug;14(10):e01301 "Complex regional pain syndrome (CRPS) has the potential to spread from the initial site to distant areas of the body. However, there is a paucity of data reporting the patterns and underlying cause of the spread. This case describes spontaneous, ipsilateral spread of CRPS from the right lower extremity to the orbit, leading to corneal abrasion."

Cook DB, Stegner AJ, Ellingson LD. 2010. Exercise alters pain sensitivity in Gulf War veterans with Chronic Musculoskeletal Pain. J Pain. [Mar 23 Epub ahead of print]. “Since returning from the Persian Gulf, nearly 100,000 veterans of the first Gulf War (GVs) have reported numerous symptoms with no apparent medical explanation. A primary complaint of these individuals is chronic musculoskeletal pain (CMP). CMP symptoms in GVs are similar to those reported by patients with fibromyalgia (FM), but have not received equivalent scientific attention. Exercise research in CMP patients suggests that acute exercise may exacerbate pain while chronic exercise can reduce pain and improve other symptoms….Gulf War veterans with CMP perceive exercise as more painful and effortful than healthy GVs and experience increased pain sensitivity following exercise. These results suggest that similar abnormalities in central nervous system processing of nociceptive information documented in FM may also be occurring in GVs with CMP.”  

Cook JR. 2021. Chiropractic management of a symptomatic patient who previously had surgery for cauda equina syndrome. J Chiropr Med Jun;20(2):85-89. "Trigger point therapy was performed on the gluteus medius, quadratus lumborum, and piriformis muscles bilaterally. After 12 months, the patient reported a reduction in lower back and radicular leg pain, was able to reduce her use of opioid medications, and experienced improved lower limb function following chiropractic care."

Cooper S, Gilbert L. 2016. The role of 'social support' in the experience of fibromyalgia - narratives from South Africa. Health Soc Care Community. [Oct 26 Epub ahead of print.] "The findings show how support from family, partners, and peers plays an integral role in the process of accepting fibromyalgia diagnosis, adapting to the demands of the condition, and seeking help from healthcare providers. The findings also show the ways in which people with fibromyalgia provide support for others with the condition, and the importance of this peer network in shaping the paths and outcomes of this illness experience. The findings of this study corroborate existing evidence that show fibromyalgia to be a complex condition to manage, due to the multiplicity, uncertainty and contestation that feature in the experience of the illness. Additionally, this study presents the challenges related to the limitations of access to healthcare in the South African context, and the utility of narrative approaches in garnering insight into the ways in which social support is harnessed in this environment."

Cooper TE, Derry S, Wiffen PJ et al. 2017. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst Rev. 1:CD012188. "There is insufficient evidence to support or refute the suggestion that gabapentin reduces pain in fibromyalgia."

Coppens E, Kempke S, Van Wambeke P et al. 2017. Cortisol and subjective stress responses to acute psychosocial stress in fibromyalgia patients and control participants. Psychosom Med. [Dec 11 Epub ahead of print] "Hypothalamic-pituitary-adrenal (HPA) axis dysfunction may play a role in fibromyalgia (FM) pathogenesis, but remains understudied in this disorder. Furthermore, early childhood adversities (ECA) are common in FM, but whether they moderate stress reactivity is unknown. Hence, we investigated cortisol and subjective responses to acute psychosocial stress in FM and controls, while adjusting for ECA.... FM patients had higher subjective stress levels compared with controls, particularly at baseline and during recovery from the TSST. In FM patients, ECA history was not associated with cortisol or subjective stress levels, or with responsivity to the TSST. Future research should investigate the mechanisms underlying HPA axis dysregulation in FM."

Coppens E, Van Wambeke P, Morlion B et al. 2017. Prevalence and impact of childhood adversities and post-traumatic stress disorder in women with fibromyalgia and chronic widespread pain. Eur J Pain. [May 24 Epub ahead of print] "In FM/CWP (fibromyalgia or chronic widespread pain), PTSD (posttraumatic stress disorder) comorbidity, but not CA (childhood adversities), was associated with self-reported pain severity and PTSD severity mediated the relationship between CA and pain severity. In summary, the prevalence of CA is higher in FM/CWP compared to achalasia, but similar to FD (functional dyspepsia). However, PTSD is more prevalent in FM/CWP compared to FD and associated with higher pain intensity in FM/CWP….As expected and has been shown in other functional disorders, we found elevated levels of childhood adversity in FM/CWP patients. Results of this study however suggest that the impact of childhood adversity (i.e. whether such events have led to the development of PTSD symptoms), rather than the mere presence of such adversity, is of crucial importance in FM/CWP patients. Screening for PTSD symptoms should be an essential part of the assessment process in patients suffering from FM/CWP, and both prevention and intervention efforts should take into account PTSD symptoms and their impact on pain severity and general functioning."

Coppieters I, De Pauw R, Caeyenberghs K et al. 2018. Differences in white matter structure and cortical thickness between patients with traumatic and idiopathic chronic neck pain: Associations with cognition and pain modulation? Hum Brain Mapp. [Jan 11 Epub ahead of print] Patients with chronic whiplash-associated disorders (CWAD), patients with chronic idiopathic neck pain (CINP)], and healthy controls were compared in this study, which also investigated associations between central sensitization and cognitive abilities, and brain structure. Brain changes indicate a connection to CWAD. "Our results emphasize the role of structural brain alterations in women with CWAD compared with CINP."

Coppieters I, De Pauw R, Caeyenberghs K et al. 2017. Decreased regional grey matter volume in women with chronic whiplash-associated disorders: Relationships with cognitive deficits and disturbed pain processing. Pain Physician. 20(7):E1025-E1051. "Patients with chronic whiplash-associated disorders (CWAD) are characterized by pain of traumatic origin, cognitive deficits, and central sensitization (CS). Previous neuroimaging studies revealed altered grey matter volume (GMV) in mild traumatic brain injury patients and chronic pain conditions also characterized by CS.... These results provide the first evidence for reduced GMV in cortical regions involved in processing cognition and pain in patients with CWAD. Accordingly, it is recommended that therapy approaches for CWAD patients should address the brain and take into account neuroplasticity of the central nervous system (CNS)". Free Article

Coppieters I, De Pauw R, Kregel J et al. 2017. Differences between women with traumatic and idiopathic chronic neck pain and women without neck pain: Interrelationships among disability, cognitive deficits, and central sensitization. Phys Ther. 97(3):338-353. "Pain-related disability, reduced health-related quality of life, and cognitive deficits were present in participants with CWAD (chronic whiplash-associated disorders) and, to a significantly lesser extent, in participants with CINP (chronic idiopathic neck pain). Local hyperalgesia was demonstrated in participants with CWAD and CINP but not in women who were healthy. However, distant hyperalgesia and decreased conditioned pain modulation efficacy were shown only in participants with CWAD; this result is indicative of the presence of central sensitization. Moderate to strong Spearman correlations… among disability, cognitive deficits, and hyperalgesia (local and distant) were observed in participants with CWAD. In participants with CINP, only local hyperalgesia and subjective cognitive deficits were moderately….correlated."

Coppieters I, Ickmans K, Cagnie B et al. 2015. Cognitive performance is related to central sensitization and health-related quality of life in patients with chronic whiplash-associated disorders and fibromyalgia. Pain Physician. 18(3):E389-401. "A growing body of research has demonstrated that impaired central pain modulation or central sensitization (CS) is a crucial mechanism for the development of persistent pain in chronic whiplash-associated disorders (WAD) and fibromyalgia (FM) patients. Furthermore, there is increasing evidence for cognitive dysfunctions among these patients. In addition, chronic WAD and FM patients often report problems with health-related quality of life (QoL). Yet, there is limited research concerning the interrelations between cognitive performance, indices of CS, and health-related QoL in these patients….this paper has demonstrated significant cognitive deficits, signs of CS, and reduced health-related QoL in chronic WAD and FM patients compared to healthy individuals. Significant relations between cognitive performance and CS as well as health-related QoL were demonstrated. These results provide preliminary evidence for the clinical importance of objectively measured cognitive deficits in patients with chronic WAD and FM." Free Article

Coppieters MW, Andersen J, Selbæk H et al. 2021. Sense of effort is distorted in people with chronic low back pain. Musculoskelet Sci Pract. Apr 2;53:102376. "The results of this study revealed that sense of effort is affected in cLBP (chronic low back pain). People with cLBP overestimated the trunk extension force they generated, and the error increased as the trial progressed. With visual feedback however, people with cLBP were able to compensate and perform the task as accurately as people without cLBP."

Corbel V, Stankiewicz M, Pennetier C et al. 2009. Evidence for inhibition of cholinesterases in insect and mammalian nervous systems by the insect repellent deet. BMC Biol. 7:47.   This research shows that the common insect repellant, DEET, can significantly inhibit acetylcholinesterase.  [Our current model for the formation and perpetuating of myofascial trigger points includes the release of excess acetylcholine (ACl) at the motor end plate.  Anything that promotes that release or inhibits acetlylcholinesterase, the enzyme that breaks down ACl, could then increase the possibility of TrP formation and maintenance.    The extra aches and pain from that walk in the woods may be due to more than the extra exercise.  DJS]

Cordon B, Orduna-Hospital E, Vilades E, Garcia-Martin E, et al. 2021. Analysis of retinal layers in fibromyalgia patients with premium protocol in optical tomography coherence and quality of life. Curr Eye Res. Jul 2. Online ahead of print. "Patients with FM present with a reduction of the inner retinal layers in the macular area. This degeneration correlates with disease severity/reduced quality of life in these patients. The PPole protocol for OCT is a non-invasive and fast tool that might help clinicians diagnose and monitor neurodegeneration in FM patients."

Correa A, Miro E, Martinez MP et al. 2010. Temporal preparation and inhibitory deficit in fibromyalgia syndrome. Brain Cogn. [Dec 10 Epub ahead of print]. "Cognitive deficits in fibromyalgia may be specifically related to controlled processes, such as those measured by working memory or executive function tasks. This hypothesis was tested here by measuring controlled temporal preparation (temporal orienting) during a response inhibition (go no-go) task. Temporal orienting effects (faster reaction times for targets appearing at temporally attended vs. unattended moments) and response inhibition were impaired in fibromyalgia compared to the control group. It is concluded that frontal networks underlying attentional control (temporal orienting and response inhibition) can be a dysfunctional neurocognitive mechanism in fibromyalgia."

Cortez MM, Millsap L, Rea NA et al.2021. Photophobia and allodynia in persistent post-traumatic headache are associated with higher disease burden. Cephalalgia. Apr 28;3331024211010304. Online ahead of print. "In all, 79% of post-traumatic headache subjects exhibited sensory hypersensitivity based on psychophysical assessment. Of those exhibiting hypersensitivity, 54% exhibited both light and tactile sensitivity. Finally, sensory thresholds were correlated across modalities, as well as with headache attack frequency. In this study, post-traumatic headache subjects with both light and tactile sensitivity had significantly higher headache frequencies and lower sensitivity thresholds to both modalities, compared to those with single or no sensory hypersensitivity. This pattern suggests that hypersensitivity across multiple modalities may be functionally synergistic, reflect a higher disease burden, and may serve as candidate markers of disease."

Corvo G, Tartaro G, Giudice A et al. 2003.  Distribution of craniomandibular disorders, occlusal factors and oral parafunctions in a paediatric population.  Eur J Paediatr Dent. 4(2):84-88.   Early diagnosis and correction of muscle dysfunctions are critical to avoid later TMJD.  [Myofascial TrPs are a very common and generally unrecognized cause of many of these dysfunctions DJS.]

Coskun Benlidayi I. 2020. Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases. Rheumatol Int. [Jan 3 Epub ahead of print] "Fibromyalgia is one of the numerous comorbidities that may accompany inflammatory rheumatic diseases. Concomitant fibromyalgia in inflammatory rheumatic conditions can interfere with symptomatology, disease activity and overall management plan… Studies representing different geographical areas of the world revealed that frequency rates of fibromyalgia are higher in inflammatory rheumatic diseases than those in the general population. Comorbid fibromyalgia interferes not only with the disease activity scores but also with the treatment outcomes and management plan. Further evidence is warranted in order to determine the potential benefits of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms in patients with inflammatory rheumatic diseases." (Turkey)

Costa YM, Conti PC, de Faria FA et al. 2017. Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms. Oral Surg Oral Med Oral Pathol Oral Radiol. 123(3):288-297. "Common neuronal pathways and central sensitization processes are acknowledged as the main factors for the association between TMD and primary headaches, although the establishment of cause-effect mechanisms requires further clarification and characterization. The biomechanical aspects are not the main factors involved in the comorbid relationship between TMD and cervical spine dysfunction, which can be better explained by the neuronal convergence of the trigeminal and cervical spine sensory pathways as well as by central sensitization processes. The association between TMD and fibromyalgia also has supporting evidence in the literature, and the proposed main mechanism underlying this relationship is the impairment of the descending pain inhibitory system. In this particular scenario, a cause-effect relationship is more likely to occur in one direction, that is, fibromyalgia as a risk factor for TMD. Therefore, clinical awareness of the association between TMD and painful comorbidities and the support of multidisciplinary approaches are required to recognize these related conditions."

Costantini R, Affaitati G, Massimini Fe et al. 2016. Laparoscopic cholecystectomy for gallbladder calculosis in fibromyalgia patients: Impact on musculoskeletal pain, somatic hyperalgesia and central sensitization. PLoS One. 11(4):e0153408. "Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms….The results of the study show that biliary colics from gallbladder calculosis represent an exacerbating factor for fibromyalgia symptoms and that laparoscopic cholecystectomy produces only a transitory worsening of these symptoms, largely compensated by the long-term improvement/desensitization due to gallbladder removal. This study provides new insights into the role of visceral pain comorbidities and the effects of their treatment on fibromyalgia pain/hypersensitivity." Free PMC Article

Costantini R, Affaitati G, Wesselmann U et al. 2017. Visceral pain as a triggering factor for fibromyalgia symptoms in comorbid patients. Pain. [Jul 3 Epub ahead of print] "Fibromyalgia (FMS) is a central sensitization syndrome, however peripheral pain sources potentially exacerbate its symptoms of chronic diffuse musculoskeletal pain and hyperalgesia. This prospective study evaluated visceral pain as a possible triggering factor for FMS pain/hyperalgesia in comorbid patients…... Visceral pain enhances FMS symptoms, probably augmenting the level of central sensitization typical of the syndrome. Systematic assessment and treatment of visceral pain comorbidities should be part of FMS management strategy."

Costantini TW, Loomis WH, Putnam JG et al. 2008. Burn-induced gut barrier injury is attenuated by phosphodiesterase inhibition: effects on tight junction structural proteins. Shock [Sep 11 Epub ahead of print]. The relevant part of this research is that the medication pentoxifylline can reduce permeable gut in burn patients. This may be a promising therapy to heal the gut, and establishing a working GI system is a vital part of healing in chronic pain patients. Compounding pharmacists can put this up in topical form. DJS]

Cotchett MP, Munteanu SE, Landorf KB. 2014. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys Ther. 94(8):1083-1094. "Dry needling provided statistically significant reductions in plantar heel pain…"

Cote B, Ross B, Fortner J et al. 2018. The use and utility of low-dose Naltrexone capsules for patients with fibromyalgia. Int J Pharm Compd. 22(3):252-256. "With few U.S. Food and Drug Administration-approved treatment options, there is evidence that low-dose naltrexone, an opioid antagonist approved for opioid and alcohol dependence at high doses, may have efficacy in the treatment of fibromyalgia and chronic pain. At the doses required for fibromyalgia treatment, naltrexone needs to be compounded, and no data currently exists regarding the long-term stability of low-dose naltrexone capsules. This limits pharmacies to a maximum beyond-use date of 180 days. Our study examined the stability of compounded capsules of low-dose naltrexone in Avicel over 360 days. Naltrexone was extracted from compounded capsules and assessed using reversed-phase high-performance liquid chromatography validated to differentiate between the degraded and undegraded naltrexone. United States Pharmacopeia guidelines state that compounded medications must remain within 10% of the labeled potency at all times during the assigned expiration date for a preparation. Our results show that low-dose naltrexone is stable for 360 days when stored at room temperature and away from light remaining within 90% to 110% of the labeled potency throughout the study period. Based on our study results, the beyond-use date for compounded low-dose naltrexone formulations stored at room temperature and protected from light can be extended to 1 year. The longer beyond-use dating allows patients greater flexibility in using these capsules during the flare-ups associated with fibromyalgia without needing a refill immediately at the onset of symptoms. In addition, it may help compounding pharmacies reduce waste associated with small-batch preparation of these capsules."

Cote, K. A. and H. Moldofsky. 1997. Sleep, daytime symptoms, and cognitive performance in patients with fibromyalgia  J Rheumatol 24:2014-2023.

Coulombe MA, Lawrence KS, Moulin DE et al. 2017. Lower functional connectivity of the periaqueductal gray Is related to negative affect and clinical manifestations of fibromyalgia. Front Neuroanat. 8;11:47. "Our study implicates the PAG (periaqueductal gray—key node of pain modulation) as a site of dysfunction contributing to the clinical manifestations and pain in FM." Free Article

Couppe C, Torelli P, Fugisang-Frederiksen A et al. 2007.  Myofascial trigger points are very prevalent in patients with chronic tension-type headache: a double-blinded controlled study.  Clin J Pain. 23(1):23-27.  “These findings suggest that active TrPs are much more frequent in CTTH (chronic tension type headaches) than in controls and the number and pain intensity of TrPs may be used to distinguish between the two groups.”

Courtney CA, Aoyagi K, Fernandez-de-Las-Penas C et al. 2020. Bilateral sensory deficits and widespread hyperalgesia occur following induced Delayed Onset Muscle Soreness of the quadriceps. Int J Sports Phys Ther. 15(1):12-21. "Unaccustomed eccentric exercise during sport or training may lead to delayed onset muscle soreness (DOMS), which has been demonstrated to influence postural control, potentially resulting in further injury…. Inflammation from unaccustomed eccentric exercise may induce neuroplastic changes in nociceptive pathways resulting in wider distribution of pain and hypoesthesia."

Courtney CA, Clark JD, Duncombe AM et al. 2011. Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions. J Man Manip Ther. 19(4):212-222. "Chronic lower quadrant injuries constitute a significant percentage of the musculoskeletal cases seen by clinicians. While impairments may vary, pain is often the factor that compels the patient to seek medical attention. Traumatic injury from sport is one cause of progressive chronic joint pain, particularly in the lower quarter. Recent studies have demonstrated the presence of peripheral and central sensitization mechanisms in different lower quadrant pain syndromes, such as lumbar spine related leg pain, osteoarthritis of the knee, and following acute injuries such as lateral ankle sprain and anterior cruciate ligament rupture. Proper management of lower quarter conditions should include assessment of balance and gait as increasing pain and chronicity may lead to altered gait patterns and falls. In addition, quantitative sensory testing may provide insight into pain mechanisms which affect management and prognosis of musculoskeletal conditions. Studies have demonstrated analgesic effects and modulation of spinal excitability with use of manual therapy techniques, with clinical outcomes of improved gait and functional ability. This paper will discuss the evidence which supports the use of manual therapy for lower quarter musculoskeletal dysfunction."

Courtney CA, Fernandez-de-Las-Penas C, Bond S. 2017. Mechanisms of chronic pain - key considerations for appropriate physical therapy management. J Man Manip Ther. 25(3):118-127. "In last decades, knowledge of nociceptive pain mechanisms has expanded rapidly. The use of quantitative sensory testing has provided evidence that peripheral and central sensitization mechanisms play a relevant role in localized and widespread chronic pain syndromes. In fact, almost any patient suffering with a chronic pain condition will demonstrate impairments in the central nervous system. In addition, it is accepted that pain is associated with different types of trigger factors including social, physiological, and psychological. This rationale has provoked a change in the understanding of potential mechanisms of manual therapies, changing from a biomechanical/medical viewpoint, to a neurophysiological/nociceptive viewpoint. Therefore, interventions for patients with chronic pain should be applied based on current knowledge of nociceptive mechanisms since determining potential drivers of the sensitization process is critical for effective management. The current paper reviews mechanisms of chronic pain from a clinical and neurophysiological point of view and summarizes key messages for clinicians for proper management of individuals with chronic pain."

Couto C, de Souza IC, Torres IL et al. 2013. Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: A randomized sham-controlled clinical trial. Clin J Pain. [Apr 25 Epub ahead of print]. "This study highlighted the greater efficacy of MDIMST (multiple deep intramuscular stimulation therapy) over the placebo-sham and (LTrP-I TrP lidocaine injection) and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities."

Covelli E, Attanasio G, Viccaro M et al. 2013. A 9-year-old boy with atypical retroauricular pain: A case report. Am J Otolaryngol. [Aug 12 Epub ahead of print]. "We present a 9-year-old child who suffered from atypical retroauricular pain resistant to conventional treatment. After excluding any other cause of retroauricular pain, a nerve block was performed with a 0.3ml lidocaine 1% injection into the trigger point. We believe that this case report is important because in the literature there are no similar cases described in children". [People of all ages can have pain behind the ears that is generated by trigger points in the clavicular sternocleidomastoid muscle, the suboccipital muscles, the posterior occipitalis or the obliquus capitis superior. It's good to see this documented. DJS]

Covelli, V., A. B. Maffione, C. Nacci, E. Tato and E. Jirillo.  1998.  Stress, neuropsychiatric disorders and immunological effects exerted by benzodiazepines.  Immunopharmacol Immunotoxicol 20(2):199-209.

Cox GR, Barish RA. 1991.  Delayed presentation of unstable cervical spine injury with minimal symptoms.  J Emerg Med 9(3):123-127.  “Physicians must aggressively search for injuries whenever a history of neck pain is present or a strong mechanism of injury exists, even if the patient has been ambulatory for days or weeks following the injury."

Cox JJ, Reimann F, Nicholas AK. 2006.  An SCN9A channelopathy causes congenital inability to experience pain.  Nature 444:894-898.  A genetic mutation can cause the inability to feel pain through a sodium channelopathy.  Studying this may offer insights into chronic pain.  [Myofascial pain may also be a channelopathy. DJS]

Coyle S. Pridinol for cancer-related myofascial pain. BMJ Support Palliat Care. 2022 Sep 13; Online ahead of print. "Myofascial pain is an important yet under recognised component of cancer pain. It has a prevalence of between 11.9 and 44.8% in cancer patients. Treatments for myofascial pain reduce the prevalence of myofascial trigger points therefore decreasing pain and improving range of motion. Pridinol is a nonbenzodiazepine antispasmodic licenced for the treatment of central and peripheral muscle spasms in adults. This paper describes two case histories where patients with myofascial pain were successfully treated with pridinol. These cases highlight the importance of treating myofascial pain and the potential of pridinol to treat cancer-related myofascial pain." [It may be useful to try this and other muscle relaxants in patients who have myofascial pain and dysfunction that coexists with other chronic pain states. DJS]

Craft JM, Ridgeway JL, Vickers KS et al. 2014. Unique Barriers and Needs in Weight Management for Obese Women with Fibromyalgia. Explore (NY). [Oct 23 Epub ahead of print.] "Women with FM identify unique barriers to weight management, including the complex interrelationships between symptoms of FM and health behaviors, such as diet and exercise. They prefer a weight management program for women with FM that consists of an in-person, group-based approach with a leader but are open to a tailored conventional weight management program. Feasibility may be one of the biggest barriers to such a program both from an institutional and individual perspective."

Crago BR, Gray MR, Nelson LA et al. 2003. Psychological, neuropsychological, and electrocortical effects of mixed mold exposure. Arch Environ Health 58(8):452-463.  Mold exposure can lead to “...organic-based dysregulation of emotions and cognitive functioning as a result of toxic or metabolic encephalopathy...”  Abnormalities in the frontal and prefrontal lobes of the brain were “...significantly and consistently related to deficits in cognitive functioning and mold-exposure measures.”  “Patients reported a loss of their sense of self, of their usual ways of doing things, and even of their personality.  They were painfully aware of their deficits and were constantly frustrated by their loss of cognitive efficiency and frequent mistakes.”

Craig, AD. 2003.  Interoception: the sense of the physiological condition of the body.  Curr Opin Neurobiol  13:500-505.  Both fibromyalgia and chronic myofascial trigger points may be associated with autonomic symptoms.  There may be mechanoreceptive and proprioceptive dysfunction.  This article discusses the interoceptive system, which includes vasomotor activity, hunger, thirst and internal sensations.  “These findings explain the distinct nature of pain, temperature, itch, sensual touch and other bodily feelings from cutaneous mechanoreception (somatosensory touch) and they identify the long-missing peripheral and central afferent complement to the efferent autonomic nervous system.  I agree with the author that this study may have profound clinical significance.

Craig KD, Lilley CM, Gilbert CA. 1996.  Social barriers to optimal pain management in infants and children.  Clin J Pain 12(3):232-242.  Care providers need to be aware that infants and children need adequate pain control.

Crane JD, Ogborn DI, Cupido C et al. 2012. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med 4(119):119ra13. "To assess the effects of massage, we administered either massage therapy or no treatment to separate quadriceps of 11 young male participants after exercise-induced muscle damage. Muscle biopsies were acquired from the quadriceps (vastus lateralis) at baseline, immediately after 10 min of massage treatment, and after a 2.5-hour period of recovery. We found that massage activated the mechanotrans-duction signaling pathways focal adhesion kinase (FAK) and extracellular signal-regulated kinase 1/2 (ERK1/2), potentiated mitochondrial biogenesis signaling [nuclear peroxisome proliferator-activated receptor γ coactivator 1α(PGC-1α)], and mitigated the rise in nuclear factor κB (NFκB) (p65) nuclear accumulation caused by exercise-induced muscle trauma. Moreover, despite having no effect on muscle metabolites (glycogen, lactate), massage attenuated the production of the inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and reduced heat shock protein 27 (HSP27) phosphorylation, thereby mitigating cellular stress resulting from myofiber injury. In summary, when administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis." This indicates that massage enhances tissue repair and promote the healing process.

Crawford BK, Piault EC, Lai C et al. 2011. Assessing fibromyalgia-related fatigue: content validity and psychometric performance of the Fatigue Visual Analog Scale in adult patients with fibromyalgia. Clin Exp Rheumatol. [Jul 14 Epub ahead of print]. "Previous studies have confirmed that fatigue is a major component of the fibromyalgia experience. This current study reports that fibromyalgia patients spontaneously rated fatigue as a highly significant feature of their illness, and supports the use of the Fatigue VAS as a valid questionnaire in fibromyalgia clinical trials."

Crawford, LJ. 1998.  Neuroendocrine findings and patients with fibromyalgia. J Musculoskel Pain 6(3):69.

Crettaz B, Marziniak M, Willeke P et al. 2013. Stress-induced allodynia-evidence of increased pain sensitivity in healthy humans and patients with chronic pain after experimentally induced psychosocial stress. PLoS One. 8(8):e69460. This study provides: "…evidence for stress-induced allodynia/hyperalgesia in humans for the first time and suggest differential underlying mechanisms determining response to stressors in healthy subjects and patients suffering from chronic pain."

Crincoli V, Di Comite M, Guerrieri M et al. 2018. Orofacial manifestations and temporomandibular disorders of Sjögren Syndrome: An observational study. Int J Med Sci. 15(5):475-483. Myofascial pain was significantly higher among Sjogren patients than the control group, and this study also found "Sjogren's Syndrome seems to play a role in temporomandibular joint disorders."

Crinnion, W. J.  2000.  Environmental medicine, Part one: the human burden of environmental toxins and their common health effects.  Altern Med Rev 5(1):52-63.

Criscuolo CM. 2001.  Interventional approaches to the management of myofascial pain syndrome.  Curr Pain Headache Rep. 5(5):407-411.  “This article describes current interventional therapies that are employed in treating myofascial pain syndromes.  The mainstay of injection therapies, the myofascial trigger point injection, is emphasized.”

Crofford LJ. 2015. Psychological aspects of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 29(1):147-55. "Chronic musculoskeletal pain, by its very nature, is associated with negative emotions and psychological distress. There are individual differences in personality, coping skills, behavioral adaptation, and social support that dramatically alter the psychological outcomes of patients with chronic pain. Patients who have an aspect of central pain amplification associated with mechanical or inflammatory pain and patients with fibromyalgia (FM) are likely to exhibit higher levels of psychological distress and illness behaviors. This manuscript discusses several different constructs for the association between chronic pain, central pain amplification, and psychological distress. The first key question addresses mechanisms shared in common between chronic pain and mood disorders, including the individual factors that influence psychological comorbidity, and the second addresses how pain affects mood and vice versa. Finally, the utility of cognitive behavioral approaches in the management of chronic pain symptoms is discussed."

Crock LW, Baldridge MT. 2020. A role for the microbiota in complex regional pain syndrome? Neurobiol Pain. Nov 25;8:100054. "Complex regional pain syndrome (CRPS) is a debilitating neuroinflammatory condition of unknown etiology. Symptoms include excruciating pain and trophic changes in the limbs as defined by the Budapest criteria..... Biomarkers that predict severity or resolution of symptoms would significantly change treatment but have not yet been identified. Interestingly, there are case reports of remission or resolution of CRPS symptoms with the use of antibiotics known to affect the gut flora.... microbiome is anti-nociceptive in visceral, inflammatory and neuropathic pain models. We hypothesize that the variable clinical potential for recovery and response to therapy in CRPS may be secondary to or reflected in changes in the gut microbiota. We suggest that the microbiota may mediate or reflect clinical status via the metabolome, activation of the immune system and/or microglial activation. We hypothesize that the gut microbiome is a potential mediator in development and persistence of CRPS symptoms and propose that the clinical condition of CRPS could provide a unique opportunity to identify biomarkers of the microbiota and potential therapies to prevent pain chronification."

Crofford, L. J. 1998. Neuroendocrine abnormalities in fibromyalgia and related disorders. Am J Med Sci 315(6):359-366.

Croghan IT, Hurt RT, Ganesh R, et al.2021. The association of current tobacco status with pain and symptom severity in fibromyalgia patients. Mayo Clin Proc Innov Qual Outcomes. May 26;5(3):614-624. "The results of our study suggest that tobacco use is associated with greater pain and other symptom severity in patients with fibromyalgia.

Crompton, R, Clifton, VL, Bisits, AT et al. 2003. Corticotropin-releasing hormone causes vasodilation in human skin via mast cell-dependent pathways.  J Clin Endocrinol Metab 88(11):5427-5432.  This study may explain some of the sensitive allergic skin symptoms of fibromyalgia.  Histamine may be a principal neurotransmitter mediator.

Crook, J., H. Moldofsky and H. Shannon.  1998. Determinants of disability after a work related musculoskeletal injury.  J Rheumatol 25(8):1570-7. 

Crooks VA. 2015. "Because everything changes that day; you don't do the routine": Alterations and activities chronically ill women undertake on days with health care provider appointments. Chronic Illn. [Feb 23 Epub ahead of print.] "Research points to the importance of interactions with health care providers for chronically ill patients. Meanwhile, we know little about how visits to providers' offices are accommodated in these patients' lives. This analysis identifies the full scope of routine alterations and preparatory activities that require chronically ill women's time and energy specifically on appointment days….Two trajectories are identified: (1) alterations to daily routines on appointment days; and (2) activities to prepare for the provider-patient interaction. Factors such as wanting to minimize symptom exacerbation, desires to come across as informed patients, limited time afforded to interactions, and access to transportation explain why these particular routine alterations and preparatory activities were undertaken.….Findings demonstrate that the health care provider-patient interaction does not start or end in the space of the provider's office but is, rather, an event that is part of a larger process primarily focused on its successful negotiation. This suggests that the boundaries of the appointment need to be reconsidered, which holds implications for appointment-focused interventions aimed at chronically ill patients."

Crotti FM, Carai A, Carai M et al. 2005.  TOS pathophysiology and clinical features.  Acta Neurochir Suppl. 92:7-12.  “In all patients neurological, vascular and myofascial pain symptoms were observed before the operation.  Neurological and vascular pain disappeared after surgery, while the myofascial pain remained.  In TOS, therefore, there is a pain loop that cannot be resolved by surgical therapy alone.  The connection between myofascial pain syndrome and TOS might explain the many controversial opinions regarding frequency, results and surgical possibilities of this lesion.”   [Thoracic Outlet Syndrome is a description, not a diagnosis.  Clinicians must learn to look for the reasons for constriction.  It is often caused by muscles contractured due to myofascial TrPs.  The sooner the TrPs are treated the less the chance for fibrosis or calcification. DJS]    

Crotti FM, Carai A, Carai M et al. 2005.  Entrapment of crural branches of the common peroneal nerve.  Acta Neurochir 92:69-70.  “Failed back surgery syndrome (FBSS) occurs in 30% of operated patients and represents a heavy problem both regarding disability and costs in first world countries.  Among FBSS we found the possibility of a double crush syndrome: a disco-radicular conflict and a peripheral nerve entrapment.  The latter, disguised by root compression symptoms, becomes evident only after spinal surgery.  We found peroneal nerve crural branches entrapped where they crossed the fascia to reach the subcutaneous layer.  Most of the patients were found to have myofascial pain syndrome (MPS).”   [Again, myofascial TrPs are often the cause of nerve entrapment.  Clinicians (and insurance companies) need to be aware of this.  Doctors need to be trained in diagnosis and treatment of TrPs to help minimize the pain and costs of chronic care.  DJS]

Crow T, Kasper D. 2006.  A myofascial trigger point on the skull: treatment improves peak flow values in acute asthma patients.  AAOJ 16(1):23-25.  Nine chronic asthma patients, varying from mild to severe cases, were given manual therapy of an MTP on the left parietal eminence.  The air flow rate of 5 patients was restored to from 96-108%, and the other 4 restored to between 66 and 88% expected flow amount based on body size.  [This is an early study, lacking much specific data, but it does imply that it is worth checking asthma patients for MTPs in the skull and treating any that are found. DJS] 

Crowson CS, Gunderson TM, Dykhoff HJ, et al. Comprehensive assessment of multimorbidity burden in a population-based cohort of patients with rheumatoid arthritis. RMD Open. 2022 Jan;8(1):e002022. "Patients with RA had significantly higher prevalence of 24 of the 44 morbidities compared with non-RA, especially interstitial lung disease, fibromyalgia, osteoarthritis and osteoporosis. Among the additional 78 categories, 7 were significantly higher in RA than non-RA, including organic sleep disorders, vitamin D deficiency and foot ulcers."

Cruz-Montecinos C, Cerda M, Becerra P, et al. 2021. Qualitative ultrasonography scale of the intensity of local twitch response during dry needling and its association with modified joint range of motion: a cross-sectional study. BMC Musculoskelet Disord. Sep 14;22(1):790. This study attempted to indicate if the local twitch response necessary for a successful dry needling result, and if the magnitude of the LTR would be reflected in the results, especially range of motion. "The US-LTR scale was used to classify the LTRs into strong, medium, and weak intensities.…. The present findings suggest that the LTR intensity can be assessed using a qualitative US-LTR scale, and the effects of DNT on joint maximal ROM is maximized with higher LTR intensity."

Cruz-Montecinos C, Nunez-Cortes R, Bruna-Melo T et al. 2018. Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: A case report. J Spinal Cord Med. 22:1-5. "Spasticity in neurological disorders (i.e. stroke patients and cerebral palsy) is positively improved by dry needling. However, reports are scarce regarding the potential effects of dry needling in reducing spasticity and improving functionality in patients with an incomplete spinal cord injury.... This case report demonstrates that dry needling treatment can have positive effects on spasticity, dynamic stability, walking velocity, self-independence, and pain in patients with incomplete spinal cord injury. Further research is needed in a larger patient population to deeply understand the mechanism(s) associated with the obtained results and regarding the clinical significances of dry needling treatment for incomplete spinal cord injury."

Cryer, P.E.1999.  Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia on awareness. Endocrinol Metab Clin North Am 28(3):495-500, v-vi.  

Cryer, P. E.  1993.  Adrenaline: a physiological metabolic regulatory hormone in humans? Int J Obes Relat Metab Disord 17 (Suppl 3):S43-S46.

Csaba G, Kovacs P, Tothfalusi L et al. 2005.  Prolonged effect of stress (water and food deprivation) at weaning or in adult age on the triiodothyronine and histamine content of immune cells.  Horm Metab Res. 37(11):711-715.  “Not only fetal or neonatal stress has long-lasting consequences, but also stress events in later periods of life in cells (organs) that are continuously differentiating.”  A significant change in rat T3 metabolism due to neonatal stress was evident.  The histamine content of granulocytes was also changed significantly. [Similar changes have been noted in adult FMS patients. DJS.]

Csako G, McGriff NJ, Rotman-Pikielny P, Sarlis NJ, Pucino F. 2001. Exaggerated levothyroxine malabsorption due to calcium carbonate supplementation in gastrointestinal disorders. Ann Pharmacother Dec:35(12):1578-83.  Calcium carbonate can decrease absorption of levothyroxine especially if the patient has a preexisting malabsorption disorder.

Cuhadar U, Gentry C, Vastani N et al. 2019. Autoantibodies produce pain in Complex Regional Pain Syndrome by sensitizing nociceptors. Pain. [Jul 22 Epub ahead of print] Complex regional pain syndrome (CRPS) is a post-traumatic pain condition with an incompletely understood pathophysiological basis. Here, we have examined the cellular basis of pain in CRPS using behavioral and electrophysiological methods in mice treated with IgG from CRPS patients, in combination with a paw incision…. Administration of IgG from CRPS patients exacerbated and prolonged the post-surgical hypersensitivity to noxious mechanical, cold and heat stimulation, but did not influence tactile sensitivity following a paw incision. Studies of IgG preparations pooled from patient cohorts (n=26-27) show that pathological autoantibodies are present in the wider population of patients with persistent CRPS, and that patients with more severe pain have higher effective autoantibody titres than patients with moderate pain intensity. Electrophysiological investigation of skin-nerve preparations from mice treated with CRPS IgG from a single patient identified both a significantly increased evoked impulse activity in A- and C-nociceptors, and an increased spontaneous impulse rate in the intact saphenous nerve. Our results show that painful hypersensitivity in persistent CRPS is maintained by autoantibodies, which act by sensitizing A- and C-nociceptors.

Cui J, Hao Z, Tian H, et al. 2024. The effects of tai chi on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude. Front Aging Neurosci. 2024 Apr 8:16:1330063. "Tai Chi has proved to be an effective therapy for balance performance and cognition…. Long-term Tai Chi practice improved sensory reweighting (more reliance on the proprioception system and less reliance on the vestibular system) and complexity of standing balance control in older adults. In addition, greater sway velocity may be as an exploratory role in standing balance control of TC older adults, which correlated with greater complexity, but no such significant relationship in the control group. Therefore, the effects of Tai Chi practice on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude."

Culpepper L. 2010. Pharmacologic therapy for fibromyalgia. J Clin Psychiatry. 71(12):e34. "While nonpharmacologic strategies can help patients understand and accept the diagnosis of fibromyalgia, pharmacologic therapy can provide important additional symptom relief and improvement in functioning. Pharmacologic therapy must be individualized based on a comprehensive evaluation of the patient and continued assessment of symptoms and response to treatment. Patient symptoms and impairments related to each of the dimensions of the 'fibromyalgia triad' (pain, sleep dysfunction, and mood disorders) as well as any other comorbidities, past experiences with treatment, and patient preferences should guide therapy selection."

Culpepper L. 2010. Recognizing and diagnosing fibromyalgia. J Clin Psychiatry. 71(11):e30. "Fibromyalgia affects an estimated 2% of the American population. Current understanding explains it as a neurologic disorder of central pain processing that causes the perception of pain in response to stimuli that in healthy individuals would not be painful. The recognition of fibromyalgia can lead to effective treatment with significant improvement in functioning. Unfortunately, because of the chronic nature of the pain condition and associated counterproductive behaviors and disability, patients and physicians may rapidly become frustrated with each other and abandon the pursuit of adequate diagnosis and treatment. If the physician instead recognizes the diagnostic pattern of pain and appreciates the real nature of the underlying pathology, then he or she can be of great benefit to patients and their families in managing this chronic disease."

Cummings M. 2003.  Myofascial pain from pectoralis major following trans-axillary surgery.  Acupunct Med. 21(3):105-107.  “This is the first reported description, to the author’s knowledge, of myofascial pain occurring at a surgical drain site.  The patient consulted a medical acupuncturist after suffering five months of continuous chest and arm pain associated with ‘tingling’ in the forearm and hand.  She had undergone trans-axillary resection of the first left rib following a left axillary vein thrombosis 18 months previously.  Her symptoms had been principally attributed to nerve traction at surgery or nerve root entrapment from scar tissue.  However, the drain passed through the free border of pectoralis major, and the myofascial trigger point that appeared to develop as a result of the muscle trauma, or the pain at that site, presented as a chronic and complex post-surgical pain problem.  The pain and tingling resolved completely after two sessions of dry needling at a single myofascial trigger point in the free border of the left pectoralis major muscle.”

Cummings M, Baldry P. 2007.  Regional myofascial pain: diagnosis and management.  Best Pract Res Clin Rheumatol. 21(2):367-387. 

Cummings M. 2003.  Myofascial pain from pectoralis major following trans-axillary surgery.  Acupuncture Med 21(3):105-107.  Myofascial referred pain and nerve entrapment symptoms can occur at a post-surgical drain site.

Cummings, M. 2003.  Referred knee pain treated with electroacupuncture to iliopsoas.  Acupunct Med 21(1-2):32-35. This is a showcase of what can happen when care providers don’t understand myofascial medicine.  The patient developed knee pain after standing for a prolonged time.  Tests indicated arthritis and left hip dysplasia, but no knee abnormalities.  After multiple surgical techniques, including femoral osteotomy, lateral shaft graft and total hip replacement, the knee pain was still present on follow-up.  After two treatments with electroacupuncture to the iliopsoas muscle, the knee pain was gone.  How might the practice of medicine, and the costs of same, be changed if the care providers were trained in the diagnosis and treatment of myofascial trigger points?

Cummings TM, White AR. 2001.  Needling therapies in the management of myofascial trigger point pain: a systematic review.  Arch Phys Med Rehabil. 82(7):986-992.

Cunali PA, Almeida FR, Santos CD et al. 2009.  Prevalence of temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy.  J Orofac Pain. 23(4):339-344.  “The most common TMD (temporomandibular disorders) diagnosis was myofascial pain with and without limited mouth opening and arthralgia (50%).  Conclusion: The high prevalence of TMD in the current study indicates that patients with OSAS (obstructive sleep apnea syndrome) referred for oral appliance therapy require specific evaluation related to TMD.”  [The dental world often looks at the term “myofascial pain” as meaning the same as “TMD.”  Appliances may make symptoms due to myofascial trigger points worse, or at best, cause them to become latent.  The solution to myofascial trigger point pain is to treat the TrPs, and to bring the perpetuating factors under control.  DJS]

Curatolo M, Arendt-Nielsen L, Petersen-Felix S. 2004.  Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury.  Clin J Pain 20(6):469-476.  “Central hypersensitivity may explain exaggerated pain in the presence of minimal nociceptive input arising from minimally damaged tissue.  This could account for pain and disability in the absence of objective signs of damage in patients with whiplash.  Central hypersensitivity may provide a neurobiological framework for the integration of peripheral and supraspinal mechanisms in the pathophysiology of chronic pain after whiplash.”

Curatolo M, Rundell SD, Gold LS, et al. Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults. Eur J Pain. 2022;26(7):1469-1480."Older adults treated with ESI have long-term improvement. However, the improvement is unlikely the result of a specific ESI effect. Significance: In this large, two-year, prospective study in older adults with a new episode of low back pain, back pain, leg pain, disability and quality of life improved after epidural steroid injections; however, propensity-score matching revealed that the improvement was unlikely the result of a specific effect of the injections, indicating that epidural steroids are unlikely to provide long-term benefits in older adults with new episodes of back and leg pain."

Curl DD. 1989.  Discovery of a myofascial trigger point in the buccinator muscle: a case report.  Cranio. 7(4):339-345.

Currow DC, Phillips J, Clark K. 2016. Using opioids in general practice for chronic non-cancer pain: an overview of current evidence. Med J Aust. 204(8):305-309. "There is limited evidence of the long term efficacy of opioids for chronic non-cancer pain, and documented clinical consequences beyond addiction include acceleration of loss of bone mineral density, hypogonadism and an association with increased risk of acute myocardial infarction. Careful clinical selection of patients can help optimize the evidence-based use of opioids for chronic non-cancer pain: only treat pain that has been as well defined as possible when non-opioid therapies have not been effective; consider referral to specialist services for assessment if doses are above 100 mg oral morphine equivalent per 24 hours or the duration of therapy is longer than 4 weeks; limit prescribing to only one practitioner; seek an agreement with the patient for the initiation and potential withdrawal of opioids if the therapeutic trial is not effective." [There have been NO studies on opioid effectiveness for patients with multiple pain generators (trigger points, arthritis, HIV, etc.) plus the pain amplifier of fibromyalgia. DJS]

Custodio L, Carlson CR, Upton B et al. 2015. The impact of cigarette smoking on sleep quality of patients with masticatory myofascial pain. J Oral Facial Pain Headache. 29(1):15-23. "Cigarette smoking is associated with numerous adverse health outcomes, including pain severity, alterations in mood, and disrupted sleep, and seems to be a significant predictor of sleep quality in patients with masticatory myofascial pain."

Cutrufello NJ, Ianus VN, Rowley JA. 2020. Opioids and sleep. Curr Opin Pulm Med. Sep 10. Online ahead of print. "Opioids have multiple effects on sleep, sleep architecture and SDB. Although originally described with methadone use, most commonly used opioids have also been shown to affect sleep. In patients on chronic methadone, sleep architecture changes include decreases in N3 and REM sleep. However, in patients with chronic nonmalignant pain, opioids improve sleep quality and sleep time. Opioids, generally at a morphine equivalent dose more than 100 mg/day, are associated with an increased incidence of CSA (central sleep apnea) and ataxic breathing as well as obstructive sleep apnea. Other risk factors may include concomitant use of other medications such as antidepressants, gabapentinoids and benzodiazepines. Opioid-induced CSA can be potentially treated with adaptive servo-ventilation. Finally, opioids are a potential therapeutic option for restless legs syndrome unresponsive to dopamine agonists and other medications. However, use in patients with restless legs syndrome should proceed with caution, taking into account the risk for dependence and development of SDB (sleep disordered breathing)".

Cygańska AK, Tomaszewski P, Anna Cabak A.2022. Pain threshold in selected trigger points of superficial muscles of the back in young adults. PeerJ. Feb 1;10:e12780. "(1) Women who reported pain more than once a week in the studied muscles showed a greater number of active trigger points. (2) A greater number of active trigger points in female is related to a lower pain threshold (which is associated with greater pain sensitivity) in female than in male. (3) A sample size of 30 people seems sufficient to detect variations in the pain threshold at active and inactive trigger points of selected back muscles, especially when the frequency of occurrence of both types of points is comparable."

Daenen L, Nijs J, Roussel N et al. 2012. "Dysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study. Clin Rheumatol. [Sep 16 Epub ahead of print]. Inefficient endogenous pain inhibition, in particular impaired conditioned pain modulation (CPM), may disturb central pain processing in patients with chronic whiplash-associated disorders (WAD). Previous studies revealed that abnormal central pain processing is responsible for a wide range of symptoms in patients with chronic WAD. Hence, the present study aimed at examining the functioning of descending pain inhibitory pathways, and in particular CPM, in patients with chronic WAD. Thirty-five patients with chronic WAD and 31 healthy controls were subjected to an experiment evaluating CPM. CPM was induced by an inflated occlusion cuff and evaluated by comparing temporal summation (TS) of pressure pain prior to and during cuff inflation. Temporal summation was provoked by means of 10 consecutive pressure pulses at upper and lower limb location. Pain intensity of first, fifth, and 10th pressure pulse was rated. During heterotopic noxious conditioning stimulation, TS of pressure pain was significantly depleted among healthy controls. In contrast, TS was quite similar prior to and during cuff inflation in chronic WAD, providing evidence for dysfunctional CPM in patients with chronic WAD. The present study demonstrates a lack of endogenous pain inhibitory pathways, and in particularly CPM, in patients with chronic WAD, and hence provides additional evidence for the presence of central sensitization in chronic WAD."

Dahan H, Shir Y, Velly A et al. 2015. Specific and number of comorbidities are associated with increased levels of temporomandibular pain intensity and duration. J Headache Pain. 16(1):528. "Temporomandibular pain disorder (TMD) is a common pain condition in the face. People with TMD report multiple pain comorbidities. The presence of fibromyalgia and migraine in people with TMD is associated with an increase in TMD pain intensity and duration. …This study shows that the number of comorbidities is positively associated with TMD pain duration and intensity. The presence of specific conditions, such as migraine and chronic fatigue syndrome, is associated with an increase in TMD intensity and duration." Free PMC Article

Dailey DL, Keffala VJ, Sluka KA. 2014. Cognitive and physical fatigue tasks enhance pain, cognitive fatigue and physical fatigue in people with fibromyalgia. Arthritis Care Res (Hoboken). [Jul 29 Epub ahead of print.] People with fibromyalgia had significantly higher increases in pain, cognitive fatigue and physical fatigue when compared to healthy controls after completion of a cognitive fatigue task, a physical fatigue task, or a dual fatigue task (p<0.01). People with fibromyalgia performed equivalently on measures of physical performance and cognitive performance on the physical and cognitive fatigue tasks, respectively. Conclusions: These data show that people with fibromyalgia show larger increases in pain, perceived cognitive fatigue and perceived physical fatigue to both cognitive and physical fatigue tasks compared to healthy controls. The increases in pain and fatigue during cognitive and physical fatigue tasks could influence subject participation in daily activities and rehabilitation.

Dailey DL, Vance CG, Rakel BA et al. A randomized controlled trial of TENS for movement-evoked pain in women with fibromyalgia. Arthritis Rheumatol. 2019 Nov 18. [Epub ahead of print] Women with FM were assigned either TENS units or placebo units. TENS was placed in the lumbar and cervicothoracic regions and used for 2 hours a day during activity. The units were set with modulated 2-125 Hz frequencies at the highest intensity that was considered tolerable by the patients. "Among women with FM and stable medication, 4-weeks of active-TENS use compared with placebo-TENS or no-TENS resulted in a significant improvement in movement-evoked pain and other clinical outcomes. Further research is needed to examine effectiveness in a real world, pragmatic setting to establish clinical importance of these findings."

Dainoff MJ, Cohen BG, Dainoff MH. 2005.  The effect of an ergonomic intervention on musculoskeletal, psychosocial, and visual strain of VDT data entry work: the United States part of the international study.  Int J Occuip Saf Ergon. 11(1):49-63.  “...extensive, intensive and relatively expensive ergonomic intervention and training...” can prevent further injury, improve health, and avoid further costs to the company.  “The cost of this intervention was estimated as $2,200 per employee, while the cost of a single worker’s compensation case could be as high as $75,000.” [The problem now is to get the employers and 3^rd party insurance payers to realize that preventative ergonomic medicine is cost effective.  DJS]

Dall’Alba PT, Sterling MM, Treleaven JM et al. 2001.  Cervical range of motion discriminates between asymptomatic persons and those with whiplash.  Spine 26(19):2090-2094.  “Range of motion was reduced in all primary movements in patients with persistent whiplash-associated disorder.”  [Decreased range of motion is often caused by myofascial trigger points. DJS]

Dalmau-Carolà J. 2010. Myofascial Pain Syndrome Affecting the Quadratus Femoris. Pain Pract. [Feb 11 Epub ahead of print]. The quadratus femoris is an external rotator of the hip.  Quadratus femoris injury can accompany damage to the surrounding muscles.  Guided by the clinical symptoms, the injection technique described here can facilitate accurate diagnosis in selected cases.

Dalmau-Carolà J. 2010. Myofascial Pain Syndrome Affecting the Quadratus Femoris.  Pain Pract. [Feb 11 Epub ahead of print]. The quadratus femoris is an external rotator of the hip. Quadratus femoris injury can accompany damage to the surrounding muscles. Guided by the clinical symptoms, the injection technique described here can facilitate accurate diagnosis in selected cases.

Dalmau-Carola J. 2005.  Myofascial pain syndrome affecting the piriformis and the obturator internus muscle.  Pain Pract. 5(4):361-363.  “The obturator internus muscle is an external rotator of the hip.  Obturator internus injury may occur and be hidden by the piriformis syndrome.  Clinical symptoms may offer some clues to the clinician.  The selective injection technique described here facilitates precise diagnosis.”

Dalpiaz AS, Lordon SP, Lipman AG. 2004.  Topical lidocaine patch therapy for myofascial pain.  J Pain Palliat Care Pharmacother 18(3):15-34. 

Dalpiaz AS, Dodds TA. 2002.  Myofascial pain response to topical lidocaine patch therapy: case report.  J Pain Palliat Care Pharmacother.  In the case described, pain was decreased and function improved with the use of lidocaine patch.

D'Ambrogi E, Giacomozzi C, Macellari V et al. 2005.  Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism. Diabetic Med 22(12):1713-1719.  “Increased thickness of Achilles tendon and plantar fascia, more evident in the presence of neuropathy...might play a significant role in the overall alteration of the biomechanics of the foot-ankle complex.”  [Diabetic neuropathy might be a significant perpetuating factor to myofascial TrPs. DJS]

Damian M, Zalpour C. 2011. Trigger point treatment with radial shock waves in musicians with nonspecific shoulder-neck pain: data from a special physio outpatient clinic for musicians. Med Probl Perform Art. 26(4):211-217. "Radial shockwave treatment plus physical therapy can bring temporary relief from shoulder and neck trigger points in professional musicians."

Danilov A, Kurganova J. 2016. Melatonin in chronic pain syndromes. Pain Ther. [Mar 16 Epub ahead of print.] "Melatonin is a neurohormone secreted by epiphysis and extrapineal structures. It performs several functions including chronobiotic, antioxidant, oncostatic, immune modulating, normothermal, and anxiolytic functions. Melatonin affects the cardiovascular system and gastrointestinal tract, participates in reproduction and metabolism, and body mass regulation. Moreover, recent studies have demonstrated melatonin efficacy in relation to pain syndromes. The present paper reviews the studies on melatonin use in fibromyalgia, headaches, irritable bowel syndrome, chronic back pain, and rheumatoid arthritis. The paper discusses the possible mechanisms of melatonin analgesic properties. On one hand, circadian rhythms normalization results in sleep improvement, which is inevitably disordered in chronic pain syndromes, and activation of melatonin adaptive capabilities. On the other hand, there is evidence of melatonin-independent analgesic effect involving melatonin receptors and several neurotransmitter systems."

Danilov AB, Danilov AlB. 2020. [Multidomain approach in chronic non-specific back pain patient's treatment] Zh Nevrol Psikhiatr Im S S Korsakova. 120(7):113-120. [Article in Russian] "The concept of chronic nonspecific back pain (CNBP) as a pathology of the spine (osteochondrosis, spondylosis, intervertebral disc herniation, facet syndrome) is extremely outdated and has not justified itself, first of all, from the therapeutic view point. Numerous studies, including meta-analyzes and systematic reviews, have convincingly shown the ineffectiveness of the methods of CNBP treatment, aimed only at solving the problems of the spine itself and / or surrounding tissues. A substantial amount of special imaging studies have proven the dissociation between morphological vertebral changes and the clinical picture of pain. CNBP is the overall result of the interaction of numerous factors in the spine tissues (changes in the discs, joints, ligaments, fascia, muscles) and factors beyond the spine. The latter include, first of all, psychological and social factors, cognitive functions, the quality of night sleep, the level of physical activity, concomitant diseases (comorbidity). In each patient, the interaction of these factors determines the development of specific pathophysiological mechanisms of pain and, as a result, an individual clinical picture of pain (phenotype). Understanding these processes will allow for the reconsideration of the approach of searching for an anatomical pain source as the main pathogenetic factor; recognizing the multifocal generation of chronic pain as the result of a complex interaction of biological, psychological and social factors; the development of new principles and therapy algorithms. The authors propose to introduce into practice a multidomain screening approach for evaluating patients with CNBP, which would take into account the phenotype of pain, factors affecting its perception, and allow personalized treatment for each patient based on the biopsychosocial approach." [Treating only the imaging has been shown to be ineffective. Time to focus on the whole patient, including the soft tissues. DJS]

Danneskiold-Samsøe B, Bartels EM, Genefke I. 2007.  Treatment of torture victims – a longitudinal clinical study.  Torture. 17(1):11-7.   “A high percentage of the torture victims in our study suffered from fibromyalgia prior to treatment.  A multidisciplinary treatment involving individualized physiotherapy and psychotherapy had a significant effect on musculoskeletal pain in torture victims.  Following nine months of treatment, only one torture victim in our study could be classified as suffering from fibromyalgia when applying the fibrositis index.”

Danneskiold-Samsøe, B, Bartels EM. 2004.  Idiopathic low back pain: classification and differential diagnosis.  J Musculoskeletal Pain 12(3/4):93-99.  “Although acute back pain is often viewed as a benign and reversible condition, it can develop into a chronic condition if not correctly diagnosed and treated accordingly.”

Danneskiold-Samsøe, E. Christiansen and R. B. Andersen.  1986.  Myofascial pain and the role of myoglobin.  Scand J Rheumatol 15:174-178.

Dao, T., T. K. Knight and V. Ton-That. 1998. Modulation of myofascial pain by the reproductive hormones: a preliminary report. J Prosthet Dent 79(6):663-670.

Dao, T. T. , W. J. Reynolds and H. C. Tenenbaum. 1997. Co morbidity between myofascial pain of the masticatory muscles and fibromyalgia. J Orofac Pain 11(3):232-241.

D'Apuzzo MR, Cabanela ME, Trousdale RT et al. 2012. Primary total knee arthroplasty inpatients with fibromyalgia. Orthopedics. 35(2):e175-e178. "Survivorship free from revision at 7 years was 89% for cruciate retaining knees and 98% for posterior stabilized knees. Patients with fibromyalgia undergoing primary TKA (total knee arthroplasty) have a high prevalence of complications and pain. Despite continued pain, the majority of patients were satisfied with the results and reported improvements after TKA. This data should be used to counsel patients with fibromyalgia preoperatively regarding limited goals with respect to pain relief and suggests that a multimodal individualized treatment program may be necessary to achieve optimal outcomes in patients with fibromyalgia." [The FM is amplifying the pain from the TKA and TrPs from the knee dysfunction and the TKA itself. The TrP-related pain might be successfully treated with targeted therapy. DJS.]

Dardano A, Bazzichi L, Bombardieri S et al. 2011. Symptoms in Euthyroid Hashimoto's Thyroiditis: Is There a Role for Autoimmunity Itself? Thyroid. [Dec 22 Epub ahead of print]. "...FM comorbidity resulted in almost one third of patients (all females) suffering from HT with or without mild hypothyroidism (SCH). Moreover, the prevalence of fibromyalgia was slightly higher in euthyroid HT patients (33.3%) than in those suffering also from SCH (28.5%). In this setting, it is noteworthy that SCH patients without autoimmunity did not show any clinical symptom consistent with FM. Therefore, our data support the hypothesis that thyroid autoimmunity per se plays a role in the development of FM comorbidity, although the specific underlying mechanism is still not completely known."

Dargaud J, Lamotte C, Dainotti JP et al. 2001.  [Venous drainage and innervation of the maxillary sinus] Morphologie 85(270):11-13. [French]  Although not mentioning myofascial TrPs specifically, this study indicates how maxillary sinus congestion could be caused by blood vessel entrapment by pterygoid TrPs.

da Silva Brum E, Pessano Fialho MF, Becker G, et al. Involvement of peripheral mast cells in a fibromyalgia model in mice. 2024. Eur J Pharmacol. 2024 Mar 15: Epub 2024 Feb 2. "Fibromyalgia is a painful disorder of unknown aetiology that presents activation and recruitment of innate immune cells, including mast cells…. The results indicate that mast cells mediate painful and fatigue behaviours in this fibromyalgia model, representing potential therapy targets to treat fibromyalgia syndrome."

da Silva SG, Sarni RO, de Souza FI et al. 2012. Assessment of nutritional status and eating disorders in female adolescents with fibromyalgia. J Adolesc Health. 51(5):524-527. CONCLUSIONS: This study verified an absence of nutritional and eating disorders in adolescents recently diagnosed with fibromyalgia that, in addition to the correlation between adiposity indexes and KEDS total score, emphasizes the importance of nutritional and body composition assessment, allowing an early and adequate nutritional intervention.

Daub CW. 2007.  A case report of a patient with upper extremity symptoms: differentiating radicular and referred pain.  Chiropr Osteopat. 15(1):10.  “During the first episode the patient was diagnosed with a cervical radiculopathy.”   “Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms.  Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle.  A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition.”  “Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain.”  [We will never know how much surgery and other invasive procedures are unnecessary until we start assessing soft tissue pain generators such as myofascial trigger points. DJS]

Davidhizar, R.  1991.  Liabilities of competence.  Adv Clin Care 6(1):44-6. 

Davidoff, R. A.  1998.  Trigger points and myofascial pain: toward understanding how they affect headaches.  Cephalalgia 18:436-48.

Davidson RJ, Kabat-Zinn J, Schumacher J, et al. 2003.  Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 65:564-570.  Meditation may positively affect brain and immune function.

Davis CG. 2000.  Injury threshold: whiplash-associated disorders.  J Manipulative Physiol Ther 23(6):420-427.  “To make a competent assessment of injury, it is important to evaluate each patient individually. The same collision may cause injury to some individuals and leave others unaffected.  With the variability of human postures, tensile strength of the ligaments between individuals, body positions in the vehicle, collagen fibers in the same specimen segment, the amount of muscle activation and inhibition of muscles, the size of the spinal canals, and the excitability of the nervous system, one specific threshold is not possible.  How individuals react to a stimulus varies widely, and it is evident peripheral stimulation has effects on the central nervous system.  It is also clear that the somatosensory system of the neck, in addition to signaling nociception, may influence the control of neck, eyes, limbs, respiratory muscles, and some preganglionic sympathetic nerves.”

Davis MC, Thummala K, Zautra AJ et al. 2014. Stress-related clinical pain and mood in women with chronic pain: Moderating effects of depression and positive mood induction. Ann Behav Med. [Feb 15 Epub ahead of print.] "Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions."

Davis MC, Zautra AJ. 2013. An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: Results of a randomized controlled trial. Ann Behav Med. [May 14 Epub ahead of print]. "FM patients experience increases in self-efficacy for coping with pain and positive engagement in relationships, marginal increases in positive affect, and decreases in relationship stress from an automated online intervention that targets socioemotional regulation skills. Findings highlight the potential utility of widely accessible, low-cost intervention methods for fibromyalgia."

Davis MP, Dickerson ED, Pappagallo M et al. 2001. Mirtazepine: heir apparent to amitriptyline?  Am J Hosp Palliat Care 18(1):42-46.  Mirtazepine “… is an atypical anti-depressant, which has both noradrenergic and specific serotonergic receptor antagonism (NaSSa), and a unique pharmacological profile.”

Davis, S.  1999.  Androgen replacement in women: a commentary.  J Clin Endocrinol Metab 84(6):1886-91.

Davis SF, Humphreys H, Maden-Wilkinson T, et al.2022. Understanding the needs and priorities of people living with persistent pain and long-term musculoskeletal conditions during the COVID-19 pandemic-A public involvement project. Healthcare (Basel). Jun 17;10(6):1130 "The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people's views and needs are heard and validated by health professionals."

Davison, J. M.  1997.  Edema in pregnancy.  Kidney Int Suppl 59:S90-6.  de Aloysio, D. and P. Penacchioni. 1992. Morning sickness control in early pregnancy by neuguan point acupressure. Obstet Gyn 80 (5):852-854.

Davydov DM, de la Coba P, Contreras-Merino AM, et al. 2024 Impact of homeostatic body hydration status, evaluated by hemodynamic measures, on different pain sensitization paths to a chronic pain syndrome. Sci Rep. 2024 Jan 22;14(1):1908. In conclusion, the body hydration status profiles assessed by (re)activity of systemic vascular resistance and effective blood volume-related measures can help predict the risk and intensity of different pain sensitization components in chronic pain syndrome….

Dean LE, Arnold L, Crofford L et al. 2017. The impact of moving from a widespread to multi-site pain definition on other fibromyalgia symptoms. Arthritis Care Res (Hoboken). [Feb 9 Epub ahead of print.] "This large-scale study demonstrates that, regardless of pain definition used, the magnitude of association between pain and other associated symptoms of fibromyalgia are similar. This supports the continued collection of both when classifying fibromyalgia but highlights that pain may not require to follow the definition outlined within the 1990ACR criteria."

DeCarvalho LT. 2010. Important missing links in the treatment of chronic low back pain patients. J Musculoskel Pain. 18(1). “Findings of this study indicate that there is an increased positive association between CLBP (chronic low back pain) patients’ level of pain severity and symptoms reported of PTSD (post-traumatic stress disorder). Findings highlight the need for pain specialists to assess not only pain severity levels, but also anxiety symptoms. Very vital links, which should not be missed when treating these patients, are to provide treatments that target their physical condition and emotional distress or anxiety and that increase their sense of control over their pain experience and treatments.”

Dechene, L.  1993.  Chronic fatigue syndrome: influence of histamine, hormones and electrolytes.  Med Hypotheses 40(1):55-60.  

Dedert EA, Studts JL, Weissbecker I et al.  2004.  Religiosity may help preserve the cortisol rhythm in women with stress-related illness.  Int J Psychiatry Med. 34(1):61-77.  “...religiosity may have a protective effect on the physiological effects of stress among women with fibromyalgia.”

Dee SW, Kao MJ, Hong CZ et al. 2012. Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature. Neuropsychiatr Dis Treat. 8:399-403. This patient presented with shoulder pain on one side, and was given conservative treatment for 13 months, including trigger point injection. Eventually, a rare case of thymic carcinoma was discovered to be the cause of the pain. Pain can come from many sources, and if trigger points aren't relieved by usual treatment, the perpetuating factor(s) must be identified.

Deere KC, Clinch J, Holliday K et al. 2012. Obesity is a risk factor for musculoskeletal pain in adolescents: Findings from a population-based cohort. Pain. 153(9):1932-1938. "Obesity is a risk factor for fibromyalgia in adults, but whether a similar relationship exists in children is uncertain. This study examined whether obesity is associated with reporting of musculoskeletal pain, including chronic regional pain (CRP) and chronic widespread pain (CWP), in adolescents, in a population-based setting....Compared with non obese participants, those with any pain, knee pain, and CRP reported more severe average pain (P<.01). Obese adolescents were more likely to report musculoskeletal pain, including knee pain and CRP. Moreover, obese adolescents with knee pain and CRP had relatively high pain scores, suggesting a more severe phenotype with worse prognosis."

Defalque, R. J. 1982.  Painful trigger points in surgical scars. Anesth Analg 61(6):518-20.

de Feijte M, Katimertzoglou A, Tiemensma J, et al. Polysomnography-estimated sleep and the negative feedback loop of the hypothalamic-pituitary-adrenal (HPA) axis. Psychoneuroendocrinology. 2022 Mar 25;141:105749.Online ahead of print. "This study suggests that more slow wave sleep is particularly associated with a stronger suppression of cortisol within the negative feedback loop of the HPA axis. These findings provide further support that slow wave sleep is important for health."

Degenhardt L, Hungerford P, Nielsen S, et al. 2021. Pharmaceutical opioid use patterns and indicators of extramedical use and harm in adults with chronic noncancer pain, 2012-2018. JAMA Netw Open. 4(4):e213059. "The current study includes one of the largest, longest, and most comprehensive cohorts of people with CNCP (chronic non-cancer pain) receiving prescribed opioids. There was a high follow-up rate, validated scales were used in our interviews, and we measured self-reported opioid consumption rather than relying on administrative data on prescriptions…. Contrary to the predominant thinking in pain management, the findings of this study suggest considerable fluidity in opioid use over time among many patients with CNCP who use opioids. These patients fluctuate between periods of using high doses and periods of abstinence, engage in extramedical opioid-use behaviors, and experience opioid dependence. These findings challenge the approach of assessing risk for adverse opioid behaviors based on static risk factors at the commencement of treatment and reinforce the need for constant individual reassessment of the effectiveness and safety of prescription opioid use."

de Heer EW, Vriezekolk JE, van der Feltz-Cornelis CM. 2017. Poor illness perceptions are a risk factor for depressive and anxious symptomatology in fibromyalgia syndrome: A longitudinal cohort study. Front Psychiatry. 8:217. "Our data suggest that not pain severity or maladaptive coping, but poor illness perceptions are important in elevated depressive and anxious symptomatology. Patients with fibromyalgia who think their illness negatively affects their mental well-being are at increased risk for more depressive symptoms, and those who think treatment of their illness will not be effective are at increased risk for more anxiety symptoms. Strengthening illness beliefs and reducing catastrophic thinking, therefore, seem crucial factors in the treatment of patients with FMS." Free Article

Dejung B. 1994.  [Manual trigger point treatment in chronic lumbosacral pain].  Schweiz Med Wochenschr Suppl. 62:82-87. [German]  “We believe that lumbosacral pain of unknown origin is frequently caused by muscular trigger points in the muscles of the trunk.  We present a new manual therapy for management of this muscular pathology.”

de la Coba P, Bruehl S, Duschek S et al. 2018. Blood pressure-related pain modulation in fibromyalgia: Differentiating between static versus dynamic pain indicators. Int J Psychophysiol. 134:79-85. "This study examined whether BP-related pain modulation, indexed by both static and dynamic evoked pain responses, is altered in fibromyalgia (FM) patients compared to pain-free individuals.... This study found BP-related inhibitory dysfunction was common in FM but not in chronic pain per se when using static evoked measures. "BP-related pain modulation is manifested in FM differentially for static versus dynamic pain indicators. Use of both types of evoked pain measures may be valuable in the study of mechanisms underlying altered pain modulatory systems in FM."

de la Coba P, Bruehl S, Galvez-Sanchez CM et al. 2018. Slowly repeated evoked pain (SREP) as a marker of central sensitization in fibromyalgia: diagnostic accuracy and reliability in comparison with temporal summation of pain. Psychosom Med. May 1. [Epub ahead of print] "SREP seems to be a dynamic evoked pain index tapping into pain sensitization that allows for greater diagnostic accuracy in identifying FM patients compared to a standard TSP protocol. Further research is needed to study mechanisms underlying SREP and the potential utility of adding SREP to standard pain evaluation protocols."

de la Coba P, Bruehl S, Moreno-Padilla M et al. 2017. Responses to slowly repeated evoked pain stimuli in fibromyalgia patients: Evidence of enhanced pain sensitization. Pain Med. [Mar 24 Epub ahead of print] "The pathophysiology of fibromyalgia has been related to central pain sensitization. This study tested a laboratory protocol evaluating responses to slowly repeated evoked pain stimuli (SREP) that may index central pain sensitization in fibromyalgia…. A protocol employing a single series of nine low-suprathreshold-intensity slowly repeated pain stimuli elicits increased perceived pain in fibromyalgia patients, consistent with central sensitization despite relatively long interstimulus intervals. SREP appears to be more useful than traditional evoked pain threshold tolerance measures in terms of predicting levels of clinical pain and discriminating between fibromyalgia patients and healthy individuals."

de-la-Hoz-López D, Gómez-Mayordomo V, Cuadrado ML, et al. 2024. Prevalence of myofascial trigger points in isolated idiopathic cervical dystonia: A possible contributor to pain, movement and disability. Mov Disord Clin Pract. 2024 Sep;11(9):1125-1131. "The role of TrPs in patients with cervical dystonia (CD) has not been investigated. Objective: To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain….TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles…. Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia."

De-la-Llave-Rincon AI, Fernandez-de-las-Penas C, Palacios-Cena D et al. 2009. Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome. J Orthop Sports Phys Ther. 39(9):658-664. "Patients with mild/moderate CTS (carpal tunnel syndrome) exhibited a greater FHP (forward head posture) and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion." [Nerve entrapment by TrPs can exist all along the median nerve. Forward head posture is a perpetuating factor of TrPs. DJS.]

de-la-Llave-Rincon AI, Puentedura EJ, Fernandez-de-Las-Penas C. 2012. New advances in the mechanisms and etiology of carpal tunnel syndrome. Discov Med. 13(72):343-348. "Some studies have demonstrated that patients with CTS exhibit sensory symptoms not only within the areas innervated by the median nerve but also in extra-median regions, i.e., forearm or shoulder. It has also been demonstrated that patients with CTS may exhibit widespread pressure hypersensitivity and generalized thermal hyperalgesia, but not hypoesthesia, which is not related to electro-diagnostic findings. In addition, fine motor control and pinch grip force disturbances have been found to be commonly observed in this patient population. All these data suggest that central sensitization mechanisms are involved in the somato-sensory and motor disturbances found in CTS, probably related to cortical plastic changes. The presence of sensitization mechanisms could play an important role in the development of bilateral sensory symptoms in CTS and also can determine the therapeutic strategies for this condition. We propose that therapeutic interventions applied to individuals with CTS should include approaches that would modulate nociceptive barrage into the central nervous system."

Delaney J.P., Leong K. S., Watkins A. et al. 2002.  The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects.  J Adv Nurs 27(4):364-71.  TrP massage to the head, neck and shoulder increased cardiac parasympathetic activity and improved relaxation even in healthy individuals.

de Las Penas CF, Cuadrado ML, Gerwin RD et al. 2005.  Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle.  Headache 45(6):731-737.  This blinded, controlled study indicates that myofascial trigger points in the superior oblique muscle may cause or contribute to typical tension headache pain.  [This study confirms the presence of myofascial trigger points in at least one of the extrinsic eye muscles, as per the 2^nd edition of “Fibromyalgia and Chronic Myofascial Pain: A Survival Manual.  TrPs in the extrinsic eye muscles may be diagnosed and treated by use of eye exercises in that book.]

DeLeo JA, Tanga FY, Tawfik VL. 2004.  Neuroimmune activation and neuroinflammation in chronic pain and opioid tolerance/hyperalgesia.  Neuroscientist 10(1):40-52. Modulation of central nervous system glial cells and 
proinflammatory cytokines may not only contribute to central sensitization but also decrease the effectiveness of opioids. The role of neuroinflammation and interstitial swelling can be integral parts of central sensitization.  “…there is now increasing evidence suggesting that the CNS mounts an organized innate immune response during systemic infection and neuronal injury.”  Also interesting is the observation of cellular adhesion molecules in the lumbar spinal cord following peripheral inflammatory stimuli.  This may indicate a similar process occurring in the central nervous system similar to the myofascial cellular adhesion in response to mechanical or biochemical trauma.

DeLeo JA, Tanga FY, Tawfik VL. 2004.  Neuroimmune activation and neuroinflammation in chronic pain and opioid tolerance/hyperalgesia.  Neuroscientist 10(1):40-52.   Modulation of central nervous system glial cells and   pro-inflammatory cytokines may not only contribute to central sensitization but also decrease the effectiveness of opioids.  The role of neuroinflammation and interstitial swelling can be integral parts of central sensitization.  " …there is now increasing evidence suggesting that the CNS mounts an organized innate immune response during systemic infection and neuronal injury."  Also interesting is the observation of cellular adhesion molecules in the lumbar spinal cord following peripheral inflammatory stimuli.  This may indicate a similar process occurring in the central nervous system similar to the myofascial cellular adhesion in response to mechanical or biochemical trauma. 

Dellon AL, Shookster LA, Maloney CT Jr et al. 2003.  Diagnosis of compressive neuropathies in patients with fibromyalgia.  J Hand Surg [Am] 28(6):894-7.  This article suggests that the Tinel sign may be a valid tool for identification of arm peripheral nerve compression in fibromyalgia.  It neglects to screen patients for myofascial trigger points, which may be the cause of such nerve entrapment.

Delorme T, Boureau F, Eymard B et al. 2004.  Clinical study of chronic pain in hereditary myopathies.  Eur J Pain 8(1):55-61. This study of 68 consecutive and unselected adult patients at a multidiciplinary consultation for hereditary myopathies found that 46 of them had chronic pain, mostly musculoskeletal.  50% had symptoms of myofascial pain and 26% had symptoms of fibromyalgia.  [It would be interesting to study how many of the relatives with hereditary myopathies also had these co-existing conditions.  Clinicians must become aware that these illness are frequent companions to other chronic illnesses, and that prompt diagnosis, recognition, and treatment of the individual TrPs and central sensitization may considerably improve the patient=s quality of life. DJS]

Delshad B, Zarean E, Yeowell G et al. 2020. The immediate effects of pelvic compression belt with a textured sacral pad on the sacroiliac function in pregnant women with lumbopelvic pain: A cross-over study. Musculoskelet Sci Pract. Aug;48:102170. "Hip joint position sense, maximum hip flexion force, and perceived effort during the active straight leg raising test were measured in twenty-eight pregnant women with lumbopelvic pain. Outcomes were measured in three randomized conditions including no pelvic belt (control), with a pelvic belt, and while a sacral pad was used with the pelvic belt. Data were analyzed using a one-way repeated measures analysis of variance for each variable…. Improvements in all study outcomes have been shown with a pelvic belt compared with the control condition….. Further improvements were noted with the addition of the textured pad for all outcome measures. This finding may inform new benefits in adding a textured sacral pad to pelvic compression belts.

DeMeo MT, Mutlu EA, Keshavarzian A et al. 2002.  Intestinal permeation and gastrointestinal disease.  J Clin Castroenterol. 34(4):385-396.  “The gastrointestinal tract constitutes one of the largest sites of exposure to the outside environment.  The function of the gastrointestinal tract in monitoring and sealing the host interior from intruders is called the gut barrier.”  “Disruptions in the gut barrier follow injury from various causes including nonsteroidal anti-inflammatory drugs and oxidant stress, and involve mechanisms such as adenosine triphosphate depletion and damage to epithelial cell cytoskeletons that regulate tight junctions.  Ample evidence links gut barrier dysfunction to multiorgan system failure in sepsis and immune dysregulation.”  [More information is coming out concerning the relationship between permeable bowel and chronic illness.  What can be done to heal the bowel is to remove irritants, replace lost enzymes, reinnoculate healthy organisms with probiotics, and repair the mucosa.  Detailed information can be found in the Textbook of Functional Medicine, (see Galland, L. and  www.functionalmedicine.org).  DJS.]

Demeter P, Vardi VK, Magyar P. 2004.  [Study on connection between gastroesophageal reflux disease and obstructive sleep apnea]  Orv Hetil. 145(37):1897-1901. [Hungarian]  “The study reveals that in patients with severe obstructive sleep apnea, erosive reflux disease is more frequent and a positive correlation can be found between severity of reflux disease and sleep apnea as well.”

Demeter P, Pap A. 2004.  The relationship between gastroesophageal reflux disease and obstructive sleep apnea.  Gastroenterol 39(9):815-820.   Reflux is more likely to occur during sleep.  Also,  “...the transdiaphragmatic pressure increases in parallel with the growing intrathoracic pressure generated during obstructive apnea episodes.”

Demeter P, Vardi VK, Magyar P. 2004.  [Study of connection between gastroesophageal reflux disease and obstructive sleep apnea] Orv Hetil. 145(37):1897-1901. [Hungarian]  “The study reveals that in patients with severe obstructive sleep apnea, erosive reflux disease is more frequent and a positive correlation can be found between severity of reflux disease and sleep apnea as well.”

De Meulemeester K, Calders P, Dewitte V et al. 2017. Surface electromyographic activity of the upper trapezius before and after a single dry needling session in female office workers with trapezius myalgia. Am J Phys Med Rehabil. [Jun 21 Epub ahead of print] "Myofascial pain can be accompanied by a disturbed surface electromyographic (sEMG) activity. Nevertheless, the effect of myofascial treatment techniques, such as dry needling (DN), on the sEMG activity is poorly investigated. Several DN studies also emphasize the importance of eliciting local twitch responses (LTRs) during treatment. However, studies investigating the added value of LTRs are scarce. Therefore, the aims of this study were first to evaluate the effect of DN on the sEMG activity of myalgic muscle tissue, compared with no intervention (rest), and secondly to identify whether this effect is dependent of eliciting LTRs during DN….The sEMG activity increased after rest and after DN, but this increase was significantly smaller 10 minutes after DN, compared with rest. These differences were independent whether LTRs were elicited or not…. Dry needling leads to a significantly lower increase in sEMG activity of the upper trapezius, compared with no intervention, after a typing task. This difference was independent of eliciting LTRs."

De Meulemeester KE, Castelein B, Coppieters I et al. 2017. Comparing trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: A randomized clinical trial. J Manipulative Physiol Ther. 40(1):11-20. "Both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain."

Demirdal US, Bilir N, Demirdal T. 2019. The effect of concomitant fibromyalgia in HIV infected patients receiving antiretroviral therapy: a prospective cross-sectional study. Ann Clin Microbiol Antimicrob. Oct 31;18(1):31. "FMS was found in 20% of the HIV infected patients…. The mean duration of disease was …significantly longer in patients with FMS (p = 0.007). The median CD4 T-lymphocyte count …was significantly higher in patients without FMS… No statistically significant difference was found between the two groups according to the drug regimens used…. A slightly higher frequency of FMS was determined in HIV infected patients receiving ART (antiretroviral therapy) compared to previous studies. It was shown that presence of FMS negatively affected the function, depression, fatigue, sleep, and quality of life. Detection of FMS may decrease depression, fatigue, and sleep disorders and increase the quality of life in HIV infected patients. FMS should be distinguished correctly for an accurate treatment management of HIV and for increasing ART compliance."

Deng C, Xia W. 2017. Effect of Tai Chi Chuan on degeneration of lumbar vertebrae and lumbar discs in middle-aged and aged people: a cross-sectional study based on magnetic resonance images. J Int Med Res. [Jan Epub ahead of print] "We assessed the effect of Tai Chi on the degeneration of lumbar vertebrae and lumbar discs with magnetic resonance images….This retrospective cohort study involved 2 groups of participants: 27 Tai Chi practitioners with more than 4 years of experience with regular Tai Chi exercise and 24 sex- and age-matched participants without Tai Chi experience….The Tai Chi practitioners had significantly fewer degenerated lumbar vertebrae (1.9) and lumbar discs (2.3) than the control group (2.6 and 2.9, respectively). The most severely affected lumbar vertebrae and discs were L5 and L4/L5, respectively…. Regular performance of the simplified Tai Chi 24 form could possibly retard the degeneration of lumbar vertebrae and lumbar discs in middle-aged and aged people."

Deng EZ, Weikel DP, Martucci KT. Evaluation by survival analysis of cold pain tolerance in patients with fibromyalgia and opioid use. J Pain Res. 2022 Sep 9;15:2783-2799. "By using survival analysis, an optimal method for time-to-event pain measures such as the CPT, we confirmed previously identified reductions in cold pain tolerance in patients with fibromyalgia. While our selected psychological and clinical measures were not significantly associated with cold pain tolerance, our data suggest that opioid medication use may impart greater cold pain tolerance in some patients."

Deng S, Hu Y, Chen S, Xue Y, et al. 2024. Chronic sleep fragmentation impairs brain interstitial clearance in young wildtype mice. J Cereb Blood Flow Metab. 2024 Apr 19:271678X241230188. Accumulating evidence shows that most chronic neurological diseases have a link with sleep disturbances, and that patients with chronically poor sleep undergo an accelerated cognitive decline. Indeed, a single-night of sleep deprivation may increase metabolic waste levels in cerebrospinal fluid…. Clearance of brain interstitial waste by the glymphatic system occurs primarily during sleep, driven by multiple oscillators including arterial pulsatility, and vasomotion…. Taken together, results of this study document that chronic sleep fragmentation suppresses brain metabolite clearance and impairs cognition, even in the absence of disease. [This may explain much of the cognitive deficits seen in fibromyalgia. DJS]

Dengler-Crish CM, Bruehl S,Walker LS. 2011. Increased wind-up to heat pain in women with a childhood history of functional abdominal pain. Pain. [Jan 29 Epub ahead of print]. "Young women with a childhood history of functional abdominal pain may have a long-term vulnerability to pain that is associated with enhanced responses of the central nervous system to pain stimuli." [According to Dr. Karel Lewit, in his book "Manipulative Therapy: Musculoskeletal Medicine (Churchill Livingstone Elsevier 2010), such "functional" pain, such as abdominal or menstrual pain beginning at the first period, may be an early sign of spinal dysfunction that may not show up on MRI until many years later. This is a critical clue, the significance of which is missed in the education of many care providers. These "functional" conditions ("functional" being a medical term for "we don't know the cause") could be indications of the early forms of initiating factors for central sensitization. They need to be pounced upon as a good mouser cat pounced on its prey. They are part of the practice of preventative medicine, and not symptoms to be dismissed. DJS]

Dennis NL, Larkin M, Derbyshire SW. 2013. 'A giant mess' - making sense of complexity in the accounts of people with fibromyalgia. Br J Health Psychol. [Jan 24 Epub ahead of print]. "Twenty people with fibromyalgia participated in email interviews exploring their experiences, history and diagnosis…. Participants described enduring the course of a 'giant mess' of unpleasant symptoms, some of which were understood to be symptoms of fibromyalgia and some the interactive or parallel effects of comorbid illness. The respondents also demonstrated their considerable efforts at imposing order and sense on complexity and multiplicity, in terms of the instability of their symptoms. They expressed ambivalence towards diagnosis, doctors and medication, and we noted that each of the above areas appeared to come together to create a context of relational uncertainty, which undermined the security of connections to family, friends, colleagues and the workplace….Three key issues were discussed. First, there was not one overall symptom (e.g., pain) driving the unpleasantness of fibromyalgia; second, participants spent excessive time and energy trying to manage forces outside their control; third, because there is no definitive 'fibromyalgia experience', each diagnosis is unique, and our participants often appeared to be struggling to understand the course of their illness. [While I disagree with the authors' contention that FM is a diagnosis of exclusion, I agree that co-existing conditions cause a lot of the confusion concerning FM, and there are many interesting points in this paper. DJS]

Deodhar, A. A. , R. A. Fisher, C. V. Blacker and A. D. Woolf. 1994. Fluid retention syndrome and fibromyalgia. Br J Rheumatol 33(6):576-582.

de Oliveira DL, Hirotsu C, Tufik S et al. 2017. The interfaces between vitamin D, sleep and pain. J Endocrinol. [May 23 Epub ahead of print] "The role of vitamin D in osteomineral metabolism is well known. Several studies have suggested its action on different biological mechanisms, such as nociceptive sensitivity and sleep-wake cycle modulation. Sleep is an important biological process regulated by different regions of the central nervous system, mainly the hypothalamus, in combination with several neurotransmitters. Pain, which can be classified as nociceptive, neuropathic and psychological, is regulated by both the central and peripheral nervous systems. In the peripheral nervous system, the immune system participates in the inflammatory process that contributes to hyperalgesia. Sleep deprivation is an important condition related to hyperalgesia, and recently it has also been associated with vitamin D. Poor sleep efficiency and sleep disorders have been shown to have an important role in hyperalgesia, and be associated with different vitamin D values. Vitamin D has been inversely correlated with painful manifestations, such as fibromyalgia and rheumatic diseases. Studies have demonstrated a possible action of vitamin D in the regulatory mechanisms of both sleep and pain. The supplementation of vitamin D associated with good sleep hygiene may have a therapeutic role, not only in sleep disorders but also in the prevention and treatment of chronic pain conditions."

de Oliveira RA, Ciampi de Andrade D, McHado AG et al. 2012. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome. BMC Neurol. 12(1):89. Myofascial pain syndrome is a common co-morbid condition with central post-stroke pain.

de-Pedro-Herraez M, Mesa-Jimenez J, Fernandez-de-Las-Penas C et al. 2016. Myogenic temporomandibular disorders: Clinical systemic comorbidities in a female population sample. Med Oral Patol Oral Cir Bucal. 21(6):e784-792. "It was found that the group affected by MTMD (muscle-caused temporomandibular disorders) presented many more associated medical conditions than the control group: health changes during the last year, medical evaluations and treatments, presence of pain, sinus disease, tinnitus, headache, joint pain, ocular disorders, fatigue, dizziness, genitourinary disorders and xerostomia among others; and they were also in a higher risk to suffer other pathological entities as headaches and articular pain…. These results reinforce our hypothesis that MTMD belong to a group of medical conditions triggered by a loss of equilibrium of the individual's Psycho-Neuro-Endocrine-Immune (PNEI) Axis that produces alterations in the response against external stimuli in some genetically predisposed individuals. It is, therefore, necessary to change the way of diagnosing and managing these individual's medical conditions, being mandatory to look from a more multidisciplinary perspective than the one we are currently offering." Free Article

DeQuervain, D.J., Roozendaal, B., Nitsch, R.M., McGaugh, J.L., Hock, C. 2000. Acute cortisone administration impairs retrieval of long term declarative memory in humans. Most patients with FMS and other chronic pain syndromes report more stress in their lives. The major endocrine manifestation of stress is increased secretion of cortisol.  Could this, in part, be an explanation for so-called "fibro fog" - the impaired memory problems described by many FMS patients?  In this study, cortisol had a selective effect of interfering with delayed recall, but not immediate recall or recognition memory.  This study is also relevant to the cognitive defects often described by lupus patients who are often treated with intermittently high doses of corticosteroids.

De Renzi, E., F. Lucchelli, S. Muggia and H. Spinnler. 1995. Persistent retrograde amnesia following a minor trauma. Cortex 31(3):531-542 .

de Ridder, D., M. Depla, P. Severens and M. Malsch.  1997.  Beliefs on coping with illness: a consumer’s perspective.  Soc Sci Med 44(5):553-9.

De Ridder D, Vanneste S. 2016. Occipital nerve field transcranial direct current stimulation normalizes imbalance between pain detecting and pain inhibitory pathways in fibromyalgia. Neurotherapeutics. [Dec 21 Epub ahead of print.] "Occipital nerve field (OCF) stimulation with subcutaneously implanted electrodes is used to treat headaches, more generalized pain, and even failed back surgery syndrome via unknown mechanisms. Transcranial direct current stimulation (tDCS) can predict the efficacy of implanted electrodes…. OCF tDCS exerts its effect via activation of the descending pain inhibitory pathway and de-activation of the salience network, both of which are abnormal in fibromyalgia."

Dernek B, Adiyeke L, Duymus TM et al. 2018. Efficacy of trigger point injections in patients with lumbar disc hernia without indication for surgery. Asian Spine J. 12(2):232-237. "Purpose: To investigate the efficacy of gluteal trigger point (TP) injections with prilocaine in patients with lumbosacral radiculopathy complaining of gluteal pain....TP injections can be performed using several anesthetic agents, primarily lidocaine and prilocaine. While several studies have used lidocaine, few have used prilocaine....A total of 65 patients who presented at the polyclinic with complaints of lower back pain with lumbar disc herniation (based on physical examination and magnetic resonance imaging) and TPs in the gluteal region were included in this prospective comparative study. Group 1 comprised 30 patients who were given TP injections, a home exercise program, and oral medications, and group 2 comprised 35 patients who were only treated with a home exercise program and oral medications.... We obtained better results with TP injections than only a home exercise program and oral medications in patients with radiculopathy and TPs in the gluteal region." Fr

Deroo BJ, Korach KS. 2006.  Estrogen receptors and human disease.  J Clin Invest. 116(3):561-570.  “Estrogens influence many physiological processes in mammals, including but not limited to reproduction, cardiovascular health, bone integrity, cognition, and behavior.  Given this widespread role for estrogen in human physiology, it is not surprising that estrogen is also implicated in the development or progression of numerous diseases, which include but are not limited to various types of cancer (breast, ovarian, colorectal, prostate, endometrial), osteoporosis, neurodegenerative diseases, cardiovascular disease, insulin resistance, lupus erythematosus, endometriosis, and obesity.  In many of these diseases, estrogen mediates its effects through the estrogen receptor (ER), which serves as the basis for many therapeutic interventions.”  Now that we are aware of the 2nd estrogen receptor and its differences, new medications may be specifically tailored to estrogen receptor beta.  More tools are being developed for preventative medicine.

Derry S, Cording M, Wiffen PJ et al. 2016. Pregabalin for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 9:CD011790. "Pregabalin 300 to 600 mg produces a major reduction in pain intensity over 12 to 26 weeks with tolerable adverse events for a small proportion of people (about 10% more than placebo) with moderate or severe pain due to fibromyalgia. The degree of pain relief is known to be accompanied by improvements in other symptoms, quality of life, and function. These results are similar to other effective medicines in fibromyalgia (milnacipran, duloxetine)".

Derry S, Wiffen PJ, Hauser W, et al. 2017. Oral nonsteroidal anti-inflammatory drugs for fibromyalgia in adults. Cochrane Database Syst Rev. [Mar 27 Epub ahead of print.] "There is only a modest amount of very low-quality evidence about the use of NSAIDs in fibromyalgia, and that comes from small, largely inadequate studies with potential risk of bias. That bias would normally be to increase the apparent benefits of NSAIDs, but no such benefits were seen. Consequently, NSAIDs cannot be regarded as useful for treating fibromyalgia."

Dertwinkel, R., A. Wiebalck, M. Zenz and M. Strumpf.  1996. [Oral opioids for long-term treatment of chronic non-cancer pain].  Anaesthesist 45(6):495-505 [German].

Desai MJ, Brestle M, Jonely H. 2024. Evidence for central sensitization as classified by the central sensitization inventory in patients with pain and hypermobility. Pain Pract. 2024 Aug 27. Epub ahead of print. [Most probably the hEDS is an initiating factor for MPS, and it is the MPS that leads to the central sensitization of FM. DJS]

Deslauriers S, Roy JS, Bernatsky S et al. Factors associated with waiting times for persons with rheumatic conditions in multidisciplinary pain treatment facilities. J Pain Res. 2019 Jul 30;12:2379-2390. "Results indicate that longer pain duration, lower household income, pain onset following a motor vehicle accident, having fibromyalgia, being on permanent disability or unemployed and being referred by a family physician (versus specialist) were significantly associated with longer waiting times….Many patients with rheumatic conditions (especially fibromyalgia) face long delays before receiving services in Quebec's MPTF."

de Tommaso M. 2015. Migraine and fibromyalgia. J Headache Pain. 16(Suppl 1):A45. "Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by diffuse pain, sleep disorders, fatigue, cognitive dysfunction and a cohort of different symptoms implying comorbidity with diseases with common pathophysiological basis. There is a growing body of evidence that abnormal pain processing at a central level has a role in FM pathogenesis, though recent evidence supports the coexistence of a peripheral nociceptive fibers sufferance. In recent years, clear phenomena of temporal summation of pain (or windup) and central sensitization have been extensively reported. Neurophysiologic methods able to explore the nociceptive afferent system suggest that FM syndrome is heterogeneous, with pain processing dysfunction at both peripheral and central level. Reduced habituation to multimodal and especially painful stimuli characterizes FM, as well as associated conditions, one of the most common is migraine. A genetic dysfunction of ionic channels may possibly explain neuronal abnormalities at both central and peripheral level in FM, opening a new scenario also in the comprehension of pathophysiological basis of associated conditions." Free Article

de Tommaso M, Delussi M, Vecchio E et al. 2014. Sleep features and central sensitization symptoms in primary headache patients. J Headache Pain. 15(1):64. "Association between sleep disorders and headache is largely known. The aim of the present study was to evaluate sleep quality and quantity in a large cohort of primary headache patients, in order to correlate these scores with symptoms of central sensitization as allodynia, pericranial tenderness and comorbidity with diffuse muscle-skeletal pain….One thousand six hundreds and seventy primary headache out patients were submitted to the Medical Outcomes Study (MOS) within a clinical assessment, consisting of evaluation of frequency of headache, pericranial tenderness, allodynia and coexistence of fibromyalgia syndrome (FM)….Self reported duration of sleep seems a useful index to be correlated with allodynia, pericranial tenderness and chronic headache as a therapeutic target to be assessed in forthcoming studies aiming to prevent central sensitization symptoms development." Free Article

de Tommaso M, Federici A, Serpino C et al. 2011. Clinical features of headache patients with fibromyalgia comorbidity. J Headache Pain. [Aug 17 Epub ahead of print]. "Our previous study assessed the prevalence of fibromyalgia (FM) syndrome in migraine and tension-type headache. We aimed to update our previous results, considering a larger cohort of primary headache patients who came for the first time at our tertiary headache ambulatory. A consecutive sample of 1,123 patients was screened. Frequency of FM in the main groups and types of primary headaches; discriminating factor for FM comorbidity derived from headache frequency and duration, age, anxiety, depression, headache disability, allodynia, pericranial tenderness, fatigue, quality of life and sleep, and probability of FM membership in groups; and types of primary headaches were assessed. FM was present in 174 among a total of 889 included patients.... Headache frequency, anxiety, pericranial tenderness, poor sleep quality, and physical disability were the best discriminating variables for FM comorbidity, with 81.2% sensitivity. Patients presenting with chronic migraine and chronic tension-type headache had a higher probability of sharing the FM profile..... A phenotypic profile where headache frequency concurs with anxiety, sleep disturbance, and pericranial tenderness should be individuated to detect the development of diffuse pain in headache patients." [It is very likely that the headaches and localized tenderness, and perhaps some of the other symptoms as well, were due to co-existing myofascial TrPs rather than FM. The FM simply amplified the symptoms. DJS]

de Tommaso M, Fernandez-de-Las-Penas C. 2015. Tension Type Headache. Curr Rheumatol Rev. [Dec 30 Epub ahead of print.] "Tension type headache (TTH) is the most common headache and it has been discussed for years without reaching consensus on its pathophysiology, or proper rationale management. This primary headache remains a challenge into its management for clinicians. This review aims to provide an updated and critical discussion on what is currently known and supported by scientific evidence about TTH and which gaps there still may be in our understanding of this condition. Clinical features of TTH resemble common manifestations of muscle referred pain. Episodic TTH may evolve into the chronic form by different aspects and several triggers may be involved at the same time. Both peripheral and central sensitization mechanisms seem to be clearly involved in this process. Individuals with episodic TTH exhibit higher levels of peripheral excitability whereas chronic TTH clearly show central sensitization manifestations. The role of associated muscle hyperalgesia seems to be important factors in TTH. Therapeutic management of individuals with TTH should be multimodal including appropriate use of pharmacological and non-pharmacological interventions to reduce the nociceptive peripheral drive to the central nervous system. If properly applied, treatment may not only reduce the number of TTH attacks but may also prevent or delay the transition from episodic to chronic TTH."

de Tommaso M, Sciruicchio V. 2015. Migraine and central sensitization: clinical features, main comorbidities and therapeutic perspectives. Curr Rheumatol Rev. [Dec 30 Epub ahead of print.] "Migraine is a disorder of neuro-vascular origin, being amongst the 20 most disabling disease. Migraine attacks are characterized by severe throbbing headache, associated to nausea, vomiting, photophobia, and phonophobia…. Abnormal neuronal excitability may subtend altered processing of sensory stimuli, leading to cortical spreading depression and trigeminal activation. A dysfunction of pain modulation enhances central sensitization phenomena, contributing to acute allodynia and headache persistence. The peculiarity of migraine pain facilitates the use of analgesics, and causes an adjunctive invalidating tendency toward drug over-use…. Chronic migraine patients are frequently affected by diffuse pain, framed in fibromyalgia diagnosis. This comorbidity seems to be supported by common pathophysiological mechanisms. It may aggravate migraine invalidity being worth of consideration for therapeutic management….Acute and preventive treatments need to be tailored to single cases. Main comorbidity and factors facilitating central sensitization should be taken into account. The management of migraine patients should include a link between headache centers and general practitioner, in order to provide for a better patient information and treatment just at the onset of the disease….Despite its high epidemiologic impact, migraine is frequently underestimated and destined to evolve into chronic form and drugs abuse. A more focused attention to factors facilitating central sensitization and invalidating comorbidities should reduce the global burden of the disease."

Devine M, Taylor S, Renton T. 2016. Chronic post-surgical pain following the placement of dental implants in the maxilla: A case series. Eur J Oral Implantol. 9(2):179-186. "PURPOSE: To present ten cases of chronic post-surgical neuropathic pain (CPSP) arising after placement of maxillary dental implants, in order to raise awareness of this potential complication of treatment…. Persistent pain after dental implant placement may occur with no apparent organic cause and without any neurosensory deficits. Practitioners must be aware of chronic post-surgical neuropathic pain as a possible complication of implant placement, particularly in patients with a significant medical history. Consideration should be given as to whether these patients are suitable for implant rehabilitation. Patients reporting very severe and prolonged postoperative pain following implant surgery should be considered at risk of CPSP and referred to a specialist in orofacial pain."

Devor M. 2006.  Sodium channels and mechanisms of neuropathic pain.  J Pain 7 Suppl 1:S3-S12.  “Neuropathic pain is a complex outcome of multiple pathophysiological changes that develop in the peripheral nervous system (PNS) and the central nervous system (CNS) following nerve injury or disease.  All or most of the CNS changes are thought to be due to abnormal signaling from the PNS, notably electrical hyperexcitability of peripheral sensory neurons.  Because hyperexcitability is associated with abnormal sodium channel regulation, this process is a prime target for therapeutic intervention.”

de Vries J, Ischebeck BK, Voogt LP et al. 2016. Cervico-ocular reflex is increased in people with nonspecific neck pain. Phys Ther. 96(8):1190-1195. "Neck pain is a widespread complaint. People experiencing neck pain often present an altered timing in contraction of cervical muscles. This altered afferent information elicits the cervico-ocular reflex (COR), which stabilizes the eye in response to trunk-to-head movements. The vestibulo-ocular reflex (VOR) elicited by the vestibulum is thought to be unaffected by afferent information from the cervical spine….The aim of the study was to measure the COR and VOR in people with nonspecific neck pain… This study suggests that people with nonspecific neck pain have an increased COR. The COR is an objective, nonvoluntary eye reflex and an unaltered VOR. This study shows that an increased COR is not restricted to patients with traumatic neck pain. [This is logical if the "nonspecific" neck pain is due to trigger points. It may be very specific indeed. DJS]

Devulder J, Jacobs A, Richarz U et al. 2009.  Impact of opioids rescue medication for breakthrough pain on the efficacy and tolerability of long-acting opioids in patients with chronic non-malignant pain.  Br J Anaesth. [Sep 6 Epub ahead of print].  “We found no evidence that rescue medication with short-acting opioids for breakthrough pain affects analgesic efficacy of long-acting opioids or the incidence of common opioids-related side effects among chronic non-malignant pain patients.”

Dhatt SS, Kumar V, Neradi D, et al. 2021. Need for testing and supplementation of vitamin D3 after release of COVID-19 lockdown in patients with increased musculoskeletal pain. Indian J Orthop. Mar 6;1-4. "Out of 120 patients presented to us in a period of 3 months, 31 patients had increased symptoms when compared to pre-lockdown status. 20 out of 31 patients had low vitamin D3 levels. 14 patients also developed symptoms of fibromyalgia…. There might be many reasons for increased pain during lockdown, but we focused specially only on vitamin D3 because of its association with increased symptoms of COVID-19."

Dhingra L, Perlman DC, Masson C et al. 2015. Longitudinal analysis of pain and illicit drug use behaviors in outpatients on methadone maintenance. Drug Alcohol Depend. 149:285-289. "This one-year longitudinal analysis did not identify a significant association between pain and illicit drug use in MMT populations. This finding conflicts with some earlier investigations and underscores the need for additional studies to clarify the complex association between pain and substance use disorders in patients in MMT program settings." Free Article

Dias RC, Costa EH, Kadija R Chrisostomo KR, et al. 2022.Fibromyalgia and menopause: an open study on postmenopausal hormone therapy. Minerva Obstet Gynecol. Jun 8. Online ahead of print. "HT improving sleep and quality of life in both groups; it was a significant clinical improvement seen by FIQ and FS in FM patients. These changes characterize improvement of functional status and symptoms severity."

Dias RCA, Kulak Junior J, Ferreira da Costa EH et al. 2019. Fibromyalgia, sleep disturbance and menopause: Is there a relationship? A literature review. Int J Rheum Dis. [Oct 14 Epub ahead of print] "The objective sleep patterns of FM patients included high sleep latency, frequent arousals and intrusion of alpha wave sleep and NREM (non-rapid eye movement) sleep in delta sleep. Poor sleep during menopause is more frequent in late perimenopause and surgical menopause, and may be related to vasomotor symptoms or not. Hormone therapy exerted a positive effect on subjective sleep quality of symptomatic menopausal women. Studies have shown a high association between FM and early and surgical menopause…. Further studies are needed to elucidate the nature of the association between menopause, sleep and persistent pain syndromes, such as FM, showing the role of hormone therapy in prospective placebo-controlled trials.

Diatchenko L, Fillingim RB, Smith SB et al. 2013. The phenotypic and genetic signatures of common musculoskeletal pain conditions. Nat Rev Rheumatol. [Apr 2 Epub ahead of print]. "Musculoskeletal pain conditions, such as fibromyalgia and low back pain, tend to coexist in affected individuals and are characterized by a report of pain greater than expected based on the results of a standard physical evaluation. The pathophysiology of these conditions is largely unknown, we lack biological markers for accurate diagnosis, and conventional therapeutics have limited effectiveness. Growing evidence suggests that chronic pain conditions are associated with both physical and psychological triggers, which initiate pain amplification and psychological distress; thus, susceptibility is dictated by complex interactions between genetic and environmental factors. Herein, we review phenotypic and genetic markers of common musculoskeletal pain conditions, selected based on their association with musculoskeletal pain in previous research. The phenotypic markers of greatest interest include measures of pain amplification and 'psychological' measures (such as emotional distress, somatic awareness, psychosocial stress and catastrophizing). Genetic polymorphisms reproducibly linked with musculoskeletal pain are found in genes contributing to serotonergic and adrenergic pathways. Elucidation of the biological mechanisms by which these markers contribute to the perception of pain in these patients will enable the development of novel effective drugs and methodologies that permit better diagnoses and approaches to personalized medicine."

Diaz, J. H. and H. J. Gould 3^rd.  1999.  Management of post-thoracotomy pseudoangina and myofascial pain with botulinum toxin.  Anesthesiology 91(3):877-9.  Diaz: Louisiana State University Medical Center, Multidisciplinary Pain Mastery Center, New Orleans 70112.

Diaz-Piedra C, Catena A, Miro E et al. 2013. The impact of pain on anxiety and depression is mediated by objective and subjective sleep characteristics in fibromyalgia patients. Clin J Pain. [Nov 25 Epub ahead of print]. "Subjective poor sleep quality was found in all patients. Pain correlated with subjective and objective sleep parameters, self-efficacy, anxiety, and, marginally, with depression. The mediated regression analysis suggested that the best models to explain the impact of pain on anxiety and depression included, as mediators, subjective sleep quality, objective sleep efficiency and self-efficacy….objective sleep efficiency being the mediator with the highest influence….These findings show a high prevalence of sleep problems in patients with FMS and suggest that they play a role in the relationship between pain and anxiety and depression. In fact, the impact of chronic pain on the later emotional variables was mediated, not only by self-efficacy, but also by subjective sleep quality and, especially, by objective sleep efficiency."

Dibai-Filho AV, Barros MA, de Oliveira AK et al. 2017. Electrical impedance of the torso is associated with the pressure pain threshold on myofascial trigger points in patients with chronic neck pain: A cross-sectional study. J Back Musculoskelet Rehabil. [Nov 10 Epub ahead of print] "Myofascial trigger points are dysfunctional structures present in skeletal muscles and are related to sensory, motor, and autonomic changes.... Electrical impedance of the torso is associated with the pressure pain threshold of myofascial trigger points on the upper trapezius of individuals with neck pain. Thus, individuals with a lower pressure pain threshold have higher electrical impedance values of the torso and vice versa."

Dibai-Filho AV, de Jesus Guirro RR, Koga Ferreira VT et al. 2018. Analysis of chronic myofascial pain in the upper trapezius muscle of breast cancer survivors and women with neck pain. J Bodyw Mov Ther. 22(2):237-241. "Myofascial trigger points are present in dysfunctioning muscles and are associated with several diseases....The conclusion of this study was that breast cancer survivors have a higher intensity of myofascial pain in the upper trapezius muscle when compared to patients with neck pain, which indicates the need for evaluation and a specific intervention for the myofascial dysfunction of these women."

Dick BD, Rashiq S. 2007. Disruption of attention and working memory traces in individuals with chronic pain.  Anesth Analg 104(5):1223-1229.  This research indicates that the maintenance of memory trace is affected by chronic pain.  Spatial memory was particularly affected.  "...pain may disrupt the maintenance of the memory trace that is required to hold information for processing and to later retain it for storage in longer-term memory stores.”

Dickman R, Feroze H, Fass R. 2006.  Gastroesophageal reflux disease and irritable bowel syndrome: a common overlap syndrome.  Curr Gastroenterol Rep 8(4):261-265.  GERD patients with IBS are less likely to respond to anti-reflux medications than patients without IBS and also perceive their symptoms to be more severe.  [The latter could be due to the central sensitization aspects of IBS.  DJS]

Dickstein, J. B., H. Moldofsky, F. A. Lue and J. B. Hay.  1999.  Intracerebroventricular injection of TNF-alpha promotes sleep and is recovered in cervical lymph.  Am J Physiol 276(4 Pt 2):

Dietz GP, Valbuena PC, Dietz B et al. 2006.  Application of a blood-brain-barrier-penetrating form of GDNF in a mouse model for Parkinson’s disease.  Brain Res. 1082(1):61-66.  [Although this is a rat study, it is an important step in finding a biochemical that can cross the blood-brain barrier and perhaps influence the development of central sensitization.  DJS]

Di Franco M, Iannuccelli C, Atzeni F et al. 2010. Pharmacological treatment of fibromyalgia. Clin Exp Rheumatol. 28(6 Suppl 63):S110-116. "Various drugs currently are available to control the complex and different symptoms reported by patients. Only three drugs (duloxetine, milnacipram, pregabalin) are approved by the American Food and Drug Administration (FDA) and none by the European Medicines Agency (EMEA), consequently, off-label use is habitual in Europe. Most of the drugs improve only one or two symptoms; no drug capable of overall symptom control is yet available. Furthermore, different classes of drugs with different mechanisms of action are used off-label, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), opioids, non-steroidal anti-inflammatory drugs (NSAIDs), growth hormone, corticosteroids and sedative hypnotics. As no single drug fully manages FM symptoms, multicomponent therapy should be used from the beginning. Various pharmacological treatments have been used to treat FM with inconclusive results, and gradually increasing low doses is suggested in order to maximize efficacy. The best treatment should be individualized and combined with patient education and non-pharmacological therapy." [It is strongly suggested that all co-existing conditions, including chronic myofascial pain, be identified and treated to decrease pain stimuli and symptom burden. All perpetuating factors of all conditions must be brought under control as much as possible. DJS]

Dias N, Zhang C, Spitznagle T et al.2020. High-density surface electromyography assessment of pelvic floor dysfunction in women with interstitial cystitis/bladder pain syndrome. J Urol. Jul 6;101097JU0000000000001237. "Up to 85% of women with interstitial cystitis/bladder pain syndrome (IC/BPS) have pelvic floor dysfunction and hypertonicity…. We examined the ability of utilizing intravaginal high-density surface electromyography (HD-sEMG) to quantitatively, objectively and non-invasively map PFM activity and innervation zone (IZ) locations in IC/BPS patients…. Conclusions: Intravaginal HD-sEMG offers an objective and quantitative strategy to non-invasively assess PFM dysfunction in women with IC/BPS." [USA] [Clinical and research specialists need to understand that this dysfunction and hypertonicity is at least largely due to myofascial trigger points. DJS]

Diem Vu TN, Aho JM, Puig CA et al. 2019. Heterotopic ossification of the xiphoid after chest compressions. Ann Thorac Surg. [May 17 Epub ahead of print] "We report the case of a 56 year-old female with a six-year history of severe epigastric pain following chest compressions for cardiac arrest. A comprehensive gastrointestinal workup was negative. However, an abdominal CT scan demonstrated an elongated xiphoid process. After a xiphoid trigger point injection, she experienced pain relief lasting four days, and thus her symptoms were attributed to xiphoidalgia secondary to heterotopic ossification following trauma. We performed an open resection of the xiphoid process. Heterotopic ossification of the xiphoid process is rare. To our knowledge, this is the only documented case secondary to trauma from chest compressions." [This case from the Mayo Clinic demonstrates how a medical procedure can create myofascial trigger points. If more care providers had expertise in TrPs, perhaps more of these would be found. Cardiac compression, like surgery, is a form of orchestrated trauma. DJS]

Di Girolamo S, Pisani V, Di Girolamo M et al. 2013. Atypical facial pain secondary to an unusual iatrogenic endonasal "contact point". Pain Med. 14(1):167-168.

DiGiusto M, Suleman MI. 2018. Anterior cutaneous nerve entrapment syndrome in a pediatric patient previously diagnosed with functional abdominal pain: A case report. A A Pract. [Mar 23 Epub ahead of print] "Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. Anterior cutaneous nerve entrapment syndrome causes abdominal wall pain but is frequently overlooked. Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but experienced pain remittance after receiving a trigger-point injection and transverse abdominis plane block."

Dijk DJ. 2008.  Slow-wave sleep, diabetes, and the sympathetic nervous system.  Proc Natl Acad Sci U S A. 105(4):1107-1108.  Slow wave (delta) sleep has a profound impact on brain regulatory functions, including glucose regulation and the development of insulin resistance.  [It is becoming more recognized that preventative medicine must include assurance of restorative sleep. DJS]

DiLorenzo L, Traballesi M, Morelli D et al. 2004.  Hemiparetic shoulder pain syndrome treated with deep dry needling during early rehabilitation: a prospective, open-label, randomized investigation.  J Musculoskel Pain 12(2):25-34.  Deep dry needling was associated with significant reduction of pain during sleep and physiotherapy.

Dimitrova S, Stoilova I, Cholakov I.  2004.  Influence of local geomagnetic storms on arterial blood pressure.  Bioelectromagnetics 25(6):408-414.  “Arterial bp was found to increase with the increase of the GMA level, and systolic and diastolic bp were found to increase significantly from the day before till the second day after the geomagnetic storm.  These effects were present irrespective of sex and medication.”  [FMS hypersensitivity to stimuli may cause greater sensitivity to geomagnetic effects. DJS.]

Ding F, O'Donnell J, Xu Q et al. 2016. Changes in the composition of brain interstitial ions control the sleep-wake cycle. Science. 352(6285):550-555. "Wakefulness is driven by the widespread release of neuromodulators by the ascending arousal system. Yet, it is unclear how these substances orchestrate state-dependent, global changes in neuronal activity." The neuromodulators may be driven by the ion channels. This study indicates that the concentration of metallic ions, such as potassium, magnesium and calcium, may be instrumental in getting us to sleep and waking us up. This may provide another promising avenue to address some sleep dysfunctions. A change in sleep state can be imposed in mice by altering the extracellular ion concentrations, independent of nerve activity. [There is also an excellent article on this written for laymen, with a report by Dr. Maiken Nedergaard. She has been involved in glymphatic system research, including the discovery of the glymphatic system. Saey TS. 2016. Ions, not neurons, may oversee sleep. Science News. May 28. DJS]

Ding X, Li Y, Cui Y et al. 2016. [Fibromyalgia syndrome after comprehensive treatment of breast cancer: a case report]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 45(4):429-431. [Article in Chinese] "Here we present a case of a 50-year-old female patient, who was admitted to the hospital because of generalized fibromyalgia for 3 months and brain metastasis after the right breast carcinoma surgery for 1 month, and the clinical diagnosis was brain metastasis from breast carcinoma combined with fibromyalgia syndrome. The fibromyalgia (symptoms) were relieved with proper symptomatic treatment but the patient eventually died of tumor progression."

DiNuzzo M, Nedergaard M. 2017. Brain energetics during the sleep-wake cycle. Curr Opin Neurobiol. 47:65-72. "Brain activity during wakefulness is associated with high metabolic rates that are believed to support information processing and memory encoding. In spite of loss of consciousness, sleep still carries a substantial energy cost. Experimental evidence supports a cerebral metabolic shift taking place during sleep that suppresses aerobic glycolysis, a hallmark of environment-oriented waking behavior and synaptic plasticity. Recent studies reveal that glial astrocytes respond to the reduction of wake-promoting neuromodulators by regulating volume, composition and glymphatic drainage of interstitial fluid. These events are accompanied by changes in neuronal discharge patterns, astrocyte-neuron interactions, synaptic transactions and underlying metabolic features. Internally-generated neuronal activity and network homeostasis are proposed to account for the high sleep-related energy demand." Free Article

Di Pierro F, Rossi A, Consensi A et al. 2016. Role for a water-soluble form of CoQ10 in female subjects affected by fibromyalgia. A preliminary study. Clin Exp Rheumatol. [Dec 13 Epub ahead of print.] "Our results show that, compared to a control group, administration of CoQ10 significantly improved most pain-related outcomes by 24-37%, including fatigue (by ~22%) and sleep disturbance (by ~33%). These results confirm the considerable role played by CoQ10 in reducing pain, fatigue, and sleep disturbance in subjects affected by fibromyalgia."

Diraçoglu D, Vural M, Karan A et al. 2012. Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: A double-blind, randomized, placebo controlled study. J Back Musculoskel Rehabil. 25(4):285-290. "Dry needling appears to be an effective treatment method in relieving the pain and tenderness of myofascial trigger points."

Dirckx M, Groeneweg G, van Daele PL et al. 2013. Mast Cells: A New Target in the Treatment of Complex Regional Pain Syndrome? Pain Pract. [Mar 14 Epub ahead of print]. "There is convincing evidence that inflammation plays a pivotal role in the pathophysiology of complex regional pain syndrome (CRPS). Besides inflammation, central sensitization is also an important phenomenon. Mast cells are known to be involved in the inflammatory process of CRPS and also play a role (at least partially) in the process of central sensitization. In the development of a more mechanism-based treatment, influencing the activity of mast cells might be important in the treatment of CRPS. We describe the rationale for using medication that counteracts the effects of mast cells in the treatment of CRPS."

Di Stefano G, Celletti C, Baron R et al. 2016. Central sensitization as the mechanism underlying pain in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. Eur J Pain. [Feb 26 Epub ahead of print]. "In patients with JHS/EDS-HT, the persistent nociceptive input due to joint abnormalities probably triggers central sensitization in the dorsal horn neurons and causes widespread pain."

Di Tella M, Tesio V, Ghiggia A et al. 2017. Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia. Scand J Psychol. [Nov 7 Epub ahead of print] "Regarding coping strategies, FM patients reported higher scores on problem-focused coping, with respect to the other two coping strategies.....the externally-oriented thinking factor of alexithymia significantly explained both problem- and emotion-focused coping, while the difficulty-describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients." ["Alexithymia" is a term coined by Peter Sifneos in 1973 to describe a state of deficiency in understanding, processing, or describing emotions."]

Di Tommaso Morrison MC, Carinci F, Lessiani G et al. 2017. Fibromyalgia and bipolar disorder: extent of comorbidity and therapeutic implications. J Biol Regul Homeost Agents. 31(1):17-20. "The reviewed articles showed that an adequate psychiatric screening for BD is recommended in FM patients with depressive symptoms, in order to decrease administration of antidepressants for BD, due to the lack of proven efficacy, and to limit antidepressant-induced mania. Alternative therapies, such as agomelatine, memantine and psychotherapic treatment should be considered."

Dixon AM, Fitzgerald CM, Brincat C. 2019. Severity and bother of prolapse symptoms in women with pelvic floor myofascial pain. Int Urogynecol J. [Mar 14 Epub ahead of print] "Our aim was to assess severity and bother of pelvic organ prolapse (POP) in women with pelvic floor myofascial pain (PFMP).... One in three women with a diagnosis of POP were found to have PFMP. On average, when pain was present, women had a lower stage of prolapse and were more severely bothered by their pelvic floor symptoms. Although limited by its nature as a retrospective analysis, this study suggests alternative etiologies, and thereby treatments, for symptom bother in women with mild prolapse."

Dixon EA, Benham G, Sturgeon JA et al. 2016. Development of the Sensory Hypersensitivity Scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli. J Behav Med. [Feb 12 Epub ahead of print]. "Sensory hypersensitivity is one manifestation of the central sensitization that may underlie conditions such as fibromyalgia and chronic fatigue syndrome. We conducted five studies designed to develop and validate the Sensory Hypersensitive Scale (SHS)….The SHS appears suitable as a screening measure for sensory hypersensitivity, though additional research is warranted to determine its suitability as a proxy for central sensitization."

Do TP, Heldarskard GF, Kolding LT et al. 2018. Myofascial trigger points in migraine and tension-type headache. J Headache Pain. 19(1):84. "Myofascial trigger points are prevalent in both migraine and tension-type headache, but the role they play in the pathophysiology of each disorder and to which degree is unclarified. In the future, ultrasound elastography may be an acceptable diagnostic test." Free Article

Docampo E, Escaramís G, Gratacos M et al. 2014. Genome-wide analysis of single nucleotide polymorphisms and copy number variants in fibromyalgia suggest a role for the central nervous system. Pain. 155(6):1102-1109. "Fibromyalgia (FM) is a highly disabling syndrome defined by a low pain threshold and a permanent state of pain. The mechanisms explaining this complex disorder remain unclear, and its genetic factors have not yet been identified. With the aim of elucidating FM genetic susceptibility factors, we selected 313 FM cases having low comorbidities, and we genotyped them on the Illumina 1 million duo array. Genotypic data from 220 control women (Illumina 610k array) was obtained for genome-wide association scan (GWAS) analysis. Copy number variants in FM susceptibility were analyzed by array comparative genomic hybridization (aCGH) experiments on pooled samples using the Agilent 2×400K platform. No single nucleotide polymorphism (SNP) reached GWAS association threshold, but 21 of the most associated SNPs were chosen for replication in 952 cases and 644 controls. Four of the SNPs selected for replication showed a nominal association in the joint analysis, and rs11127292 (MYT1L) was found to be associated to FM with low comorbidities (P=4.28×10(-5), odds ratio [95% confidence interval]=0.58 [0.44-0.75]). aCGH detected 5 differentially hybridized regions. They were followed up, and an intronic deletion in NRXN3 was demonstrated to be associated to female cases of FM with low levels of comorbidities (P=.021, odds ratio [95% confidence interval]=1.46 [1.05-2.04]). Both GWAS and aCGH results point to a role for the central nervous system in FM genetic susceptibility. If the proposed FM candidate genes were further validated in replication studies, this would highlight a neurocognitive involvement in agreement with latest reports."

Doerr JM, Fischer S2, Nater UM et al. 2017. Influence of stress systems and physical activity on different dimensions of fatigue in female fibromyalgia patients. J Psychosom Res. 93:55-61. "Fatigue is a defining characteristic and one of the most debilitating features of fibromyalgia syndrome (FMS). The mechanisms underlying different dimensions of fatigue in FMS remain unclear. The aim of the current study was to test whether stress-related biological processes and physical activity modulate fatigue experience…. Lower increases in cortisol after awakening predicted higher mean daily general and physical fatigue levels. Additionally, mean daily physical activity positively predicted next-day mean general fatigue. Levels of physical fatigue at a specific time point were positively associated with momentary cortisol levels. The increase in cortisol after awakening did not mediate the physical activity - fatigue relationship. There were no associations between alpha-amylase and fatigue…. Our findings imply that both changes in hypothalamic-pituitary-adrenal axis activity and physical activity contribute to variance in fatigue in the daily lives of patients with FMS."

Doğan AG. Evaluation of neutrophil-lymphocyte ratio, lymphocyte-monocyte, and monocyte-high density lipoprotein ratios in patients with fibromyalgia and determination of their relationship with disease activity, pain, and depression levels. Eur Rev Med Pharmacol Sci. 2023 Jun;27(11):4929-4935. This study shows that in fibromyalgia patients, monocyte level and MHR were higher than in healthy subjects. Also, high-density lipoprotein-cholesterol (HDL-C) level was found lower, and the total cholesterol level was found higher in patients with FM. Increased LMR and HDL-C values were found as responsible for decreasing the risk of developing FM and increased glucose and total cholesterol values were responsible for increasing the risk of FM developing.

Dogan SC, Karadagg A, Durmuş K et al. 2018. Evaluation of allergic rhinitis with nasal symptoms and nasal mucociliary clearance in patients with fibromyalgia syndrome. J Back Musculoskelet Rehabil. [May 25 Epub ahead of print] "The results we obtained suggest that there is a high possibility of coexistence of FM and AR Allergic rhinitis. As a result, the coexistence of AR and FM cannot be denied but we believe that comprehensive clinical studies should be conducted on this subject."

Doggweiler-Wiygul R. 2004.  Urologic myofascial pain syndromes.  Curr Pain Headache Rep. 8(6):445-451.  “Treatment of pain of urogenital origin, chronic pelvic pain syndrome, can be frustrating for patients and physicians.  The usual approaches do not always produce the desired results.  Visceral pain from pelvic organs and myofascial pain from muscle trigger points share common characteristics.  Referred pain from myofascial trigger points can mimic visceral pain syndromes and visceral pain syndromes can induce trigger point development and myofascial pain and dysfunction.  The referred pain syndrome can long outlast the initial event, making diagnosis difficult.”

Doggweiler-Wiygul R, 2004.  Urological myofascial pain syndromes.  Curr Pain Headache Rep 8(6):445-451.  It can be difficult to distinguish pain from visceral organs and pain due to myofascial  trigger points that refer to the same areas.  Visceral pain can also be a perpetuating factor of TrPs, although the TrPs themselves can perpetuate the pain and other symptoms long after the visceral problem is under control.

Doggweiler-Wiygul R., Wiygul J.P.  Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients.  World J Urol 20(5):310-4.  “Referred pain and motor activity to the pelvic floor muscles (sphincters), as well as to the pelvic organs, can be the sole cause of IC, IPP, and irritative voiding dysfunction...”

Domany E, Gilad O, Shwarz M et al. 2013. Imperforate hymen presenting as chronic low back pain. Pediatrics. 132(3):e768-770. In some women, the hymen has an insufficient opening to allow the menses to flow. This case report is from the Pediatrics Dept. of B. Schneider Children's Medical Center of Israel. "Imperforate hymen in an adolescent usually presents with cyclic abdominal pain or with pelvic mass associated with primary amenorrhea. We present a 13-year-old girl with chronic lower back pain of 6 months' duration as the only complaint. On physical examination, multiple trigger points were detected in the quadratus lumborum and gluteus medius muscles bilaterally….Hymenectomy was performed, with complete resolution of the back pain. Myofascial pain syndrome with a viscerosomatic reflex is a possible explanation for the clinical presentation of our patient."

Domingo T, Blasi J, Casals M et al. 2011. Is interfascial block with ultrasound-guided puncture useful treatment of myofascial pain of the trapezius muscle. Clin J Pain Feb 11 [Epub ahead of print] Interfascial diffusion of local anesthetic may be useful for treating trapezius myofascial pain. Patients experienced significant relief with guided local anesthetic injection into this area. The authors did a cadaver study and found that numerous nerve structures in the interfascial space could be a significant part of pain generation in some patients. [Myofascial TrPs take a while to form. This study may the first using injection of local anesthetic to treat the interfascial area to relieve pain. DJS]

Dommerholt J. 2020. How have the views on myofascial pain and its treatment evolved in the past 20 years? From spray and stretch and injections to pain science, dry needling and fascial treatments. Pain Manag. [Mar 3 Epub ahead of print]. The International Association of Pain has recognized myofascial pain as a prevalent cause of musculoskeletal pain, and the amount and quality of research continues to increase. In spite of this, there are still some who "do not believe" in trigger points. More treatments have become available, although, in the USA, some that have been shown helpful elsewhere have not been tested. This paper has an overview of dry needling status and the importance of understanding fascial involvement in the context of musculoskeletal pain, along with the hope that clinicians will incorporate available research into their practices."

Dommerholt J. 2011. Dry needling - peripheral and central considerations. J Man Manipul Ther. 19(4):223-237. This interesting review was prepared by someone I know and respect as a master of both dry needling and trigger points. I have had discussions on this topic with my co-author, John Sharkey, who fits both of these descriptions as well. This review clarifies many points. One of these is points is that the active or latent status of a TrPs at least partially depends on any degree of co-existing central sensitization. Readers are cautioned that new ultrasound and magnetic resonance elastographic techniques that have proven the existence of TrPs are not available for clinical use, and explains the importance of carefully checking anatomic landmarks to avoid damage of other tissues. Included is a fine overview of the current controversy on dry needling between acupuncturists and physical therapists. It is true that there are some physical therapists who have managed to go through school without learning about TrPs, just as there are acupuncturists who have done the same. Perhaps we are looking too much at titles and too little at specific training. Certainly, an MD, DO or any other title after a name does not qualify someone to perform a TrP injection, although many do. This article contains much food for thought, offered by an eminently qualified writer. DJS

Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part II–examination. J Bodyw Mov Ther 14(1):65-72. This second in the series article illustrates how to follow the clues given in the medical history and translate them into the examination.

Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part III-Case histories. J Bodyw Mov Ther 13(4):311-319. This last in the series article gives 3 case histories of musicians with hand pain. The clues given in the history and exam (part I and II) lead to specific diagnoses, followed with individual treatment plans and control of perpetuating factors.

Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part II–examination. J Bodyw Mov Ther 14(1):65-72. This second in the series article illustrates how to follow the clues given in the medical history and translate them into the examination.

Dommerholt J. 2010. Performing arts medicine-instrumentalist musicians part III-Case histories. J Bodyw Mov Ther 13(4):311-319.  This last in the series article gives 3 case histories of musicians with hand pain.  The clues given in the history and exam (part I and II) lead to specific diagnoses, followed with individual treatment plans and control of perpetuating factors. 

Dommerholt J. 2009.  Performing arts medicine-instrumentalist musicians part I-general considerations. J Bodyw Mov Ther 13(4):311-319.  This is an excellent paper illustrating the importance of history taking to the discovery of the total pattern of accommodation and altered function that can occur in instrumental musicians.  It has lessons for all care providers who must assess chronic pain conditions.  These patients arrived with incorrect diagnoses and a lot of pain and dysfunction, but found hope and a chance of resuming their careers.

Dommerholt J. 2009. Performing arts medicine-instrumentalist musicians part I-general considerations. J Bodyw Mov Ther 13(4):311-319.  This is an excellent paper illustrating the importance of history taking to the discovery of the total pattern of accommodation and altered function that can occur in instrumental musicians. It has lessons for all care providers who must assess chronic pain conditions.  These patients arrived with incorrect diagnoses and a lot of pain and dysfunction, but found hope and a chance of resuming their careers.

Dommerholt, Jan, 2000. Fibromyalgia: time to consider a new taxonomy?  Persons with fibromyalgia have altered nociception, hyperalgesia, allodynia, and hypervigilance. The term "fibromyalgia" does not describe the etiology of the syndrome adequately.

Dommerholt J, Bron C, Frannsen J. 2006.  Myofascial trigger points: An evidence-informed review.  J Man Manip Ther 14(4):203-221.  This excellent review includes history, examination procedures, and a good overview of the evidence-based material on MTPs.  Although it is written for manual therapists, it is worthy reading for all care providers, including physicians. 

Dommerholt J, Finnegan M, Grieve R et al. 2016. A critical overview of the current myofascial pain literature - January 2016. J Bodyw Mov Ther. 20(1):156-67. Reflecting on the past year, the number of publications on myofascial pain continues to increase in a steady rate. The current review includes 30 basic and clinical studies, case reports, reviews, and reports from fifteen different countries about trigger points (TrP), myofascial pain (MP), dry needling (DN) and other related interventions….In general, the quality of published papers is improving as well. Nevertheless, several papers included in this overview, mention the application of "ischemic compression", which is a questionable concept in the context of TrP inactivation. As we have outlined previously, in the current thinking about myofascial pain, TrPs feature significant hypoxia and a lowered pH (Ballyns et al., 2011; Shah and Gilliams, 2008), and attempts to induce more ischemia would be counterproductive. Already in 1999, Simons, Travell and Simons changed the terminology from ischemic compression to TrP compression (Simons et al., 1999) and we recommend that contemporary researchers and clinicians adopt the new terminology and stop using the term "ischemic compression."

Dommerholt J, Finnegan M, Hooks T et al. 2017. A critical overview of the current myofascial pain literature - October 2017. J Bodyw Mov Ther. 21(4):902-913. "In this overview of the myofascial pain literature, we have included several original contributions ranging from a study by Bowen and colleagues of trigger points in horses to the introduction of a new clinical entity of "laryngeal muscle myofascial pain syndrome in dysphonic patients." Minerbi and colleagues described for the first time the referred pain patterns of the longus colli muscle, while Casale and associates studied the spinal modulatory action of dry needling or acupuncture stimulation. Many dry needling articles are included in this overview with several recent outcome studies. Slowly, there is increasing scientific support for using dry needling for a variety of conditions. Several researchers explored specific aspects of dry needling, such as needle placements, whether eliciting a local twitch response is desired, and the role of psychological factors in post-needling soreness. Contributions originated in Australia, Belgium, Brazil, Canada, China, Germany, Greece, India, Israel, Italy, Korea, Portugal, Spain, Switzerland, Turkey, the UK, and the USA."

Dommerholt J, Gerwin RD. 2022. Diagnostics (Basel). 2022 Sep 29;12(10):2365. Contracture knots vs. trigger points. Comment on Ball et al. ultrasound confirmation of the multiple loci hypothesis of the myofascial trigger point and the diagnostic importance of specificity in the elicitation of the local twitch response. Diagnostics 2022, 12, 321. "A recent study published in Diagnostics attempted to visualize trigger points and contracture knots with high-definition ultrasound. Based on their findings, the authors reversed the commonly understood meaning of the two terms. However, they did so without providing any convincing evidence. The authors maintained that their sonography images represented trigger points within contracture knots, supporting the multiple loci hypothesis. On review of the paper, both conclusions seem premature and rather speculative." Free article (USA)

Dommerholt J, Gerwin RD. 2015. A critical evaluation of Quintner et al: Missing the point. J Bodyw Mov Ther. 19(2):193-204. "The objective of this article is to critically analyze a recent publication by Quinter, Bove and Cohen, published in Rheumatology, about myofascial pain syndrome and trigger points (Quintner et al., 2014). The authors concluded that the leading trigger point hypothesis is flawed in reasoning and in science. They claimed to have refuted the trigger point hypothesis. The current paper demonstrates that the Quintner et al. paper is a biased review of the literature replete with unsupported opinions and accusations. In summary, Quintner et al. have not presented any convincing evidence to believe that the Integrated TrP Hypothesis should be laid to rest." [This article proves that the article written by Quintner and company "debunking trigger points", to put it politely, is total nonsense. I wonder how the flawed article by Quintner and co. was published at all. DJS]

Dommerholt J, Grieve R, Hooks T et al. 2015. A critical overview of the current myofascial pain literature - October 2015. J Bodyw Mov Ther. 19(4):736-746. "The number of publications about myofascial pain and trigger points (TrP) seems to increase every year. In the current overview we include 27 articles published in past months. The Basic Review section includes articles about the presence and characteristics of TrPs in various neck and shoulder muscles, the correlation between referred pain from active TrPs and knee osteoarthritis, and an anatomical study exploring whether the location of TrPs may be related to the nerve innervation of muscles. Zuil-Escobar and colleagues from Spain considered the intra-rater reliability of the identification of latent TrPs in several leg muscles and the possible correlation of TrP and the presence of a lower medial longitudinal arch. In the section on manual approaches, contributing author Rob Grieve and colleagues continue their studies of TrPs in the lower extremity muscles, while Méndez-Rebolledo and colleagues studied the impact of cross taping and compression. Dry needling (DN) continues to be a topic of interest. We included twelve papers addressing a wide range of topics, such as the effectiveness and safety of DN, and the impact of DN on proprioception, spasticity, and fibromyalgia. Two papers investigated the utilization of repetitive transcranial magnetic stimulation and laser on TrPs, The final section on other clinical studies and reviews includes 8 papers. The studies originated in thirteen different countries with Spain leading the charts with 7 contributions to the literature, followed by Brazil with four."

Dommerholt J, Grieve R, Layton M et al. 2015. An evidence-informed review of the current myofascial pain literature - January 2015. J Bodyw Mov Ther. 19(1):126-137. "This article provides an up-to-date review of the most recent publications about myofascial pain, trigger points (TrPs) and other related topics. We have added some commentaries where indicated with supporting references. In the Basic Research section, we reviewed the work by Danish researchers about the influence of latent TrPs and a second study of the presence and distribution of both active and latent TrPs in whiplash-associated disorders. The section on Soft Tissue Approaches considered multiple studies and case reports of the efficacy of myofascial release (MFR), classic and deep muscle massage, fascial techniques, and connective tissue massage. Dry needling (DN) is becoming a common approach and we included multiple studies, reviews, and case reports, while the section on Injection Techniques features an article on TrP injections following mastectomy and several articles about the utilization of botulinum toxin. Lastly, we review several articles on modalities and other clinical approaches."

Dommerholt J, Layton M, Hooks T et al. 2015. A critical overview of current myofascial pain literature - March 2015. J Bodyw Mov Ther. 19(2):337-349. "The second article in this review series considers multiple recent publications about myofascial pain, trigger points (TrPs) and other related topics. The article is divided into several sections, including a Basic Research section (4 articles), a section on Soft Tissue Approaches (5 articles), a Dry Needling and Acupuncture section (7 articles), an Injection section (2 articles), a section on. Modalities (1 article), Other Clinical Approaches (3 articles) and finally a Reviews section (7 articles). The thirty publications reviewed in this article originated in all corners of the world."

Donelly JM, Fernandez-de-las-Penas C, Finnegan M, Freeman JL. 2018. Travell, Simons and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, edition 3. Philadelphia PA. Wolters Kluwer. This 3rd edition is entirely evidence based, and a valuable and much-needed addition to the definitive texts provided by the founders of myofascial medicine.

Dones V 3rd, Dalusong MT, Chiong-Maya A, et al. The difference in the upper trapezius deep fascia slides between individuals with and without myofascial pain syndrome: A case-control study. J Bodyw Mov Ther. 2024 Apr:38:375-383. "A limited deep fascia slide does not characterize MPS participants from non-MPS participants."

Dong XX, Guo M, Huang LX, et al. 2021. The efficacy of manipulation as a treatment for myofascial pelvic pain. Int Urol Nephrol. Apr 2. Online ahead of print. "The main symptoms of MFPP in the study sample consisted of lower abdominal pain, lumbosacral pain, or mixed pain, which together accounted for 67% of all symptoms. Patients often had multiple trigger points, covering 47.17% of the body. The differences between the treatment group and control group in the changes in pelvic floor muscle strength, number of pain points, pain scores, resting EMG of pelvic floor muscles, and relaxation time after muscle contraction were all statistically significant…. The differences between the pre-treatment and post-treatment groups in the changes in pelvic floor muscle strength, number of pain points, pain scores, resting EMG of pelvic floor muscles, and relaxation time after muscle contraction were all statistically significant."

Donnally CJ 3rd, Vakharia RM, Rush AJ 3rd et al. 2018. Fibromyalgia as a predictor of increased post-operative complications, readmission rates and hospital costs in patients undergoing posterior lumbar spine fusion. Spine (Phila Pa 1976). [Jul 27 Epub ahead of print] "Primary 1 to 2 level lumbar fusions performed on fibromyalgia patients have higher rates of post-operative anemia, pneumonia, cost of care, and readmission compared to match controls. Fibromyalgia patients and surgeons should be aware of these increased risks in an effort to control hospital costs and potential complications."

Donnelly JM, Palubinskas L. 2007.  Prevalence and inter-rater reliability of trigger points.  J Musculoskel Pain 15 (Supp 13):16 item 21.  [Myopain 2007 Poster]  This research not only confirmed that practitioners skilled in palpation had excellent inter-rater reliability for MTPs, but also found that many healthy college students had taut bands and MTPs.  [It would be interesting to follow these students and find out if these latent MTPs caused restricted range of motion, if there were one or more perpetuating factors, and if they activated at a later time. DJS]

Donnelly, J. M. 2002. Physical therapy approach to fibromyalgia with myofascial trigger points: a case report. J Musculoskel Pain 10(1/2)177-190.  This report indicates that a well educated and function-oriented patient coupled with a care provider who is well-trained in the recognition of fibromyalgia and myofascial trigger points can work as a team to significantly improve the patient’s quality of life, improving function and decreasing pain level.

Doorenbos AZ, Gordon DB, Tauben D et al. 2013. A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain. 14(12):1533-1538. "Findings confirm the paucity of pain education across the health sciences curriculum in a CoEPE that serves a large region of the United States. The data provide a pain curriculum blueprint that can be used to recommend added pain content tin health sciences programs across the country."

Doorley J, Greenberg J, Stauder M, et al. 2021. The role of mindfulness and relaxation in improved sleep quality following a mind-body and activity program for chronic pain. Mindfulness (N Y). Nov;12(11):2672-2680. Poor sleep quality is prevalent among individuals with chronic pain and contributes to increased physical and emotional dysfunction. However, treatments that improve sleep quality among individuals with chronic pain are scant. A previously developed mind-body activity program for chronic pain has been shown to be feasible and associated with improvements in pain and physical and emotional function. Using secondary data-analysis, the purpose of this study was to understand whether participants also experienced significant and sustained improvements in sleep quality over time and whether these improvements were explained by change in two core treatment targets, relaxation and mindfulness…. Results suggest that, despite not targeting sleep explicitly, the two mind-body activity programs hold promise for sustainably improving sleep quality among patients with chronic pain. Targeting mindfulness and relaxation may facilitate these improvements.

Doppler K1, Rittner HL, Deckart M et al. 2015. Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia. Pain. [Jul 7 Epub ahead of print.] "Our study provides further evidence of small fiber pathology in fibromyalgia syndrome and discloses differences compared to small fiber neuropathy, indicating that different pathomechanisms may lead to small fiber loss in the two disorders."

Dor A, Kalichman L. 2017. A myofascial component of pain in knee osteoarthritis. J Bodyw Mov Ther. 21(3):642-647. "The knee is the most common site of OA. Numerous studies have shown an inconsistency between patients' reports of pain and their radiographic findings. This inconsistency may be partially explained by the fact that a portion of the pain originates from the myofascial trigger points (MTrPs) located in the surrounding muscles…. The reviewed observational studies offered initial evidence as to the assumption that myofascial pain and the presence of MTrPs may play a role in pain and disability of knee OA. Because of the cross-sectional design of these studies, the causal relationships could not be established. Additional studies are needed to confirm this assumption as well as to clarify if MTrPs are a portion of OA etiology or that OA is the basis for MTrPs formation. Each interventional study elaborated on various myofascial treatment techniques. However, treatment focusing on MTrPs seems to be effective in reducing pain and improving function in OA patients." [If we treat trigger points promptly, perhaps OA may not even develop. DJS]

Dor A, Vatine JJ, Kalichman L. Proximal myofascial pain in patients with distal complex regional pain syndrome of the upper limb. J Bodyw Mov Ther. 2019 Jul; 23(3):547-554. "There is a high prevalence of MTrPs (myofascial trigger points) in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients."

Dorey G, Speakman M, Feneley R et al. 2004. Randomized controlled trial of pelvic floor muscle exdercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract 54(508):819-825. Research indicates that pelvic floor exercises and manometric biofeedback are as effective as Viagra for erectile dysfunction.

Dorris ER, Maccarthy J, Simpson K, et al. Sensory perception quotient reveals visual, scent and touch sensory hypersensitivity in people with fibromyalgia syndrome. Front Pain Res (Lausanne). 2022 Jul 5;3:926331. "Environmental sensitivity is commonly reported by people with fibromyalgia syndrome. People living with fibromyalgia syndrome frequently report hypersensitivity to noxious and non-noxious sensations…. These findings demonstrate greater sensory hypersensitivity in people with fibromyalgia compared to people with other chronic pain disorders. Greater hypersensitivity was restricted to touch, vision, and smell, all of which have previously been demonstrated to crosstalk with nociception. [FM isn't just pain. The allodynia component of FM may amplify all sorts of sensations, such as dizziness, nausea and other autonomic dysfunctions that can be caused by specific MTrPs and other co-existing illnesses. We need more research. DJS]

Doss J, Mo H, Carroll RJ et al. 2016. Phenome-wide association study of rheumatoid arthritis subgroups identifies association between seronegative disease and fibromyalgia. Arthritis Rheumatol. [Sep 2 Epub ahead of print]. Many people with the diagnosis of seronegative RA have FM. Others with seropositive RA may also have FM. [Many doctors erroneously assume FM to be a diagnosis of exclusion, including some who wrote papers included in this review, leading to a skewed representation. DJS]

Dossett ML, Yeh GY. 2018. Homeopathy use in the United States and implications for public health: A review. Homeopathy. 107(1):3-9. "Homeopathy is used by just over 2% of the U.S. population, predominantly for respiratory, otorhinolaryngology, and musculoskeletal complaints.... Data suggest the potential for public health benefit from homeopathy, especially for conditions such as upper respiratory infections and fibromyalgia.

Dotan I, Riesenberg K, Toledano R et al. 2016. Prevalence and characteristics of fibromyalgia among HIV-positive patients in southern Israel. Clin Exp Rheumatol. [Mar 3 Epub ahead of print]. "Despite the dramatic improvement in management of HIV, FMS symptoms remain highly prevalent among these patients and are not directly correlated with indices of active disease. FMS is an important clinical issue to address among patients suffering from HIV infection."

Dreon, D. M., H. A. Fernstrom, P. T. Williams and R. M. Krauss.  1999.  A very low-fat diet is not associated with improved lipoprotein profiles in men with a predominance of large, low-density lipoproteins.  Am J Clin Nutr 69(3):411-8.  

Drewes, A. M. , K. D. Kielson, S. J. Taagholt, K. Bjerregard, L. Svendsen and J. Gade. 1995. Sleep intensity in fibromyalgia: focus on the micro-structure of the sleep process. Br J Rheumatol 34(7):629-635.

Dreyer L, Kendall S, Danneskiold-Samsoe B et al. 2010. Mortality in a cohort of Danish patients with fibromyalgia - increased suicide, liver disease and cerebrovascular disease. Arthritis Rheum. [Jun 25 Epub ahead of print]. "Among the 1269 female patients, an increased risk of death from suicide SMR=10.5[95%CI: 4.5-20.7], liver cirrhosis/biliary tract disease SMR=6.4[95%CI:2.3-13.9], and cerebrovascular disease SMR=3.1[95%CI:1.1-6.8] was observed. Suicide risk was increased at time of diagnosis and remained after 5 years….No increased cause-specific mortality was observed in the 84 male patients…..The causes of markedly increased rate of suicide in female FM are at present unknown, but may be related to increased rates of lifetime depression, anxiety, and psychiatric disorders. Risk factors for suicide should be sought at time of diagnosis and at follow up. The results also suggest that risk factors for liver disease and cerebrovascular disease should be evaluated in FM patients."

Dromey C, Nissen SL, Roy N et al. 2008.  Acticulatory changes following treatment of muscle tension dysphonia: preliminary acoustic evidence.  J Speech Lang Hear Res. 51(1):196-208.  [This work indicates that manual therapy in the laryngeal muscles may be helpful in vocal dysfunction.  I believe that these authors have been working on trigger points in the laryngeal muscles without knowing it. DJS]

Druce KL, McBeth J. 2019. Central sensitization predicts greater fatigue independently of musculoskeletal pain. Rheumatology (Oxford). [Feb 27 Epub ahead of print] "Fatigue was predicted by central sensitization, independently of the presence of pain. For those seeking to treat fatigue, the benefit of interventions that reduce central sensitization should be investigated." [This is logical, and important, as it is often forgotten. To treat FM successfully, you need to identify and treat the sources of pain and irritation that are keeping the CNS aggravated, such as MTrPs, insulin and thyroid resistance, arthritis, and other coexisting conditions. DJS]

Drummond PD, Finch PM. Auditory disturbances in patients with complex regional pain syndrome. Pain. 2022 Aug 24. Online ahead of print. "Complex regional pain syndrome (CRPS) is often associated with reduced sound tolerance (hyperacusis) on the affected side, but the mechanism of this symptom is unclear. As compensatory increases in central auditory activity after cochlear injury may trigger hyperacusis, hearing and discomfort thresholds to pure tones (250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz, 4,000 Hz, 6,000 Hz and 8,000 Hz) were assessed in 34 patients with CRPS and 26 pain-free controls. In addition, in 31 patients and 17 controls, auditory evoked potentials to click stimuli (0.08 msec duration, 6 Hz, 60 dB above the hearing threshold) were averaged across 2,000 trials for each ear. Auditory discomfort thresholds were lower at several pitches on the CRPS-affected than contralateral side, and lower at all pitches on the affected side than in controls. However, ipsilateral hyperacusis was not associated with psychophysical or physiological signs of cochlear damage. Instead, neural activity in the ipsilateral brainstem and midbrain was greater when repetitive click stimuli were presented on the affected than contralateral side, and greater bilaterally than in controls. In addition, click-evoked potentials, reflecting thalamo-cortical signal transfer and early cortical processing, were greater contralaterally in patients than controls. Together, these findings suggest that hyperacusis originates in the ipsilateral brainstem and midbrain rather than the peripheral auditory apparatus of patients with CRPS. Failure of processes that jointly modulate afferent auditory signalling and pain (e.g., inhibitory influences stemming from the locus coeruleus) could contribute to ipsilateral hyperacusis in CRPS."

Drummond PD, Finch PM. 2020. Photophobia in complex regional pain syndrome: visual discomfort is greater on the affected than unaffected side. Pain. Oct 20. Online ahead of print. "In complex regional pain syndrome (CRPS), hyperalgesia encompasses uninjured sites on the ipsilateral side of the body and may also include the special senses, as auditory discomfort often is greater on the CRPS-affected side. … eadache frequency was greater in CRPS patients than controls, and unilateral headaches were more likely to be on the CRPS-affected than contralateral side. Similarly, mechanical and thermal hyperalgesia was greater in the CRPS-affected than contralateral limb and was greater ipsilateral than contralateral to CRPS in the forehead and non-symptomatic limbs. Ipsilateral photophobia was associated with mechanical and thermal hyperalgesia in the ipsilateral forehead but not the CRPS-affected limb. Together, these findings suggest that aberrant processing of nociceptive input in the ipsilateral trigeminal-medullary region of the brainstem contributes to visual discomfort in CRPS." [It would be very interesting to assess patients with CRPS for co-existing treatable myofascial TrPs in the clavicular SCM, although both conditions may be present in the same patient. DJS]

Drummond PD, Willox M. 2013. Painful effects of auditory startle, forehead cooling and psychological stress in patients with fibromyalgia or rheumatoid arthritis. J Psychosom Res. 74(5):378-383. "These findings suggest that processes linked with individual differences in distress aggravate pain in rheumatoid arthritis, whereas some other mechanism (e.g., failure of stress-related pain modulation processes or an aberrant interaction between nociceptive afferent and sympathetic efferent fibers) triggers stress-induced pain in fibromyalgia."

D'Souza RS, Lin G, Oh T et al. 2020. Fibromyalgia symptom severity and psychosocial outcomes in fibromyalgia patients with hypovitaminosis D: A prospective questionnaire study. Pain Med. [Feb 5 Epub ahead of print] "Hypovitaminosis D may be a risk factor for worse symptom severity, anxiety, and depression in FM patients."

Du PZ, Singh G, Smith S, et al. 2024. Risk factors for sacroiliac joint fusion after instrumented spinal fusion. Global Spine J. 2024 Sep 16: Epub ahead of print. "Factors associated with future SI joint fusion included female gender, patients with obesity, fibromyalgia, diabetes, tobacco use, increased construct length, and prior SI joint injection. Prior SI joint injection had the highest odds ratio…followed by 7+ vertebral segment… and 3-6 vertebral segment fusion…. Conclusions: The highest predictor of requiring subsequent SI joint fusion is a prior SI joint injection. We also found that longer fusion constructs are associated with increased risk for future SI joint fusion."

Duarte JM, Crow C, Antik A et al. 2019. Fibromyalgia and dissociative symptoms. CNS Spectr. Mar 21:1-4. [Epub ahead of print] "Patients with FM had higher scores, which might be related to the association of dissociative experiences, lifetime trauma, and victimization. Antidepressants might have some role on dissociative symptoms as well."

Dubousset J. 2003.  [Spinal instrumentation, source of progress, but also revealing pitfalls.]  Bull Acad Natl Med 187(3):523-533. [French]  Most surgeons do not check their patients presurgically for the presence of biomechanical or soft tissue dysfunctions.  Even bone evaluations are rarely done except supine views.  Computer simulation may help to remedy this lack, and may reduce needless surgery and minimize failed surgeries.

Duclos M, Gatta B, Corcuff JB et al. 2001.  Fat distribution in obese women is associated with subtle alterations of the hypothalamic-pituitary-adrenal axis activity and sensitivity to glucocorticoids.  Clin Endocrinol 55(4):447-454. [This study shows another connection between HPA axis dysfunction and abdominal obesity.  Insulin resistance, abdominal obesity and other pieces of the metabolic syndrome are perpetuating factors of both FMS and myofascial TrPs. DJS]

Due Bruun K, Christensen R, Amris K, et al. 2024 Naltrexone 6 mg once daily versus placebo in women with fibromyalgia: a randomised, double-blind, placebo-controlled trial. Lancet Rheumatol. 2024 Jan;6(1):e31-e39. "This study did not show that treatment with low-dose naltrexone was superior to placebo in relieving pain. Our results indicate that low-dose naltrexone might improve memory problems associated with fibromyalgia, and we suggest that future trials investigate this further."

Duffield SJ, Miller N, Zhao S et al. 2018. Concomitant fibromyalgia complicating chronic inflammatory arthritis: a systematic review and meta-analysis. Rheumatology (Oxford). May 16. [Epub ahead of print] Fibromyalgia is a common co-existing condition in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis, can amplify symptoms and affect management.

Dummer JS, Dinges DF. 2005.  Neurocognitive consequences of sleep deprivation.  Semin Neurol. 25(1):117-129.  “Recent chronic partial sleep deprivation experiments, which more closely replicate sleep loss in society, demonstrate that profound neurocognitive deficits accumulate over time in the face of subjective adaptation to the sensation of sleepiness.  Sleep deprivation associated with disease-related sleep fragmentation also results in neurocognitive performance decrements similar to those seen in sleep restriction studies.”

Dumolard A, Lefaucheur JP, Hodaj E, et al. Central sensitization and small-fiber neuropathy are associated in patients with fibromyalgia. Clin J Pain. 2023 Jan 1;39(1):8-14. "This is the first study that showed an association between central sensitization and both small nerve fiber impairment and neuropathic pain features in FM patients, rather than a direct association between SFN and neuropathic pain."

Dunn D. 2000.  Chronic regional pain syndrome, type 1: Part I.  AORN J. 72(3):422-432, 435-449.  Although this article is on chronic regional pain syndrome, it includes trigger point injections and other trigger point therapies, indicating the author’s understanding that TrPs are contributors to many cases of CRPS.  DJS]

Dunnett AJ, Roy D, Stewart A et al. 2007.  The diagnosis of fibromyalgia in women may be influenced by menstrual cycle phase.  J Bodywork Move Ther. 11, 99-105.  “…sensitivity to pressure and pain varies over the course of the menstrual cycle, requiring clinical adjustments in palpation-based diagnostic models and treatment modalities.”

DuPont, J. S. Jr. DDS. 1999. Trigger Point Identification and Treatment with Microcurrent. J Craniomandib Pract 17(4):293-296.

Duschek S, de Guevara CML, Serrano MJF, et al. Variability of reaction time as a marker of executive function impairments in fibromyalgia. Behav Neurol. 2022 Jul 5;2022:1821684..2022. "This study investigated executive functions in fibromyalgia via a Go/No-Go task…. Patients exhibited a lower hit rate, higher M RT (mean reaction time), and higher tau than controls. Moreover, patients showed greater decrease of the hit rate after the change of task rule. In the entire sample, SD, sigma, and tau were inversely associated with the hit rate and positively associated with the false alarm rate. While the greater decline in hit rate after the change in task rule indicates deficient cognitive flexibility, the lack of any difference in false alarm rate suggests intact response inhibition. Higher M RT reflects reduced cognitive or motor speed. Increased tau in fibromyalgia indicates greater fluctuations in executive control and more frequent temporary lapses of attention. For the first time, this study demonstrated that indices of RT variability, in particular those derived from the ex-Gaussian function, may complement speed and accuracy parameters in the assessment of executive function impairments in fibromyalgia."

Duschek S, Montoro CI, Reyes Del Paso GA. 2015. Diminished interoceptive awareness in fibromyalgia syndrome. Behav Med. [Oct 2 Epub ahead of print.] "Sensitivity to signals arising within the body (interoceptive awareness) has been implicated in emotion processing; interindividual differences in interoceptive awareness modulate both subjective and physiological indicators of emotional experience and the regulation of emotion-related behaviors..…Reduced interoceptive awareness may be involved in the affective aspects of FMS pathology. Poor access to bodily signals may restrict patients' ability to integrate these signals during emotional processing, which, by extension, may preclude optimal emotional self-regulation."

Dutra EH, Maruo H, Vianna-Lara MS. 2006.  Electromyographic activity evaluation and comparison of the orbicularis oris (lower fascicle) and mentalis muscles in predominantly nose- or mouth-breathing subjects.  Am J Orthod Dentofacial Orthop. 129(6):722.e1-9.  [Although TrPs were not specifically mentioned, this study indicated that mouth breathing influences EMG activity of specific muscles, and that could increase the chance of TrP formation. DJS]

Duyur Cakit B, Genc H, Altuntas V et al. 2009.  Disability and related factors in patients with chronic cervical myofascial pain.  Clin Rheumatol. 28(6):647-654.  “The aim of this study is to detect whether cervical myofascial pain leads to disability and to determine factors associated with disability in patients with chronic cervical myofascial pain.”  “In the patient group, the total Neck Pain and Disability scale scores were significantly correlated with the pain pressure threshold values of the trapezius and levator scapula muscles and Beck Depression Inventory scores.”  “Cervical myofascial pain is a reason for disability in chronic neck pain population.  Disease duration was found as the strongest predictor of disability.”

Easton V, Bale P, Bacon H et al. 2014. A89: the relationship between benign joint hypermobility syndrome and developmental coordination disorders in children. Arthritis Rheumatol. 66 Suppl 11:S124. "The purpose of this study was to examine baseline data from an interventional study of BJHS in childhood to assess the relationship between joint hypermobility and motor control. …The study subjects included 119 children between the ages of 5 and 16 years. All had documented joint hypermobility (assessed by a pediatric rheumatologist) and musculoskeletal pain or dysfunction. …Movement difficulty is a common independent component of BJHS in childhood. An evaluation of motor function needs to be included as part of the assessment of all children with BJHS and may merit targeted intervention as its presence represents a lower quality of functioning. Further research is needed into children with BJHS and movement difficulty, who may benefit from targeted interventions." [It would be very useful if these children were assessed for trigger points that could be affecting their coordination. DJS]

Edwards J. 2005.  The importance of postural habits in perpetuating myofascial trigger point pain.  Acupunct In Med. 23(2):77-82.  This article is a collection of examples indicating how bracing arms or knees, leg crossing and side-leaning, arm crossing, sitting with legs tucked sideways, habitual undesirable sleeping positions, and “...any habitual posture that gives rise to [prolonged contraction of muscle fibres may cause motor endplate dysfunction and the development of an MTrP...”  [ The author believes that habitual dysfunctional postures may occur without other perpetuating factors and may be often untreated and correctable perpetuating factors.  We both believe that this knowledge would be very empowering to TrP patients and should be part of the educational process. DJS]

Edwards J, Knowles N. 2003.  Superficial dry needling and active stretching in the treatment of myofascial pain — a randomized controlled trial.  Acupunct Med 21(3):80-86.  “SDN followed by active stretching is more effective than stretching alone in deactivating TrPs (reducing their sensitivity to pressure), and more effective than no treatment in reducing subjective pain.  Stretching without prior deactivation may increase TrP sensitivity

Edwards RR, Bingham CO 3^rd, Bathon J et al. 2006.  Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases.  Arthritis Rheum. 55(2):325-332.  “There appear to be multiple mechanisms by which catastrophizing exerts its harmful effects, from maladaptive influences on the social environment to direct amplification of the central nervous system’s processing of pain.”  “Catastrophizing is a critically important variable in understanding the experience of pain in rheumatologic disorders as well as other chronic pain conditions.  Pain-related catastrophizing may be an important target for both psychosocial and pharmacologic treatment of pain.”

Eftekharsadat B, Babaei-Ghazani A, Zeinolabedinzadeh V. 2016. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Med J Islam Repub Iran. 30:401. eCollection 2016."Despite the insignificant effect on ROMDF (range of motion of ankle joint in dorsiflexion) and ROMPE (plantar extension), trigger point dry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis.

Eftekhar-Sadat B, BabaeiGhazani A, Zeinolabedinzadeh V. 2012. Evaluation of dry needling in patients with chronic heel pain due to plantar fasciitis. Foot (Edinb). [Nov 28 Epub ahead of print]. This study from Iran found that although dry needling did not seem to improve range of motion of ankle joint in dorsiflexion or plantar extension, it helped improve pain significantly and should be tried before more invasive forms of treatment are attempted.

Egloff N1, von Känel R, Müller V et al. 2015. Implications of proposed fibromyalgia criteria across other functional pain syndromes. Scand J Rheumatol. [Jun 16 Epub ahead of print.] "FM according to the ACR 2010 criteria describes the 'severe half' of the spectrum of functional pain syndromes. By dropping the requirement of 'generalized pain', these criteria result in a blurring of the distinction between FM and more localized functional pain syndromes."

Eichling PS, Sahni J. 2005.  Menopause related sleep disorders.  J Clin Sleep Med. 1(3):291-300.  “The ‘domino theory’ of sleep disruption leading to insomnia followed by depression has the most scientific support.  Estrogen itself may also have an antidepressant as well as a direct sleep effect.  Treatment of insomnia in responsive individuals may be a major remaining indication for hormone therapy.”  “Due to the general under-recognition of SDB, health care providers should not assume sleep complaints are due to vasomotor related insomnia/depression without considering SDB.” “Sleep complaints are almost universal in FM.  There are associated polysomnogram (PSG) findings.”  “Treatment of sleep itself seems to improve, if not resolve FM.  Menopausal sleep disruption can exacerbate other pre-existing sleep disorders including RLS and circadian disorders.”

Eilertsen G, Ormstad H, Kirkevold M et al. 2015. Similarities and differences in the experience of fatigue among people living with fibromyalgia, multiple sclerosis, ankylosing spondylitis and stroke. J Clin Nurs. [Feb 7 Epub ahead of print.] "Fatigue is common to many long-term illnesses, but it has been studied mainly within the context of a single illness; qualitative studies comparing the experience and its impact on daily life across different long-term illnesses are lacking….Fatigue is commonly expressed by patients with long-term illnesses. Variations in experience are related to the type of diagnosis. The disparity between experiences influences how patients managed and adjusted to the conditions of everyday life. The illness-specific characteristics of fatigue warrant increased clinical awareness and may allow professionals to offer adequate information and establish effective methods of managing the condition. The feeling of invisibility and difficulty describing the experience of fatigue in particular highlights this need."

Einig S, Ruess E, Schoetzau A, et al. 2024. Pelvic pain of myofascial origin in women: Correlation with lower urinary tract symptoms. Adv Urol.2024 Mar 15:2024:5568010. Women with lower urinary tract symptoms (LUTS) and high-tone pelvic floor often experience pain and have positive trigger points upon pelvic floor examination…. There was a significant correlation between pain in various muscle groups and LUTS as well as high-tone pelvic floor muscle….The existence of myofascial pelvic floor trigger points and high pelvic floor muscle tone seem to be reflective of pelvic floor symptoms, as assessed with a standardized pelvic floor questionnaire.

Eisen SA, Kang HK, Murphy FM et al. 2005.  Gulf War veterans’ health: medical evaluation of a U.S. cohort.  Ann Intern Med. 142(11):881-890.  “Gulf War deployment is associated with an increased risk for fibromyalgia, the chronic fatigue syndrome, skin conditions, dyspepsia, and a clinically insignificant decrease in the SF-36 physical component score.”

Eisinger J, Ayavou T, Zakarian H et al. 2007. Fibromyalgia [FMS], Nitric Oxide [NO] and Insulin: Probable links between metabolic changes, inflammation and apoptosis: Taxonomy and description.  J Musculoskel Pain 15 (Supp 13):45 item 78.  Insulin modulates inflammation [TNF, cytokines], vasodilatation [NO], vasoconstriction [ET], energy metabolism, ROS and aptosis.  Its role in FM is probably underestimated.

Eisinger J. 2006. Fibromyalgia: terra incognita.  J Musculoskel Pain 14(4):5-9.  This perceptive editorial provides charts that may be valuable tools for indicating subsets of FMS, as well as possible treatment options.

Eisinger, J. 2003.  [Clinical evaluation of fibromyalgia] Rev Med Interne 24(4):237-42. [French].  The use of blood pressure tensiometetry is a new, easier and alternative way to screen for fibromyalgia. 

Eisinger J, Milliat M, Garnier R, Starlanyl D. 2000. [Commentaries sur un questionnaire "fibromyalgie" detaille.] Myalgies 1(3):1-3 insert. [French].

Eisinger J, Starlanyl D, Blotman F, Bueno L et al. 2000. [Protocole d’informations anonyme sure les fibromyalgiques.] Med du Sud-Est 1:9-13. [French].

Eisinger, J. B. 1999. Hypothyroidism treatment: one hormone or two?  Myalgies 2(Suppl 2):1-3. [French]

Eisinger, J., A. Plantamura and T. Ayavou. 1994. Glycolosis abnormalities in fibromyalgia.. J Am Col Nutri 13(2) 144-148.

Eisinger, J., A. Plantamura, P. A. Marie and T. Ayavou. 1994. Selenium and magnesium status and fibromyalgia. Magnes Res 7(3-4):285-8.

Eken C, Durmaz D, Erol B. 2009.  Successful treatment of a persistent renal colic with trigger point injection.  Am J Emerg. Med. 27(2):252.e3-4.  “We present a case of renal colic successfully treated by trigger point injection that was refractory to 150 microg fentanyl and 5 mg morphine.”

Elbeialy A, Sawy SE, Elzomor H, et al. 2024. Environmental pollution impact on the severity of some rheumatic diseases: a comparative analytical study on inflammatory and non-inflammatory samples. BMC Rheumatol. 2024 Oct 8;8(1):50. "Heavy metal exposure has been implicated in health problems, including fibromyalgia and rheumatoid arthritis….VD (vitamin D3) deficiency was significantly inversely correlated to PTH (parathyroid hormone), lead, cadmium, chromium, and activity scores in the RA and FMS groups. Lead, cadmium and chromium had a significant independent risk on the VD level in RA patients, while lead had a significant independent risk on the VD level in FMS patients."

Eldufani J, Elahmer N, Blaise G. A medical mystery of complex regional pain syndrome. Heliyon. 2020 Feb 19;6(2):e03329. Complex regional pain syndrome (CRPS) is a condition of neuropathic pain, which is characterized by significant autonomic and inflammatory features. CRPS occurs in patients who have limb surgery, limb fractures, or trauma. Many patients may have pain resolve within twelve months of the inciting incident; however, a small subset progresses to the chronic form. This transitional process often happens by changing from warm CRPS with dominant inflammatory phase to cold CRPS, in which autonomic characteristics or manifestations dominate. Several peripheral and central mechanisms are involved, which might vary among individuals over a period of time. Other contributors include peripheral and central sensitization, autonomic alterations, inflammatory and immune changes, neurochemical changes, and psychological and genetic factors."

Elert J, Kendall SA, Larsson B et al. 2001.  Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders.  J Rheumatol 28(6):1361-1368.  Some “… groups of patients with chronic pain have increased muscle tension and decreased output during dynamic activity compared to pain-free controls.  However, the results indicated there is heterogeneity within groups of patients with the same chronic pain disorder and that not all patients with chronic pain have increased muscle tension.”

El Hasbani G, Ibrahem M, Haidous M, et al. Fibromyalgia among university students: A vulnerable population. Mediterr J Rheumatol. 2022 Dec 31;33(4):407-412. "Fibromyalgia seems to be prevalent among university students; in particular, those with other musculoskeletal disorders, those with a family history of musculoskeletal disorders, and those with severe depression and anxiety."

Elias M. 1994.  Cervical epidural abscess following trigger point injection.  J Pain Symptom Manage. 9(2):71-72.  [This can be avoided by following aseptic injection procedure. DJS]

Elkana O, Nimni Y, Ablin JN, et al.2022 The Montreal Cognitive Assessment Test (MoCA) as a screening tool for cognitive dysfunction in fibromyalgia. Clin Exp Rheumatol. Jun;40(6):1136-1142. "The MoCA is an acceptable cognitive screening test for the cognitive evaluation of FM patients."

Ellapen TJ, Paul Y, Hammill HV, et al. 2021. Altered cervical posture kinematics imposed by heavy school backpack loading: A literature synopsis (2009-2019). Afr J Disabil. Jan 22;10:687. "Backpack carriage alters cervical posture, resulting in smaller CVA (craniovertebral angle) and compromised pulmonary function. There is no consensus of the precise backpack mass that initiates postural changes. Girls' posture begin changes when carrying lighter backpacks as compared to boys of the same age strata."

Ellerbrock I, Sandstrom A, Tour J et al. 2020. Polymorphisms of the μ-opioid receptor gene influence cerebral pain processing in fibromyalgia. Eur J Pain. Oct 16. Online ahead of print. "We show that the functional polymorphism of the μ-opioid receptor gene OPRM1 was associated with alterations in the fronto-parietal network as well as with increased activation of posterior cingulum during evoked pain in FM. Thus, the OPRM1 polymorphism affects cerebral processing in brain regions implicated in salience, attention, and the default mode network."

Elliott R, Burkett B. 2013. Massage therapy as an effective treatment for carpal tunnel syndrome. J Bodyw Mov Ther. 17(3):332-338. "Carpal tunnel syndrome is a common entrapment that causes neuralgia in the median nerve distribution of the hand. The primary aim of this study was to evaluate the efficacy of massage therapy as a treatment for carpal tunnel syndrome. Within this process, the locations of trigger points that refer neuropathy to the hand were identified. The creation of massage pressure tables provides a means of treatment reproducibility. Twenty-one participants received 30 min. of massage, twice a week, for six weeks. Carpal tunnel questionnaires, the Phalen, Tinel, and two-point discrimination tests provided outcome assessment. The results demonstrated significant…change in symptom severity and functional status from two weeks. Based on this study, the combination of massage and trigger-point therapy is a viable treatment option for carpal tunnel syndrome and offers a new treatment approach." [This is yet another study showing that surgery is not to be considered for CTS until all other options have been tried. DJS]

Eloqayli H. 2018. Subcutaneous accessory pain system (SAPS): A novel pain pathway for myofascial trigger points. Med Hypotheses. 111:55-57. "We propose that trigger points have an extra-innervation system that connect them with other spinal structures such as the facet, the annulus and other trigger points with a role for the subcutaneous fascia as part of trigger points pathogenesis or passage for the extra-innervation... Subcutaneous accessory pain system (SAPS)....Individuals with this accessory pathway are prone to myofascial pain, trigger point activation and segmental referred somatic pain similar to other axial spinal structures.... The existing theories about trigger point formation and referred pain is scientifically credible for each separate component and the SAPS novel system can provide the link between the two."

El-Rabbat MS, Mahmoud NK, Gheita TA. 2017. Clinical significance of fibromyalgia syndrome in different rheumatic diseases: Relation to disease activity and quality of life. Reumatol Clin. [Apr 11 Epub ahead of print] [Article in English, Spanish] This study from Egypt found that fibromyalgia was a common coexisting condition in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and Behçets disease (BD. Patients with the rheumatic disease lus FM had significantly lower quality of life. FM "could be related to the disease activity in RA and BD patients and to thrombosis in SLE and affected the QoL in RA." Free Article

El-Shewy KM, Kunbaz A, Gad MM et al. 2018. Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review. Biomed Pharmacother. 109:629-638. "Hyperbaric oxygen therapy (HBOT) has been utilized and has recently shown promising effects in the management of FM and other chronic pain disorders. In HBOT, the intermittent breathing of 100% oxygen in a pressurized chamber where the pressure is higher than 1 atmosphere absolute (ATA) has been utilized. HBOT exhibits a significant anti-inflammatory effect through reducing production of glial cells and inflammatory mediators which results in pain alleviation in different chronic pain conditions. HBOT can also influence neuroplasticity and affects the mitochondrial mechanisms resulting in functional brain changes. In addition to that, HBOT stimulates nitric oxide (NO) synthesis which helps in alleviating hyperalgesia and NO-dependent release of endogenous opioids which seemed to be the primary HBOT mechanism of antinociception. Moreover, aerobic exercise and meditative movement therapies (MMT) have gained attention for their role in pain alleviation through different anti-inflammatory and antioxidant mechanisms. In this review, we aim to elucidate the different mechanisms of HBOT and aerobic exercise in attenuating pain as adjuvant therapy in the multidisciplinary treatment strategy of chronic pain, and more particularly fibromyalgia." Free Article [It would be interesting to compare the effects of hyperbaric oxygen therapy to TrP therapies on areas with impaired microcirculation. DJS]

Eltiti S, Wallace D, Zougkou K et al. 2006.  Development and evaluation of the electromagnetic hypersensitivity questionnaire.  Bioelectromagnetics. [Sep 29 Epub ahead of print]  The electromagnetic sensitivity questionnaire was developed with eight subscales: neurovegetative, skin, auditory, headache, cardiorespiratory, cold related, locomotor and allergy.  This scale provides “...an index of the type and intensity of the symptoms commonly experienced by people believing themselves to be EHS and a screening tool that researchers can use to pre-select the most sensitive individuals...”

Elvin A, Siosteen AK, Nilsson A et al. 2006. Decreased muscle blood flow in fibromyalgia patients during standardized muscle exercise: a contrast media enhanced color doppler study.  Eur J Pain 10(2):137-144.  “…muscle ischemia can contribute to pain in FM, possibly by maintaining the central nervous changes such as central sensitization/disinhibition.  US with contrast can be a new valuable approach to assess muscle perfusion in pain patients during standardized exercise.”

Endres S, Shufelt A, Bogduk N. 2016. The risks of continuing or discontinuing anticoagulants for patients undergoing common interventional pain procedures. Pain Med.[Jun 12 Epub ahead of print.] "No complications attributable to anticoagulants were encountered in 4,766 procedures in which anticoagulants were continued. In 2,296 procedures in which anticoagulants were discontinued according to the guidelines, nine patients suffered serious morbidity, including two deaths…. Lumbar transforaminal injections, lumbar medial branch blocks, trigger point injections, and sacroiliac joint blocks appear to be safe in patients who continue anticoagulants. In patients who discontinue anticoagulants, although low (0.2%) the risk of serious complications is not zero, and must be considered when deciding between continuing and discontinuing anticoagulants."

Enestrom, S., A. Bengtsson, and T. Frodin. 1997. Dermal IgG deposits and increase of mast cells in patients with fibromyalgia–relevant findings or epiphenomena? Scand J Rheumatol 26(4):308-313.

Enge, C. C. Jr. 2002. Caring for medically unexplained physical symptoms after toxic environmental exposures: effects of contested causation. Environ Health Perspect 110(Suppl 4):641-7.  Contested causation may have serious deletory effects on the patient, and on the patient-care provider relationship. 

Engel CC Jr. 2002.  Caring for medically unexplained physical symptoms after toxic environmental exposures: effects of contested causation.  Environ Health Perspect 110 Suppl 4:641-647.  The adversarial experience when outside parties refuse to believe that patients have become ill after toxic exposure may be toxic in itself.  Medically unexplained physical symptoms, [or care providers who do not understand the cause or mechanisms of the symptoms  DJS] “…may erode patient-provider trust, test the provider’s issues of compensation, reparation and blame.  These issues may distract patients and providers from therapeutic goals.” 

Engen DJ, McAllister SJ, Whipple MO et al. 2015. Effects of transdermal magnesium chloride on quality of life for patients with fibromyalgia: a feasibility study. J Integr Med. 13(5):306-313. This (Mayo Clinic) pilot study (24 patients) suggests that transdermal magnesium chloride applied on upper and lower limbs may be beneficial to patients (women) with fibromyalgia.

Engin A. 2017. The definition and prevalence of obesity and Metabolic Syndrome. Adv Exp Med Biol. 960:1-17. "Increase in prevalence of obesity has become a worldwide major health problem in adults, as well as among children and adolescents. Furthermore, total adiposity and truncal subcutaneous fat accumulation during adolescence are positively and independently associated with atherosclerosis at adult ages. Centrally accumulation of body fat is associated with insulin resistance, whereas distribution of body fat in a peripheral pattern is metabolically less important. Obesity is associated with a large decrease in life expectancy. The effect of extreme obesity on mortality is greater among younger than older adults. In this respect, obesity is also associated with increased risk of several cancer types. However, up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy normal weight individuals, lower visceral fat content, and lower intima media thickness of the carotid artery than the majority of metabolically "unhealthy" obese patients. Abdominal obesity is the most frequently observed component of metabolic syndrome. The metabolic syndrome; clustering of abdominal obesity, dyslipidemia, hyperglycemia and hypertension, is a major public health challenge. The average prevalence of metabolic syndrome is 31%, and is associated with a two-fold increase in the risk of coronary heart disease, cerebrovascular disease, and a 1.5-fold increase in the risk of all-cause mortality."

Eraso RM, Bradford NJ, Fontenot CN et al. 2007. Fibromyalgia syndrome in young children: onset at age 10 years and younger.  Clin Exp Rheumatol. 25(4):639-644.  “FMS in young children of 10 years old and younger is frequently under-recognized.  As compared with the older group, stiffness, subjective joint swelling, abdominal pain, initial presentation on wheelchair and a higher mean count of tender points at diagnosis were significantly more common in the younger age group.  However, the type of medications used and outcome were similar in both groups.”  [We have to stop believing that FM is an illness that presents predominantly in middle aged women.  Men, children of both genders and the elderly can have FM too, and these groups are often undiagnosed or misdiagnosed. DJS]

Erbasan F, Cekin Y, Coban DT et al. 2017. The frequency of primary Sjogren's syndrome and fibromyalgia in irritable bowel syndrome. Pak J Med Sci. 33(1):137-141. "The frequency of Sjogren's Syndrome among patients with IBS is relatively higher than the general population. All IBS patients should be questioned for dryness of the mouth and eyes, and if necessary, should be evaluated for SS." Free Article

Ercan M, Ertekin A. 2024. The effect of simultaneous administration of occipital nerve block and cervical myofascial trigger point injection (MTrPI) on headache parameters in chronic migraine patients. Ir J Med Sci. 2024 Aug;193(4):2001-2009. "During trigger point examination and injection, trapezius, levator scapulae, splenius capitis, temporalis, and sternocleidomastoid muscles were targeted…. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits."

Erdem HR, Cakit BD, Ozdemirel AE et al. 2012. Fear of falling in patients with cervical myofascial pain syndrome. J Musculoskel Pain. 20(4):257-262. "Patients with cervical MPS suffer from FOF (fear of falling) probably due to balance problems and dizziness." Fear of falling is common in the elderly, and can cause limitations and psychological stress. Vestibular rehabilitation and balance exercises are recommended in myofascial pain patients. [Falling can have serious consequences. TrPs in the cervical area can adversely affect balance and proprioception, so are important to assess and treat, especially in the elderly, as well as possible co-existing vestibular and ocular dysfunctions. DJS]

Erdrich S, Hawrelak JA, Myers SP et al. 2020. A systematic review of the association between fibromyalgia and functional gastrointestinal disorders. Therap Adv Gastroenterol. Dec 8;13:1756284820977402. "Fibromyalgia and functional gastrointestinal disorders (FGID) including irritable bowel syndrome (IBS) are common conditions presenting in clinical settings and are more prevalent in women.... This review confirms previous reports that IBS is common in people living with fibromyalgia and suggests that IBS-mixed and constipation types predominate. An association with a range of FGID other than IBS is suggested, but data are limited. Research exploring the association between fibromyalgia and functional gastrointestinal dysfunction beyond IBS are warranted."

Ericsson A, Bremell T, Mannerkorpi K. 2013. Usefulness of multiple dimensions of fatigue in fibromyalgia. J Rehabil Med. [Jun 24 Epub ahead of print]. "Dimensions of fatigue, assessed by the MFI-20 (Multidimensional Fatigue Inventory), appear to be valuable in studies of employment, pain intensity, sleep, distress and physical function in women with fibromyalgia. The patients reported higher levels on all fatigue dimensions in comparison with healthy women."

Eriksson EM, Andrén KI, Kurlberg GK et al. 2015. Aspects of the non-pharmacological treatment of irritable bowel syndrome. World J Gastroenterol. 21(40):11439-11449. "Irritable bowel syndrome (IBS) is one of the most commonly diagnosed gastrointestinal conditions…. In this article we present aspects of the pathophysiology and the non-pharmacological treatment of IBS based on current knowledge. Effects of conditioned stress and/or traumatic influences on the emotional system (top-down) as well as effects on the intestine through stressors, infection, inflammation, food and dysbiosis (bottom-up) can affect brain-gut communication and result in dysregulation of the autonomic nervous system (ANS), playing an important role in the pathophysiology of IBS. Conditioned stress together with dysregulation of the autonomic nervous system and the emotional system may involve reactions in which the distress inside the body is not recognized due to low body awareness. This may explain why patients have difficulty identifying their symptoms despite dysfunction in muscle tension, movement patterns, and posture and biochemical functions in addition to gastrointestinal symptoms. IBS shares many features with other idiopathic conditions, such as fibromyalgia, chronic fatigue syndrome and somatoform disorders. The key to effective treatment is a thorough examination, including a gastroenterological examination to exclude other diseases along with an assessment of body awareness by a body-mind therapist. The literature suggests that early interdisciplinary diagnostic co-operation between gastroenterologists and body-mind therapists is necessary. Re-establishing balance in the ANS is an important component of IBS treatment. This article discusses the current knowledge of body-mind treatment, addressing the topic from a practical point of view." Free PMC Article

Erikstrup C, Pedersen LM, Heickendorff L, et al. 2001. Production of hyaluronan and chondroitin sulphate proteoglyucans from human arterial smooth muscle- the effect of glucose, insulin, IGF-I or growth hormone. Eur J Endocrinol 145(2):193-8.Chondroitin sulphate proteoglycan CSPG.  Insulin and hGH can influence the accumulation of hyaluronan and CSPG.

Erkan Turan K, Kocabeyoglu S, Unal-Cevik I et al. 2017. Ocular surface alterations in the context of corneal in vivo confocal microscopic characteristics in patients with fibromyalgia. Cornea. [Nov 9 Epub ahead of print] "To the best of our knowledge, this is the first study that evaluated ocular surface alterations in the context of corneal IVCM (in vivo confocal microscopy characteristics). Patients with FM should be evaluated in terms of ocular surface diseases. IVCM may be used in FM to assess small fiber neuropathy." [Patients were not evaluated for co-existing conditions in this Turkish study. DJS]

Ermis MN, Yildirim D, Durakbasa MO et al. 2011. Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors. J Back Musculoskel Rehabil. 24(3):137-144. "The ultrasonographic examination detected a paravertebral hypoechogenic globular-shaped muscle disorganization associated with lipomatous degeneration exclusively localized to the trigger point in the study group…This prospective study depicts the etiologic factors, ultrasonographic features and treatment protocol of MSCNE (medical superior cluneal nerve entrapment) which is usually an underestimated cause of the low back pain." This is yet another study documenting key TrP involvement in chronic low back pain and nerve entrapment. DJS]

Ernberg M, Lundeberg T, Kopp S. 2000.  Pain and allodynia/hyperalgesia induced by intramuscular injection of serotonin in patients with fibromyalgia and healthy individuals.  Pain 85(1-2):31-39.  “5-HT injected into the masseter muscle of healthy female subjects elicits pain and allodynia/hyperalgesia, while no such responses occur in patients with fibromyalgia.”

Ernst E. 2011. Herbal medicine in the treatment of rheumatic diseases. Rheum Dis Clin North Am. 37(1):95-102. "This article provides a brief overview of the evidence on herbal medicines for 4 common rheumatic conditions: back pain, fibromyalgia, osteoarthritis, and rheumatoid arthritis."

Ernst, E.  1998.  Does post-exercise massage treatment reduce delayed onset muscle soreness?  A systematic review.  Br J Sports Med 32(3):212-4.

Ertekin E, Kasar ZS, Turkdogan FT. 2021. Is early diagnosis of myofascial pain syndrome possible with the detection of latent trigger points by shear wave elastography? Pol J Radiol. Jul 12;86:e425-e431. SWE is a reliable method for detecting latent trigger points in MPS, and it can be used for evaluating the response to treatment.

Escalante, A. and M. Fischbach.  1998.  Musculoskeletal manifestations, pain, and quality of life in Persian Gulf War veterans referred for rheumatologic evaluation.  J Rheumatol 25(11):2228-35. .

Escalante Pulido, J. M. and M. Alpizar Salazar.  1999.  Changes in insulin sensitivity, secretion and glucose effectiveness during menstrual cycle.  Arch Med Res 30(1):19-22.

Escobar PL, Ballesteros J. 1988.  Teres minor.  Source of symptoms resembling ulnar neuropathy or C8 radiculopathy.  Am J Phys Med Rehabil. 67(3):120-122.  “Numbness and tingling in the ring and little fingers (fourth and fifth digits) is usually associated with a radiculopathy (C8) or compromise of a peripheral nerve (ulnar).  The presence of a trigger point in the teres minor muscle may produce similar symptoms.  Early diagnosis and appropriate treatment will save the patient unnecessary discomfort and reduce the use of sophisticated diagnostic testing.”

Esenyel M, Walsh K, Walden JG et al. 2003.  Kinetics of high-heeled gait.  J Am Podiatr Med Assoc. 93(1):27-32.  “Reduced effectiveness of the ankle plantar flexors during late stance results in a compensatory enhanced hip flexor “pull-off” that assists in limb advancement during the stance-to-swing transition.  Larger muscle moments and increased work occur at the hip and knee, which may predispose long-term wearers of high-heeled shoes to musculoskeletal pain.”  [Janet Travell indicated high heeled shoes, and any non-flexible soled shoe, can be perpetuating factors of many TrPs. DJS]

Eslamian F, Jahanjou F, Dolatkhah N et al. 2020. Relative Effectiveness of Electroacupuncture and Biofeedback in Treatment of Neck and Upper Back Myofascial Pain: a Randomized Clinical Trial. Arch Phys Med Rehabil. [Jan 16 Epub ahead of print] "Both electroacupuncture and biofeedback therapies were found to be effective in management of MPS when integrated with conventional treatment. However, intergroup differences showed priority of acupuncture in some parameters versus biofeedback. Thus, electro-acupuncture seems to be a better complementary modality for treatment of MPS in the neck and upper back area."

Espí-Lopez GV, Ruescas-Nicolau MA, Nova-Redondo C et al. 2018. Effect of soft tissue techniques on headache impact, disability, and quality of life in migraine sufferers: A pilot study. J Altern Complement Med. [Apr 30 Epub ahead of print] "Participants were randomized to receive either combined MTrP therapy and stretching (control group) or the control treatment plus suboccipital soft tissue inhibition (experimental group). Treatment was applied on four occasions over 8 weeks (one every 15 days), with a duration of 30 minutes per session in the experimental group and 20 min in the control group.... Both groups were assessed at baseline and 1 week immediately after the end of treatment....Soft tissue techniques based on MTrP therapy and stretching were helpful for improving certain aspects of migraine, such as the impact and disability caused by the headache, and the frequency and intensity of headache; however, when combined with suboccipital soft tissue inhibition, the treatment effect was larger."

Estevez-Lopez F, Camiletti-Moiron D, Aparicio VA et al. 2018. Identification of candidate genes associated with fibromyalgia susceptibility in southern Spanish women: the al-Andalus project. J Transl Med. 16(1):43. "Candidate-gene studies on fibromyalgia susceptibility often include a small number of single nucleotide polymorphisms (SNPs), which is a limitation. Moreover, there is a paucity of evidence in Europe. Therefore, we compared genotype frequencies of candidate SNPs in a well-characterised sample of Spanish women with fibromyalgia and healthy non-fibromyalgia women....We identified, for the first time, associations of the rs841 (guanosine triphosphate cyclohydrolase 1 gene) and rs2097903 (catechol-O-methyltransferase gene) SNPs with higher risk of fibromyalgia susceptibility. We also confirmed that the rs1799971 SNP (opioid receptor μ1 gene) might confer genetic risk of fibromyalgia. We did not adjust for multiple comparisons, which would be too stringent and yield to non-significant differences in the genotype frequencies between cases and controls. Our findings may be biologically meaningful and informative, and should be further investigated in other populations. Of particular interest is to replicate the present study in a larger independent sample to confirm or refute our findings. On the other hand, by including 61 SNPs of 33 candidate-genes with a strong rationale (they were previously investigated in relation to fibromyalgia susceptibility, symptoms or potential mechanisms), the present research is the most comprehensive candidate-gene study on fibromyalgia susceptibility to date."

Estevez-Lopez F, Segura-Jimenez V, Álvarez-Gallardo IC et al. 2017. Adaptation profiles comprising objective and subjective measures in fibromyalgia: the al-Ándalus project. Rheumatology (Oxford). [Aug 18 Epub ahead of print] "The aim of this study was to identify (psychological) subgroups in terms of adaptation to FM and to test differences in FM severity between these subgroups….Factor analysis yielded eight factors: three included objective measures (declarative memory, active lifestyle and objective physical fitness) and five included subjective measures (fatigue, psychological distress, catastrophizing, resilience and subjective physical fitness). Cluster analysis based on these eight factors identified five profiles: Adapted (16%), Fit (18%), Poor performer (20%), Positive (20%) and Maladapted (26%). Most profile comparisons revealed different levels of FM severity varying from Adapted (the most favourable profile) to Maladapted (the most unfavourable profile) with Fit, Poor performer and Positive obtaining intermediate positions…. (Psychological) Heterogeneity of FM was shown by five clinically meaningful profiles of modifiable factors that were associated with FM severity. It is of clinical interest to examine whether these profiles are associated with FM prognosis and the effectiveness of interventions, which would enhance the development of customized interventions based on adaptation profiles in FM. [This study from Spain focused on only the psychological aspects of FM, without taking into consideration coexisting conditions. Someone with multiple coexisting conditions including chronic myofascial pain and dysfunction, given little support, may find it more difficult to develop coping mechanisms, and similar factors also need to be taken into account. DJS]

Estrada-Marcén NC, Casterad-Seral J, Montero-Marin J, et al. Can an aerobic exercise programme improve the response of the growth hormone in fibromyalgia patients? A randomised controlled trial. Int J Environ Res Public Health. 2023 Jan 27;20(3):2261."The normalization of neuro-hormonal patterns involving the GH (growth hormone) might be key for improving some FMS symptoms."

Eugene AR, Masiak J. 2015. The neuroprotective aspects of sleep. MEDtube Sci. 3(1):35-40. "Sleep is an important component of human life, yet many people do not understand the relationship between the brain and the process of sleeping. Sleep has been proven to improve memory recall, regulate metabolism, and reduce mental fatigue. A minimum of 7 hours of daily sleep seems to be necessary for proper cognitive and behavioral function. The emotional and mental handicaps associated with chronic sleep loss as well as the highly hazardous situations which can be contributed to the lack of sleep is a serious concern that people need to be aware of. When one sleeps, the brain reorganizes and recharges itself, and removes toxic waste byproducts which have accumulated throughout the day. This evidence demonstrates that sleeping can clear the brain and help maintain its normal functioning. Multiple studies have been done to determine the effects of total sleep deprivation; more recently some have been conducted to show the effects of sleep restriction, which is a much more common occurrence, have the same effects as total sleep deprivation. Each phase of the sleep cycle restores and rejuvenates the brain for optimal function. When sleep is deprived, the active process of the glymphatic system does not have time to perform that function, so toxins can build up, and the effects will become apparent in cognitive abilities, behavior, and judgment. As a background for this paper we have reviewed literature and research of sleep phases, effects of sleep deprivation, and the glymphatic system of the brain and its restorative effect during the sleep cycle." Free PMC Article

Eva-Maj M, Hans W, Per-Anders F et al. 2013. Experimentally induced deep cervical muscle pain distorts head on trunk orientation. Eur J Appl Physiol. [Jun 29 Epub ahead of print]. "PURPOSE: We wanted to explore the specific proprioceptive effect of cervical pain on sensorimotor control. Sensorimotor control comprises proprioceptive feedback, central integration and subsequent muscular response. Pain might be one cause of previously reported disturbances in joint kinematics, head on trunk orientation and postural control. However, the causal relationship between the impact of cervical pain on proprioception and thus on sensorimotor control has to be established. METHODS: Eleven healthy subjects were examined in their ability to reproduce two different head on trunk targets, neutral head position (NHP) and 30° target position, with a 3D motion analyzer before, directly after and 15 min. after experimentally induced neck pain. Pain was induced by hypertonic saline infusion at C2/3 level in the splenius capitis muscle on one side (referred to as "injected side")….A sensory mismatch appeared in some subjects, who experienced dizziness. CONCLUSIONS: Acute cervical pain distorts sensorimotor control with side-specific changes, but also has more complex effects that appear when pain has waned." [Myofascial trigger points can and do cause these effects. Many are only evident after the pain has eased, and the TrPs have become latent. DJS]

Evans, R. W. 1992. Some observations on whiplash injuries. Neurol Clin 10(4):975-997.

Evans S, Taub R, Tsao JC et al. 2010. Sociodemographic factors in a pediatric chronic pain clinic: The roles of age, sex and minority status in pain and health characteristics. J Pain Manag. 3(3):273-281. "Little is known about how sociodemographic factors relate to children's chronic pain. This paper describes the pain, health, and sociodemographic characteristics of a cohort of children presenting to an urban tertiary chronic pain clinic and documents the role of age, sex and minority status on pain-related characteristics. A multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Two hundred and nineteen patients and their parents were given questionnaire packets to fill out prior to their intake appointment which included demographic information, clinical information, Child Health Questionnaire - Parent Report, Functional Disability Index - Parent Report, Child Somatization Index - Parent Report, and a Pain Intensity Scale. Additional clinical information was obtained from patients' medical records via chart review. This clinical sample exhibited compromised functioning in a number of domains, including school attendance, bodily pain, and health compared to normative data. Patients also exhibited high levels of functional disability. Minority children evidenced decreased sleep, increased somatization, higher levels of functional disability, and increased pain intensity compared to Caucasians. Caucasians were more likely to endorse headaches than minorities, and girls were more likely than boys to present with fibromyalgia. Younger children reported better functioning than did teens. The results indicate that sociodemographic factors are significantly associated with several pain-related characteristics in children with chronic pain. Further research must address potential mechanisms of these relationships and applications for treatment."

Evans TH, Schiller LR. 2012. Chronic vestibular dysfunction as an unappreciated cause of chronic nausea and vomiting. Proc (Bayl Univ Med Cent). 25(3):214-217. "In patients with chronic nausea and/or vomiting, gastroparesis is frequently diagnosed, often on the basis of abnormal gastric emptying scintigraphy (GES). When typical treatments fail, patients may be referred to a referral center. This retrospective study evaluated the diagnoses made in patients referred for chronic nausea and vomiting and appraised the GES utilized to assess these patients....The most common specific diagnosis in the entire group was chronic vestibular dysfunction (CVD, 64 patients, 26%) made by abnormal modified Fukuda stepping test, nystagmus, or abnormal Romberg test. CVD patients did not typically report a history of an inner-ear disorder or vertigo. Eighty-nine percent of CVD patients were given trials of antivertiginous medications; of the 39 followed for a median of 5 months, improvement occurred in two thirds. Diagnosis of gastroparesis should not be based on a nonstandardized GES. In our referred patients, gastroparesis was infrequent, while CVD was much more likely. Treatment for CVD may mitigate the nausea and vomiting." [Vestibular dysfunction is a frequent co-existing condition to both FM and CMP and is often unrecognized. DJS]

Evdokimov D, Dinkel P, Frank J et al. 2020. Characterization of dermal skin innervation in fibromyalgia syndrome. PLoS One. Jan 13;15(1):e0227674. "We found less dermal nerve fibers in contact with blood vessels in FMS patients than in controls. The pathophysiological relevance of this finding is unclear, but we suggest the possibility of a relationship with impaired thermal tolerance commonly reported by FMS patients."

Evdokimov D, Frank J, Klitsch A et al. 2019. Reduction of skin innervation is associated with a severe fibromyalgia phenotype. Ann Neurol. [Aug 3 Epub ahead of print] "The extent of small fiber pathology is related to symptom severity in FMS. This knowledge may have implications for the diagnostic classification and treatment of patients with FMS." [It would be of interest to assess these patients for co-existing TrPs, and note if they were contributing to or causing small fiber entrapment. DJS]

Evengard, B., C. G. Nilsson, G. Lindh, L. Lindquist, P. Eneroth, S. Fredrikson, L. Terenius and K. G. Henriksson.  1998.  Chronic fatigue syndrome differs from fibromyalgia.  No evidence for elevated substance P levels in cerebrospinal fluid of patients with chronic fatigue syndrome. Pain 78(2):153-5.

Everett CF, Morice AH. 2004.  Gastroesophageal reflux and chronic cough.  Minerva Gastroenterol Dietol. 50(3):205-213.  “Gastroesophageal reflux (GOR) disease is one of the 3 commonest causes of chronic cough.  It can be difficult to diagnose as the traditionally recognized symptoms of GOR, such as heartburn an acid regurgitation, are often absent.”  [GERD is an important perpetuating factor of myofascial TrPs.  Without the typical presenting symptoms, it may be missed. DJS]

Eyigor S, Karapolat H, Korkmaz OK et al. 2009. The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients. Eur J Cancer Care 18(2):195-201. [Patients with chronic pain conditions should be evaluated for FM AND for CMP. They are significant additional contributors of pain and dysfunction that need to be considered and managed DJS]

Evdokimov D, Kress L, Dinkel P et al. 2019. Pain-associated mediators and axon pathfinders in fibromyalgia skin cells. J Rheumatol. [Jun 15 Epub ahead of print] "In FMS, skin cells may contribute to cutaneous nociception by differentially expressing membrane-bound and soluble pain mediators and axon pathfinders." [Ion channels in the membranes of skin in patients with FM may be different and contribute to pain.]

Ezzati K, Ravarian B, Saberi A, et al. 2021. Prevalence of cervical myofascial pain syndrome and its correlation with the severity of pain and disability in patients with chronic non-specific neck pain. Arch Bone Jt Surg. Mar;9(2):230-234. "This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI…. Conclusion: Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients' disability and the latter variable."