Common Pain Disorder Research Articles

Comorbidity of Pterygoid Hamular Area Pain and TMD

Often craniofacial pain subjects report a number of conflicting and overlapping symptoms that can present a confusing clinical picture. Reaching a diagnosis on these individuals can prove to be a frustrating and difficult event for both the examiner and the patient. Thus, it is incumbent on clinicians treating patients with pain in the head, face and neck areas to be familiar with the less common pain disorders to assist in the differential review. This retrospective study examines the comorbidity of pterygoid hamulus pain with temporomandibular disorders (TMD). To acquire this information, the charts of 464 subjects with TMD in a private setting were examined to determine if pterygoid hamular pain was found at the evaluation. Ninety-two patients (N=92) had positive findings. Areas of referred pain that were elicited during the examination were charted. The pterygoid hamular area should be evaluated in individuals with TMD and especially those presenting with posterior palate and throat pain.

Fibromyalgia treatment update

Fibromyalgia is a common chronic pain disorder characterized by complex symptomatology and few consistently effective treatments. The purpose of this review is to highlight the recent literature from April 2005 through September 2006 involving treatment options. Prior evidence suggests that medication and self-management approaches to care can improve symptoms, function and well-being in this patient population. Recent studies examining the efficacy of two serotonin and norepinephrine-reuptake inhibitors--duloxetine and milnacipran--and the anticonvulsant pregabalin are encouraging. Studies evaluating different forms of exercise continue to support the belief that increased physical activity is an essential component of any treatment plan for the patient with fibromyalgia. Three studies added to the understanding of treatment adherence. Finally, three studies evaluating the efficacy of acupuncture in the treatment of fibromyalgia showed conflicting results, but added to the knowledge needed for clinicians to have substantive conversations with patients. Recent studies support the recommendation of a multimodal approach to treatment involving individualized, evidence-based pharmacotherapy and self-management. Treatment goals should include the improvement of symptoms, primarily pain and sleep, and the promotion of positive health behaviors with the aim of improving physical function and emotional well-being.

Duloxetine for Diabetic Peripheral Neuropathic Pain

The multiple mechanisms underlying the development of painful and nonpainful neuropathy associated with diabetes mellitus are not fully elucidated. Between 16% and 26% of diabetes patients experience chronic neuropathic pain, making diabetic peripheral neuropathic pain (DPNP) the most common neuropathic pain disorder. The use of antidepressants to treat DPNP is well established in clinical practice. Researchers performed a manufacturer-funded, multicenter, parallel, double-blind, randomized trial …

Three major haplotypes of the beta2 adrenergic receptor define psychological profile, blood pressure, and the risk for development of a common musculoskeletal pain disorder.

Adrenergic receptor beta(2) (ADRB2) is a primary target for epinephrine. It plays a critical role in mediating physiological and psychological responses to environmental stressors. Thus, functional genetic variants of ADRB2 will be associated with a complex array of psychological and physiological phenotypes. These genetic variants should also interact with environmental factors such as physical or emotional stress to produce a phenotype vulnerable to pathological states. In this study, we determined whether common genetic variants of ADRB2 contribute to the development of a common chronic pain condition that is associated with increased levels of psychological distress and low blood pressure, factors which are strongly influenced by the adrenergic system. We genotyped 202 female subjects and examined the relationships between three major ADRB2 haplotypes and psychological factors, resting blood pressure, and the risk of developing a chronic musculoskeletal pain condition-Temporomandibular Joint Disorder (TMD). We propose that the first haplotype codes for lower levels of ADRB2 expression, the second haplotype codes for higher ADRB2 expression, and the third haplotype codes for higher receptor expression and rapid agonist-induced internalization. Individuals who carried one haplotype coding for high and one coding for low ADRB2 expression displayed the highest positive psychological traits, had higher levels of resting arterial pressure, and were about 10 times less likely to develop TMD. Thus, our data suggest that either positive or negative imbalances in ADRB2 function increase the vulnerability to chronic pain conditions such as TMD through different etiological pathways that imply the need for tailored treatment options.

Interrater reliability of the needle examination in lumbosacral radiculopathy

Low back pain and lumbar radiculopathy are among the most common painful disorders affecting the adult population. This study hypothesizes that there is good correlation between the diagnostic impression of an unblinded electromyographer, using clinical and electromyographic information, and an independent electromyographer, who uses the needle examination only to assess for lumbar radiculopathy. This is a prospective, single-blinded, observational pilot study. The needle examination was electronically recorded, reproduced, and shown to a second examiner, blinded to all clinical data. Diagnostic impressions from both examiners were recorded and evaluated for agreement. Six recorded cases were reviewed by 66 blinded examiners. Overall diagnostic agreement was 46.9% (60.5% faculty level, 28.5% resident level). Logistic regression shows a strong association between training level and agreement on diagnostic impression (odds ratio, 1.9; 95% confidence interval, 1.12-3.22; P = 0.019). This study shows that there is fair interrater reliability between faculty-level examiners and poor reliability among resident-level examiners when the needle examination is used to evaluate patients with lumbar radiculopathy.

Upper-Extremity Pain Disorders in Breast Cancer

Stubblefield MD, Custodio CM. Upper-extremity pain disorders in breast cancer. Upper-extremity pain is a common and debilitating problem for patients with breast cancer. Although there is considerable literature describing symptoms, little is available on the specific disorders responsible for pain and debility in these patients. Cervical radiculopathy, brachial plexopathy, neuropathy, rotator cuff tendonitis, adhesive capsulitis, epicondylitis, postmastectomy syndrome, swelling, and bone metastases are among the common disorders responsible for upper-extremity pain in breast cancer patients. Overall Article Objective To discuss common upper-extremity pain disorders in patients with breast cancer.

Three major haplotypes of the β2 adrenergic receptor define psychological profile, blood pressure, and the risk for development of a common musculoskeletal pain disorder

Three major haplotypes of the β2 adrenergic receptor define psychological profile, blood pressure, and the risk for development of a common musculoskeletal pain disorder

Pain Management by the Family Physician: The Family Practice Pain Education Project

Pain is a common complaint of patients who visit a family physician, and its appropriate management is a medical mandate. The fundamental principles for pain management are: placing the patient at the center of care; adequately assessing and quantifying pain; treating pain adequately; maximizing function; accounting for culture and gender differences; identifying red and yellow flags early; understanding and differentiating tolerance, dependence and addiction; minimizing side effects; and being familiar with and using CAM therapies when good evidence of efficacy exists. The pharmacologic management of pain requires thorough knowledge of nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors, and opioids. A table of equianalgesic dosages is useful because patients may need to move from one opioid to another. Accompanying this article are papers discussing 5 common pain disorders seen by family physicians, including: neck pain, low back pain, joint pain, pelvic pain, and cancer/end of life pain. The family physician who learns these principles of pain management and the algorithms for these common pain disorders can serve patients well.

Central hyperexcitability in chronic musculoskeletal pain: a conceptual breakthrough with multiple clinical implications.

Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

Fibromyalgia is common in patients with transformed migraine.

Fibromyalgia (FM) and transformed migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

The Pain Clinic Manual, Second Edition .

Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto-Sao Paulo, Brazil.grlauret@fmrp.usp.brEdited by Stephen E. Abram and J. David Haddox. Philadelphia, Lippincott Williams & Wilkins, 1999. Pages: 480. Price: $45.00. This is a multiauthored manual (32 contributors plus editors), containing six sections plus appendices. Chapters, 40 in total, ranging in length from 2 to 12 pages, divide each section.It is a practical, portable guide for the treatment of chronic pain. As well-explained in the preface to the first edition, the manual per se is not a definitive reference because it contains limited information about the pathophysiology of the common and rare painful disorders presented, and it does not detail the technical aspects of treatment. However, the book does provide the experience and likelihood that a particular modality of assessment or treatment will be beneficial. The book focuses on the priority of a multimodal approach for pain treatment because the practitioner who applies a single modality to the entire range of pain conditions costs his or her patients and society financially and in personal suffering.Part I, the introduction, includes the subjects Pain Clinic Organization and Staffing, Pain Pathways and Mechanisms, and Pain: The Patient’s Perspective in three chapters. Part II discusses Patient Assessment, including collection of data, physical and psychologic assessment, and, finally, diagnostic and prognostic nerve blocks. Part III focuses on different treatment methods, including pain rehabilitation programs, intrathecal drug administration, local anesthetics, opioids, and alternative treatment, such as electrical stimulation of the nervous system. Adjuvant drugs are well-presented in a two-page table. The management of the most common pain disorders, such as back pain, myofascial pain, complex regional pain syndromes, sympathetically maintained pain, acute herpes zoster, neuropathies, facial pain, headache, chronic pelvic pain, central pain syndromes, chronic pain in children, and substance abuse, are described in part IV. Part V discusses information about cancer pain, palliative care, radiation therapy, neurolytic blocks, and the psychologic assessment. Part VI discusses sympathetic blocks, epidural steroids injections, peripheral nerve blocks, and head and neck blocks. It contains a reasonable amount of figures to help the reader. Finally, the appendices are short but useful and interesting.In general, the book The Pain Clinic Manual, Second Edition describes in a short and nice way what was proposed for each chapter, showing the best individual viewpoints of each coauthor. In addition, because it provides limited information about the pathophysiology of the common and rare painful disorders presented, I advise the book for two distinct groups. The first one, those already trained in pain syndromes and treatment, will consider this book to be an excellent manual for reference; the second one, those not familiar with pain modalities and not working in clinical practice with pain, will consider the manual to be a reference text for further information for pain specialists.

5. Pain assessment and management of common disorders

This self-directed learning module highlights the assessment and management of common pain disorders. As part of the chapter on pain in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation, this article contains sections on assessment and management of chronic back pain, osteoarthritis, postamputation neuropathic pain, fibromyalgia, and sympathetically mediated arm pain.

Tension Myalgia as a Diagnosis at the Mayo Clinic and Its Relationship to Fibrositis, Fibromyalgia, and Myofascial Pain Syndrome

Tension myalgia is a diagnosis that has been in use at the Mayo Clinic for more than 40 years. The term describes a common muscle pain disorder that is conceptually similar to other muscle pain disorders such as fibrositis, fibromyalgia, and myofascial pain syndrome. This article outlines the history of these disorders and proposes "tension myalgia" as a term that unifies these separate diagnoses under one conceptual framework. Because the diagnostic criteria for tension myalgia have been vague, the Department of Physical Medicine and Rehabilitation at the Mayo Clinic has developed specific criteria for generalized, regional, and localized forms of this disorder. The recommended treatment approach includes reassurance, elimination of contributing factors, physical therapy to restore normal neuromuscular function, conditioning, and medications.

The concept of primary fibromyalgia (fibrositis): clinical value, relation and significance to other chronic musculoskeletal pain syndromes

PFS, MPS and TMPDS can be identified using positive diagnostic criteria among patients presenting with chronic pain. A directed rather than exhaustive search for organic diseases known to coexist with these syndromes is usually all that is necessary. Criteria are presently empirical but do identify homogeneous populations of patients for study and treatment. Some patients, however, provide examples of overlap and it may be useful to think of CMPS in terms of the Venn diagram depicted in Fig. 2. In this report we have attempted an initial classification for a group of common and perplexing chronic pain disorders of the musculoskeletal system which at present have no identifiable cause. Previous investigations have been hampered by erroneous pathological concepts, heterogeneous patient populations and poor study design particularly with respect to treatment modalities. We hope that this classification, while empirical, will lead to needed epidemiological studies outlining the similarities and differences between these clinically observable and different musculoskeletal syndromes. We hope, further, that it will foster cooperation between different medical disciplines so that clinical biases might be tested in light of current concepts of the scientific method.