Myalgia Patients Research Articles

Abstract TP252: Forward Head Posturing as a Significant Risk Factor for Posterior Circulation Infarcts

Objective: Forward head posturing (FHP) has been associated with chronic anatomic vertebral artery disturbances possibly leading to posterior circulation ischemia. The data supporting FHP as a true risk factor of posterior circulation stroke has not been well established. We aim to study if patients with severe cervical myalgias and FHP have an increased risk of posterior circulation stroke. Methods: We identified all adult patients with posterior circulation stroke and diagnosis of cervical myalgia at Loyola University Medical Center from January 2018 to January 2023. Information on demographics and comorbidities were also collected. We then identified matched pair case-controls (based on age and gender) with non-stroke cervical myalgia patients in the same 5-year period. We compared the relevant comorbidities, C2 tilt angle, and C2-C7 tilt angle of patients to their matched controls to for statistical difference. Results: 76 patients (38 cases and 38 controls) with an average age of 64 years, including 38 (50%) females met our inclusion criteria. The average C2 tilt of cases was 22.9 degrees compared to 17.7 degrees in controls, and the average C2-C7 tilt of cases was 18.9 degrees in cases compared 10.5 degrees in controls. There were no significant differences between relevant comorbidities (including hypertension, hyperlipidemia, diabetes, atrial fibrillation, hyper-coagulopathy, or body mass index) of cases and controls. There was a significant difference of 5.2 degrees higher C2 tilt and 8.1 degrees higher C2-C7 tilt in cases compared to controls respectively (p-value = 0.03). Conclusion: In this single-center retrospective analysis, we found that after controlling for age, gender, and comorbidities, patients with posterior circulation stroke were more likely to have significantly higher C2 and C2-C7 cervical tilt (worse FHP based on radiographic standards) compared to their matched control counterparts.

Assessment of awake bruxism by a novel bruxism screener and ecological momentary assessment among patients with masticatory muscle myalgia and healthy controls.

Bruxism is a masticatory muscle activity occurring during sleep or wakefulness, involving grinding and clenching of teeth and/or jaw bracing. As yet, the aetiology, epidemiology and consequences of awake bruxism (AB) are largely unknown. The aims of the study were to AB behaviours using a novel bruxism screener (BruxScreen) questionnaire part and Ecological Momentary Assessment (EMA; BruxApp©) on AB behaviours, and to investigate AB's prevalence among masticatory muscle myalgia patients and non-patients. Altogether, 115 participants (masticatory myalgia patients referred to a specialist clinic (n = 67) and non-patients (n = 46)) filled in a bruxism screener questionnaire to report bruxism behaviours and jaw symptoms. A selection of both groups did a week-long EMA (patients n = 12, non-patients n = 11) to report AB behaviours. The chi-squared test was used to determine group differences in categorical variables. A logistic regression model was fitted to study the probability of AB. According to BruxScreen, bruxism behaviours and jaw symptoms were more frequent in patients than in non-patients (p < .001). Based on EMA, 14.6% of the behaviour in patients was tooth clenching; for non-patients, this was 0.5% (p < .000). Relaxed muscles were reported by patients and non-patients at 20.6% and 56.4%, respectively (p < .021). Logistic regression, adjusted by age and sex, revealed that patients reported AB 5 times more often than non-patients (OR 4.8, 95% CI 2.1-11.2). Awake bruxism behaviours are significantly more frequent in masticatory muscle myalgia patients than non-patients and associate with frequent bruxism-related symptoms. Self-reported teeth clenching seems to be the most significant sign of AB behaviour.

Psychological and Behavioral Factors Involved in Temporomandibular Myalgia and Migraine: Common but Differentiated Profiles.

Many studies have revealed high comorbidity and a clear association between temporomandibular disorders (TMD) and migraine. Furthermore, evidence points out that common psychological and behavioral factors might be related to the observed TMD and migraine association. However, this association and the underlying psychological factors are poorly understood. The main goal of this study was to describe the psychological and behavioral factors involved in TMD myalgia and migraine. A sample of 142 participants were recruited to form 4 groups: migraine patients (ICHD-III criteria), painful-TMD patients (Myalgia DC/TMD criteria), patients suffering from both pathologies according to the same criteria, and control patients. After a dental and neurological examination, the patients filled several psychological questionnaires validated for the Spanish population to assess anxiety (STAI), depression (DEP), stress coping (CRI), and somatic, anxiety, and depression symptoms (BSI-18). The TMD myalgia patients, in general, showed a state of elevated anxiety, somatization, and reduced coping strategies, while the patients with migraine presented greater anxiety symptoms, depression (dysthymia trait and state), and somatization. According to the data of the present study, situational anxiety (transient emotional state), together with the lack of coping strategies, could be more associated with TMD myalgia, while anxiety, as a more stable and long-lasting emotional state, together with depression, might be more related to migraine. Further longitudinal studies are needed to unravel whether these differentiated profiles are a consequence or possible risk factors for migraine and TMD.

BENEFITS OF RADIAL SHOCK WAVE THERAPY AND LASER THERAPY ON MYALGIA LOW BACK PAIN

Low Back Pain (LBP) does not cause death, but causes individuals to become unproductive so that it will cause an enormous economic burden for individuals, families, communities and the government. Indonesian BPS data explains that people over 15 years of age have health problems. With increasing age, the anatomical structure and function of tissues will decrease, such as muscles, bones and joints, ligaments and other soft tissues. These changes are relevant to a person's decrease in activity. Pain is a major problem in patients with LBP disorders. Physiotherapy measures to overcome these complaints are extracorporeal shock wave therapy and laser. Physiotherapeutic intervention using shock wave therapy and extracorporeal laser methods can be given to LBP myalgia patients through community service activities carried out at Grandmed Lubuk Pakam Hospital. To evaluate the results of the intervention, the measuring tool used is the Verbal Analog Scale (VAS). This activity was attended by 12 respondents who complained of low back pain. Before and after the intervention the value will be measured using the VAS. Based on the results of the last evaluation, it can be seen that the respondents' pain complaints before and after the intervention experienced withdrawal, namely 5.8 (moderate pain) before the intervention and after the intervention the value became 0.8 (mild pain). The results of these actions prove that physiotherapy interventions such as radial shock wave therapy and laser therapy are useful/effective in dealing with complaints of LBP myalgia.

The Effect of Radial Shock Wave Therapy and Laser Therapy on Pain in Myalgia Pain Low Back at EMC Hospital, Cikarang in 2022

Low Back Pain (LBP) is a leading cause of disability worldwide, which places a significant economic burden on the healthcare system. Nonspecific low back pain Low back pain (LBP) is defined as low back pain that is not caused by a recognized and recognized specific pathology. Low back pain does not cause death, but causes individuals who experience it to become unproductive so that it will cause a very large economic burden for individuals, families, communities, and governments. Promising physiotherapy measures for the treatment of LBP myalgia are extracorporeal shock wave therapy and laser. The purpose of this study was to determine the effect of radial shock wave therapy and laser therapy on pain in low back pain myalgia patients at EMC Hospital Cikarang in 2022. This research method was experimental with a quasi-experimental approach, namely research by conducting experiments to determine the symptoms or effects that arise. as a result of a certain treatment or experiment with a one group pretest posttest design, with the aim of knowing the effect of radial shockwave therapy and laser therapy on pain in low back pain myalgia patients at EMC Hospital Cikarang in 2022. The number of samples from this study was 12 people. who is an employee of EMC Cikarang Hospital in 2022 with complaints of LBP myalgia. Respondents will be measured the value of pain using Verval Analogue Scale (VAS) before and after being given radial shockwave therapy and laser therapy. The test used to analyze the data is the Wilcoxon test. The results of data analysis using the Wilcoxon test obtained a significance value (p-value) of 0.001 which is smaller than 0.05 (p&lt;0.05), which means that there is a difference in the value of pain before and after giving radial shock wave therapy and laser therapy to pain in patients. low back pain myalgia. The conclusion is that there is an effect of giving radial shock wave therapy and laser therapy to reducing pain in low back pain myalgia patients at EMC Hospital Cikarang in 2022

Effectiveness of Myofascial Release (MFR) vs. High-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief and Functional Improvement in College Students With Trapezius Myalgia.

The pain in the trapezius muscle is known as trapezius myalgia. The patient often complains of trapezius muscle soreness and tightness. Musclesoreness usually lasts for a few days, if not longer. This muscular rigidity and stiffness cause spasms inupper trapezius fibres, culminating in neck discomfort in the posterior side of the neck and shoulder area. This protocol was designed to describe the study to evaluate the effect of myofascial release (MFR) versus high-frequency transcutaneous electrical nerve stimulation (TENS) for pain relief and functional improvement in subjects with trapezius myalgia. Methods: Forty-five subjects with trapezius myalgia meeting inclusion criteria were selected for the study. Two groups were created, with group A undergoing MFR therapy and group B undergoing high-frequency TENS. The procedure was completed within four weeks. Regular assessments were carried out in the first week and fourth week of the rehabilitation. Throughout the recovery process, we evaluated pain, functional improvement, and range of motion of the neck at regular intervals. The outcome measures taken were the Numerical Pain Rating Scale (NPRS) and Neck Disability Index (NDI). Discussion: The intervention's efficacy was assessed by looking at pain alleviation using the outcome measures. The study's findings strongly supported the application of these approaches and modalities in the rehabilitation of myalgia patients.

Effects of Motor Learning on Posture and Cervical Function in Patients with Chronic Cervical Pain

Objective: For 30 patients with muscular pain around the cervical spine, 15 subjects in the control group who received conservative physical therapy and basic stretching exercises and 15 subjects in the experimental group who received intensive exercise for stretching, strength training, and posture recognition exercise in conservative physical therapy The experiment was conducted under control. Methods: The control group performed large muscle group stretching for 20 minutes after conservative physical therapy, and the experimental group focused on learning to change the movement patterns that make up the imbalance of cervical joints and muscles. Results: sEMG, distance from ground to acromion, and Neck Disability Index were found to have statistically significant differences in both the experimental group and the control group. The amount of change in the experimental group was greater than that of the control group. Conclusion: As a result of this study, learning about exercise therapy and various fused exercise therapy for myalgia patients have all the advantages of muscle activity, posture change, and pain pattern.

Effectiveness of Myofascial Release vs High Frequency TENS for Pain Relief and Functional Improvement in College Students with Trapezius Myalgia: A Comparative Study

Background: Trapezius Myalgia is characterized by pain in the trapezius muscle. The patient suffering from myalgia usually complaints of pain, stiffness and tightness of the upper trapezius muscle. Acute or chronic neck-shoulder pain is the hallmark of this condition. The pain in the muscle usually lasts for few days or it can be even longer. The presence of spasm in upper trapezius muscle is shown by neck pain in the back of the neck and between the bases of the neck and the shoulder. This protocol has been created that describes the design of experimental study to evaluate and compare the effect of Myofascial Release (MFR) versus High-Frequency TENS for pain relief and functional improvement in subjects with Trapezius Myalgia.&#x0D; Methods: The participants (n=45) will be recruited in the study suffering from Trapezius Myalgia and meeting the inclusion criteria. Two groups will be formed such that group A will be treated with Myofascial Release technique and group B will be treated with High Frequency TENS modality. The protocol will cover 4 weeks of treatment. Regular assessment will be carried out on 1st and 4th week of the rehabilitation period. During the rehabilitation period, we will evaluate pain status and functional improvement and range of motion of the neck in the subject at regular intervals. Our outcome measures will be – Numerical Pain Rating Scale (NPRS) and Neck Disability Index (NDI).&#x0D; Discussion: The efficacy of the intervention will be evaluated by analyzing pain relief using Numerical Pain Rating Scale (NPRS) and functional improvement by using Neck Disability Index (NDI). The result of the study will significantly provide affirmation on using these modalities for treating myalgia patients.

Effect of photobiomodulation therapy on painful temporomandibular disorders

To evaluate the effect of photobiomodulation therapy (PBMT) on painful temporomandibular disorders (TMD) patients in a randomized, double-blinded, placebo-controlled manner. Participants were divided into a masseter myalgia group (n = 88) and a temporomandibular joint (TMJ) arthralgia group (n = 87) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Both groups randomly received PBMT or placebo treatment once a day for 7 consecutive days, one session. The PBMT was applied with a gallium-aluminum-arsenide (GaAlAs) laser (wavelength = 810 nm) at pre-determined points in the masseter muscle (6 J/cm2, 3 regions, 60 s) or TMJ region (6 J/cm2, 5 points, 30 s) according to their most painful site. Pain intensity was rated on a 0–10 numerical rating scale (NRS) and pressure pain thresholds (PPT) and mechanical sensitivity mapping were recorded before and after the treatment on day 1 and day 7. Jaw function was assessed by pain free jaw opening, maximum unassisted jaw opening, maximum assisted jaw opening, maximum protrusion and right and left excursion. Data were analyzed with a mixed model analysis of variance (ANOVA). Pain intensity in arthralgia patients decreased over time (P < 0.001) for both types of interventions, however, PBMT caused greater reduction in pain scores than placebo (P = 0.014). For myalgia patients, pain intensity decreased over time (P < 0.001) but without difference between interventions (P = 0.074). PPTs increased in both myalgia (P < 0.001) and TMJ arthralgia patients over time (P < 0.001) but without difference between interventions (P ≥ 0.614). Overall, PBMT was associated with marginally better improvements in range of motion compared to placebo in both myalgia and arthralgia patients. Pain intensity, sensory function and jaw movements improve after both PBMT and placebo treatments in myalgia and arthralgia patients indicating a substantial non-specific effect of PBMT.

An in vivo electromyographic evaluation of pain relief using different therapies in masticatory myalgia patients.

ObjectivesThis study is aimed to evaluate and compare the effect of moist heat fomentation therapy with ultrasound therapy in patients with the masticatory myalgia.Materials and MethodsThe study was conducted on 42 patients with masticatory myalgia, dividing them into two groups; Group A (21 patients), received moist heat therapy and Group B (21 patients), received ultrasound therapy for seven effective days. Prior and after the treatment the numeric rating scale (NRS) and the electromyography (EMG) scores were recorded and compared. The observations were analyzed clinically and statistical support was taken to assess the NRS and EMG data.ResultsIrrespective of the groups, patients testified a significant reduction in pain after the treatment. From the EMG readings; even though the standard deviation for each group was varied considerably, EMG recorded an improved muscle activity. Statistical analysis was used to assess and identify the best treatment methodology between the two modalities.ConclusionFrom the statistical analysis, it is concluded that, though both the therapies had significantly reduced the symptomatic response, it is moist heat fomentation that improved muscle activity both statistically and clinically in comparison to ultrasound.

Protein Signature in Saliva of Temporomandibular Disorders Myalgia.

In the last years, several attempts have been made to study specific biological markers of temporomandibular disorders (TMD). So far, no laboratory tests have been appropriately validated for the diagnosis and prognosis of these disorders. This study aimed to investigate the proteomic profile of the whole stimulated saliva of TMD myalgia patients in order to evaluate potential diagnostic and/or prognostic salivary candidate proteins which could be useful for the management of TMD. Twenty patients diagnosed with TMD myalgia according to the validated Diagnostic Criteria for TMD (DC/TMD) and 20 matched healthy pain-free controls were enrolled. Saliva samples were collected in the morning. Comparative proteomic analysis was performed with two-dimensional gel electrophoresis followed by identification with liquid chromatography–tandem mass spectrometry. Statistical analysis of the quantitative proteomics data revealed that 20 proteins were significantly altered in patients compared to controls. Among these proteins, 12 showed significantly increased levels, and 8 showed significantly decreased levels in patients with TMD myalgia compared to controls. The identified proteins are involved in metabolic processes, immune response, and stress response. This proteomic study shows that the salivary protein profile can discriminate patients with TMD myalgia from healthy subjects, but the protein signature has no correlation with the clinical features of TMD myalgia. Additional studies are needed to validate our observations in additional sample sets and to continue assessing the utility of saliva as a suitable sample for studying processes related to TMD myalgia.

The Effect of Nonstrenuous Aerobic Exercise in Patients with Chronic Masticatory Myalgia.

To evaluate the effect of nonstrenuous aerobic exercise on chronic masticatory myalgia (CMM) patients and healthy controls (HC) by means of mechanical temporal summation (TS) and response to mechanical stimulation (RMS) performed on the dominant forearm. A total of 30 patients diagnosed with CMM and 30 pain-free HCs were first evaluated for maximum number of steps (MNS) on a stepper machine for 1 minute. Additionally, they completed the Generalized Anxiety Disorder (GAD-7), Graded Chronic Pain Scale (GCPS), and Jaw Functional Limitation Scale (JFL) questionnaires. On the second visit, RMS, mechanical TS, exercise-induced hypoalgesia (EIH), blood pressure, pulse pressure, and heart rate were assessed prior to and immediately, 5, 15, and 30 minutes following 5 minutes of stepper exercise at 50% MNS. Compared to HCs, CMM patients demonstrated increased mechanical TS and less efficient EIH. Mechanical TS scores were reduced in both groups; however, the HC reduction was more robust and persistent. CMM patients demonstrated a delayed reduction in RMS following exercise in contrast to an immediate reduction in HCs. GAD-7, GCPS, and JFL scores for CMM patients were higher than for HCs and were associated with baseline pain intensity but not with EIH or TS. These findings suggest that, compared to HC, CMM patients' pain modulation is both suppressed and has a different effect duration and timing pattern. Further research should explore the mechanisms and clinical relevance of the delayed hypoalgesia and the inhibitory effect on TS induced by nonstrenuous aerobic exercise in CMM patients.

The Effectivity of Dry Needling and Friction Massage Application on Pain Scale Changes in Upper Trapezius Myalgia Patients

Background: Upper trapezius myalgia is one of the most common symptoms in adults. This can be treated by using dry needling and friction massage. Objective. This study aims to determine the effectivity of dry needling and friction massage to improve pain in upper trapezius myalgia patients. Method. The study was conducted at Inco Hospital, Sorowako, South Sulawesi, Indonesia, involving 20 subject who meet the inclusion and exclusion criteria of having upper trapezius myalgia and 20 – 65 years old. Pain was measured using NPRS at baseline and after 3 times therapy for 5 weeks. Result. At the end of therapy (3 times), both of groups showed decrease of pain scale compared to baseline. The pain was improved significantly better in the dry needling with friction group compared to friction alone.

The addition of pharmacological treatment to physiotherapy in pain reduction of TMD-myalgia patients

Background: Myalgia is the most common cause of Temporomandibular Disorders (TMDs) pain, which has a dull and mild character. In some patients with high somatization, it can present itself as severe pain, which can complicate the treatment. Additional pharmacological treatment may thus be needed. Case Report: Two female patients came with similar symptoms but different pain intensities. The first patient had a high intensity of pain, which became severe during examination. The second patient had more complaints but showed typical symptoms of myalgia. Both received physiotherapy sessions, but for the first patient, we added analgesics to help the patient endure physiotherapy. Conclusion: Additional pharmacological treatments, especially analgesics, can be used in helping myalgia patients with high somatization to undergo physiotherapy.

The use of conventional transcutaneous electrical nerve stimulation in chronic facial myalgia patients.

The aim of this study was to evaluate the efficacy of conventional TENS in women affected by chronic facial myalgia. The study was performed on 49 women affected by chronic facial myalgia randomly allocated in the TENS group (34 women) and the control group (15 women). The subjective level of pain was assessed by the Visual Analogue Scale indicating the mean (VAS MEAN), the maximum (VAS MAX) and the current intensity of pain (VAS NOW). The level of pain at the muscular palpation sites was assessed by the Pericranial Muscle Tenderness Score (PTS) and the Cervical Muscle Tenderness Score (CTS). The TENS therapy lasted for 10weeks, and data were collected at baseline, after 5, 10, 15 and 25weeks. The differences between groups before and after treatment were compared with the Mann-Whitney and the Kolmogorov-Smirnov tests. The intra-group differences were compared with the one-way ANOVA test. The results showed that the VAS MEAN, VAS MAX, PTS and CTS were significantly reduced in the TENS group compared to the control group after 10weeks of TENS (p<0.05). The intra-group analysis revealed a decreasing tendency of VAS MEAN, VAS MAX, VAS NOW, PTS and CTS in the TENS group in a 25-week period (p<0.05). The study demonstrated the efficacy of conventional TENS in patients with chronic facial myalgia and the decrease in both subjective and objective pain. Conventional TENS is a safe, non-invasive, easy-to-administer therapy for chronic facial myalgia.

Epidemic myalgia associated with human parechovirus type 3 infection among adults occurs during an outbreak among children: Findings from Yamagata, Japan, in 2011

BackgroundBased on our findings in Yamagata, Japan, in 2008, we reported that human parechovirus type 3 (HPeV3) could be associated with epidemic myalgia among adults, although HPeV3 is generally associated with infectious diseases in children. ObjectivesTo clarify the relationship between community outbreaks among children and myalgia through the continued surveillance of HPeV3 infections. Study designIn the summer season (June–August) of 2011, we collected 586 specimens from children with infectious diseases, and throat swabs, and stool and serum specimens from 5 patients with myalgia. We detected HPeV3 using virus isolation and reverse-transcription PCR, and carried out phylogenetic analysis. We also performed screening for HPeV3 using 309 stocked frozen specimens collected in 2008 for a comparison between 2008 and 2011 strains. ResultsWe detected HPeV3 in 59 children and isolated HPeV3 from all myalgia patients. Phylogenetic analysis indicated that the HPeV3 strains circulating in 2008 and 2011 could be clearly distinguished, apart from two strains. Further, we detected HPeV3 strains with identical nucleotide sequences from children and adults in 2008 and 2011, respectively. Two children belonging to one myalgia patient had upper respiratory infections prior to the onset of their father's illness, and the HPeV3 isolates from these three patients had identical nucleotide sequences. ConclusionsThese findings suggest that HPeV3, circulating among children in the community, infects their household, including parents, a portion of whom may subsequently show symptoms of myalgia. Our observations in 2008 and 2011 strongly suggest that clinical consideration should be given to HPeV3 in children as well as in adults during summer seasons in which an HPeV3 outbreak occurs among the children in the community.

Dynamic Cervical Implant. Alternative Between Cage Fusion and Total Disc Replacement

Based on our findings in Yamagata, Japan, in 2008, we reported that human parechovirus type 3 (HPeV3) could be associated with epidemic myalgia among adults, although HPeV3 is generally associated with infectious diseases in children.To clarify the relationship between community outbreaks among children and myalgia through the continued surveillance of HPeV3 infections.In the summer season (June–August) of 2011, we collected 586 specimens from children with infectious diseases, and throat swabs, and stool and serum specimens from 5 patients with myalgia. We detected HPeV3 using virus isolation and reverse-transcription PCR, and carried out phylogenetic analysis. We also performed screening for HPeV3 using 309 stocked frozen specimens collected in 2008 for a comparison between 2008 and 2011 strains.We detected HPeV3 in 59 children and isolated HPeV3 from all myalgia patients. Phylogenetic analysis indicated that the HPeV3 strains circulating in 2008 and 2011 could be clearly distinguished, apart from two strains. Further, we detected HPeV3 strains with identical nucleotide sequences from children and adults in 2008 and 2011, respectively. Two children belonging to one myalgia patient had upper respiratory infections prior to the onset of their father's illness, and the HPeV3 isolates from these three patients had identical nucleotide sequences.These findings suggest that HPeV3, circulating among children in the community, infects their household, including parents, a portion of whom may subsequently show symptoms of myalgia. Our observations in 2008 and 2011 strongly suggest that clinical consideration should be given to HPeV3 in children as well as in adults during summer seasons in which an HPeV3 outbreak occurs among the children in the community.

Mean power frequency during speech in myalgia patients

The purpose of this study was to clarify a difference of mean power frequency (MPF) during speech between control and myalgia patients groups. The control group consisted of 20 asymptomatic volunteers and the myalgia patients group consisted of 19 patients. A bilateral electromyogram (EMG) of masseter muscles during speech movement was recorded using surface electrodes, and the EMG data were stored and analysed with a computer-based EMG analyzer. The MPF during the entire duration of EMG burst during speech was compared between the control and myalgia group. The average (SD) MPFs during speech in the myalgia and control groups were 214.06 (17.23) and 183.39 (22.35) Hz, respectively, significantly higher in the former (P < 0.001). In myalgia patients, firing rates or recruitment of motor units innervated by high threshold motoneurons might decrease and lead to a higher MPF. The result suggests the possibility that muscle pain, that is a subjective experience, could be evaluated by objective data that is calculated from electromyographic activities which is recorded during speech.

Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia

The aim of this study was to investigate how exercise influenced endogenous pain modulation in healthy controls, shoulder myalgia patients and fibromyalgia (FM) patients. Twenty-one healthy subjects, 20 shoulder myalgia patients and 20 FM patients, all females, participated. They performed standardized static contractions, that is, outward shoulder rotation (m. infraspinatus) and knee extension (m. quadriceps). Pressure pain thresholds (PPTs) were determined bilaterally at m. infraspinatus and m. quadriceps. During contractions PPTs were assessed at the contracting muscle, the resting homologous contralateral muscle and contralaterally at a distant site (m. infraspinatus during contraction of m. quadriceps and vice versa). Myalgia patients had lower PPTs compared to healthy controls at m. infraspinatus bilaterally ( p < 0.01), but not at m. quadriceps. FM patients had lower PPTs at all sites compared to healthy controls ( p < 0.001) and myalgia patients ( p < 0.001). During contraction of m. infraspinatus PPTs increased compared to baseline at the end of contraction in healthy controls (all sites: p < 0.003), but not in myalgia or FM patients. During contraction of m. quadriceps PPTs increased compared to baseline at the end of contraction in healthy controls (all sites: p < 0.001) and myalgia patients (all sites: p < 0.02), but not in FM patients. In conclusion, we found a normal activation of endogenous pain regulatory mechanisms in myalgia patients during contraction of the non-afflicted m. quadriceps, but a lack of pain inhibition during contraction of the painful m. infraspinatus. FM patients failed to activate their pain inhibitory mechanisms during all contractions.

Salivary cortisol response to acute stress and its relation to psychological factors in women with chronic trapezius myalgia—A pilot study

This study investigated differences in HPA axis function, measured as salivary cortisol concentrations, between 18 women with chronic trapezius myalgia (MYA) and 30 healthy female controls (CON). In addition, the interactions between HPA axis reactions to psychosocial stress and aspects of pain, health and psychological symptoms were analyzed. Salivary cortisol was measured both in daily life, to assess the circadian profile, and in the laboratory during light repetitive work and standardized psychosocial stress (Trier Social Stress Test, TSST). MYA and CON exhibited similar circadian rhythms and comparable salivary cortisol response magnitudes after TSST. In subjects defined as responders to the TSST, the mean peak time point of the cortisol response after TSST differed significantly between MYA and CON. Furthermore, negative psychological states and higher pain intensity were related to a slower HPA axis response to TSST. Low circadian variations in cortisol and smaller cortisol responses to TSST were found among subjects scoring high on anxiety sensitivity. Thus, a relatively favorable sample of female chronic trapezius myalgia patients exhibited normal circadian rhythm and normal salivary cortisol response magnitudes after a psychosocial stress test. In the subgroup of responders, the MYA group showed indications of a slower salivary cortisol response to psychosocial stress. Further studies are needed to elucidate the possibility of altered HPA axis activity in terms of a slower salivary cortisol response.