Muscle Pain: Diagnosis and Treatment (eBook)

Foreword 6
Preface 8
Contents 10
Contents to Muscle Pain: Understanding the Mechanisms 12
Contributors 14
Chapter 1: Introduction 16
Established Pain Terms (Partly after Merskey and Bogduk 1994 and Loeser and Treede 2008)17
General Terms 17
Diagnostic Terms 18
Myofascial Pain 18
Fibrositis 18
Fibromyalgia 18
Myogelosis and ``Muscle Indurations´´ 19
Nonarticular Rheumatism (Soft Tissue Rheumatism) 19
Non-Specific Low Back Pain 19
Tendomyopathy 19
Work-Related Disorders of the Musculoskeletal System 20
Established, but Often Ill-Defined, Terms 20
Referred Pain 20
Importance and Prevalence of Muscle Pain 20
Gender Differences 21
Pain Measurement 21
Aggravating and Perpetuating Factors 22
Patient History 23
Examining Patients with Musculoskeletal Pain 23
Distinguishing Between Different Types of Pain (Local, Projected, Referred, and Central) 24
Local Pain and Tenderness 24
Projected Pain 24
Referred Pain and Tenderness 25
Central Pain 25
References 25
Part I: Myofascial Pain Syndrome 27
Chapter 2: Myofascial Pain Syndrome 28
Introduction 30
Trigger Point Manifestations 31
Trigger Point Pain 31
Current State of Knowledge 32
Clinical Presentation 33
Definition 33
Primary Trigger Point Characteristics 33
Additional Trigger Point Characteristics 34
Trigger Point Identification 36
Weakness 37
Recruitment 37
Reciprocal Inhibition 37
Range of Motion 38
Functional Adaptation 38
Sensory Changes 38
Electrophysiology of the Trigger Point: Spontaneous Electrical Activity (Endplate Noise) 39
Etiology of Myofascial Trigger Points 41
Generation of the Taut Band 41
Muscle Overuse Syndromes and Myofascial Pain Syndrome 41
The Neuromuscular Junction: The Role of the Neuromuscular Junction in Trigger Point Formation 41
Peripheral Nerve Sensitization in Myofascial Pain Syndrome 43
Hypoxia and Ischemia 43
Biochemistry of the Trigger Point Region 44
Muscle Pathology 46
Central Sensitization 50
Central Pathways 50
Referred Pain 51
Muscle Stress and Overuse 53
Muscle Overuse Syndromes 53
Postural Stresses 56
Pain Initiation in Myofascial Pain Syndrome 56
Inflammatory Pain Models 56
Acid-Sensing Ion Channels 57
Serotonergic Mechanisms 57
Calcitonin Gene-Related Peptide 58
Spinal Modulation of Pain 58
Epidemiology of Myofascial Pain 59
Prevalence Studies 59
Gender Differences 59
Hypermobility 60
Diagnosis of Myofascial Pain Syndrome 60
Reliability of Manual Identification of Trigger Points 60
Consensus Studies and Systematic Reviews 62
Objective Criteria 63
Pain from Bone and Tendon 64
Differential Diagnosis 65
Differential Diagnostic Considerations 65
Trigger Point-Initiating Factors 65
Fibromyalgia 66
Other Disorders to Consider 66
Viscerosomatic Disorders 66
Other Causes of Referred Pain 67
Mechanical Dysfunction 67
Treatment 67
Treatment Principles 67
Manual Inactivation of Trigger Points 68
Noninvasive, Non-Manual Treatment Techniques 70
Invasive Treatment of Myofascial Trigger Points 70
Botulinum Toxin 73
Perpetuating Factors 74
Introduction to Perpetuating Factors 74
Iron Insufficiency 74
Hypothyroidism 75
Iron Status and Thyroid Function 76
Vitamin D Deficiency 77
Statins 78
Structural and Mechanical Factors 79
Selected Specific Clinical Syndromes 79
Headache 79
Fibromyalgia 80
Endometriosis and Other Pelvic Viscerosomatic Pain Syndromes 81
Radiculopathy 82
Thoracic Outlet Syndrome 83
Conclusion 84
References 84
Chapter 3: Morphology of Myofascial Trigger Points: What Does a Trigger Point Look Like? 97
Introduction and Historical Remarks 98
Normal Histology and Structure of Skeletal Muscle 100
The Striation 100
The Motor Unit 100
The Neuromuscular Junction 102
Morphological Features of a Trigger Point 104
Animal Experiments Aiming at the Production of Myofascial Trigger Points 108
Morphology of the Tender Points of the Fibromyalgia Syndrome 111
References 112
Part II: Fibromyalgia Syndrome 115
Chapter 4: Fibromyalgia Syndrome: Clinical Aspects and Management 116
Definitions and Terms 118
Fibromyalgia 118
Regional Pain Syndrome 118
Prevalence 118
Impact 119
Symptoms 120
Pain 120
Fatigue 120
Sleep Disturbance 121
Stiffness and Exercise Myalgia 121
Cognitive Disturbance 121
Abnormal Sensations 121
Vascular Disturbances 122
Signs 122
Tenderness 122
Muscle Tightness 123
Other Signs 123
Diagnosis 124
Clinical Presentation 124
Investigations 125
Comorbidities 126
Chronic Fatigue Syndrome 127
Irritable Bowel Syndrome 127
Irritable Bladder Syndrome 127
Regional Pain Syndromes 127
Restless Legs Syndrome 127
Multiple Chemical Sensitivities 128
Personality, Mood, and Psychology 128
Personality 128
Depression 130
Anxiety 130
Distress 131
Triggers 131
Trauma 131
Infection 132
Chronic Illness 132
Stress 132
Basic Management 132
Assessment 133
Management Setting 133
Lifestyle Factors 134
Stress Factors 134
Nonpharmacological Management 135
Accurate Diagnosis 135
Education 135
The Importance of Patient Involvement 136
Exercise 136
Psychological Approaches 137
Cognitive Behavioral Therapy 138
Operant Behavioral Therapy 138
Other Nonpharmacological Therapies 138
Pharmacological Management 139
General Approaches 139
Analgesics: Opioid and Nonopioid 139
Non-Steroidal Anti-inflammatory Drugs 140
Pain System Modulators 141
General Considerations 141
Tricyclic Antidepressants 141
Serotonin and Norepinephrine Reuptake Inhibitors 141
Balanced Dual Reuptake Inhibitors 142
Monoamine Oxidase Inhibitors 143
Selective Serotonin Reuptake Inhibitors 143
Serotonin Receptor Antagonists 143
Dopamine Receptor Modulators 143
N-Methyl-d-aspartate Receptor Antagonists 143
Alpha-2-Delta Ligands 144
Agents for Sleep 144
Combination Therapies 145
Other Technology 145
Treatment Plan Checklist 146
Conclusion 146
References 147
Chapter 5: Gender, Genetics, and Other Risk Factors Increasing Vulnerability to Fibromyalgia 153
Introduction 154
Gender 154
Triggers 155
Familial Factors 157
Genetic Factors 158
Human Leukocyte Antigen 158
Monoaminergic Systems 158
Catechol-O-Methyltransferase Pathway 158
Serotonin-Related Genes 161
Serotonin Transporter Gene 161
Serotonin Receptor Genes 162
Monoamine Oxidase 162
Dopamine-Related Genes 162
Other Genes 163
Conclusion 163
References 164
Part III: Other Muscle Pain Syndromes 168
Chapter 6: Low Back Pain of Muscular Origin 169
Introduction 170
Epidemiology 171
Etiology 173
Predisposing Factors 173
Mechanical 173
Comorbid Disorders 174
Psychological Factors 174
Occupational Factors 174
Sex, Gender, and Age Factors 175
Clinical Myofascial Low Back Pain Syndromes 176
Quadratus Lumborum Muscle 179
Abdominal Muscles 181
Iliopsoas 182
Gluteus Medius 185
Erector Spinae 185
Posterior Serratus Inferior Muscle 188
Functional Consequences of Myofascial Trigger Points (see Chap.2) 188
Treatment 190
Treatment Evaluation Schema 190
Nonpharmacological 190
Physiotherapy 191
Electrical Stimulation 192
Interventional Treatment 193
Botulinum Toxin 193
Trigger Point Dry Needling and Injections 193
Pharmacological Treatment 194
Muscle Relaxants 196
Opioids 196
Conclusion 197
References 197
Chapter 7: Masticatory Muscle Pain 201
The Masticatory Muscle Pain 202
Epidemiology 203
Comorbidity 204
Headache 204
Neck Pain 204
Fibromyalgia 205
Etiology and Risk Factors 205
Gender and Age 206
Stress and Psychological Factors 206
Genetic Factors 207
Parafunction 208
Pathophysiology of Localized Muscle Pain 210
Trigger Points and Masticatory Muscle Pain 212
Sensory and Motor Consequences of Masticatory Muscle Pain 215
Somatosensory Alterations 215
Motor Alterations 216
Summary on Masticatory Muscle Pain 217
Diagnosis 217
Management 220
Treatment of Acute or Persistent Masticatory Muscle Pain 220
Patient Education and Self-control 221
Physiotherapy 221
Pharmacological Treatment 222
Relaxation Therapy 222
Occlusal Appliances 223
Management of the Chronic Masticatory Muscle Pain 223
Cognitive-Behavioral Therapy 224
Pharmacological Treatment 224
References 225
Chapter 8: Inflammatory Myopathies 236
Background 237
Polymyositis and Dermatomyositis 237
Epidemiology 237
Etiology and Pathogenesis 239
Clinical Features 240
Muscle 241
Joints 241
Skin 242
Respiratory Tract System 242
Gastrointestinal Tract 243
Heart 243
Diagnosis 243
Autoantibodies in Inflammatory Myopathies 244
Treatment 246
Pharmacological Treatment 246
Physical Exercise 247
Prognosis 247
Inclusion Body Myositis 248
Clinical and Laboratory Features 248
Muscle Biopsy 248
Etiology and Pathogenesis 249
Treatment and Prognosis 250
Conclusions 250
References 250
Chapter 9: Whiplash Injury, Muscle Pain and Motor Dysfunction 254
Introduction 255
Whiplash Mechanisms 256
Classifications 263
Chronic Symptoms After Whiplash Injury 265
Muscles and Motor Function 270
Sensory Aspects of Whiplash 276
Clinical Management 279
References 280
Chapter 10: Brain Imaging of Muscle Pain 296
Introduction 297
The Pain Matrix: A Short Introduction Based on Acute Nociceptive Stimulation 297
How Does the Representation of Muscle Pain Differ from Cutaneous Nociceptive Inputs in the Brain? 300
Acute Nociceptive Stimulation in Patients with Chronic Musculoskeletal Pain 301
Nociceptive Processing in Chronic Muscle Pain 308
Structural Changes in Patients with Chronic Muscle Pain 310
Conclusions and Outlook 311
References 312
Glossary 317
Index 366