frequency and percentages for bivariate variables) were cal- culated. Student’s t-tests were used to compare continuous variables. We used a composite score consisting of the numerical average of the three vestibular sites in the lower and upper vestibule, respectively. We similarly averaged three threshold measures in order to obtain the site-specific muscle PPT. Pearson’s correlation was used for the purposes of describing the correlation between subjective report of pain with intercourse and mucosal and muscle pain sensitiv- ity respectively; the correlations were similarly examined in subgroups of women with PVD. Statistical significance was set to (P,0.05) for all comparisons.
Sport injuries and muscle pain can occur as a result of engagement in exercise and or organised sporting activities. These injuries affect all age groups and gender. The most common types of sporting activities known to cause these injuries include jogging, cycling, volley ball, swimming and heavy weight lifting. Lack of warming-up before participating in sporting activity, overtraining and/or excessive exposure to these physical activities may increase the risk of injury. These factors are categorised as extrinsic factors. Intrinsic factors that may lead to sport injuries or may precipitate these injuries are age, previous injuries and level of flexibility. The most common type of injuries seen are sprains and strains. These injuries are accompanied by pain, swelling and redness of the injured area. Non- pharmacological and pharmacological management is available for the effective management of these injuries. Pain may vary from mild to severe depending on the severity of injury. These varying types of pain can be managed optimally using non-narcotics, such as paracetamol, and non-steroidal anti-inflammatory (NSAIDs), like ibuprofen. Topical therapies of NSAIDs such as ibuprofen, diclofenac and flurbiprofen are often highly effective for managing sports-related muscle sprains and strains.
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Muscle pain, or myalgia can be in one targeted area or across many muscles. The severity of muscle pain can range from mild to severe depending on the cause. It usually occurs with overuse of the muscles, inflammation or trauma causing excitation of muscle nociceptor but is also frequently associated with a viral infection. The effective management of patients with muscle pain is through a step-wise approach, offering the greatest potential for maximum analgesia and the minimum adverse effects. Non-pharmacological and pharmacological management are often applied for patients with chronic or recurrent muscle pain associated with medical disease or injury. Pharmacological management, depending on the severity of muscle pain, may include OTC medicines such as aspirin, ibuprofen and/ or paracetamol or prescription medicine such as other NSAIDs (diclofenac, naproxen, mefenamic acid, etc) or opioids for moderate to severe muscle pain. Adjunctive therapy is sometimes necessary to manage the side-effects of medications, provide symptom relief, treat anxiety or to manage related or underlying conditions.
In general, insertion of needles on the affected mus- cles affected sensitized nociceptors whereas skin inser- tion did not . Muscle containing nociceptors such as polymodal-type receptor was demonstrated to be sensi- tized by various factors [15-17]. Sensitized polymodal- type receptors in the muscle lesion caused muscle pain  which was found mostly within the connective tis- sues of the muscle . In particular, the fascia and/or muscle were the most sensitive deep tissues . Most thin afferent fibers in muscle innervate polymodal-type receptors. Acupuncture stimulation at the affected mus- cle in myofascial pain could easily activate these recep- tors and consequently increase pain thresholds via internal analgesic system such as descending inhibition and/or diffuse noxious inhibitory controls (DNICs) in the brain stem [20-22]. Therefore, we think that
Background: Monosodium glutamate (MSG) is often thought to be associated with headache and craniofacial pains like temporomandibular disorders. This randomized, double-blinded, placebo-controlled study was performed to investigate how ingestion of MSG affects muscle pain sensitivity before and after experimentally induced muscle pain. Methods: Sixteen healthy adult subjects participated in 2 sessions with at least 1-week interval between sessions. In each session, two injections of glutamate (Glu, 0.5 M, 0.2 ml) and two injections of saline (0.9 %, 0.2 ml) into the masseter and temporalis muscles, respectively, were undertaken, with a 15 min interval between each injection. Injections of saline were made contralateral to Glu injections and done in a randomized order. Participants drank 400 mL of soda mixed with either MSG (150 mg/kg) or NaCl (24 mg/kg, placebo) 30 min before the intramuscular injections. Pressure pain thresholds (PPT), autonomic parameters and pain intensity were assessed prior to (baseline) and 30 min after ingestion of soda, as well as 5 min and 10 min after the intramuscular injections and at the end of the session. Whole saliva samples were collected prior to and 30, 45, 60, and 75 min after the ingestion of soda.
The occurrence of referred pain is dependent on the sensitivity of an MTP. Active MTPs induce larger referred pain area and higher pain intensity than latent MTPs . Experimental human pain studies also showed that the maintenance of referred pain was dependent on ongoing nociceptive input from the site of primary muscle pain [47,48]. Animal studies showed that sustained muscle damage might sensitize dorsal horn neurons and open silent synapses in adjacent seg- ments and excite neurons that supplied the body regions in which the referred pain was felt . Sustained focal ischemia and the increased algesic substances associated with muscle contraction and/or muscle cramps at MTP may sensitize the dorsal horn neurons and supraspinal structures inducing referred pain. Referred pain is a reversible process of central sensitization or neuroplasti- city  maintained by increased peripheral nociceptive input from MTP. Inactivation of active MTP results in the disappearance of referred pain . It is important to note that referred pain usually occurs seconds follow- ing mechanical stimulation of an active MTP in humans, suggesting that the induction of neuroplastic changes related to referred pain is a very rapid process, similar to the induction of central descending inhibition mechanism which is recruited a few milliseconds follow- ing intramuscular nociceptive electrical stimulation .
BACKGROUND: Malignant Hyperthermia (MH) is a potentially fatal, autosomal dominant disorder associated with administration of volatile anesthetics and/or the depolarizing paralytic succinyl- choline. Symptoms include muscle rigidity, tachycardia, elevated body temperature, and metabol- ic acidosis, which are secondary to accelerated skeletal muscle metabolism. MH susceptibility can be a chronic condition, and some MH susceptible patients may develop symptoms subsequent to anesthetic exposure. OBJECTIVE: This is the first study examining the sequelae of an MH event af- ter hospital discharge. METHODS: A survey was sent to patients who voluntarily registered with the North American Malignant Hyperthermia Registry, which included questions on severity of symptoms predominating prior to the MH event, one month after the MH event, and presently on a scale of 1 - 10 with a free text option to expound further. Participants were also asked about their opinions on causality between MH and these symptoms. RESULTS: Twenty-three responses were analyzed (34.8% response rate). Participants were categorized by their age at the time of the MH event and years since the event. Most (83%) stayed in the ICU between 1 - 4 days, and 39% expe- rienced the event over 25 years ago. While 43% did not attribute any long-term symptoms to their MH event, all others believed that certain symptoms were linked, including muscle pain (90%), muscle cramps (75%), muscle weakness (100%), back/joint pain (36%) and depression/anxiety (42%). CONCLUSIONS: Our study concluded that long-lasting morbidities may be attributed to an MH event. Chronic musculoskeletal symptoms are experienced by the majority of patients who experience acute MH.
participating in our prior research [3, 34, 43]. Interest- ingly, earlier work has demonstrated that NSAID use during the race was not effective at controlling post-race muscle soreness  though the effect of NSAIDs on muscle pain and soreness during the race has not been systematically examined. Among the present subjects using pain medication during the race, the usual dosage was relatively low compared with the maximal recom- mended dose during 24 h. Not surprisingly, our separate comparison of muscle pain and soreness ratings between subjects who used pain medication during the race and those not using pain medication during the race revealed no suggestion of an effect of the pain medication on this variable. Thus, given these considerations, it seems un- likely that the use of pain medication during the race confounded the present finding of lower muscle pain and soreness during and at the completion of the race among the riboflavin group compared with the placebo group. Another potential study limitation is that, be- cause we did not assess dietary practices of the subjects, it is conceivable that one group had a greater intake of anti-oxidants than the other. Additionally, the 400-m runs were unsupervised and self-timed, but this was the most feasible approach and we believe this study popula- tion was capable of maximally exerting themselves during unsupervised trials and correctly recording the times. Finally, we also recognize that some might consider it ideal to have measured pre-race plasma CK concentrations and to examine the pre-race to post-race change in plasma CK concentration rather than just the post-race value. But, since these runners would have reduced training prior to the race, we would expect pre- race plasma CK concentrations to have been very low relative to the post-race values, as previously demon- strated [4 – 7], so not using the pre-race to post-race change would not have altered our interpretation of the findings for this variable.
To better understand and widen the knowledge about chronic pain, use of experimental pain models that mimic pain conditions are necessary. Intramuscular in- jections of hypertonic saline are frequently used to mimic human myalgia and regarded as a valid model of myalgia, in the orofacial region . This experimental pain model has an acute character and causes a short lasting, distinct sensation of deep, diffuse pain, and pain referral [27-30]. However, to increase validity of the ex- perimental pain model, the same biomarkers as in clin- ical pain should be increased after hypertonic saline injections. Therefore the main aim of this study was to investigate if jaw muscle pain induced by hypertonic sa- line lead to a release of muscle biomarkers. A second aim was to investigate if there were any sex differences related to the release of mediators. We hypothesized that release of several inflammatory mediators, such as 5-HT, glutamate and other biomarkers of metabolic activity, such as lactate, pyruvate, glucose and glycerol were sig- nificantly higher in hypertonic saline-induced pain and that there was higher release in women than in men.
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Abstract: Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain), which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for studying local tissue alterations and allows for sampling of substances in the interstitium of the muscle, where nociceptor free nerve endings are found close to the muscle fibers. The extracellular matrix plays a key role in physiologic functions of cells, including the primary afferent nociceptor. The present review mainly concerns the results of microdialysis studies and how they can contribute to the under- standing of activated peripheral nociceptive and pain mechanisms in humans with chronic pain. The primary aim was to review molecular studies using microdialysis for the investigation of human chronic muscle pain, ie, chronic masticatory muscle pain, chronic trapezius myalgia, chronic whiplash-associated disorders, and chronic widespread pain/fibromyalgia syndrome. Several studies clearly showed elevated levels of serotonin, glutamate, lactate, and pyruvate in localized chronic myalgias and may be potential biomarkers. These results indicate that peripheral muscle alterations are parts of the activated pain mechanisms in common chronic pain conditions. Muscle alterations have been reported in fibromyalgia syndrome and chronic widespread pain, but more studies are needed before definite conclusions can be drawn. For other substances, results are inconclusive across studies and patient groups.
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comparable to tramadol ER 200 mg OD but superior to that of placebo. 15 Flupirtine has been reported to be uninterrupting in the induction of inflammatory response, so animals are treated with flupirtine to relieve pain during colitis development. 16 In a postoperative case of right frontoparietal oligodendroglioma of a 22 year old, flupirtine completely subsided the neuropathic pain, after a number of trials with other drugs. 17 In patients suffering from sub-acute musculoskeletal pain, flupirtine was found to be superior to placebo at dosages of 100 - 400 mg/d. It was as active as the comparators used in study and showed a superior tolerability profile with lower treatment discontinuation rate. 18 Patients having chronic daily headache were divided into two groups. First group consisting of 16 patients was given katadolon (flupirtine) in dosage of 300 mg per day during 2 months. The second group comprising of 18 patients was given velafax (venlafaxine) in dose 75 mg per day. The second group patients experienced nausea, constipation, less appetite and impairment of attention. First group patients did not experience these symptoms except one patient. 19 The efficacy and tolerability of flupirtine in comparison with tramadol in moderate to acute low back pain (LBP) was analyzed by randomized, double-blind, parallel-group trial by taking 209 patients (18-65 yrs age).
Background and Purpose: The lack of clear knowledge about the etiology of nonspecific neck pain (NS-NP) strengthens the need for other mech- anisms, still poorly described in the literature, to be investigated. Therefore, a quantitative analysis of two cases of NS-NP in subjects with functiona dyspepsia was conducted in order to verify the immediate and seven-day postintervention effects of visceral manipulation (VM) to the stomach and liver on neck pain, cervical range of motion (ROM), and electromyographic (EMG) activity of the upper trapezius muscle.
only trial comparing the Bergstroem NB to another technique and found a less painful alternative with the spring-loaded microbiopsy needle. They described a difference between NRS during microbiopsy versus NB of at least 3 NRS points in every single patient. We agree that this can be called clini- cally relevant, especially in contrast to our data, in which Bland–Altman analysis revealed that the majority of our patients described either no difference or just a rather small difference equal to or less than 2 NRS points between the NB and the OB (Figure 1B). When interpreting our results as indicating clinical equivalence in pain levels during NB and OB, one must also conclude that our trial does not support the general assumption that a percutaneous biopsy technique like the Bergstroem NB is automatically less painful than OB techniques. 10,11
Cervicogenic headache can be perplexing pain disorder that is refractory to treatment if it is perceived. The condi- tion’s pathophysiology and source of pain have been debat- ed, yet the pain is likely alluded from at least one or more muscular, neurogenic, bony, articular, or vascular struc- tures in the neck . Patients with cervicogenic headache showed decreases in the quality of life comparable to mi- graine patients and patients with tension-type headache, with even lower scores for physical functioning . The re- ported pervasiveness of CGH varies from 13.8% to 17.8% of the headache population in various epidemiological studies . The predominance of CGH in the all general population is estimated to be somewhere in the range of 0.4% and 2.5%, with a female dominance (2:1) . How- ever, Sjaastads and Bakketeig  reported the prevalence of 4.1% with no female preponderance, yet in pain man- agement clinics, the incidence is as high as 20% of chronic patient headache .
with treatment. It is easy to assume that all such pain is a direct consequence of, and directly proportionate to, the nociception activated by the clinical procedure (eg. placement of a new orthodontic archwire or placement of new elastomeric chains). However, it is apparent clinically that the perception of pain varies considerably across individuals when the same stimulus, such as an initial light archwire, is activated. The expected procedural pain of a new archwire activation is generally believed to be relatively minor and self-limiting; however, some patients will report a much different experience. 121 It is generally accepted that particular affective and cognitive
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There were three main findings in the present study. First, a predictive multiple regression model for experimental pain sensitivity accounted for 28.2% of the variance in pain induced from a heat injury. In this predictive regression model, no signs of a gender-related difference in experi- mental pain sensitivity were observed. Second, the study confirmed significant gender-related differences in the per- ception of electrical and cold pressor stimuli. Third, highly significant positive correlations between BSA, BMI, and pain perception during electrical, pressure, and cold pressor stimuli were demonstrated.
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Based on RTCs with some limitations, cannabinoids appear to improve muscle spasticity, pain, sleep, and spasms in patients with MS and affects appear sustained at 12 months (Corey- Bloom, 2012; Flachenecker, 2014; Wade et al., 2010; Wade et al., 2003; Zajicek et al., 2005 and Zajicek, 2012). The American Academy of Neurology recommendations for multiple sclerosis note that oral cannabis extract (OCE) or delta-9 tetrahydrocannabinol (THC) or oromucosal cannabinoid spray (nabiximols) may be offered to reduce patient-reported symptoms of spasticity and pain, except for neuropathic pain (Yadav, 2014). Although cannabinoids may improve central neuropathic pain in patients with MS, the use for this condition has less evidence and is associated with
The improvement in pain disability due to resistance ex- ercise can be assumed to be related to improvement in physical capacity and the participants becoming increas- ingly motivated to exercise with heavy loads. This process was facilitated by the person-centered approach  of the intervention, based on principles of increasing self- efficacy . To give the participant a sense of control in a given situation is an important component to enhance self-efficacy and this was achieved by the active involve- ment of the participant in adjusting and modifying the ex- ercises and loads and in the progression of the resistance exercise . The exercise was initiated at low loads during an extended time period, to allow for a positive ex- perience of the exercise and a slow adaptation of the par- ticipants’ physical capacity to avoid exercise-induced pain. Performing the exercise program in small groups together with others sharing similar difficulties and to see them manage the exercise is another of the key components of self-efficacy enhancement , and hence, it is beneficial for persons with FM to exercise in groups. Also, encour- agement and physiological feedback from physiotherapists supervising the groups is assumed to support self-efficacy to manage disabilities while exercising .
The observed age difference between symptomatic and asymptomatic subjects may have affected the present results. However, this is unlikely given the inconsistent associations observed in the correlation analysis. Age is thought to have negative effect on MFTrP phenomena  and mechanical muscle function characteristics ; therefore it is unlikely that the symptomatic partici- pants would have benefitted from skewness in age. Our symptom-based sub-group analysis was underpowered based on sample size calculation. Thus, type-II errors cannot be discounted. It is unclear from our results whether differences exist between SDN and DDN with respect to reducing self-reported pain as confounding due to DOMS, may have altered tissue sensitivity mea- surements after 48 hours. Our asymptomatic partici- pants had also received previous treatment for their neck pain; it would therefore be prudent to determine neck pain status on more than self-reported pain at the point of inclusion. More clarity is required as to whether individuals are able to differentiate between soreness and DOMS. Establishing clinical relevance fell outside the scope of this study.
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ligaments, disks and bones can result in a TMD. ATM can be affected by infectious and inflammatory, vitamin or hormonal deficiencies and changes in shape caused by trauma or parafunction. In addition to TMJ, chewing teeth and muscles may also be involved by common pathological manifestations that together constitute the symptoms of temporomandibular disorders (TMD). Temporomandibular Disorders (TMDs) are defined as functional disorders of the masticatory system (in the functional relations of the teeth), including the signs and symptoms, involving the masticatory muscles and their supporting structures and the temporomandibular joint itself. (Conti, 1996; OKENSON, 1998; PEGORARO, 1998). The etiology of TMD is multifactorial, being associated with muscular hyperactivity, trauma, emotional stress, malocclusion, and innumerable other predisposing, precipitating or perpetuating factors of this condition. Several factors can cause a TMD. There is no cause common to all TMDs, but trauma can be the main cause of this functional change. TMDs may be present in all people, but they are more common in white women, usually in the third decade of life (OKESON, 2000). Generally TMDs can be divided into muscle; when they only affect the masticatory muscles and the neck; articular, which are characterized by internal disorders of the joint and joint muscles, covering both the musculature and the joint; the displacement of the disc, caused by a borderless movement or trauma (MADEIRA, 2010). The patient with TMD is usually a chronic patient who treatment. As the symptoms are very subjective and may be linked to other medical problems (depression, otological or rheumatologic problems), the dentist is often the last health professional to be sought. (BIASOTTO-GONZALEZ, 2005). Due to the morphological and functional complexity of the ATM Some non-masticatory painful orofacial manifestations of multifactorial etiology are also observable under different aspects, such as neuromuscular, psychological and anatomical factors (RUIZ, 2004 apud MILAM, 2014). According to Neil S. Norton (Netter, 3rd ed) arthritis and ankylosis are the pathological alterations in the TMJ, affecting the bilateral bone articular structures of women and men older than 60 years. And with the increase in the elderly population the TMD has been growing considerably. MILAM et al. (2014) advised that a thorough examination be clinical, since the orofacial pains are often confused with other painful conditions, such as those of dental origin, of oral infections, those caused by otitis and sinusitis, muscular pains in the back, neck and muscles of chewing and nerves.