Current pain and headache reports
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Fibromyalgia (FM) and migraine are common chronic disorders that predominantly affect women. The prevalence of headache in patients with FM is high (35%-88%), with migraine being the most frequent type. ⋯ We also discuss the participation of hypothalamic and brainstem centers of pain control, the putative role played by neurotransmitters or neuromodulators on central sensitization, and changes in their levels in the cerebrospinal fluid. Understanding their mechanisms will help to establish new treatment strategies for treating these disabling brain disorders.
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Curr Pain Headache Rep · Oct 2009
ReviewNew techniques for the quantification of fibromyalgia and myofascial pain.
Myofascial pain and fibromyalgia share a number of common features: the patient is uncomfortable; abnormalities can be detected on physical examination; and there is a lack of an objective means to either quantify or visualize their core features. This has undoubtedly contributed to a slowed acceptance of their importance by the medical community. ⋯ Although progress may be somewhat slower in fibromyalgia, in which attention appears to focus on pain sensitivity and functional brain imaging, a number of approaches now seem promising in their ability to quantify the physical and biochemical characteristics of the taut bands and trigger points of myofascial pain. This review focuses on myofascial pain with an emphasis on the growing capability of MRI, microanalytic techniques, and ultrasonography to assess, quantitate, and even visualize the characteristics of these stigmatic lesions.
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Curr Pain Headache Rep · Oct 2009
ReviewPsychological trauma in chronic pain: implications of PTSD for fibromyalgia and headache disorders.
The association of traumatic exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. Patients with chronic pain, particularly headache disorders and fibromyalgia (FM), associated with psychological traumas need a special management strategy. Diagnosis of headache disorders and FM in traumatized patients and collecting the clinical history of a traumatic event or diagnosing PTSD in chronic pain patients is of great importance. Psychotherapy and pharmacotherapeutic options should be started on patients with comorbid PTSD and headache disorders and/or FM.
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Recent studies have clarified the nature of myofascial trigger points (MTrPs). In an MTrP region, multiple hyperirritable loci can be found. The sensory components of the MTrP locus are sensitized nociceptors that are responsible for pain, referred pain, and local twitch responses. ⋯ This MTrP circuit is the connection among spinal sensory (dorsal horn) neurons responsible for the MTrP phenomena. Recent studies suggest that measurement of biochemicals associated with pain and inflammation in the MTrP region, the sonographic study of MTrPs, and the magnetic resonance elastography for taut band image are potential tools for the diagnosis of MTrPs. Many methods have been used to treat myofascial pain, including laser therapy, shockwave therapy, and botulinum toxin type A injection.