Best practice & research. Clinical rheumatology
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Best Pract Res Clin Rheumatol · Jun 2007
ReviewFuture perspectives: pathogenesis of chronic muscle pain.
Chronic painful muscle conditions include non-inflammatory and inflammatory illnesses. This review is focused on chronic non-inflammatory pain conditions such as myofascial pain syndrome (MPS) and fibromyalgia syndrome (FM), and will not discuss metabolic, genetic or inflammatory muscle diseases such as McArdle's disease, muscular dystrophy, polymyositis, dermatomyositis, or inclusion body myositis.
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Best Pract Res Clin Rheumatol · Jun 2007
ReviewPathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition.
Chronic musculoskeletal pain has biological, psychological and social components. This review deals with the biological factors, with emphasis on the fibromyalgia syndrome (FMS). ⋯ Further research is necessary in order to determine which methods are best for diagnosis of the pain hypersensitivity in clinical practice. FMS may be the far end of a continuum that starts with chronic localized/regional musculoskeletal pain and ends with widespread chronic disabling pain.
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Chronic pain states are common in the general population. Genetic factors can explain a significant amount of the variability in the perception of pain. Fibromyalgia syndrome (FMS) and related conditions are syndromes characterized by generalized pain sensitivity as well as a constellation of other symptoms. ⋯ Environmental factors may trigger the development of these disorders in genetically predisposed individuals. Future large well-designed studies are needed to further clarify the role of genetic factors in FMS and related conditions. The knowledge of these gene polymorphisms may help with better subgrouping of FMS patients and in designing a more specific pharmacologic treatment approach.
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Many soft tissue complaints are associated with the development of neuropathic pain. This pain is produced by pathophysiological processes that are different to the processes involved in the generation of the inflammatory or nociceptive pain more commonly encountered in soft tissue disorders. One of the consequences of this is that neuropathic pain can often be less responsive to standard analgesic therapies. ⋯ This chapter aims to outline some of the clinical features associated with neuropathic pain, the aetiological factors leading to its development and the evidence base (or lack) behind current treatment strategies. It will try to provide a rational approach to the management of neuropathic pain in patients with soft tissue disorders, particularly focusing on pharmacological management. Neuropathic pain is the focus of much current research activity, particularly pharmacological research, and this chapter will attempt to identify gaps in our clinical knowledge and highlight opportunities for further research.
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This chapter defines and describes the condition that is known by the term myofascial trigger point pain syndrome. An outline is given of the current state of knowledge of the pathophysiology of myofascial trigger points, including the latest details from needle microdialysis in near real-time. The clinical features of this pain syndrome are summarised in general terms and the reliability of the clinical diagnosis is discussed. The clinical evidence for and against the common therapeutic interventions used in the management of myofascial pain is reviewed in detail and some tentative conclusions are reached with respect to needling therapies.