Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016053 (fibromyalgia)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic intractable benign pain (CIBP) is defined as non-neoplastic pain of greater than 6 months duration without objective physical findings and known nociceptive peripheral input. To test the CIBP concept, 283 consecutive chronic pain patients were examined independently by a neurosurgeon and physiatrist and only congruent physical findings were coded. Because they did not fit the CIBP definition, patients with the following primary treatment diagnoses were eliminated: degenerative disease of the spine and spinal stenosis; degenerative disease of the hips; radiculopathy; malignancy; deafferentation pain; and miscellaneous. Eliminated, also, were patients with any one finding indicative of a root compression syndrome, leaving 90 low back and 34 neck patients. These patients had abnormal physical findings in 7 categories: tender points/trigger points; decreased ranges of motion in back or neck; non-anatomical sensory loss; rigid musculature; decreased range of hip motion; gait disturbance; and miscellaneous non-neurologic signs. Low back CIBP patients had the following distribution among the 7 categories: 0% had findings of all 7; 1.1% had 6; 13.3% had 5; 24.4% had 4; 25.6% had 3; 26.7% had 2; 8.9% had 1; and 0% had none. Neck CIBP patients, in which only the first 4 categories of physical findings were applicable had the following distribution: 2.9% had 4; 41.2% had 3; 35.3% had 2; 20.6% had 1; and 0% had none. It was concluded that CIBP patients do have abnormal physical findings indicative of musculoskeletal disease: possibly fibrositis and/or specific myofascial syndromes, as sources of peripheral nociception. These findings question the validity of the CIBP concept and point to the need for a careful, all-inclusive physical examination as a basic initial requirement in the classification of chronic pain patients.
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PMID:Physical findings in patients with chronic intractable benign pain of the neck and/or back. 263 5

Myofascial pain syndromes, fibromyalgia, and articular dysfunctions may all be contributing to our patients' ubiquitous musculoskeletal pain problems that generally are poorly understood and poorly managed. Thepectoralis minor myofascial pain syndrome, for example, results from trigger points (TrPs) activated by stress overload of the muscle. Symptoms of pain referred to the shoulder and ulnar aspect of the arm and forearm, and of pain on reaching around and behind the body, are characteristic. Findings include restricted stretch range of motion and some weakness of the muscle, taut bands of muscle fibers, and focal trigger point tenderness of each taut band on palpation. Snapping palpation at the TrP elicits a local twitch response (LTR). The increased muscle tension of a pectoralis minor syndrome commonly entraps the lower trunk of the brachial plexus, producing symptoms of a cervical radiculopathy.
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PMID:Symptomatology and clinical pathophysiology of myofascial pain. 1841 64

To assess the efficacy of nonsurgical treatment of cervical radiculopathy, 50 patients with objective signs and symptoms of cervical discogenic radiculopathy (CDR) without myelopathy, treated conservatively on an outpatient basis with a mean follow-up of 9.4 months were retrospectively reviewed. Then an additional 33 patients were entered sequentially onto a prospective study to assess conservative treatment; they were followed for 100 days or longer with a mean follow-up of 24.7 months. All 83 patients (50 + 33) had objective neurologic deficits (sensory, motor, or both).Of the initial 50 patients, 27 achieved full remission (no neurologic deficits and pain free), 17 were markedly improved (minimal residual sensory or motor deficit and mild to minimal pain), and 6 were unchanged at the time of their last examination. Of the 33 patients followed prospectively, 13 were in full remission and 16 were markedly improved requiring no treatment at the 100-day follow-up evaluation (< 0.05 by one tailed t-test). Of the 33 patients with complicating depression or fibromyalgia, 4 demonstrated minimal or no pain improvement, although 3 of the 4 had full remission of sensory/motor findings. Motor vehicle accidents precipitated symptoms of CDR in 14 patients in the retrospective and 5 in the prospective study. CDR of 15 patients was in full remission by 90 days, and 4 had ongoing chronic and/or mild sensory or motor deficits at 300 days. At the final follow-up, all 33 prospectively studied patients had maintained at least the level of improvement achieved at 100 days (p < 0.05 by one tailed f-test). No one in the total group of 83 patients required surgical intervention or hospitalization.Our results suggest that outpatient nonsurgical conservative management with careful patient education and monitoring of a coordinated conservative regimen can be successful for the majority of patients with CDR.
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PMID:Conservative treatment of cervical radiculopathy. 1907 59

The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P<.009) in the maximal pain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity P<.04), consistent with peripheral neuronal damage. Both neck-arm pain groups demonstrated increased cold sensitivity in their maximal pain area (P<.03) and the foot (P<.009), and this was also the dominant sensory characteristic in patients with NSNAP. Both neck-arm pain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity P<.027). Despite commonalities in pain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group.
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PMID:Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain. 2298 Jul 46