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Myofascial pain syndrome is a disease of muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and by sensory abnormalities (tenderness and referred pain). It is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes, or a secondary disorder that occurs as a consequence of some other condition. When it becomes chronic, it tends to generalize, but it does not change to fibromyalgia. It is a treatable condition that can respond well to manual and injection techniques, but requires attention to postural, ergonomic, and structural factors, and toxic or metabolic factors that impair muscle function.
Curr Pain Headache Rep 2001 Oct
PMID:Classification, epidemiology, and natural history of myofascial pain syndrome. 1156 Aug 6

Fibromyalgia (FM) and transformed migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.
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PMID:Fibromyalgia is common in patients with transformed migraine. 1159 60

Fibromyalgia (FM) is characterized by abnormal pain sensitivity in response to diverse stimuli as well as persistent widespread pain and other symptoms such as fatigue and sleep disturbance. Progress has been made in identifying factors that contribute to the etiopathogenesis of abnormal pain sensitivity, but there is no single model of pathophysiology or treatment of FM that has gained wide acceptance among health care professionals. We review the literature on the etiopathogenesis of abnormal pain sensitivity in FM and describe an explanatory model that serves as a source of testable hypotheses in our laboratory. This model posits that interactions of exogenous (e.g., environmental stressors) and endogenous (e.g., neuroendocrine dysfunction) abnormalities in genetically predisposed individuals lead to a final common pathway, i.e., alterations in central nervous system function and neuropeptide production that underlie central sensitization and abnormal pain sensitivity. This model also suggests that efforts to develop and evaluate treatments for FM should focus on interventions with direct or indirect effects on central functions that influence pain sensitivity.
Curr Pain Headache Rep 2002 Apr
PMID:Is fibromyalgia a neurologic disease? 1187 81

Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postexertional malaise. Diagnosis of CFS is primarily by exclusion with no definitive laboratory test or physical findings. Medical research continues to examine the many possible etiologic agents for CFS (infectious, immunologic, neurologic, and psychiatric), but the answer remains elusive. It is known that CFS is a heterogeneous disorder possibly involving an interaction of biologic systems. Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient. Therapy should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's presentation.
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PMID:Chronic fatigue syndrome: evaluation and treatment. 1256 47

Functional dysepsia (FD) is defined as persistent or recurrent pain or discomfort centered in the upper abdomen without evidence of organic disease likely to explain the symptoms. Visceral hypersensitivity, motor dysfunction, and impaired gastric accommodation are found in some patients with FD, and psychological factors like chronic stress, attention and perception bias are also likely to play a part in the symptom formation. There is considerable overlap of non-specific symptoms like fatigue, headache, abdominal discomfort, muscle pain, and sleep disturbance in patients with different functional disorders, in this article exemplified by FD, fibromyalgia, and chronic fatigue syndrome. This overlap of symptoms indicates a common underlying sensitization process, leading to somatization.
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PMID:Somatization, sensitization, and functional dyspepsia. 1200 56

Biological clock and magnesium status are linked. Central magnesium regulation may be hypothetized. Balanced magnesium status is requested to obtain efficiency of suprachiasmatic nuclei and of pineal gland. Conventional bright light therapy appears as a speedy and efficient antidepressant medication useful for the treatment of various types of depression, and of non migrainous headaches also. Although decrease in melatonin production seems accessory, increases of serotonergy and perhaps of Reactive Oxygen Species constitute the main mechanisms of action. Chromatotherapy emphazizes the effects of short exposure to specific colors. Although the increased production of melatonin constitutes the best marker of darkness, it is only an accessory mechanism of its action. The psycholeptic sedative effects of darkness, like those of magnesium, rely on direct membraneous and oxidant actions, neural mediated effects (i.e. stimulation of inhibitory neuromodulators such as GABA and taurine), and on antagonism of neuroactive gases (CO and NO). Darkness therapyper se, partial substitutive therapy with melatonin and with their mimicking agents (Mg, L-Tryptophan,Taurine) apply to all the chronopathological forms of magnesium depletion with decreased production of melatonin: sleep disorders, migraine, chronic fatigue syndrome, fibromyalgia, some forms of asthma and of sudden infant death syndrome. Further research should assess the importance of the chronopathological forms of magnesium depletion in the physiopathology of these disorders.
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PMID:Biorhythms and possible central regulation of magnesium status, phototherapy, darkness therapy and chronopathological forms of magnesium depletion. 1203 Apr 24

Characteristic symptoms of fibromyalgia syndrome include widespread pain, fatigue, sleep abnormalities, and distress. Patients with fibromyalgia show psychophysical evidence of mechanical, thermal, and electrical hyperalgesia. Peripheral and central abnormalities of nociception have been described in fibromyalgia. Important nociceptor systems in the skin and muscles seem to undergo profound changes in patients with fibromyalgia through unknown mechanisms. They include sensitization of vanilloid receptor, acid-sensing ion channel receptors, and purino-receptors. Tissue mediators of inflammation and nerve growth factors can excite these receptors and cause extensive changes in pain sensitivity, but patients with fibromyalgia lack consistent evidence for inflammatory soft tissue abnormalities. Therefore, recent investigations have focused on central nervous system mechanisms of pain in fibromyalgia.
Curr Pain Headache Rep 2002 Aug
PMID:Peripheral and central sensitization in fibromyalgia: pathogenetic role. 1209 60

Chronic widespread pain is a primary feature of fibromyalgia and is a symptom that is poorly managed in many patients. In addition, patients often experience fatigue, sleep disturbances, and anxiety. Its etiology is largely unknown. The successful clinical management of this syndrome relies on a multidisciplinary approach, employing pharmacologic and nonpharmacologic treatments. Clinical evidence on the symptoms and characteristics of fibromyalgia suggests a central mechanism behind the pathogenesis of this syndrome. It is likely that drugs with central actions will prove to be effective against a number of symptoms. This article aims to outline some of the potential spinal pharmacologic targets that may be used to treat this condition.
Curr Pain Headache Rep 2002 Aug
PMID:Neuropharmacologic targets and agents in fibromyalgia. 1209 61

Myofascial pain syndrome is a chronic muscle pain disorder in one or more muscles or groups of muscles accompanied by local and referred pain, decreased range of motion, weakness, and often autonomic phenomena. Patients are readily recognized by their history of muscle pain and the presence of myofascial trigger points, which are specific areas of hyperirritability in a muscle that cause local and referred pain on palpation. Failure to recognize MPS often leads to over-investigation, unnecessary medical intervention, and iatrogenic harm with serious cost implications. The purpose of this review is to present clinically relevant data regarding myofascial pain syndrome and to discuss its possible role in the pathophysiology and optimal treatment of fibromyalgia syndrome.
Curr Pain Headache Rep 2002 Aug
PMID:Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome. 1209 62

Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by diffuse pain and tender points, which have been present for more than 3 months. Many patients with systemic illnesses can have diffuse pain similar to that found in fibromyalgia, including rheumatic diseases such as polymyalgia rheumatica, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic lupus erythematosus, and joint hypermobility. Osteomalacia and thyroid disease are also in the differential diagnosis of diffuse pain and are imminently treatable. In addition, there has been interest throughout the past 10 years in infectious diseases including hepatitis C, Lyme disease, coxsackie B, HIV, and parvovirus infection, which may cause or trigger fibromyalgia. This paper provides a framework to use when identifying these diseases as part of the evaluation of a patient with chronic widespread musculoskeletal pain.
Curr Pain Headache Rep 2002 Aug
PMID:Rheumatic mimics and selected triggers of fibromyalgia. 1209 63


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