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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper introduces a pathophysiological model for the cause of muscular tension and pain in occupational pain syndromes and chronic muskuloskeletal pain syndromes, which also might clarify why these conditions have a tendency to perpetuate themselves and spread from one muscle to another. The model can briefly be described as follows. Metabolites produced by (static) muscle contractions stimulate group III and IV muscle afferents, which activate gamma-motoneurones projecting to both homonymous and heteronymous muscles. The gamma-motoneurones influence the stretch sensitivity and discharges of secondary and primary spindle afferents. Increased activity in the primary muscle spindle afferents enhances the muscle stiffness, which leads to further production of metabolites in both homo- and heteronymous muscles. Increased activity in secondary spindle afferents, which project back to the gamma system, constitutes a 'built in' second positive feedback loop which may perpetuate the condition with less 'support' from activity in group III and IV muscle afferents.
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PMID:Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes: a hypothesis. 194 63

The purpose of this study was to investigate the neuronal mechanisms of the clinical symptoms of unusual muscle stiffness and/or pain in the neck and shoulder sometimes observed in patients suffering from chronic pulpal or periodontal diseases. Physiological properties of the neurons responding to the inferior alveolar nerve stimulation (inferior alveolar nerve driven-neurons: IANDNs) were studied by recording single unit activities in the upper cervical cord in cats anesthetized with alpha-chloralose. The results were as follows: (1) IANDNs were widely distributed from the dorsal horn to the ventral horn in the gray matter of the cervical cord (C2 and C3). (2) IANDNs were subdivided into two types of neurons based on the latencies of the spike responses: fast-type (F-type) (n = 60) and slow-type (S-type) (n = 101). (3) Two possible pathways from the inferior alveolar nerve to the cervical spinal cord participating in these spike responses were assumed: one was through the trigeminal spinal nucleus and the other through Probst's tract by way of the trigeminal mesencephalic nucleus. These results suggest that the impulses originating from dental inflammatory loci might drive IANDNs in C2 or C3 and that their activities may evoke contraction of the neck muscles, resulting in their stiffness and cervical back pain.
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PMID:[Response properties of the neurons in the cervical cord to stimulation of the inferior alveolar nerve in the cat]. 262 93

In Sweden, several studies have been performed in patients with fibromyalgia to study muscle morphology, chemistry and physiology in order to understand the origin of the most prominent symptoms in fibromyalgia: muscle pain, muscle fatigue and muscle stiffness. These studies have shown changes indicating disturbed microcirculation, mitochondrial damage and a reduced content of high energy phosphates. Thus, there may be an energy deficiency state in the resting painful muscle in fibromyalgia. Pain analysis has supported the idea that there is a nociceptive origin of the pain. Our hypothesis is that any condition that could lead to constant muscle hypoxia, e.g., through establishment of abnormal motor patterns, might be a possible cause of fibromyalgic pain.
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PMID:The muscle in fibromyalgia--a review of Swedish studies. 269 74

Muscle fiber degeneration and regeneration, inflammation in the intramuscular connective tissue and hypoxia in resting muscle are not necessarily associated with pain. However, when sustained or dynamic muscle contractions are performed in an ischaemic muscle, severe pain develops. In the chronic muscle pain syndrome called fibromyalgia (or fibrositis) the most likely cause of the pain is a combination of muscle tension and muscle hypoxia. This conclusion is supported by the finding of a pathological distribution of tissue oxygen pressure in painful muscles and a subjective feeling of muscle tension and muscle stiffness in the majority of patients. A decrease of high energy phosphates is found in biopsies from painful muscle. The most characteristic morphological finding is the so-called ragged red fiber, a finding that can be seen in mitochondrial disorders. The morphological and chemical findings are possibly a consequence of a long standing hypoxia. The possibility that sympathetic nerve activity is important for the development of chronic muscle pain is discussed.
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PMID:Muscle pain in neuromuscular disorders and primary fibromyalgia. 270 25

This new name for an old and common disease has introduced fresh criteria and initiated clinical and basic research. The present clinical knowledge of the diagnosis and treatment is reviewed. Morphological and biochemical findings in the muscle of fibromyalgia patients have shown an unevenly distributed reduction of the oxygen tension. Hypoxia in the muscle sensitizes nociceptors, resulting in hyperalgesia with a diffuse distribution of pain symptoms. These are difficult for the individual to localize and are often combined with muscle stiffness and increased fatigability. These symptoms correspond to complaints received from fibromyalgia patients.
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PMID:[Fibromyalgia--a new name for a syndrome with diffuse muscular disorders]. 291 89

The aetiology of the clinical stiff-man syndrome is likely to be heterogenous, but until we have more precise methods of identifying an individual cause the need will continue for this rather flippant appellation in patients whose condition cannot be described in any other way. It is also important because patients may otherwise become labelled as suffering from a psychiatric disorder and may even be falsely accused of abusing diazepam (Westblom, 1978). The reverse is also true, and patients may masquerade as stiff men or women (Price and Allott, 1958; Casati and Rossi, 1969). The endocrine dimension remains and should be tested for carefully, particularly in patients with predominantly lower-limb rigidity whose spasms are a relatively minor aspect of their clinical syndrome. Clearly those patients described by George et al (1984) and Slater (1960) as suffering from the stiff-man syndrome need to be reclassified as examples of the hormonal stiff muscle syndrome, and there may be others so misclassified. An endocrine aetiology may easily be missed in a patient with relatively minor muscle stiffness, pain and cramps, such as the man described by Yunus et al (1981) whose myalgia, 'arthralgia' and muscle tenderness vanished completely within four days of taking physiological replacement doses of cortisone acetate as treatment for his hypopituitarism. The rarity of the stiff-man syndrome makes prospective studies of its aetiology and treatment impossible, yet the dramatic and devastating nature of the syndrome suggests that such cases may be extreme examples of a much more common condition. On the other hand, it is possible to argue that once the psychiatric, the overtly neurological and the endocrine cases are omitted we are left with nothing. However, this is just where Moersch and Woltman came in; they could not explain 14 of their cases. Despite modern technology, despite refinements of diagnosis and despite the increasing recognition of the stiff-man syndrome as a heterogeneous condition, there still remains--albeit very rarely--a cohort of patients with progressive proximal muscular stiffness and spasms who defy proper scientific explanation, but who are likely to suffer from a chronic myelitis which destroys normal feedback mechanisms between muscle spindles and the spinal cord. Experience over the last 30 years has served at least to alert people to the psychiatric possibilities, to remove any question of primary muscle or tendon disease and to point to the usefulness of diazepam. With hope, this chapter provides an endocrine dimension which offers an actual cure and therefore deserves to be more widely recognized.
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PMID:Muscle 'contractures' and the 'stiff-man' syndrome. 307 83

The contribution of the Fiorinal and codeine phosphate components to the effectiveness of the Fiorinal with Codeine combination in the treatment of tension headache symptoms was evaluated in a randomized, placebo-controlled, multicenter double-blind study. Patients admitted to the trial took two capsules of Fiorinal with Codeine, Fiorinal alone, codeine alone, or placebo during each of two tension headache attacks. Immediately before and at intervals up to four hours after drug ingestion, patients rated pain severity, pain relief, the tense and uptight feeling, and muscle stiffness. The response to treatment was evaluated in 154 patients. Despite a high placebo response, a factor known to obscure the contribution of components, Fiorinal and codeine were each found to contribute significantly to the therapeutic effect of the Fiorinal with Codeine combination. Statistical or borderline superiority of the combination drug over Fiorinal alone was seen most frequently at the early evaluations, a finding that reflected the rapid onset of action of codeine. Statistically significant differences between Fiorinal with Codeine and codeine alone seen principally at the later assessments reflected the long duration of action of the Fiorinal component. The frequency of adverse reactions did not differ significantly among the four study groups.
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PMID:Fiorinal with codeine in the treatment of tension headache--the contribution of components to the combination drug. 307 9

Muscle fibre degeneration and regeneration, inflammation in intramuscular connective tissue and hypoxia in resting muscle are not necessarily associated with pain. However, when sustained or dynamic muscle contractions are performed in an ischaemic muscle, severe pain develops. In the chronic muscle pain syndrome called fibromyalgia (or fibrositis) the most likely cause of the pain is a combination of muscle tension and muscle hypoxia. This conclusion is supported by the finding of a pathological distribution of tissue oxygen tension in painful muscles and a subjective feeling of muscle tension and muscle stiffness in the majority of patients. A decrease in high energy phosphates is found in biopsies from painful muscle. The most characteristic morphological finding is the so called ragged red fibre, which is a finding that can been seen in mitochondrial disorders. The morphological and chemical findings are possibly a consequence of a long standing hypoxia. The possibility that activity in muscle sympathetic nerves is important for the development of chronic muscle pain is discussed.
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PMID:Muscle pain in neuromuscular disorders and primary fibromyalgia. 316 51

The authors report their experience in the arthroscopic treatment of joint-related stiffness of the knee. Arthroscopic arthrolysis is the treatment of choice for numerous conditions (stiffness subsequent to inflammatory processes, stiffness associated with marked osteoporosis, etc.) in which open arthrolysis is contraindicated. The totally atraumatic nature of arthroscopy and the more accurate lysis of the adhesions allow for postoperative management without complications or pain. This is of particular importance as it permits passive and active kinesitherapy from the moment the patient recovers from anaesthesia, without pain and therefore with greater commitment on his part. Furthermore, arthroscopic arthrolysis can be used successfully to treat extensor muscle stiffness where endoscopic study has revealed the presence of adhesions or calcification in the anterior compartments.
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PMID:Arthroscopic arthrolysis of the knee. 322 Jul 20

A double-blind, randomized, multicenter investigation was conducted to compare the efficacy and safety of Fioricet, acetaminophen with codeine, and placebo for the symptomatic treatment of tension headache. At the onset of a typical headache, the patients took two capsules of their assigned study medication and rated responses over the next four hours in three target symptoms areas: pain, emotional or psychic tension, and muscle contractions or stiffness in the head and neck. Physicians made global assessments of the same symptom responses and of adverse reactions for each patient. One hundred ninety-eight patients were evaluated. Both active analgesic preparations were more effective than placebo in relieving pain and muscle stiffness or contractions. Fioricet, but not acetaminophen with codeine, was significantly better than placebo in alleviating emotional or psychic tension; Fioricet was also significantly better than acetaminophen with codeine in relieving this symptom. Certain analyses suggested the possibility that Fioricet had a faster and more sustained analgesic effect than acetaminophen with codeine. By the end of the four-hour trial, significantly more patients achieved complete pain relief with Fioricet than with acetaminophen with codeine. The quality and quantity of adverse reactions did not differ significantly among the treatment groups. None was serious, and all abated without medical intervention.
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PMID:Symptomatic treatment of chronically recurring tension headache: a placebo-controlled, multicenter investigation of Fioricet and acetaminophen with codeine. 332 67


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