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

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

Sixty-three patients with an arthrographic diagnosis of disk displacement with reduction were randomly assigned to three treatment groups: (I) onlays to maintain disk repositioning, (II) flat occlusal splint, or (III) untreated controls. Guidance for construction of the disk-repositioning onlays was established during arthrography to obtain a recaptured disk position relative to the condyle. The onlays were cemented to the teeth and maintained the new intercuspal position anteriorly and inferiorly. The flat occlusal splint was used at night only and was adjusted to maintain a maximal occlusal contact in centric relation and centric occlusion. Clinical examinations were performed before and after 6 months of treatment. The disk-repositioning onlays improved joint function and reduced joint and muscle pain when compared with the flat occlusal splint and with nontreatment. The signs and symptoms in the flat occlusal splint group were no different from those in the control group. It is concluded that disk-repositioning onlays are effective in reducing pain and dysfunction associated with disk displacement with reduction in patients in whom the disk can be maintained in a normal relationship to the condyle with the aid of such onlays. The symptoms, however, returned when the onlays were removed after 6 months; this raises the question of whether a permanent change in the intercuspal position is necessary for long-term success.
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PMID:Disk-repositioning onlays in the treatment of temporomandibular joint disk displacement: comparison with a flat occlusal splint and with no treatment. 317 47

The single case experimental design was used to study day-to-day variations in the onset (PL), tolerance (PT), and intensity (VAS) of masseter muscle pain. Pain was induced by maximum voluntary teeth clenching, with no artificial feedback-control of the level of isometric activity, and static work efforts were quantified by cumulative electromyography. A continual effort to produce maximum static work, about 40% increase from baseline work, elicited in 30-40 s an initial sensation of muscular pain that had an intensity of about 25% of maximum possible score. A further increase in maximum static work effort, about 60% increase from baseline work, caused in about 2 min an intolerable increase in the intensity of muscular pain, about 50% of maximum possible score. Whereas PL showed day-to-day variation, PT and the ratio PL:PT did not. Intensity (VAS) scores and maximum static work efforts showed no day-to-day variations. Onset (PL) and tolerance (PT) showed no linear associations with VAS scores, and VAS scores showed no linear associations with maximum static work efforts; if anything, the latter associations tended to resemble a cubic parabola. Two different central neural processes, not associated with maximum static work efforts in a simple linear manner, might have been instrumental in: (i) the establishment of criteria for onset and tolerance of pain, and (ii) the discrimination of variable levels of pain intensity.
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PMID:Quantitative observations on maximum static work efforts and associated pain of the human masseter muscle. 323 27

This study examined the role of stress in subjects having combined muscle and temporomandibular joint pain compared to subjects having only muscle pain or only joint pain. It was found that the combined pain (n = 39) and muscle pain (n = 24) groups had comparable levels of pain intensity and activity impairment. The combined pain group, however, had the lowest level of stress and was rated lower than the muscle group in clinicians ratings of psychological factors, stress and chronicity. The combined pain group and joint pain group (n = 28) were found to be comparable in terms of the clinician's ratings. This data does not support the concept of a progression of symptoms from muscle pain to combined muscle and joint pain that would be expected from a stress-induced muscle hyperactivity model of temporomandibular disorders.
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PMID:Stress in patients with pain in the muscles of mastication and the temporomandibular joints. 323 33

The effects of low frequency-high intensity transcutaneous and intramuscular electrical nerve stimulation (TENS and IENS, respectively) on ipsilateral muscular pain threshold were studied in healthy volunteers. The combined effects of TENS (or IENS) and vibration as well as the effects of TENS applied to contralateral regions were also investigated. Muscular pain threshold was evaluated by the subjects' verbal reports in response to electrical stimulation (wire electrodes) of the vastus medialis muscle and by the appearance of blink response (startle reaction) without habituation. TENS was generally applied to the skin overlying the same muscle, and in some instances to the skin overlying the contralateral vastus medialis or triceps muscle. IENS was performed through the same electrodes used for inducing muscular pain. Vibration was applied to the tendon of ipsilateral quadriceps femoris muscle. TENS consistently induced marked and long-lasting elevations of ipsilateral muscular pain threshold. Comparable results were obtained by IENS. TENS and vibration performed simultaneously induced increases in muscular pain threshold, which were greater than those obtained with each individual conditioning stimulation. TENS proved to be capable of enhancing muscular pain threshold even when applied to contralateral regions; however, these effects were smaller and of shorter duration. The results provide evidence that low frequency-high intensity TENS (or IENS) are effective in raising muscular pain threshold and support the hypothesis that this type of stimulation brings supraspinal control systems into action through the activation of group III afferent fibres.
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PMID:Increase in muscular pain threshold following low frequency-high intensity peripheral conditioning stimulation in humans. 326 Nov 95

The incidence of different types of shoulder pain after open heart surgery was studied prospectively. Of 101 patients studied, 45 developed rheumatic symptoms during the first six weeks after the operation. Thirty eight patients reported pain in the region of the shoulder girdle with no loss of shoulder function (postpericardiotomy rheumatism). Three of these patients also had features compatible with the postpericardiotomy syndrome (fever, malaise, or pleuritic chest pain), and seven developed the syndrome without pain in the shoulder girdle. Of these 10 patients, one had generalised myalgia. Postpericardiotomy rheumatism alone was not associated with increased inflammation (measured by the erythrocyte sedimentation rate and concentration of C reactive protein); immunological tests including measurement of antibodies to cardiac muscle yielded inconclusive results. Replies to a postal questionnaire showed that symptoms of postpericardiotomy rheumatism were present for over three months in 18 patients and for six months or longer in 14. In view of the large number of patients now having open heart surgery postpericardiotomy rheumatism should be considered when patients report pain around the shoulders so that it is not misdiagnosed as angina.
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PMID:Rheumatic symptoms after cardiac surgery: a prospective study. 326 13

In an overview of the problem of occupational muscle pain the evidence indicates that injury is more common the greater the load and the worse the posture in which the work is performed. The commonest are backstrains or ligament or joint damage due to overuse. Fatigue is associated with alterations in energy metabolites in muscle while pain is often due to microscopical damage to the cellular architecture. The progress of pathological changes in muscle following occupational injury may be similar to those seen in primary fibromyalgia (fibrositis) because of a final common pathway involving calcium-induced secondary damage. Occupational muscle pain frequently occurs in the muscles supporting the upper limb girdle and head in workers engaged in repetitively performing skilled manipulations or activities requiring high or sustained mental concentration. It is suggested that both occupational myalgia of this kind may be due to an imbalance in the use of muscles for postural activity (holding or supporting fine movements) compared to phasic use in dynamic work. While there are undoubtedly muscular indications of damage these may be secondary to alterations in (unconscious) central motor control mechanisms.
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PMID:Hypotheses of peripheral and central mechanisms underlying occupational muscle pain and injury. 328 51

Primary fibromyalgia syndrome (PFS) is a common form of nonarticular rheumatism with diffuse musculoskeletal aching and stiffness at multiple sites and tender points at characteristic locations. Nonmusculoskeletal "systemic" symptoms, eg, fatigue, poor sleep, irritable bowel symptoms, and chronic headaches, are also common. Although PFS is similar to myofascial pain syndrome (MPS) in that both conditions cause muscle pain and tenderness, important differences exist. Unlike PFS, muscle pain in MPS is usually local or regional, accompanied by trigger points. Unlike tender points, trigger points produce a referral pain pattern specific to each muscle. Moreover, "systemic" features of PFS are usually absent in MPS. Common and important pathologic changes in muscle in PFS are moth-eaten appearance of Type I fiber by histochemistry, and myofibrillar lysis with glycogen and mitochondria deposition by electron microscopy; inflammatory changes are absent by light microscopy. Recent investigations have shown that PFS is a characteristic clinical entity. Further controlled studies are, however, essential to establish the pathologic changes in tender muscles in PFS.
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PMID:Primary fibromyalgia syndrome and myofascial pain syndrome: clinical features and muscle pathology. 328 73

Temporomandibular joint affections in rheumatic disease are described. They were seen in inflamed joint diseases, mostly in rheumatoid arthritis, and less so in juvenile rheumatoid arthritis, psoriatic arthritis, Reiter's syndrome, ankylosing spondylitis, and collagen vascular disease. In osteoarthrosis, the temporomandibular joint affection occurs frequently but pain seems to occur most infrequently. We must bear in mind that a painful temporomandibular joint could be a symptom of myalgia, especially fibrositis syndrome with its painful tendon.
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PMID:[The temporomandibular joint from the rheumatologic viewpoint]. 329 80

Occupational rheumatologic problems due to rapid repetitive motion are increasing in frequency in the electronics industry and are more commonly responsible for awards of Workers' Compensation benefits. If not handled correctly, these problems can result in significant pain and disability for employees and heavy medical and disability costs for employers. Corporate health and safety personnel can play a major role in reducing this human and fiscal cost by the following measures: Careful evaluation of patterns of injury and illness among employees will identify production areas with a high rate of problems. An intervention system designed to provide rapid early identification of employees with early symptoms of carpal tunnel syndrome, tendinitis, and muscle pain-spasm syndrome. Early treatment will produce much better medical results and will significantly reduce temporary disability and medical costs. Corporate ergonomic expertise or outside consultant evaluation of "hot spot" areas where significant numbers of cases are identified is critical to the prevention of future injury among employees. Some large electronics firms have ergonomic experts on staff in at least one plant facility. Arranging expert consultation can be expensive, with consulting fees of up to +1000 per day, plus expenses. However, this must be balanced against the medical disability costs of even one case of carpal tunnel syndrome, for example (up to +30,000 per case), and the required transfer of an experienced employee who develops a problem to another work area. Finally, these problems often do not occur in isolation. An employee with carpal tunnel syndrome very often has concomitant tendinitis and/or muscle pain-spasm syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Repetitive motion musculoskeletal problems in the microelectronics industry. 329 73


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