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Concept: Myofascial pain syndrome

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The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore, the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced.

Concepts: Scientific method, Critical thinking, Rheumatology, Science, Syndromes, Pain, Myofascial pain syndrome, Ailments of unknown etiology

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Fibromyalgia is a disabling, chronic pain condition of unknown etiology. Although many factors have been recognized as important contributors to the pain experiences and functional abilities of fibromyalgia patients, the factors that are most impactful (and therefore represent optimal targets for intervention) are still unclear. The aim of the present study was to examine the pathways among depression, self-efficacy, pain, and physical functioning in a large sample of fibromyalgia patients over a 1-year timeframe.

Concepts: Present, Time, Syndromes, Fibromyalgia, Fatigue, Chronic pain, Myofascial pain syndrome

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BACKGROUND: The etiology of chronic prostatitis chronic pelvic pain syndrome (CP/CPPS) is still unclear. As no pathological findings exist the diagnosis of CP/CPPS is essentially a diagnosis by exclusion and functional disorders, so-called somatoform disorders play a more important role. Osteopathy treats functional disorders of the musculoskeletal system including all associated internal organs but little attention has so far been paid to this treatment method. Therefore, the 5-year follow-up period was intended to show that this is a sustainable form of therapy using exclusively manual and gentle techniques and simple treatment procedures resulting in manageable costs. MATERIALS AND METHODS: The aim of this study was to investigate whether sustainability of osteopathic treatment could be demonstrated even after 5 years. This was a randomized controlled study initially involving 5 treatment sessions, a follow-up without treatment after 6 weeks and further follow-up after 1.5 and 5 years. Of the 20 patients 19 in the test group participated in the 5-year follow-up. The control group were not asked because it would have been unacceptable to expect the patients to refrain from having treatment for as long as 5 years. The men were aged between 29 and 70 years. The patients were asked to complete the international prostate symptom score (IPSS), the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) and the quality of life (QOL) questionnaires once again and in particular to state whether they had received osteopathic treatment specifically for the prostate problem and how often they had been treated. RESULTS: The follow-up assessment of the symptoms of chronic prostatitis (NIH-CPSI) showed that they had further improved after 1.5 years (intragroup difference -1.8 points, 95 % confidence interval CI=-3.8 to 0.3) and also after 5 years (intragroup difference -1.3 points 95 % CI=-3.4 to 0.8). The urinary tract symptoms (IPSS) showed a statistically significant improvement (intergroup difference 8.9 points, 95 % CI=4.7-13.1, p<0.0005). At the second follow-up after 1.5 years there was a further improvement (intragroup difference -2.2 points, 95% CI=-3.9 to -0.4, p=0.02) which was found to remain constant after 5 years (intragroup difference 0.2 points). The quality of life (QOL) with respect to the symptoms showed a statistically significant improvement in comparing both groups during the study phase (intergroup difference χ 2: p<0.005). At follow-up after 5 years out of 19 patients 15 answered the question"how would you feel if the symptoms currently present would not change in the future?" with excellent or satisfactory and 11 patients would not have wanted further osteopathic treatment. Of the patients 8 reported that since the second follow-up (within 3.5 years) they had received osteopathic treatment one to eight times; however, this was partially more prophylactic than due to pain. CONCLUSIONS: Due to the sustainability of osteopathic treatment and the low amount of time involved, osteopathy should be taken seriously as a treatment for patients with CP/CPPS. Furthermore, due to the osteopathic treatment the patients learnt to alleviate or even eliminate their own symptoms in treating themselves. In order to help many other affected persons out of their dilemma it would be desirable if more urologists and internists would become acquainted with osteopathy in order to be able to offer this to patients at an early stage. Further studies with larger numbers of patients should be carried out to confirm these results.

Concepts: Randomized controlled trial, Urology, Andrology, Prostate, International Prostate Symptom Score, Myofascial pain syndrome, Interstitial cystitis, Chronic prostatitis/chronic pelvic pain syndrome

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OBJECTIVE: To investigate the therapeutic effectiveness of trigger point injection into the muscles around the groin in patients with a clinically diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). DESIGN: Prospective, unicenter trial. SETTING: University rehabilitation hospital. PARTICIPANTS: Twenty-one cases of suspected myofascial pain syndrome (MPS) in patients with a clinically diagnosed CP/CPPS. INTERVENTION: Ultrasound-guided trigger point injection. MAIN OUTCOME MEASURES: Visual analog scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index score (NIH-CPSI), and injection-associated complication. RESULTS: Ultrasound (US)-guided trigger point injection on the iliopsoas, hip adductor, and lower abdominal muscles resulted in excellent outcomes. The mean values of the NIH-CPSI decreased significantly from 20.2 at pre-treatment to 12.5 at post-1st treatment (P<0.05). The mean values of VAS decreased significantly from 6.3 at pre-treatment to 2.9 at post-1st treatment (P<0.05). CONCLUSIONS: US-guided trigger point injections on the iliopsoas, hip adductor, and abdominal muscles provide a safe and effective diagnostic and therapeutic means, when the cause of groin pain is suspected to originate from muscles in a patient with CP/CPPS. In particular, the iliopsoas muscle was affected in all patients in this study.

Concepts: Syndromes, Pain, Pelvis, Myofascial pain syndrome, Urologic pelvic pain syndrome, Trigger point, Chronic prostatitis/chronic pelvic pain syndrome, Ailments of unknown etiology

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Fibromyalgia syndrome (FMS) is a common chronic widespread pain syndrome mainly affecting women. Genetic risk factors are known to contribute to the etiology of the syndrome. Clinical features show that FMS and familial Mediterranean fever (FMF) have some overlapping symptoms. Mediterranean fever (MEFV) gene has already been identified as being responsible for FMF. The aim of this study was to explore the frequency and clinical significance of missense mutations and a common polymorphism of MEFV gene in a cohort of Turkish patients with FMS.

Concepts: Genetics, Mutation, The Canon of Medicine, Familial Mediterranean fever, Rheumatology, Point mutation, Myofascial pain syndrome, MEFV

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Complex regional pain syndrome (CRPS) is a debilitating neuropathic pain condition that has been extensively reported in the extremities following variable degrees of nerve trauma. CRPS has rarely been reported in the orofacial region. We report 2 orofacial pain patients whose clinical phenotypes fit the criteria for CRPS. Two cases of orofacial complex regional pain syndrome (CRPS) are described, both of which began following trigeminal nerve trauma. In case 1 the patient presented with redness of the ipsilateral ear during painful episodes, pain that extended into the ipsilateral arm and was associated with variations in the appearance of the ipsilateral hand. Symptoms also included “electric-burning pain” of the right side of the head, including the ear, teeth, jaw, eye, neck, and cheek. In case 2 the patient presented with intractable pain of the upper left face, head, and neck accompanied by color changes in the painful areas, which increased with exposure to cold.

Concepts: Head and neck, Patient, Left-wing politics, Pain, Cranial nerves, Myofascial pain syndrome, Complex regional pain syndrome, Peripheral neuropathy

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PURPOSE: Chemical denervation is not recommended as part of the routine care of chronic non-cancer pain. Physicians face a dilemma when it comes to repeated interventions in cases of recurrent thoracolumbar facet joint pain after successful thermal radiofrequency ablation (RFA) in medial branch neurotomy. This study was performed to compare the effects of alcohol ablation (AA) with thermal RFA in patients with recurrent thoracolumbar facet joint pain after thermal RFA treatment. METHODS: Forty patients with recurrent thoracolumbar facet joint pain after successful thermal RFA defined as a numeric rating scale (NRS) score of ≥7 or a revised Oswestry disability index (ODI) of ≥22 % were randomly allocated to two groups receiving either the same repeated RFA (n = 20) or AA (n = 20). The recurrence rate was assessed with NRS and ODI during the next 24 months, and adverse events in each group were recorded. RESULTS: During the 24-month follow-up after RFA and AA, one and 17 patients, respectively, were without recurring thoracolumbar facet joint pain. The median effective periods in the RFA and AA groups were 10.7 (range 5.4-24) and 24 (range 16.8-24) months, respectively (p < 0.000). No significant complications were observed with the exception of injection site pain, which occurred in both groups. CONCLUSION: In our patient cohort, alcohol ablation in medial branch neurotomy provided a longer period of pain relief and better quality of life than repeated radiofrequency medial branch neurotomy in the treatment of recurrent thoracolumbar facet joint pain syndrome after successful thermal RFA without significant complications during the 24-month follow-up.

Concepts: Medical terms, Pain, Suffering, Myofascial pain syndrome, Pain management, Recurrence relation, Radiofrequency ablation

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INTRODUCTION: This review explores the treatment of male chronic pelvic pain syndrome (CPPS) (i.e., chronic prostatitis) through the use of neuromodulation, which is the electrical stimulation of the nervous system. Neuromodulation has been used for the treatment of chronic pain for decades, and this review will examine the theory and use of neuromodulation and the various techniques available for the treatment of CPPS. METHODS: Existing literature on the use of neuromodulation of the pelvic nerves for the treatment of chronic urogenital pelvic pain was reviewed. Because of limited published research, much of the data are not explicitly for male CPPS. RESULTS: Neuromodulation techniques used for chronic pelvic pain conditions include SNS, PTNS and pudendal nerve stimulation. Only SNS and PTNS are currently approved by the US Food and Drug Administration for the treatment of urinary symptoms, and none of these methods are acknowledged as standard therapies for treating chronic pelvic pain syndromes. The improvement of urinary symptoms is more clearly defined than improvements in pain, but at least a subset of patients in most of the published studies and case series derive some benefit in the short term and limited evidence suggests that long-term improvement of symptoms is possible. However, explantation rates are high in all long-term series of patients receiving implantable neuromodulation devices. CONCLUSIONS: Neuromodulation appears to provide benefits for patients with CPPS. However, because of the paucity of data and the limitations of small studies, the conclusions of the existing literature must be carefully considered. Because we are still becoming familiar with the pathophysiology of the pain syndromes and the mechanism of neuromodulation on urinary and pain symptoms, we cannot yet predict a particular individual’s response to neuromodulation. To determine the long-term efficacy of this therapy, more clinical study is needed to explore the use of neuromodulation in the treatment of male CPPS.

Concepts: Central nervous system, Nervous system, Syndromes, Nociception, Nerve, Myofascial pain syndrome, Interstitial cystitis, Chronic pain syndromes

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Background: The therapeutic efficacy of CP/CPPS is not very satisfactory and the impact on young male’s quality of life is considerable. The aim of the present study is to evaluate the efficacy of pollen extract associated with vitamins (DEPROX 500®) in order to improve the quality of life of young patients affected by chronic prostatitis type IIIb (CP/CPPS) by pain relieving.
Methods: All patients with clinical and instrumental diagnosis of CP/CPPS (class b) underwent DEPROX 500® 2 tablets in a single dose daily for 30 days. Clinical and microbiological analyses were carried out at the enrolment and after 1 month. NIH-CPSI and IPSS questionnaires have been used. The main outcome measure was the improvement of quality of life at the end of the whole study period, evaluated by questionnaires results.
Results: 20 men (mean age 32.8 ± 6.78) were enrolled in this pilot study. The baseline questionnaire mean scores were 25.90 ± 2.1 and 8.01 ± 3.64 for NIH-CPSI and IPSS, respectively. At the follow-up examination (1 month after treatment), 18 out of 20 patients (90.0%) reported an improvement of quality of life, in terms of pain reduction. The questionnaire results after 1 month from treatment were as follows: NIH-CPSI 12.8 ± 2.20, IPSS 7.6 ± 1.58. Statistically significant differences were then reported between the two visits, in terms of NIH-CPSI scores (p<0.001). No statistically significant differences have been reported in terms of IPSS between the two groups. All patients were negative at the Meares-Stamey test evaluation. The compliance to the study protocol 
was 100%.
Conclusions: The pollen extract associated with vitamins (DEPROX 500®) significantly improved 
total symptoms, pain, and QoL in patients with non-inflammatory CP/CPPS without severe side 
effects.

Concepts: Better, Statistics, Improve, Statistical significance, Quality, Pain, Myofascial pain syndrome, Chronic prostatitis/chronic pelvic pain syndrome

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Abstract Objective. The aim of this study was to describe the prevalence of the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among middle-aged men in a region with a temperate climate, i.e. a community in western Sweden. Material and methods. Men aged 40-69 years who, on the basis of postal invitation, volunteered to participate in a study regarding erectile dysfunction as a risk factor for cardiovascular disease, were asked also to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Results. In total, 459 of 900 men responded to the invitation. CP/CPPS-like symptoms, i.e. perineal and/or ejaculatory pain and an NIH-CPSI pain score of 4 or greater, were reported by 23 men (5%). More severe symptoms, with a pain score of at least 8 and perineal and/or ejaculatory pain, were reported by 15 men (3.3%). Conclusions. In this cross-sectional population-based study 5% had NIH-CPSI scores suggestive of CP/CPPS, which is in the lower range compared with studies from other regions, refuting the idea that CP/CPPS should be more common in regions with a temperate climate.

Concepts: Disease, Urology, Climate, Syndromes, Andrology, Erectile dysfunction, Myofascial pain syndrome, Chronic prostatitis/chronic pelvic pain syndrome