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PAIN
SYNDROME
Cabanting|Casco|Reyes
MUSCLE
- Muscles tendon and Fascia are richly
supplies with nociceptive nerve
endings
- They may be damaged acutely
- They may be damaged associated with
other injuries
MUSCLE SPASM
- Occurs to protect underlying damaged tissue
such as joints
- If pain and inflammation from joint injury
persist, MUSCLE SPASM will also persist
- Increase in muscle tension will lead to
chemical and mechanical stimulation of
nociceptive nerve endings
ANAPHYSIO OF MM PAIN:
- MP is not a prominent feature of the
serious progressive diseases affecting mm.
- Mm are relatively insensitive to pain when
elicited by needle or knife cut, but
overlying fascia is very sensitive to pain.
- Events that may lead to mm pain?
SPINAL AND
SUPRASPINAL
MXNSM OF PAIN
PATHWAY
DERMATOME
MYOTOMES
UPPER EXTREMITY
C1-C2 : NECK FLEXION
C3: LATERAL FLEXION
LOWER EXTREMITY
L2: HIP FLEXION
HISTORICAL OVERVIEW:
Early German Literature:
MYELOGELOSIS
- Change in the colloidal state of mm
cytoplasm
Massage??
HISTORICAL OVERVIEW:
EARLY BRITISH LITERATURE:
William Balfour (1815)
Concept of Fibrositis
edema and exudate*
HISTORICAL OVERVIEW:
EARLY BRITISH LITERATURE: Concept of
Fibrositis
- Valleix (1841)
- Sir William Gower (1904
SOFT TISSUE RHEUMATISM = FIBROSITIS
EPIDEMIOLOGY
30% occur among pt. in a general clinic
setting
85% occur among pt. tx in a pain center
F>M
SSX:
3 CARDINAL SIGNS OF MPS:
- Trigger Points
- Taut Bands
- Localized Twitch Response
TRIGGER POINT
TRIGGER POINT
TAUT BAND
DX CRITERIA:
5 major criteria of MPS
Regional Pain Complaint
Pain complaint
Taut band palpable in an accessible
muscle.
Spot tenderness at one point along the
length of the taut band.
Some degree of restricted range of
motion, when measurable.
DX CRITERIA:
Criteria for Classification of
Fibromyalgia
Widespread pain of 3 months duration
Pain in 11 of 18 tender points on digital
palpation.
Digital palpation must be performed
with an approximate force of 4kg
DX TEST:
No laboratory test or diagnostic imaging
technique has been established as a
diagnostic for MPS.
3 Tools that are helpful as to explain
the occurrence of trigger points:
Needle Electromyography
Ultrasound
Surface EMG
DX TEST:
NEEDLE EMG
Presence of spontatneous low-voltage
motor endplate noise activity
High-voltage spikes may occur.
DX TEST:
ULTRASOU
ND
DX TEST:
SURFACE EMG
Trigger points can cause disruption or
distortion of muscle function.
- muscles is indicated by abnormally
high amplitude of EMG activity when
the muscle is voluntarily contracted
and loaded.
DIFFERENTIAL DX:
MEDICAL MGT:
Drug Therapy
Muscle Relaxants
NSAID injections after Needling
technique
Sleep medications
Trouble-Making Drugs
MEDICAL MGT:
Trouble Making Drugs:
Caffeine
Tobacco
Sleep Relaxant:
Ramelteon (Rozerem)
Diphenhydramine(found in brand names like
Nytol, Sominex, Sleepinal, Compoz)
Doxylamine(found in brand names like Unisom,
Night time Sleep Aid)
Eszopiclone (Lunesta)
Zalepon (Sonata)
Zolpidem (Ambien)
Muscle Relaxant:
carisoprodol,cyclobenzaprine,metaxalone,
andmethocarbamol
MEDICAL MGT:
NEEDLING TECHNIQUE
Botulinum Toxin
Injections
SECONDARY COMPLICATIONS:
-
Atrophy
Contractures
Tightness
LOM