Archive for December, 2007
Low Back Pain| Travel
December 30, 2007 6:39 pmSunday, December 30, 2007
The festive season is celebrated by many with more than usual degrees of energy expenditure associated with holiday traveling. Traveling long distances involves sitting for long hours as the driver of a car or as a passenger in buses, trains or airplanes.
Sitting may induce posterior rotation of the pelvis, reduction of lumbar lordosis, and increases in muscle tension, which may be associated with low back pain. The combination of prolonged sitting in awkward positions or sitting slumped for prolonged periods, heavy or repetitive lifting of luggages, and whole body vibrations (dose and duration of exposure does matter, especially duration of exposure) can initiate pain in a person without back pain or aggravate the underlying pain in the patient already suffering from lower back pain.
The sitting position encourages the pelvis to rotate backwards, flattens the lumbar lordosis, increases muscle tension, disc pressure, and pressure on the ischium and coccyx. This increases the load on the spine and intervertebral discs. Sitting in a slumped position is known to increase disc pressure even more, and to aggravate chronic low back pain.
Sitting with the knees crossed can put tension on the sciatic nerve or compression of the peroneal nerves at the knee. Sitting with ankles crossed can compress the peroneal nerve at the ankle. Pressure on these nerves will manifest as tingling and numbness in the toes and feet and depending on the degree and duration of pressure, there can be weakness of muscles in the foot and ankle.
It has been shown that as the lumbar spine was loaded from the supine to the sitting position, the end-plate angles were decreased significantly. This decrease was worse as the spinal degeneration was increased. There were also significant changes in the anterior and middle disc heights between the supine and the sitting postures irrespective of the degree of degeneration. In the study, the overall lumbar lordosis did not significantly change between the two postures1.
Using a fitted backrest during sitting that reduces the ischial load and maintains lumbar lordosis may help increase seating comfort and reduce low back pain. Performing pelvic tilts while in the sitting position are also helpful. Frequent weight shifts and getting up often to ambulate are necessary during long trips.
1. Karadimas EJ. Siddiqui M. Smith FW. Wardlaw D. Positional MRI changes in supine versus sitting postures in patients with degenerative lumbar spine. [Journal Article. Research Support, Non-U.S. Gov't] Journal of Spinal Disorders & Techniques. 19(7):495-500, 2006 Oct.
© 2007 copyright all rights reserved www.stopmusclepain.com Low Back Pain | Travel
back, lower body topics, pain, posture
Fibromyalgia| Neuromuscular Pain Twitch Relief
December 22, 2007 11:45 pmSaturday, December 22, 2007
Various hypotheses account for the manifestations of fibromyalgia syndrome, including immunogenic, endocrine, and neurological mechanisms. Treatments for fibromyalgia are directed toward symptomatic relief without the benefit of targeting known, underlying pathology. It was observed that the common factor among partially effective therapies is a vasodilatory effect. This is true both of conventional treatments, unconventional treatments such as intravenous micronutrient therapy, and lifestyle treatments, specifically graduated exercise. The pain of fibromyalgia is described in terms suggestive of the pain in muscles following extreme exertion and anaerobic metabolism. These characteristics suggest that the pain could be induced by vasomotor dysregulation, and vasoconstriction in muscle, leading to low-level ischemia and its metabolic sequelae.
Vasodilatory influences, including physical activity, relieve the pain of fibromyalgia by increasing muscle perfusion. There are some preliminary data consistent with this hypothesis, and nothing known about fibromyalgia that refutes it. The hypothesis that the downstream cause of fibromyalgia symptoms is muscle hypoperfusion due to regional vasomotor dysregulation has clear implications for treatment; is testable with current technology; and should be investigated1.
In neuromuscular pain such as fibromyalgia the mediate cause of pain is muscle shortening and/or spasm under the control of neuromuscular junctions or trigger points. This muscle shortening and/or spasm results in focal ischemia (lack of blood supply) to intramuscular nerves and blood vessels and also produce a traction effect on pain sensitive structures such as tendons, bones and joints. Electrical Twitch Obtaining Intramuscular Stimulation (eToims® Twitch Relief Method), is a new anatomical and physiological approach to treat neuromuscular pain such as myofascial pain and fibromyalgia. It is a markedly innovative discovery in medicine as common pain therapies do not attempt to stimulate the neuromuscular junctions of muscles which mediate the pain processes.
Very brief electrical stimulation applied to neuromuscular junctions to elicit characteristic twitches which are brisk focal muscle contractions, produces active local muscle exercise and stretching which, in turn: (3) ends pain producing accumulation of local muscle tissue wastes, by increasing efflux of fluids carrying these wastes. 1. Katz DL. Greene L. Ali A. Faridi Z. The pain of fibromyalgia syndrome is due to muscle hypoperfusion induced by regional vasomotor dysregulation. [Journal Article. Research Support, N.I.H., Extramural. Research Support, U.S. Gov't, P.H.S.] Medical Hypotheses. 69(3):517-25, 2007.
© 2007 copyright all rights reserved www.stopmusclepain.com Fibromyalgia|Neuromuscular Pain Twitch Relief
eToims, fibromyalgia, lower body topics, muscles, myofascial, pain, twitch, upper body topics
Chronic Pain|Stress (2)
December 14, 2007 11:49 pmFriday, December 14, 2007
In a study to estimate the prevalence and population impact of work-related neck and upper limb pain in 10,000 adults in UK, it was found that there were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects; prolonged bending of neck; working with arms at/above shoulder height; little job control; and little supervisor support. Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Findings suggested that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk1.
The prognostic factors for developing chronic low back pain (LBP) at an early stage of LBP include those patients with neurological signs compared to those without neurological signs, those with sickness absence due to LBP and those with emotional distress2.
Chronic stress/depression may contribute to a dysregulation of neuro-endocrine, immune and central pain mechanisms in fibromyalgia3.
A study examined the specificity of the relationship between anxiety sensitivity (AS), a measure of catastrophizing about arousal-related sensations, and pain responses, by examining the effect of AS on responses to stressors of a physical and social nature. Healthy men and women (n = 129) between the ages of 18 and 25 years were recruited from the community to participate in a study examining subjective, cognitive and behavioral responses to different types of stressors. Participants were randomly assigned to one of 3 groups: (i) a neutral condition in which they sat quietly and read a popular magazine; (ii) a social stress condition in which they anticipated having to give a self-disclosing speech; and (iii) a physical stress condition in which they were presented with 3 countdown to shock trials where a mild electrical shock was administered on the non-dominant arm. Subjective ratings and physiological responses were recorded in anticipation of the stressor and immediately after stress exposure. Results indicated that AS was indirectly related to pain ratings via its effect on anticipatory anxiety ratings. AS was associated with anticipatory anxiety ratings, regardless of whether the stressor was of a physical or social nature. Furthermore, AS was not shown to be directly associated with exaggerated subjective or physiological reactions to the physical stressor. These results indicate that the role of AS in pain responses may be mediated through a global effect on anxiety, and limited to the anticipatory stage of the pain experience. If future studies yield similar findings in pain patients, then they would suggest that interventions for helping individuals high in AS should focus on catastrophic thinking in anticipation of stressors in general, rather than on pain-specific stressors4.
1. Sim J. Lacey RJ. Lewis M. The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study. BMC Public Health. 6:234, 2006.
2. Grotle M. Brox JI. Glomsrod B. Lonn JH. Vollestad NK. Prognostic factors in first-time care seekers due to acute low back pain. European Journal of Pain: Ejp. 11(3):290-8, 2007 .
3. Van Houdenhove B. Luyten P. Stress, depression and fibromyalgia. Acta Neurologica Belgica. 106(4):149-56, 2006 Dec.
4. Conrod PJ. The role of anxiety sensitivity in subjective and physiological responses to social and physical stressors. Cognitive Behaviour Therapy. 35(4):216-25, 2006
www.stopmusclepain.com Chronic Pain| Stress (2)
back, fibromyalgia, neck, painChronic pain|Stress
December 9, 2007 9:29 amSunday, December 9, 2007
Stress is often considered by patients and clinicians alike as an important factor in the onset and maintenance of widespread musculoskeletal pain, the relationship is more complex than appears on initial consideration. The types of event that lead to stress need description, and the role of traumatic events are particularly important because of the shared association with post-traumatic stress disorder. The substantial overlap with psychiatric disorders and the role of stress in their etiology must be assessed in patients. The lack of specificity of the symptoms of the different disorders used to describe widespread musculoskeletal pain may be explained by their shared etiology, including neural sensitization and alterations of the hypothalamic-pituitary-adrenal (HPA) axis due to stress. Fear avoidance is a central stress-related perceptual characteristic and behavioural dimension in these disorders. Treatment depends on thorough assessment, including psychiatric diagnosis, avoiding simplistic attributions and implementing evidence-based treatments that are well documented1.
The effects of chronic stress can be seen even in infants. When compared to a group of healthy term infants, it was found that hospitalized infants had significantly higher hair cortisol levels (a stress marker). A subgroup analysis of the term infants in the neonatal intensive care unit showed a statistically significant association between total number of ventilator days and hair cortisol levels. For every extra day on the ventilator, hair cortisol levels increased significantly indicating that hair cortisol is influenced by days on the ventilator 2.
Emotional distress is a predictor for low back disability in persons with earlier low back pain, but not in persons without. To prevent low back disability, emotional distress should be considered and treated in persons with low back pain3. In a study on computer users aged 45 or older, perceived work demands influence neck/shoulder musculoskeletal symptoms through their effect on felt stress4.
Distressing sensations, thoughts, and emotional experiences exert influence on the daily functioning of those who suffer with chronic pain. In a study examining the role of mindfulness in relation to the pain, emotional, physical, and social functioning of individuals with chronic pain, it was found that mindfulness was unrelated to age, gender, education, or chronicity of pain. However, mindfulness accounted for significant variance in measures of depression, pain-related anxiety; physical, psychosocial, and "other" disability. In each instance greater mindfulness was associated with better functioning5.
1. McFarlane AC. Stress-related musculoskeletal pain. Best Practice & Research in Clinical Rheumatology. 21(3):549-65, 2007 Jun.
2. Yamada J. Stevens B. de Silva N. Gibbins S. Beyene J. Taddio A. Newman C. Koren G. Hair cortisol as a potential biologic marker of chronic stress in hospitalized neonates. Neonatology. 92(1):42-9, 2007.
3. Brage S. Sandanger I. Nygard JF. Emotional distress as a predictor for low back disability: a prospective 12-year population-based study. Spine. 32(2):269-74, 2007 Jan 15.
4. Larsman P. Sandsjo L. Klipstein A. Vollenbroek-Hutten M. Christensen H. Perceived work demands, felt stress, and musculoskeletal neck/shoulder symptoms among elderly female computer users. The NEW study. European Journal of Applied Physiology. 96(2):127-35, 2006 Jan.
5. McCracken LM. Gauntlett-Gilbert J. Vowles KE. The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain. 131(1-2):63-9, 2007 Sep.
www.stopmusclepain.com Chronic Pain| Stress
back, chronic pain, fibromyalgia, muscles, myofascial, neck, pain, stress
Neck Pain| Back Pain| Fibromyalgia
December 1, 2007 1:04 amSaturday, December 01, 2007
Fibromyalgia is a debilitating disorder characterized by chronic pain and tenderness in muscles throughout the entire body, headache, fatigue, sleep disturbance, depression, interstitial cystitis, irritable bowel syndrome and skin sensitivity. The majority of the patients are women.
Diagnosis includes the presence of 11/18 tender points in well-defined areas, but many patients with early symptoms might not fit this definition.
Pathogenesis is still unknown, but there has been evidence of increased corticotropin-releasing hormone (CRH) and substance P (SP) in the cerebrospinal fluid and serum of patients with fibromyalgia. There is also increased IL-6 and IL-8 in their serum1.
Increased numbers of activated mast cells were also noted in skin biopsies. The hypothesis is put forward that fibromyalgia is a neuro-immunoendocrine disorder where increased release of CRH and SP from neurons in specific muscle sites triggers local mast cells to release proinflammatory and neurosensitizing molecules.
There is evidence for mechanical, thermal, and electrical hyperalgesia. Peripheral and central abnormalities of nociception have been described and these changes may be relevant for the increased pain experienced by these patients.
These changes may result from the release of pain producing substances after muscle or other soft tissue injury. These pain mediators can sensitize important nociceptor systems. Tissue mediators of inflammation and nerve growth factors can excite these receptors and cause substantial changes in pain sensitivity2.
Fibromyalgia pain is widespread and does not seem to be restricted to tender points (TP). It frequently comprises multiple areas of deep tissue pain (trigger points) with adjacent much larger areas of referred pain. Analgesia of areas of extensive nociceptive input has been found to provide often long lasting local as well as general pain relief.
Thus interventions aimed at reducing local fibromyalgia pain seem to be effective but need to focus less on tender points but more on trigger points and other body areas of heightened pain and inflammation.
There is no curative treatment although medication such as low doses of tricyclic antidepressants, serotonin reuptake inhibitors, dual reuptake inhibitors, antiseizure medications namely Pre-gabalin in high doses can help.
Although exercises have been suggested, fibromyalgia patients are unable to tolerate exercise due to their high levels of pain and fatigue.
Fibromyalgia patients may have structural or mechanical causes like scoliosis, localised joint hypomobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency. Sometimes, correction of an underlying cause of for the muscle pain is needed to resolve the condition3.
1. Lucas HJ. Brauch CM. Settas L. Theoharides TC. Fibromyalgia–new concepts of pathogenesis and treatment. International Journal of Immunopathology & Pharmacology. 19(1):5-10, 2006 Jan-Mar.
2. Staud R. Are tender point injections beneficial: the role of tonic nociception in fibromyalgia. Current Pharmaceutical Design. 12(1):23-7, 2006.3.
Gerwin RD. A review of myofascial pain and fibromyalgia–factors that promote their persistence. Acupuncture in Medicine. 23(3):121-34, 2005 Sep.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck Pain| Back pain |Fibromyalgia
