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Scarce research has examined the links between stress, anxiety, and gastrointestinal (GI) symptoms during competition, despite that they are positively correlated in the general population. A total of 186 endurance athletes completed the Perceived Stress Scale (PSS)-14, Anxiety Sensitivity Index (ASI)-3, and State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) before races. Afterwards, they reported the severity of in-race GI symptoms. Associations between high levels of stress and anxiety (defined as the top tertile) and GI distress (≥3 on a 0-10 scale) were examined using logistic regression. Athletes with high PSS-14 scores did not have greater odds of GI symptoms, except nausea (odds ratio [OR] = 2.21, 95% confidence interval [CI] 1.02-4.78). High scores on the STICSA-trait were associated with nausea (OR = 3.43, 95% CI 1.57-7.50) and regurgitation/reflux (OR = 3.31, 95% CI 1.26-8.73). Among a sub-sample of 125 participants that completed STICSA-state questionnaires, higher anxiety was associated with nausea (OR = 5.57, 95% CI 1.96-15.83), regurgitation/reflux (OR = 3.75, 95% CI 1.17-12.00), fullness (OR = 2.98, 95% CI 1.05-8.49), and cramping (OR = 3.99, 95% CI 1.36-11.68). The ORs remained relatively stable after adjusting for age, gender, experience, body mass index, type of race, and race duration. ASI-3 scores were not associated with symptoms. Individuals with higher levels of anxiety, especially on the morning of a race, may be prone GI distress, particularly nausea, regurgitation/reflux, and cramping.

Objective: To develop a novel muscle cramp scale (MCS) to assess frequency, severity and clinically meaningful information related to cramps among patients with amyotrophic lateral sclerosis (ALS). Methods: This new scale comprises four 5-point subdomains: (1) triggering factors, (2) frequency, (3) location, (4) severity, and (5) the degree to which cramps affect overall daily living. Thirty patients with ALS, who experienced at least 5 cramps per week, participated in a randomized test-retest study. An additional 26 patients participated in a second study assessing cramp changes over 4 weeks using the MCS and a detailed cramp diary. Results: To establish internal reliability of the scale, a Cronbach's coefficient value of 0.75 or higher was considered acceptable. Test/retest evaluations comparing in-person and telephone administration were assessed using paired t -tests and Cohen's kappa statistics. Non-significant differences were identified, and the results revealed moderate to high agreement for each item (range 0.60 to 0.95, p  < 0.0001). Scale construct validity against the cramp diary was acceptable. There were essentially no significant mean differences in muscle cramps over 4 weeks measured using the MCS and diary, respectively. Conclusions: The MCS is a valid, simple, and quick measure for the assessment of muscle cramps in patients with ALS. It can be reliably administered either in person or by telephone and provides richer information than the routinely utilized cramp diary.

Introduction: Muscle cramping may increase peripheral nervous system excitability. It is unknown if, and how long, cramp susceptibility is affected by previous cramping. We tested whether volitionally induced muscle cramps (VIMCs) lowered cramp threshold frequency (TF c ) and how long TF c was affected post-VIMC., Methods: Fifteen cramp-prone participants volitionally induced a flexor hallucis brevis (FHB) cramp on 4 separate days. FHB TF c was measured before VIMC (i.e., baseline) and 5, 30, and 60 min post-VIMC. VIMC electromyography (EMG) amplitude, VIMC duration, and perceived VIMC intensity were measured to ensure consistency of VIMC between days., Results: VIMC EMG amplitude, duration, and perceived intensity were similar between days (P > 0.05). VIMC lowered TF c ; baseline TF c (18 ± 6 Hz) was higher than 5-min (14 ± 6 Hz), 30-min (14 ± 5 Hz), and 60-min TF c (14 ± 5 Hz; P < 0.05)., Discussion: Acute VIMCs increase cramp susceptibility. Clinicians should apply treatments for at least 60 min postcramp to decrease the probability of cramp recurrence. Muscle Nerve 56: E95-E99, 2017., (© 2017 Wiley Periodicals, Inc.)

Muscle cramps are common in the general population and can be disabling for patients, but there is little evidence comprehensively evaluating cramp characteristics in patients with polyneuropathy. This study describes the prevalence and characteristics of muscle cramps in this patient group. Patients over 18 diagnosed with polyneuropathy were invited to join the study. Patients completed nerve conduction studies, the Toronto Clinical Neuropathy score, neuropathy-specific Vickrey's Quality of Life Assessment and a self-administered questionnaire examining demographics, neuropathy symptoms and cramp characteristics. Two hundred and twenty-five participants were enrolled (28.0% female). Sixty-three percent of patients experienced cramps, occurring on average 6 times per week, lasting 10.5 min and scoring 6 out of 10 on a pain scale and described as disabling by 43.6% of patients. No significant difference was found in cramp prevalence according to underlying pathophysiology (p = 0.52) or fiber type (p = 0.41). Patients with disabling cramps rated their physical (p < 0.0001) and mental (p = 0.04) quality of life lower than patients without disabling cramps. This study confirms that muscle cramps are common, disabling and associated with reduced quality of life in patients with polyneuropathy. Similar prevalence of cramps across predominant nerve fiber type suggests a role of sensory afferents in cramp generation, although this needs to be confirmed in larger cohorts., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the impact of nocturnal calf cramping (a condition that affects one in two people over 60 years of age) on quality of sleep and health-related quality of life., Methods: Eighty adults who experienced nocturnal calf cramp at least once per week and eighty age- and sex-matched controls who never experienced nocturnal cramp were recruited from the Greater Newcastle and Central Coast regions of New South Wales, Australia. All participants completed the SF-36v2 and the Medical Outcomes Study Sleep Survey (MOS-SS)., Results: People who experienced nocturnal muscle cramps reported more sleep disturbance (p < 0.001), less adequate sleep (p = 0.001), less quantity of sleep (p = 0.02) and more snoring (p = 0.03). Both sleep problem summary indices for the MOS-SS identified people who experienced nocturnal muscle cramp as having more sleep problems than the controls. People who experienced nocturnal muscle cramps had lower health-related quality of life for the SF-36 domains role physical (p = 0.007), bodily pain (p = 0.003) and general health (p = 0.02). SF-36 domains that primarily relate to mental health were not significantly different between groups. The impact of nocturnal calf cramps on health-related quality of life was largely explained by their negative impact on quality of sleep., Conclusions: Nocturnal calf muscle cramps are associated with substantially reduced quality of sleep and reduced physical aspects of health-related quality of life.

Health-related quality of life (HRQOL) is an important goal of therapy for chronic myeloid leukemia (CML) patients treated with current molecular-targeted therapies. The main objective of this study was to investigate factors associated with long-term HRQOL outcomes of CML patients receiving imatinib. Analysis was performed on 422 CML patients recruited in an observational multicenter study. HRQOL was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Key socio-demographic and clinical data were investigated for their association with HRQOL outcomes. Chronic fatigue and social support were also investigated. Univariate and multivariate linear regression analyses were used to identify independent factors associated with HRQOL outcomes. Fatigue was the only variable showing an independent and consistent association across all physical and mental HRQOL outcomes (P<0.01). Differences between patients reporting low versus high fatigue levels were more than eight and seven times the magnitude of a clinically meaningful difference, respectively, for the role physical (Δ=70 points) and emotional scale (Δ=63 points) of the SF-36. Fatigue did not occur as an isolated symptom and was most highly correlated with musculoskeletal pain (r=0.511; P≤0.001) and muscular cramps (r=0.448; P≤0.001). Chronic fatigue is the major factor limiting HRQOL of CML patients receiving imatinib.

The objective of this study was to investigate the health-related quality of life (HRQOL) aspects valued the most by patients with chronic myeloid leukemia (CML) receiving targeted therapies (TT), and to compare their perception with that of health-care professionals' (HCPs). Semi-structured interviews were conducted with 137 CML patients receiving TT from five different countries. An additional sample of 99 CML patients, completing an online interview, was considered for supportive analyses. A sample of 59 HCPs from 12 countries also participated in the study. Patients and HCPs were asked to rate and rank the importance of a predefined list of 74 HRQOL aspects of potential relevance for CML patients. Patients and HCPs agreed that the following five aspects are most important: fatigue, muscle cramps, swelling, worries, and uncertainty about health condition in the future, and importance of social support in coping with the disease. However, the difference in rankings between the two groups was substantial with respect to other HRQOL aspects investigated. Patients valued some issues related to symptoms much higher than HCPs, thus suggesting that a better symptom management could be the crucial aspects to improve HRQOL of CML patients.

Primary dysmenorrhea, or cramps, causes pain, limits activity, and increases emotional tension in young women, but its measurement has not received enough research attention. We have developed a functional and emotional measure of dysmenorrhea (FEMD, 14 items), and trialed it with a sample of 833 Chinese university women. Two factors (scales) were extracted by principal component analysis (PCA) and subsequently approved by a confirmatory factor analysis (CFA). The two scales were intercorrelated and were correlated with experienced pain severity and, to a lesser degree, with the depressive tendency. We have demonstrated that FEMD has stable components that might help measure dysmenorrhea-related dysfunctions.

Phantom limb phenomena are well characterized, but the underlying mechanisms remain unclear. Here we report a patient who relieves his phantom sensations and pain, experienced as itching and cramping, through scratching or massaging his prosthesis or the leg of another person. This pain relief occurs only when phantom limb sensations are present. We hypothesize that symptom relief results from incorporation of the foreign limb into the patient's body image, mediated by the sensory mirror neuron system, relieving pain by restoring concordance between sensory systems.

A health-related quality of life (HRQOL) assessment is particularly necessary for patients with chronic venous insufficiency (CVI), as is an assessment of the objective signs (edema, dilated veins, ulceration and other lesions). A comprehensive 3-year research program was undertaken in France to construct and validate the Chronic Venous Insufficiency Questionnaire (CIVIQ), a questionnaire designed specifically to evaluate the quality of life for CVI sufferers. The next step was to implement a program of cross-cultural validation in several countries. Translation into Spanish was undertaken following international guidelines. Face validity was verified with a pilot test among 12 Spanish patients. Psychometric validation was performed in Spain (n = 476 patients with CVI). The Spanish CIVIQ demonstrated very good internal consistency, high reproducibility and responsiveness, as well as longitudinal clinical validity. It appears to be a valuable instrument for assessing improvement in patient quality of life in response to both therapy in clinical practice and clinical trials.

Background & Aims: Increasing interest is being given to health-related quality of life in chronic diseases. In cirrhosis, both physical functioning and mental well-being may be altered, but no study has investigated factors associated with a poor perceived health status., Methods: We measured quality of life by Short Form-36 and Nottingham Health Profile questionnaires in 544 patients with cirrhosis. Data were compared with age- and gender-adjusted values of 2 random samples of the Italian population (more than 2000 subjects). Factors associated with poor perceived health status were identified by logistic regression., Results: All domains of health-related quality of life, except pain, were altered in cirrhosis (by 9%-42%), mainly in younger patients. There were minor differences in relation to gender, whereas etiology had no effects. Severity of disease (Child-Pugh score) and, above all, muscle cramps were the factors most closely associated with poor health status perception. Self-rating of disease progression was associated with ascites and pruritus, whereas previous variceal sclerotherapy and the use of disaccharides had a protective effect. Most areas of daily life were affected by perceived health problems; this was mainly true for paid employment and sex life in men and home life and social life in women., Conclusions: Quality of life is variably impaired in cirrhosis, also in uncomplicated patients. Non-life-threatening symptoms, such as muscle cramps, are of major concern. These data are the basis for longitudinal studies measuring the effects of therapy and procedures on patient-derived health outcomes.

The current study, for which ethical approval was obtained, was designed to assess the extent to which the tenderness or mechanical allodynia observed in delayed onset muscle soreness (DOMS) might be mediated by large diameter myelinated nerve fibres. Healthy human volunteers were recruited and randomly allocated to one of three groups: Normal-Control, Ischaemic-Control, and Test-DOMS (total n=21; n=7 in each group). In the Normal-Control group, subjects attended on a single occasion for assessment of mechanical pain threshold (MPT) at standardized sites over the biceps brachii using a pressure algometer for a period of 20 min. In both remaining groups, ischaemia was induced in subjects' non-dominant upper limbs by elevation of the limb, followed by application of a sphygmomanometer cuff at a pressure of 250 mmHg. Throughout the period of the block (20-40 min), sharp/blunt sensation was assessed at regular intervals. MPT was assessed upon inflation of the cuff and reassessed at 10 min intervals until deflation. In the two ischaemic block groups, current level of pain was also monitored using a computerized visual analogue scale (VAS) at the beginning and end of the procedure. Subjects in the Test-DOMS group attended 48 h prior to ischaemic block for induction of DOMS using a standardized regime of eccentric exercise, but thereafter were treated in exactly the same manner as the Ischaemic-Control group. Results showed a significant (P<0.05; ANOVA) increase in MPT in the Test-DOMS group by the 20 min point, corresponding to a 'normalization' of MPT; loss of the ability to distinguish between sharp/blunt sensation accompanied such changes. Parallel increases in reported pain were seen in both groups undergoing ischaemic block, indicating that the procedure did not alter nociception. While not definitive, these results suggest that altered processing of activity in large diameter (myelinated) afferents might underlie the mechanical allodynia observed in DOMS; thus, this is an area which warrants further investigation.

Gender symptom differences were studied in 948 subjects with Parkinson's disease (PD) using a questionnaire covering the most common symptoms associated with PD at debut (SP-1) and at present (SP-2). The symptoms most frequently reported by both genders were: tremor, fumblingness, writing problems, rigidity and fatigue. At SP-1 females reported neck-pain and low back pain more frequently than males. At SP-2 subjects reported an increased number of symptoms. The following symptoms were more frequent among males than females: writing difficulties, fumblingness, gait problems, speech problems, increased flow of saliva, lack of initiative. Sleep problems were common in both sexes with inability to turn in bed and calf muscle cramps in a high percentage. A majority of female subjects find their symptoms (e.g. depression) constantly distressing. Although depression is not one of primary reported symptoms (36%) attention is called for, due to the problem with compliance to treatment regimes. About 30% do not report having tremor and rigidity. This study indicates the usefulness of a symptom profile instrument capable of capturing the many symptoms involved in PD. Such an instrument could be used to detect apparent mistakes in medication and thereby increase the function and quality of life for the individual.

Spasticity and other muscle symptoms in the palliative care patient can contribute to suffering, significantly detracting from overall quality of life. Current therapy primarily includes use of centrally acting muscle relaxants, which are beneficial in treating some symptoms, but frequently have extensive side effects, such as sedation and muscle weakness. Tizanidine, a central alpha 2 adrenergic agonist, has been shown in clinical studies to be as effective as other commonly used antispastic agents, but without debilitating muscle weakness. Tizanidine can cause sedation, which is minimized by dose titration. When taken at night, patients report improvement in getting to sleep and little drowsiness or "hangover sensation" upon waking. Tizanidine is potentially helpful to many palliative care patients with chronic muscle pain and sleep disturbances.

Objectives: To examine whether the degree of stress associated with adverse physical side effects correlates with overall quality of life (QOL) and compliance rates. To determine if instruments used to assess QOL can detect differences between treatments that have no known central nervous system effects., Patients and Methods: This randomized, double-blind, parallel group study evaluated 180 to 480 mg of controlled onset, extended release (COER)-verapamil (n = 259) or 30 to 120 mg/d of nifedipine gastrointestinal therapeutic system (GITS) (n = 269) in men and women between 21 and 80 years of age with stages 1 to 3 hypertension. A battery of questions evaluating psychological well-being and a physical symptom distress index was administered after a 4-week placebo washout (baseline) and after 10 weeks of treatment or at dropout., Results: Both treatments effectively lowered blood pressure, and there were no significant between-group differences in psychosocial QOL. A difference in the level of physical symptom distress was detected between treatments (P = .002; multivariate analysis of variance), with 7 significant univariate treatment effects, all favoring COER-verapamil, being noted-pedal edema, polyuria, rapid heart beat or palpitations, hives, muscle cramps, abdominal cramps, and headaches. Constipation-related distress increased significantly (P = .001) but to a similar extent with both treatments. The difference in symptom distress tended to predict compliance as there were more withdrawals in the nifedipine GITS group (n = 85) vs COER-verapamil group (n = 64) (P = .08)., Conclusions: Patient-assessed physical symptom distress is a sensitive, simple technique to evaluate the effect of antihypertensive medications on QOL and tolerability, as shown by its ability to detect the improvement associated with COER-verapamil. Depending on the agents involved, the Physical Symptom Distress Index may more closely predict dropout rates than the traditional psychosocial instruments, as suggested by the lower dropout rate in the COER-verapamil group. Thus, in studying treatment effects on QOL, both the distress of physical symptoms and the impact of psychosocial factors should be evaluated.

This study includes 15 patients of Writer's cramp. All were male and their age ranged from 21 to 57 years. They were from urban areas and of different occupation. They had obsessional pre-morbid personality. The study showed the prognosis of Writer's cramp after 12 weeks of treatment. This study showed that younger age group with early onset and less obsessional feature improved significantly by drug, psychotherapy and behaviour therapy.

The clinical characteristics of 20 golfers suffering from golfers' cramp or the "yips" are described. The typical description is that of a middle-aged golfer who has played competitive golf since his teens and develops the problem during a tournament in the form of a jerk, spasm, or freezing of movement while putting or chipping, with the rest of the game being relatively unaffected. The problem generally takes a chronic fluctuating course, and a number of 'trick' strategies are partially or fully successful. In this study, the subjects were compared with a matched group of 20 unaffected golfers on a number of indices of psychopathology; no significant differences emerged. The more severely affected golfers also did not differ significantly from the mildly affected ones, except on the subjective report of anxiety. These data support the argument that golfers' cramp is not an anxiety disorder or a neurosis. The important role of anxiety and arousal in its manifestation is, nevertheless, recognized and its pathophysiology speculated upon.

Although its aetiopathogenesis is still unknown, writer's cramp is meanwhile regarded essentially an organically induced disorder. However, as shown by this interdisciplinary study, psychodynamic factors should not be neglected. Special attention should be given to the patients' experience of the syndrome and secondary psychoreactive processes.

The purpose of this study was to determine if patients with focal hand dystonia have any significant psychopathology. We studied 20 patients with hand cramps who were participating in a therapeutic trial of botulinum toxin injections. Patients were interviewed and administered the Minnesota Multiphasic Personality Inventory (MMPI). Beck Depression Inventory, Spielberger State-Trait Anxiety Scale, a finger tapping test, and a choice serial reaction time test. Behavioral ratings were also obtained. Group statistics indicated that all personality scale scores and performances on motor tasks were within normal limits. Four out of 20 patients demonstrated mild depression. Trait anxiety scores were higher than state anxiety scores, suggesting that receiving medical treatment had a beneficial effect on mood. The number of depressive symptoms endorsed on the MMPI was correlated with reaction time speed but not finger dexterity. None of the 20 patients reported a remarkable psychiatric history. These results indicate that hand cramps are not associated with serious psychopathology.

Historically relevant hypotheses on the pathophysiology of muscle cramp are reviewed. Psychosomatic, static, vascular, myogenic and neural theories are highlighted from a clinician's point of view. Modern neurophysiological research leaves little doubt that true muscle cramp is caused by explosive hyperactivity of motor nerves. Several mechanisms may be involved including spinal disinhibition, abnormal excitability of motor nerve terminals and spreading of muscle contraction by ephaptic transmission or axon reflexes.

We have examined 29 subjects with writers' cramp (and 4 with typists' and one with pianists' cramp) and have noted two major groupings, simple and dystonic. We have observed spread from one to the other. We have seen repeatedly, in patients with isolated simple writers' cramp certain subtle physical signs which are found also in other basal ganglia diseases. We have noted also the frequent association of other features of segmental and generalized dystonia in patients with dystonic writers' cramp. We have demonstrated that patients with isolated writers' cramp have no higher an incidence of psychiatric disturbance, as judged by formal Present State Examination, than the normal population. We conclude that isolated writers' cramp is a physical illness rather than a psychological disturbance, and that it is a focal dystonia.

An unusual case of writer's cramp in a 12-year-old deaf girl is reported. Possible aetiological and contributing factors in her environment are discussed, with particular relevance to a hysterical conversion reaction.

Although the Stiff Man Syndrome has been traditionally viewed as a neurologic disorder, a number of recent articles have documented a pattern of familial, interpersonal, and intrapsychic stress which suggests that this disease may be, to a considerable degree, psychosomatic in origin. The present paper reviews several recent articles and focuses on a single case study. Although the medical diagnosis was earlier confirmed, an in-depth psychiatric evaluation and extensive psychological assessment showed many psychopathological concomitants associated with the severe muscle spasm and stiffness. A follow-up after about a year of group and individual psychotherapy showed that the symptoms were still in remission, and that the patient was functioning personally and occupationally on a significantly improved level.

The history of writer's cramp is reviewed, and the study of ten cases described. Nine of the patients were male with obsessional personalities, and involved in a conflict with some bearing on the act of writing. Treatment by psychotherapy and re-education produced either temporary or little improvement; biofeedback, used in six cases, produced some benefit in four, of which only one relapsed. Although no statistical weight can be attached to the results of so short a series, biofeedback appears to offer a promise of response which merits further investigation. The use of the electromyograph is discussed also as a means of discriminating between tension and tremor in such cases, with particular reference to their psychosomatic meaning.

In the history of medicine new diseases have appeared recurrently, frequently in epidemic form. "New" medical and surgical treatments become fashionable and "diagnosis" becomes a reinterpretation of ambiguous phenomena in accordance with prevailing concerns, often promoted by vested interests. Such an epidemic can be understood in its social context against its background of shared beliefs, social stresses and group demands. False rumours and other exacerbating factors can be identified and eliminated, and measures taken to control them. The management of such epidemics is a public health problem which demands community and institutional support as well as cooperation by the media.

A theoretical model of writer's cramp is presented. In addition to the original emotional arousal and subsequent conditioned stimuli inherent in a classical conditioning paradigm, this model stresses the role of operant behaviors in the maintenance of the disorder. The immediate consequences of the actual cramp and subsequent escape behaviors are emphasized. An extinction procedure consisting of response-cost and response-prevention measures is tested using an A-B-A-B design. Two patients totally unable to write, were able to increase cramp latency and were gradually retrained to write. Follow-up assessments at 6, 9 and 12 months confirmed the treatment gains.

Problems involving the coordination of movements of the hand analogous to the "writers cramp" have been seen in musicians and other professions. They occur in individuals with muscular imbalance, who assume abnormal body postures affecting not only the involved limb but also the spine and pelvis. These patients also often have a particular psychological make up. Treatment is based on the re-training of their muscular actions and on teaching the patients to avoid assuming abnormal stances or postures.

Eleven patients with writer's cramp were studied during the performance of a series of writing and non-writing tasks. Their performance in the tasks and the intensity of contraction in the flexor and extensor muscles of the fingers and elbow (recorded electromyographically) were compared with the results from a group of matched normal controls. The patients showed highly significant increases in muscle activation especially in the triceps muscle which was overactive in all but one of the tasks undertaken. Psychometric testing showed no difference between patients and controls. The results support the view that writer's cramp is a form of focal dystonia in which the disorder of motor control is not confined to writing activities.

Many authors have commented on an association between writer's cramp and anxiety and some view it as a form of anxiety disorder. This study describes 22 patients with writer's cramp who were recruited from a neurology clinic. Clinical examination found little evidence of generalized anxiety or of anxiety specific to the writing situation. Additionally, the subjects' scores on the Crown-Crisp Experiential Index, which contains several anxiety subscales, did not differ significantly from those of a matched normal control group. Writer's cramp differs from the anxiety disorders in two other respects: it has a later onset (mean in the 30s) and the male preponderance is much greater than in any anxiety disorder, even social phobia.

It has been postulated that some movement disorders are secondary to unresolved, unconscious mental conflict; however, psychotherapeutic intervention has been unsuccessful and psychoanalytic formulations have not been shown to be valid. In addition, there is the interesting observation that some medications, stereotactic surgery and biofeedback have been successful in treating movement disorders. Moreover, as in the cases of amphetamine-induced stereotyped behavior, Parkinsonism, the acute dyskinesias, and Tardive Dyskinesia, there is evidence that some involuntary disorders of movement are biochemically mediated. Organicity, in varying degrees and involving different anatomical and physiological areas, has been observed in Tourette's Syndrome, Parkinson's disease and Huntington's disease. These diseases are usually associated with adjustment problems because of the effect that they have on the patient and the patient's family. Some of these psychosocial problems are discussed.