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Abstract: This study investigated the association between serological biomarkers at hospital admission with the development of long-term post-COVID pain symptoms in previously hospitalized coronavirus disease, 2019 (COVID-19) survivors. A cohort study including patients hospitalised because of COVID-19 in 1 urban hospital of Madrid (Spain) during the first wave of the outbreak was conducted. Hospitalisation data, clinical data, and 11 serological biomarkers were collected at hospital admission. Participants were scheduled for an individual telephone interview after hospital discharge for collecting data about post-COVID pain symptoms. A total of 412 patients (mean age: 62, SD: 15 years; 46.1% women) were assessed twice, at a mean of 6.8 and 13.2 months after discharge. The prevalence of post-COVID pain symptoms was 42.7% (n = 176) and 36.2% (n = 149) at 6.8 and 13.2 months after hospital discharge. Patients reporting post-COVID pain exhibited a greater number of COVID-19-associated symptoms at hospital admission, more medical comorbidities, higher lymphocyte count, and lower glucose and creatine kinase levels (all, P < 0.01) than those not reporting post-COVID pain. The multivariate analysis revealed that lower creatine kinase and glucose levels were significantly associated, but just explaining 6.9% of the variance of experiencing post-COVID pain. In conclusion, the association between serological biomarkers associated with COVID-19 severity at hospital admission and the development of post-COVID pain is small. Other factors, eg, higher number of COVID-19 onset symptoms (higher symptom load) could be more relevant for the development of post-COVID pain. Because inflammatory biomarkers were not directly analyzed, they may have stronger predictive strengths for the development of post-COVID pain symptoms. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the prevalence of long-term musculoskeletal post-COVID pain and their risk factors in a large cohort of COVID-19 survivors. A multicenter cohort study including patients hospitalised because of COVID-19 in 5 hospitals of Madrid (Spain) during the first wave of the pandemic was conducted. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview after hospital discharge for collecting data about the musculoskeletal post-COVID pain. Anxiety/depressive levels and sleep quality were likewise assessed. From 2000 patients recruited, a total of 1969 individuals (46.4% women, age: 61 years, SD: 16 years) were assessed on average at 8.4 (SD: 1.5) months after discharge. At the time of the study, 887 (45% women) reported musculoskeletal post-COVID pain. According to the presence of previous pain symptoms, the prevalence of "de novo" (new-onset) musculoskeletal post-COVID pain was 74.9%, whereas 25.1% experienced an increase in previous symptoms (exacerbated COVID-related pain). Female sex (odds ratio [OR]: 1.349, 95% confidence interval [CI]: 1.059-1.720), history of musculoskeletal pain (OR 1.553, 95% CI 1.271-1.898), presence of myalgia (OR 1.546, 95% CI 1.155-2.070) and headache (1.866, 95% CI 1.349-2.580) as COVID-19-associated onset symptoms, and days at hospital (OR 1.013, 95% CI 1.004-1.022) were risk factors associated with musculoskeletal post-COVID pain. In conclusion, musculoskeletal post-COVID pain is present in 45.1% of COVID-19 survivors at 8 months after hospital discharge with most patients developing de novo post-COVID pain. Female sex, history of musculoskeletal pain, presence of myalgia and headache as COVID-19 symptoms at the acute phase, and days at hospital were risk factors associated with musculoskeletal post-COVID pain. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this review or meta-analysis is to synthesize the prevalence of post-coronavirus disease (COVID) pain symptoms of musculoskeletal origin in hospitalized or nonhospitalized patients recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were searched up to May 1, 2021. Studies or preprints reporting data on post-COVID pain symptoms such as myalgias, arthralgias, or chest pain after SARS-CoV-2 infection and collected by personal, telephonic, or electronical interview were included. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used for meta-analytical pooled prevalence of each post-COVID musculoskeletal pain symptom. Data synthesis was categorized at onset or hospital admission and at 30, 60, and 90, and ≥180 days after. From a total of 12,123 studies identified, 27 peer-reviewed studies and 6 preprints were included. The sample included 14,639 hospitalized and 11,070 nonhospitalized COVID-19 patients. The methodological quality of almost 70% studies was fair. The overall prevalence of post-COVID myalgia, joint pain, and chest pain ranged from 5.65% to 18.15%, 4.6% to 12.1%, and 7.8% to 23.6%, respectively, at different follow-up periods during the first year postinfection. Time trend analysis showed a decrease prevalence of musculoskeletal post-COVID pain from the symptom's onset to 30 days after, an increase 60 days after, but with a second decrease ≥180 days after. This meta-analysis has shown that almost 10% of individuals infected by SARS-CoV-2 will suffer from musculoskeletal post-COVID pain symptomatology at some time during the first year after the infection. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the association between COVID-related myalgia experienced by patients at hospital admission and the presence of post-COVID symptoms. A case-control study including patients hospitalised due to COVID-19 between February 20 and May 31, 2020, was conducted. Patients reporting myalgia and patients without myalgia at hospital admission were scheduled for a telephone interview 7 months after hospital discharge. Hospitalisation and clinical data were collected from medical records. A list of post-COVID symptoms with attention to musculoskeletal pain was evaluated. Anxiety and depressive symptoms, and sleep quality were likewise assessed. From a total of 1200 hospitalised patients with COVID-19, 369 with and 369 without myalgia at hospital admission were assessed 7.2 months (SD 0.6) after hospital discharge. A greater proportion (P = 0.03) of patients with myalgia at hospital admission (20%) showed ≥3 post-COVID symptoms when compared with individuals without myalgia (13%). A higher proportion of patients presenting myalgia (odds Rratio 1.41, 95% confidence interval 1.04-1.90) exhibited musculoskeletal post-COVID pain when compared to those without myalgia. The prevalence of musculoskeletal post-COVID pain in the total sample was 38%. Fifty percent of individuals with preexisting musculoskeletal pain experienced a worsening of their symptoms after COVID-19. No differences in fatigue, dyspnoea, anxiety/depressive levels, or sleep quality were observed between myalgia and nonmyalgia groups. The presence of myalgia at hospital admission was associated with preexisting history of musculoskeletal pain (OR 1.62, 95% confidence interval 1.10-2.40). In conclusion, myalgia at the acute phase was associated with musculoskeletal pain as long-term post-COVID sequelae. In addition, half of the patients with preexisting pain conditions experienced a persistent exacerbation of their previous syndromes. [ABSTRACT FROM AUTHOR]

The article reports on the study that analyzes the differences in deficits in fine motor control and pinch grip force between patients with minimal, moderate, or severe carpal tunnel syndrome (CTS) and healthy age. The study reveals significant differences between groups. It shows that the patients exhibited lower scores in bilateral pin placement and assembly subtests, without differences among them.

The article discusses the study which aims to investigate whether cross-sectional area of the suboccipital muscles was associated with active trigger points in chronic tension-type headache (CTTH). In this study, magnetic resonance imaging of the cervical spine is performed in 11 females with CTTH. Results show that reduced cross-sectional area of the rectus capitis posterior minor (RCPmin) is associated with active trigger points (TrPs) in the suboccipital muscles in a cohort of 11 females with chronic tension-type headache. It is concluded that muscle atrophy in the RCPmin is associated with suboccipital active TrPs in CTTH.

The article offers information about a study conducted to assess the long term effects on functional and mobility outcomes of two exercise interventions for the management of ankylosing spondylitis patients. This is a long-term study with the control group using the conventional exercise regimen and the experimental group using the exercise intervention based on the treatment of the shortened muscle chains following the guideline described by the Global Posture Reeducation method. Results of the study showed that exercise regimen based on the guidelines described by the Global Posture Reeducation showed promising short-term and long-term improvements.

Abstract: This multicenter cohort study investigated the prevalence of musculoskeletal post-COVID pain during the first year after the infection with mosaic plots and an exponential bar plot model and its associated risk factors. Patients hospitalized because of COVID-19 in 5 hospitals of Madrid (Spain) were scheduled for a telephone interview at 2 follow-up periods after hospitalization for collecting data about musculoskeletal post-COVID pain. Hospitalization and clinical data were collected from hospital medical records. From 2000 patients initially recruited, 1593 (44.6% women, age: 61 ± 15 years) were assessed at T0 (hospital admission), T1 (mean: 8.0 ± 1.5 months after discharge), and T2 (mean: 13.2 ± 1.5 months after discharge). The prevalence of musculoskeletal pain (myalgia) was 30.3% (n = 483) at T0, increased to 43.4% (n = 692) at T1, and decreased to 37.8% (n = 603) at T2. The trajectory curve revealed a decreasing prevalence trend of musculoskeletal post-COVID pain the following years after hospitalization. According to the presence of pre-existing pain symptoms, the prevalence of new-onset post-COVID pain was 75.9%. Female sex (odds ratio [OR] 1.593, 95% confidence interval [CI] 1.148-2.211), history of musculoskeletal pain (OR 1.591, 95% CI 1.211-2.07), the presence of myalgia (OR 1.371, 95% CI 1.032-1.821) or headache (OR 2.278, 95% CI 1.622-3.199) at hospitalization, the days of hospitalization (OR 1.013, 95% CI 1.000-1.025), and the presence of post-COVID pain at T1 (OR 11.02, 95% CI 8.493-14.305) were factors associated with musculoskeletal post-COVID pain 1 year after hospitalization. In conclusion, musculoskeletal post-COVID pain remains highly prevalent 1 year after hospitalization. Female sex, previous history of pain symptoms, pain symptoms at onset, and days at hospital were factors associated with musculoskeletal post-COVID pain 1 year after hospitalization., (Copyright © 2022 International Association for the Study of Pain.)

Objective: To determine the presence of widespread pressure hyperalgesia in multiple sclerosis (MS) patients with and without pain and its association with pain and fatigue., Methods: A total of 108 individuals with definite MS, 49 men and 59 women (mean age, 44±8 y) and 108 age-matched and sex-matched pain-free controls (mean age, 44±9 y) were included. Fifty patients (n=58, 54%) reported pain and 50 (46%) did not. Pressure pain threshold (PPT) was bilaterally assessed over supraorbital, infraorbital, mental, median, radial and ulnar nerve trunks, C5-C6 joint, second metacarpal, and tibialis anterior muscle by an assessor blinded to the patient's condition. The intensity of pain was assessed with a numerical pain rate scale (0 to 10), fatigue was determined with the Fatigue Impact Scale, and depression was evaluated with the Beck Depression Inventory., Results: The analyses of covariance revealed that PPT were significantly decreased bilaterally over the supraorbital, infraorbital, mental, median, ulnar and radial nerve trunks, C5-C6 joint, second metacarpal, and tibialis anterior muscles in patients with MS compared with pain-free controls (all, P<0.001). No significant differences existed between MS patients with pain and those without pain (all P>0.944). Patients with pain exhibited higher fatigue and depression than those patients without pain (P<0.05). PPT was not associated with any clinical variable, that is, pain, depression, or fatigue., Conclusions: Our study found widespread pressure pain hyperalgesia in individuals with MS as compared with pain-free controls. No differences existed between MS patients with pain and those without pain in the presence of widespread pressure sensitivity. Current results suggest that MS is associated with sensory hyperexcitability of the central nervous system or dysfunction in endogenous pain modulatory systems.

Objective: To examine the relationship between knee pain, altered somatosensation, and self-reported instability in individuals with knee osteoarthrosis (OA) during a step-up-and-over task., Methods: Quantitative sensory testing, including mechanical detection threshold (MDT), allodynia, vibration perception threshold, and pressure pain threshold (PPT), was assessed in 16 individuals (mean age, 52 ± 7 y) with knee OA and in 16 age-matched and sex-matched controls. Pain intensity ratings and subjective reports of instability/buckling were recorded at rest and while performing a step-up task, and these findings were correlated with somatosensory measures., Results: In the OA group, all participants reported allodynia on MDT testing. Compared with healthy controls, MDT was significantly increased (P<0.001), and vibration perception threshold was increased (P=0.02) at the medial knee, indicating hypoesthesia. PPT was significantly decreased at the medial joint line (P=0.03) and 12 cm distal (P=0.02). Comparing participants with OA having severe versus mild radiographic changes, PPT was lower at the medial joint line (P<0.01) but not at 12 cm distal. Fourteen (87.5%) participants with knee OA reported pain and instability during the step task as compared with none or 1 (6%) of the controls. On the step task, longer duration of symptoms was associated with increased pain (P=0.02). A moderate correlation between greater self-reported instability and increased vibratory hypoesthesia at the knee (r=-0.633; P=0.01) was demonstrated, suggesting a potential relationship between somatosensory changes and functional deficits., Conclusions: Severe OA may result in both hyperalgesia and hypoesthesia at the affected knee. Perceived instability during functional tasks may be mediated in part by pain in individuals with knee OA.

Objective: This study aimed to determine differences in sleep quality between patients with mechanical neck pain, patients with whiplash (WAD) pain, and healthy controls and to determine the relationship between the intensity of ongoing pain, disability, and sleep quality., Design: Nineteen patients with mechanical neck pain (4 men, 15 women; age, 40 ± 16 yrs), 22 with WAD (4 men, 18 women; age, 38 ± 15 yrs), and 18 comparable controls (4 men, 14 women; age, 41 ± 13 yrs) completed the Pittsburgh Sleep Quality Index to assess sleep quality. A numerical pain rate scale (0-10) and the Neck Disability Index (0-50) were collected for assessing neck pain and disability., Results: Significant differences in sleep quality (P < 0.001), sleep latency (P = 0.005), sleep efficiency (P = 0.002), sleep disturbances (P < 0.001), use of sleeping medication (P < 0.001), daytime dysfunction (P < 0.001), and total Pittsburgh Sleep Quality Index score (P < 0.001) but not for sleep duration (P = 0.096) were found; patients with mechanical neck pain and WAD pain exhibited higher scores in all components compared with healthy controls. Seventeen (77%) patients with WAD and 13 (68%) with mechanical neck pain reported poor sleep quality (Pittsburgh Sleep Quality Index score, >8). Significant positive correlations between mean intensity of ongoing pain with sleep quality (r(s) = 0.693; P < 0.001); sleep duration (r(s) = 0.433; P = 0.044); sleep efficiency (r(s) = 0.644; P = 0.001) and total Pittsburgh Sleep Quality Index score (r(s) = 0.643; P = 0.001) were found in patients with WAD pain; the higher the intensity of ongoing pain, the worse the sleep quality., Conclusions: Sleep disturbances are a common finding in individuals with neck pain and are associated with the intensity of ongoing pain in WAD. It seems essential to address the ongoing cycle of pain and sleep disturbances as an integral part of the treatment of patients with neck pain.

Objective: To describe the prevalence and referred pain area of trigger points (TrPs) in blue-collar (manual) and white-collar (office) workers, and to analyze if the referred pain pattern elicited from TrPs completely reproduces the overall spontaneous pain pattern., Methods: Sixteen (62% women) blue-collar and 19 (75% women) white-collar workers were included in this study. TrPs in the temporalis, masseter, upper trapezius, sternocleidomastoid, splenius capitis, oblique capitis inferior, levator scapulae, scalene, pectoralis major, deltoid, infraspinatus, extensor carpi radialis brevis and longus, extensor digitorum communis, and supinator muscles were examined bilaterally (hyper-sensible tender spot within a palpable taut band, local twitch response with snapping palpation, and elicited referred pain pattern with palpation) by experienced assessors blinded to the participants' condition. TrPs were considered active when the local and referred pain reproduced any symptom and the patient recognized the pain as familiar. The referred pain areas were drawn on anatomic maps, digitized, and measured., Results: Blue-collar workers had a mean of 6 (SD: 3) active and 10 (SD: 5) latent TrPs, whereas white-collar workers had a mean of 6 (SD: 4) active and 11 (SD: 6) latent TrPs (P>0.548). No significant differences in the distribution of active and latent TrPs in the analyzed muscles between groups were found. Active TrPs in the upper trapezius, infraspinatus, levator scapulae, and extensor carpi radialis brevis muscles were the most prevalent in both groups. Significant differences in referred pain areas between muscles (P<0.001) were found; pectoralis major, infraspinatus, upper trapezius, and scalene muscles showed the largest referred pain areas (P<0.01), whereas the temporalis, masseter, and splenius capitis muscles showed the smallest (P<0.05). The combination of the referred pain from TrPs reproduced the overall clinical pain area in all participants., Conclusions: Blue-collar and white-collar workers exhibited a similar number of TrPs in the upper quadrant musculature. The referred pain elicited by active TrPs reproduced the overall pain pattern. The distribution of TrPs was not significantly different between groups. Clinicians should examine for the presence of muscle TrPs in blue-collar and white-collar workers.

Objective: To evaluate the effects of an 8-week multidimensional physical therapy program, including strengthening exercises and recovery massage, on neck and shoulder pain, pressure hypersensitivity, and the presence of active trigger points (TrPs) in breast cancer survivors., Methods: In this randomized controlled clinical trial, 44 breast cancer survivors were randomly assigned into 2 groups: CUIDATE group who received a multidimensional physical therapy program; or CONTROL group who received usual care treatment for breast cancer. CUIDATE program consisted of 24 hours of individual physical training (aerobic, mobility, stretching, and strengthening exercises) and 12 hours of physical therapy recovery (stretching, massage) interventions (3 times/wk, 90 min). Outcomes included neck and shoulder pain (visual analog scale, 0 to 100), pressure pain thresholds over the C5-C6 zygapophyseal joints, deltoid muscles, second metacarpal and tibialis anterior muscles, and the presence of active TrPs in shoulder muscles. Outcomes were assessed at baseline and after the 8-week program by a blinded assessor., Results: The CUIDATE group showed an estimated improvement for neck pain of -56 mm [95% confidence interval (CI), -71--40, P<0.001; effect size 2.72, 1.94 to 3.44] and for shoulder/axillary of -56 mm (95% CI, -74--38, P<0.001; effect size 2.45, 1.66 to 3.23). Improvements were also noted for pressure pain thresholds levels: C5-C6 zygapophyseal joints (between-group differences 101 kPa, 95% CI, 60-143; effect size 1.68, 1.00 to 2.35; 92 kPa 55 to 129; d: 1.98, 1.18 to 2.77), deltoid muscles (98 kPa, 45 to 149; d: 1.34, 0.62 to 2.04; 75 kPa 18 to 132; d: 1.12, 0.27 to 1.96), second metacarpal (93 kPa, 45 to 134; d: 1.30, 0.63 to 1.86; 99 kPa 59 to 139; d: 1.60, 0.96 to 2.24), and tibialis anterior muscles (71 kPa, 40 to 144; d: 1.16, 0.65 to 2.34; 118 kPa 57 to 178; d: 1.17, 0.56 to 1.77). Finally, patients within the CUIDATE program showed a greater reduction of active muscle TrPs compared with the CONTROL group (P<0.01)., Conclusions: An 8-week multidimensional program including strengthening exercises, and massage as major components was effective for improving neck and shoulder pain and reducing widespread pressure hyperalgesia in breast cancer survivors compared with usual care treatment.

Objective: To determine the differences in widespread pressure pain and thermal hypersensitivity in women with minimal, moderate, and severe carpal tunnel syndrome (CTS) and healthy controls., Methods: A total of 72 women with CTS (19 with minimal, 18 with moderate, and 35 with severe) and 19 healthy age-matched women participated. Pressure pain thresholds were bilaterally assessed over the median, ulnar, and radial nerves, the C5 to C6 zygapophyseal joint, the carpal tunnel, and the tibialis anterior muscle. In addition, warm and cold detection thresholds and heat and cold pain thresholds were bilaterally assessed over the carpal tunnel and the thenar eminence. All outcome parameters were assessed by an assessor blinded to the participant's condition., Results: No significant differences in pain parameters among patients with minimal, moderate, and severe CTS were found. The results showed that PPT were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, C5 to C6 zygapophyseal joint, and the tibialis anterior muscle in patients with minimal, moderate, or severe CTS as compared with healthy controls (all, P<0.001). In addition, patients with CTS also showed lower heat pain threshold and reduced cold pain threshold compared with controls (P<0.001). No significant sensory differences between minimal, moderate, or severe CTS were found., Conclusions: The similar widespread pressure and thermal hypersensitivity in patients with minimal, moderate, or severe CTS and pain intensity suggests that increased pain sensitivity is not related to electrodiagnostic findings.

Objectives: To determine whether the local and referred pain from active myofascial trigger points (MTrPs) reproduce the overall spontaneous fibromyalgia syndrome (FMS) pain pattern and whether widespread pressure hypersensitivity is related to the presence of widespread active MTrPs in FMS., Methods: Forty-four women with FMS (mean age: 47±8 y) and 50 comparable healthy women (age: 48±7 y) participated in the study. MTrPs in the temporalis, masseter, upper trapezius, splenius capitis, sternocleidomastoid, suboccipital, levator scapulae, scalene, pectoralis major, extensor carpi radialis brevis, extensor digitorum communis, gluteus maximus, piriformis, vastus medialis, and tibialis anterior muscles were explored. Pressure pain thresholds over 18 tender points specified in the 1990 American College of Rheumatology for FMS were also assessed by an assessor blinded to the condition of the participants., Results: The mean±SD number of MTrPs for each woman with FMS was 11±3, of which 10±2 were active MTrPs and the remaining 1±1 were latent. Healthy controls only had latent MTrPs (mean±SD: 2±1). The combination of the referred pain patterns from active MTrPs fully reproduced the overall spontaneous clinical pain area in patients with FMS. Patients with FMS had significant lower PPT compared with controls (P<0.001). Within FMS, a significant positive correlation was found between the number of active MTrPs and spontaneous pain intensity (rs=0.455; P=0.002)., Conclusions: The local and referred pain elicited from widespread active MTrPs fully reproduced the overall spontaneous clinical pain area in patients with FMS. Widespread mechanical pain hypersensitivity was related to a greater number of active MTrPs. This study suggests that nociceptive inputs from active MTrPs may contribute to central sensitization in FMS.

Study Design: Cross-sectional epidemiological study., Objective: To determine the 1-year prevalence of neck pain and low back pain in the Spanish population and their association with sociodemographic and lifestyle habits, self-reported health status and comorbidity with other chronic disorders., Summary of Background Data: No recent population-based epidemiological studies have estimated the prevalence of neck and low back pain in Spain., Methods: We analyzed data obtained from adults aged 16 years or older (n = 29,478) who participated in the 2006 Spanish National Health Survey, an ongoing, home-based personal interview which examines a nation-wide representative sample of civilian noninstitutionalized population residing in main family dwellings (household) of Spain. We analyzed prevalence data of neck and low back pain and their relationship with socio-demographic characteristics (sex, age, marital status, educational level, occupational status, or monetary income), self-perceived health status, lifestyle habits (smoking habit, alcohol consumption, sleep habit, physical exercise, or obesity), and the presence of concomitant chronic diseases or symptoms., Results: The 1-year prevalence was 19.5% (95% CI: 18.9-20.1) for neck pain and 19.9% (95% CI: 19.3-20.5) for low back pain. Both neck pain and low back pain were higher among female (26.4% and 24.5%) than male (12.3% and 15.1%). Subjects in the 31 to 50 years group were 1.5 times (95% CI: 1.3-1.8) more likely to report low back pain than participants in the 16 to 30 years group. Individuals reporting neck or low back pain showed worse self-reported health status (OR: 4.9, 95% CI: 4.5-5.3 for neck pain; OR: 4.7, 95% CI: 4.3-5.1 for low back pain) and were more likely to complain of depression (OR: 4.3, 95% CI: 3.9-4.7 or OR: 3.6, 95% CI: 3.3-3.9, respectively). Further, a strong association between neck and low back pain was found (OR: 15.6, 95% CI: 14.2-17.1). Finally, neck pain and low back pain were also associated with several other chronic conditions, particularly arthrosis (OR: 6.5, 95% CI: 6.0-7.0), and headaches (OR: 4.3, 95% CI: 3.9-4.8) for neck pain, and both arthrosis (OR: 5.7, 95% CI: 5.3-6.2), and osteoporosis (OR: 6.3, 95% CI: 5.6-7.2), for low back pain., Conclusion: This Spanish population-based survey showed that neck and low back pain are prevalent and highly associated between them, more frequent in female (particularly neck pain) and associated to worse self-reported health status. Individuals with neck and low back pain were more likely than those without pain to have depression and other painful conditions, including headache and osteoporosis.

Objective: To describe the presence of widespread pressure pain hyperalgesia and myofascial trigger points (TrPs) in neck and shoulder muscles in patients with postmastectomy pain., Methods: Twenty-nine women (mean age: 50±8 y) with postmastectomy pain and 23 matched healthy controls (mean age: 50±9 y) participated. Pressure pain thresholds (PPT) were bilaterally assessed over the C5-C6 zygapophyseal joint, the deltoid muscle, the second metacarpal, and the tibialis anterior muscle. TrPs in the upper trapezius, suboccipital, levator scapulae, sternocleidomastoid, scalene, infraspinatus, and pectoralis major muscles were explored. TrPs were considered active if the local and referred pain reproduced symptoms and the patient recognized the pain as familiar., Results: Twenty-five (86%) patients reported neck pain whereas 20 (69%) patients showed shoulder/axillary pain. The results showed that PPT levels were significantly decreased bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, second metacarpal, and tibialis anterior muscle in patients with postmastectomy pain as compared with controls (all sites, P<0.001). No significant differences in the magnitude of PPT decrease between sites were found (P=0.222). The mean number of active TrPs for each woman with postmastectomy pain was 5.4±1.8. Healthy controls only had latent TrPs (0.5±0.6). Patients with postmastectomy pain showed a greater number of TrPs than controls (P<0.001). In all muscles, there was significantly more active TrPs in patients with postmastectomy pain as compared with controls (P<0.001). Active TrPs in the pectoralis major (n=27, 93%), infraspinatus (n=23, 79%), and upper trapezius (n=19, 65%) muscles were the most prevalent in the affected side in the postmastectomy group. The number of active TrPs was positively correlated with neck (rs=0.392, P=0.036) and shoulder/axillary (rs=0.437, P=0.018) pain intensity., Conclusions: Our findings revealed bilateral widespread pressure pain hypersensitivity in patients with postmastectomy pain. In addition, the local and referred pain elicited by active TrPs reproduced neck and shoulder/axillary complaints in these patients. These results suggest peripheral and central sensitization in patients with postmastectomy pain.

Objective: To investigate the changes in surface and intramuscular electromyographic (EMG) activity at latent trigger points (TrPs) in the extensor carpi radialis brevis muscle after injection of either glutamate or isotonic saline into latent TrPs in the infraspinatus muscle., Method: Nociceptive muscle stimulation was obtained by a bolus injection of glutamate (0.2 mL, 0.5 M) into a latent TrP located in the right infraspinatus muscle in 12 healthy volunteers. A bolus of isotonic saline (0.9%, 0.2 mL) injection served as control. Injections were guided by intramuscular EMG showing resting spontaneous electrical activity at the latent myofascial TrP in the infraspinatus muscle. Intramuscular (at the TrP) and surface EMG activities of both infraspinatus and extensor carpi radialis brevis muscles were recorded before, during, and after injection for a period of 6 minutes to monitor changes produced in EMG activity., Results: Glutamate injection into latent TrPs induced higher pain intensity than isotonic saline injection (P<0.001). The analysis of variance showed a significant increase in root mean square score of intramuscular EMG activity at TrP in the extensor carpi radialis brevis after glutamate (mean+/-SD: 212.0+/-215.6 microV) but not isotonic saline (mean+/-SD: 74.2+/-72.2 microV) injections (P<0.001). No changes in surface EMG activity were found. No significant changes in root mean square of intramuscular and surface EMG activity in the infraspinatus muscle were found., Conclusions: Our results show that an increased nociceptive activity at latent TrPs in the infraspinatus muscle may increase motor activity and sensitivity of a TrP in distant muscles at a same segmental level.

Objective: The aim of this study was to investigate whether generalized deep tissue hyperalgesia exists in patients with chronic unilateral lateral epicondylalgia (LE)., Methods: A total of 26 LE patients (10 males and 16 females, aged 25 to 63 y) and 20 healthy comparable matched controls (aged 26 to 61 y) were recruited and pressure pain threshold (PPT) was assessed bilaterally over the median, ulnar, and radial nerve trunks, the lateral epicondyle, C5-C6 zygapophyseal joint, and the tibialis anterior muscle in a blind design., Results: PPT was significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the lateral epicondyle, the C5-C6 zygapophyseal joint, and tibialis anterior muscle in patients with LE than healthy controls (all P<0.001). PPTs over those measured points was negatively related to current elbow pain intensity (all P<0.05). A more significant decrease in PPTs were present in females (all P<0.05)., Conclusions: This revealed a widespread mechanical hypersensitivity in patients with LE, which suggest that central sensitization mechanisms are involved in patients with unilateral LE. The generalized decrease in PPT levels was associated with elbow pain intensity, supporting a role of peripheral sensitization mechanisms in the initiation or maintenance of central sensitization mechanisms. In addition, females may be more prone to the development of generalized mechanical hypersensitivity.

Objective: To describe the common locations of active trigger points (TrPs) in the temporalis muscle and their referred pain patterns in chronic tension type headache (CTTH), and to determine if pressure sensitivity maps of this muscle can be used to describe the spatial distribution of active TrPs., Methods: Forty women with CTTH were included. An electronic pressure algometer was used to assess pressure pain thresholds (PPT) from 9 points over each temporalis muscle: 3 points in the anterior, medial and posterior part, respectively. Both muscles were examined for the presence of active TrPs over each of the 9 points. The referred pain pattern of each active TrP was assessed., Results: Two-way analysis of variance detected significant differences in mean PPT levels between the measurement points (F=30.3; P<0.001), but not between sides (F=2.1; P=0.2). PPT scores decreased from the posterior to the anterior column (P<0.001). No differences were found in the number of active TrPs (F=0.3; P=0.9) between the dominant side the nondominant side. Significant differences were found in the distribution of the active TrPs (chi2=12.2; P<0.001): active TrPs were mostly found in the anterior column and in the middle of the muscle belly. The analysis of variance did not detect significant differences in the referred pain pattern between active TrPs (F=1.1, P=0.4). The topographical pressure pain sensitivity maps showed the distinct distribution of the TrPs indicated by locations with low PPTs., Conclusions: Multiple active TrPs in the temporalis muscle were found, particularly in the anterior column and in the middle of the muscle belly. Bilateral posterior to anterior decreased distribution of PPTs in the temporalis muscle in women with CTTH was found. The locations of active TrPs in the temporalis muscle corresponded well to the muscle areas with lower PPT, supporting the relationship between multiple active muscle TrPs and topographical pressure sensitivity maps in the temporalis muscle in women with CTTH.

Objective: The aim of this study was to develop a preliminary clinical prediction rule to identify the potential predictors for identifying patients presenting with ankylosing spondylitis who are likely to respond to a specific exercise program., Design: Consecutive patients with ankylosing spondylitis underwent a standardized examination and then received eight physical therapy sessions during a 2-mo period, which included an exercise program based on the treatment of the shortened muscle chains, following the guideline described by the global posture re-education method. Patients were classified as having experienced a successful outcome at 1 mo after discharge based on a 20% reduction on Bath Ankylosing Spondylitis Functional Index and self-report perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for identifying treatment success., Results: Data from 35 patients were included, of which 16 (46%) experienced a successful outcome. A clinical prediction rule with three variables (physical role >37, bodily pain >27, and Bath Ankylosing Spondylitis Disease Activity Index >31) was identified. The most accurate predictor of success was if the patient exhibited two of the three variables, and the positive likelihood ratio was 11.2 (95% confidence interval, 1.7-76.0) and the posttest probability of success increased to 91%. The accuracy of prediction declined if either 1/3 (+likelihood ratio = 7.7; 95% confidence interval, 0.52-113.5) or 3/3 (+likelihood ratio = 2.6, 95% confidence interval, 1.6-4.0) variables were present., Conclusions: The present preliminary clinical prediction rule provides the potential to identify patients with ankylosing spondylitis who are likely to experience short-term follow-up success with a specific exercise program. Future studies are necessary to validate the clinical prediction rule.

Objective: No study has previously analyzed pressure pain sensitivity of nerve trunks in migraine. This study aimed to examine the differences in mechanical pain sensitivity over specific nerves between patients with unilateral migraine and healthy controls., Methods: Blinded investigators assessed pressure pain thresholds (PPT) over the supra-orbital nerves (V1) and peripheral nerve trunks of both upper extremities (median, radial, and ulnar nerves) in 20 patients with strictly unilateral migraine and 20 healthy matched controls. Pain intensity after palpation over both supra-orbital nerves was also assessed. A pressure algometer was used to quantify PPT, whereas a 10-point numerical pain rate scale was used to evaluate pain to palpation over the supra-orbital nerve., Results: The analysis of covariance revealed that pain to palpation over the supra-orbital nerve was significantly higher (P<0.001) on the symptomatic side (mean: 3.4, SD: 1.5) as compared with the nonsymptomatic side (mean: 0.5, SD: 1.2) in patients with migraine and both the dominant (mean: 0.2, SD: 0.4) and nondominant (mean: 0.3, SD: 0.5) sides in healthy controls. PPT assessed over the supra-orbital nerve on the symptomatic side (mean: 1.05, SD: 0.2 kg/cm) was significantly lower (P<0.05) than PPT measurements on the nonsymptomatic side (mean: 1.35, SD: 0.3 kg/cm) and either the dominant (mean: 1.9, SD: 0.2 kg/cm) or nondominant (mean: 1.9, SD: 0.3 kg/cm) sides in controls (P<0.001). Finally, PPT assessed over the median, ulnar, and radial nerves were significantly lower in patients with migraine as compared with controls (P<0.001), without side-to-side differences (P>0.6)., Conclusions: In patients with unilateral migraine, we found increased mechano-sensitivity of the supra-orbital nerve on the symptomatic side of the head. Outside the head, the same patients showed increased mechano-sensitivity of the main peripheral nerves of both upper limbs, without asymmetries. Such diffuse hypersensitivity of the peripheral nerves lends further evidence to the presence of a state of hyperexcitability of the central nervous system in patients with unilateral migraine.

Purpose of Review: This review discusses current data on nosological boundaries related to diagnosis, pathophysiology and therapeutic strategies in chronic tension-type headache (CTTH)., Recent Findings: Diagnostic criteria of CTTH should be adapted to improve its sensitivity against migraine. It seems that mechanical pain sensitivity is a consequence and not a causative factor of CTTH. Recent evidence is modifying previous knowledge about relationships between muscle tissues and CTTH, suggesting a potential role of muscle trigger points in the genesis of pain. An updated pain model suggests that headache perception can be explained by referred pain from trigger points in the craniocervical muscles, mediated through the spinal cord and the trigeminal nucleus caudalis rather than only tenderness of the muscles themselves. Different therapeutic strategies, pharmacological, physical therapy, psychological and acupuncture, are generally used. The therapeutic efficacy of nonsteroidal anti-inflammatory drugs remains incomplete. The tricyclic antidepressants are the most used first-line therapeutic agents for CTTH. Surprisingly, few controlled studies have been performed and not all of them have found an efficacy superior to placebo. Further, there is insufficient evidence to support/refute the efficacy of physical therapy in CTTH., Summary: Although there is an increasing scientific interest in CTTH, future studies incorporating subgroups of patients who will likely to benefit from a specific treatment (clinical prediction rules) should be conducted.

Objective: The aim of the present study was to investigate the presence of active and latent muscle trigger points (TrPs) in the forearm musculature on both affected and unaffected sides in patients with lateral epicondylalgia (LE) and healthy controls., Methods: Twenty-five patients with LE and 20 healthy matched controls participated. Both groups were examined for the presence of TrPs in the extensor carpi radialis brevis, extensor carpi radialis longus, extensor digitorum communis, and brachioradialis muscles in a blinded fashion. TrPs were identified in both affected and unaffected sides within the patient group. In the control group, TrPs were explored around the dominant side. Pressure pain thresholds (PPTs) were assessed on both affected and unaffected arms., Results: In the patient group, the number of active muscle TrPs in the affected side was 3.1 [95% confidence interval (CI): 2.8-3.4], whereas in the unaffected arm, only latent TrPs were found (mean: 2.2; 95% CI: 1.8-2.6). Active TrPs were only located on the affected side (P<0.001). Within the control group, the number of latent TrPs in the dominant arm was 0.4 (95% CI: 0.0-0.7), which was significantly lower than the number of latent TrPs in the unaffected arm (P<0.001) in patients. Therefore, latent muscle TrPs in the forearm musculature were associated with the unaffected side in the patient group as compared with the dominant arm in healthy controls: extensor carpi radialis brevis [odds ratio (OR)=66 (95% CI: 9.9-48.8)], extensor carpi radialis longus [OR=16 (95% CI: 3.7-29.6)], brachioradialis [OR=2.6 (95% CI: 0.3-27.1)], and extensor digitorum communis [OR=0.5 (95% CI: 0.4-0.8)]. PPTs were lower around the affected side than around the unaffected arm in patients (mean+/-SD: 274.5+/-90.4 KPa vs. 465.4+/-140.7 KPa; P<0.001) in the patient group. Finally, PPT from the extensor digitorum muscle in those patients with active TrPs (mean+/-SD: 244+/-70.4 KPa) was significantly lower (P<0.001) than PPT levels of patients with no TrP in the same muscle (mean+/-SD: 370+/-83.4 KPa)., Conclusions: Latent TrPs are present in forearm muscles on the unaffected side in patients with LE where active TrPs contribute to the pain on the affected arm. The presence of latent TrPs on the unaffected side in unilateral LE may be related to central sensitization and be a mechanism explaining bilateral pain in some patients with unilateral pathologies.

Objective: To assess the local and referred pain areas and pain characteristics evoked from temporalis muscle trigger points (TrPs) in chronic tension-type headache (CTTH)., Methods: Thirty CTTH patients and 30 age and sex-matched controls were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and record the pain history. Both temporalis muscles were examined for the presence of myofascial TrPs in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold were recorded., Results: Referred pain was evoked in 87% and 54% on the dominant and nondominant sides in CTTH patients, which was significantly higher (P<0.001) than in controls (10% vs. 17%, respectively). Referred pain spread to the temple ipsilateral to the stimulated muscle in both patients and controls, with additional referral behind the eyes in most patients, but none in controls. CTTH patients reported a higher local [visual analog scale (VAS): 5.6+/-1.2 right side, 5.3+/-1.4 left side] and referred pain (VAS: 4.7+/-2 right side, 3.5+/-2.8 left side) intensity than healthy controls (VAS: 0.8+/-0.7 right side, 0.7+/-0.7 left side for local pain; and 0.3+/-0.2 right side, 0.4+/-0.3 left side for referred pain) in both temporalis muscles (both, P<0.001). The local and referred pain areas were larger in patients than in controls (P<0.001). Twenty-three out of 30 CTTH patients (77%) had active TrPs in the temporalis muscle leading to their usual headache (17 patients on the right side; 12 on the left side, whereas 6 with bilateral active TrPs). CTTH patients with active TrPs in either right or left temporalis muscle showed longer headache duration than those with latent TrPs (P=0.004). CTTH patients showed significantly (P<0.001) lower pressure pain threshold (1.1+/-0.2 right side, 1.2+/-0.3 left side) as compared with controls (2.5+/-0.5 right side, 2.6+/-0.4 left side)., Conclusions: In CTTH patients, the evoked local and referred pain from active TrPs in the temporalis muscle and its sensory characteristics shared similar patterns as their habitual headache pain. Local and referred pain from active TrPs in the temporalis muscles may constitute one of the sources contributing to the pain profile of CTTH.

Objective: The aim was to investigate whether increased pericranial tenderness or decreased pressure pain threshold (PPT) was related to headache intensity, duration, and frequency in chronic tension-type headache (CTTH)., Methods: Twenty-five CTTH patients and 25 matched controls were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and record the pain history. Three tenderness (total, cephalic, and neck) scores and PPT at both cephalic and neck points were objectively and blinded assessed. Bodily pain perceived by the patients was assessed with the Short Form-36 questionnaire., Results: CTTH patients showed decreased PPT and increased tenderness as compared with controls (P<0.001). Negative correlations were found between PPT on each point and their respective tenderness scores. Within the CTTH group, neither increased tenderness nor decreased PPT seemed to directly influence headache intensity, frequency or duration; or vice versa., Discussion: Increased tenderness may predispose the patients to other perpetuating factors in inducing headache attacks. Further research is needed to clearly define the role of pericranial tender tissues or other factors in the genesis and maintenance of CTTH.