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Pelvic muscle pain syndromes are poorly understood and lack reliable diagnostic criteria. Furthermore, animal models suggest that somatic pain can influence the development of pelvic visceral pain dysfunction. To develop psychophysical measures to facilitate diagnosis of pelvic floor myofascial pain syndromes, this pilot was designed to preliminarily test the feasibility, reliability, and validity of pressure-pain thresholds (PPTs) to identify and quantify pelvic floor pain sensitivity.We conducted a cross-sectional study of pelvic floor PPTs using 19 healthy women. Using a prototype vaginal pressure algometer, we measured PPTs and calculated intraclass correlations for short-term and intermediate-term reliability. Validity was assessed by correlating numerical rating scores for pain (0 to 100) at standard pressure levels applied to the right iliococcygeus muscle.The mean PPT of all pelvic floor sites was 1.52 kg/cm (SD=0.62), whereas thresholds of nonmuscle vaginal sites (anterior and posterior wall) were 1.65 kg/cm (SD=0.64). Pain numerical rating scores were positively correlated with stimulus intensity at the right iliococcygeus (Pearson r=0.61). Intraclass correlation demonstrated good short-term reliability at this same site for the first versus second, and second versus third measurements (0.75, 0.64); 1-week repeat reliability was also good for the right pubococcygeus, iliococcygeus, and obturator (0.69, 0.84, and 0.61, respectively), and both nonmuscle vaginal sites.These data suggest that PPTs may prove to be valid and reliable measures of pelvic floor somatic pain sensitivity in healthy women. Broader studies including a pelvic pain cohort should be conducted to corroborate these results and determine the technique's external validity and clinical relevance.

Objective The aim of this study was to describe the characteristics of patients referred with complex regional pain syndrome (CRPS) diagnosis to a tertiary care pain center. Method Descriptive chart review study of all patients referred by family physicians or community specialists as having CRPS (2006–2010). Data extraction included demographics, pain ratings, and diagnosis utilizing the Budapest CRPS criteria. Results The study population consisted of 54 subjects (male [M] = 7, female [F] = 47). Only 27.7% were classified as CRPS by the clinical expert. Four additional subjects carrying other diagnoses but found to have CRPS were added to the analysis. The non-CRPS group consisted of 39 subjects (M = 8, F = 31) and the CRPS group of 19 (M = 2, F = 17). CRPS patients were statistically significantly more likely to 1) have suffered a fracture; 2) report symptoms in each of the four symptom categories, as well as signs in three or four categories collectively; and 3) have allodynia/hyperalgesia alone or in combination (85/90%) as compared with the non-CRPS group (23/25%, respectively). The non-CRPS group was much more likely to report no symptoms or signs at all in the different symptom and sign categories. Of the 39 non-CRPS patients, 74% had other diagnosable entities (1/3 suffering from specific neuropathic pain conditions, e.g., radiculopathy, diabetic neuropathy, etc. and 2/3 from discreet musculoskeletal entities), while 18% were diagnosed with psychogenic pain disorders including conversion reaction associated with immobility or paralysis. Discussion Besides fulfilling the Budapest CRPS diagnostic criteria, the most important other factor for diagnosing CRPS is the exclusion of a neuropathic, musculoskeletal, or non-biomedical condition accounting for the presentation.

The goal of this study was to assess clinical consensus regarding whether myofascial pain syndrome (MPS) is a legitimate and distinct diagnosis as well as the signs and symptoms characterizing MPS.A standardized mailed survey with return postage provided.A total of 1,663 American Pain Society members in medically related disciplines listed in the 1996/1997 directory.A standardized survey assessing clinical opinion regarding whether MPS is a legitimate diagnosis, whether MPS is a clinical entity distinct from fibromyalgia, and the signs and symptoms believed to be "essential to," "associated with," or "irrelevant to" to the diagnosis of MPS.Of the 403 surveys returned, 88.5% respondents reported that MPS was a legitimate diagnosis, with 81% describing MPS as distinct from fibromyalgia. The only signs and symptoms described as essential to the diagnosis of MPS by greater than 50% of the sample were regional location, presence of trigger points, and a normal neurologic examination. Regarding the signs and symptoms considered to be essential or associated with MPS, more than 80% of respondents agreed on regional location, trigger points, normal neurologic examination, reduced pain with local anesthetic or "spray and stretch," taut bands, tender points, palpable nodules, muscle ropiness, decreased range of motion, pain exacerbated by stress, and regional pain described as "dull," "achy," or "deep." Sensory or reflex abnormalities, scar tissue, and most test results were considered to be irrelevant to the diagnosis of MPS by a large proportion of the respondents.There was general agreement across specialties that MPS is a legitimate diagnosis distinct from fibromyalgia. There was a high level of agreement regarding the signs and symptoms essential or associated with a diagnosis of MPS. Differences across specialties are discussed. This survey provides a first step toward the development of consensus-based diagnostic criteria for MPS, which can then be validated empirically.

In a prospective, double-blind, randomized study, ketorolac 60 mg, meperidine 50 mg plus promethazine 25 mg, and normal saline given by intramuscular injection were compared as treatment for acute headache crises. Thirty patients (6 men and 24 women) presenting to an urban emergency department with any type of benign headache were randomized into three groups and filled out the McGill Short-Form Pain Questionnaire with a Pain Rating Index and a Visual Analogue Pain scale. They received one of the study medications and repeated the testing after 1 hour. The objective was to test the efficacy of ketorolac in this population. Separate analyses of the McGill Short-Form (Total, Sensory, Affective, and Pain Rating Index scales) and the Visual Analogue Pain scale responses showed that the three treatments produced a significant reduction in pain (P < .0001), but that pain reduction did not differ among the treatments. This profound reduction observed after administration of a placebo prevented accurate evaluation of the effects of ketorolac. The placebo response must be considered in the design of future trials using intramuscular medications in the acute intervention of headache crises. In addition, the use of a standard analgesic is necessary to demonstrate both assay sensitivity and magnitude of response to placebo.

Objective: To test the hypothesis that there is relative sympathetic hyperactivity in the affected limb in patients with sympathetically maintained pain syndromes by measuring serum norepinephrine and epinephrine in the affected versus the unaffected sides. Design: Venous pool samples were drawn just proximal to the affected area and from an identical site on the unaffected side. Serum norepinephrine and epinephrine were measured by high-pressure liquid chromatography with electrochemical detection. Subjects: Sixteen women and seven men with a mean age of 44.4 years diagnosed as having sympathetically maintained pain on the basis of a positive response to paravertebral block and a criteria-based diagnostic scheme. Results: The serum norepinephrine level was significantly lower in the affected limbs than the unaffected limbs (p = 0.024). The serum epinephrine level was not significantly different. Conclusions: These results are not consistent with the hypothesis of segmental sympathetic hyperactivity in the affected limb in sympathetically maintained pain and support a hypothesis of peripheral receptor upregulation with pathologic response to circulating catecholamines. Other possible explanations are discussed.

The clinical approach to complex regional pain syndrome (CRPS) is complicated by a lack of precision diagnostically, and a lack of evidence-based information for treatment. The vagaries of diagnosis were somewhat improved by the Orlando Conference (1993), where a consensus panel of experts developed a new taxonomy and criteria. Unfortunately the criteria can be based entirely on subjective grounds (patient history), and as such provides a very sensitive but not very specific device. There is some effort in the research community to amend these criteria to make them more specific. We encourage the practicing physician to include as much objective data along with the quasi-objective and subjective information currently used in formulating the diagnosis. This imprecision in diagnostic issues has significantly hampered treatment because it has not led to solid, generalizable, randomized controlled trials. To date there are no substantial scientific trials of any particular therapy or medication in the specific diagnosis of CRPS. Much can be inferred from the work with peripheral neuropathy and central pain. However, it is unlikely that this will be a perfect concordance with best therapy for CRPS. It remains our responsibility to diagnose each patient as best we can, supported by the best possible objective signs and testing. Once the diagnosis is made it is necessary to proceed in a pragmatic empirical way, following the best guidelines available. The guidelines should be considered a "rough sketch" and the key to clinical success will be flexibility, a vast fund of the available knowledge, patience, and compassion. To allow the deficiencies in the science to paralyze the clinical process is therapeutic nihilism, and not acceptable.

In this prospective study, we report that the distal residual limbs (DRL) of amputee subjects are hyperesthetic/allodynic for pressure pain thresholds (large fibers) and hypoesthetic for cold perception threshold (small fibers) in comparison with the contralateral unaffected extremities. We prospectively assessed twenty-two subjects (18 with pain, 4 without) with a unilateral upper or lower limb amputation. We utilized the Fischer algometer to compare pressure pain thresholds (PPT) and the Medoc peltier type device to compare thermal perception thresholds. The Wilcoxon Signed Rank Test was used to analyze the affected limb versus the unaffected limb of these psychophysical tests. Our results revealed decreased perceptual threshold values for pressure pain threshold(p

This study was conducted to examine the psychometric properties and differential item functioning of the English version of the Short-Form McGill Pain Questionnaire (SF-MPQ) with data derived from 134 Hispanic and 134 non-Hispanic Caucasian pain patients. Reliability estimates (i.e., internal consistency and factor structure) and criterion validity of the SF-MPQ were evaluated. Differential item functioning analyses revealed statistically significant group differences in item reporting on this measure. One item, throbbing, demonstrated significant differences in terms of item endorsement relative to pain intensity. Interestingly, this same item demonstrated significant differences in item endorsement unrelated to pain intensity. Four additional items, including gnawing, aching, tiring-exhausting, and sickening, revealed significant differences in item endorsements unrelated to pain intensity. This author suggests that these observed group differences are due to culturallinguistic factors unrelated to overall pain intensity, identifying ethnicity as a moderating variable for five items on the SF-MPQ. The remaining 10 items revealed no significant differences, and appear to be used equivalently across these two ethnic groups. Group differences were not accounted for by gender, age, marital status, education, or pain location. The current study demonstrates one method in evaluating the cross-cultural validity of pain assessment instruments, and contributes to the understanding of cultural-linguistic variants in item reporting on the SF-MPQ. Additional data from a pilot study examining the cross-linguistic validity of a Spanish version of the SF-MPQ will be presented; the pilot research was funded by the Midwest Pain Society and the Illinois Institute of Technology.