Reduction of blood nitric oxide levels is associated with clinical improvement of the chronic pelvic pain related to endometriosis

The objective of this prospective study was to determine the plasma levels of nitric oxide (NO) in women with chronic pelvic pain secondary to endometriosis (n=24) and abdominal myofascial pain syndrome (n=16). NO levels were measured in plasma collected before and 1 month after treatment. Pretreatment NO levels (μM) were lower in healthy volunteers (47.0±12.7) than in women with myofascial pain (64.2±5.0, P=0.01) or endometriosis (99.5±12.9, P<0.0001). After treatment, plasma NO levels were reduced only in the endometriosis group (99.5±12.9 vs 61.6±5.9, P=0.002). A correlation between reduction of pain intensity and reduction of NO level was observed in the endometriosis group [correlation = 0.67 (95%CI = 0.35 to 0.85), P<0.0001]. Reduction of NO levels was associated with an increase of pain threshold in this group [correlation = -0.53 (-0.78 to -0.14), P<0.0001]. NO levels appeared elevated in women with chronic pelvic pain diagnosed as secondary to endometriosis, and were directly associated with reduction in pain intensity and increase in pain threshold after treatment. Further studies are needed to investigate the role of NO in the pathophysiology of pain in women with endometriosis and its eventual association with central sensitization.

Eficácia da desativação dos pontos-gatilho miofasciais para o controle do zumbido / Efficacy of myofascial trigger point deactivation for tinnitus control

Dor crônica nas imediações do ouvido pode influenciar o zumbido. OBJETIVO: Investigar a eficácia da desativação de pontos-gatilho miofasciais na melhora do zumbido. MÉTODO: Ensaio clínico randomizado com 71 pacientes com zumbido e síndrome dolorosa miofascial. O Grupo Experimental (n = 37) foi submetido a 10 sessões de desativação dos pontos-gatilho miofasciais e o Grupo Controle (n = 34), a 10 sessões de desativação placebo. RESULTADOS: O tratamento do Grupo Experimental foi eficaz para o controle do zumbido (p < 0,001). Houve associação entre as melhoras de dor e zumbido (p = 0,013) e entre os lados da orelha com pior zumbido e do corpo com mais dor (p < 0,001). A presença de modulação (aumento ou diminuição) temporária do zumbido durante a palpação inicial dos pontos foi frequente em ambos os grupos, mas a diminuição temporária foi associada à melhora persistente do zumbido ao fim do tratamento (p = 0,002). CONCLUSÃO: Além da avaliação médica e audiológica, os pacientes com zumbido devem ser avaliados para: 1) presença de dor miofascial próxima à orelha; 2) lateralidade entre ambos os sintomas; 3) diminuição temporária do zumbido durante a palpação do músculo dolorido. O tratamento deste subgrupo de pacientes pode ter melhor prognóstico que os demais.

Chronic pain in areas surrounding the ear may influence tinnitus. OBJECTIVE: To investigate the efficacy of myofascial trigger point deactivation for the relief of tinnitus. METHOD: A double-blind randomized clinical trial enrolled 71 patients with tinnitus and myofascial pain syndrome. The experimental group (n = 37) underwent 10 sessions of myofascial trigger point deactivation and the control group (n = 34), 10 sessions with sham deactivation. RESULTS: Treatment of the experimental group was effective for tinnitus relief (p < 0.001). Pain and tinnitus relieves were associated (p = 0.013), so were the ear with worst tinnitus and the side of the body with more pain (p < 0.001). The presence of temporary tinnitus modulation (increase or decrease) upon initial muscle palpation was frequent in both groups, but its temporary decrease was related to the persistent relief at the end of treatment (p = 0.002). CONCLUSION: Besides medical and audiological investigation, patients with tinnitus should also be checked for: 1) presence of myofascial pain surrounding the ear; 2) laterality between both symptoms; 3) initial decrease of tinnitus during muscle palpation. Treating this specific subgroup of tinnitus patients with myofascial trigger point release may provide better results than others described so far.

Intervencionismo musculoesquelético en cuidados paliativos / Musculoskeletal interventionism on palliatives cares

El presente estudio descriptivo da cuenta de resultados en aplicación de intervencionismo para alivio del dolor musculoesquelético en enfermos con diagnóstico de cáncer terminal, pero que se mantienen activos, e ingresados a Unidad de Alivio del Dolor y Cuidados Paliativos del Hospital del Salvador en Santiago de Chile, entre los meses de julio del 2010 a marzo del 2011. Los principales diagnósticos causantes de dolor musculoesquelético fueron síndrome miofascial, artrosis y ambos diagnósticos combinados. Las técnicas usadas fueron infiltración de punto gatillo, infiltración intra-articular, o ambas. Los resultados mostraron disminución estadísticamente significativa en la intensidad del dolor en forma global en escala numérica, así como al analizar según tipo de intervención por separado. La media de duración del efecto fue de un mes en el caso de infiltración de puntos gatillo. Este tiempo podría constituir una ventana analgésica en pacientes con sobrevida limitada y controlaría el alza de analgésicos. Cuando el DME está presente, el uso de terapia intervencionista para DME podría ser una herramienta útil en Cuidados Paliativos, pero se requieren mayores estudios con mejor diseño estadístico para poder obtener conclusiones con mayor nivel de seguridad.

This descriptive study gives an account of results of interventionism implementation to the relief of musculoskeletal pain in patients that were diagnosed with terminal cancer; but have retained activity level, which are given they state of health at the Unit Pain Relief And Palliative Care at Hospital del Salvador in Santiago, Chile between the months of July 2010 to March 2011. The main causes of musculoskeletal pain diagnoses were Myofascial pain syndrome, arthritis and both combined conditions. The techniques used were trigger point infiltration, intra-articular joint infiltration or both together. The results showed statistical significant decrease in pain intensity on a numerical scale global, as well as the analysis by the type of separately intervention. The mean duration of effect was about a month in the case of infiltration of trigger points, this time window could be a survival analgesic in patients with limited and control the rise of analgesics. When the DME is present, the use of interventional therapy for DMA could be useful tool in palliative care, but require larger studies with better statistical design in order to draw conclusions with greater security.

The relationship between myofascial trigger points of gastrocnemius muscle and nocturnal calf cramps.

To support that myofascial pain syndrome (MPS) of gastrocnemius muscle is one cause of nocturnal calf cramps, quantitative assessment of the efficacy of trigger point (TrP) injection compared with oral quinine in the treatment of nocturnal calf cramps (NCC) associated with MPS of gastrocnemius muscle was designed. Twenty four subjects with NCC and gastrocnemius TrPs were randomly divided into two groups of twelve for each treatment. Patients in group 1 were treated with xylocaine injection at the gastrocnemius TrP, and 300 mg of quinine sulfate p.o. was prescribed for patients of group 2. The treatment period was four weeks with a follow-up 4 weeks later. Cramps were assessed quantitatively (in terms of frequency, duration, pain intensity, cramp index, and pain threshold of the gastrocnemius TrPs) before treatment, after treatment and at the end of the follow-up respectively. The outcome of treatment in both groups showed a statistically significant reduction in all quantitative aspects of cramps (95% confidence interval). Also the pain threshold of the gastrocnemius TrP was significantly increased in group 1 only when comparing the pre-treatment and at the end of follow-up. In comparing the two groups we found no statistical difference during the period of treatment. The benefit of both strategies lasted up to four weeks following cessation of the treatment but the outcome of all measures (except pain threshold) were found to be significantly better in the group treated with TrP injection. The results of this study support that gastrocnemius trigger point is one cause of NCC and show that the TrP injection strategy for NCC associated with myofascial pain is not only as effective as oral quinine during the treatment period but also better in the prolonged effect at follow-up.

Prevalência da sensibilidade dolorosa muscular e na ATM em pacientes portadores de prótese parcial removível (PPR): uma avaliaçäo clínica baseada no sistema de classificaçäo de Kennedy / Prevalence of muscle tenderness and temporomandibular joint (TMJ) pain in RPD patients: a clinical evaluation based on Kennedy's classification system o

Sessenta pacientes, homens e mulheres, com idade variando de 25 a 60 anos, todos portadores de Prótese Parcial Removível (PPR), foram avaliados clinicamente, com a finalidade de analisar comparativamente a prevalência de alguns sinais e sintomas de sensibilidade dolorosa miofascial e na articulaçäo temporomandibular (ATM), entre diferentes tipos de arcos parcialmente edentados, com base na sistematizaçäo apresentada por Kennedy. Com essa finalidade, os pacientes, todos sintomáticos, foram divididos em quatro grupos de 15, correspondendo cada um a uma das quatro classes propostas por Kennedy. Procedeu-se à anamnese, ao exame clínico, particularmente dirigido à palpaçäo muscular e da regiäo da ATM, e à análise cuidadosa do trabalho protético. Estabeleceu-se uma metodologia de testes de escores, com a finalidade de mensurar as respostas dos pacientes. Após as comparaçöes estatísticas, concluiu-se que houve variaçöes significativas entre as diferentes classes estudadas, mostrando uma prevalência na severidade dos sinais e sintomas avaliados para os pacientes portadores de Próteses Parciais Removíveis em arcos parcialmente edentados unilaterais (Classe II de Kennedy). Os resultados sugeriram a existência de uma maior dificuldade no planejamento e preparo de boca para a colocaçäo de PPRs em arcos Classe II de Kennedy, aspectos esses que poderiam atuar como fatores responsáveis pelo mecanismo deflagrador (Trigger) das dores miofasciais e da ATM para esses tipos de arco

Bruxismo e apertamento dental: uma conduta clínica racional / Bruxism and dental clenching a rational clinical procedure

Os autores apresentam um revisäo crítica dos conceitos e condutas clínicas envolvidas na avaliaçäo e tratamento do bruxismo e apertamento dental, e seu papel na etiologia das desordens temporomandibulares