Chronic cervical myofascial pain syndrome: Improvement in dizziness and pain with a multidisciplinary rehabilitation program. A pilot study.

PURPOSE: The purpose of this retrospective, pilot study was to assess changes in dizziness, pain and function in subjects undergoing an outpatient rehabilitation program focusing on cervical pain. METHODS: Fifteen subjects with chronic cervical myofascial pain and concurrent dizziness of suspected cervical origin completed a retrospective questionnaire. Improvement in pain, dizziness and function were recorded on a visual analog scale (VAS) in response to a non-standardized rehabilitation program involving modalities, stretching, strengthening, trigger point injections and aerobic conditioning. RESULTS: Subjects reported an average VAS improvement in dizziness of 59% (±29%), pain 69% (±21%) and function 71%(±19). Seven subjects experienced reproduction of their dizziness and pain during trigger point injections. Overall, twenty seven percent reported no further episodes of dizziness. All subjects experienced a decrease in the frequency of episodes of dizziness. There was a correlation between dizziness and pain (r = 0.58), dizziness and function (r = 0.60), and pain and function (r = 0.74). CONCLUSION: Subjects with dizziness and cervical myofascial pain of suspected cervical origin may experience symptomatic and functional improvement through a rehabilitative program addressing their cervical pain. Future prospective, randomized controlled studies are needed to address which intervention is the most effective.

The incidence of pain in the muscles of mastication in patients with fibromyalgia.

This study recognizes the high incidence of temporomandibular symptoms in a group of patients with documented fibromyalgia. Findings indicate that the diagnosis and treatment of temporomandibular disorders and fibromyalgia have many similarities.

Trigger points and tender points: one and the same? Does injection treatment help?

Trigger points are defined as areas of muscle that are painful to palpation and are characterized by the presence of taut bands and the generation of a referral pattern of pain. Tender points are areas of tenderness occurring in muscle, muscle-tendon junction, bursa, or fat pad. When tender points occur in a widespread manner, they are usually considered characteristic of fibromyalgia. Trigger points, which typically occur in a more restricted regional pattern, are indicative of myofascial pain syndrome. In some patients the two phenomena may coexists, and overlap syndromes can occur. Although experienced examiners can generally identify the same tender points, interrater reliability of trigger points has been low in most studies. There is continued controversy regarding the defining characteristics and homogeneity of myofascial pain because of the variability of the examination findings. In appropriately selected patients, it appears that myofascial trigger point injections can be helpful in decreasing pain and improving range of motion in conjunction with a comprehensive exercise and rehabilitation program.

Botulinum toxin for the treatment of spasticity in multiple sclerosis. New observations.

Potential advantages of intramuscular botulinum toxin for the treatment of spasticity include the lack of sensory effects, ability to target specific muscle groups, ability to weaken muscles in a graded fashion and absence of caustic chemicals such as phenol. We describe the use of botulinum toxin for the treatment of severe lower extremity spasticity in two subjects with multiple sclerosis. Both subjects showed an improvement in spasticity, as measured by the modified Ashworth scale, and in functional status. Both subjects exhibited reductions in muscle tone not only in injected muscles, but also in noninjected muscles in the region. These more distant clinical effects have not been emphasized in previous studies after therapeutic injections of botulinum toxin. Further research is needed to clarify the cause and prevalence of these regional motor effects, as well as to further examine the safety and efficacy of botulinum toxin for spasticity treatment.

Health status and quality of life following cardiac transplantation.

There is little information regarding the functional status and quality of life of cardiac transplant patients. This investigation is the largest study describing outcome up to 10 years after cardiac transplantation. We conducted a cross-sectional survey of 200 cardiac transplant recipients using the Sickness Impact Profile and a supplementary questionnaire. The response rate was 48%. The median duration post-cardiac transplantation was 2.3 years (range, 0.5 to 9.7 years). The median age was 53 years (range, 27.1 to 68.7). In comparison to previously published studies, our sample of cardiac transplant recipients had worse quality of life than normals, similar scores to cardiac arrest survivors and post-myocardial infarction patients, and better quality of life than patients with low back pain. We found that those not working (44%) reported a lower quality of life. Musculoskeletal-neurologic complaints were highly prevalent, with generalized weakness in 54% responding, fatigue in 42%, and low back pain in 37%. Lower quality of life was found in patients reporting a higher number of musculoskeletal-neurological disorders. We conclude that there are specific areas for rehabilitation intervention in patients post-cardiac transplantation, and suggest areas for future research directed towards enhancing quality of life for cardiac transplant recipients.