A comparison of treatment modes in the management of myofascial pain dysfunction syndrome

This research compares different treatment regimes for the management of chronic facial pain associated with the masticatory musculature. Twenty-one females meeting specific criteria were randomly assigned to one of three treatment conditions: a dental splint and physiotherapy program; a relaxation program utilizing progressive muscle relaxation, biofeedback, and stress management techniques; or a minimal treatment program involving transcutaneous electrical nerve stimulation. Improvement was assessed through a dental examination, self-monitoring of pain, and an assessment of EMG activity during resting and task conditions. Significant changes were obtained in response to all treatment programs. The treatment programs differed only in the relative pattern of treatment effects obtained from the self-report monitoring of pain. The data are consistent with the concept of MPD as a psychological response to stress which maintains chronic pain through increased muscle tension in the jaw.     

Predictors of success in hypertensives treated with biofeedback-assisted relaxation

This paper describes differences in response in seventeen patients with essential hypertension who participated in a treatment program consisting of electromyograph biofeedback assisted relaxation training. Responders were found to have higher treatment values of urinary and plasma cortisol, Trait Anxiety and forehead muscle tension compared to treatment failures. Responders also sustained greater decreases in plasma, and urinary cortisol after treatment. These data are discussed in light of the ability to predict which hypertensive patients may be most benefitted by a relaxation based treatment.We would like to thank Dr. Charles Spielberger for his permission to use the State-Trait Anxiety Inventory. We thank Michael Robinson for assistance with statistical analysis.     

Discrimination of muscle tension in chronic pain patients and healthy controls

The purpose of this study was to assess the perception of muscle tension in chronic pain patients and healthy controls. Twenty chronic back pain patients, 20 patients who suffered from temporomandibular pain and dysfunction, and 20 healthy controls were instructed to produce eight different levels of muscle contraction in either the m. masseter or the m. erector spinae. Each level was produced three times; trials were presented in random order. Analyses of the accuracy and the sensitivity of discrimination of muscle tension levels revealed that the patients were less able to perceive muscle contraction levels correctly and that they underestimated their actual levels of muscle tension. Patients and controls did not differ in the extent to which they contracted muscles not involved in the task. Patients suffering from musculoskeletal disorders seem to display a genuine deficit in discrimination of muscle tension that is related to neither local physiological changes at the site of pain, lack of motivation, inattention, nor fatigue.This research was supported by a grant from the Deutsche Forschungsgemeinschaft (FI 156/1 and FI 156/2) to the first author and a grant from the German Department of Science and Technology (FKZ 0701503) to the third author. The authors are solely responsible for the contents of this publication. The authors would like to thank Barbara Streit, Dr. Karl Schweizer, and Dr. Sybille Rockstroh for assistance in data collection.     

At Odds over Inbreeding: An Abandoned Attempt at Mexico/United States Collaboration to “Improve” Mexican Corn, 1940–1950

During the first years of organized agricultural research in Mexico in the 1940s, two agencies ran separate programs for corn improvement. The Rockefeller Foundation’s Office of Special Studies and the Mexican government’s Office of Experiment Stations (later called the Agricultural Research Institute) carried out research on corn with distinct aims and methods. That they differed strongly is well established in the literature. Many authors have discussed a Rockefeller Foundation program that reportedly emphasized hybrid corn, a technical choice that embodied a preference for assisting wealthy farmers who could afford hybrid corn and the necessary agricultural inputs. Conversely, these authors attribute to the Mexican program a focus on open-pollinated corn, which presumably manifested its concern for Mexico’s small farmers who saved seed. This article argues that the reverse was true. The Rockefeller Foundation program initially was committed to a type of improved open-pollinated corn while the Mexican program proceeded with a strict, U.S.-style hybrid program. I try to illuminate each group’s priority on yield, as well as additional significant, and complicating, breeding priorities that precluded any collaboration between the two. This article was written while the author was a postdoctoral fellow in the History of Science and Medicine Program at Yale University. She would like to thank John Beatty and Sally Gregory Kohlstedt for their support on this project, and Daniel Kevles, Kevin Francis, the Writing History group at Yale, and four anonymous reviewers for insightful and helpful comments on earlier drafts of this article.     

Expectancy effects on relaxation instructions: Physiological and self-report indices

Two sessions of relaxation instructions were administered under high and low expectancy conditions. Fifty-four college students scoring high on a self-report measure of anxiety served as subjects. Live and taped abbreviated progressive muscle relaxation instructions and a self-relaxation condition were equally effective in reducing within-session self-report and physiological indices of anxiety. High expectancy instructions led to greater reductions in heart rate than did low expectancy instructions. Factors controlling anxiety reduction during relaxation therapies are discussed.This experiment was submitted by the first author in partial fulfillment for a master of science degree at VPI and SU. The authors would like to thank Jean Sales and Dan Fones for their help in this investigation. The First author is now at Johns Hopkins Hospital, Baltimore. The second author is currently at the Department of Neurology, University of Wisconsin-Madison.     

Biofeedback-assisted relaxation training for the aging chronic pain patient.

The older segments of the U.S. population are expanding rapidly and account for a disproportionate amount of health care, including treatment for pain-related musculoskeletal disorders. In a prospective study with objective measures and one-year follow-up, Middaugh et al. (1988) found that older patients (55-78 yr; N = 17, 76% success) treated in a multidisciplinary chronic pain rehabilitation program enjoyed a success rate equal to that of younger patients (29-48 yr, N = 20, 70% success). The current study presents additional data on these two groups of patients to compare their ability to learn the physiological self-regulation skills taught in the biofeedback/relaxation component of the multimodal program. This component included progressive muscle relaxation training, diaphragmatic breathing instruction, and EMG biofeedback. Repeated measures ANOVA showed significant increases in digital skin temperature (peripheral vasodilation) and decreases in respiration rate both within and across training sessions (p values = .04 to .0001) with no differences between age groups (p greater than .05). EMG measures for the upper trapezius ms in patients with cervical pain showed similar deficits in muscle control at evaluation and similar improvements with biofeedback training for the two age groups. These findings indicate that older pain patients responded well to the biofeedback/relaxation training component of the multimodal pain program.     

Good news—Bad press: Applied psychophysiology in cardiovascular disorders

Dysregulation in blood pressure control can occur as a result of psychological stress in either the hypertensive or hypotensive direction. Applied psychophysiological techniques incorporating biofeedback and relaxation have been shown to be efficacious in controlled studies of hypertensive patients. Electromyograph, thermal, skin conductance and direct blood pressure feedback have been utilized alone or in combination with relaxation, blood pressure monitoring, and medication. Prediction models are proposed to define what type of hypertensive is most likely to respond with significant blood pressure decrease. Neurocardiogenic syncope is a cardiovascular disorder which manifests itself as lightheadedness, dizziness, syncope, and often migraine-type headache. Preliminary indications suggest that biofeedback-assisted relaxation may also prove beneficial to patients with this syndrome.This paper was presented as a presidential address at the 27th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Albuquerque, NM, March, 1996. I wish to thank my present and past collaborators who contributed their thoughts and enthusiams to my program of research in applied psychophysiology of cardiovascular disorders. They are G. Argueta Bernal, Ph.D., Ilona Jurek, M.D., M. Woerner, M.Ed. R. Ph., J.T. Higgins, Jr., M.D., T. Fine, M.A. LPCC, S.W. Utz, RN, Ph.D., Gerard Roberts, M.D., Blair Grubb, M.D., Michael Weaver, RN, Ph.D.     

Comparison of Habit Reversal and a Behaviorally-Modified Dental Treatment for Temporomandibular Disorders: A Pilot Investigation

This study tested the hypothesis that a habit reversal program emphasizing awareness and reduction of masticatory muscle activity would significantly reduce pain in patients diagnosed with chronic temporomandibular disorder (TMD) and would be a competitive alternative to a behaviorally-modified dental intervention. Eight individuals diagnosed with TMD were randomly assigned to a splint therapy or habit reversal group. Patients in the splint group received an interocclusal appliance (splint) fabricated from acrylic and were instructed to wear the splint day and night up to a maximum of 20 h per day. Patients in the habit reversal group were given a pager and instructed to check tooth position and masticatory muscle tension when paged. Paging occurred approximately once every 2 h during the day, but not at night. Both groups were instructed to avoid tooth contact and relax the masticatory muscles during the 4 weeks of active treatment. Outcome data were collected at 1 month and 1 year post-treatment intervals. Pain decreased significantly for both groups and did not differ between groups. Habit reversal may be as effective as a behaviorally-modified splint therapy for TMD-related pain.     

Biofeedback-assisted relaxation training for the aging chronic pain patient

The older segments of the U.S. population are expanding rapidly and account for a disproportionate amount of health care, including treatment for pain-related musculoskeletal disorders. In a prospective study with objective measures and one-year follow-up, Middaugh et al. (1988) found that older patients (55–78 yr; N=17, 76% success) treated in a multidisciplinary chronic pain rehabilitation program enjoyed a success rate equal to that of younger patients (29–48 yr; N=20, 70% success). The current study presents additional data on these two groups of patients to compare their ability to learn the physiological self-regulation skills taught in the biofeedback/relaxation component of the multimodal program. This component included progressive muscle relaxation training, diaphragmatic breathing instruction, and EMG biofeedback. Repeated measures ANOVA showed significant increases in digital skin temperature (peripheral vasodilation) and decreases in respiration rate both within and across training sessions (p values=.04 to .0001) with no differences between age groups (p>.05). EMG measures for the upper trapezius ms in patients with cervical pain showed similar deficits in muscle control at evaluation and similar improvements with biofeedback training for the two age groups. These findings indicate that older pain patients responded well to the biofeedback/relaxation training component of the multimodal pain program.This research was supported in part by NIDRR grant No. H133G90085, Department of Education, DHEW, and by the Medical University of South Carolina General Clinical Research Center under NIH grant No. RR1070.     

Biofeedback and behavioral treatment of persistent pain in the older adult: a review and a study

Persistent pain is a common health problem for older adults, age 60+, with a prevalence twice that in younger adults. Yet, older adults with chronic pain and headache are underrepresented in behaviorally oriented clinical programs that have proven effective for younger adults. A review of the literature indicates that older adults develop multiple pain-related problems that are similar to those of younger individuals. When offered the opportunity, older pain patients accept and benefit from multidisciplinary pain programs, cognitive–behavioral therapies and biofeedback training. A study comparing 58 older and 59 younger adults in a multidisciplinary pain program indicates that older pain patients readily acquire the physiological self-regulation skills taught in biofeedback-assisted relaxation training, and achieve comparable decreases in pain for the pain program as a whole.     

Immunological responses of breast cancer patients to behavioral interventions

This article reports the results of an 18-month study of immune system and psychological changes in stage 1 breast cancer patients provided with relaxation, guided imagery, and biofeedback training. Thirteen lymph node negative patients who had recovered from a modified radical mastectomy were randomly assigned to either an immediate treatment or a delayed treatment control group. Multiple pre-post psychological measures were performed. Significant effects were found in natural killer cell (NK) activity (p<.017), mixed lymphocyte responsiveness (MLR) (p<.001), concanavalin A (Con-A) responsiveness (p<.001), and the number of peripheral blood lymphocytes (PBL) (p<.01). No significant psychological changes were detected; however, reductions were seen in psychological inventory scales measuring anxiety. The results show that behavioral interventions can be correlated with immune system measures, thereby replicating the results of an earlier pilot study from our Center. Discussion is provided on differential T-cell and B-cell responsiveness to behavioral interventions.We wish to thank Douglas B. Coulson, Ph.D. for his expertise on the statistical analysis of the data. We would also like to thank Clay Steiner, M.D.; Janelle Oliver, M.S.; Maureen O'Grady, Ph.D.; and Rena Goetz, Ph.D., for their contribution to the performance of the assays. Finally, we thank both Sandy Bangham, R. N., and the medical laboratory staff at The Washington Clinic, Washington, D.C. for their services in performing phlebotomy.     

The effect of amputation and leg restraint on the free walking coordination of the stick insectCarausius morosus

Summary The stepping patterns of intact, amputated and leg restrained first instar stick insects were examined by analysing video tape records of their free walking behaviour. Amputation produced changes in the relative timing of protraction movements both along and across the body axis. Restraint of individual front or rear legs produced walking behaviour similar to that of the amputee animal but restraint of middle legs caused a breakdown in the coordination of front and rear legs. The changes in behaviour produced by leg autotomy and restraint were used to test certain assumptions of a model for generating the step pattern of these insects and to investigate how the tonic influence of proprioceptive input might be incorporated into the model.I would like to thank Professor P.N.R. Usherwood and Drs. M.D. Burns and W.J.P. Barnes for their comments and ideas on this work. A special acknowledgement goes to Dr. F. Delcomyn whose Fortran step analysis programs assisted greatly in the data reduction. I wish to thank S.R.C. for a returning scientist award and the support and equipment provided by grant B/SR/9774 to Professor Usherwood. A preliminary survey of some of the amputees was carried out at the Biology Department, Case Western Reserve University and I would like to acknowledge the support provided by a P.H.S. grant NB-06054 to Professor R.K. Josephson.     

Characteristics of stress clinic attendees

Increasing numbers of self-referral stress management programs are using relaxation and biofeedback techniques, but few data are available on the characteristics of the clients upon which one might base the design or improvement of a self-regulation program. The type, duration, and severity of stress problem, medication, and demographic information were obtained from 423 adults who attended a university-based stress clinic. The clients were classified into four symptom groups (anxiety, muscle tension headache, muscle tension, and "other") and one asymptomatic (personal growth) group. Ten sessions of cognitive and somatic relaxation techniques were provided, followed by a posttreatment improvement questionnaire. The asymptomatic group was significantly different from the stress groups, whereas the latter exhibited more similarities than differences. The groups reported an average improvement in well-being of 67%, and the majority of clients equally preferred the autogenic and progressive muscle relaxation therapies.     

Fine structural and cytochemical study of the innervation of smooth muscle in an amphibian (Bufo marinus) lung before and after denervation

Summary The innervation of the toad (Bufo marinus) lung was studied with transmission electron microscopy and fluorescence techniques, both before and after 12 or 20 days close vagosympathetic denervation. Four cytologically distinct types of neuronal processes were recognised, in relation to the visceral muscles of the lung. These were described as cholinergic, adrenergic, nonadrenergic/non-cholinergic (NANC) and sensory on the basis of the characteristics of their vesicular content and cytochemical reactions. An apparent efferent innervation of visceral smooth muscle was achieved by NANC (50%), cholinergic (25%) and adrenergic (25%) fibres. A few sensory fibres were also present. After denervation only NANC fibres persisted, showing that the cell bodies of these fibres were intrapulmonary. The vascular smooth muscle was supplied by cholinergic, adrenergic and sensory fibres. In the walls of the proximal branches of the pulmonary artery were fibres containing large dense-cored vesicles. These profiles, which were associated with the vasa vasorum, were similar to neurosecretory fibres. After denervation all neural profiles associated with the vasculature had degenerated. The observations suggest that vagal vasodepressor effects in the toad lung are mediated indirectly through relaxation of visceral muscle strands which in their contracted state compress vascular channels.The authors would like to thank Dr. J.R. McLean for technical advice on fluorescence microscopy. This work was supported by a grant from the Australian Research Grants Committee     

Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study

Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.     

Diabetic ulcers: The effect of thermal biofeedback-mediated relaxation training on healing

The present study was a preliminary investigation into the effect of thermal biofeedback-mediated relaxation training on healing of diabetic ulcers. Subjects were three males who had nonhealing diabetic ulcers of the toe, ankle, and leg, respectively. Treatment consisted of thermal biofeedback training at the ulcer site, handwarming training (in two of the three subjects), and home relaxation practice. Two subjects showed significant healing. Thermal biofeedback-mediated relaxation training may be a useful adjunct to traditional treatments for diabetic foot ulcers.The authors wish to acknowledge the assistance of Drs. Naomi Alazraki, Kathryn Morton, Louis Larsen, and Mr. Barry Burkinshaw of the Salt Lake VA Medical Center, without whom this study could not have been performed. The first author would also like to thank Dr. Edward Taub for his invaluable advice and support.     

Intercellular junctions in the hypodermis,salivary gland and gené's organ of the cattle tick,Boophilus microplus

Summary The intercellular junctions that occur in the hypodermis, Gené's organ, and the salivary glands of the tick, B. microplus, are described. The epithelial cells of the hypodermis are connected by spot desmosomes and septate junctions and the secretory cells of Gené's organ by septate and gap junctions. The cap cells in the alveoli of the salivary gland connect to adjacent cells by gap junctions, hemidesmosomes and septate junctions into which microtubules are inserted.The authors would like to thank Mr. R. Lamb for preparing the plates. M.W.J. Megaw was supported by an S.R.C. Studentship     

Influence of water exercise and land stretching on salivary cortisol concentrations and anxiety in chronic low back pain patients

Land stretching exercises are common exercise therapy for low back pain (LBP) patients. However, recently, water exercise became a popular rehabilitation for LBP patients, and many studies have reported the physical benefits of water exercise. This study compared the psychological and endocrinological effects of water exercise and land stretching by measuring salivary cortisol concentration and anxiety in chronic LBP patients. Seven volunteers (4 female and 3 male, mean age: 61.9 +/- 11.8 yrs) who suffered from chronic LBP (pain duration: 4.5 +/- 1.3 yrs) participated in the sessions of water exercise and land stretching programs (90 minutes) on different days. The land stretching program consisted mainly of stretching, and the water exercise program contained not only stretching, but also walking, jogging, muscle strengthening, swimming and relaxation. After both exercise programs, the subjective pain scores of the patients showed a significant decrease. Salivary cortisol concentrations were also significantly decreased during pre- to post-90 minute water exercise. (P < 0.05). With land stretching, salivary cortisol concentrations also decreased significantly (P < 0.05). State anxiety decreased significantly (P < 0.05) after both water exercise and land stretching compared with pre-exercise scores (P < 0.05), though no significant changes were found in the patients' trait anxiety scores. No significant correlation was found between salivary cortisol concentrations and state anxiety with water exercise and land stretching. The findings of the present study suggested both exercises showed similar tendencies, and had decreased salivary cortisol level and state anxiety.     

Stress reduction treatment of severe recurrent genital herpes virus

Four individuals with high-frequency recurrences of genital herpes virus of at least 2 years' duration were treated with two behavioral stress-reduction treatments. Subjects were given 10 weekly sessions of frontalis EMG biofeedback (2 subjects) or progressive muscle relaxation treatment (2 subjects). Presession and postsession frontalis EMG measures were recorded for all subjects across treatment. Outcome was measured by daily and weekly symptom charting mailed in weekly over 6 months, or by telephone interview after 6 months. Results demonstrated substantial improvement in reported symptoms with both treatments. Relaxation treatment resulted in a 66% and 100% reduction in frequency of recurrences. Frontalis EMG biofeedback resulted in a 72% and 7% reduction in frequency of recurrences. Follow-up at 1-year posttreatment showed that treatment effects were maintained by one subject, partially maintained by two, and reversed in one subject. The need for controlled investigation is emphasized.The authors thank Stephen Ritz for his contribution to this study.