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.This article is based on a thesis submitted in partial fulfillment of the requirement for a master's degree from the University of British Columbia by the second author. This research was facilitated by National Health and Welfare Grant NAHS 30-9625 and provincial government Youth Employment Program project #1225-01 made to Drs. Crockett and Alden, respectively. The authors would like to thank J. Dory, D.D.S., M.Sc. and B. Lundgren, B.P.T. for their help in completing this project. The authors also would like to thank S. Edwards and J. Snyder for their assistance in the preparation of this paper.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Paradoxical experience of hypnotic analgesia in low hypnotizable fibromyalgic patients

The study investigated the differences in pain perception in highly (Highs) and low (Lows) hypnotizable patients with chronic benign pain undergoing hypnotic suggestions of analgesia. Self reports of pain intensity were collected in different groups of fibromyalgic patients: (1) Highs and Lows during pre-hypnosis, neutral hypnosis, suggestions for analgesia, posthypnotic conditions; (2) Lows during suggestions for analgesia administered after a mental stress instead of neutral hypnosis; (3) healthy Lows receiving nociceptive stimulation during hypnotic relaxation and suggestions of analgesia. The results showed that Highs and Lows differed in their response to suggestions, but significant analgesia was reported also by Lows. These individuals did not report any difference in pain perception between the sessions including mental stress and hypnotic relaxation. No change in pain perception was observed in healthy Lows during nociceptive stimulation associated with relaxation and suggestions for analgesia. In conclusion, the presence of chronic pain seems to be responsible for the paradoxical response of non hypnotizable patients to hypnotic suggestions.     

Effectiveness of Home-Based Cupping Massage Compared to Progressive Muscle Relaxation in Patients with Chronic Neck Pain—A Randomized Controlled Trial

Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0–100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01500330","term_id":"NCT01500330"}}NCT01500330     

Contribution of the extracellular matrix to the viscoelastic behavior of the urinary bladder wall

We previously reported that when the stress relaxation response of urinary bladder wall (UBW) tissue was analyzed using a single continuous reduced relaxation function (RRF), we observed non-uniformly distributed, time-dependent residuals (Ann Biomed Eng 32(10):1409-1419, 2004). We concluded that the single relaxation spectrum was inadequate and that a new viscoelastic model for bladder wall was necessary. In the present study, we report a new approach composed of independent RRFs for smooth muscle and the extracellular matrix components (ECM), connected through a stress-dependent recruitment function. In order to determine the RRF for the ECM component, biaxial stress relaxation experiments were first performed on decellularized extracellular matrix network of the bladder obtained from normal and spinal cord injured rats. While it was assumed that smooth muscle followed a single spectrum RRF, modeling the UBW ECM required a dual-Gaussian spectrum. Experimental results revealed that the ECM stress relaxation response was insensitive to the initial stress level. Thus, the average ECM RRF parameters were determined by fitting the average stress relaxation data. The resulting stress relaxation behavior of whole bladder tissue was modeled by combining the ECM RRF with the RRF for the smooth muscle component using an exponential recruitment function representing the recruitment of collagen fibers at higher stress levels. In summary, the present study demonstrated, for the first time, that stress relaxation response of bladder tissue can be better modeled when divided into the contributions of the extracellular matrix and smooth muscle components. This modeling approach is suitable for prediction of mechanical behaviors of the urinary bladder and other organs that exhibit rapid tissue remodeling (i.e., smooth muscle hypertrophy and altered ECM synthesis) under various pathological conditions.     

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.     

慢性疼痛治疗的研究进展

慢性疼痛是临床常见的病症,给患者和社会都带来极大的负担。其发病机制受生理、心理和社会等多种因素的影响较为复杂,因此,慢性疼痛的治疗一直是临床上的一大难题。单一的治疗手段往往不能取得令人满意的效果,目前常采用多手段联合的方式来治疗慢性疼痛,常见的包括药物治疗、心理治疗、介入治疗以及自我管理等。针对不同类型的慢性疼痛甚至同一类型的不同病人其治疗方案也不尽相同,近年来兴起的跨学科康复计划为慢性疼痛的治疗指明了方向。本文就慢性疼痛治疗的研究进展进行了综述,以期为临床实践提供更多参考和理论依据。     

Negative side effects of self-regulation training: Relaxation and the role of the professional in service delivery

Procedures used for relaxation training can resolve or precipitate dysfunction in patients undergoing self-regulation treatments. The present article discusses the role of the clinician in administering relaxation training via thermal biofeedback and coping with unforeseen negative effects of treatment. A case illustration involving the biobehavioral treatment of chest pain is presented and discussed to remind the reader of the significance of the therapist's role in helping tailor treatment programs to unique responses of the individual patient. The case highlights the value of thorough case management and clinical formulation in the successful resolution of relaxation-induced leg pain.     

Music therapy in supportive cancer care

The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of emotions, including anger, fear, sadness, guilt, embarrassment and shame. Music therapy is a part of a complementary medicine program in supportive cancer care which accompanies medical treatment. There are many benefits of music therapy for cancer patients—interactive music therapy techniques (instrumental improvisation, singing) as well as receptive music therapy techniques (listening to recorded or live music, music and imaginary) can be used to improve mood, decrease stress, pain, anxiety level and enhance relaxation. Music therapy is an effective form of supporting cancer care for patients during the treatment process. It may be also basic for planning effective programs of rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life.     

Alterations in the masseter muscle and plasma IL-6 level following experimentally induced occlusal interference and chronic stress--a study in rats

This study was undertaken to examine the alteration of masseter and plasma interleukin-6 after inducing occlusal interference and chronic stress. Male Wistar rats were submitted to chronic stress procedure, exposed to occlusal interference, or exposed to both mentioned procedures. Whole blood and masseter tissue were collected to determine interleukin-6 level, measured by means of ELISA. Masseter pain was evaluated using the orofacial formalin test. Masseter interleukin-6 level was significantly higher in animals submitted to combination of occlusal interference and chronic stress than in the control group (p<0.05). There was positive and significant correlation between pain response and masseter interleukin-6 level (r=0.5741; p<0.0003). No significant differences in plasma interleukin-6 level were found between groups (p>0.05), as well as no correlation with pain (p>0.05). Combination of occlusal interference and chronic stress leads to strong local reaction characterized by high levels of masseter interleukine-6. High concentrations of muscle interleukin-6 and its correlation with pain point to inflammatory background of masticatory muscle pain.     

Treatment of pain and neuromuscular tension; a report on intravenous use of tetracaine in 365 cases

Three hundred and sixty-five patients were given tetracaine intravenously for various types of pain and neuromuscular tension. In the treatment of pain, myositis, muscle spasm, and visceral spasm most patients were relieved. Best results were obtained in syndromes in which pain was associated with muscle spasm, such as in pain in the lower part of the back and scalenus anticus syndromes. The effects of tetracaine intravenously are those of analgesia, vasodilatation, and relaxation of spastic muscle. Sixty-five of the patients were treated for neuromuscular tension, and there was good relaxation and increased comfort. Alcoholics were relieved of some of the tension symptoms and may have been helped to resist the desire to drink. Of 14 patients with premenstrual tension, 13 had complete relief. Eight patients with mixed anxiety and tension states also responded well. Toxic and allergic reactions were negligible, and other side effects were infrequent and of no consequence.     

慢性非特异性颈部不适飞行员与无症状飞行员之间头颈夹肌表面肌电特征的比较

目的:通过对慢性非特异性颈部不适飞行员与无症状飞行员之间头颈夹肌表面肌电特征的比较,为慢性非特异性颈部不适飞行员的早期诊断提供参考依据。方法:用表面肌电仪测量52名慢性非特异性颈部不适飞行员与11名无症状飞行员双侧头颈夹肌的松弛状态、等长收缩以及异长收缩时的表面肌电特征,分析不同状态下双侧头颈夹肌疲劳性肌电指标MFs、MPFs、ZCRs以及平均肌电AEMG值,用统计学软件SPSS 18.0分析实验结果。结果:非特异性颈部不适飞行员与无症状飞行员双侧头颈夹肌在松弛状态时疲劳性肌电指标MFs、MPFs、ZCRs比较均无统计学差异(P0.05),其双侧头颈夹肌在等长收缩和异长收缩时间有统计学差异(P0.05)。头颈夹肌处于松弛状态时,两组间平均肌电AEMG比较无统计学差异(P0.05),而在肌肉等长收缩和异长收缩时,两组间比较有统计学差异(P0.05)。结论:慢性非特异性颈部不适飞行员与无症状飞行员之间头颈夹肌表面肌电相关指标存在统计学差异,慢性颈部不适的飞行员相比无症状飞行员更易出现头颈夹肌的疲劳以及头颈夹肌的功能下降。头颈夹肌表面肌电特征有助于早期诊断慢性非特异性颈部不适飞行员的肌肉功能状态的改变。     

TREATMENT OF PAIN AND NEUROMUSCULAR TENSION—A Report on Intravenous Use of Tetracaine in 365 Cases

Three hundred and sixty-five patients were given tetracaine intravenously for various types of pain and neuromuscular tension. In the treatment of pain, myositis, muscle spasm, and visceral spasm most patients were relieved. Best results were obtained in syndromes in which pain was associated with muscle spasm, such as in pain in the lower part of the back and scalenus anticus syndromes. The effects of tetracaine intravenously are those of analgesia, vasodilatation, and relaxation of spastic muscle. Sixty-five of the patients were treated for neuromuscular tension, and there was good relaxation and increased comfort. Alcoholics were relieved of some of the tension symptoms and may have been helped to resist the desire to drink. Of 14 patients with premenstrual tension, 13 had complete relief. Eight patients with mixed anxiety and tension states also responded well.Toxic and allergic reactions were negligible, and other side effects were infrequent and of no consequence.     

Effect of chronic idiopathic low back pain on the kinetic gait characteristics in different foot masks

Identification of kinetic variables in different masks of foot is important for the evaluation and treatment of chronic low back pain. The aim of this study was to investigate the effect of chronic idiopathic low back pain on kinetic variables of gait in different foot masks. 11 idiopathic chronic low back pain patients and 13 healthy matched controls participated in this study. Using Emed foot-scanner system, the ground reaction force and impulse were measured during barefoot normal walking. Then, the average footprints were divided into 10 masks using the Automask program and the data were extracted using Multimask Evaluation programs. The low back pain disability was measured by Quebec questionnaire. Our results revealed that the ground reaction force and impulse in medial and lateral midfoot and hallux masks of patients were significantly lower than controls. Furthermore, these patients demonstrated greater ground reaction force and impulse in 3–5th metatarsals mask than control group. There was a significant interaction between the low back pain and the foot masks factors. In conclusion, the ground reaction forces and impulses in different areas of foot are affected by low back pain. Therefore, the kinetic gait analysis should be considered as an appropriate tool in evaluation and prescribing proper treatment program in low back pain patients.