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.     

SOME RECENT ADVANCES IN THE SYMPTOMATIC TREATMENT OF OSTEOARTHRITIS

In over 400 treatments with procaine intravenously, moderate to good improvement was noted in about 60 per cent of patients with osteoarthritis and radiculitis. Definite improvement after a single treatment was noted occasionally, but more often relief was not obtained until six to eight treatments had been given. Symptoms due to osteoarthritic changes in peripheral joints did not respond as well as did those due to spinal arthritis.Curare relieves some of the pain of arthritis due to muscle spasm, but does not bring improvement in motion of the small joints, such as those of the fingers.Preliminary experience with a new synthetic drug, 3-ortho-toloxy-1, 2-propanediol (Tolserol®), which produces muscular relaxation differing from that induced by curare, suggests further clinical trial.Intra-articular acidification by injection relieved pain in about 50 per cent of patients with osteoarthritis of the knee.     

Biofeedback in the treatment of long-term temporomandibular joint pain an outcome study

Eleven patients with long-term pain related to the temporomandibular joint (TMJ) were trained in tension awareness and relaxation using feedback of muscle tension level in the masseter through a digital display. At a follow-up examination 4–15 months after the termination of treatment, 8 of the 11 patients were totally symptom-free or significantly better; 1 patient was slightly better, and there was no effect for 2 patients. Possible reasons for failure and sex differences are discussed.     

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.     

Sustained effects of biofeedback-assisted relaxation therapy in essential hypertension.

The usefulness of biofeedback-assisted relaxation as an adjunct or substitute for pharmacotherapy in essential hypertension can be enhanced if the effects are shown to persist after formal treatment has ended. Patients with essential hypertension successfully treated with biofeedback-assisted relaxation were recalled for follow-up yearly after the termination of treatment. Twenty-six of 40 patients met the BP criterion for success. At one-, two-, and three-year follow-up, 31%, 38%, and 27% of the successful completers continued to meet the criterion for success. The pretreatment-posttreatment decreases in BP were accompanied by decreases in forehead muscle tension and urinary cortisol. Forehead muscle tension, urinary cortisol, and anxiety levels were significantly lower than pretreatment one year after the end of treatment. Self-report data were used to assess continued relaxation practice. No relationship was found between practice and any other dependent measure. It appears that some patients trained in biofeedback-assisted relaxation can maintain lowered blood pressure, muscle tension, anxiety, and cortisol levels over the long term; however, the role of relaxation practice in maintaining these lowered levels remains unclear.     

Sustained effects of biofeedback-assisted relaxation therapy in essential hypertension

The usefulness of biofeedback-assisted relaxation as an adjunct or substitute for pharmacotherapy in essential hypertension can be enhanced if the effects are shown to persist after formal treatment has ended. Patients with essential hypertension successfully treated with biofeedback-assisted relaxation were recalled for follow-up yearly after the termination of treatment. Twenty-six of 40 patients met the BP criterion for success. At one-, two-, and three-year follow-up, 31%, 38%, and 27% of the successful completers continued to meet the criterion for success. The pretreatment-posttreatment decreases in BP were accompanied by decreases in forehead muscle tension and urinary cortisol. Forehead muscle tension, urinary cortisol, and anxiety levels were significantly lower than pretreatment one year after the end of treatment. Self-report data were used to assess continued relaxation practice. No relationship was found between practice and any other dependent measure. It appears that some patients trained in biofeedback-assisted relaxation can maintain lowered blood pressure, muscle tension, anxiety, and cortisol levels over the long term; however, the role of relaxation practice in maintaining these lowered levels remains unclear.     

Outcome of Biofeedback-Assisted Relaxation for Pain in Adults with Cerebral Palsy: Preliminary Findings

Chronic pain is a common secondary problem associated with cerebral palsy (CP). This pain may be due to the musculoskeletal problems that often accompany CP, including spasticity, scoliosis, and bony deformity. The purpose of this study was to determine the effects of biofeedback-assisted relaxation training on self-reported pain and muscle tension in 3 adults with CP using a multiple baseline design across subjects. Two of 3 participants reported decreases in their pain experiences posttreatment. Their subjective reports, however, did not correspond with physiological changes. Complications in the use of progressive relaxation exercises and EMG biofeedback equipment are described and suggestions for future research provided.     

The effects of EMG feedback training during problem solving: a case study.

The present case study investigated the effects of competing task demands on biofeedback training to reduce frontalis muscle tension. Baseline levels of frontalis muscle tension were recorded for relaxation and problem solving. The subject was trained to decrease muscle tension with biofeedback for the problem-solving task alone. The results indicated that EMG training during problem-solving was successfully accomplished. Frontalis muscle tension during relaxation baseline did not change as a result of reductions in muscle tension during problem-solving feedback training. This suggests that the decrease of muscle tension cannot be attributed to reductions in overall muscle tension levels. Instead, training was specific to the problem-solving feedback phases. Additionally, it was found that accuracy in problem-solving did not decline as a result of simultaneous feedback training. Thus EMG biofeedback training can be accomplished and exercised without disruption of ongoing mental activity.     

The effects of EMG feedback training during problem solving

The present case study investigated the effects of competing task demands on biofeedback training to reduce frontalis muscle tension. Baseline levels of frontalis muscle tension were recorded for relaxation and problem solving. The subject was trained to decrease muscle tension with biofeedback for the problem-solving task alone. The results indicated that EMG training during problem solving was successfully accomplished. Frontalis muscle tension during relaxation baseline did not change as a result of reductions in muscle tension during problem-solving feedback training. This suggests that the decrease of muscle tension cannot be attributed to reductions in overall muscle tension levels. Instead, training was specific to the problem-solving feedback phases. Additionally, it was found that accuracy in problem-solving did not decline as a result of simultaneous feedback training. Thus EMG biofeedback training can be accomplished and exercised without disruption of ongoing mental activity.     

Heterogeneity of psychophysiological stress responses in fibromyalgia syndrome patients

Dysregulated psychophysiological responses have been observed in patients with fibromyalgia syndrome (FMS), although the results are inconsistent. Surface electromyographic (EMG), systolic and diastolic blood pressure, heart rate (HR), and skin conductance levels (SCLs) were continuously recorded at baseline, and during a series of stress and relaxation tasks in 90 FMS patients and 30 age and sex matched healthy controls (HCs). The patient sample demonstrated lower baseline EMG levels compared to the HCs on all tasks. In contrast, the patients displayed elevated HR and SCL (sympathetic vasomotor and sudomotor indices, respectively) during both stress tasks. A cluster analysis identified four psychophysiological response patterns: 63.3% of HCs showed increased muscle tension and stable cardiovascular responses; 34.8% of FMS patients showed a pattern of increased sympathetic vasomotor reactivity with stable sudomotor and reduced muscular response; 12.2% of FMS patients showed a pattern of increased sympathetic sudomotor reactivity connected with increased sympathetic vasomotor response and reduced muscular response; and, in contrast, 46.7% of FMS patients showed a pattern of parasympathetic vasomotor reactivity and reduced sudomotor as well as muscular response. The identification of low baseline muscle tension in FMS is discrepant with other chronic pain syndromes and suggests that unique psychophysiological features may be associated with FMS. The different psychophysiological response patterns within the patient sample support the heterogeneity of FMS.     

Heterogeneity of psychophysiological stress responses in fibromyalgia syndrome patients

Dysregulated psychophysiological responses have been observed in patients with fibromyalgia syndrome (FMS), although the results are inconsistent. Surface electromyographic (EMG), systolic and diastolic blood pressure, heart rate (HR), and skin conductance levels (SCLs) were continuously recorded at baseline, and during a series of stress and relaxation tasks in 90 FMS patients and 30 age and sex matched healthy controls (HCs). The patient sample demonstrated lower baseline EMG levels compared to the HCs on all tasks. In contrast, the patients displayed elevated HR and SCL (sympathetic vasomotor and sudomotor indices, respectively) during both stress tasks. A cluster analysis identified four psychophysiological response patterns: 63.3% of HCs showed increased muscle tension and stable cardiovascular responses; 34.8% of FMS patients showed a pattern of increased sympathetic vasomotor reactivity with stable sudomotor and reduced muscular response; 12.2% of FMS patients showed a pattern of increased sympathetic sudomotor reactivity connected with increased sympathetic vasomotor response and reduced muscular response; and, in contrast, 46.7% of FMS patients showed a pattern of parasympathetic vasomotor reactivity and reduced sudomotor as well as muscular response. The identification of low baseline muscle tension in FMS is discrepant with other chronic pain syndromes and suggests that unique psychophysiological features may be associated with FMS. The different psychophysiological response patterns within the patient sample support the heterogeneity of FMS.     

Effects of KHEYLRFamide and KNEFIRFamide on cyclic adenosine monophosphate levels in Ascaris suum somatic muscle

KHEYLRF-NH(2) (AF2) is a FMRFamide-related peptide (FaRP) present in parasitic and free-living nematodes. At concentrations as low as 10 pM, AF2 induces a biphasic tension response, consisting of a transient relaxation followed by profound excitation, in neuromuscular strips prepared from Ascaris suum. In the present study, the effects of AF2 on cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP) and inositol-1,4,5-triphosphate (IP(3)) levels were measured following muscle tension recordings from 2 cm neuromuscular strips prepared from adult A. suum. AF2 induced a concentration- and time-dependent increase in cAMP, beginning at 1 nM; cAMP levels increased by 84-fold following 1 h exposure to 1 microM AF2. cGMP and IP(3) levels were unaffected by AF2 at concentrations 相似文献   

Pharmacological action of the heptapeptide GFSKLYFamide in the muscle of the sea cucumber Holothuria glaberrima (Echinodermata)

The holothurian neuropeptide GFSKLYFamide (GlyPheSerLysLeuTyrPheNH₂), GFSKLYFa, was characterized recently and shown to be present in nerve fibers that apparently innervate various muscle systems. We have studied the potential neurotransmitter role of this peptide by assaying its effects on the contractility of visceral and somatic muscles. GFSKLYFa in nanomolar concentrations induces a relaxation of the muscle tension in the intestine. A similar effect is observed on the longitudinal muscle bands of the body wall of the sea cucumber. The relaxing action of GFSKLYFa is dose dependent suggesting that its action is mediated by receptors present in the muscle cells. In addition, GFSKLYFa induces the relaxation of the acetylcholine contracted intestine. Our investigation provides additional evidence indicating that GFSKLYFa might be a neurotransmitter acting at the neuromuscular junctions of the sea cucumber Holothuria glaberrima.     

Resolution of back pain with the wide abdominal rectus plication abdominoplasty

Back pain is classified most easily into three types (1) muscle spasm, (2) herniated nucleus pulposus (HNP), and (3) facet syndrome and/or nerve compression. It is possible the wide abdominal rectus plication procedure will be beneficial to all three groups, but currently I limit the procedure to those back pain patients who are improved with a back brace or corset and those without back pain undergoing elective abdominoplasty. Contraindications would be (1) anticipating additional pregnancy, (2) back pain not relieved or improved by corset or brace, (3) severe or progressive disk signs, and (4) bladder and/or bowel dysfunction. Further detailed studies of the mechanism of action and of the biomechanical effect as evaluated by conventional radiology, CAT scan, and nuclear magnetic resonance imaging, as well as physical measurement, are in progress and will be forthcoming.     

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, in-attention, nor fatigue.     

The effectiveness of EMG biofeedback training in low back pain.

Eighteen patients with chronic low back pain (lbp) of muscle tension origin were given an EMG biofeedback training. Compared to seven controls they showed a significant decrease during training in muscle tension and subsequently in pain. However, at follow-up EMG levels dropped to the initial (high) level. Pain scores of patients with high pain decrements during training showed further improvement during follow-up, which was not the case with patients showing less substantial improvement. The importance of cognitions was discussed.     

The use of EMG feedback and progressive relaxation in the treatment of a woman with chronic back pain

In this systematic single-case study, a 71-year-old white female with chronic back pain and paravertebral muscle spasm was treated with 17 sessions of electromyographic (EMG) feedback, with recording site just below the right inferior scapular angle. Progressive relaxation practice was also employed. EMG level was monitored during baseline, treatment, and follow-up phases. Backaches were recorded by the subject on a daily basis. There was a marked decrease in both EMG level and frequency of backaches, as well as an increase in activities at home. Improvement was maintained 12 weeks after the last treatment session.     

Deficient Discrimination of EMG Levels and Overestimation of Perceived Tension in Chronic Pain Patients

Twenty chronic low back pain patients (CBP), twenty tension headache (THA) patients, and twenty healthy controls (HC) participated in a tension production task where subjects had to attain four levels (4, 8, 12, 16 V) of muscle tension at the m. frontalis and the m. erector spinae. Ratings of perceived tension, pain, and aversiveness as well as EMG, heart rate, and skin conductance levels were recorded. Signal detection and correlational methods revealed that the patients were deficient in muscle tension discrimination at high tension levels in both muscles. They generally overestimated low and underestimated high levels of muscle tension, especially in the CBP group. At low muscle tension levels, both healthy controls and patients showed deficient discrimination ability. Perceived muscle tension, aversiveness, and pain ratings during the tasks were higher in the patient groups. These data confirm and clarify previous reports of deficient tension perception and show concurrent overestimation of bodily symptoms in chronic musculoskeletal pain patients.     

The use of EMG feedback and progressive relaxation in the treatment of a woman with chronic back pain.

In this systematic single-case study, a 71-year-old white female with chronic back pain and paravertebral muscle spasm was treated with 17 sessions of electromyographic (EMG) feedback, with recording site just below the right inferior scapular angle. Progressive relaxation practice was also employed. EMG level was monitored during baseline, treatment, and follow-up phases. Backaches were recorded by the subject on a daily basis. There was a marked decrease in both EMG level and frequency of backaches, as well as an increase in activities at home. Improvement was maintained 12 weeks after the last treatment session.     

Effects of halothane on mechanical response of skeletal muscle from malignant hyperthermia susceptible patients.

The purpose of this investigation was to compare the effects of halothane on malignant hyperthermia (MH) and normal isolated muscle bundle performance during isometric contraction and relaxation phases. Mechanical parameters were measured: peak tension (PT), time to peak tension (TPT) and positive peak of isometric tension derivative (+dP/dtmax) characterized the contraction phase. Half-relaxation time (RT1/2) and negative peak of isometric tension derivative (-dP/dtmax) characterized the relaxation phase. The ratio R = (+dP/dtmax)/(-dP/dtmax) was used to study the coupling between contraction and relaxation under isometric condition. In normal muscle, halothane increased PT by nearly 40% without altering TPT. The +dP/dtmax value increased concomitantly with the -dP/dtmax values, thus no changes in R was observed. In MH muscle, PT was first potentiated (0.5-1.0 vol% halothane) and then depressed (2.0-3.0 vol% halothane). TPT and +dP/dtmax were not altered whereas RT1/2 increased progressively with concomitant decrease in -dP/dtmax, thus R increased by nearly 40%. The amplitude of MH muscle contracture with stepwise concentrations of halothane was correlated with the increase of RT1/2 and R, and the decrease of -dP/dtmax. These results suggest that halothane alters the relaxation phase more than the contraction phase in MH human skeletal muscle compared to normal muscle.