Lars L. Andersena, Charlotte Suettab, Jesper L. Andersenb, Michael Kjærb, Gisela Sjøgaardc

Donald R Murphy, Eric L Hurwitz, Jonathan K Gerrard and Ronald Clary

Abstract

Background

It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain.

Methods

Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root’s dermatome.

Results

Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7%) of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1%) of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n = 5).

Conclusion

In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.

Chiropractic & Osteopathy 2009, 17:9 – full text

doi:10.1186/1746-1340-17-9

Jeannette M. Potts MD

Abstract:  Chronic nonbacterial prostatitis, or urological chronic pelvic pain syndrome (UCPPS), remains a common and often challenging disorder to evaluate and treat. Employing a more holistic approach, including urological therapy, physical therapy, and psychosocial perspectives, may be more appropriate for most patients. Growing evidence supports the use of biofeedback, myofascial trigger point release, prescribed exercise regimens, relaxation techniques, and supportive counseling to treat men with UCPPS.

Current Prostate Reports, Volume 7, Number 2 / July, 2009 – abstract

JA CAMBRON,  J DEXHEIMER,  P COE,

ABSTRACT
Objectives: The objective of this study was to determine the change in blood pressure (BP) in normotensive
and prehypertensive adults resulting from a therapeutic massage, and the factors associated with such
changes, including demographic and massage characteristics.
Design: settings/location: National University of Health Sciences Massage Therapy Clinic, Lombard, IL.
Subjects: The subjects were 150 current adult massage therapy clients with BP lower than 150/95.
Interventions: BP was measured before and after a therapeutic massage
Outcome measures: Change in BP and potential associated factors such as type of massage, duration of
massage, specific body area massaged, amount of massage pressure, and demographic characteristics were studied.

Results: Overall, systolic BP decreased by 1.8 mm Hg and diastolic BP increased by 0.1 mm Hg. Demographic
factors associated with BP decrease included younger age (p
0.01) and taller stature (p
0.09). Type
of massage was associated with change in BP: Swedish massage had the greatest effect at BP reduction. Trigger
point therapy and sports massage both increased the systolic BP, and if both forms of massage were included
in a session, both the systolic and diastolic BP readings significantly increased. No other massage factors
were associated with a significant change in BP.

Conclusions: Type of massage was the main factor affecting change in BP. Increases in BP were noted for
potentially painful massage techniques, including trigger point therapy.

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 12, Number 1, 2006, pp. 65–70 – abstract

Ekici G; Bakar Y; Akbayrak T; Yuksel I

OBJECTIVE: This study analyzed and compared the effects of manual lymph drainage therapy (MLDT) and connective tissue massage (CTM) in women with primary fibromyalgia (PFM).

METHODS: The study design was a randomized controlled trial. Fifty women with PFM completed the study. The patients were divided randomly into 2 groups. Whereas 25 of them received MLDT, the other 25 underwent CTM. The treatment program was carried out 5 times a week for 3 weeks in each group. Pain was evaluated by a visual analogue scale and algometry. The Fibromyalgia Impact Questionnaire (FIQ) and Nottingham Health Profile were used to describe health status and health-related quality of life (HRQoL). Wilcoxon signed rank test and Mann-Whitney U test were used to analyze the data.

RESULTS: In both groups, significant improvements were found regarding pain intensity, pain pressure threshold, and HRQoL (P < .05). However, the scores of FIQ-7 (P = .006), FIQ-9 (P = .006), and FIQ-total (P = .010) were significantly lower in the MLDT group than they were in the CTM group at the end of treatment.

CONCLUSIONS: For this particular group of patients, both MLDT and CTM appear to yield improvements in terms of pain, health status, and HRQoL. The results indicate that these manual therapy techniques might be used in the treatment of PFM. However, MLDT was found to be more effective than CTM according to some subitems of FIQ (morning tiredness and anxiety) and FIQ total score. Manual lymph drainage therapy might be preferred; however, further long-term follow-up studies are needed.

Journal of Manipulative & Physiological Therapeutics, 2009 Feb; 32(2): 127-33- abstract

Full text available in through MTABC member only website (link) under the research tab and then library.

Patricia Olaya-Contreras; Jorma Styf

Background and purpose Methods for identification of patients with illness behavior in orthopedic settings are still being debated. The purpose of this study was to test the association between illness behavior, depressed mood, pain intensity, self-rated disability, and clinical status in patients with chronic musculoskeletal pain (CMP).

Methods We examined 174 consecutive sick-listed patients (90 women). Musculoskeletal function was estimated by range of motion, muscle strength, and motor and sensory function. The degree of illness behavior was measured by Waddell signs (WS).

Results WS were observed in 47/174 (27%) of the patients, 16% of whom manifested excessive illness behaviour. In general, more patients with WS were depressed (OR = 4.4; 95% CI: 1.8-11) and experienced greater pain (OR = 2.9; CI: 1.1-7.7). No abnormal physical function could be observed in two-thirds of the patients. Other predictive factors for manifesting WS at the clinical examinations were longer sick leave and previous full sick leave (p < 0.05).

Interpretation Excessive illness behavior is related to psychological distress in patients with CMP and long-term disability. Thus, some patients may also require psychological assessment. Looking for WS during consultation is useful for targeting other factors that may be important in the diagnostic process.

Acta Orthopaedica 2009; 80 (3): x–x  full text
DOI: 10.3109/17453670902988352
URL: http://dx.doi.org/10.3109/17453670902988352

Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, et al

Background

Adequate pain assessment is critical for evaluating the efficacy of analgesic treatment in clinical practice and during the development of new therapies. Yet the currently used scores of global pain intensity fail to reflect the diversity of pain manifestations and the complexity of underlying biological mechanisms. We have developed a tool for a standardized assessment of pain-related symptoms and signs that differentiates pain phenotypes independent of etiology.

Methods and Findings

Using a structured interview (16 questions) and a standardized bedside examination (23 tests), we prospectively assessed symptoms and signs in 130 patients with peripheral neuropathic pain caused by diabetic polyneuropathy, postherpetic neuralgia, or radicular low back pain (LBP), and in 57 patients with non-neuropathic (axial) LBP. A hierarchical cluster analysis revealed distinct association patterns of symptoms and signs (pain subtypes) that characterized six subgroups of patients with neuropathic pain and two subgroups of patients with non-neuropathic pain. Using a classification tree analysis, we identified the most discriminatory assessment items for the identification of pain subtypes. We combined these six interview questions and ten physical tests in a pain assessment tool that we named Standardized Evaluation of Pain (StEP). We validated StEP for the distinction between radicular and axial LBP in an independent group of 137 patients. StEP identified patients with radicular pain with high sensitivity (92%; 95% confidence interval [CI] 83%–97%) and specificity (97%; 95% CI 89%–100%). The diagnostic accuracy of StEP exceeded that of a dedicated screening tool for neuropathic pain and spinal magnetic resonance imaging. In addition, we were able to reproduce subtypes of radicular and axial LBP, underscoring the utility of StEP for discerning distinct constellations of symptoms and signs.

Conclusions

We present a novel method of identifying pain subtypes that we believe reflect underlying pain mechanisms. We demonstrate that this new approach to pain assessment helps separate radicular from axial back pain. Beyond diagnostic utility, a standardized differentiation of pain subtypes that is independent of disease etiology may offer a unique opportunity to improve targeted analgesic treatment.

PLoS Medicine 6(4): e1000047.- full text

doi:10.1371/journal.pmed.1000047

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CHICAGO — Scientists peered at the brains of people with a baffling chronic pain condition and
discovered something surprising. Their brains looked like an inept cable guy had changed the
hookups, rewiring the areas related to emotion, pain perception and the temperature of their skin.

The new finding by scientists at Northwestern University’s Feinberg School of Medicine begins to
explain a mysterious condition that the medical community had doubted was real.

The people whose brains were examined have a chronic pain condition called complex region pain
syndrome (CRPS.) It’s a pernicious and nasty condition that usually begins with an injury causing
significant damage to the hand or the foot. For the majority of people, the pain from the injury
disappears once the limb is healed. But for 5 percent of the patients, the pain rages on long past
the healing, sometimes for the rest of people’s lives. About 200,00 people in the U.S. have this
condition.

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PY. Geha, MN. Baliki, RN. Harden, WR. Bauer, TB. Parrish, AV. Apkarian

Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regions was characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS.

Neuron, Volume 60, Issue 4, 26 November 2008, Pages 570-581(abstract only)

doi:10.1016/j.neuron.2008.08.022