1/40. A systematic history for the patient with chronic pelvic pain.Chronic pelvic pain is a source of frustration to both the physician and the patient. physicians have been ill equipped by their training to confront the multifaceted nature of the complaints of patients with chronic pelvic pain. patients have experienced a repetitive dismissal of their complaints by physicians too busy in their practices to address their problems comprehensively. The approach to the patient with chronic pelvic pain must take into account six major sources of the origin of this pain: 1) gynecological, 2) psychological, 3) myofascial, 4) musculoskeletal, 5) urological, and 6) gastrointestinal. Only by addressing and evaluating each of these components by a very careful history and physical examination and by approaching the patient in a comprehensive manner can the source of the pain be determined and appropriate therapy be administered. This article was developed to provide the clinician with a set of tools and a methodology by which the patient with this complaint can be approached.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/40. Treating chronic-pain patients in psychotherapy.This article provides an overview of the breadth of issues a therapist may face in treating a person with chronic pain. Questions such as the relative contributions of biological and psychosocial influences on the patient's reported condition must be addressed. In addition, the counselor often must help the patient deal with psychopathology that occurs in reaction to the pain, which is likely to be contributing to it. Other financial, medical, and legal circumstances also may impinge on the therapeutic framework to limit or influence the course of treatment. Two examples of treatment lessons are offered, and a case example illustrates the lengthy and multidimensional course some treatments can take.- - - - - - - - - - ranking = 0.66666666666667keywords = pain (Clic here for more details about this article) |
3/40. Myofascial pain syndrome induced by malpositioning during surgery--a case report.It is a real challenge to the anesthesiologists to differentiate brachial plexus injury (BPI) from myofascial pain syndrome (MPS). The possibility of MPS should be suspected in a patient with complaints of pain and dysfunction of the upper arm immediately after surgery. Here we report a case of gallstone with cervical ankylosing spondylitis who sustained myofascial pain syndrome (MPS) immediately after open cholecystectomy. We utilized dry needle stimulation to deactivate the trigger point of the pectoris minor muscle and stretching the muscle to relieve the muscle pain after the diagnosis was made. The patient completely recovered 2 weeks later.- - - - - - - - - - ranking = 0.8889890079883keywords = pain, upper (Clic here for more details about this article) |
4/40. Pseudo-dental pain and sensitivity to percussion.Two case reports examine a little-known cause of dental pain and sensitivity to percussion. Contrary to the traditional assumption that pain and sensitivity to percussion almost always are diagnostic of pulpal inflammation and/or necrosis, these symptoms actually may be referred to the sensitive tooth from trigger points in the masticatory muscles. Therefore, myofascial pain syndrome must be ruled out in patients who have dental pain and display sensitivity to percussion.- - - - - - - - - - ranking = 0.88888888888889keywords = pain (Clic here for more details about this article) |
5/40. Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients.Treatment of chronic pelvic pain (CPP), interstitial cystitis (IC), prostatodynia, and irritative voiding symptoms can be frustrating for both patients and physicians. The usual approaches do not always produce the desired results. We found that when we treated myofascial trigger points (TrP) in pelvic floor muscles as well as the gluteus, piriform, infraspinatus, and supraspinatus muscles, symptoms improved or resolved. Various palpation techniques were used to isolate active myofascial TrPs in these muscles of four patients with severe CPP, IC, and irritative voiding symptoms. Injection and stretch techniques for these muscles were performed. Visual twitch responses at the skin surface and in the muscles were used to verify successful needle piercing of a TrP. The patients were asked to verbally describe exactly where the flash of distant pain was felt, a process that permitted an accurate recording of the precise pattern of pain referred by that TrP. The findings involved with the four patients substantiate the need for myofascial evaluation prior to considering more invasive treatments for IC, CPP, and irritative voiding symptoms. Referred pain and motor activity to the pelvic floor muscles (sphincters), as well as to the pelvic organs, can be the sole cause of IC, CPP, and irritative voiding dysfunction and certainly needs further investigation.- - - - - - - - - - ranking = 1.3333333333333keywords = pain (Clic here for more details about this article) |
6/40. Differentiation of active and latent trigger points by thermography.OBJECTIVE: This study tested whether two distinct thermographic patterns attributed to myofascial trigger points could distinguish between active and latent trigger points. DESIGN: A retrospective chart survey was undertaken with thermographic data divided into two groups: a) increased thermal emission only over the trigger point and b) over the area of pain referral. The criterion standard used in a blinded comparison was physical examination findings separating active from latent trigger points. SETTING: All cases were drawn from a private practice referral center for thermographic evaluation of neck and low back injuries. patients: A sample of 65 cases showing physical examination findings of trigger points was chosen from 229 consecutive motor vehicle accident case files. RESULTS: There was moderate agreement between the two methods of differentiating active from latent latent trigger points (Kappa = 0.44) with a specificity of 0.70 and a sensitivity of 0.74. When cases in which spinal segmental dysfunction were eliminated, the agreement increased (Kappa = 0.54) with specificity of 0.82 and sensitivity of 0.74. CONCLUSIONS: thermography may be a useful tool in distinguishing active from latent trigger points, but the thermal imaging of spinal joint dysfunction may be a compounding factor.- - - - - - - - - - ranking = 0.11138718695548keywords = pain, back (Clic here for more details about this article) |
7/40. Myofascial pain from pectoralis major following trans-axillary surgery.This is the first reported description, to the author's knowledge, of myofascial pain occurring at a surgical drain site. The patient consulted a medical acupuncturist after suffering five months of continuous chest and arm pain associated with 'tingling' in the forearm and hand. She had undergone trans-axillary resection of the first left rib following a left axillary vein thrombosis 18 months previously. Her symptoms had been principally attributed to nerve traction at surgery or nerve root entrapment from scar tissue. However, the drain passed through the free border of pectoralis major, and the myofascial trigger point that appeared to develop as a result of the muscle trauma, or the pain at that site, presented as a chronic and complex post-surgical pain problem. The pain and tingling resolved completely after two sessions of dry needling at a single myofascial trigger point in the free border of the left pectoralis major muscle.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
8/40. Myofascial pain response to topical lidocaine patch therapy: case report.This is a case from a preliminary open trial to assess the efficacy of topically applied lidocaine patches as an alternative to trigger point injections for myofascial pain. We describe one case in this report that had a dramatic response to the lidocaine patch. Her pain relief increased, pain intensity decreased, and functional capacity increased. Her pain intensity and relief was measured by the Brief Pain Inventory-Short Form (BPI-SF). A quality of life measure was also included in the BPI-SF. While this was a dramatic response to this patient, it is only one case from an open-trial. The response to other patients has varied. The true clinical utility cannot be obtained from this one report, but only after the data have been analyzed from this initial trial. If the data are promising, a randomized, double-blind, crossover trial is planned.- - - - - - - - - - ranking = 0.88888888888889keywords = pain (Clic here for more details about this article) |
9/40. Upper crossed syndrome and its relationship to cervicogenic headache.OBJECTIVE: To discuss the management of upper crossed syndrome and cervicogenic headache with chiropractic care, myofascial release, and exercise. CLINICAL FEATURES: A 56-year-old male writer had been having constant 1-sided headaches radiating into the right eye twice weekly for the past 5 years. Tenderness to palpation was elicited from the occiput to T4 bilaterally. trigger points were palpated in the pectoralis major, levator scapulae, upper trapezius, and supraspinatus muscles bilaterally. Range of motion in the cervical region was decreased in all ranges and was painful. Visual examination demonstrated severe forward translation of the head, rounded shoulders, and right cervical translation. INTERVENTION AND OUTCOME: The patient was adjusted using high-velocity, short-lever arm manipulation procedures (diversified technique) and was given interferential myofascial release and cryotherapy 3 times weekly for 2 weeks. He progressed to stretching and isometric exercise, McKenzie retraction exercises, and physioball for proprioception, among other therapies. The patient's initial headache lasted 4 days. He had a second headache for 1.5 days during his exercise training. During the next 7 months while returning to the clinic twice monthly for an elective chiropractic maintenance program, his headaches did not recur. He also had improvement on radiograph. CONCLUSION: The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.- - - - - - - - - - ranking = 0.14788877172319keywords = pain, headache, upper (Clic here for more details about this article) |
10/40. Myofascial pain syndrome in the differential diagnosis of chronic abdominal pain.Myofascial pain syndrome is a painful musculoskeletal condition, and a quite common cause of chronic pain. It is characterized by the development of trigger points that are locally tender when active, and refer pain through specific patterns to other areas of the body. Its etiological factors are various; trauma, vertebral column diseases, systemic disorders, psychological distress, lack of motion, and chilling of the body parts. Myofascial pain syndrome may be misdiagnosed as arising from a visceral source especially if its probability is not kept in mind and a proper patient examination is lacking. Although there are many therapeutic approaches, trigger point injections can be diagnostic and therapeutic.- - - - - - - - - - ranking = 1.446637664724keywords = pain, abdominal pain (Clic here for more details about this article) |
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