The authors describe three patients, a 22year-old woman, a 59-year-old woman, and 75-year-old man who received subcutaneous heparin for arterial insufficiency in the first patient and venous thrombophlebitis in the other two patients. None of the three patients had an inflammatory connective tissue disease prior to the use of subcutaneous heparin [30,000 units per day in the first patient and 25,000 units per day in the remaining two patients]. Fairly shortly after the institution of subcutaneous heparin [2 months afterwards in the first patient and about one month afterwards in the remaining two patients] the patients developed fatigue, fever, swelling, and enduration of the subcutaneous tissue in various parts of the body [right thigh in patient number one, forearms and thighs bilaterally in the second patient, and both lower limbs in the third patient]. A full thickness skin biopsy of the affected areas was performed in each case. The diagnosis of eosinophilic fasciitis [EF] was made on the basis of characteristic findings on full thickness skin biopsy. The fascia typically is thickened and permeated by chronic inflammatory infiltrate. Peripheral eosinophilia was present in the three patients also. All three patients were treated with Prednisone with predictable improvement in their clinical condition. The authors opined that because of this temporal association between the onset of EF and exposure to subcutaneous heparin, the subcutaneous heparin was somehow the cause of the patient’s connective tissue problem.
Objectives: Fibromyalgia syndrome [FMS] is a musculoskeletal condition that is defined by widespread pain, mood disturbance, and cognitive dysfunction. There is debate surrounding the causes of this disorder, with growing attention being placed on central nervous system [CNS] abnormalities. Neurofeedback is a form of biofeedback that is designed to alter neurophysiological processes using electro-encephalogram [EEG] technology. This review includes systematic examination and comparison of neurofeedback interventions used to treat FMS symptoms [i.e. pain, fatigue, cognitive function, depression, anxiety, FMS impact]. Systematic searches were conducted on PubMed, PsycINFO, Cochrane Library, Medline, Web of Science, and the Society of Behavioral Medicine listserv for published and unpublished reports of interventions studies.
Several hypotheses regarding the underlying mechanisms and the maintenance behind chronic work-related musculoskeletal disorders have been presented. Chronic low load work and psychosocial stress is believed to be the underlying causes to these pain conditions. The recent application of comprehensive screening methods: omnics methods; to this field of research could contribute to current knowledge regarding the pathophysiology of these disorders. The pathophysiological mechanisms behind chronic trapezius myalgia are discussed in the context of new findings obtained with proteomic and metabolomic methods. Proteins and metabolites which differ in abundance between healthy muscle and muscle suffering from chronic trapezius myalgia are presented. Primarily, the pathways and effects of the proteins and metabolites found in three recently published papers are discussed. Proteomics and metabolomics are efficient screening methods enabling the presentation of potential biomarkers and pathophysiological mechanisms explaining the pathophysiology of chronic work-related trapezius myalgia. The previous findings detecting systematic differences of proteins and metabolites when comparing chronic myalgic muscle to healthy muscle, indicating a higher glycogen metabolism, increased muscle turnover and increased neuronal signalling in the myalgic muscle, are discussed in this review.
Objectives: To report a previously undescribed sudden onset of bilateral complex regional pain syndrome [CRPS] associated with cervical disc herniation [CDH].Findings: A patient with sudden onset of intensive pain in both hands was diagnosed as bilateral CRPS. The etiologic factor was found to be CDH, spinal cord, and C6 nerve root compression. The diagnosis was confirmed by three-phase scintigraphy. The patient was treated with pregabalin.Conclusions: This case allows clinicians to suggest CDH in the etiology of CPRS, even if the patient does not have any symptoms and complaints resulting from CDH. The mechanism is not clear, but suggests nerve damage.
Background: Biphosphonates, especially alendronate, are used extensively and successfully for the treatment of osteoporosis. However, there are numerous recent studies that indicate low-energy subtrochanteric femoral fractures can be associated with long-term alendronate therapy.Findings: We present a 76-year-old female patient who has taken 70 mg alendronate per week for 7 years, and who presented with pain in the left thigh.Conclusions: The patient was diagnosed as atypical femoral fracture resulting from long-term alendronate use. The diagnosis and the treatment will be discussed with a review of the literature.
Objectives: To determine the ideal number of applications of high-power pain threshold ultrasound [HPPTUS] for the desensitization of latent myofascial trigger points [LTrPs] in the elderly.Methods: Twenty-four elderly participants [65-73 years, four males, 20 females] with LTrPs identified in the upper trapezius muscle were included in the study. The participants were equally assigned to the HPPTUS-5, HPPTUS-9, and conventional US groups. The participants received five or nine times of HPPTUS or conventional US intervention to an upper trapezius myofascial TrP. Treatments were applied during three sessions for 1 week. The primary outcome variable was pressure pain threshold to evaluate the sensitivity of LTrP in the upper trapezius muscle. The secondary outcome variables were pressure pain tolerance and visual analog scale [VAS] for the subjective pressure pain intensity at 4.5 kg/cm(2).Results: Between-group comparisons showed that the participants who received nine applications of HPPTUS showed a significantly greater increase in the pressure pain threshold and tolerance than the other groups at the end of the 1-week intervention. Within-group changes showed significantly decreased pain in all groups. No adverse effects were found.Conclusions: The results of this study indicate that nine applications of HPPTUS are more effective to reduce the pain sensitivity of LTrPs than conventional US techniques. Furthermore, this preliminary study showed no adverse effects of HPPTUS technique, even though strong stimulation was given to LTrPs.
Objectives: The economic burden of osteoarthritis [OA] has not recently been evaluated in France. This study aimed to provide a health economic update of the patient costs associated with hip or knee OA treated in the community and in medical, surgical and obstetric care [MSO] and post-acute care and rehabilitation [PAC] hospitals in France. Methods: We analyzed data from the Disease Analyzer (R) database of medical records collected by a representative sample of French general practitioners in 2009-2010 and from the French medical information system program for public and private hospitals in 2010. Results: In 2010, 90 946 patients were hospitalized in MSOs for hip OA [median age: 75 years] and 84 848 patients for knee OA [median age: 71 years], of whom 44% and 61%, respectively, were transferred to PACs. Up to 94.5% of patients underwent joint replacement. Hospitalization engendered annual costs of (sic)9797 per patient with hip OA and (sic)11 644 per patient with knee OA, that is, a total cost of (sic)1.955 billion for patients hospitalized for hip or knee OA in 2010. A total of 18 976 community patients [mean age: 66 +/- 12.7 years] with OA were followed up for 1 year in the Disease Analyzer (R) database. The annual costs per patient were (sic)715 and (sic)764 for hip and knee OA, respectively, including a cost to the healthcare system of (sic)425 and (sic)454, respectively, that is, an estimated (sic)3.5 billion [(sic)2 billion to the healthcare system] for 4.6 million patients. Conclusion: Patients with OA generate considerable healthcare costs in France.
Background: Spinal tuberculosis is an uncommon disease but still occurs widely.Findings: We describe a 56-year-old woman presenting with a severe backache. She was diagnosed with osteoporosis and a lumbar disc herniation two months ago, but tuberculosis had not been diagnosed before. We reviewed the relevant literature and emphasized the impact of early diagnosis of spinal tuberculosis.Conclusions: The onset of tuberculous spondylitis is insidious in nature, with various clinical presentations. Lack of specific symptoms causes delays in diagnosis. Its diagnosis may be delayed because tuberculosis is not considered in the differential diagnosis. In cases with severe back pain, spinal tuberculosis must be included in the differential diagnosis.
Objectives: Many studies on sleep disturbance and chronic pain such as headache, back pain, and fibromyalgia syndrome have been reported. In comparison to chronic pain, few studies have investigated sleep quality in myofascial pain syndrome [MPS]. This study investigates the association between the MPS and the quality of sleep.Methods: We investigated 100 patients who complained of muscle pain with diagnostic criteria matching that of MPS and exhibited no major medical, psychiatric, or neurological disorders, and 122 subjects who were recruited from a Health Screening Center. Participants completed the following questionnaires: the Pittsburgh Sleep Quality Index [PSQI], the Insomnia Severity Index [ISI], Epworth Sleepiness Scale, Sleep Apnea scale of the Sleep Disorders Questionnaire, and the Beck Depression Inventory. The participants were recorded on their first visiting day in an outpatient clinic.Results: The PSQI and ISI scores of patients with MPS were significantly higher than that of control subjects [PSQI: 12.3 +/- 7.1 versus 5.4 +/- 2.6, p< 0.001, ISI: 16.1 +/- 9.2 versus 6.7 +/- 4.3, p < 0.001]. Logistic regression analysis adjusted for age, sex, body mass index, the Sleep Apnea scale of the Sleep Disorders Questionnaire score, and Beck Depression Inventory score revealed that the odds ratio for MPS according to an increase in the PSQI and ISI score [PSQI: 3.60, 95% confidence interval: 2.33-7.84 versus ISI: 1.22, 95% confidence interval: 1.18-1.36].Conclusions: This study showed that poor sleep quality is significantly associated with MPS. Thus, careful evaluation of sleep disturbance should be considered in patient with MPS.
Background: Trigger point injection [TPI] is generally considered a safe and easy procedure.Findings: We describe a case of cardiac tamponade after ultrasonography [US]-guided TPI in a thin patient. The symptoms progressively appeared directly after the injection, and the patient experienced cardiogenic shock 3 h later. Cardiac tamponade was diagnosed with difficulty when US was performed near the injection site, and then pericardiocentesis was performed immediately.Conclusions: When US-guided TPI is performed near the neck and chest, the authors suggest that the entire shaft and tip of the needle be identified to prevent any critical complications during an US-guided procedure.
Objectives: In the Indian social structure, as in many other countries and regions across the globe, housewives form the nucleus of their family. They have a nonstop hectic full day assignment in the home, and yet their contribution has neither been adequately acknowledged, nor has it received due attention of researchers. The aim and objective of this study is to determine the prevalence of Low Back Pain (LBP) in non-working women of Kanpur city. Also, an attempt has been made to find the amount of social burden and its impact on LBP present in housewives of Kanpur city.Method: A sample of 300 non-working women of Kanpur city, aged 25 to 70 years, was selected. The Nordic Musculoskeletal Questionnaire, Oswestry Disability Index, and Zarit Burden Interview measuring musculoskeletal discomfort, low back disability and social burden respectively were given to all the women.Results: Descriptive analysis data reveal the recent episode of LBP were present in 93% of the women, 82% had chronic LBP and 71% of women reported restriction in their normal activity of daily living due to their pain in last 12 months. The Oswestry Disability Index data revealed that more than 55% of women reported moderate disability due to pain. Correlation analysis showed that disability due to LBP has a significant correlation with social burden.Conclusion: The findings of the present study revealed alarming information regarding the prevalence of LBP in housewives of Kanpur city. Due to its significant correlation with disability and social burden, LBP plays a crucial role in the overall health status of housewives.
Bjersing JL, Lundborg C, Bokarewa MI, Mannerkorpi K: Profile of cerebrospinal microRNAs in fibromyalgia. PLoS ONE 8(10): e78762, 2013.It has been shown that pathophysiology of fibromyalgia syndrome...
Background: Transient osteoporosis of the hip [TOH] is a rare clinical syndrome with an unknown pathogenesis. Clinical history and radiological investigations establish the diagnosis. Conservative management is the mainstay of treatment. Presented here is the conservative management of two cases of men with TOH.Findings: Magnetic resonance imaging and bone scan showed changes consistent with TOH, which resolved after initiation of treatment.Conclusion: Transient osteoporosis of the hip needs to be considered in the differential diagnosis of hip joint pain in middle-aged men with a functional disability. Prompt initial clinical evaluation with vigilant monitoring and follow-ups are a must to identify and treat complications.
Background: Arnica montana has been used as a remedy for centuries, and is common today for the treatment of pain, swelling and bruises. However its efficacy remains controversial. The authors systematically review the literature on the efficacy of A. montana applied topically. Literature searches of the main electronic databases on topical Arnica were performed. Also relevant experts and the herbal industry were consulted. Data was analyzed and the methodological quality assessed.
Objectives: A randomized placebo-controlled study was designed to determine the efficacy of suprascapular nerve block [SSNB] in the treatment of shoulder impingement syndrome.Methods: The study group consist of 96 patients who were randomized to an injection group [n = 51] or a placebo group [n = 45]. Patients in the group receiving active treatment had a single SSNB while patients in the control group received a placebo injection of normal saline. The evaluations were performed in terms of visual analog scale for pain intensity, and constant shoulder score [CSS] for shoulder function.Results: The SSNB group showed significant improvments compared with the placebo group with respect to pain improvment and shoulder function at the 2-week and 3-month follow-up periods.Conclusion: Suprascapular nerve block is a very effective treatment in shoulder impingement syndrome. It improves pain, disability, and range of movement at the shoulder compared with placebo.
Background: Sacroiliac joint injection is both a way of confirming sacroiliac joint pain and a therapeutic method.Findings: A 40-year-old woman was presumptively diagnosed as having sacroiliac joint dysfunction and we performed a fluoroscopically guided sacroiliac joint injection. Many hours after the procedure, the patient developed severe buttock pain spreading to the posterior aspect of the femur on the left side. A pelvic magnetic resonance imaging revealed a 9 x 4 x 5.5 cm sized hematoma extending from the left obturator to the perirectal region.Conclusions: Because of anatomical variations, the practitioner should be alert to the risk of damaging vascular structures when performing therapeutic injections.
Objectives: This controlled study evaluates a multi-modal pain therapy for treating severe progressions of fibromyalgia [FMS] syndrome. The aim is to establish whether the use of multi-modal therapy with inclusion of whole-body hyperthermia represents a useful therapeutic addition to inpatient therapy of FMS syndrome at a high level of chronification.Methods: The study involved 130 patients who fulfilled the criteria of the American College of Rheumatology [ACR] for FMS and whose disease showed severe progression. One group of patients [HTG] received whole-body hyperthermia, while the control group [CG] did not. The main parameters of the study were pain intensity and the mental state of the patients. Further study parameters were the diagnoses additional to FMS syndrome and the therapy density of the treatment provided in the two groups.Results: The integration of whole-body hyperthermia into the multi-modal pain therapy showed superior pain reduction [p = 0.023] and an improvement in the mental state of the patients [p = 0.055]. In addition to the primary disease, the patients presented with an average of 6.7 accompanying diseases, primarily from major diagnostic categories 8 [diseases and disturbances of the musculoskeletal system and connective tissues], 19 [mental diseases and disturbances] and 10 [endocrine, nutritional and metabolic diseases]. Analysis of the therapy density of the inpatient multi-modal pain therapy revealed a close-meshed and high-frequency therapy.Conclusions: Multi-modal pain therapy was also found to be a highly effective therapy option in the case of severely progressive FMS syndrome. Extension of the multi-modal therapy setting to include whole-body hyperthermia can be considered as a useful and effective complement for pain relief and stabilisation of the mental state.
Objectives: Fibromyalgia syndrome [FMS] is a musculoskeletal condition that is defined by widespread pain, mood disturbance, and cognitive dysfunction. There is debate surrounding the causes of this disorder, with growing attention being placed on central nervous system [CNS] abnormalities. Neurofeedback is a form of biofeedback that is designed to alter neurophysiological processes using electro-encephalogram [EEG] technology. This review includes systematic examination and comparison of neurofeedback interventions used to treat FMS symptoms [i.e. pain, fatigue, cognitive function, depression, anxiety, FMS impact]. Systematic searches were conducted on PubMed, PsycINFO, Cochrane Library, Medline, Web of Science, and the Society of Behavioral Medicine listserv for published and unpublished reports of interventions studies. Findings: Seven of the identified 255 studies met the criteria for inclusion. Three of these reports described traditional neurofeedback interventions and four described alternative neurofeedback training. There was a significant variability in terms of study design, intervention procedures [length and number of treatment sessions], and overall study quality. The traditional neurofeedback articles were ranked as having the poorest quality and reported greatest symptom improvements in response to neurofeedback as a monotherapy. The articles describing alternative neurofeedback varied in their global quality and provided mixed results with regards to its efficacy as a treatment. Conclusions: The research provides initial evidence of the utility of neurofeedback in the treatment of FMS symptoms; however, additional high quality research is needed.
Objectives: Musculoskeletal pain is a common problem among nurses. This research was designed to investigate the non-specific musculoskeletal pain and vitamin D deficiency in female nurses working in Shahid Beheshti Hospital in Kashan, Iran in 2013.Methods: In this cross-sectional study, 200 female nurses were investigated for their 25-hydroxy vitamin D level [25-OH] and musculoskeletal non-specific pain. The Extended Nordic Musculoskeletal Questionnaire [NMQ-E] was used to determine the existence of pain in nine anatomic regions. The relationship between pain in every region and vitamin D deficiency was analyzed by the Mann-Whitney U and chi-square tests. All analyses were conducted with the SPSS computer package version 16.Results: The mean age of the nurses was 32.05 years. The mean of 25-OH vitamin D level was 16.96 ng/ml. The 178 nurses [89%] had vitamin D deficiency; in 91 nurses [45.5%] the deficiency was severe. The 178 nurses had pain in at least one region in the previous month. The pain in their upper and lower back and in ankles and feet had a significant relationship with vitamin D deficiency. The 25-OH, vitamin D level, and age could explain the 6.2% of total painful regions.Conclusions: The study showed that both hypovtaminosis D and musculoskeletal pain were common among nurses. The vitamin D deficiency was significantly related to musculoskeletal pain.
Objectives: Ultrasound-guided corticosteroid injection is an effective treatment for plantar fasciitis. We aimed to examine whether the eight scales of the Short Form-36 [SF-36] quality of life questionnaire could predict outcome of ultrasound-guided corticosteroid injection for plantar fasciitis. Methods: Sixteen patients [mean age 55.7 years] with unilateral plantar fasciitis received ultrasound-guided corticosteroid injections and all evaluations. The SF-36 questionnaire was administered and tenderness threshold [TT] was measured before injection, at 3 weeks, and at 3 months post-injection. Differences in the eight SF-36 scales among the three time points were examined. Furthermore, baseline measurements and changes in the SF-36 scales were examined for their association with changes in TT at 3 weeks and 3 months post-injection. Results: The scale "bodily pain" [BP] decreased significantly after injection [baseline versus 3 months post-injection: 46.25 +/- 11.73 versus 63.06 +/- 18.26; p = 0.036]. Baseline BP correlated with change in TT at 3 weeks [r = -0.554, p = 0.026]. The change in BP correlated with change in TT at 3 weeks [r = 0.594, p = 0.015] and at 3 months [r = 0.536, p = 0.032]. Conclusion: The BP scale can be used to predict the outcome of ultrasound-guided corticosteroid injection for plantar fasciitis. Less initial bodily pain leads to less improvement in objective inferior heel tenderness.
