Trigeminocervical reflex in fibromyalgia patients

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Trigeminocervical reflex in fibromyalgia patients.

Arch Phys Med Rehabil 2003 Jul;84(7):1087-9

Yuruten B; Ozerbil OM

OBJECTIVE: To describe the properties of trigeminocervical reflex in normal

subjects and in patients with primary fibromyalgia syndrome (PFS) having

neck pain. DESIGN: Prospective testing of trigeminocervical reflex. SETTING:

University hospital electromyography laboratory in Turkey. PARTICIPANTS:

Patients with PFS (n=16) and healthy volunteers (n=20). INTERVENTIONS:

Trigeminocervical reflex is a brainstem reflex that is evoked by stimulating

the sensory branches of the trigeminal nerve and can be recorded from the

neck muscles. Electric stimulation of the supraorbital nerve evokes a reflex

response (C3) and early reflex response (C1). The mean latencies of C1 and

C3 of patients with PFS were compared with normal values.Main Outcome

Measure: The C1 and C3 latencies of trigeminocervical reflex. RESULTS: In

healthy volunteers, C3 latency +/- standard deviation was 54.17+/-6.00ms

ipsilaterally and 51.25+/-9.26ms contralaterally. The difference was not

significant (P=.26). The C!

1 latency

was 17.46+/-4.89ms. In patients with PFS, C1 latency was 13.83+/-4.48ms and

the C3 latency was 62.70+/-18.22ms. The difference was not significant

between the patients (P=.08) and healthy volunteers (P=.17). CONCLUSION: In

patients with PFS having neck pain, trigeminocervical connections were not

influenced and some other mechanisms may be responsible for pain in these

patients.

Head and neck fibromyalgia and temporomandibular arthralgia.

Otolaryngol Clin North Am 1989 Dec;22(6):1159-71

Truta MP; Santucci ET

The attentive clinician can no longer be satisfied with global diagnostic

categories such as " TMJ syndrome " or " MPD syndrome. " Nor can one be content

with nonspecific diagnostic testing or generic referral. This article has

outlined specific components of head and neck pain originating in the

masticatory musculoskeletal system. Much progress has been made in recent

years, particularly in regard to diagnostic imaging. The future will bring

us data on long-term treatment efficacy and a better understanding of

chronic pain conditions that lack discrete organic lesions. Finally, the

manifestation of psychiatric or psychologic abnormalities as pain is under

scientific scrutiny and a better understanding of conversion phenomena will

assure proper use of available treatment modalities.

Effects on muscle pain by intramuscular injection of granisetron in patients

with fibromyalgia.

Pain 2003 Feb;101(3):275-82

Ernberg M; Lundeberg T; Kopp S

We have previously reported that the level of 5-HT in the masseter muscle is

increased in patients with fibromyalgia as compared with healthy subjects

and that high intramuscular level of 5-HT is associated with muscle pain. We

have also reported that injection of the 5-HT(3) receptor antagonist

granisetron (GRA) into the masseter muscle of healthy subjects reduced pain

induced by 5-HT and abolished allodynia/hyperalgesia. The aim of this study

was to investigate whether GRA can influence pain and allodynia/hyperalgesia

of the masseter muscle in patients with fibromyalgia. Eighteen female

patients who met the criteria of fibromyalgia according to the American

College of Rheumatology participated in the study. They were examined

regarding pain intensity and pressure pain threshold (PPT) over the masseter

muscle. One milliliter of GRA (1 mg/ml) was injected into the masseter

muscle on one side and 1 ml of isotonic saline on the other side in a

randomized and double-blind manne!

r. After

the injections, the pain intensity and PPT were recorded during 30 min. The

pain intensity increased after injection of saline and to a lower degree

after injection of GRA. The PPT increased after injection of GRA, while no

such change was observed after saline. The difference between GRA and saline

was, however, not significant. Eight of the patients responded to the GRA

injection by an increase of PPT during the experimental period that differed

from saline. They also showed a tendency to a lower increase of pain

intensity after injection of GRA when compared to saline. In conclusion, the

results of this study do not prove that injection of the 5-HT(3)-antagonist

GRA into the masseter muscle influences local pain and

allodynia/hyperalgesia in patients with fibromyalgia

Effect on prostaglandin E2 and leukotriene B4 levels by local administration

of glucocorticoid in human masseter muscle myalgia.

Acta Odontol Scand 2002 Jan;60(1):29-36

Hedenberg-Magnusson B; Ernberg M; Alstergren P; Kopp S

Our aim was to determine whether masseter muscle (M) and plasma (P) levels

of prostaglandin E2 (PGE2) or leukotriene B4 (LTB4) are influenced by local

glucocorticoid administration and whether such changes would be associated

with corresponding changes in local pain or hyperalgesia. Eighteen patients

with fibromyalgia and 15 with local masseter myalgia were examined

immediately before and 2 weeks after intramuscular administration of

glucocorticoid with regard to masseter muscle resting pain and tenderness to

palpation, pressure pain threshold, maximum voluntary mouth opening (MVM),

and pain on maximum voluntary mouth opening. The primary criteria for

inclusion were presence of pain for a period of at least 3 months and

tenderness to digital palpation in the masseter muscle region. At both

visits microdialysis samples were obtained from the masseter muscle, and

venous blood was collected for analysis of PGE2 and LTB4. Dialysate levels

of M-PGE2 did not change significantly a!

fter

glucocorticoid administration, but reduction of masseter resting pain and

increase of MVM were associated with decrease of M-PGE2 in the patients with

fibromyalgia. Dialysate levels of M-LTB4 increased in both groups. In the

patients with local myalgia the plasma level of LTB4 also increased, and

this increase was associated with a decrease of pain and masseter

tenderness. In conclusion, this study shows that reduction of masseter level

of PGE2 after intramuscular glucocorticoid administration is associated with

a decrease of resting pain in patients with fibromyalgia. In addition, the

masseter muscle level of LTB4 increases in patients with fibromyalgia and

local myalgia.

Pain mediation by prostaglandin E2 and leukotriene B4 in the human masseter

muscle.

Acta Odontol Scand 2001 Dec;59(6):348-55

Hedenberg-Agnusson B; Ernberg M; Alstergren P; Kopp S

The pathophysiology behind chronic pain from masticatory muscles is unclear.

Our hypothesis was that this pain is of inflammatory origin and associated

with release of inflammatory mediators. The aim of this study was therefore

to investigate the presence of prostaglandin E2 (PGE2) and leukotriene B4

(LTB4) in the masseter muscle and plasma and their relation to myalgia.

Nineteen patients with fibromyalgia, 19 with local myalgia of the masseter

muscle, and 11 healthy individuals were examined with regard to local

muscular pain intensity at rest and pressure pain threshold. Inclusion

criteria were masseter muscle pain for at least 3 months and masseter muscle

tenderness on digital palpation. Samples were obtained from the masseter

muscle by microdialysis, and the dialysates and venous blood samples were

analyzed with regard to PGE2 and LTB4 concentration. Intramuscular levels

were found in all groups, with significantly higher levels of LTB4 in the

patients with fibromyalgia,!

in whom

PGE2 was positively correlated to muscular pain. In the healthy individuals

PGE2 was negatively correlated to pressure pain threshold. In both patient

groups but not in the healthy individuals LTB4 increased during the

consecutive samplings. PGE2 and LTB4 were detectable in the plasma of all

groups. In conclusion, both PGE2 and LTB4 were found in the human masseter

muscle. LTB4 levels are increased on needle trauma in patients with myalgia.

PGE2 levels are related to muscular pain in patients with fibromyalgia.

Masseter muscle pain therefore seems to be partly of peripheral inflammatory

origin in fibromyalgia.

Fibromyalgia in dentistry]]

[La fibromyalgie en medecine dentaire.]

J of Can Dent Assoc 1996 Nov;62(11):874-6, 879-80

Avon SL

Fibromyalgia represents one of the most frequent musculoskeletal problems.

This condition, associated with widespread pain, is characterized by a

number of specific tender points, as well as symptoms such as tiredness,

limb stiffness, depression and a lack of refreshing sleep. Patients

suffering from fibromyalgia can also demonstrate the same clinical features

as temporomandibular disorders or myofascial pain. Dentists should be aware

that certain dental treatments will not be effective in patients suffering

from temporal and masseter pain if fibromyalgia has been diagnosed.

Frequency and impact of regional musculoskeletal disorders

Baillieres Best Pract Res Clin Rheumatol 1999 Jun;13(2):197-215

Linaker CH; -Bone K; Palmer K; C

Regional musculoskeletal disorders are a major cause of morbidity both in

the community and in the workplace. They comprise a heterogeneous group of

conditions that are, for the most part, poorly characterized. Consequently,

agreed diagnostic criteria have not existed for many of these disorders, and

epidemiological investigations have used varied or ill-defined approaches to

case definition. This chapter describes our current understanding of the

epidemiology of regional pain disorders and details the strengths and

weaknesses of the available data. Pain syndromes can be divided anatomically

into those which cause generalized pain, such as fibromyalgia syndrome and

myofascial pain syndromes, and those which are confined to one regional

anatomical area. The latter group comprise those of the neck, shoulder,

elbow, wrist/hand, hip, knee and ankle/foot. Current information is

considered on the known risk factors for disorders at these sites, in

addition to their impact upon both the individual and society.

[Guest guest]

Bonnie~~

Thank you for these articles.

They were very interesting for me.. Queen of Fibro Flares!

Debbi

[Guest guest]

You're welcome. They came across my speech dysphagia list....

Re: Trigeminocervical reflex in fibromyalgia patients

Bonnie~~

Thank you for these articles.

They were very interesting for me.. Queen of Fibro Flares!

Debbi

[Guest guest]

You're welcome. They came across my speech dysphagia list....

Re: Trigeminocervical reflex in fibromyalgia patients

Bonnie~~

Thank you for these articles.

They were very interesting for me.. Queen of Fibro Flares!

Debbi

[Guest guest]

You're welcome. They came across my speech dysphagia list....

Re: Trigeminocervical reflex in fibromyalgia patients

Bonnie~~

Thank you for these articles.

They were very interesting for me.. Queen of Fibro Flares!

Debbi