Pursuing the Myofascial Pain Syndrome

The lead article for this issue of the Journal of Musculoskeletal Pain [JMP] comes from Minneapolis, Minnesota, USA ([1]). The authors are dentists with an interest in the myofascial pain syndrome [MPS], as it affects the muscles of mastication. It would not surprise anyone to learn that their interest in this disorder was prompted, at least in part, by the long-time commitment to that disorder by the local University of Minnesota dental school faculty member, James Fricton, DDS. Dr. Fricton was one of the organizers of the first international MYOPAIN meeting, which was held in Minneapolis. He supported the formation of the International MYOPAIN Society [IMS] and continues to serve on the IMS Board. He is also a productive member of the JMP Editorial Board.

It can prove difficult to learn about and conduct research regarding an orphan condition in the atmosphere of a nonsupportive institution. While there was no direct mention of Dr. Fricton in this paper outside the reference section, it is recognized that the influence of a strong supporter of an orphan disorder in an institution can facilitate local interest, learning, and research regarding that disorder. This effect can be viewed as the leadership creating a permissive atmosphere and generating a critical mass of local support.

The objectives of the Minneapolis authors' study were to determine the pH in masseter muscles of subjects with MPS, and to compare the pH readings from the most tender muscle areas [presumably, an active trigger point [TrP]] with the pH in more normal muscle areas in patients and in healthy normal controls [HNC]. The study involved 14 female subjects who met criteria for MSP and 14 demographically matched HNC subjects. This is a substantially larger sample size than was utilized in a previous study ([2]) of pH in the muscle of patients with MPS. The reader is referred to the article to learn what was found and what the findings may mean.

From several dental universities in Turkey comes a report of serum antioxidant levels in patients with MPS involving muscles of mastication ([3]). The authors comment that low levels of antioxidant had been previously documented for orofacial pain ([4]), fibromyalgia syndrome [FMS] ([5], [6]), and rheumatoid arthritis ([7]). In their own study, the authors involved 31 women with MPS of a masticator muscle and 35 age-matched HNC. Their findings are very interesting and support the author's hypotheses, but oxidative stress in these very different kinds of disorders is seeking a plausible explanation.

From two universities in China and from the National Research Institute of Sports Medicine in Biejing, China, comes a report exploring the effects of repeated exercise on calapain and calpastatin-induced muscle injury in rats ([8]). These non-lysosomal cysteine proteases are capable of degrading muscle proteins. The study was undertaken to determine whether production of these enzymes might increase substantially with repeated aggressive exercise. One can imagine that the grueling exercise training required of Olympic athletes was on the minds of the investigators as they undertook this project. Muscle histomorphology and reverse transcription-polymerase chain reaction followed by Western blot analysis of specific messenger ribonucleic were used to generate data from each of the exercise conditions. The results show significant differences by exercise group, which the authors interpret.

From Dallas, Pennsylvania, USA, with a number of contributors comes a report of the development and field-testing of a pain and functional performance assessment instrument for individuals with chronic pain ([9]). This document outlines the developmental history of a new interview-administered instrument which takes about one hour to accomplish. The instrument is copyrighted by the developers, but they offer the instrument in this issue of JMP free of charge to health care professionals who wish to use it. There are several named components but there is currently no single composite score. Health care professionals are encouraged to use the information gained from the interview format in conjunction with other available information about a given subject to compose a comprehensive view of the challenges faced by the person who is living with chronic pain.

From Dokuz Eylül University in İnciralti, İzmir, Turkey comes the report of a study of 75 patients with spinal injury from disc herniation classified as minimal, moderate and severe dysfunction ([10]). A questionnaire instrument was used to determine the level of the study subject's intention to perform therapeutic exercise. The authors outline one exercise program planned for the patient with cervical level disease and another planned for patients with lumbar level disease. Several factors were considered, such as perceived consequences, social factors, and a category named “affect” which identified feelings on a semantic differential scale.

From the Medical School affiliated with the University of Gaziantep, Gaziantep, Turkey, comes the report of a study to answer the question: “Which is more effective, betamethasone [14 mg] or triamcinolone [80 mg] as the anti-inflammatory agent injected epidurally in patients with unilateral discogenic pain?” ([11]). There were 70 patients randomly assigned to one of the two treatment groups. All study subjects were given 10 to 50 mg/day of oral amitriptyline. Patients who had incomplete responses were given a second injection at week two and a third at week six. The authors give their answer to the question at hand.

In this issue of the JMP, we again highlight two synopsis papers from the conference on FMS held in Veldhoven, The Netherlands, in conjunction with the 20th anniversary of the Dutch Fibromyalgia Association on May 12–13, 2006. The overall theme was “Multidisciplinary Treatment of the Fibromyalgia Syndrome.” The speakers were Robert Bennett, Rinie Geenen Karl Henriksson, Kaisa Mannerkorpi, Boudewijn Van Houdenhove, Johan W.S. Vlaeyen, and Muhammad Yunus. The manuscripts resulting from most of those lectures have been peer reviewed and will be included in sequential issues of the JMP until we have published all that are available. The first paper in this issue [the fifth in the series] is by Kaisa Mannerkorpi from Góteborg University, Gõteborg Sweden ([12]) in which she reviews the role of exercise in the management of FMS. The second paper is by Johan W. S. Vlaeyen from the University of Leuven, Leuven, Belgium and Maastricht University, Maastricht, The Netherlands and Stephen Morley from the University of Leeds, Leeds, United Kingdom ([13]). In their paper, Vlaeyen and Morley review the literature and their own experience with cognitive and behavioral factors in FMS. They explain what is meant by the Mood-as-Input Model in the context of task performance.

Readers of JMP are again provided three columns with summaries of the important new developments in soft tissue pain published in other medical journals since the prior issue of JMP. These features not only provide a comprehensive review of what is new in the field, but also allow readers to benefit from illuminating commentary by experts from the two continents.

As always, readers of JMP are invited to submit original manuscripts for blinded peer review, case reports of general interest, research ideas to promote further investigation, and letters to keep us all informed. The JMP editorial office frequently receives relevant books to be evaluated by and for the benefit of our readers. Book reviewers are allowed to keep the featured book after the evaluation report is completed. If you would be interested in being a book reviewer for the JMP, please communicate that to the editor.

The clear mandate of the International MYOPAIN Society [IMS] is to perpetuate the international meeting that is currently held every three years. The most recent International MYOPAIN Meeting was held in Washington, DC, USA on August 19–23, 2007. The manuscripts from the invited speakers were published in JMP, volume 16(1/2) as a combined special symposium issue. Those who were unable to attend the meeting and those who wish to jog their memory regarding some aspects of a given presentation will want to see that issue. The IMS staff members are already working on the myriads of details in preparation for the 2010 meeting to be held in Toledo, Spain. The IMS website www.myopain.com will offer details as they become available.