Myofascial pain

Finally, local anesthetics can be administered via a transdermal patch.1 In particular, transdermal patches containing 5% lidocaine have been used to treat localized pain in musculoskeletal conditions (osteoarthritis, low back pain, myofascial pain)22,25,26 and various types of neuropathic pain (postherpetic neuralgia, diabetic neuropathy).2,24,58 As indicated in Chapter 2, transdermal patches provide a convenient and predictable method for administering drugs to a given anatomical site, and lidocaine patches are now being used to provide symptomatic relief in many conditions involving fairly localized pain. 

Dalpiaz AS, Lordon SP, Lipman AG. Topical lidocaine patch therapy for myofascial pain. J Pain Palliat Care Pharfnacother. 2004 18 15-34. 

The use of BoNT/A has been increasingly reported in many conditions of pathological pain, including migraine and other headache disorders (Aoki 2003 Binder and Blitzer 2003), musculoskeletal pain, such as myofascial pain, low back pain, and other chronic pain syndromes (Luvisetto et al. 2007 Reilich et al. 2004 Sycha et al. 2004). 

Sejersted, O. M., Vollestad, N. K. (1993). Physiology of muscle fatigue and associated pain. In H. Vreroy H. Merskey (Eds.), Progress in fibromyalgia and myofascial pain (pp. 41-51). Amsterdam, The Netherlands Elsevier. 

PainEase is a mixture of two fluorocarbons dispensed in spray cans. PainEase is a vapocoolant (skin refrigerant) spray for topical application to skin, intact mucous membranes (oral cavity, nasal passageways and the lips) and minor open wounds [5]. PainEase controls pain associated with injections (venipuncture, IV starts, cosmetic procedures), minor surgical procedures (such as lancing boils, incisions, drainage of small abscesses and sutures) and the temporary relief of minor sports injuries (sprains, bruising, cuts and abrasions). PainEase can also be used for myofascial release procedures employed in physical therapy or physiatry to manage myofascial pain. 

Valproic acid migraine prophylaxis, chronic pain Phenytoin diabetic neuropathy, cancer pain Clonazepam trigeminal neuralgia, myofascial pain, migraine prophylaxis... 

Chronic non-malignancy pain antihistamines may be helpful in patients with myofascial pain, as one... 

Some pain has been correlated to the existence of interleukin substances that have been described as necessary members of an inflammatory healing cascade. Substance P has been found in elevated levels, especially in people with chronic myofascial pain syndromes. Medications such as capsaicin are thought to contribute to analgesic control of pain by blocking the formation of substance P. 

The pathophysiologic mechanisms of TTH are not clearly understood. The pain is thought to originate in the myofascial tissues of the head, but central brain processing is believed to be an important modulator of pain perception.14... 

Pain is thought to originate from myofascial factors and peripheral sensitization of nociceptors. Central mechanisms are also involved. Mental stress, nonphysiologic motor stress, a local myofascial release of irritants, or a combination of these may be the initiating stimulus. In predisposed individuals, chronic, tension-type headache can evolve. 

Reilich P, Fheodoroff K, Kern U, Mense S, Seddigh S et al. (2004) Consensus statement botulinum toxin in myofascial [corrected] pain. J Neurol 251 Suppl 1 136-8 Rickman C, Davletov B (2005) Arachidonic acid allows SNARE complex formation in the presence of Muncl8. Chem Biol 12 545-53... 

Ethyl chloride, a halogenated hydrocarbon with local anesthetic and counterirritant properties, is used as a local anesthetic in minor operative procedures and to relieve pain caused by insect stings and bums and as a counterirritant to relieve myofascial and visceral pain syndromes. 

Systematic reviews In a systematic review tizanidine was found to be very usefiil in patients with spasticity caused by multiple sclerosis, acquired brain injury, or spinal cord injury [ Q ]. It can also be helpful in patients with chronic neck and/or lower back pain who have a myofascial component to their pain. Doses should be gradually titrated upwards. 

Myofascial techniques are useful in breaking the pain-muscle tension-pain cycle. Increasing the circulation to and drainage from the tissues may aid in diminishing the inflammatory response. 

She was treated with gentle myofascial, soft-tissue teehniques to the paravertebral muscles and all tender points were treated with counterstrain techniques. She was given gentle stretching and flexibility exercises. She was given instructions on care of the back, especially how and what she could lift, and how to prevent falls. She was given a prescription for alendronate. She was treated with osteopathic manipulation weekly for 3 weeks, then every 2 weeks for 2 months. The somatic dysfunctions resolved and she had less back pain. 

Mrs. R. was admitted to labor and delivery and a normal spontaneous vaginal delivery was anticipated. Her first stage of labor was uneventful. She refused epidural anesthesia and reached full dilatation 4 hours after admission. During this phase of labor, her muscular back pain was treated with gentle myofascial stretching techniques. In general, obstetric patients in active labor tolerate these types of soft tissue techniques. However, as labor pain intensifies, patients may be unable to bear any manipulative treatment. This patient expressed relief of her muscular back pain but was unable to endure treatment of the sacrum and iliopsoas because of labor pain. 

Myofascial soft tissue treatment with counterstrain and muscle energy techniques may relieve the facial pain associated with Bell s palsy. The occipitomastoid compression should be released and the temporal bone assisted into normal internal/external rotation. Normal lymphatic flow should be assured by correcting dysfunctions of the cervical spine, cranial motion, and sacrum. C3 should always be evaluated and any dysfunction corrected. 

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