Children with migraine: Provocation of headache via pressure to myofascial trigger points in the trapezius muscle? – A prospective controlled observational study

Abstract

Background

The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine.

Methods

Children ≤18 years with the confirmed diagnosis of migraine were prospectively investigated. Comprehensive data on medical history, clinical neurological and psychological status were gathered. Trigger points in the trapezius muscle were identified by palpation and the threshold of pressure pain at these points was measured. Manual pressure was applied to the trigger points, and the occurrence and duration of induced headache were recorded. At a second consultation (4 weeks after the first), manual pressure with the detected pressure threshold was applied to non-trigger points within the same trapezius muscle (control). Headache and related parameters were again recorded and compared to the results of the first consultation.

Results

A total of 13 girls and 13 boys with migraine and a median age of 14.5 (Range 6.3–17.8) years took part in the study. Manual pressure to trigger points in the trapezius muscle led to lasting headache after termination of the manual pressure in 13 patients while no patient experienced headache when manual pressure was applied to non-trigger points at the control visit (p < 0.001). Headache was induced significantly more often in children ≥12 years and those with internalizing behavioural disorder.

Conclusion

We found an association between trapezius muscle myofascial trigger points and migraine, which might underline the concept of the trigemino-cervical complex, especially in adolescents.

Significance

In children with migraine headache can often be induced by pressure to myofascial trigger points, but not by pressure to non-trigger points in the trapezius muscle. This supports the hypothesis of a trigemino-cervical-complex in the pathophysiology of migraine, which might have implications for innovative therapies in children with migraine.

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Effects of duloxetine on pain and walking distance in neuropathic pain models via modulation of the spinal monoamine system

Abstract

Background

Approximately 40% of patients with chronic low back pain have a neuropathic component. In this study, we assessed the effects of analgesics on tactile hypersensitivity and walking distance in the rat cauda equina compression (CEC) model of neuropathic low back pain.

Methods

The effects of analgesics on tactile hypersensitivity were examined using the von Frey test in CEC and partial sciatic nerve ligation (pSNL) models. Effects on walking distance were assessed using a treadmill test. Levels of α2δ1 subunit and ATF-3 mRNA in dorsal-root ganglion (DRG) neurons and those of α2δ1 subunit protein in the spinal cord were determined using quantitative RT-PCR and western blotting, respectively. Histological features were assessed using immunohistological methods.

Results

Histological changes indicating nerve damage (increase in ATF-3 mRNA, decrease in NF-200 and an increase in CD68 immunoreactivity) were observed in the CEC model. Duloxetine had analgesic effects in both models and improved walking distance in the CEC model. Pregabalin had analgesic effects in both models; however, the effect was weaker in the CEC model than in the pSNL model. α2δ1 subunit expression in DRG neurons and in the spinal cord was unchanged in the CEC model, but significantly increased in the pSNL model. Indomethacin had no analgesic effect in either model. Intrathecal yohimbine inhibited the effects of duloxetine with significant effects on depression.

Conclusions

These findings suggest that the analgesic effects of duloxetine are mainly mediated by the spinal monoamine system, independent of the antidepressant effects of this agent.

Significance

The findings of this study suggest that duloxetine may be an effective treatment of broad neuropathic pain states, including neuropathic low back pain. The analgesic effects of duloxetine might be mediated by alterations of the descending pain modulatory pathways in the spinal cord, independent of the antidepressant effects.

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Sleep Mediates the Association between PTSD Symptoms and Chronic Pain in Youth

• Sleep quality partially mediated the association between post-traumatic stress symptoms (PTSS) and pain characteristics among a cohort of youth with chronic pain.• Higher PTSS was associated with higher levels of both pain intensity and pain interference and these PTSS-pain relationships were partially explained by poor sleep quality.• Findings provide empirical support for the pediatric model of mutual maintenance in PTSS and chronic pain, which posits that sleep disturbance is a key intrapersonal factor driving this co-occurrence.

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Attentional control and the competition between nonpain goals and the threat of pain

Abstract

Background

Fully understanding attention to pain requires taking into account the motivational context. Both pain- and (nonpain) goal-related information attracts attention. An intriguing question is which attentional bias prevails when pain- and goal-related information co-occurs? Reduced attentional bias towards pain- and goal-related information was predicted when the other competing information was presented simultaneously. Moreover, trait attentional control was predicted to be associated with stronger attentional bias towards goal-related information particularly in the presence of pain-related information.

Methods

Attentional competition between pain- and (nonpain) goal-related information was measured in ninety participants using a dot-probe task presenting two stimuli (pain-related, goal-related or neutral) simultaneously. Reaction time was the dependent variable. Dot-probe trials alternated with goal trials to induce a temporary goal. Trait attentional control was measured with the attentional control scale.

Results

For pain-related neutral stimulus pairs, participants responded fastest when probes appeared on the same, compared to the opposite, location as the pain-related stimulus. For pain-goal-related stimulus pairs, responses were fastest when probes appeared on the same, compared to the opposite, location as the goal-related stimulus. Higher trait attentional control was associated with faster responding when probes appeared on the same, compared to the opposite, location as the goal-related stimulus. Unpredicted, this effect was irrespective of the co-occurring stimulus (neutral vs. pain-related).

Conclusions

The findings suggest that the unintentional allocation of attention towards events related to a temporary (nonpain) goal prevails over attentional bias to events predicting pain. Trait attentional control predicts stronger attentional allocation towards events related to a temporary goal.

Significance

These findings indicate that treatment interventions facilitating goal pursuit in patients with chronic pain are beneficial in reducing attentional biases towards pain-related events.

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New approach for the treatment of neuropathic pain: Fibroblast growth factor 1 gene-transfected adipose-derived mesenchymal stem cells

Abstract

Background

Neuropathic pain triggered by peripheral nerve lesion is extremely difficult to manage with current approaches, hence the importance of exploring therapeutic alternatives.

Methods

We have analysed adipose-derived mesenchymal stem cells (AD-MSCs) and fibroblast growth factor 1 gene-transfected adipose-derived mesenchymal stem cells (AD-MSCs ^FGF1) on chronic constriction injury (CCI). The mechanical and thermal hypersensitivity were assessed using the von Frey filament, radiant heat and acetone drop tests. Histopathological and apoptotic changes and the level of FGF1, GFAP and TNFα proteins were assessed in the lumbar portion (L4–L6). Moreover, AD-MSCs ^FGF1 were labelled with ^99mTc -HMPAO and isolated organ counting were performed upon AD-MSCs ^FGF1 administration.

Results

Administration of AD-MSCs ^FGF1 attenuated the CCI-induced mechanical and thermal hypersensitivity. Spinal structural alterations and apoptosis were decreased in the AD-MSCs ^FGF1 group. The injection of either phosphate-buffered saline or normal NIH3T3 fibroblasts could not attenuate the behavioural symptoms of neuropathic pain. Increased genetically engineered cells were counted in the injured sciatic nerve and the elevated levels of FGF1 were detected in the spinal tissue. Stem cell therapy lead to decrement the level of the CCI-induced TNF-α and GFAP expression.

Conclusion

The intravenous administration of AD-MSCs ^FGF1 could be considered as a potential remedy for the management of neuropathic pain.

Significance

AD-MSCs ^FGF1 attenuated the CCI-induced mechanical and thermal hypersensitivity. Spinal structural alterations and apoptosis were significantly decreased in the AD-MSCs ^FGF1 group. Elevated levels of FGF1 were detected in the spinal tissue.

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Effects of Scapular Stabilization Exercise Training on Scapular Kinematics, Disability, and Pain in Subacromial Impingement: A Randomized Controlled Trial

Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion