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537 MUSCLE TRIGGER POINTS IN SUBJECTS WITH FIBROMYALGIA SYNDROME: PRELIMINARY RESULTS
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Poster Sessions / European Journal of Pain 13 (2009) S55–S285
suffered from moderate pain whereas none of the patients complained of unbearable or unbearable continuous pain when chewing or moving the mandible. On a visual analogue scale (range 0–10), 74% of the patients put their marks between 0 and 2, 7% between 2.1 and 4, 12% between 4.1 and 6 and 4% marked values greater than 6 on the scale. Conclusion: Arthrocentesis and lavage of the TMJ is an effective method for the treatment of articular temporomandibular joint pain. 535 CHANGES IN PRESSURE PAIN THRESHOLDS OF MIGRAINE PATIENTS IN RESPONSE TO PSYCHOSOCIAL STRESS 2 ¨ ceyler ¸ , C.L. Sommer3 . 1 University of A.K. Puschmann1 *, N. U Wuerzburg, W¨ urzburg, Germany; 2 Julius-Maximilians Universit¨ at, W¨ urzburg, Germany; 3 University of Wuerzburg, Wuerzburg, Germany Aims: Psychosocial stress is reported to be a major trigger factor of migraine attacks. In our study we investigate pressure pain thresholds (PPTs) of patients with migraine compared to healthy controls before and after a psychosocial stress test. Methods: To date N = 35 migraine patients and N = 9 healthy controls were examined. Patients were diagnosed according to the International Headache Society criteria and had a mean headache frequency of 9 days per month. All patients were free of headache and medication for 48 hours before assessment. A 20 minutes psychosocial stress task was conducted consisting of a speech and a mental arithmetic task under social evaluation. PPT were assessed before and after stress exposition, using a pressure pain algometer. Results: Groups did not differ regarding their baseline PPTs (2.7 vs. 2.5 kg/cm2 ). ANOVA with repeated measures revealed a significant main effect for stress (F(1;41) = 5.74, P = .02). The stress X group interaction reached marginal significance (F(1;41) = 3.42, P = .07). Controls showed a significantly greater change in PPTs between timepoints than patients (0.52 vs. 0.02 kg/cm2 ; P = .01). Discussion: Stress is known to elicit changes in pain sensitivity. Mild psychosocial stress should lead to decreases in pain thresholds. Our results show the expected changes in healthy controls after mild social stress but we could not find the same changes in migraine patients. These results suggest altered stress responses in migraine patients which could contribute to attack development after stress. 536 QUALITY OF LIFE IN MIGRAINE: PSYCHOLOGICAL FACTORS’ PREDOMINANCE? N. Starikova *. Perm State Medical Academy, Perm, Russia Background: Quality of life (QoL) reflects not the disease itself, but the influence of the disease on the life of the patient, so psychological factors may play an important role. We studied QoL in migraine in dependence on clinical features of the disease and psychological features of patients. Patients and Methods: 65 migraine patients and 10 healthy persons aged 18–56 were investigated and clinical features of the disease were documented. Migraine-specific QoL questionnaire QVM, generic Gotheborg QoL Inventory (GQI), Spielberger’s and Beck’s Inventories, MIDAS disability score, Vanderbielt Questionnaire were used. Results: Qol in migraine appeared to be poor. Scores of QVM and Goetheborg Questionnaires strongly correlated (p = 0.011–0.00001). Global index of QVM did not depend on patients’ age, length of the disease, pain intensity, frequency and duration of attacks, but correlated with MIDAS score (p = 0.017), non-adaptive coping strategies (p = 0.00009), anxiety (p = 0.0007) and depression (p = 0.002). Functional index of QVM depended on anxiety and depression levels and on non-adaptive coping strategies preference (p = 0.002). Psychological index correlated with the levels of anxiety and depression, MIDAS score and passive coping strategies.
Social index of QVM depended on the attacks’ duration, anxiety, depression and non-adaptive coping strategies score. Conclusion: All QVM indexes strongly inversely correlated with levels of anxiety and depression and passive coping strategies preference. So in QoL of migraine patients psychological peculiarities seem to prevail over the clinical features of the disease. 537 MUSCLE TRIGGER POINTS IN SUBJECTS WITH FIBROMYALGIA SYNDROME: PRELIMINARY RESULTS ´ C. Fernandez-de-las-Pe ´ nas ˜ 1 , C. Alonso-Blanco1 , J. Fernandez1 2 2 1 Carnero *, P. Zarco , M. Florez-Garcia ´ . Universidad Rey Juan Carlos, Alcorc´ on, Spain; 2 Fundaci´ on Hospital Alcorc´ on, Alcorc´ on, Spain Background and Aim: It is suggested that muscle trigger points (TrPs) can be involved in fibromyalgia syndrome (FMS). Our aim was to investigate in a blinded design the presence of TrPs in 12 pair of muscles in FMS when compared to controls. Methods: Ten women (age: 48±8 years) diagnosed with FMS according to the ACR criteria and 10 healthy women (age: 47±9 years) participated. TrPs in upper trapezius, sternocleidomastoid, suboccipital, splenius capitis, levator scapulae, scalene, temporalis, masseter, extensor carpi radialis brevis, extensor digitorum communis, piriformis and tibialis anterior muscles were bilaterally identified according to Simons et al. criteria: hyperirritable spot in a taut band, local twitch response and referred pain. TrPs were active if the referred pain reproduced pain symptoms, whereas TrPs were latent when the referred pain did not reproduce symptoms. Results: The mean number of TrPs in FMS patients was 9.4 (SD: 1.9) active TrPs and 1.5 (SD: 2.0) latent TrPs. Controls only exhibited latent TrPs (1.5±0.5). Significant difference between groups were found for active (P < 0.001), but not latent TrPs (P = 0.8). Active TrPs in the upper trapezius (n = 9, n = 6 right/left side), extensor carpi radialis brevis (n = 8, n = 7), masseter (n = 6, n = 5) and piriformis (n = 5, n = 5) muscles were the most prevalent within FMS subjects. Conclusions: The referred pain elicited from active muscle TrPs may be implicated in the genesis of FMS. 538 MYOFASCIAL TRIGGER POINTS IN SUBJECTS WITH WHIPLASH SYNDROME: A PILOT STUDY 1 , C. Fernandez-de-las-Pe ´ nas ˜ 2 , J. Fernandez´ A. Fernandez-P ´ erez ´ 1 Carnero2 *, M. Arroyo-Morales1 , C. Villaverde-Gutierrez ´ , C. Moreno-Lorenzo1 . 1 Universidad de Granada, Granada, Spain; 2 Universidad Rey Juan Carlos, Alcorc´ on, Spain Background and Aim: It is suggested that muscle trigger points (TrPs) can be involved in the genesis of the pain in whiplash associated disorders (WAD). Our aim was to investigate in a blinded design the presence of TrPs in 7 pair of muscles in WAD when compared to controls. Methods: Six male and 4 female (age: 30±5 years) diagnosed with WAD grade II and 10 matched controls (age: 31±6 years) participated. TrPs in the upper trapezius, suboccipital, scalene, levator scapulae, sternocleidomastoid, temporalis and masseter muscles were bilaterally explored following Simons et al criteria: hyperirritable spot in a palpable taut band, local twitch response elicited by snapping palpation and presence of referred pain. TrPs were active if the referred pain reproduced symptoms of the subject, and TrPs were latent when the referred pain did not reproduce symptoms. Results: The mean number of TrPs on each WAD subject was 4.8 (SD: 1.6) active TrPs and 2.5 (SD: 1.2) latent TrPs. Controls only exhibited latent TrPs (mean: 2.5; SD: 0.5). Significant difference between groups were found for active (P < 0.001), but not latent TrPs (P = 0.9). Active TrPs in the levator scapulae (n = 9, n = 9 right/left side), upper trapezius (n = 6, n = 5), and scalene (n = 4, n = 3) muscles were the most prevalent in WAD subjects.
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
suffered from moderate pain whereas none of the patients complained of unbearable or unbearable continuous pain when chewing or moving the mandible. On a visual analogue scale (range 0–10), 74% of the patients put their marks between 0 and 2, 7% between 2.1 and 4, 12% between 4.1 and 6 and 4% marked values greater than 6 on the scale. Conclusion: Arthrocentesis and lavage of the TMJ is an effective method for the treatment of articular temporomandibular joint pain. 535 CHANGES IN PRESSURE PAIN THRESHOLDS OF MIGRAINE PATIENTS IN RESPONSE TO PSYCHOSOCIAL STRESS 2 ¨ ceyler ¸ , C.L. Sommer3 . 1 University of A.K. Puschmann1 *, N. U Wuerzburg, W¨ urzburg, Germany; 2 Julius-Maximilians Universit¨ at, W¨ urzburg, Germany; 3 University of Wuerzburg, Wuerzburg, Germany Aims: Psychosocial stress is reported to be a major trigger factor of migraine attacks. In our study we investigate pressure pain thresholds (PPTs) of patients with migraine compared to healthy controls before and after a psychosocial stress test. Methods: To date N = 35 migraine patients and N = 9 healthy controls were examined. Patients were diagnosed according to the International Headache Society criteria and had a mean headache frequency of 9 days per month. All patients were free of headache and medication for 48 hours before assessment. A 20 minutes psychosocial stress task was conducted consisting of a speech and a mental arithmetic task under social evaluation. PPT were assessed before and after stress exposition, using a pressure pain algometer. Results: Groups did not differ regarding their baseline PPTs (2.7 vs. 2.5 kg/cm2 ). ANOVA with repeated measures revealed a significant main effect for stress (F(1;41) = 5.74, P = .02). The stress X group interaction reached marginal significance (F(1;41) = 3.42, P = .07). Controls showed a significantly greater change in PPTs between timepoints than patients (0.52 vs. 0.02 kg/cm2 ; P = .01). Discussion: Stress is known to elicit changes in pain sensitivity. Mild psychosocial stress should lead to decreases in pain thresholds. Our results show the expected changes in healthy controls after mild social stress but we could not find the same changes in migraine patients. These results suggest altered stress responses in migraine patients which could contribute to attack development after stress. 536 QUALITY OF LIFE IN MIGRAINE: PSYCHOLOGICAL FACTORS’ PREDOMINANCE? N. Starikova *. Perm State Medical Academy, Perm, Russia Background: Quality of life (QoL) reflects not the disease itself, but the influence of the disease on the life of the patient, so psychological factors may play an important role. We studied QoL in migraine in dependence on clinical features of the disease and psychological features of patients. Patients and Methods: 65 migraine patients and 10 healthy persons aged 18–56 were investigated and clinical features of the disease were documented. Migraine-specific QoL questionnaire QVM, generic Gotheborg QoL Inventory (GQI), Spielberger’s and Beck’s Inventories, MIDAS disability score, Vanderbielt Questionnaire were used. Results: Qol in migraine appeared to be poor. Scores of QVM and Goetheborg Questionnaires strongly correlated (p = 0.011–0.00001). Global index of QVM did not depend on patients’ age, length of the disease, pain intensity, frequency and duration of attacks, but correlated with MIDAS score (p = 0.017), non-adaptive coping strategies (p = 0.00009), anxiety (p = 0.0007) and depression (p = 0.002). Functional index of QVM depended on anxiety and depression levels and on non-adaptive coping strategies preference (p = 0.002). Psychological index correlated with the levels of anxiety and depression, MIDAS score and passive coping strategies.
Social index of QVM depended on the attacks’ duration, anxiety, depression and non-adaptive coping strategies score. Conclusion: All QVM indexes strongly inversely correlated with levels of anxiety and depression and passive coping strategies preference. So in QoL of migraine patients psychological peculiarities seem to prevail over the clinical features of the disease. 537 MUSCLE TRIGGER POINTS IN SUBJECTS WITH FIBROMYALGIA SYNDROME: PRELIMINARY RESULTS ´ C. Fernandez-de-las-Pe ´ nas ˜ 1 , C. Alonso-Blanco1 , J. Fernandez1 2 2 1 Carnero *, P. Zarco , M. Florez-Garcia ´ . Universidad Rey Juan Carlos, Alcorc´ on, Spain; 2 Fundaci´ on Hospital Alcorc´ on, Alcorc´ on, Spain Background and Aim: It is suggested that muscle trigger points (TrPs) can be involved in fibromyalgia syndrome (FMS). Our aim was to investigate in a blinded design the presence of TrPs in 12 pair of muscles in FMS when compared to controls. Methods: Ten women (age: 48±8 years) diagnosed with FMS according to the ACR criteria and 10 healthy women (age: 47±9 years) participated. TrPs in upper trapezius, sternocleidomastoid, suboccipital, splenius capitis, levator scapulae, scalene, temporalis, masseter, extensor carpi radialis brevis, extensor digitorum communis, piriformis and tibialis anterior muscles were bilaterally identified according to Simons et al. criteria: hyperirritable spot in a taut band, local twitch response and referred pain. TrPs were active if the referred pain reproduced pain symptoms, whereas TrPs were latent when the referred pain did not reproduce symptoms. Results: The mean number of TrPs in FMS patients was 9.4 (SD: 1.9) active TrPs and 1.5 (SD: 2.0) latent TrPs. Controls only exhibited latent TrPs (1.5±0.5). Significant difference between groups were found for active (P < 0.001), but not latent TrPs (P = 0.8). Active TrPs in the upper trapezius (n = 9, n = 6 right/left side), extensor carpi radialis brevis (n = 8, n = 7), masseter (n = 6, n = 5) and piriformis (n = 5, n = 5) muscles were the most prevalent within FMS subjects. Conclusions: The referred pain elicited from active muscle TrPs may be implicated in the genesis of FMS. 538 MYOFASCIAL TRIGGER POINTS IN SUBJECTS WITH WHIPLASH SYNDROME: A PILOT STUDY 1 , C. Fernandez-de-las-Pe ´ nas ˜ 2 , J. Fernandez´ A. Fernandez-P ´ erez ´ 1 Carnero2 *, M. Arroyo-Morales1 , C. Villaverde-Gutierrez ´ , C. Moreno-Lorenzo1 . 1 Universidad de Granada, Granada, Spain; 2 Universidad Rey Juan Carlos, Alcorc´ on, Spain Background and Aim: It is suggested that muscle trigger points (TrPs) can be involved in the genesis of the pain in whiplash associated disorders (WAD). Our aim was to investigate in a blinded design the presence of TrPs in 7 pair of muscles in WAD when compared to controls. Methods: Six male and 4 female (age: 30±5 years) diagnosed with WAD grade II and 10 matched controls (age: 31±6 years) participated. TrPs in the upper trapezius, suboccipital, scalene, levator scapulae, sternocleidomastoid, temporalis and masseter muscles were bilaterally explored following Simons et al criteria: hyperirritable spot in a palpable taut band, local twitch response elicited by snapping palpation and presence of referred pain. TrPs were active if the referred pain reproduced symptoms of the subject, and TrPs were latent when the referred pain did not reproduce symptoms. Results: The mean number of TrPs on each WAD subject was 4.8 (SD: 1.6) active TrPs and 2.5 (SD: 1.2) latent TrPs. Controls only exhibited latent TrPs (mean: 2.5; SD: 0.5). Significant difference between groups were found for active (P < 0.001), but not latent TrPs (P = 0.9). Active TrPs in the levator scapulae (n = 9, n = 9 right/left side), upper trapezius (n = 6, n = 5), and scalene (n = 4, n = 3) muscles were the most prevalent in WAD subjects.