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1.
J Endod ; 47(11): 1801-1807, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34400198

RESUMO

Referred orofacial pain as the first symptom of an otherwise silent distant, nonmetastatic cancer has been reported, but there is sparse literature on the subject. Referred pain may not be considered in the orofacial pain differential diagnosis because of its rarity; however, this may delay a cancer diagnosis. The authors present a case report and a review of the English literature. Peer-reviewed publications were identified through a systematic search of MEDLINE, Embase, and Cochrane CENTRAL. Historic cases were reviewed, and available data regarding demographics, pain characteristics, treatment, cancer diagnosis, and outcome were extracted. Thirty-seven cases were identified. All cancers were intrathoracic. The average age was 54.1 years with a slight female predominance (3:2). Common pain characteristics were (1) diffuse location affecting the ear (76%), jaw (46%), and temple (30%); (2) constant duration (65%); (3) aching quality (74%); (4) severe intensity (94%); and (5) associated systemic symptoms (68%) such as weight loss and digital clubbing. The average time from the onset of facial pain to seeking medical attention was 9 months, and the average time from seeking medication attention to cancer diagnosis was 8 months. Orofacial pain was often attributed to odontogenic (35%) or neuropathic (25%) causes, and treatments for these conditions were also common. The impact of referred orofacial pain on the cancer prognosis was not possible because of the nature of the reviewed studies (case reports with no comparison group). Cancer-associated referred orofacial pain as a first symptom is rare but should be considered in cases with intractable pain and associated systemic symptoms.


Assuntos
Neoplasias , Dor Referida , Diagnóstico Diferencial , Dor Facial/diagnóstico , Dor Facial/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Encaminhamento e Consulta
2.
Zhongguo Zhen Jiu ; 41(6): 633-40, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085480

RESUMO

Based on the modern anatomy and physiology, the referred pain of myofascial trigger points of each muscle is integrated; compared with the twelve meridians as well as conception vessel and governor vessel, the similarity of their position and running course is observed. With the current research progress of myofascial trigger points and fasciology, based on the running course of referred pain of trigger points, combined with fascia mechanics, nerve and vascular, the location of acupoints and meridians, as well as the relationship between acupoints and meridians, are discussed.


Assuntos
Meridianos , Pontos de Acupuntura , Humanos , Músculos , Dor Referida , Pontos-Gatilho
3.
BMC Neurol ; 21(1): 184, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941100

RESUMO

BACKGROUND: A patient with a history of cluster headaches, now in remission, presented with confirmed hemicrania continua that resolved with a local anaesthetic injection into the Sternocleidomastoid (SCM) muscle. To the best of our knowledge, this is the first reported case of a trigeminal autonomic cephalalgia arising from a soft tissue source in the neck. CASE PRESENTATION: A 66-year-old man with a history of cluster headaches presented with a six-month history of a new constant right-sided headache. The new headaches were associated with tearing and redness of the right eye and responded to indomethacin, thus meeting the International Classification of Headache Disorders (ICHD-3) diagnostic criteria for hemicrania continua. The history and physical examination suggested a cervical source of the headache arising from the ipsilateral SCM muscle. Injection of the muscle with 1% lidocaine resulted in the elimination of the pain for 1 month without indomethacin. CONCLUSIONS: Due to the convergence of trigeminal, cervical and autonomic nerve fibres, various combinations of headache syndromes can result. This case report demonstrates how a meticulous examination is a crucial component of headache evaluation. Treatment directed to this muscle spared this patient further daily indomethacin and associated side effects.


Assuntos
Músculos do Pescoço , Dor Referida/etiologia , Cefalalgias Autonômicas do Trigêmeo/etiologia , Idoso , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Bupivacaína/uso terapêutico , Humanos , Indometacina/uso terapêutico , Lidocaína/uso terapêutico , Masculino , Músculos do Pescoço/inervação , Dor Referida/tratamento farmacológico
4.
Int J Mol Sci ; 22(4)2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33671269

RESUMO

Visceral pain frequently produces referred pain at somatic sites due to the convergence of somatic and visceral afferents. In skin overlying the referred pain, neurogenic spots characterized by hyperalgesia, tenderness and neurogenic inflammation are found. We investigated whether neurogenic inflammatory spots function as acupoints in the rat model of bile duct ligation-induced liver injury. The majority of neurogenic spots were found in the dorsal trunk overlying the referred pain and matched with locations of acupoints. The spots, as well as acupoints, showed high electrical conductance and enhanced expression of the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP). Electroacupuncture at neurogenic spots reduced serum hepatocellular enzyme activities and histological patterns of acute liver injury in bile duct ligation (BDL) rats. The results suggest that the neurogenic spots have therapeutic effects as acupoints on hepatic injury in bile-duct ligated rats.


Assuntos
Ductos Biliares/patologia , Eletroacupuntura , Fígado/patologia , Inflamação Neurogênica/terapia , Dor Referida/terapia , Animais , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Condutividade Elétrica , Hiperalgesia/complicações , Ligadura , Inflamação Neurogênica/complicações , Dor Referida/complicações , Ratos Sprague-Dawley , Pele/patologia , Substância P/metabolismo
5.
Pain Med ; 22(3): 663-669, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33123739

RESUMO

OBJECTIVE: To investigate the pain referral area (number of pixels) and extent (vector length) as elicited from increasing intensities of pressure-induced pain at the shoulder. DESIGN: Cross-sectional design. SETTING: Clinical laboratory setting. PARTICIPANTS: Twenty-two healthy men and women participated in two experimental sessions. METHODS: Delayed onset of muscle soreness (DOMS) was induced in the dominant shoulder and assessed 24 hours later. Participants rated the level of DOMS on a 6-point Likert scale. Four different intensities (pressure pain threshold [PPT]+20%, PPT+30%, PPT+40%, and PPT+50%) were applied to the infraspinatus in a randomized, balanced fashion for 60 seconds from low to high intensity or vice versa. The resulting location, area, and extent of referred pain as drawn by the participants on a digital body chart were extracted and expressed in pixels. The extent of pain was defined as the vector length extending from the ipsilateral earlobe to the most distal location of the pain. RESULTS: The referred pain area from PPT+20% was smaller than PPT+30%, PPT+40%, and PPT+50%. The extent of referred pain did not differ between the pressure pain intensities. CONCLUSIONS: Pressure intensity at PPT+30%, but no more, produces the greatest referred pain area as compared with the traditional pressure intensity of PPT+20%. Thus, the intensity of PPT+30% may be ideal for exploring the mechanisms of referred pain. The extent of the pain represents an independent expression of the intensity of the provoking stimulus and may be more closely related to the location of the stimulus.


Assuntos
Mialgia , Dor Referida , Estudos Transversais , Feminino , Humanos , Masculino , Músculo Esquelético , Limiar da Dor , Pressão
6.
Clin Anat ; 34(1): 24-29, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32279338

RESUMO

BACKGROUND: The nociceptive receptive field of the vagus nerves in animals includes virtually the entire thoracic, abdominal and laryngopharyngeal regions. However, the role of the vagus nerves in the transmission of visceral pain in humans, with the exception of pain from coronary artery diseases, is believed to be insignificant. AIM: The purpose of this report is to map out the clinical visceral pain receptive field of the vagus nerves relative to its nociceptive counterpart in animals. MATERIALS AND METHODS: The PubMed database and PMC were searched for case reports of patients with orofacial pain believed by the author(s) of the article to be referred from underlying non-cardiac thoracic, laryngopharyngeal or abdominal diseases. Reports of diseases for which non-neural explanations for the orofacial spread of pain were suggested were excluded. RESULTS: A total of 52 case reports of jaw pain and/or otalgia referred from laryngopharyngeal and noncardiac thoracic sources were discovered. In addition, a multicenter prospective study found that 25.8% of more than 3,000 patients with thoracic aortic dissection experienced pain in the head and neck region. In stark contrast, no case reports of orofacially referred pain from abdominal diseases were found. DISCUSSION: The results indicate that the laryngopharyngeal and thoracic portions of the vagal receptive field are capable of referring pain orofacially while the abdominal portion is not. The roles of the somatotopic organization of the trigeminal sub nucleus caudalis and neuromodulation in this referral of pain were discussed. CONCLUSION: Referred orofacial pain can lead to delayed diagnosis and poorer outcome in visceral diseases.


Assuntos
Dor de Orelha/fisiopatologia , Dor Facial/fisiopatologia , Dor Referida/fisiopatologia , Nervo Vago/fisiopatologia , Dor Visceral/fisiopatologia , Humanos
7.
Pain Med ; 21(11): 2850-2862, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33146396

RESUMO

OBJECTIVE: Nociception caused by injuries may sensitize central mechanisms causing expanded pain areas. After recovery, the status of such pain distribution and sensitivity mechanisms is unknown. The present study investigated whether individuals who have fully recovered from a distal radius fracture demonstrate increased pain sensitivity and expanded distribution of pressure-induced pain. DESIGN: Cross-sectional single-blinded study. SETTING: Clinical setting. SUBJECTS: Twenty-three pain-free individuals with a history of painful distal radius fracture and 22 nonfractured, age/gender-matched controls participated in two experimental sessions (day 0, day 1) 24 hours apart. METHODS: Pressure pain thresholds (PPTs) were recorded bilaterally at the extensor carpi radialis longus (ECRL), infraspinatus, and gastrocnemius muscles. Spatial distribution of pain was assessed following 60-second painful pressure stimulation at the ECRL (bilateral) and the infraspinatus muscles on the fractured or dominant side. Participants drew pain areas on a body map. After day 0 assessments, prolonged pain was induced by eccentric exercise of wrist extensors on the fractured/dominant side. RESULTS: Compared with controls, pressure-induced ECRL pain in the fracture group referred more frequently toward the distal forearm (P < 0.005) on day 0. Both groups showed larger pain areas on day 1 compared with day 0 (P < 0.005), although the fracture group showed a larger relative change between days (P < 0.005). The fracture group showed larger pain areas on the fracture side compared with the contralateral side on both days (P < 0.005). CONCLUSIONS: Prolonged pain and recovered prior painful injuries like fractures may sensitize pain mechanisms manifested as expanded pain distribution. Pressure-induced referred pain can be a simple pain biomarker for clinical use.


Assuntos
Dor Referida , Fraturas do Rádio , Estudos Transversais , Humanos , Medição da Dor , Punho
8.
AJNR Am J Neuroradiol ; 41(12): 2188-2198, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33093134

RESUMO

Otalgia is very common, and when the cause of ear pain is not identified on otoscopy and physical examination, cross-sectional imaging is routinely used to evaluate for potential sources of referred ear pain (secondary otalgia). Innervation of the ear structures is complex, involving multiple upper cervical, lower cranial, and peripheral nerves, which transit and innervate a large anatomic territory involving the brain, spine, skull base, aerodigestive tract, salivary glands, paranasal sinuses, face, orbits, deep spaces of the neck, skin, and viscera. Interpreting radiologists must be familiar with these neural pathways and potential sources of secondary otalgia. The purposes of this review are to detail the currently proposed mechanisms of referred ear pain, review the salient neuroanatomy of the complex pathways responsible for secondary otalgia, highlight important benign and malignant etiologies of referred ear pain, and provide a structured search pattern for approaching these challenging cases on cross-sectional imaging.


Assuntos
Dor de Orelha/diagnóstico por imagem , Dor de Orelha/patologia , Dor Referida/diagnóstico por imagem , Dor Referida/patologia , Dor de Orelha/etiologia , Humanos , Neuroimagem/métodos , Dor Referida/etiologia
10.
Pain Physician ; 23(4): E353-E362, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709181

RESUMO

BACKGROUND: Fibromyalgia (FM) syndrome is characterized by widespread pain, fatigue, and generalized increased pain sensitivity. Appropriate and simple pain models are methods employed to assess pain mechanisms that can potentially lead to improved treatments. Pressure pain thresholds (PPTs) or mapping the referred pain area produced by pressure stimulation at suprathreshold intensities are used to assess pain mechanisms. The optimal suprathreshold stimulation intensity to elicit referred pain with minimal discomfort for patients with FM has yet to be determined. OBJECTIVES: The aim of this study was to compare the area and intensity of pressure-induced referred pain in patients with FM as elicited by systematic increases in PPTs, compared with controls. STUDY DESIGN: Observational, crossed-section study. SETTING: Research laboratory. METHODS: Twenty-six patients with FM and 26 healthy controls, age- and gender-matched, were included. Suprathreshold stimulation was applied to the infraspinatus muscle of the dominant side at 4 different intensities (PPT +20%, +30%, +40%, and +50%), after which referred pain was evaluated by measuring the area of pain in pixels using a digital body chart and its intensity on a Visual Analog Scale. Factors related to anxiety condition, pain catastrophizing, depression, and quality of life were recorded. RESULTS: The referred pain areas were larger in the FM group compared with healthy individuals at 120% (P = 0.024), 130% (P = 0.001), 140% (P = 0.001), and 150% (P = 0.001) PPT, however, within the FM group no differences were found between the intensity of suprathreshold stimulation and the size of the referred pain areas (P = 0.135) or pain intensity (P > 0.05). There was a positive correlation between the size of referred pain areas and pain catastrophizing in the FM group (r = 0.457, P = 0.032). LIMITATIONS: This study presents some limitations, among which is the variability found in the referred pain areas. CONCLUSIONS: These findings show that referred pain induced by applying a suprathreshold pressure of 120% PPT can be a useful biomarker to assess sensitized pain mechanisms in patients suffering from FM. KEY WORDS: Referred pain, pain sensitivity, fibromyalgia, central sensitization, suprathreshold, pressure pain threshold, biomarker, facilitated pain mechanisms.


Assuntos
Fibromialgia/diagnóstico , Fibromialgia/psicologia , Medição da Dor/métodos , Limiar da Dor/psicologia , Dor Referida/diagnóstico , Dor Referida/psicologia , Adulto , Idoso , Catastrofização/diagnóstico , Catastrofização/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limiar da Dor/fisiologia , Qualidade de Vida/psicologia , Adulto Jovem
11.
Bull Tokyo Dent Coll ; 61(2): 121-126, 2020 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-32507780

RESUMO

Here, we report a case in which acupuncture combined with trigger point injection was effective in a patient with chronic myofascial pain with referred pain in the masticatory muscles. The patient was a 46-year-old woman with the chief complaint of chronic persistent pain in the region of the left mandibular first molar, which had been extracted 5 months earlier. Stellate ganglion block was performed and amitriptyline administered at another hospital, but were ineffective. At her initial visit to our hospital, her primary complaint was chronic persistent pain in the region of the bilateral mandibular first molars. Several tender points were found on the masseter, temporalis, and sternocleidomastoid muscles, with bilateral referred pain. The pain score according to the visual analogue scale was 85. No significant psychological factors were found, however. Based on these findings, the diagnosis was chronic myofascial pain with referred pain in the masticatory muscles. Therefore, stretching of masticatory muscle and trigger point injection were performed. Two months later, the patient requested trigger point injections to be performed at all tender points, as the previous injections had been effective. The total volume of local anesthetic that this would require was considered to be excessive as there was a large number of tender points, however, and it was feared that a toxic reaction might occur. Therefore, acupuncture in combination with trigger point injection was selected instead. The symptoms disappeared within 9 months after commencement of this therapy, and treatment was completed within 1 year. The present results suggest that acupuncture therapy is effective when used in combination with trigger point injection.


Assuntos
Terapia por Acupuntura , Síndromes da Dor Miofascial , Feminino , Humanos , Músculos da Mastigação , Pessoa de Meia-Idade , Dor Referida , Pontos-Gatilho
12.
NeuroRehabilitation ; 46(3): 423-431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32250335

RESUMO

BACKGROUND: Several studies on carpal tunnel syndrome have reported pain that exists beyond the median nerve territory of the affected hand. However, the mechanism is unknown. PURPOSE: We investigated the cause of extra-territorial pain by the analysis of clinical assessments and cortical activity using magnetoencephalography. METHODS: To compare patients with and without extra-territorial pain, fourteen patients with carpal tunnel syndrome were assessed using clinical examination, such as patients' profile, paresthesia, physical tests, and psychological tests. The physical assessment included tactile threshold and static and moving two-point discrimination sensations on digital pulp. Neural activation in the cerebral cortex was also measured using z-scores calculated by magnetoencephalography. RESULTS: Among fourteen patients, ten patients had pain in the affected median nerve territory only and four patients had extra-territorial pain. When comparing the groups, the static and moving two-point discrimination sensation values in patients with extra-territorial pain were larger than those of patients without the pain (p < 0.05). The supra-marginal gyrus, mid-part of the precentral sulcus, angular gyrus in the left hemisphere, bilateral sensorimotor areas for legs, and bilateral isthmus-cingulate areas showed larger z-scores in patients with extra-territorial pain than in patients without the pain (p < 0.05). CONCLUSIONS: The static and moving two-point discrimination sensations signify the ability of tactile spatial acuity. Bilateral sensorimotor areas were activated in sites that were not the hand. Furthermore, the inferior parietal lobule in the left hemisphere, which synthesizes and integrates multiple sensations showed high activation. Our findings suggested that the mechanism of extra-territorial pain was associated with dysfunction of spatial cognition.


Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Dor Referida/fisiopatologia , Idoso , Feminino , Dedos/fisiopatologia , Humanos , Magnetoencefalografia , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Transtornos da Percepção/fisiopatologia
13.
Rev. bras. ortop ; 55(2): 147-155, Mar.-Apr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1138002

RESUMO

Abstract Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.


Resumo Objetivo Quantificar os níveis de satisfação e dor dos pacientes submetidos a retirada ambulatorial de fixadores externos sem anestesia. Métodos Estudo prospectivo envolvendo 28 pacientes usando fixadores externos submetidos a três questionários associados à Escala Visual Analógica e Numérica da dor durante diferentes etapas da retirada. Resultados A média de dor prévia à retirada foi de 3,61. Logo após o término do procedimento, encontramos média de 6,68 para a dor mais intensa, e de 2,25 para a dor menos intensa. A variação da dor média foi de 4,43, e a dor após uma semana teve média de 2,03. A lembrança dolorosa da retirada foi menor do que a dor referida imediatamente após a retirada (média de 5,29). A predominância no estudo foi de pacientes do sexo masculino de meia-idade, e 89,3% usavam fixador externo do tipo circular. O principal segmento dos membros envolvido foi a perna, e a maior parte dos pacientes não havia feito uso de fixador externo previamente (71,4%); eles optaram pela retirada ambulatorial por se tratar de opção mais rápida (75%), e para evitar internação hospitalar (25%). O momento de dor mais intensa ocorreu durante a retirada dos pinos de Schanz (60,7%), sendo pior nas extremidades dos membros para 75% dos entrevistados. Uma maioria absoluta de 85,7% mostrou-se satisfeita após a retirada, e 82,1% afirmaram que se submeteriam novamente ao procedimento. Conclusão A retirada ambulatorial de fixadores externos sem anestesia é uma opção bem tolerada pelos pacientes, tratando-se de um procedimento com bons níveis de aceitabilidade e satisfação.


Assuntos
Humanos , Ambulatório Hospitalar , Dor , Estudos Prospectivos , Fixadores Externos , Satisfação do Paciente , Técnica de Ilizarov , Dor Referida , Hospitalização , Anestesia
14.
Clin J Sport Med ; 30(5): e175-e177, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31453817

RESUMO

A case report is presented that gives new insight into a very rare cause of athletic pubalgia. Up till now, no case has been published in literature about the relevance of an arcuate pubic ligament (APL) injury in athletic pubalgia. The APL or inferior pubic ligament is a thick triangular arch of ligamentous fibers connecting the 2 pubic bones below. The main function of the APL is to stabilize the symphysis pubis. The rupture of this ligament can lead to groin pain due to lack of stabilization of the symphysis pubis. Despite the importance of the anatomical and clinical function of the APL, very limited research is available about injuries of this ligament. This report describes a case of a traumatic left APL rupture, confirmed by magnetic resonance imaging, causing longstanding left groin pain in an amateur athlete.


Assuntos
Ligamentos Articulares/lesões , Dor Referida/etiologia , Dor da Cintura Pélvica/etiologia , Sínfise Pubiana/lesões , Futebol/lesões , Adulto , Músculo Grácil/diagnóstico por imagem , Virilha , Humanos , Ligamentos Articulares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Dor Referida/terapia , Dor da Cintura Pélvica/terapia , Plasma Rico em Plaquetas , Sínfise Pubiana/diagnóstico por imagem , Ruptura/complicações , Ruptura/diagnóstico por imagem
15.
Pain Med ; 21(5): 1032-1038, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986304

RESUMO

OBJECTIVE: Pain experienced by patients with plantar heel pain has been associated with fascia thickness. It is possible that referred muscle pain may also be related to symptoms experienced by these patients. Our aim was to systematically investigate if the referred pain elicited by trigger points in the leg and foot musculature reproduces the symptoms in individuals with plantar heel pain and to determine the association of trigger points (TrPs) with pain and related disability. METHODS: A case-control study was conducted. Thirty-five individuals with unilateral chronic plantar heel pain and 35 matched comparable healthy controls participated. An assessor blinded to the subject's condition explored TrPs in the flexor hallucis brevis, adductor hallucis, quadratus plantae, and internal gastrocnemius. Pain and related disability were assessed with a numerical pain rating scale (0-10), the Foot Function Index, and the Foot Health Status Questionnaire. RESULTS: The number of TrPs for each patient with plantar heel pain was 4 ± 3 (2.5 ± 2 active TrPs, 1.5 ± 1.8 latent TrPs). Healthy controls only had latent TrPs (mean = 1 ± 1). Active TrPs in the quadratus plantae (N = 20, 62.5%), and flexor hallucis brevis (N = 19, 59%) were the most prevalent in patients with plantar heel pain. A greater number of active, but not latent, TrPs was associated with higher foot pain variables (0.413 < rs < 0.561, P < 0.01), higher impact of foot pain (0.350 < rs < 0.473, P < 0.05) and worse related disability (-0.447 < rs < -0.35456, P < 0.05). CONCLUSIONS: The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in patients with plantar heel pain. A greater number of active TrPs was associated with higher pain and related disability in patients with plantar heel pain.


Assuntos
Calcanhar , Pontos-Gatilho , Estudos de Casos e Controles , , Humanos , Dor Referida
16.
Braz J Phys Ther ; 24(4): 333-341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31383627

RESUMO

BACKGROUND: Shoulder injuries are common in individuals who use wheelchairs. OBJECTIVES: This study investigated the presence of mechanical pain hypersensitivity and trigger points in the neck-shoulder muscles in elite wheelchair basketball players with/without shoulder pain and asymptomatic able-bodied elite basketball players. METHODS: Eighteen male wheelchair basketball players with shoulder pain, 22 players without shoulder pain, and 20 able-bodied elite male basketball players were recruited. Pressure pain thresholds were assessed over C5-C6 zygapophyseal joint, deltoid muscle, and second metacarpal. Trigger points in the upper trapezius, supraspinatus, teres minor, infraspinatus, teres major, latissimus dorsi, subscapularis, pectoralis minor, pectoralis major and deltoid muscles were also examined. RESULTS: Wheelchair basketball players with shoulder pain showed lower pressure pain thresholds over the C5-C6 joint and second metacarpal than elite wheelchair basketball players without pain (between-groups differences: 1.1, 95%CI 0.4, 1.8 and 1.8, 95%CI 0.8, 2.8, respectively) and able-bodied basketball players without pain (between-groups differences: 0.8, 95%CI 0.4, 1.2; 1.6, 95%CI 0.8, 2.4, respectively). The mean number of myofascial trigger points for wheelchair basketball players with unilateral shoulder pain was 4.8±2.7 (2±1 active, 2.9±2.2 latent). Wheelchair basketball players and able-bodied basketball players without shoulder pain exhibited a similar number of latent trigger points (2.4±2.0 and 2.4±1.8, respectively). Wheelchair basketball players with shoulder pain exhibited higher number of active myofascial trigger points than those without pain (either with or without wheelchair), but all groups had a similar number of latent trigger points (P<0.05). CONCLUSIONS: The reported mechanical pain hypersensitivity suggests that active trigger points may play a role in the development of shoulder pain in elite male wheelchair basketball players.


Assuntos
Basquetebol/lesões , Músculo Esquelético/fisiopatologia , Dor de Ombro/fisiopatologia , Pontos-Gatilho/lesões , Pessoas com Deficiência , Humanos , Masculino , Limiar da Dor , Dor Referida , Dor de Ombro/complicações , Cadeiras de Rodas
17.
Neurocase ; 26(1): 55-59, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31762364

RESUMO

Virtual reality (VR) systems have been integrated into rehabilitation techniques for phantom limb pain (PLP). In this case report, we used electroencephalography (EEG) to analyze corticocortical coherence between the bilateral sensorimotor cortices during vibrotactile stimulation in conjunction with VR rehabilitation in two PLP patients. As a result, we observed PLP alleviation and increased alpha wave coherence during VR rehabilitation when stimulation was delivered to the cheek and shoulder (referred sensation areas) of the affected side. Vibrotactile stimulation with VR rehabilitation may enhance the awareness and movement of the phantom hand.


Assuntos
Ritmo alfa/fisiologia , Sincronização de Fases em Eletroencefalografia/fisiologia , Reabilitação Neurológica/métodos , Dor Referida , Membro Fantasma/fisiopatologia , Membro Fantasma/reabilitação , Córtex Sensório-Motor/fisiopatologia , Realidade Virtual , Adulto , Humanos , Estimulação Física , Percepção do Tato/fisiologia , Vibração
18.
Headache ; 60(1): 235-246, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675112

RESUMO

Dental pain is the most common acute pain presenting in the orofacial region; however, chronic pain conditions are also frequent and include; temporomandibular joint disorders (TMDs), primary headaches (neurovascular pain), painful post-traumatic trigeminal neuropathy (PPTTN) and less commonly referred pain and idiopathic or centralized pain conditions. All of these conditions can mimic toothache and vice versa. Many of these conditions are comorbid with high levels of tension headache and migraine reported in patients with TMD; however, dentists remain unfamiliar with headaches and medics unfamiliar with toothache's multiple presentations. The anatomical complexity of the region, the potential exhaustive differential diagnoses and the multiple siloed training of specialties, leads to incorrect and delayed diagnosis and often results in patients undergoing inappropriate surgical and medical treatments. The continued inappropriate interventions may also complicate the later presentation of the patient with pain, by changing its phenotype, preventing a timely and correct diagnosis. Due to the variable presentation of toothache, which can mimic many different chronic pains including; episodic throbbing pain of migraine, the dull continuous pain of myofascial and arthrogenous TMDs or centralized facial pain, diagnosis can be complex. Neuralgic pain occurs in the dentition in health and with disease, mimicking conditions like PPTTN, trigeminal neuralgia (TN), and trigeminal autonomic cephalalgias (TACs), many patients are inappropriately diagnosed and treated, either by general medical practitioners assuming that the neuralgia is due to TN rather than more commonly presenting toothache or by a dentists or other surgeons continuing to treat TN or TACs with routine surgical care. Many patients are prescribed countless courses of antibiotics and undergo multiple surgical interventions simply as a result of poor education due to siloed specialty training. This must be addressed to improve patient safety.


Assuntos
Dor Crônica/diagnóstico , Transtornos da Cefaleia Primários/diagnóstico , Dor Musculoesquelética/diagnóstico , Neuralgia/diagnóstico , Dor Referida/diagnóstico , Odontalgia/diagnóstico , Diagnóstico Diferencial , Humanos
19.
Clin J Sport Med ; 29(6): e83-e85, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688188

RESUMO

In a 31-year-old man, the diagnosis of medial compartment syndrome of foot was delayed for 8 days. In contrast to previously reported cases, the patient presented with mainly bilateral lateral thigh-referred pain rather than foot pain. Although delayed decompression of the medial compartment provided dramatic relief of the referred pain, the patient complained of sensory deficit at the medial side of the foot and flexion deformity of the great toe at the final follow-up visit. Medial compartment syndrome of the foot can cause referred pain, and delayed or missed diagnosis can cause irreversible damage. Therefore, prompt diagnosis of compartment syndrome is crucial, and clinicians must consider the possibility of referred pain when the origin of pain is uncertain.


Assuntos
Síndromes Compartimentais/diagnóstico por imagem , Dor Referida/etiologia , Esforço Físico/fisiologia , Coxa da Perna/fisiopatologia , Adulto , Síndromes Compartimentais/complicações , Síndromes Compartimentais/cirurgia , Descompressão Cirúrgica , Diagnóstico Tardio , Pé/diagnóstico por imagem , Pé/inervação , Pé/fisiopatologia , Pé/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso Periférico/etiologia , Complicações Pós-Operatórias
20.
Zhongguo Zhen Jiu ; 39(11): 1193-8, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31724356

RESUMO

OBJECTIVE: To observe the correlation between referred pain distribution and acupoint sensitization in patients with intestinal diseases. METHODS: In clinical research, 443 patients from 8 hospitals were recruited, including the outpatients and inpatients of Crohn's disease (n=143), ulcerative colitis (n=108), chronic appendicitis (n=87) and other intestinal diseases (n=105). The site with tenderness on the body surface and the morphological changes of local skin were observed and recorded in the patients. Using a sensory tenderness instrument, the pain threshold at the sensitization point was measured in 60 patients with ulcerative colitis. In animal experiment, SD rats were used and divided into a enteritis group (n=8), in which the enteritis model were established, and a control group (n=3), in which no any intervention was given. After the injection of Evans blue (EB) at caudal vein, the blue exudation points on the body surface were observed and the distribution rule was analyzed statistically. RESULTS: The referred pain on the body surface in the patients with intestinal diseases was mainly located in the lower abdomen (93.9%, 416/443), the lumbar region (70.9%, 314/443) and the lower legs (33.0%, 146/443). The diameter of tenderness region was 1.5 to 2.5 cm. Compared with the region without sensitization, the pain threshold of the sensitization point in the patients with ulcerative colitis was reduced significantly (P<0.001). The referred pain on the body surface in the patients with appendicitis was located in the right lower abdomen (97.7%, 85/87), the waist and back (54.0%, 47/87) and the right lower limbs on the medial side (71.3%, 62/87). The tenderness region was 1 to 2 cm in diameter and was irregular in form. After modeling of enteritis in the rats, the EB exudation points were visible from T12 to L2. CONCLUSION: Intestinal diseases induce referred pain on the body surface where is the same as or adjacent to the location of the spinal segment corresponding to the affected intestinal section. These sensitization regions are related to the locations of acupoints.


Assuntos
Pontos de Acupuntura , Enteropatias , Dor Referida , Animais , Colite Ulcerativa , Humanos , Limiar da Dor , Dor Referida/diagnóstico , Dor Referida/terapia , Ratos , Ratos Sprague-Dawley , Sensação
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