Mense / Gerwin Muscle Pain: Understanding the Mechanisms

1. Auflage 2010
ISBN: 978-3-540-85021-2
Verlag: Springer Berlin Heidelberg
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 323 Seiten

This edition of the companion volumes Muscle Pain: Understanding the Mech- isms and Muscle Pain: Diagnosis and Treatment is essential reading for those interested in clinical approaches to acute and chronic pain conditions involving muscle tissues and in the mechanisms underlying these conditions. The volumes cover a very important topic in pain medicine, since muscle pain is very common and can often be dif?cult to diagnose and treat effectively. Furthermore, chronic pain involving muscle and other components of the musculoskeletal system increases with age, such that it is a common complaint of those of us who are middle-aged or older. Indeed, as changing population demographics in 'west- nized' countries result in higher proportions of the population living longer and being middle-aged and elderly, chronic muscle pain will likely become even more of a health problem. In the case of acute muscle pain, this can often be very intense, and in the short term can limit or modify the use of components of the musculoskeletal system associated with the sensitive muscle. Chronic muscle pain can also be intense, as well as unpleasant and disabling, and it is in many cases the over-riding symptom of most musculoskeletal disorders that are associated with long-term deleterious changes in musculoskeletal function.

Autoren/Hrsg.

Mense, Siegfried

Gerwin, Robert D.

Inhaltsverzeichnis

1;Foreword;6
2;Preface;8
3;Contents;10
4;Contents to Muscle Pain: Diagnosis and Treatment;12
5;Contributors;14
6;1: Introduction;16
6.1;Subjective Nature of Pain Terms;17
6.2;Established Pain Terms (partly after Merskey and Bogduk 1994; Loeser and Treed;18
6.2.1;General Terms;18
6.2.1.1;Nociception;18
6.2.1.2;Noxious Stimulus;18
6.2.1.3;Nociceptor;18
6.2.1.4;Nociceptive Neuron;19
6.2.1.5;Pain Matrix;19
6.2.1.6;Central Pain;19
6.2.2;Increased Sensitivity;19
6.2.2.1;Allodynia;19
6.2.2.2;Hyperalgesia;19
6.2.2.3;Hyperesthesia;19
6.2.2.4;Hyperpathia;20
6.2.3;Decreased Sensitivity;20
6.2.3.1;Analgesia;20
6.2.3.2;Hypoalgesia;20
6.3;Established, But Often Ill-Defined, Pain Terms;20
6.3.1;Contracture (in the Physiological Sense);20
6.3.2;Muscle Spasm;20
6.3.3;Muscle Stiffness;21
6.3.4;Muscle Tone;21
6.3.5;Projected Pain;21
6.3.6;Referred Pain;21
6.3.7;Spread of Pain;22
6.4;General Aspects of Pain and Nociceptor Function;22
6.5;Muscle Pain Versus Skin Pain;23
6.5.1;Subjective Differences;24
6.5.1.1;First and Second Pain;24
6.5.1.2;Pain Localization;24
6.5.1.3;Nature of Pain;25
6.5.1.4;Referral of Pain;25
6.5.1.5;Affective Pain Component;26
6.5.2;Objective Differences;26
6.5.2.1;Flexion Reflexes;26
6.5.2.2;Differences in Synaptic Effectiveness and CNS Targets of Afferent Fibers;27
6.6;Descending Pain-Modulating Influences;28
6.7;Transition from Acute to Chronic Pain;28
6.8;Interactions Between Psychosocial and Somatic Factors;28
6.9;References;29
7;2: Functional Anatomy of Muscle: Muscle, Nociceptors and Afferent Fibers;31
7.1;Structure and Basic Function of Skeletal Muscle;32
7.2;Morphology of Muscle Nociceptors;39
7.2.1;Structure of Muscle Nociceptors in the Light and Electron Microscope;39
7.2.2;Receptor Molecules in the Membrane of Nociceptors;42
7.2.3;Neuropeptide Content of Nociceptors;47
7.3;The Nociceptive Afferent Fiber;49
7.4;Fiber Composition of a Muscle Nerve;51
7.5;Muscle Receptors Other Than Nociceptors;53
7.6;Free Nerve Endings in Tendon;54
7.7;Free Nerve Endings in Fascia;55
7.8;Efferent Functions of Nociceptors;55
7.8.1;Release of Neuropeptides from the Nociceptive Ending;55
7.8.2;The Axon Reflex;57
7.8.3;Neurogenic Inflammation;58
7.9;References;59
8;3: Peripheral Mechanisms of Muscle Pain: Response Behavior of Muscle Nociceptors and Factors Eliciting Local Muscle Pain;63
8.1;Methods Used for Studying the Response Behavior of Single Group III and IV Muscle Afferent Units;64
8.1.1;General Response Properties of Muscle Nociceptors;67
8.2;Stimuli Exciting Muscle Nociceptors;68
8.2.1;Mechanical Stimuli;68
8.2.2;Chemical Stimuli;71
8.2.2.1;General Considerations;71
8.2.2.2;ATP;72
8.2.2.3;Protons;72
8.2.2.4;Endogenous Inflammatory Substances;74
8.2.2.5;Hypertonic Saline;75
8.2.2.6;Cytokines and Neurotrophins;78
8.2.2.7;Glutamate;80
8.2.2.8;General Considerations Concerning the Chemical Excitability of Free Nerve Endings in Muscle;81
8.2.3;Polymodal Nociceptors;82
8.3;Acute Sensitization of Nociceptors;84
8.3.1;General Features of Peripheral Sensitization;84
8.3.2;Mechanical Sensitization by Endogenous Substances;85
8.3.3;Interactions Between Chemical Stimuli at the Receptive Nerve Ending;90
8.3.4;Responses of Free Nerve Endings in Muscle to Ischemia and Ischemic Contractions;91
8.3.4.1;Effects of Ischemia Without Contractions;91
8.3.4.2;Ischemic Contractions;92
8.3.5;Effects of Inflammatory Tissue Changes on the Activity of Muscle Group IV Units;95
8.3.5.1;Resting Discharge;96
8.3.5.2;Inflammation-Induced Mechanical Sensitization;97
8.3.5.3;Effectiveness of Chemical Stimulants in Chronically Inflamed Muscle;100
8.4;How Do Muscle Spindle Afferents Behave in Inflamed Muscle?;102
8.5;Effects of a Chronic Muscle Lesion on the Innervation of Skeletal Muscle;103
8.6;Response Properties and Possible Functions of Nonnociceptive Free Nerve Endings in Muscle;104
8.7;Local Causes of Muscle Pain;105
8.7.1;Mechanical Causes;105
8.7.1.1;Blow to Muscle;105
8.7.1.2;Rupture of Muscle and Tendon;106
8.7.1.3;Spontaneous Hematoma;107
8.7.1.4;Delayed-Onset Muscle Soreness or Postexercise Muscle Soreness;107
8.7.1.5;Local Tenderness Due to Myofascial Trigger Points;110
8.7.1.6;Chronic Work-Related Muscle Myalgia (Repetitive Strain Injury);110
8.7.1.7;Painful Contractions of Normal Muscle;111
8.8;Metabolic Problems;111
8.9;McArdle´s Disease;112
8.10;References;112
9;4: Central Nervous Mechanisms of Muscle Pain: Ascending Pathways, Central Sensitization, and Pain-Modulating Systems;118
9.1;Ascending Pathways and Centers for Nociceptive Information;120
9.1.1;Pain Components;120
9.1.2;Centers and Pathways for the Information from Muscle Nociceptors;121
9.1.2.1;General Remarks;121
9.1.2.2;The Distribution of Nociceptive Information in the Spinal Cord;121
9.1.2.3;Normal Function of a Dorsal Horn Neuron;123
9.1.2.4;Dorsal Horn Cells Responding to Nociceptive Input from Muscle;126
9.1.2.4.1;Response Types;127
9.2;Ascending Nociceptive Tracts in the Spinal Cord;130
9.2.1;Spinothalamic Tract (STT, Tr. spinothalamicus);130
9.2.2;Spinoreticular Tract (Tr. spinoreticularis);132
9.2.3;Spinomesencephalic and Spinobrachial Tract (Tr. spinomesencephalicus and Tr. spinoparabrachialis);132
9.2.4;The Thalamus:thalamus The Last Nociceptive Center Below the Cortex;134
9.3;Pain Originates in the Cortex;136
9.4;General Remarks on Pain Concepts;138
9.4.1;Pain Memory;139
9.5;Mechanisms of Central Sensitization;139
9.5.1;Introduction;139
9.5.2;Lesion-Induced Functional Changes;141
9.5.3;Events Leading to Hyperexcitability of Central Neurons;141
9.5.4;Sequelae of Central Sensitization;146
9.5.4.1;Increased Resting Activity of Dorsal Horn Neurons;146
9.5.4.2;Appearance of New Receptive Fields;147
9.5.4.3;Lesion-Induced Changes in the Wiring of the Dorsal Horn;150
9.5.5;Neuromodulatory Substances Involved in Myositis-Induced Rewiring of Spinal Connections;153
9.5.5.1;Substance P;153
9.5.5.2;Nitric Oxide;154
9.6;Neuroplasticity as a Basic Principle in Central Sensitization;157
9.7;Central Sensitization Induced by Subthreshold Synaptic Potentials in Dorsal Horn Neurons;158
9.8;The Role of Glial Cells in Central Sensitization;163
9.9;The Transition from Acute to Chronic Muscle Pain;165
9.10;Nociceptive Processing at the Trigeminal Level;167
9.11;Pain-Modulating Pathways;171
9.11.1;Segmental Inhibition of Dorsal Horn Neurons;171
9.11.1.1;Gate Control Theory;173
9.12;Pain-Modulating Descending Pathways;174
9.12.1;The Descending Pain-Inhibiting (Antinociceptive) System;174
9.12.1.1;Tonic Inhibition of Neurons Mediating Deep Somatic Pain;178
9.12.1.2;Descending Facilitation of Nociceptive Dorsal Horn Neurons;179
9.13;References;182
10;5: Referral of Musculoskeletal Pain;189
10.1;Introduction;190
10.2;Occurrence of Local and Referred Pain;191
10.3;Experimental Musculoskeletal Pain Referral in Humans;192
10.3.1;Pain Referral is a Time-Dependent Process;194
10.3.2;Local and/or Referred Pain;194
10.3.3;Need of Afferent Input from the Area of Referred Pain;197
10.4;Experimental Pain Referral in Musculoskeletal Pain Patients;198
10.5;Clinical Pain Referred from Muscle;198
10.5.1;Referral from Myofascial Trigger Points;198
10.5.2;Referral from Other Sensitive Locations in Muscle;199
10.6;Pain Referred to Muscle;199
10.6.1;Referral from Joints;199
10.6.2;Referral from Viscera;200
10.6.3;Referral from the Central Nervous System;200
10.7;Possible Mechanisms of Pain Referral;200
10.7.1;General Considerations;200
10.7.2;Branching of Primary Afferent Fibers;202
10.7.3;Input Convergence on Spinal Neurons as the Basis for the Convergence-Projection and Convergence-Facilitation Theory of Pain Re;204
10.7.3.1;The Convergence-Projection Theory by Ruch;204
10.7.3.2;The Convergence-Facilitation Theory by McKenzie;206
10.7.4;How can Referred Pain occur Without Simultaneous Local Pain?;209
10.7.5;Possible Mechanisms Underlying Changes in Dorsal Horn Connectivity;209
10.7.6;Referred Pain versus Head Zones;213
10.8;References;214
11;6: Increased Muscle Tone as a Cause of Muscle Pain;218
11.1;Nature of Muscle Tone;219
11.2;Components of Muscle Tone;220
11.2.1;Definitions Related to Muscle Tone;222
11.2.2;Viscoelastic Tone;223
11.2.2.1;Measurements of Muscle Tone;224
11.3;Clinical Applications;229
11.3.1;Stiffness Based on Resonant Frequency;229
11.3.2;Thixotropy;229
11.3.3;Clinically Relevant Deviations and Normal Muscle Tone;230
11.3.3.1;Hypotonia (synonym hypotonicity);230
11.3.3.2;Hypertonia;230
11.3.3.3;Resting Muscle Tone;231
11.4;Contracture;232
11.4.1;Contractures in the Physiological Sense;232
11.4.2;Clinical Usage of Contracture;232
11.4.3;Identification of Contracture;233
11.5;Muscle Spasm;233
11.5.1;Definition of Muscle Spasm;233
11.5.2;Measurement of Spasm;234
11.6;Clinical Conditions with Painful Increased Muscle Tension;235
11.6.1;Tension-Type Headache (TTH);235
11.6.2;Muscle Spasm;237
11.6.2.1;The Misconception of a Pain-Spasm-Pain Cycle;237
11.6.3;Spasmodic Torticollis;241
11.6.4;Trismus;244
11.6.5;Unnecessary Muscle Tension;245
11.6.5.1;Psychological Distress;245
11.6.5.2;Chronic Muscle Overload;246
11.6.5.3;Inefficient Use;247
11.6.6;Nocturnal Leg Cramps;248
11.6.7;Stiff-Man (stiff-person) Syndrome (Moersch-Woltman syndrome) ;249
11.6.8;Muscle Stiffness of Aging;249
11.7;General Remarks on Medications;250
11.8;References;253
12;7: Reorganized Motor Control Due to Muscle Pain;261
12.1;Introduction;262
12.2;Relevant Pain Modalities;263
12.3;Pain-Motor Interaction;264
12.4;Resting Muscle Activity and Muscle Pain;266
12.5;Static Muscle Activity and Muscle Pain;267
12.6;Dynamic Muscle Activity and Muscle Pain;271
12.7;Motor Neuronal Excitability During Muscle Pain;273
12.8;Conclusion;274
12.9;References;274
13;Glossary;279
14;Index;328