Sabayan B, Bagheri M, Borhani Haghighi A. 2007.  Possible joint origin of restless leg syndrome (RLS) and migraine.  Med Hypotheses. [Jan 25 Epub ahead of print]

Sabido-David C, Faravelli L, Salvati P. 2004.  The therapeutic potential of Na(+) and Ca(2+) channel blockers for pain management.  Expert Opin Investig Drugs 13(10):1249-1261.  This paper suggests promising targets for pain control.

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Sadreddini S, Molaeefard M, Noshad H et al. 2008.  Efficacy of Raloxifen in treatment of fibromyalgia in menopausal women.  Eur J Intern Med. 19(5):350-355.  Efficacy was significantly better than placebo response for improving sleep, relieving pain and other symptoms in this group.

Saey TH. 2008.  To learn without sleep, fruit flies need a proper dose of dopamine.  Science News. 174(5):8.  If fruit flies get inadequate sleep, dopamine helps them overcome the sleep deprivation so that they can learn new things.  Sleep deprivation still has a profound effect on behavior inhibition.  [Although this study was done on fruit flies, it has been my observation and experience that for those of us who do not get restorative sleep, a small amount of the neurotransmitter dopamine may help us retain the ability to learn and heal memory somewhat.  It does not give us the emotional control that can come with restorative sleep. DJS]

Sagaram S., Walji M., Bernstam E. 2002.  Evaluating the prevalence, content and readability of complementary and alternative medicine (CAM) web pages on the Internet.  Proc AMIA Symp 672-6.  It is difficult for consumers of CAM to find reliable information on the Internet, as many websites are focused on selling products and make claims without medical references.

Sagberg, F. 1999. Road accidents caused by drivers falling asleep. Accid Anal Prev 31(6):639-49.

Saggini R, Bellomo RG, Affaitati G et al. 2006.  Sensory and biomechanical characterization of two painful syndromes in the heel.  J Pain [Sep 30 Epub ahead of print].  Entrapment syndrome of the nerve to abductor digiti quinti and myofascial syndrome of the abductor hallucis may have similar symptoms but distinct patterns and treatments.

Sahelian, R. and S. Borken. 1998. Dehydroepiandrosterone and cardiac arrhythmia. Ann Intern Med 129(7):588.

Sahin N, Karatas O, Ozkaya M et al. 2008.  Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome.  Agri. 20(3):14-19.  “Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms.  The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles.  94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic.  Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations.  Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination.  A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study.  All patients were in the young age group 37.4+/-9, and 87.8% were females.  53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo.  58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign joint hypermobility syndrome.  Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.”

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Saljo, A, Huang, YL, Hansson, HA. 2003.  Impulse noise transiently increased the permeability of nerve and glial cell membranes, an effect accentuated by a recent brain injury. Neurotrauma 20(8):787-794.  Even one intense pulse noise can cause diffuse brain injury, although without visible hemorrhage or gross structural damage.  Intense noise damages both the nerve cells and the glial cells.  “The abnormal membrane permeability and the associated cytoskeletal changes may initiate events, which eventually result in progressive diffuse brain injury.

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Samborski, W., T. Stratz, T. Schochat, P. Mennet and W. Muller. 1996. Biochemical changes in fibromyalgia. Z Rheumatol 55(3):168-173. [German]

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Sandberg M, Lindberg LG, Gerdle B. 2004.  Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia.  Eur J Pain 8(2):163-171.  "...in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to healthy subjects where no significant blood flow increase was found following the subcutaneouos needling.... muscle blood flow may be related to a greater sensitivity to pain and other somatosensory input in FM."

Sandeberg, M., T. Lundeberg and B. Gerdle. 1999. Manual acupuncture in fibromyalgia: a long-term pilot study. J Musculoskel Pain 6(4):39-58.

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Sandyk, R. 1996. Effect of weak electromagnetic fields on the amplitude of the pattern reversal VEP response in Parkinson’s disease. Int J Neurosci 84(1-4):165-175.

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Santelmann H, Laerum E, Ronnevig J et al. 2001.  Effectiveness of nystatin in polysymptomatic patients.  Fam Pract 18(3):258-265.  This study found that patients with multiple symptoms such as fatigue, cognitive dysfunctions, lack of coordination, dizziness, headache, burning or tearing of the eyes, IBS, musculoskeletal aches, respiratory tract symptoms, vaginal and/or urinary burning or itching and many others found symptom relief after treatment with an anti-fungal medication.  Relief was even more significant if the therapy was coupled with a sugar and yeast-free diet.

Sapolsky, R.M. 1999.  Glucorticoids, stress, and their adverse neurological effects: relevance to aging.  Exp Gerontol 34(6):721-32.  Adrenal hormones are critical for survival of acute stressors, but excesses of these stress hormones can harm the central nervous system, especially the hippocampus, causing damage “... including disruption of synaptic plasticity, atrophy of dentritic processes, compromising the ability of neurons to survive a variety of coincident insults and, at an extreme, overt neuron death.”  [This can have implications when the HPA axis is in constant overdrive. DJS]

Sarkar S, Woolf CJ, Hobson AR et al. 2006.  Perceptual wind-up in the human esophagus is enhanced by central sensitization.  Gut. [Feb 21 Epub ahead of print]  [FM patients have central sensitization, and many have GERD.  It may be relevant to check for symptom-free “silent” GERD and sleep apnea in FM patients. DJS]

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Sarro Alvarex S. 2002  [Psychiatric view of fibromyalgia.] Actas Esp Psiquiatr 30(6):392-6. [Spanish]  “Rheumatic fibromyalgia, also known as fibrositis or myofascial pain, is a common syndrome... . This article intends to offer an up-to-date and complete information about this entity, focused on psychiatric aspects, to better identify and manage such a puzzling disease.”  [These authors do not even know that fibromyalgia and myofascial pain are separate conditions, and thus is based on a faulty premise. DJS]

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Saunders L. 2008.  Itch. Sci News. 174(11):16-19.  There is more than one type of itch.  Histamine itch and non-histamine itch are different, and have different pathways.  Some patients with FM and TrPs have maddening itches that don’t respond to antihistamines, and could be due to stimulation of these second order projection neurons.  “The pathological itch fiber also appears to sense pain sensations such as heat or a pinch.”  [Perhaps the burning associated with some myofascial TrPs and some FM symptoms may be due to this polymodal C-fiber afferent response.  DJS]

Sautter NB, Mace J, Chester AC et al. 2008.  The effects of endoscopic sinus surgery on level of fatigue in patients with chronic rhinosinusitis.  Am J Rhinol. 22(4):420-426.  “Fatigue improves after ESS, with significantly greater improvement in patients with fibromyalgia and in patients that are more severely fatigued at presentation.”  [Note my patient study on FM patients elsewhere on this website.  Post nasal drip and sinusitis were among the most common symptoms in those patients, but there are many less invasive treatments that should be tried before sinus surgery is even considered. DJS]

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Scharf, M.B., Baumann, M., Berkowitz, D.V. 2003.  The effects of sodium oxybarate on clinical symptoms and sleep patterns in patients with fibromyalgia.  J Rheumatol 30(5):1070-4. Sodium oxybarate reduced pain, fatigue and sleep abnormalities in FM patients.  [This medication, Xyrem, is an orphan drug for use in conditions of cataplexy associated with narcolepsy.  Cataplexy is a sudden loss of muscle control that can occur after a trigger such as laughter or a surprise.  It is not to be taken lightly and can cause serious side effects, including pain, dizziness, sleep disorder and vomiting.  It should not be used by people with sleep apnea, and I am not at all comfortable with its use in a central nervous system disorder such as FM.  DJS]

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Schneider C, Palomba D, Flor H. 2004.  Pavlovian conditioning of muscular responses in chronic pain patients: central and peripheral correlates.  Pain 112(3):239-247.  “These data confirm the hypothesis of enhanced muscular responding in chronic pain patients and suggest a dissociation of muscular and central processes during aversive conditioning in the patients that might contribute to the chronicity problem.”

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Shieyfer E, Jotkowitz A, Karmon A et al. 2008.  Accuracy of the diagnosis of fibromyalgia by family physicians: is the pendulum shifting?  J Rheumatol. [Dec 1 Epub ahead of print].  “Family physicians in our region are able to accurately diagnose FM.  Future studies might focus on evaluating the factors and biases accounting for differences in level of diagnostic accuracy for FM among various ethnic groups.”  [Can these physicians differentiate between FM and TrPs, and assess for both in the same patients?   Only if so can other research be meaningful.  In many areas around the world, including much of the USA, diagnostic acumen for these conditions is very rare.  DJS]

Shilo, L., Y. Dagan, Y. Smorjik, U. Weinberg, S. Dolev, B. Komptel, H. Balaum and L. Shenkman. 1999. Patients in the intensive care unit suffer from severe lack of sleep associated with loss of normal melatonin secretion pattern. Am J Med Sci 317(5):278-81.

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Shoskes DA, Berger R, Elmi A et al. 2007.  Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study.  J Urol. [Dec 12 Epub ahead of print].  "Myofascial pain is a possible etiology for category III chronic prostatitis/chronic pelvic pain syndrome, either secondary to infection/inflammation or as the primary cause."  "Abdominal/pelvic tenderness is present in half of the patients with chronic pelvic pain syndrome…."

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Simons DG. 1995.  Myofascial pain syndrome: One term but two concepts; a new understanding.  J Musculoskeletal Pain 3(1):7-14.  This paper is of vital importance.  It explains how some researchers have been using the term “myofascial pain syndrome (MPS)” as synonymous with temporomandibular dysfunction (TMJD), without explaining the definition.  [This practice is common in papers written by dentists.  This dangerous practice can lead to misleading or erroneous conclusions.  Others build on these conclusions, not realizing that authors are using the term MPS to mean TMJD, and may assume that they refer to myofascial pain due to trigger points that may occur in all four quadrants of the body.  Authors must be careful to define their terms. DJS] 

Simons DG, Mense S.  Diagnosis and therapy of myofascial trigger points.  Schmertz 17(6):419-424.  This verifies by muscle biopsy the segmental shortening of sarcomere groupings in individual muscle fibers, suggesting the mechanism behind myofascial trigger point taut band formation. It presents an integrated hypothesis for the pathophysiology of myofascial trigger points, beginning with the release of excess acetylcholine from dysfunctional motor endplates. [German]

Simons D. G. 2001.  Do endplate noise and spikes arise from normal motor endplates?  Am J. Phys Med Rehabil 80(2):134-40.  Endplate noise may be a commonly misunderstood phenomenon and needs to be more carefully assessed in regards to association with myofascial trigger points.

Simons, DG. 1999. Diagnostic criteria of myofascial pain caused by trigger points. J Musculoskel Pain 7(1-2):111-120.

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Sirvent P, Mercier J, Vassort G et al. 2005.  Simvastatin triggers mitochondria-induced Ca2+ signaling altercation in skeletal muscle.  Biochem Biophys Res Commun 329:1067-1075.  This article is vitally important for physicians who have patients with myofascial TrPs.  Simvastatin, and, by biochemical inference, statin medications, triggers flood of intra-cellular calcium.  Increased release of Ca2+ is an essential part of the formation of myofascial TrPs, according to Simons’ integrated hypothesis.  The addition of statins could cause a flare of TrP symptoms that would not abate until statins are discontinued.  [This would mesh with personal observations and communications from myofascial pain specialists who have observed that many of their patients do not improve until they are off statins.  DJS]

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Smith BW, Tooley EM, Montague EQ et al. 2008.  Habituation and sensitization to heat and cold pain in women with fibromyalgia and healthy controls.  Pain [Oct 21 Epub ahead of print].  “There were large overall differences in pain thresholds, with the FM group showing greater sensitivity to heat and cold pain stimuli compared with the HC (healthy controls) group.  While habituation occurred in both of the groups for heat pain, the HC group had stronger habituation across trials than the FM group.  Conversely, while the HC group habituated to cold pain stimuli, the FM group showed sensitization and had decreased cold pain thresholds across trials (they felt cold pain at higher temperatures).  In addition, anxiety, depression, fatigue, and pain were related to decreased heat and cold pain thresholds in the overall sample.  However, when group was controlled, none of these variables were related to thresholds or rates of habituation or sensitization.  The differences between women with FM and healthy women in habituation and sensitization may have important implications for the etiology, diagnosis, and treatment of FM and other chronic pain conditions.”

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Smith H, Elliott J. 2001.  Alpha2 receptors and agonists in pain management.  Curr Opin Anaesthesiol. 14(5):513-518.  “It has been noted that these agents can enhance analgesia provided by traditional analgesics, such as opiates, and may result in opiate-sparing effects.  This has important implications for the management of acute postoperative pain and chronic pain states…”

Smith, H.S., Audette J., Royal M.A. 2002.  Botuminum toxin in pain management of soft tissue syndrome.  Clin J Pain.  These authors suggest that because botulinum toxin has been used successfully for pain associated with myofascial trigger points, and it admits that central sensitization may be part of many chronic pain syndromes, it suggests that botulinum toxin therapy may be “particularly useful” in many soft tissue syndromes such as fibromyalgia when other approaches have failed.  [This paper ignores the specific mechanism of the myofascial trigger point (MTrP), as we believe it to be, with a release of excess acetylcholine at the motor endplate causing the release of excess calcium and the formation of MTrPs.  Botulinum toxin specifically interrupts acetylcholine in this process.  Logic indicates that one cannot extrapolate that the use of botulinum locally would be of any benefit in the control of a chronic central pain state, unless the peripheral pain generators perpetuating that state are MTrPs.  In that case, the MTrPs must first be shown to respond to local injection using the proper technique incorporating positioning of involved muscles, palpation for TrPs, injection of all related MTrPs, and full ROM stretch.  If this releases the muscle, but the release does not hold for a significant time in spite of the identification and control of all perpetuating factors, it would then be the time for consideration of more aggressive methods.]

Smith J.A., Lumley M.A., Longo D.J. 2002.  Contrasting emotional approach coping with passive coping for chronic myofascial pain.  Ann Behav Med 24(4):326-35. Emotional-approach coping (emotional processing and emotional expression) was related to less pain in myofascial pain patients, especially women, and less depression in men.  The use of passive pain coping strategies are associated with worse pain and adjustment.  Some emotion-focused types of pain coping may be adaptive.

Smith, W. A. 1998. Fibromyalgia Syndrome. Nurs Clin North Am 33(4):653-669.

Smith-Coggins, R., M. R. Rosekind, K. R. Buccino, D. F. Dinges and R. P. Moser. 1997. Rotating shift work schedules: can we enhance physician adaptation to night shifts? Acad Emerg Med 4(10):951-61.

Smythe HA. 2004.  Fibromyalgia among friends. J Rheumatol 31(4):627-630.  This editorial describes anti-fibromyalgia bias that is blatant in material from some medical authors, in spite of scientific evidence that it is real.  Legal advocates should take note of this. 

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Solomon, D. H. and M. H. Liang. 1997. Fibromyalgia: scourge of humankind or bane of a rheumatologist's existence? Arthritis and Rheumatism 40:1553-1555.

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Soppi, M. and E. Beneforti. 1999. Muscular pain in some rheumatic diseases. J Musculoskel Pain 7(1-2):225-229

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Sorrell MR, Flanagan W. 2003.  Treatment of chronic resistant myofascial pain using a multidisciplinary protocol [The Myofascial Pain Program].  J Musculoskel Pain 11(1):5-9.  Multidisciplinary treatment including myofascial technique physical therapy, surface electromyography and biofeedback training, medication and trigger point injections can significantly produce pain relief, mood elevation and increase ability to function, even in patients who have symptoms resistant to other therapies.

Sorrell MR, Flanagan W, McCall JL. 2003.  Symptom duration affects the outcome of multidisciplinary treatment of myofascial pain.  The method of assessment influences the understanding of the results.  J Musculoskel Pain 11(1):11-16.  The earlier the patient enters a multidisciplinary treatment program that understands myofascial pain, the better the results.

Sorrell MR, Flanagan W, McCall JL. 2003.  The effect of depression and anxiety on the success of multidisciplinary treatment of chronic resistant myofascial pain.  J Musculoskel Pain 11(1):17-20. Co-existing depression significantly reduced positive outcome of this treatment

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Soyupek F, Soyupek S, Akkus S et al. 2007.  The coexistence of the fibromyalgia syndrome and the overactive bladder syndrome.  J Musculoskel Pain 15(3):31-37.  “Our findings suggest that there is an association between OBS and FM, especially in female patients.”  The authors remind readers that both FM and OBS are chronic.

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Spath M, Neeck G. 2002.  [The expert assessment of fibromyalgia.]  Z Rheumatol 61(6):661-6. [German]   Pain amplification syndromes are well documented and have been researched for a decade.  The validity of the reality of fibromyalgia has no place in an expert assessment.  “The sociomedical implications (of fibromyalgia) are obvious and considerable...”  Assessments must be specific to the individual, focusing on evaluation of specific impairments and disabilities and how these handicaps affect function.

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Sperber, A. D., Y. Atzmon, L. Neumann, I. Weisberg, Y. Shalit, M. Abu-Shakrah, A. Fich and D. Buskila. 1999. Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications. Am J Gastroenterol 94(12):3541-6.

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Sprott H, Salemi S, Gay RE et al. 2004.  Increased DNA fragmentation and ultrastructural changes in fibromyalgic muscle fibres.  Ann Rheum Dis. 63(3):245-251.  This study found a significantly high rate of DNA fragmentation in FM patient samples (55.4%) compared with healthy controls (4.1%).  Myofibers and actin filaments were disorganized, and the number of mitochondria were significantly lower in FM patients.

Sprott, H., L. A. Bradley, S. J. Oh, W. Wintersberger, G. S. Alarcon, H. G. Mussell, A. Tseng, R. E. Gay and S. Gay. 1998. Immunohistochemical and molecular studies of serotonin, substance P., galanin, pituitary adenylyl cyclase-activating polypeptide, and secretoneurin in fibromyalgia to muscle tissue. Arthritis Rheum 41(9):1689-94.

Sprott, H., A. Muller and H. Hartmut. 1997. Collagen crosslinks in fibromyalgia. Arthritis Rheum 40(8):1450-1454.

Srbely JZ, Dickey JP, Lowerison M et al. 2008.  Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study.  Pain  [May 26 Epub ahead of print].  Low-dose ultrasound can cause short-term segmental pain relief from pain due to TrPs, and can be a useful adjunct in the management of musculoskeletal pain.

Srbely JZ, Dickey JP, Lowerison M et al. 2008.  Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study.  Pain. [May 26 Epub ahead of print].  Low dose ultrasound may help segmental sensitivity, and may ease symptoms of some myofascial trigger points.

Srbely JZ, Dickey JP. 2007.  Randomized controlled study of the anti-nociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy?  Clin Rehabil. 21(5):411-417.   “Ultrasound may be a useful clinical tool for the treatment and management of trigger points and myofascial pain syndromes.”

Srdic, F., Sarhus, M., Topuz, O. 2002.  Comparisons of two different techniques of electrotherapy on myofascial pain.  J Back Musculoskel Rehab 16:11-16.  Electrotherapy can be useful to treat myofascial pain.

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St. Amand, R. Paul and Claudia C. Marek. 1999. What Your Doctor May Not Tell You About Fibromyalgia. Warner Books: New York.

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Stander S, Steinhoff M, Schmetz M et al. 2003.  Neurophysiology of pruitis: cutaneous elicitation of itch.  Arch Dermatol 139(11):1463-1470.  This article is important because it indirectly explains how itch can be a manifestation of both fibromyalgia and/or myofascial pain.  It covers receptor systems, itch generation by both peripheral and central nervous systems, as well as mechanical, chemical (including biochemical) triggers. This paper may be of help in documenting itch associations with the above-mentioned conditions.

Standley LJ, Rudel RA, Swartz CH et al. 2008.  Wastewater-contaminated groundwater as a source of endogenous hormones and pharmaceuticals to surface water ecosystems.  Environ Toxicol Chem. [Jul 10 Epub ahead of print].  “While a number of papers have reported on surface water contamination by OWCs (organic wastewater compounds) from wastewater treatment plants, our results show that surface water ecosystems in unconfined aquifer settings are susceptible to contamination by estrogenic and other biologically active OWCs through recharge from aquifers contaminated by residential septic systems.”

Stark, F. M. and H. M. Sobetzko. 1999. Approaches to coping with chronic fatigue syndrome. Zentralbl Hyg Umweltmed 202(2-4):179-90.

Starlanyl DJ. 2006. Comment on Canadian consensus document on fibromyalgia syndrome.  J Musculoskel Pain. 14(4):75-81.  In the original document, there seemed to be confusion between symptoms due to FM and those that were due to co-existing myofascial TrPs.  This offers clarifications.

Starlanyl DJ, Jeffrey JL, Roentsch G, Taylor-Olson C.  The effect of transdermal T3 (3,3’,5-triiodothyronine) on geloid masses found in patients with both fibromyalgia and myofascial pain: double-blinded, N of 1 clinical study.  [Submitted for review Aug 15, 2001.]

Starlanyl, D.  T’ai Chi Chuan and Musculoskeletal Pain.  T’ai Chi Magazine.  [Accepted for publication July 2001.]

Starlanyl DJ and Jeffrey JL. 2001.  The presence of geloid masses in a patient with both fibromyalgia and chronic myofascial pain. Phys Ther Case Rep 4(1):22-31.

Starlanyl D. J. and M. E. Copeland. 2001. Fibromyalgia and Chronic Myofascial Pain: A Survival Manual. Edition 2. Oakland: New Harbinger Publications.

Starlanyl DJ. 1999. The Fibromyalgia Advocate. Oakland: New Harbinger Publications.

Starlanyl D J 1997. Chronic Myofascial Pain Syndrome: A Guide to the Trigger Points. Oakland: New Harbinger. 2 hour video.

Starlanyl DJ. 1997.  Fibromyalgia and Myofascial Pain Syndrome: A Special Challenge.  Clin Bull Myofas Ther 2 (2/3): 75-89.

Starlanyl DJ. 1995.  "Comment on Granges and Littlejohn's. "Prevalence of myofascial pain syndrome in fibromyalgia and regional pain syndrome: A comparative study."  J Musculoskel Pain 3 (1):129-132.

Starlanyl DJ 1994.  "Comment on article by Hong, Chen, Pon and Yu, "Intermediate effects of various physical medicine modalities on pain threshold of an active myofascial trigger point."  J Musculoskel Pain 2 (2):141-142.

Staud R. 2008.  Autonomic dysfunction in fibromyalgia syndrome: postural orthostatic tachycardia.  Curr Rheumatol Rep. 10(6):463-466.

Staud R, Craggs JG, Peristein WM et al. 2008.  Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls.  [Mar 24 Epub ahead of print].  “These results suggest that enhanced neural mechanisms of TSSP (temporal summation of second pain) in FM are reflected at all pain related brain areas, including posterior thalamus, and are not the result of selective enhancement at cortical levels.”

Staud R. 2007.  Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain?  Curr Rheumatol Rep. 9(6):473-481.    Acupuncture relief may take some time “...to develop and resolve."  “…some forms of AP are more effective for providing analgesia than others.”  Particularly, electro-AP seems best to activate powerful opioids and non-opioid analgesic mechanisms.”

Staud R. 2008.  The role of peripheral input for chronic pain syndromes like fibromyalgia.  J Musculoskel Pain 16(1-2):6774.  Indications are that the diffuse, bodywide pain of FM is maintained by peripheral pain stimuli.  “Most FM patients present with focal tissue abnormalities including myofascial trigger points [TrPs], ligamentous trigger points, or osteoarthritis of the joints and spine.  While not predictive for the development of FM, these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain.  Thus spatially limited forms of musculoskeletal pain, including MPS, may develop in some patients into widespread chronic pain syndromes like FM.”

Staud R, Robinson ME, Price DD. 2007.  Temporal summation of second pain and its maintenance are useful for characterizing widespread central sensitization of fibromyalgia patients.  J Pain. [Aug 1 Epub ahead of print].  “Perspective:  The pain of FM seems to be accompanied by generalized central sensitization, involving the length of the spinal neuroaxis.  Thus, widespread central sensitization appears to be a hallmark of FM and may be useful for the clinical case definition of this prevalent pain syndrome.  In addition, measures of widespread central sensitization, like TSSP-M (temporal summation of second pain and maintenance), could also be used to assess treatment responses of FM patients.”

Staud R, Koo E, Robinson ME et al. 2007.  Spatial summation of mechanically evoked muscle pain and painful aftersensations in normal subjects and fibromyalgia patients.  Pain. [Apr 23 Epub ahead of print].  “…decreasing pain in some muscle areas by local anesthetics or other means may improve overall clinical pain of FM patients.”  [This is another indication that control of peripheral pain stimuli such as caused by myofascial trigger points and arthritis can be a significant part of chronic pain treatment in FM. DJS]

Staud R, Vierck CJ, Robinson ME et al. 2005.  Effects of the N-Methyl-D-Aspartate receptor antagonist Dextromethorphan on temporal summation of pain are similar in fibromyalgia patients and normal control subjects.  Jour Pain 6(5):323-332.

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Touch EA, White AR, Richards S et al. 2007.  Variability of criteria used to diagnose myofascial trigger point pain syndrome-evidence from a review of the literature.  Clin J Pain. 23(3):278-286.  [While it is true that far too many authors of papers confuse myofascial pain as TMJ, it is unfortunate that these authors did not differentiate between the two, in spite of the clear distinction in the articles: Simons DG. 1995.  Myofascial pain syndrome: One term but two concepts; a new understanding. J Musculoskeletal Pain 3(1):7-14 and Simons DG. 2004.  New aspects of myofascial trigger points: etiological and clinical. J Musculoskeletal Pain 12(3/4):15-21.  The authors have noted an important truth.  Far too many articles purporting to be on myofascial pain do not specify the criteria that have been used.  Also, I believe that far too many articles on any kind of pain, including fibromyalgia, do not take into consideration co-existing myofascial trigger points may be influencing their research and lead to faulty or biased conclusions. DJS]

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Usui C, Doi N, Nishioka M et al. 2006.  Electroconvulsive therapy improves severe pain associated with fibromyalgia.  Pain [Feb 20 Epub ahead of print].

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Valencia-Flores M, Cardiel MH, Santiago V et al. 2004. Prevalence and factors associated with fibromyalgia in Mexican patients with systemic lupus erythematosus.  Lupus 13(1):4-10.  “Fibromyalgia is not common in Mexican patients with SLE and has a different pattern of symptoms in RP (regional pain) and NP (no pain) patients.  These data add evidence that ethnicity can play an important role in FM manifestations.”

Valim, V., Oliveira, L., Suda, A., et al. 2003.  Aerobic fitness effects in fibromyalgia.  J Rheumatol 30(5):1060-1069.  “...aerobic exercise is beneficial to patients with FM, but the cardiorespiratory gain is not related to improvement of FM symptoms.”

Valkeinen H, Hakkinen A, Alen M et al. 2007.  Physical fitness in postmenopausal women with fibromyalgia.  Int J Sports Med. [Oct 24 Epub ahead of print].  “A lower maximal load in the aerobic test suggests the patients’ unsatisfactory ability to stand physical loading and resist overall fatigue.  Moreover, fatigue rather than pain was the main factor to decrease the quality of life in women with fibromyalgia.  Additional efforts should be addressed to strength training, when planning health promotion and rehabilitation programs in fibromyalgia.”  [These results may be suspect as there is no allowance for co-existing MTPs that could be affecting the results.  Also, strength training, if there are MTPs, will only make them worse.  You can’t strengthen a muscle that is physiologically inhibited by MTPs.  DJS]

Vallbona, C., C. F. Hazelwood and G. Jurida. 1997. Response of pain to static magnetic fields in post-polio patients: a double-blind pilot study. Arch Phys Med Rehabil 78(11):1200-1203.

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Van Cauter E, Latta F, Nedeltcheva A et al.  2004.  Reciprocal interactions between the GH axis and sleep.  Growth Horm IGF Res. 14 Suppl A:S10-7.  “Preliminary data show decreased total sleep time and increased sleep fragmentation in GH-deficient patients as compared with normal controls.”

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Van Daele DJ, McCulloch TM, Palmer PM et al. 2005.  Timing of glottic closure during swallowing: a combined electromyographic and endoscopic analysis.  Ann Otol Rhinol Laryngol. 114(6):478-487.  [This article indicates why TrPs in some of the area muscles could have some patients choking on their own saliva, “swallowing the wrong way".    In such cases, it may be wise to check the thyroarytenoid and other area muscles for TrPs.]

Van den Elzen BD, Tytgat GN, Boeckxstaens GE. 2008.  Gastric hypersensitivity induced by oesophageal acid infusion in healthy volunteers.  Neurogastroenterol Motil. [Aug 18 Epub ahead of print].  Exposure to reflux acid at the distal end of the esophagus has been shown to increase gut sensitivity through central sensitization.  This study showed that the visceral sensitivity was induced without affecting the somatic sensitivity, and reduction of the stomach acid load prevented this sensitivity from developing.  [This indicates that multiple healthy means of healing the gut (see handout elsewhere on website) and restoring healthy digestion may have a profound effect on IBS and other gut sensitivity conditions. DJS]

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Wolfe, F. and D. J. Hawley. 1999. Evidence of this older symptom appraisal and fibromyalgia: increased rates of reported comorbidity and comorbidity severity Clin Exp Rheumatol 17(3):297-303.

Wolfe, F. 1999. "Silicone related symptoms" are common in patients with fibromyalgia: no evidence for a new disease. J Rheumatol 26(5):1172-5.

Wolfe, F. 1998. What use are fibromyalgia control points? J Rheumatol 25(3):546-550.

Wolfe, F. 1997. The fibromyalgia problem. J Rheumatol 24(7):1247-9.

Wolfe, F., I. J. Russell, G. Vipraio, K. Ross and J. Anderson. 1997. Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population. J Rheumatol 24(3):555-559.

Wolfe, F., Anderson J., D. Harkness, R. M. Bennett, X. J. Caro, D. L. Goldenberg, I. J. Russell and M. B. Yunus. 1997. Health status and disease severity of fibromyalgia: results of a six-center longitudinal study. Arthritis Rheum 40(9):1571-1579.

Wolfe, F., J. Anderson, D. Harkness, R. M. Bennett, X. J. Caro, D. L. Goldenberg, I. J. Russell and M. B. Yunus. 1997. A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis Rheum 40(9):1560-1570.

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Wolfe, F., Smythe H. A. , Yunus M. B. , Bennett R, M. Bombadier C., Goldenberg D. L. Tugwell P., Campbell S. M. Ables M., Clark P. et al. "The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee." Arth Rheum 33(2):160-172.

Wood PB, Kablinger AS, Caldito GS. 2005.  Open trial of pindolol in the treatment of fibromyalgia.  Ann Pharmacother 39(11):1812-1816.  In this small group (n=20), pindolol, which works by affecting beta-androgenic receptors to down-regulate the hyperactive sympathetic nervous system, improved the general FM parameters.

Wood PB. 2004.  Stress and dopamine: implications for the pathophysiology of chronic widespread pain.  Med Hypotheses 62(3):420-424.  “…prolonged stress produces both reduction of dopamine output…and persistent hyperalgesia in the context of chronic stress…”

Woodward, M. 1999. Insomnia in the elderly. Aust Fam Physician 28(7):653-8.

Woolf CJ. 2007.  Central sensitization: uncovering the relation between pain and plasticity.  Anesthesiology 106(4):864-867. “Electrophysiological analysis of the injury-induced increase in excitability of the flexion reflex shows that it in part arises from changes in the activity of the spinal cord.  The long-term consequences of noxious stimuli result, therefore, from central as well as from peripheral changes.”

Worthman, C. M. and M. K. Melby. In press. Toward a comparative developmental ecology of human sleep. In Adolescent Sleep Patterns: Biological, Social, and Psychological Influences, M. A. Carskadon, ed. New York: Cambridge University Press. 

Yakov V, Martin AA. 2008.  Use of atomoxetine in a patient with fibromyalgia syndrome and attention-deficit hyperactivity disorder.  J Musculoskel Pain. 16(3):189-192.

Yaksh, T. L., X. Y. Hua, I. Kalcheva, N. Nozaki-Taguchi and M. Marsala. 1999. The spinal biology in humans and animals of pain states generated by persistent small afferent input. Proc Natl Acad Sci 96(14):7680-6.

Yamada, H., T. Okumura, W. Motomura, Y. Kobayashi and Y Kohgo. 2000. Inhibition of food intake by central injection of anti-orexin antibody in fasted rats. Biochem Biophys Res Commun267(2):527-531.

Yang JL, Chen S, Jan MH et al. 2008.  Proprioception assessment in subjects with idiopathic loss of shoulder range of motion: joint position sense and a novel proprioceptive feedback index.  J Orthop Res. 26(9):1218-1224.  “Compared to control shoulders, involved shoulders had enhanced proprioception during end range movements (p < 0.05).”  “Results of JPS (joint position sense)  and PFI (proprioceptive feedback index) suggest that both capsuloligamentous and musculotendinous mechanoreceptors play an important role in proprioception feedback during active movements in subjects with idiopathic loss of shoulder ROM (range of motion).”  [This possibly was due to the presence of myofascial TrPs, but we will never know. When injury, ROM and proprioceptive dysfunction occur, patients must be assessed for associated TrPs. DJS]

Yang, J. 1994. Intrathecal administration of oxytocin induces analgesia in low back pain involving the endogenous opiate peptide system. Spine 19(8):867-871.

Yang M, Li ZS, Xu XR et al. 2006.  Characterization of cortical potentials evoked by oesophageal balloon distention and acid perfusion in patients with functional heartburn.  Neurogastroenterol Motil. 18(4):292-299.  “These findings provide the evidence that central sensitization contributes to the development and maintenance of oesophageal hypersensitivity.”  [This would indicate that FM patients may be especially sensitive to developing reflux.  Care may be needed to avoid TrPs in the high abdominal oblique muscles that could contribute to and be perpetuated by GERD. DJS]

Yap A.U., Tan K.B., Chua E.K et al. 2002.  Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent 88(5):479-84.  “Within the limits of this study, patients diagnosed with myofascial pain and other joint conditions (group E) has significantly higher levels of depression (P=.03) and somatization (P=.03) than patients diagnosed with only disk displacements (group B).”  [It would be interesting to find out how the levels of “depression and somatization” changed if the clinicians doing this study took into account that myofascial pain is not a “joint condition”, myofascial TrPs can occur body-wide and could be a factor in this study, and that patients should also be screened for coexisting fibromyalgia. DJS]

Yaron, I., D. Buskila, I Shirazi, I. Neumann, O. Elkayam, D. Parran and M. Yaron. 1997. Elevated levels of hyaluronic acid in the sera of women with fibromyalgia.  J Rheumatol 24(11):2221-4.

Yavuz, S, I Fresko, V Hamuryudan, S Yurdakul and H Yazici. 1998.  Fibromyalgia in Behcet’s syndrome.  J Rheumatol 25(11):2219-20.

Yeh GY, Wang C, Wayne PM et al. 2008.  The effect of tai chi exercise on blood pressure: a systematic review.  Prev Cardiol. 11(2):82-89.  “Tai chi exercise may reduce BP and serve as a practical, nonpharmacologic adjunct to conventional hypertension management.”  [“Galloping hypertension, that is, high blood pressure that consistently rises without known reason, is common in a subset of patients with FM, CMP and insulin resistance.  Non-medicinal options for these patients already taking a number of medications should be considered carefully.  DJS]

Yehuda, R., A. C. McFarlane and A. Y. Shalev. 1998. Predicting the development of post-traumatic stress disorder from the acute response to a traumatic event. Biol Psychiatry 44(12):1305-13.

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Yunus, M. B., F. Inanici, J. C. Aldag and R. F. Mangold. 2000. Fibromyalgia in men: comparison of clinical features with women. J Rheumatol 27(2):485-90

Yunus, M. B. , M. A. Kahn, K. K. Rawlings, J. R. Green, J. M. Olson and S. Shah. 1999. Genetic linkage analysis of multicase families with fibromyalgia syndrome. J Rheumatol 26(2):408-12.

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Zachrisson O, Colque-Navarro P, Gottfries CG et al. 2004. Immune modulation with a staphylococcal preparation in Fibromyalgia/Chronic Fatigue Syndrome: Relation between antibody levels and clinical improvement.  Eur J Clin Microbiol Infect Dis 23(2):98-105.  This study did not differentiate between fibromyalgia and chronic fatigue and did not account for any co-existing conditions.  Since CFIDS is an illness of exclusion, this is not logical and the conclusions must be suspect.

Zammit, G. J., J. Weiner, N. Damato, G. P. Sillup and C. A. McMillan. 1999. Quality of life in people with insomnia. Sleep 22 Suppl 2:S379-85.

Zanchet EM, Longo I, Cury Y. 2004.  Involvement of spinal neurokinins, excitatory amino acids, proinflammatory cytokines, nitric oxide and prostanoids in pain facilitation induced by Phoneutria nigriventer spider venom.  Brain Res. 102(1):101-111.  Central sensitization can be caused by this spider venom.

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Zhuo M. 2007.  A synaptic model for pain: long-term potentiation in the anterior cingulated cortex.  Mol Cells. 23(3):259-271.  “Long-term potentiation (LTP), mostly intensely studies in the hippocampus and amygdale, is proposed to be a cellular model for learning and memory.”  “ACC (anterior cingulate cortex) LTP may serve as a cellular model for studying central sensitization that related to chronic pain, as well as pain-related cognitive emotional disorders.”

Zieglgansberger W. 2004.  Mechanisms of the transition from acute to chronic pain.  J Musculoskeletal Pain 12(3/4):13.  “Objectives: Chronic pain states may arise from synaptic and cellular plasticity in a variety of distinct systems.  Novel compounds and new regimes for drug treatment to prevent activity-dependent long-term changes are emerging.”  “Conclusions: ‘Memory traces’ of pain are not necessarily permanent but can gradually diminish spontaneously or can be reversed by adequate therapeutic intervention.  In the absence of reinforcement, the behavioral responses resulting from aversive memories will gradually diminish to be finally extinct.  In a recent study we showed that in mice that were deficient in cannabinoid receptor 1 the extinction of aversive memory was impaired. (Marsicano et al., Nature 418, 2002).”

Zijlstra TR, Braakman-Jansen LM, Taal E et al. 2007.  Cost-effectiveness of spa treatment for fibromyalgia: general health improvement is not for free.  Rheumatology [Jul 17 Epub ahead of print].  “The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient.”

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Zink, T. and J. Chaffin. 1998. Herbal ‘health’ products: what family physicians need to know. Am Fam Physician 58(5):1133-40.

Zink W, Graf BM.  2004.  Local anesthetic myotoxicity.  Reg Anesth Pain Med. 29(4):333-340.  “All local anesthetic agents that have been examined are myotoxic, whereby procaine produces the least and bupivacaine the most severe muscle injury.”  [Bupivicaine (Marcaine) should not be used for trigger point injections. Procaine is much less myotoxic. DJS]

Zinnuroglu M, Ural A, Gunendi Z et al. 2008.  Is there a relationship between eagle syndrome and cervicofacial painful soft tissue rheumatisms?  Laryngoscope [Jul 31 Epub ahead of print].  “Eagle Syndrome frequently coexists with rheumatic disorders resulting in chronic pain such as MPS and FM.  Even though Eagle Syndrome is a rare condition, it should be kept in mind in patients suffering from chronic cervicofacial pain that is refractory to treatment.  Clinicians should be alert to diagnose and treat coexisting locomotor system disorders.”  [This study reminds us to continue to search for hidden perpetuating factors when the same TrPs return in spite of appropriate treatment. DJS]

Zohn, D. A. 1997. Relationship of joint dysfunction and soft-tissue problems. In: Phys Med Rehab Clin North Am 8(1):69-86.

Zohn, D. and D. Clauw. 1999. Skin rolling as a diagnostic test for fibromyalgia. J Musculoskel P 7(3):127-136.

Zuo Y, Perkins NM, Tracey DJ et al. 2003.  Inflammation and hyperalgesia induced by nerve injury in the rat: a key role of mast cells.  Pain 105(3):467-79.  “Treatment with histamine receptor antagonists suppressed the development of hyperalgesia following nerve injury and alleviated hyperalgesia once it was established.”

[No authors listed]. 1997. Practice guidelines for chronic pain management. A report by the American Society of Anesthesiologists Task Force on Pain Management, Chronic Pain Section. Anesthesiology 86(4):995-1004

[No authors listed]. 1999. Multiple chemical sensitivity: a 1999 consensus. Arch Environ Health 54(3):147-9.

[No authors listed] 1999. Insomnia: assessment and management in primary care.National Heart, Lung, and Blood Institute Working Group on Insomnia. Am Fam Physician 59(11):3029-38.