ObjectiveIndividuals with fibromyalgia (FM) have lower muscle strength and lower pressure pain thresholds (PPT). The primary aim of this study was to determine the associations between muscle strength and PPT in adults with FM to test the hypothesis that greater measures of muscle strength would be associated with greater values of PPT. Secondary aims included determining the effects of pain severity and the peak uptake of oxygen (Vo2) on the associations between muscle strength and PPT.MethodsKnee extensor and flexor strength (N = 69) was measured in the dominant leg using a dynamometer, and PPT was assessed using an electronic algometer. Pain severity was determined using the Multidimensional Pain Inventory, and peak Vo2 uptake was quantified using an electronically braked cycle ergometer.ResultsUnivariable linear regression analysis demonstrated a significant association between PPT (dependent variable) and isometric knee extensor (P<.001), isokinetic (60°/s) knee extensor (P = .002), and isokinetic (60°/s) knee flexor strength (P = .043). In a multiple variable linear regression analysis adjusted for age, sex, pain severity, body mass index and peak Vo2 uptake, a significant association was found between PPT and isometric knee extensor strength (P = .008). In a similar multiple variable analysis, a significant association was found between PPT and isokinetic knee extensor strength (P = .044).ConclusionGreater measures of isometric and isokinetic knee extensor strength were significantly associated with greater values of PPT in both univariable and multiple variable linear regression models.Trial RegistrationClinicalTrials.gov NCT01253395

Painful diabetic peripheral neuropathy impairs quality of life and can be difficult to treat. Many treatment options have adjuvant benefits or side effects which should be considered prior to initiating therapy. Often, a combination of treatment modalities with various mechanisms of action is required for adequate pain control.

Not applicable.

Cancer-related pain is a significant cause of morbidity in those affected by both primary and metastatic disease. Although oral, transdermal, and parenteral opioid medications are an integral part of the World Health Organization's analgesic ladder, their use may be limited by side effects. Fortunately, there are advanced interventional pain management strategies effective in reducing pain in the cancer patient while mitigating the aforementioned side effects. Celiac plexus blocks and neurolysis have been proven effective in treating cancers of the abdominal viscera (ie, pancreas). Transversus abdominis plane blocks, neurolysis, and catheter placement can be used to treat cancer pain associated with the abdominal wall. Peripheral nerve blocks and catheter placement at the brachial and lumbosacral plexus or peripheral nerves treat cancer pain associated with the upper and lower limbs, whereas paravertebral and intercostal blocks treat cancer pain associated with the chest wall and ribs. Finally, alternate drug delivery methods such as intrathecal drug delivery systems concentrate medication at central opioid receptors without affecting the peripheral receptors implicated in unwanted side effects. This article provides an overview of these interventions, including indications, contraindications, and potential complications of advanced interventional pain management options available for the treatment of intractable cancer-related pain.

Setting: Academic medical center. Results or Clinical Course: On examination, the patient had weakness of his right gluteus medius, tibialis anterior, tibialis posterior, peronei and extensor hallucis longus muscles. There was reduced sensation to pinprick over his dorsolateral right foot. Magnetic resonance imaging of his lumbar spine was unremarkable for neural compression. Electrodiagnostic studies revealed changes that localized either to the right sciatic nerve or sacral plexus. He was diagnosed with right lower limb weakness due to herpes zoster infection. Following physical therapy, he regained some functional strength of the right foot and was able to ambulate with an anklefoot-orthosis and cane. Discussion: Herpes zoster infection occurs due to reactivation of the varicella zoster virus. Over 90% of the reported cases are in immunocompetent individuals and the greatest risk factor is increased age. Zoster-associated limb weakness is an uncommon complication and has been reported in 3% of individuals with herpes zoster infections. The pathophysiology of zoster-associated limb weakness is hypothesized to be viral-mediated injury to the anterior horn cell or dysmyelination of the peripheral nerve. Conclusions: Zoster-associated limb weakness is a rare complication of herpes zoster infection, but should be included in the differential diagnosis of acute limb weakness.