BackgroundMyofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population. Current guidelines for the management of myofascial pain are not available. In this study we investigated how physicians on the basis of prescription behaviour evaluate the effectiveness of treatment options in their management of myofascial pain.MethodsWe conducted a cross-sectional, nationwide survey with a standardized questionnaire among 332 physicians (79.8% male, 25.6% female, 47.5 ± 9.6 years) experienced in treating patients with myofascial pain. Recruitment of physicians took place at three German meetings of pain therapists, rheumatologists and orthopaedists, respectively. Physicians estimated the prevalence of myofascial pain amongst patients in their practices, stated what treatments they used routinely and then rated the perceived treatment effectiveness on a six-point scale (with 1 being excellent). Data are expressed as mean ± standard deviation.ResultsThe estimated overall prevalence of active myofascial trigger points is 46.1 ± 27.4%. Frequently prescribed treatments are analgesics, mainly metamizol/paracetamol (91.6%), non-steroidal anti-inflammatory drugs/coxibs (87.0%) or weak opioids (81.8%), and physical therapies, mainly manual therapy (81.1%), TENS (72.9%) or acupuncture (60.2%). Overall effectiveness ratings for analgesics (2.9 ± 0.7) and physical therapies were moderate (2.5 ± 0.8). Effectiveness ratings of the various treatment options between specialities were widely variant. 54.3% of all physicians characterized the available treatment options as insufficient.ConclusionsMyofascial pain was estimated a prevalent condition. Despite a variety of commonly prescribed treatments, the moderate effectiveness ratings and the frequent characterizations of the available treatments as insufficient suggest an urgent need for clinical research to establish evidence-based guidelines for the treatment of myofascial pain syndrome.

Chronic ischemic pain is a leading cause of pain in the lower extremities. A neuropathic component in ischemic pain has been shown. Neuropathic pain questionnaires are established as a common tool in pain research. The aim of this study was to analyze the clinical nature and the character of chronic ischemic pain in peripheral arterial disease (PAD). One hundred and two patients suffering from symptomatic PAD (Fontaine stages II-IV) were surveyed using validated pain questionnaires (VAS, NPSI, S-LANSS, PDI, SF-MPQ). Pain related disability was 22.7+/-1.7 (mean+/-SEM) in patients with intermittent claudication (CI) and 34.0+/-2.3 in patients with critical limb ischemia (CLI). Neuropathic pain questionnaires revealed distinctly higher scores for CLI than for CI: The S-LANSS indicated pain of predominantly neuropathic origin in patients with CLI (17.2+/-0.8) compared to CI (6.7+/-0.8; p<0.001). Global NPSI scores were 34.1+/-3.1 for CLI and 6.6+/-1.1 for CI (p<0.001). S-LANSS and NPSI correlated well (Spearman's rho=0.779; p<0.001). The SF-MPQ revealed that patients with CLI scored significantly higher for pain descriptors stabbing, hot-burning, tender and cruel-punishing compared to those with CI. The results suggest that the character of ischemic pain changes from nociceptive pain in patients with CI to predominantly neuropathic pain in patients with CLI. A neuropathic pain component seems to be a serious aspect in CLI, while it is not in CI. Questionnaires might be a helpful tool to investigate and diagnose ischemic pain.

BackgroundMany studies show an effectiveness of hypnotic analgesia. It has been discussed whether the analgesic effect is mainly caused by the relaxation that is concomitant to hypnosis. This study was designed to evaluate the effects of hypnotic relaxation suggestion on different somatosensory detection and pain thresholds.MethodsQuantitative sensory testing (QST) measurements were performed before and during hypnosis in twenty-three healthy subjects on the dorsum of the right hand. Paired t-test was used to compare threshold changes. The influence of hypnotic susceptibility was evaluated by calculating correlation coefficients for threshold changes and hypnotic susceptibility (Harvard group scale).ResultsDuring hypnosis significantly changed somatosensory thresholds (reduced function) were observed for the following sensory detection thresholds: Cold Detection Threshold (CDT), Warm Detection Threshold (WDT), Thermal Sensory Limen (TSL) and Mechanical Detection Threshold (MDT). The only unchanged sensory detection threshold was Vibration Detection Threshold (VDT). No significant changes were observed for the determined pain detection thresholds (Cold Pain Thresholds, Heat Pain Thresholds, Mechanical Pain Sensitivity, Dynamic Mechanical Allodynia, Wind-up Ratio and Pressure Pain Threshold). No correlation of hypnotic susceptibility and threshold changes were detected.ConclusionHypnotic relaxation without a specific analgesic suggestion results in thermal and mechanical detection, but not pain threshold changes. We thus conclude that a relaxation suggestion has no genuine effect on sensory pain thresholds.Trial RegistrationClinicalTrials.gov, Identifier: NCT02261155 (9th October 2014).

The differences among the specialties and the fact that the majority of physicians characterized the available symptomatic treatment options as insufficient point towards a need to review the treatment of ischemic pain in an interdisciplinary approach.

The results suggest that there might be correlations between psychophysical tests (QST) and pain questionnaires. Subjective perceptions of pain might be represented by a certain pattern in the QST. These connections could contribute to further clarify the pathophysiologic mechanisms leading to the perception of pain.