Chronic Pain Syndromes and Their Laryngeal Manifestations

Piersiala, Krzysztof; Akst, Lee M.; Hillel, Alexander T.; Best, Simon R.

doi:10.1001/jamaoto.2020.0530

Cited by 12 publications

(19 citation statements)

References 23 publications

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“…More studies indicate fibromyalgia may include also easy bruising [ 154 , 170 ], hair-loss [ 154 ], reduced skin innervation [ 171 ], tingling, creeping or crawling sensations [ 172 ], reduced fecundity or infertility [ 173 , 174 ], urinary urgency [ 172 ], changes in bowel habits [ 3 ], decreased optic disk perfusion [ 127 ], dry eyes [ 172 ], dry mouth [ 154 ], hearing difficulties [ 154 ], functional voice disorders (including muscle tension dysphonia) [ 175 ], wheezing [ 154 ], seizures [ 154 ], impaired cognition [ 154 ], and Raynaud’s phenomenon [ 154 , 176 ].…”

Section: Discussionmentioning

confidence: 99%

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Plaut

2022

PLoS ONE

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Background Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. Methods Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. Findings 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. Conclusions MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue (“fascial armoring”). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A “global percutaneous needle fasciotomy” that respects tensegrity principles may treat MPS/fibromyalgia more effectively. “Functional-somatic syndromes” can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.

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Section: Discussionmentioning

confidence: 99%

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Plaut

2022

PLoS ONE

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“…More studies indicate fibromyalgia may include easy bruising, 149,157 hair-loss, 149 reduced skin innervation, 158 tingling, creeping or crawling sensations, 159 reduced fecundity or infertility, 160,161 urinary urgency, 159 changes in bowel habits, 3 decreased optic disk perfusion, 127 dry eyes, 159 functional voice disorders (including muscle tension dysphonia), 162 wheezing, 149 , seizures, 149 impaired cognition, 149 and Raynaud’s phenomenon. 163 Can central sensitization and neuroplastic pain circuits alone be the explanation of all these manifestations?…”

Section: Discussionmentioning

confidence: 99%

“…“Kelley’s textbook of rheumatology” and others suggest functional somatic syndromes to be on a continuum of one entity with fibromyalgia. 122,149,162 Myofascial TrPs reproduce the pain pattern of fibromyalgia and are related to widespread mechanical hypersensitivity. 239 A study found that the topography of fibromyalgia tender points consists mostly of myofascial active TrPs (r=0·78, p<0·001).…”

Section: Discussionmentioning

confidence: 99%

“…Purely biologically, there really is only one entity (S1 Fig 2 grossly illustrates this overlap of conditions). "Kelley's textbook of rheumatology" and others suggest functional somatic syndromes to be on a continuum of one entity with fibromyalgia [122,154,175]. Myofascial TrPs reproduce the pain pattern of fibromyalgia and are related to widespread mechanical hypersensitivity [259].…”

Section: Compression Versus a Global Percutaneous Needle Fasciotomy: Conclusionmentioning

confidence: 99%

“…[154], hearing difficulties [154], functional voice disorders (including muscle tension dysphonia)[175], wheezing [154], seizures [154], impaired cognition [154], and Raynaud's phenomenon[154,176].…”

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Scoping review and interpretation of Myofascial Pain/Fibromyalgia syndrome: an attempt to assemble a medical puzzle

Plaut

2021

Preprint

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Introduction: Myofascial Pain Syndrome (MPS) is a common overlooked and underdiagnosed condition, and with significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. Methods: Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro and medrXiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. Findings: 734 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. Interpretation: MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue, or "fascial armoring", which may explain pain, distribution of pain, decreased pressure/pain threshold, and other phenomena eg, occasional complete resolution after surgery. Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. MPS should no longer be overlooked but solidified in the domain of common modern medicine.

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The Puzzle of Medically Unexplained Symptoms—A Holistic View of the Patient With Laryngeal Symptoms

Misono

Dietrich

Piccirillo

2020

JAMA Otolaryngol Head Neck Surg

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Functional laryngeal and airway disorders are characterized by apparently normal anatomy and neurological function accompanied by clinically significant symptoms, which can include dysphonia, dysphagia, globus sensation, and dyspnea.These disorders are often diagnoses of exclusion, since the presenting symptoms can also accompany important anatomic and neurologic abnormalities that must be ruled out. Primary muscle tension dysphonia (MTD), also often called functional dysphonia or hyperfunctional dysphonia, presents with various forms of laryngeal muscular dysregulation during voice and speech production and remains a voice disorder without established pathophysiology. Some signs and symptoms may be observable during the examination (eg, supraglottic hyperfunction, perceived vocal strain), while others may be elusive (eg, vocal fatigue, stress-induced hyperfunction). Functional airway disorders such as paradoxical vocal fold motion disorder (sometimes also called vocal cord dysfunction) are characterized by dysfunctional respiratory/laryngeal coordination. These can lead to dynamic airway narrowing at the glottis and shortness of breath despite a neurologically normal larynx. Functional laryngeal and airway disorders are frequently associated with psychological distress, including depression, anxiety, and somatic concerns. Somatic concerns involving other parts of the body are also common in patients with MTD and are associated with heightened medical costs, which drive up the costs of health care and further burden patients, who may undergo numerous expensive evaluations, tests, and procedures owing to their symptoms.In the intriguing study by Piersiala et al 1 in the current issue of JAMA Otolaryngology-Head & Neck Surgery, a retrospective review of more than 4000 patients was undertaken to determine whether patients with chronic pain syndromes (CPS: fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome) had different patterns of voice and laryngeal disorders than those without CPS. In the 5% of patients noted to have at least 1 CPS, functional voice disorders (as grouped by the authors) were more commonly diagnosed, and laryngeal and airway conditions were less commonly diagnosed, than in those without CPS. Furthermore, regardless of the specific type of CPS, patients had similar patterns of voice and laryngeal problems. These findings are consistent with the observation in a different health care system that patients with mental health diagnoses, including somatization, had a lower likelihood of receiving anatomic laryngeal disorder diagnoses than patients without mental health diagnoses. 2 It is important to emphasize, as acknowledged by the authors, 1 that the term "medically unexplained" must be used with caution. Some major medical disorders in the past were considered medically unexplained, until they were not. Inroads into

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Chronic Pain Syndromes and Their Laryngeal Manifestations

Cited by 12 publications

References 23 publications

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Scoping review and interpretation of Myofascial Pain/Fibromyalgia syndrome: an attempt to assemble a medical puzzle

The Puzzle of Medically Unexplained Symptoms—A Holistic View of the Patient With Laryngeal Symptoms

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