Journal of

The South African Chapter of the IASP

ISSN 1998-2062

Injuries and Pain in Sports and Exercise

Assessment of Musculoskeletal Pain: Experimental and Clinical

Acute Musculoskeletal Pain

Evidence-Based Invasive Treatment of Chronic Musculoskeletal Pain

Musculoskeletal Pain

Exercise in Management of Musculoskeletal Pain

Epidemiology of Musculoskeletal Pain

Basic Aspects of Muscle Pain

Fibromyalgia

Myofascial Pain

Temporomandibular Disorder Pain

Neck Pain

Coping with Pain

Volume 5 Number 1

2010

pain sa 1 2010.indd 1 3/15/10 12:40:53 PM

pain sa 1 2010.indd 2 3/15/10 12:40:57 PM

Journal of The South African Chapter of the IASPVolume 5 Number 1

Editorial

“I am pleased to announce the 2009–2010 Global Year Against Musculoskeletal Pain. This IASP-sponsored campaign will draw attention to the disabling pain experienced by people around the world suffering from musculoskeletal disorders. Built around the theme of “When Moving Hurts: As-sess, Understand, Take Action,” this vital initiative calls upon each of us to provide a voice to those with musculoskeletal pain. ”These are the words of Gery Gebhart, the President of the IASP.

This begs the question: Why musculoskeletal pain? The reason is simple and that is because it is an enormous problem that affects millions of people worldwide. According to leading pain experts—including IASP Global Year Co-Chairs Dr. Lars Arendt-Nielsen of the University of Aal-borg, Denmark, and Dr. Kathleen A. Sluka of the University of Iowa, USA—more people around the world experience musculoskeletal pain than any other type of pain. It is complex and far-reaching,

encompassing many different types of pain, such as neck pain, limb pain, low back pain, joint pain, bone pain, and chronic widespread pain, just to name a few. Yet, despite the wide-ranging conditions and symptoms, all types of musculoskeletal pain share similar underlying mechanisms, manifestations, and potential treatments.

What has also been observed is that treatment for musculoskeletal pain is not adequate. When chronic, musculoskeletal pain is typically managed, but not cured. The situation is made more complex by the fact that it is often diffi cult to relate pathophysiological changes to the patient’s actual pain, which makes musculoskeletal pain especially challenging to di-agnose. Even when the source of the musculoskeletal pain is identifi able, it can still be diffi cult to link the source and the severity of the pain, as they do not always match. Although the patient’s pain is real, you cannot always see it. He or she is in pain, but the clinician cannot determine why or pinpoint the source.

Beyond the suffering and discomfort associated with musculoskeletal pain, there are huge fi nancial and other costs, includ-ing medical care expenses, lost work days, and diminished quality and productivity in patients’ work and personal lives—all of which are fueled by worldwide trends, including: an aging population, sedentary lifestyles, and the increasing incidence of obesity.

I am thus deviating from the standard scientifi c articles that we usually publish to a series of fact sheets containing good reference articles so that our understanding of the problem can be enhanced. The other regular features will still appear in this edition.

Let me take this opportunity of wishing you all a successful 2010. I trust that you will be able to join your colleagues at the PAINSA congress to be held in May and at the IASP World congress to be held in Montreal in September.

Dr. Milton RaffBSc (WITS), MBChB (Pret), FFA (SA

All correspondence to the editor should be addressed to: raffs@iafrica.com

1

pain sa 1 2010.indd 1 3/15/10 12:40:58 PM

EDITORDr. M Raff

BSc (WITS), MBChB (Pret), FFA (SA)

EDITORIAL BOARDProf. H Meyer

MBChB(Pret) MPraxMed(Pret) MFGP(SA)

Prof. C L Odendaal

Prof. D MitchellBSc Hons, MSc, PhD

(all University of the Witwatersrand)

Dr. S BaumannBA. Mb.Ch.B.(U.C.T.),

P.G.C.E.(University College of Wales), M.R.C.Psych.(London),

F.C.Psych (S.A.)

Mrs. P BergerBSc Physio (Wits), Acup (SA)

Dr. E FrohlichMD(Tel-Aviv), DA(SA),

FCA(SA), Master (Med) Pain Management (Syd)

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights for translation, reprinting reuse of illustrations, broad-casting, reproduction of CD-Rom, microfilm, online publication, or in any other way, and storage in data banks.

The use of registered names trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt for the relevant laws and regulations and therefore free for general use.

Product liability: the publishers cannot guarantee the accuracy of any information about the publication of medications contained in this publication. In every individual case, the user must check such information by consulting the relevant literature.

ADVERTISING & RATES

Reni Rouncivell, Tel: (012) 661 3294 Fax: 086 561 5122, Cell: 082 441 6904, e-mail: reni@medspec.co.za, Private Bag X1036, Lyttelton, South Africa 0140

Sue-Anne Smook, Tel: (012) 661 3294 Fax: 086 561 5122, Cell: 082 856 2813, e-mail: sueanne@medspec.co.za, Private Bag X1036, Lyttelton, South Africa 0140

Lelani Wearing, Tel: (012) 661 3294 Fax: 086 561 5122, Cell: 079 512 6990, e-mail: lelani@medspec.co.za, Private Bag X1036, Lyttelton, South Africa 0140

SUBSCRIPTIONS & ACCOUNTS

Elizabeth Versteeg, Tel: 072 189 8499, e-mail: accounts@medspec.co.za

Injuries and Pain in Sports and Exercise5

Musculoskeletal Pain16

Acute Musculoskeletal Pain11

Epidemiology of Musculoskeletal Pain21

Fibromyalgia27

Assessment of Musculoskeletal Pain: Experimental and Clinical7

Exercise in Management of Musculoskeletal Pain19

Evidence-Based Invasive Treatment of Chronic Musculoskeletal Pain13

Basic Aspects of Muscle Pain24

Myofascial Pain30Temporomandibular Disorder Pain33Neck Pain36Clinical Updates: Coping with PainFrancis J. Keefe, Tamara J. Somers, Sejal M. Kothadia39Pain Top 25 Articles45

2

pain sa 1 2010.indd 2 3/15/10 12:40:59 PM

pain sa 1 2010.indd 3 3/15/10 12:41:02 PM

pain sa 1 2010.indd 4 3/15/10 12:41:05 PM

5

pain sa 1 2010.indd 5 3/15/10 12:41:07 PM

6

pain sa 1 2010.indd 6 3/15/10 12:41:08 PM

δ

7

pain sa 1 2010.indd 7 3/15/10 12:41:10 PM

8

pain sa 1 2010.indd 8 3/15/10 12:41:11 PM

pain sa 1 2010.indd 9 3/15/10 12:41:14 PM

pain sa 1 2010.indd 10 3/15/10 12:41:18 PM

∞

∞

∞

∞

∞

∞

∞

∞

11

pain sa 1 2010.indd 11 3/15/10 12:41:20 PM

∞

∞

∞

∞

∞

12

pain sa 1 2010.indd 12 3/15/10 12:41:21 PM

13

pain sa 1 2010.indd 13 3/15/10 12:41:22 PM

14

pain sa 1 2010.indd 14 3/15/10 12:41:24 PM

pain sa 1 2010.indd 15 3/15/10 12:41:27 PM

∞

∞

∞

∞

∞ Inflammation:

∞ Fibrosis:

∞ Tissue degradation:

∞ Neurotransmitters: N

∞ Neurosensory/neuroimmune factors:

∞∞

ooooo

16

pain sa 1 2010.indd 16 3/15/10 12:41:28 PM

pain sa 1 2010.indd 17 3/15/10 12:41:31 PM

∞

∞

∞∞

∞

∞

∞

∞

∞o

oooo

∞

18

pain sa 1 2010.indd 18 3/15/10 12:41:33 PM

∞

∞∞

∞

∞

∞

∞∞

∞

∞

∞∞

∞∞

∞

19

pain sa 1 2010.indd 19 3/15/10 12:41:34 PM

∞∞

∞

20

pain sa 1 2010.indd 20 3/15/10 12:41:35 PM

∞

∞

∞

∞

∞

∞∞

∞

∞

21

pain sa 1 2010.indd 21 3/15/10 12:41:37 PM

∞

∞

∞

22

pain sa 1 2010.indd 22 3/15/10 12:41:38 PM

pain sa 1 2010.indd 23 3/15/10 12:41:44 PM

∞∞∞

∞

∞

∞

∞

∞

∞

∞

∞

∞∞

∞

∞

∞ N

∞

∞

24

pain sa 1 2010.indd 24 3/15/10 12:41:47 PM

pain sa 1 2010.indd 25 3/15/10 12:41:50 PM

26

pain sa 1 2010.indd 26 3/15/10 12:41:52 PM

∞∞∞∞

∞ Neuroendocrine:

∞ Neurotransmitter:

∞ Neurosensory:

∞ Genetic:

∞∞

∞

∞

oooooo

∞o

27

pain sa 1 2010.indd 27 3/15/10 12:41:53 PM

ooo

∞ooo

∞

∞oooo

o

o

28

pain sa 1 2010.indd 28 3/15/10 12:41:55 PM

rica

pain sa 1 2010.indd 29 3/15/10 12:41:55 PM

∞

∞

∞ Morphological changes

∞ Neurotransmitters

∞ Neurosensory features:

∞ Electrophysiology:

∞ Motor impairments:

∞∞∞

∞∞

30

pain sa 1 2010.indd 30 3/15/10 12:41:57 PM

pain sa 1 2010.indd 31 3/15/10 12:41:59 PM

∞

∞∞∞

∞

∞

32

pain sa 1 2010.indd 32 3/15/10 12:42:00 PM

COMT

33

pain sa 1 2010.indd 33 3/15/10 12:42:02 PM

∞

∞

∞

∞

∞∞∞∞

∞∞

34

pain sa 1 2010.indd 34 3/15/10 12:42:04 PM

pain sa 1 2010.indd 35 3/15/10 12:42:07 PM

∞∞∞∞∞

∞∞∞

∞

∞

∞

36

pain sa 1 2010.indd 36 3/15/10 12:42:08 PM

pen

pain sa 1 2010.indd 37 3/15/10 12:42:08 PM

∞

∞

∞∞

∞

∞

∞

38

pain sa 1 2010.indd 38 3/15/10 12:42:10 PM

39

pain sa 1 2010.indd 39 3/15/10 12:42:12 PM

40

pain sa 1 2010.indd 40 3/15/10 12:42:13 PM

41

pain sa 1 2010.indd 41 3/15/10 12:42:14 PM

42

pain sa 1 2010.indd 42 3/15/10 12:42:15 PM

43

pain sa 1 2010.indd 43 3/15/10 12:42:17 PM

PAIN TOP25 articles within the journal PAIN

1. Pharmacologic management of neuropathic pain: Evidence-based recommendations • Review article Pain, Volume 132, Issue 3, December 2007, Pages 237-251 Dworkin, R.H.; O\’Connor, A.B.; Backonja, M.; Farrar, J.T.; Finnerup, N.B.; Jensen, T.S.; Kalso, E.A.; Loeser, J.D.;

Miaskowski, C.; Nurmikko, T.J.; Po

2. Algorithm for neuropathic pain treatment: An evidence based proposal Pain, Volume 118, Issue 3, December 2005, Pages 289-305 Finnerup, N.B.; Otto, M.; McQuay, H.J.; Jensen, T.S.; Sindrup, S.H.

3. On the definitions and physiology of back pain, referred pain, and radicular pain • Review article Pain Bogduk, N.

4. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A ranomized trial

Pain, Volume 131, Issue 1-2, September 2007, Pages 31-37 Ferreira, M.L.; Ferreira, P.H.; Latimer, J.; Herbert, R.D.; Hodges, P.W.; Jennings, M.D.; Maher, C.G.; Refshauge, K.M.

5. Peripheral and central sensitization in remote spinal cord regions contribute to central neuropathic pain after spinal cord injury

Pain Carlton, S.M.; Du, J.; Tan, H.Y.; Nesic, O.; Hargett, G.L.; Bopp, A.C.; Yamani, A.; Lin, Q.; Willis, W.D.; Hulsebosch,

C.E.

6. Reduction of allodynia in patients with complex regional pain syndrome: A double-blind placebo-controlled trial of topical ketamine

Pain, Volume 146, Issue 1-2, November 2009, Pages 18-25 Finch, P.M.; Knudsen, L.; Drummond, P.D.

7. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study

Pain Schwartzman, R.J.; Alexander, G.M.; Grothusen, J.R.; Paylor, T.; Reichenberger, E.; Perreault, M.

8. Risk and prognostic factors for non-specific musculoskeletal pain: A synthesis of evidence from systematic re-views classified into ICF dimensions

Pain Lakke, S.E.; Soer, R.; Takken, T.; Reneman, M.F.

9. Exercise and chronic low back pain: what works? Pain, Volume 107, Issue 1-2, January 2004, Pages 176-190 Liddle, S.D.; Baxter, G.D.; Gracey, J.H.

10. Treatment of fibromyalgia syndrome with gabapentin and pregabalin - A meta-analysis of randomized control-led trials

Pain, Volume 145, Issue 1-2, September 2009, Pages 69-81 Hauser, W.; Bernardy, K.; Uceyler, N.; Sommer, C.

11. Biogenic amine depletion causes chronic muscular pain and tactile allodynia accompanied by depression: A putative animal model of fibromyalgia

Pain, Volume 146, Issue 1-2, November 2009, Pages 26-33 Nagakura, Y.; Oe, T.; Aoki, T.; Matsuoka, N.

12. Is mirror therapy all it is cracked up to be? Current evidence and future directions • Review article Pain, Volume 138, Issue 1, August 2008, Pages 7-10 Moseley, G.L.; Gallace, A.; Spence, C.

44

pain sa 1 2010.indd 44 3/15/10 12:42:17 PM

13. Differential regulation of TRP channels in a rat model of neuropathic pain Pain, Volume 144, Issue 1-2, July 2009, Pages 187-199 Staaf, S.; Oerther, S.; Lucas, G.; Mattsson, J.P.; Ernfors, P.

14. A systematic review of adverse events in placebo groups of anti-migraine clinical trials Pain Amanzio, M.; Corazzini, L.L.; Vase, L.; Benedetti, F.

15. Hypnosis for chronic pain management: A new hope • Review article Pain Jensen, M.P.

16. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Question-naire (SF-MPQ-2)

Pain, Volume 144, Issue 1-2, July 2009, Pages 35-42 Dworkin, R.H.; Turk, D.C.; Revicki, D.A.; Harding, G.; Coyne, K.S.; Peirce-Sandner, S.; Bhagwat, D.; Everton, D.;

Burke, L.B.; Cowan, P.; Farrar, J.T.; Hertz, S.; Max, M.B.; Rappaport, B.A.; Melzack, R.

17. The effect of tactile discrimination training is enhanced when patients watch the reflected image of their unaf-fected limb during training

Pain, Volume 144, Issue 3, August 2009, Pages 314-319 Moseley, G.L.; Wiech, K.

18. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale Pain, Volume 94, Issue 2, November 2001, Pages 149-158 Farrar, J.T.; Young, J.P.; LaMoreaux, L.; Werth, J.L.; Poole, R.M.

19. Studying sex and gender differences in pain and analgesia: A consensus report • Review article Pain, Volume 132, Issue 1001, November 2007, Pages S26-S45 the Consensus Working Group of the Sex, Gender, and Pain SIG of the IASP; Greenspan, J.D.; Craft, R.M.; LeRe-

sche, L.; Arendt-Nielsen, L.; Berkley, K.J.; Fillingim, R.B.; Gold, M.S.; Holdcroft, A.; Lautenbacher, S.; Mayer, E.A.; Mogil, J.S.; Murphy, A.Z.;

20. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1

Pain, Volume 145, Issue 3, October 2009, Pages 304-311 Sigtermans, M.J.; van Hilten, J.J.; Bauer, M.C.R.; Arbous, M.S.; Marinus, J.; Sarton, E.Y.; Dahan, A.

21. Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee

Pain Ahsin, S.; Saleem, S.; Bhatti, A.M.; Iles, R.K.; Aslam, M.

22. Duloxetine, a centrally acting analgesic, in the treatment of patients with osteoarthritis knee pain: A 13-week, randomized, placebo-controlled trial

Pain Chappell, A.S.; Ossanna, M.J.; Liu-Seifert, H.; Iyengar, S.; Skljarevski, V.; Li, L.C.; Bennett, R.M.; Collins, H.

23. Excitatory and inhibitory pain mechanisms during the menstrual cycle in healthy women Pain, Volume 146, Issue 1-2, November 2009, Pages 47-55 Tousignant-Laflamme, Y.; Marchand, S.

24. Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommen-dations • Review article

Pain Dworkin, R.H.; Turk, D.C.; McDermott, M.P.; Peirce-Sandner, S.; Burke, L.B.; Cowan, P.; Farrar, J.T.; Hertz, S.; Raja,

S.N.; Rappaport, B.A.; Rauschkolb, C.; Sampaio, C.

25. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial

Pain, Volume 108, Issue 1-2, March 2004, Pages 192-198 Moseley, G.L.

45

pain sa 1 2010.indd 45 3/15/10 12:42:17 PM

Product & NewsProduct & News

A HUMBLE SOUTH AFRICAN TEAM IN HAITIIt was a call Dr Fathima Docrat had to answer - and when she did, it was with the blessing of Brian Daniel, Country Manager, Pfi zer South Africa, who said simply: “Just go!”

The earthquake that devastated Haiti in January this year touched so many lives across the globe – but none more so than doctors and paramedics, who knew they had the training and calling to assist in disasters of this nature.

“I saw the footage on TV and felt compelled to go and help,” says Dr Docrat. “A friend of mine is the medical doctor who was coordinating the second South African team sent to Haiti with the Gift of the Givers organisation. Together we comprised four doctors and six paramedics from around the country.”

Arriving at night, the team only got the full impact of the devastation the next day, when they joined up with the Mexican and Cuban teams at a makeshift “hospital” next to the Cathedral where Haitian Archbishop Joseph Serge Miot had been thrown to his death by the force of the earthquake. “We created a theatre on a verandah, using old sheets and anything else we could fi nd to set up a service and start saving lives,” she says. “Buildings were unsafe so we were forced to be outdoors, but we tried to create sterile standards and wear theatre clothing in a virtually impossible situation.

“Even if the buildings were still standing, there were too many aftershocks to risk working indoors. We were present during the largest aftershock of 6.0 on the Richter scale and it was a scary experience with everyone running in different directions,” says Dr Docrat.

Using bleach, the team cleaned everything possible every morning to try and keep down the already massive rate of infection. “The infection rate also made us extremely sad,” she says. “I felt like we were digging a hole in beach sand . . . and the sand just kept fi lling the hole.”

The desolation and wreckage was, according to Dr Docrat, “humbling”. The Western Hemisphere’s most-impoverished nation, Haiti has no infrastructure whatsoever to handle a crisis of this nature. “If an earthquake of this magnitude were to happen in Johannesburg, we would at least have a baseline from which to work,” she says. “In Haiti, there was nothing to re-build.”

While the world looked on in horror and many tried to help, some of the assistance was not well thought-through, says Dr Docrat. “One NGO sent a shipload of food that needed to be prepared in a microwave oven. Of course, there was no electricity, let alone microwave ovens.” The team itself had taken two-minute noodles for sustenance – but had no boiling water!

As heartbreaking as some of the sights were, the team was sadder still to leave. “I felt as if we had brought hope and then just taken it away again,” she says. “During my travels after I left, I felt guilty sleeping in a real bed and having proper food.”

Her concern now? The many amputees who run the risk of severe infection. “We will never know,” says Dr Docrat. “There is no way to trace them. The most heart-wrenching thing was the children, who didn’t want us to dress their wounds because they said their ‘a were coming’ . . .”

While both distressed and humbled by the experience, Dr Docrat says she would go back if she could. “I believe that every little thing that was done to help make a difference, and that NGOs and the military may carry on where we left off. However, what is badly needed is a sustainable program to help the victims - not just physically, but emotionally, too.”

Asked about the threat of violence that TV viewers at home were told about, Dr Docrat says: “I never felt unsafe once. We travelled from Port-au-Prince some 60 kilometres to Petit Guave on the back of a pickup with no incident at all. The only thing that was a constant reminder of the severity of the destruction was the smell. I will remember that forever.”

The Gift of the Givers team left Johannesburg on 18 January 2010 and returned home on 29 January. “Among all the intense feelings was a sense of pride,” Dr Docrat says. “South Africans are either very stupid or very brave . . . we appear to be willing to go anywhere to help! That made me very proud and – again – very humble. The support given to me by the staff at Pfi zer was also phenomenal. I felt special and proud to be part of the Pfi zer family. It was an unforgettable experience.”

46

pain sa 1 2010.indd 46 3/15/10 12:42:20 PM

47

pain sa 1 2010.indd 47 3/15/10 12:42:23 PM

48

pain sa 1 2010.indd 48 3/15/10 12:42:27 PM

pain sa 1 2010.indd 1 3/15/10 12:42:30 PM

pain sa 1 2010.indd 2 3/15/10 12:42:32 PM