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The References' Caves You can find there some references about chronic pain and PPP.

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Old 01-02-2017, 06:06 PM   #1
Jo Bowyer
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Default The Grand Challenge in Cranial Pain—From Migraine to Cranial Neuralgias: Understanding Differences and Similarities to Advance Knowledge and Management

http://journal.frontiersin.org/artic...017.00019/full

Quote:
The field of primary headaches and cranial neuralgias has experienced in a relatively brief period a startling progress in expansion of knowledge (1, 2). This has allowed partial unraveling of the machinery involved in the occurrence of attacks and the identification of a set of mediators and genes that are likely to play a role. In the case of migraine, accumulated evidence has very recently led to the development of the first disease-specific prophylactic drug, the CGRP antibodies (3). In other cases, drugs available for indications different from pain, such as botulinum toxin or the antiepileptic drugs, have been tested with adapted protocols proving effective in chronic migraine and showing potential efficacy in other cranial pains, i.e., cluster headache, trigeminal neuralgia, and temporomandibular joint disorder (4, 5).

Notwithstanding the undeniable scientific advances, much research is still needed to fully understand and effectively treat primary headaches and cranial neuralgias. Open issues are manifold, spanning from pathophysiology to clinical aspects, and represent exciting challenges for future research.
The Challenge of Pathophysiological Components of Cranial Pain

The Anatomy
Quote:
The trigeminovascular system has been implicated as the major sensory system that mediates primary and secondary headaches of intracranial origin. More recent is the discovery that sensory innervation of the calvarial periosteum overlying the dorsal parts of the frontal and parietal calvarial bones is supplied primarily by trigeminal neurons with cell bodies located mainly within the ophthalmic division of the trigeminal ganglion (6). Taken together with the limited knowledge about the functional anatomy of the neurovascular unit, these data call for more investigations aimed at unraveling the functional anatomy and the physiology of cranial pain.



The second terminations of the suboccipital muscles: An assistant pivot for the To Be Named Ligament

http://journals.plos.org/plosone/art...l.pone.0177120

Abstract

Quote:
In the last two decades, many studies have focused on the muscles and dense connective tissues located in the suboccipital region. Our study investigated the existence of the second terminations originating from the suboccipital muscles, and the relationship between the variable types of the To Be Named Ligament (TBNL). Anatomical dissection was performed on 35 head-neck specimens. The existence of the second terminations of the suboccipital muscles was confirmed and various types of the TBNL were observed in this study. The second terminations originated from multiple suboccipital muscles including the rectus capitis posterior minor (RCPmi), rectus capitis posterior major (RCPma) and obliquus capitis inferior (OCI) muscles, merged and terminated at the TBNL. The overall incidence of the second terminations of the suboccipital muscles was 34.29% and it varied among the various suboccipital muscle origins. 28.57% of the second terminations originated from the RCPma; 11.43% was from the RCPmi and 8.57% was from the OCI. Furthermore, there was a significant relationship between the existence of second terminations and the particular type of the TBNL. 95% of the arcuate type of the TBNL was accompanied with the second terminations which attached to their turning part, whereas only 10% of all the radiate type of the TBNL was accompanied with the second terminations. This study for the first time described the second terminations originating from multiple suboccipital muscles and demonstrated the relationship with the various types of the TBNL. We speculated that the second terminations maintain the arcuate TBNL and transfer tensile forces to the Myodural Bridge (MDB), thereby modulating the physiological functions of the MDB.
Introduction

Quote:
The suboccipital region is one of the most complicated anatomical areas of the human body [1]. In 1995, Hack et al. first described the relationship between the deep suboccipital muscles and the cervical spinal dura mater. They found a connective tissue bridge named the Myodural Bridge (MDB), between the rectus capitis posterior minor (RCPmi) and the dorsal cervical spinal dura mater at the atlanto-occipital interspace. The RCPmi gave off dense connective tissue that connects with the posterior atlanto-occipital membrane, and finally merged with the dorsal cervical spinal dura mater [2]. To date, many studies have confirmed the existence of this connective tissue bridge in humans and other mammalian animals [3]. Moreover, many studies in the last decade have shown that the MDB originate from multiple suboccipital muscles including the rectus capitis posterior major (RCPma) and the obliquus capitis inferior (OCI) [4–13].

In the suboccipital region, the nuchal ligament (NL) also provides a connection between the suboccipital region and the cervical dura mater [14–17]. In 2014, we observed an intrinsic fascial structure called the To Be Named Ligament (TBNL). The TBNL is a dense fibrous band that originates from the lower part of the posterior border of the NL, runs anteriosuperiorly to enter the atlanto-axial interspace and merged with the posterior cervical dura mater. It thereby forms part of the MDB. Furthermore, the TBNL is formed by either arcuate fibers or radiate fibers. In this study, we also found a second termination which originated from the RCPmi and terminated at the arcuate fiber of the TBNL [17].

Here in this research, we conducted an extensive anatomical study about the deep suboccipital region, and we found that multiple suboccipital muscles (RCPmi, RCPma and OCI) had novel terminations on the TBNL other than the traditional bony structures. We termed these novel terminations as the “second terminations” and we additionally investigated the morphological relationship between these second terminations and the variable types of the TBNL in the deep suboccipital region of humans.
Update 26/05/2017




Mental Status as a Common Factor for Masticatory Muscle Pain: A Systematic Review

http://journal.frontiersin.org/artic...017.00646/full

Quote:
Masticatory muscle pain (MMP) is the primary reason for chronic non-odontogenic orofacial pain in the human population. MMP has become a considerable social problem, which affects about 12–14% of the adult population and is 1.5–2 times more frequent in women than in men. This term defines a pain which has its origins in the masticatory muscles. Although MMP is typically felt in the face, jaws, and preauricular area, MMP can radiate to the ear, teeth, head, and neck. This systematic review explains the relationship between MMP and common mental states, such as anxiety, depression, mood and stress-related disorders, and is reported in accordance with PRISMA guidelines. We performed a search in the PubMed database for peer-reviewed articles published after November 1st 2006 in the context of MMP and mental states. According to the defined criteria, 38 studies were finally included into the systematic review, of which prospective cohort studies were found to be the most common. We investigated four primary outcomes (anxiety, depression, mood disorders, and stress-related disorders) and several secondary outcomes of search. Seventy-nine percent of studies concerned depression, 42% anxiety, 29% mood disorders, and 21% stress-related disorders. Most of the studies showed a relationship between MMP and alterations in mental status. Nonetheless, the researchers usually evidenced only the co-occurrence of psychiatric disorders and dysfunctions of the masticatory muscles among the group of patients, in large part in women. Moreover, some studies were marked with limited generalizability of the reported results, quality flaws and heterogeneity. In the light of the analyzed literature, the causal relationship between mental states and MMP is still not clearly established.

Introduction
A number of papers confirm that there is a correlation between pain sensitivity and mental states (Gatchel, 2004; Means-Christensen et al., 2008; Vaccarino et al., 2009; Haviland et al., 2011). Moreover, muscle pain also seems to be closely involved in this pathomechanism (Rollman and Gillespie, 2000; Haviland et al., 2011; Rees et al., 2011; Hung et al., 2016). Based on the previously cited papers (Rollman and Gillespie, 2000; Gatchel, 2004; Means-Christensen et al., 2008; Vaccarino et al., 2009; Haviland et al., 2011; Rees et al., 2011; Hung et al., 2016), this pathomechanism usually involves back, neck and orofacial muscles including masticatory muscles. Defining the onset of orofacial muscle pain related to psychoemotional status is controversial. Therefore researchers are still looking for a clear explanation of this important clinical issue (Durham et al., 2015; Glaros et al., 2016).

According to the literature, the term masticatory muscle pain (MMP) describes “the pain with origin in the masticatory muscles, including tendons and fasciae” and “is diagnosed by the presence of tenderness to palpation, e.g., of tender but not trigger points” (Gatchel, 2004). Alternatively, in the commonly applied research diagnostic criteria for temporomandibular disorders (RDC/ TMD) to define the same muscle condition, the term myofascial pain (MFP) is used. Interestingly, MFP is used to define the pain caused by trigger points (Gatchel, 2004). In our study, we consider these both symptoms of muscle pain dysfunction, i.e., related to trigger points and tenderness. MMP diagnosed based on muscle tenderness with palpation occurs in 12–14% of the examined population—there is a 1.5–2 times higher chance that women will suffer from this medical condition than men (Gatchel, 2004). Surprisingly, the prevalence of MMP in the age range 7–17 years is not higher in girls than boys (Gatchel, 2004).

The etiology and likely mechanism of muscle pain has aroused many controversies over the years. It can be associated with a peripheral mechanism of muscle pain excitation, outlasting sensitization of peripheral nociceptors, which are involved in the excitation of central neurons, and/or functional disorders (Haviland et al., 2011). However, numerous sources indicate that, regardless of the original muscle pain pathology, excessive muscle tension simultaneously appears as defensive muscle reaction, and results in increasing intensification of symptoms (Means-Christensen et al., 2008; Haviland et al., 2011). Increased muscle tension can be a local result of trauma, physiological function or dysfunction, and a defensive response to psychological burden (Means-Christensen et al., 2008; Haviland et al., 2011). The central mechanism of muscle pain development due to long-term overactivity mostly relates to those muscles which tense during psychological discomfort, anxiety, anger, and bad mood or under stress (Vaccarino et al., 2009; Haviland et al., 2011). The masseter, temporal muscle, sternocleidomastoid muscle and trapezius muscle, especially its upper part, are very good examples of mentioned central mechanism. These muscles tense in response to alterations in mental status, which may induce muscle pain related to mental disorders or chronic stress (Hung et al., 2016).

According to Okeson, the MMP can be divided into several types: protective co-contraction, local muscle soreness, MFP, myospasm (tonic contraction myalgia) and centrally mediated myalgia (Okeson, 2013). In many cases, the risk of the development of these MMP types is centrally modulated and is dependent on the mental state of the patient. Moreover, there are great similarities, and possible overlaps, between patients suffering from MMP and tension-type headache (TTH) and/or fibromyalgia (FM) (Rollman and Gillespie, 2000). A muscular pain was a cause of a headache in about 38% of adults (Rees et al., 2011).

We try to explain the relationship between MMP and psychological alterations and/or disorders such as anxiety, depression, mood and stress-related disorders, as well as systematically reviewing the current literature related to this issue and investigating it objectively.
Update 09/05/2017
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Last edited by Jo Bowyer; 26-05-2017 at 07:29 AM.
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Old 27-02-2017, 08:32 AM   #2
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Default The notorious TMJ by Cody Weisbach

https://noijam.com/2017/02/27/the-notorious-tmj/

I enjoy seeing these patients, they need a lot of calming down and reassurance. Any trigeminal neuralgia is worrying to the person who is living with it.
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