Publications
APS Bulletin • Volume 17, Number 3, 2007
Resource Reviews
John D. Loeser, MD, Department Editor
Soft Tissue Pain Syndromes: Clinical Diagnosis and Pathogenesis
Reviewed by James P. Robinson, MD PhD
Dieter E. Pongratz, Siegried Mense, and Michael Spaeth (Eds.), Binghamton, NY, Haworth Medical Press, 2004. Soft cover, 134 pages, ISBN 13-978-07890, $24.95.
This book is described in the preface as “a synopsis of the plenary presentations at MYOPAIN 2004.” The presentations were made at the Sixth World Congress of the International MYOPAIN Society in July 2004 in Munich.
Most of the book’s papers address clinical issues related to fibromyalgia (FMS) and myofascial pain (MFP). However, a few of them address basic science issues, such as the metabolic basis of painful myopathies and the central nervous system consequences of muscle pain.
The presenters include several internationally recognized experts in muscle pain, MFP, and FMS. Readers who are already well versed in these areas might find useful pearls in various presentations (e.g., Robert Bennett’s review of research on pain and emotional stress following the World Trade Center attack in community cohorts and David Simons’s description of shockwave devices in the diagnosis of myofascial trigger points).
The book is not well suited for readers who are interested in getting an overview of clinical, methodological, and conceptual issues related to FMS and MFP. It is extremely choppy, contains the gaps inherent in multiauthored books, and suffers from a lack of overview articles by the editors. The reader is left with the task of deciding how to integrate a series of disconnected papers into some coherent understanding of FMS and MFP. There have been attempts to create order in these rather controversial areas (Robinson & Arendt-Nielsen, 2006).
A second problem for the uninitiated reader is that virtually all the authors are advocates for the “reality” of FMS and MFP. As a result, the papers do not address the broad questions that others might raise regarding these conditions. For example, Bennett cites studies suggesting that FMS patients have abnormalities in hypothalamic pituitary axis (HPA) functioning (Calis et al., 2004; Cohen et al., 2000). However, these studies compared FMS patients to healthy controls. The results are thus compatible with the hypothesis that abnormalities in HPA functioning are prevalent among patients with various chronic pain disorders, but have nothing specific to do with FMS. The key issue here is that if FMS is construed as a distinct disorder (rather than a variety of chronic musculoskeletal pain), nothing useful is learned comparing FMS patients with healthy controls. The distinctiveness of FMS can be demonstrated only in research involving comparisons between FMS patients and patients with other kinds of chronic musculoskeletal pain. Such comparisons suggest that FMS patients have a lot in common with patients who suffer from other kinds of chronic pain (Banic et al., 2004).
This book may provide some useful information for readers who are already well grounded in FMS and MFP, but is not recommended for those who seek an unbiased overview of these challenging areas.
Reference
Banic, B., Petersen-Felix, S., Andersen, O. K., Radanov, B. P., Villiger, P. M., Arendt- Nielsen, L., et al. (2004). Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain, 107(1–2), 7–15.
Calis, M., Gokce, C., Ates, F., Ulker, S., Izgi, H. B., Demir, H., et al. (2004). Investigation of the hypothalamo-pituitary-adrenal axis (HPA) by 1 microg ACTH test and metyrapone test in patients with primary fibromyalgia syndrome. Journal of Endocrinological Investigation, 27(1), 42–46.
Cohen, H., Neumann, L., Shore, M., Amir, M., Cassuto, Y., & Buskila, D. (2000). Autonomic dysfunction in patients with fibromyalgia: Application of power spectral analysis of heart rate variability. Seminars in Arthritis and Rheumatism, 29(4), 217–227.
Robinson J. P., & Arendt-Nielsen, L. (2006). Muscle pain syndromes. In: R. Braddom (Ed.), Physical Medicine and Rehabilitation, 3rd ed. Edinburgh: Elsevier/Saunders.
Dr. Robinson is clinical associate professor in the department of rehabilitation medicine at the University of Washington, Seattle, WA.