myofascial pain syndromes

Summary

Summary: Muscular pain in numerous body regions that can be reproduced by pressure on trigger points, localized hardenings in skeletal muscle tissue. Pain is referred to a location distant from the trigger points. A prime example is the TEMPOROMANDIBULAR JOINT DYSFUNCTION SYNDROME.

Top Publications

  1. ncbi Pain relief by electrostimulation of myofascial trigger points: peripheral or central mechanisms?
    Till Sprenger
    Clin J Pain 23:638-9. 2007
  2. ncbi Superficial dry needling and active stretching in the treatment of myofascial pain--a randomised controlled trial
    Janet Edwards
    Acupunct Med 21:80-6. 2003
  3. ncbi Coexistence of fibromyalgia, temporomandibular disorder, and masticatory myofascial pain syndromes
    Berrin Leblebici
    Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
    Rheumatol Int 27:541-4. 2007
  4. ncbi Endplate potentials are common to midfiber myofacial trigger points
    David G Simons
    Department of Physical Medicine and Rehabilitation, University of California Irvine, USA
    Am J Phys Med Rehabil 81:212-22. 2002
  5. ncbi Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle
    Ta Shen Kuan
    Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
    Am J Phys Med Rehabil 81:512-20; quiz 521-3. 2002
  6. doi Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points
    Jay P Shah
    Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA
    Arch Phys Med Rehabil 89:16-23. 2008
  7. ncbi The spinal cord connections of the myofascial trigger spots
    Ta Shen Kuan
    Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
    Eur J Pain 11:624-34. 2007
  8. ncbi Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction
    David G Simons
    Department of Rehabilitation Medicine, Emory University, 3176 Monticello Street, Atlanta, GA 20014 3535, USA
    J Electromyogr Kinesiol 14:95-107. 2004
  9. doi Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials
    Elizabeth A Tough
    Primary Care, Peninsula Medical School, Universities of Exeter and Plymouth, ITTC Building, Tamar Science Park, Plymouth PL6 8BX, UK
    Eur J Pain 13:3-10. 2009
  10. pmc High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain
    Carel Bron
    Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands
    BMC Musculoskelet Disord 12:139. 2011

Detail Information

Publications185 found, 100 shown here

  1. ncbi Pain relief by electrostimulation of myofascial trigger points: peripheral or central mechanisms?
    Till Sprenger
    Clin J Pain 23:638-9. 2007
  2. ncbi Superficial dry needling and active stretching in the treatment of myofascial pain--a randomised controlled trial
    Janet Edwards
    Acupunct Med 21:80-6. 2003
    ..The mean PPT and SFMPQ scores correlated significantly in G1 only, though no significant inter-group differences were demonstrated. Numbers of patients requiring further treatment following the trial were: 6 (G1); 12 (G2); 9 (G3)...
  3. ncbi Coexistence of fibromyalgia, temporomandibular disorder, and masticatory myofascial pain syndromes
    Berrin Leblebici
    Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
    Rheumatol Int 27:541-4. 2007
    ..Our results indicate that coexistence of FM and TMD with MMP is high. Pain and tenderness in the masticatory muscles appear to be an important element in FM, so in some patients it may be the leading complaint...
  4. ncbi Endplate potentials are common to midfiber myofacial trigger points
    David G Simons
    Department of Physical Medicine and Rehabilitation, University of California Irvine, USA
    Am J Phys Med Rehabil 81:212-22. 2002
    ....
  5. ncbi Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle
    Ta Shen Kuan
    Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
    Am J Phys Med Rehabil 81:512-20; quiz 521-3. 2002
    ....
  6. doi Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points
    Jay P Shah
    Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA
    Arch Phys Med Rehabil 89:16-23. 2008
    ..To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle...
  7. ncbi The spinal cord connections of the myofascial trigger spots
    Ta Shen Kuan
    Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
    Eur J Pain 11:624-34. 2007
    ..However, the sensory (afferent) and the motor (efferent) connections between an MTrP and the spinal cord still has never been fully studied...
  8. ncbi Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction
    David G Simons
    Department of Rehabilitation Medicine, Emory University, 3176 Monticello Street, Atlanta, GA 20014 3535, USA
    J Electromyogr Kinesiol 14:95-107. 2004
    ..Specific research needs are noted. MTrPs are treatable and they deserve increased attention and consideration by research investigators and clinicians...
  9. doi Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials
    Elizabeth A Tough
    Primary Care, Peninsula Medical School, Universities of Exeter and Plymouth, ITTC Building, Tamar Science Park, Plymouth PL6 8BX, UK
    Eur J Pain 13:3-10. 2009
    ..However, the limited sample size and poor quality of these studies highlights and supports the need for large scale, good quality placebo controlled trials in this area...
  10. pmc High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain
    Carel Bron
    Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands
    BMC Musculoskelet Disord 12:139. 2011
    ..The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain...
  11. doi New views of myofascial trigger points: etiology and diagnosis
    David G Simons
    Emory University, Atlanta, GA, USA
    Arch Phys Med Rehabil 89:157-9. 2008
    ..This report seems to present an MRE image of the taut band that shows the chevron signature of the increased tension of the taut band compared with surrounding tissues...
  12. ncbi Needling therapies in the management of myofascial trigger point pain: a systematic review
    T M Cummings
    British Medical Acupuncture Society, London, England
    Arch Phys Med Rehabil 82:986-92. 2001
    ..To establish whether there is evidence for or against the efficacy of needling as a treatment approach for myofascial trigger point pain...
  13. ncbi Lesions of rat skeletal muscle after local block of acetylcholinesterase and neuromuscular stimulation
    S Mense
    Department of Anatomy and Cell Biology III, Heidelberg University, D 69 120 Heidelberg, Germany
    J Appl Physiol (1985) 94:2494-501. 2003
    ....
  14. ncbi The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise
    Ta Shen Kuan
    Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    Am J Phys Med Rehabil 86:183-9. 2007
    ..This study was designed to investigate the correlation between the irritability of the myofascial trigger point (MTrP) and the prevalence of endplate noise (EPN) in the MTrP region of human skeletal muscle...
  15. ncbi Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs
    Yueh Ling Hsieh
    Department of Physical Therapy, Hungkuang University, Salu, Taichung, Taiwan
    Am J Phys Med Rehabil 86:397-403. 2007
    ..To investigate the changes in pressure pain threshold of the secondary (satellite) myofascial trigger points (MTrPs) after dry needling of a primary (key) active MTrP...
  16. doi Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity
    Cristina Alonso-Blanco
    Departments of Health Sciences II, Universidad Rey Juan Carlos, Avenida de Atenas s n, Alcorcon, Madrid, Spain
    Clin J Pain 27:405-13. 2011
    ....
  17. ncbi Effect of contrasting physical exercise interventions on rapid force capacity of chronically painful muscles
    Lars L Andersen
    National Research Centre for the Working Environment, Lersø Parkalle 105 DK 2100 Copenhagen Ø, Denmark
    J Appl Physiol (1985) 107:1413-9. 2009
    ..Potentially, the present method can be a useful clinical screening tool of muscle function in rehabilitation settings...
  18. doi A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance
    Corrie Myburgh
    Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark
    Arch Phys Med Rehabil 89:1169-76. 2008
    ..To determine the reproducibility of manual palpation in identifying trigger points based on a systematic review of available literature...
  19. ncbi Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients
    Hyuk Ga
    Department of Family Medicine, Inha University College of Medicine, Incheon, South Korea
    J Altern Complement Med 13:617-24. 2007
    ..To compare the efficacies of dry needling of trigger points (TrPs) with and without paraspinal needling in myofascial pain syndrome of elderly patients...
  20. ncbi Myofascial trigger points in early life
    Mu Jung Kao
    Department of Physical Medicine and Rehabilitation, Taipei City Hospital, Taipei, Taiwan
    Arch Phys Med Rehabil 88:251-4. 2007
    ..To determine whether latent myofascial trigger points (MTPs) can be identified in healthy infants and in healthy adult subjects...
  21. ncbi Classification, epidemiology, and natural history of myofascial pain syndrome
    R D Gerwin
    Johns Hopkins University, Department of Neurology, 7830 Old Georgetown Road, Bethesda, MD 20814-2432, USA
    Curr Pain Headache Rep 5:412-20. 2001
    ..It is a treatable condition that can respond well to manual and injection techniques, but requires attention to postural, ergonomic, and structural factors, and toxic or metabolic factors that impair muscle function...
  22. doi Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study
    C Fernández-de-Las-Peñas
    Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos URJC, Alcorcon, Spain
    Man Ther 12:29-33. 2007
    ..All the examined muscles evoked referred pain patterns contributing to patients' symptoms. Active TrPs were more frequent in patients presenting with mechanical neck pain than in healthy subjects...
  23. ncbi Myofascial trigger points and sensitization: an updated pain model for tension-type headache
    C Fernández-de-Las-Peñas
    Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
    Cephalalgia 27:383-93. 2007
    ..In this updated pain model, TrPs would be the primary hyperalgesic zones responsible for the development of central sensitization in CTTH...
  24. ncbi Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis
    Abdullah M Al-Shenqiti
    Centre for Rehabilitation Science, University of Manchester, UK
    Clin Rehabil 19:482-7. 2005
    ..To investigate the test-retest reliability of the following clinical diagnostic characteristics of myofascial trigger points: taut band, spot tenderness, jump sign, pain recognition, referred pain and local twitch responses (LTRs)...
  25. ncbi Regional myofascial pain: diagnosis and management
    Mike Cummings
    Best Pract Res Clin Rheumatol 21:367-87. 2007
    ..The clinical evidence for and against the common therapeutic interventions used in the management of myofascial pain is reviewed in detail and some tentative conclusions are reached with respect to needling therapies...
  26. ncbi Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review
    Kok Yuen Ho
    Pain Management Services, Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
    Eur J Pain 11:519-27. 2007
    ..The current evidence does not support the use of BTA injection in trigger points for myofascial pain. The data is limited and clinically heterogeneous...
  27. ncbi Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients--a randomised trial
    Hyuk Ga
    Department of Family Medicine, Inha University College of Medicine, Incheon, Korea
    Acupunct Med 25:130-6. 2007
    ..To compare the efficacy of acupuncture needling and 0.5% lidocaine injection of trigger points in myofascial pain syndrome of elderly patients...
  28. ncbi Treatment of myofascial pain syndrome
    Chang Zern Hong
    Department of Physical Therapy, Hungkuang University, Shalu, Taichung, Taiwan
    Curr Pain Headache Rep 10:345-9. 2006
    ..It is also important to eliminate any perpetuating factors and provide adequate education and home programs to patients so that recurrent or chronic pain can be avoided...
  29. ncbi Current studies on myofascial pain syndrome
    Ta Shen Kuan
    Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan
    Curr Pain Headache Rep 13:365-9. 2009
    ..Many methods have been used to treat myofascial pain, including laser therapy, shockwave therapy, and botulinum toxin type A injection...
  30. ncbi The impact of latent trigger points on regional muscle function
    Karen R Lucas
    RMIT University, Clinical Neuroscience Research Group, School of Health Sciences, PO Box 71, Bundoora, Melbourne, Victoria, Australia
    Curr Pain Headache Rep 12:344-9. 2008
    ..This article offers suggestions as to the mechanisms via which LTrP-related pathophysiology may explain the clinical examination findings associated with LTrP-containing and functionally related muscles...
  31. doi Myofascial pain syndromes in the maxillofacial area: a common but underdiagnosed cause of head and neck pain
    Leonidas Manolopoulos
    ENT Department, Hippokrateion General Hospital of Athens, Athens, Greece
    Int J Oral Maxillofac Surg 37:975-84. 2008
    b>Myofascial pain syndromes (MPS) are a large group of muscular disorders, characterized by the presence of hypersensitive spots called trigger points (TP). The maxillofacial region is a high-frequency area for developing TPs...
  32. ncbi Clinical precision of myofascial trigger point location in the trapezius muscle
    V M Sciotti
    New York Chiropractic College, Seneca Falls, NY 13148, USA
    Pain 93:259-66. 2001
    ....
  33. doi Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work
    Jeffrey A Hoyle
    The Ergonomics Center of North Carolina, Edward P Fitts Department of Industrial and Systems Engineering, North Carolina State University, 3701 Neil St, Raleigh, NC 27607, USA
    J Electromyogr Kinesiol 21:41-8. 2011
    ..Findings suggest that MTrPs may be one causal pathway for pain during LLSEs and both postural and visual demands may play a role in muscle activation patterns, perhaps attributing to MTrP development and resultant discomfort...
  34. doi Myofascial pain syndromes and their evaluation
    Maria Adele Giamberardino
    Ce S I, G d Annunzio Foundation, Department of Medicine and Science of Aging, Chieti University, via Carlo de Tocco n 3, Chieti, Italy
    Best Pract Res Clin Rheumatol 25:185-98. 2011
    ..article reviews the available published knowledge about the diagnosis, pathophysiology and treatment of myofascial pain syndromes from trigger points...
  35. doi Muscle trigger point therapy in tension-type headache
    Cristina Alonso-Blanco
    Department of Nursing, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
    Expert Rev Neurother 12:315-22. 2012
    ..New studies are needed to further delineate the relationship between muscle TrP inactivation and tension-type headache...
  36. ncbi [Myofascial pain syndrome in the pelvic floor: a common urological condition]
    F Itza
    Unidad de Dolor, Clínica de Dolor Pélvico, Madrid, Espana
    Actas Urol Esp 34:318-26. 2010
    ..Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed...
  37. ncbi An expansion of Simons' integrated hypothesis of trigger point formation
    Robert D Gerwin
    Johns Hopkins University Pain and Rehabilitation Medicine, Bethesda, MD 20814 2432, USA
    Curr Pain Headache Rep 8:468-75. 2004
    ..We propose an expansion of this hypothesis to account for new experimental data and established muscle pathophysiology...
  38. ncbi Myofascial pain syndromes in the upper extremity
    R D Gerwin
    Pain Treatment Center, Johns Hopkins University Medical Institutions, Baltimore, MD, USA
    J Hand Ther 10:130-6. 1997
    b>Myofascial pain syndromes of the upper extremity are common causes of pain that may follow trauma and are associated with acute or chronic musculoskeletal stress...
  39. ncbi A proposed experimental model of myofascial trigger points in human muscle after slow eccentric exercise
    Kazunori Itoh
    Meiji University of Oriental Medicine, Kyoto, Japan
    Acupunct Med 22:2-12; discussion 12-3. 2004
    ..The purpose of this study was to develop an experimental model of myofascial trigger points to investigate their pathophysiology...
  40. ncbi Botulinum toxin for myofascial pain syndromes in adults
    Adriana Soares
    Department of Medicine, Universidade Federal de Sao Paulo, Belo Horizonte, Brazil
    Cochrane Database Syst Rev 4:CD007533. 2012
    ..Botulinum toxin is a protein produced by the bacterium Clostridium botulinum and is a potent neurotoxin that eventually inhibits muscle contractions. It is capable of selectively weakening painful muscles and interrupting the pain cycle...
  41. ncbi Myofascial trigger points show spontaneous needle EMG activity
    D R Hubbard
    Department of Neurosciences, University of California, San Diego
    Spine (Phila Pa 1976) 18:1803-7. 1993
    ..Mean EMG amplitude in the patient groups was significantly greater than in normals. The authors hypothesize that TrPs are caused by sympathetically activated intrafusal contractions...
  42. ncbi Urologic myofascial pain syndromes
    Ragi Doggweiler-Wiygul
    Department of Urology, University of Tennessee, 1211 Union Avenue, Suite 340, Memphis, TN 38104, USA
    Curr Pain Headache Rep 8:445-51. 2004
    ..The referred pain syndrome can long outlast the initial event, making diagnosis difficult...
  43. doi Chronic shoulder pain of myofascial origin: a randomized clinical trial using ischemic compression therapy
    Guy Hains
    Private Practice, Trois Rivieres, Côte Richelieu, Trois Rivieres, Quebec, Canada
    J Manipulative Physiol Ther 33:362-9. 2010
    ..The aim of this clinical trial was to evaluate the effect of 15 myofascial therapy treatments using ischemic compression on shoulder trigger points in patients with chronic shoulder pain...
  44. ncbi Evidence of neuroaxonal degeneration in myofascial pain syndrome: a study of neuromuscular jitter by axonal microstimulation
    Chein Wei Chang
    Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine and Hospital, No 1, Chang Te St, Taipei 100, Taiwan
    Eur J Pain 12:1026-30. 2008
    ..The mechanism of MPS is possibly implicated with the degeneration of motor neurons...
  45. ncbi Central representation of hyperalgesia from myofascial trigger point
    David M Niddam
    Brain Research Center, National Yang Ming University, Taipei, Taiwan
    Neuroimage 39:1299-306. 2008
    ..We speculate that suppressed hippocampal activity might reflect stress-related changes in relation to chronic pain as an effective physical and emotional stressor...
  46. ncbi A review of myofascial pain and fibromyalgia--factors that promote their persistence
    Robert D Gerwin
    Acupunct Med 23:121-34. 2005
    ..Sometimes, correction of an underlying cause of myalgia is all that is needed to resolve the condition...
  47. ncbi Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle
    Hong You Ge
    Centre for Sensory Motor Interaction SMI, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D 3, DK 9220 Aalborg, Denmark
    Eur J Pain 12:859-65. 2008
    ..To screen for the presence of latent and active myofascial trigger points (MTrPs) in patients with unilateral shoulder and arm pain and perform topographical mapping of mechanical pain sensitivity bilaterally in the infraspinatus muscles...
  48. doi Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems
    Hong You Ge
    Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory Motor Interaction SMI, Department of Health Science and Technology, Aalborg University, Fredrik Bajersvej 7 D3, Aalborg, DK 9220, Denmark
    Curr Pain Headache Rep 14:339-45. 2010
    ..The considerable overlap of MTrPs and FM in pain characteristics and pathophysiology suggests that FM pain is largely due to MTrPs...
  49. ncbi Variability of criteria used to diagnose myofascial trigger point pain syndrome--evidence from a review of the literature
    Elizabeth A Tough
    Peninsula Medical School, Universities of Exeter and Plymouth, UK
    Clin J Pain 23:278-86. 2007
    ..Experts were defined as being either researchers investigating MTrP pain syndrome or the "authority" the researchers cited as a source of reference for MTrP pain syndrome diagnosis...
  50. ncbi Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache
    César Fernández-de-Las-Peñas
    Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
    Eur J Pain 11:475-82. 2007
    ..Our results suggest that spatial summation of perceived pain and mechanical pain sensitivity exists in CTTH patients...
  51. ncbi Myofascial pain syndromes and their evaluation
    Robert Bennett
    Oregon Health and Science University, SNORD 219, Portland, OR 97239 2941, USA
    Best Pract Res Clin Rheumatol 21:427-45. 2007
    ..Although myofascial pain syndromes have been described in the medical literature for about the last 100 years, it is only recently that ..
  52. ncbi Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome
    Nilay Sahin
    Department of Physical Medicine and Rehabilitation, Meram Faculty of Medicine, Selcuk University, Turkey
    Agri 20:14-9. 2008
    ....
  53. doi Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study
    F Javier Montañez Aguilera
    Department of Physical Therapy, Universidad CEU Cardenal Herrera, Valencia, Spain
    J Manipulative Physiol Ther 32:515-20. 2009
    ..The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle...
  54. ncbi Myofascial trigger point development from visual and postural stressors during computer work
    D Treaster
    The Biodynamics Laboratory, The Ohio State University, 1971 Neil Ave, 210 Baker Systems, Columbus, OH 43210, USA
    J Electromyogr Kinesiol 16:115-24. 2006
    ..5 cycles). These significant differences between conditions were found for the right trapezius but not for the left. The findings suggest that high visual stress may be involved in the development of the myofascial pain response...
  55. ncbi The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck
    César Fernández-de-Las-Peñas
    Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s n, 28922 Alcorcon, Madrid, Spain
    Curr Pain Headache Rep 11:365-72. 2007
    ..Additional studies are needed to delineate more information on the relation between muscle TrPs and musculoskeletal pain syndromes of the head and neck...
  56. pmc Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial
    Carel Bron
    Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
    BMC Med 9:8. 2011
    ..However, few studies have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of MTrPs in patients with chronic shoulder pain...
  57. pmc Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066]
    Carel Bron
    Research Centre for Allied Health Sciences, Centre for Quality of Care Research, Radboud University Medical Centre, Nijmegen, The Netherlands
    BMC Musculoskelet Disord 8:107. 2007
    ..In addition we investigate the recurrence rate during a one-year-follow-up period...
  58. doi Ability of magnetic resonance elastography to assess taut bands
    Qingshan Chen
    Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
    Clin Biomech (Bristol, Avon) 23:623-9. 2008
    ..This study explores the ability of magnetic resonance elastography to localize and investigate the mechanical properties of myofascial taut bands on the basis of their effects on shear wave propagation...
  59. ncbi Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome
    Hong You Ge
    Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory Motor Interaction SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
    Pain 147:233-40. 2009
    ..Active MTrPs may serve as one of the sources of noxious input leading to the sensitization of spinal and supraspinal pain pathways in FMS...
  60. doi A distinct pattern of myofascial findings in patients after whiplash injury
    Thierry Ettlin
    Reha Rheinfelden Rehabilitation Center, Rheinfelden, Switzerland
    Arch Phys Med Rehabil 89:1290-3. 2008
    ..To identify objective clinical examinations for the diagnosis of whiplash syndrome, whereby we focused on trigger points...
  61. pmc Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey
    Johannes Fleckenstein
    Multidisciplinary Pain Centre, Department of Anaesthesiology, University of Munich, Munich, Germany
    BMC Musculoskelet Disord 11:32. 2010
    ..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...
  62. doi Effects of treatment of peripheral pain generators in fibromyalgia patients
    Giannapia Affaitati
    Pathophysiology of Pain Laboratory, Ce S I, G d Annunzio Foundation, Department of Medicine and Science of Aging, Chieti University, via Carlo de Tocco n 3, Chieti, Italy
    Eur J Pain 15:61-9. 2011
    ..Female patients with (1) FS+myofascial pain syndromes from trigger points (n=68), or (2) FS+joint pain (n=56) underwent evaluation of myofascial/joint ..
  63. ncbi Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome
    Helgard P Meyer
    University of Pretoria, Private Bag X 396, Pretoria 0001, South Africa
    Curr Pain Headache Rep 6:274-83. 2002
    ..The purpose of this review is to present clinically relevant data regarding myofascial pain syndrome and to discuss its possible role in the pathophysiology and optimal treatment of fibromyalgia syndrome...
  64. doi Myofascial trigger points in children with tension-type headache: a new diagnostic and therapeutic option
    Celina von Stülpnagel
    Department of Pediatric Neurology and Developmental Medicine, Dr von Haunersches Kinderspital, Ludwig Maximilians University Munich, 80337 Munich, Germany
    J Child Neurol 24:406-9. 2009
    ..Trigger point-specific physiotherapy seems to be an effective therapy in these children. Further prospective and controlled studies in a larger cohort are warranted...
  65. doi Multiple active myofascial trigger points and pressure pain sensitivity maps in the temporalis muscle are related in women with chronic tension type headache
    César Fernández-de-Las-Peñas
    Facultad de Cienciasde la Salud, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Madrid, Spain
    Clin J Pain 25:506-12. 2009
    ....
  66. doi Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature
    Nicholas Lucas
    School of Biomedical and Health Sciences, University of Western Sydney, Auckland, New Zealand
    Clin J Pain 25:80-9. 2009
    ..Trigger points are promoted as an important cause of musculoskeletal pain. There is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points are conflicting...
  67. ncbi Myofascial trigger points, neck mobility and forward head posture in unilateral migraine
    C Fernández-de-Las-Peñas
    Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, and Department of Neurology, Fundacion Hospital Alcorcon, Madrid, Spain
    Cephalalgia 26:1061-70. 2006
    ..Active TrPs located ipsilateral to migraine headaches might be a contributing factor in the initiation or perpetuation of migraine...
  68. ncbi Management of myofascial trigger point pain
    Peter Baldry
    Acupunct Med 20:2-10. 2002
    ..It is also important that the practitioner excludes certain biochemical disorders...
  69. ncbi Interventional approaches to the management of myofascial pain syndrome
    C M Criscuolo
    Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, 984455 Nebraska Medical Center, Omaha, NE 68198 4455, USA
    Curr Pain Headache Rep 5:407-11. 2001
    Interventional therapies are a valuable addition to our armamentarium when treating myofascial pain syndromes. When combined with other therapies, interventional techniques can be an effective adjunct in the multidisciplinary management ..
  70. ncbi Electrophysiological assessment of acupuncture points
    Mu Jung Kao
    China Medical University and the Department of Physical Medicine and Rehabilitation, Taipei City Hospital, Taipei, Taiwan
    Am J Phys Med Rehabil 85:443-8. 2006
    ..This study was designed to assess the occurrence of end plate noise (EPN) in an acupuncture point (AcP)...
  71. ncbi Myofascial trigger points
    Elizabeth Demers Lavelle
    Department of Anesthesiology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, USA
    Anesthesiol Clin 25:841-51, vii-iii. 2007
    ..The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article...
  72. ncbi Needle electromyographic activity of myofascial trigger points and control sites in equine cleidobrachialis muscle--an observational study
    Joanne Macgregor
    Equine Veterinary Clinic, Greyfriars Farm, Puttenham, Guildford, UK
    Acupunct Med 24:61-70. 2006
    ..The objective of this study was to explore the electromyographic (EMG) and other characteristics of myofascial trigger points in equine muscle, and to compare them with normal muscle tissue...
  73. ncbi Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers
    R N Harden
    Center for Pain Studies, Rehabilitation Institute of Chicago, Illinois 60611, USA
    Clin J Pain 16:64-72. 2000
    ..The goal of this study was to assess clinical consensus regarding whether myofascial pain syndrome (MPS) is a legitimate and distinct diagnosis as well as the signs and symptoms characterizing MPS...
  74. ncbi Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points
    W P Hanten
    School of Physical Therapy, Texas Woman s University, 1130 MD Anderson Blvd, Houston, TX 77030, USA
    Phys Ther 80:997-1003. 2000
    ..The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs...
  75. ncbi Myofascial pain disorders: theory to therapy
    Anthony H Wheeler
    Pain and Orthopedic Neurology, Charlotte Spine Center, Charlotte, North Carolina 28207, USA
    Drugs 64:45-62. 2004
    ..Chronic myofascial pain is usually a product of both physical and psychosocial influences that complicate convalescence...
  76. ncbi Effectiveness of ropivacaine trigger points inactivation in the prophylactic management of patients with severe migraine
    Juan M Garcia-Leiva
    Instituto de Neurociencias, Universidad de Granada, Granada, Spain
    Pain Med 8:65-70. 2007
    ..Tenderness and referred pain have been described in migraine and involved in its pathogenesis. The present study was performed to evaluate the prophylactic effectiveness of ropivacaine injections during a 12-week period...
  77. ncbi Myofascial pain--an overview
    Eng Ching Yap
    Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
    Ann Acad Med Singapore 36:43-8. 2007
    ..Early diagnosis and management may also help reduce psychosocial complications and financial burden of chronic pain syndrome...
  78. ncbi [Myofascial pain syndrome]
    Peter Reilich
    Friedrich Baur Institut an der Neurologischen Klinik, Klinikum der Universitat Munchen
    MMW Fortschr Med 149:44-6. 2007
  79. ncbi Office management of chronic pain in the elderly
    Debra K Weiner
    Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Penn, USA
    Am J Med 120:306-15. 2007
    ..While common, chronic pain is not a normal part of aging, and it should be treated with an emphasis on improved physical function and quality of life...
  80. ncbi Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache
    César Fernández-de-Las-Peñas
    Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
    Headache 47:662-72. 2007
    ..In addition, we assess the relationship between these muscle TrPs, FHP, neck mobility, and several clinical variables concerning the intensity and the temporal profile of headache...
  81. doi On the impossibility of trigger point-acupoint equivalence: a commentary on Peter Dorsher's analysis
    Stephen Birch
    J Altern Complement Med 14:343-5. 2008
  82. ncbi Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia
    Josué Fernández-Carnero
    Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
    Clin J Pain 23:353-60. 2007
    ....
  83. ncbi Central modulation of pain evoked from myofascial trigger point
    David M Niddam
    Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, No 201 Section 2 Shih Pai Road, Taipei 112, Taiwan
    Clin J Pain 23:440-8. 2007
    ..We hypothesized that intervention induces pain inhibition via the periaqueductal gray (PAG)...
  84. ncbi Comparison between newer local anesthetics for myofascial pain syndrome management
    A Th Zaralidou
    Department of Anesthesiology, Pain Clinic, AHEPA University Hospital, Thessaloniki, Greece
    Methods Find Exp Clin Pharmacol 29:353-7. 2007
    b>Myofascial pain syndromes are characterized by the presence of painful loci within muscles, tendons or ligaments, called trigger points. Infiltration of these points with local anesthetics is often used as a treatment modality...
  85. ncbi Chronic widespread musculoskeletal pain - a comparison of those who meet criteria for fibromyalgia and those who do not
    Lars Coster
    Section of Rheumatology, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden
    Eur J Pain 12:600-10. 2008
    ..Similar coping strategies were found. Chronic widespread pain without widespread allodynia to pressure pain was found in 4.5% in the population and fibromyalgia in 2.5%...
  86. ncbi The local and referred pain from myofascial trigger points in the temporalis muscle contributes to pain profile in chronic tension-type headache
    César Fernández-de-Las-Peñas
    Department of Physical Therapy of Universidad Rey Juan Carlos, Madrid, Spain
    Clin J Pain 23:786-92. 2007
    ..To assess the local and referred pain areas and pain characteristics evoked from temporalis muscle trigger points (TrPs) in chronic tension-type headache (CTTH)...
  87. ncbi Bilateral myofascial trigger points in the forearm muscles in patients with chronic unilateral lateral epicondylalgia: a blinded, controlled study
    Josué Fernández-Carnero
    Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
    Clin J Pain 24:802-7. 2008
    ....
  88. ncbi Contribution of myofascial trigger points to migraine symptoms
    Maria Adele Giamberardino
    Headache Center, Department of Medicine and Science of Aging, G D Annunzio University Ce S I, G d Annunzio Foundation, Chieti, Italy
    J Pain 8:869-78. 2007
    ..Cervical TrPs with referred areas in migraine sites thus contribute substantially to migraine symptoms, the peripheral nociceptive input from TrPs probably enhancing the sensitization level of central sensory neurons...
  89. doi Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch's analysis revisited
    Peter T Dorsher
    Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida 32224, USA
    J Altern Complement Med 14:353-9. 2008
    ..Moreover, Birch concluded that no more than 40% of the acupuncture points examined by Melzack et al. correlated clinically for the treatment of pain (correlation was more like 18%-19%)...
  90. doi Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points
    Hong You Ge
    Laboratory for Experimental Pain Research, Center for Sensory Motor Interaction SMI, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D 3, 9220, Aalborg, Denmark
    Exp Brain Res 187:623-9. 2008
    ..These results suggest that latent MTrPs could be involved in the genesis of muscle cramps. Focal increase in nociceptive sensitivity at MTrPs constitutes one of the mechanisms underlying muscle cramps...
  91. ncbi Prognostic factors for neuroreflexotherapy in the treatment of subacute and chronic neck and back pain: a study of predictors of clinical outcome in routine practice of the Spanish National Health Service
    Francisco Kovacs
    Scientific Department, Fundacion Kovacs, Madrid, Spain
    Spine (Phila Pa 1976) 32:1621-8. 2007
    ..Prospective cohort follow-up study...
  92. ncbi Future perspectives: pathogenesis of chronic muscle pain
    Roland Staud
    Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32610 0221, USA
    Best Pract Res Clin Rheumatol 21:581-96. 2007
    ....
  93. ncbi Fibromyalgia syndrome: presentation, diagnosis, differential diagnosis, and vulnerability
    I Jon Russell
    University Clinical Research Center, University of Texas Health Science Center, San Antonio, TX 78229 3900, USA
    CNS Spectr 13:6-11. 2008
    ..Existing data suggest that some individuals with FMS may have a dysregulated physiological stress response system that predates the onset of symptoms...
  94. doi Effects of dry needling at tender points for neck pain (Japanese: katakori): near-infrared spectroscopy for monitoring muscular oxygenation of the trapezius
    Shizuo Jimbo
    Department of Orthopaedic Surgery, Rishiri Island Central Hospital, Hokkaido, Japan
    J Orthop Sci 13:101-6. 2008
    ..The purpose of this study was to investigate the effects of tender point dry needling to the trapezius muscles and the resultant changes in muscular hemodynamics...
  95. ncbi Electromyographically guided trigger point injections in the cervicothoracic musculature of obese patients: a new and unreported technique
    Kenneth P Botwin
    Deuk Spine Institute, Titusville, FL, USA
    Pain Physician 10:753-6. 2007
    ..In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we review an electromyographically guided trigger point injection technique to avoid this potential pitfall...
  96. ncbi Cervical pain and headache in patients with facial asymmetries: the effect of orthognathic surgical correction
    A Corbacelli
    Department of Surgical Sciences, Maxillofacial Surgery Institute, University of L Aquila, L Aquila, Italy
    Minerva Anestesiol 73:281-9. 2007
    ..The aim of the study was to evaluate the influence of surgical orthognathic correction of facial asymmetries on the intensity of cervicobrachial pain and headache in the short and long term...
  97. ncbi Increased muscular and cutaneous pain sensitivity in cephalic region in patients with chronic tension-type headache
    S Ashina
    Danish Headache Center and Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Copenhagen, Denmark
    Eur J Neurol 12:543-9. 2005
    ..Increased sensitivity in nociceptive pathways from cephalic region may be of importance in the pathophysiology of chronic tension type headache...
  98. ncbi Referred pain and hyperalgesia in human tendon and muscle belly tissue
    William Gibson
    Laboratory for Experimental Pain Research, Center for Sensory Motor Interaction SMI, Department of Health Science and Technology, Aalborg University, Denmark
    Pain 120:113-23. 2006
    ..Furthermore, there may be site specific central changes reflected by the differences in the results regarding sensitivity and summation over time...
  99. ncbi Increased levels of interstitial potassium but normal levels of muscle IL-6 and LDH in patients with trapezius myalgia
    Lars Rosendal
    National Institute of Occupational Health, Copenhagen, Denmark
    Pain 119:201-9. 2005
    ..This finding could be causally related to myalgia or secondary to pain due to deconditioned muscle or altered muscle activity pattern...
  100. ncbi Long-term follow-up of trigger point injections for abdominal wall pain
    Jose Nazareno
    Department of Medicine, The University of Western Ontario, London Health Sciences Centre, Canada
    Can J Gastroenterol 19:561-5. 2005
    ..Abdominal wall pain (AWP) is a common yet often overlooked source of abdominal pain. Trigger point injections (TPI) into the abdominal wall have been tried in the past. Few studies have looked at the long-term outcome from these injections...
  101. ncbi Referred pain pattern of the pronator quadratus muscle
    Miriam Hwang
    Department of Rehabilitation Medicine, Korea University College of Medicine, 516 Gozan Dong, Ansan City, Kyonggi Province 425 707, South Korea
    Pain 116:238-42. 2005
    ..Thus, myofascial pain of the PQ should be considered as a possible cause of pain in the medial forearm and hand, especially when no other neurological abnormalities are present...

Research Grants26

  1. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 2001
    ..abstract_text> ..
  2. Mechanisms of Acupuncture Analgesia
    Richard Harris; Fiscal Year: 2006
    ..There is a strong institutional commitment to see the applicant succeed in this task due to a tremendous need for well-trained clinical investigators in alternative and complementary medicine. ..
  3. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 2007
    ..In addition, our findings may contribute to the understanding of pain mechanisms related to other chronic pain disorders. ..
  4. Pathogenesis and Pathophysiological Mechanisms of Myofascial Trigger Points
    Siddhartha Sikdar; Fiscal Year: 2010
    ..Our approach would also be broadly applicable to elucidating the underlying mechanisms in other chronic musculoskeletal pain disorders, such low back pain. ..
  5. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 1999
    ..abstract_text> ..
  6. Peripheral and Central Mechanism of Pain in Patients with Fibromyalgia
    ROLAND M STAUD; Fiscal Year: 2010
    ..Either way, we will provide evidence that will characterize the role of local anesthesia, placebo analgesia, or both. Thus patients with FM and other similar pain syndromes may strongly benefit from the results of our study. ..
  7. Peripheral and Central Mechanism of Pain in Patients with Fibromyalgia
    Roland Staud; Fiscal Year: 2009
    ..Either way, we will provide evidence that will characterize the role of local anesthesia, placebo analgesia, or both. Thus patients with FM and other similar pain syndromes may strongly benefit from the results of our study. ..
  8. Peripheral and Central Mechanism of Pain in Patients with Fibromyalgia
    Roland Staud; Fiscal Year: 2007
    ..Either way, we will provide evidence that will characterize the role of local anesthesia, placebo analgesia, or both. Thus patients with FM and other similar pain syndromes may strongly benefit from the results of our study. ..
  9. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 2006
    ..In addition, our findings may contribute to the understanding of pain mechanisms related to other chronic pain disorders. ..
  10. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 2005
    ..In addition, our findings may contribute to the understanding of pain mechanisms related to other chronic pain disorders. ..
  11. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 2000
    ..abstract_text> ..
  12. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 2004
    ..In addition, our findings may contribute to the understanding of pain mechanisms related to other chronic pain disorders. ..
  13. MECHANISM OF PAIN IN PATIENTS WITH FIBROMYALGIA SYNDROME
    Roland Staud; Fiscal Year: 2008
    ..In addition, our findings may contribute to the understanding of pain mechanisms related to other chronic pain disorders. ..
  14. Peripheral and Central Mechanism of Pain in Patients with Fibromyalgia
    Roland Staud; Fiscal Year: 2008
    ..Either way, we will provide evidence that will characterize the role of local anesthesia, placebo analgesia, or both. Thus patients with FM and other similar pain syndromes may strongly benefit from the results of our study. ..
  15. Chronic Prostatitis Collaborative Research Network
    Rodney Anderson; Fiscal Year: 2007
    ..abstract_text> ..
  16. Chronic Prostatitis Collaborative Research Network
    Rodney Anderson; Fiscal Year: 2007
    ..abstract_text> ..
  17. Functional Impact of PENS for 65+ Chronic Low Back Pain
    Debra Weiner; Fiscal Year: 2004
    ....
  18. Functional Impact of PENS for 65+ Chronic Low Back Pain
    Debra Weiner; Fiscal Year: 2003
    ....
  19. Functional Impact of PENS for 65+ Chronic Low Back Pain
    Debra Weiner; Fiscal Year: 2005
    ....
  20. Functional Impact of PENS for 65+ Chronic Low Back Pain
    Debra Weiner; Fiscal Year: 2006
    ....
  21. Osteopuncture for OA-Associated Knee Pain & Disability
    Debra Weiner; Fiscal Year: 2005
    ..In addition, mechanisms of action will be explored, and the impact of osteopuncture on health care costs determined. ..
  22. Sleep Bruxism and Central Sensitization in Myofascial Face Pain
    Karen Raphael; Fiscal Year: 2007
    ..This understanding is expected to support our long-term goal of improving clinical treatment of MFP by targeting treatment to underlying pain-maintenance mechanisms. ..
  23. Novel Pelvic Floor Pain Measures to Enhance Female Pelvic Pain Evaluation
    Frank Tu; Fiscal Year: 2008
    ....
  24. Sleep Bruxism and Central Sensitization in Myofascial Face Pain
    Karen Raphael; Fiscal Year: 2008
    ..This understanding is expected to support our long-term goal of improving clinical treatment of MFP by targeting treatment to underlying pain-maintenance mechanisms. ..
  25. FIBROMYALGIA, DEPRESSION AND MYOFASCIAL TMD
    Karen Raphael; Fiscal Year: 2002
    ..If only FMS probands have familial M/TMD but M/TMD probands do not, this will support the 2nd hypothesis and indicate that the two disorders are provoked through different pathogenic processes. ..