Disturbances of Pain Perception in Myofascial Pain Syndrome and other Musculoskeletal Pains

  • Lars Arendt-Nielsen
  • Thomas Graven-Nielsen
  • Peter Svensson
Part of the Plenum Series in Rehabilitation and Health book series (SSRH)


Pains from the musculoskeletal system represent a major proportion of complaints among patients seeking health services. Moreover, the efficacy of treatment of many musculoskeletal pain conditions by currently available pharmacologic and nonpharmacologic interventions is often less than optimal (Curatolo and Bogduk, 2001). Thus, it is generally accepted that pain from deep tissues constitutes a special diagnostic and therapeutic challenge, and further insights into the peripheral and central neurobiological mechanisms are necessary to improve diagnosis and management strategies. This chapter will mainly focus on the so-called myofascial pain syndrome (MPS). An unrefined search in PubMed reveals more than 4000 publications with the keyword “myofascial pain syndrome” and several extensive reviews and books are available on this topic (Fricton and Awad, 1990; Vaeroy and Merskey, 1993; Simons et al., 1999; Mense and Simons, 2001; Rivner, 2001; Borg-Stein and Simons, 2002). However, this chapter will attempt to critically review some of the proposed pain mechanisms and most prominent clinical presentations of MPS. In addition, the utility of quantitative sensory testing in assessment of muscle pain conditions will be discussed (Arendt-Nielsen 1997).


Musculoskeletal Pain Trigger Point Masseter Muscle Tender Point Myofascial Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Arendt-Nielsen, L., & Svensson, P. (2001). Referred muscle pain: Basic and clinical findings. The Clinical Journal of Pain, 17, 11–19.PubMedCrossRefGoogle Scholar
  2. Arendt-Nielsen, L., Graven-Nielsen, T., Svarrer, H., & Svensson, P. (1996). The influence of low back pain on muscle activity and coordination during gait: A clinical and experimental study. Pain, 64, 231–240.PubMedCrossRefGoogle Scholar
  3. Arendt-Nielsen, L., Drewes, A. M., Hansen, J. B., & Tage-Jensen, U. (1997a). Gut pain reactions in man: an experimental investigation using short and long duration transmucosal electrical stimulation. Pain, 69, 255–262.PubMedCrossRefGoogle Scholar
  4. Arendt-Nielsen, L., Graven-Nielsen, T., Svensson, P., & Jensen, T. S. (1997). Temporal summation in muscles and referred pain areas: an experimental human study. Muscle and Nerve, 20, 1311–1313.PubMedCrossRefGoogle Scholar
  5. Arendt-Nielsen, L., Laursen, R. J., & Drewes, A. M. (2000). Referred pain as an indicator for neural plasticity. Progress in Brain Research, 129, 343–356.PubMedCrossRefGoogle Scholar
  6. Bajaj, P., Graven-Nielsen, T., & Arendt-Nielsen, L. (2001a). Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study. Pain, 93, 107–114.PubMedCrossRefGoogle Scholar
  7. Bajaj, P., Graven-Nielsen, T., & Arendt-Nielsen, L. (2001b). Trigger points in patients with lower limb osteoarthritis. Journal of Musculoskeletal Pain, 9, 17–33.CrossRefGoogle Scholar
  8. Bendtsen, L., Jensen, R., Jensen, N. K., & Olesen, J. (1994). Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues. Pain, 59, 235–239.PubMedCrossRefGoogle Scholar
  9. Bendtsen, L., Jensen, R., Jensen, N. K., & Olesen, J. (1995). Pressure-controlled palpation: a new technique which increases the reliability of manual palpation. Cephalalgia, 15, 205–210.PubMedCrossRefGoogle Scholar
  10. Bendtsen, L., Jensen, R., & Olesen, J. (1996a). Qualitatively altered nociception in chronic myofascial pain. Pain, 65, 259–264.PubMedCrossRefGoogle Scholar
  11. Bendtsen, L., Jensen, R., & Olesen, J. (1996b). Decreased pain detection and tolerance thresholds in chronic tension-type headache. Archives of Neurology, 53, 373–376.PubMedCrossRefGoogle Scholar
  12. Bendtsen, L., Nørregaard, J., Jensen, R., & Olesen, J. (1997). Evidence of qualitatively altered nociception in patients with fibromyalgia. Arthritis and Rheumatism, 40, 98–102.PubMedCrossRefGoogle Scholar
  13. Bengtsson, A., Bäckman, E., Lindblom, B., & Skogh, T. (1994). Long term follow-up of fibromyalgia patients: Clinical symptoms, muscular function, laboratory test — an eight year comparison study. Journal of Musculoskeletal Pain, 2, 67–80.CrossRefGoogle Scholar
  14. Berberich, P., Hoheisel, U., & Mense, S. (1988) Effects of carrageenan-induced myositis on the discharge properties of group III and IV muscle receptors in the cat. Journal of Neurophysiology, 59, 1395–1409.PubMedGoogle Scholar
  15. Bonica, J. J. (1990). General considerations of acute pain. In J. J. Bonica (Ed.), The Management of Pain. Second Edition (pp. 159–179). Philadelphia, London: Lea & Febiger.Google Scholar
  16. Borg-Stein, J., & Simons, D. G. (2002). Focused review: myofascial pain. Archives of Physical Medicine and Rehabilitation, 83, 40–47.CrossRefGoogle Scholar
  17. Cairns, B. E., Hu, J. W., Arendt-Nielsen, L., Sessle, B. J., & Svensson, P. (2001). Sex-related differences in human pain and rat afferent discharge evoked by injection of glutamate into the masseter muscle. Journal of Neurophysiology, 86, 782–791.PubMedGoogle Scholar
  18. Carlson, C. R., Reid, K. L., Curran, S. L., Studts, J., Okeson, J. P., Falace, D., Nitz, A., & Bertrand, P. M. (1998). Psychological and physiological parameters of masticatory muscle pain. Pain, 76, 297–307.PubMedCrossRefGoogle Scholar
  19. Clark, G. T., Beemsterboer, P. L., & Jacobson, R. (1984). The effect of sustained submaximal clenching on maximum bite force in myofascial pain dysfunction patients. Journal of Oral Rehabilitation, 11, 387–391.PubMedCrossRefGoogle Scholar
  20. Coderre, T. J., Katz, J., Vaccarino, A.L., & Melzack, R. (1993). Contribution of central neuroplastirity to pathological pain: review of clinical and experimental evidence. Pain, 52, 259–285.PubMedCrossRefGoogle Scholar
  21. Curatolo, M., & Bogduk, N. (2001). Pharmacologic pain treatment of musculoskeletal disorders: current perspectives and future prospects. The Clinical Journal of Pain, 17, 25–32.PubMedCrossRefGoogle Scholar
  22. Curatolo, M., Petersen-Felix, S., Arendt-Nielsen, L., Giani, C., Zbinden, A. M., & Radanov, B. P. (2001). Central hypersensitivity in chronic pain after whiplash injury. The Clinical Journal of Pain, 17, 306–315.PubMedCrossRefGoogle Scholar
  23. Dubner, R. (1995). Hyperalgesia in response to injury to cutaneous and deep tissues. In J. R. Fricton & R. Dubner (Eds.), Orofacial pain and temporomandibular disorders. Advances in pain research and therapy, vol 21 (pp. 61–71). New York: Raven Press.Google Scholar
  24. Dworkin, S. F., & LeResche, L. (Eds.) (1992). Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique, Journal of craniomandibular disorders: facial & oral pain, 6, 301–355.Google Scholar
  25. Elert, J. E., Dahlqvist, S. R., Almay, B., & Eisemann, M. (1993). Muscle endurance, muscle tension and personality traits in patients with muscle or joint pain-a pilot study. The Journal of Rheumatology, 20, 1550–1556.PubMedGoogle Scholar
  26. Ernberg, M., Hedenberg-Magnusson, B., Alstergren, P., & Kopp, S. (1998). Effect of local glucocorticoid injection on masseter muscle level of serotonin in patients with chronic myalgia. Acta Odontologwa Scandmavua, 56, 129–134.CrossRefGoogle Scholar
  27. Fischer, A. A. (Ed.) (1998). Muscle pain syndromes and fibromyalgia. Pressure algometry for quantification of diagnosis and treatment outcome (pp. 1–158). New York: Haworth Medical Press.Google Scholar
  28. Fishbain, D. A., Goldberg, M., Meagher, B. R., Steele, R., & Rosomoff, H. (1986). Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain, 26, 181–197.PubMedCrossRefGoogle Scholar
  29. Fricton,J. R., & Awad, E. A. (Eds.) (1990). Myofascial Pain ad Fibromyalgia. Advances in Pain Research and Therapy, Vol 17, New York: Raven Press.Google Scholar
  30. Gay, T., Maton, B., Rendell, J., & Majourau, A. (1994). Characteristics of muscle fatigue in patients with myofascial pain-dysfunction syndrome. Archives of Oral Biology, 39, 847–852.PubMedCrossRefGoogle Scholar
  31. Goulet, J.-P., Clark, G. T., Flack, V. F., & Liu, C. (1998). The reproducibility of muscle and joint tenderness detection methods and maximum mandibular movement measurement for the tcmporomandibular system. Journal of Orofacial Pain, 12, 17–26.PubMedGoogle Scholar
  32. Gracely, R. H., & Reid, K. I. (1995). Orofacial pain measurement. In J. R. Fricton & R. Dubner (Eds.), Orofacial pain and tetnporomandibular disorders. Advances in pain research and therapy, vol 21 (pp. 117–143). New York; Raven Press.Google Scholar
  33. Graff-Radford, S. B., Reeves, J. L., Baker, R. L., & Chiu, D. (1989). Effects of trans cutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity.Pain, 37, 1–5.PubMedCrossRefGoogle Scholar
  34. Graven-Nielsen, T., & Mense, S. (2001). The peripheral apparatus of muscle pain: Evidence from animal and human studies. The Clinical Journal of Pain, 17, 2–10.PubMedCrossRefGoogle Scholar
  35. Graven-Nielsen, T., Arendt-Nielsen, L., Svensson, P., & Jensen, T. S. (1997a). Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalqgraphy and Clinical Neurophysiology, 105, 156–164.CrossRefGoogle Scholar
  36. Graven-Nielsen, T., Kendall, S. A., Henriksson, K. G., Bengtsson, M., Sörensen, J., Johnson, A., Gerdle, B., & Arendt-Nielsen, L. (2000). Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Pain, 85, 483–491.PubMedCrossRefGoogle Scholar
  37. Göbel, H., Weigle, L., Kropp, P., & Soyka, D. (1992). Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache. Cephalalgia, 12, 142–151.PubMedCrossRefGoogle Scholar
  38. Howell, J. N., Chilla, A. G., Ford, G., David, D., & Gates, T. (1985). An electromyographic study of elbow motion during postexercise muscle soreness. Journal of Applied Physiology, 58, 1713–1718.PubMedGoogle Scholar
  39. Hu, J. W., Sessle, B. J., Raboisson, P., Dallel, R., & Woda, A. (1992). Stimulation of craniofacial muscle afferents induces prolonged facilitatory effects in trigeminal nociceptive brain-stem neurones. Pain, 48, 53–60.PubMedCrossRefGoogle Scholar
  40. Tsselee, H., De Laat, A., Bogaerts, K., & Lysens, R. (1998). Short-term reproducibility of pressure pain thresholds in masticatory muscles measured with a new algometer. Journal of Orofacial Pain, 12, 203–209.Google Scholar
  41. Jaeger, B., & Reeves, J. L. (1986). Quantification of changes in myofascial trigger point sensitivity with the pressure algometer following passive stretch. Pain, 27, 203–210.PubMedCrossRefGoogle Scholar
  42. Jensen, K., Andersen, H. Ø., Olesen, J., & Lindblom, U. (1986). Pressure-pain threshold in human temporal region: evaluation of a new pressure algometer. Pain, 25, 313–323.PubMedCrossRefGoogle Scholar
  43. Jensen, K., Tuxen, C., Pedersen-Bjergaard, U., Jansen, I., & Olesen, J. (1990). Pain and tenderness in human temporal muscle induced by bradykinin and 5-hydroxytryptamine. Peptides, 11, 1127–1132.PubMedCrossRefGoogle Scholar
  44. Jensen, R., Rasmussen, B. K., Pedersen, B., & Olesen, J. (1993a). Muscle tenderness and pressure pain thresholds in headache. A population study. Pain, 52, 193–199.PubMedCrossRefGoogle Scholar
  45. Jensen, R., Fuglsang-Frederiksen, A., & Olesen, J. (1994). Quantitative surface EMG of pericranial muscles in headache. A population study. Eledroencephalography and Clinical Neurophysiology, 93, 335–344.CrossRefGoogle Scholar
  46. Jensen, R., Bendtsen, L., & Olesen, J. (1998). Muscular factors are of importance in tension-type headache. Headache, 38, 10–17.PubMedCrossRefGoogle Scholar
  47. Kosek, E., & Hansson, P. (1997). Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects. Pain, 70, 41–51.PubMedCrossRefGoogle Scholar
  48. Kosek, E., & Ordeberg, G. (2000). Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain, 88, 69–78.PubMedCrossRefGoogle Scholar
  49. Langemark, M., Jensen, K., Jensen, T. S., & Olesen J. (1989). Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache. Pain, 38, 203–210.PubMedCrossRefGoogle Scholar
  50. Lavigne, G. J., Thon, M. T., Rompre, P., Duncan, G. H., & Goulet, J.-P. (1994). Sensory descriptors from touch to pressure-pain and experimental variables: a psychophysiological study in human on pressure-pain threshold. In G. F. Gebhart, D. L. Hammond & T. S. Jensen (Eds.), Proceedings of the 7th world congress on pain. Progress in pain research and management, vol2 (pp. 831–842). Seattle: IASP Press.Google Scholar
  51. Leffler, A. S., Kosek, E., & Hansson, P. (2000b). The influence of pain intensity on somatosensory perception in patients suffering from subacute/chronic lateral epicondylalgia. European Journal of Pain, 4, 57–71.PubMedCrossRefGoogle Scholar
  52. Leffler, A. S., Kosek, E., Lerndal, T., Nordmark, B., & Hansson, P. (2002). Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis. European Journal of Pain, 5, 161–176.CrossRefGoogle Scholar
  53. Lewis, T. (1938). Suggestions relating to the study of somatic pain. British Medical Journal, 1, 321–325.PubMedCrossRefGoogle Scholar
  54. List, T., Helldmo, M., & Falk, G. (1989). Reliability and validity of a pressure threshold meter in recording tenderness in the masseter muscle and the anterior temporalis muscle. The Journal of Craniomandibular Practice, 7, 223–229.Google Scholar
  55. List, T., Helkimo, M., & Karlsson, R. (1991). Influence of pressure rates on the reliability of a pressure threshold meter. Journal of craniomandibular disorders: facial & oral pain, 5, 173–178.Google Scholar
  56. Maixner, W., Fillingim, R., Booker, D., & Sigurdsson, A. (1995). Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain, 63, 341–351.PubMedCrossRefGoogle Scholar
  57. Maixner, W., Fillingim, R., Sigurdsson, A., Kincaid, S., & Silva, S. (1998). Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain; evidence for altered temporal summation of pain. Pain, 76, 71–81.PubMedCrossRefGoogle Scholar
  58. Malow, R. M., Grimm, L., & Olson, R. E. (1980). Differences in pain perception between myofascial pain dysfunction patients and normal subjects: a signal detection analysis. Journal of Psychosomatic Research, 24, 303–309.PubMedCrossRefGoogle Scholar
  59. McCain, G. A., & Scudds, R. A. (1988). The concept of primary fibromyalgia (fibrositis): clinical value, relation and significance to other chronic musculoskeletal pain syndromes. Pain, 33, 273–287.PubMedCrossRefGoogle Scholar
  60. McMillan, A. S., & Blasberg, B. (1994). Pain-pressure threshold in painful jaw muscles following trigger point injection. Journal of Orofacial Pain, 8, 384–390.PubMedGoogle Scholar
  61. McMillan, A. S., & Lawson, E. T. (1994). Effect of tooth clenching and jaw opening on pain-pressure thresholds in the human jaw muscles. Journal of Orofacial Pain, 8, 250–257.PubMedGoogle Scholar
  62. Melzack, R., Katz, J., & Jeans, M. E. (1985). The role of compensation in chronic pain: analysis using a new method of scoring the McGill Pain Questionnaire. Pain, 23, 101–112.PubMedCrossRefGoogle Scholar
  63. Mense, S. (1991). Considerations concerning the neurobiological basis of muscle pain. Canadian Journal of Physiology and Pharmacology, 69, 610–616.PubMedCrossRefGoogle Scholar
  64. Mense, S. (1993). Nociception from skeletal muscle in relation to clinical muscle pain. Pain, 54, 241–289PubMedCrossRefGoogle Scholar
  65. Mense, S., & Meyer, H. (1988). Bradykinin-induced modulation of the response behaviour of different types of feline group III and IV muscle receptors. The Journal of Physiology, 398, 49–63.PubMedGoogle Scholar
  66. Mense, S., & Simons, D. G. (2001). Muscle pain. Understanding its nature, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  67. Ohrbach, R., & Gale, E. N. (1989a). Pressure pain thresholds in normal muscles: reliability, measurement effects and topographic differences. Pain, 37, 257–263.PubMedCrossRefGoogle Scholar
  68. Ohrbach, R., & Gale, E. N. (1989b). Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. Pain, 39, 157–169.PubMedCrossRefGoogle Scholar
  69. Ohrbach, R., Crow, H., & Kamer, A. (1998). Examiner expectancy effects in the measurement of pressure pain thresholds. Pain, 74, 163–170.PubMedCrossRefGoogle Scholar
  70. Reeves, J. L., Jaeger, B., & Graff-Radford, S. B. (1986). Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain, 24, 313–321.PubMedCrossRefGoogle Scholar
  71. Reid, K. I., Gracely, R. H., & Dubner, R. A. (1994). The influence of time, facial side, and location on pain-pressure thresholds in chronic myogenous temporomandibular disorder. Journal of Orofacial Pain, 8, 258–265.PubMedGoogle Scholar
  72. Reinert, A., Kaske, A., & Mense, S. (1998). Inflammation-induced increase in the density of neuropeptide-immunoreactive nerve endings in rat skeletal muscle. Experimental Brain Research, 121, 174–180.CrossRefGoogle Scholar
  73. Rivner, M. H. (2001). The neurophysiology of myofascial pain syndrome. Current Pain and Headache Reports, 5, 432–440.PubMedCrossRefGoogle Scholar
  74. Sand, T., Zwart, J. A., Helde, G., & Bovim, G. (1997). The reproducibility of cephalic pain pressure thresholds in control subjects and headache patients. Cephalalgia, 17, 748–755.PubMedCrossRefGoogle Scholar
  75. Schiffman, E., Fricton, J. R., Haley, D., & Tylka, D. (1988). A pressure algometer for myofascial pain syndrome: reliability and validity testing In R. Dubner, G. F. Gebhart & M. R Bond (Eds.), Proceedings of the 5th world congress on pain. Pain research and clinical management, vol 3 (pp. 407–413). Amsterdam: Elsevier.Google Scholar
  76. Schoenen, J., Bottin, D., Hardy, F., & Gerard, P. (1991a). Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache. Pain, 47, 145–149.PubMedCrossRefGoogle Scholar
  77. Scudds, R. A., Trachsel, L. C., Luckhurst, B. J., & Percy, J. S. (1989). A comparative study of pain, sleep quality and pain responsiveness in fibrositis and myofascial pain syndrome. Journal of Rheumatology Supplement, 19, 120–126.Google Scholar
  78. Sessle, B. J. (1995). Masticatory muscle disorders: basic science perspectives In B. J. Scssle, P. S. Bryant & R. A. Dionne (Eds.), Temporomandibular disorders and related pain conditions. Progress in pain research and management, vol4 (pp. 47–61). Seattle: IASP Press.Google Scholar
  79. Sihvonen, T., Partanen, J., Hänninen, O., & Soimakallio, S. (1991). Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls. Archives of Physical and Medicine Rehabilitation, 72, 1080–1087.Google Scholar
  80. Simons, D. G., Travell, J. G., & Simons, L. (1999). Myofascial pain and dysfunction, The trigger point manual. Baltimore: Williams & Williams.Google Scholar
  81. Smythe, H. (1992). Links between fibromyalgia and myofascial pain syndromes. The Journal of Rheumatology, 19, 842–843.PubMedGoogle Scholar
  82. Sola, A. E. & Bonica, J. J. (1990). Myofascial pain syndromes. In J. J. Bonica, J. D. Loeser, C. R. Chapman & W E. Fordyce (Eds.), The Management of Pain (ed. 2) (pp. 352–367). Philadelphia: Lea & Fibiger.Google Scholar
  83. Staud, R., Vierck, C. J., Cannon, R. L., Mauderli, A. P., & Price, D. D. (2001). Abnormal senskization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain, 91, 165–175.PubMedCrossRefGoogle Scholar
  84. Stohler, C. S., Yamada, Y., & Ash, M. M.Jr. (1985). Antagonistic muscle stiffness and associated reflex behaviour in the pain-dysfunctional state. Helvetica Odontologica Acta, 29, 13–20.Google Scholar
  85. Svensson, P., Arendt-Nielsen, L., Nielsen, H., & Larsen, J. K. (1995). Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. Journal of Orofacial Pain, 9, 347–356.PubMedGoogle Scholar
  86. Svensson, P., Arendt-Nielsen, L., & Houe, L. (1996). Sensory-motor interactions of human experimental unilateral jaw muscle pain: A quantitative analysis. Pain, 64, 241–249.PubMedCrossRefGoogle Scholar
  87. Svensson, P., Houe, L., & Arendt-Nielsen, L. (1997). Bilateral experimental muscle pain changes electromyographic activity of human jaw-closing muscles during mastication. Experimental Brain Research, 116, 182–185.CrossRefGoogle Scholar
  88. Svensson, P., Graven-Nielsen, T., Matre, D. A., & Arendt-Nielsen, L. (1998). Experimental muscle pain does not cause long-lasting increases in resting EMG activity. Muscle and Nerve, 21, 1382–1389.PubMedCrossRefGoogle Scholar
  89. Svensson, P., List, T., & Hector, G. (2001). Analysis of stimulus-evoked pain in patients with myofascial temporomandibular pain disorders. Pain, 92, 399–409.PubMedCrossRefGoogle Scholar
  90. Swarbrick, E. T., Hegarty, J. E., Bat, L., Williams, C. B., & Dawson, A. M. (1980). Site of pain from the irritable bowel. The Lancet, 2, 443–446.CrossRefGoogle Scholar
  91. Taiwo, Y O., & Levine, J. D. (1992). Serotonin is a directly-acting hyperalgesic agent in the rat. Neuroscience, 48, 485–490.PubMedCrossRefGoogle Scholar
  92. Travell, J. G., & Simons, D. G. (1992). Myofascial pain and Dysfunction. The trigger point manual. Baltimore: Williams & Wilkins.Google Scholar
  93. Triano, J. J., & Schultz, A. B. (1987). Correlation of objective measure of trunk motion and muscle function with low-back disability ratings. Spine, 12, 561–565.PubMedCrossRefGoogle Scholar
  94. Tunks, E., McCain, G. A., Hart, L. E., Teasell, R. W., Goldsmith, C. H., Rollman, G. B., McDermid, A. J., & DeShane, P. J. (1995). The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls. The Journal of Rheumatology, 22, 944–952.PubMedGoogle Scholar
  95. Vaeroy, H., & Merskey, H. (Eds.) (1993). Progress in Fibromyalgia and Myofascial pain. Pain Research and Clinical Management, Vol 6. Amsterdam: Elsevier.Google Scholar
  96. Vecchiet, L., Giamberardino, M. A., & Saggini, R. (1991). Myofascial pain syndromes: clinical and pathophysiological aspects. The Clinical Journal of Pain, 7 (Suppl. 1), 16–22.Google Scholar
  97. Vecchiet, L., Giamberardino, M. A., de Bigontina, P., & Dragani, L. (1994). Comparative sensory evaluation of parietal tissues in painful and nonpainful areas in fibromyalgia and myofascial pain syndrome. In G. F. Gebhart, D. L. Hammond & T. S. Jensen (Eds.), Proceedings of the 7th world congress on pain. Progress in pain research and management, vol 2 (pp. 177–185). Seattle: IASP Press.Google Scholar
  98. Watanabe, M., Tabata, T., Huh, J. I., Inai, T., Tsuboi, A., Sasaki, K., & Endo, Y (1999). Possible involvement of histamine in muscular fatigue in temporomandibular disorders: animal and human studies. Journal of Dental Research, 78, 769–775.PubMedCrossRefGoogle Scholar
  99. Wolfe, F., Simons, D. G., Fricton, J., Bennett, R. M., Goldenberg, D. L., Gerwin, R., Hathaway, D., McCain, G. A., Russell, I. J., Sanders, H. O., Skootsky, S. A. (1992). The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. The Journal of Rheumatology, 19, 944–951.PubMedGoogle Scholar
  100. Woolf, G., Bennett, G. J., Doherty, M., Dubner, R., Kidd, B., Koltzenburg, M., Lipton, R., Loeser, J. D., Payne, R., & Totebjörk, E. (1998). Towards a mechanism-based classification of pain. Pain, 77, 227–229.PubMedCrossRefGoogle Scholar
  101. Wright, A., Graven-Nielsen, T., Davies, I., & Arendt-Nielsen, L. (2002). Temporal summation of pain from skin, muscle and joint following nociceptive ultrasonic stimulation in humans. Experimental Brain Research, 144, 475–482.CrossRefGoogle Scholar

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© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Lars Arendt-Nielsen
    • 1
  • Thomas Graven-Nielsen
    • 1
  • Peter Svensson
    • 1
  1. 1.Aalborg UniversityCenter for Sensory-Motor InteractionAalborgDenmark

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