DORSOPATHIES Thermography Atlas

This issue is devoted to the medical thermography theory and practice in patients with dorsopathies. Thermography signs of clinical manifestation, such as scoliosis, muscular-tonic syndrome, intervertebral disc and disco-radicular conflicts, lumbo-sacral joints involvment and referred pain are described, based on specific exercise tests and temperature gradients. This book may be useful for all physicians who treat patients with “back pain

Amplified Vasodilatation within the Referred Pain Zone of Trigger Points Is Characteristic of Gluteal Syndrome—A Type of Nociplastic Pain Mimicking Sciatica

Gluteal syndrome (GS) mimicking sciatica is a new disease that has been recently recognized and included in the International Classification of Diseases, 11th Revision. The present study examines nociplastic pain involvement in GS and sciatica patients using a new Skorupska protocol (SP) test that provokes amplified vasodilatation in the area of expected muscle-referred pain. A positive test is confirmed if there is (i) a development of autonomic referred pain (AURP) and (ii) an increase in the delta of average temperature (Δ₸°) > 0.3 °C at the end of the stimulation and during the observation SP phases. Chronic GS (n = 20) and sciatica (n = 30) patients were examined. The SP test confirmed muscle-referred pain for (i) all GS patients with 90.6% positive thermograms (Δ₸° 0.6 ± 0.8 °C; maximum AURP 8.9 ± 13.6% (both p < 0.05)) and (ii) those sciatica (n = 8) patients who reported pain sensation during the test with 20.6% positive thermograms (Δ₸° 0.7 ± 0.7 °C; maximum AURP 15.1 ± 17.8% (both p < 0.05)). The remaining sciatica (n = 22) patients did not report pain during the test and presented a Δ₸° decrease and the AURP size below 1%. Conclusion: Amplified vasodilatation suggesting nociplastic pain involvement was confirmed for all GS and sciatica patients who reported painful sensations in the zone typical for gluteus minimus referred pain during the test.

Stimulation of Myofascial Trigger Points in the Sternocleidomastoid Evokes Facial Thermal Response Correlated with the Referred Pain

The purpose of this research is to identify and correlate the referred pain evocated by myofascial trigger points (TrPs) pressure pain threshold (PPT) in the sternocleidomastoid muscle using thermal infrared imaging (IR). Facial IR images of 46 volunteers (21 male and 25 female, average age 32 ± 6.3) undergoing PPT of five TrPs locations on the sternocleidomastoid belly were recorded. Each PPT lasted 10 s, with an interstimulus interval of 2 min. Sixteen thermal IR images were recorded for each subject: at baseline (t0), 2 s before PPT (t1), 2 s (t2) and 60 s (t3) after PPT of each TrPs location. During the interstimulus interval, subjects were asked to draw over a head–neck template displayed on a computer screen the areas of referred pain eventually evoked by the stimulation and the referred pain intensity by means of a Visual Analogue Scale (VAS). The VAS template was then superimposed with the IR records. Two temperature (T) variations were calculated: ΔT1 = T(t2) − T(t1) and ΔT2 = T(t3) − T(t1). Differences in ∆T range ≥ 0.2 °C have been considered significant. In 77% of the superimpositions, the referred pain area corresponded to a ΔT2 ≥ 0.2 °C while only the 59% corresponded to a ΔT1 ≥ 0.2 °C. In 19% of superimpositions, a ΔT2 ≥ 0.2 °C did not correspond to a referred pain area indicated by the patient, and this percentage lowers to 4% for ΔT1 ≥ 0.2 °C. None of the areas that reported a VAS of 0 or 1 showed a ΔT1 ≥ 0.2 °C or a ΔT2 ≥ 0.2 °C. Considering the limitations of this pilot study, IR could be used to identify referred pain evocated by TrPs on sternocleidomastoid muscle.

The Automatization of a New Thermography Method Using Invasive Nociceptive Stimulation to Confirm an Autonomic Phenomenon within a Trigger Point Referred Pain Zone

The trigger points (TrPs) related to chronic low back pain that mimic sciatica have been lately recognized and included in the International Classification of Diseases, 11th Revision. This study examined the MATLAB software utility for the objective stratification of low back pain patients using the Minimally Invasive Procedure (MIP). The two diagnostic MIP parameters were: average temperature (ΔTavr) and autonomic referred pain (AURP). Chronic sciatica patients with TrPs (n = 20) and without TrPs (n = 20) were examined using the MIP. A significant increase in both parameters was confirmed for the thigh ROI of the TrP-positive patients, with ΔTavr being the leading parameter (p = 0.016, Exp(β) = 2.603). A continued significance of both parameters was confirmed from 6′00″ to 15′30″ (p < 0.05). The maximum AURP value was confirmed at 13′30″ (p < 0.05) (TrPs(+) 20.4 ± 19.9% vs. TrPs(-) 3.77 ± 9.14%; p = 0.000; CI (0.347,0.348)).

Een 19-jarige jongen met kniepijn, gerefereerd vanuit een middiafysair osteoïd osteoom van de femur?

A 19-year-old male with persistent unilateral knee pain, possibly due to a mid-diaphyseal osteoid osteoma of the femur? Osteoid osteoma is a benign bone-forming tumor that typically presents itself during the second decade and more frequently in males. The main complaint is progressive pain, usually pain at night. The pain is relieved by nonsteroidal anti-inflammatory medication. However, osteoid osteoma can present itself in a rather nonspecific pattern, for example with referred pain. On radiographs an osteoid osteoma has a characteristic image of a small round lucency (nidus) with sclerotic margin, which is best visualized with CT scan. Treatment can either be conservative with an oral NSAI or surgical, where nowadays CT guided radiofrequency ablation seems to be the primary choice.

Electroacupuncture at Neurogenic Spots in Referred Pain Areas Attenuates Hepatic Damages in Bile Duct-Ligated Rats

Visceral pain frequently produces referred pain at somatic sites due to the convergence of somatic and visceral afferents. In skin overlying the referred pain, neurogenic spots characterized by hyperalgesia, tenderness and neurogenic inflammation are found. We investigated whether neurogenic inflammatory spots function as acupoints in the rat model of bile duct ligation-induced liver injury. The majority of neurogenic spots were found in the dorsal trunk overlying the referred pain and matched with locations of acupoints. The spots, as well as acupoints, showed high electrical conductance and enhanced expression of the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP). Electroacupuncture at neurogenic spots reduced serum hepatocellular enzyme activities and histological patterns of acute liver injury in bile duct ligation (BDL) rats. The results suggest that the neurogenic spots have therapeutic effects as acupoints on hepatic injury in bile-duct ligated rats.

Missed Diagnosis of Cholangiocarcinoma Presenting with Atypical Symptoms

We report a case of delayed diagnosis of cholangiocarcinoma. A 62-year-old man developed acute abdominal pain in multiple sites. As the distribution pattern of the abdominal pain was not correctly interpreted based on the mechanisms of visceral and referred pain, the patient was not investigated with the best diagnostic test at first presentation. Moreover, miscommunication between physicians in a clinic and separate hospital delayed diagnosis. For prompt diagnosis, physicians should be practice careful reasoning and focus on good communication with physicians outside their hospital.