2006 Janet Travell Award
The IMS Grants Committee awarded a Janet Travell Myofascial Pain Syndrome IMS Training Scholarship to César Fernández de las Peñas in the amount of $2,000.00 US in 2006.
Recipient: César Fernández de las Peñas, PT Professor, of Madrid, Spain
Preceptors: Lars Arendt-Nielsen, DMSc, PhD, and Hong-You Ge, MD, PhD [Denmark]
Title: SENSORY AND MOTOR CHARACTERISTICS OF ACTIVE AND LATENT TRIGGER POINTS IN PATIENTS WITH TENSION TYPE HEADACHE
Background: Tension type headache [TTH] has been studied as a phenomenon of pericranial tenderness. Much of the headache literature concerning TTH describes pressure pain thresholds and electromyographic activity of pericranial muscles. The term “myofascial trigger point” [TrP] has been used to describe the regions of pericranial tenderness. However, the term as used in this literature does not consider referred pain from TrPs in the formation of TTH. Recent studies from the research group led by Fernández de las Peñas have recently emerged in the literature showing the relevance of referred pain elicited from TrPs in certain neck and shoulder muscles.
Objectives: The aim of the fellowship for the Candidate will be to participate in a blinded-controlled study in which we will analyze the relationship of sensory and motor characteristics of either latent or active TrPs with headache clinical features in TTH subjects. With these data, the Candidate, Dr. Arendt-Nielsen, and Dr. Ge will start to write different manuscripts with the aim to send them to different peer-reviewed scientific journals.
Methods: The Candidate already has expertise in the manual identification and treatment of TrPs in TTH patients. In addition, his contribution to the peer-reviewed literature about the possible etiologic role of TrPs in the genesis of TTH is interesting. During his fellowship the Candidate will participate directly with Dr. Arendt-Nielsen and Dr. Ge in the development of the aforementioned study. The Candidate will contribute importantly to the project by selecting appropriate clinical subjects for TrP examination, by participating in the TrP examination, by recollecting electromyographic [EMG] data, and by collaborating in the analysis of the obtained data. The following parameters will be registered: local and referred pain intensities, pressure pain threshold, spontaneous EMG amplitude, EMG activity from short contractions in active or latent TrPs.
Benefits: The Candidate is seriously interested in the contribution of referred pain elicited by TrPs in the development of TTH. His previous experience, in addition to the present fellowship, will contribute significantly to the international knowledge about the relevance of TrPs in the genesis of TTH. In addition, we will start an international collaboration between both study centers and eventually create a Myofascial Trigger Point Study Team specialized in the management of chronic TTH.
Summary: This training and improvement in the Candidate’s skills will provide an additional knowledge to the TrP research on headache patients, and also an important foundation for more advanced studies in the future.
REVIEW OF MR. FERNANDEZ'S PROJECT
[presented to the International MYOPAIN Society by the Preceptor Lars Arendt-Nielsen, DMSc, PhD]
Title: SENSORY AND MOTOR CHARACTERISTICS OF ACTIVE TRIGGER POINTS IN TENSION TYPE HEADACHE PATIENTS
Mr. Fernandez completed his one month of International MYOPAIN Society-sponsored fellowship in August of 2006. Below are the goals he accomplished:
Mr. Fernandez participated actively, in collaboration with Hong You Ge, MD, PhD, in a non-blinded study in which we assessed 15 patients with chronic tension type headache. In this study we tried to reproduce all the head pain patterns of the patients by manual exploration of active trigger points [TrPs] in several head and neck muscles. This study will be complted in the centre of Mr. Fernandez [Spain] assessing more headache patients from a headache specialized centre in order to compare TrP prevalence in both centers.
A second study done by Mr. Fernandez was a controlled EMG study, in collaboration with Deborah Falla, PT, PhD, and Dario Farina, PhD, in which Mr. Fernandez investigated muscle co-activation of cervial flexor and extensor muscles in 10 patients with chronic tension type headache as compared to nine healthy subjects.
A third study conducted during his stance was to describe the pressure pain sensitivity mapping of the temporalis muscle in both chronic tension type headache and healthy controls.
We reviewed, revised and completed one manuscript about TrPs and central sensitization which has been submitted for publication.
We analized EMG data from the motor control study and we prepared the draft of the manuscript.
Mr. Fernandez was proposed to defend his European PhD thesis about TrPs and headache, here at The Center for SEnsory-Motor Interaction, under my supervision. The defense of his PhD thesis will be programmed by the first of 2007.
We think that the fellowship travel of Cesar Fernandez de las Penas has been very productive to both and we hope that the results of our studies can be published soon.
Lars Arendt-Nielsen, DMSc, PhD