lecture for 24/12

1. The Mind/Muscle Connection: Diagnosing and Treating Chronic Pain Disorder Richard Gevirtz, Ph.D. CSPP @ Alliant International University San Diego, CA [email_address]

3. Comparative Costs of Musculoskeletal, Cardiovascular, & Cancer to the U.S. Economy

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10. Short Form Musculoskeletal Function Assessment

11. Verbal Rating Scale

12. Chiropractic Visits

13. Physical Therapy Visits

14. MRIs

15. ER Visits

16. Urgent Care Visits

17. Taking Narcotics

18. Taking Muscle Relaxant

19. Wearing Neck Brace

20. Surgical Consultation

21. Cut Back Activities

22. Bed Rest

23. Number Missed Workdays Due to Injury

24. Primary Care Doctor Office Visits

25. Relationship between attribution of pain etiology and pain improvement

29. Wait a minute here, Mr. Crumbley, maybe its not kidney stones after all!

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38. Gerwin, R., Shannon, S., Hong, C., Hubbard, D. & Gevirtz, R. (1997) Interrater reliability in myofascial trigger point examination. Pain, 69 , 65-73.

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44. Myofascial Trigger Points Show Spontaneous Needle EMG Activity (Hubbard & Berkoff, 1993)

45. Effects of Curare on nEMG in TPs and Adjacent, (Non-tender) Sites TP nEMG Adjacent nEMG Pre Injection Post

46. The Effect of Phentolamine Injection on TP & Adjacent nEMG

47. 12/20/09 Gevirtz Gevirtz Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle*1 . Archives of Physical Medicine and Rehabilitation , Volume 79 , Issue 7 , Pages 790 - 794 J . Chen , S . Chen , T . Kuan , K . Chung , C . Hong

48. Clinical Efficacy of Phenoxybenzamine (Myotech)

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51. Muscle Spindle

54. Spindles are sympathetically preparing for motor action

57. Trigger Point vs. Adjacent nEMGs across Conditions ) McNulty,W., Gevirtz,R.N., Hubbard, D., and Berkoff,G. (1994) Needle electromyographic evaluation of trigger point response to a psychological stressor. Psychophysiology ,31, (3), 313-316.

58. Trigger Point vs. Adjacent nEMG vs. Frontal sEMG Lewis, C. & Gevirtz, R.N, (1994) Needle Trigger Point and Surface EMG easurements of Psychophysiological Responses in Tension-Type Headache Patients , Biofeedback and Self-Regulation , 19, 274-275 (abstract)

59. Autogenic Relaxation Reduces Trigger Point Activity Banks, S., Jacobs, D., Gevirtz, R. & Hubbard, D. (1998) Effects of autogenic relaxation training on EMG activity in myofascial trigger points. Journal of Musculoskeletal Pain , 6, #4.

60. Video

61. Trigger point vs. Adjacent nEMG across Conditions Gadler, R. & Gevirtz, R.(1997) Evaluation of Needle Electromyographic Response to Emotional Stimuli Applied Psychophysiology and Biofeedback, 22 , 137 (abstract)

62. nEMG Across Ergonomic & Stress Conditions Muse, J. & Gevirtz, R. (1999) The effects of a psychological stressor on nEMG activity while performing a typing task in good and poor ergonomic positions. Applied Psychophysiology and Biofeedback, 24 (2) , 120 (abstract).

63. Cafaro, T.A., Gevirtz, R.N., Hubbard, D., & Harvey, M. (2001) The exploration of trigger point and heart rate variability excitation and recovery patterns in actors performing anger inhibition and anger expression. Applied Psychophysiology and Biofeedback, 26 , 236(abstract).

65. Mediational Model of Muscle Pain Muscle Pain- Myofascial Pain- TP Pain TP or Spindle Spasm Pressure on Capsule Prolonged Sympathetic Activity Worry or FNE ongoing Overexertion Lack of Assertiveness Situations requiring self-assertion

66. Treatment

67. Insert Myopoint Video Here

71. Differential Diagnosis of FM and MPS (adapted from Schneider, 1995)

72. Differential (continued)

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78. 12/20/09 Gevirtz Gevirtz Leah 1 HF(.15-.4Hz) LF(.08-.14Hz) VLF(.001-.07Hz)

79. 12/20/09 Gevirtz Gevirtz L 4, Paced Breathing