Four articles on PainSci cite Holman 2008: 1. Anxiety & Chronic Pain 2. The Complete Guide to Chronic Tension Headaches 3. The Complete Guide to Neck Pain & Cricks 4. A Rational Guide to Fibromyalgia
PainSci commentary on Holman 2008: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This study found that 71% of fibromyalgia patients and 85% with chronic widespread pain showed positional cervical spinal cord compression on MRI — basically, light pinching of their spinal cord during neck extension. And so “recognition of unsuspected, comorbid cervical cord compression may provide new insight into [fibromyalgia’s] variable presentation.” Hoo boy, no kidding it would.
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
The variable presentation and treatment response of fibromyalgia (FM) may be related to comorbidities, including positional cervical cord compression (PC3). Prevalence of PC3 among routine referrals for rheumatology consultation was assessed over 2 random months (January and February 2006) from a 4-year experience of 1100 patients. PC3 was defined as cord abutment, compression or flattening with a spinal canal diameter of <10 mm by magnetic resonance sagittal flexion, neutral, and extension images. Of 107 referrals, 53 had FM, 32 had a connective tissue disease (CTD) without FM, and 22 had chronic widespread pain (CWP) without FM criteria. The dynamic cervical spine images were obtained in 70 patients: 49 of 53 with FM, 20 of 22 with CWP and 1 of 32 with CTD, based on history and examination. Among those who received magnetic resonance imaging [MRI], 52 patients met PC3 criteria (71% of FM group [35/49], 85% of CWP group [17/20]). Two patients had a Chiari malformation (FM), 1 had multiple sclerosis (CWP), and 1 had multiple myeloma (CWP). Extension views were required for diagnosis for 37 of these 52 (71%) subjects, as well as for 8 patients who also had cervical spinal cord flattening. The pilot data suggest that further evaluation of PC3 in a controlled trial is warranted among patients with FM and CWP.
PERSPECTIVE: Fibromyalgia is complex and poorly understood. Recognition of unsuspected, comorbid cervical cord compression may provide new insight into its variable presentation, leading to novel treatment considerations. Also, dissemination of this dynamic MRI protocol may promote further study of this emerging concept of cervical cord irritation.
- “Fibromyalgia and Positional Cervical Cord Compression Differ Only By Autonomic Nervous System Consequences: A Double-Blinded, Prospective Study,” Andrew J Holman, Arthritis Rheumatol, 2015.
- “Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia,” Dan S Heffez, Ruth E Ross, Yvonne Shade-Zeldow, Konstantinos Kostas, Sagar Shah, Robert Gottschalk, Dean A Elias, Alan Shepard, Sue E Leurgans, and Charity G Moore, European Spine Journal, 2004.
- “Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications,” Dan S Heffez, Ruth E Ross, Yvonne Shade-Zeldow, Konstantinos Kostas, Mary Morrissey, Dean A Elias, and Alan Shepard, European Spine Journal, 2007.
- “Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis,” Peter C Rowe, Colleen L Marden, Scott Heinlein, and 2nd Edwards, J Transl Med, 2018.
Specifically regarding Holman 2008:
- “Using Dynamic MRI to Diagnose Neck Pain: The Importance of Positional Cervical Cord Compression (PC3),” Andrew Holman, PracticalPainManagement.com.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.