A randomised controlled trial was used to test the hypothesis that cutaneous injections of sterile water (SWI) have no benefit over saline (PSI) as a method of pain reduction among patients with myofascial pain syndromes. Six general practitioners located at 6 different clinics of general practice treated 117 patients (91 female, 26 male, aged > or = 25 years) with myofascial pain syndrome for at least 3 months in one or both of the upper quadrants of the body. Patients were randomised to receive either SWI or PSI which was administered sub- and intracutaneously on 1 occasion. The patients received a mean number of 10 injections of 0.5 ml of either substance. The main outcome measure was pain intensity which was measured with visual analogue scales before intervention, 10 min after intervention and 14 days after intervention. We found no statistically or clinically significant difference in pain level reduction between the 2 groups. However, patients who received SWI reported a much more painful treatment experience than those who received PSI. Our study shows that injections of sterile water are substantially more painful but demonstrate no better clinical outcome than similar injections of saline as a method to treat patients with chronic myofascial pain syndrome.

Serum relaxin levels were analysed in 12 healthy women every other day during the menstrual cycle and during a second cycle on oral contraceptives. Relaxin levels in 7 women with posterior pelvic and lumbar pain were also measured. Relaxin was detected during both the follicular and luteal phases of the menstrual cycle in some of the healthy women. Serum levels were further increased during the use of oral contraceptives. Oestradiol levels in the untreated women correlated to the relaxin levels. Women with posterior pelvic and lumbar pain had higher relaxin levels than did healthy women, a finding that needs to be further explored. Our data indicate the existence of sources for relaxin production other than the corpus luteum in the non-pregnant woman. Endogenous and exogenous oestrogens may stimulate the production of relaxin.

No abstract

The study evaluated the manual treatment of dysfunction of the pelvic joints. This is one of many condition causing low back pain. In 1987-1988 a general practitioner with special knowledge of physical examination and manual treatment of lumbar and pelvic dysfunctions made a survey of patients with acute or subacute low back pain as the main cause of the patient-to-doctor contact. Patients with defined criteria of pelvic joint dysfunction (n = 46) were randomized. After dropouts and exclusions, 18 patients with defined criteria of pelvic joint dysfunction received manual treatment, while 21 patients with similar dysfunction served as controls and received placebo treatment in a form of massage. Both groups were seen only once to evaluate whether a single treatment might be sufficient. After a period of three weeks, evaluation was made by an independent observer. Subjective pain measurement and a mobility test showed no significant difference. Sick-leave and consumption of analgesics (both decided by patient) were significantly less in the treatment group.

The intriguing association between OC use and a higher incidence of low back pain, does not enable us to conclude that there is a causal connection, but it should lead to further studies.