This narrative review summarizes the current knowledge of the genetic and epigenetic contributions to the development of fibromyalgia (FM). Although there is no single gene that results in the development of FM, this study reveals that certain polymorphisms in genes involved in the catecholaminergic pathway, the serotonergic pathway, pain processing, oxidative stress, and inflammation may influence susceptibility to FM and the severity of its symptoms. Furthermore, epigenetic changes at the DNA level may lead to the development of FM. Likewise, microRNAs may impact the expression of certain proteins that lead to the worsening of FM-associated symptoms.

Purpose of Review: Complex regional pain syndrome (CRPS) is a debilitating condition that manifests with sensory, neurologic, autonomic, and/or trophic impairment. In addition to manifesting with severe neuropathic pain, CRPS is associated with poor quality of life and higher annual healthcare costs. This systematic review appraises the current body of evidence on all treatment modalities for CRPS. Recent Findings: In patients with CRPS-related pain, there is level I evidence supporting modest to moderate improvement in pain intensity from physical therapy, occupational therapy, massage therapy, acupuncture, and transcutaneous electrical nerve stimulation (TENS), although changes in functionality were inconsistent. Topical medications such as eutectic mixture of local anesthetic (EMLA) and ketamine cream were associated with decreased allodynia and hyperalgesia. Inconsistency was present in the current literature in terms of the analgesic effects of gabapentinoids for CRPS. Patients who received intramuscular or intravenous bisphosphonate therapy may achieve modest to moderate improvement in pain intensity and functionality. Systemic steroid and ketamine provided only short-term pain reduction. In terms of interventional therapy, there was an association of modest to moderate improvement in pain with sympathetic ganglion block, sympathectomy, dorsal column spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation, although the level of evidence was limited. Summary: In summary, the purpose of this systematic review is to equip the clinician with important updates on conservative, pharmacologic, and interventional treatment modalities for CRPS-related pain.

To evaluate the efficacy of physical therapy (PT) to alleviate symptomatic thoracic radiculopathy (TR) without the use of invasive procedures. Database search was conducted by an experienced medical librarian from inception until January 27, 2023, in EBSCO CINAHL with Full Text, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science Core Collection. Inclusion criteria included studies that involved adult patients (age≥18) who had a magnetic resonance imaging-confirmed TR and underwent a structured, supervised PT program of any length. All types of studies were included. Study quality and risk of bias were assessed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality of Assessment Tool. Certainty in evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was not performed. A total of 1,491 studies were screened and 7 studies met inclusion criteria, 5 case studies and 2 cohort studies. All studies showed improvement or resolution of the TR with PT. Quantitative improvements were not noted in most studies and PT regimens were sparsely described. Overall quality assessment demonstrated 3 studies had “good,” 1 “fair,” and 3 “poor” quality evidence. Certainty of evidence was “low” due to risk of bias. A dedicated PT program may help to alleviate symptomatic TR; however due to limited evidence, risk of bias, and low certainty in evidence, the data is too weak to support a definite conclusion.