PAIN IN SPASMODIC TORTICOLLIS

Spasmodic torticollis (cervical dystonia) is frequently a painful cond ition but little is known of the characteristics of the pain. We asses sed 39 patients with spasmodic torticollis for the presence or absence , location, and quality of pain, as well as its correlation to postura l abnormality. Muscle tenderness was evaluated by manual palpation and pressure algometry. Measurements were made on muscles either actively maintaining or opposing abnormal head posture, as well as on muscles not contributing to it. Control measurements were made in 18 healthy s ubjects. Two-thirds of patients reported continuous or intermittent re current pain. Pain was reported widespread and diffuse over the neck a nd shoulders, with some radiation, predominantly on the side toward wh ich the head was twisted. There were no differences between study grou ps when compared for pressure algometry and only moderate differences when compared for manual palpation. No correlation was found between t he severity of motor signs and pain. Degenerative changes seen on X-ra ys were similar in painful and pain-free patients. These findings sugg est that pain associated with spasmodic torticollis does not arise in muscles alone, and we hypothesise that central mechanisms are also inv olved.