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Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of Latent Myofascial Trigger Points. Clin Biomech (Bristol, Avon) 2010; 25:765-70. [PMID: 20667633 DOI: 10.1016/j.clinbiomech.2010.05.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 05/17/2010] [Accepted: 05/17/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Latent Myofascial Trigger Points are pain-free neuromuscular lesions that have been found to affect muscle activation patterns in the unloaded state. The aim was to extend these observations to loaded motion by investigating muscle activation patterns in upward scapular rotator muscles (upper and lower trapezius and serratus anterior) hosting Latent Myofascial Trigger Points simultaneously with lesion-free synergists for shoulder abduction (infraspinatus and middle deltoid). This approach allowed examination of the effects of these lesions on both their hosts and their lesion-free synergists in order to understand their effects on the performance of shoulder abduction. METHODS Surface electromyography was employed to measure the timing of onset of muscle activation of the upper and lower trapezius and serratus anterior (upward scapular rotators), infraspinatus (rotator cuff) and middle deltoid (abductor of the arm) initially without load and then with light (1-4 kg) dumbbells. Comparisons were made between control (no Latent Trigger Points; n=14) and Latent Trigger Point (n=28) groups. FINDINGS The control group displayed a relatively stable sequence of muscle activation that was significantly different in timing and variability to that of the Latent Trigger Point group in all muscles except middle deltoid (all P<0.05). The Latent Trigger Point group muscle activation pattern under load was inconsistent, with the only common feature being the early activation of the infraspinatus. INTERPRETATION The presence of Latent Trigger Points in upward scapular rotators alters the muscle activation pattern during scapular plane elevation, potentially predisposing to overuse conditions including impingement syndrome, rotator cuff pathology and myofascial pain.
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Affiliation(s)
- Karen R Lucas
- Musculoskeletal Research Centre, Level 2, HS3, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Australia.
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152
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Chen KH, Hong CZ, Hsu HC, Wu SK, Kuo FC, Hsieh YL. Dose-dependent and Ceiling Effects of Therapeutic Laser on Myofascial Trigger Spots in Rabbit Skeletal Muscles. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10582450903586433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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153
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Chang WD, Wu JH, Yang WJ, Jiang JA. Therapeutic Effects of Low-Level Laser on Lateral Epicondylitis from Differential Interventions of Chinese-Western Medicine: Systematic Review. Photomed Laser Surg 2010; 28:327-36. [DOI: 10.1089/pho.2009.2558] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wen-Dien Chang
- Department of Rehabilitation Medicine, Da Chien General Hospital, Miaoli City, Taiwan
- Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, Taiwan
| | - Jih-Huah Wu
- Department of Biomedical Engineering, Ming Chuan University, Taipei, Taiwan
| | - Wen-Ju Yang
- Department of Rehabilitation Medicine, Da Chien General Hospital, Miaoli City, Taiwan
| | - Joe-Air Jiang
- Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, Taiwan
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154
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Treatment of myofascial pain in the shoulder with Kinesio Taping. A case report. ACTA ACUST UNITED AC 2010; 15:292-5. [DOI: 10.1016/j.math.2009.09.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 09/03/2009] [Accepted: 09/16/2009] [Indexed: 11/23/2022]
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155
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Comparison of miniscalpel-needle release, acupuncture needling, and stretching exercise to trigger point in myofascial pain syndrome. Clin J Pain 2010; 26:251-7. [PMID: 20173440 DOI: 10.1097/ajp.0b013e3181b8cdc8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. Several methods have been recommended for the inactivation of trigger points (TrPs). We carried out this study to investigate the effectiveness of miniscalpel-needle (MSN) release and acupuncture needling and self neck-stretching exercises on myofascial TrPs of the upper trapezius muscle. METHODS Eighty-three TrPs in 43 patients with MPS were treated and randomly assigned to 3 groups: group 1 received MSN release in conjunction with self neck-stretching exercises; group 2 received acupuncture needling treatment and performed self neck-stretching exercises; and group 3, the control group, was assigned self neck-stretching exercises only. The therapeutic effectiveness was evaluated using subjective pain intensity (PI) with a visual analog scale, pressure pain threshold (PPT), and contralateral bending range of motion (ROM) of cervical spine at pretreatment, 2 weeks, and 3 months after treatment. RESULTS The improvement of PI, PPT, and contralateral bending ROM of cervical spine was significantly greater in group 1 and 2 than that in control group at 2 weeks and 3 months follow-up. Compared with group 2, patients in group 1 had a statistically significant reduction in PI, an increase in PPT, contralateral bending ROM of cervical spine at 3 months follow-up. DISCUSSION The effectiveness of MSN release for MPS is superior to that of acupuncture needling treatment or self neck-stretching exercises alone. The MSN release is also safe, without severe side effects in treatment of MPS.
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Ojala TA, Jurvelin JS, Partanen JV, Arokoski JPA. Soft Tissue Stiffness Before and after Trigger Point Injections in Neck–Shoulder Myofascial Pain Syndrome: A Double-Blind, Randomized, and Controlled Crossover Trial with Botulinum Toxin A and Saline Injections. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10582450903496021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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157
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Remote Effects of Dry Needling on the Irritability of the Myofascial Trigger Point in the Upper Trapezius Muscle. Am J Phys Med Rehabil 2010; 89:133-40. [DOI: 10.1097/phm.0b013e3181a5b1bc] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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158
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Needle-Electromyography Findings of Trigger Points in Neck-Shoulder Area Before and After Injection Treatment. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v14n01_02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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159
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160
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161
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No Increased Neuromuscular Jitter at Rabbit Skeletal Muscle Trigger Spot Spontaneous Electrical Activity Sites. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v08n03_06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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162
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Spontaneous Needle Electromyographic Activity in Myofascial Trigger Points in the Infraspinatus Muscle: A Blinded Assessment. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v09n03_02] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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163
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164
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Decrease in Pressure Pain Thresholds of Latent Myofascial Trigger Points in the Middle Finger Extensors Immediately After Continuous Piano Practice. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v08n03_07] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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165
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Musculoskeletal Disorders in Mechanical Neck Pain: Myofascial Trigger Points versus Cervical Joint Dysfunction–A Clinical Study. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v13n01_04] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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166
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Effective Pain Palliation in Fibromyalgia Syndrome Patients with Botulinum Toxin Type-A: Case Series of 25. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v15n04_07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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167
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Therapeutic Effect on the Change of Gait Performance in Chronic Calf Myofascial Pain Syndrome: A Time Series Case Study. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v13n03_06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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169
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170
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171
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Teres Minor Tendinitis Manifested with Chronic Myofascial Pain Syndrome in the Scapular Muscles: A Case Report. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v14n01_06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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172
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Hunter C, Dubois M, Zou S, Oswald W, Coakley K, Shehebar M, Conlon AM. A New Muscle Pain Detection Device to Diagnose Muscles as a Source of Back and/or Neck Pain. PAIN MEDICINE 2010; 11:35-43. [DOI: 10.1111/j.1526-4637.2009.00773.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hsieh LF, Hong CZ, Chern SH, Chen CC. Efficacy and side effects of diclofenac patch in treatment of patients with myofascial pain syndrome of the upper trapezius. J Pain Symptom Manage 2010; 39:116-25. [PMID: 19822404 DOI: 10.1016/j.jpainsymman.2009.05.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 04/30/2009] [Accepted: 05/14/2009] [Indexed: 11/30/2022]
Abstract
Locally administered nonsteroidal anti-inflammatory drugs have been widely used in acute soft-tissue damage and articular musculoskeletal pain. This double-blind, placebo-controlled, randomized study was designed to evaluate the efficacy and safety of a topical diclofenac sodium patch in the relief of pain and inflammation as a result of myofascial pain syndrome (MPS) in the upper trapezius. After sample size calculations indicated that 147 patients would be needed to detect a 25% difference between drug and control, 153 patients with MPS were recruited and randomized to receive either a diclofenac sodium patch or control (menthol) patch. Visual analog scale (VAS), cervical active range of motion, pressure pain threshold of the myofascial trigger point (MTrP), patient global assessment, Neck Disability Index, and the occurrence of adverse events were assessed on Day 0 (baseline), Day 4, and Day 8. Use of the diclofenac sodium patch elicited favorable responses for the VAS, cervical active range of motion, and Neck Disability Index by the end of the treatment course (P<0.05), and was consistently superior to the control patch at all time intervals. No significant differences were observed for the pressure pain threshold of the MTrP for either patch. Tolerability assessment similarly showed the diclofenac patch to be comparatively superior. When assessed at the end of the study, 20 diclofenac patch patients, but only four control patients, considered the tolerability of treatment to be "very good." Significant differences in adverse reactions were observed between the diclofenac and control patches, with the control patch more likely to produce overall skin irritation. This study demonstrate that the diclofenac sodium patch was superior to the control patch in terms of reducing pain and improving functional outcomes, and did not result in significant adverse effects.
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Affiliation(s)
- Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
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174
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Srbely JZ, Dickey JP, Bent LR, Lee D, Lowerison M. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. THE JOURNAL OF PAIN 2009; 11:636-43. [PMID: 20015704 DOI: 10.1016/j.jpain.2009.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 09/22/2009] [Accepted: 10/02/2009] [Indexed: 12/19/2022]
Abstract
UNLABELLED This study investigated whether inducing central sensitization evokes segmental increases in trigger point pressure sensitivity. We evoked central sensitization at the C(5) segment and validated its presence via mechanical cutaneous sensitivity (brush allodynia) testing. Trigger point pressure sensitivity was quantified using the pain pressure threshold (PPT) value. A 50 cm(2) area of the C(5) dermatome at the right lateral elbow was pretreated with 45 degrees heat for 10 minutes. Test subjects (n = 20) then received topical capsaicin cream (0.075%; Medicis, Toronto, Canada) to the C(5) dermatome, whereas control subjects (n = 20) received a topical placebo cream (Biotherm Massage, Montreal, Canada). PPT readings were recorded from the infraspinatus (C(5,6)) and gluteus medius (L(4,5)S(1)) trigger points at zero (pre-intervention), 10, 20, and 30 minutes after intervention; all PPT readings were normalized to pre-intervention (baseline) values. The difference between the PPT readings at the 2 trigger point sites represents the direct influence of segmental mechanisms on the trigger point sensitivity at the infraspinatus site (PPT(seg)). Test subjects demonstrated statistically significant increases in Total Allodynia scores and significant decreases in PPT(seg) at 10, 20, and 30 minutes after application, when compared with control subjects. These results demonstrate that increases in central sensitization evoke increases in trigger point pressure sensitivity in segmentally related muscles. PERSPECTIVE Myofascial pain is the most common form of musculoskeletal pain. Myofascial trigger points play an important role in the clinical manifestation of myofascial pain syndrome. Elucidating the role of central sensitization in the pathophysiology of trigger points is fundamental to developing optimal strategies in the management of myofascial pain syndrome.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.
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175
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Reichling DB, Levine JD. Critical role of nociceptor plasticity in chronic pain. Trends Neurosci 2009; 32:611-8. [PMID: 19781793 PMCID: PMC2787756 DOI: 10.1016/j.tins.2009.07.007] [Citation(s) in RCA: 336] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 07/14/2009] [Accepted: 07/15/2009] [Indexed: 01/29/2023]
Abstract
The transition from acute to chronic pain states might be the most important challenge in research to improve clinical treatment of debilitating pain. We describe a recently identified mechanism of neuronal plasticity in primary afferent nociceptive nerve fibers (nociceptors) by which an acute inflammatory insult or environmental stressor can trigger long-lasting hypersensitivity of nociceptors to inflammatory cytokines. This phenomenon, "hyperalgesic priming," depends on the epsilon isoform of protein kinase C (PKCepsilon) and a switch in intracellular signaling pathways that mediate cytokine-induced nociceptor hyperexcitability. We discuss the impact of this discovery on our understanding of, and ultimately our ability to treat, a variety of enigmatic and debilitating pain conditions, including those associated with repetitive injury, and generalized pain conditions, such as fibromyalgia.
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Affiliation(s)
- David B Reichling
- Department of Oral and Maxillofacial Surgery and Division of Neuroscience, University of California, San Francisco, CA 94143-0440, USA
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176
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Abdominal myofascial pain syndrome must be considered in the differential diagnosis of chronic pelvic pain. Eur J Obstet Gynecol Reprod Biol 2009; 147:21-4. [DOI: 10.1016/j.ejogrb.2009.06.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 05/06/2009] [Accepted: 06/22/2009] [Indexed: 11/19/2022]
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178
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Tsai CT, Hsieh LF, Kuan TS, Kao MJ, Hong CZ. Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle. Orthopedics 2009; 32:orthopedics.41914. [PMID: 19708635 DOI: 10.3928/01477447-20090624-04] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The goal of this double-blinded, randomized, controlled study was to confirm the effectiveness of the cervical facet joint injection in treating shoulder pain with the myofascial trigger point in the upper trapezius muscle secondary to cervical facet lesion. Eighty-nine patients with chronic unilateral shoulder pain due to myofascial trigger points in the upper trapezius muscle received an injection to the C4-5 facet joint in the experimental group and to the corresponding unilateral multifidi muscle in the control group. Subjective pain intensity and pressure pain threshold of the myofascial trigger point were assessed, and the prevalence of endplate noise in the myofascial trigger point region was measured in 28 patients before, immediately after, and 1 month after the injection. Half of the patients in the experimental group, but none of the control patients, reported being completely pain free 1 month after the injection. Both the decrease in the pain intensity and the increase in pressure pain threshold were significantly more in the experimental group than in the control group either immediately or 1 month after the injection. There was no significant difference in the change of endplate noise prevalence between the 2 groups. This study demonstrates that intra-articular or peri-articular injection into the cervical facet joint region can effectively inactivate the upper trapezius myofascial trigger point secondary to the facet lesion.
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Affiliation(s)
- Chien-Tsung Tsai
- Department of Rehabilitation Medicine, Da Chien General Hospital, Miao-Li City, Taiwan
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179
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Insausti Valdivia J. [Non-specific lower back pain: In search of the origin of pain]. REUMATOLOGIA CLINICA 2009; 5 Suppl 2:19-26. [PMID: 21794654 DOI: 10.1016/j.reuma.2009.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 04/08/2009] [Indexed: 05/31/2023]
Abstract
Lower back pain is a condition considered benign and with a specific cause determined only in 15% of patients. In the past years this concept has varied, because many papers have described no benign condition leading to back pain, citing their capacity to cause disability. Through many different diagnostic techniques it is possible to identify the structures capable of producing back pain. This identification, and the level of evidence of the interventional techniques, is the aim of this paper.
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180
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Hsu HC, Hong CZ. Floating Kidney with Chronic Myofascial Pain Syndrome in the AbdominalMuscles as the Major Clinical Manifestation: A Case Report. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450802161994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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181
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Bahadir C, Majlesi J, Unalan H. The Effect of High-Power Pain Threshold Ultrasound Therapy on the Electrical Activity of Trigger Points and Local Twitch Response on Electromyography: A Preliminary Study. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450902820572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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182
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Lucas KR, Rich PA, Polus BI. How Common Are Latent Myofascial Trigger Points in the Scapular Positioning Muscles? ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450802479800] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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183
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Lim PF, Schmidt J, de Leeuw R, Carlson C, Albuquerque R, Okeson JP. Inability of Surface Electromyography to Register the Local Twitch Response Elicited by Trigger Point Injection and Snapping Palpation in Myofascial Pain Patients. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450802161911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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184
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Chou LW, Hong JY, Hong CZ. A New Technique for Acupuncture Therapy and Its Effectiveness in Treating Fibromyalgia Syndrome: A Case Report. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450802161978] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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185
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Kostopoulos D, Nelson AJ, Ingber RS, Larkin RW. Reduction of Spontaneous Electrical Activity and Pain Perception of Trigger Points in the Upper Trapezius Muscle through Trigger Point Compression and Passive Stretching. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450802479594] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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186
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Chou LW, Hsieh YL, Kao MJ, Hong CZ. Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. Arch Phys Med Rehabil 2009; 90:905-12. [PMID: 19480864 DOI: 10.1016/j.apmr.2008.12.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 12/14/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the remote effect of acupuncture on the pain intensity and the endplate noise (EPN) recorded from a myofascial trigger point (MTrP) of the upper trapezius muscle. DESIGN Randomized controlled trial. SETTING University hospital. PARTICIPANTS Patients (N=20) with active MTrPs in upper trapezius muscles and no experience in acupuncture therapy. INTERVENTIONS Patients were divided into 2 groups. Those in the control group received sham acupuncture, and those in the acupuncture group received modified acupuncture therapy with needle insertion into multiple loci to elicit local twitch responses. The acupuncture points of Wai-guan and Qu-chi were treated. MAIN OUTCOME MEASURES Subjective pain intensity (numerical pain rating scale) and mean EPN amplitude in the MTrP of the upper trapezius muscle. RESULTS The pain intensity in the MTrP was significantly reduced after remote acupuncture (from 7.4+/-0.8 to 3.3+/-1.1; P<.001), but not after sham acupuncture (from 7.4+/-0.8 to 7.1+/-0.9; P>.05). The mean EPN amplitude was significantly lower than the pretreatment level after acupuncture treatment (from 21.3+/-9.5 microV to 9.5+/-3.5 microV; P<.01), but not after sham acupuncture treatment (from 19.6+/-7.6 microV to 19.3+/-7.8 microV; P>.05). The change in the pain intensity was significantly correlated with the change of EPN amplitude (r=0.685). CONCLUSIONS Both subjective changes in the pain intensity and objective changes of the EPN amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points. This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control.
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Affiliation(s)
- Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University, Taichung, Taiwan
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187
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Partanen JV, Ojala TA, Arokoski JPA. Myofascial syndrome and pain: A neurophysiological approach. ACTA ACUST UNITED AC 2009; 17:19-28. [PMID: 19500953 DOI: 10.1016/j.pathophys.2009.05.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 03/26/2009] [Accepted: 05/07/2009] [Indexed: 12/15/2022]
Abstract
It has been debated whether muscle spindles have a role in myofascial pain or not. We present a number of arguments for the former hypothesis. It was hypothesized that firing of intrafusal muscle fibres, i.e. fusimotor activity can be observed as "end plate spikes" (EPSs) in electromyography (EMG). The EPSs may be found in local active spots of muscle, often associated with miniature end plate potentials (MEPPs). Insertion of EMG needle electrodes into an active spot is painful, indicating nociception in the muscle spindle. Myofascial syndrome patients have taut bands with active trigger points (TrPs) in painful muscles. End plate activity (EPSs and MEPPs) is a significantly more common finding in TrPs of myofascial pain than in control points of the muscle, indicating the presence of muscle spindles. However, some control sites may show EPSs of normal muscle spindles. Increased amount of inflammatory metabolites have been observed in active TrPs. Muscle spindle is a capsulated gel-filled container, where inflammatory and contraction metabolites may be heavily concentrated during sustained fusimotor activation. Thus the intrafusal chemosensitive pain mediating III- and IV-afferents are sensitized and activated. Intrafusal inflammation causes further reflex activation of the fusimotor and skeletofusimotor systems via sensitized III- and IV-afferents. The taut band itself may be a contracture (rigor) of local skeletofusimotor (beta) units caused by sustained reflex drive by the given muscle spindles. In EMG this may be seen as complex repetitive discharges. We conclude that TrPs of myofascial pain are related to painful muscle spindles in taut bands.
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Affiliation(s)
- Juhani V Partanen
- University and University Hospital of Helsinki, Department of Clinical Neurophysiology, Jorvi Hospital, P.O. Box 800, FIN-00029 HUS, Finland
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188
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Harden RN, Cottrill J, Gagnon CM, Smitherman TA, Weinland SR, Tann B, Joseph P, Lee TS, Houle TT. Botulinum Toxin A in the Treatment of Chronic Tension-Type Headache With Cervical Myofascial Trigger Points: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. Headache 2009; 49:732-43. [DOI: 10.1111/j.1526-4610.2008.01286.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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189
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Abstract
To date, most investigation of latent myofascial trigger points (LTrPs) has occurred in pain populations. Many have thought that LTrPs are clinically relevant as -potential precursors to developing active myofascial trigger points and spontaneous pain. Nociceptive substances have been found in greater concentrations at LTrP sites compared with non-TrP sites, indicating the potential for group III and IV afferent fibers to provide input to the central nervous system from affected peripheral sites. Fatigue and neurophysiologic studies provide evidence as to the pathways via which group III and IV afferents can alter activity of the motoneuron pool and therefore affect muscle activation and performance. This article offers suggestions as to the mechanisms via which LTrP-related pathophysiology may explain the clinical examination findings associated with LTrP-containing and functionally related muscles.
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190
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Ibáñez-García J, Alburquerque-Sendín F, Rodríguez-Blanco C, Girao D, Atienza-Meseguer A, Planella-Abella S, Fernández-de-las Peñas C. Changes in masseter muscle trigger points following strain-counterstrain or neuro-muscular technique. J Bodyw Mov Ther 2009; 13:2-10. [DOI: 10.1016/j.jbmt.2008.03.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 02/11/2008] [Accepted: 03/11/2008] [Indexed: 11/15/2022]
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191
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Electrophysiologic effects of a therapeutic laser on myofascial trigger spots of rabbit skeletal muscles. Am J Phys Med Rehabil 2008; 87:1006-14. [PMID: 18617861 DOI: 10.1097/phm.0b013e31817f9fee] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To better understand the mechanisms of therapeutic lasers for treating human myofascial trigger points, we designed a blinded controlled study of the effects of a therapeutic laser on the prevalence of endplate noise (EPN) recorded from the myofascial trigger spot (MTrS) of rabbit skeletal muscle. DESIGN In eight rabbits, one MTrS in each biceps femoris muscle was irradiated with a 660-nm, continuous-wave, gallium-aluminum-arsenate (GaAlAs) laser, at 9 J/cm2. The contralateral side of muscle was treated with a sham laser. Each rabbit received six treatments. The immediate and cumulative effects were assessed by the prevalence of EPN with electromyographic (EMG) recordings after the first and last treatments. RESULTS Compared with pretreatment values, the percentages of EPN prevalence in the experimental side after the first and last treatments were significantly reduced (P < 0.01 for both). The change in EPN prevalence in the experimental side was significantly greater than in the control side immediately after the first and last treatments (P < 0.05). However, no significant differences were noted between the first and last treatments (P > 0.05). CONCLUSIONS In our study, immediate and cumulative effects of a GaAlAs laser applied on MTrS were demonstrated on the basis of the assessment of EPN prevalence. It seems that laser irradiation may inhibit the irritability of an MTrS in rabbit skeletal muscle. This effect may be a possible mechanism for myofascial pain relief with laser therapy.
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192
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Calder KM, Stashuk DW, McLean L. Motor unit potential morphology differences in individuals with non-specific arm pain and lateral epicondylitis. J Neuroeng Rehabil 2008; 5:34. [PMID: 19087309 PMCID: PMC2654455 DOI: 10.1186/1743-0003-5-34] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 12/16/2008] [Indexed: 12/13/2022] Open
Abstract
Background The pathophysiology of non-specific arm pain (NSAP) is unclear and the diagnosis is made by excluding other specific upper limb pathologies, such as lateral epicondylitis or cervical radiculopathy. The purpose of this study was to determine: (i) if the quantitative parameters related to motor unit potential morphology and/or motor unit firing patterns derived from electromyographic (EMG) signals detected from an affected muscle of patients with NSAP are different from those detected in the same muscle of individuals with lateral epicondylitis (LE) and/or control subjects and (ii) if the quantitative EMG parameters suggest that the underlying pathophysiology in NSAP is either myopathic or neuropathic in nature. Methods Sixteen subjects with NSAP, 11 subjects with LE, eight subjects deemed to be at-risk for developing a repetitive strain injury, and 37 control subjects participated. A quantitative electromyography evaluation was completed using decomposition-based quantitative electromyography (DQEMG). Needle- and surface-detected EMG signals were collected during low-level isometric contractions of the extensor carpi radialis brevis (ECRB) muscle. DQEMG was used to extract needle-detected motor unit potential trains (MUPTs), and needle-detected motor unit potential (MUP) and surface detected motor unit potential (SMUP) morphology and motor unit (MU) firing rates were compared among the four groups using one-way analysis of variance (ANOVA). Post hoc analyses were performed using Tukey's pairwise comparisons. Results Significant group differences were found for all MUP variables and for MU firing rate (p < 0.006). The post-hoc analyses revealed that patients with NSAP had smaller MUP amplitude and SMUP amplitude and area compared to the control and LE groups (p < 0.006). MUP duration and AAR values were significantly larger in the NSAP, LE and at-risk groups compared to the control group (p < 0.006); while MUP amplitude, duration and AAR values were smaller in the NSAP compared to the LE group. SMUP duration was significantly shorter in the NSAP group compared to the control group (p < 0.006). NSAP, LE and at-risk subjects had lower mean MU firing rates than the control subjects (p < 0.006). Conclusion The size-related parameters suggest that the NSAP group had significantly smaller MUPs and SMUPs than the control and LE subjects. Smaller MUPs and SMUPs may be indicative of muscle fiber atrophy and/or loss. A prospective study is needed to confirm any causal relationship between smaller MUPs and SMUPs and NSAP as found in this work.
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Affiliation(s)
- Kristina M Calder
- School of Rehabilitation Therapy, Louise D, Acton Building, 31 George Street, Queen's University, Kingston, Ontario, Canada.
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193
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Clark GT. Classification, causation and treatment of masticatory myogenous pain and dysfunction. Oral Maxillofac Surg Clin North Am 2008; 20:145-57, v. [PMID: 18343321 DOI: 10.1016/j.coms.2007.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This article focuses on chronic myogenous pains affecting the masticatory muscles, including focal myalgia, regional myalgia, myofascial pain, and fibromyalgia. The probable mechanisms are discussed and treatment options, including self-directed treatment, physical medicine modalities, and several types of pharmacologic agents, are presented.
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Affiliation(s)
- Glenn T Clark
- Department of Diagnostic Sciences, University of Southern California, School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089-0641, USA.
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194
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A Systematic, Critical Review of Manual Palpation for Identifying Myofascial Trigger Points: Evidence and Clinical Significance. Arch Phys Med Rehabil 2008; 89:1169-76. [DOI: 10.1016/j.apmr.2007.12.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 12/12/2007] [Accepted: 12/13/2007] [Indexed: 11/18/2022]
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195
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Abstract
Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Trigger points may be relieved through noninvasive measures, such as spray and stretch, transcutaneous electrical stimulation, physical therapy, and massage. Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.
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Affiliation(s)
- Elizabeth Demers Lavelle
- Department of Anesthesiology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, USA
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196
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In Reply. J Manipulative Physiol Ther 2008. [DOI: 10.1016/j.jmpt.2008.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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197
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Woodley SJ, Duxson MJ, Mercer SR. Preliminary observations on the microarchitecture of the human abdominal muscles. Clin Anat 2008; 20:808-13. [PMID: 17708566 DOI: 10.1002/ca.20523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Precise knowledge of muscle architecture and innervation patterns is essential for the development of accurate clinical and biomechanical models. Although the gross anatomy of the human abdominal muscles has been investigated, the finer details of their microanatomy are not well described. Fascicles were systematically sampled from each of the human abdominal muscles, and small fiber bundles from selected fascicles stained with acetylcholinesterase to determine the location of motor endplate bands, myomyonal junctions, and myotendinous junctions. Statistical analysis was used to ascertain the association between fascicular length and number of endplate bands. The number of endplate bands along a fascicle was variable between different portions of each muscle, but was strongly correlated with fascicular length (r = 0.814). In fascicles less than 50 millimeters (mm) in length, only a single endplate band was generally present, while multiple endplate bands (usually two or three) were found in fascicles longer than 50 mm. The presence of myomyonal junctions throughout the longer (>50 mm) fascicles verified that they were composed of short, intrafascicularly terminating fibers, while shorter fascicles comprised fibers spanning the entire fascicular length. This preliminary study provides evidence that multiple endplate bands are contained in some regions of the abdominal muscles, an arrangement that differs from most human appendicular muscles. It is not clear whether the variations in the described fine architectural features reflect regional differences in muscle function.
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Affiliation(s)
- Stephanie J Woodley
- Department of Anatomy and Structural Biology, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
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198
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Malanga G, Wolff E. Evidence-informed management of chronic low back pain with trigger point injections. Spine J 2008; 8:243-52. [PMID: 18164472 DOI: 10.1016/j.spinee.2007.10.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 10/13/2007] [Indexed: 02/03/2023]
Abstract
The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
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Affiliation(s)
- Gerard Malanga
- Overlook Pain Center, 11 Overlook Road, Summit, NJ 07901, USA.
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199
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Bezerra Rocha CAC, Sanchez TG, Tesseroli de Siqueira JT. Myofascial trigger point:a possible way of modulating tinnitus. Audiol Neurootol 2007; 13:153-60. [PMID: 18075244 DOI: 10.1159/000112423] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 08/22/2007] [Indexed: 11/19/2022] Open
Abstract
In order to investigate whether myofascial trigger points can modulate tinnitus, as well as the association between tinnitus and myofascial trigger points, 94 individuals with and 94 without tinnitus, matched by age and gender, were analyzed by means of bilateral digital pressure of 9 muscles. Temporary modulation of tinnitus was frequently observed (55.9%) during digital pressure, mainly in the masseter. The rate of tinnitus modulation was significantly higher on the same side of the myofascial trigger point subject to examination in 6 out of 9 muscles. An association between tinnitus and the presence of myofascial trigger points was observed (p < 0.001), as well as a laterality association between the ear with the worst tinnitus and the side of the body with more myofascial trigger points (p < 0.001). Thus, this relationship could be explained not only by somatosensory-auditory system interactions but also by the influence of the sympathetic system.
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200
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Chen Q, Bensamoun S, Basford JR, Thompson JM, An KN. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil 2007; 88:1658-61. [PMID: 18047882 DOI: 10.1016/j.apmr.2007.07.020] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 06/29/2007] [Accepted: 07/03/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the feasibility of using a new magnetic resonance imaging (MRI) technique--magnetic resonance elastography (MRE)--to identify and quantitate the nature of myofascial taut bands. DESIGN This investigation consisted of 3 steps. The first involved proof of concept on gel phantoms, the second involved numeric modeling, and the third involved a pilot trial on 2 subjects. Imaging was performed with a 1.5 T MRI machine. Shear waves were produced with a custom-developed acoustically driven pneumatic transducer with gradient-echo image collection gated to the transducer's motion. Shear wave propagation were imaged by MRE. SETTING An MRI research laboratory. PARTICIPANTS Two women, one with a 3-year history of myofascial pain and the other serving as the control. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES MRE images, finite element analysis calculations, and tissue and phantom stiffness determinations. RESULTS Results of the phantom measurements, finite element calculations, and study patients were all consistent with the concept that taut bands are detectable and quantifiable with MRE imaging. The findings in the subjects suggest that the stiffness of the taut bands (9.0+/-0.9 KPa) in patients with myofascial pain may be 50% greater than that of the surrounding muscle tissue. CONCLUSIONS Our findings suggest that MRE can quantitate asymmetries in muscle tone that could previously only be identified subjectively by examination.
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Affiliation(s)
- Qingshan Chen
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, College of Medicine, Rochester, MN 55905, USA
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