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Al-Zamil M, Kulikova NG, Shnayder NA, Korchazhkina NB, Petrova MM, Mansur TI, Blinova VV, Babochkina ZM, Vasilyeva ES, Zhhelambekov IV. Efficiency of Lidocaine Intramuscular and Intraosseous Trigger Point Injections in the Treatment of Residual Chronic Pain after Degenerative Lumbar Spinal Stenosis Decompression Surgery. J Clin Med 2024; 13:5437. [PMID: 39336924 PMCID: PMC11432395 DOI: 10.3390/jcm13185437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/30/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Introduction: Despite the long-term use of intramuscular and intraosseous lidocaine trigger point injections (LTPI) in the treatment of patients with low back pain, there have been no studies examining their efficiency in treatment of residual pain after degenerative lumbar spinal stenosis (DLSS) decompression surgery. The purpose of our research is to examine the LTPI efficiency in the treatment of residual lumbar pain after DLSS decompression surgery and to compare the analgesic and recovery effects of intramuscular and intraosseous LTPI administered in the L4-S1 region and in the posterior superior iliac spine (PSIS) after treatment and during four months of follow-up. Materials and Methods: We observed 99 patients (F:50, M:49) aged 42 to 59 years with residual neurological disorders after DLSS decompression surgery. In all patients, the pain syndrome exceeded 6 points on the VAS and averaged 7.2 ± 0.11 points. The control group (n = 21) underwent only pharmacotherapy. In addition to pharmacotherapy, the LTPI group underwent intramuscular LTPI in L4-S1 (n = 20), intramuscular LTPI in the PSIS (n = 19), intraosseous LTPI in L5, S1 (n = 20), and intraosseous LTPI in the PSIS (n = 19). A neurological examination was carried out before treatment, 7 days after completion of treatment, and at the end of the second and fourth months of the follow-up period. Results: In the control group, intramuscular LTPI in L4-S1 subgroup, intramuscular LTPI in PSIS subgroup, intraosseous LTPI in L5, S1 subgroup, and intraosseous LTPI in PSIS subgroup, the severity of pain decreased after treatment by 27.1% (p ≤ 0.05), 41.7% (p ≤ 0.01), 50.7% (p ≤ 0.01), 69% (p ≤ 0.01), and 84.7% (p ≤ 0.01), respectively, and at the end of the second month of follow-up, by 14.3% (p > 1), 29.2% (p ≤ 0.05), 38% (p ≤ 0.01), 53.5% (p ≤ 0.01), and 72.2% (p ≤ 0.01), respectively. Reduction of neurogenic claudication, regression of sensory deficit, increase of daily step activity, and improvement of quality of life after treatment were noted in intramuscular LTPI subgroups by 19.6% (p ≤ 0.05), 36.4 (p ≤ 0.05), 40.3% (p ≤ 0.01), and 21.0% (p ≤ 0.05), respectively, and in interosseous LTPI subgroups by 48.6% (p ≤ 0.01), 67.4% (p ≤ 0.01), 68.3% (p ≤ 0.01), and 46% (p ≤ 0.01), respectively. Conclusions: LTPI is highly effective in the treatment of patients with residual pain after DLSS decompression surgery. High analgesic effect, significant regression of sensory deficits and gait disorders, and remarkable improvement of daily step activity and quality of life are noted not only after the end of LTPI treatment but also continue for at least 2 months after treatment. Intraosseous LTPI is more effective than intramuscular LTPI by 92%, and LTPI in PSIS is more effective than LTPI in L4-S1 by 28.6%.
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Affiliation(s)
- Mustafa Al-Zamil
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | - Natalia G Kulikova
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, 117198 Moscow, Russia
- Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Natalia A Shnayder
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
- Shared Core Facilities "Molecular and Cell Technologies", Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Natalia B Korchazhkina
- Department of Restorative Medicine and Biomedical Technologies, Federal State Educational Institution of Higher Education, Moscow State Medical and Dental University Named after A.I. Evdokimov, Ministry of Health of Russia, 127473 Moscow, Russia
| | - Marina M Petrova
- Shared Core Facilities "Molecular and Cell Technologies", Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Tatyana I Mansur
- General Medical Practice Department, Medical Institute of PFUR, Peoples' Friendship University of Russia, 117198 Moscow, Russia
| | - Vasilissa V Blinova
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples' Friendship University of Russia, 117198 Moscow, Russia
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia
| | - Zarina M Babochkina
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia
| | - Ekaterina S Vasilyeva
- Department of Restorative Medicine and Biomedical Technologies, Federal State Educational Institution of Higher Education, Moscow State Medical and Dental University Named after A.I. Evdokimov, Ministry of Health of Russia, 127473 Moscow, Russia
| | - Ivan V Zhhelambekov
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia
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Liang CL, Yen CY, Wang HK, Tsai YD, Chye CL, Wang KW. Intramuscular Pulsed Radiofrequency Upregulates BNDF-TrKB Expression in the Spinal Cord in Rats as an Alternative Treatment for Complicated Pain. Int J Mol Sci 2024; 25:7199. [PMID: 39000303 PMCID: PMC11240886 DOI: 10.3390/ijms25137199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Two cases of complicated pain exist: posterior screw fixation and myofascial pain. Intramuscular pulsed radiofrequency (PRF) may be an alternative treatment for such patients. This is a two-stage animal study. In the first stage, two muscle groups and two nerve groups were subdivided into a high-temperature group with PRF at 58 °C and a regular temperature with PRF at 42 °C in rats. In the second stage, two nerve injury groups were subdivided into nerve injury with PRF 42 °C on the sciatic nerve and muscle. Blood and spinal cord samples were collected. In the first stage, the immunohistochemical analysis showed that PRF upregulated brain-derived neurotrophic factor (BDNF) in the spinal cord in both groups of rats. In the second stage, the immunohistochemical analysis showed significant BDNF and tropomyosin receptor kinase B (TrkB) expression within the spinal cord after PRF in muscles and nerves after nerve injury. The blood biomarkers showed a significant increase in BDNF levels. PRF in the muscle in rats could upregulate BDNF-TrkB in the spinal cord, similar to PRF on the sciatica nerve for pain relief in rats. PRF could be considered clinically for patients with complicated pain and this study also demonstrated the role of BDNF in pain modulation. The optimal temperature for PRF was 42 °C.
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Affiliation(s)
- Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Cheng-Yo Yen
- Department of Orthopedic, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan;
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Yu-Duan Tsai
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Cien-Leong Chye
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Kuo-Wei Wang
- Department of Neurosurgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 824005, Taiwan
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Formenton MR, Portier K, Gaspar BR, Gauthier L, Yeng LT, Fantoni DT. Location of Trigger Points in a Group of Police Working Dogs: A Preliminary Study. Animals (Basel) 2023; 13:2836. [PMID: 37760236 PMCID: PMC10526025 DOI: 10.3390/ani13182836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
This study examined the percentage and location of trigger points in police working dogs. Twelve dogs housed at a military police kennel were selected through convenience sampling. Only active dogs with no comorbidities or radiographic changes doing 6 hours of intense physical activity per day were included. After orthopedic and neurological examination, dogs were palpated for the detection of trigger points (TPs), carried out by two independent examiners, with criteria of palpations previously standardized. TPs were recorded using an anatomy reference image according to the corresponding anatomical location. The percentage of TPs was highest in the lumbar portion of the longissimus dorsi muscle (42%), followed by the latissimus dorsi, pectineus, quadriceps femoris, and sartorius (33%) muscles. Most TPs were located on the right side of the body. This study's percentage of TPs in police working dogs was higher in spinal and hind limb muscles, especially on the right side. The major criteria for identifying TPs in dogs were the pain responses to palpation and contractile local response. The findings of this study could be used to refine myofascial pain prevention to reduce early retirement due to musculoskeletal pain and draw attention to this kind of problem that can also affect dogs.
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Affiliation(s)
- Maira Rezende Formenton
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo 05508-270, Brazil; (B.R.G.); (D.T.F.)
| | - Karine Portier
- VetAgro Sup (Campus Vétérinaire), Centre de Recherche et de Formation en Algologie Comparée (CREFAC), University of Lyon, 69280 Marcy l’Etoile, France; (K.P.); (L.G.)
- Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Neurosciences de Lyon (CRNL), University of Lyon, U1028 UMR 5292, Trajectoires, 69500 Bron, France
| | - Beatriz Ribeiro Gaspar
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo 05508-270, Brazil; (B.R.G.); (D.T.F.)
| | - Lisa Gauthier
- VetAgro Sup (Campus Vétérinaire), Centre de Recherche et de Formation en Algologie Comparée (CREFAC), University of Lyon, 69280 Marcy l’Etoile, France; (K.P.); (L.G.)
| | - Lin Tchia Yeng
- School of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo 05403-010, Brazil;
| | - Denise Tabacchi Fantoni
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo 05508-270, Brazil; (B.R.G.); (D.T.F.)
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Afonso J, Carvalho T, Cruz L, Cardoso H. Ultrasound-Guided Electroacupuncture for Thoracic Myofascial Pain Syndrome: A Case Report. Cureus 2023; 15:e36973. [PMID: 37131555 PMCID: PMC10149117 DOI: 10.7759/cureus.36973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
Myofascial pain syndrome is a painful condition characterized by trigger points in muscles that can be treated effectively with acupuncture. While cross-fiber palpation can help localize trigger points, needle accuracy may be limited and accidental puncture of delicate structures, such as the lung, is a risk, as evidenced by reports of pneumothorax after acupuncture. Ultrasound imaging can help in reducing the risk of iatrogenic pneumothorax from needling, but there is a paucity of papers describing the use of ultrasound imaging during acupuncture. We present a report on electroacupuncture treatment for myofascial pain syndrome using real-time ultrasound guidance, aimed at avoiding accidental puncture of the pleura when targeting deep muscle layers in the thoracic region.
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The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review. Semin Arthritis Rheum 2023; 58:152127. [PMID: 36462303 DOI: 10.1016/j.semarthrit.2022.152127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anecdotally, fibromyalgia syndrome (FMS) and connective tissue disorders (hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum disorders (HSD) and Generalized Joint Hypermobility (GJH)) manifest overlap in their diagnostic approach and symptomatic features. Understanding this overlap is important for accurate diagnosis and the success of subsequent management. This study therefore aimed to identify the prevalence of concomitant diagnosis of FMS and hEDS/HSD/GJH in adults and their shared symptomatic manifestations using a systematic review. METHODS MEDLINE (via EBSCO host) was systematically searched. Observational research (case-control or single group) studies were considered for inclusion, where adults screened for hEDS/HSD/GJH and FMS were compared in terms of diagnostic prevalence, and musculoskeletal and non-musculoskeletal manifestations. Studies on pediatric populations were excluded. The quality of the included studies was assessed using the National Institute of Health Quality Assessment of Case-Control Studies and Jonna Briggs Critical Appraisal checklist for prevalence studies. The review was registered prospectively in PROSPERO (CRD42020216283). FINDINGS The review included eleven studies: nine case-control studies and two single group studies. The prevalence of concomitant diagnosis of hEDS/HSD and FMS ranged from 68%-88.9% and from 8.0 to 64.2% for GJH and FMS. The prevalence and severity of a range of objective and patient-reported features were similar between hEDS/HSD and FMS, including joint pain (duration, persistence, SF-36-pain component score); joint swelling; muscle weakness; neurological problems; multidimensional pain inventory-activity; dysautonomia and total autonomic symptoms burden (including orthostatic intolerance, reflex syncope, vasomotor, gastrointestinal, diarrhea, constipation and pupillomotor domains); function; and quality of life. Shared symptomatic features between GJH and FMS were mean pain level, tender points count, total myalgia score and psychological impact. INTERPRETATION There may be overlapping symptomatology and diagnostic prevalence of FMS and hEDS/HSD/GJH. Clinicians should consider both diagnoses to ensure appropriate diagnosis and management.
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Lu F, Ren P, Zhang Q, Shao X. Research Trends of Acupuncture Therapy on Myofascial Pain Syndrome from 2000 to 2022: A Bibliometric Analysis. J Pain Res 2023; 16:1025-1038. [PMID: 36974309 PMCID: PMC10039639 DOI: 10.2147/jpr.s401875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
Background Acupuncture has been widely used to relieve myofascial pain syndromes (MPS) in many countries. However, the bibliometric analysis of the global application of acupuncture for MPS remains unknown. Purpose The present study aims to evaluate the research trends and hot spots of acupuncture for MPS. Methods Literatures about acupuncture for MPS from 2000 to 2022 were obtained from the Web of Science. CiteSpace (6.1.R3) was used to analyze the number of publications, countries, institutions, authors, cited journals, cited authors, cited references and keywords. Results A total of 403 records were included in the final analysis. The total number of publications increased but with some fluctuations. The Pain was the most cited journals. The most productive country and institution were USA, and China Medicine University, respectively. Liwei Chou was the most prolific author, and Simons DG ranked first in the cited author. In the ranking of frequency and centrality in cited references, the first article was published by Tough EA and Simons DG, respectively. The keyword of "acupuncture" ranked first in frequency, "double blind" ranked first in centrality. "Meta-analysis" was the keyword with the strongest citation burst. There were three hot topics in this field, including "the clinical feature of MPS", "measure of intervention" and "research method". The mechanism of acupuncture on MPS was one of the main research directions. Conclusion This study reveals that acupuncture was more and more acceptable, while the cooperation between different countries, institutions and authors should be strengthened. The researches of therapeutic effect and mechanism were the main research directions. More high-quality clinical trials are needed to confirm the therapeutic effect of acupuncture for MPS, and more studies to unify the acupuncture parameters such as frequency, duration, and intensity. More basic studies are needed to elucidate the precise mechanism of acupuncture for MPS.
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Affiliation(s)
- Fengyan Lu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China
| | - Peizhong Ren
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China
| | - Quanai Zhang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China
| | - Xiaomei Shao
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China
- Correspondence: Xiaomei Shao, Email
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Álvarez SD, Velázquez Saornil J, Sánchez Milá Z, Jaén Crespo G, Campón Chekroun A, Barragán Casas JM, Frutos Llanes R, Rodríguez Sanz D. Effectiveness of Dry Needling and Ischemic Trigger Point Compression in the Gluteus Medius in Patients with Non-Specific Low Back Pain: A Randomized Short-Term Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12468. [PMID: 36231767 PMCID: PMC9564974 DOI: 10.3390/ijerph191912468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The presence of latent myofascial trigger points (MTrPs) in the gluteus medius is one of the possible causes of non-specific low back pain. Dry needling (DN) and ischemic compression (IC) techniques may be useful for the treatment of these MTrPs. METHODS For this study, 80 participants were randomly divided into two groups: the dry needling group, who received a single session of DN to the gluteus medius muscle plus hyperalgesia (n = 40), and the IC group, who received a single session of IC to the gluteus medius muscle plus hyperalgesia (n = 40). Pain intensity, the pressure pain threshold (PPT), range of motion (ROM), and quality of life were assessed at baseline, immediately after treatment, after 48 h, and one week after treatment. RESULTS Statistically significant differences were shown between the two groups immediately after the intervention, showing a decrease in PPT (p < 0.05) in the DN group and an increase in PPT in the IC group. These values increased more and were better maintained at 48 h and after one week of treatment in the DN group than in the IC group. Quality of life improved in both groups, with greater improvement in the DN group than in the IC group. CONCLUSIONS IC could be more advisable than DN with respect to UDP and pain intensity in the most hyperalgesic latent MTrPs of the gluteus medius muscle in subjects with non-specific low back pain, immediately after treatment. DN may be more effective than IC in terms of PPT, pain intensity, and quality of life in treating latent plus hyperalgesic gluteus medius muscle MTrPs in subjects with non-specific low back pain after 48 h and after one week of treatment.
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Affiliation(s)
| | | | | | - Gonzalo Jaén Crespo
- Department of Physiotherapy, Universidad Europea de Madrid, 28670 Madrid, Spain
| | | | | | - Raúl Frutos Llanes
- Department of Physiotherapy, Universidad Católica de Ávila, 05005 Ávila, Spain
| | - David Rodríguez Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Liu Q, Huang Q, Liu L, Nguyen TT. Efficacy of Dry Needling Under EMG Guidance for Myofascial Neck and Shoulder Pain: A Randomized Clinical Trial. J Pain Res 2022; 15:2293-2302. [PMID: 35967467 PMCID: PMC9374203 DOI: 10.2147/jpr.s372074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the difference in maintenance of improvement of pain and disability for dry needling (DN) under needle electromyography (EMG) guidance technique in myofascial neck and shoulder pain patients, compared with DN alone. Patients and Methods In this randomized single-blind clinical trial, 30 participants with myofascial pain in the neck and shoulder were randomly allocated to two groups: myofascial trigger points (MTrPs) DN with EMG guided (DN-EMG) group and MTrPs DN without EMG (DN) group. Needling treatment lasted for 2 weeks, twice a week. The primary outcome was pain intensity as assessed by visual analogue scale (VAS) and neck disability index (NDI). A number of mappings referred to pain and spontaneous muscle activity (SEA) were considered secondary outcomes. VAS and NDI were measured before treatment, after 2 weeks of intervention and at 4-, 6- and 12-week follow-up periods after the intervention. Secondary outcomes were assessed before each treatment (T1-T4). Data were analysed using mixed-model analyses of variance (ANOVA) with time as a within-subject variable and groups as between-subject variables followed by Bonferroni's post-hoc test. Results Mixed-model ANOVA revealed significant time-by-group interaction effects (F = 3.49, P = 0.01) for VAS. Post-hoc analysis showed a significant decrease in VAS and NDI after 2 weeks of intervention and at all follow-up periods compared with baseline in both groups (p < 0.01). The DN-EMG group exhibited higher improvements in VAS at 6- and 12-week follow-up period than the DN group (p < 0.05). In the SEA of MTrPs, we found positive sharp waves, fibrillation and fascicular potentials. DN-EMG group exhibited lower amplitudes at T2-T4 and frequencies at T2 and T3. Conclusion DN under needle EMG guidance technique exhibited greater improvements in maintenance of improvement of pain and lower SEA value than the DN group due to sufficient MTrPs inactivation.
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Affiliation(s)
- Qingguang Liu
- International College of Football, Tongji University, Shanghai, People’s Republic of China
| | - Qiangmin Huang
- Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, People’s Republic of China
- Shanghai Ciyuan Rehabilitation Hospital, Sinopharm Healthcare, Shanghai, People’s Republic of China
| | - Lin Liu
- Department of Rehabilitation, School of Sport and Health, Nanjing Sport Institute, Nanjing, People’s Republic of China
| | - Thi-Tham Nguyen
- Faculty of Sport Science, Ton Duc Thang University, Ho Chi Minh City, Vietnam
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The Challenges of Identifying Fibromyalgia in Adolescents. Case Rep Pediatr 2022; 2022:8717818. [PMID: 35433068 PMCID: PMC9012618 DOI: 10.1155/2022/8717818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/05/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Aim Fibromyalgia (FM) is a noninflammatory disorder of the nervous system characterized by widespread musculoskeletal pain and somatic complaints of at least 3 months duration. There are no current diagnostic criteria for fibromyalgia in children to guide clinicians in recognition, thus leading to many subspecialty referrals and extensive imaging and tests. The purpose of this retrospective review is to compare two diagnostic criteria for juvenile fibromyalgia. Methods A retrospective chart review of 20 children diagnosed with juvenile fibromyalgia from a singular pain physician practice was performed. Both the Yunus diagnostic criteria and the 2016 American College of Rheumatology (ACR) diagnostic criteria were applied and compared. Results 85% of patients met criteria for fibromyalgia under both criteria. 15% of patients met only ACR criteria as the Yunus criteria excluded those with underlying conditions. Of the children who fulfilled criteria with use of both diagnostic tools, this cohort reported a high somatic symptom burden as demonstrated by the ACR symptom severity scales of 12 and satisfaction of at least 4 Yunus and Masi minor criteria on average. Widespread pain was noted with an ACR Widespread Pain Index (WPI) of 7, and tender points were 4.8 on average across the cohort. Effective therapeutic regimens among patients varied widely from medical monotherapy to multimodal treatment. Patients presented with pain for 1.8 yrs on average prior to a diagnosis. All of the cohort had a normal laboratory evaluation; half the cohort received additional imaging and testing. Conclusion This case series suggests the need for an updated diagnostic tool for pediatric fibromyalgia to facilitate recognition and treatment.
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Weiss K, Kalichman L. Deep fascia as a potential source of pain: A narrative review. J Bodyw Mov Ther 2021; 28:82-86. [PMID: 34776204 DOI: 10.1016/j.jbmt.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/24/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The fascial component of the myofascial pain syndrome and the contribution of the deep fascia to various painful conditions has not been well-described and is still less understood. OBJECTIVES The aims of this study were to evaluate the possible role of the deep fascia on musculoskeletal pain, focusing on findings from histological and experimental studies; and to assess the nociceptive and associated responses of the deep fascia to experimentally-induced irritation. METHODS Narrative review of the English scientific literature. RESULTS AND CONCLUSIONS Different components of the deep fascia, both in humans and animals are richly innervated, with some differences between body segments. These fascial components usually exhibit dense innervation, encompassing amongst others, nociceptive afferents. The application of different types of stimuli, i.e., electrical, mechanical, and chemical to these fascial components produces long-lasting pain responses. In some cases, the intensity and severity of pain produced by the stimulation of fascia were higher than ones produced by the stimulation of the related muscular tissue. These observations may denote that the deep fascia and its various components could be a source of pain in different pathologies and various pain syndromes.
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Affiliation(s)
- Kobi Weiss
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial. J Clin Med 2021; 10:jcm10194434. [PMID: 34640451 PMCID: PMC8509591 DOI: 10.3390/jcm10194434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 h later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusions: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice.
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Montero Navarro S, Del Rio Medina S, Martín Botella Rico J, Isabel Rocha Ortiz M, Teresa Pérez Gracia M. Analysis and comparison of pain pressure threshold and active cervical range of motion after superficial and deep dry needling techniques of the upper trapezius muscle. Acupunct Med 2021; 40:13-23. [PMID: 34553614 DOI: 10.1177/09645284211039523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the changes in pain pressure threshold (PPT) and active cervical range of motion (ACROM) after the application of superficial dry needling (DN) or deep DN in myofascial trigger point (MTrP) 1 of the upper trapezius versus a simulated DN technique in the gastrocnemius muscle (control group). DESIGN Double-blind, randomized controlled trial with 7-day follow-up. PARTICIPANTS Asymptomatic volunteers (n = 180; 76 men, 104 women) with a latent MTrP 1 in the upper trapezius were randomly divided into three groups: G1, receiving superficial DN in the upper trapezius; G2, receiving deep DN in the upper trapezius; and G3, control group, receiving simulated DN technique in the gastrocnemius muscle. MAIN OUTCOME MEASURES While sitting in a chair, each subject underwent measurements of PPT and ACROM (ipsilateral and contralateral side flexion and rotation, flexion and extension) preintervention, (immediately) postintervention, and at 24 h, 72 h and 7 days. RESULTS Superficial and deep DN produced an increase in PPT at 7 days with respect to preintervention levels. Furthermore, superficial and deep DN produced a decrease in cervical flexion at 24 h and an increase in ipsilateral rotation until 72 h, increasing to 7 days in the case of deep DN. On the contrary, superficial DN produced an increase in ipsilateral and contralateral side flexion after intervention, unlike deep DN that produced a decrease at 24 h. Furthermore, superficial DN produced an increase in contralateral rotation at 24 h and deep DN decreased extension at 72 h. CONCLUSION A single intervention of superficial or deep DN did not produce statistically significant changes in PPT or goniometry measurements.Trial registration number: NCT03719352 (ClinicalTrials.gov).
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Affiliation(s)
- Sergio Montero Navarro
- Department of Physiotherapy, Health Science Faculty, CEU-Universidad Cardenal Herrera, Elche, Spain
| | - Sonia Del Rio Medina
- Department of Physiotherapy, Health Science Faculty, CEU-Universidad Cardenal Herrera, Elche, Spain
| | - José Martín Botella Rico
- Department of Physiotherapy, Health Science Faculty, CEU-Universidad Cardenal Herrera, Elche, Spain
| | - María Isabel Rocha Ortiz
- Department of Physiotherapy, Health Science Faculty, CEU-Universidad Cardenal Herrera, Elche, Spain
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Peterson E, Finkel J. Trigger point injections for axial back pain in adolescents. BMJ Case Rep 2021; 14:e242727. [PMID: 34167984 PMCID: PMC8231043 DOI: 10.1136/bcr-2021-242727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/04/2022] Open
Abstract
Adolescents who participate in athletics or have abnormal musculoskeletal anatomy have higher incidences of back pain than non-athletic peers with normal anatomy. Significant time and money spent in diagnostic evaluations for axial back pain can result in treatment delay causing a subsequent decrease in quality of life. Myofascial trigger points are a commonly overlooked reason for axial back pain. They develop due to an abnormal myoneural connection in the setting of muscle overuse. Trigger point injections are a technically simple intervention that is both diagnostic and therapeutic in alleviating trigger point-mediated back pain. There are few complications from these injections, and they should be considered prior to surgical referral or fluoroscopic-guided interventions.
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Affiliation(s)
- Elisha Peterson
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Julia Finkel
- Pain Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Hospital, Pediatrics and Critical Care Medicine, The George Washington University, Washington, District of Columbia, USA
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Kim JB, Chang MC. Spinal cord injury by direct damage during trigger point injection: a case report. J Int Med Res 2021; 49:3000605211012367. [PMID: 33942634 PMCID: PMC8113941 DOI: 10.1177/03000605211012367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trigger point injection (TPI) is commonly administered for myofascial pain
syndrome management, but occasionally leads to complications, including
bleeding, muscle hematoma, vasovagal syncope, skin infections, and pneumothorax.
This report presents a case of TPI-induced iatrogenic spinal cord injury (SCI).
A 59-year-old woman received TPI for myofascial pain on both thoracolumbar
paraspinal muscles. She experienced an electric shock sensation throughout the
lower extremities upon receiving blind TPI in the left thoracolumbar paraspinal
muscle, and later complained of weakness (manual muscle test grade: 0–2) and
neuropathic pain (numeric rating scale [NRS]: 7) in the lower left extremity.
Thoracolumbar magnetic resonance imaging (MRI) 3 days after the TPI revealed a
high-intensity T2 signal in the left T12 to L2 spinal cord segments, indicating
the presence of edema or inflammation in this region. In concordance with the
MRI findings, electrophysiological recordings performed 11 days after the TPI
revealed no central motor conduction time response in the left leg. At 7 months
post-onset, the patient had partially recovered motor function and neuropathic
pain was reduced to NRS 4. Clinicians should be aware of the possibility of
needle-induced SCI during paraspinal muscle TPI; imaging guidance may be helpful
for accurate needle targeting during the procedure.
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Affiliation(s)
- Jong Bum Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
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Buttagat V, Muenpan K, Wiriyasakunphan W, Pomsuwan S, Kluayhomthong S, Areeudomwong P. A comparative study of Thai massage and muscle energy technique for chronic neck pain: A single-blinded randomized clinical trial. J Bodyw Mov Ther 2021; 27:647-653. [PMID: 34391301 DOI: 10.1016/j.jbmt.2021.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/13/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Myofascial pain syndrome (MPS) is the most common form of muscle disorders. Traditional Thai massage (TM) and muscle energy (ME) technique have been used to treat patients with MPS for long time but head-to-head comparisons of these interventions have not been established. AIM The aim of the current study was to compare the effects of TM and the ME technique on pain intensity (PI), pressure pain threshold (PPT), neck disability (ND), and neck flexion range of motion (NFROM) in patients with chronic neck pain associated with myofascial trigger points (MTrPs). DESIGN A randomized, single-blinded clinical trial. SETTING Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University. POPULATION Forty-five patients with chronic neck pain associated with MTrPs were recruited. METHODS The patients were randomly allocated to the TM, ME, or control groups, with each having eight treatment sessions over a period of two weeks. PI, PPT, ND, and NFROM were assessed before, immediately after the first treatment session, and one day after the last treatment session. RESULTS Based on the results, both TM and the ME technique resulted in a significant improvement in all parameters (p < 0.05) compared to the control group. Additionally, no significant difference was observed between TM and the ME technique in all parameters. CONCLUSIONS The application of TM or the ME technique can be a practical alternative approach for the treatment of chronic neck pain associated with MTrPs.
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Affiliation(s)
- Vitsarut Buttagat
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand.
| | - Kanokwan Muenpan
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Witawit Wiriyasakunphan
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Saowalak Pomsuwan
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Sujittra Kluayhomthong
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Pattanasin Areeudomwong
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
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Frederice CP, Brito LGO, Pereira GMV, Lunardi ALB, Juliato CRT. Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis. Int Urogynecol J 2021; 32:1087-1096. [PMID: 33640993 DOI: 10.1007/s00192-021-04725-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Female myofascial pain (MFP) of the pelvic floor muscles (PFM) is a subtype of chronic pelvic pain associated with urinary, anorectal, and sexual symptoms, such as dyspareunia. Treatment remains poorly discussed, and we hypothesized that different treatments could improve outcomes versus placebo or no treatment. METHODS A systematic review (CRD 42020201419) was performed in June 2020 using the following databases: PubMed, Cochrane Library, Web of Science, Embase, Scopus, BVSalud, Clinicaltrials.gov , and PEDro, including randomized clinical trials related to MPF of PFM. Primary outcome was pain after treatment, and secondary outcomes were quality of life and sexual function. Risk of bias and quality of evidence (GRADE criteria) were evaluated. Meta-analysis for continuous variables was performed (mean difference between baseline and treatment and post-treatment mean between groups). RESULTS Five studies were included (n = 218). Final mean VAS score (GRADE: very low) after 4 weeks of treatment (p = 0.14) and the mean difference from baseline and 4 weeks (p = 0.66) between groups were not different between the intervention and control groups. Quality of life according to the SF-12 questionnaire (GRADE: very low) followed the same pattern. However, sexual function (GRADE: low) according to the total FSFI score (MD = -5.07 [-8.31, -1.84], p < 0.01, i2 = 0%) and the arousal, orgasm, and pain domains improved in the intervention groups when the mean difference from baseline and 4 weeks was compared with controls. CONCLUSION Pain and quality of life after 4 weeks of heterogeneous intervention differed between the intervention and control groups in sexual function: FSFI in studies improved in almost all domains. VAS (in three studies) and SF-12 (in two studies) failed to demonstrate differences.
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Affiliation(s)
- Claudia Pignatti Frederice
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, Brazil.,Department of Physiotherapy, Unimetrocamp University Center, Campinas, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, Brazil
| | - Glaucia Miranda Varella Pereira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, Brazil
| | | | - Cássia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, Brazil.
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Benito-de-Pedro M, Becerro-de-Bengoa-Vallejo R, Elena Losa-Iglesias M, Rodríguez-Sanz D, López-López D, Palomo-López P, Mazoteras-Pardo V, Calvo-Lobo AC. Effectiveness of Deep Dry Needling vs Ischemic Compression in the Latent Myofascial Trigger Points of the Shortened Triceps Surae from Triathletes on Ankle Dorsiflexion, Dynamic, and Static Plantar Pressure Distribution: A Clinical Trial. PAIN MEDICINE 2021; 21:e172-e181. [PMID: 31502640 DOI: 10.1093/pm/pnz222] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the immediate efficacy of a single session of deep dry needling (DDN) vs ischemic compression (ICT) in a latent myofascial trigger point (MTrP) of the shortened triceps surae from triathletes for ankle dorsiflexion and redistribution of plantar pressures and stability. DESIGN A randomized simple blind clinical trial (NCT03273985). SETTING An outpatient clinic. SUBJECTS Thirty-four triathletes with a latent MTrP in the shortened gastrocnemius. METHODS Triathletes were randomized to receive a single session of DDN (N = 17) or ICT (N = 17) in a latent MTrP of the shortened triceps surae. The primary outcome was ankle dorsiflexion range of motion (ROM) by a universal goniometer. Secondary objectives were distribution of dynamic and static plantar pressures by T-Plate platform pressure, with measurements both before and after five, 10, 15, 20, and 25 minutes of treatment. RESULTS There were no statistically significant differences (P > 0.05) for ankle dorsiflexion ROM or dynamic and static plantar pressures between the experimental group treated with DDN and the control group treated with ICT before and after treatment. CONCLUSIONS DDN vs ICT carried out in latent MTrPs of the shortened gastrocnemius of triathletes did not present differences in terms of dorsiflexion ROM of the tibiofibular-talar joint or in static and dynamic plantar pressure changes before and immediately after treatment.
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Affiliation(s)
- María Benito-de-Pedro
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences. Faculty of Nursing and Podiatry, Universidade da Coruña, Coruña, Spain
| | - Patricia Palomo-López
- Department of Nursing, University Center of Plasencia, University of Extremadura, Extremadura, Spain
| | - Victoria Mazoteras-Pardo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - And César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
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18
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Salik E, Donat A, Ağaoğlu MH. Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report. J Chiropr Med 2021; 19:249-259. [PMID: 33536862 DOI: 10.1016/j.jcm.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 09/20/2019] [Accepted: 01/29/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of the present study objective was to describe adjacent segment disease (ASD) from a chiropractic management prospective and subsequently to stimulate further research into the chiropractic therapeutic effects on such cases and to contribute to chiropractic literature. Clinical Features A 44-year-old woman had a history of lumbar stabilization revision operation by pedicle screw fixation for spondylolisthesis. Her intractable back pain episodes, which were diagnosed as ASD, began shortly after this surgery. At presentation, she was taking pregabalin 75 mg 2 times a day for postoperative neuropathic pain without any pain relief. Clinical testing revealed myofascial tender points reproducing the pain. Intervention and Outcome After taking the case history and performing a physical examination, the patient was managed with chiropractic Nimmo receptor-tonus technique in combination with McKenzie exercises. Nimmo was applied by manually pressing on clinically relevant points for 5 to 15 seconds in 11 visits over 3 weeks. The patient by herself did McKenzie exercises 5 to 10 times a day for 10 to 12 repetitions over 2 months. After 3 weeks of therapy, visual analog scale and Oswestry Disability Index scores were improved. Furthermore, because of the amelioration of the patient's symptoms, her neurosurgeon successfully discontinued pregabalin 75 mg 2 times a day without negative consequences to care. Conclusion As far as the authors are aware, there is currently no published case of ASD care in chiropractic literature. Our rehabilitative management received a favorable response. It can be hypothesized that it offers a perspective that informs improved patient care.
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Affiliation(s)
- Emsal Salik
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Ali Donat
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Mustafa Hulisi Ağaoğlu
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
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19
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Zmyślna A, Żurawski AŁ, Śliwiński G, Śliwiński ZW, Kiebzak WP. Assessment of Body Posture of Children With Chest Pain. Front Pediatr 2021; 9:704087. [PMID: 34485195 PMCID: PMC8416038 DOI: 10.3389/fped.2021.704087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: An increase in the appearance of chest pain among children is observed globally. The authors present various reasons for their appearance. As can be seen from numerous observations, the majority of cases are not related to the pathology of the circulatory system. Increasingly, studies on the causes of chest pain in children show their association with musculoskeletal disorders. Aim: of the work was assessment of body posture in children with chest pain using the Diers Formetric 4D system. Methods: The study involved a group of 184 female and male children, aged 7-12 years. The study group consisted of 64 patients with chest pain. The children from this group were diagnosed with functional chest pain by a cardiologist. The control group consisted of 120 patients without chest pain. The study included the assessment of body posture using the DIERS Formetric system. Results: The analysis of the results obtained during the study showed that among the children with chest pain, there are statistically significant irregularities in the parameters determining body posture compared to the control group. Comparing the study group with the control group, there is a statistically significant difference in the lateral deviation of VPDM (rms) (mm) (p = 0.001). Both children from the test group aged 9-10 and 11-12 obtained higher results than their peers from the control group. In the group of the youngest children in terms of the lateral deviation of VPDM (rms) (mm), increasing the number of children under study would contribute to significant differences in this variable. In the study group, among children aged 9-10 years, there were also statistically significant abnormalities regarding trunk imbalance and pelvic skewness compared to the children of the same age in the control group. Conclusions: Irregularities in the parameters determining body posture may cause chest pain in children.
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Affiliation(s)
- Anna Zmyślna
- Collegium Medicum, Department of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Centre for Pediatrics, Regional Hospital in Kielce, Kielce, Poland
| | - Arkadiusz Łukasz Żurawski
- Collegium Medicum, Department of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Centre for Pediatrics, Regional Hospital in Kielce, Kielce, Poland
| | - Grzegorz Śliwiński
- Faculty of Electrical and Computer Engineering, Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | | | - Wojciech Piotr Kiebzak
- Collegium Medicum, Department of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Centre for Pediatrics, Regional Hospital in Kielce, Kielce, Poland
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El Sharnoby AFES, Sultan HAM, Saba EKA. Spinal accessory neuropathy in patients with chronic trapezius myofascial pain syndrome. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Myofascial pain syndrome is a common musculoskeletal problem affecting the trapezius muscle. The aim was to assess the presence of spinal accessory neuropathy in patients with unilateral chronic trapezius myofascial pain syndrome.
Results
The study included 25 patients with unilateral chronic trapezius myofascial pain syndrome and 20 apparently healthy volunteers as the control group. There was a significantly delayed spinal accessory nerve latency on the symptomatic side in comparison to either asymptomatic side (P = 0.014) and control group (P = 0.001). Compound muscle action potential amplitude did not significantly differ between the symptomatic side versus the asymptomatic side and control group. Delayed spinal accessory nerve latency was present in seven patients (28%) and reduced compound muscle action potential amplitude in one of them (4%). The needle electromyography of the upper trapezius muscle revealed neuropathic motor units and incomplete interference pattern in the patient who showed reduced compound muscle action potential amplitude. Abnormal rest potentials were absent in all patients. Individually, seven patients (28%) had electrophysiological evidence of spinal accessory neuropathy, but only one (4%) of them had clinical evidence of spinal accessory neuropathy. Patients with abnormal electrophysiological findings had longer duration of complaint and more severe pain.
Conclusions
Spinal accessory neuropathy is common among patients with chronic trapezius myofascial pain syndrome. It could contribute to increased pain severity of myofascial pain syndrome. Electrodiagnosis is a good modality for identifying subclinical spinal accessory neuropathy.
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Eftekharsadat B, Fasaie N, Golalizadeh D, Babaei-Ghazani A, Jahanjou F, Eslampoor Y, Dolatkhah N. Comparison of efficacy of corticosteroid injection versus extracorporeal shock wave therapy on inferior trigger points in the quadratus lumborum muscle: a randomized clinical trial. BMC Musculoskelet Disord 2020; 21:695. [PMID: 33076888 PMCID: PMC7574569 DOI: 10.1186/s12891-020-03714-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/13/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In this study, we aimed to compare the efficacy of corticosteroid trigger point injection (TPI) versus extracorporeal shock wave therapy (ESWT) on inferior trigger points in the quadratus lumborum (QL) muscle. METHODS In this single-blind randomized clinical trial, 54 low back pain patients with myofascial trigger points on QL muscle were investigated. Participants were randomly allocated into two groups with A and B pockets. Patients in group A underwent radial ESWT and received 5 treatment sessions (1 per week) and actually were not followed-up. However, patients in group B received corticosteroid TPI and received one session of corticosteroid treatment and followed-up for 4 weeks after injection. Oswestry Disability Index (ODI), visual analogue scale (VAS), pain pressure threshold (PPT) and short form (36) health survey (SF-36) were measured in both groups before, two weeks after and four weeks after intervention. RESULTS The between group comparison indicated that corticosteroid TPI leaded to significant higher improvements of ODI (P-value< 0.01), VAS (P value< 0.001), and PPT (P-value = 0.001) scores compared to the ESWT group at two-week follow-up time-point. ESWT group recorded significant higher improvement of ODI (P-value< 0.01) and SF-36 (P-value< 0.001) compared to the corticosteroid TPI at 4th week post treatment evaluation. At four-week follow-up time-point, the patients in the ESWT group were 1.46 times more likely to achieve 30% reduction in VAS, 2.67 times more likely to achieve 30% reduction in ODI, and 2.30 times more likely to achieve 20% improvement in SF-36 compared to the participants in corticosteroid TPI group. These results refer to large effect size for all study outcomes in ESWT group (d = 4.72, d = 1.58, d = 5.48, and d = 7.47 for ODI, PPT, SF-36, and VAS, respectively). CONCLUSION Corticosteroid TPI was more effective compared to ESWT in short-term controlling of pain and disability caused by myofascial pain syndrome of QL muscle. However, after 4 weeks treatment, ESWT further improved the quality of life and disability and was related with more probability of achievement the minimal clinically important difference concerning pain, disability and quality of life and large effect size for all study outcomes in treated patients compared to corticosteroid TPI. TRIAL REGISTRATION www.irct.ir , IRCT20100827004641N14 , retrospectively registered 2019-01-19.
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Affiliation(s)
- Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negar Fasaie
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dina Golalizadeh
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Babaei-Ghazani
- Neuromusculoskeletal Research Center, Department of physical medicine and rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | | | - Yashar Eslampoor
- Palliative Care Medicine Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Kohli D, Thomas DC. Orofacial pain: Time to see beyond the teeth. J Am Dent Assoc 2020; 152:954-961. [PMID: 32950209 DOI: 10.1016/j.adaj.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
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Developing Improved Translational Models of Pain: A Role for the Behavioral Scientist. Perspect Behav Sci 2020; 43:39-55. [PMID: 32440644 DOI: 10.1007/s40614-019-00239-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The effective management of pain is a longstanding public health concern. Although opioids have been frontline analgesics for decades, they also have well-known undesirable effects that limit their clinical utility, such as abuse liability and respiratory depression. The failure to develop better analgesics has, in some ways, contributed to the escalating opioid epidemic that has claimed tens of thousands of lives and has cost hundreds of billions of dollars in health-care expenses. A paradigm shift is needed in the pharmacotherapy of pain management that will require extensive efforts throughout biomedical science. The purpose of the present review is to highlight the critical role of the behavioral scientist to devise improved translational models of pain for drug development. Despite high heterogeneity of painful conditions that involve cortical-dependent pain processing, current models often feature an overreliance on simple reflex-based measures and an emphasis on the absence, rather than presence, of behavior as evidence of analgesic efficacy. Novel approaches should focus on the restoration of operant and other CNS-mediated behavior under painful conditions.
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Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process. J Manipulative Physiol Ther 2019; 42:677-693. [PMID: 31864769 DOI: 10.1016/j.jmpt.2019.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities. METHODS A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range. RESULTS Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool. CONCLUSION This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.
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Vining RD, Shannon ZK, Minkalis AL, Twist EJ. Current Evidence for Diagnosis of Common Conditions Causing Low Back Pain: Systematic Review and Standardized Terminology Recommendations. J Manipulative Physiol Ther 2019; 42:651-664. [PMID: 31870637 DOI: 10.1016/j.jmpt.2019.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to evaluate and summarize current evidence for diagnosis of common conditions causing low back pain and to propose standardized terminology use. METHODS A systematic review of the scientific literature was conducted from inception through December 2018. Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane, and Index to Chiropractic Literature. Methodological quality was assessed with the Scottish Intercollegiate Guidelines Network checklists. RESULTS Of the 3995 articles screened, 36 (8 systematic reviews and 28 individual studies) met final eligibility criteria. Diagnostic criteria for identifying likely discogenic, sacroiliac joint, and zygapophyseal (facet) joint pain are supported by clinical studies using injection-confirmed tissue provocation or anesthetic procedures. Diagnostic criteria for myofascial pain, sensitization (central and peripheral), and radicular pain are supported by expert consensus-level evidence. Criteria for radiculopathy and neurogenic claudication are supported by studies using combined expert-level consensus and imaging findings. CONCLUSION The absence of high-quality, objective, gold-standard diagnostic methods limits the accuracy of current evidence-based criteria and results in few high-quality studies with a low risk of bias in patient selection and reference standard diagnosis. These limitations suggest practitioners should use evidence-based criteria to inform working diagnoses rather than definitive diagnoses for low back pain. To avoid the unnecessary complexity and confusion created by multiple overlapping and nonspecific terms, adopting International Association for the Study of Pain terminology and definitions is recommended.
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Affiliation(s)
- Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
| | - Zacariah K Shannon
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Amy L Minkalis
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Elissa J Twist
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
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Benito-de-Pedro M, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, López-López D, Cosín-Matamoros J, Martínez-Jiménez EM, Calvo-Lobo C. Effectiveness between Dry Needling and Ischemic Compression in the Triceps Surae Latent Myofascial Trigger Points of Triathletes on Pressure Pain Threshold and Thermography: A Single Blinded Randomized Clinical Trial. J Clin Med 2019; 8:E1632. [PMID: 31590390 PMCID: PMC6832626 DOI: 10.3390/jcm8101632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/28/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Deep dry needling (DDN) and ischemic compression technic (ICT) may be considered as interventions used for the treatment of Myofascial Pain Syndrome (MPS) in latent myofascial trigger points (MTrPs). The immediate effectiveness of both DDN and ICT on pressure pain threshold (PPT) and skin temperature of the latent MTrPs of the triceps surae has not yet been determined, especially in athletes due to their treatment requirements during training and competition. OBJECTIVE To compare the immediate efficacy between DDN and ICT in the latent MTrPs of triathletes considering PPT and thermography measurements. METHOD A total sample of 34 triathletes was divided into two groups: DDN and ICT. The triathletes only received a treatment session of DDN (n = 17) or ICT (n = 17). PPT and skin temperature of the selected latent MTrPs were assessed before and after treatment. RESULTS Statistically significant differences between both groups were shown after treatment, showing a PPT reduction (p < 0.05) in the DDN group, while PPT values were maintained in the ICT group. There were not statistically significant differences (p > 0.05) for thermographic values before and treatment for both interventions. CONCLUSIONS Findings of this study suggested that ICT could be more advisable than DDN regarding latent MTrPs local mechanosensitivity immediately after treatment due to the requirements of training and competition in athletes' population. Nevertheless, further studies comparing both interventions in the long term should be carried out in this specific population due to the possible influence of delayed onset muscle soreness and muscle damage on PPT and thermography values secondary to the high level of training and competition.
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Affiliation(s)
- María Benito-de-Pedro
- Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid, Madrid 28040 Spain.
| | | | | | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid, Madrid 28040 Spain.
| | - Daniel López-López
- Research, Health and Podiatry Unit. Department of Health Sciences. Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol 15403, Spain.
| | - Julia Cosín-Matamoros
- Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid, Madrid 28040 Spain.
| | - Eva María Martínez-Jiménez
- Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid, Madrid 28040 Spain.
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid, Madrid 28040 Spain.
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Roldan CJ, Osuagwu U, Cardenas-Turanzas M, Huh BK. Normal Saline Trigger Point Injections vs Conventional Active Drug Mix for Myofascial Pain Syndromes. Am J Emerg Med 2019; 38:311-316. [PMID: 31477359 DOI: 10.1016/j.ajem.2019.158410] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) originates in the muscle and fascia. MPS presents with referred pain specific for each muscle and a trigger point that reproduces the symptoms. Trigger-point-injection (TPI) is an effective approach to treating MPS. Some TPI agents, however, are associated with systemic and local side effects. OBJECTIVE The aim of this study was to evaluate the effectiveness of TPI with a conventional active drug mixture (CADM) vs. that with normal saline solution (NS) alone in patients with MPS presenting to the emergency department (ED). METHODS Adults with MPS diagnosed in the ED, participants were randomly assigned to receive TPI with NS or with CADM. Pain intensity was scored using a 0-10 numeric rating scale prior to and after TPI, before discharge and 2 weeks after TPI. RESULTS Among 48 patients analyzed, 23 received TPI with NS. The mean pain scores were as follows: immediately before TPI, 7.59 (NS) and 7.44 (CADM); immediately after TPI, 2.22 (NS) and 1.76 (CADM); prior to discharge, 1.52 (NS) and 1.76 (CADM). At 2-week follow up, the mean pain scores were 4.29 (NS) and 4.14 (CADM). Pain was significantly reduced after TPI in both groups. At 2 weeks, the mean pain scores were similar between the groups. No adverse events were reported. CONCLUSION In cases of MPS in the ED, pain can be controlled with TPI independent of the injectate. TPI with NS may be preferred over CADM because of its lower cost and more favorable side effect profile.
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Affiliation(s)
- Carlos J Roldan
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
| | - Uzondu Osuagwu
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marylou Cardenas-Turanzas
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Billy K Huh
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sukareechai C, Sukareechai S. Comparison of radial shockwave and dry needling therapies in the treatment of myofascial pain syndrome. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2016.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Myofascial pain syndrome is a frequent problem in the musculoskeletal system. As a method of treatment for myofascial pain syndrome, dry needling therapy is an effective and convenient treatment for patients because they do not need to be treated every day. However, as patients often have post-needle soreness or some patients are afraid of needles, there are limitations to this treatment. The purpose of this study is to compare the effectiveness of radial shockwave therapy with dry needling therapy to treat myofascial pain. Methods A total of 42 patients attending the rehabilitation department with at least one myofascial pain trigger point in their upper back muscles, were randomly assigned to receive radial shockwave therapy or dry needling therapy. Treatment was performed once a week for 3 weeks in both groups. Participants' pain pressure threshold, measured using an algometer, and pain levels, measured using a numeric pain scale, were assessed before the designated treatment was applied each week. Each patient also performed upper trapezius, rhomboid and infraspinatus muscle stretches twice a day throughout the study period. Results There was no difference in pain pressure threshold at the three trigger points before treatment with the different modalities commenced. At the end of the study, the radial shockwave therapy group had a significant improvement in trapezius pain pressure threshold, increasing from 11.7 at baseline to 14.8 at the end of study. There was no significant between-group difference in pain level (P=3.4 vs P=2.6) at the end of the study. Both treatments significantly reduced pain levels: from 7.2 to 3.4 in the radial shockwave group (P<0.001) and from 6.8 to 2.6 in the dry needling therapy group (P<0.001). Conclusions Dry needling and radial shock wave therapies are effective in reducing myofascial pain syndrome originating in the upper back muscles. Participants' pain pressure threshold increased after 3 weeks of treatment with both therapies. Radial shock therapy can be used as an alternative to dry needling in the treatment of myofascial pain syndrome in patients who have trouble attending daily physical therapy or in whom dry needling therapy is contraindicated.
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Affiliation(s)
- Chomkajee Sukareechai
- Lecturer, Department of Rehabilitation, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Somchai Sukareechai
- Lecturer, Department of Rehabilitation, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
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Reversible tactile hypoesthesia associated with myofascial trigger points: a pilot study on prevalence and clinical implications. Pain Rep 2019; 4:e772. [PMID: 31579863 PMCID: PMC6727998 DOI: 10.1097/pr9.0000000000000772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/15/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Tactile hypoesthesia observed in patients with myofascial pain syndrome (MPS) is sometimes reversible when pain is relieved by trigger point injections (TPIs). We aimed to investigate the prevalence of such reversible hypoesthesia during TPI therapy and topographical relations between areas of tactile hypoesthesia and myofascial trigger points (MTrP) in patients with MPS. Methods: Forty-six consecutive patients with MTrP were enrolled in this study. We closely observed changes in areas of tactile hypoesthesia in patients who had tactile hypoesthesia at the first visit, and throughout TPI therapy. Tactile stimulation was given using cotton swabs, and the areas of tactile hypoesthesia were delineated with an aqueous marker and recorded in photographs. Results: A reduction in the size of hypoesthetic area with TPI was observed in 27 (58.7%) patients. All the 27 patients experienced a reduction in pain intensity by more than 50% in a numerical rating scale score through TPI therapy. In 9 patients, the reduction in the sizes of hypoesthetic areas occurred 10 minutes after TPI. Complete disappearance of tactile hypoesthesia after TPI therapy was observed in 6 of the 27 patients. Myofascial trigger points were located in the muscles in the vicinity of ipsilateral cutaneous dermatomes to which the hypoesthetic areas belonged. Conclusion: Our results indicate a relatively high prevalence of reversible tactile hypoesthesia in patients with MPS. Mapping of tactile hypoesthetic areas seems clinically useful for detecting MTrP. In addition, treating MTrP with TPI may be important for distinguishing tactile hypoesthesia associated with MPS from that with neuropathic pain.
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High-Energy Flux Density Extracorporeal Shock Wave Therapy Versus Traditional Physical Therapy Modalities in Myofascial Pain Syndrome: A Randomized-controlled, Single-Blind Trial. Arch Rheumatol 2019; 35:78-89. [PMID: 32637923 DOI: 10.5606/archrheumatol.2020.7496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/21/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effects of extracorporeal shock wave therapy (ESWT) on pain, sleep, fatigue, disability, depression, and quality of life (QoL) in patients with myofascial pain syndrome (MPS). Patients and methods Between March 2018 and September 2018, a total of 94 patients (16 males, 78 females; mean age 44.2±11.94 years; range, 19 to 74 years) with the diagnosis of MPS were included in the study. The patients were divided into two groups. The treatment group consisted of 49 patients and a total of seven sessions of high-energy flux density ESWT (H-ESWT) (0.26 mJ/mm2) were given with three days interval. The control group consisted of 45 patients and the treatment of hot pack, transcutaneous electrical nerve stimulation, and ultrasound was given for five days for two weeks. At baseline and one month after treatment, the visual analog scale (VAS), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, Neck Disability Index (NDI), and Beck Depression Inventory (BDI) scores were compared between the groups. Results There were no statistically significant differences in the age, sex, demographic characteristics, and baseline VAS, SF-36, NDI, BDI, FACIT, and PSQI scores between the groups (p>0.05). In the ESWT group, there was a statistically significant decrease in the VAS, SF-36, NDI, BDI, FACIT, and PSQI scores after treatment compared to the baseline scores, while only the SF-36 subscale scores were statistically significantly higher (p<0.05). There was a statistically significant correlation between the VAS and SF-36 scores and the BDI, NDI, FACIT and PSQI scores after the treatment. Conclusion Our study results suggest that H-ESWT is more effective than traditional physical therapy methods on pain, QoL, sleep, fatigue, depression, and disability in patients with MPS.
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Minerbi A, Brill S, Dayan L, Vulfsons S, Hochberg U. Letter to the Editor: A survey on the position of Israeli pain specialists on the adequate diagnosis and treatment of myofascial pain. J Bodyw Mov Ther 2019; 23:441-442. [PMID: 31563349 DOI: 10.1016/j.jbmt.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Amir Minerbi
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Department of Anesthesia and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Dayan
- Institute of Pain Medicine, Department of Anesthesia and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simon Vulfsons
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Uri Hochberg
- Institute of Pain Medicine, Department of Anesthesia and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Denneny D, Frawley HC, Petersen K, McLoughlin R, Brook S, Hassan S, Williams AC. Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 100:562-577. [DOI: 10.1016/j.apmr.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
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Transcutaneous Electrical Nerve Stimulation on Acupuncture Points Improves Myofascial Pain, Moods, and Sleep Quality. Rehabil Nurs 2019; 45:225-233. [PMID: 30694996 DOI: 10.1097/rnj.0000000000000198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of transcutaneous electrical nerve stimulation at acupuncture points versus trigger points on myofascial pain, moods, and sleep quality. DESIGN A randomized controlled study recruited 64 patients with spinal cord injury with myofascial pain. METHODS Outcomes of pain, moods, and sleep quality were measured and analyzed by the generalized estimation equation, analysis of covariance, and paired t test. Transcutaneous electrical nerve stimulation was applied for seven consecutive days at Hegu (LI4) and Daling (PC7) acupuncture points or myofascial trigger points. FINDING Significant differences were found in pain intensity from Day 3 forward, after controlling for confounders. Significant within-group differences were found in pain, moods, and sleep quality. CONCLUSIONS Transcutaneous electrical nerve stimulation at acupuncture and trigger points effectively improved pain, moods, and sleep quality in patients with spinal cord injury with myofascial pain. Acupuncture points had superior improvement in pain intensity and slight improvement in sleep quality than did trigger points. CLINICAL RELEVANCE Transcutaneous electrical nerve stimulation at acupuncture points could be applied for improving myofascial pain.
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Takla MKN. Low-frequency high-intensity versus medium-frequency low-intensity combined therapy in the management of active myofascial trigger points: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1737. [DOI: 10.1002/pri.1737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/07/2018] [Accepted: 07/11/2018] [Indexed: 11/09/2022]
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Khalifeh S, Rezaee E, Azizi A, Ebrahimi H. Efficacy of Low-Level Laser Versus Transcutaneous Electrical Nerve Stimulation for Treatment of Myofascial Pain Syndrome: A Clinical Trial. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2018. [DOI: 10.29252/jrdms.3.3.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Minerbi A, Vulfsons S. Challenging the Cinderella Hypothesis: A New Model for the Role of the Motor Unit Recruitment Pattern in the Pathogenesis of Myofascial Pain Syndrome in Postural Muscles. Rambam Maimonides Med J 2018; 9:RMMJ.10336. [PMID: 29944114 PMCID: PMC6115483 DOI: 10.5041/rmmj.10336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The energy crisis hypothesis, which is a widely accepted model for the pathogenesis of myofascial pain, has been corroborated by experimental observations. However, the nature of the insult leading to the energy crisis remains elusive. A commonly cited model for this insult is the Cinderella hypothesis, suggesting that hierarchical recruitment of motor units leads to a disproportional load on small units, thus driving them towards an energy crisis. New findings cast doubt on this model, showing that in postural muscles motor units are recruited in rotation, rather than in a hierarchical order, precluding the formation of the so-called Cinderella units. OBJECTIVE To explore the influence of common myofascial predisposing factors such as muscle load and muscle strength on the relaxation time of postural muscle motor units, assuming they are recruited in rotation. METHODS A stochastic model of a postural skeletal muscle was developed which integrates the energy crisis model and motor unit rotation patterns observed in postural muscles. Postulating that adequate relaxation time is essential for the energetic replenishment of motor units, we explored the influence of different parameters on the relaxation time of individual motor units under varying conditions of muscle loads and muscle strengths. RESULTS The motor unit relaxation/contraction time ratio decreases with elevated muscle loads and with decreased total muscle strength. CONCLUSIONS In a model of a postural muscle, in which motor units are recruited in rotation, common predisposing factors of myofascial pain, such as increased muscle load and decreased muscle force, lead to shortened motor unit relaxation periods.
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Affiliation(s)
- Amir Minerbi
- Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Israel
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Simon Vulfsons
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Nasirzadeh Y, Ahmed S, Monteiro S, Grosman-Rimon L, Srbely J, Kumbhare D. A Survey of Healthcare Practitioners on Myofascial Pain Criteria. Pain Pract 2018; 18:631-640. [PMID: 29090531 DOI: 10.1111/papr.12654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/15/2017] [Accepted: 10/21/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The goal of this study was to assess agreement on signs and symptoms of myofascial pain for chiropractors, physicians, and registered massage therapists. METHODS 337 healthcare practitioners participated in the survey. The questionnaire probed clinician agreement with the chosen signs and symptoms using a 7-point agreement scale (1 = absolutely agree, 7 = absolutely disagree). Agreement was assessed using intraclass correlation within chiropractor, physician, and registered massage therapist groups and across all groups. Descriptive statistics, including mean response values, were used to assess which signs or symptoms were most often associated with myofascial pain. RESULTS There was poor agreement within chiropractors, physicians, and registered massage therapists on the criteria that represent myofascial pain syndrome. Physicians and massage therapists were in agreement on 4 items and disagreed on 2 items. Chiropractors were in agreement on a different set of signs and symptoms relative to physicians and registered massage therapists, and they expressed neutrality on most statements in the questionnaire. Registered massage therapists were in most agreement amongst each other as a group (intraclass correlation coefficient [ICC] = 0.80) relative to chiropractors (ICC = 0.59) and physicians (ICC = 0.51). DISCUSSION Our results suggest that there is a lack of agreement within and between healthcare practitioner groups on the signs and symptoms that define myofascial pain syndrome. We suggest the demonstrated variability in diagnostic knowledge be remedied through the establishment and universal use of official validated criteria. Future research should focus on developing criteria specific to myofascial pain syndrome. Finally, knowledge translation strategies may be implemented to increase clinician knowledge of available criteria.
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Affiliation(s)
- Yasmin Nasirzadeh
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Ahmed
- University of Toronto, Toronto, Ontario, Canada
| | | | - Liza Grosman-Rimon
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - John Srbely
- University of Guelph, Guelph, Ontario, Canada
| | - Dinesh Kumbhare
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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García-Espinoza Ó, Salas-Fraire Ó, Flores-Garza P, Salas-Longoria K, Valadez-Lira J. Analgesic effect of whole body cryotherapy in patients with trapezius myofascial pain syndrome: A longitudinal, non-blinded, experimental study. MEDICINA UNIVERSITARIA 2017. [DOI: 10.1016/j.rmu.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord 2017; 18:188. [PMID: 28499364 PMCID: PMC5429540 DOI: 10.1186/s12891-017-1549-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. Methods A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Results Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. Conclusions This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom Petersen
- Back Center Copenhagen, Mimersgade 41, 2200, Copenhagen N, Denmark.
| | - Mark Laslett
- PhysioSouth Ltd, 7 Baltimore Green, Shirley, Christchurch, 8061, New Zealand.,Southern Musculoskeletal Seminars, Christchurch, New Zealand
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, University Hospital of Copenhagen, Herlev and Gentofte, Niels Andersen Vej 65, 2900, Hellerup, Denmark
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Denneny D, Petersen K, McLoughlin R, Brook S, Hassan S, Williams ACDC. Trigger point manual therapy for the treatment of chronic non-cancer pain in adults. Hippokratia 2017. [DOI: 10.1002/14651858.cd011763.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Suzanne Brook
- UCLH NHS Foundation Trust; Pain Management; London UK
| | - Salma Hassan
- UCLH NHS Foundation Trust; Pain Management; London UK
| | - Amanda C de C Williams
- University College London; Research Department of Clinical, Educational & Health Psychology; Gower Street London UK WC1E 6BT
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Hochberg U, Elgueta MF, Perez J. Interventional Analgesic Management of Lung Cancer Pain. Front Oncol 2017; 7:17. [PMID: 28261561 PMCID: PMC5306685 DOI: 10.3389/fonc.2017.00017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/25/2017] [Indexed: 12/31/2022] Open
Abstract
Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases.
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Affiliation(s)
- Uri Hochberg
- Cancer Pain Program, McGill University Health Centre , Montreal, QC , Canada
| | | | - Jordi Perez
- Cancer Pain Program, McGill University Health Centre, Montreal, QC, Canada; Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
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Gerber LH, Sikdar S, Aredo JV, Armstrong K, Rosenberger WF, Shao H, Shah JP. Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. PM R 2017; 9:105-112. [PMID: 27297448 PMCID: PMC5149452 DOI: 10.1016/j.pmrj.2016.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dry needling is an effective treatment for reducing pain associated with active myofascial trigger points (a-MTrPs) in the short term. The duration of the benefits of this treatment have not been fully assessed. OBJECTIVE To determine whether the benefits of dry needling (DN) of a-MTrPs are sustained 6 weeks posttreatment. DESIGN Follow-up of a prospective study. SETTING University. PARTICIPANTS A total of 45 patients (13 male and 32 female) with cervical pain >3 months and a-MTrPs in the upper trapezius who completed 3 DN treatments and who were evaluated 6 weeks posttreatment. INTERVENTIONS None. MAIN OUTCOME MEASURES Primary outcomes were changes from baseline to follow-up in scores for the verbal analogue scale (VAS), Brief Pain Inventory (BPI), and MTrP status. MTrPs were rated as active (spontaneously painful), latent (painful only on compression), and nonpalpable nodule. Responders were patients whose MTrP status changed from active to latent or nonpalpable nodule (resolved). Secondary outcomes were pain pressure threshold (PPT), Profile of Mood States, Oswestry Disability Index (ODI), MOS 36-Item Short-Form Health Survey (SF-36), and cervical range of motion. RESULTS Pain measures remained significantly improved 6 weeks posttreatment (P < .003), as did the SF-36 physical functioning score (0.01) and ODI (P = .002). Side bending and PPT for subjects with unilateral MTrPs had sustained improvement (P = .002). The number of subjects with sustained MTrP response at 6 weeks was significant (P < .001). Comparing responders to nonresponders, the changes in VAS and BPI were statistically significant (P = .006, P = .03) but the change in PPT was not. Patients with higher baseline VAS scores had a higher risk of not responding to DN; those with a greater drop in VAS score from baseline had a higher probability of sustained response. A 1-unit decrease in VAS at baseline resulted in a 6.3-fold increase in the odds of being a responder versus a nonresponder (P = .008). CONCLUSIONS In this study, there was sustained reduction of pain scores after completion of DN, which is more likely with a greater drop in VAS score. Patients with higher baseline VAS scores are less likely to respond to DN. Early intervention toward significant pain reduction is likely to be associated with sustained clinical response. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lynn H Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, MSN: 2G7, 4400 University Dr., Fairfax, VA 22030(∗).
| | | | - Jacqueline V Aredo
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(‡)
| | - Katee Armstrong
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA(§)
| | | | - Hui Shao
- Department of Statistics, George Mason University, Fairfax, VA(¶)
| | - Jay P Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(#)
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Panta P. The Possible Role of Meditation in Myofascial Pain Syndrome: A New Hypothesis. Indian J Palliat Care 2017; 23:180-187. [PMID: 28503039 PMCID: PMC5412127 DOI: 10.4103/0973-1075.204239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND OF HYPOTHESIS Myofascial pain syndrome (MPS) is the most common musculoskeletal pain disorder of the head and neck area. In the past, several theories were put forth to explain its origin and nature, but none proved complete. Myofascial pain responds to changing psychological states and stress, anxiety, lack of sleep, anger, depression and chronic pain are direct contributional factors. Myofascial pain syndrome may be considered as a psychosomatic disorder. There are numerous accepted palliative approaches, but of all, relaxation techniques stand out and initiate healing at the base level. In this article, the connection between mental factors, MPS and meditation are highlighted. Recent literature has shed light on the fundamental role of free radicals in the emergence of myofascial pain. The accumulating free radicals disrupt mitochondrial integrity and function, leading to sustenance and progression of MPS. Meditation on the other hand was shown to reduce free radical load and can result in clinical improvement. 'Mindfulness' is the working principle behind the effect of all meditations, and I emphasize that it can serve as a potential tool to reverse the neuro-architectural, neurobiological and cellular changes that occur in MPS. CONCLUSIONS The findings described in this paper were drawn from studies on myofascial pain, fibromyalgia, similar chronic pain models and most importantly from self experience (experimentation). Till date, no hypothesis is available connecting MPS and meditation. Mechanisms linking MPS and meditation were identified, and this paper can ignite novel research in this direction.
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Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana, India
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Wu CL, Liao LL, Yang SW. Efficacy of Acupuncture Treatment on Myofascial Pain Syndrome in Upper Trapezius. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0175-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ameloot B, Bagust J. The immediate effect of multiple mechanical impulses on electromyography and pressure pain threshold of lumbar latent trigger points: an experimental study. Chiropr Man Therap 2016; 24:20. [PMID: 27379178 PMCID: PMC4931704 DOI: 10.1186/s12998-016-0101-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/09/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Myofascial pain is a common syndrome, which has not been studied extensively in the low back. Despite a variety of manual and instrument assisted interventions available, little work has targeted the possible effects of fast mechanical impulses on myofascial trigger points (MTrPs) on its sensitivity and electrical activity. The purpose of this experimental study was to quantify the immediate effect of one session of mechanical impulses to lumbar latent MTrPs and to normal muscle tissue with pressure pain threshold (PPT) and surface electromyography (sEMG) as outcome measures. METHODS During the autumn of 2009, in 41 asymptomatic subjects between 17-40 years of age the lumbar musculature was searched for a latent MTrP by a trained clinician. Using 3 disposable pre-gelled electrodes bilaterally, sEMG was recorded continuously from muscle containing either latent or no MTrP. Both the trigger point group and control group received the intervention and were blinded to group allocation. The immediate effects of mechanical impulses were assessed by sEMG and PPT before and after intervention using Wilcoxon matched-pairs signed-ranks test, Mann-Whitney U test and paired t-tests. RESULTS The PPT increased significantly across both groups (p < 0.01) after intervention. The proportionate increase (14.6 %) was comparable in both MTrP and control groups. The electrical activity on the MTrP side was not significantly higher in the MTrP group compared to the contralateral side. The decrease of resting electrical activity after intervention was significant in the MTrP group on the side of the latent MTrP (P = 0.001) as well as the contralateral side (p=0.022), and not significant in the control group on either side (p=0.33 and p=0.93). CONCLUSION In this study, the immediate effect of one session of mechanical impulses was associated with a significant increase in PPT for both groups and a significant decrease in the resting electrical activity of the lumbar muscles only in the MTrP group. It is unknown if these effects have clinical significance.
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Affiliation(s)
- Bert Ameloot
- />Graaf van Landaststraat 17, 9700 Oudenaarde, Belgium
| | - Jeff Bagust
- />Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF Dorset UK
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Dommerholt J, Hooks T, Finnegan M, Grieve R. A critical overview of the current myofascial pain literature - March 2016. J Bodyw Mov Ther 2016; 20:397-408. [PMID: 27210859 DOI: 10.1016/j.jbmt.2016.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The worldwide interest in myofascial pain syndrome (MPS) and trigger points (TrPs) is reflected in the increasing number of publications. In this overview of the literature, we included 26 studies, case reports and review articles by authors from 18 different countries. Several research groups are exploring the characteristic of TrPs such as Chen and colleagues, who continued their work on the quantification of the taut bands. Meng and colleagues studied the relationships between TrPs and central sensitization, while Yu and colleagues examined the electrophysiological characteristics that occur as a result of active TrPs. Several researchers used objective measurements to determine clinical outcomes, such as Koppenhaver and colleagues who measured objective changes in the function and nociceptive sensitivity of lumbar multifidus muscle subjects with low back pain. Turo and colleagues quantified muscle tissue changes after dry needling in chronic myofascial pain using elastography. Multiple studies explored various treatment options for TrPs, such as dry needling, injections with lidocaine or granisetron, traditional Thai massage, self-myofascial release, kinesiotaping, and monochromatic infrared photo energy, among others.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Todd Hooks
- New Orleans Pelicans, New Orleans, LA, USA.
| | - Michelle Finnegan
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Rob Grieve
- Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol, United Kingdom.
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Joseph K, Hitchcock SA, Meyer HP, Geyser MM, Becker PJ. Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2015.1120932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Turo D, Otto P, Hossain M, Gebreab T, Armstrong K, Rosenberger WF, Shao H, Shah JP, Gerber LH, Sikdar S. Novel Use of Ultrasound Elastography to Quantify Muscle Tissue Changes After Dry Needling of Myofascial Trigger Points in Patients With Chronic Myofascial Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2149-2161. [PMID: 26491094 PMCID: PMC5555767 DOI: 10.7863/ultra.14.08033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/04/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To compare a mechanical heterogeneity index derived from ultrasound vibration elastography with physical findings before and after dry-needling treatment of spontaneously painful active myofascial trigger points in the upper trapezius muscle. METHODS Forty-eight patients with chronic myofascial pain enrolled in a prospective interventional trial of 3 weekly dry-needling treatments for active myofascial trigger points. Trigger points were evaluated at baseline and at treatment completion using palpation, the pressure-pain threshold, and the mechanical heterogeneity index. Thirty patients were reevaluated at 8 weeks. Trigger points that "responded" changed to tissue that was no longer spontaneously painful, with or without the presence of a palpable nodule. Trigger points that "resolved" changed to tissue without a palpable nodule. The mechanical heterogeneity index was defined as the proportion of the upper trapezius muscle that appeared mechanically stiffer on elastography. Statistical significance for comparisons was determined at P < .05. RESULTS Following 3 dry needle treatments, the mechanical heterogeneity index decreased significantly for the 38 myofascial trigger points (79% of 48) that responded to treatment. Among these, the baseline mechanical heterogeneity index was significantly lower for the 13 trigger points (27% of 38) that resolved, but the decrease after 3 dry needle treatments did not reach significance. The pressure-pain threshold improved significantly for both groups. At 8 weeks, the mechanical heterogeneity index decreased significantly for the 22 trigger points (73% of 30) that responded and for the 10 (45% of 22) that resolved. The pressure-pain threshold improvement was significant for trigger points that responded but did not reach significance for resolved trigger points. CONCLUSIONS The mechanical heterogeneity index identifies changes in muscle tissue properties that correlate with changes in the myofascial trigger point status after dry needling.
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Affiliation(s)
- Diego Turo
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Paul Otto
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Murad Hossain
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Tadesse Gebreab
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Katherine Armstrong
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - William F Rosenberger
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Hui Shao
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Jay P Shah
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Lynn H Gerber
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Siddhartha Sikdar
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.).
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Horton LM, John RM, Karibe H, Rudd P. Jaw disorders in the pediatric population. J Am Assoc Nurse Pract 2015; 28:294-303. [PMID: 26485343 DOI: 10.1002/2327-6924.12322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/01/2015] [Indexed: 11/07/2022]
Abstract
PURPOSE This article will review the etiology, risk factors, history, and physical assessment of temporomandibular joint disorders (TMDs). In particular, this article discusses the role of the pediatric provider in diagnosing and beginning the initial treatment of TMDs, as well as the appropriate treatment plans. It also reveals some of the controversies regarding etiology and treatment of TMDs, as well as the paucity of research specific to TMDs in pediatrics. DATA SOURCES A computerized search in PubMed and Ovid Medline, from 2006 to 2012, was conducted. A few seminal articles were included that were published before 2006. Hand searching was also performed, which included a few articles between 2012 and 2015. CONCLUSIONS Although TMDs are mostly found in adults, it is also a finding in pediatrics, which increases in prevalence during adolescence. More research specific to pediatric patients with TMDs needs to be conducted so that pediatric-specific care can be provided. IMPLICATIONS FOR PRACTICE TMD is a condition found in the pediatric population, and it is important for providers to take an adequate history and physical examination that incorporates the temporomandibular joint (TMJ) and muscles of mastication. It is also critical that providers begin initial education and management, followed by appropriate referrals.
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Affiliation(s)
| | - Rita Marie John
- Department of Clinical Nursing at Columbia University's School of Nursing, New York, New York
| | - Hiroyuki Karibe
- Department of Pediatric Dentistry at the Nippon Dental University, Tokyo, Japan
| | - Patricia Rudd
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, California
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Shah N, Ginzburg N, Morrissey D, Whitmore K. Update in Diagnosis and Treatment of Chronic Pelvic Pain Syndromes. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0302-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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