1
|
Agee OA, Leggit JC. Ultrasound-Guided Lidocaine Injection as a Novel Predictor of Response to Botulinum for Patients With Myofascial Pain Syndrome: A Case Report. Mil Med 2024:usae201. [PMID: 38758085 DOI: 10.1093/milmed/usae201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.
Collapse
Affiliation(s)
- Olivia A Agee
- The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jeffery C Leggit
- The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
2
|
Lam C, Francio VT, Gustafson K, Carroll M, York A, Chadwick AL. Myofascial pain - A major player in musculoskeletal pain. Best Pract Res Clin Rheumatol 2024:101944. [PMID: 38644073 DOI: 10.1016/j.berh.2024.101944] [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: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
Myofascial pain is a soft tissue pain syndrome with local and referred musculoskeletal pain arising from trigger points. Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Myofascial pain can exist independently of other pain generators or can coexist with or is secondary to other acute and chronic painful musculoskeletal conditions. Myofascial pain is most effectively treated with a multimodal treatment plan including injection therapy (known as trigger point injections, physical therapy, postural or ergonomic correction, and treatment of underlying musculoskeletal pain generators. The objectives of this review are to outline the prevalence of myofascial pain, describe the known pathophysiology of myofascial pain and trigger points, discuss the clinical presentation of myofascial pain, and present evidence-based best practices for pharmacologic, non-pharmacologic, and interventional treatments for myofascial pain.
Collapse
Affiliation(s)
- Christopher Lam
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Vinicius Tieppo Francio
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Kelsey Gustafson
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Michael Carroll
- Department of Physical Medicine and Rehabilitation, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Abigail York
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Andrea L Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| |
Collapse
|
3
|
Wendt M, Waszak M. Assessment of the stiffness of the upper trapezius muscle in a group of asymptomatic people with cervical spine rotation asymmetry. PLoS One 2024; 19:e0298544. [PMID: 38386652 PMCID: PMC10883562 DOI: 10.1371/journal.pone.0298544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
This study investigated the relationship between the stiffness of the upper trapezius muscle and the range of rotational movement of the cervical spine. A total of 60 right-handed asymptomatic students participated in the study. Participants (N = 22) characterised by asymmetry in rotational movements were selected for the experimental group. A difference of ≥10° between right and left rotation of the cervical spine was considered asymmetrical. The control group (N = 38) included participants whose rotation difference was < 10°. Belonging to the experimental or control group did not significantly differentiate trapezius muscle stiffness. The rotation side differentiated the stiffness of the right and left trapezius muscles only in the group of people with rotational movement asymmetry. There were high correlation coefficients between right cervical rotation and the stiffness of the muscle on the right side, and between rotation to the left and the stiffness of the muscle on the left side. There is a relationship between the stiffness of the right and left upper trapezius muscles and the range of right and left rotational motion of the cervical spine. Stiffness of the upper trapezius correlates more strongly with rotation to the side on which the muscle lies than to the opposite side. Increased stiffness of the upper trapezius muscle on the side of limited cervical spine rotation is likely to be determined by the muscle fibre stretching mechanism.
Collapse
Affiliation(s)
- Michał Wendt
- Department of Medical Biology, Poznan University of Physical Education, Poznań, Poland
| | - Małgorzata Waszak
- Department of Medical Biology, Poznan University of Physical Education, Poznań, Poland
| |
Collapse
|
4
|
Bodine N. An overview of myofascial pain syndrome with a focus on trigger point injection. Nurse Pract 2023; 48:18-25. [PMID: 37884018 DOI: 10.1097/01.npr.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT Myofascial pain syndrome (MPS) is a very common condition, with an estimated lifetime prevalence of 85% in the general population. MPS is commonly underdiagnosed or misdiagnosed due to the lack of standardized diagnostic criteria and the symptoms' overlap with those of other musculoskeletal pain conditions. The most notable and bothersome feature of MPS is the presence of myofascial trigger points (MTrPs), hypersensitive areas of muscle commonly characterized as knots, nodules, or bumps that cause strain and pain with and oftentimes without stimulation. A low-risk, low-cost procedure, trigger point injection (TPI) is the gold standard for MPS treatment, and NPs can perform the procedure in an outpatient practice setting. Through administration of TPIs and use of other treatment modalities, primary care NPs can significantly impact the quality of life for those patients affected by acute and chronic MPS. This article aims to educate primary care NPs on MPS diagnosis and provide an overview of treatment options, with a focus on TPI use and administration for MPS relief.
Collapse
Affiliation(s)
- Nicole Bodine
- Nicole Bodine is a family NP with the Defense Health Agency, currently serving as a provider in the Pain Clinic at Evans Army Community Hospital in Colorado Springs, Colo
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Alqahtani AS, Parveen S. Kinesio Taping as a Therapeutic Tool for Masticatory Myofascial Pain Syndrome-An Insight View. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3872. [PMID: 36900882 PMCID: PMC10001559 DOI: 10.3390/ijerph20053872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Myofascial pain syndrome (MPS) is thought to stem from masticatory muscle hypersensitivity. Masticatory myofascial pain syndrome (MMPS) is characterized by multiple trigger points (MTrPs), also known as hyperirritable points, in taut bands of affected muscles, regional muscle pain, or referred pain to nearby maxillofacial areas like teeth, masticatory muscles or the temporomandibular joint (TMJ). Muscle stiffness, reduced range of motion, muscle weakening without atrophy, and autonomic symptoms may accompany regional discomfort. Multiple treatments have been utilized to reduce trigger points and mandibular function restrictions. As a result of these incapacitating symptoms, MMPS can significantly impair many elements of quality of life. The application of Kinesio tape (KT) is a non-invasive method of treating dormant myofascial trigger points. Utilizing the body's innate capacity for self-repair, this technique entails taping specific regions of the skin. KT alleviates discomfort, decreases swelling and inflammation, enhances or suppresses motor function in the muscles, stimulates proprioception, promotes lymphatic drainage, stimulates blood flow, and expedites tissue recovery. However, studies conducted to assess its effects have frequently yielded contradictory results. To the best of our knowledge, just a few research has looked into the therapeutic effects of KT on MMPS. The purpose of this review is to determine the efficacy of KT as a therapeutic tool for regular treatment or as an adjunct to existing therapy for MMPS based on the evidence presented in this review. To establish KT as a reliable independent treatment option, additional research is necessary to confirm the efficacy of KT techniques and applications, specifically randomized clinical trials.
Collapse
|
7
|
Comparison of dry needling and kinesio taping® in management of latent trapezius myofascial trigger points. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-01025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
|
8
|
Carvalho HC, Machado NCSS, Yáñez-Silva A, Rocabado M, Júnior ARDP, Alves LP, Ribeiro W, Lazo-Osório RA. Autonomic nerve regulation in joint hypermobility patients with myofascial trigger points by Musculoskeletal Interfiber Counterirritant Stimulation (MICS). Med Eng Phys 2022; 109:103903. [DOI: 10.1016/j.medengphy.2022.103903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
|
9
|
Khalife T, Hagen AM, Alm JEC. Retroperitoneal Causes of Genitourinary Pain Syndromes: Systematic Approach to Evaluation and Management. Sex Med Rev 2022; 10:529-542. [PMID: 37051972 DOI: 10.1016/j.sxmr.2022.06.009] [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: 03/14/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Women with pelvic pain commonly report pain in their ovaries, vagina, uterus, or bladder. These symptoms may be caused by visceral genitourinary pain syndromes but also may be caused by musculoskeletal disorders of the abdomen and pelvis. Understanding neuroanatomical and musculoskeletal factors that may contribute to genitourinary pain is important for evaluation and management. OBJECTIVES This review aims to (i) highlight the importance of clinical knowledge of pelvic neuroanatomy and sensory dermatomal distribution of the lower abdomen, pelvis, and lower extremities, exemplified in a clinical case; (ii) review common neuropathic and musculoskeletal causes of acute and chronic pelvic pain that may be challenging to diagnose and manage; and (iii) discuss female genitourinary pain syndromes with a focus on retroperitoneal causes and treatment options. METHODS A comprehensive review of the literature was performed by searching the PubMed, Ovid Embase, MEDLINE, and Scopus databases using the keywords "chronic pelvic pain," "neuropathy," "neuropathic pain," "retroperitoneal schwannoma," "pudendal neuralgia," and "entrapment syndromes." RESULTS Retroperitoneal causes of genitourinary pain syndromes have substantial overlap with common conditions treated in a primary care setting. Thus, a comprehensive and systematic history and physical examination, with focused attention to the pelvic neuroanatomy, is key to establishing the correct diagnosis. In the clinical case, such a comprehensive approach led to the unexpected finding of a large retroperitoneal schwannoma. This case highlights the intricacy of pelvic pain syndromes and the complex nature of their possible overlapping causes, which ultimately affects treatment planning. CONCLUSION Knowledge of the neuroanatomy and neurodermatomes of the abdomen and pelvis, in addition to understanding pain pathophysiology, is critical when evaluating patients with pelvic pain. Failure to apply proper evaluation and implement proper multidisciplinary management strategies contributes to unnecessary patient distress, decreased quality of life, and increased use of health care services. Khalife T, Hagen AM, Alm JEC. Retroperitoneal Causes of Genitourinary Pain Syndromes: Systematic Approach to Evaluation and Management. Sex Med Rev 2022;XX:XXX-XXX.
Collapse
Affiliation(s)
- Tarek Khalife
- Obstetrics and Gynecology, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.
| | - Amy M Hagen
- Obstetrics and Gynecology, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA
| | - Jessica E C Alm
- Physical Medicine and Rehabilitation, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA
| |
Collapse
|
10
|
McDonald A. Primary Care-Based Interventional Procedures for Chronic Pain. Prim Care 2022; 49:425-437. [DOI: 10.1016/j.pop.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Lu W, Li J, Tian Y, Lu X. Effect of ischemic compression on myofascial pain syndrome: a systematic review and meta-analysis. Chiropr Man Therap 2022; 30:34. [PMID: 36050701 PMCID: PMC9434898 DOI: 10.1186/s12998-022-00441-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Myofascial pain syndrome (MPS) is a condition with local and referred pain characterized by trigger points (taut bands within the muscle). Ischemic compression is a noninvasive manual therapy technique that has been employed for the treatment of MPS in past decades. However, little attention has been devoted to this topic. Objectives The present review was designed to explore the efficacy of ischemic compression for myofascial pain syndrome by performing a descriptive systematic review and a meta-analysis to estimate the effect of ischemic compression on MPS. Methods A systematic review and meta-analysis concerning randomized controlled trials (RCTs) with myofascial pain subjects who received ischemic compression versus placebo, sham, or usual interventions. Five databases (PubMed, The Cochrane Library, Embase, Web of Science, Ovid) were searched from the earliest data available to 2022.1.2. The standardized mean difference (SMD) and the 95% confidence interval (CI) were used for statistics. Version 2 of the Cochrane risk of tool 2 (RoB 2) was used to assess the quality of the included RCTs. Results Seventeen studies were included in the systematic review, and 15 studies were included in the meta-analysis. For the pressure pain threshold (PPT) index, 11 studies and 427 subjects demonstrated statistically significant differences compared with the control at posttreatment (SMD = 0.67, 95% CI [0.35, 0.98], P < 0.0001, I2 = 59%). For visual analog scale (VAS) or numeric rating scale (NRS) indices, 7 studies and 251 subjects demonstrated that there was no significant difference between ischemic compression and controls posttreatment (SMD = − 0.22, 95% CI [− 0.53, 0.09], P = 0.16, I2 = 33%). Conclusion Ischemic compression, as a conservative and noninvasive therapy, only enhanced tolerance to pain in MPS subjects compared with inactive control. Furthermore, there was no evidence of benefit for self-reported pain. The number of currently included subjects was relatively small, so the conclusion may be changed by future studies. Big scale RCTs with more subjects will be critical in future.
Collapse
Affiliation(s)
- Wei Lu
- Department of Nursing, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People's Republic of China
| | - Jiong Li
- Department of Hepatobiliary Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People's Republic of China
| | - Ye Tian
- Department of Rehabilitation, Baoshan Branch, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200436, People's Republic of China
| | - Xingang Lu
- Department of Traditional Chinese Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.
| |
Collapse
|
12
|
Elbarbary M, Sgro A, Goldberg M, Tenenbaum H, Azarpazhooh A. Diagnostic Applications of Ultrasonography in Myofascial Trigger Points: A Scoping Review and Critical Appraisal of Literature. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Myofascial trigger points (MTrPs) are pathognomonic of myofascial pain syndrome. The detection ability of MTrPs via ultrasonography is underreported and the characteristics of MTrPs are not sufficiently standardized. The objective was to summarize the characteristics and diagnostic abilities of ultrasonography for MTrP investigations. Materials and Methods: A multi-database, and bibliography hand-search was implemented. Studies of ≥10 patients, published after 1980, appraising ultrasonography as a diagnostic aid for myofascial pain syndrome were included. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to evaluate the diagnostic accuracy of the included studies. Results: Six cross-sectional studies met the inclusion criteria. The back and trapezius muscles were the most studied locations. The diagnostic studies were of low-medium risk of bias. The studies reported a large range of diagnostic metrics (accuracy 58%–100%, sensitivity 33%–91%, specificity 75%–100%, positive predictive value 91%–100%, negative predictive value 47%–97%, positive likelihood ratio 3.6, and negative likelihood ratio 0.12–0.67). Conclusion: This review found low-medium risk of bias evidence in support of ultrasonography for MTrP investigations. The clinical studies identified in the scoping review used gray-scale ultrasound equipment systems with a 5 to 14 MHz transducer to diagnose MTrPs and the local twitch response, and MTrPs were visualized mostly as hypoechoic nodules.
Collapse
Affiliation(s)
| | - Adam Sgro
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Michael Goldberg
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Howard Tenenbaum
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
13
|
A randomized clinical trial of self-stretching with and without mindful breathing immediate effect on pressure pain and range of motion in myofascial pain syndrome. J Bodyw Mov Ther 2022; 32:29-35. [DOI: 10.1016/j.jbmt.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/16/2022] [Accepted: 05/15/2022] [Indexed: 11/20/2022]
|
14
|
Intramuscular Neural Distribution of the Serratus Anterior Muscle: Regarding Botulinum Neurotoxin Injection for Treating Myofascial Pain Syndrome. Toxins (Basel) 2022; 14:toxins14040271. [PMID: 35448880 PMCID: PMC9033065 DOI: 10.3390/toxins14040271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 02/06/2023] Open
Abstract
The serratus anterior muscle is commonly involved in myofascial pain syndrome and is treated with many different injective methods. Currently, there is no definite injection point for the muscle. This study provides a suggestion for injection points for the serratus anterior muscle considering the intramuscular neural distribution using the whole-mount staining method. A modified Sihler method was applied to the serratus anterior muscles (15 specimens). The intramuscular arborization areas were identified in terms of the anterior (100%), middle (50%), and posterior axillary line (0%), and from the first to the ninth ribs. The intramuscular neural distribution for the serratus anterior muscle had the largest arborization patterns in the fifth to the ninth rib portion of between 50% and 70%, and the first to the fourth rib portion had between 20% and 40%. These intramuscular neural distribution-based injection sites are in relation to the external anatomical line for the frequently injected muscles to facilitate the efficiency of botulinum neurotoxin injections. Lastly, the intramuscular neural distribution of serratus anterior muscle should be considered in order to practice more accurately without the harmful side effects of trigger-point injections and botulinum neurotoxin injections.
Collapse
|
15
|
Plaut S. Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PLoS One 2022; 17:e0263087. [PMID: 35171940 PMCID: PMC8849503 DOI: 10.1371/journal.pone.0263087] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. METHODS Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. FINDINGS 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. CONCLUSIONS MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue ("fascial armoring"). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A "global percutaneous needle fasciotomy" that respects tensegrity principles may treat MPS/fibromyalgia more effectively. "Functional-somatic syndromes" can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.
Collapse
Affiliation(s)
- Shiloh Plaut
- School of Medicine, St. George’s University of London, London, United Kingdom
- * E-mail:
| |
Collapse
|
16
|
Yürük D, Akkaya ÖT, Polat ÖE, Alptekin HA. Ultrasound-Guided Erector Spinae Plane Block and Trapezius Muscle Injection for Myofascial Pain Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:185-191. [PMID: 33713473 DOI: 10.1002/jum.15694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There were two goals to this study: the first goal was to research the analgesic effectiveness of erector spinae plane block (ESPB) added to the treatment after trapezius muscle injection (TMI) and the second was to investigate whether repeated TMI increases the analgesic effect in myofascial pain syndrome (MPS). METHODS Sixty patients with a diagnosis of MPS were randomized into two groups. The TMI group (n = 30) received ultrasound-guided (USG) TMI with 5 mL of 0.25% bupivacaine two times, with a 1-week interval in between. The ESPB group (n = 30) received USG TMI with 5 mL of 0.25% bupivacaine in the first week and USG ESPB with 20 mL of 0.125% bupivacaine in the second week. The pain severity of the patients was evaluated using the visual analog scale (VAS). The data obtained before (week 0) and after (weeks 1, 2, 3, and 4) the injections were statistically compared between the groups. RESULTS In both groups, the mean VAS score decreased in the first week compared to the mean pretreatment score (p < .001). When the VAS scores were compared between the first and second weeks, a decrease was observed in both groups (p < .001), but it was more evident in the ESPB group. Compared to previous weeks, there was no significant difference in VAS scores at the third and fourth weeks. CONCLUSIONS The analgesic effect of repeated TMI for MPS was superior to a single injection, but ESPB combined with TMI provided more effective analgesia than repeated TMI.
Collapse
Affiliation(s)
- Damla Yürük
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ömer Taylan Akkaya
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Özgür Emre Polat
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hüseyin Alp Alptekin
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
17
|
Fricova J, Janatova M, Albrecht J, Mares T, Rokyta R, Masopust V, Anders M. A Prospective Single-Center Study of the Effects of Repetitive Transcranial Magnetic Stimulation at 2-Week Follow-Up in 17 Patients with Chronic Orofacial Pain Diagnosed by Infrared Thermography. Med Sci Monit 2021; 27:e933017. [PMID: 34789713 PMCID: PMC8609768 DOI: 10.12659/msm.933017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Infrared thermography is a diagnostic method used to monitor acute and chronic orofacial pain syndrome. Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive brain stimulation. This prospective study from a single center aimed to investigate the effects of rTMS and used infrared thermography as a confirmatory test of orofacial pain. Material/Methods We used infrared thermography to examine the incidence of inflammatory changes as orofacial pain triggers. During the analysis of rTMS effects on patients with orofacial pain, we compared the decrease in pain and the thermal difference in the study group (n=17) and in the research group (n=13). Results In the control group (n=13), there were no statistically significant changes. Both groups showed a significant decrease in self-reported pain. Numerical pain rating scores were significantly lower after S2 stimulation than after S1/M1 (P=0.0071) or sham (P=0.0187) stimulation. The Brief Pain Inventory scores were also lower 3 to 5 days after S2 stimulation than at the pretreatment baseline (P=0.0127 for the intensity of pain and p=0.0074 for the interference of pain), and after S1/M1 (P=0.001 and P=0.0001) and sham (P=0.0491 and P=0.0359) stimulations. Conclusions The findings from this study support the role of infrared thermography for the diagnosis of chronic orofacial pain, and showed that on the first and fifth days of rTMS therapy in the study group there was a significant reduction of the thermography findings when compared with the control group without rTMS therapy.
Collapse
Affiliation(s)
- Jitka Fricova
- Department of Anestesiology, Resuscitation and Intensive Medicine, Pain Management Center, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Markéta Janatova
- Department of Rehabilitation Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Albrecht
- Department of Psychiatry, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tadeas Mares
- Department of Psychiatry, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Rokyta
- Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vaclav Masopust
- Department of Neurosurgery, Military Faculty Hospital, Charles University in Prague, Prague, Czech Republic
| | - Martin Anders
- Department of Psychiatry, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Masticatory Myofascial Pain Syndrome: Implications for Endodontists. J Endod 2021; 48:55-69. [PMID: 34710470 DOI: 10.1016/j.joen.2021.10.004] [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: 11/30/2020] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Masticatory myofascial pain syndrome can present similarly to other dental conditions in odontogenetic structures. Endodontists should be familiar with the symptomology and pathophysiology of masticatory myofascial pain syndrome to avoid misdiagnosis, incorrect treatment, and medicolegal repercussions. The aim of this review was to provide a foundational summary for endodontists to identify and correctly manage masticatory myofascial pain syndrome. METHODS A narrative review of the literature was performed through a MEDLINE search and a hand search of the major myofascial pain textbooks. RESULTS Masticatory myofascial pain syndrome is a musculoligamentous syndrome that can present similarly to odontogenic pain or refer pain to the eyebrows, ears, temporomandibular joints, maxillary sinus, tongue, and hard palate. Currently, the most comprehensive pathophysiology theory describing masticatory myofascial pain syndrome is the expanded integrated hypothesis. The most widely accepted diagnostic guidelines for masticatory myofascial pain syndrome are the Diagnostic Criteria for Temporomandibular Disorders; however, their diagnostic capability is limited. There is no hierarchy of treatment methods because each patient requires a tailored and multidisciplinary management aimed at regaining the muscle's range of motion, deactivating the myofascial trigger points, and maintaining pain relief. CONCLUSIONS The pain patterns for masticatory myofascial pain syndrome are well-known; however, there is a lack of consensus on the most proper method of trigger point diagnosis or pain quantification. The diagnostic strategies for masticatory myofascial pain syndrome vary, and the diagnostic aids are not well developed.
Collapse
|
20
|
Patel J, Javed S. Myofascial pain syndrome and SARS-CoV-2: a case series. Pain Manag 2021; 12:255-260. [PMID: 34601951 PMCID: PMC8491650 DOI: 10.2217/pmt-2021-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SARS-CoV-2 is a novel virus that has caused a plethora of dysfunctions and changes in the human body. Our goal in this case study series was to demonstrate the relationship that coronavirus has had in newly diagnosing patients with myofascial pain syndrome (MFPS). Medical records were obtained from a pain clinic that demonstrated the effects of this virus on patients who developed MFPS between March 2020 and December 2020. Chart reviews were performed and demonstrated patients who had a history of chronic pain had subsequent episodes of worsening exacerbations of pain, more specifically trigger points, after being diagnosed with coronavirus. MFPS and SARS-CoV-2 are proposed to be correlated amongst chronic pain patients. Potential pathological mechanisms include coronavirus-induced hypoxic muscle dysfunctions as well as psychological stress triggering pain receptors, leading to myofascial pain syndrome. COVID-19, the disease caused by the SARS-CoV-2 virus, may cause many problems and changes in the human body. In this case series, we propose a relationship between COVID-19 and myofascial pain syndrome (MFPS), a kind of chronic muscle pain affecting connective tissue in the muscles. Medical records of people who developed MFPS after a diagnosis of COVID-19 between March 2020 and December 2020 were obtained from a pain clinic. Chart reviews demonstrated that the three people with chronic pain included in this case series had episodes of worsening pain, more specifically in focal points, after being diagnosed with COVID-19. COVID-19 is suggested to have affected the development of MFPS in these chronic pain patients. Potential mechanisms of this relationship include different types of stress leading to MFPS.
Collapse
Affiliation(s)
- Jaldhi Patel
- Department of Anesthesiology, University of Texas Health & Sciences Center, Houston, TX, USA
| | - Saba Javed
- Department of Pain Management, University of Texas Health & Sciences Center, Houston, TX, USA
| |
Collapse
|
21
|
Is early diagnosis of myofascial pain syndrome possible with the detection of latent trigger points by shear wave elastography? Pol J Radiol 2021; 86:e425-e431. [PMID: 34429789 PMCID: PMC8369817 DOI: 10.5114/pjr.2021.108537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of the study was to investigate the contribution of shear wave elastography to the diagnosis of myo-fascial pain syndrome (MPS) of the upper part of the trapezius. Material and methods Ethical committee approval was obtained for the study. Thirty volunteer women with trigger points in the upper part of the trapezius muscle and 30 healthy women with a similar age distribution were included in the study. The patient group performed a self-stretching exercise program for 4 weeks. No intervention was applied to the control group. Muscle stiffness values of both groups were evaluated with shear wave elastography (SWE), and pain levels of all volunteers were evaluated by the Visual Analogue Scale at the beginning and the end of the study. The statistical analyses were performed using SPSS version 18.0. Results There was a significant decrease after the treatment in terms of upper trapezius muscle stiffness and the pain levels in the patient group (p < 0.001 and p < 0.001). In the patient group, there was a moderate correlation between the decrease in the pain level and the reductions in muscle stiffness (r = 0.595). In control group, there was no significant difference in terms of both muscle stiffness and pain levels before and after treatment (p > 0.05). Conclusions SWE is a reliable method for detecting latent trigger points in MPS, and it can be used for evaluating the response to treatment.
Collapse
|
22
|
Liu WD, Zhang B, Cheng ZC, Zhang R, Yang XZ, Yi HL, Yang BH. Two mixed-ligand coordination polymers: Magnetic properties and biological evaluation on myofascial pain syndrome by reducing IL-6 release. J SOLID STATE CHEM 2021. [DOI: 10.1016/j.jssc.2021.122223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
23
|
Duarte FCK, West DWD, Linde LD, Hassan S, Kumbhare DA. Re-Examining Myofascial Pain Syndrome: Toward Biomarker Development and Mechanism-Based Diagnostic Criteria. Curr Rheumatol Rep 2021; 23:69. [PMID: 34236529 DOI: 10.1007/s11926-021-01024-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW We discuss the need for a mechanism-based diagnostic framework with a focus on the development of objective measures (e.g., biomarkers) that can potentially be added to the diagnostic criteria of the syndrome. Potential biomarkers are discussed in relation to current knowledge on the pathophysiology of myofascial pain syndrome (MPS), including alterations in redox status, inflammation, and the myofascial trigger point (MTrP) biochemical milieu, as well as imaging and neurophysiological outcomes. Finally, we discuss the long-term goal of conducting a Delphi survey, to assess the influence of putative MPS biomarkers on clinician opinion, in order to ultimately develop new criteria for the diagnosis of MPS. RECENT FINDINGS Myofascial pain syndrome (MPS) is a prevalent healthcare condition associated with muscle weakness, impaired mood, and reduced quality of life. MPS is characterized by the presence of myofascial trigger points (MTrPs): stiff and discrete nodules located within taut bands of skeletal muscle that are painful upon palpation. However, physical examination of MTrPs often yields inconsistent results, and there is no gold standard by which to diagnose MPS. The current MPS diagnostic paradigm has an inherent subjectivity and the absence of correlation with the underlying pathophysiology. Recent advancements in ultrasound imaging, systemic biomarkers, MTrP-specific biomarkers, and the assessment of dysfunction in the somatosensorial system may all contribute to improved diagnostic effectiveness of MPS.
Collapse
Affiliation(s)
- Felipe C K Duarte
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Daniel W D West
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Lukas D Linde
- Inernational Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavid Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samah Hassan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Dinesh A Kumbhare
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. .,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, 550 University Ave, Toronto, Ontario, M5G 2A2, Canada.
| |
Collapse
|
24
|
Rozenfeld E, Strinkovsky A, Finestone AS, Kalichman L. Reliability of trigger points evaluation in the lower leg muscles. PAIN MEDICINE 2021; 22:2283-2289. [PMID: 34048586 DOI: 10.1093/pm/pnab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Myofascial trigger point diagnosis is a clinical palpatory skill dependent on the patient's subjective response. The inter- and intra-rater reliability of trigger point physical evaluation in the lower leg muscles has rarely been reported. Previous reliability studies suffered from the Kappa paradox. OBJECTIVE To evaluate the inter- and intra-rater reliability of trigger point recognition in the lower leg muscles implying a specific method to overcome the 1st Kappa paradox. DESIGN A reliability study with pre-second examiner exclusion to correct prevalence index. SETTING Physical therapy outpatient clinic, Beer-Sheva, Israel. SUBJECTS 86 soldiers aged 18-30 referred for physical therapy with a diagnosis of musculoskeletal pain consented to take part in this study. 26 were excluded for lacking trigger points, leaving 60 subjects for analysis (31 women, 29 men). METHODS Both legs were evaluated, and the results were analyzed separately for symptomatic (N = 87) and asymptomatic legs (N = 31).Each subject was evaluated three times, twice by one examiner, and once by a second examiner. Dichotomous findings including palpable taut-band, tenderness, referred pain, and relevance of referred pain were recorded. RESULTS Inter-rater reliability for active trigger points ranged from 0.49 to 0.75 (median: 0.52) and intra-rater reliability ranged from 0.41 to 0.84 (median: 0.65) and. For total trigger points intra-rater reliability ranged from 0.52 to 0.79 (median: 0.67), and inter-rater reliability ranged from 0.44 to 0.77 (median: 0.66). CONCLUSIONS Physical examination is a reliable method of trigger point evaluation in lower leg muscles, and it can be used as a diagnostic method for trigger point evaluation.
Collapse
Affiliation(s)
- Evgeni Rozenfeld
- Israel Defense Force, Medical Corps, Israel.,Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Asia Strinkovsky
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Aharon S Finestone
- Israel Defense Force, Medical Corps, Israel.,Shamir Medical Center, Zerifin, Affiliated to the Faculty of Medicine, Tel Aviv University, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Effectiveness of training about kinesiotaping in myofascial pain syndrome: A prospective, single-blind, randomized-controlled study. Turk J Phys Med Rehabil 2021; 67:17-24. [PMID: 33948539 PMCID: PMC8088793 DOI: 10.5606/tftrd.2021.4258] [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: 01/31/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives
In this study, we aimed to investigate whether there was any difference in kinesiotaping (KT) application on the upper trapezius muscle between a trained and untrained physiatrist in the management of patients with myofascial pain syndrome (MPS).
Patients and methods
Between April 2013 and July 2015, a total of 45 patients (44 females, 1 males; mean age 31.9±8.0 years; range, 18 to 55 years) with MPS were included in this prospective, single-blind, randomized-controlled study. The patients were randomly divided into two groups. The first group (intervention group, n=24) was administered KT band with the muscle in a tense condition according to the muscle technique performed by a trained physiatrist, from the muscle origo toward its insertion point. The second group (control group, n=21) received no technique and KT was applied to the painful area by an untrained physiatrist using a randomly selected method. Primary outcome measures were pain at rest, during activity (0-10 cm visual analog scale), and threshold measurement with algometry (kg/cm2). Secondary outcome measures were function (Neck Pain and Disability Scale), degree of palpable muscle spasm, and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, at three and six weeks after the treatment.
Results
There were significant improvements in all parameters in both groups. There were no significant differences in any parameters at six weeks. We demonstrated that KT, which was applied on active trigger points on the upper trapezius muscle by trained and untrained physiatrists, improved pain, palpable muscle spasm, neck function, quality of life, and patient satisfaction degree in patients with MPS.
Conclusion
Our study results show that KT, which is applied by trained and untrained physiatrists, improves pain, palpable muscle spasm, neck function, quality of life in patients with MPS.
Collapse
|
27
|
Luciani M, Negro A, Spuntarelli V, Bentivegna E, Martelletti P. Evaluating and managing severe headache in the emergency department. Expert Rev Neurother 2021; 21:277-285. [PMID: 33297780 DOI: 10.1080/14737175.2021.1863148] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Headache is the fifth most common reason to visit an emergency department (ED). In most of the cases, headache is benign and has a primary origin, with migraine as the most common diagnosis. Inappropriate use of ED for non-emergency conditions causes overcrowding, unnecessary testing, and increased medical costs.Areas covered: All stages of headache management in ED, from the reasons to go there, the diagnosis that is made and the investigations necessary to make it, to get to the therapies administered and those prescribed at discharge, if there were any. Finally, the authors evaluated the habit of recommending medical follow-up and how often the headache is still present at discharge or returns within 24 hours.Expert Opinion: Primary headaches are underdiagnosed, misdiagnosed, and the majority do not receive drug therapy either in ED or on discharge, and in cases where the therapy is prescribed is not specific. Increase the number of primary care medical services, spread the 'headaches culture' among GPs and ED doctors, the adoption of ICHD in the diagnostic protocols used in EDs and a fast referral to a headache center could decrease the inappropriate use of ED and improve the headache management in the emergency units.
Collapse
Affiliation(s)
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Valerio Spuntarelli
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| |
Collapse
|
28
|
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.
Collapse
|
29
|
Dalpiaz A, Kuriki HU, Barbosa RAP, Diefenthaeler F, Marcolino AM, Barbosa RI. Dry Needling and Photobiomodulation Decreases Myofascial Pain in Trapezius of Women: Randomized Blind Clinical Trial. J Manipulative Physiol Ther 2020; 44:61-71. [PMID: 33248747 DOI: 10.1016/j.jmpt.2020.07.002] [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] [Received: 12/11/2019] [Revised: 05/22/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether dry needling (DN) added to photobiomodulation (PBM) has effects on the treatment of active myofascial trigger points in the upper trapezius. METHODS This study was a randomized clinical trial, with 43 participants divided into 3 groups: DN and PBM (DNP), DN, and DN outside of the trigger point (DNout). Each group received 1 session of DN followed by PBM therapy with the machine turned on or off. Pain, disability, pain pressure threshold, and muscle activity were assessed before the intervention and afterward at intervals of 10 minutes, 30 minutes, 1 week, and 1 month. RESULTS Pain decreased after intervention in the DNP and DNout groups, with mean differences, respectively, of 1.33 cm (95% confidence interval [CI], 0.019-2.647) and 2.78 cm (95% CI, 1.170-2.973). Scores for the disability questionnaire decreased in all groups after intervention (F = 36.53, P < .0001) after the intervention, with mean differences of 3.8 points in the DNP group (95% CI, 1.082-5.518), 3.57 in the DN group (95% CI, 0.994-6.149), and 5.43 in the DNout group (95% CI, 3.101-7.756). There were no significant differences between or within groups in pain pressure threshold (F = 2.14, P = .139), with mean differences after 30 minutes of 0.139 kgf for the DNP group (95% CI, -0.343 to 0.622), 0.273 for the DN group (95% CI, -0.661 to 1.209), and -0.07 for the DNout group (95% CI, -0.465 to 0.324). Muscle activation for the DN group increased 8.49% after the intervention, where for the DNP group it decreased 11.5%, with a significant difference between groups. CONCLUSION DN added to PBM presented similar results compared to DNout and DN. In this sample, the effects of the application of DN outside of the trigger point had better effects on pain and disability scores than DN applied directly on the trigger point.
Collapse
Affiliation(s)
- Ameg Dalpiaz
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Heloyse Uliam Kuriki
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Renan Andrade Pereira Barbosa
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Fernando Diefenthaeler
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Alexandre Marcio Marcolino
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Rafael Inacio Barbosa
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil.
| |
Collapse
|
30
|
Chiu YC, Manousakas I, Kuo SM, Shiao JW, Chen CL. Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome. PLoS One 2020; 15:e0242371. [PMID: 33211769 PMCID: PMC7676738 DOI: 10.1371/journal.pone.0242371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance. METHODS Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system. RESULTS During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group (p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group (p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group (p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder (p = 0.023) and upper extremity function (p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups. CONCLUSION This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.
Collapse
Affiliation(s)
- Yen-Chun Chiu
- Department of Orthopedics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
- Department of Electrical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Ioannis Manousakas
- Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Shyh Ming Kuo
- Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jen-Wen Shiao
- Center for General Education, I-Shou University, Kaohsiung, Taiwan
| | - Chien-Liang Chen
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
- * E-mail:
| |
Collapse
|
31
|
Wendt M, Waszak M. Evaluation of the Combination of Muscle Energy Technique and Trigger Point Therapy in Asymptomatic Individuals with a Latent Trigger Point. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8430. [PMID: 33202559 PMCID: PMC7696776 DOI: 10.3390/ijerph17228430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 01/02/2023]
Abstract
(1) Background: The aim of the study was to determine the effect of the combination therapy of Muscle Energy Technique (MET) and Trigger Point Therapy (TPT) on the angular values of the range of movements of the cervical spine and on the pressure pain threshold (PPT) of the trapezius muscle in asymptomatic individuals. METHODS: The study involved 60 right-handed, asymptomatic students with a latent trigger point in the upper trapezius muscle. All qualified volunteers practiced amateur symmetrical sports. The study used a tensometric electrogoniometer (cervical spine movement values) and an algometer (pressure pain threshold (PPT) of upper trapezius). Randomly (sampling frame), volunteers were assigned to three different research groups (MET + TPT, MET and TPT). All participants received only one therapeutic intervention. Measurements were taken in three time-intervals (pre, post and follow-up the next day after therapy). (2) Results: One-time combined therapy (MET + TPT) significantly increases the range of motion occurring in all planes of the cervical spine. One-time treatments of single MET and single TPT therapy selectively affect the mobility of the cervical spine. The value of the PPT significantly increased immediately after all therapies, but only on the right trapezius muscle, while on the left side only after the therapy combining MET with TPT. (3) Conclusion: The MET + TPT method proved to be the most effective, as it caused changes in all examined goniometric and subjective parameters.
Collapse
Affiliation(s)
- Michał Wendt
- Department of Biology and Anatomy, Poznan University of Physical Education, 61-871 Poznań, Poland;
| | | |
Collapse
|
32
|
Kaewcum N, Siripornpanich V. An electroencephalography (EEG) study of short-term electromyography (EMG) biofeedback training in patients with myofascial pain syndrome in the upper trapezius. J Phys Ther Sci 2020; 32:674-679. [PMID: 33132529 PMCID: PMC7590857 DOI: 10.1589/jpts.32.674] [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: 05/26/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] In the present study, electroencephalography was used to explore neural
activity related to electromyography biofeedback training, focusing on pain perception
before and after electromyography biofeedback. [Participants and Methods] Twenty-seven
participants (female=23; mean age: 28.85 ± 4.99 years) with mild-to-moderate myofascial
pain syndrome in the upper trapezius were recruited for this study. All participants
underwent electroencephalography recording before, during, and after (0 and 15 min)
electromyography biofeedback training. Quantitative electroencephalography analysis was
performed to obtain the absolute power of the four main frequency bands. Pain scores
before and after electromyography biofeedback were also evaluated by subjective rating.
[Results] Electromyography biofeedback increased alpha power and decreased delta power 15
minutes after training, suggestive of relaxation. However, although a tendency for scores
to decrease was observed, no significant improvements in pain scores were observed
following the intervention. Such results may be due to the short duration of the
biofeedback session and the subjective nature of pain assessments. [Conclusion] Despite no
obvious changes in pain perception, brief electromyography biofeedback training may induce
relaxation in patients with myofascial pain syndrome of the upper trapezius muscle.
Collapse
Affiliation(s)
- Nattakarn Kaewcum
- Research Center for Neuroscience, Institute of Molecular Biosciences, Mahidol University, Nakhonpathom 73170, Thailand
| | - Vorasith Siripornpanich
- Research Center for Neuroscience, Institute of Molecular Biosciences, Mahidol University, Nakhonpathom 73170, Thailand
| |
Collapse
|
33
|
A comparison of dry needling and kinesiotaping therapies in myofascial pain syndrome: A randomized clinical study. Turk J Phys Med Rehabil 2020; 66:351-359. [PMID: 33089092 PMCID: PMC7557629 DOI: 10.5606/tftrd.2020.3917] [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] [Received: 11/13/2018] [Accepted: 05/06/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to compare the effectiveness of dry needling (DN) and kinesiotaping (KT) therapies on pain, quality of life, depression, and physical function in the treatment of myofascial pain syndrome (MPS). Patients and methods
The study included a total of 60 patients (4 males, 56 females; mean age 31.2±9.8 years; range, 18 to 56 years) diagnosed with MPS between January 2014 and June 2014. The patients were randomly divided into two treatment groups: the DN group (n=30) and KT group (n=30). Both groups performed stretching and postural exercises. The scales used for measurements were the Visual Analog Scale (VAS) for pain, a pressure algometer for the pressure-pain threshold, the Short Form-36 (SF-36) for the quality of life, Beck Depression Inventory (BDI) for depression, and the Neck Pain and Disability Scale (NPDS) for physical function. The patients were evaluated by a single assessor three times: pre-treatment, at the end of the treatment, and two months after the treatment. Results
Both DN and KT provided significant improvements for all baseline measurements (VAS, pressure pain threshold, all subscales of SF-36, BDI, and NPDS scores) at the end of the treatment and two months after the treatment (p<0.05). However, there was no significant difference between the groups in all measurements (p>0.05). Conclusion Kinesiotaping is as an effective method as DN in the treatment of MPS. It can be served as a non-invasive alternative to patients with needle phobia.
Collapse
|
34
|
Urits I, Charipova K, Gress K, Schaaf AL, Gupta S, Kiernan HC, Choi PE, Jung JW, Cornett E, Kaye AD, Viswanath O. Treatment and management of myofascial pain syndrome. Best Pract Res Clin Anaesthesiol 2020; 34:427-448. [PMID: 33004157 DOI: 10.1016/j.bpa.2020.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
Myofascial Pain Syndrome (MPS) is a regional pain disorder that affects every age-group and is characterized by the presence of trigger points (TrPs) within muscles or fascia. MPS is typically diagnosed via physical exam, and the general agreement for diagnostic criteria includes the presence of TrPs, pain upon palpation, a referred pain pattern, and a local twitch response. The prevalence of MPS among patients presenting to medical clinics due to pain ranges anywhere from 30 to 93%. This may be due to the lack of clear criteria and guidelines in diagnosing MPS. Despite the prevalence of MPS, its pathophysiology remains incompletely understood. There are many different ways to manage and treat MPS. Some include exercise, TrP injections, medications, and other alternative therapies. More research is needed to form uniformly-accepted diagnostic criteria and treatments.
Collapse
Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | - Amanda L Schaaf
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Soham Gupta
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Hayley C Kiernan
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Paula E Choi
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Elyse Cornett
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| |
Collapse
|
35
|
Alayat MS, Battecha KH, ELsodany AM, Ali MI. Pulsed ND:YAG laser combined with progressive pressure release in the treatment of cervical myofascial pain syndrome: a randomized control trial. J Phys Ther Sci 2020; 32:422-427. [PMID: 32753780 PMCID: PMC7344286 DOI: 10.1589/jpts.32.422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/03/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effect of pulsed Nd:YAG laser combined with the progressive
pressure release technique (PPRT) and exercises in the treatment of myofascial trigger
points (MTrPs) in patients with myofascial pain syndrome (MPS). [Participants and Methods]
A total of 50 patients with MTrPs in the upper trapezius muscle participated in the study.
The patients were randomly assigned to two groups and treated with laser plus PPRT (Laser
+ PPRT group) or placebo laser and exercises (PL + PPRT group). The laser was applied for
eight MTrPs with a 50 J/point. PPRT was applied for 30 seconds for each point. Exercises
included strengthening and stretching exercises applied three times per week for four
weeks. A visual analogue scale (VAS) and pressure pain threshold (PPT) were used to
measure pain and pain threshold, respectively. A cervical range of motion device (CROM)
was used to measure the cervical range of motion. [Results] Both treatment groups showed
significant improvement in CROM, PPT, and VAS post-treatment with a more significant
effect in the Laser + PPRT group compared to the PL + PPRT group. [Conclusion] PPRT and
exercises alone or that in combination with laser therapy were effective in the treatment
of active MTrPs in patients with MPS.
Collapse
Affiliation(s)
- Mohamed Salaheldein Alayat
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
| | - Kadrya Hosney Battecha
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
| | - Ahmed Mohamed ELsodany
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
| | - Mohamed Ibrahim Ali
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
| |
Collapse
|
36
|
Dueñas L, Zamora T, Lluch E, Artacho-Ramírez MA, Mayoral O, Balasch S, Balasch-Bernat M. The effect of vibration therapy on neck myofascial trigger points: A randomized controlled pilot study. Clin Biomech (Bristol, Avon) 2020; 78:105071. [PMID: 32521284 DOI: 10.1016/j.clinbiomech.2020.105071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of low-frequency self-administered vibration therapy into myofascial trigger points in the upper trapezius and levator scapulae on patients with chronic non-specific neck pain. METHODS Twenty-eight patients with chronic non-specific neck pain were randomly assigned into a vibration group, receiving 10 self-applied sessions of vibration therapy in the upper trapezius and levator scapulae trigger points; or a control group, receiving no intervention. Self-reported neck pain and disability (Neck Disability Index) and pressure pain threshold were assessed at baseline and after the first, fifth and 10th treatment sessions. FINDINGS Significant differences were found in the vibration group when compared to the control group after the treatment period: the vibration group reached lower Neck Disability Index scores (F = 4.74, P = .033, η2 = 0.07) and greater pressure pain threshold values (F = 7.56, P = .01, η2 = 0.10) than the control group. The vibration group reported a significant reduction in Neck Disability Index scores (χ2 = 19,35, P = .00, Kendall's W = 0.28) and an increase in pressure pain threshold (χ2 = 87,10, P = .00, Kendall's W = 0.73) between the assessment times over the course of the treatment. The mean increase in pressure pain threshold in the vibration group after the 10 sessions was 8.54 N/cm2, while the mean reduction in Neck Disability Index scores was 4.53 points. INTERPRETATION Vibration therapy may be an effective intervention for reducing self-reported neck pain and disability and pressure pain sensitivity in patients with chronic non-specific neck pain. This tool could be recommended for people with non-specific neck pain.
Collapse
Affiliation(s)
- L Dueñas
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain.
| | - T Zamora
- European Sleep Care Institute, San Vicente 16, 46023, Valencia, Spain.
| | - E Lluch
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain; "Pain in Motion" international research group, Belgium.
| | - M A Artacho-Ramírez
- Department of Engineering Projects, Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain.
| | - O Mayoral
- Physical Therapy Unit, Hospital Provincial de Toledo, Toledo, Spain.
| | - S Balasch
- Departamento de Estadística e Investigación Operativa Aplicadas y Calidad, Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain.
| | - M Balasch-Bernat
- Department of Physical Therapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain.
| |
Collapse
|
37
|
Yanuck J, Saadat S, Lee JB, Jen M, Chakravarthy B. Pragmatic Randomized Controlled Pilot Trial on Trigger Point Injections With 1% Lidocaine Versus Conventional Approaches for Myofascial Pain in the Emergency Department. J Emerg Med 2020; 59:364-370. [PMID: 32712034 DOI: 10.1016/j.jemermed.2020.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Myofascial neck and back pain is an increasingly common chief symptom in the emergency department. Currently, there are no widely accepted conventional therapies, and there is little evidence on the efficacy of interventions such as trigger point injections (TPIs). OBJECTIVE This study evaluates whether TPIs with 1% lidocaine can improve myofascial back and neck pain compared with conventional therapies. Secondary outcomes include changes in length of stay and number of opioid prescriptions on discharge. METHODS This single-center, prospective, randomized, pragmatic trial was carried out in patients clinically determined to have myofascial back or neck pain. Patients were randomized into the experimental arm (TPI with 1% lidocaine) or the control arm (standard conventional approach). Numeric Rating Scores (NRS) for pain and additional surveys were obtained prior to and 20 min after the intervention. RESULTS The NRS for pain was lower in the TPI group compared with the control group after adjustment for initial pain (median difference -3.01; 95% confidence interval -4.20 to -1.83; p < 0.001). Median length of stay was 2.61 h for the TPI group and 4.63 h for the control group (p < 0.001). More patients in the control group (47.4%) were discharged home with an opioid compared with the TPI group (2.9%) (p < 0.001). CONCLUSIONS TPI is an effective method for managing myofascial pain in the emergency department. This study indicates it may improve pain compared with conventional methods, reduce length of stay in the emergency department, and reduce opioid prescriptions on discharge.
Collapse
Affiliation(s)
- Justin Yanuck
- Department of Emergency Medicine, University of California, Irvine, Orange, California; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine, Orange, California
| | - Jonathan B Lee
- Department of Emergency Medicine, University of California, Irvine, Orange, California
| | - Maxwell Jen
- Department of Emergency Medicine, University of California, Irvine, Orange, California
| | - Bharath Chakravarthy
- Department of Emergency Medicine, University of California, Irvine, Orange, California
| |
Collapse
|
38
|
Costantini R, Affaitati G, Fiordaliso M, Giamberardino MA. Viscero-visceral hyperalgesia in dysmenorrhoea plus previous urinary calculosis: Role of myofascial trigger points and their injection treatment in the referred area. Eur J Pain 2020; 24:933-944. [PMID: 32034979 DOI: 10.1002/ejp.1542] [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] [Received: 07/14/2019] [Revised: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Women with dysmenorrhoea plus symptomatic urinary calculosis experience enhanced pain and referred muscle hyperalgesia from both conditions than women with one condition only (viscero-visceral hyperalgesia). The study aimed at verifying if enhanced dysmenorrhoea persists after urinary stone elimination in comorbid women and if local anaesthetic inactivation of myofascial trigger points (TrPs) in the lumbar area (of urinary pain referral) also relieves dysmenorrhoea. METHODS Thirty-one women with dysmenorrhoea plus previous urinary calculosis (Dys+PrCal) and lumbar TrPs, and 33 women with dysmenorrhoea without calculosis (Dys) underwent a 1-year assessment of menstrual pain and muscle hyperalgesia in the uterus-referred area (electrical pain threshold measurement in rectus abdominis, compared with thresholds of 33 healthy controls). At the end of the year, 16 comorbid patients underwent inactivation of TrPs through anaesthetic injections, whereas the remaining 12 received no TrP treatment. Both groups were monitored for another year at the end of which thresholds were re-measured. RESULTS In year1, Dys+PrCal presented significantly more painful menstrual cycles and lower abdominal thresholds than Dys, thresholds of both groups being significantly lower than normal (p < .001). Anaesthetic treatment versus no treatment of the lumbar TrP significantly reduced the number of painful cycles during year2 and significantly increased the abdominal thresholds (p < .0001). CONCLUSION Viscero-visceral hyperalgesia between uterus and urinary tract may persist after stone elimination due to nociceptive inputs from TrPs in the referred urinary area, since TrPs treatment effectively reverses the enhanced menstrual symptoms. The procedure could represent an integral part of the management protocol in these conditions. SIGNIFICANCE A past pain process from an internal organ can continue enhancing pain expression from a painful disease in another neuromerically connected organ (viscero-visceral hyperalgesia) if secondary myofascial trigger points (TrPs) developed in the referred area at the time of the previous visceral disease. Inactivation of these TrPs reverts the enhancement. Assessment and treatment of TrPs in referred areas from past visceral pain conditions should be systematically carried out to better control pain from current diseases in other viscera.
Collapse
Affiliation(s)
- Raffaele Costantini
- Institute of Surgical Pathology, Department of Medical, Oral and Biotechnological Sciences, "G D'Annunzio" University of Chieti, Chieti, Italy
| | - Giannapia Affaitati
- Geriatrics Clinic, Department of Medicine and Science of Aging, "G D'Annunzio" University of Chieti, Chieti, Italy
| | - Michele Fiordaliso
- Kliniske Abteilung für Allgemeine Viszeral und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt, Germany
| | - Maria Adele Giamberardino
- Geriatrics Clinic, Department of Medicine and Science of Aging, "G D'Annunzio" University of Chieti, Chieti, Italy
| |
Collapse
|
39
|
An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9240581. [PMID: 32076620 PMCID: PMC6998759 DOI: 10.1155/2020/9240581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/07/2019] [Accepted: 12/27/2019] [Indexed: 11/21/2022]
Abstract
Myofascial pain syndrome is characterized by pain and a limited range of joint motion caused by muscle contracture related to motor-end-plate dysfunction and the presence of myofascial trigger points (MTrPs). It is the most frequent cause of musculoskeletal pain, with a worldwide prevalence varying between 13.7% and 47%. Of the patients with myofascial pain syndrome, approximately 17% have pain in the medial hindfoot area. The abductor hallucis muscle is located in the medial, posterior region of the foot and is related to painful plantar syndromes. The objective of this study was to describe the distribution of the medial plantar nerve and their anatomical relationship with MTrPs found in the literature. Thirty abductor hallucis muscles were dissected from 15 human cadavers (8 males and 7 females). The muscles were measured, and the distribution data of the medial plantar nerve branches in each quadrant were recorded. For statistical analysis, we used generalized estimation equations with a Poisson distribution and a log logarithm function followed by Bonferroni multiple comparisons of the means. The data are expressed as the mean ± standard deviation. The level of significance was adjusted to 5% (p < 0.05). A high concentration of nerve branches was observed in the first quadrant (Q1) of the abductor hallucis muscle, which is the same area in which the MTrPs are described. The topography of the entry points of the branches of the medial plantar nerve to the abductor hallucis muscle correlates with the topography of the muscular trigger points. The anatomical structure of the MTrPs may be useful for a better understanding of the pathophysiology of myofascial disorders and provide a basis for surgical and clinical treatments.
Collapse
|
40
|
Doğan N, Şengül İ, Akçay-Yalbuzdağ Ş, Kaya T. Kinesio taping versus dry needling in the treatment of myofascial pain of the upper trapezius muscle: A randomized, single blind (evaluator), prospective study. J Back Musculoskelet Rehabil 2020; 32:819-827. [PMID: 30883331 DOI: 10.3233/bmr-181162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although a number of therapeutic interventions for trigger-point inactivation have been studied, it remains controversial which intervention is better. OBJECTIVE To compare the effectiveness of the kinesio taping and dry needling methods in patients with trigger-point related myofascial pain syndrome of the upper trapezius muscle. METHODS A total of 42 patients were randomly allocated to the kinesio taping group (n= 23) and dry needling group (n= 19). The patients were assessed for pain, pressure pain threshold (PPT), cervical range of motion (CROM), and function at baseline, at short- and medium-term stages after treatment. To investigate the effects of the interventions over time, two-way repeated measures analysis of variance (ANOVA) was used. RESULTS There was a significant improvement in pain intensity at rest and cervical motion, in the PPT readings (p< 0.05), in CROM (p< 0.05), and in function (p< 0.05) in both groups, with no superiority either (p> 0.05). CONCLUSIONS Kinesio taping may be a choice of trigger point inactivation in patients who do not want to be needled or who show contraindication(s) to treatments other than kinesio taping.
Collapse
Affiliation(s)
- Nesibe Doğan
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - İlker Şengül
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.,Department of Physical Medicine and Rehabilitation, Medical Faculty of İzmir Katip Çelebi University, İzmir, Turkey
| | - Şeniz Akçay-Yalbuzdağ
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
41
|
Giamberardino MA, Affaitati G, Costantini R, Guglielmetti M, Martelletti P. Acute headache management in emergency department. A narrative review. Intern Emerg Med 2020; 15:109-117. [PMID: 31893348 DOI: 10.1007/s11739-019-02266-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
Headache is a significant reason for access to Emergency Departments (ED) worldwide. Though primary forms represent the vast majority, the life-threatening potential of secondary forms, such as subarachnoid hemorrage or meningitis, makes it imperative for the ED physician to rule out secondary headaches as first step, based on clinical history, careful physical (especially neurological) examination and, if appropriate, hematochemical analyses, neuroimaging or lumbar puncture. Once secondary forms are excluded, distinction among primary forms should be performed, based on the international headache classification criteria. Most frequent primary forms motivating ED observation are acute migraine attacks, particularly status migrainous, and cluster headache. Though universally accepted guidelines do not exist for headache management in an emergency setting, pharmacological parenteral treatment remains the principal approach worldwide, with NSAIDs, neuroleptic antinauseants, triptans and corticosteroids, tailored to the specific headache type. Opioids should be avoided, for their scarce effectiveness in the acute phase, while IV hydration should be limited in cases of ascertained dehydration. Referral of the patient to a Headache Center should subsequently be an integral part of the ED approach to the headache patients, being ascertained that lack of this referral involves a high rate of relapse and new accesses to the ED. More controlled studies are needed to establish specific protocols of management for the headache patient in the ED.
Collapse
Affiliation(s)
- Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy
| | - Giannapia Affaitati
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy
| | - Raffaele Costantini
- Institute of Surgical Pathology, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Martina Guglielmetti
- Department of Clinical Pathology, University of Sassari, Sassari, Italy
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy.
- UOC Medicina Interna, AOU Sant'Andrea, Rome, Italy.
| |
Collapse
|
42
|
Co-occurrence of pain syndromes. J Neural Transm (Vienna) 2019; 127:625-646. [DOI: 10.1007/s00702-019-02107-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/17/2019] [Indexed: 12/17/2022]
|
43
|
Abstract
The first article featured in this quarter's overview deserves special attention. Margalef and colleagues developed the first viable animal model of trigger points (TrPs). They also provided evidence of glycosaminoglycans (GAGs) near TrPs, which is a new finding that deserves further scientific inquiry (Margalef et al 2019). In 2011, Stecco et al. already mentioned a possible role of hyaluronan, which constitutes a subgroup of GAGs, in the etiology of myofascial pain (Stecco et al 2011). Mayoral Del Moral and colleagues published an excellent study that showed very good inter-examiner reliability for identifying subjects with MPS for identifying specific muscles (Mayoral Del Moral et al 2018). Sollmann and colleagues described a new and objective method to identify TrPs, using T2 mapping with quantitative MRI-based techniques (Sollmann et al 2016). As usual, many new dry needling (DN) studies, reviews, manual TrP papers and case reports are included. Finally, we would like to thank Dr. Michelle Finnegan for her contributions to this overview paper during the past 5 years. Dr. Finnegan will be focusing on other professional endeavors and she will not return as a contributing author.
Collapse
|
44
|
Aydin T, Dernek B, Sentürk Ege T, Karan A, Aksoy C. The Effectiveness of Dry Needling and Exercise Therapy in Patients with Dizziness Caused By Cervical Myofascial Pain Syndrome; Prospective Randomized Clinical Study. PAIN MEDICINE 2019; 20:153-160. [PMID: 29718418 DOI: 10.1093/pm/pny072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective The aim of this study is to compare the effectiveness of dry needling therapy combined with exercise and exercise treatment alone for alleviating the dizziness caused by cervical myofascial pain syndrome. Design This was a prospective randomized clinical study that included 61 women who had dizziness and myofascial trigger points on the neck muscles. The patients were randomized into a dry needling + exercise group (N = 31) and an exercise only group (N = 30). Results The mean age of the patients (±SD) was 38.4 ± 8.3 years. The intragroup comparisons of the severity of neck pain, algometric measurement, number of dizziness attacks per week, severity of the dizziness, fall index, and the Dizziness Handicap Inventory were improved in both groups at the first and fourth months (P < 0.05). The intergroup comparisons of the severity of neck pain, algometric measurement, number of dizziness attacks per week, the severity of the dizziness, and the Dizziness Handicap Inventory were more improved in the dry needling + exercise group at the first or fourth month compared with their inital assessments (P < 0.05). There was no diffence in fall index scores between the groups (P > 0.05). Conclusions Both dry needling + exercise therapy and exercise therapy alone were effective in treating dizziness caused by cervical myofascial pain syndrome. However, dry needling + exercise treatment was superior to exercise treatment alone.
Collapse
Affiliation(s)
- Tugba Aydin
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
| | - Bahar Dernek
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
| | - Tülin Sentürk Ege
- Department of Otolaryngology, Bagcilar Education and Research Hospital, Istanbul, Turkey
| | - Ayse Karan
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
| | - Cihan Aksoy
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
| |
Collapse
|
45
|
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.
Collapse
|
46
|
Ibrahim DA, Abdelrahem HA. Cervical region trigger point Injection with dry needling versus wet needling by lidocaine in geriatric population: a comparative study. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s42077-019-0026-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
47
|
Pecos-Martin D, Ponce-Castro MJ, Jiménez-Rejano JJ, Nunez-Nagy S, Calvo-Lobo C, Gallego-Izquierdo T. Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial. Acupunct Med 2019; 37:141-150. [PMID: 31060367 DOI: 10.1136/acupmed-2018-011738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Latent myofascial trigger points (MTrPs) of the levator scapulae have a high prevalence and may influenceconditions of the neck and shoulder. The pressure release technique is one of the most recommended manual therapy techniques. The aim of this study was to determine the effect of varying durations of the pressure release technique application on latent MTrPs of the levator scapulae. METHODS In a three-arm (1:1:1 ratio), double-blinded, parallel, randomised clinical trial, 60 healthy university students (23 men, 37 women) with a mean±SD age of 20.0±2.67 years were recruited. Subjects were assigned to receive pressure release in one latent MTrP of the levator scapulae lasting 30s (T30s; n=17), 60s (T60s; n=22) or 90s (T90s; n=21). Active cervical range of movement (CROM), strength, pressure pain threshold (PPT) and neck pain intensity at full stretch were measured immediately before and after treatment. RESULTS Mixed-model analyses of variance showed statistically significant differences for PPT (P=0.045; partial Eta2=0.103), comparing T60s versus T30s (P=0.009; Cohen's d=1.044) and T90s versus T30s groups (P=0.001; Cohen's d=1.253), and for left side bending strength (P=0.043; partial Eta2=0.105), comparing T90s versus T30s (P=0.023; Cohen's d=0.907). The rest of the comparisons did not present any significant differences (P⩾0.05). CONCLUSIONS The 60 s and 90 s applications of the pressure release technique may be recommended to increase PPT and strength, respectively, in latent MTrPs of the levator scapulae in the short term. TRIAL REGISTRATION NUMBER NCT03006822.
Collapse
Affiliation(s)
- Daniel Pecos-Martin
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
| | - Manuel José Ponce-Castro
- 2 Faculty of Physical Therapy, Nursing and Podiatry, University of Sevilla, Sevilla, Sevilla, Spain
| | | | - Susana Nunez-Nagy
- 4 Physiotherapy and Nursing Departament, Alcalá University, Alcalá de Henares, Spain
| | - César Calvo-Lobo
- 5 Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, Spain
| | - Tomás Gallego-Izquierdo
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
| |
Collapse
|
48
|
Duckett J, Bodner-Adler B, Rachaneni S, Latthe P. Management of complications arising from the use of mesh for stress urinary incontinence-International Urogynecology Association Research and Development Committee opinion. Int Urogynecol J 2019; 30:1413-1417. [PMID: 30918979 DOI: 10.1007/s00192-019-03935-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/14/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Management of pain or mesh exposure complications after stress incontinence surgery has become a new issue over the last 20 years with the introduction of mesh techniques to treat stress incontinence. There is much debate regarding the incidence of complications and how best to treat them. METHODS A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed. An initial document was drafted based on a literature review. The review focused on complications of vaginal mesh inserted for stress incontinence. After evaluation by the entire IUGA R&D Committee revisions were made. The final document represents the IUGA R&D Committee Opinion. RESULTS The R&D Committee Opinion reviews the literature on the management of complications arising from the use of mesh for stress urinary incontinence. The review concentrated on the assessment and treatment of pain and exposure. CONCLUSIONS Complications after surgery for stress incontinence using mesh may not be common occurrences for individual surgeons. Complications may be difficult to manage and outcomes are variable. Specialist centres and a multidisciplinary approach may optimise treatment and reporting of outcomes.
Collapse
Affiliation(s)
- Jonathan Duckett
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
| | - Barbara Bodner-Adler
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Suneetha Rachaneni
- Department of Urogynaecology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Pallavi Latthe
- Department of Urogynaecology, Birmingham Women's NHS Foundation Trust, Edgbaston, UK
| |
Collapse
|
49
|
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.
| |
Collapse
|
50
|
Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep 2019; 23:23. [PMID: 30854609 DOI: 10.1007/s11916-019-0757-1] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general US adult population is 10-30%, and the lifetime prevalence of US adults is as high as 65-80%. RECENT FINDINGS Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is most effective and can include multimodal medical, psychological, physical, and interventional approaches. Low back pain is a difficult condition to effectively treat and continues to affect millions of Americans every year. In the current investigation, we present a comprehensive review of low back pain and discuss associated pathophysiology, diagnosis, and treatment.
Collapse
Affiliation(s)
- Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Aaron Burshtein
- Department of Orthopedic Surgery, Hofstra-Northwell Health System, Great Neck, NY, 11021, USA
| | - Medha Sharma
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Lauren Testa
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Peter A Gold
- Department of Orthopedic Surgery, Hofstra-Northwell Health System, Great Neck, NY, 11021, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Mark R Jones
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Moises A Sidransky
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Tyler, TX, USA
| | - Boris Spektor
- Department of Anesthesiology, Emory School of Medicine, Atlanta, GA, 30308, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA, 70112, USA
| |
Collapse
|