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Yanling Z, Hong L, Wang C, Nie Y, Xiong Y, Zheng Z, Zhu J. Efficacy and Safety of Ultrasound-Guided Acupotomy Versus Celecoxib in Patients with Thoracodorsal Myofascial Pain Syndrome: A Randomized Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38770602 DOI: 10.1089/jicm.2023.0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Objective: To evaluate the efficacy and safety of ultrasound-guided acupotomy (UgA) for the treatment of thoracodorsal myofascial pain syndrome (TDMPS) and monitor its mid-term efficacy at 3 months after treatment. Methods: A 3-week, evaluator-blinded randomized clinical trial was conducted among 100 patients with TDMPS (visual analogue scale [VAS] score > 3) in the outpatient clinic of the Department of Orthopaedics of the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, with a 3-month follow-up starting after completion of treatment. These patients were randomly assigned to receive UgA (n = 50) or oral celecoxib (n = 50). Recruitment was conducted between January 2021 and July 2022. The primary outcome was the VAS score, and the secondary outcomes included the Oswestry Disability Index (ODI), Pain Anxiety Symptoms Scale (PASS), and TNF-α and IL-1β levels. Outcome data were collected at baseline, week 3 (post-treatment) and week 15 (follow-up). Results: Compared with that in the celecoxib group, the pain in the UgA group was alleviated more strongly, with an adjusted mean group difference of -0.69 (95% CI,-1.07 to -0.31 after multiple imputation) at week 3 and -1.96 (95% CI,-2.33 to -1.59 after multiple imputation) at week 15 (p < 0.001 for overall group × time interaction). Both groups exhibited improvements in the ODI and PASS scores at weeks 3 and 15, but these improvements were significantly greater in the UgA group (p < 0.05). At week 3, the TNF-α and IL-1 levels were significantly lower in both groups, but celecoxib was more effective (p < 0.05). Results from analyses with multilevel multiple imputation for missingness were similar. Conclusion: UgA led to greater and safer alleviation of pain, dysfunction, and pain anxiety in patients treated with TDMPS than did celecoxib and had a durable 3-month efficacy but was inferior to celecoxib in reducing the level of inflammatory factors. These findings may prompt clinicians to recommend UgA as an alternative and supplementary therapy for pain management in patients with TDMPS.
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Affiliation(s)
- Zhou Yanling
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui, University of Chinese Medicine, HeFei, Anhui Province, China
| | - Lingxiang Hong
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui, University of Chinese Medicine, HeFei, Anhui Province, China
| | - Chao Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui, University of Chinese Medicine, HeFei, Anhui Province, China
| | - Yong Nie
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui, University of Chinese Medicine, HeFei, Anhui Province, China
| | - Yingzong Xiong
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui, University of Chinese Medicine, HeFei, Anhui Province, China
| | - Zhiwen Zheng
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui, University of Chinese Medicine, HeFei, Anhui Province, China
| | - Junchen Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui, University of Chinese Medicine, HeFei, Anhui Province, China
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Ma YT, Dong YL, Wang B, Xie WP, Huang QM, Zheng YJ. Dry needling on latent and active myofascial trigger points versus oral diclofenac in patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:36. [PMID: 36650486 PMCID: PMC9847151 DOI: 10.1186/s12891-022-06116-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Latent and active myofascial trigger points (MTrPs) in knee-associated muscles may play a key role in pain management among patients with knee osteoarthritis (KOA). The aim of this study was to investigate the effect of dry needling treatment on pain intensity, disability, and range of motion (ROM) in patients with KOA. METHODS This randomized, single-blinded, clinical trial was carried out for 6 weeks of treatment and 6-month follow-up. A total of 98 patients met the entry criteria and were randomly assigned to the dry needling latent and active myofascial trigger point (MTrPs) with the stretching group or the oral diclofenacwith the stretching group. Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and ROM were statistically analyzed before and after treatment and at the 6-month follow-up. RESULTS A total of 42 patients in the dry needling group (DNG) and 35 patients in the diclofenac group (DG), respectively, completed the study, and there was no significant difference in the general data between the two groups. After treatments, both the groups showed a good effect in knee pain, function, and ROM, However, the DNG showed a significantly better result than the DG. Especially in the results of the 6-month follow-up, the DNG showed much better results than the DG. CONCLUSIONS Dry needling on latent and active MTrPs combined with stretching and oral diclofenac combined with stretching can effectively relieve pain, improve function, and restore knee ROM affected by KOA. However, the effects of dry needling and stretching are better and longer lasting than those of oral diclofenac and stretching for at least 6 months. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ) in 17/11/2017 with the following code: ChiCTR-INR-17013432.
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Affiliation(s)
- Yan-Tao Ma
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yu-Lin Dong
- Department of Treatment, Yang Zhi Affiliated Rehabilition Hospital of Tongji, Shanghai, China
| | - Bo Wang
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wen-Pin Xie
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Qiang-Min Huang
- grid.412543.50000 0001 0033 4148Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, China ,Department of Pain Management, Shanghai Ciyuan Rehablitation Hospital, Sinophama Holding, Shanghai, China
| | - Yong-Jun Zheng
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Li Y, Yu J, Zhang J, Zhang Z, Wang X. Quantifying the stiffness of lumbar erector spinae during different positions among participants with chronic low back pain. PLoS One 2022; 17:e0270286. [PMID: 35749429 PMCID: PMC9231815 DOI: 10.1371/journal.pone.0270286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The purposes of this study were to (1) detect the intra- and inter-reliabilities of the lumbar erector spinae stiffness by MyotonPRO among participants with chronic lower back pain (CLBP); (2) compare the muscle stiffness between pain and non-pain sides during different positions; (3) explore the correlation between intensity of pain and muscle stiffness. Design Twenty participants with CLBP were recruited and the stiffness measurements were carried out by two experienced physiotherapists (operators Ⅰ and Ⅱ). Each participant was evaluated by the operatorⅠ in different postures (static prone and sitting). After a 5-day interval, the same participant was reassessed by the operatorⅠ in the static prone posture. For the inter-rater reliability test, each participant was quantified by both operators once, with 30 minutes between the measurements on the same day. The intensity of pain was evaluated using a 0–10 visual analog scale (VAS). Results The intra- and inter-rater reliabilities were excellent (ICC = 0.88–0.99). The MDC values ranged from 25.03 to 86.26 N/m. Examples of Bland-Altman plots showed good agreement. The erector spinae stiffness on the painful sides was higher with a marked increase in the sitting position (P < .05) when compared with the non-painful side. However, there was no significant difference in the prone position (P > .05). The intensity of pain among adults with CLBP was not associated with muscle stiffness of the lumbar erector spinae muscle. Conclusions Our findings indicated that the MyotonPRO is a feasible device in quantifying the stiffness of the lumbar erector spinae muscle in patients with CLBP. Meanwhile, the erector spinae stiffness on the painful sides was higher in the sitting when compared with the non-painful side.
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Affiliation(s)
- Yapeng Li
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Jiafeng Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhang
- Department of Rehabilitation, Institute of Rehabilitation and Health Care, Hunan Traditional Chinese Medical College, Hunan, China
| | - Zhijie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
- * E-mail:
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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Melo ASC, Cruz EB, Vilas-Boas JP, Sousa ASP. Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review. SENSORS 2022; 22:s22072565. [PMID: 35408180 PMCID: PMC9002787 DOI: 10.3390/s22072565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023]
Abstract
Several tools have been used to assess muscular stiffness. Myotonometry stands out as an accessible, handheld, and easy to use tool. The purpose of this review was to summarize the psychometric properties and methodological considerations of myotonometry and its applicability in assessing scapular muscles. Myotonometry seems to be a reliable method to assess several muscles stiffness, as trapezius. This method has been demonstrated fair to moderate correlation with passive stiffness measured by shear wave elastography for several muscles, as well as with level of muscle contraction, pinch and muscle strength, Action Research Arm Test score and muscle or subcutaneous thickness. Myotonometry can detect scapular muscles stiffness differences between pre- and post-intervention in painful conditions and, sometimes, between symptomatic and asymptomatic subjects.
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Affiliation(s)
- Ana S. C. Melo
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
- Center for Interdisciplinary Applied Research in Health, School of Health, Setubal Polytechnic Institute, Campus do IPS Estefanilha, 2914-503 Setubal, Portugal
| | - Eduardo B. Cruz
- Department of Physiotherapy, School of Health, Setubal Polytechnic Institute, Campus do IPS Estefanilha, 2914-503 Setubal, Portugal;
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - João Paulo Vilas-Boas
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
| | - Andreia S. P. Sousa
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
- Correspondence: or
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Rodríguez-Jiménez J, Ortega-Santiago R, Bonilla-Barba L, Falla D, Fernández-de-Las-Peñas C, Florencio LL. Immediate Effects of Dry Needing or Manual Pressure Release of Upper Trapezius Trigger Points on Muscle Activity during the Cranio-Cervical Flexion Test in People with Chronic Neck Pain: A Randomized Clinical Trial. PAIN MEDICINE 2022; 23:1717-1725. [PMID: 35179608 DOI: 10.1093/pm/pnac034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the effects of dry needling or manual pressure release on an active trigger point in the upper trapezius on cranio-cervical flexion test performance, pressure pain thresholds, and cervical range of motion in chronic neck pain. DESIGN A parallel randomized clinical trial. SETTING Physical therapy service. SUBJECTS Individuals with chronic neck pain. METHODS Subjects were randomized to receive dry needling (n = 25) or manual trigger point pressure release (n = 25) on upper trapezius active trigger points. Surface electromyography from upper trapezius, splenius capitis, sternocleidomastoid, and scalene muscles during performance of the cranio-cervical flexion test was assessed before and immediately after the intervention as primary outcome. Neck pain intensity, range of motion and pressure pain thresholds were the secondary outcomes. RESULTS A decrease in sternocleidomastoid activity on all stages of the cranio-cervical flexion test (time effect, p < 0.001) was found in both groups after the interventions, with no significant between-group difference. Pressure pain thresholds measured over the cervical spine and second metacarpal increased after dry needling when compared to manual trigger point pressure release (p < 0.05). Pain intensity decreased immediately after both treatments with moderate to large effect sizes, whereas cervical range of motion increased for both groups but with small effect sizes. CONCLUSION A single session of dry needling or manual pressure release over upper trapezius active trigger points promotes limited effects on muscle performance during the cranio-cervical flexion test, pressure pain thresholds and cervical range of motion in patients with chronic neck pain.
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Affiliation(s)
- Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Laura Bonilla-Barba
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Zha M, Chaffee K, Alsarraj J. Trigger point injections and dry needling can be effective in treating long COVID syndrome-related myalgia: a case report. J Med Case Rep 2022; 16:31. [PMID: 35039086 PMCID: PMC8763132 DOI: 10.1186/s13256-021-03239-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Myofascial pain is a complex health condition that affects the majority of the general population. Myalgia has been recognized as a symptom of long COVID syndrome. The treatment for long COVID syndrome-related myalgia lacks research. Dry needling is a technique that involves the insertion of a needle into the tissue of, or overlaying, a pain point. Wet needling is the addition of an injection of an analgesic substance such as lidocaine while performing needling. Both dry and wet needling have are practiced as treatment modalities for myofascial pain. Limited literature exists to define long COVID syndrome-related myalgia and its relation to myofascial pain, or to examine the utility of needling techniques for this pain. We report a case of dry and wet needling as effective treatments for long COVID-related myofascial pain. CASE PRESENTATION A 59-year-old, previously healthy Hispanic male with no comorbid conditions was diagnosed with COVID-19 pneumonia. The patient suffered moderate disease without hypoxia and was never hospitalized. Three months later, the patient continued to suffer from symptoms such as exertional dyspnea, "brain fog," and myalgia. An extensive multisystem workup revealed normal cardiac, pulmonary, and end organ functions. The patient was then diagnosed with long COVID syndrome. The nature and chronicity of the patient's myalgia meet the criteria for myofascial pain. Both wet and dry needling were used to treat the patient's myofascial pain, with good short- and long-term therapeutic effects. CONCLUSIONS COVID-19 infection has been shown to exacerbate preexisting myofascial pain syndrome. Our case report indicates that long COVID syndrome-related myalgia is likely a form of new-onset myofascial pain. Additionally, both wet and dry needling can be utilized as an effective treatment modality for this pain syndrome, with short- and long-term benefits.
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Affiliation(s)
- Mengyi Zha
- Columbia Basin Health Association, 1515 E Columbia St, Othello, WA, 99344, USA. .,Targeted Rural Underserved Track, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Kristina Chaffee
- Targeted Rural Underserved Track, School of Medicine, University of Washington, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Jude Alsarraj
- Columbia Basin Health Association, 1515 E Columbia St, Othello, WA, 99344, USA
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