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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.
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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.
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Alshammari SS, Amin S, Siddiqui AA, Malik YR, Alshammari AF, Amin J. An Evidence-Based Treatment of Myofascial Pain and Myofascial Trigger Points in the Maxillofacial Area: A Narrative Review. Cureus 2023; 15:e49987. [PMID: 38179392 PMCID: PMC10766389 DOI: 10.7759/cureus.49987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Myofascial pain (MFP) is characterized by localized pain in the maxillofacial region attributed to the presence of hypersensitive spots known as trigger points (TrPs). This condition is particularly prevalent in the maxillofacial area, warranting a comprehensive examination of evidence-based management techniques. This review aims to equip healthcare professionals with a more profound insight into evidence-based MFP management techniques, facilitating improved patient care and treatment outcomes. In this review, we conducted a thorough literature search using Google Scholar, Scopus, Web of Science (WOS), and MEDLINE, with the keywords "Myofascial pain syndrome," "Pain," and "Orofacial pain." Articles were selected based on their relevance to the study's objective. Pharmacological interventions, such as analgesics and muscle relaxants, are frequently prescribed. Additionally, a range of non-pharmacological modalities, including transcutaneous electrical nerve stimulation (TENS), ultrasound therapy, topical applications, dry needling, TrP injections, oral myofunctional therapy, and stretching exercises, have demonstrated efficacy in MFP management. The authors hope to give clinicians a more thorough understanding of the therapies for MFP by conducting a rigorous evidence-based evaluation of pharmacologic and non-pharmacological treatments. Our findings support the use of a combined approach that integrates both pharmacological and non-pharmacological strategies for the holistic management of TrPs.
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Affiliation(s)
- Sattam S Alshammari
- Department of Preventive Dental Sciences, College of Dentistry, University of Ha'il, Ha'il, SAU
| | - Salman Amin
- Department of Oral and Maxillofacial Surgery, College of Medicine and Dentistry, The University of Lahore, Lahore, PAK
| | - Ammar Ahmed Siddiqui
- Department of Preventive Dental Sciences, College of Dentistry, University of Ha'il, Ha'il, SAU
| | - Yasser Riaz Malik
- Department of Preventive Dental Sciences, College of Dentistry, University of Ha'il, Ha'il, SAU
| | - Abdullah Faraj Alshammari
- Department of Basic Dental and Medical Science, College of Dentistry, University of Ha'il, Ha'il, SAU
| | - Junaid Amin
- Department of Physical Therapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, SAU
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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.
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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
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Du Y, Cai X, Xu B, Wu Y, Chen M, Wang J, Yuan B, Zhang W, Zhu J, Yang C. Global Status and Future Trends of Fascia and Pain Research in 2013-2022: Bibliometric Analysis Based on CiteSpace and VOSviewer. J Pain Res 2023; 16:2633-2653. [PMID: 37538250 PMCID: PMC10394092 DOI: 10.2147/jpr.s412161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background Fascial pathological pain is the main type of chronic pain in older adults today, and studying the relationship between fascia and pain can help in the clinical search for effective treatments. However, in the face of the vast amount of research findings, there is no systematic assessment of the relationship between fascia and pain in a bibliometric analysis. Therefore, the purpose of this study is to analyze studies on fascia and pain using CiteSpace and VOSviewer to identify research hotspots and future directions. Materials and Methods A total of 744 papers related to fascia and pain from 2013 to 2022 were collected from the core collection database of Web of Science, and the authors, countries, institutions, keyword co-occurrence, keyword clustering, and keyword emergence were analyzed by CiteSpace and VOSviewer to construct a knowledge map. Results Literature publication has shown an overall upward trend over the past decade, but there have been some fluctuations. Carmelo Pirri, Caterina Fede, and Raffaele De Caro are the top three authors with the most articles. The United States, China, and Spain are major contributors to fascial and pain research. The University of Padua, Universidad Complutense and Harvard Medical School are leading institutions in this field. However, it is noteworthy that the collaboration between authors, countries and institutions is not active. Keyword analysis showed that hot spots and trends in research on fascia and pain focused on hot diseases, major interventions, and mechanism exploration. Conclusion This analysis identifies the most influential authors, institutions, and countries in the field of fascial and pain research and provides a reference for assessing their academic impact. The analysis of keywords and co-cited literature is useful for analyzing research hotspots and their evolution, as well as for predicting future trends.
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Affiliation(s)
- Yikuan Du
- Central Laboratory, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, 523059, People’s Republic of China
| | - Xiaolin Cai
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Bijun Xu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Yuqing Wu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Mianhai Chen
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Jinjin Wang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Bing Yuan
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Weichui Zhang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Jinfeng Zhu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Chun Yang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
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Quantitative Ultrasound Texture Feature Changes With Conservative Treatment of the Trapezius Muscle in Female Patients With Myofascial Pain Syndrome. Am J Phys Med Rehabil 2021; 100:1054-1061. [PMID: 33480607 DOI: 10.1097/phm.0000000000001697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We set out to assess whether quantitative ultrasound could be used to assess changes that occur after physical therapy in patients experiencing myofascial pain syndrome. METHODS We consecutively recruited female subjects experiencing myofascial pain syndrome of the neck and shoulder region and provided 10 sessions of conservative physical therapy. A control group was recruited for textural analyses. We measured change in pain ratings, range of motion, and ultrasound texture features before and after the intervention and after 3 mos. RESULTS We recruited 63 female myofascial pain syndrome subjects and 20 healthy controls. After treatment, the mean blob size (an ultrasound texture feature) value for each subject decreased from 30.84 ± 5.00 to 25.86 ± 5.67 on the right and decreased from 31.70 ± 5.51 to 28.08 ± 5.53 on the left (P < 0.0005). The blob count showed a significant increase only on the left side (P < 0.01). Corresponding to this were reductions in pain and disability scores after treatment and at 3 mos compared with retreatment (P < 0.0005 for all checkpoints). Cervical range of motion values were significantly increased only at 3 mos compared with pretreatment except for mean flexion range of motion. CONCLUSIONS Ultrasound texture feature of blob size and count changes correspond to routine clinical outcomes after conservative physical therapy of myofascial pain syndrome in female individuals.
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Dry needling has lasting analgesic effect in shoulder pain: a double-blind, sham-controlled trial. Pain Rep 2021; 6:e939. [PMID: 34235343 PMCID: PMC8240781 DOI: 10.1097/pr9.0000000000000939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Dry needling has analgesic effects in shoulder pain associated with myofascial pain syndrome. The analgesic effects last for up to 1 week. Introduction: Myofascial pain syndrome (MPS) affects most patients with chronic shoulder pain. Dry needling (DN) is a common treatment for MPS, but its temporal pattern and sensory effects remain unknown. Objectives: We evaluated in a randomized, sham-controlled study the pattern of analgesic efficacy and local sensory changes of a single session of DN for MPS in patients with chronic shoulder pain. Methods: Patients with chronic shoulder pain were randomized into active (n = 20) or sham (n = 21) groups. A single DN was performed by a researcher blinded to group assignment and pain outcomes. Pain intensity was assessed by the numeric rating score, and sensory thresholds were evaluated with a quantitative sensory testing protocol, including the area of tactile sensory abnormalities 7 days before needling, right before, and 7 days after the intervention. Results: Dry needling led to significant larger pain intensity reduction (from 6.30 ± 2.05 to 2.40 ± 2.45 in the active group; P = 0.02, effect size = −1.3 (95% CI [−2.0 to −0.68]); (number necessary to treat = 2.1). Pain reduction scores were significantly different on the second day after needling and persisted so until the seventh day and were accompanied by improvement in other dimensions of pain and a decrease in the area of mechanical hyperalgesia in the active DN group alone (P < 0.05). Conclusion: Active trigger points DN provided analgesic effects compared with sham and decreased the area of local mechanical hyperalgesia. These findings have practical clinical implications and may provide mechanistic insights behind MPS.
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Martín-Corrales C, Bautista IV, Méndez-Mera JE, Fernández-Matías R, Achalandabaso-Ochoa A, Gallego-Izquierdo T, Nuñez-Nagy S, Pecos-Martín D. Benefits of Adding Gluteal Dry Needling to a Four-Week Physical Exercise Program in a Chronic Low Back Pain Population. A Randomized Clinical Trial. PAIN MEDICINE 2020; 21:2948-2957. [PMID: 33580803 DOI: 10.1093/pm/pnaa279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine if adding dry needling to a four-week exercise program has an additional benefit compared with adding sham dry needling to the same exercise program in subjects with chronic low back pain. DESIGN Randomized clinical trial. SETTING Physiotherapy and Pain Clinic of Alcala University. SUBJECTS Forty-six patients with chronic low back pain. METHODS Subjects were randomized to two groups: the dry needling group (N = 23) or sham dry needling group (N = 23). Both groups received a four-week exercise program and before the exercise started a session of dry needling or sham dry needling. Pain (visual analog scale), disability (Roland-Morris Questionnaire), and fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire) were assessed at baseline, after treatment, and at three-month follow-up. Pressure pain thresholds (algometer) were measured at baseline, after the dry needling or the sham dry needling, and after treatment. RESULTS Both groups showed significant improvements for all variables. In the between-group comparison, the dry needling group improved significantly in pain at three-month follow-up and pressure pain thresholds at the end of treatment for all measures, and at three-month follow-up there was no improvement in gluteus medium. CONCLUSIONS In chronic low back patients, adding dry needling to a four-week exercise program has an additional benefit in pain and sensitivity compared with adding sham dry needling to the same exercise program.
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Affiliation(s)
| | | | | | | | | | - Tomás Gallego-Izquierdo
- Research Institute of Physiotherapy and Pain. Universidad de Alcalá, Alcalá, Spain.,Department of Physical Therapy and Nursing, Universidad de Alcalá, Alcalá, Spain.,Physiotherapy and Pain Group, Universidad de Alcalá, Alcalá, Spain
| | - Susana Nuñez-Nagy
- Department of Physical Therapy and Nursing, Universidad de Alcalá, Alcalá, Spain
| | - Daniel Pecos-Martín
- Research Institute of Physiotherapy and Pain. Universidad de Alcalá, Alcalá, Spain.,Department of Physical Therapy and Nursing, Universidad de Alcalá, Alcalá, Spain.,Physiotherapy and Pain Group, Universidad de Alcalá, Alcalá, Spain
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Chou Y, Chiou HJ, Wang HK, Lai YC. Ultrasound-guided dextrose injection treatment for chronic myofascial pain syndrome: A retrospective case series. J Chin Med Assoc 2020; 83:876-879. [PMID: 32349034 PMCID: PMC7478217 DOI: 10.1097/jcma.0000000000000339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Due to the lack of an evidence-based consensus, managing refractory myofascial pain syndrome is challenging for clinicians. Dextrose injection (dextrose prolotherapy) emerged as a promising, cost-effective treatment. This study evaluated the efficacy of targeted ultrasound-guided dextrose injection for localized myofascial pain syndrome. METHODS We retrospectively reviewed the clinical outcomes of 45 patients with myofascial pain syndrome refractory to alternative treatments with targeted ultrasound-guided dextrose injection. Pretreatment symptom severity and symptomatic response 1 month after treatment were statistically analyzed using a visual analog scale (VAS)-based scoring system. RESULTS Of 45 patients, 8 (24.4%) reported complete resolution of symptoms at the treated site. In total, 36 (80.0%) patients reported greater than 50% improvement in their symptoms. The mean pretreatment and posttreatment VAS scores were 7.0 and 2.44 (p < 0.001), indicating an overall 65.0% reduction in symptom severity. CONCLUSION Targeted ultrasound-guided dextrose injection was remarkably effective for refractory localized myofascial pain syndrome, significantly reducing symptom intensities in the majority of treated patients within 1 month after a single injection.
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Affiliation(s)
- Yen Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Address correspondence. Dr. Hong-Jen Chiou, Department of Radiology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (H.-J. Chiou)
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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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.
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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
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Abstract
PURPOSE OF REVIEW Myofascial pain syndrome (MPS) is a musculoskeletal pain condition that stems from localized, taut regions of skeletal muscle and fascia, termed trigger points. The purpose of this comprehensive review is to provide updated information on prevalence, pathophysiology, and treatment modalities with a focus on interventional modalities in managing MPS. RECENT FINDINGS Though MPS can present acutely, it frequently presents as a chronic condition, affecting up to 85% of adults during their lifetime. MPS is an often-overlooked component of pain with overarching effects on society, including patient quality of life, physical and social functioning, emotional well-being, energy, and costs on health care. The prevalence of MPS is generally increased among patients with other chronic pain disorders and has been associated with various other conditions such as bladder pain syndrome, endometriosis, and anxiety. MPS is poorly understood and remains a challenging condition to treat. Non-pharmacologic treatment modalities such as acupuncture, massage, transcutaneous electrical stimulation, and interferential current therapy may offer relief to some patients with MPS. Additional studies are warranted to get a better understanding of managing myofascial pain.
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Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019; 12:1899-1911. [PMID: 31354339 PMCID: PMC6590623 DOI: 10.2147/jpr.s154728] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023] Open
Abstract
Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not. The application of trigger point dry needling is able to reduce the excitability of the central nervous system by reducing peripheral nociception associated to the trigger point, by reducing dorsal horn neuron activity, and by modulating pain-related brainstem areas. However, the effects are mainly observed in the short-term, and effect sizes are moderateto small. Therefore, the current review proposes that the application of trigger point dry needling should be integrated into current pain neuroscience paradigm by combining its application with pain neuroscience education, graded exercise and manual therapy. Additionally, patient’s expectations, beliefs, previous experiences and patient–clinician interaction should be considered when integrating trigger point dry needling into a comprehensive treatment approach.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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12
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Chen Y, Li X, Xu J, Chen J, Huo Z, Zhang L. Acupuncture for lumbar myofascial pain Protocol for a systematic review of randomized controlled trials. Medicine (Baltimore) 2019; 98:e16271. [PMID: 31261598 PMCID: PMC6617118 DOI: 10.1097/md.0000000000016271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Lumbar myofascial pain is a major contributor to chronic low back pain. Acupuncture has been applied as an effective treatment for chronic low back pain worldwide. However, few critical systematic reviews focus on the effect of acupuncture on chronic low back pain caused by lumbar myofascial pain have been published. The study aims to evaluate the current evidence on the efficacy of acupuncture for chronic low back pain caused by lumbar myofascial pain. METHODS A total of 7 databases will be searched from their inception to March 2019, including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure database, the Chinese Biomedical database, and the Wanfang database. Randomized controlled trials (RCTs) that compared the effect of acupuncture for lumbar myofascial pain will be included. The primary outcomes will be reduction of lumbar myofascial pain assessed by Visual Analog Scale (VAS). Secondary outcomes are questionnaires to evaluate the effects of treatment on patients' daily life activities and psychological status; and adverse events. The primary and secondary outcomes will be assessed before (0 day) treatment and at 0, 7, 30, and 90 days after treatment. Data synthesis will be computed by RevManV.5.3.5 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION The study will provide evidence to illustrate acupuncture is an effective therapeutic intervention for chronic low back pain caused by lumbar myofascial pain. TRIAL REGISTRATION NUMBER PROSPERO CRD42019129735.
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Affiliation(s)
- Yupei Chen
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine
| | - Xiaohong Li
- School of Life Sciences, Beijing University of Chinese Medicine
| | - Jing Xu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine
| | - Jie Chen
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine
| | - Zejun Huo
- Department of Chinese Medicine, Peking University 3rd Hospital, Beijing, China
| | - Li Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine
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Transcutaneous Electrical Nerve Stimulation on Acupuncture Points Improves Myofascial Pain, Moods, and Sleep Quality. Rehabil Nurs 2019; 45:225-233. [PMID: 30694996 DOI: 10.1097/rnj.0000000000000198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of transcutaneous electrical nerve stimulation at acupuncture points versus trigger points on myofascial pain, moods, and sleep quality. DESIGN A randomized controlled study recruited 64 patients with spinal cord injury with myofascial pain. METHODS Outcomes of pain, moods, and sleep quality were measured and analyzed by the generalized estimation equation, analysis of covariance, and paired t test. Transcutaneous electrical nerve stimulation was applied for seven consecutive days at Hegu (LI4) and Daling (PC7) acupuncture points or myofascial trigger points. FINDING Significant differences were found in pain intensity from Day 3 forward, after controlling for confounders. Significant within-group differences were found in pain, moods, and sleep quality. CONCLUSIONS Transcutaneous electrical nerve stimulation at acupuncture and trigger points effectively improved pain, moods, and sleep quality in patients with spinal cord injury with myofascial pain. Acupuncture points had superior improvement in pain intensity and slight improvement in sleep quality than did trigger points. CLINICAL RELEVANCE Transcutaneous electrical nerve stimulation at acupuncture points could be applied for improving myofascial pain.
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Fernández-De-Las-Peñas C, Arendt-Nielsen L. Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications. Expert Rev Neurother 2017; 17:933-939. [DOI: 10.1080/14737175.2017.1359088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- César Fernández-De-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Spain
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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García-Espinoza Ó, Salas-Fraire Ó, Flores-Garza P, Salas-Longoria K, Valadez-Lira J. Analgesic effect of whole body cryotherapy in patients with trapezius myofascial pain syndrome: A longitudinal, non-blinded, experimental study. MEDICINA UNIVERSITARIA 2017. [DOI: 10.1016/j.rmu.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? Clin J Pain 2016; 32:711-8. [DOI: 10.1097/ajp.0000000000000318] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Momenzadeh S, Akhyani V, Razaghi Z, Ebadifar A, Abbasi M. Evaluation of the Effects of Intravenous and Percutaneous Low Level Laser Therapy in the Management of Shoulder Myofascial Pain Syndrome. J Lasers Med Sci 2016; 7:16-20. [PMID: 27330692 DOI: 10.15171/jlms.2016.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Myofascial pain syndrome (MPS) treatment is challenging with a high recurrence rate and still lacks a clear treatment frame. Therefore research on new, more efficient and long lasting effect treatment modalities is necessary. This study looked at the effects of intravenous laser therapy (IVL) and percutaneous low level laser (PLLL) in the management of shoulder MPS. METHODS In this randomized controlled trial, 30 patients fulfilling inclusion criteria were randomly equally allocated to 3 groups, control, IVL and PLLL. Control group received 12 sessions of placebo low level laser, IVL group received 12 sessions of IVL therapy, and PLLL group received 12 sessions of PLLL therapy. All patients were trained for better body posture, body mechanics, gentle massage of trigger points, stretching exercises of affected muscle (trapezius), and received 10 mg of oral nortriptyline regimen every night for 3 months. Outcomes included pain severity, functional disability, and quality of life. Patients were assessed using Numeric Rating Scale (NRS), Pain Disability Index (PDI), and Short Form Health Survey (SF-12). Data collected were analyzed using analysis of variance (ANOVA), Mann-Whitney and t tests. RESULTS The mean of PDI and maximum pain intensity during day and night significantly reduced in both PLLL and IVL groups compared to control group. Although pain severity and PDI reduction was more pronounced in IVL group compared to PLLL group, the differences were not statistically significant. Also, quality of life statistically significantly improved in both IVL and PLLL groups compared to control group was more, and although higher in IVL group, the difference was not statistically significant when compared to PLLL group. No side effects were observed in the intervention groups. CONCLUSION Intravenous laser and PLLL therapy had a positive effect on pain severity and PDI reduction, and quality of life in this study. Also no adverse event was recorded. Thus, intravenous lasers and PLLL therapy seem to be effective complementary modalities in managing patients with shoulder MPS.
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Affiliation(s)
- Sirous Momenzadeh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Department of Anesthesiology and Pain Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Akhyani
- Department of Anesthesiology and Pain Medicine, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Razaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Ebadifar
- Dentofacial Deformities Research Center Orthodontics Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadzaki Abbasi
- Department of Urology, Boushehr University of Medical Sciences, Boushehr, Iran
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Shanthanna H, Busse JW, Thabane L, Paul J, Couban R, Choudhary H, Kaushal A, Suzumura E, Kim I, Harsha P. Local anesthetic injections with or without steroid for chronic non-cancer pain: a protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2016; 5:18. [PMID: 26831725 PMCID: PMC4736179 DOI: 10.1186/s13643-016-0190-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/15/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Steroids are often combined with local anesthetic (LA) and injected to reduce pain associated with various chronic non-cancer pain (CNCP) complaints. The biological rationale behind injection of a steroid solution is unclear, and it is uncertain whether the addition of steroids offers any additional benefits over injection of LA alone. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using steroids and LA vs. LA alone in the treatment of CNCP. METHODS An experienced librarian will perform a comprehensive search of EMBASE, MEDLINE, and the Cochrane Central Registry of Controlled Trials (CENTRAL) databases with search terms for clinical indications, LA, and steroid agents. We will review bibliographies of all relevant published reviews in the last 5 years for additional studies. Eligible trials will be published in English and randomly allocate patients with CNCP to treatment with steroid and LA injection therapy or injection with LA alone. We will use the guidelines published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes that we collect and present. Teams of reviewers will independently and in duplicate assess trial eligibility, abstract data, and assess risk of bias among eligible trials. We will prioritize intention to treat analysis and, when possible, pool outcomes across trials using random effects models. We will report our findings as risk differences, weighted mean differences, or standardized mean differences for individual outcomes. Further, to ensure interpretability of our results, we will present risk differences and measures of relative effect for pain reduction based on anchor-based minimally important clinical differences. We will conduct a priori defined subgroup analyses and use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the certainty of the evidence on an outcome-by-outcome basis. DISCUSSION Our review will evaluate both the effectiveness and the adverse events associated with steroid plus LA vs. LA alone for CNCP, evaluate the quality of the evidence using the GRADE approach, and prioritize patient-important outcomes guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with chronic non-cancer pain and identify key areas for future research. TRIAL REGISTRATION PROSPERO CRD42015020614.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada.
| | - Jason W Busse
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - Lehana Thabane
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - James Paul
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada.
| | - Rachel Couban
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada.
| | - Harman Choudhary
- Department of Orthopedics, McMaster University, Hamilton, Canada.
| | - Alka Kaushal
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Erica Suzumura
- Research Institute - Hospital do Coração (HCor), São Paulo, Brazil.
| | - Isabel Kim
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Hamilton, Canada.
| | - Prathiba Harsha
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Roldan CJ, Hu N. Myofascial Pain Syndromes in the Emergency Department: What Are We Missing? J Emerg Med 2015; 49:1004-10. [PMID: 26153029 DOI: 10.1016/j.jemermed.2015.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/24/2015] [Accepted: 04/16/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Myofascial pain syndrome (MPS), pain originating in the myofascial tissue, is a widely recognized pathology characterized by the presence of referred pain (often distant from its origin and specific to each muscle) that can resemble other pathologies and by the presence of a trigger point, a localized hyperirritable band able to reproduce the pain and its associated symptoms. Patients with acute or chronic MPS are commonly seen in the emergency department (ED), usually complaining of pain of undetermined origin. Traditionally, the emergency physician (EP) is not trained to diagnose and treat MPS, and many patients with MPS have received less than optimal management of this condition in the ED. Many types of treatments are known to be effective against MPS. Among these, trigger point injection (TPI) is considered a practical and rapid approach that can be carried out in the ED by EPs. OBJECTIVE This article reviews the current diagnostic methods, treatment options, and procedures for MPS patients seen in the ED to enable EPs to diagnose and successfully treat this condition. DISCUSSION This article discusses the clinical characteristics, etiology, diagnosis, and treatment of MPS in the ED, including a description of performing TPI. CONCLUSIONS MPS can mimic other clinical conditions commonly seen in the ED. MPS can be diagnosed on the basis of clinical findings; in many cases, no imaging or laboratory testing is needed. Therefore, MPS diagnosis and treatment can be successfully accomplished in the ED by EPs.
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Affiliation(s)
- Carlos J Roldan
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Na Hu
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Lisi AJ, Breuer P, Gallagher RM, Rodriguez E, Rossi MI, Schmader K, Scholten JD, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part II: Myofascial Pain. PAIN MEDICINE 2015; 16:1282-9. [DOI: 10.1111/pme.12821] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/22/2015] [Accepted: 05/02/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Anthony J. Lisi
- VA Connecticut Healthcare System
- Rehabilitation and Prosthetics Services; Veterans Health Administration
- University of Bridgeport College of Chiropractic
| | - Paula Breuer
- University of Pittsburgh Medical Center Centers for Rehab Services
| | - Rollin M. Gallagher
- Departments of Psychiatry
- Department of Anesthesiology; University of Pennsylvania
- Pain Service; Philadelphia VA Medical Center
| | - Eric Rodriguez
- Division of Geriatric Medicine; Department of Medicine; University of Pittsburgh School of Medicine
| | - Michelle I. Rossi
- Division of Geriatric Medicine; Department of Medicine; University of Pittsburgh School of Medicine
- Geriatric Research, Education & Clinical Center (GRECC), VA Pittsburgh Healthcare System
| | - Kenneth Schmader
- Durham VA Medical Center; GRECC
- Department of Medicine; Duke University Medical Center, Division of Geriatrics
| | - Joel D. Scholten
- Washington DC VA Medical Center
- Rehabilitation and Prosthetics Services; Veterans Health Administration
| | - Debra K. Weiner
- Division of Geriatric Medicine; Department of Medicine; University of Pittsburgh School of Medicine
- Geriatric Research, Education & Clinical Center (GRECC), VA Pittsburgh Healthcare System
- Department of Psychiatry
- Anesthesiology
- Clinical and Translational Science Institute, University of Pittsburgh; Pittsburgh PA
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Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford) 2014; 54:392-9. [PMID: 25477053 DOI: 10.1093/rheumatology/keu471] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore, the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced.
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Affiliation(s)
- John L Quintner
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Geoffrey M Bove
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Milton L Cohen
- Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia
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Kim DH, Yoon KB, Park S, Jin TE, An YJ, Schepis EA, Yoon DM. Comparison of NSAID Patch Given as Monotherapy and NSAID Patch in Combination with Transcutaneous Electric Nerve Stimulation, a Heating Pad, or Topical Capsaicin in the Treatment of Patients with Myofascial Pain Syndrome of the Upper Trapezius: A Pilot Study. PAIN MEDICINE 2014; 15:2128-38. [DOI: 10.1111/pme.12611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms.
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Affiliation(s)
- Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 300 First Avenue, Boston, MA 02129, USA.
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 300 First Avenue, Boston, MA 02129, USA
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A closer look to botulinum neurotoxin type A-induced analgesia. Toxicon 2013; 71:134-9. [PMID: 23747735 DOI: 10.1016/j.toxicon.2013.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/10/2013] [Accepted: 05/14/2013] [Indexed: 11/20/2022]
Abstract
Chronic pain indicates a type of pain that lasts over time and is accompanied by diagnostic and therapeutic difficulties. It follows that treatment failures are common and patients roam from doctor to doctor in search of an effective care program. So there is an urgent need for long-acting and effective therapeutics to alleviate symptoms of the varied forms of chronic pain. During the past few years, a good success has been achieved with a derivative of a neurotoxin. It has been shown that administration of this toxin can block the release of neurotransmitters and pain mediators. Botulinum neurotoxin type A (BoNT/A) is well known as a treatment for neuromuscular conditions such as dystonia and spasticity. However, the clinical application for BoNT/A has continued to expand. Its analgesic effect has been used in clinical practice with satisfactory results. This review provides an introduction of a hypothesis for the mechanism by which BoNT/A eases chronic pain. It also summarizes the clinical therapeutic effects of BoNT/A in different types of chronic pain and its potential prospects.
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