The Effect of High-Power Pain Threshold Ultrasound Therapy on the Electrical Activity of Trigger Points and Local Twitch Response on Electromyography: A Preliminary Study

The immediate effects of deep transverse friction massage, high- power pain threshold ultrasound and whole body vibration on active myofascial trigger points

BACKGROUND

The most important clinical problem in myofascial pain syndrome (MPS) is trigger points (TrPs). The aim of the present study was to investigate the comparison of immediate effect of deep transverse friction massage (DTFM), high-power pain threshold ultrasound (HPPTUS), and whole body vibration (WBV) on treatment of active myofascial trigger points (MTrPs).

MATERIALS AND METHODS

sixty six men with active TrPs of upper trapezius muscle were randomly divided into three equal groups: DTFM, HPPT US, and WBV. Pain intensity based on the Visual Analogue Scale (VAS), pressure pain threshold (PPT) and active contralateral lateral flexion range of motion (CLF ROM) of the neck were evaluated before and immediately after the interventions.

RESULTS

The VAS, PPT and the active CLF ROM were substantially improved after intervention in all groups (P < 0.01). When the three groups were compared regarding VAS, participants in the WBV group reported significantly more reduction in pain (P < 0.01). On comparing the interventions, there were no significant differences in PPT values (P > 0.05). The CLF ROM value in HPPTUS and WBV groups have significant increase in comparison to the DTFM group.

CONCLUSION

All three interventions can improve neck pain, PPT and ROM in participants with active TrPs in upper trapezius muscle, but due to the fact that the DTFM has more pressure on therapist fingers, and the HPPTUS technique requires proper interaction with the participants, WBV can be used as one of the effective intervention on active MTrPs of upper trapezius.

CLINICAL TRIAL REGISTRATION NUMBER

IRCT20200518047498N1.

Comparison of High Power Pain Threshold Ultrasound and Ischemic Compression Techniques for the Treatment of Latent Myofascial Trigger Points: A Randomized Controlled Study

Objective Myofascial trigger points (MTrPs) have been defined as discrete and hyperirritable areas located within a taut band of skeletal muscle or fascia, which when compressed produce pain, tenderness, dysfunction and autonomic phenomena. The treatment techniques aimed to return the fiber groups to their optimum length and end plates to their optimum function. Ischemic Compression (IC) and of High Power Pain Threshold Ultrasound (HPPT-US) are among the treatment techniques used for MTrPs. The aim of the current study is to compare the efficacy of IC and HTTP-US which was applied in different ways on MTrPs treatment.

Patients and Methods This is a randomized prospective study conducted with 153 participants have at least three latent trigger points. Participants received HPPT-US technique in which the intensity is kept constant at the pain level, HPPT-US technique in which the intensity is kept constant at half the pain level or IC. Outcome measures were the Visual Analog Scale, Beck Depression Inventory, Neck Pain and Disability Scale, number of deactivated MTrPs and Pain Pressure Threshold (PPT).

Results Pain, psychological status and disability improved in each group; there was no significant difference between the groups (p>0.05). PPT increased in each group; a significant difference was found between the groups (p<0.05). IC was slightly more effective than HPPT-US.

Conclusion Our results have shown that HPPT-US which was applied in different ways and IC were effective therapies for latent trigger points.

WITHDRAWN: Acupuncture for neck disorders

BACKGROUND

Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic.

OBJECTIVES

To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.

SELECTION CRITERIA

We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs).

DATA COLLECTION AND ANALYSIS

Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models.

MAIN RESULTS

Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I2 = 20%). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence.

AUTHORS' CONCLUSIONS

Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.

Acupuncture for neck disorders

BACKGROUND

Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic.

OBJECTIVES

To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.

SELECTION CRITERIA

We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs).

DATA COLLECTION AND ANALYSIS

Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models.

MAIN RESULTS

Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I(2) = 20%). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence.

AUTHORS' CONCLUSIONS

Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.

Effectiveness of dry needling on reducing pain intensity in patients with myofascial pain syndrome: a Meta-analysis

OBJECTIVE

To summarize the literature about the effectiveness of dry needling (DN) on relieving pain and increasing range of motion (ROM) in individuals with myofascial pain syndrome (MPS).

METHODS

Papers published from January 2000 to January 2013 were identified through an electronic search in the databases MEDLINE, Dialnet, Cochrane Library Plus, Physiotherapy Evidence Data-base (PEDro) and Spanish Superior Council of Scientific Research (CSIC). The studies included were randomized controlled trials written in English and/or Spanish about the effectiveness of DN on pain and ROM in individuals with MPS.

RESULTS

Out of 19 clinical trials that were potentially relevant, a total of 10 were included in the Meta-analysis. Regarding pain intensity reduction when measured before and immediately after the intervention, DN achieved improvement compared with the placebo treatment [d = - 0.49; 95% CI (- 3.21, 0.42)] and with the control group [d = - 9.13; 95% C (- 14.70, - 3.56)]. However, other treatments achieved better results on the same variable compared with DN, considering the measurements for pre-treatment and immediately after [d = 2.54; 95% CI (- 0.40, 5.48)], as well as the pre-treatment and after 3-4 weeks [d = 4.23; 95% CI (0.78, 7.68)]. DN showed a significantly increased ROM when measured before the intervention and immediately after, in comparison with the placebo [d = 2.00; 95% C (1.60, 2.41)]. However, other treatments achieved a significant better result regarding ROM when it was measured before the intervention and immediately after, as compared with DN [d = - 1.42; 95% CI (- 1.84, - 0.99)].

CONCLUSION

DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3-4 weeks. However, on increasing ROM, DN was more effective comparing to that of placebo group, but less than other treatments.

Effect of lidocaine patches on upper trapezius EMG activity and pain intensity in patients with myofascial trigger points: A randomized clinical study

OBJECTIVE

To compare the effects of 5% lidocaine patches and placebo patches on pain intensity and electromyographic (EMG) activity of an active myofascial trigger point (MTrP) of the upper trapezius muscle.

MATERIALS AND METHODS

Thirty-six patients with a MTrP in the upper trapezius muscle were randomly divided into two groups: 20 patients received lidocaine patches (lidocaine group) and 16 patients received placebo patches (placebo group). They used the patches for 12 h each day, for 2 weeks. The patch was applied to the skin over the upper trapezius MTrP. Spontaneous pain, pressure pain thresholds, pain provoked by a 4-kg pressure applied to the MTrP and trapezius EMG activity were measured before and after treatment.

RESULTS

Baseline spontaneous pain values were similar in both groups and significantly lower in the lidocaine group than the placebo group after treatment. The baseline pressure pain threshold was significantly lower in the lidocaine group, but after treatment it was significantly higher in this group. Baseline and final values of the pain provoked by a 4-kg pressure showed no significant difference between the groups. Baseline EMG activity at rest and during swallowing of saliva was significantly higher in the lidocaine group, but no significant difference was observed after treatment. Baseline EMG activity during maximum voluntary clenching was similar in both groups, but significantly higher in the lidocaine group after treatment.

CONCLUSIONS

These clinical and EMG results support the use of 5% lidocaine patches for treating patients with MTrP of the upper trapezius muscle.

A comparison of the effectiveness of low-, moderate- and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome

OBJECTIVE

This study aimed to compare and evaluate the effects of ultrasound (US) treatment applied at low-, medium- and high-power-pain threshold (HPPT) doses to trigger points in the treatment of myofascial pain syndrome (MPS).

METHODS

The study comprised 61 (40 female and 21 male) patients diagnosed with MPS, aged between 18 and 60 years. The patients were randomly allocated to three groups for the US application at different dosages. Group I patients received treatment of medium-dose US (1.5 Watt/cm(2)), Group II received HPPT US, and Group III received low-dose US (0.5 W/cm(2)). The patients were evaluated pre-treatment and 3 weeks after treatment in respect of visual analogue scale (VAS) scores, number of trigger points (NTP), pressure pain threshold (PPT), Range of Tragus-Acromioclavicular joint (RT-AJ) and neck pain disability scores (NPDS).

RESULTS

A significant improvement was determined after treatment in all scores except PPT in Group I, in all scores in Group II, and only in the VAS score in Group III. When the groups were compared post-treatment in respect of improvement in NTP, VAS, RT-AJ and NPDS scores, Group II showed significant superiority over Group I, and Group I was determined to have significant superiority over Group III in respect of VAS, RT-AJ and NPDS scores (p < 0.05).

CONCLUSIONS

In the treatment of MPS, US therapy at HPPT dose can be considered as an alternative therapy method, which is more economical and more effective than low-dose and conventional US therapy.