1
|
Agarwal S, Bedekar N, Shyam A, Sancheti P. Comparison between effects of instrument-assisted soft tissue mobilization and manual myofascial release on pain, range of motion and function in myofascial pain syndrome of upper trapezius - A randomized controlled trial. Hong Kong Physiother J 2024; 44:57-67. [PMID: 38577397 PMCID: PMC10988271 DOI: 10.1142/s1013702524500069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 04/06/2024] Open
Abstract
Background Myofascial pain syndrome (MPS) is a muscle pain disorder characterized by the presence of Myofascial Trigger Point (MTrP) within a taut band, local tenderness, referral of pain to a distant site, restricted range of motion, and autonomic phenomena. The upper trapezius is the muscle most often affected by MTrPs. Manual myofascial release (MFR) and Instrument-Assisted Soft Tissue Mobilization (IASTM) are techniques of soft tissue release that are used to resolve MPS. Fifty six percent of physiotherapists complain of pain in multiple areas due to the massage and manual therapy that they have to perform. Objective The objective of this study is to find whether IASTM is better than manual MFR in treating patients with MPS in upper trapezius. Methods This study was a single-blinded randomized controlled trial that included 31 participants, both males and females between the age groups of 18-50 years. Participants were randomly divided into two groups. Three sessions were given over a period of one week for both groups. Group A received IASTM along with conventional treatment and Group B received Manual MFR along with the conventional treatment. The outcome measures evaluated were pain, cervical range of motion, pain pressure threshold (PPT) of trigger points, and the neck disability index. Pre- and post-measurements were taken and the analysis was done. Results Both the treatment methods significantly reduced pain, improved PPT, range of motion, and function. The effects between the groups showed that IASTM was significantly better than manual MFR to reduce pain. The improvement in PPT, range of motion and function were equal in both the groups. Conclusion IASTM and manual MFR both are effective individually as treatment procedures for pain, PPT, range of motion, and function. Neither of the treatment options can be considered better that the other. The clinician can decide based on the availability of the instrument, training, patient's preference, and his/her comfort whether which of the two treatment methods should be used.
Collapse
Affiliation(s)
- Shweta Agarwal
- Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Shivajinagar, Pune, India
| | - Nilima Bedekar
- Department of Academic Research, Sancheti Institute for Orthopaedics and Rehabilitation, Shivajinagar, Pune, India
| | - Ashok Shyam
- Department of Academic Research, Sancheti Institute for Orthopaedics and Rehabilitation, Shivajinagar, Pune, India
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation, Shivajinagar, Pune, India
| |
Collapse
|
2
|
Zuo C, Zheng Z, Ma X, Wei F, Wang Y, Yin Y, Liu S, Cui X, Ye C. Efficacy of Core Muscle Exercise Combined with Interferential Therapy in Alleviating Chronic Low Back Pain in High-Performance Fighter Pilots: A Randomized Controlled Trial. BMC Public Health 2024; 24:700. [PMID: 38443845 PMCID: PMC10913547 DOI: 10.1186/s12889-024-18177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Chronic low back pain (LBP) related to flight is a prevalent health issue in military aviation, impacting pilots. The objective of this investigation was to ascertain if the application of core muscle training in conjunction with interferential current (IFC) therapy results in a reduction in pain severity and associated disability, consequently enhancing core muscle functionality in Chinese Air Force high-performance fighter pilots experiencing chronic LBP. METHODS Fifty-three fighter pilots with chronic LBP were randomized into 3 groups: a core muscle exercise combined with IFC group (CG, n = 19), a core muscle exercise group (EG, n = 19), and an IFC group (IG, n = 15). The three groups underwent therapeutic intervention 5 times a week for 12 weeks. The primary outcomes were pain intensity, Oswestry Disability Index (ODI) score and SF-12 health-related quality of life (PCS and MCS) score. Secondary outcomes included evaluations of trunk muscle strength, endurance, and range of motion (ROM) during medial/lateral rotation to assess muscle functionality. Measurements were obtained both before and after the implementation of the intervention therapy. RESULTS After 12 weeks of intervention therapy, all the health condition parameters significantly improved among the three groups. However, the CG had a significant improvement in pain intensity compared to the EG (MD = - 0.84 scores; 95% CI = - 1.54 to - 0.15; p = 0.013) and the IG (MD = - 1.22 scores; 95% CI = - 1.96 to - 0.48; p = 0.000). Additionally, the CG led to greater conservation of ODI and improved SF-12 PCS scores than did the IG (p < 0.05). Finally, compared with those at baseline, the core muscle function parameters in the CG and EG improved significantly at the end of the study, but no statistically significant differences were observed between the two groups (p > 0.05). CONCLUSION Among participants with chronic LBP, three intervention therapies appear effective in reducing pain, diminishing disability, and enhancing quality of life. Also, combined therapy significantly improved pain and disability compared to the other two monotherapies; moreover, combined therapy and core muscle exercise provided similar benefits in terms of core muscle function after 12 weeks of intervention therapy.
Collapse
Affiliation(s)
- Chongwen Zuo
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Zhiyang Zheng
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
- Beijing Sports University, 100091, Beijing, China
| | - Xiaoyan Ma
- Tianjin University, 300072, Tianjin, China
| | - Fen Wei
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Yushui Wang
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Yi Yin
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Shuai Liu
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Xiaosong Cui
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China
| | - Chaoqun Ye
- Department of Rehabilitation Medicine, Air Force Medicine Centre of Chinese PLA, 100142, Beijing, China.
| |
Collapse
|
3
|
Gross AR, Lee H, Ezzo J, Chacko N, Gelley G, Forget M, Morien A, Graham N, Santaguida PL, Rice M, Dixon C. Massage for neck pain. Cochrane Database Syst Rev 2024; 2:CD004871. [PMID: 38415786 PMCID: PMC10900303 DOI: 10.1002/14651858.cd004871.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Massage is widely used for neck pain, but its effectiveness remains unclear. OBJECTIVES To assess the benefits and harms of massage compared to placebo or sham, no treatment or exercise as an adjuvant to the same co-intervention for acute to chronic persisting neck pain in adults with or without radiculopathy, including whiplash-associated disorders and cervicogenic headache. SEARCH METHODS We searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, Index to Chiropractic Literature, trial registries) to 1 October 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any type of massage with sham or placebo, no treatment or wait-list, or massage as an adjuvant treatment, in adults with acute, subacute or chronic neck pain. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. We transformed outcomes to standardise the direction of the effect (a smaller score is better). We used a partially contextualised approach relative to identified thresholds to report the effect size as slight-small, moderate or large-substantive. MAIN RESULTS We included 33 studies (1994 participants analysed). Selection (82%) and detection bias (94%) were common; multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding to the placebo was effective. Massage was compared with placebo (n = 10) or no treatment (n = 8), or assessed as an adjuvant to the same co-treatment (n = 15). The trials studied adults aged 18 to 70 years, 70% female, with mean pain severity of 51.8 (standard deviation (SD) 14.1) on a visual analogue scale (0 to 100). Neck pain was subacute-chronic and classified as non-specific neck pain (85%, including n = 1 whiplash), radiculopathy (6%) or cervicogenic headache (9%). Trials were conducted in outpatient settings in Asia (n = 11), America (n = 5), Africa (n = 1), Europe (n = 12) and the Middle East (n = 4). Trials received research funding (15%) from research institutes. We report the main results for the comparison of massage versus placebo. Low-certainty evidence indicates that massage probably results in little to no difference in pain, function-disability and health-related quality of life when compared against a placebo for subacute-chronic neck pain at up to 12 weeks follow-up. It may slightly improve participant-reported treatment success. Subgroup analysis by dose showed a clinically important difference favouring a high dose (≥ 8 sessions over four weeks for ≥ 30 minutes duration). There is very low-certainty evidence for total adverse events. Data on patient satisfaction and serious adverse events were not available. Pain was a mean of 20.55 points with placebo and improved by 3.43 points with massage (95% confidence interval (CI) 8.16 better to 1.29 worse) on a 0 to 100 scale, where a lower score indicates less pain (8 studies, 403 participants; I2 = 39%). We downgraded the evidence to low-certainty due to indirectness; most trials in the placebo comparison used suboptimal massage doses (only single sessions). Selection, performance and detection bias were evident as multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding was effective, respectively. Function-disability was a mean of 30.90 points with placebo and improved by 9.69 points with massage (95% CI 17.57 better to 1.81 better) on the Neck Disability Index 0 to 100, where a lower score indicates better function (2 studies, 68 participants; I2 = 0%). We downgraded the evidence to low-certainty due to imprecision (the wide CI represents slight to moderate benefit that does not rule in or rule out a clinically important change) and risk of selection, performance and detection biases. Participant-reported treatment success was a mean of 3.1 points with placebo and improved by 0.80 points with massage (95% CI 1.39 better to 0.21 better) on a Global Improvement 1 to 7 scale, where a lower score indicates very much improved (1 study, 54 participants). We downgraded the evidence to low-certainty due to imprecision (single study with a wide CI that does not rule in or rule out a clinically important change) and risk of performance as well as detection bias. Health-related quality of life was a mean of 43.2 points with placebo and improved by 5.30 points with massage (95% CI 8.24 better to 2.36 better) on the SF-12 (physical) 0 to 100 scale, where 0 indicates the lowest level of health (1 study, 54 participants). We downgraded the evidence once for imprecision (a single small study) and risk of performance and detection bias. We are uncertain whether massage results in increased total adverse events, such as treatment soreness, sweating or low blood pressure (RR 0.99, 95% CI 0.08 to 11.55; 2 studies, 175 participants; I2 = 77%). We downgraded the evidence to very low-certainty due to unexplained inconsistency, risk of performance and detection bias, and imprecision (the CI was extremely wide and the total number of events was very small, i.e < 200 events). AUTHORS' CONCLUSIONS The contribution of massage to the management of neck pain remains uncertain given the predominance of low-certainty evidence in this field. For subacute and chronic neck pain (closest to 12 weeks follow-up), massage may result in a little or no difference in improving pain, function-disability, health-related quality of life and participant-reported treatment success when compared to a placebo. Inadequate reporting on adverse events precluded analysis. Focused planning for larger, adequately dosed, well-designed trials is needed.
Collapse
Affiliation(s)
- Anita R Gross
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Haejung Lee
- Department of Physical Therapy, Silla University, Busan, Korea, South
| | - Jeanette Ezzo
- Research Director, JME Enterprises, Baltimore, Maryland, USA
| | - Nejin Chacko
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Geoffrey Gelley
- Applied Health Sciences PhD Program, University of Manitoba, Winnipeg, MB, Canada
- Integrative Medicine, University of Manitoba, Winnipeg, Canada
| | - Mario Forget
- Canadian Forces Health Services Group | Groupe de services de santé des Forces Canadiennes, National Defense | Défense Nationale, Kingston, Canada
| | - Annie Morien
- Research Department, Florida School of Massage, Gainesville, FL, USA
| | - Nadine Graham
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Pasqualina L Santaguida
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Craig Dixon
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
4
|
Jha AK, Gupta S, Sinha A, Tanna M, Priya L, Singh S, Gore NR. Efficacy of Two Types of Noninvasive Nerve Stimulation in the Management of Myofascial Pain Caused by Temporomandibular Joint (TMJ) Disorders. Cureus 2023; 15:e42584. [PMID: 37637545 PMCID: PMC10460256 DOI: 10.7759/cureus.42584] [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: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Background A range of diseases affecting the jaw muscles and/or temporomandibular joint are referred to as temporomandibular disorders (TMDs). Nearly 80% of the general population is affected by TMDs, and 48% of those people have trouble opening their mouths and have painful muscles. Aim To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) and microcurrent nerve stimulation (MENS) for the relief of masticatory muscle discomfort. Methods Groups I and II were further separated into two groups of 30 persons each (A and B), as well as subgroups C and D. Subjects in Group I received TENS treatment for 20 minutes at frequencies of 0-5 and 5-5 for subgroups A and B, and with visual analog scale (VAS) scores of 1-5 and 6-10 for subgroups C and D, respectively. Subjects in Group II received MENS for 20 minutes, with subgroups C and D receiving the same frequency and VAS score as subgroups A and B, respectively. All individuals underwent treatment with a comparable frequency and length of time every day for five days. Results For subgroup D treated with MENS, there was a considerable reduction in pain; however, for subgroups A and C, there was a comparable reduction in the VAS score for both groups treated with MENS and TENS therapy. Conclusion Compared to TENS, MENS provides quicker and more effective pain relief. Paresthesia and tingling are two adverse effects of TENS that are not present with MENS. However, MENS and TENS are equally helpful at treating masticatory muscle discomfort that is both acute and chronic, as well as improving mouth opening.
Collapse
Affiliation(s)
- Awanindra K Jha
- Department of Orthodontics and Dentofacial Orthopaedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi, IND
| | - Sweta Gupta
- Departmental of Orthodontics and Dentofacial Orthopedics, Patna Dental College and Hospital, Patna, IND
| | - Abhishek Sinha
- Department of Dentistry, Patna Medical College, Patna, IND
| | - Medha Tanna
- Departmental of Orthodontics and Dentofacial Orthopedics, Government Dental College and Hospital, Mumbai, IND
| | - Leena Priya
- Department of Oral Medicine and Radiology, Patna Medical College and Hospital, Patna, IND
| | - Shailee Singh
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Research Center, Udaipur, IND
| | - Navmi R Gore
- Department of Dentistry, Dr. Vasantrao Pawar Medical College and Research Centre, Nashik, IND
| |
Collapse
|
5
|
He P, Fu W, Shao H, Zhang M, Xie Z, Xiao J, Li L, Liu Y, Cheng Y, Wang Q. The effect of therapeutic physical modalities on pain, function, and quality of life in patients with myofascial pain syndrome: a systematic review. BMC Musculoskelet Disord 2023; 24:376. [PMID: 37173661 PMCID: PMC10176871 DOI: 10.1186/s12891-023-06418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) is a common musculoskeletal pain and dysfunction, which is characterised by myofascial trigger points. Therapeutic physical modalities, as potentially effective treatment options, are commonly used in the clinical setting for the patients with MPS. OBJECTIVE This systematic review aimed to evaluate the safety and effectiveness of therapeutic physical modalities in the treatment of MPS, investigate its therapeutic mechanisms and provide a scientific evidence-based decision. METHODS According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Cochrane Central Library, Embase, and CINAHL databases were searched for randomized controlled clinical studies published from database inception to October 30, 2022. A total of 25 articles met the study inclusion criteria. Data were extracted from these studies and a qualitative analysis was performed. RESULTS Transcutaneous electrical nerve stimulation therapy, extracorporeal shock wave therapy, laser therapy, and other therapeutic physical modalities have been demonstrated to improve the pain symptoms, joint mobility, psychological state, and quality of life in the patients with MPS and no side effects have been reported. The curative effect of therapeutic physical modalities was found to be possibly associated with increased blood perfusion and oxygen supply in ischaemic tissues, reduced hyperalgesia in the peripheral and central nerves, and decreased involuntary muscle contractions. CONCLUSION The systematic review has shown that therapeutic physical modalities could provide a safe and effective therapeutic option for MPS. However, the consensus is currently lacking regarding the optimal treatment paradigm, therapeutic parameters, and mutual combination of therapeutic physical modalities. The clinical trials with robust quality are required to further promote the evidence-based application of therapeutic physical modalities for MPS.
Collapse
Affiliation(s)
- Peijue He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Wenxuan Fu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hang Shao
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Meng Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhuoli Xie
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Juan Xiao
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lijuan Li
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yiwei Liu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yi Cheng
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China.
| |
Collapse
|
6
|
Hussein HM, Alshammari RS, Al-Barak SS, Alshammari ND, Alajlan SN, Althomali OW. A Systematic Review and Meta-analysis Investigating the Pain-Relieving Effect of Interferential Current on Musculoskeletal Pain. Am J Phys Med Rehabil 2022; 101:624-633. [PMID: 34469914 DOI: 10.1097/phm.0000000000001870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interferential current is one of the most common electrotherapeutic modalities used in the treatment of painful conditions. Patients seeking medical help to reduce their musculoskeletal pain can be treated using interferential current. OBJECTIVE The current review aimed to analyze the recently available information regarding the efficacy of interferential current in alleviating the pain of musculoskeletal origin. METHODS This study used Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, and EBSCOas as data sources. The initial selection of the studies, thorough assessment of the full articles, and extraction of the necessary study characteristics were carried out by two independent reviewers. Another two independent reviewers assessed the methodological quality of each included trial against 39 criteria. These criteria were integrated from several popular scales. Pain intensity-measured using the visual analog scale, numeric pain rating scale, or McGill Pain Questionnaire-was the outcome of interest. RESULTS This review included 35 trials of variable methodological quality from which 19 trials were selected for the meta-analysis. In general, interferential current alone versus placebo demonstrated a significant pain-relieving effect. On the other hand, interferential current showed no significant difference when added to standard treatment compared with placebo plus standard treatment or standard treatment alone. Similarly, interferential current showed no significant difference when compared with other single interventions (laser, transcutaneous electrical nerve stimulation, cryotherapy). CONCLUSIONS Interferential current alone is better than placebo at discharge. However, the low number of studies raises suspicions about this conclusion. Interferential current alone or added to other interventions is not more effective than comparative treatments in relieving musculoskeletal pain.
Collapse
Affiliation(s)
- Hisham M Hussein
- From the Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha'il, Saudi Arabia (HMH, RSA, SSA-B, NDA, SNA, OWA); and Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt (HMH)
| | | | | | | | | | | |
Collapse
|
7
|
Johnson MI, Paley CA, Wittkopf PG, Mulvey MR, Jones G. Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060803. [PMID: 35744066 PMCID: PMC9230499 DOI: 10.3390/medicina58060803] [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: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.
Collapse
Affiliation(s)
- Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Correspondence: ; Tel.: +44-113-812-30-83
| | - Carole A. Paley
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Research & Development Department, Airedale NHS Foundation Trust, Steeton, Keighley BD20 6TD, UK
| | - Priscilla G. Wittkopf
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| | - Matthew R. Mulvey
- Academic Unit of Primary and Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK;
| | - Gareth Jones
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| |
Collapse
|
8
|
Naqvi WM, Quraishi MF, Arora SP, Goyal C. A Novel Method for Muscle Elongation in Myalgia with Naqvi's-Dynamic Electrical Therapy Approach (DELTA)©: The First-Ever Case Report. Cureus 2022; 14:e23075. [PMID: 35419248 PMCID: PMC8995098 DOI: 10.7759/cureus.23075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Lifestyle-related neck and shoulder pain can be attributed to trapezius myalgia (TM) in a significant number of cases. Apart from pain, manifestations of TM include tightness of the trapezius muscle, especially in the upper fibres. Naqvi's-Dynamic Electrical Therapy Approach (Naqvi's-DELTA)© is a novel electrotherapeutic intervention based on the principle of myofibril elongation obtained by interference of poled vector current that is moved along the length of muscle fibres. A 22-year-old male approached the physiotherapy outpatient department (OPD) with the chief complaint of persistent neck pain and stiffness for three years that adversely affected his activities of daily living (ADLs). The pain was evaluated using a visual analog scale (VAS), restrictions in the range of motion (ROM) were determined by the cervical range of motion (CROM) device, and limitations in ADLs were assessed by neck disability index (NDI). Naqvi's-DELTA© was administered once a day for seven days, with each session lasting for 15 minutes. After the intervention, an evident beneficial effect was noted in all outcomes measures suggesting that this novel method was effective in decreasing pain, stiffness, and limitations in ADLs. Further investigation to explore this method for myalgia management is warranted.
Collapse
|
9
|
Ebadi S, Alishahi V, Ahadi T, Raissi GR, Khodabandeh M, Haqiqatshenas H, Sajadi S. Acupuncture-like versus conventional transcutaneous electrical nerve stimulation in the management of active myofascial trigger points: A randomized controlled trial. J Bodyw Mov Ther 2021; 28:483-488. [PMID: 34776182 DOI: 10.1016/j.jbmt.2021.06.016] [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: 10/14/2020] [Revised: 04/13/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. The transcutaneous electrical nerve stimulation (TENS) is a non-expensive, safe, feasible modality, used recently for the treatment of MPS with promising but limited results. The purpose of this study was to determine the efficacy of acupuncture-like TENS (AL-TENS) vs conventional TENS (C-TENS) in the treatment of active myofascial trigger points. METHODS This randomized controlled trial study was carried out with 60 consecutive patients with active trapezius trigger points referred to Physical Medicine and Rehabilitation Clinic. Participants randomly assigned to receive AL-TENS, C-TENS or sham TENS (S-TENS). The Visual Analogue Scale (VAS), Pressure Pain Thresholds (PPTs), and neck range of motion (ROM) were measured at baseline, after the first treatment sessions, after the final treatment session, and 3 months after the end of the last treatment session. Patients function was evaluated by Disabilities of the Arm, Shoulder, and Hand (DASH) at baseline, after the final treatment sessions, and 3 months after the end of intervention. RESULTS The interaction effect of time and group was significantly different when evaluating VAS (df = 4.65, F = 2.50, p = 0.038) and DASH (df = 2.63, F = 7.25, p < 0.001) in favor of active groups, as well as neck total lateral bending in favor of AL-TENS group compared other two groups (df = 4.16, F = 5.23, p = 0.001). Both VAS and DASH improved significantly at all follow-ups in AL-TENS and C-TENS groups. Of note, significant immediate improvement in all outcomes was observed only with AL-TENS. CONCLUSIONS According to the present study, both AL-TENS and C-TENS were superior to placebo in pain reduction and functional improvement. Although both TENS techniques have similar efficiency on pain reduction, functional and pain perception improvement, the AL-TENS was the superior approach when evaluating neck lateral bending ROM.
Collapse
Affiliation(s)
- Safoora Ebadi
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Vajiheh Alishahi
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Tannaz Ahadi
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Gholam Reza Raissi
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mehrdad Khodabandeh
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Hosnieh Haqiqatshenas
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Simin Sajadi
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
10
|
Rampazo ÉP, Martignago CCS, de Noronha M, Liebano RE. Transcutaneous electrical stimulation in neck pain: A systematic review and meta-analysis. Eur J Pain 2021; 26:18-42. [PMID: 34288255 DOI: 10.1002/ejp.1845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this systematic review was to investigate the effectiveness of electrical stimulation (ES) for neck pain (NP). DATABASES AND DATA TREATMENT The databases CINAHL, Embase, MEDLINE (via OVID), PEDro and Web of Science were searched, with no date restrictions. Two independent reviewers selected randomized controlled trials (RCTs) reporting pain, range of motion or psychosocial factors in people with NP, in which ES was applied. Methodological quality was assessed using the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the quality of evidence. Thirty studies met eligibility criteria. RESULTS Main results showed evidence of moderate quality that ES combined with other intervention significantly decreases the pain intensity compared to other intervention immediately post-treatment and at short-term follow-up; evidence of low quality showed significant effects of ES combined with other intervention in decreasing neck disability compared to other intervention immediately post-treatment; evidence of very-low quality that ES increased the pressure pain threshold compared to placebo immediately post-treatment and that ES + other intervention also increased the pressure pain threshold compared to other intervention at short-term follow-up. CONCLUSIONS ES combined with other intervention seems to be useful to relieve pain and to improve disability in people with NP, however, more studies are needed. SIGNIFICANCE Electrical stimulation seems to be effective for improving pain intensity, immediately post-treatment in people with neck pain, mainly as an adjunct therapeutic modality. Nevertheless, high-quality RCTs are still needed to investigate the efficacy of electrical stimulation in neck pain.
Collapse
Affiliation(s)
- Érika Patrícia Rampazo
- Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Cintia Cristina Santi Martignago
- Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Marcos de Noronha
- Rural Department of Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| |
Collapse
|
11
|
Bhoi D, Jain D, Garg R, Iyengar KP, Hoda W, Vaishya R, Jain VK. Complementary and Alternative Modalities (CAM) for pain management in musculoskeletal diseases (MSDs). J Clin Orthop Trauma 2021; 18:171-180. [PMID: 34017678 PMCID: PMC8113975 DOI: 10.1016/j.jcot.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
Musculoskeletal diseases are a group of clinical conditions affecting the body's movement and remain a common source of pain affecting the quality of life. The aetio-pathological reasons for pain associated with musculoskeletal diseases can be varied and complex. Conventional medicine can treat or modify pain due to musculoskeletal diseases; however, these may be associated with some side effects and at times may not be able to relieve pain completely. These treatment modalities also have ceiling effects like doses of analgesics, the number of nerve blocks, etc. Complementary and Alternative Medicine (CAM) provides a supplementary, unconventional modality to alleviate discomfort and disability associated with these mostly chronic conditions to manage activities of daily living. These modalities have been variedly combined with conventional management for symptom control and thus improve day-to-day activities. We assess the role of commonly used CAM modalities in the management of pain arising from Musculoskeletal diseases.
Collapse
Affiliation(s)
- Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, 110029, India
| | - Dhruv Jain
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Wasimul Hoda
- Department of Superspeciality Anesthesia, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| |
Collapse
|
12
|
Albornoz-Cabello M, Barrios-Quinta CJ, Espejo-Antúnez L, Escobio-Prieto I, Casuso-Holgado MJ, Heredia-Rizo AM. Immediate clinical benefits of combining therapeutic exercise and interferential therapy in adults with chronic neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2021; 57:767-774. [PMID: 33759439 DOI: 10.23736/s1973-9087.21.06688-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Therapeutic exercise is highly recommended for the management of non-specific neck pain and has shown promising results combined with interferential current therapy. Yet, the clinical relevance of the pooled effect of these approaches remains uncertain. AIM To investigate the immediate clinical effect size of combining therapeutic exercise and interferential therapy, compared with the isolated use of therapeutic exercise, in adults with chronic non-specific neck pain. DESIGN Randomized, single-blinded, controlled, superiority trial. SETTING Outpatients, primary care center. POPULATION Forty-nine adults with chronic non-specific neck pain. METHODS Participants with neck pain (grades I or II) lasting for more than 12 weeks were allocated to a therapeutic exercise plus interferential currents group (n = 25) or to a therapeutic exercise only group (n = 24). All individuals underwent treatment 5 times a week for 2 weeks. The primary outcome was current neck pain intensity (11-point numeric pain rating scale). Secondary outcomes included neck disability (Neck Disability Index) and active cervical range-of-movement (CROM device). Measurements were taken at baseline and immediately after treatment. An intention-to-treat analysis was carried out. To quantify the effect size of the interventions, the relative risk, the absolute and relative risk reduction, and the number needed to treat were calculated. RESULTS A significant time*group effect was found for pain intensity, disability, and neck flexion and right rotation (all, p < 0.05). In the analysis for treatment benefit, the number needed to treat was 2 (95% CI: 2 to 4, p < 0.001) for neck pain and disability, and 3 (95% CI: 2 to 11, p = 0.029) for neck flexion. CONCLUSIONS Adding interferential therapy to therapeutic exercise is clinically more effective than therapeutic exercise alone to immediately improve neck pain and disability, but not active cervical range-of-movement, in adults with persistent neck pain. CLINICAL REHABILITATION IMPACT Our results suggest that this multimodal intervention can be a useful strategy for rehabilitation of patients with non-specific neck pain. This is the first study on this topic reporting findings in terms of clinical relevance, which is key to transfer research evidence into practice.
Collapse
Affiliation(s)
- Manuel Albornoz-Cabello
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapeutics, Faculty of Medicine, Extremadura University, Badajoz, Spain
| | - Isabel Escobio-Prieto
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | - María J Casuso-Holgado
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain -
| | - Alberto M Heredia-Rizo
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| |
Collapse
|
13
|
Li L, Stoop R, Clijsen R, Hohenauer E, Fernández-de-Las-Peñas C, Huang Q, Barbero M. Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review. Clin J Pain 2020; 36:955-967. [PMID: 32841969 DOI: 10.1097/ajp.0000000000000875] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to conduct an updated systematic review of diagnostic criteria for myofascial trigger points (MTrPs) used in clinical trials of physical therapy interventions from 2007 to 2019. METHODS MEDLINE and Physiotherapy Evidence Database (PEDro) were searched using the following MeSH keywords: "trigger points," "trigger point," "myofascial trigger point," "myofascial trigger points," "myofascial pain," and "myofascial pain syndrome." The MeSH keywords were combined by using Boolean operators "OR"/"AND." All physiotherapy clinical trials including patients with musculoskeletal conditions characterized by at least 1 active MTrP or latent MTrP in any body area were selected. We pooled data from an individual criterion and criteria combinations used to diagnose MTrPs. The protocol was developed in accordance with the PRISMA-P guidelines. RESULTS Of 478 possibly relevant publications, 198 met the inclusion criteria. Of these 198 studies, 129 studies (65.1%) stated specifically the diagnostic criteria used for MTrPs in the main text, 56 studies (28.3%) failed to report any method whereby MTrP was diagnosed, and 13 studies (6.6%) adopted expert-based definitions for MTrPs without specification. Of 129 studies, the 6 criteria applied most commonly were: "spot tenderness" (n=125, 96.9%), "referred pain" (95, 73.6%), "local twitch response" (63, 48.8%), pain recognition (59, 45.7%), limited range of motion" (29, 22.5%), and "jump sign" (10, 7.8%). Twenty-three combinations of diagnostic criteria were identified. The most frequently used combination was "spot tenderness," "referred pain," and "local twitch response" (n=28 studies, 22%). CONCLUSIONS A number of the included studies failed in properly reporting the MTrP diagnostic criteria. Moreover, high variability in the use of MTrP diagnostic was also observed. Spot tenderness, referred pain, and local twitch response were the 3 most popular criteria (and the most frequently used combination). A lack of transparency in the reporting of MTrP diagnostic criteria is present in the literature. REGISTRY This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO number: CRD42018087420.
Collapse
Affiliation(s)
- Lihui Li
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- School of Medicine, Southern University of Science and Technology, Shenzhen
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Rahel Stoop
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
| | - Ron Clijsen
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erich Hohenauer
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Qiangmin Huang
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
| |
Collapse
|
14
|
INYBI: A New Tool for Self-Myofascial Release of the Suboccipital Muscles in Patients With Chronic Non-Specific Neck Pain: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2020; 45:E1367-E1375. [PMID: 32796456 DOI: 10.1097/brs.0000000000003605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized, single-blinded (the outcome assessor was unaware of participants' allocation group) controlled clinical trial. OBJECTIVE To investigate the effects of myofascial release therapy (MRT) over the suboccipital muscles, compared with self-MRT using a novel device, the INYBI tool, on pain-related outcomes, active cervical mobility, and vertical mouth opening, in adults with chronic non-specific neck pain (NSNP). SUMMARY OF BACKGROUND DATA MRT is used to manage chronic musculoskeletal pain conditions, with purported positive effects. The efficacy of self-MRT, compared with MRT, has been scarcely evaluated. METHODS Fifty-eight participants (mean age of 34.6 ± 4.7 yrs; range 21-40 yrs; 77.6% females, 22.4% males) with persistent NSNP agreed to participate, and were equally distributed into an INYBI (n = 29) or a control group (n = 29). Both groups underwent a single 5-minutes intervention session. For participants in the control group, MRT of the suboccipital muscles was performed using the suboccipital muscle inhibition technique, while those in the INYBI group underwent a self-MRT intervention using the INYBI device. Primary measurements were taken of pain intensity (visual analogue scale), local pressure pain sensitivity, as assessed with an algometer, and active cervical range-of-movement. Secondary outcomes included pain-free vertical mouth opening. Outcomes were collected at baseline, immediately after intervention and 45 minutes later. RESULTS The analysis of variance (ANOVAs) demonstrated no significant between-groups effect for any variable (all, P > 0.05). In the within-groups comparison, all participants significantly improved pain-related outcomes, and showed similar positive changes for mouth opening. Cervical range-of-movement- mainly increased after intervention for participants in the control group. CONCLUSION Both, MRT and self-MRT using the INYBI, are equally effective to enhance self-reported pain intensity, and local pressure pain sensitivity in chronic NSNP patients. For cervical mobility, MRT appears to be slighlty superior, compared with the INYBI, to achieve improvements in this population. LEVEL OF EVIDENCE 2.
Collapse
|
15
|
Sadala AY, Rampazo da Silva ÉP, Liebano RE. Electroanalgesia during a carboxytherapy procedure for cellulite: a study protocol for a randomized controlled trial. Pain Manag 2020; 10:283-290. [PMID: 32781939 DOI: 10.2217/pmt-2020-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The aim of the present study is to describe a study protocol to compare different types of analgesic electrical currents on pain intensity and sensory comfort during the application of carboxytherapy for the treatment of cellulite. Seventy five women with the presence of moderate and/or severe gluteal cellulite will be randomly allocated into three groups: carboxytherapy plus transcutaneous electrical nerve stimulation, carboxytherapy plus interferential current or carboxytherapy plus Aussie current. Pain intensity, which is the primary outcome, will be measured by a numeric rating scale (0-10). The secondary outcome is sensory comfort, which will be measured using the visual analogue scale (0-10). Trial registration: Brazilian Clinical Trials Registry: ReBEC (RBR-6z82zb) www.ensaiosclinicos.gov.br/rg/RBR-6z82zb/.
Collapse
Affiliation(s)
- Adria Yared Sadala
- Physioterapeutics Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP, Brazil
| | - Érika Patrícia Rampazo da Silva
- Physioterapeutics Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP, Brazil
| | - Richard Eloin Liebano
- Physioterapeutics Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP, Brazil
| |
Collapse
|
16
|
Urits I, Charipova K, Gress K, Schaaf AL, Gupta S, Kiernan HC, Choi PE, Jung JW, Cornett E, Kaye AD, Viswanath O. Treatment and management of myofascial pain syndrome. Best Pract Res Clin Anaesthesiol 2020; 34:427-448. [PMID: 33004157 DOI: 10.1016/j.bpa.2020.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
Myofascial Pain Syndrome (MPS) is a regional pain disorder that affects every age-group and is characterized by the presence of trigger points (TrPs) within muscles or fascia. MPS is typically diagnosed via physical exam, and the general agreement for diagnostic criteria includes the presence of TrPs, pain upon palpation, a referred pain pattern, and a local twitch response. The prevalence of MPS among patients presenting to medical clinics due to pain ranges anywhere from 30 to 93%. This may be due to the lack of clear criteria and guidelines in diagnosing MPS. Despite the prevalence of MPS, its pathophysiology remains incompletely understood. There are many different ways to manage and treat MPS. Some include exercise, TrP injections, medications, and other alternative therapies. More research is needed to form uniformly-accepted diagnostic criteria and treatments.
Collapse
Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | - Amanda L Schaaf
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Soham Gupta
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Hayley C Kiernan
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Paula E Choi
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Elyse Cornett
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| |
Collapse
|
17
|
Rodríguez-Huguet M, Rodríguez-Almagro D, Rodríguez-Huguet P, Martín-Valero R, Lomas-Vega R. Treatment of Neck Pain With Myofascial Therapies: A Single Blind Randomized Controlled Trial. J Manipulative Physiol Ther 2020; 43:160-170. [DOI: 10.1016/j.jmpt.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 10/24/2022]
|
18
|
Rampazo ÉP, de Andrade ALM, da Silva VR, Back CGN, Liebano RE. Photobiomodulation therapy and transcutaneous electrical nerve stimulation on chronic neck pain patients: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19191. [PMID: 32080103 PMCID: PMC7034724 DOI: 10.1097/md.0000000000019191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chronic neck pain is a common musculoskeletal disorder that is associated with functional disability and decreased of quality of life. Electrophysical agents are commonly used to relieve pain, however the effects of combined use of these agents are little studied. The objective is to investigate the efficacy of photobiomodulation and electrical stimulation to relieve pain, both in isolation and combined. MATERIALS AND METHODS This a 4-arm randomized placebo-controlled trial with patient and evaluator blinded. This study will be performed in Department of Physical Therapy at Federal University of São Carlos, São Carlos/SP, Brazil. One hundred and forty-four patients with chronic neck pain will be randomized into 4 groups: active photobiomodulation therapy with active electrical stimulation, active photobiomodulation therapy, active electrical stimulation, or placebo treatment. They will receive 10 sessions of treatment. PRIMARY OUTCOME pain intensity (measured by pain numerical rating scale) posttreatment. SECONDARY OUTCOMES pain during movement, neck disability, range of motion, pressure pain threshold, temporal summation, conditioned pain modulation, depressive symptoms, pain catastrophizing, quality of life, analgesic intake, and global perceived effect at posttreatment (10 sessions). Pain intensity and global perceived effect will also be measured after 6 weeks randomization. DISCUSSION The findings of this study might clarify the importance of using the photobiomodulation therapy and transcutaneous electrical nerve stimulation for patients with chronic neck pain. TRIAL REGISTRATION NCT04020861. https://clinicaltrials.gov/ct2/show/NCT04020861?term=NCT04020861&draw=2&rank=1.
Collapse
|
19
|
Vaillancourt S, Coulombe-Lévêque A, Fradette J, Martel S, Naour W, da Silva RA, Léonard G. Combining transcutaneous electrical nerve stimulation with therapeutic exercise to reduce pain in an elderly population: a pilot study. Disabil Rehabil 2019; 43:2141-2148. [PMID: 31841037 DOI: 10.1080/09638288.2019.1693639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Chronic pain is a highly prevalent and debilitating condition, and there is a pressing need to find safe, effective and affordable treatments to tackle this public health issue. This pilot study aimed to assess whether therapeutic exercises supplemented by transcutaneous electrical nerve stimulation induces a greater hypoalgesic effect than therapeutic exercises supplemented by sham transcutaneous electrical nerve stimulation, in an elderly population suffering from chronic pain. MATERIALS AND METHODS Eighteen elderly participants suffering from chronic pain completed a therapeutic exercise program consisting of 45-min group sessions administered twice a week for 4 weeks. Half of the participants received real transcutaneous electrical nerve stimulation during the exercise sessions, while the others received sham transcutaneous electrical nerve stimulation. Participants completed pain questionnaires (McGill Pain Questionnaire, Brief Pain Inventory, Beck Depression Index) before and after the intervention, and recorded their pain levels on an 11-point numerical rating scale before and after each session (Clinical Trial.Gov ID: NCT02445677). RESULTS AND CONCLUSION Our results suggest that supplementing exercise sessions with transcutaneous electrical nerve stimulation does not improve the long-term outcomes of elderly patients suffering from chronic pain, but does induce short-term hypoalgesia during exercise sessions. Our study also offers valuable guidelines for the implementation of a future and adequately powered study looking at this research question.Implications for rehabilitationThe application of transcutaneous electrical nerve stimulation during exercises is well tolerated by elderly individuals suffering from chronic pain.Supplementing exercises with transcutaneous electrical nerve stimulation does not seem to improve general outcome in elderly suffering from chronic pain.Notwithstanding, the addition of transcutaneous electrical nerve stimulation tends to produce a marked hypoalgesic effect during the exercise sessions, an effect that could prompt indirect benefits for pain patients.
Collapse
Affiliation(s)
- Simon Vaillancourt
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.,Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - Alexia Coulombe-Lévêque
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.,Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - Julie Fradette
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
| | - Stéphanie Martel
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
| | - Wafaa Naour
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
| | - Rubens A da Silva
- Health Sciences Department, CUpht and LabBioNR, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Guillaume Léonard
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.,Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| |
Collapse
|
20
|
Martimbianco ALC, Porfírio GJM, Pacheco RL, Torloni MR, Riera R. Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain. Cochrane Database Syst Rev 2019; 12:CD011927. [PMID: 31830313 PMCID: PMC6953309 DOI: 10.1002/14651858.cd011927.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic neck pain is a highly prevalent condition, affecting 10% to 24% of the general population. Transcutaneous electrical nerve stimulation (TENS) is the noninvasive, transcutaneous use of electrical stimulation to produce analgesia. It is a simple, low-cost and safe intervention used in clinical practice as an adjunct treatment for painful musculoskeletal conditions that have a considerable impact on daily activities, such as chronic neck pain. This review is a split from a Cochrane Review on electrotherapy for neck pain, published in 2013, and focuses specifically on TENS for chronic neck pain. OBJECTIVES To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) (alone or in association with other interventions) compared with sham and other clinical interventions for the treatment of chronic neck pain. SEARCH METHODS We searched Cochrane Back and Neck Trials Register, CENTRAL, MEDLINE, Embase, five other databases and two trials registers to 9 November 2018. We also screened the reference lists of relevant studies to identify additional trials. There were no language, source, or publication date restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) involving adults (≥ 18 years of age) with chronic neck pain (lasting > 12 weeks) that compared TENS alone or in combination with other treatments versus active or inactive treatments. The primary outcomes were pain, disability and adverse events. DATA COLLECTION AND ANALYSIS Two independent review authors selected the trials, extracted data and assessed the risk of bias of included studies. A third review author was consulted in case of disagreements. We used the Cochrane 'Risk of bias' tool (adapted by Cochrane Back and Neck), to assess the risk of bias of individual trials and GRADE to assess the certainty of evidence. We used risk ratios (RRs) to measure treatment effects for dichotomous outcomes, and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). MAIN RESULTS We included seven RCTs with a total of 651 participants, mean age 31.7 to 55.5 years, conducted in three different countries (Turkey, Jordan and China). The length of follow-up ranged from one week to six months. Most RCTs used continuous TENS, with a frequency of 60 Hz to 100 Hz, pulse width of 40 μs to 250 μs and tolerable intensity, described as a tingling sensation without contraction, in daily sessions lasting 20 to 60 minutes. Due to heterogeneity in interventions and outcomes, we did not pool individual study data into meta-analyses. Overall, we judged most studies as being at low risk for selection bias and high risk for performance and detection bias. Based on the GRADE approach, there was very low-certainty evidence from two trials about the effects of conventional TENS when compared to sham TENS at short-term (up to 3 months after treatment) follow-up, on pain (assessed by the Visual Analogue Scale (VAS)) (MD -0.10, 95% CI -0.97 to 0.77) and the percentage of participants presenting improvement of pain (RR 1.57, 95% CI 0.84 to 2.92). None of the included studies reported on disability or adverse events. AUTHORS' CONCLUSIONS This review found very low-certainty evidence of a difference between TENS compared to sham TENS on reducing neck pain; therefore, we are unsure about the effect estimate. At present, there is insufficient evidence regarding the use of TENS in patients with chronic neck pain. Additional well-designed, -conducted and -reported RCTs are needed to reach robust conclusions.
Collapse
Affiliation(s)
- Ana Luiza C Martimbianco
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Gustavo JM Porfírio
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Rafael L Pacheco
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Maria Regina Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | | |
Collapse
|
21
|
High-Energy Flux Density Extracorporeal Shock Wave Therapy Versus Traditional Physical Therapy Modalities in Myofascial Pain Syndrome: A Randomized-controlled, Single-Blind Trial. Arch Rheumatol 2019; 35:78-89. [PMID: 32637923 DOI: 10.5606/archrheumatol.2020.7496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/21/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effects of extracorporeal shock wave therapy (ESWT) on pain, sleep, fatigue, disability, depression, and quality of life (QoL) in patients with myofascial pain syndrome (MPS). Patients and methods Between March 2018 and September 2018, a total of 94 patients (16 males, 78 females; mean age 44.2±11.94 years; range, 19 to 74 years) with the diagnosis of MPS were included in the study. The patients were divided into two groups. The treatment group consisted of 49 patients and a total of seven sessions of high-energy flux density ESWT (H-ESWT) (0.26 mJ/mm2) were given with three days interval. The control group consisted of 45 patients and the treatment of hot pack, transcutaneous electrical nerve stimulation, and ultrasound was given for five days for two weeks. At baseline and one month after treatment, the visual analog scale (VAS), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, Neck Disability Index (NDI), and Beck Depression Inventory (BDI) scores were compared between the groups. Results There were no statistically significant differences in the age, sex, demographic characteristics, and baseline VAS, SF-36, NDI, BDI, FACIT, and PSQI scores between the groups (p>0.05). In the ESWT group, there was a statistically significant decrease in the VAS, SF-36, NDI, BDI, FACIT, and PSQI scores after treatment compared to the baseline scores, while only the SF-36 subscale scores were statistically significantly higher (p<0.05). There was a statistically significant correlation between the VAS and SF-36 scores and the BDI, NDI, FACIT and PSQI scores after the treatment. Conclusion Our study results suggest that H-ESWT is more effective than traditional physical therapy methods on pain, QoL, sleep, fatigue, depression, and disability in patients with MPS.
Collapse
|
22
|
Does the Use of Electrotherapies Increase the Effectiveness of Neck Stabilization Exercises for Improving Pain, Disability, Mood, and Quality of Life in Chronic Neck Pain?: A Randomized, Controlled, Single-Blind Study. Spine (Phila Pa 1976) 2018; 43:E1174-E1183. [PMID: 29652778 DOI: 10.1097/brs.0000000000002663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study was a prospective, randomized, controlled study. OBJECTIVE The aim of this study was to determine whether transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) increase the effectiveness of neck stabilization exercises (NSEs) on pain, disability, mood and quality of life for chronic neck pain (CNP). SUMMARY OF BACKGROUND DATA Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Electrotherapies, such as IFC and TENS, have been applied solo or combined with exercise for management of neck pain; however, the efficacy of these combinations is unclear. METHODS A total of 81 patients with CNP were included in this study. Patients were randomly assigned into three groups regarding age and gender. First group had NSE, second group had TENS and NSE, and third group had IFC and NSE. Pain levels [visual analogue scale (VAS)], limits of cervical range of motion (ROM), quality of life (short form-36), mood (Beck depression inventory), levels of disability (Neck Pain and Disability Index), and the need for analgesics of all patients were evaluated before treatment, at 6th and 12th week follow-up. Physical therapy modalities were applied for 15 sessions in all groups. All participants had group exercise accompanied by a physiotherapist for 3 weeks and an additional 3 weeks of home exercise program. RESULTS According to the intragroup assessment, the study achieved its purpose of pain reduction, ROM increase, improvement of disability, quality of life, mood and reduction in drug use in all three treatment groups (P < 0.05). However, clinical outcomes at 6th and 12 th week had no significant difference among the three groups (P > 0.05). CONCLUSION TENS and IFC therapies are effective in the treatment of CNP patients. However, they have no additional benefit or superiority over NSE. LEVEL OF EVIDENCE 2.
Collapse
|