Pretreatment anxiety and pain acceptance are associated with response to trigger point injection therapy for chronic myofascial pain

Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing

BACKGROUND

Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident.

AIM

The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population.

METHODS

This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling.

RESULTS

Pain not only had a direct positive impact (B = 0.575; SE   =   0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE  =  0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE  =   0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE   =  0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data.

CONCLUSION

The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.

The effect of therapeutic physical modalities on pain, function, and quality of life in patients with myofascial pain syndrome: a systematic review

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.

Effectiveness of self-myofascial release combined with biofeedback and electrical stimulation for the management of myofascial pelvic pain: A randomized controlled trial

BACKGROUND

Myofascial pelvic pain (MFPP) caused by myofascial trigger points (MTrPs) is a major contributor to chronic pelvic pain in women. However, the effect of the patient's self-myofascial release (SMFR) is unclear. This study aimed to investigate the effect of SMFR combined with biofeedback and electrical stimulation (BES) therapy in comparison with BES alone in patients with MFPP.

METHODS

A prospective randomized controlled study was conducted. Sixty-eight patients were randomly allocated into BES-SMFR group (n = 34) and BES group (n = 34). Every patient received 4 weeks of treatment, evaluated at baseline (T0), 4 weeks post-intervention (T4) and 12-week follow-up (T12). The primary outcome was pain intensity. The secondary outcomes were degree of activation of MTrPs, surface electromyography (sEMG) levels and Patient Global Impression of Improvement (PGI-I).

RESULTS

Compared with the effect of BES, BES-SMFR treatment significantly decreased pain intensity and the degree of activation of MTrPs in the levator ani (p = 0.02) and obturator internus (p = 0.03), as well as the sEMG levels of the pre-test resting baseline and post-test resting baseline (all p < 0.01). The degree of activation of MTrPs in the piriformis and coccygeus (all p > 0.05) and the sEMG levels of the quick flicks and endurance contraction were not significantly different. The BES-SMFR treatment improved the PGI-I scale at T4 (p = 0.02) but not at T12 (p = 0.40).

CONCLUSIONS

This study confirmed that the addition of SMFR to BES treatment resulted in superior outcomes compared with those with BES alone in patients with MFPP.

SIGNIFICANCE STATEMENT

Myofascial pelvic pain (MFPP) is a major contributor of female chronic pelvic pain. Myofascial release has been used commonly for better pain release; however, poor therapeutic effect due to poor patient compliance is common in clinical practice. Therefore, in future research, there is a need to investigate the effect of patient's self-myofascial release (SMFR) technique, which can eliminate the need for frequent office visits and improve patient compliance to some extent, in patients with MFPP.

Neuroticism Traits and Anxiety Symptoms are Exhibited in Athletes With Chronic Gastrocnemius Myofascial Pain Syndrome

San-Antolín, M, Rodríguez-Sanz, D, Becerro-de-Bengoa-Vallejo, R, Losa-Iglesias, ME, Martínez-Jiménez, EM, López-López, D, and Calvo-Lobo, C. Neuroticism traits and anxiety symptoms are exhibited in athletes with chronic gastrocnemius myofascial pain syndrome. J Strength Cond Res 34(12): 3377-3385, 2020-Common psychological factors, such as anxiety or neurotic personality traits, seem to be associated with pain suffered by athletes. Gastrocnemius muscles present a high prevalence for injury in athletes. These muscles are a region in which myofascial pain syndrome (MPS) frequently develops. Myofascial pain syndrome is characterized by the presence of active myofascial trigger points (MTrPs). This study compared different personality and anxiety symptoms between athletes with and without active MTrPs in the gastrocnemius. A case-control study was conducted in an outpatient clinic. Athletes who performed moderate or vigorous physical activity according to the International Physical Activity Questionnaire were included. Fifty paired-matched athletes with and without active MTrPs in their gastrocnemius muscles (n = 25 in each group) were recruited. Different personality traits (neuroticism, extraversion, psychoticism, and sincerity) and anxiety (state and trait) were evaluated by the Eysenck Personality Questionnaire and State-Trait Anxiety Inventory, respectively. Statistically significant differences (p < 0.01) with an effect size from moderate to large (d = 0.75-1.29) were found for greater neuroticism and sincerity traits in addition to state and trait anxiety in athletes with gastrocnemius MPS compared with healthy controls. In conclusion, athletes with gastrocnemius active MTrPs exhibited higher neuroticism and anxiety symptoms compared with healthy athletes. Mental health may play a key role in athletes with myofascial pain, and future studies should be performed to determine whether neuroticism-related and anxiety-related psychological care could be a key intervention in athletes with gastrocnemius active MTrPs to improve athletic performance and rehabilitation or prevent injuries.

The potential buffering role of self-efficacy and pain acceptance against invalidation in rheumatic diseases

A substantial amount of people with a rheumatic disease perceive invalidation consisting of lack of understanding and discounting (negative social responses). To get insight into the potential buffering role of self-efficacy and pain acceptance against invalidation, this cross-sectional study examined associations between these variables. Spanish speaking people (N = 1153, 91% female, mean age 45 ± 11 years) with one or multiple rheumatic diseases completed online the Illness Invalidation Inventory, the Chronic Pain Acceptance Questionnaire, and the Chronic Disease Self-Efficacy Scale. Higher self-efficacy (t = − 4.80, p = < 0.001) and pain acceptance (t = − 7.99, p = < 0.001) were additively associated with discounting. Higher self-efficacy (t = − 5.41, p = < 0.001) and pain acceptance (t = − 5.71, p = < 0.001) were also additively associated with lack of understanding. The combined occurrence of high self-efficacy and high acceptance was associated most clearly with lower lack of understanding (interaction: t = − 2.12, p = 0.034). The findings suggest the usefulness of examining whether interventions aimed at increasing self-efficacy and pain acceptance can help people with rheumatic diseases for whom invalidation is a considerable burden.

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

Myofascial pain, presented as myofascial trigger points (MTrPs)-related pain, is a common, chronic disease involving skeletal muscle, but its underlying mechanisms have been poorly understood. Previous studies have revealed that chronic pain can induce microstructural abnormalities in the cerebral gray matter. However, it remains unclear whether the brain gray matters of patients with chronic MTrPs-related pain undergo alteration. In this study, we employed the Diffusion Kurtosis Imaging (DKI) technique, which is particularly sensitive to brain microstructural perturbation, to monitor the MTrPs-related microstructural alterations in brain gray matter of patients with chronic pain. Our results revealed that, in comparison with the healthy controls, patients with chronic myofascial pain exhibited microstructural abnormalities in the cerebral gray matter and these lesions were mainly distributed in the limbic system and the brain areas involved in the pain matrix. In addition, we showed that microstructural abnormalities in the right anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) had a significant negative correlation with the course of disease and pain intensity. The results of this study demonstrated for the first time that there are microstructural abnormalities in the brain gray matter of patients with MTrPs-related chronic pain. Our findings may provide new insights into the future development of appropriate therapeutic strategies to this disease.