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Physical Medicine and Rehabilitation... May 2022Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Many interventional procedures can be performed in... (Review)
Review
Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Many interventional procedures can be performed in both an acute and chronic pain setting to address myofascial pain syndromes. Trigger point injections can be performed with or without imaging guidance such as fluoroscopy and ultrasound; however, the use of imaging in years past has been recommended to improve patient outcome and safety. Injections can be performed using no injectate (dry needling), or can involve the administration of local anesthetics, botulinum toxin, or corticosteroids.
Topics: Anesthetics, Local; Chronic Pain; Humans; Myofascial Pain Syndromes; Treatment Outcome; Trigger Points
PubMed: 35526973
DOI: 10.1016/j.pmr.2022.01.011 -
The Journal of Manual & Manipulative... Jun 2021Patients with myofascial pain syndrome of the neck and upper back have active trigger points and may present with pain and decreased function. Dry needling (DN) and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patients with myofascial pain syndrome of the neck and upper back have active trigger points and may present with pain and decreased function. Dry needling (DN) and trigger point manual therapy (TMPT) techniques are often used to manage MPS.
OBJECTIVE
To compare DN and TPMT for reducing pain on the Visual Analog Scale (VAS) and Pressure Pain Threshold (PPT) scores and improving function on the Neck Disability Index (NDI) in patients with neck and upper back MPS.
METHODS
PubMed, PEDro, and CINAHL were searched for randomized controlled trials within the last 10 years comparing a group receiving DN and the other receiving TPMT. Studies were assessed using PEDro scale and Cochrane risk-of-bias tool to assess methodological quality. Meta-analyses were performed using random-effect model. Standardized mean differences (Cohen's d) and confidence intervals were calculated to compare DN to TPMT for effects on VAS, PPT, and NDI.
RESULTS
Six randomized controlled trials with 241 participants total were included in this systematic review. The effect size of difference between DN and TPMT was non-significant for VAS [d = 0.41 (-0.18, 0.99)], for PPT [d = 0.64 (-0.19, 1.47)], and for NDI [d = -0.66 (-1.33, 0.02)].
CONCLUSIONS
Both DN and TPMT improve pain and function in the short to medium term. Neither is more superior than the other.
Topics: Dry Needling; Humans; Musculoskeletal Manipulations; Myofascial Pain Syndromes; Neck Pain; Trigger Points
PubMed: 32962567
DOI: 10.1080/10669817.2020.1822618 -
American Family Physician Feb 2002Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often... (Review)
Review
Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.
Topics: Anesthetics, Local; Diagnosis, Differential; Humans; Injections; Lidocaine; Muscle, Skeletal; Myofascial Pain Syndromes; Palpation
PubMed: 11871683
DOI: No ID Found -
The Journal of Headache and Pain Sep 2018A myofascial trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. It has been... (Review)
Review
BACKGROUND
A myofascial trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. It has been suggested that myofascial trigger points take part in chronic pain conditions including primary headache disorders. The aim of this narrative review is to present an overview of the current imaging modalities used for the detection of myofascial trigger points and to review studies of myofascial trigger points in migraine and tension-type headache.
FINDINGS
Different modalities have been used to assess myofascial trigger points including ultrasound, microdialysis, electromyography, infrared thermography, and magnetic resonance imaging. Ultrasound is the most promising of these modalities and may be used to identify MTrPs if specific methods are used, but there is no precise description of a gold standard using these techniques, and they have yet to be evaluated in headache patients. Active myofascial trigger points are prevalent in migraine patients. Manual palpation can trigger migraine attacks. All intervention studies aiming at trigger points are positive, but this needs to be further verified in placebo-controlled environments. These findings may imply a causal bottom-up association, but studies of migraine patients with comorbid fibromyalgia syndrome suggest otherwise. Whether myofascial trigger points contribute to an increased migraine burden in terms of frequency and intensity is unclear. Active myofascial trigger points are prevalent in tension-type headache coherent with the hypothesis that peripheral mechanisms are involved in the pathophysiology of this headache disorder. Active myofascial trigger points in pericranial muscles in tension-type headache patients are correlated with generalized lower pain pressure thresholds indicating they may contribute to a central sensitization. However, the number of active myofascial trigger points is higher in adults compared with adolescents regardless of no significant association with headache parameters. This suggests myofascial trigger points are accumulated over time as a consequence of TTH rather than contributing to the pathophysiology.
CONCLUSIONS
Myofascial trigger points are prevalent in both migraine and tension-type headache, but the role they play in the pathophysiology of each disorder and to which degree is unclarified. In the future, ultrasound elastography may be an acceptable diagnostic test.
Topics: Adolescent; Adult; Chronic Disease; Electromyography; Female; Humans; Male; Migraine Disorders; Muscle, Skeletal; Myofascial Pain Syndromes; Pain; Pain Measurement; Pressure; Tension-Type Headache; Trigger Points
PubMed: 30203398
DOI: 10.1186/s10194-018-0913-8 -
Seminars in Reproductive Medicine Jan 2017Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies... (Review)
Review
Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies target ectopic endometrial lesions, they do not directly address pain due to central sensitization of the nervous system and myofascial dysfunction, which can continue to generate pain from myofascial trigger points even after traditional treatments are optimized. This article provides a background for understanding how endometriosis facilitates remodeling of neural networks, contributing to sensitization and generation of myofascial trigger points. A framework for evaluating such sensitization and myofascial trigger points in a clinical setting is presented. Treatments that specifically address myofascial pain secondary to spontaneously painful myofascial trigger points and their putative mechanisms of action are also reviewed, including physical therapy, dry needling, anesthetic injections, and botulinum toxin injections.
Topics: Analgesics; Anesthetics; Botulinum Toxins; Central Nervous System Sensitization; Chronic Pain; Endometriosis; Female; Humans; Injections; Myofascial Pain Syndromes; Neural Pathways; Pain Measurement; Pain Perception; Pain Threshold; Pelvic Pain; Physical Therapy Modalities; Treatment Outcome; Trigger Points
PubMed: 28049214
DOI: 10.1055/s-0036-1597123 -
The Journal of Manual & Manipulative... Jul 2019: The purpose of this randomized controlled trial was to investigate the long-term clinical effect of dry needling with two-week and three-month follow up, on... (Randomized Controlled Trial)
Randomized Controlled Trial
: The purpose of this randomized controlled trial was to investigate the long-term clinical effect of dry needling with two-week and three-month follow up, on individuals with myofascial trigger points in the upper trapezius muscle. : A sample of convenience (33 individuals) with a trigger point in the upper trapezius muscle, participated in this study. The individuals were randomly assigned to two groups: trigger point compression ( = 17) or dry needling ( = 16). Pain intensity, neck disability, and disability of the arm, hand, and shoulder (DASH) were assessed before treatment, after treatment sessions, and at two-week and three-month follow ups. : The result of repeated measures ANOVA showed significant group-measurement interaction effect for VAS ( = .02). No significant interaction was found for NPQ and DASH ( > .05). The main effect of measurements for VAS, NPQ, and DASH were statistically significant ( < .0001). The results showed a significant change in pain intensity, neck disability, and DASH after treatment sessions, after two weeks and three months when compared with before treatment scores in both groups. There was no significant difference in the tested variables after two-week or three-month as compared to after treatment sessions between the two groups. However, pain intensity after treatment sessions was significantly different between the two groups ( = .02). : Dry needling and trigger point compression in individuals with myofascial trigger point in the upper trapezius muscle can lead to three-month improvement in pain intensity and disability.
Topics: Adult; Dry Needling; Female; Humans; Middle Aged; Musculoskeletal Manipulations; Myofascial Pain Syndromes; Superficial Back Muscles; Trigger Points; Young Adult
PubMed: 30935341
DOI: 10.1080/10669817.2018.1530421 -
American Journal of Physical Medicine &... Sep 2017This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with myofascial pain syndrome expressed as tension-type headache.
DESIGN
Individuals (n = 62) with episodic or chronic tension-type headache were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on trigger point release (ischemic compression) of MTrPs in the bilateral upper trapezius and suboccipital muscles. PPT was measured at MTrPs with a pressure algometer pre and post the first and final (12th) treatments.
RESULTS
PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups (P < 0.0001 for suboccipital; P < 0.004 for upper trapezius). Post hoc analysis within the massage group showed (1) an initial, immediate increase in PPT (all P values < 0.05), (2) a cumulative and sustained increase in PPT over baseline (all P values < 0.05), and (3) an additional immediate increase in PPT at the final (12th) massage treatment (all P values < 0.05, except upper trapezius left, P = 0.17).
CONCLUSIONS
Single and multiple massage applications increase PPT at MTrPs. The pain threshold of MTrPs have a great capacity to increase; even after multiple massage treatments additional gain in PPT was observed.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand the contribution of myofascial trigger points to myofascial pain; (2) Describe an effective treatment for decreasing tenderness of a myofascial trigger point; and (3) Discuss the relative values of single vs. multiple massage sessions on increasing pressure-pain thresholds at myofascial trigger points.
LEVEL
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Adult; Female; Humans; Isometric Contraction; Male; Massage; Muscle, Skeletal; Myofascial Pain Syndromes; Occipital Lobe; Pain Measurement; Pain Threshold; Pressure; Single-Blind Method; Superficial Back Muscles; Tension-Type Headache; Treatment Outcome; Trigger Points; Waiting Lists; Young Adult
PubMed: 28248690
DOI: 10.1097/PHM.0000000000000728 -
Trials Mar 2022Chronic low back pain is considered to be one of the main causes of absenteeism from work and primary and specialized consultations. The symptoms of nonspecific chronic... (Randomized Controlled Trial)
Randomized Controlled Trial
Electrical dry needling versus conventional physiotherapy in the treatment of active and latent myofascial trigger points in patients with nonspecific chronic low back pain.
BACKGROUND
Chronic low back pain is considered to be one of the main causes of absenteeism from work and primary and specialized consultations. The symptoms of nonspecific chronic low back pain may be accompanied by the activation of myofascial trigger points in the muscles, together with local and/or referred pain. Electrical dry needling is increasingly used in the treatment of lumbar myofascial pain. Conventional physiotherapy, however, is a popular approach to chronic pathologies, and there is evidence of different modalities of physiotherapy being used in the treatment of chronic low back pain. The aim of this study has been to determine the effectiveness of electrical dry needling versus conventional physiotherapy when applied to active and latent myofascial trigger points in patients with nonspecific chronic low back pain.
METHODS
This is a controlled, randomized, two-arm, double-blind study. A total of 92 patients with chronic low back pain (time to onset ≥ 3 months, Roland Morris Disability Questionnaire score ≥ 4) will be recruited from the University of Almería. Participants will be divided into two study groups (n = 40) to receive treatment of low back pain with electrical dry needling and conventional physiotherapy (ischaemic compression, analytic stretching and postural education training dossier). A total of 6 sessions will be administered once a week for 6 weeks. Pain intensity, disability, fear of movement, quality of life, quality of sleep, anxiety and depression, pressure pain threshold, abdominal strength and lumbar mobility will be recorded at 6 weeks (post-immediate) and 2 months after the end of treatment.
DISCUSSION
We believe that an approach including electrical dry needling to chronic low back pain dysfunction will be more effective in these patients. The results of this study will inform clinicians on which type of treatment is more beneficial for patients with chronic low back pain.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04804228. Registered on 14 January 2021.
Topics: Dry Needling; Humans; Low Back Pain; Physical Therapy Modalities; Quality of Life; Trigger Points
PubMed: 35346331
DOI: 10.1186/s13063-022-06179-y -
PM & R : the Journal of Injury,... Jul 2015The intent of this article is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific... (Review)
Review
The intent of this article is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e., active) or painful only on compression (i.e., latent). MPS is a term used to describe a pain condition that can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. fascia). According to Travell and Simons, MTrPs are central to the syndrome-but are they necessary? Although the clinical study of muscle pain and MTrPs has proliferated over the past two centuries, the scientific literature often seems disjointed and confusing. Unfortunately, much of the terminology, theories, concepts, and diagnostic criteria are inconsistent, incomplete, or controversial. To address these deficiencies, investigators have recently applied clinical, imaging (of skeletal muscle and brain), and biochemical analyses to systematically and objectively study the MTrP and its role in MPS. Data suggest that the soft tissue milieu around the MTrP, neurogenic inflammation, sensitization, and limbic system dysfunction may all play a role in the initiation, amplification, and perpetuation of MPS. The authors chronicle the advances that have led to the current understanding of MTrP pathophysiology and its relationship to MPS, and review the contributions of clinicians and researchers who have influenced and expanded our contemporary level of clinical knowledge and practice.
Topics: History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Muscle, Skeletal; Myofascial Pain Syndromes; Pain Measurement; Trigger Points
PubMed: 25724849
DOI: 10.1016/j.pmrj.2015.01.024