Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome

BACKGROUND Active myofascial trigger points(TrPs)often occur in the upper region of the upper trapezius(UT)muscle.These TrPs can be a significant source of neck,shoulder,and upper back pain and headaches.These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning,work-related productivity,and general quality of life.AIM To investigate the effects of instrument assisted soft tissue mobilization(IASTM)vs extracorporeal shock wave therapy(ESWT)on the TrPs of the UT muscle.METHODS A randomized,single-blind,comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo.Forty patients(28 females and 12 males),aged between 20-years-old and 40-years-old,with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups(A and B).Group A received IASTM,while group B received ESWT.Each group was treated twice weekly for 2 weeks.Both groups received muscle energy technique for the UT muscle.Patients were evaluated twice(pre-and posttreatment)for pain intensity using the visual analogue scale and for pain pressure threshold(PPT)using a pressure algometer.RESULTS Comparing the pre-and post-treatment mean values for all variables for group A,there were significant differences in pain intensity for TrP1 and TrP2(P=0.0001)and PPT for TrP1(P=0.0002)and TrP2(P=0.0001).Also,for group B,there were significant differences between the pre-and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2(P=0.0001).There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1(P=0.9)and TrP2(P=0.76)and PPT for TrP1(P=0.09)and for TrP2(P=0.91).CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs.There is no significant difference between either treatment method.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to the lack of specific laboratory indicators and imaging evidence,there is no unified diagnostic criteria for MPS,making it easy to confuse with other diseases.The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS.This article reviews relevant domestic and foreign literature on the definition,epidemiology,pathogenesis,clinical manifestation,diagnostic criteria and treatments of MPS.The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors,including pain physicians to manage patients with MPS.

Clinical efficacy of electromagnetic field therapy combined with traditional Chinese pain-reducing paste in myofascial pain syndrome

BACKGROUND Pulsed electromagnetic field(PEMF)therapy is widely used to treat myofascial pain syndrome(MPS).Damp-clearing and pain-reducing paste(DPP)comprises medical herbs and has been a traditional method of reducing myofascial pain in China for a long time,and it is usually administered with heating.However,the synergistic effect of PEMF therapy on heating-DPP in patients with MPS is unclear.AIM To investigate the synergistic effect of PEMF therapy plus heating-DPP in lumbar MPS.METHODS This double-blind,randomized,placebo-controlled trial was conducted on 120 patients with lumbar MPS who were randomly divided into an experimental group(EG,n=60)and a control group(CG,n=60).Patients in both groups were treated with heating-DPP combined with PEMF therapy;however,the electromagnetic function of the therapeutic apparatus used in the CG was disabled.Each treatment lasted for 20 min and was applied five times a week for two weeks.The short-form McGill Pain Questionnaire was applied at five time points:pretest,end of the first and second weeks of treatment,and end of the first and fourth week after completing treatment.Visual analog scale(VAS),present pain intensity index(PPI),and pain rating index(PRI;total,affective pain,and sensory pain scores)scores were then analyzed.RESULTS Compared with the CG,the VAS,PPI and PRI scores(total,affective pain and sensory pain scores)in the EG were significantly lower after treatment and during follow-up.CONCLUSION PEMF therapy combined with heating-DPP showed better efficacy than heating-DPP alone in reducing the overall intensity of pain and sensory and affective pain.

Effect and cerebral mechanism of moxibustion at heat-sensitized Yaoyangguan(GV3)in patients with lumbar disc herniation and myofascial pain syndrome by resting-state functionality magnetic resonance imaging:protocol for an observational study

We want to explore the analgesic brain effect of the moxibustion at heat-sensitized Yaoyangguan(GV3)in patients with lumbar disc herniation(LDH)and myofascial pain syndrome(MPS).In an assessor-blinded observational study,we will include 15 LDH and 15 MPS.They will accept same treatment of heat-sensitive moxibustion at Yaoyangguan(GV3).The resting-state functionality magnetic resonance imaging image data of brain activities before and after treatment will be analyzed by mean fractional amplitude of low-frequency fluctuation,regional homogeneity analysis and brain functional connection.We select seed of first sensory cortex,second sensory cortex,insula cortex,periaqueductal gray and anterior cingulate cortex as the regions of interest to analyse the relationship between brain functional connectivity of pain-related networks and clinical data.Our study could disclose key brain targets and central response characteristics of the analgesic brain effect and the brain functional connection of heat-sensitive moxibustion.

The Effect of Internal Heat Acupuncture on the Tolerance Time of Plantar Hot Plate and Pain Threshold of Gastrocnemius Muscle in Rats with Chronic Myofascial Pain Syndrome

Objective:To investigate the effect of internal heat acupuncture on the tolerance time of plantar hot plate and the pain threshold of gastrocnemius in rats with chronic myofascial pain syndrome(MPS).Methods:A total of 80 adult Wistar rats were randomly selected to establish chronic MPS rat models,and randomly divided into four groups:control group,acupuncture group,internal heat acupuncture group A,and internal heat acupuncture group B,with 20 rats in each group.The rats in the control group were not given any treatment,and the rats in the acupuncture group were only given acupuncture treatment.The rats in group A were treated with internal heat acupuncture(needle heating up to 42℃),and the rats in group B were treated with internal heat acupuncture(needle heating up to 44℃).The tolerance time of plantar hot plate,the pain threshold of gastrocnemius muscle and the level of tumor necrosis factor-α(TNF-α)were observed and compared before modeling,1 d before treatment,and 1,7 and 14 d after treatment.Results:There were significant differences in hot plate tolerance time,time and interaction among the four groups(P<0.05),as well as in gastrocnemius tenderness threshold,time and interaction among the four groups(P<0.05),and there were also significant differences in TNF-αlevel among the three groups(P>0.05).There were significant differences in the number of electric shocks,time and interaction among the four groups(P<0.05).Conclusion:In contrast to conventional acupuncture treatment,internal heat acupuncture demonstrates greater efficacy in extending the tolerance duration of hot plate exposure and enhancing the pain threshold of the gastrocnemius muscle in rats afflicted with myofascial pain syndrome.Additionally,it accelerates the amelioration of inflammatory markers and motor function.However,it is important to note that the therapeutic impact of internal heat acupuncture may be influenced by its temperature,with 44℃being the most effective in this research.

Effect of bloodletting therapy at local myofascial trigger points and acupuncture at Jiaji(EX-B 2) points on upper back myofascial pain syndrome: a randomized controlled trial

OBJECTIVE： To observe the clinical efficacy of bloodletting therapy and acupuncture at Jiaji points for treating upper back myofascial pain syndrome （MPS）, and compare this with lidocaine block therapy. METHODS： A total of 66 were randomly assigned upper back MPS patients to either the treatment group or the control group in a 1 ： 1 ratio. The treatment group （n = 33） were treated with bloodletting therapy at local myofascial trigger points and acupuncture at Jiaji （EX-B 2） points; one treatment course consisted of five, single 20-min-treatments with a 2-day break between each treatment. The control group （n = 33） were treated with a lidocaine block at trigger points; one treatment course consisted of five sessions of lidocaine block therapy with a 2-day break between each session. The simplified McGill Scale （SF-MPQ） and tenderness threshold determination were used to assess pain before and after a course of treatment. RESULTS： After the third and fifth treatment, the SF-MPQ values were significantly decreased （P 〈 0.01） and the tenderness thresholds were significantly increased （P 〈 0.01） in both groups compared with before treatment. There were no significant differences in pain assessments between the two groups after three and five treatments （P 〉 0.05）. There were five cases with minor adverse reactions reported in the control patients, while no adverse reactions were reported in the treatment group. CONCLUSION： Bloodletting therapy at local myo- fascial trigger points and acupuncture at Jiaji points was effective in treating upper back MPS. Clinically, bloodletting and acupuncture therapy had the same efficacy as the lidocaine block therapy, with fewer adverse reactions.

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

OBJECTIVE: To summarize the literature about the effectiveness of dry needling(DN) on relieving pain and increasing range of motion(ROM) in individuals with myofascial pain syndrome(MPS).METHODS: Papers published from January 2000 to January 2013 were identified through an electronic search in the databases MEDLINE, Dialnet, Cochrane Library Plus, Physiotherapy Evidence Database(PEDro) and Spanish Superior Council of Scientific Research(CSIC). The studies included were randomized controlled trials written in English and/or Spanish about the effectiveness of DN on pain and ROM in individuals with MPS.RESULTS: Out of 19 clinical trials that were potentially relevant, a total of 10 were included in the Meta-analysis. Regarding pain intensity reduction when measured before and immediately after the intervention, DN achieved improvement compared with the placebo treatment [d =-0.49; 95% CI(-3.21, 0.42)] and with the control group [d =-9.13;95% CI(- 14.70,- 3.56)]. However, other treatments achieved better results on the same variable compared with DN, considering the measurements for pre-treatment and immediately after [d = 2.54;95% CI(-0.40, 5.48)], as well as the pre-treatment and after 3-4 weeks [d = 4.23; 95% CI(0.78, 7.68)].DN showed a significantly increased ROM when measured before the intervention and immediately after, in comparison with the placebo [d = 2.00;95% CI(1.60, 2.41)]. However, other treatments achieved a significant better result regarding ROM when it was measured before the intervention and immediately after, as compared with DN [d =-1.42;95% CI(-1.84,-0.99)].CONCLUSION: DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3-4 weeks. However, on increasing ROM,DN was more effective comparing to that of placebo group, but less than other treatments.

Clinical Study on Treatment of Myofascial Pain Syndrome with Ashi Points

Objective： To investigate the clinical efficacy of Ashi points in the treatment of myofascial pain syndrome. Method： A hundred and fifty cases were randomized into a treatment group and a control group by the order of visit. The cases in the treatment group were treated with ＂Stuck Needle＂ method in Ashi points plus tuina manipulations. The cases in the control group were treated with external local application of Votalin. The cases in both groups were treated once a day and 10 times made up one course. Results： Among 90 cases in the treatment group, 18 got clinical recovery, 34 got marked effect, 34 got certain effect, the marked effective rate was 57.8% and the total effective rate was 94.4%; while among 60 cases in the control group, 1 got clinical recovery, 18 got marked effect, 15 got certain effect, the marked effective rate was 31.7% and the total effective rate was 73.3%. Statistical management showed P〈0.01, indicating a significantly better effect in the treatment group. In addition, ＂Stuck Needle＂ method in Ashi points plus tuina manipulations can effectively improve local pain, tenderness, muscle spasm and motion range of joints, and can obtain significantly better effect for muscle spasm and motion range of joints. Conclusion： This therapy is safe, reliable and effective, and therefore worth spreading for clinical application.

Clinical Study on Extracorporeal Shock Wave Therapy plus Electroacupuncture for Myofascial Pain Syndrome

Objective: To observe the clinical effect of extracorporeal shock wave plus electroacupuncture(EA) on myofascial pain syndrome(MPS) and to investigate its treatment mechanism. Methods: Ninety cases who met the inclusion criteria were randomly allocated into an EA group, an extracorporeal shock wave therapy(ESWT) group and a combined therapy group, 30 in each group. EA was employed in the EA group, extracorporeal shock wave therapy in the ESWT group and EA plus extracorporeal shock wave therapy in the combined therapy group. The VAS, tenderness threshold and therapeutic efficacy were evaluated after three months of treatment. Results: After 2 weeks, 4 weeks and 3 months of treatment, the VAS scores in all three groups were significantly reduced and the tenderness threshold significantly elevated. The recovery rate and total effective rate were 23.3% and 83.3% respectively in the EA group, versus 40.0% and 90.0% in the ESWT group and 63.3% and 96.7% in the combined therapy group, showing statistical differences(P<0.05). Conclusion: EA combined with EWST works remarkably well for MPS.

Short-term effectiveness of high-and low-intensity percutaneous electrolysis in patients with patellofemoral pain syndrome:A pilot study

BACKGROUND Unilateral patellofemoral pain syndrome(PFPS)is the most frequently diagnosed knee condition in populations aged<50 years old.Although the treatment of myofascial trigger points(MTrPs)is a common and effective tool for reducing pain,previous studies showed no additional benefits compared with placebo in populations with PFPS.Percutaneous electrolysis is a minimally invasive approach frequently used in musculotendinous pathologies which consists of the application of a galvanic current through dry needling(DN).AIM To evaluate changes in sensitivity,knee pain perception and perceived pain during the application of these three invasive techniques.METHODS A triple-blinded,pilot randomized controlled trial was conducted on fifteen patients with unilateral PFPS who were randomized to the high-intensity percutaneous electrolysis(HIPE)experimental group,low-intensity percutaneous electrolysis(LIPE)experimental group or DN active control group.All interventions were conducted in the most active MTrP,in the rectus femoris muscle.The HIPE group received a 660 mA galvanic current for 10 s,the LIPE group 220 mA×30 s and the DN group received no galvanic current.The MTrP and patellar tendon pain pressure thresholds(PPTs)and subjective anterior knee pain perception(SAKPP)were assessed before,after and 7 d after the single intervention.In addition,perceived pain during the intervention was also assessed.RESULTS Both groups were comparable at baseline as no significant differences were found for age,height,weight,body mass index,PPTs or SAKPP.No adverse events were reported during or after the interventions.A significant decrease in SAKPP(both HIPE and LIPE,P<0.01)and increased patellar tendon PPT(all,P<0.001)were found,with no differences between the groups(VAS:F=0.30;η2=0.05;P>0.05;tendon PPT immediate effects:F=0.15;η2=0.02;P>0.05 and tendon PPT 7-d effects:F=0.67;η2=0.10;P>0.05).A significant PPT increase in rectus femoris MTrP was found at follow-up in both the HIPE and LIPE groups(both,P<0.001)with no differences between the groups(immediate effects:F=1.55;η2=0.20;P>0.05 and 7-d effects:F=0.71;η2=0.10;P>0.05).Both HIPE and LIPE interventions were considered less painful compared with DN(F=8.52;η2=0.587;P<0.01).CONCLUSION HIPE and LIPE induce PPT changes in MTrPs and patellar tendon and improvements in SAKPP,and seem to produce less pain during the intervention compared with DN.

The Comparison of trigger point acupuncture and traditional acupuncture

Trigger point（TrP） acupuncture（dry needling）,the use of solid filiform needles at TrPs,has been developed from a comprehensive integration and adaptation of traditional acupuncture using current understandings of TrPs.During the past twenty years,the concept and technique continues to evolve,with a potential to expand to other conditions beyond myofascial pain syndromes that can be managed via stimulating TrPs.In this article,we compared TrP acupuncture and traditional acupuncture from the following aspects：points of needle insertion,needles and needling techniques,and therapeutic indications.Traditional acupuncture encompasses an abundance of methods and techniques in acupuncture practices and has been widely used and studied for a variety of disorders.With unique specific characteristics,TrP acupuncture further develops traditional acupuncture theories,especially the concepts of Ashi point.The location of TrPs,their distribution pattern and pain indication are similar to those of traditional acupoints;the selection of needles,depth of needle insertion,and manipulation techniques are part of traditional acupuncture.TrP acupuncture is thus an integral part of traditional acupuncture.

Efficacy observation on acupuncture plus moving cupping with compound white mustard oil for lumbar myofascitis

To observe the clinical effect of acupuncture plus moving cupping with white mustard oil to treat lumbar myofascitis. Methods： A total of 90 patients with lumbar myofascitis who met the inclusion criteria were randomly divided into an observation group and a control group, 45 cases in each group. The observation group received acupuncture and moving cupping with white mustard oil; the control group received acupuncture plus warm needling treatment. The treatment was given twice a week for a total of 4 weeks. The visual analog scale （VAS） and Chinese version of Roland-Morris disability questionnaire （RMDQ） score of pain before the treatment, and respectively after 1-week and 4-week treatment were recorded for efficacy evaluation. Results： After 4 weeks of treatment, the difference in total effective rate between the two groups was not significantly （P〉0.05）. After i week of treatment, there was no significant difference in VAS score between the two groups （P〉0.05）. After 4 weeks of treatment, the VAS score of the observation group was lower than that of the control group, and there was a significant difference between the two groups （P〈0.05）. After 4 weeks of treatment, the Chinese version of RMDQ scores of both groups were significantly decreased, there were statistical differences in comparing with those before treatment （both P〈0.05）. After treatment for 1 week and 4 weeks, the Chinese version of RMDQ score in the observation group was lower than that in the control group, with significant differences between the two groups （all P〈0.05）. Conclusion： Acupuncture plus moving cupping and acupuncture plus warm needling both can relieve the pain of patients with lumbar myofascitis, improve the function of back muscles, while the curative effect of acupuncture plus moving cupping is better.