Similarities and differences between the trigger point of myofascial pain and the traditional meridian points

In recent years,the treatment of myofascial pain trigger point is a relatively popular technology,many people regard it as"Ashi point"in meridian theory,but compared with the traditional meridian theory,the description of myofascial pain trigger point is more intuitive and easier to master.This paper expounds the similarities and differences between myofascial pain trigger point and traditional meridian theory from the aspects of theory,basic research and clinical application,in order to provide a specific idea for the scientific interpretation of meridian phenomenon in traditional Chinese medicine.

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.

针刀松解颈肩部MTrPs联合“三期”辩证牵引法治疗神经根型颈椎病临床症状及对患者血清炎性因子的影响

目的:观察针刀松解颈肩部肌筋膜疼痛触发点联合“三期”辩证牵引法治疗神经根型颈椎病患者的临床疗效,并检测其对患者COX-2、PGE2、5-HT、TNF-α等炎症因子的影响。方法:选择110例神经根型颈椎病(ervical spondylotic radiculopathg,CSR)患者作为研究对象,将其分为观察组(针刀松解颈肩部肌筋膜疼痛触发点联合“三期”辩证牵引法)55例和对照组(常规针刺联合“三期”辩证牵引法)55例。比较两组患者治疗前、后,改良MacNab疗效评定结果、简化McGill疼痛量表评分、颈椎曲度以及血清COX-2、PGE2、5-HT、TNF-α等炎症因子水平。结果:经过两周的治疗,观察组总有效率为96.36%,高于对照组的83.63%,差异具有统计学意义(P<0.05);治疗后两组患者的PRI、VAS、PPI等评分较治疗前均降低,差异具有统计学意义(P<0.05);但治疗后两组间患者的PRI、VAS、PPI评分比较,差异无统计学意义(P>0.05)。两组治疗后的COX-2、PGE2、5-HT、TNF-α较治疗前均降低,差异具有统计学意义(P<0.05);但治疗后两组间患者的COX-2、PGE2、5-HT、TNF-α比较,差异无统计学意义(P>0.05)。两组治疗后颈椎曲度值均比治疗前显著增加,差异具有统计学意义(P<0.05);组间比较,经检验分析差异无统计学意义(P>0.05)。结论:针刀松解颈肩部肌筋膜疼痛触发点结合“三期”辩证牵引法可明显改善神经根型颈椎病患者疼痛和不适感,明显减轻症状,恢复颈椎生理曲度,降低血清中炎症因子。

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.

Myofascial Foot Pain Following Uneventful Epidural Analgesia for Labor and Delivery

Following an uneventful delivery under epidural analgesia, a 17 year old female patient was referred to the Pain Clinic because of numbness and pain of the left big toe for 2 and a half Months. An Orthopedic consultation had ruled out foot injury and concluded that the pain was radicular and secondary to nerve damage from the epidural analgesia. A Pain Clinic evaluation made the diagnosis of myofascial pain which was successfully treated with trigger pint block using normal saline.

Clinical symptoms of cervical and shoulder MTrPs combined with the "third stage" dialectical traction in the treatment of cervical radiculopathy and its effect on the serum inflammatory factors of patients

Objective:To observe the clinical efficacy of acupotomology in the treatment of cervical and shoulder myofascial pain trigger point for cervical radiculopathy,and to detect its effect on COX-2,PGE2,5-HT,TNF-α and other inflammatory factors.Methods:A total of 110 CSR patients were selected as the research objects and divided into observation group(Acupotomology to release the trigger points of myofascial pain in neck and shoulder combined with"three-stage"dialectical traction method)and control group(conventional acupuncture combined with"Stage 3"dialectical traction)with 55 cases.Before and after treatment,the two groups were compared by improving the efficacy of MacNab,simplifying the SCORE of Mc Gill Pain Scale,measuring cervical curvature and serum levels of inflammatory factors such as COX-2,PGE2,5-HT and TNF-α.Results:After two weeks of treatment,the total effective rate of the observation group was 96.36%,higher than that of the control group(83.63%),and the difference was statistically significant(P<0.05).After the treatment,PRI,VAS,PPI and other scores of the two groups were all lower than those before the treatment,with statistical significance(P<0.05).However,there was no statistically significant difference in PRI,VAS and PPI scores between the two groups after treatment(P>0.05).The serum inflammatory factors of coX-2,PGE2,5-HT and TNF-αin the two groups were significantly lower after treatment than before treatment(P<0.05).However,the comparison of cox-2,PGE2,5-ht and TNF-αbetween the two groups showed no statistical significance(P>0.05).The cervical curvature values measured after treatment were significantly increased compared with those before treatment,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups(P>0.05).Conclusion:The combination of acumotomology and"three-stage"dialectical traction method can significantly improve the pain and discomfort of patients with cervical radiculopathy,significantly reduce the symptoms,restore the physiological curvature of cervical vertebra,and reduce the inflammatory factors in serum.

针灸肌筋膜触发点作用机制研究进展

肌筋膜触发点(myofascial trigger points,MTrPs)为骨骼肌绷紧带中的过敏结节,可引发压痛、特征性转移痛、运动功能障碍和自主神经现象。近年来,基于MTrPs特殊的病理生理机制,采用针灸治疗非器质性神经肌纤维的疼痛综合征取得了满意的效果。针刺干预MTrPs对于组织修复、恢复功能活动具有重要的指导价值,为临床治疗肌筋膜疼痛综合征(myofascial pain syndrome,MPS)提供了有效手段。但针刺MTrPs作用机制尚未完全阐明,今后还需从多层次、多角度、多领域深入探究,以期为临床针灸施治提供有力的理论依据。

滞动针干预“激痛点”对肌筋膜疼痛综合征模型大鼠中枢镇痛的作用机制

背景:滞动针治疗肌筋膜疼痛综合征的镇痛效果显著,但镇痛机制尚不明确。目的:探索滞动针干预激痛点缓解肌筋膜疼痛综合征疼痛的作用机制。方法:按照随机数字表法将54只SD大鼠随机分为空白组(n=16)和造模组(n=38),造模组采用“打击结合离心运动”方式制备左侧股内侧肌筋膜疼痛综合征模型,造模12周后随机挑选6只验证造模成功,将剩余32只造模大鼠随机分为模型组(n=16)与滞动针组(n=16),使用滞动针对滞动针组大鼠左侧股内侧肌局部激痛点进行干预治疗,2次/周,治疗4周。造模前后及治疗后进行左足机械缩足阈值测定;治疗后第4周,苏木精-伊红染色观察大鼠左侧股内侧肌肌肉组织形态学变化,ELISA法检测血清和中脑导水管周围灰质中P物质、β-内啡肽水平,免疫组化检测中脑导水管周围灰质中小胶质细胞标志物(Iba-1)和c-fos阳性表达,Western Blot检测中脑导水管周围灰质脑源性神经营养因子蛋白表达。结果与结论:①与空白组比较,造模后模型组、滞动针组大鼠机械缩足阈值降低(P<0.05);治疗4周后,滞动针组大鼠机械缩足阈值高于模型组(P<0.05);②苏木精-伊红染色结果显示,模型组肌纤维排列紊乱、粗细不等,肌细胞增大并出现核内移现象,细胞内出现圆形挛缩结节以及紧张带;滞动针组肌纤维排列整齐,肌细胞多呈角状,细胞内偶见挛缩结节;③与空白组比较,模型组血清中P物质水平升高(P<0.05),血清中β-内啡肽及脑中P物质、β-内啡肽水平均降低(P<0.05);与模型组比较,滞动针组血清中P物质水平降低(P<0.05),血清中β-内啡肽及脑中P物质、β-内啡肽水平均升高(P<0.05);④与空白组比较,模型组c-fos、Iba-1阳性表达及脑源性神经营养因子蛋白均升高(P<0.05);与模型组比较,滞动针组c-fos阳性表达升高(P<0.05),Iba-1阳性表达及脑源性神经营养因子蛋白均降低(P<0.05);(5)结果表明,滞动针可能通过抑制中脑导水管周围灰质小胶质细胞的活性、下调脑源性神经营养因子蛋白表达间接促进小胶质细胞向M2表型极化释放β-内啡肽、增加c-fos神经元兴奋性,从而降低中枢致敏程度,有效缓解肌筋膜疼痛综合征疼痛的症状。

按压肌筋膜触发点对功能性踝关节不稳患者的疗效研究

目的:探讨按压肌筋膜触发点在功能性踝关节不稳(functional ankle instability,FAI)患者中的临床疗效。方法:选取西南大学医院康复医学中心门诊2021年5月—8月就诊的功能性踝关节不稳患者29例,随机分为试验组15例和对照组14例。试验组在踝关节平衡训练基础上增加按压肌筋膜触发点技术,对照组采用BOSU球进行踝关节平衡训练。分别在基线、干预第4周后和干预第8周后对两组患者进行疼痛视觉模拟评分(visual analogue scale,VAS)评估、踝关节功能量表评分(American Orthopedic Foot and Ankle Score,AOFAS)和Y平衡测试(Ybalance test,YBT)评估。结果:治疗前,两组患者在评估的各项指标上无明显差异(P>0.05)。治疗8周后,两组患者在VAS疼痛评分上均有显著降低(P<0.05),Y平衡测试综合数值得到显著改善(P<0.01),AOFAS踝关节功能评分得到显著提高(P<0.05)。治疗后,试验组在上述各项评估指标中均显著优胜于对照组(P<0.05)。结论:为期8周的平衡训练和平衡训练联合按压MTrPs治疗均对FAI患者有显著的临床康复疗效,而平衡训练联合按压MTrPs治疗在缓解FAI患者的疼痛、促进踝关节功能和动态平衡的改善等方面具有更好的康复效益。

Understanding of myofascial trigger points

Objective To investigate the current practice of myofascial pain syndrome （MPS） including current epidemiology, pathology, diagnosis and treatment. Data sources The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed, MedSci, Google scholar. The terms ＂myofasial trigger points＂ and ＂myofacial pain syndrome＂ were used for the literature search. Study selection Original articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points （MTrPs） and MPS were retrieved, reviewed, analyzed and summarized. Results Myofascial pain syndrome （MPS） is characterized by painful taut band, referred pain, and local response twitch with a prevalence of 85% to 95% of incidence. Several factors link to the etiology of MTrPs, such as the chronic injury and overload of muscles. Other factors, such as certain nutrient and hormone insufficiency, comorbidities, and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain. The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots, relative to some hypotheses of integration, muscle spindle discharges, spinal segment sensitization, ect. MTrPs can be diagnosed and localized based on a few subjective criteria. Several approaches, including both direct and supplementary treatments, can inactivate MTrPs. Direct treatments are categorized into invasive and conservative. Conclusion This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China.

慢性肌筋膜触发点模型大鼠的尿液代谢组学分析

背景:慢性肌筋膜触发点通过非靶向代谢组学技术可识别差异性代谢物变化,有助于从内源性小分子代谢物层面理解并进一步探究慢性肌筋膜触发点的病理生理过程和发病机制。目的:以慢性肌筋膜触发点模型大鼠为研究对象,基于尿液代谢组学寻找潜在生物标志物及相关代谢通路。方法:将16只SD大鼠随机分为造模组和正常组,造模组大鼠采用钝性打击结合离心运动(跑台坡度为-16°,跑速为16 m/min,训练时间为90 min/次)方式建立慢性肌筋膜触发点动物模型,每周1次,连续干预8周,休息4周;正常组大鼠不做干预。12周造模结束后,采用代谢笼法收集大鼠造模后24 h尿液,利用液相色谱-质谱联用非靶向代谢组学技术对尿样进行代谢图谱检测,筛选出共同差异代谢物,并进行生物信息学分析。结果与结论:①与正常组相比,造模组有32个差异代谢标志物,其中上调21个、下调11个;依据变量权重值>3,共14个差异代谢物被认定为潜在生物标志物;②京都基因与基因组百科全书富集分析表明,慢性肌筋膜触发点的形成与初级胆汁酸生物合成、花生四烯酸代谢通路密切相关。

不同力量推拿按法对大鼠肌筋膜疼痛触发点的影响

背景:推拿按法干预肌筋膜触发点疼痛疗效明确,但是不同力量按法的作用需要深入研究。目的:观察不同力量推拿按法对肌筋膜疼痛大鼠触发点的影响。方法:将60只SPF级雄性SD大鼠随机分为不参与造模的空白组10只和参与触发点造模的大鼠50只。以定期钝性击打结合离心运动法在大鼠左侧大腿内侧肌建立慢性触发点模型,将造模成功的40只大鼠随机分为模型组、轻按组、中按组和重按组,每组10只。空白组、模型组大鼠不予干预,轻按组、中按组和重按组以自制按法刺激器,分别以轻力量(0.3 kg)、中力量(0.5 kg)和重力量(0.7 kg)对触发点局部进行干预,7.5 min/次,隔天1次,共计7次。在干预前后分别以电生理仪、软组织张力测定仪和机械痛阈测定仪检测触发点局部肌电图、软组织张力和机械痛阈值。干预结束后,空白组大鼠取左侧大腿内侧肌组织,其余组大鼠取触发点组织,以苏木精-伊红染色观察病理形态,ELISA法检测环氧化酶2、前列腺素E2和缓激肽水平。结果与结论:①与空白组比较,模型组机械痛阈值降低,软组织张力升高,自发电活动振幅频率升高,病理形态学明显改变,环氧化酶2、前列腺素E2和缓激肽水平增加(P<0.05);②与模型组比较,中按组和重按组机械痛阈值升高,软组织张力降低,肌电图频率和振幅降低,环氧化酶2、前列腺素E2和缓激肽水平降低(P<0.05),病理形态学恢复明显;轻按组以上指标无明显变化(P>0.05);③与中按组比较,重按组上述指标改善作用更明显(P<0.05)。结果表明:对触发点疼痛,按压力度可能为中至重度才能有治疗效果。

肌骨超声下辅助针刺肌筋膜触发点治疗脑卒中偏瘫肩痛的临床疗效

目的:探讨肌骨超声下辅助针刺肌筋膜触发点治疗脑卒中偏瘫肩痛的临床疗效。方法:选取2020年5月—2021年12月就诊于广东省第二中医院针灸康复科的脑卒中偏瘫肩痛患者66例,随机分为对照组和治疗组,每组33例。对照组以常规针刺治疗,治疗组在肌骨超声检查下结合针刺肌筋膜触发点治疗。观察治疗前后患者疼痛评级指数、FuglMeyer运动功能评定量表评分、患肩活动度及肩关节活动度评分,并对结果进行评估。结果:治疗后,两组患者McGill疼痛评分均较治疗前明显降低,且治疗组改善程度优于对照组,差异有统计学意义(P<0.01,P<0.05)。两组患者FuglMeyer上肢运动评分,患侧肩关节外展、前屈、内旋、外旋与后伸的被动活动度均较治疗前明显升高,且观察组明显高于对照组,差异有统计学意义(P<0.05,P<0.01)。结论:在肌骨超声技术支持下针刺肌筋膜触发点治疗脑卒中偏瘫肩痛,可显著缓解肩痛症状,提高肩关节活动度,提高针刺治疗脑卒中偏瘫肩痛的疗效,促进上肢功能的恢复,总体疗效优于常规针刺。

冲击波联合肌筋膜触发点治疗神经根型颈椎病疗效观察

目的:探讨发散式体外冲击波联合针刺肌筋膜触发点治疗神经根型颈椎病(CSR)的疗效。方法:将80例神经根型颈椎病患者随机分为两组,各40例。两组患者均给予颈椎牵引、口服甲钴胺片,对照组在此基础上给予发散式体外冲击波联合普通针刺治疗,观察组给予发散式体外冲击波联合针刺颈肩部肌筋膜触发点治疗。比较两组治疗前后简化McGill疼痛问卷(SF-MPQ)、颈椎功能障碍指数量表(NDI)及中文版简明健康调查问卷(SF-36)评分变化情况,比较两组治疗后的临床疗效及6个月内的复发情况。结果:两组均治疗4周,治疗前,两组患者一般资料、SF-MPQ、NDI、SF-36评分组间比较,无统计学差异(P>0.05)。治疗后,两组患者的SF-MPQ评分、NDI评分较治疗前均降低(P<0.05),SF-36评分较治疗前均升高(P<0.05);组间比较,观察组患者的SF-MPQ、NDI及SF-36改善程度均优于对照组(P<0.05);治疗后,观察组总有效率(97.5%)高于对照组(80.0%),治疗后6个月内观察组复发率(5%)低于对照组(25%),差异均有统计学意义(χ^(2)=4.507、6.275,均P<0.05)。结论:发散式体外冲击波联合肌筋膜触发点治疗能够有效减轻神经根型颈椎病患者的疼痛症状,改善颈椎功能,提高生活质量,临床疗效显著,复发率低。

Study on the relationship between relieving energy crisis in myofascial trigger points with An-Pressing manipulation and AMPK/PGC-1α pathway activation

Objective To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points(MTrPs)by observing the effects of An-Pressing manipulation on adenosine triphosphate(ATP),adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK)/peroxisome proliferator-activated receptorγcoactivator 1α(PGC-1α)pathway and mitochondrial ultrastructure of skeletal muscle cells in MTrPs rats.Methods Forty-eight male Sprague-Dawley rats were randomly divided into a blank group,a model group,a lidocaine group,and an An-Pressing manipulation group,with 12 rats in each group.The model group,lidocaine group and An-Pressing manipulation group were used to replicate the MTrPs rat model by blunt shock and centrifugal motion method.After modeling,the An-Pressing manipulation group was subjected to 7 times An-Pressing manipulation,once every other day;the lidocaine group was treated with 3 times of injection of lidocaine at the MTrPs,once every 6 d.The blank group and the model group were fed normally without intervention.After the intervention,local muscle tissue was taken to detect the content of ATP and the expression of AMPK,phosphorylated AMPK(phospho-AMPK),PGC-1α,and glucose transporter 4(GluT4),and the ultrastructure of mitochondria was observed under an electron microscope.Results Compared with the blank group,the ATP content in the model group was decreased(P<0.05),the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were decreased(P<0.05);under the electron microscope,the number of mitochondria decreased,and they were deformed,small in volume,and had deformed cristae.Compared with the model group,the ATP contents in the An-Pressing manipulation group and the lidocaine group were increased(P<0.05),and the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were increased(P<0.05);under the electron microscope,the number of mitochondria increased,the shape and size of the mitochondria were basically normal,and the cristae could be seen.Compared with the lidocaine group,phospho-AMPK and the ratio of phospho-AMPK to AMPK in the An-Pressing manipulation group were increased(P<0.05);under the electron microscope,the numbers of mitochondria were similar,and the shape and size of the mitochondria were basically normal without swelling,and the cristae could be observed.Conclusion An-Pressing manipulation can increase the ATP content in MTrPs tissue,improve the expression levels of PGC-1α and GluT4 proteins and the ratio of phospho-AMPK to AMPK;its mechanism may relate to the activation of AMPK/PGC-1α signaling pathway to promote the repair of mitochondrial damages.

超声引导下针刀松解激痛点治疗腰背肌筋膜疼痛综合征临床观察

目的观察超声引导下针刀松解激痛点治疗腰背肌筋膜疼痛综合征(myofascial pain syndrome,MPS)的临床疗效。方法将60例腰背MPS患者随机分为常规组和超声组,每组30例。常规组采用普通针刀疗法进行治疗,超声组在超声引导下行针刀疗法治疗,两组均每周治疗1次,连续治疗4次为1个疗程。分别于治疗前后采用简化McGill疼痛问卷(short-form McGill pain questionnaire,SF-MPQ)评估患者疼痛程度,采用多裂肌杨氏模量值评估患者肌肉状态变化,并于治疗后观察两组临床疗效。结果与治疗前比较,两组患者治疗后SF-MPQ评分及杨氏模量值均显著降低(P<0.05);与常规组比较,超声组SF-MPQ评分及杨氏模量值降低程度更显著(P<0.05);超声组临床疗效显著优于常规组(P<0.05)。结论超声引导下针刀松解激痛点治疗腰背MPS,能显著缓解患者疼痛症状,显著改善肌肉组织弹性。

阿是穴理论初探

阿是穴理论是以阿是穴为核心的中医经典理论,临床上重视阿是穴的应用却常忽视其理论内涵。通过梳理古代文献及现代理论,总结阿是穴理论作为腧穴定位方法及针灸治疗选穴原则的内涵。比较阿是穴理论与激痛点理论、浮针医学理论、针刀医学理论,发现这些理论与阿是穴理论本同末异,是对阿是穴理论的继承与发展。认为阿是穴是阿是穴理论的核心,阿是穴具有动态取治的性质,并提出阿是穴治未病的思考。

基于“以痛为输”探讨针刺激痛点治疗肌筋膜疼痛综合征镇痛效应机制

肌筋膜疼痛综合征(myofascial pain syndrome,MPS)已成为一种全球多发病,疼痛是MPS患者最常见的主诉症状。激痛点(myofascial trigger points,MTrPs)实质为挛缩的肌小节,利用体格检查或生物化学检测可以确定MTrPs在骨骼肌中的位置,它是引发肌肉紧绷疼痛的主要原因之一,亦为肌骨疼痛疾病尤其是MPS的有效治疗部位。这与《灵枢·经筋》“以痛为输”理论高度契合。“以痛为输”重点关注患者软组织损伤的疼痛部位和医者触诊到的压痛点,是针刺治疗经筋病的基本取穴原则,已被沿用二千余年,但其作用机制尚不清楚。国内外已开展大量研究探查针刺MTrPs治疗MPS作用机制,基于其与“以痛为输”的相似性,该文就MTrPs实质、MPS疼痛发病机制及针刺MTrPs治疗MPS抗炎镇痛机制等方面进行探讨,以期丰富“以痛为输”理论的科学内涵。

针刺激痛点联合盐酸氟桂利嗪治疗偏头痛的临床研究

目的观察针刺激痛点联合盐酸氟桂利嗪治疗偏头痛患者的疗效及对炎症相关指标、血管活性物质的影响。方法选择2017年1月—2022年1月首都医科大学附属北京中医医院诊治的80例偏头痛患者为研究对象,根据随机数字表法按1:1比例将患者分为观察组、对照组,每组40例。对照组予以假针刺+口服盐酸氟桂利嗪治疗,观察组予以激痛点针刺+口服盐酸氟桂利嗪治疗,针刺隔天治疗1次,2组均治疗4周。比较2组治疗后头痛情况,临床疗效,血清炎症相关指标[环氧化酶-2(COX-2)、降钙素基因相关肽(CGRP)、前列腺素E 2(PGE_(2))]及血管活性物质[血管性血友病因子(vWF)、内皮素-1(ET-1)、一氧化氮(NO)]水平、脑血流速度及不良反应发生情况。结果治疗后,观察组偏头痛发生次数、头痛发作总时间、疼痛程度VAS评分均明显低于对照组(P均<0.05);观察组总有效率明显高于对照组[92.5%(37/40)比75.0%(30/40),P<0.05];观察组血清COX-2、CGRP、PGE_(2)、vWF、ET-1水平均明显低于治疗前及对照组(P均<0.05),NO水平均明显高于治疗前及对照组(P均<0.05);观察组大脑前动脉、大脑中动脉、大脑后动脉、椎动脉、基底动脉的血流速度均明显慢于治疗前及对照组(P均<0.05)。治疗期间2组不良反应发生率比较差异无统计学意义(P>0.05)。结论针刺激痛点联合盐酸氟桂利嗪治疗偏头痛疗效显著,可有效缓解患者的疼痛症状,降低炎症相关指标水平,改善血管内皮功能和脑血流动力学,且治疗安全。

基于肌筋膜理论“激痛点松解法”内涵及机制探讨

肌筋膜理论与经筋理论相类似,肌筋膜激痛点在中医视角下与经筋病更贴切,灭活激痛点具有调和营卫,平衡阴阳、祛除外邪、活血化瘀,调和气血、中和筋骨、调神等作用;现代医学认为灭活激痛点是多因素、多途径的综合作用效应,能够通过恢复生物力学平衡、改善血液循环、减轻痛觉增敏等起效机制,实现以骨骼肌为主体的软组织正常结构和生理功能的重塑,以达到骨正筋柔之效。文章概述了激痛点松解疗法的内涵,并从中医和西医的角度探讨了灭活激痛点机制,以期为肌筋膜理论“激痛点疗法”提供科学的理论依据。