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.

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.

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.

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.

Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Brief and Useful Guide—Part 2

This work aims to describe a well standardized therapeutic path in reference to the article “Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Part 1 in the form of a practical guide for manual therapist, Open Journal of Therapy and Rehabilitation, Vol. 10, No. 7, July 2018, https://doi.org/10.4236/health.2018.107074”. The osteopathic manipulative treatment (OMT) approach we propose can be complementary to the psychological therapy in use today, and consists of ten standardized techniques directed to the anatomical structures more involved in the stress answer. This protocol was designed to improve and sustain the management of subjects exposed to extraordinary exogenous stress or post-traumatic stress disorder patients (PTSD).

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.

Orofacial pain and fibromyalgia pain:Being aware of comorbid conditions

Orofacial pain originating from myofascial pain of temporomandibular disorders is the second most common source of pain, after tooth pain. However, diagnosis of myofascial pain is challenging due to its characteristic referral pattern. Furthermore, pain arising from structures in the orofacial region may be a presentation of fibromyalgia and treatment directed at temporomandibular disorders fails to alleviate the pain. Similarly, patients with fibromyalgia may present with pain in the orofacial region. The physician in this case should be aware of temporomandibular disorders, its characteristic findings and treatment approaches that might be included in the treatment plan.

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.

The Effects of the Quantum and Finesse Bridles on Equine M. Brachiocephalicus and M. Splenius Function at Three Different Speeds

Badly designed and fitted tack induces physiological stress responses in horses, and may compromise animal welfare. Moreover, horses, just like humans, comprise a series of interconnected myofascial lines. However, to date there are no measurements of the effects of horse tack, such as bridles on muscle parameters. This study used acoustic myography to test whether two commercial anatomically designed and fitted bridles, have a measurable and positive effect on both equine muscle-function and performance. A Quantum bridle was tested on 12 Icelandic horses, whilst a Finesse bridle was tested on 8 Icelandic horses, and results compared with data from a standard bridle (n = 12) tested at the same time and under identical conditions. Sensors were placed on M. Brachiocephalicus and M. Splenius, and the horses exercised following a set protocol at three speeds. The results revealed statistically significant improvements in muscle performance as assessed by both the regularity of the recording at each speed, and the number of transient powerful contractions (spikes) for the anatomically designed and fitted bridles, compared with the standard bridle. It is concluded that the effect of anatomically designed bridles can not only be measured in the neck muscles of exercising horses, but that they appear to have a positive effect on muscle performance.

Surgical Treatment of Ankylosis of Temporomandibular Joint with Temporalis Myofascial Flap

Objective. To study the effects of temporalis myofasdal flap (TMF) transferred to treat the long ankylosis of temporomandibular joint (TMJ). Methods : Seventeen cases with ankylosed condytes received arlhroplasty. The degrees of mouth opening pre- and post-operation were e-vahiated, and the spaces of joints in the X-ray films were also measured. The evaluation of the results of the surgical treatment was based on the TMJ functions. Results .Following up 0. 5-3. 0 years, in 12 of 17 cases the degree of mouth opening improved up to 27 mm. The doctors and the patients were both satisfied with the results. Conclusion:The use of TMF in artkroplasty of temporomandibular joint is a good approach in the treatment of TMJ.

Simultaneous Occurrence of Myofascial Pain Referred to Tooth and Endodontic Lesions in Patient with Toothache: A Case Report

Toothache is almost always caused by odontogenic toothache, but diagnosis is more difficult in the case of nonodontogenic toothache. We report a case of simultaneous occurrence of odontogenic and nonodontogenic toothache. This manuscript presents a case report for a 35-year-old woman who visited our Orofacial and Head Pain Clinic with the chief complaint of continuous dull pain in left maxillary molar teeth region. It was concluded to be a case of simultaneous odontogenic toothache and nonodontogenic toothache. It was successfully treated by an endodontist and an orofacial pain specialist. The endodontist performed root canal treatment against odontogenic toothache caused by apical periodontitis using a dental operating microscope. The presence of a trigger point (TP) resulting in tooth pain was inferred. A trigger point injection (TPI) was administered by orofacial pain specialist, and toothache relief was confirmed. Myofascial pain was diagnosed definitively. After confirming that the toothache had resolved at multiple TPIs, a crown prosthesis was placed. Following the application of crown prosthesis, we were concerned but did not find recurrence of toothache from myofascial pain due to increased occlusal force. This case suggests that there is no single cause of chronic pain and that multiple causes must be considered for diagnosis, suggesting the need for treatment by multiple specialists.

Deep Myofascial Kinetic Lines in Horses, Comparative Dissection Studies Derived from Humans

Seven superficial myofascial kinetic lines have been described earlier in horses in a comparative dissection study to the human lines. The lines act as an anatomical basis for understanding locomotion, stabilization, and posture. Further dissections verified three profound equine lines comparable to those described in humans and a fourth line not described previously. Forty-four horses of different breed and gender were dissected, imaged and video recorded. The horses were euthanized due to reasons not related to this study. A Deep Ventral Line (DVL) very similar to that in the human was verified in these studies. The line spans from the insertion of the profound flexor tendon in the hindlimb to the base of the cranium and oral part of the cavities of the head. It includes the profound, hypaxial myofascial structures, the ventral coccygeal muscles, the psoas muscles, the diaphragm, the longus colli/capitis muscles and the ventral capital muscles. The inner lining of the pelvic, abdominal and thoracic cavities with all the organs, vessels and nerves are also included. The line is closely connected to the autonomic nervous system by the vagus nerve, the pelvic nerves, the sympathetic trunk and several of the prevertebral nerves and ganglia. The new line identified in this study, is a Deep Dorsal Line (DDL), which starts in the dorsal tail muscles. It comprises myofascial structures of the spinocostotransversal system from the tail to the head including the nuchal ligament. It connects to the dura mater and has a major role in controlling the motion and stabilization of the Columna vertebralis. Both the DDL and the DVL include the coccygeal myofascia and periosteum of the skull. Due to differences in biped and quadruped anatomy the Front Limb Adduction Line (FADL) and the Front Limb Abduction Line (FABL) differ from the human lines. The lines are identified as slings in the brachial and antebrachial regions. The FABL includes structures for abduction and internal rotation connecting to the Front Limb Retraction Line (FLRL), and the FADL structures of adduction and external rotation in close proximity to the Front Limb Protraction Line (FLPL). The front limb lines support the movement of the front limb around the “thoraco-scapula pivot joint” medially at the level of the upper third of the scapula. The DVL identified in this study is similar to the human DFL whereas the front limb lines differ somewhat from the deep human arm lines due to differences in bi- and quadruped anatomy and biomechanics. We have identified and described this new equine DDL. The lines altogether explain a profound body balance and confirm the three-dimensional equine fascial network, which is of great clinical and biomechanical importance.

Relationship Between Symptom Distress,Functional Status and Quality of Life in Patients with Low Back Myofascial Pain Syndrome

Objective:To explore the relationship between symptomatic functional status and quality of life of patients with low back myofascial pain syndrome(MPS).Methods:From July 2021 to June 2022,106 patients with low back myofascial pain syndrome in the Affiliated Hospital of Hebei University were selected as the research subjects.A total of 106 MPS patients were investigated with general information questionnaire,Memory Symptom Assessment Scale(MSAS),Oswestry Disability Index(ODI)and Short Form Questionnaire(SF-36).The relationship between quality of life and symptom distress and dysfunction was observed and analyzed based on symptom distress and dysfunction scores,SF-36 scores,and so on.Results:The total score of MSAS was 1.79±0.91.The overall symptom distress of the patients was moderate.The ODI score was 18.46±5.95.The functional disability of the patients was classified as moderately impaired.The MSAS-PHYS,MSAS-PSYCH,MSAS-GDI three scale scores were 2.14±0.75,1.69±0.88,1.55±0.46,respectively,and the variability of the three scales is relatively large;the dimension scores were significantly lower than those of the conventional scoring models,and P<0.05,indicating a statistical difference;the scores of each dimension of the patient’s quality of life were compared with the scores of symptom distress and functional status.The higher the symptom distress score,the lower the quality of life,with P<0.05,indicating a statistical difference;the higher the score of each dimension of functional status,the better the quality of life,showing a positive correlation,and P<0.05,indicating a statistical difference.Conclusion:MPS patients face a number of physical and psychological symptoms,and their functional status is limited.Nursing staff should implement health education and intervention measures according to the actual situation of the patients,so as to improve the quality of their lives.

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.

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.

Effect of miniscalpel-needle on relieving the pain of myofascial pain syndrome: a systematic review

OBJECTIVE: To evaluate the effect and safety of miniscalpel-needle(MSN) on reducing the pain of myofascial pain syndrome(MPS).METHODS: We reviewed the available literatures inception up to February 2014 using Pubmed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure Database, Chinese Biomedical Database and Wanfang Database.RESULTS: Eight randomized controlled trials were finally identified. The main controls involved acupuncture, medications, injection, massage and cupping. We found that all of the studies agreed on the potential benefit of MSN as a strategy for MPS and the superiority compared to the controls, however,randomized methods applied in most of the trials could be criticized for their high or unclear risk of bias. Further research is also needed to clarify questions around the appropriate frequency and number of treatment sessions of MSN.CONCLUSION: This review shows that MSN might have the effect on MPS, even though there were some limitations in the studies included in the review. Studies with robust methodology are warranted to further test its pain-relieving effect on MPS.

Comparison between four treatment modalities for active myofascial triggers points

Aim:The study aimed at the painful trigger points(TrPs)for the purpose of ablating muscle spasms and restoring normal muscle length to find the most effective treatment for alleviating pain and improving mouth range of motion in patients with myofascial pain dysfunction.Methods:We enrolled 72 patients with pain and reduced mouth opening due to temporomandibular joint dysfunction.Patients assigned to four groups and four treatment modalities used to treat myofascial TrPs pain.We used mean and standard deviation values.The Mann–Whitney U-test was used to compare the two groups.The Wilcoxon signed-rank test was used to study the changes by the time in mean pain scores.The Student’s t-test was used to compare maximum mouth opening(MMO)groups.Then paired t-test was also used to study the changes of time in an MMO.Results:The results showed that pulsed electromagnetic field(PEMF)therapy is the most effective treatment modality regarding for pain relief.Both the anesthesia and PEMF groups showed a reduction in mean pain scores throughout all follow-up periods,and a statistically significant increase in mean MMO.Conclusion:The findings suggest that PEMF is the most effective treatment for alleviating pain and improving mouth range of motion in patients with myofascial pain.