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.

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.

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.

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.

Updates on therapies for chronic prostatitis/chronic pelvic pain syndrome

Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics.After much debate, it has been divided into four distinct categories by National Institutes of Health namely(1) acute bacterial prostatitis;(2) chronic bacterial prostatitis;(3) chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) which is further divided into inflammatory and non-inflammatory CP/CPPS; and(4)asymptomatic inflammatory prostatitis. CP/CPPS has been a cause of great concern for both patients and physicians because of the lack of presence of thoroughinformation about the etiological factors along with the difficult-to-treat nature of the syndrome. For the presented manuscript an extensive search on PubM ed was conducted for CP/CPPS aimed to present an updated review on the evaluation and treatment options available for patients with CP/CPPS. Several diagnostic criteria's have been established to diagnose CP/CPPS, with prostatic/pelvic pain for at least 3 mo being the major classifying symptom along with the presence of lower urinary tract symptoms and/or ejaculatory pain. Diagnostic tests can help differentiate CP/CPPS from other syndromes that come under the heading of prostatitis by ruling out active urinary tract infection and/or prostatic infection with uropathogen by performing urine cultures, Meares-Stamey Four Glass Test, Preand Post-Massage Two Glass Test. Asymptomatic inflammatory prostatitis is confirmed through prostate biopsy done for elevated serum prostate-specific antigen levels or abnormal digital rectal examination. Researchers have been unable to link a single etiological factor to the pathogenesis of CP/CPPS, instead a cluster of potential etiologies including atypical bacterial or nanobacterial infection, autoimmunity, neurological dysfunction and pelvic floor muscle dysfunction are most commonly implicated. Initially monotherapy with anti-biotics and alpha adrenergic-blockers can be tried, but its success has only been observed in treatment nave population. Other pharmacotherapies including phytotherapy, neuromodulatory drugs and anti-inflammatories achieved limited success in trials. Complementary and interventional therapies including acupuncture, myofascial trigger point release and pelvic floor biofeedback have been employed. This review points towards the fact that treatment should be tailored individually for patients based on their symptoms. Patients can be stratified phenotypically based on the UPOINT system constituting of Urinary, Psychosocial, Organ-specific, Infectious, Neurologic/Systemic and symptoms of muscular Tenderness and the treatment algorithm should be proposed accordingly. Treatment of CP/CPPS should be aimed towards treating local aswell as central factors causing the symptoms. Surgical intervention can cause significant morbidity and should only be reserved for treatment-refractory patients that have previously failed to respond to multiple drug therapies.

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。

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.

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.

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.

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.

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.

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。

电针激痛点对肌筋膜疼痛综合征大鼠BDNF、NGF表达的影响

目的探讨电针疗法对肌筋膜疼痛综合征(MPS)大鼠促炎性因子、氧化应激和脊髓神经生长因子(NGF)、脑源性神经营养因子(BDNF)的影响。方法24只SPF级SD大鼠随机分为空白组(n=8)、模型组(n=8)、电针组(n=8)。模型组和电针组通过打击结合离心运动方式建立MPS模型,造模后电针组给予电针干预。分别于造模前、造模后及治疗后对3组进行热缩足潜伏期检测;HE染色法观察大鼠肌细胞形态学变化;用ELISA技术检测各组大鼠血清促炎细胞因子白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和氧化应激指标超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)的水平;Western blot检测大鼠L4~6脊髓NGF及BDNF的蛋白表达水平;实时荧光定量PCR(RT-PCR)检测NGF和BDNF的mRNA表达水平。结果与空白组相比,模型组大鼠热缩足潜伏期时间明显缩短,电针干预后明显延长(P<0.01)。与空白组相比,模型组大鼠出现膨大、圆染的肌细胞,核内移明显,电针干预后肌细胞大小形状规则,较为接近正常组肌组织形态;与空白组相比,模型组大鼠血清促炎性因子IL-1β、IL-6、TNF-α水平显著升高,经电针干预后显著降低(P<0.01);与空白组相比,模型组大鼠血清SOD、GSH-px、CAT水平显著降低,MDA水平显著升高(P<0.01);与模型组相比,电针组大鼠血清SOD、GSH-px、CAT水平显著升高,MDA水平显著降低(P<0.01);与空白组相比,模型组大鼠脊髓组织NGF、BDNF的蛋白和mRNA表达水平显著升高;与模型组相比,电针组大鼠脊髓组织NGF、BDNF的蛋白和mRNA表达水平显著降低(P<0.01)。结论电针可以显著降低MPS大鼠的疼痛阈值,具体机制涉及了对促炎性因子和氧化应激的抑制,同时又与降低NGF、BDNF的蛋白和mRNA表达水平有关。

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。

盆底肌筋膜手法联合磁电治疗女性慢性盆腔疼痛综合征的疗效观察

目的探讨盆底肌筋膜手法联合磁电治疗对女性慢性盆腔疼痛综合征患者疼痛、基本生活活动能力及盆底电生理的影响。方法选取2021年1月至2022年2月遂宁市中心医院盆底康复中心收治的60例女性慢性盆腔疼痛综合征患者作为研究对象。按照随机数字表法分为对照组和试验组,各30例。对照组采用磁电治疗,试验组在磁电治疗的基础上采用盆底肌筋膜手法治疗。收集两组治疗前及治疗后即刻的视觉模拟评分法(VAS)评分、疼痛障碍指数(PDI)及盆底电生理指标,随访两组治疗后3个月及6个月的VAS评分及PDI。结果试验组在治疗后即刻、治疗后3个月及6个月的VAS评分和PDI均低于对照组,差异具有统计学意义(P<0.05);治疗后即刻,试验组的前静息及后静息平均肌电值(EMG)均低于对照组,试验组的快肌最大肌电值、慢肌平均肌电值及耐力平均肌电值均高于对照组,差异具有统计学意义(P<0.05)。结论盆底肌筋膜手法联合磁电治疗女性慢性盆腔疼痛综合征患者有利于改善盆底电生理功能、减轻疼痛程度及提高基本生活活动能力。

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。

肌骨超声检查在肌筋膜疼痛综合征临床诊疗中的应用研究进展

肌筋膜疼痛综合征是以骨骼肌疼痛、功能障碍和肢体运动范围受限为主要表现的综合征,肌筋膜疼痛触发点是该病的诱发因素,准确定位以及评估肌筋膜疼痛触发点特征是该疾病诊断和治疗的核心。肌骨超声检查能够显示肌筋膜疼痛触发点的图像,测量相关的超声影像学指标,为肌筋膜疼痛综合征的临床诊断和疗效评价提供客观依据。本文就肌骨超声检查在肌筋膜疼痛综合征临床诊疗中的应用进展进行了综述。

银质针导热治疗肌筋膜疼痛综合征大鼠骨骼肌线粒体和SIRT3表达的变化

背景:临床研究发现银质针导热治疗对肌筋膜疼痛综合征患者具有良好镇痛作用,但其具体机制仍不清楚。目的:观察银质针导热治疗对肌筋膜疼痛综合征大鼠线粒体超微结构和沉默信息调节因子同源蛋白3变化的影响。方法:26只大鼠随机取20只予以打击结合运动疲劳的方法复制肌筋膜疼痛综合征大鼠模型,造模成功的16只大鼠随机分为模型组和银质针导热组,每组各8只;银质针导热组给予银质针导热处理;剩余6只为正常对照。分别于造模前1 d、造模完成后第1天、银质针导热处理后第14天检测大鼠机械刺激缩足阈值、热缩足潜伏期;银质针导热处理后第14天检测大鼠股内侧肌肌电图电活动,取大鼠右侧股内侧肌分别进行苏木精-伊红染色观察局部形态、透射电镜观察线粒体超微结构、Western blot检测沉默信息调节因子同源蛋白3表达。结果与结论:①痛阈值:与正常组和造模前相比,模型组、银质针导热组造模后机械刺激缩足阈值和热缩足潜伏期显著缩短(P<0.01);经银质针导热处理后,与模型组相比,银质针导热组机械刺激缩足阈值和热缩足潜伏期显著延长(P<0.01);②肌电图:模型组大鼠右侧股内侧出现自发电活动,银质针导热组自发电活动较模型组减少,时限较模型组延长(P<0.01),波幅较模型组降低(P<0.05);③苏木精-伊红染色:正常组大鼠肌纤维排列紧密规则,模型组大鼠肌纤维萎缩、变性,排列紊乱,银质针导热组大鼠肌肉结构紊乱改善;④骨骼肌线粒体微观结构:透射电镜显示正常组肌组织线粒体结构正常;模型组肌组织线粒体肿胀,嵴断裂或消失;银质针导热组肌组织线粒体肿胀明显缓解或趋于正常;⑤沉默信息调节因子同源蛋白3表达:模型组较正常组明显下调,银质针导热组较模型组明显上调(P<0.05);⑥结果表明:肌筋膜疼痛综合征大鼠局部肌肉线粒体出现异常,沉默信息调节因子同源蛋白3的表达下调,提示存在能量代谢障碍;银质针导热处理后线粒体变化恢复,接近正常,且沉默信息调节因子同源蛋白3的表达上调接近正常组,推测银质针导热疗法可能通过促进线粒体修复而改善能量代谢障碍发挥治疗作用。