scholarly journals Scoping Review and Interpretation of Myofascial Pain/Fibromyalgia Syndrome: An Attempt to Assemble a Medical Puzzle

Author(s):  
shiloh plaut

Introduction: Myofascial Pain Syndrome (MPS) is a common overlooked and underdiagnosed condition, and with significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. Methods: Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro and medrXiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. Findings: 734 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. Interpretation: MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue, or "fascial armoring", which may explain pain, distribution of pain, decreased pressure/pain threshold, and other phenomena eg, occasional complete resolution after surgery. Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. MPS should no longer be overlooked but solidified in the domain of common modern medicine.

2018 ◽  
Vol 108 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Rocío Melero-Suárez ◽  
José Antonio Sánchez-Santos ◽  
Gabriel Domínguez-Maldonado

Background: Closely related pathologic disorders sometimes manifest with the same symptoms, making for a complex differential diagnosis. This is the situation in plantar fasciitis (PF) and myofascial pain syndrome (MPS) with myofascial trigger points (MTPs) in the sole of the foot. This research assessed the analgesic effect on plantar pain of combination therapy with interferential current stimulation therapy (ICST), treating MTPs in the great toe adductor muscle and the short flexor muscles of the toes in patients whose diagnosis was compatible with PF or MPS. Methods: This study included 22 feet of 17 patients with a diagnosis compatible with PF or MPS with MTP. Participants received combination therapy with ICST for 15 sessions, and the decrease in pain was measured with an algometer and the visual analog scale. Both measurements were taken before and after every fifth session. The pressure pain threshold (PPT) results obtained with the Student t test and the pain intensity perception (PIP) results obtained with the Wilcoxon signed rank test were analyzed by comparing the measurements taken before the treatment and after the fifth, tenth, and 15th sessions. Results: The decrease in PIP was significant after the fifth, tenth, and 15th sessions (P < .001). The increase in PPT was also significant after the fifth (P = .010), tenth (P = .023), and 15th (P = .001) sessions (P < .05). Conclusions: The suggested combination therapy of ultrasound with ICST is clinically significant for reducing plantar pain after 15 treatment sessions, with a 6.5-point reduction in mean PIP and a 4.6-point increase in PPT.


2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Chao Ching Wang ◽  
Tse Hung Huang ◽  
Kuo Ching Chiou ◽  
Zi Yu Chang

The aim of this study was to compare the treatment efficacies of superficial acupuncture and traditional acupuncture on trigger points of the upper trapezius muscle. Forty people were recruited and randomly allocated to the traditional and superficial acupuncture groups. Each subject received two treatments per week in a four-week period. Outcomes were measured by visual analogue scale (VAS), the Northwick Park neck pain questionnaire scores (NPQ), and pressure pain threshold (PPT) assessments of trigger points. Data collected before the interventions were considered as baseline. Assessments were performed after the first treatment and at the end of the second and fourth weeks of treatment. Patients reported significant (p<0.05) and immediate improvements in VAS and PPT for both superficial acupuncture and traditional acupuncture after the first treatment and after two and four weeks. Significant improvements (p<0.05) in NPQ were attained after two weeks of treatments in both groups. Because superficial acupuncture is associated with less pain while producing immediate pain relief, we recommend it for treating myofascial pain syndrome in the upper trapezius muscle.


2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Zahra Rezasoltani ◽  
Hanna Ehyaie ◽  
Reza Kazempour Mofrad ◽  
Fatemeh Vashaei ◽  
Reza Mohtasham ◽  
...  

Abstract Objectives Granisetron and lidocaine injections have been used for the management of myofascial pain syndrome. This study was aimed to compare the efficacy of granisetron and lidocaine injections to trigger points of upper trapezius in the management of myofascial pain syndrome. Methods We performed a double-blind randomized clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. A total of 40 patients aged ≥18 with neck pain due to myofascial pain syndrome were included. They had pain for at least one month with the intensity of at least 30 mm on a 100 mm visual analog scale. Each participant received a single dose of 1 mL lidocaine 2% or 1 mg (in 1 mL) granisetron. The solutions were injected into a maximum of three trigger points of the upper trapezius. We instructed all patients to remain active while avoiding strenuous activity for three or four days, and to perform stretch exercise and massage of their upper trapezius muscles. We assessed the patients before the interventions, and one month and three months post-injection. The primary outcome was the Neck Disability Index and the secondary outcome was the Neck Pain and Disability Scale. Results Both interventions were successful in reducing neck pain and disability (all p-values <0.001). However, the neck pain and disability responded more favorably to lidocaine than granisetron (p=0.001 for Neck Disability Index, and p=0.006 for Neck Pain and Disability Scale). No significant side-effect was recognized for both groups. Conclusions Both lidocaine and granisetron injections to trigger points are effective and safe for the management of the syndrome and the benefits remain at least for three months. However, lidocaine is more effective in reducing pain and disability. The injections are well-tolerated, although a transient pain at the site of injections is a common complaint. One mL of lidocaine 2% is more effective than 1 mg (in 1 mL) granisetron for injecting into the trigger points of the upper trapezius in myofascial pain syndrome.


2019 ◽  
Vol 13 (3) ◽  
pp. 270-276 ◽  
Author(s):  
Marco Barbero ◽  
Alessandro Schneebeli ◽  
Eva Koetsier ◽  
Paolo Maino

2018 ◽  
Vol 17 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Sheryl Bourgaize ◽  
Imtisal Janjua ◽  
Kent Murnaghan ◽  
Silvano Mior ◽  
John Srbely ◽  
...  

2019 ◽  
Vol 42 (12) ◽  
pp. 695-703
Author(s):  
Juliusz Huber ◽  
Przemysław Lisiński

Purpose: Comparison of early effects of supervised (led by physiotherapist) and unsupervised rehabilitation protocols in patients with myofascial pain syndrome, disk-root conflict and degenerative spine disease at cervical level. Methods: Three groups of patients (n = 60 each) with clinically and neurophysiologically confirmed myofascial pain syndrome, disk-root conflict and degenerative spine disease were randomly subdivided to supervised and unsupervised treatment subgroups (n = 30 each). Thirty healthy subjects with similar demographic and anthropometric properties as patients were enrolled to control group. Patients were examined before and after rehabilitation with visual analog scale of pain, Spurling’s test, painful passive elongation and active trigger points detection in trapezius muscle, sensory perception studies and surface electromyography (at rest, during maximal contraction) and electroneurography. Results: Supervised treatment resulted in decrease of pain intensity (P = .001) and Spurling’s symptoms incidence (P = .008) in patients from disk-root conflict group. Painful elongation and incidence of trigger points in trapezius muscle were the least observed at P = .009 after supervised therapy of myofascial pain syndrome. Supervised therapy resulted in decrease of resting electromyography amplitude and increase of maximal contraction electromyography amplitude from trapezius muscle (P = .02) in myofascial pain syndrome patients and from biceps and abductor pollicis brevis muscles of patients from other groups (P from .05 to .001). Median nerve electroneurography and sensory perception results improved at P = .05 after supervised treatment in disk-root conflict group. Conclusions: Twenty-day supervised rehabilitation provides better therapeutic effects than unsupervised one in treatment of muscle dysfunctions in patients with myofascial pain syndrome, degenerative changes and disk-root conflict at cervical spine.


2018 ◽  
Vol 6 (2) ◽  
pp. 26
Author(s):  
Putu Ayu Sita Saraswati ◽  
Ni Komang Juni Antari ◽  
Anak Agung Gede Angga Puspa Negara

ABSTRACT``Myofascial pain syndrome in upper trapezius muscle is a muscle pain that implicated by one or somemyofascial trigger points in upper trapezius muscle. Working with static position in long time stimulating the presence ofmyofascial trigger points that causing pain and movement limitation of the neck that stimulate neck disability. Physicaltherapy’s intervention for reducing pain in this case could be integrated neuromuscular inhibition technique or contractrelax stretching combined with ultrasound modality. Purpose: to compare the both interventions in reducing neckdisability of myofascial pain syndrome in upper trapezius muscle. Method: this was an experimental study withRandomized Pre and Post Test Group Design. Samples were divided into 2 treatment group that consist 12 samplesfor each group. The first group treated with integrated neuromuscular inhibition technique with ultrasound while thesecond group treated with contract relaxes stretching with ultrasound. The data was collected by measuring neck rangeof motion using goniometer at the time before and after treatment. Result: the 1st group showed that the Neck ROMincrease 5.083±1.0840 (p<0.001) and the 2nd group showed that the Neck ROM increase 3.333±0.7780(p<0.001). Itmeans there were significant effect of each treatment in both groups. The results of independent t-test showed p<0.001,so that there was significant difference of increased Neck ROM between these groups. The result of independent t-testshowed p value 0.001, so there was significant difference between two groups at increasing neck ROM. Conclusion:combination integrated neuromuscular inhibition technique is more effective than contract relax stretching to ultrasoundmodality in increasing neck range of motion of myofascial syndrome in upper trapezius muscle.Keywords: myofascial, neck disability, trapezius, INIT, ultrasound, stretching


2015 ◽  
Vol 772 ◽  
pp. 603-607
Author(s):  
Marius Cristian Cojocaru ◽  
Ioana Maria Cojocaru ◽  
Nida Alexandra Cojan Carlea ◽  
Delia Cinteza ◽  
Mihai Berteanu

Muscle pain can be elicited by any irritation of the nociceptors in the muscle or central sensitization in the central nervous system and represent a challenge for medical as well as for neurological rehabilitation. The most frequently described muscle pain syndromes are myofascial pain syndrome (MPS) and fibromyalgia syndrome (FMS). The use of infrared thermography in rehabilitation medicine for assessment of musculoskeletal disorders is not well documented in the current literature. This study is focused around MPS due to the more localized manifestations of this syndrome and it’s objective is to asses a correlation between the clinical findings, ultrasound examination and the thermal pattern of trigger points.


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