Concomitant Sympathetically Mediated Pain and Myofascial Trigger Point Pain

1994 ◽  
Vol 12 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Peter Baldry
Keyword(s):  
Myofascial Pain ◽  
Trigger Point ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Myofascial Trigger Point ◽  
Sympathetically Maintained Pain ◽  
Myofascial Trigger Points ◽  
Release Of Noradrenaline ◽  
Genetically Determined

It is not sufficiently well recognised that the reflex sympathetic dystrophy syndrome (RSDS) and the myofascial pain syndrome (MPS) may develop concomitantly. This happens because they have similar aetiological factors, with trauma being by far the commonest. Everyone is liable to develop nociceptor pain as a result of trauma-induced activation and sensitisation of C afferent skin and Group IV muscle nociceptors; also A-β mediated pain as a result of the sensory afferent barrage produced by these nociceptors giving rise to sensitisation of dorsal horn transmission neurones. With most people these neural changes lead only to the development of MPS. In a minority of people, possibly those with a genetically determined predisposition, this sensory afferent barrage also causes changes to take place in the sympathetic nervous system, with the development of a characteristic burning type of sympathetically mediated pain. This may develop alone or in association with myofascial trigger point pain. There is much controversy concerning the mechanisms for development of RSDS pain. One theory is that the pain develops as a result of the nociceptor-induced sensory afferent barrage setting up aberrant sympathetic efferent activity. This results in the release of noradrenaline which binds to α-1 adrenoreceptors in the walls of the nociceptors, exciting them further. Much research, however, still has to be done before the development of sympathetically maintained pain can be adequately explained. It is stressed that for the successful treatment of RSDS early diagnosis is essential. Treatment involves sympathetic blockade either by the injection of local anaesthetic into a sympathetic ganglion, or by the regional infusion of a catecholamine depleting drug. Sympathetically maintained pain is morphine resistant and is therefore unlikely to be relieved by acupuncture, the analgesic effect of which is mediated by opioid peptides. The main place for acupuncture is in the treatment of concomitant myofascial trigger point pain. It is emphasised that in all cases of RSDS it is essential to search for myofascial trigger points and, when present, to deactivate these by means of acupuncture stimulation of A-δ nerve fibres present in the skin and subcutaneous tissues at the trigger point sites.

scholarly journals Myofascial Pain Syndrome: Looked through the Lens of 11 Cases Managed by Myofascial Trigger Point Massage Therapy, Riyadh, Saudi Arabia

2019 ◽  
pp. 1-12
Author(s):  
Naseem Akhtar Qureshi ◽  
Hamoud Abdullah Alsubai ◽  
Mohammed Khulaif Alharbi
Keyword(s):  
Saudi Arabia ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Massage Therapy ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Myofascial Trigger Point ◽  
Myofascial Trigger Points ◽  
Trigger Point Therapy

Background: Myofascial pain syndrome is a common pain condition characterized by a key symptoms and signs, determined by multiple etiologies, comorbid with a variety of systemic diseases and regional pain syndromes and managed by diverse therapies with variable outcomes. Objective: This study aimed to concisely report 11 cases of myofascial pain syndrome managed by myofascial trigger point therapy. Methods: The relevant information about 11 cases was collected prospectively using a semistructured proforma. All patients were diagnosed mainly by detailed history and gold standard palpation method that helps identify taut muscles, tender myofascial trigger points, local twitch response and autonomic manifestations. Results: Most of the patients with variable age and profession presented in emergency room with acute pain, limited motion, weakness, referred pain of specific pattern and associated autonomic signs and symptoms. Myofascial trigger point therapy alone with a timeline of about 30-60 minutes of 1-3sessions brought about good results in all 11 patients (100%) who remained stable at two to three months followup. Conclusion: Myofascial pain syndrome linked with latent or active myofascial trigger points developed due to repeated strains and injuries needs to be diagnosed by history and palpation method, systemic evaluation and laboratory investigations. Though several interventions are used in myofascial pain syndrome, myofascial trigger point massage therapy alone is found to be reasonably effective with excellent results. This clinical case series is calling for double-blind randomized controlled trials among patients with myofascial pain syndrome not only in Saudi Arabia but also in other Middle East countries in future.

scholarly journals Myofascial Pain Syndrome: A Concise Update on Clinical, Diagnostic and Integrative and Alternative Therapeutic Perspectives

2019 ◽  
pp. 1-14 ◽  
Author(s):  
Naseem A. Qureshi ◽  
Hamoud A. Alsubaie ◽  
Gazzaffi I. M. Ali
Keyword(s):  
Myofascial Pain ◽  
Trigger Point ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Muscle Twitch ◽  
Myofascial Trigger Points ◽  
Pain Syndromes ◽  
Clinical Diagnostic ◽  
Regional Pain Syndromes

Background: Myofascial pain syndrome is a common multifactorial condition that presents with key manifestations and comorbid with many systemic diseases and regional pain syndromes. Objective: This study aims to concisely review clinical, diagnostic and integrative therapeutic aspects of myofascial pain syndrome. Methods: E-searches (2000-2019) using keywords and Boolean operators were made and using exclusion and inclusion criteria, 50 full articles that focused on myofascial pain syndrome were retained for this review. Results: Myofascial pain syndrome is a multidimensional musculoskeletal disorder with ill-understood etiopathogenesis and pathophysiology and characterized by tender taut muscle with myofascial trigger points, muscle twitch response, specific pattern of referred pain and autonomic symptoms. A variety of pharmacological and nonpharmacological therapies with variable efficacy are used in myofascial pain syndrome, the latter modalities such as education, stretching and exercises, moist hot and cold packs, dry needling and myofascial massage or myofascial trigger point massage are used as first line options. Conclusion: Myofascial pain syndrome and trigger points initiated by repeated strains and injuries co-occur with diverse physical diseases and regional pain syndromes, which need comprehensive diagnostic evaluation using multiple methods. Several interventions are used in patients with myofascial pain syndrome who effectively respond to myofascial massage. This study calls for exploring etiopathogenesis and basic pathophysiological mechanisms underlying myofascial pain syndrome in future.

scholarly journals Dry needling versus ultrasonic in treating cervical myofascial pain syndrome

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H A Ali ◽  
A K Elzohiery ◽  
M M Arafa ◽  
N A Elkadery
Keyword(s):  
Skeletal Muscles ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Trapezius Muscle ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Ultrasonic Waves ◽  
Dry Needling ◽  
Myofascial Trigger Points

Abstract Background Myofascial pain syndrome (MPS) is a complex pain syndrome characterized by myofascial trigger points (MTrPs) in skeletal muscles. Ultrasound (US) therapy is one of the main devices used in physical therapy, for the treatment of MTrPs in MPS. Dry needling is skilled technique also used in the treatment of MTrPs in MPS. Purpose This study aimed to compare the effect of dry needling with the effect of ultrasonic waves in the treatment of cervical myofascial pain. Subjects a sample of 30 patients with myofascial trigger points in trapezius muscle was randomly chosen and divided into 2 groups each contains 15 patients. Methods the first group was treated by ultrasonic waves in a pulsed mode (1MHz, 1W/cm², 1:1 ratio) 5 min to each trigger point and the second group was treated with deep dry needling (peppering technique) to each trigger point with a rate of 3 times per week for 3 weeks. Results All patients shows significant improvement (P > 0.001) immediately after treatment period with disappearance of trigger points, increasing in cervical ROM and decreasing in VAS ; but 3 weeks later trigger points reappeared, ROM decreased and VAS increased again. Conclusion both modalities of treatment were considered effective in treating myofascial pain syndrome.

scholarly journals The effectiveness of myofascial trigger point therapy on myofascial pain syndrome trigger points

1994 ◽  
Author(s):  
◽  
Andrew D Jones
Keyword(s):  
Back Pain ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Controlled Trial ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Myofascial Trigger Point ◽  
Trigger Point Therapy ◽  
Single Blind

The efficacy of myofascial trigger point therapy in treatment of myofasciitis was evaluated in a single blind, randomised, placebo controlled trial. The patient population consisted of twenty individuals who presented with one of the following: upper-back pain, shoulder pain, and neck-pain and or headaches and who were diagnosed as having myofasciitis.

Evaluation of the Analgesic Effect of Combination Therapy on Chronic Plantar Pain Through the Myofascial Trigger Points Approach

2018 ◽  
Vol 108 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Rocío Melero-Suárez ◽  
José Antonio Sánchez-Santos ◽  
Gabriel Domínguez-Maldonado
Keyword(s):  
Combination Therapy ◽  
Analgesic Effect ◽  
Myofascial Pain ◽  
Pressure Pain Threshold ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Adductor Muscle ◽  
Rank Test ◽  
Myofascial Trigger Points

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.

scholarly journals Results of the post-registration clinical study “PARUS” on efficiency and safety assessment of Mydocalm-Richter for local injection therapy of a myofascial trigger zone

2018 ◽  
Vol 90 (6) ◽  
pp. 81-88
Author(s):  
F I Devlikamova
Keyword(s):  
Muscle Relaxant ◽  
Blood Circulation ◽  
Myofascial Pain ◽  
Ultrasound Examination ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Orthostatic Test ◽  
Myofascial Trigger Points ◽  
Sedative Effects

Aim. The “PARUS” program included investigation of the analgesic, muscle relaxant and sedative effects of Mydocalm-Richter which acts as central muscle relaxant in patients with myofascial pain syndrome, taking into account its registered indication for use - the hypertonus and cross-striated muscle spasm. Materials and methods. Fifty patients with myofascial trigger points, the mean age of 41.67±11.86 years, have been enrolled in the study. All patients had undergone clinical examination that allowed the diagnosis of myofascial pain syndrome. The intensity of pain syndrome was evaluated using the pain visual analogue scales and McGill pain questionnaire. Visualization of area in spasm and evaluation of blood circulation was carried out using the ultrasound scan of target muscle. In order to objectively evaluate any conceivable hypotensive and sedative effects of Mydocalm-Richter we used the orthostatic test, Schulte’s test for attention span and perfor-mance distribution and Munsterberg’s test for attention discrimination and concentration. Results. The analgesic and muscle relaxant effects of Mydocalm-Richter become apparent by day 3 post-injection, and the muscle relaxation effect is reaching its maximum on day 10 post-injection. Cardiovascular function following administration of Mydocalm-Richter was evaluated using the orthostatic test which revealed good orthostatic tolerance. Single injection of tolperisone hydrochloride possessing a central muscle relaxant activity has no sedative effect and does not influence patient response time. The ultrasound examination data demonstrated the improvement and in some cases restoration of blood circulation in the myofascial trigger points. Conclusion. Clinical study “PARUS” conducted in patients with myofascial pain has demonstrated a positive muscle relaxant and analgesic effect of Mydocalm-Richter that resulted in restoration of peripheral circulation in the myofascial trigger pointsconfirmed by ultrasound examination. An important benefit of this drug product is the absence of sedative effect and arterial hypotension.

scholarly journals The relative effectiveness of a home programme of ischaemic compression, sustained stretch and a combination of both for the treatment of myofascial trigger points in the upper trapezius musculature

2003 ◽  
Author(s):  
◽  
Marlon Thoresson
Keyword(s):  
Myofascial Pain ◽  
Relative Effectiveness ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Clinical Findings ◽  
Myofascial Trigger Points ◽  
Upper Trapezius

The purpose of this study was to determine the relative effectiveness of a home programme of ischaemie compression, sustained stretch and a combination of the two, in terms of subjective and objective clinical findings for the treatment of Myofascial Pain Syndrome.

Dry Needling Versus Sham Needling for Myofascial Pain Syndrome: A Critically Appraised Topic

2020 ◽  
Vol 25 (6) ◽  
pp. 289-293
Author(s):  
Melissa Jack ◽  
Ryan Tierney ◽  
Jamie Mansell ◽  
Anne Russ
Keyword(s):  
Myofascial Pain ◽  
Trigger Point ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Clinical Question ◽  
Myofascial Trigger Point ◽  
Dry Needling ◽  
Bottom Line

Focused Clinical Question: In patients with myofascial trigger point pain, does dry needling result in greater decreases in pain compared to sham needling? Clinical Bottom Line: The evidence supporting dry needling as more effective than sham needling in reducing patients’ pain is mixed.

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