scholarly journals Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

2014 ◽  
Vol 04 (01) ◽  
pp. e13-e20 ◽  
Author(s):  
Michael Freeman ◽  
Ake Nystrom ◽  
Christopher Centeno
Keyword(s):  
Central Sensitization ◽  
Trigger Points ◽  
Pain Modulation ◽  
Myofascial Trigger Points ◽  
Chronic Whiplash

scholarly journals CENTRAL SENSITIZATION OF PAIN IN PHYSIOTHERAPY

2020 ◽  
Vol 32 (32) ◽  
pp. 35-39
Author(s):  
Elżbieta Skorupska
Keyword(s):  
Central Sensitization ◽  
Physical Therapists ◽  
International Association ◽  
Somatosensory System ◽  
Trigger Points ◽  
Myofascial Trigger Points ◽  
Neuronal Excitation ◽  
The Central Nervous System ◽  
Pain Descriptors ◽  
Neural Signaling

Nowadays, there are three main pain descriptors: nociceptive pain, neuropathic pain, and nociplastic pain. The last one is the newest expression defining pain as ‘Pain that arises from altered nociception, despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain’ (International Association for the Study of Pain). The implementation of modern pain neuroscience in practice is said to be the most important for musculoskeletal physical therapists around the world. One of the examples of the nociplastic pain mechanism can be myofascial trigger points that are connected with central sensitization (one of the subtypes of nociplastic pain). Central sensitization (CS) is defined as an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity and ongoing neuronal excitation which outlasts the initial nociceptor input. Features typical of that state are abnormally low peripheral thresholds for pain from pressure, temperature, electrical, and other stimuli and it has been proposed that trigger points may function as peripheral mediators of CS.

Myofascial Trigger Points and Sensitization: An Updated Pain Model for Tension-Type Headache

Cephalalgia ◽  
2007 ◽  
Vol 27 (5) ◽  
pp. 383-393 ◽  
Author(s):  
C Fernández-de-las-Peñas ◽  
ML Cuadrado ◽  
L Arendt-Nielsen ◽  
DG Simons ◽  
JA Pareja
Keyword(s):  
Central Sensitization ◽  
Trigger Point ◽  
Trigger Points ◽  
Tension Type Headache ◽  
Referred Pain ◽  
Tender Points ◽  
Myofascial Trigger Points ◽  
Pain Model ◽  
Type Headache ◽  
Chemical Mediators

Present pain models for tension-type headache suggest that nociceptive inputs from peripheral tender muscles can lead to central sensitization and chronic tension-type headache (CTTH) conditions. Such models support that possible peripheral mechanisms leading to pericranial tenderness include activation or sensitization of nociceptive nerve endings by liberation of chemical mediators (bradikinin, serotonin, substance P). However, a study has found that nonspecific tender points in CTTH subjects were not responsible for liberation of algogenic substances in the periphery. Assuming that liberation of algogenic substances is important, the question arising is: if tender muscle points are not the primary sites of on-going neurogenic inflammation, which structure can be responsible for liberation of chemical mediators in the periphery? A recent study has found higher levels of algogenic substances, and lower pH levels, in active myofascial trigger point (TrPs) compared with control tender points. Clinical studies have demonstrated that referred pain elicited by head and neck muscles contribute to head pain patterns in CTTH. Based on available data, an updated pain model for CTTH is proposed in which headache can at least partly be explained by referred pain from TrPs in the posterior cervical, head and shoulder muscles. In this updated pain model, TrPs would be the primary hyperalgesic zones responsible for the development of central sensitization in CTTH.

scholarly journals An investigation into the association between the role of myofascial trigger points of the lower extremity and the clinical diagnosis of iliotibial band friction syndrome

2004 ◽  
Author(s):  
◽  
Michele Broadhurst
Keyword(s):  
Lower Extremity ◽  
Clinical Diagnosis ◽  
Clinical Presentation ◽  
Trigger Points ◽  
Iliotibial Band ◽  
Myofascial Trigger Points ◽  
Iliotibial Band Friction Syndrome ◽  
Friction Syndrome

The purpose of this study was to investigate the association between the role of Myofascial Trigger Points of the lower extremity to the clinical presentation of lIiotibialband Friction syndrome

scholarly journals Quantitative Response of Healthy Muscle Following the Induction of Capsaicin: An Exploratory Randomized Controlled Trial

2019 ◽  
Author(s):  
Valerie Evans ◽  
Michael Behr ◽  
Kei Masani ◽  
Dinesh Kumbhare
Keyword(s):  
Motor Unit ◽  
Unit Activity ◽  
Central Sensitization ◽  
Controlled Trial ◽  
Ultrasound Image ◽  
Trigger Points ◽  
Image Texture ◽  
Control Treatment ◽  
Myofascial Trigger Points ◽  
Motor Unit Activity

Abstract Background: Myofascial pain syndrome (MPS) is a prevalent chronic pain disorder primarily characterized by myofascial trigger points (MTrP). There is limited knowledge on the pathophysiology and mechanisms underlying MTrP and its development. Research has previously demonstrated the identification of MTrPs using ultrasound and vibration sonoelastography, although there is some contradictory evidence regarding if MTrPs present as hyper or hypoechoic regions. Electromyography (EMG) investigations of MTrP have demonstrated that MTrP are usually located proximal to innervation zones where the peak surface EMG signals are obtained from. Central sensitization has been proposed as the primary mechanism underlying MTrP development. Central sensitization is associated with hyperexcitability of neuronal responses to normal or noxious stimuli. There is a need for a study that measures ultrasound image textural changes and motor unit activity responses in the muscle following sensitization. The purpose of this study is to determine whether sensitizing healthy muscle using capsaicin induces a regional change in image texture variables within the specific and surrounding muscles, as well as the motor unit frequency and amplitude changes that accompany them.This is an exploratory trial that aims to provide preliminary evidence on whether central sensitization is a direct cause of taut band and MTrP development. Methods: The study conforms to the Consolidated Standards of Reporting Trials recommendations. Ethical approval will be sought from the University Health Network (UHN) Research Ethics Board. This proposed study is a single centered, factorial, randomized placebo-controlled trial with two independent variables, depth of capsaicin application and dose of capsaicin, for a total of four treatment arms and two control treatment groups. Discussion: This will be the first study that assesses the B-mode ultrasound image texture of induced sensitized muscles, and will provide more evidence on muscle motor unit activity and regional changes of central sensitization. Findings from this study may support one of few hypotheses proposed delineating the involvement of central sensitization in the development of trigger points.

Role of myofascial trigger points in post-amputation pain: causation and management

2012 ◽  
Vol 37 (2) ◽  
pp. 120-123 ◽  
Author(s):  
Finn Reiestad ◽  
Jai Kulkarni
Keyword(s):  
Treatment Strategies ◽  
Phantom Limb Pain ◽  
Trigger Points ◽  
Pain Clinic ◽  
Phantom Limb ◽  
Weekly Basis ◽  
Myofascial Trigger Points ◽  
Multiple Treatment ◽  
Amputation Stumps

Background: Post-amputation pain is a multifactorial issue and thus necessitates multiple treatment strategies. Myofascial trigger points-related pain remains under diagnosed and hence not addressed. This study investigates causation and management. Objectives: To identify the presence and role of myofascial trigger points in post amputation pain. Study Design: Post-amputation pain clinic review and recruitment. Methods: Twenty one identified patients in the post-amputation pain clinic with myofascial trigger points were recruited, of which 13 were transtibial and eight transfemoral and all had phantom limb pain and stump pain. The trigger points were identified and injected with long-acting local anaesthetic on a weekly basis and patients were followed up on an ongoing basis. Results: There was significant resolution of pain on the Visual Analogue Scale in the majority of these patients within five weeks, though some of the transtibial cohort needed further eight injections on a weekly basis for resolution of the pain. Conclusion: Identification of myofascial trigger points in amputation stumps and their role in post-amputation pain, followed by appropriate intervention is an important facet of management of this complex chronic pain. Clinical relevance Myofascial trigger points in amputation stumps can lead to ongoing chronic post-amputation pain and our results indicate that identification and intervention of these trigger points does lead to notable resolution of this pain.

The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck

2007 ◽  
Vol 11 (5) ◽  
pp. 365-372 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
David G. Simons ◽  
Maria Luz Cuadrado ◽  
Juan A. Pareja
Keyword(s):  
Head And Neck ◽  
Musculoskeletal Pain ◽  
Trigger Points ◽  
Myofascial Trigger Points ◽  
Pain Syndromes

scholarly journals Quantitative response of healthy muscle following the induction of capsaicin: an exploratory randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Valerie Evans ◽  
Michael Behr ◽  
Kei Masani ◽  
Dinesh Kumbhare
Keyword(s):  
Motor Unit ◽  
Unit Activity ◽  
Central Sensitization ◽  
Controlled Trial ◽  
Ultrasound Image ◽  
Trigger Points ◽  
Image Texture ◽  
Control Treatment ◽  
Myofascial Trigger Points ◽  
Motor Unit Activity

Abstract Background Myofascial pain syndrome (MPS) is a prevalent chronic pain disorder primarily characterized by myofascial trigger points (MTrPs). There is limited knowledge on the pathophysiology and mechanisms underlying MTrP and its development. Research has previously demonstrated the identification of MTrPs using ultrasound and vibration sonoelastography, although there is some contradictory evidence regarding if MTrPs present as hyper or hypoechoic regions. Electromyography (EMG) investigations of MTrP have demonstrated that MTrPs are usually located proximal to innervation zones where the peak surface EMG signals are obtained from. Central sensitization has been proposed as the primary mechanism underlying MTrP development. Central sensitization is associated with hyperexcitability of neuronal responses to normal or noxious stimuli. There is a need for a study that measures ultrasound image textural changes and motor unit activity responses in the muscle following sensitization. The purpose of this study is to determine whether sensitizing healthy muscle using capsaicin induces a regional change in image texture variables within the specific and surrounding muscles, as well as the motor unit frequency and amplitude changes that accompany them. This is an exploratory trial that aims to provide preliminary evidence on whether central sensitization is a direct cause of taut band and MTrP development. Methods Ethical approval was obtained from the University Health Network (UHN) Research Ethics Board. This proposed study is a single centered, factorial, randomized placebo-controlled trial with two independent variables, depth of capsaicin application and dose of capsaicin, for a total of six treatment arms and three control treatment groups. Discussion This will be the first study that assesses the B-mode ultrasound image texture of induced sensitized muscles and will provide more evidence on muscle motor unit activity and regional changes of central sensitization. Findings from this study may support one of few hypotheses proposed delineating the involvement of central sensitization in the development of trigger points. Trial registration National Institutes of Health ClinicalTrials.gov NCT03944889. Registered on May 07, 2019

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