scholarly journals Opioid Reduction and Long-Term Outcomes in Abdominal Myofascial Pain Syndrome (AMPS): A 6-Year Longitudinal Prospective Audit of 207 Patients

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E441-E449 ◽  
Author(s):  
G Niraj
Keyword(s):  
Pain Relief ◽  
Myofascial Pain ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Chronic Abdominal Pain ◽  
Opioid Consumption ◽  
Long Term Outcomes ◽  
Clinically Significant

Background: Abdominal myofascial pain syndrome is an important cause of refractory chronic abdominal pain. It causes severe functional impairment resulting in significant patient distress and substantial health care costs, and it can be a challenge to treat. Opioid consumption is a recognized challenge in this cohort. Design: We conducted a prospective longitudinal audit over a 6-year period. Setting: The study was conducted at a tertiary pain medicine clinic in a university teaching hospital. Methods: Over a 6-year period, 234 patients diagnosed with chronic abdominal pain secondary to abdominal myofascial pain syndrome were included in a structured management pathway. Long-term outcomes were prospectively audited at a tertiary-care university hospital. Patients who completed a minimum of 12 months in the pathway were included. The main outcome was reduction in opioid consumption. Treatment outcomes included treatment failure, number of patients with clinically significant pain relief, durable pain relief, and long-term pain relief. Other outcomes included patient satisfaction and success in maintaining gainful employment. Results: Two hundred seven patients completed a minimum of 12 months of follow-up. Seventyeight percent (162 of 207) were on opioids at presentation. There was significant reduction in opioid consumption at ≥ 12 months’ follow-up. Among patients who underwent interventional management, clinically significant relief was reported in 31 patients (31 of 180, 17%), durable relief in 71 patients (71 of 180, 40%) and long-term relief lasting 12 months in 23 patients (23 of 180, 13%). Twenty-six patients (26 of 180, 15%) reported cure from symptoms. The treatment failure rate was 15%. Limitations: This was an open-label study that took place at a single center. Conclusion: The authors present the first prospective practice-based evidence report on the long-term outcomes in patients diagnosed with abdominal myofascial pain syndrome. There was significant reduction in opioid consumption at 12 months and over two-thirds of patients reported significant durable relief on long-term follow-up. The authors present their recommendation for managing this complex group of patients. Keywords: Abdominal myofascial pain syndrome, abdominal plane blocks, chronic abdominal wall pain, opioid reduction, quadratus lumborum block, TAP block, viscerosomatic convergence

scholarly journals Effectiveness of joint mobilization and dry needling in myofascial pain syndrome with neck pain

2019 ◽  
Vol 02 (02) ◽  
pp. 096-097
Author(s):  
Martín Pérez S. ◽  
Montaño Ocaña J. ◽  
Barragán Carballar C. ◽  
Arribas Pérez H.
Keyword(s):  
Myofascial Pain ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Dry Needling ◽  
Post Intervention ◽  
Joint Mobilization ◽  
Upper Trapezius ◽  
Pain Pressure Threshold ◽  
Clinically Significant

Abstract Background and Aim Almost 70% of the population has suffered from cervical pain of a mechanical origin (CPM) at some point in their life. In myofascial pain syndrome (MPS), besides the zygapophyseal joint, the myofascial trigger point (MTrP) is involved as the main source of CPM. Manual therapy (MT) based on joint mobilization (JM) in combination with dry needling (DN), are the most used treatments in these patients. Aims 1) To compare the pain and range of motion (ROM) between the MT interventions using JM and deep DN and MT using JM and sham DN in patients with CPM and activation of MTrP 2 of the upper trapezius (UT). 2) To assess the changes in the active cervical ROM, pain pressure threshold (PPT), intensity of pain at rest and with movement (measured using the Visual Analog Scale) and post-needling soreness in these patients. Material and Methods An experimental, double blind randomized pilot study in which the effects produced by the interventions were compared among two groups: a first group (n = 5) received a treatment based on sham DN of the UT and MT using JM of C2 and a second group (n = 6) who received deep DN of the MTrP 2 of the UT and the same mobilization technique. Three prospective measurements were performed: pre-intervention, post-intervention and follow-up (1 month after the post-intervention measurement). Results 11 subjects participated in this study (7 women and 4 men; mean age: 49.9 ±  10.8 years) who completed both the four interventions (1 session/week) as well as the follow-up. According to the PPT, measured on the MTrP 2 of the UT, none of the two groups presented clinically significant changes, and only 3 patients presented increases beyond the MDC (MDC) in the follow-up measurement (1.11 kg/cm2). Regarding the VAS measured at rest, only the first group (sham DN) obtained a clinically significant post intervention improvement (56%) and at follow-up (150%). The VAS in response to movement decreased significantly with treatment in both groups for all movement planes and axes; however, the active cervical ROM did not display significant changes in any of the two groups; lastly, the mean, maximum and minimum values of post-needling soreness in the group with placebo DN were lesser to those of the group who received the real deep DN technique, for the entire treatment. Conclusion Deep DN combined with MT improved the intensity of pain in response to cervical movement, whereas sham dry needling combined with MT caused a greater decrease of intensity at rest. Although both techniques are similar for improving active cervical ROM, sham DN combined with MT increased post-needling soreness both during treatment as well as at follow-up. Further research is necessary to deepen our information of the effects of the combination of these two techniques in the treatment of MPS.

scholarly journals McKENZIE NECK EXERCISE LEBIH BAIK DALAM MENURUNKAN DISABILITAS LEHER DARIPADA DYNAMIC NECK EXERCISE PADA PENJAHIT DENGAN MYOFASCIAL PAIN SYNDROME OTOT UPPER TRAPEZIUS

2020 ◽  
Vol 8 (2) ◽  
pp. 41
Author(s):  
Boki Jaleha ◽  
I Putu Gede Adiatmika ◽  
Sugijanto Sugijanto ◽  
I Made Muliarta ◽  
Ketut Tirtayasa ◽  
...  
Keyword(s):  
Myofascial Pain ◽  
Neck Disability Index ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
T Test ◽  
Upper Trapezius ◽  
Paired Samples ◽  
Post Test ◽  
Neck Disability

Pendahuluan: Myofascial pain syndrome otot upper trapezius merupakan gangguan muskuloskeletal pada otot upper trapezius akibat penggunaan otot secara berlebihan, postur yang jelek, dan repetitif mikrotrauma sehingga menyebabkan nyeri, taut band, kelemahan otot dan disabilitas pada daerah leher. Tujuan Penelitian: Untuk mengetahui perbedaan efek kedua intervensi, Mckenzie Neck Exercise dan Dynamic Neck Exercise dalam menurunkan disabilitas leher pada penjahit dengan myofascial pain syndrome otot upper trapezius. Metode: Penelitian eksperimental ini menggunakan rancangan randomized pre and post test two group design. Sampel penelitian sebanyak 18 orang yang dibagi secara acak menjadi 2 kelompok, masing-masing kelompok berjumlah 9 orang. Kelompok I diberikan McKenzie Neck Exercise sedangkan Kelompok II diberikan Dynamic Neck Exercise. Perlakuan dilakukan 3 kali seminggu selama 6 minggu dengan evaluasi menggunakan kuesioner penilaian Neck Disability Index (NDI). Hasil: Hasil uji statistik menggunakan paired-samples t test pada Kelompok I dengan rerata skor sebelum intervensi (23,8±2,1)% dan sesudah intervensi yaitu (16,4±2,4)% dengan nilai (p < 0,05) dan Kelompok II dengan rerata skor sebelum intervensi (23,6±2,2)% dan sesudah intervensi (20,9±2,3)% dengan nilai (p < 0,05). Uji beda hipotesis antara Kelompok I dengan Kelompok II menggunakan independent-samples t test diperoleh nilai (p < 0,05). Simpulan: McKenzie Neck Exercise lebih baik dalam menurunkan disabilitas leher daripada Dynamic Neck Exercise dengan myofascial pain syndrome otot upper trapezius. Saran: Penelitian selanjutnya diharapkan dapat mengontrol aktivitas pekerja dilingkungan kerja maupun tempat tinggal dan diperlukan adanya tindak lanjut ataupun pengawasan (follow up) sampel penelitian setelah berakhirnya program penelitian pada masing-masing sampel, untuk mengetahui hasil intervensi yang diberikan dapat memberikan efek jangka panjang.  

What’s the Prognosis?

2002 ◽  
Author(s):  
Daniel J. Wallace ◽  
Janice Brock Wallace
Keyword(s):  
Primary Care Physicians ◽  
Myofascial Pain ◽  
Tertiary Care ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
The Body ◽  
Community Physician ◽  
Proper Perspective ◽  
Line Of Therapy

When patients are diagnosed with fibromyalgia, one of their first questions to us relates to its outcome. “Is there hope, doc?” and “Will the pain ever go away?” are two of the more common queries we hear. Unfortunately, few surveys have addressed this issue, and some have arrived at contradictory conclusions. This chapter will try to put these studies in their proper perspective. Yes, there is hope! When discomfort is limited to a specific region of the body and is not widespread, the outlook for long-term relief of pain is usually quite good. With local physical measures, injections, emotional support, and anti-inflammatory and analgesic medication, as well as instruction in proper body mechanics, over 75 percent of regional myofascial pain syndrome patients have substantial pain relief within two–three years. Unfortunately, there is little middle ground. For example, in an 18-year analysis of 53 patients with low back pain followed by musculoskeletal specialists, 25 percent ultimately developed fibromyalgia. Therefore, we believe that myofascial pain should not be shrugged off or given short shrift. A problem that is addressed early and effectively saves patients, health plans, and society money. Also ameliorated are the heartaches of patients and those close to them. Improved productivity promotes a feeling of relief, as well as a better quality of life. When a practitioner prescribes Advil and says that this is all that can be done for TMJ dysfunction syndrome, it is penny wise but pound foolish. The outcome of fibromyalgia depends on who sees the patient and calls the shots. For example, in one report that tracked family practitioners, internists, or other primary care physicians familiar with fibromyalgia’s diagnosis and management, 24 percent of patients were in remission at two years and 47 percent no longer met the ACR criteria for the syndrome. This implies that early intervention by a knowledgeable community physician is the first line of therapy. Children with fibromyalgia also have a favorable outcome. In the largest study to date, symptoms resolved in 73 percent within two years of diagnosis. The outlook in tertiary care settings is not as rosy. Once the symptoms and signs of the syndrome are serious enough to warrant referral to an academically oriented rheumatologist who is involved in fibromyalgia research, improvement is common but recovery rare.

Ultrasound-Guided Subcostal TAP Block with Depot Steroids in the Management of Chronic Abdominal Pain Secondary to Chronic Pancreatitis: A Three-Year Prospective Audit in 54 Patients

Pain Medicine ◽  
2019 ◽  
Vol 21 (1) ◽  
pp. 118-124 ◽  
Author(s):  
Gopinath Niraj ◽  
Yehia Kamel
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Myofascial Pain ◽  
Visceral Pain ◽  
Pain Syndrome ◽  
Chronic Abdominal Pain ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane

Abstract Background Chronic pancreatitis is a common cause of recurrent chronic abdominal pain that utilizes significant health care resources. Pain in chronic pancreatitis can be of two types. Visceral pain occurs during ongoing pancreatic inflammation. Once pancreatic inflammation subsides, the pain generator can move to the abdominal wall as a result of viscerosomatic convergence and present as abdominal myofascial pain syndrome. Subcostal transversus abdominis plane block is an abdominal plane block that has been proven effective in upper abdominal pain of somatic origin. Design The authors discuss the two distinct types of chronic abdominal pain as a result of pancreatitis and present a prospective audit of a management pathway. Methods Over a three-year period, 54 patients with chronic abdominal pain as a result of pancreatitis were prospectively audited at a tertiary care university hospital. Patients were offered bilateral subcostal transversus abdominis plane block with depot steroids as the primary interventional treatment in the pathway. Results In patients with myofascial pain secondary to chronic pancreatitis, the block was effective in producing clinically significant pain relief at three months (95%, 20/21) and durable pain relief lasting six months (62%, 13/21). In patients with visceral pain, the block produced a transient benefit lasting two to three weeks in one-third (six of 17). Conclusions Subcostal transversus abdominis plane block may be an option in the management of abdominal myofascial pain syndrome secondary to chronic pancreatitis. The block is ineffective in producing clinically significant pain relief in the presence of ongoing pancreatic inflammation.

Immediate Effects of Core-Stability Exercises and Clinical Massage on Dynamic-Balance Performance of Patients With Chronic Specific Low Back Pain

2015 ◽  
Vol 24 (4) ◽  
pp. 373-383 ◽  
Author(s):  
Athanasios Trampas ◽  
Anastasia Mpeneka ◽  
Vivian Malliou ◽  
George Godolias ◽  
Periklis Vlachakis
Keyword(s):  
Myofascial Pain ◽  
Dynamic Balance ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Core Stability ◽  
Cross Sectional ◽  
Physically Active ◽  
Group I ◽  
Clinical Instability ◽  
Clinically Significant

Context:Previous studies showed improved dynamic-balance (DB) performance after core-stability (CS) exercises in populations with chronic low back pain. Although clinical massage plus exercise is likely to better enhance analgesia than exercise alone, its efficacy on balance remains unclear.Objective:To evaluate the immediate effects of CS exercises plus myofascial trigger-point (MTrP) therapy in comparison with CS exercises alone on DB performance, pressure-pain threshold (PPT), and cross-sectional area of active MTrPs in patients with clinical instability of the lumbar spine and chronic myofascial pain syndrome.Design:Randomized, assessor-blind, test–retest.Setting:University research laboratory.Patients:10 physically active adults (5 men, 5 women).Main Outcome Measures:Single-leg DB performance and side-to-side ratios in 2 planes of motion (frontal, sagittal), as well as PPT and cross-sectional area of active MTrPs, were measured using stabilometry, pressure algometry, and real-time ultrasound scanning, respectively.Interventions:The 1st group performed CS exercises alone, whereas the same exercise program was applied in the 2nd group plus cross-fiber friction on active MTrPs (3.5 min/MTrP).Results:Within-group statistically and clinically significant differences were observed only for group II in PPT. However, group I also exhibited a large effect size with clinically significant changes from baseline on this outcome. Furthermore, patients in group II clinically improved their balance ratios and differed from group I at posttest in sagittal-plane DB performance of the painful side.Conclusion:CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in DB are minimized.

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