Myofascial Trigger Points/ Miyofasial Tetik Noktalar
Title: Extracorporeal Shock Wave Therapy in Myofascial Pain Syndrome of Upper Trapezius
Authors:
- Hye Min Ji, M.D.
- Ho Jeong Kim, M.D.
- Soo Jeong Han, M.D. (corresponding author)
Abstract
To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analog scale (VAS) and pressure threshold by digital algometer.
Method
Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm2, 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm2. The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer.
Results
There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91±1.76 to 2.27±1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4±9.94 N to 61.2±12.16 N in the treated group (p<0.05), but there was no significant change in the control group.
Conclusion
ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.
Keywords: Extracorporeal shock wave therapy, Myofascial pain syndrome, Upper trapezius, Visual analogue scale, Pressure threshold
Title: Usefulness of Extracorporeal Shockwave Therapy on Myofascial Pain Syndrome
Authors: Chang Han Lee, MD 1 and Shi-Uk Lee, MD, PhD 2
Abstract
Myofascial pain syndrome (MPS) is a clinically common observation with characteristics such as localized muscle tenderness, a palpable intramuscular taut band, and muscle spasm following trigger point injection [1]. It is a musculoskeletal disorder with sensory, motor, and autonomic symptoms and is commonly encountered in clinical settings [2]. Myofascial trigger points (MTrPs) are the primary cause of MPS, accounting for approximately 54% of chronic pain in the head and neck [3]. A recent study also found that the upper trapezius muscles were the primary cause of MPS in patients with chronic nonspecific neck pain [4].
The exact pathophysiology of MTrPs and MPS remains unknown. However, the proposed mechanisms have been reported in the literature. MPS is thought to be a complex form of neuromuscular dysfunction consisting of motor and sensory abnormalities involving peripheral and central nervous systems [5,6]. The primary mechanism is known to involve an abnormal increase in acetylcholine, triggering a continuous release and uptake of calcium ions, leading to muscle ischemia resulting from a sustained shortening of sarcomeres and release of sensitizing substances [7,8]. Excessive release of acetylcholine may cause the development of a tight band that results in persistent muscle contraction [9].
There are various therapeutic approaches to treat MPS, including invasive techniques (such as dry needling, trigger point injection) and non-invasive techniques (such as drug therapy and electrical and exercise treatments). Electrical treatments include interference current therapy, ultrasound, and transcutaneous electrical nerve stimulation, while exercise treatments include stretching, massage, and taping [10-13].
As a non-invasive and safe modality, the use of extracorporeal shock wave therapy (ESWT) has expanded to the treatment of MPS [12,14-17]. Some evidence-based medical reviews have also explored the effectiveness of ESWT for MPS of the trapezius muscle [18-20]. ESWT improves capillary blood circulation in ischemic zones and alters pain signaling in ischemic tissues caused by calcium influx in a study by De Sanctis et al. [21]. A previous study demonstrated that ESWT might interrupt the cascade of referred pain by inhibiting peripheral muscle nociceptors and reducing the levels of substance P [15].
However, thus far, not a single treatment modality has been proven to be superior to treat MPS. A systematic review and meta-analysis suggested ESWT to be helpful for pain in patients with MPS of the trapezius and could serve as an adjunct therapeutic method to treatments such as dry needling, trigger point injection, and laser therapy [19]. In light of these observations, a study on the impact of the combined effect of ESWT and integrated neuromuscular inhibition on MPS of the upper trapezius published in this issue of the Annals of Rehabilitation Medicine can be considered highly remarkable [22]. The authors investigated the combined effect of ESWT and integrated neuromuscular inhibition on MPS of the upper trapezius in 60 subjects aged 18–24 years by randomized controlled trials. The results revealed that the combined treatment of ESWT and integrated neuromuscular inhibition for treating MTrPs in the upper trapezius is more effective than using only one of them considering the clinical, functional, and neurophysiological aspects.
ESWT should be recommended as a standard therapy in clinical settings for managing MPS of the upper trapezius. Considering various mechanisms of MPS, combined therapy with ESWT and other interventions would be a reliable treatment method for MPS of the upper trapezius.
Keywords: Chronic prostatitis/chronic pelvic pain syndrome, extracorporeal shockwave therapy, acupuncture, network meta-analysis
Title: Comparison of the treatment effects of extracorporeal shock wave therapy and trigger point injection in myofascial pain syndrome
Authors: Alper UYSAL1,* , Murat GÜNTEL2
Abstract
Myofascial pain syndrome (MPS) is a common chronic musculoskeletal disease and the lifetime prevalence is about 85%. Comparison of the
effects of ESWT (extracorporeal shock wave therapy) and trigger point injection (TPI) treatments on sleep quality in myofascial pain syndrome
has rarely been studied. The aim of this study was to compare the effects of TPI + Dry Needling (DN) and ESWT treatments on pain, neck
disability level, and sleep quality in patients with myofascial pain syndrome. 63 patients diagnosed with myofascial pain syndrome were included
in the study. The patients were divided into two groups. ESWT was given to 32 patients and TPI to 31 patients. These two treatment regimens
were compared in terms of pain (VAS), sleep quality (PSQI), and neck disability (NDI). In terms of mean VAS, NDI, and PSQI values, there was
no statistically significant difference between the groups in the mean of pre-treatment, post-treatment day 0 and post-treatment 1 month. A similar
and significant improvement was observed in both groups in terms of the evaluated parameters and based on our results, we can recommend both
treatment options to MPS patients.
Keywords: myofascial pain syndrome, ESWT, trigger point injection, trapezius, dry needling
