Biochemicals Associated With Pain and Inflammation are Elevated in Sites Near to and Remote From Active Myofascial Trigger Points. Commentary

Neck pain is the fourth leading cause of disability, with an annual prevalence rate exceeding 30%. Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences. History and physical examination can provide important clues as to whether the pain is neuropathic or mechanical and can also be used to identify "red flags" that may signify serious pathology, such as myelopathy, atlantoaxial subluxation, and metastases. Magnetic resonance imaging is characterized by a high prevalence of abnormal findings in asymptomatic individuals but should be considered for cases involving focal neurologic symptoms, pain refractory to conventional treatment, and when referring a patient for interventional treatment. Few clinical trials have evaluated treatments for neck pain. Exercise treatment appears to be beneficial in patients with neck pain. There is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm, conflicting evidence for epidural corticosteroid injections for radiculopathy, and weak positive evidence for cervical facet joint radiofrequency denervation. In patients with radiculopathy or myelopathy, surgery appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people.

https://www.mayoclinicproceedings.org/article/S0025-6196(14)00833-7/pdf

Epidemiology, Diagnosis, and Treatment of Neck Pain

Objectives The aim of the literature review was to investigate the criteria adopted by "experts" to diagnose myofascial trigger point (MTrP) pain syndrome. Experts were defined as being either researchers investigating MTrP pain syndrome or the "authority" the researchers cited as a source of reference for MTrP pain syndrome diagnosis. Methods We searched electronic databases to identify relevant empirical research (excluding studies not in English and those relating to dental pathology). Of 607 possibly relevant publications 93 met our inclusion criteria. We recorded (1) the individual criterion and criteria combinations used to diagnose MTrP pain syndrome; (2) the cited "authoritative" publications and (3) the criteria recommended by the authoritative publications as being essential for MTrP pain syndrome diagnosis. Results The review identified 19 different diagnostic criteria. The 4 most commonly applied criteria were: "tender spot in a taut band" of skeletal muscle, "patient pain recognition," "predicted pain referral pattern," and "local twitch response." There was no consistent pattern to the choice of specific diagnostic criteria or their combinations. However, one pair of criteria "tender point in a taut band" and "predicted or recognized pain referral" were used by over half the studies. The great majority of studies cited publications by Travell and more recently Simons as a principal authoritative source for MTrP pain syndrome diagnosis, yet most of these studies failed to apply the diagnostic criteria as described by these authorities. Discussion We conclude that there is as yet limited consensus on case definition in respect of MTrP pain syndrome. Further research is needed to test the reliability and validity of diagnostic criteria. Until reliable diagnostic criteria have been established, there is a need for greater transparency in research papers on how a case of MTrP pain syndrome is defined, and claims for effective interventions in treating the condition should be viewed with caution.

Variability of criteria used to diagnose myofascial trigger point pain syndrome--evidence from a review of the literature.

Dry needling is a common treatment technique in orthopedic manual physical therapy. Although various dry needling approaches exist, the more common and best supported approach targets myofascial trigger points. This article aims to place trigger point dry needling within the context of pain sciences. From a pain science perspective, trigger points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. Trigger point dry needling should be based on a thorough understanding of the scientific background of trigger points, the differences and similarities between active and latent trigger points, motor adaptation, and central sensitize application. Several outcome studies are included, as well as comments on dry needling and acupuncture.

/pdf/dry-needling-peripheral-and-central-considerations-3ip2o8x6hv.pdf

Dry needling — peripheral and central considerations

Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general US adult population is 10–30%, and the lifetime prevalence of US adults is as high as 65–80%. Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is most effective and can include multimodal medical, psychological, physical, and interventional approaches. Low back pain is a difficult condition to effectively treat and continues to affect millions of Americans every year. In the current investigation, we present a comprehensive review of low back pain and discuss associated pathophysiology, diagnosis, and treatment.

/pdf/low-back-pain-a-comprehensive-review-pathophysiology-5ecxuycpvo.pdf

Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment.

Objectives:Myofascial pain syndrome is a common cause of muscular pain in the shoulder-neck region. Injections of large amounts of botulinum toxin A have been found to be beneficial for the alleviation of myofascial pain, but large doses of this toxin may cause paresis of the muscle and other advers

The Effect of Small Doses of Botulinum Toxin A on Neck-Shoulder Myofascial Pain Syndrome: A Double-Blind, Randomized, and Controlled Crossover Trial

Simple but objective measurement of soft tissue consistency would be advantageous in the assessment of many neurological, lymphostatic and venous disorders. The aim of the present study was to evaluate the feasibility of using a novel hand-held computerized soft tissue stiffness meter (STSM). The STSM describes the soft tissue stiffness (STS) in the form of the instantaneous force (N) by which the tissue resists the constant deformation produced by a cylindrical intender. Firstly, the STSM was used to test elastomer samples with known mechanical properties. In the in vivo assessment, 12 healthy, nondisabled adults (age range, 24-57 years) and 16 subjects with chronic myofascial neck pain syndrome (age range, 27-55 years) were studied. To study the reproducibility (coefficient of variation (CV(%))) of the method, the measurement sites were either marked with a marker pen (marked points) or localized anatomically (unmarked points). Measurements were made from the dorsal forearm (Arm), trapezius (Tra), levator scapulae (Lev), infraspinatus (Inf) and deltoideus (Del) muscle areas. STS in the forearm was studied during different types of short-term relative isometric loading of the muscle as well as during venous occlusion. STS values of the myofascial trigger points in the Lev muscles were evaluated bilaterally. A linear, positive relationship was found between the indenter force (N) and the dynamic compressive modulus (MPa) of elastomer stiffness (r(2) = 0.90, n = 9). Intra- and interrater CVs of marked and unmarked sites varied between 4.31% and 12.06%. STS increased linearly along the relative muscle load (r(2) = 0.96) and nonlinearly during the venous occlusion (r(2) = 0.97). Statistically significant regional variation of STS was found between the different measurement sites (p < 0.05). In conclusion, STSM can evaluate tissue stiffness quantitatively and yield reproducible data.

https://iopscience.iop.org/article/10.1088/0967-3334/26/3/007/pdf

Feasibility of the use of a novel soft tissue stiffness meter.

Myofascial syndrome and pain: A neurophysiological approach.

Objectives: Evaluate the electromyographic findings in the trigger points [TrPs] of 31 patients, suffering from myofascial pain syndrome in the neck-shoulder area, before and after injection treatment.Methods: One hundred and seventy-two TrPs and 31 reference points were studied with needle-electromyography and then the TrPs were injected via the same needle with small doses of either botulinum toxin A [BTA] or saline in a double-blind study.Results: In the baseline, the occurrence of spontaneous electrical activity containing endplate spikes [EPS] was 23.3 percent in all the TrPs and 9.7 percent in the reference points. This difference did not reach statistical significance, but the difference was statistically significant in the TrPs of upper trapezius [P = 0.02 on the left and 0.04 on the right side]. We found complex repetitive discharges in 3.5 percent of studied TrPs, but not at any of the reference points. At four weeks after the BTA treatment, fibrillation potentials were found in 31.3 percent of ...

Needle-Electromyography Findings of Trigger Points in Neck-Shoulder Area Before and After Injection Treatment

Objectives: To determine values of soft tissue stiffness [STS] before and after injection treatment in neck–shoulder myofascial pain and to correlate them with self-reported and clinically assessed pain and disability.Methods: Thirty-one patients recruited by newspaper advertisement were screened by a physician. The subjects received either botulinum toxin A [BTA] or saline injections on two occasions four weeks apart. The volume of each injection was 0.05 ml of either normal saline [without preservative] or saline containing five units of BTA. The total dose varied from 15 to 35 U of BTA [total volume 0.15 to 0.35 ml]. The follow-up measurements were performed at four weeks after each treatment. The STS of trigger points [TrPs] and a reference point was determined using the STS meter [STSM]. The pressure-pain threshold [PPT] was determined using the dolorimeter. The subjective severity of neck–shoulder pain [SSNP] and the neck pain and disability scale [NPDS] were assessed with questionnaires. Th...

Soft Tissue Stiffness Before and after Trigger Point Injections in Neck–Shoulder Myofascial Pain Syndrome: A Double-Blind, Randomized, and Controlled Crossover Trial with Botulinum Toxin A and Saline Injections

Tuula A. Ojala

Papers

The Effect of Small Doses of Botulinum Toxin A on Neck-Shoulder Myofascial Pain Syndrome: A Double-Blind, Randomized, and Controlled Crossover Trial

Feasibility of the use of a novel soft tissue stiffness meter.

Myofascial syndrome and pain: A neurophysiological approach.

Needle-Electromyography Findings of Trigger Points in Neck-Shoulder Area Before and After Injection Treatment

Soft Tissue Stiffness Before and after Trigger Point Injections in Neck–Shoulder Myofascial Pain Syndrome: A Double-Blind, Randomized, and Controlled Crossover Trial with Botulinum Toxin A and Saline Injections