A influência dos pontos-gatilho latente na lombalgia aguda: um estudo prospectivo longitudinal / Influence of latent trigger points in acute low back pain: a prospective longitudinal study

Pontos-gatilho são nódulos musculares que podem desenvolver dor. A dor lombar é um importante problema de saúde pública e estudos apontam que todas as pessoas que sofrem de dor na coluna apresentam ponto-gatilho. Objetivo: Analisar o nível dor de pacientes com dor lombar aguda que quando assintomáticos apresentava pontos-gatilho latente, comparado com os níveis de dor de pacientes com dor lombar aguda que quando assintomáticos não apresentava pontos-gatilho. Método:96 indivíduos de ambos os sexos entre 18 -60 anos participaram de um estudo transversal com avaliador cego. Foram analisados o nível de dor, função, atividade física, cinesiofobia, algometria e mensurada a força do músculo glúteo máximo e médio do membro dominante e não-dominante, no memento que os participantes estavam assintomáticos e após desenvolverem dor lombar aguda. Para análise estatística consideramos valores de significância igual ou menor que 0,05. Resultados: Foi observado diferenças significativas entre os grupos na intensidade da dor (p=0,01), na funcionalidade (p=0,02), na algometria (p=0,00), na dinamometria do músculo glúteo máximo do membro não-dominante (p=0,05) e da dinamometria do glúteo médio do membro dominante (p=0,01) e não-dominante (p=0,00). Conclusão: Indivíduos assintomáticos com pontos-gatilho latente nos músculos paravertebrais lombares apresentam pior intensidade da dor e outros desfechos quando evoluem dor lombar aguda, comparados com indivíduos que não apresentam pontos-gatilho no momento que estão assintomáticos

Trigger points are muscle nodules that can lead to pain. Low back pain is an important problem of public health and studies point out all the people who suffer from spinal pain present trigger points. Objective: To analyze the pain level of the asymptomatic patients, with acute low back pain, who present latent trigger point, when compared to the pain level of the asymptomatic patients with acute low back pain who did not present latent trigger point. Method:96 individuals of both genres, aged 18 to 60 years took part in a transversal, evaluator-blind study. Level pain, function, physical activity, kynesiophobia, algometer were analyzed and the gluteus maximus and gluteus medius muscles' strength of the dominant limb and non-dominant were measured, at the moment the participants were asymptomatic and after developing acute back low pain. For statistical analysis, we considered significant value ≤ 0.05 Results: It was observed significant differences between the groups in relation to pain intensity (p=0.01), functionality (p=0.02), algometer (p=0.05), gluteus maximus muscle dynamometry of the non-dominant limb (p=0.05) and in the gluteus medius muscle of the dominant limb (p=0.01) and non-dominant (p=0.00). Conclusion: Asymptomatic individuals with latent trigger points in the paravertebral lumber muscles present worse pain intensity and other outcomes when it evolves to acute back pain if compared to individuals who don't present trigger points at the moment they, are considered asymptomatic.

The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review / Os efeitos do laser de baixa intensidade no tratamento da síndrome da dor miofascial: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Among the approaches inherent to conservative treatment, the low-level laser therapy (LLLT) is one of the most used resources in the treatment of myofascial pain. This research sought to search the literature for the available evidence on the treatment of myofascial pain syndrome with LLLT in order to analyze the reported effects of this intervention. CONTENTS: Medline/PubMed, SCOPUS, Web of Science, Cochrane Central Registry of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) by Ebsco was used to search for articles on randomized clinical trials that related myofascial pain syndrome with LLLT. Studies were systematically selected by two reviewers independently, through title, abstract and, later, full text. Ten articles that met the criteria were included in this integrative review. In six of these articles, the improvement in pain compared to placebo group was presented right after LLLT session, although these results did not remain in the follow-ups of the studies that performed follow ups. CONCLUSION: LLLT seems to be a resource that decreases pain in patients with myofascial pain syndrome. Despite the positive results in reducing pain with the use of LLLT in some studies, this review admits the heterogeneity of studies with conficting results related to the effectiveness of LLLT. Research that defines the parameters and adequate therapeutic dosages are necessary for a better understanding of the real effects of LLLT on this clinical condition.

RESUMO JUSTIFICATIVA E OBJETIVOS: Das abordagens inerentes ao tratamento conservador, o laser de baixa intensidade (LBI) é um dos recursos mais utilizados no tratamento da dor miofascial. Esta pesquisa buscou avaliar na literatura as evidências disponíveis sobre o tratamento da síndrome da dor miofascial com o LBI para analisar os efeitos reportados dessa intervenção. CONTEÚDO: Foram utilizadas as bases de dados Medline/Pubmed, SCOPUS, Web of Science, Registro Central Cochrane de Ensaios Controlados (CENTRAL) e Cumulative Index to Nursing and Allied Health Literature (CINAHL), da Ebsco, para busca de artigos de ensaios clínicos randomizados que relacionassem síndrome da dor miofascial com LBI. Os estudos foram selecionados sistematicamente por dois revisores, independentemente, por meio do título, resumo e, posteriormente, texto completo. Dez artigos que se adequaram aos critérios foram incluídos nessa revisão sistemática. Em seis destes artigos, foi apresentada a melhora da dor comparada ao grupo placebo logo após a sessão de LBI, embora esses resultados não tenham permanecido nos acompanhamentos dos estudos que realizaram follow-ups. CONCLUSÃO: O LBI parece ser um recurso que diminui a dor em pacientes com síndrome da dor miofascial. Apesar dos resultados positivos na diminuição da dor com o uso do LBI em alguns estudos, esta análise admite a heterogeneidade dos estudos com resultados conflitantes relacionados à efetividade do LBI. Pesquisas que definam os parâmetros e dosagens terapêuticas adequadas são necessárias para um melhor entendimento sobre os reais efeitos do LBI sobre essa condição clínica.

Effect of Electroacupuncture at Proximal and Distal Acupoints on Pain-inducing Substances， Macrophages and Related Inflammatory Factors in Myofascial Pain Syndrome Model Rats / 中医杂志

ObjectiveTo explore the possible peripheral analgesic mechanism of electroacupuncture （EA） at promimal and distal acupoints in treatment of myofascial pain syndrome （MPS）. MethodsTwenty-four SD rats were randomly divided into blank group， model group， proximal group， and distal group， with six rats in each group. MPS model was prepared by “strike combined with centrifugal exercise” in all groups except for the blank group. After modeling， the rats in the proximal group received EA at the local myofascial trigger points （MTrPs）， namely the Ashi points， with dilatational waves of frequency of 2/100 HZ and voltage of 2-4 V， current intensity depending on a slight trembling of the left lower limbs， once a day， 15min each time，for 14 days. The rats in the distal group received EA at “Yanglingquan” （GB 34） and “Yinlingquan” （SP 9）， with the same operations as the proximal group. The rats in the blank group and the model group were only grasped and hedged， without other interventions. After intervention， the paw withdrawl mechanical threshold （PWMT） was measured， and variability between the left and right hind paws was calculated. Musculoskeletal ultrasound imaging and electromyography monitoring were performed on the left lower extremity vastus medialis. The morphological changes of vastus medialis muscle of the left lower extremity were observed by HE staining. The positive expression of substance P （SP）， calcitonin gene-related peptide （CGRP）， CD68 and CD206 in muscle tissue was detected by immunohistochemistry. Abdominal aortic serum interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， interleukin-10 （IL-10）， and interleukin-8 （interleukin-8） were detected by ELISA. ResultsCompared to those in the blank group， the fibers of the vastus medial muscle of the rats in the model group were broken and distorted with thickness in variation， and the myofascia was broken， with fibrillation potential， enlarged muscle cells， inward moved nucleus， and widened muscle space； the variability of PWMT between the left and right hind paws significantly increased， as well as the levels of SP， CGRP， CD68， and CD206 in the vastus medialis muscle （P＜0.01）， and the serum IL-8 and TNF-αlevels were significantly elevated （P＜0.05 or P＜0.01）. Compared to those in the model group， the muscle fibers in the proximal and distal group were complete in shape and arranged in an orderly manner， with continued non-broken myofascia， regular shape of muscle cells， and significantly reduced level of IL-8 （P＜0.01）； the amplitude and frequency of spontaneous discharge in the proximal group significantly decreased， as well as the variability of PWMT between the left and right hind paws， and the levels of SP， CGRP， and CD68 in the vastus medialis muscle， while the CD206 level increased significantly （P＜0.05 or P＜0.01 ）； there was complex discharges in the distal group， with significantly decreased level of CD68 in the vastus medialis muscle and increased level of CD206 （P＜0.01）. Compared to the proximal group， the level of IL-8 in the distal group was significantly higher （P＜0.05）. ConclusionsEA at proximal acupoints can significantly improve the pain threshold and local muscle tissue morpho-logy in rats， and its mechanism may be related to reducing the levels of pain-causing substances and related inflammatory factors and promoting the polarization of macrophages. The analgesic effect of EA at distal acupoints is not obvious， and the mechanism is still unclear.

Do myofascial trigger points in masseter muscles affect the symptoms of disc displacement with reduction? A cross-sectional study

SUMMARY OBJECTIVE: The aim of this study was to demonstrate the effect of myofascial pain with referral from the trigger points in the masseter muscles on the clinical symptoms and functional limitations of the temporomandibular joint in participants with disc displacement with reduction. METHODS: This prospective, cross-sectional study recruited participants aged 18-45 years with disc displacement with reduction with/without myofascial pain with referral in the masseter muscles based on the inclusion criteria. Maximum mouth opening and the presence of probable awake bruxism were assessed. The "Graded Chronic Pain Scale version 2.0" and "Jaw Function Limitation Scale-8" were used to evaluate Diagnostic Criteria for Temporomandibular Disorders Axis II. Pain levels were measured using the Visual Analog Scale. RESULTS: A comparison between the disc displacement with reduction and disc displacement with reduction+myofascial pain with referral groups revealed statistically significant differences in Visual Analog Scale (p<0.001), the presence of awake bruxism (p=0.038), and Graded Chronic Pain Scale version 2.0 (p=0.010). However, no statistically significant difference was observed between the two groups concerning maximum mouth opening and Jaw Function Limitation Scale-8. CONCLUSION: Participants with both disc displacement with reduction and myofascial pain with referral in the masseter muscle exhibited higher pain intensity, a higher prevalence of awake bruxism, and increased pain-related disability compared to those with disc displacement with reduction alone.

Mechanical hyperalgesia in athletes' shoulder: integrative review / Hiperalgesia mecânica no ombro de atletas: revisão integrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic shoulder pain in throwing athletes is a common complaint in everyday practice. Despite the growing number of publications, it is unclear whether these athletes have mechanical hyperalgesia associated with pain, which could alter the treatment options undertaken. The aim of the study was to summarize the results of the main evidence found on the pressure pain threshold in the shoulder, to compare these results in athletes of different sports. METHODS: Electronic search via PubMed/Medline, PEDro, SPORTDiscuss, Web of Science and Scielo databases was done verifying studies in English or Portuguese. The keywords: pressure pain threshold; athletes; shoulder; pressure algometry and its derivations were searched in both languages. The articles should have included athletes from sports that use upper limbs and that assess the pressure pain threshold in the shoulder. Five studies were included for analysis. RESULTS: Athletes with shoulder pain had a lower pressure pain threshold. In swimmers, changes in mechanical sensitivity to pain seem to be related to weekly training hours, years of sports practice and age group. Sports competitions apparently have an influence on the reduction of pressure pain threshold in amateur tennis players. CONCLUSION: Swimming athletes have a lower pressure pain threshold and this is related to the volume and time of training in the modality. This variable seems to be sport-dependent, and the absence of a greater number of studies in sports such as tennis and wheelchair basketball limits conclusions on this subject.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica no ombro de atletas arremessadores é uma queixa comum no cotidiano do esporte. Apesar do número crescente de publicações sobre o tema, não está claro se esses atletas apresentam hiperalgesia mecânica associada a dor, o que poderia alterar as abordagens de tratamento realizadas. O objetivo da presente pesquisa foi sintetizar os resultados das principais evidências encontradas sobre o limiar de dor a pressão no ombro, comparando estes resultados em esportistas de diversas modalidades. MÉTODOS: Para esta revisão integrativa, as buscas eletrônicas ocorreram nas bases de dados Pubmed/Medline, PEDro, SPORTDiscuss, Web of Science e Scielo, verificando estudos em inglês ou português. As palavras-chave pressure pain threshold; athletes; shoulder; pressure algometry e suas derivações foram pesquisadas em ambas as linguagens. Os artigos deveriam incluir atletas de esportes com gestos esportivos no membro superior e que avaliassem o limiar de dor a pressão no ombro. Cinco estudos foram incluídos para análise. RESULTADOS: Atletas com dor no ombro apresentaram menor limiar de dor a pressão. Em nadadores, as alterações na sensibilidade mecânica a dor parecem estar relacionadas com horas de treino semanais, anos de prática esportiva e faixa etária. As competições esportivas aparentemente possuem influência na redução do limiar de dor a pressão em tenistas amadores. CONCLUSÃO: Atletas de natação apresentam menor limiar de dor a pressão, o qual se relaciona com o volume e tempo de treinamento na modalidade. Essa variável parece ser esporte-dependente, e a ausência de um maior número de estudos em esportes como tênis e basquete em cadeiras de rodas limita conclusões acerca do assunto. DESTAQUES Dor no ombro é uma condição comum em atletas overhead e atletas com dor no ombro apresentam alterações no limiar de dor a pressão (LDP). Na natação, o LDP parece sofrer influência do volume de treinamento semanal, de anos de prática da modalidade e da faixa etária. Alterações no LDP em tenistas e jogadores de basquete em cadeira de rodas ainda carecem de dados mais conclusivos.

Effectiveness of Dry Needling in Bothersome Chronic Tinnitus in Patients with Myofascial Trigger Points

Abstract Introduction Therapeutic dry needling (DN) is effective in reducing the discomfort of chronic somatosensory tinnitus in patients with myofascial trigger points (MTP)s. Objective To evaluate the efficacy of DN in chronic somatosensory tinnitus discomfort in patients with MTP. Methods Placebo-controlled paired trial that included 16 patients with a diagnosis of somatosensory chronic tinnitus and with the presence of at least one active or latent MTP. Treatment was performed in two phases: (1) four sessions (one session per week for four consecutive weeks) of placebo DN and (2) four sessions of therapeutic DN with a gap (washout) of 15 days between these phases. Results The Tinnitus Handicap Inventory (THI) variable and its emotional domain had a statistically significant reduction in therapeutic DN when compared with placebo DN (p= 0.024 and p = 0.011, respectively). The tinnitus visual analogic scale (VAS) signaled a reduction in tinnitus discomfort when compared with moments before and after therapeutic DN (p< 0.05). Conclusion The therapeutic DN technique for MTP in patients with chronic tinnitus of somatosensory origin proved effective in reducing symptom discomfort, as measured by the THI (total score) and its emotional domain when compared with placebo DN.

Comparando o efeito da liberação miofascial e técnica de energia muscular no ângulo craniovertebral e cefaleia em pacientes com cefaleia tensional / Comparing the effect of myofascial release and muscle energy technique on craniovertebral angle and headache in tension-type headache patients

INTRODUÇÃO: Cefaleias tensionais podem ser induzidas pela postura da cabeça para frente, e há uma grande quantidade de evidências disponíveis para o manejo de cefaleias crônicas. Os dados corroboram uso de abordagens de terapia manual para gerenciar dores de cabeça do tipo tensional. Devido à postura anterior da cabeça, a região do músculo suboccipital torna-se curta, resultando em aumento da lordose e dor no pescoço. Pacientes com uma postura de cabeça ainda mais para frente têm um ângulo craniovertebral menor, o que, por sua vez, causa cefaleia do tipo tensional. OBJETIVO: O objetivo deste estudo é comparar os efeitos da terapia de liberação miofascial (LMF) e da técnica de energia muscular (TEM) com exercícios gerais do pescoço no ângulo crânio-vertebral e na cefaleia em pacientes com cefaleia do tipo tensional. MÉTODOS: No total, 75 indivíduos com cefaleia tensional e sensibilidade muscular suboccipital foram recrutados e randomizados cegamente em três grupos: o grupo LMF, o grupo TEM e o grupo controle (25 indivíduos em cada grupo). Um ângulo pré-crânio vertebral foi obtido por método fotográfico e um questionário de índice de incapacidade pré-cefaleia foi preenchido. O grupo LMF recebeu liberação crânio-basal na região suboccipital com exercícios de pescoço; o grupo TEM recebeu relaxamento pós-isométrico na região suboccipital com exercícios, e o grupo controle recebeu apenas exercícios por 2 semanas. Após duas semanas, o ângulo pós-craniano e o questionário de cefaleia foram coletados e medidos. RESULTADOS: O ângulo crânio-vertebral e o índice de cefaleia mostraram melhora significativa nos grupos TEM e LMF. Não houve diferença significativa quando os grupos TEM e LMF foram comparados. Quando comparados com o grupo controle, tanto o TEM quanto o LMF apresentaram aumento significativo do ângulo crânio-vertebral. Houve melhora significativa no índice de cefaleia após TEM, LMF ou exercício de rotina no pescoço. CONCLUSÃO: Comparado ao grupo controle, o LMF apresenta melhores resultados do que o TEM no ângulo crânio-vertebral e cefaleia.

INTRODUCTION: Tension headaches can be induced by forward head posture, and there is a wealth of evidence available for managing chronic headaches. The data support the use of manual therapy approaches to manage tension-type headaches. Because of the forward head posture, the suboccipital muscle region becomes short, resulting in an increase in lordosis and neck pain. Patients with an even more forward head posture have a smaller craniovertebral angle, which in turn causes tension-type headache. OBJECTIVE: This study aims to compare the effects of Myofascial release therapy (MFR) and Muscle energy technique (MET) with general neck exercises on the craniovertebral angle and headache in tension-type headache patients. METHODS: In total, 75 subjects with tension-type headache and suboccipital muscle tenderness were recruited and randomized blindly into three groups: the MFR group, the MET group, and the control group (25 subjects in each group). A pre-craniovertebral angle was taken by photographic method, and a pre-headache disability index questionnaire was filled in. The MFR group receives cranio-basal release in the suboccipital region with neck exercises, the MET group receives post­isometric relaxation in the suboccipital region with exercises, and the control group receives only exercises for two weeks. After two weeks, the postcranial angle and the headache questionnaire were taken and measured. RESULTS: Craniovertebral angle and headache index showed significant improvement in both the MET and MFR groups. There was no significant difference when MET and MFR groups were compared. When compared with the control group, both MET and MFR showed a significant increase in craniovertebral angle. There was a significant improvement in the headache index following MET, MFR, or routine neck exercise. CONCLUSION: Compared to the control group, MFR shows better results than MET on craniovertebral angle and headache.

Supplementing massage with dry needling can better relieve facial pain / 中华物理医学与康复杂志

Objective:To observe any effect of dry needling of myofascial trigger points on substance P and synaptophysin expression in the spinal dorsal horn.Methods:Sixty-four Sprague-Dawley rats were randomly divided into a control group ( n=16) and a model group ( n=48). Myofascial trigger points were induced in the model group by a blunt strike and eccentric running. That group was then randomly divided into a no-treatment group ( n=15), a massage group ( n=16), and a dry needling group (16 rats). The rats in the two treatment groups received 4 weeks of dry needling or Chinese massage. Pressure pain thresholds were recorded before the experiment and after the 4 weeks. The content of substance P and synaptophysin in the spinal dorsal horn were measured using immunoblotting and immunohistochemistry. Results:After the treatment 14 rats (93%) in the model group had trigger points, significantly higher than the 8 rats (50%) in the massage group and the 7 rats (44%) in the dry needling group. After treatment, the average pressure pain thresholds of the no-treatment and massage groups was significantly lower than the control group′s average, while the difference between the dry needling group and the control group was not significant. The average pressure pain threshold had improved significantly in the no-treatment group, the massage group and the dry needling group, and the averages of the massage group and the dry needling group were significantly higher than that of the no-treatment group. The level of substance P was significantly higher in the no-treatment group than in the other three groups and the ratio of substance P to Glyceraldehyde 3-phosphate dehydrogenase (GAPDH)was significantly higher. The substance P: GAPDH ratio of the massage group was significantly higher than that of the control group.Conclusions:Dry needling and massage are effective in relieving myofascial pain, at least in rats. Both can reduce the content of substance P in the spinal dorsal horn.

Influência da ventosaterapia sobre o limiar de dor a pressão e flexibilidade muscular da cadeia posterior de membro inferior em atletas de futebol / Influencia de la terapia de ventosas sobre el umbral del dolor por presión y flexibilidad de los músculos de la cadena posterior del miembro inferior en jugadores de fútbol / Influence of cupping therapy on the pain threshold pressure and muscle flexibility of the subsequent chain leg in football athletes

RESUMO O objetivo deste estudo é avaliar o limiar de dor à pressão (LDP) e flexibilidade pré e pós-protocolo de ventosaterapia em toda cadeia muscular posterior do membro inferior de atletas de futebol masculino. O estudo é de intervenção de múltiplos casos, com um grupo submetido a um protocolo de ventosaterapia em região posterior de membro inferior nos trilhos anatômicos, mensurando-se a flexibilidade de flexão de quadril (FQ), extensão de joelho (EJ) e dorsiflexão de tornozelo (DT) e o LDP nos pontos gatilhos miofasciais de toda a cadeia posterior, pré e pós-intervenção no primeiro e quarto dia de coleta. A amostra foi composta por 20 atletas, sendo quatro recusas e duas perdas no decorrer do estudo, finalizando o estudo com 16 atletas no momento agudo imediato (n=32) e 14 atletas no momento agudo tardio (n=28). Para análise estatística utilizou-se o teste t-student para amostras pareadas e o nível de significância de p<0,05. Houve diferença estatística significativa no momento agudo tardio no pré e pós-intervenção para as variáveis EJ e DT, demonstrando aumento da flexibilidade após o protocolo. Conclui-se que a intervenção sobre os trilhos anatômicos em região posterior de membro inferior é capaz de aumentar a flexibilidade, porém não diminui LDP.

RESUMEN El objetivo de este estudio es evaluar el umbral de dolor por presión (UDP) y la flexibilidad antes y después de la terapia de ventosas en toda la cadena muscular posterior del miembro inferior de jugadores de fútbol masculino. Esta es una intervención de múltiples casos que sometió a un grupo a un protocolo de terapia de ventosas en la región posterior del miembro inferior sobre los raíles anatómicos, midiendo la flexibilidad de flexión de cadera (FC), la extensión de rodilla (ER) y la dorsiflexión de tobillo (DT) y UDP en los puntos gatillo miofasciales de toda la cadena posterior, antes y después de la intervención en el primer y cuarto día de recolección. La muestra estuvo formada inicialmente por 20 deportistas, pero hubo cuatro rechazos y dos bajas durante el estudio, lo que finalizó el estudio con 16 deportistas en el momento agudo inmediato (n=32) y 14 deportistas en el momento agudo tardío (n=28). Para el análisis estadístico se utilizó la prueba t student en muestras pareadas y el nivel de significancia de p<0,05. Se encontró una diferencia estadísticamente significativa en el momento agudo tardío antes y después de la intervención para las variables ER y DT, demostrando una mayor flexibilidad después del protocolo. Se concluye que la intervención sobre los raíles anatómicos en la región posterior del miembro inferior es capaz de aumentar la flexibilidad, pero no de disminuir el UDP.

ABSTRACT This study aimed to evaluate the pressure pain threshold (PPT) and flexibility before and after cupping therapy in the entire posterior muscle chain of the lower limb of soccer players. This study is a multiple-case intervention, with a group submitted to the posterior lower limb cupping therapy protocol on the anatomical trains, measuring the flexibility of hip flexion (HF), knee extension (KE), and ankle dorsiflexion (AD) and PPT at the myofascial trigger points, pre- and post-intervention on the first and fourth day of collection. The initial sample consisted of 20 athletes, four refusals and two losses during the study, ending with 16 athletes in the immediate acute moment (n=32) and 14 athletes in the late acute (n=28). Statistical analysis was performed using Student's t-test and significance level, p <0.05. There was a statistically significant difference in late acute pre- and post-intervention for KE and AD variables, demonstrating increased flexibility after the protocol. We concluded that the intervention on the anatomical trains in the posterior lower limb increases the flexibility, but does not decrease PPT.

Myofascial Pain Syndrome, myofascial trigger points and trigger points in veterinary medicine: a review / Revisão: Síndrome Dolorosa Miofascial, pontos gatilhos miofascial e pontos gatilhos na medicina veterinária

Myofascial Pain Syndrome (MPS) a is a painful condition related to myofascial trigger points (TP) in skeletal muscle. The aim of this study was to perform a literature review on the etiology, pathophysiology, diagnosis and treatment of MPS in veterinary medicine. The research sites used for this purpose were: Scientific Electronic Library, PubMed and Medline. The inclusion criteria for the papers were: must be written in English; published between 1990 and 2018; include the following keywords: myofascial pain syndrome veterinary/dog/canine/cat/feline/horse/equine, trigger points veterinary/dog/canine/cat/feline/horse/equine. Through the review, it was observed that veterinary clinical studies are scarce, and the articles found lack information such as MPS description, incidence and specific treatment techniques in dogs and horses, and no studies in cats were found.(AU)

Síndrome Dolorosa Miofascial (SDM) é uma condição dolorosa relacionada aos pontos gatilhos miofasciais (PG) no músculo esquelético. Este trabalho tem como objetivo realizar uma revisão bibliográfica sobre a etiologia, fisiopatogenia, diagnóstico e tratamento na medicina veterinária. Foram utilizados sites de pesquisas Scientific Electronic Library, Pubmed e Medline. Os critérios de inclusão estabelecidos foram: ser escrito em inglês; no período de 1990 a 2018; ter as palavras chaves para busca: myofascial pain syndrome veterinary/dog/canine/cat/feline/ horse/equine, trigger points veterinary/dog/canine/cat/feline/horse/equine. Após a revisão observa-se que faltam estudos clínicos em medicina veterinária, sendo que os artigos encontrados se limitam à descrição, incidência e técnicas pontuais em cães e equinos, não sendo encontradas referencias em felinos.(AU)

Immediate Effect Of Dry Needling Vs Ultrasound On Releasing Trigger Points In Quadriceps In Patients With Patello-Femoral Pain Syndrome On Pain

Background: Patello-femoral pain syndrome is a very common complaint seen in adolescence and young adults characterized by pain around and behind the patella. There has been prevalence of trigger points in the quadriceps leading to disruption of the VMO/VL firing pattern due to muscle inhibition by pain. Current studies suggest the use of strengthening exercises for hip and knee not focusing on releasing the trigger points. Releasing these trigger points could give additional benefit to the patient and can also be employed along with other conventional therapies. Purpose of the study: To find out which treatment method gives faster results and works directly on the pain and function of the patient. Objectives: To assess the immediate effect of Dry Needling Vs Ultrasound on releasing Trigger points in Quadriceps in patients with Patello-femoral Pain Syndrome on pain and knee/lower extremity function. Study Design: Randomized Control trail Setting: OPD setting. Participants: 70 patients with chronic anterior knee pain, without any ligament, bony or sensory involvement around the knee. Main outcome measures: Numerical Pain rating scale and Pressure Algometer. Results: In the ultrasound group there was a change of 38.60% seen in NRPS post values with a mean difference of 2.21±1.21 and for pressure algometer a change of 36.23% was seen with a mean difference of 3.08±4.40. In the dry needling group there was a change of 64.53% seen in NRPS post values with a mean difference of 3.07±1.48 and for pressure algometer a change of 56.86% was seen with a mean difference of 8.36±6.90. When compared within group dry needling had a better effect than ultrasound on both NRPS and Pressure algomter. Conclusion: The current study indicates that Dry needling is more effective than ultrasound for reducing pain and increasing functional outcome in patients with patellofemoral pain syndrome.

Migraña: efectividad del tratamiento quirúrgico: revisión de la literatura / Migraine headache: effectiveness of surgical treatment: review of the literature

Resumen La migraña afecta a un porcentaje importante de la población y los síntomas pueden interferir con calidad de vida de manera importante. A pesar de los avances en el manejo médico, existe una proporción de pacientes que no responden adecuadamente a la intervención farmacológica. En los últimos años, se han planteado nuevos enfoques en el tratamiento de la migraña. Éstos se basan en la teoría que ramas sensoriales extracraneales del trigémino y de los nervios espinales cervicales pueden irritarse, atraparse o comprimirse en algún punto a lo largo de su trayecto, generándose una cascada de eventos fisiológicos que finalmente resulta en la migraña. Se ha demostrado que la inyección diagnóstica y terapéutica de toxina botulínica y la descompresión quirúrgica de estos puntos gatillos reducen o eliminan las migrañas en pacientes que no responden adecuadamente a la intervención farmacológica y siguen sintomáticos. La evidencia que respalda la eficacia y seguridad de la descompresión quirúrgica de los puntos de gatillos periféricos se está acumulando rápidamente, y la tasa de éxito general de la cirugía se acerca a 90%. Este trabajo revisa la evidencia clínica y pretende proporcionar un artículo sobre el estado actual de la técnica en el tratamiento quirúrgico de las migrañas.

Migraine headaches affect a significant percentage of the population and the symptoms can interfere with quality of life in an important way. Despite advances in medical management, there is a proportion of patients who do not respond adequately to the pharmacological intervention. In recent years, new approaches have been proposed in the treatment of migraine. These are based on the theory that extracranial sensory branches of the trigeminal and cervical spinal nerves can become irritated, trapped or compressed at some point along their path, generating a cascade of physiological events that ultimately results in migraine. It has been shown that the diagnostic and therapeutic injection of botulinum toxin and the surgical decompression of these trigger points reduce or eliminate migraines in patients who do not respond adequately to the pharmacological intervention and remain symptomatic. The evidence supporting the efficacy and safety of surgical decompression of peripheral trigger points is rapidly accumulating, and the overall success rate of surgery approaches 90%. This paper reviews the clinical evidence and aims to provide an article on the current state of the art in the surgical treatment of migraines.

Capsaicin topical cream (8%) for the treatment of myofascial pain syndrome / Creme tópico de capsaicina (8%) para o tratamento da síndrome da dor miofascial

Abstract Background: Myofascial pain syndrome is a common cause of musculoskeletal pain. The objective of this study was to evaluate the potential analgesic action of 8% capsaicin cream for topical use in patients with myofascial pain syndrome. Methods: Initially, cream formulations of PLA (Placebo) and CPS (Capsaicin 8%) were developed and approved according to the current requirements of the health authority agency. The 40 participating patients were randomly assigned to the PLA and CPS groups in a double-blind fashion. Before the creams were topically administered, according to the allocation group, the local anesthetic was used for a period of 50 minutes directly in the area of interest. The cream was applied to the area of the skin over the trigger point, represented by the area with pain at palpation, in an amount of 10 g for 30 minutes in a circular area of 24 mm diameter. Subsequently, the cream was removed and the skin tolerability parameters were evaluated. The pain was measured before and during the formulation application, as well as at 1 hour, 7 days, 30 days, and 60 days after the procedure, evaluated using a verbal numerical scale (from 0 to 10: with 0 = no pain and 10 = worst pain imaginable). Results: No patient in PLA Group had hyperemia or burning sensation at the site of application, while 85% of patients in CPS Group had hyperemia or burning sensation at 15 minutes. These complaints disappeared 24 hours after the cream was removed. The pain score in CPS Group decreased steadily up to the 60th day of evaluation (p < 0.0001). Conclusion: Application of the formulations did not cause macroscopic acute or chronic skin lesions in patients, and the 8% capsaicin formulation was beneficial and well tolerated.

Resumo Justificativa: A síndrome da dor miofascial é uma causa comum de dor musculoesquelética. O objetivo deste estudo foi avaliar a potencial ação analgésica de 8% do creme de capsaicina para uso tópico em pacientes com síndrome da dor miofascial. Métodos: Inicialmente, as formulações de creme de PLA (Placebo) e CPS (Capsaicina 8%) foram desenvolvidas e aprovadas de acordo com os requisitos atuais da agência de autoridade de saúde. Os 40 pacientes participantes foram distribuídos aleatoriamente e de forma duplo-cega para os grupos PLA e CPS. Antes dos cremes serem administrados topicamente, de acordo com o grupo de alocação, o anestésico local foi usado por um período de 50 minutos diretamente na área de interesse. A administração ocorreu na área da pele sobre o ponto-gatilho, o qual apresentou a área dolorida à palpação, em uma quantidade de 10 g por 30 minutos em área circular com diâmetro de 24 mm. Posteriormente, o creme foi removido e os parâmetros de tolerabilidade à pele foram avaliados. A dor foi medida antes e durante a aplicação da formulação, bem como 1 hora, 7 dias, 30 dias e 60 dias após o procedimento avaliado pela escala numérica verbal (0 a 10, com zero sem dor e dez a pior dor imaginável). Resultados: Nenhum paciente no grupo PLA experimentou hiperemia ou sensação de queimação no local de aplicação do creme, enquanto 85% dos que experimentaram no grupo CPS apresentaram hiperemia ou sensação de queimação 15 minutos. Essas queixas desapareceram 24 horas após a remoção do creme. O escore de dor no grupo CPS diminui de forma sustentada até o 60° dia de avaliação (p < 0,0001). Conclusão: A administração das formulações não causou lesões cutâneas agudas ou crônicas macroscópicas nos pacientes e a formulação de 8% de capsaicina foi benéfica e bem tolerada.

Determining The Prevalence Of Trigger Points In Acute Shoulder Pain Patients

Background: Shoulder pain due to its high prevalence has great significance in its contribution to morbidity. It’s the third most common musculoskeletal problem.There are two types of trigger points found they are active and latent trigger points.Active trigger points are the one which when palpated causes spontaneous pain or referred pain and latent trigger points are the one which do not cause any pain except they are present either in form of taut band or nodules. MyofascialTrigger points (MTrPs) cause a local pain syndrome. The main cause of myofascial pain syndrome are trigger points. Purpose of the study: The purpose of the study was to determine the exact muscles that have the tendency for developing trigger points in acute shoulder pain pathologies and to see the trigger points developed are due to the shoulder pathology. Materials and Methods: A observational study was performed. Patients were selected by convenient sampling. 70 people participated within the age of 18-65, pain duration within 3 months, males and female included with no history of recent trauma, neurovascular injuries, degenerative pathology and shoulder dislocation. Patients were assessed for myofascial trigger points (MTrPs) on both affected and non-affected side. MTrPs were assessed on different muscles by manual palpation method. Results: The result shows that the muscle affected maximum is upper trapezius with 84.28% and pectoralis major with 71.42%. Also on the affected side, upper trapezius with 37.14% and pectoralis major and subscapularis with 20.00%. Conclusion: This study showed the prevalence of trigger points in acute shoulder pain pathologies is66.59% . Each patient of any acute pathology had the presence of more than 3 trigger points in the affected side proving trigger points to be of significant importance and it is due to underlying shoulder pathology.

Laserterapia versus técnica de compressão isquêmica: avaliação comparativa dos efeitos terapêuticos e funcionais da contratura do músculo trapézio / Laser therapy versus ischemic compression technique: comparative evaluation of the therapeutic and functional effects of trapezius contracture

Introdução: A contratura muscular ocorre quando o músculo se contrai de maneira incorreta e não volta ao seu estado normal de relaxamento, em resposta a uma sobrecarga de esforço. Objetivos: Comparou-se a utilização de duas técnicas e os benefícios proporcionados ao tratamento dos pacientes acometidos com contratura do músculo trapézio superior. Métodos: Tratou-se de um estudo transversal, intervencionista, comparativo e quantitativo no período de agosto de 2015 a junho de 2016, com 49 acadêmicos, que foram divididos em dois grupos (G1/G2). Os dados foram obtidos através da ficha de avaliação cinético-funcional desenvolvida para o estudo, que foi aplicada antes e ao término do tratamento fisioterapêutico, Escala dos Sintomas de Dyrek e Escala Visual Analógica. Resultados: Dos 49 acadêmicos, 80% eram do sexo feminino, sendo 95% solteiras, todos naturais de Fortaleza, todos cursando o ensino superior, com média de idade de 23,33 anos. No G1 (Compressão isquêmica) antes da aplicação a maior predominância foi a de nível de dor 7 e logo depois da aplicação o nível de maior predominância foi de dor 2, conforme Escala Visual Analógica. No G2 (Laserterapia) o nível de dor antes da aplicação foi de 7 e logo depois da aplicação, foi de dor 1 conforme Escala Visual Analógica. Conclusão: As técnicas de Laserterapia e a Compressão Isquêmica melhoraram o aporte sanguíneo da área tratada, porém na laserterapia houve a diminuição do limiar de dor e restabelecimento da normalidade funcional local. (AU)

Introduction: Muscle contracture occurs when the muscle contracts incorrectly and does not return to its normal state of relaxation in response to effort overload. Objectives: We compared the use of two techniques and the benefits provided to the treatment of patients with upper trapezius contracture. Methods: This was a cross-sectional, interventional, comparative and quantitative study between August 2015 and June 2016, with 49 academics divided into two groups (G1/G2). The data were obtained through the functional kinetic evaluation sheet developed for the study, which was applied before and at the end of the physiotherapeutic treatment, Dyrek Symptom Scale and Visual Analog Scale. Results: Of the 49 students, 80% were female, 95% single, all of them from Fortaleza/CE, all of them attending higher education, with a mean age of 23.33 years. In G1 (Ischemic Compression), before the application, the greatest predominance was pain level 7 and soon after the application the greater predominance was level pain 2, according to Visual Analog Scale. In G2 (Laser Therapy) the level of pain before the application was 7 and soon after the application was level pain 1 according to Visual Analog Scale. Conclusion: Laser therapy and ischemic compression improved the blood supply of the treated area, and laser therapy decreased th pain threshold and restored the local functional normality. (AU)

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

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.

The Effect of Trigger Point Injections on Pain in Patients with Advanced Cancer / 가정의학회지

BACKGROUND: It has been reported that in 62.5% of cases of incurable cancer pain, the complaint is due to myofascial pain syndrome. Trigger point injections using dibucaine hydrochloride help patients with such cancer pain. This study evaluated the efficacy of trigger point injections for alleviating pain in patients with advanced cancer. METHODS: Twenty patients with advanced cancer who had a life expectancy of 6 months or less and had been diagnosed with myofascial pain syndrome were treated with trigger point injections. Prior to treatment, a Visual Analog Scale (VAS) was used to measure the resting pain level and discomfort upon application of pressure on the site of pain. These values were compared with last treatment measurements. RESULTS: The mean pre-treatment VAS scores for pain at rest and upon application of pressure on the pain site were 7.3 and 9.0, respectively. These scores decreased significantly to 1.95 and 3.2, respectively, after the treatment (P<0.05). CONCLUSION: Trigger point injection is an alternative and effective pain control modality for advanced cancer patients with myofascial pain syndrome.

Therapeutic effect of acupuncture on myofascial trigger points combined with low frequency bioelectrical stimulation and manipulative stretch reduction on sacroiliac joint on perinatal period separation of symphysis pubis / 中国实用妇科与产科杂志

OBJECTIVE: To observe the impact of acupuncture on myofascial trigger points(MTrPs),low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint on perinatal period separation of symphysis pubis.METHODS: Totally 100 cases of perinatal separation of pubic symphysis in Huai'an Women and Children Health Hospital from January 2013 to July 2016 were selected.They were randomly divided into comprehensive treatment group,electrical stimulation group,manipulative reduction group,pelvic belt group and control group,20 cases in each group.The comprehensive treatment group was given acupuncture on myofascial trigger points,low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint,the other three treatment groups were treated with their respective monotherapy,and the control group only received the brake observation.The NRS pain score and clinical efficacy were compared among the groups.RESULTS: Six days after treatment,18 cases,7 cases,4 cases,0 case and 0 case were cured in the five groups,respectively.Six weeks after treatment,20 cases,13 cases,11 cases,4 cases and 0 case were cured in the five groups,respectively.Six months after treatment,20 cases,18 cases,15 cases,13 cases and 9 cases were cured in the five groups,respectively.The treatment effect of the comprehensive group was the best,followed by the electric stimulation group,and then manipulation reduction group.CONCLUSION: acupuncture on myofascial trigger points and electrical stimulation combined with manipulative stretch reduction can not only quickly relieve the pain of patients in a short time,but also quickly make the pubic symphysis form return to normal.It has a high treatment efficiency and is less painful.So it has a high clinical value.

Ultrasound-guided dry needling for myofascial trigger points in treatment of plantar fasciitis / 中国医学影像技术

Objective: To explore the clinical effect of ultrasound-guided dry needling of myofascial trigger points in treatment of plantar fasciitis. Methods: Totally 48 patients with plantar fasciitis were randomly divided into 2 groups. Patients in the simple treatment group (n=24) received sole non-weight-bearing plantar fascia stretching training, and the ones in the combined treatment group (n=24) received ultrasound-guided dry needling for myofascial trigger points combined with stretching training. The numeric pain-rating scale (NPRS) of the first move, American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS), physical component summary (PCS) and mental component summary (MCS) of 36-item short-form health survey were evaluated before (T0) as well as 1 month (T1) and 3 months (T2) after treatment respectively. Results: The overall differences of NPRS, AOFAS, PCS and MCS were significant before and after treatment in both two groups (all P0.05). Conclusion: Ultrasound-guided dry needling for myofascial trigger points combined with stretching training and sole non-weight-bearing plantar fascia stretching training are both effective for treatment of plantar fasciitis, while the former is better for relieving pain and improving ankle function.

Observation on therapeutic effect of electroacupuncture plus Tanbo-plucking the trigger points for scapulohumeral periarthritis / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of electroacupuncture (EA) plus Tanbo-plucking the trigger points for scapulohumeral periarthritis (SP). Methods:A total of 80 patients with SP were randomized into an observation group and an EA group by the random number table, with 40 cases in each group. The EA group was treated with EA therapy, and the observation group was treated with EA therapy plus Tanbo-plucking the trigger points. After treatment, the visual analog scale (VAS) and Melle scores of the two groups were compared to evaluate the improvement of shoulder pain and functional activity, and meanwhile the clinical efficacy was observed. Results: After treatment, the total effective rate of the observation group was 95.0％ and the cure and markedly effective rate was 72.5％. The total effective rate of the EA group was 87.5％ and the cure and markedly effective rate was 42.5％. There was no significant difference in the total effective rate between the two groups (P>0.05). The cure and markedly effective rate of the observation group was higher than that of the EA group, and the difference between the two groups was statistically significant (P<0.05). After treatment, the intra-group differences in VAS and Melle scores of both groups were statistically significant (bothP<0.001). The inter-group differences in the changes of the VAS and Melle scores after treatment were statistically significant (bothP<0.001). Conclusion: EA plus Tanbo-plucking the trigger points has a better curative effect than EA therapy alone in the treatment of SP.