ABSTRACT
SUMMARY OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.
Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Neck Pain/epidemiology , Trigger Points/physiopathology , Superficial Back Muscles/physiopathology , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/physiopathology , Reproducibility of Results , Chronic Pain , Middle AgedABSTRACT
The myofascial pain syndrome is an entity that is often associated with many of the prevalent pathologies that generate musculoskeletal pain distributed in the different body segments (upper extremities, spine and lower extremities), and may be responsible for the chronification of problem if it is not considered, diagnosed and managed in a comprehensive and timely manner in conjunction with the underlying pathology. (AU)
Subject(s)
Humans , Male , Female , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/physiopathology , Myofascial Pain Syndromes/epidemiology , Myofascial Pain Syndromes/drug therapyABSTRACT
BACKGROUND: Infrared thermography is recognized as a viable method for evaluation of subjects with myofascial pain. OBJECTIVE: The aim of the present study was to assess the intra- and inter-rater reliability of infrared image analysis of myofascial trigger points in the upper trapezius muscle. METHOD: A reliability study was conducted with 24 volunteers of both genders (23 females) between 18 and 30 years of age (22.12±2.54), all having cervical pain and presence of active myofascial trigger point in the upper trapezius muscle. Two trained examiners performed analysis of point, line, and area of the infrared images at two different periods with a 1-week interval. The intra-class correlation coefficient (ICC2,1) was used to assess the intra- and inter-rater reliability. RESULTS: With regard to the intra-rater reliability, ICC values were between 0.591 and 0.993, with temperatures between 0.13 and 1.57 °C for values of standard error of measurement (SEM) and between 0.36 and 4.35 °C for the minimal detectable change (MDC). For the inter-rater reliability, ICC ranged from 0.615 to 0.918, with temperatures between 0.43 and 1.22 °C for the SEM and between 1.19 and 3.38 °C for the MDC. CONCLUSION: The methods of infrared image analyses of myofascial trigger points in the upper trapezius muscle employed in the present study are suitable for clinical and research practices. .
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Thermography/methods , Trigger Points/physiology , Superficial Back Muscles/physiology , Infrared Rays , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/physiopathologyABSTRACT
BACKGROUND: Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. OBJECTIVE: The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. METHOD: Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05). RESULTS: There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). CONCLUSION : EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly. .
Subject(s)
Humans , Female , Adult , Pain Measurement , Acupuncture Therapy , Range of Motion, Articular , Myofascial Pain Syndromes/physiopathology , Myofascial Pain Syndromes/therapy , Neck/physiopathology , Electroacupuncture , Double-Blind Method , Myofascial Pain Syndromes/diagnosisABSTRACT
Myofascial pain syndrome is a disorder that has had a great interest in the last years. Its pathophysiology still not completely understood makes the physiological basis of the treatment incomplete. In this paper the scientific evidence and theories that exist on every component of myofascial pain syndrome and how they can be part of the treatments used are described...
El síndrome de dolor miofascial es un trastorno cuya difusión ha ido en aumento en los últimos años; sin embargo, su fisiopatología aún sigue sin dilucidarse por completo; esto conlleva a que no se conozcan las bases fisiológicas que sustentan la terapéutica que se utiliza para su manejo. En este texto se describen la evidencia científica y las teorías que existen ante cada una de las partes que componen el síndrome de dolor miofascial y cómo pueden formar parte de los tratamientos que se emplean...
Subject(s)
Humans , Myofascial Pain Syndromes/physiopathology , Myofascial Pain Syndromes/therapy , Myofascial Pain Syndromes/diagnosisABSTRACT
BACKGROUND: Electroacupunture (EA) includes the passage of an electrical current through the acupuncture needle and is commonly used for pain relief. OBJECTIVE: To evaluate the EA treatment effects for myofascial pain in the upper trapezius muscle. METHODS: Twenty women aged ranging from 18 to 40 years (mean=24.95; SD=5.88 years), with a body mass index ranging from 19 to 25 kg/m2 (mean=22.33; SD=0.56 kg/m2), with regular menstrual cycles controlled by oral contraceptive, local or referred pain for more than six months and at least one myofascial trigger point in the upper trapezius participated in this study. The participants received a total of nine EA sessions over five weeks. The needles were inserted at the accupoints GB20, GB21, LV3, LI4, and at ashi points. A mixed current of 2 Hz and 100 Hz was applied alternatively every 5 seconds for 30 minutes. The outcomes were pain intensity measured by the visual analogue scale (VAS), pressure pain threshold (PPT) measured by an algometer, electromyography (EMG) and quality of life measured by the SF-36 questionnaire. Inter-occurrences between sessions were monitored. Paired t-test, Wilcoxon test, and repeated measure analysis of variance (ANOVA) having Tukey-Kramer as post-hoc tests were used. RESULTS: Significant improvement in pain intensity and in PPT occurred after treatment (P<0.0001). EMG of the right trapezius during contraction increased significantly, suggesting muscle function enhancement; the quality of life improved, related to physical components of the SF-36 (P<0.05). CONCLUSION: The EA showed to be a reliable method for myofascial pain relief. Large randomized blinded controlled trials might be carried out to confirm these results. Article registered in the Registro Brasileiro de Ensaios Clínicos under number RBR-4hb6f6.
CONTEXTUALIZAÇÃO: A eletroacupuntura (EA) inclui a passagem de uma corrente elétrica pela agulha de acupuntura e é comumente utilizada para aliviar a dor. OBJETIVO: Avaliar o efeito da EA no tratamento da dor miofascial do músculo trapézio superior. MÉTODOS: Participaram 20 voluntárias com idade entre 18 e 40 anos (24,95±5,88 anos), índice de massa corpórea entre 19 e 25 kg/m2 (22,33±0,56 kg/m2), ciclo menstrual regulado por anticoncepcionais, dor por mais de seis meses no trapézio superior, com pelo menos um ponto gatilho miofascial. Nove sessões de EA foram agendadas, sendo duas por semana. As agulhas foram inseridas nos pontos VB20, VB21, F3, IG4 e em pontos ashi. Aplicou-se uma corrente alternada de 2 Hz e 100 Hz a cada 5 segundos durante 30 minutos. Avaliou-se a eficácia do tratamento quantificando a intensidade da dor com a Escala Visual Analógica (EVA); o limiar de dor à pressão (LDP), com algômetro digital, eletromiografia (EMG) e com o questionário de qualidade de vida SF-36. Possíveis fatores influenciadores entre as sessões foram monitorados. Aplicaram-se os testes t pareado, Wilcoxon e análise de variância com medidas repetidas (ANOVA) e, como post-hoc, o teste de Tukey-Kramer. RESULTADO: Após o tratamento, houve melhora na intensidade da dor e no LDP (P<0,0001). A EMG no trapézio direito, durante a contração, aumentou significativamente, sugerindo melhora da função muscular. A qualidade de vida melhorou considerando os componentes físicos do SF-36 (P<0,05). CONCLUSÃO: A EA mostrou-se confiável no alívio da dor miofascial. Estudos randomizados, cegos e controlados devem ser realizados para confirmar esses resultados. Artigo registrado no Registro Brasileiro de Ensaios Clínicos sob o número RBR-4hb6f6.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Electroacupuncture/methods , Myofascial Pain Syndromes/therapy , Back , Muscle, Skeletal , Myofascial Pain Syndromes/diagnosis , Pain MeasurementABSTRACT
OBJETIVE: To evaluate a sample of patients with atypical facial pain (AFP) in comparison to patients with symptomatic facial pain (SFP). METHOD: 41 patients with previous diagnostic of AFP were submitted to a standardized evaluation protocol, by a multidisciplinary pain team. RESULTS: 21 (51.2 percent) were considered AFP and 20 (48.8 percent) (SFP) received the following diagnosis: 8 (40.0 percent) had temporomandibular disorders (TMD); 3 (15.0 percent) had TMD associated to systemic disease (fibromyalgia, systemic erythematosus lupus); 4 (20.0 percent) had neuropathy after ear, nose and throat (ENT) surgery for petroclival tumor; 2 (10.0 percent) had Wallenberg syndrome; 1 (5.0 percent) had intracranial tumor; 1 (5.0 percent) had oral cancer (epidermoid carcinoma), and 1 (5.0 percent) had burning mouth syndrome (BMS) associated to fibromyalgia. Spontaneous descriptors of pain were not different between AFP and SFP groups (p=0.82). Allodynia was frequent in SFP (p=0.05) and emotion was the triggering factor most prevalent in AFP (p=0.06). AFP patients had more traumatic events previously to pain (p=0.001). CONCLUSION: AFP patients had more: a) traumatic events previously to pain onset, and b) emotions as a triggering factor for pain. These data support the need of trained health professionals in multidisciplinary groups for the accurate diagnosis and treatment of these patients.
OBJETIVO: Avaliar uma amostra de pacientes com dor facial atípica (DFA) e compará-la a outra com dor facial sintomática (DFS). MÉTODO: 41 pacientes com diagnóstico prévio de DFA foram submetidos a um protocolo padronizado de avaliação aplicado por uma equipe multidisciplinar. RESULTADOS: 21 (51,2 por cento) foram mantidos com o diagnóstico de DFA e 20 (48,8 por cento) (DFS) receberam os seguintes diagnósticos: 8 (40.0 por cento) tinham disfunções temporomandibulares (DTM); 3 (15,0 por cento) tinham DTM associada a doença sistêmica (fibromialgia, lupus eritematoso sistêmico); 4 (20,0 por cento) tinham neuropatia após cirurgia otorrinolaringológica (ORL) para tumor petroclival; 2 (10,0 por cento) tinham síndrome de Wallenberg; 1 (5,0 por cento) tinha um tumor intracraniano; 1 (5,0 por cento) tinha câncer oral (carcinoma epidermóide), e 1 (5,0 por cento) tinha síndrome da ardência bucal (SAB) associada à fibromialgia. Expressões espontâneas utilizadas para a dor não diferiram entre os 2 grupos (p=0,82). Alodínia foi freqüente nos doentes com DFS (p=0,05) e emoções foi o fator desencadeante mais comum no grupo com DFA (p=0,06). Doentes com DFA apresentaram mais eventos traumáticos anteriores ao início da dor (p=0,001). CONCLUSÃO: Pacientes com DFA apresentaram mais: a) eventos traumáticos anteriores à cirurgia e b) emoções como fator desencadeante de dor. Estes dados realçam a necessidade de profissionais treinados em dor nas equipes multidisciplinares para o diagnóstico preciso e tratamento adequado desses doentes.
Subject(s)
Adult , Aged , Female , Humans , Male , Facial Neuralgia/diagnosis , Facial Pain/diagnosis , Temporomandibular Joint Disorders/diagnosis , Chronic Disease , Clinical Protocols , Diagnosis, Differential , Facial Pain/etiology , Myofascial Pain Syndromes/diagnosis , Pain Clinics , Pain Measurement , Trigeminal Nerve/physiopathologyABSTRACT
Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.
Subject(s)
Adult , Female , Humans , Diagnosis, Differential , Hemangioma/diagnosis , Magnetic Resonance Imaging/methods , Muscle, Skeletal/anatomy & histology , Muscular Diseases/diagnosis , Myofascial Pain Syndromes/diagnosis , Pain , Radiography/methods , Time FactorsABSTRACT
A espectroscopia por ressonância magnética foi utilizada para comparar os níveis dos metabólitos de fósforo, do pH e do Mg, durante o repouso e após o exercício, na musculatura do antebraço em 19 mulheres com síndrome dolorosa miofascial relacionada com o trabalho e em 19 controles. Uma seqüência de imagem foi realizada nos indivíduos estudados / We used 31P magnetic resonance spectroscopy to compare phosphorus metabolites, intracellular pH (pHi) and intracellular Mg (Mgi) levels, during rest and after exercise, in the flexor forearm muscles in 19 women with work-related myofascial pain syndrome and in 19 women without pain complaints. A fat suppression magnetic resonance image...
Subject(s)
Adult , Middle Aged , Magnetic Resonance Spectroscopy , Myofascial Pain Syndromes/diagnosis , Cumulative Trauma Disorders/diagnosis , Exercise , Magnesium , Magnetic Resonance Imaging , Rest , Forearm Injuries/diagnosis , WomenABSTRACT
Este estudo vem discutir inicialmente a diferença clínica entre a fibromialgia e a síndrome miofascial, indicando os principais sintomas, a localizaçäo da dor e a diferenciaçäo ao exame clínico. É fundamental que se conheça as características de cada estado para poder diferenciá-los corretamente, resultando em um tratamento mais elaborado e eficaz. Diante da falta de protocolo específico e carência de estudos nesta área, muito ainda deve ser pesquisado sobre a importante atuaçäo da fisioterapia no processo de recuperaçäo no processo de tais pacientes
Subject(s)
Diagnosis, Differential , Fibromyalgia , Physical Therapy Specialty , Myofascial Pain Syndromes/diagnosis , Symptoms in HomeopathyABSTRACT
A lombalgia e uma das queixas mais comuns no ser humano. Varias sao as razoes de sua ocorrencia. Dentre elas destacam-se as de origem musculo-esqueletica, incluindo...
Subject(s)
Humans , Pain , Low Back Pain , Myofascial Pain Syndromes/diagnosis , Low Back Pain , Diagnosis, DifferentialABSTRACT
A avaliacao de doentes com dor e necessaria para estimar a magnitude e a natureza das variadas facetas da dor e de suas repercussoes presentes, quantificar os resultados dos tratamentos e...
Subject(s)
Humans , Pain , Pain Measurement/methods , Myofascial Pain Syndromes/diagnosis , Pain , Medical History Taking , Chronic Disease , Prognosis , Myofascial Pain Syndromes/physiopathology , Diagnostic Techniques and ProceduresABSTRACT
A sindrome dolorosa miofascial (SDM) e condicao comum. Pode ser primaria ou resultante de anormalidades organicas ou funcionais musculo-esqueleticas, neurogenicas, viscerais e ou...
Subject(s)
Humans , Pain , Myofascial Pain Syndromes/etiology , Pain , Diagnosis, Differential , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/epidemiology , Myofascial Pain Syndromes/physiopathologyABSTRACT
Dor e comum em todas as faixas etarias pediatricas. E provavel que se manifeste tambem durante a vida fetal. Os instrumentos para avaliacao da dor em pediatria...
Subject(s)
Humans , Child , Adolescent , Pain , Child Behavior , Pain Measurement , Myofascial Pain Syndromes/diagnosisABSTRACT
Dor e comum nos membros superiores. Varias sao as razoes de sua ocorrencia quer em afeccoes musculo-esqueleticas, dermatologicas, vasculares, neuropaticas ou viscerais toracicas e cervicais concorrem...
Subject(s)
Humans , Shoulder Pain , Myofascial Pain Syndromes/diagnosis , Arm Injuries/diagnosis , Shoulder Pain , Joint Diseases , Diagnosis, Differential , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/physiopathologyABSTRACT
O presente trabalho tem como objetivo avaliar a eficácia de Placa Miorrelaxante Anterior no diagnóstico dos distúrbios craniomandibulares, bem como descrever sua técnica de confecçäo. Para tanto, realizou-se uma revisäo bibliográfica abrangendo desde a fisiopatologia dos distúrbios craniomandibulares, até aspectos concernentes às vantagens, desvantagens, indicaçöes, contra-indicaçöes e técnica de confecçäo da Placa Miorrelaxante Anterior. Concluiu-se que a Placa Miorrelaxante Anterior é eficaz no diagnóstico dos distúrbios craniomandibulares, quando usada corretamente
Subject(s)
Craniomandibular Disorders/diagnosis , Diagnosis, Oral , Occlusal Splints/statistics & numerical data , Myofascial Pain Syndromes/diagnosisABSTRACT
O objetivo deste artigo foi apresentar aspectos da síndrome dolorosa miofascial encontrados na literatura. Além dos conhecidos distúrbios dos tecidos moles, que incluem os efeitos de traumas, as inflamaçöes, fraqueza, tensäo e espasmos musculares, há uma entidade fisiopatológica descrita a alguns anos, que também atinge estes tecidos e é conhecida como síndrome dolorosa miofascial. Esta síndrome é descrita como sendo uma disfunçäo neuromuscular regional caracterizada pela presença de locais sensíveis em bandas musculares contraturadas/tensas que produzem dor referida em áreas distantes ou adjacentes. Inúmeros tratamentos têm sido propostos visando à remissäo do quadro clínico, entre eles: agulhamento seco, uso do spray de cloreto de etila ou fluormetano seguido por alongamento, injeçäo do ponto-gatilho com anestésicos ou soluçäo fisiológica salina também seguida por alongamento, compressäo isquêmica, técnicas de fricçäo profunda miofascial, TENS (estimulaçäo elétrica nervosa transcutânea), ultra-som, iontoforese, calor (seco e úmido), medicamentos analgésicos, antiinflamatórios ou relaxantes musculares, biofeedback. O objetivo desses tratamentos é a iliminaçäo do ponto gatilho, restauraçäo da amplitude de movimento e força muscular normais e sem dor. Além disso, é necessária uma educaçäo para o paciente prevenir e lidar com as recorrências e também bloquear os fatores precipitantes e/ou perpetuantes. Mas ainda há muitas divergências nos resultados de diferentes estudos, o que sugere uma análise crítica dos mesmos e uma maior preocupaçäo com as metodologias empregadas.
Subject(s)
Humans , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/therapy , Transcutaneous Electric Nerve Stimulation/methods , Fibromyalgia/diagnosis , Neurogenic Inflammation/physiopathology , Lasers/therapeutic use , Myofascial Pain Syndromes/etiology , Botulinum Toxins, Type A/therapeutic useABSTRACT
Aunque la demanda de atención está generalmente referida a ruidos en la región de la ATM, alteraciones en el movimiento mandibular y dolor (artralgia o mialgia), la necesidad y prioridad es el dolor, especialmente cuando deviene en cronicidad. Por su acción discapacitante. Uno de los enfoques más modernos en la avanzada del conocimiento es la llamada: modelo "diatesis orgánica-psicosomática" que utiliza la llamada Clasificación Biaxial, el eje 1 son las afecciones orgánicas de los desórdenes temporomandibulares y el eje II se refiere a los factores que actúan en el stress emocional, ya que ambos tipos de causas interactúan, el tratamiento debe realizarse en ambas áreas
Subject(s)
Facial Pain/diagnosis , Myofascial Pain Syndromes/diagnosis , Temporomandibular Joint Dysfunction Syndrome/diagnosis , Bruxism/diagnosis , Bruxism/therapy , Chronic Disease , Craniomandibular Disorders/diagnosis , Stress, Psychological/diagnosis , Stress, Psychological/therapy , Facial Pain/physiopathology , Facial Pain/therapy , Occlusal Splints , Dental Occlusion, Traumatic/physiopathology , Physical Therapy Specialty , Temporomandibular Joint Dysfunction Syndrome/therapy , Psychophysiologic Disorders/therapyABSTRACT
La existencia de una apófisis estiloides excesivamente larga es un hecho relativamente común. Correll y cols. (1) encuentran esta anomalía en el 18,2 porciento de una población sometida a un estudio con radiografías panorámicas de la región maxilofacial. Afortunadamente, sólo unos pocos de estos sujetos presentan síntomas atribuibles a esta alteración (2). Presentamos dos casos clínicos de algias cráneofaciales causadas por apófisis estiloides de gran tamaño y tratadas quirúrgicamente con resultados satisfactorios. Se revisa la literatura disponible, especialmente en lo relativo a los mecanismos etiopatogénicos implicados en estos raros síndromes dolorosos