Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain

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.

Síndrome de dolor miofascial / The myofascial pain syndrome

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)

The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome / Efetividade do kinesio taping na dor e incapacidade na síndrome dolorosa miofascial cervical

Abstract Objective: The aim of this study was to investigate the effectiveness of Kinesio Taping and sham Kinesio Taping on pain, pressure pain threshold, cervical range of motion, and disability in cervical myofascial pain syndrome patients (MPS). Methods: This study was designed as a randomized, double-blind placebo controlled study. Sixty-one patients with MPS were randomly assigned into two groups. Group 1 (n = 31) was treated with Kinesio Taping and group 2 (n = 30) was treated sham taping five times by intervals of 3 days for 15 days. Additionally, all patients were given neck exercise program. Patients were evaluated according to pain, pressure pain threshold, cervical range of motion and disability. Pain was assessed by using Visual Analog Scale, pressure pain threshold was measured by using an algometer, and active cervical range of motion was measured by using goniometry. Disability was assessed with the neck pain disability index disability. Measurements were taken before and after the treatment. Results: At the end of the therapy, there were statistically significant improvements on pain, pressure pain threshold, cervical range of motion, and disability (p < 0.05) in both groups. Also there was a statistical difference between the groups regarding pain, pressure pain threshold, cervical flexion-extension (p < 0.05); except cervical rotation, cervical lateral flexion and disability (p > 0.05). Conclusion: This study shows that Kinesio Taping leads to improvements on pain, pressure pain threshold and cervical range of motion, but not disability in short time. Therefore, Kinesio Taping can be used as an alternative therapy method in the treatment of patients with MPS.

Resumo Objetivo Investigar a eficácia do kinesio taping e do taping placebo sobre a dor, limiar de dor à pressão, amplitude de movimento cervical e incapacidade em pacientes com síndrome dolorosa miofascial (SDM) cervical. Métodos: Ensaio clínico randomizado duplo-cego controlado por placebo. Foram alocados em dois grupos, aleatoriamente, 61 pacientes com SDM. O grupo 1 (n = 31) foi tratado com kinesio taping e o grupo 2 (n = 30) foi tratado com taping placebo cinco vezes em intervalos de três dias, durante 15 dias. Além disso, todos os pacientes foram submetidos a um programa de exercícios para o pescoço. Os pacientes foram avaliados em relação à dor, ao limiar de dor à pressão, à amplitude de movimento cervical e à incapacidade. A dor foi avaliada com a escala visual analógica, o limiar de dor à pressão foi medido com um algômetro e a amplitude de movimento cervical ativa foi mensurada com a goniometria. A incapacidade foi avaliada com o Neck Pain Disability Scale. As mensurações foram feitas antes e depois do tratamento. Resultados: No fim do tratamento, houve melhoria estatisticamente significativa na dor, no limiar de dor à pressão, na amplitude de movimento cervical e na incapacidade (p < 0,05) em ambos os grupos. Também houve uma diferença estatisticamente significativa entre os grupos em relação à dor, ao limiar de dor à pressão e à flexão-extensão cervical (p < 0,05); não houve diferença na rotação cervical, flexão lateral cervical e incapacidade (p > 0,05). Conclusão: O kinesio taping leva à melhoria na dor, no limiar de dor à pressão e na amplitude de movimento cervical, mas não na incapacidade em um curto período. Portanto, o kinesio taping pode ser usado como um método de terapia opcional para o tratamento de pacientes com SDM.

Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain

ABSTRACT Background Dry needling (DN) and percutaneous electrical nerve stimulation (PENS) are widely used techniques in the treatment of myofascial pain. Objective To investigate the immediate and short-term effects of the combination of DN and PENS compared to DN alone on the upper trapezius muscle. Method This is a 72-hour follow-up single-blinded randomized controlled trial. Sixty-two volunteer patients with chronic myofascial neck pain with active Myofascial Trigger Points (MTrPs) in the upper trapezius muscle were recruited. Randomization was performed, and 31 patients received DN treatment (DN group) and 31 received DN and PENS (DN+PENS group). The primary outcomes were neck disability index (NDI) and visual analog scale for pain for both post-needling soreness (PNS) and neck pain intensity (NPI). Pressure pain threshold (PPT) and cervical range of motion (CROM) were the secondary outcomes. Results We detected between-group differences in NPI and PNS in favor of the DN+PENS group immediately after treatment. No between-group differences in NDI were observed. Conclusion PENS application after dry needling treatment is more effective than dry needling alone for decreasing soreness in the short term and improving neck pain intensity immediately in patients with myofascial chronic neck pain.

Reliability of different methodologies of infrared image analysis of myofascial trigger points in the upper trapezius muscle

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. .

Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial

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. .

Fisiopatología del síndrome miofascial ¿qué sustenta la terapéutica actual? / Pathophysiology of myofascial syndrome: what sustains the current therapeutic?

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...

Eficácia da desativação dos pontos-gatilho miofasciais para o controle do zumbido / Efficacy of myofascial trigger point deactivation for tinnitus control

Dor crônica nas imediações do ouvido pode influenciar o zumbido. OBJETIVO: Investigar a eficácia da desativação de pontos-gatilho miofasciais na melhora do zumbido. MÉTODO: Ensaio clínico randomizado com 71 pacientes com zumbido e síndrome dolorosa miofascial. O Grupo Experimental (n = 37) foi submetido a 10 sessões de desativação dos pontos-gatilho miofasciais e o Grupo Controle (n = 34), a 10 sessões de desativação placebo. RESULTADOS: O tratamento do Grupo Experimental foi eficaz para o controle do zumbido (p < 0,001). Houve associação entre as melhoras de dor e zumbido (p = 0,013) e entre os lados da orelha com pior zumbido e do corpo com mais dor (p < 0,001). A presença de modulação (aumento ou diminuição) temporária do zumbido durante a palpação inicial dos pontos foi frequente em ambos os grupos, mas a diminuição temporária foi associada à melhora persistente do zumbido ao fim do tratamento (p = 0,002). CONCLUSÃO: Além da avaliação médica e audiológica, os pacientes com zumbido devem ser avaliados para: 1) presença de dor miofascial próxima à orelha; 2) lateralidade entre ambos os sintomas; 3) diminuição temporária do zumbido durante a palpação do músculo dolorido. O tratamento deste subgrupo de pacientes pode ter melhor prognóstico que os demais.

Chronic pain in areas surrounding the ear may influence tinnitus. OBJECTIVE: To investigate the efficacy of myofascial trigger point deactivation for the relief of tinnitus. METHOD: A double-blind randomized clinical trial enrolled 71 patients with tinnitus and myofascial pain syndrome. The experimental group (n = 37) underwent 10 sessions of myofascial trigger point deactivation and the control group (n = 34), 10 sessions with sham deactivation. RESULTS: Treatment of the experimental group was effective for tinnitus relief (p < 0.001). Pain and tinnitus relieves were associated (p = 0.013), so were the ear with worst tinnitus and the side of the body with more pain (p < 0.001). The presence of temporary tinnitus modulation (increase or decrease) upon initial muscle palpation was frequent in both groups, but its temporary decrease was related to the persistent relief at the end of treatment (p = 0.002). CONCLUSION: Besides medical and audiological investigation, patients with tinnitus should also be checked for: 1) presence of myofascial pain surrounding the ear; 2) laterality between both symptoms; 3) initial decrease of tinnitus during muscle palpation. Treating this specific subgroup of tinnitus patients with myofascial trigger point release may provide better results than others described so far.

Síndrome dolorosa pós-laminectomia: estudo descritivo da abordagem terapêutica em 56 pacientes / Failed back surgery pain syndrome: therapeutic approach descriptive study in 56 patients

OBJETIVO: Os autores apresentam os resultados da avaliação clínica e acompanhamento de 56 pacientes com diagnóstico de síndrome dolorosa pós-laminectomia lombar. MÉTODOS: Estudo descritivo, prospectivo realizado no período de um ano. Neste estudo foram avaliados 56 pacientes caracterizados com síndrome dolorosa pós-laminectomia lombar em nossa instituição. As idades variaram de 28 a 76 anos (média de 48,8 ± 13,9 anos). Avaliação da dor com Escala Visual e Analógica (EVA). RESULTADOS: A dor pós-operatória foi mais intensa (8,3, média de EVA) que a pré-operatória (7,2). Síndrome dolorosa miofascial (SDM) foi diagnosticada em 85,7 por cento dos pacientes, anormalidades neuropáticas associadas ou não à SDM em 73,3 por cento. O tratamento farmacológico associado à medicina física proporcionou melhora de mais de 50 por cento da dor em 57,2 por cento dos casos, a infiltração dos pontos-gatilho miofasciais em 60,1 por cento e a infusão de morfina com lidocaína no compartimento epidural lombar em 69,3 por cento dos casos refratários. CONCLUSÃO: Nos pacientes com síndrome pós-laminectomia, a dor pós-operatória foi mais intensa que a dor pré-operatória da hérnia de disco. Um componente miofascial foi verificado na maioria dos doentes.

OBJECTIVE: The authors show the clinical evaluation and follow-up results in 56 patients diagnosed with a failed back surgery pain syndrome. METHODS: Descriptive and prospective study conducted over a one-year period. In this study, 56 patients with a failed back surgery pain syndrome were assessed in our facility. The age ranged from 28 to 76 years (mean, 48.8 ± 13.9 years). The pain was assessed through a Visual Analog Scale (VAS). RESULTS: Postoperative pain was more severe (mean VAS score 8.3) than preoperative pain (7.2). Myofascial pain syndromes (MPS) were diagnosed in 85.7 percent of patients; neuropathic abnormalities associated or not with MPS were found in 73.3 percent. Drug therapy associated with physical medicine treatment provided > 50 percent pain improvement in 57.2 percent of cases; trigger point injection in 60.1 percent, and epidural infusion of morphine with lidocaína in 69.3 percent of refractory cases. CONCLUSION: In patients with a post-laminectomy syndrome, postoperative pain was more severe than preoperative pain from a herniated disk. A miofascial component was found in most patients.

Angioma em tufo e síndrome dolorosa miofascial / Tufted angioma and myofascial pain syndrome

O Angioma em tufo é considerado um raro tumor vascular cutâneo adquirido. Caracteriza-se por máculas purpúrico-violáceas, dolorosas que podem evoluir para placas com pápulas angiomatosas. Tem natureza benigna, mas o envolvimento extenso é comum, gerando alteração funcional do membro afetado em caso de dor. Os autores relatam um caso de angioma em tufo associado à síndrome dolorosa miofascial, em que o elemento predisponente foi a presença deste tumor desde a infância. A dor local prejudicou a utilização da musculatura e possibilitou o surgimento da síndrome relatada. A realização de bloqueio anestésico de pontos-gatilhos no membro afetado, levou à melhora total dos sintomas.

Tufted angioma is a rare acquired vascular tumor. It is characterized by painful purplish macules that may progress to plaques containing angiomatous papules. The condition is benign; however, it often affects extensive areas of the skin, leading to functional disability of the affected limb if painful. The present report describes a case of a tufted angioma associated with myofascial pain syndrome in which the predisposing element was the presence of this tumor since childhood. Pain at the site of the lesion affected muscle use and led to the onset of the associated syndrome. Complete relief from symptoms was achieved by blocking the trigger points of the affected limb with anesthesia.

Avaliacao funcional do doente com dor cronica / Functional evaluation of chronic pain patients

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...

Fisiopatologia da dor musculo-esqueletica / Physiopatology of the muscleskeletal pain

Dor decorrente das afeccoes musculo-esqueleticas e muito frequente em todas as faixas etarias. Musculos, fascias musculares, articulacoes, ligamentos, tendoes, periosteo, bursas sinoviais e enteses sao ricamente inervados, o que justifica a ocorrencia de dor quando...

Sindrome dolorosa miofascial / Myofascial pain syndrome

A sindrome dolorosa miofascial (SDM) e condicao comum. Pode ser primaria ou resultante de anormalidades organicas ou funcionais musculo-esqueleticas, neurogenicas, viscerais e ou...

Sindrome fibromialgica / Fibromyalgic syndrome

Fibromialgia caracteriza-se pela ocorrencia de dor generalizada referida na musculatura na ausencia de anormalidades evidenciadas aos exames complementares. Ocorrencia mais frequentemente no...

Dor em afeccoes reumatologicas / Pain in rheumatology

Dores musculo-esqueletica sao comuns. Os autores apresentam descricoes simples e objetivos das mais prevalentes condicoes reumatologicas associadas a dor. Destacam...

Dolor orofacial: Características. Neurofisiología: mecanismos moduladores. Su vinculación con alteraciones del movimiento mandibular / Orofacial pain: Characteristics. Neurophysiology: modulating mechanisms. Its association with mandibular movement alterations

El dolor es el síntoma más habitual en la consulta odontológica y el factor causal de mayor importancia y frecuencia para que el paciente acuda en busca de asistencia. En los últimos años los neurólogos han hecho importantes avances en el estudio de los aspectos neurofisiológicos del dolor, referidos fundamentalmente a los mecanismos y sustancias que regulan su persistencia e intensidad. Lamentablemente gran parte de la información llega muy escasamente al odontólogo. Es interesante señalar también que tanto en el nivel pregrado como en el de posgrado son muy escasos los cursos con contenidos referidos a este tema. El objetivo de este trabajo es brindar una revisión básica y actualizada sobre distintos aspectos del síntoma dolor, a saber: nocicepción y dolor, diferencias conceptuales. Características: tipo de dolor: crónico-agudo, superficial, heterotópico. Neurofisiología: vías de conducción. Mecanismos modulares inhibitorios y de sensibilización, metaméricos y centrales. Sustancias que lo provocan: fenómenos de hiperalgesia, neuroplasticidad y persistencia del síntoma. Características del dolor inflamatorio, sensibilización periférica. El factor psicológico como modulador intrínseco del dolor vinculado al sufrimiento. Aspectos cognitivos, afectivo-emocionales y conductuales. Por último, algunos conceptos referidos a la posible asociación del dolor con alteraciones del movimiento mandibular

Comparaçäo clínica e funcional de pacientes com fibromialgia e dor miofascial / Clinical and functional comparison of patients with fibromyalgia and mioyfalcial pain

Objetivo: Estabelecer as diferenças e semelhanças entre mulheres com fibromialgia (FM) e mulheres com dor miofascial regional (DM) do ponto de vista clínico, funcional e qualidade de vida. Material e métodos: Estudo transversal de 26 mulheres que preencheram os critérios de classificaçäo de fibromialgia da American College of Rheumatology e 18 mulheres com dor músculo-esquelética regional associada à pontos-gatilho dolorosos na área afetada pela dor. Foram analisados estatisticamente pela disciplina de Bioestatística da Faculdade os seguintes parâmetros:intensidade da dor (escala analógica numérica de dor-0 a 10-END); intensidade de fadiga (escala analógica numérica fadiga-0 a 10-END);no de pontos dolorosos/gatilho; capacidade funcional (Health Assessment Questionnaire - 0 a 3 - HAQ); qfualidade do sono (Post-sleep Inventory - 0 a 120 - PSI); intensidade de sintomas depressivos (Bech Depression Inventory - 0 a 60 -BDI); e qualidade de vida global (Fibromyalgia Impacti Questionnaire - 0 a 100 - FIQ). Conclusöes: As semelhanças observadas entre pacientes com FM e DM säo: dados demográficos, intensidade da dor e fadiga, presença de fatores desencadeantes e nível de atividade física. As diferenças observadas foram: escolaridade, capacidade funcional, qualidade do sono, intensidade da depressäo e qualidade de vida.

Myofascial pain syndromes--the great mimicker

Five myofascial pain syndromes, some mimicking more serious diseases, have been presented. They were diagnosed as and treated for: headache, shoulder bursitis, lumbar herniated disc with radiculopathy, angina pectoris and appendicitis. An understanding of these pain problems, produced from trigger points in muscles and ligaments, is important in order to differentiate myofascial pain syndromes from more dangerous diseases and to avoid unnecessary and expensive diagnostic procedures

Síndrome mio-fascial: abordagem fisiátrica / Myofascial syndrome: physiatric approach

A síndrome mio-fascial é a causa mais comum de dor músculo-esquelética na prática médica. Os pontos de gatilho em áreas de representaçäo da musculatura säo aspectos clássicos na apresentaçäo desta afeccäo. A fisipatologia desta entidade é incerta. Os métodos terapêuticos correntes säo eficazes em pequeno número de casos. Os métodos de medicina física e de prevençäo da progressäo da síndrome já instalada säo medidas adequadas para seu tratamento

Orofacial manifestations of myofascial pain dysfunction syndrome amongst dental patients.

Orofacial manifestations in cases of Myofascial Pain Dysfunction Syndrome (MPD) diagnosed amongst 71 Dental patients were studied in detail. Findings of this study show that the chief complaint and associated orofacial manifestations of MPD are related to muscular hypertonicity. Stressful situations may produce muscular hypertension, which leads to muscle tenderness as a symptom of over work and fatigue. MPD may be considered a psycosomatic disease.