ABSTRACT
Background: Cough variant asthma (CVA) is a chronic inflammatory airway disease characterized by airway hyper-responsiveness (AHR), of which cough is the only symptom. The cough is a result of the contraction of the vocal cords, diaphragm, sternocleidomastoid muscle, and other respiratory related muscles caused by the AHR. Long-term chronic coughing can lead to repetitive contraction and chronic strain of the muscles involved in the head and neck, ultimately contributing to the formation of latent myofascial trigger points (MTrPs). In turn, latent MTrPs can also irritate or compress the nerves around them, triggering cough. The date indicated that latent MTrPs can induce autonomic phenomena and are effective in allergic rhinitis. But their roles in asthma are unclear. In this article, the efficacy and safety of latent MTrPs injection therapy in CVA were investigated. Methods: This randomized controlled trial was conducted with 110 patients. Patients were assigned to the intervention or control group in a 1:1.5 ratio. Intervention group (n = 44): single injection therapy with latent MTrPs. Control group (n = 66): budesonide-formoterol plus montelukast for 8 weeks. During the 36-week follow up period, the recurrence rate at week 36, cough visual analog scale (VAS), ACT (asthma control test)-scores, ACQ5 (asthma control questionnaire)-scores, AQLQ (asthma quality of life questionnaire)-scores, proportion of using rescue medication, and adverse events were evaluated. Results: The recurrence rate at week 36 was lower in the intervention group than in the control group (36 weeks, 5.0 vs. 34.55%, p = 0.001). There were significant differences between groups in change from baseline to 36 weeks in VAS [36 weeks, 1.70 (1.49) vs. 3.18 (2.04), p < 0.001]; ACT-score [36 weeks, 21.38 (2.65) vs. 18.53 (3.00), p < 0.001]; ACQ5-score [36 weeks, 0.85 (0.55) vs. 1.52 (0.62), p < 0.001]; AQLQ-score [36w, 174.40 (18.22) vs. 151.69 (24.04), p < 0.001]; proportion of using rescue medication (36 weeks, 5.0 vs. 29.1%, p = 0.003). Fewer adverse events occurred in the two groups. Conclusion: Latent myofascial trigger points injection therapy provided long-acting, practical, short treatment duration and safety methods for CVA. Clinical Trials Registration: http://www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry Center, ChiCTR2100044079.
ABSTRACT
Background: Myofascial trigger points (MTrPs) injection has been effectively used for the management of chronic painful diseases. Latent MTrPs can induce autonomic nerve phenomena. In our clinic, we observed that allergic rhinitis (AR) symptoms significantly improved when latent MTrPs injection was performed for migraine. Objective: To compare the efficacy and safety between latent MTrPs injection and sublingual immunotherapy (SLIT) in patients with persistent, moderate to severe AR. Methods: This randomized controlled trial was conducted with 112 patients with AR. Patients were randomized to receive SLIT (n = 56) or latent MTrPs injection. Total nasal symptom score (TNSS, n = 56), nasal symptoms, medication days, and adverse events were evaluated during the 9 months follow-up period after treatment in both groups. Results: Latent MTrPs injection significantly reduced TNSS to a greater level from baseline (from 8.36 ± 1.96 to 4.43 ± 2.18) than SLIT (from 8.66 ± 2.31 to 7.80 ± 2.47) at week 1 (P < 0.001), and sustained the improvement in symptoms throughout to month 9. Latent MTrPs showed statistically significant differences vs. SLIT for the TNSS reduction both at month 2 (6.59 ± 2.37 vs. 2.64 ± 2.38; p < 0.001) and month 3 (4.59 ± 2.77 vs. 2.62 ± 2.43; p <0.001). Latent MTrPs also showed a better improvement in the onset time of efficacy compared with SLIT. Adverse reactions were few and non-serious in both treatment groups. Conclusions: Latent MTrPs injection significantly improved symptoms and decreased symptom-relieving medication use in patients with AR and was well tolerated. Clinical Trials Registration: Chinese Clinical Trial Registry, ChiCTR1900020590. Registered 9 January 2019, http://www.chictr.org.cn/index.aspx.
ABSTRACT
BACKGROUND: Myofascial pain syndrome (MPS) is an important clinical condition that is characterized by chronic muscle pain and a myofascial trigger point (MTrP) located in a taut band (TB). Previous studies showed that EphrinB1 was involved in the regulation of pathological pain via EphB1 signalling, but whether EphrinB1-EphB1 plays a role in MTrP is not clear. METHODS: The present study analysed the levels of p-EphB1/p-EphB2/p-EphB3 in biopsies of MTrPs in the trapezius muscle of 11 MPS patients and seven healthy controls using a protein microarray kit. EphrinB1-Fc was injected intramuscularly to detect EphrinB1s/EphB1s signalling in peripheral sensitization. We applied a blunt strike to the left gastrocnemius muscles (GM) and eccentric exercise for 8 weeks with 4 weeks of recovery to analyse the function of EphrinB1/EphB1 in the muscle pain model. RESULTS: P-EphB1, p-EphB2, and p-EphB3 expression was highly increased in human muscles with MTrPs compared to healthy muscle. EphB1 (r = 0.723, n = 11, P < 0.05), EphB2 (r = 0.610, n = 11, P < 0.05), and EphB3 levels (r = 0.670, n = 11, P < 0.05) in the MPS group were significantly correlated with the numerical rating scale (NRS) in the MTrPs. Intramuscular injection of EphrinB1-Fc produces hyperalgesia, which can be partially prevented by pre-treatment with EphB1-Fc. The p-EphB1 contents in MTrPs of MPS animals were significantly higher than that among control animals (P < 0.01). Intramuscular administration of the EphB1 inhibitor EphB1-Fr significantly suppressed mechanical hyperalgesia. CONCLUSIONS: The present study showed that the increased expression of p-EphB1/p-EphB2/p-EphB3 was related to MTrPs in patients with MPS. This report is the first study to examine the function of EphrinB1-EphB1 signalling in primary muscle afferent neurons in MPS patients and a rat animal model. This pathway may be one of the most important and promising targets for MPS.
