Patients with Chronic Musculoskeletal Pain of 3-6-Month Duration Already Have Low Levels of Health-Related Quality of Life and Physical Activity.

PURPOSE OF REVIEW: To determine the level of physical activity and health-related quality of life in patients with chronic musculoskeletal pain of 3-6-month duration who have not been diagnosed or treated before. RECENT FINDINGS: Low levels of quality of life and physical activity have been reported for patients with musculoskeletal pain with a duration of longer than 6 months. This study assessed the levels of quality of life and physical activity at the beginning stage of chronic musculuskeletal pain. Prospective cross-sectional study carried out at a musculoskeletal and sports medicine clinic. Eighty-five consecutive patients with muskuloskeletal (i.e., spine, peripheral joint, muscle, tendon) pain of 3-6-month duration, not diagnosed before, age 14 and older, and from either gender were recruited. Short Form-36 Health Survey and International Physical Activity Questionnaire long were administered during assessments. Scores on subscales of Short Form-36 Health Survey and total scores of International Physical Activity Questionnaire were used as outcome measures. A total of 85 patients with an age range of 15-86 (51.22 ± 15.99) were enrolled. There were 23 male (27.06%) and 62 (72.94%) female subjects. Forty-six (54.11%) patients had three or less painful regions; 39 (45.88%) had more than three painful regions. Majority of the patients had low scores on both Short Form-36 Health Survey subscales and International Physical Activity Questionnaire. Forty-nine patients had low, 32 patients had moderate, and 4 patients had high level of physical activity. Overall, females had lower level of physical activity in all age groups. All patients had less than optimal scores on all subscales of Physical Health and Mental Health scales of the Short Form-36. The female patients had lower scores in role physical and bodily pain subscales of physical health. Patients with musculoskeletal pain duration of 3-6 months have low levels of physical activity and health-related quality of life at the time of their first evaluation.

Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle.

OBJECTIVE: To compare the effects of high-power pain threshold ultrasound (HPPTUS) therapy and local anesthetic injection on pain and active cervical lateral bending in patients with active myofascial trigger points (MTrPs) of the upper trapezius muscle. DESIGN: Randomized single-blinded controlled trial. SETTING: Physical medicine and rehabilitation department of university hospital. PARTICIPANTS: Subjects (N=49) who had active MTrPs of the upper trapezius muscle. INTERVENTIONS: HPPTUS or trigger point injection (TrP). MAIN OUTCOME MEASURES: Visual analog scale, range of motion (ROM) of the cervical spine, and total length of treatments. RESULTS: All patients in both groups improved significantly in terms of pain and ROM, but there was no statistically significant difference between groups. Mean numbers of therapy sessions were 1 and 1.5 in the local injection and HPPTUS groups, respectively. CONCLUSIONS: We failed to show differences between the HPPTUS technique and TrP injection in the treatment of active MTrPs of the upper trapezius muscle. The HPPTUS technique can be used as an effective alternative to TrP injection in the treatment of myofascial pain syndrome.

Effect of treatment on trigger points.

Patients with muscle pain complaints commonly are seen by clinicians treating pain, especially pain of musculoskeletal origin. Myofascial trigger points merit special attention because its diagnosis requires examinations skills and its treatment requires specific techniques. If undiagnosed, the patients tend to be overinvestigated and undertreated, leading to chronic pain syndrome. Patients with myofascial pain syndrome present primarily with painful muscle(s) and restricted range of motion of the relevant joint. Palpable painful taut bands are named trigger points and are the main and pathognomonic finding on physical examination. Eliciting local twitch response and referred pain requires experience and examination skills. It may be useful to classify the patient as having acute or chronic, and as having primary or secondary, myofascial pain so the decision on the details of treatment can be curtailed to the needs of each patient. Effective treatment modalities are local heat and cold, stretching exercises, spray-and-stretch, needling, local injection, and high-power pain threshold ultrasound.

The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation.

BACKGROUND: An accurate and specific diagnosis prevents the recurrences of low back pain and chronic spinal pain. The physical examination is the most useful tool to diagnosis. The examiner must aim to determine the exact tissue that pain arises from to make the specific diagnosis. Lumbar disc herniation is 1 disease that physical examination, symptoms, and findings on imaging technique do not always correlate with each other. The Straight Leg Raising (SLR) test has been used as the primary test to diagnosis lumbar disc herniations and found to have high correlation with findings on operation since its sensitivity is high in only disc herniations leading to root compression that may eventually need operation. More sensitive test, like the Slump, might be used in herniations in which the SLR is negative. The Slump test is really a variant of the SLR and the Lasègue's tests performed in the seated position and is a progressive series of maneuvers designed to place the sciatic nerve roots under increasing tension. At each step in the procedure, the patient informs the examiner what is being felt and whether radicular pain is produced. As a result, the Slump test applies traction to the nerve roots by incorporating spinal and hip joint flexion into the leg raising and would warn the examiner of the presence of nerve root compression when there is a negative SLR test. OBJECTIVES: This study measured the sensitivity and specificity of the Slump test and compare it with the SLR test in patients with and without lumbar disc herniations. METHODS: A prospective case control study of 75 patients with complaints suggestive of lumbar disc herniation was carried out in the outpatient clinics of the neurosurgery department of a state teaching hospital. Seventy-five referred or self-admitted patients with low back, leg, or low back and leg pain who had results of magnetic resonance imaging (MRI) of the lumbar spine were included in the study. Thirty-eight patients had signs of herniation demonstrated by MRI. Control patients (n = 37) had no disc bulges or herniations on MRI. Both the Slump and SLR tests were performed during the assessment of all the patients by the second author. The MRI results were assessed and recorded by the first author. RESULTS: The Slump test was found to be more sensitive (0.84) than the SLR (0.52) in the patients with lumbar disc herniations. However, the SLR was found to be a slightly more specific test (0.89) than the Slump test (0.83). CONCLUSION: The Slump test might be used more frequently as a sensitive physical examination tool in patients with symptoms of lumbar disc herniations. In contrast, owing to its higher specificity, the SLR test may especially help identify patients who have herniations with root compression requiring surgery.

High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study.

OBJECTIVE: To study what effects a high-power, pain-threshold, static ultrasound technique applied to acute myofascial trigger points of the upper trapezius has on pain and on active cervical lateral bending. DESIGN: Double-blind randomized trial. SETTING: Physical therapy unit of a private general hospital. PARTICIPANTS: Seventy-two adults with acute pain on 1 side of the neck, admitted to the outpatient unit during 1999 and 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Visual analog scale and goniometric measurement of active lateral bending of the neck performed daily after treatment sessions and length of treatment (number of therapy sessions). RESULTS: High-power ultrasound applied to the trigger points before stretching the muscle was more effective (P<.05) than conventional ultrasound, and it also significantly (P<.001) decreased the length of therapy. CONCLUSIONS: High-power, pain-threshold, static ultrasound technique may be considered in the treatment of patients with acute myofascial pain syndrome, with the understanding that this technique demands more concentration and communication between the patient and the therapist.