The effect of combining physiotherapy with dry needling in patients with cervical spondylosis: A randomized controlled trial.

BACKGROUND: There are no data on the additional contribution of dry needling (DN) for trigger points (TPs) accompanying patients with cervical spondylosis (CS). OBJECTIVE: To analyse the contribution of DN applied to concomitant active TPs in the upper trapezius muscle on the treatment outcomes of physiotherapy in CS. METHODS: In this prospective randomized controlled study, 70 patients with CS and active TPs in the upper trapezius muscle were included. The first group received physiotherapy for 5 days per week for 3 weeks. The second group received DN with the same program. All participants were evaluated before treatment (day 0) and at the end of treatment (day 21) in terms of pain, functional status, quality of life, anxiety/depression scores, and number of TPs. RESULTS: 33 patients in the first group and 32 patients in the second group completed the study. While the change over time was found significant in all variables, the change was not different between groups. The group-time interaction effect was not found to be statistically significant in any variable. Percentage changes of all variables were similar between the groups. CONCLUSION: DN treatment added to the physiotherapy did not contribute to recovery in patients with CS.

Association between myofascial trigger point therapy and conditioned pain modulation.

INTRODUCTION: Myofascial trigger point therapy (MTrP) is a widely used therapeutic approach, although the underlying mechanisms remain unclear. Mechanisms discussed include peripheral involvement of muscles as well as central pain modulating processes such as the conditioned pain modulation (CPM). The aim of this study was to investigate whether the analgesic response of MTrP and the analgesic response of CPM correlate in asymptomatic participants in order to identify shared underlying mechanisms of MTrP and CPM. METHOD: Both, CPM and MTrP protocols consisted of heat-based test stimuli (heat pain thresholds before and after the intervention) and pressure-based (conditioning) stimuli. Asymptomatic participants (n = 94) were randomly assigned to receive either mild, intense or no pressure stimuli (between-group design) to both the fingernail and the MTrP of the infraspinatus muscle (within-group design). Pressure stimuli at both locations (fingernail, MTrP) were applied with a pressure algometer for 120 s and continuously adjusted to maintain a constant pain intensity of mild or intense pain. All thermal stimuli were applied on the lower leg with a thermal stimulator. RESULTS: A significant correlation was shown between the analgesic effect of CPM and MTrP therapy for mild (r = 0.53, p = 0.002) and intensive stimuli (r = 0.73, p < 0.001). 17.3% of the variance of the MTrP effect were explained by CPM after mild stimulation, and 47.1% after intense stimulation. Pain-related characteristics did not explain the variance within the analgesic response using a regression analysis. CONCLUSIONS: Between the analgesic responses following MTrP and CPM paradigms, a moderate to strong correlation was observed, suggesting shared underlying mechanisms.

Efficacy of capacitive-resistive therapy on the treatment of myofascial pain - A randomized control trial.

BACKGROUND: Myofascial pain syndrome is a painful musculoskeletal condition with muscle spasm, referred pain, stiffness, restricted range of motion. Capacitive-resistive diathermy heats deep tissues by transferring energy through radiofrequency waves. Although this modality is used to treat various musculoskeletal disorders, there is no specific data on myofascial trigger points. Thus, we aimed to evaluate the effectiveness of capacitive-resistive diathermy on the myofascial trigger points. METHODS: Thirty-six volunteers with active myofascial trigger points were included. Patients were randomly and equally allocated into two groups. Group-1 is the capacitive-resistive diathermy treatment group; Group-2 is the placebo capacitive-resistive diathermy (PG). Visual analog scale (VAS), pain pressure threshold (PPT), neck disability index (NDI), neck range of motion (nROM), Short form-36 (SF-36) were used as outcomes before and after the intervention. RESULTS: In both groups, VAS, PPT, NDI score significantly improved within the groups (p < 0.05). The CRG showed a statistically significant improvement in nROM for flexion, extension, and rotation (p < 0.05). However, ROM increase in CRG is not superior to PG (p > 0.05). CONCLUSIONS: There was no significant difference between the two groups. We thought positive results in the PG might attributed to doing exercise. As a result, capacitive-resistive diathermy is not superior to exercise, but can be used as an adjuvant modality in myofascial trigger points treatment.

Characteristics of patients with myofascial pain syndrome of the low back.

The objective of this study is to determine characteristics of patients with myofascial pain syndrome (MPS) of the low back and the degree to which the low back pain in the patients examined can be attributed to MPS. Twenty-five subjects with myofascial trigger point(s) [MTrP(s)] on the low back participated in this cross-sectional study. The location, number, and type of selected MTrPs were identified by palpation and verified by ultrasound. Pain pressure threshold, physical function, and other self-reported outcomes were measured. Significant differences were found in Group 1 (Active), 2 (Latent), 3 (Atypical, no twitching but with spontaneous pain), and 4 (Atypical, no twitching and no spontaneous pain) of participants in the number of MTrPs, current pain, and worst pain in the past 24 h (p = .001-.01). There were interaction effects between spontaneous pain and twitching response on reports of physical function, current pain, and worst pain (p = .002-.04). Participants in Group 3 reported lower levels of physical function, and higher levels of current pain and worst pain compared to those in Group 4. Participants in Group 1 and 2 had similar levels of physical function, current pain, and worst pain. The number of MTrPs is most closely associated with the level of pain. Spontaneous pain report seems to be a decisive factor associated with poor physical function; however, twitching response is not.

Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report.

Key Clinical Message: The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS. Abstract: Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.

Temporal aneurysms and migraine surgery.

The present study reports two cases of chronic migraines associated with superficial temporal artery aneurysms. The patients received aneurysm's ligation, with no other surgical maneuvers. In the six months following surgery, both patients were disease-free and did not experience any migraine attacks. Evidence-based medicine ranking: Level V.

Efficacy of Medical Ozone for Treatment of Chronic Musculoskeletal Pain with Abnormal Mitochondrial Redox State: Prospective Randomized Clinical Trial.

BACKGROUND: Chronic primary musculoskeletal pain is multifaceted and 20% of the adult population lives with severe chronic pain and experience symptoms such as intense pain, depression, weakness, sleep problems, decreased quality of life and decreased emotional well-being. OBJECTIVES: This paper studies the efficacy of trigger point injections with ozone compared to standard steroid injection or combination therapy for the treatment of chronic musculoskeletal pain in patients with abnormal mitochondrial redox state. STUDY DESIGN: This is a prospective randomized clinical study conducted with 51 patients experiencing chronic musculoskeletal pain. SETTING: Medical Research Institute Hospital, Alexandria University. METHODS: By computer-generated random numbers the 51 patients were divided into 3 groups. Group A (17 patients) received ozone injection, group B (17 patients) received betamethasone injection and group C (17 patients) received combined ozone and betamethasone injections. The groups were compared based on the intensity of pain and correction of mitochondrial redox state of the patients. RESULTS: Three days after intervention, the visual analog scale (VAS) scores reported by patients were lower in group A compared to group B (with a mean difference 1.27, 95% confidence interval (CI) of 0.15-2.39 (P < 0.02). One and 3 weeks after intervention, VAS scores of patients were lower in groups A and C compared to group B. At one week the mean difference between A and B was 1.2, with a 95% CI of 0.15-2.25 (P < 0.02) and the mean difference between C and B was 1.73 with a 95% CI of 0.69-2.78 (P < 0.001). At 3 weeks the mean difference between A and B was 1.5 with a 95% CI of 0.2-2.87 (P < 0.01) and the mean difference between C and B was 2.27 with a 95% CI of 0.93-3.60 (P < 0.0001). The reduced/oxidized glutathione ratio after intervention was higher in groups A and C compared to group B (P > 0.008). The mitochondrial copy number was higher in group A compared to group B (P < 0.002). LIMITATION: This study didn't allow for the comparison of the experimental groups with a placebo or control group for musculoskeletal pain conditions in orderto establish the role of an abnormal mitochondrial redox state on the pathogenesis of patients from an ethical view. CONCLUSIONS: Ozone therapy or combined ozone and betamethasone treatment are  effective techniques for management of pain since it produced a significant reduction of muscle pain and increase of the pain free interval experienced by patients. Ozone therapy causes pain improvement which increases with time and it improves muscle oxygenation and mitochondrial function. TRIAL REGISTRATION: This study was approved by the Ethics Committee of Medical Research Institute (IORH: IOR 00088812) and was registered at the Pan African Clinical Trial Registry (www.pactr.org) under the identification number PACTR201908620943471. The registration this experiment started on 07/08/2019. This study's protocol followed the CONSORT guidelines and was performed under the relevant guidelines.

Immediate Effects of Instrument-Assisted Soft-Tissue Mobilization Versus Dry Needling on Trigger Point Pain and Tightness of Calf Muscles in Long-Distance Runners.

Introduction Muscle tightness is frequently identified as a potential precursor to muscle injuries. Reclaiming flexibility and enhancing range of motion (ROM) is crucial for preventing injuries and achieving improvements in performance. The present study examines the immediate effects of instrument-assisted soft-tissue mobilization (IASTM) and dry needling (DN) in reducing trigger point pain and calf tightness in long-distance runners. Methodology A total of 40 long-distance runners were recruited in the study (30 males and 10 females). The procedure was performed under the author's surveillance at the sports complex. These recruited players were placed into two groups: the IASTM (n=20) and the DN (n=20) group. The outcome measures used were the pressure algometer for assessing pain pressure threshold and the lunge test. An iPhone Measure app (Measure app, Apple App Store 2023) is used to assess ankle dorsiflexion ROM. The evaluation took place both prior to and immediately following the intervention and 48 hours after the intervention. Result The analysis within each group revealed a significant alteration in pain pressure threshold for both the IASTM and DN groups (p≤0.05), along with a relative enhancement in ankle dorsiflexion ROM observed in the IASTM group (p≤0.05). Between-group analysis revealed a notable difference with an effect size difference of Cohen's d=1.06 (large difference) in pain pressure threshold, d=0.21 (small difference) in lunge test, and d=0.57 (medium difference) in ankle dorsiflexion ROM. Conclusion The present study concludes that both groups, IASTM and DN, showed significant effects in improving pain pressure threshold in long-distance runners. However, DN showed better results. IASTM showed significant results in enhancing the ankle dorsiflexion ROM immediately. This implies that it can be used in conjunction with stretching to decrease pain and enhance flexibility, hence improving performance and preventing injuries.

Association between smartphone addiction and myofascial trigger points.

BACKGROUND: The purpose of this study was to clarify the relationship between smartphone addiction and miyafascial trigger points in university students. METHODS: A cross-sectional study of university students was conducted for the purpose of this study. The participants were assessed based on age, gender, dominant side, the amount of time they spent on their smartphones, the purpose of their use, and their posture. The Smartphone Addiction Scale Short Form (SAS-SF) was used to determine addictes and non-addicts. The cut-off value of SAS-SF is 31 and above for male and 33 and above for female. RESULTS: There were 136 participants in the study. The posture score for addicts and non-addicts ones was not significantly different (p > 0,05), but the number of trigger points, maximal bending posture and trigger points in the right levator scapula and right cervical erector muscles were significantly higher in the smartphone addict participants (p < 0,05). CONCLUSIONS: Smartphone addiction in university students is associated with postural changes and trigger points in the bilateral levator scapula and right cervical erector muscles. Public health programs should be developed to raise awareness about smartphone addiction, encourage screen breaks, and emphasize physical activity and exercise regularly.

Effect of Sympathetic Blockade on Spontaneous Discharge and the H-Reflex at Myofascial Trigger Points in Rats.

Purpose: Myofascial trigger points (MTrPs) are the main cause of myofascial pain syndrome (MPS), and patients with MPS also have symptoms of sympathetic abnormalities. Consequently, this study aimed to investigate the potential relationship between MTrPs and sympathetic nerves. Materials and Methods: Twenty-four seven-week-old male rats were randomly divided into four groups (six rats every group). Groups I and II were kept in normal condition (n=12), and groups III and IV underwent MTrPs modelling (n=12). After successful MTrPs modelling, differences in sympathetic outcomes between the MTrPs groups (III and IV) and non-MTrPs groups (I and II) were observed. Sympathetic blockade was then applied to groups III and I (n=12). Data were collected on peak inversion spontaneous potentials (PISPs) and the H-reflex-evoked electromyography during spontaneous discharge at the MTrPs before and after sympathetic blockade. Results: Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were significantly higher in the MTrPs group than in the non-MTrPs group (P<0.05). Compared with group I, group III had the PISPs potential lower wave amplitude, shorter duration and amplitude-to-duration ratio, and lower H latency and latency difference H-M (P<0.05). Compared with group IV, group III had the PISPs potential lower wave amplitude, duration, amplitude-to-duration ratio, M-wave latency, H maximum wave amplitude, and maximal wave amplitude ratio H/M (P<0.05). The changes before and after sympathetic blockade in the MTrPs group were significant, and the amplitude, duration, and amplitude-to-duration ratio of the PISPs potentials were lower after the blockade (P<0.05). Conclusion: MTrPs and sympathetic nerves interact with each other forming a specific relationship. MTrPs sensitize sympathetic nerves, and sympathetic nerve abnormalities affect local muscle myoelectric hyperactivity, leading to MTrPs. This finding is instructive for the clinical management of sympathetic disorders.

Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial.

Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.

Myofascial pain - A major player in musculoskeletal pain.

Myofascial pain is a soft tissue pain syndrome with local and referred musculoskeletal pain arising from trigger points. Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Myofascial pain can exist independently of other pain generators or can coexist with or is secondary to other acute and chronic painful musculoskeletal conditions. Myofascial pain is most effectively treated with a multimodal treatment plan including injection therapy (known as trigger point injections, physical therapy, postural or ergonomic correction, and treatment of underlying musculoskeletal pain generators. The objectives of this review are to outline the prevalence of myofascial pain, describe the known pathophysiology of myofascial pain and trigger points, discuss the clinical presentation of myofascial pain, and present evidence-based best practices for pharmacologic, non-pharmacologic, and interventional treatments for myofascial pain.

Comparing Myofascial Pain Syndrome Treatment with Dry Needling Versus Extracorporeal Shock Wave Therapy for Plantar Fasciitis on Pain and Function of the Heel.

The aim of this study was to compare the effects of dry needling (DN) and extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis (PF). The study included 55 patients with PF. The patients were randomly divided into 2 groups. The DN group applied 3 sessions of DN to the myofascial trigger points in the lower limb muscles. The ESWT group applied 3 sessions of ESWT to the plantar fascia. For clinical evaluation, we used a visual analog scale (VAS) (first step, rest, activity) and Foot Function Index (FFI) (pain, disability, activity). Assessments were done baseline, post-treatment first week, and fourth week. Maximum pain-free standing time (Max PfST) and maximum pain-free walking distance (Max PfWD) were recorded at baseline and post-treatment fourth week. In this study, we found significant improvement in VAS, FFI, Max PfST, and Max PfWD in both groups (p < .01). VAS-activity baseline-forth week change was significantly superior in the DN group compared to the ESWT group (p = .023). FFI-disability baseline-fourth week change was significantly superior in the DN group compared to the ESWT group (p = .048). There was no significant difference in other treatment-related changes between the groups (p > .05). However, VAS-rest baseline-fourth week change and FFI-pain baseline-fourth week change trended towards statistical significance between groups ((p = .056), (p = .052) respectively). This study showed that DN may be a good alternative treatment for patients with PF, with effects similar to or even superior to ESWT.

Effects of transcutaneous radiofrequency diathermy versus ultrasound on latent myofascial trigger points in the upper trapezius: A randomized crossover trial.

BACKGROUND: Currently, the use of radiofrequency diathermy for the treatment of neck pain is booming. OBJECTIVE: This study aimed to evaluate the clinical efficacy of Digital Capacitive Diathermy (DCD®) on stiffness, pain, cervical range of motion, and cervical disability and to compare it with ultrasound (US) in patients with latent myofascial trigger point (MTrP) in the upper trapezius. METHODS: Nineteen participants with latent MTrPs in the upper trapezius were included in the assessor-masked, randomized, clinical crossover trial. Subjects were exposed to both interventions: US and DCD® and treatment effectiveness was measured by myotonometric variables, pressure pain threshold (PPT), visual analog scale (VAS), cervical side-bending flexion ranges, and the neck disability index scale (NDI). RESULTS: There were no significant differences between US and DCD® interventions regarding changes in outcome measures. The US group achieved a statistically significant difference of 2.16 to 1.13 points (p= 0.005; r= 0.646) for the VAS. The DCD® intervention showed a statistically significant improvement of 1.11 points for the NDI at 1-week following intervention (95% CI 0.14-2.07; p= 0.27; d= 0.217). CONCLUSION: Our findings suggest that DCD® and US can both be considered effective modalities for the treatment of latent MTrPs, having a longer duration of action with DCD® therapy.

The effect of simultaneous administration of occipital nerve block and cervical myofascial trigger point injection (MTrPI) on headache parameters in chronic migraine patients.

BACKGROUND AND AIM: Peripheral myofascial mechanisms have been identified as contributors to migraine pathophysiology. The specific comorbid relationship between migraine and cervical trigger points may exacerbate the occurrence and severity of migraine attacks. Trigger point injections (TPIs) are frequently employed to address headaches and alleviate migraine symptoms. The current study explores the impact of concurrent myofascial trigger point injection (MTrPI) and occipital nerve block (greater occipital nerve block [GONB] + lesser occipital nerve block [LONB]) on the severity of headaches and the number of migraine attacks in individuals with chronic migraine (CM) and cervical myofascial trigger points (MTrPs), with a comparison of occipital nerve block alone (GONB + LONB). During trigger point examination and injection, trapezius, levator scapulae, splenius capitis, temporalis, and sternocleidomastoid muscles were targeted. We planned the treatment based on whether they were in the muscle groups we determined, rather than the number of trigger points. MATERIALS AND METHOD: This study enrolled 62 individuals experiencing CM with bilateral headache and cervical MTrP who sought care at the Algology Unit within the Departments of Neurology and Physical Therapy and Rehabilitation at Siirt Training and Research Hospital between 2020 and 2022. The CM cohort was stratified into two groups: group 1 received trigger point injections (TrPI), while group 2 underwent concurrent bilateral occipital nerve block (GONB + LONB) and TrPI. Both groups underwent three treatment sessions with bupivacaine 0.5% (1 ml = 5 mg) in weeks 1, 2, and 4. Visual analog scale (VAS) was used to measure the patients' pain intensity. The evaluation included the assessment of the monthly migraine frequency and visual analog scale (VAS) p score for pain before treatment (BT) and after treatment (AT), conducted at baseline and during follow-up visits. Analysis of the data was conducted utilizing IBM SPSS Statistics for Windows version 28.0 software. RESULTS: Among patients diagnosed with CM and MTrPs, 32 individuals (51.6%) underwent GONB and LONB, while 30 patients (48.4%) received simultaneous GONB, LONB, and cervical MTrPI. Within the entire sample, 51 participants (82.3%) were female, and 11 (17.7%) were male, with a mean age of 32.81 ± 10.75 years. With an average age of 32.81 ± 10.75 years, there was no statistically significant variance between the two groups (p = 0.516). Of the total cohort, 45 individuals (72.6%) reported experiencing headaches persisting for 12 months or longer. Among CM patients, 80% had active trigger points, while 20% had latent trigger points. No statistically significant difference was observed between the groups concerning TrPs (p = 0.158), and the distribution of TrPs was homogenous across the two groups. In group 1, the median (min-max) monthly frequency of migraines reduced from 18.5 days (range: 15.0 to 25.0 days) before treatment to 12.0 days (range: 7.0 to 17.0 days) after treatment (p = 0.000). In group 2, the median monthly frequency of migraines reduced from 16.5 days (range: 15.0 to 22.0 days) before treatment to 4.0 days (range: 2.0 to 8.0 days) after treatment (p = 0.000). The median (min-max) VAS score in group 1 was 8.0 (range: 5.0 to 9.0) before treatment, 4.0 (range: 2.0 to 6.0) at week 1, and 5.0 (range: 4.0 to 8.0) at week 4 (p = 0.000). In group 2, the median VAS score was 7.0 (range: 5.0 to 9.0) before treatment, 0.0 (range: 0.0 to 0.3) at week 1, and 2.0 (range: 0.0 to 0.3) at week 4 (p = 0.000). There were significant distinctions between the groups in terms of both the monthly count of migraine days and the severity of headaches (p = 0.000). CONCLUSION: The combination of repeated MTrPIs and ONB proves more effective than ONB alone in managing patients with CM and cervical MTrP. In patients with CM, performing TrPs examination and adding treatments for this may contribute to the treatment. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits.

Extracorporeal shockwave therapy of the perineum for male patients with chronic pelvic pain syndrome: a pilot study.

Background: Chronic pelvic pain syndrome (CPPS) is a complex condition that is often difficult to treat and may sometimes require a multidisciplinary team. Among the wide array of treatment options is extracorporeal shockwave therapy (ESWT). However, its role in CPPS remains controversial. The purpose of our study is to assess the efficacy and safety of ESWT of the perineum in male patients with CPPS. Methods: Fourteen patients aged between 21 and 85 years were recruited in this single-center, single-arm prospective trial from October 2018 to October 2020. ESWT was delivered to the perineum weekly for up to 8 weeks. Assessment was done via International Index for Erectile Function, International Prostate Symptom Score, King's Health Questionnaire, National Institutes of Health - Chronic Prostatitis Symptom Index, Visual Analogue Scale, Analgesic Questionnaire, and UPOINT (urinary symptoms [U], psychosocial dysfunction [P], organ-specific symptoms [O], infection-related symptoms [I], neurological/systemic conditions [N], tenderness of skeletal muscles [T]) phenotype system. The parameters are assessed before the start and end of treatment as well as at regular time points on follow-up appointments up to 20 weeks. Results: Thirteen patients completed the study. There was improvement in the Visual Analogue Scale pain score, Tenderness domain on UPOINT, King's Health Questionnaire, and National Institutes of Health - Chronic Prostatitis Symptom Index scores. In terms of erectile function, improvement in the erectile function domain of International Index for Erectile Function was observed. There was also significant improvement in lower urinary tract symptoms assessed on International Prostate Symptom Score. There were no adverse events reported post treatment and during the follow-up period. Conclusions: ESWT improved pain and quality of life of male patients with CPPS. It can be a safe and effective treatment modality in the armamentarium of CPPS.

Efficacy of trigger point injection therapy in noncardiac chest pain: A randomized controlled trial.

Objectives: This study aimed to compare the effects of trigger point injections and stretching exercises in patients with noncardiac chest pain (NCCP) associated with myofascial pain syndrome. Patients and methods: This prospective randomized controlled trial included 50 patients with noncardiac chest pain and trigger points in the pectoralis muscles between October 2019 and June 2020. The patients were randomly assigned to receive trigger point injections into the pectoralis muscles and exercise (n=25; 15 males, 10 females; mean age: 42.8±9.2 years; range, 25 to 57 years) or only perform exercise (n=25; 11 males, 14 females; mean age: 41.8±11.2 years; range, 18 to 60 years). The primary outcome was pain intensity at the first month and three months after the first treatment session, measured using the Visual Analog Scale from 0 to 100. The secondary outcome was the Nottingham Health Profile score. Results: Treatment with stretching exercises and trigger point injection resulted in significant pain reduction compared to stretching exercises alone, and the reduction was persistent at the three-month follow-up (p<0.001). A between-group comparison showed no significant difference in the Nottingham Health Profile (p=0.522). Complications related to the procedure or severe adverse events attributable to treatment were not reported. Conclusion: Trigger point injection combined with stretching exercises is an efficient treatment for noncardiac chest pain related to myofascial pain syndrome compared to exercise treatment alone.

Reliability of muscle stiffness measures in popliteus, medial and lateral gastrocnemius muscles by ultrasound shear wave elastography in participants with knee osteoarthritis accompanied by myofascial trigger points.

BACKGROUND: The objective of this investigation is to evaluate the consistency of intra-rater and inter-rater assessments utilizing ultrasound elastography to examine the muscle stiffness of the popliteus and gastrocnemius (medial and lateral heads) in patients with knee osteoarthritis accompanied by myofascial trigger points. METHODS: Thirty individuals with knee osteoarthritis accompanied by myofascial trigger points were assessed. Two examiners independently measured the muscle stiffness levels of the popliteus and gastrocnemius (medial and lateral heads) three times using ultrasound elastography in the first session. The second session was conducted one week later. RESULTS: In the initial test session, the mean shear modulus values for the popliteus and gastrocnemius (medial and lateral heads) muscles were measured as follows for tester 1 (12.75, 13.72, 14.13 kPa) and tester 2 (11.66, 12.81, 13.17 kPa). During the retest session, the previously measured variables by tester 1 and tester 2 yielded the following values: (12.61, 13.43, 14.26 kPa) and (11.62, 12.87, 13.30 kPa) respectively." Good to excellent intra-rater reliability (ICC = 0.912-0.986) and inter-rater reliability (ICC = 0.766-0.956) were reported for the shear moduli of the popliteus, medial and lateral gastrocnemius muscles. CONCLUSIONS: The assessment of muscle stiffness in the popliteus and gastrocnemius (medial and lateral heads) using ultrasound elastography is a reliable method in patients with knee osteoarthritis accompanied by myofascial trigger points.

Therapeutic Effects of Dry Needling on Lateral Epicondylitis: An Updated Systematic Review and Meta-analysis.

OBJECTIVE: To investigate the therapeutic effects of dry needling on lateral epicondylitis and identify a relatively more effective needling technique. DATA SOURCES: English databases (Pubmed, Web of Science, Scopus, EBSCO, ScienceDirect, Taylor & Francis, ProQuest, Cochrane, Ovid, and Embase) and Chinese databases (China National Knowledge Infrastructure, Wanfang, and VIP) were searched. STUDY SELECTION: This study included randomized controlled trials for comparing the effectiveness of dry needling with other treatment methods for lateral epicondylitis. The primary outcome measures were pain intensity and elbow disability, while the secondary outcome measures included grip strength and upper limb function. DATA EXTRACTION: Data extraction was performed by 2 researchers who used the Cochrane risk of bias analysis tool and the Physiotherapy Evidence Database checklist to assess the risk of bias and methodological quality of the included studies. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the quality of evidence. DATA SYNTHESIS: A total of 17 studies that involved 979 subjects were included in this research. Dry needling exhibited a significant advantage in improving pain intensity among patients with lateral epicondylitis within 1 week after treatment (mean difference [MD]=-0.95, 95% confidence interval [CI], -1.88 to -0.02). Within 1 week and in the follow-ups that exceeded 1 week, dry needling also demonstrated better improvement in elbow disability (<1 week: standardized mean difference [SMD]=-1.37, 95% CI, -1.88 to -0.86; ≥1 week: SMD=-1.32, 95% CI, -2.23 to -0.4) and grip strength (<1 week: SMD=0.27, 95% CI, 0.01 to 0.53; ≥1 week: SMD=0.45, 95% CI, 0.02 to 0.88). Trigger point dry needling with local twitch response exhibited more significant improvement in pain intensity within 1 week (MD=-1.09, 95% CI, -1.75 to -0.44). CONCLUSIONS: Dry needling demonstrates good therapeutic effects on pain intensity (within 1 week), function, and grip strength among patients with lateral epicondylitis. Local twitch response is necessary in treatment that targets trigger points.

Comparison of Dry Needling and Cold-Spray-Stretching Treatments by Ultrasonography and Electrophysiology: Prospective, Randomized Controlled Trial.

OBJECTIVES: To compare the efficacy of dry needling (DN) and cold-spray-stretching treatments using surface electromyography (sEMG) and ultrasound (US) in the treatment of patients with myofascial pain syndrome (MPS) with active trigger point (ATrP) in the upper trapezius muscle. METHODS: This prospective randomized single-blind study included 60 MPS patients aged 18-65 years who have ATrP in the upper trapezius muscle. Patients were randomized into two treatment groups as DN and cold spray stretching. Both treatment groups received 1 treatment per week and totally 3 sessions. Evaluation parameters were pain level assessed by Numeric Rating Scale and algometer, neck range of motion angles, neck disability index (NDI). The effects of the treatments on ATrP were evaluated by sEMG and US histogram. All parameters were evaluated at the beginning of the treatment and at the end. Algometer and sEMG were performed also before and after the first and third sessions. RESULTS: There was no significant difference between the two groups regarding demographic data. The mean age of the participants was 39.7 ± 11.6 years. Fifty-one patients were female. Significant improvement in terms of pain level, functionality, sEMG, and US histogram were achieved in both groups (P < .05). When comparing the two groups, algometer scores and the NDI score were statistically higher in the cold-spray-stretching group than in the DN group (P < .008 and P < .028, respectively). CONCLUSION: Both treatment options should be preferred. The efficacy of both treatments was observed via sEMG and US histograms.