Instant analgesic effect of radial extracorporeal shock wave therapy on primary dysmenorrhoea according to functional magnetic resonance imaging: study protocol for a randomised placebo-controlled trial.

BACKGROUND: Primary dysmenorrhoea (PDM) is defined as a series of pain-dominated symptoms during and after menstruation without organic lesions. Nonsteroidal anti-inflammatory drugs and oral contraceptives are usually recommended as first-line therapy for the clinical treatment of PDM, but their widespread long-term application is controversial. Radial extracorporeal shock wave therapy (rESWT) has been widely applied in musculoskeletal rehabilitation because of its secure and noninvasive characteristics and its confirmed effect in improving pain symptoms. This research seeks to explore the efficacy of rESWT for PDM and the changes in brain function of patients with PDM. METHODS: This clinical research will be a randomised, blind, sham-controlled trial. Thirty-six patients with PDM will be randomly divided into the rESWT group (n = 18) and the sham rESWT group (n = 18). In the rESWT group, treatment will be applied once within 48 h of menstruation at six abdominal myofascial trigger points. The sham rESWT group will receive sham shockwave therapy on the same sites but without energy input. Other dysmenorrhoea-related treatments in both groups will be limited. The main indicators include the short form of the McGill Pain Questionnaire and the Cox Menstrual Symptom Scale. The secondary indicators include the Zung Self-rating Anxiety Scale and Self-rating Depression Scale and functional magnetic resonance imaging (fMRI) changes in brain regions. Results will be evaluated at the screening, at baseline, and before and after treatment, and adverse treatments will be examined. Inter- and intragroup analyses will be performed. DISCUSSION: This randomised controlled study is designed to explore the immediate efficacy of rESWT for PDM. After rESWT treatment, PDM symptom tests and pain tests, as well as fMRI data, will be investigated for the potential connections between immediate neuroanalgesic mechanisms, which are associated with pain and brain networks. The main results will be used to assess the efficacy of rESWT, and secondary results will focus on improving the neurobiological understanding of disease treatment. TRIAL REGISTRATION: China Clinical Trial Register, ChiCTR1900020678. Registered on 13 January 2019.

Tratamiento del dolor de hombro mediante vibración puntual en lesionados medulares / Shoulder pain treatment with punctual vibration in spinal cord injury patients

Objetivo: Analizar los efectos inmediatos agudos de cuatro tratamientos sobre puntos gatillo miofasciales (PGM) en pacientes con lesión medular con dolor de hombro crónico (casos) y sin dolor de hombro (controles). Material y método: 16 pacientes con lesión medular (11 varones y 5 mujeres) recibieron cuatro tratamientos, uno por semana, en orden aleatorio, siendo los tratamientos: I) presión, II) vibración [Vib], III) vibración más calor [Vib+C] y IV) vibración más frío [Vib+F]. Las variables dependientes registradas fueron: Wheelchair User's Shoulder Pain Index (WUSPI) y Performance-corrected Wheelchair User's Shoulder Pain Index (PCWUSPI), escala visual analógica (EVA), amplitud de movimiento (AMD) y los umbrales de tolerancia a la presión (TP) que fueron registrados en cinco PGM, incluyendo el infraespinoso lateral (IL), infraespinoso medial (IM), supraespinoso (S), trapecio superior (TS) y el pectoral mayor (PM). Resultados: Los valores de WUSPI, PC-WUSPI y EVA fueron mayores en los casos que en los controles (p<0,05). La AMD de rotación interna fue mayor después de los tratamientos que antes (p<0,05). La Vib+F aumentó TP para el IL. La Vib+C fue el único tratamiento que incrementó TP en los casos (p<0,05) para el S; para el TS el tratamiento de Vib+C aumentó la TP (p<0,05). Conclusión: La terapia combinada resultó más eficaz para aumentar la tolerancia a la presión de la mayoría de los PGM analizados, por lo que podría ser utilizada para tratar el dolor de hombro en lesionados medulares (AU)

Objective: To analyze the acute effects of four treatments for myofascial trigger points (PGM) in spinal cord injury patients with chronic shoulder pain (cases) and without shoulder pain (controls). Material and method: 16 SCI patients (10 men and 6 women) volunteered to participate in the study. Four treatments were applied, once a week, in random order: I) pressure, II) vibration [Vib] III) heat vibration [Vib+C], and IV) cold vibration [Vib+F]. The dependent variables recorded were: Wheelchair User's Shoulder Pain Index (WUSPI) & Performance-corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI), visual analog scale (VAS), range of motion (AMD) and the tolerance thresholds pressure (TP) that were recorded in five PGM, including lateral infraspinatus (IL), infraspinatus medial (IM), supraspinatus (S), upper trapezius (TS) and pectoralis major (PM). Results: WUSPI, PC-WUSPI and EVA values were higher in cases than in controls (p <0.05). AMD internal rotation was greater after treatment than before (P <0.05). The Vib+F increased TP for the IL. The Vib+C was the only treatment that increased TP in cases (p <0.05) for the S; for the TS, the Vib+C treatment increased the TP (p <0.05). Conclusion: Combination therapy was more effective to increase the TP in the majority of the PGM analyzed. In addition, the Vib+F significantly increased the AMD of shoulder internal rotation (AU)

Laser therapy and needling in myofascial trigger point deactivation.

The aim of this study was to evaluate different approaches to deactivating myofascial trigger points (MTPs). Twenty-one women with bilateral MTPs in the masseter muscle were randomly divided into three groups: laser therapy, needle treatment and control. Treatment effectiveness was evaluated after four sessions with intervals ranging between 48 and 72 h. Quantitative and qualitative methods were used to measure pain perception/sensation. The Wilcoxon test based on results expressed on a visual analog scale (VAS) demonstrated a significant (P < 0.05) decrease in pain only in the laser and needle treatments groups, although a significant increase in the pressure pain threshold was evident only for needling with anesthetic injection (P = 0.0469), and laser therapy at a dose of 4 J/cm² (P = 0.0156). Based on these results, it was concluded that four sessions of needling with 2% lidocaine injection with intervals between 48 and 72 h without a vasoconstrictor, or laser therapy at a dose of 4 J/cm², are effective for deactivation of MTPs.