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A trigger point for hiccup.
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[Trigger point therapy in functional and inflammatory diseases in the dento-oro-gnathic region].
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Myofascial trigger points: their importance and diagnosis in the dental office.
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The nature of myofascial trigger points.
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Trigger points related to calcium channel blockers.
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Fibromyalgia and trigger point injections.
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Ultrasound identification of the myofacial trigger point.
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Asystole during trigger point injections in a patient with panic disorder.
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Myofascial trigger points of pain.
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Raymond L Nimmo and the evolution of trigger point therapy, 1929-1986.
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Galactorrhoea following acupuncture.
A 41-year-old woman with breast cancer was referred to the pain management clinic for a course of acupuncture for intense pain following a subcutaneous mastectomy and a latissimus dorsi flap reconstruction. She was treated with a standard course of acupuncture for breast pain, using paravertebral segmental points, trigger points, plus contralateral L14 on the non-lymphoedematous arm. She experienced an episode of galactorrhoea six days following the first treatment and during the second treatment. She had not previously lactated for four years. CT and MRI of the brain revealed no focal abnormality. Acupuncture has been used in to promote lactation in the Traditional Chinese literature using the 'Tianzong' acupoint SI11. This acupoint coincided with a trigger point over infraspinatus that was included in the neurophysiologically based acupuncture treatment. Quantitative analysis has shown an increase in the production of prolactin and oxytocin following acupuncture. These hormones are involved in the synthesis and release of milk from mammary glands respectively. This is the first report of galactorrhoea, in the contralateral normal breast, following acupuncture in a patient with breast cancer.
Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome.
OBJECTIVE: We aimed to evaluate the effectiveness of laser therapy in myofascial pain syndrome treatment. BACKGROUND DATA: Myofascial pain syndrome is a disease that is characterized by hypersensitive points called trigger points found in one or more muscles and/or connective tissues. It can cause pain, muscle spasm, sensitivity, stiffness, weakness, limitation of range of motion and rarely autonomic dysfunction. Physical therapy modalities and exercise are used in the treatment of this frequently encountered disease. METHODS: The placebo controlled, prospective, long-term follow up study was planned with 60 patients who had trigger points in their upper trapezius muscles. The patients were divided into three groups randomly. Stretching exercises were taught to each group and they were asked to exercise at home. Treatment duration was 4 weeks. Placebo laser was applied to group 1, dry needling to group 2 and laser to group 3. He-Ne laser was applied to three trigger points in the upper trapezius muscles on both sides with 632.8 nm. The patients were assessed at before, post-treatment, and 6 months after-treatment for pain, cervical range of motion and functional status. RESULTS: We observed a significant decrease in pain at rest, at activity, and increase in pain threshold in the laser group compared to other groups. Improvement according to Nottingham Health Profile gave the superiority of the laser treatment. However, those differences among the groups were not observed at 6-month follow up. CONCLUSIONS: Laser therapy could be useful as a treatment modality in myofascial pain syndrome because of its noninvasiveness, ease, and short-term application.
Myofascial pain disorders: theory to therapy.
Voluntary muscle is the largest human organ system. The musculotendinous contractual unit sustains posture against gravity and actuates movement against inertia. Muscular injury can occur when soft tissues are exposed to single or recurrent episodes of biomechanical overloading. Muscular pain is often attributed to a myofascial pain disorder, a condition originally described by Drs Janet Travell and David Simons. Among patients seeking treatment from a variety of medical specialists, myofascial pain has been reported to vary from 30% to 93% depending on the subspecialty practice and setting. Forty-four million Americans are estimated to have myofascial pain; however, controversy exists between medical specialists regarding the diagnostic criteria for myofascial pain disorders and their existence as a pathological entity. Muscles with activity or injury-related pain are usually abnormally shortened with increased tone and tension. In addition, myofascial pain disorders are characterised by the presence of tender, firm nodules called trigger points. Within each trigger point is a hyperirritable spot, the 'taut-band', which is composed of hypercontracted extrafusal muscle fibres. Palpation of this spot within the trigger point provokes radiating, aching-type pain into localised reference zones. Research suggests that myofascial pain and dysfunction with characteristic trigger points and taut-bands are a spinal reflex disorder caused by a reverberating circuit of sustained neural activity in a specific spinal cord segment. The treatment of myofascial pain disorders requires that symptomatic trigger points and muscles are identified as primary or ancillary pain generators. Mechanical, thermal and chemical treatments, which neurophysiologically or physically denervate the neural loop of the trigger point, can result in reduced pain and temporary resolution of muscular overcontraction. Most experts believe that appropriate treatment should be directed at the trigger point to restore normal muscle length and proper biomechanical orientation of myofascial elements, followed by treatment that includes strengthening and stretching of the affected muscle. Chronic myofascial pain is usually a product of both physical and psychosocial influences that complicate convalescence.
Needle electromyographic evaluation of patients with myofascial or fibromyalgic pain.
Several past studies have evaluated the electromyographic activity of myofascial trigger points with conflicting results. This study was performed to determine whether spontaneous activity or motor unit activity was present in patients with focal myofascial pain or fibromyalgia. Using routine needle electromyographic techniques, we sampled reproducibly tender focal areas (tender points), similar tender areas with pain referral (trigger points), associated muscle bands and adjacent uninvolved musculature. Twenty-five subjects (14 females, 11 males, mean +/- SD age 43 +/- 14 years) were studied; twenty-one subjects with focal myofascial pain and four with fibromyalgia. Spontaneous fibrillatory or positive sharp wave potentials were not found in any muscle in the 25 subjects. There was no evidence of focal motor unit activity in the tender points, trigger points or associated muscle bands in either group. Motor unit recruitment was similar in all areas sampled. We conclude that no electrodiagnostic evidence of ongoing denervation or focal muscle spasm is found in association with focal myofascial pain or fibromyalgia.
The local mechanism of acupuncture.
Scientific development of acupuncture is described to increase its therapeutic efficacy and ultimate utilization. Acupuncture may have central, local and placebo effects. Little is known about the local effects of acupuncture specific to needle penetration and/or movement. Acupuncture points, muscle trigger points and motor end-plate zones are identical. Therefore, the benefit of acupuncture in musculoskeletal pain relief for which it is most commonly used, would not be limited to classical acupuncture points on the meridians. Intramuscular movements of the needle causes insertional activity which can be recorded on electromyography (EMG). The insertional activity occurs from depolarization of innervated single or grouped muscle fiber discharges which are micro-twitches and this is the basis of pain relief with EMG and intramuscular stimulation methods. Occasionally, needle penetration or manipulation in classical or electrical acupuncture may also evoke small local twitches. These observations suggest that needle induced local muscle twitches mediate musculoskeletal pain relief in acupuncture. These micro-twitches are capable of producing micro stretch effects on the adjacent shortened muscle fibers undergoing varying stages of denervation. This reduces the mechanical traction effect produced by these shortened muscle fibers on pain sensitive structures including intramuscular nerves and blood vessels. This theory of stretching shortened muscle fibers to produce pain relief would be justified when even more significant musculoskeletal pain relief can be obtained through inducing larger force twitches. Therefore, automated and electrical twitch-obtaining intramuscular stimulation methods were invented to elicit larger twitches. These methods allow the objective localization of the motor end-plate zones and allow recording of the number, frequency and force of the twitches. Therefore, by mechanism of action and associated therapeutic relief, the twitch may be the local key to pain relief, notjust a diagnostic sign for the localization of myofascial trigger points.
Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups.
The presence of postural, myofascial, and mechanical abnormalities in patients with migraine, tension-type headache, or both headache diagnoses was compared to a headache-free control sample. Twenty-four control subjects were obtained from a convenience sampling and each was matched by age and sex to three patients with headache (one with migraine [with or without aura], one with tension-type headache, and one with diagnoses of both migraine and tension-type headache [combined diagnosis]) who had been previously assessed by a physical therapist at a headache clinic. Physical therapy assessment findings were compared among the four groups. There was a significant difference in the presence of postural abnormalities between the controls and the patients, with posture abnormalities more likely to be present in those with headache. The patients were also significantly more likely to have active trigger points and trigger points in the neck than were the control subjects. There were no significant group differences identified in the mechanical measures, nor were there any significant differences among the three headache categories. Determination of the clinical significance of these musculoskeletal abnormalities in patients with headache will require the development and testing of further standardized assessments as well as physical therapy treatment programs.