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PubMed1994

The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice.

The presence of a trigger point is essential to the myofascial pain syndrome. This study centres on identifying clearer criteria for the presence of trigger points in the quadratus lumborum and gluteus medius muscle by investigating the occurrence and inter-rater reliability of trigger point symptoms. Using the symptoms and signs as described by Simons' 1990 definition and two other former sets of criteria, 61 non-specific low back pain patients and 63 controls were examined in general practice by 5 observers, working in pairs. From the two major criteria of Simons' 1990 definition only 'localized tenderness' has good discriminative ability and inter-rater reliability (kappa > 0.5). This study does not find proof for the clinical usefulness of 'referred pain', which has neither of these two abilities. The criteria 'jump sign' and 'recognition', on the condition that localized tenderness is present, also have good discriminative ability and inter-rater reliability. Trigger points defined by the criteria found eligible in this study allow significant distinction between non-specific low back pain patients and controls. This is not the case with trigger points defined by Simons' 1990 criteria. Concerning reliability there is also a significant difference between the two different criteria sets. This study suggests that the clinical usefulness of trigger points is increased when localized tenderness and the presence of either jump sign or patient's recognition of his pain complaint are used as criteria for the presence of trigger points in the M. quadratus lumborum and the M. gluteus medius.

Adult↗
PubMed2006

Effects of trigger point acupuncture on chronic low back pain in elderly patients--a sham-controlled randomised trial.

INTRODUCTION: There is some evidence for the efficacy of acupuncture, but it remains unclear whether trigger point acupuncture is effective. Our objective was to evaluate the effects of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared with sham acupuncture. METHODS: Twenty-six consecutive out-patients (17 women, 9 men; age range: 65-91 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating low back pain for at least six months and normal neurological examination, were randomised to two groups. Each group received one phase of trigger point acupuncture and one of sham acupuncture with a three week washout period between them, over 12 weeks. Group A (n = 13) received trigger point acupuncture in the first phase and sham acupuncture in the second. Group B (n = 13) received the same interventions in the reverse order. Outcome measures were pain intensity (visual analogue scale, VAS) and Roland Morris Questionnaire. RESULTS: Nineteen patients were included in the analysis. At the end of the first treatment phase, group A receiving trigger point acupuncture scored significantly lower VAS (P < 0.001) and Roland Morris Questionnaire scores (P < 0.01) than the sham control group. There were significant within-group reductions in pain in both groups during the trigger point acupuncture phase but not in the sham treatment phase. However, the beneficial effects were not sustained. CONCLUSION: These results suggest that trigger point acupuncture may have greater short term effects on low back pain in elderly patients than sham acupuncture.

Acupuncture Points↗
PubMed2004

Trigger point acupuncture treatment of chronic low back pain in elderly patients--a blinded RCT.

OBJECTIVE: There is some evidence for the efficacy of acupuncture in chronic low back pain, but it remains unclear which acupuncture modes are most effective. Our objective was to evaluate the effects of two different modes of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared to standard acupuncture treatment. METHODS: Thirty five consecutive out-patients (25 women, 10 men; age range: 65-81 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating low back pain for at least six months and normal neurological examination, were randomised to one of three groups over 12 weeks. Each group received two phases of acupuncture treatment with an interval between them. Nine patients dropped out during the course of the study. The standard acupuncture group (n=9) received treatment at traditional acupuncture points for low back pain, while the other acupuncture groups received superficial (n=9) or deep (n=9) treatments on trigger points. Outcome measures were VAS pain intensity and Roland Morris Questionnaire. RESULTS: After treatment, the group that received deep needling to trigger points reported less pain intensity and improved quality of life compared to the standard acupuncture group or the group that received superficial needling to trigger points, but the differences were not statistically significant. There was a significant reduction in pain intensity between the treatment and interval in the group that received deep needling to trigger points (P<0.01), but not in the standard acupuncture group or the group that received superficial needling to trigger points. CONCLUSION: These results suggest that deep needling to trigger points may be more effective in the treatment of low back pain in elderly patients than either standard acupuncture therapy, or superficial needling to trigger points.

Acupuncture Analgesia↗
PubMed1988

Thermographic imaging of myofascial trigger points.

Thermographic findings in two patients suffering from myofascial trigger points are presented. These are shown as discrete foci of increased thermal emission, with corresponding areas of diffuse hyperthermia. These thermal findings correlate highly with the classic locations of specific trigger points and their areas of pain referral, respectively, as described in literature. Not only do these cases describe a thermal pattern that varies somewhat from previous reports, but they also illustrate the previously unreported imaging of areas of pain referral from specific trigger points.

Diagnosis, Computer-Assisted↗
PubMed2004

Bilateral activation of motor unit potentials with unilateral needle stimulation of active myofascial trigger points.

OBJECTIVE: The objective of this study was to determine if there are electromyographic differences between active and latent myofascial trigger points (MTrPs) during trigger point needling. DESIGN: A total of 21 subjects were recruited prospectively. The experimental group consisted of 13 subjects who had active myofascial pain in the neck for >6 mos. The age-matched, control group consisted of eight subjects without neck pain but with taut bands in the cervical musculature. The active MTrPs (or latent MTrPs in the control group) were identified in the trapezius or levator scapulae muscles, then needle electrodes were inserted ipsilaterally into the muscle with the MTrPs and into the same muscle on the contralateral side. Electromyographic activity was recorded bilaterally with a dual-channel electromyographic machine, and local twitch responses were obtainedusinganacupuncturedryneedlingtechniqueonlyonthesideoftheactiveMTrPs. RESULTS: We demonstrated that in subjects with active MTrPs, bilateral motor unit activation could be obtained with unilateral needle stimulation of the trigger point. In contrast, in all the subjects with latent MTrPs, only unilateral motor unit activation could be obtained in the muscle on the same side of the needle stimulation. The motor unit potentials seen on the electromyograph were similar in morphology to a fasciculation potential but more complex. CONCLUSION: We demonstrated bilateral or mirror-image electromyographic activity associated with unilateral needle stimulation of active MTrPs. We have found no previous mention of this phenomenon in the literature. Our study supports the concept that the perpetuation of pain and muscle dysfunction in active MTrPs may be related to abnormal central nervous system processing of sensory input at the level of the spinal cord.

Acupuncture Points↗
PubMed2006

Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review.

Botulinum toxin injection is used to treat various pain conditions including muscle spasticity, dystonia, headache and myofascial pain. Results are conflicting regarding the use of Botulinum toxin for trigger point injection in terms of improvement in pain. The aim of this study was to carry out a systematic review to assess the evidence for efficacy of Botulinum toxin A (BTA) compared with placebo for myofascial trigger point injection. Electronic databases on Medline, Cochrane Library, Scopus, CINAHL were queried using key words such as "botulinum toxin", "myofascial pain", "trigger point", "chronic pain" and "musculoskeletal pain". Relevant published randomized controlled trials that described the use of BTA as injection therapy for trigger points were considered for inclusion. The five-item 0-16 point Oxford Pain Validity Scale (OPVS) was used as a selection criteria for suitable clinical trials. Trials were also assessed based on quality using the Oxford Rating Scale. Data extracted from qualified trials included outcome measures such as pain intensity and pain pressure threshold. All studies were ranked according to the OPVS and the authors' conclusions were compared. Five clinical trials met the inclusion criteria. One trial concluded that BTA was effective, and four concluded that it was not effective for reducing pain arising from trigger points. OPVS scores ranged from 8 to 14 with the negative studies corresponding with higher validity scores. The current evidence does not support the use of BTA injection in trigger points for myofascial pain. The data is limited and clinically heterogeneous.

Botulinum Toxins, Type A↗
PubMed1982

Painful trigger points in surgical scars.

A group of 69 patients with painful trigger points in operative scars were treated following abdominal, inguinal, lumbar, or extremity surgery. Patients undergoing thoracotomies, neurosurgical procedures, or limb amputations, and patients with neurotic features or seeking secondary gains were excluded. The diagnosis was made by finding one or more definite, consistent, tender trigger points in the scar in which total, transient relief of pain was provided by injection of bupivacaine. Repeated injections of alcohol into the trigger point proved to be a simple, safe, and effective treatment with permanent cure or marked improvement in 63 (91%) patients.

Adult↗
PubMedDate not supplied

Ciprofloxacin- and hypocalcemia-induced torsade de pointes triggered by hemodialysis.

Torsade de pointes is a polymorphic form of ventricular tachycardia associated with prolongation of the QT interval, which may be either congenital or acquired. Etiologies for the acquired forms include drug effects, hypokalemia, hypomagnesemia, hypocalcemia, starvation, sick sinus syndrome, and atrioventricular block. We present a 76-year-old man with acute on chronic renal failure, hypocalcemia, on ciprofloxacin, and a prolonged QT interval with torsade de pointes triggered by hemodialysis. The QT prolongation was corrected by treating the hypocalcemia. Hypocalcemia and ciprofloxacin are known to independently cause prolonged QT interval and torsade de pointes; our case illustrates that dialysis can trigger torsade on a background of this risk factor combination.

Aged↗
PubMed1994

Needle electromyographic evaluation of trigger point response to a psychological stressor.

Fourteen subjects were evaluated by needle electromyography in a trapezius myofascial trigger point and simultaneously in adjacent nontender trapezius muscle fibers during a control condition (forward counting), a stressful condition (mental arithmetic), and resting baselines. Based on recent data implicating autonomic innervation in muscle function, we hypothesized that the trigger point would be more responsive than the adjacent muscle to psychological stress. The results showed increased trigger point electromyographic activity during stress, whereas the adjacent muscle remained electrically silent. These results suggest a mechanism by which emotional factors influence muscle pain. This may have significant implications for the psychophysiology of pain associated with trigger points.

Adult↗
PubMed2006

Sympathetic facilitation of hyperalgesia evoked from myofascial tender and trigger points in patients with unilateral shoulder pain.

OBJECTIVE: To provide evidence for the sympathetic-sensory interaction within a trigger point, which may contribute to local and referred pain and sympathetic symptoms in myofascial pain syndrome. METHODS: Pressure pain threshold (PPT) was measured from a trigger point in the painful side, from a tender point in the non-painful side in the infraspinatus muscles, and from a normal control point in the tibialis anterior muscle in 21 patients with unilateral shoulder pain. In addition, pressure threshold for eliciting referred pain (referred pain threshold, PTRP) was determined, then the intensity was measured of local and referred pain evoked by a pressure equal to 1.5 times PRPT, applied at the trigger point, in 11 patients. All measurements were taken during normal respiration and elevated intrathoracic pressure (EITP). RESULTS: PPT was significantly lower at the trigger than tender points during normal respiration (P=0.001). PPT decreased significantly at both the tender and trigger points during EITP compared with normal respiration (P<0.001). Significant decreases in referred pain threshold and increases in local and referred pain intensities were seen during EITP than normal respiration (all, P<0.01). CONCLUSIONS: These results provide evidence of sympathetic facilitation of mechanical sensitization and the local and referred muscle pain. SIGNIFICANCE: Sympathetic hyperactivity needs to be considered during the clinical evaluation and management of myofascial pain syndrome.

Adult↗
PubMedDate not supplied

Trigger points in 48 dogs with myofascial pain syndromes.

Seven foci of pain (trigger points) were identified in the triceps brachii, infraspinatus, adductor-pectineus, peroneus longus, gluteus medius, ileocostorum lumborum, and quadriceps femoris muscles in 48 lame dogs. The dogs had been lame for 1 day to 150 weeks (mean, 24 weeks). Thirty-one dogs had been treated unsuccessfully with corticosteroids, nonsteroidal anti-inflammatory drugs, analgesics, or acupuncture. Palpating the trigger points induced severe pain. Treatment consisted of weekly stimulation of the trigger points by needling or injection of a local anesthetic. The mean treatment period was 2.8 weeks. Excellent results and complete recovery were observed in 34 dogs (60%).

Animals↗
PubMed1981

Myofascial trigger points: a need for understanding.

The muscle pain syndromes caused by myofascial trigger points are beset with a cloud of confusing terminology and confusing concepts. This paper introduces the presentations made at a symposium entitled "Myofascial Trigger Points: Multidisciplinary Facets," at the 55th Annual Session of the American Congress of Rehabilitation Medicine in New Orleans on November 17, 1978. Following a summary of discussions at the end of the symposium, the "Commentary" proposes a set of neurophysiologic mechanisms that may account for most of the clinical phenomena associated with myofascial trigger points.

Fascia↗
PubMed1989

A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain.

The efficacy of trigger-point injection therapy in treatment of low-back strain was evaluated in a prospective, randomized, double-blind study. The patient population consisted of 63 individuals with low-back strain. Patients with this diagnosis had nonradiating low-back pain, normal neurologic examination, absence of tension signs, and lumbosacral roentgenograms interpreted as being within normal limits. They were treated conservatively for 4 weeks before entering the study. Injection therapy was of four different types: lidocaine, lidocaine combined with a steroid, acupuncture, and vapocoolant spray with acupressure. Results indicated that therapy without injected medication (63% improvement rate) was at least as effective as therapy with drug injection (42% improvement rate), at a P value of 0.09. Trigger-point therapy seems to be a useful adjunct in treatment of low-back strain. The injected substance apparently is not the critical factor, since direct mechanical stimulus to the trigger-point seems to give symptomatic relief equal to that of treatment with various types of injected medication.

Acupuncture Therapy↗
PubMed2006

Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training.

PURPOSE: The impact of chronic pelvic pain syndrome on sexual function in men is underestimated. We quantified sexual dysfunction (ejaculatory pain, decreased libido, erectile dysfunction and ejaculatory difficulties) in men with chronic pelvic pain syndrome and assessed the effects of pelvic muscle trigger point release concomitant with paradoxical relaxation training. MATERIALS AND METHODS: We treated 146 men with a mean age of 42 years who had had refractory chronic pelvic pain syndrome for at least 1 month with trigger point release/paradoxical relaxation training to release trigger points in the pelvic floor musculature. The Pelvic Pain Symptom Survey and National Institutes of Health-Chronic Prostatitis Symptom Index were used to document the severity/frequency of pain, urinary and sexual symptoms. A global response assessment was done to record patient perceptions of overall therapeutic effects at an average 5-month followup. RESULTS: At baseline 133 men (92%) had sexual dysfunction, including ejaculatory pain in 56%, decreased libido in 66%, and erectile and ejaculatory dysfunction in 31%. After trigger point release/paradoxical relaxation training specific Pelvic Pain Symptom Survey sexual symptoms improved an average of 77% to 87% in responders, that is greater than 50% improvement. Overall a global response assessment of markedly or moderately improved, indicating clinical success, was reported by 70% of patients who had a significant decrease of 9 (35%) and 7 points (26%) on the National Institutes of Health-Chronic Prostatitis Symptom Index (p < 0.001). Pelvic Pain Symptom Survey sexual scores improved 43% with a markedly improved global response assessment (p < 0.001) but only 10% with moderate improvement (p = 0.96). CONCLUSIONS: Sexual dysfunction is common in men with refractory chronic pelvic pain syndrome but it is unexpected in the mid fifth decade of life. Application of the trigger point release/paradoxical relaxation training protocol was associated with significant improvement in pelvic pain, urinary symptoms, libido, ejaculatory pain, and erectile and ejaculatory dysfunction.

Adolescent↗
PubMed1993

Inter- and intra-rater reliability of the pressure threshold meter in measurement of myofascial trigger point sensitivity.

This study was designed to establish the intra-rater and inter-rater reliability of measurements of trigger point sensitivity using a commercially available pressure threshold meter. Fifty healthy adult volunteers (25 men and 25 women, aged 20 to 51 years) underwent repeated pressure threshold readings from two separate trigger point locations in the trapezius muscle, TP2 (left) and TP3 (right) by two independent examiners. Pressure threshold readings, using a 1.0 kg/s application, were done alternately by each experimenter. Measurements from each trigger point were completed 5 minutes apart. Intraclass correlation coefficients (ICC) revealed the inter-rater reliability to be high for both the first (ICC = 0.82) and second trial (ICC = 0.90) of TP2 and for the first (ICC = 0.86) and second trial (ICC = 0.92) of TP3. Intra-rater reliabilities for TP3 (ICC = 0.91) were higher than for TP2 (ICC1 = 0.80; (ICC2 = 0.83). These results show that the pressure threshold meter is highly reliable in measuring trigger point sensitivity, between and within experimenters, and may be useful in the diagnosis and monitoring of treatment of myofascial pain syndrome.

Adult↗
PubMed2002

Randomized trial of trigger point injection for renal colic.

BACKGROUND: Many drugs have been utilized for the treatment of renal colic, but to date no drugs that relieve pain quickly and completely have been developed. Thus, we conducted a prospective trial to evaluate the effects of trigger point injection on renal colic. In this study, we used a local injection of lidocaine to the trigger point of patients experiencing renal colic, and evaluated the efficacy in patients using the visual analog scale. METHODS: Sixty patients with renal colic were enrolled in this study and divided into two groups by a simple randomization: (i) the butylscopolamine group (n = 30, intravenous injection of butylscopolamine bromide and sulpyrine); and (ii) the lidocaine group (n = 30, local anesthesia to the trigger point with lidocaine). RESULTS: Renal colic had disappeared completely at the end of the trigger point injection in 15/30 patients and the average time required to produce a 50% improvement in symptoms was 9 min in all patients in the group. In the lidocaine group, only one patient needed an additional anodyne treatment after 60 min and none of the 29 patients whose pain disappeared within 60 min needed further anodyne treatment within 24 h. These results were all significantly superior to those of the conventional treatment. No side-effects and complications were observed. CONCLUSION: Trigger point injection, in our experience, is an easy, safe and effective method for the amelioration of renal colic. It was significantly superior to the combination of intravenous butylscopolamine and sulpyrine.

Adult↗
PubMedDate not supplied

The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points.

This study is designed to investigate the immediate effectiveness of electrotherapy on myofascial trigger points of upper trapezius muscle. Sixty patients (25 males and 35 females) who had myofascial trigger points in one side of the upper trapezius muscles were studied. The involved upper trapezius muscles were treated with three different methods according to a random assignment: group A muscles (n = 18) were given placebo treatment (control group); group B muscles (n = 20) were treated with electrical nerve stimulation (ENS) therapy; and group C muscles (n = 22) were given electrical muscle stimulation (EMS) therapy. The effectiveness of treatment was assessed by conducting three measurements on each muscle before and immediately after treatment: subjective pain intensity [(PI) with a visual analog scale], pressure pain threshold [(PT) with algometry], and range of motion [(ROM) with a goniometer] of upper trapezius muscle (lateral bending of cervical spine to the opposite side). When the effectiveness of treatment was compared with that of the placebo group (group A), there was significant improvement in PI and PT in group B (P < 0.01) but not in group C (P > 0.05). The improvement of ROM was significantly more in group C (P < 0.01) as compared with that in group A or group B. When each group was divided into two additional subgroups based on the initial PI, it was found that ENS could reduce PI and increase PT significantly (P < 0.05), but did not significantly (P > 0.05) improve ROM, as compared with the placebo group for both subgroups. EMS could significantly (P < 0.05) improve ROM, but not PT, better than the placebo groups, for either subgroup. It could reduce PI significantly more (P < 0.05) than placebo controls only for the subgroup with mild to moderate pain, but not with severe pain. For pain relief, ENS was significantly better (P < 0.05) than EMS; but for the improvement of ROM, EMS was significantly better (P < 0.05) than ENS. It is concluded that ENS is more effective for immediate relief of myofascial trigger point pain than EMS, and EMS has a better effect on immediate release of muscle tightness than ENS.

Adult↗
PubMed2002

The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects.

AIM OF THE STUDY: To investigate the effects of myofascial trigger-point massage therapy to the head, neck and shoulder areas on cardiac autonomic tone.Background. No studies have reported on the effect of back massage on autonomic tone as measured by heart rate variability. This is especially relevant to the nursing profession, as massage is increasingly available as a therapy complementary to conventional nursing practice. DESIGN/METHODS: An experimental study in which subjects were initially placed in age- and sex-matched groups and then randomized to treatment or control by alternate allocation. The study involved 30 healthy subjects (16 female and 14 male, aged 32.47 +/- 1.55 years, mean +/- standard error). A 5-minute cardiac interbeat interval recording, systolic and diastolic blood pressure and subjective self-evaluations of muscle tension and emotional state were taken before and after intervention. Autonomic function was measured using time and frequency domain analysis of heart rate variability. RESULTS: Following myofascial trigger-point massage therapy there was a significant decrease in heart rate (P < 0.01), systolic blood pressure (P=0.02) and diastolic blood pressure (P < 0.01). Analysis of heart rate variability revealed a significant increase in parasympathetic activity (P < 0.01) following myofascial trigger-point massage therapy. Additionally both muscle tension and emotional state, showed significant improvement (P < 0.01). CONCLUSIONS: In normal healthy subjects myofascial trigger-point massage therapy to the head, neck and shoulder areas is effective in increasing cardiac parasympathetic activity and improving measures of relaxation.

Adult↗