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PubMed2004

Trigger point injection treatment with the 5-HT3 receptor antagonist tropisetron in patients with late whiplash-associated disorder. First results of a multiple case study.

Preliminary results of an ongoing study on the effectiveness of trigger point injections with tropisetron in 20 patients with late whiplash-associated disorder are presented. The study demonstrated more than 50% pain relief for more than 2 weeks in 52% of the 73 treatment sessions. The duration of effectiveness of the injections showed great intraindividual and interindividual variation.

Female↗
PubMed2002

Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity.

OBJECTIVE: To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle. DESIGN: Randomized controlled trial. SETTING: Institutional practice. PATIENTS: One hundred nineteen subjects with palpably active myofascial trigger points (MTrPs). INTERVENTION: Stage 1 evaluated the immediate effect of ischemic compression, including 2 treatment pressures (P1, pain threshold; P2, averaged pain threshold and tolerance) and 3 durations (T1, 30s; T2, 60s; T3, 90s). Stage 2 evaluated 6 therapeutics combinations, including groups B1 (hot pack plus active range of motion [ROM]), B2 (B1 plus ischemic compression), B3 (B2 plus transcutaneous electric nerve stimulation [TENS]), B4 (B1 plus stretch with spray), B5 (B4 plus TENS), and B6 (B1 plus interferential current and myofascial release). MAIN OUTCOME MEASURES: The indexes of changes in pain threshold (IThC), pain tolerance (IToC), visual analog scale (IVC), and ROM (IRC) were evaluated for treatment effect. RESULTS: In stage 1, the IThC, IToC, IVC, and IRC were significantly improved in the groups P1T3, P2T2, and P2T3 compared with the P1T1 and P1T2 treatments (P<.05). In stage 2, groups B3, B5, and B6 showed significant improvement in IThC, ItoC, and IVC compared with the B1 group; groups B4, B5, and B6 showed significant improvement in IRC compared with group B1 (P<.05). CONCLUSIONS: Ischemic compression therapy provides alternative treatments using either low pressure (pain threshold) and a long duration (90s) or high pressure (the average of pain threshold and pain tolerance) and short duration (30s) for immediate pain relief and MTrP sensitivity suppression. Results suggest that therapeutic combinations such as hot pack plus active ROM and stretch with spray, hot pack plus active ROM and stretch with spray as well as TENS, and hot pack plus active ROM and interferential current as well as myofascial release technique, are most effective for easing MTrP pain and increasing cervical ROM.

Adult↗
PubMed1993

Use of trigger point injections in chronic pelvic pain.

In order to fully evaluate the woman with chronic pelvic pain, the clinician must consider the possibility of abdominal wall pain. A useful technique in both diagnosis and treatment may be trigger point injections.

Abdominal Muscles↗
PubMed1981

Myofascial trigger points: relation to acupuncture and mechanisms of pain.

The gate control theory of pain describes the modulation of sensory nerve impulses by inhibitory mechanisms in the central nervous system. One of the oldest methods of pain relief is hyperstimulation analgesia produced by stimulating myofascial trigger points by dry needling, acupuncture, intense cold, intense heat, or chemical irritation of the skin. The moderate-to-intense sensory input of hyperstimulation analgesia is applied to sites over, or sometimes distant from, the pain. A brief painful stimulus may relieve chronic pain for long periods, sometimes permanently. Pain may be relieved by "closing the gate" by means of a central biasing mechanism possibly located in the brainstem reticular formation. Prolonged relief may require the disruption of reverberatory neural circuits responsible for the "memory" of pain. The termination of pain by either hyperstimulation, or by local injection of an anesthetic, normalizes function, which helps to prevent recurrence of abnormal neural activity. Thus, modulation of sensory inputs by use of many techniques may reduce pain more than by surgically interrupting the sensory input.

Acupuncture Therapy↗
PubMed1981

Myofascial trigger point syndromes in the practice of rheumatology.

Pain referred from a muscle can mimic both pain from a joint and radicular pain associated with disease of spinal joints, leading to mistakes in diagnosis and in treatment. When articular disease is present, it predisposes to myofascial trigger point (TP) syndromes. With arthritis, TPs in muscles may result from decreased mobility with prolonged shortening of muscles, from abnormal mechanical stress on muscles and from stimuli arising in diseased joints. During examination for signs of myofascial disorders, the numbers of tender points and of local twitch responses in women with rheumatoid arthritis were twice those found in women free of any rheumatic illness. It is important to consider this high frequency of myofascial syndromes in persons with arthritis, when treating pain or weakness which could be due to the muscles rather than the joints. Conversely, it has been proposed, on theoretical and clinical grounds, that muscular TPs can cause joint disease. This hypothesis has important implications for the treatment of arthritis.

Arthritis↗
PubMed2005

Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men.

PURPOSE: A perspective on the neurobehavioral component of the etiology of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is emerging. We evaluated a new approach to the treatment of CP/CPPS with the Stanford developed protocol using myofascial trigger point assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT). MATERIALS AND METHODS: A total of 138 men with CP/CPPS refractory to traditional therapy were treated for at least 1 month with the MFRT/PRT protocol by a team comprising a urologist, physiotherapist and psychologist. Symptoms were assessed with a pelvic pain symptom survey (PPSS) and National Institutes of Health-CP Symptom Index. Patient reported perceptions of overall effects of therapy were documented on a global response assessment questionnaire. RESULTS: Global response assessments of moderately improved or markedly improved, considered clinical successes, were reported by 72% of patients. More than half of patients treated with the MFRT/PRT protocol had a 25% or greater decrease in pain and urinary symptom scores, as assessed by the PPSS. In those at the 50% or greater improvement level median scores decreased 69% and 80% for pain and urinary symptoms, respectively. The 2 scores decreased significantly by a median of 8 points when the 25% or greater improvement was first observed, that is after a median of 5 therapy sessions. PPSS and National Institutes of Health-CP Symptom Index showed similar levels of improvement after MFRT/PRT protocol therapy. CONCLUSIONS: This case study analysis indicates that MFRT combined with PRT represents an effective therapeutic approach for the management of CP/CPPS, providing pain and urinary symptom relief superior to that of traditional therapy.

Adolescent↗
PubMed1984

Neurological factors in chronic pelvic pain: trigger points and the abdominal pelvic pain syndrome.

A collection of neurological signs and symptoms, entitled abdominal pelvic pain syndrome, is identified as the most common cause of chronic pelvic pain. Techniques to identify abdominal wall, vaginal, and sacral components are described, with painful tissues commonly limited to a single dermatomic area. Superficial local areas of hyperpathia (trigger points) appeared not only to cause the pelvic pain but also to be responsive to local anesthetics for a duration in excess of the presence of the medication. Successful responses were noted in 89.3% of 131 patients, with 92.6% requiring five or fewer treatments and 68.2% followed up for longer than 6 months. The diagnosis of the abdominal pelvic pain syndrome is an important component in avoiding unnecessary operation in patients with pelvic pain.

Abdomen↗
PubMed2002

Role of injection therapy: review of indications for trigger point injections, regional blocks, facet joint injections, and intra-articular injections.

Injection therapies play a major role in the management of various pain conditions. Some injections are relatively simple to perform whereas others are technically demanding with significant risk of mortality and morbidity. Traditional therapies such as intra-articular injections, regional blocks, and trigger-point injections continue to be redefined as we gain a better understanding into the pathophysiology of nociception, with a greater insight into regional anatomy using improved imaging capabilities. Injection therapies are becoming an integral part of the multidisciplinary therapies required to improve and rehabilitate pain patients. The necessity of clinical outcome assessments including functional-based outcomes and cost-effective analysis is becoming more important in the current medical reimbursement environment.

Humans↗
PubMed1997

Local and remote sustained trigger point therapy for exacerbations of chronic low back pain. A randomized, double-blind, controlled, multicenter trial.

STUDY DESIGN: A randomized, double-blind, controlled, multicenter trial was conducted. OBJECTIVES: To assess the efficacy of neuroreflexotherapy in the management of low back pain. SUMMARY AND BACKGROUND DATA: Neuroreflexotherapy consists of temporary implantation of epidermal devices in trigger points in the back and referred tender points in the ear. METHODS: The rheumatology and rehabilitation departments of three teaching hospitals in Madrid recruited 78 patients with chronic low back pain. These patients were randomly assigned to the control group (37 patients) or to the treatment group (41 patients). Patients in the treatment group underwent one neuroreflexotherapeutic intervention. The control group received sham treatment consisting of placement of the same number of epidermal devices within a 5-cm radius of the target zones. Patients from both groups were allowed to continue drug treatment as previously prescribed. The use of medications during the trial was recorded. RESULTS: Patients underwent clinical evaluations on three occasions: within 5 minutes before intervention, within 5 minutes after intervention, and 45 days later. The preintervention assessment was carried out by the physician from each hospital department who included the patient in the study. Each of the two follow-up assessments were carried out independently by two of three physicians who had no connection with the research team. Patients in the treatment group showed immediate lessening of pain compared with the results in patients in the control group. The pain relief was clinically relevant and statistically significant, and it persisted up to the end of the trial. CONCLUSIONS: Neuroreflexotherapy intervention seems to be a simple and effective treatment for rapid amelioration of pain episodes in patients with chronic low back pain. At this time, the duration of pain relief beyond 45 days has not been evaluated.

Adult↗
PubMedDate not supplied

Trigeminal neuralgia with intraoral trigger points: report of two cases.

A variety of pathologic conditions can cause orofacial pain. Establishing the etiology of the pain is key to providing appropriate treatment. Trigeminal neuralgia (TN) is a relatively uncommon condition and can present a diagnostic challenge to even the experienced dental practitioner. The authors discuss two cases of TN that exhibited intraoral trigger points, which initially resulted in confusion regarding the establishment of a correct diagnosis and treatment.

Aged↗
PubMed2006

The role of the pain psychologist, trigger point injections, reflex sympathetic dystrophy.

This feature presents information for patients in a question and answer format. It is written to simulate actual questions that many pain patients ask and to provide answers in a context and language that most pain patients will comprehend. Issues addressed in this issue are the role of the pain psychologist, trigger point injections, and reflex sympathetic dystrophy.

Acupuncture Points↗
PubMed2006

Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache.

Referred pain and pain characteristics evoked from the upper trapezius muscle was investigated in 20 patients with chronic tension-type headache (CTTH) and 20 age- and gender-matched controls. A headache diary was kept for 4 weeks in order to confirm the diagnosis and record the pain history. Both upper trapezius muscles were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold (PPT) were recorded. The results show that referred pain was evoked in 85% and 50% on the dominant and non-dominant sides in CTTH patients, much higher than 55% and 25% in controls (P<0.01). Referred pain spread to the posterior-lateral aspect of the neck ipsi-lateral to the stimulated muscle in both patients and controls, with additional referral to the temple in most patients, but none in controls. Nearly half of the CTTH patients (45%) recognized the referred pain as their usual headache sensation, i.e. active TrPs. CTTH patients with active TrPs in the right upper trapezius muscle showed greater headache intensity and frequency, and longer headache duration than those with latent TrPs. CTTH patients with bilateral TrPs reported significantly decreased PPT than those with unilateral TrP (P<0.01). Our results showed that manual exploration of TrPs in the upper trapezius muscle elicited referred pain patterns in both CTTH patients and healthy subjects. In CTTH patients, the evoked referred pain and its sensory characteristics shared similar patterns as their habitual headache pain, consistent with active TrPs. Our results suggest that spatial summation of perceived pain and mechanical pain sensitivity exists in CTTH patients.

Adult↗
PubMed1981

A randomised trial to evaluate the effect of infra-red stimulation of local trigger points, versus placebo, on the pain caused by cervical osteoarthrosis.

Claims have been made that local heat is particularly useful in treating osteoarthritis pain. This randomised trial evaluates the short term efficacy of local heat, on the pain caused by cervical osteoarthrosis. Two treatment groups were compared, one receiving mock TNS and the other heat from an infra-red gun (the IRS Medtec 100). Both the placebo and treatment groups received treatment on local tender trigger points. Each patient received four treatments. Pain was assessed before entry into the trial and after the completion of treatment; the parameters used for assessing pain were, analgesic intake, sleep disturbance due to pain and subjective pain score. Twenty-six patients were entered into the trial, twenty-five completed treatment. In the group receiving treatment from the infra-red gun (IRS Medtec 100) 75% obtained significant pain relief. In the group receiving mock TNS 31% obtained significant pain relief. A chi-squared test comparing these two groups give a P value of 0.07.

Adult↗
PubMedDate not supplied

[Appraisal of treatment of the trigger points associated with relaxation to treat chronic headache in the adult. Relationship with anxiety and stress adaptation strategies].

UNLABELLED: Since the 1950's and even still today, the concomitance between headaches and psychological symptoms (anxiety and depression) is the subject of considerable research. Even so, headaches still pose a problem of difficult diagnosis related to their multiform aspect. Their understanding may be regarded as neurological, psychological or musculo-articular. This complexity explains the lack of effectiveness of anti-migraine treatments in certain cases. This situation encourages recourse to complementary procedures such as those used in physiotherapy. The questions that could be posed regarding physiotherapeutic treatment are: Is the treatment effective? How does it act on the level of pain? and How does it act at the psychological level? It is to answer these questions that the work, which is the basis of this article, has been carried out. METHODOLOGY: Two groups were studied during this research: a group of 25 patients and a reference group of 100 people. The headache patients were sent for physiotherapy by a GP or consultant neurologist. The pathologies retained for experimentation were: migraines without aura; Arnold's neuralgia; headaches of spinal origin; tension headaches and associated migraines. These pathologies are covered in International Headache Society Classification: Essential headache and in Section 45.4 of DSM IV: Painful problems . The physiotherapeutic treatments applied to the patients were: muscular massage and friction plus ultra-sound vibration of the trigger-points in the spinal, scapular, dorsal and facial regions; articular reharmonisation work on the spinal column; thermotherapy and relaxation as a technique allowing control of physical (muscular) and psychological (anxiety, fear of pain) tension to be regained. The treatment is evaluated by comparison of the periodicity and intensity of the headaches before and after treatment; comparison of anxiety (state and trait) before and after treatment and comparison of coping strategies before and after treatment. RESULTS: As far as the description of the headaches of the patient group is concerned, the periodicity/intensity evaluated each day of the week before the treatment and presented in graphical form, showed a heterogeneous distribution and did not exhibit any particular characteristics. In addition, the fact of having studied this periodicity/intensity during a period of one week reinforces the reliability of the values found and reinforces the impact, showing clearly that it is not just incidental. The headaches were hereditary in 32-64% of cases; the trigger factors related to stress were the large majority. As far as the treatment used in the population studied is concerned, medication was used punctually, as prescribed. This was in the form of analgesics/antipyretics (68%) or anxiolytics (20%). In 85% of the cases, at the end of the physiotherapy treatment, the person no longer used any medication. The effectiveness of the treatment is clearly illustrated by the fact that the periodicity/intensity of the headaches had diminished significantly after treatment. The physiotherapy treatment lasted for 10 to 20 sessions with an average duration of 14 sessions. The treatment results in a significant reduction in the anxiety trait and the anxiety state as well as a readjustment of the coping strategies. During periods of headache crisis, anxiety and coping strategies are modified significantly. The modifications to these coping strategies during crises are: an increase in auto-accusation, the search for social support, avoidance and strategies for the resolution of emotion prior to treatment; an increase in strategies for the resolution of the problem after treatment; co-ping self-control is diminished if the anxiety state increases and it increases if the anxiety trait increases. Apart from the headache crises, there are no differences in anxiety characteristics or coping strategies between headache sufferers and others except for a greater use of coping avoidance by the headache sufferer. CONCLUSION: Treatment by relaxation allows for a perceived increase in control of symptoms by the sufferer. Consequently, it reduces anxiety, improves the quality of life and the behavioural responses to stress. In turn, the treatment improves the long-term prognosis for the headaches as well as the health of the sufferer in general. The treatment described here addresses 3 types of people: 1. Sufferers with difficult headaches which do not respond well to medical treatment. 2. People for whom anxiety and coping strategies are very much modified by the headaches. 3. People who abuse medication for the treatment of their headaches.

Adaptation, Psychological↗
PubMed1998

Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve.

Chronic pain in the chest wall is a major complication after herpes zoster infection of intercostal nerves. It is usually difficult to control pain of such origin. Two cases are reported of postherpetic neuralgia after herpes zoster infection involving the intercostal nerves. Both patients had shooting, burning, aching, and localized pain in the muscle supplied by the involved intercostal nerves 1 to 3 months after onset. Compression palpation of a tender spot in one of these muscles induced a referred pain that followed the corresponding interspace, usually in the distal anterior direction. Local twitch responses could be elicited during injection of 0.5% or 1% lidocaine into one of these tender spots; the pain in the interspace was consistently eliminated immediately after injection. One patient had complete pain relief after three series of injections. The effect of pain relief for the other patient lasted for 1 to 2 weeks after the initial injection and lasted progressively longer (up to 2 months) after repeated injections. It appears that many of the tender spots formed in intercostal muscles after herpes zoster are myofascial trigger points that respond to injection with referred pain, local twitch responses, and immediate pain relief.

Anesthetics, Local↗