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At least 19 recordsLinked to original sources
PubMed1979

Chronic pain syndromes and their treatment. II. Trigger points.

Trigger points are distinct areas of focal hyperirritability which give rise to areas of refered pain in well-defined areas of the musculo-skeletal system, sometimes remote from the point itself and not related to it by anatomically definable pathways. While the vast majority of pain manifestations from trigger points are related to the musculo-skeletal system, this need not be invariably so, as has been demonstrated in two of the cases cited, where injection of trigger points in the neck relieved chronic tinnitus. In all manifestations of chronic pain it is recommended that a diligent search be made for such trigger points.

Female↗
PubMed1994

[Fibromyalgia and trigger points].

Trigger points in chronic pain and myofascial syndromes are often localized at a distance from the painful area. Infiltration of trigger points with Bupivacaine 0.5% greatly reduces pain and can eliminate it with no need of any other analgesic therapy.

Adolescent↗
PubMed1992

The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease.

Four experts on myofascial pain syndrome (MFP) performed trigger point examinations and 4 experts on fibromyalgia performed tender point examinations on 3 groups of subjects (7 patients with fibromyalgia, 8 with MFP, and 8 healthy persons) while blinded as to diagnosis. Local tenderness was common in both disease groups (65-82%), but was elicited in a greater proportion of MFP experts' examinations (82%). Active trigger points were found in about 18% of examinations of patients with fibromyalgia and MFP, but latent trigger points were rare in all groups. A more liberal definition of trigger point, however, resulted in a 38 and 23% positive rate among patients with fibromyalgia and MFP, respectively. Taut muscle bands and muscle twitches were common (50 and 30%, respectively) and noted equally in all 3 diagnostic groups. Problems with reliability were identified for taut bands, muscle twitch, and active trigger points. Our data are exploratory and tentative, but suggest that attention to definition and reliability are required to advance our knowledge of these common syndromes.

Fibromyalgia↗
PubMed1996

Pathophysiology of myofascial trigger point.

Myofascial trigger point is a sensitive spot in a palpable taut band of skeletal muscle fibers. Two important clinical characteristics of trigger points, referred pain and local twitch response, can be elicited by mechanical stimulation (palpation or needling). The trigger point is usually activated by acute or chronic injury to a muscle, tendon, ligament, joint, disc or nerve. Recent human and animal studies have suggested that the pathogenesis of either referred pain or local twitch response is related to integration in the spinal cord. It has been proposed that there are multiple sensitive loci in a trigger point region. A sensitive locus may contain one or more sensitized nociceptive nerve endings. Mechanical stimulation of a sensitive locus can elicit a local twitch response which is frequently associated with characteristic referred pain. Theoretically, sensitive loci can be found in any site of a skeletal muscle, but is usually distributed with highest concentration near the endplate region where a trigger point is frequently found. The trigger point is a common pathogenic pathway of muscle pain from different causes.

Humans↗
PubMed2003

Trigger point--acupuncture point correlations revisited.

UNLABELLED: In 1977, Melzack and colleagues examined the possible correspondence of acupuncture points and trigger points for the treatment of pain. They claimed a 71% correspondence between these two classes of points. Their findings have influenced many researchers and practitioners but have not been examined since 1977. The current study explores the claim of a 71% correspondence between these two classes of points through a more extensive examination of the acupuncture literature. OBJECTIVES: To investigate the claim of a 71% correspondence of acupuncture points and trigger points for the treatment of pain. METHODS: The study involved a review of acupuncture texts published since 1977, focusing on five textbooks for the in-depth analyses and a broader range of texts for the more general analyses. RESULTS: If trigger points correspond to any class of acupuncture points it would have to be to the a shi points rather than the "channel" or "extra" points with which the 1977 study attempted to find correlation. Approximately 35% of recommended acupuncture points in the treatment of pain are distant from the site of the pain, making assumptions about the infrequency of use of distant acupuncture points for pain suspect. Sixty-one percent (61%) of the acupuncture points that the 1977 study examined for the treatment of pain are not recommended at all for the treatment of pain, and 44% are not recommended in the treatment of any problem, while only 19% of the acupuncture points are frequently recommended for pain and 20% for all conditions. For the acupuncture points that corresponded in the 1977 study, the equivalent numbers are: 60% not recommended at all for pain, 47% not recommended for anything, 18% commonly recommended for pain, and 16% commonly recommended for anything. CONCLUSION: The claimed 71% correspondence of trigger points to acupuncture points is conceptually not possible. Furthermore, even putting this conceptual problem aside, no more than 40% of the acupuncture points that the 1977 study examined could correlate for the treatment of pain, and more likely, only approximately 18%-19% correlate rather than the 71% that was claimed. However, this study found a probable correspondence of trigger points to a different class of acupuncture points, the a shi points, which appears to be an important finding. Researchers and clinicians who have assumed the conclusions of the 1977 study to be correct will need to reexamine the impact of the current findings on any claims that are dependent on the conclusions of that study.

Acupuncture Points↗
PubMed1999

A blinded pilot study investigating the use of diagnostic ultrasound for detecting active myofascial trigger points.

Myofascial trigger points (MFTPs) have been cited by numerous authors as the cause of local and referred pain which arises from muscle and its surrounding fascia. At present there is no reliable objective test which is capable of determining their presence. It was the purpose of this pilot study to assess the use of diagnostic ultrasound in determining any soft tissue changes in the region of clinically identified active MFTPs. Eleven subjects with clinically identified, unilateral, active MFTPs were examined with diagnostic ultrasound at the site of the trigger point as well as the asymptomatic, contralateral side. The analysis of the results of this pilot study found no correlation between the clinical identification of active MFTPs and diagnostic ultrasound.

Adult↗
PubMed1992

Trigger point therapy.

Trigger points (TP) are objectively demonstrable foci in muscles. They are painful on compression and trigger pain in a referred area. This area may be the only locus of complaint in humans. In dogs we cannot prove the existence of referred zones of pain. Therefore, we can only diagnose a TP-induced claudication if we cannot find bone, joint, or neurologic abnormalities, and we do find TP that disappear after treatment together with the original lameness. Several methods have been developed to demonstrate TP existence objectively. These are pressure algometry, pressure threshold measurements, magnetic resonance thermography, and histology. In humans, 71% of the TP described are acupuncture points. TP treatment consists of TP stimulation with non-invasive or invasive methods such as dry needling or injections. In the dog, ten TP are described in two categories of clinical patients. First, those with one or few TP reacting favorably on treatment (+/- 80% success in +/- 2-3 weeks). Second, those with many TPs reacting badly on treatment. Most probably the latter group are fibromyalgia patients.

Animals↗
PubMed2002

Trigger points: diagnosis and management.

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.

Anesthetics, Local↗
PubMed1998

Intrathecal injection: unusual complication of trigger-point injection therapy.

Trigger-point injection therapy is a common procedure in primary care medicine and emergency medicine and is generally considered safe. A 28-year-old woman experienced respiratory depression and hemiplegia after the injection of a superficial trapezius trigger point. The patient required emergency tracheal intubation for ventilatory support. Computed tomography of her head revealed pneumocephalus. She recovered fully over the course of 24 hours. Intrathecal injection during a trigger-point injection is a previously unreported complication of trigger-point injection therapy.

Administration, Topical↗
PubMed1997

Interrater reliability in myofascial trigger point examination.

The myofascial trigger point (MTrP) is the hallmark physical finding of the myofascial pain syndrome (MPS). The MTrP itself is characterized by distinctive physical features that include a tender point in a taut band of muscle, a local twitch response (LTR) to mechanical stimulation, a pain referral pattern characteristic of trigger points of specific areas in each muscle, and the reproduction of the patient's usual pain. No prior study has demonstrated that these physical features are reproducible among different examiners, thereby establishing the reliability of the physical examination in the diagnosis of the MPS. This paper reports an initial attempt to establish the interrater reliability of the trigger point examination that failed, and a second study by the same examiners that included a training period and that successfully established interrater reliability in the diagnosis of the MTrP. The study also showed that the interrater reliability of different features varies, the LTR being the most difficult, and that the interrater reliability of the identification of MTrP features among different muscles also varies.

Adult↗
PubMed1977

Trigger points and acupuncture points for pain: correlations and implications.

Trigger points associated with myofascial and visceral pains often lie within the areas of referred pain but many are located at a distance from them. Furthermore, brief, intense stimulation of trigger points frequently produces prolonged relief of pain. These properties of trigger points--their widespread distribution and the pain relief produced by stimulating them--resemble those of acupuncture points for the relief of pain. The purpose of this study was to determine the correlation between trigger points and acupuncture points for pain on the basis of two criteria: spatial distribution and the associated pain pattern. A remarkably high degree (71%) of correspondence was found. This close correlation suggests that trigger points and acupuncture points for pain, though discovered independently and labeled differently, represent the same phenomenon and can be explained in terms of the same underlying neural mechanisms. The mechanisms that play a role in the genesis of trigger points and possible underlying neural processes are discussed.

Acupuncture Therapy↗
PubMed1994

Pain-pressure threshold in painful jaw muscles following trigger point injection.

Pain and tenderness at trigger points and referral sites may be modified in subjects with myofascial pain in the head and neck region by injecting local anesthetic into active trigger points, but the effect of injection on jaw muscle pain-pressure thresholds has not been measured. The mechanism by which trigger-point injection affects muscle tenderness is also unclear and may be related to the "hyper-stimulation analgesia" induced by stimulation of an acupuncture point. A pressure algometer was used before and after an active trigger point injection in the masseter to measure the pain-pressure threshold in the masseter and temporal muscles of 10 subjects with jaw muscle pain of myogenous origin. The pain-pressure threshold in the masseter and temporal muscles was also measured in a matched control group before and after an acupuncture-point injection in the masseter. The pain-pressure threshold was significantly lower in myofascial pain subjects than in control subjects at all recording sites. Pain-pressure thresholds increased minimally in the masseter after trigger-point injection, whereas the temporal region was relatively unaffected. In the control group, the pain-pressure threshold increased significantly at all recording sites in the masseter after acupuncture-point injection. Although local anesthetic injection acts peripherally at the painful site and centrally where pain is sustained, pain-pressure thresholds were not dramatically increased in myofascial pain subjects, in contrast to controls. This suggests that in subjects with myofascial pain, there was continued excitability in peripheral tissues and/or central neural areas which may have contributed to the persistence of jaw muscle tenderness.

Acupuncture Points↗
PubMed1998

Association of active myofascial trigger points and cervical disc lesions.

We investigated the occurrence of active myofascial trigger points in specific muscle groups in relation to the existence of cervical disc bulging at various levels. One hundred and five patients (48 men, 57 women; mean age, 45.8 +/- 12.1 yr) who had active trigger points in the neck or upper back after trauma were divided into two groups on the basis of magnetic resonance imaging (MRI) evidence of bulging disc(s). The discN group consisted of 46 patients who had normal MRI findings in the cervical spine. The other 59 patients, with mild cervical disc bulging, were assigned to the disc' group. The correlations between specific muscles with active trigger points (clinical finding) and cervical disc lesions at specific levels (MRI finding) were analyzed. There were significant associations between the level of disc lesion and the muscles with trigger points, namely C3-4 lesions with levator scapulae and latissimus dorsi trigger points; C4-5 lesions with splenius capitis, levator scapulae, and rhomboid minor trigger points; C5-6 lesions with splenius capitis, deltoid, levator scapulae, rhomboid minor, and latissimus dorsi trigger points; and C6-7 lesions with latissimus dorsi and rhomboid minor trigger points. For each disc level, the average pain intensity (assessed using a numerical analog scale) of trigger points in certain correlated muscles (as indicated above) in the disc group was significantly higher than that in the discN group (p < 0.05 for all disc levels). We conclude that active trigger points are more likely to occur in certain muscles in the presence of cervical disc lesions at specific levels.

Adult↗
PubMed1986

Fibrositis/fibromyalgia: a form of myofascial trigger points?

The diagnostic criteria for fibrositis and primary fibromyalgia are similar to those for myofascial pain syndromes due to trigger points. Tender points in muscles are likely to be myofascial trigger points; nonmuscular tender points clearly are not myofascial trigger points, but may be areas of tenderness referred from such trigger points. Myofascial trigger points refer pain to a distance and restrict range of motion of the muscle. They are associated with a palpable taut band that exhibits a local twitch response of the muscle, and they are responsive to treatment. Persistence of myofascial trigger points is due to perpetuating factors that can usually be corrected. Although their number is unknown, it is likely that some patients who are diagnosed as having fibrositis/fibromyalgia have multiple myofascial trigger points aggravated by a powerful perpetuating factor and also have a systemic disease process independent of the myofascial trigger points. Since myofascial pain syndromes are treatable, these patients would benefit greatly by identification and relief of the myofascial component of their pain.

Diagnosis, Differential↗
PubMed1992

An evaluation of the sensitivity and specificity of medical thermography for the documentation of myofascial trigger points.

This investigation evaluated the diagnostic value of medical thermology for the documentation of myofascial trigger points. Previous investigators have suggested that circumscribed 'hot spots' reflect the thermal activity of trigger points. A total of 365 patients participated in the four separate experiments. Upper back trigger points were isolated via palpation. A separate thermographic examination, specific to that experiment, was conducted by a technologist who was blind to the presence or absence of trigger points. The first experiment examined the Swerdlow-Dieter protocol. Fifty percent of the subjects with trigger points demonstrated hot spots. Over 60% of patients without trigger points exhibited hot spots. Chi-square analysis determined that there was no significant difference between these two groups. The majority of hot spots were unrelated to trigger point location. The second experiment evaluated the protocol suggested by Fisher. Hot spots were evident in the majority of subjects, regardless of whether they possessed trigger points. The third experiment investigated hot spot persistence by adapting the Weinstein-Weinstein alcohol spray protocol. Chi-square analysis found no significant difference between the effect which spray had on the hot spots of patients with or without trigger points. Following a post-spray machine adjustment, the majority of pre-spray hot spots could be reproduced. The final experiment used a pressure threshold meter (PTM) to evaluate the number of kilograms pressure a patient's hot spot could comfortably sustain in comparison to the opposite location on the back. Using the t test, no significant difference was found between the kilograms pressure withstood by hot spot and non-hot spot regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗
PubMed1989

Effects of the infrared laser therapy at treated and non-treated trigger points.

For reliability of the pain threshold measurement there were measured first 390 trigger points of 22 healthy students twice at each point. The reliability of two different measurements was found to be perfect. Infrared (904 nm) laser therapy was compared to placebo laser at the trigger points. Our study tested eighteen patients (11 men and 7 women), with 31 active trigger points in the muscles of the infraspinatus, extensor carpi radialis, levator scapulae, trapezius and tibialis anterior. Trigger points were randomly managed by infrared laser (dose 1.5J/point and place laser. The study was carried out by double-blind and cross-over principle. The responses of the management were documented by the pain threshold meter measurements of these trigger points before and after the treatments, and then fifteen minutes later. The trigger points of the other side of the body were also measured from the same muscles. In the results there were observed highly significant changes between the laser and placebo groups immediately after the treatment, 0.97 (SE 0.16) kg/cm2 (p less than 0.001). The differences between these two treatments were greater after fifteen minutes of the therapy--1.87 (SE 0.30) kg/cm2 (p less than 0.001). At the non-treated trigger points, the significant increase of the values was seen after fifteen minutes (p less than 0.05). Our research study results suggest that infrared laser had an effect at the trigger points and that the treatment significantly increased the pain threshold.

Adult↗
PubMed1996

Trigger points and tender points: one and the same? Does injection treatment help?

Trigger points are defined as areas of muscle that are painful to palpation and are characterized by the presence of taut bands and the generation of a referral pattern of pain. Tender points are areas of tenderness occurring in muscle, muscle-tendon junction, bursa, or fat pad. When tender points occur in a widespread manner, they are usually considered characteristic of fibromyalgia. Trigger points, which typically occur in a more restricted regional pattern, are indicative of myofascial pain syndrome. In some patients the two phenomena may coexists, and overlap syndromes can occur. Although experienced examiners can generally identify the same tender points, interrater reliability of trigger points has been low in most studies. There is continued controversy regarding the defining characteristics and homogeneity of myofascial pain because of the variability of the examination findings. In appropriately selected patients, it appears that myofascial trigger point injections can be helpful in decreasing pain and improving range of motion in conjunction with a comprehensive exercise and rehabilitation program.

Fibromyalgia↗