Cervical myofascial pain syndrome - Is the ultrasound-guided needling approach a therapeutic option?

Abstract

Myofascial pain syndrome (MPS) is a frequent entity in clinical practice and is characterized by the presence of trigger points, limitation of joint mobility and neurological symptoms. The main purpose of this work was to evaluate the results obtained by perform an ultrasound-guided needling of the trapezius and levator scapulae muscles with simultaneous injection of steroids and local anesthetics, in the pain intensity and interference in daily life and the subjective benefits in patients with cervical MPS. Prospective longitudinal study, including patients with clinical diagnosis of unilateral or bilateral cervical MPS refractory to the conventional rehabilitation program, submitted to treatment during the year 2017. The technique included to pepper the trigger point with a fanlike manner under ultrasound guidance, using a 22G needle with simultaneous injection of 2% lidocaine and methylprednisolone acetate 40 mg/mL. A sociodemographic questionnaire, the pain numerical rating scale (NRS) and the brief pain inventory (BPI) were applied prior and 1 month after the procedure. In this last evaluation, a Likert scale was also applied to evaluate the subjective benefits. Eighteen patients were included, 82% female, with a mean of 54 years (SD = 8.2). No adverse effects were recorded. There was a statistically significant and clinically relevant reduction in the score obtained in the NRS (2.9, P < 0.001) and in all components of the BPI, including intensity (2.6, P < 0.001), pain interference in general activity (1.9, P < 0.001) and in the affective subdimension (1.7, P < 0.001). Fifty-four percent of the patients reported a very significant improvement with the procedure, but only 33% presented a ≤ 4 value in the NRS at 1 month reassessment. The results presented in this study show the importance of ultrasound-guided needling procedures in the treatment of myofascial pain and, at least, it short-term efficacy on reliefing pain, particularly in refractory cervical MPS.