Chronic Myofascial Pain Research Articles

Platelet-derived Growth Factor Receptor-α Induces Contraction Knots and Inflammatory Pain-like Behavior in a Rat Model of Myofascial Trigger Points.

Myofascial trigger points (MTrPs) are the primary etiological characteristics of chronic myofascial pain syndrome. Receptor tyrosine kinases (RTKs) are associated with signal transduction in the central mechanisms of chronic pain, but the role of RTKs in the peripheral mechanisms of MTrPs remains unclear. The current study aimed to identify RTKs expression in MTrPs and elucidate the molecular mechanisms through which platelet-derived growth factor receptor-α (PDGFR-α) induces contraction knots and inflammatory pain-like behavior in a rat model of myofascial trigger points. MTrPs tissue samples were obtained from the trapezius muscles of patients with myofascial pain syndrome through needle biopsy, and PDGFR-α activation was analyzed by microarray, enzyme-linked immunosorbent assay, and histological staining. Sprague-Dawley rats (male and female) were used to investigate PDGFR-α signaling, assessing pain-like behaviors with Randall-Selitto and nest-building tests. Muscle fiber and sarcomere morphologies were observed using histology and electron microscopy. The PDGFR-α binding protein was identified by coimmunoprecipitation, liquid chromatograph mass spectrometer, and molecular docking. PDGFR-α-related protein or gene levels, muscle contraction, and inflammatory markers were determined by Western blot and reverse-transcription quantitative polymerase chain reaction. PDGFR-α phosphorylation levels were elevated in the MTrPs tissues of individuals with trapezius muscle pain and were positively correlated with pain intensity. In rats, PDGFR-α activation caused pain-like behaviors and muscle contraction via the Janus kinase 2/signal transducer and activator of transcription-3 (JAK2/STAT3) pathway. JAK2/STAT3 inhibitors reversed the pain-like behaviors and muscle contraction induced by PDGFR-α activation. Collagen type I α 1 (COL1A1) binds to PDGFR-α and promotes its phosphorylation, which contributed to pain-like behaviors and muscle contraction. COL1A1-induced phosphorylation of PDGFR-α and the subsequent activation of the JAK2/STAT3 pathway may induce dysfunctional muscle contraction and increased nociception at MTrPs.

Acupuncture for low back pain and migraine

Acupuncture has been increasingly used as an integrative or complementary therapy for pain. It is well-tolerated with little risk of serious adverse effects. Traditional acupuncture and nontraditional techniques, such as electroacupuncture and dry needling, often result in reported pain improvement. Acupuncture is an ancient Chinese medical practice that involves inserting thin needles into specific points on the body. Acupuncture can be used to treat a wide range of health conditions, including migraines and low back pain. Acupuncture works by stimulating the nervous system, releasing endorphins and increasing blood flow to the affected area. Acupuncture may also help to reduce inflammation and improve circulation in the body. Controlled trials have been published on pain syndromes, such as acupuncture for acute and chronic low back pain, knee osteoarthritis, headache, myofascial pain, neck pain, and fibromyalgia. For some conditions, enough data are available for systematic evaluations or meta-analyses. Acupuncture may provide modest benefits in the treatment of chronic low back pain, tension headache and chronic headache, migraine headache prophylaxis, and myofascial pain.The benefits of acupuncture for people with back pain has been well researched compared to many other conditions, with more higher quality clinical trials. This systematic review will focus on the use of acupuncture and its role in the treatment of low back pain to help better guide physicians in their practice. To determine the effects of a policy of ‘use acupuncture’ on headache, health status and chronic pain. The results of this study will determine if acupuncture, alone or as an adjunct to pharmacotherapy provides effective, safe and acceptable pain relief for patients.

Effects of myofascial trigger point injection on the disease activity in patients with comorbidity of fibromyalgia and cervical myofascial pain syndrome

Aims: To investigate the effect of myofascial trigger point injection on the disease activity of FS in patients with myofascial trigger points in the coexistence of fibromyalgia syndrome (FS) and chronic cervical myofascial pain syndrome (MAS). Methods: 30 consenting patients between the ages of 18-60 who has had FS for at least for 3 months and also MPS in trapezius, levator skapula, splenius capitis, and multifidus muscles in cervical region and 15 patients with FS but without MPS were included in the present study. Patients newly diagnosed with FS, were evaluted for the presence of MPS and FS, disease activity was evaluated before administering treatment and after administration of trigger point injection tretament for cervical MPS. In the group with only FS, cervical region tender point injection was carried out. Patients were evaluated before injection and one month after injection. Severity of pain was evaluated with VAS (visual analog scale), pressure pain threshold was measured with algometer, total myalgic score (TMS) , fibromiyalgia impact questionnaire (FIQ), Pittsburgh sleep quality index (PSQI) , Beck depression inventory (BDI), Beck anxiety inventory (BAI), fatique severity scale (FSS) results were evaluated prior to and after treatment. Results: When patients were evaluted at 1st month after myofacial trigger point and cervical tender point injections statistically significant decrease was found in VAS, TMS, PSQI, FIQ, FSS, BAI and BAI scores and the number of trigger points in both FS and FS+MAS groups. (for all parameters p<;0,005). However, this decrease was more evident in FS+MPS group. Conclusion: In conclusion, in the concomitance of MPS and FS, which is one of the most common causes of widespread musculoskletal pain, the treatment of MPS with trigger point injection has been shown to exert positive effects on the severity of FS, affective disorders, sleep and fatique. In the treatment of FS, thetreatment of MPS, which is one of the periheral pain generators, should be given priority.

The challenge of ecological validity in temporomandibular disorders research.

To review the ecological validity of outcomes from current research involving temporomandibular disorders (TMDs), with an emphasis on chronic myofascial pain and the precocious development of degenerative disease of the temporomandibular joint (TMJ). Current approaches used to study TMDs in terms of neuromechanics, masticatory muscle behaviours, and the dynamics of the autonomic nervous system (ANS) were assessed for ecological validity in this review. In particular, the available literature was scrutinized regarding the effects of sampling, environmental and psychophysiological constraints and averaging data across biological rhythms. Validated computer-assisted numerical modelling of the neuromechanics used biological objective functions to accurately predict muscle activation patterns for jaw-loading tasks that were individual-specific. With respect to masticatory muscle behaviour, current findings refute the premise that sustained bruxing and clenching at high jaw-loading magnitudes were associated with painful TMDs such as myofascial pain. Concerning the role of the ANS in TMDs, there remains the need for personalized assessments based on biorhythms, and where the detection of dysregulated physiologic oscillators may inform interventions to relieve pain and restore normal function. Future human research which focuses on TMD myofascial pain or the precocious development and progression of TMJ degenerative joint disease requires experimental designs with ecological validity that capture objectively measured data which meaningfully reflect circadian and ultradian states.

Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison.

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2-C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2-C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2-C7 SVA and ARA C2-C7 were measured. A linear-regression R2 value to assess the correlation between the CVA, C2-C7 SVA, and ARA C2-C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman's r = 0.549; R2 = 0.30, p < 0.001) between the CVA and C2-C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2-C7 and the CVA: Spearman's r = 0.524; R2 = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2-C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2-C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions.

Treatment of Fascial Pain with Glucopuncture

Over the last decade, clinicians worldwide discovered that fascia plays an important role in musculoskeletal posture, balance and tensegrity. Most physicians are not fully aware that the fascial system also contains a lot of nociceptors. This may explain its potential role in vague musculoskeletal pain syndromes. However, treating fascial pain effectively is not an easy task. Recently, it has been postulated that glucopuncture – a technique which applies multiple regional injections with dextrose 5% - can regulate pain originating from fascial dysfunction. The mode of action is probably related to ATP and TRPV1. Especially the superficial layer of fascia is an interesting target for regional injections when dealing with a patient with vague pain patterns. It is particularly interesting for sports injuries, neuralgia and chronic nonrheumatic musculoskeletal pain. The major advantage of glucopuncture over steroid injections is the interesting safety profile of dextrose 5%. The disadvantages of dextrose versus steroids is that multiple injections and multiple sessions are required. The latter is particularly the case when dealing with chronic myofascial pain. It is hypothesized that glucopuncture has a very interesting balance between efficacy versus side effects. More research in this field may confirm our preliminary findings. And we hope to spread this message worldwide, especially in low-income communities.

Ab. No. 129 Current Practice of Fascial Distortion Model (FDM) on Chronic Pain in Individuals With Chronic Myofascial Neck Pain: A Review Study

Introduction: The purpose of the study is to determine the effect of FDM on chronic pain in individuals with Chronic Myofascial Neck Pain Syndrome. The study provides insights regarding the current practice of FDM on chronic pain among physiotherapists and health professionals in individuals with chronic myofascial neck pain. Methods: The research of Randomized clinical trials and cross-over trials published between 2014 and 2023 was performed on various databases, including PubMed, and search engines, including Research Gate and Google Scholar. The data was limited to the last 10 years (2014–2023) and was in the English language. 10 articles were identified, out of which 7 articles that met the inclusion criteria were selected. PRISMA methodology guidelines were used for data extraction. Qualitative analysis of the study was done using the PEDro scale (Physiotherapy Evidence Database). According to the PEDro analysis, the majority of the articles included were of good quality. Results: In this study, a total of 7 studies on FDM for the treatment of chronic myofascial neck pain syndrome were reviewed. Most of them showed significant results in improving pain and range of motion. Data showed that FDM is a fascial manipulation technique that works on the deep fascia and leads to myofascial pain reduction. Conclusion: FDM can aid in reducing pain and improving the function and extensibility of the upper region. Implications: FDM has been found to be a good and effective method for improving myofascial neck pain and increasing limited range of motion by working fascia.

Association between central sensitivity syndrome and psychophysical factors in patients with masticatory myofascial pain.

This study explored the relationship between central sensitization symptoms, assessed using the Central Sensitization Inventory (CSI), and psychophysical factors in patients with chronic masticatory myofascial pain (MMP) transitioning from the acute to chronic stages. In this study, 23 patients with MMP and 22 healthy volunteers were assessed using psychophysical tests, including measurements of pressure pain threshold (PPT) and temporal summation of pain (TSP). Additionally, CSI scores were recorded to evaluate central sensitization symptoms. Patients with chronic MMP showed significantly lower PPT in all masticatory muscles and extratrigeminal areas compared with controls. However, there was no significant correlation between CSI scores and psychophysical test results in patients with MMP. The significant enhancement of TSP in patients with subchronic MMP suggests a potential role in the onset of myofascial pain. The main finding suggests that sub-chronic symptom patients show higher CSI scores despite no sensory testing changes, indicating that central sensitization possibly precedes observable symptoms.

Erector spinae plane block with warm saline solution for treating chronic myofascial pain.

Erector spinae plane block with warm saline solution for treating chronic myofascial pain.

Prevalence and risk factors of vitamin D deficiency among patients with chronic myofascial pain syndrome: a cross-sectional study

BackgroundMyofascial pain syndrome (MPS) is a common muscle condition characterized by painful trigger points. Vitamin D deficiency has been recognized as a precipitating factor of MPS. The present study aimed to determine the prevalence and risk factors of vitamin D deficiency in patients with chronic MPS.MethodsA cross-sectional study was conducted, using a structured face-to-face interview to collect demographic information, clinical characteristics, pain duration and location, as well as the bodily pain subscale of SF36 and EQ-5D-5 L. The Elecsys vitamin D total II assay was used to measure serum total 25-hydroxyvitamin D level.ResultsOf 120 participants, vitamin D insufficiency (20 to 29.9 ng/ml) and deficiency (< 20 ng/ml) were 47.5% (95% CI: 38.3–56.8%) and 34.2% (95% CI: 25.8–43.4%), respectively. The adjusted odds ratios for vitamin D deficiency of participants aged < 45 years and who reported having ≤ 15 min sunlight exposure per day were 3.5 (95% CI: 1.54 to 7.98) and 2.38 (95% CI: 1.05 to 5.26), respectively. The bodily pain score (r = − 0.02, P = 0.86) and EQ-5D-5 L utility (r = 0.04, P = 0.66) did not significantly correlate with vitamin D levels.ConclusionApproximately one third of patients with chronic MPS had vitamin D deficiency. Age < 45 years and sunlight exposure ≤ 15 min/day were identified as potential risk factors for vitamin D deficiency in MPS patients.

Different treatments modalities for tempromandibular dysfunction

Aim To clinically compare treatment of TMDs using hard occlusal stent constructed by CAD/CAM technology, low-level laser therapy (LLLT) and a combination of hard occlusal stent and LLLT. Patients and methods Twenty-one adult patients have suffered from chronic myofascial pain for at least three months. The patients were randomly divided into three equal groups based on the kind of treatment. Group A: Patients have received hard occlusal stent constructed by CAD/CAM technology. Group B: Patients have received LLLT. Group C: Patients have received a combination of hard occlusal stents constructed by CAD/CAM technology and LLLT. Clinical evaluations were done using Visual Analogue Scale (VAS) evaluation before therapy, at the fifth week, the third and sixth months after the onset of the study period. Data at the end of the trial was gathered, tabulated and statistically analyzed. Results Clinical results revealed that all three groups showed a general improvement in TMDs symptoms throughout the study period. The improvement was significant in all the study group periods. There was no statistically significant difference between the groups. Conclusions It has been established that the CAD/CAM occlusal stent, LLLT, and combination of CAD/CAM occlusal stent and LLLT enhances patient satisfaction and pain alleviation in individuals with TMDs.

Pressure release technique versus placebo applied to cervical and masticatory muscles in patients with chronic painful myofascial temporomandibular disorder: A randomised clinical trial.

The therapeutic approach to myofascial TMD should focus on pain relief and rehabilitation of function. This study investigated whether pressure release technique (PRT) is effective for reducing pain in people with chronic myofascial temporomandibular disorders (TMD). A single-blinded randomised parallel-group trial, with 3 months follow-up was conducted. A total of 72 patients were randomly allocated to receive PRT or sham PRT. Primary outcome was pain assessed with a visual analogue scale (VAS). Secondary outcomes included pressure pain thresholds (PPTs), range of opening of the mouth (ROM), Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), State-Trait Anxiety Index (STAI) and State-Trait Depression Index (ST-DEP). All parameters were assessed at baseline, at the end of the treatment and at 3 months follow-up. Statistical analysis was performed by ANOVA. There were significant main effects of time, group and interaction between time and group (F ≥ 21.92; p < .001) on VAS pain. Post hoc tests showed a significant reduction in VAS pain scores in the PRT group (≥31.9%; p < .001). Effect sizes were moderate in the PRT group at all follow-up periods (≥1.25 Cohen's d). Also, there were significant effects of time in secondary outcomes (F ≥ 9.65; p < .001), and there were also interactions between time and group (F ≥ 3.82; p < .002) with better effects in the PRT group. The inclusion of PRT to conventional management with occlusal splints and self-care management appears to be effective to improve self-reported levels of pain in patients with chronic myofascial TMD pain. Retrospectively registered (ClinicalTrials.gov: NCT03619889).

Descending serotonergic modulation from rostral ventromedial medulla to spinal trigeminal nucleus is involved in experimental occlusal interference-induced chronic orofacial hyperalgesia

BackgroundDental treatment associated with unadaptable occlusal alteration can cause chronic primary myofascial orofacial pain. The serotonin (5-HT) pathway from the rostral ventromedial medulla (RVM) exerts descending modulation on nociceptive transmission in the spinal trigeminal nucleus (Sp5) and facilitates chronic pain. The aim of this study was to investigate whether descending 5-HT modulation from the RVM to the Sp5 is involved in the maintenance of primary myofascial orofacial hyperalgesia after persistent experimental occlusal interference (PEOI) or after delayed removal of experimental occlusal interference (REOI).MethodsExpressions of 5-HT3A and 5-HT3B receptor subtypes in the Sp5 were assessed by immunofluorescence staining and Western blotting. The release and metabolism of 5-HT in the Sp5 were measured by high-performance liquid chromatography. Changes in the pain behavior of these rats were examined after specific pharmacologic antagonism of the 5-HT3 receptor, chemogenetic manipulation of the RVM 5-HT neurons, or selective down-regulation of 5-HT synthesis in the RVM.ResultsUpregulation of the 5-HT3B receptor subtype in the Sp5 was found in REOI and PEOI rats. The concentration of 5-HT in Sp5 increased significantly only in REOI rats. Intrathecal administration of Y-25130 (a selective 5-HT3 receptor antagonist) dose-dependently reversed the hyperalgesia in REOI rats but only transiently reversed the hyperalgesia in PEOI rats. Chemogenetic inhibition of the RVM 5-HT neurons reversed the hyperalgesia in REOI rats; selective down-regulation of 5-HT in advance also prevented the development of hyperalgesia in REOI rats; the above two manipulations did not affect the hyperalgesia in PEOI rats. However, chemogenetic activation of the RVM 5-HT neurons exacerbated the hyperalgesia both in REOI and PEOI rats.ConclusionsThese results provide several lines of evidence that the descending pathway from 5-HT neurons in the RVM to 5-HT3 receptors in the Sp5, plays an important role in facilitating the maintained orofacial hyperalgesia after delayed EOI removal, but has a limited role in that after persistent EOI.Graphical

Ultrasound-guided pulsed radiofrequency versus dry needling for pain management in chronic neck and shoulder myofascial pain syndrome patients at a tertiary hospital in China: a randomised controlled trial protocol

IntroductionMyofascial pain syndrome (MPS), especially in the neck and shoulder region, is one of the most common chronic pain disorders worldwide. Dry needling (DN) and pulsed radiofrequency (PRF) are the...

Preliminary outcomes of the COVID-19 pandemic: a new chronic pain profile

In summing up the preliminary results of the COVID-19 pandemic that has not yet ended, modern research pays much attention to the so-called post-COVID syndrome, which includes the long-term consequences of the disease. In English, symptoms are reported as long COVID, post-acute COVID, or chronic post-COVID syndrome and are described as symptoms of fatigue, respiratory disorders, memory, and sleep problems. Symptoms such as muscle pain and decreased endurance when performing habitual physical exertion are mentioned much less often. Meanwhile, among the complaints of those who have been ill, this symptom is present quite often, reducing the quality of life and tolerability of normal physical exertion. This review aimed to provide an in-depth study of a new type of the chronic myofascial pain syndrome after COVID-19, i.e., the frequency of occurrence, causes of the development, and pathophysiology of chronic pain syndrome associated with COVID-19 and manifested as fibromyalgia of various localizations. To answer the questions posed, the authors searched for information in four electronic databases. The key search terms used were COVID-19, long COVID, and signs and symptoms of pain syndrome. A review of current literature data has shown that close study and dynamic monitoring of patients who had COVID-19 can contribute to further deciphering the pathophysiological mechanisms of the development of its long-term consequences and provide answers to questions on the prevention and treatment of chronic pain syndrome in this patient cohort.

Effect of Different Physical Therapy Interventions on Brain-Derived Neurotrophic Factor Levels in Chronic Musculoskeletal Pain Patients: A Systematic Review.

The main objectives of this review were, firstly, to study the effect of different physiotherapy interventions on BDNF levels, and, secondly, to analyze the influence of physiotherapy on pain levels to subsequently draw conclusions about its possible relationship with BDNF. Based on the theory that neurotrophic factors such as BDNF play a fundamental role in the initiation and/or maintenance of hyperexcitability of central neurons in pain, it was hypothesized that the levels of this neurotrophic factor may be modified by the application of therapeutic interventions, favoring a reduction in pain intensity. A literature search of multiple electronic databases (Pubmed, PsycINFO, Medline (Ebsco), Scopus, WOS, Embase) was conducted to identify randomized control trials (RCTs) published without language restrictions up to and including March 2022. The search strategy was based on the combination of medical terms (Mesh) and keywords relating to the following concepts: "pain", "chronic pain", "brain derived neurotrophic factor", "BDNF", "physiotherapy", and "physical therapy". A total of seven papers were included. There were two studies that showed statistically significant differences in pain intensity reduction and an increase in the BDNF levels that used therapies such as rTMS and EIMS in patients with chronic myofascial pain. However, the same conclusions cannot be drawn for the other physical therapies applied. rTMS and EIMS interventions achieved greater short-term reductions in pain intensity and increased BDNF over other types of interventions in chronic myofascial pain patients, as demonstrated by a moderate amount of evidence. In contrast, other types of physical therapy (PT) interventions did not appear to be more effective in decreasing pain intensity and increasing BDNF levels than placebo PT or minimal intervention, as a low amount of evidence was found.

Clinical Experience with Transdermal Combination Drug Therapy: Treatment of Various Pain Conditions with Transdermally Applied Combination of Gabapentin and Naproxen

Background: The authors challenged the current pain treatment paradigm and its focus on the systemic treatment of pain by the oral administration of opioids, high dose non-steroid anti-inflammatory drugs, anticonvulsants, and psychotropic drugs and studied and retrospectively analyzed the efficacy of a transdermal emulsion on various chronic pain conditions. Case Reports: The clinician has an active chronic and acute pain practice and favors transdermal drug treatment for various pain conditions. The therapy consisted of a transdermal emulsion containing gabapentin and naproxen sodium in a 10% to 5% ratio. The treatment included 2-3/day application of emulsion to the target area. Substantial pain relief was obtained in the treatment of chronic and acute myofascial, musculoskeletal, and neuropathic pain. Conclusion: The authors offer transdermal combination drug therapy as an appropriate peripheral pain treatment alternative to systemic drug therapy and avoid the human and societal costs of opioids, high dose NSAIDs and psychoactive drugs.

Comparison of Local Anesthetic Injection and Exercise Therapy Results in Patients with Chronic Cervical Myofascial Pain Syndrome

Objective: The study was planned to evaluate patients with chronic cervical myofascial pain syndrome treated with lidocane injection and exercise and to compare the efficacy of treatments.Material and Method: The study included 73 patients (40 females, 33 males) aged between 25 and 65 years, who had been treated with exercise and lidocane injection due to the diagnosis of myofascial pain syndrome in our clinic 6 months ago, and volunteered to participate in the study. The mean age of the participants in the exercise group (n=38) was 44.16±10.63 years. The age of the participants in the lidokayn injection group (n=35) was 42.20±11.63 years. The exercise group was given stretching exercises for the neck and upper back muscles, and strengthening exercises for the neck muscles, 3 sets of 10 times a day. On the other hand, to the Lidokayn injection group participating in the study, 2 ml of 1% lidocaine was applied locally to the trigger points according to the injection technique defined by Travell and Simons. Patients' pain Visual Analogue Scale. pressure pain threshold Algometer, muscle spasm Palpable Muscle Spasm Scoring, cervical normal joint movement (CROM), disability level Neck Disability Scale, depression status Beck Depression Scale, anxiety status Beck Anxiety Inventory and quality of life SF-36 Short Form-36 scales. . Statistical significance level is (p&amp;lt;0.05).Results: The results of lidocaine ejection and exercise are similar in the treatment of MAS. We think that exercise therapy is more feasible in the treatment of MAS because it is non-invasive, easily applicable and more economical.

Differential Sensitization of Muscle versus Fascia in Individuals with Low Back Pain.

Muscles and the deep fascia surrounding them have been suggested to play an important role in various musculoskeletal pain conditions including low back pain. Both have been shown to host rich nociceptive innervation and to undergo changes in individuals with chronic pain. However, evidence for the respective contribution of muscle and fascia sensitization in humans with myofascial pain syndrome is lacking. Here, we studied the sensitization of muscle and fascia in individuals with myofascial low back pain. Twenty individuals with acute (5) and chronic (15) myofascial low back pain of the quadratus lumborum muscle and a matched control group of twenty healthy individuals were recruited and clinically evaluated. All participants underwent ultrasound-guided needling of their subcutaneous tissue, deep fascia and quadratus lumborum muscle. Reported pain intensity and episodes of muscle twitching were recorded and analyzed. Among pain patients, both muscles and deep fascia demonstrated pain hypersensitivity, but muscles were significantly more sensitized than the deep fascia. No difference between acute- or chronic-pain patients was observed. Results of this study suggest that while both deep fascia and muscle show pain sensitization in both early and chronic stages of low back pain, muscles are more sensitized than fascia.

Complementary Effect of Electro Acupuncture on Refractory Head and Neck Myofascial Pain: A Retrospective Investigation of Patient-Reported Outcomes

Introduction: Acupuncture (AC) is among the complementary treatment modalities to manage chronic myofascial pain. The aim of this investigation was to assess the additive effect of AC in reducing the intensity of primary chronic myalgia/myofascial head and neck pain in patients using oral orthotic appliances (OA). Methods: A retrospective chart review was conducted for 103 patients diagnosed with primary chronic myalgia/myofascial pain and received OA with/without AC at Tufts University School of Dental Medicine (TUSDM). Subjective reporting of face/TMJ/neck pain was recorded at the initial visit and at short-term and long-term follow-ups using patient-reported pain/discomfort numeric rating scale (NRS). Results: Most subjects were females (77.7%) with the mean age of the entire study population being 53 years old. In patients with refractory response to OA, combining AC with OA showed significant improvement in NRS score compared to baseline, in TMJ pain (P=0.023), neck pain (P= 0.055), facial pain (P=0.006). The addition of AC to OA has also brought refractory pain to low levels, comparable to what OA-only respondents reported [TMJ pain (P= 0.395), neck pain (P=0.694), face pain (P=0.553)]. Conclusion: AC may provide a complementary therapeutic modality to manage refractory cases of primary chronic myofascial pain.