Deactivation Of Trigger Points Research Articles

Assessing the Relationship between Obesity and Trigger Point-specific Outcomes after Headache Surgery.

Trigger point deactivation surgery is a safe and effective treatment for properly selected patients experiencing migraine, with 68.3%-100% experiencing symptom improvement postoperatively. However, it is still unknown why certain patients do not respond. Obesity has been shown to be associated with worsened migraine symptoms and a decreased response to select pharmacotherapies. This study aimed to determine whether obesity may also be associated with an attenuated response to surgery. A retrospective chart review was conducted to identify patients who had undergone trigger point deactivation surgery for migraine. Patients were split into obese and nonobese cohorts. Obesity was classified as a body mass index of 30 or higher per Centers for Disease Control and Prevention guidelines. Outcomes and follow-up periods were determined with respect to individual operations. Outcomes included migraine attack frequency, intensity, duration, and the migraine headache index. Differences in demographics, operative characteristics, and operative outcomes were compared. A total of 62 patients were included in the study. The obese cohort comprised 31 patients who underwent 45 total operations, and the nonobese cohort comprised 31 patients who underwent 34 operations. Results from multivariable analysis showed no impact of obesity on the odds of achieving a more than 90% reduction in any individual outcome. The overall rates of improvement (≥50% reduction in any outcome) and elimination (100% reduction in all symptoms) across both cohorts were 89.9% and 65.8%, respectively. Obese patients have outcomes comparable to a nonobese cohort after trigger point deactivation surgery for migraine.

Secondary Trigger Point Deactivation Surgery for Nerve Compression Headaches: A Scoping Review.

Primary trigger point deactivation surgery has been successful in reducing or eliminating nerve compression headaches between 79% and 90% of the time. The aim of this review article was to discuss the factors that contribute to index trigger point deactivation surgery failure, the importance of reevaluating trigger points following failure, and the options for secondary surgery. A literature search was performed using a combination of keywords involving "chronic headache" and "nerve deactivation surgery," in databases until February 2023. Data of 1071 patients were evaluated and included (11 articles). The failure rate after index trigger point deactivation surgery occurs is approximately 12%, primarily due to incomplete primary trigger point deactivation. Secondary trigger points may not appear until the primary trigger is eliminated, which occurs in 17.8% of patients. Reevaluation of previously diagnosed trigger points as well as uncovered trigger points and additional preoperative testing is indicated to help determine candidacy for further surgical deactivation. To address scarring that could contribute to failure, corticosteroid injection, acellular dermal matrix, adipofascial fat, or expanded polytetrafluoroethylene sleeves have been described with beneficial effects. For neuroma management, regenerative peripheral nerve interface, targeted muscle reinnervation, a combination of both, relocation nerve grafting, or nerve capping have also been described. Neurectomy can be performed when patients prefer anesthesia and/or paresthesia over current pain symptoms. Secondary trigger point deactivation surgery is indicated when there is suspicion of incomplete deactivation, internal scarring, neuroma, or newly-diagnosed trigger points.

Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study

IntroductionChronic migraine headaches (MH) are a principal cause of disability worldwide. This study evaluated and compared functional outcomes after peripheral trigger point deactivation surgery or botulinum neurotoxin A (BTA) treatment in patients with MH. MethodsA long-term, multicenter, and prospective study was performed. Patients with chronic migraine were recruited at the Ohio State University and Massachusetts General Hospital and included in each treatment group according to their preference (BTA or surgery). Assessment tools including the Migraine Headache Index (MHI), Migraine Disability Assessment Questionnaire (MIDAS) total, MIDAS A, MIDAS B, Migraine Work and Productivity Loss Questionnaire-question 7 (MWPLQ7), and Migraine-Specific Quality of Life Questionnaire (MSQ) version 2.1 were used to evaluate functional outcomes. Patients were evaluated prior to treatment and at 1, 2, and 2.5 years after treatment. ResultsA total of 44 patients were included in the study (surgery=33, BTA=11). Patients treated surgically showed statistically significant improvement in headache intensity as measured on MIDAS B (p = 0.0464) and reduced disability as measured on MWPLQ7 (p = 0.0120) compared to those treated with BTA injection. No statistical difference between groups was found for the remaining functional outcomes. Mean scores significantly improved over time independently of treatment for MHI, MIDAS total, MIDAS A, MIDAS B, and MWPLQ 7 (p<0.05). However, no difference in mean scores over time was observed for MSQ. ConclusionsHeadache surgery and targeted BTA injections are both effective means of addressing peripheral trigger sites causing headache pain. However, lower pain intensity and work-related disabilities were found in the surgical group.

Trigger Point Deactivation in MPDS: A Comprehensive Guide to Non-invasive Therapeutic Modalities

Myofascial pain syndrome MPS is defined as pain origination due to the activation of myofascial trigger points present in taut bands of skeletal muscle. This article aimed to review the existing hypothesis regarding the deactivation of trigger points in myofascial region as a treatment modality to reduce the muscle pain. Various pharmacologic interventional methods were reviewed such as are physiotherapy occlusal therapy anti-inflammatory and analgesics manual and massage technique muscle relaxants transcutaneous electric nerve stimulation laser therapy ultrasound therapy and botulinum toxin which may be attempted in severe cases. Through a critical evidence-based review of the pharmacologic and non-pharmacologic treatment options this article aims to provide clinicians with a complete comprehensive knowledge of the interventions for deactivation of trigger points in the treatment of myofascial pain.

Manual therapy associated with topical heat reduces pain and self-medication in patients with tension-type headache

ABSTRACT Tension-type headache (TTH) is a significant public health problem. The myofascial trigger points in the masticatory and cervical muscles are related to pain located in the temporomandibular joint, face, and cranium according to specific patterns. Thus, therapeutic procedures should be directed to myofascial trigger points rather than to the area of referred pain. For this purpose, the massage therapy combined with the topical heat can provide effective results due to the increase of the local microcirculation, improving tissue perfusion and promoting muscle relaxation. In this study we investigated the effects of manual therapy associated with topical heat therapy in TTH pain. This is a single-arm study composed of 13 participants with TTH (females), which were submitted to a three-month research protocol. In the first month , they filled out a pain diary and then they were evaluated. In the following month, the treatment protocol was applied (8 sessions of 45 minutes, twice a week, involving massage for skin desensitization, myofascial trigger point deactivation and stretching (friction massage) on masticatory and trapezius muscles after the topical heat). Then, in the third month (follow-up period), the participants were instructed to fill out the pain diary once again. We observed a significant decrease in pain intensity in TTH episodes, and medication intake after treatment and it keeps decreasing in follow-up. We conclude that the combination of manual therapy protocol and topical heat reduced pain and episodes related to TTH, and self-medication use in our sample.

Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part II: Myofascial Pain

To present an algorithm of sequential treatment options for managing myofascial pain (MP) in older adults, along with a representative clinical case. A modified Delphi process was used to synthesize evidence-based recommendations. A multidisciplinary expert panel developed the algorithm, which was subsequently refined through an iterative process of input from a primary care physician panel. We present an algorithm and supportive materials to help guide the care of older adults with MP, an important contributor to chronic low back pain (CLBP). Addressing any perpetuating factors should be the first step of managing MP. Patients should be educated on self-care approaches, home exercise, and the use of safe analgesics when indicated. Trigger point deactivation can be accomplished by manual therapy, injection therapy, dry needling, and/or acupuncture. The algorithm presented gives a structured approach to guide primary care providers in planning treatment for patients with MP as a contributor to CLBP.

A Rational Approach to the Management of Chronic Migraine

About 2% of the adult population has chronic migraine with only 20% diagnosed with this disorder. Those with medication overuse may improve with withdrawal of overuse medications. The intravenous dihydroergotamine regimen usually produces short-term benefit for those with medically refractory chronic migraine. OnabotulinumtoxinA and topiramate have shown efficacy in large placebo-controlled randomized trials. Sodium valproate, gabapentin, tizanidine, amitriptyline, fluoxetine, zonisamide, and possibly memantine may be alternative or possibly combined treatment options but with lesser levels of evidence supporting their use. Preliminary evidence suggests that nerve blocks might be beneficial. Acupuncture, biofeedback, relaxation therapy, and cognitive behavioral therapy might be of benefit. Surgical treatments including bariatric and deactivation of trigger points are of growing interest but not appropriate for most sufferers. Occipital nerve stimulation is a promising treatment with ongoing studies defining its use.

Laser therapy and needling in myofascial trigger point deactivation

The aim of this study was to evaluate different approaches to deactivating myofascial trigger points (MTPs). Twenty-one women with bilateral MTPs in the masseter muscle were randomly divided into three groups: laser therapy, needle treatment and control. Treatment effectiveness was evaluated after four sessions with intervals ranging between 48 and 72 h. Quantitative and qualitative methods were used to measure pain perception/sensation. The Wilcoxon test based on results expressed on a visual analog scale (VAS) demonstrated a significant (P < 0.05) decrease in pain only in the laser and needle treatments groups, although a significant increase in the pressure pain threshold was evident only for needling with anesthetic injection (P = 0.0469), and laser therapy at a dose of 4 J/cm² (P = 0.0156). Based on these results, it was concluded that four sessions of needling with 2% lidocaine injection with intervals between 48 and 72 h without a vasoconstrictor, or laser therapy at a dose of 4 J/cm², are effective for deactivation of MTPs.

Efficacy of myofascial trigger point deactivation for tinnitus control

Chronic pain in areas surrounding the ear may influence tinnitus. ObjectiveTo investigate the efficacy of myofascial trigger point deactivation for the relief of tinnitus. MethodA double-blind randomized clinical trial enrolled 71 patients with tinnitus and myofascial pain syndrome. The experimental group (n = 37) underwent 10 sessions of myofascial trigger point deactivation and the control group (n = 34), 10 sessions with sham deactivation. ResultsTreatment of the experimental group was effective for tinnitus relief (p < 0.001). Pain and tinnitus relieves were associated (p = 0.013), so were the ear with worst tinnitus and the side of the body with more pain (p < 0.001). The presence of temporary tinnitus modulation (increase or decrease) upon initial muscle palpation was frequent in both groups, but its temporary decrease was related to the persistent relief at the end of treatment (p = 0.002). ConclusionBesides medical and audiological investigation, patients with tinnitus should also be checked for: 1) presence of myofascial pain surrounding the ear; 2) laterality between both symptoms; 3) initial decrease of tinnitus during muscle palpation. Treating this specific subgroup of tinnitus patients with myofascial trigger point release may provide better results than others described so far.

Trigger Point Deactivation Effects of the Sternocleidomastoid Muscle on Tinnitus, Balance and Hearing Function

Trigger Point Deactivation Effects of the Sternocleidomastoid Muscle on Tinnitus, Balance and Hearing Function

Os efeitos da desativação dos pontos-gatilho miofasciais, da mobilização articular e do exercício de estabilização cervical em uma paciente com disfunção temporomandibular: um estudo de caso

INTRODUÇÃO: A disfunção temporomandibular (DTM) pode alterar o equilíbrio dinâmico das estruturas, levando a uma série de sinais e sintomas característicos dessa disfunção, sendo a dor a principal delas. A DTM acomete grande parte da população mundial, o que torna essencial o desenvolvimento de técnicas terapêuticas para seu tratamento. OBJETIVO: O objetivo deste estudo foi verificar a eficácia do tratamento fisioterapêutico em uma paciente com DTM. MATERIAIS E MÉTODOS: Pesquisa experimental, um relato de caso com uma paciente com disfunção temporomandibular, tratamento fisioterapêutico com técnicas de desativação de pontos-gatilho, mobilização articular, estabilização segmentar e exercícios funcionais, sendo realizados duas vezes por semana, com duração de 30 minutos, durante oito semanas. RESULTADOS: A paciente apresentou melhora na dor, na função muscular, na amplitude de movimento e na postura. Portanto, podemos concluir que a intervenção fisioterapêutica tem grandes chances de melhorar o quadro clínico da DTM, juntamente com outras áreas, por ser uma patologia multifatorial.

The efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: a randomized controlled trial

Currently, large levels of practice variability exist regarding the clinical deactivation of trigger points. Manual physical therapy has been identified as a potential means of resolving active trigger points; however, to date the ideal treatment approach has yet to be elucidated. The purpose of this clinical trial was to compare the effects of two manual treatment regimens on individuals with upper trapezius trigger points. Sixty patients, 19–38 years of age with non-specific neck pain and upper trapezius trigger points, were randomized into one of two, 4 week physical therapy programs. One group received muscle energy techniques while the second group received an integrated neuromuscular inhibition technique (INIT) consisting of muscle energy techniques, ischemic compression, and strain–counterstrain (SCS). Outcomes including a visual analog pain scale (VAS), the neck disability index (NDI), and lateral cervical flexion range of motion (ROM) were collected at baseline, 2 and 4 weeks after the initiation of therapy. Results revealed large pre–post-effect sizes within the INIT group (Cohen's d = 0.97, 0.94 and 0.97). Additionally, significantly greater improvements in pain and neck disability and lateral cervical flexion ROM were detected in favor of the INIT group (0.29–0.57, 0.57–1.12 and 0.29–0.57) at a 95% CI respectively. The findings of this study indicate the potential benefit of an integrated approach in deactivating upper trapezius trigger points. Further research should be performed to investigate the long-term benefits of the current treatment approach.

Self‐hypnosis and osteopathic soft tissue manipulation with a ballet dancer

AbstractThis single case study of a ballet dancer incorporates essentially osteopathy, self‐hypnosis and neurolinguistic programming (NLP) in the management of exhaustion, stress, anxiety and pain symptoms of the right thigh, calf and ankle combined with confidence strengthening techniques. Physical and mental burnout symptoms had reached the point of constant pain and overstrain of the muscles of the right leg and hip, spine and neck. In parallel with these were symptoms of exhaustion, unhappiness and a tendency to over‐focus on other dancers at the expense of self‐focus and motivation. The osteo/physical therapy entailed the rebalancing of overused, strained and hyper‐tense muscular tissues using myofascial‐release techniques, together with the deactivation of trigger points and postural integration. The mental attitude was supported through reframing techniques during self‐hypnosis directed at general feelings of being blocked, imprisoned, cramped, exhausted and weakened in the right leg. Psychophysiological assessment post therapy was compatible with self‐regulation training. Copyright © 2003 British Society of Experimental and Clinical Hypnosis