Management Of Myofascial Pain Syndrome Research Articles

Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review.

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

Ultrasound-Guided Lidocaine Injection as a Novel Predictor of Response to Botulinum for Patients With Myofascial Pain Syndrome: A Case Report.

Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.

Extracorporeal ShockWave Treatment vs. mesotherapy in the treatment of myofascial syndromes: a clinical trial.

Numerous scientific papers have compared different treatment options in the management of myofascial pain syndrome. This study evaluated the efficacy of Extracorporeal ShockWave Treatment (ESWT) and mesotherapy in patients with Myofascial Pain Syndrome (MPS) in terms of improvement in pain, functional capacity, and quality of life. A case-control study was conducted on 54 patients, who were randomized into 2 groups: group A, consisting of 27 patients, who were treated with 5 sessions of focal ESWT on a weekly basis; and group B, consisting of 27 patients, who underwent 5 sessions of mesotherapy with Thiocolchicoside fl 4 mg/2 mL and Mepivacaine fl 10 mg/1 mL on a weekly basis. Patients were evaluated at enrollment (T0), after 5 weeks, at the end of rehabilitation treatment (T1), and at a follow- up 30 days after the end of treatment (T2), by administering rating scales (Numeric Rating Scale (NRS) - Pressure Pain Threshold (PPT) - Short Form-36 (SF-36)). The results showed that focal ESWT and Mesoterapy are two valid and effective treatment options in reducing algic symptoms and improving short- and long-term quality of life. However, the use of ESWTs, despite being mildly painful but tolerated, has been shown to be superior to mesotherapy in terms of pain reduction and increased functional capacity.

Comparative effects of Bowen therapy and tennis ball technique on pain and functional disability in patients with thoracic myofascial pain syndrome

BackgroundThoracic myofascial pain syndrome is a clinical problem arising from the muscles and soft tissues of thoracic region, which include the mid and upper back area. Risk factors associated with myofascial pain syndrome are muscle overuse and repetitive strain, poor posture, trauma or injury, emotional and psychological stresses. The management of myofascial pain syndrome (MPS) typically involves a multidimensional approach that focuses on relieving pain, reducing muscle tension, and improving muscle function. Bowen therapy and tennis ball technique are also recommended for treating myofascial pain syndrome.ObjectiveThe objective of this study was to compare the effects of Bowen therapy and tennis ball technique on pain and functional disability in patients with thoracic myofascial pain syndrome.MethodsIt was a randomized clinical trial conducted on thirty patients. It was carried out in physiotherapy outpatient department of D.H.Q Hospital, Kasur. Non-probability convenience sampling technique was used. Data collection was done from the patients of thoracic myofascial pain syndrome by using Numeric Pain Rating Scale (NPRS) for pain and Pain Disability Questionnaire (PDQ) for functional disability. Participants were randomly allocated into two groups using computer generated random number method. Group A received Bowen therapy, and group B received tennis ball technique. Outcome measures were measured at baseline, after second week treatment session and after fourth week with three sessions in a week on alternate days. Data analysis was done by using Statistical Package for the Social Sciences (SPSS) version 26.ResultsThere was significant difference between the mean values of NPRS and PDQ in both groups at baseline, second week and fourth week with p value < 0.05. The results indicated that both treatments were significant but Bowen therapy is more effective treatment than tennis ball technique. Within-group difference calculated with repeated-measure ANOVA indicated that there was significant difference from pre- to post-values of both groups.ConclusionThis study concluded that Bowen therapy produced statistically significant and clinically relavant results for all the outcome measures. Trial registration. (IRCT20190717044238N7).

A Study on Percutaneous Electrical Nerve Stimulation with Open Kinematic Exercises on Gluteus Medius Activation in Patellofemoral Pain Syndrome

Background: Patellofemoral pain accounts for 25-40% of knee pain cases. It is thought that weakness or inadequate activation of gluteus medius muscle while weight-bearing can lead to internal rotation of the femur and consequently lateral tracking of the patella, gradually leading to patellofemoral pain syndrome. Percutaneous Electrical Nerve Stimulation is a novel treatment modality for the management of myofascial pain syndrome, when combined with open kinematic exercises, it helps to improve the strength of a particular muscle. Objective: To determine the effects of Percutaneous Electrical Nerve Stimulation with open kinematic exercises on gluteus medius activation in patellofemoral pain syndrome. Methods: A study conducted on 30 patients with patellofemoral pain syndrome. All the patients received Percutaneous Electrical Nerve Stimulation, in the myofascial trigger points of the gluteus medius muscle, along with it open kinematic exercises were given targeting the gluteus medius muscle. PENS was given twice a week for 6 weeks. Open kinematic exercises were given 5 days a week for 6 weeks. Results: Paired t – test was used to analyze the statistical difference. The pre - test value of electromyography was (138.11 ± 2.08, P ˂ 0.0001) and post - test value was (140.61 ± 1.83, P ˂ 0.0001). As for the pain score (NPRS) the pre – test value was (6.67 ± 1.54, P ˂ 0.0001) and post - test value was (3.2 ± 1.2, P ˂ 0.0001). A significant difference was noted in the gluteus medius activation levels and the pain score with the application of Percutaneous Electrical Nerve Stimulation with open kinematic exercises targeting the gluteus medius muscle. Conclusion: The study concluded that Percutaneous Electrical Nerve Stimulation with open kinematic exercises is effective in the activation of gluteus medius muscle.

Masticatory myofascial pain syndrome provoked by SARS-COV-2 infection in a patient with orofacial pathology (clinical case)

Abstract. Myofascial pain syndrome (MFPS) is a chronic pain condition characterised by the appearance of myofascial trigger points (MTP) in muscles. The condition can be caused by various factors and is diagnosed through clinical examination and palpation of MTPs. Recent studies have shown that infections like SARS-CoV-2 can cause MFPS, along with other symptoms. Dentists often encounter the problem of MFPS in patients with temporomandibular joint dysfunction, but it can also develop in patients with a normally functioning joint. Symptoms include pain, sensitivity, and abnormalities in mandible mobility. In this article, the case of MFPS in a person with orofacial pathology after SARS-CoV-2 diagnosis is presented. Materials and methods of research. Describes a person who has the instability of the bite caused by the absence, destruction and disposition of the chewing teeth led to disorders of the chewing muscles. The patient was found to have appearing MFPS symptoms after COVID-19. The systematic online search of articles utilising the search terms «Coronavirus, SARS-COV-2 and Myofascial pain syndrome», published between January 2020 and October 2023, was performed. Results. The patient was diagnosed with SARS-CoV-2 in October 2021 and was hospitalised for 10 days. After discharge, she went to the dentist with complaints of headache and stiffness in the area of masticatory muscles, absence and destruction of lateral teeth, difficulty in chewing food, mobility and displacement of individual teeth, periodic bleeding gums, as well as aesthetic disorders. During the objective examination, secondary partial adentia was revealed, which led to instability of the bite, defects of the hard tissues of the chewing teeth, pathological wear of the frontal group, and traumatic occlusion phenomena. During palpation, trigger points were found in the area of the masticatory and temporal muscles. The patient underwent a series of ten trigger point injections (dry needling) in her chewing muscles, with about 30 % immediate relief. Conclusion. MFPS can be caused by various factors, including infections like SARS-CoV-2. The diagnosis is based on clinical examination and palpation of MTPs, and treatment may include trigger point injections, physical therapy, and non-invasive therapy methods. In the presented case, the patient had partial adentia, leading to instability of the bite and MFPS symptoms after SARS-CoV-2 diagnosis. Prompt diagnosis and management of MFPS are necessary to improve the patient’s quality of life.

Management of Myofascial Pain Syndrome: A Randomized Control Trial

Myofascial pain syndrome is collection of sensory, motor, and autonomic symptoms that include local and referred pain, decreased range of motion, and weakness. To compare outcome of physical therapy alone and physical therapy with trigger point injection in the management of myofascial pain syndrome. This prospective randomized control study was performed in a tertiary-care teaching institution of North India. Age- and sex-matched subjects with myofascial pain syndrome were enrolled in this study. Subjects were assessed by cervical ROM parameters, numerical pain rating scale, and pressure pain threshold at third day, 1 week, and fourth week. Sixty patients were included in this study with mean age-group of 25.93 + 4.65 years and 26.60 + 4.99 years, respectively, and median of 22 years and 23 years in control and intervention groups, respectively. The female–male ratio was 1.5:1 and 1.3:1, respectively. Using CF, CE, NPRS, and PPT as outcome parameters were 39.00 ± 2.49, 8.60 ± 0.62, and 1.00 ± 0.00, respectively, which improved to 66.17 ± 4.09, 67.33 ± 3.65, 1.17 ± 0.65, and 5.00 ± 0.00, respectively, at fourth week of trigger point injection. Combined approach of trigger point injection with physical therapy is more effective and safe to be administered in outpatient as very good alternative for oral drugs and physical therapy alone. Srivastava A. Management of Myofascial Pain Syndrome: A Randomized Control Trial. Indian J Phys Med Rehab 2019;30(3):81–84.

Retrospective study of the clinical effect of incobotulinumtoxinA for the management of myofascial pain syndrome in refractory patients

The aim was to evaluate the effectiveness and safety of IncobotulinumtoxinA (IncoA) for the management of myofascial pain syndrome (MPS) in refractory patients. This single-center, observational, retrospective study includes 37 patients. The pain reduction was 4.7 points (95%CI: 5.6 to −3.8) from baseline to one-month post-injection (using a 10-point visual analogue scale). Only 18.9% experienced mild adverse events. In conclusion, IncoA is an effective and safe alternative for the treatment of MPS in refractory patients.

Granisetron vs. lidocaine injection to trigger points in the management of myofascial pain syndrome: a double-blind randomized clinical trial.

Granisetron and lidocaine injections have been used for the management of myofascial pain syndrome. This study was aimed to compare the efficacy of granisetron and lidocaine injections to trigger points of upper trapezius in the management of myofascial pain syndrome. We performed a double-blind randomized clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. A total of 40 patients aged≥18 with neck pain due to myofascial pain syndrome were included. They had pain for at least one month with the intensity of at least 30mm on a 100mm visual analog scale. Each participant received a single dose of 1mL lidocaine 2% or 1mg (in 1mL) granisetron. The solutions were injected into a maximum of three trigger points of the upper trapezius. We instructed all patients to remain active while avoiding strenuous activity for three or four days, and to perform stretch exercise and massage of their upper trapezius muscles. We assessed the patients before the interventions, and one month and three months post-injection. The primary outcome was the Neck Disability Index and the secondary outcome was the Neck Pain and Disability Scale. Both interventions were successful in reducing neck pain and disability (all p-values<0.001). However, the neck pain and disability responded more favorably to lidocaine than granisetron (p=0.001 for Neck Disability Index, and p=0.006 for Neck Pain and Disability Scale). No significant side-effect was recognized for both groups. Both lidocaine and granisetron injections to trigger points are effective and safe for the management of the syndrome and the benefits remain at least for three months. However, lidocaine is more effective in reducing pain and disability. The injections are well-tolerated, although a transient pain at the site of injections is a common complaint. One mL of lidocaine 2% is more effective than 1mg (in 1mL) granisetron for injecting into the trigger points of the upper trapezius in myofascial pain syndrome.

Recent Advances in Diagnosis and Management of Myofascial Pain Syndrome: A Narrative Review

Myofascial Pain Syndrome (MFPS) is a disorder common among patients who experience musculoskeletal pain. The condition originates from the muscles and the fascia which surrounds it. Initially, this condition used to be prevalent among people in their 40s and 50s. But presently, even young adults are affected. In this review, several databases have been consulted in the course of reviewing MFPS related studies. Aspects reviewed include its aetiopathophysiology, diagnostic criteria and management of MFPS. It is important to note that an increasing number of people among the ageing population suffer from musculoskeletal discomfort that interferes with their everyday activities and functions. It has a huge influence on their overall well being. This is creating a growing financial burden on the healthcare system. There is a lack of consensus regarding proper diagnostic criteria or tool, and treatment of MFPS. This review aimed to summarise recent advances in the diagnosis and intervention.

Роль инъекций в триггерные точки при коррекции миофасциального болевого синдрома челюстно-лицевой области

Цель. Оценить эффективность инъекций в триггерные точки при лечении миофасциального болевого синдрома челюстно-лицевой области. Материал и методы. С 2014-2017 гг. было пролечено 124 человека с миофасциальным болевым синдромом лица, из них 76 женщин и 48 мужчин в возрасте от 19 до 62 лет. Кроме клинических и рентгенологических методов диагностики всем пациентам выполняли электромиографию и тестирование болей по визуальной аналоговой шкале боли (VAS). С целью купирования миофасциального болевого синдрома применялись методы традиционной терапии: шиновая терапия, коррекция окклюзии, медикаментозная и физиотерапия. При неэффективности традиционных методов выполнялись инъекции «Лимфомиозот» и «Траумель С» в триггерные точки по методике J. Kersschot (2010). Контрольные осмотры проводились через 1, 3, 6, 12 и 18 и 24 месяца после выполнения манипуляции. При контрольных осмотрах обращали внимание на жалобы пациентов, определяли интенсивность боли по VAS. Критерием положительных результатов лечения являлось отсутствие болей в покое и при функциях. Результаты. При стандартном лечении положительные результаты были получены у 86 из 124 человек (69,4%). Инъекции в триггерные точки, выполняемые при недостаточной эффективности лечения у 38 человек, привели к прекращению боли у 32 (84,2%) пациентов. Как показали наши наблюдения, длительный период без боли (в течение двух лет) наблюдали у 12 (37,6%) человек. Продолжительный эффект в течение периода времени до полутора лет был констатирован у 8 пациентов (25%), до 1 года – у 7 человек (21,8%), до 6 месяцев – у 5 (15,6%). Заключение. Инъекции в триггерные точки повышают эффективность терапии и обеспечивают длительный период ремиссии заболевания, что проявляется в отсутствии болевых приступов и ощущения дискомфорта. Научная новизна статьи Впервые для лечения миофасциального болевого синдрома (МБС) лица была использована методика с применением инъекций «Лимфомиозот» и «Траумель С» в триггерные точки. Установлено, что данная методика инъекций в триггерные точки является эффективным методом лечения МБС лица в независимости от причины, его вызвавшей. Показано, что применение инъекций в триггерные точки при миофасциальном болевом синдроме лица способствовало быстрому купированию болей и длительному безболевому периоду сроком наблюдения до двух лет.

Treatment and management of myofascial pain syndrome.

Myofascial Pain Syndrome (MPS) is a regional pain disorder that affects every age-group and is characterized by the presence of trigger points (TrPs) within muscles or fascia. MPS is typically diagnosed via physical exam, and the general agreement for diagnostic criteria includes the presence of TrPs, pain upon palpation, a referred pain pattern, and a local twitch response. The prevalence of MPS among patients presenting to medical clinics due to pain ranges anywhere from 30 to 93%. This may be due to the lack of clear criteria and guidelines in diagnosing MPS. Despite the prevalence of MPS, its pathophysiology remains incompletely understood. There are many different ways to manage and treat MPS. Some include exercise, TrP injections, medications, and other alternative therapies. More research is needed to form uniformly-accepted diagnostic criteria and treatments.

A Comprehensive Review of the Treatment and Management of Myofascial Pain Syndrome.

Myofascial pain syndrome (MPS) is a musculoskeletal pain condition that stems from localized, taut regions of skeletal muscle and fascia, termed trigger points. The purpose of this comprehensive review is to provide updated information on prevalence, pathophysiology, and treatment modalities with a focus on interventional modalities in managing MPS. Though MPS can present acutely, it frequently presents as a chronic condition, affecting up to 85% of adults during their lifetime. MPS is an often-overlooked component of pain with overarching effects on society, including patient quality of life, physical and social functioning, emotional well-being, energy, and costs on health care. The prevalence of MPS is generally increased among patients with other chronic pain disorders and has been associated with various other conditions such as bladder pain syndrome, endometriosis, and anxiety. MPS is poorly understood and remains a challenging condition to treat. Non-pharmacologic treatment modalities such as acupuncture, massage, transcutaneous electrical stimulation, and interferential current therapy may offer relief to some patients with MPS. Additional studies are warranted to get a better understanding of managing myofascial pain.

Evidence for kinesio taping in management of myofascial pain syndrome: a systematic review and meta-analysis

Objective: The aim of this study was to evaluate the effectiveness of kinesio taping for managing myofascial pain syndrome in terms of pain intensity, pressure pain threshold, range of motion, muscle strength and disability. Data sources: PubMed, EBSCO, ScienceDirect, Web of Science, Cochrane Library and Physiotherapy Evidence Databases were searched from database inception to November 2018. Methods: Randomized controlled trials (RCTs) that used kinesio taping as the main treatment protocol for participants diagnosed with myofascial pain syndrome were included. Two reviewers independently screened articles, scored methodological quality using Cochrane risk-of-bias tool and extracted data. The primary outcomes were pain intensity, pressure pain threshold and range of motion at post-intervention and follow-up. The secondary outcomes were muscle strength and disability at post-intervention and follow-up. Data synthesis: Meta-analyses of 20 RCTs involving 959 patients showed that kinesio taping was more effective than other treatments in reducing pain intensity (mean difference (MD) = 1.06 cm, 95% confidence interval (CI): −1.66 to −0.46 cm, P = 0.006) and increasing range of motion (standardized mean difference (SMD) = 0.26, 95% CI: 0.09 to 0.43, P = 0.003) at post-intervention. Kinesio taping was also superior to other non-invasive techniques in relieving pain intensity at follow-up (MD = −0.68 cm, 95% CI: −1.22 to −0.13 cm, P = 0.02). However, there was no detectable effect on disability or function. Conclusion: Statistical evidence showed that kinesio taping could be recommended to relieve pain intensity and range of motion for patients with myofascial pain syndrome at post-intervention.

Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial.

Chronic neck pain attributed to a myofascial pain syndrome is characterized by the presence of muscle contractures referred to as myofascial trigger points. In this randomized, parallel-group, blinded, controlled clinical trial, we examined the effectiveness of deep dry needling (DDN) of myofascial trigger points in people with chronic nonspecific neck pain. The study was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2010 to December 2014. A total of 130 participants with nonspecific neck pain presenting with active myofascial trigger points in their cervical muscles were included. These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65]). Four sessions of treatment were applied over 2 weeks with a 6-month follow-up after treatment. Pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability were measured at baseline, after 2 sessions of intervention, after the intervention period, and 15, 30, 90, and 180 days after the intervention. Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P < 0.001) at both short and long follow-ups. Deep dry needling and passive stretching is more effective than passive stretching alone in people with nonspecific neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.

A Comparative Study of Trigger Point Therapy with Local Anaesthetic (0.5% Bupivacaine) Versus Combined Trigger Point Injection Therapy and Levosulpiride in the Management of Myofascial Pain Syndrome in the Orofacial Region.

To compare the efficacy of combined local anesthetic injection with 0.5% bupivacaine and levosulpiride versus local anesthetic injection alone on outcome measures including levels of pain intensity and depression in the management of myofascial pain syndrome in orofacial region. This was a prospective, randomized, controlled and open-label comparative clinical study. Seventy-four patients diagnosed to have myofascial pain syndrome and fulfilling the inclusion criteria were enrolled for the study. Patients were randomly assigned into 2 groups. Group A received local anesthetic injection (0.5% bupivacaine) on trigger points and Group B received combined trigger point injection therapy and 50mg of tablet Levosulpiride orally B.I.D. They were assessed for pain intensity and depression at baseline and at follow-up of 1, 4, 6 and 12week intervals. The mean age of patients was 44.54+15.977years in group A and 39.97+14.107years in group B (P value=0.2). Group A comprised of 25 females (67.567%) and 12 males (32.432%) while group B had 27 females (75%) and 9 males (25%). 70.27% were diagnosed with moderate depression in group A and 75% in group B. 18.91% in group A and 19.44% in group B were diagnosed with severe depression. When the VAS score and BDI score was compared at the follow-up intervals with the baseline scores in both treatment groups, the mean difference was highly significant at all the follow-up intervals. However when the relative efficacies of two interventions were compared between the two groups, improvement in pain was significant at all the follow-up intervals except the 1st week follow-up whereas the improvement in depression was non-significant at 1st and 4th week interval while it was highly significant at 6th and 12th week intervals. The combined therapy with trigger point injection and levosulpiride as antidepressant significantly reduces pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region.

Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study.

Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double-blind study, we evaluated the effects of high-intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12). Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and 12 relative to pretreatment values, the HILT group showed greater improvement in pain scores, the neck disability index, and several subparts of the short-form 36 health survey (SF-36) (physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, social functioning, and role limitations due to emotional problems) than did the sham therapy group. We conclude that HILT is an effective therapeutic method in the treatment of patients with chronic MPS of the trapezius muscle.

A new insight into the management of myofascial pain syndrome

Myofascial pain syndrome (MPS) is a musculoskeletal disorder which is characterized by pain, muscle spasms, and muscle tenderness, as well as a limited range of motion, weakness, and rarely, autonomous dysfunction. Management includes exercise programs in particular, and many other invasive and non-invasive therapies, depending on the clinical status of the patient. The main options include medical therapies with analgesics, myorelaxants and antidepressants, hot pack therapy, exercise, stretch and spray therapy, ischemic compression, therapeutic massage, biofeedback, transcutaneous electrical nerve stimulation (TENS), ultrasound (US), interferential (IFA) current, low-energy light amplification by stimulated emission of radiation (LASER), extracorporeal shock wave therapy (ESWT), trigger point injections, dry needling, and acupuncture. There is growing evidence that trigger point injections and dry needling, as well as stretching exercises, are effective alternatives in the management of MPS. Management success is primarily based on the cooperation of the patient and the treating physician and the elimination of predisposing factors.

A Comparative Pilot Study to Evaluate the Adjunctive Role of Levosulpride with Trigger Point Injection Therapy in the Management of Myofascial Pain Syndrome of Orofacial Region.

To evaluate the effect of therapy with levosulpride combined with conventional trigger point injection therapy in terms of pain and depression in the chronic myofascial pain syndrome patients. This was a comparative prospective study in which subjects with at least one trigger point and symptom duration of at least 3months were recruited and randomized into two groups. Group A subjects received trigger point injections with 0.5% bupivacaine and tablet levosulpride and group B received trigger point injections and a placebo. Subjects were assessed for pain with visual analog scale (VAS) and depression with Beck's depression inventory (BDI) at the follow-up periods of 1, 4, 6 and 12weeks. The treatment effect was measured in terms of mean difference of BDI and VAS scores at various studied intervals from the baseline values. The sample was composed of 15 subjects with 8 in group A (6 females and 2 males, with a mean age of 41.88±15.13years, disease duration of 12.37±16.11months) and 7 in group B (6 females and 1 male, with a mean age of 43.86±12.34years, disease duration of 9.64±9.34months). The mean baseline VAS score and BDI score was 6.75±1.03 in group A and 6.86±1.06 in group B and 24.25±10.20 in group A and 24.43±11.16 in group B respectively. The mean difference of VAS scores at 12thweek interval from the baseline values was highly significant. Although the mean difference of VAS scores at all the other intervals and mean difference of BDI scores at all the intervals was statistically nonsignificant, there was improvement in the mean differences at all the follow-up intervals in terms of both pain as well as depression. The combined therapy with conventional trigger point injection and levosulpride as antidepressant significantly reduce pain and depression in the study subjects suffering from chronic myofascial pain with moderate to severe depression in the orofacial region.

Ultrasound Imaging of Embedded Shrapnel Facilitates Diagnosis and Management of Myofascial Pain Syndrome

Trigger points can result from a variety of inciting events including muscle overuse, trauma, mechanical overload, and psychological stress. When the myofascial trigger points occur in cervical musculature, they have been known to cause headaches. Ultrasound imaging is being increasingly used for the diagnosis and interventional management of various painful conditions. A veteran was referred to the pain clinic for management of his severe headache following a gunshot wound to the neck with shrapnel embedded in the neck muscles a few years prior to presentation. He had no other comorbid conditions. Physical examination revealed a taut band in the neck. An ultrasound imaging of the neck over the taut band revealed the deformed shrapnel located within the levator scapulae muscle along with an associated trigger point in the same muscle. Ultrasound guided trigger point injection, followed by physical therapy resolved his symptoms. This is a unique report of embedded shrapnel and coexisting myofascial pain syndrome revealed by ultrasound imaging. The association between shrapnel and myofascial pain syndrome requires further investigation.