Myofascial Neck Pain Research Articles

Trigeminal cervical complex: A neural network affecting the head and neck

ObjectivesTo introduce the trigeminal cervical complex (TCC) as a comprehensive framework for understanding the anatomical and functional scope of the afferences and efferences of the trigeminal nerve and explaining common otolaryngologic symptoms, including head and neck myofascial pain syndrome. Additionally, it explores how the bidirectional transmission of neurotransmitters contributes to the sensitization of the TCC and motor nuclei. MethodsThe study was conducted as a narrative review. The authors performed a comprehensive search of multiple databases, including Medline/OVID, Embase, Scopus, and PubMed, covering publications from inception until August 2023. Both keywords and medical subject headings related to the TCC were utilized in the search. Information from 66 studies was extracted based on predetermined inclusion and exclusion criteria. ResultsThis review discusses the multiple afferent connections from cranial nerves, specifically VII, IX, X, and XI, to the TCC, and their respective efferent pathways. These connections may explain various clinical manifestations in the head and neck that cannot be attributed to other medical conditions. Additionally, the review highlights the dual sensory and motor nature of cranial nerves, emphasizing the bidirectional transmission of neurotransmitters in head and neck areas, which leads to the sensitization of both the TCC and motor nuclei innervating the cervicofacial muscles. ConclusionThe authors hypothesize that the central and peripheral sensitization and the intricate connections of the TCC can elucidate the pathophysiology of conditions such as otalgia, tinnitus, hearing loss, vertigo, headache, cervicogenic dizziness, bruxism, and other symptoms affecting the head and neck.

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.

The Effect of ISBT-Bowen Therapy in the Treatment of Myofascial Neck Pain-a Randomized, Single-Blinded Clinical Trial.

Myofascial pain syndrome (MPS) is the most common diagnosis in patient presenting with chronic non-specific neck pain. It affects people's work performance, productivity, and quality of life. To date, there is little research evaluating the effectiveness of non-invasive techniques, such as ISBT-Bowen Therapy in managing neck MPS. To investigate the effectiveness of Bowen therapy in managing myofascial pain syndrome with symptoms lasting for more than six weeks. The study will also examine the long-term effect of ISBT-Bowen Therapy on functional enhancement, quality of life, and physical and mental well-being. This is a prospective, single-blinded randomized controlled trial (RCT). A total of 90 myofascial neck pain patients were recruited and randomized to receive 8 sessions of ISBT-Bowen Therapy over a 12-week period (n = 45) or to continue their usual conventional treatment (n = 45). Pressure pain threshold (PPT), cervical range of motion (CROM), numerical rating pain scores, Neck Disability Index (NDI), SF-12 Health Survey (SF-12) Version 2, Generalized Anxiety Disorder 7-item (GAD7), and Patient Health Questionnaire (PHQ9) were measured at baseline, 12 weeks, and 24 weeks after baseline. When compared with the control group, PPT significantly increased after ISBT-Bowen Therapy at 12 and 24 weeks. CROM on flexion, lateral flexion, and rotation were greatly improved at 12 weeks after Bowen therapy, and maintained at 24 weeks, except left lateral flexion. NDI, GAD7, and PHQ9 were all reduced after Bowen Therapy at both 12 and 24 weeks. Both Physical and Mental Component Summary scores of SF-12 were improved after Bowen therapy at 12 and 24 weeks. This study confirmed the efficacy of ISBT-Bowen Therapy for patients with MPS. It alleviates pain, improves functional outcomes, enhances quality of life, and relieves mood symptoms.

Comparison Between the Effectiveness of Static Stretching and Effleurage Massage for Pain Reduction in Myofascial Neck Pain

Myofascial neck pain is a musculoskeletal complaint that occurs due to hypersensitivity in one or more muscles. Static stretching is one of the techniques that can reduce the risk of injury. Static stretching can lengthen muscles and tendons in a fixed position, thereby increasing flexibility and relaxation, reducing spasms and decreasing pain. Effleurage massage is a massage technique with strokes to smooth and increase blood flow which can also reduce pain and spasms. This study aimed to compare the effectiveness of two interventions for myofascial neck pain. The research design was pre-experimental with two groups of pretest-postest design. A total of 30 female cigarette-rolling workers were sampled in this study, and they met the research criteria. Respondents received static stretching exercises with effleurage massage 3 times a week for 4 weeks. The visual Analogue Scale was used to measure the pain felt by the respondent. The results showed that both interventions in each group had an effect on reducing myofascial neck pain in cigarette rolling workers (p<0.05). The results of the comparison test of the effect of giving Static Stretching with Effleurage Massage showed a p-value of 0.00 (p <0.05), which means that H1 is accepted or there is a difference in the effect of Static Stretching and effleurage massage on reducing myofascial neck pain in cigarette rolling workers. Based on the average decrease, the group with Static Stretching had a greater effect of reduced myofascial neck pain.
 Keywords: cigarette laborer, exercise, muscle lengthening, muscle relaxation, muscle pain

Combined effect of dry needling and muscle energy technique on neck pain of myofascial origin

BACKGROUND: Neck pain is a common musculoskeletal complaint, with a point prevalence of 15% of males and 23% of females experiencing symptoms. Approximately 20% of individuals visiting orthopaedic clinics have neck pain that originates from myofascial cause. Persistence of myofascial trigger points (MTrPs) in the neck for long periods results in headache, dizziness or vertigo, limited neck and shoulder range of motion (ROM), abnormal sensation, autonomic dysfunction, and disability. AIM: The purpose of the study was to determine the combined effect of dry needling (DN) and muscle energy technique (MET) on neck pain of myofascial origin. MATERIALS AND METHODS: Thirty-six subjects, both male and female, aged 20–40 years with MTrPs in the upper trapezius (UT) and levator scapulae (LS) muscles having unilateral or bilateral pain in the neck, were recruited with a convenience sampling technique. The subjects were equally (n = 12) divided into three groups: Group A received only MET, Group B received only DN, and Group C received both DN and MET. The Visual Analog Scale (VAS), Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), pain pressure threshold (PPT) levels, and cervical ROM were assessed at baseline and after each intervention. The subjects were treated for three sessions with a 2-days break between each session, and the outcomes were assessed. The data collected were analyzed by SPSS (version 26). RESULTS AND CONCLUSION: Significant improvements were observed in all the three groups in terms of decrease in the VAS, NDI, and PCS scores (P < 0.05). The PPT levels on both UT and LS muscles, along with ROM of cervical (lateral flexion and rotation), were improved (P < 0.05) in all the three groups; however, Group DN + MET showed (P < 0.01) better results. Therefore, the combined use of DN and MET is recommended as a better technique for the management of myofascial neck pain.

Efficacy of low-level laser therapy on pain, disability, pressure pain threshold, and range of motion in patients with myofascial neck pain syndrome: a systematic review and meta-analysis of randomized controlled trials.

Low-level laser therapy (LLLT) is one of recent modalities for treatment of myofascial neck pain (MNP). Several RCTs have been conducted on its effectiveness. The aim of this comprehensive meta-analysis was to evaluate the effectiveness of LLLT on MNP. Electronic databases were searched for identifying eligible studies comparing the effectiveness of LLLT using any wavelength with placebo or active control in myofascial neck pain up to June 2022. Data related to pain intensity, pain pressure threshold (PPT), range of motion (ROM), and disability was analyzed as a pooled estimate of mean difference or standard mean difference (SMD) with 95% confidence intervals (CIs) using random/fixed-effect model. Funnel plot and Egger's linear regression test were also conducted to examine the risk of publication bias. A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The data assessing laser effectiveness on different outcomes of 556 patients were considered for meta-analysis. Pooled results revealed that LLLT was significantly effective in pain reduction (MD = - 1.29, 95% CI = - 2.36; - 0.23, P < 0.001). Also, secondary outcomes including PPT (SMD of 2.63, 95% CI = 0.96; 4.30, P < 0.01) and right bending ROM (SMD of 3.44, 95% CI = 0.64; 6.24, P < 0.01) were improved, while disability (MD of - 7.83, 95% CI = - 17.1; 0.08, P = 1.34) did not improve significantly after LLLT. Our meta-data revealed that LLLT may reduce myofascial neck pain and its related outcomes. LLLT is suggested to be used by clinicians along with other therapies such as manual and exercise therapy.

Efficacy of Dry Needling Under EMG Guidance for Myofascial Neck and Shoulder Pain: A Randomized Clinical Trial.

PurposeTo determine the difference in maintenance of improvement of pain and disability for dry needling (DN) under needle electromyography (EMG) guidance technique in myofascial neck and shoulder pain patients, compared with DN alone.Patients and MethodsIn this randomized single-blind clinical trial, 30 participants with myofascial pain in the neck and shoulder were randomly allocated to two groups: myofascial trigger points (MTrPs) DN with EMG guided (DN-EMG) group and MTrPs DN without EMG (DN) group. Needling treatment lasted for 2 weeks, twice a week. The primary outcome was pain intensity as assessed by visual analogue scale (VAS) and neck disability index (NDI). A number of mappings referred to pain and spontaneous muscle activity (SEA) were considered secondary outcomes. VAS and NDI were measured before treatment, after 2 weeks of intervention and at 4-, 6- and 12-week follow-up periods after the intervention. Secondary outcomes were assessed before each treatment (T1–T4). Data were analysed using mixed-model analyses of variance (ANOVA) with time as a within-subject variable and groups as between-subject variables followed by Bonferroni’s post-hoc test.ResultsMixed-model ANOVA revealed significant time-by-group interaction effects (F = 3.49, P = 0.01) for VAS. Post-hoc analysis showed a significant decrease in VAS and NDI after 2 weeks of intervention and at all follow-up periods compared with baseline in both groups (p < 0.01). The DN-EMG group exhibited higher improvements in VAS at 6- and 12-week follow-up period than the DN group (p < 0.05). In the SEA of MTrPs, we found positive sharp waves, fibrillation and fascicular potentials. DN-EMG group exhibited lower amplitudes at T2–T4 and frequencies at T2 and T3.ConclusionDN under needle EMG guidance technique exhibited greater improvements in maintenance of improvement of pain and lower SEA value than the DN group due to sufficient MTrPs inactivation.

Dry Needling Compared With Manual Pressure Trigger Point Manual Therapy for Improving Pain in Patients Experiencing Myofascial Neck Pain: A Critically Appraised Topic

Focused Clinical Question: What is the efficacy of dry needling (DN) compared to ischemic compression point therapy for improving pain and pain pressure threshold (PPT) in patients experiencing myofascial neck pain? Clinical Bottom Line: There is low-level evidence suggesting DN has the potential to elicit greater improvements in pain and PPT relief compared to ischemic compression techniques for individuals with myofascial neck pain.

Extracorporeal Shock Wave Therapy Versus Phonophoresis Therapy for Neck Myofascial Pain Syndrome: A Randomized Clinical Trial.

ObjectivesThis study aimed to assess the effects of using Extracorporeal Shock Wave Therapy (ECSWT) and phonophoresis therapy on pain and neck disability in patients with neck myofascial pain syndrome (MPS).MethodsForty eligible patients were randomly divided into two groups of ECSWT (received three sessions of ECSWT, once a week for three weeks) and phonophoresis (received ultrasound using hydrocortisone gel 1% over the trigger point on trapezius muscle, three times a week for three weeks). Patients in both groups received the same stretching exercise program and drug regimen during the intervention.ResultsPain and NDI scores in both groups were significantly improved at the end of the treatment and four weeks later. At the end of the treatment, the pain score was similar between the groups. Four weeks after the treatment, the pain score in the ECSWT group was significantly lower than in the phonophoresis group (P-value = 0.030). The NDI score was not significantly different between the groups at the end of the treatment. However, four weeks after the treatment, the NDI score was significantly lower in the ECSWT group than in the phonophoresis group (P-value=0.032). The trend of changes in the pain and NDI scores was not significantly different between the groups.ConclusionsBoth phonophoresis and ECSWT groups effectively decreased pain and neck disability in patients with MPS, with the superiority of ECSWT with a more lasting effect for a month after the end of the treatment.

Effectiveness of Dry Needling with Percutaneous Electrical Nerve Stimulation of High Frequency Versus Low Frequency in Patients with Myofascial Neck Pain

Percutaneous nerve electrical stimulation is a novel treatment modality for the management of acute and chronic myofascial pain syndrome. To compare the effectiveness of dry needling combined with percutaneous electrical nerve stimulation of low frequency versus high frequency, in patients with chronic myofascial neck pain. Randomized, single-blind trial. Laboratory in an academic institution. A total of 40 volunteer patients with chronic neck pain were randomly divided into 2 groups. All patients initially received deep dry needling in a myofascial trigger point of the upper trapezius. Then, one group received high frequency percutaneous electrical nerve stimulation while the other group received low frequency percutaneous electrical nerve stimulation. The primary outcomes were the visual analog scale and the pressure pain threshold, while Neck Disability Index and Kinesiophobia were secondary outcomes. We detected significant improvements in the visual analog scale score in both groups without differences between them. We did not observe significantly different statistics in either group during the evaluation of data on pressure pain threshold. Limitations of the study include (1) heterogeneity of the sample in relation to gender, with more women, (2) the small sample size (40 patients), (3) the absence of placebo group, and (4) the fact that the treatment is focused exclusively on the upper trapezium myofascial trigger point. . Low and high frequency percutaneous electrical nerve stimulation combined with deep dry needling showed similar effects, since no differences between groups were observed on any of the outcome measures. High and low frequency of percutaneous electrical nerve stimulation generates changes on pain intensity and disability, but not on pressure pain threshold or fear of movement.

Clinical outcomes of maitland mobilization in patients with Myofascial Chronic Neck Pain: A randomized controlled trial.

Background and Objective:Myofascial neck pain is a common musculoskeletal problem caused by presence of trigger points and local and referred pain patterns. Chronic neck pain is responsible for the involvement of joints, ligaments, fascia and connective tissue as well. The objective of this study was to assess the effect of Maitland mobilization in patients with myofascial chronic neck pain.Methods:In this randomized, placebo treatment-controlled trial, 30 patients consecutively aged 25-45 years meeting inclusion criteria were isolated into two groups. The study group was treated with Maitland mobilization consistently for eight weeks while the control group got placebo treatment for a similar timeframe. Visual analog Scale (VAS), Neck disability index (NDI) and cervical range of motion (ROM) questionnaire was filled by patients before, intermediate and after the intervention to evaluate the severity of pain, functional ability and range of motion.Results:Following eight weeks of treatment, when compared the post treatment effects of both groups, the significance value for VAS was 0.008, for NDI p=0.030, for Flexion p=0.573, for extension p=0.001, for right rotation p<0.001, for left rotation p=0.002, for right and left side bending p<0.001.Conclusion:The study concluded that Maitland mobilization grades (I-IV) are effective in reducing pain and improving functional level of NDI scale and the ranges of cervical spine in patients with myofascial chronic neck pain.

Deep Cervical Plexus Block for Neck and Shoulder Pain Due to Myofascial Pain: A Randomized Clinical Trial.

Myofascial pain is one of the most common causes of regional pain with no definitive treatment. This randomized clinical trial was conducted to assess the efficacy of deep cervical plexus block versus placebo injection (sham block) for the treatment of myofascial neck and shoulder pain in terms of analgesic consumption and pain during a follow-up period of 2 weeks after the block. Patients were randomly divided into 2 groups. Group I (block) received deep cervical plexus block and group II (placebo) received normal saline. A total of 66 patients were included in the study, 34 patients in the block group and 32 patients in the placebo group. Two weeks after the intervention, the average pain duration was significantly lower in the block group: 1.38±1.39 versus 5.25±1.72 for the block and placebo groups, respectively (P<0.0001). Pain intensity was significantly less in the block group such that 2.9% of patients in the block group had severe pain compared with 53.1% of patients in the placebo group (P<0.0001). Two weeks after receiving the block, the mean opioid consumption calculated as tramadol equivalent was 21.1±44.2 mg compared with 166.1±118.8 mg for the block and placebo groups, respectively. Multivariate analysis showed that patients with a longer history of pain had a higher pain score after 2 weeks. The possibility of recovery is affected by pain duration as patients with a history of chronic pain were least affected by the block. This technique could be an alternative to pharmacological and other nonpharmacological treatments for myofascial pain.

Myofascial Release Menurunkan Nyeri dan Meningkatkan Fungsional Leher Myofascial Pain Syndrome Otot Upper Trapezius

Background: Complaints due to upper trapezius myofascial pain syndrome include spasm, pain, and limitations in functional motion of the neck and surrounding areas. One way to overcome this is myofascial release, but there is no review article about the effect of myofascial release on the functional neck of myofascial pain syndrome. This study is to analyze the effect of myofascial release on pain and functional neck myofascial pain syndrome in the upper trapezius muscle. Methods: systematic review with the PICO framework (Population, Intervention, Comparison, Outcomes). Identify articles using relevant databases (Googlescholar, PubMed, PeDro) with customized keywords. Article selection using PRISMA flowchart, article assessment using critical appraisal. Results: The number of articles from 3 databases contained 3684 articles. After screening the title and the relevance of the abstract, 10 articles were obtained that proved the effectiveness of myofascial release in reducing neck pain and disability. Conclusion: myofascial release technique in the condition of myofascial pain syndrome, upper trapezius muscle is effective for reducing pain and increasing functional motion in the neck.

Prevalence of head and neck Myofascial Pain Syndrome in a South American population

Objective: To diagnose the prevalence of Myofascial Pain Syndrome (MPS) with respect to sex, age, affected muscle, socioeconomic stratum, occupation and associated symptoms.&#x0D; Methods: This is a descriptive, cross-sectional study of a convenience sample of 220 outpatients who attended the Faculty of Dentistry of the Universidad de Antioquia Medellín-Colombia, between September 30th, 2015 and September 7th, 2017. Interventions: not applicable. Main measure of results: Myofascial Pain Syndrome.&#x0D; Results: 26.4% of our sample presented symtoms of MPS. More women than men were found to have MPS. The number of cases decreases with age. The most affected muscle is the trapezium, followed by the temporalis, and there are no significant differences in terms of socioeconomic stratum and occupation. The most frequently reported associated symptom is neck pain.&#x0D; Conclusion: Because there is such a high prevalence, and on a global scale, we believe it is important to establish effective means of diagnosis and adequate measures for the prevention and treatment of this pathology.

Epidemiology of musculoskeletal complaints and diseases in Qatar: A cross-sectional study.

Background: Musculoskeletal (MSK) conditions are considered a significant public health problem on account of their high prevalence in communities worldwide and their pervasive impact. Knowledge of the epidemiology of MSK symptoms and diseases is lacking in Qatar. Obtaining this information will guide local health policymakers in the future strategic planning of the health budget.Objective: To estimate the prevalence rate of MSK disorders in the Qatari population above 15 years of age using the Community Oriented Program for the Control of Rheumatic Disease (COPCORD) survey.Methods: This cross-sectional study targeted 1000 Qatari participants, including 500 males and 500 females. A door-to-door survey was conducted using the Arabic version of the COPCORD questionnaire with the help of research assistants. Participants with positive surveys were asked to visit Hamad General Hospital Rheumatology outpatient clinics for clinical evaluation by a rheumatologist. When necessary, laboratory testing and X-rays were conducted to confirm any MSK diagnosis.Results: A total of 1239 (males, 50.8%) Qatari individuals randomly selected from the different municipalities of Qatar completed the COPCORD survey. Among the participants, 563 (45.4%) screened positive for MSK pain. Knee pain (24.5%) and back pain (23.3%) were the most common sites of pain, and both conditions showed no gender predominance (p = 0.073 and 0.108, respectively). Shoulder, wrist, hand, hip, and neck pain were significantly predominant in females (p < 0.001 for all). A total of 237 MSK disorders were diagnosed in 196 (15.8%) participants, including 181 degenerative joint diseases, 52 soft-tissue rheumatism conditions, and 4 autoimmune inflammatory disorders. Among degenerative joint diseases, knee osteoarthritis (6.4%) was the most common. Among soft-tissue rheumatic conditions, muscular lower back pain (1.9%), myofascial neck pain (0.64%), generalized body pain (0.32%), and shoulder tendinitis (0.7%) were the most common diseases. The autoimmune inflammatory disorders identified included rheumatoid arthritis (n = 2), connective tissue disease (n = 1), and inflammatory bowel disease-associated arthritis (n = 1).Conclusion: The overall prevalence rate of MSK disorders in this small cross-sectional cohort of Qatari individuals was 15.8%. Knee pain (24.5%) and knee osteoarthritis (6.4%) were the most common MSK complaints and diagnosis in the studied Qatari population. This study guides future efforts directed toward the prevention and management of MSK diseases. Further studies with a larger sample size are needed to verify the findings.

Pragmatic Randomized Controlled Pilot Trial on Trigger Point Injections With 1% Lidocaine Versus Conventional Approaches for Myofascial Pain in the Emergency Department.

Myofascial neck and back pain is an increasingly common chief symptom in the emergency department. Currently, there are no widely accepted conventional therapies, and there is little evidence on the efficacy of interventions such as trigger point injections (TPIs). This study evaluates whether TPIs with 1% lidocaine can improve myofascial back and neck pain compared with conventional therapies. Secondary outcomes include changes in length of stay and number of opioid prescriptions on discharge. This single-center, prospective, randomized, pragmatic trial was carried out in patients clinically determined to have myofascial back or neck pain. Patients were randomized into the experimental arm (TPI with 1% lidocaine) or the control arm (standard conventional approach). Numeric Rating Scores (NRS) for pain and additional surveys were obtained prior to and 20min after the intervention. The NRS for pain was lower in the TPI group compared with the control group after adjustment for initial pain (median difference -3.01; 95% confidence interval -4.20 to -1.83; p<0.001). Median length of stay was 2.61h for the TPI group and 4.63h for the control group (p<0.001). More patients in the control group (47.4%) were discharged home with an opioid compared with the TPI group (2.9%) (p<0.001). TPI is an effective method for managing myofascial pain in the emergency department. This study indicates it may improve pain compared with conventional methods, reduce length of stay in the emergency department, and reduce opioid prescriptions on discharge.

A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device.

The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.

Benefits, Safety, and Adjunct Modality Prevalences of Long-Term Botulinum Toxin Injections for Cervical Dystonia and Myofascial Neck Pain: A Retrospective Cohort Study.

IntroductionThere is a paucity of long-term treatment benefit and safety data of botulinum toxin A (BTX-A) for cervical dystonia (CD) and myofascial neck pain syndrome (MPS). Additionally, the prevalence of adjunct modality uses during this period is unknown despite evolving practices.ObjectiveTo assess and compare treatment benefit, safety, and adjunct modality prevalences of long-term BTX-A injections between CD and MPS patients.DesignRetrospective cohort study.SettingPrivate practice tertiary care clinics in Toronto.PatientsConvenience sample of 37 (52.9%) CD and 33 (47.1%) MPS patients treated for a mean±SD duration of 7.2±4.3 and 8.3±4.7 years, respectively.InterventionsBTX-A injections administered at least once yearly, for a duration longer than 1 year.Main Outcome MeasuresToronto Western Spasmodic Torticollis Rating Scales (TWSTRS) for disability and pain, Patient Global Impression of Change (PGIC) score, time to peak effect, duration of total response, adverse effects, and prevalence of adjunct modalities.ResultsCD patients experienced improvements in TWSTRS disability (17.57±6.79 to 9.81±4.35, p<0.001) and pain (14.61±3.08 to 9.05±3.49, p<0.001) scores as well as PGIC score (52.00%±23.60% to 64.80%±23.60%, p=0.007). MPS patients experienced improvements in TWSTRS disability (15.86±7.70 to 10.07±7.01, p=0.01) and pain (15.25±4.09 to 10.85±4.49, p=0.01) scores. In both cohorts, there were no changes in time to peak effect and duration of total response. Adverse effects were minimal and self-limiting. Prevalences of adjunct modalities used by CD versus MPS patients were 28.13% versus 50.00% for anesthetic procedures, 23.08% versus 15.38% for image-guidance, 65.71% versus 56.25% for pectoralis minor injections, and 47.06% versus 53.13% for cannabis-use.ConclusionThere were demonstrated and comparable treatment benefit, safety, and adjunct modality prevalences. Our study is the first to demonstrate that long-term BTX-A injections for MPS, although commonly used off-label, can be effective and safe.

Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: a randomized clinical trial.

The aim of this study was to observe the medium-term effects on pain, disability, and psychological factors of a combination of myofascial trigger point (MTrP) dry needling (DN) with pain neuroscience education (PNE) versus DN alone versus control care as usual (CUC) in patients with chronic neck pain. A total of 60 patients were randomly selected in a Spanish National Health Service Public Hospital and divided into three groups: 6 sessions of DN with 3 sessions of PNE (TrPDN + PNE group, n = 21), 6 sessions of DN alone (TrPDN group, n = 20), or 10 sessions of usual care (CUC group, n = 19). The primary outcome was neck pain intensity, while neck disability, medication intake, and psychological factors were secondary outcomes. These variables were measured at baseline, post-treatment, and at 1 month and 3 months after treatment. TrPDN + PNE and DN alone were associated with greater reductions in pain intensity and disability compared to CUC (p < 0.01). TrPDN + PNE resulted in greater improvements in kinesiophobia, pain anxiety, and pain-related beliefs than DN alone and CUC (p < 0.01). No differences between groups were observed in medication intake, quality of life, catastrophizing, depression, or fear of pain (p > 0.05). Provision of PNE and DN in the management of chronic neck pain in a Spanish National Health Service Public Hospital was associated with greater improvements in psychological factors than DN therapy only. DN alone was more effective at reducing chronic non-specific neck pain and disability than CUC at 3-month follow-up. However, the inclusion of PNE combined with DN resulted in greater improvements in kinesiophobia, pain anxiety, and pain-related beliefs. NCT03095365 (ClinicalTrials.gov).

The effectiveness of acupuncture in the management of persistent regional myofascial head and neck pain: A systematic review and meta-analysis

Persistent head and neck myofascial pain is among the most frequently reported pain complaints featuring major variability in treatment approaches and perception of improvement. Acupuncture is one of the least invasive complimentary modalities that can optimize conventional treatment. The aim of this review was to determine the evidence for the effectiveness of acupuncture in the management of localized persistent myofascial head and neck pain. Only randomized controlled clinical trials (RCTs) were included. The search was conducted in PubMed, Ovid Medline, Embase, Google Scholar, and Cochrane Library in addition to manual search. The main outcome measure was the comparison of the mean pain intensity score on VAS between acupuncture and sham-needling/no intervention groups. Safety data and adherence rate were also investigated. Six RCTs were identified with variable risk of bias. All included studies reported reduction in VAS pain intensity scores in the groups receiving acupuncture when compared to sham needling/no intervention. Meta-analysis, using a weighted mean difference as the effect estimate, included only 4 RCTs, revealed a 19.04 point difference in pain intensity between acupuncture and sham-needling/no intervention (95 %CI: -29.13 to -8.95). High levels of safety were demonstrated by the low rates of side effects/withdrawal. Inconsistency in reporting of outcomes was a major limitation. In conclusion, moderate-quality evidence suggests that acupuncture may be an effective and safe method in relieving persistent head and neck myofascial pain. Optimizing study designs and standardizing outcome measures are needed for future RCTs.