Myofascial Neck Pain Research Articles

The effect of myofascial neck pain on postural control: Visual deprivation

The aim of this study was to investigate the standing balance (with open and closed eyes) on rigid surface in women with myofascial neck pain syndromes. This study was carried out in single and double limbs stances, open versus closed eyes, and the results were compared with control group. Forty subjects (20 in each group) were tested on a force-platform, during 30 seconds. The mean velocity (cm/s), surface area (cm2), antero-posterior and medio-lateral displacements (cm) of center of foot pressure (COP) were determined. There were significant differences between two groups regarding the mean velocity and area of COP displacements. In addition, significant differences were observed in respect to eye and limb conditions (open versus closed; single versus double limbs stances; respectively) on mean velocity, area, antero-posterior (AP) and medio-lateral (ML) displacements of COP. Our results showed that myofascial neck pain syndrome might be one of the disturbing factors on standing balance.

Physician-Delivered Injection Therapies for Mechanical Neck Disorders: A Systematic Review Update (Non-Oral, Non-Intravenous Pharmacological Interventions for Neck Pain)

Background: Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs).Objectives: To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs.Search Methods: We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012.Selection Criteria: We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies.Data Collection and Analysis: Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models.Results: We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls.Authors' Conclusions: Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain.

Low Level Laser Therapy (LLLT) for Neck Pain: A Systematic Review and Meta-Regression.

Purpose:This systematic review update evaluated low level laser therapy (LLLT) for adults with neck pain.Methods:Computerized searches (root up to Feb 2012) included pain, function/disability, quality of life (QoL) and global perceived effect (GPE). GRADE, effect-sizes, heterogeneity and meta-regression were assessed.Results:Of 17 trials, 10 demonstrated high risk of bias. For chronic neck pain, there was moderate quality evidence (2 trials, 109 participants) supporting LLLT over placebo to improve pain/disability/QoL/GPE up to intermediate-term (IT). For acute radiculopathy, cervical osteoarthritis or acute neck pain, low quality evidence suggested LLLT improves ST pain/function/QoL over a placebo. For chronic myofascial neck pain (5 trials, 188 participants), evidence was conflicting; a meta-regression of heterogeneous trials suggests super-pulsed LLLT increases the chance of a successful pain outcome.Conclusions:We found diverse evidence using LLLT for neck pain. LLLT may be beneficial for chronic neck pain/function/QoL. Larger long-term dosage trials are needed.

An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders.

Introduction: Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited.Purpose: To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain.Methods:A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus.Results:Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up.Conclusions:The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research.

Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up

A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The aim of this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain. The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical range of motion (ROM) was analyzed and the neck pain disability questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analyzed by ultrasonography. There were significant differences between healthy subjects and patients with CNP in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia both at the end of treatment as during follow-up. A significant decrease in pain and thickness of the fasciae were found. Analysis of the thickness of the sub-layers showed a significant decrease in loose connective tissue, both at the end of treatment and during follow-up. The data support the hypothesis that the loose connective tissue inside the fasciae may plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue.

The possible use of ultrasonography for the diagnosis of myofascial neck pain

A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The aim of this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain. The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical Range Of Motion (ROM) was analysed and the Neck Pain Disability Questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analysed by ultrasonography. There were significant differences between healthy subjects in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia. Analysis of the thickness of the sub-layers showed a significant increase of the loose connective tissue inside the fascia, rather than of the fibrous sublayers. The data support the hypothesis that the loose connective tissue inside the fasciae plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue, and probably more specifically with hyaluronan.

Patterns of Nonarticular Rheumatism in a Rural Area of Bangladesh

Objectives: Estimate the prevalence of nonarticular (soft tissue) rheumatism in a rural population of Bangladesh. Methods: The survey was carried out in eight villages of Sonargaon upazila of Narayanganj district about 30 kilometers from Dhaka. All subjects of both genders (5217) of ?15 years old of 8 villages were evaluated. Door to door survey was done to cover missing cases. Trained field workers identified subjects with musculoskeletal pain using Bengali version of the COPCORD (Community Oriented Program for the Control of Rheumatic Disease) questionnaire. Positive respondents were examined by trained internist and rheumatologists for definite non articular rheumatic disorders. COPCORD guideline was used for diagnosis. Results: MSK pains (positive respondent) were 1260 (24.2%) in out of 5217 (male 2556, female 2661). Among of them definite soft tissue rheumatic diseases were identified in 439 (male 102 and female 337). Major occupations were house wives (54.7), weavers (18%), and peasants (5.1%). Definite point prevalence of nonarticular rheumatism was 8.41% (male 3.7%, female 11.09%). The most common diseases were fibromyalgia (3.95%), repetitive strain injury (2.3%), nocturnal muscle cramp (0.59%), myofascial neck pain (0.48%), planter fasciitis (0.46%). Conclusion: Prevalence of nonarticular rheumatism is common in this rural community. Fibromyalgia is the leading disease. DOI: http://dx.doi.org/10.3329/jom.v13i2.12752 J Medicine 2012; 13 : 165-169

Poster 157 Evaluation of the Role of Ultrasonography in the Diagnosis of the Myofascial Neck Pain

Poster 157 Evaluation of the Role of Ultrasonography in the Diagnosis of the Myofascial Neck Pain

Efficacy of a 0.1% Capsaicin Hydrogel Patch for Myofascial Neck Pain: A Double-Blinded Randomized Trial

The objective of this study was to evaluate the efficacy of a hydrogel patch containing capsaicin 0.1% compared with a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain. The study was designed as a double-blinded randomized controlled trial. Setting. The study was set at Kyung-hee University Hospital at Gangdong, Korea. Sixty-one participants between 18 and 65 years with at least 3 months duration of neck pain and a clinical presentation of myofascial pain syndrome were enrolled in the study from September 1 to November 20, 2010. Interventions. Participants received capsaicin 0.1% hydrogel patches or control hydrogel patches without capsaicin according to the randomization scheme. All participants were instructed to apply one patch to each side of the neck and shoulder girdle overlying the point of maximal pain for 12 hours daily during the duration of the 4-week study. Each participant completed five surveys at baseline, at 2 weeks after the start of treatments, and at the conclusion of the 4-week study. The primary outcome measure was visual analog scale (VAS). Other outcome measures included the Neck Disability Index (NDI), Beck's Depression inventory (BDI), Short Form 36 Korean version, and Euroqol 5-D. Fifty-seven patients completed the study. The mean VAS, NDI, and BDI scores were significantly decreased at 2 and 4 weeks after the start of the intervention in both groups. There was no significant difference between the two groups in any of the outcome measures. Future research may help to discern specific effects of capsaicin, trigger point stimulation by application of the patch, and the placebo effect.

Anterior and posterior neck muscle activation during a variety of biting tasks

Bruxism may be involved in the aetiology of myofascial neck pain. The objective of this study was to test the hypothesis that anterior and posterior neck muscles co-contract during jaw clenching. Ten test subjects developed different feedback-controlled submaximum bite forces in a variety of bite-force directions by means of bite-force transducers. The electromyographic activity of the sternocleidomastoid and supra/infrahyoidal muscles, and of the semispinalis capitis, semispinalis cervicis, and multifidi muscles was recorded by use of surface electrodes and intramuscular wire electrodes, respectively. For normalization of electromyography data, maximum voluntary contraction tasks of the neck muscles were conducted in eight different loading directions. The results confirmed co-contraction of the neck muscles in the range of 2-14% of the maximum voluntary contraction at a bite force ranging from 50 to 300 N. Significant activity differences were observed as a result of the different force levels and force directions exerted by the jaw muscles. Long-lasting tonic activation of specific neck muscles triggered by the jaw-clenching tasks was also detected. These findings support the assumption of a relationship between jaw clenching and the activity of the neck muscles investigated. The low level of co-contraction activity, however, requires further study to elucidate possible pathophysiological interactions at the level of single motor units.

P02.02. Efficacy of a topical 0.1% Capsaicin hydrogel patch to treat chronic neck pain: a double-blind randomized clinical trial

Purpose Myofascial trigger points are a common component of musculoskeletal neck pain. Capsaicin, a vanilloid 1 (TRPV1) receptor agonist, has been shown to induce pain in human tendon tissues and to increase trigger point sensitivity in humans. TRPV1 receptor agonists, with repeated use, inhibit the initiation of transmission of pain-related neurotransmitters and may alleviate pain. This study evaluated the efficacy of a hydrogel patch containing capsaicin 0.1% compared to a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain.

Postural Control in Women with Myofascial Neck Pain

ObjectivesMyofascial pain syndrome [MPS] is one of the problems of the musculoskeletal system, which is characterized by painful muscle dysfunction and myofascial trigger points. Earlier studies have demonstrated postural control disturbances in patients with neck pain of different etiologies. There are no studies investigating the postural control in patients with MPS-related neck pain. The aim of this study was to evaluate the standing balance in women with MPS-related neck pain and compare them with those of age-matched healthy controls.MethodsTwenty-one women with MPS-related neck pain and 21 healthy age-matched women were tested using the force platform to quantify postural sway during unipedal and bipedal standing under varying conditions of surface [firm and foam surfaces] and in the eyes-open condition. The balance measures were 1. anteroposterior displacements [AP] in cm, 2. mediolateral displacements in cm, 3. surface area [cm2], and 4. mean velocity [cm/s].ResultsIn bipedal standing, foam surfa...

ABC de la acupuntura en reumatología

Acupuncture is a medical procedure and therefore requires a diagnosis, a therapeutic indication and a prognosis. These tasks form part of medical expertise and must be carried out by suitably qualified and accredited health professionals. Recent investigations have started to establish the scientific basis of acupuncture and consequently the mechanisms of action and the local and systemic mediators involved in this modality are beginning to be understood. Published systematic reviews indicate that the main rheumatic diseases the benefit from acupuncture are osteoarthritis, myofascial pain syndrome, epicondylitis, and neck, shoulder and low back pain. From the perspective of evidence-based medicine, the use of acupuncture in the treatment of osteoarthritis and chronic cervical and lumbar pain is efficient in terms of quality-adjusted life years. Accordingly, acupuncture is a strategy that should be considered in excellent healthcare management.

The Therapeutic Effects of Acupuncture on Patients with Chronic Neck Myofascial Pain Syndrome: A Single-Blind Randomized Controlled Trial

Chronic neck myofascial pain syndrome (MPS) is a common disorder seen in clinics. There is no gold standard method to treat myofascial pain. We investigated the effects of acupuncture on patients with chronic neck MPS by a single-blind randomized controlled trial. A total of 35 patients were randomly allocated to an acupuncture group (AG) or a sham acupuncture group (SG). Each subject received acupuncture treatment twice per week for three consecutive weeks. The primary outcome measure was quality of life as assessed with Short Form-36, and secondary outcome measures were neck range of motion (ROM), motion-related pain, and Short-Form McGill Pain Questionnaire (SF-MPQ), as determined by a blinded investigator. The clinical assessments were made before treatment (BT) and after six acupuncture treatments (AT), as well as four weeks (F1) and 12 weeks (F2) after the end of the treatment. A total of 34 patients completed the trial. The results indicated that there is no significant difference in the ROM, motion-related pain, and SF-MPQ scores between AG and SG at AT, F1 and F2 (all p > 0.05). However, AG has greater improvement in physical functioning and role emotional of Short Form-36 quality of life at F2. The results indicate that acupuncture may be used to improve the quality of life in patients with chronic neck MPS.

Feasibility of the use of a novel soft tissue stiffness meter

Simple but objective measurement of soft tissue consistency would be advantageous in the assessment of many neurological, lymphostatic and venous disorders. The aim of the present study was to evaluate the feasibility of using a novel hand-held computerized soft tissue stiffness meter (STSM). The STSM describes the soft tissue stiffness (STS) in the form of the instantaneous force (N) by which the tissue resists the constant deformation produced by a cylindrical intender. Firstly, the STSM was used to test elastomer samples with known mechanical properties. In the in vivo assessment, 12 healthy, nondisabled adults (age range, 24–57 years) and 16 subjects with chronic myofascial neck pain syndrome (age range, 27–55 years) were studied. To study the reproducibility (coefficient of variation (CV(%))) of the method, the measurement sites were either marked with a marker pen (marked points) or localized anatomically (unmarked points). Measurements were made from the dorsal forearm (Arm), trapezius (Tra), levator scapulae (Lev), infraspinatus (Inf) and deltoideus (Del) muscle areas. STS in the forearm was studied during different types of short-term relative isometric loading of the muscle as well as during venous occlusion. STS values of the myofascial trigger points in the Lev muscles were evaluated bilaterally. A linear, positive relationship was found between the indenter force (N) and the dynamic compressive modulus (MPa) of elastomer stiffness (r2 = 0.90, n = 9). Intra- and interrater CVs of marked and unmarked sites varied between 4.31% and 12.06%. STS increased linearly along the relative muscle load (r2 = 0.96) and nonlinearly during the venous occlusion (r2 = 0.97). Statistically significant regional variation of STS was found between the different measurement sites (p < 0.05). In conclusion, STSM can evaluate tissue stiffness quantitatively and yield reproducible data.

Controlled Trial of Japanese Acupuncture for Chronic Myofascial Neck Pain: Assessment of Specific and Nonspecific Effects of Treatment

Abstract:Objective:This article examines the specific and nonspecific effects of Japanese acupuncture on chronic myofascial neck pain in a randomized single-blind trial.Design:Forty-six patients were randomly assigned to receive relevant acupuncture, irrelevant acupuncture, or no-acupuncture control

Spontaneous Electrical Activity at Combined Acupuncture and Myofascial Trigger Point Sites

Small, localised areas of spontaneous electrical activity were found at combined acupuncture and myofascial trigger point sites, corresponding to Gall Bladder 21 in the Trapezius and Small Intestine 11 in the Infraspinatus, in patients with active myofascial neck and shoulder pain. The monopolar needle EMG techniques used to assess spontaneous electrical activity offer the possibility of providing an objective measure of both point activity and the effects of therapeutic intervention. Further studies are needed to examine not just the painful lesion itself, but its dynamic relationship with its corresponding spinal segment and associated higher centres. There are important similarities between acupuncture pain points and trigger points, and observations of both can be used profitably in further studies of myofascial pain and dysfunction.

Myofascial pain-dysfunction syndrome: the role of nonmasticatory muscles in 91 patients.

Ninety-one new patients with myofascial pain-dysfunction (MPD) syndrome were studied prospectively. The patients experienced aural fullness, tinnitus, vertigo, odynophagia, and headache in addition to the cardinal symptoms of otalgia, muscle tenderness, temporomandibular joint (TMJ) click, and trismus. Some nonmasticatory muscles were found to be tender as frequently as the masticatory muscles. It is proposed that MPD syndrome as seen clinically involves more than just the masticatory musculature and is a composite of several head and neck myofascial pain syndromes including tensor tympani syndrome, muscle tension headache, cervical syndrome, and hyoid syndrome.