Myofascial Trigger Point Injection Research Articles

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

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

The effect of simultaneous administration of occipital nerve block and cervical myofascial trigger point injection (MTrPI) on headache parameters in chronic migraine patients.

Peripheral myofascial mechanisms have been identified as contributors to migraine pathophysiology. The specific comorbid relationship between migraine and cervical trigger points may exacerbate the occurrence and severity of migraine attacks. Trigger point injections (TPIs) are frequently employed to address headaches and alleviate migraine symptoms. The current study explores the impact of concurrent myofascial trigger point injection (MTrPI) and occipital nerve block (greater occipital nerve block [GONB] + lesser occipital nerve block [LONB]) on the severity of headaches and the number of migraine attacks in individuals with chronic migraine (CM) and cervical myofascial trigger points (MTrPs), with a comparison of occipital nerve block alone (GONB + LONB). During trigger point examination and injection, trapezius, levator scapulae, splenius capitis, temporalis, and sternocleidomastoid muscles were targeted. We planned the treatment based on whether they were in the muscle groups we determined, rather than the number of trigger points. This study enrolled 62 individuals experiencing CM with bilateral headache and cervical MTrP who sought care at the Algology Unit within the Departments of Neurology and Physical Therapy and Rehabilitation at Siirt Training and Research Hospital between 2020 and 2022. The CM cohort was stratified into two groups: group 1 received trigger point injections (TrPI), while group 2 underwent concurrent bilateral occipital nerve block (GONB + LONB) and TrPI. Both groups underwent three treatment sessions with bupivacaine 0.5% (1ml = 5mg) in weeks 1, 2, and 4. Visual analog scale (VAS) was used to measure the patients' pain intensity. The evaluation included the assessment of the monthly migraine frequency and visual analog scale (VAS) p score for pain before treatment (BT) and after treatment (AT), conducted at baseline and during follow-up visits. Analysis of the data was conducted utilizing IBM SPSS Statistics for Windows version 28.0 software. Among patients diagnosed with CM and MTrPs, 32 individuals (51.6%) underwent GONB and LONB, while 30 patients (48.4%) received simultaneous GONB, LONB, and cervical MTrPI. Within the entire sample, 51 participants (82.3%) were female, and 11 (17.7%) were male, with a mean age of 32.81 ± 10.75years. With an average age of 32.81 ± 10.75years, there was no statistically significant variance between the two groups (p = 0.516). Of the total cohort, 45 individuals (72.6%) reported experiencing headaches persisting for 12months or longer. Among CM patients, 80% had active trigger points, while 20% had latent trigger points. No statistically significant difference was observed between the groups concerning TrPs (p = 0.158), and the distribution of TrPs was homogenous across the two groups. In group 1, the median (min-max) monthly frequency of migraines reduced from 18.5days (range: 15.0 to 25.0days) before treatment to 12.0days (range: 7.0 to 17.0days) after treatment (p = 0.000). In group 2, the median monthly frequency of migraines reduced from 16.5days (range: 15.0 to 22.0days) before treatment to 4.0days (range: 2.0 to 8.0days) after treatment (p = 0.000). The median (min-max) VAS score in group 1 was 8.0 (range: 5.0 to 9.0) before treatment, 4.0 (range: 2.0 to 6.0) at week 1, and 5.0 (range: 4.0 to 8.0) at week 4 (p = 0.000). In group 2, the median VAS score was 7.0 (range: 5.0 to 9.0) before treatment, 0.0 (range: 0.0 to 0.3) at week 1, and 2.0 (range: 0.0 to 0.3) at week 4 (p = 0.000). There were significant distinctions between the groups in terms of both the monthly count of migraine days and the severity of headaches (p = 0.000). The combination of repeated MTrPIs and ONB proves more effective than ONB alone in managing patients with CM and cervical MTrP. In patients with CM, performing TrPs examination and adding treatments for this may contribute to the treatment. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits.

The Role of Manual Therapies in the Treatment of Headache Disorders.

A comprehensive headache treatment plan typically requires both medication and non-medication treatment strategies. Manual therapies offer another therapeutic approach to headache treatment. This article reviews the evidence for manual therapies in the treatment of headache disorders. Current evidence shows potential benefit from myofascial trigger point injections, myofascial release, and massage for the treatment of various headache types. There is also evidence for strain counterstrain technique, ischemic compression, and spinal manipulative therapies for cervicogenic headache. Although larger randomized clinical trials are necessary for many of these modalities, recent findings show that manual therapies could be an important tool for the treatment of some headache disorders.

Do ultrasound-guided myofascial trigger point injections lead to better outcomes and fewer complications when compared with trigger point injections without ultrasound guidance?

Do ultrasound-guided myofascial trigger point injections lead to better outcomes and fewer complications when compared with trigger point injections without ultrasound guidance?

Minimally-invasive pain management techniques in palliative care.

Pain is a common source of suffering for seriously ill patients. Typical first-line treatments consist of lifestyle modifications and medication therapy, including opioids. However, medical treatments often fail or are associated with limiting systemic toxicities, and more targeted interventional approaches are necessary. Herein, we present options for minimally invasive techniques for the alleviation of pain in palliative patients from a head-to-toe approach, with a focus on emerging therapies and advanced techniques. Head and neck: image-guided interventions targeted to sympathetic ganglia of the head and neck, such as sphenopalatine ganglion (SPG) and stellate ganglion, have been shown to be effective for some forms of sympathetically-maintained and visceral pain. Interventions targeting branches of cranial nerves and upper cervical nerves, such as the glossopharyngeal nerve (GPN), are options in treating somatic head and face pain. Abdominal and pelvic: sympathetic blocks, including celiac plexus, inferior hypogastric, and ganglion impar can relieve visceral abdominal and pelvic pain. Spine and somatic pain: fascial plane blocks of the chest and abdominal wall and myofascial trigger point injections can be used for somatic pain indications. Cementoplasties, such as kyphoplasty and vertebroplasty, are used for pain related to bony metastases and compression fractures. Tumor ablative techniques can also be used for lytic lesions of the bone. Spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cordotomy have also been used successfully in patients requiring advanced options, such as those with significant spinal, ischemic, or visceral pain.

Feasibility of Ultrasound-Guided Trigger Point Injection in Patients with Myofascial Pain Syndrome.

We compared the feasibility of ultrasound (US)-guided myofascial trigger point (MTrP) injection with that of a blind injection technique following the use of shear wave elastography (SWE) for the measurement of stiffness at the MTrPs in patients with trapezius myofascial pain syndrome (MPS). A total of 41 patients (n = 41) were randomized to either the trial group (n = 21, SWE combined with US-guided injection) or the control group (n = 20, SWE combined with blind injection). At baseline and four weeks, they were evaluated for the manual muscle test (MMT), the range of motion (ROM), pain visual analogue scale (VAS) scores, Shoulder Pain and Disability Index (SPADI) scores and Neck Disability Index (NDI) scores during the abduction, adduction, flexion, extension, external rotation and internal rotation of the shoulder joint. Differences in changes in pain VAS scores, NDI scores and SPADI scores at four weeks from baseline between the two groups reached statistical significance (p = 0.003, 0.012, and 0.018, respectively). US-guided MTrP injection is a more useful modality as compared with a blind injection in patients with MPS.

Complex Regional Pain Syndrome is a Manifestation of the Worsened Myofascial Pain Syndrome: Case Review

Complex regional pain syndrome is a severe chronic pain condition. Its diagnosis to date is controversial. Effects of various treatment methods also remain controversial with unpredictable outcomes. The author experienced a case of complex regional pain syndrome type 2 which was cured by sympathetic blockade and myofascial trigger point injection. Afterwards, the author focused on myofascial trigger points for the management of CRPS and the results were successful in almost all the cases. Through the review of complex regional pain syndrome cases those were successfully treated, the author tried to figure out pathologic mechanism, methods of treatment, and diagnostic criteria of complex regional pain syndrome.

The Effects of Myofascial Trigger Point Injections on Nocturnal Calf Cramps

The purpose of this study was to elucidate the effects of injection at trigger points on pain and sleep disturbance in patients with nocturnal calf cramps (NCCs). Patients with NCCs that occurred at least once per week and who had myofascial trigger points (MTrPs) on the gastrocnemius muscles were enrolled in the study for 9 months. At the first visit (T0), we measured the intensity of NCC pain on an 11-point numeric rating scale, recorded the frequency of NCCs, and calculated the Insomnia Severity Index (ISI). We then checked for MTrPs on the gastrocnemius muscles and injected 1-2 mL of 0.25% lidocaine into each of the trigger points. At 1 (T1), 2 (T2), and 4 (T3) weeks after the first visit, we repeated the process performed at T0. Twelve patients completed the treatment schedule and attended the follow-up visits. Mean values of the numeric rating scale pain score, frequency of cramps, and ISI declined significantly at T1, T2, and T3 compared with baseline (all P < .01). Of 12 patients, 10 had clinical insomnia before treatment, and this number decreased significantly to 3 patients at T2 and 1 patient at T3 (P = .012 and P = .001, respectively). These preliminary data show that injection at MTrPs in patients with NCCs not only alleviated pain and reduced the frequency of cramps but also lessened the severity of insomnia as measured by the ISI. A larger randomized controlled trial is needed to confirm these findings and determine whether the effect lasts over the long term.

Experience of atypical chest pain that can be overlooked and neglected in youths

To the Editor: Chest pain in the young can be a diagnostic challenge to physicians. Although adolescents scarcely have heart-origin problems, meticulous examination is important to rule these out thoroughly [1]. Sometimes, physical examination and history taking, rather than complicated laboratory tests, give an answer. A 17-year-old girl visited our hospital because of intermittent sharp and brief left chest pain. It had started 10 days previously, and she pointed out the site well with her finger tips. The attack came during inspiration, so she breathed shallowly. The pain lasted approximately 3–15 min and completely resolved without medication. With left pneumothorax 2 weeks before visiting, she recovered with oxygen supply therapy. No abnormal findings were detected by physical examination, electrocardiography, or chest X-ray. Once we assumed the pain was rarely related to heart, myofascial trigger point injection was performed. We performed an intercostal nerve block at 3 levels on her left anterior chest. Unexpectedly, this seemed to have hardly any effect on relieving her pain. Later, we heard she experienced the pain again on her way to school and, separately, at the school. We considered the features of her pain were benign and were derived from the parietal pleura, and finally diagnosed the problem the precordial catch syndrome. Unfortunately, since Miller and Texidor first described PCS in 1955 [1], precordial catch syndrome (PCS) has long been under-recognized among physicians. PCS commonly occurs at age 6–12 years with no sex predominance. The pain is sharp, brief, knifelike, and easily located with the finger, commonly at the left sternal border, over an intercostal space [2]. More exclusively, the attack is aggravated by inspiration only, so patients breathe shallowly. The episode usually lasts from 3 to 30 min, and complete pain relief comes spontaneously. Most of these patients are basically healthy [1, 3]. One study evaluated the causes of chest pain of 380 children. Interestingly, only 0.3 % had a cardiac origin and 1.1 % had abnormal electrocardiogram. Approximately 15 % were miscellaneous disorders, for example PCS. As a result, meticulous history taking and physical examination are sufficient to diagnose PCS. It seems unnecessary to conduct complicated laboratory tests, for example complete blood count, electrocardiogram, chest X-ray, and echocardiogram [2]. To diagnose the PCS, many other origins of chest pain must be ruled out on the basis of their distinct features (Table 1). So far, definitive treatment of PCS is unknown and there are no data for effectiveness of nerve block in PCS. We tried intercostal nerve block, expecting pain relief, however, that seemed to be ineffective for PCS. According to several reports, nerve block is not always effective to any pain. For example, greater occipital nerve block is ineffective in chronic tension type headache, and idiopathic persistent facial pain [4, 5]. Finally, we should consider nerve block as a new treatment for PCS more carefully. Further investigation is required to validate its effectiveness. M.-S. Jang Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea

Needling Therapy for Myofascial Pain Control

Needling Therapy for Myofascial Pain Control

Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature

We report a case of thymic carcinoma presenting as unilateral shoulder pain for 13 months. Before an accurate diagnosis was made, the patient received conservative treatment, cervical discectomies, and myofascial trigger point injection, none of which relieved his pain. When thymic carcinoma was eventually diagnosed, he received total resection of the tumor and the shoulder pain subsided completely. Thymic carcinoma is a rare carcinoma, and our review of the literature did not show shoulder pain as its initial presentation except for one case report. The purpose of this report is to document our clinical experience so that other physiatrists can include thymic carcinoma in their differential diagnosis of shoulder pain.

European Pain Management Discussion Forum

ABSTRACTQueries from European physicians about analgesic pharmacotherapy and responses from the author are presented. The topics addressed in this issue are unilateral continuous headache, serotonin syndrome, and myofascial trigger point injections.

Ultrasound-guided trigger point injections

Myofascial trigger point injections are frequently indicated for myofascial pain syndrome and are performed as blind procedures. Although these injections are usually safe and effective, complications resulting in pneumothorax, epidural abscess, skeletal muscle toxicity, and intrathecal injection been reported. Avoiding the risk of radiation, ultrasonography provides real-time visualization of soft tissue, bone, cartilage, and foreign body, and may be used to guide injections. The clinical manifestation of myofascial pain syndrome and trigger points will be presented. A review of the etiology and identification of trigger point will be introduced. This paper presents the technique of ultrasound (US)-guided trigger point injections. It will also discuss the advantages of US guidance over the blind technique, including minimizing risks. The technical challenges and their solutions for needle visualization and guidance will be presented.

Injection of Remote Myofascial Trigger Points for Pain Control: A casereport

The purpose of this case report is to demonstrate the remote effect of myofascial trigger point (MTrP) injection for pain control. It describes a patient suffering from chronic pain due to MTrPs in bilateral upper trapezius muscle with poor results to direct MTrP injection to upper trapezius. After injection to the MTrPs in bilateral extensor carpi radialis longus, extensor indicis, and first dorsal interosseous muscles, the effectiveness of MTrP injection to bilateral upper trapezius muscles remarkably enhanced. This patient finally became almost pain free. The reason for poor relief of pain immediately after the first MTrP injection (directly on the upper trapezius muscles) was probably due to low pain threshold as a consequence of superimposed fibromyalgia syndrome. The muscles selected for the subsequent injection were actually satellite MTrPs of the key MTrP in the upper trapezius muscle. The remote effectiveness of MTrP injection is probably related to the neural connection in the spinal cord.

A New Technique for Acupuncture Therapy and Its Effectiveness in Treating Fibromyalgia Syndrome: A Case Report

Background: The purpose of this case report is to demonstrate a new acupuncture technique in treating fibromyalgia syndrome [FMS].Findings: A patient with FMS had poor responses to previous treatments. She received treatment at our acupuncture clinic. The new acupuncture technique we applied was similar to Hong's technique for myofascial trigger point injection but used simultaneous needle rotation to facilitate the insertion movement of a small acupuncture needle. After five sessions, she assessed her overall pain level to be at less than 20 percent of its original level. A follow-up confirmed that she was no longer suffering any serious discomfort.Conclusion: A patient with FMS may show remarkable pain relief after this treatment. The mechanism is probably similar to hyperstimulation analgesia, but postneedling discomfort may be reduced due to the small size of acupuncture needle. It is suggested to have a well-controlled, double-blinded study on a large sample to confirm that conclusion.

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

Interventional approaches to the management of myofascial pain syndrome

Interventional therapies are a valuable addition to our armamentarium when treating myofascial pain syndromes. When combined with other therapies, interventional techniques can be an effective adjunct in the multidisciplinary management of pain. This article describes current interventional therapies that are employed in treating myofascial pain syndromes. The mainstay of injection therapies, the myofascial trigger point injection, is emphasized. More recent advances, such as the use of botulinum toxin, are also discussed. In addition, other techniques such as acupuncture and the use of laser therapy are mentioned.

Intramuscular Sensory Neurolysis : A New Technique to Control Spasticity

This preliminary report demonstrated a new technique, “intramuscular sensory neurolysis” (IMSN), to control the muscle spasticity. Similar to myofascial trigger point (MTrP) injection, the needle were rapidly inserted, for a short distance (1 mm) each thrust, into the MTrP region (in the endplate zone) to elicit local twitch responses to identify the terminal sensory fibers for phenol injection. Immediate relief of spasticity was noticed both subjectively and objectively after IMSN. As compared with the traditional motor point block, the advantage of IMSN includes: 1) less time (usually 3-5 minutes for each MTrP region) required to perform the whole procedure in a site, 2) less amount of phenol solution required to inject a muscle to obtain significant therapeutic effectiveness, 3) less trauma to muscle, 4) Less systemic side effects, 5) no obvious side effect of motor weakness, and 6) less cost.

Characteristics of Postradical Neck Pain Syndrome: A Report of 25 Cases

The postradical neck pain syndrome has been briefly described in the literature, but detailed characterization has not been reported. To further define this syndrome, 25 patients with persistent pain for at least 1 month following neck dissection were evaluated. The sample consisted of 13 men and 12 women with moderate to severe pain ranging from 1 month to 27 years in duration. All patients had at least one type of neuropathic pain: spontaneous, continuous burning pain (81%), shooting pain (69%), and/or allodynia (88%). Neuropathic pain sites were within the distribution of the superficial cervical plexus (SCP). Regional myofascial pain was also common (72%). Seventeen patients agreed to undergo diagnostic local anesthetic injections. Ten of these patients had both neuropathic and somatic (myofascial) pain. Local anesthetic injection of the SCP temporarily eliminated all neuropathic pain in the 17 patients who underwent the procedure. The 10 patients who also had myofascial pain reported temporary relief of their somatic pain following myofascial trigger point injections (TPI). Criteria for the postradical neck pain syndrome are proposed: (1) persistent, nonprogressive neuropathic pain involving one or more branches of the SCP, which may be accompanied by (2) regional nonprogressive somatic pain associated with myofascial pain trigger points in head and neck muscles.

Referred pain elicited by palpation and by needling of myofascial trigger points: A comparison

Objective: To investigate the occurrence of referred pain (REP) elicited by palpation (Pal-ReP) or by needle injection (Inj-ReP) of myofascial trigger point (MTrP), and to assess the correlated factors, including the pain intensity of an active MTrP and the occurrence of local twitch response (LTR). Design: Correlational study. Patients: Ninety-five patients who were treated with MTrP injections. Intervention: MTrP injections. Main Outcome Measure: Pain intensity of MTrP and occurrence of Pal-ReP, Inj-ReP, and LTR. Results: Both Pal-ReP and Inj-ReP were elicited in 53.9% of MTrPs. Inj-ReP, but not Pal-ReP, was elicited in 33.7% of MTrPs. Both Pal-ReP and Inj-ReP were unobtainable in 12.3% of MTrPs. The occurrence of ReP was significantly correlated to the pain intensity of active MTrP and the occurrence of LTR. Conclusion: ReP could be elicited more frequently by needling than by palpation. The frequency of occurrence in ReP mainly depends on pain intensity of an active MTrP.