Trigger Points Research Articles

A novel designed atrial septum linear ablation method (Icho line) for non-pulmonary vein triggers originating from atrial postero-septum and crista terminalis

Abstract Background Therapeutic strategy for non-pulmonary vein (PV) trigger of atrial fibrillation (AF) has not been well established although they are the major cause of AF recurrence after PV isolation. The atrial postero-septum or right atrial crista terminalis (CT) are the common non-PV trigger sites of AF. For them, a focal ablation is often insufficient due to a regional arrhythmogenicity. We devised an original linear ablation method, named "Icho Line". Icho means ginkgo in Japanese. Methods Eight hundred and thirty-two AF ablation patients were retrospectively studied. An AF induction test was conducted after each PV isolation procedure. Non-PV triggers from the postero-septum or CT that initiate AF were analyzed. Premature atrial contractions that did not initiate AF were excluded. A linear ablation was designed horizontally from the anterior right PV isolation line to fossa ovalis in the left atrium. In the right atrium, the opposite side of the left atrial ablation and CT were continuously ablated like the shape of a ginkgo leaf (Figure 1). Results A hundred and fifteen non-PV triggers were detected in 104 patients (12.5%), among which Icho line ablation was performed in 39 patients (37.5%) with documented triggers from the postero-septum or CT (Figure 1). Atrial tachyarrhythmia recurrence free rate in the Icho line group and other non-PV ablation patients were 61.8% and 45.4%, respectively (P=0.54, Figure 2). Conclusions A novel designed Icho line is a feasible and effective ablation strategy covering non-PV triggers from the atrial septum and CT.Icho Line Figure 1Icho Line Figure 2

Abstract 12216: A Novel Designed Atrial Postero-Septum Linear Ablation Method (Icho Line) for Non-Pulmonary Vein Triggers of Atrial Fibrillation (AF)

Introduction: Therapeutic strategy for non-pulmonary vein (PV) triggers of atrial fibrillation (AF) has not been well established although they are the major cause of AF recurrence after PV isolation. The atrial postero-septum or right atrial crista terminalis (CT) are the common non-pulmonary vein (PV) trigger sites of atrial fibrillation (AF). For them, a focal ablation is often insufficient due to a regional arrhythmogenicity. We devised an original linear ablation method, named "Icho Line” covering the non-PV triggers from this area. Methods: Eight hundred and thirty-two AF ablation patients were retrospectively studied. An AF induction test was conducted after each PV isolation procedure. Non-PV triggers were detected in 104 patients (12.7%), among which Icho line ablation was performed in 39 patients (37.5%) with documented triggers of AF from postero-septum or CT. A linear ablation was designed horizontally from the anterior right PV isolation line to fossa ovalis in the left atrium. In the right atrium, the opposite side of the left atrial ablation was continuously ablated toward the CT like the shape of a ginkgo leaf (Figure). Results: Atrial tachyarrhythmia recurrence free rate in the Icho line group and other non-PV ablation patients were 61.8% and 45.4%, respectively (P=0.54, Figure). Recurrence with atrial tachycardia was very rare in the Icho line group. Conclusions: A novel designed Icho line is a feasible and effective ablation strategy covering non-PV triggers from the atrial septum and CT.

In vitro culture of muscle cells derived from myofascial trigger points.

To examine for the in vitro existence of contractile nodules on the taut band of muscle fibers where myofascial trigger points (MTrPs) are located (using cell culture). Sixteen male Sprague-Dawley rats (7 weeks old) were randomly divided into experimental and control groups. A blunt striking injury and eccentric exercise were applied to the gastrocnemius muscle of rats in the experimental group once a week for 8 weeks to establish an MTrP model. Subsequently, the rats were reared normally and rested for 4 weeks. After modeling, the skeletal muscles at the MTrPs (and non-MTrPs at the same anatomical position) were extracted from the two groups of rats for in vitro cell culture experiments of single muscle fibers. Potential contractile nodules in the MTrP group were exposed to different concentrations of acetylcholinesterase, whereas non-MTrP cells were exposed to acetylcholine. The morphological changes of muscle cells in each group were observed. By culturing MTrP cells in vitro, large contractile nodules remained in single MTrP muscle fibers, whereas some contractile nodules were twisted and deformed. After the addition of different acetylcholinesterase concentrations, no obvious morphological changes were observed in the contractile nodules in the MTrP group. After the non-MTrP cells were exposed to different acetylcholine concentrations, no significant morphological changes were observed in the single muscle fibers. MTrP cells can continue to maintain contractile morphology in vitro, but whether the recovery of such contractile nodules is related to acetylcholine remains uncertain.

Can Myofascial Trigger Points Involve Nociplastic Pain? A Scoping Review on Animal Models.

Nociplastic pain is a non-specific, regional pain lasting more than three months, characterised by the onset of hypersensitivity, despite no clear evidence of tissue damage. It is a relatively new classified type of pain. As a result, there has not yet been much work describing its precise modelling. The mechanism of its formation needs to be clearly explained. Authors point out that the occurrence of myofascial trigger points (MTrPs) can lead to this type of pain as one possibility. This paper summarises the available literature on modelling nociplastic pain and MTrPs. It complies with studies describing animal model creation and presents the results of performed experiments. The literature search was conducted in December 2022 and included the following databases: PubMed, Scopus, and Web of Science. In this scoping review, six studies were included. Two described the creation of animal models of nociplastic pain, one adapted old models to nociplastic pain, and three described the modelling of MTrPs. This is the first paper pointing in the possible direction of detecting and studying the correlation between MTrPs and nociplastic pain in animal models. However, there is currently insufficient evidence to describe MTrPs as nociplastic, as few studies with animal models exist.

Self-Massage Techniques for the Management of Pain and Mobility With Application to Resistance Training: A Brief Review.

MacLennan, M, Ramirez-Campillo, R, and Byrne, PJ. Self-massage techniques for the management of pain and mobility with application to resistance training: a brief review. J Strength Cond Res 37(11): 2314-2323, 2023-Fascial restrictions that occur in response to myofascial trigger points (MTrP), exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) cause soft tissue to lose extensibility, which contributes to abnormal muscle mechanics, reduced muscle length, and decrements in joint range of motion (ROM) and actively contributes to musculoskeletal pain. Resistance training and in particular, weightlifting movements have unique mobility requirements imperative for movement efficacy and safety with ROM restrictions resulting in ineffective volume and intensity tolerance and dampened force output and power, which may lead to a failed lift or injury. Self-massage (SM) provides an expedient method to promote movement efficiency and reduce injury risk by improving ROM, muscular function, and reducing pain and allows athletes to continue to train at their desired frequency with minimal disruption from MTrPs-associated adverse effects. Thus, the aim of this review was to determine the efficacy of various self-massage tools in managing pain and mobility and to explore the potential benefits of SM on resistance training performance. Many SM devices are available for athletes to manage ROM restrictions and pain, including differing densities of foam rollers, roller massagers, tennis balls, and vibrating devices. To attenuate adverse training effects, a 10-to-20-minute bout consisting of 2-minute bouts of SM on the affected area may be beneficial. When selecting a SM device, athletes should note that foam rollers appear to be more effective than roller massagers, with vibrating foam rollers eliciting an increased reduction to pain perception, and tennis balls and soft massage balls were shown to be efficacious in targeting smaller affected areas.

An overview of myofascial pain syndrome with a focus on trigger point injection.

Myofascial pain syndrome (MPS) is a very common condition, with an estimated lifetime prevalence of 85% in the general population. MPS is commonly underdiagnosed or misdiagnosed due to the lack of standardized diagnostic criteria and the symptoms' overlap with those of other musculoskeletal pain conditions. The most notable and bothersome feature of MPS is the presence of myofascial trigger points (MTrPs), hypersensitive areas of muscle commonly characterized as knots, nodules, or bumps that cause strain and pain with and oftentimes without stimulation. A low-risk, low-cost procedure, trigger point injection (TPI) is the gold standard for MPS treatment, and NPs can perform the procedure in an outpatient practice setting. Through administration of TPIs and use of other treatment modalities, primary care NPs can significantly impact the quality of life for those patients affected by acute and chronic MPS. This article aims to educate primary care NPs on MPS diagnosis and provide an overview of treatment options, with a focus on TPI use and administration for MPS relief.

Effects of high-power pain threshold ultrasound technique in patients with knee osteoarthritis: A single-blind randomized controlled trial

Osteoarthritis (OA) is a highly prevalent, degenerative disease of the joints manifested by joint pain, tenderness, decreased function, and limited range of motion (ROM). The current study aimed at evaluating the therapeutic effect of the high-power pain-threshold ultrasound technique (HPPTUS) in comparison with conventional ultrasound (US) techniques in patients with knee osteoarthritis (KOA). A single-masked, pre–post randomized controlled trial was conducted. Fifty participants of both sexes (between 40 and 50 years of age), diagnosed with stage II knee osteoarthritis, participated in this study. They were randomized into two groups: Group A (experimental group, n=25), which received HPPTUS on the knee joint in addition to the traditional treatment (hot packs and isometric exercise for quadriceps), and Group B (control group, n=25), which received conventional ultrasound on knee joint in addition to the traditional treatment (hot packs and isometric exercise for quadriceps). Both groups underwent a four-week treatment plan in which sessions were conducted twice per week. The visual analogue scale (VAS) was used to estimate the intensity of pain, Digital Electronic Pressure Algometer was used to measure pressure pain threshold (PPT) on trigger point around knee, and Digital goniometer was utilized to assess ROM of the knee joint before and after treatment. The MANOVA test revealed statistically significant improvements in all variables (VAS, PPT, knee ROM) post-treatment compared to pre-treatment values in the HPPTUS group (experimental group) (p < 0.05), while the control group revealed statistically significant improvement only in VAS post-treatment compared with pre-treatment (p < 0.05). Comparison between groups revealed statistically significant improvements in VAS, PPT, knee ROM in participants receiving HPPTUS compared with the control group (p < 0.05). High-power ultrasound can be effectively implemented in the treatment of knee OA as it produces significant improvements in the intensity of pain, pressure-pain threshold, and knee joint ROM.

A Bibliometric Analysis of Acupuncture Therapy in the Treatment of Musculoskeletal Pain from 2003 to 2022.

Acupuncture therapy has been widely used in the treatment of musculoskeletal pain (MP) in many countries around the world. However, there are no bibliometric studies on acupuncture therapy for MP. Therefore, the aim of this study was to analyze the current status, frontiers and hot spots in the use of acupuncture therapy for the treatment of MP. Literature on acupuncture therapy for MP was extracted from the Web of Science Core Collection database from 2003 to 2022. CiteSpace 6.2.R4 (64-bit) software was used to analyze the number and centrality of journals, countries, institutions, authors, references and keywords, and the functions of co-occurrence and clustering were applied to draw a visual knowledge map. Over the past 20 years, the annual journal publications have been on a steady upward trend, with 438 articles published in 143 journals, including Acupuncture in Medicine Journal published the most (28, 6.39%), JAMA-Journal of the American Medical Association was the journal with the highest impact factor (IF = 120.7003), USA dominated with the most publications (140, 31.96%) among 44 countries, and among 196 research organizations Kyung Hee University was the most prolific (19, 4.34%) and Ha, In-Hyuk was the most published author (9, 2.05%). "Acupuncture" is the most popular and highly sought after keywords. "Low back pain" is the keyword with the highest centrality. This article provides the current situation of the use of acupuncture therapy in the treatment of MP in the past 20 years, and statistical analysis reveals that "low back pain", "knit osteoporosis" and "break cancer" are new research diseases related to acupuncture therapy for MP, and "myobasic trigger point" is a new research direction of acupuncture therapy for MP. Therefore, this study helps researchers grasp the research hotspots and provide certain references for in-depth research and future topic selection.

An overview of myofascial pain syndrome with a focus on trigger point injection.

An overview of myofascial pain syndrome with a focus on trigger point injection.

Multimodal treatment, including extracorporeal shock wave therapy, for refractory chronic tension-type headache: a case report

BackgroundFew reports have described multidisciplinary treatment, including extracorporeal shock wave therapy, for patients with refractory chronic tension-type headache. In this study, we conducted multidisciplinary treatment for a patient with chronic tension-type headache who suffered from chronic headache refractory to treatment.Case presentationThe patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended.ConclusionA patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy.

Electroacupuncture at Trigger point gains better pain relief effectiveness than Electroacupuncture at Meridian point: A non-blind randomized trial of chronic neck pain treatment among patients at Traditional Medicine Hospital

Neck pain is one of the leading causes of disabilities and increasing economic and social burden. Methods affecting the trigger point (TrP) have initially shown good pain relief effectiveness and decreased degree of invasion in patients. The research is conducted to evaluate the effectiveness of Electroacupuncture (EA) at TrP in chronic neck pain (CNP) treatment. A non-blind randomized study on 125 patients with CNP at Traditional Medicine Hospital in Ho Chi Minh City from September 2020 to June 2021. Patients will be randomly classified into EA at the TrP group or EA at the meridian points group. There were 62 patients in the TrP group and 63 patients in the other group. After 4 weeks, in the TrP group, the Questionnaire Douleur Saint-Antoine (QDSA) score of 38.2 ± 2.6 decreased to 9.3 ± 5.7, compared with the meridian points group’s QDSA score of 37.8 ± 2.3 decreased to 12.3 ± 7.1. The percentage of patients to reach good pain relief effectiveness of EA at TrP measured by QDSA is 71.0%, statistically significantly higher than 47.6% of the other group. The decrease in the number of TrPs of EA at TrP is higher and has statistical value compared with EA at meridian points. EA at TrP showed better pain relief effectiveness, has a higher percentage of patients reaching good pain relief effectiveness measured by QDSA, and decreases the number of TrPs more than EA at meridian points does on patients with CNP.

Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study.

Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex.

The Effect Of Integrated Neuromuscular Inhibition Technique On Improving Neck Functional Ability In Tension-Type Headache

Tension-type headache is one of the most common complaints of musculoskeletal pain due to myofascial trigger points. The presence of pain and soreness in the neck and head, tightness, stiffness, spasms, and limitation of motion is a complaint that is often experienced by patients. Methods: This study aims to determine the effect of the Integrated Neuromuscular Inhibition Technique exercise on increasing the functional ability of the neck in Tension-Type Headache conditions. This research is a pre-experimental study with a pre-test and post-test one-group design using an accidental sampling technique with a total sample of 30 people. The place of research was conducted at the Telkomedika Makassar Clinic. A tool to measure the functional ability of the neck using the Neck Disability Index (NDI). Result: The results of the study were an increase in the functional ability of the neck based on measurements of the Neck Disability Index (NDI), namely a pre-test value of 48.80 to a post-test of 41.13 in the condition of Tension-Type Headache at the Telkomedika Clinic Makassar because after being given Integrated Neuromuscular Inhibition Technique therapy (INIT) decreased neck pain, decreased spasm of the neck muscles, and increased functional ability of the neck. Conclusion: Integrated Neuromuscular Inhibition Technique exercises can improve the functional ability of the neck in Tension-Type Headache conditions at the Telkomedika Clinic in Makassar.

Myofascial urinary frequency syndrome is a novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

This study describes a novel, distinct phenotype of urinary symptoms named “myofascial urinary frequency syndrome” (MUFS) present in one-third of individuals presenting with urinary frequency. In addition to a characteristic symptom constellation suggestive of myofascial dysfunction, MUFS subjects exhibit “persistency”: a persistent feeling of needing to urinate regardless of urine volume. On examination, 97% of MUFS patients demonstrated pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation, hallmarks of myofascial dysfunction. To confirm this symptom pattern was attributable to the pelvic floor musculature, we confirmed the presence of “persistency” in 68 patients with pelvic floor myofascial dysfunction established through comprehensive examination and electromyography and corroborated by improvement with pelvic floor myofascial release. These symptoms distinguish subjects with myofascial dysfunction from subjects with OAB, IC/BPS, and asymptomatic controls, confirming MUFS is a distinct LUTS symptom complex.

Analysis of the characteristics and clinical significance of pelvic floor electrophysiology and imaging changes in female patients with MFPP

ObjectiveChronic Pelvic Pain (CPP) is a very common disease. Studies have found that some female patients with CPP have a myofascial trigger point for pain, which has classified as myofascial pelvic pain (MFPP). This study intends to compare the changes of pelvic floor electrophysiology and imaging between female patients with MFPP and normal women by measuring pelvic floor muscle potential, tension and two-dimensional and three-dimensional ultrasound, and then to explore the characteristics and significance of the changes. MethodsA total of 49 MFPP patients were randomly selected as the study group and 41 healthy women were randomly selected as the control group. Vaginal muscle potential was detected by pelvic floor muscle potential tester. The electronic tensioner was used to measure the muscle tension and the pelvic floor muscle contraction force of 5o and 10o, respectively. The parameters of the two groups were detected by transperineal 2D ultrasound and transvaginal 3D ultrasound respectively. Results1. The resting muscle potential and maximum muscle potential of the study group were higher than those of the control group. 2. The static tension, dynamic tension and contractile force of pelvic floor muscle in the study group were higher than those in the control group when the tensioner was opened for 5o. 3. In resting state, BND, BSD and anterior-to-posterior diameter of genital tract hiatus in the study group were smaller than those in the control group. The anal Angle in Valsalva state was greater in study group than in control group. 4. At rest, the hiatus area, anterior-posterior diameter, transverse diameter and defect score of the levator anal muscle in the study group were smaller than those in the control group. ConclusionMFPP presents a state of continuous spasm and loss of coordination of pelvic floor muscle fascia.

Comparison between effects of instrument-assisted soft tissue mobilization and manual myofascial release on pain, range of motion and function in myofascial pain syndrome of upper trapezius - A randomized controlled trial.

Myofascial pain syndrome (MPS) is a muscle pain disorder characterized by the presence of Myofascial Trigger Point (MTrP) within a taut band, local tenderness, referral of pain to a distant site, restricted range of motion, and autonomic phenomena. The upper trapezius is the muscle most often affected by MTrPs. Manual myofascial release (MFR) and Instrument-Assisted Soft Tissue Mobilization (IASTM) are techniques of soft tissue release that are used to resolve MPS. Fifty six percent of physiotherapists complain of pain in multiple areas due to the massage and manual therapy that they have to perform. The objective of this study is to find whether IASTM is better than manual MFR in treating patients with MPS in upper trapezius. This study was a single-blinded randomized controlled trial that included 31 participants, both males and females between the age groups of 18-50 years. Participants were randomly divided into two groups. Three sessions were given over a period of one week for both groups. Group A received IASTM along with conventional treatment and Group B received Manual MFR along with the conventional treatment. The outcome measures evaluated were pain, cervical range of motion, pain pressure threshold (PPT) of trigger points, and the neck disability index. Pre- and post-measurements were taken and the analysis was done. Both the treatment methods significantly reduced pain, improved PPT, range of motion, and function. The effects between the groups showed that IASTM was significantly better than manual MFR to reduce pain. The improvement in PPT, range of motion and function were equal in both the groups. IASTM and manual MFR both are effective individually as treatment procedures for pain, PPT, range of motion, and function. Neither of the treatment options can be considered better that the other. The clinician can decide based on the availability of the instrument, training, patient's preference, and his/her comfort whether which of the two treatment methods should be used.

Utilizing an ultrasound guided 5-in-1 trigger point and hydrodissection technique for interscapular mid-thoracic myofascial pain: A retrospective review

Poor posture can lead to excessive strain of the neck and upper back musculature, leading to irritation of the dorsal scapular nerve (DSN) and spinal accessory nerve (SAN). A 5-in-1 trigger point technique has been described that specifically target trapezius, rhomboids, levator scapulae, SAN and DSN in a single percutaneous injection. We modified the technique to include hydrodissecting the DSN and SAN to provide further pain relief from possible nerve entrapments. Our retrospective review revealed that the modified 5-in-1 technique is a safe and effective way to address medial periscapular pain, often seen with anterior head carriage and upper crossed syndrome. Patients who received the modified 5-in-1 technique had statistically significant pain relief, allowing them to participate in rehabilitation programs.

THE RELATIONSHIP BETWEEN PES PLANUS, TRIGGER POINTS AND MUSCLE STRENGTH

Introduction: The objective was to compare the rate and localization of trigger points and muscle strength in patients with and without pes planus. Methods: A total of 88 female patients were divided into two groups according to the presence (with the mean age of 32.50 ± 7.95) (n=52) or absence of pes planus (with the mean age of 33.5 ± 7.80) (n=36). Muscle strength was evaluated with handgrip-strength, leg-back strength. The presence of trigger points (present/absent), the pain region of trigger points (masseter muscle, cervical/thoracic/lumber regions, upper/lower extremity) and the Visual Analog-Scale for pain severity were detected. Results: The rate of trigger points was significantly higher in the pes planus group in all regions: in the masseter muscle (p=0.042), upper extremities (p=0.006), cervicotorasic region (p=0.020), lumbar region (p=0.014), and lower extremities (p=0.020). 98.1% of the patients with pes planus were found to have at least one trigger point. The pain severity of trigger points was significantly higher in pes planus group (p=0.037). However muscle strength were found to be significantly similar between the groups. Conclusion: A significant relationship was found between pes planus and the rate of having trigger points not only in lower extremities and lumbar region, but also in masseter, upper extremities and the servicotorasic region in females. However, any relationship were not found between pes planus and muscle strength.

Myodystonic pain syndromes in pathogenesis neurological diseases

Myodistonic pain syndrome is a common cause of algia in the neck, back, limbs, emanating from skeletal muscles and adjacent fascia. Pathophysiologically, in this condition, myogenic trigger points are formed, which, increasing muscle tone, cause their spasm. The resulting discomfort can be both local and causing reflected signs in other areas. The article presents the main mechanisms of implementation and clinical classification of neurological manifestations of myodistonic pain phenomena from the position of pathomorphology of muscular and tendon-ligament localization. Separately, the possibility of a pathogenetic approach to preventive and therapeutic measures in the clinical manifestations of myodistonic pain syndromes is considered. In general, the article contains historical bibliographic material on the study of the development and formation of an autonomous scientific direction of myogenic pain pathology.

Everyday youth climate politics and performances of climate citizenship in Aotearoa New Zealand

Young people around the world are creating their own spaces, strategies, and politics for climate action. In this article we explore the everyday informal politics of climate activism by youth from Aotearoa New Zealand's largest city (Auckland). We examine how young people, frustrated by the lack of global and domestic political inertia, are operationalizing their concerns about climate change into actions in their daily lives directed at mitigating their greenhouse gas emissions. Through a relational qualitative approach, we document the contradictory standing of youth, specifically as agentic actors and environmental citizens, who are aware of and seeking climate action through multiple modes of action including protesting, eco-consuming, influencing others, and eco-caring work. Our youth participants reported how their participation in various forms of climate activism helped to reduce their eco-anxiety and made them more hopeful about their collective abilities to address climate change. Our participants highlighted a hopeful view that their small-scale individual actions will collectively add up to large-scale changes at a systemic level. However, they were highly aware of and critical of state and corporate actors attempts to shift responsibility for taking actions to mitigate climate change onto individuals. Rather than situating themselves solely as eco-consumers engaging in eco-friendly purchasing practices, our youth participants narrated their sometimes contradictory climate actions (protesting, buy-cotting or boycotting, changing how they used goods, and services) as acts of resistance against the socio-economic status quo (high-carbon, neoliberal, and capitalist) that could act as trigger points for wider change. In this article we identify the various methods by which young people are participating in daily climate politics and demonstrating their agency, which are evident in their diverse pro-environmental-oriented and climate mitigation actions; all of which is evidence of how youth are seeking to be good climate citizens.