Trigger Points Research Articles

The prediction and treatment of postpartum myofascial pelvic pain.

The clinical manifestations of myofascial pelvic pain (MFPP) are mainly acute or chronic muscle pain at one or more trigger points in the pelvic cavity or pelvic floor. This study aims to explore the predictive value of pelvic floor myoelectric parameters with respect to MFPP and the effect of its clinical treatment. Two hundred and one women followed up in the Wenzhou People's Hospital 6-12 weeks postpartum between July 2020 and July 2021. They were divided into an MFPP group (n= 90) and a non-MFPP group (n= 102), but 9 MFPP patients without a pelvic floor electromyography evaluation were not included. The general demographic data and pelvic floor electromyography evaluation parameters of the two groups were compared; the related factors of postpartum women suffering from MFPP were analyzed, and a nomogram model of the postpartum risk of suffering from MFPP was established. The 99 patients with postpartum MFPP were divided into a treatment group (n= 10) and a control group (n= 89). The difference in visual analog scale scores between the two groups initially and after three months of treatment was compared to evaluate the effective remission rate of postpartum MFPP after treatment. A significant difference was observed in the relaxation time at the rapid contraction stage (z= 4.369, p< 0.05) and the tension contraction stage (z= 135.645, p< 0.01) between the MFPP group and the non-MFPP group. The nomogram model for predicting postpartum MFPP was established with nine variables as potential predictors. The calibration chart and C index of 0.68 (95% CI: 0.65-0.71) proved that the model had a certain degree of discrimination. The clinical decision-making curve showed that the model could increase the net benefit rate of patients. The pain relief rate in the treatment group was significantly higher than that in the control group (p< 0.01). There is a significant correlation between postpartum MFPP and relaxation time at rapid contraction stage and tension contraction stage. The risk prediction nomogram model of postpartum MFPP established with nine potential predictors has a certain prediction capability, and clinical treatment can effectively relieve MFPP in postpartum patients.

Can Dry Needling Technique Replace Cervical Manipulation Technique for Patients with Migraine

Background of the study: Migraine is a renowned medical condition in 15% of general population. The patients with migraine exhibited active Trigger Points in their neck extensor muscles. Dry needling is a treatment using a thin filament sterile needle to puncture skin and create tiny lesions in a muscle, tendon, to help restore normal physiology function, and reduce pain. Needling has applications for myofascial pain, chronic pain, headache, migraine. Cervical Manipulation Technique has been used to reduce pain and improve range of motion and used in the treatment of patients with head and neck disorders, including neck pain and stiffness, muscle-tension headache, and migraine. The aim of this study is to compare the effectiveness of dry needling technique versus cervical manipulation technique on patients with migraine. Methodology: 30 patients were randomly divided into two groups; fifteen patients in the experimental group-A received cervical manipulation technique (3 times/week) and fifteen patients in the experimental group-B received Dry needling technique. The VAS and NDI were used as outcome measures. Result: Comparing between Group A and Group B showed significant difference in effectiveness on pain and Neck disability with P value &gt;0.0001 among patients with migraine. Group B with Dry needling technique found more effective than Group A with cervical manipulation technique with mean difference of (2.867) and (11.40) over (2.267) and (10.47) respectively. Conclusion: Dry needling technique group is more effective over cervical manipulation technique on enhancing on pain and neck disability. Therefore, this study concludes that Dry needling technique is an effective intervention for migraine patients. Key words: Visual analog scale, Neck disability index, cervical manipulation technique, Dry needling technique, Trigger points.

Treatment of postsurgical trigeminal neuralgia with Fu's subcutaneous needling therapy resulted in prompt complete relief: Two case reports.

Trigeminal neuralgia is a recurrent unilateral transient electroshock-like pain. Fu's subcutaneous needling (FSN), used to treat the musculoskeletal problems, has not been reported in this field. The pain extent of case 1 had no reduction after the previous microvascular decompression, the pain of case 2 relapsed 4 years after the microvascular decompression. Postsurgical trigeminal neuralgia. FSN therapy was applied on the muscles around the neck and face area, which the myofascial trigger points were palpated in these muscles. The FSN needle was inserted into the subcutaneous layer and the needle tip was pointed toward the myofascial trigger point. The following outcome measurements were observed before and after treatment, including numerical rating scale, Barrow Neurology Institute Pain Scale scores, Constant Face Pain Questionnaire scores, Brief Pain Inventory-Facial scores, Patient Global Impression of Change scores, and medication dosage. The follow-up surveys were made after 2 and 4 months respectively. The pain of Case 1 was significantly reduced after 7 times FSN treatments and the pain of Case 2 was even disappeared after 6 times FSN treatments. This case report suggested that FSN can relieve postsurgical trigeminal neuralgia safely and effectively. Clinical randomized controlled studies are needed to be further conducted.

Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain.

Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia.

Event-Triggered Model Reference Adaptive Control for Linear Partially Time-Variant Continuous-Time Systems With Nonlinear Parametric Uncertainty

In this work, we develop an event-triggered adaptive control approach for solving the state tracking problem of linear partially time-variant continuous-time systems with the nonlinear state-dependent matched parametric uncertainty under unknown system dynamics. First, an event-triggered model reference adaptive controller is designed, which is composed of event-triggered adaptive laws based on the event-updated information and an event-triggering condition depending on the state tracking error of the controlled plant and reference model. Then, the state-tracking error and the error between control parameters and ideal ones of the resulting closed-loop system are proven to be uniformly ultimately bounded. Moreover, based on the designed event-triggering condition, the interevent time between two consecutive triggering points is proven to have a positive lower bound. Finally, a simulation example is provided to show the effectiveness of the proposed approach.

The Effectiveness Of Trigger Point Treatment In Chronic Pelvic Pain; A Pilot Randomised Controlled Trial

Abstract Objective To investigate the effectiveness of ischemic compression and low-level laser therapy methods combined with exercise on the myofascial trigger points in women with Chronic Pelvic Pain and to determine which method is more effective. Methods It was a parallel designed, single-blind pilot randomized clinical trial. Patients were recruited at physiotherapy laboratory of the Istanbul University from September 2017 to June 2019. Twenty-eight women patients with Chronic Pelvic Pain were included into the trial. Patients were randomized into two groups. Group 1 received ischemic compression and Group 2 received low-level laser therapy twice a week for 6 weeks. Both groups received the same standard exercise program. Pain, range of motion, pelvic floor symptom severity, quality of life, satisfaction, anxiety, and depression were assessed after 6 weeks, and 1-year follow up. Results Following the treatment, significant differences were observed within both group subjects in pain, range of motion, symptom severity, quality of life, and anxiety-depression (p&lt;0.05). This significant improvement in pain, symptom severity, symptoms related quality of life and pain subgroup of Short Form 36, continued after 1-year follow up (p&lt;0.05). In comparison between group, Group 1 have more significant improvement than Group 2 in terms of symptoms related quality of life (p&lt;0.05). Conclusion Both methods have shown efficacy and can be used safely in chronic pelvic pain patients. Because it is more effective on symptoms related quality of life, the ıschemic compression method may be preferred for primary use.

Acupuncture &amp; electrotherapy: An alternative and complementary treatment method

Acupuncture involves activating specific points on the skin, usually by inserting needles. Acupuncture was based on the principles of traditional Chinese Medicine. Traditional acupuncturists understood health in terms of a vital force or energy called "Qi" that circulates between the organs along channels called meridians. The flow of 'Qi' energy must be of the right strength and quality in each of these meridians and organs so that health is maintained. Acupoints are located along the meridians and can alter the flow of energy and appear to correspond to nerve endings. There is a distinct difference between traditional and Western acupuncture, but the two approaches overlap significantly. In terms of Western theories, acupuncture induces signals in central nerves that modify the transmission through the spinal cord, as well as the perception of pain in the brain. Electrotherapy leads to stimulation of the sensory and motor nerves, and is especially used in the treatment of pain. Different set of parameters may lead to different physiological effects and treatment may be more specific. Electroacupuncture can be performed with or without needles, activating traditional acupuncture points or choosing points that have a neural background, such as trigger points or tender points. The purpose of this study is to verify that acupuncture works as an effective alternative and complementary treatment method. It is a safe, effective and natural approach, which helps to regain and maintain health and mental well-being.

Muscle Energy Technique Efektif pada Pasien Nyeri Musculus Upper Travezius

Neck pain radiating to the upper trapezius muscles can interfere with the patient's daily activities due to the limited range of motion of the neck, the cervical extensors and flexors become tense due to changes in cervical biomechanics and generally affect workers who require repetition of movements coupled with high work speeds. If you hold your head down for too long it will cause muscle tension or spasm in the neck area and there will be limited neck movement so that the neck is functionally disturbed. The purpose of this study was to determine the effectiveness of muscle energy techniques in neck muscle pain, spasm of the upper travezius muscles. The design of this study was experimental with a pre test-post test one group design. The research subjects met the criteria, namely neck pain myofascial trigger point of the upper trapezius muscle, men and women with moderate to severe pain intensity, willing to be respondents and no musculoskeletal disorders. This research was conducted in June-July 2018. 10 patients with upper trapezius pain (age 21-23 years) were given muscle energy techniques with minimal isometric contractions and stretching 3 times/week, isometric movements repeated 5 times and stretching on the upper trapezius for 45 second. Pain was measured with a Visual analog scale at the beginning and end of the intervention. The results of the study found a significant reduction in pain with scores (p &lt;0.05). The conclusion of this study is that muscle energy technique is effective in reducing pain in cases of spasm of the upper travezius muscle.

Ефективність мобілізації та ішемічної компресії при адгезивному капсуліті та міофасціальному больовому синдромі

The purpose of the study was to investigate the effect of end- range mobilization and ischemic compression on the range of motion and pain scores in patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic spine. Materials and methods. 20 patients participated in the study. Goniometry of the shoulder joint, pain assessment on a numerical scale at the endpoints of the range of motion and trigger points (when applying a pressure of 2.5 kg×cm-2) were performed before the intervention, at the end of the first week of therapy, at the end of the second and third week. Physical therapy began after an examination and consultation with an orthopedic traumatologist. All patients received intensive end-range mobilization performed by a physical therapist and ischemic compression performed by the patient 5 times a week (3 weeks). Mobilization techniques from I to V degrees of intensity according to the Maitland classification system were used. Localization of active and latent trigger points was determined, their marking was carried out on an individual map, which was provided to the patient. The patient was instructed in techniques and methods of influencing trigger points of various locations. Compression was performed with an average or above average pain level and a duration of 30 seconds for each trigger point. Results and discussion. The existence of differences in the results of the amplitude was established, taking into account the time factor. The median score for active abduction increased by 65.5° and for flexion – by 115.5°. The amplitude of active internal rotation increased by 73°, and external – by 72°. According to Friedman's test, similar results were obtained when comparing pain indicators, which were assessed at the endpoints of the range of motion. The dynamics of medians was from 5 to 6 points. The median trigger point pain score decreased by 5.5 points after three weeks of physical therapy. The results obtained when studying the effectiveness of ischemic compression in patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome are consistent with the conclusions of previous studies and complement the data presented in the literature. Conclusion. Physical therapy, which consists of a combination of end-range mobilization and ischemic compression, is effective in increasing passive and active range of motion in the shoulder joint, reducing pain at the end of the range of motion, and reducing pain at trigger points

Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation.

Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18-65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.

Latent myofascial trigger points injection therapy for adult cough variant asthma: A randomized controlled trial.

Cough variant asthma (CVA) is a chronic inflammatory airway disease characterized by airway hyper-responsiveness (AHR), of which cough is the only symptom. The cough is a result of the contraction of the vocal cords, diaphragm, sternocleidomastoid muscle, and other respiratory related muscles caused by the AHR. Long-term chronic coughing can lead to repetitive contraction and chronic strain of the muscles involved in the head and neck, ultimately contributing to the formation of latent myofascial trigger points (MTrPs). In turn, latent MTrPs can also irritate or compress the nerves around them, triggering cough. The date indicated that latent MTrPs can induce autonomic phenomena and are effective in allergic rhinitis. But their roles in asthma are unclear. In this article, the efficacy and safety of latent MTrPs injection therapy in CVA were investigated. This randomized controlled trial was conducted with 110 patients. Patients were assigned to the intervention or control group in a 1:1.5 ratio. Intervention group (n = 44): single injection therapy with latent MTrPs. Control group (n = 66): budesonide-formoterol plus montelukast for 8 weeks. During the 36-week follow up period, the recurrence rate at week 36, cough visual analog scale (VAS), ACT (asthma control test)-scores, ACQ5 (asthma control questionnaire)-scores, AQLQ (asthma quality of life questionnaire)-scores, proportion of using rescue medication, and adverse events were evaluated. The recurrence rate at week 36 was lower in the intervention group than in the control group (36 weeks, 5.0 vs. 34.55%, p = 0.001). There were significant differences between groups in change from baseline to 36 weeks in VAS [36 weeks, 1.70 (1.49) vs. 3.18 (2.04), p < 0.001]; ACT-score [36 weeks, 21.38 (2.65) vs. 18.53 (3.00), p < 0.001]; ACQ5-score [36 weeks, 0.85 (0.55) vs. 1.52 (0.62), p < 0.001]; AQLQ-score [36w, 174.40 (18.22) vs. 151.69 (24.04), p < 0.001]; proportion of using rescue medication (36 weeks, 5.0 vs. 29.1%, p = 0.003). Fewer adverse events occurred in the two groups. Latent myofascial trigger points injection therapy provided long-acting, practical, short treatment duration and safety methods for CVA. http://www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry Center, ChiCTR2100044079.

Kinesio Taping as a Therapeutic Tool for Masticatory Myofascial Pain Syndrome—An Insight View

Myofascial pain syndrome (MPS) is thought to stem from masticatory muscle hypersensitivity. Masticatory myofascial pain syndrome (MMPS) is characterized by multiple trigger points (MTrPs), also known as hyperirritable points, in taut bands of affected muscles, regional muscle pain, or referred pain to nearby maxillofacial areas like teeth, masticatory muscles or the temporomandibular joint (TMJ). Muscle stiffness, reduced range of motion, muscle weakening without atrophy, and autonomic symptoms may accompany regional discomfort. Multiple treatments have been utilized to reduce trigger points and mandibular function restrictions. As a result of these incapacitating symptoms, MMPS can significantly impair many elements of quality of life. The application of Kinesio tape (KT) is a non-invasive method of treating dormant myofascial trigger points. Utilizing the body's innate capacity for self-repair, this technique entails taping specific regions of the skin. KT alleviates discomfort, decreases swelling and inflammation, enhances or suppresses motor function in the muscles, stimulates proprioception, promotes lymphatic drainage, stimulates blood flow, and expedites tissue recovery. However, studies conducted to assess its effects have frequently yielded contradictory results. To the best of our knowledge, just a few research has looked into the therapeutic effects of KT on MMPS. The purpose of this review is to determine the efficacy of KT as a therapeutic tool for regular treatment or as an adjunct to existing therapy for MMPS based on the evidence presented in this review. To establish KT as a reliable independent treatment option, additional research is necessary to confirm the efficacy of KT techniques and applications, specifically randomized clinical trials.

Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative Review

Cervical myofascial pain is a very common clinical condition in the daily practice of musculoskeletal physicians. Physical examination is currently the cornerstone for evaluating the cervical muscles and identifying the eventual presence of myofascial trigger points. Herein, the role of ultrasound assessment in precisely localizing them is progressively mounting in the pertinent literature. Moreover, using ultrasound, not only the muscle tissue but also the fascial and neural elements can be accurately located/evaluated. Indeed, several potential pain generators, in addition to paraspinal muscles, can be involved in the clinical scenario of cervical myofascial pain syndrome. In this article, the authors extensively reviewed the sonographic approach for cervical myofascial pain in order to better diagnose or guide different procedures that can be performed in the clinical practice of musculoskeletal physicians.

Intrafasciomembranal Fluid Pressure: A Novel Approach to the Etiology of Myalgias, Part II.

The fascia forms a hierarchy of spaces (small and large compartments) that contain and enclose muscle fibers, fiber bundles, skeletal muscles, and compartments of several skeletal muscles. Solid fascia serves as a membrane that enables an increased volume and fluid pressure within such a fasciomembrane, an intrafasciomembrial fluid pressure (IFMFP). Increased IFMFP provides a theoretical model and a common explanation for the etiology of the myalgias: trigger point (TrP), chronic exertional compartment syndrome (CECS), overtraining syndrome (OTS), and delayed onset muscle soreness (DOMS). Many myalgias and their symptoms are poorly understood, and this review aims to provide an extension to this theoretical model and novel approach. This review suggests that the swelling from elevated IFMFP also likely leads to a longitudinal shortening of the same affected tissue. This model of swelling and shortening provides additional explanations for the changes in the lines of force through the body that can lead to changes in the body's posture and, thus, to compensatory movements. This new approximation also provides a biomechanical explanation for the thickening of the fascia and referred pain, and also suggests that IFMFP is a factor in weather-related pain.

A Peptide-Conjugated Probe with Cleavage-Induced Morphological Change for Treatment on Tumor Cell Membrane.

Despite the promising advancements of in situ forming nanoassembly for the inhibition of tumor growth and metastasis, the lack of sufficient triggering sites and hardly controlling the forming position restrict their further developments. Herein, a smart transformable peptide-conjugated probe (DMFA) with enzyme cleavage-induced morphological change is designed for treatment on the tumor cell membrane. Specifically, after self-assembling into nanoparticles and anchoring on the cell membrane with sufficient interaction sites rapidly and stably, DMFA will be efficiently cleaved into α-helix forming part (DP) and β-sheet forming part (LFA) by overexpressed matrix metalloproteinase-2. Thus, the promoted Ca2+ influx by DP-induced cell membrane breakage and decreased Na+ /K+ -ATPase activity by LFA-assembled nanofibers wrapping the cells can inhibit PI3K-Akt signaling pathway, leading to the inhibition of tumor cell growth and metastasis. This peptide-conjugated probe undergoes in situ morphological transformation on the cell membrane, exhibiting great potential in tumor therapy.

Endoscope-Assisted Greater Occipital Nerve Decompression for Migraines, Occipital Neuralgia, and New Daily Persistent Headaches.

In the occipital trigger site for migraine, the greater occipital nerve (GON) is thought to be irritated by surrounding structures, including the semispinalis capitis muscle and occipital artery (OA), producing headaches in the back of the neck. Thus, standard decompression involves removal of surrounding tissue and dissection away from the vessel. The authors noticed a consistent pattern between the GON and OA more distally: the OA approaching laterally and diving under the GON, the OA looping back over the GON and intertwining with the medial branch of the GON, and lastly the OA traveling parallel to the GON. The technique described uses a modified endoscopic approach with a counter incision, endoscopic assistance, and radical artery lysis to address distal sites in addition to the standard release. At the counter incision, distal intertwining between vessel and nerve was released. A high-definition endoscope was used to address dynamic compression points more proximally, including hidden areas where the vessel dives under the GON, as well as to facilitate cautery and removal of the vessel. Without the use of an endoscope and counterincision, it is difficult to achieve complete decompression of the nerve distally without injury to the proximal body of the nerve.

The reliability of using light therapy compared with LASER in pain reduction of temporomandibular disorders: a randomized controlled trial

BackgroundTemporomandibular Disorders (TMD) refer to a group of symptoms where pain is the most leading cause to demand a treatment by the patient. Light therapies are of great importance at current times due to its biosafety and non-invasive quality when used for the management of TMD symptoms. This study aimed to evaluate the efficacy of red LED light with low-level LASER in treating TMD patients.Materials and methodsA double-blind randomized clinical study was conducted and included 60 patients along 3 groups (20 for each group) presented with myofascial pain related to TMD. Patients were randomly divided into 3 groups. Group A were managed by applying the LED light device into the trigger points without switching the device on. A red LED light was given to group B for 5 min at the tender muscles. Group C were treated by using low-level LASER therapy for 30 s. Patients were evaluated for any improvements regarding the pain score, presence of trigger points, and trismus along 4 visits (1 week interval between each visit). Any side effects related to the 2 devices were also assessed.ResultsBoth group B and C patients showed a statistically significant improvement in the pain value (P < 0.05) at the 3rd and 4th visits when compared to group A. Regarding tenderness, there was a reduction in the number of trigger points in both study groups; however, the results were insignificant in group B. Statistics showed insignificant differences between group B & C patients regarding pain and number of trigger points at all visits (P > 0.05).ConclusionBoth LED light and LASER therapies could effectively relieve pain associated with myogenic TMD as there were no important differences between their outcomes. However, the biosafety and lower cost of the LED light device compared to the LASER should also be considered.Trial Registration This clinical trial was prospectively registered (TCTR ID: TCTR20190507002) on 07/05/2019. URL: http://www.thaiclinicaltrials.org/show/TCTR20190507002

Interventional pathway in the management of refractory post cholecystectomy pain (PCP) syndrome: a 6-year prospective audit in 60 patients.

Post cholecystectomy pain syndrome can affect over a third of patients undergoing laparoscopic cholecystectomy. Acute exacerbations can result in recurrent emergency admission with excessive healthcare utilization. Standard surgical management appears to focus on visceral aetiology. Abdominal myofascial pain syndrome is a poorly recognised somatic pathology that can cause refractory pain in this cohort. It develops as a result of trigger points in the abdominal musculature. The report describes the pathophysiology and a novel interventional pathway in the management of post cholecystectomy pain secondary to abdominal myofascial pain syndrome. The prospective longitudinal audit was performed at a tertiary pain medicine clinic in a university teaching hospital. Over a six-year period, adult patients with refractory abdominal pain following laparoscopic cholecystectomy wereincluded in a structured interventional management pathway. The pathway included two interventions. Intervention I was a combination of abdominal plane blocks and epigastric port site trigger injection with steroids. Patients who failed to report durable relief (>50% pain relief at 12weeks) were offered pulsed radiofrequency treatment to the abdominal planes (Intervention II). Outcomes included patient satisfaction, change in opioid consumption and impact on emergency visits. Sixty patients who failed to respond to standard management were offered the pathway. Four patients refused due to needle phobia. Fifty-six patients received Intervention I. Failure rate was 14% (8/56). Forty-eight patients (48/56, 86%) reported significant benefit at 12weeks while 38 patients reported durable relief at 24weeks (38/56, 68%). Nine patients received Intervention II and all (100%) reported durable relief. Emergency admissions and opioid consumption were reduced. Abdominal myofascial pain syndrome is a poorly recognised cause of post cholecystectomy pain. The novel interventional management pathway could be an effective solution in patients who fail to benefit from standard management.

Effect of trigger point acupuncture on pain and functional activity in patients with chronic non-specific low back pain: a randomised controlled trial.

Trigger point (TrP) acupuncture is commonly used to treat chronic non-specific low back pain (CNLBP). Evidence for the efficacy of most TrP acupuncture modalities is weak or lacking. To assess the effect of TrP acupuncture on pain, disability, gait and muscle activation in patients with CNLBP. From May 2019 to February 2020, a randomised, single-blind clinical trial was carried out involving 33 participants with CNLBP, divided into one of two intervention groups or a control group (n = 11 per group). The intervention groups received TrP acupuncture or traditional acupuncture treatment three times a week for 4 weeks, and the control group remained on a waiting list and received no treatment. Pain, disability, gait and muscle activation were assessed at baseline and at 4 and 8 weeks of follow-up. At baseline, the three groups showed no significant differences in age, gender, height, weight, body mass index (BMI) or disease course (p ⩾ 0.05). At 4 weeks, pain was relieved (measured by visual analogue scores, p = 0.036) and disability was improved (reflected by lower Oswestry disability index scores, p = 0.029) in TrP acupuncture versus waiting list groups. Moreover, lumbar extension range of motion was increased in TrP acupuncture versus both traditional acupuncture and waiting list groups (p = 0.029 and p = 0.027, respectively). At 8 weeks, there were no significant differences in any parameter between the three groups (p > 0.05). TrP acupuncture had a significant short-term effect on pain relief and disability in patients with CNLBP, but there was no evidence of a long-term influence (at 8 weeks following the intervention). Further high-quality randomised controlled trials are needed for verification in the future.Trial registration number: ChiCTR1900022838 (Chinese Clinical Trial Registry).

The first taxonomic and functional characterization of human CAVD-associated microbiota.

Calcific aortic valve disease (CAVD) is the most common heart valve disorder, defined by a remodeling multistep process: namely, valve fibrosis with its area narrowing, impaired blood flow, and final calcification phase. Nowadays, the only treatment is the surgical valve replacement. As for other cardiovascular diseases, growing evidence suggest an active role of the immune system in the calcification process that could be modulated by the microbiota. To address this point, we aimed to investigate and characterize, for the first time, the presence of a valve microbiota and associated immune response in human CAVD. Calcified aortic valve (CAV) samples from twenty patients (11 from Germany and 9 from Italy) with diagnosis of severe symptomatic CAVD were used to assess the presence of infiltrating T cells, by cloning approach, and to characterize the valve microbiota, by 16S rRNA gene sequencing (NGS). We documented the presence of infiltrating T lymphocytes, especially the T helper subset, in CAV samples. Moreover, we found a tissue-associated microbiota in freshly collected CAV samples, which was significantly different in Italian and German patients, suggesting potential correlation with other cardiovascular risk factors. The presence of microbiota in inflamed CAV samples represents the right trigger point to explain the valve calcification process, encouraging further studies to explore the potential link between bacteria and adaptive immune response and to define the critical role of local microbiota-immunity axis on CAVD development.