Treatment Of Myofascial Pain Syndrome Research Articles

Lidocaine Needling in Myofascial Pain Syndrome for Palliative Oncologic Care: A Randomized Clinical Study.

Background: Physical pain is highly prevalent and impacts the well-being of patients with advanced oncologic disease. Although myofascial pain syndrome (MPS) can be one of the components of pain in cancer patients on palliative care (PC), so far there is no evidence about the benefit of treatment with 1% lidocaine needling. Objectives: To evaluate the efficacy of MPS treatment with injection of 1% lidocaine on the reduction of pain in cancer patients on PC. Design: Single-blind randomized clinical trial. Subjects: Patients aged 50 years or older with end-stage cancer, admitted to a cancer ward or monitored during radiotherapy in three Brazilian hospitals, with a diagnosis of MPS with a pain intensity of five or more according to the Visual Analog Scale (VAS). The patients were divided into two groups: trigger point (TP) injection with 1% lidocaine and control. Measurements: Pain intensity was assessed with the VAS, pain threshold with an algometer, and the medications being used were determined before and 72 hours after the intervention. Results: Thirty patients (15 per group) were assessed. After 72 hours, there was a reduction in referred pain intensity (p < 0.001) and an increase in pressure threshold (p = 0.007) in the intervention group (IG), with no difference in the control. The frequency of individuals who reduced the doses and/or classes of pain medications was higher in the IG (p = 0.011). Conclusion: One percent lidocaine needling in TPs was an effective therapy for pain reduction in MPS.

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.

Buccal acupuncture combined with ultrasound-guided dry needle-evoked inactivation of trigger points to treat cervical and shoulder girdle myofascial pain syndrome.

Myofascial pain syndrome (MPS) is a common disease with easy persistence and recurrence. In clinical practice, although many methods have been adopted to prevent and treat MPS, the control of MPS is still not satisfactory. To compare the safety and effectiveness of buccal acupuncture, inactivation of trigger points (MTrPs), and their combination in the treatment of MPS. Two hundred MPS patients in the pain clinic were randomly divided into four groups (n= 50) to receive oral drugs (Group A), oral drugs + buccal needle (Group B), oral drugs + MTrP inactivation (Group C), or oral drugs + buccal needle + MTrP inactivation (Group D). The visual analogue scale (VAS) and cervical range of motion (ROM) of Group D were significantly lower than those of the other three groups, and the pressure pain threshold (PPT) value of labelled MTrPs was significantly higher than those of the other three groups (P< 0.05). The excellent rate and total effective rate of Group D were significantly higher than those of the other three groups. Group C had the highest pain score and the lowest acceptance score. The results showed that buccal acupuncture combined with ultrasound-guided dry needle-evoked inactivation of MTrPs can significantly reduce the VAS score of MPS patients, improve the range of motion of the cervical spine, and improve patient satisfaction. This study provides a highly accepted and satisfactory treatment for MPS, which is worthy of clinical promotion.

Comparison of the efficacy of oxygen-ozone and lidocaine injections in the treatment of myofascial pain syndrome: A randomized clinical trial.

This study aims to compare effectiveness of oxygen-ozone injection versus lidocaine injection on the trigger point in the treatment of myofascial pain syndrome (MPS). Between April 2021 and December 2021, a total of 46 patients with MPS (8 males, 38 females; mean age: 44.7±10.4 years; range, 25 to 65 years) were included. The patients were randomized to either ozone injection (n=23) or lidocaine injection (n=23) groups. All injections were administered once a week for three consecutive weeks. The primary outcome measure was the pain severity assessed by Visual Analog Scale (VAS). Secondary outcome measures were cervical lateral flexion range of motion (ROM), pain score (PS), and Neck Disability Index (NDI). The measurements were performed before the treatment, and at four and 12 weeks after treatment. There was a significant effect of time for VAS, PS, and NDI scores in both groups. Compared to baseline versus Weeks 4 and 12, the VAS, PS, and NDI scores significantly decreased over time in both groups (p<0.001 for all). A significant group X time interaction was identified regarding the VAS scores. The mean difference in the VAS scores over time was significantly higher in the lidocaine group compared to the oxygen-ozone group (p=0.028). Oxygen-ozone and lidocaine injections of the trigger point can effectively improve pain and functional status. However, lidocaine injection appears to be superior in reducing pain compared to oxygen-ozone injection, but is not superior in improving function and PS.

Bibliometric and Visual Analysis in the Field of Dry Needling for Myofascial Pain Syndrome from 2000 to 2022.

Evidence has shown that dry needling (DN) is effective for myofascial pain syndrome (MPS). However, bibliometrics has rarely been used to analyze the literature related to DN for MPS. The purpose of this study is to provide a systematic overview of global frontiers and research hotspots of DN in the treatment of MPS from 2000 to 2022. A search was conducted on Web of Science Core Collection (WoS CC) for literature on DN for MPS from 2000 to 2022. Based on the basic information provided by WoS CC, CiteSpace software was used to conduct bibliometric analysis of the countries, institutions, categories, journals, authors, references and keywords involved in this topic. A total of 458 papers were obtained, with the number of publications increasing over time. Journal of Bodywork and Movement Therapies (31) was the most productive journal based on the number of publications, while Arch Phys Med Rehab (329) was the most co-cited journal. The most productive countries and institutions were USA (112) and Universidad Rey Juan Carlos (39), respectively. Fernandez-de-las-penas, Cesar has the highest number of publications (24) and Simons DG, who was an author with the highest number of citations (250). The article published by Gattie et al (co-citations: 65), and Mejuto-Vazquez et al (centrality: 0.36) were the most representative and symbolic. Based on the co-cited literature and keywords, myofascial trigger point, research methods, and acupuncture were the hot research topics and trends in the field. The current status and trends in clinical research of DN for MPS are revealed according to the results of this bibliometric study, which may facilitate researchers to identify hot topics and new directions for future research.

Multimodal programmes in the treatment of myofascial pain syndrome (MPS) – a two-step review

Myofascial pain syndrome (MPS) is one of the most common ailments associated with the human musculoskeletal system, characterised by the presence of the so-called trigger points (TrP – trigger point; MTrPs – myofascial trigger points). The International Association for the Study of Pain indicates that MPS may affect approximately one-third of people with chronic musculoskeletal pain, and that there is a lack of appropriate classification which can be attributed to a misunderstanding and/or misinterpretation of the pathophysiology. Given the diverse causes of pain syndromes in myofascial structures, it is vital to properly select and integrate therapeutic methods. The scientific literature indicates that treatment programmes should include a variety of manual therapy methods and rehabilitation exercises. Trigger point therapies, such as dry needling or dry cupping, are also widely used. At the heart of the success of rehabilitation programmes, in the opinion of the authors of this publication, is their multimodality, i.e. selection of therapeutic methods based on the cause of the pain, providing for measurable, reproducible diagnostic methods in therapy. Aim of the study. The aim of this study is to analyse and infer conclusions on multimodal myofascial pain therapy programmes. Material and methods. Given the complex research problem set as the aim, the study was carried out through a literature review in terms of two criteria: Criterion I (C I): analysis of the literature on the etiology and pathogenesis of myofascial pain (i.e. causes and triggers, symptoms, social and environmental factors determining the onset of MPS), diagnostic procedures (initial diagnosis and ongoing monitoring of treatment outcomes), and therapeutic methods used in the course of MPS. Criterion II (C II): a literature study of research publications addressing multimodal programmes for myofascial pain therapy, with their qualitative evaluation using the modified PEDro scale, and empirical testing of hypotheses based on the literature study and the analysis made in Part I. Data sources: PubMed, SCOPUS, Science Direct, MEDLINE, PEDro, Cochrane, Embase, Web of Science Core Collection, Google Scholar electronic databases were searched systematically, restricting the languages to English and German only. Results. The analysis of the literature showed that the causes, symptoms and associations of myofascial pain have been described in detail. There are also numerous reports on a variety of therapeutic methods, together with a precisely described methodology for their implementation. It is not uncommon to recommend combining methods into multimodal programmes, which unfortunately does not mean that there are many such programmes or that studies on MPS are consistent. The literature study on multimodal treatment programmes for MPS revealed that there is no correlation between its pathogenesis and a purposeful selection of specific therapeutic methods. In a small number of cases, a complex etiopathogenesis led to the formation of multidisciplinary teams. This may be associated with the absence of strict recommendations on the diagnostic methods applicable to the assessment of MPS. Conclusions. 1. Multimodal programmes for the treatment of musculoskeletal pain, notably MPS and MTrPs, should include a detailed and comprehensive diagnosis (structural, biochemical, psycho-emotional) which should serve as the basis for the formation of interdisciplinary rehabilitation teams. 2. Musculoskeletal diagnosis, in addition to radiological assessment, should include measurable techniques of postural and functional assessment (such as pedobarography, wearable sensors, assisted anthropometry, i.e. photogrammetry, videogrammetry, etc.), aimed primarily at the ongoing assessment of posture. 3. The choice of therapeutic methods and patient education should be based on the causes of the patient’s pain, taking into account systemic diseases, postural defects, lifestyle and psycho-emotional state. 4. Scientific research in multimodal treatment programmes should be carried out in randomised groups, with due attention to the methodologies of diagnostic and therapeutic procedures and group selection.

The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review

The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review

Os efeitos do laser de baixa intensidade no tratamento da síndrome da dor miofascial: revisão sistemática

Os efeitos do laser de baixa intensidade no tratamento da síndrome da dor miofascial: revisão sistemática

Preliminary evidence of safety and effectiveness of Loxoprofen Sodium Cataplasm combined with physiotherapy for myofascial pain syndrome treatment: A randomized controlled pilot clinical trial.

Myofascial pain syndrome (MPS) is one of the most common causes of chronic skeletal muscle pain, which is closely related to skeletal muscle myofascial trigger point (MTRP). Since there is no first-line treatment for MPS, we investigated Loxoprofen Sodium Cataplasm combined with physiotherapy as a non-invasive therapy in patients at different levels to a protocol with superior efficacy that is safe and easy to promote. Moreover, this treatment could represent an alternative therapeutic strategy for low-income patients to a safer, more convenient, and more economical treatment scheme. A randomized clinical study was aimed at evaluating the safety and efficacy of Loxoprofen Sodium Cataplasm combined with physiotherapy in patients diagnosed with MPS in the pain clinic. We screened 100 patients with MPS, and using a computer-generated random allocation sequence, we stratified patients in a ratio of 2:1:1:1 (A: B: C: D) to one of the four treatment groups. Group A received Loxoprofen Sodium Cataplasm combined with extracorporeal shock wave therapy (ESWT) and transcutaneous electrical nerve stimulation (TENS). Group B received Loxoprofen Sodium Cataplasm alone. Group C received physiotherapy alone. Group D received Flurbiprofen Cataplasm combined with physiotherapy. After 2 weeks of treatment, the overall efficiency and secondary assessment indicators, including visual analog scale (VAS) scores, chronic soft tissue injury (CSTI) scores, Oswestry Disability Index (ODI) scores, or Northwick Park Neck Pain Questionnaire (NPQ) scores, were evaluated before and after treatment to analyze the difference in efficacy of each group. All groups were well tolerated with no reported adverse events. Significant treatment differences in the change from baseline in overall efficiency (primary efficacy endpoint) (P = 0.0078) were observed in subjects of groups A and C. Showing valuable data of efficacy in primary and secondary endpoints, Loxoprofen Sodium Cataplasm combined with physiotherapy is superior in the treatment of MPS. https://www.chictr.org.cn/ (ChiCTR2100054756).

Dexmedetomidine inhibits abnormal muscle hypertrophy of myofascial trigger points via TNF-α/ NF-κB signaling pathway in rats.

Myofascial pain syndrome (MPS) is a chronic pain disorder with inflammation-related primarily characterized by the presence of myofascial trigger points (MTrPs). Myocyte enhancer factor 2C (MEF2C) is involved in the occurrence of a variety of skeletal muscle diseases. However, it is not yet clear if MEF2C is involved in MTrPs. The purpose of this study was to investigate whether MEF2C was involved in the inflammatory pathogenesis of MTrPs. In the present study, we used RNA sequencing (RNA-seq) to compare the differential expression of myocyte enhancer factor 2C (MEF2C) in healthy participants and MTrPs participants. The widely used rat MTrPs model was established to research the upstream and downstream regulatory mechanism of MEF2C and found that MEF2C was significantly increased in patients with MTrPs. Dexmedetomidine (Dex) was injected intramuscularly in the MTrPs animal to assess its effects on MEF2C. The expression of MEF2C protein and mRNA in skeletal muscle of rats in the MTrPs group were up-regulated. In addition, the expression of TNF- α, p-P65, MLCK, and Myocilin (MyoC) was up-regulated and the mechanical pain threshold was decreased. Peripheral TNF- α injection significantly decreased the mechanical pain threshold and increased the expression of p-P65, MLCK, MEF2C, and MyoC in healthy rats. Maslinic acid increased the mechanical pain threshold and inhibited the expression of p-P65, MLCK, MEF2C, and MyoC. In addition, peripheral injection of DEX in MTrPs rats also inhibited the expression of TNF- α, p-P65, MLCK, MEF2C, and MyoC. These results suggest that MEF2C is involved in the inflammatory pathogenesis of MTrPs and DEX serves as a potential therapeutic strategy for the treatment of MPS.

Effectiveness of Photobiomodulation Therapy in the Treatment of Myofascial Pain Syndrome of the Upper Trapezius Muscle: A Systematic Review and Meta-Analysis.

Objective: This systematic review aimed to investigate the efficacy of photobiomodulation therapy (PBMT) on pain and pressure pain threshold (PPT) in patients with myofascial pain syndrome (MPS) of the upper trapezius muscle. Materials and methods: A total of 17 studies (944 patients) were included; data regarding participants, intervention parameters, outcome measures, time of measurement, and follow-up were extracted. Evaluation of the methodological quality was performed by Physiotherapy Evidence Database (PEDro) scale. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence. A meta-analysis was performed on 16 studies, and standardized mean difference (SMD), corresponding 95% confidence interval (CI), and overall effect size (ES) were calculated. Results: Meta-analysis using a random-effect model was performed to evaluate the effects of PBMT alone or PBMT plus exercise (EX) compared with placebo, medical treatment, physical therapy (PT) modality, manual therapy, or complementary PT. Assessment according to the PEDro scale revealed 12 high-quality, 3 fair-quality, and 2 low-quality studies. According to the GRADE system, studies exhibited low to medium quality of evidence, with medium ES [SMD -0.54 (95% CI -1.05 to -0.02)] for studies using PBMT alone and large ES [SMD -0.80 (95% CI -1.35 to -0.26)] for PBMT+EX. Conclusions: The present systemic review revealed that PBMT is an effective PT modality for reducing pain and increasing PPT in patients with MPS of the upper trapezius. PBMT, when combined with EX, had more significant effects in reducing pain and increasing PPT compared with controls. The low-quality studies with low to moderate quality of evidence limit the confidence in the effect estimate and recommend further high-quality studies for standardization of treatment protocols and irradiation parameters. PROSPERO registration number: CRD42021241155.

Subacute postoperative myofascial pain diagnosed and treated successfully by ultrasound: a case after laparoscopic hepatectomy

BackgroundMyofascial pain syndrome is one of the causes of prolonged postoperative pain after abdominal surgery. However, diagnosis and treatment of myofascial pain syndrome, especially its myofascial trigger point (MTrP), have not been well established.Case presentationA 55-year-old man experienced severe subacute abdominal pain after laparoscopic hepatectomy despite aggressive postoperative pain management. He had a positive Carnett’s sign, indicating abdominal wall pain, 2 weeks after the surgery. Ultrasonography showed a hyperechoic spot surrounded by a hypoechoic area in the inner abdominal oblique muscle under the palpable spot that fulfills the criteria of MTrP. The echogenic MTrP disappeared after repetitive ultrasound-guided trigger point injections (USG TPIs) with pain relief.ConclusionsOur present case indicates that diagnosing myofascial pain by visualizing the echogenic MTrPs in the abdominal muscles, and subsequent USG TPIs, might provide an accurate maneuver for diagnosis and treatment of subacute myofascial pain after abdominal surgery.

Possibility of using osteopathic methods of correction in the treatment of myofascial pain syndrome

Recently, there has been a significant improvement in the methods of diagnosis and treatment of myofascial pain syndrome. The continuing high frequency of occurrence of this pathological condition against the background of numerous scientific studies in the field of its diagnosis, treatment and prevention testifies to the significant scientific and practical relevance of this problem at the present time, and the predominant use of pharmacotherapy, which often entails side effects, significant financial costs against the background of its comparatively low effectiveness, actualizes the use of non-drug methods of influence.

Comparison of Dry Needling and Inhibitory Kinesio Taping in Treatment of Myofascial Pain Syndrome of the Upper Trapezius Muscle: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to compare the effects of dry needling and inhibitory Kinesio taping on the pressure pain threshold and muscle thickness in women with myofascial pain syndrome in the upper trapezius muscle. MethodsThe present study was a single-blind randomized controlled clinical trial. Seventy-five women with active trigger points in the upper trapezius muscle were included and randomly divided into 3 groups of equal sizes. Groups 1 and 2 were treated in 2 sessions with a 3-day interval by dry needling and inhibitory Kinesio taping, respectively. Group 3 did not receive treatment (ie, the control group). Pressure pain threshold and muscle thickness were measured using a pressure algometer and an ultrasound device, respectively, and this was done before, 3 days after, and 10 days after the treatment. ResultsPressure pain threshold increased significantly in groups 1 and 2 (P < .001) after the intervention. Muscle thickness reduced significantly in group 1 (P = .015) and group 2 (P = .010) after the intervention. No significant differences were observed between these 2 intervention groups in terms of these variables. Meanwhile, the changes in the control group in muscle thickness (P = .430) and pressure pain threshold (P = .230) were not significant. ConclusionBoth dry needling and inhibitory Kinesio taping increased pressure pain threshold and reduced muscle thickness in participants with active trigger points in the upper trapezius muscle. These 2 therapeutic techniques appear to cause similar positive changes in pain and muscle function but may do so through different mechanisms.

Efficacy of extracorporeal shock waves in the treatment of myofascial pain syndrome: a systematic review and meta-analysis of controlled clinical studies.

BackgroundMyofascial pain syndrome (MPS) is recurrent local myofascial pain with various treatment methods. In recent years, extracorporeal shock wave therapy (ESWT) has attracted much attention, but its role still lacks systematic review. We included controlled clinical studies for meta-analysis to systematically evaluate the application effect of ESWT.MethodsThe English literature from PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science to October 2021 was searched by computer. After screening, the quality was evaluated by the PEDro (Physiotherapy Evidence Database) scale and analyzed by RevMan 5.4 software.ResultsA total of 571 patients were included in 8 studies. The MPS pain sites of 541 patients were in the neck and upper back, and only 30 patients had pain sites in the waist. Meta-analysis showed that the pain level after ESWT was lower than that after other treatment methods [mean difference (MD) =−1.34, 95% confidential interval (CI): −1.87 to −0.81, P<0.00001], the pain threshold after ESWT was higher than that after other treatment methods (MD =0.90, 95% CI: 0.73 to 1.07, P<0.00001), and the neck disability index after ESWT was lower (MD =−1.79, 95% CI: −2.48 to −1.10, P<0.00001).DiscussionESWT can avoid the adverse effects of invasive procedures on patient tolerance and compliance; compared with trigger point injection (TPI), dry needling, ultrasound-guided pulsed radiofrequency (US), and other methods, ESWT can more effectively relieve pain in patients with MPS.

Effectiveness of high-intensity laser therapy added to a physical therapy program for the treatment of myofascial pain syndrome - a systematic review and meta-analysis

Effectiveness of high-intensity laser therapy added to a physical therapy program for the treatment of myofascial pain syndrome - a systematic review and meta-analysis

Results of treatment of myofascial pain syndrome using apparatus-punctural anti-pain therapy

<h3></h3> Миофасциальный болевой синдром (МФБС) является полифакторным заболеванием. Для того чтобы выставить пациенту этот диагноз при осмотре, врачу необходимо обращать внимание не только на данные анамнеза, жалобы и неврологический осмотр, но и на данные мануального мышечного тестирования. Обнаруженные при его использовании триггерные точки (ТТ) и болезненные мышечные тяжи в пораженных мышцах подтверждают этот диагноз, а также позволяют нам прицельно использовать наш метод лечения для эффективного устранения болевого синдрома. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить результаты лечения пациентов с МФБС с применением аппаратно-пунктурной противоболевой терапии (АПП-терапии), осуществляемой посредством введения лекарственного средства при помощи аппарата ППА-01. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В период с ноября 2020 г. по октябрь 2021 г. в исследование был отобран 51 человек (женщин — 29 (57%), мужчин — 22 (43%)) с МФБС различной локализации. Использовали мануальное мышечное тестирование, цифровую рейтинговую шкалу боли, опросник качества жизни Oswestry, опросник боли Макгилла, эстезиометрическое исследование, термографическое исследование. <h3>РЕЗУЛЬТАТЫ</h3> Установлено что наиболее часто встречается МФБС мышц поясничной локализации — 55%, далее идут шейная — 37% и грудная локализация — 8% от количества обследованных пациентов. Разработан алгоритм подбора зоны воздействия при МФБС различной локализации, позволяющий воздействовать на ТТ во всех заинтересованных мышцах. Во время исследования выявлено снижение интенсивности боли, порогов тактильной и болевой чувствительности и улучшение качества жизни практически у всех (у 94%) пролеченных пациентов. <h3>ЗАКЛЮЧЕНИЕ</h3> Использование АПП-терапии в лечении МФБС различной локализации позволит повысить эффективность лечения, улучшить качество жизни пациентов и сократить сроки лечения.

Results of ultrasound-guided interfascial block of the trapezius muscle for myofascial pain.

Myofascial pain syndrome (MPS) is a regional pain syndrome that causes pain due to hyperirritable trigger points in the musculoskeletal system. Trapezius is one of the most commonly affected muscles in MPS. We aimed to evaluate the efficacy of an ultrasound-guided interfascial block of the trapezius muscle in patients with MPS. The records of patients who underwent an ultrasound-guided interfascial block of the trapezius between November 2019 and October 2020 were retrospectively examined. The pain levels of the patients were evaluated with the numeric rating scale (NRS). Patients with a reduction in pain ≥50% after the procedure were considered to have benefited from the procedure. A total of 54 patients (41 women and 13 men) were evaluated. The mean NRS values of the patients were 7.16 (5-9) before the procedure, 3.31 (0-8) 10 min after the procedure, and 3.37 (0-8) 1 week after the procedure. The number of patients who benefited from the procedure was 40 (74.07%) 10 min after the procedure. The number of patients who benefited from the procedure for up to 1 week, 1-2 weeks, 2 weeks-1 month, 1-3 months, and more than 3 months after the procedure was 38 (70.37%), 36 (66.66%), 31 (57.40%), 26 (48.14%), and 17 (31.48%), respectively. Pain relief lasting for months was achieved in most of the patients. We believe that ultrasound-guided interfascial block of the trapezius is effective for the treatment of MPS.

Retrospective study of the clinical effect of incobotulinumtoxinA for the management of myofascial pain syndrome in refractory patients

The aim was to evaluate the effectiveness and safety of IncobotulinumtoxinA (IncoA) for the management of myofascial pain syndrome (MPS) in refractory patients. This single-center, observational, retrospective study includes 37 patients. The pain reduction was 4.7 points (95%CI: 5.6 to −3.8) from baseline to one-month post-injection (using a 10-point visual analogue scale). Only 18.9% experienced mild adverse events. In conclusion, IncoA is an effective and safe alternative for the treatment of MPS in refractory patients.

Applications of a muscle relaxant (tolperizone) in clinical practice

Tolperizone is a central type of muscle relaxant that is widely used in clinical practice for the treatment of patients with acute and chronic nonspecific lower back pain(LBP), inflammatory and degenerative-dystrophic joint diseases, and is used in the treatment of myofascial pain syndrome (MPS).The Russian market widely used drug tolperizone, which is comparable in its clinical and anti-inflammatory activity with the original tolperizone, as well as with non-steroidal anti-inflammatory drugs (NSAIDs). Tolperizone is prescribed mainly in complex therapy, as well as as monotherapy.In some studies, based on the clinical efficacy of tolperizone (200 mg 3 times a day), it is concluded that tolperizone can be considered as a promising treatment for acute muscle spasm, without causing drowsiness. In the treatment of pain syndromes and osteoarthritis (OA) of various localization, the optimal dosage regimen of tolperizone is currently recommended: oral 150-300 mg per day for a course of 14 days, or according to a 2-stage scheme of administration, first intramuscularly 1.0 ml 2 times a day for 5 injections, then switching to oral administration of 150 mg 3 times a day; with MPS, a single local intramuscular injection of tolperizone is prescribed at the trigger point. The addition of tolperizone (150 mg/s) to the scheme of complex therapy allows to achieve an earlier clinical effect in OA of the hip and ankle joints, suppressing further progression of the disease. When included in the therapy regimen of tolperizone (150 mg/s, 14 days) OA of the ankle joint, with ultrasound examination, there is a statistically significant decrease in the signs of synovitis.