针刺激痛点治疗肌筋膜疼痛综合征研究进展

从针刺治疗肌筋膜疼痛综合征的主要选穴(激痛点)、针刺激痛点治疗本病的中医和现代研究机制及治疗该病时针刺激痛点的临床应用几个方面,对针刺激痛点治疗肌筋膜疼痛综合征的相关文献进行综述。结果表明针刺激痛点在治疗肌筋膜疼痛综合征中具有十分显著的疗效,且针刺激痛点时选择的针具、针刺的手法、角度、深度等各项参数对治疗肌筋膜疼痛综合征临床疗效有重要影响,但目前对此研究非常薄弱,缺乏多因素分析的系统性研究,且在临床诊断及基础性研究等方面有待改进。     

恢刺配合排刺治疗颈肩肌筋膜疼痛综合征案

<正>肌筋膜疼痛综合征是以"激痛点"为标志性特点的慢性软组织源性疼痛的病症。激痛点是形成肌筋膜疼痛综合征的病理因素,同时亦是其病理产物,常累及肌肉、筋膜、肌腱等部位,表现为颈部、肩部、腰背部肌肉固定压痛、牵涉痛、抽搐反应甚至导致运动功能障碍、自主神经功能障碍,严重影响人们生活质量。目前对于该病尚无统一的治疗方案,而针灸以其安全、有效、简便、无副作用等优势,广泛应用于     

激痛点特种针法治疗颈肩肌筋膜疼痛综合征的临床研究进展

随着现代颈肩疾病的频繁发生,颈肩肌筋膜疼痛综合征(Myofascial Pain Symdrome, MPS)已逐渐成为困扰人们生活和工作的因素。针刺治疗软组织损伤引起的疼痛,因疗效确切、安全、无不良反应等优势在临床上被广泛应用。在国家知识基础设施数据库、中文科技期刊数据库、中国学术期刊数据库、PubMed数据库中,对2009—2019年间有关针刺治疗肌筋膜疼痛综合征、针刺治疗肌筋膜炎、激痛点的相关资料进行查阅和筛选,从激痛点特种针刺手法运用,特种针具使用以及复合其他温热电等针刺疗法临床运用3个方面来对激痛点针刺治疗颈肩MPS临床文献进行总结,结果发现颈肩MPS在激痛点行特种针刺疗法有显著的疗效。     

激痛点与腧穴的解剖与临床关系

目的探讨激痛点（Trigger point）及其感传痛路线（Referral pain pattern）和传统针灸腧穴及其所属的经络关系。方法利用解剖图和解剖图分析软件，共研究比较了255个激痛点和747个腧穴，观察和分析了激痛点与腧穴的对应程度。本研究还比较了这些对应点的临床主治，以及激痛点的疼痛感传路线与其对应的腧穴所在的经络分布。结果在255个激痛点中，92％（235／255）与腧穴在解剖位置上对应。在747个腧穴中，79．5％（594／747）的穴位所主治的局部疼痛与其对应的激痛点相似。在这些对应穴中，其肌筋膜感传痛路线与其对应的针灸腧穴所在的经络分布完全或基本一致的占76％，14％部分一致。结论肌筋膜疼痛的科学基础应有助于进一步阐明针灸治疗疼痛的治疗机制。这项研究的结果可能有助于针灸与当代临床疼痛治疗的进一步整合。     

陆彦青运用激痛点速刺法结合三角肌透刺治疗肩周炎的临床思路

总结陆彦青教授以经筋理论和肌肉功能解剖为基础,灵活运用激痛点速刺结合三角肌排针透刺治疗肩周炎的临床经验。陆彦青教授认为肩周炎引起的疼痛和活动受限与颈肩部经筋受损形成筋结病灶点有关,结合肌筋膜激痛点理论,对受累肌肉的激痛点精准定位,以松解痉挛肌束、条索与硬结为重点,采用速刺和透刺法解痉挛、疏筋络,改善局部血液循环,疼痛及炎症反应终止,大幅度改善肩关节活动功能。     

刃针针刺肌筋膜激痛点治疗颈心综合征30例

目的:探讨刃针针刺肌筋膜激痛点治疗颈心综合征的临床疗效.方法:将颈心综合征患者60例随机分为两组,分别采用刃针针刺肌筋膜激痛点治疗、口服稳心颗粒治疗.结果:两组间综合疗效,治疗前后各症状、体征比较,经统计学处理相比具有显著性差异(P＜0.05),治疗组优于对照组.结论:刃针针刺肌筋膜激痛点治疗颈心综合征有良好疗效.     

髂腰肌筋膜痛体外冲击波与推拿干预的疗效观察

目的：探讨体外冲击波（EMS）与推拿松解治疗髂腰肌筋膜痛的疗效.方法：将60例符合诊断标准的患者随机分为治疗组和对照组,每组30例,治疗组采用EMS髂腰肌激痛点治疗,对照组采用推拿松解髂腰肌激痛点治疗,2组间进行自身治疗前后疼痛、硬结条索状物指数对照观察.结果：2组间治疗前后对照指数比较有差异显著（P＜0.01）;治疗组有效率为96.66%,对照组有效率为86.66%,有统计学意义.结论：采用激痛点EMS技术治疗髂腰肌筋膜痛疗效显著,优于推拿松解的治疗效果.     

冲击波复合激痛点针刺对肌筋膜疼痛综合征的影响

目的:探究冲击波复合激痛点针刺对肌筋膜疼痛综合征的影响。方法:本研究采用回顾性分析法,选取厦门大学附属第一医院2017年3月至2019年3月期间收治的100例肌筋膜疼痛综合征患者作为研究对象,通过随机数字分组法将其分为对照组50例(接受体外冲击波治疗)和观察组50例(接受体外冲击波治疗联合激痛点针刺治疗),比较两组患者的临床治疗效果以及治疗后生活质量评分。结果:观察组患者的治疗总有效率较对照组高,差异具有统计学意义(P 0.05);治疗后,观察组患者的生活质量评分明显高于对照组,差异具有统计学意义(P 0.05)。讨论:体外冲击波与激痛点针刺治疗均有着较为优异的临床治疗效果,且在两者联合应用的情况下,治疗效果更加突出,使治疗后患者的生活质量评分更高。     

刃针干预上斜方肌肌筋膜激痛点治疗颈肩肌筋膜疼痛综合征

目的 比较刃针和干针干预上斜方肌肌筋膜激痛点治疗颈肩肌筋膜疼痛综合征的临床效果。方法 72例依据随机数字表法分为对照组(36例,脱落2例)和研究组(36例,脱落3例)。研究组应用刃针干预治疗,对照组运用干针干预治疗,治疗点均为双侧MTrP₃、MTrP₅共四个激痛点。结果 ⑴刃针组总有效率90.9%,干针组总有效率88.2%,刃针组VAS评分、McGill疼痛积分改善程度均优于干针组(P<0.05)。即刻疗效上刃针组的颈椎活动度改善及激痛点疼痛值极差增大程度明显优于干针组。总疗程结束后刃针组左侧MTrP₃疼痛值极差较干针组显著增大(P<0.05),其他激痛点疼痛值极差无明显差别(P>0.05)。刃针组颈椎活动度改善程度较干针组无显著差异(P>0.05)。⑵治疗后,两组患者VAS评分、McGill疼痛积分均较治疗前显著降低(P<0.01),颈椎活动度改善,激痛点疼痛值极差增大程度均较治疗前显著增加(P<0.01)。刃针组总有效率90.9%,干针组总有效率88.2%,刃针组VAS评分、McG...     

激痛点按压治疗肌筋膜疼痛综合征的Meta分析

目的:对激痛点按压技术治疗肌筋膜疼痛综合征(MPS)的临床疗效进行Meta分析。方法:计算机检索2010年1月至2020年3月范围内,PubMed,EMbase,Cochrane Library,中国知网(CNKI),中国生物医学文献数据库(CBM)和万方数据库中,查找激痛点按压技术与其他疗法比较治疗MPS患者的随机对照试验(RCT)。由2位评价员依据纳入和排除标准对文献进行独立筛选、提取数据和评价纳入研究的方法学质量后,通过RevMan5.2软件对单次治疗前后VAS评分,压痛阈值(PPT)等评分变化进行Meta分析。结果:最终纳入8篇RCT,共计352名受试者。Meta分析结果显示,使用激痛点按压技术的治疗组VAS评分改善显著优于其他疗法的治疗/对照组[MD=-8.38;95%CI(-11.31,-5.44);Z=5.60;P=<0.00001];使用激痛点按压的治疗组PPT改善显著优于其他疗法的治疗/对照组[MD=0.56;95%CI(0.33, 0.70);Z=5.53;P<0.00001]。结论:激痛点按压技术在改善肌筋膜疼痛综合征的疼痛症状方面存在一定的疗效和优势。     

Effects of the infrared laser therapy at treated and non-treated trigger points

For reliability of the pain threshold measurement there were measured first 390 trigger points of 22 healthy students twice at each point. The reliability of two different measurements was found to be perfect. Infrared (904 nm) laser therapy was compared to placebo laser at the trigger points. Our study tested eighteen patients (11 men and 7 women), with 31 active trigger points in the muscles of the infraspinatus, extensor carpi radialis, levator scapulae, trapezius and tibialis anterior. Trigger points were randomly managed by infrared laser (dose 1.5J/point and place laser. The study was carried out by double-blind and cross-over principle. The responses of the management were documented by the pain threshold meter measurements of these trigger points before and after the treatments, and then fifteen minutes later. The trigger points of the other side of the body were also measured from the same muscles. In the results there were observed highly significant changes between the laser and placebo groups immediately after the treatment, 0.97 (SE 0.16) kg/cm2 (p less than 0.001). The differences between these two treatments were greater after fifteen minutes of the therapy--1.87 (SE 0.30) kg/cm2 (p less than 0.001). At the non-treated trigger points, the significant increase of the values was seen after fifteen minutes (p less than 0.05). Our research study results suggest that infrared laser had an effect at the trigger points and that the treatment significantly increased the pain threshold.     

Effects of trigger point acupuncture treatment on temporomandibular disorders: a preliminary randomized clinical trial

We compared the effects of trigger point acupuncture with that of sham acupuncture treatments on pain and oral function in patients with temporomandibular disorders (TMDs). This 10-week study included 16 volunteers from an acupuncture school with complaints of chronic temporomandibular joint myofascial pain for at least 6 months. The participants were randomized to one of two groups, each receiving five acupuncture treatment sessions. The trigger point acupuncture group received treatment at trigger points for the same muscle, while the other acupuncture group received sham treatment on the trigger points. Outcome measures were pain intensity (visual analogue scale) and oral function (maximal mouth opening). After treatment, pain intensity was less in the trigger point acupuncture group than in the sham treatment group, but oral function remained unchanged in both groups. Pain intensity decreased significantly between pretreatment and 5 weeks after trigger point (p<0.001) and sham acupunctures (p<0.050). Group comparison using the area under the curve demonstrated a significant difference between groups (p=0.0152). Compared with sham acupuncture therapy, trigger point acupuncture therapy may be more effective for chronic temporomandibular joint myofascial pain.     

Trigger Points and Classical Acupuncture Points: Part 3: Relationships of Myofascial Referred Pain Patterns to Acupuncture Meridians

Background

In the first part of this study, myofascial trigger point regions were demonstrated to have strong (93.3%) anatomic correspondences with classical acupuncture points. The second portion of this study examined the clinical correspondences of trigger point regions and classical acupuncture points in the treatment of both pain and somatovisceral disorders, and found they had ∼ 97% correlation for treating pain conditions and over 93% correlation in treating somatovisceral conditions.

Objective

To examine the relationships of myofascial trigger point regions' referred-pain patterns to the meridian distributions of their anatomically corresponding classical acupuncture points.

Methods

The 238 anatomically corresponding trigger point region – classical acupuncture point pairs in part one of this study were analyzed to compare the distributions of their myofascial referred-pain patterns and acupuncture meridians in order to determine if their distributions correlated.

Results

Seventeen of the 238 anatomically corresponding trigger point regions had no described myofascial referred-pain. In the remaining 221 trigger point region-classical acupuncture point pairs, 180 (81.5%) demonstrated complete or near-complete correlation, and another 9.5% of point pairs partially showed correlations regarding the distributions of their myofascial referred-pain patterns and associated acupuncture meridians. Only 9% of point pairs showed little or no consistency of their referred-pain patterns and acupuncture meridians.

Conclusions

The strong (up to 91%) consistency of the distributions of trigger point regions' referred pain patterns to acupuncture meridians provides a fourth line of evidence that trigger points most likely represent the same physiological phenomenon as acupuncture points in the treatment of pain disorders.     

基于软组织解剖浅谈对“气至”的认识

"气至"包含"气至针下"及"气至病所"。针对肌源性疾病,结合患者症状体征,找到病灶的激痛点,触诊激痛点下的结节或紧绷肌带,触手按压固定或拇食指钳住,刺手持针,针尖沿触手拇指甲边缘刺入紧绷肌带,较易使"气至针下"。若激痛点除表现肌肉疼痛外,可诱发可识别的引传症状,在针刺激痛点下的结节或紧绷肌带,使针感沿引传痛的部位感传,做到"气至病所"。针对神经源性疾病,结合患者症状体征,判断病灶神经节段,有针对性针刺刺激神经根、神经干、外周神经卡压点,使针感沿神经走行的方向放射至肢体末端,做到"气至病所"。     

肌筋膜疼痛触发点治疗技术治疗腰背肌筋膜疼痛综合征疗效分析

目的:评价利用肌筋膜疼痛触发点治疗腰背肌筋膜疼痛综合征临床疗效的优越性。方法:将500例符合诊断标准的患者随机分为治疗组和对照组,每组250例,治疗组采用肌筋膜疼痛触发点治疗技术(针刺和推拿疗法)进行治疗,对照组采用替扎尼定进行治疗;2组治疗均隔日1次,7d为1个疗程;治疗8个疗程后,进行2组自身治疗前后对照,以及2组间疗效的比较。结果:2组自身治疗前后对照,各组疼痛指数、功能状态指数和硬结条索状物指数均降低(P<0.05);治疗组总有效率为95.60%;对照组总有效率为85.20%;2组疗效比较差异有统计学意义(P<0.05)。结论:采用肌筋膜疼痛触发点治疗技术治疗腰背肌筋膜疼痛综合征疗效明显,且优于替扎尼定的治疗效果,值得临床进一步研究和推广。     

针刺肌筋膜疼痛触发点联合推拿治疗腰椎间盘突出症疗效观察

目的：观察针剌肌筋膜疼痛触发点联合推拿治疗腰椎间盘突出症（LDH）的疗效。方法：将60例LDH患者随机分为治疗组（30例）和对照组（30例）,治疗组采用针刺肌筋膜疼痛触发点联合推拿治疗,对照组给予常规药物及理疗,比较两组患者JOA、VAS评分改善情况及临床疗效。结果：治疗组总有效率、JOA评分均高于对照组（P〈0．01）,VAS评分低于对照组（P〈0．01）。结论：针剌肌筋膜疼痛触发点联合推拿治疗LDH疗效显著。     

痛点封闭配合推拿治疗肩关节周围炎154例疗效分析

探讨痛点封闭配合推拿治疗肩关节周围炎的效果,采取局部封闭,局部痛点注射1％普鲁卡因或利多卡因10～20ml,加强的松龙25mg或曲安奈德50mg,再配合手法推拿,二者合用比单独药物封闭和单纯手法治疗效果好。     

Vibratory stimulation for the alleviation of pain

In the present study 66 patients suffering from chronic myalgia were given vibratory stimulation as a pain relieving measure. Several of these patients had previously undergone treatments of various kinds without any significant relief. Forty-one patients reported a significant (20%) reduction of pain during vibratory stimulation. The best pain reducing site was found to be either the area of pain, a trigger or acupuncture point outside the painful area. The best pain reducing effect was obtained when the vibratory stimulation was applied with moderate pressure (1.0 kg) over the underlying structures. To obtain a maximal duration of pain relief the stimulation had to be applied for about 30 minutes.