Efficacy of Topical Vibratory Stimulation for Reducing Pain During Trigger Point Injection to the Gastrocnemius: A Randomized Controlled Trial

ObjectiveTo evaluate the efficacy of topical vibratory stimulation for reducing pain during trigger point injection (TPI).DesignDouble-blind randomized placebo-controlled clinical trial.SettingTertiary care university hospital.ParticipantsA total of 136 participants were randomly recruited from among patients with myofascial pain syndrome who were scheduled for TPI. Of these, 65 were excluded because they met the exclusion criteria, and 11 because they refused to participate. Finally, 60 participants were enrolled. No participants dropped out of the study.InterventionParticipants were randomly assigned to the vibration group or control group. TPI was performed with 0.5% lidocaine using a 25-gauge needle. A vibrator was applied to the popliteal fossa for 3 to 5 seconds prior to and during TPI to the gastrocnemius; 100-Hz vibration was turned on for the vibration group and turned off for the control group.Main Outcome MeasuresPain intensity during TPI was assessed using a 100-mm visual analog scale (VAS) as a primary outcome, and participant satisfaction and preference for repeated use were measured using 5-point Likert scales as a secondary outcome. These parameters were evaluated immediately after TPI. The primary outcome was evaluated using analysis of covariance and secondary outcome using the Mann-Whitney U test.ResultsVAS scores for pain during TPI were significantly lower in the vibration group (30.30; 95% confidence interval [CI], 22.65-39.26) compared with the control group (47.58; 95% CI, 38.80-56.52; F=7.74; P< .01). The mean difference in VAS scores between the 2 groups was 17.27 (95% CI, 5.24-29.30). Participant satisfaction and preference for repeated use were significantly higher in the vibration group than in the control group (P<.05). No participant showed any side effects.ConclusionTopical vibratory stimulation significantly decreased pain during TPI of the gastrocnemius.     

Impact of physical therapists’ instructions on function and the perception of post-dry needling soreness in mechanical cervical pain; a randomized clinical trial

BackgroundTo investigate the impact of physical therapists’ instructions on the perception of post dry needling (DN) soreness and function in patients with mechanical neck pain.MethodsSeventy-five patients with neck pain were randomly assigned to three groups: “positive” group (n = 25) received positive verbal input; “negative” group (n = 25) received negative verbal input, and control group (n = 25) did not receive any input about post-needling soreness. All three groups received DN of a trigger point in the upper trapezius muscle. The subjective pain experience, pressure pain threshold (PPT), and neck disability Index (NDI) were assessed before and after DN.ResultsPatients in all groups showed improvement in pain, PPT and NDI. There were no significant differences in pain (P = 0.41) and PPT (P = 0.68) in the positive and negative groups compared with the control group. Significant difference in function was seen with the NDI after DN of patients in the positive and negative groups compared with the control group (P = 0.011, standard error: 1.08–1.5).ConclusionConsidering that the power of our study may be too low to draw more definitive conclusions, DN appears to be an effective technique to improve pain and mechanical hyperalgesia. The experience of post-needling soreness does not appear to influence the outcome of DN on pain, PPT, and NDI. Post-needling soreness does not seem to be a limiting factor in achieving acceptable outcomes, especially when clinicians offer DN within a therapeutic emphasizing a positive patient response. This study questions whether any treatments need to be offered to patients receiving DN.     

新生儿病房不良事件筛查工具初探

[摘要]目的：探讨适合我国新生儿病房的不良事件筛查工具并验证其可行性。方法：结合文献及专家咨询法形成筛查工具;通过2015年7月30日至2015年9月30日2个月回顾性研究及2016年5月9日至2016年6月9日一个月实时观察研究,记录筛查指标及不良事件,验证本工具可行性。结果：回顾性研究纳入病例782例,筛查指标总计887例次（1.13例/次）,独立不良事件391例次（0.50例/次）;筛查指标发现的不良事件占78.8%,筛查工具阳性预测值为0.39,其中新生儿普通病房0.45,新生儿重症监护室（NICU）0.26,二者比较差异有统计学意义（P<0.01）。实时研究纳入筛查指标417例次,独立不良事件261例次,总阳性预测值0.64,高于回顾性研究阶段（0.45）,其中阳性预测值有统计学差异的筛查指标为“皮肤完整性受损”及“抗生素应用”（P值均<0.01）。结论：本研究的筛查工具对新生儿普通病房不良事件监测具有较好的可行性,加强医务工作者如实、及时记录不良事件的培训,可提高本筛查工具的监测效果。     

Survey on changes in subjective symptoms,onset/trigger factors,allergic diseases,and chemical exposures in the past decade of Japanese patients with multiple chemical sensitivity

Background

Recently, with rapid changes in the Japanese lifestyle, the clinical condition of patients with multiple chemical sensitivity (MCS) may also have undergone change. Thus, we conducted a new survey for subjective symptoms, ongoing chemical exposures, the prevalence of allergic diseases, and presumed onset/trigger factors in patients with MCS and compared results with those of an old survey from ten years ago.

Myofascial trigger points, neck mobility and forward head posture in unilateral migraine

This paper describes the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles between unilateral migraine subjects and healthy controls, and the differences in the presence of TrPs between the symptomatic side and the non-symptomatic side in migraine subjects. In addition, we assess the differences in the presence of both forward head posture (FHP) and active neck mobility between migraine subjects and healthy controls and the relationship between FHP and neck mobility. Twenty subjects with unilateral migraine without side-shift and 20 matched controls participated. TrPs were identified when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band and reproduction of the referred pain typical of each TrP. Side-view pictures were taken in both sitting and standing positions to measure the cranio-vertebral angle. A cervical goniometer was employed to measure neck mobility. Migraine subjects showed a significantly greater number of active TrPs (P<0.001), but not latent TrPs, than healthy controls. Active TrPs were mostly located ipsilateral to migraine headaches (P<0.01). Migraine subjects showed a smaller cranio-vertebral angle than controls (P<0.001), thus presenting a greater FHP. Neck mobility in migraine subjects was less than in controls only for extension (P=0.02) and the total range of motion in flexion/extension (P=0.01). However, there was a positive correlation between the cranio-vertebral angle and neck mobility. Nociceptive inputs from TrPs in head and neck muscles may produce continuous afferent bombardment of the trigeminal nerve nucleus caudalis and, thence, activation of the trigeminovascular system. Active TrPs located ipsilateral to migraine headaches might be a contributing factor in the initiation or perpetuation of migraine.     

Gender differences in treatment-seeking chronic headache sufferers

OBJECTIVE: To identify gender differences within a group of patients seeking treatment for chronic headache. Previous studies of the general population have reported differences in headache symptoms, frequency, disability, and psychological distress, with women affected with more severe and disabling symptoms than men. This study evaluated these features in a population seeking treatment. METHODS: Two hundred fifty-eight consecutive patients with headache attending a university headache clinic were evaluated with questionnaires about headache symptoms and psychological distress. Comparisons between men and women were made for headache symptoms, severity, frequency, trigger factors, comorbid depression and anxiety, and response to treatment. RESULTS: There were no gender differences in headache symptoms, frequency, severity, and duration. Headache triggers were gender-specific, with men more likely to endorse exercise and women more likely to endorse stress and exposure to odors. Psychological comorbidity was similar among men and women seeking treatment, with a mean Beck Depression Inventory score of 10 and a mean Spielberger trait anxiety score of 39 for both men and women. Disability was greater in men, with 46% reporting restrictions in activities more than 3 days per week because of headache compared with 29% of women. In addition, men were more likely to contribute headache control to external figures than women. CONCLUSIONS: Patients seeking treatment for chronic headache do not have the same gender-specific differences that have been reported in general population surveys. Men who seek treatment for headache are more likely to have significant disability, and are equally likely to have symptoms of depression and anxiety as women who seek treatment. Clinical and research investigations of headache triggers need to be gender-specific.