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。     

温和灸激痛点治疗肩背部肌筋膜疼痛综合征:随机对照研究

目的:比较温和灸与针刺激痛点治疗肩背部肌筋膜疼痛综合征(MPS)的疗效差异,为肩背部MPS的治疗提供参考。方法:60例肩背部MPS患者随机分为温和灸组和针刺组,每组30例,两组均选取疼痛部位的激痛点进行治疗。温和灸组采用温和灸疗法,每次艾灸因人而异,20~100min不等,以患者出现透热感为度;针刺组采用毫针与皮肤呈45°角斜刺入并贯穿激痛点结节,每次留针30min。两组每日均治疗1次,10次为一疗程,治疗1个疗程后,采用国际公认的简化麦吉尔疼痛量表(McGill)作为观察指标,以治疗前后疼痛分级指数(PRI)、视觉模拟评分(VAS)和现时疼痛强度(PPI)的变化来评价疗效。结果:温和灸组愈显率80.0%(24/30),优于针刺组愈显率40.0%(12/30,P0.001)。治疗后两组PRI、VAS、PPI评分较治疗前均降低(均P0.001);两组治疗后PRI、VAS、PPI评分比较,差异均无统计学意义(均P0.05)。结论:温和灸激痛点与针刺激痛点对肩背部MPS均具有良好的治疗效果,但温和灸治愈显效更为明显,且操作简便,易于推广。     

毫钝针疗法治疗腰肌筋膜疼痛综合征的临床研究

目的探讨毫钝针针刺治疗在腰肌筋膜疼痛综合征中的应用效果。方法选取60例腰肌筋膜疼痛综合征(MPS)患者进行研究,按照1∶1比例随机分组,毫钝针刺组采用毫钝针针刺激痛点治疗,普通针刺组采用普通针刺常规穴位治疗。每2天治疗1次,每个疗程治疗6次,连续治疗2个疗程,治疗完毕采用视觉模拟疼痛量表(VAS)和Roland-Morri功能障碍调查问卷表(RMDQ)评价疗效。结果与治疗前VAS评分相比,毫钝针刺组经过治疗降低(4.17±1.53)分,普通针刺组经过治疗降低(3.33±1.40)分,差异均具有统计学意义(P <0.05)。毫钝针刺组治疗后VAS评分较普通针刺组低,而VAS差值较普通针刺组高,差异具有统计学意义(P <0.05)。与治疗前RMDQ评分相比,毫钝针刺组经过治疗降低(10.80±2.34)分,普通针刺组经过治疗降低(8.63±2.91)分,差异均具有统计学意义(P <0.05)。毫钝针刺组治疗后RMDQ评分较普通针刺组低,而RMDQ差值较普通针刺组高,差异具有统计学意义(P <0.05)。毫钝针刺组总有效率为93.33%,普通针刺组总有效率为80.00...     

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.     

“以痛为腧”治疗肌筋膜疼痛综合征针刺时间之临床研究

目的:观察"以痛为腧"治疗肌筋膜疼痛综合征(MPS)3种针刺时间之临床疗效差异。方法:与皮肤表面呈平行方向按压扳机点(条索状硬结),病患最感疼痛的方向定义为痛点方向。将90例确诊为背部肌筋膜疼痛综合征的患者随机分为针刺5min组、针刺15min组与针刺25min组等3组,每一组有30例患者。远离痛点方向平刺(15°),并进行疗效比较。按压力量值之测定:采用指针式拉压力计规范所有之按压力量,每一次试验前后,试验者使用指针式拉压力计之按压方式,包括按压位置、方向、力量等,必须严格规定其一致性。本试验均采用视觉模拟量表之数字量表评订疼痛缓解的临床疗效。结果:针刺5min组、针刺15min组与针刺25min组等3组针刺时间对肌筋膜疼痛之治疗前后疼痛改善均有显著性差异(P<0.05)。针刺后留针时间越久完全缓解率增加。针刺5min组、针刺15min组与针刺25min组等3组针刺时间之总有效率均相同,可达100%。针刺后留针时间越久平均减分率仅略为增加。3种针刺时间比较,疼痛缓解统计学上均无显著性差异(P>0.05)。结论:针刺得宜,针刺5min即有很好的疼痛缓解效果;针刺时间延长,疼痛再缓解有限。     

浮针法治疗肌筋膜疼痛综合征的相关理论探讨

浮针疗法是治疗各种痛症的新型针刺疗法,临床疗效显著,尤其对软组织镇痛,收效快速。本文以传统中医学理论、现代医学及经络实验研究为基础,结合笔者的临床体会,对浮针疗法治疗肌筋膜疼痛综合征的作用机理进行探讨和分析,同时对其今后的发展及研究方向提出了展望。     

针刺治疗颈肩腰背部肌筋膜疼痛综合征临床研究进展

针刺治疗颈肩腰背部肌筋膜疼痛综合征(myofascial pain syndrome,MPS)以局部选穴、远部选穴及直接针刺激痛点为主,辨证选穴应用不多,可能与MPS辨证分型尚不完备有关,因而针刺补泻亦无统一标准。针刺治疗肌筋膜疼痛综合征的特色针法有:"金钩钓鱼"针法,"董氏奇穴"针刺法,滞针法,阻力针法,排针刺法,管氏特殊针刺法等。亦有根据针刺时间治疗的方法有:根据就诊时间采用灵龟八法开穴,子午流注择时取穴。大多针刺后采用平补平泻法,个别穴位在针刺时会强调补泻,一些特殊针法操作时会有特殊补泻要求。笔者认为,应针对患者的年龄、体质等进行辨证选穴,并施以相应的补泻手法。此外,针刺后留针是针刺疗法的重要组成部分,而留针时间长短对疗效的影响不可小觑,针刺后留针时间从不留针到留针2 min、15 min、20 min、30 min、40 min等不尽相同。对于针刺激痛点后是否留针、留针多久存在争议,有待进一步研究。     

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2...     

针刺肌筋膜激痛点在疼痛治疗中的相关理论探析

从肌筋膜激痛点定义、疼痛机制、止痛原理、针刺激痛点在疼痛治疗中的应用、激痛点与针灸穴位的相关性等方面就目前围绕肌筋膜激痛点的相关理论研究及进展进行综述,阐明其研究意义和临床价值。     

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。     

毫火针治疗肌筋膜疼痛综合征疗效观察

目的观察毫火针治疗肌筋膜疼痛综合征的临床疗效。方法将72例肌筋膜疼痛综合征患者随机分为治疗组和对照组,每组36例。治疗组采用毫火针治疗,对照组采用常规针刺治疗。观察两组治疗前后简化麦吉尔疼痛量表(MPQ)评分,比较两组临床疗效。结果治疗组总有效率和愈显率分别为94.4%和77.8%,对照组分别为80.6%和30.6%。两组愈显率比较,差异具有统计学意义(P0.01)。两组治疗后MPQ量表各项评分(PRI、PPI及VAS)与同组治疗前比较,差异均具有统计学意义(P0.05)。治疗组治疗后MPQ量表各项评分与对照组比较,差异具有统计学意义(P0.05)。结论毫火针是一种治疗肌筋膜疼痛综合征的有效方法。     

Trigger Points and Classical Acupuncture Points: Part 2: Clinical Correspondences in Treating Pain and Somatovisceral Disorders

Background

Anatomic comparisons of the locations of myofascial trigger points (mTrPs) to those of classical acupuncture points in the first part of this study showed that at least 238 (93.3 %) of 255 “common” mTrPs described by the Trigger Point Manual have proximate, anatomically corresponding classical acupoints that anatomy references document enter the same muscle regions of those mTrPs.

Objectives

To determine whether these correlated common mTrP–classical acupoint pairs have similar indications for treating pain and somatovisceral disorders.

Methods

The clinical indications of the 238 anatomically corresponding classical acupoints were examined in acupuncture references to determine whether they include indications for treating pain and/or somatovisceral disorders that are comparable to those described for their correlated common mTrPs by the Trigger Point Manual.

Results

93 % (221/238) of the correlated common mTrPs have pain indications described by the Trigger Point Manual. Of their anatomically corresponding classical acupoints, 208/221 (94 %) have similar regional pain indications described, and another 6 (3 %) of these acupoints have indications for painful conditions in the distributions of their correlated mTrPs' described referred-pain. Only 7 classical acupoints that anatomically corresponded to common mTrPs had no comparable pain indications. The Trigger Point Manual describes somatovisceral effects for 60 (24 %) of its common mTrPs. Of their anatomically corresponding classical acupoints, 82 % (49/60) have “definite” and another 11 % (7/60) have “probable” clinical correspondences of their somatovisceral effects.

Conclusions

The marked correspondences of the pain indications (up to 97 %) and somatovisceral indications (up to 93 %) of anatomically corresponding common mTrP-classical acupoint pairs provide a second, clinical line of evidence that trigger points and acupuncture points likely describe the same physiologic phenomena.     

疼痛测评量表在国外针刺治疗慢性疼痛临床随机对照试验中的应用

针刺治疗慢性疼痛的科学研究常涉及对疼痛的定量评价,其中以疼痛相关量表最为常用。文章总结、分析近10年来发表在Pub Med上的高质量针刺治疗慢性疼痛的RCT研究中慢性疼痛量表使用情况,以期为今后研究中疼痛测评量表的选择提供借鉴。     

Trigger Points and Classical Acupuncture Points: Part 1: Qualitative and Quantitative Anatomic Correspondences

Background

Data from a recently published study suggest that substantial anatomic, clinical, and physiologic overlap of myofascial trigger points (mTrPs) and acupoints exists in the treatment of pain disorders.

Objective

To evaluate the anatomic relationships between classical acupoint locations and those of mTrPs both qualitatively and quantitatively.

Methods

Graphics software was used to demonstrate the different muscle layers of a virtual, digitized human cadaver. The locations of 255 “common” mTrPs described in the Trigger Point Manual were superimposed as a separate layer to these graphics as were the locations of the 361 classical acupoints and the meridians they exist on. The relationships of the anatomic locations of acupoints and meridians to those of muscles and common mTrPs could then be directly visualized. Classical acupoints and mTrPs that entered the same muscle regions and were physically closest to each other, as confirmed by acupuncture and human anatomy references, were termed “anatomically corresponding” point pairs. A quantitative analysis of these anatomically corresponding mTrP-acupoint pairs was also performed.

Results

Of 255 common mTrPs, 238 (93.3 %) had anatomically corresponding classical acupoints. Quantitatively, 89 (37 %) of these 238 corresponding mTrP-acupoint pairs were estimated to be within 1 cm of each other, 107 point pairs (45 %) within 1–2 cm of each other, and another 32 point pairs (13 %) within 2–3 cm of each other. Trigger-acupuncture point correspondences would rise to 95.7 % if six other common mTrPs are considered anatomically corresponding.

Conclusions

Analysis of the relationships of the anatomic locations of mTrPs and acupoints while adhering to the modern conceptualization of myofascial pain as a regional muscle disorder demonstrates ≥ 93.3 % anatomic correspondence of common mTrPs to classical acupoints.     

针刺对慢性疲劳综合征患者疼痛程度影响的随机对照研究

目的观察针刺对慢性疲劳综合征(CFS)患者疼痛程度的影响。方法采用随机(区组随机)、对照(非经穴点针刺)、单盲(第三者评价盲)研究方法,将70例患者随机分成观察组(35例)和对照组(35例)。观察组针刺百会、膻中、中脘、气海、关元、合谷、足三里、三阴交、太冲、太溪、肝俞、脾俞、肾俞;对照组选择非经穴点进行针刺。每周治疗3次,共治疗14次。采用视觉模拟评分法(VAS)对治疗前后患者的疼痛程度进行测量,并对脱落病例进行观察和记录。结果脱落6例,最终完成64例,每组各32例。与治疗前比较,2组治疗后VAS积分均显著降低(观察组P0.001,对照组P0.01)。观察组疼痛减缓百分比显著高于对照组(P0.01)。结论针刺治疗可有效缓解CFS患者的疼痛程度。经穴点的特异程度高于非经穴点。     

肌筋膜链理论在疼痛诊疗中的应用探析

肌筋膜链是在西方解剖学的基础上发展而来的一个现代医学概念。它强调人体是以骨骼为支架,由肌筋膜、韧带等紧密连接构成的一个张拉整体结构,各部分通过链条式网络相互影响,共同维持机体结构与功能的稳定。疼痛作为人体的第五大生命体征,其重要性不置可否。目前仍然有很高比例的慢性、顽固性疼痛患者无法真正彻底的摆脱束缚。文章通过对肌筋膜链理论的探讨,以期为相关疼痛疾病的诊疗提供新的思路和手段。     

小针刀治疗颈肩肌筋膜疼痛综合征的疗效观察

〔摘 要〕 目的：研究小针刀治疗颈肩肌筋膜疼痛综合征的临床疗效。方法：选择化州市中医院 2020 年 1 月至 2021 年 1 月收治的颈肩肌筋膜疼痛综合征患者 80 例作为研究对象,按照数字随机表法分为对照组和观察组,各 40 例。 对照组实施常规针灸治疗,观察组采用小针刀治疗,观察两组患者临床治疗效果,两组患者治疗前后血清 5– 羟色胺 （5–HT）、β– 内啡肽（β–ET）水平以及疼痛视觉模拟评分法（VAS）评分、巴氏量表（BI）评分以及颈椎功能障 碍指数（NDI）评分。结果：观察组患者的治疗有效率为 97.5 %,明显高于对照组的 82.5 %,差异具有统计学意义 （P ＜ 0.05）。治疗前,两组患者血清 5–HT、β–ET 水平比较,差异无统计学意义（P ＞ 0.05）;治疗后,观察组患者 β–ET 水平明显高于对照组,5–HT 水平明显低于对照组,差异具有统计学意义（P ＜ 0.05）。治疗前,两组患者 VAS、BI 评分以及 NDI 评分比较,差异无统计学意义（P ＞ 0.05）;治疗后,观察组患者的 BI 评分明显高于对照组, VAS 评分及 NDI 评分明显低于对照组,差异具有统计学意义（P ＜ 0.05）。结论：治疗颈肩肌筋膜疼痛综合征采取 小针刀治疗,有利于患者恢复颈肩部功能,明显减轻疼痛。     

国内外针刺治疗肠易激综合征随机对照试验的对比分析

检索近10年国内外针刺治疗肠易激综合征的随机对照试验,从以下6个方面进行对比分析:1治疗类型,2随机和盲法,3结局指标,4对照干预措施,5治疗方案,6结果。研究显示国内研究存在治疗类型较单一、不重视随机隐藏及盲法的应用、结局指标非国际公认、缺乏生活质量及心理状态评价等问题;国外研究整体质量较高,但假针刺对照设置合理性不足。今后的研究应充分考虑上述问题,严格按照随机对照的临床研究方法对针刺治疗肠易激综合征的有效性进行进一步探讨,更好地为临床决策提供证据。     

针灸与西药治疗更年期综合征疗效比较的系统评价

目的:比较针灸与西药治疗更年期综合征的有效性和安全性。方法:计算机检索CBM(1979-2009)、CNKI(1979-2009)、VIP(1989-2009)和WF(1998-2009)、Pubmed(1966-2009)、Embase(1980-2009)和Cochrane Library(Issue 3,2009)。辅以手工检索天津中医药大学图书馆过刊资料库。收集针灸和西药比较治疗更年期综合征的RCT,由两名评价者独立提取资料并按照Cochrane Review Handbook 4.2.8进行质量评估。统计学分析采用RevMan 5.0.20软件。结果:共纳入19篇RCT,其中围绝经期干眼症1篇,围绝经期抑郁症6篇。Meta分析结果显示:⑴Kupperman评分:针灸VS谷维素在第4周时[WMD=-10.17,95%CI(-13.49,-6.84)]有差异;针灸VS尼尔雌醇在第4周、12周时无差别,但在第8周时[WMD=-0.83,95%CI(-1.42,-0.23)]有差别;针灸VS利维爱、替勃龙无差异;针灸VS倍美力有差异。(2)Kupperman减分率:针灸VS雌二醇和谷维素在12周时[RR=1.06,95%CI(0.98,1.13)]无差异;针灸VS谷维素在4周时[RR=1.37,95%CI(1.01,1.87)]有差异;针灸VS替勃龙、尼尔雌醇、利维爱、倍美力均无差异。(3)血清E2含量:针灸VS雌二醇和谷维素在12周时[WMD=-29.69,95%CI(-37.02,-22.36)]有差异;针灸VS谷维素、倍美力、替勃龙均有差异;针灸VS利维爱在4周时[WMD=10.99,95%CI(6.59,15.39)]有差异,在12周时[WMD=13.45,95%CI(-13.95,40.85)]无差异。(4)围绝经期抑郁症和围绝经期干眼症:根据对照药物和测量指标与时间的不同,结果不同。结论:针灸治疗更年期综合征的疗效与西药比较有差异,且针灸的不良反应少。但纳入质量不高,尚需要更多高质量的RCT来进一步证实。     

Efficacy of Acupuncture in the Management of Primary Dysmenorrhea: A Randomized Controlled Trial

Introduction

Dysmenorrhea constitutes one of the most frequent disorders in women of a fertile age. The present study was conducted to evaluate the efficacy of acupuncture in the management of primary dysmenorrhea.