肌筋膜疼痛触发点内理化环境的改变及其作用

背景：以往研究对肌筋膜疼痛触发点的研究主要集中在发病特点和临床治疗方面,有关肌筋膜疼痛触发点局部组织的理化环境变化及其作用的研究较少。目的：总结并讨论肌筋膜疼痛触发点局部组织的理化环境变化及各种理化因子在肌筋膜疼痛中的作用。方法：由第一作者用计算机检索中国期刊全文数据库（CNKI：2000/2010）和Medline数据库（2000/2010）,检索词分别为＂肌筋膜疼痛触发点、致痛因子、神经系统致敏、伤害性感受器＂和＂myofascial trigger points,algogenic substance,nervous system sensitization,nociceptors＂。共检索到159篇文章,按纳入和排除标准对文献进行筛选,共纳入30篇文章。从肌筋膜疼痛触发点局部理化环境变化及各种理化因子的作用两方面进行总结,对理化环境在肌筋膜疼痛触发点发病中的重要作用进行介绍。结果与结论：肌筋膜疼痛触发点局部肌肉组织各种理化因子发生显著性变化,表现为各神经血管反应物质增多,炎症递质和致痛因子浓度明显升高。但是国内外对肌筋膜疼痛触发点理化环境变化及其作用的相关研究较少,了解仍不深入。     

卫星细胞与肌肉肥大关系及成肌因子的运动性调控

背景:卫星细胞是成体肌肉发生重要的"原料",它的增殖、分化和融合增加了肌纤维的细胞核数量或肌纤维数的数量,继而引起肌肉功能和形态学的变化,但是肌肉肥大是否一定有卫星细胞参与还存在争议.成肌因子是肌肉发生调节的核心因子,在肌肉发生的多个阶段发挥重要作用,但是目前对它们功能上特点和差异的了解仍然不够深入.目的:总结并讨论卫星细胞和成肌因子在肌肉发生和肌肉肥大以及在肌肉训练中的作用.方法:由第一作者用计算机检索中国期刊全文数据库(CNKI:2000/2010)和Medline(2000/2010)数据库,检索词分别为"骨骼肌,肥大,运动,肌肉发生,卫星细胞,成肌因子"和"skeletal muscle,hypertrophy,exercise,myogenesis,satellite cell,MRF",语言分别设定为中文和英文.从卫星细胞与肌肉肥大、成肌因子的作用及成肌因子的运动性调控特点2方面进行总结,对卫星细胞及成肌因子在肌肉发生中的作用及其调节机制和肌肉重塑等方面进行介绍.结果与结论:共检索到177篇文章,按纳入和排除标准对文献进行筛选,共纳入30篇文章.结果表明肌肉发生是肌肉肥大的生物学基础,卫星细胞是成体肌肉发生关键,但肌肉肥大早期过程可能没有卫星细胞的参与,以DNA含量来衡量卫星细胞改变可能有较大误差,成肌因子是肌肉发生核心因子.目前研究对成肌因子成员之间功能的异同和成肌因子的运动性调控特点的了解仍不深入.     

慢性软组织损害的概念与纤维肌痛综合征及肌筋膜疼痛综合征的比较

目的:在发病机制、临床表现、诊断、治疗等方面比较慢性软组织损害的学说概念与纤维肌痛综合征、肌筋膜疼痛综合征诸方面的异同。方法:应用计算机检索Medline2001-01/2005-05的纤维肌痛综合征、肌筋膜疼痛综合征相关文献,检索词“fibromyalgiasyndrome,myofascialpainsyndrome”,并限定文献语种为英文。同时计算机检索中国期刊网医学专题全文数据库2000-01/2005-05的与慢性软组织损害、纤维肌痛综合征、肌筋膜疼痛综合征相关文献,检索词“慢性软组织损害、纤维肌痛综合征、肌筋膜疼痛,肌筋膜疼痛综合征”,并限定文献语种为中文。相关主题的书籍3本。对资料进行初审,选取包括上述专题的临床试验文献及所有相关的综述文献,筛除非随机临床试验的研究。对剩余的文献查找全文,以随机对照临床试验及论述相关课题的正反意见的综述作为纳入标准。对文献中有关慢性软组织损害的学说、纤维肌痛综合征、肌筋膜疼痛综合征在发病机理、临床表现、诊断、治疗等方面的资料进行综合。结果:共收集到“纤维肌痛综合征”的英文文献216篇,中文文献57篇,“肌筋膜疼痛综合征”的英文文献67篇,中文文献19篇,慢性软组织损害中文文献6篇,删除内容几近重复的文献,剩余20篇。①发病机制:纤维肌痛综合征的发病因素包括睡眠困扰、生长激素水平下降、心理异常、血清5-HT3受体异常等,但这些发病因素都不一定是病因,而是疾病产生的症状;肌筋膜疼痛综合征可发生于创伤、劳累过度或肌肉长时间维持在收缩状态之后,后者常见于长时间在书桌前从事读写或计算机工作者,同时本病还可见于患有颈或下腰部骨关节炎的患者中;软组织外科学认为,椎管内软组织损害性病变是由于硬膜外和神经根鞘膜外脂肪急性损伤后遗或慢性劳损形成的原发性无菌性炎症病变的化学性刺激,作用于鞘膜外神经末梢,结合椎管外软组织无菌性炎症病变,引起头、颈、背、肩、臂、腰、骶、臀、腿痛。②临床表现:纤维肌痛综合征患者通常表现为躯体、髋部和肩带部位的疼痛和僵硬感,也有患者可出现肌肉疼痛、无力,患者有特殊痛点存在,而在压痛点邻近区正常;肌筋膜疼痛综合征的特征是与触发点相关的局部肌肉、骨骼出现疼痛和压痛,疼痛部位深并可伴有烧灼感;慢性软组织损害病变范围可广可狭,主要取决于病变时间长短和就诊时患者是否存在椎管内炎症反应。③诊断:纤维肌痛综合征的诊断依据是患者具有广泛疼痛的病史,指压检查中18个部位中有11个阳性压痛点;肌筋膜疼痛综合征患者颈后、下腰部、肩和胸部是最常累及部位;慢性软组织损害患者只要有头、颈、背、肩、臂、腰、骶、臀、腿部的疼痛、酸胀、麻木、冷热异常等症状,排除其他系统性疾病、传染性疾病和肿瘤后,均可诊断为某某部位慢性软组织损害。④治疗:纤维肌痛综合征常用水杨酸盐、局部治疗、生物反馈法、行为改善法、催眠疗法、三环类抗抑郁药物、进行规律的有氧锻炼等;肌筋膜疼痛综合征的治疗除镇痛药物外,对受累部位予以按摩和超声有一定的益处;慢性软组织损害的治疗除药物、理疗外,中国特有的推拿按摩、针灸、手法及银质针松解术在治疗慢性软组织损伤中发挥了重要作用。结论:纤维肌痛综合征可基本覆盖肌筋膜疼痛综合征概念,而慢性软组织损害的学说与纤维肌痛综合征、肌筋膜疼痛综合征的概念相比在诊断、治疗方面更完善,更具有临床指导意义,慢性软组织损害的学说是先进而准确的。     

肌筋膜触发点综合征的治疗进展

<正>肌筋膜疼痛综合征(myofascial pain syndrome,MPS)是由肌筋膜触发点引起的常见的临床疾病。肌筋膜触发点主要表现为:在触发点位置可以触摸到拉紧的带(条索样结节),挤压触发点时会产生疼痛,并且能引起远处的牵涉痛和交感现象~([1])。触发点可能是由于肌肉创伤、长期姿势不正确或者反复局部损伤引起。分为活动性触发点(active trigger     

肌内效贴对肌筋膜疼痛综合征疼痛治疗效果的Meta分析北大核心CSCD

目的系统评价肌内效贴对肌筋膜疼痛综合征疼痛程度的治疗效果。方法检索Pub Med、EBSCO、Science Direct、Web of Science、Physiotherapy Evidence Database和Cochrane Library等数据库中关于肌内效贴治疗肌筋膜疼痛综合征或肌筋膜触发点的随机对照试验(RCT),检索时限从数据库建库至2017年10月。采用Cochrane协作网中RCT偏倚风险评价标准进行方法学质量评估,采用Rev Man 5.3软件进行Meta分析,采用Stata 12.0软件进行异质性分析和潜在发表偏倚分析。结果共纳入12个RCT,584例患者。与对照组相比,肌内效贴组在干预后和随访时的疼痛治疗效果均具有显著性优势(干预后:MD=-1.14,95%CI-1.88^-0.40,P=0.002。随访时:MD=-0.69,95%CI-1.16^-0.22,P=0.004)。干预时间(P=0.024)和随访时间(P=0.020)是随访结果主要异质性来源。结论肌内效贴在治疗肌筋膜疼痛综合征疼痛方面有优势。治疗时间或随访时间越长,肌内效贴的疗效越好。     

肌内效贴对肌筋膜疼痛综合征疼痛治疗效果的Meta分析

目的系统评价肌内效贴对肌筋膜疼痛综合征疼痛程度的治疗效果。方法检索Pub Med、EBSCO、Science Direct、Web of Science、Physiotherapy Evidence Database和Cochrane Library等数据库中关于肌内效贴治疗肌筋膜疼痛综合征或肌筋膜触发点的随机对照试验(RCT),检索时限从数据库建库至2017年10月。采用Cochrane协作网中RCT偏倚风险评价标准进行方法学质量评估,采用Rev Man 5.3软件进行Meta分析,采用Stata 12.0软件进行异质性分析和潜在发表偏倚分析。结果共纳入12个RCT,584例患者。与对照组相比,肌内效贴组在干预后和随访时的疼痛治疗效果均具有显著性优势(干预后:MD=-1.14,95%CI-1.88~-0.40,P=0.002。随访时:MD=-0.69,95%CI-1.16~-0.22,P=0.004)。干预时间(P=0.024)和随访时间(P=0.020)是随访结果主要异质性来源。结论肌内效贴在治疗肌筋膜疼痛综合征疼痛方面有优势。治疗时间或随访时间越长,肌内效贴的疗效越好。     

颈肌筋膜触发点疼痛和头部牵涉痛的诊断与治疗

目的:调查颈肌触发点疼痛和其头部牵涉痛的特征,观察利用不同部位颈肌在不同辅助镇痛下的牵张治疗效果。方法:对80例不同颈部肌筋膜触发点疼痛患者,明确触发点疼痛和其头部牵涉痛的位置,并做正确诊断;根据诊断对这些病人在不同镇痛方法下进行不同的肌牵张疗法,有些病例在牵张前加用针刺破坏触发点或扎断挛缩增粗的纤维。治疗后教病人在家做自我牵张法和随访,并对治疗前后做VAS评分。结果:治疗前后VAS评分差异有显著性(P<0.001)。结论:本法对颈部肌触发点疼痛和其头部牵涉痛的治疗有效,并且方便易行。但治疗者必须理解其致痛病理和牵张治疗的基本原理,同时需要积累诊断经验。     

慢性软组织损害的概念与纤维肌痛综合征及肌筋膜疼痛综合征的比较

目的：在发病机制、临床表现、诊断、治疗等方面比较慢性软组织损害的学说概念与纤维肌痛综合征、肌筋膜疼痛综合征诸方面的异同。方法：应用计算机检索Medline2001—01／2005—05的纤维肌痛综合征、肌筋膜疼痛综合征相关文献，检索词“fibromyalgia syndrome，myofascial painsyndrome”，并限定文献语种为英文。同时计算机检索中国期刊网医学专题全文数据库2000—01／2005—05的与慢性软组织损害、纤维肌痛综合征、肌筋膜疼痛综合征相关文献，检索词“慢性软组织损害、纤维肌痛综合征、肌筋膜疼痛，肌筋膜疼痛综合征”，并限定文献语种为中文。相关主题的书籍3本。对资料进行初审，选取包括上述专题的临床试验文献及所有相关的综述文献，筛除非随机临床试验的研究。对剩余的文献查找全文，以随机对照临床试验及论述相关课题的正反意见的综述作为纳入标准。对文献中有关慢性软组织损害的学说、纤维肌痛综合征、肌筋膜疼痛综合征在发病机理、临床表现、诊断、治疗等方面的资料进行综合。结果：共收集到“纤维肌痛综合征”的英文文献216篇，中文文献57篇，“肌筋膜疼痛综合征”的英文文献67篇，中文文献19篇，慢性软组织损害中文文献6篇，删除内容几近重复的文献，剩余20篇。①发病机制：纤维肌痛综合征的发病因素包括睡眠困扰、生长激素水平下降、心理异常、血清5-HT 3受体异常等，但这些发病因素都不一定是病因，而是疾病产生的症状；肌筋膜疼痛综合征可发生于创伤、劳累过度或肌肉长时间维持在收缩状态之后，后者常见于长时间在书桌前从事读写或计算机工作者，同时本病还可见于患有颈或下腰部骨关节炎的患者中；软组织外科学认为，椎管内软组织损害性病变是由于硬膜外和神经根鞘膜外脂肪急性损伤后遗或慢性劳损形成的原发性无菌性炎症病变的化学性刺激，作用于鞘膜外神经末梢，结合椎管外软组织无菌性炎症病变，引起头、颈、背、肩、臂、腰、骶、臀、腿痛。②临床表现：纤维肌痛综合征患者通常表现为躯体、髋部和肩带部位的疼痛和僵硬感，也有患者可出现肌肉疼痛、无力，患者有特殊痛点存在，而在压痛点邻近区正常；肌筋膜疼痛综合征的特征是与触发点相关的局部肌肉、骨骼出现疼痛和压痛，疼痛部位深并可伴有烧灼感；慢性软组织损害病变范围可广可狭，主要取决于病变时间长短和就诊时患者是否存在椎管内炎症反应。③诊断：纤维肌痛综合征的诊断依据是患者具有广泛疼痛的病史，指压检查中18个部位中有11个阳性压痛点；肌筋膜疼痛综合征患者颈后、下腰部、肩和胸部是最常累及部位；慢性软组织损害患者只要有头、颈、背、肩、臂、腰、骶、臀、腿部的疼痛、酸胀、麻木、冷热异常等症状，排除其他系统性疾病、传染性疾病和肿瘤后，均可诊断为某某部位慢性软组织损害。④治疗：纤维肌痛综合征常用水杨酸盐、局部治疗、生物反馈法、行为改善法、催眠疗法、三环类抗抑郁药物、进行规律的有氧锻炼等；肌筋膜疼痛综合征的治疗除镇痛药物外，对受累部位予以按摩和超声有一定的益处；慢性软组织损害的治疗除药物、理疗外，中国特有的推拿按摩、针灸、手法及银质针松解术在治疗慢性软组织损伤中发挥了重要作用。结论：纤维肌痛综合征可基本覆盖肌筋膜疼痛综合征概念，而慢性软组织损害的学说与纤维肌痛综合征、肌筋膜疼痛综合征的概念相比在诊断、治疗方面更完善，更具有临床指导意义，慢性软组织损害的学说是先进而准确的。     

肌筋膜触发点疼痛特征的要点分析

介绍肌筋膜触发点疼痛的病理和临床特点及怎样理解其诊断和治疗方法。肌筋膜触发点是受累骨骼肌上能够激惹疼痛的局限小区,挤压时疼痛和拉紧的带,引起牵涉痛和交感现象。静息下运动终板神经末梢处乙酰胆碱浓度增高,引起肌后连接持续去极化和持续性肌节缩短和收缩结节。慢性持续肌节缩短增加局部能量的消耗和血循环的减少,神经血管反应物质释放,致敏传入神经引起触发点疼痛。触发点诊断常依赖病理生理学的诊断标准。触发点治疗的可能原则是对受累肌的牵张,其次是想法刺激或破坏触发点。常用的方法有肌疗法、肌肉牵张和冷喷雾疗法、针刺法加肌肉牵张法、肉毒素注射加肌肉牵张法。同时,常需要辅以补充各种维生素和改善周围循环和提高免疫功能的药物。     

肌筋膜触发点疼痛特征的要点分析

介绍肌筋膜触发点疼痛的病理和临床特点及怎样理解其诊断和治疗方法。肌筋膜触发点是受累骨骼肌上能够激惹疼痛的局限小区，挤压时疼痛和拉紧的带，引起牵涉痛和交感现象。静息下运动终板神经末梢处乙酰胆碱浓度增高，引起肌后连接持续去极化和持续性肌节缩短和收缩结节。慢性持续肌节缩短增加局部能量的消耗和血循环的减少，神经血管反应物质释放，致敏传入神经引起触发点疼痛。触发点诊断常依赖病理生理学的诊断标准。触发点治疗的可能原则是对受累肌的牵张，其次是想法刺激或破坏触发点。常用的方法有肌疗法、肌肉牵张和冷喷雾疗法、针刺法加肌肉牵张法、肉毒素注射加肌肉牵张法。同时，常需要辅以补充各种维生素和改善周围循环和提高免疫功能的药物。     

Endplate potentials are common to midfiber myofacial trigger points

OBJECTIVES: To compare the prevalence of motor endplate potentials (noise and spikes) in active central myofascial trigger points, endplate zones, and taut bands of skeletal muscle to assess the specificity of endplate potentials to myofascial trigger points. DESIGN: This nonrandomized, unblinded needle examination of myofascial trigger points compares the prevalence of three forms of endplate potentials at one test site and two control sites in 11 muscles of 10 subjects. The endplate zone was independently determined electrically. Active central myofascial trigger points were identified by spot tenderness in a palpable taut band of muscle, a local twitch response to snapping palpation, and the subject's recognition of pain elicited by pressure on the tender spot. RESULTS: Endplate noise without spikes occurred in all 11 muscles at trigger-point sites, in four muscles at endplate zone sites outside of trigger points (P = 0.024), and did not occur in taut band sites outside of an endplate zone (P = 0.000034). CONCLUSIONS: Endplate noise was significantly more prevalent in myofascial trigger points than in sites that were outside of a trigger point but still within the endplate zone. Endplate noise seems to be characteristic of, but is not restricted to, the region of a myofascial trigger point.     

Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle

OBJECTIVE: To assess the effect of botulinum toxin type A (BTX-A) on the endplate noise prevalence in rabbit myofascial trigger spots to confirm the role of excessive acetylcholine release on the pathogenesis of myofascial trigger points and to develop an objective indicator of the effectiveness of BTX-A in the treatment of myofascial trigger points. DESIGN: Eighteen adult New Zealand rabbits were divided into three groups that received a single bolus of BTX-A over a myofascial trigger spot region on one side of the biceps femoris muscle. Another 10 rabbits received multiple-point injections in a myofascial trigger spot where endplate noises were found. A control study was performed on the other side of the biceps femoris muscle. The endplate noise prevalence in a myofascial trigger spot region was assessed. RESULTS: It was found that injection of BTX-A reduced the prevalence of endplate noise. No significant differences between a single bolus injection and multiple-point injections were noted, although there was some evidence that multiple-point injections might maintain the endplate noise decreasing effect much longer than a single injection. CONCLUSIONS: This study demonstrated the suppressive effect of BTX-A on endplate noise prevalence in a myofascial trigger spot region. The prevalence of endplate noise in the myofascial trigger point region may be a useful objective indicator for evaluating the therapeutic effectiveness of BTX-A injection to treat myofascial trigger points.     

Traditional Chinese Medicine acupuncture and myofascial trigger needling: The same stimulation points?

BackgroundAcupuncture originates in China, and its effectiveness has been well documented in musculoskeletal pain disorders and other conditions. A widely accepted contemporary medical treatment option for myofascial pain is trigger point needling. Although there are many differences between Traditional Chinese Medicine acupuncture theory and the myofascial trigger point needling framework, it is argued that the stimulation sites for these two needling modalities are similar.DiscussionIn this paper we examined the correspondence between Traditional Chinese Medicine acupoints and myofascial trigger points. Based on this correspondence, we considered exploration of Ah-shi points from four aspects: pain recognition, distal Ah-shi points, Anti-Ah-shi points, and management approaches.Summary: The extent of correspondence is influenced by definitions of acupoints. Myofascial trigger points are significantly correlated to Traditional Chinese Medicine acupoints, including primary channel acupoints, extra acupoints, and Ah-shi points. Considering the correlation between MTrPs and acupoints and the rarely-studied research area of Ah-shi points, it may be reasonable to incorporate research findings of myofascial trigger points into further investigations into Ah-shi points. Correspondence between myofascial trigger points and acupoints enhances contemporary understanding of the mechanism of action of acupuncture, and may serve to facilitate increased integration of acupuncture into clinical management.     

Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome

This article discusses muscle pain concepts in the context of myofascial pain syndrome (MPS) and summarizes microdialysis studies that have surveyed the biochemical basis of this musculoskeletal pain condition. Though MPS is a common type of non-articular pain, its pathophysiology is only beginning to be understood due to its enormous complexity. MPS is characterized by the presence of myofascial trigger points (MTrPs), which are defined as hyperirritable nodules located within a taut band of skeletal muscle. MTrPs may be active (spontaneously painful and symptomatic) or latent (non-spontaneously painful). Painful MTrPs activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. This process is called sensitization. In order to investigate the peripheral factors that influence the sensitization process, a microdialysis technique was developed to quantitatively measure the biochemical milieu of skeletal muscle. Biochemical differences were found between active and latent MTrPs, as well as in comparison with healthy muscle tissue. In this paper we relate the findings of elevated levels of sensitizing substances within painful muscle to the current theoretical framework of muscle pain and MTrP development.     

Electrophysiological characteristics according to activity level of myofascial trigger points

[Purpose] This study compared the differences in electrophysiological characteristics of normal muscles versus muscles with latent or active myofascial trigger points, and identified the neuromuscular physiological characteristics of muscles with active myofascial trigger points, thereby providing a quantitative evaluation of myofascial pain syndrome and clinical foundational data for its diagnosis. [Subjects] Ninety adults in their 20s participated in this study. Subjects were equally divided into three groups: the active myofascial trigger point group, the latent myofascial trigger point group, and the control group. [Methods] Maximum voluntary isometric contraction (MVIC), endurance, median frequency (MDF), and muscle fatigue index were measured in all subjects. [Results] No significant differences in MVIC or endurance were revealed among the three groups. However, the active trigger point group had significantly different MDF and muscle fatigue index compared with the control group. [Conclusion] Given that muscles with active myofascial trigger points had an increased MDF and suffered muscle fatigue more easily, increased recruitment of motor unit action potential of type II fibers was evident. Therefore, electrophysiological analysis of these myofascial trigger points can be applied to evaluate the effect of physical therapy and provide a quantitative diagnosis of myofascial pain syndrome.Key words: Electromyography, Electrophysiological characteristics, Myofascial trigger point     

Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle

OBJECTIVE: Dry needling of myofascial trigger points can relieve myofascial pain if local twitch responses are elicited during needling. Spontaneous electrical activity (SEA) recorded from an active locus in a myofascial trigger point region has been used to assess the myofascial trigger point sensitivity. This study was to investigate the effect of dry needling on SEA. DESIGN: Nine adult New Zealand rabbits were studied. Dry needling with rapid insertion into multiple sites within the myofascial trigger spot region was performed to the biceps femoris muscle to elicit sufficient local twitch responses. Very slow needle insertion with minimal local twitch response elicitation was conducted to the other biceps femoris muscle for the control study. SEA was recorded from 15 different active loci of the myofascial trigger spot before and immediately after treatment for both sides. The raw data of 1-sec SEA were rectified and integrated to calculate the average integrated value of SEA. RESULTS: Seven of nine rabbits demonstrated significantly lower normalized average integrated value of SEA in the treatment side compared with the control side (P < 0.05). The results of two-way analysis of variance show that the mean of the normalized average integrated value of SEA in the treatment group (0.565 +/- 0.113) is significantly (P < 0.05) lower than that of the control (0.983 +/- 0.121). CONCLUSIONS: Dry needling of the myofascial trigger spot is effective in diminishing SEA if local twitch responses are elicited. The local twitch response elicitation, other than trauma effects of needling, seems to be the primary inhibitory factor on SEA during dry needling.     

Analysis of chronic myofascial pain in the upper trapezius muscle of breast cancer survivors and women with neck pain

Myofascial trigger points are present in dysfunctioning muscles and are associated with several diseases. However, the scientific literature has not established whether myofascial trigger points of differing etiologies have the same clinical characteristics. Thus, the objective of the present study was to compare the intensity of myofascial pain, catastrophizing, and the pressure pain threshold at myofascial trigger points among breast cancer survivors and women with neck pain. This was a cross-sectional study that included women over 18 years old complaining of myofascial pain in the upper trapezius muscle region for more than 90 days, equally divided into breast cancer survivors (n = 30) and those with neck pain (n = 30). For inclusion, the presence of a bilateral, active, and centrally located trigger point with mean distance from C7 to acromion in the upper trapezius was mandatory. The measures of assessment were: pain intensity, catastrophizing, and the pressure pain threshold at the myofascial trigger points. A significant difference was observed only when comparing pain intensity (p < 0.001) between the breast cancer survivors (median score: 8.00 points, first quartile: 7.00 points, third quartile: 8.75 points) and women with neck pain (median score: 2.50 points, first quartile: 2.00 points, third quartile: 4.00 points). No significant difference was found between groups in catastrophizing and pressure pain threshold. The conclusion of this study was that breast cancer survivors have a higher intensity of myofascial pain in the upper trapezius muscle when compared to patients with neck pain, which indicates the need for evaluation and a specific intervention for the myofascial dysfunction of these women.     

Myofacial trigger point

Myofascial trigger points are one of the most common causes of acute and chronic musculoskeletal pain. Contrary to popular belief, myofascial trigger points can be primary, and not just secondary due to other non-muscular pathology. The main criteria, for which the interrater reliability has been established, include the presence of a taut band, a local twitch response, an exquisite tender point within the taut band, and typical referred pain patterns. During the past few years, the actual existence and high prevalence of myofascial trigger points are supported by worldwide research findings. The “energy crisis theory” describes the peripheral pathophysiologic events of myofascial trigger points. In most cases myofascial trigger points can be treated successfully both in acute and chronic pain syndromes. Several treatment options are available including manual therapy, injections, dry needling, and electrotherapeutic modalities. In some cases neuroplastic changes in the spinal dorsal horn and sympathetic-afferent coupling play a role in the development of chronic pain syndromes and complicate the treatment.      

Thermographic imaging of myofascial trigger points: a follow-up study.

Thermographic evaluation was performed on 11 adult volunteers with myofascial trigger points and on 11 asymptomatic controls. Infrared thermography was used to obtain a series of images to compare the sensory referral areas of myofascial trigger points with their thermal referral patterns. A series of images was then taken at, and distal to, the sensory referral area of each trigger point during quantitative compression of the trigger point, and dynamic temperature changes were monitored. Asymmetric thermal patterns were observed at all trigger points in the sensory referral area and distal to the referred area before compression. The thermal referral areas showed a reduction in temperature from precompression levels during compression. When similar but asymptomatic areas were compressed, no significant changes in temperature were noted at distal sites.