腰臀肌筋膜触发点疼痛和其下肢牵涉痛的诊断与治疗

目的:探讨腰臀肌触发点疼痛和其腿部牵涉痛的特征,观察以反复针刺为主,受累腰臀肌牵张为辅的治疗效果。方法:研究对象为114例不同腰臀肌筋膜触发点疼痛的病例,根据诊断对这些患者以湿针刺触发点和对不同受累肌牵张疗法进行治疗。针刺触发点后,教患者在家做自我受累肌牵张和随访,并根据疼痛的程度、并发症状和体征设计和定义评分标准,对治疗前后自拟疼痛评分。本文重点描述大部分腰臀肌触发点位置和它们特定牵涉痛的范围;同时也重点描述各腰臀肌的自我牵张法和湿针刺触发点方法。结果:治疗前为4.6±1.1分,治疗后(3—6个月)为1.5±1.2分,治疗后的疼痛评分显著低于治疗前评分(P<0.001)。结论:本法对伴有腿部牵涉痛的腰臀肌触发点疼痛治疗有效,并且方便易行。     

牵涉膝关节周围疼痛的下肢肌疼痛触发点诊断和治疗的要点分析

目的观察引起膝关节周围疼痛的下肢肌疼痛触发点特征和以反复针刺为主,受累下肢肌牵张为辅的治疗效果。方法120例不同膝关节位置疼痛的病例,诊断为不同股部和小腿肌疼痛触发点引起的膝关节牵涉痛。对这些患者以湿针刺触发点和对不同受累肌牵张疗法进行治疗。针刺触发点后,教患者在家中做自我受累肌牵张锻炼,并根据疼痛的程度、并发症状和体征,设计和定义评分标准,对治疗前后做自拟疼痛评分。本文重点描述大部分股部和小腿部肌触发点的位置和特定牵涉痛的范围;同时也重点描述这些肌肉的自我牵张法和湿针刺触发点方法。结果治疗前评分为（4．9±1．5）分,治疗后3～6个月随访为（1．3±0．5）分,治疗后的疼痛评分显著低于治疗前评分（P〈0．001）。结论许多膝关节疼痛常常是股部和小腿部肌疼痛触发点的牵涉痛,只要有效地对这些肌触发点疼痛进行治疗,可以有效的控制膝关节疼痛,减少患者的担忧和避免不必要的膝关节内手术。     

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。     

应用腰方肌筋膜触发点疼痛理论综合治疗腰腿痛:68例分析

目的:观察牵张和药物综合治疗改善腰方肌筋膜触发点疼痛患者症状的效果。方法:选自 2003-03/2004-01云南省玉溪市中医院民族科收治的腰方肌触发点疼痛患者 68例,随机分成两组,治疗组 35例,应用手法压榨和牵张受累肌肉,牵张前注射当归注射液于触发点处镇痛,同时给予改善周围循环的药物如三七、复方丹参片及少腹逐瘀汤加减口服等综合疗法治疗;对照组 33例,应用牵张前注射 10g/L 利多卡因于触发点处镇痛。两组治疗后教会患者在家做自我牵张疗法并进行随访,对治疗前后的疼痛作自拟评分。结果:治疗组治疗前自拟评分总分为(3.54±1.19)分;治疗后为 分 0 25例,1分 5例,2分 5例;治愈 25例,显效 5例,好转 5例。对照组治疗前自拟评分总分为(3.55±1.08)分;治疗后为 0分 20例,1分 3例,2分 2例,3分 例;治愈 8 20例,显效 3例,好转 2例和无效 8例。两组比较差异有显著性意义(χ 2 =5.5284,P <0.05)。结论:综合疗法治疗腰方肌筋膜触发点疼痛,可以改善疼痛症状,增强肌肉力量,促进炎症吸收。     

肌肉牵张与冷敷对颈部肌筋膜触发点针刺后疼痛的效果

目的 探讨肌肉牵张与冷敷对颈部肌筋膜触发点针刺后疼痛的应用效果。 方法 选取2016年6月-2017年6月行颈肌筋膜触发点针刺治疗后的80例患者为研究对象,采用随机数字表法将其分为实验组及对照组各40例。比较2组疼痛评分及随访3个月内颈肌筋膜疼痛复发情况。 结果 2组疼痛评分在时间效应及组间效应上比较,差异有统计学意义(F_时间=23.703,P<0.001;F_组间=29.395,P<0.001);3个月内实验组颈肌筋膜疼痛复发例数少于对照组(χ²=26.593,P<0.001)。 结论 肌筋膜触发点针刺治疗后进行肌肉牵张加冷敷能够有效地改善患者的疼痛症状,降低颈部肌筋膜疼痛的复发率,提升患者满意度。     

应用腰方肌筋膜触发点疼痛理论综合治疗腰腿痛：68例分析

目的：观察牵张和药物综合治疗改善腰方肌筋膜触发点疼痛患者症状的效果。方法：选自2003-03／2004-01云南省玉溪市中医院民族科收治的腰方肌触发点疼痛患者68例，随机分成两组，治疗组35例，应用手法压榨和牵张受累肌肉，牵张前注射当归注射液于触发点处镇痛，同时给予改善周围循环的药物如三七、复方丹参片及少腹逐瘀汤加减口服等综合疗法治疗；对照组33例，应用牵张前注射10 g／L利多卡因于触发点处镇痛。两组治疗后教会患者在家做自我牵张疗法并进行随访，对治疗前后的疼痛作自拟评分。结果：治疗组治疗前自拟评分总分为(3．54&;#177;1、19)分；治疗后为O分25例，1分5例，2分5例；治愈25例，显效5例，好转5例。对照组治疗前自拟评分总分为(3．55&;#177;1．08)分；治疗后为O分20例，1分3例，2分2例，3分8例；治愈20例，显效3例，好转2例和无效8例。两组比较差异有显著性意义(X^2=5．5284，P＜O．05)。结论：综合疗法治疗腰方肌筋膜触发点疼痛，可以改善疼痛症状，增强肌肉力量，促进炎症吸收。     

肌肉牵张联合冰敷、艾灸对颈肩部肌筋膜疼痛综合征病人治疗效果观察

目的:探讨肌肉牵张联合冰敷、艾灸对颈肩部肌筋膜疼痛综合征病人疼痛、颈部功能及心理焦虑的影响。方法:选取2021年12月—2022年11月在广西某三级甲等医院康复医学科住院的颈肩部肌筋膜疼痛综合征进行针刺治疗的77例病人为研究对象,按照入院的前后顺序分为对照组、冰敷组各26例,冰敷联合艾灸组(联合组)25例。三组病人均给予常规疼痛护理;在此基础上冰敷组给予肌肉牵张训练及冰敷的干预方法,肌肉牵张训练10 min,每天1次,冰敷20 min,每天1次;联合组在冰敷组的基础上联合艾灸,时间为30 min,每天1次。观察针刺治疗前1天,治疗后第1、3、7天的疼痛情况,针刺治疗前和治疗后第7天的颈部功能障碍情况和心理焦虑状况。结果:治疗后第1、3、7天,3组病人视觉模拟评分(VAS)比较差异有统计学意义(P<0.05),3组病人VAS评分在干预因素与时间因素上存在着交互效应(P<0.05);治疗后第7天,经两两比较发现,联合组、冰敷组在颈部残障指数表(NDI)评分、贝克焦虑量表(BAI)评分的改善程度上优于对照组(P<0.05),联合组的改善程度优于冰敷组(P<0.01)。...     

实时剪切波弹性成像对颈肩部肌筋膜疼痛综合征阿是穴针刺疗效的评估

目的探讨实时剪切波弹性成像(SWE)评价颈肩部肌筋膜疼痛综合征(MPS)患者经阿是穴针刺治疗的疗效。方法应用SWE技术定量测量30例颈肩部MPS患者经阿是穴针刺治疗前后斜方肌疼痛触发点的弹性模量值及弹性评分,应用视觉模拟评分(VAS)法评估其主观疼痛强度,分析治疗前VAS评分与杨氏模量值及弹性评分的相关性,以及针刺治疗后VAS评分变化值(?VAS)与杨氏模量变化值(?杨氏模量值)及弹性评分变化值(?弹性评分)的相关性。结果与阿是穴针刺治疗前比较,颈肩部MPS患者针刺治疗后斜方肌疼痛触发点弹性评分及杨氏模量值均明显降低(t=6.34、33.36,均P0.001),VAS评分减低(t=10.02,P0.001)。阿是穴针刺治疗前,颈肩部MPS患者VAS评分与杨氏模量值及弹性评分均呈正相关(r=0.572、0.474,均P0.05);阿是穴针刺治疗后,颈肩部MPS患者?VAS与?杨氏模量值及?弹性评分均呈正相关(r=0.611、0.561,均P0.05)。结论 SWE能客观有效地评估颈肩部MPS患者阿是穴针刺疗效,具有较好的临床应用价值。     

实时剪切波弹性成像对颈肩部肌筋膜疼痛综合征阿是穴针刺疗效评估

目的 探讨实时剪切波弹性成像（SWE）对颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗后的效果评估价值。方法 应用SWE技术定量测量30例颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗前后斜方肌疼痛触发点的弹性模量值及弹性评分,并且测量患者治疗前后的疼痛视觉模拟评分（VAS）。结果 针刺治疗前患者VAS评分与斜方肌MTrPs杨氏模量值及弹性评分均呈明显正相关(r=0.572, P<0.001;r=0.474, P=0.008),经阿是穴针刺治疗后,MPS患者VAS评分较治疗前减低(t=10.02, P<0.001),斜方肌MTrPs超声弹性成像评分 (t=6.34, P<0.001)及杨氏模量值(t=33.36,P<0.001)明显降低,差异均具有统计学意义;经针刺治疗后?VAS、?杨氏模量值与?弹性评分均呈明显正相关(r=0.611, P<0.001;r=0.561, P=0.001)。 结论 实时剪切波弹性成像能客观有效评估颈肩部肌筋膜膜疼痛综合征阿是穴针刺疗效。     

Congruence between health professionals' and patients' pain ratings: a review of the literature

The literature suggests that health professionals have a tendency to underestimate pain when performing clinical assessments. In addition, it appears that the more clinical experience one has, the greater will be the underestimation of pain. Pain assessment is difficult because of the complex interaction between environment, patient and practitioner variables. Although there is a need for further research in this area, there are clinical implications worthy of consideration. Health professionals need to use a variety of valid and reliable measures, use measures of pain behaviour and disability to complement self-report measures and examine how their own biases and values may influence pain judgements.     

Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta‐Analysis

Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population‐based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into “0 to 3 months” and “3 months and above.” Meta‐analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.     

颈肩痛患者颈肩部肌肉的表面肌电图特征

背景：颈肩痛是由颈肩部软组织（主要是肌肉）的慢性劳损所引起的常见临床症状.表面肌电图是一种新型、无创的肌肉活动检查手段,能测量肌肉的活动和功能.目的：评价颈肩疼痛患者颈肩部肌肉功能,为表面肌电图的应用和颈肩疼痛患者合理防治与康复提供理论依据.方法：应用表面肌电图对32例单侧颈肩疼痛的办公室工作人员在站立下,进行低头、头后伸、双手上举时颈竖脊肌、斜方肌上支的表面肌电测试.在测试前,对患者的颈肩疼痛进行目测类比评分.然后根据收集的数据,比较受试者颈肩部疼痛侧与非疼痛侧测试肌肉的肌电活动.结果与结论：测试前,受试者颈肩疼痛目测类比评分（平均分）为5.03分;受试者在低头、头后伸、双手上举过程中,其疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号较非疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号弱;疼痛侧颈竖脊肌、斜方肌上支肌电的平均振幅值与非疼痛侧相比差异有显著性意义（P＜0.05）;疼痛侧颈竖脊肌、斜方肌上支肌电的平均频率斜率值与非疼痛侧相比差异无显著性意义（P＞0.05）.提示颈肩疼痛患者疼痛侧的颈肩肌肉的活动能力下降,长期坐位作业的办公室人员要定时进行颈肩部肌肉锻炼.     

Pain behaviors in infants and toddlers

The purposes of this qualitative study were to describe behaviors of infants and toddlers when in acute pain and to describe changes in those behaviors across the 3-yr span. With the use of naturalistic observation, 32 children, birth to 36 mo of age, were observed following surgery, fractures, or burns. Purposeful sampling of children, who were inpatients of a private midwestern hospital, was used. Data sources included child observations, parent interviews, and patient records. The research method used was grounded theory. Three pain behavior categories were developed, and characteristics of each category were identified. Pain categories included motor movement, communication, and facial expression. Theoretic implications were proposed. It is concluded that predictable changes in pain behaviors occur within infancy and toddlerhood. A matrix of pain behavior is presented.     

癌症患者物理治疗前后疼痛强度等级和记忆力及其影响的研究

目的探讨临床疼痛强度的等级和记忆力及影响范围、目前疼痛强度增加的影响因素。方法32例癌症患者在社区医疗中心接受一段时间物理治疗之前和之后出现因运动而导致疼痛或使疼痛加重,记录其疼痛强度和影响,同时记录前3d普通和最高、最低疼痛强度和疼痛影响,随机记录理疗前后的这些等级。结果理疗能够增加强度等级(P<0.01),但不增加疼痛所引起的不适(P<0.05)。结论疼痛强度与疼痛影响无相关性。所以患者对既往疼痛强度和影响的记忆力均与目前疼痛强度和疼痛影响有显著相关性(P<0.01)。记忆力与目前疼痛水平相关。     

Using mode and maximum values from the Numeric Rating Scale when evaluating postoperative pain management and recovery

Aims and objectives. To (1) examine the clinical applicability of compiled mode and maximum values from the Numeric Rating Scale (NRS) by comparing the correspondence between patient perceptions of pain and pain values from monitoring records, as well as (2) to study the relationship between mode and maximum values and self‐assessed ability for early postoperative recovery. Background. Documentation of pain remains a problem despite recommendations of quality improvements. To examine the correlation between patient perceptions and documented pain therefore becomes important. Few have studied how pain affects recovery. Design. A quantitative cross‐sectional design was used in which 157 postoperative patients answered a questionnaire on pain intensity and recovery. A parallel examination of pain in monitoring records was conducted. Results. A total of 57% had a mode value calculated from records between 0 and 3 on postoperative day 1 and 69% on day 2. A maximum value between 4 and 10 was found in monitoring records for 73% on day 1 and for 67% on day 2. The correspondence between mode value from monitoring records and the patients’ retrospective perceptions was 88% for NRS 0–3 and 92% between maximum value and NRS 4–10. The correlation between documented pain and retrospectively identified pain for mode value of the NRS in all (0–10) was rather weak (r = 0·37), while maximum value had a stronger correlation (r = 0·53). Conclusion. Mode and maximum values could be used as outcome measures when evaluating postoperative pain. Pain affects recovery negatively, but more research is needed to strengthen the evidence for the use and clarify the link between pain and recovery. Relevance to clinical practice. International organisations emphasise the importance of improving pain assessment. Mode and maximum values are easy to compile for nurses and can, together with assessments of how experienced pain levels affect postoperative recovery, improve treatment of postoperative pain.