Relationship between myofascial pain and facial types: an observational study / Relação entre dor miofascial e tipos faciais: um estudo observacional

Temporomandibular disorder (TMD) is a term that covers a number of clinical problems involving the masticatory muscles, TMJ and all associated structures leading to signs and symptoms such as jaw pain, otalgia, headaches and limitation of function. In this context, TMD has been related to facial type and there are three distinct facial types (euryprosopic, mesoprosopic, and leptoprosopic). Objective: The aim of this study was to investigate the correlation between myofascial pain and facial types classified by the RDC/TMD Axis I. Material and Methods: this study was composed of 64 women aged between 12 and 49 years, using data obtained from two institutions. We used the anthropometric methodology, which meets the criteria of simplicity and reliability. We also applied the Brugsh Facial Index. The individuals were classified as euryprosopic (51.56%), mesoprosopic (12.50%) and leptoprosopic (35.94%), without statistical significance among the groups (p=0,3492). Results: there is no statistical difference between the age groups (p=0.2976) and no association between facial type and age range. Conclusion: this study found that there was a correlation between myofascial pain and facial types, with the predominance of euryprosopic faced women aged between 20 and 29 years when compared with other facial types and other age groups. (AU)

A Disfunção Temporomandibular é um termo que cobre uma série de problemas clínicos envolvendo os músculos mastigatórios, ATM e todas as estruturas associadas que levam a sinais e sintomas como dor na mandíbula, otalgia, dores de cabeça e limitação de função. Nesse contexto, a DTM tem sido relacionada ao tipo facial que são classificados em três tipos distintos (euryprosopo, mesoprosopo e leptoprosopo). Objetivo: O objetivo deste estudo foi investigar a correlação entre a dor miofascial e os tipos faciais classificados pelo RDC/TMD Eixo I. Material e Métodos: este estudo foi composto por 64 mulheres com idade entre 12 e 49 anos, utilizando dados obtidos em duas instituições. Utilizou-se a metodologia antropométrica, que atende aos critérios de simplicidade e de confiabilidade. Também foi utilizado o Índice Facial de Brugsh. Os indivíduos foram classificados em euriprosopo (51,56%), mesoprosopo (12,50%) e leptoprosopo (35, 94%), sem significância estatística entre os grupos (p = 0,3492). Resultados: não houve diferença estatística entre as faixas etárias (p = 0,2976) e nenhuma associação entre tipo facial e faixa etária. Conclusão: este estudo constatou que houve correlação entre dor miofascial e tipos faciais, com predomínio de mulheres euriprosopo com idade entre 20 a 29 anos quando comparadas com outros tipos faciais e outras faixas etárias.(AU)

Abordaje transcervical en el síndrome de Eagle. Reporte de caso clínico / Transcervical Approach in Eagle Syndrome. Clinical Case Report

Resumen El síndrome de Eagle es una enfermedad rara responsable de múltiples síntomas de cabeza y cuello, resultado de un alargamiento del proceso estiloideo u osificación del ligamento estilohioideo comprimiendo estructuras neurovasculares adyacentes, hay dos variantes, el clásico caracterizado principalmente por dolor y disfagia y la variante carotídea distinguido con dolor y en ocasiones isquemia cerebral. Describimos un reporte de caso clínico de un paciente femenino de 45 años, quien experimentaba dolor cervical de lado izquierdo, realizando el protocolo completo de dolor miofascial del Hospital Regional General Ignacio Zaragoza ISSSTE de la Ciudad de México, el estudio de tomografía computada evidenció una elongación de 50mm del proceso estiloideo, confirmando el diagnóstico, enfocando el artículo en la descripción anatómico-quirúrgica.

Abstract Eagle syndrome is a rare disease responsible for multiple head and neck symptoms, resulting from an elongation of the styloid process or ossification of the stylohyoid ligament compressing adjacent neurovascular structures. There are two variants, the classic one characterized mainly by pain and dysphagia and the carotid variant distinguished with pain and sometimes cerebral ischemia. We describe a clinical case report of a 45-year-old female patient, who experienced left cervical pain, performing the complete myofascial pain protocol of the Regional Hospital "General Ignacio Zaragoza" ISSSTE in Mexico City, resulting in a 50mm elongation of the styloid process in the CT scan, confirming the diagnosis, and focusing the article on the anatomical-surgical description.

Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain

SUMMARY OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.

Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey's post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

O modelo de dor inflamatória induzida pela carragenina como estratégia para avaliar a ação de drogas sobre a dor miofascial / The carrageenan-induced inflammatory pain model as a tool to assess the action of drugs on myofascial pain

A dor miofascial orofacial vem sendo tratada com analgésicos, anti-inflamatórios, relaxantes musculares, fisioterapia, laserterapia e placas oclusais. Contudo, muitas vezes, tais condutas falham em amenizar o quadro doloroso, havendo a necessidade de testar outras estratégias de tratamento. Metodologia: Uma opção para avaliação experimental dessas terapias seria o teste de dor induzido pela carragenina, associado ao teste de avaliação do limiar nociceptivo, originalmente desenvolvido para avaliar a ação de drogas nas patas de roedores. Sendo assim, o presente estudo analisou a nocicepção causada pela carragenina em masseteres de ratos, através do teste de Von Frey, correlacionando-a com alterações teciduais produzidas por esta droga. A carragenina foi injetada no músculo masseter de ratos, enquanto o grupo controle recebeu soro fisiológico. O limiar nociceptivo foi mensurado com um analgesímetro digital antes da administração da carragenina e 5 horas, 1, 3 e 7 dias após o seu uso. Decorridos 8 dias da intervenção, os animais foram eutanasiados, sendo seus masseteres encaminhados para processamento histológico e coloração H&E. Resultados: Observou-se uma diminuição do limiar da resposta nociceptiva em todos os períodos no grupo com carragenina, quando comparado com o grupo controle, havendo diferença estatisticamente significante nas 5 horas. A análise histológica do grupo experimental mostrou a presença de espaços perimisial e endomisial alargados e preenchidos por uma matriz com alguns linfócitos, muitos macrófagos e raros mastócitos. Conclusão: Os resultados indicaram que a associação de uma droga inflamatória com o método Von Frey pode ser uma opção para o estudo do efeito de terapias de dor miofascial.

Myofascial orofacial pain has been treated with analgesics, anti-inflammatories, muscle relaxants, physiotherapy, laser therapy and occlusal plaques. However, many times, such behaviors fail to alleviate the painful condition, with the need to test other treatment strategies. Methodology: An option for experimental evaluation of these therapies would be the pain test induced by carrageenan associated with the nociceptive threshold assessment test, originally developed to assess the action of drugs on the rodents' feet. Thus, the present study analyzed the nociception caused by carrageenan in rat masseter using the Von Frey test, correlating it with tissue changes produced by this drug. Carrageenan was injected into the masseter muscle of rats, while the control group received saline. The nociceptive threshold was measured with a digital analgesometer before administration of carrageenan and 5 hours, 1, 3 and 7 days after its use. After 8 days of the intervention, the animals were euthanized, and their masseters were sent for histological processing and H&E staining. Results: There was a decrease in the nociceptive response threshold in all periods in the group treated with carrageenan when compared to the control group, with a statistically significant difference at 5 hours. Histological analysis of the experimental group showed the presence of enlarged perimisial and endomisial spaces, filled by a matrix with some lymphocytes, many macrophages and rare mast cells. Conclusion: Results indicated that the association of an inflammatory drug with the Von Frey method may be an option for studying the effect of therapies on myofascial pain.

Bruxismo nocturno y síndrome de dolor miofascial / Sleep bruxism and myofascial pain syndrome

El bruxismo es un factor iniciador y coadyuvante de alteraciones de la región temporomandibular, entre las que se incluye el síndrome de dolor miofascial. Sin embargo, en los diversos estudios realizados en la literatura científica no hay homogeneidad en los métodos diagnósticos, en la clasificación de bruxismo o en las alteraciones temporomandibulares, lo que no permite asegurar que existe una relación causa-efecto entre el bruxismo y los diferentes desórdenes temporomandibulares. Para intentar aclarar la relación entre el bruxismo y el síndrome de dolor miofascial se realizó una revisión sistemática de la literatura sobre estudios que hayan buscado identificar la asociación entre las dos condiciones. Los estudios que han sugerido una relación causal entre bruxismo nocturno y dolor miofascial han utilizado métodos diagnósticos variables, apoyándose, principalmente, en encuestas de corte transversal, lo cual ha limitado la posibilidad de lograr conclusiones firmes; mientras que aquéllos que usan métodos objetivos, como polisomnografía, no han encontrado una concluyente relación causal (AU)

Bruxism is an initiating and coadjuvant factor of temporomandibular disorders, including myofascial pain syndrome. However, in the various studies conducted in the scientific literature, there is a lack of consistency in diagnostic methods, the classification of bruxism, or temporomandibular disorders, which has prevented to ensure that there are a cause and effect relationship between bruxism and the different temporomandibular disorders. To try to clarify the relationship between bruxism and myofascial pain syndrome, a systematic review of the literature was carried out on studies that have sought an association about these two conditions. Studies that have found a causal relationship between nocturnal bruxism and myofascial pain have used variable diagnostic methods, relying mainly on surveys, which has limited the possibility of reaching firm conclusions; while those who used objective methods, such as polysomnography, have not found a conclusive causal relationship (AU)

Myofascial Pain Syndrome, myofascial trigger points and trigger points in veterinary medicine: a review / Revisão: Síndrome Dolorosa Miofascial, pontos gatilhos miofascial e pontos gatilhos na medicina veterinária

Myofascial Pain Syndrome (MPS) a is a painful condition related to myofascial trigger points (TP) in skeletal muscle. The aim of this study was to perform a literature review on the etiology, pathophysiology, diagnosis and treatment of MPS in veterinary medicine. The research sites used for this purpose were: Scientific Electronic Library, PubMed and Medline. The inclusion criteria for the papers were: must be written in English; published between 1990 and 2018; include the following keywords: myofascial pain syndrome veterinary/dog/canine/cat/feline/horse/equine, trigger points veterinary/dog/canine/cat/feline/horse/equine. Through the review, it was observed that veterinary clinical studies are scarce, and the articles found lack information such as MPS description, incidence and specific treatment techniques in dogs and horses, and no studies in cats were found.(AU)

Síndrome Dolorosa Miofascial (SDM) é uma condição dolorosa relacionada aos pontos gatilhos miofasciais (PG) no músculo esquelético. Este trabalho tem como objetivo realizar uma revisão bibliográfica sobre a etiologia, fisiopatogenia, diagnóstico e tratamento na medicina veterinária. Foram utilizados sites de pesquisas Scientific Electronic Library, Pubmed e Medline. Os critérios de inclusão estabelecidos foram: ser escrito em inglês; no período de 1990 a 2018; ter as palavras chaves para busca: myofascial pain syndrome veterinary/dog/canine/cat/feline/ horse/equine, trigger points veterinary/dog/canine/cat/feline/horse/equine. Após a revisão observa-se que faltam estudos clínicos em medicina veterinária, sendo que os artigos encontrados se limitam à descrição, incidência e técnicas pontuais em cães e equinos, não sendo encontradas referencias em felinos.(AU)

Evaluation of short-term effectiveness of orthopedic manual therapy in signs and symptoms of myofascial pain: a controlled clinical trial / Evaluación de la eficacia a corto plazo de la terapia manual ortopédica en signos y síntomas de dolor miofascial: un ensayo clínico controlado

To evaluate the short-term effectiveness of orthopedic manual therapy (OMT) in signs and symptoms of myofascial pain (MFP) in young adults. Materials and Methods: An experimental controlled clinical study was performed in young adults between 19 and 24 years old. Thirty-one patients with MFP according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were divided into two groups. Group A: Orthopedic Manual Therapy (n=16; 10 females, 6 males; 21.6 ± 1.70 years old), and Group B: Control group (n=15; 10 females, 5 males; 20.9 ± 2.00 years old). The participants of group A were treated for a period of 6 weeks; Six therapeutic interventions were performed. Degree of dysfunction (Helkimo index), pain level (VAS scale), and range of mandibular movements (opening and lateral movements) were taken at baseline (T0) and immediately at post-treatment (T1). The data were analyzed with chi-square test and t-test; p<0.05 was considered significant. Result: After the OMT, there were no significant changes in diagnosis of MFP according to RDC/TMD (p=0.41); however, there was a statistically significant improvement in the Helkimo index (p=0.0083) and the level of pain according to the VAS scale (p=0.0004). Mandibular movements did not show significant differences (p>0.05). Conclusion: This study suggested that a 6-week period of OMT treatment has a clinically significant effect in pain level and degree of dysfunction in patients with MFP. A longer follow-up study is required to better assess the effects of manual therapy.

Evaluar la efectividad a corto plazo de la terapia manual ortopédica (TMO) en los signos y síntomas del dolor miofascial (DMF) en adultos jóvenes. Materiales and Métodos: Se realizó un estudio clínico controlado en adultos jóvenes entre 19 y 24 años. Treinta y un pacientes fueron diagnosticados con DMF según los criterios de diagnóstico para trastornos tempo-romandibulares (CDI/TTM) y se dividieron en dos grupos. Grupo A: Terapia manual ortopédica (n = 16; 10 mujeres, 6 hombres; 21,6 ± 1,70 años), y Grupo B: grupo de control (n = 15; 10 mujeres, 5 hombres; 20,9 ± 2,00 años). Los participantes del grupo A fueron tratados por un período de 6 semanas. Se realizaron seis intervenciones terapéuticas. El grado de disfunción (índice Helkimo), el nivel de dolor (escala EVA) y el rango de movimientos mandibulares (movimientos de apertura y laterales) se evaluaron al inicio del estudio (T0) e inmediatamente después del tratamiento (T1). Los datos se analizaron con la prueba de chi-cuadrado y la prueba t de student; se consideró significativo cuando p fue menor a 0.05. Resultados: Después de la TMO, no hubo cambios significativos en el diagnóstico de DMF según CDI /TTM (p=0,41); sin embargo, hubo una mejora estadísticamente significativa en el índice Helkimo (p=0.0083) y el nivel de dolor según la escala EVA (p= 0.0004). Los movimientos mandibulares no mostraron diferencias significativas (p>0.05). Conclusión: Este estudio sugirió que un período de 6 semanas de tratamiento con TMO tiene un efecto clínicamente significativo en el nivel de dolor y el grado de disfunción en pacientes con DMF. Se requiere un estudio de largo plazo para evaluar de mejor forma el efecto de la terapia manual ortopédica.

Evaluation of pain intensity of the masticatory muscles after occlusal appliance and combined therapy: a 6-months follow-up pilot study

Masticatory muscle pain (MMP) is a common type of orofacial pain.Occlusal appliance (OA) is contemplated as a first-line conservative approach for chronic MMP, however, integrated biopsychosocial approaches such as counseling and self-care therapies (CSG) are also considered essential. Aim: This pilot study aimed to compare the use of a combined therapy (GSG + OA) and solely OA treatment on pain intensity related to chronic MMP over a 6-month follow-up. Methods:For this, 20 patients diagnosed with chronic MMP using the Diagnostic criteria for temporomandibular disorders (DC/TMD) were divided into 2 groups (n=10) and treated with OA or combined therapy (CoT; OA + CSG). Electromyographic muscle activity (EMG), visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded at baseline, 1, 3 and 6 months after treatment. Data was collected and statistical analysis were applied at a significance level of 5%. Results:Results showed no significant differences at baseline among groups for any assessment. VAS showed that both treatments decreased subjective pain in volunteers over time, but no significant differences among both groups were observed at any evaluation time. For electromyography, CoT and OA presented no significant differences throughout the experiment neither on relaxed muscle position or maximum volunteer contraction. Finally, a significantly higher PPT for CoT was found for all muscles at the last assessment point (p<0.05). Conclusion: These findings suggest that both treatments are effective for the reduction of pain perception (VAS) in patients with chronic MMP. However, the addition of CSG to an OA therapy may be more beneficial for the improvement of tenderness on the same patients, at least in a long-term basis (> 3 months). Notwithstanding, a larger study should be performed to substantiate these findings

Síndromes dolorosos musculotendinosos. revisión de literatura / Musculotendinous painful syndromes. Literature review

Introducción: los síndromes dolorosos musculotendinosos se presentan a nivel de hombro, codo, muñeca, cadera, rodilla, tobillo y pie. Manifiestan una clínica localizada y el tratamiento está compuesto por infiltraciones locales, iontoforesis y en ciertas ocasiones TENS y ultrasonidos. Objetivo: resumir las características de los síndromes dolorosos tendinosos. Desarrollo: los síndromes dolorosos musculotendinosos se manifiestan a escala de hombro, codo, muñeca, cadera, rodilla, tobillo y pie. Se identifican por presentar una clínica localizada y el tratamiento se compone de infiltraciones locales, iontoforesis y en algunos ejemplos TENS y ultrasonidos. Conclusiones: el síndrome de dolor miofascial se concibe como un cuadro de dolor regional manifestado habitualmente en cintura escapular y pélvica. Provoca unos puntos desencadenantes del dolor y contractura muscular. El tratamiento está compuesto por control del dolor, restablecimiento de la fuerza muscular y movilidad(AU)

Introduction: musculotendinous pain syndromes occur at the level of the shoulder, elbow, wrist, hip, knee, ankle and foot. They manifest a localized clinic and the treatment is composed of local infiltrations, iontophoresis and, in some cases, TENS and ultrasound. Objective: to summarize the characteristics of the tendinous pain syndromes. Development: musculotendinous painful syndromes manifest at shoulder, elbow, wrist, hip, knee, ankle and foot scales. They are identified by presenting a localized clinic and the treatment consists of local infiltrations, iontophoresis and, in some cases, TENS and ultrasound. Conclusions: the myofascial pain syndrome is conceived as a regional pain pattern usually manifested in the scapular and pelvic girdle. It provokes some trigger points of pain and muscular contracture. The treatment consists of pain control, restoring muscle strength and mobility(AU)

Capsaicin topical cream (8%) for the treatment of myofascial pain syndrome / Creme tópico de capsaicina (8%) para o tratamento da síndrome da dor miofascial

Abstract Background: Myofascial pain syndrome is a common cause of musculoskeletal pain. The objective of this study was to evaluate the potential analgesic action of 8% capsaicin cream for topical use in patients with myofascial pain syndrome. Methods: Initially, cream formulations of PLA (Placebo) and CPS (Capsaicin 8%) were developed and approved according to the current requirements of the health authority agency. The 40 participating patients were randomly assigned to the PLA and CPS groups in a double-blind fashion. Before the creams were topically administered, according to the allocation group, the local anesthetic was used for a period of 50 minutes directly in the area of interest. The cream was applied to the area of the skin over the trigger point, represented by the area with pain at palpation, in an amount of 10 g for 30 minutes in a circular area of 24 mm diameter. Subsequently, the cream was removed and the skin tolerability parameters were evaluated. The pain was measured before and during the formulation application, as well as at 1 hour, 7 days, 30 days, and 60 days after the procedure, evaluated using a verbal numerical scale (from 0 to 10: with 0 = no pain and 10 = worst pain imaginable). Results: No patient in PLA Group had hyperemia or burning sensation at the site of application, while 85% of patients in CPS Group had hyperemia or burning sensation at 15 minutes. These complaints disappeared 24 hours after the cream was removed. The pain score in CPS Group decreased steadily up to the 60th day of evaluation (p < 0.0001). Conclusion: Application of the formulations did not cause macroscopic acute or chronic skin lesions in patients, and the 8% capsaicin formulation was beneficial and well tolerated.

Resumo Justificativa: A síndrome da dor miofascial é uma causa comum de dor musculoesquelética. O objetivo deste estudo foi avaliar a potencial ação analgésica de 8% do creme de capsaicina para uso tópico em pacientes com síndrome da dor miofascial. Métodos: Inicialmente, as formulações de creme de PLA (Placebo) e CPS (Capsaicina 8%) foram desenvolvidas e aprovadas de acordo com os requisitos atuais da agência de autoridade de saúde. Os 40 pacientes participantes foram distribuídos aleatoriamente e de forma duplo-cega para os grupos PLA e CPS. Antes dos cremes serem administrados topicamente, de acordo com o grupo de alocação, o anestésico local foi usado por um período de 50 minutos diretamente na área de interesse. A administração ocorreu na área da pele sobre o ponto-gatilho, o qual apresentou a área dolorida à palpação, em uma quantidade de 10 g por 30 minutos em área circular com diâmetro de 24 mm. Posteriormente, o creme foi removido e os parâmetros de tolerabilidade à pele foram avaliados. A dor foi medida antes e durante a aplicação da formulação, bem como 1 hora, 7 dias, 30 dias e 60 dias após o procedimento avaliado pela escala numérica verbal (0 a 10, com zero sem dor e dez a pior dor imaginável). Resultados: Nenhum paciente no grupo PLA experimentou hiperemia ou sensação de queimação no local de aplicação do creme, enquanto 85% dos que experimentaram no grupo CPS apresentaram hiperemia ou sensação de queimação 15 minutos. Essas queixas desapareceram 24 horas após a remoção do creme. O escore de dor no grupo CPS diminui de forma sustentada até o 60° dia de avaliação (p < 0,0001). Conclusão: A administração das formulações não causou lesões cutâneas agudas ou crônicas macroscópicas nos pacientes e a formulação de 8% de capsaicina foi benéfica e bem tolerada.

Analgesic effects of a capacitive-resistive monopolar radiofrequency in patients with myofascial chronic neck pain: a pilot randomized controlled trial

SUMMARY BACKGROUND: To date, there is a lack of prior studies on the use of capacitive resistive monopolar radiofrequency (RF) to treat neck pain. The objective of this study was to investigate the immediate effect of capacitive resistive monopolar radiofrequency (RF=448 kHz), in comparison with a placebo, on (1) reducing neck pain intensity at myofascial trigger points (MTrP), (2) decreasing neck disability and (3) improving cervical range of motion (CROM). METHODS: A randomized, double-blind, placebo-controlled trial (NCT02353195) was carried out. Patients with myofascial chronic neck pain (N=24) with active MTrP in one upper trapezius muscle were randomly divided into two groups: a radio-frequency group, which received eight sessions of a monopolar capacitive resistive radio-frequency application over the upper trapezius muscle, and a placebo group (PG), which received eight sessions of placebo radio-frequency over the same muscle. Visual analog scale (VAS), CROM and Neck Disability Index (NDI) were evaluated after the first session and after the eight sessions. RESULTS: The Wilcoxon test for VAS showed statistically significant differences between baseline, immediately after the first session and after eight sessions (p<.001). No significant differences for PG were found. No differences were observed between groups. NDI improved in both groups after eight sessions, but no differences were found between groups (p<.05). ANOVA for time factor showed statistically significant changes in the right cervical rotation in both groups (F=4.112; p=.026) after eight sessions. CONCLUSIONS: Even though there were no differences between both groups, the monopolar capacitive, resistive RF could have a potential effect on pain intensity.

RESUMO ANTECEDENTES: Até a data, há uma falta de estudos prévios para tratar a dor no pescoço por radiofrequência (RF) monopolar capacitiva resistiva. O objetivo deste estudo foi investigar o efeito imediato da radiofrequência monopolar capacitiva resistiva (RF = 448 kHz) versus placebo em (1) redução da intensidade da dor no pescoço em pontos de gatilho miofascial (MTrP), (2) diminuição da incapacidade do pescoço e (3) melhorando a amplitude de movimento cervical (Crom). MÉTODOS: Foi realizado um ensaio randomizado, duplo-cego, controlado por placebo (NCT02353195). Os pacientes com dor no pescoço crônica miofascial (N = 24) com MTrP ativo em um músculo trapézio superior foram divididos aleatoriamente em dois grupos: um grupo de radiofrequência, que recebeu oito sessões com uma aplicação de radiofrequência resistiva capacitiva monopolar sobre o músculo trapézio superior, e um grupo de placebo (PG), que recebeu oito sessões de radiofrequência de placebo no mesmo músculo. A escala analógica visual (VAS), Crom e Índice de incapacidade do pescoço (NDI) foram avaliadas após a primeira sessão e após as oito sessões. RESULTADOS: O teste de Wilcoxon para VAS mostrou diferenças estatisticamente significativas entre a linha de base e imediatamente após a primeira sessão e após oito sessões (p < 0,001). Não foram encontradas diferenças significativas para PG. Não foram observadas diferenças entre os grupos. O NDI melhorou em ambos os grupos após oito sessões, mas não foram encontradas diferenças entre os grupos (p < 0,05). A Anova para o fator de tempo mostrou mudanças estatisticamente significativas na rotação direita cervical em ambos os grupos (F = 4,12; p = 0,26) após oito sessões. CONCLUSÕES: Apesar de não haver diferenças entre os dois grupos, o RF resistivo capacitivo monopolar pode ter um efeito potencial sobre a intensidade da dor.

The myofascial component of the pain in the painful shoulder of the hemiplegic patient

OBJECTIVES: Poststroke shoulder pain occurs very frequently and compromises function and quality of life. Because treatment depends on a multidisciplinary approach, it is desirable to optimize effectiveness. Myofascial pain syndrome is defined by the presence of trigger points that can also be found in spastic stroke patients. The aim of this study was to evaluate the frequency of myofascial pain in the shoulder girdle muscles in patients with poststroke shoulder pain and to document the clinical and functional results obtained with specific treatment for this condition. METHODS: Spastic stroke hemiplegic patients undergoing rehabilitation at the Rehabilitation Center of the Hospital das Clínicas of the Ribeirão Preto Medical School of the University of São Paulo were evaluated regarding the intensity and characteristics of shoulder pain, previous therapeutic interventions, shoulder goniometry and the presence of trigger points. Patients underwent trigger point blockade by intramuscular infiltration of 1% lidocaine. The evaluation and treatment procedures were repeated in the subsequent 3 weeks as long as the pain intensity was greater than 5 on a visual analog scale (VAS). In the fourth week, the evaluation procedures were repeated. Patients who were in a multiprofessional rehabilitation program were instructed to continue the treatment, and the others received complementary therapeutic advice if necessary to initiate it. The evaluations were performed at 0, 1, and 3 weeks and after 4 months. RESULTS: Twenty-one patients (13 men; age=67.8±10.2 years; right hemiparesis: 11) participated in the study, and there was a reduction in pain assessed by VAS from baseline (7.6±2.7) to the first week (5.8±3.6; p<0.05) through the end of the third week (5.2±3.5; p<0.05), but not at the end of four months (6.6±2.9; p=0.11). Good responders had significantly lower pain levels after the third week and presented with a larger range of motion for passive abduction by the end of 4 months. These results demonstrate that the myofascial component of pain should be considered in poststroke shoulder pain and that its treatment may be a pathway for the rapid and long-lasting relief of symptoms. CONCLUSION: Trigger point blockade with lidocaine can reduce pain perception in spastic hemiplegic shoulder in as much as 50% of stroke survivors for four months.

Síndrome de dolor miofascial / The myofascial pain syndrome

The myofascial pain syndrome is an entity that is often associated with many of the prevalent pathologies that generate musculoskeletal pain distributed in the different body segments (upper extremities, spine and lower extremities), and may be responsible for the chronification of problem if it is not considered, diagnosed and managed in a comprehensive and timely manner in conjunction with the underlying pathology. (AU)

Constipation in patients with myofascial pain syndrome as important aspect for clinical and nutritional treatment: A case-control study / Constipação em pacientes com síndrome dolorosa miofascial como importante aspecto para o tratamento clínico e nutricional: um estudo caso-controle

ABSTRACT Objective To identify the occurrence of constipation in patients with myofascial pain syndrome and to correlate these disorders with the clinical and nutritional variables. Methods This report describes a case-control study performed with 98 adults of both sexs, including 49 patients and 49 individuals without pain. The intensity of the reported pain was evaluated using the Pain Visual Analog Scale, which provided a simple and efficient measurement of pain intensity consisting of a 10cm horizontal line with the ends marked "absence of pain" and "worst possible pain". The occurrence of constipation was evaluated using the Rome III criteria. A multivariate linear regression was proposed to investigate risk factors between the frequency of bowel movements per week and independent variables this study. Results The mean ages of the patients and controls were 45.9 (7.6) years and 41.2 (12.2) years, respectively. The intensity of the reported pain showed a mean of 7.3 (1.6) points. The likelihood of exhibiting constipation was 4.5 times higher in the patients than in the controls (p=0.001). The number of stools per week was negatively correlated with the intensity of the reported pain (r=-0.613, p<0.001). The use of benzodiazepines was negatively correlated with the frequency of bowel movements per week, while the use of muscle relaxants appeared to increase the frequency of defecation when combined with the use of benzodiazepines and adjusted for the intake of fiber, water and sexs (p=0.037). Conclusion Constipation was a frequent nosological entity in this patient population and the persistence of a change in intestinal motility showed a significant correlation with the pain intensity and low water intake. The reduction of the number of stools per week seems to be associated with the use of benzodiazepines.

RESUMO Objetivo Identificar a ocorrência de constipação em pacientes com síndrome dolorosa miofascial e correlacionar essa desordem da motilidade intestinal com variáveis clínicas e nutricionais. Métodos Trata-se de um estudo de caso-controle, realizado com 98 indivíduos adultos de ambos os sexos, sendo 49 pacientes e 49 indivíduos sem dor. A intensidade da dor foi avaliada usando a Escala Visual Analógica de Dor, que forneceu uma medida simples e eficaz de intensidade da dor, e consiste em uma linha horizontal de 10cm com as extremidades marcadas "ausência de dor" e "pior dor possível". A ocorrência de constipação foi avaliada utilizando os critérios de Roma III. Uma regressão linear multivariada foi proposta para investigar fatores de risco entre a frequência de dejeções por semana e demais variáveis independentes do estudo. Resultados A média da idade dos pacientes e controles foi de 45,9 anos ± 7,6 DP e 41,2 anos ± 12,2 DP, respectivamente. A intensidade da dor referida mostrou uma média de 7,3 pontos ± 1,6 DP. A probabilidade de exibir a constipação foi 4,5 vezes maior nos pacientes com dor miofascial que nos indivíduos do grupo controle (p=0,001). A frequência de dejeções semanais relatada pelos pacientes apresentou correlação negativa com a intensidade da dor (r=-0,613, p<0,001). O uso de benzodiazepínicos foi negativamente correlacionado com a frequência de dejeções por semana, enquanto que o uso de relaxantes musculares aumentou a frequência de dejeções quando combinado com o uso de benzodiazepínicos, e ajustado pela ingestão de fibras, água e sexo (p=0.037). Conclusão A constipação foi uma entidade nosológica frequente no grupo de pacientes com dor miofascial. A alteração na motilidade intestinal mostrou uma correlação significativa com a intensidade da dor e a baixa ingestão hídrica. A redução do número de dejeções por semana parece estar associada ao uso de benzodiazepínicos.

The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome / Efetividade do kinesio taping na dor e incapacidade na síndrome dolorosa miofascial cervical

Abstract Objective: The aim of this study was to investigate the effectiveness of Kinesio Taping and sham Kinesio Taping on pain, pressure pain threshold, cervical range of motion, and disability in cervical myofascial pain syndrome patients (MPS). Methods: This study was designed as a randomized, double-blind placebo controlled study. Sixty-one patients with MPS were randomly assigned into two groups. Group 1 (n = 31) was treated with Kinesio Taping and group 2 (n = 30) was treated sham taping five times by intervals of 3 days for 15 days. Additionally, all patients were given neck exercise program. Patients were evaluated according to pain, pressure pain threshold, cervical range of motion and disability. Pain was assessed by using Visual Analog Scale, pressure pain threshold was measured by using an algometer, and active cervical range of motion was measured by using goniometry. Disability was assessed with the neck pain disability index disability. Measurements were taken before and after the treatment. Results: At the end of the therapy, there were statistically significant improvements on pain, pressure pain threshold, cervical range of motion, and disability (p < 0.05) in both groups. Also there was a statistical difference between the groups regarding pain, pressure pain threshold, cervical flexion-extension (p < 0.05); except cervical rotation, cervical lateral flexion and disability (p > 0.05). Conclusion: This study shows that Kinesio Taping leads to improvements on pain, pressure pain threshold and cervical range of motion, but not disability in short time. Therefore, Kinesio Taping can be used as an alternative therapy method in the treatment of patients with MPS.

Resumo Objetivo Investigar a eficácia do kinesio taping e do taping placebo sobre a dor, limiar de dor à pressão, amplitude de movimento cervical e incapacidade em pacientes com síndrome dolorosa miofascial (SDM) cervical. Métodos: Ensaio clínico randomizado duplo-cego controlado por placebo. Foram alocados em dois grupos, aleatoriamente, 61 pacientes com SDM. O grupo 1 (n = 31) foi tratado com kinesio taping e o grupo 2 (n = 30) foi tratado com taping placebo cinco vezes em intervalos de três dias, durante 15 dias. Além disso, todos os pacientes foram submetidos a um programa de exercícios para o pescoço. Os pacientes foram avaliados em relação à dor, ao limiar de dor à pressão, à amplitude de movimento cervical e à incapacidade. A dor foi avaliada com a escala visual analógica, o limiar de dor à pressão foi medido com um algômetro e a amplitude de movimento cervical ativa foi mensurada com a goniometria. A incapacidade foi avaliada com o Neck Pain Disability Scale. As mensurações foram feitas antes e depois do tratamento. Resultados: No fim do tratamento, houve melhoria estatisticamente significativa na dor, no limiar de dor à pressão, na amplitude de movimento cervical e na incapacidade (p < 0,05) em ambos os grupos. Também houve uma diferença estatisticamente significativa entre os grupos em relação à dor, ao limiar de dor à pressão e à flexão-extensão cervical (p < 0,05); não houve diferença na rotação cervical, flexão lateral cervical e incapacidade (p > 0,05). Conclusão: O kinesio taping leva à melhoria na dor, no limiar de dor à pressão e na amplitude de movimento cervical, mas não na incapacidade em um curto período. Portanto, o kinesio taping pode ser usado como um método de terapia opcional para o tratamento de pacientes com SDM.

Dry needling the masseter muscle in the treatment of myofascial pain: case reports / Agulhamento a seco no músculo masseter no tratamento da dor miofascial: relato de casos

O objetivo desta pesquisa foi avaliar o tratamento com agulhamento seco (AS) no músculo masseter dos pacientes diagnosticados com dor miofascial quanto à sintomatologia dolorosa e a abertura bucal (AB). Após cálculo amostral, foram selecionados 10 deles, diagnosticados com dor miofascial com ou sem limitação de abertura pelo Eixo I do RDC/TMD, que foram submetidos a seis sessões de AS uma vez por semana. A sintomatologia dolorosa foi determinada semanalmente através da Escala Visual Analógica (EVA), e foi mensurada a AB sem auxílio e sem dor e a AB máxima sem auxílio antes do início do tratamento, e uma semana após o fim do mesmo. Ambas as médias foram analisadas através do ANOVA. Todos eram do gênero feminino e a média de idade foi de 39,2 anos, com 8 (80%) possuindo diagnóstico de dor miofascial com limitação de abertura bucal e 2 (20%) com dor miofascial somente. A abertura sem auxílio e sem dor antes do tratamento era de 31,9 mm e passou para 36,2 mm, e a abertura máxima sem auxílio de 39,6 mm para 43,1 mm. Em ambas, porém, não foi possível encontrar significância estatística (p > 0,05). Quanto ao valor médio semanal da EVA, este passou de 8,3 antes do tratamento, para 2,3 uma semana após o mesmo, com resultados significativos estatísticamente (p < 0,05). No presente estudo, o AS no músculo masseter apresentou-se uma alternativa terapêutica no tratamento da dor miofascial.(AU)

The aim of this study was to evaluate treatment with dry needling (AS) in the masseter muscle of patients diagnosed with myofascial pain as the pain symptoms and the mouth opening (AB). After sample size calculation, we selected 10 patients referred for treatment of temporomandibular disorders (TMD) diagnosed with MP, with or without limited mouth opening according to Axis I of the RDC/TMD, who underwent six DN sessions, once a week. Pain measurement using the Visual Analogue Scale (VAS) and an evaluation of the extent of mouth opening were done. All participants were female and the average age was 39.2 years, with 8 (80%) having a diagnosis of myofascial pain with limited mouth opening and 2 (20%) with only myofascial pain. Maximum unaided opening without pain before treatment was 31.9 mm and went to 36.2 mm, and the maximum unaided opening went from 39.6 mm to 43.1 mm. In both, however, could not find statistical significance (p> 0.05). Regarding the mean weekly VAS value, this went from 8.3 before treatment to 2.3 a week later, with statistically significant results (p < 0.05). In this study, the AS in the masseter muscle presented is a therapeutic alternative in the treatment of myofascial pain.(AU

Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain

ABSTRACT Background Dry needling (DN) and percutaneous electrical nerve stimulation (PENS) are widely used techniques in the treatment of myofascial pain. Objective To investigate the immediate and short-term effects of the combination of DN and PENS compared to DN alone on the upper trapezius muscle. Method This is a 72-hour follow-up single-blinded randomized controlled trial. Sixty-two volunteer patients with chronic myofascial neck pain with active Myofascial Trigger Points (MTrPs) in the upper trapezius muscle were recruited. Randomization was performed, and 31 patients received DN treatment (DN group) and 31 received DN and PENS (DN+PENS group). The primary outcomes were neck disability index (NDI) and visual analog scale for pain for both post-needling soreness (PNS) and neck pain intensity (NPI). Pressure pain threshold (PPT) and cervical range of motion (CROM) were the secondary outcomes. Results We detected between-group differences in NPI and PNS in favor of the DN+PENS group immediately after treatment. No between-group differences in NDI were observed. Conclusion PENS application after dry needling treatment is more effective than dry needling alone for decreasing soreness in the short term and improving neck pain intensity immediately in patients with myofascial chronic neck pain.

Inyección de músculo psoas guiado por radioscopía en paciente con lumbocruralgia: presentación de caso clínico / Flouroscopy-guided psoas muscle injection in a patient with back pain and cruralgia: case report

Se comunica el caso clínico de una paciente con síndrome del músculo psoas iliaco izquierdo de severa intensidad (Escala Verbal Numérica de 8/10), de 9 meses de evolución. Inicialmente tratado como un síndrome radicular de las raíces L2 y L3. Ante el fracaso del tratamiento fisiátrico instituido así como falta de respuesta a las inyecciones espinales, se coordina para realizar inyección con anestésicos locales y corticoides del musculo psoas. Se realizó inyección guiada por radioscopía con una ligera variante de la técnica descrita clásicamente. Se obtuvo un buen resultado, logrando un alivio completo del dolor a los 20 minutos. A la semana, la paciente refería dolor leve (Escala Verbal Numérica de 2/10), manteniendo dicha respuesta al mes de procedimiento. Se discute la importancia del síndrome del Iliopsoas, así como la técnica de inyección guiada por radioscopía.

A case of a patient with left Iliopsoas syndrome of severe intensity (Numerical Verbal Scale 8/10) of 9 months of evolution is communicated. Initially, it was treated as a radicular syndrome of L2 and L3 roots. Given the failure of physiatric treatment and the lack of response to spinal injections, psoas muscle injection with local anesthetics and steroids was scheduled. Fluoroscopy guided injection was preformed with a slight variation of the classical described technique. A good result was obtained achieving complete pain relief within 20 minutes of injection. A week later the patient had mild pain (Numerical Verbal Scale 2/10), maintaining the same level of pain a month afterward. The importance of the Iliopsoas syndrome and the fluoroscopy guided injection technique is discussed.

Injecction of trigger points in the temporal muscles of patients with miofascial syndrome / Infiltrações de pontos-gatilho na musculatura temporal em pacientes com fibromialgia e cefaleia

Objective : The aim was to examine the effect of blocking trigger points in the temporal muscles of patients with masticatory myofascial pain syndrome, fibromyalgia and headache.Method : Seventy patients with one trigger point were randomly divided into 3 groups: injection with saline or anesthetic and non-injected (control).Results : Pain was reduced in 87.71% patients injected with saline and 100% injected with anesthetic. Similar results were obtained for headache frequency. With regard to headache intensity, the injection groups differed from the control group, but not between themselves.Conclusion : Treatment with injection at trigger points decreased facial pain and frequency and intensity of headache. Considering the injected substance there was no difference.

Objetivo : Comparar o efeito terapêutico do bloqueio de pontos-gatilho na musculatura temporal com soro fisiológico e anestésico em pacientes com síndrome da dor miofascial mastigatória, fibromialgia e cefaleia, entre sí e com controles não-infiltrados.Método : Setenta pacientes que apresentaram pelo menos um ponto-gatilho na musculatura temporal foram aleatoriamente divididas em 3 grupos: infiltração com soro fisiológico, infiltração com anestésico e controle (não-infiltradas).Resultados : Houve redução na intensidade de dor na face em 87,71% dos pacientes infiltrados com soro fisiológico e em 100% dos pacientes infiltrados com anestésico, mas não no grupo controle. Houve similaridade dos resultados considerando a frequência da cefaléia. Quanto à intensidade da cefaléia, tanto a infiltração com soro fisiológico, quanto com anestésico foram efetivos e sem diferença significativa entre sí, ao contrário do grupo controle.Conclusões : O tratamento com infiltração diminui a dor na face, bem com a frequência e a intensidade da cefaléia. Quando considerado a substância infiltrada não há diferenças no tratamento.