Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial.

OBJECTIVE: To investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of persistent arm pain after finishing breast cancer treatment. DESIGN: Double-blinded (patient and assessor) randomized controlled trial. SETTING: University Hospitals Leuven, Belgium. PATIENTS: A total of 50 patients with persistent arm pain and myofascial dysfunctions after breast cancer treatment. INTERVENTION: Over three months, all patients received a standard physical therapy program. The intervention group received in addition 12 sessions of myofascial therapy, and the control group received 12 sessions of placebo therapy. MAIN MEASUREMENTS: Main outcome parameters were pain intensity (primary outcome) (maximum visual analogue scale (VAS) (0-100)), prevalence rate of arm pain, pressure hypersensitivity (pressure pain thresholds (kg/cm2) and pain quality (McGill Pain Questionnaire). Measures were taken before and after the intervention and at long term (6 and 12 months follow-up). RESULTS: Patients in the intervention group had a significantly greater decrease in pain intensity compared to the control group (VAS -44/100 vs. -24/100, P = 0.046) with a mean difference in change after three months between groups of 20/100 (95% confidence interval, 0.4 to 39.7). After the intervention, 44% versus 64% of patients still experienced pain in the intervention and control group, respectively ( P = 0.246). No significant differences were found for the other outcomes. CONCLUSION: Myofascial therapy is an effective physical therapy modality to decrease pain intensity at the arm in breast cancer survivors at three months, but no other benefits at that time were found. There were no long-term effects at 12 months either.

A Multimodal Approach for Myofascial Pain Syndrome: A Prospective Study.

OBJECTIVE: The purpose of this study was to analyze pain intensity in patients with myofascial pain syndrome (MPS) following a multimodal rehabilitation protocol. METHODS: A prospective study was carried out following the Template for Intervention Description and Replication criteria. Patients were recruited from the rehabilitation unit of a university hospital in Spain between 2009 and 2013. Patients were included if they had a medical diagnosis of MPS in any of the following regions: cervicobrachial (n = 102), lumbosacral (n = 30), elbow (n = 14), ankle and foot (n = 10), and temporomandibular jaw (n = 1). The multimodal rehabilitation protocol included myofascial trigger point dry needling, spray and stretching, Kinesio taping, eccentric exercise, and patient education. The protocol was applied for 4 weeks (5 sessions) for the active and/or latent myofascial trigger points in each body region. Pain intensity was measured by using the visual analog scale (VAS) immediately before beginning of the study and 1 week after completion of the protocol. RESULTS: The study sample comprised 150 patients (mean ± standard deviation age, 51.5 ± 1.19 years). Statistically significant differences were obtained for reduction in pain intensity (4 ± 2.03; P = .002). Clinically relevant reductions (VAS ≥30 mm; P < .001) were obtained in 78.7% of the interventions. Four treatment sessions reduced the VAS score by 10 mm in 83.55% of the sample. There were no statistically significant differences (P = .064) for reduction in pain intensity in the different body regions. CONCLUSIONS: A multimodal rehabilitation protocol showed clinically relevant differences in the reduction in pain intensity in different body regions in patients with MPS.

Effects of deep cervical flexor training on pressure pain thresholds over myofascial trigger points in patients with chronic neck pain.

OBJECTIVE: The purpose of this study was to assess the effects of a low-load training program for the deep cervical flexors (DCFs) on pain, disability, and pressure pain threshold (PPT) over cervical myofascial trigger points (MTrPs) in patients with chronic neck pain. METHODS: Thirty patients with chronic idiopathic neck pain participated in a 6-week program of specific training for the DCF, which consisted of active craniocervical flexion performed twice per day (10-20 minutes) for the duration of the trial. Perceived pain and disability (Neck Disability Index, 0-50) and PPT over MTrPs of the upper trapezius, levator scapulae, and splenius capitis muscles were measured at the beginning and end of the training period. RESULTS: After completion of training, there was a significant reduction in Neck Disability Index values (before, 18.2 ± 12.1; after, 13.5 ± 10.6; P < .01). However, no significant changes in PPT were observed over the MTrPs. CONCLUSION: Patients performing DCF training for 6 weeks demonstrated reductions in pain and disability but did not show changes in pressure pain sensitivity over MTrPs in the splenius capitis, levator scapulae, or upper trapezius muscles.

The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point.

OBJECTIVE: To compare the effects of pressure release (PR), phonophoresis of hydrocortisone (PhH) 1%, and ultrasonic therapy (UT) in patients with an upper trapezius latent myofascial trigger point (MTP). DESIGN: Repeated-measure design. SETTING: A pain control medical clinic. PARTICIPANTS: Subjects (N=60; mean±SD age, 21.78±1.76y) with a diagnosis of upper trapezius MTP participated in this study. Subjects were randomly divided into 4 groups: PR, PhH, UT, and control (15 in each group). All patients had a latent MTP in the upper trapezius muscle. INTERVENTIONS: PR, PhH, UT. MAIN OUTCOME MEASURES: Subjective pain intensity, pain pressure threshold (PPT), and active cervical lateral flexion range of motion were assessed in 6 sessions. RESULTS: All 3 treatment groups showed decreases in pain and PPT and an increase in cervical lateral flexion range of motion (P<.001) compared with the control group. Both PhH and PR techniques showed more significant therapeutic effects than UT (P<.001). CONCLUSIONS: Our results indicate that all 3 treatments used in this study were effective for treating MTP. According to this study, PhH is suggested as a new method effective for the treatment of MTP.

[The role of therapeutic exercises in the combined treatment and rehabilitation of patients with pain syndrome associated with the dysfunction of temporomandibular joint].

In a group of patients with pain syndrome associated with the dysfunction of temporomandibular joint positive results of combined therapy and rehabilitative treatment including remedial gymnastics persisted significantly longer than in controls (p < 0.01). Results of long-term follow-up confirmed the desirability of rehabilitation based on therapeutic exercises. This approach permits to enhance the effectiveness of therapy and rehabilitation of patients with pain syndrome associated with the dysfunction of temporomandibular joint, reduce the number of the patients' visits for repeated treatment and its total duration during a year.

Muscle pain syndromes.

This article summarizes the evidence for two major clinical syndromes of muscle pain: fibromyalgia and myofascial pain syndrome. The evidence for diagnostic and treatment approaches is reviewed.

Treatment of fibromyalgia, myofascial pain, and related disorders.

Chronic muscle pain is a common complaint among patients who seek care for musculoskeletal disorders. A spectrum of clinical presentations exists, ranging from focal or regional complaints that usually represent myofascial pain syndromes to more wide spread pain that may meet criteria for a diagnosis of fibromyalgia. This article addresses the epidemiology, pathophysiology, and clinical management of myofascial pain syndrome and fibromyalgia. These conditions are challenging to treat and require physiatrists to be aware of the wide range of pharmacologic, rehabilitative,and psychosocial interventions that can be helpful.

Myofascial pain syndrome in farmers--a comprehensive approach to treatment.

There is evidence that chronic pain disorders such as Myofascial Pain Syndrome (MPS), resulting from repeated biomechanical stress caused by ergonomic hazards. e.g. trauma and overuse of the muscles, often occur in agricultural workers. Hypothetically, the neuropathic character of MPS makes the disease unresponsive to the typical analgesics. Accordingly, in this study three trials of treatment in patients with MPS were performed and compared. The first trial (I) was based on rehabilitation, while the second (II) was based on treatment with sertraline, an antidepressive, serotoninergic drug. For third trial (III), rehabilitation plus the above-mentioned administration of sertraline, were applied. Altogether, 49 patients were recruited to the trials. Control group consisted of 23 persons. Response to the treatment was assessed according to the criteria of neuropsychological tests MADRS and BDI. The MPS syndrome was found to be relatively common in Polish farmers and formed 12.7% of all chronic pain syndromes diagnosed in the Institute of Agricultural Medicine during 18 months. All the patients with MPS showed mood disorders in the baseline assessment by the neuropsychological tests. Patients from groups I, II, and III declared improvement after two months of the treatment (77%, 80% and 93% respectively). In the neuropsychological tests, only patients treated with rehabilitation and sertraline (group III) showed statistically significant improvement in comparison with baseline assessment both after one month and after two months of the observation. Thus, rehabilitation and serotoninergic system modification might be a good solution in the management of MPS.