Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing.

BACKGROUND: Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident. AIM: The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population. METHODS: This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling. RESULTS: Pain not only had a direct positive impact (B = 0.575; SE = 0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE = 0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE = 0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE = 0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data. CONCLUSION: The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.

Myofascial Findings and Psychopathological Factors in Patients with Chronic Pelvic Pain Syndrome.

OBJECTIVE: Chronic pelvic pain syndrome (CPPS) is a common pain condition with psychosocial and somatic symptoms. Myofascial findings and psychiatric comorbidities are frequent. Therefore, the aim of the study was to analyze myofascial and psychosocial aspects. Furthermore, the study focuses on correlations between these aspects and gender differences in this topic. DESIGN: Cross-sectional study. SETTING: Interdisciplinary outpatient clinic for patients with CPPS at the University Medical Centre Hamburg-Eppendorf, Germany. METHODS: Participants underwent a multimodal diagnostic algorithm including physiotherapeutic assessment and psychotherapeutic evaluation. Those with a positive diagnosis of CPPS were included. Descriptive statistics were used to characterize and analyze the sample. Bivariate correlations were calculated for the association between myofascial findings and psychopathological symptoms. RESULTS: A total of 187 patients (56.7% female, mean age ± SD = 49.06 ± 17.05 years) were included. Women had significantly higher numbers of tender (mean ± SD = 17.53 ± 9.58 vs 13.40 ± 8.79, P = 0.003) and trigger points (mean ± SD = 6.23 ± 6.64 vs 4.09 ± 7.15, P = 0.036). They had also significantly higher values in the PHQ-15 (mean ± SD = 11.51 ± 5.24 vs 9.28 ± 5.49, P = 0.009) and the SF-MPQ (mean ± SD = 17.84 ± 8.95 vs 15.11 ± 7.97, P = 0.041). Several significant correlations between myofascial findings and psychosocial factors exist. CONCLUSIONS: There might be a link between psychosomatic and myofascial aspects in CPPS; thus further studies are needed. Nevertheless, the results stress the urgent need of a multimodal treatment including physiotherapy and psychotherapy in these patients.

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Background: Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose: This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods: The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results: Along with an improvement in the clinical pain intensity (p = 0.001) and sensitivity to experimental pain tests (p = 0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p = 0.04; p = 0.001; p = 0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p = 0.001). Conclusions: The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.

The Role of Stress in the Etiology of Oral Parafunction and Myofascial Pain.

Oral parafunction during waking comprises possible behaviors that can be measured with a comprehensive checklist or behavioral monitoring. Multiple studies lead to largely consistent findings: stressful states can trigger parafunctional episodes that contribute to myofascial pain. However, this simple causal pathway coexists with at least 3 other pathways: anxiety and stress are potent direct contributors to pain, pain results in maladaptive behaviors such as parafunction, and parafunction may be a coping response to potential threat coupled with hypervigilance and somatosensory amplification. Awake parafunction remains an important risk factor for myofascial pain onset and overuse models alone of causation are insufficient.

Depressive symptoms account for differences between self-reported versus polysomnographic assessment of sleep quality in women with myofascial TMD.

Patients with temporomandibular disorder (TMD) report poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI). However, polysomnographic (PSG) studies show meagre evidence of sleep disturbance on standard physiological measures. The present aim was to analyse self-reported sleep quality in TMD as a function of myofascial pain, PSG parameters and depressive symptomatology. PSQI scores from 124 women with myofascial TMD and 46 matched controls were hierarchically regressed onto TMD presence, ratings of pain intensity and pain-related disability, in-laboratory PSG variables and depressive symptoms (Symptoms Checklist-90). Relative to controls, TMD cases had higher PSQI scores, representing poorer subjective sleep and more depressive symptoms (both P < 0·001). Higher PSQI scores were strongly predicted by more depressive symptoms (P < 0·001, R2 = 26%). Of 19 PSG variables, two had modest contributions to higher PSQI scores: longer rapid eye movement latency in TMD cases (P = 0·01, R2 = 3%) and more awakenings in all participants (P = 0·03, R2 = 2%). After accounting for these factors, TMD presence and pain ratings were not significantly related to PSQI scores. These results show that reported poor sleep quality in TMD is better explained by depressive symptoms than by PSG-assessed sleep disturbances or myofascial pain. As TMD cases lacked typical PSG features of clinical depression, the results suggest a negative cognitive bias in TMD and caution against interpreting self-report sleep measures as accurate indicators of PSG sleep disturbance. Future investigations should take account of depressive symptomatology when interpreting reports of poor sleep.

A self-determination theory-based self-myofascial release program in older adults with myofascial trigger points in the neck and back: A pilot study.

PURPOSE: To examine the effectiveness and adherence to a self-determination theory (SDT)-based self-myofascial release (SMR) program in older adults with myofascial trigger points (MTrPs), and to investigate the factors that influence participant behavioral change while conducting the program in a home setting. METHODS: An explanatory mixed-method design was used to evaluate a 12-week SDT-based SMR program, including a 4-week group-based education and practice (EP) phase and an 8-week home-based self-management (SM) phase. Pain intensity on palpation and sensitivity to pain were assessed at baseline and the post EP and post SM phase. Focus group interviews were conducted at the post SM phase. FINDINGS: Fifteen participants completed the study. Pain intensity and sensitivity to pain significantly improved at the post SM phase compared with the baseline. Adherence increased during the SM phase compared with that during the EP phase. Four main themes emerged as factors that influenced participant behavioral change: 1) "awareness of the effectiveness"; 2) "a sense of duty to perform the exercise"; 3) "obedience to expert instruction"; and 4) "lack of friendship." CONCLUSIONS: These results support the effectiveness of an SDT-based SMR program for the treatment of MTrPs and in motivating older adults to participate in the program.

Comparision of two different dry-needling techniques in the treatment of myofascial pain syndrome.

OBJECTIVES: To compare the efficacy of two different dry needling (DN) techniques (deep dry needling & peppering) in myofascial pain syndrome (MPS). METHODS: Seventy-two patients, who were diagnosed as MPS at our outpatient clinic were randomly assigned into two groups as deep dry needling (DDN) and peppering. All patients were evaluated four times as: before the treatment and 1-5-12 weeks after the completion of treatment protocol. In each evaluation, Visual analogue scale (VAS), Nottingham extended activities of daily living scale (NEADLS), Beck depression inventory (BDI) scores were recorded. Additionally, all patients were evaluated for the pain felt during the procedure and side effect profile. RESULTS: Twenty-six patients from DDN group and twenty-eight patients from peppering group accomplished the follow-up period. Both DDN and peppering seem to be effective for relieving pain and depressive symptoms and improving functionality compared to baseline when evaluated on the 1st, 5th and 12th weeks. On the other hand the intergroup analyses showed no significant differences between DDN and peppering groups. The only significant difference between the groups is the lesser pain felt during the procedure in the DDN group. CONCLUSION: Both DDN and peppering are effective in MPS and the effects last up to 12 weeks. Also the adverse event profiles of the two techniques are similar. On the other hand, DDN is a painless procedure.

Change in Health-Related Quality-of-Life at Group and Individual Levels Over Time in Patients Treated for Chronic Myofascial Neck Pain.

BACKGROUND: This study evaluated change in health-related quality of life at the group and individual levels in a consecutive series of patients with chronic myofascial neck pain. METHODS: Fifty patients with chronic neck pain self-administered the Short Form-36 Version 2 (SF-36 v2) before treatment and 6 weeks later. Internal consistency reliability was estimated for the 8 scale scores and Mosier's formula was used to estimate reliability of the physical and mental health composite scores. Significance of group-level change was estimated using within-group t statistics. Significance of individual change was evaluated by reliable change index. RESULTS: Statistically significant ( P < .05) group mean improvement over time was found for all SF-36 scores. At the individual level, 20% of the possible changes were statistically significant (17% improvement, 3% decline). CONCLUSIONS: Estimating the significance of individual change in health-related quality of life adds important information in comparing different treatment modalities for chronic myofascial neck pain.

Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach.

BACKGROUND: This study comprehensively evaluated a myofascial triggerpoint release (MTR) technique for shoulder pain. METHODS: Twenty-three (from an initial sample of 25) patients experiencing shoulder pain received MTR, in four 10-min sessions over a period of 2 weeks, applied exclusively on the more painful shoulder, with assessments being recorded both before and after treatment (and for pain at 1 and 13 months). Measures of stiffness and elasticity were collected to monitor the process of therapy, while subjective measures of pain and objective measures of pressure pain thresholds tracked primary outcomes. Secondary outcomes focused on suffering, stress, and quality of life. RESULTS: A statistically significant decrease in stiffness and increase in elasticity was observed post intervention for the treated side only, while pressure pain thresholds improved on the untreated side as well. Reports of pain significantly decreased after treatment, with gains being maintained at 1 and 13 months following treatment. Levels of suffering, stress, and quality of life revealed statistically significant improvement as well. CONCLUSIONS: MTR resulted in clinically significant improvements in the primary measures of pain, objective mechanical tissue properties, and secondary measures in patients with chronic shoulder pain.

Pretreatment anxiety and pain acceptance are associated with response to trigger point injection therapy for chronic myofascial pain.

BACKGROUND AND AIM: This study examined the psychosocial profile of patients who responded or did not respond to trigger point injection therapy for chronic myofascial pain. METHODS: Seventy one patients with a diagnosis of chronic myofascial pain of the paraspinous muscles completed a pretreatment questionnaire measuring demographic and social factors, and validated scales to assess pain intensity, pain interference (physical and emotional), and defined psychological characteristics (pain catastrophizing, pain acceptance, pain self-efficacy, mood and anxiety). Trigger point injection therapy of the affected areas of myofascial pain was performed and follow-up was conducted by telephone at one week (n = 65) and one month (n = 63) post intervention to assess treatment outcome (pain intensity and pain-related physical interference). RESULTS: At one week follow-up and one-month follow-up, using pain-related physical interference as the outcome measure, we found that those who responded well to treatment were characterized by a lower level of pretreatment anxiety and a higher level of pain acceptance, with anxiety being the strongest predictor. CONCLUSION: These results suggest that responses to interventional pain management in chronic myofascial paraspinous pain may be influenced by psychological characteristics, especially pretreatment anxiety.

Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study.

OBJECTIVES: Myofascial pain syndrome (MPS) is a complex pain syndrome characterized with trigger points (TP) in skeletal muscles. We aimed to assess the efficacy of ultrasound (US) therapy, which is one of the main devices used in physical medicine and rehabilitation, for the treatment of TP in MPS. METHODS: Fifty nine patients (49 females, 10 males) with active TP on the upper trapezius fibers were randomized into the treatment (n=30) and the control groups (n=29). The treatment group received conventional US therapy for 6 minutes, on 1.5 Watt/cm2 dose with 1 MHz frequency for 15 days whereas a placebo US therapy was administered to the control group. Prior to the treatment, immediately and 3 months later pain severity during rest and physical activity was assessed with visual analog scale (VAS), TP tenderness was measured with 0-5 scale, pressure pain threshold (PPT) was analyzed with algometer and the depression level was evaluated with Beck's depression questionnaire (BDP) by a clinician blinded to the groups. RESULTS: The mean age of the patients were 37.43±9.07 and 35.83±5.68 years, in the treatment and control groups, respectively. Compared to the pre-treatment values VAS, 0-5 scale and BDP scores decreased (p<0.01) along with an increase in PPT (p<0.01) in both groups at the follow-up visits. 0-5 scales and BDP scores were significantly lower and PPT was significantly higher in the treatment group, compared to the control group (p<0.001). CONCLUSION: Our results revealed that US treatment is effective on MPS.

[Treatment of myofascial lumbar dorsal pain. Effective clinical diagnostics and therapy]. / Die Behandlung myofaszialer lumbaler Rückenschmerzen. Effektive Diagnostik und Therapie.

BACKROUND: Lumbar dorsal pain is a problem that must be taken seriously and is part of many people's everyday lives. Not only does it cause high costs for the health system, it also frequently leads to inability to work. The significance of the myofascial system is still not taken seriously enough in therapy and clinical diagnostics, when treating dorsal pain. In the following article, the effectiveness of specifically targeted therapy for myofascial pain is evaluated. METHODS: Included in the study were 44 patients referred for lumbar dorsal treatment-resistant pain to a practice specializing in pain therapy. Therapy focused on treatment of the affected muscle area with physiotherapy and the additional techniques of infiltrating trigger points, neural therapy, and general relaxation exercises. Medication was optimized according to the specific guidelines for the condition. The effect of therapy was evaluated using the German pain questionnaire (Deutsche Schmerzfragebogen). RESULTS: After the therapy phase, patients had a significantly lower intensity of pain, anxiety, and depression, as well as an increased quality of life. CONCLUSION: The results indicate that targeted treatment of muscles and fascia in patients with chronic back pain can lead to a reduction of pain symptoms. The consideration of the myofascial systems, particularly in relation to nonspecific back pain, could contribute to improving the treatment of pain and contribute to lowering costs.

Painful connections: densification versus fibrosis of fascia.

Deep fascia has long been considered a source of pain, secondary to nerve pain receptors becoming enmeshed within the pathological changes to which fascia are subject. Densification and fibrosis are among such changes. They can modify the mechanical properties of deep fasciae and damage the function of underlying muscles or organs. Distinguishing between these two different changes in fascia, and understanding the connective tissue matrix within fascia, together with the mechanical forces involved, will make it possible to assign more specific treatment modalities to relieve chronic pain syndromes. This review provides an overall description of deep fasciae and the mechanical properties in order to identify the various alterations that can lead to pain. Diet, exercise, and overuse syndromes are able to modify the viscosity of loose connective tissue within fascia, causing densification, an alteration that is easily reversible. Trauma, surgery, diabetes, and aging alter the fibrous layers of fasciae, leading to fascial fibrosis.

Botulinum toxin type a injections for cervical and shoulder girdle myofascial pain using an enriched protocol design.

BACKGROUND: Myofascial pain syndrome is a regional condition of muscle pain and stiffness and is classically characterized by the presence of trigger points in affected musculature. Botulinum toxin type A (BoNT-A) has been shown to have antinociceptive properties and elicit sustained muscle relaxation, thereby possibly affording even greater relief than traditional strategies. Our goal was to determine whether direct injection of BoNT-A into painful muscle groups is effective for cervical and shoulder girdle myofascial pain. METHODS: An enriched protocol design was used, wherein 114 patients with cervical and shoulder girdle myofascial pain underwent injection of BoNT-A to determine their response to the drug. Fifty-four responders were then enrolled in a 12-week, randomized, double-blind, placebo-controlled trial. Pain scales and quality of life measures were assessed at baseline and at routine follow-up visits until completion of the study after 26 weeks. RESULTS: Injection of BoNT-A into painful muscle groups improved average visual numerical pain scores in subjects who received a second dose of BoNT-A compared to placebo (P = 0.019 [0.26, 2.78]). Subjects who received a second dose of BoNT-A had a reduced number of headaches per week (P = 0.04 [0.07, 4.55]). Brief Pain Inventory interference scores for general activity and sleep were improved (P = 0.046 [0.038, 3.700] and 0.02 [0.37, 4.33], respectively) in those who received a second dose of BoNT-A. CONCLUSION: BoNT-A injected directly into painful muscle groups improves average pain scores and certain aspects of quality of life in patients experiencing severe cervical and shoulder girdle myofascial pain.

An update on botulinum toxin A injections of trigger points for myofascial pain.

Myofascial pain syndrome (MPS) is a common chronic pain condition that is characterized by distinct "trigger points." Despite current treatments with physical therapy, analgesics, anti-depressants and trigger-point injections, myofascial pain remains a challenging chronic pain condition in clinical practice. Botulinum toxin A (BTX-A) can cause prolonged muscle relaxation through inhibition of acetylcholine release. It may offer some advantages over the current treatments for MPS by providing a longer sustained period of pain relief. Despite numerous clinical trials, the efficacy of BTX-A in alleviating MPS is not well-established due to mixed results from recent clinical trials. Active trigger points are associated with referred pain and greatly impact many aspects of activities of daily living, mood, and health status. This review is designed to analyze the clinical trials regarding the efficacy of BTX-A injection of active trigger points as a treatment for MPS. The literature referenced was obtained via a computer search with Google Scholar, Pubmed, Medline and EMbase. Our search terms included "Botulinum toxin," "myofascial pain," "trigger points," "myofascial trigger points," "chronic pain." Additional references were retrieved from the reference list of the reports found via this search. Studies were considered eligible for inclusion if they were double-blinded, randomized, controlled trials evaluating the efficacy of BTX-A injections into trigger points for pain reduction, and if the trigger point selection in the trial included referred pain and/or local twitch response. Open-label studies, case reports, and other non-randomized studies were excluded. Eight trials were found according to the above criteria and are summarized in Table 1. There are well-designed clinical trials to support the efficacy of trigger-point injections with BTX-A for MPS. However, further clinical trials with considerations of minimizing placebo effect, repeated dosing, adequate coverage of trigger points, and using ultrasound confirmation and guidance are required to provide conclusive evidence for BTX-A in the treatment of myofascial pain.

The relationship between cortical excitability and pain catastrophizing in myofascial pain.

UNLABELLED: Pain catastrophizing regularly occurs in chronic pain patients. It has been suggested that pain catastrophizing is a stable, person-based construct. These findings highlight the importance of investigating catastrophizing in conceptualizing specific approaches for pain management. One important area of investigation is the mechanism underlying pain catastrophizing. Therefore, this study explored the relationship between a neurophysiological marker of cortical excitability, as assessed by transcranial magnetic stimulation, and catastrophizing, as assessed by the Brazilian Portuguese Pain Catastrophizing Scale, in patients with chronic myofascial pain syndrome. The Pain Catastrophizing Scale is a robust questionnaire used to examine rumination, magnification and helplessness that are associated with the experience of pain. We include 24 women with myofascial pain syndrome. The Brazilian Portuguese Pain Catastrophizing Scale and cortical excitability were assessed. Functional and behavioral aspects of pain were evaluated with a version of the Profile of Chronic Pain scale and by multiple pain measurements (eg, pain intensity, pressure pain threshold, and other quantitative sensory measurements). Intracortical facilitation was found to be significantly associated with pain catastrophizing (ß = .63, P = .001). Our results did not suggest that these findings were influenced by other factors, such as age or medication use. Furthermore, short intracortical inhibition showed a significant association with pressure pain threshold (ß = .44, P = .04). This study elaborates on previous findings indicating a relationship between cortical excitability and catastrophizing. The present findings suggest that glutamatergic activity may be associated with mechanisms underlying pain catastrophizing; thus, the results highlight the need to further investigate the neurophysiological mechanisms associated with pain and catastrophizing. PERSPECTIVE: This study highlights the relationship between cortical excitability and catastrophizing. Cortical measures may illuminate how catastrophizing responses may be related to neurophysiological mechanisms associated with chronic pain.

[Fibromyalgia syndrome as a psychosomatic disorder - diagnosis and therapy according to current evidence-based guidelines]. / Das Fibromyalgiesyndrom als psychosomatische Erkrankung - empfehlungen Aktueller Evidenzbasierter Leitlinien zu Diagnostik und Therapie.

OBJECTIVES: The classification and therapy of patients with chronic widespread pain without evidence of somatic factors as an explanation is currently a matter of debate. The diagnostic label "fibromyalgia syndrome"(FMS) has been rejected by some representatives of general and psychosomatic medicine. METHODS: A summary is given of the main recommendations from current evidence-based guidelines on FMS and nonspecific/functional/somatoform bodily complaints. RESULTS: The criteria of FMS and of persistent somatoform pain disorder or chronic pain disorder with somatic and psychological factors partly overlap. They include differential clinical characteristics of persons with chronic widespread pain but without sufficiently explaining somatic factors. Not all patients diagnosed with FMS meet the criteria of a persistent somatoform pain disorder. FMS is a functional disorder, in which in most patients psychosocial factors play an important role in both the etiology and course of illness. FMS can be diagnosed by looking at the history of a typical symptom cluster and excluding somatic differential diagnoses (without a tender point examination) using the modified 2010 diagnostic criteria of the American College of Rheumatology. Various levels of severity of FMS can be distinguished from a psychosomatic point of view, ranging from slight (single functional syndrome) to severe (meeting the criteria of multiple functional syndromes) forms of chronic pain disorder with somatic and psychological factors, of persistent somatoform pain disorder or of a somatization disorder. The diagnosis of FMS as a functional syndrome/stress-associated disorder should be explicitly communicated to the patient. A therapy within collaborative care adapted to the severity should be provided. For long-term management, nonpharmacological therapies such as aerobic exercise are recommended. In more severe cases, psychotherapy of comorbid mental disorders should be conducted. CONCLUSIONS: The coordinated recommendations of both guidelines can synthesize general medical, somatic, and psychosocial perspectives, and can promote graduated care of patients diagnosed with FMS.

The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial.

The objective of this study was to test the hypothesis that dry needling is more effective than sham dry needling in the treatment of myofascial pain syndrome (MPS). This was a prospective, double-blinded, randomized-controlled study conducted in an outpatient clinic. Thirty-nine subjects with established myofascial trigger points were randomized into two groups: study group (N = 22) and placebo group (N = 17). Dry needling was applied using acupuncture needles, and sham dry needling was applied in the placebo group. The treatment was composed of six sessions which were performed in 4 weeks; the first four sessions were performed twice a week (for 2 weeks) and the last two, once a week (for 2 weeks). The visual analog scale (VAS) and Short Form-36 (SF-36) were used. When compared with the initial values, VAS scores of the dry needling group following the first and sixth sessions were significantly lower (p = 0.000 and p < 0.000, respectively). When VAS scores were compared between the groups, the first assessment scores were found to be similar, but the second and third assessment scores were found to be significantly lower in the dry needling group (p = 0.034 and p < 0.001, respectively). When SF-36 scores of the groups were compared, both the physical and mental component scores were found to be significantly increased in the dry needling group, whereas only those of vitality scores were found to be increased significantly in the placebo (sham needling) group. The present study shows that the dry needling treatment is effective in relieving the pain and in improving the quality of life of patients with MPS.

Self-reported data on sleep quality and psychologic characteristics in patients with myofascial pain and disc displacement versus asymptomatic controls.

PURPOSE: The aim of this research was to compare the differences between patients with myofascial pain and disc displacement and asymptomatic individuals based on aspects of psychologic status and sleep quality. MATERIALS AND METHODS: One hundred thirty patients (81 women, 49 men; mean ages: 30.0 and 31.0 years, respectively) with temporomandibular disorder were selected, and 64 control subjects (32 women, 32 men; mean ages: 27.2 and 27.5 years, respectively) were included in the investigation over a period of 1 year. Clinical diagnosis of 65 patients with myofascial pain and 65 patients with disc displacement with or without limitation and joint pain was determined according to the Research Diagnostic Criteria for Temporomandibular Disorders. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Psychologic status was assessed using Symptom Checklist-90-Revised (SCL-90-R). Chi-square, Kolmogorov-Smirnov, one-way analysis of variance, and Tukey Honestly Significant Difference post hoc multiple comparison or Tamhane T2 tests were used for statistical analysis. RESULTS: There was a significant difference between patients with myofascial pain and disc displacement regarding somatization and paranoid ideation. No statistically significant difference was found between patients with disc displacements and controls in all dimensions of the SCL-90-R. Total score for the PSQI was statistically significantly different between patients with myofascial pain and controls; no significant differences were found between patients with disc displacement and those with myofascial pain or controls regarding the PSQI. CONCLUSION: To manage patients with myofascial pain, psychologic assessments including sleep quality should be considered.