Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome.

Objective: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Methods: Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. Results: There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Conclusion: Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.

Musculoskeletal evaluation of the lower pelvic complex in women with endometriosis: A case-control study.

OBJECTIVE: Use clinical pain measurement tools to investigate and compare the prevalence of pelvic loin disoders in women with and without endometriosis. STUDY DESIGN: Chronic pelvic pain (CPP) associated with endometriosis has diverse origins, including musculoskeletal factors. Musculoskeletal dysfunction in the pelvic region is theorized to result from sustained muscular contraction, triggered by altered visceral stimuli and adoption of antalgic postures, causing secondary damage to muscles, ligaments, and joints. CPP significantly impacts quality of life, relationships, sexuality, and mental health. However, limited data exists on musculoskeletal impacts of endometriosis and CPP. It was made a case-control study at Maternidade Escola Assis Chateaubriand from August 2017 to January 2021. Evaluated 71 women: 41 in endometriosis group (EG) and 30 in control group (CG). Data collection included sociodemographic questionnaires, musculoskeletal physiotherapeutic evaluations, pain mapping, pressure pain thresholds, kinesiophobia, and disability measurements. Statistical analysis was performed using Spearman's Rho test to determine correlations. RESULTS: Mean age of participants was 31 years. EG exhibited lower pain threshold variations in lumbopelvic trigger points than CG (P < .05). Significant muscle flexibility differences between groups were observed; EG had reduced flexibility (P < .05). Most common pain areas were hypogastrium in EG (48.78 %) and left lumbar in CG (30 %). EG had higher kinesiophobia values (P = .009). There was a weak association between kinesiophobia-pressure threshold association observed in CG's lumbar pelvic region. CONCLUSION: Women with Endometriosis and CPP exhibit higher prevalence of musculoskeletal disorder, lower pain thresholds, decreased lumbopelvic muscle range of motion, higher kinesiophobia scores, and increased disability indices with low back pain compared to healthy women.

Nociceptive and histomorphometric evaluation of the effects of ozone therapy on the rat masseter muscle in a carrageenan model of myofascial pain.

OBJECTIVE: This study evaluated the effects of intramuscular ozone therapy on nociception, inflammation, and tissue damage caused by the injection of carrageenan in the masseter muscle of rats. DESIGN: Rat masseter muscles were injected with saline or carrageenan. Seventy-seven adult male rats were divided into six groups: Sal, saline; Car, carrageenan; Ibup + Sal, ibuprofen and saline; Ibup + Car, ibuprofen and carrageenan; O3 + Sal, ozone and saline; and O3 + Car, ozone and carrageenan. The mixture of 5% ozone and 95% oxygen (20 µg/mL) was administered three times in the course of a week. Nociceptive responses in the masseter muscles were measured using a head withdrawal threshold, determined by an electronic von Frey anesthesiometer. The animals were euthanized one or eight days after the carrageenan injection, and the masseters were submitted to histological and histomorphometric analyses. RESULTS: Mechanical allodynia and inflammation levels were reduced in the Ibup + Car group compared to the other groups. Myonecrosis was similar among carrageenan-treated groups. Picrosirius red stained sections showed more collagen fibers and more regenerating myofibers in the O3 + Car group compared to the other groups. Eight days after carrageenan injection, the O3 + Car group showed neutrophils close to the regenerating myofibers. CONCLUSIONS: Intramuscular ozone therapy did not alleviate mechanical allodynia, and it did not protect the masseter muscle against the deleterious effects produced by carrageenan, probably due to the mode of administration of this therapeutic agent.

Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome

Abstract Objective: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Methods: Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. Results: There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Conclusion: Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.

Efficacy of ultrasound-guided infiltration with levobupivacaine and triamcinolone for myofascial pain syndrome of the quadratus lumborum: a retrospective observational study

Abstract Introduction and objectives: Myofascial Pain Syndrome (MPS) of the Quadratus Lumborum muscle (QL) is a frequent cause of chronic low back pain. With this study, we aimed to assess the efficacy of ultrasound-guided infiltration with 0.25% levobupivacaine and 40 mg triamcinolone for MPS of the QL. Methods: Observational and retrospective study of participants submitted to ultrasound-guided infiltration of the QL muscle from January 1, 2015 to June 31, 2019. Pain intensity was assessed using the five-point pain Numeric Rating Scale (NRS): pre-intervention, at 72 hours, 1 month, 3 months and 6 months post-intervention. Additional data collected were demographic characteristics, opioid consumption, and adverse effects. Results: We assessed 90 participants with mean age of 55.2 years. Sixty-eight percent of participants were female. Compared to the pre-intervention assessment, there was an improvement in pain at 72 hours (Mean Difference [MD = 3.085]; 95% CI: 2.200-3.970, p < 0.05), at the 1st month (MD = 2.644; 95% CI: 1.667-3.621, p < 0.05), at the 3rdmonth (MD = 2.017; 95% CI: 0.202-2.729, p < 0.05) and at the 6th month (MD = 1.339; 95% CI 0.378-2.300, p < 0.05), post-intervention. No statistically significant differences in opioid consumption were observed. No adverse effects associated with the technique were reported. Conclusions: Ultrasound-guided infiltration of the QL muscle is a safe and effective procedure for the treatment of pain in the QL MPS within 6 months post-intervention.

Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain / Tratamento da dor miofascial com agulhamento a seco: uma revisão sistemática para as melhores práticas baseadas em evidências em lombalgia

Abstract Background Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling. Objective The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain. Methods A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023. Results A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability. Conclusion Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.

Resumo Antecedentes A síndrome dolorosa miofascial (SDM) é uma fonte comum de dor em centros primários de atenção à saúde ou nas clínicas de dor. Existem muitas formas diferentes de manejar e tratar a SDM, como o exercício físico, a massagem dos pontos de gatilho e o agulhamento a seco. Objetivo O objetivo desta revisão é destacar e discutir o tratamento baseado em evidências da dor miofascial por agulhamento a seco em doentes com dor lombar. Métodos Foi realizada uma revisão sistemática baseada em metanálises (MA) e ensaios clínicos randomizados (RCTs) relacionados ao tratamento da dor miofascial com agulhamento a seco em pacientes com dor lombar, publicados de 2000 a 2023. Resultados Foram identificados, inicialmente, um total de 509 registos. Setenta deles, publicados antes de 2000, foram excluídos. Dos 439 estudos restantes, 92 eram RCTs ou MA, dos quais 86 foram excluídos pelas seguintes razões: não relacionados a tratamento com agulhamento a seco (n = 79), não publicados em inglês (n = 4), duplicados (n = 1), protocolo de projeto (n = 1) e não relacionados com dor miofascial (n = 1). Assim, esta revisão baseou-se em quatro RCTs e duas MA. Esses estudos compararam a eficácia do agulhamento seco com outros tratamentos, tais como acupuntura, agulhamento a seco "sham", terapia com laser, fisioterapia, injeção de anestésico local, compressão isquêmica e educação em neurociências. Apesar de os resultados e o período de seguimento variarem entre os estudos, os estudos demonstram que o agulhamento a seco pode diminuir a intensidade da dor pós-intervenção e a incapacidade relacionada à dor. Conclusão O agulhamento a seco é um procedimento eficaz para o tratamento da dor miofascial em pacientes com dor lombar aguda e crônica. Mais estudos são necessários para esclarecer sua eficácia a longo prazo.

Dry needling in the treatment of myofascial trigger points and painful shoulder dysfunctions: narrative review of the literature / Agulhamento a seco no tratamento de pontos-gatilho miofasciais e disfunções dolorosas do ombro: revisão narrativa da literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Shoulder painful dysfunctions comprises one of the most common musculoskeletal disorders that requires specialized assistance. Dry Needling (DN) became an adjuvant approach with increased use in clinical practice to treat this type of condition. The present study discusses the literature related to DN in the treatment of myofascial trigger points (MTPs), shoulder dysfunctions and associated pain. METHODS: A narrative review through search of articles from 2010 to 2022 written in Portuguese, English or Spanish was performed in Latin American and Caribbean Literature on Health Sciences (LILACS), Health Information from the National Library of Medicine (Medline), Web of Science and the Scientific Electronic Library Online (Scielo) databases using the keywords: <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <"Shoulder Dysfunctions">; <"Disfunções do ombro">. The qualitative analysis was performed determining the level of evidence for DN treatment of MTPs, shoulder dysfunctions and pain. RESULTS: A total of 45 citations were found, 22 citations were excluded because they did not meet the selection criteria. The 23 remaining citations were examined for titles and abstracts and duplicate studies were removed. Finally, 10 articles met the selection criteria and were included in the present review. No articles were excluded after full-text screening. The analysis showed poor advances and knowledge regarding the application of DN for the treatment of pain, painful and general shoulder dysfunctions and MTPs, with few evidence regarding treatment effectiveness, patient's pain scores data, mechanisms of action and statistical analysis. CONCLUSION: There is still a lack of concrete scientific evidence to assess DN effectiveness in modulating pain in patients with MTPs shoulder. More systematic reviews and meta-analyses together with experimental and clinical searches must be conducted to provide stronger evidence of this modality to relief painful symptoms in the shoulder, as well as a treatment of MTPs and general shoulder disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: As disfunções dolorosas de ombro constituem uma das disfunções musculoesqueléticas mais comuns que requerem assistência especializada. O agulhamento a seco (AS) tornou-se uma abordagem adjuvante com uso crescente na prática clínica para tratar esse tipo de condição. O objetivo deste estudo foi rever na literatura aspectos relacionados ao AS no tratamento de pontos-gatilho miofasciais (PGMs), disfunções do ombro e dores associadas. MÉTODOS: Foi realizada uma revisão narrativa através da busca de artigos de 2010 a 2022 escritos em português, inglês ou espanhol, na Literatura Latino-Americana e do Caribe nos bancos de dado Ciências da Saúde (LILACS), Informações em Saúde da Biblioteca Nacional de Medicina (Medline), Web of Science e Scientific Electronic Library Online (Scielo) utilizando as palavras-chave <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <" Disfunções do ombro">. A análise qualitativa foi realizada determinando o nível de evidência para tratamento de AS para o tratamento de PGMs, disfunções do ombro e dor. RESULTADOS: Um total de 45 citações foram encontradas, 22 citações foram excluídas porque não atenderam aos critérios de seleção. As 23 citações restantes foram examinadas para títulos e resumos e estudos duplicados foram removidos. Finalmente, 10 artigos atenderam aos critérios de seleção e foram incluídos na presente revisão. Nenhum artigo foi excluído após a triagem de texto completo. A análise mostrou poucos avanço e conhecimento sobre a aplicação de AS para o tratamento da dor, disfunções dolorosas e gerais do ombro e PGMs, com poucas evidências sobre a eficácia do tratamento, dados dos escores de dor do paciente, mecanismos de ação e análise estatística. CONCLUSÃO: Ainda faltam evidências científicas concretas para avaliar a eficácia do AS na modulação da dor em pacientes com PGMs no ombro. Mais revisões sistemáticas e meta-análises associadas a pesquisas experimentais e clínicas devem ser realizadas para fornecer evidências dessa modalidade promissora para alívio de sintomas dolorosos no ombro, bem como tratamento de PGMs e distúrbios gerais do ombro.

TMD diagnosis: Sensitivity and specificity of the Fonseca Anamnestic Index.

OBJECTIVE: To verify whether the Fonseca Anamnestic Index (FAI) has adequate sensitivity and specificity to be used in the diagnosis of temporomandibular disorder (TMD). METHODS: Two hundred-sixty-five participants with symptoms of TMDs were assessed through the FAI and through the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and then classified as sick or non-sick. The sensitivity, specificity, and predictive values of the FAI in relation to the RDC/TMD were calculated using the STATA 14.0 software. RESULTS: Most of the patients were female, white, without a steady job, and the average age was 37.57 years. The FAI showed high sensitivity (97.21%) but obtained a low specificity (26.00%). The positive and negative predictive values were 84.96% and 68.42%, respectively. CONCLUSION: The FAI is very sensitive in identifying patients who actually have TMD but not very specific in identifying non-TMD patients, being indicated only for initial screening of patients.

Efficacy of ultrasound-guided infiltration with levobupivacaine and triamcinolone for myofascial pain syndrome of the quadratus lumborum: a retrospective observational study.

INTRODUCTION AND OBJECTIVES: Myofascial Pain Syndrome (MPS) of the Quadratus Lumborum muscle (QL) is a frequent cause of chronic low back pain. With this study, we aimed to assess the efficacy of ultrasound-guided infiltration with 0.25% levobupivacaine and 40.ßmg triamcinolone for MPS of the QL. METHODS: Observational and retrospective study of participants submitted to ultrasound-guided infiltration of the QL muscle from January 1, 2015 to June 31, 2019. Pain intensity was assessed using the five-point pain Numeric Rating Scale (NRS): pre-intervention, at 72.ßhours, 1 month, 3 months and 6 months post-intervention. Additional data collected were demographic characteristics, opioid consumption, and adverse effects. RESULTS: We assessed 90 participants with mean age of 55.2 years. Sixty-eight percent of participants were female. Compared to the pre-intervention assessment, there was an improvement in pain at 72.ßhours (Mean Difference [MD.ß=.ß3.085]; 95% CI: 2.200...3.970, p.ß<.ß0.05), at the 1st month (MD.ß=.ß2.644; 95% CI: 1.667...3.621, p.ß<.ß 0.05), at the 3rdmonth (MD.ß=.ß2.017; 95% CI: 0.202...2.729, p.ß<.ß0.05) and at the 6th month (MD.ß=.ß1.339; 95% CI 0.378...2.300, p.ß<.ß0.05), post-intervention. No statistically significant differences in opioid consumption were observed. No adverse effects associated with the technique were reported. CONCLUSIONS: Ultrasound-guided infiltration of the QL muscle is a safe and effective procedure for the treatment of pain in the QL MPS within 6 months post-intervention.

Relationships Between Active Myofascial Trigger Points and Depressive Symptoms and Physical and Clinical Characteristics of Individuals With Shoulder Pain: A Cross-sectional Study.

Objective: The purpose of this study was to evaluate relationships between the presence and number of active myofascial trigger points (MTPs) in shoulder muscles and physical and demographic characteristics, depressive symptoms, pain and function, range of motion (ROM), and strength in individuals with shoulder pain. Methods: Fifty-eight individuals were assessed for physical and demographic characteristics, depressive symptoms, shoulder pain and function, MTPs (upper and lower trapezius, infraspinatus, and supraspinatus), shoulder ROM and strength test, and pain during ROM and strength test. Relationships were verified using point-biserial (rpb), Spearman correlation test, and multiple linear regression analysis. Results: We found weak to moderate (P < .05) correlations between presence and number of MTPs and depressive symptoms (rpb, 0.28-0.32), pain during ROM (rpb, 0.36-0.40), pain during strength test (rpb, 0.29-0.38), and shoulder function (rpb, -0.29 to 0.33) and strength (rpb, 0.26-0.34). MTPs in the infraspinatus contributed 10% (R² = 0.10; P < .05) to depressive symptoms; in the upper and lower trapezius contributed 27% (R² = 0.27; P < .05) to pain during internal rotation ROM; in the upper trapezius contributed 15% (R² = 0.15; P < .01) to pain during internal rotation strength test and 14% to pain during internal rotation ROM (R² = 0.14; P < .01); and in the supraspinatus contributed 17% (R² = 0.17; P < .01) to pain during external rotation ROM. Conclusion: This study found that MTPs in individuals with shoulder pain contributed to depressive symptoms and pain during internal and external rotation ROM and internal rotation strength test.

Primary headache and myofascial pain: a data based study / Cefaleia primária e dor miofascial: um estudo baseado em dados

Aim: This study aimed to evaluate the relationship be-tween the presence of primary headaches and myofascial pain in orofacial patients. Materials and methods: Six hundred and ninety-nine records of patients seeking treatment in a specialized orofacial pain clinic were assessed. The primary diagnostic categories of heada-che and myofascial pain were recorded. Data analyses were carried out by Pearson Chi-square and Logistic Regression, with a p-value of 0.05. Results: Average age of patients was 34.6 years. Females constituted 82.8% of the sample. A relationship between the presence of tension-type headache and myofascial pain was found (p=0.00); however, this relationship was not found for the presence of migraine and myofascial pain (p>0.05). Discussion: Tension-type headaches may be triggered or perpetuated by trigger points in orofacial structures. Conclusion: It can be concluded that trigger points in myofascial pain patients can play an important role in the genesis of tension-type headache.

Objetivo: Este estudo avaliou a relação entre a presença de cefaleia primária e dor miofascial em pacientes orofaciais. Materiais e métodos: Foram avaliados 699 prontuários de pacientes que buscavam atendimento em clínica especiali-zada em dor orofacial. As categorias diagnósticas primárias de cefaleia e dor miofascial foram registradas. A análise dos dados foi realizada pelo Qui-quadrado de Pearson e Regressão Logística, com valor de p=0,05. Resultados: A idade média dos pacientes foi de 34,6 anos. O sexo feminino constituiu 82,8% da amostra. Foi encontrada relação entre a presença de cefaleia do tipo tensional e dor miofascial (p = 0,00); en-tretanto, essa relação não foi encontrada para a presença de enxaqueca e dor miofascial (p> 0,05). Discussão: As cefaleias primárias do tipo tensionais podem ser desencadeadas ou perpetuadas por pontos-gatilhos nas estruturas orofaciais. Conclusão: Pode-se concluir que os pontos-gatilhos em pacientes com dor miofascial podem desempenhar um papel importante na gênese da cefaleia do tipo tensional.

Distribution of anxiety and depression among different subtypes of temporomandibular disorder: A systematic review and meta-analysis.

BACKGROUND: The evidence on the relationship between anxiety and depression and patients with distinct subtypes of temporomandibular disorder (TMD) is uncertain, so a thorough review study on the topic is still missing. OBJECTIVES: This systematic review investigated the distribution and severity of anxiety and depression in patients diagnosed with different subtypes of TMD. METHODS: The study is registered in PROSPERO (CRD42020150562) and it followed the PRISMA 2020 Statement. We searched in PubMed, Web of Science, Scopus and SciELO databases (last search: 12 March 2021) and the reference list from the included studies. Study eligibility criteria consisted of: (i) patients diagnosed with TMD using the Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) instruments; (ii) assessment of anxiety and/or depression with validated psychological instruments and (iii) allocation of patients into a minimum of two distinct TMD subtypes with at least one group having myofascial pain (comparison group). Analyses were carried out using RevMan 5.3.5 statistical package and random- or fixed-effects models (α = 0.05). The quality of evidence was assessed based on review authors' judgment derived from a 10-item appraisal tool for prevalence studies and with the Newcastle-Ottawa scale. RESULTS: Of the 4086 records identified in total, 24 were eligible for inclusion; meta-analyses were conducted with 20 studies. In total, 3678 subjects were included in the review. Most of the studies found that patients with myofascial pain showed similar occurrence and severity of anxiety/depression as compared to other subtypes of TMD, although the average prevalence seemed to be higher among the diagnoses consisting of myofascial pain (muscular TMD). Despite the moderate-to-high heterogeneity, anxiety and depression were more frequently distributed within patients with myofascial pain (p = .001). TMD patients without myofascial pain presented less severe levels of anxiety and depression than patients with only myofascial pain (p ≤ .01). The type of psychological instrument seems to affect the assessment of both anxiety and depression emotional states. CONCLUSION: The findings of this review suggest that patients with myofascial pain are more anxious and more depressed than patients with other subtypes of TMD. IMPLICATIONS: Considering that anxiety and depression are differently distributed within the TMD population, a proper assessment of the psychological state of patients seems essential to offer an adequate treatment and management of each specific subtype of TMD.

Effects of stabilization splints on the signs and symptoms of temporomandibular disorders of muscular origin: A systematic review.

OBJECTIVE: To assess effects of stabilization splints on signs and symptoms of temporomandibular disorders of muscular origin compared to other treatments. METHODS: A search for articles via six electronic databases and gray literature was conducted. The risk of bias was evaluated with the Cochrane Collaboration tool. The Grading of Recommendations Assessment, Development and Evaluation approach determined the certainty of evidence. RESULTS: Ten articles were included. Stabilization splints (n = 160 subjects) were reported to be as effective as other treatments (n = 209 patients) on analyzed outcomes (pressure pain threshold, pain during chewing, mouth opening, spontaneous pain intensity and by palpation). Five studies were judged at low and five at some concerns of risk of bias. The certainty of evidence was very low for all outcomes. CONCLUSION: Positive effect on signs and symptoms of temporomandibular disorders of muscular origin, when managed with stabilization splint, could not be confirmed or refuted.

Comorbidities associated with temporomandibular joint disorders and the role of central sensitization: literature review / Comorbidades associadas aos transtornos da articulação temporomandibular e o papel da sensibilização central: revisão de literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular joint (TMJ) disorder is a musculoskeletal disorder that causes the exacerbation of painful sensation during function and the presence of sensitivity/pain to palpation of the masticatory muscles and/or TMJ. People with pain complaints in the head, neck, shoulder or lower back may present signs and symptoms of TMJ disorders, sharing sleep disturbances, forgetfulness or difficulty concentrating, abdominal pain and differences in fecal consistency. Studies have also shown that TMJ disorders can be associated with emotional distress and multiple comorbidities related to central sensitization (CS). This, in turn, is responsible for producing hypersensitivity to pain, altering the sensory response. The pathophysiology of CS in TMJ disorders is not yet well understood. Thus, it is the scope of this review to synthesize knowledge about the relationship between CS and Temporomandibular Disorder (TMD) and describe the comorbidities most frequently found in this profile of patients. CONTENTS: TMJ disorders do not seem to occur in isolation. Comorbidities such as migraine, tension headache, fatigue, dizziness, tinnitus and allergies have been reported. Hyperexcitability in central nociceptive processing is part of the pathophysiology of TMJ disorder, which could explain the greater sensitivity to pain in other areas of the body in these individuals, characterizing a CS process. CONCLUSION: The most frequently reported comorbid conditions are headache, psychological factors, allergies, irritable bowel syndrome, and sleep disturbances. It is admitted that CS is a neurophysiological phenomenon present in some chronic pain disorders, including TMD.

RESUMO JUSTIFICATIVA E OBJETIVOS: O transtorno da articulação temporomandibular (ATM) apresenta-se como uma desordem musculoesquelética que causa a exacerbação da sensação dolorosa durante a função e a presença de hipersensibilidade/dor à palpação da musculatura mastigatória e/ou da ATM. Pessoas com queixas álgicas na cabeça, pescoço, ombro ou lombar podem apresentar sinais e sintomas de transtornos da ATM, compartilhando de distúrbios do sono, dificuldade de concentração ou esquecimento, dor abdominal e diferenças na consistência fecal. Estudos também têm mostrado que os transtornos da ATM podem estar associados a sofrimento emocional e múltiplas comorbidades relacionadas à sensibilização central (SC). Esta, por sua vez, é responsável por produzir hipersensibilidade à dor, alterando a resposta sensorial. A fisiopatologia da SC nos transtornos da ATM ainda não está bem esclarecida. Desse modo, torna-se escopo dessa revisão sintetizar o conhecimento sobre a relação entre SC e disfunção temporomandibular e descrever as comorbidades mais frequentemente encontradas nesse perfil de pacientes. CONTEÚDO: Os transtornos da ATM parecem não ocorrer isoladamente. Comorbidades como enxaqueca, cefaleia tensional, fadiga, tontura, zumbido e alergias têm sido relatadas. Uma hiperexcitabilidade no processamento nociceptivo central faz parte da fisiopatologia da desordem da ATM, o que poderia explicar a maior sensibilidade à dor em outras áreas do corpo nesses indivíduos, caracterizando um processo de SC. CONCLUSÃO: As condições de comorbidades mais frequentemente relatadas são cefaleias, fatores psicológicos, alergias, síndrome do intestino irritável e distúrbios do sono. Admite-se que a SC é um fenômeno neurofisiológico presente em alguns distúrbios de dor crônica, incluindo as disfunções temporomandibulares.

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.

Treatment of myofascial pain with a rapid laser therapy protocol compared to occlusal splint: A double-blind, randomized clinical trial.

OBJECTIVE: To compare the effect of a rapid low-level laser therapy (LLLT) protocol to Michigan occlusal splint in the treatment of myofascial pain, as well as to evaluate their impact on Oral Health-Related Quality of Life (OHRQoL). METHODS: Thirty participants were randomly allocated into three groups: G1: occlusal splint (n = 11), G2: LLLT (n = 10), and G3: LLLT placebo (n = 9). LLLT and placebo were applied in the points of pain upon palpation. RESULTS: G1 presented improvement in pain (p = 0.014) and in the diagnosis of myofascial pain (p = 0.008), while G2 and G3 did not. Regarding OHRQoL, G1 and G2 presented significant improvement (p = 0.005, in both), whereas, G3 did not. CONCLUSION: Michigan occlusal splint was effective in reducing pain and improving OHRQoL. Treatment with the rapid LLLT protocol only provided an improvement in OHRQoL.

Influence of age and lymphedema on the postural balance of women undergoing breast cancer treatment.

INTRODUCTION: Breast cancer affects women of different ages, and comorbidities resulting from treatment can affect postural stability. The study aimed to evaluate the influence of age and lymphedema on the postural balance of women undergoing breast cancer treatment. METHODS: The study included 77 women undergoing breast cancer treatment, divided into different groups: 37 young adult women divided into 17 with lymphedema (GYL) and 20 young adults without lymphedema (GY); 40 elderly women, 20 elderly women with lymphedema (GEL) and 20 elderly women without lymphedema (GE). Mini Balance Evaluation Systems Test (Mini BESTest) and Falls Efficacy Scale - International (FES-I) were used. RESULTS: Mini BESTest and FES-I between the groups showed that GE and GEL had a significant difference to GY. Mini BESTest Total and Time Up and Go TUG-Double Task showed that GE has a significant difference to GYL, with GE and GEL having lower scores. Moderate negative correlation in the GEL between FES-I and Mini BESTest. In the age correlation between the Mini BESTest, FES-I, TUG, and double task TUG, a moderate positive correlation was observed for TUG. GEL showed a moderate positive correlation for FES-I and double-task TUG, strong for TUG, and moderate negative correlation with Mini BESTest. Correlation of the volume difference between the limb affected and not affected by lymphedema and the FES-I, Mini BESTest, TUG, and TUG double task, GYL showed moderate negative correlation for TUG. CONCLUSION: Age and lymphedema influenced the dynamic postural balance of women undergoing breast cancer treatment.

Is There a Difference in Whole Body Standing Posture in Women With Urinary Incontinence Based on the Presence of Myofascial Dysfunction in the Pelvic Floor Muscles?

OBJECTIVE: The purpose of this study was to assess the prevalence of postural changes in women who had urinary incontinence (UI) with myofascial dysfunction (MD) and women who had UI without MD in the pelvic floor muscles (PFM). METHODS: A cross-sectional study was performed with 234 women who had UI and were at least 18 years old at the urogynecology outpatient clinic of a tertiary academic hospital. The International Consultation on Incontinence Questionnaire-Short Form and the International Consultation on Incontinence Questionnaire-Overactive Bladder were used to collect urinary data. Standing postural assessment was performed using photogrammetry in anterior, posterior, and right and left lateral views and was analyzed with Postural Assessment Software. MD was defined as pain of any intensity during palpation of the PFM, and the strength of these muscles was evaluated using the Modified Oxford Scale. RESULTS: The prevalence of MD in women with UI was 51.7% (121/234). Women with MD had significantly smaller angles in the horizontal alignment of the pelvis in the right-side view (mean [SD] = -11.9 [6.9] degrees and -9.6 [7.1] degrees), left-side view (-13.6 [6] degrees and -11.5 [6.6] degrees), and vertical alignment of the body in the left-side view (3 [1.5] degrees and 3.4 [1.5] degrees), showing anterior pelvic tilt and posterior displacement of the body. CONCLUSION: Women with UI and MD had greater anterior pelvic tilt and posterior displacement of the body than women without dysfunction. IMPACT: This study informs physical therapists and other health care professionals about the prevalence of MD in the pelvic floor muscles of women with UI and highlights the need to rule out MD, because it appears to be a concomitant impairment in women who self-report UI. During a postural screen, health care professionals should look for anterior pelvic tilt relative to horizon when evaluating posture in women with UI and MD. The findings of postural changes in women with MD and UI may influence the PFM assessment. LAY SUMMARY: Women with involuntary urinary loss, pain, and stiffness in the pelvic area may show changes in posture associated with this condition.

Myofascial pain syndrome as a diagnosis of chronic abdominal pain. Case report / Síndrome dolorosa miofascial como diagnóstico diferencial de dor abdominal crônica. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic abdominal pain may originate in visceral, somatic or nervous structures. Diagnosis is challenging and, in prolonged cases with atypical development, the possibility of a myofascial pain syndrome should be considered. The objective was to report a case of post-surgical chronic abdominal pain perpetuated by the presence of trigger points in the musculature of the abdominal wall. CASE REPORT: Male patient, 15 years old, underwent appendectomy without complications. Due to the persistence of pain after surgery, gabapentin and analgesics were prescribed. After 45 days, the patient still had disabling pain, preventing him from performing usual activities. The patient underwent surgical revision, which was not conclusive, and other attempts at pain control, such as anesthetic block of the abdominal transverse plane and transdermal lidocaine, without success. He was then referred to the acupuncture clinic, presenting antalgic gait, voluntary guarding to palpation of the hypochondrium and right iliac fossa, presence of trigger points in the rectus abdominis and right quadratus lumborum muscles, with pain referred at right iliac fossa, with no signs or symptoms of neuropathic pain. The needling of trigger points, electrostimulation at the motor points of referred muscles and stretching guidance were performed. During the follow-up period, the patient presented a gradual improvement in symptoms, suspension of the drugs in use and return to activities. CONCLUSION: Myofascial painful syndrome is one of the most common causes of pain and disability, is still underdiagnosed and should be considered among the differential diagnosis.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor abdominal crônica pode ter origem em estruturas viscerais, somáticas ou nervosas. O diagnóstico é desafiador e, em casos prolongados e com evolução atípica, deve-se considerar a síndrome dolorosa miofascial. O objetivo foi relatar um caso de dor crônica abdominal após cirurgia perpetuada pela presença de pontos-gatilho na musculatura da parede abdominal. RELATO DO CASO: Paciente do sexo masculino, 15 anos, submetido a apendicectomia sem intercorrências. Devido à persistência da dor pós-operatória, foi prescrita gabapentina e analgésicos. Após 45 dias, continuava com dor incapacitante, impedindo-o de realizar suas atividades habituais. Foi submetido à revisão cirúrgica, não elucidativa, e outras tentativas de controle álgico, como bloqueio anestésico do plano transverso abdominal e lidocaína por via transdérmica, sem sucesso. Encaminhado ao ambulatório de acupuntura, apresentando marcha antálgica, defesa voluntária à palpação de hipocôndrio e fossa ilíaca direita, presença de pontos-gatilho em músculo reto abdominal e quadrado lombar direito, com dor referida em fossa ilíaca direita, sem sinais ou sintomas de dor neuropática. Foi realizado o agulhamento dos pontos-gatilho, eletroestimulação nos pontos motores dos referidos músculos e orientação de alongamentos. Na fase de monitoramento, o paciente apresentou melhora gradual dos sintomas, suspensão dos fármacos e retorno às suas atividades. CONCLUSÃO: A síndrome dolorosa miofascial é uma das causas mais comuns de dor e incapacidade, é pouco diagnosticada e deve ser considerada entre os diagnósticos diferenciais.

Dry Needling and Photobiomodulation Decreases Myofascial Pain in Trapezius of Women: Randomized Blind Clinical Trial.

OBJECTIVE: The purpose of this study was to assess whether dry needling (DN) added to photobiomodulation (PBM) has effects on the treatment of active myofascial trigger points in the upper trapezius. METHODS: This study was a randomized clinical trial, with 43 participants divided into 3 groups: DN and PBM (DNP), DN, and DN outside of the trigger point (DNout). Each group received 1 session of DN followed by PBM therapy with the machine turned on or off. Pain, disability, pain pressure threshold, and muscle activity were assessed before the intervention and afterward at intervals of 10 minutes, 30 minutes, 1 week, and 1 month. RESULTS: Pain decreased after intervention in the DNP and DNout groups, with mean differences, respectively, of 1.33 cm (95% confidence interval [CI], 0.019-2.647) and 2.78 cm (95% CI, 1.170-2.973). Scores for the disability questionnaire decreased in all groups after intervention (F = 36.53, P < .0001) after the intervention, with mean differences of 3.8 points in the DNP group (95% CI, 1.082-5.518), 3.57 in the DN group (95% CI, 0.994-6.149), and 5.43 in the DNout group (95% CI, 3.101-7.756). There were no significant differences between or within groups in pain pressure threshold (F = 2.14, P = .139), with mean differences after 30 minutes of 0.139 kgf for the DNP group (95% CI, -0.343 to 0.622), 0.273 for the DN group (95% CI, -0.661 to 1.209), and -0.07 for the DNout group (95% CI, -0.465 to 0.324). Muscle activation for the DN group increased 8.49% after the intervention, where for the DNP group it decreased 11.5%, with a significant difference between groups. CONCLUSION: DN added to PBM presented similar results compared to DNout and DN. In this sample, the effects of the application of DN outside of the trigger point had better effects on pain and disability scores than DN applied directly on the trigger point.