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.

Lidocaine Needling in Myofascial Pain Syndrome for Palliative Oncologic Care: A Randomized Clinical Study.

Background: Physical pain is highly prevalent and impacts the well-being of patients with advanced oncologic disease. Although myofascial pain syndrome (MPS) can be one of the components of pain in cancer patients on palliative care (PC), so far there is no evidence about the benefit of treatment with 1% lidocaine needling. Objectives: To evaluate the efficacy of MPS treatment with injection of 1% lidocaine on the reduction of pain in cancer patients on PC. Design: Single-blind randomized clinical trial. Subjects: Patients aged 50 years or older with end-stage cancer, admitted to a cancer ward or monitored during radiotherapy in three Brazilian hospitals, with a diagnosis of MPS with a pain intensity of five or more according to the Visual Analog Scale (VAS). The patients were divided into two groups: trigger point (TP) injection with 1% lidocaine and control. Measurements: Pain intensity was assessed with the VAS, pain threshold with an algometer, and the medications being used were determined before and 72 hours after the intervention. Results: Thirty patients (15 per group) were assessed. After 72 hours, there was a reduction in referred pain intensity (p < 0.001) and an increase in pressure threshold (p = 0.007) in the intervention group (IG), with no difference in the control. The frequency of individuals who reduced the doses and/or classes of pain medications was higher in the IG (p = 0.011). Conclusion: One percent lidocaine needling in TPs was an effective therapy for pain reduction in MPS.

Dry needling, trigger point electroacupuncture and motor point electroacupuncture for the treatment of myofascial pain syndrome involving the trapezius: a randomised clinical trial.

OBJECTIVE: The objective of this study was to compare trigger point (TrP) dry needling, TrP electroacupuncture and motor point electroacupuncture of the trapezius muscle for the treatment of myofascial pain syndrome (MPS). METHODS: This randomised clinical trial included 90 patients divided into three groups. Group 1 was treated with dry needling of TrPs, group 2 with intramuscular electrical stimulation of TrPs, and group 3 with electroacupuncture of motor points and/or the spinal accessory nerve. Each group received seven treatment sessions. The outcomes were the pain score measured by visual analogue scale (VAS) and quality of life evaluated by the 12-item short form (SF-12) health questionnaire. We compared the pain outcome over serial time points using growth curve analysis methods. RESULTS: Participants in the three groups experienced significant improvements in pain scores over time. The average pain level of participants in group 3 across the repeated assessments was 0.98 units lower than in group 1 (mean difference (95% confidence interval (CI) = 1.74-0.23)), p = 0.012). There were no significant differences in pain scores between participants in groups 1 and 2, and there were no significant differences in quality of life across the three groups at the end of the treatment period. CONCLUSION: Our results provide evidence that electrical stimulation of motor points and/or of the spinal accessory nerve may be superior in terms of pain relief (but not quality of life) to dry needling and possibly electrical stimulation of trigger points for the management of MPS involving the trapezius. TRIAL REGISTRATION NUMBER: TRIAL-RBR-43R7RF (Brazilian Clinical Trials Registry).

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.

Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain.

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.

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.

Análise da eficácia do agulhamento seco e da massagem facial no tratamento de disfunções temporomandibulares com base em relato de caso clínico / Analysis of the effectiveness of dry needing and facial massage in the treatment of temporomandibular disorders based on a clinical case report

O objetivo do presente trabalho é apresentar um relato de caso de Disfunção Temporomandibular (DTM) dolorosa de origem muscular, tratado por meio de Agulhamento Seco (AS) e Massagem Facial (MF). Paciente do sexo feminino, M.R.B.A., de 47 anos, com diagnóstico de dor miofascial com referência do lado esquerdo e deslocamento de disco com redução do lado esquerdo, de acordo com os Critérios de Diagnóstico e Tratamento das Disfunções Temporomandibulares (DC/TMD). A paciente foi submetida a cinco sessões de AS e MF, executadas por fisioterapeuta experiente. Na primeira consulta, foi realizada a anamnese e exame físico para a obtenção de informações sobre qualidade, frequência, duração e intensidade da dor, bem como fatores de melhora, fatores de piora, fatores acompanhantes, fatores desencadeantes e tratamentos prévios. A intensidade da dor foi avaliada através de escala visual analógica e as intervenções com agulhamento seco foram iniciadas a partir da segunda consulta. Ao final das sessões, a paciente foi orientada quanto à continuidade de exercícios de relaxamento muscular e ao uso de placa interoclusal. Com base na escala adotada, o quadro doloroso geral da paciente teve evolução positiva de 6 a 0 após o tratamento, com destaque observado em seus pontos gatilhos de 10 e 8 para 6 e 3, para os lados esquerdo e direito respectivamente. Concluise que, após a aplicação da terapia proposta, a paciente obteve melhora com redução significativa em sua sintomatologia dolorosa em ambos os lados(AU)

The objective of this work is to present a case report of Dysfunction Painful temporomandibular joint (DTM) of muscular origin, treated with needling Dry (AS) and Facial Massage (MF). Female patient, M.R.B.A., 47 years old, with a diagnosis of myofascial pain with reference on the left side and displacement of disc with reduction on the left side, according to the Diagnostic and Treatment of Temporomandibular Disorders (DC/TMD). The patient underwent five sessions of AS and MF, performed by an experienced physiotherapist. At the first consultation, anamnesis and physical examination were carried out to obtain information on quality, frequency, duration and intensity of pain, as well as improvement factors, worsening factors, accompanying factors, triggering factors and previous treatments. The intensity of pain was assessed using a visual analogue scale and interventions with needling dry were started from the second consultation. At the end of the sessions, the patient was guided regarding the continuation of muscle relaxation exercises and the use of interocclusal splint. Based on the adopted scale, the patient's general painful condition was positive evolution of 6 to 0 after treatment, with emphasis on its points triggers from 10 and 8 to 6 and 3, for the left and right sides respectively. It is concluded that, after applying the proposed therapy, the patient improved with reduction significant in its painful symptoms on both sides

Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders.

OBJECTIVE: Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. This study aimed to determine the test-retest reliability of the IC test. METHODS: A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated. RESULTS: The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values. CONCLUSION: The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.

Do myofascial trigger points in masseter muscles affect the symptoms of disc displacement with reduction? A cross-sectional study.

OBJECTIVE: The aim of this study was to demonstrate the effect of myofascial pain with referral from the trigger points in the masseter muscles on the clinical symptoms and functional limitations of the temporomandibular joint in participants with disc displacement with reduction. METHODS: This prospective, cross-sectional study recruited participants aged 18-45 years with disc displacement with reduction with/without myofascial pain with referral in the masseter muscles based on the inclusion criteria. Maximum mouth opening and the presence of probable awake bruxism were assessed. The "Graded Chronic Pain Scale version 2.0" and "Jaw Function Limitation Scale-8" were used to evaluate Diagnostic Criteria for Temporomandibular Disorders Axis II. Pain levels were measured using the Visual Analog Scale. RESULTS: A comparison between the disc displacement with reduction and disc displacement with reduction+myofascial pain with referral groups revealed statistically significant differences in Visual Analog Scale (p<0.001), the presence of awake bruxism (p=0.038), and Graded Chronic Pain Scale version 2.0 (p=0.010). However, no statistically significant difference was observed between the two groups concerning maximum mouth opening and Jaw Function Limitation Scale-8. CONCLUSION: Participants with both disc displacement with reduction and myofascial pain with referral in the masseter muscle exhibited higher pain intensity, a higher prevalence of awake bruxism, and increased pain-related disability compared to those with disc displacement with reduction alone.

Myofascial pain syndrome in the oncologic patient: general considerations.

This article aims to make visible a common non-oncologic pain condition in cancer patients. Myofascial pain syndrome can generate an increase in the symptomatic burden of the oncologic patient, increase the demand for opioid medication, and decrease the quality of life. We consider that health professionals involved in the care of cancer patients in its different stages should be aware of it, diagnose it, and treat it early to avoid processes of pain chronification, peripheral tissue modification, and deterioration of the functional condition of patients with oncologic diseases.

Global hotspots and trends in Myofascial Pain Syndrome research from 1956 to 2022: A bibliometric analysis.

Myofascial Pain Syndrome (MPS) is a prevalent disease, and the related literature research has been increasing in recent years. However, there is a lack of scientific and comprehensive bibliometric analyses in the MPS research field. This study aimed to summarize and visualize the literature distribution laws, research hotspots and development trends in MPS based on bibliometric methods. Relevant literature on MPS research from 1956 to 2022 was retrieved from the Web of Science Core Collection database. Quantitative and visual analyses of the collected literature were performed using Microsoft Office 2021, Bibliometrics, VOSviewer, and CiteSpace. A total of 1099 papers were included, and the number of papers in this research field is generally upward. The USA has the most publications (270), and Univ Sao Paulo is the institution with the most publications (31). Hong CZ and Calvo-Lobo C have the same number of publications and are the authors with the most publications (20), and Simons DG is the author with the most co-citations (1078). Journal of Musculoskeletal Pain is the journal with the most publications (61), and Pain is the journal with the most co-cited papers (2598) and the highest impact factor (7.926). Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response is the reference with the highest number of co-citations (136). The top 5 keywords in this period are myofascial pain syndrome (571), trigger points (218), pain (97), myofascial pain (92), and myofascial trigger point (80). The keywords of recent bursts are dry needling (2016-2022), efficacy (2020-2022), validity (2020-2022), temporomandibular joint disorder (2020-2022), and orofacial pain (2020-2022). This study summarizes and visualizes the evolution, research hotspots, and future trends of the global MPS domain from 1956 to 2022. It is helpful for scholars to understand the general situation of MPS research quickly and provide a reference for clinical decision-making and future research directions.

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.

Overview de revisões sistemáticas das modalidades de tratamentos em disfunções temporomandibulares musculares / Overview of systematic reviews of treatment modalities in temporomandibular muscle disorders

As disfunções temporomandibulares (DTM) são alterações capazes de comprometer substancialmente a qualidade funcional mastigatória, além de resultar em quadros clínicos dolorosos que podem ser constantes ou transitórios. No caso das disfunções temporomandibulares musculares (DTM-M), terapias que buscam melhorar a contração muscular sustentada são as mais indicadas. Várias abordagens terapêuticas são disponibilizadas, no entanto foram selecionados para análise farmacoterapia, fisioterapia, placas oclusais, laser de baixa potência, acupuntura, ozonioterapia, agulhamento seco, agulhamento com infiltração de: toxina botulínica ­ A, plasma rico em plaquetas e anestésico local, analisados e investigados por revisões sistemáticas e metanálises. Dessa forma, o presente estudo teve como objetivo unificar em uma revisão geral (overview) as sínteses das revisões sistemáticas já produzidas para buscar uma base de evidências ampla e de qualidade sobre os tratamentos para DTM-M. Para isso foi realizada uma busca sistemática nas bases de dados: MEDLINE-PubMed, EMBASE, BVS (LILACS e BBO), Web of Science, SCOPUS e Cochrane of Sistematic Reviews. Foram examinados 1623 artigos e após a análise dos títulos e resumos, foram selecionados 134 artigos para leitura na íntegra, resultando em 12 estudos para análise de qualidade pela ferramenta AMSTAR 2. Destes, dez revisões foram consideradas criticamente baixas e duas de qualidade baixa. De acordo com a síntese dos resultados, os tratamentos abordados apresentam certa efetividade, porém necessitam de estudos de qualidade metodológica mais consistente para que haja maior robustez de evidências (AU)

Temporomandibular disorders (TMD) are alterations to able of compromising masticatory functional quality, in addition to resulting in painful clinical conditions that may be constant or transient. In the case of muscle temporomandibular disorders (TMD-M), therapies that seek to improve sustained muscle contraction are the most indicated. Several therapeutic approaches are available, however, pharmacotherapy, physiotherapy, occlusal splints, low power laser, acupuncture, ozone therapy, dry needling, needling with infiltration of: botulinum toxin - A, platelet-rich plasma and local anesthetic, were selected for analysis. and investigated by systematic reviews and meta-analyses. Thus, the present study aimed to unify in a general review (overview) the syntheses of systematic reviews already produced to seek a broad and quality evidence base on treatments for M-TMD. For this, a systematic search was carried out in the databases: MEDLINE-PubMed, EMBASE, BVS (LILACS and BBO), Web of Science, SCOPUS and Cochrane of Systematic Reviews. 1623 articles were reviewed and after analyzing the titles and abstracts, 134 articles were selected for reading in full, generated in 12 studies for quality analysis by the AMSTAR 2 tool. Of these, ten reviews were considered critically low and two were considered low. According to the synthesis of the results, the observed treatments presented certain patterns, however observed from studies of more consistent methodological quality so that there is greater robustness of evidence (AU)

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)

Correlation Between the Sinew Channels with the Myofascial System, Pathology, and Treatment.

The sinew channels are a tendon and muscle network, and their description is based on the observation presented on the Huangdi Neijing Ling Shu. However, the myofascial system is an uninterrupted series of connective tissue that is comprised of layers that run in different directions. The similarities on these pathways are compared, such as a brief description on the myofascial pain syndrome and its similitude with the Impediment disorder from the Traditional Chinese Medicine (TCM). Furthermore, we discuss the treatment of these conditions from a Traditional Chinese Medicine perspective.

Therapeutic ultrasound versus injection of local anesthetic in the treatment of women with chronic pelvic pain secondary to abdominal myofascial syndrome: a randomized clinical trial.

BACKGROUND: Chronic pelvic pain (CPP) is defined as recurrent or continuous pain in the lower abdomen or pelvis, either non-menstrual or noncyclical, lasting for at least 6 months. There is strong evidence that up to 85% of patients with CPP have serious dysfunctions of the musculoskeletal system, including abdominal myofascial pain syndrome (AMPS). AMPS is characterized by intense and deep abdominal pain, originating from hyperirritable trigger points, usually located within a musculoskeletal band or its lining fascia. In the literature, there are few studies that address AMPS. OBJECTIVES: To evaluate and compare the efficacy of therapeutic ultrasound (TUS) and injection of local anesthetic (IA) to improve pain in women with abdominal myofascial syndrome secondary to CPP. STUDY DESIGN: Randomized controlled clinical trial. SETTING: Tertiary University Hospital. MATERIALS AND METHODS: A randomized clinical trial was conducted, patients were allocated to two types of treatment: group TUS (n = 18), and group IA (n = 20). The instruments used for evaluation and reassessment were the Visual Analog Scale, Numerical Categorical Scale, McGill Pain Questionnaire, and SF-36 quality of life assessment questionnaire. They were evaluated before starting treatment, 1 week after the end of treatment, and at 1, 3, and 6 months. RESULTS: TUS and IA were effective in reducing clinical pain and improving quality of life through the variables analyzed among study participants. There was no significant difference between groups. LIMITATIONS: absence of blinding; exclusion of women with comorbidities and other causes of CPP, the absence of a placebo group, the difference between the number of sessions used for each technique, and the COVID-19. CONCLUSION: Treatment with TUS and IA were effective in reducing clinical pain and improving quality of life in women with AMPS secondary to CPP. TRAIL REGISTRATION: We declare that this clinical trial has been registered under the number [(ReBEC) no. RBR-39czsv] on 07/18/2018 in the Brazilian Registry of Clinical Trials.

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.

Effects of botulinum toxin in patients with myofascial pain related to temporomandibular joint disorders: A systematic review.

Botulinum toxin is used as an alternative for the treatment of chronic refractory myofascial pain derived from temporomandibular disorders (TMDs). It is important to establish the benefits of botulinum toxin in this type of symptomatology. The aim of the study was to conduct a systematic review in order to evaluate the effects of botulinum toxin in patients with myofascial pain related to temporomandibular disorders. The search was carried out systematically, without limitations of language or year of publication, until February 2021. The databases searched included PubMed, Web of Science, Scopus, The Cochrane Library, and Latin American and Carribean Health Sciences Literature (LILACS). Partial gray literature was searched using Google Scholar, ClinicalTrials.gov, OpenGrey, and the reference lists of selected articles. Randomized controlled clinical trials evaluating the effects of botulinum toxin in the treatment of myofascial pain were included. The risk of bias was assessed with the Cochrane RoB 2.0 tool, and the The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the certainty of the scientific evidence. A total of 900 studies were retrieved, out of which only 8 randomized clinical trials were selected. From these 8 studies, the data of a total of 314 patients, predominantly women, between the ages of 18 to 75 years was obtained. After the assessment of the studies with the RoB 2.0 tool, 7 studies showed some concerns regarding the reported results and only one was at a low risk of overall bias. The analysis of the studies has shown that low doses of botulinum toxin are effective in the treatment of refractory myofascial pain associated with temporomandibular disorders. The studies presented mediumto low-certainty evidence..

Malocclusion Complexity in Patients with Myofascial Pain with or without Mouth-Opening Limitation: A Case-Control Study.

Background: This study is aimed at determining the association between myofascial pain with or without mouth-opening limitation and malocclusion complexity. Methods: A prospective, cross-sectional, case-control study was conducted. The Research Diagnostic Criteria were used to evaluate the presence of myofascial pain, chronic pain, and depression. The Index of Complexity, Outcome, and Need (ICON) was applied to quantify malocclusion complexity. A total of 96 patients with myofascial pain were grouped into two: subjects without mouth-opening limitation (n = 76, group A) and subjects with mouth-opening limitation (group B, n = 20). Both groups were compared with 231 controls (group C). A Chi-squared test and a multinomial logistic regression (p ≤ 0.05) were used to identify associations between the variables. Results: Statistically significant associations were found between myofascial pain and the variables gender, malocclusion complexity, and depression (p ≤ 0.05). Age was not significantly associated (p = 0.327). Concerning malocclusion complexity, 77.9% of the controls were distributed in the first three ICON levels; however, 76.5% of group A subjects and 90% of group B were in the last three (p < 0.001). The multinomial logistic regression showed a significant association between malocclusion complexity in group A (p < 0.05) and an association between depression and group B (p < 0.05). Group B had the highest grades of chronic pain. Conclusions: Females had greater risk of myofascial pain without mouth-opening limitation. As the complexity of the malocclusion increases, so do the odds of presenting myofascial pain without mouth-opening limitation. Myofascial pain with mouth-opening limitation frequently coexists with depression and chronic pain.

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.

Acute effects of myofascial reorganization on trapezius muscle oxygenation in individuals with nonspecific neck pain.

BACKGROUND AND PURPOSE: Nonspecific neck pain (NNP) is a common idiopathic disorder in the general population that affects the trapezius muscle (TM) and blood supply, thereby compromising the fascial system. Myofascial reorganization (MR) is a physical therapy technique that can influence the dynamics of local fluids reducing excessive muscle tension and capillary constriction, and increasing local blood flow. This study aimed to investigate whether MR improves peripheral muscle oxygenation. METHODS: This was a quasi-experimental study with an intentional non-probability sample. Fifty participants (women: 36, men: 14) with and without NNP were assigned to either the experimental group (EG: n = 25, with NNP, subjected to MR) or the control group (CG: without NNP, no MR intervention). TM oxygenation was measured using near-infrared spectroscopy (NIRS) before and after a single intervention. All participants were evaluated and reassessed after 10 min. RESULTS: The results revealed that immediately after 10 min of MR, the EG exhibited an increase in the oxyhemoglobin level of the medium fibers of the TM (0.72 ± 1.47 vs. -0.14 ± 1.33 mmol/dL, p = 0.01). In addition, functional disability (CG: 5.48 ± 5.58%/EG: 21.12 ± 7.73%) and neck pain were measured using the neck disability index. The pain pressure threshold (CG: 70.49 ± 32.29 kgf/EG: 51.08 ± 27.65 kgf) and pain intensity (CG: 0.76 ± 1.56/EG: 3.28 ± 2.35) were also measured. CONCLUSION: The findings indicate that application of MR for 10 min increases the tissue oxyhemoglobin level in the TM of the group with NNP compared to the CG without NNP.