Based on the modern anatomy and physiology, the referred pain of myofascial trigger points of each muscle is integrated; compared with the twelve meridians as well as conception vessel and governor vessel, the similarity of their position and running course is observed. With the current research progress of myofascial trigger points and fasciology, based on the running course of referred pain of trigger points, combined with fascia mechanics, nerve and vascular, the location of acupoints and meridians, as well as the relationship between acupoints and meridians, are discussed.
Acupuncture Points ; Humans ; Meridians ; Muscles ; Pain, Referred ; Trigger Points

OBJECTIVE: Based on the establishment of a rat model of trigger point, this study was to intervene with warm acupuncture, and to evaluate the effect on pathological morphology and pain-induced inflammation of the rat model by microscopic pathology and microdialysis. METHODS: Sixty-four SD rats were randomly divided into group A (blank control), group B (model control) and group C (model and intervention control). Groups A and B were divided into 3 groups (A0, A1, A2 and B0, B1, B2), the group C was divided into 2 groups (C1 and C2). The MTrPs model was established in both groups B and C, warm acupuncture intervention were given to the C1 group for 7 days and the C2 group for 15 days. Rats were sacrificed in batches. MTrPs were locally sampled and stained with hematoxylin-eosin after the preparation. The pathological changes were observed under light microscopy. The iocal interleukin-1β and prostaglandin E2 were detected by microdialysis technique. RESULTS: Microscopically, the muscle fibers of the model were arranged disorderly, broken, twisted, local fibrosis, contracture thickening and so on; macrophage and other inflammatory cell invasion in local area and a large area of adhesion occurred on the contracture nodule, the pathological state of local muscle fibers was significantly improved after warm needle intervention, local microvascular formation and maturation, local muscle fiber repair. After successful modeling, the amount of interleukin-1β and prostaglandin E2 in group B0 was significantly higher than that in group A0 before warm needle intervention (<0.01). After warming intervention for 7 days, there was no significant difference in the amount of interleukin-1β and prostaglandin E2 between group C1 and group B1 (>0.05). Group C1 and B1 were significantly higher than group A1 (<0.01); warm needle intervention for 15 days, the amount of interleukin-1β and prostaglandin E2 in group C2 were lower than those in group B2 (<0.05), but those in group C2 and B2 were significantly higher than group A2 (<0.01), and the amount of interleukin-1β and prostaglandin E2 in group C2 was lower than group C1 (<0.05). CONCLUSIONS The modeling method of exercise combined hitting used in this study was proved to be effective by histopathology; warm acupuncture can improve the pathological and inflammatory state of local muscle fiber in myofascial pain trigger of rat, promote local microvascular formation and maturation, and help the trigger point local muscle fiber repair.
Acupuncture Therapy ; Animals ; Inflammation Mediators ; Myofascial Pain Syndromes ; Rats ; Rats, Sprague-Dawley ; Trigger Points

BACKGROUND: It has been reported that in 62.5% of cases of incurable cancer pain, the complaint is due to myofascial pain syndrome. Trigger point injections using dibucaine hydrochloride help patients with such cancer pain. This study evaluated the efficacy of trigger point injections for alleviating pain in patients with advanced cancer. METHODS: Twenty patients with advanced cancer who had a life expectancy of 6 months or less and had been diagnosed with myofascial pain syndrome were treated with trigger point injections. Prior to treatment, a Visual Analog Scale (VAS) was used to measure the resting pain level and discomfort upon application of pressure on the site of pain. These values were compared with last treatment measurements. RESULTS: The mean pre-treatment VAS scores for pain at rest and upon application of pressure on the pain site were 7.3 and 9.0, respectively. These scores decreased significantly to 1.95 and 3.2, respectively, after the treatment (P<0.05). CONCLUSION: Trigger point injection is an alternative and effective pain control modality for advanced cancer patients with myofascial pain syndrome.
Dibucaine ; Humans ; Life Expectancy ; Myofascial Pain Syndromes ; Trigger Points ; Visual Analog Scale

OBJECTIVE: To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. METHODS: In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. RESULTS: Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. CONCLUSION: Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum.
Back Pain ; Humans ; Myofascial Pain Syndromes* ; Outcome Assessment (Health Care) ; Pain Measurement ; Quebec ; Retrospective Studies ; Shock* ; Trigger Points*

OBJECTIVE: To report the characteristics of myofascial trigger points (MTrPs) in the infraspinatus muscle and evaluate the therapeutic effect of trigger-point injections. METHODS: Medical records of 297 patients (221 women; age, 53.9±11.3 years) with MTrPs in the infraspinatus muscle were reviewed retrospectively. Because there were 83 patients with MTrPs in both infraspinatus muscles, the characteristics of total 380 infraspinatus muscles with MTrPs (214 one side, 83 both sides) were investigated. Specific characteristics collected included chief complaint area, referred pain pattern, the number of local twitch responses, and distribution of MTrPs in the muscle. For statistical analysis, the paired t-test was used to compare a visual analogue scale (VAS) before and 2 weeks after the first injection. RESULTS: The most common chief complaint area of MTrPs in the infraspinatus muscle was the scapular area. The most common pattern of referred pain was the anterolateral aspect of the arm (above the elbow). Active MTrPs were multiple rather than single in the infraspinatus muscle. MTrPs were frequently in the center of the muscle. Trigger-point injection of the infraspinatus muscle significantly decreased the pain intensity. Mean VAS score decreased significantly after the first injection compared to the baseline (7.11 vs. 3.74; p<0.001). CONCLUSION: Characteristics of MTrPs and the therapeutic effects of trigger-point injections of the infraspinatus muscle were assessed. These findings could provide clinicians with useful information in diagnosing and treating myofascial pain syndrome of the infraspinatus muscle.
Arm ; Female ; Humans ; Medical Records ; Muscles ; Myofascial Pain Syndromes* ; Pain, Referred ; Retrospective Studies ; Therapeutic Uses ; Trigger Points

Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection in the left upper trapezius. Chest computed tomography showed evidence of DNM, and antibiotic therapy was immediately administered intravenously. Because of the risk of sudden death, poor prognosis due to underlying disease, and his age, he declined surgical treatment and died of septic shock. Although trigger point injections are generally considered safe, caution should be used in patients with an underlying disease or in the elderly. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical management are essential to improve the prognosis.
Aged ; Anti-Bacterial Agents ; Death, Sudden ; Early Diagnosis ; Emergency Service, Hospital ; Fever ; Humans ; Mediastinitis* ; Prognosis ; Rupture ; Shock, Septic ; Superficial Back Muscles ; Thorax ; Tomography, X-Ray Computed ; Trigger Points*

No abstract available.
Female ; Humans ; Pectoralis Muscles/*diagnostic imaging ; Trigger Points/*diagnostic imaging ; Ultrasonography

OBJECTIVETo provide an evidence-based overview regarding the efficacy of Ashi points stimulation for the treatment of shoulder pain.

METHODSA comprehensive search [PubMed, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Chongqing Weipu Database for Chinese Technical Periodicals (VIP) and Wanfang Database] was conducted to identify randomized or quasi-randomized controlled trials that evaluated the effectiveness of Ashi points stimulation for shoulder pain compared with conventional treatment. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. RevMan 5.0 was used for data synthesis.

RESULTSNine trials were included. Seven studies assessed the effectiveness of Ashi points stimulation on response rate compared with conventional acupuncture. Their results suggested significant effect in favour of Ashi points stimulation [odds ratio (OR): 5.89, 95% confidence interval (CI): 2.97 to 11.67, P<0.01, heterogeneity: χ(2) =3.81, P=0.70, I (2) =0% ]. One trial compared Ashi points stimulation with drug therapy. The result showed there was a significantly greater recovery rate in group of Ashi points stimulation (OR: 9.58, 95% CI: 2.69 to 34.12). One trial compared comprehensive treatment on the myofascial trigger points (MTrPs) with no treatment and the result was in favor of MTrPs.

CONCLUSIONSAshi points stimulation might be superior to conventional acupuncture, drug therapy and no treatment for shoulder pain. However, due to the low methodological quality of included studies, a firm conclusion could not be reached until further studies of high quality are available.

Acupuncture Points ; Acupuncture Therapy ; Humans ; Publication Bias ; Randomized Controlled Trials as Topic ; Risk Factors ; Shoulder Pain ; drug therapy ; therapy ; Trigger Points

Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.
Adenosine Triphosphate ; Amitriptyline ; Dental Caries ; Diagnosis* ; Humans ; Infusions, Intravenous ; Lidocaine ; Massage ; Neuralgia ; Pain, Referred ; Periodontitis ; Pulpitis ; Trigger Points

Chronic pelvic pain in women is a very annoying condition that is responsible for substantial suffering and medical expense. But dealing with this pain can be tough, because there are numerous possible causes for the pelvic pain such as urologic, gynecologic, gastrointestinal, neurologic, or musculoskeletal problems. Of these, musculoskeletal problem may be a primary cause of chronic pelvic pain in patients with a preceding trauma to the low back, pelvis, or lower extremities. Here, we report the case of a 54-year-old female patient with severe chronic pelvic pain after a transcutaneous electrical nerve stimulation (TENS) accident that was successfully managed with image-guided trigger point injections on several pelvic stabilizing muscles.
Female ; Hip Joint* ; Hip* ; Humans ; Lower Extremity ; Middle Aged ; Muscles* ; Pelvic Pain* ; Pelvis* ; Transcutaneous Electric Nerve Stimulation ; Trigger Points