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Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Parthasarathy S, Sundar S, Mishra G. Assessment of predisposing factors in myofascial pain syndrome and the analgesic effect of trigger point injections - A primary therapeutic interventional clinical trial. Indian J Anaesth 2019; 63:300-303. [PMID: 31000895 PMCID: PMC6460974 DOI: 10.4103/ija.ija_6_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Myofascial pain syndrome (MPS) is a common cause of chronic musculoskeletal pain, characterised by myofascial trigger points (TPs). TP injection is an established technique for management of MPS. In this study, we analysed the efficacy of myofascial TP injection of lignocaine and the influencing biomechanical factors on MPS. Methods After obtaining ethical committee approval, we included the first 100 adult patients of MPS with failed physical therapy aged above 18 years, and with TPs in the trapezius, infraspinatus, and/or the levator scapulae muscles and Visual analog scale (VAS) >4. TP injection of 2% (2 ml) lignocaine was performed. Visual analogue scale (VAS) scores were recorded immediately and after 1 month. Number of repeat TP injections and use of oral analgesic in one month was noted. Results were analysed with the analysis of variance test. Results The mean VAS reduced significantly both immediately and 1 month after therapeutic injections (8.57 ± 0.77, 2.67 ± 1.43 and 2.82 ± 1.4, respectively, P < 0.01). Keeping the palm below the head during sleep was the major contributing factor for myofascial TP, followed by slanting the neck to use mobile phones. Repeat TP injection was used in 4% of cases. Conclusion TP injection of 2 ml of 2% lignocaine along with correction of predisposing biomechanical factors provided significant pain relief for MPS in patients with failed physical therapy without any side effects.
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Affiliation(s)
- S Parthasarathy
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India
| | - Siyam Sundar
- Department of Anaesthesiology, Kovai Medical Centre Hospitals, Coimbatore, Tamil Nadu, India
| | - Gayatri Mishra
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India
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Mitidieri AMDS, Gurian MBF, da Silva APM, Poli-Neto OB, Nogueira AA, Candido-Dos-Reis FJ, Rosa-E-Silva JC. Effect of Acupuncture on Chronic Pelvic Pain Secondary to Abdominal Myofascial Syndrome Not Responsive to Local Anesthetic Block: A Pilot Study. Med Acupunct 2017; 29:397-404. [PMID: 29279735 DOI: 10.1089/acu.2017.1248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Strong evidence shows that 85% of women with chronic pelvic pain (CPP) have musculoskeletal disorders, such as abdominal myofascial pain syndrome (AMPS). The aim of this research was to assess the efficacy of local acupuncture treatment for women with CPP secondary to AMPS unresponsive to treatment with trigger-point injection. Materials and Methods: This pilot study involved 17 women with moderate-to-severe AMPS-related CPP. Acupuncture treatments were given at abdominal-wall trigger points once per week for 10 consecutive weeks. Pain relief was assessed with a visual analogue scale (VAS), the McGill questionnaire, and pressure dynamometer. Quality of life and psychosocial function (risk for anxiety and depression) were evaluated using the Short-Form-36 questionnaire and the Hospital Anxiety and Depression scale. Assessments were performed at baseline and after 1, 3, and 6 months of treatment. Results: Both the VAS and McGill pain questionnaire showed significantly decreased pain intensity (VAS, P < 0.001; and McGill, P 0.049), and the effects were sustained even at 6 months after treatment. Conclusions: Acupuncture treatment was effective for the women who participated in this study, and the current authors believe that these preliminary results suffice to recommend performing randomized controlled trials.
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Affiliation(s)
| | - Maria Beatriz Ferreira Gurian
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | - Ana Paula Moreira da Silva
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | - Omero Benedicto Poli-Neto
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | - Antônio Alberto Nogueira
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | | | - Júlio César Rosa-E-Silva
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
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Impact of Needle Diameter on Long-Term Dry Needling Treatment of Chronic Lumbar Myofascial Pain Syndrome. Am J Phys Med Rehabil 2017; 95:483-94. [PMID: 27333534 PMCID: PMC4902326 DOI: 10.1097/phm.0000000000000401] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental digital content is available in the text. Objective To investigate the impact of diameter of needles on the effect of dry needling treatment of chronic lumbar myofascial pain syndrome. Design Forty-eight patients with chronic lumbar myofascial pain syndrome were randomly allocated to 3 groups. They received dry needling with needles of diameter 0.25 (group A), 0.5 (group B), and 0.9 mm (group C). Visual analog scale evaluation and health survey were conducted at baseline and 3 months after the treatment. Results Visual analog scale scores were significantly different in all groups from baseline to 3 months. Visual analog scale scores at 3 months showed differences between group C and the other 2 groups. When baseline and 3 months after treatment (0 day and 3 months) in each of the 3 groups was compared, there was a difference between group C and group B. The Short Form (36) Health Survey scores from baseline to 3 months were different within the treatment groups. Conclusions Visual analog scale score evaluations at 3 months showed efficacy in all groups. Results of 3 months showed that efficacy of treatment with larger needles (0.9-mm diameter) was better than that of smaller ones (0.5-mm diameter). The Short Form (36) Health Survey scores at 3 months indicated that treatments with needles of varying diameters were all effective, and when the results of 3 months were compared, there was no difference between the 3 groups.
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Cerezo-Téllez E, Lacomba MT, Fuentes-Gallardo I, Mayoral Del Moral O, Rodrigo-Medina B, Gutiérrez Ortega C. Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial. J Man Manip Ther 2016; 24:223-32. [PMID: 27582622 DOI: 10.1179/2042618615y.0000000004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Neck pain is a frequent complaint in office workers. This pain can be caused by myofascial trigger points (MTrPs) in the trapezius muscle. This study aimed to determine the effectiveness of deep dry needling (DDN) of active MTrPs in the trapezius muscle. METHODS A randomized, single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women's Health Research Group at Physical Therapy Department of University of Alcalá, in Alcalá de Henares, Madrid, Spain. Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were randomly allocated to either the DDN or the control group (CG). The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle. They also received passive stretch of the trapezius muscle. The CG received the same passive stretch of the trapezius muscle only. The primary outcome measure was subjective pain intensity, measured using a visual analogue scale (VAS). Secondary outcomes were pressure pain threshold (PPT), cervical range of motion (CROM) and muscle strength. Data were collected at baseline, after interventions and 15 days after the last treatment. RESULTS Differences were found between the DDN group and the CG for the VAS (P < 0.001), PPT (P < 0.001), range of motion (AROM) (P < 0.05) and strength (P < 0.05) after intervention and at the 15-day follow-up. DISCUSSION Deep dry needling and passive stretch seems to be more effective than passive stretch only. The effects are maintained in the short term. The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain.
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Affiliation(s)
- Ester Cerezo-Téllez
- Alcalá de Henares University, Physical Therapy in Women's Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Torres Lacomba
- Alcalá de Henares University, Physical Therapy in Women's Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Isabel Fuentes-Gallardo
- Alcalá de Henares University, Physical Therapy in Women's Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain; Primary Health Care, Alcalá de Henares, Madrid, Spain
| | - Orlando Mayoral Del Moral
- Alcalá de Henares University, Physical Therapy in Women's Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain; Physical Therapy Unit, Provincial Hospital, Toledo, Spain
| | | | - Carlos Gutiérrez Ortega
- Alcalá de Henares University, Physical Therapy in Women's Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology (Preventive Medicine), Central de la Defensa Hospital, Madrid, Spain
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Montenegro MLLS, Braz CA, Rosa-e-Silva JC, Candido-dos-Reis FJ, Nogueira AA, Poli-Neto OB. Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain. BMC Anesthesiol 2015; 15:175. [PMID: 26628263 PMCID: PMC4667406 DOI: 10.1186/s12871-015-0155-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Chronic pelvic pain is a common condition among women, and 10 to 30 % of causes originate from the abdominal wall, and are associated with trigger points. Although little is known about their pathophysiology, variable methods have been practiced clinically. The purpose of this study was to evaluate the efficacy of local anaesthetic injections versus ischemic compression via physical therapy for pain relief of abdominal wall trigger points in women with chronic pelvic pain. Methods We conducted a parallel group randomized trial including 30 women with chronic pelvic pain with abdominal wall trigger points. Subjects were randomly assigned to one of two intervention groups. One group received an injection of 2 mL 0.5 % lidocaine without a vasoconstrictor into a trigger point. In the other group, ischemic compression via physical therapy was administered at the trigger points three times, with each session lasting for 60 s, and a rest period of 30 s between applications. Both treatments were administered during one weekly session for four weeks. Our primary outcomes were satisfactory clinical response rates and percentages of pain relief. Our secondary outcomes are pain threshold and tolerance at the trigger points. All subjects were evaluated at baseline and 1, 4, and 12 weeks after the interventions. The study was conducted at a tertiary hospital that was associated with a university providing assistance predominantly to working class women who were treated by the public health system. Results Clinical response rates and pain relief were significantly better at 1, 4, and 12 weeks for those receiving local anaesthetic injections than ischemic compression via physical therapy. The pain relief of women treated with local anaesthetic injections progressively improved at 1, 4, and 12 weeks after intervention. In contrast, women treated with ischemic compression did not show considerable changes in pain relief after intervention. In the local anaesthetic injection group, pain threshold and tolerance improved with time in the absence of significant differences between groups. Conclusion Lidocaine injection seems to be better for reducing the severity of chronic pelvic pain secondary to abdominal wall trigger points compared to ischemic compression via physical therapy. Trial registration ClinicalTrials.gov NCT00628355. Date of registration: February 25, 2008. Electronic supplementary material The online version of this article (doi:10.1186/s12871-015-0155-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary L L S Montenegro
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil.
| | - Carolina A Braz
- Department of Cardiology, Federal University of São Paulo, São Paulo, Brazil.
| | - Julio C Rosa-e-Silva
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil.
| | - Francisco J Candido-dos-Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil.
| | - Antonio A Nogueira
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil.
| | - Omero B Poli-Neto
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil.
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Terayama H, Yamazaki H, Kanazawa T, Suyama K, Tanaka O, Sawada M, Ito M, Ito K, Akamatsu T, Masuda R, Suzuki T, Sakabe K. Multi-Acupuncture Point Injections and Their Anatomical Study in Relation to Neck and Shoulder Pain Syndrome (So-Called Katakori) in Japan. PLoS One 2015; 10:e0129006. [PMID: 26046784 PMCID: PMC4457803 DOI: 10.1371/journal.pone.0129006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/03/2015] [Indexed: 01/03/2023] Open
Abstract
Katakori is a symptom name that is unique to Japan, and refers to myofascial pain syndrome-like clinical signs in the shoulder girdle. Various methods of pain relief for katakori have been reported, but in the present study, we examined the clinical effects of multi-acupuncture point injections (MAPI) in the acupuncture points with which we empirically achieved an effect, as well as the anatomical sites affected by liquid medicine. The subjects were idiopathic katakori patients (n = 9), and three cadavers for anatomical investigation. BL-10, GB-21, LI-16, SI-14, and BL-38 as the WHO notation were selected as the acupuncture point. Injections of 1 mL of 1% w/v mepivacaine were introduced at the same time into each of these points in the patients. Assessment items were the Pain Relief Score and the therapeutic effect period. Dissections were centered at the puncture sites of cadavers. India ink was similarly injected into each point, and each site that was darkly-stained with India ink was evaluated. Katakori pain in the present study was significantly reduced by MAPI. Regardless of the presence or absence of trigger points, pain was significantly reduced in these cases. Dark staining with India ink at each of the points in the anatomical analysis was as follows: BL-10: over the rectus capitis posterior minor muscle and rectus capitis posterior major muscle fascia; GB-21: over the supraspinatus muscle fascia; LI-16: over the supraspinatus muscle fascia; SI-14: over the rhomboid muscle fascia; and BL-38: over the rhomboid muscle fascia. The anatomical study suggested that the drug effect was exerted on the muscles above and below the muscle fascia, as well as the peripheral nerves because the points of action in acupuncture were darkly-stained in the spaces between the muscle and the muscle fascia.
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Affiliation(s)
- Hayato Terayama
- Department of Anatomy, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Hajime Yamazaki
- Department of Anesthesiology, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Teruhisa Kanazawa
- Department of Anatomy, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Kaori Suyama
- Department of Anatomy, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Osamu Tanaka
- Department of Anatomy, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Makoto Sawada
- Department of Anesthesiology, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Miho Ito
- Department of Anesthesiology, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Kenji Ito
- Department of Anesthesiology, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Tadashi Akamatsu
- Department of Plastic and Cosmetic Surgery, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Ritsuko Masuda
- Department of Anesthesiology, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Toshiyasu Suzuki
- Department of Anesthesiology, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Kou Sakabe
- Department of Anatomy, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
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A new look at trigger point injections. Anesthesiol Res Pract 2011; 2012:492452. [PMID: 21969825 PMCID: PMC3182370 DOI: 10.1155/2012/492452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/28/2011] [Accepted: 07/30/2011] [Indexed: 11/17/2022] Open
Abstract
Trigger point injections are commonly practised pain interventional techniques. However, there is still lack of objective diagnostic criteria for trigger points. The mechanisms of action of trigger point injection remain obscure and its efficacy remains heterogeneous. The advent of ultrasound technology in the noninvasive real-time imaging of soft tissues sheds new light on visualization of trigger points, explaining the effect of trigger point injection by blockade of peripheral nerves, and minimizing the complications of blind injection.
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Min SH, Chang SH, Jeon SK, Yoon SZ, Park JY, Shin HW. Posterior auricular pain caused by the trigger points in the sternocleidomastoid muscle aggravated by psychological factors -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S229-32. [PMID: 21286448 PMCID: PMC3030044 DOI: 10.4097/kjae.2010.59.s.s229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 04/10/2010] [Accepted: 04/26/2010] [Indexed: 11/26/2022] Open
Abstract
Psychological factors play a significant role in the pain mechanism, and psychological approaches may be useful complements to traditional medical and surgical treatments in pain management. The authors report a case of recurrent severe posterior auricular pain caused by trigger points in the right sternocleidomastoid muscle and influenced by stressful psychological situations (e.g., family affairs, job loss) in a 50-year-old man.
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Affiliation(s)
- Sam Hong Min
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Kim PS. Role of injection therapy: review of indications for trigger point injections, regional blocks, facet joint injections, and intra-articular injections. Curr Opin Rheumatol 2002; 14:52-7. [PMID: 11790997 DOI: 10.1097/00002281-200201000-00010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Injection therapies play a major role in the management of various pain conditions. Some injections are relatively simple to perform whereas others are technically demanding with significant risk of mortality and morbidity. Traditional therapies such as intra-articular injections, regional blocks, and trigger-point injections continue to be redefined as we gain a better understanding into the pathophysiology of nociception, with a greater insight into regional anatomy using improved imaging capabilities. Injection therapies are becoming an integral part of the multidisciplinary therapies required to improve and rehabilitate pain patients. The necessity of clinical outcome assessments including functional-based outcomes and cost-effective analysis is becoming more important in the current medical reimbursement environment.
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Affiliation(s)
- Philip S Kim
- Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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