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Myofascial Syndrome



Trigger points: diagnosis and management.

Alvarez DJ, Rockwell PG. Department of Family Medicine, University of Michigan Medical School, Ann Arbor, USA. dalvarez@umich.edu

Am Fam Physician 2002 Feb 15;65(4):653-60

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms. Excerpted from Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual by Devin J. Starlanyl and Mary Ellen Copeland. copyright 1996.

[Comparison between the side-effects of buprenorphine and morphine in conscious man (author's transl)] [Article in French]

Cathelin M, Vignes R, Viars P.

Anesth Analg (Paris) 1980;37(5-6):283-93

Side-effects of increasing doses of morphine (0.100, 0.150, 0.200 mg/kg) and buprenorphine (0.0015, 0.003, 0.006 mg/kg), given intramuscularly, are clinically observed in conscient subjects suffering from intense pain in the facial or trigeminal nerves territory. Buprenorphine induces a drop in ventilation even with the lower doses, which persists for 120-180 minutes. This effect is more important after the injection of an equianalgesic dose of morphine. The same phenomenon is observed for the drop in heart rate and for the hypotension, which remained in all cases very slight. The central side-effects are of the same nature with buprenorphine and with morphine. On the whole this phenomenon appears with the same frequency with both drugs, especially for drowsiness and sleep, for nausea, vomiting and dizziness. Yet, the patient under buprenorphine becomes more frequently confused and agitated. Lastly, a state of euphoria can occur which might be feared to be related to a drug-addict activity of buprenorphine.

Acupuncture, transcutaneous electrical nerve stimulation, and laser therapy in chronic pain.

Fargas-Babjak A. Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada. babjaka@mcmaster.ca

Clin J Pain 2001 Dec;17(4 Suppl):S105-13

OBJECTIVE: The purpose of this review was to determine how effective acupuncture, transcutaneous electrical nerve stimulation, acupuncture-like transcutaneous nerve stimulation, laser therapy, electrical nerve stimulation, and neuroreflexotherapy are in the management of chronic pain. METHODOLOGY: The literature search identified six systematic reviews of the literature and four randomized controlled trials to provide evidence for this review. RESULTS: The systematic reviews included different methodologies and heterogeneity of study groups, but studies were generally of poor methodology. Although sham acupuncture may have analgesic effects, it was used as a control in many studies. CONCLUSIONS: In general, the evidence was contradictory or inadequate, reflecting poor study methodologies. No positive conclusion could be reached for acupuncture, transcutaneous electrical nerve stimulation, acupuncture-like transcutaneous nerve stimulation, laser therapy, or neuroreflexotherapy. A single randomized controlled trial provided limited evidence (level 3) that electrical nerve stimulation is effective for pain relief in myofascial pain syndrome for up to 4 weeks, but further study in humans is needed. Future randomized controlled trials and systematic reviews should include subgroup analyses of sham acupuncture and inert placebos as controls.

Emotional factors in temporomandibular joint disorders.

Glaros AG. Department of Dental Public Health and Behavioral Science, University of Missouri-Kansas City, USA.

J Indiana Dent Assoc 2000-01;79(4):20-3

The chronic pain of many temporomandibular disorders is associated with multiple changes in emotional function and activities of daily living. Temporomandibular disorders (TMD) are similar to other chronic pain disorders in their impact on patients. Depression is probably the most common emotional state associated with chronic pain, although anxiety disorders also can be associated with TMD. The probability of emotional problems appears to be greatest in those individuals diagnosed with myofascial pain and least in those with disk displacement. Dental practitioners are encouraged to seek professional liaisons with mental health professionals who can assist them in managing chronic pain patients.

Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain.

Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M, Natalis M, Senn E, Beyer A, Schops P. Department of Anaesthesiology, Ludwig-Maximilians University, 81377 Munich, Germany. Dominik.Irnich@lrz.uni-muenchen.de

BMJ 2001 Jun 30;322(7302):1574-8

OBJECTIVES: To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain.

DESIGN: Prospective, randomised, placebo controlled trial. Setting: Three outpatient departments in Germany.

PARTICIPANTS: 177 patients aged 18-85 years with chronic neck pain. Interventions: Patients were randomly allocated to five treatments over three weeks with acupuncture (56), massage (60), or "sham" laser acupuncture (61).

MAIN OUTCOME MEASURES: Primary outcome measure: maximum pain related to motion (visual analogue scale) irrespective of direction of movement one week after treatment. Secondary outcome measures: range of motion (3D ultrasound real time motion analyser), pain related to movement in six directions (visual analogue scale), pressure pain threshold (pressure algometer), changes of spontaneous pain, motion related pain, global complaints (seven point scale), and quality of life (SF-36). Assessments were performed before, during, and one week and three months after treatment. Patients' beliefs in treatment were assessed.

RESULTS: One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage (difference 24.22 (95% confidence interval 16.5 to 31.9), P=0.0052) but not compared with sham laser (17.28 (10.0 to 24.6), P=0.327). Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years (n=75) and in patients with myofascial pain syndrome (n=129). The acupuncture group had the best results in most secondary outcome measures. There were no differences in patients' beliefs in treatment.

CONCLUSIONS: Acupuncture is an effective short term treatment for patients with chronic neck pain, but there is only limited evidence for long term effects after five treatments.

Water-diluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: evaluation of types of local anesthetic and concentrations in water.

Iwama H, Ohmori S, Kaneko T, Watanabe K. Department of Anesthesiology, Central Aizu General Hospital, Aizuwakamatsu, Japan.

Reg Anesth Pain Med 2001 Jul-Aug;26(4):333-6

BACKGROUND AND OBJECTIVES: We have recently demonstrated that a mixture of 1% lidocaine with water in a 1:3 ratio has less injection pain and is more effective than unaltered 1% lidocaine in treating chronic myofascial pain syndromes. Yet, the most suitable local anesthetic and the most effective dilution in water have not been evaluated.

METHODS: Various mixtures of local anesthetics and water or saline were injected intramuscularly into the shoulder of 40 female volunteers, and pain scores on injection were evaluated in a randomized and double-blinded manner. In another portion of the study, 0.25% or 0.2% lidocaine in water were injected randomly into 1 side of 21 outpatients with chronic neck, shoulder, or lumbar myofascial pain to the same degree in both sides. The other solution was injected into the other side of the same patients.

RESULTS: Less injection pain was experienced with the water-diluted 0.25% lidocaine and water-diluted 0.25% mepivacaine than the saline-diluted 0.25% lidocaine and water-diluted 0.0625% bupivacaine. Also, less injection pain was experienced with the water-diluted 0.25% and 0.2% lidocaine than the water-diluted 0.3% and 0.15% lidocaine. In the other study, there were no differences in either the effectiveness or duration of analgesia between the 0.25% and 0.2% water-diluted lidocaine.

CONCLUSIONS: The suitable type of local anesthetic may be lidocaine or mepivacaine, and the most effective water-diluted concentration is considered to be 0.2% to 0.25%.

Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation.

Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Department of Rheumatology, Frederiksberg Hospital, Copenhagen, Denmark.

Scand J Rheumatol 1991;20(4):294-302

S-adenosylmethionine is a relatively new anti-inflammatory drug with analgesic and anti-depressant effects. Efficacy of 800 mg orally administered s-adenosylmethionine daily versus placebo for six weeks was investigated in 44 patients with primary fibromyalgia in double-blind settings. Tender point score, isokinetic muscle strength, disease activity, subjective symptoms (visual analog scale), mood parameters and side effects were evaluated. Improvements were seen for clinical disease activity (P = 0.04), pain experienced during the last week (P = 0.002), fatigue (P = 0.02), morning stiffness (P = 0.03) and mood evaluated by Face Scale (P = 0.006) in the actively treated group compared to placebo. The tender point score, isokinetic muscle strength, mood evaluated by Beck Depression Inventory and side effects did not differ in the two treatment groups. S-adenosylmethionine has some beneficial effects on primary fibromyalgia and could be an important option in the treatment hereof.

An audit of the effectiveness of acupuncture on musculoskeletal pain in primary health care.

Kam E, Eslick G, Campbell I.

Acupunct Med 2002 Mar;20(1):35-8

Little is known about the use of acupuncture in general practice. We performed a retrospective review of the use of acupuncture in relieving musculoskeletal pain, a condition that is commonly encountered in general practice. A sample of 116 patient records was reviewed, from which 92 patients (mean age 52 years, 64% female) met the inclusion criterion of musculoskeletal pain. Information obtained included age, sex, diagnosis, duration of the problem, length of treatment (weeks), number of treatments, duration of each treatment (minutes), number of needles used, level of benefit obtained from the treatment, and recurrence of pain. There were many different conditions encountered. We found an association between the general practitioner using fewer needles and patients experiencing greater pain relief. This could be a reflection of treating myofascial pain syndromes, which often appear to respond well to a single needle in the key trigger point. Overall, we found that sixty-nine percent of patients had a good or excellent response to acupuncture treatment. We recommend acupuncture as a treatment option for patients who do not respond to the usual therapies (non-steroidal anti-inflammatory drugs) for musculoskeletal conditions.

Lipid profile in patients with fibromyalgia and myofascial pain syndromes.

Ozgocmen S, Ardicoglu O. Department of Physical Medicine & Rehabilitation, Ankara State Hospital, Turkey. sozgocmen@hotmail.com

Yonsei Med J 2000 Oct;41(5):541-5

In this study serum lipid profile of patients with fibromyalgia syndrome (FMS) and myofascial pain syndrome (MPS) were investigated and compared with healthy controls. Thirty women who had FMS and 32 women who had MPS with the characteristic trigger points (TrP), especially on the periscapular region were included in this study. Thirty one age matched healthy women were assigned as a control group. All of the subjects were sedentary healthy housewives. Total cholesterol, triglyceride and high-density lipoprotein cholesterol (HDL-c) levels were not significantly different between the FMS and control groups. On the other hand the MPS group had total cholesterol (198.7 vs 172.9 mg/dL, p=0.003), triglyceride (124.7 vs 87.6 mg/dL, p=0.01), low-density lipoprotein cholesterol (LDL-c) (127.5 vs 108.4 mg/dL, p=0.02) and very low-density lipoprotein cholesterol (VLDL-c) (24.9 vs 17.3 mg/dL, p=0.008) levels, which were significantly higher than the controls. There was no significant difference between the lipid profiles in the FMS and MPS groups. Tissue compliance, which was measured from trigger points in the MPS group, correlated significantly with total cholesterol and LDL-c levels. In conclusion, a significant difference was found between the lipid levels of patients with MPS and the controls. More extensive investigation of lipid and lipoprotein levels is required to determine whether high lipid levels are the cause or result of MPS.

Amitriptyline treatment of chronic pain in patients with temporomandibular disorders.

Plesh O, Curtis D, Levine J, McCall WD Jr. Department of Restorative Dentistry, School of Dentistry, University of California, San Francisco 94143-0758, USA. oplesh@itsa.ucsf.edu

J Oral Rehabil 2000 Oct;27(10):834-41

Randomized clinical trials of amitriptyline will require data from pilot studies to be used for sample size estimates, but such data are lacking. This study investigated the 6-week and 1-year effectiveness of low dose amitriptyline (10-30 mg) for the treatment of patients with chronic temporomandibular disorder (TMD) pain. Based on clinical examination, patients were divided into two groups: myofascial and mixed (myofascial and temporomandibular joint disorders). Baseline pain was assessed by a Visual Analogue Scale (VAS) for pain intensity and by the McGill Pain Questionnaire (MPQ). Depression was assessed by the Beck Depression Inventory (BDI) short form. Patient assessment of global treatment effectiveness was obtained after 6 weeks and 1 year of treatment by using a five-point ordinal scale: (1) worse, (2) unchanged, (3) minimally improved, (4) moderately improved, (5) markedly improved. The results showed a significant reduction for all pain scores after 6 weeks and 1 year post-treatment. The depression scores changed in depressed but not in non-depressed patients. Global treatment effectiveness showed significant improvement 6 weeks and 1 year post-treatment. However, pain and global treatment effectiveness were less improved at 1 year than at 6 weeks.

Myofascial Pain and Dysfunction: The Trigger Point Manual 1983.

Travell, J.G., Simons, D.G.

Baltimore: Williams & Wilkins.

[A study on the clinical curative effect by acupuncture for myofascial pain dysfunction syndrome] [Article in Chinese]

Wang C, Long X, Zhu X. Hospital of Stomatology, Hubei Medical University, Wuhan 430070.

Zhonghua Kou Qiang Yi Xue Za Zhi 1998 Sep;33(5):273-5

OBJECTIVE: To study the acupuncture treatment for myofascial pain dysfunction (MPD) using infrared thermography and microcirculation. METHODS: The temperature of the skin on the TMJ regions, the blood vessels and the blood flow of the Nail Fold capillary loops, were observed in the group of the acupuncture He Gu and Min Yin point and the control group. RESULTS: There were high temperature of the skin on the TMJ regions, and enlarged blood vessels and increased blood flow of the Nail Fold capillary loops in the treatment group, with elimination of, pain and increase of mouth opening as compared with the control group. The effective rate of the acupuncture treatment of 477 cases of MPD is 93.1%. CONCLUSION: The He Gu and Min Yin points are sensitive point for the treatment of MPD.


Does EMG (dry needling) reduce myofascial pain symptoms due to cervical nerve root irritation?

Chu J Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.

Electromyogr Clin Neurophysiol 1997 Aug;37(5):259-72

OBJECTIVE: EMG examination at tender points affects myofascial pain symptoms related to cervical nerve root irritation.

METHODS: Consecutive patients with neck and arm pain had physical examinations immediately before and after having EMGs of bilateral C3-C8 myotomes. Patients were randomly chosen for EMG either at the most tender point along the palpated myofascial band or at a nonselected site. The myotomal presence of > or = 30% incidence of normal duration and amplitude, and polyphasic motor unit potentials confirm the diagnosis of cervical nerve root irritation.

RESULTS: 52% returned patient questionnaires 2 weeks post EMG examination. Group I (82/122 patients [67.2%]), averaged pain relief of 51.8 +/- 21.9%, a mean of 10.2 +/- 8 days; 14% had > or = 75% relief. The number of days of pain relief correlated positively with the percentage of pain relief (p < 0.005), but negatively with the number of nerve roots involved on EMG (p < 0.05). Group 2 (23/42 patients [54.8%]), averaged relief of 39.0 +/- 18.7%, lasting 8.8 +/- 11.2 days. None had > or = 75% pain relief. Both groups' duration of pain symptoms affected onset of relief. Evidence of bilateral multiple-level cervical nerve root irritation, especially noted at bilateral C6 and C7 levels.

CONCLUSION: EMG at tender points on myofascial bands tends to improve symptoms. Needling these points elicits motor endplate activity and twitches, and induces more relief than when needling random points.

Interventional approaches to the management of myofascial pain syndrome.

Criscuolo CM. Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, 984455 Nebraska Medical Center, Omaha, NE 68198-4455, USA. ccriscuo@unmc.edu

Curr Pain Headache Rep 2001 Oct;5(5):407-11

Interventional therapies are a valuable addition to our armamentarium when treating myofascial pain syndromes. When combined with other therapies, interventional techniques can be an effective adjunct in the multidisciplinary management of pain. This article describes current interventional therapies that are employed in treating myofascial pain syndromes. The mainstay of injection therapies, the myofascial trigger point injection, is emphasized. More recent advances, such as the use of botulinum toxin, are also discussed. In addition, other techniques such as acupuncture and the use of laser therapy are mentioned.

Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials.

Ernst E, White AR Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter England. e.ernst@ex.ac.uk

Arch Otolaryngol Head Neck Surg 1999 Mar;125(3):269-72

OBJECTIVE: To summarize the data from randomized controlled trials of acupuncture for temporomandibular joint dysfunction.

METHODS: Four independent computerized literature searches were performed. Only randomized trials were admitted in which acupuncture was tested vs sham acupuncture, standard therapy, or no treatment at all. Data were extracted in a predefined, standardized fashion.

RESULTS: Six reports met the inclusion and exclusion criteria, representing 3 distinct trials. Overall, their results suggest that acupuncture might be an effective therapy for temporomandibular joint dysfunction. However, none of the studies was designed to control for a placebo effect.

CONCLUSION: Even though all studies are in accordance with the notion that acupuncture is effective for temporomandibular joint dysfunction, this hypothesis requires confirmation through more rigorous investigations.

Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation.

Hesse J, Mogelvang B, Simonsen H Pain Clinic and Medical Department, Skodsborg Sanatorium, Denmark.

J Intern Med 1994 May;235(5):451-6

OBJECTIVES. To compare the effects of dry needling of myofascial trigger points in the neck region to metoprolol in migraine prophylaxis.

DESIGN. Randomized, group comparative study. patients, investigator and statistician were blinded as to treatment, the therapist was blinded as to results.

SETTING. Outpatient pain clinic in the northern Copenhagen area. Patients were referred by general practitioners or respondents to newspaper advertisements.

SUBJECTS. Included were patients with a history of migraine with or without aura for at least 2 years. Excluded were persons with contraindications against treatment with beta blockers, chronic pain syndromes, pregnancy or previous experience with acupuncture or beta-blocking agents. A total of 85 patients were included; 77 completed the study.

INTERVENTIONS. After a 4-week run-in period, patients were allocated to a 17-week regimen either with acupuncture and placebo tablets or to placebo stimulation and metoprolol 100 mg daily.

RESULTS. Both groups exhibited significant reduction in attack frequency (P < 0.01). No difference was found between the groups regarding frequency (P > 0.20) or duration (P > 0.10) of attacks, whereas we found a significant difference in global rating of attacks in favour of metoprolol (P < 0.05).

CONCLUSIONS. Trigger point inactivation by dry needling is a valuable supplement to the list of migraine prophylactic tools, being equipotent to metoprolol in the influence on frequency and duration (but not severity) of attacks, and superior in terms of negative side-effects.

Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response.

Hong CZ Department of Physical Medicine & Rehabilitation, University of California Irvine, Orange.

Am J Phys Med Rehabil 1994 Jul-Aug;73(4):256-63

This study was designed to investigate the effects of injection with a local anesthetic agent or dry needling into a myofascial trigger point (TrP) of the upper trapezius muscle in 58 patients. Trigger point injections with 0.5% lidocaine were given to 26 patients (Group I), and dry needling was performed on TrPs in 15 patients (Group II). Local twitch responses (LTRs) were elicited during multiple needle insertions in both Groups I and II. In another 17 patients, no LTR was elicited during TrP injection with lidocaine (9 patients, group Ia) or dry needling (8 patients, group IIa). Improvement was assessed by measuring the subjective pain intensity, the pain threshold of the TrP and the range of motion of the cervical spine. Significant improvement occurred immediately after injection into the patients in both group I and group II. In Groups Ia and Ib, there was little change in pain, tenderness or tightness after injection. Within 2-8 h after injection or dry needling, soreness (different from patients' original myofascial pain) developed in 42% of the patients in group I and in 100% of the patients in group II. Patients treated with dry needling had postinjection soreness of significantly greater intensity and longer duration than those treated with lidocaine injection. The author concludes that it is essential to elicit LTRs during injection to obtain an immediately desirable effect. TrP injection with 0.5% lidocaine is recommended, because it reduces the intensity and duration of postinjection soreness compared with that produced by dry needling.

Trigger point therapy.

Janssens LA Referral Small Animal Surgery Center, Antwerp, Belgium.

Probl Vet Med 1992 Mar;4(1):117-24

Trigger points (TP) are objectively demonstrable foci in muscles. They are painful on compression and trigger pain in a referred area. This area may be the only locus of complaint in humans. In dogs we cannot prove the existence of referred zones of pain. Therefore, we can only diagnose a TP-induced claudication if we cannot find bone, joint, or neurologic abnormalities, and we do find TP that disappear after treatment together with the original lameness. Several methods have been developed to demonstrate TP existence objectively. These are pressure algometry, pressure threshold measurements, magnetic resonance thermography, and histology. In humans, 71% of the TP described are acupuncture points. TP treatment consists of TP stimulation with non-invasive or invasive methods such as dry needling or injections. In the dog, ten TP are described in two categories of clinical patients. First, those with one or few TP reacting favorably on treatment (+/- 80% success in +/- 2-3 weeks). Second, those with many TPs reacting badly on treatment. Most probably the latter group are fibromyalgia patients.

[Interrelation between physical disease and chronic pain--importance of understanding myofascial pain syndrome] [Article in Japanese]

Kitami K. Section of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital.

Nippon Rinsho 2001 Sep;59(9):1768-72

Myofascial pain syndrome(MPS) is characterized by its unique pathology on developing the intramuscular trigger points. The author performed the psychological tests(Cornell Medical Index, Tokyo University Egogram, Minnesota Multiphasic Personality Inventory) on 46 MPS patients to clarify the psychological background. Results revealed that the MPS patients had remarkable hypochondriacal tendency with irrational way of thinking. The author concluded that it is necessary to be hypochondriacal and irrational for the formation of apparent MPS with outstanding TPs. This fact suggests that TPs in MPS are the result of deteriorated central pain control mechanism that should actually suppress the mechanical constriction of damaged muscles.

Evaluation of acupuncture effect to chronic myofascial pain syndrome in the cervical and upper back regions by the concept of Meridians.

Kung YY, Chen FP, Chaung HL, Chou CT, Tsai YY, Hwang SJ. Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Acupunct Electrother Res 2001;26(3):195-202

Myofascial pain syndrome (MPS) in the cervical and upper back regions is a common medical problem. The involved muscles include trapezius, multifidi, splenius cervicis, levator scapulae, supraspinatus or infraspinatus. Acupuncture is a well-known method for relief of chronic pain. In this study, we evaluated the effect of acupuncture in MPS and its durability by using the concept of meridians. Twenty-nine patients with chronic MPS in the upper back and cervical regions received acupuncture 2 times per week for 3 weeks. According to the pathways of the meridians, we chose acupuncture points by the pain regions located in which parts of meridian passing (i.e. "Where the meridian passes, where to treat the disease."). We evaluated the intensity of pain by visual analog scales (VAS) and active range of motion (ROM) of neck before and after therapy. After receiving acupuncture for 3 weeks, VAS of pain fell significantly from 9.0+/-1.0 to 4.9+/-2.5 and active ROM of neck significantly increased from 35.8+/-10.2 degrees to 61.3+/-9.4 degrees (p<0.05). The onset of symptom relief was gradual and duration of symptom relief after a course of acupuncture was average 5.3+/-1.2 days. In conclusion, acupuncture is a somewhat effective method for pain relief of patients with chronic MPS in the cervical and upper back regions. However, the effect of acupuncture with the concept of meridians on MPS is insidious and the duration of the relief is not long enough.

[Acupuncture in stomatology]. [Article in Czech]

Satko I, Zalesak R, Zajko J

Prakt Zubn Lek 1990 Sep;38(7):194-7

The authors draws attention to the possible use of acupuncture in stomatology used in the course of 13 years in diseases of polyaetiological nature or where the aetiology is not well known. They demonstrate the success of this therapeutic method in diseases such as glossodynia, stomatodynia, primary neuralgia of the trigreminal nerve, contractures of the jaws, myofacial dysfunctional syndrome and disorders of salivary secretion in 178 patients treated at the out-patient department of the Second Stomatological Clinic in Bratislava.

Physical therapy in the management of myofacial pain dysfunction syndrome.

Talaat AM, el-Dibany MM, el-Garf A

Ann Otol Rhinol Laryngol 1986 May-Jun;95(3 Pt 1):225-8

A study of the effectiveness of physical therapy for patients with myofacial pain dysfunction syndrome was performed. Clinical evaluation of 120 patients revealed marked male preponderance, distribution according to age showed a great prevalence of the third decade, and most common chief complaints were pain and muscle tenderness. Patients were classified randomly into three equal groups treated by muscle relaxant drugs, shortwave diathermy, and ultrasonic therapy, respectively. Regular follow-up was carried out for 6 to 12 months to assess patients' responses to different forms of treatment. Evaluation revealed marked relief of symptoms by the use of physical therapy, and the best results were obtained by the use of ultrasonic therapy.

Selective tomography of the TMJ and the myofacial pain-dysfunction syndrome.

Rozencweig D, Martin G

J Prosthet Dent 1978 Jul;40(1):67-74

Tomography is the only technique that gives a precise representation of the temporomandibular articulation. To delineate a discrete impingement upon the articular space and compare before-and-after treatment modalities it is essential to strictly respect the angular criteria. Selective tomography can be accomplished only if three criteria are met: 1. To make an axial cephalogram perpendicular to the submental-vertical film and to measure the angle of the grand axis of each condyle with the median sagittal plane; 2. To orient the incident ray perpendicular to this axis for the sagittal sections and parallel for the frontal sections; 3. To be sure of the exact position of the head on the tomograph. The teeth also must be placed in maximum occlusal contact.

Movements, lumbar and temporomandibular pain and psychopathology.

Sundsvold MO, Vaglum P, Ostberg B

Psychother Psychosom 1981;35(1):1-8

157 males and females divided into four psychodiagnostic groups have been examined according to a specially defined physiotherapeutic (ad modum Sundsvold). In this paper, results from the evaluation of passive and active movements in five body significant differences concerning inhibited movements between the four groups were found, the psychotic group being most inhibited followed by the ego-week neurotic group, the substance-abusing group and the healthy control group. With regard to the slack movements, significant differences were found in the two extremity regions. The substance-abusing group had the most slack movements, next came the ego- weak neurotic group, the psychotic group and lastly the control group. Men were more inhibited than women in three regions, mostly in the lumbosacral region. This finding is discussed in relationship to the high frequency of lumbar disc herniation in men. Women were more significantly inhibited in the temporomandibular region, a finding which may explain why mostly women are suffering from the myofacial pain syndrome.

Pain threshold responses to two different modes of sensory stimulation in patients with orofacial muscular pain: psychologic considerations.

Widerstrom-Noga E, Dyrehag LE, Borglum-Jensen L, Aslund PG, Wenneberg B, Andersson SA Department of Physiology, Goteborg University, Sweden. ewiderst@miamiproj.med.miami.edu

J Orofac Pain 1998 Winter;12(1):27-34

This study focuses on the influence of trait anxiety and mood variables on changes in tooth pain threshold following two similar methods of somatic afferent stimulation, one familiar (manual acupuncture) and one unfamiliar (low-frequency transcutaneous electrical nerve stimulation [low-TENS]). Twenty-one acupuncture responders, treated for long-lasting orofacial muscular pain but naive to low-TENS, were selected for the study. In an experimental session, acupuncture and low-TENS were randomly given during two periods separated by a rest interval. Tooth pain thresholds (PT) were measured before and after stimulation with a computerized electrical pulp tester. Trait anxiety and depression were assessed with psychometric forms before the experimental session in all patients, whereas momentary mood was assessed in 10 randomly selected patients with visual analogue scales during and after the two types of stimulation. Following acupuncture, the group average PT increased significantly, whereas no significant change was observed following low-TENS. Higher scores on trait anxiety correlated significantly with a low PT increase following low-TENS, and higher ratings of stress correlated significantly with a low PT increase following acupuncture. This indicates that the magnitude of analgesia induced by these methods may be modified by psychologic factors like anxiety and stress.