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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2010

Open Access 01-12-2010 | Research article

Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey

Authors: Johannes Fleckenstein, Daniela Zaps, Linda J Rüger, Lukas Lehmeyer, Florentina Freiberg, Philip M Lang, Dominik Irnich

Published in: BMC Musculoskeletal Disorders | Issue 1/2010

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Abstract

Background

Myofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population. Current guidelines for the management of myofascial pain are not available. In this study we investigated how physicians on the basis of prescription behaviour evaluate the effectiveness of treatment options in their management of myofascial pain.

Methods

We conducted a cross-sectional, nationwide survey with a standardized questionnaire among 332 physicians (79.8% male, 25.6% female, 47.5 ± 9.6 years) experienced in treating patients with myofascial pain. Recruitment of physicians took place at three German meetings of pain therapists, rheumatologists and orthopaedists, respectively. Physicians estimated the prevalence of myofascial pain amongst patients in their practices, stated what treatments they used routinely and then rated the perceived treatment effectiveness on a six-point scale (with 1 being excellent). Data are expressed as mean ± standard deviation.

Results

The estimated overall prevalence of active myofascial trigger points is 46.1 ± 27.4%. Frequently prescribed treatments are analgesics, mainly metamizol/paracetamol (91.6%), non-steroidal anti-inflammatory drugs/coxibs (87.0%) or weak opioids (81.8%), and physical therapies, mainly manual therapy (81.1%), TENS (72.9%) or acupuncture (60.2%). Overall effectiveness ratings for analgesics (2.9 ± 0.7) and physical therapies were moderate (2.5 ± 0.8). Effectiveness ratings of the various treatment options between specialities were widely variant. 54.3% of all physicians characterized the available treatment options as insufficient.

Conclusions

Myofascial pain was estimated a prevalent condition. Despite a variety of commonly prescribed treatments, the moderate effectiveness ratings and the frequent characterizations of the available treatments as insufficient suggest an urgent need for clinical research to establish evidence-based guidelines for the treatment of myofascial pain syndrome.
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Literature
1.
Skovron ML: Epidemiology of low back pain. Baillieres Clin Rheumatol. 1992, 6: 559-573. 10.1016/S0950-3579(05)80127-X.CrossRefPubMed
2.
Simons DG: Clinical and Etiological Update of Myofascial Pain from Trigger Points. Journal of Musculoskeletal Pain. 1996, 4: 93-122. 10.1300/J094v04n01_07.CrossRef
3.
Simons DG: Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004, 14: 95-107. 10.1016/j.jelekin.2003.09.018.CrossRefPubMed
4.
Hubbard DR, Berkoff GM: Myofascial trigger points show spontaneous needle EMG activity. Spine. 1993, 18: 1803-1807. 10.1097/00007632-199310000-00015.CrossRefPubMed
5.
Shah JP, Phillips TM, Danoff JV, Gerber LH: An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005, 99: 1977-1984. 10.1152/japplphysiol.00419.2005.CrossRefPubMed
6.
Mense S, Hoheisel U: [A lack of NO in the spinal cord as a possible factor for the occurrence of spontaneous pain]. Schmerz. 2001, 15: 19-25. 10.1007/s004820170044.CrossRefPubMed
7.
Mense S: Nociception from skeletal muscle in relation to clinical muscle pain. Pain. 1993, 54: 241-289. 10.1016/0304-3959(93)90027-M.CrossRefPubMed
8.
Mense S, Simons DG, Russell IJ: Muscle pain: its Nature, Diagnosis, and treatment. 2001, Philadelphia: Lippincott, Williams & Wilkins
9.
Bron C, Wensing M, Franssen JL, Oostendorp RA: Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066]. BMC Musculoskelet Disord. 2007, 8: 107-10.1186/1471-2474-8-107.CrossRefPubMedPubMedCentral
10.
Irnich D: Trigger Point Manual [Leitfaden Triggerpunkte]. 2008, Munich, Jena: Elsevier, Urban&Fischer
11.
Lavelle ED, Lavelle W, Smith HS: Myofascial trigger points. Anesthesiol Clin. 2007, 25: 841-851. 10.1016/j.anclin.2007.07.003. vii-iiiCrossRefPubMed
12.
Srbely JZ: Ultrasound in the management of osteoarthritis: part I: a review of the current literature. JCCA J Can Chiropr Assoc. 2008, 52: 30-37.PubMed
13.
Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M, Natalis M, Senn E, Beyer A, Schops P: Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain. Bmj. 2001, 322: 1574-1578. 10.1136/bmj.322.7302.1574.CrossRefPubMedPubMedCentral
14.
Castien RF, Windt van der DA, Dekker J, Mutsaers B, Grooten A: Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial. BMC Musculoskelet Disord. 2009, 10: 21-10.1186/1471-2474-10-21.CrossRefPubMedPubMedCentral
15.
Wheeler AH: Myofascial pain disorders: theory to therapy. Drugs. 2004, 64: 45-62. 10.2165/00003495-200464010-00004.CrossRefPubMed
16.
Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW: Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2005, 30: 2153-2163. 10.1097/01.brs.0000182227.33627.15.CrossRefPubMed
17.
Ga H, Choi JH, Park CH, Yoon HJ: Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients--a randomised trial. Acupunct Med. 2007, 25: 130-136. 10.1136/aim.25.4.130.CrossRefPubMed
18.
Cummings M, Baldry P: Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol. 2007, 21: 367-387. 10.1016/j.berh.2006.12.006.CrossRefPubMed
19.
Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW, Berman BM: Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev. 2005, CD001351-
20.
Tough EA, White AR, Cummings TM, Richards SH, Campbell JL: Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain. 2009, 13: 3-10. 10.1016/j.ejpain.2008.02.006.CrossRefPubMed
21.
Peloso P, Gross A, Haines T, Trinh K, Goldsmith CH, Burnie S: Medicinal and injection therapies for mechanical neck disorders. Cochrane Database Syst Rev. 2007, CD000319-
22.
Ho KY, Tan KH: Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review. Eur J Pain. 2007, 11: 519-527. 10.1016/j.ejpain.2006.09.002.CrossRefPubMed
23.
Cummings TM, White AR: Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001, 82: 986-992. 10.1053/apmr.2001.24023.CrossRefPubMed
24.
Tsang JL, Mendelsohn A, Tan MK, Hackam DG, Leiter LA, Fitchett D, Lin PJ, Grima E, Langer A, Goodman SG: Discordance between physicians' estimation of patient cardiovascular risk and use of evidence-based medical therapy. Am J Cardiol. 2008, 102: 1142-1145. 10.1016/j.amjcard.2008.06.037.CrossRefPubMed
25.
Bishop A, Foster NE, Thomas E, Hay EM: How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008, 135: 187-195. 10.1016/j.pain.2007.11.010.CrossRefPubMedPubMedCentral
26.
Majumdar SR, McAlister FA, Soumerai SB: Synergy between publication and promotion: comparing adoption of new evidence in Canada and the United States. Am J Med. 2003, 115: 467-472. 10.1016/S0002-9343(03)00422-4.CrossRefPubMed
27.
IOM: Clinical Practice Guidelines: Directions for a New Program. Book Clinical Practice Guidelines: Directions for a New Program (Editor ed.êds.). 1990, City: Institute of Medicine, National Academy Press
28.
Miceli F, Soldovieri MV, Martire M, Taglialatela M: Molecular pharmacology and therapeutic potential of neuronal Kv7-modulating drugs. Curr Opin Pharmacol. 2008, 8: 65-74. 10.1016/j.coph.2007.10.003.CrossRefPubMed
29.
Magni G, Caldieron C, Rigatti-Luchini S, Merskey H: Chronic musculoskeletal pain and depressive symptoms in the general population. An analysis of the 1st National Health and Nutrition Examination Survey data. Pain. 1990, 43: 299-307. 10.1016/0304-3959(90)90027-B.CrossRefPubMed
30.
Chapman CR, Tuckett RP, Song CW: Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008, 9: 122-145. 10.1016/j.jpain.2007.09.006.CrossRefPubMed
31.
Simons DG: Understanding effective treatments of myofascial trigger points. J Bodywork Movement Therap. 2002, 6: 81-88. 10.1054/jbmt.2002.0271.CrossRef
32.
Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N: Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain. 2009, 25: 80-89. 10.1097/AJP.0b013e31817e13b6.CrossRefPubMed
33.
Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gevirtz R: Interrater reliability in myofascial trigger point examination. Pain. 1997, 69: 65-73. 10.1016/S0304-3959(96)03248-4.CrossRefPubMed
34.
Sciotti VM, Mittak VL, DiMarco L, Ford LM, Plezbert J, Santipadri E, Wigglesworth J, Ball K: Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001, 93: 259-266. 10.1016/S0304-3959(01)00325-6.CrossRefPubMed
35.
Licht G, Müller-Ehrenberg H, Mathis J, Berg G, Greitemann G: Untersuchung myofaszialer Triggerpunkte ist zuverlässig [Examination of myofascial trigger points is reliable]. Manuelle Medizin. 2007, 45: 402-408. 10.1007/s00337-007-0559-0.CrossRef
36.
Harden RN, Bruehl SP, Gass S, Niemiec C, Barbick B: Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers. Clin J Pain. 2000, 16: 64-72. 10.1097/00002508-200003000-00010.CrossRefPubMed
Metadata
Title
Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey
Authors
Johannes Fleckenstein
Daniela Zaps
Linda J Rüger
Lukas Lehmeyer
Florentina Freiberg
Philip M Lang
Dominik Irnich
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2010
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-11-32

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