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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Treatment of myofascial pain syndrome with lidocaine injection and physical therapy, alone or in combination: a single blind, randomized, controlled clinical trial

Authors: Luz Helena Lugo, Hector Ivan García, Heather L. Rogers, Jesús Alberto Plata

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

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Abstract

Background

Myofascial pain syndrome (MPS) of the shoulder girdle and cervical region is a common musculoskeletal problem that is often chronic or recurrent. Physical therapy (PT) and lidocaine injections (LI) are two treatments with demonstrated effectiveness compared to a control group, however little is known about their combined value. The objective of this study was to determine whether LI into trigger points combined with a PT program would be more effective than each separate treatment alone in improving pain, function, and quality of life in a group of patients with MPS of the shoulder girdle and cervical region.

Methods

A single-blind, randomized, controlled clinical trial (RCT) was conducted with three parallel groups in the Departments of Physical Medicine and Rehabilitation of two urban hospitals in Medellin, Colombia. One hundred and twenty seven patients with shoulder girdle MPS for more than 6 weeks and pain greater than 40 mm on the visual analog scale (VAS) were assigned to 1 of 3 intervention groups: PT, LI, or the combination of both (PT + LI). The primary outcome was VAS pain rating at 1-month post-treatment. The secondary outcomes included VAS pain rating at 3 months, and, at both 1 and 3 months post-treatment: (a) function, evaluated by hand-back maneuver and the hand-mouth maneuver, (b) quality of life, as measured by sub-scales of the Short Form – 36 (SF-36), and (c) depressive symptoms, as measured by the Patient Health Questionnaire – 9 (PHQ-9). Independent t-tests were used to compare outcomes between groups at 1 month and 3 months post-treatment.

Results

In the per protocol analysis, there were no significant intergroup differences in VAS at 1 month PT + LI, 40.8 [25.3] vs. PT, 37.8 [21.9], p = 0.560 and vs. LI, 44.2 [24.9], p = 0.545. There were also no differences between groups on secondary outcomes except that the PT and PT + LI groups had higher right upper limb hand-back maneuver scores compared to the LI alone group at both 1 and 3 months (p = 0.013 and p = 0.016 respectively).

Conclusions

The results of this RCT showed that no differences in pain ratings were observed between the individual treatments (PT or LI) compared to the combined treatment of PT and LI. In general, no difference in primary or secondary outcomes was observed between treatments.

Trial registration

NTC01250184 November 27, 2010.
Literature
1.
Simons DG, Travell JG. Apropos of all muscles. In: Simons DG, Travell JG, Simons LS, editors. Travell & Simons’ myofascial pain and dysfunction: the trigger point manual. 2nd ed. Baltimore: Williams & Wilkins; 1999. p. 94–173.
2.
3.
Lin Y-C, Kuan T-S, Hsieh P-C, Yen W-J, Chang W-C, Chen S-M. Therapeutic effects of lidocaine patch on myofascial pain syndrome of the upper trapezius: a randomized, double-blind, placebo-controlled study. Am J Phys Med Rehabil. 2012;91:871–82.CrossRefPubMed
4.
Cummings M, White A. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82:986–92.CrossRefPubMed
5.
Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Arch Phys Med Rehabil. 2011;92:657–62.CrossRefPubMed
6.
Quintner JL, Bove GM, Cohen ML. Comment: a critical evaluation of the trigger point phenomenon. Rheumatology. 2015;54(3):392–9.CrossRefPubMed
7.
Dommerholt J, Gerwin RD. A critical evaluation of Quintner et al: Missing the point. J Bodyw Mov Ther. 2015;19:193–204.CrossRefPubMed
8.
Doggweiler-Wiygul R. Urologic myofascial pain syndromes. Curr Pain Headache Rep. 2004;8(6):445–51.CrossRefPubMed
9.
Ge HY, Fernández-de-Las-Peñas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med. 2011;6:13.CrossRefPubMedPubMedCentral
10.
Shah JP, Elizabeth A, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008;12:371–84.CrossRefPubMed
11.
12.
Hocking MJ. Exploring the central modulation hypothesis: do ancient memory mechanisms underlie the pathophysiology of trigger points? Curr Pain Headache Rep. 2013;17(7):347.CrossRefPubMed
13.
14.
15.
16.
Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gevirtz R. Inter-rater reliability in myofascial trigger point examination. Pain. 1997;69:65–73.CrossRefPubMed
17.
Bron C, Franssen J, Wensing M, Oostendorp RAB. Interrater reliability of palpation of myofascial trigger points in three shoulder muscles. J Man Manip Ther. 2007;15:203–15.CrossRefPubMedPubMedCentral
18.
Barbero M, Bertoli P, Cescon C, Macmillan F, Coutts F, Gatti R. Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle. J Man Manip Ther. 2012;20:171–7.CrossRefPubMedPubMedCentral
19.
Simons DG. New views of myofascial trigger points: etiology and diagnosis [commentary]. Arch Phys Med Rehabil. 2008;89:157–9.CrossRefPubMed
20.
Kay TM, Gross A, Goldsmith CH, Rutherford S, Voth S, Hoving JL, Brønfort G, Santaguida PL. Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD004250. DOI: 10.​1002/​14651858. CD004250.pub4.
21.
Guyatt G, Oxman AD, Akl E, Kunz R, Vist G, Brozek J, et al. GRADE guidelines 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383–94.CrossRefPubMed
22.
Green S, Buchbinder R, Hetrick SE. Physiotherapy interventions for shoulder pain. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD004258. DOI: 10.​1002/​14651858.​CD004258.
23.
Kong LJ, Hong Sheng Z, Cheng YW, Yuan WA, Chen BO, Fang M. Massage therapy for neck and shoulder pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2013;1:1–10.
24.
Cho JH, Brodsky M, Kim EJ, Cho YJ, Kim KW, Fang JY, et al. Efficacy of a 0.1% capsaicin hydrogel patch for myofascial neck pain: a double-blinded randomized trial. Pain Med. 2012;13:965–70. 1413.CrossRefPubMed
25.
Affaitati G, Fabrizio A, Savini A, Lerza R, Tafuri E, Costantini R, et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain. Clin Ther. 2009;31(4):705–20.CrossRefPubMed
26.
Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Ozkurt Zenigin F, Bayik Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2005;25:604–11.CrossRefPubMed
27.
Yoon S-H, Rah UW, Sheen SS, Cho KH. Comparison of 3 needle sizes for trigger point injection in myofascial pain syndrome of upper- and middle-trapezius muscle: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:1332–9.CrossRefPubMed
28.
Peloso PMJ, Gross A, Haines T, Trinh K, Goldsmith CH, Burnie SJ, Cervical Overview Group. Medicinal and injection therapies for mechanical neck disorders. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD000319. DOI:10.​1002/​14651858.​CD000319.
29.
Bron C, De Gast A, Jommerholt J, Stegenga B, Wensing M, Oostendorp RAB. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Med. 2011;9:8. 1-14.CrossRefPubMedPubMedCentral
30.
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American college of rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160–72.CrossRefPubMed
31.
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RS, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol. 2011;38:1113–22.CrossRefPubMed
32.
Lugo LH, Garcia HI, Gómez C. Reliability of SF36 quality of life questionnaire in SF-36 Medellín Colombia [Reliability of SF36 quality of life questionnaire in SF-36 Medellín, Colombia]. Rev Fac Nac Sal Pub. 2006;24(2):37–50.
33.
34.
35.
Ruiz-Sáez M, Fernández-de-las-Peñas C, Rodríguez-Blanco C, Martinez-Segura R, García-León R. Changes in pressure pain sensitivity in latent myofascial trigger points in the upper Trapezius muscle following a cervical spine manipulation in pain-free subjects. J Manipulative Physiol Ther. 2007;30:578–83.CrossRefPubMed
36.
Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, Dupont G, Graham N, Burnie SJ, Gelley G, Goldsmith, CH, Forget M, Hoving JL, Brønfort G, Santaguida PL, Cervical Overview Group. Exercises f or mechanical neck disorders. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004250. DOI: 10.​1002/​14651858.​CD004250.​pub5
37.
Hains G, Descarreaux M, Hains F. Chronic shoulder pain of myofascial origin: a randomized clinical trial using ischemic compression therapy. J Manipulative Physiol Ther. 2010;33(5):362–9.CrossRefPubMed
38.
Brosseau L, Wells GA, Tugwell P, Casimiro L, Novikov M. Ottawa panel evidence-based clinical practice guidelines on therapeutic massage for neck pain. J Bodyw Mov Ther. 2012;16:300–25.CrossRefPubMed
39.
Ay S, Evcik D, Tur SB. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2010;29:19–23.CrossRefPubMed
40.
Karadas O, Gul HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain. 2013;14:44.CrossRefPubMedPubMedCentral
41.
BPhty JO, Claydon LS, PG Cert Tert Teach, BSc (Hons). The effect of dry needling for myofascial trigger points in the neck and shoulders: A systematic review and meta-analysis. J Bodyw Mov Ther. 2014;18:390–8.CrossRef
42.
Canadian Agency for drugs and Technologies for Health (CADTH). Botulinum toxin a for myofascial pain syndrome: a review of the clinical effectiveness. Otawa: Canadian Agency for drugs and Technologies for Health (CADTH); 2014.
43.
Tough EA, White AR, Cummings TM, Richards S, 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.CrossRefPubMed
44.
45.
De Andre’s J, Adsuara VM, Palmisani S, Villanueva V, Lopez MD. A double blind, controlled, randomized trial to evaluate the efficacy of botulinum toxin for the treatment of lumbar myofascial pain in humans. Reg Anesth Pain Med. 2010;35:255–60.CrossRef
46.
Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study. Arch Phys Med Rehabil. 2008;89:75–80.CrossRefPubMed
47.
Graboski CL, Gray DS, Burnham RS. Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: A randomised double blind crossover study. Pain. 2005;118:170–5.CrossRefPubMed
Metadata
Title
Treatment of myofascial pain syndrome with lidocaine injection and physical therapy, alone or in combination: a single blind, randomized, controlled clinical trial
Authors
Luz Helena Lugo
Hector Ivan García
Heather L. Rogers
Jesús Alberto Plata
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-0949-3

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