A Preliminary Study to Determine if a Muscle Pain Protocol Can Produce Long-Term Relief in Chronic Back Pain Patients

Marcus, Norman J.; Shrikhande, Allyson; McCarberg, Bill; Gracely, Edward J.

doi:10.1111/pme.12144

Cited by 10 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Once a week for 6 weeks throughout the protocol, a global injection was administered into the iliococcygeus, pubococcygeus, or the puborectalis one side at a time. 7 This way, each muscle of the levator ani sling was treated one time throughout the 6 weeks. With the patient lying in prone, a flexible, 6-in., 27-gauge needle was used to inject the targeted muscle from the subgluteal posterior approach, using an aseptic technique under ultrasound guidance.…”

Section: Methodsmentioning

confidence: 99%

Pain and functionality improved when underlying neuromuscular dysfunction addressed in chronic pelvic pain patients

Natarajan

Ahmed

Mamsaang

et al. 2021

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aim: Examine the effects of treating underlying neuromuscular dysfunction in chronic pelvic pain (CPP) patients.Methods: A retrospective longitudinal study of 200 female and male patients with CPP was performed upon an Institutional Review Board (IRB) approval (IRB# 17-0761). The outpatient protocol consisted of ultrasound-guided trigger point injections to the pelvic floor musculature with peripheral nerve blocks once a week for 6 weeks in an outpatient setting. Pelvic pain and functionality were measured before and after treatment using the Visual Analogue Scale and the Functional Pelvic Pain Scale. Functionality categories assessed were intercourse, bladder, bowel, working, walking, running, lifting, and sleeping. Results: Pretreatment, mean VAS score was 6.44 (standard deviation [SD] = 2.50; p < 0.05, 95% confidence interval [CI] = 6.09-6.79). Posttreatment mean VAS score was 4.25 (SD = 2.63; p < 0.05, 95% CI = 3.88-4.61). The mean FPPS score before treatment was 10.77 (SD = 6.39; p < 0.05, 95% CI = 9.88-11.65). Posttreatment mean FPPS score was 7.42 (SD = 5.87; p < 0.05, 95% CI = 6.61-8.23). Analysis of subcategories within FPPS indicated statistically significant improvement in the categories of intercourse, working, and sleeping. Conclusion: Findings show the treatment was efficient at decreasing pain in CPP patients. Results show promise for improving overall pelvic functionality, particularly within the categories of intercourse, sleeping, and working. K E Y W O R D S chronic pelvic pain, chronic prostatitis, endometriosis, pelvic floor dysfunction, pelvic floor myalgia, pelvic pain 1 | INTRODUCTION Chronic Pelvic Pain (CPP) is characterized by noncyclical pain in the pelvis or abdomen present for 3-6 months, interfering with daily function. 1 CPP is also known as Urological Chronic Pelvic Pain (UCPPS) and Chronic Pelvic Pain Syndrome (CPPS), 2 for the purposes of this study, CPP will be the consistent nomenclature. Rather than being perceived as a single disorder, CPP should be viewed as a pattern of symptoms caused by overlapping

show abstract

Section: Methodsmentioning

confidence: 99%

Pain and functionality improved when underlying neuromuscular dysfunction addressed in chronic pelvic pain patients

Natarajan

Ahmed

Mamsaang

et al. 2021

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…Case 1 represents many of the patients seen in a practice specializing in the identification and treatment of MGP. A retrospective pilot study 10 of 97 patients who had failed one or more interventions for the back pain including spine surgery, epidural steroid injections, facet blocks, radiofrequency ablations, trigger point injections, and prolotherapy, were evaluated for the presence of specific sensitized muscles that could be the source of their ongoing pain. A sensitized muscle is defined as one whose nociceptors have a lowered threshold for depolarization, thereby allowing that sensitized muscle to produce pain with normal activity.…”

Section: Case Reports and Methodsmentioning

confidence: 99%

“…A pilot study was done at KP in San Diego in the Department of Orthopedic Spine Surgery on patients with long-standing back and leg pain who were scheduled for spine surgery and reported in the same paper noted above for post failed treatment back pain patients. 10 Patients were told that it was possible that their pain was related to muscles that were not identified as part of their evaluation, and if so, treatment might avoid the scheduled surgery. Eleven patients volunteered.…”

Section: Case Reports and Methodsmentioning

confidence: 99%

Soft Tissue: A Possible Source of Pain Pre and Post Minimally Invasive Spine Surgery

Marcus

Schmidt

2020

Global Spine Journal

Self Cite

View full text Add to dashboard Cite

Study Design: Case studies. Objectives: To demonstrate that muscle generated pain (MGP) may be a cause of pain in patients who have undergone minimally invasive spine surgery (MISS). Methods: A physical examination including electrical stimulation of putative pain generating muscles to identify the presence of lowered thresholds for depolarization of muscle nociceptors, and an examination of strength and flexibility of key muscles in the upper and lower body, may identify multiple etiologies of MGP. Treatment of identified muscles consisted of muscle/tendon injections to identified sensitized muscles followed by exercises incorporating relaxation limbering and stretching. Results: Postsurgical pain was eliminated and mobility restored in both presented cases replicating success in prior published studies. Conclusions: Understanding the pathophysiological mechanisms of muscle pain may facilitate the evaluation and treatment of MGP in MISS patients diagnosed with failed back surgery syndrome.

show abstract

“…A significant volume of patients with LBP are reported to present with structural pain involving tendon, ligament, and joint degeneration and dysfunction. 15 – 17 If the etiology of the ongoing pain and dysfunction includes both movement impairments and soft tissue degenerative change, interventions to address both impairments and pathology should prove to be more beneficial than addressing one problem alone.…”

Section: Background and Significancementioning

confidence: 99%

Use of localized human growth hormone and testosterone injections in addition to manual therapy and exercise for lower back pain: a case series with 12-month follow-up

Dubick¹,

Ravin²,

Michel³

et al. 2015

JPR

View full text Add to dashboard Cite

ObjectiveThe objective of this case series was to investigate the feasibility and safety of a novel method for the management of chronic lower back pain. Injections of recombinant human growth hormone and testosterone to the painful and dysfunctional areas in individuals with chronic lower back pain were used. In addition, the participants received manual therapies and exercise addressing physical impairments such as motor control, strength, endurance, pain, and loss of movement. Pain ratings and self-rated functional outcomes were assessed.Study designThis is a case series involving consecutive patients with chronic lower back pain who received the intervention of injections of recombinant human growth hormone and testosterone, and attended chiropractic and/or physical therapy. Outcomes were measured at 12 months from the time of injection.SettingA community based hospital affiliated office, and a private practice block suite.ParticipantsA total of 60 consecutive patients attending a pain management practice for chronic lower back pain were recruited for the experimental treatment. Most participants were private pay.InterventionsParticipants who provided informed consent and were determined not to have radicular pain received diagnostic blocks. Those who responded favorably to the diagnostic blocks received injections of recombinant human growth hormone and testosterone in the areas treated with the blocks. Participants also received manipulation- and impairment-based exercises.Outcome measuresOutcomes were assessed at 12 months through pain ratings with the Mankowski Pain Scale and the Oswestry Disability Index.ResultsOf the 60 patients recruited, 49 provided informed consent, and 39 completed all aspects of the study. Those patients receiving the intervention reported a significant decrease in pain ratings (P<0.01) and a significant improvement in self-rated Oswestry Disability Index scores (P<0.01). In addition, in the Oswestry Disability Index results, 41% of the patients demonstrated a 50% or greater change in their disability score. Of the subjects who withdrew from the study, one was due to the pain created by the injections and nine were for nonstudy factors.ConclusionThe intervention appeared to be safe and the results provide a reasonable expectation that the intervention would be beneficial for a population of individuals with chronic nonradicular lower back pain. Due to the design of the study, causality cannot be inferred, but the results do indicate that further study of the intervention may be warranted.

show abstract

A Preliminary Study to Determine if a Muscle Pain Protocol Can Produce Long-Term Relief in Chronic Back Pain Patients

Cited by 10 publications

References 24 publications

Pain and functionality improved when underlying neuromuscular dysfunction addressed in chronic pelvic pain patients

Pain and functionality improved when underlying neuromuscular dysfunction addressed in chronic pelvic pain patients

Soft Tissue: A Possible Source of Pain Pre and Post Minimally Invasive Spine Surgery

Use of localized human growth hormone and testosterone injections in addition to manual therapy and exercise for lower back pain: a case series with 12-month follow-up

Contact Info

Product

Resources

About