Paraspinal Stimulation Combined With Trigger Point Needling and Needle Rotation for the Treatment of Myofascial Pain

Couto, Cláudio Luiz Mendes; Souza, Izabel Cristina Custodio de; Torres, Iraci Lucena da Silva; Fregni, Felipe; Caumo, Wolnei

doi:10.1097/ajp.0b013e3182934b8d

Cited by 49 publications

(54 citation statements)

References 42 publications

(45 reference statements)

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“…The number of patients in each study group was determined by previous clinical trials [32]. An a priori estimate indicated that a total sample size of 57 patients divided into three balanced treatment groups (n = 19) was needed to detect a 1.4-cm reduction (average standard deviation 1.2 cm) in pain intensity associated with melatonin or placebo at power and α levels of 0.8 and 0.01, respectively [33]; such a reduction would be clinically relevant and comparable to other pharmacological interventions.…”

Section: Methodsmentioning

confidence: 99%

Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial

Zanette

Vercelino

Laste

et al. 2014

BMC Pharmacol Toxicol

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102

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BackgroundCentral disinhibition is a mechanism involved in the physiopathology of fibromyalgia. Melatonin can improve sleep quality, pain and pain threshold. We hypothesized that treatment with melatonin alone or in combination with amitriptyline would be superior to amitriptyline alone in modifying the endogenous pain-modulating system (PMS) as quantified by conditional pain modulation (CPM), and this change in CPM could be associated with serum brain-derived neurotrophic factor (BDNF). We also tested whether melatonin improves the clinical symptoms of pain, pain threshold and sleep quality.MethodsSixty-three females, aged 18 to 65, were randomized to receive bedtime amitriptyline (25 mg) (n = 21), melatonin (10 mg) (n = 21) or melatonin (10 mg) + amitriptyline (25 mg) (n = 21) for a period of six weeks. The descending PMS was assessed with the CPM-TASK. It was assessed the pain score on the Visual Analog Scale (VAS 0-100 mm), the score on Fibromyalgia Impact Questionnaire (FIQ), heat pain threshold (HPT), sleep quality and BDNF serum. Delta values (post- minus pre-treatment) were used to compare the treatment effect. The outcomes variables were collected before, one and six weeks after initiating treatment.ResultsMelatonin alone or in combination with amitriptyline reduced significantly pain on the VAS compared with amitriptyline alone (P < 0.01). The delta values on the VAS scores were-12.85 (19.93),-17.37 (18.69) and-20.93 (12.23) in the amitriptyline, melatonin and melatonin+amitriptyline groups, respectively. Melatonin alone and in combination increased the inhibitory PMS as assessed by the Numerical Pain Scale [NPS(0-10)] reduction during the CPM-TASK:-2.4 (2.04) melatonin + amitriptyline,-2.65 (1.68) melatonin, and-1.04 (2.06) amitriptyline, (P < 0.05). Melatonin + amitriptyline treated displayed better results than melatonin and amitriptyline alone in terms of FIQ and PPT improvement (P < 0.05, fort both).ConclusionMelatonin increased the inhibitory endogenous pain-modulating system as assessed by the reduction on NPS(0-10) during the CPM-TASK. Melatonin alone or associated with amitriptyline was better than amitriptyline alone in improving pain on the VAS, whereas its association with amitriptyline produced only marginal additional clinical effects on FIQ and PPT.Trial registrationCurrent controlled trail is registered at clinical trials.gov upon under number NCT02041455. Registered January 16, 2014.

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Section: Methodsmentioning

confidence: 99%

Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial

Zanette

Vercelino

Laste

et al. 2014

BMC Pharmacol Toxicol

Self Cite

102

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“…However, studies in which acupuncture was applied in patients with muscle pain in the upper trapezius [49] or with nonspecific low back pain [21] pointed out that the real acupuncture therapy was more effective than placebo acupuncture for pain relief.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the placebo effect between different non-penetrating acupuncture devices and real acupuncture in healthy subjects: a randomized clinical trial

Maciel

Leite

Neto

et al. 2016

BMC Complement Altern Med

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BackgroundSeveral studies have used placebo acupuncture methods in recent years as a way for blinding therapeutic effect of acupuncture, however placebo method selection has not followed enough methodological criteria to the point of stabilishing a consensus of what should be the best method to be used. This study aimed to evaluate the effectiveness of three different placebo acupuncture methods for blinding applied in healthy subjects.MethodsThis study was approved by the Ethics Committee of the Federal University of Sergipe with the number 47193015.5.0000.5546 and all individuals participating in the study signed a free and informed consent. For this study, 321 healthy volunteers were randomly divided into seven groups using the abdominal point stomach (ST) 25 and seven groups using the lumbar point bladder (Bl) 52 for stimulation. For real acupuncture procedure, three different methods of placebo acupuncture plus a mix between real acupuncture and placebo applied in the same individual, totaling fourteen groups in this study. Outcome assessments were performed before and immediately after applying the technique. Investigator who assessed variables had no knowledgement about the method was applied. Identification, weight and height were measured before puncture by using. At the end, subjects were asked if they believed they were receiving real or placebo acupuncture.ResultsThere was no significant difference between groups for the perception about the type o stimulation (wheter real or placebo puncture). Percentage of subjects who reported to have received real acupuncture in the abdominal point was 69.56% in real group, 86.95% in group Park Sham, 82.60% in needle + foam, 91.30% in insertion and removal, 78.26% in real + Park Sham, 86.36% in real + needle and foam, 86.95% in real + insertion and removal, and for the lumbar point was 86.36% in real group, 86.95% in group Park Sham, 69.56% in needle + foam, 72% in insertion and removal, 86.95% in real + Park Sham, 81.81% in real + needle and foam and 78.26% in real + insertion and removal.ConclusionAll placebo acupuncture methods proposed in this study were equally effective for bliding the study participants using either abdominal or lumbar acupoints, and none of the placebo methods presented benefit compared to the other to be used in future clinical trials.Ethics CommitteeFederal University of Sergipe (UFS), number of approval: 47193015.5.0000.5546Trial registrationensaiosclinicos.gov.br RBR-3w2p32 Registered in 28th January 2016.

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“…However, in addition to regional pain, local tenderness in trigger points and loss of joint function, MPS may also be associated with psychiatric complications such as anxiety, sleeplessness and depression. 31 Only two studies, namely those by Couto et al 19 and Tekin et al, 20 examined for any improvement in mental health.…”

Section: Overall Completeness and Applicability Of Evidencementioning

confidence: 99%

Manual Acupuncture for Myofascial Pain Syndrome: A Systematic Review and Meta-Analysis

Wang

Zhou

et al. 2017

Acupunct Med

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Objective To assess the efficacy of manual acupuncture (MA) in the treatment of myofascial pain syndrome (MPS). Methods We searched for randomised controlled trials (RCTs) comparing MA versus sham/placebo or no intervention in patients with MPS in the following databases from inception to January 2016: PubMed; Cochrane Library; Embase; Web of Science; and China Biology Medicine. Two reviewers independently screened the literature extracted data and assessed the quality of the included studies according to the risk of bias tool recommended by the Cochrane Handbook (V.5.1.0). Then, a meta-analysis was performed using RevMan 5.3 software. Results Ten RCTs were combined in a metaanalysis of MA versus sham, which showed a favourable effect of MA on pain intensity after stimulation of myofascial trigger points (MTrPs; standardised mean difference (SMD) −0.90, 95% CI −1.48 to −0.32; p=0.002) but not traditional acupuncture points ( p>0.05). Benefit was seen both after a single treatment (SMD −1.05, 95% CI −1.84 to −0.27; p=0.009) and course of eight sessions (weighted mean difference (WMD) −1.96, 95% CI −2.72 to −1.

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Paraspinal Stimulation Combined With Trigger Point Needling and Needle Rotation for the Treatment of Myofascial Pain

Abstract: This study highlighted the greater efficacy of MDIMST over the placebo-sham and LTrP-I and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities.

Cited by 49 publications

References 42 publications

Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial

Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial

Comparison of the placebo effect between different non-penetrating acupuncture devices and real acupuncture in healthy subjects: a randomized clinical trial

Manual Acupuncture for Myofascial Pain Syndrome: A Systematic Review and Meta-Analysis

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