Re-Examining Myofascial Pain Syndrome: Toward Biomarker Development and Mechanism-Based Diagnostic Criteria

Duarte, Felipe C. K.; West, Daniel W. D.; Linde, Lukas D; Hassan, Samah; Kumbhare, Dinesh

doi:10.1007/s11926-021-01024-8

Cited by 27 publications

(25 citation statements)

References 89 publications

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“…The visual confirmation of contracture knots in the muscle being hyperperfused challenges the idea that the therapeutic benefit of dry needling is related to a “wash out effect” that somehow results in reperfusion of what we now suggest is an already hyperperfused region [ 20 , 21 ]. We propose a new hypothesis suggesting that when performing TrP-DN, an initial therapeutic effect may occur due to decreasing (not increasing) perfusion of hyperperfused contracture knot relative to the surrounding skeletal muscle.…”

Section: Discussionmentioning

confidence: 94%

“…Proper understanding of ultrasound imaging (US) suggests that, in general, hyperperfused structures appear as hypoechoic (dark grey) and hypoperfused structures as hyperechoic (light grey) [ 19 ]. Previous US studies had instead identified and labeled TrPs as hypoechoic (dark grey) [ 20 , 21 ]. A hypoechoic TrP image suggests either anisotropy (image error) or, in direct contrast to widely accepted micro-dialysis literature [ 17 , 18 ], that the TrP is a hyperperfusion area.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound Confirmation of the Multiple Loci Hypothesis of the Myofascial Trigger Point and the Diagnostic Importance of Specificity in the Elicitation of the Local Twitch Response

Ball¹,

Perreault

Fernández‐de‐las‐Peñas

et al. 2022

Diagnostics

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The literature has hypothesized that a trigger point (TrP) area consists of a hyperperfused contracture knot with smaller hypoperfused TrPs within the contracture knot. By contrast, the only published ultrasound image of a TrP has it labeled hypoechoic (i.e., hyperperfused) with no commentary regarding smaller speckles of hypoperfusion within. Furthermore, the lack of clarity in objective definition of the terms associated with the TrP (namely, the palpable “contracture knot” and smaller nonpalpable “trigger point”) has led to unnecessary communication difficulties between and among clinicians and researchers. In this case series of three muscles across two patients, by using high-definition musculoskeletal ultrasound imaging technology, we present what we believe to be the first reliable capture of palpable hypoechoic (e.g., hypoperfused) contracture knots (previously mislabeled as a hypoechoic TrP), and a visual support of the multiple loci hypothesis first proposed by Hong and Simons—the first reliable confirmation of the hyperechoic (i.e., hypoperfused) TrP within. Initially proposed by a histological study and supported by microdialysis study, this case series lends further support for the multiple loci hypothesis through visual confirmation of palpable hypoechoic contracture knots, with smaller hypoechoic TrPs “speckles” within.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Ultrasound Confirmation of the Multiple Loci Hypothesis of the Myofascial Trigger Point and the Diagnostic Importance of Specificity in the Elicitation of the Local Twitch Response

Ball¹,

Perreault

Fernández‐de‐las‐Peñas

et al. 2022

Diagnostics

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“…On the other hand, myofascial pain syndrome (MPS) is defined as pain in the muscles and surrounding fascia with the presence of hypersensitive sites known as “trigger points” [ 60 ]. As addressed in the recent systematic review of Yang et al, 10 sessions of high-frequency rTMS over the left M1 was considered a beneficial therapeutic option for patients with chronic MPS [ 61 ].…”

Section: Painmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence

et al. 2022

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Transcranial magnetic stimulation (TMS) has emerged as a novel technique to stimulate the human brain through the scalp. Over the years, identifying the optimal brain region and stimulation parameters has been a subject of debate in the literature on therapeutic uses of repetitive TMS (rTMS). Nevertheless, the primary motor cortex (M1) remained the conventional target for rTMS to treat motor symptoms, such as hemiplegia and spasticity, as it controls the voluntary movement of the body. However, with an expanding knowledge base of the M1 cortical and subcortical connections, M1-rTMS has shown a therapeutic efficacy that goes beyond the conventional motor rehabilitation to involve pain, headache, fatigue, dysphagia, speech and voice impairments, sleep disorders, cognitive dysfunction, disorders of consciousness, anxiety, depression, and bladder dysfunction. In this review, we summarize the latest evidence about using M1-rTMS to treat non-motor symptoms of diverse etiologies and discuss the potential mechanistic rationale behind the management of each of these symptoms.

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“…All the substances together participate in the generation of inflammatory pain in the body. 10 Clinically, MTrPs are generally managed by physiotherapy interventions such as acupuncture, massage and cupping, which could deactivate MTrPs thus to relieve symptoms. 11 Pressing is a type of manual therapy belonging to the massage category, which is noninvasive, effective, cost-effective and has a safety profile.…”

Section: Introductionmentioning

confidence: 99%

Pressing Intervention Promotes the Skeletal Muscle Repair of Traumatic Myofascial Trigger Points in Rats

Jiang¹,

Xiang²,

Liú³

et al. 2021

JPR

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Objective: To observe the effect of pressing intervention on the skeletal muscle repair of myofascial trigger points (MTrPs) in rats and explore the mechanism of pressing intervention on the deactivation of trigger points. Methods: Thirty SPF rats were randomly divided into blank group, model group and press group, with 10 rats in each group. The MTrPs models were established by blunt striking plus eccentric exercise, and then evaluated. The press group was given a pressing intervention with a self-made device for 14 days, and the rats in the other two groups were fed normally. Soft tissue tension (STT) D 0.2 and pressure pain threshold (PPT) were measured before and after intervention. The skeletal muscle tissue at MTrPs was extracted and assessed by hematoxylin-eosin (HE) and Masson staining. The expression of collagen I, collagen III, α-smooth muscle actin (α-SMA), myosin heavy chain (MHC) and fibronectin (FN) were detected by Western Blotting. Enzyme linked immunosorbent assay (ELISA) was used to evaluate the expression of substance P (SP), 5-hydroxytryptamine (5-HT), cyclooxygenase 2 (COX-2) and prostaglandin E2 (PGE2). Results: (1) Compared with the blank group, the PPT and D 0.2 reduced (P < 0.05) in the model group; while compared with the model group, the PPT and D 0.2 increased (P < 0.05) in the press group. (2) Compared with the blank group, the model group showed obvious spontaneous potentials with higher amplitude and frequency, which were also much higher than those of the press group (P < 0.05). (3) The HE and Masson staining results showed evident fibrosis in the muscle tissue of the model group, with a larger area of collagen fibers relative to that of the press group (P < 0.05). ( 4) The amount of collagen I, collagen III, FN, α-SMA, SP, 5-HT, COX-2 and PGE2 increased and the content of MHC decreased (P < 0.05) in the model group, as compared to the blank group; while all the substances (P < 0.05), instead of MHC which increased (P < 0.05), in the press group were decreased as compared to the model group. Conclusion:Pressing intervention on the MTrPs in rats can alleviate chronic inflammation, inhibit fibrosis, promote skeletal muscle repair and relieve pain.

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Re-Examining Myofascial Pain Syndrome: Toward Biomarker Development and Mechanism-Based Diagnostic Criteria

Cited by 27 publications

References 89 publications

Ultrasound Confirmation of the Multiple Loci Hypothesis of the Myofascial Trigger Point and the Diagnostic Importance of Specificity in the Elicitation of the Local Twitch Response

Ultrasound Confirmation of the Multiple Loci Hypothesis of the Myofascial Trigger Point and the Diagnostic Importance of Specificity in the Elicitation of the Local Twitch Response

Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence

Pressing Intervention Promotes the Skeletal Muscle Repair of Traumatic Myofascial Trigger Points in Rats

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