OMTrigger Inject- Treating Trigger Points: Comparing Muscle Energy Technique vs. Lidocaine Needling Technique
Condition: Myofascial Pain Syndrome
MeSH terms: Myofascial Pain Syndromes; Fibromyalgia
Study type: Observational

Summary: 
      The primary aim of this study is to determine if osteopathic manipulative treatment is as
      effective to traditional lidocaine injection technique in treating myofascial trigger points
      in regard to post intervention pain intensity and quality of life.
    

Detailed description: 
      Myofascial pain syndrome is one of the most common musculoskeletal disorders seen in the
      aging US population. Its characterized by myofascial trigger points (MTPs) which were defined
      as hyperirritable nodules in a taut band of skeletal muscle, associated with pain on manual
      stretching, contraction, or stimulation of the muscle. Trigger points are further classified
      into active and latent based on their clinical features. Active MTPs are characterized by
      spontaneous pain at rest with referred pain on palpation whereas latent MTPs produce pain on
      palpation in addition to restriction of range of motion.

      Currently, there are a variety of treatment options for MTPs including lidocaine injections,
      dry needling, osteopathic manipulative treatment, massage therapy, ultrasound therapy etc.
      There has been a lot of research investigating the safety and efficacy of dry needling and
      lidocaine trigger point injection techniques in treating MTPs. It was found that dry needling
      and lidocaine injections were both equally effective in reducing symptoms associated with
      MTPs as it was the mechanical disruption of the taut fibers due to the needle effect and the
      depth of adequate penetration that resulted in pain reduction more than the substance
      actually delivered into the muscle. Some authors also suggested the importance of a local
      twitch response (LTR); which is an observable contraction of the taut part of muscle band
      upon stimulation, during dry needling technique as being pertinent for maximum effectiveness.
      However, a recent systemic review found that LTR during dry needling treatment was
      unnecessary and not required for management of myofascial pain syndrome.

      On the other hand, there has been fewer research investigating the effects of manual
      treatment on trigger points. Reasearchers had initially treated trigger points with ischemic
      compression but later changed their recommendation to applying gentle digital pressure to
      trigger points. A recent study done on traction-compression-stretch technique (TTCE) compared
      with ischemic compression showed some, albeit minor, increased outcome measures (pain
      pressure threshold) warranting clinical investigation. Another study compared active release
      and muscle energy techniques in treating latent trigger points of the upper trapezius and
      found that both techniques were equally effective in increasing cervical range of motion and
      decreasing pain and upper trapezius thickness. Other studies have also shown interest in
      similar osteopathic manipulative techniques such as counterstrain, myofascial release,
      facilitated positional release and high velocity-low amplitude thrust techniques in treating
      trigger points.

      Studies have showed that the upper trapezius is one of the most common muscles affected by
      myofascial pain syndrome leading to referred pain manifesting as headaches and stiff neck.

      Currently, there is no consensus as to which treatment method is superior, with the decision
      to treat in a certain way largely based upon the training received by the individual
      physician rather than the characteristics of the trigger point itself. There are no studies
      to date evaluating the efficacy of the various treatment options specifically osteopathic
      manipulative treatment vs. trigger point injections. Thus, the intention of the present study
      is to determine the efficacy rates of muscle energy techniques vs. lidocaine injections in
      treating MTPs in the upper trapezius region.
    

Intervention name(s): OMT
Intervention type(s): Procedure
Intervention description(s): OMT will be performed on identified areas of trapezius trigger points
Other intervention name(s): muscle energy
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study is a prospective cohort study comprised of participants between ages 25-75 that
        presented to Atlanticare Regional Medical Center interventional pain department and
        Philadelphia College of Osteopathic Medicine Osteopathic Clinic between 2021 August and
        2021 october with trigger point in the upper trapezius muscle. It is expected that
        approximately 60 patients will be enrolled to produce approximately 50 evaluable subjects.