A Study to Determine the Tissue Properties, Vascular Physiology and Biochemical Milieu of Myofascial Trigger Points

Study Overview
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Brief Summary
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Determine the effect of dry needling using a 32 gauge needle on active trigger points in subjects with chronic myofascial pain. Participants will receive treatment for active trigger points (3 on successive weeks) and will have pain, status of the trigger point and functional measures assessed at baseline, after treatment and eight weeks later.

Detailed Description
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Chronic myofascial pain syndromes, such as pain associated with myofascial trigger points (MTrPs), are prevalent yet poorly understood. Our long-term goal is to determine the pathogenesis and pathophysiological mechanisms of chronic pain associated with trigger points, eventually leading to the development of objective diagnostic criteria and effective pain management strategies. We propose to achieve this goal using a new and unique integrative methodology combining microanalytic biochemical assays, ultrasound technology (imaging) and mathematical modeling. An additional component of the study plan is to learn if a standard treatment for MTrPs is associated with the biochemical and ultrasound changes we will be measuring This project has the following specific aims: 1) To understand the viscoelastic soft tissue neighborhood and vascular physiology of affected muscle at a macroscopic level using ultrasound imaging, elastography and Doppler blood flow imaging; 2) To understand the pathophysiology of myofascial trigger points at a nanotechnological level through assays of biochemical milieu using a microdialysis technique; 3) To develop mathematical models of underlying pathophysiological mechanisms based on experimental observations for quantitative hypothesis testing; 4) To determine if dry needle therapy, a standard of care for MTrPs, changes the macroscopic and/or microscopic measurements and leads to resolution of the trigger point and secondarily associated pain symptoms.. Our hypothesis is that pathogenesis of myofascial pain syndrome involves local trauma to the muscle fibers, and the biochemical response to the injury leads to sustained muscle contracture, compression of blood vessels and a local energy crisis that causes tissue hypoxia and the expression of pain-producing substances at myofascial trigger points. Relieving the trigger point through dry needle therapy

Official Title
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A Study to Determine the Tissue Properties, Vascular Physiology and Biochemical Milieu of Myofascial Trigger Points

Conditions
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Myofascial Pain

Intervention / Treatment
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* Procedure: dry needling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: spontaneous soft tissue pain in shoulder and neck region Exclusion Criteria: recent fracture, neurological injury or history of stroke, use of opioids

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: SIngle arm<br>Single arm, intervention All recipients were treated with dry needling technique into active myofascial trigger points They received 1 treatment weekly for three weeks. | Procedure: dry needling<br>* insertion of needle into active myofascial trigger point<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Verbal Analog Scale | scale of 0-10 as a measure of pain severity | change from baseline to 3 weeks and at 8 weeks | 
| Presence of myofascial trigger point | Digital palpation of the trigger point was performed by investigators and scored as present or absent; if present was it associated with spontaneous pain or was pain induced with palpation | change from baseline to 3 weeks and at 8 weeks | 
| Brief Pain Inventory | Validated scale of pain severity and interference | change from baseline to 3 weeks and at 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oswestry Disability Scale | self-reports of disability | change from baseline to 3 weeks and at 8 weeks | 
| MOS-short form 36 v2 | self-reports of disability and health related quality of life Profile of Mood States, range of motion of neck and shoulder, manual muscle test) | change from baseline to 3 weeks and at 8 weeks | 
| Manual Muscle test | grade strength 0-5, neck and shoulder girdle muscle | change from baseline to 3 weeks and at 8 weeks | 
| Profile of Mood States | measures of mood and affect (depression and anxiety) | change from baseline to 3 weeks and at 8 weeks | 
| range of motion | shoulder and neck range of motion in degrees | change from baseline to 3 weeks and at 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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active trigger points