Two-dimensional ultrasound and ultrasound elastography imaging of trigger points in women with myofascial pain syndrome treated by acupuncture and electroacupuncture: a double-blinded randomized controlled pilot study

Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and AC treatment groups and the control sham AC (SHAM) group. Intensity of pain was assessed by visual analogue scale; MTrP mean area and strain ratio (SR) by 2D US and UE. A significant decrease of intensity in general, RTPz, and LTPz pain was observed in the EA group (p = 0.027; p < 0.001; p = 0.005, respectively) and in general pain in the AC group (p < 0.001). Decreased MTrP area in RTPz and LTPz were observed in AC (p < 0.001) and EA groups (RTPz, p = 0.003; LTPz, p = 0.005). Post-treatment SR in RTPz and LTPz was lower than pre-treatment in both treatment groups. 2D US and UE effectively characterized MTrP and surrounding tissue, pointing to the possibility of objective confirmation of subjective EA and AC treatment effects.372152167COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPSem informação2011/12659-

Avaliação da acupuntura, da eletroacupuntura e da acupuntura sham no tratamento da dor miofascial na parte superior do músculo trapézio

Orientador: Maria Beatriz Duarte GaviãoTexto em português e inglêsTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A dor miofascial (DM), proveniente de um ponto gatilho miofascial (Pg), é a principal causa de dor de cabeça e pescoço. A sua presença é associada à rigidez muscular e estresse e pode influenciar a qualidade de vida de pacientes sintomáticos. Imagens ultrassonográficas do tecido disfuncional têm sido realizadas com o intuito de avaliar objetivamente o Pg. Com o objetivo de avaliar o efeito da acupuntura e da eletroacupuntura no tratamento da DM da parte superior do músculo trapézio, sessenta voluntárias com idade entre 18 e 40 anos, índice de massa corpórea entre 18 e 30 Kg/m2, com pelo menos um ponto gatilho na parte superior do músculo trapézio, dor local ou referida por mais de seis meses foram randomizadas em três grupos: eletroacupuntura (EA), acupuntura (AC) e acupuntura SHAM (SHAM). O avaliador e as voluntárias eram cegos aos tratamentos. Os pontos de acupuntura utilizados foram: VB20, VB21, F3 e IG4, além de no máximo, 2 pontos ashi em cada lado do trapézio superior. A efetividade do tratamento, assim como a manutenção dos resultados até um mês após o final do tratamento, foram avaliada pela intensidade de dor (escala visual analógica: EVA), amplitude de movimento cervical (fleximetria), qualidade de vida (SF-36), estresse (área abaixo da curva: AUCG; resposta do cortisol ao acordar: CAR), imagem de ultrassom (área do Pg). De acordo com sua distribuição os dados foram analisados pelos testes: teste-t pareado, Wilcoxon signed rank, ANOVA para medidas repetidas ou teste de Friedman, ANOVA ou Kruskal Wallis. Foi aplicado o teste de correlação de Pearson. O nível de significância foi de ?= 0,05. Foi observada redução na dor geral (DG) nos grupos EAC (P<0.001) e AC (P<0.001) após todas as sessões. Na reavaliação, a dor no trapézio direito (TPzD) diminuiu para os grupos EA (P<0.001) e AC (P=0.025), já no trapézio esquerdo (TPzE), apenas o grupo EA mostrou melhora (P<0.001). Em relação à DG correu interação dos fatores "fase de avaliação" e "grupo" para AC e EAC, e para dor no TPzD e E apenas para o grupo EA. Após o tratamento houve aumento da rotação para a esquerda no grupo EA (P=0.049), e aumento da inclinação e rotação para a direita no grupo AC (P=0.005; P=0.032). Houve aumento da AUCG (P=0.006) e CAR (P<0.001) no grupo AC. Em relação aos dados obtidos pelo SF-36, o grupo SHAM apresentou aumento significativo da dor (P=0.005); os grupos EA e AC mostraram aumento nos mesmos domínios, com valores respectivos de P: capacidade funcional (P=0.011; P=0.016), aspectos físicos (P=0.027; P=0.13), dor (P=0.010; P=0.003), estado geral da saúde (P=0.017; P=0.011), vitalidade (P=0.010; P=0.011), saúde mental (P=0.018; P=0.014) e componente físicos (P=0.019; 0.002). Ocorreu diminuição na área do ponto gatilho (US) nos grupos EA (TPzD: P<0.001; TPzE: P=0.001) e AC (TPzD e TPzE P<0.001), e no grupo SHAM apenas no TPzE (P=0.036). A EA se mostrou mais eficaz no alívio da dor quando comparada aos outros grupos. Tanto AC quanto EA foram eficazes na melhora da morfologia do tecido muscular (US) e da qualidade de vida. A AC parece ser mais indicada na diminuição do estresse e na melhora da amplitude de movimento cervical em mulheres com dor miofascial no trapézio superiorAbstract: Myofascial pain (MP), caused by myofascial trigger points (MTrP), is of the main cause of headache and neck pain. It is associated with muscular stiffness, stress and can influence the quality of life of symptomatic patients. Ultrasound images of dysfunctional tissue have been used aiming to objectively evaluate the myofascia trigger point. Aiming to evaluate the effect of acupuncture and electroacupuncture on the treatment of MP at the upper trapezius muscle, sixty women aged between 18 and 40 years old, body max index between 19 and 30 Kg/m2, presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized in to and three groups: electroacupuncture (EAC), acupuncture (AC) and SHAM-acupuncture (SHAM). Both examiner (CEEM) and volunteers were blinded to the treatments. The selected acupoints were VB20, VB21, F3 and IG4, besides a maximum of 2 "ashi points" in each upper trapezius. The effectiveness of treatment (eight sessions), as well as it maintenance till one month follow up, were evaluated concerning the intensity of pain (Visual analog scale: VAS), range of motion (fleximetry), quality of life (SF-36), stress (area under the curve to the ground: AUCG; cortisol awaking response: CAR) and ultrasound image (area of MTrP). Influencing factors and the menstrual cycle phases were monitored. According to its distribution, data were analyzed by pared t-test, Wilcoxon signed rank, ANOVA repeated measures, Friedman test, ANOVA or Kruskal Wallis. Pearson¿s correlation was applied. The level of significance was set in ?= 0.05. It was observed reduction on general pain (GP) on treated groups after all sessions (EA: P<0.001; AC: P<0.001). After treatment, intensity of pain on the right trapezius (RTPz) decreased in the EA (P<0.001) and AC (P=0.025) groups, but on the left trapezius (LTPz) it was only observed in the EA group (P<0.001). There was interaction of factor "time of evaluation" with factor "group" for GP in the AC and EA groups; and for pain at the RTPz and LTPz only in the EA group. There was increase on rotation to the left in the EA group (P=0.049) and on inclination and rotation to the right on group AC (P=0.005; P=0.032). There was increase on AUCG (P=0.006) and CAR (P<0.001) in the AC group. While SHAM presented significant increase only on bodily pain (P=0.005), EA and AC showed increase at the same following domains, with respectively P values: physical function (P=0.011; P=0.016), role physical (P=0.027; P=0.13), bodily pain (P=0.010; P=0.003), general health (P=0.017; P=0.011), vitality (P=0.010; P=0.011), mental health (P=0.018; P=0.014) and physical components (P=0.019; 0.002). It was observed a decrease on MTrP area (US) in the groups EA (TPzD: P<0.001; TPzE: P=0.001) and AC (RTPz e LTPz P<0.001), and in the SHAM groups only at the LTPz (P=0.036). The EA group has shown to be more effective on pain relief when compared to other groups. Both AC and EA were effectiveness improving tissue morphology (US) and quality of life. AC seems to be more indicated to the decrease stress and increase cervical range of motion than EA in women with myofascial pain at the upper trapeziusDoutoradoAnatomiaDoutora em Biologia Buco-Denta

Two-dimensional Ultrasound And Ultrasound Elastography Imaging Of Trigger Points In Women With Myofascial Pain Syndrome Treated By Acupuncture And Electroacupuncture: A Double-blinded Randomized Controlled Pilot Study.

Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and AC treatment groups and the control sham AC (SHAM) group. Intensity of pain was assessed by visual analogue scale; MTrP mean area and strain ratio (SR) by 2D US and UE. A significant decrease of intensity in general, RTPz, and LTPz pain was observed in the EA group (p = 0.027; p < 0.001; p = 0.005, respectively) and in general pain in the AC group (p < 0.001). Decreased MTrP area in RTPz and LTPz were observed in AC (p < 0.001) and EA groups (RTPz, p = 0.003; LTPz, p = 0.005). Post-treatment SR in RTPz and LTPz was lower than pre-treatment in both treatment groups. 2D US and UE effectively characterized MTrP and surrounding tissue, pointing to the possibility of objective confirmation of subjective EA and AC treatment effects.37152-6