Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture
Restricted accessResearch articleFirst published online April, 2015
Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture
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.
DommerholtJ. Dry needling—peripheral and central considerations. J Man Manip Ther. 2011;19:223-7.
5.
SimonsDGTravellJGSimonsLS. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins;1999.
6.
Borg-SteinJSimonsDG. Focused review: myofascial pain. Arch Phys Med Rehabil. 2002;83:40-9.
7.
Fernández-de-las-PeñasCGalán-del-RíoFAlonso-BlancoCJiménez-GarcíaRArendt-NielsenLSvenssonP. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disorders. J Pain. 2010;11:1295-304.
8.
GerberLHSikdarSArmstrongKDiaoGHeimurJKopeckyJ. A systematic comparison between subjects with no pain and pain associated with active myofascial trigger points. PM R. 2013;5:931-8.
9.
FleckensteinJZapsDRügerLJLehmeyerLFreibergFLangPM. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord. 2010;11:32.
10.
TravellJGSimonsDG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD, and London: Williams & Wilkins;1983.
BasfordJRAnKN. New techniques for the quantification of fibromyalgia and myofascial pain. Curr Pain Headache Rep. 2009;13:376-8.
13.
LucasNMacaskillPIrwingLMoranRBogdukN. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain. 2009;25:80-9.
14.
Fernández-de-las-PeñasCCuadradoMLParejaJA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache. 2007;47:662-72.
15.
McEvoyJHuijbregtsPA. Reliability of myofascial trigger point palpation: a systematic review. In: DommerholtJHuijbregtsP, eds. Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management. Sudbury, MA: Jones & Bartlett Publishers;2011. pp. 65-88.
16.
ChenQBensamounSBasfordJRThompsonJMAnK-N. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil. 2007;88:1658-61.
17.
SikdarSShahJPGebreabTYenRHGilliamsEDanoffJ. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 2009;90:1829-38.
18.
SikdarSOrtizRGebreabTGerberLHShahJP. Understanding the vascular environment of myofascial trigger points using ultrasonic imaging and computational modeling. Conf Proc IEEE Eng Med Biol Soc. 2010;1:5302-5.
19.
BotwinKPSharmaKSalibaRPatelBC. Ultrasound-guided trigger point injections in the cervicothoracic musculature: a new and unreported technique. Pain Physician. 2008;11:885-9.
20.
NirajGCollettBJBoneM. Ultrasound-guided trigger point injection: first description of changes visible on ultrasound scanning in the muscle containing the trigger point. Br J Anaesth. 2011;107:474-5.
21.
ArijiYGotohAHiraiwaYKiseYNakayamaMNishiyamaW. Sonographic elastography for evaluation of masseter muscle hardness. Oral Radiol. 2013;29:64-9.
22.
TuroDOttoPShahJPHeimurJGebreabTZaazhoaM. Ultrasonic characterization of the upper trapezius muscle in patients with chronic neck pain. Ultrason Imaging. 2013;35:173-87.
23.
GotohAArijiYHasegawaTNakayamaMKiseYMatsuokaM. Sonographic elastography for assessing changes in masseter muscle elasticity after low-level static contraction. Oral Radiol. 2013;29:140-5.
24.
GongXWangYXuP. Application of real-time ultrasound elastography for differential diagnosis of breast tumors. J Ultrasound Med. 2013;32:2171-6.
LiAWangYXinJLaoLRenKBermanBM. Electroacupuncture suppresses hyperalgesia and spinal fos expression by activating the descending inhibitory system. Brain Res. 2007;1186:171-9.
27.
TaguchiTTaguchiR. Effect of varying frequency and duration of electroacupuncture stimulation on carrageenan-induced hyperalgesia. Acupunct Med. 2007;25:80-6.
28.
MelzackRStillwellDFoxE. Trigger point and acupuncture points for pain: correlations and implications. Pain. 1977;3:3-23.
29.
KaoMJHsiehYLKuoFJHongCZ. Electrophysiological assessment of acupuncture points. Am J Phys Med Rehabil. 2006;85:443-8.
30.
ZhengZGuoRJHelmeRDMuirADa CostaCXueCC. The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: a pilot randomized controlled clinical trial. Eur J Pain. 2008; 12:671-6.
31.
SunMYHsiehCLChengYYHungHCLiTCYenSM. The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. Am J Chin Med. 2010;38:849-59.
32.
AranhaMFAlvesMCBérzinFGaviãoMB. Efficacy of electroacupuncture for myofascial pain in the upper trapezius muscle: a case series. Rev Bras Fisioter. 2011;15:371-9.
33.
GreenspanJDCraftRMLeRescheLArendt-NielsenLBerkleyKJFillingimRB. Studying sex and gender differences in pain and analgesia: a consensus report. Pain. 2007;132 Suppl. 1:S26-45.
34.
LianYLChenCYHammesMKolsterBC. Pictorial Atlas of Acupuncture: An Illustrated Manual of Acupuncture Points. Slovenia: h.f.ullmann; 2005.
35.
ZhuXMPolusB. A controlled trial on acupuncture for chronic neck pain. Am J Chin Med. 2002;30:13-28.
36.
XueCCDongLPolusBEnglishRAZhengZDa CostaC. Electroacupuncture for tension-type headache on distal acupoints only, a randomized, controlled, crossover trial. Headache. 2004;44:333-41.
LewisJTehanP. A blinded pilot study investigating the use of diagnostic ultrasound for detecting active myofascial trigger points. Pain. 1999;79:39-44.
39.
ShahJPPhillipsTMDanoffJVGerberLH. An in vitro microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99:1977-84.
40.
SteccoAMeneghiniASternRSteccoCImamuraM. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surgical & Radiologic Anatomy. Published electronically August23, 2013. doi:10.1007/s00276-013-1185-2.
41.
LangevinHMStevens-TuttleDFoxJRBadgerGJBouffardNAKragMH. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskelet Disord. 2009;10:151.
42.
ShankarHReddyS. Two- and three-dimensional ultrasound imaging to facilitate detection and targeting of taut bands in myofascial pain syndrome. Pain Med. 2012;13:971-5.
43.
LangevinHMFoxJRKoptiuchCBadgerGJGreenan-NaumannACBouffardNA. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord. 2011;12:203.
44.
FischerTSackIThomasA. Characterization of focal breast lesions by means of elastography. Rofo. 2013;185:816-23.
