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Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome

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Abstract

Background: Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. Several methods have been recommended for the inactivation of trigger points (TrP). Objectives: This prospective, single-blind study was proposed to compare TrP injection with botulinum toxin type A (BTX-A) to dry needling and lidocaine injection in MPS. Methods: Eighty-seven trigger points (cervical and/or periscapular regions) in 23 female and six male patients with MPS were treated and randomly assigned to three groups: lidocaine injection (n=10, 32 TrP), dry needling (n=10, 33 TrP), and BTX-A injection (n=9, 22 TrP). Outcome measures: Clinical assessment including cervical range of motion, TrP pain pressure threshold (PPT), pain scores (PS), and visual analog scales for pain, fatigue, and work disability were evaluated at entry and the end of the 4th week. Additionally, depression and anxiety were evaluated with the Hamilton depression and anxiety rating scales, and quality of life was assessed using the Nottingham health profile (NHP). The subjects were also asked to describe side effects. Injection procedure: One milliliter of 0.5% lidocaine was administered to each TrP in the lidocaine injection group, 10–20 IU of BTX-A to each TrP in the BTX-A group, and dry needling to each TrP in the last group, followed by stretching of the muscle groups involved. The patients were instructed to continue their home exercise programs. Results: Pain pressure thresholds and PS significantly improved in all three groups. In the lidocaine group, PPT values were significantly higher than in the dry needle group, and PS were significantly lower than in both the BTX-A and dry needle groups. In all, visual analog scores significantly decreased in the lidocaine injection and BTX-A groups and did not significantly change in the dry needle group. Disturbance during the injection procedure was lowest in the lidocaine injection group. Quality of life scores assessed by NHP significantly improved in the lidocaine and BTX-A groups but not in the dry needle group. Depression and anxiety scores significantly improved only in the BTX-A-injected group. Conclusions: Injection is more practical and rapid, since it causes less disturbance than dry needling and is more cost effective than BTX-A injection, and seems the treatment of choice in MPS. On the other hand, BTX-A could be selectively used in MPS patients resistant to conventional treatments.

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References

  1. Sola AE, Bonica JJ (1990) Myofascial pain syndromes. In: Bonica JJ (ed) The management of pain. Lea and Febiger, Philadelphia, pp 352–367

  2. Alo KM, Yland MJ, Kramer DL, Charnov JH, Redko V (1997) Botulinum toxin in the treatment of myofascial pain. The Pain Clinic 10:107–116

    Google Scholar 

  3. Esenyel M, Çaglar N, Aldemir T (2000) Treatment of myofascial pain. Am J Phys Med Rehabil 79:48–52

    Article  CAS  PubMed  Google Scholar 

  4. Flor H, Birbaumer N (1993) Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol 61:653–658

    Article  CAS  PubMed  Google Scholar 

  5. Hong CZ (1994) Lidocaine injection versus dry needling to myofascial trigger point. Importance of the local twitch response. Am J Phys Med Rehabil 73:256–263

    CAS  PubMed  Google Scholar 

  6. Janzen VD, Scudds R (1997) Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome. Laryngoscope 107:1420–1422

    Article  CAS  PubMed  Google Scholar 

  7. Scudds RA, Janzen V, Delaney G, Heck C, McCain GA, Russell AL, Teasel RW, Varkey G, Woodbury MG (1995) The use of topical 4% lidocaine in spheno-palatine ganglion blocks for the treatment of chronic muscle pain syndromes: a randomized, controlled trial. Pain 62:69–77

    Article  CAS  PubMed  Google Scholar 

  8. Travell JG, Simons DG (1992) Myofascial pain and dysfunction: the trigger point manual. Williams and Wilkins, Baltimore

    Google Scholar 

  9. Simons DG (1988) Myofascial pain syndrome due to trigger points. In: Goodgold J (ed) Rehabilitation medicine. Mosby, St. Louis, pp 686–723

  10. Fricton JR (1994) Myofascial pain. Baillieres Clin Rheumatol 8:858–880

    Google Scholar 

  11. Yunus MB, Kalyan-Raman UP (1989) Muscle biopsy findings in primary fibromyalgia and other forms of nonarticular rheumatism. Rheum Dis Clin North Am 15:115–134

    CAS  PubMed  Google Scholar 

  12. Cheshire WP, Abashian SW, Mann JD (1994) Botulinum toxin in the treatment of myofascial pain syndrome. Pain 59:65–69

    Article  CAS  PubMed  Google Scholar 

  13. Wheeler AH, Goolkasian P, Gretz SS (2001) Botulinum toxin A for the treatment of chronic neck pain. Pain 94:255–260

    Article  CAS  PubMed  Google Scholar 

  14. Wheeler AH, Goolkasian P (2001) Open label assessment of botulinum toxin A for pain treatment in a private outpatient setting. J Musculoskelet Pain 9:67–82

    Google Scholar 

  15. Wheeler AH, Goolkasian P, Gretz SS (1998) A randomized, double-blind, prospective pilot study of botulinum toxin for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome. Spine 23:1662–1667

    Article  CAS  PubMed  Google Scholar 

  16. Porta M (2000) A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain 85:101–105

    Article  CAS  PubMed  Google Scholar 

  17. Rosen NB (1994) Physical medicine and rehabilitation approaches to the management of myofascial pain and fibromyalgia syndromes. Baillieres Clin Rheumatol 8:881–916

    CAS  PubMed  Google Scholar 

  18. Hong CZ, Hsueh TC (1996) Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch Phys Med Rehabil 77:1161–1166

    Article  CAS  PubMed  Google Scholar 

  19. Fischer AA (1986) Pressure threshold meter: its use for quantification of tender spots. Arch Phys Med Rehabil 67:836–838

    CAS  PubMed  Google Scholar 

  20. Fischer AA (1987) Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain 30:115–126

    Article  CAS  PubMed  Google Scholar 

  21. Esenyel M, Çaglar N, Aldemir T (2000) Treatment of myofascial pain. Am J Phys Med Rehabil 79:48–52

    Article  CAS  PubMed  Google Scholar 

  22. Reeves JL, Jaeger B, Graff-Redford SB (1986) Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain 24:313–321

    Article  CAS  PubMed  Google Scholar 

  23. Ozgocmen S, Ardicoglu O (2000) Lipid profile in patients with primary fibromyalgia and myofascial pain syndromes. Yonsei Med J 41:541–545

    CAS  PubMed  Google Scholar 

  24. Durett MR, Rodriguez AA, Agre JC, Silverman JL (1991) Needle electromyographic evaluation of patients with myofascial or fibromyalgic pain. Am J Phys Med Rehabil 70:154–156

    PubMed  Google Scholar 

  25. Hong CZ, Kuan TS, Chen JT, Chen SM (1997) Referred pain elicited by palpation and by needling of myofascial trigger points: a comparison. Arch Phys Med Rehabil 78:957–960

    Article  CAS  PubMed  Google Scholar 

  26. Berker E (1997) Miyofasiyal agri sendromu ve tedavisi. Romatol Tıb Rehab 8:121–124

    Google Scholar 

  27. Buskila D (1999) Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol 11:119–126

    Article  CAS  PubMed  Google Scholar 

  28. Dohrenwend BP, Raphael KG, Marbach JJ, Gallagher RM (1999) Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses. Pain 83:183–192

    Article  CAS  PubMed  Google Scholar 

  29. Heikkila H, Heikkila E, Eisemann M (1998) Predictive factors for the outcome of a multidisciplinary pain rehabilitation programme on sick-leave and life satisfaction in patients with whiplash trauma and other myofascial pain: a follow-up study. Clin Rehabil 12:487–496

    Google Scholar 

  30. Han SC, Harrison P (1997) Myofascial pain syndrome and trigger point management. Reg Anesth 22:89–101

    CAS  PubMed  Google Scholar 

  31. Tschopp KP, Gysin C (1996) Local injection therapy in 107 patients with myofascial pain syndrome of the head and neck. ORL J Otorhinolaryngol Relat Spec 58:306–310

    CAS  PubMed  Google Scholar 

  32. Genc H, Erdem R, Karaoglan B, Ertürk C, Yorgancšoglu R (1997) Effectivity of local anesthetic injection and dry needling in myofascial pain syndrome. J Rheum Med Rehab 8:29–33

    Google Scholar 

  33. Wreje U, Brorsson B (1995) A multicenter randomized controlled trial of injections of sterile water and saline for chronic myofascial pain syndromes. Pain 61:441–444

    Article  CAS  PubMed  Google Scholar 

  34. Hong CZ, Hsueh TC (1996) Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch Phys Med Rehabil 77:1161–1166

    Article  CAS  PubMed  Google Scholar 

  35. Eden L, Ejlertsson G, Leden I, Nordbeck B (2000) High rates of psychosomatic and neurotic symptoms among disability pensioners with musculoskeletal disorders. J Musculoskelet Pain 8:75–88

    Google Scholar 

  36. Faucette MT, Gil K, Williams DA, Keefe FJ, Goli V (1993) Predictors of response to pain management treatment. Clin J Pain 9:115–123

    Google Scholar 

  37. Katz WA (1998) The needs of a patient in pain. Am J Med 105:2S–7S

    Article  CAS  Google Scholar 

  38. Keefe FJ, Dolan E (1986) Pain behavior and pain coping strategies in low back pain and myofascial pain dysfunction syndrome patients. Pain 24:49–56

    Article  CAS  PubMed  Google Scholar 

  39. Lewit K, Simons DG (1984) Myofascial pain: relief by post-isometric relaxation. Arch Phys Med Rehabil 65:452–456

    CAS  PubMed  Google Scholar 

  40. Hanten WP, Olson SL, Butts NL, Nowicki AL (2000) Effectiveness of a home program of ischemic pressure followed by sustained stretching for treatment of myofascial trigger points. Phys Ther 80:997–1003

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Elazig, Turkey

    A. Kamanli, A. Kaya, O. Ardicoglu, S. Ozgocmen & F. Ozkurt Zengin

  2. Department of Psychiatry, Firat University, Elazig, Turkey

    Y. Bayık

  3. Firat Universitesi, Tip Fakultesi, Firat Tip Merkezi, FTR AD, 23119, Elazig, Turkey

    A. Kamanli

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  1. A. Kamanli
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  2. A. Kaya
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  3. O. Ardicoglu
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  4. S. Ozgocmen
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  5. F. Ozkurt Zengin
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  6. Y. Bayık
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Correspondence to A. Kamanli.

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Kamanli, A., Kaya, A., Ardicoglu, O. et al. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int 25, 604–611 (2005). https://doi.org/10.1007/s00296-004-0485-6

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  • DOI: https://doi.org/10.1007/s00296-004-0485-6

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