Adjunctive Therapy for Myofascial Pain Syndrome

Abstract

The lead article for this issue of the Journal of Musculoskeletal Pain [JMP] comes from investigators in Gaziantep, Turkey (1). The authors proposed to evaluate the efficacy of ultrasound [10 sessions] versus extracorporeal shock wave therapies [three sessions] in patients with myofascial pain syndrome [MPS] involving the trapezius muscle on at least one side of the body. They made the diagnosis of MPS according to the criteria of Simons and Travell (2). Their approach involved a controlled clinical trial in which 66 selected MPS patients were randomized to one of two treatment groups. Wisely, patients with comorbid fibromyalgia syndrome [FMS] were excluded. Evaluations were conducted at 3 weeks and 3 months by an examiner blinded to the randomization code. The patients tolerated both of the therapies and there were no severe complications. Statistically significant improvement was observed. Readers are advised to see the authors’ data to determine whether one of these interventions was favored by the experiment and whether the findings of this experiment will inform future choices of a physical modality for treatment of MPS. The second original contribution in this issue, relating to treatment of MPS, comes from Ankara, Turkey (3). This study was designed to determine whether a form of audio biofeedback would augment the treatment of MPS. They made the diagnosis of MPS according to the criteria of Simons and Travell (2). Patients with comorbid FMS were excluded. The authors recruited 90 patients with MPS involving the upper trapezius muscle on at least one side of the body and randomly assigned them into two intervention groups. Sixty of those patients [30 per intervention group] completed the study. The experimental group was instructed to use a portable audio biofeedback device for 30 min twice a day in addition to complying with a home-based exercise program. The control group received only the home-based exercise program. The home-based exercise program included neck isometric-isotonic exercise, back extensor stretching exercise, and posture exercises which were to be accomplished five times a week for 4 weeks, performing 15 repetitions of each exercise once daily. Outcome measurements were taken before starting therapy and after 4 weeks of therapy. The severity of the patient’s pain was measured by a visual analog scale. The number of trigger points, pressure pain threshold, cervical joint range of motion, and head–shoulder angles were recorded. Disability was assessed by the Neck Pain Disability Scale. Statistically significant improvements were observed in this study, including some differences in outcome between the experimental treatment and control groups. Readers are advised to see the authors’ data to determine whether the magnitude of these differences should prompt clinicians to add audio biofeedback to the exercise protocols they order for MPS patients with the objective of achieving specific outcome benefits. An uncontrolled pilot study conducted in Boston, MA, USA has reported the effects of a pain-specific relaxation response resiliency enhancement program [R3P, eight group sessions] for the management of chronic refractory temporomandibular joint disorder of the MPS type, involving the masticatory muscles (4). Twenty-four subjects [16 females], mean age 38 years, with at least a 6-month history of temporomandibular joint disorder completed the study between 2008 and 2010. Eligible participants underwent the R3P intervention after completing a standard medical management program. Preand post-intervention assessments included measures of impairment [vertical and lateral range of motion with and without pain, and temporomandibular joint and muscle pain palpation and algometry measures] and completed psychosocial measures [Symptom Severity Index, Perceived Stress Scale,