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Effect of Bloodletting Therapy at Local Myofascial Trigger

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Effect of Bloodletting Therapy at Local Myofascial Trigger Online Submissions: http://www.journaltcm.com J Tradit Chin Med 2016 February 15; 36(1): 26-31 [email protected] ISSN 0255-2922 © 2016 JTCM. All rights reserved. CLINICAL STUDYTOPIC Effect of bloodletting therapy at local myofascial trigger points and acupuncture at Jiaji (EX-B 2) points on upper back myofascial pain syndrome: a randomized controlled trial Jiang Guimei, Jia Chao, Lin Mode aa Jiang Guimei, Physiotherapy Department, Guangdong Pro- control group (n = 33) were treated with a lidocaine vincial Hospital of Traditional Chinese Medicine, Guangzhou block at trigger points; one treatment course con- 510120, China sisted of five sessions of lidocaine block therapy Jia Chao, Tuina Department, No.1 Affiliated Hospital of with a 2-day break between each session. The sim- Guangzhou University of TCM, Guangzhou 510405, China plified McGill Scale (SF-MPQ) and tenderness Lin Mode, Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of TCM, Guangzhou 510120, threshold determination were used to assess pain China before and after a course of treatment. Supported by the Science and Technology Plan Project of RESULTS: After the third and fifth treatment, the Social Development of Guangdong Provincial Department of Science and Technology (Project name: Effect of Bloodlet- SF-MPQ values were significantly decreased (P < ting Therapy at Local Myofascial Trigger Points and Acu- 0.01) and the tenderness thresholds were signifi- puncture at Jiaji Points on Upper Back Myofascial Pain Syn- cantly increased (P < 0.01) in both groups com- drome, No. 2011B080701089) pared with before treatment. There were no signifi- Correspondence to: Associate chief physician Jia Chao, cant differences in pain assessments between the Tuina Department, No.1 Affiliated Hospital of Guangzhou two groups after three and five treatments (P > University of TCM, Guangzhou 510405, China. doctorji- 0.05). There were five cases with minor adverse re- [email protected] actions reported in the control patients, while no Telephone: +86-13535307000 Accepted: June 1, 2015 adverse reactions were reported in the treatment group. CONCLUSION: Bloodletting therapy at local myo- Abstract fascial trigger points and acupuncture at Jiaji points was effective in treating upper back MPS. OBJECTIVE: To observe the clinical efficacy of Clinically, bloodletting and acupuncture therapy bloodletting therapy and acupuncture at Jiaji had the same efficacy as the lidocaine block thera- points for treating upper back myofascial pain syn- py, with fewer adverse reactions. drome (MPS), and compare this with lidocaine block therapy. © 2016 JTCM. Open access under CC BY-NC-ND license. METHODS: A total of 66 upper back MPS patients Key words: Myofascial pain syndromes; Acupunc- were randomly assigned to either the treatment ture; Bloodletting; Treatment outcome; Random- group or the control group in a 1∶1 ratio. The treat- ized controlled trial ment group (n = 33) were treated with bloodletting therapy at local myofascial trigger points and acu- puncture at Jiaji (EX-B 2) points; one treatment INTRODUCTION course consisted of five, single 20-min-treatments Myofascial pain syndrome (MPS) is originally generat- with a 2-day break between each treatment. The ed within connective tissue such as muscles, tendons JTCM | www. journaltcm. com 26 February 15, 2016 |Volume 36 | Issue 1 | Jiang GM et al. / Clinical Study and fascia. MPS is a common cause of neck pain, lum- tremely tender spot known as a TrP. (c) In addition to bar pain and pain around the major joints.1 Myofascial referring pain to the reference zone, TrPs may cause trigger points (MTrPs) are a major clinical feature of other sensory changes such as tenderness and dysesthe- MPS. sia. (e) Muscles with active MTrPs have a restricted pas- The most common treatment for MPS in Western sive (stretch) range of motion because of pain. (f) The Medicine is local block therapy, usually lidocaine.2 taut muscle band fibers respond consistently with a Muscle stretch therapy3,4 dry needle therapy5 and oral twitch response when the TrP is penetrated by a nee- non-steroidal anti-inflammatory drugs6 are also com- dle. (g) The patient feels pain when the muscle is monly used. However, there are limitations of these strongly contracted against fixed resistance. (h)Sleep treatments, such as adverse reactions to anesthetic and disturbance can increase pain sensitivity. oral medications, and intense pain associated with dry needle therapy and muscle stretch therapy.6-8 Traditional Chinese Medicine (TCM) syndrome The analgesic effect of acupuncture is recognized differentiation worldwide. Local acupuncture is mainly used in the According to the Criteria of diagnosis and therapeutic treatment of MPS; this relieves pain by damaging the effect of diseases and syndromes in TCM assigned by trigger points and improving local circulation. Howev- the State Administration of TCM,18 back myofasciitis er, there is a lack of specific treatment programs target- can be summarized into three syndromes: internal ing repeated pain caused by spinal segmental sensitiza- pathogen with wind, cold and dampness; stagnation of tion and central sensitization. Because Jiaji (EX-B 2) Qi and blood; and deficiency of Qi and blood. has special anatomic and physiologica functions, it was used in treating many diseases, especially in acupunc- Inclusion criteria ture analgesia.9-17 The skin over the trigger points (a) Diagnosed with MPS according to the above men- (TrPs) is pricked to release blood, and acupuncture is tioned diagnostic criteria. (b) Aged 20-60 years. (c) performed at the Jiaji (EX-B 2) points where the TrPs Provided written informed consent. are located. Exclusion criteria The purpose of this study was to evaluate the clinical (a) Comorbid diseases including cervical spondylosis, efficacy of bloodletting and Jiaji (EX-B 2) acupuncture cervical and spinal tuberculosis, ankylosing spondylitis, treatment for upper back MPS, and compare this with cervical tumor, severe pain caused by psychological fac- the efficacy of lidocaine block therapy. tors and other organic pathologic changes. (b) Hyper- sensitivity to drugs, injections, and/or acupuncture. (c) MATERIALS AND METHODS Severe cardiovascular and respiratory disease. (d) Tak- ing conflicting or related medicine during the study. This study was approved by the Ethics Committee of (e) Mental or psychiatric disease. (f) Pregnant women. Guangdong Provincial Traditional Chinese Medicine (g) Patients intolerant of or uncooperative with the Hospital. All participants provided written informed study. consent. A total of 66 participants were randomly divided into Treatment Treatment group: to locate the MTrPs, each patient two groups at a 1∶1 ratio of treatment group (n = 33) to control group (n = 33). All participants were outpa- pointed out their painful area, which the doctor then tients of the Physiotherapy Department of Guangdong pressed with their thumbs to confirm the presence of a Provincial Hospital of TCM from October 2011 to tense muscle band. The doctor pressed the TrP to bring June 2013. out the circumscribed pain and spasm, and then en- The random digits were generated by SPSS 11.0 soft- hanced the stimulus to induce referred pain. When the ware (SPSS Inc., Chicago, IL, USA) and were loaded pain was induced, patients were asked whether it felt in the envelopes. The corresponding envelopes were se- similar to the pain that usually occurs. To quantitative- 2 lected according to the sequence of the participants, ly evaluate the MTrPs, a tenderness meter with a 1 cm and the method in it was used in the research. spring end was placed on the major MTrPs. Pressure Because the treatment method is different, so the blind was applied, and the threshold of tenderness was mea- 2 method can't be used. Only in the data collation and sured. A threshold of tenderness of 2 kg/cm or below statistical analysis phase, there was a assign specific per- was regarded as abnormal. When the MTrPs were locat- son to manage the data. ed, an X was drawn on it with inerasable ink. Each MTrP was held steady with the doctor's non-dominant Diagnostic criteria of myofascial pain syndrome3,4 hand, and then the dominant hand was used to stab (a) Medical history of pain associated with some degree the triangle-edged needle (Hanyi triangle-edged nee- of mechanical abuse of the muscle in the form of mus- dle, 6.5 cm length, 0.5 mm tip length and 1.6 mm di- cle overload, which may have been acute, sustained ameter. Manufactured by Changchun AIK Medical De- and/or repetitive. (b) Palpation along the taut muscle vices Co., Ltd. Address: No. 25 karan Industrial park, band reveals a nodule exhibiting a highly localized, ex- jiutai Econimic Development Zone, Changchun. JTCM | www. journaltcm. com 27 February 15, 2016 |Volume 36 | Issue 1 | Jiang GM et al. / Clinical Study 130507, China) into the MTrP about 0.2 mm deep, five times, with a 10-15 s break between each measure- and then quickly remove the needle. This was repeated ment; the mean value was recorded as the PPT and PTT. three times to bleed the MTrP. Adverse reactions we related to the therapy were record- After bloodletting, the glass cups were cupped on the ed, including subcutaneous hemorrhage and hemato- bleeding area for 10 min. The left hand held the hemo- ma, hypersensitivity, palpitations and dizziness. static clamping 95% alcohol cotton, right hand held glass cup. After the fire lighted alcohol cot, quickly ro- Data management and statistical analysis tated lighting cotton 1-3 turning in the cup, exited All clinical data were recorded on a specific clinical re- quickly, immediately covered the cup on the bleeding search form and managed by a specific person excluded sites. Ten minutes later, the cups were withdrew and from the researchers and therapists. Statistical analysis gore was abrased by disinfected cotton swab. was done using SPSS11.0 software (SPSS Inc., Chica- After cupping, acupuncture needles were inserted into go, IL, USA).
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