DOCSLIB.ORG

Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain UCSF UC San Francisco Previously Published Works Title Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. Permalink https://escholarship.org/uc/item/6rz7g5b9 Journal Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 41(5) ISSN 0884-2175 Authors Pastore, Elizabeth A Katzman, Wendy B Publication Date 2012-09-01 DOI 10.1111/j.1552-6909.2012.01404.x Peer reviewed eScholarship.org Powered by the California Digital Library University of California JOGNN I N F OCUS Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain Elizabeth A. Pastore and Wendy B. Katzman Correspondence ABSTRACT Elizabeth A. Pastore PT, Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified MA, COMT, Lizanne by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor Pastore Physical Therapy, 224-A Weller musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial Street, Petaluma, CA 94952. trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and [email protected] successfully treating MFPP. JOGNN, 41, 680-691; 2012. DOI: 10.1111/j.1552-6909.2012.01404.x Accepted March 2012 Keywords myofascial pelvic pain chronic pelvic pain myofascial trigger points yofascial pelvic pain (MFPP) is a frequently a precursor or sequela to urological, gynecolog- Elizabeth A. Pastore PT, M unrecognized and untreated component of ical, and colorectal medical conditions or other MA, COMT is the owner of chronic pelvic pain (CPP). Prevalence estimates musculo-skeletal-neural issues. The hallmark di- Lizanne Pastore Physical Therapy based in Petaluma, range from as low as 14% to 23% of women agnostic indicator of MFPP is the presence of CA. with CPP have myofascial pelvic pain (Tu, As- myofascial trigger points (MTrPs) in the muscles Wendy B. Katzman PT, Sanie, & Steege, 2006) to as high as 78% among of the pelvic floor and remotely. A number of re- DPTSc, OCS, is an women with interstitial cystitis (Bassaly et al., 2010; cent studies in the CPP literature have demon- associate professor in the Doggweiler-Wiygul, 2004; Itza et al., 2010). In a strated the existence of MTrPs or hypertonic pelvic Department of Physical recent review, researchers found that very few floor muscles in a variety of medical conditions Therapy and Rehabilitation Science, University of providers actually perform a vaginal digital pal- of distinctly different origins (Bassaly et al., 2010; California, San Francisco, pation of pelvic floor muscles during routine gy- Bendana et al., 2009; Chiarioni, Nardo, Vantini, San Francisco, CA. necological exams to examine for the presence of Romito, & Whitehead, 2010; Doggweiler-Wiygul myofascial pelvic pain and trigger points (Kavva- & Wiygul, 2002; Gentilcore-Saulnier, McLean, dias, Baessler, & Schuessler, 2011). An estimated Goldfinger, Pukall, & Chamberlain, 2010). For in- 10% to 15% of women’s gynecologic consultations stance, myofascial pain is often overlooked by are secondary to CPP, and 40% of gynecologic la- first-line health care providers as either a primary paroscopies are performed to determine a cause or contributing source of pain for conditions such of CPP (Paulson & Delgado, 2005). Pelvic pain as urgency/frequency, irritable bowel syndrome patients often attend numerous visits to different (IBS), interstitial cystitis/painful bladder syndrome health care providers before being properly diag- (IC/PBS), urge incontinence, constipation, dys- nosed. Identification and treatment of the myofas- pareunia, endometriosis, vulvodynia, coccygody- cial component of CPP is needed to effectively nia, pudendal neuralgia, proctalgia fugax, or post- manage this complex, often multifaceted problem. surgical or birthing pelvic pain (Apte et al., 2011; Butrick, 2009; Doggweiler-Wiygul, 2004; Neville, Myofascial pelvic pain, sometimes called myofas- Fitzgerald, Mallinson, Badillo, & Hynes, 2010). cial pelvic pain syndrome, refers to pain found in Our goal with this article is to educate obstetric the pelvic floor musculature and connecting fas- and gynecologic nurses about MFPP as a critical The authors report no con- cia. This syndrome exists alone with no concomi- component of CPP, provide an overview of how flict of interest or relevant financial relationships. tant medical pathology, or it may exist as either to screen women with CPP for suspected MFPP, 680 C 2012 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org Pastore, E. A. and Katzman, W. B. I N F OCUS and describe current evidence-based physi- cal therapy treatments and appropriate use of Myofascial pelvic pain is a frequently unrecognized and referrals. untreated component of chronic pelvic pain. Overview of Myofascial Pelvic Pain Etiology of Myofascial Trigger Points Myofascial Trigger Points The development and perpetuation of MFPP Myofascial pain syndrome, a recognized medi- and MTrPs can be explained by a variety of cal diagnosis among pain specialists, is charac- mechanical, nutritional, metabolic, and psycho- terized by adverse symptoms caused by tender logical factors that affect muscular strain, cir- points and MTrPs in skeletal muscles (Harden, culation, and pain. Mechanical factors such as Bruehl, Gass, Niemiec, & Barbick, 2000; Itza et al., direct trauma, chronic poor posture or body me- 2010; Simons, Travell, & Simons, 1999a, 1999b). chanics, ergonomic stressors, joint hypermobility, Myofascial trigger points are localized, often ex- leg length discrepancy, scoliosis, and pelvic tor- tremely painful lumps or nodules in the muscles sion can increase muscular strain (Fernandez-de- or associated connective tissue known as fascia Las-Penas, Alonso-Blanco, & Miangolarra, 2006; and are classified as either active or latent. Active Fricton, Auvinen, Dykstra, & Schiffman, 1985; MTrPs produce local or referred pain or sensory Simons et al., 1999b; Treaster, Marras, Burr, disturbances, whereas latent MTrPs will not trigger Sheedy, & Hart, 2006). In the woman expe- symptoms unless activated by an exacerbating riencing CPP, these mechanical factors may physical, emotional, or other associated stressor occur from prior surgeries, birthing trauma, child- (Dommerholt, 2005). The pain is often reproduced hood falls, injuries, accidents, illnesses, physi- when the muscle is compressed or stretched. An cal or sexual abuse, and repetitive movement MTrP is found within a taut band in the muscle patterns. Such events can be the preexisting and typically refers pain in a predictable pattern trauma that leads to future myofascial dysfunc- when palpated. Often women with MTrPs will re- tion (Doggweiler-Wiygul, 2004; Montenegro, Vas- spond with an increased sensitivity to pain, known concelos, Candido Dos Reis, Nogueira, & Poli- as hyperalgesia. In addition, women report pain Neto, 2008; Simons et al., 1999b). Women with from stimuli that are not normally painful, de- CPP have reported more musculoskeletal impair- fined as allodynia (Vecchiet, 1994, 1998; Vecchiet ments than women without CPP (Kavvadias, 2011; et al., 1990). Muscles with trigger points are Tu, Holt, Gonzales, & Fitzgerald, 2008), and one often weak, stiff, and have restricted range of group of researchers reported 85% of patients motion (Lucas, 2004; Weissmann, 2000). Fre- with CPP had musculoskeletal dysfunction and quently, impaired circulation in tissues surround- postural changes that contributed to their CPP ing trigger points, and autonomic disturbances, (Montenegro et al., 2008). A commonly accepted such as lacrimation and piloerection (goose hypothesis is that these musculoskeletal impair- bumps), may be present (Dommerholt, 2005; ments cause muscular strain due to low-level Ge, Madeleine, Cairns, & Arendt-Nielsen, 2006; static exertion of the muscle during prolonged mo- Lidbeck, 2002; Munglani, 2000; Simons et al., tor tasks, or result from mechanical factors cre- 1999a). ating muscle pain and injury (Henneman, Som- jen, & Carpenter, 1965). Muscular strain can also Myofascial trigger points can develop in any of the cause decreased circulation, localized hypoxia, pelvic floor muscles, and these trigger points usu- and ischemia (Armstrong, 1990; Hagg, 2003; Ot- ally refer sensation or pain to adjacent sites. These ten, 1988). These conditions can all result in the referral patterns do not present in classic nerve or formation of MTrPs (Sjogaard, Jorgensen, Ekner, & dermatomal regions, although characteristic refer- Sogaard, 2000; Sjogaard & Sogaard, 1998). Once ral patterns for pelvic MTrPs have been well docu- established, MTrPs can continue to be an ongo- mented (see Table 1). The perineum, vagina, ure- ing source of peripheral pain contributing to cen- thra, and rectum are common referral sites for the tral sensitization, a priming of the nervous system, pelvic floor muscles, but women may complain of making it more sensitive to painful stimuli (Dom- pain in the abdomen, back, thorax, hip/buttocks, merholt, 2005; Lidbeck, 2002; Munglani, 2000). and lower leg (Simons et al., 1999b). The lower abdominal region is a very common referral site Myofascial trigger points can remain latent for for levator ani trigger points, making it possible years, so identifying the original etiology is of- to confuse gynecologic, gastrointestinal, and my- ten challenging. Healthy tissues are designed to ofascial
Load more

Recommended publications
  • Enigma of Myofascial Pain-Dysfunction Syndrome - a Revisit of Review of Literature
    e-ISSN: 2349-0659 p-ISSN: 2350-0964 REVIEW ARTICLE doi: 10.21276/apjhs.2018.5.1.03 Enigma of myofascial pain-dysfunction syndrome - A revisit of review of literature Abdullah Bin Nabhan* Oral and Facial Pain Specialist, Department of Dentistry, King Khalid Hospital, Al Kharj, Saudi Arabia ABSTRACT Myofascial pain-dysfunction syndrome (MPDS) is a form of myalgia that is characterized by local regions of muscle hardness that are tender and cause pain to be felt at a distance, i.e., referred pain. The central component of the syndrome is the trigger point (TrP) that is composed of a tender, taut band. Stimulation of the band, either mechanically or with activity, can produce pain. Masticatory muscle fatigue and spasm are responsible for the cardinal symptoms of pain, tenderness, clicking, and limited function that characterize the MPDS. Since MPDS covers a wide range of symptoms, it might be difficult to diagnose and provide definitive treatment. A better understanding and working knowledge of TrPs and MPDS offers an effective approach to relieve pain, restore function, and contribute significantly to patient’s quality of life. Key words: Myalgia, myofascial pain-dysfunction syndrome, referred pain, trigger points INTRODUCTION The main acceptable factors include occlusion disorders and psychological problems.[6,7-10] Muscle pain is a common problem that is underappreciated and often undertreated. Myofascial pain-dysfunction Common etiologies of MPDS may be from direct or indirect trauma, syndrome (MPDS) is a myalgic condition in which muscle and spine pathology, exposure to cumulative and repetitive strain, musculotendinous pain are the primary symptoms and is the postural dysfunction, and physical deconditioning.
    [Show full text]
  • Myogenous Orofacial Pain Disorders: a Retrospective Study
    Gomez-Marroquin E, Abe Y, Padilla M, Enciso R, Clark GT. Myogenous Orofacial Pain Disorders: A Retrospective Study. J Anesthesiol & Pain Therapy. 2020;1(3):12-19 Research Article Open Access Myogenous Orofacial Pain Disorders: A Retrospective Study Erick Gomez-Marroquin1, Yuka Abe1,2, Mariela Padilla1*, Reyes Enciso3, Glenn T. Clark1 1Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California, USA 2Department of Prosthodontics, Showa University School of Dentistry, Tokyo, Japan. Visitor Scholar Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA 3Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California, USA Article Info Abstract Article Notes Aim: To assess treatment efficacy in the management of orofacial Received: August 21, 2020 myogenous conditions by a retrospective study of patients seen at an orofacial Accepted: November 04, 2020 pain clinic. *Correspondence: Methods: A single researcher conducted a retrospective review of charts *Dr. Mariela Padilla, Orofacial Pain and Oral Medicine, Herman of patients assigned to the same provider, to identify those with myogenous Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA; Telephone No: 90089-0641; disorders. The reviewed charts belonged to patients of the Orofacial Pain and Email: [email protected]. Oral Medicine Center of the University of Southern California, seeing from June 2018 to October 2019. ©2020 Padilla M. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. Results: A total of 129 charts included a myogenous disorder; the most common primary myogenous disorder was localized myalgia (58 cases, 45.0%).
    [Show full text]
  • Chronic Pelvic Pain & Pelvic Floor Myalgia Updated
    Welcome to the chronic pelvic pain and pelvic floor myalgia lecture. My name is Dr. Maria Giroux. I am an Obstetrics and Gynecology resident interested in urogynecology. This lecture was created with Dr. Rashmi Bhargava and Dr. Huse Kamencic, who are gynecologists, and Suzanne Funk, a pelvic floor physiotherapist in Regina, Saskatchewan, Canada. We designed a multidisciplinary training program for teaching the assessment of the pelvic floor musculature to identify a possible muscular cause or contribution to chronic pelvic pain and provide early referral for appropriate treatment. We then performed a randomized trial to compare the effectiveness of hands-on vs video-based training methods. The results of this research study will be presented at the AUGS/IUGA Joint Scientific Meeting in Nashville in September 2019. We found both hands-on and video-based training methods are effective. There was no difference in the degree of improvement in assessment scores between the 2 methods. Participants found the training program to be useful for clinical practice. For both versions, we have designed a ”Guide to the Assessment of the Pelvic Floor Musculature,” which are cards with the anatomy of the pelvic floor and step-by step instructions of how to perform the assessment. In this lecture, we present the video-based training program. We have also created a workshop for the hands-on version. For more information about our research and workshop, please visit the website below. This lecture is designed for residents, fellows, general gynecologists,
    [Show full text]
  • Myofascial Pain Dysfunction Syndrome: a Revisit
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 16, Issue 1 Ver. V (January. 2017), PP 13-21 www.iosrjournals.org Myofascial Pain Dysfunction Syndrome: A Revisit Dr. Rhea reji1, Dr. Vasavi krishnamurthy2, Dr. Mandavi garud3 1(department of oral medicine and maxillofacial radiology/ d.y. Patil university, school of dentistry, navi mumbai, india) 2(department of oral medicine and maxillofacial radiology/ d.y. Patil university, school of dentistry, navi mumbai, india) 3(department of oral medicine and maxillofacial radiology/ d.y. Patil university, school of dentistry, navi mumbai, india) Abstract: Myofascial Pain Dysfucntion Syndrome is a heterogeneous group of signs and symptoms that affect the jaw joint and/or the chewing musculature. Myofascial pain syndrome (MPS) is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators like Temporomandibular disorders (TMD). The appropriate evaluation and management of myofascial pain is an important part of musculoskeletal rehabilitation, and regional axial and limb pain syndromes. Currently a multifactorial theory on MPDS has received a great support among the scientific community. Myofascial Pain is the most common form of TMD, affecting principally women in reproductive age. This article gives a deeper insight into the pathogenesis, diagnosis and management of MPDS which will help clinicians to better understand this perplexing and mystifying condition. Keywords: craniomandibular, myofascial pain dysfunction syndrome, patients, temporomandibular joint, trigger points. I. Introduction Craniomandibular disorders (CMD) are a combination of symptoms that may include pain, tenderness and dysfunction of the temporomandibular joint, the mouth and the occlusal contacts, the cervical spine, and the muscles of mastication.
    [Show full text]
  • Myofascial Pain Syndrome in the Craniomandibular Region
    Myofascial Pain Syndrome in the Craniomandibular Region# Jan Dommerholt, PT, MPS* Craniomandibular disorders (CMD) are characterized become chronic pain patients (3-5). Patients with by a combination of symptoms that may include pain, persistent craniomandibular pain without objective tenderness and dysfunction of the temporomandibular clinical or radiographic findings are especially joint, the mouth and the occlusal contacts, the cervical challenging not only to the general dentist, but also to spine, and the muscles of mastication. Patients may orthodontists, oral surgeons, TMJ specialists, and other present with local dentoalveolar pain; muscle pain; clinicians. Some patients may be considered good head, facial and neck pain; sounds during condylar candidates for splint therapy. Others are referred to movements; deviations and limitations of mandibular oral surgeons when common dental procedures fail to movements; altered occlusal relations; parafunctions offer relief. Some frustrated pain patients may even and poor oral habits; and functional limitations of request surgical treatment in an effort to eliminate mastication. Craniofacial pain conditions have special chronic craniomandibular pain (6). emotional and psychological meaning. The face, the It is generally accepted that CMD have a mouth, speech, and other oral functions are essential for multifactorial etiology (7). Although many diseases, nearly all human interactions; craniofacial pain such as dental disease, infections and tumors, can be conditions interfere with such functions and with the associated with pain, most chronic pain problems are ability to communicate. thought to be musculoskeletal in nature. Different Approximately 10% of the general population perspectives of the primary source of pain have passed experience craniomandibular pain (1). The prevalence the revue.
    [Show full text]
  • 3 Myofascial Pain Syndromes and Their Evaluation
    Best Practice & Research Clinical Rheumatology Vol. 21, No. 3, pp. 427–445, 2007 doi:10.1016/j.berh.2007.02.014 available online at http://www.sciencedirect.com 3 Myofascial pain syndromes and their evaluation Robert Bennett* MD, FRCP, FACP Professor of Medicine Oregon Health & Science University, SNORD-219, 3455 SW Veterans Road, Portland, OR 97239-2941, USA Myofascial pain refers to a specific form of soft-tissue rheumatism that results from irritable foci (trigger points) within skeletal muscles and their ligamentous junctions. It must be distinguished from bursitis, tendonitis, hypermobility syndromes, fibromyalgia and fasciitis. On the other hand it often exists as part of a clinical complex that includes these other soft-tissue conditions, i.e., it is not a diagnosis of exclusion. The clinical science of trigger points can be traced to the pioneer- ing work of Kellgren in the 1930s, with his mapping of myotomal referral patterns of pain resulting from the injection of hypertonic saline into muscle and ligaments. Most muscles have characteristic myotomal patterns of referred pain; this feature forms the basis of the clinical recognition of myofascial trigger points in the form of a tender locus within a taut band of muscle which restricts the full range of motion and refers pain centrifugally when stimulated. Although myofascial pain syndromes have been described in the medical literature for about the last 100 years, it is only recently that scientific studies have revealed objective abnormalities. Key words: myofascial; pain; myotomal; trigger points; fibromyalgia; taut band; central sensitization. Myofascial pain is a common form of pain arising from hyperirritable foci in muscle, usually referred to as myofascial trigger points.
    [Show full text]
  • Tinnitus of Myofascial Origin
    ORIGINAL ARTICLE International Tinnitus Journal. 2012;17(1):73-76. Tinnitus of myofascial origin William S. Teachey1 Erik H. Wijtmans2 Frank Cardarelli3 Robert A. Levine4 Abstract Tinnitus in some instances is due to a primary muscle disorder: myofascial dysfunction of the muscles of the head and neck. Tinnitus of this origin can be diminished in some cases, and completely abolished in others, by appropriate treatment; this includes trigger point deactivation, specific exercises, and treatment of the underlying causes of the muscle dysfunction. Keywords: bruxism, injections, myofascial pain syndromes, otolaryngology, tinnitus. 1 MD College of Health Sciences, School of Physical Therapy - Old Dominion University - Norfolk, VA; Myopain Seminars - Bethesda, MD - AC - United States. E-mail: [email protected] 2 PT, MTC, CMTPT, CGIMS College of Health Sciences, School of Physical Therapy - Old Dominion University - Norfolk, VA; Myopain Seminars - Bethesda, MD - AC - United States. E-mail: [email protected] 3 LiAc Eaton-Peabody Laboratory - Massachusetts General Hospital - Boston, MA - United States. E-mail: [email protected] 4 MD Eaton-Peabody Laboratory Massachusetts Eye & Ear Infirmary - Massachusetts General Hospital - Boston, MA - United States. E-mail: [email protected] Send correspondence to: William S. Teachey, MD 1020 Independence Blvd. Suite 313, Virginia Beach, VA 23455. Paper submitted to the RBCMS-SGP (Publishing Management System) on July 15, 2012; and accepted on August 16, 2012. cod. 98. International Tinnitus Journal, Vol. 17, No 1 (2012) www.tinnitusjournal.com 70 17(1).indb 70 02/01/2013 13:41:06 INTRODUCTION 1. Tinnitus which has been present for a shorter period — e.g. under 2 years vs.
    [Show full text]
  • Fibromyalgia Syndrome
    Fibromyalgia Syndrome For Churchill Livingstone: Publishing Director, Health Professions: Mary Law Project Development Manager: Katrina Mather Project Manager: Wendy Gardiner Design: Judith Wright Illustration Manager: Bruce Hogarth A Practitioner’s Guide to Treatment Leon Chaitow ND DO Registered Osteopathic Practitioner and Senior Lecturer, School of Integrated Health, University of Westminster, London, UK With contributions by Peter Baldry MB FRCP Jan Dommerholt PT MPS Gina Honeyman-Lowe BLS DC Tamer S. Issa PT John C. Lowe MA DC Carolyn McMakin MA DC Paul J. Watson BSc (Hons) MSC MCSP Foreword by Sue Morrison General Practitioner, Marylebone Health Centre, London, and Associate Dean, Postgraduate General Practice, North Thames (West), UK Illustrated by Graeme Chambers BA (Hons) Medical Artist SECOND EDITION EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2003 - 1 - CHURCHILL LIVINGSTONE An imprint of Elsevier Science Limited © Harcourt Publishers Limited 2000 © 2003, Elsevier Science Limited. All rights reserved. The right of Leon Chaitow to be identified as author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239, e-mail: [email protected].
    [Show full text]
  • Trigger Point Injection Therapy in the Management of Myofascial Temporomandibular Pain Temporomandibular Miyofasyal Ağrılarda Tetik Nokta Enjeksiyonu Tedavisi
    AĞRI 2011;23(3):119-125 CLINICAL TRIALS - KLİNİK ÇALIŞMA doi: 10.5505/agri.2011.04796 Trigger point injection therapy in the management of myofascial temporomandibular pain Temporomandibular miyofasyal ağrılarda tetik nokta enjeksiyonu tedavisi Fatih ÖZKAN,1 Nilüfer ÇAKIR ÖZKAN,2 Ünal ERKORKMAZ3 Summary Objectives: Myofascial pain is the most common temporomandibular disorder. The objective of this study was to compare the effectiveness of combined treatment modalities in the management of myofascial temporomandibular pain. Methods: Fifty patients (44 female, 6 male) clinically and radiologically diagnosed with myofascial temporomandibular dis- order (TMD) were selected for the study and randomly assigned to two groups of 25 patients. Group 1 patients were treated with stabilization splint (SS) and Group 2 patients were treated with trigger point injection combined with SS therapy. Results: Positive improvement in overall signs and symptoms with statistically significant differences was observed in both groups. Group 2 showed significant reduction in visual analogue scale (VAS) scores, and statistical analysis revealed a significant difference between the VAS scores of Group 1 and Group 2 at the 4th and 12th weeks of treatment follow-up (p<0.001). Conclusion: Our results indicate that trigger point injection therapy combined with splint therapy is effective in the manage- ment of myofascial TMD pain. Further research, especially randomized controlled trials, should be carried out to ascertain its effectiveness over other treatment modalities. Key words: Myofascial temporomandibular disorder; treatment modalities; trigger point injection. Özet Amaç: Miyofasyal ağrılar en sık görülen temporomandibular bozukluklardır. Bu çalışmada, miyofasyal temporomandibular ağrının te- davisinde kombine tedavi yöntemlerinin etkinliği karşılaştırıldı. Gereç ve Yöntem: Klinik ve radyolojik olarak miyofasyal temporomandibular bozukluk tanısı almış 50 hasta (44 kadın, 6 erkek) ça- lışmaya alındı ve randomize olarak her grupta 25 hasta olacak şekilde iki gruba ayrıldı.
    [Show full text]
  • The Case for Comorbid Myofascial Pain—A Qualitative Review
    International Journal of Environmental Research and Public Health Review The Case for Comorbid Myofascial Pain—A Qualitative Review Simon Vulfsons * and Amir Minerbi Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel Rappaport School of Medicine, Technion Institute of Technology, Haifa 31096, Israel; [email protected] * Correspondence: [email protected]; Tel.: +972-47772234; Fax: +972-47773505 Received: 2 May 2020; Accepted: 8 July 2020; Published: 17 July 2020 Abstract: Myofascial pain syndrome is widely considered to be among the most prevalent pain conditions, both in the community and in specialized pain clinics. While myofascial pain often arises in otherwise healthy individuals, evidence is mounting that its prevalence may be even higher in individuals with various comorbidities. Comorbid myofascial pain has been observed in a wide variety of medical conditions, including malignant tumors, osteoarthritis, neurological conditions, and mental health conditions. Here, we review the evidence of comorbid myofascial pain and discuss the diagnostic and therapeutic implications of its recognition. Keywords: myofascial pain syndrome; comorbid pain; chronic pain; secondary pain 1. Introduction Myofascial pain syndrome (MPS) is a regional pain syndrome arising in muscles and muscle fascia, characterized by tenderness to palpation, limited range of motion and the presence of taut bands [1–3]. The diagnosis of MPS rests strictly on clinical criteria, including a history and physical examination of the involved muscles [4–6]. Myofascial trigger points (MTrPs) are considered a cornerstone of the pathophysiology of the MPS by many authors [3,7–10]. MTrPs are defined as hypersensitive, palpable, taut bands of muscle that are painful to palpation, reproduce the patient’s symptoms, and cause referred pain [3,11].
    [Show full text]
  • Trigger Point and Tender Point Injections (604)
    Medical Policy Trigger Point and Tender Point Injections Table of Contents • Policy: Commercial • Coding Information • Information Pertaining to All Policies • Policy: Medicare • Description • References • Authorization Information • Policy History Policy Number: 604 BCBSA Reference Number: 2.01.103 Related Policies Dry Needling and Trigger Point Injections for Myofascial, #792 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Trigger point injections with anesthetic and/or corticosteroid may be considered MEDICALLY NECESSARY for the treatment of myofascial pain syndrome when all of the following criteria have been met: • There is a regional pain complaint in the expected distribution of referral pain from a trigger point, AND • There is spot tenderness in a palpable taut band in a muscle, AND • There is restricted range of motion, AND • Conservative therapy (eg, physical therapy, active exercises, ultrasound, heating or cooling, massage, activity modification, or pharmacotherapy) for 6 weeks fails or is not feasible, AND • Trigger point injections are provided as a component of a comprehensive therapy program, AND • No more than 4 injections are given in a 12-month period. Trigger point and tender point injections are considered INVESTIGATIONAL for all other indications, including the treatment of myofascial pain syndrome not meeting the criteria above, complex regional pain syndrome, abdominal wall pain, and fibromyalgia. Ultrasound guidance of trigger point injections is considered INVESTIGATIONAL. Prior Authorization Information Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient. Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.
    [Show full text]
  • Simultaneous Occurrence of Myofascial Pain Referred to Tooth and Endodontic Lesions in Patient with Toothache: a Case Report
    Open Journal of Stomatology, 2020, 10, 230-240 https://www.scirp.org/journal/ojst ISSN Online: 2160-8717 ISSN Print: 2160-8709 Simultaneous Occurrence of Myofascial Pain Referred to Tooth and Endodontic Lesions in Patient with Toothache: A Case Report Takashi Uchida1, Chiaki Komine2, Takashi Iida1, Masakazu Okubo1, Osamu Komiyama1 1Orofacial and Head Pain Clinic, Nihon University Hospital at Matsudo, Chiba, Japan 2Department of Oral Health Science, Division of Laboratory Medicine for Dentistry, Nihon University School of Dentistry at Matsudo, Chiba, Japan How to cite this paper: Uchida, T., Ko- Abstract mine, C., Iida, T., Okubo, M. and Komiya- ma, O. (2020) Simultaneous Occurrence of Toothache is almost always caused by odontogenic toothache, but diagnosis is Myofascial Pain Referred to Tooth and more difficult in the case of nonodontogenic toothache. We report a case of Endodontic Lesions in Patient with Too- simultaneous occurrence of odontogenic and nonodontogenic toothache. thache: A Case Report. Open Journal of Sto- matology, 10, 230-240 This manuscript presents a case report for a 35-year-old woman who visited https://doi.org/10.4236/ojst.2020.108022 our Orofacial and Head Pain Clinic with the chief complaint of continuous dull pain in left maxillary molar teeth region. It was concluded to be a case of Received: July 20, 2020 simultaneous odontogenic toothache and nonodontogenic toothache. It was Accepted: August 10, 2020 Published: August 13, 2020 successfully treated by an endodontist and an orofacial pain specialist. The endodontist performed root canal treatment against odontogenic toothache Copyright © 2020 by author(s) and caused by apical periodontitis using a dental operating microscope.
    [Show full text]