Probable mechanisms of needling therapies for myofascial pain control

Li-Wei Chou, Mu-Jung Kao, Jaung-Geng Lin, Li-Wei Chou, Mu-Jung Kao, Jaung-Geng Lin

Abstract

Myofascial pain syndrome (MPS) has been defined as a regional pain syndrome characterized by muscle pain caused by myofascial trigger points (MTrPs) clinically. MTrP is defined as the hyperirritable spot in a palpable taut band of skeletal muscle fibers. Appropriate treatment to MTrPs can effectively relieve the clinical pain of MPS. Needling therapies, such as MTrP injection, dry needling, or acupuncture (AcP) can effectively eliminate pain immediately. AcP is probably the first reported technique in treating MPS patients with dry needling based on the Traditional Chinese Medicine (TCM) theory. The possible mechanism of AcP analgesia were studied and published in recent decades. The analgesic effect of AcP is hypothesized to be related to immune, hormonal, and nervous systems. Compared to slow-acting hormonal system, nervous system acts in a faster manner. Given these complexities, AcP analgesia cannot be explained by any single mechanism. There are several principles for selection of acupoints based on the TCM principles: "Ah-Shi" point, proximal or remote acupoints on the meridian, and extra-meridian acupoints. Correlations between acupoints and MTrPs are discussed. Some clinical and animal studies of remote AcP for MTrPs and the possible mechanisms of remote effectiveness are reviewed and discussed.

References

    1. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1. Baltimore, Md, USA: Williams & Wilkins; 1983.
    1. Hong CZ. Myofascial pain therapy. Journal of Musculoskeletal Pain. 2004;12(3-4):37–43.
    1. Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Archives of Physical Medicine and Rehabilitation. 1998;79(7):863–872.
    1. Hong CZ. Braddom: Physical Medicine and Rehabilitation. 4th edition. chapter 43. New York, NY, USA: Elsevier; 2011. Muscle pain syndrome; pp. 971–1001.
    1. Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd edition. Vol. 1. Baltimore, Md, USA: Williams & Wilkins; 1999.
    1. Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain. 1997;69(1-2):65–73.
    1. Hong CZ. Considerations and recommendations regarding myofascial trigger point injection. Journal of Musculoskeletal Pain. 1994;2(1):29–59.
    1. Hong CZ. Treatment of myofascial pain syndrome. Current Pain and Headache Reports. 2006;10(5):345–349.
    1. Borg-Stein J, Simons DG. Myofascial pain. Archives of Physical Medicine and Rehabilitation. 2002;83(3):S40–S47.
    1. Kostopoulos D, Rizopoulos K. The Manual of Trigger Point and Myofascial Therapy. Thorofare, NJ, USA: SLACK; 2001.
    1. Cailliet Soft tissue pain R, disability . Philadelphia, Pa, USA: F. A. Davis; 1977.
    1. Hong CZ. New trends in myofascial pain syndrome. Chinese Medical Journal. 2002;65(11):501–512.
    1. Kao MJ, Han TI, Kuan TS, Hsieh YL, Su BH, Hong CZ. Myofascial trigger points in early life. Archives of Physical Medicine and Rehabilitation. 2007;88(2):251–254.
    1. Han TI, Hong CZ, Kuo FC, Hsieh YL, Chou LW, Kao MJ. Mechanical pain sensitivity of deep tissues in children—possible development of myofascial trigger points in children. BMC Musculoskeletal Disorders. 2012;13, article 13
    1. Simons DG, Travell J. Myofascial trigger points, a possible explanation. Pain. 1981;10(1):106–109.
    1. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Journal of Electromyography and Kinesiology. 2004;14(1):95–107.
    1. Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Practice and Research Clinical Rheumatology. 2007;21(2):367–387.
    1. Kuan TS. Current studies on myofascial pain syndrome. Current Pain and Headache Reports. 2009;13(5):365–369.
    1. Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. Journal of the American Board of Family Medicine. 2010;23(5):640–646.
    1. Travell J, Bobb AL. Mechanism of relief of pain in sprains by local injection technics. Federation Proceedings. 1947;6, article 378
    1. Hong CZ. Myofascial trigger point injection. Critical Review of Physical and Rehabilitation Medicine. 1993;5:203–217.
    1. Fischer AA. New approaches in treatment of myofascial pain. Physical Medicine and Rehabilitation Clinics of North America. 1997;8(1):153–169.
    1. Gunn CC, Milbrandt WE, Little AS, Mason KE. Dry needling of muscle motor points for chronic low-back pain. A randomized clinical trial with long-term follow-up. Spine. 1980;5(3):279–291.
    1. Chu J. Does EMG (dry needling) reduce myofascial pain symptoms due to cervical nerve root irritation? Electromyography and Clinical Neurophysiology. 1997;37(5):259–272.
    1. Chu J, Neuhauser DV, Schwartz I, Aye HH. The efficacy of automated/electrical twitch obtaining intramuscular stimulation (atoims/etoims) for chronic pain control: evaluation with statistical process control methods. Electromyography and Clinical Neurophysiology. 2002;42(7):393–401.
    1. Chu J, Yuen KF, Wang BH, Chan RC, Schwartz I, Neuhauser D. Electrical twitch-obtaining intramuscular stimulation in lower back pain: a pilot study. American Journal of Physical Medicine and Rehabilitation. 2004;83(2):104–111.
    1. Baldry P. Superficial dry needling at myofascial trigger point sites. Journal of Musculoskeletal Pain. 1995;3(3):117–126.
    1. Baldry P. Superficial dry needling. In: Chaitow CL, editor. Fibromyalgia Syndrome: A Practitioner's Guide to Treatment. Edinburgh, UK: Churchill Livingston; 2000.
    1. Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Journal of Orofacial Pain. 2002;16(1):71–76.
    1. Acquadro MA, Borodic GE. Treatment of myofascial pain with botulinum A toxin. Anesthesiology. 1994;80(3):705–706.
    1. Cheshire WP, Abashian SW, Mann JD. Botulinum toxin in the treatment of myofascial pain syndrome. Pain. 1994;59(1):65–69.
    1. Göbel H, Heinze A, Reichel G, Hefter H, Benecke R. Efficacy and safety of a single botulinum type A toxin complex treatment (Dysport) for the relief of upper back myofascial pain syndrome: results from a randomized double-blind placebo-controlled multicentre study. Pain. 2006;125(1-2):82–88.
    1. Soares A, Andriolo RB, Atallah AN, da Silva EMK. Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database of Systematic Reviews. 2009;(1)CD007533
    1. Chou LW, Hong JY, Hong CZ. A new technique for acupuncture therapy and its effectiveness in treating fibromyalgia syndrome: a case report. Journal of Musculoskeletal Pain. 2008;16(3):193–198.
    1. Chou LW, Hsieh YL, Kao MJ, Hong CZ. Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. Archives of Physical Medicine and Rehabilitation. 2009;90(6):905–912.
    1. Unschuld PU. Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. London, UK: University of California Press; 2003.
    1. Unschuld PU, Tessenow H, Jinsheng Z. Huang Di Nei Jing Su Wen: An Annotated Translation of Huang Di's Inner Classic—Basic Questions. 1st edition. London, UK: University of California Press; 2011.
    1. Lin JG, Chen WL. Acupuncture analgesia: a review of its mechanisms of actions. American Journal of Chinese Medicine. 2008;36(4):635–645.
    1. Lin JG, Chen WL. Review: acupuncture analgesia in clinical trials. American Journal of Chinese Medicine. 2009;37(1):1–18.
    1. Lin JG, Chen YH. Acupuncture analgesia research and clinical practice in Taiwan. In: Saad M, editor. Acupuncture—Concepts and Physiology. chapter 11. Vienna, Austria: InTech Open Access; 2011. pp. 175–200. .
    1. Han JS. Acupuncture analgesia: areas of consensus and controversy. Pain. 2011;152(3):S41–S48.
    1. Research Group of Acupuncture Anesthesia BMC. Effect of needling positions in acupuncture on pain threshold of human skin. Zhonghua Yi Xue Za Zhi. 1973;3:151–157.
    1. Pomeranz B, Chiu D. Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sciences. 1976;19(11):1757–1762.
    1. Pomeranz B, Cheng R, Law P. Acupuncture reduces electrophysiological and behavioral responses to noxious stimuli: pituitary is implicated. Experimental Neurology. 1977;54(1):172–178.
    1. Clement-Jones V, McLoughlin L, Tomlin S. Increased β-endorphin but not metenkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. The Lancet. 1980;2(8201):946–949.
    1. Han JS, Xie GX, Zhou ZF, Folkesson R, Terenius L. Enkephalin and beta-endorphin as mediators of electro-acupuncture analgesia in rabbits: an antiserum microinjection study. Advances in Biochemical Psychopharmacology. 1982;33:369–377.
    1. Mendelson G. The possible role of enkephalin in the mechanism of acupuncture analgesia in man. Medical Hypotheses. 1977;3(4):144–145.
    1. Han Z, Jiang YH, Wan Y, Wang Y, Chang JK, Han JS. Endomorphin-1 mediates 2 Hz but not 100 Hz electroacupuncture analgesia in the rat. Neuroscience Letters. 1999;274(2):75–78.
    1. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences. 2003;26(1):17–22.
    1. Cheng RSS, Pomeranz B. Electroacupuncture analgesia could be mediated by at least two pain-relieving mechanisms; endorphin and non-endorphin systems. Life Sciences. 1979;25(23):1957–1962.
    1. Chen XH, Han JS. Analgesia induced by electroacupuncture of different frequencies is mediated by different types of opioid receptors: another cross-tolerance study. Behavioural Brain Research. 1992;47(2):143–149.
    1. Lin JG, Hao T, Chen XH, Han JS. Intermittent-alternating mode of administering electroacupuncture stimulation postpones the development of electroacupuncture tolerance. American Journal of Acupuncture. 1993;21(1):51–57.
    1. Lao L, Zhang RX, Zhang G, Wang X, Berman BM, Ren K. A parametric study of electroacupuncture on persistent hyperalgesia and Fos protein expression in rats. Brain Research. 2004;1020(1-2):18–29.
    1. Tsai HY, Lin JG, Inoki R. Further evidence for possible analgesic mechanism of electroacupuncture: effects on neuropeptides and serotonergic neurons in rat spinal cord. Japanese Journal of Pharmacology. 1989;49(2):181–185.
    1. Takagi J, Yonehara N. Serotonin receptor subtypes involved in modulation of electrical acupuncture. Japanese Journal of Pharmacology. 1998;78(4):511–514.
    1. Chang FC, Tsai HY, Yu MC, Yi PL, Lin JG. The central serotonergic system mediates the analgesic effect of electroacupuncture on zusanli (ST36) acupoints. Journal of Biomedical Science. 2004;11(2):179–185.
    1. Liu X, Zhu B, Zhang SX. Relationship between electroacupuncture analgesia and descending pain inhibitory mechanism of nucleus raphe magnus. Pain. 1986;24(3):383–396.
    1. Sekido R, Ishimaru K, Sakita M. Differences of electroacupuncture-induced analgesic effect in normal and inflammatory conditions in rats. American Journal of Chinese Medicine. 2003;31(6):955–965.
    1. Huang C, Hu ZP, Long H, Shi YS, Han JS, Wan Y. Attenuation of mechanical but not thermal hyperalgesia by electroacupuncture with the involvement of opioids in rat model of chronic inflammatory pain. Brain Research Bulletin. 2004;63(2):99–103.
    1. Hokfelt T. Neuropeptides in perspective: the last ten years. Neuron. 1991;7(6):867–879.
    1. Stein C. The control of pain in peripheral tissue by opioids. The New England Journal of Medicine. 1995;332(25):1685–1690.
    1. Tracey KJ. The inflammatory reflex. Nature. 2002;420(6917):853–859.
    1. Oke SL, Tracey KJ. The inflammatory reflex and the role of complementary and alternative medical therapies. Annals of the New York Academy of Sciences. 2009;1172:172–180.
    1. Lewit K. The needle effect in the relief of myofascial pain. Pain. 1979;6(1):83–90.
    1. Chu J. Dry needling (intramuscular stimulation) in myofascial pain related to lumbosacral radiculopathy. European Journal of Physical Medicine and Rehabilitation. 1995;5(4):106–121.
    1. Gunn CC. Treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin. London, UK: Churchill Livingston; 1996.
    1. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Archives of Physical Medicine and Rehabilitation. 2001;82(7):986–992.
    1. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. European Journal of Pain. 2009;13(1):3–10.
    1. Itoh K, Katsumi Y, Hirota S, Kitakoji H. Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Complementary Therapies in Medicine. 2007;15(3):172–179.
    1. Sun MY, Hsieh CL, Cheng YY, et al. The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. American Journal of Chinese Medicine. 2010;38(5):849–859.
    1. Hong CZ, Torigoe Y. Electrophysiological characteristics of localized twitch responses in responsive taut bands of rabbit skeletal muscle fibers. Journal of Musculoskeletal Pain. 1994;2(2):17–43.
    1. Chen JT, Chen SM, Kuan TS, Chung KC, Hong CZ. Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle. Archives of Physical Medicine and Rehabilitation. 1998;79(7):790–794.
    1. Hsieh YL, Kao MJ, Kuan TS, Chen SM, Chen JT, Hong CZ. Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. American Journal of Physical Medicine and Rehabilitation. 2007;86(5):397–403.
    1. Shah JP. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis. Journal of Musculoskeletal Pain. 2008;16(1-2):17–20.
    1. Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of Physical Medicine and Rehabilitation. 2008;89(1):16–23.
    1. Melzack R. Myofascial trigger points: relation to acupuncture and mechanisms of pain. Archives of Physical Medicine and Rehabilitation. 1981;62(3):114–117.
    1. Hong CZ. Myofascial trigger points: pathophysiology and correlation with acupuncture points. Acupuncture in Medicine. 2000;18(1):41–47.
    1. Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons’ integrated hypothesis of trigger point formation. Current pain and headache reports. 2004;8(6):468–475.
    1. Jimbo S, Atsuta Y, Kobayashi T, Matsuno T. Effects of dry needling at tender points for neck pain (Japanese: Katakori): near-infrared spectroscopy for monitoring muscular oxygenation of the trapezius. Journal of Orthopaedic Science. 2008;13(2):101–106.
    1. Cheng KJ. Neuroanatomical basis of acupuncture treatment for some common illnesses. Acupuncture in Medicine. 2009;27(2):61–64.
    1. Cheng KJ. Neuroanatomical characteristics of acupuncture points: relationship between their anatomical locations and traditional clinical indications. Acupuncture in Medicine. 2011;29(4):289–294.
    1. Irnich D, Behrens N, Gleditsch JM, et al. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain. 2002;99(1-2):83–89.
    1. Xue CCL, Dong L, Polus B, et al. Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover trial. Headache. 2004;44(4):333–341.
    1. Tsai CT, Hsieh LF, Kuan TS, Kao MJ, Chou LW, Hong CZ. Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle. American Journal of Physical Medicine and Rehabilitation. 2010;89(2):133–140.
    1. Matsubara T, Arai YCP, Shiro Y, et al. Comparative effects of acupressure at local and distal acupuncture points on pain conditions and autonomic function in females with chronic neck pain. Evidence-Based Complementary and Alternative Medicine. 2011;2011:6 pages.543291
    1. Melzack R, Stillwell DM, Fox J. Trigger points and acupuncture points for pain: correlations and implications. Pain. 1977;3(1):3–23.
    1. Birch S. Trigger point-acupuncture point correlations revisited. Journal of Alternative and Complementary Medicine. 2003;9(1):91–103.
    1. Dorsher PT. Trigger points and acupuncture points: anatomic and clinical correlations. Medical Acupuncture. 2006;17(3):20–23.
    1. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 2. Baltimore, Md, USA: Williams & Wilkins; 1992.
    1. 'Connor J O, Bensky D. Acupuncture: A Comprehensive Text. Chicago, Ill, USA: Shanghai College of Traditional Medicine, Eastland Press; 1981.
    1. Dorsher PT. Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch’s analysis revisited. Journal of Alternative and Complementary Medicine. 2008;14(4):353–359.
    1. Kuan TS, Hsieh YL, Chen SM, Chen JT, Yen WC, Hong CZ. The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. American Journal of Physical Medicine and Rehabilitation. 2007;86(3):183–189.
    1. Simons DG, Hong CZ, Simons LS. Endplate potentials are common to midfiber myofacial trigger points. American Journal of Physical Medicine and Rehabilitation. 2002;81(3):212–222.
    1. Ge HY, Fernández-de-las-Peñas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chinese Medicine. 2011;6, article 13
    1. Chou LW, Hsieh YL, Chen HS, Hong CZ, Kao MJ, Han TI. Remote therapeutic effectiveness of acupuncture in treating myofascial trigger point of the upper trapezius muscle. American Journal of Physical Medicine and Rehabilitation. 2011;90(12):1036–1049.
    1. Hong CZ, Chen YN, Twehous D, Hong DH. Pressure threshold for referred pain by compression on the trigger point and adjacent areas. Journal of Musculoskeletal Pain. 1996;4(3):61–79.
    1. Hong CZ, Kuan TS, Chen JT, Chen SM. Referred pain elicited by palpation and by needling of myofascial trigger points: a comparison. Archives of Physical Medicine and Rehabilitation. 1997;78(9):957–960.
    1. Hoheisel U, Mense S, Simons DG, Yu XM. Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? Neuroscience Letters. 1993;153(1):9–12.
    1. Mense S. Nociception from skeletal muscle in relation to clinical muscle pain. Pain. 1993;54(3):241–289.
    1. Mense S, Simons DG, Hoheisel U, Quenzer B. Lesions of rat skeletal muscle after local block of acetylcholinesterase and neuromuscular stimulation. Journal of Applied Physiology. 2003;94(6):2494–2501.
    1. Mense S, Simons DG. Muscle Pain: Understanding Its Nature, Diagnosis, and Treatment. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2001.
    1. Sluka KA, Kalra A, Moore SA. Unilateral intramuscular injections of acidic saline produce a bilateral, long-lasting hyperalgesia. Muscle and Nerve. 2001;24(1):37–46.
    1. Sato A, Sato Y, Uchida S. Reflex modulation of visceral functions by acupuncture-like stimulation in anesthetized rats. International Congress Series. 2002;1238:111–123.
    1. Hsieh YL, Chou LW, Joe YS, Hong CZ. Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle. Archives of Physical Medicine and Rehabilitation. 2011;92(7):1098–1105.
    1. Jones SL. Descending noradrenergic influences on pain. Progress in Brain Research. 1991;88:381–394.
    1. Takeshige C, Sato T, Mera T, Hisamitsu T, Fang J. Descending pain inhibitory system involved in acupuncture analgesia. Brain Research Bulletin. 1992;29(5):617–634.
    1. Yoshimura M, Furue H. Mechanisms for the anti-nociceptive actions of the descending noradrenergic and serotonergic systems in the spinal cord. Journal of Pharmacological Sciences. 2006;101(2):107–117.
    1. Hong CZ. Persistence of local twitch response with loss of conduction to and from the spinal cord. Archives of Physical Medicine and Rehabilitation. 1994;75(1):12–16.
    1. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. American Journal of Physical Medicine and Rehabilitation. 1994;73(4):256–263.
    1. Hong CZ, Torigoe Y, Yu J. The localized twitch responses in responsive taut bands of rabbit skeletal muscle fibers are related to the reflexes at spinal cord level. Journal of Musculoskeletal Pain. 1995;3(1):15–33.
    1. Murase K, Kawakita K. Diffuse noxious inhibitory controls in anti-nociception produced by acupuncture and moxibustion on trigeminal caudalis neurons in rats. Japanese Journal of Physiology. 2000;50(1):133–140.
    1. Reinert A, Treede RD, Bromm B. The pain inhibiting pain effect: an electrophysiological study in humans. Brain Research. 2000;862(1-2):103–110.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner