Painful Muscular Condition Responds to Noninvasive Ultrasound Treatment
Feb. 28, 2000 (Minneapolis) -- Ultrasound treatment of a painful muscular
condition known as myofascial pain is as effective as an earlier therapy, which
consists of injecting painful places in the muscle called trigger points,
according to Turkish investigators. Their findings, which were published in the
American Journal of Physical Medicine and Rehabilitation, suggest that
physicians offer patients ultrasound, which is less invasive than injection
Myofascial pain is a chronic, painful condition that affects the fascia, or
connective tissue covering the muscles. All the patients in the study had
myofascial pain in the upper trapezius muscle. The trapezius muscle, located on
the back, extends up the neck, across the shoulder, and down to approximately
the midpoint of the back.
Myofascial trigger points are tender locations within a taut band of muscle
fibers, write Meltem Esenyel, MD, et al. Esenyel and colleagues are affiliated
with the departments of physical medicine and rehabilitation and with the
anesthesiology and pain clinic at Vakif Gureba Teaching Hospital in
"The effectiveness of ultrasound therapy is comparable to trigger point
injections and should be offered as a noninvasive treatment of choice,
especially to the patients who want to avoid injections," the authors
write. Psychological and social factors may contribute to chronic myofascial
pain, and patients should be assessed for these contributing factors and
receive counseling if they are present. However, these factors won't undermine
the effectiveness of treatment for pain, the authors write.
"It's not surprising that trigger-point injections and ultrasound,
combined with stretching, have similar results in treating myofascial pain and
are both superior to stretching alone," Paul C. Biewen, MD, tells WebMD in
an interview seeking objective analysis of the study. "Physicians need to
know, however, that this was not a controlled study. All patients received a
treatment without controlling for the placebo effect." Examples of placebo
treatment would be a sham ultrasound treatment or needle injections into areas
of the body that were not trigger points, says Biewen, a physiatrist at
Fairview University Pain Management Center in Minneapolis, which is affiliated
with the University of Minnesota.
Ultrasound and trigger point injections have both been used in the treatment
of myofascial pain, as have a variety of other therapies. Examples include
transcutaneous electrical nerve stimulation (TENS), so-called "dry
needling," and massage therapy. Ultrasound is thought to promote pain
relief as the result of several factors. It may neutralize pain mediators due
to increased circulation in the painful area, or it may cause other changes
that result in decreased inflammation.
Trigger point injections have typically used a local anesthetic. However,
some investigators think that injecting the needle itself causes pain relief.
Injecting the needle may disrupt the trigger point mechanism, block the nerve
fibers, and neutralize nerve-sensitizing substances due to either the injected
fluid or local bleeding. On the other hand, the drug that is injected may
interrupt the trigger point.