Transcutaneous electrical nerve stimulation and myoneural injection therapy for management of chronic myofascial pain.
ABSTRACT The purpose of this article has been to discuss in detail both the rationale and techniques for TENS and myoneural injection therapy as modalities for the management of chronic myofascial pain. In a more subtle sense, we have also interjected some of our philosophy regarding the treatment of chronic myofascial pain. As was discussed earlier in the text of this article, very seldom, if ever, will any single technique stand alone as a "cure" for the patient with chronic pain, but, instead, each modality must be considered as an adjunctive form of multidisciplinary care. The multidisciplinary approach to pain management includes, as a minimum, pharmacotherapy, physical therapy, and behavioral medicine therapy. The concept of the team approach and goals of management, rather than cure, for chronic myofascial pain, cannot be overstated and is often as difficult to impart to the clinician as it is to the patient. To employ any individual form of therapy, the clinician must understand the indications and limitations of each modality in a total treatment program. Over the last several years TENS therapy has become extremely popular to a large extent because it is a noninvasive technique that most patients can be taught to use safely and effectively. An additional advantage to TENS therapy is that it provides many patients with some means of control over their pain, independent of medications and hands-on therapy by health care providers. Myoneural block therapy is often utilized to add a measure of control over the severe pain and dysfunction that may be present during the early phases of active treatment of chronic myofascial pain. It is used to enhance the effects of a conservative multidisciplinary pain management program when utilized on a short-term basis. Myoneural block therapy is often a useful adjunct to physical therapy to improve the patient's overall range of motion and facilitate either treatment by the physical therapist or a home exercise program. The clinician is reminded that myoneural injection therapy can be overutilized. It should be limited as to the number of injections per visit. Also, the total number of visits the patient receives injections should be kept low. After the initial myoneural injection treatment series of three to five sessions, it should be utilized only for severe pain exacerbation that has been unresponsive to conservative, noninvasive management.
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ABSTRACT: To establish whether there is evidence for or against the efficacy of needling as a treatment approach for myofascial trigger point pain. PubMed, Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, AMED, and CISCOM databases, searched from inception to July 999. Randomized, controlled trials in which some form of needling therapy was used to treat myofascial pain. Two reviewers independently extracted data concerning trial methods, quality, and outcomes. Twenty-three papers were included. No trials were of sufficient quality or design to test the efficacy of any needling technique beyond placebo in the treatment of myofascial pain. Eight of the 10 trials comparing injection of different substances and all 7 higher quality trials found that the effect was independent of the injected substance. All 3 trials that compared dry needling with injection found no difference in effect. Direct needling of myofascial trigger points appears to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor refuted by the evidence from clinical trials. Any effect of these therapies is likely because of the needle or placebo rather than the injection of either saline or active drug. Controlled trials are needed to investigate whether needling has an effect beyond placebo on myofascial trigger point pain.Archives of Physical Medicine and Rehabilitation 08/2001; 82(7):986-92. · 2.36 Impact Factor
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ABSTRACT: Although high-frequency low-intensity transcutaneous electric nerve stimulation (TENS) has been extensively used to relieve low back pain, experimental studies of its effectiveness have yielded contradictory findings mainly due to methodological problems in pain evaluation and placebo control. In the present study, separate visual analog scales (VAS) were used to measure the sensory-discriminative and motivational-affective components of low back pain. Forty-two subjects were randomly assigned to 1 of 3 groups: TENS, placebo-TENS, and no treatment (control). In order to measure the short-term effect of TENS, VAS pain ratings were taken before and after each treatment session. Also, to measure long-term effects, patients rated their pain at home every 2 h throughout a 3-day period before and 1 week, 3 months and 6 months after the treatment sessions. In comparing the pain evaluations made immediately before and after each treatment session, TENS and placebo-TENS significantly reduced both the intensity and unpleasantness of chronic low back pain. TENS was significantly more efficient than placebo-TENS in reducing pain intensity but not pain unpleasantness. TENS also produced a significant additive effect over repetitive treatment sessions for pain intensity and relative pain unpleasantness. This additive effect was not found for placebo-TENS. When evaluated at home, pain intensity was significantly reduced more by TENS than placebo-TENS 1 week after the end of treatment, but not 3 months and 6 months later. At home evaluation of pain unpleasantness in the TENS group was never different from the placebo-TENS group.(ABSTRACT TRUNCATED AT 250 WORDS)Pain 08/1993; 54(1):99-106. · 5.64 Impact Factor
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ABSTRACT: Reductions in cutaneous thermal sensation produced by placebo, aspirin, transcutaneous electrical nerve stimulation, and transcutaneous electrical nerve stimulation plus aspirin were compared in 60 normal volunteers. The combination of transcutaneous electrical nerve stimulation plus aspirin produced a statistically significant reduction as compared with placebo. The results suggest this treatment combination may provide levels of analgesia useful for completion of minor dental procedures.Anesthesia Progress 35(5):195-8.