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DRY NEEDLING UNDER ULTRASOUND GUIDANCE DECREASE NEUROPATHIC COMPONENT AND INCREASE LEVEL OF MOTION IN PATIENT WITH LOW BACK PAIN

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Abstract

Introduction/Background Dry needling (DN) of myofascial trigger points (MTrP) under ultrasound (US) guidance is effective method for treatment myofascial pain, and restoring postural imbalance. Crosslinks among TrPs, movement patterns in spine, pelvis and extremity and neuropathic pain in low back pain patients have not been studied. The aim was to evaluate efficacy of dry needling under US guidance for neuropathic pain treatment; and resoring joints motility and muscle function in spine, pelvis and lower extremity. Material and Method We included 23 patients, 10 males and 13 females, (aged 18-55 years) with clinically diagnosed low back pain over 3 month with neuropathic component and reduced motility in spine, pelvis and lower extremity. We conducted precise physical tests and neuromuscular ultrasound using M-mode and evaluated nerves and motion in intervetrebral spaces, pelvis, intrinsic foot and leg muscles. Patients received DN of MTrP under US guidance according to approach by Bubnov [PMID:23088743]. VAS (0-10) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores were measured before, immediately after, 24 hours, and 7 days after intervention. Results After 7 days, VAS scores showed pain improvement from 7.6 to 2.3; LANSS scores improved from 15 to 4. US demonstrated improvement nerve structure, increasing motility, contractility (muscle contracted / rested thickness) on M-mode during functional tests and walking in all levels. Conclusion Our preliminary data demonstrated that DN under US guidance effectively reduce myofascial pain, ameliorate symptoms of neuropathy and local hypomotility. Further research needed for development US patterns and study causation in chain spasticity-contractility- motion-neuropathic pain.
DRY NEEDLING UNDER ULTRASOUND GUIDANCE
DECREASE NEUROPATHIC COMPONENT AND
INCREASE LEVEL OF MOTION IN PATIENT WITH LOW BACK PAIN
R. Bubnov1, L. Kalika2.
1Clinical Hospital "Feofaniya", Ultasound; Institute of Microbiology and Virology, NAS of Ukraine , Kyiv, Ukraine
2New York Dynamic Neuromuscular Rehabilitation & Physical Therapy,
https://nydnrehab.com/, New York, USA.
ABSTRACT RESULTS
METHODS
CONCLUSIONS
REFERENCES
The aim was to evaluate efficacy of dry needling under US
guidance for neuropathic pain treatment; and restoring joints
motility and muscle function in spine, pelvis and lower
extremity.
We included 23 patients, 10 males and 13 females, (aged
18-55 years) with clinically diagnosed low back pain over 3
month with neuropathic component and reduced motility in
spine, pelvis and lower extremity. We conducted precise
physical tests and neuromuscular ultrasound using M-mode
and evaluated nerves and motion in intervetrebral spaces,
pelvis, intrinsic foot and leg muscles. Patients received DN
of MTrP under US guidance according to approach by R.
Bubnov (PMID:23088743) [2,3] . VAS (0-10) and Leeds
Assessment of Neuropathic Symptoms and Signs (LANSS)
scores were measured before, immediately after, 24 hours,
and 7 days after intervention.
1.Clinical definition zone of possible trigger pointpain syndrome with typical referred
pain pattern registration.
2.Trigger point palpation. Palpation of a hypersensitive bundle or nodule of the muscle
fiber of harder than normal consistency. Localization of a trigger point is based on the
sense of feel, assisted by patient expressions of pain, and by visual and palpable
observations of local twitch response [1]
3.Using precise physical tests, extensive neuromuscular ultrasound using M-mode to
evaluate muscle thickness, CSA and motion, different patterns of decreasing motility,
contractility (muscle contracted / rested thickness) in intervetebral spaces, pelvis, intrinsic
/extrinsic muscles in pelvis, gluteus region, foot and ankle, etc. [5].
4.When the affected muscle is detected, ultrasonography examination is performed for
myofascial trigger point visualization using gray-scale, Doppler, and sonoelastography [2-
4].
5.After the visual identification of the trigger point, dry needling was performed fine
(acupuncture 28-30G) needles were inserted into MTrP to elicit the LTR effect. The
needle was held in the tissue until complete disappearance of the LTR which could be
considered similar to the phenomenon of the ‘needle grasp,’ which has been attributed to
the muscle fibers contracting around the needle, and was held tightly in place to increase
the resistance to further move the inserted needle [2-4].
6.Ultrasound control after procedure [2-4].
7.Visual analog scale (VAS) scores (010) were recorded throughout the study period
before, immediately after, and 24 h after the procedure.
Our preliminary data demonstrated that DN under US guidance
effectively reduce myofascial pain, ameliorate symptoms of
neuropathy and local hypomotility. Further research needed for
development US patterns and study causation in the chain of
spasticity-contractility-motion-neuropathic pain.
1.Simons DG, Travell JG, Simons LS. Travell and Simons‘ myofascial pain and dysfunction; the trigger point manual. 2 ed. Baltimore: Williams & Wilkins; 1999.
2.Bubnov R. V. The use of trigger point dry needling under ultrasound guidance for the treatment of myofascial pain (technological innovation and literature
review). Lik Sprava. 2010 Jul-Sep;(5-6):56-64.
3.Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J. 2012;3(1):13. doi: 10.1186/1878-5085-3-13.
4.Bubnov R. Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the Rheumati c Diseases
2015;74:624. http://dx.doi.org/10.1136/annrheumdis-2015-eular.2323
5.R. V. Bubnov, L. Kalika, L. Babenko MULTILEVEL EVALUATION OF MOTION AND POSTURE PATTERNS IN LOWER EXTREMITY AND SPINE USING
DYNAMIC ULTRASOUND Annals of the Rheumatic Diseases 77(Suppl 2):1699. DOI: 10.1136/annrheumdis-2018-eular.3949
6.Bubnov R, Kalika L. WIP18-0393 DRY NEEDLING UNDER ULTRASOUND GUIDANCE FOR LOW BACK PAIN ALLEVIATE NEUROPATHIC COMPONENT
AND INCREASE MOTION IN SPINE, PELVIS AND LOWER EXTREMITY. Pain Pract. 2018; 18(S1):87.
7.Bubnov RV. Ultrasonography diagnosis of peripheral neuropathy. The initial experience. Ultrasound Med Biol. 2011;37(Suppl 1):S144-5.
8.Bubnov RV, Ostapenko NV: Ultrasound diagnosis for diabetic neuropathy - comparative study. EPMA J. 2016; 7(Suppl
1):A12.https://doi.org/10.1186/s13167-016-0054-6
9.https://nydnrehab.com/what-we-treat/back-pain-and-neck-pain/low-back-pain/
10.https://nydnrehab.com/what-we-treat/back-pain-and-neck-pain/sciatica/
Introduction/Background
Dry needling (DN) of myofascial trigger points (MTrP) under ultrasound (US) guidance is e ffective method
for treatment myofascial pain, and restoring postural imbalance. Crosslinks among TrPs , m ovement
patterns in spine, pelvis and e xtremity a nd n europathic pain in lo w bac k p ain patients have not been
studied.
The aim was to e valuate efficacy of dry needling under US guidance for neuropathic pain treatment; an d
restoring joints motility and muscle functi on in spine, pelvis and lower extremity.
Material and Method
We included 23 patients, 10 male s and 13 females, (aged 18-55 yea rs) with clinically diagnosed low back
pain over 3 month with neuropathic component an d red uced motility in spine, pelvis and lower extremity.
We conducted precise physical t ests and neuromuscular ultrasound using M -mode and evaluated nerves
and motion in intervetrebral spaces, pelvis, intrinsic foot a nd l eg muscl es. Patients received DN of MTrP
under US guidance according to approach by Bubnov [PMID:23088743]. VAS (0-10) and Leeds
Assessment of Neuropathic Symptoms and Signs (LANSS) scores were measured before, immediately
after, 24 hours, an d 7 days afte r int ervention.
Results
After 7 days, VAS scores showed pain improvement from 7. 6 to 2.3; LANSS scores improved from 15 to 4.
US demonstrated improvement n erve st ructure, increasing m otility, contractility (muscle contracted / rested
thickness) on M-mode during functio nal test s a nd wal king in al l le vels.
Conclusion
Our preliminary data demonstrated that DN under US guidance effectively reduce myofascial pain,
ameliorate symptoms of ne uropathy and local hypomotility. Further research needed for development US
patterns and study causation i n c hain spasticity-contractility- motion-neuropathic pain.
Keywords:
low back pain; neuropathic pain; dry n eedling
Ultrasound detected sciatic neuropathy (left) vs normal
nerve (right)
After 7 days, VAS scores showed pain improvement from
7.6 to 2.3; LANSS scores improved from 15 to 4. US
demonstrated improvement nerve structure, increasing
motility, contractility (muscle contracted / rested thickness)
on M-mode during functional tests and walking in all levels.
The case of low back pain and sciatica
Female 67 y.o. Diabetes M type 2, obesity
Complains during one month on low back pain and sciatic pain, moderate
neuropathic pain
Dx
Evalutation physical, ultrasound (grey scale, M-mode):
Hypomobility was detected in the thoracic, lumbar level, right sacroiliac joint
(SIJ).
Ultrasound revealed neuropathy in the right side (sciatic pain) contrary to
the left side.
Trigger points detected in multifidus muscles correlated with sites of
hypomobility
and areas of spasticity in qudratus lumborm, soleus, plantar muscles, etc.
Thx
Dry needling of multiple TrPs 2 sessions (multifidus, pelvic, foot, plantar
area)
Effect: Full recover. Recommendations given
Case - right knee pain (largely medial)
female 67 years
- trigger points in back (multifidus R/L; quadratus lumborum R);
sacroiliac joint (SIJ) hypomobility - L;
additional TrPs in hip adductors muscles - R.
Case presentation
Approach [2-7]
Note: basic TrPS on the back, evoking knee pain;
and SIJ hypomobility and needling on the
controlateral site (L)
dr.rbubnov@gmail.com
drlevkalika@gmail.com
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Article
Full-text available
Background Many approaches exist for low back pain treatment, myofascial trigger points (MTrP) inactivation is crucial therapeutic aspect. Dry needliong (DN) of MTrP under Ultrasound guidance is most effective method [1,2], is preferred as personalized monotherapy for pain relief and prevent trigger point (spasticity) relapse [3]. Spinal mechanism and neuropathic for trigger points still are not studied. Objectives The objectives of the study were to determine efficacy of inactivation of central compared to peripheral MTrP for treatment of low back pain. Methods We included 32 patients, 14 males 18 females, aged 22-68 years (the average was 52 years) who were diagnosed low back pain with irradiative pain in lower limb - lumboischialgia. MTrP were identificated according to the clinical examination, reffered pain pattern and ultrasound visualization as “central” MTrP in paravertebral muscles (multifidii muscles, longissimius, quadratus lumborum) and “peripheral” and limb muscles (piriformis mucle, glutei muscles, soleus muscle, etc). All patients had symptoms over 1 month, underwent general diagnostic examination including MRI, laboratory, neurologic, orthopedic tests. Rheumatic, spine diseases were excluded. Patients were randomly assigned to: patients of group A, who received dry needling (DN) of paravertebral (“central”) MTrP under ultrasound guidance according to clinical examination, reffered pain pattern, considering the spinal innervation of affected by pain area and innervation of muscles with MTrP and ultrasound visualization; and patients of group B, who received DN under ultrasound guidance of “peripheral” MTrP in muscles according to the same criteria. Visual analogue scale data (VAS, 0-10) and PainDetects (1-38) scores were measured for low back pain assessment before, immediately after, 24 hours, 7 days after intervention. We evaluated pain and trigger point (spasticity) recurrence 24 hours and 28 days after manipulation in both groups. Results After 14 days, VAS shown pain improvement from 7.2 to 1.2 in group A compared to 7.3 to 3.5 in group B (P<0.05); PainDetect scores improved by 98% (18.3 to 9.2) in A vs. 25% (18.5 to 11.5) in group B (P<0.01); MTrP recurrence was lower in group A: 25% vs. 58% in group B (P<0.01) at 24 hours after manipulation; outcome at 7th day was 7% vs. 35% respectively (P<0.05). In group B after insufficient efficacy of treatment after peripheral MTrPs inactivation, trigger points were found in paravertebral muscles. After their inactivation pain relief was revealed at level of VAS 3.4 - 95% improvement vs baseline. Conclusions DN under Ultrasound guidance of central MTrP is effective method for low back pain, is preferred over peripheral and in most cases is suffiecient to treat the pain case. Central MTrPs inactivation evoke significant decreasing of neuropathic component of low back pain. References Disclosure of Interest None declared
Article
Full-text available
The aim of the study was to examine the use of trigger point dry needling under ultrasound guidance and myofascial release for the treatment of myofascial pain and to increase the provability of the puncture treatment by visual verification. A review of modern and traditional approaches to myofascial pain treatment is presented in the article. For the first time the trigger point was visualized by ultrasound (US) in this study and ultrasound guided needling therapy of muscles was performed as well. The group of 91 patients, suffered from myofascial pain of different location was included in the study. The patients were treated during last year by patented method (UA patent A 2010 06283). The pain relief effect was registered in 93.3% patients.
Evidence-based pain management: is the concept of integrative medicine applicable?
  • R V Bubnov
Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J. 2012;3(1):13. doi: 10.1186/1878-5085-3-13.
  • R V Bubnov
  • L Kalika
R. V. Bubnov, L. Kalika, L. Babenko MULTILEVEL EVALUATION OF MOTION AND POSTURE PATTERNS IN LOWER EXTREMITY AND SPINE USING DYNAMIC ULTRASOUND Annals of the Rheumatic Diseases 77(Suppl 2):1699. DOI: 10.1136/annrheumdis-2018-eular.3949