Soft Tissue Stiffness Before and after Trigger Point Injections in Neck–Shoulder Myofascial Pain Syndrome: A Double-Blind, Randomized, and Controlled Crossover Trial with Botulinum Toxin A and Saline Injections

Autor: Ojala, Tuula A, Jurvelin, Jukka S, Partanen, Juhani V, Arokoski, Jari PA
Zdroj: Journal of Musculoskeletal Pain; March 2010, Vol. 18 Issue: 1 p38-48, 11p
Abstrakt: ABSTRACTObjectives: To determine values of soft tissue stiffness STS before and after injection treatment in neck–shoulder myofascial pain and to correlate them with self-reported and clinically assessed pain and disability.Methods: Thirty-one patients recruited by newspaper advertisement were screened by a physician. The subjects received either botulinum toxin A BTA or saline injections on two occasions four weeks apart. The volume of each injection was 0.05 ml of either normal saline without preservative or saline containing five units of BTA. The total dose varied from 15 to 35 U of BTA total volume 0.15 to 0.35 ml. The follow-up measurements were performed at four weeks after each treatment. The STS of trigger points TrPs and a reference point was determined using the STS meter STSM. The pressure-pain threshold PPT was determined using the dolorimeter. The subjective severity of neck–shoulder pain SSNP and the neck pain and disability scale NPDS were assessed with questionnaires. The active and passive range of motion ROM of cervical spine was determined.Results: The mean STS of all TrPs showed a slight but statistically significant decline during the whole study period P0.040, but there were no statistically significant changes in the individual STS values of TrPs after the injections although pain measured by SSNP, NPDS, and PPT was reduced. The STS values differed significantly P< 0.001 depending on the site of measurement. There was no clear consistent correlation between STS and SSNP, NPDS, PPT or ROM measurements.Conclusions: The STS of single neck muscles is not changed after injections of physiological saline or small doses of BTA. There is no clear consistent correlation between STS and self-reported or clinically assessed pain and disability.
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