EFFECT OF TRIGGER POINT INJECTION VS ULTRASONIC THERAPY VS TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION IN REHABILITATION OF CERVICAL AND PERI-SCAPULAR MYOFASCIAL PAIN SYNDROME- A RANDOMIZED CLINICAL TRIAL
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 7
Abstract
BACKGROUND Myofascial Pain Syndrome (MPS) is a major cause of musculoskeletal pain in the shoulder neck region in modern era, originating from Myofascial Trigger Points (MTrPs) in skeletal muscle, either alone or in combination with other pain generators. The objectives of this study were- 1. to compare the efficacy and outcome of 3 different treatment modalities namely ultrasound therapy (UST), transcutaneous electrical nerve stimulation (TENS) and steroid mixed with local anaesthetics injection to trigger points, in the clinical outcome of MPS and 2. to propose steps for early rehabilitation after identifying area needing clinical research. MATERIALS AND METHODS Based on the Travell and Simon’s criteria, 109 patients diagnosed to have MPS in the cervical and peri scapular region were recruited for this study. They were randomly divided into 3 groups. Group A received ultrasound therapy (UST), group B received transcutaneous electrical nerve stimulation (TENS) and group C received depot form of steroid (Triamcinolone 20 mg) injection with local anaesthetics (lidocaine 2%) at trigger points (TPI). All patients also received therapeutic exercises (Stretching exercises of trapezius muscle, strain/ counter strain exercise of cervical and upper back), hot packs application and tablet amitriptyline (10 mg) daily at night for 6 weeks. They were followed up after initial visit, at 2nd week, 6th week, 12th week and at 24th week. Pain and result of the treatment were assessed with visual analogue scale (VAS) scores, number of trigger points, index of MTrPs and neck disability index (NDI) questionnaire method. RESULTS Pain scores improved in the patients of all the 3 groups, in the early visits but gradually worsened in later visits. Group C showed significant improvement (p value <0.01) in the pain scores by VAS scale and other scores like number of trigger points, MTrP index score and neck disability index score as compared to group A and B. But no group could show significant improvement in outcome measures at long term follow up. CONCLUSION MPS can be effectively managed by TPI. UST and TENS are also approved methods of treatment, but their efficacy is not as remarkable as TPI. But the improvements were sustained for a short term only.
Authors and Affiliations
Piyali Mondal, Manomohan Biswas, Jayanta Saha, Asoke Kumar Middhya
Keywords
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- EP ID EP554901
- DOI 10.14260/jemds/2019/95
- Views 84
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