Article
Referred pain elicited by palpation and by needling of myofascial trigger points: A comparison

https://doi.org/10.1016/S0003-9993(97)90057-5Get rights and content

Abstract

Objective: To investigate the occurrence of referred pain (REP) elicited by palpation (Pal-ReP) or by needle injection (Inj-ReP) of myofascial trigger point (MTrP), and to assess the correlated factors, including the pain intensity of an active MTrP and the occurrence of local twitch response (LTR).

Design: Correlational study.

Patients: Ninety-five patients who were treated with MTrP injections.

Intervention: MTrP injections.

Main Outcome Measure: Pain intensity of MTrP and occurrence of Pal-ReP, Inj-ReP, and LTR.

Results: Both Pal-ReP and Inj-ReP were elicited in 53.9% of MTrPs. Inj-ReP, but not Pal-ReP, was elicited in 33.7% of MTrPs. Both Pal-ReP and Inj-ReP were unobtainable in 12.3% of MTrPs. The occurrence of ReP was significantly correlated to the pain intensity of active MTrP and the occurrence of LTR.

Conclusion: ReP could be elicited more frequently by needling than by palpation. The frequency of occurrence in ReP mainly depends on pain intensity of an active MTrP.

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      LTR during needling is also a sensitive measure and objective confirmation of needles penetrated in to the correct spot and should be used as the primary goal to achieve maximal response (Ge et al., 2008). The number of LTRs elicited was directly proportional to subjective pain intensity and LTR would be elicited in 100% of MTrPs treated by dry needling (Hong et al., 1997). The mechanism by which the LTR relieves pain is still not fully understood but studies have shown that LTR is associated with immediate and long-lasting pain relief than no elicitation of LTR (Shah et al., 2008).

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      Moreover, early studies (Hong, 1994b; Hong et al., 1997b) also observed that the number of LTRs elicited was directly proportional to subjective pain intensity before needling of MTrPs. Hong et al. (1997b) further found the LTR was elicited in 100% of MTrPs treated with needling, while manual palpation prior to injection was only able to elicit the LTR in 39% of the same MTrPs, a phenomenon which is likely due to the needle tip's ability to directly stimulate sensitive loci (Hong et al., 1997b). TrPDN to elicit the LTR is associated with neurophysiological responses (Cagnie et al., 2013) that may contribute to its therapeutic effects.

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