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The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature
Rickards, L. D. [7]

Journal: International Journal of Osteopathic Medicine Date: 2006/12, 9(4):Pages: 120-136. doi: Subito , type of study: systematic review

Full text    (http://www.sciencedirect.com/science/article/pii/S1746068906000952)

Keywords:

myofascial pain [24]
myofascial pain syndrome [19]
myofascial trigger point [15]
OMT [2951]
osteopathic manipulative treatment [2973]
systematic review [297]
trigger point [39]

Abstract:

Background Myofascial pain syndrome associated with active myofascial trigger points is a common diagnosis in patients presenting with symptoms of neuromusculoskeletal pain. The literature details dozens of proposed treatment interventions used to treat myofascial trigger points. However, reliable evidence for the intra- and inter-effectiveness for many of these treatments appears deficient. Objectives To review the evidence for the effectiveness of non-invasive interventions in the treatment of patients with myofascial pain resulting from active myofascial trigger points. Data sources The following databases were searched from inception to May 2006: Medline, PubMed, CINAHL, EMBASE, PEDro, and CENTRAL/CCTR. The reference lists of retrieved studies were scanned to identify additional relevant trials. Study selection Randomised controlled trials or quasi-randomised trials examining the effectiveness of non-invasive treatments for myofascial trigger point pain were included where the criteria for the diagnosis of trigger points were clearly stated and acceptable. Data extraction The reviewer extracted trial information and scored trials for methodological quality. The data were standardised into a percentage score and the strength of the evidence of effectiveness was assessed using pre-specified criteria. Data synthesis Twenty-three trials met the inclusion criteria for this review. Five types of treatments studied were as follows: laser therapies, electrotherapies, ultrasound, magnet therapies, and physical/manual therapies. Twenty of the twenty-three included trials assessed the treatment of MTrPs in the neck and/or upper trapezius region. According to the results of this review there is a significant evidence that laser therapy may be effective as a short-term intervention for reducing pain intensity in myofascial trigger point pain of the neck and upper back. Further research is necessary to determine the long-term effectiveness, the most effective type of laser, and the optimum dosage, duration and frequency of treatment. TENS appears to have an immediate effect in decreasing pain intensity in myofascial trigger point pain of the neck and upper back. However, there are insufficient data to provide the evidence of effectiveness for TENS beyond immediately after treatment. There is limited evidence for the use of FREMS, HVGS, EMS and IFC for myofascial trigger point pain. Moderate evidence derived from one high quality and two lower quality studies indicates that conventional ultrasound is no more effective than placebo or no treatment for myofascial trigger point pain in the neck and upper back. Preliminary evidence suggests that magnet therapy may be effective, however, further studies are needed to support the findings. Due to the heterogeneity of trials examining physical and manual therapies the current evidence did not exceed the moderate level. Trials examining manual techniques suggest that such approaches may be effective, however, no conclusions can be drawn regarding medium to long-term effectiveness or effect beyond placebo. Evidence for many of the commonly used treatments for myofascial trigger point pain is lacking. Conclusions Current evidence suggests that only a few of the numerous non-invasive physical treatments proposed for myofascial pain resulting from active myofascial trigger points may be effective, however, the clinical effectiveness of these interventions requires further research in higher quality trails. The heterogeneity of the included trials means that the conclusions of this review could be easily influenced by the results of a few additional high quality trials in the future. Future research should also address the effect of contributing and perpetuating factors.

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