BACKGROUND: The mainstream of treatment in myofascial pain is to breakdown the vicious cycle of pain through the elimination of trigger points (Trp). Several methods have been recommended in order to achieve this goal. OBJECTIVES: It is a prospective, randomised active controlled study of the effect of a variety of technical interventions in chronic myofascial pain syndrome compared with the effect of stretching exercise. METHODS: Ninety patients with trigger points on one side of the trapezius muscle for more than 6 months duration were randomly assigned to one of the 5 groups. Group I: Botox-A Trp injection (TPI) 10 U (n = 18), group II: Lidocaine 0.5% 1 ml (n = 18), group III: US (conventional) (n = 18), group IV: US (high-power pain threshold) (n = 18); group V: stretching exercise (n = 18). Stretching exercises were also combined with the therapies in groups I to IV. Visual analog scale (VAS) for pain intensity was used as the parameter for comparative evaluations before treatment and at one week and one month after treatment. RESULTS: At 1 week post-treatment evaluations, all groups showed statistically significant improvements (p < 0.05), however, none of the treatment methods proved to be superior to the others when intergroup comparisons were made. At 1 month post-treatment evaluations, statistically significant improvements were detected both in Lidocaine Trp and Botox A Trp injection groups (p < 0.05), when compared to the other groups. There was no statistically significant difference between lidocaine and Botox A injection groups (p > 0.05). CONCLUSIONS: Lidocaine and Botox A Trp injections were more effective in treating patients with chronic MPS in one month controls. Both techniques in US treatment were equally effective.

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