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Immediate effects of various physical medicine modalities on pain threshold of an active myofascial trigger point
Hong C-Z, Chen Y-C, Pon CH, Yu J
Journal of Musculoskeletal Pain 1993;1(2):37-53
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To study the immediate effectiveness of treatment on an active myofascial trigger point with physical medicine modalities, including spray and stretch, hydrocollator superficial heat, ultrasound deep heat, and deep pressure soft tissue massage. METHODS: Eighty-four patients with myofascial pain syndrome and 24 normal subjects were studied. Pain threshold of the active trigger point in the upper trapezius muscle was measured with a pressure algometer (Pressure Threshold Meter) before and after the treatment with each one of the above mentioned modalities and placebo "sham ultrasound". The index of threshold change (ITC) is defined as the ratio of post-treatment pain threshold to pre-treatment pain threshold. RESULTS: In the control study, the normal subjects without any treatment had an average ITC value of 1.02 +/- 0.06 based upon 48 measurements; the patients without any treatment had an average ITC value of 1.02 +/- 0.07 (n = 21), and the patients treated with the placebo had an average ITC value of 1.09 +/- 0.18 (n = 16). The average ITC values were 1.53 +/- 0.52 (n = 19) from spray and stretch treatment; 1.38 +/- 0.32 (n = 17) from hydrocollator treatment; 1.41 +/- 0.39 (n = 16) from ultrasound therapy; and 1.77 +/- 0.40 (n = 16) from deep pressure massage therapy. The ITC value from treatment with any of the 4 modalities was significantly higher than the ITC of any of the 3 control groups (p < 0.05, 2-tailed ANOVA). The ITC value from deep pressure massage therapy was significantly higher than that of any other 3 modalities (p < 0.05, 2-tailed ANOVA), however, there were no significant differences among the other 3 modalities. The ITC value from treatment with stretch therapy (spray and stretch or massage, n = 35) was significantly higher than (p < 0.05, 2-tailed ANOVA) that with thermotherapy (hydrocollator or ultrasound, n = 33) CONCLUSIONS: It would appear that all 4 therapeutic modalities can be effectively applied for the treatment of myofascial pain syndrome to obtain an immediate increase of pain threshold of an active myofascial trigger point, although the stretch therapy is more effective than the thermotherapy.
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