Effekter som rapporterats efter behandling med nålar, elektrisk nervstimulering, töjning och ultraljud är minskad smärta, ökad funktion och rörelseomfång. Kliniska signifikanta effekterna på kortsikt rapporterade efter behandling med nålar var minskad smärta ökad rörelseomfång, ökad funktion och höjd smärttröskel över TrP. Signifikanta effekter på lägre sikt efter behandling med nålar var minskad smärta. Kortsiktiga signifikanta effekter efter ENS var smärtminskning, ökad rörlighet och ökad funktion. Rapporterade långsiktiga signifikanta effekter efter ENS var minskad smärta och förhöjd smärttröskel. Signifikanta effekter på kortsikt efter ultraljud var minskad smärta och ökat rörelseomfång. Kortsiktiga signifikanta effekter efter töjning var ökat rörelseomfång minskad smärta. Långsiktiga effekter efter töjning var minskad tryckkänslighet och minskad smärta. Minskning av den subjektiva smärtan var den effekt som rapporterades mest frekvent efter intervention med nålar, elektrisk nervstimulering, ultraljud och töjning. Evidensen för att behandling med nålar och elektrisk nervstimulering signifikant minskar den subjektivt uppskattade smärtan jämfört mot placebo eller ingen behandlig är begränsat. Det vetenskapliga stödet för att behandling med nålar och elektrisk nervstimulering är signifikant bättre än placebo eller ingen behandling betträffande att öka rörelseomfånget och minskade symtom vid bedömning av triggerpunkten var otillräckligt. Det vetenskapliga stödet för att ultraljud och töjning var effektivare än placebo eller ingen behandling vid TrPRS beträffande subjektivt uppskattad smärta, ökat rörelseomfång och minskade symtom vid bedömning av triggerpunkten är otillräckligt.
Tack!
Ett varmt tack riktas till Daina Dagis och personal på universitetsbiblioteket vid Luleå tekniska Universitet. Ni har varit till stor hjälp.
6 Referenslista
Airaksinen, O., & Põntinen, P.J. (1992). Effects of the electrical stimulation of myofascial trigger points with tension headache. Acupuncture & electro-therapeutics research,17, 4, 285 -290.
Ardic, F., Sarhus, M., & Topuz, O. (2002). Comparison of two different techniques of electrotherapy on myofascial pain. Journal of Back and Musculoskeletal Rehabilitation, 16, (1), 11-16.
Baldry, P. (2002) Management of myofascial trigger point pain. Acupuncture in medicine, 20, (1), 2 -10.
Birch, S., & Jamison, R.N. (1998). Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. The Clinical journal of pain, 14, 3, 248 -55.
Britton, M. (2008-05-08). Evidensgradering. (WWW dokument). URL:
[http://sbu.se/sv/Evidensbaserad-vard/Om-SBUs-metodergranskning/Evidensgradering/]
Ceccheerelli, F., Bordin, M., Gagliardi, G., & Caravello, M. (2001). Comparison between superficial and deep acupuncture in the treatment of the shoulder's myofascial pain: a randomized and controlled study. Acupuncture & electro-therapeutics research, 26, (4), 229-238.
Ceccherelli, F., Rigoni, M.T., Gagliardi, G., & Ruzzante, L. (2002). Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double-blind randomized controlled study. The Clinical journal of pain, 18, (3), 149-153.
Ceccherelli, F., Tortora, P., Nassimbeni, C., Casale, R., Gagliardi G., & Giron, G. (2006). The therapeutic efficacy of somatic acupuncture is not increased by auriculotherapy: a randomised, blind control study in cervical myofascial pain. Complementary Therapies in Medicine, 14, (1), 47-52.
Cummings, M., & Baldry, P. (2007). Regional myofascial pain: diagnosis and management.
Best Practice and Research. Clinical Rheumatology, 21, 367-387.
Cummings, T.M., & White, A.R. (2001). Needling therapies in the management of myofascial trigger point pain: a systematic review. Archives of Physical Medicine and Rehabilitation, 82, 986-992.
De Laat, A., Stappaerts, K., & Papy, S. (2003). Counseling and physical therapy as treatment for myofascial pain of the masticatory system. Journal of orofacial pain, 17, 1, 42 -49.
Drewes, A.M., & Jennum, P. (1995). Epidemiology of myofascial pain, low back pain, morning stiffness and sleep related complaints in the general population. Journal of Musculoskeletal Pain, 3, (1), 121
Edward, J., & Knowles, N. (2003). Superficial dry needling and active stretching in the treatment of myofascial pain--a randomised controlled trial. Acupuncture in medicine, 21, (3), 80-86.
Esenyel, M., Aldemir, T., Gursoy, E., Esenyel, C.Z., Demir, S., & Durmusoglu G. (2007).
Myofascial pain syndrome: efficacy of different therapies. Journal of Back and Musculoskeletal Rehabilitation, 20, (1), 43-47.
Esenyel, M., Caglar, N., & Aldemir, T. (2000). Treatment of myofascial pain.
American journal of physical medicine & rehabilitation, 79, 148 –152.
Falconer, J., Hayes K.W., & Chang, R.W. (1990).Therapeutic ultrasound in the treatment of muskuloskeletal conditions. Arthritis care and Research, 3, 85-89.
Farina, S., Casarotto, M., Benelle, M., Tinazzi, M., Fiaschi, A., Goldoni, M., & Smania, N.
(2004). A randomized controlled study on the effect of two different treatments (FREMS and TENS) in myofascial pain syndrome. Europa MedicoPhysica, 40, (4), 293-301.
Fu, C.H., Wang, J.H., Sun, J.H., Chen, X.Y., & Xu, J.G. ( 2007). Fu's subcutaneous needling:
possible clinical evidence of the subcutaneous connective tissue in acupuncture, The journal of alternative and complementary medicine, 13, (1), 47-51.
Ga, H., Choi, J.H., Park, C.H., & Yoon, H.J. (2007). Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. The journal of
Gam, A.N., Warming, S., Larsen, L.H., Jensen, B., Høydalsmo, O., Allon, I., Andersen, B., Gøtzsche, N.E., Petersen, M., & Mathiesen, B. (1998). Treatment of myofascial trigger-points with ultrasound combined with massage and exercise-a randomised controlled trial. Pain, 77, 1, 73 –79.
Goddard, G., Karibe, H., McNeill, C., & Villafuerte, E. (2002). Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Journal of orofacial pain, 16, (1), 71 -76.
Graff-Radford, S.B., Reeves, J.L., Baker, R.L., & Chiu, D. (1989). Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity. Pain, 37, (1), 1-5.
Han, S.C., & Harrison, P. (1997). Myofascial pain syndrome and trigger-point management.
Regional anesthesia and pain medicine, 22, (1), 89-101.
Hanten, WP., Olson, SL., Butts, NL., & Nowicki, AL. (2000). Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.
Physical Therapy, 80, 997-1003.
Hesse, J., Møgelvang, B., & Simonsen, H. (1994). Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation. Journal of internal medicine, 235, 5, 451 -456.
Hou, C.R., Tsai, L.C., Cheng, K.F., Chung, K.C., & Hong, C.Z. (2002).
Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of physical medicine and rehabilitation, 83, 10, 1406 –1414.
Hsieh, Y.L., Kao, M.J., Kuan, T.P., Chen, S.M., Chen, J.T., & Hong, C.Z. (2007). Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. American journal of physical medicine & rehabilitation, 86, (5), 397-403.
Hsueh, T.C., Cheng, P.T., Kuan, T.S., & Hong, C,Z. (1997). The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points.
American journal of physical medicine & rehabilitation, 76, (6), 471 -476.
Ilbuldu, E., Cakmak, A., Disci, R., & Aydin,R. (2004). Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome. Photomedicine and laser surgery, 22, (4), 306-311.
Irnich, D., Behrens, N., Gleditsch, J.M., Stör, W., Schreiber, M.A., Schöps, P., Vickers, A.J., &
Beyer, A. (2002) Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Source: Pain, 99, (1-2), 83 -89.
Irnich, D., Behrens, N., Molzen, H., König, A., Gleditsch, J., Krauss, M., Natalis, M., Senn, E., Beyer, A., & Schöps P. (2001). Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain.
BMJ, 322, (7302), 1574 -1578.
Itoh, K., Katsumi, Y., & Kitakoji, H. (2004).Trigger point acupuncture treatment of chronic low back pain in elderly patients--a blinded RCT.Acupuncture in medicine, 22, (4), 170-177.
Itoh, K., Katsumi, Y., Hirota, S., & Kitakoji H. (2006). Effects of trigger point acupuncture on chronic low back pain in elderly patients- a sham-controlled randomised trial. Acupuncture in medicine, 24, (1), 5 -12.
Itoh, K., Katsumi, Y., Hirota, S., & Kitakoji, H. (2007). Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain.
Complementary Therapies in Medicine, 15, (3), 172-179.
Juhlin, M., Smeds-isaksson, Y., & Tano-nordin, A. (2006). Effekter av helkroppsvibrationsträning på muskelfunktion, balans och bentäthet: systematisk litteraturöversikt. Institutionen för hälsovetenskap, avdelningen för sjukgymnastik, Luleå tekniska universitet
Kaergaard, A., & Andersen, J.H. (2000). Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis. Occupational and
Kaergaard, A., Andersen, JH., Rasmussen, K., & Mikkelsen, S. (2000). Identification of neck-shoulder disorders in a 1 year follow-up study. Validation Of a questionnaire-based method.
Pain, 86, 305-310.
Kamanli, A., Kaya, A., Ozgocmen, S., Zengin, F.O., & Bayik, Y. (2005). Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatology international, 25, (8), 604-611.
Karst, M., Rollnik, J.D., Fink, M., Reinhard, M., & Piepenbrock S. (2000). Pressure pain threshold and needle acupuncture in chronic tension-type headache--a double-blind placebo-controlled study. Pain, 88, 2, 199 -203.
Kellgren, J.H.(1938). Obervations on referred pain arising from muscle. Clinical Science, 3, 175-190.
Kruger, L.R., Van Der Linden, W.J., & Cleaton-Jones, P.E. (1998). Transcutaneous electrical nerve stimulation in the treatment of myofascial pain dysfunction. South African journal of surgery, 36, 1, 35 -38.
Le Bars, D., Dickenson, A.H., Besson, J.M. (1979). Diffuse noxious inhibitory controls (DNIC).
I. Effects on dorsal horn convergent neurones in the rat. Pain 6, (3), 283 -304.
Lee, J.C., Lin, D.T., & Hong, C. (1997). The effectiveness of simultaneous thermotherapy with ultrasound and electrotherapy with combined. AC and DC current on the immediate pain relief of myofascial trigger points. Journal of Musculoskeletal Pain, 5, (1), 81-90.
Linderoth, B., & Meyerson, BA. (2001). Transkutan nervstimulering (TENS). Läkartidningen, 98, 5328-5336.
Majlesi, J., & Unalan, H. (2004). High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study.
Archives of physical medicine and rehabilitation, 85, 5, 833 –836.
Melzack, R., & Wall, P.D. (1965). Pian Mechanisms: A New Theory. Science 150, (3699), 971-979.
Mense, S. (1993). Nociception from skeletal muscels in relation to clinical muscle in relation to clinical muscle pain. Pain, 54 (3), 241-289
Parsons, A., Breen, NE., Foster, L., Letley, T., Pincus, S., Vogel., & Underwood,M. (2007).
Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations. Family Practice, 24, 308-316.
Pomeranz, B.H., & Chiu, D. (1976). Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Science,19, 1757-1762.
Shen, Y.F., & Goddard, G. (2007). The short-term effects of acupuncture on myofascial pain patients after clenching. Pain Practice, 7, (3), 256-264.
Sjölund, B. (1992). Förord - Grundläggande akupunktur vid smärtbehandling Sverige:
Studentlitteratur.
Skootsky S.A., Jaeger, B., & Oye, K. (1989). Prevalence of myofascial pain in general internal medicine practice. The Western Journal of Medicine 51, 157-160.
Sluka, KA., & Walsh, D. (2003). Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. The Journal of Pain, 4, 109-121.
Smania, N., Corato, E., Fiaschi, A., Pietropoli, P., Aglioti, S.M., & Tinazzi, M. (2005). Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. Journal of neurology, 252, (3), 307 –314.
Schmid-Schwap, M., Simma-Kletschka, I., Stockner, A., Sengstbratl, M., Gleditsch, J., Kundi, M., & Piehslinger, E. (2006). Oral acupuncture in the therapy of craniomandibular dysfunction syndrome - a randomized controlled trial. Wiener klinische Wochenschrift, 118, (1-2), 36 -42.
Smith, P., Mosscrop, D., Davies, S., Sloan, P., & Al-Ani Z. (2007). The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial.
Journal of dentistry, 35, (3), 259 -267.
Srbely, J.Z., & Dickey, J.P. (2007). Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy?. Clinical rehabilitation, 21, (5), 411 –417.
Travell, J., & Rinzler S.H. (1952). The myofascial genesis of pain. Postgraduate medicine, 11, (5), 425 -434
Travell, JG., Simons DG & Simons LS. (1999). Myofacial Pain and Dysfunction: The Trigger Point Manual. Volume 1. Upper Half of Body. Second edition. Baltimore: Williams & Wilkins.
Treaster, D., Marras, W.S., Burr, D., Sheedy, J.E., & Hart, D. (2006). Myofascial trigger point development from visual and postural stressors during computer work. Journal of
Electromyography and Kinesiology, 16, 115-24.
Wang, C., Xiong, Z., Deng, C., Yu, W., & Ma, W. (2007). Miniscalpel-needle versus triggerpoint injection for cervical myofascial pain syndrome: a randomized comparative trial. The journal of alternative and complementary medicine, 13, (1), 14-6.
Yagci, N., Uygur, F., & Bek, N. (2004). Comparison of connective tissue massage and spray-and-stretch technique in the treatment of chronic cervical myofascial pain syndrome. Pain Clinic, 16, (4), 469-474.
Bilaga 1
PEDro Scale
1. eligibility criteria were specified no yes where:
2. subjects were randomly allocated to groups (in a crossover study, subjects
were randomly allocated an order in which treatments were received) no yes where:
3. allocation was concealed no yes where:
4. the groups were similar at baseline regarding the most important prognostic
indicators no yes where:
5. there was blinding of all subjects no yes where:
6. there was blinding of all therapists who administered the therapy no yes where:
7. there was blinding of all assessors who measured at least one key outcome no yes where:
8. measures of at least one key outcome were obtained from more than 85%
of the subjects initially allocated to groups no yes where:
9. all subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case,
data for at least one key outcome was analysed by “intention to treat” no yes where:
10. the results of between-group statistical comparisons are reported for at least one
key outcome no yes where:
11. the study provides both point measures and measures of variability for at
least one key outcome no yes where:
The PEDro scale is based on the Delphi list developed by Verhagen and colleagues at the Department of Epidemiology, University of Maastricht (Verhagen AP et al (1998). The Delphi list: a criteria list for quality assessment of randomised clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of Clinical Epidemiology, 51(12):1235-41). The list is based on "expert consensus" not, for the most part, on empirical data. Two additional items not on the Delphi list (PEDro scale items 8 and 10) have been included in the PEDro scale. As more empirical data comes to hand it may become possible to "weight" scale items so that the PEDro score reflects the importance of individual scale items.
The purpose of the PEDro scale is to help the users of the PEDro database rapidly identify which of the known or suspected randomised clinical trials (ie RCTs or CCTs) archived on the PEDro database are likely to be internally valid (criteria 2-9), and could have sufficient statistical information to make their results interpretable (criteria 10-11). An additional criterion (criterion 1) that relates to the external validity (or “generalisability” or “applicability” of the trial) has been retained so that the Delphi list is complete, but this criterion will not be used to calculate the PEDro score reported on the PEDro web site.
The PEDro scale should not be used as a measure of the “validity” of a study’s conclusions. In particular, we caution users of the PEDro scale that studies which show significant treatment effects and which score highly on the PEDro scale do not necessarily provide evidence that the treatment is clinically useful. Additional considerations include whether the treatment effect was big enough to be clinically worthwhile, whether the positive effects of the treatment outweigh its negative effects, and the cost-effectiveness of the treatment. The scale should not be used to
Notes on administration of the PEDro scale:
All criteria Points are only awarded when a criterion is clearly satisfied. If on a literal reading of the trial report it is possible that a criterion was not satisfied, a point should not be awarded for that criterion.
Criterion 1 This criterion is satisfied if the report describes the source of subjects and a list of criteria used to determine who was eligible to participate in the study.
Criterion 2 A study is considered to have used random allocation if the report states that allocation was random. The precise method of randomisation need not be specified. Procedures such as coin-tossing and dice-rolling should be considered random. Quasi-randomisation allocation procedures such as allocation by hospital record number or birth date, or alternation, do not satisfy this criterion.
Criterion 3 Concealed allocation means that the person who determined if a subject was eligible for inclusion in the trial was unaware, when this decision was made, of which group the subject would be allocated to. A point is awarded for this criteria, even if it is not stated that allocation was concealed, when the report states that allocation was by sealed opaque envelopes or that allocation involved contacting the holder of the allocation schedule who was “off-site”.
Criterion 4 At a minimum, in studies of therapeutic interventions, the report must describe at least one measure of the severity of the condition being treated and at least one (different) key outcome measure at baseline. The rater must be satisfied that the groups’ outcomes would not be expected to differ, on the basis of baseline differences in prognostic variables alone, by a clinically significant amount. This criterion is satisfied even if only baseline data of study completers are presented.
Criteria 4, 7-11 Key outcomes are those outcomes which provide the primary measure of the effectiveness (or lack of effectiveness) of the therapy. In most studies, more than one variable is used as an outcome measure.
Criterion 5-7 Blinding means the person in question (subject, therapist or assessor) did not know which group the subject had been allocated to. In addition, subjects and therapists are only considered to be “blind” if it could be expected that they would have been unable to distinguish between the treatments applied to different groups. In trials in which key outcomes are self-reported (eg, visual analogue scale, pain diary), the assessor is considered to be blind if the subject was blind.
Criterion 8 This criterion is only satisfied if the report explicitly states both the number of subjects initially allocated to groups and the number of subjects from whom key outcome measures were obtained. In trials in which outcomes are measured at several points in time, a key outcome must have been measured in more than 85% of subjects at one of those points in time.
Criterion 9 An intention to treat analysis means that, where subjects did not receive treatment (or the control condition) as allocated, and where measures of outcomes were available, the analysis was performed as if subjects received the treatment (or control condition) they were allocated to. This criterion is satisfied, even if there is no mention of analysis by intention to treat, if the report explicitly states that all subjects received treatment or control conditions as allocated.
Criterion 10 A between-group statistical comparison involves statistical comparison of one group with another. Depending on the design of the study, this may involve comparison of two or more treatments, or comparison of treatment with a control condition. The analysis may be a simple comparison of outcomes measured after the treatment was administered, or a comparison of the change in one group with the change in another (when a factorial analysis of variance has been used to analyse the data, the latter is often reported as a group × time interaction). The comparison may be in the form hypothesis testing (which
provides a “p” value, describing the probability that the groups differed only by chance) or in the form of an estimate (for example, the mean or median difference, or a difference in proportions, or number needed to treat, or a relative risk or hazard ratio) and its confidence interval.
Criterion 11 A point measure is a measure of the size of the treatment effect. The treatment effect may be described as a difference in group outcomes, or as the outcome in (each of) all groups. Measures of variability include standard deviations, standard errors, confidence intervals, interquartile ranges (or other quantile ranges), and ranges. Point measures and/or measures of variability may be provided graphically (for example, SDs may be given as error bars in a Figure) as long as it is clear what is being graphed (for example, as long as it is clear whether error bars represent SDs or SEs). Where outcomes are categorical, this criterion is considered to have been met if the number of subjects in each category is given for each group.