Objective To investigate whether Tuina alleviates fibrotic symptoms in myofascial trigger points(MTrPs)by regulating transforming growth factor(TGF)-β1/Smad3 signaling pathway,thereby deactivating these points.Method...Objective To investigate whether Tuina alleviates fibrotic symptoms in myofascial trigger points(MTrPs)by regulating transforming growth factor(TGF)-β1/Smad3 signaling pathway,thereby deactivating these points.Methods This study comprised two experimental phases.In phase 1,27 specific pathogenfree(SPF)grade female Sprague-Dawley(SD)rats were randomized into three groups:control 1,model 1,and Tuina 1 groups.Model 1 and Tuina 1 groups underwent an 8-week MTrPs modeling protocol involving blunt impact and eccentric exercise.After successful modeling,rats in Tuina 1 group received manual pressing on nodules or cord-like taut bands on the medial aspect of the left hindlimb.Pain sensitivity and tissue stiffness were evaluated via pressure pain threshold(PPT)and soft tissue tension(STT).Muscle histopathology and fibrosis were observed using hematoxylin and eosin(HE)and Masson staining.Inflammatory factors in muscle were measured by enzyme-linked immunosorbent assay(ELISA),while immunofluorescence(IF)and Western blot(WB)were used to detect the expression levels ofα-smooth muscle actin(α-SMA),collagenⅢ,and TGF-β1.In phase 2,45 SPF female SD rats were randomized into five groups:control 2,model 2,Tuina 2,TGF-β1 inhibitor(TI),and Tuina+TGF-β1 agonist(Tuina+TA)groups.All groups except control 2 underwent standardized MTrPs modeling.Rats in Tuina 2 group received consistent pressing manipulation.TI group received intraperitoneal injections of oxymatrine,while Tuina+TA group received intraperitoneal injections of SRI-011381 hydrochloride followed by the same pressing protocol as Tuina 2 group.WB was used to detect the expression of collagen I,collagen III,TGF-β1,and phosphorylated-Smad3(p-Smad3)/Smad3.Results In phase 1,Tuina significantly improved PPT and STT in MTrPs of rats(P<0.01),reversed pathological damages including disorganized muscle fiber arrangement,abnormal myocyte morphology,and exacerbated fibrosis.In addition,in MTrPs of rats in model 1 group,expression levels of nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,and fibrosis markers(α-SMA,collagen I,and collagen III)were upregulated,and all exhibited a significant downward trend after Tuina intervention(P<0.05 or P<0.01).This indicates that the therapeutic effects of Tuina are directly associated with reduced local inflammation and fibrosis in MTrPs.In phase 2,compared with model 2 group,rats in TI and Tuina 2 groups had decreased expression levels of TGF-β1 and p-Smad3/Smad3 in MTrPs,alongside reduced levels of inflammatory factors(IL-1β,IL-6,NF-κB,and TNF-α)and fibrosis markers(α-SMA,collagen I,and collagen III)(P<0.05 or P<0.01).When co-administered with TGF-β1 agonist,the therapeutic effects of Tuina were significantly attenuated,with rebounded TGF-β1 expression and p-Smad3/Smad3 in local MTrPs,and fibrosis and inflammatory responses were re-exacerbated(P<0.05 or P<0.01).Conclusion Tuina can effectively reduce inflammatory responses and fibrosis in MTrPs tissue,and its mechanism is closely related to the inhibition of the TGF-β1/Smad3 signaling pathway,which plays a critical role in Tuina-mediated regulation of MTrPs fibrosis.展开更多
Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interac...Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods: Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results: Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P Conclusions: HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.展开更多
Trigger point（TrP） acupuncture（dry needling）,the use of solid filiform needles at TrPs,has been developed from a comprehensive integration and adaptation of traditional acupuncture using current understandings of ...Trigger point（TrP） acupuncture（dry needling）,the use of solid filiform needles at TrPs,has been developed from a comprehensive integration and adaptation of traditional acupuncture using current understandings of TrPs.During the past twenty years,the concept and technique continues to evolve,with a potential to expand to other conditions beyond myofascial pain syndromes that can be managed via stimulating TrPs.In this article,we compared TrP acupuncture and traditional acupuncture from the following aspects：points of needle insertion,needles and needling techniques,and therapeutic indications.Traditional acupuncture encompasses an abundance of methods and techniques in acupuncture practices and has been widely used and studied for a variety of disorders.With unique specific characteristics,TrP acupuncture further develops traditional acupuncture theories,especially the concepts of Ashi point.The location of TrPs,their distribution pattern and pain indication are similar to those of traditional acupoints;the selection of needles,depth of needle insertion,and manipulation techniques are part of traditional acupuncture.TrP acupuncture is thus an integral part of traditional acupuncture.展开更多
BACKGROUND Functional gastrointestinal disorders(FGIDs)are common gastrointestinal conditions that significantly impair patient quality of life.Current clinical treatment methods are relatively limited,making the sear...BACKGROUND Functional gastrointestinal disorders(FGIDs)are common gastrointestinal conditions that significantly impair patient quality of life.Current clinical treatment methods are relatively limited,making the search for more effective therapeutic strategies critically important.Latent myofascial trigger points(MTrPs)injection,as an emerging minimally invasive treatment method,has shown potential in alleviating muscle pain and improving function,but its application in FGIDs remains insufficiently validated.AIM To assess improvements in gastrointestinal symptom severity,quality of life indices,and treatment-related adverse events between the two therapeutic approaches.METHODS This single-blind randomized controlled study recruited 60 FGIDs patients from Qilu Hospital of Shandong University,randomly divided into an injection group(TI group)and an oral medication group(PO group)at a 1:1 ratio.The TI group received abdominal wall latent MTrPs injection therapy,while the PO group received oral symptomatic medication treatment.Primary outcome measures were gastrointestinal symptom severity scores(Gastrointestinal Symptom Rating Scale,Irritable Bowel Syndrome Severity Scoring System scales)at 2 weeks and 4 weeks after treatment completion.Secondary outcome measures included Gastrointestinal Quality of Life Index scores.Both groups underwent rigorous follow-up and assessment.RESULTS The TI group is anticipated to significantly outperform the PO group in gastrointestinal symptom relief and quality of life improvement.TI group patients are expected to show a notable decrease in symptom scores,increased quality of life index,and higher clinical effectiveness rate.Additionally,the TI group is projected to have a low adverse event rate and good safety profile.CONCLUSION Latent MTrPs injection therapy may represent an effective and safe new method for treating FGIDs.Compared to traditional oral medication treatment,this method demonstrates significant advantages in improving patient symptoms and quality of life.展开更多
Acupoints and trigger points in traditional Chinese medicine represent two different minimally invasive therapy systems-based,respectively,on traditional acupuncture and dry needles.Many studies argue that trigger poi...Acupoints and trigger points in traditional Chinese medicine represent two different minimally invasive therapy systems-based,respectively,on traditional acupuncture and dry needles.Many studies argue that trigger points and traditional acupoints are conceptually similar because they generally have identical locations on the human body.However,whether trigger points contribute to the formation of the traditional acupuncture technique is controversial.Although many relevant studies have been conducted,this controversy continues to hinder the development of both disciplines.Recently,researchers of Chinese acupuncture have proposed the“acupoint sensitization”theory,which postulates that traditional acupoints may be sensitized by diseases,environments,and therapies.This turns them into a“sensitized state.”Recent studies suggest that trigger points and sensitized acupoints share similar biological properties.To clarify the above-mentioned confusion,we reviewed relevant studies on these two concepts and attempted to analyze their relationship.In this paper,we provide a general summary of acupoint sensitization theory and sensitized acupoints.We then compare trigger points with sensitized acupoints by categorizing their similarities and differences,including location and range,pathological morphology,pain perception,surface temperature effects,and bioelectrical properties.We believe that,because trigger points and sensitized acupoints have many shared properties,they might constitute“the same book with different covers.”展开更多
In recent years,the treatment of myofascial pain trigger point is a relatively popular technology,many people regard it as"Ashi point"in meridian theory,but compared with the traditional meridian theory,the ...In recent years,the treatment of myofascial pain trigger point is a relatively popular technology,many people regard it as"Ashi point"in meridian theory,but compared with the traditional meridian theory,the description of myofascial pain trigger point is more intuitive and easier to master.This paper expounds the similarities and differences between myofascial pain trigger point and traditional meridian theory from the aspects of theory,basic research and clinical application,in order to provide a specific idea for the scientific interpretation of meridian phenomenon in traditional Chinese medicine.展开更多
Objective To evaluate the clinical efficacy of ultrasound-guided acupuncture at myofascial trigger points(MTrPs)on treating post-stroke foot drop.Methods Sixty patients with post-stroke foot drop were randomly assigne...Objective To evaluate the clinical efficacy of ultrasound-guided acupuncture at myofascial trigger points(MTrPs)on treating post-stroke foot drop.Methods Sixty patients with post-stroke foot drop were randomly assigned to an observation group 1(20 cases,1 case dropped out),an observation group 2(20 cases,2 casses dropped out),and a control group(20 cases).The control group received conventional acupuncture at Yanglingquan(GB34),Jiexi(ST41),Taichong(LR3),Zusanli(ST36),Xuanzhong(GB39),and Qiuxu(GB40)on the affected side,once daily.In addition to the treatment of the control group,the observation group 1 received acupuncture at the tibialis anterior and gastrocnemius MTrPs,once every other day,while the observation group 2 received ultrasound-guided acupuncture at the tibialis anterior and gastrocnemius MTrPs,once every other day.All groups were treated for twooweeks.Three-dimensional gaitanalysis was performed using an infrared motion capture system,and the Holden walking scale was used to evaluate walking ability before and after treatment in the three groups.Results Compared before treatment,the patients in the observation groups 1 and 2 showed increased walking speed(P<0.05,P<0.01),and improved Holden walking scale grades(P<0.05,P<0.01)after treatment;the patients in the observation group 2 also showed increased ankle dorsiflexion angles(P<0.05).The walking speeds of the observation groups 1 and 2 were faster than those of the control group after treatment(P<0.05),the Holden walking scale grade in the observation group 2 was superior to that in the control group(P<0.05).Conclusion The ultrasound-guided acupuncture at MTrPs could effectively improve gait function in post-stroke foot drop patients.展开更多
Objective To investigate the current practice of myofascial pain syndrome （MPS） including current epidemiology, pathology, diagnosis and treatment. Data sources The data analyzed in this review were mainly from rele...Objective To investigate the current practice of myofascial pain syndrome （MPS） including current epidemiology, pathology, diagnosis and treatment. Data sources The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed, MedSci, Google scholar. The terms ＂myofasial trigger points＂ and ＂myofacial pain syndrome＂ were used for the literature search. Study selection Original articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points （MTrPs） and MPS were retrieved, reviewed, analyzed and summarized. Results Myofascial pain syndrome （MPS） is characterized by painful taut band, referred pain, and local response twitch with a prevalence of 85% to 95% of incidence. Several factors link to the etiology of MTrPs, such as the chronic injury and overload of muscles. Other factors, such as certain nutrient and hormone insufficiency, comorbidities, and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain. The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots, relative to some hypotheses of integration, muscle spindle discharges, spinal segment sensitization, ect. MTrPs can be diagnosed and localized based on a few subjective criteria. Several approaches, including both direct and supplementary treatments, can inactivate MTrPs. Direct treatments are categorized into invasive and conservative. Conclusion This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China.展开更多
Objective: To observe the clinical efficacy of electroacupuncture (EA) plus Tanbo-plucking the trigger points for scapulohumeral periarthritis (SP). Methods:A total of 80 patients with SP were randomized into an obser...Objective: To observe the clinical efficacy of electroacupuncture (EA) plus Tanbo-plucking the trigger points for scapulohumeral periarthritis (SP). Methods:A total of 80 patients with SP were randomized into an observation group and an EA group by the random number table, with 40 cases in each group. The EA group was treated with EA therapy, and the observation group was treated with EA therapy plus Tanbo-plucking the trigger points. After treatment, the visual analog scale (VAS) and Melle scores of the two groups were compared to evaluate the improvement of shoulder pain and functional activity, and meanwhile the clinical efficacy was observed. Results: After treatment, the total effective rate of the observation group was 95.0% and the cure and markedly effective rate was 72.5%. The total effective rate of the EA group was 87.5% and the cure and markedly effective rate was 42.5%. There was no significant difference in the total effective rate between the two groups (P>0.05). The cure and markedly effective rate of the observation group was higher than that of the EA group, and the difference between the two groups was statistically significant (P<0.05). After treatment, the intra-group differences in VAS and Melle scores of both groups were statistically significant (bothP<0.001). The inter-group differences in the changes of the VAS and Melle scores after treatment were statistically significant (bothP<0.001). Conclusion: EA plus Tanbo-plucking the trigger points has a better curative effect than EA therapy alone in the treatment of SP.展开更多
Objective To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points(MTrPs)by observing the effects of An-Pressing manipulation on adenosine triphosphate(ATP),...Objective To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points(MTrPs)by observing the effects of An-Pressing manipulation on adenosine triphosphate(ATP),adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK)/peroxisome proliferator-activated receptorγcoactivator 1α(PGC-1α)pathway and mitochondrial ultrastructure of skeletal muscle cells in MTrPs rats.Methods Forty-eight male Sprague-Dawley rats were randomly divided into a blank group,a model group,a lidocaine group,and an An-Pressing manipulation group,with 12 rats in each group.The model group,lidocaine group and An-Pressing manipulation group were used to replicate the MTrPs rat model by blunt shock and centrifugal motion method.After modeling,the An-Pressing manipulation group was subjected to 7 times An-Pressing manipulation,once every other day;the lidocaine group was treated with 3 times of injection of lidocaine at the MTrPs,once every 6 d.The blank group and the model group were fed normally without intervention.After the intervention,local muscle tissue was taken to detect the content of ATP and the expression of AMPK,phosphorylated AMPK(phospho-AMPK),PGC-1α,and glucose transporter 4(GluT4),and the ultrastructure of mitochondria was observed under an electron microscope.Results Compared with the blank group,the ATP content in the model group was decreased(P<0.05),the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were decreased(P<0.05);under the electron microscope,the number of mitochondria decreased,and they were deformed,small in volume,and had deformed cristae.Compared with the model group,the ATP contents in the An-Pressing manipulation group and the lidocaine group were increased(P<0.05),and the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were increased(P<0.05);under the electron microscope,the number of mitochondria increased,the shape and size of the mitochondria were basically normal,and the cristae could be seen.Compared with the lidocaine group,phospho-AMPK and the ratio of phospho-AMPK to AMPK in the An-Pressing manipulation group were increased(P<0.05);under the electron microscope,the numbers of mitochondria were similar,and the shape and size of the mitochondria were basically normal without swelling,and the cristae could be observed.Conclusion An-Pressing manipulation can increase the ATP content in MTrPs tissue,improve the expression levels of PGC-1α and GluT4 proteins and the ratio of phospho-AMPK to AMPK;its mechanism may relate to the activation of AMPK/PGC-1α signaling pathway to promote the repair of mitochondrial damages.展开更多
Objective:To observe the clinical effect of needling gluteus medius muscle trigger point (TrP) plus chiropractic for sacroiliac joint subluxation.Methods:A total of 124 cases conforming to the inclusion criteria of sa...Objective:To observe the clinical effect of needling gluteus medius muscle trigger point (TrP) plus chiropractic for sacroiliac joint subluxation.Methods:A total of 124 cases conforming to the inclusion criteria of sacroiliac joint subluxation were classified by anterior subluxation and posterior subluxation,and randomized into a TrP group and a conventional group respectively.There were 63 patients with anterior subluxation who were randomized into a TrP group of 32 cases (including 4 dropped out cases) and a conventional group of 31 cases (including 3 dropped out cases);and 61 patients with posterior subluxation who were randomized into a TrP group of 31 cases (including 3 dropped out cases) and a conventional group of 30 cases (including 3 dropped out cases).Patients in the TrP group received the treatment of needling gluteus medius muscle TrP plus chiropractic,while patients in the conventional group received conventional acupuncture treatment plus chiropractic.The treatment was done twice a week for a succession of 8 weeks.Then,the pain visual analog scale (VAS),Oswestry disability index (ODI) and therapeutic efficacy were evaluated.Results:After treatment,the total effective rate of TrP group with anterior subluxation was 96.9%,higher than 77.4% in the conventional group,the difference showed a statistical significance (P<0.05);the total effective rate was 93.5% in the TrP group with posterior subluxation,higher than 73.3% in the conventional group.After treatment,the VAS and ODI scores in both groups dropped obviously,the differences showed statistical significance (all P<0.05);the scores of VAS and ODI in the TrP group were obviously lower than those in the conventional group (all P<0.05).Conclusion:Needling gluteus medius muscle TrP plus chiropractic had a better therapeutic effect than conventional acupuncture plus chiropractic for sacroiliac joint subluxation.展开更多
Objective:To investigate the mechanism of trigger point deactivation induced by pressing manipulation in a rat model and to explore its potential regulation of the inflammatory response through the extracellular signa...Objective:To investigate the mechanism of trigger point deactivation induced by pressing manipulation in a rat model and to explore its potential regulation of the inflammatory response through the extracellular signal-regulated kinase(ERK)/nuclear factor-κB(NF-κB)pathway.Methods:Fifty male Sprague-Dawley rats were randomly divided into a blank group,a model group,a pressing manipulation group,an ERK agonist group,and a pressing manipulation+ERK agonist group,with 10 rats in each group.Except for the blank group,rats in other groups were used to establish the trigger point rat model using the blunt blow combined with the eccentric exercise method.The pressing manipulation group underwent pressing manipulation intervention at the trigger points.The ERK agonist group received an injection of recombinant human epidermal growth factor via the tail vein.The pressing manipulation+ERK agonist group received interventions from both the pressing manipulation and ERK agonist groups.The pressure pain threshold(PPT)was measured by a mechanical pain threshold detector before and after the intervention.The histological changes were evaluated by hematoxylin-eosin staining after the intervention;the expression levels of ERK,phosphorylated ERK(p-ERK),NF-κB p65(p65),phosphorylated NF-κB p65(p-p65),and phosphorylated NF-κB inhibitor(p-IκB)were detected by Western blotting;the levels of interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-αwere detected by enzyme-linked immunosorbent assay.Results:The PPT increased(P<0.05);the inflammatory cells disappeared;the ratios of p-ERK/ERK,p-p65/p65,and p-IκB/β-actin,also the levels of IL-1β,IL-6,and TNF-αall decreased in the pressing manipulation group after the intervention compared with the model group(P<0.05).The PPT decreased significantly(P<0.05),the inflammatory cell presence increased,and the ratios of p-ERK/ERK and p-p65/p65 were elevated(P<0.05);additionally,the levels of IL-6 and TNF-αwere significantly higher in the pressing manipulation+ERK agonist group compared with the pressing manipulation group(P<0.05).The PPT was significantly lower(P<0.05),the inflammatory cell count was higher,the ratios of p-ERK/ERK and p-IκB/β-actin and the levels of IL-1βand TNF-αwere significantly higher in the ERK agonist group compared with the pressing manipulation+ERK agonist group(P<0.05).Conclusion:Pressing manipulation can effectively alleviate inflammation and pain in trigger point model rats,potentially by inhibiting the ERK/NF-κB signaling pathway.展开更多
基金Natural Science Foundation of China(82274676 and 82374613)Program of Hunan Provincial Natural Science(2023JJ30458).
文摘Objective To investigate whether Tuina alleviates fibrotic symptoms in myofascial trigger points(MTrPs)by regulating transforming growth factor(TGF)-β1/Smad3 signaling pathway,thereby deactivating these points.Methods This study comprised two experimental phases.In phase 1,27 specific pathogenfree(SPF)grade female Sprague-Dawley(SD)rats were randomized into three groups:control 1,model 1,and Tuina 1 groups.Model 1 and Tuina 1 groups underwent an 8-week MTrPs modeling protocol involving blunt impact and eccentric exercise.After successful modeling,rats in Tuina 1 group received manual pressing on nodules or cord-like taut bands on the medial aspect of the left hindlimb.Pain sensitivity and tissue stiffness were evaluated via pressure pain threshold(PPT)and soft tissue tension(STT).Muscle histopathology and fibrosis were observed using hematoxylin and eosin(HE)and Masson staining.Inflammatory factors in muscle were measured by enzyme-linked immunosorbent assay(ELISA),while immunofluorescence(IF)and Western blot(WB)were used to detect the expression levels ofα-smooth muscle actin(α-SMA),collagenⅢ,and TGF-β1.In phase 2,45 SPF female SD rats were randomized into five groups:control 2,model 2,Tuina 2,TGF-β1 inhibitor(TI),and Tuina+TGF-β1 agonist(Tuina+TA)groups.All groups except control 2 underwent standardized MTrPs modeling.Rats in Tuina 2 group received consistent pressing manipulation.TI group received intraperitoneal injections of oxymatrine,while Tuina+TA group received intraperitoneal injections of SRI-011381 hydrochloride followed by the same pressing protocol as Tuina 2 group.WB was used to detect the expression of collagen I,collagen III,TGF-β1,and phosphorylated-Smad3(p-Smad3)/Smad3.Results In phase 1,Tuina significantly improved PPT and STT in MTrPs of rats(P<0.01),reversed pathological damages including disorganized muscle fiber arrangement,abnormal myocyte morphology,and exacerbated fibrosis.In addition,in MTrPs of rats in model 1 group,expression levels of nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,and fibrosis markers(α-SMA,collagen I,and collagen III)were upregulated,and all exhibited a significant downward trend after Tuina intervention(P<0.05 or P<0.01).This indicates that the therapeutic effects of Tuina are directly associated with reduced local inflammation and fibrosis in MTrPs.In phase 2,compared with model 2 group,rats in TI and Tuina 2 groups had decreased expression levels of TGF-β1 and p-Smad3/Smad3 in MTrPs,alongside reduced levels of inflammatory factors(IL-1β,IL-6,NF-κB,and TNF-α)and fibrosis markers(α-SMA,collagen I,and collagen III)(P<0.05 or P<0.01).When co-administered with TGF-β1 agonist,the therapeutic effects of Tuina were significantly attenuated,with rebounded TGF-β1 expression and p-Smad3/Smad3 in local MTrPs,and fibrosis and inflammatory responses were re-exacerbated(P<0.05 or P<0.01).Conclusion Tuina can effectively reduce inflammatory responses and fibrosis in MTrPs tissue,and its mechanism is closely related to the inhibition of the TGF-β1/Smad3 signaling pathway,which plays a critical role in Tuina-mediated regulation of MTrPs fibrosis.
文摘Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods: Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results: Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P Conclusions: HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.
文摘Trigger point（TrP） acupuncture（dry needling）,the use of solid filiform needles at TrPs,has been developed from a comprehensive integration and adaptation of traditional acupuncture using current understandings of TrPs.During the past twenty years,the concept and technique continues to evolve,with a potential to expand to other conditions beyond myofascial pain syndromes that can be managed via stimulating TrPs.In this article,we compared TrP acupuncture and traditional acupuncture from the following aspects：points of needle insertion,needles and needling techniques,and therapeutic indications.Traditional acupuncture encompasses an abundance of methods and techniques in acupuncture practices and has been widely used and studied for a variety of disorders.With unique specific characteristics,TrP acupuncture further develops traditional acupuncture theories,especially the concepts of Ashi point.The location of TrPs,their distribution pattern and pain indication are similar to those of traditional acupoints;the selection of needles,depth of needle insertion,and manipulation techniques are part of traditional acupuncture.TrP acupuncture is thus an integral part of traditional acupuncture.
文摘BACKGROUND Functional gastrointestinal disorders(FGIDs)are common gastrointestinal conditions that significantly impair patient quality of life.Current clinical treatment methods are relatively limited,making the search for more effective therapeutic strategies critically important.Latent myofascial trigger points(MTrPs)injection,as an emerging minimally invasive treatment method,has shown potential in alleviating muscle pain and improving function,but its application in FGIDs remains insufficiently validated.AIM To assess improvements in gastrointestinal symptom severity,quality of life indices,and treatment-related adverse events between the two therapeutic approaches.METHODS This single-blind randomized controlled study recruited 60 FGIDs patients from Qilu Hospital of Shandong University,randomly divided into an injection group(TI group)and an oral medication group(PO group)at a 1:1 ratio.The TI group received abdominal wall latent MTrPs injection therapy,while the PO group received oral symptomatic medication treatment.Primary outcome measures were gastrointestinal symptom severity scores(Gastrointestinal Symptom Rating Scale,Irritable Bowel Syndrome Severity Scoring System scales)at 2 weeks and 4 weeks after treatment completion.Secondary outcome measures included Gastrointestinal Quality of Life Index scores.Both groups underwent rigorous follow-up and assessment.RESULTS The TI group is anticipated to significantly outperform the PO group in gastrointestinal symptom relief and quality of life improvement.TI group patients are expected to show a notable decrease in symptom scores,increased quality of life index,and higher clinical effectiveness rate.Additionally,the TI group is projected to have a low adverse event rate and good safety profile.CONCLUSION Latent MTrPs injection therapy may represent an effective and safe new method for treating FGIDs.Compared to traditional oral medication treatment,this method demonstrates significant advantages in improving patient symptoms and quality of life.
基金financially supported by the National Natural Science Foundation of China(Nos.81590951,81973962,82004486)the National Key Research and Development Project(No.2019YFC1709701)+1 种基金the Key Research and Development Project of Science and Technology Department of Sichuan Province(Nos.2020YFS0304,2021YFS0087)Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine.(No.ZYYCXTD-D-202003).
文摘Acupoints and trigger points in traditional Chinese medicine represent two different minimally invasive therapy systems-based,respectively,on traditional acupuncture and dry needles.Many studies argue that trigger points and traditional acupoints are conceptually similar because they generally have identical locations on the human body.However,whether trigger points contribute to the formation of the traditional acupuncture technique is controversial.Although many relevant studies have been conducted,this controversy continues to hinder the development of both disciplines.Recently,researchers of Chinese acupuncture have proposed the“acupoint sensitization”theory,which postulates that traditional acupoints may be sensitized by diseases,environments,and therapies.This turns them into a“sensitized state.”Recent studies suggest that trigger points and sensitized acupoints share similar biological properties.To clarify the above-mentioned confusion,we reviewed relevant studies on these two concepts and attempted to analyze their relationship.In this paper,we provide a general summary of acupoint sensitization theory and sensitized acupoints.We then compare trigger points with sensitized acupoints by categorizing their similarities and differences,including location and range,pathological morphology,pain perception,surface temperature effects,and bioelectrical properties.We believe that,because trigger points and sensitized acupoints have many shared properties,they might constitute“the same book with different covers.”
基金Natural Science Foundation of Hainan Province(2017)
文摘In recent years,the treatment of myofascial pain trigger point is a relatively popular technology,many people regard it as"Ashi point"in meridian theory,but compared with the traditional meridian theory,the description of myofascial pain trigger point is more intuitive and easier to master.This paper expounds the similarities and differences between myofascial pain trigger point and traditional meridian theory from the aspects of theory,basic research and clinical application,in order to provide a specific idea for the scientific interpretation of meridian phenomenon in traditional Chinese medicine.
文摘Objective To evaluate the clinical efficacy of ultrasound-guided acupuncture at myofascial trigger points(MTrPs)on treating post-stroke foot drop.Methods Sixty patients with post-stroke foot drop were randomly assigned to an observation group 1(20 cases,1 case dropped out),an observation group 2(20 cases,2 casses dropped out),and a control group(20 cases).The control group received conventional acupuncture at Yanglingquan(GB34),Jiexi(ST41),Taichong(LR3),Zusanli(ST36),Xuanzhong(GB39),and Qiuxu(GB40)on the affected side,once daily.In addition to the treatment of the control group,the observation group 1 received acupuncture at the tibialis anterior and gastrocnemius MTrPs,once every other day,while the observation group 2 received ultrasound-guided acupuncture at the tibialis anterior and gastrocnemius MTrPs,once every other day.All groups were treated for twooweeks.Three-dimensional gaitanalysis was performed using an infrared motion capture system,and the Holden walking scale was used to evaluate walking ability before and after treatment in the three groups.Results Compared before treatment,the patients in the observation groups 1 and 2 showed increased walking speed(P<0.05,P<0.01),and improved Holden walking scale grades(P<0.05,P<0.01)after treatment;the patients in the observation group 2 also showed increased ankle dorsiflexion angles(P<0.05).The walking speeds of the observation groups 1 and 2 were faster than those of the control group after treatment(P<0.05),the Holden walking scale grade in the observation group 2 was superior to that in the control group(P<0.05).Conclusion The ultrasound-guided acupuncture at MTrPs could effectively improve gait function in post-stroke foot drop patients.
文摘Objective To investigate the current practice of myofascial pain syndrome （MPS） including current epidemiology, pathology, diagnosis and treatment. Data sources The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed, MedSci, Google scholar. The terms ＂myofasial trigger points＂ and ＂myofacial pain syndrome＂ were used for the literature search. Study selection Original articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points （MTrPs） and MPS were retrieved, reviewed, analyzed and summarized. Results Myofascial pain syndrome （MPS） is characterized by painful taut band, referred pain, and local response twitch with a prevalence of 85% to 95% of incidence. Several factors link to the etiology of MTrPs, such as the chronic injury and overload of muscles. Other factors, such as certain nutrient and hormone insufficiency, comorbidities, and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain. The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots, relative to some hypotheses of integration, muscle spindle discharges, spinal segment sensitization, ect. MTrPs can be diagnosed and localized based on a few subjective criteria. Several approaches, including both direct and supplementary treatments, can inactivate MTrPs. Direct treatments are categorized into invasive and conservative. Conclusion This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China.
文摘Objective: To observe the clinical efficacy of electroacupuncture (EA) plus Tanbo-plucking the trigger points for scapulohumeral periarthritis (SP). Methods:A total of 80 patients with SP were randomized into an observation group and an EA group by the random number table, with 40 cases in each group. The EA group was treated with EA therapy, and the observation group was treated with EA therapy plus Tanbo-plucking the trigger points. After treatment, the visual analog scale (VAS) and Melle scores of the two groups were compared to evaluate the improvement of shoulder pain and functional activity, and meanwhile the clinical efficacy was observed. Results: After treatment, the total effective rate of the observation group was 95.0% and the cure and markedly effective rate was 72.5%. The total effective rate of the EA group was 87.5% and the cure and markedly effective rate was 42.5%. There was no significant difference in the total effective rate between the two groups (P>0.05). The cure and markedly effective rate of the observation group was higher than that of the EA group, and the difference between the two groups was statistically significant (P<0.05). After treatment, the intra-group differences in VAS and Melle scores of both groups were statistically significant (bothP<0.001). The inter-group differences in the changes of the VAS and Melle scores after treatment were statistically significant (bothP<0.001). Conclusion: EA plus Tanbo-plucking the trigger points has a better curative effect than EA therapy alone in the treatment of SP.
文摘Objective To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points(MTrPs)by observing the effects of An-Pressing manipulation on adenosine triphosphate(ATP),adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK)/peroxisome proliferator-activated receptorγcoactivator 1α(PGC-1α)pathway and mitochondrial ultrastructure of skeletal muscle cells in MTrPs rats.Methods Forty-eight male Sprague-Dawley rats were randomly divided into a blank group,a model group,a lidocaine group,and an An-Pressing manipulation group,with 12 rats in each group.The model group,lidocaine group and An-Pressing manipulation group were used to replicate the MTrPs rat model by blunt shock and centrifugal motion method.After modeling,the An-Pressing manipulation group was subjected to 7 times An-Pressing manipulation,once every other day;the lidocaine group was treated with 3 times of injection of lidocaine at the MTrPs,once every 6 d.The blank group and the model group were fed normally without intervention.After the intervention,local muscle tissue was taken to detect the content of ATP and the expression of AMPK,phosphorylated AMPK(phospho-AMPK),PGC-1α,and glucose transporter 4(GluT4),and the ultrastructure of mitochondria was observed under an electron microscope.Results Compared with the blank group,the ATP content in the model group was decreased(P<0.05),the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were decreased(P<0.05);under the electron microscope,the number of mitochondria decreased,and they were deformed,small in volume,and had deformed cristae.Compared with the model group,the ATP contents in the An-Pressing manipulation group and the lidocaine group were increased(P<0.05),and the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were increased(P<0.05);under the electron microscope,the number of mitochondria increased,the shape and size of the mitochondria were basically normal,and the cristae could be seen.Compared with the lidocaine group,phospho-AMPK and the ratio of phospho-AMPK to AMPK in the An-Pressing manipulation group were increased(P<0.05);under the electron microscope,the numbers of mitochondria were similar,and the shape and size of the mitochondria were basically normal without swelling,and the cristae could be observed.Conclusion An-Pressing manipulation can increase the ATP content in MTrPs tissue,improve the expression levels of PGC-1α and GluT4 proteins and the ratio of phospho-AMPK to AMPK;its mechanism may relate to the activation of AMPK/PGC-1α signaling pathway to promote the repair of mitochondrial damages.
文摘Objective:To observe the clinical effect of needling gluteus medius muscle trigger point (TrP) plus chiropractic for sacroiliac joint subluxation.Methods:A total of 124 cases conforming to the inclusion criteria of sacroiliac joint subluxation were classified by anterior subluxation and posterior subluxation,and randomized into a TrP group and a conventional group respectively.There were 63 patients with anterior subluxation who were randomized into a TrP group of 32 cases (including 4 dropped out cases) and a conventional group of 31 cases (including 3 dropped out cases);and 61 patients with posterior subluxation who were randomized into a TrP group of 31 cases (including 3 dropped out cases) and a conventional group of 30 cases (including 3 dropped out cases).Patients in the TrP group received the treatment of needling gluteus medius muscle TrP plus chiropractic,while patients in the conventional group received conventional acupuncture treatment plus chiropractic.The treatment was done twice a week for a succession of 8 weeks.Then,the pain visual analog scale (VAS),Oswestry disability index (ODI) and therapeutic efficacy were evaluated.Results:After treatment,the total effective rate of TrP group with anterior subluxation was 96.9%,higher than 77.4% in the conventional group,the difference showed a statistical significance (P<0.05);the total effective rate was 93.5% in the TrP group with posterior subluxation,higher than 73.3% in the conventional group.After treatment,the VAS and ODI scores in both groups dropped obviously,the differences showed statistical significance (all P<0.05);the scores of VAS and ODI in the TrP group were obviously lower than those in the conventional group (all P<0.05).Conclusion:Needling gluteus medius muscle TrP plus chiropractic had a better therapeutic effect than conventional acupuncture plus chiropractic for sacroiliac joint subluxation.
文摘Objective:To investigate the mechanism of trigger point deactivation induced by pressing manipulation in a rat model and to explore its potential regulation of the inflammatory response through the extracellular signal-regulated kinase(ERK)/nuclear factor-κB(NF-κB)pathway.Methods:Fifty male Sprague-Dawley rats were randomly divided into a blank group,a model group,a pressing manipulation group,an ERK agonist group,and a pressing manipulation+ERK agonist group,with 10 rats in each group.Except for the blank group,rats in other groups were used to establish the trigger point rat model using the blunt blow combined with the eccentric exercise method.The pressing manipulation group underwent pressing manipulation intervention at the trigger points.The ERK agonist group received an injection of recombinant human epidermal growth factor via the tail vein.The pressing manipulation+ERK agonist group received interventions from both the pressing manipulation and ERK agonist groups.The pressure pain threshold(PPT)was measured by a mechanical pain threshold detector before and after the intervention.The histological changes were evaluated by hematoxylin-eosin staining after the intervention;the expression levels of ERK,phosphorylated ERK(p-ERK),NF-κB p65(p65),phosphorylated NF-κB p65(p-p65),and phosphorylated NF-κB inhibitor(p-IκB)were detected by Western blotting;the levels of interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-αwere detected by enzyme-linked immunosorbent assay.Results:The PPT increased(P<0.05);the inflammatory cells disappeared;the ratios of p-ERK/ERK,p-p65/p65,and p-IκB/β-actin,also the levels of IL-1β,IL-6,and TNF-αall decreased in the pressing manipulation group after the intervention compared with the model group(P<0.05).The PPT decreased significantly(P<0.05),the inflammatory cell presence increased,and the ratios of p-ERK/ERK and p-p65/p65 were elevated(P<0.05);additionally,the levels of IL-6 and TNF-αwere significantly higher in the pressing manipulation+ERK agonist group compared with the pressing manipulation group(P<0.05).The PPT was significantly lower(P<0.05),the inflammatory cell count was higher,the ratios of p-ERK/ERK and p-IκB/β-actin and the levels of IL-1βand TNF-αwere significantly higher in the ERK agonist group compared with the pressing manipulation+ERK agonist group(P<0.05).Conclusion:Pressing manipulation can effectively alleviate inflammation and pain in trigger point model rats,potentially by inhibiting the ERK/NF-κB signaling pathway.
