Title: The Clinical Outcomes of Local Steroid Injection Plus Conservative Management and Conservative Management Alone in Chronic Low Back Pain Due to Myofascial Pain Syndrome
Authors: Dr Bisha Babu, Dr Sreejith Kalathummarath, Dr Sreedevi Menon P
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.174
Abstract
Background: Myofascial Pain Syndrome (MPS) is defined as a regional pain syndrome characterised by muscle pain caused by myofascial trigger points (MTrPs). The prevalence of MPS among chronic back pain patients is high. Clinical features are exquisite spot tenderness, pain recognition, taut band, referred pain and local twitch response. Treatment includes both conservative and invasive type. There was no obvious study to assess the effectiveness of steroid infiltration in myofascial pain syndrome when compared to conservative management. So aim of the study was to compare the pain and functional outcomes of local steroid injection and conservative management and conservative management alone in chronic low back pain due to Myofascial Pain Syndrome.
Methods: This prospective comparative study was conducted in Department of Physical Medicine and Rehabilitation, Government Medical College Kozhikode. Duration of study was one year and consisted of a sample size of 60. Study started with collection of information regarding demographic factors and randomly giving the treatment to the groups. Patients were followed up at 3rd week. Outcome measures were Visual Analogue Scale and Short Form Mcgill Pain Questionnaire for pain and Oswestry Low Back Pain and Disability Index for functional outcome and Case record form.
Results: When pain scores were measured by the SF McGill Pain Questionnaire and by the VAS, steroid infiltration combined with conservative management showed better results than those in the conservative management group at the follow-up visit, the scores being statistically significant.
Conclusion: In this study it was found that local steroid injection of Myofascial Trigger Points combined with conservative management resulted in better pain relief and functional outcome in chronic low back pain due to Myofascial Pain Syndrome than conservative management alone.
References
- Physical Medicine And Rehabilitation, Randall L. Braddom
- Chee Kean Chen, Abd Jalil Nizar, Myofascial Pain Syndrome in Chronic Back Pain Patients, Korean J Pain, 2011 Jun; 24(2): 100–104)
- Gerwin RD, Shannon S, Hong C-Z, et al: Identification of myofascial trigger points: interrater agreement and effect of training, pain 69:65-73.
- Simons DG, Travell JG, Simons LS: Travell & Simons myofascial pain and dysfunction: the trigger point manual, vol. 1, ed2, Baltimore, 1999, Williams & Wilkins.
- Malanga G, Wolff E Evidence-informed management of chronic low back pain with trigger point injections:Spine Journal in 2008Jan-Feb;8(1):243-52.doi: 10.1016/j.spinee.2007.10.029.
- Iwama H, Akama Y. The superiority of water diluted 0.25% to near 1% lidocaine for trigger point injections in myofascial pain syndrome: a prospective, randomized, double blinded trial. AnesthAnalg 2000;91(2):408-409.
- Xie P, Qin B, Yang F, Yu T, Yu J, Wang J, Zheng H ;Lidocaine Injection in the Intramuscular Innervation Zone Can Effectively Treat Chronic Neck Pain Caused by MTrPs in the Trapezius Muscle:2015 Sep-Oct;18(5):E815-26.
- Bonica’s management of Pain by Scott M. Fishmen (editor), Jane C. Ballantyne (editor), James P. Rathmell (editor).
- Mata Diz JB1, de Souza JR1, Leopoldino AA2, Oliveira VC3; Exercise, especially combinedstretching and strengthening exercise, reduces myofascial pain a systematic review: J Physiother. 2017 Jan;63 (1):17-22. doi: 10.1016/j.jphys.2016.11.008. Epub 2016 Dec 3.
- Clara S. M. Wong, Steven H. S. Wong : A New Look at Trigger Point Injections; Anesthesiol Res Pract. 2012; 2012: 492452.2011 Sep 29.
- Niraj G1; Pathophysiology and Management of Abdominal Myofascial PainSyndrome (AMPS): A Three-Year Prospective Audit of a Management Pathway in 120 Patients;Pain 2018 Feb 9. doi: 10.1093/pm/pnx343.