Objective To determine whether standard evaluations of pain distinguish subjects with no pain from those with myofascial pain syndromes (MPS) and active trigger points (MTrPs); and to assess whether self-reports of mood, function and health-related quality of life differ between these groups. Design Prospective, descriptive study. Setting University Patients Adults with and without neck pain Methods We evaluated adults with MPS and active (painful) MTrPs and those without pain. Subjects in the “Active” (‘A’) group had at least one active MTrP with spontaneous pain which was persistent, lasted more than 3 months and had characteristic pain on palpation. Subjects in the “No pain” (‘Np’) group had no spontaneous pain. However, some had discomfort on MTrP palpation (latent MTrP) while others in the Np group had no discomfort on palpation of nodules or had no nodules. Outcome Measures Each participant underwent range of motion (ROM) measurement, 10-point manual muscle test, and manual and algometric palpation. The latter determined the pain/pressure threshold using an algometer of 4 pre-determined anatomical sites along the upper trapezius. Participants rated pain using a verbal analogue scale (0–10); completed the Brief Pain Inventory and Oswestry Disability Scale (ODS), which included a sleep sub-scale; Short Form 36(SF36) and the Profile of Mood States (POMS). Results here were 24 in the ‘A’ group (mean 36 yrs, 16 women) and 26 in the ‘Np’ group (mean 26 yrs, 12 women). Subjects in group ‘A’ differed from ‘Np’ in number of latent MTrPs (p=.0062); asymmetrical cervical ROM (p=.01 side bending and p=.002 rotation); in all pain reports (p<.0001); algometry (p<.03); POMS (p<.038); SF36 (p<.01) and ODS (p<.0001). Conclusion A systematic musculoskeletal evaluation of people with MPS reliably distinguishes them from subjects with no pain. The two groups are significantly different in their physical findings and self-reports of pain, sleep disturbance, disability, health status and mood. These findings support the view that a “local” pain syndrome has significant associations with mood, health-related quality of life and function..

Background Dry needling is an effective treatment for reducing pain associated with active myofascial trigger points (aMTrPs) in the short term. The duration of the benefits of this treatment have not been fully assessed. Objective This study attempts to determine whether the benefits of dry needling (DN) of a-MTrPs are sustained 6 weeks post-treatment. Design Follow-up of a prospective study Setting University Participants Forty-five subjects (13 males) with cervical pain > 3 months and a-MTrPs in the upper trapezius who completed 3 DN treatments, evaluated 6-weeks post-treatment. Interventions None Main Outcome Measures Primary Outcomes: Changes from baseline to follow-up in scores for the verbal analogue scale (VAS), Brief Pain Inventory (BPI), and MTrP status. MTrPs were rated: active (spontaneously painful), latent (painful only on compression) and non-palpable nodule. Responders: patients whose MTrP status changed from active to latent or non-palpable nodule (resolved). Secondary Outcomes Pain pressure threshold (PPT), Profile of Mood States, Oswestry Disability Index (ODI), SF-36, Cervical Range of Motion. Results Pain measures remained significantly improved 6 weeks post-treatment (p<.003), as did the SF-36 physical functioning score (.01) and ODI (p=.002). Side bending and PPT for subjects with unilateral MTrPs had sustained improvement (p=.002). The number of subjects with sustained MTrP response at 6 weeks was significant (p<.001). Comparing responders to non-responders, change in VAS and BPI were statistically significant (p = .006, p=.03), but PPT was not. Patients with higher baseline VAS have higher risk of not responding to DN, those with a greater drop in VAS from baseline have a higher probability of sustained response. One unit decrease in VAS at baseline results in a 6.3-fold increase in the odds of being a responder versus a non-responder (p = .008). Conclusions There is sustained reduction of pain scores after completion of DN, which is more likely with a greater drop in VAS. Patients with higher baseline VAS are less likely to respond to DN. Early intervention toward significant pain reduction is likely to be associated with sustained clinical response.

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