Ashi Acupuncture Versus Local Anesthetic Trigger Point Injections in the Treatment of Abdominal Myofascial Pain Syndrome: A Randomized Clinical Trial

Abstract

Background: Chronic pelvic pain (CPP) is defined as recurrent or continuous pain in the lower abdomen or pelvis, non-menstrual or non-cyclic, lasting at least 6 months. There is strong evidence that up to 85% of patients with CPP have serious dysfunction of the musculoskeletal system, including abdominal myofascial syndrome (AMPS). AMPS is characterized as deep abdominal pain, originating from hyperirritable trigger points, usually located within a musculoskeletal range or its fascia of coating. In the literature, there are few studies that address AMPS. Objective: This study aimed to compare the responses of ashi acupuncture treatment and local anesthetic injection in the treatment of chronic pelvic pain secondary to abdominal myofascial pain syndrome in women. Study Design: Randomized controlled clinical trial. Setting: Tertiary University Hospital. Methods: Women with a clinical diagnosis of CPP secondary to AMPS were randomized and evaluated using instruments to assess clinical pain, namely, the visual analogue scale (VAS), numerical categorial scale (NCS), and the McGill Questionnaire, after receiving treatment with ashi acupuncture (group A, n = 16) or local anesthetic injections (group B, n = 19). They were reevaluated after one week and one, 3, and 6 months after each treatment, in addition to assessments of pain and adverse events performed during the sessions. Results: Ashi acupuncture and local anesthetic injections were both effective in reducing clinical pain assessed through the analyzed variables among study participants. There was no difference between the groups and there was a strong correlation between these pain assessment instruments. Limitations: The absence of blinding to the different forms of treatment among the patients and the researcher directly involved in the treatment, the absence of a placebo group, the selective exclusion of women with comorbidities and other causes of CPP, and the difference between the number of sessions used for each technique. Conclusion: Treatments with ashi acupuncture and local anesthetic injections were effective in reducing clinical pain in women with abdominal myofascial pain syndrome. Key words: Chronic pelvic pain, abdominal myofascial pain syndrome, trigger points, acupuncture, topical injectable anesthetic

The Effects and Potential Mechanisms of Moxibustion for Rheumatoid Arthritis-Related Pain: A Randomized, Controlled Trial

“…Previous studies indicated that moxibustion on ST36 and BL23 had promising antiarthritic effects, 18 and stimulating A-Shi points could play an analgesic role. 39 , 40 Therefore, the three acupoints were selected in this study, embodied the principle of treating both symptoms and root causes.…”

Non-pharmacological therapies for treating chronic pelvic pain in women: A review

“…[43] Another randomized sham-controlled trial also showed that Japanese-style acupuncture is safe, effective, and non-addictive for treating endometriosis-related pelvic pain in women. [44] Studies also indicate that Ashi acupuncture is as effective as local anesthetic injections in easing pain in women with CPP, [41] and manual acupuncture plus usual care is more acceptable, safe, and effective than usual care alone. [45] In addition, a randomized controlled trial concluded that neurogenic acupoint cupping, a traditional antient treatment, could significantly reduce inflammation, pelvic pain, and improve quality of life in women with CPP.…”

“…[1] The mechanism of acupuncture analgesia is not clear, but studies have shown that neuroendocrine, immunological, and cardiovascular reactions can be triggered by acupuncture that penetrates the peripheral system, producing mechanical signals and generating cascaded effect. [40,41] Acupuncture can balance homeostasis by stimulating sympathetic neurons and somatic afferent fibers of neurons. [41] Acupuncture can also form a cutaneous microcurrent to promote tissue growth.…”

“…[40,41] Acupuncture can balance homeostasis by stimulating sympathetic neurons and somatic afferent fibers of neurons. [41] Acupuncture can also form a cutaneous microcurrent to promote tissue growth. [42] Unlike morphine, which develops drug tolerance in patients with chronic pain, multiple sessions of acupuncture do not inhibit the reaction to needling.…”

Importance of an Interdisciplinary Approach in the Treatment of Women with Endometriosis and Chronic Pelvic Pain

“…Approximately 85% of women with CPP have musculoskeletal associated disorders; myofascial pain syndrome can be managed, among other strategies, by trigger point anesthetic injections, therapeutic ultrasound 11 and also by acupuncture. 12 Despite the lack of robust evidence, some studies show beneficial effects of acupuncture in the treatment of these conditions. 12 Physical exercise is another domain that should be addressed and encouraged.…”