Effects of Intramuscular Electrical Stimulation on Symptoms Following Trigger Points; A Controlled Pilot Study

Abstract

Introduction: Myofascial Pain Syndrome (MPS) is a common disorder of musculoskeletal system. About one third of the people with musculoskeletal disorders have been diagnosed as having MPS. It is a painful condition caused by trigger points. A variety of treatment approaches are used to cure MPS and its associated disorders. This study aimed to investigate the effects of single session Intramuscular Electrical Stimulation (IMES) through dry needling on pain and Range Of Motion (ROM) following trigger points in upper trapezius. Materials and Methods:Sixteen volunteers with active trigger points in upper trapezius were randomly divided into two groups: 1) the IMES treatment group (8 females) and 2) placebo group (8 females). In the IMES group, trigger points of the affected side were injected through dry needling, then a burst current (2 Hz) was applied on the muscle while the electrical stimulation steadily increases to form a pain free contraction for the patient. In placebo group, the procedure was exactly the same but there was no applied electrical stimulation through dry needling. Pain sensation by Visual Analog Scale (VAS) and cervical flexion ROM were measured before treatment, immediately after treatment and one week later by another blinded researcher.Results: VAS scores showed improvement in both groups at the end of the treatment session and also one week later. There was no significant difference between the groups; IMES and placebo in terms of the VAS after treatment session. However, the pain scores were substantially decreased in the IMES group one week after the intervention. The ROMs were significantly lower in placebo group one week after treatment. There was no significant correlation between improvement and duration of symptoms. Conclusion:Both IMES and placebo methods might be effective in relieving symptoms of patients with the MPS in upper trapezius; however, patients following the IMES treatment showed higher level of improvement during one week after the intervention. Further relevant studies with higher number of volunteers and different treatment protocols are necessary to get high quality evidence.

Effects of percutaneous neuromodulation in neuromusculoskeletal pathologies: A systematic review

“…All articles that analyzed the effect of PNM on pain found significant improvements. The studies made by Hadizadeh et al [ 23 ] in patients with trigger points in upper trapezius, Botelho et al [ 16 ] in patients with myofascial pain syndrome, da Graca-Tarragó et al 2016 [ 17 ] in patients with knee osteoarthritis, and Raphael et al [ 33 ] in patients with chronic pain and hyperalgesia obtained a significant improvement when it came to pain intensity ( P ≤ .048; P < .001; P = .001, and P < .0005, respectively). Likewise, García-Bermejo et al 2020 found a significant improvement on PNM based treatment when treating unilateral anterior knee pain, regardless using it in a contralateral or homolateral manner ( P = .01 in both groups).…”

“…There was a significant improvement in three out of six articles that analyzed this parameter. In patients with trigger points in upper trapezius ( P = .048), [ 23 ] patients with bilateral reduced hamstring syndrome ( P < .01), [ 21 ] and patients with anterior knee pain ( P = .001). [ 22 ] Nonetheless, de la Cruz et al 2019 found no significant improvement in ballet dancers, [ 19 , 21 ] nor did Sumen et al in patients with trigger points in upper trapezius.…”

“…In terms of the ROM, only 50% of the articles that studied this parameter found a significant improvement thanks to the PNM. [ 20 , 22 , 23 ] The adverse results on the ROM may be conditioned because of the characteristics of the studied sample. In two of the articles, they studied the ROM of ballet dancers, since their activity involves a lot of ROM and, therefore, it is unlikely to improve due to this intervention.…”

Intramuscular Electrical Stimulation to Trigger Points: Insights into Mechanisms and Clinical Applications—A Scoping Review

“…Intramuscular electrical stimulation (IMES) is an electrotherapeutic modality that uses needles to deliver electrical current into muscles and, more specifically, into TrPs [ 42 ]. The electrical stimulation is often used as an additive to manual needling.…”

“…Nevertheless, both electrical and manual stimulation of needles have overlapping physiological mechanisms due to the insertion of needles [ 43 ]. Evidence is gradually accumulating to support the use of IMES in patients with MPS [ 39 , 42 , 44 , 45 , 46 ]. However, a recent systemic review on IMES reported that among the six included studies, only three directly targeted TrPs [ 47 ].…”