Efficacy of Trigger Points Mesotherapy for the Treatment of Chronic Neck Pain: A Short Term Retrospective Study

Abstract

Case StudyOpen Access IntroductionThe lifetime prevalence of neck pain in Western populations has been estimated at around 70%, while annual or point prevalence rates range from 10% to 35% [1][2][3]. Chronic neck pain (CNP) can be defined as pain experienced in the anatomic region of the cervical spine between C1 and C7 and the surrounding musculature only, in accordance with the criteria set by the International Association for the Study of Pain and the American Pain Society which defines the condition as chronic when pain persists beyond 3 months regards the normal tissue healing time [4,5]. Many factors contribute to the development of CNP and many have not yet been identified. However, it is known that pain can become more complex in its pathophysiology than its original injury. Chronic musculoskeletal pain, like CNP for instance, usually develops as a result of an injury or an insult followed by neurogenic inflammation, hyperalgesia, and allodynia; then occurs a central sensitization followed by a loss of nociceptive control [6,7].Clinical guidelines for CNP treatment recommends cervical mobilization, thoracic spine thrust manipulation, flexibility exercises for specific muscles group (anterior/medial/posterior scalene, upper trapezius, elevator scapulae, pectoralis minor, and pectoralis major), the use of coordination, strengthening, and endurance exercises to reduce neck pain and headache. To improve recovery in patients with whiplash-associated disorder, clinicians should educate the patient to be more confident in coming back at a well-being status [8]. It is well known that there are many therapeutic strategies for CNP, but the long term effects of individual rehabilitation approaches are limited. Between the flexibility muscles exercises, the relaxation of myofascial trigger points (MTrPs) in the splenius capitis, elevator scapulae, or upper trapezius muscles as a clinical entity seems to contribute to CNP [9]. Moreover, the reported pain elicited by active MTrPs in the neck and shoulder muscles has been shown to contribute to symptoms of mechanical neck pain [10,11]. An MTrP is defined as a hyperirritable focus within a taut band of skeletal muscle that is painful However, no studies have investigated the effects of mesotherapy on MTrPs to improve chronic neck pain and function. Moreover the efficacy of mesotherapy was confirmed as a viable option as an additional treatment in an overall rehabilitation treatment planning in other research on chronic lower back pain [13]. Mesotherapy was introduced 50 years ago by Michel Pistor, a French physician who used this technique as a novel analgesic therapy for a variety of rheumatologic disorders. Mesotherapy is a minimally invasive technique that consists of subcutaneous injections of drugs and, occasionally, plant extracts, homeopathic agents, or other bioactive substances [14][15][16].The pharmacological effects of intradermal administration do not entirely account for the observed clinical benefits of mesotherapy. The needle dry prick activates the cutan...

<p>Mesotherapy in the treatment of musculoskeletal pain in rehabilitation: the state of the art</p>

“…Seven articles (N=7) satisfied the inclusion criteria and were considered in the review: 2 articles treated osteoarthritis of the knee,16,17 and 5 articles treated spine diseases 2 on neck pain,18,19 2 on low back pain,20,21 and 1 on chronic spinal pain 22. The PEDro scores in these studies ranged from 5 to 8 (Table 1).…”

“…The Visual Analogue Scale (VAS) is a measurement instrument usually used in clinical research to measure the intensity of musculoskeletal pain while WOMAC is a scale used to evaluate the condition of patients with osteoarthritis of the knee and hip, including pain, stiffness, and physical functioning of the joints. Paolucci et al18 used the Verbal Rating Scale (VRS), a 5-category verbal scale with which pain is assessed by asking patients to indicate which of 5 words best describe their current pain 25…”

“…With respect to the assessment of pain and function of the spine, the authors used specific scales and, specifically, the Neck Disability Index (NDI), a valid and sensitive tool for measuring changes in pain and disability in patients with musculoskeletal neck pain,18,19,27 and the Patient-Specific Functional Scale (PSFS), a patient-specific outcome measure that examines the functional status of the spine 21,28. The Knee Injury and Osteoarthritis Outcome Score (KOOS) is used to quantify short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis 17,29…”

“…Finally, to evaluate the increase in quality of life that is perceived by patients, the Short Form-12 Health Survey (SF-12), a 12-item questionnaire that assesses generic health outcomes from the patient’s perspective, was administered 18,30. The self-reported Patient Global Impression of Change (PGIC) scale quantifies how the patients’ health change in painful condition 19,31…”

The effects of dry needling and radial extracorporeal shockwave therapy on latent trigger point sensitivity in the quadriceps: A randomised control pilot study

“…Myofascial trigger points (TrPs) can cause local pain (Paolucci et al, 2016) or referred pain and sensory and motor phenomena (Espí-L opez et al, 2014). Latent TrPs are not spontaneously painful (Bron and Dommerholt, 2012).…”