Ultrasound-Guided Inactivation of Trigger Points Combined with Muscle Fascia Stripping by Liquid Knife in Treatment of Postherpetic Neuralgia Complicated with Abdominal Myofascial Pain Syndrome: A Prospective and Controlled Clinical Study

Abstract

Objective. To evaluate ultrasound-guided inactivation of myofascial trigger points (MTrPs) combined with abdominal muscle fascia stripping by liquid knife in the treatment of postherpetic neuralgia (PHN) complicated with abdominal myofascial pain syndrome (AMPS). Methods. From January 2015 to July 2018, non-head-and-neck PHN patients in the Pain Department, The First Affiliated Hospital of Soochow University, were treated with routine oral drugs and weekly paraspinal nerve block for two weeks. Patients with 2 < VAS (visual analogue scale) score < 6 were subjects of the study. They were assigned into control group 1 (C1, n = 33) including those with PHN and without myofascial pain syndrome (MPS) and control group 2 (C2, n = 33) including those with PHN complicated with MPS and observation group 1 (PL, n = 33) including those with PHN complicated with limb myofascial pain syndrome (LMPS) and observation group 2 (PA, n = 33) including those with PHN complicated with AMPS. All groups received zero-grade treatment: routine oral drugs and weekly paraspinal nerve block. PL and PA groups were also treated step by step once a week: primary ultrasound-guided inactivation of MTrPs with dry needling, secondary ultrasound-guided inactivation of MTrPs with dry and wet needling, and tertiary ultrasound-guided dry and wet needling combined with muscle fascia stripping by liquid knife. At one week after primary treatment, patients with a VAS score > 2 proceeded to secondary treatment. If the VAS score was <2, the treatment was maintained, and so on, until the end of the four treatment cycles. Pain assessment was performed by specialized nurses at one week after each treatment, including VAS score, McGill pain questionnaire (MPQ) score, pressure pain sensory threshold (PPST), and pressure pain tolerance threshold (PPTT). VAS score was used as the main index and VAS <2 indicated effective treatment. At 3 months after treatment, outpatient and/or telephone follow-up was performed. The recurrence rate was observed and VAS > 2 was regarded as recurrence. Results. At one week after primary treatment, the effective rate was 66.7% in PL group, significantly higher than that in PA group (15.2%, P<0.05). At one week after secondary treatment, the effective rate was 100% and 37.5% in PL and PA groups, respectively, with significant difference between the groups (P<0.05). The effective rate increased to 90.6% in PA group at one week after tertiary treatment. At one week after the end of treatment cycles, the scores of VAS and MPQ were significantly lower in C1, PL, and PA groups than in C2 group (P<0.05), while PPST and PPTT were significantly higher than in C2 group (P<0.05). There was no significant difference between C1 group and PL group (P>0.05). At follow-up at 3 months after treatment, the recurrence rate was low in each group, with no significant difference between the groups (P>0.05). Conclusion. About 57% of PHN patients with mild to moderate pain are complicated with MPS, and ultrasound-guided inactivation of MTrPs with dry and wet needling can effectively treat PHN patients complicated with LMPS. However, patients with PHN complicated with AMPS need to be treated with ultrasound-guided MTrPs inactivation combined with muscle fascia stripping by liquid knife as soon as possible.

Neuropathic Pain and Ultrasonography: A Multiperspective Literature Evaluation

“…Concerning other diseases, the diagnostic contribution of US was even assessed in sciatica, where it showed morphological changes of the nerve, with enlargement and higher stiffness in the impaired nerve [ 27 , 28 ]. In the cases of herpes/postherpetic neuralgia, US was mainly used to guide the treatment, improving painful symptoms [ 29 ]. Patients with chronic pain were successfully treated with US-guided block [ 30 ].…”

Ultrasound-Guided Dry Needling for Trigger Point Inactivation in the Treatment of Postherpetic Neuralgia Mixed with Myofascial Pain Syndrome: A Prospective and Controlled Clinical Study

“…Conventional treatment has an ideal therapeutic effect on PHN patients without MPS, but the therapeutic effect on PHN patients with MPS is not clear. Unfortunately, some studies have shown that more than a half of PHN patients had MPS [ 8 ]. This study showed that for these patients, DN treatment on PHN mixed with MPS had an unexpected good effectiveness, the effective rate was as high as 92.9%, and the recurrent rate was as low as 7.1% in the follow-up study three months later after the treatment.…”

“…Dry needling (DN) treatment is a safe technique, which leaves no side effects other than a slight discomfort that disappears after 3 days at the most [ 7 ]. Some research found out that more than a half of PHN patients had mild to moderate pain mixed with MPS [ 8 ]. MPS is also found in other conditions, such as osteoarthritis of the knee [ 9 ].…”

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

“…Oxygen-ozone injection: Oxygen-ozone injection induces muscle twitching in the same way as stimulating MTrPs by a tiny needle producing a therapeutic effect similar to dry-needle treatment. Compared to corticosteroid injection, ozone can be metabolized and transformed into oxygen with the final absorption into the tissue, avoiding the side effect of local adhesion and the systematic response of a corticosteroid[ 52 ]. The concentration of ozone injected should be no more than 30 μg/mL, with the dose of 1 mL to 5 mL for a single trigger point and a maximum of 30 mL at a time.…”