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Pain Management 2018
Internal Medicine 2018
International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X
Page 31
March 26-28, 2018
Vienna, Austria
JOINT EVENT
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Internal Medicine and Patient Care
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Pain Management
Volume 4
M
yofascial pain syndrome (MPS) is identified by palpating
skeletal muscle for myofascial trigger points (MTrPs).
A MTrP is “a hyperirritable spot in skeletal muscle that is
associated with a hypersensitive palpable nodule in a taut
band.” There are emerging findings suggest that MPS is
a complex form of neuromuscular dysfunction consisting
of motor and sensory abnormalities involving both the
peripheral and central nervous systems. Sensitization in
corresponding spinal segments plays a major role in the
formation of continuous pain in a given part of the body. The
clinical manifestation of dorsal horn sensitization includes
hyperalgesia of the dermatome, pressure pain sensitivity
of the sclerotome and myofascial trigger points within the
myotomes, which are supplied by the same sensitized spinal
segment. Hence therapeutic approaches require varieties
of techniques for eradiation of MTrP and desensitization
of the whole related spinal segment. Spinal segmental
sensitization (SSS) is a hyperactive state of the spinal cord
caused by irritative foci sending nociceptive impulses from
a sensitized damaged tissue to dorsal horn neurons. The
clinical manifestation of dorsal horn sensitization includes
hyperalgesia of the dermatome, pressure pain sensitivity of the
sclerotome and myofascial trigger points within the myotomes,
which are supplied by the sensitized spinal segment. There
are significant elevated levels of substance P, calcitonin
gene-related peptide (CGRP), bradykinin, tumor necrosis
factor-α (TNF-α) and interleukin-1β (IL-1β), serotonin, and
norepinephrine in the vicinity of the active myofascial trigger
point. Overall, pH was significant lower in the active trigger
point. The mechanism consists of the nociceptive stimuli
generated in the sensitized areas bombarding the dorsal
horn of the spinal cord. This causes central nervous system
sensitization with resultant hyperalgesia of the dermatome
and sclerotome and spreads from the sensory component of
the spinal segment to the anterior horn cells, which control the
myotome within the territory of the SSS. The development or
amplified activity of MTrPs is one of the clinical manifestations
of SSS. The Segmental Desensitization treatment consists of
injection of local anesthetic agents in the involved dermatome
to block the posterior branch of the dorsal spinal nerve along
the involved paraspinal muscles. In addition, local anesthetic
injection is applied peripherally near the foci of irritation in local
soft tissue, directly into taut bands and trigger points, using
a needling and infiltration technique. Stretching exercises,
local heat application and additional transcutaneous electrical
nerve stimulation (TENS) treatment complete the muscular
relaxation after the injections. Extracorporeal shockwave
therapy (ESWT) and High Power Laser (HPL) also play a role
as desensitization. Prevention of recurrence should focus on
appropriate ergonomic changes common in patients’ day-to-
day activities to avoid repetitive stress to the injured muscles.
In conclusion, MPS, a common pain syndrome consists of local
pathology and SSS. Hence therapeutic approaches require
varieties of techniques for eradiation of trigger point and
desensitization of the whole related spinal segment.
Biography
Areerat Suputtitada MD is a Professor of Rehabilitation Medicine from Chu-
lalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok,
Thailand. She is the Director of Excellent Center for Gait and Motion at King
Chualongkorn Memorial Hospital and Chairperson of Neurorehabilitation
Research Unit of Chulalongkorn University. She has been involved in edu-
cation, residency training, research, and clinical treatment related to reha-
bilitation medicine for more than 20 years. She was invited as international
speaker more than 80 times around the world. She received 18 national and
international awards, and published more than 60 national and international
articles in several areas of Rehabilitation Medicine including Neurological
Rehabilitation, Spasticity and Dystonia, Pain, Gait and Motion, and Sport and
Exercise Medicine. She has been elected and appointed to important posi-
tions in the ISPRM such as the Chairperson of ISPRM Women and Health
Task Force and ISPRM International Exchange Committee.
prof.areerat@gmail.comMyofascial pain syndrome and sensitization
Areerat Suputtitada
King Chulalongkorn Memorial Hospital, Thailand
Areerat Suputtitada, Int J Anesth Pain Med 2018, Volume 4
DOI: 10.21767/2471-982X-C1-002