Background Many approaches exist for low back pain treatment, myofascial trigger points (MTrP) inactivation is crucial therapeutic aspect. Dry needliong (DN) of MTrP under Ultrasound guidance is most effective method [1,2], is preferred as personalized monotherapy for pain relief and prevent trigger point (spasticity) relapse [3]. Spinal mechanism and neuropathic for trigger points still are not studied.

Objectives The objectives of the study were to determine efficacy of inactivation of central compared to peripheral MTrP for treatment of low back pain.

Methods We included 32 patients, 14 males 18 females, aged 22-68 years (the average was 52 years) who were diagnosed low back pain with irradiative pain in lower limb - lumboischialgia. MTrP were identificated according to the clinical examination, reffered pain pattern and ultrasound visualization as “central” MTrP in paravertebral muscles (multifidii muscles, longissimius, quadratus lumborum) and “peripheral” and limb muscles (piriformis mucle, glutei muscles, soleus muscle, etc).

All patients had symptoms over 1 month, underwent general diagnostic examination including MRI, laboratory, neurologic, orthopedic tests. Rheumatic, spine diseases were excluded.

Patients were randomly assigned to: patients of group A, who received dry needling (DN) of paravertebral (“central”) MTrP under ultrasound guidance according to clinical examination, reffered pain pattern, considering the spinal innervation of affected by pain area and innervation of muscles with MTrP and ultrasound visualization; and patients of group B, who received DN under ultrasound guidance of “peripheral” MTrP in muscles according to the same criteria. Visual analogue scale data (VAS, 0-10) and PainDetects (1-38) scores were measured for low back pain assessment before, immediately after, 24 hours, 7 days after intervention. We evaluated pain and trigger point (spasticity) recurrence 24 hours and 28 days after manipulation in both groups.

Results After 14 days, VAS shown pain improvement from 7.2 to 1.2 in group A compared to 7.3 to 3.5 in group B (P<0.05); PainDetect scores improved by 98% (18.3 to 9.2) in A vs. 25% (18.5 to 11.5) in group B (P<0.01); MTrP recurrence was lower in group A: 25% vs. 58% in group B (P<0.01) at 24 hours after manipulation; outcome at 7th day was 7% vs. 35% respectively (P<0.05).

In group B after insufficient efficacy of treatment after peripheral MTrPs inactivation, trigger points were found in paravertebral muscles. After their inactivation pain relief was revealed at level of VAS 3.4 - 95% improvement vs baseline.

Conclusions DN under Ultrasound guidance of central MTrP is effective method for low back pain, is preferred over peripheral and in most cases is suffiecient to treat the pain case. Central MTrPs inactivation evoke significant decreasing of neuropathic component of low back pain.

References

1. Bubnov RV: The use of trigger point “dry” needling under ultrasound guidance for the treatment of myofascial pain (technological innovation and literature review). Lik Sprava 2010, 5-6:56-64.

2. Bubnov RV: Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13.

3. Bubnov RV, Strokan AM, Logvinchuk PV, Aleksieieva TS: Personalized monotherapy vs protocol therapy complex for frozen shoulder. Comparative study. EPMA J 2014, 5(Suppl 1): A163.

Disclosure of Interest None declared