REFERRED PAIN MAPS OF MYOFASCIAL TRIGGER POINTS IN … Cescon... · e-mail: [email protected]...
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e-mail: [email protected] REFERRED PAIN MAPS OF MYOFASCIAL TRIGGER POINTS IN TENSION TYPE HEADACHE 1 Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland; 2 Università degli studi di Padova, Padova, Italy. 3 College of Life and Environmental Sciences, University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 4 Universidad Rey Juan Carlos, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Alorcon, Spain, 5 Aalborg University, Department of Health Science and Technology, Center for Sensory- Motor Interaction, Aalborg, Denmark Corrado Cescon 1 , Marco Barbero 1 , Piera Zuin 2 , Deborah Falla 3 , María Palacios-Ceña 4 , Lars Arendt-Nielsen 5 , César Fernández-de-las-Peñas 4 • Myofascial trigger points (MTrPs) in the head and neck muscles are frequently found in people with tension type headache (TTH). • MTrPs are implicated in the etiology of tension type headache and constitute a peripheral source of nociception that can induce central sensitization. • Referred pain from MTrPs can be spontaneous or elicited by palpation and can contribute to the clinical manifestation of TTH. Aim of the study: • describe the referred pain pattern of MTrPs in persons with TTH. • compare the mean extent of referred pain from each MTrPs with pain complains Background and Aim • Mean pain extent for usual pain: 12.4% of total head and neck area, • Slight but not significant prevalence of pain in the posterior aspect of the head. • MTrPs prevalence: 31% for Masseter 48% for Sternocleidomastoid 50% for Suboccipitalis 46% for Splenius Capitis 77% for Temporalis 44% for Upper Trapezius • Mean extent of referred pain was 2.9%, 4.0%, 6.9%, 5.7%, 4.9% and 5.4% respectively (range: 22% to 54% of the extent of the usual pain). Results • Referred pain was localized in specific areas of the neck and head region in people with TTH. • The identified pain pattern was similar to the one originally reported by Travell and Simons (1983). • Referred pain from MTrPs appears to contribute to pain symptoms of patients with TTH. • Clinicians can use the pain frequency maps of MTrPs generated in this study for the evaluation of patients with head and neck complains. Conclusion and Implications Figure 2 World Confederation for Physical Therapy Congress, 10 th - 13 th May 2019, Geneva, Switzerland Table 1 Pain extent in the four views of the head and neck region in TTH (usual pain) and of the referred pain during each of the six stimulations. Figure 1 Image digitalization and list of areas describing the head and neck regions in frontal and left lateral views. REFERENCES: 1. Alonso-Blanco C, Fernández-de-Las-Peñas C, de-la-Llave-Rincón AI, Zarco-Moreno P, Galán-Del-Río F, Svensson P. Characteristics of referred muscle pain to the head from active trigger points in women with myofascial temporomandibular pain and fibromyalgia syndrome. J Headache Pain. 2012 Nov;13(8):625-37. 2. Palacios-Ceña M, Barbero M, Falla D, Ghirlanda F, Arend-Nielsen L, Fernández-de-Las-Peñas C. Pain Extent Is Associated with the Emotional and Physical Burdens of Chronic Tension-Type Headache, but Not with Depression or Anxiety. Pain Med. 2017 Oct 1;18(10):2033-2039 University Ethical Committee approval: Universidad Rey Juan Carlos, Spain URJC 23/2014, HRJ 07/14 • Patients involved: 113 with TTH. • Pain drawings of their usual pain and referred pain elicited by palpation of MTrPs were completed using 4 different paper body charts of the head and neck region (frontal, dorsal, right, left). • Muscles examined to identify MTrPs: • Masseter, Sternocleidomastoid, Suboccipitalis, Splenius Capitis, Temporalis, Upper Trapezius. • Participants were instructed to color, using a pencil, every part of the body chart where they perceived pain, independently from the type and the severity of pain (A4 sheets). • Image digitalization using an image analysis software. • Pain extent: sum of the pixels in each view as a percentage (%) of the total area. • Pain frequency maps superimposing all the pain drawings produced on the same body chart. Materials and Methods Figure 4 Figure 3 Tension type headache Masseter Sternocleidomastoid Suboccipital Splenius capitis Temporalis Upper trapezius Frontal Dorsal 89 86 87 82 68 65 28 32 25 31 11 12 36 5 5 2 1 6 6 54 46 59 59 69 68 21 22 4 3 16 20 6 11 16 12 23 29 5 4 0 19 22 1 1 0 1 1 1 0 1 0 0 0 0 13 14 31 30 21 21 23 29 21 27 3 3 6 5 12 0 0 11 13 1 1 11 5 13 7 0 0 22 21 19 19 11 14 18 17 5 8 4 5 4 1 0 0 0 0 0 16 14 33 35 38 40 4 5 10 13 17 13 11 11 11 11 7 4 1 0 5 1 0 0 0 4 1 18 12 36 31 33 37 9 9 49 50 72 74 40 36 33 22 19 18 2 2 6 0 0 0 0 0 0 23 19 7 4 2 1 0 0 8 11 16 17 5 7 12 16 5 7 0 0 0 2 4 0 0 18 18 3 1 15 13 21 32 22 32 100% 0% 50% Heat-Map of the referred pain location in head and neck areas during palpation of specific MTrPs. 0% 10% 20% 30% 40% 50% 60% 70% 80% Usual Pain N = 113 Frontal Temporal Occipital Zygomatic Buccal Temporal Occipital Occipital Temporal Neck Referred Pain Suboccipitalis: n=57 Travell.Head.Front.side Number of patients 60 40 20 0 20 40 60 Frontal Temporal Orbital Auricolar Zygomatic Infraorbital Nasal Buccal Oral Mental Anterior neck Travell.Head.Rear.side Number of patients 60 40 20 0 20 40 60 Parietal Occipital Suboccipital Auricolar Posterior neck MTrP Pain extent Muscle n Prevalence Front Dorsal Right Left Masseter 35 31% 5.20 (3.68) 0.12 (0.73) 2.93 (2.64) 3.36 (3.04) Sternocleidomastoid 54 48% 5.91 (5.13) 0.07 (0.51) 4.53 (4.02) 5.80 (4.89) Suboccipital 57 50% 5.00 (7.84) 15.02 (12.50) 3.80 (5.87) 4.28 (6.72) Splenius capitis 52 46% 1.73 (5.77) 12.58 (10.87) 2.91 (4.82) 4.47 (6.16) Temporalis 87 77% 3.90 (5.50) 0.10 (0.71) 6.65 (3.86) 8.28 (5.07) Upper trapezius 50 44% 3.61 (4.92) 6.94 (7.69) 5.59 (4.39) 5.52 (5.95) Subjs Pain extent Condition n Front Dorsal Right Left TTH (usual pain) 113 13.15 (11.03) 15.25 (17.27) 10.02 (10.78) 11.31 (10.68) Left frontal Right frontal Left temporal Right temporal Right orbital Left auricolar Right auricolar Left zygomatic Right zygomatic Left infraorbital Right infraorbital Nasal Left buccal Right buccal Oral Mental Left anterior neck Right anterior neck Left parietal Left occipital Left posterior neck Left suboccipital Left orbital IMAGE DIGITALIZATION Pain frequency maps in TTH (usual pain) and of the referred pain during each of the six stimulations. Histogram of pain prevalence in frontal and posterior view of referred pain during stimulation of suboccipitalis region.
Transcript of REFERRED PAIN MAPS OF MYOFASCIAL TRIGGER POINTS IN … Cescon... · e-mail: [email protected]...
e-mail: [email protected]
REFERRED PAIN MAPS OF MYOFASCIAL TRIGGER POINTS IN
TENSION TYPE HEADACHE
1 Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland; 2 Università degli studi di Padova, Padova, Italy. 3 College of Life and
Environmental Sciences, University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 4 Universidad Rey Juan Carlos, Department of Physical
Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Alorcon, Spain, 5 Aalborg University, Department of Health Science and Technology, Center for Sensory- Motor Interaction, Aalborg, Denmark
Corrado Cescon1, Marco Barbero1, Piera Zuin2, Deborah Falla 3, María Palacios-Ceña 4, Lars Arendt-Nielsen 5, César Fernández-de-las-Peñas 4
• Myofascial trigger points (MTrPs) in the head and neck muscles
are frequently found in people with tension type headache (TTH).
• MTrPs are implicated in the etiology of tension type headache
and constitute a peripheral source of nociception that can induce
central sensitization.
• Referred pain from MTrPs can be spontaneous or elicited by
palpation and can contribute to the clinical manifestation of TTH.
Aim of the study:
• describe the referred pain pattern of MTrPs in persons with
TTH.
• compare the mean extent of referred pain from each MTrPs
with pain complains
Background and Aim
• Mean pain extent for usual pain: 12.4% of total head and neck area,
• Slight but not significant prevalence of pain in the posterior aspect of the
head.
• MTrPs prevalence:
31% for Masseter 48% for Sternocleidomastoid
50% for Suboccipitalis 46% for Splenius Capitis
77% for Temporalis 44% for Upper Trapezius
• Mean extent of referred pain was 2.9%, 4.0%, 6.9%, 5.7%, 4.9% and
5.4% respectively (range: 22% to 54% of the extent of the usual pain).
Results
• Referred pain was localized in specific areas of the neck and head
region in people with TTH.
• The identified pain pattern was similar to the one originally reported
by Travell and Simons (1983).
• Referred pain from MTrPs appears to contribute to pain symptoms of
patients with TTH.
• Clinicians can use the pain frequency maps of MTrPs generated in
this study for the evaluation of patients with head and neck
complains.
Conclusion and Implications
Figure 2
World Confederation for Physical Therapy Congress, 10th - 13th May 2019, Geneva, Switzerland
Table 1
Pain extent in the four views of the head and neck region in TTH (usual pain) and of the referred pain during each
of the six stimulations.
Figure 1
Image digitalization and list of areas describing the head and neck regions in frontal and left lateral views.
REFERENCES:1. Alonso-Blanco C, Fernández-de-Las-Peñas C, de-la-Llave-Rincón AI, Zarco-Moreno P, Galán-Del-Río F, Svensson P. Characteristics of referred muscle pain to the head from
active trigger points in women with myofascial temporomandibular pain and fibromyalgia syndrome. J Headache Pain. 2012 Nov;13(8):625-37.
2. Palacios-Ceña M, Barbero M, Falla D, Ghirlanda F, Arend-Nielsen L, Fernández-de-Las-Peñas C. Pain Extent Is Associated with the Emotional and
Physical Burdens of Chronic Tension-Type Headache, but Not with Depression or Anxiety. Pain Med. 2017 Oct 1;18(10):2033-2039
University Ethical Committee approval: Universidad Rey Juan Carlos, Spain URJC 23/2014, HRJ 07/14
• Patients involved: 113 with TTH.
• Pain drawings of their usual pain and referred pain elicited by
palpation of MTrPs were completed using 4 different paper body
charts of the head and neck region (frontal, dorsal, right, left).
• Muscles examined to identify MTrPs:
• Masseter, Sternocleidomastoid, Suboccipitalis, Splenius
Capitis, Temporalis, Upper Trapezius.
• Participants were instructed to color, using a pencil, every part of
the body chart where they perceived pain, independently from the
type and the severity of pain (A4 sheets).
• Image digitalization using an image analysis software.
• Pain extent: sum of the pixels in each view as a percentage (%)
of the total area.
• Pain frequency maps superimposing all the pain drawings
produced on the same body chart.
Materials and Methods
Figure 4
Figure 3
Tension type headache
Masseter
Sternocleidomastoid
Suboccipital
Splenius capitis
Temporalis
Upper trapezius
Frontal Dorsal
89 86 87 82 68 65 28 32 25 31 11 12 36 5 5 2 1 6 6 54 46 59 59 69 68 21 22
4 3 16 20 6 11 16 12 23 29 5 4 0 19 22 1 1 0 1 1 1 0 1 0 0 0 0
13 14 31 30 21 21 23 29 21 27 3 3 6 5 12 0 0 11 13 1 1 11 5 13 7 0 0
22 21 19 19 11 14 18 17 5 8 4 5 4 1 0 0 0 0 0 16 14 33 35 38 40 4 5
10 13 17 13 11 11 11 11 7 4 1 0 5 1 0 0 0 4 1 18 12 36 31 33 37 9 9
49 50 72 74 40 36 33 22 19 18 2 2 6 0 0 0 0 0 0 23 19 7 4 2 1 0 0
8 11 16 17 5 7 12 16 5 7 0 0 0 2 4 0 0 18 18 3 1 15 13 21 32 22 32
100%
0%
50%
Heat-Map of the referred pain location in head and neck areas during palpation of specific MTrPs.
0%
10%
20%
30%
40%
50%
60%
70%
80%
Usual Pain
N = 113
FrontalTemporalOccipital
ZygomaticBuccal
Temporal Occipital Occipital Temporal Neck
Referred Pain
Suboccipitalis: n=57
Travell.Head.Front.side
Number of patients
60 40 20 0 20 40 60
Frontal
Temporal
Orbital
Auricolar
Zygomatic
Infraorbital
Nasal
Buccal
Oral
Mental
Anterior neck
Travell.Head.Rear.side
Number of patients
6040200 204060
Parietal
Occipital
Suboccipital
Auricolar
Posterior neck
MTrP Pain extent
Muscle n Prevalence Front Dorsal Right Left
Masseter 35 31% 5.20 (3.68) 0.12 (0.73) 2.93 (2.64) 3.36 (3.04)
Sternocleidomastoid 54 48% 5.91 (5.13) 0.07 (0.51) 4.53 (4.02) 5.80 (4.89)
Suboccipital 57 50% 5.00 (7.84) 15.02 (12.50) 3.80 (5.87) 4.28 (6.72)
Splenius capitis 52 46% 1.73 (5.77) 12.58 (10.87) 2.91 (4.82) 4.47 (6.16)
Temporalis 87 77% 3.90 (5.50) 0.10 (0.71) 6.65 (3.86) 8.28 (5.07)
Upper trapezius 50 44% 3.61 (4.92) 6.94 (7.69) 5.59 (4.39) 5.52 (5.95)
Subjs Pain extent
Condition n Front Dorsal Right Left
TTH (usual pain) 11313.15
(11.03)
15.25
(17.27)
10.02
(10.78)
11.31
(10.68)
Left frontalRight frontal
Left temporalRight temporal
Right orbitalLeft auricolar
Right auricolar
Left zygomatic
Right zygomaticLeft infraorbital
Right infraorbital
Nasal
Left buccal
Right buccal
Oral
Mental
Left anterior neckRight anterior neck
Left parietal
Left occipital
Left posterior
neck
Left suboccipital
Left orbital
IMAGE DIGITALIZATION
Pain frequency maps in TTH (usual pain) and of the referred pain during each of the six stimulations.
Histogram of pain prevalence in frontal and posterior view of referred pain during stimulation of suboccipitalis region.
