Nociceptive and Non-nociceptive Hypersensitivity at Latent Myofascial Trigger Points
Nociceptive and Non-nociceptive Hypersensitivity at Latent Myofascial Trigger Points
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DOI：
10.1097/ajp.0b013e3181878f87
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发表时间：
2009-02-01
影响因子：
2.9
通讯作者：
Arendt-Nielsen, Lars
中科院分区：
文献类型：
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作者：
Li, Lian-Tao;Ge, Hong-You;Arendt-Nielsen, Lars
目的：方法：11名健康志愿者在肌电图引导下进行3次肌内注射，每次间隔至少1周，观察潜伏肌筋膜触发点（MTrPs）是否存在伤害性和非伤害性超敏反应。在每次治疗中，将高渗盐水（6%，各0.1 mL）、谷氨酸盐（0.1 mL，各0.5 M）或等渗盐水（0.9%，各0.1 mL）的推注随机注射到位于右侧或左侧腓肠肌内侧肌的潜伏性MTrP和非MTrP中。每次注射后，要求参与者在电子视觉模拟量表（VAS）上对感知的疼痛强度进行评分，并在疼痛图上标记疼痛区域。结果：在潜伏性MTrPs内注射高渗盐水、谷氨酸盐或等渗盐水，均能引起较非MTrPs更高的VAS（peak）和更大的VAS（auc）（均P < 0.05）。此外。疼痛注射后有牵涉痛的MTrPs的VAS（peak）和VAS（auc）均显著高于无牵涉痛的MTrPs（P均< 0.001）。结论：本实验结果证实了潜伏性MTrPs存在伤害性超敏反应，并首次为潜伏性MTrPs存在非伤害性超敏反应（异常性疼痛）提供了证据。最后，牵涉性肌肉疼痛的发生与潜伏性肌筋膜激痛点的疼痛敏感性较高有关。
Objective: The ann of the study was to evaluate whether or not there exists nociceptive and non-nociceptive hypersensitivity at latent myofascial trigger points (MTrPs).Methods: Eleven healthy volunteers participated in this study, which consisted of 3 sessions of electromyography-guided intramuscular injection with a minimum of a week interval in between. In each session, a bolus of either hypertonic saline (6%, 0.1 mL each), glutamate (0.1 mL, 0.5 M, each), or isotonic saline (0.9%, 0.1 mL, each) was randomly injected into a latent MTrP and a non-MTrP located in the right or left gastrocnemius medialis muscles. After each injection, participants were asked to rate the perceived pain intensity on an electronic visual analog scale (VAS) and to mark the pain areas on pain drawings. Maximal pain intensity (VAS(peak)), the area under the curve (VAS(auc)) and local and referred pain areas were extracted.Results: Injections of either hypertonic saline, glutamate, or isotonic saline into the latent MTrPs induced a higher VAS(peak) and larger VAS(auc) than the non-MTrPs (all, P < 0.05). Furthermore. the MTrPs with referred pain after painful injections were found to show higher VAS(peak) and larger VAS(auc) than those without referred pain (both, P < 0.001).Conclusions: These results confirm the existence of nociceptive hypersensitivity at latent MTrPs and provide the first evidence that there exists non-nociceptive hypersensitivity (allodynia) at latent MTrPs. Finally, the occurrence of referred muscle pain is associated with higher pain sensitivity at latent MTrPs.