Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial.
Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial.
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DOI：
10.1097/ajp.0000000000000091
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发表时间：
2015-02
期刊：
影响因子：
--
通讯作者：
Mann JD
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文献类型：
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作者：
Moraska AF;Stenerson L;Butryn N;Krutsch JP;Schmiege SJ;Mann JD
肌筋膜触发点（MTrPs）是骨骼肌中的局灶性中断，可以将疼痛指向头部并再现紧张型头痛（TTH）的疼痛模式。本研究应用按摩集中于TTH受试者的MTrP，在安慰剂对照的临床试验中评估其减轻头痛的疗效。五十六例TTH患者被随机分为两组，一组在六周内接受12次按摩或安慰剂（失谐超声）治疗，另一组在等待治疗。触发点释放（TPR）按摩集中在颈部肌肉组织的肌筋膜。头痛疼痛（频率、强度和持续时间）记录在每日头痛日记中。额外的结果测量包括头痛和压迫性疼痛阈值（PPT）的感觉临床变化的自我报告，在MTrPs在上腭肌和枕下肌。根据日记记录，在头痛频率（p=0.026）方面检测到了不同时间的组间差异，但在强度或持续时间方面没有检测到差异。事后分析表明，按摩（p<0.0003）和安慰剂（p=0.013）的头痛频率较基线降低，但按摩和安慰剂之间没有差异。受试者报告的感觉到的临床变化是一个更大的减少头痛按摩比安慰剂或等待名单组（p=0.002）。仅针对按摩测试的所有肌肉中的PPT改善（所有p <0.002）。这项研究的两个发现是显而易见的：1）MTRP是TTH治疗的重要组成部分，2）TTH与其他慢性疾病一样，对安慰剂有反应。不包括安慰剂组的头痛临床试验有高估积极干预的具体贡献的风险。
Myofascial trigger points (MTrPs) are focal disruptions in skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type headache (TTH). The present study applied massage focused on MTrPs of subjects with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache pain. Fifty-six subjects with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over six weeks, or to wait-list. Trigger point release (TPR) massage focused on MTrPs in cervical musculature. Headache pain (frequency, intensity and duration) was recorded in a daily headache diary. Additional outcome measures included self-report of perceived clinical change in headache pain and pressure-pain threshold (PPT) at MTrPs in the upper trapezius and sub-occipital muscles. From diary recordings, group differences across time were detected in headache frequency (p=0.026), but not for intensity or duration. Post hoc analysis indicated headache frequency decreased from baseline for both massage (p<0.0003) and placebo (p=0.013), but no difference was detected between massage and placebo. Subject report of perceived clinical change was a greater reduction in headache pain for massage than placebo or wait-list groups (p=0.002). PPT improved in all muscles tested for massage only (all p's<0.002). Two findings from this study are apparent: 1) MTrPs are important components in the treatment of TTH, and 2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on headache that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention.