Pathogenesis and Pathophysiological Mechanisms of Myofascial Trigger Points

描述（由申请人提供）：慢性软组织（或肌筋膜）疼痛是一个重要的公共卫生问题。尽管其发病率很高，但其潜在机制却知之甚少。特别是，很少有人知道的病理生理学和软组织环境的肌筋膜触发点（MTrP）。肌筋膜疼痛综合征（MPS）是骨骼肌绷紧带中可触及的局部疼痛结节，是肌筋膜疼痛综合征（MPS）的特征性发现。MTrP与有症状患者的自发性牵涉痛相关，并且是MPS当前管理策略的目标，例如干针疗法。最近，我们的研究小组已经开发出新的超声成像方法来可视化和表征的MTrPs及其周围软组织的生理和物理特性;和微分析技术来分析当地的生化环境。这些创新的方法学进步提供了一个独特的机会，整合物理，生理和生化的发现，以实现更全面的理解与MTRP相关的异常（例如，肌肉、筋膜、血管）;并将这些发现与临床评估相关联，以更好地了解肌筋膜激痛点在慢性疼痛中的作用。我们的最终目标是开发一个工作模型的基本机制的MTRP和翻译的结果，以客观的临床结果的措施，使用办公室为基础的技术。该项目的具体目的是：1）确定慢性颈痛患者活动性肌筋膜激痛点周围受影响软组织的机械组织特性、血管生理学和生化环境，并与有/无可触及肌筋膜激痛点的无症状对照受试者进行比较;和2）为了确定由干针疗法（一种广泛接受的治疗方法）引起的物理扰动的影响，在有症状的受试者中，活动性MTrPs的软组织环境和生化环境。我们的工作假设是，MTrPs是肌肉损伤的部位，局部生化变化导致持续的肌肉挛缩，血管压缩和局部能量危机，导致组织缺氧。这种情况使炎性细胞因子和伤害性（疼痛诱导）物质的释放持续存在。为了检验这一假设，我们将在我们的特定目标中将超声成像评分、分析物水平和功能性临床测量相关联。为了将这些发现转化为可以在办公室环境中使用的临床结果测量，我们将采用可靠且廉价的3D触觉成像仪器来量化与MTrPs相关的机械软组织变化。

DESCRIPTION (provided by applicant): Chronic soft-tissue (or myofascial) pain is a significant public health problem. Despite its high prevalence, the underlying mechanisms are poorly understood. In particular, very little is known about the pathophysiology and soft tissue environment of a myofascial trigger point (MTrP). MTrPs are palpable, localized painful nodules in a taut band of skeletal muscle that are a characteristic finding in myofascial pain syndrome (MPS). MTrPs are associated with spontaneous referred pain in symptomatic patients, and are the target for current management strategies for MPS, such as dry needle therapy. Recently, our research group has developed new ultrasound imaging methods to visualize and characterize the physiology and physical properties of the MTrPs and their surrounding soft tissue; and microanalytic techniques to assay the local biochemical milieu. These innovative methodological advances provide a unique opportunity to integrate the physical, physiological and biochemical findings to achieve a more comprehensive understanding of the abnormalities associated with MTrPs (e.g., muscle, fascia, blood vessels); and to correlate these findings with clinical assessments to better understand the role of MTrPs in chronic pain. Our ultimate goal is to develop a working model of the underlying mechanisms of MTrPs and translate the findings to objective clinical outcome measures using office-based technology. The specific aims of the project are: 1) To determine the mechanical tissue properties, vascular physiology and biochemical milieu of the affected soft tissue neighborhood of active MTrPs in patients with chronic neck pain compared to asymptomatic control subjects with/without palpable MTrPs; and 2) To determine the effect of a physical perturbation caused by dry needle therapy, a widely accepted method of treatment, on the soft tissue environment and biochemical milieu of active MTrPs in symptomatic subjects. Our working hypothesis is that MTrPs are sites of muscle injury where local biochemical changes lead to sustained muscle contracture, compression of blood vessels and a local energy crisis that causes tissue hypoxia. This condition perpetuates the release of inflammatory cytokines and nociceptive (pain-inducing) substances. To test this hypothesis, we will correlate ultrasound imaging scores, analyte levels and functional clinical measures in our specific aims. To translate these findings into clinical outcome measures that can be used in an office-based setting, we will adapt a reliable and inexpensive 3D Tactile Imaging instrument for quantifying mechanical soft tissue changes associated with MTrPs.