Electrophysiological and ultrasound quantitative biomarkers for myofascial pain

项目摘要 肌筋膜疼痛综合征（MPS）仍然是一个不好的特点。虽然影响了数百万人 个人，我们不了解其发展的基本机制，持久性， 对治疗的反应，包括使用常见的治疗，如触发点（TrP）注射，干针， 和肌筋膜松解改善评估MPS的方法，包括其活动和潜伏阶段，以及其 我们不仅需要提高我们的诊断能力， MPS的起源和量化治疗效果。在这项研究中，我们建议采用三种方法， MPS和TrP定量评估，据我们所知，其中两个从未使用过 在此之前，在此背景下。第一种是电阻抗肌电图（EIM），这是一种最近开发的方法， 使用定向的、非常高频率的电流非侵入性地表征肌肉组织， 深入了解组织的组织学特征和结构。它被证明是敏感的， 肌纤维肥大或萎缩或其他病理性疾病 出现纤维化等变化。这种技术的一个优点是，它是完全无痛，快速， 适用于肌肉的离散区域，甚至可以在家里进行。第二种方法，肌纤维 阈值跟踪（TT）兴奋性测试，通过使用单个 小针电极，以提供调节刺激，然后是测试刺激。条件刺激 增加了肌纤维中的传导速度，因此可以提供一种方便的兴奋性测量 在一个Trp。它已经被证明是敏感的一些条件影响肌纤维功能。的 第三种方法，超声与剪切波弹性成像（SWE），已在一定程度上研究了MPS 并且提供了对肌肉组织的刚性的洞察，并且将提供与这些其他的肌肉组织的有价值的比较物。 两种技术。在拟议工作的R61阶段，我们将研究活动性和潜伏性的患者。 MPS影响上肌，以及一组健康受试者与这三种方法， 确定组间差异、技术的可重复性以及它们之间的关系（目标 1a、1b和1c）及其与标准疼痛评分的关系。在根据我们的 R61里程碑，在R33阶段（目标2），我们将在临床试验中使用所有三种方法评估 TrP干刺法对一组活动性MPS影响上睑肌的患者的有效性。EIM 结果将作为关注的主要结果，在诊所和 回家在这项工作结束时，我们将建立这些技术的使用， 评估MPS，为潜在机制提供新的见解，并提供方便的新生物标志物， 预测和评估治疗干预的益处。

Project Summary Myofascial pain syndrome (MPS) remains a poorly characterized entity. Although affecting millions of individuals, we do not understand the basic underlying mechanisms of its development, persistence, and response to therapy, including the use of common therapies such as trigger point (TrP) injection, dry needling, and myofascial release. Improved methods of assessing MPS, both in its active and latent phases, and its response to therapy are needed, not only to improve our diagnostic capabilities but also to better understand MPS’ origins and for quantifying the effect of treatment. In this study, we propose to apply three methodologies to the assessment of MPS and TrP quantification, two of which, to our knowledge, have never been used before in this context. The first, electrical impedance myography (EIM), a recently developed method that characterizes muscle tissue non-invasively using directed, very high-frequency, electrical current provides insights into tissue histological features and structure non-invasively. It has been shown to be sensitive to conditions in which muscle fibers are hypertrophied or atrophied or in which disease other pathological changes, such as fibrosis, are present. An advantage of this technique is that it is entirely painless, rapid to apply to discrete areas of muscle, and can even be performed at home. The second method, myofiber threshold tracking (TT) excitability testing, assesses the relatively excitability of myofibers by using a single small needle electrode to provide a conditioning stimulus followed by a test stimulus. The conditioning stimulus increases the speed of conduction in the myofibers and can thus provide a convenient measure of excitability within a TrP. It has already proven to be sensitive to a number of conditions impacting myofiber function. The third method, ultrasound with shear wave elastography (SWE), has been studied to some extent in MPS and provides insight into the rigidity of the muscle tissue and will provide a valuable comparator to these other two technologies. In the R61 phase of the proposed work, we will study patients with both active and latent MPS affecting the upper trapezius, as well as a group of healthy subjects with these three methodologies to establish differences between groups, repeatability of the techniques, and the relationships across them (Aims 1a, 1b, and 1c, respectively) and their relationship to standard pain scores. After approval based on our R61milestones, in the R33 phase (Aim 2), we will use all three methods in a clinical trial assessing the effectiveness of TrP dry needling in a group of patients with active MPS affecting the upper trapezius. EIM outcomes will serve as the primary outcome of interest, with data being collected both in the clinic and at home. At the conclusion of this work, we will have established the use of these technologies for the assessment MPS, providing new insights into underlying mechanisms and convenient new biomarkers to predict and assess the benefit of therapeutic intervention.