Pathogenesis and Pathophysiological Mechanisms of Myofascial Trigger Points

描述(由申请人提供)：慢性软组织(或肌肉筋膜)疼痛是一个重大的公共卫生问题。尽管它的流行率很高，但其潜在的机制却鲜为人知。特别是，对肌筋膜触发点(MTrP)的病理生理学和软组织环境知之甚少。肌筋膜疼痛综合征(MPS)是一种典型的肌筋膜疼痛综合征(MPS)，可触及肌筋膜疼痛综合征(MPS)骨骼肌束中的局部疼痛结节。MTP与有症状的患者的自发性牵涉疼痛有关，是目前MPS治疗策略(如干针疗法)的靶点。最近，我们的研究小组开发了新的超声成像方法来可视化和表征MTrp及其周围软组织的生理和物理特性，并开发了微分析技术来分析局部生化环境。这些创新的方法进步提供了一个独特的机会，将物理、生理和生化的发现结合起来，以更全面地了解与MTP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MTP在慢性疼痛中的作用。我们的最终目标是开发一个MTrp潜在机制的工作模型，并使用基于办公室的技术将研究结果转化为客观的临床结果衡量标准。该项目的具体目标是：1)与有/没有可触及的MTP的无症状对照组相比，确定慢性颈痛患者活动MTP所受影响软组织附近的机械组织特性、血管生理学和生化环境；以及2)确定干针疗法对有症状的受试者活动MTP的软组织环境和生化环境的影响。我们的工作假设是，MTrp是肌肉损伤的部位，局部生化变化导致持续的肌肉痉挛、血管压迫和导致组织缺氧的局部能量危机。这种情况使炎性细胞因子和致痛物质的释放永久化。为了验证这一假设，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指标联系起来。为了将这些发现转化为可在办公室环境中使用的临床结果测量，我们将采用一种可靠且廉价的3D触觉成像仪器来量化与MTrp相关的机械性软组织变化。 公共卫生相关性：慢性疼痛是一个重大的公共卫生问题。本研究旨在确定斜方肌和颈部疼痛区域的肌肉、筋膜和血流的解剖和生理异常与肌筋膜触发点(MTrP)相关，这是肌筋膜疼痛综合征(MPS)的特征表现。显示哪些组织受累(例如肌肉、筋膜、血管)，以及哪些生化物质在MTrP中异常，将有助于制定适当的预防和治疗策略，建立可用于治疗试验的诊断标准和潜在的结果衡量标准。我们的方法也将广泛适用于阐明其他慢性肌肉骨骼疼痛疾病的潜在机制，如下腰痛。

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. PUBLIC HEALTH RELEVANCE: Chronic pain is a significant public health concern. This proposal aims to identify anatomical and physiological abnormalities of muscle, fascia and blood flow in painful areas of the trapezius and neck associated with myofascial trigger points (MTrPs), which are a characteristic finding in myofascial pain syndrome (MPS). Demonstrating which tissues are involved (e.g., muscle, fascia, vessels), and which biochemicals are abnormal in MTrPs, will help develop appropriate preventive and therapeutic strategies, establish diagnostic criteria and potential outcome measures that can be used in treatment trials. Our approach would also be broadly applicable to elucidating the underlying mechanisms in other chronic musculoskeletal pain disorders, such low back pain.