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。尽管发病率很高，但人们对其潜在机制知之甚少。特别是，对肌筋膜触发点（MTrP）的病理生理和软组织环境知之甚少。肌筋膜痛是肌筋膜痛综合征（MPS）的特征性表现，是骨骼肌紧绷带中可触及的局部疼痛结节。MTrPs与有症状患者的自发性牵涉性疼痛有关，是目前MPS管理策略的目标，如干针治疗。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MTrPs及其周围软组织的生理和物理特性；用微量分析技术测定当地的生化环境。这些创新的方法进步为整合物理、生理和生化发现提供了独特的机会，从而更全面地了解与MTrPs相关的异常（例如，肌肉、筋膜、血管）；并将这些发现与临床评估联系起来，以更好地了解MTrPs在慢性疼痛中的作用。我们的最终目标是建立MTrPs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测量。该项目的具体目的是：1)与有无可触及MTrPs的无症状对照组相比，确定慢性颈痛患者活跃MTrPs附近受影响软组织的力学组织特性、血管生理生化环境；2)确定干针疗法（一种被广泛接受的治疗方法）引起的物理扰动对有症状受试者软组织环境和活性MTrPs生化环境的影响。我们的工作假设是MTrPs是肌肉损伤的部位，在那里局部生化变化导致持续的肌肉挛缩、血管受压和局部能量危机导致组织缺氧。这种情况使炎症细胞因子和伤害性（疼痛诱导）物质的释放持续存在。为了验证这一假设，我们将在我们的具体目标中关联超声成像评分、分析物水平和功能性临床测量。为了将这些发现转化为可用于办公室环境的临床结果测量，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.