Electrophysiological and ultrasound quantitative biomarkers for myofascial pain

项目摘要 肌筋膜疼痛综合征(MPS)仍然是一个特征不佳的实体。尽管影响了数百万人 对于个体，我们不了解其发展、持续和发展的基本潜在机制 对治疗的反应，包括使用常见的治疗方法，如触发点注射、干针、 和肌筋膜释放。改进了对处于活跃和潜伏期的MPS进行评估的方法，并 对治疗的反应是必要的，不仅是为了提高我们的诊断能力，也是为了更好地理解 MPS的起源和治疗效果的量化。在这项研究中，我们建议应用三种方法 对MPS和TRP量化的评估，据我们所知，其中两项从未使用过 以前在这种情况下。第一种是电阻抗肌图(EIM)，这是一种最近开发的方法，它可以 使用定向、超高频、电流提供的非侵入性表征肌肉组织 洞察组织的组织学特征和非侵入性结构。它已被证明对 肌肉纤维肥大或萎缩或其他病理性疾病的情况 变化，如纤维化，是存在的。这项技术的一个优点是完全无痛，快速 适用于不连续的肌肉区域，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 小针状电极，提供条件性刺激，然后是测试刺激。条件性刺激 增加肌纤维的传导速度，因此可以提供一种方便的兴奋性测量方法 在TRP内。它已经被证明对一些影响肌纤维功能的条件很敏感。这个 第三种方法？？超声剪切波弹性成像(Swe)已在一定程度上研究了mps。 提供了对肌肉组织僵硬的洞察，并将为这些其他组织提供有价值的比较 两种技术。在拟议工作的R61阶段，我们将研究活动和潜伏期患者 影响上斜方肌的MPS，以及一组健康受试者，采用这三种方法 建立群体之间的差异、技术的可重复性以及他们之间的关系(目标 分别为1a、1b和1c)以及它们与标准疼痛评分的关系。经批准后，基于我们的 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来评估 色氨酸干针疗法对影响上斜方肌的活动期MPS患者的疗效。EIM 结果将作为感兴趣的主要结果，数据将在临床和临床上收集 回家。在这项工作结束时，我们将确定将这些技术用于 评估MPS，提供对潜在机制的新见解和方便的新生物标记物 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.