• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.127-131
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• 2014

Skeletal muscles which are the largest part of human body may develop pain and dysfunction. The myofascial pain syndrome that has trigger points as a unique characteristic is a major cause of morbidity. Trigger points are focal, hyperirritable painful areas located in a taut band of skeletal muscle. They produce local area pain and a referred pattern pain and often accompany chronic joint dysfunction. Various modalities are used to inactivate trigger points in myofascial pain syndrome. Trigger-point injection has been shown to be one of the most effective treatment modality to provide prompt relief of symptoms. This review article presents general concept of myofascial pain syndrome and technique of trigger point injection.

• The Korean Journal of Pain
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• v.3 no.2
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• pp.150-159
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• 1990

The patient with muscle contraction headache usually have one or more specific trigger points. These trigger points have been treated with various treatment modalities including "stretch and spray" and regional infiltration with local anesthetics with or without corticosteroids. I treated 36 patients with muscle contraction headache with regional infiltration of local anesthetics and steroid into trigger points and the results were as follows 1) The diagnosis of muscle contraction headache was possible by confirming specific trigger points by palpation. 2) Patients relieved rapidly from headache by regional infiltration of local anesthetics and steroid into the tender point. 3) Single injection was effective in relieving headache. But the curability of the single injection could not be assessed because of difficulty in follow-up study. 4) Active trigger points could be occasionally inactive, which also made difficult in assessing the effectiveness of the treatment.

• Journal of Oral Medicine and Pain
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• v.42 no.3
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• pp.53-61
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• 2017

Myogenous temporomandibular disorder is a collective term for pathologic conditions of the masticatory muscles, mainly characterized by pain and dysfunction associated with various pathophysiological processes. Among the subtypes of myogenous temporomandibular disorder, myofascial pain is one of the most common muscle disorders, characterized by the presence of trigger points (TrPs). Various modalities, such as ultrasound, manipulative therapy, spray-and-stretch technique, transcutaneous electrical nerve stimulation, injection/dry needling, and low-level laser therapy are used to inactivate TrPs. Needling/injection on the TrPs is one of the most common treatments for myofascial pain. Despite the evidence, there is continued controversy over defining the biological and clinical characteristics of TrPs and the efficacy of injection/dry needling. This review discusses the current concept of injection/needling to relieve TrPs.

• Journal of Korean Physical Therapy Science
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• v.2 no.3
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• pp.727-738
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• 1995

Myofascial pain syndrome is one of the major cause of chronic pain and trigger point injection, stretching, spray and electrical therapy are often used in clinical situation for treatment of myofascial pain syndrome. Myofascial pain syndrome is characterzied by the existence of a hypersensitive region, called the trigger point in a muscle or in the connective tissue, together with palpable noble, stiffness, limitation of motion and referred pain when trigger point is stimulated. Physiologically, they represent a self-sustaining vicious cycle of pain-spasm-pain. The purpose of this study is to illustrate mechanisms of pain by stimulation of acupuncture and trigger point, to introduce clinic application of orient and western stimulative point (acupuncture, trigger point)for treatment of MPS(myofascial pain syndrome), to make physiotherapist use both stimulative points for treatment of MPS.

• Journal of Korean Physical Therapy Science
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• v.4 no.2
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• pp.383-390
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• 1997

The purpose of this study is the evaluation of the degree of post injection soreness, symptom duration, factor and autonomic symptoms after trigger point injection in patients with trigger points. We devided the subjects of the study into four groups Such as, only dry needling, needle-TENS, with massage-stretch, massage-stretch only, including 100 patients, and measured the visual analog scale before treatment and after treatment. Before treatment, The VAS mean scores were $6.2{\pm}1.03$ in needle-TENS with massage-stretch group ; $6.2{\pm}1.75$ in needdle-TENS group, and $6.3{\pm}1.85$ in dry needling group, and $6.8{\pm}1.03$ in massage-stretch group. In post injection 3rd day, The VAS mean score were $0.9{\pm}1.78$ in needling-TENS with massage-stretch group, $1.1{\pm}1.52$ in needling-TENS group, $1.7{\pm}1.10$ in dry needling group, and $3.9{\pm}3.01$ in massage-stretch group. As for a causative factor of activities for trigger were overload with 37.0%, overwork with 35.0% and fatigue with 13.0%. Symptoms for trigger were tenderness with 28.0%, numbness and tingling with 24.0%. ROM limit with 17.0% and tightness with 17.0%. As a result, needling-TENS with massage-stretch group showed less soreness and effect than other group.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.32-36
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• 2001

Background: There is no reliable objective test for the diagnosis of myofascial pain syndromes. The aim of this study was to evaluate the usefulness of a pressure algometer for the diagnosis of the trigger points and for the evaluation of the treatment in myofascial pain syndromes (MPS). Methods: Twenty female patients with clinical MPS of shoulder were included in this study. Pressure pain thresholds were measured by a pressure algometer at three different sites including the trapezius, supraspinatus and infraspinatus before, and then the 1st, 3rd and 7th days after TPI. Results: Mean pressure pain thresholds were lower in patients with MPS in than normal volunteers in all the examined skeletal muscles. Mean pressure pain thresholds in patients with MPS were increased significantly after TPI in all the examined skeletal muscles. Conclusions: Pressure algometer can be used as relatively objective diagnostic tool for locating trigger points and to quantify the effect of TPI in MPS. However, more investigation is necessary.

• Clinical Pain
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• v.20 no.2
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• pp.141-144
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• 2021

There are some cases of myofascial pain syndrome (MPS) with chronic upper back pain that does not respond to dry needling or trigger point injection, well-known treatments for MPS. A 67-year-old female developed a stabbing upper back pain with trigger point at left T7~8 levels 10 years ago. She complained of the pain with Numeral Rating Scale (NRS) 8 points. Myofascial release technique and trigger point injection had no effect. Under ultrasound guidance 20 ml of 1% lidocaine was injected into thoracic paravertebral space. Immediately, the pain was reduced to NRS 4 points. One week later, the second block was performed in the same way as the first, and the pain was reduced to NRS 2 points. The stabbing pain disappeared, and oral opioids were discontinued. Ultrasound guided thoracic paravertebral space block is an effective and safe treatment for refractory MPS with chronic upper back pain.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.105-108
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• 1996

Localized or radiating pain in the arm and shoulder joint may result after faulty alignment causing compression or tension on nerves, blood vessels, or supporting soft tissues. The critical site of faulty alignment is the quadrangular space in the axilla bounded by the teres major, teres minor, long head of triceps, and humerus. The axillary nerve emerges through this space to supply the deltoid and teres minor. The activity of the trigger point on teres minor compressing the axillary nerve causes pain to develop through the area of sensory distribution of cutaneous branch of the axillary nerve. Relieving compression on the axillary nerve and suprascapular nerve is the key point to relieving the pain. Spasm of the supraspinatus and infraspinatus compressing the suprascapular nerve caused pain to develop in the shoulder joint and scapular area. We treated those patients experiencing such pain with local anesthetic infiltration or I-R laser stimulation on the identified trigger points.

• Korean Journal of Veterinary Research
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• v.46 no.1
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• pp.43-46
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• 2006

A 6-month-old thoroughbred filly foal had torticollis and circled towards the right side. A local veterinarian treated her twice using dexamethasone for 1 week but there was little clinical improvement. Needles were inserted into Ting points of both hind limb and one ocular acupoint (shang jiao area from GB01). Injection acupuncture (dexamethasone, twice/week) was used at GV16, GB20, BL10 and LU07, for the neck and head. Acupoint GB34 was added to those points at session 4. In addition, a trigger point in the left neck was injected with 0.2 ml ($200{\mu}g$ of apitoxin) of bee-venom diluted with 1 ml of 2% lidocaine from session 1 to session 3. At session 2, the symptoms had ameliorated a little. At session 3, they were much improved; the right ear was completely normal and the neck could be moved about 60% of normal range. At session 4, nodding was possible and stiffness of the neck was much improved, having returned to about 80% of normal range. Three days after session 4, the symptom of torticollis had disappeared completely and the foal could walk in a straight line. In conclusion, the present patient was a case with equine torticollis which showed favourable therapeutic response by combination of needle-acupuncture plus injection-acupuncture with dexamethasone and apitoxin.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.164-170
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• 2001

Background: Infrared Thermal Imaging (ITI) is an effective tool for the diagnosis of disease and evaluation of the therapeutic effects following pain treatment. Patients who were treated for pain in pain clinic described the intensity of pain and the degree of change of their pain using a visual analogue scale (VAS). In this study, the usefulness of ITI following multimodal methods for pain management were compared with the change of VAS. Methods: 1119 patients were evaluated. The patients were treated with stellate ganglion block, epidural block or trigger points injection. Before treatment, the temperature difference (${\Delta}T$) of the involved area and the corresponding area on the opposite side of the body was measured using ITI and VAS was assessed. After treatment, the temperature difference (${\Delta}T$) between the normal and involved areas, the change of ${\Delta}T$ (${\Delta}dT$), VAS and the change of VAS (${\Delta}VAS$) were measured. Statistic correlations between ${\Delta}dT$and ${\Delta}VAS$ were calculated in all groups. Results: Correlation of the ${\Delta}dT$ and ${\Delta}VAS$ was significant by contingency coefficient test. (SGB group, C = 0.358, Epi group, C = 0.377, TPI group, C = 0.374, P < 0.05) Conclusions: ITI is a reliable tool for the assessment of therapeutic effects following multidimensional management of painful disease.