reg d’souza bphil mcsp mbacc clinical specialist ... · myofascial pain and fibromyalgia...

Reg D’Souza BPhil MCSP MBAcC

Clinical Specialist Physiotherapist

Pain Clinic, Royal Cornwall Hospitals

Trust Treliske, Truro, Cornwall. AACP Road show Bristol. 17th March, 2008.

Myofascial Trigger points

A condition that causes damage to muscle

producing local and referred pain.

Symptoms are tenderness and referred pain.

It can be acute or chronic, local or generalised.

Associated with trauma, poor posture or excessive

strain of muscles. Complementary Therapies for Pain Management. An Evidence-Based

Approach. 2007. Editors: Edzard Ernst, Max Pittler and Barbara Wider.

The good news is:

“The evidence suggesting that acupuncture

has beneficial effects for patients with

Myofascial pain is convincing.”

Complementary Therapies for Pain Management. An Evidence-Based

Approach. 2007. Editors: Edzard Ernst, Max Pittler and Barbara Wider.

Physical signs

‘jump & shout’ reactions

Pain reproduction

Palpable taut bands

Local twitch response

Peau d’Orange subcutaneous tissue

thickening Dr P Baldry, 2001

Symptoms of MTrPs

Pain

Restricted range of movement

Muscle weakness

Sleep disturbance

Peripheral hypothermia Dr P Baldry, 2001

Trigger points can be active or

latent

Active trigger point

Painful

Stiffness

Limited movement

Latent trigger points

May not be painful

On examination there would be evidence of

limited movement

The Pain Cycle

Injury Pool

Levator Scapula Acupuncture, Trigger Points and Musculoskeletal Pain. 1993 Dr P E Baldry

Levator scapula referral pattern Dr P E Baldry 1993

Piriformis Dr P Baldry, 1993

Piriformis Dr P Baldry, 1993

Piriformis Dr P Baldry, 1993

Pressure Threshold Meter

Treatment

Combining acupuncture “dry” needling with:

A progressive programme of stretching

exercises.

Further reading

Complementary Therapies for Pain Management. An

Evidence-Based Approach. 2007. Editors: Edzard Ernst,

Max Pittler and Barbara Wider.

Myofascial Pain and Fibromyalgia Syndromes-A clinical

guide to diagnosis and management. P. E. Baldry. 2001

Myofascial Pain and Dysfunction. The Trigger point

manual. Janet Travell and David Simons. Two volumes:

One for the upper limb and second for the lower

extremities. 1983.

Reg D’Souza BPhil MCSP MBAcC

Clinical Specialist Physiotherapist

Pain Clinic, Royal Cornwall Hospitals Trust Treliske,

Truro, Cornwall. AACP Road show Bristol. 17th March, 2008.

Modifying Acupuncture when

treating Chronic pain

Anecdote

A tale of two acupuncturists

Practice tip.

A graded increase in treatment intensity

from gentle to strong stimulation, will

reduce the risk of exacerbating symptoms!

Factors that will improve pain

relief

Frequency of treatment

Time of treatment Number of Sessions

Depth of needling

Position of needle Segmental/extrasegmental

Pain Relief

To get the best results for the relief

of pain

1. Segmental or extra segmental points

2. Depth of needling

3. Treatment time

4. Frequency of treatment

5. Number of sessions

6. Optimum settings for electro acupuncture

7. Which type of pain responds best to

acupuncture.