BACKGROUND: Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated.
OBJECTIVE: To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain.
METHODS: Thirty-one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).
RESULTS: The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale.
CONCLUSIONS: Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia.

Numerous scientific papers have compared different treatment options in the management of myofascial pain syndrome. This study evaluated the efficacy of Extracorporeal ShockWave Treatment (ESWT) and mesotherapy in patients with Myofascial Pain Syndrome (MPS) in terms of improvement in pain, functional capacity, and quality of life. A case-control study was conducted on 54 patients, who were randomized into 2 groups: group A, consisting of 27 patients, who were treated with 5 sessions of focal ESWT on a weekly basis; and group B, consisting of 27 patients, who underwent 5 sessions of mesotherapy with Thiocolchicoside fl 4 mg/2 mL and Mepivacaine fl 10 mg/1 mL on a weekly basis. Patients were evaluated at enrollment (T0), after 5 weeks, at the end of rehabilitation treatment (T1), and at a follow- up 30 days after the end of treatment (T2), by administering rating scales (Numeric Rating Scale (NRS) - Pressure Pain Threshold (PPT) - Short Form-36 (SF-36)). The results showed that focal ESWT and Mesoterapy are two valid and effective treatment options in reducing algic symptoms and improving short- and long-term quality of life. However, the use of ESWTs, despite being mildly painful but tolerated, has been shown to be superior to mesotherapy in terms of pain reduction and increased functional capacity.

BACKGROUND: Myofascial pain syndrome is a painful musculoskeletal condition with muscle spasm, referred pain, stiffness, restricted range of motion. Capacitive-resistive diathermy heats deep tissues by transferring energy through radiofrequency waves. Although this modality is used to treat various musculoskeletal disorders, there is no specific data on myofascial trigger points. Thus, we aimed to evaluate the effectiveness of capacitive-resistive diathermy on the myofascial trigger points.
METHODS: Thirty-six volunteers with active myofascial trigger points were included. Patients were randomly and equally allocated into two groups. Group-1 is the capacitive-resistive diathermy treatment group; Group-2 is the placebo capacitive-resistive diathermy (PG). Visual analog scale (VAS), pain pressure threshold (PPT), neck disability index (NDI), neck range of motion (nROM), Short form-36 (SF-36) were used as outcomes before and after the intervention.
RESULTS: In both groups, VAS, PPT, NDI score significantly improved within the groups (p < 0.05). The CRG showed a statistically significant improvement in nROM for flexion, extension, and rotation (p < 0.05). However, ROM increase in CRG is not superior to PG (p > 0.05).
CONCLUSIONS: There was no significant difference between the two groups. We thought positive results in the PG might attributed to doing exercise. As a result, capacitive-resistive diathermy is not superior to exercise, but can be used as an adjuvant modality in myofascial trigger points treatment.

The sinew channels are a tendon and muscle network, and their description is based on the observation presented on the Huangdi Neijing Ling Shu. However, the myofascial system is an uninterrupted series of connective tissue that is comprised of layers that run in different directions. The similarities on these pathways are compared, such as a brief description on the myofascial pain syndrome and its similitude with the Impediment disorder from the Traditional Chinese Medicine (TCM). Furthermore, we discuss the treatment of these conditions from a Traditional Chinese Medicine perspective.

Chronic pain syndromes are an important medical problem generated by various molecular, genetic, and pathophysiologic mechanisms. Back pain, neuropathic pain, and posttraumatic pain are the most important pathological processes associated with chronic pain in adults. Standard approaches to the treatment of them do not solve the problem of pain chronicity. This is the reason for the search for new personalized strategies for the prevention and treatment of chronic pain. The nitric oxide (NO) system can play one of the key roles in the development of peripheral pain and its chronicity. The purpose of the study is to review publications devoted to changes in the NO system in patients with peripheral chronical pain syndromes. We have carried out a search for the articles published in e-Library, PubMed, Oxford Press, Clinical Case, Springer, Elsevier, and Google Scholar databases. The search was carried out using keywords and their combinations. The role of NO and NO synthases (NOS) isoforms in peripheral pain development and chronicity was demonstrated primarily from animal models to humans. The most studied is the neuronal NOS (nNOS). The role of inducible NOS (iNOS) and endothelial NOS (eNOS) is still under investigation. Associative genetic studies have shown that single nucleotide variants (SNVs) of NOS1, NOS2, and NOS3 genes encoding nNOS, iNOS, and eNOS may be associated with acute and chronic peripheral pain. Prospects for the use of NOS inhibitors to modulate the effect of drugs used to treat peripheral pain syndrome are discussed. Associative genetic studies of SNVs NOS1, NOS2, and NOS3 genes are important for understanding genetic predictors of peripheral pain chronicity and development of new personalized pharmacotherapy strategies.

The article describes case history and multiphase treatment of the patient with attacks of vertigo, initially regarded as the onset of Meniere\'s disease, but later qualified as secondary positional attacks with combined musculoskeletal pathology of the craniovertebral region and temporomandibular joint. Medicinal, local and surgical treatment led to the perfect result. Thus, the team work of neurologist, otolaryngologist, maxillofacial surgeon and orthodontist led to the successful elimination of vertigo attacks.
В статье приводится описание истории болезни и поэтапного лечения пациентки с приступами головокружения, первоначально расцененными как дебют болезни Меньера, но в дальнейшем квалифицированными как вторичные позиционные приступы на фоне сочетанной костно-мышечной патологии краниовертебральной области и области височно-нижнечелюстного сустава. Медикаментозное, местное и хирургическое лечение дало стойкий эффект. Таким образом, совместная работа невролога, оториноларингологов, мануального терапевта, а также челюстно-лицевого хирурга и ортодонта привела к успеху — полному прекращению приступов головокружения.

OBJECTIVE: To demonstrate one of the effective methods of treatment of the piriformis syndrome under the control of a highly technological visualization method.
METHODS: Eight patients (7 women and 1 man), aged 44 to 63 years, with piriformis syndrome, were studied from 2016 to 2018. The main complaints of the patients were pain in the lumbosacral spine with irradiation to the gluteal region and/or legs. All patients underwent MRI and/or MSCT of the lumbosacral spine, the pelvic ultrasound, according to the results of which 1 patient was diagnosed with uterine myoma, 5 with lesions of intervertebral discs in the L4-L5 and L5-S1 segments of varying severity in combination with changes in posture. For therapeutic purposes, all patients under the control of CT fluoroscopy were administered to xeomin (n=3), dexamethasone (n=1) or betamethasone (n=4).
RESULTS: In all patients, a positive therapeutic effect was observed after 4-12 months for xeomin injections, 2-3 weeks for dexamethasone and up to 3 months for betamethasone. No complications during the manipulations were observed. The authors present a clinical case to describe the botulinum therapy technique under the control of CT fluoroscopy, which allows effective treatment of the piriformis syndrome.
CONCLUSIONS: In the treatment of the piriformis syndrome it is necessary to apply an integrated approach, the leading of which are methods of local impaction on the suffering muscle. Only a methodologically correct injection can increase the effectiveness of treatment in these patients and reduce the risk of complications.
Синдром грушевидной мышцы (СГМ) — это редкое патологическое состояние, при котором происходит поражение седалищного нерва как результат сдавления между измененной грушевидной мышцей и крестцово-остистой связкой. В редких случаях наблюдается анатомический вариант расположения седалищного нерва, при котором он проходит через саму мышцу. Многие авторы утверждают, что существует причинно-следственная связь между некоторыми анатомическими соотношениями седалищного нерва и грушевидной мышцы и развитием СГМ. Знание особенностей седалищного нерва и его связь с грушевидной мышцей, ягодичными сосудами облегчают понимание клинической картины данного патологического состояния. Из-за отсутствия строгих диагностических критериев остается спорной дифференциальная диагностика синдрома с другими причинами болей в пояснице и бедре. Следует подчеркнуть, что СГМ скорее является диагнозом исключения. Длительность терапевтического эффекта при блокадах грушевидной мышцы во многом зависит не только от применяемого препарата, но и от методики его введения. Проведение инъекций классическим методом не всегда является точным и безопасным. На клиническом примере в нашей работе мы описываем технику проведения ботулинотерапии под контролем КТ-скопии, позволяющую проводить эффективное лечение СГМ.

The article describes a series of seven cases characterized by a change in the type of attack in the perimenopausal period: migraine attacks before menopause and cochleovestibular paroxysms after the onset of menopause. Clinical data and results of diagnostic tests are presented and the possible link of both attack variants with cervical pathology is discussed. The authors explain this dynamics by stem neural integrator dysfunction during hormonal changes.
В статье описана серия из 7 случаев, характеризующихся сменой типа приступа в перименопаузальном периоде: мигренозные приступы до менопаузы и кохлеовестибулярные после ее наступления. Приводятся клинические данные и результаты дополнительных методов обследования. Обсуждается возможность связи обоих вариантов приступов с патологией шейного отдела спинного мозга. Предложено объяснение динамики характера приступов в связи с изменением функционирования стволового неврального интегратора на фоне гормональных сдвигов.

Objective: Strong evidence shows that 85% of women with chronic pelvic pain (CPP) have musculoskeletal disorders, such as abdominal myofascial pain syndrome (AMPS). The aim of this research was to assess the efficacy of local acupuncture treatment for women with CPP secondary to AMPS unresponsive to treatment with trigger-point injection. Materials and Methods: This pilot study involved 17 women with moderate-to-severe AMPS-related CPP. Acupuncture treatments were given at abdominal-wall trigger points once per week for 10 consecutive weeks. Pain relief was assessed with a visual analogue scale (VAS), the McGill questionnaire, and pressure dynamometer. Quality of life and psychosocial function (risk for anxiety and depression) were evaluated using the Short-Form-36 questionnaire and the Hospital Anxiety and Depression scale. Assessments were performed at baseline and after 1, 3, and 6 months of treatment. Results: Both the VAS and McGill pain questionnaire showed significantly decreased pain intensity (VAS, P < 0.001; and McGill, P 0.049), and the effects were sustained even at 6 months after treatment. Conclusions: Acupuncture treatment was effective for the women who participated in this study, and the current authors believe that these preliminary results suffice to recommend performing randomized controlled trials.