Abstract
Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals
associated with pain and inflammation are elevated in sites near to and remote from
active myofascial trigger points.
Objectives
To investigate the biochemical milieu of the upper trapezius muscle in subjects with
active, latent, or absent myofascial trigger points (MTPs) and to contrast this with
that of the noninvolved gastrocnemius muscle.
Design
We used a microanalytic technique, including needle insertions at standardized locations
in subjects identified as active (having neck pain and MTP), latent (no neck pain
but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling
schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to
measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis
factor alpha, interleukin 1β (IL-1β), IL-6, IL-8, serotonin, and norepinephrine, using
immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry
was obtained. We compared analyte concentrations among groups with 2-way repeated-measures
analysis of variance.
Setting
A biomedical research facility.
Participants
Nine healthy volunteer subjects.
Interventions
Not applicable.
Main Outcome Measures
Preselected analyte concentrations.
Results
Within the trapezius muscle, concentrations for all analytes were higher in active
subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active
group were always higher (pH not different) than concentrations in the gastrocnemius
muscle. At all times within the gastrocnemius, the active group had higher concentrations
of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).
Conclusions
We have shown the feasibility of continuous, in vivo recovery of small molecules from
soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle
have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines,
and catecholamines different from subjects with latent or absent MTPs in their trapezius.
These concentrations also differ quantitatively from a remote, uninvolved site in
the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active
MTPs in the trapezius differs from subjects without active MTPs.
Key Words
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Article info
Footnotes
Supported by the Intramural Research Program, National Institutes of Health (NIH), the Clinical Center and Office of the Director, NIH.
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or 1 or more of the authors. Shah, Danoff, Phillips, and Gerber have filed a patent application for the device used in this study.
Identification
Copyright
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- New Views of Myofascial Trigger Points: Etiology and DiagnosisArchives of Physical Medicine and RehabilitationVol. 89Issue 1
- PreviewSimons DG. New views of myofascial trigger points: etiology and diagnosis. Two studies appearing in Archives, one by Shah and colleagues and another one by Chen and colleagues, present groundbreaking findings that can reduce some of the controversy surrounding myofascial trigger points (MTPs). Both author groups recognize the ubiquity of this disease and the importance to patients of health care professionals becoming better acquainted with the cause and identification of MTPs. The integrated hypothesis is the most credible and most complete proposed etiology of MTPs.
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