Fernández-de-Las-Peñas César, Nijs Jo
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
J Pain Res. 2019 Jun 18;12:1899-1911. doi: 10.2147/JPR.S154728. eCollection 2019.
Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not. The application of trigger point dry needling is able to reduce the excitability of the central nervous system by reducing peripheral nociception associated to the trigger point, by reducing dorsal horn neuron activity, and by modulating pain-related brainstem areas. However, the effects are mainly observed in the short-term, and effect sizes are moderateto small. Therefore, the current review proposes that the application of trigger point dry needling should be integrated into current pain neuroscience paradigm by combining its application with pain neuroscience education, graded exercise and manual therapy. Additionally, patient's expectations, beliefs, previous experiences and patient-clinician interaction should be considered when integrating trigger point dry needling into a comprehensive treatment approach.
肌筋膜疼痛综合征是一种以存在触发点为特征的疼痛病症。目前的证据，大多是实验研究，明确支持触发点在外周和中枢敏化中的作用，因为它们能够促成外周伤害感受器、脊髓背角神经元和脑干的敏化。针对触发点的治疗提出了几种干预措施，干针疗法是临床医生最常用的方法之一。关于触发点干针疗法的临床应用尚无共识：一些作者提出，在针刺干预期间应引发局部抽搐反应才有效，而另一些人则不这样认为。触发点干针疗法的应用能够通过减少与触发点相关的外周伤害感受、降低背角神经元活动以及调节与疼痛相关的脑干区域来降低中枢神经系统的兴奋性。然而，这些效果主要在短期内观察到，效应大小为中等至较小。因此，当前的综述提出，应通过将触发点干针疗法的应用与疼痛神经科学教育、分级运动和手法治疗相结合，将其纳入当前的疼痛神经科学范式。此外，在将触发点干针疗法纳入综合治疗方法时，应考虑患者的期望、信念、既往经历以及患者与临床医生的互动。
