McMillan A S, Nolan A, Kelly P J
Department of Restorative Dentistry, University of Newcastle, Newcastle upon Tyne, United Kingdom.
J Orofac Pain. 1997 Fall;11(4):307-14.
In patients with myofascial pain, painful trigger points are often treated using dry needling and local anesthetic injections. However, the therapeutic effect of these treatments has been poorly quantified, and the mechanism underlying the effect is poorly understood. In a randomized, double-blind, double-placebo clinical trial, a pressure algometer was used to measure pain-pressure thresholds in the masseter and temporalis muscles of 30 subjects aged 23 to 53 years with myofascial pain in the jaws, before and after a series of dry needling treatments, local anesthetic injections, and simulated dry needling and local anesthetic treatments (treatment group A: Procaine + simulated dry needling; treatment group B: dry needling + simulated local anesthetic; control group C: simulated local anesthetic + simulated dry needling). Subjects rated pain intensity and unpleasantness using visual analogue scales, and the data were analyzed using analysis of variance. Pain pressure thresholds increased slightly after treatment, irrespective of the treatment modality. Pain intensity and unpleasantness scores decreased significantly at the end of treatment in all groups. There were no statistically significant between-group differences in pain pressure thresholds and visual analogue scale scores at the end of treatment. The findings suggest that the general improvement in pain symptoms was the result of nonspecific, placebo-related factors rather than a true treatment effect. Thus, the therapeutic value of dry needling and Procaine in the management of myofascial pain in the jaw muscles is questionable.
在肌筋膜疼痛患者中,疼痛触发点通常采用干针疗法和局部麻醉注射进行治疗。然而,这些治疗方法的疗效尚未得到充分量化,其作用机制也知之甚少。在一项随机、双盲、双安慰剂临床试验中,使用压力痛觉计测量了30名年龄在23至53岁、患有颌面部肌筋膜疼痛的受试者在进行一系列干针治疗、局部麻醉注射以及模拟干针和局部麻醉治疗(治疗组A:普鲁卡因+模拟干针;治疗组B:干针+模拟局部麻醉;对照组C:模拟局部麻醉+模拟干针)前后咬肌和颞肌的疼痛压力阈值。受试者使用视觉模拟量表对疼痛强度和不适感进行评分,并采用方差分析对数据进行分析。无论治疗方式如何,治疗后疼痛压力阈值均略有升高。所有组在治疗结束时疼痛强度和不适感评分均显著降低。治疗结束时,各组之间在疼痛压力阈值和视觉模拟量表评分方面无统计学显著差异。研究结果表明,疼痛症状的总体改善是由非特异性、安慰剂相关因素导致的,而非真正的治疗效果。因此,干针疗法和普鲁卡因在治疗颌面部肌肉肌筋膜疼痛方面的治疗价值值得怀疑。
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