Alternative Therapies
To date, no universally accepted therapy for the treatment and management of fibromyalgia and myofascial pain exists, so patients often seek alternative and complementary therapies. Many complementary treatments are available. Among the most common are trigger-point injections, chiropractic manipulation, acupuncture and myofascial release therapy. Although anecdotally claimed as effective, most of these modalities have not been rigorously investigated due to poor research quality. Appropriate controls, sample sizes and blinding measures are often lacking. Despite these issues, the trend to efficacy exists and further examination is often warranted.
Trigger Point (TrP) Injection
Like that of other chronic pain states, management of myofascial pain disorders often requires a multidisciplinary approach that reflects the physical manifestations of the pain as well as the psychological and social patterns that can contribute to pain maintenance (Han, S. C., Harrison, P., 1997); (Sherman, J. J. and Turk, D. C., 2001). One physical approach is to “de-activate” the TrPs by “spray and stretch” techniques, with the addition of trigger point injections for more severe cases. An aggressive regimen of muscle stretching and strengthening is sometimes recommended. The psychological approach - usually cognitive behavioral therapy - is used when physical or biomedical approaches have failed. Currently, there is no universally accepted treatment for myofascial pain disorders and it is up to the clinician to choose the most appropriate therapy.
Acupuncture
Acupuncture is a healing technique traditionally used in Asian countries. Thin needles are inserted into specific body locations to alter the body's Qi, or life energy, which may be excessive or deficient (Cheng, X., 1999). Western science has so far failed to objectively measure Qi, but research has shown that acupuncture can change body physiology. Insertion of acupuncture needles results in the release of endogenous pain killing opioids and alters neuronal pain synapses in the spinal cord by a “gate theory” mechanism (Stux, G., Hammerschlag, R., 2001). Belief in efficacy may not be required since animal studies also have shown analgesic responses to acupuncture (Stux, G., Hammerschlag, R., 2001), but a significant non-specific placebo effect may be present.
A widely-used acupuncture technique is insertion of the acupuncture needle into a point that is painful upon palpation. This point is termed an Ashi point (Cheng, X., 1999), and the patient typically exclaims “that is it” when the point is located. This is reminiscent of the palpation of TrPs and dry needling for myofascial pain disorders mentioned above. Anecdotal evidence suggests that dry needling can result in immediate relief, but multiple injections may be required. Similarly, immediate relief may occur with the Ashi method of acupuncture, but a typical course of treatments for musculoskeletal pain may require five to 10 30- to 60-minute sessions either weekly or biweekly. Acupuncture needles can be manually or electrically stimulated once inserted, and, unlike typical hypodermic needles, acupuncture needles elicit less pain and can be inserted multiple times to identify the correct point.
Reference list
Han, S. C. and Harrison, P. (1997). Myofascial pain syndrome and trigger-point management. Reg Anesth, 22(1):89-101.
Sherman, J. J. and Turk, D. C. (2001). Nonpharmacologic approaches to the management of myofascial temporomandibular disorders. Curr Pain Headache Rep, 5:421-31.
Cheng Xinnong. (1999). Chinese Acupuncture and Moxibustion. Bejing: Foreign Languages Press.
Stux, G. and Hammerschlag, R. (2001). Clinical Acupuncture: scientific basis. New York, Springer. This book covers the effects of acupuncture in both clinical and animal research settings. The authors combine information from Asian as well as Western researchers and provide compelling arguments for the neurological basis of acupuncture analgesia. This reference contains important information for any acupuncture researcher.
