AAPM: Muscles Triggering Back and Neck Pain Identified by

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Jun 7, 2013 at 8:51 PM

AAPM: Muscles Triggering Back and Neck Pain Identified by Investigational Device By John Gever, Senior Editor, MedPage Today Published: January 29, 2009 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco HONOLULU, Jan. 29 -- Back and neck pain originating in muscles was more accurately diagnosed with an investigational electrical stimulation device than with conventional palpation, said a researcher here. Patients in a randomized trial reported more pain relief when treatments were targeted to muscles identified with the device, compared with patients treated on the basis of palpation, reported Corey Hunter, M.D., of New York University, at the American Academy of Pain Medicine annual meeting here. The noninvasive device, developed at NYU and similar in appearance to an ultrasound wand, sends an electrical impulse through the skin to cause muscles directly underneath to twitch, said Dr. Hunter at a poster presentation. If abnormal tension in the specific muscle is responsible for back or neck pain, the stimulation will briefly cause pain. Physicians have traditionally identified these muscles by attempting to find tensed or cramped muscles with their fingers. In the study, 40 patients with a three-month history of back or neck pain and clinical findings of muscle tenderness were randomized to be evaluated with the device or with conventional palpation. Patients found to have one to three muscles that were painful following either procedure immediately received injections of lidocaine in the identified sites. There were follow-up evaluations at one and four weeks after the diagnosis and treatment session. Both groups showed improvements at one week in pain scores, using two different self-reporting instruments, and in Oswestry disability scores. But at the four-week evaluations, patients diagnosed with palpation "shot right back" to near baseline levels of pain and disability, Dr. Hunter said, whereas the improvements continued in patients whose treatment was guided by the electrical stimulation device. Some 82.6% of patients evaluated with the device reported pain improvement at four weeks, compared with 53.2% of the control group (P<0.0001). Patients' self-reported mood mirrored the disability and pain findings. Overall, 86.4% of the device group reported satisfaction with the treatment versus 61.2% of the control patients (P=0.002). Dr. Hunter said the results indicated that the device was superior to palpation at correctly identifying the specific muscles responsible for back and neck pain of muscular origin. He added that a separate retrospective study of patients with failed back surgery syndrome, who were evaluated with the same device, showed that a majority obtained durable pain relief after muscle-targeted treatment. Dr. Hunter said it was not easy to target stimulation to specific desired muscles with the device. "You really have to know your anatomy," he said. Limitations to the study included a long list of exclusion criteria, such as history of substance abuse, implanted pacemakers or defibrillators, skin conditions, and severe joint diseases leading to limited range of motion. Robert I. Cohen, M.D., an anesthesiologist at Beth Israel Deaconess Medical Center in Boston, said it was intriguing to see a potential alternative to traditional trigger-point identification methods. "Muscle pain can be very intense and very resistant to treatment," and to diagnosis as well, said Dr. Cohen, who was not involved in the study. He said there has been little research on approaches to identifying sources of muscle pain, except for palpation to find trigger points, and "physicians aren't particularly good at finding particular muscles unless they are specialists." "What was interesting about this [study] was that it is proposing a technique that appears to reliably identify the pain generator to a specific muscle." But he echoed Dr. Hunter's point that the user needs strong familiarity with muscle anatomy. If it were to be made commercially available, it would likely require substantial training, Dr. Cohen said. No external funding was reported. No potential conflicts of interest were reported by Dr. Hunter or Dr. Cohen. Primary source: American Academy of Pain Medicine Source reference: Hunter C, et al "A randomized controlled evaluation of a new muscle pain detection device (MPDD) to diagnose muscle pain as the source of back and/or neck pain in patients" AAPM 2009; Abstract 170A.

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