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      Effectiveness of ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis

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          The objective of this review was to assess the therapeutic effect of ultrasound (US) on myofascial pain syndrome (MPS).

          Date sources

          PubMed, Embase, and Cochrane Library were searched to find relevant studies from January 1966 to May 2016 using keywords. Four investigators performed the data extraction.

          Study selection

          Randomized controlled trials (RCTs) investigating the outcomes of pain and physical function between MPS patients receiving and not receiving US were selected by two researchers independently.

          Data extraction

          Data were extracted from the RCTs. Risk of bias and study quality were evaluated following the recommendations of Cochrane Collaboration. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated.

          Data synthesis

          A total of 10 studies involving 428 MPS patients were included. US therapy significantly reduced pain intensity (SMD [CI]=−1.41 [−2.15, −0.67], P=0.0002) and increased pain threshold (SMD [CI]=1.08 [0.55, 1.60], P<0.0001), but had no significant effect on cervical range of motion (ROM) of lateral flexion (SMD [CI]=0.40 [−0.19, 0.99], P=0.19), rotation (SMD [CI]=0.10 [−0.33, 0.52], P=0.66), or extension or flexion (SMD [CI]=0.16 [−0.35, 0.68], P=0.53). Heterogeneity between studies was mainly attributed to differences in the follow-up time, parameter of US, course of treatment, and the control group. The overall risk of bias from the included studies was high, and the evidence proving these effect calculations were assessed as low quality.


          Owing to the high risk of bias and the across-trial heterogeneity of the studies, the current evidence is not clear enough to support US as an effective method to treat MPS. Clinical trials with methodological rigorousness and adequate power are needed to confirm it in the future.

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          Most cited references 33

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          A review of therapeutic ultrasound: effectiveness studies.

          Therapeutic ultrasound is one of the most widely and frequently used electrophysical agents. Despite over 60 years of clinical use, the effectiveness of ultrasound for treating people with pain, musculoskeletal injuries, and soft tissue lesions remains questionable. This article presents a systematic review of randomized controlled trials (RCTs) in which ultrasound was used to treat people with those conditions. Each trial was designed to investigate the contributions of active and placebo ultrasound to the patient outcomes measured. Depending on the condition, ultrasound (active and placebo) was used alone or in conjunction with other interventions in a manner designed to identify its contribution and distinguish it from those of other interventions. Thirty-five English-language RCTs were published between 1975 and 1999. Each RCT identified was scrutinized for patient outcomes and methodological adequacy. Ten of the 35 RCTs were judged to have acceptable methods using criteria based on those developed by Sackett et al. Of these RCTs, the results of 2 trials suggest that therapeutic ultrasound is more effective in treating some clinical problems (carpal tunnel syndrome and calcific tendinitis of the shoulder) than placebo ultrasound, and the results of 8 trials suggest that it is not. There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing. The few studies deemed to have adequate methods examined a wide range of patient problems. The dosages used in these studies varied considerably, often for no discernable reason.
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            Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity.

            Three studies are presented demonstrating the reliability of the pressure algometer as an index of myofascial trigger point sensitivity. The first study showed high reliability between and within experimenters when measuring marked trigger point locations. In study 2, significant between experimenter reliability in locating and measuring the same unmarked trigger point locations was shown, while study 3 supported the idea that trigger points are discrete points of focal tenderness within the muscle. The ability to quantify and reliably measure trigger point sensitivity opens the door to a range of clinical and research possibilities for myofascial and related musculoskeletal pain problems.
              • Record: found
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              • Article: not found

              Ultrasound therapy for musculoskeletal disorders: a systematic review.

              Ultrasound therapy is used frequently to reduce pain and related disability, mainly by physiotherapists. The objective of this review was to evaluate the effectiveness of ultrasound therapy in the treatment of musculoskeletal disorders. Published reports of randomized clinical trials investigating the effects of ultrasound therapy on pain, disability or range of motion were identified by a systematic search of MEDLINE, EMBASE and the Cochrane databases, supplemented with citation tracking. The quality of methods of all selected publications was assessed systematically by two independent and 'blinded' reviewers, using ten validity criteria. Data from the original publications were used to calculate the differences between groups for success rate, pain, disability and range of motion. Statistical pooling was performed if studies were homogeneous with respect to study populations, interventions, outcome measures and timing of follow-up. 38 Studies were included in the review, evaluating the effects of ultrasound therapy for lateral epicondylitis (n = 6), shoulder pain (n = 7), degenerative rheumatic disorders (n = 10), ankle distorsions (n = 4), temporomandibular pain or myofacial pain (n = 4) and a variety of other disorders (n = 7). In 11 out of 13 placebo-controlled trials with validity scores of at least five out of ten points, no evidence of clinically important or statistically significant results was found. Statistical pooling was only feasible for placebo-controlled trials on lateral epicondylitis, and produced a pooled estimate for the difference in success rate of 15% (95% confidence interval -8%-38%). As yet, there seems to be little evidence to support the use of ultrasound therapy in the treatment of musculoskeletal disorders. The large majority of 13 randomized placebo-controlled trials with adequate methods did not support the existence of clinically important or statistically significant differences in favour of ultrasound therapy. Nevertheless, our findings for lateral epicondylitis may warrant further investigation.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                07 March 2017
                : 10
                : 545-555
                Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
                Author notes
                Correspondence: Xueping Li, Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, People’s Republic of China, Tel +86 189 5167 0129, Email lixueping6504@ 123456163.com

                These authors contributed equally to this work

                © 2017 Xia et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.


                Anesthesiology & Pain management

                ultrasound, myofascial pain syndrome, meta-analysis


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