COMPARISON OF ROPIVACAINE ALONE VS ROPIVACAINE WITH METHYLPREDNISOLONE INJECTION AS A TREATMENT OF TRIGGER POINTS FOR MYOFASCIAL PAIN: A SUPERIORITY RANDOMIZED CLINICAL TRIAL

Authors

  • S MUSHTAQ Department of Pain Medicine, National Hospital & Medical Centre, Lahore, Pakistan
  • KM BHATTI Department of Pain Medicine, National Hospital & Medical Centre, Lahore, Pakistan
  • Q NAWAZ Department of Anaesthesia, ICU and Pain Medicine, National Hospital and Medical Centre, Lahore, Pakistan
  • K BASHIR Department of Pain Medicine, National Hospital & Medical Centre, Lahore, Pakistan
  • AUR GHAFOOR Department of Pain Medicine, National Hospital & Medical Centre, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.744

Keywords:

Local anesthetic, Local injection, Myofascial pain syndrome, Ropivacaine

Abstract

Soft tissue rheumatism, known as myofascial pain syndrome (MPS), is typified by taut bands, transferred pain that is distinct, sensory alterations that occur, and a local twitch response. It is also connected with trigger points in one or more muscles. The purpose of the research is to evaluate the effects of injections of Ropivacaine alone vs. Ropivacaine with methylprednisolone in decreasing pain in people in our community who have myofascial pain caused by trigger points. The design of this study was a randomized controlled trial. This study was carried out from July 2022 to August 2023. The research comprised 50 individuals (27 females and 23 males) diagnosed with MPS who came to our clinic. Using online randomization software, the patients were randomly divided into two groups. Group B got a mixture of 0.25% Ropivacaine & 10mg methylprednisolone in 3ml normal saline at each trigger point, whereas Group A received 3ml of 0.25% Ropivacaine. Dry needling of trigger sites was done in both groups. Patients were assessed at two, four, and eight weeks of intervention. The patients' pre-treatment assessment measures showed no statistically significant differences. After 4 and 8 weeks of assessment, Group B NRS pain and BDI scores showed statistically significant improvements compared to pre-treatment results (p<0.05). NRS and BDI scores were reduced in group A compared to their pretreatment values, but that was not clinically significant. Results of our study showed that there was a statistically significant difference between both groups in terms of pain, stress, and anxiety after the intervention. Ropivacaine with methylprednisolone gave better results than Ropivacaine alone in reducing pain and anxiety among the study population.

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References

Alshammari, S. S., Amin, S., Siddiqui, A. A., Malik, Y. R., Alshammari, A. F., Amin, J., Siddiqui III, A. A., and Amin Sr, J. (2023). An Evidence-Based Treatment of Myofascial Pain and Myofascial Trigger Points in the Maxillofacial Area: A Narrative Review. Cureus 15.

Appasamy, M., Lam, C., Alm, J., and Chadwick, A. L. (2022). Trigger point injections. Physical medicine and rehabilitation clinics of North America 33, 307.

Bodine, N. (2023). An overview of myofascial pain syndrome with a focus on trigger point injection. The Nurse Practitioner 48, 18-25.

Bourgaize, S., Newton, G., Kumbhare, D., and Srbely, J. (2018). A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management. The Journal of the Canadian Chiropractic Association 62, 26.

de Abreu Venancio, R., Guedes Pereira Alencar, F., and Zamperini, C. (2009). Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. CRANIO® 27, 46-53.

Desai, M. J., Saini, V., and Saini, S. (2013). Myofascial pain syndrome: a treatment review. Pain and Therapy 2, 21-36.

García-Leiva, J. M., Hidalgo, J., Rico-Villademoros, F., Moreno, V., and Calandre, E. P. (2007). Effectiveness of ropivacaine trigger points inactivation in the prophylactic management of patients with severe migraine. Pain medicine 8, 65-70.

Graboski, C. L., Gray, D. S., and Burnham, R. S. (2005). Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: a randomized, double-blind crossover study. Pain 118, 170-175.

Hou, C.-R., Tsai, L.-C., Cheng, K.-F., Chung, K.-C., and Hong, C.-Z. (2002). Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of physical medicine and rehabilitation 83, 1406-1414.

JAIN, S., GOYAL, R. K., AJMERA, P., AGGARWAL, G., and DHIMAN, S. (2021). Recent Advances in Diagnosis and Management of Myofascial Pain Syndrome: A Narrative Review. Journal of Clinical & Diagnostic Research 15.

Li, B.-z., Tang, W.-h., Li, Y., Zhou, L., Liu, M.-g., and Bao, S.-X. (2022). Clinical Efficacy of Epidural Injections of Local Anesthetic Alone or Combined with Steroid for Neck Pain: A Systematic Review and Meta-Analysis. BioMed Research International 2022.

Money, S. (2017). Pathophysiology of trigger points in myofascial pain syndrome. Journal of pain & palliative care pharmacotherapy 31, 158-159.

Navarro-Santana, M. J., Sanchez-Infante, J., Gómez-Chiguano, G. F., Cleland, J. A., Fernández-de-Las-Peñas, C., Martín-Casas, P., and Plaza-Manzano, G. (2022). Dry needling versus trigger point injection for neck pain symptoms associated with myofascial trigger points: a systematic review and meta-analysis. Pain Medicine 23, 515-525.

Niraj, G. (2018). Pathophysiology and management of abdominal myofascial pain syndrome (AMPS): a three-year prospective audit of a management pathway in 120 patients. Pain Medicine 19, 2256-2266.

Nouged, E., Dajani, J., Ku, B., Al-Eryani, K., Padilla, M., and Enciso, R. (2019). Local Anesthetic Injections for the Short-Term Treatment of Head and Neck Myofascial Pain Syndrome: A Systematic Review with Meta-Analysis. Journal of Oral & Facial Pain & Headache 33.

Ottem, E. N. (2016). Neurophysiology of Musculoskeletal Pain. Muscular Injuries in the Posterior Leg: Assessment and Treatment, 49-59.

Plaut, S. (2022). Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PloS one 17, e0263087.

Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., and Gerber, L. (2015). Myofascial trigger points then and now: a historical and scientific perspective. PM&R 7, 746-761.

Simons, D. G., Travell, J. G., and Simons, L. S. (1999). "Travell & Simons' myofascial pain and dysfunction: upper half of body," Lippincott Williams & Wilkins.

Sorathiya, A. R., Prajapati, S., Kansagra, M., Patel, B. R., Patel, J., and Desai, D. (2023). Comparative study of Bupivacaine.

Vázquez Delgado, E., Cascos-Romero, J., and Gay Escoda, C. (2010). Myofascial pain associated with trigger points: a literature review. Part 2: differential diagnosis and treatment. Medicina Oral, Patología Oral y Cirugia Bucal, 2010, vol. 15, num. 4, p. 639-643.

Yilmaz, O., Sivrikaya, E. C., Taskesen, F., Pirpir, C., and Ciftci, S. (2021). Comparison of the efficacy of botulinum toxin, local anesthesia, and platelet-rich plasma injections in patients with myofascial trigger points in the masseter muscle. Journal of Oral and Maxillofacial Surgery 79, 88. e1-88. e9.

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Published

2024-03-11

How to Cite

MUSHTAQ , S., BHATTI , K., NAWAZ , Q., BASHIR , K., & GHAFOOR , A. (2024). COMPARISON OF ROPIVACAINE ALONE VS ROPIVACAINE WITH METHYLPREDNISOLONE INJECTION AS A TREATMENT OF TRIGGER POINTS FOR MYOFASCIAL PAIN: A SUPERIORITY RANDOMIZED CLINICAL TRIAL. Biological and Clinical Sciences Research Journal, 2024(1), 744. https://doi.org/10.54112/bcsrj.v2024i1.744