Myofascial pain syndrome (MPS) is clinically defined as a regional pain syndrome characterised by muscle pain caused by myofascial trigger points (MTrPs). Often overlooked or misdiagnosed, pain due to MPS is common and may range from an annoying dull ache to debilitating pain capable of mimicking nerve root irritation, osteoarthritic type pain and even visceral pain.

Peripheral intramuscular nociceptors can become sensitised by mechanical ischaemic and/or peripheral inflammatory factors resulting in a physiological cascade involving the the release of excess acetylcholine by the motor end plate. This in turn leads to the development of a contraction ‘knot’ within the muscle, commonly referred to as a MTrP. This localised contracture has been proposed to further impair local circulation resulting in an energy crisis which in turn results in further nociceptive sensitisation and so the cycle continues.

A hand held point stimulator device is a very useful tool which may be used when needling in the treatment of musculoskeletal pain syndromes - mainly for the deactivation of trigger points (TrP). It may be tolerated better with less treatment soreness as opposed to a more conventional dry needling technique, this is certainly the case from my own clinical experience with the device. The lack of evidence for efficacy is due to the fact that to my knowledge no trials have been performed to date, however we may be guided by the current evidence we have supporting the use of needling for myofascial pain syndrome for example. Clinically we have very good evidence to suggest a handheld point stimulator is an extremely effective way of comfortably augmenting the needle effect.

Is a versatile hand held electro-stimulatory device and can also be used to locate areas of decreased skin resistance thought to correspond with traditional acupuncture points.

What follows is an attempt to further rationalise the use of an integrated mechanisms based needling approach in the treatment of myofascial pain related to the presence of trigger points.

I have provided a list of references which have influenced my understanding of the proposed neurophysiological mechanisms which may occur at the various levels. However some of the effects listed are based on clinical observation and discussion with colleagues.

The following mechanisms may apply when a myofascial trigger point is accurately located using the diagnostic criteria and then needled using:

1. A local needling approach using electrostimulation
2. A segmental approach in addition to or as an alternative to a local approach
3. Enhanced central regulatory effects

How does Acupuncture work?

Needling activates specific nerve endings within the muscles - this triggers the release of substances which improve blood flow to the area, reduces pain and inflammation and promotes healing.

Needling also has effects within the CNS which further reduces pain, eases muscle tension and can promote a sense of wellbeing.

2 Hz EA - Adding gentle low frequency electrical stimulation enhances the segmental and central analgesic effects of needling by activating the central nervous system in a way similar to exercise

I’ve written on this topic before and given more recent evidence in support of a mechanisms based approach, I thought it time to revisit. Furthermore, as a sinus pain and congestion sufferer the role of Acupuncture in providing relief is definitely of interest to me!

First a quick review of the condition:

Acute sinusitis is defined as inflammation with swelling and engorgement of the nasal cavity and sinuses characterised by the existence, for 12 weeks or less, of two or more of the following symptoms (Fokkens, 2005).

• Blockage/congestion and discharge (anterior or posterior nasal drip which may result in a cough)
• Facial pain or pressure
• Reduced or loss of smell

Other associated symptoms may include toothache (involving the upper teeth), tenderness, swelling, malaise and fever (Ah-See 2007). Clinically neck pain and stiffness and headache may also occur.