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Reg D’Souza BPhil MCSP MBAcC
Clinical Specialist Physiotherapist
Pain Clinic, Royal Cornwall Hospitals
Trust Treliske, Truro, Cornwall. AACP Road show Bristol. 17th March, 2008.
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Myofascial Trigger points
A condition that causes damage to muscle
producing local and referred pain.
Symptoms are tenderness and referred pain.
It can be acute or chronic, local or generalised.
Associated with trauma, poor posture or excessive
strain of muscles. Complementary Therapies for Pain Management. An Evidence-Based
Approach. 2007. Editors: Edzard Ernst, Max Pittler and Barbara Wider.
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The good news is:
“The evidence suggesting that acupuncture
has beneficial effects for patients with
Myofascial pain is convincing.”
Complementary Therapies for Pain Management. An Evidence-Based
Approach. 2007. Editors: Edzard Ernst, Max Pittler and Barbara Wider.
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Physical signs
‘jump & shout’ reactions
Pain reproduction
Palpable taut bands
Local twitch response
Peau d’Orange subcutaneous tissue
thickening Dr P Baldry, 2001
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Symptoms of MTrPs
Pain
Restricted range of movement
Muscle weakness
Sleep disturbance
Peripheral hypothermia Dr P Baldry, 2001
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Trigger points can be active or
latent
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Active trigger point
Painful
Stiffness
Limited movement
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Latent trigger points
May not be painful
On examination there would be evidence of
limited movement
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The Pain Cycle
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Injury Pool
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Levator Scapula Acupuncture, Trigger Points and Musculoskeletal Pain. 1993 Dr P E Baldry
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Levator scapula referral pattern Dr P E Baldry 1993
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Piriformis Dr P Baldry, 1993
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Piriformis Dr P Baldry, 1993
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Piriformis Dr P Baldry, 1993
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Pressure Threshold Meter
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Treatment
Combining acupuncture “dry” needling with:
A progressive programme of stretching
exercises.
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Further reading
Complementary Therapies for Pain Management. An
Evidence-Based Approach. 2007. Editors: Edzard Ernst,
Max Pittler and Barbara Wider.
Myofascial Pain and Fibromyalgia Syndromes-A clinical
guide to diagnosis and management. P. E. Baldry. 2001
Myofascial Pain and Dysfunction. The Trigger point
manual. Janet Travell and David Simons. Two volumes:
One for the upper limb and second for the lower
extremities. 1983.
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Reg D’Souza BPhil MCSP MBAcC
Clinical Specialist Physiotherapist
Pain Clinic, Royal Cornwall Hospitals Trust Treliske,
Truro, Cornwall. AACP Road show Bristol. 17th March, 2008.
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Modifying Acupuncture when
treating Chronic pain
Anecdote
A tale of two acupuncturists
Practice tip.
A graded increase in treatment intensity
from gentle to strong stimulation, will
reduce the risk of exacerbating symptoms!
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Factors that will improve pain
relief
Frequency of treatment
Time of treatment Number of Sessions
Depth of needling
Position of needle Segmental/extrasegmental
Pain Relief
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To get the best results for the relief
of pain
1. Segmental or extra segmental points
2. Depth of needling
3. Treatment time
4. Frequency of treatment
5. Number of sessions
6. Optimum settings for electro acupuncture
7. Which type of pain responds best to
acupuncture.