Topical anesthetic to release trigger points in painful myofascial syndrome. Pilot study

Ana Paula de Oliveira Maciel Matheus Henrique Lopes Dominguete José Dias da Silva NetoAbout the authors

ABSTRACT

BACKGROUND AND OBJECTIVES:

The myofascial syndrome is a painful regional disorder that is characterized by the presence of painful points that cause referred pain in other sites different from the one of origin, known as trigger points. The use of topical anesthetic associated with acupressure to release trigger points helps to alleviate pain during the myofascial release. The objective of this study was to calibrate instruments to evaluate the topical anesthetic action of lidocaine in active myofascial trigger points during the myofascial release procedure.

METHODS:

Pilot, prospective study, tied with the Professional Master’s Degree in Health Applied Sciences of the University of Vale do Sapucaí, Pouso Alegre, MG, conducted with the purpose to evaluate the analgesic effect of lidocaine in concentrations of 2, 4 and 7% after 3, 5 and 10 minutes of the application in patients with painful myofascial syndrome.

RESULTS:

The descriptive statistics analysis showed a painful response in all lidocaine concentrations related to the evaluated times, except for 7% of lidocaine 10 minutes after the application.

CONCLUSION:

The myofascial release was more efficient using lidocaine at 7%, with a ten-minute interval for the anesthetic effect to start the physiotherapy intervention.

Keywords:
Anesthetics; Local anesthesia; Lidocaine; Myofascial pain syndromes; Trigger points

RESUMO

JUSTIFICATIVA E OBJETIVOS:

A síndrome miofascial é uma desordem dolorosa regional que se caracteriza pela presença de pontos dolorosos, que provocam dor referida em outros locais diferentes do de origem, conhecidos como pontos-gatilho. A utilização de anestésico tópico associado a digito-pressão na liberação de pontos-gatilho, tem a finalidade de aliviar a dor durante o procedimento de liberação miofascial. O objetivo deste estudo foi calibrar instrumentos para a avaliação da ação anestésica tópica de lidocaína em pontos-gatilhos miofasciais ativos, durante o procedimento de liberação miofascial.

MÉTODOS:

Estudo piloto prospectivo, vinculado ao Mestrado Profissional em Ciências Aplicadas à Saúde da Universidade do Vale do Sapucaí, Pouso Alegre, MG, realizado com a finalidade de avaliar o efeito analgésico do uso de lidocaína em concentrações de 2, 4 e 7% após 3, 5 e 10 minutos da aplicação em pacientes com síndrome dolorosa miofascial.

RESULTADOS:

A análise estatística descritiva demonstrou que houve resposta dolorosa em todas as concentrações da lidocaína relacionadas aos tempos avaliados, exceto para 7% de lidocaína após 10 minutos da aplicação.

CONCLUSÃO:

A liberação miofascial foi mais eficiente utilizando a lidocaína a 7%, com intervalo de efeito do anestésico para realização da intervenção fisioterápica de 10 minutos.

Descritores:
Anestesia local; Anestésicos; Lidocaína; Pontos-gatilho; Síndromes da dor miofascial

INTRODUCTION

Myofascial pain syndrome (MPS) is one of the most common causes of musculoskeletal pain, affecting the muscles, connective tissue and fascia, especially in the cervical region. Compromising 21 to 90% of people with regional pain complaints, MPS may occur isolated or associated with multiple factors, thus making it hard to diagnose and treat11 Yeng LT, Hideko H, Kaziyama S, Teixeira MJ. Myofascial pain syndrome. Rev Med. 2001;80(1):94-110.

2 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.
-33 Dommerholt J, Grieve R, Hooks T, Finnegan M. A critical overview of the current myofascial pain literature - January 2017. J Bodyw Mov Ther. 2017;21(1):141-7..

Clinically, MPS manifests itself with some key components, including trigger point (TP), segmental muscle spasm, referred pain and involvement of soft tissues, with variable degrees of pain22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,44 Fricton J. Myofascial Pain: Mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311.. In the patient with MPS, the diagnosis is performed through medical history and physical examination, mainly palpation of the TPs55 Kuan TS. Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009;13(5):365-9.. When the diagnosis is determined, the type of treatment to be used for MPS should be chosen to aim at the elimination of the TP, recovery of range of motion and muscle strength66 Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008;89(1):157-9.,77 Ay S, Konak HE, Evcik D, Kibar S. The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome. Rev Bras Reumatol. 2017;57(2):93-9..

TPs are clinically manifested as discrete nodules, hardened and painful, whose pathogenesis is not well defined yet. However, it is believed that this phenomenon is due to the enclosure of nerve endings in muscular fibers, onsetting the sensitization. Due to its high sensitivity to digital pressure, patients with TP manifest motor breakout, called stress signs, or referred pain in close locations44 Fricton J. Myofascial Pain: Mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311.,55 Kuan TS. Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009;13(5):365-9.,88 Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins; 1992.,99 Shah JP, Thaker N, Heimur J, Aredo J V, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM&R. 2015;7(7):746-61..

Several treatments are used with the purpose of recovering the quality of life of the patient with MPS. The release of the muscle and the fascia, performed through manual pressure on the TP, is the most effective treatment, but it causes a discomfort sensation and pain while being performed. Reduction of pain on the active TP may happen by producing an anesthetic coating around the painful area to be treated11 Yeng LT, Hideko H, Kaziyama S, Teixeira MJ. Myofascial pain syndrome. Rev Med. 2001;80(1):94-110.,22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,1010 Borg-Stein J, Simons DG. Myofascial pain. Arch Phys Med Rehabil. 2002;83(3 Suppl 1):S40-7.,1111 Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin. 2007;25(4):841-51..

There are different types of anesthetics with different basis that can be applied on superficial tissues for pain-associated treatment. Lidocaine has proven its efficacy in MPS in the form of a patch, adhered to the cutaneous region of the TP; however, its effect is on the long-term, preventing its use in the therapeutic practice at the time of the intervention22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,1212 Fisher A. Muscle pain: basic algorithm for pain management. Simpósio Internacionacional de Dor 2. 1995;1(1):72p.

13 Flores MP, Castro AP, Nascimento J. Analgésicos tópicos. Rev Bras Anestesiol. 2012;62(2):248-52.

14 Kaweski S. Topical anesthetic creams. Plast Reconstr Surg. 2008;121(6):2161-5.
-1515 Gerwin R. Botulinum toxin treatment of myofascial pain: A critical review of the literature. Curr Pain Headache Rep. 2012;16(5):413-22..

The literature presents numerous papers on MPS, but there are no approaches regarding topical anesthetic application techniques to prevent the pain caused by diagnosis procedures, and/or MPS treatment during the manipulation of the TP. Therefore, the proposal of the present study is to evaluate the most effective concentration and time range for the topical analgesic action of lidocaine used on taut bands region over active TPs during the myofascial release procedure.

METHODS

A prospective pilot study held with the purpose of calibrating instruments for posterior study with a larger sample, linked to the Master’s degree in Applied Health Sciences of Universidade do Vale do Sapucaí, a university in Pouso Alegre, MG.

The sample calculation was performed using the Gpower software, version 3.1.9.2 (University of Dusseldorf, Germany) establishing a total of 5 patients for the preliminary analysis. The sample was formed by healthy volunteer patients, non-pregnant, with ages from 30 to 65 years old, both genders, with no restriction regarding ethnicity, education and social class, with no hypersensitivity to topical anesthetics. Patients who accepted to participate in the research signed the Free and Informed Consent Form (FICT).

Volunteers were evaluated by the researcher in individual visits. The first procedure performed was the diagnosis, TP location and mapping, according to TP evaluation criteria established in the literature44 Fricton J. Myofascial Pain: Mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311.,55 Kuan TS. Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009;13(5):365-9.,88 Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins; 1992.,99 Shah JP, Thaker N, Heimur J, Aredo J V, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM&R. 2015;7(7):746-61.. The evaluated area was stabilized through the placement of the duly calibrated hand of the operator on the patient, in a painless place close to the TP. Muscle palpation was performed to locate the taut band with the purpose of finding the most sensitive area, thus selecting muscular fibers in which the TP indicates pain in the affected area. The TP was pressured, and the patient questioned about the presence of pain. Then, the TP was mapped using a ballpoint pen to outline the point area with a circumference.

The anesthetic chosen to conduct the study was lidocaine in gel/base cream22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,1616 Karaca I, Yapca OE, Adiyeke M, Toz E, Yildirim Karaca S. Effect of cervical lidocaine gel for pain relief in pipelle endometrial sampling. Eurasian J Med. 2017;48(3):189-91.. Patients were evaluated before and after the application of lidocaine by digital pressure of the TP, previously mapped for five seconds, using a questionnaire with dichotomous scoring set in “yes” and “no” regarding the presence and/or absence of pain, respectively. The drugs were applied in concentrations of 2, 4 and 7%, with three different waiting times to start the procedure (3, 5, and 10 minutes)1616 Karaca I, Yapca OE, Adiyeke M, Toz E, Yildirim Karaca S. Effect of cervical lidocaine gel for pain relief in pipelle endometrial sampling. Eurasian J Med. 2017;48(3):189-91., submitted in different sessions.

The study was performed in the Centro de Especialidades Odontológicas (CEO - Dental Specialty Center) in the city of Três Corações, Minas Gerais, Brazil. Submitted and approved by UNIVAS Research Ethics Committee, Brazil Platform, opinion 1.512.271 of 2016.

Statistical analysis

The information gathered from the questionnaires was input into a database (Microsoft Excel® - Microsoft Corporation) and statistically analyzed with the support of the SPSS® 20 for Windows (Statistical Package for Social Sciences). The data was submitted to descriptive statistical analysis and the results were expressed in percentage.

RESULTS

The instruments calibrated in this study were the concentration of lidocaine used and the drug’s time of action to perform the psychotherapeutic procedure. The descriptive statistical analysis showed a painful response in all concentrations of lidocaine related to the evaluated time, except for 7% of lidocaine in a 10-minute period (Table 1). Results are indicated in figure 2 regarding time/concentration.

Table 1
Negative responses to the pressure pain questionnaire

Figure 1
Trigger point outlined after analysis of palpation on the tautest muscle band

Figure 2
Negative pain responses in different concentrations of the anesthetic at different waiting times for the anesthetic effect

DISCUSSION

Chronic pain affects around 100 million adults, who have their quality of life and social impact inestimably affected by drugs, work disability, and depression. MPS is a muscular disorder that manifests itself through the high prevalence of chronic pain and difficult diagnosis. Control and relief of pain are necessary to maintain the well-being and quality of life of a patient with MPS, which justifies this study11 Yeng LT, Hideko H, Kaziyama S, Teixeira MJ. Myofascial pain syndrome. Rev Med. 2001;80(1):94-110.,22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,44 Fricton J. Myofascial Pain: Mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311.,99 Shah JP, Thaker N, Heimur J, Aredo J V, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM&R. 2015;7(7):746-61.,1717 Bron C, Dommerholt J, Stegenga B, Wensing M, Oostendorp RA. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskelet Disord. 2011;12(1):139.

18 Roman-Torres CV, Brandt WC, Muller KC, Cortelli SC, Aquino DR, Schwartz-Filho HO. Avaliação dos diferentes métodos utilizados no tratamento da síndrome dolorosa miofascial. Rev Gestão Saúde. 2015;12:1-9.

19 Batalha LM, Carreira MC, Correia MM. Dor para não ter dor: aplicação de anestésico tópico. Rev Enferm Ref. 2011;III Série (no 5):203-9.
-2020 Babaie S, Ghanbarzadeh S, Daravan S, Kouhsoltani M, Samishehkar H. Nanoethosomes for dermal delivery of lidocaine. Adv Pharm Bull. 2015;5(4):549-56..

Massage of TP during myofascial release therapy becomes a painful procedure due to the activation of proinflammatory cytokines in the region, accumulated by persistent local muscular contraction33 Dommerholt J, Grieve R, Hooks T, Finnegan M. A critical overview of the current myofascial pain literature - January 2017. J Bodyw Mov Ther. 2017;21(1):141-7.,44 Fricton J. Myofascial Pain: Mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311.,1515 Gerwin R. Botulinum toxin treatment of myofascial pain: A critical review of the literature. Curr Pain Headache Rep. 2012;16(5):413-22.,2121 Kalichman L, Ben David C. Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: a narrative review. J Bodyw Mov Ther. 2016;21(2):446-51.. Borg-Stein and Laccarino22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74. reported that MPS treatment should start by preventing these cytokines from forming. One form of treatment proposed by the authors is the infiltrative administration of local anesthetics in the region to relieve the painful symptoms. This methodology has been showing itself effective in multiple studies, including using bupivacaine associated with antidepressant1919 Batalha LM, Carreira MC, Correia MM. Dor para não ter dor: aplicação de anestésico tópico. Rev Enferm Ref. 2011;III Série (no 5):203-9.,2222 Giordano D, Raso MG, Pernice C, Agnoletti V, Barbieri V. Topical local anesthesia: focus on lidocaine-tetracaine combination. Local Reg Anesth. 2015;8:95-100.

23 Gupta P, Singh V, Sethi S, Kumar A. A comparative study of trigger point therapy with local anaesthetic (0.5% bupivacaine) versus combined trigger point injection therapy and levosulpiride in the management of myofascial pain syndrome in the orofacial region. J Maxillofac Oral Surg. 2016;15(3):376-83.
-2424 Weilbach C, Hoppe C, Karst M, Winterhalter M, Raymondos K, Schultz A, et al. Effectiveness of various formulations of local anesthetics and additives for topical anesthesia - a prospective, randomized, double-blind, placebo-controlled study. J Pain Res. 2017;10:1105-9.. Xie et al.2525 Xie P, Qin B, Yang F, Yu T, Yu J, Wang J, et al. Lidocaine injection in the intramuscular innervation zone can effectively treat chronic neck pain caused by MTrPs in the trapezius muscle. Pain Physician. 2015;18(5):E815-26. support these studies, presenting the lidocaine injection as therapy, reducing pain intensity, length and frequency of patients treated after six months of therapy. However, this type of treatment presents flaws, including injection fear by the patient, possible formation of painful stimulus and cardiovascular complications associated with the injection of antidepressants22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,1818 Roman-Torres CV, Brandt WC, Muller KC, Cortelli SC, Aquino DR, Schwartz-Filho HO. Avaliação dos diferentes métodos utilizados no tratamento da síndrome dolorosa miofascial. Rev Gestão Saúde. 2015;12:1-9.,1919 Batalha LM, Carreira MC, Correia MM. Dor para não ter dor: aplicação de anestésico tópico. Rev Enferm Ref. 2011;III Série (no 5):203-9.,2222 Giordano D, Raso MG, Pernice C, Agnoletti V, Barbieri V. Topical local anesthesia: focus on lidocaine-tetracaine combination. Local Reg Anesth. 2015;8:95-100..

Another proposed form of treatment is the topical application of anesthetics, with an expressive history of efficacy and safety to perform dermatological procedures2222 Giordano D, Raso MG, Pernice C, Agnoletti V, Barbieri V. Topical local anesthesia: focus on lidocaine-tetracaine combination. Local Reg Anesth. 2015;8:95-100.. For MPS treatment, the most used drugs are available as a 5% lidocaine patch and the eutectic mixture of local anesthetics (EMLA) in the form of a cream, containing prilocaine 2.5% and lidocaine 2.5%22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,1818 Roman-Torres CV, Brandt WC, Muller KC, Cortelli SC, Aquino DR, Schwartz-Filho HO. Avaliação dos diferentes métodos utilizados no tratamento da síndrome dolorosa miofascial. Rev Gestão Saúde. 2015;12:1-9.,2626 Ustun N, Arslan F, Mansuroglu A, Inanoglu D, Yagiz AE, Guler H, et al. Efficacy of EMLA cream phonophoresis comparison with ultrasound therapy on myofascial pain syndrome of the trapezius: A single-blind, randomized clinical study. Rheumatol Int. 2014;34(4):453-7.. Rauck, Busch e Marriott2727 Rauck R, Busch M, Marriott T. Effectiveness of a heated lidocaine/tetracaine topical patch for pain associated with myofascial trigger points: results of an open-label pilot study. Pain Pract. 2013;13(7):533-8. noted in their studies that the effect of lidocaine in patch form associated to heat significantly decreased pain during TP release procedure. Firmani, Miralles and Casassus2828 Firmani M, Miralles R, Casassus R. Effect of lidocaine patches on upper trapezius EMG activity and pain intensity in patients with myofascial trigger points: a randomized clinical study. Acta Odontol Scand. 2014;73(3):210-8. used lidocaine in patch form in a 5% concentration to compare to placebo regarding pain intensity and electromyography activity of the trapezius muscle, with this being a possible MPS aggravating factor when found in hyperactivity. These authors observed that pain intensity and electromyography activity decreased in lidocaine-group patients, showing its treatment efficacy. EMLA has been widely used and its efficacy has been reported when compared to other therapies22 Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.,1818 Roman-Torres CV, Brandt WC, Muller KC, Cortelli SC, Aquino DR, Schwartz-Filho HO. Avaliação dos diferentes métodos utilizados no tratamento da síndrome dolorosa miofascial. Rev Gestão Saúde. 2015;12:1-9.,2929 Sobanko JF, Miller CJ, Alster TS. Topical anesthetics for dermatologic procedures: a review. Dermatologic Surg. 2012;38(5):709-21.,3030 Sawynok J. Topical analgesics for neuropathic pain in the elderly: current and future prospects. Drugs Aging. 2014;31(12):853-62., but these drugs do not satisfy their use in patients with MPS. The waiting time for its effectiveness is around one to five hours, making it impossible to use for TP release during its manipulation. The use of patch was a therapy developed in a way to stay adhered to the patient for long periods of time, not having total effectiveness in the control of pain. The development of a fast-acting local anesthetic protocol for the treatment of TPs will aid in the improvement of pain during manipulation55 Kuan TS. Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009;13(5):365-9.,1616 Karaca I, Yapca OE, Adiyeke M, Toz E, Yildirim Karaca S. Effect of cervical lidocaine gel for pain relief in pipelle endometrial sampling. Eurasian J Med. 2017;48(3):189-91.. The use of anesthetic gel developed for this study influenced in the decrease of pain during TP manipulation in a way the patients did not present stress signs during pressure, indicating full desensitization of the area in a short amount of time, easing the removal of local cytokines.

Lidocaine gel has proven efficacy when used in mucous tissue, such as the uterine, genitourinary and oral mucosa2020 Babaie S, Ghanbarzadeh S, Daravan S, Kouhsoltani M, Samishehkar H. Nanoethosomes for dermal delivery of lidocaine. Adv Pharm Bull. 2015;5(4):549-56.,2323 Gupta P, Singh V, Sethi S, Kumar A. A comparative study of trigger point therapy with local anaesthetic (0.5% bupivacaine) versus combined trigger point injection therapy and levosulpiride in the management of myofascial pain syndrome in the orofacial region. J Maxillofac Oral Surg. 2016;15(3):376-83.,2424 Weilbach C, Hoppe C, Karst M, Winterhalter M, Raymondos K, Schultz A, et al. Effectiveness of various formulations of local anesthetics and additives for topical anesthesia - a prospective, randomized, double-blind, placebo-controlled study. J Pain Res. 2017;10:1105-9.,3131 Bastazini Júnior I, Martins AL, Alves FS, Nascimento DC. Estudo comparativo entre escores de dor após uso de duas preparações de lidocaína tópica. Surg Cosmet Dermatol. 2011;3(1):28-30.

32 Abd Ellah NH, Abouelmagd SA, Abbas AM, Shaaban OM, Hassanein KM. Dual-responsive lidocaine in situ gel reduces pain of intrauterine device insertion. Int J Pharm. 2018;538(1-2):279-86.

33 Gooran S, Pourfakhr P, Bahrami S, Fakhr Yasseri AM, Javid A, et al. A randomized control trial comparing combined glandular lidocaine injection and intraurethral lidocaine gel with intraurethral lidocaine gel alone in cystoscopy and urethral dilatation. Urol J. 2017;14(4):4044-7.
-3434 Peyronnet B, Drouin SJ, Gomez FD, Seisen T, Goujon A, Pradere B, et al. [Local analgesia during flexible cystoscopy in male patients: a non-inferiority study comparing XylocaineR gel to InstillagelR Lido]. Prog Urol. 2016;26(11-12):651-5. French. Pereira et al.3535 Pereira F, Shiroma HF, Urias MG, Yamada VH, Lima AAS, Hofling-Lima AL, et al. Pilot study comparing topical anesthetic agents in pterygium surgery: subconjunctival injection versus 2% lidocaine gel versus 5% lidocaine gel. Cornea. 2018;37(2):194-8. showed that the use of 5% lidocaine gel in eye surgeries presented effective results regarding previous subconjunctival lidocaine injection. In cutaneous tissue, although less effective, lidocaine shows promising results in concentrations higher than 5%2323 Gupta P, Singh V, Sethi S, Kumar A. A comparative study of trigger point therapy with local anaesthetic (0.5% bupivacaine) versus combined trigger point injection therapy and levosulpiride in the management of myofascial pain syndrome in the orofacial region. J Maxillofac Oral Surg. 2016;15(3):376-83.,3636 Okayasu I, Komiyama O, Ayuse T, De Laat A. Effect of topical lidocaine in the oral and facial regions on tactile sensory and pain thresholds. Arch Oral Biol. 2016;72:51-5.. However, Bastazini Júnior et al.3131 Bastazini Júnior I, Martins AL, Alves FS, Nascimento DC. Estudo comparativo entre escores de dor após uso de duas preparações de lidocaína tópica. Surg Cosmet Dermatol. 2011;3(1):28-30. reported that higher anesthetics concentration does not influence the sensitivity during dermatological procedures when compared to the same formulation in low concentration. When lidocaine is used in low concentration, it presents inferior analgesic results. According to Arab et al.3737 Arab V, Bagheri-Nesami M, Mousavinasab SN, Espahbodi F, Pouresmail Z. Comparison of the effects of hegu point ice massage and 2% lidocaine gel on arteriovenous fistula puncture-related pain in hemodialysis patients: a randomized controlled trial. J Caring Sci. 2017;6(2):141-51., 2% lidocaine concentration presented lower local analgesic effect compared to other therapies, such as the use of icy tips during venipuncture of arteriovenous fistulas. On the other hand, this study demonstrated that the anesthetic used in the 7% concentration achieved its analgesic peak 10 minutes after its application, compared to other concentrations used with similar times in which there was a painful response. This fact makes it feasible for clinical practice when used at 7% after 10 minutes of application.

No studies performed with the application of anesthetic gel for the manipulation of TP during the treatment of MPS were found in the literature. Due to the lack of evidence of this treatment methodology, it is necessary to carry out new physiotherapy clinical trials that develop a local anesthetic protocol in order to provide relief of the pain caused by myofascial release procedure. This pilot study calibrated instruments so a study with higher sample could be conducted.

CONCLUSION

This study defined as the protocol the use of 7% lidocaine topical anesthetic in a 10-minute utilization time.

  • Sponsoring sources: none.

REFERENCES

  • 1
    Yeng LT, Hideko H, Kaziyama S, Teixeira MJ. Myofascial pain syndrome. Rev Med. 2001;80(1):94-110.
  • 2
    Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357-74.
  • 3
    Dommerholt J, Grieve R, Hooks T, Finnegan M. A critical overview of the current myofascial pain literature - January 2017. J Bodyw Mov Ther. 2017;21(1):141-7.
  • 4
    Fricton J. Myofascial Pain: Mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311.
  • 5
    Kuan TS. Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009;13(5):365-9.
  • 6
    Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008;89(1):157-9.
  • 7
    Ay S, Konak HE, Evcik D, Kibar S. The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome. Rev Bras Reumatol. 2017;57(2):93-9.
  • 8
    Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins; 1992.
  • 9
    Shah JP, Thaker N, Heimur J, Aredo J V, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM&R. 2015;7(7):746-61.
  • 10
    Borg-Stein J, Simons DG. Myofascial pain. Arch Phys Med Rehabil. 2002;83(3 Suppl 1):S40-7.
  • 11
    Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin. 2007;25(4):841-51.
  • 12
    Fisher A. Muscle pain: basic algorithm for pain management. Simpósio Internacionacional de Dor 2. 1995;1(1):72p.
  • 13
    Flores MP, Castro AP, Nascimento J. Analgésicos tópicos. Rev Bras Anestesiol. 2012;62(2):248-52.
  • 14
    Kaweski S. Topical anesthetic creams. Plast Reconstr Surg. 2008;121(6):2161-5.
  • 15
    Gerwin R. Botulinum toxin treatment of myofascial pain: A critical review of the literature. Curr Pain Headache Rep. 2012;16(5):413-22.
  • 16
    Karaca I, Yapca OE, Adiyeke M, Toz E, Yildirim Karaca S. Effect of cervical lidocaine gel for pain relief in pipelle endometrial sampling. Eurasian J Med. 2017;48(3):189-91.
  • 17
    Bron C, Dommerholt J, Stegenga B, Wensing M, Oostendorp RA. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskelet Disord. 2011;12(1):139.
  • 18
    Roman-Torres CV, Brandt WC, Muller KC, Cortelli SC, Aquino DR, Schwartz-Filho HO. Avaliação dos diferentes métodos utilizados no tratamento da síndrome dolorosa miofascial. Rev Gestão Saúde. 2015;12:1-9.
  • 19
    Batalha LM, Carreira MC, Correia MM. Dor para não ter dor: aplicação de anestésico tópico. Rev Enferm Ref. 2011;III Série (no 5):203-9.
  • 20
    Babaie S, Ghanbarzadeh S, Daravan S, Kouhsoltani M, Samishehkar H. Nanoethosomes for dermal delivery of lidocaine. Adv Pharm Bull. 2015;5(4):549-56.
  • 21
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Publication Dates

  • Publication in this collection
    Apr-Jun 2018

History

  • Received
    29 Mar 2017
  • Accepted
    23 Mar 2018
Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
E-mail: dor@dor.org.br