Protocol Number: 02-CC-0245

Title:

The Natural History of Upper Trapezius Myofascial Trigger Points: Comparison of Local and Remote Tissue Milieu in Normal Muscle, Latent and Active Myofascial Trigger Points Over Time

Number:

02-CC-0245

Summary:

This study will use microdialysis to investigate myofascial pain. This pain is characterized by "trigger points" (exquisitely tender spots) in a group of tense muscle fibers that extend from the trigger point to the muscle attachments. Trigger points in the trapezius, a large muscle lying between the neck and shoulder, are typically caused by emotional stress, postures such as hunching shoulders, certain activities like using a telephone receiver without elbow support, or by wearing certain articles such as a heavy coat or heavy purse. Microdialysis uses a very thin needle probe (about the size and shape of an acupuncture needle) to collect and measure chemicals directly from soft tissue. Analysis of these chemicals will show whether changes in the tissue around a muscle with trigger points are confined to that muscle, or if these changes also occur in more distant muscles.

The study will examine two types of trigger points. An "active" trigger point causes pain or other abnormal symptoms and often causes problems with movement. A "latent" trigger point often causes movement problems without causing pain. Many healthy adults have latent trigger points.

People between 21 and 65 years of age with the following characteristics may be eligible for this study: 1) no neck pain or trigger points in either upper trapezius muscle; 2) no neck pain but a latent trigger point in at least one upper trapezius muscle; or 3) neck pain of less than 3 months' duration and an active trigger point in at least one upper trapezius muscle. Participants undergo the following procedures:

-Physical examination of the muscles of the neck and shoulder area, testing strength and range of motion, and response to palpation to find trigger points.

-Pain inventory. Subjects complete a questionnaire for measuring pain and its intensity, location, quality, causes, relievers, and associated symptoms. The questionnaire is filled in before and after each microdialysis procedure.

-Microdialysis in upper trapezius muscle. An electrode patch is placed on either side of the site for insertion of the microdialysis probe and another electrode is placed on the outer edge of the shoulder. The electrodes are used to measure any electrical activity that occurs with insertion or movement of the probe. The subject lies face down and the probe is inserted in the upper trapezius muscle. It remains in place for 5 minutes while chemical substances are collected from the muscle. It is then advanced about 1.5 cm deeper into the muscle until a twitch response is obtained and remains in place for 10 more minutes while substances are collected.

-Microdialysis in the gastrocnemius muscle (large muscle of the calf). The same procedure for the upper trapezius muscle is done in the calf muscle.

Sponsoring Institute:

National Institutes of Health Clinical Center (CC)

Recruitment Detail

Type: Participants currently recruited/enrolled

Gender: Male & Female

Referral Letter Required: No

Population Exclusion(s): Children

Eligibility Criteria:

INCLUSION CRITERIA:

A total of 24 adults are expected to be accrued (8 in each group; Normal, Latent and Active) ages 18-65, without pain and those with continuous idiopathic cervical pain of less than 3 months duration.

EXCLUSION CRITERIA:

Fibroymaylgia.

Cervical radiculopathy.

Lumbro-sacral radiculopathy.

Atypical facial neuralgia.

History of trigger point injections in the upper trapezius muscle.

History of cervical spine or shoulder surgery.

History of previous trigger point injections in the medial gastrocnemius muscle.

History of below the knee or above the knee amputation.

History of total knee arthroplasty.

History of bleeding disorder.

Subjects on anticoagulation therapy.

If the subject has taken aspirin within 3 days of needling.

Tobacco smokers.

Other concurrent pain syndromes.

On any NSAID, COX2 inhibitor, TCA, narcotic, antiepilectic, muscle relaxant, ancetaminophen or other medication for the purpose of pain relief.

Subjects who have an inoordinate fear of needles.

HEENT infections.

Cancer.

Knee pain.

History of DVT.

History of Baker's Cyst.

History of Myopathy.

History of meniscal tear.

History of anterior cruciate ligament/posterior cruciate ligament/medial collateral ligament/lateral collateral ligament tear.

History of knee surgery.

History of Achilles pathology or rupture.

Special Instructions:

Currently Not Provided

Keywords:

Pressure Pain Threshold

MTrP

Musculoskeletal Pain

Soft Tissue Pain

Pathophysiology

Myofascial Pain

Microdialysis

Myofascial Trigger Points

Rehabilitation

Recruitment Keyword(s):

Muscle Pain

Neck Pain

Healthy Volunteer

HV

Normal Control

Condition(s):

Neck Pain

Investigational Drug(s):

None

Investigational Device(s):

None

Intervention(s):

None

Supporting Site:

Warren G. Magnuson Clinical Center

Contact(s):

Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citation(s):

Quintner JL, Cohen ML Referred pain of peripheral nerve origin: an alternative to the "myofascialpain" constructClin J Pain 1994 Sep;10(3):243-51 ReviewPMID: 7833584

Hong CZ Pathophysiology of myofascial trigger pointJ Formos Med Assoc 1996 Feb;95(2):93-104 ReviewPMID: 9064014

Bohr T Problems with myofascial pain syndrome and fibromyalgia syndromeNeurology 1996 Mar;46(3):593-7 Review No abstract availablePMID: 8618650

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