ORIJINAL ARAŞTIRMA
Miyofasiyal Ağrı Sendromunda Ekstrakorporeal Şok Dalga Tedavisi ve Lokal Anesteziklerle Tetik Nokta Enjeksiyonunun Etkinliğinin Karşılaştırılması
Comparison of the Efficacy of Extracorporeal Shock Wave Therapy and Trigger Point Injection with Local Anesthetics in Myofascial Pain Syndrome
Received Date : 25 Aug 2022
Accepted Date : 30 May 2023
Available Online : 07 Jun 2023
Hakan ÖZDİŞLİa, Özlem BİLGEN ÇİMENb, Günşah ŞAHİNb, Melek SEZGİNb,
Nurgül ARINCI İNCELb, Hamit GÖKSUc, Mehmet OKÇUd
aDepartment of Physical Medicine and Rehabilitation, Division of Rheumatology,
Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
bDepartment of Physical Medicine and Rehabilitation, Mersin University Faculty of Medicine, Mersin, Türkiye
cClinic of Physical Medicine and Rehabilitation, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye
dDepartment of Physical Medicine and Rehabilitation, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
Doi: 10.31609/jpmrs.2022-93064 - Makale Dili: EN
J PMR Sci. 2023;26(3):270-5
ÖZET
Amaç: Bu çalışmanın amacı, miyofasiyal ağrı sendromunun (MAS) tedavisinde
tetik nokta enjeksiyonunun (TNE) lokal anestezik ve ekstrakorporeal
şok dalga tedavisi [extracorporeal shock wave therapy (ESWT)] ile etkinliğini
karşılaştırmaktır. Gereç ve Yöntemler: Çalışmaya alınan 79 hasta randomizasyonla
TNE grubuna (n=39) ve ESWT grubuna (n=40) atandı. Her iki gruptaki
katılımcılar görsel analog skala [visual analog scale (VAS)], algometri, Nottingham
Sağlık Profili (NSP) ve Beck Depresyon İndeksi (BDI) ile ağrı, ağrı eşiği
skorları, yaşam kalitesi ve psikolojik durum açısından tedavi öncesi, tedaviden
sonra 1. haftada ve 1. ayda değerlendirildi. Birinci grupta (TNE grubu) her tetik
noktası için 0,1 cc %2 prilokain kullanılarak birer hafta arayla 3 TNE yapıldı.
İkinci grupta, tetik noktalara 1,8-3 bar basınç aralığında 400-800 10 Hz frekans
ile 3 haftalık seanslarda ESWT uygulandı. Tüm hastalara servikal ve sırt germe
ve postür egzersizlerini içeren ev egzersiz programı verildi. Bulgular: Gruplar demografik
özellikler ve VAS tedavi öncesi skorları açısından benzerdi. VAS, ağrı
basınç eşiği, NSP ve BDI skorları tedavinin 1. haftasında ve 1. ayında her iki
grupta da anlamlı olarak düzeldi. Tedavi sonrası 1. hafta ve 1. ayda VAS, ağrı
eşiği ve BDI skorları benzerdi (p>0,05). NSP skorları 1. haftada benzerdi; ancak
tedaviden sonraki 1. ayda ESWT grubunda anlamlı olarak daha düşük bulundu
(p=0,04). Sonuç: ESWT özellikle iğne fobisi olan hastalarda MAS için iyi bir alternatif
tedavi yöntemi olabilir.
Anahtar Kelimeler: Miyofasyal ağrı sendromu; tetik nokta enjeksiyonu; ekstrakorporeal şok dalga tedavisi
ABSTRACT
Objective: To compare the effectiveness of trigger point injection
(TPI) with local anesthetic and extracorporeal shock wave therapy (ESWT) in
treatment of myofascial pain syndrome (MPS). Material and Methods: Seventy-
nine patients in the study were randomly assigned to the TPI group (n=39)
and the ESWT group (n=40) using computer assistive randomization. Both groups
were evaluated for pain, pain threshold scores, life quality, and psychological status
with the visual analog scale (VAS), algometry, Nottingham Health Profile
(NHP), and Beck Depression Index (BDI) before treatment; at 1st week, and 1st
month after treatment. In group one (the TPI group), TPI was applied to trapezius,
levator scapula, rhomboid, deltoid or latissimus dorsi muscles three times at
one-week intervals using 0.1 cc of 2% prilocaine for every trigger point (TP). In
the second group, ESWT was applied to TPs in three weekly sessions with 400-
800 10 Hz frequency between 1.8-3 bar pressure range. All patients were given
a home exercise program, including cervical and back stretching and posture exercises.
Results: Groups were similar in demographic features and VAS pre-treatment
scores. VAS, pain pressure threshold, NHP, and BDI scores improved
significantly in both groups at 1st week and 1st month of treatment. VAS, pain
threshold and BDI scores were similar at 1st week and 1st month (p>0.05). NHP
scores were similar at 1st week; but were significantly lower in the ESWT group
at 1st month after treatment (p=0.04). Conclusion: ESWT may be a good alternative
treatment method for MPS, especially for patients with needle phobia.
Keywords: Myofascial pain syndrome; trigger point injection; extracorporeal shock wave therapy
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