TREATMENT OF MYOFASCIAL TRIGGER-POINTS WITH ULTRASOUND COMBINED WITH MASSAGE AND EXERCISE - A RANDOMIZED CONTROLLED TRIAL

The effect of treatment with ultrasound, massage and exercises on myof ascial trigger-points (MTrP) in the neck and shoulder was assessed in a randomised controlled trial. The outcome measures were pain at rest and on daily function (Visual Analogue Scale, VAS), analgesic usage, g lobal preference and index of MTrP. Long-term effect for treatment and control groups was assessed after 6 months using a questionnaire. The patients were randomised to three groups. The first group was treated with ultrasound, massage and exercise (A), the second group with sham -ultrasound, massage and exercise (B), while the third group was a con trol group (C). The duration of the study was 6 weeks. Treatment was g iven twice a week from the second to the fifth week. The number and in dex of MTrPs were recorded at each treatment session in groups A and B but only at entry as well as end of study in group C. VAS and analges ic usage was recorded in all three groups throughout the study period. Six months after the last treatment session a questionnaire was send to the patients. A total of 67 patients were included. Nine patients d ropped-out during the study, which left 58 patients that could be incl uded in the final analysis. Twenty patients were randomised to group A , 18 to group B and 18 to group C. A significant reduction in index we re found between treatment groups (A and B) and control group (C), but no difference between group A and B. VAS scores, analgesic usage or g lobal preference showed no difference between group A, B or C. The pat ients in the group C were offered treatment (ultrasound, massage, exer cise) after the 6 weeks treatment period. At the questionnaire after 6 month 44 (87%) of the 52 patients from all three groups who had treat ment responded. Sixty-four percent answered that they had had good or some effects, 68 percent were still doing the exercise programme and 1 7 percent had received other forms of therapy after they had completed the study. No difference between groups given ultrasound or sham ultr asound were found. It is concluded that US give no pain reduction, but apparently massage and exercise reduces the number and intensity of M TrP. The impact of this reduction on neck and shoulder pain is weak. ( C) 1998 International Association for the Study of Pain. Published by Elsevier Science B.V.