Multi-dimensional Study On The Treatment Of Non-specific Chronic Neck Pain With Radial Shockwave Combined With Lidocaine Injection At Myofascial Trigger Point Of Upper Trapezius Muscle

BackgroundNon-specific chronic neck pain,(NCNP)is a common type of neck pain.It refers to chronic pain in the anatomical area of the cervical spine and its muscle tissues,caused by a variety of factors rather than local tissue structural lesions,with no specific pathological manifestations,and characteristic signs and symptoms.The incidence rate is 22-70%,and the recurrence rate is high.The cause of NCNP is complex and lacks effective treatment measures,causing serious health problems and national economic losses,which need to be resolved urgently.Myofascial trigger points(MTr Ps)are hyperactive nodules in the tight muscle bands of Myofascial Pain Syndrome(MPS).According to this theory,MTr Ps are one of the major reasons for the clinical problem of NCNP.MTr Ps have a high prevalence in trapezius muscle due to its principal function in the mobility and stability of the neck.Trigger points in the trapezius muscle lead towards local pain and functional loss and develop vascular,electromyographic,and metabolic muscle changes in patients with chronic neck pain,therefore,upper trapezius MTr Ps is an important target for intervention in NCNP.MTr Ps intervention in the treatment of NCNP includes drug therapy and physical therapy.At present,there is commonly a single method as the main method of treatment.The most commonly used method of drug treatment is low-concentration lidocaine trigger point injection(Trigger Point Injection,TPI),as well as various forms of exercise therapy,physical therapy,acupuncture,etc.Whether it is TPI or other treatments,the efficacy of a single method is not satisfactory.In recent years,the application of radial shockwave therapy(r SWT)in chronic soft tissue diseases has gradually increased,and relatively good curative effects have been obtained,while r SWT has been used less in NCNP.Whether r SWT can improve NCNP and enhance the effect of lidocaine trigger point injection for the treatment of NCNP is worthy of discussion.Based on the above,the present study intends to recruit patients with NCNP using radial shockwave or low concentration lidocaine injection alone,or a combination of both to intervene in the upper trapezius MTr Ps,by using pain visual analog scale(Visual analog scale,VAS),neck disability index(Neck disability index,NDI),shoulder pain and disability index(Shoulder pain and disability index,SPADI)to determine the effect of radial shockwave on NCNP and the effect of radial shockwave on lidocaine injection in the treatment of NCNP;and by using musculoskeletal ultrasound,surface electromyography(SEMG),shear-wave elastography(Shear-wave elastography,SWE),infrared thermography(Infrared thermography,IRT),for multidimensional observation of radial shockwave on enhancing the effect of lidocaine injection in the treatment of NCNP.The results of the present study are expected to provide a new strategy and theoretical basis for the prevention and treatment of NCNP.Part-1 Role of intervention of myofascial trigger point of the upper trapezius with radial shockwave or lidocaine injection in the treatment of nonspecific chronic neck painObjective:To observe the effect of radial shockwave therapy or ultrasound-guided trigger point injection of low concentration lidocaine on the upper trapezius MTr Ps to treat NCNP.Material and Methods:1.A Randomized Clinical Trial(RCT)was conducted in the Department of Rehabilitation Medicine,China.2.Thirty-six participants were randomly divided into shockwave(n = 12),ultrasound-guided trigger point injection(n = 12),and control(standard care;conventional physical therapy treatment with heat therapy and exercise n = 12)groups.3.Participants were evaluated at the baseline before the treatment,at one week,and four weeks of post-treatment by using the Visual analog scale(VAS)to measure pain intensity,neck disability index(NDI)to measure neck functional disability,and shoulder pain and disability index(SPADI)to measure shoulder functional disability.Results:1.After one week of treatment1)VAS score: Compared with the control group,there was a significant reduction in pain in the shockwave group(p < 0.01)and the injection group(p < 0.01).There was no significant difference between the shockwave group and injection group(p > 0.05).2)NDI score: Compared with the control group,there was a significant reduction in neck disability index in the shockwave group(p < 0.01)and the injection group(p < 0.01).There was no significant difference between the shockwave group and injection group(p > 0.05).3)SPADI score: Compared with the control group,there was a significant reduction in shoulder disability index in the shockwave group(p < 0.05)and the injection group(p < 0.05).There was no significant difference between the shockwave group and injection group(p > 0.05).2.After four weeks of treatment1)VAS score: Compared with the control group,there was a significant reduction in pain in the shockwave group(p < 0.01)and the injection group(p < 0.01).There was no significant difference between the shockwave group and injection group(p > 0.05).2)NDI score: Compared with the control group,there was a significant reduction in neck disability index in the shockwave group(p < 0.01)and the injection group(p < 0.01).There was no significant difference between the shockwave group and injection groups(p > 0.05).3)SPADI score: Compared with the control group,there was a significant reduction in shoulder disability index in the shockwave group(p < 0.05)and the injection group(p < 0.05).There was no significant difference between the shockwave group and injection group(p > 0.05).Conclusion:1.Radial shockwave is as effective as lidocaine injection at the trigger point,which can alleviate the pain of patients with NCNP faster than conventional physical therapy.2.Radial shockwave is as useful as lidocaine injection at the trigger point,which improves cervical spine dysfunction in patients with NCNP more effectively than conventional physical therapy.3.There is no significant difference between radial shockwave and lidocaine injection at trigger point in rapid pain relief and dysfunction.(?) The intervention of upper trapezius MTr Ps with radial shockwave or lidocaine injection is more effective than conventional physical therapy in the treatment of NCNP.Part-2 Effect of radial shockwave on lidocaine injection at the myofascial trigger point of upper trapezius for non-specific chronic neck painObjective:To explore the difference in the efficacy of radial shockwave combined with ultrasound-guided lidocaine injection at MTr P,single radial shockwave or lidocaine injection,and conventional physical therapy on patients with NCNP.Material and Methods:1.A Randomized Clinical Trial(RCT)was conducted in the Department of Rehabilitation Medicine,China.2.Sixty-eight participants were randomly divided into shockwave group(radial shockwave therapy,n = 16),injection group(ultrasound-guided lidocaine injection at MTr P,n = 18),combined group(radial shockwave combined with lidocaine injection,n = 18),and control group(standard care;conventional physical therapy treatment with heat therapy and exercises,n =16).3.Participants were evaluated at the baseline before the treatment,at one week,at four weeks,and three months of post-treatment by using the Visual analog scale(VAS)to measure pain intensity,neck disability index(NDI)to measure neck functional disability,and shoulder pain and disability index(SPADI)to measure shoulder functional disability.Results:1.After one week of treatment1)VAS score: Compared with the control group,the VAS scores of the patients in the shockwave group(p < 0.01),injection group(p < 0.01),and combined group(p < 0.01)were significantly reduced.Compared with the shockwave group and injection group,the VAS score of the combined group was significantly reduced(p < 0.05),but there was no significant difference between the shockwave group and the injection group(p > 0.05).2)NDI score: Compared with the control group,the NDI scores of the shockwave group,injection group,and combined group were significantly lower(p < 0.01);Compared with the shockwave group and the injection group,the NDI score of the combined group decreased more significantly(p < 0.05),while there was no significant difference between the shockwave group compared with the injection group(p > 0.05).3)SPADI score: Compared with the control group,the SPADI score of the shockwave group and the injection group(p < 0.05),and the SPADI score of the combined group(p < 0.01)were significantly decreased.There was no significant difference between the shockwave group,injection group,and combined group(p > 0.05).2.After four weeks of treatment1)VAS score: Compared with the control group,the VAS score of patients in the shockwave group,injection group,and combined group were significantly reduced(p < 0.01);Compared with the shockwave group and the injection group,the VAS score of the combined group was significantly reduced(p < 0.05),but there was no significant difference between the shockwave group and the injection group(p > 0.05).2)NDI score: Compared with the control group,the shockwave group,and the injection group was significantly decreased(p < 0.05),while the changes in the combined group were more significant(p < 0.01);compared with the shockwave group and the injection group,the NDI score of the combined group decreased more significantly(p < 0.05),while the shockwave group had no significant difference as compared with the injection group(p > 0.05).3)SPADI score: Compared with the control group,the SPADI score of the shockwave group and the injection group were significantly improved(p < 0.05),and the SPADI score of the combined group was more significant(p < 0.01);compared with the shockwave group and the injection group,the SPADI score of the combined group decreased more significantly(p < 0.05),while there was no significant difference between the shockwave group and injection group(p > 0.05).3.After three months of treatment1)VAS score: Compared with the control group,the VAS score of patients in the shockwave group and injection group had no significant difference(p > 0.05),but the VAS score of the combined group was significantly reduced(p < 0.05);Compared with the shockwave group and the injection group,the VAS score of the combined group was significantly reduced(p < 0.05),but there was no significant difference between the shockwave group and the injection group(p > 0.05).2)NDI score: Compared with the control group,the NDI score of patients in the shockwave group and injection group had no significant difference(p > 0.05),but the NDI score of the combined group was significantly reduced(p < 0.05);Compared with the shockwave group and the injection group,the NDI score of the combined group was significantly reduced(p < 0.05),but there was no significant difference between the shockwave group and the injection group(p > 0.05).3)SPADI score: Compared with the control group,the SPADI score of patients in the shockwave group and injection group had no significant difference(p > 0.05),but the SPADI score of the combined group was significantly reduced(p < 0.05);Compared with the shockwave group and the injection group,the SPADI score of the combined group was significantly reduced(p < 0.05),but there was no significant difference between the shockwave group and the injection treatment group(p > 0.05).Conclusion:1.Radial shockwave enhanced and prolonged the effect of lidocaine injection at the upper trapezius myofascial trigger point in improving the neck pain of patients with NCNP.2.Radial shockwave enhanced and prolonged the effect of lidocaine injection at the upper trapezius myofascial trigger point in improving the neck functional disability of patients with NCNP.3.Radial shockwave enhanced and prolonged the effect of lidocaine injection at the upper trapezius myofascial trigger point in improving shoulder dysfunction of patients with NCNP.(?) Radial shockwave can enhance and prolong the effectiveness of lidocaine injectionat the upper trapezius myofascial trigger point in NCNP rather than control andsingle therapy alone.Multi-dimensional observation of the role of radial shockwave on enhancing the effect of lidocaine injection at the myofascial trigger point of upper trapezius in the treatment of non-specific chronic neck pain Part-3Objective:Use multiple detection methods including surface electromyography,sonoelastography,infrared thermography imaging to analyze the effect of the intervention of MTr Ps in NCNP by applying radial shockwave combined with lidocaine injection from multiple dimensions which include two-dimensional structure,electrical activity,elastic stiffness,and muscle metabolism.Material and Methods:1.A single-blinded,Prospective Randomized Clinical Trial(RCT)was conducted in the Department of Rehabilitation Medicine,China.2.Sixty-eight participants were randomly divided into shockwave group(radial shockwave therapy,n = 16),injection group(ultrasound-guided lidocaine injection at trigger point,n = 18),combined group(radial shockwave therapy combined with lidocaine injection at the trigger point,n = 18),and control group(standard care;conventional physical therapy treatment with heat therapy and exercises n = 16)group.3.Combine palpation and ultrasound check was performed to evaluate the twodimensional structural changes of the trigger point of the upper trapezius muscle before treatment,1 week after treatment,and 4 weeks after treatment.4.The surface electromyography(sEMG)was used to measure the spontaneous electrical activity and changes in the potential activity of the upper trapezius muscle were evaluated before treatment,1 week after treatment,and 4 weeks after treatment.5.Shear wave sonoelastography(SWE)was used to evaluate the changes in the elasticity of the upper trapezius muscle before treatment,1 week,and 4 weeks after treatment.6.Infrared thermography(IRT)was performed to measure the skin temperature changes in the trapezius muscle before treatment,1 week,and 4 weeks after treatment.Results:1.After 1 week of treatment1)s EMG: Compared with the control group,the spontaneous electrical activity of the shockwave group(p < 0.05),the injection group(p < 0.05),and the combination group(p < 0.01)was significantly reduced;Compared with the shockwave group and the injection group,there was no significant reduction in spontaneous electrical activity in the combined group(p > 0.05).2)SWE: Compared with the control group,the shockwave group(p < 0.05),the injection group(p < 0.05),and the combined group(p < 0.01)have a significant reduction in the elastic stiffness;Compared with the shockwave group and the injection group,the elastic stiffness of the combined group was significantly reduced(p < 0.05).3)IRT: Compared with the control group,the skin temperature of the shockwave group(p >0.05)and the injection group(p > 0.05)did not decrease significantly,but the local skin temperature of the combined group(p < 0.05)had significant reduction;Compared with the shockwave group and the injection group,the combined group showed no significant change(p > 0.05).2.After 4 weeks of treatment1)s EMG: Compared with the control group,the spontaneous electrical activity of the shockwave group(p < 0.05),the injection group(p < 0.05),and the combination group(p < 0.01)was significantly reduced;Compared with the shockwave group and the injection group,there was a significant reduction in spontaneous electrical activity in the combined group(p < 0.05).2)SWE: Compared with the control group,the shockwave group(p < 0.05),the injection group(p < 0.05),and the combined group(p < 0.01)have a significant reduction in the elastic stiffness;Compared with the shockwave group and the injection group,the elastic stiffness of the combined group was significantly reduced(p < 0.05).3)IRT: Compared with the control group,the skin temperature of the shockwave group(p > 0.05)and the injection group(p > 0.05)did not decrease significantly,but the local skin temperature of the combined group(p < 0.05)had significant reduction;Compared with the shockwave group and the injection group,the combined group showed no significant change(p > 0.05).Conclusion:1.The present study showed the effectiveness of radial shockwave combined with lidocaine injection at trigger point in the treatment of NCNP.2.The study showed significant changes in electrical activity,elastic stiffness,and temperature changes after the intervention of upper trapezius MTr P in NCNP with radial shockwave and lidocaine injection.It showed greater effectiveness when shockwave combined with lidocaine injection.3.It may be more conducive to explore the underlying mechanism of NCNP by applying multiple evaluation methods in treatment.(?)The use of multiple evaluation methods in the combined treatment of shockwave and lidocaine injection on myofascial trigger points can be more effective to explore the underlying mechanism of NCNP.