Sustained Nociceptive Mechanical Stimulation of Latent Myofascial Trigger Point Induces Central Sensitization in Healthy Subjects

• Published in: The journal of pain Vol. 11; no. 12; pp. 1348 - 1355
• Main Authors: Xu, Yi-Meng, Ge, Hong-You, Arendt-Nielsen, Lars
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2010
• Subjects: Adult; Anesthesia & Perioperative Care; Central sensitization; Electromyography; Female; Humans; intramuscular electromyography; Male; Muscle Cramp - etiology; muscle cramps; Muscle, Skeletal - physiology; myofascial pain; Myofascial Pain Syndromes - complications; Pain Measurement - methods; Pain Medicine; Pain Threshold; Pain, Referred - etiology; pressure pain threshold; Central sensitization; muscle cramps; pressure pain threshold; intramuscular electromyography; myofascial pain
• DOI: 10.1016/j.jpain.2010.03.010
• ISSN: 1526-5900; 1528-8447

Abstract The aim of the study is to test if sustained nociceptive mechanical stimulation (SNMS) of latent myofascial trigger points (MTrPs) induces widespread mechanical hyperalgesia. SNMS was obtained by inserting and retaining an intramuscular electromyographic (EMG) needle within a latent MTrP or a nonMTrP in the finger extensor muscle for 8 minutes in 12 healthy subjects. Pain intensity (VAS) and referred pain area induced by SNMS were recorded. Pressure pain threshold (PPT) was measured immediately before and after, and 10-, 20-, and 30-minutes after SNMS at the midpoint of the contralateral tibialis anterior muscle. Surface and intramuscular EMG during SNMS were recorded. When compared to nonMTrPs, maximal VAS and the area under VAS curve (VASauc) were significantly higher and larger during SNMS of latent MTrPs (both, P < .05); there was a significant decrease in PPT 10 minutes, 20 minutes, and 30 minutes postSNMS of latent MTrPs (all, P < .05). Muscle cramps following SNMS of latent MTrPs were positively associated with VASauc ( r = .72, P = .009) and referred pain area ( r = .60, P = .03). Painful stimulation of latent MTrPs can initiate widespread central sensitization. Muscle cramps contribute to the induction of local and referred pain. Perspective This study shows that MTrPs are one of the important peripheral pain generators and initiators for central sensitization. Therapeutic methods for decreasing the sensitivity and motor-unit excitability of MTrPs may prevent the development of muscle cramps and thus decrease local and referred pain.