Although trigger point related pain is widely recognised by health professionals, reliable clinical evaluation and imaging for diagnosis still eludes us. Many treatments in widespread use are poorly validated and not necessarily more effective than placebo. The application of a noxious stimulus may be the key to obtaining improvements in pain
perception. Less stimulatory interventions, such as laser and ultrasound, have not convincingly been shown to be beneficial. Most stimulatory interventions are able to induce subjective improvements in pain scores, if not objectively measurable improvement. Stretch, TENS(1), injection therapies, and dry needling have all shown benefit. Unfortunately, we have extremely limited data comparing results between different therapeutic approaches, in particular, invasive versus non-invasive from which to draw clinical conclusions.
Studies of invasive treatment utilising a placebo intervention have not found the active treatments to be any more effective. Importantly, the placebo interventions used are themselves, stimulatory. The amount of stimulation required to induce analgesia is currently unknown. Despite EMG evidence of changes in the regions of trigger points, muscle penetration does not seem to be necessary to produce an analgesic effect. The evidence is trending towards the magnitude of the effect being consistent regardless of the therapy chosen, or the depth of needle penetration, as long as some counter-stimulation is involved. The relative contributions of local tissue effects and central pain modulation to these clinical improvements require further investigation.
The choice of therapy can, therefore, be guided by patient specific criteria, the therapist’s experience and qualifications, and patient preference. The discomfort induced by the therapy, the likelihood of post-treatment soreness, and the current functional level of the patient are important to consider. (Put Reflexology on the patients list of treatments to choose") Dry needling may not be appropriate for someone with long standing chronic pain that is known to flare after deep massage treatment, but it may be the treatment of choice for an athlete with a regional pain that has not responded to previous soft tissue work. Needle phobias or other known adverse reactions will limit therapeutic choices.
Regardless of the treatment chosen, it is imperative to remember that trigger points are rarely an isolated phenomenon, and the key to successful long-term outcomes of any treatment regime is addressing the precipitating and predisposing factors for each particular patient. (Right up our "alley"!)
"ANOVA showed that there was a significant increase in pain threshold of the
subjects following reflexology when compared with sham TENS control data
(F(1,9)=5.68, P<0.05).Thus, for example at 60 min, pain threshold increased from a control mean value
(sham TENS) ± s.e. mean of 9.1 ± 1.4 s to 15.5 ± 2.1 s following reflexology
(P<0.01). Similarly, there was a significant increase in pain tolerance
(F(1,9) = 5.132, P<0.05). Thus, at 60 min, pain tolerance increased from a
control mean value ± s.e. mean of 120.2 ± 37.9 s to 171.4 ± 42.0 s (P<0.02).
The results of this study show that reflexology increases both pain
threshold and tolerance in human volunteers exposed to acute pain. These
findings indicate the possibility of using reflexology in the management of
pain."