Original ContributionComparison of intravenous NSAIDs and trigger point injection for low back pain in ED: A prospective randomized study
Introduction
Acute or chronic pain results in a remarkable burden for mankind from the clinical, economic, and social aspects. The most common cause of physician visits is the pain. Pain caused extra burden in the patients and their families; including opioid use and dependence, depression, poor social relationships and economic costs [1]. The feeling of pain is, in fact, one of the control mechanisms of the body. Pain transmits the information about the presence of injuries in the body tissues to the brain, allowing for awareness. This is a protective mechanism essentially [2].
Low back pain (LBP) is a common and expensive medical condition. LBP rarely refers to a serious disorder. The annual prevalence of low back pain in the US is estimated between 15% and 20% and its lifetime prevalence is over 60% [3]. LBP is one of the most common causes of admission to emergency departments (ED) [4,5]. LBP related accounts for approximately 2.5% of ED visits [6,7]. However the prevalence and analgesic management of LPB in the ED is still unclear [8].
Myofascial pain syndrome (MPS) is an uncommon cause of musculoskeletal pain. MPS is a neuromuscular disorder characterized by localized muscle tenderness and often manifests with pain in the back, shoulders, lower back; and tension-type headaches. The origin of the MPS is the presence of a hyperalgesic spot in the form of a painful band and it is called as a trigger point. A trigger point (TrP) is defined as a sensitivity felt at deeper levels in the musculoskeletal tissue, causing pain in the zone of reference, which is the region of pain associated with the TrP. The TrPs are localized only in the muscles and myofascial trigger points (MTrPs) are a common source of (regional) pain in patients presenting with musculoskeletal pain, with a lifetime prevalence of up to 85% in the general population [9]. The pain is usually localized in the TrP, and referred to the surroundings. The main objective in the treatment of MPS is to break the pain cycle by eliminating the trigger points. Currently, several therapies are available for treating myofascial trigger points; including massaging, stretching, dry needle injections, electrical stimulation, cold laser treatment, and ultrasound [10]. An insufficient treatment of pain will cause a significant socioeconomic burden, as well as, a reduction in the quality of lives of the affected individuals.
In our study, we aimed to compare the intravenously administered nonsteroidal anti-inflammatory drug (NSAID) treatment versus trigger point injection (TPI) in patients admitted to the emergency department due to pain caused by an LBP with TrPs.
Section snippets
Study design and setting
All patients were informed about the study and its procedures, and informed consents on paper were collected from the agreeing volunteers before their inclusion in the study. The study was approved by the Ethics Committee at Ataturk University Faculty of Medicine. Our study was conducted in the emergency department at Ataturk University, Faculty of Medicine between 01.04.2018 and 30.10.2018. The patients presenting to the emergency department with the complaint of LBP, who had trigger points as
Results
Our study was conducted on patients who presented to the emergency department due to LBP associated with identified TrPs. The patients were allocated to two groups at the time of admission so that a total of 80 individuals would be included in the study with 40 patients in either group. As some patients did not agree to participate in the study or some met with at least one of the exclusion criteria, a total of 54 patients completed the study with 22 (40.7%) patients in the TPI group and 32
Discussion
Our study was conducted on LBP patients who presented to the emergency department. Patients presenting to the emergency department due to LBP with TrPs; identified in the deep lumbar paraspinal muscles, right and left quadratus lumborum, and right and left gluteus medius muscles by means of the medical history and physical examination were included in the study. The aim of our study was to investigate the efficacy of trigger point injection in the emergency department. For this purpose,
Conclusion
In this small randomized study with several methodological limitations, TPI was superior to the intravenously administered NSAID in the acute treatment of LBP caused by trigger points. We believe that the trigger point injection should be a part of the acute treatment of LBP in the selected patient group.
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2020, American Journal of Emergency MedicineCitation Excerpt :The mean decrease in the VAS (delta VAS) and the mean of the percentage of reduction in the VAS scores were calculated. The study outcomes were stated as a >50% decrease in the VAS scores at the end of treatment [10] and a final score of ≤4 [11]. These two criteria were used to define clinically effective treatment.
Comparison of intradermal mesotherapy with systemic therapy in the treatment of low back pain: A prospective randomized study
2020, American Journal of Emergency MedicineCitation Excerpt :The correct use of mesotherapy requires clinical and pharmacological skills, aseptic technique, and convenient hygiene and sterilization procedures [8]. Our center has had a clinical experience in which the intradermal administration of drugs via mesotherapy and the trigger point injections in patients with musculoskeletal pain [4,17]. We also composed a cocktail solution, including a mixture of thiocolchicoside, lidocaine and tenoxicam, can be injected intradermally without complication and our clinical experience suggests our cocktail solution can be used effectively via mesotherapy [17].