Treatment of Myofascial Pain Syndrome in Patients Scheduled for Total Hip Arthroplasty
Authors: M Imamura, M Riberto, HHS Kaziyama, F Palacius, C Stappe, ST Imamura.
Division of Physical Medicine, Institute of Orthopedics and Traumatology, HC-FMUSP. Sao Paulo, Brazil.
Aims of the study: To evaluate the results of the treatment of myofascial component in patients scheduled for total hip arthroplasty (THA).
Methods: Thirteen men and 19 women scheduled for THA were examined by an experienced physiatrist for myofascial pain syndrome in the hip. Pain was evaluated by visual analogue scale (VAS) and pressure dolorimetry in the begging and during the treatment. Therapeutic approach consisted of inactivation of myofascial trigger points followed by physical therapy procedures, comparative study of data was done with Wilcoxon test.
Results: Eleven (34%) patients did not return for a second evaluation. Of those who continued in the study 12 had ostheoarthitis (OA), 4 a previous THA (20A and 2 aseptic necrosis) and 5 with other disorders. They were 14 women and 7 men, their average age was 56 years (ranging from 22 to 84). The medium VAS value significantly decreased from 6,1±2,5cm to 3,3±3,6 in the end of treatment (p<0,005). Medium pressure dolorimetry significantly increased from 2,5±1,4 kgf/cm2 to 4,2±1,9 kgf/cm2 (p<0,001). The most frequently affected muscles were the piriformis (20% of the muscles. treated), iliopsoas (18%), adutor longus (18%), gluteus medius (12,5%) and gluteus minimus (12,5%).
Conclusions: Myofascial pain syndrome represents an important component of pain in the patients scheduled for THA. Some clues about the origin of pain in OA may be inferred. A precise diagnosis is needed for an adequate planning of therapeutic approach.
ISCHEMIC PAIN: CLINICAL ASPECTS AND TREATMENT.
M Imamura, ST Imamura, NS Habu, MJ Teixeira. Division of Physical Medicine, Institute of Orthopedics and Traumatology, Sao Paulo Medical School, Sao Paulo, BRAZIL.
Purpose: To evaluate the clinical findings and result of treatment of ischemic pain in the lower limbs that did not improve with conventional analgesic and anti-ischemic procedures.
Method: 30 patients (16 male and 14 female) with mean age of 56.1 years (range 33-82) presenting lower limbs ischemic pain were evaluated. Peripheral vascular disease included arteriosclerosis obliterans, tromboangiitis obliterans, vascular trauma, arterial trombosis, lower limbs embolia and arteritis. Conservative treatment with tricyclic antidepressants, phenothiazines associated with non steroid anti-infiamatory drags and physical medicine and rehabilitation procedures were employed in all patients. Inactivation of myofascial trigger points was employed in 3 patients. Intravenous regional sympathetic blockade with guanethidine was performed in one patient. In those patients without symptomatic relief of pain with conservative treatment, spinal cord stimulation with epidural electrodes (2), lumbar epidural infusion of morphine (1) and lumbar sympathectomy (1) was performed.
Result: Statistical significant improvement in pain intensity measured lay visual analogue scale analysed by Wilcoxon test with significant level of 55% was demonstrated.
Conclusion: The therapeutic approach presented provided satisfactory results in patients with ischemic pain that failed to respond to conventional analgesic and anti-ischemic procedures.