新華醫院

新華醫院/物理治療師黃純政

＊簡介肌筋膜疼痛(Myofascial pain ; MFP)

雖然在目前對於肌筋膜疼痛的定義仍然不是這麼的明確，但是大多數人多半採用Simons於1999年時對於肌筋膜疼痛所下的一個定義，定義為”肌筋膜疼痛是由肌筋膜激發點所引起感於感覺、動作和自主方面的症狀＂，那些症狀包含：

1有局部的壓痛(Localized tenderness)

2轉移痛(Referred pain)

3可以被摸到的緊帶(Palpable band)

4抽蓄反應(Twitch response)

5疼痛感覺的改變(Recognition of pain)

6跳躍徵狀(Jump sign)

另外也有人描述和肌筋膜激發點有關的肌筋膜疼痛是一種由骨骼肌所產生非發性的疾病也和局部疼痛還有肌肉僵硬(muscle stiffness)有關。

而肌筋膜疼痛在一般人群中的發病率約從百分之三十和百分之八十五之間，不同的族群會有不同的發病率，較常見於女性，在患者年齡介於30歲~40歲之間時發病率是最高的，大多數的個案會在頭部、頸部、肩部、下背等區域會有局部性的疼痛。

＊定義肌筋膜激發點(Myofascial trigger point ; MTrP)

如前面所提過的，肌筋膜疼痛在Simon的定義中，是由於肌筋膜激發點所造成的，那什麼是肌筋膜激發點呢？肌筋膜激發點定義為 ”他是在緊帶上一個過度敏感的點 “然後這個點在被壓迫的時候會產生疼痛和轉移痛，而每條肌肉都有一定的轉移痛模式(characteristic/refers pain pattern)，肌筋膜激發點會發生在身體任何的部位，但是有部分的肌肉常會包含有肌筋膜激發點，尤其是在維持姿勢(posture muscle)的肌肉上。

＊現今定義肌筋膜激發點的標準

那要如何去判斷肌筋膜激發點呢？以Simon在1999年所提出的四項基本標準可以用來判斷肌筋膜激發點

1要摸的到緊帶

2按壓緊帶上的結節時 ,有強烈的壓痛感

3在按壓結節時會重現病人的疼痛(這點是針對活化的肌筋膜激發點而言)

4動作伸展的範圍會因為疼痛而被限制

另外可以用一些檢查來驗證，例如:

1可用視覺或觸覺去確認局部抽蓄反應(local twitch response,LTR)

2使用針去穿透那個結節(tender nodule)，去誘導出抽蓄反應

3當去按壓結節時會有疼痛或是感覺改變的情形

4使用肌電圖(EMG)去確認該點是否有自發性電位活動(spontaneous electrical activity,SEA)的情形

參考資料與圖片出處:
1. Sahin N, Albayrak I, Ugurlu H: Effect of different transcutaneous electrical stimulation modalities on cervical myofascial pain syndrome. Journal of Musculoskeletal Pain 2011, 19(1):18-23.
2. Renan-Ordine R, Alburquerque-Sendin F, de Souza DPR, Cleland JA, Fernandez-de-Las-Penas C: Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. The Journal of orthopaedic and sports physical therapy 2011, 41(2):43-50.
3. Ma C, Wu S, Li G, Xiao X, Mai M, Yan T: Comparison of miniscalpel-needle release, acupuncture needling, and stretching exercise to trigger point in myofascial pain syndrome. Clinical Journal of Pain 2010, 26(3):251-257.
4. Kostopoulos D, Nelson AJ, Ingber RS, Larkin RW: Reduction of Spontaneous Electrical Activity and Pain Perception of Trigger Points in the Upper Trapezius Muscle through Trigger Point Compression and Passive Stretching. Journal of Musculoskeletal Pain 2008, 16(4):267-267-279.
5. Farina S, Casarotto M, Benelle M, Tinazzi M, Fiaschi A, Goldoni M, Smania N: A randomized controlled study on the effect of two different treatments (FREMS AND TENS) in myofascial pain syndrome. Europa medicophysica 2004, 40(4):293-301.
6. Edwards J, Knowles N: Superficial dry needling and active stretching in the treatment of myofascial pain--a randomised controlled trial. Acupuncture in Medicine 2003, 21(3):80-86.
7. Janet G. Travell DGS: Myofascial pain and dysfunction the trigger point manual, volume 1. Upper half of body, second edition: David G. Simons, M.D., Janet G. Travell, M.D., Lois S. Simons, P.T., Williams & Wilkins, Baltimore, MD , Regional Anesthesia and Pain Medicine 1999, 24(4):378-379.
8. Hsueh TCT, Cheng PTP, Kuan TST, Hong CZC: The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 1997, 76(6):471-471-476.
9. Graff-Radford SB, Reeves JL, Baker RL, Chiu D: Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity. PAIN 1989, 37(1):1-5.
10. Rosenblatt RM, Corkill G: Transcutaneous electrical nerve stimulation in myofascial lumbar and cervical pain. Analysis of its efficacy and optimal electrode placement : Reg. Anesth., 8 (1983) 99-103. PAIN 1984, 19(2):196-196.
11 http://beverlyjacobsequinemassage.com/wp-content/uploads/2014/03/myofascial-pain-syndrome-10026_0.jpg
12 http://doylene.files.wordpress.com/2008/11/trap-pain-composite.jpg
13 http://www.tandempoint.com/images/fig7.jpg
14 http://www.epharmapedia.com/img/diseases/1310383905.jpg