The effects of conti̇nuous and i̇ntermi̇ttent ultrasound i̇n myofaci̇al pai̇n sendrom

Introduction: This study seeks to compare potential effect of continuous, pulsed and sham modes of therapeutic ultrasound on pain, degree of muscle spasm, cervical function, quality of life and the depression in patients diagnosed with myofascial pain syndrome (MPS). Material and Methods: Sixty patients aged between 18-60 years admitted to outpatient service of department of Physical Treatment and Rehabilitation at Dicle University between April 2012 and May 2013 were enrolled into study. The MPS diagnoses were based on the Travell and Simons' diagnosis criteria. Patients fulfilling the diagnosis criteria were randomized into three groups. Standard stretching and range of motion exercises with a 10-minute application of hot pack to painful area were given to all patients. Patients in group one received continuous ultrasound, group two received pulsed ultrasound (ratio=1:1) and group three received sham ultrasound application (machine were shutdown) for five minutes in 10 sessions by the same investigator. Baseline to 12 and 24 weeks, patients' pain severity were measured with visual analogue scale (0-10 VAS) at rest, movement and palpation, quality of life measured with Nottingham Health Profile, cervical functions were measured using Neck Pain and Disability Scale and depression were measured using Beck's Depression Scale. Also degree of muscle spasm and patients' satisfaction were evaluated. Results: The findings between the groups in terms of age, gender, duration of pain, education and occupation were not statistically significant (p>0.05). All patients had significant improvement concerning the pain, degree of muscle spasm, cervical function, quality of life and the depression following the treatment (p<0.05). Depression scores of sham group and satisfaction scores of all groups were not significantly improved (p>0.05). When we have compared the results of the groups, pre-treatment rest pain of group one were significantly better, and other parameters were similar among all groups. Post-treatment scores of all groups were similar and no significant difference was detected. However, when we have compared the changes after treatment, improvement in pain at rest in group one and improvement in palpation pain in group one and two were significantly higher than the sham group (p<0.05), but other parameters were similar between the groups (p>0.05). Conclusion: Continuous ultrasound therapy showed significant improvement in pain at rest, and continuous and pulsed ultrasound therapy showed valuable improvement in palpation pain, psychological status of MPS patients in contrast to sham group but quality of life, pain at movement and degree of muscle spasm were nor significantly improved after treatment. Our findings need to be verified with further studies of larger cohorts.