Clinical and ultrasonographic evaluation of the efficacy of ultrasound and laser treatments in pati̇ents with myofascial pain syndrome

Objective: We aimed to demonstrate the efficacy of ultrasound and laser treatments applied to the myofascial active trigger point objectively with clinical and ultrasonographic evaluations. Materials and Methods: Patients with chronic neck pain and an active trigger point in the upper trapezius were included in the study. Patients were divided into 5 groups consisting of ultrasound, laser, sham ultrasound, sham laser and ultrasound+laser treatment with sequential randomization. All the patients who were involved in the study were given a home schedule consisting of stretching exercises for the upper trapezium muscle. Patients were evaluated three times before treatment, first and third months after treatment. As clinical evaluation parameters; pain via visual analogue scale (VAS), cervical lateral flexion angle with goniometer, physical function subgroup scale of short form-36 (SF-36), anxiety subgroup parameters of profile of mood scale and neck disability index were used. B-mode, Doppler and elastographic evaluation by ultrasonography; trigger point and elasticity measurement, TIS (Tissue Imaging Score) and BFS (Blood Flow Waveform Score) parameters were used. Results: Ultrasound therapy significantly improved both clinically and ultrasonographically (elastography, Doppler, TIS) parameters compared to placebo. Laser therapy showed no significant improvement in clinical parameters, but significant improvement in radiological parameters compared to placebo, especially in the third month. Significant improvement in both clinical and radiological parameters was detected in both early and late periods with combined therapy. Most of the evaluation parameters in the combined therapy were significantly improved compared with the laser therapy, whereas had no superiority to the ultrasound therapy except the pain evaluation at the first month after the treatment. Correlation between clinical and radiological parameters was found to be more significant and stronger in elasticity and Doppler parameters than trigger point size and TIS parameters, especially in the late period. Conclusion: High-power pain threshold ultrasound therapy was found to have a significant positive effect on most of the clinical and ultrasonographic parameters. In the beneficial effect of combined treatment, we believe that the contribution of high-power pain threshold ultrasound is higher. In the treatment of myofascial pain syndrome, when treatment cost and workload are considered, ultrasound therapy alone may be an alternative to combined treatment. Beyond macro-change / nodule in the tissue in myofascial pain syndrome, micro-changes / flexibility and blood-flow are more valuable.