為了評估針刺療效以及減少安慰劑效應，試驗設計以隨機、單盲之 對照試驗，除了評估頸部活動度改善以及疼痛強度減少情況，也評估病 患生活品質，因為對於慢性疼痛病患而言，生活品質與生理健康狀態的 重要性並不亞於身體上的病痛。
在病患基本特性以及自認治療方式正確性兩組皆無差異的情況下，
針刺與假針刺對於頸部活動度及疼痛程度均有所改善，但未達到統計顯 著差異，然而針刺在完成治療後 12 週評估時，於身體心理功能以及情緒 角色受限的改善上，顯現明顯優於假針刺。而且試驗過程中，一位病患 左側風池穴瘀青、另一位有輕微暈眩，兩位病患症狀輕微且快速緩解，
顯示針刺是相當安全的一種治療方式。
對於慢性頸部 MPS，針刺治療對於頸部活動及疼痛有改善效果，針 刺治療更是有助於生活品質的改善。此外，針刺對於疼痛而言是一個安 全的治療工具。然而大規模的研究、設立第三組別藥物組以及加入客觀 具有疾病特異性的生化評估項目是未來進一步研究設計的方向。
參 考 文 獻
1. Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction:
the trigger point manual. 2 ed. Vol. upper half of body.Williams &
Wilkins, Baltimore 1999.
2. Skootsky SA, Jaeger B,Oye RK.Prevalence of myofascial pain in general internal medicine practice. West J Med. 1989; 151:157-160.
3. Gerwin RD. A study of 96 subjects examined both for fibromyalgia and myofascial pain. J Musculoskelet Pain.1995;3:121.
4. Kaergaard A, Andersen JH. Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis. Occup Environ Med. 2000;57:528-534.
5. Simons DG. Fibrositis/fibromyalgia: a form of myofascial trigger points? Am J Med. 1986;81:93-8.
6. Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol. 2007;21:367-387.
7. Aronoff GM. Myofascial Pain Syndrome and Fibromyalgia: A Critical Assessment and Alternate View. Clin J Pain. 1998; 14: 74-78.
8. Mense S. Pathophysiologic basis of muscle pain syndromes. Phys Med Rehabil Clin North Am. 1997;8:23-53.
9. Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil. 2002;83:S40-47.
10. Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil.
1998;79:863-872.
11. Kuch K, Cox B, Evans RJ, Watson PC, Bubela C. To what extent do anxiety and depression interact with chronic pain? Can J Psychiatry.
1993;38:36-38.
12. Krishnan KR, France RD, Pelton S, McCann UD, Davidson J, Urban BJ. Chronic pain and depression. I. Classification of depression in chronic low back pain patients. Pain. 1985;22: 279-287.
13. Brown GK. A causal analysis of chronic pain and depression. J Abnorm Psychol. 1990;99:127-137.
14. Balfour GW. Observations on the pathology and cure of rheumatism.
Edinb Med Surg J. 1815;11:168-187.
15. Scudamore C. A Treatise on the Nature and Cure of Rheumatism.
Longman, London 1827.
16. Gowers WR. Lumbago: its lessons and analogues. Br Med J.
1904;1:117-121.
17. Valleix F. Traite´ des Neuralgies; ou, affections douloureuses des nerfs. Ballie`re, Paris 1841.
18. Cornelius A. Narben und Nerven. Dtsch Milita¨ra¨rztlische Z.
1903;32:657-673.
19. Osler W. The Principles and Practice of Medicine. 7 ed. Appleton, New York 1909.
20. Hunter C. Myalgia of the abdominal wall. Can Med Assoc J.
1933;28:157-161.
21. Kellgren JH. A preliminary account of referred pains arising from muscle. Br Med J (Clin Res Ed). 1938;1:325-327.
22. Travell JG, Simons DG. Myofascial Pain and Dysfunction. The Trigger Point Manual. The Lower Extremities. 1 ed. Vol. 2. Williams
& Wilkins, Baltimore 1992.
23. Travell JG, Simons DG. Myofascial Pain and Dysfunction. The Trigger Point Manual. The Upper Extremities. 1 ed. Vol. 1. Williams
& Wilkins, B altimore 1983.
24. Simons DG. Myofascial pain caused by trigger points. In: Muscle Pain: Understanding its Nature, Diagnosis, and Treatment, Eds Mense S, Simons DG and Russel I, Lippincott Williams & Wilkins,
Philadelphia 2001;pp. 205-288.
25. Simons DG, Travell JG. Myofascial pain syndromes.In: Textbook of Pain, Eds Wall PD and Melzack R, Churchill Livingstone, New York 1984;pp. 263-276.
26. Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2007;21:427-445.
27. Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol. 1985; 60:615-623.
28. Fishbain DA, Goldberg M, Meagher BR, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain. 1986;26:181-197.
29. Kraybak B, Borg-Stein J, Oas J, Dumais D. Reduced dizziness and pain with treatment of cervical myofascial pain [abstract]. Arch Phys Med Rehabil. 1996;77:939-940.
30. Goldman LB, Rosenberg NL. Myofascial pain syndrome and fibromyalgia. Semin Neurol. 1991;11:274-280.
31. Baldry PE. Myofascial Pain and Fibromyalgia Syndromes. Churchill Livingstone, Edinburgh 2001.
32. Mense S, Simons DG, Russell I. Muscle Pain: Understanding its Nature, Diagnosis and Treatment. Lippincott Williams & Wilkins, Philadelphia 2001.
33. Tough EA, White AR, Richards S, Campbell J. Variability of criteria used to diagnose myofascial trigger point pain syndrome--evidence from a review of the literature. Clin J Pain. 2007;23:278-286.
34. Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain.
1986;24:313-321.
35. Delaney GA, McKee AC. Inter- and intra-rater reliability of the pressure threshold meter in measurement of myofascial trigger point
sensitivity. Am J Phys Med Rehabil. 1993;72:136-139.
36. Bendtsen L, Jensen R, Jensen NK, Olesen J. Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues.[see comment]. Pain. 1994;59:235-239.
37. Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain. 1996;65:259-264.
38. Shah JP, Philips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99:1977-1984.
39. Chen Q, Bensamoun S, Basford JR, Thompson JM, An KN.
Identification and quantification of myofascial taut bands with magnetic resonance elastography.[see comment]. Arch Phys Med Rehabil. 2007;88:1658-1661.
40. Simons DG, Stolov WC. Microscopic features and transient contraction of palpable bands in canine muscle. Am J Phys Med Rehabil. 1976;55:65-88.
41. Windisch A, Reitinger A, Traxler H, Radner H, Neumayer C, Feigl W, Firbas W. Morphology and histochemistry of myogelosis. Clin Anat.
1999;12:266-271.
42. Hong CZ, Torigoe Y. Electrophysiologic characteristics of localized twitch responses in responsive bands of rabbit skeletal muscle fibers. J musculoskelet pain. 1994;2:17-43.
43. Hong CZ. Myofascial trigger point injection. Crit Rev Phys Rehab Med. 1993;5:203-217.
44. Hong CZ. Consideration and recommendation of myofascial trigger point injection. J Musculoskelet Pain. 1994;2:29-59.
45. 張 英 明 、 洪 章 仁 ： 肌 膜 疼 痛 症 候 群 的 新 觀 點
。
內 科 學 誌 1995;6:218-227.46. 洪章仁:肌激痛點之病態生理學。當代醫學 2002;29:912-915.
47. Bahr R, Blumberg H, Janig W. Do dichotomizing afferent fibersexist
which supply visceral organs as well as somatic structures? A contribution to the problem of referred pain. Neurosci Lett.
1981;24:25-28.
48. Hoheisel U, Mense S, Simons DG, Yu XM. Appearance of new
receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain?
Neurosci Lett. 1993;153:9-12.
49. Vecchiet L, Vecchiet J, Giamberardino MA. Referred muscle
pain: clinical and pathophysiologic aspects. Curr Rev Pain.
1999;3:489-498.
50. Davidoff RA. Trigger points and myofascial pain: toward understanding how they affect headaches. Cephalalgia.
1998;18:436-448.
51. Argoff CE, Wheeler AH. Spinal and radicular pain disorders. Neurol Clin. 1998;16:833-849.
52. Wheeler AH. Myofascial pain disorders: theory to therapy. Drugs.
2004;64:45-62.
53. Davies J. Selective depression of synaptic transmission of spinal neurones in the cat by a new centrally acting muscle relaxant, 5-chloro-4-(2-imidazolin-2-yl-amino)-2, 1, 3-benzothiodazole (DS103-282). Br J Pharmacol. 1982;76:473-481.
54. Ono H, Mishima A, Ono S, Fukuda H, Vasko MR. Inhibitory effects of clonidine and tizanidine on release of substance P from slices of rat spinal cord and antagonism by alpha-adrenergic receptor antagonists.
Neuropharmacology. 1991;30:585-589.
55. Longmire DR. The relationship between the sympathetic nervous system and chronic myofascial pain has led to the use of the term chronic neuro-muscular pain (CNMP). American Academy of Pain Management Annual Meeting Pain Management: A Decade of Intergrating Clinical Services, Las Vegas (NV) 1999.
56. Turturro MA, Frater CR, D'Amico FJ. Cyclobenzaprine with ibuprofen versus ibuprofen alone in acute myofascial strain: a randomized, double-blind clinical trial. Ann Emerg Med.
2003;41:818-826.
57. Rosenberg JM, Harrell C, Ristic H, Werner RA, de Rosayro AM. The Effect of Gabapentin on Neuropathic Pain. Clin J Pain.
1997;13:251-255.
58. Cheshire WP, Abashian SW, Mann JD. Botulinum toxin in the treatment of myofascial pain syndrome [see comment]. Pain.
1994;59:65-69.
59. Wheeler AH, Goolkasian P, Gretz SS. A randomized, double-blind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome.
Spine. 1998;23:1662-1667.
60. Crockett DJ, Foreman ME, Alden L, Blasberg B. A comparison of treatment modes in the management of myofascial pain dysfunction syndrome. Biofeedback Self Regul. 1986;11:279-291.
61. Gam AN, Warming S, Larsen LH, Jensen B, Hoydalsmo O, Allon I, Andersen B, Gotzsche NE, Petersen M, Mathiesen B. Treatment of myofascial trigger-points with ultrasound combined with massage and exercise--a randomised controlled trial. Pain. 1998;77:73-79.
62. Graff-Radford SB, Reeves JL, Baker RL, Chiu D. Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity. Pain. 1989;37:1-5.
63. Airaksinen O, Pontinen PJ. Effects of the electrical stimulation of myofascial trigger points with tension headache. Acupunct Electrother Res. 1992;17:285-290.
64. Jaeger B, Reeves JL. Quantification of changes in myofascial trigger point sensitivity with the pressure algometer following passive stretch.
Pain. 1986;27:203-210.
65. Hsueh TC, Cheng PT, Kuan TS, Hong CZ. The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. Am J Phys Med Rehabil.
1997;76:471-476.
66. Hong CZ. New trends in myofascial pain syndrome. Zhonghua Yi Xue Za Zhi (Taipei). 2002;65:501-512.
67. Majlesi J, Unalan H. High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study. Arch Phys Med Rehabil.
2004;85:833-836.
68. Beckerman H, de Bie RA, Bouter LM, De Cuyper HJ, Oostendorp RA.
The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther.
1992;72:483-491.
69. Lundeberg T, Hode L, Zhou J. Effect of low power laser irradiation on nociceptive cells in Hirudo medicinalis. Acupunct Electrother Res.
1988;13:99-104.
70. Lundeberg T, Zhou J. Low power laser irradiation does not affect the generation of signals in a sensory receptor. Am J Chin Med.
1988;16:87-91.
71. Hong CZ. Treatment of myofascial pain syndrome. Curr Pain Headache Rep. 2006;10:345-349.
72. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82:986-992.
73. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73:256-263.
74. Fine PG, Milano R, Hare BD. The effects of myofascial trigger point injections are naloxone reversible. Pain. 1988;32:15-20.
75. Baldry PE. Acupuncture, Trigger Points and Musculoskeletal Pain.
3rd ed. Churchill Livingstone, Edinburgh 2004.
76. Bowsher D. Mechanisms of acupuncture. In: Medical Acupuncture- A Western Scientific Approach, Eds Filshie J and White A, Churchill Livingstone, Edinburgh 1998; pp.69-82.
77. Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M.
Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. J Neurol. 2005;252:307-314.
78. 林昭庚、中國醫藥大學、長庚大學:新編彩圖針灸學 2009; pp.
620-623.
79. 奚中和:中醫學概要，江蘇省 2004;pp. 264-266.
80. 黃維三:針灸科學 第三版，國立編譯館 2007;pp. 9-13.
81. Research Group of Acupuncture Anesthesia. Peking Medical College.
The role of some neurotransmitters of brain in finger-acupuncture analgesia. Sci Sin. 1974;17:112-130.
82. Mayer DJ, Price DD, Rafii A. Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone. Brain Res. 1977;121:368-72.
83. Han JS, Terenius L. Neurochemical basis of acupuncture analgesia.
Annu Rev Pharmacol Toxicol. 1982;22:193-220.
84. Cheng RS, Pomeranz B. Monoaminergic mechanism of electroacupuncture analgesia. Brain Res. 1981;215:77-92.
85. 清‧吳謙：醫宗金鑒，大中國圖書公司，台北 1970
89. Birch S, Jamison RN. Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Clin J Pain. 1998;14:248-255.
90. Kisiel C, Lindh C. Smartlindring med fysikalisk terapi och manuell akupunktur vid myofasciella nackoch skuldersmartor. Sjukgymnasten.
1996;12:24-31.
91. Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M, Natalis M, Senn E, Beyer A, Schops P. Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain. Br Med J.
2001;322:1-6.
92. Irnich D, Behrens N, Gleditsch JM, Stor W, Schreiber MA, Schops P, Vickers AJ, Beyer A. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain.
2002;99:83-89.
93. Ware JE. SF-36 health survey: Manual and interpretation guide. RI:
Quality Metric, Lincoln 2000.
94. Ware JE, Kosinski M. SF-36 physical and mental health summary scales: A manual for users of version 1. 2nd ed. RI: Quality Metric, Lincoln 2001.
95. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection. Med Care.
1992;30:473-483
96. Mosley T, Penzien DB, Jamison RN. Differentiating chronic pain from acute pain using the short form McGill Pain Questionnaire. Poster presented at the Tenth Annual Scientific Meeting of the American Pain Society, New Orleans, LA 1991
97. Chiang CY, Chang CT, Chu HL. Peripheral afferent pathway for acupuncture analgesia. Sci Sin. 1973;16:210-217.
98. Hashimoto T, Aikawa S. Manual acupuncture and its peripheral mechanisms: involvement of nociceptors in muscle. Kitasato Arch Exp Med. 1994;6:191-200.
99. Ceccherelli F, Rigoni MT, Gagliardi G, Ruzzante L. Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double-blind randomized controlled study. Clin J Pain. 2002;18:149-153.
附錄一、署立南投醫院人體試驗委員會核准函
附錄二、署立南投醫院受試者同意書
續下頁
附錄二（續）
續下頁
附錄二（續）
續下頁
附錄二（續）
附錄三、SF-36 生活品質量表
續下頁
附錄三（續）
續下頁
附錄三（續）
續下頁
附錄三（續）
附錄四、ROM 記錄表
附錄五、SF-MPQ 問卷
The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome:
A single-blind randomized controlled trial
English Abstract
Purpose: Chronic neck myofascial pain syndrome (MPS) is a common
disorder in clinics which impacts patients on physiological and psychologic aspects. No gold standard method is suggested and acupuncture is often used to treat patients with pain. The aim of this study was to evaluate thetherapeutic efficacy of acupuncture on patients with chronic neck myofascial pain syndrome.
Method: We investigated the effects of acupuncture on patients with chronic
neck MPS by means of a single-blind randomized controlled trial.Thirty-five patients were randomly allocated to an acupuncture group or a sham acupuncture group. Each subject received acupuncture treatment two times per week for 3 consecutive weeks. The primary outcome measure was quality of life as assessed with the Medical Outcomes 36-Item Short Form Health Survey, and secondary outcome measures were neck range of motion, and results of the Short-Form McGill Pain Questionnaire, as determined by a blinded investigator. The clinical assessments were made before treatment (BT) and after six acupuncture treatments (AT), as well as at 4 weeks (F1) and 12 weeks (F2) after the end of treatment. Total 34 patients completed the trial.
Results: The results indicated that both groups had increased ROM scores
and decreased VAS and SF-MPQ scores (P < 0.05) at AT, and there were no significant differences in these measures between the two groups at F1 and F2; at F2, patients in the acupuncture group showed greater improvements on the physical functioning and role emotional subscales for quality of lifethan did patients in the sham acupuncture group (P = 0.013 and P = 0.049, respectively).
Conclusions: We conclude that acupuncture may be used for pain relief in
patients with chronic neck MPS, and acupuncture stimulation withachievement of qi is more effective in improving quality of life.
Keywords: Acupuncture; Chronic neck myofascial pain; Short Form-36
謝 辭
本試驗首先感謝謝慶良教授熱心且周延的督促指導整個試驗的計 劃、執行以及完成，中國醫藥大學生統中心李采娟教授不厭其煩地指導 及幸玉助理的熱心幫忙，中西所陳汶吉所長及技佐嫦萍的時時輔助，衛 生署南投醫院陳能謹院長、賴慧貞副院長、鄭勇彥主任、洪弘昌醫務秘 書、顏素美主任、黃依欣護理師、千佳助理、企劃室、檢查中心全體人 員和所有院內同仁的幫忙，以及所有參與試驗的受試病患配合，使得研 究得以順利進行圓滿結束，本人對於各位老師、同仁以及受試病患致上 由衷的感謝。
另外，對於默默付出的家人，父母的養育提攜以及家人們的支持與 鼓勵，還有牽手無怨無悔的陪伴以及工作及學業上的幫忙，促使我得以 無後顧之憂的在臨床及研究上學習精進，謝謝你們！
最後，感謝中國醫藥大學以及中西醫結合研究所提供如此豐富的學 術資源，相信可以帶領醫學領域之同仁，在中西醫學上有更精湛的成就。
我也會持續努力，謙卑的學習，希望將己所學貢獻於臨床及醫學研究領 域。
孫美緣 謹誌