行政院國家科學委員會專題研究計畫 期中進度報告
引痛點酚注射療法對肌膜疼痛症引痛點敏感度的影響(1/2)
計畫類別： 個別型計畫
計畫編號： NSC92-2314-B-006-032-
執行期間： 92 年 08 月 01 日至 93 年 07 月 31 日 執行單位： 國立成功大學醫學系復健醫學科
計畫主持人： 陳若佟
報告類型： 精簡報告
處理方式： 本計畫可公開查詢
中 華 民 國 93 年 5 月 31 日
行政院國家科學委員會補助專題研究計畫成果報告
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※ 引痛點酚注射療法對肌膜疼痛症引痛點敏感度的影響(1/2) ※
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計畫類別：個別型計畫 □整合型計畫
計畫編號：NSC 92－2314－B－006－032
執行期間： 92 年 08 月 01 日至 93 年 07 月 31 日
計畫主持人： 陳若佟 共同主持人：
本成果報告包括以下應繳交之附件：
□赴國外出差或研習心得報告一份
□赴大陸地區出差或研習心得報告一份
□出席國際學術會議心得報告及發表之論文各一份
□國際合作研究計畫國外研究報告書一份
執行單位：國立成功大學醫學系復健學科
中 華 民 國 93 年 5 月 28 日
引痛點酚注射療法對肌膜疼痛症引痛點敏感度的影響 計畫編號：NSC 92-2314-B-006-032
執行期限：92 年 8 月 1 日至 93 年 7 月 31 日
主持人：陳若佟 國立成功大學醫學系復健醫學科
中文摘要
肌膜疼痛症為最常見的肌肉疼痛疾病，
其罹患的人數很多且再發率相當高，往往 嚴重影響患者日常工作及生活品質。其特 徵為在肌肉緊張帶上有一特定敏感的引痛 點(Myofascial Trigger Point) ，如果在引痛 點上給與機械性刺激，可以誘發局部抽搐 反應及投射遠方肌肉的引傳痛。引痛點內 含有多個活化小點且於此可記錄到具特徵 化的自發性電位活動，目前學者認為此自 發性電位活動乃是一種不正常的終板雜訊 電位(End-plate Noise)，而引痛點的病生理 機轉在於因肌肉傷害造成不正常運動神經 終板，並於此處有過多的乙醯膽鹼釋放。
引痛點注射療法為目前臨床上治療肌膜疼 痛症最快速有效的治療方法，但對嚴重肌 膜疼痛症患者效果可能很短暫。酚(Phenol) 已使用於臨床幾十年, 之前多用於治療肌 肉痙攣及嚴重疼痛, 未曾用於肌膜疼痛症 之 治 療 。 本 試驗之目的就是要應用洪氏 (Hong)引痛點多小點注射法來研究引痛點 酚注射療法對肌膜疼痛症引痛點敏感度的 影響，以進一步改善對嚴重肌膜疼痛症患 者之治療。
實驗對象為 10 隻紐西蘭大白兔，於兔子 股二頭肌引痛點內搜尋約十個敏感小點的 終板雜訊電位，當紀錄到終板雜訊電位後 即做引痛點酚注射療法，即注射約一滴的 酚(5% aqua phenol)，並紀錄此終板雜訊電 位於注射藥物後隨時間的變化；對照組施 於對側股二頭肌的引痛點並重複以上之步 驟，但注射生理食鹽水。實驗分析以終板 雜 訊 電 位 平 均 積 分 值 (averaged integrated value, AIV)做為量化引痛點敏感度的參數。
normalized AIV 均較對照組小，且結果具 統計學意義。由 two-way ANOVA 分析得 知 ， 實 驗 組 平 均 normalized AIV 為 0.237±0.064，而對照組平均 normalized AIV 為 0.975
±
0.103，二者差異具統計學意義。結論：引痛點酚注射療法可有效的降低引 痛點敏感度。
關鍵詞：肌筋膜疼痛症、引痛點、自發性 電位活動、終板雜訊電位、酚注射療法
Abstract
The aim of this study is to apply electrophysiological signal analysis in quantitatively characterizing the change of end-plate noise for MTrP injection with phenol, using both rabbit and human subjects.
Ten adult New Zealand rabbits were studied. Electromyography with needle electrodes was used to record end-plate noise from the active loci within the MTrP of rabbit biceps femoris muscle. After a train of end-plate noise was recorded from the active locus, one drop of 5% aqueous phenol was pushed into the active locus. The active recording needle electrode was kept at the same locus for the continuous recording of end-plate noise after phenol injection for about 5 minutes. The same procedure was repeated for a total of 10 different active loci within the MTrP area. Control study was conducted on the other side with the same procedure except that normal saline instead of phenol was used. The average integrated value [AIV] of end-plate noise was statistically analyzed for comparing the treatment effect.
All 10 rabbits demonstrate significantly lower normalized AIV in the treatment side compared to the control [P<0.05]. The results of two-way ANOVA show that the mean of normalized AIV in treatment group
lower than that of control [0.975 ± 0.103].
MTrP injection with phenol is effective in diminishing the sensitivity of MTrP.
Keywords: Myofascial Pain Syndrome, Myofascial Trigger Point, Spontaneous Electric Activity, End-plate Noise, Phenol Rationale and Purpose
Myofascial pain syndrome (MPS) is the most common cause of painful muscular dysfunction in clinics. Myofascial trigger point (MTrP), a hyperirritable spot within a palpable taut band of skeletal muscle, is the primary characteristic of MPS.Referred pain and local twitch response can be elicited by mechanical stimulus to the MTrP. Simons and others have proposed that MTrPs basically represent a neuromuscular disease associated with dysfunction of motor end-plates. Hong has also demonstrated that there are multiple active loci within an MTrP area, in which end-plate noise is shown in electromyography. Clinically, MTrP injection has been often used as an effective and valuable procedure to inactivate an active MTrP, and subsequently relieve the pain and tightness of the muscle involved in myofascial pain syndrome. However, some of the chronic MPS patients may become very severe that little clinical effectiveness can be gained from any form of therapy.
Although Phenol has been widely employed to relieve both pain and spasticity, it has not been used in the treatment of MPS. Our hypothesis was that MTrP injection with phenol is useful in diminishing the sensitivity of MTrP, leading to effective pain relief of refractory MPS patients. The aim of this study was to apply electrophysiological signal analysis in quantitatively characterizing the change of end-plate noise for MTrP injection with phenol, using rabbit subjects. The aim of this study was to apply electrophysiological signal analysis in quantitatively characterizing the change of end-plate noise for MTrP injection with phenol.
Results and Discussion
In this animal study, electrophysiological
characteristics of end-plate noise recorded from multiple loci of MTrPs of skeletal muscle of rabbits were investigated by using digital signal processing. The end-plate noise consists of continuous, noise-like action potentials (5 to 50µV), accompanied by intermittent large-amplitude spikes (100 to 600µV) (Fig. 1). If the recording needle was advanced or withdrawn as little as 1mm away from the tiny active loci, it could not record the electrical activity. Usually there were several active loci with evidencing end-plate recording in an MTrP region of biceps femoris muscle of rabbits. The control needle electrode in the nearby normal muscle fibers of a non-MTrP region shows no end-plate noise (Fig. 2). The magnitude of resting activity signals is less than 1µV.
All 10 rabbits demonstrate significantly lower normalized AIV in the treatment side compared to the control [P<0.05]. The results of two-way ANOVA show that the mean of normalized AIV in treatment group [0.237 ± 0.064] is significantly [P<0.05]
lower than that of control [0.975 ± 0.103]
(Table 1).
Fig 1: An example of end-plate noise recording from one active locus of MTrP.
Fig 2: EMG recording from the control site of normal muscle at rest.
Table 1: The Mean and S.D. of the Normalized Average Integrated Value (AIV) of end-plate noise in 10 Different Loci on the experimental and control Sides
Rabbit Experimental Control 1 0.242± 0.158* 0.886±0.406 2 0.136± 0.129* 0.987±0.342 3 0.318± 0.289* 0.995±0.303 4 0.226 ± 0.126* 0.972±0.247 5 0.307 ± 0.219* 0.892±0.412 6 0.185 ± 0.099* 0.996±0.341 7 0.240 ± 0.126* 1.005±0.462 8 0.284 ± 0.232* 0.982±0.333 9 0.224 ± 0.156* 1.127±0.522 10 0.208 ± 0.132* 0.908±0.333
Mean 0.237± 0.064* 0.975±0.103
*P < .05 (compared to the control side)
It was concluded that MTrP injection with phenol is effective in diminishing the sensitivity of MTrP. The outcome of this research would provide fundamental information to improve understanding of MTrP; more important, it is expected to beneficial to effective treatment options for the severe MPS patients.
計劃成果自評
本研究成果已被接受且即將發表於 MYOPAIN 2004, The International MYOPAIN Society Sixth International Scientific and Clinical Meeting, July 18-22, 2004 in Munich, Germany
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