title: Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.
abstract: OBJECTIVE
  To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle.
  
  
  METHODS
  We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1beta (IL-1beta), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance.
  
  
  METHODS
  A biomedical research facility.
  
  
  METHODS
  Nine healthy volunteer subjects.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Preselected analyte concentrations.
  
  
  RESULTS
  Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).
  
  
  CONCLUSIONS
  We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs.
authors.affiliation: Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA. jshah@mail.cc.nih.gov
authors.forename: Jay P
authors.initials: JP
authors.lastname: Shah
authors.forename: Jerome V
authors.initials: JV
authors.lastname: Danoff
authors.forename: Mehul J
authors.initials: MJ
authors.lastname: Desai
authors.forename: Sagar
authors.initials: S
authors.lastname: Parikh
authors.forename: Lynn Y
authors.initials: LY
authors.lastname: Nakamura
authors.forename: Terry M
authors.initials: TM
authors.lastname: Phillips
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Gerber
mesh_terms: D000704:Analysis of Variance; D015740:Calcitonin Gene-Related Peptide / Q000378:metabolism; D053801:Capillary Electrochromatography; D004586:Electrophoresis; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D018836:Inflammation Mediators / Q000378:metabolism*; D053583:Interleukin-1beta / Q000378:metabolism; D017551:Microdialysis; D018482:Muscle, Skeletal / Q000378:metabolism*; D009209:Myofascial Pain Syndromes / Q000378:metabolism*; D019547:Neck Pain / Q000378:metabolism; D010147:Pain Measurement; D012701:Serotonin / Q000378:metabolism; D013048:Specimen Handling; D013373:Substance P / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D018836:Inflammation Mediators; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; D012701:Serotonin; D013373:Substance P; D015740:Calcitonin Gene-Related Peptide