title: A comprehensive protocol to diagnose and treat pain of muscular origin may successfully and reliably decrease or eliminate pain in a chronic pain population.
abstract: OBJECTIVE
  A comprehensive protocol is presented to identify muscular causes of regional pain syndromes utilizing an electrical stimulus in lieu of palpation, and combining elements of Prolotherapy with trigger point injections.
  
  
  METHODS
  One hundred seventy-six consecutive patients were evaluated for the presence of muscle pain by utilizing an electrical stimulus produced by the Muscle Pain Detection Device. The diagnosis of "Muscle Pain Amenable to Injection" (MPAI), rather than trigger points, was made if pain was produced for the duration of the stimulation. If MPAI was found, muscle tendon injections (MTI) were offered to patients along with post-MTI physical therapy, providing neuromuscular electrical stimulation followed by a validated exercise program [1]. A control group, evaluated 1 month prior to their actual consultation/evaluation when muscle pain was identified but not yet treated, was used for comparison.
  
  
  RESULTS
  Forty-five patients who met criteria completed treatment. Patients' scores on the Brief Pain Inventory decreased an average of 62%; median 70% (P < 0.001) for pain severity and 68%; median 85% (P < 0.001) for pain interference one month following treatment. These changes were significantly greater (P < 0.001) than those observed in the untreated controls.
  
  
  CONCLUSIONS
  A protocol incorporating an easily reproducible electrical stimulus to diagnose a muscle causing pain in a region of the body followed by an injection technique that involves the entirety of the muscle, and post injection restoration of muscle function, can successfully eliminate or significantly reduce regional pain present for years.
authors.affiliation: NYU School of Medicine, Departments of Anesthesiology and Psychiatry, Norman Marcus Pain Institute, New York, New York 10016, USA. njm@nmpi.com
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Marcus
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gracely
authors.forename: Kelly O
authors.initials: KO
authors.lastname: Keefe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002908:Chronic Disease; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004558:Electric Stimulation; D005081:Exercise Therapy; D005157:Facial Pain / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis; D009135:Muscular Diseases / Q000175:diagnosis* / Q000628:therapy*; D010146:Pain / Q000175:diagnosis*; D059408:Pain Management; D010147:Pain Measurement; D010808:Physical Examination; D026741:Physical Therapy Modalities; D013710:Tendons; D016896:Treatment Outcome; D055815:Young Adult