Myofascial pain in patients waitlisted for total knee arthroplasty.
BACKGROUND
Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA).


OBJECTIVE
To determine the presence of myofascial pain in OA patients waitlisted for TKA and to determine whether their knee pain may be alleviated by trigger point injections.


METHODS
Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8. Outcome measures included the Timed Up and Go test, Brief Pain Inventory, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory and Short-Form McGill Pain Questionnaire.


RESULTS
Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility. All participants had trigger points identified in medial muscles, most commonly in the head of the gastrocnemius muscle. An acute reduction in pain and improved functionality was observed immediately following intervention, and persisted over the eight-week course of the investigation.


CONCLUSIONS
All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA.
Department of Anesthsiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
Richard
R
Henry
Catherine Marie
CM
Cahill
Gavin
G
Wood
Jennifer
J
Hroch
Rosemary
R
Wilson
Tracy
T
Cupido
Elizabeth
E
Vandenkerkhof
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000150:complications / Q000188:drug therapy*; D020370:Osteoarthritis, Knee / Q000150:complications / Q000188:drug therapy*; D059408:Pain Management; D010147:Pain Measurement; D016896:Treatment Outcome; D061028:Trigger Points
D002045:Bupivacaine