title: Trigger point-related sympathetic nerve activity in chronic sciatic leg pain: a case study.
abstract: Sciatica has classically been associated with irritation of the sciatic nerve by the vertebral disc and consequent inflammation. Some authors suggest that active trigger points in the gluteus minimus muscle can refer pain in similar way to sciatica. Trigger point diagnosis is based on Travel and Simons criteria, but referred pain and twitch response are significant confirmatory signs of the diagnostic criteria. Although vasoconstriction in the area of a latent trigger point has been demonstrated, the vasomotor reaction of active trigger points has not been examined. We report the case of a 22-year-old Caucasian European man who presented with a 3-year history of chronic sciatic-type leg pain. In the third year of symptoms, coexistent myofascial pain syndrome was diagnosed. Acupuncture needle stimulation of active trigger points under infrared thermovisual camera showed a sudden short-term vasodilatation (an autonomic phenomenon) in the area of referred pain. The vasodilatation spread from 0.2 to 171.9 cm(2) and then gradually decreased. After needling, increases in average and maximum skin temperature were seen as follows: for the thigh, changes were +2.6°C (average) and +3.6°C (maximum); for the calf, changes were +0.9°C (average) and +1.4°C (maximum). It is not yet known whether the vasodilatation observed was evoked exclusively by dry needling of active trigger points. The complex condition of the patient suggests that other variables might have influenced the infrared thermovision camera results. We suggest that it is important to check if vasodilatation in the area of referred pain occurs in all patients with active trigger points.
authors: Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland.
authors: Elżbieta
authors: E
authors: Skorupska
authors: Department of Virtual Engineering, Poznan University of Technology, Poznan, Poland.
authors: Michał
authors: M
authors: Rychlik
authors: Department of Biomechanics, University School of Physical Education, Poznan, Poland.
authors: Wiktoria
authors: W
authors: Pawelec
authors: Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland.
authors: Agata
authors: A
authors: Bednarek
authors: Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland.
authors: Włodzimierz
authors: W
authors: Samborski
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D006801:Humans; D007866:Leg; D035002:Lower Extremity; D008297:Male; D009209:Myofascial Pain Syndromes / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D053591:Referred Pain / Q000175:diagnosis* / Q000628:therapy; D012585:Sciatica / Q000150:complications / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D012881:Skin Temperature; D013564:Sympathetic Nervous System; D013817:Thermography; D013848:Thigh; D061028:Trigger Points; D014664:Vasodilation; D055815:Young Adult
keywords: Acupuncture; Myofascial Pain; Pain Research