Multi-modal Evaluation Of Lumbar Myofascial Pain Syndrome And Ultrasound-guided Dry Needling Therapy

Background and ObiectiveMyofascial pain syndrome(MPS)refers to a chronic pain of the muscles,fascia,or related soft tissues that can be accompanied by significant mood disorders such as depression.Numerous studies have shown that dry needling(DN)can reduce myofascial trigger points(MTrPs)activity or pain caused by trigger points,and alleviate accompanying depressive symptoms.At present,there are few objective and accurate evaluation criteria for the influence of MPS with depression on the central system,and the therapeutic effect of ultrasound-guided DN.In this study,functional magnetic resonance imaging(fMRI)was used to evaluate the effects of lumbar MPS with depression on subjects’ brain pain matrix and the therapeutic effects of ultrasound-guided DN on brain function changes,ultrasonic diagnostic instrument and MyotonPro muscle detector was used to evaluated the effect of ultrasound-guided DN on muscle performance.The efficacy and objective evaluation method of ultrasound-guided DN for lumbar MPS with depression was determined.MethodsSubjects with lumbar MPS were recruited,and the following experimental procedures were completed:(1)Subjects were divided into CBP-D group(with depressive symptoms)and CBP group(without depressive symptoms).FMRI was performed,Visual analogue scale(VAS),Pain disability index(PDI)and Self-Rating Depression Scale(SDS)were employed.Investigate the relationship between depression and lumbar MPS and the effect of fMRI on the assessment of brain function.(2)The subjects were treated with ultrasound-guided DN.FMRI was performed,VAS,brief Pain Inventory(BPI)and SDS were compared before and after treatment.The evaluation effect of fMRI on the treatment of ultrasound-guided DN was discussed.(3)The subjects were treated with ultrasound-guided DN(DN-U group),conventional DN(DN group)and fake DN(DN-F group).The thickness of erector spinae was measured by ultrasound before and after treatment.Oswestry disability index(ODI)was calculated,and the stiffness of erector spinae was measured by Shear-wave elastography(SWE)and MyotonPro.To analyze the effect of ultrasound-guided DN on the stiffness and ODI of erector spinae,and to evaluate the efficacy of ultrasound-guided DN by SWE and MyotonPro.Results(1)VAS and PDI of lumbar MPS Subjects with depression were significantly increased,and SDS was significantly correlated with VAS and PDI.Depressive symptoms could be mediators between VAS and PDI,and VAS could be mediators between depressive symptoms and PDI.The disconnection and instability of pain matrix functional connectivity in subjects with depression will aggravate the damage of pain matrix network function.Depressive symptoms lead to increased parietal cortex activity,which enhances the perception of pain stimuli in patients,and impaired control of pain representations.(2)After dry needling,SDS,Brief pain inventory(BPI)and VAS were significantly decreased.After dry needling,ALFF value of thalamus decreased significantly,nodal efficiency,nodal local efficiency and nodal aggregation coefficient of posterior central gyrus increased significantly.There was a significant positive correlation between thalamic ALFF and VAS/BPI/SDS.(3)After ultrasound guided DN and conventional DN,the value of Young’s modulus calculated by SWE and muscle stifness calculated by MyotonPro decreased significantly.There was a positive correlation between MyotonPro and SWE in measuring muscle performance before and after ultrasound-guided DN.ODI in DN-U,DN and DN-F groups was significantly decreased after dry needling treatment,and the thickness of erector spinae muscle wwas not significantly changed.ConclusionPart pain matrix brain regions may be an important neural basis for depression and lumbar MPS.Depressive symptoms interact with lumbar myofascial pain,but depression does not increase pain intensity by directly affecting the function of the pain matrix.Ultrasound-guided dry needling can significantly improve pain and depression symptoms and reduce thalamic ALFF value.Both pain and depression were significantly correlated with thalamic ALFF value.FMRI has an objective evaluation on brain function changes and effect of ultrasound-guided DN in lumbar MPS patients with depression.Ultrasound-guided dry needling can reduce the stiffness of erector spinae and lumbar function and quality of life in subjects.SWE and MyotonPro examination have an objective evaluation effect on the treatment of lumbar MPS with ultrasound-guided DN.