Myofascial Techniques for
Back and Neck Pain
Presented by:
Edward S. Lee MD
National Program Faculty:
Edward S. Lee MD
Director, Interdisciplinary Pain Rehabilitation Program
VA Pittsburgh Healthcare System
PART 4
Specialty Care National Program Mini-Residency – Pain Management
February 10-12, 2015
Dry Needling
• Described by Travell as equally effective as
injection.
• Part of acupuncture traditions.
• Use acupuncture needles to minimize tissue
trauma.
Physiologic Effects of Dry Needling
Styles of Dry Needling
• Superficial – targeting
fascia surrounding muscle.
• Deep – Travell, Simons
• Intramuscular Stimulation –
Gunn
Drug Therapy
• Mild analgesics
– Nonsteroidal Anti-inflammatory Drugs
– Acetaminophen
• pain and sleep
– tricyclic antidepressants (nortriptyline low dose)
• Muscle relaxants
– Cyclobenzaprine
• Anticonvulsants - gabapentin
• depression and pain
– SSRI
– SNRI
• Topical lidocaine
• Avoid opioids – no studies to support use, and may cause hyperalgesia. However, tramadol, a weak opioid agonist, may be more effective due to effects on serotonin and NE uptake at dorsal horn.
Take Home • A biopsychosocial interdisciplinary team approach is most
effective.
• There are a wide variety of approaches to treatment of trigger
points and myofascial restriction.
• Physical rehabilitation is the mainstay of management for
both Fibromyalgia and Myofascial Pain Syndrome.
• Teach self-management and measure outcome using pain
rating and a function tool.
• Self-management insures active patient participation in
managing pain and achieving reasonable functional goals.
• Psychosocial rehabilitation, including cognitive behavioral
therapy for management of depression, stress, anger, fear,
avoidance, chemical dependency and non-restorative sleep,
is essential.
Acknowledgements
• Dr. Sandra Smeeding, for her pioneering work in developing an
integrative health care program at the Salt Lake City VA.
• Dr. David MacPherson, Dr. Timothy Burke, Dr. Michael Mangione,
Dr. Mark Wilson, Dr. Rajiv Jain, and Dr. Ali Sonel, for their support in
bringing integrative medicine to the Pittsburgh VA.
• Dr. Joseph Helms, for his vision for medical acupuncture in the US,
and his ongoing mentoring.
• Dr. Ilene Robeck, for her ongoing efforts to promote safe and
effective pain management at the Richmond VA and in VHA
nationally, and for the use of some of her materials.
• Dr. Mitchell Elkis, for his mentoring and for the use of some of his
materials.
• Dr. Cynthia Kirsch, Nick Vlasic DPT, Sue Delanko KT, and all of the
other IPRP team members, for their vision and hard work in
developing the Pittsburgh IPRP.
• Jean Yavorski RN, for her tremendous efforts in ushering us through
the CARF accreditation process.
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• http://www.chronicpainperspectives.com/articles/feature-article/article/diagnosing-fibromyalgia-and-myofascial-pain-syndrome-a-guide/674266a2da3a75abf9b7c5002f54037c.html
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• http://www.istop.org/papers/imspaper.pdf
Are Active Self-Care Complementary and
Integrative Therapies Effective for
Management of Chronic Pain?
A Rapid Evidence Assessment of the
Literature and Recommendations for the Field
• Pain Medicine April 2014, Volume 15,
Supplement 1
• http://onlinelibrary.wiley.com/doi/10.1111/pme.20
14.15.issue-s1/issuetoc
Building the Evidence Base for Complementary and Integrative
Medicine Use among Veterans and Military Personnel
• Medical Care December 2014, Volume 52, Issue
12, Supplement 5
• http://journals.lww.com/lww-
medicalcare/toc/2014/12001
2011 Complementary and Alternative Medicine Survey
• http://shfwire.com/files/pdfs/2011CAM_FinalR
eport.pdf