Title

下背肌筋膜疼痛症之針刺治療

Translated Titles

Needling Therapy for Myofascial Low Back Pain

DOI

10.6320/FJM.201905_23(3).0006

Authors

周立偉(Li-Wei Chou);洪章仁(Chang-Zern Hong)

Key Words

下背痛 ; 肌筋膜疼痛症候群 ; 肌激痛點 ; 針刺治療 ; low back pain ; myofascial pain syndrome ; myofascial trigger point ; needling therapy

PublicationName

台灣醫學

Volume or Term/Year and Month of Publication

23卷3期(2019 / 05 / 25)

Page #

335 - 345

Content Language

繁體中文

Chinese Abstract

下背痛僅是一個症狀,治療前必需要有確實的鑑別診斷,特別是必須先排除嚴重的疾病(紅旗),和因為心理社會因素導致疼痛遷延化(黃旗)的可能。下背肌筋膜疼痛症的治療方式有很多,如藥物,物理治療,姿勢調整和衛教,以及運動治療等,多學科的復健治療(multidisciplinary rehabilitation approach)和成人肌筋膜疼痛的評估及治療流程,可供臨床醫師做參考。針刺治療,則是上述的傳統保守治療效果不佳的另一種選擇。針刺治療的種類很多,包括肌激痛點注射,乾針治療,針灸,浮針治療等,但這些都只是執行治療的工具,最重要的還是要找到可能引起症狀的患肌,給予適當的治療,同時,治療後的自我牽拉運動和核心肌群的肌力訓練,更是預防下背痛再復發的不二法門。

English Abstract

Low back pain is just a symptom. It is very important the make exact different diagnosis before treatment, especial to find out the most severe diseases (red flags) and the psychosocial factors possible related to pain chronification (yellow flags). There are many treatments for the myofascial low back pain, including medication, physical therapy, posture correction, education, and exercise therapy. Multidisciplinary rehabilitation approach and algorithm for the evaluation and treatment of myofascial pain in an older adult are suggested for primary care specialist in this paper. Needling therapies are another choices while the traditional conservative treatments are less response for pain control. There are many needling therapies, including myofascial trigger points injection, dry needling, acupuncture, and Fu's subcutaneous needling, etc., whom are the modalities to be used for treatment. The most important thing is to figure out the tightened muscles leading to the symptoms, then giving the appropriate treatment. Besides, self-stretching exercises and muscle strengthening for core muscles might preventing recurrent of low back pain.

Topic Category 醫藥衛生 > 醫藥衛生綜合
Reference
  1. 1. Golob AL, Wipf JE: Low back pain. Med Clin N Am 2014;98:405-28.
    連結:
  2. 3. Hooten WM, Cohen SP: Evaluation and treatment of low back pain - a clinically focused review for primary care specialists. Mayo Clin Proc 2015;90:1699-718.
    連結:
  3. 7. Hong CZ, Simons DG: Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil 1998;79:863-72.
    連結:
  4. 8. Hong CZ: Considerations and recommendations regarding myofascial trigger point injection. J Musculoskelet Pain 1994;2:29-59.
    連結:
  5. 12. Sharan D, Rajkumar JS, Mohandoss M, et al: Myofascial low back pain treatment. Curr Pain Headache Rep 2014;18:449.
    連結:
  6. 13. Lisi AJ, Breuer P, Gallagher RM, et al: Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part II: Myofascial Pain. Pain Med 2015;16:1282-9.
    連結:
  7. 14. Kalichman L, Vulfsons S: Dry needling in the management of musculoskeletal pain. J Am Board Fam Med 2010;23:640-6.
    連結:
  8. 17. Fischer AA: New approaches in treatment of myofascial pain. Physical Medicine and Rehabilitation Clinics of North America 1997;8:153-69.
    連結:
  9. 18. Chu J, Yuen K, Wang B, et al: Electrical twitch-obtaining intramuscular stimulation in lower back pain: a pilot study. Am J Phys Med Rehab 2004;83:104-11.
    連結:
  10. 19. Baldry P: Superficial dry needling at myofascial trigger point sites. J Musculoskelet Pain 1995;3:117-26.
    連結:
  11. 20. Hsieh YL, Chou LW, Joe YS, et al: Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle. Arch Phys Med Rehabil 2011;92:1098-105.
    連結:
  12. 21. Chou LW, Hsieh YL, Kao MJ, et al: Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. Arch Phys Med Rehabil 2009;90:905-12.
    連結:
  13. 22. Chou LW, Hsieh YL, Chen HS, et al: Remote therapeutic effectiveness of acupuncture in treating myofascial trigger point of the upper trapezius muscle. Am J Phys Med Rehab 2011;90:1036-49.
    連結:
  14. 23. Chou LW, Kao MJ, Lin JG: Probable mechanisms of needling therapies for myofascial pain control. Evid Based Complementary Alternat Med. vol. 2012; Article ID 705327.
    連結:
  15. 24. 符仲華:浮針醫學綱要。人民衛生出版社,2016。[Fu ZH: The foundation of Fu’s subcutaneous needling, 1st Edition. People’s Medical Publishing House, 2016]
    連結:
  16. 27. Langevin HM, Churchill DL, Cipolla MJ: Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J 2001;15:2275-82.
    連結:
  17. 28. Fu ZH, Hsieh YL, Hong CZ: Remote subcutaneous needling to suppress the irritability of myofascial trigger spots: an experimental study in rabbits. Evid Based Complementary Alternat Med. 2012;Article ID 353916.
    連結:
  18. 29. Lipinski B: Biological significance of piezoelectricity in relation to acupuncture, Hatha Yoga, osteopathic medicine and action of air ions. Med Hypotheses 1977;3:9-12.
    連結:
  19. 2. Casser HR, Seddigh S, Rauschmann M: Acute lumbar back pain - investigation, differential diagnosis and treatment. Dtsch Arztebl Int 2016;113:223-34.
  20. 4. Simons DG: Myofascial pain syndrome due to trigger points. In: Goodgold J, editor. Rehabilitation Medicine, St Louis, CV Mosby Co, 1988:686-723.
  21. 5. Simons DG: Muscular Pain Syndromes. In: Fricton JR, Award EA editors. Myofascial Pain and Fibromyalgia. Advances in Pain Research and Therapy, Vol. 17. Raven Press, New York 1990:1-41.
  22. 6. Hong CZ: Persistence of local twitch response with loss of conduction to and from the spinal cord. Arch Phys Med Rehabil 1994;75:12-6.
  23. 9. Hong CZ: New trends in myofascial pain syndrome. Chinese Medical Journal (Taipei). 2002;65:501-12.
  24. 10. 洪章仁,周立偉:肌肉疼痛。合記圖書出版社,2016。[Hong CZ, Chou LW: Muscle pain, 1st Edition, Ho-Chi Book Publishing Company, 2016]
  25. 11. Simons DG, Travell JG, Simons LS: Myofascial pain and dysfunction: the trigger point manual. Vol. 1, 2nd ed. Baltimore: Williams & Wilkins, 1999.
  26. 15. Hong CZ: Muscle pain syndrome. In Braddom: Physical Medicine and Rehabilitation, 4th ed. Chapter 43. New York, Elsevier, 2011:971-1001.
  27. 16. Travell J, Bobb AL: Mechanism of relief of pain in sprains by local injection technics. Fed Proc 1947;6:378.
  28. 25. Fu ZH, Chou LW: Chapter 16 Fu’s subcutaneous needling. In: Trigger Point Dry Needling: An Evidence and Clinical-Based Approach, Second Edition. Elsevier Health Sciences, 2018.
  29. 26. 李康、吳威廷、符仲華、周立偉:浮針,現代針灸療法。中華針灸醫學雜誌 2016;19:45-52. [Li K, Wu WT, Fu ZH, Chou LW: Fu’s subcutaneous needling, modern acupuncture. Journal of Chinese Medical Association of Acupuncture 2016:19:45-52.
  30. 30. Joseph M Donnelly, César Fernández-de-Las-Peñas, Michelle Finnegan, et al: Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, Third Edition. Wolters Kluwer, 2019.