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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Gam 1998.

Ultrasound for trigger point pain no better than massage and exercise

Gam AN, Warming S, Larsen LH, Jensen B, Høydalsmo O, Allon I, Andersen B, Gøtzsche NE, Petersen M, Mathiesen B. Treatment of myofascial trigger-points with ultrasound combined with massage and exercise — a randomised controlled trial. Pain. 1998 Jul;77(1):73–9. PubMed #9755021.
Tags: treatment, devices, massage, muscle pain, neck, manual therapy, muscle, pain problems, head/neck, spine

PainSci summary of Gam 1998?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

In this research, two small groups of about 20 patients each were given either real ultrasound or a fake substitute for the trigger points in their neck and shoulder. They also did massage and exercise therapy. If ultrasound is significantly effective, the group that received it should have fared the best — but there was no difference at all. On the bright side, both groups did a little better than patients who got no treatment at all — a small but definite difference. The researchers concluded that ultrasound made no difference, but “apparently massage and exercise reduces the number and intensity of myofascial trigger points.”

This study was well-designed, but also too small to be the last word — there are number of complicated variables (the type of ultrasound, for instance) and it’s certainly possible that doing the experiment again would produce different results. Still, it’s a valuable piece of the puzzle, and certainly ultrasound failed to shine as a treatment in this case.

~ Paul Ingraham

original abstractAbstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The effect of treatment with ultrasound, massage and exercises on myofascial trigger-points (MTrP) in the neck and shoulder was assessed in a randomised controlled trial. The outcome measures were pain at rest and on daily function (Visual Analogue Scale, VAS), analgesic usage, global preference and index of MTrP. Long-term effect for treatment and control groups was assessed after 6 months using a questionnaire. The patients were randomised to three groups. The first group was treated with ultrasound, massage and exercise (A), the second group with sham-ultrasound, massage and exercise (B), while the third group was a control group (C). The duration of the study was 6 weeks. Treatment was given twice a week from the second to the fifth week. The number and index of MTrPs were recorded at each treatment session in groups A and B but only at entry as well as end of study in group C. VAS and analgesic usage was recorded in all three groups throughout the study period. Six months after the last treatment session a questionnaire was send to the patients. A total of 67 patients were included. Nine patients dropped-out during the study, which left 58 patients that could be included in the final analysis. Twenty patients were randomised to group A, 18 to group B and 18 to group C. A significant reduction in index were found between treatment groups (A and B) and control group (C), but no difference between group A and B. VAS scores, analgesic usage or global preference showed no difference between group A, B or C. The patients in the group C were offered treatment (ultrasound, massage, exercise) after the 6 weeks treatment period. At the questionnaire after 6 month 44 (87%) of the 52 patients from all three groups who had treatment responded. Sixty-four percent answered that they had had good or some effects, 68 percent were still doing the exercise programme and 17 percent had received other forms of therapy after they had completed the study. No difference between groups given ultrasound or sham ultrasound were found. It is concluded that US give no pain reduction, but apparently massage and exercise reduces the number and intensity of MTrP. The impact of this reduction on neck and shoulder pain is weak.

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