PainSci commentary on Kostopoulos 2009: ?This page is one of thousands in the PainScience.com 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 wherever possible.
This is one of the larger trials of ischemic pressure for trigger points, with 90 subjects, but sadly it has a fatal flaw that strongly undermines it: no control group, “because ethics,” which is ridiculous.
The rationale for not using a control group is laughable nonsense based on the ludicrous assumption that treatment for shoulder trigger points is so valuable that it would be unethical to withhold it from study subjects. This ethical concern is only relevant where the stakes are much higher and being part of a control group poses some genuine risk, which is simply not the case here. The authors concede that this is “limits the robustness” of the findings. That’s an understatement: I’d call it crippling. Po-tay-toe, po-tah-to! Other researchers have had no qualms about using control groups for nearly identical studies (eg Oliveira-Campelo).
For whatever it's worth, they tested ischemic pressure, stretching, and a pressure-stretching combination. All of those methods produced “significant decreases” in pain perception and spontaneous electrical activity (abnormal electrical activity putatively associated with trigger points). The combination produced the largest changes. The size of all changes appears to have been pretty healthy — what we’d call a genuine improvement if only it was based on a comparison to a good control group.
But without comparison to a control group, this data can prove nothing about efficacy — it is “suggestive” at best.
~ Paul Ingraham
original abstract †Abstracts 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.
OBJECTIVES: Investigate the effects of ischemic compression [IC] technique and passive stretching [PS] in isolation and in combination on the reduction of spontaneous electrical activity [SEA] and perceived pain in trigger points [TrPs] located in the upper trapezius muscle.
METHODS: Ninety participants with TrPs in the upper trapezius muscle were randomly assigned to three treatment groups: IC, PS, and IC + PS. TrP compression was applied on the TrP for three applications of 60 seconds each, followed by a 30-second rest period. PS was applied for three 45-second applications, with 30-second rest intervals. All patients received the same amount of therapy.
RESULTS: Significant decreases were found in pain perception and on SEA for all study participants. The IC + PS group evidenced greater declines in pain perception and SEA when compared to the IC and PS groups.
CONCLUSION: Because of ethical considerations, a control group design was not possible, [that’s ridiculous!] thereby limiting the robustness of the findings. Although each technique significantly reduced pain perception and SEA, the combination of IC and PS was superior, apparently because of the complementary nature of the therapeutic interventions.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
- Sudden amnesia resulting in pain relief: the relationship between memory and pain. Choi 2007 Pain.