In the Advanced Lower Quadrant Course we look in detail at the involvement of the abdominal musclesand their contribution to back and pelvic pain, plus the associated viscerosomatic reflex. This article demonstrates in young women, the potential contribution of abdominal muscle trigger points to dysmenorrhoea.
Titled “Wet needling of myofascial trigger points in abdominal muscles for treatment of primary dysmenorrhoea”by authors Qiang-Min Huang, Lin Liu.
Reference is “Huang Q-M, et al. Acupunct Med 2014;32:346–349. doi:10.1136/acupmed-2013-010509”
The authors recruited 65 participants with primary dysmenorrhoea, average age of subjects was 22 ± 2.5 years and mean VAS pain scores 7.49 ± 1.16, over a 6 year period. Patients with other diseases and conditions of the reproductive and urinary systems, as well as endometriosis, were excluded.
The intervention involved wet needling (lignocaine) into identified abdominal muscle trigger points, 2 weeks prior to onset of menstruation. Participants were also taught abdominal stretches and asked to repeat these with a static stretch hold of 0.5 -1 minutes, several times per day.
After the first session, 63% of the participants feel beneath the pain inclusion threshold of VAS 3/10 (mean 1.63 ± 0.49) and continued only with their stretching program. The remainder (VAS > 3) received a second needling session and reported a mean VAS 0.58 ± 0.50 during their subsequent menstruation. At the 1-year follow-up, all participants provided data and the mean VAS score was 0.28 ± 0.45. The reduction in VAS pain scores from baseline to 1 year for all patients after wet needling treatment was highly significant (p<0.0001). Moreover, those that required a second treatment, there was a highly significant decrease (p<0.001) between the first and second treatments.
As indicated by the authors, this pilot study provides some interesting clinical information. Based upon the positive findings, the authors recommended further study. Ideally I believe this would involve a control group (say educational intervention) and a sham needle group (as an active control). To improve patient reported outcomes, the use of numerical rating scales cf to VAS, and the inclusion of a functional/quality of life measurement (like Medical Outcomes Study 36-Item Short-Form Health Survey) would seem appropriate. It would also be of interest to include a dry needling group to compare to the wet needling approach, but that would start to push up recruitment numbers.
In the mean time clinicians can use this information to assist them in identifying potential abdominal trigger points to treat dysmenorrhoea (as discussed and taught on the Advanced Lower Quadrant Course) and it provides a general expectation on clinical outcomes from 1 or 2 treatment interventions.
All the best,
Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education
ph/fx: 08 90715055
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