1. 2020;23;507-518Ashi Acupuncture Versus Local Anesthetic Trigger Point Injections in the Treatment of Abdominal Myofascial Pain Syndrome: A Randomized Clinical Trial
   Randomized Trial
   Andreia Moreira de Souza Mitidieri, Pht, PhD, Maria Carolina Dalla Vecchia Baltazar, Pht, Ana Paula Moreira da Silva, Pht, PhD, Maria Beatriz Ferreira Gurian, Pht, PhD, Omero Benedicto Poli-Neto, MD, PhD, Francisco Jose Candido-dos-Reis, MD, PhD, Antonio Alberto Nogueira, MD, PhD, and Julio Cesar Rosa-e-Silva, MD, PhD.

BACKGROUND: Chronic pelvic pain (CPP) is defined as recurrent or continuous pain in the lower abdomen or pelvis, non-menstrual or non-cyclic, lasting at least 6 months. There is strong evidence that up to 85% of patients with CPP have serious dysfunction of the musculoskeletal system, including abdominal myofascial syndrome (AMPS). AMPS is characterized as deep abdominal pain, originating from hyperirritable trigger points, usually located within a musculoskeletal range or its fascia of coating. In the literature, there are few studies that address AMPS.

OBJECTIVE: This study aimed to compare the responses of ashi acupuncture treatment and local anesthetic injection in the treatment of chronic pelvic pain secondary to abdominal myofascial pain syndrome in women.

STUDY DESIGN: Randomized controlled clinical trial.

SETTING: Tertiary University Hospital.

METHODS: Women with a clinical diagnosis of CPP secondary to AMPS were randomized and evaluated using instruments to assess clinical pain, namely, the visual analogue scale (VAS), numerical categorial scale (NCS), and the McGill Questionnaire, after receiving treatment with ashi acupuncture (group A, n = 16) or local anesthetic injections (group B, n = 19). They were reevaluated after one week and one, 3, and 6 months after each treatment, in addition to assessments of pain and adverse events performed during the sessions.

RESULTS: Ashi acupuncture and local anesthetic injections were both effective in reducing clinical pain assessed through the analyzed variables among study participants. There was no difference between the groups and there was a strong correlation between these pain assessment instruments.

LIMITATIONS: The absence of blinding to the different forms of treatment among the patients and the researcher directly involved in the treatment, the absence of a placebo group, the selective exclusion of women with comorbidities and other causes of CPP, and the difference between the number of sessions used for each technique.

CONCLUSION: Treatments with ashi acupuncture and local anesthetic injections were effective in reducing clinical pain in women with abdominal myofascial pain syndrome.

KEY WORDS: Chronic pelvic pain, abdominal myofascial pain syndrome, trigger points, acupuncture, topical injectable anesthetic