Preliminary data suggest that patients with active myofascial trigger points (MTrPs) have a significantly different biochemical profile within the local milieu of the MTrPs compared to those without MTrPs or those with a latent (non-symptomatic) MTrP. Specifically, subjects with an active MTrP have a significantly lower pH and significantly higher levels of SP, CGRP, bradykinin, serotonin, norepinephrine, TNF-alpha and IL-1beta at a standardized anatomical location in the upper trapezius muscle than subjects in the latent and normal groups. Furthermore, the local biochemical milieu does appear to change with a LTR. An important question to answer is whether anatomical loci, remote from active or latent MTrPs have similar biochemical profiles to the MTrP itself. These remote sites should be evaluated to help distinguish whether MTrPs have local biochemical profiles or are associated with a more widespread phenomenon. ? ? We selected three groups of subjects based on the following characteristics [1, 2, 3 below]. We then sampled GB-21 in the upper trapezius muscle and LV-7 (posterior and inferior to the medial condyle of the tibia in the upper portion of the medial gastrocnemius) standardized sites for pH, muscle metabolites, inflammatory mediators, arachidonic acid derivatives, neuropeptides, etc. ? ? The goal of this study is to determine whether the local biochemical milieu of an active MTrP is the same as the biochemical milieu at anatomical sites remote from the MTrP. ? ? The acupuncture points GB-21 and LV-7 were selected specifically to standardize the locations of a sampling point in three carefully selected groups: ? ? 1) ?Normal? group: healthy subjects without neck pain and who have no MTrPs identified by palpation bilaterally in GB-21, and who have no MTrPs identified by palpation bilaterally in LV-7? ? 2) ?Latent? group: healthy subjects without neck pain in whom latent MTrPs are identified by palpation in GB-21 in one of the upper trapezius muscles, and who have no MTrPs identified by palpation bilaterally in LV-7, ? ? 3) ?Active? group: healthy subjects complaining of neck pain of less than 3 months duration with active MTrPs identified by palpation in GB-21 in one of the upper trapezius muscles, and who have no MTrPs identified by palpation bilaterally in LV-7.? ? ? Description of protocol progress:? ? We recruited 10 subjects (5 women and 5 men), ranging in age from 25 to 56 years old. With our microanalytical sampling technique, we have successfully collected samples at trigger point 1 in the upper trapezius muscle and LV-7 in the calf from each subject without any untoward events. ? ? Major Findings: ? ? 1) We confirmed our previous findings that at needle insertion in the upper trapezius muscle the concentrations of protons, bradykinin, SP, CGRP, serotonin, norepinephrine, TNF-a, and IL-1a were significantly higher in the """"""""Active"""""""" group than the """"""""Latent"""""""" and """"""""Normal"""""""" groups. The new analytes tested (IL-6, IL-8 and IL-12) were also significantly higher in the Active group. ? ? 2) Significant differences in analyte levels at needle insertion were demonstrated between the trapezius and gastrocnemius in the """"""""Active"""""""" group, suggesting that the vicinity of the active MTrP exhibits a unique biochemical milieu of substances associated with pain and inflammation. ? ? 3) Gastrocnemius analyte levels were higher in the """"""""Active"""""""" group than either the """"""""Latent"""""""" or """"""""Normal"""""""" groups. This suggests that analyte abnormalities may not be limited to local areas of active (painful) MTrPs in the upper trapezius but may be present at sites remote from the active MTrP.
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