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An active TrPs causes pain at rest, while a latent TrPs does Treatment modalities that have been used to inactivate of
not cause spontaneous pain, but may restrict movement MTrPs include: interrupting the pain cycle by penetrating
or cause muscle weakness. [8] the MTrPs with a needle; injecting local anesthetic or
saline; and applying a cooled spray to the skin, followed
Thus, a typical TrPs is characterized by the presence of [11]
discrete focal tenderness within a palpable taut band by muscle stretching.
of skeletal muscle, which generates both referred Low-level laser therapy (LLLT), ultrasound and electro
regional pain and a local twitch response (LTR). TrPs galvanic stimulation can also be useful in managing
are associated with referred pain in MPDS, while tender MTrPs. [14,15]
points in comparison are associated with pain at the site Modern dental practice encompasses low-level lasers
of palpation only and occur in the insertion zones of therapy to accelerate tissue healing, alleviate pain, reduce
muscles, not in the taut bands in the muscle belly. [9]
inflammation and physiotherapy in the orofacial region.
Several histopathologic mechanisms have been proposed Low-level laser application plays an important role in
to account for the development of TrPs and subsequent the treatment of most musculofacial disorders and facial
pain patterns. Many researchers concur that acute trauma pain. [16-19]
or repeated microtrauma may lead to the development of Laser light is energy that results from stimulated
a TrPs. [10]
emission of radiation. The laser light biostimulation
In the head and neck regions, MPDS presents as tension of structural tissue can be increased to an energy level
headaches, tinnitus, temporomandibular joint pain, and in that creates chemical reactions. It stimulates protein
rare cases visual symptoms. [11] synthesis, phagocytic activities and aerobic energy to
induce anti-inflammatory, analgesic, and tissue repair
Palpation of a hypersensitive bundle or nodule of muscle effects. The laser type is determined by the wavelength
[20]
fiber of harder than normal consistency is the physical of the light based on the solid state aggregation of the
finding most often associated with a TrPs. Localization of energized material. Many types of lasers have been used,
a TrPs is based on the physician’s sense of feel, assisted e.g., helium: neon, gallium-aluminum-arsenide (Ga-Al-As),
by patient expressions of pain and by visual and palpable neodymium-doped yttrium aluminum garnet, and carbon
observations of LTR. [7]
dioxide. [21]
The diagnosis of temporomandibular joint dysfunction Gallium-aluminum-arsenide is a diode laser with a
(TMJD) requires a skilled clinician with training and wavelength of 780 nm. Some studies have shown that
experience in recording a patient’s histories, conducting Ga-Al-As lasers have positive effects, [22,23] including
thorough examinations, and identifying MTrPs. Diagnosis acceleration of wound healing and pain reduction, [24,25]
confirmed by the occurrence, at least of a taut band, and although many studies have shown no positive effect. [26,27]
pain felt by the patient when pressure is applied to a
tender nodule. [12] Laser photobiomodulation is a low-cost, noninvasive
treatment that has been widely used for treating a diverse
Most treatment methods for myofascial pain are empirical range of conditions, including muscle/joint conditions.
and aim to identify painful TrPs for the purpose of It has been used frequently in physical therapy practice
ablating muscle spasm and restoring normal muscle for pain relief and tissue regeneration, and has been
length, function and strength.
proven as beneficial in treating TMJD. Various studies
Both psychological and physical treatments are necessary have confirmed therapeutic effects including are
to overcome MPDS. Conservative treatments are anti-inflammatory, analgesic and cell activity modulating
[1]
generally useful for alleviating pain and preventing actions. [28-30]
dysfunction. Dentists use different therapies such as Dry needling has been found to be as effective as drug
pharmacologic treatments, which include analgesics, injection for the relief of pain in muscles and connective
muscle relaxants, antidepressants, neuroleptics, or tissue. In the treatment of TrPs for persons with myofascial
nonsteroidal anti-inflammatory drugs. [13]
pain syndrome, in which an acupuncture needle is inserted
Alternative treatment modalities include acupuncture, into the skin and muscle directly into a MTrPs. [31]
massage, acupressure, ultrasonography, application A MTrPs consists of multiple contraction knots, which
of heat or ice, diathermy, transcutaneous electrical are related to the production and maintenance of the
nerve stimulation, ethyl chloride spray, and stretching pain cycle. Accurate dry needling of a MTrPs elicits a
techniques.
LTR, which is an involuntary spinal cord reflex in which
Other methods of treatment include: dry needling; TrPs the muscle fibers in a taut band of skeletal muscle
injections with local anesthetic, saline, or steroid; occlusal contraction. An LTR indicates the proper placement of the
splints; biofeedback; and physiotherapy. [2] needle in a TrPs. Research has shown that dry needling

22 Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014