Symptom Duration Affects the Outcome of Multidisciplinary Treatment of Myofascial Pain: The Method of Assessment Influences the Understanding of the Results

Abstract

Objectives: To study the effect of symptom duration on the outcome of a multidisciplinary program treating patients with myofascial pain failing standard therapies. We also study the effect of the assessment method on the clarity of the report of the results.

Methods: Fifty-two consecutive patients enrolled in a multidisciplinary pain treatment program who failed physical, chiropractic, medication, and surgical therapies were treated with myofascial technique physical therapy, clinical psychophysiology [biofeedback, surface electromyography, and counseling], medication, and trigger point injections. We used two McGill Pain Scales, the visual analog scale [VAS], and a Global Self Assessment Scale of Improvement [GSASI] to assess outcomes.

Results: Twenty-nine of 34 [85 percent] patients treated within three years of symptom onset and 12 of 18 [67 percent] patients with symptoms of longer duration were likely to have good or excellent outcomes. The earlier group had 24 of 34 [71 percent] and the latter five of 18 [28 percent] excellent results. Defining quality of outcome in percentage terms was cumbersome using the two McGill Pain Scales and the VAS. The correlation among the four scales was good to excellent. The GSASI illustrated most patients having good or excellent improvement more clearly than the other scales.

Conclusions: The earlier the patient entered the multidisciplinary treatment program, the more likely she or he would have an excellent outcome. Patients had > 50 percent chance of good or excellent improvement. Outcomes illustrated by GSASI were more understandable than those demonstrated by the other rating scales.

KEYWORDS:

• Myofascial
• trigger point
• Global Self Assessment Scale of Improvement
• McGill Pain Scale
• visual analog scale