This letter is concerning the article in Vol. 15#2 starting on page 111 by Pinto et al on “Management of Low Back Pain.” Their discussion started with the statement, “The origin of low back pain (LBP) is difficult to establish.” That is so true if you do as they did and base thinking only on symptoms with no regard or concern for the literature that clearly identifies its treatable cause, i.e., myofascial trigger points. I am referring here to the clear and rather complete presentation of the cause of LBP on pages 804–809 of the 1999 edition of the Trigger Point Manual1 and the seven references of published articles provided below2–8 that describe its successful treatment by addressing skillfully the myofascial trigger point cause of the pain and dysfunction. Patients deserve and need to be examined for myofascial trigger points that are common and likely to be causing their LBP. How to identify those muscles and treat them is fully explained in the Trigger Point Manuals, volume 1 & 21,9.
REFERENCES
- 1.Simons DG, Travell JG, Simons LS. Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1 Upper Half of Body. 2nd ed. Baltimore, MD: Williams & Wilkins; 1999. [Google Scholar]
- 2.Dejung B. Die Behandlung unspezifischer chronischen Rückenschmerzen mit manuelle Triggerpunkt-Therapie. [German: Treatment of chronic non-specific low back pain with manual trigger point therapy] Manuelle Medizin. 1999;37:124–131. [Google Scholar]
- 3.Hsieh CYJ, Hong CZ, Adams AH, et al. Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. Arch Phys Med Rehabil. 2000;81:258–264. doi: 10.1016/s0003-9993(00)90068-6. [DOI] [PubMed] [Google Scholar]
- 4.Hsieh CY, Adams AH, Tobis J, et al. Effectiveness of four conservative treatments for subacute low back pain: A randomized clinical trial. Spine. 2002;27:1142–1148. doi: 10.1097/00007632-200206010-00003. [DOI] [PubMed] [Google Scholar]
- 5.Itoh K, Katsumi Y, Kitakoji H. Trigger point acupuncture treatment of chronic low back pain in elderly patients: A blinded RCT. Acupunct Med. 2004;22:170–177. doi: 10.1136/aim.22.4.170. [DOI] [PubMed] [Google Scholar]
- 6.Kovacs FM, Abraira V, Pozo F, et al. Local and remote sustained trigger point therapy for exacerbations of chronic low back pain: A randomized, double-blind, controlled, multicenter trial. Spine. 1997;22:786–97. doi: 10.1097/00007632-199704010-00017. [DOI] [PubMed] [Google Scholar]
- 7.Ney JP, Difazio M, Sichani A, Monacci W, Foster L, Jabbari B. Treatment of chronic low back pain with successive injections of botulinum toxin A over 6 months: A prospective trial of 60 patients. Clin J Pain. 2006;22:363–369. doi: 10.1097/01.ajp.0000174267.06993.3f. [DOI] [PubMed] [Google Scholar]
- 8.Raj PP, Paradise LA. Myofascial pain syndrome and its treatment in low back pain. Semin Pain Med. 2004;2(3):167–174. [Google Scholar]
- 9.Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 2. Baltimore, MD: Williams & Wilkins; 1992. [Google Scholar]