Background: Low back pain (LBP) involves both myofascial and neuropathic components of pain. Neuropathic pain is a widespread problem, require continuous consumption of medications. Muscle spasticity might evoke nerve compression, dry needling (DN) of myofascial trigger points (MTrP) under ultrasound (US) guidance is effective method for treatment myofascial pain [1,2] restoring posture [3] and can be effective for neuropathic pain.

Objectives: The aim was to evaluate efficacy of dry needling under US guidance for treatment myofascial and neuropathic components of LBP.

Methods: We included 52 patients, 37 females, aged 18-84 years (the average was 55 years) with clinically diagnosed chronic low back pain with neuropathic component with clinically diagnosed low back pain over 3 month with neuropathic component and reduced motility in spine, pelvis and lower extremity. All patients had symptoms over 3 month, underwent general exam, including MRI, laboratory, neurologic, orthopedic tests. We conducted precise physical tests and neuromuscular ultrasound using M-mode and evaluated nerves and motion in intervetrebral spaces, pelvis, intrinsic foot and leg muscles. We conducted ultrasound survey at the levels of predicted nerve injury. Patients received DN of MTrP under US guidance according to approach by R.Bubnov [1,2], considering nerve entrapment area. Visual analogue scale (VAS, 0-10) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores were measured before, immediately after, 24 hours, and 7 days after intervention.

Results: After 7 days, VAS scores showed pain improvement from 7.4 to 2.2; LANSS scores improved from 16 to 4. In diabetic and postherpetic neuropathy cases we obtained similar results as in rest of patients (p < 0.05). US demonstrated improvement nerve structure, increasing motility, contractility (muscle contracted/rested thickness) on M-mode during functional tests and walking in all levels. Improvement of neuropathy signs as decrease of fascicles diameter from 2 to 0.9 mm measured on US in sciatic nerve, both in tibial, peroneal portions, data correlated with self-assessment pain decrease (r > 0.8). Preferably MTrP were identification in supinator muscle (wrist pain); rotator muscles (infraspinatus, supraspinatus, subscapular and teres minor muscles); scalene muscles; obliquus capitis muscles, and also in fascial tissue.

Conclusion: Dry needling under US guidance guidance effectively reduce myofascial pain, ameliorate symptoms of neuropathy and local muscle hypomotility in low back pain. Further research needed for development US patterns and study causation in chain spasticity-contractility- motion-neuropathic pain.

REFERENCES:

[1] Bubnov RV: The use of trigger point “dry” needling under ultrasound guidance for the treatment of myofascial pain (technological innovation and literature review). Lik Sprava2010, 5-6:56-64.

[2] Bubnov RV: Evidence-based pain management: is the concept of integrative medicine applicable?EPMA J2012, 3(1):13.

[3] Bubnov R, Kalika L, Babenko L. AB1199 Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949

Disclosure of Interests: None declared

DOI: 10.1136/annrheumdis-2019-eular.5533