Document Type : Original articles


Department of Medicine (Rheumatology), Al-Ramadi Teaching Hospital, Anbar Health Directorate, Ramadi, Anbar, Iraq


Background: Myofascial pain syndrome (MFPS) is defined as the motor, sensory, and autonomic signs resulting from trigger points (TrPs).
Objectives: To assess the effectiveness of the perineural injection in patients with MFPS.
Materials and methods: The study was conducted at AL Ramadi Teaching Hospital, Department of Rheumatology, Ramadi City, Iraq. The study period was from June 2019 to January 2021. A retrospective review of 100 patients with prospectively collected clinical and radiologic data was performed to evaluate the effectiveness of perineural injection on MFPS. A 3 ml of 5% dextrose solution was managed sub-cutaneous straight at the labeled chronic constrictive injury and tender spots rounding the knee. The VAS and WOMAC were calculated for each participant at the time of the presentation and 1, 3, and 6 months following treatment.
Results: The mean age of the patients was 60.93 ± 6.17 years (25-70 years). Three-quarters (75/100) of the cases were female. Seventy subjects were from the age group ≥ 40 years, while the remaining 30 cases were from the age group < 40 years.  Fifty-five cases were with right-sided involvement. Successful results were achieved in 90% of the participants. There were no statistically significant differences between the effective and not effective groups regarding the age, gender, and the involved side (P-value > 0.05). There was a reduction in the mean VAS (8.47 ± 0.77) of pain and WOMAC (78.99 ± 5.69) score at the time of presentation to 1.87 ± 1.32 for the VAS and 17.84 ± 4.66 WOMAC at 6-months post-injection period. No complications were reported in all patients apart from mild pain at the injection site.    
Conclusion: Perineural dextrose injection was successful in 90% of the patients with MFPS. This modality results in a sharp reduction of both VAS and WOMAC scores from the time of the presentation to 6-months post-treatment. We recommend using this modality because it is easy, effective, and safe.  


Main Subjects

[1]      J. A. V. Calero, “Percutaneous Electrolysis: A Potential Tool for Myofascial Pain Syndrome Treatment?,” In Vivo (Brooklyn)., vol. 5302, p. 5305, 2020.
[2]      A. K. Yeung, C. S. Patil, and M. F. Jackson, “Pannexin‐1 in the CNS: Emerging concepts in health and disease,” J. Neurochem., vol. 154, no. 5, pp. 468–485, 2020.
[3]      J. A. Thor, N. H. Mohamed Hanapi, H. Halil, and A. Suhaimi, “Perineural injection therapy in the management of complex regional pain syndrome: A sweet solution to pain,” Pain Med., vol. 18, no. 10, pp. 2041–2045, 2017.
[4]      N. Crichton, “Visual analogue scale (VAS),” J Clin Nurs, vol. 10, no. 5, p. 706, 2001.
[5]      C. Jinks, K. Jordan, and P. Croft, “Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC),” Pain, vol. 100, no. 1–2, pp. 55–64, 2002.
[6]      M. Santos et al., “Genetically engineered elastin-based biomaterials for biomedical applications,” Curr. Med. Chem., vol. 26, no. 40, pp. 7117–7146, 2019.
[7]      H. Kehlet, “Enhanced postoperative recovery: good from afar, but far from good?,” Anaesthesia, vol. 75, pp. e54–e61, 2020.
[8]      D. J. Weber, M. Hao, M. A. Urbin, C. Schoenewald, and N. Lan, “Sensory information feedback for neural prostheses,” Biomed. Inf. Technol., pp. 687–715, 2020.
[9]      E. A. Bittner and J. A. J. Martyn, “Neuromuscular physiology and pharmacology,” in Pharmacology and Physiology for Anesthesia, Elsevier, 2019, pp. 412–427.
[10]    İ. Güzel, D. Gül, S. Akpancar, and J. Lyftogt, “Effectiveness of Perineural Injections Combined with Standard Postoperative Total Knee Arthroplasty Protocols in the Management of Chronic Postsurgical Pain After Total Knee Arthroplasty,” Med. Sci. Monit. Int. Med. J. Exp. Clin. Res., vol. 27, pp. e928759-1, 2021.
[11]    R. Núñez-Cortés, C. Cruz-Montecinos, Á. Vásquez-Rosel, O. Paredes-Molina, and A. Cuesta-Vargas, “Dry needling combined with physical therapy in patients with chronic postsurgical pain following total knee arthroplasty: a case series,” J. Orthop. Sport. Phys. Ther., vol. 47, no. 3, pp. 209–216, 2017.
[12]    M. B. Maclver and D. L. Tanelian, “Activation of C fibers by metabolic perturbations associated with tourniquet ischemia,” J. Am. Soc. Anesthesiol., vol. 76, no. 4, pp. 617–623, 1992.
[13]    M. H. Abu-Zaid, S. A. Tabra, and S. Elmorsy, “FRI0687 Effect of perineural injection therapy in moderate and severe knee osteoarthritis; a comparative study.” BMJ Publishing Group Ltd, 2018.