Latent Myofascial Trigger Points Injection Reduced the Severity of Persistent, Moderate to Severe Allergic Rhinitis: A Randomized Controlled Trial

Abstract

Background: Myofascial trigger points (MTrPs) injection has been effectively used for the management of chronic painful diseases. Latent MTrPs can induce autonomic nerve phenomena. In our clinic, we observed that allergic rhinitis (AR) symptoms significantly improved when latent MTrPs injection was performed for migraine. Objective: To compare the efficacy and safety between latent MTrPs injection and sublingual immunotherapy (SLIT) in patients with persistent, moderate to severe AR. Methods: This randomized controlled trial was conducted with 112 patients with AR. Patients were randomized to receive SLIT (n = 56) or latent MTrPs injection. Total nasal symptom score (TNSS, n = 56), nasal symptoms, medication days, and adverse events were evaluated during the 9 months follow-up period after treatment in both groups. Results: Latent MTrPs injection significantly reduced TNSS to a greater level from baseline (from 8.36 ± 1.96 to 4.43 ± 2.18) than SLIT (from 8.66 ± 2.31 to 7.80 ± 2.47) at week 1 (P < 0.001), and sustained the improvement in symptoms throughout to month 9. Latent MTrPs showed statistically significant differences vs. SLIT for the TNSS reduction both at month 2 (6.59 ± 2.37 vs. 2.64 ± 2.38; p < 0.001) and month 3 (4.59 ± 2.77 vs. 2.62 ± 2.43; p <0.001). Latent MTrPs also showed a better improvement in the onset time of efficacy compared with SLIT. Adverse reactions were few and non-serious in both treatment groups. Conclusions: Latent MTrPs injection significantly improved symptoms and decreased symptom-relieving medication use in patients with AR and was well tolerated. Clinical Trials Registration: Chinese Clinical Trial Registry, ChiCTR1900020590. Registered 9 January 2019, http://www.chictr.org.cn/index.aspx.

Keywords: allergic rhinitis; autonomic nerve network; latent myofascial trigger points; sublingual immunotherapy; treatment.

Figure 1

Performance of the latent MTrPs injection for AR. Sternocleidomastoid muscles latent MTrPs injection (A). Lateral pterygoid muscles latent MTrPs injection (B). Medial pterygoid muscles latent MTrPs injection (C). Splenius capitis and Semispinalis muscles latent MTrPs injection (D, E). MTrPs, myofascial trigger points.

Figure 2

Flow diagram of trial procedure.

Figure 3

Effect of the SLIT and latent MTrPs injection on nasal and eye symptoms during the 9 months follow-up period in patient with AR. *: p < 0.05, **: p < 0.01, and ***: p < 0.001. SLIT, sublingual immunotherapy; MTrPs, myofascial trigger points.

Figure 4

The trend of the changes of TNSS and number days of rescue medication usage during the past week prior to the assessment points. TNSS, total nasal symptom score.