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Licensed Unlicensed Requires Authentication Published by De Gruyter March 10, 2021

Granisetron vs. lidocaine injection to trigger points in the management of myofascial pain syndrome: a double-blind randomized clinical trial

Zahra Rezasoltani, Hanna Ehyaie, Reza Kazempour Mofrad, Fatemeh Vashaei, Reza Mohtasham and Sharif Najafi

Abstract

Objectives

Granisetron and lidocaine injections have been used for the management of myofascial pain syndrome. This study was aimed to compare the efficacy of granisetron and lidocaine injections to trigger points of upper trapezius in the management of myofascial pain syndrome.

Methods

We performed a double-blind randomized clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. A total of 40 patients aged ≥18 with neck pain due to myofascial pain syndrome were included. They had pain for at least one month with the intensity of at least 30 mm on a 100 mm visual analog scale. Each participant received a single dose of 1 mL lidocaine 2% or 1 mg (in 1 mL) granisetron. The solutions were injected into a maximum of three trigger points of the upper trapezius. We instructed all patients to remain active while avoiding strenuous activity for three or four days, and to perform stretch exercise and massage of their upper trapezius muscles. We assessed the patients before the interventions, and one month and three months post-injection. The primary outcome was the Neck Disability Index and the secondary outcome was the Neck Pain and Disability Scale.

Results

Both interventions were successful in reducing neck pain and disability (all p-values <0.001). However, the neck pain and disability responded more favorably to lidocaine than granisetron (p=0.001 for Neck Disability Index, and p=0.006 for Neck Pain and Disability Scale). No significant side-effect was recognized for both groups.

Conclusions

Both lidocaine and granisetron injections to trigger points are effective and safe for the management of the syndrome and the benefits remain at least for three months. However, lidocaine is more effective in reducing pain and disability. The injections are well-tolerated, although a transient pain at the site of injections is a common complaint. One mL of lidocaine 2% is more effective than 1 mg (in 1 mL) granisetron for injecting into the trigger points of the upper trapezius in myofascial pain syndrome.


Corresponding author: Sharif Najafi, Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Etemadzadeh St, Western Fatemi, Tehran 1411718541, Islamic Republic of Iran, Phone: +98 21 43823476, Fax: +98 21 88028724, E-mail:

  1. Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  2. Author contributions: ZR contributed to the design and development of the study protocols, supervised physical examinations, and contributed to the decision on eligibility. HE helped with the literature review and performed statistical analyses. RKM contributed to the literature review and design and helped with statistical analyses. FV and RM participated in the design of the study, guided the recruitment process, interviewed patients, and performed physical examinations. SN conceptualized and designed the study, guided the development of the protocols and performed the injections, helped with the decision on patients’ eligibility, and the interpretation of the results. All the authors participated in drafting and its final approval.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent has been obtained from all individuals included in this study.

  5. Ethics approval: Obtained from the Institutional Review Board of Aja University of Medical Sciences with the Ethics Committee reference number of IR.AJAUMS.REC.1398.202.

  6. Registration: Iranian Registry of Clinical Trials (IRCT) website http://www.irct.ir/, a WHO Primary Register setup, with registration code: IRCTID: IRCT20200114046128N1.

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Received: 2020-10-04
Accepted: 2021-01-12
Published Online: 2021-03-10
Published in Print: 2021-10-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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