Currently we are lacking objective pain and myofascial trigger points (MFTPs) measurement tools. Researchers and practitioner need objective clinical means for assessment. Pain questionnaire and scales although useful, when used alone, rely heavily on interpretation and or patients opinion of pain and severity. Pain is a subjective phenomenon and for the scientist it has presented a difficult and intriguing challenge. As such pain has no external singular criteria, one can never be certain of the validity of any given pain measure or as the case maybe the patient is lying.
Barnsley L, Bogduk N, (1995) noted that pain is not morphologic it cannot be seen on radiographs, computer tomography, or magnetic resonance imaging.1 Subjectively interpreted, pain can leave patients inadequately assessed and treated. We can only know if the person is in pain by his or her statements or actions Fordyce WE, Cousins MJ, stated that no such so-called objective measures currently exist for low back pain.
MFTPs have been cited by numerous authors as the cause of local and referred pain which arises from muscle and its surrounding fascia. Jeremy Lewis, Philip Tehan (1999) stated presently there is no reliable objective test which is capable of determining their presence. The analysis of the results of the ultrasound study found no correlation between the clinical identification MFTPs and diagnostic ultrasound.2
Forbes, Harriet J.; Thomas, Sara L.; Smeeth, Liam; A systematic review and meta-analysis of risk factors for postherpetic neuralgia
In the section called Inflammation as a Cause of Pain and MFTPs we examine Inflammation as the rationale cause of pain. To construct validity we used medical text quotes examining various aspect of inflammation from its cause and way we could measure it. Tissue damage as presented as the cause of pain signalling. Cardinal Signs include: The Roman encyclopaedist Aulus Cornelius Celsus(ca 25BC–ca 50AD) deﬁned the cardinal signs of inﬂammation, namely rubor (redness), calor (increased heat), tumor (swelling) and dolor (pain). In 1870,Rodulph Virchow highlighted that inﬂammation is also associated with functio laesa or loss of function (Larhammar 1996).3
Malik K, Joseph NJ. (2007) stated that no diagnostic test currently exists that can reliably confirm presence of a painful disc and that early diagnosis and treatment of a painful disc may reduce enormous pain and suffering from low back pain.4
In 1995 an article in Spine magazine identified that “scans were interpreted as showing abnormalities (herniated disc, bulging disc, foranimal stenosis) in as many as 19% of the asymptomatic subjects; the frequency of abnormalities was 28% in subjects aged 40 or older. It can be expected that its use, in patients Whiplash Associated Disorders will be impeded by this high proportion of false positive findings.5 Fordyce WE, Cousins MJ, describe that chronic pain exceeds the combined costs more than coronary artery disease, cancer, and AIDS combined. It is aptly described as a ‘hidden epidemic’.6
Mense, Simons, Russell (1983) found these is a lack of general agreement as to appropriate diagnostic criteria for examining TrPs.There has been an increasingly serious impediment to more widespread recognition of myofascial TrPs and to comparable studies of the effectiveness of treatment.7 Therefore we need to find pain measurement tools to evaluate objective outcomes towards best treatment practices.
Different therapists are unable to reliably determine when a trigger point is present in a patient with LBP, Lamb RL et al. (1992) suggesting that the presence of trigger points in patients with LBP should be questioned.8 Patients remain inadequately treated, feeling alone in their pain experiences and inadequately treated by current diagnostics.
In certain cases individuals may be unable to express the feeling of pain. Effectively. This includes the disabled, elderly, children and animals. Health Care Providers are inadequately equipped to identify how much pain a patient feels, where the pain is coming from or whether the treatment applied was effective. Patients are being left inaccurately assessed; pain at times are felt at unbearable levels.
Hovi, Lauri states studies using Gold Pain Standard show these Pain questionnaires are subjective by nature, that “the differences between patients’ and nurses. 10 There aree currently no objective standard against which to test the extent to which the sensation that one individual describes as a burning pain is physiologically the same as what another individual thinks of when he or she hears that term.
According to L Bakketeig, Hartvigsen, S Lings, C Leboeuf-Yde no positive association between perception of work, organisational aspects of work, and social support at work and LBP. There were major methodological problems in the majority of studies included in this review and the diversity in methods was considerable. Therefore associations reported may be spurious and should be interpreted with caution.11 MRIs scans are expensive, frequently prescribed CTs exposure patients to substantially higher dosage of radiation are they and are a leading cost in diagnosing low back pain.
Catherine Guthrie (2008) In the first study of its kind, physicians at hospitals in Florida and Washington, D.C., evaluated the medical-imaging records of 1,243 randomly selected patients to calculate just how much radiation each patient had sustained in the past five years. Although CT scans were the biggest source of radiation, other offenders included X-rays and mammograms. The results of the study, Medicine, were disturbing: the average patient had received 45 millisieverts (mSv) of radiation. How Dangerous Are CT Scans: presented in May at the annual conference of the Society for Academic Emergency12
Matsumoto, Fujimura, Suzuki, Nishi, Nakamura, Yabe, Shiga (1998) studied 497 asymptomatic subjects by MRI and evaluated the disc showing degeneration was the most common observation, being present in 17% of discs of men and 12% of those of women in their twenties, and 86% and 89% of discs of both men and women over 60 years of age. Their results should be taken into account when interpreting the MRI findings in patients with symptomatic disorders.14
Once a pain site is located clinicians can measure and compare damaged and healthy tissue comparisons. Digitized data can be collected for treatment outcomes. Over time we can used this data to identify effectiveness of various treatments. Zhenqiang Ma (2011) noted that clinical physicians strongly desire more compact and even wireless health monitoring devices. 15