Ultrasound-Guided Electroacupuncture for Thoracic Myofascial Pain Syndrome: A Case Report

This case report describes an innovative approach to improve the safety of acupuncture in the thoracic region through the use of real-time ultrasound. The study was conducted by researchers at the Centro Hospitalar Tâmega e Sousa in Portugal and published in the journal Cureus in 2023. The case involved a 56-year-old man who presented with chronic myofascial pain syndrome in the right parascapular region, with intense pain (7/10 scale) and limitation of shoulder range of motion for more than five years. The patient also reported sleep disturbances and depressed mood, was obese (BMI 33 kg/m²), and was taking medications for hypertension and depression.

Previous treatments with anti-inflammatory drugs, muscle relaxants, and physical therapy showed low or temporary efficacy. Myofascial pain syndrome is characterized by the presence of trigger points in muscles and is one of the most common chronic musculoskeletal pain conditions. Although acupuncture is generally safe, there is risk of complications such as pneumothorax when performed in the thoracic region, especially in obese patients in whom precise localization of the points can be challenging. The methodology employed used real-time ultrasound (Logic-e equipment from GE Healthcare with a 10 MHz linear probe) to guide the insertion of eight acupuncture needles per session.

The protocol consisted of six weekly sessions of electroacupuncture with parameters of 4 Hz and 100 ms for 20 minutes, with intensity considered significant but tolerable by the patient. The ultrasound allowed visualization of the different muscle layers (trapezius, rhomboid, and erector spinae) below the thick subcutaneous tissue, maintaining a safe distance from the pleura to prevent pneumothorax. The results showed significant pain reduction on the numerical scale from 7 to 3, improvement in range of motion, and better sleep quality one month after completing the treatment. Interestingly, mood did not show improvement.

No complications were reported during the entire procedure. The main advantage of this technique was that it allowed precise positioning of the needles in different deep and superficial muscle layers, maintaining consistency between sessions and avoiding vital structures. However, the authors identified some practical limitations, including difficulty caused by the ultrasound gel during needle positioning, difficulty in handling the probe after some needles were already in place, and difficulty in visualizing the thin needles. In addition, the procedure took longer and was more costly compared with the conventional unguided technique.

The clinical implications of this work suggest that ultrasound may be a valuable tool for medical acupuncture practitioners, especially when treating trigger points in the thoracic region where the risk of complications is greater. The technique proved feasible for pain medicine specialists with training in ultrasound. The study contributes to the knowledge of how to improve the precision and safety of dry needling and acupuncture procedures, particularly in complex anatomical regions and in obese patients in whom palpation may be limited.