臺灣博碩士論文加值系統

肌筋膜疼痛症候群(MPS)為最常見的肌肉疼痛疾病，特徵為肌肉緊繃帶出現特定敏感的引痛點(myofascial trigger point)。近年發生率大幅上升，肌筋膜疼痛症候群成為導致長期失能的主因之一，嚴重影響患者的生活品質與日常工作。引痛點成為現行臨床與基礎研究以及復健治療的主流概念，由於肌筋膜疼痛症候群的關鍵性引痛點病理機轉尚不明確，因而阻礙相關的正確診斷與治療成效。
肌筋膜疼痛症候群(MPS)基於肌筋膜激痛點(MTrP)的存在特徵，MTrP屬於骨骼肌肉緊繃肌帶內部可觸覺的局部性過度激活疼痛點。強力地觸壓MTrP會產生局部抽搐反應(LTR)與該處肌肉的特定型式引傳痛。記錄MTrP的特徵性肌電圖活呈現終板雜訊(End Plate Noise, EPN)的異常型終板電位，源自神經肌肉交接處過度釋出乙醯膽素。其中MTrP致病機轉或與能量危機理論相關，肌纖維過度負荷產生功能失常的終板(EPN)，導致肌纖維過度收縮的緊繃肌帶，致使局部區域缺血與痛覺神經傳導介質敏感化；再者，EPN的出現頻率亦呈現與MTrP激活性相關。目前發展多種MTrP處置的治療策略，例如物理治療的熱療、冷療、與電療，徒手治療的按摩、噴療與牽拉，以及激痛點注射暨施用藥物。生物共振電場波對於MTrP治療的輔助療效則仍無研究報告。
活體組織細胞給與低感度低電量單相正性方波能量源自微流式電性神經刺激儀(MENS)的生物共振電場波(BRW)，證實增進細胞能量ATP濃度、胞膜通道主動運輸、與細胞代謝生化合成；或由個別組織細胞內外電荷物質產生極化分佈與電位差異引發共振形成動作電位，開啟接壁疆合胞間通訊的電性門禁通道暨成為似半導體的生物連續組織，以及開啟胞膜主動運輸的電性離子通道暨改變細胞型態骨架分佈與基因表現酵素活性。
本研究的目的為探討生物共振波對肌筋膜疼痛患者的疼痛緩減情形，提供患者於居家治療的可行性。研究施加能量的設定電場波頻與電流週頻(WF/CF Hz)含約8min舒緩期的25,000 ~500 /100暨約8min修癒期的500 ~10 /10，設定組合電場波頻含單式頻率、減式掃集、與縮式擴區，個別成分電場波載(WD)為50%單相正性方波能量，設定電流600uA於電壓均峰值6.2V，電流週載(CD)試驗組(C1) 70%與對照組(C2) 1%。
細胞形態趨同與體液抗氧增效相關研究，施加0.24W單式波頻電流週載(WF Hz/CD %)四種組合能量2/50、2k/50、2/70、與2k/70相關MCF-7乳癌管腺株細胞形態，顯示2/70組合能量似可誘發較高比例細胞形態趨同效應的單獨圓化與團塊勻化。同時，本研究施加前述能量僅只ICF生物體液緩衝系統顯示對於後續過氧化氫(H2O2)攻擊的氧化耐受趨勢顯著增效；研究施加前述能量MLE-15肺部細胞株顯示氧化耐受30分鐘100uM H2O2氧化攻擊的代謝提昇，細胞能量測定儀檢測結果似乎呈現氧耗提昇與產酸減少。
生物共振波對肌筋膜疼痛患者的疼痛緩減相關臨床試驗，針對共60人次的患者，經過每週三次，為期四週的進行。探討評估分別運用生物共振波及使用安慰劑之兩組來進行治療。用基本資料表、疼痛等級量表、頸椎功能障礙指數、壓痛點檢查表、SF-12 、盤斯心情量表來確定測量結果。評估介入前後進行之量測對肌筋膜疼痛改善的程度。結果顯示：經過治療，在疼痛等級量表(VRS)在生物共振組有顯著的改善;但是在對照組並沒有觀察到差異之處。頸椎功能障礙指數(NDI)於生物共振組有顯著改善。壓力痛覺閾值(Pressure Pain Threshold，PPT)，不論是生物共振組或對照組都有顯著的改善。
生物共振波於肌筋膜疼痛症候群治療上確實有改善肌筋膜疼痛之效果。患者應可利用此治療法達到即時緩解疼痛的效果。未來可進一步做長期療效評估，供長期治療參考，達到逐漸改善病症的目的。在更親切、更具人性化的操作界面下，患者可於居家使用。結合生醫保健概念與電子科技的技術，達到更多元化、人性化之需求。

Myofascial pain syndrome (MPS) is a common pain issue that disturbs many people. The MPS not only causes the painful condition but affects the patient’s mood state and even life function. There have been many studies show variety of treatment approaches including invasive and noninvasive. However the efficiency of noninvasive therapies has its limitation.
Application of bio-resonance wave (BRW) with microcurrent electrical nerve stimulator (MENS) may work on respective cells by means of charged molecule polarization into both electric potential and resonant action potential in order to open the electric gate channel of gap junction intercellular communication. An integration effect of neighboring cells may form semiconductor-like tissue block and cellular changes of cytoskeleton and morphology conformity.
This study wants to discuss whether the bioresonance therapy is considered as a new treatment to myofascial pain syndrome. The BRW electric field energy of applied wave frequency and cycle frequency (WF/CF Hz) included an 8min easing phase of 25,000 ~500 /100 along with an 8min healing phase of 500 ~10 /10. The applied BRW energy was of assorted WF bank including single frequency, sweep decreasing, and spread contraction with same monophasic positive square waves of 50% wave duty (WD) based on same specifications of 600uA current at 6.2V mean peak potential despite of different cycle duty (CD) in test group (C1) 70% and in control group (C2) 1%.
With 0.24W BRW energy of single frequency combinations (WF Hz /CD %), the MCF-7 cell line with 2/70 energy showed better cellular morphology conformity of round-up discrete cell and homogeneous grouped cells based on statistics morphology data among four applied energy combinations of 2/50, 2k/50, 2/70, and 2k/70. With the stated treatment of BRW energy, the ICF-like buffer system showed better oxidative tolerance under H2O2 challenges based on trend difference of oxidation reduction potential (ORP) data. The MLE-15 cell line with stated treatment and with added 30min of 100uM H2O2 challenge showed better physiological metabolism based on likely differences of increased oxygen consumption rate (OCR) and decreased extra cellular acidification rate (ECAR) from extracellular flux analyzer XF-24.
Sixty patients with MPS were divided into two groups: bioresonance group and control group. After twelve times interventions, the bioresonance group shows significant decreases in VRS, NDI, SF-12 and PPT, while the control group only shows significant decreases in PPT. This study suggests that bioresonance therapy might be considered as a new intervention to myofascial pain syndrome.
Key words: Myofascial Pain Syndrome, Bio-resonance electric field wave, Trigger Point, Muscle Spindle Hypothesis, In Vivo Resonance.

誌 謝 I
摘 要 II
Abstract IV
Contents VII
Chapter 1 Myofascial Pain Syndrome 1
1.1 Clinical Profile of Myofascial Pain Syndrome 1
1.1.1 Clinical Cases of Myofascial Pain Syndrome 1
1.1.2 Clinical Manifestation of Myofascial Pain Syndrome 1
1.1.3 Clinical Classifications of Myofascial Pain Syndrome 1
1.2 Pathophysiological Mechanisms of Myofascial Pain Syndrome 2
1.2.1 Myofascial Pain Syndrome Related Pathological Mechanisms 2
1.2.2 Clinical Pathophysiological Mechanisms of Pain 3
2A Transmission Pathway of Pain Impulses towards Brain 3
2B Transmission Pathway of Pain Impulses from Brain 7
1.3 Systemic Energization of Pathological Pain Relief Mechanism 8
1.3.1 Practical Strategies of Pain Relief Mechanism 8
1.3.2 Clinical Practices of Pain Relief Mechanism 10
1.4 Energetic Pain Relief on Continuous Tissue from Discrete Cells 10
1.4.1 TENS and BRW 10
1.4.2 Cationic Effect of Intracellular Buffer Fluid with BRW 11
1.4.3 Anionic Effect of Intracellular Buffer Fluid with BRW 12
1.4.4 Pain Amelioration Effect on Responsive Bio-Subject with BRW 13
1.5 Thesis Structure 13
Chapter 2 Materials and Methods 14
2.1 BRW-Responsive Effects of ICF-Like Buffer System 14
2.1.1 Buffer Cation of ICF-Like Solution 14
2.1.2 Buffer Anion of ICF-Like Solution 15
2.2 Clinical Trial of BRW Supplement in Human Subject Treatments 16
2.2.1 Clinical Trial on Human Subjects with IRB Audit 16
2.2.2 Clinical Trials on Pain Relief 18
Chapter 3 Results and Discussion 33
3.1 Results on ICF-Like Buffer with BRW Treatment 33
3.1.1 ICF-Like Buffer Cation Effects with BRW Treatment 33
3.1.2 ICF-Like Buffer Anion Effects with BRW Treatment 33
3.2 Subject Information 35
3.3 Changes in Subject Parameters Following Treatment 36
3.3.1 Verbal Rating Scale (VRS) 37
3.3.2 Neck Disability Index (NDI) 37
3.3.3 Pressure Pain Threshold (PPT) 38
3.3.4 Short Form-12 Health Survey (SF-12) Scales 38
3.3.5 Profile of Mood States (POMS) 38
Chapter 4 Conclusions and Future Prospects 40
4.1 Conclusions 40
4.1.1 BRW responsive effects of bio cells 40
4.1.2 Clinical Trials 41
4.2 Future Prospects 43
4.2.1 Clinical Trials 43
4.2.2 Possible Applications with BRW Modulations 45
Reference 48
Appendix-1 Publication Lists 53
A1.1 Publication list of journal papers 53
A1.2 Publication list of conference papers 53
Appendix-2 Related Tables 54
A2.1 Appendix 2-1 54
A2.2 Appendix 2-2 55
A2.3 Appendix 2-3 56
A2.4 Appendix 2-4 59
A2.5 Appendix 2-5 61
A2.6 Appendix 2-6 62
A2.7 Appendix 2-7 63

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