Gayathri Subhash Banasode Associate Professor, Department of Anaesthesiology, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India
Nivedita Page Directors, The Painex Clinic, Pune, Maharashtra, India
Kashinath Bangar Directors, The Painex Clinic, Pune, Maharashtra, India
Nisheed Joseph Associate Professor, Department of Anaesthesiology, Kodagu Institute of Medical Sciences, Madikeri Karnataka, India
Address for correspondence: Nisheed Joseph, Associate Professor, Department of Anaesthesiology, Kodagu Institute of Medical Sciences, Madikeri Karnataka, India E-mail: dr.nisheed.joseph@gmail.com
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Banasode GS, Page N, Bangar K, et al. 5-in-1 block for chronic myofascial upper back and neck pain: a prospective patients series. Ind J Anesth Analg. 2025;12(1):52-56.
Timeline
Received : November 28, 2024
Accepted : December 28, 2024
Published : March 15, 2025
Abstract
Chronic myofascial pain of cervical spine and shoulder is often related to faulty posture. Extended period of screen usage, faulty posture and sedentary lifestyle exacerbate tightness and weakness of back and core muscles. Excessive strain on the surrounding muscles and cervical spine leads to inter vertebral strain and spinal misalignment, and spine shaped like a “question mark” exaggeration of lumbar spine lordosis and excessive kyphosis of the thoracic spine. A bad posture can cause the musculature of the neck and upper back to strain excessively, which can irritate the spinal accessory nerve (SAN) and dorsal scapular nerve (DSN). A 5-in-1 trigger point and hydro-dissection technique has been described by Tang et al that specifically target trapezius, rhomboids, levator scapulae, and hydro dissecting the DSN and SAN to provide pain relief. We report ten patients of chronic myofascial upper back and neck pain managed by 5-in 1 block.
Conclusions: 5-in 1 block is a good treatment option for patients suffering from chronic upper back and, neck pain and multidisciplinary approaches are essential.
References
1. Manchikanti L., Damron K., Cash K., Manchukonda R., Pampati V. Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-blind, controlled trial: clinical trial NCT0033272. Pain Physician. 2006 Oct; 9(4): 333-46.
2. Enthoven P., Skargren E., Oberg B. Clinical course in patients seeking primary care for back or neck pain: a prospective 5-year followup of outcome and health care consumption with subgroup analysis. Spine (Phila Pa 1976). 2004; 29: 2458–65.
3. Cote P., Cassidy J.D., Carroll L. The Saskatchewan Health and Back Pain Survey: the prevalence of neck pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976). 1998; 23: 1689–98.
4. Reyes-Gibby C.C., Aday L., Cleeland C. Impact of pain on self-rated health in communitydwelling older adults. Pain. 2002; 95: 75–82.
5. Alvarez D.J., Rockwell P.G.. Trigger points: diagnosis and management. Am Fam Physician. 2002; 65: 653–60.
6. Tang T.Y., Wu C.H. Identifying the dorsal scapular artery optimizes the safety and precision of the ultrasound-guided 5-in-1 injection. Am J Phys Med Rehabil. 2019 Jul; 98(7): e80-e81.
7. Hong C.Z. Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil. 1994; 73: 256–63.
8. Tang T.Y., Shyu S.G., Kao B.C., Wu C.H. Ultrasound-guided 5-in-1 injection: trigger point injections and nerve hydrodissections for nonspecific upper back pain. Am J Phys Med Rehabil. 2019 Jun; 98(6): e55–6. 9. Simons D.G., Travell J.G., Simons LS. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Baltimore: Lippincott Williams & Wilkins; 1999.
10. Modi D.J., Tuttle J.M., Kang S., Singh J.R. Utilizing an ultrasound guided 5-in-1 trigger point and hydrodissection technique for interscapular mid-thoracic myofascial pain: A retrospective review. Intervent Pain Med. 2023 Dec; 2(4): 100285.
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This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
Acknowledgements
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Conflicts of Interest
The authors report no conflicts of interest in this work.
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Banasode GS, Page N, Bangar K, et al. 5-in-1 block for chronic myofascial upper back and neck pain: a prospective patients series. Ind J Anesth Analg. 2025;12(1):52-56.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.