2003 / 2004 Janet Travell Award
The IMS Grants Committee awarded the first Janet Travell Myofascial Pain Syndrome IMS Training Scholarship to Christian Gröbli in the amount of $ 4,000.00 US in 2003. His grant has been extended, again in the amount of $ 4,000.00 US, for the year of 2004. Below is the original grant abstract. After that you will find Mr. Gröbli’s summary of the work in 2003, and the extension request.
Recipient: Christian Gröbli, PT of Schaffhausen, Switzerland
Preceptor: Professor Dr. Med. Dieter Pongratz of the Friedrich-Baur-Institut, Munich, Germany
Title: TRIGGER POINT MUSCLE BIOPSY
Background: There is a serious need for well performed biopsies of active myofascial trigger points [TrPs] that are analyzed in terms of our current understanding of TrP pathology. There are very few professionals trained and qualified to perform such biopsies.
Objectives: For the Candidate to learn muscle biopsy techniques and to become familiar with appropriate processing techniques for various kinds of histological examinations of muscle tissue.
Methods: The Candidate will participate in a pilot study that will carefully examine the tissue from eight muscle biopsy specimens from subjects with myofascial pain syndrome [MPS]. Four critical specimens will be from active TrPs, and four control specimens will be from TrP endplate zone sites. The Candidate already has expertise in the manual identification of TrPs, but he has had no prior training or experience in how to perform or process muscle biopsies of TrPs.
Each biopsy section will be divided into two portions, one for routine muscle disease processing and the other for specific TrP analysis. The routine sections will go to Prof. Pongratz for evaluation. Of the special processing sections, one set will go to Professor Dr. Med. Siegfried Mense for light microscopic evaluation and the other set will go to Professor Mueller-Hoecker for ultramicroscopic processing.
The Candidate will contribute importantly to the project by selecting appropriate clinical subjects and determining the best muscle sites for biopsy. In addition, the Candidate will assist in performing the biopsy procedure, in preparing the tissue for sectioning and in analysis of the resultant data.
Benefits: The Candidate is seriously interested in gaining such skills in this field, so this experience will prepare him for better service to the field. In addition, he will be most beneficial as new member of an experienced muscle biopsy team.
Summary: This training opportunity will provide a critical additional member to complete an outstanding biopsy team for this pilot study and provide an important foundation for more advanced studies in the future.
REVIEW OF MR. GRÖBLI’S PROJECT
[presented to the IMS Board July 2005]
Title: TRIGGER POINT MUSCLE BIOPSY
As outlined in the award documents for the IMS Training Grant, the objectives of this grant included to learn muscle biopsy techniques and to become familiar with appropriate processing techniques for various kinds of histological examinations of muscle tissue. The purpose of this document is to provide the IMS Board with a brief review of the current status of the grant.
Since the award, I have actively participated in the myofascial trigger point biopsy studies under the direction of Prof. Dr. med. Dieter Pongratz at the Friedrich-Baur Institut in Munich, Germany.
The study consisted of the examination of the eight muscle biopsy specimens. As an experienced clinician trained to identify myofascial trigger points, I was instrumental in the proper identification of trigger points in the subjects. My role in the research team was essential for the success of the applied methodology. In addition to locating trigger points in subjects with myofascial pain syndrome, I also identified those muscles in control volunteer subjects without trigger points. The following muscles were included in the study: biceps brachii, vastus lateralis, and deltoid muscles.
To allow Dr. med. Peter Reilich to perform accurate biopsies, I marked the location of each trigger point as well as the direction of the corresponding taut band. Through detailed palpation, I was able to provide Dr. Reilich insights into the actual tissue depth. The biopsy involved an open technique with local cutaneous anesthesia without anesthetizing any muscle. In some cases, we used a “matchstick” technique [in German: Stäbchenbiopsie] in an attempt to maintain the same tissue tension before and after the biopsy. We encountered several procedural difficulties with this technique after which the methodology was modified.
Following the biopsies, the samples were processed for analysis using light microscopy and electron-microscopy.
Unfortunately, at this point the pilot study has not revealed any consistent specific pathological changes at trigger points. Nevertheless, the pilot study was in many other ways very fruitful. We have learned much about proper trigger point biopsy methodology and feel better prepared for future studies. Therefore, we can conclude that the pilot study indeed provided an excellent foundation for such future studies.
I feel that this learning experience with such qualified physicians and researchers has been an important advancement. I have used the grant exclusively to cover travel, lodging, and meal expenses and did not assign any of the funds to other expenses, including salary. Each trip from my residence in Switzerland to Munich costs approximately $500 for a total of eight trips.
In addition to having learned much, I also feel that my participation in this pilot study was essential. I am looking forward to extending my role in future studies. The success of future studies is partially dependent upon the proper identification of myofascial trigger points, and I believe that I am the most qualified individual on the research team.
As was anticipated in the original award, this pilot study provided an important step in the right direction. The preceptor, Prof. Dr. med. Pongratz, has already indicated that he is anticipating future biopsy studies at the Friedrich-Baur Institut. Therefore, I would like the IMS Board to consider extending the current grant consistent with future biopsy research activities.
I am thankful for the opportunity the IMS Board has provided me and hope that the Board indeed will consider extending the grant.
Sincerely,
Christian Gröbli
REVIEW OF MR. GRÖBLI’S PROJECT
[presented to the IMS Board August 2007]
I would like to provide the board of the International MYOPAIN Society this interim report on the trigger point muscle biopsy study at the Friedrich Baur Iinstitut, University Munich, Germany.
After having solved difficultis with the ethics committee concerning anonymization of patients' data and patient informed consent, the project was finally approved in October of 2006. Subsequently, the contract with the insurance company could have been effected starting in Januaty 2007.
At the turn of the year, problems arose with the operating room. After January of 2007 Dr. P. Reilich and all other colleagues of the Friedrich-Baur-Institut no longer had access to that room. This problem was not predictable and was due to internal reorganization within the department of the University hospital that had been offering that room to the Friedrich-Baur-Institut for the last years. We were immediately looking for an alternative solution. We are now in contact with the plastic surgery department to do this biopsy for us but still have no definitive response from them.
The next problem is that there are now additional costs from about 300 EUR for each biopsy demanded by the plastic surgeons. These are costs which were not included in the initial plan. The change of the surgeon requires a new approval by the ethics committee as well as an adaptation of the contract with the insurance company.
As mentioned above, this new situation will lead us beyond the budget. The entire study team would very much regret if the study project would die due to lack of money. The David G. Simons Academy will support the study as much as possible if necessary.
Christian Grobli, President of the David G. Simons Academy