Dry needling for management of pain in the upper quarter and craniofacial region (original) (raw)
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Dry needling in the management of musculoskeletal pain
The Journal of the American Board …, 2010
Myofascial pain is a common syndrome seen by family practitioners worldwide. It can affect up to 10% of the adult population and can account for acute and chronic pain complaints. In this clinical narrative review we have attempted to introduce dry needling, a relatively new method for the management of musculoskeletal pain, to the general medical community. Different methods of dry needling, its effectiveness, and physiologic and adverse effects are discussed. Dry needling is a treatment modality that is minimally invasive, cheap, easy to learn with appropriate training, and carries a low risk. Its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews. The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial trigger points. However, over areas with potential risk of significant adverse events, such as lungs and large blood vessels, we suggest using the superficial technique, which has also been shown to be effective, albeit to a lesser extent.
PM & R : the journal of injury, function, and rehabilitation, 2016
Dry needling is an effective treatment for reducing pain associated with active myofascial trigger points (a-MTrPs) in the short term. The duration of the benefits of this treatment have not been fully assessed. To determine whether the benefits of dry needling (DN) of a-MTrPs are sustained 6 weeks posttreatment. Follow-up of a prospective study. University. A total of 45 patients (13 male and 32 female) with cervical pain >3 months and a-MTrPs in the upper trapezius who completed 3 DN treatments and who were evaluated 6 weeks posttreatment. None. Primary outcomes were changes from baseline to follow-up in scores for the verbal analogue scale (VAS), Brief Pain Inventory (BPI), and MTrP status. MTrPs were rated as active (spontaneously painful), latent (painful only on compression), and nonpalpable nodule. Responders were patients whose MTrP status changed from active to latent or nonpalpable nodule (resolved). Secondary outcomes were pain pressure threshold (PPT), Profile of Mood...
Dry Needling for Myofascial Pain: Prognostic Factors
The Journal of Alternative and Complementary Medicine, 2011
Objectives: The study objectives were to evaluate outcomes in patients who have received dry needling treatments and to identify predictors of pain and disability. Design: The study was a prospective cohort follow-up design. Setting: The study was conducted at the Pain Clinic at Pingtung Christian Hospital, Taiwan. Subjects: Ninety-two (92) patients sick-listed for 3 months or longer for myofascial pain syndrome. Interventions: From February to October 2008, participants were treated at the pain clinic with dry needling of trigger points and muscle stretches of the involved muscles. Outcome measures: Data were collected by self-administered questionnaires to assess changes in pain intensity and pain interference. Data collection was performed at baseline and after 2, 4, and 8 weeks. Sociodemographic variables, symptom characteristics, and baseline outcome measures were analyzed using generalized estimating equation methodology. Results: The proposed dry-needling protocol reduced pain intensity and pain interference. Long duration of pain symptoms, high pain intensity, poor quality of sleep, and repetitive stress were associated with poor outcomes. Conclusions: Dry needling is an effective treatment for reducing pain and pain interference. However, long pain duration, high pain intensity, poor quality of sleep, and repetitive stress are associated with poor outcomes. Treatment outcome depends not only on the dry needling protocol, but also on disease characteristics and patient demographic profile.
The role of a dry needling technique in pain reduction
Journal of Health Sciences
Introduction: Dry needling is a therapeutic procedure using the insertion of thin needles through the skin into myofascial trigger points (MTrPs), muscular or connective tissue with the aim to reduce pain intensity. The objective of this systematic review is to analyze the literature for the efficacy of the dry needle technique in pain reduction in conditions of musculoskeletal pain caused by MTrPs. Reference Sources: Web of Science, Scopus and EBSCOhost database were searched for studies and e-books published from January 2010 to December 2018. Studies Selection: We included randomized controlled studies, prospective and longitudinal studies, and case studies which analyzed the efficacy of dry needling for musculoskeletal pain reduction. Data Extraction Method: The studies, which satisfied criteria for inclusion were further analyzed. The primary instrument of the evaluation was pain intensity analyses. Results: Dry needling treatment is efficient in pain intensity reduction in pat...
DRY NEEDLING TECHNIQUE IN MYOFASCIAL PAIN -CLINICAL CASE REPORT
Myofascial pain characterized by the presence of myofascial trigger points (TP) that can cause local pain and referred pain, that is, perceived in a different location. TP is a palpable nodule and a painful point of compression, which, in addition to local pain, promotes pain. It is called referred pain when pain caused by TP also affects other regions, such as: other muscles, teeth, gums, TMJ and ears. It is of fundamental importance the anatomical knowledge of the muscles, since it facilitates the localization of the TP and palpation, as well as the functional knowledge of the muscles, since the TP can be activated when the patient makes a certain movement / gesture, this facilitates the correct diagnosis. When the procedures performed reach the TP areas, muscle pain is rapidly eliminated, restoring function and normal muscle length. One of the most widely used treatments has been dry pressing, the theory is that the needle through mechanical trauma stimulates the release of intracellular potassium, which blocks the transmission of nerve impulses temporarily. The needle also breaks the adhesions of the fibers that may exist. The objective of this work is to report two cases of myofascial pain treatment using the dry needling technique. Where, Ms D.S.R and Ms O.H.S.R. attended the UNIFEB clinic, with symptoms of muscular pain and difficulty opening the mouth and chewing, dry needling was performed and there was instant improvement of the pain picture, and improvement in movements that were previously limited.
Journal of Traditional Chinese Medicine, 2016
OBJECTIVE: To summarize the literature about the effectiveness of dry needling (DN) on relieving pain and increasing range of motion (ROM) in individuals with myofascial pain syndrome (MPS). METHODS: Papers published from January 2000 to January 2013 were identified through an electronic search in the databases MEDLINE, Dialnet, Cochrane Library Plus, Physiotherapy Evidence Database (PEDro) and Spanish Superior Council of Scientific Research (CSIC). The studies included were randomized controlled trials written in English and/or Spanish about the effectiveness of DN on pain and ROM in individuals with MPS. RESULTS: Out of 19 clinical trials that were potentially relevant, a total of 10 were included in the Me-ta-analysis. Regarding pain intensity reduction when measured before and immediately after the intervention, DN achieved improvement compared with the placebo treatment [d =-0.49; 95% CI (-3.21, 0.42)] and with the control group [d =-9.13; 95% CI (-14.70,-3.56)]. However, other treatments achieved better results on the same variable compared with DN, considering the measurements for pre-treatment and immediately after [d = 2.54; 95% CI (-0.40, 5.48)], as well as the pre-treatment and after 3-4 weeks [d = 4.23; 95% CI (0.78, 7.68)]. DN showed a significantly increased ROM when measured before the intervention and immediately after, in comparison with the placebo [d = 2.00; 95% CI (1.60, 2.41)]. However, other treatments achieved a significant better result regarding ROM when it was measured before the intervention and immediately after, as compared with DN [d =-1.42; 95% CI (-1.84,-0.99)]. CONCLUSION: DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3-4 weeks. However, on increasing ROM, DN was more effective comparing to that of placebo group, but less than other treatments.
2015
Objective: To determine whether dry needling of an active myofascial trigger point (MTrP) reduces pain and alters the status of the trigger point to either a nonespontaneously tender nodule or its resolution. Design: A prospective, nonrandomized, controlled, interventional clinical study. Setting: University campus. Participants: A total of 56 subjects with neck or shoulder girdle pain of more than 3 months duration and active MTrPs were recruited from a campus-wide volunteer sample. Of these, 52 completed the study (23 male and 33 female). Their mean age was 35.8 years. Interventions: Three weekly dry needling treatments of a single active MTrP. Main Outcome Measures: Primary Outcomes: Baseline and posttreatment evaluations of pain using a verbal analogue scale, the Brief Pain Inventory, and the status of the MTrP as determined by digital palpation. Trigger points were rated as active (spontaneously painful), latent (requiring palpation to reproduce the characteristic pain), or resolved (no palpable nodule). Secondary Outcomes: Profile of Mood States, Oswestry Disability Index, and Short Form 36 scores, and cervical range of motion. Results: Primary outcomes: A total of 41 subjects had a change in trigger point status from active to latent or resolved, and 11 subjects had no change (P < .001). Reduction in all pain scores was significant (P < .001). Secondary outcomes: Significant improvement in posttreatment cervical rotational asymmetry in subjects as follows: unilateral/bilateral MTrPs (P ¼ .001 and P ¼ 21, respectively); in pain pressure threshold in subjects with unilateral/bilateral MTrPs, (P ¼ .006 and P ¼ .012, respectively); improvement in the SF-36 mental health and physical functioning subscale scores (P ¼ .019 and P ¼ .03), respectively; and a decrease in the Oswestry Disability Index score (P ¼ .003). Conclusions: Dry needling reduces pain and changes MTrP status. Change in trigger point status is associated with a statistically and clinically significant reduction in pain. Reduction of pain is associated with improved mood, function, and level of disability.
Dry needling: a literature review with implications for clinical practice guidelines
Physical Therapy Reviews, 2014
Background: Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an 'intramuscular' procedure involving the isolated treatment of 'myofascial trigger points' (MTrPs). Objectives: To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. Major findings: According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. 'sensitive loci' or 'nociceptors') when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. Conclusions: Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as 'pistoning' or 'sparrow pecking'; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical 'acupuncture' literature that have used the very same 'dry needles' to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just 'TrPs'.