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Author information
Abstract
Pain is a complex and multifactorial phenomenon that depends on the interaction of biopsychosocial
factors. Between 15-25% of adults suffer from chronic pain at some point in their lives. Cervical chronic
pain is considered a public health problem affecting 9.6% men and 21.9% women, according to the latest
National Health Survey 2011-12. A high percentage of medical consultations due to muscle pain turn out
to be myofascialpain syndrome (MPS). Its existence implies the presence of myofascial trigger points
which can be latent or active throughout the whole population. The aim of this review is to update
knowledge in the various therapies applied by the physiotherapist in the treatment of
this syndrome at cervicallevel. From the review it appears that some of the most used techniques that
may be useful in the short or medium term are: ischemic compression and/or trigger point pressure
release and dry needling. Furthermore, various combinations of treatment modalities are used to treat
this syndrome, taking other aspects into account, such as education.
PMID:
25963463[PubMed - in process]
CONCLUSIONS:
This study demonstrated the remote effectiveness of dry needling. Dry needling of a
distal myofascial trigger point can provide a remote effect to reduce the irritability of a
proximal myofascial trigger point.
PMID: 19404189
[PubMed - indexed for MEDLINE]
3.
Evid Based Complement Alternat Med. 2012;2012:705327. doi: 10.1155/2012/705327. Epub 2012 Dec 31.
Author information
Abstract
Myofascial pain syndrome (MPS) has been defined as a regional pain syndrome characterized by muscle
pain caused by myofascial trigger points (MTrPs) clinically. MTrP is defined as the hyperirritable spot in a
palpable taut band of skeletal muscle fibers. Appropriate treatment to MTrPs can effectively relieve the
clinical pain of MPS. Needling therapies, such as MTrP injection, dry needling, or acupuncture (AcP) can
effectively eliminate pain immediately. AcP is probably the first reported technique in treating MPS
patients with dry needling based on the Traditional Chinese Medicine (TCM) theory. The possible
mechanism of AcP analgesia were studied and published in recent decades. The analgesic effect of AcP
is hypothesized to be related to immune, hormonal, and nervous systems. Compared to slow-acting
hormonal system, nervous system acts in a faster manner. Given these complexities, AcP analgesia
cannot be explained by any single mechanism. There are several principles for selection of acupoints
based on the TCM principles: "Ah-Shi" point, proximal or remote acupoints on the meridian, and extrameridian acupoints. Correlations between acupoints and MTrPs are discussed. Some clinical and animal
studies of remote AcP for MTrPs and the possible mechanisms of remote effectiveness are reviewed and
discussed.
PMID:23346211
[PubMed]
PMCID:PMC3549415
4.
Author information
Abstract
Myofascial pain syndrome (MPS) is caused by myofascial trigger points (MTrPs) located within taut bands
of skeletal muscle fibers. Treating the underlying etiologic lesion responsible for MTrP activation is the
most important strategy in MPS therapy. If the underlying pathology is not given the appropriate
treatment, the MTrP cannot be completely and permanently inactivated. Treatment of active MTrPs may
be necessary in situations in which active MTrPs persist even after the underlying etiologic lesion has
been treated appropriately. When treating the active MTrPs or their underlying pathology, conservative
treatment should be given before aggressive therapy. Effective MTrP therapies include manual therapies,
physical therapy modalities, dry needling, or MTrP injection. It is also important to eliminate any
perpetuating factors and provide adequate education and home programs to patients so that recurrent or
chronic pain can be avoided.
PMID:16945250
5.
Author information
Abstract
This review article summarizes recent studies on myofascial trigger point (MTrP) to further clarify the
mechanism of MTrP. MTrP is the major cause of muscle pain (myofascial pain) in clinical practice. There
are multiple MTrP loci in an MTrP region. An MTrP locus contains a sensory component (sensitive locus)
and a motor component (active locus). A sensitive locus is the site from which pain, referred pain (ReP),
and local twitch response (LTR) can be elicited by needle stimulation. Sensitive loci are probably
sensitized nociceptors based on a histological study. They are widely distributed in the whole muscle, but
are concentrated in the endplate zone. An active locus is the site from which spontaneous electrical
activity (SEA) can be recorded. Active loci are dysfunctional endplates since SEA is essentially the same
as endplate noise (EPN) recorded from an abnormal endplate as reported by neurophysiologists. Both
ReP and LTRs are mediated through spinal cord mechanisms, demonstrated in both human and animal
studies. The pathogenesis of MTrPs appears to be related to the integration in the spinal cord (formation
of MTrP circuits) in response to the disturbance of the nerve endings and abnormal contractile
mechanism at multiple dysfunctional endplates. Methods usually applied to treat MTrPs include stretch,
massage, thermotherapy, electrotherapy, laser therapy, MTrP injection, dry needling, and acupuncture.
The mechanism of acupuncture is similar to dry needling or MTrP injection. The new technique of MTrP
injection can also be used to treat neurogenic spasticity.
PMID:12583512
6.
Author information
Abstract
Myofascial trigger point (MTrP) is a major cause of muscle pain, characterized with a hyperirritable spot
due to accumulation of sensitized nociceptors in skeletal muscle fibers. Many needling therapy
techniques for MTrP inactivation exist. Based on prior human and animal studies, multiple insertions can
almost completely eliminate the MTrP pain forthwith. It is an attempt to stimulate many sensitive loci
(nociceptors) in the MTrP region to induce sharp pain, referred pain or local twitch response. Suggested
mechanisms of needling analgesia include effects related to immune, hormonal or nervous system.
Compared to slow-acting biochemical effects involving immune or hormonal system, neurological effects
can act faster to provide immediate and complete pain relief. Most likely mechanism of multiple needle
insertion therapy for MTrP inactivation is to encounter sensitive nociceptors with the high-pressure
stimulation of a sharp needle tip to activate a descending pain inhibitory system. This technique is
strongly recommended for myofasical pain therapy in order to resume patient's normal life rapidly, thus
saving medical and social resources.
KEYWORDS:
Acupuncture; Analgesia; Mechanism; Myofascial trigger point; Needling
PMID:25520926
[PubMed]
PMCID:
PMC4264979
PubMed Commons
7.
Author information
Abstract
OBJECTIVE:
Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain.
Several methods have been recommended for the inactivation of trigger points (TrPs). We carried out this
study to investigate the effectiveness of miniscalpel-needle (MSN) release and acupuncture needling and
self neck-stretching exercises on myofascial TrPs of the upper trapezius muscle.
METHODS:
Eighty-three TrPs in 43 patients with MPS were treated and randomly assigned to 3 groups: group 1
received MSN release in conjunction with self neck-stretching exercises; group 2 received acupuncture
needling treatment and performed self neck-stretching exercises; and group 3, the control group, was
assigned self neck-stretching exercises only. The therapeutic effectiveness was evaluated using
subjective pain intensity (PI) with a visual analog scale, pressure pain threshold (PPT), and contralateral
bending range of motion (ROM) of cervical spine at pretreatment, 2 weeks, and 3 months after treatment.
RESULTS:
The improvement of PI, PPT, and contralateral bending ROM of cervical spine was significantly greater in
group 1 and 2 than that in control group at 2 weeks and 3 months follow-up. Compared with group 2,
patients in group 1 had a statistically significant reduction in PI, an increase in PPT, contralateral bending
ROM of cervical spine at 3 months follow-up.
DISCUSSION:
The effectiveness of MSN release for MPS is superior to that of acupuncture needling treatment or
self neck-stretching exercises alone. The MSN release is also safe, without severe side effects in
treatment of MPS.
PMID:
20173440
Comment in
Painful and tender muscles: dry needling can reduce myofascial pain related to trigger points
muscles. [J Orthop Sports Phys Ther. 2013]
PMID:23756457
9.
Dry needling for management of pain in the upper quarter and craniofacial
region.
Kietrys DM1, Palombaro KM, Mannheimer JS.
Author information
Abstract
Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with
patients that have pain of myofascial origin. This review provides background about dry
needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness
of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and metaanalysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain
(especially immediately after treatment) in patients with upper quarter pain. There have been fewer
studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies
report findings to suggest the dry needling may be helpful in reducing pain and improving other pain
related variables such as the pain pressure threshold. More rigorous randomized controlled trials are
clearly needed to more fully elucidate the effectiveness of dry needling.
PMID:
24912453
10. J Bodyw Mov Ther. 2014 Jul;18(3):390-8. doi: 10.1016/j.jbmt.2013.11.009. Epub 2013 Nov 9.
RESULTS:
Four RCTs compared dry needling to lidocaine and one RCT compared dry needling to placebo. Metaanalyses of dry needling revealed no significant difference between dry needling and lidocaine
immediately after treatment standardized mean difference (SMD) 0.41 (95%CI -0.15 to 0.97), at one
month (SMD -1.46; 95% CI -2.04 to 4.96) and three to six months (SMD -0.28; 95% CI -0.63 to 0.07).
DISCUSSION:
Although not significant in the meta-analyses, there were interesting patterns favoring lidocaine
immediately after treatment and dry needling at three to six months.
Copyright 2013 Elsevier Ltd. All rights reserved.
KEYWORDS:
Dry needling; Lidocaine; Myofascial trigger points; Randomised controlled trial
Comment inWhether lidocaine or dry needling should be the favored treatment after meta
analysis. [J Bodyw Mov Ther. 2014]
PMID:25042309
[PubMed - indexed for MEDLINE]
11. Clin Rheumatol. 2013 Mar;32(3):309-15. doi: 10.1007/s10067-012-2112-3. Epub 2012 Nov 9.
Author information
Abstract
The objective of this study was to test the hypothesis that dry needling is more effective than sham dry
needling in the treatment of myofascial painsyndrome (MPS). This was a prospective, double-blinded,
randomized-controlled study conducted in an outpatient clinic. Thirty-nine subjects with
established myofascial trigger points were randomized into two groups: study group (N =22) and placebo
group (N=17). Dry needling was applied using acupuncture needles, and sham dry needling was applied
in the placebo group. The treatment was composed of six sessions which were performed in 4 weeks; the
first four sessions were performed twice a week (for 2 weeks) and the last two, once a week (for 2
weeks). The visual analog scale (VAS) and Short Form-36 (SF-36) were used. When compared with the
initial values, VAS scores of the dry needling group following the first and sixth sessions were significantly
lower (p=0.000 and p<0.000, respectively). When VAS scores were compared between the groups, the
first assessment scores were found to be similar, but the second and third assessment scores were found
to be significantly lower in the dry needling group (p =0.034 and p < 0.001, respectively). When SF-36
scores of the groups were compared, both the physical and mental component scores were found to be
significantly increased in the dry needling group, whereas only those of vitality scores were found to be
increased significantly in the placebo (sham needling) group. The present study shows that the dry
needling treatment is effective in relieving the pain and in improving the quality of life of patients with
MPS.
PMID:23138883
[PubMed - indexed for MEDLINE]