Dry needling frequency and its effect on pain and disability in acute cervical myofascial pain: a multicenter study.

Chronic mechanical neck pain is associated with musculoskeletal tissue alterations. Active trigger points in the trapezius and levator scapulae muscles are common in patients with chronic mechanical neck pain. In this study, we compared the effect of dry needling (DN) combined with manual therapy (MT) to sham dry needling (SDN) combined with MT on pain, pain pressure threshold, cervical range of motion and neck disability in patients with chronic mechanical neck pain. A randomised, single-blind clinical trial was carried out involving 101 participants with chronic mechanical neck pain, divided into an intervention group (DN+MT, n=47) and a control group (SDN+MT, n=54). Participants received two treatment sessions. The intervention group received MT in conjunction with DN of the most mechano-sensitive myofascial trigger point (MTrP). The control group received MT plus SDN. Outcomes measures were: pain intensity (numeric pain rating scale, NPRS), pressure pain threshold (PPT), cervical range of motion (ROM) and neck disability (neck disability index, NDI). This study found that between-group differences in pain intensity were statistically significant (P<0.01). Pain decreased after the first intervention in the DN+MT group (3.47±0.25 points on the NPRS) and even more so after the second intervention (4.76±0.24 points on the NPRS). After 4 weeks, pain intensity differed from baseline by 4.89±0.27 points on the NPRS. Statistically significant differences (P<0.001) in PPT were also found between the intervention group and the control group. After the first intervention, a significant increase in PPT within the DN+MT group (3.09±0.8 kg/cm2) was observed. Cervical ROM also showed highly statistically significant differences. After 4 weeks, a statistically significant reduction (P<0.001) in NDI was observed between the two groups. Our results show that DN+MT is efficacious and significantly better than SDN+MT at reducing pain intensity, PPT, neck disability and cervical ROM in patients with chronic mechanical neck pain. 1b.

Background Mulligan sustained natural apophyseal glide (SNAG) is a mobilization technique that aims to reduce pain and improve function by correcting positional errors in the facet joint. Purpose To investigate the immediate effects of the Mulligan SNAG application on muscle stiffness, pain, pressure pain threshold (PPT) and range of motion (RoM) in patients with chronic mechanical neck pain. Methods A randomized, double-blind trial was conducted. Forty individuals with chronic mechanical neck pain (mean age = 39.35 ± 6.68 years) were randomized into two groups: Mobilization with movement group (MWMG), and sham group (SG). Muscle stiffness was measured with MyotonPro, pain intensity with Numerical Pain Rating Scale, cervical RoM with a digital inclinometer, and PPT with an algometer. Measurements were performed pre-and 5 minutes post-intervention in a single session. Results Muscle stiffness significantly changed in the MWMG for the left trapezius and right cervical extensors (p = .003, effect size (ES) = 0.42; p = .031, ES = 0.49, respectively), whereas no significant changes were observed in the SG (p = .097, ES = 0.12; p = .270, ES = 0.22, respectively). The MWMG showed improvements in pain (p = .001, ES = 0.70) and RoM (right: p = .0001, ES = 0.89; left: p = .0001, ES = 0.99). The SG also showed improvements in pain (p = .0001, ES = 0.76) and RoM (right: p = .0001, ES = 0.49; left: p = .0001, ES = 0.35). PPT improvements were observed in the MWMG for right and left trapezius (p = .0001, ES = 1.21; p = .040, ES = 0.43, respectively), whereas no significant changes occurred in the SG (p = .713, ES = 0.03; p = .839, ES = 0.01, respectively). Conclusion The mobilization with movement technique leads to significant immediate improvements in muscle stiffness and pain-related parameters in individuals with chronic neck pain.

The influence of physical and psychosocial variables on self-rated disability in patients with chronic mechanical neck pain has not been fully determined. This study examined the relationship of pain, physical impairment, and pain-related fear to disability in individuals with chronic mechanical neck pain. A cross-sectional study was conducted. Ninety-seven (n = 97) subjects (28 men, 69 women; mean age, 39.3 yrs) with chronic mechanical neck pain were prospectively recruited. Demographic information, duration of pain symptoms, pain intensity, pain-related fear, and cervical range of motion were collected on all subjects. Self-reported disability was measured with the Neck Disability Index. Correlation and regression analyses were performed to determine the association among the variables and to determine the proportions of explained variance in disability. Significant positive correlations existed between disability and previous history of neck pain (r = 0.45; P < 0.001), disability and pain intensity (r = 0.32, P = 0.01), and disability and kinesiophobia (r = 0.23, P = 0.02). In addition, a significant negative correlation existed between disability and cervical extension range of motion (r = -0.18, P = 0.04). Stepwise regression analyses revealed that previous neck pain episodes, intensity of neck pain, kinesiophobia, and cervical extension range of motion were significant predictors of disability (r = 0.400; r adjusted = 0.372; F = 14.64; P < 0.001). This study found that previous episodes of neck pain, pain intensity, pain-related fear, and cervical extension range of motion explained 37.2% of the variability of self-report disability. Future longitudinal studies will help to determine the clinical implications of these findings.

To investigate potential relationships of clinical (age, function, side of pain, years with pain), physical (cervical range of motion, pinch grip force), psychological (depression), and neurophysiological (pressure and thermal pain thresholds) outcomes and hand pain intensity in carpal tunnel syndrome (CTS). Two hundred and forty-four (n=224) women with CTS were recruited. Demographic data, duration of the symptoms, function and severity of the disease, pain intensity, depression, cervical range of motion, pinch tip grip force, heat/cold pain thresholds (HPT/CPT), and pressure pain thresholds (PPT) were collected. Correlation and regression analysis were performed to determine the association among those variables and to determine the proportions of explained variance in hand pain intensity. Significant negative correlations existed between the intensity of pain and PPTs over the radial nerve, C5/C6 zygapophyseal joint, carpal tunnel and tibialis anterior muscle, HPT over the carpal tunnel, cervical extension and lateral-flexion, and thumb-middle, fourth, and little finger pinch tip forces. Significant positive correlations between the intensity of hand pain with function and depression were also observed. Stepwise regression analyses revealed that function, thumb-middle finger pinch, thumb-little finger pinch, depression, PPT radial nerve, PPT carpal tunnel, and HPT carpal tunnel were significant predictors of intensity of hand pain (R²=0.364; R² adjusted=0.343; F=16.87; P<0.001). This study showed that 36.5% of the variance of pain intensity was associated to clinical (function), neurophysiological (localized PPT and HPT), psychological (depression), and physical (finger pinch tip force) outcomes in women with chronic CTS.

To compare the effects of dry needling or manual pressure release on an active trigger point in the upper trapezius on craniocervical flexion test performance, pressure pain thresholds, and cervical range of motion in chronic neck pain. A parallel randomized clinical trial. Physical therapy service. Individuals with chronic neck pain. Subjects were randomized to receive dry needling (n = 25) or manual trigger point pressure release (n = 25) on upper trapezius active trigger points. Surface electromyography from the upper trapezius, splenius capitis, sternocleidomastoid, and scalene muscles during performance of the craniocervical flexion test was assessed before and immediately after the intervention as the primary outcome. Neck pain intensity, range of motion, and pressure pain thresholds were the secondary outcomes. A decrease in sternocleidomastoid activity at all stages of the craniocervical flexion test (time effect, P < 0.001) was found in both groups after the interventions, with no significant between-group difference. Pressure pain thresholds measured over the cervical spine and second metacarpal increased after dry needling when compared with manual trigger point pressure release (P < 0.05). Pain intensity decreased immediately after both treatments with moderate to large effect sizes, whereas cervical range of motion increased for both groups but with small effect sizes. A single session of dry needling or manual pressure release over upper trapezius active trigger points promotes limited effects on muscle performance during the craniocervical flexion test, pressure pain thresholds, and cervical range of motion in patients with chronic neck pain.

Dry needling (DN) has emerged as a potential treatment for mechanical neck pain, but the evidence remains inconclusive. This study aimed to assess the efficacy of DN in improving pain and functionality in patients with chronic mechanical neck pain. A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Databases, including PubMed, Cochrane Library, Scopus, and Google Scholar, were searched from December 2013 to January 2024. Studies involving adult participants with chronic mechanical neck pain treated with DN were included in the study. The primary outcomes were pain pressure threshold (PPT), Neck Disability Index (NDI), and cervical range of motion. Statistical analysis used a random-effect model. Nine RCTs with a total of 540 participants were included in the study. DN significantly improved the PPT with an MD of 0.52 (95% confidence interval [CI], 0.39-0.65; P < 0.001). NDI also showed a significant improvement, with an MD of -0.68 (95% CI, -1.32--0.05; P = 0.04). In terms of cervical range of motion, DN improved flexion (MD 4.07, 95% CI, 0.39-7.75; P = 0.03) and right rotation (MD 8.20, 95% CI, 3.05-13.35; P = 0.002), but no significant differences were observed in extension, left rotation, or lateral flexions (P > 0.05). DN appears effective in short-term pain relief and functional outcomes for patients with mechanical neck pain but shows limited impact on the cervical range of motion.

Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial

Self-stretching exercises with kinesio taping for management of chronic nonspecific neck pain in taxi drivers: A single-blind, randomized controlled trial

Although current evidence supports the use of dry needling for improving some clinical outcomes in people with neck pain, no previous research explored the effects of dry needling on the central processing of pain and autonomic nervous system in this population. Therefore, this clinical trial aimed to compare the effects of real and sham dry needling on autonomic nervous system function, pain processing as well as clinical and psychological variables in patients with chronic nonspecific neck pain. A double-blinded randomized clinical trial including 60 patients with neck pain was conducted. Patients were randomized to the real needling (n = 30) or sham needling (n = 30) group. Skin conductance (SC), pressure pain thresholds (PPTs), temporal summation (TS), conditioned pain modulation (CPM) as well as pain intensity, related-disability, catastrophism, and kinesiophobia levels were assessed by an assessor blinded to the allocation intervention. The results did not find significant group * time interactions for most outcomes, except for the global percentage of change of SC values (mean: F = 35.90, p &lt; 0.001, ηp2 = 0.459; minimum: F = 33.99, p = 0.839, ηp2 = 0.371; maximum: F = 24.71, p &lt; 0.001, ηp2 = 0.037) and PPTs at C5-C6 joint in the same side of needling (F = 9.982; p = 0.003; = 0.147), in favor of the dry needling group. Although the proportion of subjects experiencing moderate to large self-perceived improvement after the intervention was significantly higher (X2 = 8.297; p = 0.004) within the dry needling group (n = 18, 60%) than in the sham needling group (n = 7, 23.3%), both groups experienced similar improvements in clinical and psychological variables. Our results suggested that dry needling applied to patients with chronic nonspecific neck pain produced an immediate decrease in mechanical hyperalgesia at local sites and produced an increase in skin conductance as compared with sham needling. No changes in central pain processing were observed. A single session of sham or real dry needling was similarly effective for decreasing related disability, pain intensity, catastrophism, and kinesiophobia levels. Further studies are needed to better understand the clinical implications of autonomic nervous system activation on central sensitization and pain processing in the long-term after the application of dry needling.

Randomized clinical trial. To compare the effects of cervical versus thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity, neck pain, and cervical range of motion (CROM). Evidence suggests that spinal interventions can stimulate descending inhibitory pain pathways. To our knowledge, no study has investigated the neurophysiological effects of thoracic thrust manipulation in individuals with bilateral chronic mechanical neck pain, including widespread changes on pressure sensitivity. Ninety patients (51% female) were randomly assigned to 1 of 3 groups: cervical thrust manipulation on the right, cervical thrust manipulation on the left, or thoracic thrust manipulation. Pressure pain thresholds (PPTs) over the C5-6 zygapophyseal joint, lateral epicondyle, and tibialis anterior muscle, neck pain (11-point numeric pain rating scale), and cervical spine range of motion (CROM) were collected at baseline and 10 minutes after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of covariance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable, time and side as the within-subject variables, and gender as the covariate. The primary analysis was the group-by-time interaction. No significant interactions were found with the mixed-model analyses of covariance for PPT level (C5-6, P>.210; lateral epicondyle, P>.186; tibialis anterior muscle, P>.268), neck pain intensity (P = .923), or CROM (flexion, P = .700; extension, P = .387; lateral flexion, P>.672; rotation, P>.192) as dependent variables. All groups exhibited similar changes in PPT, neck pain, and CROM (all, P<.001). Gender did not influence the main effects or the interaction effects in the analyses of the outcomes (P>.10). The results of the current randomized clinical trial suggest that cervical and thoracic thrust manipulation induce similar changes in PPT, neck pain intensity, and CROM in individuals with bilateral chronic mechanical neck pain. However, changes in PPT and CROM were small and did not surpass their respective minimal detectable change values. Further, because we did not include a control group, we cannot rule out a placebo effect of the thrust interventions on the outcomes. Therapy, level 1b.J Orthop Sports Phys Ther 2012;42(9):806-814, Epub 18 June 2012. doi:10.2519/jospt.2012.4151.

Background: The objectives of this study were: (1) to compare the pain intensity, cervical range of motion (ROM), psychological distress and kinesiophobia in patients with cervicogenic dizziness (CGD), tension-type headache (TTH), and mechanical chronic neck pain (MCNP); and (2) to investigate the relationships between pain intensity and cervical ROM and between psychological distress and kinesiophobia. Methods: a cross-sectional and correlational study was designed. In total, 109 patients (32 patients with CGD, 33 with TTH and 44 with MCNP) were included. Pain intensity, cervical ROM, psychological distress and kinesiophobia were assessed. Results: Statistically significant differences were found between the groups in pain intensity, psychological distress and kinesiophobia. The patients with MCNP showed higher pain intensity compared to the other groups (p < 0.001). The patients with CGD showed higher depression and kinesiophobia values compared to the MCNP and TTH groups (p < 0.05). No differences were found for cervical flexion, extension, lateral flexion, or rotation ROM (p > 0.05). The CGD and MCNP groups found a moderate positive correlation between psychological distress and kinesiophobia (p < 0.05). The patients with TTH and MCNP showed a moderate positive correlation between pain intensity, psychological distress and kinesiophobia (p < 0.05). Conclusion: Pain intensity, psychological distress and kinesiophobia should be considered in the three groups. Psychological distress was correlated with kinesiophobia in the CGD and MCNP groups. The MCNP group showed a correlation between pain intensity, psychological distress and kinesiophobia.

Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial

Background: A depressed scapular position has been proposed to be associated with cervical disorders. Active scapular correction is suggested as a potential intervention that may improve symptoms for patients with neck pain. The purpose of this research was to examine the effects of active scapular correction on cervical range of motion (ROM), pain, and pressure pain threshold (PPT) in chronic neck pain with the depressed scapula. Methods: This research consists of two studies. Study I: A randomized control trial was conducted in 46 participants with chronic neck pain and depressed scapula. Participants were randomly assigned into either the intervention (n = 23) or control (n = 23) group. Active cervical ROM, pain at the end range of cervical movement, and PPT over the upper trapezius region were compared at post intervention within and between groups. Study II: A one-group pretest-posttest research design was conducted in 23 participants with chronic neck pain and depressed scapula. Active cervical rotation ROM and neck pain at the end range of cervical rotation during active scapular correction were compared to baseline. Results: Study I: At post-intervention, the participants in the intervention group showed significantly greater active cervical ROM in all directions (p &lt; .01) and less pain at the end range of cervical movement than the control group (p &lt; .01) except for extension (p = .16). No significant difference in PPT between groups was demonstrated (p = .21). Study II: Active scapular correction significantly increased cervical rotation ROM approximately 10 degrees in each direction (p &lt; .002) and decreased neck pain intensity at end range of active cervical rotation by two points on the NPRS (p &lt; .002) while performing active scapular correction. Conclusion: The active scapular correction intervention resulted in an immediate increase in active cervical ROM and PPT over the upper trapezius muscle region as well as a decrease in neck pain at end range of cervical movement.

Objective To evaluate the effects of combining dry needling with other physical therapy interventions versus the application of the other interventions or dry needling alone applied over trigger points (TrPs) associated to neck pain. Databases and Data Treatment. Electronic databases were searched for randomized controlled trials where at least one group received dry needling combined with other interventions for TrPs associated with neck pain. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool, methodological quality was assessed with PEDro score, and the quality of evidence was assessed by using the GRADE approach. Between-groups mean differences (MD) and standardized mean difference (SMD) were calculated. Results Eight trials were included. Dry needling combined with other interventions reduced pain intensity at short-term (SMD −1.46, 95% CI −2.25 to −0.67) and midterm (SMD −0.38, 95% CI −0.74 to −0.03) but not immediately after or at long-term compared with the other interventions alone. A small effect on pain-related disability was observed at short-term (SMD −0.45, 95% CI −0.87 to −0.03) but not at midterm or long-term. The inclusion of dry needling was also effective for improving pressure pain thresholds only at short-term (MD 112.02 kPa, 95% CI 27.99 to 196.06). No significant effects on cervical range of motion or pain catastrophism were observed. Conclusion Low-to-moderate evidence suggests a positive effect to the combination of dry needling with other interventions for improving pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion in people with neck pain associated with TrPs at short-term. No midterm or long-term effects were observed.

Objective Clinical guidelines recommend combining exercise with other interventions, including dry needling (DN), for chronic neck pain (NP). The aim was to compare the effects of adding DN, applied locally or distant to the myofascial trigger point (MTrP) site location, to home exercise (HE) on pain, disability, and pressure pain sensitivity for chronic mechanical NP. Methods A single-blind parallel randomized controlled trial was conducted, including 68 adults (78.7% females, mean age: 47 ± 8.2 years) with chronic NP. All participants were assigned to one of the four groups: local DN + HE; distant DN + HE; sham DN + HE; or HE alone. A 12-week HE program was combined with three DN sessions over 4 weeks. The primary outcome was pain intensity at rest in neutral position, highest pain during cervical rotation and in the last 24 h, and pain in the previous week. The arithmetic mean (overall pain) of these ratings was calculated. Secondary measures included neck disability, pressure pain thresholds (PPTs) at muscular and neural sites, and the global rating of change (GROC). Data were collected at baseline, 4 weeks, and at 3- and 6-months. Results A group-by-time interaction was found for pain intensity at rest in neutral position, and for PPTs at ulnar nerve (both sides) and median nerve, anterior scalene, and splenius cervicis (all, left side only; p < 0.05). Post hoc comparisons showed a decrease of overall pain intensity at 6-months in the local DN vs. sham DN groups: estimated ratio ± standard error, 0.55 ± 0.09, p = 0.017. There were no differences between local or distant DN, except for the GROC at discharge. Conclusions Combining DN with HE reduces pain intensity in the medium term compared with HE alone. There were no differences between DN site locations (whether local or distant to the MTrP).