Short-Term Effects of PENS versus Dry Needling in Subjects with Unilateral Mechanical Neck Pain and Active Myofascial Trigger Points in Levator Scapulae Muscle: A Randomized Controlled Trial

Dry needling (DN) is commonly used to treat myofascial trigger points (MTrPs). To compare the effect between DN with and without needle retention in the treatment of MTrPs in the upper trapezius muscle. Fifty-four patients who had active MTrPs in the upper trapezius muscle were randomly allocated into the DN group or the DN with retention group. The DN group received DN only, while the DN with retention group received DN with needle retention for 30 minutes. The visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded both before and after 7 and 14 days of the treatment sessions. Both groups showed a significant decrease of the VAS at 7 and 14 days (mean difference DN group -53.0, DN with retention group -57.0, p< 0.001). The PPT was also significantly improved in both groups (mean difference DN group 109.8 kPa, DN with retention group 132.3 kPa, p< 0.001). However, there were no significant differences in the VAS or PPT between the groups. Both DN and DN with retention had significant improvement of pain intensity in the treatment of MTrPs in the upper trapezius muscle at 14 days. However, pain reduction was not significantly different between the interventions.

Background and Aims Percutaneous Electrical Nerve Stimulation (PENS) is a type of current which is frequently used for post-needling soreness. However, to date, no studies have compared the different frequencies available for reducing post-needling soreness. The aim of this study was to research the immediate and short-term effects of the PENS current at 2 Hz frequency compared to PENS at 1000 Hz frequency applied after dry needling on post-needling soreness, disability associated with post-needling soreness and the pain pressure threshold (PPT) in latent myofascial trigger points (MTrPs) of the upper trapezius. Material and Methods An experimental double-blind non-controlled study. In total, 23 subjects without pain and with latent MTrPs in the upper trapezius participated in the study. Dry needling was performed, until the disappearance of local twitch responses. After randomization, 11 subjects received PENS at 100 Hz, whereas 12 received PENS at 2 Hz. The current was applied during 15 minutes, the duration of the current pulse was 100 microseconds. The main variable used was the Visual Analog Scale (VAS) to evaluate post-needling pain. The Neck Disability Index (NDI) and the PPT were secondary variables. The patient completed a diary on post-needling soreness in the hours following the intervention. A follow-up of the study variables was performed at 24 hours, 72 hours and one week after performing the intervention. Results Statistically significant differences were obtained between both groups in post-needling soreness immediately after the intervention (P = 0.002) and at 5 minutes (P = 0.03) in favor of the high frequency group. No differences were found in any of the follow-up periods and the pain disappeared in all subjects before 72 hours. Regarding the PPT, no significant differences were found between both groups. However, the group who received high frequency returned to their baseline conditions at 24 hours, whereas those who received low frequency returned to baseline conditions at 72 hours. All the subjects increased their PPT one week after receiving the intervention (P &lt; 0.05), nonetheless, they did not reach the minimum detectable change. No significant differences were found between groups according to the NDI. Conclusion The application of high frequency PENS after dry needling is more effective than low frequency PENS to reduce post-needling soreness in the short term in patients with latent MTrPs in the sample under study. No differences were found between groups regarding disability or the PPT. Our results are limited, future studies are required to establish the optimal frequency for reducing post-needling soreness.

Percutaneous nerve electrical stimulation is a novel treatment modality for the management of acute and chronic myofascial pain syndrome. To compare the effectiveness of dry needling combined with percutaneous electrical nerve stimulation of low frequency versus high frequency, in patients with chronic myofascial neck pain. Randomized, single-blind trial. Laboratory in an academic institution. A total of 40 volunteer patients with chronic neck pain were randomly divided into 2 groups. All patients initially received deep dry needling in a myofascial trigger point of the upper trapezius. Then, one group received high frequency percutaneous electrical nerve stimulation while the other group received low frequency percutaneous electrical nerve stimulation. The primary outcomes were the visual analog scale and the pressure pain threshold, while Neck Disability Index and Kinesiophobia were secondary outcomes. We detected significant improvements in the visual analog scale score in both groups without differences between them. We did not observe significantly different statistics in either group during the evaluation of data on pressure pain threshold. Limitations of the study include (1) heterogeneity of the sample in relation to gender, with more women, (2) the small sample size (40 patients), (3) the absence of placebo group, and (4) the fact that the treatment is focused exclusively on the upper trapezium myofascial trigger point. . Low and high frequency percutaneous electrical nerve stimulation combined with deep dry needling showed similar effects, since no differences between groups were observed on any of the outcome measures. High and low frequency of percutaneous electrical nerve stimulation generates changes on pain intensity and disability, but not on pressure pain threshold or fear of movement.

BACKGROUNDUnilateral patellofemoral pain syndrome (PFPS) is the most frequently diagnosed knee condition in populations aged < 50 years old. Although the treatment of myofascial trigger points (MTrPs) is a common and effective tool for reducing pain, previous studies showed no additional benefits compared with placebo in populations with PFPS. Percutaneous electrolysis is a minimally invasive approach frequently used in musculotendinous pathologies which consists of the application of a galvanic current through dry needling (DN).AIMTo evaluate changes in sensitivity, knee pain perception and perceived pain during the application of these three invasive techniques.METHODSA triple-blinded, pilot randomized controlled trial was conducted on fifteen patients with unilateral PFPS who were randomized to the high-intensity percutaneous electrolysis (HIPE) experimental group, low-intensity percutaneous electrolysis (LIPE) experimental group or DN active control group. All interventions were conducted in the most active MTrP, in the rectus femoris muscle. The HIPE group received a 660 mA galvanic current for 10 s, the LIPE group 220 mA × 30 s and the DN group received no galvanic current. The MTrP and patellar tendon pain pressure thresholds (PPTs) and subjective anterior knee pain perception (SAKPP) were assessed before, after and 7 d after the single intervention. In addition, perceived pain during the intervention was also assessed. RESULTSBoth groups were comparable at baseline as no significant differences were found for age, height, weight, body mass index, PPTs or SAKPP. No adverse events were reported during or after the interventions. A significant decrease in SAKPP (both HIPE and LIPE, P < 0.01) and increased patellar tendon PPT (all, P < 0.001) were found, with no differences between the groups (VAS: F = 0.30; η2 = 0.05; P > 0.05; tendon PPT immediate effects: F = 0.15; η2 = 0.02; P > 0.05 and tendon PPT 7-d effects: F = 0.67; η2 = 0.10; P > 0.05). A significant PPT increase in rectus femoris MTrP was found at follow-up in both the HIPE and LIPE groups (both, P < 0.001) with no differences between the groups (immediate effects: F= 1.55; η2 = 0.20; P > 0.05 and 7-d effects: F = 0.71; η2 = 0.10; P > 0.05). Both HIPE and LIPE interventions were considered less painful compared with DN (F = 8.52; η2 = 0.587; P < 0.01).CONCLUSIONHIPE and LIPE induce PPT changes in MTrPs and patellar tendon and improvements in SAKPP, and seem to produce less pain during the intervention compared with DN.

Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points

Background and Purpose:Shoulder pain is a prevalent condition in older adults. Some authors associate nonspecific shoulder pain with myofascial trigger points (MTrPs) in the infraspinatus muscle. Dry needling is recommended to relieve the MTrP pain of shoulders in the short term (<9 days). Active MTrPs dry needling improves shoulder pain and the irritability of the satellite MTrPs in the referred pain area. Nociceptive activity at a latent MTrP may influence motor activity and the sensitivity of MTrPs in distant muscles at a similar segmental level. Therefore, this study aimed to evaluate dry needling on 1 latent MTrP, in conjunction with 1 active MTrP, in the infraspinatus muscle of older adults with nonspecific shoulder pain.Methods:A single-center, randomized, single-blinded, controlled study (NCT02032602) was carried out. Sixty-six patients aged 65 years and older with trigger points in the ipsilateral infraspinatus of the painful shoulder were randomly assigned to (1) of (2) treatment groups. A session of dry needling on the infraspinatus was performed in (1) the most hyperalgesic active and latent MTrP or (2) only the most hyperalgesic active MTrP. The Numeric Rating Scale, the pressure pain threshold (primary outcome) on the anterior deltoid and extensor carpi radialis brevis latent MTrPs, and grip strength were assessed before, after, and 1 week after the intervention.Results:Statistically significant differences in the reduction of pain intensity (P ≤ .001; η2 = 0.159-0.269; d = 1.017-1.219) and the increase of pressure pain threshold (P < .001; η2 = 0.206-0.481; d = 0.870-1.924) were found for the (1) treatment group immediately and 1 week postintervention. Nevertheless, no statistical significant differences were found in grip strength (P >. 05; η2 = 0.006-0.033; d = 0.158-0.368).Conclusions:One dry needling intervention of the latent MTrP associated with the key active MTrP of the infraspinatus reduces pain intensity and the irritability of the satellite MTrPs located in the referred pain area in the short term in older adults with nonspecific shoulder pain.

ObjectiveThe study aimed to compare the effects of a combined intervention of dry needling and eccentric exercises versus oral and topical NSAID treatment, each combined with eccentric exercises, on pain intensity and hand function in patients with lateral epicondylalgia.DesignA single-blind, randomized controlled trial.MethodsA total of 111 participants with LE were randomly assigned to three groups: Dry needling plus eccentric exercise, Oral treatment plus eccentric exercise, and Topical treatment plus eccentric exercise. Pain intensity was assessed using the Visual Analog Scale and pressure pain threshold at the lateral epicondyle, medial epicondyle, radial styloid, and ulnar styloid. Functional impairment was measured using the HAND10 questionnaire. Statistical analysis included repeated measures ANOVA and post-hoc tests.ResultsAll groups showed significant improvements in pain intensity and function over the 30-day intervention period The DN group achieved the most substantial reduction in pain and the greatest improvement in pressure pain threshold and functional scores, followed by the TopA group. The OralI group demonstrated the least improvement across all measures. Significant differences were found between the three groups,with the dry needling group outperforming both Oral and Topical treatment groups in pain relief and functional outcomes.ConclusionThe combination of dry needling and eccentric exercises was more effective in reducing pain and improving hand function compared to NSAID-based interventions. These findings support the use of dry needling as an adjunct therapy to eccentric exercises for the management of lateral epicondylalgia.Clinical Trials Registry number: NCT05021354.

Management of Bronchiectasis

bands and hypersensitive Trigger Points (TrPs), contributing to musculoskeletal pain. The objective of this study is to investigate and assess the effectiveness of Advanced High-Power Pain Threshold Static Ultrasound (AHPPTSU) and Muscle Energy Technique (MET) in altering pain thresholds and enhancing functional outcomes in individuals with myofascial trigger points. Methods: In this randomized clinical trial involving 86 individuals with TrPs in the upper trapezius muscle, the participants were divided into experimental and control groups. 33 males and 53 females, underwent six sessions of treatment over two weeks. A repeated measure Analysis of variance was used to compare baseline values and altered values at 1 and 2 weeks. Results: The study demonstrated that the Pressure Pain Threshold (PPT) and the Neck Pain Disability Index (NPDI) score, showed a significant improvements in participants receiving AHPPTUS in experimental group compared to the other group. Experimental group showed a significantly greater improvement in PPT (p=0.001) and both groups experienced a significant enhancement in function. However, when comparing the two groups, experimental group showed a significantly greater improvement (p=0.001). Importantly, no adverse effects were reported in either group. Conclusion: In the treatment of myofascial trigger point, AHPPTSU can be considered as an alternative therapy method, which is more effective than previously used High-Power Pain Threshold Static Ultrasound (HPPTSU) therapy and it also shortens the total treatment protocol to 2 weeks.

The purpose was to determine the efficacy of deep dry needling (DDN) applied on an active myofascial trigger point (MTrP) versus a latent-MTrP versus a non-MTrP location, on pain reduction and cervical disability, in patients with chronic neck pain. A randomized, double-blind clinical trial design was used. A sample of 65 patients was divided into non-MTrP-DDN, active-MTrP-DDN and latent-MTrP-DDN groups. The visual analog scale (VAS), reproduction of the patient’s pain, number of local twitch responses, pressure pain threshold (PPT) and Neck Disability Index (NDI) were assessed before, during and after the intervention and up to 1 month post-intervention. The active-MTrP-DDN-group reduced pain intensity more than non-MTrP-DDN-group after a week and a month (P < 0.01), as well as showing the greatest improvement in tibialis muscle PPT. The treatment of both Active and Latent MTrPs was associated with the reproduction of the patient’s pain. The application of DDN on an active-MTrP in the upper trapezius muscle shows greater improvements in pain intensity after 1 week and 1 month post-intervention, compared to DDN applied in latent-MTrPs or outside of MTrPs in patients with neck pain.

Muscular temporomandibular joint disorders (M-TMDs) encompass a wide range of painful muscular conditions, which can provoke functional limitation and severely affect quality of life. The aim of the present study was to assess the treatment outcomes in patients affected by M-TMDs in terms of pain scores assessed with pressure pain threshold (PPT). The levels of depression, anxiety, and the Oral Health Impact Profile were also assessed and compared to healthy controls. Patients with a clinical diagnosis of M-TMDs and a control group of healthy subjects were enrolled. At baseline, OHIP-14, PHQ-9, and GAD-7 were administered. PPT was registered at the level of masseter and temporalis muscles. The patients affected by M-TMDs were then treated with oral splints and physio-kinesiotherapy following a standardized treatment protocol. At the 6-month follow-up of M-TMD-affected patients, PPT was registered, and the questionnaires were re-administered to evaluate treatment outcomes. In total, sixty patients and sixty controls were enrolled. The treatment of M-TMDs produced a significant improvement in PPT at the level of the masseter muscle. OHIP-14 at baseline in the M-TMD group was significantly higher compared to the control group (p < 0.05). At the 6-month follow-up, a significant reduction in OHIP-14 scores was registered, although with higher scores compared to the control group (p < 0.05). PHQ-9 was significantly higher at baseline in the M-TMD group (p < 0.05) and decreased to values comparable to the control group after treatment. GAD-7 presented statistically significant differences between the control group and M-TMD patients at baseline (p < 0.05) and between pre- and post-treatment in the M-TMD group. Following treatment, the GAD-7 scores were comparable to the control group. The symptom burden associated with M-TMDs negatively affects quality of life, with higher oral health impairment and a tendency towards depression and anxiety compared to healthy subjects. Following treatment, an improvement in both PPT and quality of life was observed.

The beneficial effects of traditional Thai massage on young patients with latent myofascial trigger points in the wrist extensor muscles: A randomized controlled trial

Muscle pain syndrome: Evaluation and treatment

Effectiveness of Dry Needling on the Lower Trapezius in Patients With Mechanical Neck Pain: A Randomized Controlled Trial

Myofascial Trigger Points, Pain, Disability, and Sleep Quality in Individuals With Mechanical Neck Pain