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.

Santiago Garcia-De-Miguel,Ruben Fernandez-Matias,Tamara Larroca-Sanz,Laura Garcia-Montes,Tomas Gallego-Izquierdo,Beatriz Sanz-De-Vicente,Daniel Pecos-Martin

doi:10.3390/jcm9061665

Abstract

Procedures such as dry needling (DN) or percutaneous electrical nerve stimulation (PENS) are commonly proposed for the treatment of myofascial trigger points (MTrP). The aim of the present study is to investigate if PENS is more effective than DN in the short term in subjects with mechanical neck pain. This was an evaluator-blinded randomized controlled trial. Subjects were recruited through announcements and randomly allocated into DN or PENS groups. Pain intensity, disability, pressure pain threshold (PPT), range of motion (ROM), and side-bending strength were measured. The analyses included mixed-model analyses of variance and pairwise comparisons with Bonferroni correction. The final sample was composed of 44 subjects (22 per group). Both groups showed improvements in pain intensity (ηp2 = 0.62; p < 0.01), disability (ηp2 = 0.74; p < 0.01), PPT (ηp2 = 0.79; p < 0.01), and strength (ηp2 = 0.37; p < 0.01). The PENS group showed greater improvements in disability (mean difference, 3.27; 95% CI, 0.27–6.27) and PPT (mean difference, 0.88–1.35; p < 0.01). Mixed results were obtained for ROM. PENS seems to produce greater improvements in PPT and disability in the short term.

Highlights

Dry needling (DN) is a therapeutic intervention in which thin needles are used to penetrate the skin to affect the underlying connective tissue and neuromuscular system without the use of any medication [1]
This randomized controlled trial was conducted according to the recommendations of the Consolidated Standards of Reporting Trials (CONSORT) statement [30]
Posttreatment decreases in visual analogue scale (VAS) were near the minimum clinically important difference (MCID) of 2 cm, whereas improvements in pain intensity at 48-hour and 1-week follow-up were above the MCID [47]

Summary

Introduction

Dry needling (DN) is a therapeutic intervention in which thin needles are used to penetrate the skin to affect the underlying connective tissue and neuromuscular system without the use of any medication [1]. A MTrP may be related to motor dysfunction, fatigue, weakness of the affected muscle, and restricted range of mobility [6]. These hyperirritable nodules can be classified as active, in which case the MTrP is clinically associated with spontaneous pain and, when palpated, reproduces a patient’s familiar pain. They may be latent MTrPs. Latent MTrPs do not produce spontaneous pain unless they are encouraged [6,7]. DN has been shown to increase the pressure pain threshold (PPT) [8] and range of movement (ROM) [9]; to improve function [10]; and to decrease pain in patients with patellofemoral pain syndrome [10], hip osteoarthritis [11], low-back pain [12], and piriformis syndrome [13]

Objectives

Findings

Discussion

Conclusion