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Martín-Pintado-Zugasti A, López-López A, González Gutiérrez JL, Pecos-Martín D, Rodríguez-Fernández ÁL, Alguacil-Diego IM, Gallego-Izquierdo T, Fernández-Carnero J. The Role of Psychological Factors in the Perception of Postneedling Soreness and the Influence of Postneedling Intervention. PM R 2016; 9:348-355. [PMID: 27492276 DOI: 10.1016/j.pmrj.2016.07.529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Myofascial trigger point dry needling is frequently associated with postneedling soreness, which can generate patient dissatisfaction and reduced treatment adherence. Psychological factors may influence the perception of postneedling soreness and the effectiveness of postneedling soreness treatments. OBJECTIVES The objectives of the present study were to determine whether catastrophizing, kinesiophobia, pain anxiety, and fear of pain are significant predictors of postneedling soreness over time; and to analyze whether the relationships between psychological variables and postneedling soreness vary as a function of the postneedling soreness intervention, which included ischemic compression, placebo or control (without treatment). DESIGN Repeated-measures observational study nested within a randomized controlled trial. SETTING University community. PARTICIPANTS Healthy volunteers (N = 90; 40 men and 50 women) 18 to 39 years of age (mean ± standard deviation 22 ± 3 years). METHODS Catastrophizing, kinesiophobia, pain anxiety, and fear of pain were evaluated as possible predictors of postneedling pain before dry needling in a latent myofascial trigger point in the upper trapezius muscle. Participants were then divided into a treatment group that received ischemic compression as a postneedling intervention, a placebo group that received sham ischemic compression, and a control group that did not receive any treatment. MAIN OUTCOME MEASUREMENTS Pain during needling and postneedling soreness were quantified using a visual analogue scale during needling, after treatment, and at 6, 12, 24, and 48 hours. RESULTS A multilevel analysis revealed that individuals who exhibited more catastrophic thinking showed less postneedling soreness intensity immediately after needling in all participants (β = -0.049). Pain-related anxiety was linked to greater immediate postneedling soreness in the compression condition (β = 0.057). Finally, participants who exhibited more catastrophic thinking showed a slower rate of decline in postneedling soreness levels over time in the compression condition (β = 0.038). CONCLUSIONS Catastrophizing was associated with lower levels of postneedling soreness immediately after needling in all subjects. Although ischemic compression seems to be a useful procedure to reduce postneedling soreness, its efficacy could be slightly reduced in patients presenting higher scores of pain-related anxiety. Psychological procedures may help to correct the distorted pain expectancies associated with needling interventions and might also improve the effectiveness of ischemic compression. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Aitor Martín-Pintado-Zugasti
- Department of Nursing and Physiotherapy, CEU-San Pablo University, Carretera Boadilla del Monte, Km 5,300, Urbanización Montepríncipe, 28668 Boadilla del Monte, Madrid, Spain∗.
| | - Almudena López-López
- Department of Psychology, Universidad Rey Juan Carlos Alcorcón, Madrid, Spain(†)
| | | | - Daniel Pecos-Martín
- Physiotherapy Department, Physiotherapy and Pain Group, School of Physiotherapy, Alcalá de Henares University, Alcalá de Henares, Madrid, Spain(§)
| | | | - Isabel María Alguacil-Diego
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain(¶)
| | - Tomás Gallego-Izquierdo
- Physiotherapy Department, Physiotherapy and Pain Group, School of Physiotherapy, Alcalá de Henares University, Alcalá de Henares, Madrid, Spain(#)
| | - Josue Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain; Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain; Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, Madrid, Spain∗∗
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Direct electrical stimulation on the injured ulnar nerve using acupuncture needles combined with rehabilitation accelerates nerve regeneration and functional recovery—A case report. Complement Ther Med 2016; 24:103-7. [DOI: 10.1016/j.ctim.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/03/2015] [Indexed: 01/29/2023] Open
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Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sánchez-Milá Z, Fernández-de-las-Peñas C, Alburquerque-Sendín F. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:790209. [PMID: 26064172 PMCID: PMC4430654 DOI: 10.1155/2015/790209] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 01/31/2023]
Abstract
Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P < 0.001) and for pain (F = 44.420; P < 0.001): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.
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Affiliation(s)
- Jaime Salom-Moreno
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Grupo de Excelencia Investigadora URJC-Banco de Santander: Investigación Traslacional en el Proceso de Salud-Enfermedad (ITPSE), Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | - Blanca Ayuso-Casado
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | - Beatriz Tamaral-Costa
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Grupo de Excelencia Investigadora URJC-Banco de Santander: Investigación Traslacional en el Proceso de Salud-Enfermedad (ITPSE), Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
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Ischemic Compression After Dry Needling of a Latent Myofascial Trigger Point Reduces Postneedling Soreness Intensity and Duration. PM R 2015; 7:1026-1034. [PMID: 25836591 DOI: 10.1016/j.pmrj.2015.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effect of ischemic compression (IC) versus placebo and control on reducing postneedling soreness of 1 latent myofascial trigger point and on improving cervical range of motion (CROM) in asymptomatic subjects. DESIGN A randomized, double-blind, placebo-controlled trial with 72-hour follow-up. SETTING A university community. PARTICIPANTS Asymptomatic volunteers (N = 90: 40 men and 50 women) aged 18 to 39 years (mean ± standard deviation [SD]: 22 ± 3 years). INTERVENTION All subjects received a dry needling application over the upper trapezius muscle. Participants were then randomly divided into 3 groups: a treatment group who received IC over the needled trapezius muscle, a placebo group who received sham IC, and a control group who did not receive any treatment after needling. MAIN OUTCOME MEASURES Visual analog scale (VAS; during needling, at posttreatment and 6, 12, 24, 48, and 72 hours) and CROM (at preneedling, postneedling, and 24 and 72 hours). RESULTS Subjects in the IC group showed significantly lower postneedling soreness than the placebo and the control group subjects immediately after treatment (mean ± standard deviation [SD]: IC, 20.1 ± 4.8; placebo, 36.7 ± 4.8; control, 34.8 ± 3.6) and at 48 hours (mean ± SD: IC, 0.6 ± 1; placebo, 4.8 ± 1; control, 3.8 ± 0.7). In addition, subjects in the dry needling+IC group showed significantly lower postneedling soreness duration (P = .026). All subjects significantly improved CROM in contralateral lateroflexion and both homolateral and contralateral rotations, but only the improvements found in the IC group reached the minimal detectable change. CONCLUSIONS IC can potentially be added immediately after dry needling of myofascial trigger point in the upper trapezius muscle because it has the effect of reducing postneedling soreness intensity and duration. The combination of dry needling and IC seems to improve CROM in homolateral and contralateral cervical rotation movements.
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Skorupska E, Rychlik M, Pawelec W, Bednarek A, Samborski W. Intensive short-term vasodilation effect in the pain area of sciatica patients--case study. BMC Res Notes 2014; 7:620. [PMID: 25201416 PMCID: PMC4171577 DOI: 10.1186/1756-0500-7-620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 09/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background Varied and complicated etiology of low back pain radiating distally to the extremities is still causing disagreement and controversy around the issue of its diagnosis and treatment. Most clinicians believe that the source of that pain is generally radicular. While some of them postulate the clinical significance of the sacroiliac joint syndrome, others demonstrate that almost one in five people with back pain experience symptoms indicative of the neuropathic pain component. To date, neuropathic involvement has not been completely understood, and different mechanisms are thought to play an important role. It has been established that muscle pain (myofascial pain) e.g. active trigger points from the gluteus minimus, can mimic pain similar to sciatica, especially in the chronic stage. This paper describes patients presenting with radicular sciatica (case one and two) and sciatica-like symptoms (case three). For the first time, intensive short-term vasodilation in the pain area following needle infiltration of the gluteus minimus trigger point was recorded. Case presentation Three Caucasian, European women suffering from radicular sciatica (case one and two) and sciatica-like symptoms (case three) at the age of 57, 49 and 47 respectively underwent infrared camera observation during needle infiltration of the gluteus minimus trigger point. The patients were diagnosed by a neurologist; they underwent magnetic resonance imaging, electromyography, neurography and blood test analysis. Apart from that, the patients were diagnosed by a clinician specializing in myofascial pain diagnosis. Conclusion In the examined cases, trigger points-related short-term vasodilation was recorded. Confirmation of these findings in a controlled, blinded study would indicate the existence of a link between the pain of sciatica patients (radicular or sciatica-like pain) and the activity of the autonomic nervous system. Further studies on a bigger group of patients are still needed. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-620) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elżbieta Skorupska
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland.
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Brady S, McEvoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther 2014; 22:134-40. [PMID: 25125935 DOI: 10.1179/2042618613y.0000000044] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Trigger point dry needling (TrP-DN) is commonly used to treat persons with myofascial pain, but no studies currently exist investigating its safety. The aim of this study was to determine the incidence of Adverse Events (AEs) associated with the use of TrP-DN by a sample of physiotherapists in Ireland. METHODS A prospective survey was undertaken consisting of two forms recording mild and significant AEs. Physiotherapists who had completed TrP-DN training with the David G Simons Academy (DGSA) were eligible to take part in the study. Data were collected over a ten-month period. RESULTS In the study, 39 physiotherapists participated and 1463 (19.18%) mild AEs were reported in 7629 treatments with TrP-DN. No significant AEs were reported giving an estimated upper risk rate for significant AEs of less than or equal to (≤) 0.04%. Common AEs included bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19%). Uncommon AEs were aggravation of symptoms (0.88%), drowsiness (0.26%), headache (0.14%), and nausea (0.13%). Rare AEs were fatigue (0.04%), altered emotions (0.04%), shaking, itching, claustrophobia, and numbness, all 0.01%. DISCUSSION While mild AEs were very commonly reported in this study of TrP-DN, no significant AEs occurred. For the physiotherapists surveyed, TrP-DN appeared to be a safe treatment.
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Affiliation(s)
- Sarah Brady
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Ireland
| | | | | | - Catherine Doody
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Ireland
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Martín-Pintado Zugasti A, Rodríguez-Fernández ÁL, García-Muro F, López-López A, Mayoral O, Mesa-Jiménez J, Fernández-Carnero J. Effects of spray and stretch on postneedling soreness and sensitivity after dry needling of a latent myofascial trigger point. Arch Phys Med Rehabil 2014; 95:1925-1932.e1. [PMID: 24928191 DOI: 10.1016/j.apmr.2014.05.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity. DESIGN A 72-hour follow-up, single-blind randomized controlled trial. SETTING University community. PARTICIPANTS Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle. INTERVENTION All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention. MAIN OUTCOME MEASURES Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised. RESULTS Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F3,204.8=3.19; P<.05; ηp(2)=.04) for changes in postneedling soreness. Between-group differences were significant only immediately after intervention (P=.002), and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F2.6,175=1.9; P=.131; ηp(2)=.02). CONCLUSIONS The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain.
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Affiliation(s)
- Aitor Martín-Pintado Zugasti
- Faculty of Medicine, Department of Physical Therapy, Centro de Estudios Universitarios (CEU)-San Pablo University, Madrid, Spain.
| | - Ángel L Rodríguez-Fernández
- Faculty of Medicine, Department of Physical Therapy, Centro de Estudios Universitarios (CEU)-San Pablo University, Madrid, Spain
| | - Francisco García-Muro
- Faculty of Medicine, Department of Physical Therapy, Centro de Estudios Universitarios (CEU)-San Pablo University, Madrid, Spain
| | | | - Orlando Mayoral
- Physical Therapy Unit, Hospital Provincial de Toledo, Toledo, Spain
| | - Juan Mesa-Jiménez
- Faculty of Medicine, Department of Physical Therapy, Centro de Estudios Universitarios (CEU)-San Pablo University, Madrid, Spain
| | - Josue Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
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