The short-term effects of TENS plus therapeutic ultrasound combinations in chronic neck pain

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

PURPOSE

To evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain.

MATERIAL AND METHODS

A randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression.

RESULTS

No significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030).

CONCLUSION

The addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.

Pain reduction, physical performance, and psychological status compared between Hatha yoga and stretching exercise to treat sedentary office workers with mild/moderate neck/shoulder pain: A randomized controlled non-inferiority trial

OBJECTIVE

To investigate pain reduction, physical performance, and psychological status compared between Hatha yoga and stretching exercises.

DESIGN

Randomized controlled non-inferiority trial SUBJECTS: 150 sedentary office workers with mild/moderate neck/shoulder pain.

INTERVENTIONS

Participants received group Hatha yoga or stretching exercise once a week (30 min for 4 weeks), and were asked to practice at home. Subjects were followed up at 4 and 8 weeks.

MAIN OUTCOME MEASURES

The primary outcome was a numeric rating scale (NRS) score. The secondary outcomes were a sit-and-reach test, Functional Reach Test, Neck Disability Index, pain pressure threshold, Patient Health Questionnaire-9, General Anxiety Disorder-7, and the EuroQoL.

RESULTS

Of the 150 subjects, 59 and 71 participants in the Hatha yoga and stretching groups were analyzed. At baseline, no significant differences between groups were found. After 4 weeks, the mean difference in the NRS score was statistically significant between groups (p < 0.001), including a 95% confidence level of < 1 score, but there was no significant difference between groups for any other outcome. Most participants reported being satisfied with their assigned treatment (98.3-100%), and rated themselves as improved or much improved (91.8-98.3%) (both p > 0.05 between groups). The most common adverse events were musculoskeletal pain and muscle tension. Repeated measures analysis of variance that compared among weeks 0, 4, and 8 revealed no significant difference between groups.

CONCLUSION

Hatha yoga was tentatively found to be non-inferior to stretching exercise relative to safety, for decreasing pain, anxiety, and depression, and for improving flexibility, neck functions, and quality of life.

A comparison of different physical stimulation combined with platelet-rich plasma for the treatment of knee osteoarthritis: study protocol for a randomized controlled trial

BACKGROUND

Platelet-rich plasma (PRP) contains various growth factors and inflammatory regulators, which can effectively reduce inflammation in joints and promote tissue repair. Multiple studies have proved its effectiveness in the treatment of knee osteoarthritis (KOA). Low-intensity focused ultrasound (LIFU) and transcutaneous electrical nerve stimulation (TENS) are non-invasive and safe physical therapy methods for KOA. This study is the first to propose the treatment of KOA with physical stimulation after PRP treatment, and to observe the clinical efficacy of the treatment method.

METHODS

This is a protocol paper that outlines a randomized controlled trial, patients will be assigned randomly to the PRP group, PRP+LIFU group, PRP+TENS group, and PRP+LIFU combined TENS group. The patients will be followed at 12-week and 24-week time points to evaluate the primary and secondary outcomes of the study. The primary outcome is the VAS pain score. Secondary outcomes include Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and International Knee Documentation Committee scores (IKDC). After baseline examination, all patients will sign a written informed consent for study participation after a full explanation of the treatment protocol. We have planned a total of 120 patients (30 patients per group).

DISCUSSION

The objective of this clinical trial is to evaluate the effect of different physical stimulation after PRP treatment for KOA. The data will be published after the completion of the study.

TRIAL REGISTRATION

This study has been registered with the Chinese Clinical Trials Registry.

REGISTRATION NUMBER

ChiCTR2200065119 (registered date: 10/28/2022).

Effects of dry needling on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain: A randomized controlled pilot study

BACKGROUND

Myofascial trigger points (MTrPs) in neck muscles seem to be related to the main symptoms of patients with chronic neck pain.

OBJECTIVE

The objective was to investigate the effects of dry needling (DN) on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain.

METHODS

A double blind randomized controlled pilot trial was designed. Twenty-one patients with chronic neck pain were randomly allocated to the DN group (n= 7), Sham-DN group (n= 7) or Control group (n= 7). All groups received a Transcutaneous Electrical Nerve Stimulation and Therapeutic Ultrasound (TENS/US) protocol with patient education. The DN and Sham-DN groups received two sessions of DN and sham DN, respectively. The primary outcome was pain intensity. Secondary outcomes were disability, kinesiophobia, pain catastrophizing, psychological distress, self-reported improvement and success of blinding.

RESULTS

The DN group showed a greater decrease in pain intensity, disability and pain catastrophizing compared to the Sham-DN group (p< 0.05) and the Control group (p< 0.05). The DN group showed the highest self-reported improvement.

CONCLUSION

Adding two sessions of DN in active MTrPs in upper trapezius, levator scapulae and sternocleidomastoid muscles to a TENS/US protocol with patient education decreased pain intensity, disability and pain catastrophizing in patients with chronic neck pain.

Effects of Personal Low-Frequency Stimulation Device on Myalgia: A Randomized Controlled Trial

Electrotherapy is commonly used for myalgia alleviation. Low-frequency stimulation (LFS) is primarily used for controlling acute and chronic pain and is a non-invasive therapy that can be easily performed with electric stimulation applied on the skin. However, little evidence exists regarding the pain alleviation effects of personal low-frequency stimulation device for home use. Moreover, no studies have compared myalgia alleviation effects between personal low-frequency stimulation (PLS) and physical therapy (PT), which are most commonly used for patients with myalgia in hospitals and clinics. Therefore, we aimed to investigate the pain alleviation effects of PLS in patients with myalgia and compare these effects with those of conventional PT (transcutaneous electrical nerve stimulation + ultrasound). In total, 39 patients with myalgia in the neck, shoulder, back, and waist areas were randomly assigned to the personal low-frequency stimulation group (PLSG: n = 20) and physical therapy group (PTG: n = 19). Both groups were treated for 3 weeks (20 min per session and 5 sessions per week). Patients were assessed for pain intensity by surface electromyography (sEMG), visual analogue scale (VAS) and a short-form McGill pain questionnaire (SF-MPQ) before and after the intervention period. Our results showed that PLSG showed a tendency of muscle relaxation with a significant decrease in sEMG in the neck (p = 0.0425), shoulder (p = 0.0425), and back (p = 0.0046) areas compared to the control group. However, there was no significant difference in waist area. Additionally, VAS scores significantly decreased between pre- and post-treatment in both PTG (p = 0.0098), and PLSG (p = 0.0304) groups, but there was no significance difference between the groups. With respect to SF-MPQ, the PLSG showed greater pain alleviation (5.23 ± 0.25) effects than the PTG (6.23 ± 0.25). Accordingly, our results suggest that PLS treatment using a home device might offer positive assistance in pain alleviation for patients with myalgia that is as equally effective as conventional PT treatment. However, further detailed studies are required considering larger samples to fully claim the effectiveness of this device.

The effect of intermittent diet and/or physical therapy in patients with chronic low back pain: A single-blinded randomized controlled trial

BACKGROUND AND PURPOSE

This study aimed to investigate the effect of intermittent diet and/or physical therapy in patients with chronic low back pain.

MATERIALS AND METHODS

Sixty sedentary volunteers with chronic low back pain participated in the study. Body weight and body mass index (BMI) were measured. Pain severity was assessed using Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), while assessment of disability was done using Barthel Index (BI).

RESULTS

The weight and BMI were reduced after treatment with diet only and diet plus physical therapy (p < 0.001). The pain severity was reduced in all the treated groups (p < 0.001), while BI was increased in the group treated with only physical therapy (p < 0.001).

CONCLUSION

The present study indicated that intermittent diet and/or physical therapy are beneficial to patients with chronic low back pain in terms of pain sensation and daily activities.

Effects of patient-specific mobility therapy for TMJ, neck, and shoulder dysfunction after submandibular gland tumor surgery: a case report

Aims: This case report describes a patient-specific mobility therapy (PSMT) program to restore range of motion (ROM) and overcome functional limitations of the temporomandibular joint (TMJ), neck, and shoulder in a 48-year-old man who underwent submandibular gland tumor surgery.Methods: The patient also received transcutaneous electrical stimulation and ultrasound to relieve pain. Treatment was provided four sessions per week for four weeks. The measured outcomes included the Neck Disability Index (NDI), Patient-Specific Functional Scale (PSFS), and mobility of the TMJ, neck, and shoulder.Outcomes: The ROM of the TMJ, neck, and shoulder improved from 4.00 mm to 21.00 mm, 1.67 cm to 6.40 cm, and 9.75° to 56.00°, respectively, during the 1^st intervention phase when compared with the baseline phase, and these gains were also maintained in the later phases. Furthermore, the NDI and PSFS scores improved by 12.75 points (24.50 to 11.75) and 5.25 points (2.00 to 7.25), respectively.Conclusion: These findings demonstrate the success of PSMT in conjunction with transcutaneous electrical stimulation and ultrasound in alleviating pain and improving targeted impairments for this patient following submandibular gland tumor surgery.