Fear of needles does not influence pain tolerance and sympathetic responses among patients during a therapeutic needling

Manual therapy and dry needling improve mobility, pain and reduce fear of COVID-19 in temporomandibular disorder patients: Randomized controlled trial

BACKGROUND AND PURPOSE

The COVID-19 pandemic exacerbated pain and joint mobility outcomes in patients with temporomandibular disorders (TMD), being that effective treatments are of clinical interest. We aimed to evaluate the effects of manual therapy (MT) and dry needling (DN), compared to cognitive-behavioral therapy/control (CO), on pain, articular mobility, and fear of COVID-19 in patients with TMD.

MATERIALS AND METHODS

Sixty participants with myofascial TMD were randomly assigned to three groups: MT, DN, and CO. Participants received four weeks of treatment (30 min per week). The participants completed the Fear of COVID- 19 Scale, the Visual Analog Scale, and mandibular mobility was assessed. Data were collected before the intervention (T1), after the last treatment session (T2), and 30 days after the end of treatment (T3). The data were analyzed using two-way Mixed-Design ANOVA, considering the group effect (DN x MT x CO), time (T1, T2, and T3), and the interaction time × group in the observed variance of outcomes.

RESULTS

We observed an interaction effect of time × group for maximum mouth opening, protrusion, and pain. The maximum mouth opening increased in the DN and MT groups (p = 0.005), while protrusion increased in the DN group (p = 0.007; test power = 97%, large effect size). A decrease in pain scores over time was observed in the DN and MT groups (p < 0.001; test power>99%, large effect size). The fear of COVID-19 score decreased in the DN and MT groups after 30 days (p = 0.033).

CONCLUSION

DN and MT improve pain, joint mobility, and fear of COVID-19 in patients with TMD.

Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design

Background and Objectives: Trigger points (TrPs) are prevalent in patients with migraine headaches. Needling interventions targeting TrPs in migraine patients may reduce the intensity and frequency of headaches, yet systematic reviews reveal a lack of robust evidence. Intramuscular electrical stimulation (IMES) is a modality that delivers electrical current into muscles and TrPs, with recent studies suggesting it may amplify the therapeutic effects of dry needling peripherally and centrally. This could be advantageous for patients with migraine and symptomatic TrPs. Materials and Methods: This study will implement a multiple baseline single-case experimental design (SCED). In a clinical setting, a SCED study lends itself to conducting research with only a few patients that each serve as their own controls. In this SCED study, four participants with chronic migraine will be enrolled in a non-concurrent manner and randomized to one of four baseline measurement periods (4, 5, 6 or 7 weeks), leading to four potentially different start dates for each participant in the intervention phase. During the intervention phase, patients will receive five sessions of dry needling with IMES, one session per week for five weeks. The primary outcome measure will be headache frequency, i.e., the reduction in the number of headache days over a one-month period using electronic headache diary data from the Migraine Buddy smartphone application. Secondary outcome measures will be changes in mean migraine pain intensity using a numeric pain rating scale (NPRS), migraine disability using the Migraine Disability Assessment Test (MIDAS), the Headache Impact Test (HIT-6), and changes in selected cervical musculoskeletal impairments including pressure pain thresholds (PPTs) over TrPs, the craniocervical flexion test (CCFT), and cervical active range of motion (AROM). Primary and secondary outcome measures will be analyzed separately using both visual and statistical analyses. Results: Actively recruiting participants. This project was approved by the Mass General Brigham Institutional Review Board (protocol #2023P000931) and is registered with ClinicalTrials.gov (NCT05893914). Conclusions: This study will seek to determine the effects of a five-week intervention period of IMES to TrPs in the posterior cervical muscles of subjects with chronic migraine.

A critical overview of the current myofascial pain literature - January 2020

We are starting 2020 with 6 basic research studies, 9 review articles, 14 dry needling/injection studies, and one manual therapy paper for a total of 30 new papers. Topics range from studies on mechanisms, inflammatory mediators in myofascial pain, fascia, screening, Platelet-rich plasma intramuscular injections, and temporal summation to clinical studies on patients with tension-type headache, chronic pelvic pain, knee osteoarthritis, plantar fasciitis, generalized musculoskeletal pain, neck pain, breast cancer, tendinopathies, thoracic outlet syndrome, and canine dry needling, among others.

Effects of spray and stretch on postneedling soreness and sensitivity after dry needling of a latent myofascial trigger point

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.