Neurophysiological and psychophysical effects of dry versus sham needling of the infraspinatus muscle in patients with chronic shoulder pain: a randomized feasibility study

Placebo and nocebo effects of percutaneous needle electrolysis and dry-needling: an intra and inter-treatment sessions analysis of a three-arm randomized double-blinded controlled trial in patients with patellar tendinopathy

Objective

This study aimed to investigate the influence of potential placebo and nocebo effects on pain perception of percutaneous needle electrolysis (PNE) in individuals with patellar tendinopathy.

Methods

In this secondary analysis of a three-arm randomized double-blinded controlled trial, intra and inter-session pain perception data from 48 sporting participants with patellar tendinopathy between 18 and 45 years were investigated. Participants were divided into 3 parallel groups: "no-sham group" [PNE intervention], "single-sham group" [sham PNE by using dry needling], and "double-sham group" [sham PNE by using sham needles]. Every group received 4 sessions of the needling therapies targeting the patellar tendon over 8 weeks and was instructed to perform a unilateral eccentric exercise program of the quadriceps muscle on the affected side. Clinical and needle-related pain was assessed before, during, and after each treatment session using a visual analog scale.

Results

No differences were found between groups intra- or inter-session in terms of pain reduction (P = 0.424) despite clinical pain decreased in all groups since the first treatment session (P < 0.001). Furthermore, although the double-sham group showed a lower percentage of participants reporting needle-related pain during needle intervention (P = 0.005), the needle-related pain intensity after needle intervention was similar between groups (P = 0.682). Moreover, there were no group differences for the duration of pain sensation after any needle intervention (P = 0.184), extending in many cases beyond 24 h.

Conclusion

Needling therapies for individuals with patellar tendinopathy are prone to elicit placebo effects regarding clinical pain and nocebo effects regarding needling-related pain. Clinicians and physical therapists treating musculoskeletal pain conditions should consider the added value and potential mechanisms of action before routinely using needle techniques.

Immediate effects of superficial dry needling of the trigeminal nerve innervation field for participants with cervicogenic headache. A randomized controlled trial

BACKGROUND

Cervicogenic headache (CGH) is a common condition with a neuroanatomical basis involving the trigeminal nerve. Dry needling (DN) is a safe and effective treatment for CGH but most studies involve deep DN to cervical musculature.

OBJECTIVE

The aim of this study was to investigate immediate effects of superficial DN of the trigeminal nerve innervation field on numeric pain rating scale (NPRS), flexion-rotation test (FRT), cervical range of motion (AROM), and pain-pressure threshold (PPT) of right (R) and left (L) supraorbital (SO), and right (R) and left (L) greater occipital (GO) nerves in participants with CGH.

METHODS

A parallel controlled randomized design involving 30 participants with CGH received either superficial DN (N = 17) or sham DN (N = 13). Participants and outcome assessors were blind to group assignment. Wilcoxon signed rank analyzed within-group effects and Mann-Whitney U analyzed between-group.

RESULTS

Statistically significant between-group differences were observed for NPRS (P < .001) and AROM (P < .006) favoring DN and were clinically meaningful. Right and left Flexion rotation tests (FRT) outcomes were non-significant (P = .137) but clinically meaningful. No differences were observed for PPT over: R SO (P = .187); L SO (P = .052); R GO (P = .187); or L GO (P = .052). Between-group effect sizes across variables were moderate to large (0.53-1.4) but confidence intervals were wide.

CONCLUSION

Superficial DN targeting the innervation field of the trigeminal nerve improves clinical outcomes in patients with CGH. Only the immediate effects were analyzed and the sample size was small. Larger, longer-term assessments are needed comparing superficial DN of the trigeminal innervation field and other conservative interventions for CGH.

Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial

Background

: Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR.

Methods

: A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit.

Discussion

: The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.