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Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 5/2012

01-10-2012 | Myofascial Pain (RD Gerwin, Section editor)

Trigger Point Needling: Techniques and Outcome

Authors: Simon Vulfsons, Motti Ratmansky, Leonid Kalichman

Published in: Current Pain and Headache Reports | Issue 5/2012

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Abstract

In this review we provide the updates on last years’ advancements in basic science, imaging methods, efficacy, and safety of dry needling of myofascial trigger points (MTrPs). The latest studies confirmed that dry needling is an effective and safe method for the treatment of MTrPs when provided by adequately trained physicians or physical therapists. Recent basic studies have confirmed that at the site of an active MTrP there are elevated levels of inflammatory mediators, known to be associated with persistent pain states and myofascial tenderness and that this local milieu changes with the occurrence of local twitch response. Two new modalities, sonoelastography and magnetic resonance elastography, were recently introduced allowing noninvasive imaging of MTrPs. MTrP dry needling, at least partially, involves supraspinal pain control via midbrain periaqueductal gray matter activation. A recent study demonstrated that distal muscle needling reduces proximal pain by means of the diffuse noxious inhibitory control. Therefore, in a patient too sensitive to be needled in the area of the primary pain source, the treatment can be initiated with distal needling.
Literature
1.
2.
Dommerholt J. Dry needling in orthopaedic physical therapy practice. Orthop Pract. 2004;16:11–6.
3.
Alexander RW, Bradley LA, Alarcón GS, et al. Sexual and physical abuse in women with fibromyalgia: association with outpatient health care utilization and pain medication usage. Arthritis Care Res. 1998;11(2):102–15.PubMedCrossRef
4.
Dommerholt J, Moral O, Gröbli C. Trigger point dry needling. J Man Manip Ther. 2006;14(4):E70–87.CrossRef
5.
Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 2010;23(5):640–6.PubMedCrossRef
6.
Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82(7):986–92.PubMedCrossRef
7.
•• Sikdar S, Shah JP, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009;90(11):1829–38. This article is of great interest for it allows a simple, cheap, and noninvasive method for imaging myofascial trigger points. There is great scope for further study, especially in outcome studies correlating trigger points with clinical findings.PubMedCrossRef
8.
Chen Q, Bensamoun S, Basford JR, Thompson JM, An KN. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil. 2007;88(12):1658–61.PubMedCrossRef
9.
Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99(5):1977–84.PubMedCrossRef
10.
• Srbely JZ, Dickey JP, Lee D, Lowerison M. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med 2010;42(5):463–8. This study confirms the understanding of the segmental pattern of myofascial pain. PubMedCrossRef
11.
Hsieh YL, Chou LW, Joe YS, Hong CZ. Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle. Arch Phys Med Rehabil. 2011;92(7):1098–105.PubMedCrossRef
12.
Niddam DM, Chan RC, Lee SH, Yeh TC, Hsieh JC. Central modulation of pain evoked from myofascial trigger point. Clin J Pain. 2007;23(5):440–8.PubMedCrossRef
13.
Itoh K, Minakawa Y, Kitakoji H. Effect of acupuncture depth on muscle pain. Chin Med. 2011;6(1):24.PubMedCrossRef
14.
Huang YT, Lin SY, Neoh CA, Wang KY, Jean YH, Shi HY. Dry needling for myofascial pain: prognostic factors. J Altern Complement Med. 2011;17(8):755–62.PubMedCrossRef
15.
Pérez-Palomares S, Oliván-Blázquez B, Magallón-Botaya R, et al. Percutaneous electrical nerve stimulation versus dry needling: effectiveness in the treatment of chronic low back pain. J Musculoskelet Pain. 2010;18(1):23–30.CrossRef
16.
Ay S, Evcik D, Tur BS. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2010;29(1):19–23.PubMedCrossRef
17.
Simons D. Muscular pain syndrome. In: Friction J, Awad EA, editors. Advances in pain research and therapy. New York: Raven; 1990. p. 1–41.
18.
Venancio Rde A, Alencar Jr FG, Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009;27(1):46–53.PubMed
19.
Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayik Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2005;25(8):604–11.PubMedCrossRef
20.
Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256–63.PubMedCrossRef
21.
•• Tsai CT, Hsieh LF, Kuan TS, Kao MJ, Chou LW, Hong CZ. Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle. Am J Phys Med Rehabil 2010;89(2):133–40. In this study, the effects of remote dry needling appear to be associated with the activation of the diffuse noxious inhibitory control system. This has importance for treating those patients who are too sensitive for direct needling of involved muscles.PubMedCrossRef
22.
Graven-Nielsen T, Babenko V, Svensson P, Arendt-Nielsen L. Experimentally induced muscle pain induces hypoalgesia in heterotopic deep tissues, but not in homotopic deep tissues. Brain Res. 1998;787(2):203–10.PubMedCrossRef
23.
Reinert A, Treede R, Bromm B. The pain inhibiting pain effect: an electrophysiological study in humans. Brain Res. 2000;862(1–2):103–10.PubMedCrossRef
24.
Ga H, Choi JH, Park CH, Yoon HJ. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. J Altern Complement Med. 2007;13(6):617–24.PubMedCrossRef
25.
Huguenin L, Brukner PD, McCrory P, Smith P, Wajswelner H, Bennell K. Effect of dry needling of gluteal muscles on straight leg raise: a randomised, placebo controlled, double blind trial. Br J Sports Med. 2005;39(2):84–90.PubMedCrossRef
26.
Lee JH, Lee H, Jo DJ. An acute cervical epidural hematoma as a complication of dry needling. Spine (Phila Pa 1976). 2011;36(13):E891–3.CrossRef
27.
McCutcheon LJ, Yelland M. Iatrogenic pneumothorax: safety concerns when using acupuncture or dry needling in the thoracic region. Phys Ther Rev. 2011;16(2):126–32.CrossRef
28.
Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009;16(2):91–7.PubMedCrossRef
29.
White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ. 2001;323(7311):485–6.PubMedCrossRef
30.
Peuker ET, White A, Ernst E, Pera F, Filler TJ. Traumatic complications of acupuncture. Therapists need to know human anatomy. Arch Fam Med. 1999;8(6):553–8.PubMedCrossRef
31.
Andersen SA. Bilateral pneumothorax associated to acupuncture. Ugeskr Laeger. 2011;173(43):2724–5.PubMed
32.
Kennedy B, Beckert L. A case of acupuncture-induced pneumothorax. N Z Med J. 2010;123(1320):88–90.PubMed
33.
Lee WM, Leung HB, Wong WC. Iatrogenic bilateral pneumothorax arising from acupuncture: a case report. J Orthop Surg (Hong Kong). 2005;13(3):300–2.
34.
Su JW, Lim CH, Chua YL. Bilateral pneumothoraces as a complication of acupuncture. Singapore Med J. 2007;48(1):e32–3.PubMed
35.
Yamashita H, Tsukayama H, Tanno Y, Nishijo K. Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan. J Altern Complement Med. 1999;5(3):229–36.PubMedCrossRef
Metadata
Title
Trigger Point Needling: Techniques and Outcome
Authors
Simon Vulfsons
Motti Ratmansky
Leonid Kalichman
Publication date
01-10-2012
Publisher
Current Science Inc.
Published in
Current Pain and Headache Reports / Issue 5/2012
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-012-0279-6

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