Dry Needling For Myofascial Pain Syndrome

Physicians and healthcare professionals often encounter myofascial pain syndrome in their work. It can affect up to 10% of the adult population and is responsible for severe and chronic pain. In this article, we will present to the public dry needling, a relatively new method of management myofascial pain syndrome. We will discuss different methods of dry needling, its effectiveness and physiological and possible side effects. We know the deep and superficial method of dry needling.

Dry needling is a treatment modality that has a minimal level of invasiveness. It is affordable and easy to learn with proper training, and has a low level of risk. Its effectiveness has been confirmed by numerous studies and two comprehensive systematic reviews. We know the deep and superficial method of dry needling. The first was in the treatment or relieving pain associated with myofascial pain syndrome has been shown to be more effective than others. However, for areas where there is a potential risk of side effects, such as lungs and large blood vessels. We recommend the use of a superficial technique that has also proven effective, but to a lesser extent.

Of course, additional studies are needed to evaluate the effectiveness of dry needles. Namely, there is a great need for further research on the development of pain at myofascial trigger points Myofascial pain syndrome is a common form of pain that arises from muscles or is associated with fascia (connective tissue). And is often associated with myofascial trigger points. The latter is highly localized, extremely sensitive points in tangible, taut bundles of skeletal muscle fibers. When the myofascial trigger point is stimulated, two important clinical phenomena can be extracted from it: Reflex pain and local response, which is expressed in the form of twitching.

Why does the trigger point appear?

The muscle is made up of several muscle fibers that are wrapped with sheaths (fascia). One muscle fiber runs from the beginning to the end of the muscle. It is made up of several parts of the same length, called sarcomeres. Sudden, rapid overload, prolonged poor posture, overstretching, or incorrect muscle loading can cause muscle changes. Thus, muscle fiber cannot perform its function. And when problems in muscle fibers persist for a long time, they are also passed on to the muscle fascia.

Epidemiological studies have shown that myofascial trigger points are the primary source of pain in 31 to 86% of patients. At the same time, myofascial trigger points in a recent study by a recognized group of neurologists proved to be the main source of pain in 74 of 96% of participating patients suffering from musculoskeletal pain.

Of the 164 patients referred to the dental clinic for chronic headaches in the head and neck, 55% were those whose active myofascial trigger points were detected and identified as the main cause of pain. The situation was similar in 172 patients who participated in a study workshop in which future internists were practically trained. 30% of participants had active myofascial trigger points, which means that the pain they cause

Nevertheless, there is evidence that myofascial trigger points that cause musculoskeletal pain often remain undiagnosed by both physicians and physiotherapists, often leading to chronic conditions.

Many non-invasive methods are used to relieve chronic myofascial pain. But none of these strategies have been shown to be generally effective.

Stretching.
Massage.
Ischemic compression.
Laser therapy.
Acupressure.
Ultrasound.
Transcutaneous electrical nerve stimulation (TENS).
Biological feedback.
Pharmacological treatments

Do something for yourself and start with the diagnostic hour.

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Dry needling and Myofascial Pain Syndrome

In addition to pressing the trigger point, there is an even more effective way to treat myofascial pain syndrome – dry needling (internal muscle stimulation). We have to insist on pressure for more minutes, it is less precise and consequently less effective. Dry needling, on the other hand, involves the precise, immediate release of a point with minimally invasive intervention, in which an acupuncture needle is inserted directly into the myofascial trigger points.

Although an acupuncture needle is used, the therapy is based on the traditional understanding of Western medicine. Needle puncture sites are located in skeletal muscle. Physiotherapists or doctors learn dry needles quickly, as the basic course lasts from 2 to 4 days.

The aim of this article is to present dry point as a relatively new method of treatment used worldwide as part of a complex treatment of chronic musculoskeletal pain to the general public, including family physicians, rheumatologists, orthopedic surgeons, psychiatrists, psychiatrists, pain specialists, dentists and physiotherapists. .

The effectiveness of dry point in the management of myofascial trigger points has been evaluated in a number of randomized trials and three comprehensive systematic reviews. In their review of 23 randomized trials of dry-needle therapies, Cummings and White wrote that direct needling of myofascial trigger points works as an effective approach.

Nevertheless, the hypothesis that acupuncture therapies are effective beyond placebo has not been confirmed or refuted through various clinical trials. Any effect of these therapies is likely due to the needle or placebo and not e.g. Saline injections.

The most recent systematic review included 7 tests of acupuncture and dry needling to manage myofascial trigger points. The findings of one of the studies show that direct needling of myofascial trigger points is supposed to be effective in eliminating or reducing pain compared to no treatment or consideration. Two studies offered conflicting findings comparing direct needling to myofascial trigger points and needling elsewhere in the muscle.

The other 4 studies, however, failed to demonstrate that direct needling would be more effective than other approaches. Tough and his colleagues reported significant limitations in the original studies.

First:

They cited the fact that, despite the careful identification of myofascial trigger points, most studies do not clearly show whether these were the only cause of the pain.

Second:

The specimens of the test samples were mostly small, which increases the possibility of errors and consequently leads to a high probability that the conclusion of the study is incorrect.

Third:

Needle interventions varied greatly depending on the location of the needle placement. The site of the injection, its depth, the time of treatment and the total number of repetitions required.

Until evidence of possible mechanisms of needle activity is available and different approaches are directly compared with each other, there is no rational basis for selecting the optimal intervention.

Additional research

Cochran’s systematic review of 35 randomized trials evaluated the effectiveness of acupuncture and dry point for relieving lower back pain. He concluded that there is evidence to eliminate pain and functionally improve chronic pain using acupuncture.

He observed these effects after the end of the treatments and at the examinations that followed. Thirty years ago, Gunn published an article outlining the results of a study conducted in collaboration with 56 patients treated at the Worker’s Compensation Board. They were treated with needles, which proved to be very effective.

There is evidence that acupuncture, in combination with other conventional therapies, relieves pain and improves bodily functions better than conventional therapy alone. However, the effects of the treatments are small. Dry needling is a useful adjunct to other therapies for chronic low back pain.

Furlan and his colleagues talked about the low methodological quantities of the original research. We agree with the conclusion of Cummings and Whit that further research is needed. Especially if we want to determine whether the needling of myofascial trigger points has any effect beyond placebo, with special emphasis on appropriate management or needle control.

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About dry needles for myofascial pain syndrome

In the early 1980s, Baldry suggested that needles be inserted superficially into tissue to cover myofascial trigger points. He called this technique “surface dry needle” and used it for myofascial pain syndrome throughout the body with good empirical results, even in treatment in deeper muscles.

Baldry suggested that acupuncture needles be inserted about 5 to 10 mm deep into the tissues that overlap each myofascial trigger point for thirty seconds. Since the needles do not necessarily actually reach these points, no twitching is expected. Nevertheless, patients often experience an immediate decrease in sensitivity after treatment. If any pain persists, the needle is re-inserted for an additional two or three minutes.

Baldry advocates the use of a surface against deep dry needling, as it is easier to perform. Unlike deep, it is not painful (except for the initial sting) and carries with it a minimal level of risk of damage to nerves, blood vessels and other structures, while also having a low rate of inflammation after treatment.

There are two smaller studies that evaluated the effectiveness of surface dry needling.

In the first, Edwards and Knowles conducted a test in which participants were divided into three groups. Members of the first group received superficial dry needling along with active stretching exercises. Members of the second group performed only stretching exercises, while the third group was free of anything.

After 6 weeks, the first group had significantly less pain compared to the third, which did not receive any treatment. At the same time, she also had a slightly higher pain threshold compared to the group that performed only stretching exercises.

However, Macdonald and his colleagues found in their study that superficial dry needles were much more effective in relieving pain than placebo.

Superficial Or deep needles for myofascial pain syndrome

Numerous studies have compared surface needling with deep for myofascial pain syndrome. Naslund and his team compared their effectiveness in a group of 58 individuals suffering from idiopathic anterior knee pain. The researchers found no statistical difference between the two methods. The pain rate decreased significantly in both groups and remained low for three to six months.

Lumbar myofascial pain syndrome

In their study, Ceccherelli and colleagues compared the therapeutic effects of these two methods in a group of 42 participants suffering from lumbar myofascial pain syndrome. They were divided into two smaller groups. The first group had a needle inserted into the skin above the myofascial trigger point up to 2 mm thick. And the second group received intramuscular needle (approx. 1.5 cm) at four arbitrarily selected myofascial trigger points. At the end of therapy, no differences were observed between the groups except that after three months, deep dry needling led to significantly better analgesia than the superficial technique.

Chronic low back pain in the elderly

Another randomized trial compared the effectiveness of these two methods and standard acupuncture in treating chronic low back pain in the elderly. The group that received acupuncture received treatments at traditional acupuncture sites (meridians), where needles were inserted into their muscles to a depth of 20 mm. Members of the second group who received deep dry needling were treated at myofascial trigger points in the lumbar quadriceps muscle, Ilipsoas, Piriformis, and large buttock muscle.

In the last group, whose members received superficial dry-needle treatments, the needles were inserted into the skin above the myofascial trigger points to a depth of about 3 mm. The study lasted 11 weeks and was divided into two treatment parts. Each lasted four weeks, with a three-week break in between.

At the end of the study, the group that received a deep needle puncture at myofascial trigger points reported lower pain intensity and improved quality of life compared to the remaining groups.

The differences were not statistically significant.

In his later discussion, Ceccherelli said muscle afferents are thought to be far more important for transmitting acupuncture pain signals than those found in the skin. He supported this theory by referring to the findings of Chiang and his team, who noted that blocking nerve afferent fibers from the skin did not eliminate acupuncture analgesia, whereas analgesic blockade in deep tissue actually eliminated acupuncture analgesia.

Itoh wrote that myofascial trigger points were actually sites where nociceptors (pain receptors) were sensitized by a number of different factors. It also suggests poly-modal types of receptors (nociceptors) as potential candidates for acupuncture and moxibustion, thanks to their good responsiveness to chemical, thermal and mechanical stimulation. All this can produce an analgesic effect.

As a result, there is a possibility that superficial needles will activate poly-modal receptors in the skin and produce an analgesic effect. Additional and better-designed research is needed to assess the effectiveness of the surface dry-needle method. An acupuncture stimulation of myofascial trigger points in muscles is thought to produce greater activation of sensitized poly-modal receptor types, leading to a greater pain-relieving effect. However, we must not forget that poly-modal receptors are distributed both in the skin and in the fascia and muscles.

Video for dry needling for deltoid muscle to treat myofascial pain syndrome

Side Effects

There are reports of a number of side effects associated with dry needles when used for myofascial pain syndrome.

Swelling after needling.
Bleeding at puncture points.
Syncopated responses.

Some comprehensive records have also been made on the side effects of acupuncture, similar to those of dry needles. A recent observational study involved 229,230 patients and 13,679 German doctors who treated patients with acupuncture treatments.

8.6% of patients reported at least one adverse effect, while approximately 2.2% of them required medical attention. Common effects were bleeding (6.1% of patients), pain (1.7% of patients) and vegetative symptoms (0.7% of patients).

A recent British study of acupuncture, conducted jointly by doctors and physiotherapists, did not report any serious side effects, while the frequency of minor ones was recorded in only 671 of 10,000 acupuncture sessions. Of these, 14 were classified as “severe”.

All severe effects were resolved within one week, except for one case where the pain lasted for about two weeks. Considering these results, we can conclude that dry needles and acupuncture offered by doctors and physiotherapists are a safe form of treatment.

Safety of dry needles for myofascial pain syndrome

Dry needling is a relatively new method of treatment used by doctors and physiotherapists around the world. It is minimally invasive, beneficial and simple, and carries a minimal level of risk. Its effectiveness has been confirmed by numerous studies and two comprehensive systematic reviews.

Dry needling can be used as part of a complex treatment for chronic myofascial pain syndrome. It can be used by family physicians as well as rheumatologists, orthopedic surgeons, psychiatrists, pain specialists, dentists and physiotherapists. The deep method of dry needling has proven to be more effective than superficial. Especially in relieving pain associated with myofascial pain syndrome.

We therefore propose that it become a standard method in such treatments. In areas where there is a possibility of unwanted side effects (such as lungs and large blood vessels), we suggest the use of a surface technique that has also proven to be effective, but to a lesser extent than deep.

Additional research will be needed to evaluate the effectiveness of superficial dry needles. As well as to confirm the results of another study that showed that myofascial trigger points were more effective when co-administered with paraspinal needles. There is also a great need for further research on the etiology of the development of myofascial pain syndrome.

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Dry Needling For Myofascial Pain Syndrome – Fitoont

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