- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04914637
Does Dry Needling Affect Treatment Outcomes of Interlaminar Epidural Steroid Injection in Cervical Disc Herniation?
The Effect of Dry Needling on the Treatment Outcomes of Interlaminar Epidural Steroid Injection in Patients With Chronic Neck Pain Due to Cervical Disc Herniation.
Chronic neck pain is among the most frequently seen chronic painful conditions. As an important cause of disability, chronic neck pain is a musculoskeletal disorder that negatively affects quality of life. Cervical disc herniation is one of the leading causes of chronic neck pain and conservative methods such as exercise and pain medications are used first in the treatment. In patients unresponsive to conservative treatment, epidural steroid injection is successfully and frequently used treatment option. Epidural steroid injection in the cervical region can be applied with two approaches: interlaminar or transforaminal.
Myofascial trigger point characterized by intramuscular taut band and hypersensitive spots is a condition in which central and peripheral sensitization play a role in the pathophysiology. There are underlying myofascial trigger points in many etiologies that cause chronic neck pain. Trigger points can increase the severity of pain and in some cases they can be the main factor in the etiology of pain. Therefore, the presence of myofascial trigger points should be investigated, even if another cause is detected in chronic neck pain. Dry needling is an easily applicable and effective treatment option in myofascial trigger point.
Although it is well known that myofascial trigger points frequently accompany cervical disc herniation, their effect on treatment outcomes has not been investigated. In this study, we aimed to investigate the effect of dry needling for trigger points on the treatment results of interlaminar epidural steroid injection in patients diagnosed with cervical disc herniation.
Study Overview
Status
Conditions
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Istanbul, Turkey
- Marmara University Pendik Education and Research Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Between the ages of 18-65
- Chronic neck pain due to cervical disc herniation for at least 3 months and being unresponsive to conservative treatment
- Presence of at least one active myofascial trigger point on physical examination of cervical paraspinal muscles, scapulothoracic muscles and extremity muscles.
Exclusion Criteria:
- Previous surgical/interventional procedure for the cervical region
- Previous application of dry needling/acupuncture to any part of the body
- Presence of other musculoskeletal disorders (such as lateral epicondylitis, tendinitis, entrapment neuropathy) that may cause diagnostic confusion in terms of pain pattern and localization
- Signs of trauma, fracture, malignancy, or active infection
- Rheumatological (RA, AS, etc.), endocrinological (such as osteoporosis, Paget's disease) or another systemic disease that may change the anatomical or physiological structure of the relevant regions
- Presence of coagulopathy
- History of whiplash injury, cervical spinal stenosis, cervical spondylosis
- Have a diagnosis of fibromyalgia
- Being pregnant and breastfeeding
- Presence of mental deterioration or psychiatric/neurological disease that can affect flow of the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: interlaminar epidural steroid injection plus dry needling
Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered to patients with chronic neck pain due to cervical disc herniation. Also, dry needling will be applied to the active trigger points for the patients in this group. Interlaminar epidural steroid injection will be applied at week 0, while dry needling will be applied in 3 sessions per week (week 0, week 1, week 2). The first session of the dry needling will be in the same day with interlaminar epidural steroid injection. |
Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered to patients with chronic neck pain due to cervical disc herniation.
The injection area is cleaned 3 times with an antiseptic solution and covered with a sterile cloth.
Local anesthesia with 2 cc 3% prilocaine will be applied to the skin and subcutaneous tissues in the area of interest.
Under fluoroscopy guidance, the needle is advanced into the C7-T1 intervertebral disc level.
With the help of the loss of resistance technique, it is understood that the needle is in the epidural space, and second control is provided by administering contrast material.
After the confirmation of needle place is done, a mixture of 12 mg dexamethasone, 1 cc 2% lidocaine, 1 cc saline is injected.
The patient is taken to the rest room after the procedure and followed up for any complications.
Dry needling will be applied to the active trigger points for the patients in this group.
After cleaning the area of interest with an antiseptic solution, dry needling will be applied with the fast-in/fast-out technique for the active trigger point.
During needle maneuvers, local contractions (local twitch response-LTR) are obtained and rapid needle movements are continued until the contractions end.
Afterwards, the needle is removed and compression is applied to ensure hemostasis in the relevant area.
|
Sham Comparator: interlaminar epidural steroid injection plus sham dry needling
Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered same as the arm titled "interlaminar epidural steroid injection plus dry needling". The only difference in the interventions in this arm is that dry needling is applied without penetrating the skin. The blunt tip of the needle will be used in sham intervention. Interlaminar epidural steroid injection will be applied at week 0, while sham dry needling will be applied in 3 sessions per week (week 0, week 1, week 2) |
Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered to patients with chronic neck pain due to cervical disc herniation.
The injection area is cleaned 3 times with an antiseptic solution and covered with a sterile cloth.
Local anesthesia with 2 cc 3% prilocaine will be applied to the skin and subcutaneous tissues in the area of interest.
Under fluoroscopy guidance, the needle is advanced into the C7-T1 intervertebral disc level.
With the help of the loss of resistance technique, it is understood that the needle is in the epidural space, and second control is provided by administering contrast material.
After the confirmation of needle place is done, a mixture of 12 mg dexamethasone, 1 cc 2% lidocaine, 1 cc saline is injected.
The patient is taken to the rest room after the procedure and followed up for any complications.
Although the method of intervention is like dry needling, the only difference is that the blunt end of the needle is used and it does not penetrate the skin.
|
Other: interlaminar epidural steroid injection only
Only interlaminar epidural steroid injection will be administered to patients in this arm with the same method as in the other arms (one session, week 0).
No dry needling or sham dry needling will be used.
|
Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered to patients with chronic neck pain due to cervical disc herniation.
The injection area is cleaned 3 times with an antiseptic solution and covered with a sterile cloth.
Local anesthesia with 2 cc 3% prilocaine will be applied to the skin and subcutaneous tissues in the area of interest.
Under fluoroscopy guidance, the needle is advanced into the C7-T1 intervertebral disc level.
With the help of the loss of resistance technique, it is understood that the needle is in the epidural space, and second control is provided by administering contrast material.
After the confirmation of needle place is done, a mixture of 12 mg dexamethasone, 1 cc 2% lidocaine, 1 cc saline is injected.
The patient is taken to the rest room after the procedure and followed up for any complications.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of pain severity from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 1st hour, 3rd week, 3rd month
|
Pain severity will be assessed with Numeric Rating Scale (NRS).
The patient scores his/her pain between 0-10.
Higher score indicates more severe pain
|
from pre-interventional time to post-interventional 1st hour, 3rd week, 3rd month
|
Change of the number of active trigger points from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
The number of active trigger points will be determined by clinical examination.
The trigger point will be defined as "active" if it causes spontaneous pain or pain occured during the examination is familiar to the patient.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of depression severity from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
Severity of depression will be assessed with Beck Depression Inventory (BDI).
BDI scoring ranges from 0 to 63, with a high score indicating an increased severity of depression.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Change of the number of the patients with neuropathic pain from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
The number of patients with neuropathic pain will be assessed with Douleur Neuropathique 4 Questions (DN4).
Scores ≥ 4/10 indicate presence of neuropathic pain.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Change of the number of the patients with central sensitization from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
The number of patients with central sensitization will be assessed with The number of patients with neuropathic pain will be assessed with Central Sensitisation Inventory (CSI).
The CSI is composed of two parts: Part A and part B. Only Part A is scored and a score of more than 40 indicates the presence of central sensitisation.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Change of the measurement of quality of life from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
The measurement of quality of life will be assessed with Short Form-12 Survey (SF-12).
Two summary scores are reported from the SF-12 - a mental component score (MCS-12) and a physical component score (PCS-12).
A high score indicates better quality of life.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Change of the measurement of disability related with chronic neck pain from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
The measurement of disability will be assessed with Neck Disability Index (NDI).
The NDI can be scored as a raw score (0-50) or doubled and expressed as a percent (0%-100%).
A higher score indicates more activity limitation.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Change of the measurement of sleep quality from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
The measurement of sleep quality will be assessed with Pittsburgh Sleep Quality Index (PSQI).
7 components are evaluated and each component is scored between 0-3; the total score is between 0-21.
Higher total score indicates poor sleep quality.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Change of the pain sensitivity of active trigger points from baseline to each checkpoints
Time Frame: from pre-interventional time to post-interventional 3rd week, 3rd month
|
The measurement of pain sensitivity will be done by using manual algometer.
Measurement will be made from active trigger points and the average of 3 measurements will be taken.
The higher score indicates more resistance to pain.
|
from pre-interventional time to post-interventional 3rd week, 3rd month
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Osman Hakan Gunduz, MD, Marmara University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 09.2020.692
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Pain, Chronic
-
Pain ConcernThe Thistle Foundation; Health and Social Care Alliance Scotland (the ALLIANCE) and other collaboratorsCompletedChronic Pain | Chronic Pain Syndrome | Chronic Pain, Widespread | Chronic Pain Due to Trauma | Chronic Pain Due to Malignancy (Finding) | Chronic Pain Due to Injury | Chronic Pain Post-Procedural | Chronic Pain HipUnited Kingdom
-
Consorci Sanitari de l'Alt Penedès i GarrafRecruitingChronic Post Operative Pain | Chronic Post-surgical Pain | Chronic Knee PainSpain
-
Dow University of Health SciencesRecruitingLow Back Pain | Chronic Low-back Pain | Low Back Pain, Mechanical | Mechanical Low Back Pain | Pain, Chronic | Pain, Back | Lower Back Pain Chronic | CLBP - Chronic Low Back PainPakistan
-
University of Alabama, TuscaloosaPatient-Centered Outcomes Research Institute; East Carolina University; Whatley...CompletedPain | Chronic Pain | Chronic Pain Syndrome | Widespread Chronic Pain | Chronic Pain Due to InjuryUnited States
-
University of UtahRecruitingChronic Pain | Chronic Pain Syndrome | Widespread Chronic PainUnited States
-
Evolve Restorative CenterFlowonix Medical; Celéri Health, Inc.; Advanced Infusion SolutionsCompletedPain, Chronic | Pain, Intractable | Chronic Nonmalignant PainUnited States
-
Assiut UniversityNot yet recruiting
-
Atatürk Chest Diseases and Chest Surgery Training...RecruitingPostoperative Pain | Thoracotomy | Postoperative Pain, Acute | Postoperative Pain, ChronicTurkey
-
Istanbul UniversityCompletedLow Back Pain, Mechanical, Biofeedback, Pain, Chronic
-
Vastra Gotaland RegionActive, not recruitingPain, Chronic | Widespread Chronic PainSweden
Clinical Trials on Cervical interlaminar epidural steroid injection
-
Marmara UniversityRecruiting
-
Diskapi Teaching and Research HospitalCompletedCervical RadiculopathyTurkey
-
Seoul National University Bundang HospitalUnknownNeck Pain | Head Pain | Upper Extremity PainKorea, Republic of
-
Kyungpook National University HospitalUnknownAnalgesia, EpiduralKorea, Republic of
-
Yakov Perper, MDCompletedNeck Pain | Cervical Radiculopathy | Disc Prolapse With RadiculopathyUnited States
-
Emory UniversityWithdrawn
-
Diskapi Teaching and Research HospitalCompletedNeck Pain | Cervical RadiculopathyTurkey
-
Centre Hospitalier Universitaire Saint PierreUnknown
-
Istanbul Medeniyet UniversityMarmara UniversityRecruitingLumbosacral RadiculopathyTurkey
-
Keimyung University Dongsan Medical CenterCompletedAnalysis, Event History