Comparative Analysis of Dry Needling Techniques for Orofacial Myofascial Pain

Comparative Analysis of the Effectiveness and Comfort of Different Dry Needling Techniques in the Treatment of Orofacial Myofascial Pain: A Randomized Clinical Trial

This study aims to compare the clinical effectiveness and individual comfort of three distinct dry needling techniques (dynamic, static, and hybrid) for managing orofacial myofascial pain. Myofascial pain is a highly prevalent manifestation of temporomandibular disorders (TMD), characterized by painful trigger points in the masticatory muscles, such as the masseter and temporalis, which cause pain, muscle tenderness, and jaw movement limitations. While dry needling is widely recognized as an effective minimally invasive therapy to deactivate these trigger points, there is still a lack of consensus in scientific literature regarding the standardization of application protocols.

To address this gap, this randomized, triple-blind, parallel-group clinical trial will enroll 45 individuals diagnosed with myofascial pain according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Participants will be randomly allocated into three equal groups (15 individuals per group): Group 1 will receive dynamic dry needling (fanning technique); Group 2 will receive static dry needling (needle kept in situ for 10 minutes); and Group 3 will receive a hybrid approach (combining an initial static period followed by dynamic manipulation).

The primary outcome will evaluate changes in self-reported pain intensity using a Visual Analog Scale (VAS) from baseline to 7 days post-intervention. Secondary outcomes will assess changes in pressure pain thresholds (PPT) via digital algometry, mandibular range of motion via digital caliper measurements, and the subjective perception of comfort and acceptability of each technique. Evaluations will be conducted at baseline, immediately post-intervention, at 7 days, and at 15 days of follow-up. The findings are expected to contribute to the standardization of more effective and comfortable clinical protocols for managing orofacial pain.

Study Overview

• Status: Not yet recruiting
• Conditions: Myofascial Pain Syndromes; Facial Pain; Trigger Points
• Intervention / Treatment: Procedure: Dry needling

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Flávio Magno Gonçalves, Professor; Phone Number: 55 (42) 98816-7711; Email: flaviomagno93@yahoo.com.br

Study Locations

• Brazil
  • Paraná
    • Curitiba, Paraná, Brazil, 80430140
      • Center for Diagnosis and Treatment of the Temporomandibular Joint, Universidade Tuiuti do Paraná (CDATM-UTP)
      • Contact: Flávio Magno Gonçalves, Professor; Phone Number: 55 42 98816-7711; Email: flaviomagno93@yahoo.com.br

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• 1. Clinical diagnosis of Myofascial Pain (with or without referred pain) in the masseter and/or temporalis muscles according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I; 2. Presence of at least one active trigger point in a taut band reproducing the chief complaint; 3. Baseline pain intensity ≥ 2 on the VAS in the last two weeks; 4. Confirmed pressure pain threshold (PPT ≤ 1.5 kg/cm²); 5. Signed informed consent form.

Exclusion Criteria:

• 1. TMD treatment in the last 3 months (physical therapy, needling, laser therapy) or Botulinum Toxin injection in the orofacial region within 12 months; 2. Continuous systemic use of analgesics, anti-inflammatories, or muscle relaxants; 3. Diagnosis of fibromyalgia, systemic rheumatic diseases, neurological disorders, or neuropathic pain; 4. Needle phobia (belonephobia), coagulation disorders, or use of anticoagulant drugs; 5. Active skin or odontogenic infections in the application area; 6. History of recent facial trauma or orthognathic/joint surgery; 7. Pregnancy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Dynamic Dry Needling; Individuals will receive fast-in and fast-out needle manipulation (Hong's technique) in a fanning shape inside the trigger point of the masseter and/or temporalis muscles. The procedure continues until local twitch responses cease or the individual's tolerance limit is reached.	Procedure: Dry needling; Dry needling therapy targeted at active myofascial trigger points in masseter and temporalis muscles. Sterile, disposable, stainless steel needles (0.25x25mm or 0.25x30mm) will be used based on muscle depth. Procedures will be performed by a single operator with the individual in a supine position, following strict 70% alcohol antisepsis. Mechanical manipulation follows three randomized protocols: Dynamic: Fast-in and fast-out needle manipulation (Hong's technique) in a fanning shape until local twitch responses cease or tolerance limit is reached.; Static: Direct insertion into the trigger point, remaining completely static in situ for 10 minutes without further stimulation.; Hybrid: Direct needle insertion kept static for 5 minutes for initial desensitization, followed by a brief period of dynamic fanning manipulation.
Active Comparator: Static Dry Needling; The needle will be inserted directly into the core of the active trigger point in the masseter and/or temporalis muscles and will remain completely static in situ for 10 minutes, focusing on neurophysiological modulation without further mechanical stimulation.	Procedure: Dry needling; Dry needling therapy targeted at active myofascial trigger points in masseter and temporalis muscles. Sterile, disposable, stainless steel needles (0.25x25mm or 0.25x30mm) will be used based on muscle depth. Procedures will be performed by a single operator with the individual in a supine position, following strict 70% alcohol antisepsis. Mechanical manipulation follows three randomized protocols: Dynamic: Fast-in and fast-out needle manipulation (Hong's technique) in a fanning shape until local twitch responses cease or tolerance limit is reached.; Static: Direct insertion into the trigger point, remaining completely static in situ for 10 minutes without further stimulation.; Hybrid: Direct needle insertion kept static for 5 minutes for initial desensitization, followed by a brief period of dynamic fanning manipulation.
Active Comparator: Hybrid Dry Needling; A combination protocol where the needle is inserted into the trigger point and kept static for 5 minutes for initial desensitization, followed by a brief period of dynamic fanning manipulation (fast-in and fast-out).	Procedure: Dry needling; Dry needling therapy targeted at active myofascial trigger points in masseter and temporalis muscles. Sterile, disposable, stainless steel needles (0.25x25mm or 0.25x30mm) will be used based on muscle depth. Procedures will be performed by a single operator with the individual in a supine position, following strict 70% alcohol antisepsis. Mechanical manipulation follows three randomized protocols: Dynamic: Fast-in and fast-out needle manipulation (Hong's technique) in a fanning shape until local twitch responses cease or tolerance limit is reached.; Static: Direct insertion into the trigger point, remaining completely static in situ for 10 minutes without further stimulation.; Hybrid: Direct needle insertion kept static for 5 minutes for initial desensitization, followed by a brief period of dynamic fanning manipulation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Self-Reported Orofacial Pain Intensity	Evaluated using a 100 mm Visual Analog Scale (VAS), where 0 mm indicates "no pain" and 100 mm indicates the "worst imaginable pain". The individual marks their current pain perception on the scale. The score is determined by measuring the distance from the left anchor to the individual's mark.	Baseline (T0) and 7 days post-intervention (T2). (This is the primary endpoint to identify mid-term clinical relevance).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Pressure Pain Threshold (PPT)	Measured using a calibrated digital pressure algometer equipped with a 1 cm² rubber tip applied perpendicularly over the active trigger point. Pressure increases constantly at a rate of 1.5 kg/cm²/second until the individual reports that the pressure sensation turns into pain. Higher values (in kg/cm²) indicate lower mechanical pain sensitivity.	Baseline (T0), 7 days post-intervention (T2), and 15 days post-intervention (T3).
Change from Baseline in Mandibular Range of Motion	Functional assessment measuring maximum functional mouth opening, maximum assisted mouth opening, protrusion, and lateralities (all in millimeters) using a high-precision digital caliper.	Baseline (T0), 7 days post-intervention (T2), and 15 days post-intervention (T3).

Collaborators and Investigators

• Sponsor: Flávio Magno Gonçalves

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): April 1, 2027

Study Registration Dates

• First Submitted: July 9, 2026
• First Submitted That Met QC Criteria: July 9, 2026
• First Posted (Actual): July 15, 2026

Study Record Updates

• Last Update Posted (Actual): July 15, 2026
• Last Update Submitted That Met QC Criteria: July 9, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: dry needling; orofacial pain; myofascial pain syndromes
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Muscular Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Myofascial Pain Syndromes; Facial Pain; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Dry Needling
• Other Study ID Numbers: NEC 02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: I will analyze any request and will decide later

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No