Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm

César Fernández-de-Las-Peñas, Jo Nijs, César Fernández-de-Las-Peñas, Jo Nijs

Abstract

Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not. The application of trigger point dry needling is able to reduce the excitability of the central nervous system by reducing peripheral nociception associated to the trigger point, by reducing dorsal horn neuron activity, and by modulating pain-related brainstem areas. However, the effects are mainly observed in the short-term, and effect sizes are moderateto small. Therefore, the current review proposes that the application of trigger point dry needling should be integrated into current pain neuroscience paradigm by combining its application with pain neuroscience education, graded exercise and manual therapy. Additionally, patient's expectations, beliefs, previous experiences and patient-clinician interaction should be considered when integrating trigger point dry needling into a comprehensive treatment approach.

Keywords: chronic pain; dry needling; sensitization; trigger point.

Conflict of interest statement

Dr Jo Nijs has co-authored a book for clinicians on pain neuroscience education, but the royalties for the book were collected by the Vrijie Universiteit Brussel and not him personally. Dr. Fernandez-de-las-Penas is an instructor in Trigger Point Therapy and also receive royalties from published books. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Proposed model explaining potential variables influencing neurophysiological mechanisms of trigger point dry needling.

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Source: PubMed

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