Effectiveness of dry needling versus a classical physiotherapy program in patients with chronic low-back pain: a single-blind, randomized, controlled trial

Emİne Handan Tüzün, Sıla Gıldır, Ender Angın, Büşra Hande Tecer, Kezban Öztürk Dana, Mehtap Malkoç, Emİne Handan Tüzün, Sıla Gıldır, Ender Angın, Büşra Hande Tecer, Kezban Öztürk Dana, Mehtap Malkoç

Abstract

[Purpose] We compared the effectiveness of dry needling with a classical physiotherapy program in patients with chronic low-back pain caused by lumbar disc hernia (LHNP). [Subjects and Methods] In total, 34 subjects were allocated randomly to the study (n=18) and control groups (n=16). In the study group, dry needling was applied using acupuncture needles. The control group performed a home exercise program in addition to hot pack, TENS, and ultrasound applications. Pain was assessed with the short form of the McGill Pain Questionnaire. The number of trigger points and their pressure sensitivity were evaluated with a physical examination (palpation). The Beck Depression Inventory was used to assess depression. The Tampa Kinesiophobia Scale was used to assess fear of movement. [Results] In the study group, the calculated Cohen's effect sizes were bigger than those in the control group in terms of pain, trigger point-related variables, and fear of movement. Effect sizes for reducing depressive symptoms were similar in both groups. [Conclusion] These results suggest that dry needling can be an effective treatment for reducing pain, number of trigger points, sensitivity, and kinesiophobia in patients with chronic low-back pain caused by lumbar disc hernia.

Keywords: Dry needling; Low-back pain; Physiotherapy.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the study

References

    1. Sinaki M, Mokri B: Low back pain and disorders of the lumbar spine. In: Braddom R. Physical Medicine and Rehabilitation. Philadelphia: WB Saunders Company Publishing, 2000, pp 853–893.
    1. Press JM, Herring SA: Low back pain, health care problems and physiatrits’ role in future. In: Lox DM (ed.), Physical Medicine and Rehabilitation: State of the Art Reviews, 1999, 13: 389–94.
    1. Andersson GB: Epidemiological features of chronic low-back pain. Lancet, 1999, 354: 581–585.
    1. Melzack R: From the gate to the neuromatrix. Pain, 1999, 6: S121–S126.
    1. Melzack R: Recent concepts of pain. J Med, 1982, 13: 147–160.
    1. Holmgren A, Wise MG, Bouckoms AJ: Pain management. In: Wise MG, Rundell RJ (eds.), Textbook of Consultation-Liaison Psychiatry. Washington DC: American Psychiatric Publishing, 2002, pp 989–1013.
    1. Klaber Moffett JA, Carr J, Howarth E: High fear-avoiders of physical activity benefit from an exercise program for patients with back pain. Spine (Philapa 1976), 2004, 29: 1167–1172.
    1. Simons DG, Travell J, Simons LS: Myofascial pain and dysfunction: the trigger point manual, 2nd ed. Vol. 1. Baltimore: Williams & Wilkins, 1999.
    1. Shah JP, Gilliams EA: Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther, 2008, 12: 371–384.
    1. Gunn CC: The Gunn approach to the treatment of chronic pain: intramuscular stimulation for myofascial pain of radiculopathic origin. New York: Churchill Livingston, 1996, pp 11–37.
    1. Dommerholt J: Dry needling—peripheral and central considerations. J Manual Manip Ther, 2011, 19: 223–227.
    1. Furlan AD, van Tulder M, Cherkin D, et al. : Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine, 2005, 30: 944–963.
    1. Tough EA, White AR, Cummings TM, et al. : Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain, 2009, 13: 3–10.
    1. Saghaei M: Random allocation software for parallel group randomized trials. BMC Med Res Methodol, 2004, 4: 26.
    1. Melzack R: The short form McGill pain questionnaire. Pain, 1987, 30: 191–197.
    1. Yakut Y, Yakut E, Bayar K, et al. : Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis. Clin Rheumatol, 2007, 26: 1083–1087.
    1. Gerwin RD, Shannon S, Hong CZ, et al. : Interrater reliability in myofascial trigger point examination. Pain, 1997, 69: 65–73.
    1. Vázquez-Delgado E, Cascos-Romero J, Gay-Escoda C: Myofascial pain syndrome associated with trigger points: a literature review. (I): Epidemiology, clinical treatment and etiopathogeny. Med Oral Patol Oral Cir Bucal, 2009, 14: e494–e498.
    1. Gam AN, Warming S, Larsen LH, et al. : Treatment of myofascial trigger-points with ultrasound combined with massage and exercise—a randomised controlled trial. Pain, 1998, 77: 73–79.
    1. Beck AT, Ward CH, Mendelson M, et al. : An inventory for measuring depression. Arch Gen Psychiatry, 1961, 4: 561–571.
    1. Hisli N: Beck Depresyon Envanterinin geçerliliği üzerine bir çalışma. Psikol Derg, 1988, 6: 118–122.
    1. Miller R, Kori S, Todd D: The Tampa scale: a measure of kinesiophobia. Clin J Pain, 1991, 7: 51–52.
    1. Tunca Yılmaz Ö, Yakut Y, Uygur F, et al. : Tampa kinezyofobi ölçeği’nin türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoter Rehabil, 2011, 22: 44–49.
    1. Téllez-García M, de-la-Llave-Rincón AI, Salom-Moreno J, et al. : Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: a preliminary clinical trial. J Bodyw Mov Ther, 2015, 19: 464–472.
    1. Hou CR, Tsai LC, Cheng KF, et al. : Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil, 2002, 83: 1406–1414.
    1. Cohen J: Statistical power analysis for the behavioral sciences, 2nd ed. Hillsdale New Jersey: Lawrence Earlbaum Associates.
    1. Brosseau L, Wells GA, Poitras S, et al. : Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain. J Bodyw Mov Ther, 2012, 16: 424–455.
    1. Haladay DE, Miller SJ, Challis J, et al. : Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain. J Orthop Sports Phys Ther, 2013, 43: 242–250.
    1. Rubinstein SM, van Middelkoop M, Assendelft WJ, et al. : Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine, 2011, 36: E825–E846.
    1. French SD, Cameron M, Walker BF, et al. : A Cochrane review of superficial heat or cold for low back pain. Spine, 2006, 31: 998–1006.
    1. Grabois M: Management of chronic low back pain. Am J Phys Med Rehabil, 2005, 84: S29–S41.
    1. van Tulder M, Koes B: Low back pain (chronic). Clin Evid, 2006, 15: 1634–1653.
    1. Pillastrini P, Gardenghi I, Bonetti F, et al. : An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine, 2012, 79: 176–185.
    1. Dagenais S, Tricco AC, Haldeman S: Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J, 2010, 10: 514–529.
    1. Cornwall J, John Harris A, Mercer SR: The lumbar multifidus muscle and patterns of pain. Man Ther, 2006, 11: 40–45.
    1. Chen CK, Nizar AJ: Myofascial pain syndrome in chronic back pain patients. Korean J Pain, 2011, 24: 100–104.
    1. Simons DG, Travell J, Simons LS: Myofascial pain and dysfunction in: the trigger point Manual, 2nd ed. Vol. 2. Baltimore: Williams & Wilkins, 1999.
    1. Jaeger B, Skootsky SA: Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain, 1987, 29: 263–266.
    1. Kalichman L, Vulfsons S: Dry needling in the management of musculoskeletal pain. J Am Board Fam Med, 2010, 23: 640–646.
    1. Garvey TA, Marks MR, Wiesel SW: A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Spine, 1989, 14: 962–964.
    1. Itoh K, Katsumi Y, Hirota S, et al. : Effects of trigger point acupuncture on chronic low back pain in elderly patients—a sham-controlled randomised trial. Acupunct Med, 2006, 24: 5–12.
    1. Fargas-Babjak A: Acupuncture, transcutaneous electrical nerve stimulation, and laser therapy in chronic pain. Clin J Pain, 2001, 17: S105–S113.
    1. Lamé IE, Peters ML, Vlaeyen JW, et al. : Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. Eur J Pain, 2005, 9: 15–24.
    1. Boersma K, Linton SJ: Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability. Clin J Pain, 2006, 22: 160–166.
    1. Ay S, Evcik D, Tur BS: Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol, 2010, 29: 19–23.
    1. Altındağ Ö, Gür A: Miyofasiyal ağrı sendromunda kuru iğneleme ve lokal anestezik enjeksiyonun etkinliği. Harran Univ Tip Fak Derg, 2006, 3: 84–88.
    1. Manoj A, Gaurav M: Role of kinesiophobia in low back pain. IOSR, 2014, 3: 44–46.

Source: PubMed

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