Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study

Irene Campa-Moran, Etelvina Rey-Gudin, Josué Fernández-Carnero, Alba Paris-Alemany, Alfonso Gil-Martinez, Sergio Lerma Lara, Almudena Prieto-Baquero, José Luis Alonso-Perez, Roy La Touche, Irene Campa-Moran, Etelvina Rey-Gudin, Josué Fernández-Carnero, Alba Paris-Alemany, Alfonso Gil-Martinez, Sergio Lerma Lara, Almudena Prieto-Baquero, José Luis Alonso-Perez, Roy La Touche

Abstract

Objective. The aim of this study was to compare the efficacy of three interventions for the treatment of myofascial chronic neck pain. Methods. Thirty-six patients were randomly assigned to one of three intervention groups: orthopedic manual therapy (OMT), dry needling and stretching (DN-S), and soft tissue techniques (STT). All groups received two treatment sessions with a 48 h time interval. Outcome measures included neck pain intensity measured using a visual analogue scale, cervical range of motion (ROM), pressure pain threshold for measuring mechanical hyperalgesia, and two self-reported questionnaires (neck disability index and pain catastrophizing scale). Results. The ANOVA revealed significant differences for the group × time interaction for neck disability, neck pain intensity, and pain catastrophizing. The DN-S and OMT groups reduced neck disability. Only the OMT group showed decreases in mechanical hyperalgesia and pain catastrophizing. The cervical ROM increased in OMT (i.e., flexion, side-bending, and rotation) and DN-S (i.e., side-bending and rotation) groups. Conclusions. The three interventions are all effective in reducing pain intensity. Reduction in mechanical hyperalgesia and pain catastrophizing was only observed in the OMT group. Cervical ROM improved in the DN-S and OMT groups and also neck disability being only clinically relevant for OMT group.

Figures

Figure 1
Figure 1
Flow fiagram.

References

    1. Borghouts J. A. J., Koes B. W., Vondeling H., Bouter L. M. Cost-of-illness of neck pain in The Netherlands in 1996. Pain. 1999;80(3):629–636. doi: 10.1016/s0304-3959(98)00268-1.
    1. Fernández-de-las-Peñas C., Hernández-Barrera V., Alonso-Blanco C., et al. Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine. 2011;36(3):E213–E219. doi: 10.1097/brs.0b013e3181d952c2.
    1. Simons D. G., Travell J. S. L. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1. Baltimore, Md, USA: Lippincott Williams & Wilkins; 1999.
    1. Muñoz-Muñoz S., Muñoz-García M. T., Alburquerque-Sendín F., Arroyo-Morales M., Fernández-De-Las-Peñas C. Myofascial trigger points, pain, disability, and sleep quality in individuals with mechanical neck pain. Journal of Manipulative and Physiological Therapeutics. 2012;35(8):608–613. doi: 10.1016/j.jmpt.2012.09.003.
    1. Fernández-de-las-Peñas C., Alonso-Blanco C., Miangolarra J. C. Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study. Manual Therapy. 2007;12(1):29–33. doi: 10.1016/j.math.2006.02.002.
    1. Sciotti V. M., Mittak V. L., DiMarco L., et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001;93(3):259–266. doi: 10.1016/s0304-3959(01)00325-6.
    1. Meleger A. L., Krivickas L. S. Neck and back pain: musculoskeletal disorders. Neurologic Clinics. 2007;25(2):419–438. doi: 10.1016/j.ncl.2007.01.006.
    1. Fischer A. A. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30(1):115–126. doi: 10.1016/0304-3959(87)90089-3.
    1. Falla D. L., Jull G. A., Hodges P. W. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004;29(19):2108–2114. doi: 10.1097/01.brs.0000141170.89317.0e.
    1. Falla D., Jull G., Hodges P. W. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental Brain Research. 2004;157(1):43–48. doi: 10.1007/s00221-003-1814-9.
    1. Zakharova-Luneva E., Jull G., Johnston V., O'Leary S. Altered trapezius muscle behavior in individuals with neck pain and clinical signs of scapular dysfunction. Journal of Manipulative and Physiological Therapeutics. 2012;35(5):346–353. doi: 10.1016/j.jmpt.2012.04.011.
    1. Cooper G., Bailey B., Bogduk N. Cervical zygapophysial joint pain maps. Pain Medicine. 2007;8(4):344–353. doi: 10.1111/j.1526-4637.2006.00201.x.
    1. Vos C. J., Verhagen A. P., Passchier J., Koes B. W. Management of acute neck pain in general practice: a prospective study. British Journal of General Practice. 2007;57(534):23–28.
    1. Gross A., Miller J., D'Sylva J., et al. Manipulation or mobilisation for neck pain: a cochrane review. Manual Therapy. 2010;15(4):315–333. doi: 10.1016/j.math.2010.04.002.
    1. Cassidy J. D., Lopes A. A., Yong-Hing K. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 1992;15(9):570–575.
    1. Martínez-Segura R., Fernández-de-las-Peñas C., Ruiz-Sáez M., López-Jiménez C., Rodríguez-Blanco C. Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2006;29(7):511–517. doi: 10.1016/j.jmpt.2006.06.022.
    1. Schmid A., Brunner F., Wright A., Bachmann L. M. Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation. Manual Therapy. 2008;13(5):387–396. doi: 10.1016/j.math.2007.12.007.
    1. Sterling M., Jull G., Wright A. Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Manual Therapy. 2001;6(2):72–81. doi: 10.1054/math.2000.0378.
    1. Montañez-Aguilera F. J., Valtueña-Gimeno N., Pecos-Martín D., Arnau-Masanet R., Barrios-Pitarque C., Bosch-Morell F. Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy. Journal of Back and Musculoskeletal Rehabilitation. 2010;23(2):101–104. doi: 10.3233/bmr-2010-0255.
    1. Aguilera F. J. M., Martín D. P., Masanet R. A., Botella A. C., Soler L. B., Morell F. B. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlle. Journal of Manipulative and Physiological Therapeutics. 2009;32(7):515–520. doi: 10.1016/j.jmpt.2009.08.001.
    1. Ay S., Evcik D., Tur B. S. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clinical Rheumatology. 2010;29(1):19–23. doi: 10.1007/s10067-009-1307-8.
    1. Kamanli A., Kaya A., Ardicoglu O., Ozgocmen S., Zengin F. O., Bayik Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatology International. 2005;25(8):604–611. doi: 10.1007/s00296-004-0485-6.
    1. Peloso P., Gross A., Haines T., Trinh K., Goldsmith C. H., Burnie S. Medicinal and injection therapies for mechanical neck disorders. Cochrane Database of Systematic Reviews. 2007;(3) doi: 10.1002/14651858.CD000319.pub4.CD000319
    1. Venâncio Rde A., Alencar F. G. PJ., Zamperini C. Different substances and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2008;26(2):96–103.
    1. Cummings T. M., White A. R. Needling therapies in the management of myofascial trigger point pain: a systematic review. Archives of Physical Medicine and Rehabilitation. 2001;82:986–992. doi: 10.1053/apmr.2001.24023.
    1. Jull G., Moore A. Systematic reviews assessing multimodal treatments. Manual Therapy. 2010;15(4):303–304. doi: 10.1016/j.math.2010.05.001.
    1. Andrade Ortega J. A., Delgado Martínez A. D., Almécija Ruiz R. Validation of the Spanish version of the neck disability index. Spine. 2010;35(4):E114–E118. doi: 10.1097/brs.0b013e3181afea5d.
    1. Vernon H., Mior S. The neck disability index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics. 1991;14(7):409–415.
    1. Simons D., Travell J., Simons L. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd. Vol. 1. Baltimore, Md, USA: Lippincott Williams & Wilkins; 1999.
    1. Sullivan M. J. L., Bishop S. R., Pivik J. The pain catastrophizing scale: development and validation. Psychological Assessment. 1995;7(4):524–532. doi: 10.1037/1040-3590.7.4.524.
    1. García Campayo J., Rodero B., Alda M., Sobradiel N., Montero J., Moreno S. Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia. Medicina Clinica. 2008;131(13):487–492. doi: 10.1157/13127277.
    1. MacDermid J. C., Walton D. M., Avery S., et al. Measurement properties of the neck disability index: a systematic review. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(5):400–417. doi: 10.2519/jospt.2009.2930.
    1. Bijur P. E., Silver W., Gallagher E. J. Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine. 2001;8(12):1153–1157. doi: 10.1111/j.1553-2712.2001.tb01132.x.
    1. Svensson P., Arendt-Nielsen L., Nielsen H., Larsen J. K. Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. Journal of Orofacial Pain. 1995;9(4):347–356.
    1. Audette I., Dumas J.-P., Côté J. N., De Serres S. J. Validity and between-day reliability of the cervical range of motion (CROM) device. Journal of Orthopaedic and Sports Physical Therapy. 2010;40(5):318–323. doi: 10.2519/jospt.2010.3180.
    1. Simons D. G. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Journal of Electromyography and Kinesiology. 2004;14(1):95–107. doi: 10.1016/j.jelekin.2003.09.018.
    1. La Touche R., París-Alemany A., Mannheimer J. S., et al. Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain?: a randomized-controlled trial. The Clinical Journal of Pain. 2013;29(3):205–215. doi: 10.1097/ajp.0b013e318250f3cd.
    1. Coppieters M. W., Stappaerts K. H., Wouters L. L., Janssens K. The immediate effects of a cervical lateral glide treatment technique in patients with neurogenic cervicobrachial pain. Journal of Orthopaedic and Sports Physical Therapy. 2003;33(7):369–378. doi: 10.2519/jospt.2003.33.7.369.
    1. Vicenzino B., Neal R., Collins D., Wright A. The displacement, velocity and frequency profile of the frontal plane motion produced by the cervical lateral glide treatment technique. Clinical Biomechanics. 1999;14(8):515–521. doi: 10.1016/S0268-0033(99)00011-X.
    1. Cowell I. M., Phillips D. R. Effectiveness of manipulative physiotherapy for the treatment of a neurogenic cervicobrachial pain syndrome: a single case study—experimental design. Manual Therapy. 2002;7(1):31–38. doi: 10.1054/math.2001.0429.
    1. Cohen J. Eta-squared and partial eta-squared in fixed factor anova designs. Educational and Psychological Measurement. 1973;33(1):107–112. doi: 10.1177/001316447303300111.
    1. Emshoff R., Bertram S., Emshoff I. Clinically important difference thresholds of the visual analog scale: a conceptual model for identifying meaningful intraindividual changes for pain intensity. Pain. 2011;152(10):2277–2282. doi: 10.1016/j.pain.2011.06.003.
    1. Ostelo R. W. J. G., Deyo R. A., Stratford P., et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90–94. doi: 10.1097/BRS.0b013e31815e3a10.
    1. Hong C.-Z., Kuan T.-S., Chen J.-T., Chen S.-M. Referred pain elicited by palpation and by needling of myofascial trigger points: a comparison. Archives of Physical Medicine and Rehabilitation. 1997;78(9):957–960. doi: 10.1016/s0003-9993(97)90057-5.
    1. Hong C.-Z. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. American Journal of Physical Medicine & Rehabilitation. 1994;73(4):256–263. doi: 10.1097/00002060-199407000-00006.
    1. De Venancio R. A., Alencar F. G. P., Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009;27(1):46–53.
    1. Hanten W. P., Olson S. L., Butts N. L., Nowicki A. L. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Physical Therapy. 2000;80(10):997–1003.
    1. Sarrafzadeh J., Ahmadi A., Yassin M. The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point. Archives of Physical Medicine and Rehabilitation. 2012;93(1):72–77. doi: 10.1016/j.apmr.2011.08.001.
    1. Hou C.-R., Tsai L.-C., Cheng K.-F., Chung K.-C., Hong C.-Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of Physical Medicine and Rehabilitation. 2002;83(10):1406–1414. doi: 10.1053/apmr.2002.34834.
    1. Kim S. A., Oh K. Y., Choi W. H., Kim I. K. Ischemic compression after trigger point injection affect the treatment of myofascial trigger points. Annals of Rehabilitation Medicine. 2013;37(4):541–546. doi: 10.5535/arm.2013.37.4.541.
    1. Hill J. C., Lewis M., Sim J., Hay E. M., Dziedzic K. Predictors of poor outcome in patients with neck pain treated by physical therapy. Clinical Journal of Pain. 2007;23(8):683–690. doi: 10.1097/AJP.0b013e3181468e67.
    1. Verhagen A. P., Karels C. H., Schellingerhout J. M., Willemsen S. P., Koes B. W., Bierma-Zeinstra S. M. A. Pain severity and catastrophising modify treatment success in neck pain patients in primary care. Manual Therapy. 2010;15(3):267–272. doi: 10.1016/j.math.2010.01.005.
    1. George S. Z., Valencia C., Beneciuk J. M. A psychometric investigation of fear-avoidance model measures in patients with chronic low back pain. Journal of Orthopaedic and Sports Physical Therapy. 2010;40(4):197–205. doi: 10.2519/jospt.2010.3298.
    1. Young B. A., Walker M. J., Strunce J. B., Boyles R. E., Whitman J. M., Childs J. D. Responsiveness of the neck disability index in patients with mechanical neck disorders. Spine Journal. 2009;9(10):802–808. doi: 10.1016/j.spinee.2009.06.002.
    1. Cleland J. A., Childs J. D., Whitman J. M. Psychometric properties of the neck disability index and numeric pain rating scale in patients with mechanical neck pain. Archives of Physical Medicine and Rehabilitation. 2008;89(1):69–74. doi: 10.1016/j.apmr.2007.08.126.
    1. Walton D. M., Macdermid J. C., Nielson W., Teasell R., Chiasson M., Brown L. Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. Journal of Orthopaedic & Sports Physical Therapy. 2011;41(9):644–650. doi: 10.2519/jospt.2011.3666.
    1. Vernon H. T., Aker P., Burns S., Viljakaanen S., Short L. Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study. Journal of Manipulative and Physiological Therapeutics. 1990;13(1):13–16.
    1. Rayegani S. M., Bayat M., Bahrami M. H., Raeissadat S. A., Kargozar E. Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome. Clinical Rheumatology. 2014;33(6):859–864. doi: 10.1007/s10067-013-2448-3.
    1. Cagnie B., Dewitte V., Coppieters I., Van Oosterwijck J., Cools A., Danneels L. Effect of ischemic compression on trigger points in the neck and shoulder muscles in office workers: a cohort study. Journal of Manipulative and Physiological Therapeutics. 2013;36(8):482–489. doi: 10.1016/j.jmpt.2013.07.001.
    1. Shah J. P., Phillips T. M., Danoff J. V., Gerber L. H. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. Journal of Applied Physiology. 2005;99(5):1977–1984. doi: 10.1152/japplphysiol.00419.2005.
    1. Shah J. P., Danoff J. V., Desai M. J., et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of Physical Medicine and Rehabilitation. 2008;89(1):16–23. doi: 10.1016/j.apmr.2007.10.018.
    1. Kuan T.-S., Hong C.-Z., Chen J.-T., Chen S. M., Chien C. H. The spinal cord connections of the myofascial trigger spots. European Journal of Pain. 2007;11(6):624–634. doi: 10.1016/j.ejpain.2006.10.001.
    1. Niddam D. M., Chan R.-C., Lee S.-H., Yeh T.-C., Hsieh J.-C. Central representation of hyperalgesia from myofascial trigger point. NeuroImage. 2008;39(3):1299–1306. doi: 10.1016/j.neuroimage.2007.09.051.
    1. Skyba D. A., Radhakrishnan R., Rohlwing J. J., Wright A., Sluka K. A. Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord. Pain. 2003;106(1-2):159–168. doi: 10.1016/s0304-3959(03)00320-8.
    1. Paungmali A., O'Leary S., Souvlis T., Vicenzino B. Naloxone fails to antagonize initial hypoalgesic effect of a manual therapy treatment for lateral epicondylalgia. Journal of Manipulative and Physiological Therapeutics. 2004;27(3):180–185. doi: 10.1016/j.jmpt.2003.12.022.
    1. Vicenzino B., Collins D., Benson H., Wright A. An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. Journal of Manipulative and Physiological Therapeutics. 1998;21(7):448–453.
    1. Paungmali A., Vicenzino B., Smith M. Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance. Journal of Pain. 2003;4(8):448–454. doi: 10.1067/s1526-5900(03)00731-4.
    1. Beneciuk J. M., Bishop M. D., George S. Z. Effects of upper extremity neural mobilization on thermal pain sensitivity: a sham-controlled study in asymptomatic participants. Journal of Orthopaedic and Sports Physical Therapy. 2009;39(6):428–438. doi: 10.2519/jospt.2009.2954.
    1. Bialosky J. E., Bishop M. D., Price D. D., Robinson M. E., Vincent K. R., George S. Z. A randomized sham-controlled trial of a neurodynamic technique in the treatment of carpal tunnel syndrome. Journal of Orthopaedic and Sports Physical Therapy. 2009;39(10):709–723. doi: 10.2519/jospt.2009.0411.
    1. Park S.-C., Kim K.-H. Effect of adding cervical facet joint injections in a multimodal treatment program for long-standing cervical myofascial pain syndrome with referral pain patterns of cervical facet joint syndrome. Journal of Anesthesia. 2012;26(5):738–745. doi: 10.1007/s00540-012-1404-8.
    1. Tsai C.-T., Hsieh L.-F., Kuan T.-S., Kao M.-J., Hong C.-Z. Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle. Orthopedics. 2009;32(8) doi: 10.3928/01477447-20090624-04.
    1. Kim K.-H., Choi S.-H., Kim T.-K., Shin S.-W., Kim C.-H., Kim J.-I. Cervical facet joint injections in the neck and shoulder pain. Journal of Korean Medical Science. 2005;20(4):659–662. doi: 10.3346/jkms.2005.20.4.659.
    1. Lin Y.-C., Lai C.-H., Chang W.-H., Lin J.-C., Chou S.-W. Immediate effects of ischemic compression on neck function in patients with cervicogenic cephalic syndrome. Journal of Manipulative and Physiological Therapeutics. 2012;35(4):301–307. doi: 10.1016/j.jmpt.2012.04.009.
    1. Nagrale A. V., Glynn P., Joshi A., Ramteke G. The efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: a randomized controlled trial. Journal of Manual and Manipulative Therapy. 2010;18(1):37–43. doi: 10.1179/106698110x12595770849605.
    1. Sari H., Akarirmak U., Uludag M. Active myofascial trigger points might be more frequent in patients with cervical radiculopathy. European Journal of Physical and Rehabilitation Medicine. 2012;48(2):237–244.
    1. Faul F., Erdfelder E., Lang A.-G., Buchner A. G∗Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39(2):175–191. doi: 10.3758/bf03193146.
    1. Miller J., Gross A., D'Sylva J., et al. Manual therapy and exercise for neck pain: a systematic review. Manual Therapy. 2010;15(4):334–354. doi: 10.1016/j.math.2010.02.007.
    1. Kietrys D. M., Palombaro K. M., Azzaretto E., et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. Journal of Orthopaedic and Sports Physical Therapy. 2013;43(9):620–634. doi: 10.2519/jospt.2013.4668.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅