Short-Term Changes in Neck Pain, Widespread Pressure Pain Sensitivity, and Cervical Range of Motion After the Application of Trigger Point Dry Needling in Patients With Acute Mechanical Neck Pain: A Randomized Clinical Trial

Abstract

Mechanical neck pain has a lifetime and point pre valence almost as high as low back pain 31 and results in substantial disability and economic burden for society. 29 The authors of a recent study 16 found that the prevalence of mechanical neck pain has decreased in the last few years in Spain, potentially attributed to a better understanding and management of the condition. Physical therapy is usually the first management option for individuals with insidious-onset mechanical neck pain. T T METHODS: Seventeen patients (53% female)were randomly assigned to 1 of 2 groups: a single session of TrPDN or no intervention (waiting list). Pressure pain thresholds over the C5-6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle; neck pain intensity; and cervical spine range-of-motion data were collected at baseline (pretreatment) and 10 minutes and 1 week after the intervention by an assessor blinded to the treatment allocation of the patient. Mixed-model analyses of variance were used to examine the effects of treatment on each outcome variable. T T RESULTS: Patients treated with 1 session ofTrPDN experienced greater decreases in neck pain, greater increases in pressure pain threshold, and higher increases in cervical range of motion than those who did not receive an intervention at both 10 minutes and 1 week after the intervention (P<.01 for all comparisons). Between-group effect sizes were medium to large immediately after the TrPDN session (standardized mean score differences greater than 0.56) and large at the 1-week follow-up (standardized mean score differences greater than 1.34). T T CONCLUSION:The results of the current randomized clinical trial suggest that a single session of TrPDN may decrease neck pain intensity and widespread pressure pain sensitivity, and also increase active cervical range of motion, in patients with acute mechanical neck pain. Changes in pain, pressure pain threshold, and cervical range of motion surpassed their respective minimal detectable change values, supporting clinically relevant treatment effects. Therapy, level 1b-. J Orthop Sports Phys Ther 2014;44(4):252-260. Epub T T LEVEL OF EVIDENCE:

The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis

“…This systematic review focused on musculoskeletal pain and included 13 studies: 6 on neck pain (5 on mechanical neck pain 6,24,28,32,43 and 1 on chronic whiplash-associated disorder 38 ), 1 on postoperative shoulder pain, 2 1 on chronic lower back pain, 33 1 on total knee arthroplasty, 27 1 on chronic ankle instability, 35 2 on myofascial pain, 12,36 and 1 on fibromyalgia. 7 Inclusion and exclusion criteria varied greatly across the studies.…”

“…After the full review process, 12 studies were selected for inclusion. 2,7,12,24,27,28,32,33,35,36,38,43 After contact with primary authors of included studies, 1 further study was identified for inclusion, 6 resulting in a total of 13 studies. The absolute degree of rater agreement for the first and second stages of the study selection was 86% and 93%, respectively.…”

“…18,19 Dry needling has been shown to immediately increase pressure pain threshold (PPT) and range of motion, decrease muscle tone, and decrease pain in patients with musculoskeletal conditions. 17,24,28,32 T T STUDY DESIGN: Systematic review and metaanalysis.…”

Dry Needling and its Use in Health Care A Treatment Modality and Adjunct for Pain Management

“…[16] Soft tissue interventions such as stretching, manual therapy, and exercises to the deep neck flexors are considered an effective approach to manage neck pain. Dry needling is also used to treat neck pain.…”

“…When palpated, active MTrPs could elicit referred pain, reproducing the patient's symptoms; whereas, latent MTrPs do not cause a pain that will reproduce the patient's symptoms but could be responsible for tightness of the muscle. [2,3] Dry needling is used for myofascial pain, lower and upper extremity pain, neck pain, back pain, headaches, jaw pain, and migraines, among other conditions. The effects of dry needling in the treatment of knee osteoarthritis has been well documented.…”