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ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.
RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.
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Abstract Background Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling. Objective The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain. Methods A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023. Results A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability. Conclusion Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.
Resumo Antecedentes A síndrome dolorosa miofascial (SDM) é uma fonte comum de dor em centros primários de atenção à saúde ou nas clínicas de dor. Existem muitas formas diferentes de manejar e tratar a SDM, como o exercício físico, a massagem dos pontos de gatilho e o agulhamento a seco. Objetivo O objetivo desta revisão é destacar e discutir o tratamento baseado em evidências da dor miofascial por agulhamento a seco em doentes com dor lombar. Métodos Foi realizada uma revisão sistemática baseada em metanálises (MA) e ensaios clínicos randomizados (RCTs) relacionados ao tratamento da dor miofascial com agulhamento a seco em pacientes com dor lombar, publicados de 2000 a 2023. Resultados Foram identificados, inicialmente, um total de 509 registos. Setenta deles, publicados antes de 2000, foram excluídos. Dos 439 estudos restantes, 92 eram RCTs ou MA, dos quais 86 foram excluídos pelas seguintes razões: não relacionados a tratamento com agulhamento a seco (n = 79), não publicados em inglês (n = 4), duplicados (n = 1), protocolo de projeto (n = 1) e não relacionados com dor miofascial (n = 1). Assim, esta revisão baseou-se em quatro RCTs e duas MA. Esses estudos compararam a eficácia do agulhamento seco com outros tratamentos, tais como acupuntura, agulhamento a seco "sham", terapia com laser, fisioterapia, injeção de anestésico local, compressão isquêmica e educação em neurociências. Apesar de os resultados e o período de seguimento variarem entre os estudos, os estudos demonstram que o agulhamento a seco pode diminuir a intensidade da dor pós-intervenção e a incapacidade relacionada à dor. Conclusão O agulhamento a seco é um procedimento eficaz para o tratamento da dor miofascial em pacientes com dor lombar aguda e crônica. Mais estudos são necessários para esclarecer sua eficácia a longo prazo.
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ABSTRACT BACKGROUND AND OBJECTIVES: Shoulder painful dysfunctions comprises one of the most common musculoskeletal disorders that requires specialized assistance. Dry Needling (DN) became an adjuvant approach with increased use in clinical practice to treat this type of condition. The present study discusses the literature related to DN in the treatment of myofascial trigger points (MTPs), shoulder dysfunctions and associated pain. METHODS: A narrative review through search of articles from 2010 to 2022 written in Portuguese, English or Spanish was performed in Latin American and Caribbean Literature on Health Sciences (LILACS), Health Information from the National Library of Medicine (Medline), Web of Science and the Scientific Electronic Library Online (Scielo) databases using the keywords: <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <"Shoulder Dysfunctions">; <"Disfunções do ombro">. The qualitative analysis was performed determining the level of evidence for DN treatment of MTPs, shoulder dysfunctions and pain. RESULTS: A total of 45 citations were found, 22 citations were excluded because they did not meet the selection criteria. The 23 remaining citations were examined for titles and abstracts and duplicate studies were removed. Finally, 10 articles met the selection criteria and were included in the present review. No articles were excluded after full-text screening. The analysis showed poor advances and knowledge regarding the application of DN for the treatment of pain, painful and general shoulder dysfunctions and MTPs, with few evidence regarding treatment effectiveness, patient's pain scores data, mechanisms of action and statistical analysis. CONCLUSION: There is still a lack of concrete scientific evidence to assess DN effectiveness in modulating pain in patients with MTPs shoulder. More systematic reviews and meta-analyses together with experimental and clinical searches must be conducted to provide stronger evidence of this modality to relief painful symptoms in the shoulder, as well as a treatment of MTPs and general shoulder disorders.
RESUMO JUSTIFICATIVA E OBJETIVOS: As disfunções dolorosas de ombro constituem uma das disfunções musculoesqueléticas mais comuns que requerem assistência especializada. O agulhamento a seco (AS) tornou-se uma abordagem adjuvante com uso crescente na prática clínica para tratar esse tipo de condição. O objetivo deste estudo foi rever na literatura aspectos relacionados ao AS no tratamento de pontos-gatilho miofasciais (PGMs), disfunções do ombro e dores associadas. MÉTODOS: Foi realizada uma revisão narrativa através da busca de artigos de 2010 a 2022 escritos em português, inglês ou espanhol, na Literatura Latino-Americana e do Caribe nos bancos de dado Ciências da Saúde (LILACS), Informações em Saúde da Biblioteca Nacional de Medicina (Medline), Web of Science e Scientific Electronic Library Online (Scielo) utilizando as palavras-chave <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <" Disfunções do ombro">. A análise qualitativa foi realizada determinando o nível de evidência para tratamento de AS para o tratamento de PGMs, disfunções do ombro e dor. RESULTADOS: Um total de 45 citações foram encontradas, 22 citações foram excluídas porque não atenderam aos critérios de seleção. As 23 citações restantes foram examinadas para títulos e resumos e estudos duplicados foram removidos. Finalmente, 10 artigos atenderam aos critérios de seleção e foram incluídos na presente revisão. Nenhum artigo foi excluído após a triagem de texto completo. A análise mostrou poucos avanço e conhecimento sobre a aplicação de AS para o tratamento da dor, disfunções dolorosas e gerais do ombro e PGMs, com poucas evidências sobre a eficácia do tratamento, dados dos escores de dor do paciente, mecanismos de ação e análise estatística. CONCLUSÃO: Ainda faltam evidências científicas concretas para avaliar a eficácia do AS na modulação da dor em pacientes com PGMs no ombro. Mais revisões sistemáticas e meta-análises associadas a pesquisas experimentais e clínicas devem ser realizadas para fornecer evidências dessa modalidade promissora para alívio de sintomas dolorosos no ombro, bem como tratamento de PGMs e distúrbios gerais do ombro.
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Abstract Background: Temporomandibular disorder (TMD) is an umbrella term encompassing various clinical complaints involving the temporomandibular joints, masticatory muscles, and/or associated orofacial structures. Myogenous TMDs are the most frequent cause of chronic orofacial pain. Musculoskeletal pain is commonly associated with myofascial trigger points (MTPs), for which dry needling (DN) is a routine treatment. Objective: To investigate muscle oxygenation and pain immediately after DN application on an MTP in the masseter muscle of patients with myogenous TMDs. Methodology: Masseter muscle oxygen tissue saturation indices (TSI%) were assessed by near-infrared spectroscopy (NIRS) pre- and post-interventions by a randomized, controlled, double-blind, crossover DN/Sham clinical trial (primary outcome). Pain was investigated by the visual analog scale (VAS). In total, 32 individuals aged from 18 to 37 years who were diagnosed with myogenous TMD and myofascial trigger points in their masseter muscles participated in this study. Relative deltas for the studied variables were calculated. Data normality was tested using the Shapiro-Wilk test. According to their distribution, data were analyzed by two-way ANOVA and the Student's t-, and Mann-Whitney tests. Statistical analyses were performed using Prism® 5.0 (GraphPad, USA). Results: We found a significant difference (2,108% vs. 0,142%) between masseter muscle TSI% deltas after the DN and Sham interventions, respectively (n=24). We only evaluated women since men refused to follow NIRS procedures. Pain increased immediately after DN (n=32, 8 men), in comparison to Sham delta VAS. Conclusion: These findings show an increase in tissue oxygen saturation in the evaluated sample immediately after the DN intervention on the MTP of patients' masseter muscle. Pain may have increased immediately after DN due to the needling procedure.
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La electrólisis percutánea intratisular es un procedimiento terapéutico tecnológico mínimamente invasivo para el tratamiento de lesiones en el sistema musculoesquelético mediante inflamación controlada y fagocitosis para recuperar el tejido afectado. Acerca de esta, se realizó un análisis de la producción científica publicada de 2014 a 2021. El estudio se realizó por medio de una revi-sión bibliográfica sistémica siguiendo la metodología PRISMA, que incluyó el uso de fuentes de información en las bases científicas: PubMed, SciencieDirect, EuropePMC, ResearchGate, Sage Journal, Thiem Connect y PHysiotherapy evidence database (PEdro). Previamente al procesa-miento de los datos, los documentos encontrados fueron sometidos diversos criterios de selec-ción. Los investigadores concluyeron que la electrólisis percutánea intratisular resulta un trata-miento efectivo para el tratamiento de tendinopatías crónicas, cuando se realiza combinado con un programa de ejercicios enfocado en la progresión de las cargas.
This work presents an analysis of the scientific production developed between 2014 and 2021 on percutaneous intratissue electrolysis. The objective is to analyze the bibliograpHy on the diffe-rent EPI interventions. The study was carried out through a systemic review following a methodological process according to PRISMA using various sources for the collection of information, such as: Pubmed, Scienciedirect, Europe PMC, Hindawi, Cochrane, Sage Journal, Thiem Connect, Pedro, Puerta Of the investigation. Selection and quality criteria were applied to these documents, with a subsequent analysis using qualitative techniques. In conclusion, intratissue percutaneous electrolysis turns out to be a favorable tool in the treatment of chronic tendinopathies as long as it is combined with an exercise program focused on load progression.
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Humans , Male , Female , Administration, Cutaneous , Electrolysis , Musculoskeletal System , Bibliography , PubMed , Systematic ReviewABSTRACT
Background:Myofascial pain syndrome is defined as sensory, motor and autonomic symptoms that are caused trigger points (MTrP). It is defined as a hyperirritable spot in skeletal muscle, which is associated with hypersensitive palpable nodule in a taut band. Objectives: Present study was undertaken to add on to available treatment methods for myofascial Trigger points and to find out the effectiveness of dry needling and Transcutaneous Electrical Nerve Stimulation (TENS) therapy for treating myofascial trigger point. Material And Methods:In this study, 32 participants were recruited based on inclusion and exclusion criteria. Dry Needling and TENS therapy was administered to them for a period of 2 weeks, 6 sessions in 2 weeks. Pre and post assessme nt were taken using following outcome measures-Pain Pressure Threshold, Numerical Pain Rating Scale (NPRS), Functional Assessment Scale for Acute Hamstring Injuries (FASH)Result:There was significant decrease in Pain due to hamstring injury on NPRS, agility score and increase in Pain Pressure threshold in patients which is suggestive of decrease in pain and improve functional independency. The outcome of Pressure Algometer, Agility score and NPRS were statistically analyzed. It was found to be effective with significant P value<0.000. Conclusion:Statistically both Dry Needling and TENS are competent enough to alleviate pain but clinically TENS having better response in pain depletion and in increase in functional independency compared to Dry Needling.
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Abstract Introduction Therapeutic dry needling (DN) is effective in reducing the discomfort of chronic somatosensory tinnitus in patients with myofascial trigger points (MTP)s. Objective To evaluate the efficacy of DN in chronic somatosensory tinnitus discomfort in patients with MTP. Methods Placebo-controlled paired trial that included 16 patients with a diagnosis of somatosensory chronic tinnitus and with the presence of at least one active or latent MTP. Treatment was performed in two phases: (1) four sessions (one session per week for four consecutive weeks) of placebo DN and (2) four sessions of therapeutic DN with a gap (washout) of 15 days between these phases. Results The Tinnitus Handicap Inventory (THI) variable and its emotional domain had a statistically significant reduction in therapeutic DN when compared with placebo DN (p= 0.024 and p = 0.011, respectively). The tinnitus visual analogic scale (VAS) signaled a reduction in tinnitus discomfort when compared with moments before and after therapeutic DN (p< 0.05). Conclusion The therapeutic DN technique for MTP in patients with chronic tinnitus of somatosensory origin proved effective in reducing symptom discomfort, as measured by the THI (total score) and its emotional domain when compared with placebo DN.
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Objective:To observe any effect of dry needling of myofascial trigger points on substance P and synaptophysin expression in the spinal dorsal horn.Methods:Sixty-four Sprague-Dawley rats were randomly divided into a control group ( n=16) and a model group ( n=48). Myofascial trigger points were induced in the model group by a blunt strike and eccentric running. That group was then randomly divided into a no-treatment group ( n=15), a massage group ( n=16), and a dry needling group (16 rats). The rats in the two treatment groups received 4 weeks of dry needling or Chinese massage. Pressure pain thresholds were recorded before the experiment and after the 4 weeks. The content of substance P and synaptophysin in the spinal dorsal horn were measured using immunoblotting and immunohistochemistry. Results:After the treatment 14 rats (93%) in the model group had trigger points, significantly higher than the 8 rats (50%) in the massage group and the 7 rats (44%) in the dry needling group. After treatment, the average pressure pain thresholds of the no-treatment and massage groups was significantly lower than the control group′s average, while the difference between the dry needling group and the control group was not significant. The average pressure pain threshold had improved significantly in the no-treatment group, the massage group and the dry needling group, and the averages of the massage group and the dry needling group were significantly higher than that of the no-treatment group. The level of substance P was significantly higher in the no-treatment group than in the other three groups and the ratio of substance P to Glyceraldehyde 3-phosphate dehydrogenase (GAPDH)was significantly higher. The substance P: GAPDH ratio of the massage group was significantly higher than that of the control group.Conclusions:Dry needling and massage are effective in relieving myofascial pain, at least in rats. Both can reduce the content of substance P in the spinal dorsal horn.
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@#Trigeminal neuralgia is a debilitating disease that can lead to depression and even suicide. Trigeminal neuralgia is usually treated using carbamazepine; however, many patients are refractory to such medical treatment. Thus, other treatment modalities are required, such as physical treatment and dry needling. The objective of this case report is to describe the management of trigeminal neuralgia in a 35 years old Malay housewife, who had left side atypical trigeminal neuralgia involving V2 region in the last four years, which was refractory to medical treatment. The application of Malay massage, combined with dry needling executed along the distribution of trigeminal nerve showed an improvement of pain on the Visual Analog Scale (VAS) from 7–8/10 to 0-1/10 after 11 sessions. Therefore, Malay massage combined with dry needling can be used as a non-pharmaceutical approach to managing trigeminal neuralgia.
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Background: Patello-femoral pain syndrome is a very common complaint seen in adolescence and young adults characterized by pain around and behind the patella. There has been prevalence of trigger points in the quadriceps leading to disruption of the VMO/VL firing pattern due to muscle inhibition by pain. Current studies suggest the use of strengthening exercises for hip and knee not focusing on releasing the trigger points. Releasing these trigger points could give additional benefit to the patient and can also be employed along with other conventional therapies. Purpose of the study: To find out which treatment method gives faster results and works directly on the pain and function of the patient. Objectives: To assess the immediate effect of Dry Needling Vs Ultrasound on releasing Trigger points in Quadriceps in patients with Patello-femoral Pain Syndrome on pain and knee/lower extremity function. Study Design: Randomized Control trail Setting: OPD setting. Participants: 70 patients with chronic anterior knee pain, without any ligament, bony or sensory involvement around the knee. Main outcome measures: Numerical Pain rating scale and Pressure Algometer. Results: In the ultrasound group there was a change of 38.60% seen in NRPS post values with a mean difference of 2.21±1.21 and for pressure algometer a change of 36.23% was seen with a mean difference of 3.08±4.40. In the dry needling group there was a change of 64.53% seen in NRPS post values with a mean difference of 3.07±1.48 and for pressure algometer a change of 56.86% was seen with a mean difference of 8.36±6.90. When compared within group dry needling had a better effect than ultrasound on both NRPS and Pressure algomter. Conclusion: The current study indicates that Dry needling is more effective than ultrasound for reducing pain and increasing functional outcome in patients with patellofemoral pain syndrome.
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OBJECTIVE@#Acupuncture guidelines have advised caution when treating women during pregnancy, because historical "forbidden" acupuncture points are believed to stimulate miscarriage or early labor. Despite recent research demonstrating that acupuncture is a useful and safe treatment tool for pregnancy-related low-back pain (LBP) and pelvic girdle pain (PGP), it is postulated that fear of miscarriage and subsequent blame by association, restricts its provision. More recently, an increase in dry needling (DN) courses for physiotherapists has potentiated the rapid growth in DN practice in New Zealand (NZ). Many dry needlers do not consider DN to be a form of acupuncture; it is unknown if they have similar safety concerns.@*METHODS@#NZ registered physiotherapists practicing acupuncture and/or DN were invited to participate in an electronic survey to examine their practice and level of understanding in regard to safe needling during pregnancy.@*RESULTS@#Of 124 respondents, only 60 (48%) would needle pregnant women, with a further 66% of those still expressing safety concerns. NZ physiotherapists practicing DN only, were more likely to needle areas related to "forbidden" points in all trimesters. However, overall, NZ physiotherapists were less likely to needle "forbidden" points than their UK peers.@*CONCLUSION@#Conflicting literature and a "fear of blame" influences NZ physiotherapists' decisions to offer needling (both acupuncture and DN) during pregnancy. Further training in this field is recommended to ensure safe practice and adequate provision of acupuncture treatment options for pregnant women suffering musculoskeletal pain, such as LBP and PGP. Further research, particularly into DN, for women during pregnancy, is warranted.
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Objective: To explore the clinical effect of ultrasound-guided dry needling of myofascial trigger points in treatment of plantar fasciitis. Methods: Totally 48 patients with plantar fasciitis were randomly divided into 2 groups. Patients in the simple treatment group (n=24) received sole non-weight-bearing plantar fascia stretching training, and the ones in the combined treatment group (n=24) received ultrasound-guided dry needling for myofascial trigger points combined with stretching training. The numeric pain-rating scale (NPRS) of the first move, American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS), physical component summary (PCS) and mental component summary (MCS) of 36-item short-form health survey were evaluated before (T0) as well as 1 month (T1) and 3 months (T2) after treatment respectively. Results: The overall differences of NPRS, AOFAS, PCS and MCS were significant before and after treatment in both two groups (all P0.05). Conclusion: Ultrasound-guided dry needling for myofascial trigger points combined with stretching training and sole non-weight-bearing plantar fascia stretching training are both effective for treatment of plantar fasciitis, while the former is better for relieving pain and improving ankle function.
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Based on the traditional theory in (), the acupuncture effects of non-acupoints on the body surface were explored. There are the effects of the non-acupoints on meridians, the effects of five tissues (local effects, resonance effects, five- effects and particular effects) and regional effects (nearby effects, structural corresponding effects, holistic effects and the special effects on the specific regions), etc. The innovative recognitions are proposed. ① Stimulating the non-acupoint sites on the body surface generates definite effects, not limited to the local nearby effects. For example, the resonance effects and five- effects are generated by stimulating five tissues. The counter-acting force presents between five tissues and five- organs. ② The regional effects are rich in content and its mechanisms on the induction, coordination and correspondence are not in reference to , meridian and collateral, but are related to the characteristics of activity of the regional body itself. ③ Acupuncture presents not only the effects of the abstract meridian-collateral and the acupoints, but also the effects of concrete five tissues and regions. Acupuncture therapeutic effects may result from the cumulative effects, especially related to the stimulation of the strength by the needle tip. ④ Regarding the differences in the effects between the meridian points and non-acupoint stimulation, the former attaches the importance on " ", which is abstract and dynamic and the later on "shape", which is concrete and static.
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Acupuncture Points , Meridians , MoxibustionABSTRACT
Objetivo: comparar a eficácia de dois protocolos de tratamento para disfunção temporomandibular (DTM) de origem muscular. Sujeitos e método: Estudantes da Faculdade Especializada na Área de Saúde do Rio Grande do Sul foram selecionados por meio de questionário, para avaliar a presença de sinais e sintomas de DTM e diagnóstico de DTM muscular pelos Critérios de Diagnóstico para Transtornos da Pesquisa Temporomandibular. Dez estudantes compuseram a amostra, divididos em dois grupos, de acordo com o protocolo de tratamento: G1 hipertermia induzida, exercícios mandibulares e massagem; e G2 agulhamento seco, hipertermia induzida, exercícios mandibulares e massagem. Os alunos foram instruídos a realizar o protocolo do tratamento G1 todos os dias em casa e na instituição de ensino por três sessões, que ocorreram a cada cinquenta dias. O agulhamento seco foi realizado no G2 apenas nas segunda e terceira sessões de tratamento. Para avaliar a efetividade dos dois tratamentos antes e após cada sessão, avaliaram-se: abertura bucal (AB), por meio de régua milimetrada; dor, pela escala visual analógica; força de mordida (FM), usando um medidor de força digital; e qualidade de vida, avaliada imediatamente antes do início do tratamento e depois do término do tratamento. Resultados: a dor mostrou diferença estatística significativa no G2 após a segunda sessão (p=0,020) e a terceira sessão (p=0,047). Os demais resultados mostram que não houve diferença estatisticamente significativa entre os grupos (p>0,05). Conclusão: considera-se que neste estudo piloto ambos os tratamentos foram eficazes para DTM muscular, uma vez que todos os pacientes apresentaram melhora dos sintomas. Não houve diferença estatisticamente significativa entre os tratamentos, exceto a dor pós-procedimento, causada pela técnica do agulhamento seco. (AU)
Objective: the present study aims to compare the efficacy of two treatment protocols for temporomandibular dysfunction (TMD) of muscular origin. Subjects and method: students of the Faculdade Especializada na área de Saúde do Rio Grande do Sul, that were selected through the questionnaire to evaluate the presence of TMD signs and symptoms and diagnosis of muscular TMD from the Diagnostic Criteria for Temporomandibular Research Disorders. Ten students composed the sample, divided into two groups according to the treatment protocol: hyperthermia induced by G1, mandibular exercises and massage; G2 â dry needling, induced hyperthermia, mandibular and massage exercises. Students were instructed to complete the G1 treatment protocol every day at home and at the educational institution for three sessions that occurred every fifty days. Dry needling was performed in G2 only in the second and third treatment sessions. To evaluate the effectiveness of the two treatments before and after each session, we evaluated: mouth opening (AB), through a millimeter ruler; visual analogue scale; bite force (FM) using a digital force gauge and quality of life was assessed immediately prior to initiation of treatment and after termination of treatment. Results: pain obtained a statistically significant difference in G2 after the second session (p=0.020) and the third session (p=0.047). The other results show that there was no statistically significant difference between the groups (p>0.05). Conclusion: it is considered that in this pilot study both treatments were effective for muscular TMD, since all the patients presented improvement of the symptoms. There was no statistically significant difference between treatments, except for post- -procedure pain, caused by the dry needling technique. (AU)
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Humans , Male , Female , Adolescent , Adult , Temporomandibular Joint Dysfunction Syndrome/therapy , Dry Needling/methods , Hyperthermia, Induced/methods , Massage/methods , Bite Force , Pain Measurement , Facial Pain/therapy , Temporomandibular Joint Dysfunction Syndrome/physiopathology , Analysis of Variance , Treatment Outcome , Statistics, NonparametricABSTRACT
The similarities and differences between trigger points of myalgia and acupoints were explored. Nodules could be detected by B-ultrasound at trigger points of myalgia, but not acupoints. In clinical symptoms, the referred pain pathway of trigger points of myalgia is similar with the pathway of acupuncture meridian. Therefore, the location of trigger points of myalgia should take referred pain as pathway, which is similar with locating acupoints as meridian. Acupuncture at trigger points of myalgia takes jumping feeling as criterion, while acupuncture at acupoints are mainly based on acid swelling and numbness. From clinical observation to basic experimental research, a lot of pathophysiological evidence is provided for trigger point of myalgia. It is believed that the trigger point of myalgia might be the precise acupoint in modern scientific research, and the meridian is the synthesis of the mechanics of nerve, blood vessel and fascia. Although acupuncture and dry needling are different in theory, but the scientific foundation of TCM and western medicine is coherent.
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@#Objective To explore the clinical effect of inner heating dry needle therapy on nonspecific chronic neck pain (NCNP). Methods From October, 2017 to March, 2018, 60 patients with NCNP were randomly divided into needle group (n=30) and magner group (n=30). The needle group received inner heating dry needle therapy, and the magner group received hot magner therapy. They were measured the strain ratio (SR) of bilateral trapezius muscles, scalp clamp muscles, cephalospinal muscles, semispinalis muscles and multifidus muscles with ultrasound elastography before, and one week and one month after treatment, respectively, while they were assessed with Visual Analogue Scale (VAS) of pain and Neck Disability Index (NDI). Results The scores of VAS and NDI decreased in both groups one week and one month after treatment (t>2.693, P<0.05), and decreased more in the needle group than in the magner group (F>8.048, P<0.001). SR of all the muscles decreased in the needle group one week and one month after treatment (F>6.22, P<0.01), and only decreased in the right cephalospinal muscles in the magner group (F=4.35, P<0.05).Conclusion Inner heating dry needle therapy could recover the neck muscle elasticity to relieve pain and improve ceivical function in patients with NCNP.
ABSTRACT
OBJECTIVE: To attempt to establish an objective quantitative indicator to characterize the trigger point activity, so as to evaluate the effect of dry needling on myofascial trigger point activity. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into blank control group, dry needling (needling) group, stretching exercise (stretching) group and needling plus stretching group (n＝6 per group). The chronic myofascial pain (trigger point) model was established by freedom vertical fall of a wooden striking device onto the mid-point of gastrocnemius belly of the left hind-limb to induce contusion, followed by forcing the rat to make a continuous downgrade running exercise at a speed of 16 m/min for 90 min on the next day which was conducted once a week for 8 weeks. Electromyography (EMG) of the regional myofascial injured point was monitored and recorded using an EMG recorder via electrodes. It was considered success of the model if spontaneous electrical activities appeared in the injured site. After a 4 weeks' recovery, rats of the needling group were treated by filiform needle stimulation (lifting-thrusting-rotating) of the central part of the injured gastrocnemius belly (about 10 mm deep) for 6 min, and those of the stretching group treated by holding the rat's limb to make the hip and knee joints to an angle of about 180°, and the ankle-joint about 90° for 1 min every time, 3 times altogether (with an interval of 1 min between every 2 times). The activity of the trigger point was estimated by the sample entropy of the EMG signal sequence in reference to Richman's and Moorman's methods to estimate the curative effect of both needling and exercise. RESULTS: After the modeling cycle, the mean sample entropies of EMG signals was significantly decreased in the model groups (needling group [0.034±0.010], stretching group [0.045±0.023], needling plus stretching group [0.047±0.034]) relevant to the blank control group (0.985±0.196, P0.05), suggesting a better efficacy of dry needling in easing trigger point activity. CONCLUSION: Dry needling is able to relieve myofascial trigger point activity in rats, which is better than that of simple passive stretching therapy.
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In the last twenty years, in the United States and other Western countries, dry needling (DN) became a hot and debatable topic, not only in academic but also in legal fields. This White Paper is to provide the authoritative information of DN versus acupuncture to academic scholars, healthcare professional administrators, lawmakers, and the general public through providing the authoritative evidence and experts' opinions regarding critical issues of DN versus acupuncture, and then reach consensus. DN is the use of dry needles alone, either solid filiform acupuncture needles or hollow-core hypodermic needles, to insert into the body for the treatment of muscle pain and related myofascial pain syndrome. DN is sometimes also known as intramuscular stimulati on, trigger points (TrP) acupuncture, TrP DN, myofascial TrP DN, or biomedical acupuncture. In Western countries, DN is a form of simplified acupuncture using biomedical language in treating myofascial pain, a contemporary development of a portion of Ashi point acupuncture from Chinese acupuncture. It seeks to redefine acupuncture by reframing its theoretical principles in a Western manner. DN-like needling with filiform needles have been widely used in Chinese acupuncture practice over the past 2,000 years, and with hypodermic needles has been used in China in acupuncture practice for at least 72 years. In Eastern countries, such as China, since late of 1800s or earlier, DN is a common name of acupuncture among acupuncturists and the general public, which has a broader scope of indications, not limited to treating the myofascial pain.
Subject(s)
Humans , Acupuncture Therapy , China , Expert Testimony , Needles , Societies, Medical , United StatesABSTRACT
In the United States and other Western countries, dry needling has been a topic in academic and legal fields. This White Paper is to provide the authoritative information of dry needling versus acupuncture to academic scholars, healthcare professionals, administrators, policymakers, and the general public by providing the authoritative evidence and expertise regarding critical issues of dry needling and reaching a consensus. We conclude that Dr. Travell, Dr. Gunn, Dr. Baldry and others who have promoted dry needling by simply rebranding (1) acupuncture as dry needling and (2) acupuncture points as trigger points (dry needling points). Dry needling simply using English biomedical terms (especially using "fascia" hypothesis) in replace of their equivalent Chinese medical terms. Dry needling is an over-simplified version of acupuncture derived from traditional Chinese acupuncture except for emphasis on biomedical language when treating neuromuscularskeletal pain (dry needling promoters redefined it as "myofascial pain"). Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy (a surgical procedure) instead of manual therapy. Dr. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture's local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients' safety, dry needling practitioners should meet standards required for licensed acupuncturists and physicians.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Methods , Reference Standards , Consensus , Cooperative Behavior , Expert Testimony , Myofascial Pain Syndromes , Therapeutics , Needles , Reference Standards , Physicians , Practice Guidelines as Topic , Societies, Medical , Reference Standards , United StatesABSTRACT
O objetivo desta pesquisa foi avaliar o tratamento com agulhamento seco (AS) no músculo masseter dos pacientes diagnosticados com dor miofascial quanto à sintomatologia dolorosa e a abertura bucal (AB). Após cálculo amostral, foram selecionados 10 deles, diagnosticados com dor miofascial com ou sem limitação de abertura pelo Eixo I do RDC/TMD, que foram submetidos a seis sessões de AS uma vez por semana. A sintomatologia dolorosa foi determinada semanalmente através da Escala Visual Analógica (EVA), e foi mensurada a AB sem auxílio e sem dor e a AB máxima sem auxílio antes do início do tratamento, e uma semana após o fim do mesmo. Ambas as médias foram analisadas através do ANOVA. Todos eram do gênero feminino e a média de idade foi de 39,2 anos, com 8 (80%) possuindo diagnóstico de dor miofascial com limitação de abertura bucal e 2 (20%) com dor miofascial somente. A abertura sem auxílio e sem dor antes do tratamento era de 31,9 mm e passou para 36,2 mm, e a abertura máxima sem auxílio de 39,6 mm para 43,1 mm. Em ambas, porém, não foi possível encontrar significância estatística (p > 0,05). Quanto ao valor médio semanal da EVA, este passou de 8,3 antes do tratamento, para 2,3 uma semana após o mesmo, com resultados significativos estatísticamente (p < 0,05). No presente estudo, o AS no músculo masseter apresentou-se uma alternativa terapêutica no tratamento da dor miofascial.(AU)
The aim of this study was to evaluate treatment with dry needling (AS) in the masseter muscle of patients diagnosed with myofascial pain as the pain symptoms and the mouth opening (AB). After sample size calculation, we selected 10 patients referred for treatment of temporomandibular disorders (TMD) diagnosed with MP, with or without limited mouth opening according to Axis I of the RDC/TMD, who underwent six DN sessions, once a week. Pain measurement using the Visual Analogue Scale (VAS) and an evaluation of the extent of mouth opening were done. All participants were female and the average age was 39.2 years, with 8 (80%) having a diagnosis of myofascial pain with limited mouth opening and 2 (20%) with only myofascial pain. Maximum unaided opening without pain before treatment was 31.9 mm and went to 36.2 mm, and the maximum unaided opening went from 39.6 mm to 43.1 mm. In both, however, could not find statistical significance (p> 0.05). Regarding the mean weekly VAS value, this went from 8.3 before treatment to 2.3 a week later, with statistically significant results (p < 0.05). In this study, the AS in the masseter muscle presented is a therapeutic alternative in the treatment of myofascial pain.(AU