Effectiveness of Dry Needling with Percutaneous Electrical Nerve Stimulation of High Frequency Versus Low Frequency in Patients with Myofascial Neck Pain.

BACKGROUND: Percutaneous nerve electrical stimulation is a novel treatment modality for the management of acute and chronic myofascial pain syndrome. OBJECTIVES: To compare the effectiveness of dry needling combined with percutaneous electrical nerve stimulation  of low frequency versus high frequency, in patients with chronic myofascial neck pain. STUDY DESIGN: Randomized, single-blind trial. SETTING: Laboratory in an academic institution. METHODS: A total of 40 volunteer patients with chronic neck pain were randomly divided into 2 groups. All patients initially received deep dry needling in a myofascial trigger point of the upper trapezius. Then, one group received high frequency percutaneous electrical nerve stimulation while the other group received low frequency percutaneous electrical nerve stimulation. The primary outcomes were the visual analog scale  and the pressure pain threshold, while Neck Disability Index and Kinesiophobia were secondary outcomes. RESULTS: We detected significant improvements in the visual analog scale score in both groups without differences between them. We did not observe significantly different statistics in either group during the evaluation of data on pressure pain threshold. LIMITATIONS: Limitations of the study include (1) heterogeneity of the sample in relation to gender, with more women, (2) the small sample size (40 patients), (3) the absence of placebo group, and (4) the fact that the treatment is focused exclusively on the upper trapezium myofascial trigger point. . CONCLUSIONS: Low and high frequency percutaneous electrical nerve stimulation combined with deep dry needling showed similar effects, since no differences between groups were observed on any of the outcome measures. High and low frequency of percutaneous electrical nerve stimulation generates changes on pain intensity and disability, but not on pressure pain threshold or fear of movement.

Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial.

Background: Virtual reality (VR) applied to patients with neck pain is a promising intervention to produce positive effects when used alone or combined with exercise. Therefore, the objective of this manuscript is to compare the effects of VR versus exercise treatment on pain intensity, conditioned pain modulation (CPM), temporal summation (TS) and functional and somatosensory outcomes in patients with non-specific chronic neck pain (NS-CNP). Methods: A single-blinded, randomized clinical trial was carried out. A total sample of 44 patients with NS-CNP was randomized into a VR treatment group or neck exercises group. The intervention consisted of two treatment sessions per week, for four weeks and eight sessions. Four measurement moments (at baseline, immediately, 1 month, and 3 months after intervention) were considered. Pain intensity, CPM, TS, functional and somatosensory outcomes were measured. Results: Statistically significant differences were revealed for time factor (F = 16.40, p < 0.01, ηp2 = 0.28) and group*time interaction for kinesiophobia (F = 3.89, p = 0.01, ηp2 = 0.08) showing post-hoc differences in favor of the VR group at 3 months (p < 0.05, d = 0.65). Significant effects were shown for time factor (p < 0.05) but not for the group*time interaction (p > 0.05) for pain intensity, rotation range of motion (ROM), Neck Disability Index, pain catastrophizing, fear-avoidance beliefs, left side pressure pain threshold (PPT) and anxiety. Statistically significant differences were not found for time factor (p > 0.05) and neither in group*time interaction (p > 0.05) for CPM, TS, right side PPT, flexo-extension and lateral-flexion ROM. Conclusions: Kinesiophobia was the only outcome that showed differences between VR and exercise at 3 months. Nevertheless, pain intensity, CPM, TS, ROM, neck disability, pain catastrophizing, fear-avoidance beliefs, PPT and anxiety did not show differences between both interventions.

Effects of movement representation techniques on motor learning of thumb-opposition tasks.

The present work is the first study that assess long run change after motor learning. The study's main objective was to evaluate the short to medium-term impact of motor imagery (MI) and action observation (AO) on motor learning of a sequence of thumb-opposition tasks of increasing complexity. We randomly assigned 45 participants to an AO, MI, or placebo observation (PO) group. A sequence of 12 thumb-opposition tasks was taught for 3 consecutive days (4 per day). The primary outcome was accuracy. The secondary outcomes were required time and perfect positioning. The outcomes were assessed immediately after the intervention and at 1 week, 1 month and 4 months postintervention. Regarding the primary outcome, AO group had significantly higher accuracy than the MI or PO group until at least 4 months (p < 0.01, d > 0.80). However, in the bimanual positions, AO was not superior to MI at 1 week postintervention. Regarding secondary outcomes, AO group required less time than the MI group to remember and perform the left-hand and both-hand gestures, with a large effect size (p < 0.01, d > 0.80). In terms of percentage of perfect positions, AO group achieved significantly better results than the MI group until at least 4 months after the intervention in the unimanual gestures (p < 0.01, d > 0.80) and up to 1 month postintervention in the bimanual gestures (p = 0.012, d = 1.29). AO training resulted in greater and longer term motor learning than MI and placebo intervention. If the goal is to learn some motor skills for whatever reason (e.g., following surgery or immobilization.), AO training should be considered clinically.

The Role of Movement Representation Techniques in the Motor Learning Process: A Neurophysiological Hypothesis and a Narrative Review.

We present a neurophysiological hypothesis for the role of motor imagery (MI) and action observation (AO) training in the motor learning process. The effects of movement representation in the brain and those of the cortical-subcortical networks related to planning, executing, adjusting, and automating real movements share a similar neurophysiological activity. Coupled with the influence of certain variables related to the movement representation process, this neurophysiological activity is a key component of the present hypothesis. These variables can be classified into four domains: physical, cognitive-evaluative, motivational-emotional, and direct-modulation. The neurophysiological activity underlying the creation and consolidation of mnemonic representations of motor gestures as a prerequisite to motor learning might differ between AO and MI. Together with variations in cognitive loads, these differences might explain the differing results in motor learning. The mirror neuron system appears to function more efficiently through AO training than MI, and AO is less demanding in terms of cognitive load than MI. AO might be less susceptible to the influence of variables related to movement representation.

Effects of Motor Imagery and Action Observation on Lumbo-pelvic Motor Control, Trunk Muscles Strength and Level of Perceived Fatigue: A Randomized Controlled Trial.

Purpose: The aim of the study was to evaluate the effects of motor imagery (MI) and action observation (AO) combined with a motor control exercises program for the lumbopelvic region. Method: Forty-five asymptomatic individuals were randomized into three groups: MI (n = 15), AO (n = 15) or control group (CG) (n = 15). The outcome measures included lumbopelvic motor control measured with a stabilizer pressure biofeedback, trunk muscle strength using a dynamometer and the perceived fatigue using a visual analogue scale. Participants were assessed at pre-intervention, at first week of intervention (mid) and post-intervention. Results: Regarding lumbopelvic motor control, we observed significant within-group differences between pre- and the mid and post-intervention assessment in AO group (p < .001, d > 0.80). MI and CG groups showed significant differences between pre- and post-intervention assessment (p < .05, d > 0.80). Regarding the direct comparison in the ΔMid-Pre differences between groups, only the AO group was superior to the CG with a large effect size (d > 0.80). Regarding trunk muscle strength, significant within-group differences between pre- and post-intervention assessments were observed in AO (p < .001, d = -1.25) and MI (p < .05, d = -1.00) groups. In relation to the perceived fatigue, statistically significant within-group differences were found in all groups (p < .05, d > 0.60). Conclusion: AO training caused faster changes in lumbopelvic motor control compared with the CG group. The AO strategy could be used as a guideline for teaching lumbopelvic motor control exercises.

Mental practice in isolation improves cervical joint position sense in patients with chronic neck pain: a randomized single-blind placebo trial.

OBJECTIVE: The main objective of this trial was to assess whether action observation (AO) training and motor imagery (MI) produced changes in the cervical joint position sense (CJPS) both at the end of the intervention and 10 min postintervention compared with a placebo intervention in patients with nonspecific chronic neck pain (NSCNP). METHODS: A single-blind placebo clinical trial was designed. A total of 30 patients with NSCNP were randomly assigned to the AO group, MI group or placebo observation (PO) group. CJPS in flexion, extension and rotation movements in both planes were the main variables. RESULTS: The results obtained in the vertical plane showed that the AO group obtained greater improvements than the PO group in the CJPS in terms of cervical extension movement both at the end of the intervention and 10 min postintervention (p = .001, d = 1.81 and p = .004, d = 1.74, respectively), and also in cervical flexion movement, although only at 10 min after the intervention (p = .035, d = 0.72). In addition, the AO group obtained greater improvements than the MI group in the CJPS only at the end of the intervention in cervical extension movement (p = .041, d = 1.17). Regarding the left rotation cervical movement, both the MI and AO groups were superior to the PO group in both planes at the end of the intervention (p < .05, d > 0.80). CONCLUSIONS: Although both AO and MI could be a useful strategy for CJPS improvement, the AO group showed the strongest results. The therapeutic potential of the application of mental practice in a clinical context in the early stages of rehabilitation of NSCNP should be considered.

Motor Imagery and Action Observation of Specific Neck Therapeutic Exercises Induced Hypoalgesia in Patients with Chronic Neck Pain: A Randomized Single-Blind Placebo Trial.

The aim of the present study was to explore the pain modulation effects of motor imagery (MI) and action observation (AO) of specific neck therapeutic exercises both locally, in the cervical region, and remotely. A single-blind, placebo clinical trial was designed. A total of 30 patients with chronic neck pain (CNP) were randomly assigned to an AO group, MI group, or placebo observation (PO) group. Pain pressure thresholds (PPTs) of C2/C3, trapezius muscles, and epicondyle were the main outcome variables. Secondary outcomes included heart rate measurement. Statistically significant differences were observed in PPTs of the cervical region in the AO and MI groups between the preintervention and first postintervention assessment. Significant differences were found in the AO group in the epicondyle between the preintervention, first and second post-intervention assessments. Regarding heart rate response, differences were found in the AO and MI groups between the preintervention and average intervention measurements. AO and MI induce immediate pain modulation in the cervical region and AO also induces remote hypoalgesia. OA appears to lead to greater pain modulation as well as a greater heart rate response, however, both should be clinically considered in patients with CNP.

Effect of laterality discrimination on joint position sense and cervical range of motion in patients with chronic neck pain: a randomized single-blind clinical trial.

Purpose: The main objective of the present study was to evaluate the effects of laterality discrimination training on neck joint position sense and cervical range of motion (ROM) in patients with chronic non-specific neck pain (NSCNP). Materials and methods: Forty-eight patients with NSCNP were randomly assigned to the neck group (NG) that observed neck images or the foot group (FG) that observed foot images. Response time, response accuracy, cervical ROM, and joint position error (JPE) were the main variables. The secondary outcome measures included psychosocial variables. Results: Differences between groups in the cervical ROM for flexion (p = .043) were obtained, being NG group the one which obtained greater values. NG showed an improvement in right rotation (p = .018) and a decrease in flexion was found in the FG (p = .039). In JPE, differences between groups were obtained in the left rotation (p = .021) and significant changes were found in the NG for flexion, extension, and left rotation movements (p < .05). Moderate associations were found between left and right accuracy regarding to post-intervention flexion and right rotation (r = 0.46, r = 0.41; p < .05) in NG. Conclusion: Improvements in cervical range of motion and joint position sense are obtained after the performance of the laterality discrimination task of images of the neck but not the feet. Visualization of images of the painful region presents moderate correlations with the accuracy and response time in the movements of flexion and right rotation.

Postneedling Soreness and Tenderness After Different Dosages of Dry Needling of an Active Myofascial Trigger Point in Patients With Neck Pain: A Randomized Controlled Trial.

BACKGROUND: Previous studies in asymptomatic subjects have demonstrated that myofascial trigger point (MTrP) dry needling frequently is associated with postneedling soreness. However, to the authors' knowledge, there is not any study that performs a detailed description of postneedling soreness characteristics in patients with myofascial pain. This information could help clinicians to make evidence-informed decisions considering the benefits and negative effects of different dry needling dosages. OBJECTIVE: To (1) compare the prevalence, intensity, and duration of postneedling soreness and tenderness after different dosages of deep dry needling (DDN) and (2) analyze the influence on postneedling soreness of psychological factors and other factors involved in the DDN process DESIGN: 1-week follow-up, double-blind randomized controlled trial. SETTING: University community. PARTICIPANTS: Patients (n = 120: 34 male; 86 female) aged 18-53 years (median ± interquartile range, 21.0 ± 7.0 years) with active MTrPs in the upper trapezius. INTERVENTION: All patients received DDN in an active MTrP. They were randomly divided into 4 groups: no local twitch responses (LTRs) elicited (control group), 4 LTRs elicited, 6 LTRs elicited, and DDN until no more LTRs were elicited. MAIN OUTCOME MEASURES: Postneedling soreness and pressure pain threshold were assessed before treatment, during DDN procedure, and every 24 hours during 1 week. RESULTS: Postneedling soreness showed a significant effect for time (F2,006 = 173.603; P < .001, ηp2 = 0.659) and a significant interaction between group and time (F6,017 = 3.763; P = .001; ηp2 = 0.111). Pressure pain threshold showed a significant effect for time (F2,377 = 16.833; P < .001; ηp2 = 0.127) and a significant interaction between group and time (F7,130 = 2.100; P = .04; ηp2 = 0.052). Psychological factors did not show relevant correlations with the intensity of postneedling soreness. CONCLUSIONS: Postneedling soreness is present in most of subjects after DDN of active MTrPs. The groups in which DDN was performed eliciting LTRs exhibited greater post-needling soreness. The number of needle insertions was associated with postneedling soreness but psychological factors did not seem to play a relevant role on its perception. CLINICAL TRIAL REGISTRATION NUMBER: NCT02190890 LEVEL OF EVIDENCE: I.

Effectiveness of Different Deep Dry Needling Dosages in the Treatment of Patients With Cervical Myofascial Pain: A Pilot RCT.

OBJECTIVE: To assess the effectiveness of different dosages of local twitch responses (LTRs) elicited by deep dry needling (DDN) in relation to pain intensity, pressure pain threshold (PPT), cervical range of movement (CROM), and disability degree in cervical myofascial pain patients. DESIGN: A randomized, double-blind clinical trial. PARTICIPANTS: Eighty-four patients (21 males, 63 females; 27.18 ± 10.91 yrs) with cervical pain. INTERVENTIONS: DDN in active myofascial trigger points (MTrPs) in the upper trapezius. Patients were randomly divided into four groups: (a) no LTRs elicited, (b) four LTRs elicited, (c) six LTRs elicited, and (d) needling until no more LTRs were elicited. OUTCOME MEASURES: Pain intensity, PPT, CROM, and disability degree were assessed before treatment, post-immediate, 48 hrs, 72 hrs, and 1 wk after treatment. RESULTS: Significant differences were found in the time factor for all the variables (P < 0.005), but no significant changes were found in the group-time interaction (P > 0.05). CONCLUSIONS: DDN in the upper trapezius MTrP improved pain at a 1-wk follow-up, but improvements were not significantly different among DDN dosages. A higher number of patients with neck pain improvements superior to the moderate clinically important differences were observed when eliciting 6 LTRs and LTRs until exhaustion compared with not eliciting LTRs.

Role of anxiety and brooding in specificity of autobiographical recall.

Overgeneral schemas and lack of autobiographical memory (AM) specificity about our past experiences can predict mood disturbance. Rumination, functional avoidance and executive processes are the main explanatory variables of such overgenerality. However, in non-clinical samples, rumination predicts overgenerality most consistently after the induction of dysphoric mood. Anxiety also activates rumination. Furthermore, anxiety predicts memory performance and has effects on mood which are independent of the effects of rumination. So, what might be the role of anxiety in autobiographical memory performance? A sample of 210 voluntary participants reported measures of autobiographical memory, anxiety, rumination (brooding and reflection), functional avoidance and executive functions (semantic and phonetic verbal fluency task). Autobiographical performance (specificity) was negatively associated with brooding and age and positively with phonetic verbal fluency but not with functional avoidance and anxiety. However, anxiety and brooding were positively correlated even after controlling for depression scores. Moreover, using structural equation modeling, anxiety showed a significant indirect effect on autobiographical specificity through brooding rumination. These results suggest a possible association of anxiety with autobiographical recall through brooding rumination.