Efficacy of Dry Needling Versus Transcutaneous Electrical Nerve Stimulation in Patients With Neck Pain Due to Myofascial Trigger Points: A Randomized Controlled Trial

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2023 Apr 24

PMID 37090321

Authors

Anjana G

Anil K Gupta

Dileep Kumar

Sudhir Mishra

Ganesh Yadav

Madhumita Singha Roy

Laxmi Prajapti

Affiliations

Soon will be listed here.

Abstract

Introduction Myofascial pain is defined as pain arising primarily in muscles and associated with multiple trigger points. Among the non-pharmacological methods, trigger point injection and electrotherapy are effective methods to treat myofascial pain syndrome. This study compares the effectiveness of dry needling (DN) and transcutaneous electrical nerve stimulation (TENS) in reducing cervical pain intensity and improving cervical range of motion in patients with neck pain due to myofascial trigger points. Methods Fifty patients were enrolled and randomized into two groups. Patients in group A received dry needling, and those in group B received TENS. Patients were evaluated using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Cervical Range of Motion (CROM) before the treatment and on days 14 and 28 after the treatment. The unpaired t-test was used to evaluate quantitative data, except for VAS, where the Mann-Whitney U test was used. All quantitative variables had a normal distribution with a standard deviation except for pain intensity (VAS), which deviated from the normal distribution. The significance level was set at a P-value=0.05. Results Both DN and TENS groups showed significant improvement in VAS, NDI, and CROM between days 0 and 28 (p=<0.001). The DN group showed greater improvements in pain intensity from day 0 to day 28 (p =<0.001). Between days 0 and 28, there was no discernible difference in NDI changes between the groups (p = 0.157 and p = 0.799, respectively). Mixed results were obtained for CROM, with significant improvement of cervical flexion in the dry needling group (p=<0.008) and significant improvement of cervical rotation to the painful side in the TENS group (<0.001). Conclusion Both dry needling and TENS are effective in reducing pain and improving NDI and CROM in patients with neck pain due to myofascial trigger points. However, as dry needling is more effective in pain reduction, a single session of dry needling is more beneficial and cost-effective as compared to multiple sessions of TENS.

References

Hogg-Johnson S, van der Velde G, Carroll L, Holm L, Cassidy J, Guzman J . The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009; 32(2 Suppl):S46-60. DOI: 10.1016/j.jmpt.2008.11.010. View

Ziaeifar M, Arab A, Karimi N, Nourbakhsh M . The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. J Bodyw Mov Ther. 2014; 18(2):298-305. DOI: 10.1016/j.jbmt.2013.11.004. View

Rollman G, Lautenbacher S . Sex differences in musculoskeletal pain. Clin J Pain. 2001; 17(1):20-4. DOI: 10.1097/00002508-200103000-00004. View

Gerwin R . Diagnosis of myofascial pain syndrome. Phys Med Rehabil Clin N Am. 2014; 25(2):341-55. DOI: 10.1016/j.pmr.2014.01.011. View

Ardic F, Sarhus M, Topuz O . Comparison of two different techniques of electrotherapy on myofascial pain. J Back Musculoskelet Rehabil. 2012; 16(1):11-6. DOI: 10.3233/bmr-2002-16103. View

Yap E . Myofascial pain--an overview. Ann Acad Med Singap. 2007; 36(1):43-8. View

Gauns S, Gurudut P . A randomized controlled trial to study the effect of gross myofascial release on mechanical neck pain referred to upper limb. Int J Health Sci (Qassim). 2018; 12(5):51-59. PMC: 6124822. View

Wolfe F, Clauw D, Fitzcharles M, Goldenberg D, Hauser W, Katz R . 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016; 46(3):319-329. DOI: 10.1016/j.semarthrit.2016.08.012. View

Leon-Hernandez J, Martin-Pintado-Zugasti A, Frutos L, Alguacil-Diego I, de la Llave-Rincon A, Fernandez-Carnero J . Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain. Braz J Phys Ther. 2016; 20(5):422-431. PMC: 5123263. DOI: 10.1590/bjpt-rbf.2014.0176. View

10.

Vernon H . The Neck Disability Index: state-of-the-art, 1991-2008. J Manipulative Physiol Ther. 2008; 31(7):491-502. DOI: 10.1016/j.jmpt.2008.08.006. View

11.

Azatcam G, Simsir Atalay N, Akkaya N, Sahin F, Aksoy S, Zincir O . Comparison of effectiveness of Transcutaneous Electrical Nerve Stimulation and Kinesio Taping added to exercises in patients with myofascial pain syndrome. J Back Musculoskelet Rehabil. 2016; 30(2):291-298. DOI: 10.3233/BMR-150503. View

12.

Skootsky S, Jaeger B, Oye R . Prevalence of myofascial pain in general internal medicine practice. West J Med. 1989; 151(2):157-60. PMC: 1026905. View

13.

Gerwin R . Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001; 5(5):412-20. DOI: 10.1007/s11916-001-0052-8. View

14.

Ay S, Evcik D, Sonel Tur B . Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2009; 29(1):19-23. DOI: 10.1007/s10067-009-1307-8. View

15.

Boyles R, Fowler R, Ramsey D, Burrows E . Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther. 2016; 23(5):276-93. PMC: 4768380. DOI: 10.1179/2042618615Y.0000000014. View

16.

Sciotti V, Mittak V, DiMarco L, Ford L, Plezbert J, Santipadri E . 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. View

17.

Garcia-de-Miguel S, Pecos-Martin D, Larroca-Sanz T, Sanz-de-Vicente B, Garcia-Montes L, Fernandez-Matias R . Short-Term Effects of PENS versus Dry Needling in Subjects with Unilateral Mechanical Neck Pain and Active Myofascial Trigger Points in Levator Scapulae Muscle: A Randomized Controlled Trial. J Clin Med. 2020; 9(6). PMC: 7355914. DOI: 10.3390/jcm9061665. View

18.

Cerezo-Tellez E, Torres-Lacomba M, Fuentes-Gallardo I, Perez-Munoz M, Mayoral-Del-Moral O, Lluch-Girbes E . Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial. Pain. 2016; 157(9):1905-1917. DOI: 10.1097/j.pain.0000000000000591. View

19.

MacDowall A, Skeppholm M, Robinson Y, Olerud C . Validation of the visual analog scale in the cervical spine. J Neurosurg Spine. 2017; 28(3):227-235. DOI: 10.3171/2017.5.SPINE1732. View

20.

Abbaszadeh-Amirdehi M, Nakhostin Ansari N, Naghdi S, Olyaei G, Nourbakhsh M . Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. Acupunct Med. 2016; 35(2):85-92. PMC: 5466920. DOI: 10.1136/acupmed-2016-011082. View