Pain •Sensible advice for aches, pains & injuries

Trigger point needling for myofascial pain

Tags: treatment, muscle pain, acupuncture, injections, muscle, pain problems, mind, controversy, debunkery, energy work, medicine

PainSci summary of Couto 2013 ★★★☆☆?3-star ratings are for average studies, with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

This study found “significantly” better results from dry needling of trigger points. (That’s a method of lancing painful spots in muscle with acupuncture needles. To make them feel better. No, really, that is the idea.)

But that “significant” was the statistical sense of the word, meaning “real” not “large.” The abstract actually neglects to mention how much better the results were, which often means that the number wasn’t worth advertising. Sure enough, looking at the data, the decrease is just 2 points on a 10-point scale. That’s not nothing, but for someone who starts at a 6 or an 8, it’s not exactly a cure, is it? If it actually does work that “well” — assuming that these pro-IMS researchers (unconfirmed, but very likely) didn’t make any mistakes or do anything that might have skewed the data towards their bias a little — is a 2-point drop actually worth the high cost and discomfort of this treatment? An open question …

original abstract

BACKGROUND: There are different types and parameters of dry needling (DN) that can affect its efficacy in the treatment of pain that have not been assessed properly.

OBJECTIVE: To test the hypothesis that either multiple deep intramuscular stimulation therapy (MDIMST) or TrP lidocaine injection (LTrP-I) is more effective than a placebo-sham for the treatment of myofascial pain syndrome (MPS) and that MDIMST is more effective than LTrP-I for improving pain relief, sleep quality, and the physical and mental state of the patient.

METHODS: Seventy-eight females aged 20 to 40 who were limited in their ability to perform active and routine activities due to MPS in the previous 3 months were recruited. The participants were randomized into 1 of the 3 groups as follows: placebo-sham, LTrP-I, or MDIMST. The treatments were provided twice weekly over 4 weeks using standardized MDIMST and LTrP-I protocols.

RESULTS: There was a significant interaction (time vs. group) for the main outcomes. Compared with the sham-treated group, MDIMST and LTrP-I administration improved pain scores based on a visual analog scale, the pain pressure threshold (P<0.001 for all analyses), and analgesic use (P<0.01 for all analyses). In addition, when comparing the active groups for these outcomes, MDIMST resulted in better improvement than LTrP-I (P<0.01 for all analyses). In addition, both active treatments had a clinical effect, as assessed by a sleep diary and by the SF-12 physical and mental health scores.

CONCLUSIONS: This study highlighted the greater efficacy of MDIMST over the placebo-sham and LTrP-I and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities.

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