Four articles on PainSci cite Couto 2013: (1) The Complete Guide to Trigger Points & Myofascial Pain (2) The Complete Guide to Chronic Tension Headaches (3) The Complete Guide to Neck Pain & Cricks (4) Complete Guide to Frozen Shoulder
PainSci notes on Couto 2013:
This study was conducted based on the premise that sticking needles in trigger points is an effective treatment for pain, and they wanted to find out which method works better: dry needling or wet needling (lidocaine injection). That’s a bit of dodgy way to start, but they did compare both types to a proper sham (a deactivated electroacupuncture device that patients were told was “a high-frequency, low-intensity stimulation and that they would most likely feel no sensation from it.”)
They worked with 70 female patients who had “experienced limitations in their routine activities due to MPS … as confirmed by an independent examiner” and excluding eliminating a variety of other common diagnoses. The primary outcomes measured were pain, sensitivity to pressure, and pain-killer usage over several weeks of treatment (plus some secondary measures, like sleep quality, that seem highly vulnerable to confounding factors).
All the women improved, including those who received only a sham (as they always do), but the researchers concluded that dry needling produced the greatest improvement.
After a week, the improvement in pain compared to sham was detectable but trivial. Needling gained a little ground each week, until those patients were enjoying a stastically and clinically significant lead over the other groups: about one point better on a 10-point scale than wet needling, a couple points better than the sham. Results were similar with pressure tolerance and pain-killer usage.
How clinically significant the difference was is debatable. It’s not enough of a difference to seem like a “powerful” treatment, and that’s the damning-with-faint-praise problem that afflicts so many “positive” studies of pain treatments.
The other concern I have about is that it was a fairly large, relatively long-term study, which is both a strength and a weakness. Such a complex study presents plenty of opportunities for p-hacking, for statistical jiggery pokery … and the text is overflowing with assumptions that betray a strong bias in favour of needling. These authors clearly were looking for a “win,” and so I just flat out don’t trust the conclusion.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
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.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.
- Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Nakale 2018 Foot Ankle Int.
- No Added Benefit of Combining Dry Needling With Guideline-Based Physical Therapy When Managing Chronic Neck Pain: A Randomized Controlled Trial. Stieven 2020 J Orthop Sports Phys Ther.
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.