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Trigger point size and pain reduced by dry needling

PainSci » bibliography » Müller et al 2015
Tags: muscle pain, trigger points doubts, dry needling, muscle, pain problems, treatment

Two articles on PainSci cite Müller 2015: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Neck Pain & Cricks

PainSci commentary on Müller 2015: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

These reseachers tested trigger point treatment in 24 women who’d had shoulder pain for at least six months, presumed to be caused by trigger points in the trapezius muscles. They compared acupuncture and electroacupuncture to a sham treatment, and measured the size of the trigger points with ultrasonography and ultrasound elastography before and after.

(Acupuncture disclaimer: acupuncture does not work, and the use of acupuncture and electroacupuncture casts some doubt on the whole experiment. However, whether the authors saw it this way or not, it’s also just a test of the effect of inserting fine needles in or near trigger points — which happens to be a popular non-acupuncture treatment, “dry needling,” used by many physical therapists and doctors. In this study, the authors noted that some of the points they picked corresponded with suspected trigger points — ashi points, the acupuncture term for a tender point or trigger point. In other words, even though acupuncture doesn’t work, this was still a test of a popular form of trigger point therapy, at least partially.)

A standard set of acupuncture points was treated, plus up to two relevant ashi points in both trapezius muscles. For the sham, needles were inserted one centimetre from the real point.

Pain was reduced, and the trigger points decreased in size in all groups, but significantly more so in the treatment groups. The size of the effect on pain was clinically significant: pain dropped by about 2-3 points (on a 10-scale). Trigger points got about 30 to 50% smaller.

~ Paul Ingraham

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.

Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and AC treatment groups and the control sham AC (SHAM) group. Intensity of pain was assessed by visual analogue scale; MTrP mean area and strain ratio (SR) by 2D US and UE. A significant decrease of intensity in general, RTPz, and LTPz pain was observed in the EA group (p = 0.027; p < 0.001; p = 0.005, respectively) and in general pain in the AC group (p < 0.001). Decreased MTrP area in RTPz and LTPz were observed in AC (p < 0.001) and EA groups (RTPz, p = 0.003; LTPz, p = 0.005). Post-treatment SR in RTPz and LTPz was lower than pre-treatment in both treatment groups. 2D US and UE effectively characterized MTrP and surrounding tissue, pointing to the possibility of objective confirmation of subjective EA and AC treatment effects.

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