Trigger point size and pain reduced by dry needling
Two articles on PainSci cite Müller 2015: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. The Complete Guide to Neck Pain & Cricks
PainSci commentary on Müller 2015: ?This page is one of thousands in the PainScience.com 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.
- “Microscopic features and transient contraction of palpable bands in canine muscle,” Simons et al, Am J Phys Med, 1976.
- “Endplate potentials are common to midfiber myofacial trigger points,” Simons et al, Am J Phys Med Rehabil, 2002.
- “Accelerated muscle fatigability of latent myofascial trigger points in humans,” Ge et al, Pain Med, 2012.
- “Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points,” Ge et al, Exp Brain Res, 2008.
- “Assessment of myofascial trigger points (MTrPs): a new application of ultrasound imaging and vibration sonoelastography,” Sikdar et al, Conf Proc IEEE Eng Med Biol Soc, 2008.
- “Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome,” Shah et al, Journal of Bodywork & Movement Therapies, 2008.
- “Ability of magnetic resonance elastography to assess taut bands,” Chen et al, Clin Biomech (Bristol, Avon), 2008.
- “Identification and quantification of myofascial taut bands with magnetic resonance elastography,” Chen et al, Archives of Physical Medicine & Rehabilitation, 2007.
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:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.