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Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial

PainSci » bibliography » Llamas-Ramos et al 2014
Tags: dry needling, muscle pain, muscle, pain problems, treatment

Two articles on PainSci cite Llamas-Ramos 2014: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Neck Pain & Cricks

PainSci commentary on Llamas-Ramos 2014: ?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.

A biggish short-term study of dry needling for trigger points, comparing it to massage in 94 neck pain patients. The risk of bias is high, based on the authors’ excessively optimistic acceptance of Kietrys 2013 (as indicated in their response to a letter to the editor).

Pain, disability, range of motion, and sensitivity to pressure were all measured before and then up to two weeks after treatment. There was no difference on first three of the four outcomes measured, and only a small one on the fourth and least important measure (pressure sensitivity on the tip of the C7 vertebrae, which is an odd choice). In my opinion, that one difference is not meaningful.

This study strongly suggests that there is no advantage at all to needling over massage for trigger points: they are either equally effective for neck pain, or equally ineffective!

~ 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.

STUDY DESIGN: Randomized clinical study.

OBJECTIVES: To compare the effects of trigger point (TrP) dry needling (DN) and TrP manual therapy (MT) on pain, function, pressure pain sensitivity, and cervical range of motion in subjects with chronic mechanical neck pain.

BACKGROUND: Recent evidence suggests that TrP DN could be effective in the treatment of neck pain. However, no studies have directly compared the outcomes of TrP DN and TrP MT in this population.

METHODS: Ninety-four patients (mean ± SD age, 31 ± 3 years; 66% female) were randomized into a TrP DN group (n = 47) or a TrP MT group (n = 47). Neck pain intensity (11-point numeric pain rating scale), cervical range of motion, and pressure pain thresholds (PPTs) over the spinous process of C7 were measured at baseline, postintervention, and at follow-ups of 1 week and 2 weeks after treatment. The Spanish version of the Northwick Park Neck Pain Questionnaire was used to measure disability/function at baseline and the 2-week follow-up. Mixed-model, repeated-measures analyses of variance (ANOVAs) were used to determine if a time-by-group interaction existed on the effects of the treatment on each outcome variable, with time as the within-subject variable and group as the between-subject variable.

RESULTS: The ANOVA revealed that participants who received TrP DN had outcomes similar to those who received TrP MT in terms of pain, function, and cervical range of motion. The 4-by-2 mixed-model ANOVA also revealed a significant time-by-group interaction (P<.001) for PPT: patients who received TrP DN experienced a greater increase in PPT (decreased pressure sensitivity) than those who received TrP MT at all follow-up periods (between-group differences: posttreatment, 59.0 kPa; 95% confidence interval [CI]: 40.0, 69.2; 1-week follow-up, 69.2 kPa; 95% CI: 49.5, 79.1; 2-week follow-up, 78.9 kPa; 95% CI: 49.5, 89.0).

CONCLUSION: The results of this clinical trial suggest that 2 sessions of TrP DN and TrP MT resulted in similar outcomes in terms of pain, disability, and cervical range of motion. Those in the TrP DN group experienced greater improvements in PPT over the cervical spine. Future trials are needed to examine the effects of TrP DN and TrP MT over long-term follow-up periods.

LEVEL OF EVIDENCE: Therapy, level 1b.

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