Paraspinal Dry Needling

Wed, 8 Oct 2008

Comparison of dry needling with and without paraspinal needling for trigger points in elderly patients.

Hyuk GA, Choi J, Park C, Yoon H. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. Journal of Alternative and Complementary Medicine 2007;13(6):617-623.

Why Was This Study Conducted?

The objective of this study was to compare the use of dry needling with and without paraspinal needling for the treatment of myofascial trigger points in elderly patients.

What Were The Parameters Of This Study?

Forty patients with an average age of 75 years were selected, and all participants suffered from chronic myofascial pain syndrome in their upper trapezius.

The participants were randomly divided into two groups. The first group received dry needing of myofascial trigger points (DRY), and the second group received both dry needling of myofascial trigger points and intramuscular stimulation (IMS). There were no significant differences between the two groups for age, gender or body mass index.

All treatments were performed with the participant lying prone. Members of the DRY group were needled backwards and forwards with an acupuncture needle with the therapist holding the relative taut muscle bands between the thumb and index finger. This action was repeated until there were no more localised twitch responses.

The IMS group received the treatment described above, and additional needling in the multifidi muscles at C3 and C5 level. The additional needling was done using a different method from the 'pecking' method used in dry needling. The IMS treatment involved first dry needling the muscle and then rotating it using a plunger-type needle holder until the therapist could feel a grasping in the muscle.

How Were The Measurements Taken?

Pain intensity in the head, neck and shoulder was measured using an eleven point visual analogue scale (VAS) with 0 indicating no pain and 10 indicating extreme pain, and the six point Wong-Baker FACES pain scale (FACES) with 0 indicating no pain and 5 indicating extreme pain.

Participants' pain pressure thresholds scores (PTS) were obtained using thumb pressure on the trigger point until there was a whitening in the nail bed and then evaluating the pain intensity. This was scored on a scale of 0 to 3 with 0 indicating no pain or visible reaction, 1 some pain, 2 painful tenderness and visible facial reaction and 3 severe pain and a marked facial reaction.

Range of movement (ROM) was measured using a specialised measuring device called a goniometer. The Geriatric Depression Scale-Short Form (GDS-SF) was used on days 0 and 28 to measure depression.

What Were The Results?

The results showed significant improvements in pain intensity for both groups in the VAS, FACES and PTS scores. There were no significant differences between time and type of treatments between groups for VAS and PTS, but FACE showed a borderline significance in favour of the IMS group.

GDS-SF values showed no significant differences in the DRY group at the end of the study. However, the IMS group showed a significant improvement for depression.

All ROM measurements improved significantly in both groups except for extension in the DRY group. There were no significant differences between the two groups for levels or duration of post treatment soreness. None of the participants showed visible signs of hemorrhaging.

What Did The Researchers Conclude?

The researchers concluded that 'dry needling of trigger points with paraspinal needling is suggested to be a better method than dry needling of trigger points only for treating myofascial pain syndrome in elderly patients, but further studies are needed for verification'.

What Were The Limitations Of This Study?

The researchers highlighted two limitations. The first limitation was that pain threshold measurements were taken using the thumb as opposed to specialised equipment in the form of an algometer. The second limitation was, with the exception of day 0, those responsible for taking measurements were not blinded as to which treatment the participants received.