Objective To evaluate current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with neck and shoulder pain. Data Sources PubMed, EBSCO, Physiotherapy Evidence Database, ScienceDirect, The Cochrane Library, ClinicalKey, Wanfang Data Chinese database, China Knowledge Resource Integrated Database, Chinese Chongqing VIP Information, and SpringerLink databases were searched from database inception to January 2014. Study Selection Randomized controlled trials were performed to determine whether dry needling was used as the main treatment and whether pain intensity was included as an outcome. Participants were diagnosed with MTrPs associated with neck and shoulder pain. Data Extraction Two reviewers independently screened the articles, scored methodological quality, and extracted data. The results of the study of pain intensity were extracted in the form of mean and SD data. Twenty randomized controlled trials involving 839 patients were identified for meta-analysis. Data Synthesis Meta-analyses were performed using RevMan version 5.2 and Stata version 12.0. The results suggested that compared with control/sham, dry needling of MTrPs was effective in the short term (immediately to 3 days) (standardized mean difference [SMD]=−1.91; 95% confidence interval [CI], −3.10 to −.73; P =.002) and medium term (SMD=−1.07; 95% CI, −1.87 to −.27; P =.009); however, wet needling (including lidocaine) was superior to dry needling in relieving MTrP pain in the medium term (SMD=1.69; 95% CI, .40–2.98; P =.01). Other therapies (including physiotherapy) were more effective than dry needling in treating MTrP pain in the medium term (9–28d) (SMD=.62; 95% CI, .02–1.21; P =.04). Conclusions Dry needling can be recommended for relieving MTrP pain in neck and shoulders in the short and medium term, but wet needling is found to be more effective than dry needling in relieving MTrP pain in neck and shoulders in the medium term.
Summary Background and purpose: The aim of this systematic review with meta-analysis is to determine the effect of dry needling in the treatment of MTrPs. Methods Searches were performed using the electronic databases AMED, EBM reviews, Embase, and Ovid MEDLINE (all from database inception-February 2012). Study selection Randomized controlled trials (RCTs) were included if they compared dry needling with another form of treatment or placebo and included pain intensity as an outcome. Data extraction Two blinded reviewers independently screened the articles, scored their methodological quality and extracted data. Quality assessment Physiotherapy Evidence Database (PEDro) quality scale and the Cochrane risk of bias tool were used. Results Four RCTs compared dry needling to lidocaine and one RCT compared dry needling to placebo. Meta-analyses of dry needling revealed no significant difference between dry needling and lidocaine immediately after treatment standardized mean difference (SMD) 0.41 (95%CI −0.15 to 0.97), at one month (SMD −1.46; 95% CI −2.04 to 4.96) and three to six months (SMD −0.28; 95% CI −0.63 to 0.07). Discussion Although not significant in the meta-analyses, there were interesting patterns favoring lidocaine immediately after treatment and dry needling at three to six months.
BACKGROUND: Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs).
OBJECTIVES: To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs.
SEARCH METHODS: We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012.
SELECTION CRITERIA: We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies.
DATA COLLECTION AND ANALYSIS: Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models.
RESULTS: We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls.
AUTHORS' CONCLUSIONS: Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain.
Conception de l'étude: examen systématique et méta-analyse. CONTEXTE: Le syndrome de la douleur myofasciale (MPS) est associée à des zones hyperalgésiques dans les muscles appelés points de déclenchement myofascial (PDM). Lorsque la palpation, MTrPs actifs provoquent des symptômes locaux ou visé, y compris la douleur. Aiguilletage à sec consiste à insérer une aiguille d'acupuncture-like dans un MTrP dans le but de réduire la douleur et la restauration de l'amplitude des mouvements. Objectif: explorer les données probantes concernant l'efficacité de la DN pour réduire la douleur chez les patients atteints de MPS du quart supérieur. Méthodes: Une recherche documentaire électronique a été réalisée en utilisant le mot-clé "aiguilletage sec." Les articles identifiés par la recherche ont été criblées pour les critères d'inclusion suivants: des sujets humains, des essais contrôlés randomisés (ECR), le groupe d'intervention d'aiguilletage sec, et les députés impliquant le quart supérieur. Les ECR qui répondaient à nos critères ont été évalués et ont marqué pour la validité interne avec la liste de contrôle de la qualité MacDermid. Quatre méta-analyses distinctes ont été effectuées: (1) aiguilletage sec par rapport à simulacre ou de contrôle, effets immédiats; (2) aiguilletage sec par rapport à simulacre ou de contrôle, 4 semaines; (3) aiguilletage sec par rapport à d'autres traitements, les effets immédiats; ( 4) aiguilletage sec par rapport à d'autres traitements, 4 semaines. RÉSULTATS: La recherche initiale a abouti à 246 articles. Douze ECR ont été finalement sélectionnés. Les scores de qualité méthodologique ont varié de 23 à 40 points avec une moyenne de 34 points (étendue de l'échelle 0-48, note-48 meilleur possible). Les résultats de 3 études qui aiguilletage sec par rapport au trompe-l'œil ou un traitement placebo fournir la preuve que aiguilletage sec peut immédiatement réduire la douleur chez les patients atteints de MPS de quart supérieur, avec un effet global favorisant aiguilletage sec. Les résultats de 2 études qui aiguilletage sec par rapport au trompe-l'œil ou un traitement placebo fournir la preuve que aiguilletage sec peut réduire la douleur au bout de 4 semaines chez les patients atteints de MPS trimestre supérieurs, même si un large intervalle de confiance pour l'effet global limite l'impact de l'effet. Les conclusions des études qui aiguilletage sec par rapport à d'autres traitements ont été très hétérogène, très probablement en raison de la variance dans les traitements de comparaison. Il existe des preuves à partir de 2 études que la lidocaïne injection peut être plus efficace dans la réduction de la douleur que aiguilletage sec à 4 semaines. CONCLUSIONS: Basé sur les meilleures données actuellement disponibles, il est recommandé (grade A) aiguilletage sec, par rapport au trompe-l'œil ou un placebo, pour diminuer la douleur (immédiatement après le traitement et après 4 semaines) chez les patients atteints de MPS trimestre supérieurs. En raison du petit nombre de haute qualité ECR publiés à ce jour, des études bien conçues supplémentaires sont nécessaires pour informer l'évolution future de cette recommandation. QUALITÉ DES PREUVES: Therapy, niveau 1A-.J Orthop Sport Phys Ther, Epub 11 Juin 2013. doi: 10.2519/jospt.2013.4668.
Objective To evaluate current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with neck and shoulder pain. Data Sources PubMed, EBSCO, Physiotherapy Evidence Database, ScienceDirect, The Cochrane Library, ClinicalKey, Wanfang Data Chinese database, China Knowledge Resource Integrated Database, Chinese Chongqing VIP Information, and SpringerLink databases were searched from database inception to January 2014. Study Selection Randomized controlled trials were performed to determine whether dry needling was used as the main treatment and whether pain intensity was included as an outcome. Participants were diagnosed with MTrPs associated with neck and shoulder pain. Data Extraction Two reviewers independently screened the articles, scored methodological quality, and extracted data. The results of the study of pain intensity were extracted in the form of mean and SD data. Twenty randomized controlled trials involving 839 patients were identified for meta-analysis. Data Synthesis Meta-analyses were performed using RevMan version 5.2 and Stata version 12.0. The results suggested that compared with control/sham, dry needling of MTrPs was effective in the short term (immediately to 3 days) (standardized mean difference [SMD]=−1.91; 95% confidence interval [CI], −3.10 to −.73; P =.002) and medium term (SMD=−1.07; 95% CI, −1.87 to −.27; P =.009); however, wet needling (including lidocaine) was superior to dry needling in relieving MTrP pain in the medium term (SMD=1.69; 95% CI, .40–2.98; P =.01). Other therapies (including physiotherapy) were more effective than dry needling in treating MTrP pain in the medium term (9–28d) (SMD=.62; 95% CI, .02–1.21; P =.04). Conclusions Dry needling can be recommended for relieving MTrP pain in neck and shoulders in the short and medium term, but wet needling is found to be more effective than dry needling in relieving MTrP pain in neck and shoulders in the medium term.
