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Physiotherapy Research Reviews — 12 Studies Reviewed Monthly

Key Points

Dry needling was not superior to sham needling for treatment of neck pain thought to be caused by myofascial trigger points in patients with chronic idiopathic neck pain.
Dry needling and sham needling both failed to create meaningful effects in the primary outcome measure, which was distant pain pressure threshold.

BACKGROUND & OBJECTIVE

Dry needling is a common treatment for neck pain. It has been proposed that dry needling can treat myofascial trigger points which may be causing neck pain, and that such treatment can reduce pain through neurophysiological effects. The precise nature of these effects are unknown.

To investigate this issue, this study compared the effects of dry needling versus sham needling on local and distant pressure pain thresholds, and conditioned pain modulation in patients with chronic idiopathic neck pain.

Dry needling is a common treatment for neck pain.

There were no significant differences between the groups for any of the outcome measures.

METHODS

54 participants with chronic idiopathic neck pain were divided into two groups: dry needling and sham needling.
Both groups were informed that the needling intervention was designed to treat trigger points that may be causing the pain. Both groups received a single needling intervention at the upper trapezius of the more painful side of the neck.
For the dry needling group, the therapist attempted to insert the needle into a trigger point and elicit a local twitch response, which is thought to indicate a successful needle placement. In the sham needling group, the needle was inserted in the location of a trigger point but was not inserted deep enough to penetrate the fascia or elicit a local twitch response.
The primary outcome was pressure pain threshold (PPT) in the quadriceps to measure distant pain sensitivity/hyperalgesia. Secondary outcomes were PPTs on both upper trapezius muscles, and conditioned pain modulation (CPM) effects during hot water immersion.
Patients were assessed before and immediately after the interventions. Linear mixed models were used to assess differences between the groups.

RESULTS

There were no significant differences between the two groups for nearly all of the outcome measures.
Dry needling and sham needling both failed to create a difference in the primary outcome measure (PPT in the quadriceps) that was clinically significant (MCID), or that even exceeded the range of potential measurement error (MCD).
The authors concluded that the data showed no immediate superior effect of dry needling compared to sham needling on local and distant PPTs and CPM in patients with chronic idiopathic neck pain.

LIMITATIONS

There was only one measurement immediately after the intervention, so the longer-term effects of the intervention are unknown. It is possible that the dry needling group would have done better in the longer term, because this group might have had more muscle soreness immediately following the intervention, and this would tend to reduce over time.
The therapists were not blinded as to whether the intervention was a sham, and this may have affected the outcome.
The sham needling group may have received treatment effects from the needle penetrating the skin, even though it did not affect the trigger point.

CLINICAL IMPLICATIONS

Neck pain may be caused in part by altered processing of nociception in the spinal cord, which may be related to central sensitivity and/or lack of endogenous pain inhibition efficiency (1). A variety of assessments have been recommended to test for these conditions, including comparisons of local and distant PPTs and assessments of conditioned pain modulation (2,3).

Dry needling is a common intervention for neck pain that purports to treat myofascial trigger points that may be causing some form of central sensitivity or impaired endogenous pain inhibition (4,5).

The goal of the study was to examine the neurophysiological effects of dry needling by comparing it to sham needling regarding its immediate effects on local and distant PPTs, as well as CPM.

It was hypothesized that dry needling would be superior to sham needling in: (1) increasing distant and local PPTs, indicating less central sensitivity, and/or (2) increasing measures of CPM, reflecting more efficient pain inhibition.

However, there were no significant differences between the groups for any of the outcome measures. Clinicians should interpret this study as failing to provide evidence that dry needling is superior to sham needling for treatment of chronic idiopathic neck pain.

+STUDY REFERENCE

Chys M, Bontinck J, Voogt L, Sendarrubias G, Cagnie B, Meeus M, De Meulemeester K (2023) Immediate effects of dry needling on pain sensitivity and pain modulation in patients with chronic idiopathic neck pain: a single-blinded randomized clinical trial, Brazilian Journal of Physical Therapy, 27(1).

SUPPORTING REFERENCE

Coppieters I, De Pauw R, Kregel J, Malfliet A, Goubert D, Lenoir D, et al. Differences between women with traumatic and idio- pathic chronic neck pain and women without neck pain: interre- lationships among disability, cognitive deficits, and central sensitization. Phys Ther. 2017;97(3):338353.
Coronado RA, George SZ. The central sensitization inventory and pain sensitivity questionnaire: an exploration of construct validity and associations with widespread pain sensitivity among individuals with shoulder pain. Musculoskelet Sci Pract. 2018;36:6167.
Yarnitsky D, Bouhassira D, Drewes A, Fillingim R, Granot M, Hanson P, et al. Recommendations on practice of conditioned pain modulation (CPM) testing. Eur J Pain. 2015;19(6):805806.
Niddam DM, Chan RC, Lee SH, Yeh TC, Hsieh JC. Central modulation of pain evoked from myofascial trigger point. Clin J Pain. 2007;23(5):440448.
Stieven FF ,Ferreira GE, deAraujo FX, Angellos RF, Silva MF, da Rosa LHT. Immediate effects of dry needling and myofascial release on local and widespread pressure pain threshold in individuals with active upper trapezius trigger points: a randomized clinical trial. J ManipulPhysiolTher. 2021;44 (2):95102.