Effects of dry needling on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain: A randomized controlled pilot study

Alternative therapies in chronic non-cancer pain management: A scoping review of randomized controlled trials

BACKGROUND

Chronic pain is one of the most challenging health problems in modern society, placing significant burdens on individuals and healthcare systems. While pharmacological treatments remain the primary approach to pain management, their limitations often restrict choices for both clinicians and patients. In contrast, complementary therapies are gaining recognition for their potential effectiveness and safety. However, the current literature lacks a comprehensive summary of the role of complementary therapies in chronic pain management.

OBJECTIVE

This review aims to summarize the complementary therapies used in chronic non-cancer pain management, assess their practical applications, identify research gaps and limitations, and provide a comprehensive perspective for the development of chronic non-cancer pain management and personalized pain management strategies.

METHODS

This scoping review followed the PRISMA-ScR guidelines. Randomized controlled trials (RCTs) published in the last decade were retrieved from PubMed and Web of Science using the keywords "chronic pain" and "complementary therapy." Non-English studies were excluded.

RESULTS

A total of 848 RCTs were identified, of which 128 met the inclusion criteria. The included studies addressed chronic musculoskeletal pain (102 studies), chronic visceral pain (5 studies), chronic neuropathic pain (7 studies), and 13 studies that did not specify the pain type. The complementary therapies investigated included acupuncture, manual therapy, exercise therapy, psychological interventions, mind-body therapies, and physical modalities.

CONCLUSION

This review provides preliminary evidence supporting the efficacy and safety of complementary therapies in the management of chronic non-cancer pain. However, methodological and quality-related limitations were identified in the included studies. Future high-quality RCTs are needed to validate the long-term efficacy of these therapies, explore their mechanisms of action, and provide stronger evidence for their clinical application.

REGISTRATION

This scoping review is registered on the Open Science Framework (OSF) under the following DOI: https://doi.org/10.17605/OSF.IO/67K32.

A prospective clinical study to evaluate the comparative effectiveness of dry needling and laser therapy in neck and upper back myofascial pain syndrome

INTRODUCTION

Myofascial pain syndrome (MPS) is a disorder of the musculoskeletal system that is distinguished by the presence of pain, tenderness, muscle spasms, restricted joint range of motion, fatigue, and, in rare cases, autonomic dysfunction.

Research Trends in Dry Needling for Neck Pain Treatment: A Bibliometric Analysis

Objective

The objective of this study was to analyze the published literature on the utilization of dry needling in the management of neck pain.

Methods

We performed a bibliometric analysis of publications from January 1, 2002 to December 31, 2022. Using the Scopus database, articles about the utilization of dry needling in neck pain were found. Scopus analyzer was used to obtain results such as "documents by year," "source," "country," and so on. VOS viewer Version 1.6.18 was used to analyze various units such as "co-authorship," "co-occurrences," and "citation analysis."

Results

The search yielded 125 articles. Most articles were published in the years 2022, followed by 2021. A network analysis of various parameters reveals that the topic has a high research potential.

Conclusion

This bibliometric analysis offers an understanding of the literature on dry needling therapy for neck pain. The number of studies in this sector has increased over a decade. There is a gap in research from low- and middle-income countries on use of dry needling in the management of neck pain.

Unraveling the Mechanisms Behind the Short-Term Effects of Dry Needling: New Insights From a Mediation Analysis With Repeatedly Measured Mediators and Outcomes

OBJECTIVE

To explore the causal pathways underlying the short-term effects of deep dry needling (DDN) in people with chronic neck pain.

DESIGN

Explanatory longitudinal mediation analysis with repeatedly measured mediators and outcomes.

SETTING

Primary care setting.

PARTICIPANTS

Patients (N=128) with chronic neck pain.

INTERVENTIONS

Participants were randomized into 2 groups; DDN of the neck muscles combined with stretching (n=64) and stretching alone (n=64).

MAIN OUTCOME MEASURES

Two outcomes (pain intensity and neck pain-related disability) and 3 candidate mediators (local pressure pain thresholds [PPTs], cervical range of motion [ROM], and neck muscle strength) were included. Pain intensity was also included as a competing mediator in the mediation analysis for disability. Mediators and outcomes were measured at 3 time points: after intervention and at 2- and 4-week follow-up. Age, sex, and the baseline values of the outcome and mediators were included as pretreatment mediator-outcome confounders.

RESULTS

Reductions in pain intensity strongly mediated the short-term effects of DDN on disability, from after intervention to 4-week follow-up. In addition, the attenuation of local hypersensitivity (via increasing PPTs) moderately mediated reductions in pain intensity at each time point. On the other hand, gains in cervical ROM contributed to reducing neck pain-related disability. Changes in muscle strength did not lead to better outcomes.

CONCLUSIONS

This novel study demonstrated that DDN effect on neck pain-related disability is strongly driven by the analgesic effects of this physical therapy modality. Increasing PPTs and cervical ROM seem to be also part of the mechanisms behind DDN's effect.

Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial

PURPOSE

To evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain.

MATERIAL AND METHODS

A randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression.

RESULTS

No significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030).

CONCLUSION

The addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.

Immediate effects of dry needling on pain sensitivity and pain modulation in patients with chronic idiopathic neck pain: a single-blinded randomized clinical trial

BACKGROUND

Dry needling is frequently used for the treatment of neck pain but knowledge about its neurophysiological central effects is scarce.

OBJECTIVES

To compare the immediate effects of a single session of dry needling (DN) and sham needling (SN) on local and distant pressure pain thresholds and conditioned pain modulation in patients with chronic idiopathic neck pain.

METHOD

Participants with chronic idiopathic neck pain were randomly allocated to a DN or SN group. The primary outcome measure was the pressure pain threshold (PPT) at one peripheral location: quadriceps muscle (Q). Secondary outcome measures were local PPTs at the treated (most painful) (tUT) and non-treated upper trapezius muscle (ntUT), absolute and relative conditioned pain modulation (CPM) effects and pain during hot water immersion. Patients were assessed at baseline and immediately post intervention. Linear mixed models were used to examine interaction effects as well as between- and within-group differences.

RESULTS

Fifty-four participants were included for statistical analysis. Linear mixed model analyses showed no significant "group X time" interaction effects for any of the outcome measures. The relative CPM effect at the Q was significantly higher post-intervention, compared to baseline within the DN group (mean difference= 13.52%; 95% CI: 0.46, 26.59).

CONCLUSION

The present study shows no superior effect of DN, compared to SN, in the immediate effect on local and distant PPTs and CPM in patients with chronic idiopathic neck pain.