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  • Systematic Review: Dry Needling, Ischemic Compression for Neck Pain Supported by Moderate-to-Strong Evidence

    Authors of a new systematic review of neck pain interventions say that while it's clear more research is needed, there is already moderate-to-strong evidence that both dry needling (DN) and ischemic compression (IC) can lessen pain intensity and increase range of motion, at least in the short-term. Evidence on the treatments' effects in other areas associated with functionality and quality of life, however, is another story.

    The review, e-published ahead of print in the American Journal of Physical Medicine & Rehabilitation (abstract only available for free), examined 15 clinical trials focused on trigger points (TPs) in the upper trapezius (UT) muscle in patients with neck pain, comparing either IC (7 studies) or DN (8 studies) with other interventions. None of the studies compared DN with IC.

    The studies themselves varied in size (from 39 to 117 patients), and some employed more than 1 intervention (for instance, the use of stretching exercises in all groups in some studies), but all were limited to randomized clinical trials in which all participants had neck pain with active or latent TPs in the UT—a feature of myofascial pain syndrome. Only studies that focused on the therapeutic effects of treatment were included, with articles about side effects or complications excluded.

    Researchers found strong evidence that DN (which they defined as an intramuscular procedure that could include insertion of needles into the TP) reduced both pain intensity and the pressure pain threshold, although not necessarily any more than other treatments, including lidocaine injections, passive stretching, and muscle energy techniques (MET). Similar results were found for the IC studies, which presented moderate-to-strong evidence that both pressure pain threshold and pressure pain intensity were reduced.

    The other area that returned moderate evidence of effectiveness had to do with range of motion (ROM)—specifically, side bending. Here, researchers found evidence, albeit sometimes weak, that both DN and IC were as effective as other approaches, and that in at least 1 study, IC seemed to have an effect over time as well. "The increase in side-bending ROM after IC was equal to MET and passive stretching immediately after treatment," authors write, "but it was significantly greater 24 [hours] and 1 [week] after treatment."

    The review found little available evidence to support the interventions' effects on functionality or quality of life, including how the interventions may lessen depression.

    Areas for future research abound. Authors noted, for example, that "there is strong evidence that DN has an analgesic effect," but that "the optimal dosage remains unclear and requires further research."

    Also lacking--research on DN and IC compared with each other, as well as studies on the effectiveness of the interventions over time.

    "Until now, most studies have evaluated the immediate effect of IC and DN, with only a few studies describing longer-term effects," authors write. "Although the goal of DN and IC is often rapid relief of pain so that patients can be progressed to other forms of therapy, further research of long-term effects is needed."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • recently i received a letter from my PT stating she has been certified to perform trigger point dry needle. her practice is in New Jersey. When i called to schedule an appointment I was told Trigger point was suspended per a court hearing. I know this envolves the Accupuncture board. I am a medicare recepient which does not cover accupuncture. I find this troubling a person with chronic pain

      Posted by timothy dunphy on 3/23/2018 11:00 AM

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