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Dry Needling in Chronic Neck Pain

Chronic Neck Pain (CNP) is one of the main causes of disability worldwide, and it is necessary to promote new strategies of therapeutic approach in the treatment of chronic pain. Dry needling (DN) is defined as an invasive physiotherapy technique used in the treatment of neuromusculoskeletal disorders. 

  • chronic pain
  • dry needling
  • neck pain
  • physical therapy

1. Introduction

Cervical pain, or neck pain, can be defined as that unpleasant sensory and emotional experience associated with actual or potential tissue damage that affects the cervical region [1][2]. It may range from the suboccipital line to the level of the spine of the scapula [1][2]. Therefore, this condition is one of the main causes of disability worldwide, with a prevalence above 30% [1][3][4], which entails significant socioeconomic costs [1][4][5][6][7]. It becomes persistent in half of the cases, which exhibit chronic symptoms and recurrent pain episodes [3] that can extend beyond six months [5]. However, the updated classification of chronic pain allows people to understand chronic neck pain (CNP) as a primary entity that is not associated with a specific etiology, and lasts with functional limitation and emotional affectation for more than three months [8].
Studies indicate a female predominance in terms of the distribution by sex of neck pain, and in the age range of 35–49 years [9], especially from the age of 45 [10]. Typically, research indicates that the risk of neck pain is linked to physical and psychosocial factors, and may be related to lack of movement, sustained postures, and office work [11][12].
Usually, neck pain is nonspecific. This way, it is not attributable to fractures, trauma, or any other specific recognizable pathology (such as infectious, vascular, or oncological conditions). Therefore, examination and clinical analysis can rule out the warning signs that may relate the cases to specific systemic origins [1][3][5][13]. The assessment of patients with neck pain involves determining: (a) pain intensity by means of pain assessment scales (VAS or NPRS); (b) associated functionality or disabilities (Neck Disability Index, NDI) [14]; and (c) mobility of the cervical region (Range of Motion, ROM) [5]. Furthermore, in the complete evaluation of the neck, it is convenient to attend to the neurological assessment based on myotomes, dermatomes, and reflexes [15][16][17].
In addition, the assessment of patients with CNP should necessarily objectify comorbidities and associated symptoms [18], such as anxiety, depression, stress (DASS Scale) [19][20][21][22], and sleep disorders (Pittsburgh Sleep Quality Index) [20]. At present, it is essential to deepen the investigation of new strategies of therapeutic approach in the treatment of chronic pain, especially motivated by the low efficacy of the available pharmacological treatments. Therefore, it becomes convenient to look for alternatives that are effective and tolerable for patients [7][13].
In regard to physical therapy in the management of neck pain, the effect of conventional treatments is limited. Electrotherapy modalities (transcutaneous electrical nerve stimulation) could improve symptoms in CNP, but the evidence in this regard is not conclusive [23], and passive mobilization or manipulative therapy is no better than an exercise program [24].
Dry needling (DN) is defined as a minimally invasive physiotherapy technique used in the treatment of neuromusculoskeletal disorders [25][26][27]. Needling the most painful point of the muscle is also contemplated in traditional Chinese medicine acupuncture, where it is described as Ah Shi needling [28][29]. Its goal is to restore the physiological state of the tissue, reduce pain levels, and increase mobility through the application of mechanical stimuli caused by the insertion of acupuncture needles. These techniques are typical of physiotherapy, in which the physical agents pass through patient’s skin [25][26][27]. With respect to the classification of the needling technique, the purpose of classifying it as “dry” is to emphasize the condition of the physical agent, i.e., in this type of technique, there is neither pharmacological substances nor chemical agents introduced nor any fluid extracted [25][27][30].
Regarding the DN techniques, it is possible to define two modalities based on the depth of needle insertions [26][30]. The first is superficial DN, which confers analgesia by hyperstimulation. In this case, the needle goes through the skin and the subcutaneous cellular tissue without reaching the muscle. The other modality is deep DN, which functions directly on myofascial trigger points, since the needle penetrates the muscle tissue and has the ability to produce a local twitch response [26][30][31]. Local twitch response is an involuntary contraction reaction of the muscles to the mechanical stimulus of the puncture [31].
Thus, DN could be a treatment option for myofascial trigger points (hypersensitive areas of muscle fibers associated with motor abnormalities) [27]. However, precision during needling and the performance of the procedure seems to be essential for its correct development, with the ability of the physiotherapists being vital to perform the treatment properly [25][32]. The mechanism of action of DN is related to the effects achieved on myofascial trigger points [27]. The persistence of these points can favor the phenomenon of central sensitization. Therefore, it is possible to apply these invasive physiotherapy techniques in chronic pathologies [33], and it can be recommended for the treatment of CNP [27].

2. DN in Physical Therapy Treatment for CNP

Pain intensity was the most studied variable. Depending on the study, the VAS scale or the NPRS scale were used, both of which showed high reproducibility and validity for short- and long-term assessments of CNP [34][35][36]. Focusing on pain, the shorter-term outcomes were found in the study conducted by Stieven et al. [37], who demonstrated the immediate effects of a single-session treatment. That study showed that a single application of unilateral DN at the level of the upper trapezius or a myofascial release treatment of that musculature could generate a superior response than a placebo intervention, with pain reduction and increased PPT.
Along the same lines, Sobhani et al. [38] performed a treatment of five sessions distributed over ten days, collecting the outcomes at the end of the intervention. These authors observed a decrease in the intensity of pain, a reduction in the NDI and catastrophic thoughts, and increased mobility. Disability is one of the important variables to assess in CNP, and usually the NDI scale is used, but it is also possible to use other scales [39]. Manafnezhad et al. [35] found similar effects in the follow-up performed one week after the intervention and after three weeks of treatment at the rate of one session per week.
On the other hand, it was possible to find the outcomes achieved by carrying out a long-term follow-up of up to one year (Gattie et al. [40]), also in comparison to a placebo-type sham DN treatment. These authors did not observe differences between DN treatment and placebo. Alternatives interventions based on placebo could suggest that the use of placebo could have a place within the treatments. In the same way, Irnich et al. [29] compared the effects of DN intervention versus traditional acupuncture treatment and sham laser treatment in the same group of patients.
Most studies performed intermediate follow-ups ranging from three to six months [34][41][42], with four to six treatment sessions distributed over two to four weeks or one-month follow-up after two sessions with a one-week interval [43]. Regarding the periodicity of the follow-ups, it is worth highlighting the study conducted by Cerezo-Téllez et al. [34], whose analysis included up to six post-intervention assessments.
Upper trapezius and levator muscles are the most frequent locations to DN intervention [35][37][38][43]; usually, the treatment of studies includes DN in this musculature, and combine with other neck or back muscles [34][40][41][42]. Another aspect to analyze would be the performance of the technique unilaterally or bilaterally, although this would be related to the lateral predominance of the symptoms and to the proprioceptive control at the cervical level, as in cases in which there is a structural alteration [44].
In general, the applications of DN techniques were performed following the action protocols described by Travell and Simons [34][41][43], with rapid needle entry and exit movements under the principles of the Hong’s technique, in which the needle is retracted into the subcutaneous tissue and then redirected to another region of the trigger point without leaving the tissue [34][39][41] by means of the therapists’ wrist flexion and extension movements [35]. The procedure affected the musculature bilaterally [38], for one to two minutes [35], seeking to trigger local spasm reactions [34][41][42][43]. In many cases, DN was accompanied by ischemic compression or post-needling stretching [34][36][38][41][42][43].
The mechanism of action of DN can be determined based on chemical and neurophysiological changes associated with mechanical effects derived from the stimulus provided by invasive therapy on soft tissue [35], which modifies the activation and perpetuation of myofascial trigger points [43]; usually, the DN intervention causes a local twitch response [29][34][35][40][41][42]. The methodology proposed in the assessed studies focused on DN interventions on the myofascial trigger points of the upper trapezius and the levator scapulae muscles [35][37][38][43], and, to a lesser extent, on splenium, multifidus, or middle trapezius, among others [34][40][41][42].
In the studies that performed placebo interventions with sham DN [37][40][43], sham needles were used to simulate the puncture without penetrating the skin [40][43]. Therefore, three of the studies apply sham DN as a placebo treatment option, making it necessary to delve into the conditions of this intervention. In addition, the alternative treatment was performed by means of stretching [34][41], therapeutic physical exercises [40][42], or manual therapy techniques (myofascial treatment or cervical and thoracic mobilization) [37][38][40][42][43], or by means of instrumental techniques, such as TENS and microwaves [41], kinesiotaping [38], and waves shock [35].
The research of Leon-Hernandez et al. [36] stands out for the comparison between two treatment modalities based on the percutaneous needle electrical stimulation after application of the DN. In these treatments, the DN of the upper trapezius is performed (with local twitch response), and then a low or high frequency current is applied. This option shows that DN can be combined with associated electrotherapy and can obtain similar results regardless of the stimulation frequency.
Specifically, in the comparison between DN interventions and alternative treatments, it should be noted that the results may be favorable to invasive treatments [34][41][43]. However, the differences may be slight [42], or the beneficial effects achieved may be similar to those produced by the control treatment [35][38].
In general, it highlights the relationship of the treatment proposals of the trials with therapeutic exercise, and this reinforces the need to direct physiotherapy to a relationship between passive techniques and active movement. Exercise has positive effects on pain and functionality, and it should be oriented according to the interests and individual goals of the patient, and could be combined with instrumental techniques [45][46]. Is it possible to achieve the same effects with manual stimulation of the treatment points? [47].
The positive outcomes that support the success of DN with respect to the study variables in CNP are in line with the conclusions of other previous reviews that considered this type of intervention useful [48]. In addition, the changes achieved are in line with what has been observed in other related pathologies, such as headache [49][50]. In the same way, it would be possible to point out that these effects could help reduce over-medicalization, and represent a non-pharmacological treatment option [7], which will also reduce the socioeconomic costs associated with neck pain.

This entry is adapted from 10.3390/jcm11092370

References

  1. Bier, J.D.; Scholten-Peeters, W.G.; Staal, J.B.; Pool, J.; van Tulder, M.W.; Beekman, E.; Knoop, J.; Meerhoff, G.; Verhagen, A.P. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain. Phys. Ther. 2018, 98, 162–171.
  2. Climent, J.M.; Bagó, J.; García-López, A. Patología dolorosa de columna: Cervicalgia, dorsalgia y lumbalgia. FMC Form. Médica Contin. Atención Primaria 2014, 21, 9–35.
  3. Cohen, S.P. Epidemiology, diagnosis, and treatment of neck pain. In Mayo Clinic Proceedings; Elsevier Ltd.: Amsterdam, The Netherland, 2015; Volume 90, pp. 284–299.
  4. Cohen, S.P.; Hooten, W.M. Advances in the diagnosis and management of neck pain. BMJ 2017, 358, j3221.
  5. Blanpied, P.R.; Gross, A.R.; Elliott, J.M.; Devaney, L.L.; Clewley, D.; Walton, D.M.; Sparks, C.; Robertson, E.K. Clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American physical therapy association. J. Orthop. Sports Phys. Ther. 2017, 47, A1–A83.
  6. Liu, R.; Kurihara, C.; Tsai, H.T.; Silvestri, P.J.; Bennett, M.I.; Pasquina, P.F.; Cohen, S.P. Classification and treatment of chronic Neck pain: A longitudinal cohort study. Reg. Anesth. Pain Med. 2017, 42, 52–61.
  7. George, S.Z.; Lentz, T.A.; Goertz, C.M. Back and neck pain: In support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health. Transl. Res. 2021, 234, 129–140.
  8. Treede, R.-D.; Rief, W.; Barke, A.; Aziz, Q.; Bennett, M.I.; Benoliel, R.; Cohen, M.; Evers, S.; Finnerup, N.B.; First, M.B.; et al. A classification of chronic pain for ICD-11. Pain 2015, 156, 1003.
  9. Hoy, D.G.; Protani, M.; De, R.; Buchbinder, R. The epidemiology of neck pain. Best Pract. Res. Clin. Rheumatol. 2010, 24, 783–792.
  10. Lin, I.H.; Chang, K.H.; Liou, T.H.; Tsou, C.M.; Huang, Y.C. Progressive shoulder-neck exercise on cervical muscle functions in middle-aged and senior patients with chronic neck pain. Eur. J. Phys. Rehabil. Med. 2018, 54, 13–21.
  11. Ye, S.; Jing, Q.; Wei, C.; Lu, J. Risk factors of non-specific neck pain and low back pain in computer-using office workers in China: A cross-sectional study. BMJ Open 2017, 7, e014914.
  12. Kim, R.; Wiest, C.; Clark, K.; Cook, C.; Horn, M. Identifying risk factors for first-episode neck pain: A systematic review. Musculoskelet. Sci. Pract. 2018, 33, 77–83.
  13. Côté, P.; Yu, H.; Shearer, H.M.; Randhawa, K.; Wong, J.J.; Mior, S.; Ameis, A.; Carroll, L.J.; Nordin, M.; Varatharajan, S.; et al. Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur. J. Pain 2019, 23, 1051–1070.
  14. Andrade Ortega, J.A.; Martínez, A.D.D.; Ruiz, R.A. Validación de una versión Española del Índice de Discapacidad Cervical. Med. Clin. 2008, 130, 85–89.
  15. Riew, K.D. Variations in cervical myotomes and dermatomes. Spine J. 2019, 19, 1143–1145.
  16. Furukawa, Y.; Miyaji, Y.; Kadoya, A.; Kamiya, H.; Chiba, T.; Hokkoku, K.I.; Hatanaka, Y.; Imafuku, I.; Miyoshi, K.; Sonoo, M. Determining C5, C6 and C7 myotomes through comparative analyses of clinical, MRI and EMG findings in cervical radiculopathy. Clin. Neurophysiol. Pract. 2021, 6, 88–92.
  17. Hakimi, K.; Spanier, D. Electrodiagnosis of cervical radiculopathy. Phys. Med. Rehabil. Clin. N. Am. 2013, 24, 1–12.
  18. Malfliet, A.; Coppieters, I.; Van Wilgen, P.; Kregel, J.; De Pauw, R.; Dolphens, M.; Ickmans, K. Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review. Eur. J. Pain 2017, 21, 769–786.
  19. Yavuz, B.G.; Aydinlar, E.I.; Dikmen, P.Y.; Incesu, C. Association between somatic amplification, anxiety, depression, stress and migraine. J. Headache Pain 2013, 14, 53.
  20. Yalinay Dikmen, P.; Yavuz, B.G.; Aydinlar, E.I. The relationships between migraine, depression, anxiety, stress, and sleep disturbances. Acta Neurol. Belg. 2015, 115, 117–122.
  21. Peres, M.F.P.; Mercante, J.P.P.; Tobo, P.R.; Kamei, H.; Bigal, M.E. Anxiety and depression symptoms and migraine: A symptom-based approach research. J. Headache Pain 2017, 18, 1–8.
  22. Seidel, S.; Beisteiner, R.; Manecke, M.; Aslan, T.S.; Wöber, C. Psychiatric comorbidities and photophobia in patients with migraine. J. Headache Pain 2017, 18, 1–4.
  23. Martimbianco, A.L.C.; Porfírio, G.J.M.; Pacheco, R.L.; Torloni, M.R.; Riera, R. Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain. Cochrane Database Syst. Rev. 2019, 2019, 1465–1858.
  24. Ganesh, G.S.; Mohanty, P.; Pattnaik, M.; Mishra, C. Effectiveness of mobilization therapy and exercises in mechanical neck pain. Physiother. Theory Pract. 2015, 31, 99–106.
  25. Mayoral-del-Moral, O.; Torres-Lacomba, M. Fisioterapia invasiva y punción seca. Informe sobre la eficacia de la punción seca en el tratamiento del síndrome de dolor miofascial y sobre su uso en Fisioterapia. Cuest. Fisioter. 2009, 38, 206–217.
  26. Capó-Juan, M.A. Síndrome de dolor miofascial cervical. Revisión narrativa del tratamiento fisioterápico. An. Sist. Sanit. Navar. 2015, 38, 105–116.
  27. Mayoral-del-Moral, O.; Salvat-Salvat, I. Punción seca de los puntos gatillo miofasciales. In Fisioterapia Invasiva; Valera-Garrido, F., Minaya-Muñoz, F., Eds.; Elsevier: Barcelona, Spain, 2017; pp. 297–312. ISBN 978-84-9113-099-4.
  28. Li, X.; Wang, R.; Xing, X.; Shi, X.; Tian, J.; Zhang, J.; Ge, L.; Zhang, J.; Li, L.; Yang, K. Acupuncture for Myofascial Pain Syndrome: A Network Meta-Analysis of 33 Randomized Controlled Trials. Pain Physician 2017, 20, E883–E902.
  29. Irnich, D.; Behrens, N.; Gleditsch, J.M.; Stör, W.; Schreiber, M.A.; Schöps, P.; Vickers, A.J.; Beyer, A. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: Results of a randomized, double-blind, sham-controlled crossover trial. Pain 2002, 99, 83–89.
  30. Mayoral-del-Moral, O. Fisioterapia invasiva del síndrome de dolor miofascial. Fisioterapia 2005, 27, 69–75.
  31. Perreault, T.; Dunning, J.; Butts, R. The local twitch response during trigger point dry needling: Is it necessary for successful outcomes? J. Bodyw. Mov. Ther. 2017, 21, 940–947.
  32. Dommerholt, J.; Mayoral-del-Moral, O.; Gröbli, C. Trigger Point Dry Needling. J. Man. Manip. Ther. 2006, 14, 70–87.
  33. Shah, J.P.; Thaker, N. Punción seca segmentaria en el dolor musculoesquelético. In Fisioterapia Invasiva; Valera-Garrido, F., Minaya-Muñoz, F., Eds.; Elsevier: Barcelona, Spain, 2017; pp. 335–356. ISBN 978-84-9113-099-4.
  34. Cerezo-Téllez, E.; Torres-Lacomba, M.; Fuentes-Gallardo, I.; Perez-Muñoz, M.; Mayoral-Del-Moral, O.; Lluch-Girbés, E.; Prieto-Valiente, L.; Falla, D. Effectiveness of dry needling for chronic nonspecific neck pain: A randomized, single-blinded, clinical trial. Pain 2016, 157, 1905–1917.
  35. Manafnezhad, J.; Salahzadeh, Z.; Salimi, M.; Ghaderi, F.; Ghojazadeh, M. The effects of shock wave and dry needling on active trigger points of upper trapezius muscle in patients with non-specific neck pain: A randomized clinical trial. J. Back Musculoskelet. Rehabil. 2019, 32, 811–818.
  36. Leon-Hernandez, J.V.; Calvo-Lobo, C.; Martin-Pinado-Zugasti, A.; Fernandez-Carnero, J.; Beltran-Alacreu, H. Effectiveness of Dry Needling with Percutaneous Electrical Nerve Stimulation of High Frequency Versus Low Frequency in Patients with Myofascial Neck Pain. Pain Physician 2021, 24, 135–143.
  37. Stieven, F.; Ferreira, G.; de Araújo, F.; Angellos, R.; Silva, M.; da Rosa, L. 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. Manipulative Physiol. Ther. 2021, 44, 95–102.
  38. Sobhani, V.; Shamsoddini, A.; Khatibi-Aghda, A.; Mazloum, V.; Kia, H.H.; Emami Meybodi, M.K. Effectiveness of dry needling, manual therapy, and Kinesio Taping for patients with chronic myofascial neck pain: A single-blind clinical trial. Trauma Mon. 2017, 22.
  39. Llamas-Ramos, R.; Pecos-Martín, D.; Gallego-Izquierdo, T.; Llamas-Ramos, I.; Plaza-Manzano, G.; Ortega-Santiago, R.; Cleland, J.; Fernández-de-las-Peñas, C. Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: A randomized clinical trial. J. Orthop. Sports Phys. Ther. 2014, 44, 852–861.
  40. Gattie, E.; Cleland, J.A.; Pandya, J.; Snodgrass, S. Dry Needling Adds No Benefit to the Treatment of Neck Pain: A Sham-Controlled Randomized Clinical Trial With 1-Year Follow-up. J. Orthop. Sports Phys. Ther. 2021, 51, 37–45.
  41. Valiente-Castrillo, P.; Martín-Pintado-Zugasti, A.; Calvo-Lobo, C.; Beltran-Alacreu, H.; Fernández-Carnero, J. Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: A randomized clinical trial. Acupunct. Med. 2021, 39, 91–105.
  42. Stieven, F.; Ferreira, G.; Wiebusch, M.; de Araújo, F.; da Rosa, L.; Silva, M. Dry Needling Combined With Guideline-Based Physical Therapy Provides No Added Benefit in the Management of Chronic Neck Pain: A Randomized Controlled Trial. J. Orthop. Sports Phys. Ther. 2020, 50, 447–454.
  43. Gallego-Sendarrubias, G.M.; Rodríguez-Sanz, D.; Calvo-Lobo, C.; Martín, J.L. Efficacy of dry needling as an adjunct to manual therapy for patients with chronic mechanical neck pain: A randomised clinical trial. Acupunct. Med. 2020, 38, 244–254.
  44. Reddy, R.S.; Tedla, J.S.; Dixit, S.; Abohashrh, M. Cervical proprioception and its relationship with neck pain intensity in subjects with cervical spondylosis. BMC Musculoskelet. Disord. 2019, 20, 1–7.
  45. Iqbal, Z.A.; Alghadir, A.H.; Anwer, S. Efficacy of Deep Cervical Flexor Muscle Training on Neck Pain, Functional Disability, and Muscle Endurance in School Teachers: A Clinical Trial. Biomed Res. Int. 2021, 2021, 7190808.
  46. Iversen, V.M.; Vasseljen, O.; Mork, P.J.; Fimland, M.S. Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: A randomized controlled trial. J. Rehabil. Med. 2018, 50, 743–750.
  47. Kim, M.; Kim, J. Effects of Acupressure on Pain, Flexibility, and Substance P in Middle-Age Women with Chronic Neck Pain. J. Altern. Complement. Med. 2021, 27, 160–167.
  48. Callejas-Marcos, I.; Torrijos-Bravo, A.; Torres-Chica, B.; Ortiz-Gutiérrez, R.M. Eficacia de la punción seca en la cervicalgia en comparación con otras técnicas de fisioterapia: Una revisión sistemática. Rehabilitación 2019, 53, 189–197.
  49. Gildir, S.; Tüzün, E.H.; Eroğlu, G.; Eker, L. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine 2019, 98, e14520.
  50. Pourahmadi, M.; Mohseni-Bandpei, M.A.; Keshtkar, A.; Koes, B.W.; Fernández-De-Las-Peñas, C.; Dommerholt, J.; Bahramian, M. Effectiveness of dry needling for improving pain and disability in adults with tension-type, cervicogenic, or migraine headaches: Protocol for a systematic review. Chiropr. Man. Therap. 2019, 27, 1–11.
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