Tratamento da dor miofascial com agulhamento a seco: uma revisão sistemática para as melhores práticas baseadas em evidências em lombalgia

Dach, Fabíola; Ferreira, Karen S.

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Arquivos de Neuro-Psiquiatria

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Sumário

View and Review • Arq. Neuro-Psiquiatr. 81 (12) • Dez 2023 • https://doi.org/10.1055/s-0043-1777731 copiar

Tratamento da dor miofascial com agulhamento a seco: uma revisão sistemática para as melhores práticas baseadas em evidências em lombalgia

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Antecedentes

A síndrome dolorosa miofascial (SDM) é uma fonte comum de dor em centros primários de atenção à saúde ou nas clínicas de dor. Existem muitas formas diferentes de manejar e tratar a SDM, como o exercício físico, a massagem dos pontos de gatilho e o agulhamento a seco.

Objetivo

O objetivo desta revisão é destacar e discutir o tratamento baseado em evidências da dor miofascial por agulhamento a seco em doentes com dor lombar.

Métodos

Foi realizada uma revisão sistemática baseada em metanálises (MA) e ensaios clínicos randomizados (RCTs) relacionados ao tratamento da dor miofascial com agulhamento a seco em pacientes com dor lombar, publicados de 2000 a 2023.

Resultados

Foram identificados, inicialmente, um total de 509 registos. Setenta deles, publicados antes de 2000, foram excluídos. Dos 439 estudos restantes, 92 eram RCTs ou MA, dos quais 86 foram excluídos pelas seguintes razões: não relacionados a tratamento com agulhamento a seco (n = 79), não publicados em inglês (n = 4), duplicados (n = 1), protocolo de projeto (n = 1) e não relacionados com dor miofascial (n = 1). Assim, esta revisão baseou-se em quatro RCTs e duas MA. Esses estudos compararam a eficácia do agulhamento seco com outros tratamentos, tais como acupuntura, agulhamento a seco “sham”, terapia com laser, fisioterapia, injeção de anestésico local, compressão isquêmica e educação em neurociências. Apesar de os resultados e o período de seguimento variarem entre os estudos, os estudos demonstram que o agulhamento a seco pode diminuir a intensidade da dor pós-intervenção e a incapacidade relacionada à dor.

Conclusão

O agulhamento a seco é um procedimento eficaz para o tratamento da dor miofascial em pacientes com dor lombar aguda e crônica. Mais estudos são necessários para esclarecer sua eficácia a longo prazo.

Palavras-chave
Agulhamento a Seco; Síndromes da Dor Miofascial; Dor Lombar

Medication		Physiotherapy	Others
Antidepressants	Amitriptyline	Spray and stretch technique	Dry needling
	Duloxetine
	Venlafaxine
Muscle relaxants	Cyclobenzaprine	Hands-on therapy	Infiltration with lidocaine, saline
	Tizanidine
	Baclofen
Anticonvulsants	Pregabalin	Massage or ischemic compression	Laser - low frequency
	Gabapentin		Botulinum toxin
	Gabapentin		Acupuncture

Authors (year)	Number of studies	Sample size	Results (Std. Mean difference, 95% CI)
Liu, L; et al. (2018)¹³13 Liu L, Huang QM, Liu QG, et al. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018;99(01):144-152.e2. Doi: 10.1016/j.apmr.2017. 06.008 https://doi.org/10.1016/j.apmr.2017.06.0...	11	802	Dry needling versus other treatments Post-intervention pain intensity: -2.74 [-3.77,-1.71] ^* * p < 0.05. Post-intervention pain disability: -0.76 [-1.46,-0.06]^* * p < 0.05. Follow-up pain intensity: -0.43 [-1.17,0.30] Follow-up pain disability: -0.20 [-0.80,0.40] Dry needling versus Dry needling plus other treatments Post-intervention pain intensity: 0.83[0.55,1.11]^* * p < 0.05. Post-intervention pain disability: 0.13[-0.14,0.40]
Hu, HT; et al. (2018)¹⁴14 Hu HT, Gao H, Ma RJ, Zhao XF, Tian HF, Li L. Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis Medicine (Baltimore) 2018;97(26):e11225. Doi: 10.1097/MD.0000000000011225 https://doi.org/10.1097/MD.0000000000011...	16	1233	Dry needling versus sham needling Post-intervention pain intensity: -1.06 [-1.77,-0.36]^* * p < 0.05. Post-intervention functional disability: -1.70 [-2.59,-0.81];^* * p < 0.05. Follow-up pain intensity: -1.05 [-1.70,-0.40]^* * p < 0.05. Follow-up pain disability: -0.58 [-1.19,0.04] Dry needling versus acupuncture Post-intervention pain intensity: -0.96 [-1.80,-0.12]^* * p < 0.05. Post-intervention functional disability: -0.63 [-0.09, -0.26];^* * p < 0.05. Post-intervention response rate: 1.07[1.01,1.14]^* * p < 0.05. Follow-up pain intensity: -0.47 [-1.04, 0.09] Follow-up functional disability: -0.10 [-0.65,0.45]

Authors (year)	Study sample (n)	Site of intervention	End-points	Results (Std. Mean difference, 95% CI)
Télles-García, M et al. (2015)¹⁵15 Téllez-García M, de-la-Llave-Rincón AI, Salom-Moreno J, Palacios-Ceña M, Ortega-Santiago R, Fernández-de-Las-Peñas C. Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: A preliminary clinical trial. J Bodyw Mov Ther 2015;19(03): 464-472. Doi: 10.1016/j.jbmt.2014.11.012 https://doi.org/10.1016/j.jbmt.2014.11.0...	Mechanical low back pain CG – Dry needling (6) SG – Dry needling plus neuroscience education (6)	Active TrPs in gluteus medius and quadratus lumborum muscles	Baseline versus 3 week scores: Pain intensity (NPRS) Disability (ODI, RMQ) Kinesiophobia (TSK) PPT (Algometry on C5-C6, transverse process of L3, second metacarpal, tibialis anterior)	Within-group change scores Pain intensity= CG: -3.6 (-6.0, -1.1); SG: -4.2 (-6.6,-1.7) ODI= CG:-24.0 (-39.1, -8.9); SG: -19.5 (-29.9, -9.0) RMQ= CG: -6.1 (-8.0, 4.3); SG: -9.7 (-13.6, -5.1) Kinesiophobia= CG: -5.0 (-11.6, 1.6); SG: -17.7 (-25.1, -10.2) Between-group difference in change scores Pain intensity= 0.6 (-3.8, 4.8); ODI= 4.5 (-11.3, 20.4) RMQ= 3.6 (-1.0, 7.2) Kinesiophobia= -12.7 (-21.3, -4.0);^* * p < 0.05. PPT C5-C6 dominant side= 18.0 (-30.0, 65.7) PPT C5-C6 non dominant side= 6.6 (-12.0, 15.6) PPT L3 dominant side= 61.8 (4.5, 128.1)^* * p < 0.05. PPT L3 non dominant side= 58.7 (50.9, 66.5)^* * p < 0.05. PPT 2^nd metacarpal dominant side= 41.9 (-16.7, 75.3) PPT 2^nd metacarpal non dominant side= 5.4 (-14.6, 25.8) PPT tibialis anterior dominant side= 8.1 (-13.8, 30.1) PPT tibialis anterior non dominant side= 37.1 (-26.3, 100.5)
Wang, G et al. (2016)¹⁶16 Wang G, Gao Q, Li J, Tian Y, Hou J. Impact of Needle Diameter on Long-Term Dry Needling Treatment of Chronic Lumbar Myofascial Pain Syndrome. Am J Phys Med Rehabil 2016;95(07): 483-494. Doi: 10.1097/PHM.0000000000000401 https://doi.org/10.1097/PHM.000000000000...	Chronic lumbar myofascial pain Needle diameters: A – 0.25mm (16) B – 0.5mm (15) C – 0.9mm (15)	Lumbar TrPs	Baseline versus 3-month scores: Pain intensity (VAS) Health survey (SF-36)	Within-group change in mean: Pain intensity: A: -2.48^* * p < 0.05. ; B: -2.87^* * p < 0.05. ; C: -4,43^* * p < 0.05. SF-36: A: 13.31*; B: 14.20^ * p < 0.05. ; C:20.14^* * p < 0.05. Between-group difference mean: Pain intensity: A: 4.15 ± 2.37; B: 4.05 ± 2.51; C: 2.16 ± 1.64; A versus B, p = 0.858; A versus C, p = 0.064; B versus C, p = 0.047. SF-36: A: 66.00 ± 9.20; B: 67.33 ± 11.36; C: 71.27 ± 7.81. A versus B, p = 0.739; A versus C, p = 0.487; B versus C, p = 0.721.
Castro-Sanchez, AM et al. (2017)¹⁷17 Castro-Sanchez AM, Garcia-Lopez H, Mataran-Penarrocha GA, et al. Effects of Dry Needling on Spinal Mobility and Trigger Points in Patients with Fibromyalgia Syndrome. Pain Physician 2017;20 (02):37-52	Fibromialgia CG – Cross Tape Therapy (32) SG – Dry Needling + Compression for 15 sec. (32)	Active or latente TrPs in latissimus dorsi, iliocostalis, multifidus, and quadratus lumborum muscles	Baseline versus 1 month scores: Pain intensity (VAS) PPT (Algometry) Spinal Mobility (SMS)	Within-group change in mean: Pain intensity: CG: 0.56 (1.11, 1.01)^* * p < 0.05. SG: 3.31 (2.50, 4.13)^* * p < 0.05. Between-group change in mean: Pain intensity: SG > CG (F = 36.285)^* * p < 0.05. PPT = latissimus dorsi muscle (right axillary portion: F = 9.80)^* * p < 0.05. ; multifidus muscle (right L2 level: F = 11.80)^* * p < 0.05. ; quadratus lumborum (right lateral superficial upper: F = 6.67)^* * p < 0.05. ; quadratus lumborum (right lateral superficial lower: F = 5.38)^* * p < 0.05. . SMS= thoracic spine segmental amplitude in the erect standing position (F = 7.33)^* * p < 0.05. , lumbar spine segmental amplitude in the erect sitting position (F = 11.60)^* * p < 0.05. , sacral slope in the flexed sitting position (F = 5.54)^* * p < 0.05. , the range of flexion for thoracic-lumbar spine segmental amplitude in the sitting position (F = 9.11)^* * p < 0.05. , the range of erect to flexion for the sacral slope (F = 4.48)^* * p < 0.05. , thoracic spine segmental amplitude (F = 6.45)^* * p < 0.05. , and thoracic-lumbar spine segmental amplitude in the sitting position (F = 13.11)^* * p < 0.05.
Álvarez, SD et al. (2022)¹⁸18 Álvarez SD, Velázquez Saornil J, Sánchez Milá Z, et al. Effectiveness of Dry Needling and Ischemic Trigger Point Compression in the Gluteus Medius in Patients with Non-Specific Low Back Pain: A Randomized Short-Term Clinical Trial. Int J Environ Res Public Health 2022;19(19):12468. Doi: 10.3390/ijerph191912468 https://doi.org/10.3390/ijerph191912468...	Non-specific low back pain CG – Ischemic Compression (40) SG – Dry needling (40)	Latent trigger point in the gluteus medius muscles	Baseline versus post-intervention, 48 h, and 1 week scores: Pain Intensity (VAS) Quality of life (OQL) Range of motion (SRM) PPT (Algometry on gluteus medius muscle)	Within-group change in mean (Post-intervention) Pain intensity= CG: -4.2^* * p < 0.05. ; SG: -0.63 PPT= CG:0.66 ^* * p < 0.05. ; SG: -0.46^* * p < 0.05. Within-group change in mean (at 48 h) Pain intensity= CG: -3.27^* * p < 0.05. ; SG: -3.0^* * p < 0.05. PPT= CG: 0.37; SG: 0.32^* * p < 0.05. Within-group change in mean (at 1 week) Pain Intensity= CG: -3.07^* * p < 0.05. ; SG:-3.40^* * p < 0.05. SRM= CG:-0.20; SG:-0.13 OQL= CG:-2.1^* * p < 0.05. ; SG:-5.4^* * p < 0.05. PPT= CG: 0.2; SG: 0.32^* * p < 0.05. Between group differences (at 1 week/mean ± standard deviation) Pain Intensity= CG: 5 ± 1.81; SG: 4.20 ± 1.26^* * p < 0.05. PPT= CG:4.81 ± 1.18; SG:4.787 ± 0.92 SRM = CG:0.07 ± 0.25; SG:0.07 ± 0.025 OQL= CG:20.73 ± 4.78; SG:15 ± 4.17 ^* * p < 0.05.

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[1] Address for correspondence Fabíola Dach (email:fabioladach@usp.br)