Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain

León-Hernández, Jose V.; Martín-Pintado-Zugasti, Aitor; Frutos, Laura G.; Alguacil-Diego, Isabel M.; de la Llave-Rincón, Ana I.; Fernandez-Carnero, Josue

doi:10.1590/bjpt-rbf.2014.0176

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Brazilian Journal of Physical Therapy

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Original Articles • Braz. J. Phys. Ther. 20 (05) • Oct 2016 • https://doi.org/10.1590/bjpt-rbf.2014.0176 copy

Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Dry needling (DN) and percutaneous electrical nerve stimulation (PENS) are widely used techniques in the treatment of myofascial pain.

Objective

To investigate the immediate and short-term effects of the combination of DN and PENS compared to DN alone on the upper trapezius muscle.

Method

This is a 72-hour follow-up single-blinded randomized controlled trial. Sixty-two volunteer patients with chronic myofascial neck pain with active Myofascial Trigger Points (MTrPs) in the upper trapezius muscle were recruited. Randomization was performed, and 31 patients received DN treatment (DN group) and 31 received DN and PENS (DN+PENS group). The primary outcomes were neck disability index (NDI) and visual analog scale for pain for both post-needling soreness (PNS) and neck pain intensity (NPI). Pressure pain threshold (PPT) and cervical range of motion (CROM) were the secondary outcomes.

Results

We detected between-group differences in NPI and PNS in favor of the DN+PENS group immediately after treatment. No between-group differences in NDI were observed.

Conclusion

PENS application after dry needling treatment is more effective than dry needling alone for decreasing soreness in the short term and improving neck pain intensity immediately in patients with myofascial chronic neck pain.

Keywords:
neck pain; disability; trigger points; TENS; physical therapy

Outcomes Measures	DN (n=31)	DN+PENS (n=31)
Age years	23.32±4.77	26.81±9.63
Gender M/F (female%)	7/24 (77.4%)	9/22 (71.0%)
Neck pain duration (months)	16.03±17.23	19.36±19.23
VAS (0-100mm)	4.82±1.91	4.82±1.83
PPT (Kg/cm²)	1.72±0.81	1.80±0.90
Flexion (degrees)	52.16±11.67	49.03±13.09
Extension (degrees)	58.41±12.75	56.41±12.96
Right Lateral Flexion (degrees)	38.71±10.08	37.34±8.96
Left Lateral Flexion (degrees)	40.63±9.23	37.44±9.57
Right Rotation (degrees)	60.18±9.70	59.56±10.80
Left Rotation (degrees)	61.03±12.10	59.94±13.00
NDI	10.09±4.07	11.04±4.70

			Median (first and third quartiles)			Wilcoxon a) 24h vs. 48h b) 24h vs. 72h c) 48h vs. 72h
		Group	24h Post-DN	48h Post-DN	72h Post-DN
PNS		DN	5.00 (3.25 and 6.12)	3.50 (2.12 and 5.00)	3.00 (1.00 and 4.75)	a) .002 b) <.001 c) .110
		DN + PENS	2.75 (0.50 and 5.00)	1.00 (0.00 and 3.75)	1.00 (0.00 and 2.75)	a) .038 b) .002 c) .005
	Kruskal-Wallis		.002	<.001	<.001
		Group	Baseline	Immediately Post-DN	72h Post-DN	Wilcoxon a)Baseline vs. Post b)Baseline vs. 72 h c)Post vs. 72 h
VAS NPI		DN	5.00 (4.00 and 6.00)	5.00 (3.00 and 6.25)	2.50 (1.00 and 4.00)	a) .504 b) <.001 c) .001
		DN + PENS	5.00 (3.50 and 6.00)	3.00 (1.25 and 4.50)	2.00 (1.00 and 5.00)	a) .001 b) .001 c) .014
	Kruskal-Wallis		.742	.016	.669

			Median (first and third quartiles)			Wilcoxon Baseline vs 72h post-DN
		Group	Baseline		72h Post-DN
NDI		DN	9.50 (8.00 and 13.00)		6.50 (3.25 and 10.00)	.005
		DN + PENS	11.00 (7.00 and 14.50)		6.00 (4.00 and 14.00)	.005
	Kruskal-Wallis		.588		.700
		Group	Baseline	Immediately Post-DN	72h Post-DN	Wilcoxon a)Baseline vs. Post b)Baseline vs. 72 h c)Post vs. 72 h
PPT		DN	1.67 (1.00 and 2.00)	1.58 (1.03 and 1.99)	1.50 (1.15 and 1.87)	a) .112 b) .180 c) .469
		DN + PENS	1.66 (1.27 and 3.03)	2.43 (1.25 and 4.50)	1.70 (1.18 and 6.75)	a) .016 b) .927 c) .280
	Kruskal-Wallis		.577	.050	.371

Mean ± SD (95%CI)
Outcomes Measures	Group	Baseline	Post DN	72 h Post DN	Cohen’s d
FLEXION	DN DN + PENS	52.42±11.72 52.05±12.24	49.96±13.71 53.24±12.53	51.07±12.21	.112
FLEXION	DN DN + PENS	52.42±11.72 52.05±12.24	49.96±13.71 53.24±12.53	53.76±12.07	.140
EXTENSION	DN DN + PENS	58.11±12.44 58.62±11.80	57.27±13.91 61.13±12.10	60.26±13.73 ^* * P<.05 (within-group comparison, ANOVA).	.164
EXTENSION	DN DN + PENS	58.11±12.44 58.62±11.80	57.27±13.91 61.13±12.10	62.98±10.90 ^* * P<.05 (within-group comparison, ANOVA).	.383
LEFT LATERO FLEXION	DN DN + PENS	39.05±8.01 38.16±9.36	39.79±9.21 41.78±9.42	39.77±9.18 ^* * P<.05 (within-group comparison, ANOVA).	.083
LEFT LATERO FLEXION	DN DN + PENS	39.05±8.01 38.16±9.36	39.79±9.21 41.78±9.42	41.80±9.63 ^* * P<.05 (within-group comparison, ANOVA).	.383
RIGHT LATEROFLEXION	DN DN + PENS	38.77±10.46 37.55±9.11	36.94±8.93 40.00±11.23	40.59±9.67 ^* * P<.05 (within-group comparison, ANOVA).	.180
RIGHT LATEROFLEXION	DN DN + PENS	38.77±10.46 37.55±9.11	36.94±8.93 40.00±11.23	40.75±9.91 ^* * P<.05 (within-group comparison, ANOVA).	.336
LEFT ROTATION	DN DN + PENS	61.40±12.82 59.31±13.72	62.48±9.98 63.69±9.30	64.33±8.58	.268
LEFT ROTATION	DN DN + PENS	61.40±12.82 59.31±13.72	62.48±9.98 63.69±9.30	59.59±11.98	.021
RIGHT ROTATION	DN DN + PENS	60.36±10.24 60.50±10.73	59.95±8.86 60.04±11.37	62.22±7.42	.208
RIGHT ROTATION	DN DN + PENS	60.36±10.24 60.50±10.73	59.95±8.86 60.04±11.37	61.18±10.92	.062

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[1] *Correspondence Jose Vicente León Hernández Universidad Autónoma de Madrid Faculty of Health Science The Center for Advanced Studies University La Salle Department of Physiotherapy Aravaca, Madrid, Spain e-mail: jv.leon@lasallecampus.es