Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Marcos J Navarro-Santana ◽  
Guido F Gómez-Chiguano ◽  
Joshua A Cleland ◽  
Jose L Arias-Buría ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Pain Intensity ◽  
Shoulder Pain ◽  
Trigger Point ◽  
Meta Analysis ◽  
Dry Needling ◽  
Short Term ◽  
Positive Effects ◽  
Evidence Level ◽  
Quality Evidence

Abstract Objective The purpose of this study was to evaluate the effects of trigger point (TrP) dry needling alone or as an adjunct to other interventions on pain intensity and related disability in nontraumatic shoulder pain. Methods Ten databases were searched from inception to January 2020 for randomized clinical trials in which at least 1 group received TrP dry needling for shoulder pain of musculoskeletal origin with outcomes collected on pain intensity and related disability. Data extraction including participant and therapist details, interventions, blinding strategy, blinding assessment outcomes, and results were extracted by 2 reviewers. The risk of bias (RoB, Cochrane Guidelines), methodological quality (PEDro score), and evidence level (GRADE approach) were assessed. The search identified 551 publications with 6 trials eligible for inclusion. Results There was moderate quality evidence that TrP dry needling reduces shoulder pain intensity with a small effect (MD = −0.49 points, 95% CI = −0.84 to −0.13; SMD = −0.25, 95% CI = −0.42 to −0.09) and low quality evidence that TrP dry needling improves related disability with a large effect (MD = −9.99 points, 95% CI -15.97 to −4.01; SMD = −1.14, 95% CI -1.81 to −0.47) as compared to a comparison group. The effects on pain were only found at short-term. The RoB was generally low, but the heterogenicity of the results downgraded the evidence level. Conclusions Moderate- to low-quality evidence suggests positive effects of TrP dry needling for pain intensity (small effect) and pain-related disability (large effect) in nontraumatic shoulder pain of musculoskeletal origin, mostly at short term. Future clinical trials investigating long-term effects are needed. Impact Dry needling is commonly used for the management of musculoskeletal pain. This is the first meta-analysis to examine the effects of dry needling on nontraumatic shoulder pain.

Dry Needling for the Treatment Of Tension-Type, Cervicogenic, or Migraine Headaches: a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Mohammadreza Pourahmadi ◽  
Jan Dommerholt ◽  
César Fernández-de-Las-Peñas ◽  
Bart Willem Koes ◽  
Mohammad Ali Mohseni-Bandpei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Intensity ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Dry Needling ◽  
Short Term ◽  
Patient Will ◽  
Headache Pain ◽  
Better Than

Abstract Objective Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review's main objective was to assess the effectiveness of dry needling on headache pain intensity and related-disability in patients with TTH, CGH, or migraine. Methods Medline/PubMed, Scopus, Embase®, PEDro, WoS, Ovid, AMED/EBSCO, CENTRAL, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris’s dppc2) and their respective confidence intervals. Results Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only four trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity at short-term in patients with TTH (SMD −1.27, 95% CI −3.56 to 1.03, n = 230), CGH (SMD −0.41, 95% CI −4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI −0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related-disability at short-term in patients with TTH (SMD −2.28, 95% CI −2.66 to −1.91, n = 160) and CGH (SMD −0.72, 95% CI −1.09 to −0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH. Conclusions Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related-disability in the short-term. Impact Although further high methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every one to two patients with TTH treating by dry needling, one patient will likely show decreased headache intensity (NNT = 2; large effect) and improved related-disability (NNT = 1; very large effect). In CGH, for every three to four patients treating by dry needling, one patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related-disability (NNT = 3; medium effect).

Effects of manual acupuncture and electroacupuncture for lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis

2020 ◽  
pp. 096452842096736
Author(s):  
Marcos J Navarro-Santana ◽  
Jorge Sanchez-Infante ◽  
Guido F Gómez-Chiguano ◽  
Mike Cummings ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Effect Size ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Short Term ◽  
Positive Effects ◽  
Small Effect Size ◽  
Lateral Epicondylalgia ◽  
Moderate Effect Size ◽  
Moderate Effect

Objective: The aim of this study was to evaluate the effect of acupuncture/electroacupuncture, alone or combined with other interventions, on pain intensity, pain-related disability, and strength in lateral epicondylalgia (LE) of musculoskeletal origin. Databases and data treatment: Electronic databases were searched for randomized clinical trials, where at least one group received acupuncture or electroacupuncture for LE of musculoskeletal origin. To be eligible, trials had to include humans and collect outcomes on pain intensity or pain-related disability in LE. Data were extracted by two reviewers. The risk of bias (RoB) of the trials was assessed using the Cochrane RoB tool, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the level of evidence was summarized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) using random effects were calculated. Results: A total of 14 trials (10 acupuncture) were included. The meta-analysis found a moderate effect size of acupuncture (SMD = −0.66, 95% confidence interval (CI) = −1.22 to −0.10), but not electroacupuncture (SMD = −0.08, 95% CI = −0.99 to 0.83), in the reduction of elbow pain as compared to a comparative group. Acupuncture exhibited a significant moderate effect size (SMD = −0.51, 95% CI = −0.91 to −0.11) in the improvement of related-disability. Acupuncture (SMD = 0.36, 95% CI = 0.16 to 0.57), but not electroacupuncture (SMD = 0.34, 95% CI = −0.29 to 0.98), exhibited a significant but small effect size on strength. Most significant effects were in the short term. The RoB was low but the heterogeneity of trial results led to a downgrading of the GRADE evidence level. Conclusion: Low-level evidence suggests positive effects of acupuncture, but not electroacupuncture, for pain, related-disability, and strength, in LE of musculoskeletal origin, in the short term.

Is Dry Needling Effective for the Management of Plantar Heel Pain or Plantar Fasciitis? An Updated Systematic Review and Meta-analysis

Pain Medicine ◽  
2021 ◽  
Author(s):  
Luis Llurda-Almuzara ◽  
Noé Labata-Lezaun ◽  
Toni Meca-Rivera ◽  
Marcos J Navarro-Santana ◽  
Joshua A Cleland ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Plantar Fasciitis ◽  
Meta Analysis ◽  
Heel Pain ◽  
Risk Of Bias ◽  
Dry Needling ◽  
Level Of Evidence ◽  
Plantar Heel Pain ◽  
Quality Evidence

Abstract Objective Dry needling is commonly used for the management of plantar fasciitis. This meta-analysis evaluated the effects of dry needling over trigger points (TrPs) associated with plantar heel pain on pain intensity and related disability or function. Methods Electronic databases were searched for randomized controlled trials where at least one group received dry needling, not acupuncture, for TrPs associated with plantar heel pain and collected outcomes on pain intensity and related-disability. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool, methodological quality was assessed with PEDro score, and the level of evidence is reported using the GRADE approach. Between-groups mean differences (MD) and standardized mean difference (SMD) were calculated. Results The search identified 297 publications with 6 trials eligible for inclusion. The meta-analysis found low quality evidence that TrP dry needling reduces pain intensity at short term (MD -1.70 points, 95%CI -2.80 to -0.60; SMD -1.28, 95%CI -2.11 to -0.44) and moderate quality evidence for improving pain intensity (MD -1.77 points, 95%CI -2.44 to -1.11; SMD -1.45, 95%CI -2.19 to -0.70) and related-disability (SMD -1.75, 95% CI -2.22 to -1.28) at long-term compared to a comparison group. The RoB of the trials was generally low, but the heterogeneity of the results downgraded the level of evidence. Discussion Moderate to low evidence suggests a positive effect of TrP dry needling for improving pain intensity and pain-related disability in patients with plantar heel pain of musculoskeletal origin at short- and long-term, respectively. Current results should be considered with caution due to the small number of trials.

scholarly journals Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2044 ◽  
Author(s):  
Youssef Rahou-El-Bachiri ◽  
Marcos J. Navarro-Santana ◽  
Guido F Gómez‐Chiguano ◽  
Joshua Cleland ◽  
Ibai López‐de‐Uralde‐ Villanueva ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Trigger Point ◽  
Meta Analysis ◽  
Patellofemoral Pain ◽  
Risk Of Bias ◽  
Dry Needling ◽  
Short Term ◽  
Post Surgery

Background: To evaluate the effect of trigger point dry needling alone or as an adjunct with other interventions on pain and related disability in people with knee pain. Methods: Several electronic databases were searched for randomized controlled trials where at least one group received dry needling for knee pain. Studies had to include human subjects and collect outcomes on pain and pain-related disability in musculoskeletal knee pain. Data were extracted by two reviewers. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the quality of evidence by using the GRADE approach. Standardized mean differences (SMD) were calculated. Results: Ten studies (six patellofemoral pain, two knee osteoarthritis, two post-surgery knee pain) were included. The meta-analysis found moderate effect sizes of dry needling for reducing pain (SMD −0.53, 95% CI −0.87 to −0.19) and improving related disability (SMD −0.58, 95% CI −1.08 to −0.09) as compared to a comparison group at short-term. The main effect was observed for patellofemoral pain (SMD −0.64, 95% CI −1.17 to −0.11). No significant effects were observed at mid- or long-term follow-ups. The risk of bias was generally low, but the heterogenicity and the imprecision of the results downgraded the level of evidence. Conclusion: Low to moderate evidence suggests a positive effect of trigger point dry needling on pain and related disability in patellofemoral pain, but not knee osteoarthritis or post-surgery knee pain, at short-term. More high-quality trials investigating long-term effects are clearly needed.

scholarly journals Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials

2021 ◽  
pp. 1-18
Author(s):  
Ignacio Hernando Garijo ◽  
Sandra Jiménez del Barrio ◽  
Teresa Mingo Gómez ◽  
Ricardo Medrano de la Fuente ◽  
Luis Ceballos Laita
Keyword(s):  
Clinical Trials ◽  
Pain Intensity ◽  
Physical Function ◽  
Strong Evidence ◽  
Randomized Clinical Trials ◽  
Cochrane Library ◽  
Short Term ◽  
High Quality ◽  
Positive Effects

BACKGROUND: Fibromyalgia is a chronic condition characterized by generalized pain. Several studies have been conducted to assess the effects of non-pharmacological conservative therapies in fibromyalgia. OBJECTIVE: To systematically review the effects of non-pharmacological conservative therapies in fibromyalgia patients. METHODS: We searched MEDLINE, Cochrane library, Scopus and PEDro databases for randomized clinical trials related to non-pharmacological conservative therapies in adults with fibromyalgia. The PEDro scale was used for the methodological quality assessment. High-quality trials with a minimum score of 7 out of 10 were included. Outcome measures were pain intensity, pressure pain threshold, physical function, disability, sleep, fatigue and psychological distress. RESULTS: Forty-six studies met the inclusion criteria. There was strong evidence about the next aspects. Combined exercise, aquatic exercise and other active therapies improved pain intensity, disability and physical function in the short term. Multimodal therapies reduced pain intensity in the short term, as well as disability in the short, medium and long term. Manual therapy, needling therapies and patient education provided benefits in the short term. CONCLUSIONS: Strong evidence showed positive effects of non-pharmacological conservative therapies in the short term in fibromyalgia patients. Multimodal conservative therapies also could provide benefits in the medium and long term.

Effects of electromyographic biofeedback interventions for shoulder pain and function: Systematic review and meta-analysis

2021 ◽  
pp. 026921552199095
Author(s):  
Danilo Harudy Kamonseki ◽  
Letícia Bojikian Calixtre ◽  
Rodrigo Py Gonçalves Barreto ◽  
Paula Rezende Camargo
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Confidence Interval ◽  
Shoulder Pain ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Electromyographic Biofeedback ◽  
Mean Differences ◽  
And Function

Objective: To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain. Design: Systematic review of controlled clinical trials. Literature search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020. Study selection criteria: Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized. Data synthesis: The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis. Results: Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48). Conclusion: Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.

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