Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke

Objectives: To determine the presence of post-needling induced pain in subjects who had suffered a stroke and received trigger point (TrP) dry needling (DN), and to investigate the effects of including TrP-DN into a rehabilitation program for shoulder pain in this population. Methods: A randomized clinical trial was conducted. Sixteen patients who had suffered a stroke and presented with shoulder pain were randomly assigned to receive rehabilitation alone or rehabilitation combined with DN. Both groups received a neurorehabilitation session including modulatory interventions targeting the central nervous system. Patients in the DN group also received a single session of DN over active TrPs in the shoulder musculature. A numerical pain rating scale (NPRS, 0–10) was used to asses post-needling induced pain at 1 min, 24 h, and 72 h after needling. Shoulder pain (NPRS, 0–10) was assessed at baseline, and 3 and 7 days after DN in both groups. Results: Five (62%) patients receiving TrP-DN reported post-needling induced pain. Post hoc analysis found that post-needling induced pain decreased significantly at 24 and 72 h (both p < 0.001) after DN. Patients receiving TrP-DN plus rehabilitation exhibited greater decreases in shoulder pain intensity at 3 days (Δ = −4.2, 95% confidence interval (CI) = −5.8 to −2.6) and 7 days (Δ = −4.3, 95% CI = −5.9 to −2.7) after the intervention compared with those receiving rehabilitation alone (all p < 0.001). Conclusion: This trial found that 50% of stroke patients receiving DN experienced post-needling induced pain, a side effect that almost disappeared 72 h after the intervention without any additional therapeutic action. In addition, the inclusion of TrP-DN into a rehabilitation session was effective at decreasing shoulder pain in these patients.

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Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm9061837 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1837 ◽

Cited By ~ 4

Author(s):

Manuel Rodríguez-Huguet ◽

Jorge Góngora-Rodríguez ◽

Pablo Rodríguez-Huguet ◽

Alfonso Javier Ibañez-Vera ◽

Daniel Rodríguez-Almagro ◽

...

Keyword(s):

Shoulder Pain ◽

Rating Scale ◽

Trigger Point ◽

Controlled Trial ◽

Pressure Pain Threshold ◽

Dry Needling ◽

Invasive Approach ◽

Shoulder Range Of Motion ◽

One Year

Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder pain, although evidence about its long-term effects is scarce. The aim of this trial was to determine the effects of PE on supraspinatus tendinopathy compared with trigger point dry needling (TDN). Thirty-six patients with supraspinatus tendinopathy were randomly assigned to either a PE group (n = 18) or a TDN group (n = 18). Both groups also performed eccentric exercises. The main outcome to be measured was the Numerical Pain Rating Scale (NPRS), but the shoulder range of motion (ROM) and trigger point pressure pain threshold (PPT) were also considered. A one-year follow-up was conducted. Significant differences favoring the PE group were found regarding pain at one-year follow-up (p = 0.002). The improvement achieved in the PE group was greater in the NPRS (p < 0.001), proximal PPT, middle PPT, distal PPT (all p < 0.001) and ranges of movement. PE seems to be more effective than TDN in relieving pain and improving ROM and PPT supraspinatus values in patients with supraspinatus tendinopathy, both right after treatment and at one-year follow-up.

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Child Life Reduces Distress and Pain and Improves Family Satisfaction in the Pediatric Emergency Department

Clinical Pediatrics ◽

10.1177/0009922818798386 ◽

2018 ◽

Vol 57 (13) ◽

pp. 1567-1575 ◽

Cited By ~ 5

Author(s):

Natasha Sanchez Cristal ◽

Jennifer Staab ◽

Rachel Chatham ◽

Sarah Ryan ◽

Brian Mcnair ◽

...

Keyword(s):

Emergency Department ◽

Rating Scale ◽

Pediatric Trauma ◽

Family Satisfaction ◽

Pediatric Emergency ◽

Child Life ◽

Convenience Sample ◽

Patient Cooperation ◽

To Receive ◽

Pain Rating Scale

This study evaluated the effects of Certified Child Life Specialist (CCLS) intervention on pediatric distress and pain and family satisfaction during routine peripheral intravenous (PIV) line placement in the emergency department (ED). A convenience sample of 78 children (3-13 years) requiring PIV placement for their treatment at a regional level 1 pediatric trauma center ED with 70 000 annual visits were selected to receive either standard nursing care or CCLS intervention for PIV placement. CCLS involvement was associated with fewer negative emotional behaviors as indicated by a lower score on the Children’s Emotional Manifestation Scale (−3.37 ± 1.49, P = .027), a reduction in self-reported pain on the Wong-Baker Faces pain rating scale (−1.107 ± 0.445, P = .017), an increase in parent-reported patient cooperation during PIV placement, and greater satisfaction with the ED visit. This study demonstrates that Child Life can have an impact on important outcomes in the pediatric ED such as distress, pain, and visit satisfaction.

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LAPAROSCOPIC CHOLECYSTECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.05.1513 ◽

2013 ◽

Vol 20 (05) ◽

pp. 699-706

Author(s):

HEMMATPOOR BEHZAD ◽

MAHVAR TAYEBEH ◽

MAKHSOSI BEHNAM REZA ◽

Saeb Morteza

Keyword(s):

Laparoscopic Cholecystectomy ◽

Shoulder Pain ◽

Rating Scale ◽

Controlled Study ◽

P Value ◽

Medical Sciences ◽

Preoperative Administration ◽

Elective Laparoscopic Cholecystectomy ◽

Double Blinded ◽

To Receive

Background: shoulder pain after laparoscopic procedure is a frequent complication encountered in surgery ward. Severaltreatments have been proposed to reduce it. This study aimed to evaluate the efficacy of preoperative administration of gabapentin inpreventing and attenuating Post Laparoscpoic Shoulder Pain (PLSP) after laparoscopic cholecystectomy. Design: In a randomised,double blinded placebo controlled study. Setting: Woman's Hospital, Kermanshah University of Medical Sciences. Period: April 2011 toMarch 2012. Material and methods: 90 patients of ASA physical status I-II undergoing elective laparoscopic cholecystectomy wererandomly allocated to receive gabapentin 600 mg or placebo ,half an hour before surgery. The presence analgesia and side effects wererecorded for 12h postoperatively in same times. Results: Incidence Verbal Rating Scale (VRS) ≥ 4 at different times after arrival to PACUwere significantly lower in gabapentin group in arrival (P Value= 0.003) and then after 30 miniute (P Value= 0.02) and 2 (P Value=0.003), 4 (P Value= 0.03) and 6 (P Value= 0.04) hours after arrival to Post Anesthesia Care Unit (PACU). But this sigificancy lost at 12hours (P Value= 0.07) after arrival to PACU. Also there was a reduction in amounts of postoperative in ward analgesic consumption. Sideeffects were not different between two groups. Conclusions: 600 mg gabapentin as premedication is effective and safe for reducing postlaparoscopicshoulder pain intensity after general laparoscopy compared with placebo.

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Changes in Muscle Tone, Function, and Pain in the Chronic Hemiparetic Shoulder after Dry Needling Within or Outside Trigger Points in Stroke Patients: A Crossover Randomized Clinical Trial

Pain Medicine ◽

10.1093/pm/pnaa132 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2939-2947 ◽

Cited By ~ 2

Author(s):

Alma R Hernández-Ortíz ◽

Raquel Ponce-Luceño ◽

Carlos Sáez-Sánchez ◽

Olga García-Sánchez ◽

César Fernández-de-las-Peñas ◽

...

Keyword(s):

Upper Extremity ◽

Shoulder Pain ◽

Repeated Measures ◽

Muscle Tone ◽

Trigger Point ◽

Treatment Session ◽

Dry Needling ◽

Extremity Function ◽

Upper Extremity Function

Abstract Objectives To investigate the effects of applying dry needling into a trigger point (TrP) or non-TrP area in people who have suffered a stroke and to investigate if the effects of dry needling are maintained at six-week follow-up. Methods A controlled, repeated-measures, crossover, double-blinded randomized trial was conducted. Nineteen patients with hemiparetic shoulder pain after a stroke event were randomly assigned to receive a single multimodal treatment session combined with TrP dry needling or non-TrP dry needling. The neuro-rehabilitation session included modulatory interventions targeting the central nervous system. Spasticity (Modified Ashworth Scale), shoulder pain intensity (numerical pain rate scale, 0–10), and upper extremity function (Motor Evaluation Scale for Upper Extremity in Stroke [MESUPES], Reaching Performance Scale [RPS]) were assessed before (baseline) and one, two, three, four, five, and six weeks after the treatment session by a blinded assessor. All participants received both sessions in a randomized order where they were followed up for six weeks before receiving the opposite treatment and then followed up for another six weeks. Results Changes in muscle tone (all P > 0.266) and upper extremity function (MESUPES: F = 0.544, P = 0.465; RPS close task: F = 0.820, P = 0.371; RPS far task: 0.830, P = 0.368) were similar after both interventions at all follow-up periods. The decrease in shoulder pain was higher within the TrP dry needling group as compared with the non-TrP dry needling group, particularly at two and four weeks (P = 0.01). Conclusions The effect of dry needling on muscle tone (spasticity) and upper extremity function is not related to its application in or outside of a TrP area. The effect of dry needling on shoulder pain was slightly superior when applied over a TrP in poststroke people. These effects were maintained six weeks after treatment.

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Efficacy of Vitamin B1, B6, and B12 Forte Therapy in Peripheral Neuropathy Patients

Diponegoro International Medical Journal ◽

10.14710/dimj.v2i1.9549 ◽

2021 ◽

Vol 2 (1) ◽

pp. 14-19

Author(s):

Meyvita Silviana ◽

Dodik Tugasworo ◽

Maria Belladonna

Keyword(s):

Peripheral Neuropathy ◽

Rating Scale ◽

Vitamin B1 ◽

Wilcoxon Test ◽

Nutritional Deficiencies ◽

Once Daily ◽

Tunnel Syndrome ◽

Michigan Neuropathy Screening Instrument ◽

Post Hoc ◽

Pain Rating Scale

Background: Peripheral neuropathy can be caused by diabetes mellitus, nutritional deficiencies, entrapment or Carpal Tunnel Syndrome (CTS), and idiopathic.Objective: To determine the therapeutic efficacy of Vitamin B1, B6, and B12 forte in relieving symptoms of peripheral neuropathy.Methods: This was pre- and post-experimental study involving patients with moderate peripheral neuropathy (Toronto Clinical Neuropathy Score [TCNS] ≥6 and Michigan Neuropathy Screening Instrument [MNSI] ≥7) taken from outpatient neurological clinic of Dr. Kariadi Hospital, Semarang. The patient was prescribed Vit B1 100 mg, B6 100 mg, and B12 5000 mcg once daily for 2 months. Evaluation of the numerical pain rating scale in the form of VAS and Total Symptom Score (TSS) was conducted at the first and second month. The VAS score difference test was conducted with the Wilcoxon test and TSS with the Post Hoc test and considered significant if p <0.05.Results: There were 30 patients aged 18 - 65 years, consisted of 70% female and 30% male. The etiology of peripheral neuropathy were idiopathic (40%), CTS (26.7%), DM (23.3%), and HNP (10%). There were significant differences of the VAS scale and TSS at every evaluations.Conclusion: Administration of VitB1, B6, and B12 forte relieved symptoms of moderate peripheral neuropathy with improvement of VAS and TSS scores

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

Physical Therapy ◽

10.1093/ptj/pzaa216 ◽

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.

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Inclusion of Trigger Point Dry Needling in a Multimodal Physical Therapy Program for Postoperative Shoulder Pain: A Randomized Clinical Trial

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2014.11.007 ◽

2015 ◽

Vol 38 (3) ◽

pp. 179-187 ◽

Cited By ~ 19

Author(s):

José L. Arias-Buría ◽

Raquel Valero-Alcaide ◽

Joshua Aland Cleland ◽

Jaime Salom-Moreno ◽

Ricardo Ortega-Santiago ◽

...

Keyword(s):

Clinical Trial ◽

Physical Therapy ◽

Randomized Clinical Trial ◽

Shoulder Pain ◽

Trigger Point ◽

Dry Needling ◽

Therapy Program ◽

Physical Therapy Program ◽

Postoperative Shoulder

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Effects of Dry Needling in Teres Major Muscle in Elite Handball Athletes. A Randomised Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10184260 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4260

Author(s):

Luis Ceballos-Laita ◽

Ricardo Medrano-de-la-Fuente ◽

Elena Estébanez-De-Miguel ◽

Jorge Moreno-Cerviño ◽

María Teresa Mingo-Gómez ◽

...

Keyword(s):

Pain Intensity ◽

Internal Rotation ◽

Shoulder Pain ◽

Isometric Strength ◽

Control Group ◽

Single Session ◽

Dry Needling ◽

Myofascial Trigger Points ◽

Shoulder Range Of Motion ◽

Teres Major

Objective: To determine the effects of dry needling (DN) in active myofascial trigger points in the teres major muscle compared to an untreated control group in pain during throwing actions, shoulder range of motion (ROM), strength, and extensibility of the tissues in professional handball (HB) athletes. Methods: A randomised, single-blinded, controlled clinical trial was designed. Thirty HB athletes with shoulder pain were randomly assigned to the DN group (n = 15) or control group (n = 15). The DN group received a single session of ultrasound-guided DN technique in the teres major muscle. The control group received no intervention. Pain intensity during throwing actions (Numeric Pain Rating Score), shoulder ROM (inclinometer), isometric strength (hand-held dynamometer), and extensibility (inclinometer) were measured before and after treatment. Results: DN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 1.3), internal rotation ROM (p < 0.001; E.S: 3.0) and extensibility (p < 0.001; E.S: 2.9) compared to the control group. No statistically significant differences were found for isometric strength (p > 0.05). Conclusion: A single session of DN in the teres major muscle was effective for improving pain intensity during throwing actions, internal rotation ROM and extensibility in HB athletes with shoulder pain.

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Responsiveness of the Numeric Pain Rating Scale in Patients With Shoulder Pain and the Effect of Surgical Status

Journal of Sport Rehabilitation ◽

10.1123/jsr.20.1.115 ◽

2011 ◽

Vol 20 (1) ◽

pp. 115-128 ◽

Cited By ~ 75

Author(s):

Lori A. Michener ◽

Alison R. Snyder ◽

Brian G. Leggin

Keyword(s):

Shoulder Pain ◽

Outcome Measures ◽

Rating Scale ◽

Effect Sizes ◽

Outpatient Rehabilitation ◽

Pain Rating ◽

Characteristic Analysis ◽

Point Change ◽

Numeric Pain Rating Scale ◽

Pain Rating Scale

Context:The Numeric Pain Rating Scale (NPRS) is commonly used to assess pain. Change in the NPRS across time can be interpreted with responsiveness indices.Objective:To determine the minimal clinically important difference (MCID) of the NPRS.Design:Single-group repeated measures.Setting:Outpatient rehabilitation clinics.Patients:Patients with shoulder pain (N = 136).Main Outcome Measures:At the initial evaluation patients completed the Penn Shoulder Score (PSS), which includes pain, satisfaction, and function sections. Pain was measured using an 11-point NPRS for 3 conditions of pain: at rest, with normal daily activities, and with strenuous activities. The NPRS average was calculated by averaging the NPRS scores for 3 conditions of pain. The final PSS was completed after 3–4 wk of rehabilitation. To determine the MCID for the NPRS average, the minimal detectible change of 8.6 points for the PSS function scale (0–60 points) was used as an external criterion anchor to classify patients as meaningfully improved (≥8.6 point change) or not improved (<8.6-point change). The MCID for the NPRS average was also determined for subgroups of surgical and nonsurgical patients. Cohen’s effect sizes were calculated as a measure of group responsiveness for the NPRS average.Results:Using a receiver-operating-characteristic analysis, the MCID for the average NPRS for all patients was 2.17, and it was 2.17 for both the surgical and nonsurgical subgroup: area-under-the-curve range .74–.76 (95%CI: .55–.95). The effect size for all patients was 1.84, and it was 1.51 and 1.94 for the surgical and nonsurgical groups, respectively.Conclusions:The NPRS average of 3 pain questions demonstrated responsiveness with an MCID of 2.17 in patients with shoulder pain receiving rehabilitation for 3–4 wk. The effect sizes indicated a large effect. However, responsiveness values are not static. Further research is indicated to assess responsiveness of the NPRS average in different types of patients with shoulder pain.

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