The effect of one dry needling session on pain, central pain processing, muscle co-contraction and gait characteristics in patients with knee osteoarthritis: a randomized controlled trial

Abstract Objectives To assess the immediate and three days postintervention effect of one dry needling session compared to one sham needling session on pain, central pain processing, muscle co-contraction and spatiotemporal parameters during gait in knee osteoarthritis patients. Methods A double-blind randomized controlled trial was conducted. Sixty-one knee osteoarthritis patients were randomly assigned to the dry needling or sham needling group. Primary outcomes were pain and central pain processing. Secondary outcomes included muscle co-contraction and spatiotemporal parameters during gait. Patients were assessed at baseline and 15 min after the intervention, and pain also three days after the intervention. Linear mixed models were used to examine between- and within-group differences. Results No significant between-group differences for pain were found, but within-group scores showed a significant decrease 15 min after sham needling and three days after dry needling. The mean conditioned pain modulation effect measured at the m. Trapezius worsened significantly 15 min after sham needling compared to after dry needling (between-group difference). However, individual conditioned pain modulation percentage scores remained stable over time. Various significant within-group differences were found 15 min after sham needling: a decrease of conditioned pain modulation measured at m. Quadriceps and m. Trapezius and stride- and step-time scores, and an increase in step length and widespread pain pressure threshold. A significant decrease in muscle co-contraction index of the m. Vastus Medialis and Semitendinosus was found as within-group difference 15 min after dry needling. Conclusions Dry needling has no larger effect on pain, central pain processing, muscle co-contraction and gait pattern 15 min and three days postintervention compared to sham needling. Mean conditioned pain modulation scores worsened after sham needling compared to after dry needling. Further research remains necessary.

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POS1096 THE EFFECT OF ONE DRY NEEDLING SESSION ON PAIN AND CENTRAL PAIN PROCESSING IN PATIENTS WITH KNEE OSTEOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2108 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 828.1-828

Author(s):

S. Vervullens ◽

L. Meert ◽

I. Baert ◽

N. Delrue ◽

K. Heusdens ◽

...

Keyword(s):

Controlled Trial ◽

Group Differences ◽

Pain Processing ◽

Dry Needling ◽

Knee Oa ◽

Pressure Threshold ◽

Pain Pressure Threshold ◽

Spatiotemporal Parameters ◽

Central Pain Processing ◽

Over Time

Background:Osteoarthritis (OA) is the leading cause of chronic disability in the elderly1,2. Abnormal central pain processing (CPP) is present in around 30% of the knee OA patients3 and can be partly induced by peripheral nociception through long term potentiation4. An attempt to resolve abnormal CPP can be to eliminate this nociception5. Myofascial trigger points (MTrPs) are often present in knee OA6, can lead to nociception7 and therefore abnormal CPP if prolonged present8. These are usually defined as hypersensitive tender spots within taut bands of a muscle9. Additionally, both MTrPs and knee OA can induce disturbed motor control, increased co-antagonist activation and modified gait pattern10,11. Dry needling (DN) is often used to deactivate the MTrP and thus resolve the source of nociception, which normally results in reducing pain and restoring muscle dysfunction12. However, studies about the effect of DN on CPP and other outcomes than pain are very limiting. Therefore, more high-quality studies concerning DN and its effects on CPP, muscle features and gait are needed13,14.Objectives:The aim of this randomized controlled trial is to assess the effect of one DN session compared to one sham needling (SN) session on pain (processing), muscle activity and gait in patients with knee OA.Methods:61 patients participated of which 31 were allocated to the DN and 30 to the SN group. Each patient underwent one treatment session. Primary outcomes were pain intensity, measured with questionnaires; and CPP, measured with quantitative sensory testing. Secondary outcomes included muscle co-activation, measured with electromyography; and spatiotemporal parameters, measured with gait analysis. Patients were assessed at baseline, 15 minutes (post 1) and 3 days after intervention (post2- only for the outcome pain). Linear mixed models was used to identify the possible differences over time between the two therapy modalities.Results:The following significant within group differences were observed: decreased pain, stride- and step time and increased widespread pain pressure threshold and step length. A significant between group difference of the conditioned pain modulation score was found, whereas the SN group showed a decrease in difference between the pain pressure threshold scores (with and without conditioning stimulus) and the DN group remained stable. No other significant between or within group differences were detected. However, if we compared both interventions, the change over time for the visual analogue scale (VAS) behaved different in the DN (p<0.05, post 2 - baseline) and SN group (p<0.05, post 1 - baseline and post 2 - post 1).Conclusion:One DN session has no larger effect on all outcome measurements compared to SN. Both therapies seem to be useful to improve pain and widespread pain pressure threshold in short term, however the improvement of pain differs in the groups. Although improvements in some spatiotemporal parameters were observed, it is uncertain they are of clinical relevance or related to treatment. More research is necessary to reveal the ideal number of sessions of DN to improve outcomes and to reveal the effect of DN compared to no treatment, as SN could have hide the real treatment effect.References:[1]Reginster, J. Y. Rheumatol. Oxf. 41 Supp 1, 3–6 (2002)[2]Lespasio, M. J. et al. Perm J 21, 16–183 (2017)[3]Lluch, E. et al. Eur J Pain 18, 1367–75 (2014)[4]Mease, P. J. et al. J. Rheumatol. 38, 1546–1551 (2011)[5]Nijs, J. et al. Expert Opin Pharmacother 15, 1671–83 (2014)[6]Bajaj, P. et al. J. Musculoskelet. Pain 9, 17–33 (2001)[7]Jafri, M. S. Int. Sch. Res. Not. 2014, (2014)[8]Cagnie, B. et al. Curr Pain Headache Rep 17, 348 (2013)[9]Borg-Stein, J. et al. Arch. Phys. Med. Rehabil. 83, S40–S47 (2002)[10]Childs, J. D. et al. Clin. Biomech. 19, 44–9 (2004)[11]Ibarra, J. M. et al. J Pain 12, 1282–8 (2011)[12]Rahou-El-Bachiri, Y. et al. J. Clin. Med. 9, (2020)[13]Stieven, F. F. et al. J. Manipulative Physiol. Ther. (2021)[14]Dor, A. et al. J Bodyw Mov Ther 21, 642–647 (2017)Figure 1.Mean and standard error of VAS scores over time in the DN and SN groupAcknowledgements:I like to thank and acknowledge the contribution of the other executive researchers (Lise Brosens, Ayoub El Bouchaoni, Ben Ceusters, Sven Huybrechts and Mathias Van Loon), the participated dry needling therapists, Dry Needling Ghent, Trigger and the University Hospital of Antwerp.Disclosure of Interests:None declared.

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Does Acetaminophen Activate Endogenous Pain Inhibition in Chronic Fatigue Syndrome/ Fibromyalgia and Rheumatoid Arthritis? A DoubleBlind Randomized Controlled Cross-over Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e61 ◽

2013 ◽

Vol 2;16 (2;3) ◽

pp. E61-E70 ◽

Cited By ~ 2

Author(s):

Mira Meeus

Keyword(s):

Temporal Summation ◽

Chronic Fatigue ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Pain Processing ◽

Central Pain ◽

Healthy Controls ◽

Fatigue Syndrome ◽

Central Pain Processing ◽

Pain Inhibition

Background: Although enhanced temporal summation (TS) and conditioned pain modulation (CPM), as characteristic for central sensitization, has been proved to be impaired in different chronic pain populations, the exact nature is still unknown. Objectives: We examined differences in TS and CPM in 2 chronic pain populations, patients with both chronic fatigue syndrome (CFS) and comorbid fibromyalgia (FM) and patients with rheumatoid arthritis (RA), and in sedentary, healthy controls, and evaluated whether activation of serotonergic descending pathways by acetaminophen improves central pain processing. Study Design: Double-blind randomized controlled trial with cross-over design. Methods: Fifty-three women (19 CFS/FM patients, 16 RA patients, and 18 healthy women) were randomly allocated to the experimental group (1 g acetaminophen) or the placebo group (1 g dextrose). Participants underwent an assessment of endogenous pain inhibition, consisting of an evaluation of temporal summation with and without conditioned pain modulation (CPM). Seven days later groups were crossed-over. Patients and assessors were blinded for the allocation. Results: After intake of acetaminophen, pain thresholds increased slightly in CFS/FM patients, and decreased in the RA and the control group. Temporal summation was reduced in the 3 groups and CPM at the shoulder was better overall, however only statistically significant for the RA group. Healthy controls showed improved CPM for both finger and shoulder after acetaminophen, although not significant. Limitations: The influence of acetaminophen on pain processing is inconsistent, especially in the patient groups examined. Conclusion: This is the first study comparing the influence of acetaminophen on central pain processing in healthy controls and patients with CFS/FM and RA. It seems that CFS/ FM patients present more central pain processing abnormalities than RA patients, and that acetaminophen may have a limited positive effect on central pain inhibition, but other contributors have to be identified and evaluated. Key words: Chronic pain, sensitization, acetaminophen, conditioned pain modulation, temporal summation, chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis

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The development of a novel questionnaire assessing alterations in central pain processing in people with and without chronic pain

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0087 ◽

2020 ◽

Vol 20 (2) ◽

pp. 407-417

Author(s):

Philip D. Austin ◽

Ali Asghari ◽

Daniel S.J. Costa ◽

Philip J. Siddall

Keyword(s):

Chronic Pain ◽

Factor Analysis ◽

Exploratory Factor Analysis ◽

Pain Modulation ◽

Self Report ◽

Pain Processing ◽

Central Pain ◽

Item Questionnaire ◽

Excellent Internal Consistency ◽

Central Pain Processing

AbstractBackground and aimsThe purpose of this study was to (a) develop and (b) conduct exploratory factor analysis on a novel self-report instrument for symptoms associated with altered central pain processing.MethodsWe first developed a 25-item questionnaire based on previous literature identifying symptoms and behaviours that may reflect altered spinal and supraspinal pain processing. We then administered this questionnaire to 183 people with chronic pain (n = 99) and healthy individuals (n = 84). Exploratory factor analysis was conducted to identify the factor structure of the questionnaire.ResultsOur results support a two-factor solution for the 25-item questionnaire that accounted for 57.2% of the total variance of responses in people with and without chronic pain. Factor one (11 items) included items related to alterations in sensation of pain, while factor two (seven items) included items associated with emotional and fatigue symptoms. Seven items showed weak factor loadings and were eliminated. Reliability was excellent, while both factors showed strong correlations with previously-validated self-report Instruments: (pain catastrophising, mood, vigilance, pain self-efficacy) and conditioned pain modulation, providing evidence for their validity.ConclusionsWe have developed a questionnaire containing two factors that appear to be related to two different symptom clusters, one of which is specifically related to pain and one of which contains other health-related symptoms related to mood and fatigue. These factors show excellent internal consistency and validity. This questionnaire may be a quick, easy and reliable instrument to assess central pain processing in clinical settings.

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(478) Effect of high and low frequency TENS on central pain processing in patients with knee osteoarthritis and healthy controls

Journal of Pain ◽

10.1016/j.jpain.2015.01.398 ◽

2015 ◽

Vol 16 (4) ◽

pp. S95

Author(s):

C. Valencia ◽

R. Vallandingham ◽

T. Demchak

Keyword(s):

Knee Osteoarthritis ◽

Low Frequency ◽

Pain Processing ◽

Central Pain ◽

Healthy Controls ◽

Central Pain Processing

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(480) Conditioned pain modulation and treatment response in patients with knee osteoarthritis

Journal of Pain ◽

10.1016/j.jpain.2014.01.391 ◽

2014 ◽

Vol 15 (4) ◽

pp. S96 ◽

Cited By ~ 1

Author(s):

M. Cornelius ◽

R. Edwards

Keyword(s):

Knee Osteoarthritis ◽

Treatment Response ◽

Pain Modulation ◽

Conditioned Pain Modulation

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Treatment response and central pain processing in Anterior Cutaneous Nerve Entrapment Syndrome: An explorative study

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.09.014 ◽

2017 ◽

Vol 14 (1) ◽

pp. 53-59 ◽

Cited By ~ 2

Author(s):

Dagmar C. van Rijckevorsel ◽

Oliver B. Boelens ◽

Rudi M. Roumen ◽

Oliver H. Wilder-Smith ◽

Harry van Goor

Keyword(s):

Abdominal Wall ◽

Nerve Entrapment ◽

Cutaneous Nerve ◽

Diagnosis And Treatment ◽

Pain Processing ◽

Central Pain ◽

Pain Thresholds ◽

Generalized Hyperalgesia ◽

Central Pain Processing ◽

Nerve Entrapment Syndrome

AbstractBackground10–30% of chronic abdominal pain originates in the abdominal wall. A common cause for chronic abdominal wall pain is the Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), in which an intercostal nerve branch is entrapped in the abdominal rectus sheath. Treatment consists of local anaesthetics and neurectomy, and is ineffective in 25% of cases for yet unknown reasons.In some conditions, chronic pain is the result of altered pain processing. This so-called sensitization can manifest as segmental or even generalized hyperalgesia, and is generally difficult to treat.ObjectiveThe aim of this study was to assess pain processing in ACNES patients responsive and refractory to treatment by using Quantitative Sensory Testing, in order to explore whether signs of altered central pain processing are present in ACNES and are a possible explanation for poor treatment outcomes.Methods50 patients treated for ACNES with locally orientated treatment were included. They were allocated to a responsive or refractory group based on their response to treatment. Patients showing an improvement of the Visual Analogue Scale (VAS) pain score combined with a current absolute VAS of <40 mm were scored as responsive.Sensation and pain thresholds to pressure and electric skin stimulation were determined in the paravertebral bilateral ACNES dermatomes and at four control areas on the non-dominant side of the body, i.e. the musculus trapezius pars medialis, musculus rectus femoris, musculus abductor hallucis and the thenar. The ACNES dermatomes were chosen to signal segmental hyperalgesia and the sum of the control areas together as a reflection of generalized hyperalgesia. Lower thresholds were interpreted as signs of sensitized pain processing. To test for alterations in endogenous pain inhibition, a conditioned pain modulation (CPM) response to a cold pressor task was determined. Also, patients filled in three pain-related questionnaires, to evaluate possible influence of psychological characteristics on the experienced pain.ResultsPatients refractory to treatment showed significantly lower pressure pain thresholds in the ACNES dermatomes and for the sum of as well as in two individual control areas. No differences were found between groups for electric thresholds or CPM response. Duration of complaints before diagnosis and treatment was significantly longer in the refractory compared to the responsive group, and refractory patients scored higher on the pain-related psychological surveys.Conclusion and ImplicationsIn this hypothesis-generating exploratory study, ACNES patients refractory to treatment showed more signs of sensitized segmental and central pain processing. A longer duration of complaints before diagnosis and treatment may be related to these alterations in pain processing, and both findings could be associated with less effective locally orientated treatment. In order to validate these hypotheses further research is needed.Registration numberNCT01920880 (Clinical Trials Register; http://www.clinicaltrials.gov).

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