Percutaneous nerve electrical stimulation is a novel treatment modality for the management of acute and chronic myofascial pain syndrome.
To compare the effectiveness of dry needling combined with ...percutaneous electrical nerve stimulation of low frequency versus high frequency, in patients with chronic myofascial neck pain.
Randomized, single-blind trial.
Laboratory in an academic institution.
A total of 40 volunteer patients with chronic neck pain were randomly divided into 2 groups. All patients initially received deep dry needling in a myofascial trigger point of the upper trapezius. Then, one group received high frequency percutaneous electrical nerve stimulation while the other group received low frequency percutaneous electrical nerve stimulation. The primary outcomes were the visual analog scale and the pressure pain threshold, while Neck Disability Index and Kinesiophobia were secondary outcomes.
We detected significant improvements in the visual analog scale score in both groups without differences between them. We did not observe significantly different statistics in either group during the evaluation of data on pressure pain threshold.
Limitations of the study include (1) heterogeneity of the sample in relation to gender, with more women, (2) the small sample size (40 patients), (3) the absence of placebo group, and (4) the fact that the treatment is focused exclusively on the upper trapezium myofascial trigger point. .
Low and high frequency percutaneous electrical nerve stimulation combined with deep dry needling showed similar effects, since no differences between groups were observed on any of the outcome measures. High and low frequency of percutaneous electrical nerve stimulation generates changes on pain intensity and disability, but not on pressure pain threshold or fear of movement.
Objectives
The aim of this study was to observe the medium-term effects on pain, disability, and psychological factors of a combination of myofascial trigger point (MTrP) dry needling (DN) with pain ...neuroscience education (PNE) versus DN alone versus control care as usual (CUC) in patients with chronic neck pain.
Methods
A total of 60 patients were randomly selected in a Spanish National Health Service Public Hospital and divided into three groups: 6 sessions of DN with 3 sessions of PNE (TrPDN + PNE group, n = 21), 6 sessions of DN alone (TrPDN group, n = 20), or 10 sessions of usual care (CUC group, n = 19). The primary outcome was neck pain intensity, while neck disability, medication intake, and psychological factors were secondary outcomes. These variables were measured at baseline, post-treatment, and at 1 month and 3 months after treatment.
Results
TrPDN + PNE and DN alone were associated with greater reductions in pain intensity and disability compared to CUC (p < 0.01). TrPDN + PNE resulted in greater improvements in kinesiophobia, pain anxiety, and pain-related beliefs than DN alone and CUC (p < 0.01). No differences between groups were observed in medication intake, quality of life, catastrophizing, depression, or fear of pain (p > 0.05).
Discussion
Provision of PNE and DN in the management of chronic neck pain in a Spanish National Health Service Public Hospital was associated with greater improvements in psychological factors than DN therapy only.
Conclusion
DN alone was more effective at reducing chronic non-specific neck pain and disability than CUC at 3-month follow-up. However, the inclusion of PNE combined with DN resulted in greater improvements in kinesiophobia, pain anxiety, and pain-related beliefs.
Trial registration number
NCT03095365 (ClinicalTrials.gov).
Chronic neck pain is among the most common types of musculoskeletal pain. Manual therapy has been shown to have positive effects on this type of pain, but there are not yet many predictive models for ...determining how best to apply manual therapy to the different subtypes of neck pain. The aim of this study is to develop a predictive learning approach to determine which basal outcome could give a prognostic value (Global Rating of Change, GRoC scale) for Mulligan's mobilization technique and to identify the most important predictive factors for recovery in chronic neck pain subjects in four key areas: the number of treatments, time of treatment, reduction of pain, and range of motion (ROM) increase. A prospective cohort dataset of 80 participants with chronic neck pain diagnosed by their family doctor was analyzed. Logistic regression and machine learning modeling techniques (Generalized Boosted Models, Support Vector Machine, Kernel, Classsification and Decision Trees, Random Forest and Neural Networks) were each used to form a prognostic model for each of the nine outcomes obtained before and after intervention: disability-neck disability index (NDI), patient satisfaction (GRoC), quality of life (12-Item Short Form Survey, SF-12), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI II), pain catastrophizing scale (ECD), kinesiophobia-Tampa scale of kinesiophobia (TSK-11), Pain Intensity Visual Analogue Scale (VAS), and cervical ROM. Pain descriptions from the subjects and pain body diagrams guided the physical examination. The most important predictive factors for recovery in chronic neck pain patients indicated that the more anxiety and the lower the ROM of lateroflexion, the higher the probability of success with the Mulligan concept treatment.
Background. The tongue is made up of multiple muscles both extrinsic and intrinsic. The hyoid, jaw and maxillary complex contain the tongue, which hangs between these structures forming an important ...biomechanical system. This organ has to work in coordination with craniofacial structures to ensure normal orofacial functioning. There are different devices on the market for tongue force measurement. However, they are not accessible for patients due to their size and very high prices. Likewise, other devices have not yet carried out validity and reliability studies. The purpose of this study was to validate a new device proving that it is accurate compared to the algometer. Moreover, the study wanted to determine the intra-rater reliability of a protocol to assess the maximum tongue force in asymptomatic subjects. Material and methods. This is an observational-longitudinal study with repeated measurements. A prototype device was developed specifically for this study to measure tongue force through force-sensitive resistor sensors. The prototype system was equipped with a device to perform and transmit the measurement and a C++ programming software in the computer to take data from the session. Different formulas were made to calibrate the system. For validity, the force measured by the prototype and the algometer was compared. For intra-rater reliability, 29 asymptomatic Spanish subjects were recruited, and a standardized protocol was carried out for the tests. Results. Experiments to assess validity showed a strong correlation (r>0.97) and an excellent reliability (ICC>0.90) between devices. On the other hand, the intra-rater reliability analysis showed an excellent ICC (0.93) with a 95% CI of 0.86 to 0.97 and a MDC.sub.90 of 6.26N. Conclusion. We demonstrated good validity values and high intra-rater reliability for the prototype device for the maximum tongue force. KEYWORDS Device, Reliability, Temporomandibular Disorders, Tongue Force, Validity.
Abstract Objective The purpose of this study was to evaluate the immediate mechanical hypoalgesic effect of neural mobilization in asymptomatic subjects. We also compared neural gliding vs neural ...stretching to see which produced greater hypoalgesic effects in asymptomatic subjects. Methods Forty-five asymptomatic subjects (20 men and 25 women; mean ± SD age, 20.8 ± 2.83 years) were randomly allocated into 3 groups: the neural glide group, the neural stretch group, and the placebo group. Each subject received 1 treatment session. Outcome measures included bilateral pressure pain threshold measured at the trigeminal, cervical, and tibialis anterior points, assessed pre-treatment and immediately post-treatment by a blinded assessor. Three-way repeated-measures analysis of variance was used to evaluate changes in pressure pain threshold, with group (experimental or control) as the between-subjects variable and time (pre-, post-treatment) or side (dominant, nondominant) as the within-subjects variable. Results Group differences were identified between neural mobilization groups and the placebo group. Changes occurred in all of the pressure pain threshold measures for neural gliding, and in all but the trigeminal point for neural stretch. No changes in the pressure pain threshold measures occurred in the placebo group. Conclusions This research provides new experimental evidence that neural mobilization produces an immediate widespread hypoalgesic effect vs placebo but neural gliding produces hypoalgesic effects in more body sites than neural stretching.
Background
Previous studies in asymptomatic subjects have demonstrated that myofascial trigger point (MTrP) dry needling frequently is associated with postneedling soreness. However, to the authors’ ...knowledge, there is not any study that performs a detailed description of postneedling soreness characteristics in patients with myofascial pain. This information could help clinicians to make evidence‐informed decisions considering the benefits and negative effects of different dry needling dosages.
Objective
To (1) compare the prevalence, intensity, and duration of postneedling soreness and tenderness after different dosages of deep dry needling (DDN) and (2) analyze the influence on postneedling soreness of psychological factors and other factors involved in the DDN process
Design
1‐week follow‐up, double‐blind randomized controlled trial.
Setting
University community.
Participants
Patients (n = 120: 34 male; 86 female) aged 18‐53 years (median ± interquartile range, 21.0 ± 7.0 years) with active MTrPs in the upper trapezius.
Intervention
All patients received DDN in an active MTrP. They were randomly divided into 4 groups: no local twitch responses (LTRs) elicited (control group), 4 LTRs elicited, 6 LTRs elicited, and DDN until no more LTRs were elicited.
Main outcome measures
Postneedling soreness and pressure pain threshold were assessed before treatment, during DDN procedure, and every 24 hours during 1 week.
Results
Postneedling soreness showed a significant effect for time (F2,006 = 173.603; P < .001, ηp2 = 0.659) and a significant interaction between group and time (F6,017 = 3.763; P = .001; ηp2 = 0.111). Pressure pain threshold showed a significant effect for time (F2,377 = 16.833; P < .001; ηp2 = 0.127) and a significant interaction between group and time (F7,130 = 2.100; P = .04; ηp2 = 0.052). Psychological factors did not show relevant correlations with the intensity of postneedling soreness.
Conclusions
Postneedling soreness is present in most of subjects after DDN of active MTrPs. The groups in which DDN was performed eliciting LTRs exhibited greater post‐needling soreness. The number of needle insertions was associated with postneedling soreness but psychological factors did not seem to play a relevant role on its perception.
Clinical trial registration number
NCT02190890
Level of Evidence
I
: To determine the effectiveness of a therapeutic patient education (TPE) intervention based on a biobehavioral approach combined with manual therapy (MT) to reduce pain in patients with chronic ...nonspecific neck pain (CNSNP). In addition, this study intended to assess the effectiveness of a multimodal physiotherapy program including TPE to reduce pain in patients with CNSNP.
: Single-blind randomized controlled trial.
: A total of 47 patients with CNSNP were randomized into three groups: (1) MT (control group); (2) MT plus TPE based on a biobehavioral approach (Exp1); and (3) MT plus TPE based on a biobehavioral approach, and therapeutic exercise (Exp2).
: The clinical outcomes were recorded at baseline and at 1 and 4 months after the initiation of treatment. The primary outcome was pain intensity (Visual Analog Scale), and the secondary outcomes were pain catastrophizing (Pain Catastrophizing Scale), illness severity and global improvement (Clinical Global Impression Scale), and mechanosensitivity of the median nerve (Upper Limb Neural Test) and the cervical region (Modified Passive Neck Flexion Test).
: Statistically significant differences in pain intensity were found when Exp2 was compared with Exp1 and the control group at 4 months (
= 0.015 and
= 0.001, respectively), but no difference was found between Exp1 and the control group at the same follow-up period (
= 0.86). Exp2 showed statistically significant differences in all of the secondary outcomes except for pain catastrophizing when compared with the control group at 4 months.
: The Exp2 group was more effective than Exp1 and the control group in terms of reducing pain intensity at 4 months; at post-treatment, only Exp2 was more effective than the control group.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The aim of this observational, cross-sectional study is to evaluate potential differences in kinematics, specifically range of motion (ROM) and velocity, during planar cervical movements between ...patients with non-traumatic chronic neck pain and disability and asymptomatic controls, while accounting for potential influencing variables of age, sex and fear of movement. The influence of pain intensity, neck disability, age, sex or fear of motion on kinematics was analyzed through robust multivariate Bayesian regression models fitted using the brms library in R. Forty-three patients with neck pain (aged 36.70 ± 13.75 years; 10 men and 33 women) and 42 asymptomatic participants (aged 32.74 ± 13.24 years; 25 men and 17 women) completed the study protocol. The presence of neck pain/disability was associated with lower ROM and peak velocity during all planar movements when considering the influence of age, sex or fear of motion, with standardized regression coefficients that had a small effect size (ranged from 0.11 to 0.28) and estimated differences of less than 2.21° in ROM and 25.61°/s in peak velocity. Although patients with chronic mechanical neck pain showed reduced ROM and peak velocity, the small effect sizes and the low estimated differences between groups question the relevance and clinical usefulness of kinematic analysis of planar movements in samples of patients similar to those included in our study. It is probable that there are differences between the groups, but it is insufficient to rely solely on kinematic variables for patient discrimination. This limitation likely arises from the substantial variability in patient kinematics.
Postoperative pain after knee arthroplasty (TKA) is a reality that continues to be experienced today. Recently, virtual reality (VR) has demonstrated effectiveness in the management of pain. Our aim ...was to review the original controlled trials evaluating the effectiveness of VR for pain management and quality of life after TKA. Six databases were searched for articles published from inception to September 2023, following (PRISMA) guidelines. The methodological quality was assessed using the Risk of Bias tool for Randomized Trials (ROB2). Five RCTs were included in the systematic review, and four of them in the meta-analysis. The effectiveness of VR for short term pain relief was superior compared to the control (MD = -0.8 cm; CI 95%: -1.3 to -0.4;
< 0.001). VR showed a greater effect on the secondary outcomes of WOMAC (MD = -4.6 points; CI 95%: -6.5 to -2.6,
< 0.001) and the HSS scale (MD = 6.5 points; CI 95%: 0.04 to 13.0,
= 0.049). However, no differences were found in the effect on the ROM between groups (MD = 3.4 grades; CI 95%: -6.0 to 12.8,
= 0.48). Our findings suggest that the use of virtual reality during the postoperative period could be an effective non-pharmacological therapy in relieving acute pain, compared to a control intervention, with a very low degree of certainty according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). However, the low methodological quality of the articles limits our findings.
Background
There is a current lack of sufficiently high‐quality randomized controlled clinical trials that measure the effectiveness of neural tissue mobilization techniques such as median nerve ...neural mobilization (MNNM) and their specific effects on cervicobrachial pain (CP). The aim of this study was to compare the effectiveness of MNNM in subjects with CP vs. a waiting list control group (WLCG).
Methods
A single‐blinded, parallel, randomized controlled clinical trial was performed (NCT02596815). Subjects were recruited with a medical diagnosis of CP corroborated by magnetic resonance imaging. In total, 156 individuals were screened, 60 subjects were recruited, and 51 completed the trial. Pain intensity reported using the Numeric Rating Scale for Pain (NRSP; primary outcome), cervical range of motion (CROM), and functionality using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scale were the outcome measurements. Assessments were conducted at baseline and 1 hour after treatment (intervention days 1, 15, and 30). Therefore, MNNM was implemented with 30 days of follow‐up.
Results
The NRSP values of the MNNM group were significantly (P < 0.0001; 95% confidence interval CI) superior to those obtained in the WLCG. Subjects treated with MNNM reported an NRSP decrease of 3.08 points at discharge. CROM and QuickDASH outcome values were significantly (P ˂ 0.0001; 95% CI) improved only in the MNNM group. Hedges′ g showed a very large effect of the MNNM intervention.
Conclusion
MNNM may be superior to no treatment in reducing pain and increasing function in the affected upper limbs of subjects with CP.
PDF
