Cervical dystonia is characterized by involuntary muscle contractions of the neck and abnormal head positions that affect daily life activities. Botulinum toxin treatment continues to be the first ...choice treatment for most types of focal dystonia. Unfortunately, botulinum toxins are expensive and have limitations. Dry needling has been used widely to relieve muscle spasms and restore its length.
A 34 years-old man developed severe axial neck dystonia gradually. His symptoms began approximately 6 months earlier with painless pulsing in his neck followed by involuntary neck movement and rotated of the neck with spasm. There was severe right head rotation and laterocollis with mild retrocollis. Head CT-scan was normal but cervical spine x ray showed retrolisthesis and narrowing intervertebral disc gap of C4-C5 and C6-C7. We used the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) to monitor the progress of dry needling in this patient. Before dry needling was performed, the TWSTRS was 47 and after 5 times dry needling in one week interval, the score became 2 and persisted at 6 months reassessment. Dry needling was done on the myotendinous junction and/or muscle belly of ipsilateral sternocleidomastoideus muscle, spinalis capitis muscle and upper trapezius muscle.
Few treatment options are available and dry needling may be useful in facilitating a rapid reduction in disability and severity. However, management using dry needling technique may require further assessment and re-needling after 3–6 months.
Abnormal muscle stiffness is a potential complication after injury and identifying interventions that modify muscle stiffness may be useful to promote recovery. The purpose of this study was to ...identify the short-term effects of dry needling (DN) on resting and contracted gastrocnemius muscle stiffness and strength of the triceps surae in individuals with latent myofascial trigger points (MTrPs). In this randomized controlled trial, 52 individuals received two DN treatment sessions to latent MTrPs and 50 individuals received two sham needling sessions. Resting and contracted muscle stiffness were assessed both at the treatment site and a standardized central site in the medial gastrocnemius head immediately post-treatment and one week after the last session. There were significant group by time interactions for resting muscle stiffness at the site of the MTrP (p = .03), but not at the central site (p = .29). Post-needling between group comparison indicated that the DN group had significantly lower resting muscle stiffness at the site of the MTrP than the sham group after adjusting for baseline differences. There were no significant between group differences in contracted muscle stiffness or muscle strength. Identifying strategies that can reduce aberrant muscle stiffness may help to guide management of individuals with neuromuscular pain-related conditions.
Level of evidence: Therapy, level 2.
Melasma is an acquired disorder of hyperpigmentation that is often recalcitrant to current therapies. Microneedling is used to treat scars, striae, and rhytides and has a relatively low risk of ...post-treatment dyspigmentation. Several studies have examined its use in melasma.
To review the published evidence on the efficacy and safety of microneedling in the treatment of melasma.
A systematic review was performed. A meta-analysis could not be performed because of methodological differences across studies and data heterogeneity.
Eight studies were included for analysis. Most studies assessed the utility of microneedling in combination with other topical therapies and detected some success. However, microneedling-mediated transdermal delivery of medications is not superior to microinjections of medications. There is less evidence supporting the use of microneedling as monotherapy. Microneedling, when used with a 1064-nm Q-switched Nd:YAG laser, may provide additional benefit, although with a risk of post-treatment dyspigmentation.
Based on low-quality evidence, microneedling may play a role in the treatment of melasma, with the mechanism of action likely being the facilitation of delivery of topical therapies to the epidermis and dermis, and one ancillary benefit of this approach being the very low risk of postinflammatory hyperpigmentation.
Background
Several studies have shown that both acupuncture and dry needling are effective in the treatment of musculoskeletal pains. Therefore, the aim of this network meta‐analysis (NMA) was to ...investigate the treatment outcome of acupuncture and dry‐needling for masticatory muscle pain (TMD‐M) and to compare with active and inactive placebo.
Material and Method
An electronic search was performed to identify randomised controlled trials (RCTs) published until September 2019, comparing dry‐needling, acupuncture, and inactive as well as active placebo in patients with TMD‐M. Outcome variables were post‐treatment pain intensity, pressure pain threshold (PPT), and maximum mouth opening (MMO). The quality of evidence was rated according to Cochrane's tool for assessing the risk of bias. Mean difference was used to analyse via frequentist NMA using STATA‐software.
Results
Both NMA and direct pairwise meta‐analysis have shown that there was no difference between active treatment with either acupuncture or dry‐needling when compared to active and inactive placebo in patients with TMD‐M with respect to pain intensity, and PPT (p > .05). However, there was a significant increase in MMO following dry‐needling when compared to the placebo (very low‐quality evidence).
Conclusion
Despite the short‐term positive effect of MMO by dry‐needling, this NMA could not show any pain‐reducing effect in patients with TMD‐M by acupuncture or dry‐needling when compared to an active or inactive placebo. Taken together, this NMA indicates that it is the placebo effect that accounts for the majority of the treatment effect of TMD‐M, rather than a real therapeutic effect of acupuncture/dry‐needling.
Despite the short‐term positive effect in MMO by dry‐needling, this NMA could not show any pain reducing effect in patients with TMD‐M by acupuncture or dry‐needling when compared to active or inactive placebo. Taken together, this NMA indicates that it is the placebo effect that accounts for the majority of the treatment effect of TMD‐M, rather than a real therapeutic effect of acupuncture/dry‐needling.
To monitor public interest (PI) in information related to Dry needling (DN) therapy and examine potential temporal, seasonal, and income-related trends that may impact PI by using the relative search ...volume (RSV) from the Google Trends tool for the keyword "Dry Needling."
For this cross-sectional observational study, a dataset was created using the Google Trends tool from 2004 to the present in the United States (US). To examine potential income-related disparities in PI in DN across the US, RSV values were recorded in the five states with the highest and the lowest median income (Maryland, New Hampshire, New Jersey, Utah, and Washington and Mississippi, West Virginia, Arkansas, New Mexico, Kentucky, respectively).
A linear regression model showed that the PI in DN increased significantly (R2 = 0,902, p < 0.001). There were no significant differences between the RSV values between the month of the year and the season of the year (p = 1.000 and p = 0.997, respectively). RSV values of the five highest-income and low-income states showed significant increases (R2 = 0,624, p < 0.001, and R2 = 0,477, p < 0.001, respectively). More rapid growth in interest in DN in states with high income compared to those with low income (p < 0.001).
PI in DN treatment is increasing in both high and low-income states. States with higher incomes are more interested. DN treatment is expected to become more popular, which will lead to a rising demand for comprehensive education in medical schools and clinician training programs. In addition, there will also be a need for easily accessible, high-quality information resources.
Acne scarring occurs at a young age and causes distress for many patients. Various treatment modalities have been tried.
This study investigated the efficacy of combination therapy with topical ...poly-lactic acid and microneedle fractional radiofrequency (MFRF) for acne scars.
Patients with acne scars on both the cheeks were included. Poly-lactic acid was applied to the acne scars on one side of the face before MFRF treatment. The other side of the face was treated with MFRF and normal saline. Patients received 3 treatment sessions and were evaluated based on visual assessment and patient satisfaction. After the last treatment, objective scar assessment of scar smoothness, size, brightness, and overall improvement was performed.
Both acne scar assessment scores and patient satisfaction were better with combination therapy (p = .036 and p = .009, respectively) than with monotherapy. Combination therapy resulted in significantly better efficacy for scar smoothness (p < .001), scar size (p = .003), and overall improvement (p < .001), but not for brightness (p = .151).
Combination therapy resulted in significantly better clinical outcomes, including better scar smoothness and smaller scar size. Therefore, we believe this combination therapy is a safe and effective treatment for acne scars.
Background
Androgenetic alopecia (AGA) is the result of progressive patterned hair density reduction and sometimes can be associated with telogen effluvium (TE). The efficacy of conventional therapy ...is variable, and therefore, there is a need for adjuvant and newer modalities of treatment in order to give faster and better outcomes. Microneedling has been reported to be a promising, effective, and safe new technique in the treatment of AGA.
Objective
The aim of this study was to prove that microneedling procedure should be offered to patients with AGA and TE along with the existing therapeutic modalities, in order to obtain faster hair regrowth and, therefore, a better patient compliance.
Patients and methods
We collected data of 36 females, 29 with AGA, and 7 with TE, and 14 males with AGA between January 2017 and December 2018 and then treated with 3 session of microneedling over a total period of 6 months.
Results
No serious adverse side effects were reported. All the patients reported a partial or complete reduction in hair loss, associated to the perception of improvement of hair density and thickening of the hair shaft diameter, results confirmed by clinical iconography and trichoscopy.
Conclusions
Scalp areas typical affected by AGA, that is, the vertex in males and the frontal area in females, are the ones that showed the greater percentage of improvement. Moreover, microneedling can have a role also in TE, especially when cosmetic procedures do not give enough results, because it induces a rapid arresting of the hair loss.
Objectives
To compare the efficacy of dry needling (DN) and cold‐spray‐stretching treatments using surface electromyography (sEMG) and ultrasound (US) in the treatment of patients with myofascial ...pain syndrome (MPS) with active trigger point (ATrP) in the upper trapezius muscle.
Methods
This prospective randomized single‐blind study included 60 MPS patients aged 18–65 years who have ATrP in the upper trapezius muscle. Patients were randomized into two treatment groups as DN and cold spray stretching. Both treatment groups received 1 treatment per week and totally 3 sessions. Evaluation parameters were pain level assessed by Numeric Rating Scale and algometer, neck range of motion angles, neck disability index (NDI). The effects of the treatments on ATrP were evaluated by sEMG and US histogram. All parameters were evaluated at the beginning of the treatment and at the end. Algometer and sEMG were performed also before and after the first and third sessions.
Results
There was no significant difference between the two groups regarding demographic data. The mean age of the participants was 39.7 ± 11.6 years. Fifty‐one patients were female. Significant improvement in terms of pain level, functionality, sEMG, and US histogram were achieved in both groups (P < .05). When comparing the two groups, algometer scores and the NDI score were statistically higher in the cold‐spray‐stretching group than in the DN group (P < .008 and P < .028, respectively).
Conclusion
Both treatment options should be preferred. The efficacy of both treatments was observed via sEMG and US histograms.
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