Acupuncture Needling versus Lidocaine Injection of Trigger Points in Myofascial Pain Syndrome in Elderly Patients – a Randomised Trial

Abstract

IntroductionMyofascial pain syndrome (MPS) is a common cause of musculoskeletal pain characterised by trigger points (MTrPs), that is tender loci in taut bands of skeletal muscle, limited range of motion in joints, referred pain and local twitch responses (LTRs) during mechanical stimulation of the MTrPs. 1 Inactivation of MTrPs is essential in managing MPS and several methods have been recommended. The treatments most commonly used for this purpose are dry needling of the MTrPs, injection treatments with local anaesthetics or saline, sprays, and stretching. 2According to the results of several studies, injection continues to be the most effective choice for treatment. The superiority of local injection or dry needling for the inactivation of MTrPs is controversial, [2][3][4][5][6][7][8] and hollow needles were used for dry needling in these studies. 2;6 Gunn suggests that the 'hollow needle' induces more tissue injury and is more painful than a 'pointed-tip needle '. 9 In this single-blinded randomised trial, we compared the efficacies and adverse events of acupuncture needling and 0.5% lidocaine injection of trigger points in myofascial pain syndrome. Method ParticipantsWe obtained retrospective ethical approval from the institutional review board of Inha University Hospital. We selected 40 subjects with chronic MPS of the upper trapezius from volunteers at four communitybased facilities; one further subject proved unable to complete the necessary forms. Subjects were selected on the basis of physical examination and interview, and signed informed consent was obtained. Participants were randomised into two groups by coin-toss: 1) ACU (acupuncture needling) group and 2) TPI (trigger point injection with 0.5% lidocaine) group.Inclusion criteria for the trial were 1) aged more than 60 years old; 2) complaining of chronic shoulder AbstractAim To compare the efficacy of acupuncture needling and 0.5% lidocaine injection of trigger points in myofascial pain syndrome of elderly patients. Methods Thirty nine participants with myofascial pain syndrome of one or both upper trapezius muscles were randomised to treatment with either acupuncture needling (n=18) or 0.5% lidocaine injection (n=21) at all the trigger points on days 0, 7 and 14, in a single-blinded study. Pain scores, range of neck movement, pressure pain intensity and depression were measured up to four weeks from the first treatment. Results Local twitch responses were elicited at least once in 94.9% of all subjects. Both groups improved, but there was no significant difference in reduction of pain in the two groups at any time point up to one month. Overall, the range of cervical movement improved in both groups, apart from extension in the acupuncture needling group. Changes in depression showed only trends. Conclusion There was no significant difference between acupuncture needling and 0.5% lidocaine injection of trigger points for treating myofascial pain syndrome in elderly patients.

Dry Needling in the Management of Musculoskeletal Pain

“…In addition, in numerous randomized clinical trials (RCTs) and one systematic review, no difference was found between injections of different substances and dry needling in the treatment of MTrP symptoms. 10,[12][13][14] Several schools and conceptual models of dry needling have developed during the last 3 decades; most common are radiculopathy 15 and MTrP 1 models. The radiculopathy model is based on empirical observations by the Canadian physician Dr. Chan Gunn, 15 who was one of the pioneers of dry needling.…”

Short-term efficacy of joint and soft tissue injections for musculoskeletal pain: An interventional cohort study

“…[9] In another study, 39 elderly patients complaining of myofascial pain in the trapezius muscle were randomly divided into two groups; significant improvements in pain were observed after 4 weeks, but there was no significant difference between groups. [10] Shoulder pain of different etiologies may respond to a single IA or subacromial CS injection. The main indications for shoulder injection are subacromial impingement syndrome, adhesive capsulitis, and rotator cuff arthropathy.…”

Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

“…The 21-and 25-gauge needles were chosen because they are generally recommended or used in research studies for trigger point injections. 6,[8][9][10][11][12] In addition, a needle size (23 gauge) in between the 2 sizes was selected for this study for comparison. The 23-and 25-gauge needles were 1in long and the 21-gauge needles c 1.25in long; injections were made with a 3mL syringe filled with 0.5% lidocaine.…”

“…7 Nevertheless, many studies on trigger point injection in patients with myofascial pain syndrome of neck and shoulder have used a smaller diameter 25-gauge needle. [8][9][10][11][12] In the present study, we selected 3 differently sized needles to determine whether different needle thicknesses affect treatment efficacy and pain intensity. Accordingly, the purpose of this study was to determine the best needle size in terms of treatment efficacy and pain intensity during trigger point injection in myofascial pain syndrome of upper-and middletrapezius muscle.…”