Improvement in CRPS After Deep Dry Needling Suggests a Role in Myofascial Pain

Commentary: Selective Fiber Degeneration in the Peripheral Nerve of a Patient With Severe Complex Regional Pain Syndrome

“…We have developed a more comprehensive and extensive dry needling protocol (discussed later), carried out under ultrasound guidance. As previously reported by our group (Vas and Pai, 2012, 2014, 2016a; Pai and Vas, 2018; Vas et al, 2018), this protocol of ultrasound-guided dry needling (USGDN) has shown remarkable success, producing not only sustained pain relief, but also disability relief, as indicated by improvement in the Disability of Arm, Hand, and Shoulder scale (Vas and Pai, 2016a,b). Importantly, USGDN-treated patients are able to routinely reassume their previous lifestyles and professions (Vas and Pai, 2012, 2014, 2016a; Vas et al, 2018).…”

“…The authors postulated that large Aα fiber degeneration could consequently affect the associated innervated muscles. These findings are of interest to us as they provide a mechanistic explanation for the profound structural disruption we have observed in the muscles of CRPS-affected limbs using musculoskeletal ultrasound (MSKUSG) (Vas and Pai, 2012, 2014, 2016b; Vas et al, 2013, 2016c, 2018; Pai and Vas, 2018). The sonographic signature of normal muscle is fairly distinct with a well-defined hyperechoic epimysium with an echolucent (dark) background with bright punctate and curvilinear echoes of the perimysium that appear as bright streaks [Figure 1A, left panels; (Walker et al, 2004)].…”

“…There are many important differences, including the number of needles (6 vs. 30–60 needles), length of needles (25–50 vs. 13–120 mm), duration of needle maintenance in muscle (<1 vs. 30 min), maximum sessions (6 vs. 20), and method (blind unguided vs. ultrasound-guided). We believe that these differences, particularly ultrasound guidance, the number of needles, and duration of maintenance of needles in muscles, may contribute to the effectiveness of USGDN at our clinic in treating myriad conditions, including CRPS (Vas and Pai, 2012, 2014, 2016a; Vas et al, 2014a,b, 2015, 2016a,b,c, 2018).…”

The Case for Comorbid Myofascial Pain—A Qualitative Review

“…The prevalence of active myofascial trigger points in the different muscles which were evaluated was 15–35% in CRPS patients, as opposed to 0% in the control group. Finally, several cases and case series were reported in which the treatment of comorbid MPS led to significant symptomatic relief in patients with CRPS [ 61 , 62 , 63 ].…”

The Effects of Ultrasound-guided Dry Needling on Patients With Myofascial Pain Syndrome

“…The inclusion criteria of the present review were as follows: retrospective and prospective, experimental, quasiexperimental, and observational studies; English articles on the effects of US-guided DN on MPS, and relevant articles published from 2010 to March 2020. Based on the inclusion and exclusion criteria (using US-guided DN as the main inclusion criterion), a total of 11 articles were finally reviewed [14][15][16][17][18][19][20][21][22][23][24]. Three of these studies were randomized clinical trials, comparing US-guided DN with other treatment methods [15,18,22]; 5 were case reports and case-series [14,17,19,21,24]; two were retrospective analyses of the effect of US-guided DN on the treatment of MPS [16,23], and one was a single-group, pretest, post-test study [20].…”