Dry needling versus magnesium sulfate iontophoresis of active trigger points of the axioscapular muscle in neck pain: a single blind randomized controlled trial

Abstract

Objective:

To compare the effects of dry needling (DN) and magnesium sulfate (MgSO4) iontophoresis on pressure pain threshold (PPT), neck disability, pain intensity and muscle activity/amplitude in patients with upper-trapezius active myofascial trigger points (MTrPs) and neck pain.

Methods:

Sixty subjects with neck pain and cervical myofascial pain syndrome (MPS) of the upper trapezius muscles were randomly assigned into a DN group that received DN and stretching of all cervical muscles, an iontophoresis group that received MgSO4 iontophoresis and stretching of all cervical muscles or a control group C that received only stretching of all cervical muscles. The subjects received the treatment twice a week for 4 weeks. PPT, Arabic neck disability index (ANDI), pain intensity visual analogue scale (VAS) and cervical muscle amplitude (assessed by electromyography and expressed as a normalized root mean square (RMS)) were measured before and after completion of the treatment.

Results:

In the within-group analysis, there were statistically significant differences pre- versus post-treatment in all variables in both experimental groups (p < 0.05) but no significant differences in the control group with the single exception of pain intensity. In the between-group analysis post-treatment, there were statistically significant differences between all three groups. Compared with the iontophoresis group, the DN group showed significant improvements in VAS (mean difference (MD) −2.0, 95% confidence interval (CI) −2.84 to −1.36; p < 0.01), RMS (MD −1.32, 95% CI −1.79 to −0.85; p < 0.001), ANDI (MD −2.60, 95% CI −4.50 to −0.70; p = 0.004) and PPT (MD 1.48, 95% CI 1.01–1.95; p < 0.001).

Conclusion:

DN and MgSO4 iontophoresis both had positive effects on PPT, ANDI, VAS and muscle amplitude in the treatment of neck pain subjects with upper-trapezius MTrPs. DN had a superior effect than MgSO4 iontophoresis for all outcomes studied.

Keywords

dry needling electrophoresis iontophoresis myofascial trigger points neck pain

Get full access to this article

View all access options for this article.

References

Fejer

Kyvik

Hartvigsen

. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006; 15: 834–848.

Hoy

Protani

, et al. The epidemiology of neck pain. Best Pract Res Clin Rheumatol 2010; 24: 783–792.

Mohandoss

Sharan

Ranganathan

, et al. Co morbidities of myofascial neck pain among information technology professionals. Ann Occup Environ Med 2014; 26: 21.

Gerwin

. Myofascial pain syndromes from trigger points. Curr Rev Pain 1999; 3: 153–159.

Donnelly

Fernandez de las Penas

Finnegan

, et al. Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. 3rd ed. Philadelphia, PA: Wolters Kluwer, 2019.

San-Antolín-Gil

López-López

Becerro-de-Bengoa-Vallejo

, et al. Chapter 36—influence of psychological factors on myofascial pain. In: Rajendram

Patel

Preedy

, et al. (eds) The neurobiology, physiology, and psychology of pain. Cambridge, MA: Academic Press, 2022, pp 405–415.

Chiarotto

Clijsen

Fernandez-de-Las-Penas

, et al. Prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil 2016; 97: 316–337.

Hong

Simons

. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil 1998; 79: 863–872.

Kuan

. Current studies on myofascial pain syndrome. Curr Pain Headache Rep 2009; 13(5): 365–369.

10.

Hou

Tsai

Cheng

, et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002; 83(10): 1406–1414.

11.

Moraska

Schmiege

Mann

, et al. Responsiveness of myofascial trigger points to single and multiple trigger point release massages: a randomized, placebo-controlled trial. Am J Phys Med Rehabil 2017; 96: 639–645.

12.

Gulick

. Evidence-based interventions for myofascial trigger points. Phys Med Rehabil Res 2016; 1(3): 41–47.

13.

Simons

Travell

Simons

. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1. Upper Half of Body. 2nd ed. Baltimore, MD: Williams & Wilkins, 1999, pp. 12–93.

14.

D’Ambrogio

Roth

. Positional release therapy: assessment and treatment of musculoskeletal, dysfunction. St Louis, MO: Mosby, 1997, pp. 383–387.

15.

Jones

. Strain and counter-strain. Newark, OH: American Academy of Osteopathy, 1981.

16.

Chaitow

. Effect of muscle energy technique with nontraumatic neck pain. In: Muscle energy techniques. 2nd ed. Edinburgh: Churchill Livingstone, 2001; 141, pp. 432–439.

17.

Jyothirmai

Kumar

Raghavkrishna

, et al. Effectiveness of integrated neuromuscular inhibitory technique (INIT) with specific strength training exercises in subjects with upper trapezius trigger points. Int J Physiother 2015; 2(5): 759–764.

18.

Lewit

. The needle effect in the relief of myofascial pain. Pain 1979; 6: 83–90.

19.

Vulfsons

Ratmansky

Kalichman

. Trigger point needling: techniques and outcome. Curr Pain Headache Rep 2012; 16: 407–412.

20.

Lee

Lin

Hong

. The effectiveness of simultaneous thermotherapy with ultrasound and electrotherapy with combined AC and DC current on the immediate pain relief of myofascial trigger points. J Musculosk Pain 1997; 5: 81–90.

21.

Gam

Warming

Larsen

, et al. Treatment of myofascial trigger points with ultrasound, combined with massage and exercise-a randomized controlled trial. Pain 1998; 77: 73–79.

22.

Pontinen

Airaksinen

. Evaluation of myofascial pain and dysfunction syndromes and their response to low level laser therapy. J Muskuloskele Pain 1995; 3(2): 149–154.

23.

Kaya

Kamali

Ardicoglu

, et al. Direct current therapy with/without lidocaine iontophoresis in myofascial pain syndrome. Bratisl Lek Listy 2009; 110(3): 185–191.

24.

Rayegani

Bayat

Bahrami

, et al. Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome. Clin Rheumatol 2014; 33(6): 859–864.

25.

Liamas-Ramos

Pecos-Martin

Gallego

, et al. Comparison of short-term outcome between trigger point dry needling and trigger point manual therapy: a randomized clinical trial. J Orthop Sports Phys Ther 2014; 44: 852–861.

26.

Kietrys

Palombaro

Azzaretto

, et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013; 43: 620–634.

27.

Liu

Huang

Liu

, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2015; 96(5): 944–955.

28.

Shah

Danoff

Desai

, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 2008; 89: 16–23.

29.

Shah

Philips

Danoff

, et al. A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biochemical differences in 3 clinically distinct groups: normal, latent, and active. Arch Phys Med Rehabil 2003; 84: A4.

30.

Hong

. Persistence of local twitch response with loss of conduction to and from the spinal cord. Arch Phys Med Rehabil 1994; 75: 12–16.

31.

Clijsen

Taeymans

Baeyens

, et al. The effects of iontophoresis in the treatment of musculoskeletal disorders -a systematic review and meta-analysis. Drug Deliv Lett 2012; 2(3): 180–194.

32.

Ibrahim

Abdel Raoof

Mosaad

, et al. Effect of magnesium sulfate iontophoresis on myofascial trigger points in the upper fibres of the trapezius. J Taibah Univ Med Sci 2021; 16(3): 369–378.

33.

Mizutani

Taniguchi

Miyagawa

, et al. The analgesic effect of iontophoresis with magnesium sulfate. Masui 1995; 44(8): 1076–1079.

34.

Schulz

Altman

Moher

, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332.

35.

Simons

Travell

Simons

. Travell & Simons’ myofascial pain and dysfunction: the trigger point manual, volume 1: upper half of body. 2nd ed. Baltimore, MD: Williams & Wilkins, 1998.

36.

Gary

Hodgson

. The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. J Bodyw Mov Ther 2005; 9(4): 248–255.

37.

Salavati

Akhbari

Takamjani

, et al. Reliability of the upper trapezius muscle and fascia thickness and strain ratio measures by ultrasonography and sonoelastography in participants with myofascial pain syndrome. J Chiropr Med 2017; 16(4): 316–323.

38.

American Physical Therapy Association. Physical therapists & the performance of dry needling: an educational resource paper. Alexandria, VA: American Physical Therapy Association, 2012.

39.

White

Cummings

Filshie

. An introduction to western medical acupuncture. Edinburgh: Churchill Livingstone, 2008.

40.

Myburgh

Larsen

Hartvigsen

. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil 2008; 89(6): 1169–1176.

41.

Simons

. Clinical and etiological update of myofascial pain from trigger points. J Musculoskele Pain 1996; 4: 93–122.

42.

Baldry

. Superficial versus deep dry needling at myofascial trigger point sites. J Musculoskele Pain 1995; 3: 117–126.

43.

Teslim

Olaogun

MOB

Obembe

, et al. Electromotive drug administration of magnesium sulphate on spastic biceps brachii of stroke survivors: a technical report. J Med Med Sci Res 2013; 2(4): 38–43.

44.

Boonstra

Preuper

Reneman

, et al. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008; 31(2): 165–169.

45.

McLean

. The effect of postural correction on muscle activation amplitudes recorded from the cervicobrachial region. J Electromyogr Kinesiol 2005; 15(6): 527–535.

46.

Ekstrom

Soderberg

Donatelli

. Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis. J Electromyogr Kinesiol 2005; 15(4): 418–428.

47.

Khan

Bhati

, et al. Influence of forward head posture on cervicocephalic kinesthesia and electromyographic activity of neck musculature in asymptomatic individuals. J Chiropr Med 2020; 19(4): 230–240.

48.

Nicoletti

Spengler

Läubli

. Physical workload, trapezius muscle activity, and neck pain in nurses’ night and day shifts: a physiological evaluation. Appl Ergon 2014; 45(3): 741–746.

49.

Kinser

Sands

Stone

. Reliability and validity of a pressure algometer. J Strength Cond Res 2009; 23(1): 312–314.

50.

Shaheen

Omar

Vernon

. Cross-cultural adaptation, reliability, and validity of the Arabic version of Neck Disability Index in patients with neck pain. Pain 2013; 38(10): 609–615.

51.

Vernon

Mior

. The Neck Disability Index: a study of reliability and validity. J Manipul Physiol Ther 1991; 14(7): 409–415.

52.

MacDermid

Walton

Avery

, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther 2009; 39(5): 400–417.

53.

Katz

Paillard

Ekman

. Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res 2015; 10: 24.

54.

Young

Walker

Strunce

, et al. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J 2009; 9(10): 802–808.

55.

Walton

Levesque

Payne

, et al. Clinical pressure pain threshold testing in neck pain: comparing protocols, responsiveness, and association with psychological variables. Phys Ther 2014; 94(6): 827–837.

56.

Tekin

Akarsu

Durmuş

, et al. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clin Rheumatol 2013; 32(3): 309–315.

57.

Tough

White

Cummings

, et al. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2009; 13(1): 3–10.

58.

Edwards

Knowles

. Superficial dry needling and active stretching in the treatment of myofascial pain–a randomised controlled trial. Acupunct Med 2003; 21: 80–86.

59.

Leung

. Neurophysiological basis of acupuncture-induced analgesia–an updated review. J Acupunct Meridian Stud 2012; 5(6): 261–270.

60.

Zhao

. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 2008; 85(4): 355–375.

61.

Cagnie

Barbe

De Ridder

, et al. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. J Manipul Physiol Ther 2012; 35(9): 685–691.

62.

Garcia-de-Miguel

Pecos-Martin

Larroca-Sanz

, et al. Short-term effects of PENS versus dry needling in subjects with unilateral mechanical neck pain and active myofascial trigger points in levator scapulae muscle: a randomized controlled trial. J Clin Med 2020; 9(6): 1665.

63.

Dommerholt

. Dry needling in orthopedic physical therapy practice. Orthopaedic Practice 2004; 16(3): 15–20.

64.

Shah

Heimur

. New frontiers in the pathophysiology of myofascial pain. Pain 2012; 22(2): 26–30.

65.

Bolel

Hizmetli

Akyüz

. Sympathetic skin responses in reflex sympathetic dystrophy. Rheumatol Int 2006; 26(9): 788–791.

66.

Vetrugno

Liguori

Cortelli

, et al. Sympathetic skin response: basic mechanisms and clinical applications. Clin Auton Res 2003; 13: 256–270.

67.

Sakai

Hori

Umeno

, et al. Specific acupuncture sensation correlates with EEGs and autonomic changes in human subjects. Auton Neurosci 2007; 133: 158–169.

68.

Chen

Chung

Hou

. Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil 2001; 80(10): 729–735.

69.

Hsieh

Chou

Joe

, et al. Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle. Arch Phys Med Rehabil 2011; 92(7): 1098–1105.

70.

Kubo

Yajima

Takayama

, et al. Changes in blood circulation of the contralateral achilles tendon during and after acupuncture and heating. Int J Sports Med 2011; 32(10): 807–813.

71.

Kubo

Yajima

Takayama

, et al. Effects of acupuncture and heating on blood volume and oxygen saturation of human Achilles tendon in vivo. Eur J Appl Physiol 2010; 109(3): 545–550.

72.

Sato

Shimura

, et al. Calcitonin gene-related peptide produces skeletal muscle vasodilation following antidromic stimulation of unmyelinated afferents in the dorsal root in rats. Neurosci Lett 2000; 283(2): 137–140.

73.

De Meulemeester

Castelein

Coppieters

, et al. Comparing trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: a randomized clinical trial. J Manipul Physiol Ther 2017; 40(1): 11–20.

74.

Irnich

Behrens

Gleditsch

, et al. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain 2002; 99(1–2): 83–89.

75.

Ruela

Perissinato

Sousa Lino

, et al. Evaluation of skin absorption of drugs from topical and transdermal formulations. Braz J Pharm Sci 2016; 52(3): 527–544.

76.

Chu

Bruyninckx

Neuhauser

. Transdermal magnesium sprays for myofascial pain relief and facilitation of autonomous twitch elicitation with electrical twitch-obtaining intramuscular stimulation (ETOIMS). Eur J Pharm Med Res 2018; 5(2): 148–156.

77.

Sirvinskas

Laurinaitis

. Use of magnesium sulphate in anesthesiology. Medicina (Kaunas) 2002; 38(7): 695–698.

78.

Borg-Stein

Simons

. Focused review: myofascial pain. Arch Phys Med Rehabil 2002; 83(3): S40–S49.

79.

Mizutani

Taniguchi

Miyagawa

.et al The analgesic effect of iontophoresis with magnesium sulfate. Masui 1995; 44(8): 1076–1079.