Does Dry Needling Affect Treatment Outcomes of Interlaminar Epidural Steroid Injection in Cervical Disc Herniation?
Condition: Pain, Myofacial; Pain, Neck; Pain, Chronic
MeSH terms: Intervertebral Disc Displacement; Chronic Pain; Neck Pain; Facial Pain
Study type: Interventional

Summary: 
      Chronic neck pain is among the most frequently seen chronic painful conditions. As an
      important cause of disability, chronic neck pain is a musculoskeletal disorder that
      negatively affects quality of life. Cervical disc herniation is one of the leading causes of
      chronic neck pain and conservative methods such as exercise and pain medications are used
      first in the treatment. In patients unresponsive to conservative treatment, epidural steroid
      injection is successfully and frequently used treatment option. Epidural steroid injection in
      the cervical region can be applied with two approaches: interlaminar or transforaminal.

      Myofascial trigger point characterized by intramuscular taut band and hypersensitive spots is
      a condition in which central and peripheral sensitization play a role in the pathophysiology.
      There are underlying myofascial trigger points in many etiologies that cause chronic neck
      pain. Trigger points can increase the severity of pain and in some cases they can be the main
      factor in the etiology of pain. Therefore, the presence of myofascial trigger points should
      be investigated, even if another cause is detected in chronic neck pain. Dry needling is an
      easily applicable and effective treatment option in myofascial trigger point.

      Although it is well known that myofascial trigger points frequently accompany cervical disc
      herniation, their effect on treatment outcomes has not been investigated. In this study, we
      aimed to investigate the effect of dry needling for trigger points on the treatment results
      of interlaminar epidural steroid injection in patients diagnosed with cervical disc
      herniation.
    


Intervention name(s): Cervical interlaminar epidural steroid injection; Dry needling; Sham dry needling
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered to patients with chronic neck pain due to cervical disc herniation. The injection area is cleaned 3 times with an antiseptic solution and covered with a sterile cloth. Local anesthesia with 2 cc 3% prilocaine will be applied to the skin and subcutaneous tissues in the area of interest. Under fluoroscopy guidance, the needle is advanced into the C7-T1 intervertebral disc level. With the help of the loss of resistance technique, it is understood that the needle is in the epidural space, and second control is provided by administering contrast material. After the confirmation of needle place is done, a mixture of 12 mg dexamethasone, 1 cc 2% lidocaine, 1 cc saline is injected. The patient is taken to the rest room after the procedure and followed up for any complications.; Dry needling will be applied to the active trigger points for the patients in this group. After cleaning the area of interest with an antiseptic solution, dry needling will be applied with the fast-in/fast-out technique for the active trigger point. During needle maneuvers, local contractions (local twitch response-LTR) are obtained and rapid needle movements are continued until the contractions end. Afterwards, the needle is removed and compression is applied to ensure hemostasis in the relevant area.; Although the method of intervention is like dry needling, the only difference is that the blunt end of the needle is used and it does not penetrate the skin.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: myofascial trigger point pain; disc, herniated; epidural injections