Central Pain Modulatory Effects of Dry-Needling in Patients With Non-Specific Neck Pain
Condition: Neck Pain, Posterior; Trapezius Muscle Strain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      An experimental study will be conducted to evaluate the effect of a single dry needling
      session, compared to a sham needling session, on pain intensity, local and peripheral
      hyperalgesia, and conditioned pain modulation in patients with chronic idiopathic neck pain.
    

Detailed description: 
      Chronic idiopathic neck pain frequently has a myofascial origin. This cervical myofascial
      pain is caused by myofascial trigger points (MTrPs). Myofascial trigger points are defined as
      hyperirritable nodules in a contracture of skeletal muscle fibers, which can cause pain
      symptoms, motor symptoms as well as autonomic symptoms.

      Many chronic pain populations (e.g. chronic whiplash associated disorders, fibromyalgia,
      chronic low back pain) show impaired pain processing and signs of central sensitisation.
      Central pain processing is defined as an increased responsivity of the nociceptive neurons in
      the central nerve system and is characterized by hyperalgesia (increased pain after a painful
      stimuli), allodynia (pain caused by a non-painful stimuli) and temporal summation (increased
      pain response after repeated stimuli with the same intensity). Hyperalgesia can be divided in
      local (increased sensitivity in the area of the complaints) and peripheral (increased
      sensitivity at remote area's). Furthermore, deficient inhibitory pain modulation can be
      present in this population. Conditioned pain modulation (CPM) can be measured by combining a
      painful conditioning stimuli (e.g. cold or heat) on a remote location, with a painful test
      stimuli.

      Cervical myofascial pain is often treated by dry needling (DN). DN is a myofascial treatment
      technique, which has been gaining interest in recent years. During DN, a thin, solid filiform
      needle is inserted directly into the MTrP. During this treatment, local twitch responses can
      be elicited. These are involuntary contractions of muscle fibers, leading to muscle
      relaxation, an increased local blood flow, recovery of the muscle metabolism and thus a
      reduction of pain and stiffness. By deactivation of the source of pain, chronification of the
      pain can be prevented.

      Up to this moment, there are no studies that investigated the central effects of DN. The aim
      of this study is to compare the effects of DN with sham needling on pain intensity, local and
      peripheral hyperalgesia and CPM, in patients with chronic idiopathic neck pain. Therefore,
      100 patients will be recruited. Participants are included based on online questionnaires, a
      clinical examination of neck and shoulder, and the identification of a MTrP in the upper
      trapezius muscle. All participants will receive information and have to sign an informed
      consent form. Participants will be subjected to baseline assessment, which involves
      measurements of pain scores, hyperalgesia (pressure pain thresholds (PPT) by algometry) and
      CPM (by combining immersion of the hand in hot water while repeating the PPT). Then,
      participants will be randomly allocated to either a dry needling group or a sham needling
      group. The dry needling group will receive a dry needling treatment at the identified trigger
      point location of the upper trapezius, whereas the sham needling group will receive an
      intervention in which the needle only penetrates the skin but not the fascia and muscle
      tissue. The one-time intervention of both groups will take approximately 15 minutes. After
      the treatment, the baseline measurements will be repeated.
    

Intervention name(s): Dry needling; Sham needling
Intervention type(s): Other; Other
Intervention description(s): Dry needling (DN) is a myofascial treatment technique, in which a thin, solid filiform needle is inserted directly into the MTrP. During dry needling, local twitch responses (LTR) can be elicited. These are involuntary contractions of muscle fibers, leading to muscle relaxation, an increase in blood flow,recovery of the muscle metabolism and thus a reduction of pain and stiffness.; During sham needling, a solid, filiform needle is inserted in the skin surface at the trigger point location, without penetrating the fascia and muscle tissue.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Other
Keywords: Dry Needling; Sham Needling; Myofascial Pain Syndrome; Central Pain Modulatory Effects