Immediate Effect of Dry Needling of the Lumbar Multifidus on Pain Sensitivity In A Healthy Population

Study Overview
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Brief Summary
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The goal of this interventional study is to test the effects of trigger point dry needling to the low back in a healthy population. The main aims are to answer: Is there a change in sensitivity to experimental pain after trigger point dry needling To determine if there is an association between demographic and psychological factors and immediate changes in pain sensitivity after receiving trigger point dry needling. Participants will be randomly assigned to one of two groups a dry needling group or a sham dry needling group. The dry needling group will receive trigger point dry needling to the lumbar spine. The sham dry needling group will receive needling to the lumbar spine with a sham needle which does not penetrate the skin. In other words, researchers will compare an intervention group and a sham group to see if dry needling has an immediate change in pain sensitivity in response to experimentally induced pain.

Detailed Description
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The intent of this study is to investigate the effects of trigger point dry needling on pain sensitivity in a healthy population. In this study, the effects of trigger point dry needling will be measured using quantitative sensory testing. This is a method of testing pain sensitivity by providing a painful stimulus and having the participant rate their response to the stimulus on a pain scale. In this way, the researchers will be able to determine changes to participant's response to painful stimuli and changes to the nervous system after trigger point dry needling interventions to the low back. This information will provide important insight as to how dry needling modulates pain.

Official Title
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Immediate Effect of Dry Needling of the Lumbar Multifidus on Pain Sensitivity In A Healthy Population

Conditions
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Low Back Pain

Intervention / Treatment
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* Other: Trigger point dry needling
* Other: Sham dry needling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ages 18 - 65 Be pain-free Exclusion Criteria: Participants will not be excluded on the basis of race or gender but will be excluded if they meet any of the following exclusion criteria: a) Non-English speaker b) presence of a medical condition known to affect sensation c) history of surgery to the low back d) history of blood clotting disorders or medical conditions associated with bleeding disorders e) Current use of the medication causing difficulty with clotting (such as blood thinners) f) Contraindication to the application of needles including, but not limited to, fear of needles or metal allergy --g) women who are pregnant or planning on becoming pregnant any contraindication to application of ice or cold pack, such as: uncontrolled hypertension, cold urticaria, cryoglobulinemia, paroxysmal cold hemoglobinuria, and circulatory compromise.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Double blind, randomized control
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Actual dry needling group<br>Will receive actual dry needling of the lumbar multifidus with a 50-60mm filiform needle | Other: Trigger point dry needling<br>* Filiform needle that pierces the skin and is inserted into an identified trigger point in the muscle<br>|
| Sham Comparator: Sham dry needling group<br>Will receive needling from a sham needle that is blunted so it does not pierce the skin but has been shown to be valid for being indistinguishable from receiving an actual needle. | Other: Sham dry needling<br>* A validated sham dry needle that is blunted on the end and does not pierce the skin<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Heat Thermal Pain Threshold degrees Celsius baseline and Heat Thermal Pain Threshold degrees Celsius immediately following intervention | Participants will indicate when an thermode of ascending temperatures first changes from a sensation of warmth to painful by saying pain and indicating the amount of pain with a visual analog scale. This change will be calculated by taking the difference between the two scores. | Baseline and immediately following the intervention | 
| Change in Cold Thermal Pain Threshold degrees Celsius baseline and Cold Thermal Pain Threshold degrees Celsius immediately following intervention | Participants will indicate when an thermode of descending temperatures first changes from a sensation of cold to painful by saying pain and indicating the amount of pain with a visual analog scale. This change will be calculated by taking the difference between the two scores. | Baseline and immediately following the intervention | 
| Change in Pressure Pain Threshold Kilopascals baseline and Pressure Pain Threshold Kilopascals immediately after following intervention | Participants will indicate when ascending pressure from an algometer first changes from a sensation of pressure to painful by saying pain and indicating the amount of pain with a visual analog scale. This change will be calculated by taking the difference between the two scores. | Baseline and immediately following the intervention | 
| Change in baseline Thermal Temporal Summation | Participants will rate the pain associated with a series of 10 heat pulses applied to the skin on a 0 to 100 numerical rating scale with 0= no pain to 100= worst pain imaginable. | Baseline and immediately following the intervention | 
| Change in baseline After sensation | After sensation is the term used to describe the measurement of pain that remains after a painful stimulus. Participants will rate the pain remaining every 15 seconds for a total of one minute following the final thermal pulse in the Thermal Temporal Summation protocol (as described in outcomes 4). The numeric rating scale is (0 - 100) with 0 being no pain at all and 100 being worst pain imaginable | Baseline and immediately following the intervention | 
| Change in baseline Conditioned pain modulation | Pressure pain threshold will be assessed immediately prior to and following a pain inducing cold water bath immersion. Condition pain modulation will be defined by the changes in pressure pain threshold prior to and immediately following the cold water bath immersion | Baseline and immediately following the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Expectations | Expectation will be assessed using a 15 point global rating of change anchored with -7= expect a very great deal more pain; 0= unchanged, and 7= a very great deal less pain | Baseline, immediately following intervention | 
| Degree to which expectations met | Single question, In response to the pain testing, participants will be asked to indicate, How would you describe how you feel now compared to how you expected categorically, with more, less, or expected level of pain | Immediately following follow pain testing | 
| Blinding | Five point scale with 1= strongly believe the treatment is active and 3= somewhat believe the treatment is placebo and 5= do not know | Immediately following the assigned intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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trigger point dry needling, quantitative sensory testing, low back pain