Bubnov Rostyslav V. and Wang Jun. Medical Acupuncture. December 2013, 25(6): 437-443.

ABSTRACT
Background: Most pain syndromes in clinical practice are myofascial in nature and are caused by the myofascial trigger point (MTrP) formation. Recent clinical studies show that MTrP dry needling is most effective to release myofascial pain after local twitch response (LTR) is elicited.

Objective: The aim of this study was to compare trigger point dry needling (TrP-DN) under ultrasound (US) guidance with TrP-DN without US guidance for myofascial pain management.

Design: This was a case series study with randomized intervention and control groups. The intervention group received dry needling with US guidance and the control group received dry needling without US guidance.

Setting: The study was conducted in the Clinical Hospital Pheophania in Kyiv, Ukraine.

Patients: This study included 133 patients who had myofascial pain diagnosed after assessment by clinical examination and necessary diagnostic tests. The intervention group consisted of 91 patients: 41 males and 23 females; median age 56. The control group consisted of 42 patients: 19 males and 23 females; median age 58.

Intervention: After US scanning identified the MTrP, dry needling, steel acupuncture needles (28 gauge) were used to elicit the LTR. The needling was performed during 2–4 sessions to inactivate all available trigger points.

Results: Pain, as measured on a visual analogue scale (VAS; 0–10) showed a significant reduction (P<0.001) from 7.2 to 1.1 at 24 hours after dry needling with US in the intervention group (pain level decreased in 84% of the subjects), compared to improvement from 7.4 to 2.7 at 24 hours after dry needling without US guidance (pain level decreased in 63.5% of the subjects) in the control group (P<0.001). There were significant correlations registered between the level of eliciting LTR during needling and the pain-relief effect (VAS decreased more than average percentage in group; r=0.717). Conclusions: US guidance significantly increased the pain relief effect, increases the level of eliciting LTR, and significantly decreased the average number of needled trigger points and the average number of treatment sessions. This approach can be utilized further to address musculoskeletal pain and neuromuscular diseases. Journal Reference