Rivas Calvo P1, Martínez Cepa CB1, Zuíl-Escobar JC1, Martín Urrialde JA1
1San Pablo CEU, Physiotherapy, Madrid, Spain
Background: Patients with fibromyalgia (FM) complain of widespread chronic pain from deep tissues including muscles. Previous research highlights the relevance of impulse input from deep tissues for clinical FM pain. Deep dry needle stimulation is an invasive treatment modality used in the management of musculoskeletal pain. Its efficacy has been confirmed in the management of myofascial trigger points.
Purpose: To determine if blocking abnormal impulse input with deep dry needling stimulation of tender point may decrease hyperalgesia and clinical pain in FM patients.
Methods: 120 patients that fulfilled the ACR 1990 criteria for FM were enrolled into a prospective controlled study of 12 weeks. Patients were randomly split into two groups: The control group (CG), 56 women and 4 men, who received medical treatment, and the deep dry needling group (DNG), 54 women and 6 men, who apart from continuing their medical treatment, also underwent weekly one-hour session of deep dry needling over 18 FM tender points for a 6-week-period. Study variables included pressure hyperalgesia as well as clinical pain. Patients were assessed at the start, at the end of the 6-week intervention period, and at 12th week after the onset of the study. Study questionnaires and protocol were approved by the Ethical Committee of the regional health authority. All statistical analyses were performed with de software Stata 12/SE (Stata Corporation, College Station, TX, US). P values 0.05 were considered significant.
Results: A total of 100 patients completed the study: 50 in the CG and 50 in the DNG. The mean ± SD age of participants was 53.54 ± 11.07 years, and the average reported in Fibromyalgia Impact Questionnaire (FIQ) was 73.16. At the beginning of the program, there were only significant differences between groups in age (p: 0.01) and McGill Pain Questionnaire (MPQ), (p: 0.03). At the end of the intervention, DNG showed reduction in the FIQ (p: 0.02), VAS of pain (p: 0.002), pain of SF-36 (p: 0.0007), MPQ (p:0.02), Pain Catastrophizing Scale (PCS) (p: 0.02), activity engagement of Chronic Pain Assessment Questionnaire (CPAQ) (p: 0.008), pain intensity of Brief Pain Inventory (BPI) (p: 0.03), pain interference of BPI (p: 0.01), myalgic score (p: 0.0005), number of tender points (p: 0.0004), and pressure pain threshold (p: 0.002). At the 12th week, DNG still showed significant differences in the FIQ (p: 0.03), VAS of pain (p: 0.01), pain of SF-36 (p: 0.01), MPQ (p: 0.02), PCS (p: 0.03), activity engagement of CPAQ (p = 0.01), pain intensity of BPI (p: 0.04), pain interference of BPI (p: 0.01), number of tender points (p: 0.0008), myalgic score (p: 0.00001) and pressure pain threshold (p: 0.0004).
Conclusion(s): These results suggest that deep dry needling of tender points can reliably reduce clinical FM pain, and that peripheral input is required for the maintenance of mechanical hyperalgesia of these patients.
Implications: FM syndrome pain is associated with the high prevalence of trigger points, so dry needling may be considered as a part of the treatment for to relief the pain and associated symptoms.
Keywords: Fibromyalgia, Chronic pain, Dry needling
Funding acknowledgements: No funding acknowledgements
Purpose: To determine if blocking abnormal impulse input with deep dry needling stimulation of tender point may decrease hyperalgesia and clinical pain in FM patients.
Methods: 120 patients that fulfilled the ACR 1990 criteria for FM were enrolled into a prospective controlled study of 12 weeks. Patients were randomly split into two groups: The control group (CG), 56 women and 4 men, who received medical treatment, and the deep dry needling group (DNG), 54 women and 6 men, who apart from continuing their medical treatment, also underwent weekly one-hour session of deep dry needling over 18 FM tender points for a 6-week-period. Study variables included pressure hyperalgesia as well as clinical pain. Patients were assessed at the start, at the end of the 6-week intervention period, and at 12th week after the onset of the study. Study questionnaires and protocol were approved by the Ethical Committee of the regional health authority. All statistical analyses were performed with de software Stata 12/SE (Stata Corporation, College Station, TX, US). P values 0.05 were considered significant.
Results: A total of 100 patients completed the study: 50 in the CG and 50 in the DNG. The mean ± SD age of participants was 53.54 ± 11.07 years, and the average reported in Fibromyalgia Impact Questionnaire (FIQ) was 73.16. At the beginning of the program, there were only significant differences between groups in age (p: 0.01) and McGill Pain Questionnaire (MPQ), (p: 0.03). At the end of the intervention, DNG showed reduction in the FIQ (p: 0.02), VAS of pain (p: 0.002), pain of SF-36 (p: 0.0007), MPQ (p:0.02), Pain Catastrophizing Scale (PCS) (p: 0.02), activity engagement of Chronic Pain Assessment Questionnaire (CPAQ) (p: 0.008), pain intensity of Brief Pain Inventory (BPI) (p: 0.03), pain interference of BPI (p: 0.01), myalgic score (p: 0.0005), number of tender points (p: 0.0004), and pressure pain threshold (p: 0.002). At the 12th week, DNG still showed significant differences in the FIQ (p: 0.03), VAS of pain (p: 0.01), pain of SF-36 (p: 0.01), MPQ (p: 0.02), PCS (p: 0.03), activity engagement of CPAQ (p = 0.01), pain intensity of BPI (p: 0.04), pain interference of BPI (p: 0.01), number of tender points (p: 0.0008), myalgic score (p: 0.00001) and pressure pain threshold (p: 0.0004).
Conclusion(s): These results suggest that deep dry needling of tender points can reliably reduce clinical FM pain, and that peripheral input is required for the maintenance of mechanical hyperalgesia of these patients.
Implications: FM syndrome pain is associated with the high prevalence of trigger points, so dry needling may be considered as a part of the treatment for to relief the pain and associated symptoms.
Keywords: Fibromyalgia, Chronic pain, Dry needling
Funding acknowledgements: No funding acknowledgements
Topic: Pain & pain management; Rheumatology
Ethics approval required: Yes
Institution: Hospital Universitario Marqués de Valdecilla
Ethics committee: CEIC
Ethics number: CEIC
All authors, affiliations and abstracts have been published as submitted.
