Needling Therapy for Myofascial Pain Control

91 Pages·2013·9.32 MB·English

Evidence-Based Complementary and Alternative Medicine
Needling Therapy for
Myofascial Pain Control
Guest Editors: Chang-Zern Hong, Marta Imamura, and José M. Climent Barberá
Needling Therapy for Myofascial Pain Control
Evidence-Based Complementary and Alternative Medicine
Needling Therapy for Myofascial Pain Control
Guest Editors: Chang-Zern Hong, Marta Imamura,
and Jose´ M. Climent Barbera´
Copyright©2013HindawiPublishingCorporation.Allrightsreserved.
Thisisaspecialissuepublishedin“Evidence-BasedComplementaryandAlternativeMedicine.”Allarticlesareopenaccessarticles
distributedundertheCreativeCommonsAttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninany
medium,providedtheoriginalworkisproperlycited.
Editorial Board
TerjeAlraek,Norway PeterFisher,UK Ire´neLund,Sweden
ShrikantAnant,USA RomainForestier,France GailB.Mahady,USA
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HyunsuBae,RepublicofKorea MuhammadN.Ghayur,Pakistan J.L.Marnewick,SouthAfrica
LijunBai,China AnwarulH.Gilani,Pakistan FrancescoMarotta,Italy
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VassyaBankova,Bulgaria SveinHaavik,Norway JamesH.McAuley,Australia
WinfriedBanzer,Germany Seung-HeonHong,Korea AndreasMichalsen,Germany
VernonA.Barnes,USA MarkusHorneber,Germany DavidMischoulon,USA
JairoKenuppBastos,Brazil Ching-LiangHsieh,Taiwan Hyung-InMoon,RepublicofKorea
SujitBasu,USA BennyT.K.Huat,Singapore AlbertMoraska,USA
DavidBaxter,NewZealand RomanHuber,Germany MarkMoss,UK
Andre-MichaelBeer,Germany AngeloA.Izzo,Italy MinKyunNa,RepublicofKorea
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PaoloBellavite,Italy StefanieJoos,Germany VitalyNapadow,USA
YongC.Boo,RepublicofKorea Z.Kain,USA F.R.F.Nascimento,Brazil
FrancescaBorrelli,Italy OsamuKanauchi,Japan IsabellaNeri,Italy
GloriaBrusotti,Italy KrishnaKaphle,Nepal T.B.Nguelefack,Cameroon
ArndtBu¨ssing,Germany KenjiKawakita,Japan MartinOffenbacher,Germany
LeighF.Callahan,USA JongY.Kim,RepublicofKorea Ki-WanOh,RepublicofKorea
RaffaeleCapasso,Italy Cheorl-HoKim,RepublicofKorea Y.Ohta,Japan
OpherCaspi,Israel YounC.Kim,RepublicofKorea OlumayokunA.Olajide,UK
Shun-WanChan,HongKong YoshiyukiKimura,Japan ThomasOstermann,Germany
Il-MooChang,RepublicofKorea ToshiakiKogure,Japan StaceyA.Page,Canada
RajnishChaturvedi,India ChingLan,Taiwan Tai-LongPan,Taiwan
Tzeng-JiChen,Taiwan AlfredLa¨ngler,Germany BhushanPatwardhan,India
YunfeiChen,China LixingLao,USA BeritSmestadPaulsen,Norway
KevinChen,USA Jang-HernLee,RepublicofKorea AndreaPieroni,Italy
Juei-TangCheng,Taiwan Tatl.Lee,Singapore RichardPietras,USA
EvanP.Cherniack,USA MyeongS.Lee,UK XianqinQu,Australia
Jen-HweyChiu,Taiwan ChristianLehmann,Canada CassandraL.Quave,USA
WilliamCho,HongKong MarcoLeonti,Italy RojaRahimi,Iran
JaeYoulCho,Korea Ping-ChungLeung,HongKong KhalidRahman,UK
Shuang-EnChuang,Taiwan ChunGuangLi,Australia CheppailRamachandran,USA
EdwinL.Cooper,USA Xiu-MinLi,USA KeRen,USA
VincenzoDeFeo,Italy ShaoLi,China Mee-RaRhyu,RepublicofKorea
Roc´ıoDelaPuertaVa´zquez,Spain SabinaLim,Korea Jose´LuisR´ıos,Spain
AlexandraDeters,Germany WenChuanLin,China PaoloR.diSarsina,Italy
DrissaDiallo,Norway ChristopherG.Lis,USA BasharSaad,PalestinianAuthority
MohamedEddouks,Morocco GerhardLitscher,Austria A.Sandner-Kiesling,Austria
AmrE.Edris,Egypt I-MinLiu,Taiwan AdairSantos,Brazil
TobiasEsch,Germany KeLiu,China G.Schmeda-Hirschmann,Chile
YibinFeng,HongKong YijunLiu,USA RosaSchnyer,USA
JosueFernandez-Carnero,Spain GaofengLiu,China AndrewScholey,Australia
JulianoFerreira,Brazil CynthiaR.Long,USA VeroniqueSeidel,UK
DanaSeidlova-Wuttke,Germany K.V.Trinh,Canada KenjiWatanabe,Japan
SenthamilR.Selvan,USA VolkanTugcu,Turkey W.Weidenhammer,Germany
TuhinadriSen,India Yew-MinTzeng,Taiwan JennyM.Wilkinson,Australia
RonaldSherman,USA CatherineUlbricht,USA HarukiYamada,Japan
KarenJ.Sherman,USA DawnM.Upchurch,USA NobuoYamaguchi,Japan
KanShimpo,Japan AlfredoVannacci,Italy HitoshiYamashita,Japan
Byung-CheulShin,Korea ManiVasudevan,Malaysia YongQingYang,China
Jian-nanSong,China JosephR.Vedasiromoni,India KenYasukawa,Japan
RachidSoulimani,France CarloVentura,Italy E.Yesilada,Turkey
MohdR.Sulaiman,Malaysia WagnerVilegas,Brazil M.Yoon,RepublicofKorea
VenilN.Sumantran,India PradeepVisen,Canada HongQ.Zhang,HongKong
TokuTakahashi,USA AristoVojdani,USA RuixinZhang,USA
TakashiTakahashi,Japan DietlindWahner-Roedler,USA BoliZhang,China
RabihTalhouk,Lebanon Chong-ZhiWang,USA HongZhang,Sweden
ChunTaoChe,USA Shu-MingWang,USA HaiboZhu,China
MeiTian,China ChenchenWang,USA
YaoTong,HongKong Y.Wang,USA
Contents
NeedlingTherapyforMyofascialPainControl,Chang-ZernHong,MartaImamura,
andJose´M.ClimentBarbera´
Volume2013,ArticleID946597,2pages
ComparisonsofPredictionModelsofMyofascialPainControlafterDryNeedling:AProspectiveStudy,
Yuan-TingHuang,Choo-AunNeoh,Shun-YuanLin,andHon-YiShi
Volume2013,ArticleID478202,8pages
RemoteEffectofLowerLimbAcupunctureonLatentMyofascialTriggerPointofUpperTrapezius
Muscle:APilotStudy,Kai-HuaChen,Kuang-YuHsiao,Chu-HsuLin,Wen-MingChang,Hung-ChihHsu,
andWei-ChiHsieh
Volume2013,ArticleID287184,8pages
NeuromuscularDamageandRepairafterDryNeedlinginMice,AresDomingo,OrlandoMayoral,
SoniaMonterde,andManelM.Santafe´
Volume2013,ArticleID260806,10pages
EfficacyofMyofascialTriggerPointDryNeedlinginthePreventionofPainafterTotalKnee
Arthroplasty:ARandomized,Double-Blinded,Placebo-ControlledTrial,OrlandoMayoral,
IsabelSalvat,Mar´ıaTeresaMart´ın,StellaMart´ın,Jesu´sSantiago,Jose´Cotarelo,andConstantinoRodr´ıguez
Volume2013,ArticleID694941,8pages
BotulinumToxinfortheTreatmentofMyofascialPainSyndromesInvolvingtheNeckandBack:
AReviewfromaClinicalPerspective,Jose´M.Climent,Ta-ShenKuan,PedroFenollosa,
andFranciscoMartin-del-Rosario
Volume2013,ArticleID381459,10pages
ProbableMechanismsofNeedlingTherapiesforMyofascialPainControl,Li-WeiChou,Mu-JungKao,
andJaung-GengLin
Volume2012,ArticleID705327,11pages
RemoteSubcutaneousNeedlingtoSuppresstheIrritabilityofMyofascialTriggerSpots:An
ExperimentalStudyinRabbits,ZhonghuaFu,Yueh-LingHsieh,Chang-ZernHong,Mu-JungKao,
Jaung-GengLin,andLi-WeiChou
Volume2012,ArticleID353916,8pages
DryNeedlingatMyofascialTriggerSpotsofRabbitSkeletalMusclesModulatestheBiochemicals
AssociatedwithPain,Inflammation,andHypoxia,Yueh-LingHsieh,Shun-AnYang,Chen-ChiaYang,
andLi-WeiChou
Volume2012,ArticleID342165,12pages
PercutaneousSoftTissueReleaseforTreatingChronicRecurrentMyofascialPainAssociatedwith
LateralEpicondylitis:6CaseStudies,Ming-TaLin,Li-WeiChou,Hsin-ShuiChen,andMu-JungKao
Volume2012,ArticleID142941,7pages
HindawiPublishingCorporation
Evidence-BasedComplementaryandAlternativeMedicine
Volume2013,ArticleID946597,2pages
http://dx.doi.org/10.1155/2013/946597
Editorial
Needling Therapy for Myofascial Pain Control
Chang-ZernHong1,2
1DepartmentofPhysicalTherapy,HungkuangUniversity,Sha-Lu,Tai-Chung433,Taiwan
2DepartmentofPhysicalMedicineandRehabilitation,UniversityofCaliforniaIrvine,Irvine,CA92818,USA
CorrespondenceshouldbeaddressedtoChang-ZernHong;[email protected]
Received25July2013;Accepted25July2013
Copyright©2013Chang-ZernHong.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense,
whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
Needling therapy has been widely used for pain control. bicepsfemorismusclescouldmodulatevariousbiochemicals
“Needling”includesallprocedureswithpenetrationofanee- associated with pain, inflammation,and hypoxia in a dose-
dlethroughtheskinwithinjectionofmedication(injection dependentmanner.TheotheranimalstudybyA.Domingo
therapy)orwithoutintroductionofanydrug(dryneedling). etal.foundthatrepeateddryneedlingpuncturesinmuscle
Ineitherinjectionordryneedling,thesiteoftreatmentcan do not perturb the different stages of muscle regeneration
beatthesiteofpain(directneedling)orfarfromthesiteof andreinnervation.AnotherresearchstudybyM.-T.Linetal.
pain(remoteneedling).Needlingtherapyincludestraditional suggestedthattheartificialneuralnetwork(ANN)modelwas
acupuncture,needlingwithmultipleinsertions,dryneedling moreaccurateinpredictingpatient-reportedpainscoresand
withelectricalstimulation,superficialneedling,andFu’ssub- had higher overall performance indices. Finally two papers
cutaneousdryneedling. reported their newly developed techniques for myofascial
Myofascial pain is a regional pain syndrome character- pain control. An animal study by Fu et al. further confirm
izedwiththeexistenceofasensitivespot(myofascialtrigger theeffectivenessandthepossiblemechanismofFu’sremote
point(MTrP))inthetautbandofskeletalmusclefibers.MTrP needlingformyofascialpantherapy.ThestudybyLinetal.
can be inactivated by appropriate treatment with physical demonstratedtheeffectivenessofLin’spercutaneoussofttis-
therapy(includingmanualtherapy)orneedlingtherapy. suerelease(lessinvasivethanthesurgicalrelease)fortreating
Thisspecialissuecontainsninepapers,ofwhichtwoare chronicrecurrentmyofascialpainduetolateralepicondylitis.
review articles and seven are research articles. The review Many studies in this issue reported the application of
paperbyL.-W.Chouetal.discussedvariousproposedmech- multiple insertion technique for dry needling therapy. In
anisms published previously and concluded that multiple either clinical practice or research studies, it has been sug-
mechanisms are probably involved in needling analgesia. gestedthatneedlingwith“multipleinsertiontechnique”can
Another review paper by J. M. Climent et al. discussed the usuallyprovidethebestandfastesteffectsforimmediatepain
clinicaltrialsofbotulinumtoxininjectionfortreatingmyo- control. This technique was originally described by Travell
fascial pain in the neck and back, and concluded that bot- and Bobb for myofascial trigger point (MTrP) injection.
ulinum toxin could be useful in specific myofascial pain Duringinjection,theneedlewasmovedinandoutintodif-
regions, especially for patients with refractory myofascial ferent directions to elicit painful sensation (to encounter
pain that has not responded to other myofascial injection the sensitive loci) in an MTrP region. In this way, MTrP
therapies.Twoclinicalstudiesdemonstratedtheeffectiveness paincanusuallybeeliminatednearlycompletelyimmediately
of dry needling in treating myofascial pain after total knee aftermostofthosemultiplesensitivelocihavebeeninjected
arthroplasty(O.Mayoraletal.)andremotepainintheupper (orencountered).Consideringthetimeconsumingandthe
trapezius muscle (K.-H. Chen et al.). One animal study by possibility of muscle fiber damage during this slow needle
Y.-L.Hsiehetal.showedthatdryneedlingatthemyofascial movement, C.-Z. Hong has modified this technique into a
trigger spots (MTrSs, equivalent to human MTrP) of rabbit “fast-movementprocedure”inordertoavoidtissuedamage
2 Evidence-BasedComplementaryandAlternativeMedicine
fromsidemovementofneedleorgrabofneedlebytheelicited
localtwitchresponses(LTRs).Later,thisnewtechniquehas
beenrecommendedbySimonsandhasbeenwidelyusedfor
MTrPinjectionordryneedling.
The descending pain inhibitory system is probably
involved in the mechanism of immediate pain relief after
multipleneedleinsertion.Eitherhyperstimulationanalgesia
for general pain control or disruption of “MTrP” circuit
for myofascial pain control is actually via the descend-
ing inhibitory system. It has been suggested that eliciting
LTRs(feelingsimilarto“De-Qui”effect)duringneedlingis
essential to obtain an immediate and complete pain relief
after MTrP needling or MTrP injection. Eliciting an LTR
or obtaining “De-Qi” effect indicates that a sensitive locus
(sensitized nociceptor) is encountered by the needle tip. It
appears that, when a sensitive locus is encountered by the
tinyneedletip,“De-Qi”effectcanbeperceivedandanLTR
canbeelicited,andthentheirritabilityofthissensitivelocus
canbesuppressedimmediately.NeedlingofakeyMTrPcan
also inhibit the irritability of satellite MTrPs due to central
desensitization phenomenon. It is important to provide
strong stimuli to the sensitive loci as many as possible to
obtain optimal hyperstimulation in order to have maximal
pain relief; so that the “multiple insertion technique” can
providebettereffectsthanjustasinglesitestimulation.
Basedonthereportsinthisspecialissue,itisverylikely
thattheaboveissueshavebeenfurtherclarified.
Chang-ZernHong
HindawiPublishingCorporation
Evidence-BasedComplementaryandAlternativeMedicine
Volume2013,ArticleID478202,8pages
http://dx.doi.org/10.1155/2013/478202
Research Article
Comparisons of Prediction Models of Myofascial Pain Control
after Dry Needling: A Prospective Study
Yuan-TingHuang,1Choo-AunNeoh,2 Shun-YuanLin,2andHon-YiShi3
1NursingDepartment,KaohsiungArmedForcesGeneralHospital,Kaohsiung80201,Taiwan
2SectionofAnesthesiology,PingtungChristianHospital,Pingtung90059,Taiwan
3DepartmentofHealthcareAdministrationandMedicalInformatics,KaohsiungMedicalUniversity,No.100,
Shih-Chuan1stRoad,Kaohsiung80708,Taiwan
CorrespondenceshouldbeaddressedtoHon-YiShi;[email protected]
Received3December2012;Accepted10June2013
AcademicEditor:Jose´M.ClimentBarbera´
Copyright©2013Yuan-TingHuangetal. This is an open access article distributed under the Creative Commons Attribution
License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly
cited.
Background.Thisstudypurposedtovalidatetheuseofartificialneuralnetwork(ANN)modelsforpredictingmyofascialpain
control after dry needling and to compare the predictive capability of ANNs with that of support vector machine (SVM) and
multiplelinearregression(MLR).Methods.Totally400patientswhohavereceiveddryneedlingtreatmentscompletedtheBrief
PainInventory(BPI)atbaselineandat1yearpostoperatively.Results.ComparedtotheMLRandSVMmodels,theANNmodel
generallyhadsmallermeansquareerror(MSE)andmeanabsolutepercentageerror(MAPE)valuesinthetrainingdatasetand
testingdataset.MostANNmodelshadMAPEvaluesrangingfrom3.4%to4.6%andmosthadhighpredictionaccuracy.The
globalsensitivityanalysisalsoshowedthatpretreatmentBPIscorewasthebestparameterforpredictingpainafterdryneedling.
Conclusion.ComparedwiththeMLRandSVMmodels,theANNmodelinthisstudywasmoreaccurateinpredictingpatient-
reportedBPIscoresandhadhigheroverallperformanceindices.Furtherstudiesofthismodelmayconsidertheeffectofamore
detaileddatabasethatincludescomplicationsandclinicalexaminationfindingsaswellasmoredetailedoutcomedata.
1.Introduction constructing hyperplanes in a multidimensional space that
separatescasesofdifferentclasslabels.However,SVMshave
Myofascialpainsyndrome(MPS),acommoncauseofmus- also been proven effective for solving regression problems
culoskeletal pain presenting in primary care, results from because they can handle multiple continuous variables [6–
myofascialtriggerpointactivity[1,2].Dryneedlingisatreat- 10].Artificialneuralnetworks(ANNs)arecomplexandflex-
mentmodalitythatisminimallyinvasive,cheap,andeasyto ible nonlinear systems with properties not found in other
learnwithappropriatetrainingandcarriesalowrisk.Itseffec- modeling systems. These properties include robust perfor-
tivenesshasbeenconfirmedinnumerousstudiesandcom- mance in dealing with noisy or incomplete input patterns,
prehensive systematic reviews [3–5]. Accurately predicting highfaulttolerance,andthecapabilitytogeneralizefromthe
myofascial pain control, a standard outcome measure after input data [6–10]. The computational power of an ANN is
dryneedling,isimportantwhenselectingtreatmentmodality derived from the distributed nature of its connections. The
andwhenallocatingscarcemedicalresources[1,2]. ANNmodelisawell-establisheddataminingalgorithmthat
Regression analysis, one of the most widely used mul- iswidelyusedinvariousfields,fromengineeringtobiomed-
tivariate analysis methods, assumes linear relationships icalscience[6–10].
between independent and dependent variables. However, Themultilayerperceptron(MLP)isthemostfrequently
studies show that changes in biomedical variables are often used ANN due to its ability to model nonlinear systems
nonlinear [6–10]. The major classifier methods use support andestablishnonlineardecisionboundariesinclassification
vectormachines(SVMs)tosolveclassificationproblemsby problemssuchasopticalcharacterrecognition,datamining,