Journal Club October 2016: Impact of Needle Diameter on Long-Term Dry Needling Treatment of Chronic Lumbar Myofascial Pain Syndrome

Whether it is in the inpatient or outpatient setting, myofascial pain is a common problem that all physiatrists will eventually see in their medical career. The following study conducted by Wang et al. 2016 examined the impact of needle diameter on lumbar myofascial pain. Specifically, the researchers were looking to identify whether the diameter of a dry-needle had an effect on myofascial pain. The article was originally published in the American Journal of Physical Medicine and Rehabilitation. Through a web search, on the database PUBMED, the article was obtained to read.

This was a double-blinded study. Wang et al. 2016 separated 48 patients with a history of lumbar myofascial pain into one of three groups. Each group corresponded to a specific dry-needle diameter. The three groups examined were: 0.25 mm, 0.5mm, and 0.9mm.

The primary outcomes used were the visual analog score (VAS) and the short form health survey (SF-36). Patients rated their pain before treatment and three months after treatment. Secondary outcomes examined included: pain intensity after treatment and whether the patient would consider undergoing the same treatment again if needed.

The researchers determined that dry-needling as a practice improved patient’s pain scores over a three month period regardless of needle diameter. They also determined that the efficacy of the larger diameter needle (0.9mm) improved over the course of three months in comparison to the other two diameter sizes. Patient’s willingness to return for another treatment improved as time went on with the larger diameter needle.

In conclusion, dry-needling and the diameter of the needle both play an important role in the treatment of myofascial pain.  

Discussion Points:

1) What is myofascial pain syndrome? How is it diagnosed?

2) What is dry needling therapy? Can you think of any other forms of alternative medicine that have been used to treat myofascial pain?

3) What is the difference between a tender point and a trigger point? Could dry needling also be used as a treatment modality for tender points?

4) Do you think the diameter of the needle could play a role in other treatment modalities (trigger points, nerve blocks, etc.) for chronic pain?

5) Do you think the VAS score is an accurate way to measure pain? Do you think another scale could be used or designed to better measure a patient’s pain level?

6) How can this study be used to further improve treatment for myofascial pain?

7) What type of future research could be designed based on this new study?

8) With this new information, how will you incorporate this information into your own medical practice?

LEARN MORE by downloading the article:

Journal Article October 2016

Journal Discussion Questions October 2016