Abstract of the Week: Myofascial Trigger Point Dry Needling in Prevention of Pain After Knee Arthroplasty

Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial.”

Mayoral O1Salvat IMartín MTMartín SSantiago JCotarelo JRodríguez C.

In this study, 40 subjects were randomized into one of two groups, those receiving dry needling, and a control/sham group.  Immediately after the subjects in the dry needling group were anesthetized and right before surgery began, an experienced physical therapists identified and treated any myofascial trigger points in the associated knee musculature with dry needling.  Patient follow up was done at 1, 3, and 6 months post-surgery.

Image from Henry Gray (1918) “Anatomy of the Human Body”
Image from Henry Gray (1918) “Anatomy of the Human Body”

 

The patients in the dry needling group demonstrated a significant reduction in pain on the visual analog scale at 1 month compared to the control/sham group. The authors concluded that the use of dry needling allowed patients to achieve a level of pain relief at 1 month that most patients took 6 months to achieve. This obviously opens an avenue for post-operative pain relief with total knee arthroplasty, but should pose several questions.  Consider the support in the scientific literature of increased perfusion, changes of local inflammatory biochemical, and reduced EMG activity on the local level, as well as support for stimulation of endogenous descending anti-nociceptive activity through central pain mediation. Given these results, one can’t help but consider how much of a patient’s pain pre-operatively is due to local degenerative changes in the tissue (articular cartilage, subchondral bone, tendons, etc.) versus a neural sensitization on the peripheral level, or in severe cases, central sensitization.  With dry needling one must consider the dysfunction pain processing that is likely present in chronic and degenerative cases and not be blinded by the local structural changes that are evident on imaging. True, we will never change severe degenerative changes, however there remains a viable avenue to symptom improvement and relief via dry needling when considering its impact on both the local and central pain processing.

Why You Should Care: Yes, this article provides an avenue of marketing to physicians, i.e. pre-operative session(s) of dry needling to reduce pain post-operatively, but you can come to a deeper conclusion. Given these results, one can’t help but consider how much of a patient’s pain pre-operatively is due to local degenerative changes in the tissue (articular cartilage, subchondral bone, tendons, etc.) versus a neural sensitization on the peripheral level, or in severe cases, central sensitization.  With dry needling one must consider the dysfunction pain processing that is likely present in chronic and degenerative cases and not be blinded by the local structural changes that are evident on imaging.  True, we will never change severe degenerative changes, however there remains a viable avenue to symptom improvement and relief via dry needling when considering its impact on both the local and central pain processing.

Your thoughts?

Join us for Dry Needling Upper Quadrant in Dallas, TX September 19-20.

Gary KearnsPT, COMT, FAAOMPT

NAIOMT Guest Faculty & Clinical Fellowship Instructor

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