| Objects:In recent years, with the accelerated pace of the modern life, the development of sports and the coming of aging society, chronic pain caused by sports injury is gradually becoming one of the major problems affecting the style of life and production of urban residents and sports career of individual athletes. According to many years of clinical studies, more than half of chronic pain are intractable and nonorganic-lesions pain, and they are derived from skeletal muscle systems. The clinicians of Europe and the United States call them myofascial trigger points(MTr Ps) pain. The pathogenesis of the disease has been a research focus in the field of pain, but there is still lack of some systematic reviews of the effectiveness of different treatments for MTr Ps in different terms. Therefore, this systematic review and meta-analysis aims to determine short, medium, and long terms effectiveness of dry needling in reducing pain among patients with MTr Ps compared with placebo/sham dry needling, wet needling, and other treatments. In addition, based on the conclusion about the superiority of wet needling for MTr Ps, the study will make a clinical retrospective survey to observe the effectiveness of wet needling for women primary dysmenorrhoea, to improve the reliability of the results of the systematic review. Methods:Pub Med, EBSCO, Physiotherapy Evidence Database, Science Direct, The Cochrane Library, Clinical Key, Wangfang Data, CNKI, Chinese VIP Information, and Springer Link databases were searched from database inception to January 2014. Randomized controlled trials(RCTs) were performed to determine if dry needling was used as main treatment and if pain intensity was included as an outcome. Participants were diagnosed with MTr Ps associated with neck and shoulder pain. Two reviewers independently screened the articles, scored methodological quality, and extracted data. Results regarding pain intensity were extracted in the form of mean and standard deviation data. Meta-analyses were performed using Rev Man 5.2 and Stata 12.0.The effect of wet needing of MTr Ps in abdominal muscles, supplemented by home stretching exercises, was observed in 65 patients with moderate and severe primary dysmenorrhoea from 2007 to 2013. The MTr Ps in the abdominal region were localised and repeatedly needled with lidocaine injection. Menstrual pain was evaluated with a Visual Analogue Scale(VAS) score after every treatment, with the final evaluation made at a 1-year follow-up. Treatment was stopped when the VAS pain score reduced to ?3. Symptoms scores were analysed with one-way analysis of variance. Results:(1) Twenty RCTs involving 839 patients were obtained for meta-analysis.Results suggested that compared with control/sham group, dry needling to MTr Ps was effective in short term [SMD=-1.91, 95% CI(-3.10,-0. 73), P=0.002] and medium term [SMD=-1.07, 95% CI(-1.87,-0.27), P=0.009]; however, wet needling(including lidocaine) was superior to dry needling in relieving MTr Ppain in medium term [SMD=1.69, 95% CI(0.40, 2.98), P=0.01]. Other therapies(including physiotherapy) were more effective than dry needling to treat MTr P pain in medium term [SMD=0.62, 95% CI(0.02, 1.21), P=0.04].(2) The mean VAS pain score before treatment was 7.49±1.16. After a single wet needling session, 41 patients had a reduction in their VAS pain score to <3 during their following menstrual cycle, with a mean of 1.63±0.49. Twenty-four patients who needed two treatments showed a reduction in menstrual pain scores to 0.58±0.50. After 1 year, the mean VAS pain score among all patients was 0.28±0.45, with a response rate of 100%.Conclusions:(1) Dry needling can be recommended to relieve MTr P pain of neck and shoulders in short and medium terms, but wet needling is more effective than dry needling in reducing MTr P pain in neck and shoulders in medium term(9 days to 28 days).(2) Primary dysmenorrhoea was significantly reduced 1 year after wet needling to MTr Ps in the abdominal region and home stretching exercises, which showed the the superiority of wet needling for MTr Ps, justifying further research with controlled trials. |
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