Clinical Rheumatology

, Volume 32, Issue 3, pp 309–315 | Cite as

The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial

  • Levent Tekin
  • Selim Akarsu
  • Oğuz Durmuş
  • Engin Çakar
  • Ümit Dinçer
  • Mehmet Zeki Kıralp
Original Article


The objective of this study was to test the hypothesis that dry needling is more effective than sham dry needling in the treatment of myofascial pain syndrome (MPS). This was a prospective, double-blinded, randomized-controlled study conducted in an outpatient clinic. Thirty-nine subjects with established myofascial trigger points were randomized into two groups: study group (N = 22) and placebo group (N = 17). Dry needling was applied using acupuncture needles, and sham dry needling was applied in the placebo group. The treatment was composed of six sessions which were performed in 4 weeks; the first four sessions were performed twice a week (for 2 weeks) and the last two, once a week (for 2 weeks). The visual analog scale (VAS) and Short Form-36 (SF-36) were used. When compared with the initial values, VAS scores of the dry needling group following the first and sixth sessions were significantly lower (p = 0.000 and p < 0.000, respectively). When VAS scores were compared between the groups, the first assessment scores were found to be similar, but the second and third assessment scores were found to be significantly lower in the dry needling group (p = 0.034 and p < 0.001, respectively). When SF-36 scores of the groups were compared, both the physical and mental component scores were found to be significantly increased in the dry needling group, whereas only those of vitality scores were found to be increased significantly in the placebo (sham needling) group. The present study shows that the dry needling treatment is effective in relieving the pain and in improving the quality of life of patients with MPS.


Dry needling Myofascial pain syndrome Pain Quality of life 



Myofascial pain syndrome


Randomized clinical trials


Visual analog scale


Quality of life





  1. 1.
    Simons DG, Travell JG, Simons PT (1999) Travell and Simons' myofascial pain and dysfunction: the trigger point manual. Williams & Wilkins, Baltimore, pp 11–93Google Scholar
  2. 2.
    Simons DG (2002) Understanding effective treatments of myofascial trigger points. J Bodywork Movement Therap 6:81–88CrossRefGoogle Scholar
  3. 3.
    Borg-Stein J, Simons DG (2002) Focused review: myofascial pain. Arch Phys Med Rehabil 83:40–49CrossRefGoogle Scholar
  4. 4.
    Skootsky SA, Jaeger B, Oye RK (1989) Prevalence of myofascial pain in general internal medicine practice. West J Med 151:157–160PubMedGoogle Scholar
  5. 5.
    Lavelle ED, Lavelle W, Smith HS (2007) Myofascial trigger points. Med Clin N Am 91:229–239PubMedCrossRefGoogle Scholar
  6. 6.
    Cummings TM, White AR (2001) Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 82:986–992PubMedCrossRefGoogle Scholar
  7. 7.
    King JC, Goddard MJ (1994) Pain rehabilitation: chronic pain syndrome and myofascial pain syndrome. Arch Phys Med Rehabil 75:9–14CrossRefGoogle Scholar
  8. 8.
    Lewit K (1979) The needle effect in the relief of myofascial pain. Pain 6:83–90PubMedCrossRefGoogle Scholar
  9. 9.
    Hong CZ (1994) Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil 73:256–263PubMedCrossRefGoogle Scholar
  10. 10.
    Barbagli P, Bollettin R, Ceccherelli F (2003) Acupuncture (dry needle) versus neural therapy (local anesthesia) in the treatment of benign back pain. Immediate and long-term results. Minerva Med 94:17–25PubMedGoogle Scholar
  11. 11.
    Ga H, Choi JH, Park CH, Yoon HJ (2007) Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients—a randomised trial. Acupunct Med 25:130–136PubMedCrossRefGoogle Scholar
  12. 12.
    Cline ME, Herman J, Shaw ER, Morton RD (1992) Standardization of the visual analogue scale. Nurs Res 41:378–380PubMedCrossRefGoogle Scholar
  13. 13.
    Demirsoy C (1999) The MOS-SF 36 health survey: a validation study with a Turkish sample. Master tezi, Boğaziçi Üniversitesi, İstanbulGoogle Scholar
  14. 14.
    Tough EA, White AR, Cummings TM, Richards SH, Campbell JL (2009) Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain 13:3–10PubMedCrossRefGoogle Scholar
  15. 15.
    DiLeronzo L, Traballesi M, Morelli D, Pompa A, Brunelli S, Buzzi MG et al (2004) Hemiparatic shoulder pain syndrome treating with dry needling during early rehabilitation: a prospective, open-labed, randomized investigation. J Musculoskel Pain 12:25–34CrossRefGoogle Scholar
  16. 16.
    Chu J (1997) Does EMG (dry needling) reduce myofascial pain symptoms due to cervical nerve root irritation? Electromyogr Clin Neurophysiol 37:259–272PubMedGoogle Scholar
  17. 17.
    Itoh K, Katsumi Y, Kitakoji H (2004) Trigger point acupuncture treatment of chronic low back pain in elderly patients—a blinded RCT. Acupunct Med 22:170–177PubMedCrossRefGoogle Scholar
  18. 18.
    Huguenin L, Brukner PD, McCrory P, Smith P, Wajswelner H, Bennell K (2005) Effect of dry needling of gluteal muscles on straight leg raise: a randomised, placebo controlled, double blind trial. British Journal of Sports Medicine 39:84–90PubMedCrossRefGoogle Scholar
  19. 19.
    Ilbuldu E, Cakmak A, Disci R, Aydin R (2004) Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome. Photomed Laser Surg 22:306–311PubMedCrossRefGoogle Scholar
  20. 20.
    Itoh K, Katsumi Y, Hirota S, Kitakoji H (2006) Effects of trigger point acupuncture on chronic low back pain in elderly patients—a sham-controlled randomised trial. Acupunct Med 24:5–12PubMedCrossRefGoogle Scholar
  21. 21.
    Itoh K, Katsumi Y, Hirota S, Kitakoji H (2007) Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Compl Ther Med 15:172–179CrossRefGoogle Scholar
  22. 22.
    Sterling M, Valentin S, Vicenzino B, Souvlis T, Connelly LB (2009) Dry needling and exercise for chronic whiplash—a randomised controlled trial. BMC Musculoskelet Disord 10:160PubMedCrossRefGoogle Scholar
  23. 23.
    Goddard G, Karibe H, McNeill C, Villafuerte E (2002) Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Journal of Orofacial Pain 16:71–76PubMedGoogle Scholar
  24. 24.
    Gunn CC (1996) The Gunn approach to the treatment of chronic pain; intramuscular stimulation for myofascial pain of radiculopathic origin. Churchill Livingston, New York, pp 11–37Google Scholar
  25. 25.
    Streitberger K, Kleinhenz J (1998) Introducing a placebo needle into acupuncture research. Lancet 352:364–365PubMedCrossRefGoogle Scholar
  26. 26.
    Park J, White AR, Lee H, Ernst E (1999) Development of a new sham needle. Acupunct Med 17:110–112CrossRefGoogle Scholar
  27. 27.
    Ceccherelli F, Rigoni MT, Gagliardi G, Ruzzante L (2002) Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double-blind randomized controlled study. Clin J Pain 18:149–153PubMedCrossRefGoogle Scholar
  28. 28.
    Kawakita K (1993) Polymodal receptor hypothesis on the peripheral mechanisms of acupuncture and moxibustion. Am J Acupunct 21:331–338Google Scholar
  29. 29.
    Hong CZ (1994) Persistence of local twitch response with loss of conduction to and from the spinal cord. Arch Phys Med Rehabil 75:12–16PubMedGoogle Scholar
  30. 30.
    Chen JT, Chung KC, Hou CR, Kuan TS, Chen SM, Hong CZ (2001) Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil 80:729–735PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Levent Tekin
    • 1
  • Selim Akarsu
    • 1
  • Oğuz Durmuş
    • 1
  • Engin Çakar
    • 1
  • Ümit Dinçer
    • 1
  • Mehmet Zeki Kıralp
    • 1
  1. 1.Department of Physical Medicine and Rehabilitation, Gülhane Military Medical AcademyHaydarpaşa Training HospitalİstanbulTurkey

Personalised recommendations