Background/Purpose: Patients with fibromyalgia (FM) complain of widespread chronic pain from deep tissues including muscles. Previous research highlights the relevance of impulse input from deep tissues for clinical FM pain. Deep dry needle stimulation is an invasive treatment modality used in the management of musculoskeletal pain. Its efficacy has been confirmed in the management of myofascial trigger points, acute and chronic low back pain, and chronic whiplash. To determine if blocking abnormal impulse input with deep dry needling stimulation of tender point may decrease hyperalgesia and clinical pain in FM patients.

Methods: 120 patients that fulfilled the ACR 1990 criteria for FM were enrolled into a prospective controlled study of 12 week. Patients were randomly split into two groups: The control group (CG), 56 women and 4 men, who continued their treatment, and the deep dry needling group (DNG), 54 women and 6 men, who apart from continuing their medical treatment, also underwent weekly one-hour session of deep dry needling over 18 FM tender points for a 6-week-period. Study variables included pressure hyperalgesia as well as clinical pain. Patients were assessed at the start (at week 0), at the end of the 6-week intervention period (end of intervention), and were again evaluated 6 week later (at week 12 after the onset of the study). Study questionnaires and protocol were approved by the Ethical Committee of the regional health authority. All statistical analyses were performed with de software Stata 12/SE (Stata Corporation, College Station, TX, US). P values < 0.05 were considered significant.

Results: 60 patients were randomly assigned to the CG and 60 to the DNG. A total of 100 (83.3%) patients completed the study: 50 (83.3%) in the CG and 50 (83.3%) in the DNG. The mean ± SD age of participants was 53.5 ± 11.1 years, and the average reported in Fibromyalgia Impact Questionnaire (FIQ) was 73.1. At the beginning of the program (week 0), there were only significant differences between groups in age (56.2 in DNG versus 50.8 in the CG, p: 0.01) and McGill Pain Questionnaire (MPQ) (39.1 in DNG versus 42.4 in the CG, p: 0.03). At the end of the intervention (week 6), DNG showed reduction in the FIQ (p: 0.02), VAS of pain (p: 0.002), pain of SF-36 (p: 0.0007), MPQ (p: 0.02), Pain Catastrophizing Scale (PCS) (p: 0.02), activity engagement of Chronic Pain Assessment Questionnaire  (CPAQ) (p: 0.008), pain intensity of Brief Pain Inventory  (BPI) (p: 0.03), pain interference of BPI (p: 0.01), myalgic score (p: 0.0005), number of tender points (p: 0.0004), and pressure pain threshold (p: 0.002). Six weeks after the end of the treatment, DNG still showed significant differences in the FIQ (p: 0.03), VAS of pain (p: 0.01), pain of SF-36 (p: 0.01), MPQ (p: 0.02), PCS (p: 0.03), activity engagement of CPAQ (p = 0.01), pain intensity of BPI (p: 0.04), pain interference of BPI (p: 0.01), number of tender points (p: 0.0008), myalgic score (p: 0.00001) and pressure pain threshold (p: 0.0004). 

Conclusion: These results suggest that deep dry needling of tender points can reliably reduce clinical FM pain, and that peripheral input is required for the maintenance of mechanical hyperalgesia of these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analgesic-and-anti-hyperalgesic-effects-of-deep-dry-needling-therapy-in-fibromyalgia-patients/