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Paraspinal Stimulation Combined With Trigger Point Needling and Needle Rotation for the Treatment of Myofascial Pain: A Randomized Sham-controlled Clinical Trial

Couto, Cláudio MD, MS*; de Souza, Izabel Cristina C. PhD*,†; Torres, Iraci L.S. PharmD, PhD*,‡; Fregni, Felipe MD, PhD§,∥; Caumo, Wolnei MD, PhD*,†,‡,¶,#

doi: 10.1097/AJP.0b013e3182934b8d
Original Articles

Background: There are different types and parameters of dry needling (DN) that can affect its efficacy in the treatment of pain that have not been assessed properly.

Objective: To test the hypothesis that either multiple deep intramuscular stimulation therapy multiple deep intramuscular stimulation therapy (MDIMST) or TrP lidocaine injection (LTrP-I) is more effective than a placebo-sham for the treatment of myofascial pain syndrome (MPS) and that MDIMST is more effective than LTrP-I for improving pain relief, sleep quality, and the physical and mental state of the patient.

Methods: Seventy-eight females aged 20 to 40 who were limited in their ability to perform active and routine activities due to MPS in the previous 3 months were recruited. The participants were randomized into 1 of the 3 groups as follows: placebo-sham, LTrP-I, or MDIMST. The treatments were provided twice weekly over 4 weeks using standardized MDIMST and LTrP-I protocols.

Results: There was a significant interaction (time vs. group) for the main outcomes. Compared with the sham-treated group, MDIMST and LTrP-I administration improved pain scores based on a visual analog scale, the pain pressure threshold (P<0.001 for all analyses), and analgesic use (P<0.01 for all analyses). In addition, when comparing the active groups for these outcomes, MDIMST resulted in better improvement than LTrP-I (P<0.01 for all analyses). In addition, both active treatments had a clinical effect, as assessed by a sleep diary and by the SF-12 physical and mental health scores.

Conclusions: This study highlighted the greater efficacy of MDIMST over the placebo-sham and LTrP-I and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities.

Supplemental Digital Content is available in the text.

Pain and Palliative Care Service at the Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS)

Pharmacology Department, Instituto de Ciências Básicas da Saúde, UFRGS, Brazil

*Post Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)

Laboratory of Pain & Neuromodulation at HCPA/UFRGS

§Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital

Physical Medicine and Rehabilitation

#Neurology Harvard Medical School

Supported by grants from the following Brazilian agencies: The Committee for the Development of Higher Education Personnel—CAPES—PNPD/CAPES (for W.C. and I.C.C.S), the National Council for Scientific and Technological Development—CNPq (I.L.S.T. and W.C.); and the Foundation of Support of Research at Rio Grande do Sul (FAPERGS). F.F. is supported by an NIH grant (5R21DK081773-03). The authors declare no conflict of interest.

Reprints: Wolnei Caumo, MD, PhD, Rua Ramiro Barcelos, 2350, zip code 90035-003 Bairro Rio Branco, Porto Alegre, RS, Brazil (e-mail:

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Received November 3, 2012

Accepted March 19, 2013

© 2014 by Lippincott Williams & Wilkins