Changes in Muscle Tone, Function, and Pain in the Chronic Hemiparetic Shoulder after Dry Needling Within or Outside Trigger Points in Stroke Patients: A Crossover Randomized Clinical Trial

• Published in: Pain medicine (Malden, Mass.) Mass.), 2020-11, Vol.21 (11), p.2939-2947
• Main Authors: Hernández-Ortíz, Alma R, Ponce-Luceño, Raquel, Sáez-Sánchez, Carlos, García-Sánchez, Olga, Fernández-de-las-Peñas, César, de-la-Llave-Rincón, Ana I
• Format: Article
• Language: English
• Subjects: Care and treatment; Central nervous system; Chronic pain; Clinical trials; Dry Needling; Hemiplegia; Humans; Motor task performance; Muscle Tonus; Muscles; Pain; Patient outcomes; Patients; Rehabilitation; Shoulder; Shoulder pain; Shoulder Pain - etiology; Shoulder Pain - therapy; Spasticity; Stroke; Stroke - complications; Stroke patients; Trigger Points
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnaa132

Abstract Objectives To investigate the effects of applying dry needling into a trigger point (TrP) or non-TrP area in people who have suffered a stroke and to investigate if the effects of dry needling are maintained at six-week follow-up. Methods A controlled, repeated-measures, crossover, double-blinded randomized trial was conducted. Nineteen patients with hemiparetic shoulder pain after a stroke event were randomly assigned to receive a single multimodal treatment session combined with TrP dry needling or non-TrP dry needling. The neuro-rehabilitation session included modulatory interventions targeting the central nervous system. Spasticity (Modified Ashworth Scale), shoulder pain intensity (numerical pain rate scale, 0–10), and upper extremity function (Motor Evaluation Scale for Upper Extremity in Stroke [MESUPES], Reaching Performance Scale [RPS]) were assessed before (baseline) and one, two, three, four, five, and six weeks after the treatment session by a blinded assessor. All participants received both sessions in a randomized order where they were followed up for six weeks before receiving the opposite treatment and then followed up for another six weeks. Results Changes in muscle tone (all P > 0.266) and upper extremity function (MESUPES: F = 0.544, P  = 0.465; RPS close task: F = 0.820, P = 0.371; RPS far task: 0.830, P  = 0.368) were similar after both interventions at all follow-up periods. The decrease in shoulder pain was higher within the TrP dry needling group as compared with the non-TrP dry needling group, particularly at two and four weeks (P  = 0.01). Conclusions The effect of dry needling on muscle tone (spasticity) and upper extremity function is not related to its application in or outside of a TrP area. The effect of dry needling on shoulder pain was slightly superior when applied over a TrP in poststroke people. These effects were maintained six weeks after treatment.