Does Dry Needling Affect Treatment Outcomes of Interlaminar Epidural Steroid Injection in Cervical Disc Herniation?

Marmara University

Status: Completed

Conditions: Pain, Neck; Pain, Myofacial; Pain, Chronic

Treatments: Procedure: Cervical interlaminar epidural steroid injection; Procedure: Sham dry needling; Procedure: Dry needling

Study type: Interventional

Funder types: Other

Identifiers

NCT04914637

09.2020.692

Details and patient eligibility

About

Chronic neck pain is among the most frequently seen chronic painful conditions. As an important cause of disability, chronic neck pain is a musculoskeletal disorder that negatively affects quality of life. Cervical disc herniation is one of the leading causes of chronic neck pain and conservative methods such as exercise and pain medications are used first in the treatment. In patients unresponsive to conservative treatment, epidural steroid injection is successfully and frequently used treatment option. Epidural steroid injection in the cervical region can be applied with two approaches: interlaminar or transforaminal.

Myofascial trigger point characterized by intramuscular taut band and hypersensitive spots is a condition in which central and peripheral sensitization play a role in the pathophysiology. There are underlying myofascial trigger points in many etiologies that cause chronic neck pain. Trigger points can increase the severity of pain and in some cases they can be the main factor in the etiology of pain. Therefore, the presence of myofascial trigger points should be investigated, even if another cause is detected in chronic neck pain. Dry needling is an easily applicable and effective treatment option in myofascial trigger point.

Although it is well known that myofascial trigger points frequently accompany cervical disc herniation, their effect on treatment outcomes has not been investigated. In this study, we aimed to investigate the effect of dry needling for trigger points on the treatment results of interlaminar epidural steroid injection in patients diagnosed with cervical disc herniation.

Enrollment: 66 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Between the ages of 18-65
• Chronic neck pain due to cervical disc herniation for at least 3 months and being unresponsive to conservative treatment
• Presence of at least one active myofascial trigger point on physical examination of cervical paraspinal muscles, scapulothoracic muscles and extremity muscles.

Exclusion criteria

• Previous surgical/interventional procedure for the cervical region
• Previous application of dry needling/acupuncture to any part of the body
• Presence of other musculoskeletal disorders (such as lateral epicondylitis, tendinitis, entrapment neuropathy) that may cause diagnostic confusion in terms of pain pattern and localization
• Signs of trauma, fracture, malignancy, or active infection
• Rheumatological (RA, AS, etc.), endocrinological (such as osteoporosis, Paget's disease) or another systemic disease that may change the anatomical or physiological structure of the relevant regions
• Presence of coagulopathy
• History of whiplash injury, cervical spinal stenosis, cervical spondylosis
• Have a diagnosis of fibromyalgia
• Being pregnant and breastfeeding
• Presence of mental deterioration or psychiatric/neurological disease that can affect flow of the study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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66 participants in 3 patient groups

interlaminar epidural steroid injection plus dry needling

Active Comparator group

Description:

Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered to patients with chronic neck pain due to cervical disc herniation. Also, dry needling will be applied to the active trigger points for the patients in this group. Interlaminar epidural steroid injection will be applied at week 0, while dry needling will be applied in 3 sessions per week (week 0, week 1, week 2). The first session of the dry needling will be in the same day with interlaminar epidural steroid injection.

Treatment:

Procedure: Dry needling

Procedure: Cervical interlaminar epidural steroid injection

interlaminar epidural steroid injection plus sham dry needling

Sham Comparator group

Description:

Fluoroscopy-guided cervical interlaminar epidural steroid injection will be administered same as the arm titled "interlaminar epidural steroid injection plus dry needling". The only difference in the interventions in this arm is that dry needling is applied without penetrating the skin. The blunt tip of the needle will be used in sham intervention. Interlaminar epidural steroid injection will be applied at week 0, while sham dry needling will be applied in 3 sessions per week (week 0, week 1, week 2)

Treatment:

Procedure: Sham dry needling

Procedure: Cervical interlaminar epidural steroid injection

interlaminar epidural steroid injection only

Other group

Description:

Only interlaminar epidural steroid injection will be administered to patients in this arm with the same method as in the other arms (one session, week 0). No dry needling or sham dry needling will be used.

Treatment:

Procedure: Cervical interlaminar epidural steroid injection