Abstract
Objective
To determine the differences between clinical effects of electroacupuncture and biofeedback
therapy in addition to conventional treatment in patients with cervical myofascial
pain syndrome (MPS).
Design
Randomized clinical trial.
Setting
Physical medicine and rehabilitation clinic of a university hospital.
Participants
Fifty patients (N=50) aged 25-55 years of both sexes with chronic neck pain diagnosed
with MPS (characterized by trigger points within taut bands) were randomly assigned
to 2 equal groups of 25 individuals.
Interventions
The patients in electroacupuncture group were treated with standard acupuncture and
concomitant electrical stimulation; those in biofeedback group received visual electromyography
biofeedback therapy for muscle activity and relaxation. Both groups received the intervention
2 times a week for a total of 6 sessions. Basic exercise training and medicines were
administered for all the patients.
Main Outcome Measures
Pain severity based on the visual analog scale (VAS), functional status using Neck
Disability Index (NDI), cervical range of motion (ROM) using and inclinometer, and
pressure pain threshold (PPT) using an algometer were evaluated before and at 3 and
12 weeks after the treatment. Primary outcome was defined as 20% reduction in the
3-month neck pain and dysfunction compared to baseline, assessed through the NDI.
Results
Fifty patients (39 women, 11 men) with a mean age (years) ± SD of 39.0±5.5 and neck
pain duration (weeks) of 6.0±2.2 were analyzed. All parameters, except for PPT of
the lower trapezius and paravertebral muscles were improved significantly in both
groups, while baseline values were controlled. The primary outcome was achieved more
significantly in the acupuncture group than in the biofeedback group: 20 (80.0%) vs
10 (40.0%); rate ratio=2 with 95% confidence interval (CI), 1.19-3.36; number needed
to treat (NNT)=2.5 with 95% CI, 1.54-6.58. Advantages of acupuncture over biofeedback
were observed according to values obtained from the NDI, VAS, extension and left lateral-bending
ROM, and PPT on the left upper trapezius after the last session of intervention until
3 months (P<.05).
Conclusions
Both electroacupuncture and biofeedback therapies were found to be effective in management
of MPS when integrated with conventional treatment. However, intergroup differences
showed priority of acupuncture in some parameters vs biofeedback. Thus, electroacupuncture
seems to be a better complementary modality for treatment of MPS in the neck and upper
back area.
Keywords
List of abbreviations:
CI (confidence interval), EAC (electroacupuncture), ES (electrical stimulation), MPS (myofascial pain syndrome), MTrP (myofascial trigger point), NDI (Neck Disability Index), NNT (number needed to treat), NSAID (nonsteroidal anti-inflammatory drug), PPT (pressure pain threshold), ROM (range of motion), RR (rate ratio), TrP (trigger point), VAS (visual analog scale)To read this article in full you will need to make a payment
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References
- Prevalence of myofascial pain syndrome in chronic non-specific neck pain: a population-based cross-sectional descriptive study.Pain Med. 2016; 17: 2369-2377
- Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study.Man Ther. 2007; 12: 29-33
- Myofascial pain syndrome associated with trigger points: a literature review. (I): Epidemiology, clinical treatment and etiopathogeny.Med Oral Patol Oral Cir Bucal. 2009; 14: e494-e498
- Myofascial pain and dysfunction: the trigger point manual, vol 1, upper half of body.2nd ed. Lippincott Williams and Wilkins, Baltimore1998
- Ethyl chloride spray for painful muscle spasm.Arch Phys Med Rehabil. 1952; 33: 291-298
- Exercise therapy for fibromyalgia.Curr Pain Headache Rep. 2011; 15: 358-367
- Physical agent modalities.in: Cifu D. Braddom’s physical medicine and rehabilitation. 5th ed. Saunders Elsevier, Philadelphia2016: 391-393
- Efficacy of electroacupuncture for myofascial pain in the upper trapezius muscle: a case series.Rev Bras Fisioter. 2011; 15: 371-379
- Mechanisms of acupuncture-electroacupuncture on persistent pain.Anesthesiology. 2014; 120: 482-503
- Biofeedback in medicine: who, when, why and how?.Ment Health Fam Med. 2010; 7: 85-91
- Biofeedback.(Available at:)https://www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664Date accessed: October 19, 2019
- Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: a randomized controlled trial.Arch Phys Med Rehabil. 2011; 92: 849-858
- Electromyography biofeedback exergames to enhance grip strength and motivation.Games Health J. 2018; 7: 75-82
- An evaluation of the effectiveness of acupuncture with seven acupoint-penetrating needles on cervical spondylosis.J Pain Res. 2019; 12: 1441-1445
- Effectiveness of acupuncture and electroacupuncture for chronic neck pain: a systematic review and meta-analysis.Am J Chin Med. 2017; 45: 1573-1595
- Effect of electroacupuncture on thermal pain threshold and expression of calcitonin-gene related peptide, substance P and γ-aminobutyric acid in the cervical dorsal root ganglion of rats with incisional neck pain.Acupunct Med. 2017; 35: 276-283
- Acupuncture for pain.Am Fam Physician. 2019; 100: 89-96
- Acupuncture and electro-acupuncture for people diagnosed with subacromial pain syndrome: a multicentre randomized trial.Eur J Pain. 2017; 21: 1007-1019
- Acupuncture for chronic neck pain: a protocol for an updated systematic review.Syst Rev. 2016; 5: 76
- Evaluation of acupuncture effect to chronic myofascial pain syndrome in the cervical and upper back regions by the concept of Meridians.Acupunct Electrother Res. 2001; 26: 195-202
- Warm needling therapy and acupuncture at meridian-sinew sites based on the meridian-sinew theory: hemiplegic shoulder pain.Evid Based Complement Alternat Med. 2015; 2015: 694973
- Electrical currents.in: Cameron M.H. Physical agents in rehabilitation from research to practice. 1st ed. Saunders, Philadelphia1999: 345-392
- EMG biofeedback and exercise for treatment of cervical and shoulder pain in individuals with a spinal cord injury: a pilot study.Top Spinal Cord Inj Rehabil. 2013; 19: 311-323
- The efficacy of electromyographic biofeedback on pain, function, and maximal thickness of vastus medialis oblique muscle in patients with knee osteoarthritis: a randomized clinical trial.J Pain Res. 2018; 11: 2781-2789
- Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain - a reanalysis of 4 randomized controlled trials of cupping therapy.Complement Ther Med. 2013; 21: 342-347
- Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms.Physiother Theory Pract. 2019; 35: 1328-1335
- Cross-cultural adaptation, validity, and reliability of the Persian version of the spine functional index.Health Qual Life Outcomes. 2018; 16: 95
- Reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with neck pain and its associated disorders: part 4. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) collaboration.Musculoskelet Sci Pract. 2018; 38: 128-147
- Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain.Ann Rehabil Med. 2011; 35: 412-417
- Combination of exercise and acupuncture versus acupuncture alone for treatment of myofascial pain syndrome: a randomized clinical trial.J Acupunct Meridian Stud. 2018; 11: 315-322
- Reliability and validity of a pressure algometer.J Strength Cond Res. 2009; 23: 312-314
- Efficacy of acupuncture treatment on myofascial pain syndrome in upper trapezius.J Med Biol Eng. 2016; 36: 686-692
- Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial.Braz J Phys Ther. 2015; 19: 34-43
- Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2015; 96: 944-955
- Electric stimulation for pain relief in patients with fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.Pain Physician. 2017; 20: 15-25
- Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia.Int J Surg. 2015; 24: 201-206
- Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain.J Phys Ther Sci. 2013; 25: 657-661
- Immediate effects of real-time postural biofeedback on spinal posture, muscle activity, and perceived pain severity in adults with neck pain.Gait Posture. 2019; 67: 187-193
- Effects of low-level laser therapy in combination with physiotherapy in the management of rotator cuff tendinitis.Lasers Med Sci. 2012; 27: 951-958
- Comparison of therapeutic efficacy of acupuncture and low-level laser in the treatment of cervical myofascial pain syndrome: a single-blind randomized controlled clinical trial.Phys Med Rehab & Electrodiagnosis. 2019; 1: 14-24
Article info
Publication history
Published online: January 16, 2020
Footnotes
Supported by Physical Medicine and Rehabilitation Research Center of Tabriz University of Medical Sciences. The funding body didn’t have any role in the design of the study or collection, analysis, or interpretation of data and also in writing of the manuscript.
Clinical Trial Registration No.: IRCT20100127003217N12.
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine