Removal of a broken acupuncture needle in retroperitoneum by laparoscopy: a case report.

BACKGROUND: Acupuncture is a famous traditional medicine in China, but the complications caused by broken acupuncture needles have been rarely reported. It seems easy to remove the foreign matters usually, but things become difficulty in special issues. Here, we reported a recently encountered case to provide an important teaching point of treating a chronically retained broken needle in retroperitoneum. CASE PRESENTATION: A 42-year-old man presented with a chronically retained broken needle in his body after acupuncture therapy two years ago. However, due to the discomfort at the left back recently and ordinary inconvenience such as security check, he came to our hospital for minimally invasive surgery. He was introduced to our department because the broken needle had migrated from subcutaneous to adipose tissue in retroperitoneum during the two years. Considering the position of the broken needle, the patient was performed by laparoscopy in general anesthesia. The operation time was about 31 min and there were only three 7 mm incisions in the left lateral abdominal wall. The X-ray exam was performed to confirm that the broken needle was removed integrally. The patients begun normal activity at 6 h after surgery and was discharged on the second day after surgery. CONCLUSIONS: Acupuncture is widely used for pain treatment in China, but how to handle the complication of acupuncture needle broken in body are rarely reported. Laparoscopy will be the reasonable choice for treating needles broken in retroperitoneum.

Amphiphilic Functionalized Acupuncture Needle as SERS Sensor for In Situ Multiphase Detection.

Surface enhanced Raman spectroscopy (SERS) is a powerful spectroscopic technique with unique vibrational fingerprints, making it an ideal candidate for in situ multiphase detection. However, it is a great challenge to determine how to guide the SERS sensor to target molecules of interest in multiphase heterogeneous samples with minimal disturbance. Here, we present a portable ultrasensitive and highly repeatable SERS sensor for in situ multiphase detection. The sensor is composed of commercial Ag acupuncture needle and PVP-Au nanoparticles (Au NPs). The PVP on the Au NPs can adsorb and induce the Au NPs into a highly uniform array on the surface of the Ag needle because of its adhesiveness and steric nature. The Au NPs-Ag Needle system (Au-AgN) holds a huge SERS effect, which is enabled by the multiple plasmonic couplings from particle-film and interparticle. The PVP, as the amphiphilic polymer, promotes the target molecules to adsorb on surface of the Au-AgN whether in the oil phase or in the water phase. In this work, the Au-AgN sensor was directly inserted into the multiphase system with the laser in situ detection, and SERS detection at different spots of the Au-AgN sensor provided Raman signal of targets molecule in the different phase. In situ multiphase detection can minimize the disturbance of sampling and provide more accurate information. The facile fabrication and amphiphilic functionalization make Au-AgN sensor as generalized SERS detection platform for on-site testing of aqueous samples, organic samples, even the multiphase heterogeneous samples.

Functionalized Acupuncture Needle as Surface-Enhanced Resonance Raman Spectroscopy Sensor for Rapid and Sensitive Detection of Dopamine in Serum and Cerebrospinal Fluid.

It is a challenge to develop a robust sensor for simple, rapid operation and sensitive detection of neurotransmitters in complex specimens. Herein, ferric citrate functionalized gold nanoparticles (CA-FeIII /Au NPs) are utilized to develop a facile sensor based on surface-enhanced resonance Raman spectroscopy (SERRS) for sensitive detection of dopamine (DA). The sensor is prepared by decorating the acupuncture needle with Au NPs, which enables sufficient surface-enhanced Raman spectroscopy enhancement. The CA-FeIII structure is highly sensitive and selective for DA due to the formation of the CA-FeIII -DA resonant structure; this indicates the advantages of capturing, carrying, and separating DA molecules from complicated samples in a simple operation. Furthermore, the practical application of the fabricated sensor is validated by the detection of DA in pretreated serum and cerebrospinal fluid of acupuncture-treated mice with detection limits of 0.1 and 2.5 nm DA, respectively. The developed active acupuncture needle sensor has potential benefits for sensitive detection and qualitative identification of DA molecules from biological samples.

The effectiveness of long-needle acupuncture at acupoints BL30 and BL35 for CP/CPPS: a randomized controlled pilot study.

BACKGROUND: The chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the commonest chronic inflammatory diseases in adult men, for which acupuncture has been used to relieve related symptoms. The present study aimed to evaluate the therapeutic effect of the long-needle acupuncture on CP/CPPS. METHODS: A randomized traditional acupuncture-controlled single blind study was conducted on 77 patients who were randomized into long-needle acupuncture (LA) and traditional acupuncture (TA) groups. The patients received six sessions of acupuncture for 2 weeks and a follow-up was scheduled at week 24. The primary outcome was measured by the total National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at week 2. Four domains of the NIH-CPSI (urination, pain or discomfort, effects of symptoms, and quality of life) and the clinical efficacy score served as the secondary outcome. RESULTS: The total NIH-CPSI score at week 2 and week 24 was significantly improved in the LA group compared with the TA group. LA significantly improved urination, pain or discomfort, the effects of symptoms, and the quality of life at week 2 and week 24 and patients undergoing LA treatment had a higher clinical efficacy score. CONCLUSION: Needling at the BL30 and BL35 using LA benefits patients with CP/CPPS. TRIAL REGISTRATION: The study was registered at the Chinese Clinical Trial Register ( ChiCTR-ICR-15006138 ).

Coarse needle surface potentiates analgesic effect elicited by acupuncture with twirling manipulation in rats with nociceptive pain.

BACKGROUND: Biomechanical phenomenon called "needle grasp" through the winding of connective tissue has been proposed as an action mechanism of acupuncture manipulation. The aim of the present study is to verify whether the needle grasp force affects the pain-relieving activity of acupuncture in the tail-flick latency (TFL) and the rat paw formalin tests. METHODS: In order to make different roughness on the acupuncture needle surface, the needles with 0.2 mm-diameter were scratched using silicon carbide sandpapers with the grit numbers of 600 (mild coarse) and 200 (extra coarse). The surface roughness and rotation-induced torque of the scratched needles were then measured by atomic force microscope and Acusensor®, respectively. Rat abdominal wall tissues including insertion site of acupuncture needle were excised after 5 unidirectional rotations of the needles having various degrees of roughness, and the morphological changes of connective tissues were analyzed using hematoxylin and eosin (H-E) staining. Finally, the effects of coarse needle surface on anti-nociception induced by twirling manipulation were tested in rat TFL and formalin test. RESULTS: It was observed that the rougher the needle surface, the stronger the needle grasp force and thickness of subcutaneous connective tissue while rotating. TFL increased in proportion to surface roughness of the ground needles 10 min after acupuncture into the Zusanli acupoint (ST36) on rat's legs. In the rat formalin test, the rougher needle also significantly exerted the larger analgesic effect during both early and late phases compared to non-ground normal needle. CONCLUSION: Surface roughness of the acupuncture needle enhanced an anti-nociceptive activity of acupuncture therapy in rats, which partially supports the mechanical signaling theory through connective tissues in acupuncture manipulation.

New Perspectives on the Origin of Korean Acupuncture: Based on Materials from Xiaoyingzi Tomb, Yanji and Neighbouring Region.

This article discusses the development of early acupuncture needles as demonstrated by the artifacts excavated from the Northern part of the Yanji district, Jilin, China, during the Japanese colonial era (reported in 1941). Numerous bone needles, stone needles, and other medical devices were found in the Xiaoyingzi excavation. The stone needles from Xiaoyingzi can be categorized into three grades, based on length, of 8cm, 12-15cm, and 18cm. A set of round stones for massage were also discovered, along with obsidian blades. These relics were carefully stored in the middle of the body in the stone coffin. In addition to Xiaoyingzi, stone needles were also excavated along the lower valley region of the Tuman (Tumen, ) River. These facts indicate that the owner was involved in medical practice, and that medical procedures using stone needles were quite popular at the time. This article carefully investigates that the relics have nothing to do with weaving textile or military use. Current research on the origin of acupuncture has been confined either to stone needles from the prehistoric age or to bronze needles, as well as to literature from the Warring States period to the Han China, during which acupuncture technology was considerably expanded. However, substantial knowledge on the "gap" between stone needles and metal needles has been procured through the analysis of Xiaoyingzi, Yanji. The findings of Xiaoyingzi are also significant in providing a more detailed reconstruction of the development of acupuncture in East Asia and emergence of acupuncture throughout history. A large amount of medical items (stone and bone needles, cases for needles, massage stone type bianshi, and etc.), have been excavated from Xiaoyingzi and other neighbouring sites, Along with geographic and ecological factors, this archeological data strongly suggests the medical tradition of using acupuncture needles was practiced around Tumen River basin in the Bronze Age (10th century B.C.).

Evaluating validity of various acupuncture device types: a random sequence clinical trial.

BACKGROUND: Although various placebo acupuncture devices have been developed and used in acupuncture research, there is controversy concerning whether these devices really serve as appropriate placebos for control groups. METHODS/DESIGN: The proposed study is a single-center prospective random sequence participant- and assessor-blinded trial with two parallel arms. A total of 76 participants will be randomly assigned to Group 1 or Group 2 in a 1:1 ratio. Group 1 will consist of Sham Streitberger's needle, Real Streitberger's needle, and Phantom acupuncture session. Group 2 will consist of Park Sham device with real needle, Park Sham device with sham needle, and no treatment session. Participants will have a total of three acupuncture sessions in a day. The primary endpoint is blinding test questionnaire 1. Secondary endpoints are the Bang's blinding index, the Massachusetts General Hospital Acupuncture Sensation Scale index, and physiological data including heart rate, heart rate variability, and skin conductance response. DISCUSSION: This trial will evaluate the relevance of using placebo acupuncture devices as controls using a validation test procedure. TRIAL REGISTRATION: Clinical Research Information Service: KCT0001347 .

Comparison of the placebo effect between different non-penetrating acupuncture devices and real acupuncture in healthy subjects: a randomized clinical trial.

BACKGROUND: Several studies have used placebo acupuncture methods in recent years as a way for blinding therapeutic effect of acupuncture, however placebo method selection has not followed enough methodological criteria to the point of stabilishing a consensus of what should be the best method to be used. This study aimed to evaluate the effectiveness of three different placebo acupuncture methods for blinding applied in healthy subjects. METHODS: This study was approved by the Ethics Committee of the Federal University of Sergipe with the number 47193015.5.0000.5546 and all individuals participating in the study signed a free and informed consent. For this study, 321 healthy volunteers were randomly divided into seven groups using the abdominal point stomach (ST) 25 and seven groups using the lumbar point bladder (Bl) 52 for stimulation. For real acupuncture procedure, three different methods of placebo acupuncture plus a mix between real acupuncture and placebo applied in the same individual, totaling fourteen groups in this study. Outcome assessments were performed before and immediately after applying the technique. Investigator who assessed variables had no knowledgement about the method was applied. Identification, weight and height were measured before puncture by using. At the end, subjects were asked if they believed they were receiving real or placebo acupuncture. RESULTS: There was no significant difference between groups for the perception about the type o stimulation (wheter real or placebo puncture). Percentage of subjects who reported to have received real acupuncture in the abdominal point was 69.56% in real group, 86.95% in group Park Sham, 82.60% in needle + foam, 91.30% in insertion and removal, 78.26% in real + Park Sham, 86.36% in real + needle and foam, 86.95% in real + insertion and removal, and for the lumbar point was 86.36% in real group, 86.95% in group Park Sham, 69.56% in needle + foam, 72% in insertion and removal, 86.95% in real + Park Sham, 81.81% in real + needle and foam and 78.26% in real + insertion and removal. CONCLUSION: All placebo acupuncture methods proposed in this study were equally effective for bliding the study participants using either abdominal or lumbar acupoints, and none of the placebo methods presented benefit compared to the other to be used in future clinical trials. ETHICS COMMITTEE: Federal University of Sergipe (UFS), number of approval: 47193015.5.0000.5546 TRIAL REGISTRATION: ensaiosclinicos.gov.br RBR-3w2p32 Registered in 28th January 2016.

Study on stability of DMS meridian detector.

The stability of meridian detector was the basis to study meridian through conductance method. Ancient documents mentioned that the human body's blood could change with the time and meridians. When qi and blood came, the qi and blood would be full of that place; when qi and blood gone, the local skin shining could fade and recess. It liked the tidal fluctuation, then caused the corresponding acupuncture points conductance value changes. Modern studies had reported that meridian detector instrument the skin area of twelve meridians acupuncture points could change along with time within 24 hours. In this circumstance, whether the conductance values changes in human acupuncture points had statistical significance was vital important. DMS meridian detector instruction was adopt to measure the twelve meridian jingyuan acupuncture point in order to analyze the acupuncture point conductance value changes within one day.

[Pneumothorax following dry needling treatment: legal and ethical aspects]. / Pneumotorace successivo a trattamento riabilitativo con tecnica "dry needling": aspetti medico legali e etico-deontologici.

Trigger point "dry needling" is a technique used to treat myofascial pain. It involves using filiform needles which are inserted into muscles to give local pain relief. Few cases of serious adverse events following this treatment have been reported in the literature. In this paper we describe the case of a professional swimmer who developed pneumothorax after dry needling treatment and discuss the medicolegal and ethical aspects related to competencies and responsibilities of medical doctors and physiotherapists performing the procedure.

Outbreak of primary inoculation tuberculosis in an acupuncture clinic in southeastern China.

Outbreak of Mycobacterium tuberculosis infections associated with acupuncture has not been reported. Thirteen patients with a painful swollen lump were referred to our hospital. The index patient received acupuncture and paraspinal muscular injection at a local acupuncture clinic in April 2011 and was diagnosed with M. tuberculosis 1 month later. From May 2011 to August 2011, 12 more patients with a swollen lump on the nuchal region or in the lower back or the buttocks region were referred to our hospital. Tuberculin skin test (TST), T-SPOT.TB, acid-fast stain, M. tuberculosis culture, chest radiograph, and lump magnetic resonance imaging (MRI) were performed and the patients were diagnosed with tuberculous abscess of the lump. All 13 patients received intramuscular injection at the paraspinal muscle by two acupuncturists at a local clinic and reported a swollen lump at the injection site. The needles and syringes were reused after autoclave sterilization. The TST was positive in all patients. Twelve patients had positive acid-fast stains. Mycobacterial cultures of abscess specimens were positive in all 13 patients. T-SPOT.TB tests were positive in all patients who underwent the test. The lesions and biopsies were subjected to polymerase chain reaction (PCR) and gene sequencing by the Disease Control Center of Zhejiang Province, China and the causative agent was identified as M. tuberculosis, Beijing type. In conclusion, physicians should consider the possibility of mycobacterial infections, apart from other bacterial agents, in patients with a swollen paraspinal lump following intramuscular injection.

Effective Hotspot Arrays Based on Non-Close-Packed Gold Nanoshells in Microporous Polystyrene Film on Acupuncture Needles.

To constructing effective hotspot arrays in SERS substrates, gold nanoshells (GNSs) were assembled layer by layer on acupuncture needles by covalent absorption of bifunctional chemicals; three dimensional structures of the GNSs were locked by polystyrene (PS) coating; effective hotspots were obtained by removing bifunctional chemicals on surface of the GNSs, and the spacing between GNSs was enlarged by corroding gold shell layers of the GNSs partly. The strongest SERS signal was obtained from the SERS-active substrate with two-layer GNSs. After effective hotspot arrays were constructed in the SERS-active substrate with two-layer GNSs, its enhancement factor was higher about two to three orders of magnitude than that of the monolayer of close-packed GNSs. The hotspot arrays integrated on acupuncture needles would be used to detect low concentration of biomolecules in vivo.

Implementation of laser acupuncture with lifting-thrusting through the use of mechanically immobile components.

Lifting and thrusting constitute an important manipulation method in traditional Chinese acupuncture. Lifting and thrusting enables the implementation of various features, such as reinforcement and reduction, which enhance acupuncture effectiveness. Laser acupuncture stimulates acupoints through laser light, which is a noninvasive treatment, but can still achieve effects similar to those obtained from traditional acupuncture. Lifting and thrusting can be achieved by moving the laser focal point back and forth, thus concentrating the energy, as does the tip of the acupuncture needle when it is moved upward and downward in the acupoint. This article presents a novel optical design of a laser acupuncture device, in which a focus-tunable lens is used to move the position of the focused light in order to achieve the lifting and thrusting mechanism through programmable changes to the control current of the focus-tunable lens. The device employs an infrared laser with a wavelength of 808 nm and a maximum power of 150 mW. The focus-tunable lens used in this study had a diopter of -10 to +5. The results revealed that by controlling the lens diopter, the focused light can be moved from 4.5 to 9.5 cm. Therefore, the range of the lift and thrust for the laser acupuncture device was 5 cm. The area of the focal point was approximately 6×10(-3) mm2, which is comparable to that of the commonly used traditional acupuncture needle tip. Because the components are immobile, no additional space is required for the moving lens. Therefore, the size of the laser acupuncture head can be minimized, and the effectiveness of focus tuning can be improved.

Deep dry needling of trigger points located in the lateral pterygoid muscle: Efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction.

BACKGROUND: To determine whether deep dry needling (DDN) of trigger points (TPs) in the lateral pterygoid muscle (LPM) would significantly reduce pain and improve function, compared with methocarbamol/paracetamol medication. MATERIAL AND METHODS: Forty-eight patients with chronic myofascial pain located in the LPM were selected and randomly assigned to one of two groups (DDN test group, n=24; drug-treated control group, n=24). The test group received three applications of needling of the LPM once per week for three weeks, while control group patients were given two tablets of a methocarbamol/paracetamol combination every six hours for three weeks. Assessments were carried out pre-treatment, 2 and 8 weeks after finishing the treatment. RESULTS: A statistically significant difference (p<0.05) was detected for both groups with respect to pain reduction at rest and with mastication, but the DDN test group had significantly better levels of pain reduction. Moreover, statistically significant differences (p<0.05) up to day 70 in the test group were seen with respect to maximum mouth opening, laterality and protrusion movements compared with pre-treatment values. Pain reduction in the test group was greater as a function of pain intensity at baseline. The evaluation of efficacy as assessed both by patients/investigators was better for the test group. 41% of the patients receiving the combination drug treatment described unpleasant side effects (mostly drowsiness). CONCLUSIONS: DDN of TPs in the LPM showed better efficacy in reducing pain and improving maximum mouth opening, laterality, and protrusion movements compared with methocarbamol/paracetamol treatment. No adverse events were observed with respect to DDN.

Effects of P6 stimulation on postoperative nausea and vomiting in laparoscopic cholecystectomy patients.

PURPOSE: Postoperative nausea and vomiting (PONV) remains one of the most common postsurgical complications after anesthesia and surgery. Pericardium 6 (P6) stimulation is believed to prevent PONV and is a potential adjunctive treatment with pharmacologic agents. The purpose of this study was to compare the effects of P6 stimulation on PONV occurrence to a control group not receiving the P6 stimulation in sequential female patients undergoing laparoscopic cholecystecomy at a community hospital in central Florida between November 2010 and March 2013. DESIGN: This study is a double-blinded randomized controlled trial. METHODS: PONV was measured on admission to the postanesthesia care unit (PACU), at 30 and 60 minutes, at discharge from the PACU to home and at two points at home up to 6 hours and between 6 and 24 hours. FINDINGS: Of the 56 total patients, those in the P6 group (n = 26) had statistically significant lower incidence of PONV, 0%, vs 14.3% in the control group (n = 27; P < .05) on admission to the PACU, but at all other time points, there was no significant difference in PONV. Thirty-one percent of the patients in the P6 group had PONV in PACU or at home compared with 51.9% in the control group. CONCLUSIONS: The results of the study demonstrate that the use of P6 stimulation in the perioperative arena is clinically meaningful; however, more research is needed with a larger sample size.

Effect of miniscalpel-needle on relieving the pain of myofascial pain syndrome: a systematic review.

OBJECTIVE: To evaluate the effect and safety of miniscalpel-needle (MSN) on reducing the pain of myofascial pain syndrome (MPS). METHODS: We reviewed the available literatures inception up to February 2014 using Pubmed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure Database, Chinese Biomedical Database and Wanfang Database. RESULTS: Eight randomized controlled trials were finally identified. The main controls involved acupuncture, medications, injection, massage and cupping. We found that all of the studies agreed on the potential benefit of MSN as a strategy for MPS and the superiority compared to the controls, however, randomized methods applied in most of the trials could be criticized for their high or unclear risk of bias. Further research is also needed to clarify questions around the appropriate frequency and number of treatment sessions of MSN. CONCLUSION: This review shows that MSN might have the effect on MPS, even though there were some limitations in the studies included in the review. Studies with robust methodology are warranted to further test its pain-relieving effect on MPS.

Nursing and safety of silver needle diathermy treating ankylosing spondylitis.

This paper aims to discuss the nursing and safety of silver needle diathermy in the treatment for ankylosing spondylitis. We nursed 46 patients with ankylosing spondylitis treated with silver needle diathermy. Specific nursing was focused on physical condition evaluation and mental nursing before treatment, observation during and after treatment, diet nursing, needle eye nursing, functional training and propaganda and education when discharged. The result suggested that all the patients received mental nursing, diet guide, skin care, health education, functional training and follow-up visit from the nurse and all of them could endure silver needle diathermy as discomfort or drug allergy was barely found, so were slight scald and skin infection nearby the needle eye caused by fainting during acupuncture, accidental puncture or overheat. Follow-up visit showed that no patient suffered obvious untoward effect and the pain, joint range of motion and living condition were distinctly improved a week after discharging. In conclusion, during the treatment for ankylosing spondylitis applying silver needle diathermy, the nursing before, during and after the treatment can obviously reduce the complication, accelerate the recovery, which is highly safe.

Emulated laser-acupuncture system.

A novel laser-acupuncture system was developed that can be used to implement the manipulation methods of traditional acupuncture, such as lifting and thrusting. A 780 nm laser diode with a maximum power of 90 mW was used as the light source. The focus point of the laser beam was adjustable by changing the position of the lens, facilitating the implementation of the lifting and thrusting methods of traditional Chinese medicine and achieving various stimulation depths at the acupuncture point. The images for the light spots from the outlet of the emulated laser acupuncture were captured at various distances and their sizes were calculated. The result showed that the diameter of the focused light spot (i.e., at the focus point) was 0.11 mm, which is close to the diameter of commonly used needles (with diameters of approximately 0.22 mm). The area of the light spot 1 cm from the focus point was approximately 50 times larger, indicating that the unit power might be 1/50 of the power of the focus point. To study the effect of emulated laser acupuncture on human meridians, after stimulating the Shenmen point (HT7) of five subjects and obtaining their Ryodoraku values of the heart meridian and the small-intestine meridian, a paired t test showed that the laser stimulation incorporating lifting and thrusting was significantly higher than the laser stimulation without lifting and thrusting (p<0.05). The result is consistent with traditional acupuncture in that acupuncture incorporating lift and thrust is more effective than that without lift and thrust.

Cervical necrotizing fasciitis resulting in acupuncture and herbal injection for submental lipoplasty.

Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. Necrotizing fasciitis is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of serious cervical necrotizing fasciitis that developed after acupuncture and herbal injection treatment of fat accumulation of the submental area in a 32-year-old healthy woman. She presented with discharging wound over the submental area. The initial diagnosis was based on clinical information, in which localized necrosis areas in the cervical and chin regions were observed. Wide antibiotic therapy was applied, followed by surgical drainage, debridement, and negative pressure wound therapy. Culture was positive for Serratia liquefaciens and Staphylococcus intermedius. She made a good recovery.

3,5,11 needles: looking for the perfect number of needles--a randomized and controlled study.

Acupuncture has been successfully used in myofascial pain syndromes. However, the number of needles used, i.e. the "dose" of acupuncture stimulation, to obtain the best antinociceptive efficacy, is still a matter of debate. The question was addressed comparing the clinical efficacy of 3 different therapeutic schemes, mainly characterized by different numbers of needles used on 90 patients affected by a painful cervical myofascial syndrome. Patients were divided into 3 groups; the first group of 30 patients was treated with 11 needles, the second group of 30 patients was treated with 5 needles and the third group of 30 patients was treated with 3 needles. Each group underwent eight cycles of somatic acupuncture. In each session and in each group, all needles were stimulated until the pain tolerance threshold was reached; "pain tolerance is the amount of pain a person can handle without breaking down, either physically or emotionally". Pain intensity was evaluated before therapy, immediately after, and at 1 and 3 months follow-up by means of both the Mc Gill Pain Questionnaire and the Visual Analogue Scale (VAS). Pain and the repercussion of pain on the patient's quality of life (DOPE- Descriptors Of Pain Effects) were also measured using a test we developed, administered at each session. In all groups, needles were inserted superficially, except for the two most painful trigger points that were deeply inserted. All groups, independently from the number of needles used, obtained a good and significant therapeutic effect without clinically relevant differences among groups. For this pathology and patients of this kind, the number of needles, 3 or 5 or 11, seems not to be an important variable in determining the therapeutic effect.