Comparison of the effectiveness of dry needling and high-intensity laser therapy in the treatment of myofascial pain syndrome: a randomized single-blind controlled study.

Myofascial pain syndrome (MPS) is a very common disease in the population that seriously affects quality of life. Although many treatment modalities are used, there is still no common protocol. The aim of this study was to compare the effectiveness of high-intensity laser therapy (HILT) and dry needling options. This prospective study included 108 patients with neck and/or upper back pain, diagnosed with MPS, who were randomly separated into 3 groups: the exercise group, the exercise + HILT group (HILT group), and the exercise + dry needling group (needling group). The visual analog scale (VAS), neck disability index (NDI), short form-36 (SF-36) scores, and neck range of motion (ROM) values of the patients before and after treatment were recorded and compared between the groups. In all 3 groups, the VAS and NDI scores decreased and ROM levels increased after treatment. The results in the HILT and needling groups were statistically significantly better than those of the exercise group (p < 0.05).The addition of HILT and dry needling to exercises is seen as a more successful treatment option to reduce pain in MPS. Clinical trial registration number: NCT05078333.

Effectiveness of Photobiomodulation Therapy in the Treatment of Myofascial Pain Syndrome of the Upper Trapezius Muscle: A Systematic Review and Meta-Analysis.

Objective: This systematic review aimed to investigate the efficacy of photobiomodulation therapy (PBMT) on pain and pressure pain threshold (PPT) in patients with myofascial pain syndrome (MPS) of the upper trapezius muscle. Materials and methods: A total of 17 studies (944 patients) were included; data regarding participants, intervention parameters, outcome measures, time of measurement, and follow-up were extracted. Evaluation of the methodological quality was performed by Physiotherapy Evidence Database (PEDro) scale. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence. A meta-analysis was performed on 16 studies, and standardized mean difference (SMD), corresponding 95% confidence interval (CI), and overall effect size (ES) were calculated. Results: Meta-analysis using a random-effect model was performed to evaluate the effects of PBMT alone or PBMT plus exercise (EX) compared with placebo, medical treatment, physical therapy (PT) modality, manual therapy, or complementary PT. Assessment according to the PEDro scale revealed 12 high-quality, 3 fair-quality, and 2 low-quality studies. According to the GRADE system, studies exhibited low to medium quality of evidence, with medium ES [SMD -0.54 (95% CI -1.05 to -0.02)] for studies using PBMT alone and large ES [SMD -0.80 (95% CI -1.35 to -0.26)] for PBMT+EX. Conclusions: The present systemic review revealed that PBMT is an effective PT modality for reducing pain and increasing PPT in patients with MPS of the upper trapezius. PBMT, when combined with EX, had more significant effects in reducing pain and increasing PPT compared with controls. The low-quality studies with low to moderate quality of evidence limit the confidence in the effect estimate and recommend further high-quality studies for standardization of treatment protocols and irradiation parameters. PROSPERO registration number: CRD42021241155.

Efficacy of low-level laser therapy on pain, disability, pressure pain threshold, and range of motion in patients with myofascial neck pain syndrome: a systematic review and meta-analysis of randomized controlled trials.

Low-level laser therapy (LLLT) is one of recent modalities for treatment of myofascial neck pain (MNP). Several RCTs have been conducted on its effectiveness. The aim of this comprehensive meta-analysis was to evaluate the effectiveness of LLLT on MNP. Electronic databases were searched for identifying eligible studies comparing the effectiveness of LLLT using any wavelength with placebo or active control in myofascial neck pain up to June 2022. Data related to pain intensity, pain pressure threshold (PPT), range of motion (ROM), and disability was analyzed as a pooled estimate of mean difference or standard mean difference (SMD) with 95% confidence intervals (CIs) using random/fixed-effect model. Funnel plot and Egger's linear regression test were also conducted to examine the risk of publication bias. A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The data assessing laser effectiveness on different outcomes of 556 patients were considered for meta-analysis. Pooled results revealed that LLLT was significantly effective in pain reduction (MD = - 1.29, 95% CI = - 2.36; - 0.23, P < 0.001). Also, secondary outcomes including PPT (SMD of 2.63, 95% CI = 0.96; 4.30, P < 0.01) and right bending ROM (SMD of 3.44, 95% CI = 0.64; 6.24, P < 0.01) were improved, while disability (MD of - 7.83, 95% CI = - 17.1; 0.08, P = 1.34) did not improve significantly after LLLT. Our meta-data revealed that LLLT may reduce myofascial neck pain and its related outcomes. LLLT is suggested to be used by clinicians along with other therapies such as manual and exercise therapy.

Vaginal stretching therapy and class IIIB vaginal laser treatment for pelvic floor myofascial pain: a randomized clinical trial.

PURPOSE: Several treatment options are proposed for the management of pelvic floor myofascial pain (PFMP). Manual therapy, such as vaginal stretching (VS), is one of these options. Photobiomodulation therapy (PBMT) with a laser device is a treatment option for PFMP that has been tested on other muscles. The aim of this study was to evaluate the effect of VS combined or not with PBMT for PFMP treatment. METHODS: One hundred three women with PFMP were enrolled in a double-blind randomized trial and assigned to VS+PBMT (10 treatments over 2 weeks with 100 mw delivering 12 joules to surface intravaginally, using near-infrared light 808 nm) and VS+shamPBMT treatment groups. Pain severity was assessed by Visual Analog Scale (VAS). Pelvic floor muscle function was assessed by Oxford Scale and surface electromyography. Urinary symptoms were evaluated by ICIQ-OAB and ICIQ-SF questionnaires, and intestinal constipation was assessed by ROMA criteria. RESULTS: There was a significant improvement in pain intensity (VAS) after treatment in both groups, with no difference between groups (p = 0.46). More than 50% of the women complained of severe pain before treatment, and after treatments, it was reported by less than 20% of women (p < 0.001), with no difference between groups (p = 0.08). Urinary symptoms improved in both groups (p < 0.001) with no difference between groups (p = 0.37). Intestinal constipation improved in the VS+PBMT group only (p = 0.01). CONCLUSION: VS and VS with near-infrared vaginal laser therapy were equally effective at decreasing myofascial pelvic pain and reducing urinary symptoms TRIAL REGISTRATION: REBEC (Registro Brasileiro de Ensaios Clínicos; Brazilian Registry of Clinical Trials) under no.RBR-2TDCQ4 (November 11, 2018).

Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain.

Women with temporomandibular disorders (TMD) frequently report pain areas in body regions. This process is associated with central sensitization phenomena, present in chronic pain. The low-level laser therapy (LLLT) has been reported as a therapeutic option for the painful TMD treatment. The aim of this study was to analyze the effect of LLLT on pain intensity (visual analogue scale, VAS), pain sensitivity in orofacial and corporal points (pressure pain threshold, PPT), and on Short Form-McGill Pain Questionnaire (SF-MPQ) indexes of women with myofascial pain (subtype of muscle TMD). Ninety-one women (18-60 years) were included in the study, among which 61 were diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorder-Ia and Ib) and were divided into laser (n = 31) and placebo group (n = 30), and 30 were controls. The LLLT was applied at pre-established points, twice a week, eight sessions (780 nm; masseter and anterior temporal = 5 J/cm2, 20 mW, 10 s; TMJ area = 7.5 J/cm2, 30 mW, 10 s). Pain intensity, pain sensitivity, and the SF-MPQ indexes were measured at the baseline, during laser sessions, and 30 days after treatment. For intra-group comparisons, the Friedman test was performed, and for inter-group, the Mann-Whitney test. Increased pain sensitivity was found in women with myofascial pain when compared to controls (p < 0.05). There was a reduction in pain intensity for both groups after LLLT. The LLLT did not change the PPT for any group (p > 0.05). Active laser and placebo reduced the indexes of sensory, total pain, and VAS, maintaining the results after 30 days; there was a reduction in the affective pain rating index for both groups, with no maintenance after 30 days for placebo, and the present pain intensity decreased in the laser group and did not change in the placebo after LLLT. In conclusion, the LLLT active or placebo are effective in reducing the overall subjective perception of myofascial pain (VAS and SF-MPQ indexes); however, they have no effectiveness in reducing the pain sensitivity in orofacial and corporal points (PPT increase).

Measurement of effective remnant power in low intensity laser after passage through the buccinator muscle in anatomical human hemifaces / Determinação da potência efetiva remanescente após a passagem do laser de baixa intensidade através do músculo bucinador em peças anatômicas/hemifaces

Objective: To determine the effective remnant power after the passage of low intensity laser of two different wavelengths (660 and 780 nm) through buccinator muscle in anatomical hemifaces. Methods: Five human hemifaces were dissected, and a laser was shone in the central region of the muscle with a receiver placed on the opposite side. The hemifaces were irradiated using the same dosimetric parameters (40 mW, 1 W/cm2, continuous mode, 0.04 cm2) and at the same point in every muscle; remnant power was measured for each irradiation. Results: The average remnant power after irradiation with 660 nm (149 ± 15 µW) light was significantly lower (p<0.0001) than with that of 780 nm (380 ± 40 µW). Conclusion: The LIL of 780 nm presented greater remnant power in comparison to the 660 nm laser after passage through the buccinator muscle, indicating the latter ́s greater penetration capacity.

Objetivo: Determinar a potência remanescente após a passagem do laser de baixa intensidade em dois comprimentos de onda (660 e 780 nm) através do músculo bucinador em peças anatômicas dissecadas. Métodos: Dissecaram-se cinco hemifaces humanas expondo o músculo bucinador. Aplicou-se o laser na região central de cada músculo, e o receptor, para aferir a potência remanescente, foi posicionado na superfície intraoral contrária. As hemifaces foram irradiadas nos mesmos parâmetros dosimétricos (40 mW, 1 W/cm2, modo contínuo, 0,04 cm2) e no mesmo ponto em cada músculo, sendo a potência remanescente aferida a cada repetição. Resultados: A potência média restante após as irradiações de 660 nm (149 ± 15 µW) foi menor (p <0,0001) que com as irradiações de 780 nm (380 ± 40 µW). Conclusão: O LBI de 780 nm apresentou maior potência remanescente que o LBI de 660 nm, após passagem pelo músculo bucinador, denotando sua maior capacidade de penetração.

Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial.

BACKGROUND AND OBJECTIVES: A prospective, double-blind, randomized, and controlled trial was conducted in patients with chronic myofascial pain syndrome (MPS) in the neck to evaluate the effects of infrared low level 904 nm Gallium-Arsenide (Ga-As) laser therapy (LLLT) on clinical and quality of life (QoL). STUDY DESIGN/PATIENTS AND METHODS: The study group consisted of 60 MPS patients. Patients were randomly assigned to two treatment groups: Group I (actual laser; 30 patients) and Group II (placebo laser; 30 patients). LLLT continued daily for 2 weeks except weekends. Follow-up measures were evaluated at baseline, 2, 3, and 12 weeks. All patients were evaluated with respect to pain at rest, pain at movement, number of trigger points (TP), the Neck Pain and Disability Visual Analog Scale (NPAD), Beck depression Inventory (BDI), and the Nottingham Health Profile (NHP). RESULTS: In active laser group, statistically significant improvements were detected in all outcome measures compared with baseline (P < 0.01) while in the placebo laser group, significant improvements were detected in only pain score at rest at the 1 week later of the end of treatment. The score for self-assessed improvement of pain was significantly different between the active and placebo laser groups (63 vs. 19%) (P < 0.01). CONCLUSION: This study revealed that short-period application of LLLT is effective in pain relief and in the improvement of functional ability and QoL in patients with MPS.

Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation.

BACKGROUND AND OBJECTIVES: The efficacy of low level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. Our aim was to clarify the effect of LLLT in MPS by using algometry and thermography. STUDY DESIGN/MATERIALS AND METHODS: Sixty-two patients with MPS having an active trigger point in the neck or upper back region were randomly divided into two equal groups according to therapy applied (group 1: LLLT + stretching exercises, group 2: stretching exercises alone). The outcome measures were pain measured with visual analogue scale (VAS), algometry on the trigger point, algometric difference, thermographic difference, and thermal asymmetry. Comparison was made within and between the groups pre- and post-therapeutically and 3 weeks after therapy. RESULTS: Mean pain values decreased more significantly in group 1 from baseline to 3 weeks follow up (7.54-3.06) while these values were 7.03-5.19 in group 2 (P < 0.05). Group comparisons revealed significant favorable differences in group 1 patients in terms of all other parameters at the first and the second evaluation post therapeutically (P < 0.05). CONCLUSIONS: LLLT seemed to be beneficial for pain in MPS by using algometry and thermography.

Effects of low-power laser exposure on masseter muscle pain and microcirculation.

One possible cause of the reported positive treatment effect by low-power laser exposure in muscle pain conditions could be that it increases the local microcirculation. The aim of this study was therefore to investigate the immediate effects on masseter muscle blood flow by low-power laser exposure in patients with chronic orofacial pain of muscular origin in comparison to healthy individuals. Twelve patients with myofascial pain of orofacial muscles and 12 age and gender matched healthy individuals participated in the study. Before laser exposure the subjects were examined clinically and the patients scored their current pain intensity from the most tender masseter muscle. Intramuscular laser-Doppler flowmetry was performed unilaterally in the most tender point (patients) or in a standardized point (healthy subjects) of the masseter muscle. The muscle was first exposed with a Gallium-Aluminum-Arsenide laser (active laser) or placebo laser for 2 min in a randomized and double-blind manner. After another 8 min the muscle was treated with the other laser for 2 min and the LDF recording continued for 8 min. Finally, the patients again assessed the pain intensity. Data were analyzed blindly by one of the authors not participating in data collection. The pain intensity was not affected by laser exposure. The blood flow did not change significantly in the patients, but increased after active laser exposure and decreased after placebo exposure in the healthy individuals. The difference between active laser and placebo was significant. In conclusion, the results of this study do not support an effect of low-power laser exposure on masseter muscle microcirculation in patients with chronic orofacial pain of muscular origin.

Treatment of medial and lateral epicondylitis--tennis and golfer's elbow--with low level laser therapy: a multicenter double blind, placebo-controlled clinical study on 324 patients.

BACKGROUND AND OBJECTIVE: Among the other treatment modalities of medial and lateral epicondylitis, low level laser therapy (LLLT) has been promoted as a highly successful method. The aim of this clinical study was to assess the efficacy of LLLT using trigger points (TPs) and scanner application techniques under placebo-controlled conditions. STUDY DESIGN/MATERIAL AND METHODS: The current clinical study was completed at two Laser Centers (Locarno, Switzerland and Opatija, Croatia) as a double-blind, placebo controlled, crossover clinical study. The patient population (n = 324), with either medial epicondylitis (Golfer's elbow; n = 50) or lateral epicondylitis (Tennis elbow; n = 274), was recruited. Unilateral cases of either type of epicondylitis (n = 283) were randomly allocated to one of three treatment groups according to the LLLT technique applied: (1) Trigger points; (2) Scanner; (3) Combination Treatment (i.e., TPs and scanner technique). Bilateral cases of either type of epicondylitis (n = 41) were subject to crossover, placebo-controlled conditions. Laser devices used to perform these treatments were infrared (IR) diode laser (GaAlAs) 830 nm continuous wave for treatment of TPs and HeNe 632.8 nm combined with IR diode laser 904 nm, pulsed wave for scanner technique. Energy doses were equally controlled and measured in Joules/cm2 either during TPs or scanner technique sessions in all groups of patients. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: (1) short form of McGill's Pain Questionnaire (SF-MPQ); (2) visual analogue scales (VAS); (3) verbal rating scales (VRS); (4) patient's pain diary; and (5) hand dynamometer. RESULTS: Total relief of the pain with consequently improved functional ability was achieved in 82% of acute and 66% of chronic cases, all of which were treated by combination of TPs and scanner technique. CONCLUSIONS: This clinical study has demonstrated that the best results are obtained using combination treatment (i.e., TPs and scanner technique). Good results are obtained from adequate treatment technique correctly applied, individual energy doses, adequate medical education, clinical experience, and correct approach of laser therapists. We observed that under- and overirradiation dosage can result in the absence of positive therapy effects or even opposite, negative (e.g., inhibitory) effects. The current clinical study provides further evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis.

Low level laser therapy with trigger points technique: a clinical study on 243 patients.

Among the various methods of application techniques in low level laser therapy (LLLT) (HeNe 632.8 nm visible red or infrared 820-830 nm continuous wave and 904 nm pulsed emission) there are very promising "trigger points" (TPs), i.e., myofascial zones of particular sensibility and of highest projection of focal pain points, due to ischemic conditions. The effect of LLLT and the results obtained after clinical treatment of more than 200 patients (headaches and facial pain, skeletomuscular ailments, myogenic neck pain, shoulder and arm pain, epicondylitis humery, tenosynovitis, low back and radicular pain, Achilles tendinitis) to whom the "trigger points" were applied were better than we had ever expected. According to clinical parameters, it has been observed that the rigidity decreases, the mobility is restored (functional recovery), and the spontaneous or induced pain decreases or even disappears, by movement, too. LLLT improves local microcirculation and it can also improve oxygen supply to hypoxic cells in the TP areas and at the same time it can remove the collected waste products. The normalization of the microcirculation, obtained due to laser applications, interrupts the "circulus vitiosus" of the origin of the pain and its development (Melzak: muscular tension > pain > increased tension > increased pain, etc.). Results measured according to VAS/VRS/PTM: in acute pain, diminished more than 70%; in chronic pain more than 60%. Clinical effectiveness (success or failure) depends on the correctly applied energy dose--over/underdosage produces opposite, negative effects on cellular metabolism. We did not observe any negative effects on the human body and the use of analgesic drugs could be reduced or completely excluded. LLLT suggests that the laser beam can be used as monotherapy or as a supplementary treatment to other therapeutic procedures for pain treatment.

Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study.

In a controlled, cross-over study the effect of low level laser therapy (LLLT) was evaluated. During a five weeks period forty-seven female laboratory technicians received six laser and six placebo treatments to tender points in the neck and shoulder girdle. Subjects rated the placebo treatment significantly more beneficial than LLLT (p = .04). There was no reduction in consumption of analgesics associated with either laser or placebo treatment. The results indicate no beneficial effect of LLLT for myofascial pain.

Diode laser in cervical myofascial pain: a double-blind study versus placebo.

We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. At each session, the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated. Those in the placebo group submitted to the same number of sessions following an identical procedure, the only difference being that the laser apparatus was nonoperational. Pain was monitored using the Italian version of the McGill pain questionnaire and the Scott-Huskisson visual analogue scale. The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at the end of therapy and at the 3-month follow-up examination.

Effects of helium-neon laser irradiation on skin resistance and pain in patients with trigger points in the neck or back.

The purpose of this double-blind study was to ascertain the effects of helium-neon (He-Ne) laser irradiation on skin resistance and pain in patients with trigger points in the neck or low back. This study entailed a partial replication of a previous study by Snyder-Mackler and associates that determined the use of the He-Ne laser increased skin resistance overlying a trigger point. Twenty-four patients were randomly assigned to either a treatment or a control group and received three 20-second applications of laser irradiation or placebo "stimulation," respectively. Pretreatment and posttreatment skin resistance and pain measurements (via visual analog scale) were taken during each session. Results indicated a statistically significant increase in skin resistance (p less than .001) and a decrease in pain (p less than .005) following laser treatment. There was not a significant correlation between skin resistance and pain across subjects. These data substantiate the previous findings of Snyder-Mackler and associates and demonstrate a reduction in pain. Helium-neon laser treatment, therefore, may be an effective adjunct to conventional physical therapy of these patients.

Chronic myofascial pain: management by low-output helium-neon laser therapy.

Therapeutic benefits of low-output helium-neon laser therapy have not been established, but laser therapy has been suggested as an effective means of treating many acute and chronic musculoskeletal pain syndromes. Although not released for general clinical use by the FA, the helium-neon laser has been promoted to physical therapists and athletic trainers as potentially useful for the treatment of pain syndromes. In particular, it has been proposed that it may be more effective than conventional measures such as medication and conventional physical therapy in the treatment of myofascial pain syndromes (fibrositis, fibromyalgia). The citations in the literature include only case reports. Sixty-two patients were treated by using acupuncture points. Two sessions of five treatments were given six weeks apart. A crossover double-blind technique was used in the treatments. The clinical responses were assessed using portions of the McGill Pain Questionnaire. No statistical difference between the treatment and the placebo groups could be determined.

Effect of helium-neon laser on musculoskeletal trigger points.

Cold lasers have been proposed recently as a therapeutic tool for treating a wide variety of pathological conditions, including wounds, arthritis, orthopedic problems, and pain. These proposed therapeutic effects largely have been unsubstantiated by research. A randomized, double blind study was undertaken to ascertain the effect of a helium-neon (He-Ne) laser on the resistance of areas of skin overlying musculoskeletal trigger points. These areas usually demonstrate decreased skin resistance when compared with the surrounding tissue. Thirty patients with musculoskeletal trigger points were assigned randomly to either an experimental or a placebo group. In addition to standard physical therapy, each patient received three 15-second applications of a He-Ne laser or placebo "stimulation" from an identical unit that did not emit a laser. The results of a two-way analysis of covariance with one repeated measure showed a statistically significant increase (p less than .007) in skin resistance. This increase in an abnormal skin resistance pattern may accompany the resolution of pathological conditions.