Factors Associated with Immediate Post-needling Soreness after Dry Needling at Upper Trapezius Muscle in Patients with Myofascial Pain syndrome


  • Triluk Vorawanthanachai Department of Rehabilitation Medicine, Phetchabun Hospital, Phetchabun, Thailand


post-needling soreness, dry needling, upper trapezius muscle, myofascial pain syndrome


Objectives: To investigate the factors associated with immediate post-needling soreness after dry needling at the upper trapezius muscle in patients with myofascial pain syndrome.

Study design: Prospective study.

Setting: Department of Rehabilitation Medicine, Phetchabun Hospital, Phetchabun province, Thailand.

Subjects: The participants were 265 patients with myofascial pain syndrome at the upper trapezius muscle who were treated by dry needling between January and September 2022. The inclu-sion criteria comprised ages 18-65 years and a numeric rating scale (NRS) of muscle pain intensity ≥ 3 scores.

Methods: The participants were interviewed regarding their demo-graphic data, including gender, age, BMI, affected side, and NRS of initial muscle pain intensity. Dry needling at the upper Trapezius was performed by using an acupuncture needle. Data recorded during needling included needle size, the number of needle insertions, the total number of needles, responses during needling, and the number of muscle twitching. Data recorded immediately after dry needling, included the bleeding size, presence of hemato-ma, duration of ischemic compression, NRS of muscle pain, and NRS of soreness. The demographic data are shown as frequency, percentage, means, and standard deviations. The relationship of factors associated with post-needling soreness was analyzed by chi-square test, and potential associated factors of post-needling soreness were analyzed by multiple binary logistic regression, Forward Wald test.

Results: Two hundred sixty-five patients were 19.2% of males and 80.8% of females, with a mean age of 44 years, and average BMI of 23.7 kg/m2, and average initial muscle pain intensity of 5.8. The most frequently affected side was the right side (54.3%). Most patients had post-needling soreness (54.0%), with a mean soreness score of 3.3.  Chi-square analysis identified seven variables that involved post-needling soreness: needle size, number of needle insertions, total number of needles, number of muscle twitching, bleeding size, presence of hematoma, and duration of ischemic compression. However, multivariate analysis identified only three factors that were statistically significantly associated with post-needling soreness, including needle size (ORadj 4.38, 95%CI 2.40-8.04, p < 0.001), number of muscle twitching (ORadj 1.19, 95%CI 1.08-1.36, p = 0.007), and number of needle insertions (ORadj 1.07, 95%CI 1.03-1.11, p = 0.001)

Conclusions: The associated factors with immediate post-needling soreness in patients after upper trapezius dry needling were needle size, number of muscle twitching, and number of needle insertions.


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