Comparison of the efficacy of DRY needling and balneotherapy in the treatment of myofascial pain syndrome

Objective: Myofascial pain syndrome (MAS) constitutes 50-80% of chronic painful musculoskeletal diseases and is an important cause of disability. Our aim in this study is to compare the effects of dry needling and balneotherapy on pain, pressure pain threshold (PPT), cervical range of motion (ROM), mood, anxiety state, kinesiophobia, neck functions and quality of life in the treatment MAS. Materials and Methods: 120 patients diagnosed with MPS due to the trigger points on the trapezoidal muscle were included in the study from patients admitted to Kırşehir Ahi Evran University Faculty of Medicine Physical Medicine and Rehabilitation outpatient clinic between February 2020 and May 2020. The patients were randomized with the closed envelope method and divided into 3 groups of 40 people. Dry needling treatment was applied to the first group. After the trapezoidal muscle was cleaned with an appropriate antiseptic, the trigger points determined by the examination were pinned until they found the TN in the muscle band with sterile acupuncture needles of 0.25x0.25 mm. Then, after the needles in the TNs were pinned with the salt-pepper method 3 times with 2 minutes intervals, 20 minutes were waited and then the needle was withdrawn. This treatment was repeated once a week for 3 weeks. Balneotherapy was applied to the second group. Balneotherapy was performed within the body of Kırşehir Ahi Evran University Physical Therapy and Rehabilitation Center, for 3 weeks, 5 days a week, 20 minutes once a day, for a total of 15 sessions. Balneotherapy treatment was applied to patients in the form of a whole body bath at 09.00 for 20 minutes. Both treatment methods were applied to the third group together. Some demographics such as age, gender, height, weight, body mass index (BMI), marital status, education status, occupational information, cigarette-alcohol use, presence of additional disease, medications used, dominant hand side, pain duration and pain location and clinical features were recorded. Visual Analogue Scale (0-10 cm) to measure pain at rest and in motion, algometric measurement to measure PPT, cervical goniometric measurements to measure cervical ROM, Beck Depression Inventory (BDI) to assess depressive mood, anxiety level to assess Beck Anxiety Inventory (BAI), Tampa Kinesiophobia Scale (TKS) to evaluate fear of movement,,Neck Disability Inquiry Questionnaire (NDIQ) to evaluate neck functions, Short Form-36 (Short Form-36 = SF-36) was used to measure the quality of life. These scales were evaluated 3 times in total: pretreatment, 1st week after treatment and 3rd month after treatment. The Global Assessment Scale (GAS) was used to subjectively assess the success of the volunteers. This scale was evaluated twice, 1 week after treatment and 3 months after treatment. Results: 120 patients with an average age of 40.3 ± 8.5 years were included in the study. 80.8% of the patients participating in the study were female and 19.1% were male. There was only statistically significant difference between the groups in age variable (p <0.05). While the average age in group 1 was 37.4 ± 9.3 years, it was 40.9 ± 8.1 years in group 2 and 42.6 ± 7.5 years in group 3. There was no statistically significant difference between the duration of pain of the patients participating in the study (p> 0.05). Pain site was classified as right trapezoidal muscle fibers, left trapezoidal muscle fibers and bilateral, and no statistically significant difference was found between the groups (p> 0.05). In the pre-treatment evaluations, there was no statistically significant difference between the VAS-Rest, VAS-Movement, PPT, all ROM, BAI, TKS, NDIQ, SF-36 subgroup scores (p> 0.05). In the pre-treatment measurements, there was a statistically significant difference between the depressive mood level (p = 0.008) assessed by BDI between group 1 and group 2, and between group 2 and 3 in the social function subgroup of SF-36 (p = 0.029). In intra-group comparisons, statistically significant improvements were observed in all 3 groups evaluated after treatment (p <0.05). In comparisons made between the groups, it can be said that in all evaluation parameters, in group 3, where both treatments are applied together, it is the most favorable condition. Dry needling alone was more effective than the balneotherapy group alone in the VAS-assessed pain levels, BDI and BAI evaluations, and functional status assessed by the NDIQ; In the PPT evaluations, dry needling alone and balneotherapy alone were not statistically different; It was determined that there was no difference between the groups in the post-treatment evaluations in the ROM measurements, and the most favorable state occurred in group 3 in the treatment of kinesiophobia evaluated with TKS. In terms of quality of life, in the evaluations other than mental health and general health subgroups, it was found that there was a statistically significant increase in SF-36 subgroup scores in the dry needling groups (group 1 and group 3) compared to the group receiving only balneotherapy (group 2). In terms of GAS scores, the highest evaluation made in the first week after treatment in group comparisons was in group 3; ın the 3-month post-treatment evaluations, GAS scores were found to be statistically higher in groups with dry needling (group 1 and group 3) compared to the group receiving only balneotherapy (group 2). Conclusıon: Both dry needling and balneotherapy treatments in MPS are effective in pain, PPT, cervical ROM, depressive mood, anxiety, kinesiophobia, disability and quality of life scores. The application of two treatment methods together increases the success of the treatment. Keywords: Myofascial pain syndrome, dry needling, balneotherapy, disability, quality of life