Needling Therapy for Myofascial Pain Control

Needling therapy has been widely used for pain control. " Needling " includes all procedures with penetration of a needle through the skin with injection of medication (injection therapy) or without introduction of any drug (dry needling). In either injection or dry needling, the site of treatment can be at the site of pain (direct needling) or far from the site of pain (remote needling). Needling therapy includes traditional acupuncture, needling with multiple insertions, dry needling with electrical stimulation, superficial needling, and Fu's sub-cutaneous dry needling. Myofascial pain is a regional pain syndrome characterized with the existence of a sensitive spot (myofascial trigger point (MTrP)) in the taut band of skeletal muscle fibers. MTrP can be inactivated by appropriate treatment with physical therapy (including manual therapy) or needling therapy. This special issue contains nine papers, of which two are review articles and seven are research articles. The review paper by L.-W. Chou et al. discussed various proposed mechanisms published previously and concluded that multiple mechanisms are probably involved in needling analgesia. Another review paper by J. M. Climent et al. discussed the clinical trials of botulinum toxin injection for treating myo-fascial pain in the neck and back, and concluded that bot-ulinum toxin could be useful in specific myofascial pain regions, especially for patients with refractory myofascial pain that has not responded to other myofascial injection therapies. Two clinical studies demonstrated the effectiveness of dry needling in treating myofascial pain after total knee arthroplasty (O. Mayoral et al.) and remote pain in the upper trapezius muscle (K.-H. Chen et al.). One animal study by Y.-L. Hsieh et al. showed that dry needling at the myofascial trigger spots (MTrSs, equivalent to human MTrP) of rabbit biceps femoris muscles could modulate various biochemicals associated with pain, inflammation, and hypoxia in a dose-dependent manner. The other animal study by A. Domingo et al. found that repeated dry needling punctures in muscle do not perturb the different stages of muscle regeneration and reinnervation. Another research study by M.-T. Lin et al. suggested that the artificial neural network (ANN) model was more accurate in predicting patient-reported pain scores and had higher overall performance indices. Finally two papers reported their newly developed techniques for myofascial pain control. An animal study by Fu et al. further confirm the effectiveness and the possible mechanism of Fu's remote needling for myofascial pan therapy. The study by Lin et al. demonstrated …