Study Compares Dry Needling Techniques for Relief from Heel Pain

PainRelief.com Interview with:
Dr. Pablo Herrero Gallego. PT, PhD.
Head of iPhysio Research Group.
Editor-in-Chief Journal of Invasive Techniques in Physical Therapy
Zaragoza, Spain

PainRelief.com:  What is the background for this study?

Response: The background of this study is that there has been an increasing use of minimally invasive techniques in physiotherapy in the last years, that apparently leading to very good results in the clinical practice, but there are no studies comparing the effectiveness of different treatment modalities. In the case of this study, about plantar heel pain (PHP), many physiotherapists use dry needling (DN) or percutaneous needle electrolysis (PNE) to treat myofascial trigger points when conservative treatment fails. However, although some clinicians claim that PNE has a superior effect to DN because it adds a galvanic current to the mechanical stimuli with the needle, there is no evidence to support this. Because of it, we decided to conduct this first study comparing these two treatment options for PHP.

Which Back Pain Patients Get Pain Relief from Yoga?

PainRelief.com Interview with:
Eric J. Roseen, DC, MSc
Department of Family Medicine
Boston University School of Medicine
Department of Rehabilitation Science
Massachusetts General Hospital Institute of Health Professions
Boston, MA 02215

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: The Back to Health Study is a noninferiority randomized controlled trial of yoga, physical therapy, and back pain education for chronic low back pain. Participants were recruited from a SafetyNet hospital (Boston Medical Center) and seven affiliated federally-qualified community health centers. Participants reflected the population served by this health system, they were predominately low-income and non-white.

The yoga intervention consisted of 12 group-based, weekly, 75-minute, hatha yoga classes incorporating poses, relaxation and meditation exercises, yoga breathing and yoga philosophy. Thirty minutes of daily home practice was encouraged and supported with at-home yoga supplies. The physical therapy intervention consisted of 15 one-on-one 60-minute appointments over 12 weeks. During each appointment, the physical therapist utilized the Treatment-Based Classification Method and supervised aerobic exercise, while providing written instructions and supplies to continue exercises at home. The self-care intervention consisted of reading from a copy of The Back Pain Handbook, a comprehensive resource describing evidence-based self-management strategies for chronic lower back pain including stretching, strengthening, and the role of psychological and social factors. Participants received check-in calls regarding the reading every three weeks.

The main findings from the trial published in Annals of Internal Medicine found that yoga was non-inferior to physical therapy in terms of pain and function outcomes.

In this study published in Pain Medicine, we wanted to dig deeper and understand the characteristics of patients who tended to do better no matter what treatment they received (i.e., predictors) and characteristics that modified the likelihood that they would improve with a particular treatment (i.e., treatment effect modifiers). This type of information is useful to patients and clinicians who are trying to decide which type of treatment may be best for a unique individual experiencing back pain.

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Early Physical Therapy Can Be Protective Against Chronic Opioid Use

PainRelief.com Interview with:

Steven Z. George, PT, PhD  Professor Director of Musculoskeletal Research Duke Clinical Research Institute Vice Chair of Clinical Research Orthopaedic Surgery

Dr. George

Steven Z. George, PT, PhD 
Professor
Director of Musculoskeletal Research
Duke Clinical Research Institute
Vice Chair of Clinical Research
Orthopaedic Surgery

PainRelief.com: What is the background for this study? What are the main findings?Response: This study adds to existing health services research investigating the sequence of services/providers for musculoskeletal pain and its impact on opioid use.

The study suggest that early physical therapy (PT) for the 4 most common musculoskeletal conditions (back, neck, shoulder, and knee) can be protective of chronic/long term opioid use for individuals that were opioid naïve when presenting for their care.  What is different about this study is that the 4 conditions were studied in the same cohort and the same definition of early PT was used (many of the previous studies just looked at 1 conditions, and used different definitions of early physical therapy).  The other thing that was different is that we used a larger dataset of private insurance providers, so this study cuts across different regions of the study (many of the previous studies included one health system).

There was notable consistency in the findings for the 4 conditions and protection of any opioid use, but there were some contingencies.

First was that there was no benefit on decreased dosage for individuals with neck pain – as that was not expected.

Second was that in a follow up sensitivity analysis it looked like the largest benefit of early physical therapy may be for those with back and knee pain.  Continue reading