Dry Needling for Scars

Recruiting at 1 trial location

Overseen By Maryam Ahmadi, Ms.c.

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Iran University of Medical Sciences

Must not be taking: Anticoagulants

Disqualifiers: Needle phobia, Immature scar, Diabetes, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 10

Duration: 2 weeks

80 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

If you are taking anticoagulant medications (blood thinners), you will need to stop them to participate in this trial.

What data supports the effectiveness of this treatment for scars?

Research shows that dry needling can effectively reduce pain from myofascial trigger points, which are tight areas in muscles, and this effect can last for several weeks. While this research focuses on pain relief, it suggests that dry needling might also help with other conditions involving muscle and tissue, like scars. ^{1 2 3 4 5}

Is dry needling generally safe for humans?

Dry needling is generally considered safe, but there can be some adverse events (unwanted effects) like muscle soreness or bruising. It's important for practitioners to screen patients for underlying conditions that might increase the risk of complications. ^{2 5 6 7 8}

How does dry needling for scars differ from other treatments?

Dry needling for scars is unique because it involves inserting thin needles into specific points in the muscle to relieve pain and improve tissue function, which is different from other treatments that might not target these trigger points directly. This method is often used for muscle-related pain and aims to elicit a local twitch response, which can help reduce sensitivity and improve healing. ^{2 5 9 10 11}

What is the purpose of this trial?

Scar tissue can cause serious complications that significantly impact a patient's quality of life. Common complications include stiffness and contractions, which can restrict joint mobility and make daily activities challenging. In severe cases, these limitations can even prevent patients from fulfilling their work responsibilities or engaging in activities they enjoy. The deleterious effect of scar tissue on a patient's well-being is of utmost significance. However, several therapeutic approaches have been proposed to manage scar tissue complications. Enhancing scar tissue compliance can help patients regain their functional abilities and reduce limitations. One such approach is dry needling, a technique used to improve the flexibility of myofascial tightness. Nevertheless, the effectiveness of dry needling in improving scar tissue compliance remains debatable. Therefore, this study aims to investigate the therapeutic effects of dry needling on complications resulting from linear hypertrophic scars caused by surgery or trauma.

Eligibility Criteria

This trial is for individuals aged 20-60 with linear hypertrophic scars older than six weeks, without joint movement restrictions near the scar. It's not suitable for those with a fear of needles, diabetes, keloid scars, skin infections near the scar tissue, altered joint mobility due to fractures or those on anticoagulant medications.

Inclusion Criteria

I have a scar that is raised and older than six weeks.

I can move my joints freely near my scar.

I am between 20 and 60 years old.

Exclusion Criteria

I am taking blood thinner medications.

I have skin conditions or infections near my scar.

I have had fractures that changed how my joints move.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants receive dry needling or sham treatment along with routine physiotherapy for scar tissue

2 weeks

6 visits (in-person)

Reassessment

Measures of primary and secondary outcomes are collected immediately and two weeks after the final treatment session

2 weeks

2 visits (in-person)

Follow-up

Participants are monitored for changes in health status, flexibility, range of motion, and pain intensity

2 weeks

1 visit (in-person)

Treatment Details

Interventions

• Sham dry needling
• True dry needling

Trial Overview The study tests dry needling's effectiveness on improving flexibility and reducing complications from surgery or trauma-induced linear hypertrophic scars. Participants will receive either true dry needling or sham (fake) treatment to compare outcomes.

Participant Groups

Group I: True dry needling of the hypertrophic scar tissue Experimental Treatment 1 Intervention

Participants with hypertrophic linear scar tissue in the true dry needling group will undergo authentic dry needling interventions targeted at the scar tissue, in conjunction with routine physiotherapy.

Group II: Sham dry needling of the hypertrophic scar tissue Placebo Group 1 Intervention

In the sham dry needling group, participants presenting with hypertrophic linear scar tissue will receive superficial dry needling of the skin, performed at a location distinct from the scar tissue. This will be administered alongside routine physiotherapy.

Sham dry needling is already approved in United States, European Union for the following indications:

Approved in United States as Dry Needling for:

• Musculoskeletal pain
• Myofascial pain syndrome
• Chronic pain
• Low back pain
• Strains
• Osteoarthritis
• Fibromyalgia
• Tendinopathies

Approved in European Union as Dry Needling for:

• Musculoskeletal pain
• Myofascial pain syndrome
• Chronic pain
• Low back pain
• Strains
• Osteoarthritis
• Fibromyalgia
• Tendinopathies

Who Is Running the Clinical Trial?

Iran University of Medical Sciences

Lead Sponsor

Trials

30

Recruited

2,000+

Findings from Research

Dry needling (DN) effectively reduces pain from active myofascial trigger points (a-MTrPs) with significant improvements in pain scores sustained for at least 6 weeks after treatment, as shown in a study of 45 patients with cervical pain.

Patients who experienced a greater initial reduction in pain (measured by the VAS score) were more likely to maintain their pain relief, indicating that early and significant pain reduction is crucial for long-term benefits from DN.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. Gerber, LH., Sikdar, S., Aredo, JV., et al.[2023]

In a study involving nine rabbits, dry needling of myofascial trigger points significantly reduced spontaneous electrical activity (SEA) in the treated muscle, indicating its effectiveness in relieving myofascial pain.

The results suggest that eliciting local twitch responses during dry needling is crucial for reducing SEA, highlighting that this response, rather than just the needling itself, plays a key role in the treatment's efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Chen, JT., Chung, KC., Hou, CR., et al.[2019]

In a study of 52 subjects with myofascial pain, dry needling significantly increased pain pressure thresholds compared to sham dry needling, indicating its effectiveness in relieving muscle pain.

However, there were no significant differences in pain intensity or jaw opening without pain between the two groups, suggesting that while dry needling helps with tenderness, it may not impact overall pain perception or jaw function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo controlled study. Dıraçoğlu, D., Vural, M., Karan, A., et al.[2022]

In a study of 52 participants with Achilles tendinopathy, adding intramuscular stimulation to a 12-week rehabilitation program did not provide any additional benefit compared to rehabilitation alone or sham treatment, as measured by the VISA-A score.

All treatment groups showed improvement over time, but there were no significant differences in self-reported improvement or secondary outcomes, indicating that standard rehabilitation alone is effective for this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial. Solomons, L., Lee, JJY., Bruce, M., et al.[2020]

In a study of 26 participants with chronic neck pain, dry needling (DN) without eliciting a local twitch response (LTR) showed greater improvements in pain, pain pressure threshold, and cervical range of motion compared to DN with LTR after 4 weeks of treatment.

While both methods were effective, DN without LTR was found to be superior for achieving better clinical outcomes, suggesting it may be a safer option by potentially reducing the risk of muscle damage and tissue fibrosis associated with LTR.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes. Hakim, IK., Takamjani, IE., Sarrafzadeh, J., et al.[2020]

Myofascial trigger points are linked to various systemic and psychological factors, making it essential for clinicians to thoroughly screen patients for underlying conditions before using dry needling as a treatment.

Clinicians should be aware of specific medical conditions and comorbidities that could affect the safety and efficacy of dry needling, including those that may present with similar symptoms to musculoskeletal issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New perspectives on dry needling following a medical model: are we screening our patients sufficiently? Kearns, G., Fernández-De-Las-Peñas, C., Brismée, JM., et al.[2020]

In a study involving 39 physiotherapists and 7629 treatments, trigger point dry needling (TrP-DN) was found to have a high incidence of mild adverse events (AEs), with 1463 reported cases, but no significant AEs occurred, indicating a very low risk of serious complications (≤ 0.04%).

Common mild AEs included bruising (7.55%) and bleeding (4.65%), but the overall safety profile suggests that TrP-DN is a safe treatment option for myofascial pain when performed by trained physiotherapists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. Brady, S., McEvoy, J., Dommerholt, J., et al.[2022]

A study involving 42 healthy participants demonstrated that low-cost sham dry needles can effectively serve as a control in dry needling research, as they produced similar pain perceptions to real dry needling.

Both groups reported similar pain levels, but the quality of pain differed, indicating that the sham needles can mimic the experience of real treatment without eliciting a physiological response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Construction of Sham Dry Needles and Their Validity. Mitchell, UH., Stoneman, P., Larson, RE., et al.[2020]

In a study involving 20 asymptomatic subjects, dry needling of latent trigger points in the gastrocnemius medialis muscle resulted in a significant decrease in the electromyographic (EMG) peak activity of local twitch responses (LTRs) with each subsequent twitch, indicating a reduction in muscle hyperactivity during treatment.

Despite the decrease in LTR amplitude, there were no significant changes in the overall EMG activity at rest before and after the dry needling procedure, suggesting that while dry needling may effectively reduce localized muscle tension, it does not affect general muscle activity levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electromyographic Activity Evolution of Local Twitch Responses During Dry Needling of Latent Trigger Points in the Gastrocnemius Muscle: A Cross-Sectional Study. Baraja-Vegas, L., Martín-Rodríguez, S., Piqueras-Sanchiz, F., et al.[2021]

A single session of dry needling (DN) significantly reduced sympathetic nervous system hyperactivity and improved pain intensity in patients with upper trapezius myofascial trigger points (MTrPs), indicating its efficacy as a treatment method.

After DN, patients experienced increased pressure pain thresholds and a reduction in neuromuscular junction response abnormalities, suggesting that DN effectively deactivates active MTrPs and alleviates associated symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. Abbaszadeh-Amirdehi, M., Ansari, NN., Naghdi, S., et al.[2018]

In a study involving 54 patients with myofascial trigger points in the upper trapezius muscle, both dry needling (DN) and DN with needle retention for 30 minutes significantly reduced pain intensity and improved pressure pain threshold after 7 and 14 days.

Despite both methods showing effectiveness in treating pain, there were no significant differences in outcomes between the two techniques, suggesting that needle retention may not provide additional benefits over standard dry needling.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of the effectiveness between dry needling with and without needle retention in myofascial trigger points in upper trapezius muscle: A randomized comparative trial. Khanittanuphong, P., Saesim, A.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. [2019]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo controlled study. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial. [2020]

5. Netherlands pubmed.ncbi.nlm.nih.gov

The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes. [2020]

6. England pubmed.ncbi.nlm.nih.gov

New perspectives on dry needling following a medical model: are we screening our patients sufficiently? [2020]

7. England pubmed.ncbi.nlm.nih.gov

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

The Construction of Sham Dry Needles and Their Validity. [2020]

9. England pubmed.ncbi.nlm.nih.gov

Electromyographic Activity Evolution of Local Twitch Responses During Dry Needling of Latent Trigger Points in the Gastrocnemius Muscle: A Cross-Sectional Study. [2021]

10. England pubmed.ncbi.nlm.nih.gov

Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. [2018]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Comparison of the effectiveness between dry needling with and without needle retention in myofascial trigger points in upper trapezius muscle: A randomized comparative trial. [2022]