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Drug Needling Offers Effective Treatment for Hip Pain

April 26, 2017
Producing fewer serious side effects, this study offers support that dry needling represents a safe, effective alternative to cortisone shots for greater trochanteric pain syndrome.

Interview with Kindyle L. Brennan, PT, PhD, OCS, COMT

Too often, practitioners have found themselves weighing the benefits of cortisone (corticosteroid) injections against the risk of side effects when treating patients for greater trochanteric pain syndrome (GTPS).  

Dry needling, a technique using thin filament needles to penetrate the skin and stimulate the trigger points of pain, proved a viable alternative treatment to cortisone injections, according to a study published in the Journal of Orthopaedic & Sports Physical Therapy.1

“The most obvious and direct implication of this study is the successful treatment of GTPS without the introduction of drugs to the system or the risk of serious side effects,” lead author Kindyle L. Brennan, PT, PhD, OCS, COMT, told Practical Pain Management.

Dry needling is a safe and effective treatment for hip pain.

Getting to the Site of GTPS Pain

This study, the first to compare the use of dry needling and cortisone injections to manage the pain of GPTS, confirmed the equal effectiveness of dry needling with less significant adverse side effects, according to Dr. Brennan, a clinical physical therapist at Roney Bone and Joint Institute in Temple, Texas.

Cortisone injections became the standard treatment for GTPS based on the belief that the pain originated from inflammation of the hip bursa. However, evidence now suggests that GTPS pain arises in response to a muscle and tendon injury, not due to inflammation.2,3

Determining the underlying cause of GTPS pain opened the way to pursue alternative treatments to cortisone injections, according to Dr. Brennan.

“Dry needling the myofascial structures of the hip region is aimed at improving the biochemical and neuromuscular homeostasis of these structures, which research has demonstrated is more likely the source of patients’ pain,” Dr. Brennan said.

Dry Needling Offers Pain Relief Equal to Cortisone

This randomized clinical trial followed 43 participants (50 hips) with GTPS, randomly assigned to receive cortisone injections or dry needling over 6 weeks.1  Pain and function were monitored at 4 intervals: at the start of the trial, and at 1,3 and 6 weeks.

Patients in both study groups reported less pain and improved mobility at the end of treatment. However, dry needling offered equal pain reduction and functional outcomes, without the side effects consistent with the use of cortisone. The primary outcome, pain relief, was measured on a numeric scale (0-10), and the secondary outcome, function, was based on the Patient-Specific Function Scale (0-10) with a P = < .01, and a level of evidence of 1b.

While Dr. Brennan and her team noted that dry needling avoids the risk of serious complications consistent with cortisone injections, the treatments do share some adverse reactions such as post-injection soreness, flushing, and sweating. These reactions are relatively minor and fleeting.

Distinguishing Between Dry Needling and Acupuncture

Use of dry needles to stimulate a pain response is often confused with acupuncture. While both use non-cannulated, non-beveled needles, the theoretical framework for diagnosis, application, and interpretation of response is entirely different, said Dr. Brennan.

The intent of acupuncture is to work along meridians to align Chi to correct energy flow whereas dry needling works at the muscular level.

“Dry needling is aimed at specific alterations in the myofascial tissue that are biochemically, vascularly, mechanically, and neurologically abnormal,” Dr. Brennan told Practical Pain Management.  

“The differences continue at the clinical level,” she said. Acupuncture has its roots in Eastern medicine with licensure requirements that vary by state. Physicians and physical therapists rely on dry needling training and certification as a professional specialty.

More Than Dry Needling Needed for Full Recovery

Dr. Brennan indicated that dry needling ideally should be followed by physical therapy to introduce neuromuscular re-education of the movement patterns of the involved region once normalization of the tissue environment has been restored. Though this study didn’t address neuromuscular re-education after dry needling, Dr. Brennan suggested this as an important next step to pursue for future research.

“The end result is not simply addressing the pain, as cortisone would, but the factors that led up to and continue to contribute to the pain,” she said “Pain is a very complex entity that can become its own animal long after the original injury is healed. The clinical and basic science of dry needling suggests tremendous potential for modulating pain perception, local pain sources, and motor recruitment patterns, which have become dysfunctional as sequelae of injury or regional dysfunction.”

Last updated on: May 24, 2017
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