Martín-Pintado-Zugasti Aitor, López-López Almudena, González Gutiérrez Jose Luis, Pecos-Martín Daniel, Rodríguez-Fernández Ángel Luis, Alguacil-Diego Isabel María, Gallego-Izquierdo Tomás, Fernández-Carnero Josue
Department of Nursing and Physiotherapy, CEU-San Pablo University, Carretera Boadilla del Monte, Km 5,300, Urbanización Montepríncipe, 28668 Boadilla del Monte, Madrid, Spain∗.
Department of Psychology, Universidad Rey Juan Carlos Alcorcón, Madrid, Spain(†).
PM R. 2017 Apr;9(4):348-355. doi: 10.1016/j.pmrj.2016.07.529. Epub 2016 Aug 1.
Myofascial trigger point dry needling is frequently associated with postneedling soreness, which can generate patient dissatisfaction and reduced treatment adherence. Psychological factors may influence the perception of postneedling soreness and the effectiveness of postneedling soreness treatments.
The objectives of the present study were to determine whether catastrophizing, kinesiophobia, pain anxiety, and fear of pain are significant predictors of postneedling soreness over time; and to analyze whether the relationships between psychological variables and postneedling soreness vary as a function of the postneedling soreness intervention, which included ischemic compression, placebo or control (without treatment).
Repeated-measures observational study nested within a randomized controlled trial.
University community.
Healthy volunteers (N = 90; 40 men and 50 women) 18 to 39 years of age (mean ± standard deviation 22 ± 3 years).
Catastrophizing, kinesiophobia, pain anxiety, and fear of pain were evaluated as possible predictors of postneedling pain before dry needling in a latent myofascial trigger point in the upper trapezius muscle. Participants were then divided into a treatment group that received ischemic compression as a postneedling intervention, a placebo group that received sham ischemic compression, and a control group that did not receive any treatment.
Pain during needling and postneedling soreness were quantified using a visual analogue scale during needling, after treatment, and at 6, 12, 24, and 48 hours.
A multilevel analysis revealed that individuals who exhibited more catastrophic thinking showed less postneedling soreness intensity immediately after needling in all participants (β = -0.049). Pain-related anxiety was linked to greater immediate postneedling soreness in the compression condition (β = 0.057). Finally, participants who exhibited more catastrophic thinking showed a slower rate of decline in postneedling soreness levels over time in the compression condition (β = 0.038).
Catastrophizing was associated with lower levels of postneedling soreness immediately after needling in all subjects. Although ischemic compression seems to be a useful procedure to reduce postneedling soreness, its efficacy could be slightly reduced in patients presenting higher scores of pain-related anxiety. Psychological procedures may help to correct the distorted pain expectancies associated with needling interventions and might also improve the effectiveness of ischemic compression.
II.
肌筋膜触发点干针疗法常伴有针刺后疼痛，这可能导致患者不满并降低治疗依从性。心理因素可能影响对针刺后疼痛的感知以及针刺后疼痛治疗的效果。
本研究的目的是确定灾难化思维、运动恐惧、疼痛焦虑和疼痛恐惧是否是针刺后疼痛随时间变化的重要预测因素；并分析心理变量与针刺后疼痛之间的关系是否因针刺后疼痛干预措施（包括缺血性按压、安慰剂或对照（不治疗））的不同而有所变化。
嵌套在随机对照试验中的重复测量观察性研究。
大学社区。
18至39岁（平均±标准差22±3岁）的健康志愿者（N = 90；40名男性和50名女性）。
在斜方肌上部潜在肌筋膜触发点进行干针治疗前，评估灾难化思维、运动恐惧、疼痛焦虑和疼痛恐惧作为针刺后疼痛的可能预测因素。然后将参与者分为接受缺血性按压作为针刺后干预的治疗组、接受假缺血性按压的安慰剂组和未接受任何治疗的对照组。
在针刺期间、治疗后以及6、12、24和48小时，使用视觉模拟量表对针刺时的疼痛和针刺后疼痛进行量化。
多层次分析显示，在所有参与者中，表现出更多灾难化思维的个体在针刺后立即出现的针刺后疼痛强度较低（β = -0.049）。在按压条件下，与疼痛相关的焦虑与针刺后立即出现的更强烈疼痛有关（β = 0.057）。最后，在按压条件下，表现出更多灾难化思维的参与者针刺后疼痛水平随时间下降的速度较慢（β = 0.038）。
在所有受试者中，灾难化思维与针刺后立即出现的较低针刺后疼痛水平相关。尽管缺血性按压似乎是减轻针刺后疼痛的有效方法，但在疼痛相关焦虑得分较高的患者中，其疗效可能会略有降低。心理治疗方法可能有助于纠正与针刺干预相关的扭曲疼痛预期，也可能提高缺血性按压的效果。
II级。
