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Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation [Observation on therapeutic effect of shu-needling therapy as main on cervical spondylosis of nerve root type]. Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome. Design of a randomised acupuncture trial on functional neck/shoulder stiffness with two placebo controls Fu's subcutaneous needling: possible clinical evidence of the subcutaneous connective tissue in acupuncture. A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. Does EMG (dry needling) reduce myofascial pain symptoms due to cervical nerve root irritation? A Randomized Trial Comparing Acupuncture and Simulated Acupuncture for Subacute and Chronic Whiplash Cervical spondylosis treated by acupuncture at Ligou (LR 5) combined with movement therapy. Botulinum Toxin, Lidocaine, and Dry-Needling Injections in Patients with Myofascial Pain and Headaches Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain. Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. Short-term effects of acupuncture and stretching on myofascial trigger point pain of the neck: a blinded, placebo-controlled RCT. Acupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain Superficial Dry Needling and Active Stretching in the Treatment of Myofascial Pain – a Randomised Controlled Trial Clinical observation on cervical spondylopathy vertebroarterial type treated by electro-acupuncture. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: A randomised controlled study Statistical Reanalysis of Four Recent Randomized Trials of Acupuncture for Pain Using Analysis of Covariance Evaluation of the immediate effect of acupuncture on pain, cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain: study protocol for a randomized controlled trial Electroacupuncture at Jing-jiaji points for neck pain caused by cervical spondylosis: a study protocol for a randomized controlled pilot trial Is Sham Laser a Valid Control for Acupuncture Trials? Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. Effects of Temperature on Chronic Trapezius Myofascial Pain Syndrome during Dry Needling Therapy The optimized acupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of a multicentre randomized controlled trial Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial Bee venom acupuncture, NSAIDs or combined treatment for chronic neck pain: study protocol for a randomized, assessor-blind trial Skeletal muscle contractility, self-reported pain and tissue sensitivity in females with neck/shoulder pain and upper Trapezius myofascial trigger points– a randomized intervention study Cost-effectiveness of acupuncture treatment in patients with chronic neck pain Electrical Stimulation of Auricular Acupuncture Points Is More Effective Than Conventional Manual Auricular Acupuncture in Chronic Cervical Pain: A Pilot Study Tension neck syndrome treated by acupuncture combined with physiotherapy: a comparative clinical trial (pilot study). Effect of Intensive Acupuncture on Pain-Related Social and Psychological Variables for Women with Chronic Neck and Shoulder Pain – An Rct with Six Month and Three Year Follow Up A randomized, controlled trial of acupuncture for chronic daily headache. [Clinical observation on cervical headache treated with acupuncture and fire needling technique]. A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo controlled study. Percutaneous Neuromodulation Therapy: Does the Location of Electrical Stimulation Effect the Acute Analgesic Response? Efficacy of acupunture in patients with chronic neck pain--a randomised, sham controlled trial. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial Comparison of Miniscalpel-needle Release, Acupuncture Needling, and Stretching Exercise to Trigger Point in Myofascial Pain Syndrome The annual incidence and course of neck pain in the general population: a population-based cohort study Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. Reliability of 3 Assessment Tools Used to Evaluate Randomized Controlled Trials for Treatment of Neck Pain The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. [Clinical observation on treatment of cervicogenic headache with turtle-probing needling at Tianzhu (BL 10)]. Ultrasound-Guided Miniscalpel-Needle Release versus Dry Needling for Chronic Neck Pain: A Randomized Controlled Trial Dry-needling and exercise for chronic whiplash-associated disorders: a randomized single-blind placebo-controlled trial Remote Effects of Dry Needling on the Irritability of the Myofascial Trigger Point in the Upper Trapezius Muscle The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial). A controlled study of acupuncture in neck pain. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. [Logistic regression analysis on therapeutic effect of acupuncture on neck pain caused by cervical spondylosis and factors influencing therapeutic effect]. Relief of chronic neck and shoulder pain by manual acupuncture to tender points--a sham-controlled randomized trial. [Treatment of cervical spondylosis by spinal balancing combined with intervention of pathway of qi: a randomized controlled study]. The therapeutic efficacy of somatic acupuncture is not increased by auriculotherapy: a randomised, blind control study in cervical myofascial pain. Does acupuncture activate endogenous analgesia in chronic whiplash-associated disorders? A randomized crossover trial. [Comparison of the analgesic effect of acupuncture between otopoint-penetrative needling and otopoint-straight needling for cervical type and nerve-root type cervicospondylopathy]. Different Substances and Dry-Needling Injections in Patients with Myofascial Pain and Headaches Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. [Observation on therapeutic effect of long-time needle retention at Baihui (GV 20) on vertebroarterial cervical spondylopathy]. Analysis on the effect of acupuncture in treating cervical spondylosis with different syndrome types Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: a randomized controlled trial. Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial [Evaluation on clinical therapeutic effect of needle-knife therapy on cervical spondylosis]. The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation: A Validation Study Chronic neck pain: a comparison of acupuncture treatment and physiotherapy. [Chronic neck pain of cervical spondylosis treated with acupuncture and moxibustion in terms of the heart and kidney theory: a randomized controlled trial]. [Influence of electroacupuncture with penetration needling method on comprehensive pain score in patients with cervical spondylotic radiculopathy]. Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study. [Clinical observation on cervical spondylosis of neck type treated with acupuncture at original and terminal points of trapezius]. [Acupuncture and laser treatment in cervical and lumbar syndrome]. Multimodal group rehabilitation compared to usual care for patients with chronic neck pain: a pilot study. The acupuncture treatment of neck pain: a randomized controlled study. 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Introduction This study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department ( ED ) setting . Methods and analysis A total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain , ankle sprain or primary headache will be recruited by ED physicians . An intravenous or intramuscular injection of analgesics will be provided as the initial st and ard pain control intervention for all patients . Patients who still have moderate to severe pain after the 30 min of initial st and ard ED management will be considered eligible . These patients will be allocated in equal proportions to acupuncture plus st and ard ED management or to st and ard ED management alone based on computer-generated r and om numbers concealed in opaque , sealed , sequentially numbered envelopes . A 30 min session of acupuncture treatment with manual and /or electrical stimulation will be provided by qualified Korean medicine doctors . All patients will receive additional ED management at the ED physician 's discretion and based on each patient 's response to the allocated intervention . The primary outcome will be pain reduction measured at discharge from the ED by an unblinded assessor . Adverse events in both groups will be documented . Other outcomes will include the patient-reported overall improvement , disability due to neck pain ( only for neck-pain patients ) , the treatment response rate , the use of other healthcare re sources and the patients ’ perceived effectiveness of the acupuncture treatment . A follow-up telephone interview will be conducted by a blinded assessor 72±12 h after ED discharge . Ethics and dissemination Written informed consent will be obtained from all participants . The study has been approved by the Institutional Review Boards ( IRBs ) . The results of this study will guide a full-scale r and omised trial of acupuncture in an ED context . Trial registration number Clinical Trials.gov : NCT02013908 BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review OBJECTIVES To compare the efficacies of dry needling of trigger points ( TrPs ) with and without paraspinal needling in myofascial pain syndrome of elderly patients . DESIGN Single-blinded , r and omized controlled trial . SUBJECTS Forty ( 40 ) subjects , between the ages of 63 and 90 with myofascial pain syndrome of the upper trapezius muscle . INTERVENTIONS Eighteen ( 18 ) subjects were treated with dry needling of all the TrPs only and another 22 with additional paraspinal needling on days 0 , 7 , and 14 . RESULTS At 4-week follow-up the results were as follows : ( 1 ) TrP and paraspinal dry needling result ed in more continuous subjective pain reduction than TrP dry needling only ; ( 2 ) TrP and paraspinal dry needling result ed in significant improvements on the geriatric depression scale but TrP dry needling only did not ; ( 3 ) TrP and paraspinal dry needling result ed in improvements of all the cervical range of motions but TrP dry needling  only did not in extensional cervical range of motion ; and ( 4 ) no cases of gross hemorrhage were noted . CONCLUSIONS TrP and paraspinal dry needling is suggested to be a better method than TrP dry needling only for treating myofascial pain syndrome in elderly patients Background Neck pain caused by cervical spondylosis has become a common health problem worldwide among > 40-year-old adults .  Acupuncture intervention is one of the most popular treatment measures for this disorder . However , evidence for its efficacy in relieving neck pain and recovering neck physiological function has not been established in r and omized , placebo-controlled trials . The primary aim of this trial is to assess the efficacy and safety of active acupuncture compared with sham acupuncture intervention for neck pain caused by cervical spondylosis . Methods / Design We will conduct a r and omized , double-blind , parallel-group , placebo-controlled trial comparing active acupuncture with placebo ( sham acupuncture ) . A total of 456 patients with neck pain caused by cervical spondylosis who meet the eligibility criteria from outpatient clinics of the Second People ’s Hospital of Fujian Province and the Affiliated Rehabilitation Hospital , Fujian University of Traditional Chinese Medicine will be recruited and r and omized into an active acupuncture or sham acupuncture group . The participants will undergo treatment sessions with either active or sham acupuncture intervention five times a week for 2 weeks . Evaluation by blinded assessors at baseline and at intervention for 1 and 2 weeks will include demographic characteristics , vali date d question naires ( Northwick Park Neck Pain Question naire ( NPQ ) scale , Short-Form 36 ( SF-36 ) scale , and McGill pain scale ) , examination of neck physiological function , and adverse events . All included patients will be followed up and investigated for relapse of neck pain at 4 , 8 , and 12 weeks after intervention . Discussion This paper describes the rationale and design of a r and omized double-blind , placebo-controlled trial that aims to determine the efficacy and safety of acupuncture intervention for neck pain caused by cervical spondylosis . The primary outcomes are changes in the NPQ score and neck physiological function . Secondary outcome measures include quality of life , adverse events , and relapse of neck pain . If successful , this project will provide evidence of the efficacy and safety of acupuncture for neck pain caused by cervical spondylosis . Trial registration Chinese Clinical Trial Registry : ChiCTR-TRC-12002206 . Registration date : 11 May 2012 To evaluate the efficacy of Chinese medicine ( CM ) acupuncture for  chronic neck pain ( CNP ) , a single blind , controlled , crossover , clinical trial was undertaken . Twenty-nine volunteers with CNP were r and omly recruited into two groups . Both groups received two phases of treatment with a washout period between the two phases . Group A ( 14 volunteers ) received CM acupuncture in the first phase and sham acupuncture in the second , while Group B ( 15 volunteers ) received sham in the first and real in the second . CM acupuncture was individualized and consisted of nine sessions on both local and distal points . Manual twisting of the needle was applied on all points plus strong electrical stimulation of distal points in CM acupuncture . Sham acupoints ( lateral to the real ) and sham ( weak ) electrical stimulation was used in the control group . Comparison of subjective and objective measures between the two groups was made at different periods , including baseline , after each phase of treatment , after washout , and after the 16th week follow-up . The subjective measures included pain intensity , duration per day , analgesic medication count , visual analogue scales ( VAS ) and neck disability index ( NDI ) . The objective measures consisted of neck range of motion ( ROM ) and pain threshold ( PT ) . Both the real and sham treatments significantly reduced subjective pain , without significant differences between groups for most subjective measures . Objective measures showed no significant change for either group before and after each period or by inter-groups analysis . A minimum 16-week effect of both real and sham acupuncture was found for subjective measures in the follow-up periods . Further study is recommended with an increased sample size , a longer washout period , and a longer baseline period Background Chronic whiplash is a common and costly problem . Sensory hypersensitivity is a feature of chronic whiplash that is associated with poor responsiveness to physical treatments such as exercise . Modalities such as dry-needling have shown some capacity to modulate sensory hypersensitivity , suggesting that when combined with advice and exercise , such an approach may be more effective in the management of chronic whiplash . The primary aim of this project is to investigate the effectiveness of  dry-needling , advice and exercise for chronic whiplash . Method / Design A double-blind r and omised controlled trial will be conducted . 120 participants with chronic whiplash , grade II will be r and omised to receive either 1 ) dry-needling , advice and exercise or 2 ) sham dry-needling , advice and exercise . All participants will receive an educational booklet on whiplash . Participants who are r and omised to Group 1 will receive 6 treatments of combined dry-needling and exercise delivered in the first 3 weeks of the 6 week program , and 4 treatments of exercise only in the last 3 weeks of the program . Participants r and omised to Group 2 will receive an identical protocol , except that a sham dry-needling technique will be used instead of dry-needling . The primary outcome measures are the Neck Disability Index ( NDI ) and participants ' perceived recovery . Outcomes will be measured at 6 , 12 , 24 and 52 weeks after r and omization by an assessor who is blind to the group allocation of the participants . In parallel , an economic analysis will be conducted . Discussion This trial will utilise high quality trial method ologies in accordance with CONSORT guidelines . The successful completion of this trial will provide evidence of the effectiveness and cost-effectiveness of a combined treatment approach for the management of chronic whiplash . Trial registration OBJECTIVE To probe into an effective therapy for chronic pain of cervical intervertebral disc . METHODS Sixty-six cases of chronic pain of cervical intervertebral disc were r and omly divided into an acupoint sticking group and an acu puncture group , 33 cases in each group . The acupoint sticking group was treated with acupoint sticking therapy , and the acupuncture group with acupuncture . Ti and ing ( LI 17 ) , Futu ( LI 18 ) , Dazhui ( GV 14 ) , Tianzong ( S 11 ) , etc . were selected in the two groups . After treatment for 3 therapeutic courses , their therapeutic effects were observed . RESULTS The effective rate was 93.5 % in the acupoint sticking group and 72.4 % in the acupuncture group , the former being better than the latter ( P<0.05 ) ; in a 3-month following-up survey , the effective rate was 90.3 % in the acupoint sticking group and 65.5 % in the acupuncture group , the former being better than the latter ( P<0.05 ) . CONCLUSION The acupoint sticking therapy has an satisfactory therapeutic effect on chronic pain of cervical intervertebral disc OBJECTIVE To evaluate the therapeutic effects of acupotomy-injection with FENG Tian-you spinal manipulation ( FSM ) for treating cervical spondylotic radiculopathy ( CSR ) . METHODS Seventy-two patients with CSR were r and omly divided into two groups ( n = 36 respectively ) : treatment and control group . The patients in treatment group were treated with acupotomy-injection combined with FSM , and patients in control group were treated with traction . All the patients were followed up for 3 months after treatment and the therapeutic effects were evaluated . RESULTS Totally there were 72 patients and 69 completed the treatment and the other 3 patients withdraw from treatment . In treatment group , 24 patients were cured , 6 patients had remarkable effects , 4 effective and 2 ineffective ; as well in control group , above data were 15 , 3 , 10 and 8 respectively . The comprehensive effects and the cured patients in the treatment group were obviously better than those of control group ( P < 0.05 ) . The comparison of scales for assessment of symptoms and short-form McGill Pain Question aire before and after treatment in two groups had significant differences ( P < 0.001 ) . CONCLUSION The method of acupotomy-injection combined with FSM for treating CSR is better than conventional traction method UNLABELLED The aim of this paper was to quantify the influence of the physician 's training and experience in the field of acupuncture on the outcome in patients with chronic pain . Patients visiting their physician because of chronic low back pain , headache , pain due to osteoarthritis of the knee or hip , or neck pain , were included in 4 multicenter , r and omized , controlled studies . All patients received routine care ; patients in the acupuncture groups received additional acupuncture treatment ( on average 10 sessions ) . The data was pooled , and the 3-month change from baseline of the SF-36 bodily pain subscale as the main outcome defined . A total of 9,990 patients ( mean age 49.6 + /- 13.6 years , 68 % female ) treated by 2,781 physicians ( mean age 46.3 + /- 7 years , 37 % female ) were analyzed . The physicians had 7.3 + /- 5.2 ( mean + /- sd ) years of experience in acupuncture  and their mean duration of formal acupuncture training had been 287 + /- 321 hours . The outcome was markedly improved in the acupuncture group . We identified only 1 physician characteristic with a significant influence on the outcome : Internists performed better ( odds ratio OR = 1.49 , confidence interval CI : 1.01;2.18 ; P = .043 ) ; orthopedists worse ( OR = .79 , CI : .62;1 ; P = .043 ) than the average physician . Neither the duration of training nor the duration of experience had any impact on the extent of the  acupuncture effect . PERSPECTIVE In this analysis , physician characteristics such as training did not influence patients ' outcome after acupuncture , suggesting that formal training parameters have only a limited influence on treatment effect . Other skills such as the therapeutic relationship , which are difficult to measure , may probably play a more important role and should be taken into consideration Introduction The use of acupuncture has been suggested for the treatment of acute neck pain caused by stiff neck in China . However , current evidence is insufficient to draw any conclusions about its efficacy . Therefore this pilot study was design ed to evaluate the feasibility and efficacy of acupuncture at the Houxi ( SI3 ) acupoint for treatment of acute neck pain . Methods / analysis This pilot study will be a two-parallel-group , assessor-blinded , r and omised controlled trial . Thirty-six stiff neck participants with acute neck pain will be recruited and r and omly divided into two groups in a 1:1 ratio . Participants in the control group will receive massage on the local neck region ( 5 min each session , three times a day for 3 days ) . In addition to massage , patients in the treatment group will receive acupuncture ( one session a day for 3 days ) . Measures will be taken at 0 , 3 and 15 days . The primary outcome is the Northwick Park Neck Pain Question naire ( NPQ ) . The secondary outcome is the Short Form of the McGill Pain Question naire ( SF-MPQ ) . Ethics/dissemination The protocol for this pilot r and omised clinical trial has undergone ethics scrutiny and been approved by the ethics review boards of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine ( Permission number : HZYLL201303502 ) . The findings of this study will provide important clinical evidence on the feasibility and efficacy of acupuncture treatment for stiff neck patients with acute neck pain . In addition , it will explore the feasibility of further acupuncture research . Trial registration number ChiCTR-TRC-13003911 From January 1993 to December 1996 , we treated 482 cases of cervical spondylopathy with a combined method of point-injection and needle-warming via moxibustion . Except for the cases of sympathetic nerve type and spinal cord type , the combined method was superior to traction therapy in the control group and reported as follows . Clinical Data The Criteria of Diagnosis and Curative Effect in TCM issued by the State Administrative Bureau of TCM and Pharmacy in 1994 was adopted for the enrollment of patients of cervical spondylopathy and the pathological typing . Only the patients who had completed the treatment and with complete records were collected for analysis A prospect i ve , controlled clinical trial was undertaken to assess the relative efficacies of physiotherapy and electroacupuncture in the treatment of cervical spondylosis . The results suggested that , while both methods were effective , electroacupuncture produced an earlier symptomatic improvement with increased neck movement , especially in patients with mild degenerative changes of the cervical spine Clinicians cl aim that myofascial trigger points ( MTrPs ) are a primary cause of pain in whiplash injured patients . Pain from MTrPs is often treated by needling , with or without injection . We conducted a placebo controlled study to test the feasibility of a phase III r and omised controlled trial investigating the efficacy of MTrP needling in patients with whiplash associated pain . Forty-one patients referred for physiotherapy with a recent whiplash injury , were recruited . Patients were r and omised to receive st and ardised physiotherapy plus either acupuncture or a sham needle control . A trial was judged feasible if : i ) the majority of eligible patients were willing to participate ; ii ) the majority of patients had MTrPs ; iii ) at least 75 % of patients provided completed self- assessment data ; iv ) no serious adverse events were reported and v ) the end of treatment attrition rate was less than 20 % . 70 % of those patients eligible to participate volunteered to do so ; all participants had clinical ly identified MTrPs ; a 100 % completion rate was achieved for recorded self- assessment data ; no serious adverse events were reported as a result of either intervention ; and the end of treatment attrition rate was 17 % . A phase III study is both feasible and clinical ly relevant . This study is currently being planned Background Acupuncture is increasingly being used for many conditions including chronic neck pain . However the evidence remains inconclusive , indicating the need for further well- design ed research . The aim of this study was to conduct a pilot r and omised controlled parallel arm trial , to establish key features required for the design and implementation of a large-scale trial on acupuncture for chronic neck pain . Methods Patients whose GPs had diagnosed neck pain were recruited from one general practice , and r and omised to receive usual GP care only , or acupuncture  ( up to 10 treatments over 3 months ) as an adjunctive treatment to usual GP care . The primary outcome measure was the Northwick Park Neck Pain Question naire ( NPQ ) at 3 months . The primary analysis was to determine the sample size for the full scale study . Results Of the 227 patients with neck pain identified from the GP data base , 28 ( 12.3 % ) consenting patients were eligible to participate in the pilot and 24 ( 10.5 % ) were recruited to the trial . Ten patients were r and omised to acupuncture , receiving an average of eight treatments from one of four acupuncturists , and 14 were r and omised to usual GP care alone . The sample size for the full scale trial was calculated from a clinical ly meaningful difference of 5 % on the NPQ and , from this pilot , an adjusted st and ard deviation of 15.3 % . Assuming 90 % power at the 5 % significance level , a sample size of 229 would be required in each arm in a large-scale trial when allowing for a loss to follow-up rate of 14 % . In order to achieve this sample , one would need to identify patients from data bases of GP practice s with a total population of 230,000 patients , or approximately 15 GP practice s roughly equal in size to the one involved in this study ( i.e. 15,694 patients ) . Conclusion This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial , which in turn will help to clarify the existing evidence base on acupuncture for neck pain To compare the effects of dry needling and physiotherapy in treatment of myofascial pain syndrome , a r and omized controlled trial was performed on 28 patients with myofascial pain syndrome ( MPS ) of upper trapezius muscle in the Physical Medicine and Rehabilitation Center of Shohadaye Tajrish Hospital from April 2009 to April 2010 . After matching the age , sex , duration of symptoms , pain severity , and quality of life measures , subjects were r and omly assigned into two subgroups of case ( dry needling ) and control ( physiotherapy ) . One week and 1 month after receiving st and ard therapeutic modalities , outcomes and intragroup and intergroup changes in pain severity , pressure pain of trigger point ( TP ) , and quality of life measures were evaluated and compared . After 1 month , both the physiotherapy and dry needling groups had decreased resting , night , and activity pain levels ( p < 0.05 ) . Pressure pain threshold of TP and some scores of quality of life ( SF-36 ) were improved ( p < 0.05 ) . Overall results were similar in both groups . It seems that both physiotherapy modalities and dry needling have equal effect on myofascial pain of the upper trapezius muscle & NA ; Acupuncture is widely used by patients with neck pain , but there is a lack of information about its effectiveness in routine medical care . The aim was to investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone . We performed a r and omized controlled multicentre trial plus non‐r and omized cohort in general practice s in Germany . 14,161 patients with chronic neck pain ( duration > 6 months ) . Patients were r and omly allocated to an acupuncture group or a control group receiving no acupuncture . Patients in the acupuncture group received up to 15 acupuncture sessions over three months . Patients who did not consent to r and omization received acupuncture treatment . All subjects were allowed to receive usual medical care in addition to study treatment . Neck pain and disability ( NPAD Scale by Wheeler ) after three months . Of 14,161 patients ( mean age 50.9 ± 13.1 years , 68 % female ) 1880 were r and omized to acupuncture and 1886 to control , and 10,395 included into the non‐r and omized acupuncture group . At three months , neck pain and disability improved by 16.2 ( SE : 0.4 ) to 38.3 ( SE : 0.4 ) ; and by 3.9 ( SE : 0.4 ) to 50.5 ( SE : 0.4 ) , difference 12.3 ( p < 0.001 ) in the acupuncture and control group , respectively . Treatment success was essentially maintained through six months . Non‐r and omized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to r and omized patients . Treatment with acupuncture added to routine care in  patients with chronic neck pain  was associated with improvements in neck pain and disability compared to treatment with routine care alone OBJECTIVE To compare therapeutic effects of acupuncture at " cervical three points " combined with cake-separated moxibustion and routine acupuncture at Jiaji ( EX-B 2 ) on cervical hyperosteogeny . METHODS Single blind , r and omized and controlled methods were used and 91 cases were divided into an observation group of 46 cases and a control group of 45 cases . The observation group was treated by acupuncture at " cervical three points " combined with cake-separated moxibustion , i.e. acupuncture at Chonggu ( EX ) , Dazhui ( GV 14 ) , Taodao ( GV 13 ) and moxibustion at pain points with cake made by Rhizoma Atractylodis Macrocephalae and Radix Paeoniae Alba ; the control group was treated with acupuncture at Jiaji ( EX-B 2 ) . Changes of sourness and pain of the neck , the shoulder and back , pressure pain and cervical activity scores were used for assessment of therapeutic effects . RESULTS The markedly cured rate of 76.1 % in the observation group was better than 42.2 % in the control group ( P<0.05 ) . After treatment , the scores of all the items were significantly improved in the two groups ( all P<0.05 ) , and the observation group in sourness and pain of the neck , the shoulder and back , and cervical activity were better than the control group ( all P<0.05 ) . CONCLUSION The therapeutic effect of acupuncture at " cervical three points " combined with cake-separated moxibustion on cervical hyperosteogeny is superior to routine acupuncture at Jiaji ( EX-B 2 ) Study Design . A r and omized controlled clinical trial was conducted . Objective . To compare medication , needle acupuncture , and spinal manipulation for managing chronic ( > 13 weeks duration ) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain . Summary of Background Data . Between February 1999 and October 2001 , 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital ’s multidisciplinary spinal pain unit . Methods . One of three separate intervention protocol s was used : medication , needle acupuncture , or chiropractic spinal manipulation . Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index ( Oswestry ) , the Neck Disability Index ( NDI ) , the Short-Form-36 Health Survey question naire ( SF-36 ) , visual analog scales ( VAS ) of pain intensity and ranges of movement . These instruments were administered again at 2 , 5 , and 9 weeks after the beginning of treatment . Results . R and omization proved to be successful . The highest proportion of early ( asymptomatic status ) recovery was found for manipulation ( 27.3 % ) , followed by acupuncture ( 9.4 % ) and medication ( 5 % ) . Manipulation achieved the best overall results , with improvements of 50 % ( P = 0.01 ) on the Oswestry scale , 38 % ( P = 0.08 ) on the NDI , 47 % ( P < 0.001 ) on the SF-36 , and 50 % ( P < 0.01 ) on the VAS for back pain , 38 % ( P < 0.001 ) for lumbar st and ing flexion , 20 % ( P < 0.001 ) for lumbar sitting flexion , 25 % ( P = 0.1 ) for cervical sitting flexion , and 18 % ( P = 0.02 ) for cervical sitting extension . However , on the VAS for neck pain , acupuncture showed a better result than manipulation ( 50%vs 42 % ) . Conclusions . The consistency of the results provides , despite some discussed shortcomings of this study , evidence that in patients with chronic spinal pain , manipulation , if not contraindicated , results in greater short-term improvement than acupuncture or medication . However , the data do not strongly support the use of only manipulation , only acupuncture , or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain . The results from this exploratory study need confirmation from future larger studies OBJECTIVE To explore a better method for treatment of cervical spondylosis of nerve root type . METHODS One hundred and two cases were r and omly divided into an observation group and a control group , 51 cases in each group . The observation group were treated with Shu-needling , i. e. the needles were deeply inserted into the cervical vertebrae of corresponding Jiaji ( EX-B 2 ) , and the control group were treated with routine needling method . Electroacupuncture was used in the two groups . RESULTS The cured rate and the total effective rate were 68.6 % and 98.0 % in the observation group and 47.1 % and 84.3 % in the control group , with significant differences between the two groups ( both P<0.05 ) . CONCLUSION Shu-needling therapy as main has a better therapeutic effect on cervical spondylosis of nerve root type OBJECTIVE This article examines the specific and nonspecific effects of Japanese  acupuncture on chronic myofascial neck pain in a r and omized single-blind trial . DESIGN Forty-six patients were r and omly assigned to receive relevant acupuncture , irrelevant acupuncture , or no-acupuncture control treatment consisting of nonsteroidal anti-inflammatory medication . The two acupuncture groups underwent comparable light shallow needling . The irrelevant acupuncture group received acupuncture at specific sites not relevant for cervical pain . OUTCOME MEASURES The study measures included the McGill Pain Question naire-Short Form ( SF-MPQ ) , the Short-Form Health Survey ( SF-36 ) , the Symptom Checklist 90-Revised ( SCL-90-R ) , medication diary , and physiologic measures . The factors examined as predictors of outcome pain ratings were experience with , beliefs about , and knowledge of acupuncture before treatment ; perceived efficacy , credibility , and logic of acupuncture ; perceived competence of the acupuncturist ; and painfulness of acupuncture . RESULTS No differences were found among the three groups at baseline , except that the relevant acupuncture group reported having had more previous acupuncture treatments . No significant differences in terms of perceived credibility or perceived effectiveness of treatment were found between the two acupuncture groups . The relevant acupuncture group had significantly greater pre-/posttreatment differences in pain than the irrelevant acupuncture and control groups ( p < .05 ) . The nonspecific effects of confidence in the acupuncturist , willingness to try any treatment , mood , and physiologic effect of needling were not predictive of treatment outcome , whereas confidence in the treatment and past experiences with acupuncture did correlate significantly with a decrease in pain . CONCLUSIONS Relevant acupuncture with heat contributes to modest pain reduction in persons with myofascial neck pain . Previous experience with and confidence in treatment help to predict benefit . Measurement of nonspecific effects of alternative therapy is recommended in future clinical trials OBJECTIVE We aim ed to evaluate the effectiveness of laser therapy in myofascial pain syndrome treatment . BACKGROUND DATA Myofascial pain syndrome is a disease that is characterized by hypersensitive points called trigger points found in one or more muscles and /or connective tissues . It can cause pain , muscle spasm , sensitivity , stiffness , weakness , limitation of range of motion and rarely autonomic dysfunction . Physical therapy modalities and exercise are used in the treatment of this frequently encountered disease . METHODS The placebo controlled , prospect i ve , long-term follow up study was planned with 60 patients who had trigger points in their upper trapezius muscles . The patients were divided into three groups r and omly . Stretching exercises were taught to each group and they were asked to exercise at home . Treatment duration was 4 weeks . Placebo laser was applied to group 1 , dry needling to group 2 and laser to group 3 . He-Ne laser was applied to three trigger points in the upper trapezius muscles on both sides with 632.8 nm . The patients were assessed at before , post-treatment , and 6 months after-treatment for pain , cervical range of motion and functional status . RESULTS We observed a significant decrease in pain at rest , at activity , and increase in pain threshold in the laser group compared to other groups . Improvement according to Nottingham Health Profile gave the superiority of the laser treatment . However , those differences among the groups were not observed at 6-month follow up . CONCLUSIONS Laser therapy could be useful as a treatment modality in myofascial pain syndrome because of its noninvasiveness , ease , and short-term application Background Functional neck/shoulder stiffness is one of the most well-known indications for acupuncture treatment in Japan . There is little evidence for the effectiveness of acupuncture treatment for functional neck/shoulder stiffness . Research using two different placebos may allow an efficient method to tease apart the components of real acupuncture from various kinds of ‘ non-specific ’ effects such as ritual with touch or ritual alone . Herein , we describe a protocol of an ongoing , single-centre , r and omised , placebo-controlled trial which aims to assess whether , in functional neck/shoulder stiffness , acupuncture treatment with skin piercing has a specific effect over two types of placebo : skin-touching plus ritual or ritual alone . Methods Six acupuncturists and 400 patients with functional neck/shoulder stiffness are r and omly assigned to four treatment groups : genuine acupuncture penetrating the skin , skin-touch placebo or no-touch placebo needles in a double-blind manner ( practitioner-patient blinding ) or no-treatment control group . Each acupuncturist applies a needle to each of four acupoints ( Bladder10 , Small Intestine14 , Gallbladder21 and Bladder42 ) in the neck/shoulder to 50 patients . Before , immediately after and 24 hours after the treatment , patients are asked about the intensity of their neck/shoulder stiffness . After the treatment , practitioners and patients are asked to guess whether the treatment is “ penetrating ” , “ skin-touch ” or “ no-touch ” or to record “ can not identify the treatment ” . Discussion In addition to intention-to-treat analysis , we will conduct subgroup analysis based on practitioners ’ or patients ’ guesses to discuss the efficacy and effectiveness of treatments with skin piercing and various placebo controls . The results of practitioner and patient blinding will be discussed . We believe this study will further distinguish the role of different components of acupuncture . Trial registration Current Controlled Trial IS RCT OBJECTIVES Recently it was reported that the loose connective tissue in the subcutaneous layer rapidly responded to mechanical forces evoked by acupuncture , massage , and normal physical movements . However , there were no clinical studies to substantiate these findings so far . Fu 's Subcutaneous Needling ( FSN ) is the innovative needling strategy acting specifically in the subcutaneous layer . A single-blinded and r and omized trial was design ed to compare the immediate effects of FSN with different needling directions on myofascial trigger points ( MTrP ) in the neck . DESIGN For simplicity , we chose two mutually perpendicular needle directions in this study . In one group , the needle was along the local muscle fibers and pointed to the MTrP ( Along Group ) . In the other group , the needle was across the local muscle fibers and also pointed to the MTrP ( Across Group ) . SUBJECTS Forty-seven ( 47 ) patients were r and omly divided into two groups : the Along Group ( n = 22 ) and the Across Group ( n = 25 ) . There were no significant differences with respect to age , duration of pain , and gender between the two groups . INTERVENTIONS FSN needles were inserted and swayed in the subcutaneous layer 200 times in 2 minutes . RESULTS Before and after FSN treatment , patients were subjected to the assessment of the following three parameters : motion-related pain , pain under pressure , and the range of cervical movement . Three parameters were all reduced after the FSN intervention . There were no significant differences in variation of the three parameters between the two groups . CONCLUSION Immediate effects of FSN on alleviating MTrP in the neck were not relevant to the needling directions Introduction Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk . In this project , we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice . Consumer Navigation of Electronic Cardiovascular Tools ( CONNECT ) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Isl and er and non-indigenous adults , recruited through primary care , at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care . Methods and analysis R and omised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk . The trial will be augmented by formal economic and process evaluations to assess acceptability , equity and cost-effectiveness of the intervention . The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management . The programme is electronically integrated with the primary care provider 's software and will include interactive smart phone and Internet platforms . The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline -recommended blood pressure ( BP ) and cholesterol targets . Secondary outcomes include change in mean BP and fasting cholesterol levels , proportion meeting BP and cholesterol targets separately , self-efficacy , health literacy , self-reported point prevalence abstinence in smoking , body mass index and waist circumference , self-reported physical activity and self-reported medication adherence . Ethics and dissemination Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences Clinical Trials registration number ACTRN12613000715774 STUDY DESIGN R and omized clinical trial . OBJECTIVES To determine the effects of trigger point dry needling ( TrPDN ) on neck pain , widespread pressure pain sensitivity , and cervical range of motion in patients with acute mechanical neck pain and active trigger points in the upper trapezius muscle . BACKGROUND TrPDN seems to be effective for decreasing pain in individuals with upper-quadrant pain syndromes . Potential effects of TrPDN for decreasing pain and sensitization in individuals with acute mechanical neck pain are needed . Methods Seventeen patients ( 53 % female ) were r and omly assigned to 1 of 2 groups : a single session of TrPDN or no intervention ( waiting list ) . Pressure pain thresholds over the C5 - 6 zygapophyseal joint , second metacarpal , and tibialis anterior muscle ; neck pain intensity ; and cervical spine range-of-motion data were collected at baseline ( pretreatment ) and 10 minutes and 1 week after the intervention by an assessor blinded to the treatment allocation of the patient . Mixed-model analyses of variance were used to examine the effects of treatment on each outcome variable . RESULTS Patients treated with 1 session of TrPDN experienced greater decreases in neck pain , greater increases in pressure pain threshold , and higher increases in cervical range of motion than those who did not receive an intervention at both 10 minutes and 1 week after the intervention ( P<.01 for all comparisons ) . Between-group effect sizes were medium to large immediately after the TrPDN session ( st and ardized mean score differences greater than 0.56 ) and large at the 1-week follow-up ( st and ardized mean score differences greater than 1.34 ) . CONCLUSION The results of the current r and omized clinical trial suggest that a single session of TrPDN may decrease neck pain intensity and widespread pressure pain sensitivity , and also increase active cervical range of motion , in patients with acute mechanical neck pain . Changes in pain , pressure pain threshold , and cervical range of motion surpassed their respective minimal detectable change values , supporting clinical ly relevant treatment effects . Level of Evidence Therapy , level 1b- OBJECTIVE EMG examination at tender points affects myofascial pain symptoms related to cervical nerve root irritation . METHODS Consecutive patients with neck and arm pain had physical examinations immediately before and after having EMGs of bilateral C3-C8 myotomes . Patients were r and omly chosen for EMG either at the most tender point along the palpated myofascial b and or at a nonselected site . The myotomal presence of > or = 30 % incidence of normal duration and amplitude , and polyphasic motor unit potentials confirm the diagnosis of cervical nerve root irritation . RESULTS 52 % returned patient question naires 2 weeks post EMG examination . Group I ( 82/122 patients [ 67.2 % ] ) , averaged pain relief of 51.8 + /- 21.9 % , a mean of 10.2 + /- 8 days ; 14 % had > or = 75 % relief . The number of days of pain relief correlated positively with the percentage of pain relief ( p < 0.005 ) , but negatively with the number of nerve roots involved on EMG ( p < 0.05 ) . Group 2 ( 23/42 patients [ 54.8 % ] ) , averaged relief of 39.0 + /- 18.7 % , lasting 8.8 + /- 11.2 days . None had > or = 75 % pain relief . Both groups ' duration of pain symptoms affected onset of relief . Evidence of bilateral multiple-level cervical nerve root irritation , especially noted at bilateral C6 and C7 levels . CONCLUSION EMG at tender points on myofascial b and s tends to improve symptoms . Needling these points elicits motor endplate activity and twitches , and induces more relief than when needling r and om points Study Design . A r and omized controlled trial with 3 and 6 months follow-up . Objective . To compare the effectiveness of acupuncture with simulated acupuncture in patients with subacute and chronic whiplash-associated disorders . Summary of Background Data . Acupuncture is widely used for the treatment of neck and other musculoskeletal pain , and there is some evidence supporting its effectiveness for short-term pain relief . The effectiveness of acupuncture in the treatment of whiplash-associated disorders is not clear . Methods . A total of 124 patients between 18 and 65 years with chronic ( 85 % ) or subacute whiplash-associated disorders ( Grade I or II ) were r and omly allocated to real or simulated electroacupuncture treatment for 12 sessions during a 6-week period . Both treatments involved skin penetration with acupuncture needles and were provided by a single university-trained acupuncturist in a University Clinic in Sydney , Australia . Primary outcome measures were pain intensity ( 10-cm visual analog scale ) , disability ( Neck Disability Index ) , and health-related quality of life ( SF-36 ) . Secondary outcomes were patient-specific activity scales , and the McGill Pain Rating Index . Results . Mean initial pain intensity for all participants was 5.6 cm . Participants receiving the real electroacupuncture treatment had significantly greater reduction in pain intensity at 3 and 6 months , 0.9 cm ( P = 0.05 ) and 1.3 cm ( P = 0.007 ) , respectively , in comparison to the sham electro-acupuncture group . After adjustment for baseline status , there was no significant reduction in disability , or improvement in health-related quality of life . There was an improvement in the activity scales of a similar size to the reduction in pain , but no difference in the McGill Index . Conclusion . Real electroacupuncture was associated with a significant reduction in pain intensity over at least 6 months . This reduction was probably not clinical ly significant . There was no improvement in disability or quality of life OBJECTIVE To compare therapeutic effects of acupuncture at Ligou ( LR 5 ) plus movement therapy and conventional acupuncture on cervical spondylosis . METHODS The therapeutic effect of acupuncture at Ligou ( LR 5 ) plus movement therapy on 57 cases of cervical spondylosis ( Group Acup.+M ) was observed and compared with that of conventional acupuncture ( Group Acup . ) on 65 cases of cervical spondylosis with the same types of the disease during the same observation period as those treated by the former therapy . RESULTS The cured rate , effective rate and total effective rate were 52.63 % , 45.61 % and 98.24 % , respectively in Group Acup.+M ; 46.15 % , 50.77 % and 96.92 % , respectively in Group Acup . There were no significant differences in therapeutic effects between the two groups , shown by Ridit test ( P>0.05 ) . CONCLUSION Both acupuncture plus movement therapy and conventional acupuncture were similarly effective in treating cervical spondylosis , but the former was superior to the latter in shorter treatment course and fewer Abstract Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain ( MFP ) patient management . However , few studies have analyzed their effect in a chronic headache population with associated MFP . The purpose of this study was to assess if trigger point injections using botulinum toxin , lidocaine , and dry-needling injections for the management of local pain and associated headache management .  Forty-five ( 45 ) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point , were r and omly assigned into one of the three groups : G1 , dry-needling , G2 , 0.25 % lidocaine , at 0.25 % and G3 botulinum toxin and were assessed during a 12 week period . Levels of pain intensity , frequency and duration , local post-injection sensitivity , obtainment time and duration of relief , and the use of rescue medication were evaluated . Statistically , all the groups showed favorable results for the evaluated requisites ( p≤0.05 ) , except for the use of rescue medication and local post injection sensitivity ( G3 showed better results ) . Considering its reduced cost , lidocaine could be adopted as a substance of choice , and botulinum toxin should be reserved for refractory cases , in which the expected effects could not be achieved , and the use of a more expensive therapy would be m and atory Abstract Objectives : To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain . Design : Prospect i ve , r and omised , placebo controlled trial . Setting : Three outpatient departments in Germany . Participants : 177 patients aged 18–85 years with chronic neck pain . Interventions : Patients were r and omly allocated to five treatments over three weeks with acupuncture ( 56 ) , massage ( 60 ) , or “ sham ” laser acupuncture ( 61 ) . Main outcome measures : Primary outcome measure : maximum pain related to motion ( visual analogue scale ) irrespective of direction of movement one week after treatment . Secondary outcome measures : range of motion ( 3D ultrasound real time motion analyser ) , pain related to movement in six directions ( visual analogue scale ) , pressure pain threshold ( pressure algometer ) , changes of spontaneous pain , motion related pain , global complaints ( seven point scale ) , and quality of life ( SF-36 ) . Assessment s were performed before , during , and one week and three months after treatment . Patients ' beliefs in treatment were assessed . Results : One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage ( difference 24.22 ( 95 % confidence interval 16.5 to 31.9 ) , P=0.0052 ) but not compared with sham laser ( 17.28 ( 10.0 to 24.6 ) , P=0.327 ) . Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years ( n=75 ) and in patients with myofascial pain syndrome ( n=129 ) . The acupuncture group had the best results in most secondary outcome measures . There were no differences in patients ' beliefs in treatment . Conclusions : Acupuncture is an effective short term treatment for patients with chronic neck pain , but there is only limited evidence for long term effects after five treatments . What is already known on this topic Acupuncture is a widespread complementary treatment Evidence from trials have given conflicting results on its use in the treatment of neck pain because of method ological shortcomings and because effects were compared either with alternative treatments or with different sham procedures imitating acupuncture , but not both What this study adds Compared with sham laser acupuncture and massage , needle acupuncture has beneficial effects on mobility and pain related to motion in patients with chronic neck pain Acupuncture was clearly more effective than massage , but differences were not always significant compared with sham laser acupuncture Acupuncture was the best treatment for patients with the myofascial syndrome and those who had had pain for longer than five Objective To investigate the feasibility and sample size required for a full-scale r and omised controlled trial of the effectiveness of acupuncture with non-steroidal anti-inflammatory drugs ( NSAIDs ) for chronic neck pain compared with acupuncture or NSAID treatment alone . Methods A total of 45 patients with chronic neck pain participated in the study . For 3 weeks the acupuncture with NSAIDs treatment group took NSAIDs ( zaltoprofen , 80 mg ) daily while receiving acupuncture treatment three times a week . The acupuncture treatment group received treatment three times a week and the NSAID treatment group took NSAIDs daily . The primary outcomes were to determine the feasibility and to calculate the sample size . As secondary outcomes , pain intensity and pain-related symptoms for chronic neck pain were measured . Results With regard to enrolment and dropout rates , 88.2 % of patients consented to be recruited to the trial and 15.6 % of participants were lost to follow-up . The sample size for a full-scale trial was estimated to be 120 patients . Although preliminary , there was a significant change in the visual analogue scale ( VAS ) for neck pain intensity between the baseline measurement and each point of assessment in all groups . However , there was no difference in VAS scores between the three groups . Conclusions This pilot study has provided the feasibility and sample size for a full-scale trial of acupuncture with NSAIDs for chronic neck pain compared with acupuncture or NSAID treatment alone . Further research is needed to vali date the effects of acupuncture with NSAIDs . Clinical Trial Registration NIH Clinical Trials.gov NCT01205958 OBJECTIVE To investigate the remote effect of acupuncture on the pain intensity and the endplate noise ( EPN ) recorded from a myofascial trigger point ( MTrP ) of the upper trapezius muscle . DESIGN R and omized controlled trial . SETTING University hospital . PARTICIPANTS Patients ( N=20 ) with active MTrPs in upper trapezius muscles and no experience in acupuncture therapy .  INTERVENTIONS Patients were divided into 2 groups . Those in the control group received sham acupuncture , and those in the acupuncture group received modified acupuncture therapy with needle insertion into multiple loci to elicit local twitch responses . The acupuncture points of Wai-guan and Qu-chi were treated . MAIN OUTCOME MEASURES Subjective pain intensity ( numerical pain rating scale ) and mean EPN amplitude in the MTrP of the upper trapezius muscle . RESULTS The pain intensity in the MTrP was significantly reduced after remote acupuncture ( from 7.4+/-0.8 to 3.3+/-1.1 ; P<.001 ) , but not after sham acupuncture ( from 7.4+/-0.8 to 7.1+/-0.9 ; P>.05 ) . The mean EPN amplitude was significantly lower than the pretreatment level after acupuncture treatment ( from 21.3+/-9.5 microV to 9.5+/-3.5 microV ; P<.01 ) , but not after sham acupuncture treatment ( from 19.6+/-7.6 microV to 19.3+/-7.8 microV ; P>.05 ) . The change in the pain intensity was significantly correlated with the change of EPN amplitude ( r=0.685 ) . CONCLUSIONS Both subjective changes in the pain intensity and objective changes of the EPN amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points . This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control OBJECTIVES This trial aim ed to evaluate the short-term effectiveness of acupuncture plus stretching to reduce pain and improve range of motion in patients afflicted by cervical myofascial pain syndrome . DESIGN R and omized , blinded , placebo-controlled crossover study . INTERVENTION Nineteen patients ( 11 females , eight males , 33 ± 14 years ) with myofascial neck pain in r and omized order received the following treatments with one week washout between : acupuncture , acupuncture plus stretching , and placebo laser acupuncture . MAIN OUTCOME MEASURES Mechanical pain threshold ( MPT , measured with a pressure algometer ) represented the primary outcome . Secondary outcomes were motion-related pain ( Visual Analogue Scale , VAS ) and cervical range of motion ( ROM , recorded by means of an ultrasonic 3D movement analysis system ) . Outcomes were assessed immediately prior as well as 5 , 15 and 30 min post treatment . Friedman tests with post hoc Bonferroni-Holm correction were applied to compare differences between treatments . RESULTS Both acupuncture as well as acupuncture plus stretching  increased MPT by five , respectively , 11 percent post treatment . However , only acupuncture in combination with stretching was superior to placebo ( p<0.05 ) . There were no significant differences between interventions at 15 and 30 min post treatment . VAS did not differ between treatments at any measurement . Five minutes after application of acupuncture plus stretching , ROM was significantly increased in the frontal and the transversal plane compared to placebo ( p<0.05 ) . CONCLUSIONS The combination of acupuncture and stretching could represent a suitable treatment option to improve cervical movement behavior and reduce trigger point pain in the short-term . However , additional studies further discriminating the placebo effects are still warranted Context  Chronic neck pain  is a common , disabling condition and is difficult to treat . Because traditional therapies , such as physical therapy and nonsteroidal anti-inflammatory drugs , have limited effectiveness and can have adverse effects , many patients seek alternative therapies , such as acupuncture . Contribution This r and omized , controlled trial of acupuncture versus sham transcutaneous electrical stimulation for patients with chronic mechanical neck pain  identified no clinical ly significant benefit of acupuncture over placebo with respect to pain , function , or analgesic use . Implication s Acupuncture did not lead to clinical ly significant improvement in chronic mechanical neck pain when compared with placebo . The Editors Chronic mechanical neck pain can be caused by dysfunction of a variety of structures within the neck ( 1 - 3 ) but specifically excludes systemic problems such as rheumatoid arthritis . It is usually associated with unspecified degenerative changes ( cervical spondylosis ) that include osteoarthritis . Neck pain presents a substantial problem and may be responsible for as many days of work absenteeism as low back pain ( 4 ) . Osteoarthritis is the most common of the chronic diseases and affects most people older than 65 years of age ( 5 ) . It is degenerative and progressive in nature ( 1 - 3 , 6 ) . Because there is no cure for cervical spondylosis , treatment tends to center on symptom relief ( 7 , 8) . If the condition is symptomatic and symptoms are left untreated , this manifests as increasing episodic pain , stiffness , or both , and patients may then experience a spiral of increasing dysfunction ( 9 ) . Two systematic review s of conventional conservative physical therapy suggest that little evidence supports the efficacy of such intervention ( 8 , 10 ) . Nonsteroidal anti-inflammatory drugs , the mainstay of pharmacologic treatment , are associated with a wide spectrum of serious and well-documented adverse reactions ( 5 ) . There has been a huge increase in the use of complementary and alternative medicine in both the United States and the United Kingdom ( 11 , 12 ) . Acupuncture is the most frequently used type of complementary and alternative medicine therapy for the treatment of osteoarthritis ( 13 ) . Despite little sound evidence of efficacy ( 14 ) , approximately 1 million people seek complementary and alternative medicine treatment annually in the United States ( 15 ) . Two systematic review s of acupuncture in neck pain ( 4 , 16 ) suggest that there has been insufficient research in this area and that the published studies are of poor quality . Therefore , we conducted a rigorous evaluation to test whether western-style acupuncture performs better than placebo for treatment of chronic mechanical neck pain . We defined western acupuncture as a conventional diagnosis followed by individualized acupuncture treatment using a combination of prescriptive tender , local , and distal points . This is in contrast to a traditional Chinese approach , which would formulate an individualized diagnosis based on traditional Chinese theories of meridians and energy ( or qi ) . Methods Study Design and Patient Selection We design ed a r and omized , single-blind , placebo-controlled trial using a pragmatic treatment regimen . The study was conducted in the outpatient departments of Southampton General Hospital and Salisbury District Hospital in the United Kingdom . Between 1999 and 2001 , patients were referred by rheumatologists or family physicians or from physiotherapy waiting lists . Appropriate ethical approval was obtained from the Southampton and South West Hampshire Joint Research Ethics Committee . Patients were 18 to 80 years of age , had chronic ( > 2 months ) mechanical neck pain , and had a pain score of more than 30 mm on a visual analogue scale ( VAS ) for 5 of 7 pretreatment days ( possible score on this VAS ranges from 0 to 100 mm ) . We excluded pregnant patients ; those with a history of fracture or surgery to the neck , cervical congenital abnormality , uncontrolled low back pain , contraindication to acetaminophen , systemic illness ( for example , rheumatoid arthritis ) , or ongoing neck-related litigation or disability cl aims ; and those with current or recent manual neck treatment or steroid use ( oral or local injection ) . Sample Size Previous studies suggested a 50 % to 75 % improvement using  acupuncture  for patients with chronic pain  , compared with 30 % for placebo treatment ( 17 ) . We used these findings as the basis for our power calculation . At 5 % significance and 90 % power , 53 patients were required in each group to detect a 30 % difference in response between active and placebo treatments . Interventions Informed consent was obtained along with a full medical history , neurologic examination , cervical radiography , and laboratory investigations ( full blood count , erythrocyte sedimentation rate , and liver function tests ) . We told patients that we were comparing 2 types of intervention : 1 ) acupuncture with needles and 2 ) treatment with a machine design ed to stimulate acupuncture points through skin electrodes . The patients were informed that the treatment might or might not prove to be effective and that there was a 50 % chance that they would be assigned to a placebo but were not told what the placebo was . Blinding was not broken until 1 year after treatment . One practitioner performed all interventions . Acupuncture We used single-use , sterile , silver-h and le , prepacked needles without guide tubes . Sizes used were 13 mm 0.25 mm , 25 mm 0.25 mm , and 40 mm 0.25 mm . We based point selection on individualized western acupuncture techniques by using a list of points previously reported as being effective in neck pain ( 18 , 19 ) and by reaching a consensus according to our own clinical and teaching practice ( Appendix Table ) . The specific points for each individual were defined at each treatment session , depending on the patient 's pain distribution  and palpation of the neck and thorax to determine ah-shi points , or local tender points , for acupuncture . At least 1 distal point was used . Point location and depth of insertion were as described in traditional texts ( 19 ) . Six points on average , per side if pain was bilateral , were used on each patient , and deqi ( a term used to describe acupuncture needle sensation ) was obtained on each needle . Twenty-minute treatment sessions were given . The patient was checked every 6 or 7 minutes to ascertain whether deqi was still present , and needles were manipulated again if required . Placebo There is considerable debate about the ideal placebo for acupuncture studies ( 20 ) . To enhance the rigor of our study , we chose to use a previously well-vali date d placebo ( 17 , 21 - 23 ) that could not have a specific physiologic effect . The Noma FM-4 electroacupuncture stimulator ( Noma Ltd. , Southampton , United Kingdom ) was used . It has 4 channels , allowing pseudostimulation of up to 8 acupuncture points simultaneously , and emits visual and audio signals . Reusable electrodes ( Body Clock Health Care Ltd. , London , United Kingdom ) were fixed to the surface of the patient 's skin and were connected to the stimulator through decommissioned cables . The cables were severed inside the output plug , so that no current could reach the patient . Examination and point selection were the same as with real acupuncture for each treatment . Point location and treatment variables were changed during subsequent treatment sessions if patients felt they were not progressing . Patients were told that the machine could stimulate acupuncture points through high-frequency , low-intensity stimulation and therefore would not produce any sensation . If patients reported sensation , the therapist adjusted the unit for comfort ( although since this was a sham procedure , such adjustment made no real difference ) . Patients in both groups were instructed to use acetaminophen alone for pain relief and were not given or permitted any other form of treatment , including exercises or stretches , during the study and for 2 months after treatment ended . Patients were treated twice per week for 4 weeks . The therapist had taken an Acupuncture Association of Chartered Physiotherapists accredited course on western acupuncture techniques and had 7 years of experience practicing acupuncture . R and omization R and omization lists for Southampton General Hospital and Salisbury District Hospital were generated by using a computer program , R and omlogue , produced by Southampton University Department of Medical Statistics , Southampton , United Kingdom . Sealed envelopes containing the individual r and omization codes , numbered consecutively with sex and age strata , were then prepared ( sex strata were male and female , and age strata were 18 to 49 years and 50 to 80 years ) Patients were strictly allocated across 4 strata for either of the study hospitals according to the next available envelope number . Data Collection Before r and omization , patients were instructed to use a daily pain diary  ( on a VAS ) to record pain and  acetaminophen  use for 7 consecutive days . After a week , the pain diaries were examined , and if the inclusion criteria ( which were unknown to the patients ) were satisfied , r and omization occurred . Patients completed the various question naires before treatment and at 1 and 8 weeks after treatment . Pain continued to be recorded either weekly or daily throughout treatment and up to 8 weeks after treatment . Additional question naires and pain evaluation were also completed at 6 and 12 months after treatment . Figure 1 shows a flow chart of the trial . Figure 1 . Study flow with outcome assessment s. Outcomes The VAS score for pain 1 week after treatment , recorded daily for 7 consecutive days , was the primary outcome . Pain was recorded on a scale of 0 mm ( indicating no pain ) to 100 mm ( indicating worst pain imaginable ) . A significant outcome for acupuncture was considered to be a 30 % difference in VAS score between groups 5 weeks after r and omization ( 1 week after treatment ) , taking into account baseline pain . Secondary A pragmatic , single blind , r and omised , controlled trial was conducted to test the hypothesis that superficial dry needling ( SDN ) together with active stretching is more effective than stretching alone , or no treatment , in deactivating trigger points ( TrPs ) and reducing myofascial pain . Forty patients with musculoskeletal pain , referred by GPs for physiotherapy , fulfilled inclusion / exclusion criteria for active TrPs . Subjects were r and omised into three groups : group 1 ( n=14 ) received  superficial dry needling ( SDN ) and active stretching exercises ( G1 ) ; group 2 ( n=13 ) received stretching exercises alone ( G2 ) ; and group 3 ( n=13 ) were no treatment controls ( G3 ) . During the three-week intervention period for G1 and G2 , the number of treatments varied according to the severity of the condition and subject/clinician availability . Assessment was carried out pre-intervention ( M1 ) , post-intervention ( M2 ) , and at a three-week follow up ( M3 ) . Outcome measures were the Short Form McGill Pain Question naire ( SFMPQ ) and Pressure Pain Threshold ( PPT ) of the primary TrP , using a Fischer algometer . Ninety-one per cent of assessment s were blind to grouping . At M2 there were no significant inter-group differences , but at M3 , G1 demonstrated significantly improved SFMPQ versus G3 ( p=0.043 ) and significantly improved PPT versus G2 ( p=0.011 ) . There were no differences between G2 and G3 . The mean PPT and SFMPQ scores correlated significantly in G1 only , though no significant inter-group differences were demonstrated . Numbers of patients requiring further treatment following the trial were : 6 ( G1 ) ; 12 ( G2 ) ; 9 ( G3 ) . Conclusion : SDN followed by active stretching is more effective than stretching alone in deactivating TrPs ( reducing their sensitivity to pressure ) , and more effective than no treatment in reducing subjective pain . Stretching without prior deactivation may increase TrP sensitivity OBJECTIVE To observe the clinical therapeutic effects of electro-acupuncture in the treatment of cervical spondylopathy of the vertebroarterial type . METHODS According to the consulting order , the patients were r and omly divided into a treatment group ( 29 cases treated with electro-acupuncture ) , and a control group ( 28 cases treated with simple acupuncture ) . 20 treatments were given to patients in both groups . RESULTS The markedly effective rate of the treatment group was 75 % and that of the control group was 61.54 % ( P<0.05 ) . CONCLUSION Electro-acupuncture has a better therapeutic effect than the simple acupuncture in the treatment of cervical spondylopathy of the vertebroarterial type & NA ; Chronic neck pain is highly prevalent . To determine the efficacy and safety of acupuncture , in comparison with transcutaneous nerve stimulation‐placebo ( TENS‐placebo ) in the treatment of chronic uncomplicated neck pain , a single blind prospect i ve study was design ed , to be carried out at a Primary Healthcare Centre , with r and om assignment to two parallel groups and with evaluation and analysis by independent evaluators . A r and om assignment was made from 123 patients of the 149 initially recruited . These patients had been diagnosed with uncomplicated neck pain and experienced neck motion‐related pain intensity equal to or exceeding 30 on a visual analogue scale ( VAS ) from 0 to 100 mm . The treatment with acupuncture was compared with TENS‐placebo , applied over 5 sessions in three weeks . The primary endpoint was the change in maximum pain intensity related to motion of the neck , one week after the final treatment . Sensitivity was analysed per protocol ( PP ) and variant analyses were by intention to treat ( ITT ) . Adjustment was made for confounders by multiple linear regression , including baseline values and rescue therapy . By ITT analysis , the change in the pain‐VAS variable was greater among the experimental group ( 28.1 ( 95 % CI 21.4–34.7 ) ) . The improvements in quality of life ( physical aspect ) , active neck mobility and reduced rescue medication were clinical ly and statistically significant . In the treatment of the intensity of chronic neck pain , acupuncture is more effective than the placebo treatment and presents a safety profile making it suitable for routine use in clinical practice Objectives : Acupuncture has been promoted for the treatment of chronic pain . Though many r and omized trials have been conducted , these have been criticized for deficiencies of methodology , acupuncture technique , and sample size . Somewhat less emphasis has been placed on methods of statistical analysis . This paper describes 4 recent r and omized trials of acupuncture for musculoskeletal or headache pain . Each trial used statistical methods that did not adjust for baseline pain scores and were thus of suboptimal power . The objective of this study is to reanalyze the trials using analysis of covariance ( ANCOVA ) . Methods : Raw data for the 4 trials were obtained from the original authors . Data were reanalyzed by ANCOVA . Results : For 2 trials — acupuncture versus placebo for chronic headache and acupuncture versus transcutaneous electric nerve stimulation for back pain — re analysis did not change the conclusion of no difference between groups , but showed that clinical ly significant differences between groups could not ruled out . Re analysis of a trial of acupuncture versus placebo for shoulder pain slightly strengthened the evidence of acupuncture effectiveness . Re analysis of the fourth trial , which compared acupuncture to placebo acupuncture and massage for neck pain , reversed the results of the original paper : re analysis found acupuncture to be effective and that its effectiveness could not be ascribed to a placebo effect . Discussion : Future trials of acupuncture and other modalities for pain should use efficient statistical methods . ANCOVA is more efficient than unadjusted analysis where used appropriately Background Nonspecific neck pain can cause considerable suffering , possible disability and reductions in quality of life and productivity . The aim of the proposed study is to evaluate the immediate effect of acupuncture on pain , cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain . Methods / Design A total of 12 patients with nonspecific neck pain and 12 healthy subjects will be enrolled in a r and omized , single-blind crossover study . Each subject will receive two forms of treatment in r and om order : a single session of traditional acupuncture ( acupoints : triple energizer 5 , ‘ Wai-guan ’ and large intestine 11 , ‘ Qu-chi ’ ) and sham acupuncture . To eliminate carry-over treatment effects , a one-week wash-out period will be respected between sessions . Surface electromyography will be used to determine motor control in the upper trapezius muscle before and after treatment . The outcome measures in the group with neck pain will be a numerical pain rating scale ( range : 0 ( no pain ) to 10 ( maximum pain ) ) , documentation of the pain area on a body chart and cervical range of motion . Comparisons before and after acupuncture treatment will demonstrate whether acupoints affect the activity of the upper trapezius muscle , pain and cervical range of motion . Discussion The purpose of this r and omized clinical trial is to evaluate the immediate effect of acupuncture on pain , cervical range of motion and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain . Data will be published after the study is completed . The study will support the practice of evidence -based physical therapy for individuals with nonspecific neck pain . Trial registration This trial was registered with Clinical trials.gov ( identifier : NCT0984021 ) on 7 November 2013 ( https:// clinical trials.gov/ct2/show/NCT01984021 ) Background Neck pain caused by cervical spondylosis ( CS ) has become one of the most common health problems around the world . Electroacupuncture ( EA ) has been employed to relieve CS neck pain , but there is limited clinical evidence for its effectiveness . Methods / Design This study consists of a r and omized controlled trial ( RCT ) with two parallel arms : an acupuncture group and an EA group . Both groups will receive acupuncture at Jing-jiaji points for 30 minutes each time , for five sessions per week for a total of 20 sessions during this four-week period . In addition , the EA group will be connected with EA apparatus . The following outcome measurements will be used in examination of subjects : the Northwick Park Neck Pain Question naire ( NPQ ) , McGill Pain Question naire ( MPQ ) , and Short-Form 36 ( SF-36 ) scale . All these outcomes will be examined at the start of the study , at the end of the second week , at four weeks after r and omization , and one and three months after treatment cessation respectively . Discussion This study aims to assess the efficacy of EA , compared with acupuncture intervention at Jing-jiaji points for the CS neck pain . Trial registration Chinese Clinical Trials Register : ChiCTR-TRC-13003422 Method ological problems of acupuncture trials focus on adequate placebo controls . In this trial we evaluated the use of sham laser acupuncture as a control procedure . Thirty-four healthy volunteers received verum laser ( invisible infrared laser emission and red light , 45 s and 1 J per point ) and sham laser ( red light ) treatment at three acupuncture points ( LI4 , LU7 and LR3 ) in a r and omized , double-blinded , cross-over design . The main outcome measure was the ratio of correct to incorrect ratings of treatment immediately after each session . The secondary outcome measure was the occurrence of deqi-like sensations at the acupuncture points and their intensity on a 10-fold visual analog scale ( VAS ; 10 being the strongest sensible sensation ) . We pooled the results of three former trials to evaluate the credibility of sham laser acupuncture when compared to needle acupuncture .  Fifteen out of 34 ( 44 % ) healthy volunteers ( age : 28 ± 10.7 years ) identified the used laser device after the first session and 14 ( 41 % ) after the second session . Hence , both treatments were undistinguishable ( P = .26 ) . Deqi-like sensations occurred in 46 % of active laser ( 2.34 VAS ) and in 49.0 % of sham laser beams ( 2.49 VAS ) . The credibility  of sham laser was not different from needle acupuncture . Sham laser acupuncture can serve as a valid placebo control in laser acupuncture studies . Due to similar credibility and the lack of sensory input on the peripheral nervous system , sham laser acupuncture can also serve as a sham control for acupuncture trials , in order to evaluate needling effects per se OBJECTIVE To assess the long-term benefits of medication , needle acupuncture , and spinal manipulation as exclusive and st and ardized treatment regimens in patients with chronic ( > 13 weeks ) spinal pain syndromes . STUDY DESIGN Extended follow-up ( > 1 year ) of a r and omized clinical trial was conducted at the multidisciplinary spinal pain unit of Townsville 's General Hospital between February 1999 and October 2001 . PATIENTS AND METHODS Of the 115 patients originally r and omized , 69 had exclusively been treated with the r and omly allocated treatment during the 9-week treatment period ( results at 9 weeks were reported earlier ) . These patients were followed up and assessed again 1 year after inception into the study reapplying the same instruments ( ie , Oswestry Back Pain Index , Neck Disability Index , Short-Form-36 , and Visual Analogue Scales ) . Question naires were obtained from 62 patients reflecting a retention proportion of 90 % . The main analysis was restricted to 40 patients who had received exclusively the r and omly allocated treatment for the whole observation period since r and omization . RESULTS Comparisons of initial and extended follow-up question naires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit : 5 of the 7 main outcome measures showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups . CONCLUSIONS In patients with chronic spinal pain syndromes , spinal manipulation , if not contraindicated , may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit The purpose of this study was to investigate the effects of temperature on chronic trapezius myofascial pain syndrome during  dry needling therapy . Sixty patients were r and omized into two groups of  dry needling ( DN ) alone ( group A ) and DN combined with heat therapy group ( group B ) . Each patient was treated once and the therapeutic effect was assessed by the visual analogue scale ( VAS ) , pressure pain threshold ( PPT ) , and the 36-item short form health survey ( SF-36 ) at seven days , one month , and three months after treatment . Evaluation based on VAS and PPT showed that the pain of patients in groups A and B was significantly ( P < 0.05 ) relieved at seven days , one month , and three months after treatment Compared to before treatment . There was significantly ( P < 0.05 ) less pain in group B than group A at one and three months after treatment . The SF-36 evaluation demonstrated that the physical condition of patients in both groups showed significant ( P < 0.05 ) improvement at one month and three months after treatment than before treatment . Our study suggests that both DN and DN heating therapy were effective in the treatment of trapezius MPS , and that DN heating therapy had better long-term effects than DN therapy Background Neck pain is one of the chief symptoms of cervical spondylosis ( CS ) .  Acupuncture is a well-accepted and widely used complementary therapy for the management of neck pain caused by CS . In this paper , we present a r and omized controlled trial protocol evaluating the use of acupuncture for CS neck pain  , comparing the effects of the optimized acupuncture therapy in real practice compared with sham and shallow acupuncture . Methods / Design This trial uses a multicentre , parallel-group , r and omized , sham acupuncture and shallow acupuncture , controlled single-blind design . Nine hospitals are involved as trial centres . 945 patients who meet inclusion criteria are r and omly assigned to receive optimized acupuncture therapy , sham acupuncture or shallow acupuncture by a computerized central r and omization system . The interventions past for 4 weeks with eight to ten treatments in total . The group allocations and interventions are concealed to patients and statisticians . The Northwick Park Neck Pain Question naire ( NPQ ) is used as the primary outcome measure , and the McGill Pain Question naire ( MPQ ) and The Short Form ( 36 ) Health Survey ( SF-36 ) are applied as secondary outcome measures . The evaluation is performed at baseline , at the end of the intervention , and at the end of the first month and the third month during follow-up . The statistical analyses will include baseline data comparison and repeated measures of analysis of variance ( ANOVA ) for primary and secondary outcomes of group and time differences . Adverse events ( AEs ) will be reported if they occur . Discussion This trial is a multicentre r and omized control trial ( RCT ) on the efficacy of acupuncture for CS neck pain and has a large sample size and central r and omization in China . It will strictly follow the CONSORT statement and STRICTA extension guideline to report high- quality study results . By setting the control groups as sham and shallow acupuncture , this study attempts to reveal the effects of real acupuncture versus placebo or non-classic acupuncture treatment and evaluate whether classic Chinese medical acupuncture is effective on CS neck pain . This study will provide evidence for the effects of acupuncture on CS neck pain . Trial Registration Chinese Clinical Trial Registry : ChiCTR-TRC-00000184 Background Chronic neck pain is a common condition in the adult population . More research is needed to evaluate interventions aim ing to facilitate beneficial long-term change . We propose to evaluate the effect of Alex and er Technique lessons and acupuncture in a rigorously conducted pragmatic trial with an embedded qualitative study . Methods / Design We will recruit 500 patients who have been diagnosed with neck pain in primary care , who have continued to experience neck pain for at least three months with 28 % minimum cut-off score on the Northwick Park Neck Pain Question naire ( NPQ ) . We will exclude patients with serious underlying pathology , prior cervical spine surgery , history of psychosis , rheumatoid arthritis , ankylosing spondylitis , osteoporosis , haemophilia , cancer , HIV or hepatitis , or with alcohol or drug dependency currently or in the last 12 months , or actively pursuing compensation or with pending litigation . The York Trials Unit will r and omly allocate participants using a secure computer-based system . We will use block r and omisation with allocation to each intervention arm being unambiguously concealed from anyone who might subvert the r and omisation process . Participants will be r and omised in equal proportions to Alex and er Technique lessons , acupuncture or usual care alone . Twenty 30-minute Alex and er Technique lessons will be provided by teachers registered with the Society of Teachers of the Alex and er Technique and twelve 50-minute sessions of acupuncture will be provided by acupuncturists registered with the British Acupuncture Council . All participants will continue to receive usual GP care . The primary outcome will be the NPQ at 12 months , with the secondary time point at 6 months , and an area-under-curve analysis will include 3 , 6 and 12 month time-points . Adverse events will be documented . Potential intervention effect modifiers and mediators to be explored include : self-efficacy , stress management , and the incorporation of practitioner advice about self-care and lifestyle . Qualitative material will be used to address issues of safety , acceptability and factors that impact on longer term outcomes . Discussion This study will provide robust evidence on whether there are significant clinical benefits to patients , economic benefits demonstrating value for money , and sufficient levels of acceptability and safety . Trial registration Current Controlled Trials IS RCT Background Chronic neck pain ( CNP ) is a common painful medical condition with a significant socioeconomic impact . In spite of widespread usage , the effectiveness and safety of combined treatments between conventional and complementary alternative medical treatment modalities has not been fully established in a rigorous r and omized clinical trial ( RCT ) . This pilot study will provide the clinical evidence to evaluate the feasibility and refine the protocol for a full-scale RCT on combined treatment of bee venom acupuncture ( BVA ) and non-steroidal anti-inflammatory drugs ( NSAIDs ) in patients with CNP . Methods / Design This is a r and omized , single-blind clinical trial with three parallel arms . Sixty patients between 18 and 65 years of age with non-specific , uncomplicated neck pain lasting for at least three months will be enrolled . Participants will be r and omly allocated into the BVA , NSAIDs or combined treatment group . Assessors and statisticians will be blinded to the r and om allocation . All research ers will receive training to ensure their strict adherence to the study protocol . Patients from the BVA and combined treatment group will be treated with a bee venom increment protocol into predefined acupoints for six sessions over a three week period . BVA intervention is developed through a comprehensive discussion among interdisciplinary spine disorder experts , according to the guidelines of St and ards for Reporting Interventions in Clinical Trials of Acupuncture ( STRICTA ) . Patients from the NSAIDs and combined treatment groups will be prescribed loxoprofen ( one tablet to be taken orally , three times a day for three weeks ) . Bothersomeness from CNP measured using a visual analogue scale ( VAS ) will be the primary outcome assessed at screening , visit two ( baseline ) , four , six , eight ( 4th week assessment ) and nine ( 8th week assessment ) follow-up session . VAS for pain intensity , neck disability index ( NDI ) , quality of life , depressive status and adverse experiences will also be analyzed . Discussion Our study results will contribute to feasibility evaluation and to relevant RCT protocol development for a full-scale RCT on combined treatment of BVA and NSAIDs for CNP patients .Trial registration This study is registered with the United States ( US ) National Institutes of Health Clinical Trials Registry : NCT01922466 Background In relation to Myofascial Triggerpoints ( MFTrPs ) of the upper Trapezius , this study explored muscle contractility characteristics , the occurrence of post-intervention muscle soreness and the effect of dry needling on muscle contractile characteristics and clinical outcomes . Methods Seventy-seven female office workers ( 25 - 46yrs ) with and without neck/shoulder pain were observed with respect to self-reported pain ( NRS-101 ) , pressure-pain threshold ( PPT ) , maximum voluntary contraction ( Fmax ) and rate of force development ( RFD ) at baseline ( pre-intervention ) , immediately post-intervention and 48 hours post-intervention . Symptomatic and asymptomatic participant groups were each r and omized into two treatment sub-groups ( superficial ( SDN ) and deep dry needling ( DDN ) ) after baseline testing . At 48 hours post-intervention participants were asked whether delayed onset muscle soreness ( DOMS ) and /or post-needling soreness had developed . Results Muscle contractile characteristics did not differ between groups at baseline . Forty-six individuals developed muscle soreness ( 39 from mechanical testing and seven from needling ) . No inter-group differences were observed post-intervention for Fmax or RFD for the four sub-groups . Over the observation period , symptomatic participants reported less pain from both SDN ( p= 0.003 ) and DDN ( p=0.011 ) . However , PPT levels were reduced for all participants ( p=0.029 ) . Those reporting DOMS experienced significant decreases in PPT , irrespective of symptom state or intervention ( p=0.001 ) . Conclusions In selected female neck/shoulder pain sufferers , maximum voluntary contraction and rapid force generation of the upper Trapezius was not influenced by clinical ly relevant self-reported pain or the presence of diagnostically relevant MFTrPs . Dry needling , deep or superficial , did not affect measured functional outcomes over the 48-hour observation period . DOMS affected participants uniformly irrespective of pain , MFTrP status or intervention type and therefore is like to act as a modifier . Trial registration Clinical Trials.gov- NCT01710735 Significance and InnovationsThe present investigation is one of the first to examine the hypothesis of gross muscle contractile inhibition due to the presence of diagnostically relevant MFTrPs . Individuals suffering from clinical ly relevant levels of self-reported pain are able to tolerate maximum voluntary contraction testing , but delayed onset muscle soreness ( DOMS ) is a likely side-effect irrespective of symptom status . As a consequence , its confounding effect during subsequent testing must be taken into account & NA ; Acupuncture is increasingly used in patients with chronic pain , but there is a lack of evidence on the cost – benefit relationship of this treatment strategy . The objective of this study was to assess costs and cost‐effectiveness of additional acupuncture treatment in patients with chronic neck pain compared to patients receiving routine care alone . A r and omized controlled trial including patients ( ≥18 years of age ) with chronic neck pain ( > 6 months ) was carried out . We assessed the re source use and health related quality of life ( SF‐36 ) at baseline and after 3 months using complete social health insurance funds and st and ardized question naires , respectively . The main outcome parameters were direct and indirect cost differences during the 3 months study period and the incremental cost‐effectiveness ratio ( ICER )  of acupuncture treatment . A total of 3,451 patients ( 1,753 acupuncture‐group , 1,698 control‐group ) were r and omized ( 31 % men , age 53.5 ± 12.9 years ; 69 % women , 49.2 ± 12.7 years )  . Acupuncture treatment was associated with significantly higher costs over the 3 months study duration compared to routine care ( & U20AC;925.53 ± 1,551.06 vs. & U20AC;648.06 ± 1,459.13 ; mean difference : & U20AC;277.47 [ 95 % CI : & U20AC;175.71–&U20AC;379.23 ] ) . This cost increase was mainly due to costs of acupuncture ( & U20AC;361.76 ± 90.16 ) . The ICER was & U20AC;12,469 per QALY gained and proved robust in additional sensitivity analyses . Since health insurance data bases were used , private medical expenses such as over the counter medication were not included . Beyond the 3 months study duration , acupuncture might be associated with further health economic effects . According to international cost‐effectiveness threshold values , acupuncture is a cost‐effective treatment strategy in patients with chronic neck pain In this prospect i ve , r and omized , double-blinded , controlled study , we tested the hypothesis that auricular electroacupuncture relieves pain more effectively than conventional manual auricular acupuncture . We studied 21 chronic cervical pain patients without radicular symptoms with insufficient pain relief ( visual analogue scale > 5 ) treated with st and ardized analgesic therapy .  All patients received disposable acupuncture needles on the dominant side on the following acupuncture points : cervical spine , shen men , and cushion . In 10 patients , needles were continuously stimulated ( 2-mA constant current , 1 Hz monophasic ) by using the electrical point stimulation device P-STIM ™ . In 11 control patients , no electrical stimulation was administered . All needles were withdrawn 48 h after insertion . Acupuncture was performed once a week for 6 wk . Patients had to complete a question naire assessing pain intensity , psychological well-being , activity , sleep , and dem and for rescue medication ( lornoxicam and tramadol ) . The reduction in pain scores was significant in the electrical acupuncture group . Similarly , psychological well-being , activity , and sleep were significantly improved in patients receiving electrical acupuncture , and consumption of rescue medication was significantly less . These results demonstrate that continuous electrical stimulation of auricular acupuncture points by using the new point stimulation device P-STIM ™ improves the treatment of chronic cervical pain in an outpatient population OBJECTIVE To evaluate the effect of acupuncture combined with physiotherapy in comparison with acupuncture and physiotherapy performed alone in different parameters ; pain intensity , muscle tension , functional disability and muscle strength in the treatment of tension neck syndrome ( TNS ) . DESIGN A prospect i ve , comparative clinical trial . SETTING Acupuncture and Rehabilitation Department . BACKGROUND TNS can occur in computer users .  Acupuncture has been one alternative treatment in physiotherapeutic rehabilitation of musculoskeletal disorders . SUBJECTS Forty-six patients with TNS . INTERVENTIONS Patients were allocated into three groups : Group-1 received physiotherapy ( therapeutic exercises ) combined with acupuncture ; Group-2 , acupuncture alone , and Group-3 , physiotherapy alone ; over a period of 10 weeks , with one or two sessions weekly . OUTCOME ASSESSMENT All patients had completed the protocol s and were assessed using a visual analogue scale for pain intensity ( VASpain ) and muscle tension ( VASmt ) , the Neck Disability Index : Brazilian Portuguese version for functional disability , and the cranio-cervical Flexion Test for isometric neck muscle strength ( INMS ) ; in the periods before treatment ( baseline ) , after 10 weeks of treatment , and after 6 months of follow-up . RESULTS All groups showed significant improvement ( p < 0.001 ) in these parameters after 10 weeks of treatment and after 6 months of follow-up . Group-1 was superior to Group-3 in pain and functional disability improvements ( p<0.05 ) ; and Group-1 was superior to both Group-2 ( p < 0.01 ) and Group-3 ( p < 0.05 ) in INMS . After 6 months of follow-up , the improvements of all groups were maintained ( p < 0.05 ) . CONCLUSION The data suggested that acupuncture effect may facilitate and /or enhance physiotherapy performance in musculoskeletal rehabilitation for tension neck syndrome Objectives This study examines whether intensive acupuncture treatment can improve several social and psychological variables for women with chronic pain in the neck and shoulders , and whether possible effects are long-lasting . The effects on pain have been reported elsewhere . Methods Twenty-four female office workers ( 47±9 years old , mean ± SD ) who had had neck and shoulder pain for 12±9 years , were r and omly assigned to a test group or a control group . Acupuncture was applied 10 times during three to four weeks either at presumed acupuncture points for pain ( test group ) or at sham points ( control group ) . In addition , acupressure was given to patients between treatments , at either real or sham points . Question naires for social and psychological variables were completed before each treatment , just after the course , and six months and three years later . Results The pain-related activity impairment at work was significantly less in the test group than the controls by the end of treatment ( P<0.04 ) . Also there were significant differences between the groups for quality of sleep , anxiety , depression and satisfaction with life ( P<0.05 ) . At six months and three years follow ups the acupuncture group showed further improvements in most variables and was again significantly different from the control group . Conclusion Intensive acupuncture treatment may improve activity at work and several relevant social and psychological variables for women with chronic pain in the neck and shoulders . The effect may last for at least three years BACKGROUND Approximately 4 % of adults experience headaches nearly every day . Nonpharmacologic interventions for frequent headaches may be appropriate because medical management alone is often ineffective . OBJECTIVE To assess the efficacy of acupuncture as an adjunct to medical management for  chronic daily headache ( CDH ) . METHODS We conducted a r and omized , controlled trial of 74 patients with CDH that compared medical management provided by neurologists to medical management plus 10 acupuncture treatments .  Primary outcome measures were daily pain severity and headache-related quality of life ( QoL ) . RESULTS Patients who received only medical management did not demonstrate improvement in any of the st and ardized measures . Daily pain severity scores trended downward but did not differ between treatment groups ( P= .60 ) . Relative to medical management only , medical management plus acupuncture was associated with an improvement of 3.0 points ( 95 % CI , 1.0 to 4.9 ) on the Headache Impact Test and an increase of 8 or more points on the role limitations due to physical problems , social functioning , and general mental health domains of the Short Form 36 Health Survey . Patients who received acupuncture were 3.7 times more likely ( CI , 1.7 to 8.1 ) to report less suffering from headaches at 6 weeks ( absolute risk reduction 46 % ; number needed to treat 2 ) . CONCLUSION Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population . Supplementing medical management with acupuncture , however , result ed in improvements in health-related QoL and the perception by patients that they suffered less from headaches OBJECTIVE To observe the efficacy in cervical headache of acupuncture combined with fire needling and the simple acupuncture therapy . METHODS One hundred and eighty cases were r and omized into an acupuncture plus fire needling group ( group A ) and an acupuncture group ( group B ) , 90 cases in each one . Baihui ( GV 20 ) , Wangu ( GB 12 ) , Fengchi ( GB 20 ) , Tianzhu ( BL 10 ) and Neck-Jiaji ( EX-B 2 ) were selected in the two groups . In group A , the fire needling technique was applied to all the above points before acupuncture with filiform needles . In group B , the acupuncture therapy was used only . The treatment was given once a day , the efficacy was compared between the two groups after 20 treatments . RESULTS The total effective rate was 95.6 % ( 86/90 ) in group A and was 84 . 4 % ( 76/90 ) in group B , indicating the significant difference in comparison ( P<0.05 ) . VAS were 7.44+/-1.26 and 0.73+/-l . 44 before and after treatment in group A separately , those were 7.56+/-1.07 and 2 . 56+/-2 . 99 in group B , indicating the significant difference in comparison ( P<0.01 ) . The difference in VAS after treatment was significant between the two groups . In group A , the follow-up visit was conducted at 3 months and 6 months after treatment for the cured cases . The total recurrence rate in the patients without bony pathological changes was 14.8 % ( 4/27 ) and that in the patients with bony pathological changes was 43 . 5 % ( 10/23 ) , there was significant difference between them ( P<0 . 05 ) . CONCLUSION The combined therapy of fire needling technique and filiform needle acupuncture improves the efficacy and sustains the efficacy especially on cervical headache without bony pathological changing Forty-four patients with chronic cervical osteoarthritis took part in this study . Patients were treated with acupuncture , sham-acupuncture , diazepam or placebo-diazepam in r and omized order . Pain was rated on visual analogue scales before , during , and after treatment . Two scales were separately used to rate the intensity ( sensory component ) and the unpleasantness ( affective component ) of pain . The results analyzed from these trials show that diazepam , placebo-diazepam , acupuncture and sham-acupuncture have a more pronounced effect on the affective than on the sensory component of pain .  Acupuncture was significantly more effective than placebo-diazepam ( p less than 0.05 ) , but not significantly more effective than diazepam or sham-acupuncture We studied the effect of the location of electrical stimulation on the acute analgesic response to percutaneous neuromodulation therapy in patients with nonradiating neck pain . Sixty-eight patients received three different nonpharmacologic modalities , namely “ needles only ” ( neck ) , local ( neck ) dermatomal stimulation , and remote ( lower back ) dermatomal stimulation in a r and om sequence over the course of an 11-wk study period . All treatments were given for 30 min , 3 times per week for 3 wk , with 1 wk “ off ” between each modality . The assessment tools included the health status survey short form ( SF-36 ) question naire , as well as 10-cm visual analog scales for assessing pain , physical activity , and quality of sleep . The pain visual analog scale was repeated 5–10 min after each treatment session . The daily oral nonopioid analgesic requirements were recorded in the patient diary during the entire study period . At the end of each 3-wk treatment block , the SF-36 question naire was repeated . Compared with needles only and remote dermatomal stimulation , local dermatomal stimulation produced a significantly greater decrease in pain ( 38 % ± 17 % vs 9 % ± 16 % and 13 % ± 18 % ) , increase in physical activity ( 41 % ± 21 % vs 11 % ± 17 % and 16 % ± 15 % ) , and improvement in the quality of sleep ( 34 % ± 18 % vs 7 % ± 17 % and 10 % ± 18 % ) compared with baseline values ( P < 0.05 ) . The need for oral analgesic medications was decreased by an average of 6 % ± 15 % , 37 % ± 18 % , and 9 % ± 13 % during the 3-wk treatment period with the needle only , local dermatomal , and remote dermatomal stimulation , respectively . The posttreatment SF-36 test results revealed that all three modalities produced improvements compared with the pre study scores for both the physical component summary and mental component summary . However , the magnitude of the changes in the physical component summary and mental component summary with local dermatomal stimulation was significantly greater ( + 7.9 and + 3.6 , respectively ) than needle only ( + 3.4 and + 1.7 , respectively ) or remote dermatomal stimulation ( + 3.7 and + 1.9 , respectively ) . No side effects were reported at the needle insertion sites . We conclude that electrical stimulation at the specific dermatomal levels corresponding to the local pathology produces greater short-term improvements in pain control , physical activity , and quality of sleep in patients with chronic neck pain . Implication s The location of peripheral electrical stimulation influences the acute analgesic response to percutaneous modulation therapy in patients with long-term neck pain . This study demonstrates that electrical stimulation at the involved dermatomal levels produced a greater hypoalgesic effect than remote dermatomal stimulation . These data suggest that percutaneous modulation therapy-induced analgesia results from neuromodulatory changes The aim of this study was to compare the efficacy of electroacupuncture and sham acupuncture in the treatment of patients with chronic neck pain . 31 patients with chronic neck pain were included in a r and omised , controlled trial . Electric stimulation was given for 30 minutes at low frequency ( 1 - 4Hz ) , pulse width of 200 micros , interrupted wave form . Of the 29 patients who completed the therapy , 13 were assigned to conventional acupuncture and 16 to sham acupuncture groups , receiving 3 sessions a week for a total of 10 sessions , each lasting for 30 minutes . Patients were evaluated before and after therapy and 3 months later by Visual Analogue Scale ( VAS ) and the bodily pain subscale of the Short Form Health Survey-36 scale . The treating physician was different from the evaluating physician who , like the patient , was blinded . VAS scores in both groups significantly reduced after therapy and at 3 months post-therapy , but the difference between groups was not significant . In respect of bodily pain , there was a significant improvement in the acupuncture group after therapy ( P<0.01 ) . Stimulation of conventional acupuncture points was not generally superior to needling ofnonspecific points on the neck , and both treatments were associated with improvement of symptoms . Needles inserted into the neck are likely to be an inappropriate sham control for acupuncture & NA ; To evaluate immediate effects of two different modes of acupuncture on motion‐related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure . Thirty‐six patients with chronic neck pain and limited cervical spine mobility participated in a prospect i ve , r and omized , double‐blind , sham‐controlled crossover trial . Every patient was treated once with needle acupuncture at distant points , dry needling ( DN ) of local myofascial trigger points and sham laser acupuncture ( Sham ) . Outcome measures were motion‐related pain intensity ( visual analogue scale , 0–100 mm ) and range of motion ( ROM ) . In addition , patients scored changes of general complaints using an 11‐point verbal rating scale . Patients were assessed immediately before and after each treatment by an independent ( blinded ) investigator . Multivariate analysis was used to assess the effects of true acupuncture and needle site independently . For motion‐related pain , use of acupuncture at non‐local points reduced pain scores by about a third ( 11.2 mm ; 95 % CI 5.7 , 16.7 ; P=0.00006 ) compared to DN and sham . DN led to an estimated reduction in pain of 1.0 mm ( 95 % CI −4.5 , 6.5 ; P=0.7 ) . Use of DN  slightly improved ROM by 1.7 ° ( 95 % CI 0.2 , 3.2 ; P=0.032 ) with use of non‐local points improving ROM by an additional 1.9 ° ( 95 % CI 0.3 , 3.4 ; P=0.016 ) . For patient assessment of change , non‐local acupuncture was significantly superior both to Sham ( 1.7 points ; 95 % CI 1.0 , 2.5 ; P=0.0001 ) and DN ( 1.5 points ; 95 % CI 0.4 , 2.6 ; P=0.008 ) but there was no difference between DN and Sham ( 0.1 point ; 95 % CI −1.0 , 1.2 ; P=0.8 ) . Acupuncture is superior to Sham in improving motion‐related pain and ROM following a single session of treatment in chronic neck pain patients . Acupuncture at distant points improves ROM more than DN ; DN was ineffective for motion‐related pain Objective Myofascial pain syndrome ( MPS ) is one of the most common causes of chronic musculoskeletal pain . Several methods have been recommended for the inactivation of trigger points ( TrPs ) . We carried out this study to investigate the effectiveness of miniscalpel-needle ( MSN ) release and acupuncture needling and self neck-stretching exercises on myofascial TrPs of the upper trapezius muscle . Methods Eighty-three TrPs in 43 patients with MPS were treated and r and omly assigned to 3 groups : group 1 received MSN release in conjunction with self neck-stretching exercises ; group 2 received acupuncture needling treatment and performed self neck-stretching exercises ; and group 3 , the control group , was assigned self neck-stretching exercises only . The therapeutic effectiveness was evaluated using subjective pain intensity ( PI ) with a visual analog scale , pressure pain threshold ( PPT ) , and contralateral bending range of motion ( ROM ) of cervical spine at pretreatment , 2 weeks , and 3 months after treatment . Results The improvement of PI , PPT , and contralateral bending ROM of cervical spine was significantly greater in group 1 and 2 than that in control group at 2 weeks and 3 months follow-up . Compared with group 2 , patients in group 1 had a statistically significant reduction in PI , an increase in PPT , contralateral bending ROM of cervical spine at 3 months follow-up . Discussion The effectiveness of MSN release for MPS is superior to that of acupuncture needling treatment or self neck-stretching exercises alone . The MSN release is also safe , without severe side effects in treatment of MPS & NA ; Although neck pain is a common source of disability , little is known about its incidence and course . We conducted a population ‐based cohort study of 1100 r and omly selected Saskatchewan adults to determine the annual incidence of neck pain and describe its course . Subjects were initially surveyed by mail in September 1995 and followed‐up 6 and 12 months later . The age and gender st and ardized annual incidence of neck pain is 14.6 % ( 95 % confidence interval : 11.3 , 17.9 ) . Each year , 0.6 % ( 95 % confidence interval : 0.0–1.1 ) of the population develops disabling neck pain . The annual rate of resolution of neck pain is 36.6 % ( 95 % confidence interval : 32.7 , 40.5 ) and another 32.7 % ( 95 % confidence interval : 25.5 , 39.9 ) report improvement . Among subjects with prevalent neck pain at baseline , 37.3 % ( 95 % confidence interval : 33.4 , 41.2 ) report persistent problems and 9.9 % ( 95 % confidence interval : 7.4 , 12.5 ) experience an aggravation during follow‐up . Finally , 22.8 % ( 95 % confidence interval : 16.4 , 29.3 ) of those with prevalent neck pain at baseline report a recurrent episode . Women are more likely than men to develop neck pain ( incidence rate ratio=1.67 , 95 % confidence interval 1.08–2.60 ) ; more likely to suffer from persistent neck problems ( incidence rate ratio=1.19 , 95 % confidence interval 1.03–1.38 ) and less likely to experience resolution ( incidence rate ratio=0.75 , 95 % confidence interval 0.63–0.88 ) . Neck pain is a disabling condition with a course marked by periods of remission and exacerbation . Contrary to prior belief , most individuals with neck pain do not experience complete resolution of their symptoms and disability & NA ; The study was carried out to examine whether acupuncture treatment can reduce  chronic pain in the neck and shoulders and related headache  , and also to examine whether possible effects are long‐lasting . Therefore , 24 female office workers ( 47±9 years old , mean±SD ) who had had neck and shoulder pain for 12±9 years were r and omly assigned to a test group ( TG ) or a control group ( CG ) . Acupuncture was applied 10 times during 3–4 weeks either at presumed anti‐pain acupoints ( TG ) or at placebo‐points ( CG ) . A physician measured the pain threshold ( PPT ) in the neck and shoulder regions with algometry before the first treatment , and after the last one and six months after the treatments . Question naires on muscle pain and headache were answered at the same occasions and again 3 years after the last treatment . The intensity and frequency of pain fell more for TG than for CG ( Pb≤0.04 ) during the treatment period . Three years after the treatments TG still reported less pain than before the treatments ( Pw<0.001 ) , contrary to what CG did ( Pb<0.04 ) . The degree of headache fell during the treatment period for both groups , but more for TG than for CG ( Pb=0.02 ) . Three years after the treatments the effect still lasted for TG ( Pw<0.001 ) while the degree of headache for CG was back to the pre‐treatment level ( Pb<0.001 ) . PPT of some muscles rose during the treatments for TG and remained higher 6 months after the treatments ( Pw<0.05 ) , which contrasts the situation for CG . Adequate acupuncture treatment may reduce chronic pain in the neck and shoulders and related headache . The effect lasted for 3 years STUDY DESIGN R and omized clinical study . OBJECTIVES To compare the effects of trigger point ( TrP ) dry needling ( DN ) and TrP manual therapy ( MT ) on pain , function , pressure pain sensitivity , and cervical range of motion in subjects with chronic mechanical neck pain . BACKGROUND Recent evidence suggests that TrP DN could be effective in the treatment of neck pain . However , no studies have directly compared the outcomes of TrP DN and TrP MT in this population . METHODS Ninety-four patients ( mean ± SD age , 31 ± 3 years ; 66 % female ) were r and omized into a TrP DN group ( n = 47 ) or a TrP MT group ( n = 47 ) . Neck pain intensity ( 11-point numeric pain rating scale ) , cervical range of motion , and pressure pain thresholds ( PPTs ) over the spinous process of C7 were measured at baseline , postintervention , and at follow-ups of 1 week and 2 weeks after treatment . The Spanish version of the Northwick Park Neck Pain Question naire was used to measure disability/function at baseline and the 2-week follow-up . Mixed-model , repeated- measures analyses of variance ( ANOVAs ) were used to determine if a time-by-group interaction existed on the effects of the treatment on each outcome variable , with time as the within-subject variable and group as the between-subject variable . RESULTS The ANOVA revealed that participants who received TrP DN had outcomes similar to those who received TrP MT  in terms of pain , function , and cervical range of motion . The 4-by-2 mixed-model ANOVA also revealed a significant time-by-group interaction ( P<.001 ) for PPT : patients who received TrP DN experienced a greater increase in PPT ( decreased pressure sensitivity ) than those who received TrP MT at all follow-up periods ( between-group differences : posttreatment , 59.0 kPa ; 95 % confidence interval [ CI ] : 40.0 , 69.2 ; 1-week follow-up , 69.2 kPa ; 95 % CI : 49.5 , 79.1 ; 2-week follow-up , 78.9 kPa ; 95 % CI : 49.5 , 89.0 ) . CONCLUSION The results of this clinical trial suggest that 2 sessions of TrP DN and TrP MT result ed in similar outcomes in terms of pain , disability , and cervical range of motion . Those in the TrP DN group experienced greater improvements in PPT over the cervical spine . Future trials are needed to examine the effects of TrP DN and TrP MT over long-term follow-up periods . LEVEL OF EVIDENCE Therapy , level 1b Study Design . Pragmatic , cross-sectional study . Objective . To assess the interrater reliability of 3 tools used by the Cervical Overview Group ( COG ) for the assessment of the internal validity of r and omized controlled trials ( RCTs ): Jadad , van Tulder , and risk of bias ( RoB ) . Summary of Background Data . For clinicians to implement evidence -based practice , they need to critically appraise health care literature . Checklists , scales , and domain-based criteria exist to evaluate the internal validity of RCTs for rehabilitation studies , but there is a lack of research reporting the reliability of existing assessment tools . Methods . Four members of the COG with multiprofessional and method ological background independently evaluated the internal validity of 54 RCTs using prepiloted Jadad and van Tulder reporting forms , and 18 RCTs using RoB , from June 2003 to May 2009 . The & kgr ; statistic was calculated for each combination of raters and assessment tools . St and ard agreement categorizations were used . Results . For Jadad , 4 of 7 items demonstrated mean & kgr ; statistic ranges from moderate to substantial agreement ( mean values , 0.42–0.78 ) , as did 8 of 11 items on the van Tulder tool ( mean values , 0.44–0.77 ) . The RoB demonstrated moderate to substantial ( mean values , 0.56–0.76 ) agreement on 3 of 12 items . Consistent substantial agreement was found across all assessment tools for the domain “ allocation concealment ” : Jadad 0.69 ( mean range , 0.60–0.77 ) ; van Tulder 0.77 ( mean range , 0.73–0.81 ) ; RoB 0.76 ( mean range , 0.65–0.88 ) ; and moderate to substantial across 2 tools for the domain “ sequence generation ” : van Tulder 0.53 ( mean range , 0.37–0.66 ) and RoB 0.66 ( mean range , 0.45–0.88 ) . Other domains demonstrated slight or fair agreement . Conclusion . Consistent interrater agreement was found across the 3 assessment tools for allocation concealment and for 2 tools for sequence generation . However , users should acknowledge that moderate variation exists within other items requiring more judgment . When evaluating rehabilitation RCTs , clinicians should consider limitations of rating certain items within the selected assessment tool Dry needling ( DN ) has been used recently by physical therapists as a therapy of choice for patients with myofascial trigger points ( TrP ) . The purpose of this r and omized controlled trial was to investigate the effect of DN in the treatment of TrPs in the upper trapezius ( UT ) muscle . A sample of convenience of 33 patients with TrP in the UT muscle participated in this study . Patients were r and omly assigned to a st and ard ( N = 17 ) or experimental group ( N = 16 ) . The treatment protocol for the st and ard group consisted of trigger point compression technique ( TCT ) on MTP , while the patients in the experimental group received DN .  Pain intensity and pressure pain thresholds were assessed for both groups before and after the treatment sessions . In addition , the Disability of Arm , H and , and Shoulder ( DASH ) was administered . Statistical analysis ( paired t-test ) revealed a significant improvement in pain , PPT and DASH scores after treatment in the experimental ( DN ) and st and ard ( TCT ) group compared with before treatment ( P < 0.05 ) . The ANCOVA revealed significant differences between the DN and TCT groups on the post-measurement VAS score ( P = 0.01 ) . There was , however , no significant difference between the two groups on the post-measurement score of the PPT ( P = 0.08 ) and DASH ( P = 0.34 ) . DN produces an improvement in pain intensity , PPT and DASH and may be prescribed for subjects with TrP in UT muscles especially when pain relief is the goal of the treatment OBJECTIVE To observe therapeutic effect of turtle-probing needling at Tianzhu ( BL 10 ) on cervicogenic headache . METHODS Seventy cases were r and omly divided into a treatment group ( n=36 ) and a control group ( n= 34 ) . The treatment group were treated with turtle-probing needling at Tianzhu ( BL 10 ) on the affected side , first perpendicularly needling the point and then penetration-needling homolateral Fengchi ( GB 20 ) , Fengfu ( GV 16 ) , below cervical Jiaji points ( EX-B2 ) , and occipital tuberosity in order . And the control group were treated with acupuncture at Fengchi ( GB 20),Tianzhu ( BL 10 ) , Shuaigu ( GB 8) , Touwei ( ST 8) and corresponding cervical Jiaji points ( EX-B2 ) , Houxi ( SI 3 ) , Ashi points at the affected side with routine needling manipulation . Treatment was given once each day , 6 sessions constituting one course . RESULTS There was no significant difference between the two groups in therapeutic effect ( P > 0.05 ) , but the cured and markedly effective rates for analgesic effect in the observation group at the first three sessions were higher than those in the control group ( P < 0.05 ) . CONCLUSION The turtle-probing needling method and the routine needling have a similar therapeutic effect , but the turtle-probing needling method more rapidly produces the analgesic effect Objective . To compare ultrasound-guided miniscalpel-needle ( UG-MSN ) release versus ultrasound-guided dry needling ( UG-DN ) for chronic neck pain . Methods . A total of 169 patients with chronic neck pain were r and omized to receive either UG-MSN release or UG-DN . Before treatment and at 3 and 6 months posttreatment , pain was measured using a 10-point visual analogue scale ( VAS ) . Neck function was examined using the neck disability index . Health-related quality of life was examined using the physical component score ( PCS ) and mental component score ( MCS ) of the SF-36 health status scale . Results . Patients in the UG-MSN release had greater improvement on the VAS ( by 2 points at 3 months and 0.9 points at 6 months ) versus in the UG-DN arm ; ( both P < 0.0001 ) . Patients receiving UG-MSN release also showed significantly lower scores on the adjusted neck disability index , as well as significantly lower PCS . No severe complications were observed . Conclusion . UG-MSN release was superior to UG-DN in reducing pain intensity and neck disability in patients with chronic neck pain and was not associated with severe complications . The procedural aspects in the two arms were identical ; however , we did not verify the blinding success . As such , the results need to be interpreted with caution Abstract This r and omized controlled trial investigated the effectiveness and cost-effectiveness of dry-needling and exercise compared with sham dry-needling and exercise for chronic whiplash-associated disorders ( WAD ) . The setting was a single university centre and 4 physiotherapy practice s in Queensl and , Australia . Eighty patients with chronic WAD ( > 3 months ) were enrolled between June 2009 and August 2012 with 1-year follow-up completed in August 2013 . The interventions were 6 weeks of dry-needling to posterior neck muscles ( n = 40 ) and exercise or sham dry-needling and exercise ( n = 40 ) . The primary outcomes of the Neck Disability Index ( NDI ) and self-rated recovery were measured at baseline , 6 and 12 weeks , 6 and 12 months by a blinded assessor . Analysis was intention to treat . An economic evaluation was planned but missing data deemed further analysis unwarranted . Seventy-nine patients ( 99 % ) were followed up at 6 weeks , 78 ( 98 % ) at 12 weeks , 74 ( 93 % ) at 6 months , and 73 ( 91 % ) at 12 months . The dry-needling and exercise intervention was more effective than sham dry-needling and exercise  in reducing disability at 6 and 12 months but not at 6 and 12 weeks . The treatment effects were small and not clinical ly worthwhile . At 6 weeks , the treatment effect on the 0 - 100 NDI was −0.3 ( 95 % confidence interval −5.4 to 4.7 ) , 12 weeks −0.3 ( −5.2 to 4.9 ) , 6 months −4.4 ( −9.6 to −0.74 ) , and 12 months −3.8 ( −9.1 to −0.5 ) . There was no effect for self-rated recovery . In patients with chronic WAD  , dry-needling and exercise has no clinical ly worthwhile effects over sham dry-needling and exercise Tsai C-T , Hsieh L-F , Kuan T-S , Kao MJ , Chou L-W , Hong C-Z : Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle . Objective : To investigate the remote effect of dry needling on the irritability of a myofascial trigger point in the upper trapezius muscle . Design : Thirty-five patients with active myofascial trigger points in upper trapezius muscles were r and omly divided into two groups : 18 patients in the control group received sham needling , and 17 patients in the dry-needling  group received dry needling into the myofascial trigger point in the extensor carpi radialis longus muscle . The subjective pain intensity , pressure pain threshold , and range of motion of the neck were assessed before and immediately after the treatment . Results : Immediately after dry needling in the experimental group , the mean pain intensity was significantly reduced , but the mean pressure threshold and the mean range of motion of cervical spine were significantly increased . There were significantly larger changes in all three parameters of measurement in the dry-needling group than that in the control group . Conclusions : This study demonstrated the remote effectiveness of dry needling . Dry needling of a distal myofascial trigger point can provide a remote effect to reduce the irritability of a proximal myofascial trigger point Abstract In a pooled analysis of four r and omized controlled trials of acupuncture in patients with migraine , tension‐type headache , chronic low back pain , and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome . The 864 patients included in the analysis received either 12 sessions of  acupuncture or minimal ( i.e. sham ) acupuncture ( superficial needling of non‐acupuncture points ) over an 8 week period . Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment . After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving . Patients were classified as responders if the respective main outcome measure improved by at least fifty percent . Both univariate and multivariate analyses adjusted for potential confounders ( such as condition , intervention group , age , sex , duration of complaints , etc . ) consistently showed a significant influence of attitudes and expectations on outcome . After completion of treatment , the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 ( 95 % confidence interval 1.20–2.32 ) . For personal expectations and confidence after the third session , odds ratios were 2.03 ( 1.26–3.26 ) and 2.35 ( 1.68–3.30 ) , respectively . Results from the 6‐month follow‐up were similar . In conclusion , in our trials a significant association was shown between better improvement and higher outcome expectations Evidence supports exercise-based interventions for the management of neck pain , however there is little evidence of its superiority over usual physiotherapy . This study investigated the effectiveness of a group neck and upper limb exercise programme ( GET ) compared with usual physiotherapy ( UP ) for patients with non-specific neck pain . A total of 151 adult patients were r and omised to either GET or UP . The primary measure was the Northwick Park Neck pain Question naire ( NPQ ) score at six weeks , six months and 12 months . Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point . Both interventions result ed in modest significant and clinical ly important improvements on the NPQ score with a change score of around 9 % between baseline and 12 months . Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain , however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches Twenty-five out- patients with chronic neck pain participated in a prospect i ve , r and omized trial of acupuncture versus placebo transcutaneous nerve stimulation . A single-blind , non-cross-over design incorporated several outcome measures in an attempt to determine any particular facet of pain that responded to acupuncture .  No significant difference between the two treatments was found either post-treatment or at follow-up . Whilst the small population studied limits the conclusions that may be drawn , these findings suggest that acupuncture may have no greater effect than that of a powerful placebo OBJECTIVE To compare needle acupuncture , medication ( tenoxicam with ranitidine ) , and spinal manipulation for managing chronic ( > 13 weeks duration ) spinal pain syndromes . DESIGN Prospect i ve , r and omized , independently assessed preintervention and postintervention clinical pilot trial . SETTING Specialized spinal pain syndrome out-patient unit at Townsville General Hospital , Queensl and , Australia . SUBJECTS Seventy-seven patients ( without contraindication to manipulation or medication ) were recruited . INTERVENTIONS One of three separate , clearly defined intervention protocol s : needle acupuncture , nonsteroidal anti-inflammatory medication , or chiropractic spinal manipulation . MAIN OUTCOME MEASURES Main outcome measures were changes ( 4 weeks vs. initial visit ) in the scores of the ( 1 ) Oswestry Back Pain Disability Index , ( 2 ) Neck Disability Index , and ( 3 ) three visual analogue scales of local pain intensity . RESULTS R and omization was successful . After a median intervention period of 30 days , spinal manipulation was the only intervention that achieved statistically significant improvements ( all expressed as percentages of the original scores ) with ( 1 ) a reduction of 30.7 % on the Oswestry scale , ( 2 ) an improvement of 25 % on the neck disability index , and ( 3 ) reductions on the visual analogue scale of 50 % for low back pain , 46 % for upper back pain , and 33 % for neck pain ( all P<.001 ) . Neither of the other interventions showed any significant improvement on any of the outcome measures . CONCLUSIONS The consistency of the results provides , in spite of several discussed shortcomings of this pilot study , evidence that in patients with chronic spinal pain syndromes  spinal manipulation , if not contraindicated , results in greater improvement than acupuncture and medicine OBJECTIVE To explore the main factors influencing the therapeutic effect of acupuncture on neck pain caused by cervical spondylosis , so as to provide references for further increasing the therapeutic effect of acupuncture . METHODS One hundred and six cases were r and omly divided into an observation group and a control group , 53 cases in each group . The observation group was treated with routine acupuncture at Dazhui ( GV 14 ) , Jingbailao ( Ex-HN 15 ) and Jianzhongshu ( SI 15 ) ; and the control group was treated with sham acupuncture at 1 cm lateral to Bailao ( Ex-HN 15 ) and Jianzhongshu ( SI 15 ) . The needles were retained for 20 min in the two groups and infrared radiation was used for adjuvant treatment in this period . Northwick Park Neck Pain Question naire ( NPQ ) was used to assess the patients ' quality of life before and after the treatment . The potential influential factors were analyzed by Logistic regression . RESULTS The effective rate was 75.5 % in the observation group and 52.8 % in the control group with a significant difference between the two groups ( P<0.05 ) . The Logistic regression analysis indicated that the therapeutic effect in the observation group was superior to the control group ( OR = 2.670 ) , and both the attack frequency and duration of the neck pain will influence the therapeutic effect ( OR = 1.055 and OR = 2.446 ) . CONCLUSION Acupuncture has a better therapeutic effect on neck pain caused by cervical spondylosis , and patient 's clinical history about attack frequency and duration of neck pain are factors influencing clinical therapeutic effect OBJECTIVES To compare the effects of real acupuncture to tender points for neck and shoulder pain and stiffness ( Japanese : katakori ) with those of sham acupuncture . DESIGN R and omized-controlled trial . METHODS Thirty-four volunteers from an acupuncture school with complaints of chronic pain and stiffness , who had no arm symptoms and gave informed consent , were r and omly allocated to acupuncture or sham groups . Acupuncture or sham acupuncture was applied to the tender points once a week for 3 weeks . In the acupuncture group the acupuncture needle was inserted to the muscle , then the sparrow pecking technique was applied five times . Sham acupuncture was done without insertion of the needle . Dull pain and stiffness were evaluated by visual analog scale ( VAS ) before , and every 2 days after the first needling for 1 month . Pressure pain threshold on the tender points was measured before and after each treatment . RESULTS There was no statistical difference of VAS scores between acupuncture and sham groups 9 days after the last treatment . However , the acupuncture group showed significant reduction of VAS scores immediately after and /or 1 day after the real acupuncture treatments ( P<0.01 ) . The effect tended to be prolonged after repeated treatment . Pressure pain thresholds tended to increase after real acupuncture treatment but not after sham acupuncture . CONCLUSIONS Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness , but this study was unable to demonstrate any long-term superiority over sham acupuncture OBJECTIVE To compare the difference in the efficacy of cervical spondylosis between the combined therapy of spinal balancing and the intervention of pathway of qi and the conventional acupuncture and massage therapy . METHODS Two hundred and seventy-four cases of cervical spondylosis were r and omized into a  spinal balancing group  and a  conventional acupuncture group , 137 cases in each one . In the spinal balancing group , the points on the pathway of qi on the head and on the abdomen were selected [ the pathway of qi on the head : Baihui ( GV 20 ) , Tianzhu ( BL 10 ) , Wangu ( GB 12 ) and the others ; the pathway of qi on the abdomen : Shenshu ( BL 23 ) , Guanyuan ( CV 4 ) , Zhongji ( CV 3 ) and the others ] . The bimanual needling technique was applied in combination with spinal balancing therapy . In the conventional acupuncture group , the points were Jiaji ( EX-B 2 ) ( C3-C7 ) , Fengchi ( GB 20 ) , Wangu ( GB 12 ) , Baihui ( GV 20 ) , etc . The conventional acupuncture technique and massage therapy were adopted . The neck pain question naire ( NPQ ) was adopted to assess the clinical efficacy of the two groups before and after treatment . RESULTS NPQ score was all improved significantly after treatment in the two groups ( all P < 0.05 ) . The result in the spinal balancing group was superior to the conventional acupuncture group ( P < 0.05 ) . The curative and effective rate was 83.2 % ( 114/137 ) in the spinal balancing group , which was better than 69.3 % ( 95/137 ) in the conventional acupuncture group ( P < 0.05 ) . In terms of the types of cervical spondylosis , from high to low , the efficacy sequence was cervical type , nerve root type , vertebral artery type , sympathetic nerve type and spinal cord type . CONCLUSION The combined therapy of spinal balancing and the intervention of pathway of qi achieves the superior efficacy on various types of cervical spondylosis as compared with the conventional acupuncture and massage therapy . It apparently relieves the symptoms and improves the life quality of the patients Auriculotherapy ( ear acupuncture ) is a therapeutic technique in which points on the auricle are stimulated with needles . Usually it is combined with somatic acupuncture because of possible synergy , although the efficacy of this pairing has neither been confirmed nor disproved . The aim of this study was to verify : ( 1 ) if somatic acupuncture can reduce myofascial cervical pain ; ( 2 ) if concomitant auriculotherapy improves the efficacy of somatic acupuncture . A group of 62 patients affected by cervical myofascial pain was r and omly divided into two groups of 31 . Group A ( 6 males and 25 females ) underwent eight sessions of somatic acupuncture . Group B ( 7 males and 24 females ) underwent eight sessions of somatic acupuncture in the same way as group A , paired with auriculotherapy .  Pain was scored using the McGill Pain Question naire before and at the end of treatment , and 1 and 3 months later . The results showed that both somatic acupuncture and somatic plus ear acupuncture have a positive effect in reducing pain . The pain intensity score was 40.70 + /- 17.78 in group A before therapy and 13.32 + /- 9.62 after therapy ; in group B it was 38.90 + /- 15.31 and 13.43 + /- 10.96 . Somatic plus auriculotherapy was therefore not statistically significantly superior to somatic therapy alone in the treatment of cervical myofascial pain BACKGROUND Many patients with chronic pain , including those with chronic whiplash-associated disorders ( WAD ) , show features of central sensitization . R and omized trials examining whether treatments are able to influence the process of central sensitization in patients with chronic WAD are emerging . Therefore , the present study aim ed at examining whether acupuncture results in activation of endogenous analgesia and relief in symptoms in patients with chronic WAD . METHODS In this r and omized crossover pilot trial with blinded assessors , each patient ( n = 39 ) received two treatment sessions of identical duration , with acupuncture and relaxation therapy r and omly crossed over in visit 2 . Primary outcome measurement included immediate activation of endogenous analgesia i.e. , pressure pain sensitivity and conditioned pain modulation . Secondary outcome measurements included pain relief and reduced disability level . RESULTS Local pressure pain sensitivity at baseline and during conditioned pain modulation decreased significantly more following acupuncture compared with relaxation ( time × group interactions : p < 0.001 ) , both in the neck and at a site distinct from the painful region . When comparing the effects of acupuncture versus relaxation , no differences were observed on conditioned pain modulation , temporal summation of pressure pain , neck disability or symptom severity ( all p-values > 0.05 ) . CONCLUSION It was shown that one session of acupuncture treatment results in acute improvements in pressure pain sensitivity in the neck and calf of patients with chronic WAD .  Acupuncture had no effect on conditioned pain modulation or temporal summation of pressure pain . Both acupuncture and relaxation appear to be well-tolerated treatments for people with chronic WAD . These findings suggest that acupuncture treatment activates endogenous analgesia in patients with chronic WAD OBJECTIVE To confirm the better analgesic effect of otopoint-penetrative needling for cervical type and nerve-root type cervicospondylopathy . METHODS A total of 98 cervicospondylopathy out patients ( 50 cases of cervical type and 48 cases of nerve-root type ) were r and omly divided into treatment group ( otopoint-penetrative needling ) and control group ( otopoint-straight needling ) in the light of paring method of comprehensive factors of sexes , ages and the state of disease . The main oto-points used were bilateral Jingzhui Area ( AH 13 ) in combination with Jian-Jianguanjie-Suogu ( Shoulder-Shoulder-joint-Collarbone ) Area , etc . The simplified McGill Pain Scaling was used to give the score of patient 's pain before the treatment , 5 min and 30 min after the treatment . RESULTS Results of sequential trial indicated that the analgesic effect of otopoint-penetrative needling was significantly superior to that of otopoint-straight needling 30 min after the treatment ( P < 0.05 ) . Findings of matched-pair t test showed that no marked differences were found between two groups in the pain scores before the treatment , while after the treatment , the pain scores of otopoint-penetrative needling group were significantly lower than those of otopoint-straight needling group ( P < 0.001 , 0.01 ) , meaning that the analgesic effect of otopoint-penetrative needling was significantly better than that of otopoint-straight needling 5 min and 30 min after the treatment in both men and women , in both cervical type and nerve-root type patients , and in both young and older patients . CONCLUSION The analgesic effect of otopoint-penetrative needling is obviously superior to that of otopoint-straight needling Abstract Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain ( MFP ) patient management . However , few studies have analyzed their effect in a chronic headache population with associated MFP . The purpose of this study was to assess if trigger point injections using lidocaine associated with corticoid would be better than lidocaine alone , as in comparison with dry-needling in for the management of local pain and associated headache management . Forty-five ( 45 ) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point , were r and omly assigned into one of the three groups : G1 , dry-needling , G2 , 0.25 % lidocaine , at 0.25 % and G3 , 0.25 % lidocaine at 0.25 % associated with corticoid , and were assessed during a 12 week period . Levels of pain intensity , frequency and duration , local post-injection sensitivity , obtainment time and duration of relief , and the use of rescue medication were evaluated . Statistically , all three groups showed favorable results for the evaluated requisites ( p≤0.05 ) , but only for post-injection sensitivity did the association of lidocaine with corticoid present the best results and ingestion of rescue medication INTRODUCTION There is some evidence for the efficacy of acupuncture in chronic neck pain ( CNP ) treatment , but it remains unclear which acupuncture modes are most effective . Objective was to evaluate the effects of trigger point acupuncture on pain and quality of life ( QOL ) in CNP patients compared to three other acupuncture treatments ( acupoints , non-trigger point and sham treatment ) . METHODS Forty out- patients ( 29 women , 11 men ; age range : 47 - 80 years ) from the Department of Orthopaedic Surgery , Meiji University of Oriental Medicine , with non-radiating CNP for at least 6 months and normal neurological examination were r and omised to one of four groups over 13 weeks . Each group received two phases of acupuncture treatment with an interval between them . The acupoint group ( st and ard acupuncture ; SA , n=10 ) received treatment at traditional acupoints for neck pain , the trigger point ( TrP , n=10 ) and non-trigger point ( non-TrP , n=10 ) groups received treatment at tenderness points for the same muscle , while the other acupuncture group received sham treatments on the trigger point ( SH , n=10 ) . Outcome measures were pain intensity ( visual analogue scale ; VAS 0 - 100 mm ) and disease specific question naire ( neck disability index ; NDI , 60-point scale ) . RESULTS After treatment , the TrP group reported less pain intensity and improved QOL compared to the SA or non-TrP group . There was significant reduction in pain intensity between the treatment and the interval for the TrP group ( p<0.01 , Dunnett 's multiple test ) , but not for the SA or non-TrP group . CONCLUSION These results suggest that trigger point acupuncture therapy may be more effective on chronic neck pain in aged patients than the st and ard acupuncture therapy OBJECTIVE To compare therapeutic effects of long-time needle retention at Baihui ( GV 20 ) and routine needle retention on vertebroarterial cervical spondylopathy . METHODS One hundred and twenty cases of vertebroarterial cervical spondylopathy were r and omly divided into a treatment group and a control group , 60 cases in each group . The treatment group were treated with needle retention at Baihui ( GV 20 ) for 8 h and electroacupuncture at local points , and the control group with needle retention at Baihui ( GV 20 ) for 30 min and electroacupuncture at local points . RESULTS The cured rate and the total effective rate were 70.0 % and 98.3 % in the treatment group and 45.0 % and 86.7 in the control group with very significant difference or significant difference in the cured rate and the total effective rate between the two groups ( P < 0.01 , P < 0.05 ) . CONCLUSION Long-time needle retention at Baihui ( GV 20 ) has a better therapeutic effect on vertebroarterial cervical spondylopathy Objective To observe the clinical effect of acupuncture in treating cervical spondylosis with different syndrome types . Methods One hundred and seventeen patients were r and omized into the treated group : ( 59 cases ) , treated with normal acupuncture , and the control group ( 58 cases ) , treated with sham acupuncture , operated once every other day , 9 times in total ( in 18 days ) as one therapeutic course , and a succeeding 3-month follow-up study was carried out after terminating the therapy . The efficacy of treatment was evaluated with the Northwick Park Neck Pain Question naire ( NPQ ) and Visual Analogue Scale ( VAS ) , and the scores gained in patients with different syndrome types were analyzed with a general linear model . Results The NPQ and VAS : scores showed a linear decreasing tendency in both groups at the time of ending treatment and the 1st month of follow-up , but showed a secondary curve increasing tendency in the 3rd month of follow-up . Multivariate analysis showed the difference was of statistical significance ( P<0.05 ) . However , the analysis through lead-in of syndrome type as an individual influencing factor showed that syndrome type exerts a significant influence on VAS score ( P<0.05 ) , but has insignificant influence on the NPQ score ( P>0.05 ) . Conclusion Acupuncture shows : good immediate effect in treating cervical spondylosis , but its long-term effect is not satisfactory . The difference in syndrome type may have some impact on the effects of acupuncture in alleviating pain , but exerts no evident influence on the comprehensive effect OBJECTIVE To evaluate the effect of dry needling into a myofascial trigger point ( MTrP ) in the lower trapezius muscle of patients with mechanical idiopathic neck pain . DESIGN A single-center , r and omized , double-blinded controlled study . SETTING Patients were recruited from the student population of a local hospital by advertisement in the university clinic from January 2010 to December 2011 . PARTICIPANTS Patients ( N=72 ) with unilateral neck pain , neck pain for ≥3 months , and active trigger points in the lower trapezius muscle were r and omly assigned to 1 of 2 treatment groups . All the patients completed the study . INTERVENTIONS Dry needling in an MTrP in the lower trapezius muscle , or dry needling in the lower trapezius muscle but not at an MTrP. MAIN OUTCOME MEASURES The visual analog scale ( VAS ) , Neck Pain Question naire ( NPQ ) , and pressure-pain threshold ( PPT ) were assessed before the intervention and 1 week and 1 month postintervention . RESULTS Treatment with dry needling of the lower trapezius muscle close to the MTrP showed decreases in pain and PPT as well as an improvement in the degree of disability ( P<.001 ) compared with the baseline and control group measurements ( P<.001 ) . The dry-needling technique performed in the MTrP showed more significant therapeutic effects ( P<.001 ) . CONCLUSIONS The application of dry needling into an active MTrP of the lower trapezius muscle induces significant changes in the VAS , NPQ , and PPT levels compared with the application of dry needling in other locations of the same muscle in patients with mechanical neck pain Background : Neck pain is a frequent complaint in office workers . This pain can be caused by myofascial trigger points ( MTrPs ) in the trapezius muscle . This study aim ed to determine the effectiveness of deep dry needling ( DDN ) of active MTrPs in the trapezius muscle . Methods : A r and omized , single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women 's Health Research Group at Physical Therapy Department of University of Alcalá , in Alcalá de Henares , Madrid , Spain . Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were r and omly allocated to either the DDN or the control group ( CG ) . The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle . They also received passive stretch of the trapezius muscle . The CG received the same passive stretch of the trapezius muscle only . The primary outcome measure was subjective pain intensity , measured using a visual analogue scale ( VAS ) . Secondary outcomes were pressure pain threshold ( PPT ) , cervical range of motion ( CROM ) and muscle strength . Data were collected at baseline , after interventions and 15 days after the last treatment . Results : Differences were found between the DDN group and the CG for the VAS ( P < 0.001 ) , PPT ( P < 0.001 ) , range of motion ( AROM ) ( P < 0.05 ) and strength ( P < 0.05 ) after intervention and at the 15-day follow-up . Discussion : Deep dry needling and passive stretch seems to be more effective than passive stretch only . The effects are maintained in the short term . The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain OBJECTIVE To compare therapeutic effects of needle-knife therapy and acupuncture on cervical spondylosis . METHODS Multi- central clinical r and omized controlled trial was adopted . The patients were divided into a needle-knife treatment group treated with needle-knife therapy at the upper and lower interspinal ligaments of the affected vertebral body and bilateral posterior joint capsules ; and the acupuncture control group were treated with acupuncture at Laozhen , Ashi points and cervical Jiaji points , etc . The short-term and the long-term therapeutic effects were observed at the end of the therapeutic course and 6 months after the end of the therapeutic course . RESULTS The short-term therapeutic effect and the long-term therapeutic effect were 91.3 % and 94.7 % in the needle-knife treatment group and 59.4 % and 56.6 % in the acupuncture control group , respectively , with a very significant difference between the two groups ( P < 0.01 ) . CONCLUSION The needle-knife treatment in the therapeutic effect on cervical spondylosis is superior to acupuncture treatment Chronic neck myofascial pain syndrome ( MPS ) is a common disorder seen in clinics . There is no gold st and ard method to treat myofascial pain . We investigated the effects of acupuncture on patients with chronic neck MPS by a single-blind r and omized controlled trial . A total of 35 patients were r and omly allocated to an acupuncture group ( AG ) or a sham acupuncture group ( SG ) . Each subject received acupuncture treatment twice per week for three consecutive weeks . The primary outcome measure was quality of life as assessed with Short Form-36 , and secondary outcome measures were neck range of motion ( ROM ) , motion-related pain , and Short-Form McGill Pain Question naire ( SF-MPQ ) , as determined by a blinded investigator . The clinical assessment s were made before treatment ( BT ) and after six acupuncture treatments ( AT ) , as well as four weeks ( F1 ) and 12 weeks ( F2 ) after the end of the treatment . A total of 34 patients completed the trial . The results indicated that there is no significant difference in the ROM , motion-related pain , and SF-MPQ scores between AG and SG at AT , F1 and F2 ( all p > 0.05 ) . However , AG has greater improvement in physical functioning and role emotional of Short Form-36 quality of life at F2 . The results indicate that acupuncture may be used to improve the quality of life in patients with chronic neck MPS Context In this r and omized , controlled trial , spinal manipulation plus exercise produced outcomes for low back pain  similar to those produced by exercise alone . Yet , some patients did respond to spinal manipulation , and it would be helpful for doctors to be able to identify such patients . Contribution Patients were most likely to benefit from  spinal manipulation  if they met 4 of 5 of the following criteria : symptom duration less than 16 days , no symptoms distal to knee , score less than 19 on a fear-avoidance measure , at least 1 hypomobile lumbar segment , and at least 1 hip with more than 35 degrees of internal rotation . Implication s Clinicians may be able to use these criteria to identify patients with low back pain who are good c and i date s for  spinal manipulation . The Editors Next to the common cold , low back pain is the most common reason that individuals visit a physician 's office ( 1 ) . Billions of dollars in medical expenditures and lost labor costs for this condition are incurred each year ( 2 , 3 ) . Attempts to identify effective interventions for individuals with low back pain have been largely unsuccessful ( 4 ) . In particular , conflicting evidence exists about the effectiveness of spinal manipulation ; some r and omized trials have shown a benefit , while other trials have not ( 5 - 7 ) . These conflicting conclusions are reflected in the various recommendations in national clinical practice guidelines , with some recommending manipulation and others not ( 8) . The variety of conclusions in trials of manipulation may be attributable to the failure of research ers to adequately consider the importance of classification . Using broad inclusion criteria results in a heterogeneous sample that may include many patients for whom no benefit is expected , thus masking the intervention 's true value ( 9 , 10 ) . Consequently , developing methods for matching patients with low back pain to treatments that are most likely to benefit them has become an important research priority ( 11 ) . Clinical prediction rules are tools design ed to assist clinicians in decision making when caring for patients ( 12 ) . Several clinical prediction rules have been developed and vali date d to improve clinical decision making for the use of imaging in patients with ankle , knee , cervical spine , or minor head injuries ( 13 - 16 ) . Few studies have attempted to develop rules that establish prognosis on the basis of outcome from a specific intervention , such as spinal manipulation . Recently , Flynn and colleagues ( 17 ) developed a clinical prediction rule for identifying patients with low back pain who are likely to benefit from  manipulation .  They examined a series of patients with low back pain who received a manipulation intervention .  Five factors formed the most parsimonious set of predictors for identifying patients who achieved at least 50 % improvement in disability within 1 week with a maximum of 2 manipulation interventions ( Table 1 ) ( 17 ) . The positive likelihood ratio among patients who met at least 4 of 5 of the criteria was 24.4 ( 95 % CI , 4.6 to 139.4 ) . Table 1 . Five Criteria in the Spinal Manipulation Clinical Prediction Rule Clinical prediction rules must be vali date d in separate population s before being recommended for widespread implementation ( 18 ) . A clinical prediction rule for identifying which patients with low back pain are most likely to respond to manipulation could improve clinical efficiency and re source utilization . Thus , we aim ed to vali date the spinal manipulation clinical prediction rule in a multicenter trial . Methods We considered consecutive patients with a primary symptom of low back pain who were referred to physical therapy for participation . We used 14 physical therapists at 8 clinics in various U.S. regions and setting s ( 2 academic medical centers and smaller outpatient practice setting s ) . Most participating sites were health care facilities within the U.S. Air Force . Each site 's institutional review board approved the study before we began recruitment and data collection . Inclusion criteria were age 18 to 60 years ; a primary symptom of low back pain , with or without referral into the lower extremity ; and an Oswestry Disability Question naire ( ODQ ) score of at least 30 % . We excluded patients who had red flags for a serious spinal condition ( for example , tumor , compression fracture , or infection ) , those who had signs consistent with nerve root compression ( that is , positive straight-leg increase < 45 degrees or diminished reflexes , sensation , or lower-extremity strength ) , those who were pregnant , or those who had previous surgery to the lumbar spine or buttock . These criteria are consistent with those used in Flynn and colleagues ' study ( 17 ) and were design ed to include patients without a contraindication to manipulation . Once patients were admitted to the study , we used intention-to-treat principles , and no patient was removed for nonadherence . History and Physical Examination Before r and omization , patients completed several self-report measures and then received a st and ardized history and physical examination . We collected demographic information , including age and sex ; medical history ; and location and nature of symptoms . Self-report measures included a body diagram to assess the symptom distribution ( 19 ) . We used an 11-point pain-rating scale ranging from 0 ( no pain ) to 10 ( worst imaginable pain ) to assess current pain intensity and the best and worst level of pain during the last 24 hours ( 20 ) . We used the average of the 3 ratings . We used the Fear-Avoidance Beliefs Question naire ( FABQ ) to quantify the patient 's fear of pain and beliefs about avoiding activity ( 21 ) . Previous studies have found a high level of testretest reliability for both the FABQ physical activity and work subscales ( 22 ) . Fearavoidance beliefs have been associated with current and future disability and work loss in patients with acute ( 23 ) and chronic ( 24 ) low back pain . The modified ODQ is a region-specific disability scale for patients with low back pain ( 25 ) that has high levels of reliability , validity , and responsiveness ( 26 ) . Physical examination measures included lumbar active range of motion ( 27 ) and various tests purported to identify dysfunction in the lumbopelvic region ( 28 ) . Complete details of the physical examination are described elsewhere ( 26 ) . Specific components pertinent to validation of the rule were assessment s of segmental mobility and hip internal rotation range of motion , the performance of which is described in Appendix 1 and Appendix 3 video . Each physical therapist received a detailed manual that operationally defined each examination and treatment procedure and was trained in the study procedures by an investigator before data collection began . Supplement . Appendix 3 video : A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation Determining Status on the Clinical Prediction Rule A physical therapist who was blinded to the patients ' treatment group assignment assessed the 5 criteria in the rule ( Table 1 , Appendix 1 , and Appendix 3 video ) . To further minimize bias , examiners were not instructed in the rule 's criteria and were unaware of the patient 's status on the rule . After completion of the study , an examiner who was blinded to the patient 's treatment assignment determined the patient 's status on the rule by using the results of the baseline examination . As was done in the initial study ( 17 ) , we classified patients as positive if they met at least 4 of 5 criteria and were therefore likely to respond to manipulation . We classified patients with 3 or fewer criteria as negative . An examiner who was blinded to the patient 's status on the rule repeated the history and physical examination 1 and 4 weeks after r and omization . Patients also completed a 6-month follow-up postal question naire to assess disability , work status , and health care utilization . Treatment Groups We used a r and om-number generator to generate a r and omization list before the study began . We prepared individual , sequentially numbered index cards with the r and omization assignments . We folded the cards and placed them in sealed envelopes . After the baseline examination , the physical therapist who conducted the examination opened the next envelope , indicating the treatment group assignment . We r and omly assigned patients to 1 of 2 groups : 1 ) spinal manipulation plus an exercise program ( manipulation group ) or 2 ) an exervideocise program alone ( exercise group ) . Patients in both groups attended physical therapy twice during the first week and then once a week for the next 3 weeks , for a total of 5 sessions . We initiated treatment immediately after completion of the baseline examination , unless prohibited by time constraints ; in that case the first treatment session took place 24 to 48 hours after the baseline examination . All patients received an exercise instruction booklet that outlined the proper performance and frequency of each exercise and were instructed to perform their assigned exercise program once daily on the days that they did not attend therapy . On the basis of the benefits associated with remaining active ( 29 ) , patients in both groups were given advice to maintain usual activity within the limits of pain . Manipulation Group The treatment received by the manipulation group differed from that of the exercise group during the first 2 physical therapy sessions . During these 2 sessions , patients received high-velocity thrust spinal manipulation  and a  range-of-motion exercise only . First , the physical therapist performed the manipulation by using the same technique used by Flynn and colleagues ( 17 ) . Appendix 2 describes and Figure 1 and Appendix 3 video illustrate the procedures used to perform the manipulation technique . Figure 1 . Manipulative intervention used in developing and validating the spinal manipulation clinical prediction rule .  Exercise Group We treated patients in the exercise group with a low-stress OBJECTIVE To evaluate the effectiveness of acupuncture , as compared with physiotherapy , in the management of  chronic neck pain .  DESIGN Seventy adult patients with non-inflammatory neck pain of > 6 weeks duration and with no abnormal neurology were r and omly assigned to receive either of the treatments . Thirty-five patients were included in each group . OUTCOME MEASURES Pain by visual analogue scale and neck pain question naire , improvement in range of movement of neck relative to baseline , and well-being ( general health question naire ) . Measurements were recorded at the start of treatment , at 6 weeks and at 6 months . RESULTS Both treatment groups improved in all criteria . Acupuncture was slightly more effective in patients who had higher baseline pain scores . CONCLUSIONS Both acupuncture and physiotherapy are effective forms of treatment . Since an untreated control group was not part of the study design , the magnitude of this improvement can not be quantified OBJECTIVE To evaluate the clinical efficacy of acupuncture and moxibustion on chronic neck pain of cervical spondylosis in terms of the heart and kidney theory . METHODS One hundred and eleven cases were r and omized into a heart-kidney acupuncture group ( 55 cases ) and a conventional acupuncture group ( 56 cases ) . In the heart-kidney acupuncture group , acupuncture was applied to Bailao ( EX-HN 15 ) , Shenmen ( HT 7 ) and Wangu ( SI 4 ) . Afterwards , the direct moxibustion was applied to Dazhui ( GV 14 ) , Xinshu ( BL 15 ) and Shenshu ( BL 23 ) . After moxibustion , the intradermal needling therapy was provided at Bailao ( EX-HN 15 ) , Xinshu ( BL 15 ) and Shenshu ( BL 23 ) . In the conventional acupuncture group , acupuncture was applied to Bailao ( EX-HN 15 ) and Zhongzhu ( TE 3 ) at first . Afterwards , the direct moxibustion was done at Dazhui ( GV 14 ) , Bailao ( EX-HN 15 ) and Jianzhongshu ( SI 15 ) . After moxibustion , the interdermal needling therapy was provided at Bailao ( EX-HN 15 ) and Jianzhongshu ( SI 15 ) . The northwick park pain question naire ( NPQ ) was adopted as the main efficacy index for the evaluation . RESULTS After the intervention and during the follow-up visit period , NPQ scores were all reduced remarkably as compared with those before the intervention for the patients in two groups ( all P < 0.001 ) , but the differences were not statistically significant in groups ( all P > 0.05 ) . By the age stratification analysis for the patients in two groups , the program in terms of the heart and kidney theory achieved the superior efficacy for the patients over 45 years old as compared with those in the conventional acupuncture group ( P < 0.05 , P < 0.01 ) . By the stratification analysis of the sick duration , the program in terms of the heart and kidney theory achieved the superior efficacy for the patients with over 7 years sick duration as compared with those in the conventional acupuncture group ( P < 0.05 , P < 0.01 ) . CONCLUSION The acupuncture and moxibustion therapeutic program in terms of the heart and kidney theory achieves the superior efficacy on chronic pain of cervical spondylosis for the patients over 45 years old and with over 7 years sick duration . It is one of the optimized programs for the treatment of this disease OBJECTIVE To compare the efficacy differences among electroacupuncture with penetration needling method , Jiaji electroacupuncture and Jing fukang granule for cervical spondylotic radiculopathy ( CSR ) and to explore the best therapeutic method . METHODS One hundred and sixty patients with CSR were r and omly divided into 3 groups . Sixty patients in electroacupuncture with penetration needling method group ( group A ) were treated by electroacupuncture with penetration needling method , and C4 Jiaji-to-C7 Jiaji , Jianwaishu ( SI 14)-to-Quyuan ( SI 13 ) , Tianzong ( SI 11)-to-Naoshu ( SI 10 ) , Shousanli ( LI 10)-to-Xialian ( LI 8) were selected , once a day . Sixty patients in Jiaji electroacupuncture group ( group B ) were treated by Jiaji electroacupuncture at C4 Jiaji-to-C7 Jiaji , once a day . Fourty patients in Jing fukang granule group ( group C ) were treated by oral administration of Jing fukang granule , 1 bag each time , twice each day . Six days as a course , the 3 groups were all treated for two courses . The simplified MPQ ( SF-MPQ ) scale which was internationally accepted was adopt to evaluate the improving situations in pain . RESULTS After treatment , pain rating idex ( PRI ) , visual analogue scale ( VAS ) , present pain intensity ( PPI ) and the total pain score were significantly improved in the group A and B compared with those before treatment ( all P < 0.01 ) , which was also improved in the group C ( all P < 0.05 ) . Compared with the group C , all the scores were significantly improved in the group A ( all P < 0.01 ) , the improvement of PRI , VAS , PPI and total pain score in the group B was superior to those in the group C ( all P < 0.05 ) , and all the improvements in the group A were superior to those in the group B ( P < 0.05 , P < 0.01 ) . CONCLUSION Electroacupuncture with penetration needling method can relive pain rapaidly in patients with CSR , which is superior to Jiaji electroacupuncture and Jing fukang granule in improving the comprehensive pain scores OBJECTIVE This study is aim ed to assess the efficacy of traditional acupuncture for chronic neck pain in patients by comparing the differences in symptoms , dysfunctions and quality of life . METHODS The study used a two-arm , single-blinded , r and omised controlled design . The patients were r and omised to the study group and control group , who respectively received traditional acupuncture and placebo treatment . The Northwick Park Neck Pain Question naire ( NPQ ) , visual analogue scale ( VAS ) , Short Form ( 36 ) Health Survey ( SF-36 ) and doctor 's judgement were applied for measuring effectiveness . The patients ' effectiveness outcome was assessed , respectively , before the intervention , immediately after the intervention , at the end of the first month of follow-up and at the end of the third month of follow-up . The statistical analysis was done on Statistical Package for Social Sciences ( SPSS ) v13 , which included comparison of demographic and clinical homogeneity , the repeated measures approach based on the general linear model ( GLM ) for effectiveness assessment and the sum rank test for doctors ' subjective efficacy judgement . RESULTS Totally , 190 patients were recruited and 178 patients ( 88 in the study group and 90 in the control group ) completed the intervention and follow-up assessment . The scores of NPQ , VAS and SF-36 were improved after the intervention and during follow-up ( P<0.01 vs. before the intervention ) . The patients in the study group had better effectiveness outcome in NPQ , VAS and in the VT , SF and MH domains of SF-36 ( P<0.05 ) . CONCLUSION Traditional acupuncture can relieve pain intensity and improve the quality of daily life with a relative long-term clinical efficacy in patients with chronic neck pain OBJECTIVE To compare the differences of therapeutic effect of cervical spondylosis of neck type treated with acupuncture at starting and ending points of trapezius and the Jiaji ( EX-B 2 ) points . METHODS Sixty cases of cervical spondylosis of neck type were r and omly divided into an observation group and a control group , 30 cases in each group . In observation group , the acupoints related with starting and ending points of trapezius , such as Tianzhu ( BL 10 ) , Fengchi ( GB 20 ) , Quyuan ( SI 13 ) , Jugu ( LI 16 ) and Ashi were punctured ; in control group , Jiaji ( EX-B 2 ) points of neck were punctured . The treatments were applied 5 times a week and 2 weeks made one course . The international simplified McGill scale was adoped to assess the scores of Pain Rating Index ( PRI ) , Visual Analogue Scale ( VAS ) and Present Pain Intensity ( PPI ) before treatment and after one course treatment , and the therapeutic effects were measured . RESULTS After treatment , all the scores were obviously reduced in both groups : ( all P < 0.01 ) , and the PRI-sensory subscore , PRI-affective subscore and total score in observation group reduced more obviously than those in control group , and there were statistically significant differences between groups ( all P < 0.01 ) . There were no statistically significant differences between groups in VAS and PPI score ( both P > 0.05 ) . The total effective rate of 96.7 % ( 29/30 ) in observation group was superior to that of 70.0 % ( 21/30 ) in control group ( P < 0.01 ) . CONCLUSION The therapeutic effect of cervical spondylosis of neck type treated with acupuncture at the starting and ending points of trapezius is positive , which is better than that of acupuncture at the Jiaji ( EX-B 2 ) points Eight r and om groups , each of 15 patients with tendomyotic cervical and lumbar syndrome , underwent acupuncture , one group receiving needle acupuncture at the " correct " sites according to Chinese medicine and another receiving placebo needles at the same sites . In a third group , acupuncture needles were applied at sites which were wholly inconsistent with Chinese practice . The remaining 5 groups took part in a single blind trial involving various types of radiation at the correct acupuncture sites , using an apparatus emitting either laser rays , red light , mixed light , infrared or no radiation at all , without interference from the therapist . All the groups showed improvement , but an analysis according to Kruskal and Wallis revealed no significant differences between type and site of treatment The aim of this pilot r and omised controlled trial ( RCT ) was to compare multimodal group rehabilitation to usual care physiotherapy for patients with chronic neck pain ( CNP ) . Participants ( n=14 ) were r and omly assigned to one of two interventions , multimodal group rehabilitation or usual care physiotherapy . Multimodal group rehabilitation involved stability , strengthening and proprioceptive exercises along with an educational programme . Patients attended for 1h , once a week for six weeks . The usual care group was treated as deemed appropriate by their physiotherapist . A blinded assessor recorded baseline and post-intervention scores of disability and pain using the neck disability index ( NDI ) and the 0 - 10 pain numerical rating scale ( NRS ) , respectively . One participant from each group dropped out before receiving any intervention . Post-intervention both groups significantly improved in both function and pain scores ( p ≤ 0.01 ) . The mean change in the NDI scores for the multimodal group versus the usual care group were 12.3 ± 5.3 % and 7.4 ± 4.8 % , and pain NRS score changes were 4.6 ± 2.3 and 4.5 ± 2.2 , respectively . There was no significant difference in improvements in disability ( p = 0.84 ) or pain ( p = 0.67 ) between groups . These results warrant further investigation of multimodal group rehabilitation for CNP , and provide data to inform an appropriately powered full-scale RCT with long-term follow-up Thirty patients with cervical spine pain syndromes persisting a mean of 8 years were assigned r and omly into equal treatment and control groups . After 12 weeks , 12 of 15 ( 80 % ) of the treated group felt improved , some dramatically , with a mean 40 % reduction of pain score , 54 % reduction of pain pills , 68 % reduction of pain hours per day and 32 % less limitation of activity . Two of 15 ( 13 % ) of the control group reported slight improvement after 12.8 weeks . The control group had a mean 2 % worsening of the pain score , 10 % reduction in pain pills , no lessening of pain hours and 12 % less limitation of activity Objectives The aim of this study was to identify patients ' characteristics that increase or decrease their benefit from acupuncture treatment of chronic pain . Methods Patients with chronic low back pain , headache , neck pain , or pain due to osteoarthritis of the knee or hip , were included in 4 multicenter , r and omized , controlled studies , all conducted in Germany . All patients received routine care ; the patients r and omized to the acupuncture group received additional acupuncture treatment . Data were pooled , and the main outcome was defined as the 3-month change from baseline of the SF-36 bodily pain subscale . To identify predictors for treatment effects and effect modifiers ( ie , variables that interact with the form of treatment ) , patients ' characteristics and their interaction with treatment were included in a mixed linear model to predict treatment outcome . Results A total of 9,990 patients who were treated by 2,781 physicians were analyzed . The outcome was markedly improved in the acupuncture group ( P<0.001 ) . Age , education , duration of illness , baseline pain , and some concomitant diseases predicted treatment outcome in both groups . Patients ' characteristics that enlarged the acupuncture effect ( ie , acted as effect modifiers ) were being female ( P=0.028 ) , living in a multi-person household  ( P=0.002 ) , failure of other therapies before the study ( P=0.049 ) , and former positive acupuncture experience ( P=0.005 ) . Discussion Future research to clarify the modifying effects with special focus on patients ' expectations and other psychological variables is needed OBJECTIVE To observe acupuncture at Jiquan ( HT 1 ) with different manipulations for improvement of abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type . METHODS One hundred and seven cases were r and omly divided into 3 groups . The lifting-thrusting group ( n = 37 ) were treated with acupuncture at Jiquan ( HT 1 ) with lifting-thrusting manipulation , the twirling group ( n = 36 ) with acupuncture at Jiquan ( HT 1 ) with twirling manipulation and the routine needling group ( n = 34 ) with acupuncture at C4 - T1 Jiaji ( EX-B 2 ) , Quchi ( LI 11 ) . RESULTS The total effective rate of 91.9 % in the lifting-thrusting group was significantly better than 58.3 % in the twirling group ( P < 0.005 ) and 76.5 % in the routine needling group ( P < 0.05 ) , and the therapeutic effect of the twirling group was similar to that in the routine needling group CP > 0.05 ) . CONCLUSION Acupuncture at Jiquan ( HT 1 ) with lifting-thrusting manipulation can obviously improve abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type OBJECTIVES To investigate ( 1 ) the relation between needle diameter and treatment efficacy of myofascial pain syndrome and ( 2 ) the relation between needle diameter and pain intensity during injection . DESIGN R and omized controlled trial . SETTING University-affiliated tertiary-care hospital . PARTICIPANTS Volunteers ( N=77 ) with myofascial pain syndrome affecting upper- and middle-trapezius muscles with at least 3 months ' duration of pain . INTERVENTION Participants were r and omly assigned to receive trigger point injections on 1 side of the trapezius with a 21- , 23- , or 25-gauge needle . After a 1-time injection , participants were followed up for 14 days . Participants and the assessor were blinded for group assignment . MAIN OUTCOME MEASURES Treatment efficacy was measured with the visual analog scale ( VAS ; at pretreatment , and posttreatment on days 1 , 4 , 7 , 14 ) for neck and upper-back pain , the Neck Disability Index ( NDI ; at pretreatment , and posttreatment on days 7 , 14 ) , and the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 , at pretreatment and posttreatment on days 7 , 14 ) for health-related quality of life . Pain intensity during injection was evaluated immediately after injection with VAS . RESULTS VAS scores for posttreatment on days 4 , 7 , and 14 decreased significantly compared with pretreatment scores in all groups ; NDI scores on days 7 and 14 decreased significantly compared with pretreatment scores in all groups ; SF-36 scores on days 7 and 14 decreased significantly compared with pretreatment scores in the 21- and 23-gauge needle groups ; and SF-36 score on day 14 showed significant difference between the 21- and 25-gauge needle groups . For pain intensity during injection , VAS scores indicated no significant difference between the 3 groups . CONCLUSIONS No difference between the needle types was observed in terms of VAS or NDI , or in terms of pain intensity felt by patients during injection . In terms of SF-36 scores , injections with 21- or 23-gauge needles were found to be more effective . However , a well-controlled investigation is needed to explore the effect of needle thickness on health-related quality of life
BACKGROUND Neck pain is one of the three most frequently reported complaints of the musculoskeletal system .
Treatments for neck pain are varied , as are perceptions of benefit .
Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain .
This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute , subacute and chronic neck pain .
This up date replaces our 2006 Cochrane review up date on this topic .
OBJECTIVES To determine the effects of acupuncture for adults with neck pain , with focus on  pain relief , disability or functional measures , patient satisfaction and global perceived effect .