Short-Term Pain Outcomes of Trigger Point Injection Versus Dry Needling for Acute Myofascial Low Back Pain in the Emergency Department: A Prospective Randomized Comparative Study.

BACKGROUND Acute myofascial low back pain prompts emergency department visits, where rapid pain relief matters. Trigger point injection and dry needling are used for myofascial trigger points, but comparative evidence in emergency care is limited. This study compared the short-term analgesic effectiveness of trigger point injection and dry needling in patients with acute myofascial low back pain presenting to the emergency department. MATERIAL AND METHODS This prospective, randomized, comparative study randomized 52 patients; 49 patients who completed at least 1 post-procedure pain assessment were included in the analysis. Pain was assessed using the Numeric Rating Scale (NRS) at baseline and 5, 15, 30, and 60 minutes after the procedure. The principal effectiveness outcome was the between-group difference in percentage pain reduction at 30 minutes. Intravenous fentanyl (1 &#xb5;g/kg) was administered as rescue analgesia after the 60-minute assessment when required. RESULTS Baseline NRS scores were similar between groups (P=0.191). Percentage pain reduction at 30 minutes was greater after trigger point injection than after dry needling (86.85&#xb1;17.53% vs 32.98&#xb1;13.48%; mean difference, 53.86 percentage points; 95% confidence interval, 44.78-62.94; P<0.001). Pain scores were lower and pain reduction was greater after trigger point injection at all post-procedure timepoints (all P<0.001). Rescue analgesia was required in 0 of 26 patients after trigger point injection and 15 of 23 patients (65.2%) after dry needling (P<0.001). No procedure-related adverse events were observed. CONCLUSIONS Trigger point injection was associated with greater short-term pain reduction and less frequent rescue analgesia than dry needling during the first hour of emergency department care. These preliminary findings require confirmation in larger studies.