To the Editor:
We are deeply grateful to the reviewer [Jan Dommerholt] for his comments on our two articles concerning myofascial pain syndrome [MPS] of the Korean elderly and comparison of several treatment methods for them (Citation1). Here are our responses:
REPLY TO THE COMMENTS ON ARTICLE #1
“Intramuscular and nerve root stimulation versus lidocaine injection of trigger points [TrPs] in MPS (Citation2)”:
We also regard it as the first study that compared TrP injections with dry needling using acupuncture needles. However, because additional paraspinal needling was performed only in the IMS group, it cannot be accurately concluded that dry needling of TrP is superior to 0.5 percent lidocaine injection of TrP in MPS patients. Fortunately, most recently published study of our research group (Citation3) compared acupuncture needling [ACU group] and 0.5 percent lidocaine injection [TPI group] of TrP in the elderly people, and found that there were no significant differences in several outcomes between these two methods.
Although the reviewer presumed that local twitch responses [LTRs] were a coincidental finding, we attempted to purposefully elicit LTRs as we described in section “Treatment Protocols” of our article. It is based upon a previous study (Citation4) and our casual experiences in practice.
We agree that the needling procedure utilized in our study is not a representative of Gunn's approach (Citation5) because we inactivated peripheral TrP. Now we desire to know what would happen if Gunn's IMS and TrP injection were compared.
It is interesting to know that there are insurance codes for TrP injections but not for dry needling, and this fact would persuade physicians to use injections rather than dry needling in the United States and this situation is exactly the same as in Korea.
REPLY TO THE COMMENTS ON ARTICLE #2
“Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients (Citation6)”:
As the reviewer again indicated, the IMS group was not treated by Gunn's approach. But we think that in order to compare efficacy of additional paraspinal needling with TrP needling only, this design was more appropriate.
Since introduction of Gunn's IMS into Korea in early 2000s, there have been remarkable progress in theory and technique and Ahn, one of the most celebrated certified IMS practitioners, and his colleagues (Citation7) developed a new technique named Interventional Muscle and Nerve Stimulation [IMNS] for spinal origin pain intractable by conservative Gunn's approach. There are several differences of IMNS from Gunn's IMS. First, IMNS’ targets are along the traveling course of spinal nerve root branches and not only the paraspinal deep muscles. Second, they use several types of round, sharp-edged needles in IMNS procedure. Third, a new concept of “microadhesiolysis” was introduced in IMNS. To the best of our knowledge, all researches concerning IMNS have been performed only in Korea till now (Citation8, 9). We can give more information about IMNS to anyone who wants to know more about it.
REFERENCES
- Dommerholt J, Simons DG: Myofascial trigger points. J Musculoskelet Pain 16(3): 211–228, 2008.
- Ga H, Koh HJ, Choi JH, Kim CH: Intramuscular and nerve root stimulation vs lidocaine injection of trigger points in myofascial pain syndrome. J Rehabil Med 39(5): 374–378, 2007.
- Ga H, Choi JH, Park CH, Yoon HJ: Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients – a randomised trial. Acupunct Med 25(4): 130–136, 2007.
- Hong CZ: Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil 73(4): 256–263, 1994.
- Gunn CC: The Gunn Approach to the Treatment of Chronic Pain, 2nd ed. Churchill Livingstone, New York, 1996.
- Ga H, Choi JH, Park CH, Yoon HJ: Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. J Altern Complement Med 13(6): 617–623, 2007.
- Ahn K, Lee YJ, Lee SC, Lee CW, Lee YC: Clinical effect of fluoroscopy guided interventional muscle and nerve stimulation (IMNS) on intractable spinal origin pain. Korean J Anesthesiol 47(1): 96–100, 2004.
- Kim EH: Clinical effects of fluoroscopy guided interventional microadhesiolysis and nerve stimulation (FIMS) on cervical zygapophyseal joints in patients with chronic cervical radicular pain. Korean J Pain 20(1): 31–39, 2007.
- Lee YJ: Mechanism of chronic pain and interventional muscle and nerve stimulation. J Korean Acad Fam Med 27(5): 341–351, 2006.