***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: 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 The aim of this case series was to investigate changes in pain and pressure pain sensitivity after manual treatment of active trigger points ( TrPs ) in the shoulder muscles in individuals with unilateral shoulder impingement . Twelve patients ( 7 men , 5 women , age : 25 ± 9 years ) diagnosed with unilateral shoulder impingement attended 4 sessions for 2 weeks ( 2 sessions/week ) . They received TrP pressure release and neuromuscular interventions over each active TrP that was found . The outcome measures were pain during arm elevation ( visual analogue scale , VAS ) and pressure pain thresholds ( PPT ) over levator scapulae , supraspinatus infraspinatus , pectoralis major , and tibialis anterior muscles . Pain was captured pre-intervention and at a 1-month follow-up , whereas PPT were assessed pre- and post-treatment , and at a 1-month follow-up . Patients experienced a significant ( P < 0.001 ) reduction in pain after treatment ( mean ± SD : 1.3 ± 0.5 ) with a large effect size ( d > 1 ) . In addition , patients also experienced a significant increase in PPT immediate after the treatment ( P < 0.05 ) and one month after discharge ( P < 0.01 ) , with effect sizes ranging from moderate ( d = 0.4 ) to large ( d > 1).A significant negative association ( r(s ) = -0.525 ; P = 0.049 ) between the increase in PPT over the supraspinatus muscle and the decrease in pain was found : the greater the decrease in pain , the greater the increase in PPT . This case series has shown that manual treatment of active muscle TrPs can help to reduce shoulder pain and pressure sensitivity in shoulder impingement . Current findings suggest that active TrPs in the shoulder musculature may contribute directly to shoulder complaint and sensitization in patients with shoulder impingement syndrome , although future r and omized controlled trials are required 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 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 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 Objectives To explore myoelectrical activity and muscle morphology of myofascial trigger points ( MTrPs ) in an injury model of rats . Methods A total of 24 male SD rats were r and omly divided into a control group ( group A ) and model group ( group B ) . A blunt striking injury and eccentric exercise were applied to the vastus medialis ( VM ) of rats in group B for 8 weeks . Later , the palpable taut b and ( TB ) , local twitch response , myoelectrical activities and morphology in the two groups were examined . Results An average of 2.5 ( 30/12 ) palpable TBs were detected in the VM in group B compared with none in group A. The MTrPs had two types of abnormal potential . Their amplitudes were significantly higher than those in the control group ( p<0.01 ) but their duration s showed no significant differences . A series of reflex contractions appeared in groups A and B in response to external stimulation to the ear . Their amplitude and duration in group B were significantly lower than those in group A. A series of lower fibrillation potentials repeatedly occurred in model MTrPs in group B. The morphology of MTrPs showed abnormal muscle fibres with large round or ellipse shapes in cross-section and enlarged tapering shapes in longitudinal section . Conclusions Active MTrPs can be provoked by repeated blunt injury . Active MTrPs are a group of muscle fibres with abnormal shapes and abnormal myoelectrical potentials . External stimulation provokes low-voltage responses in MTrPs , which is different from the response of normal muscle fibres 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 In this study ; we aim ed to compare the efficacy of local anesthetic injection and dry needling methods on pain , cervical range of motion ( ROM ) , and depression in myofascial pain syndrome patients ( MPS ) . This study was design ed as a prospect i ve r and omized controlled study . Eighty patients ( female 52/male 28 ) admitted to a physical medicine and rehabilitation outpatient clinic diagnosed as MPS were included in the study . Patients were r and omly assigned into two groups . Group 1 ( n = 40 ) received local anesthetic injection ( 2 ml lidocaine of 1 % ) and group 2 ( n = 40 ) received dry injecting on trigger points . Both patient groups were given stretching exercises aim ed at the trapezius muscle to be applied at home . Patients were evaluated according to pain , cervical ROM , and depression . Pain was assessed using Visual Analog Scale ( VAS ) and active cervical ROM was measured using goniometry . Beck Depression Inventory ( BDI ) was used to assess the level of depression . There were no statistically significant differences in the pre-treatment evaluation parameters of the patients . There were statistically significant improvements in VAS , cervical ROM , and BDI scores after 4 and 12 weeks in both groups compared to pre-treatment results ( p < 0.05 ) . No significant differences were observed between the groups ( p > 0.05 ) . Our study indicated that exercise associated with local anesthetic and dry needling injections were effective in decrease of pain level in MPS as well as increase of cervical ROM and decrease of depressive mood levels of individuals & 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 ,  
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CONCLUSIONS Dry needling can be recommended for relieving MTrP pain in neck and shoulders in the short and medium term , but wet needling is found to be more effective than dry needling in relieving MTrP pain in neck and shoulders in the medium term