The Role of Psychological Factors in the Perception of Postneedling Soreness and the Influence of Postneedling Intervention

PM R. 2017 Apr;9(4):348-355. doi: 10.1016/j.pmrj.2016.07.529. Epub 2016 Aug 1.


Background: Myofascial trigger point dry needling is frequently associated with postneedling soreness, which can generate patient dissatisfaction and reduced treatment adherence. Psychological factors may influence the perception of postneedling soreness and the effectiveness of postneedling soreness treatments.

Objectives: The objectives of the present study were to determine whether catastrophizing, kinesiophobia, pain anxiety, and fear of pain are significant predictors of postneedling soreness over time; and to analyze whether the relationships between psychological variables and postneedling soreness vary as a function of the postneedling soreness intervention, which included ischemic compression, placebo or control (without treatment).

Design: Repeated-measures observational study nested within a randomized controlled trial.

Setting: University community.

Participants: Healthy volunteers (N = 90; 40 men and 50 women) 18 to 39 years of age (mean ± standard deviation 22 ± 3 years).

Methods: Catastrophizing, kinesiophobia, pain anxiety, and fear of pain were evaluated as possible predictors of postneedling pain before dry needling in a latent myofascial trigger point in the upper trapezius muscle. Participants were then divided into a treatment group that received ischemic compression as a postneedling intervention, a placebo group that received sham ischemic compression, and a control group that did not receive any treatment.

Main outcome measurements: Pain during needling and postneedling soreness were quantified using a visual analogue scale during needling, after treatment, and at 6, 12, 24, and 48 hours.

Results: A multilevel analysis revealed that individuals who exhibited more catastrophic thinking showed less postneedling soreness intensity immediately after needling in all participants (β = -0.049). Pain-related anxiety was linked to greater immediate postneedling soreness in the compression condition (β = 0.057). Finally, participants who exhibited more catastrophic thinking showed a slower rate of decline in postneedling soreness levels over time in the compression condition (β = 0.038).

Conclusions: Catastrophizing was associated with lower levels of postneedling soreness immediately after needling in all subjects. Although ischemic compression seems to be a useful procedure to reduce postneedling soreness, its efficacy could be slightly reduced in patients presenting higher scores of pain-related anxiety. Psychological procedures may help to correct the distorted pain expectancies associated with needling interventions and might also improve the effectiveness of ischemic compression.

Level of evidence: II.

Publication types

  • Observational Study
  • Randomized Controlled Trial

MeSH terms

  • Acupuncture Therapy / methods*
  • Acupuncture Therapy / psychology*
  • Adolescent
  • Adult
  • Anxiety / physiopathology
  • Anxiety / psychology
  • Female
  • Humans
  • Male
  • Pain Measurement
  • Pain Perception / physiology*
  • Pain Threshold / psychology*
  • Predictive Value of Tests
  • Psychology
  • Reference Values
  • Superficial Back Muscles / physiopathology*
  • Trigger Points / physiopathology
  • Young Adult