Download Full Text (2.0 MB)

Document Type



Myofascial pain syndrome (MPS) is one of the most common musculoskeletal conditions characterized by tight bands of fascia and muscle fibers known as myofascial trigger points (MTrP’s). Empirical evidence suggests that deactivation of MTrP’s is best accomplished with invasive needling therapy such as dry needling, trigger point injections (TPI’s), and botulinum toxin (BTX-A) injections. The objective of this systemic review is to compare the efficacy of various needling therapies on pain intensity and additionally determine if ultrasound guidance and obtaining an LTR improves clinical outcomes. A comprehensive search of five databases including PubMed, Science Direct, Google Scholar, Cochran, and CINHAL was completed using a variety of key terms. The 15 selected studies were peer-reviewed and included randomized control trials, pilot studies, quasi-experimental studies, retrospective cohorts, systemic reviews, and meta-analysis. Research suggests that all three therapies are effective for decreasing pain intensity associated with MPS, however, superiority is inconclusive. Dry needling and local anesthetics have similar short-term efficacy and are best indicated for treating regions of the shoulder and cervical muscles. Analgesic effects of BTX-A are delayed but tend to be longer-lasting and are more effective when treating regions of highly active muscles. Ultrasound guidance improves clinical outcomes by reducing localization errors and adverse events. Obtaining a local twitch response (LTR) inconsistently correlates with short-term pain relief but is not dependent upon it


Physician Assistant Studies

Date of Work


Publication Date



Myofascial pain syndrome, trigger point, trigger point injections, dry needling, local anesthetic, botulinum toxin-A, local twitch response, and ultrasonography


Medicine and Health Sciences

Invasive Needling Therapy for Myofascial Pain Syndrome