INTRODUCTION
General background
Myofascial pain, described by Travell and Simons, is a non-inflammatory regional muscle condition characterized by hypersensitive trigger points —palpable nodules— within taut bands of skeletal muscle. These trigger points may elicit pain during compression, contraction, or stretching. Both central and peripheral sensitization mechanisms are involved, with peripheral sensitization likely playing a predominant role.1
Etiology
Myofascial pain multiple interacting factors including anatomical variations, pathophysiological mechanisms, psychosocial stressors, and trauma. These can perpetuate muscle overload, leading to reduced ATP and oxygenation, and increased nociceptor activation.1Demographically, prevalence varies, potentially affecting up to 80-90% of the general population and is more frequently observed in women.2
Pathology in the temporomandibular region
At the temporomandibular level, myofascial pain is classified as a subtype of myalgia under Axis I of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) classification.3,4 Myofascial pain is characterized by both examination and the clinical history. Clinically, it manifests as localized or radiating jaw, ear, or temporal pain. In terms of clinical history, the patient reports jaw pain, ear pain or pain in the temporal or masseter muscle that radiates beyond the palpation site but within the limits of the palpated muscle which is called myofascial pain without referral, while myofascial pain with referral refers to pain extending beyond the limits of the palpated muscle.4
In contrast to the DC/TMD, its predecessor, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), classifies myofascial pain as with or without limited opening. Myofascial pain with limited opening is described as a mandibular opening of 40 mm or less without assistance and without pain, or a maximum passive opening that is 5 mm greater than the pain-free, unassisted opening.4 Studies indicate that it is more common among individuals aged 27 to 50, with no significant differences between genders.5
However, a study conducted in Temuco, Chile, suggests that the prevalence of temporomandibular myofascial pain is not associated with age but rather with gender, being more common in women (80.6%) than in men (19.39%).6 Regarding its location, the masseter muscle is the most affected, followed by the temporalis and upper trapezius muscles.6
Pain has a negative impact on quality of life, as revealed by assessments using the Short-Form Health Status Questionnaire (SF-36) and the Nottingham Health Profile (NHP).7,8 Although temporomandibular disorders are not always painful, they are one of the main causes of non-dental pain in the orofacial region, directly affecting patient's quality of life.9
Management modalities
Management includes multimodal approaches such as patient education, pharmacotherapy, behavioral strategies, and physical therapies (e.g., laser, ultrasound, exercises). Needling techniques —both wet and dry— are among the proposed options.10-13
Limitations of conventional pharmacological options
Pharmacological interventions, while useful for acute symptom relief, may carry systemic side effects, fail to address underlying muscular dysfunction, and have limited evidence for sustained benefit.14
Innovations and study rationale
Dry needling (DN) is minimally invasive, targeting trigger points to elicit local twitch responses and potentially reducing inflammatory mediators, and it has been widely investigated in other muscle groups, but evidence for its efficacy in the masseter remains inconsistent.15 Althought the mechanisms underlying DN remain incompletely understood, it has been suggested that the insertion of a needle into the trigger point causes a localized contraction which generates an analgesic effect. This pain relief might be due to the reduction of concentrations of substances such as substance P, cytokines and CGRP. Despite being an old technique, there remains some uncertainty about the clinical response in the masseter muscle.16,17
Given the prevalence of temporomandibular myofascial pain and its impact on quality of life, as well as the lack of clarity regarding the clinical response of dry needling in the masseter muscle, it is crucial to evaluate its use in this condition. This review aims to address these gaps by synthesizing the recent evidence, assessing clinical outcomes specific to masseter DN, and identifying research priorities
MATERIALS AND METHODS
Protocol
This scoping review was conducted following the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) from Equator Network. The study was performed by three independent reviewers (RB, CL, GO).
The research question was: What is the therapeutic response of dry needling in the masseter muscle in the management of temporomandibular myofascial pain?
Information sources and search strategy
A systematic search was conducted in the PubMed, SCOPUS and Web Of Science (WOS) databases on December 5, 2023. Controlled vocabulary and free-text terms were adapted to each database. Although gray literature databases were not researched, the three selected databases were considered sufficient to provide a broad and representative coverage of peer-reviewed evidence on this topic. This decision aimed to ensure methodological rigor and feasibility, but we acknowledge it may limit sensitivity. The complete strategies are presented in Table 1, Table 2 and Table 3.
Table 1. Search strategy used in PubMed
| No of search | Search strategy | Results |
|---|---|---|
| #1 | "masseter muscle" [MeSH Terms] OR ("masseter"[All Fields] AND "muscle"[All Fields]) OR "masseter muscle"[All Fields] OR ("masseter muscle"[MeSH Terms] OR ("masseter"[All Fields] AND "muscle"[All Fields]) OR "masseter muscle"[All Fields] OR ("masseter"[All Fields] AND "muscles"[All Fields]) OR "masseter muscles"[All Fields]) OR (("chewings"[All Fields] OR "chews" [All Fields] OR "mastication"[MeSH Terms] OR "mastication"[All Fields] OR "chewed"[All Fields] OR "chewing"[All Fields]) AND ("muscles" [All Fields] OR "muscles" [MeSH Terms] OR "muscles" [All Fields] OR "muscle"[All Fields])) OR (("chewings"[All Fields] OR "chews" [All Fields] OR "mastication"[MeSH Terms] OR "mastication" [All Fields] OR "chewed"[All Fields] OR "chewing" [All Fields])AND ("muscle s" [All Fields] OR "muscles" [MeSH Terms] OR "muscles" [All Fields] OR "muscle"[All Fields])) OR ("masticatory muscles" [MeSH Terms] OR ("masticatory" [All Fields] AND "muscles"[All Fields]) OR "masticatory muscles"[All Fields]) | 18,602 |
| #2 | "acupunctural"[All Fields] OR "acupuncture"[MeSH Terms] OR "acupuncture" [All Fields] OR "acupuncture therapy" [MeSH Terms] OR ("acupuncture"[All Fields] AND "therapy" [All Fields]) OR "acupuncture therapy"[All Fields] OR "acupunctures" [All Fields] OR "acupunctured" [All Fields] OR "acupunctures"[All Fields] OR "acupuncturing"[All Fields] OR ("dry needling"[MeSH Terms] OR ("dry" [All Fields] AND "needling"[All Fields]) OR "dry needling"[All Fields]) | 43,948 |
| #3 | ("myofascial"[All Fields] AND ("pain"[MeSH Terms] OR "pain" [All Fields])) OR ("temporomandibular joint disorders"[MeSH Terms] OR ("temporomandibular"[All Fields] AND "joint"[All Fields] AND "disorders" [All Fields]) OR "temporomandibular joint disorders" [All Fields] OR ("temporomandibular"[All Fields] AND "disorder" [All Fields]) OR "temporomandibular disorder"[All Fields]) OR ("temporomandibular joint disorders"[MeSH Terms] OR ("temporo-mandibular"[All Fields] AND "joint"[All Fields] AND "disorders" [All Fields]) OR "temporomandibular joint disorders"[All Fields] OR "temporomandibular" [All Fields] AND "disorders"[ All Fields]) OR "temporomandibular disorders"[All Fields]) | 26,314 |
| #4 | ((#1) AND (#2)) AND (#3) | 63 |
Table 2. Search strategy used in Scopus
| No of search | Search strategy | Results |
|---|---|---|
| #1 | (ALL ("masseter" AND "muscle") OR ALL ("masseter" AND "muscles") OR ALL ("chewing" AND "muscle") OR ALL ("chewing" AND "muscles") OR ALL ("masticatory" AND "muscles")) | 50,152 |
| #2 | (ALL (“acupuncture”) OR ALL (“dry” AND “needling”)) | 122,461 |
| #1 AND #2 AND #3 | ((ALL ("masseter" AND "muscle") OR ALL ("masseter" AND "muscles") OR ALL ("chewing AND "muscle") OR ALL ("chewing" AND "muscles") OR ALL ("masticatory" AND "muscles"))) AND ((ALL ("acupuncture") OR ALL ("dry" AND needling))) AND ((ALL ("myofascial" AND "pain") OR ALL ("temporomandibular" AND "disorder") OR ALL ("temporomandibular" AND "disorders"))) | 1.197 |
| #1 AND #2 AND #3 | (("ALL" ("masseter" AND "muscle") OR "ALL" ("masseter" AND "muscles") OR "ALL" ("chewing" AND "muscle") OR "ALL" ("chewing" AND "muscles") OR "ALL" ("masticatory" AND "muscles"))) AND (("ALL" ("acupuncture") OR "ALL" ("dry" AND "needling"))) AND (("ALL" ("myofascial" AND "pain") OR "ALL" ("temporomandibular" AND "disorder") OR "ALL" ("temporomandibular" AND "disorders))) "Filtered: Years" | 486 |
| #2 | (ALL (“acupuncture”) OR ALL (“dry” AND “needling”)) | 122,461 |
Table 3. Search strategy used in Web of Science (WOS)
| No of search | Search strategy | Results |
|---|---|---|
| #1 | "masseter muscle" (All Fields) OR "masseter muscles" (All Fields) OR "chewing muscle" (All Fields) OR "chewing muscles" (All Fields) OR "masticatory muscles" (All Fields) | 10,662 |
| #2 | "acupuncture" (All Fields) OR "dry needling" (All Fields) | 37,733 |
| #3 | "myofascial pain" (All Fields) OR "temporomandibular disorder" (All Fields) OR "temporomandibular disorders" (All "Fields") | 15,158 |
| #1 AND #2 AND #3 | #3 AND #2 AND #1 | 55 |
| #1 AND #2 AND #3 | #3 AND #2 AND #1 AND 2019 or 2020 OR 2021 OR 2022 OR 2023 (Publication Years) | 29 |
Eligibility criteria Studies published within the last five years from the search date (December 5, 2023) that evaluated dry needling of the masseter muscle in adult patients (>18 years) with myofascial pain. Eligible studies compared DN with placebo or alternative interventions (e.g., local anesthetics, platelet-rich plasma, botulinum toxin). Articles had to be available in English with full text accessible. Reviews, systematic reviews, and meta-analyses were excluded, as well as duplicated and studies that combine dry needling of the masseter muscle with interventions in other masticatory muscle without separate analysis. Data extraction and synthesis Data extraction was performed using a standardized Microsoft Excel template. Extracted information included for each article: the author and year of publication, the study design, the number of patients with myofascial pain, the age of the participants and the country were recorded. The description of the intervention, the dependent variables, the data collection method and the diagnostic criteria used were specifically detailed, the outcomes assessed and follow-up periods. Functional measures such as mouth opening and lateral/protrusive movements were also collected. Quality appraisal Articles were assessed with the Critical Appraisal Skills Programme (CASP) Randomized Controlled Trial Checklist, this tool contains 11 items that score 0-2 points, with Articles were assessed using the Critical Appraisal Skills Programme (CASP) Randomized Controlled Trial Checklist. This tool contains 11 items scored from 0 to 2 points, with total scores ranging from 0 (low quality) to 22 (high quality).¹⁸ Studies were classified as high quality (22 points), moderate quality (16–21 points), or low quality (<15 points). Protocol This scoping review was conducted following the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) from Equator Network. The study was performed by three independent reviewers (RB, CL, GO). The research question was: What is the therapeutic response of dry needling in the masseter muscle in the management of temporomandibular myofascial pain? Information sources and search strategy A systematic search was conducted in the PubMed, SCOPUS and Web Of Science (WOS) databases on December 5, 2023. Controlled vocabulary and free-text terms were adapted to each database. Although gray literature databases were not researched, the three selected databases were considered sufficient to provide a broad and representative coverage of peer-reviewed evidence on this topic. This decision aimed to ensure methodological rigor and feasibility, but we acknowledge it may limit sensitivity. The complete strategies are presented in Table 1, Table 2 and Table 3. Eligibility criteria Studies published within the last five years from the search date (December 5, 2023) that evaluated dry needling of the masseter muscle in adult patients (>18 years) with myofascial pain. Eligible studies compared DN with placebo or alternative interventions (e.g., local anesthetics, platelet-rich plasma, botulinum toxin). Articles had to be available in English with full text accessible. Reviews, systematic reviews, and meta-analyses were excluded, as well as duplicated and studies that combine dry needling of the masseter muscle with interventions in other masticatory muscle without separate analysis. Data extraction and synthesis Data extraction was performed using a standardized Microsoft Excel template. Extracted information included for each article: the author and year of publication, the study design, the number of patients with myofascial pain, the age of the participants and the country were recorded. The description of the intervention, the dependent variables, the data collection method and the diagnostic criteria used were specifically detailed, the outcomes assessed and follow-up periods. Functional measures such as mouth opening and lateral/protrusive movements were also collected. Quality appraisal Articles were assessed with the Critical Appraisal Skills Programme (CASP) Randomized Controlled Trial Checklist, this tool contains 11 items that score 0-2 points, with Articles were assessed using the Critical Appraisal Skills Programme (CASP) Randomized Controlled Trial Checklist. This tool contains 11 items scored from 0 to 2 points, with total scores ranging from 0 (low quality) to 22 (high quality).¹⁸ Studies were classified as high quality (22 points), moderate quality (16–21 points), or low quality (<15 points).
RESULT
Study selection
The initial search identified 529 articles across PubMed, Scopus and Web of Science. After duplicate removal (n=41) using the Rayyan platform, 488 unique records remained for screening. Based on title and abstract review, 477 articles were excluded, leaving 11 for full-text assessment. Of these, 5 were excluded for not meeting inclusion criteria, resulting in 6 studies included in the review. The selection process is summarized in the PRISMA-ScR flowchart (Figure 1).
Characteristics of included studies
Four randomized controlled trials (RCTs), one prospective cohort and one study without a specified design were included, with a total of 243 patients, aged 18-65 years, all diagnosed with myofascial pain. Diagnostic criteria varied: two studies used RDC/TMD,19–21 three studies used DC/TMD (with one restricted to pain with referral), and one applied only clinical criteria.22 Given these differences, results are reported collectively as myofascial pain according to RDC/TMD or DC/TMD, without subclassification (Table 4).
Table 4. Search strategy used in Web of Science (WOS)
| No of search | Search strategy | Results | No of search | No of search | Search strategy | Results |
|---|---|---|---|---|---|---|
| Diagnostic criteria of Myofascial pain | DC/TMD | RDC/TMD | RDC/TMD | DC/TMD | Clinical findings | DC/TMD |
| Age (in years) | Mean of age: Test group: 40.40; control group: 32.60 | 18–40 | 18–65 | 18–54 | 20–60 | 18–37 |
| Gender | Female: 6, Male: 24 | NR | Female: 24, Male: 16 | Female: 39, Male: 6 | Female: 29, Male: 11 | Female: 24, Male: 8 |
| No. of temporomandibular MFP patients | 30 | 36 | 40 | 45 | 40 | 32 |
| Study design | RCT | Double blind RCT | RCT | NR (non-randomized controlled trial) | Prospective study | Double blind, crossover RCT |
| Reference | Agarwal et al. 2022 | Dib-Zakkour et al. 2022 | Özden et al. 2018 | Taşkesen et al. 2020 | Kütük et al. 2019 | Macedo et al. 2023 |
| DC/TMD: Diagnostic Criteria for Temporomandibular Disorders. NR: Not reported. RCT: Randomized clinical trial. RDC/TMD: Research Diagnostic Criteria for Temporomandibular Disorders. VAS: Visual Analog Scale. | ||||||
Critical Appraisal
Of the six selected articles only four were randomized clinical trials. The methodological quality of these four studies was assessed with the (CASP) Randomized Controlled Trial Checklist”.18 The two non-randomized studies were not formally appraised with CASP, but their methodological features (study design, diagnostic criteria, outcome measures) were described narratively to provide context, highlighting limitations in design and outcome reporting. Overall, quality ranged from moderate to high (Figure 2).
Risk of bias
A formal risk of bias assessment was not conducted because of heterogeneity in study design (RCTs, prospective studies, non-randomized interventions). Applying a single standardized tool would not have been appropriate. Instead, a qualitative appraisal of design strengths and weaknesses was performed. This limitation is acknowledged in the discussion.
Follow-up periods
Follow-up duration varied considerably: Two studies measured outcomes immediately after intervention,19,23 one study extended follow-up to six months.24 The remaining studies assessed outcomes at intervals between 3 and 12 weeks.19,20,22,25 These differences in follow-up likely influenced the observed consistency of treatment effects. Longer-term outcomes remain insufficiently documented (Table 5).
Table 5. Characteristics of the studies according to type of interventions and follow-up periods
| Reference | No. of TMD/ MFP patients |
Treatments performed | Follow-up |
|---|---|---|---|
| Agarwal, et al., 2022 | 30 | PRP injections and DN | Baseline, 2 weeks, 1-month, 3-month, 6-month |
| Dib-Zakkour, et al., 2022 | 36 | bilateral DDN and sham DDN | Pre intervention and immediate post-intervention |
| Özden, et al., 2018 | 60 | SND and DDN | Baseline, 3 weeks, 6 weeks. |
| Taşkesen, et al., 2020. | 45 | DN, TrP injections with local anaesthetic or MNB | Baseline, 1 week, 4 weeks and 12 weeks |
| Kütük, et al., 2019 | 40 | Abobotulinum toxin-A and DN | Baseline and 6 weeks |
| Macedo, et al., 2023 | 32 | DN and sham | Pre intervention and immediate post-interventio |
| DN: Dry needling. SDN: Superficial dry needling. DDN: Deep dry needling. MFP:Myofascial pain. MNB: Masseteric nerve block. PRP: Platelet-rich plasma. TrP: Trigger points. TMD: Temporomandibular disorder. | |||
Pain outcomes
All six studies assessed pain intensity using the Visual Analogue Scale (VAS). Some also incorporated algometry for pressure pain threshold:19,20
Pre- and post-treatment values: Dib-Zakkour et al.,19 reported that at baseline 73.3% of patients presented with moderate pain, while after six months 60% reported only mild pain, reflecting clinically significant improvement. Similarly, Agarwal et al.,24 found that VAS scores decreased consistently from baseline through 2 weeks, 1 month, 3 months, and 6 months post-intervention, with both DN and platelet-rich plasma groups improving. Immediate versus delayed effects: In Dib-Zakkour et al.,19 and Macedo et al.,23 sinificant VAS reductions were observed immediately after DN compared to sham interventions.24
Superficial versus deep DN: Özden et al.,20 reported greater short-term pain reduction with superficial DN compared to deep DN. However, by six weeks, differences between techniques were not statistically significant.
Comparisons with other interventions: Taş-kesen et al.,25 observed that DN and masseteric nerve block both produced significant reductions in pain during function, with no differences between groups. Kütük et al.,22 reported that both DN and botulinum toxin-A improved resting and chewing-related pain, though relative efficacy remained inconclusive due to protocol variability.
Overall, DN demonstrated a consistent trend toward pain reduction across studies, with improvements maintained for up to six months in some cases.
Functional movement ranges outcomes
Three studies evaluated mandibular function. Dib-Zakkour et al.,19 reported an increase in mean maximum mouth opening from 45 mm at baseline to 51 mm post-treatment. Taşkesen et al.,25 found significant short-term improvements in pain-free maximum mouth opening across DN, local anesthetic, and nerve block groups, with no differences between interventions. Kütük et al.,22. observed significant improvements in lateral mandibular movements in DN compared to botulinum toxin-A after six weeks.
DISCUSIÓN
Pain in the orofacial region represents a significant challenge in clinical practice and public health. This review synthesized the available evidence on the therapeutic response of dry needling (DN) applied to the masseter muscle in patients with temporomandibular myofascial pain.
Main findings
Across the six included studies, DN consistently demonstrated a reduction in pain intensity measured by VAS, with improvements sustained up to six months in some cases.19,24Functional outcomes, including increased maximum mouth opening and lateral movements, were also reported.26 These findings suggest that DN has potential as a therapeutic option for temporomandibular myofascial pain, particularly for short- to mid-term symptom relief.27-29
Comparison with placebo and technique variations
When compared to sham interventions, DN produced greater reductions in pain, supporting its efficacy beyond placebo effects.19,21 Both superficial and deep DN techniques improved symptoms, although no consistent differences were identified between them in medium-term follow-up.20,30 These results are congruent with systematic reviews on other muscle groups,27,29 which similarly report comparable outcomes between superficial and deep approaches.31-33
Comparison with alternative therapies
The comparative efficacy of DN versus other interventions remains less conclusive. DN showed similar pain reductions when compared to masseteric nerve block and local anesthetic trigger point injections.25,34
Likewise, DN and platelet-rich plasma demonstrated comparable effects,24 although meta-analyses suggest PRP may offer superior short-term outcomes.16 In contrast, comparisons with botulinum toxin-A yielded mixed results: some studies favored DN,22 while others reported no significant differences.35 This variability highlights the need for standardized protocols and longer follow-up to determine relative efficacy.
Critical appraisal of evidence
The methodological quality of the RCTs included ranged from moderate to high, while the two non-randomized studies provided weaker evidence. Diagnostic criteria varied (RDC/TMD versus DC/TMD versus clinical), and follow-up times were inconsistent, limiting comparability with other previous reviews.20,27-30,32 Overall, these studies suggest that dry needling treatment of the masseter muscle is successful in reducing myofascial pain, maintaining its effect after various weeks of follow-up.19,20,22-25
Adverse effects and safety considerations
While DN is generally safe, transient adverse effects were reported, most commonly post-needling soreness, temporary pain exacerbation, and localized hematomas or minor bleeding. These effects usually resolved within 72 hours.23 Factors such as needle depth, gauge, number of insertions, and operator technique may influence the occurrence of adverse events.26 Importantly, no severe complications were reported in the included studies.36 Nevertheless, the current literature does not allow firm conclusions regarding safety,37 partly due to the lack of standardized reporting of adverse events.38
Previous studies have evaluated post-puncture pain after the application of physical therapies in order to treat this adverse effect.38 One study even suggests the application of simultaneous local anesthetic to reduce post-puncture pain.26 The heterogeneity of the available studies and and the limited reporting of post-puncture pain post-puncture pain makes it difficult to understand. Finally, the presence of hematomas has been reported in 7.55% and bleeding in 4.65%.36
Some contraindications for its use have been described, including patients with needle phobia, local or systemic infections, localized edema and patients with a compromised immune system, among others.39 However, it should be considered that dry needling improves the quality of life when measured through SF-36 after its execution28 and even in its components such as physical and social function, general health and quality of sleep.40
Clinical and public health relevance
The results of this review suggest that DN can reduce pain and improve function in patients with temporomandibular myofascial pain.37 In clinical practice, DN may be considered as part of multimodal management, particularly when pharmacological therapies are insufficient or contraindicated. From a public health perspective, wider adoption of DN could reduce reliance on systemic medications, thereby lowering the burden of side effects and improving quality of life.41,42 Nevertheless, the absence of standardized protocols and the variability of outcomes call for cautious implementation and highlight the importance of interdisciplinary care that incorporates biopsychosocial factors (Axis II).
Limitations of this review
This scoping review had some limitations that must be acknowledged: first, only six studies were included, with relatively small sample sizes. Second, the heterogeneity of diagnostic criteria, treatment protocols, and outcome measures limits comparability. Third, the absence of a formal risk of bias assessment reduces the certainty of conclusions, which further constrains the interpretation of comparative efficacy. Fourth, the search was restricted to three databases and English-language publications, which may have excluded relevant studies. Finally, the lack of clear diagnostic criteria through recognized guidelines such as DC/TMD and standardization of the technique are other aspects that should be improved for future studies. Therefore, although the studies included in this scoping review are of a moderate to high quality according to CASP guidelines,18 they should be reviewed with caution. These limitations must be considered when interpreting the findings.
Future directions
Further research is required to: Conduct well-powered RCTs with standardized DN protocols, incorporate longer-term follow-up to assess durability of treatment ef-fects, compare DN with other commonly used interventions (e.g., PRP, botulinum toxin-A, local anesthetics) using uniform outcome measures, evaluate the influence of psychosocial factors and integrate Axis II assessments into study designs and improve reporting of adverse effects to better define the safety profile of DN.
Strengths of this review
This review focuses specifically on the application of DN to the masseter muscle, synthesizing recent evidence published in the last five years. By restricting inclusion to this muscle, the review provides a more targeted evaluation of DN in temporomandibular myofascial pain compared to prior reviews with broader scopes. The systematic approach, adherence to PRISMA-ScR guidelines, and independent review process strengthen its methodological rigor.
CONCLUSIONS
Current evidence suggests potential benefit in dry needling of the masseter muscle as an option for temporomandibular myofascial pain., with evidence supporting reductions in pain intensity and improvements in function. However, conclusions regarding comparative efficacy are limited by heterogeneity of stu-dy designs and the absence of risk of bias analysis. DN may serve as a useful component of multimodal therapy, but further high-quality, standardized studies are necessary to establish its role in clinical protocols and public health recommendations.
REFERENCIAS BIBLIOGRÁFICAS
1. Travell, J.G. and Simons, D.G. (1999) Myofascial Pain and Dysfunction The Trigger Point Manual. Vol. 1 and 2, 2nd Edition. Williams & Wilkins, Baltimore, MD. - References - Scientific Research Publishing.
2. de Leeuw R, Klasser GD, editors. Orofacial pain: Guidelines for assessment, diagnosis, and management. STOMATOL EDU J. 2015;2(2):173.
3. Simons DG, Travell JG. Dolor y disfuncion miofascial V.1: El manual de los puntos gatillo, mitad superior del cuerpo. Ed. Médica Panamericana; 2002.
4. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: re-commendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27. https://doi.org/10.11607/jop.1151. PMID: 24482784; PMCID: PMC4478082.
5. Tantanatip A, Chang KV. Myofascial Pain Syndrome. StatPearls Publishing; 2023.
6. Iturriaga V, Bornhardt T, Hermosilla L, Avila M. Prevalencia de Dolor Miofascial en Mús-culos de la Masticación y Cervicales en un Centro Especializado en Trastornos Tem-poromandibulares y Dolor Orofacial. Int J Odontostomat. 2014;8(3):413–7.
7. Golanska P, Saczuk K, Domarecka M, Kuć J, Lukomska-Szymanska M. TemporomandibularMyofascial Pain Syndrome-Aetiology and Biop-sychosocial Modulation. A Narrative Review. Int J Environ Res Public Health. 2021; 18(15):7807. https://doi.org/10.3390/ijerph18157807.
8. Badil Güloğlu S, Tunç S. The assessment of affective temperament and life quality in myofascial pain syndrome patients. Int J Psychiatry Clin Pract. 2022;26(1):79-84. https://doi.org/10.1080/13651501.2020.1833039. PMID: 33084454.
9. Bilbeny N. DOLOR CRÓNICO EN CHILE. Rev médica Clín Las Condes. 2019;30(6):397–406.
10. Fricton J. Myofascial Pain: Mechanisms to Management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311. https://doi.org/10.1016/j.coms.2016.03.010. PMID: 27475508.
11. Khan I, Ahmad A, Ahmed A, Sadiq S, Asim HM. Effects of dry needling in lower extremity myofascial trigger points. J Pak Med Assoc. 2021;71(11):2596-2603. https://doi.org/10.47391/JPMA.01398. PMID: 34783743.
12. Blasco-Bonora PM, Martín-Pintado-Zugasti A. Effects of myofascial trigger point dry ne-edling in patients with sleep bruxism and temporomandibular disorders: a prospective case series. Acupunct Med. 2017;35(1):69-74. https://doi.org/10.1136/acupmed-2016-011102.PMID: 2769776 9.
13. Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y, Song T, Shen W, Yu LZ, Zheng YJ, Liu YQ, Huang D. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases. 2021 Mar 26;9(9):2077-2089. https://doi.org/110.12998/wjcc.v9.i9.2077. PMID: 33850927; PMCID: PMC8017503.
14. Anwar N, Wei X, Jie Y, Hongbo Z, Jin H, Zhu Z. Current advances in the treatment of myofascial pain syndrome with trigger point injections: A review. Medicine. 2024;103(40):e39885. https://doi.org/10.1097/MD.0000000000039885. PMID:39465697
15. Fernández-De-Las-Peñas C, Plaza-Manzano G, Sanchez-Infante J, Gómez-Chiguano GF, Cleland JA, Arias-Buría JL, López-de-Uralde-Villanueva I, Navarro-Santana MJ. Is Dry Needling Effective When Combined with Other Therapies for Myofascial Trigger Points Associated with Neck Pain Symptoms? A Systematic Review and Meta-Analysis. Pain Res Manag. 2021 Feb 2;2021:8836427. https://doi.org/10.1155/2021/8836427. PMID: 33603940; PMCID: PMC7872772.
16. Lew J, Kim J, Nair P. Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis. J Man Manip Ther. 2021;29(3):136–46.
17. Fernández-De-Las-Peñas C, Plaza-Manzano G, Sanchez-Infante J, Gómez-Chiguano GF, Cleland JA, Arias-Buría JL, López-de-Uralde-Villanueva I, Navarro-Santana MJ. Is Dry Needling Effective When Combined with Other Therapies for Myofascial Trigger Points Associated with Neck Pain Symptoms? A Systematic Review and Meta-Analysis. Pain Res Manag. 2021;2021:8836427. https://doi.org/10.1155/2021/8836427. PMID: 33603940
18. CASP checklists. CASP - Critical Appraisal Skills Programme.
19. Dib-Zakkour J, Flores-Fraile J, Montero-Martin J, Dib-Zakkour S, Dib-Zaitun I. Evaluation of the Effectiveness of Dry Needling in the Treatment of Myogenous Temporomandibular Joint Disorders. Medicina. 2022;58(2).
20. Özden MC PhD, Atalay B DDS, MSc, PhD, Özden AV DDS, PhD, Çankaya A DDS, PhD, Kolay E PhD, Yıldırım S DDS, PhD. Efficacy of dry needling in patients with myofascial temporomandibular disorders related to the masseter muscle. Cranio. 2020;38(5):305-311. https://doi.org/10.1080/08869634.2018.1526848.
21. Sirikaku K, Watinaga GK, de Souza Moraes S, Guimarães TB, Onishi ET. Effect of Dry Needling on the Masseter Muscle in the Tin-nitus Perception of Patients with Temporo-mandibular Disorder. J Maxillofac Oral Surg. 2023;22(3):571–8.
22. Kütük SG, Özkan Y, Kütük M, Özdaş T. Comparison of the Efficacies of Dry Needling and Botox Methods in the Treatment of Myofascial Pain Syndrome Affecting the Temporomandibular Joint. J Craniofac Surg. 2019;30(5):1556–9.
23. Macedo CF de, Sonza A, Puel AN, Santos ARD. Trigger point dry needling increases mas-seter muscle oxygenation in patients with temporomandibular disorder. J Appl Oral Sci. 2023;31:e20230099.
24. Agarwal V, Gupta A, Singh H, Kamboj M, Popli H, Saroha S. Comparative Efficacy of Platelet-Rich Plasma and Dry Needling for Management of Trigger Points in Masseter Muscle in Myofascial Pain Syndrome Patients: A Randomized Controlled Trial. J Oral Facial Pain Headache. 2022; 36(3-4):253–262. https://doi.org/10.11607/ofph.3188.
25. Taşkesen F, Cezairli B. The effectiveness of the masseteric nerve block compared with trigger point injections and dry needling in myofascial pain. CRANIO®. 2023;41(2):96–101.
26. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994 Jul-Aug;73(4):256–63.
27. Fernández-Carnero J, La Touche R, Ortega-Santiago R, Galan-del-Rio F, Pesquera J, Ge HY, Fernández-de-Las-Peñas C. Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. J Orofac Pain. 2010 Winter;24(1):106-12. PMID: 20213036
28. Tekin L, Akarsu S, Durmuş O, Cakar E, Dinçer U, Kıralp MZ. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clin Rheumatol. 2013 Mar;32(3):309–15.
29. Gattie E, Cleland JA, Snodgrass S. The Effec-tiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical The-rapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;47(3):133-149. https://doi.org/10.2519/jospt.2017.7096. Epub 2017 Feb 3. PMID: 28158962
30. Griswold D, Wilhelm M, Donaldson M, Learman K, Cleland J. The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis. J Man Manip Ther. 2019 Jul;27(3):128–40
31. Hoseininejad Z, Kouhzad Mohammadi H, Azadeh H, Taheri N. Comparison of immediate and delayed effects of superficial and deep dry needling in patients with upper trapezius myofascial trigger points. J Bodyw Mov Ther. 2023 Jan;33:106–11
32. Griswold D, Learman K, Ickert E, Clewley D, Donaldson MB, Wilhelm M, Cleland J. Comparing dry needling or local acupuncture to various wet needling injection types for musculoskeletal pain and disability. A systematic review of randomized clinical trials. Disabil Rehabil. 2024 Feb;46(3):414-428. https://doi.org/10.1080/09638288.2023.2165731. Epub 2023 Jan 12. PMID: 36633385.
33. Zha M, Chaffee K, Alsarraj J. Trigger point injections and dry needling can be effective in treating long COVID syndrome-related myalgia: a case report. J Med Case Rep. 2022 Jan 17;16(1):31. https://doi.org/10.1186/s13256-021-03239-w. PMID: 35039086; PMCID: PMC8763132.
34. Lewit K. The needle effect in the relief of myofascial pain. Pain. 1979;6(1):83–90.
35. Venancio R de A, Alencar FGP Jr, Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009 Jan;27(1):46–53.
36. Boyce D, Wempe H, Campbell C, Fuehne S, Zylstra E, Smith G, Wingard C, Jones R. Adverse events associated with therapeutic dry needling. Int J Sports Phys Ther. 2020;15(1):103-113. PMID: 32089962; PMCID: PMC7015026.
37. Kearns GA, Brismée JM, Riley SP, Wang-Price S, Denninger T, Vugrin M. Lack of standardization in dry needling dosage and adverse event documentation limits outcome and safety reports: a scoping review of randomized clinical trials. J Man Manip Ther. 2023;31(2):72–83.
38. Martín-Pintado-Zugasti A, Mayoral Del Moral O, Gerwin RD, Fernández-Carnero J. Post-needling soreness after myofascial trigger point dry needling: Current status and future research. J Bodyw Mov Ther. 2018 Oct;22(4):941-946. https://doi.org/10.1016/j.jbmt.2018.01.003. Epub 2018 Jan 17. PMID: 30368339.
39. McAphee D, Bagwell M, Falsone S. Dry needling: A clinical commentary. Int J Sports Phys Ther. 2022 Jun 1;17(4):551–5.
40. Castro Sánchez AM, García López H, Fernández Sánchez M, Pérez Mármol JM, Aguilar-Ferrándiz ME, Luque Suárez A, Matarán Peñarrocha GA. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. Disabil Rehabil. 2019;41(19):2235-2246. https://doi.org/10.1080/09638288.2018.1461259. Epub 2018 Apr 23. PMID: 29681188.
41. Rothman MG, Ortendahl M, Rosenblad A, Johansson AC. Improved quality of life, working ability, and patient satisfaction after a pretreatment multimodal assessment me-thod in patients with mixed chronic muscular pain: a randomized-controlled study. Clin J Pain. 2013;29(3):195-204. https://doi.org/10.1097/AJP.0b013e 318250e544. PMID: 22469637.
42. He P, Fu W, Shao H, Zhang M, Xie Z, Xiao J, Li L, Liu Y, Cheng Y, Wang Q. The effect of therapeutic physical modalities on pain, function, and quality of life in patients with myofascial pain syndrome: a systematic review. BMC Musculoskelet Disord. 2023;24(1):376. https://doi.org/10.1186/s12891-023-06418-6. PMID: 37173661; PMCID: PMC10176871.
CONFLICT OF INTERESTS
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AUTHORS’ CONTRIBUTIONS
Rosario Bäumle: Investigation, Methodology, Writing – Original Draft. | Camilo León-Morales: Conceptualization, Formal Analysis, Supervision, Writing – Review and Editing. | Gustavo Ossa: Investigation, Methodology, Writing – Original Draft.
Rosario Bäumle: Investigación, Metodología, Redacción – Borrador original. | Camilo León-Morales: Conceptualización, Análisis formal, Supervisión, Redacción – Revisión y edición. | Gustavo Ossa: Investigación, Metodología, Redacción – Borrador original.
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