Effects of dry needling and therapeutic exercise on sleep in individuals with chronic neck pain and sleep disturbance: A pilot randomized clinical trial
Although there is evidence demonstrating a bidirectional relationship between sleep and pain, non-pharmacological interventions are lacking to address both sleep dysfunction and pain together. Therefore, research that investigates the effects of non-pharmacological interventions not only on pain but also on sleep dysfunction is warranted. As dry needling (DN) has been shown to influence biochemical substances that are associated with both pain modulation and sleep regulation, it has potential as an effective intervention in addressing sleep disturbance (SD) in patients with chronic neck pain (CNP). Before a large-scale randomized clinical trial (RCT) is carried out to examine the effects of DN for individuals with CNP and SD, a pilot study was conducted in order to examine the feasibility of an RCT. Therefore, the purposes of this pilot RCT were to determine: 1) the feasibility of an RCT aimed to examine the effects of DN in addition to therapeutic exercise (TE) in individuals with CNP and SD, and 2) the effect sizes of DN in order to estimate an appropriate sample size for a large-scale RCT. Thirty eligible participants were randomly assigned into two groups: DN plus TE (n = 14) and TE only (n = 16), but two from the TE group dropped out. The outcome measurements included total sleep duration using wrist actigraphy, sleep quality using the Pittsburgh Sleep Quality Index (PSQI), pain severity using the Numerical Pain Rating Scale (NPRS), and disability level using the Neck Disability Index (NDI). Sleep duration was collected four times: at baseline in week 1 and weekly in the following 3 weeks. The PSQI, NPRS and NDI scores were collected three times: at baseline, the 4-week follow-up, and the 12-week follow-up. The results demonstrated that a large-scale RCT is feasible and provided necessary insight into budgetary and personnel requirements. Additionally, a sample size of 68 was estimated for a full RCT. The effect size results suggest that PSQI is useful for detecting improvement in sleep quality for individuals with CNP and SD. However, total sleep time via actigraphy may not be a useful outcome measurement.
Sleep duration, Sleep quality, Chronic neck pain, Actigraphy, Sleep disturbance, Dry needling, Physical therapy
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