OBJECTIVE: To assess the effectiveness of different dosages of local twitch responses (LTRs) elicited by deep dry needling (DDN) in relation to pain intensity, pressure pain threshold (PPT), cervical range of movement (CROM), and disability degree in cervical myofascial pain patients. DESIGN: A randomized, double-blind clinical trial. PARTICIPANTS: Eighty-four patients (21 males, 63 females; 27.18 +/- 10.91 yrs) with cervical pain. INTERVENTIONS: DDN in active myofascial trigger points (MTrPs) in the upper trapezius. Patients were randomly divided into four groups: (a) no LTRs elicited, (b) four LTRs elicited, (c) six LTRs elicited, and (d) needling until no more LTRs were elicited. OUTCOME MEASURES: Pain intensity, PPT, CROM, and disability degree were assessed before treatment, post-immediate, 48 hrs, 72 hrs, and 1 wk after treatment. RESULTS: Significant differences were found in the time factor for all the variables (p < 0.005), but no significant changes were found in the group-time interaction (p > 0.05). CONCLUSIONS: DDN in the upper trapezius MTrP improved pain at a 1-wk follow-up, but improvements were not significantly different among DDN dosages. A higher number of patients with neck pain improvements superior to the moderate clinically important differences were observed when eliciting 6 LTRs and LTRs until exhaustion compared with not eliciting LTRs.

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