ComparativeEfficacyofPlatelet-RichPlasmaandDryNeedlingforManagementofTriggerPointsinMasseterMuscleinMyofascialPainSyndromePatients:ARandomizedControlledTrial

Myofascial pain syndrome (MPS) is a common regional muscular pain condition characterized by myofascial trigger points (MTrPs) in muscles and connective tissues. The masseter muscle is frequently involved, causing facial pain, limited mouth opening, and chewing difficulty that significantly impacts daily functioning and quality of life. While dry needling (DN) has been widely used to inactivate trigger points by eliciting local twitch responses, platelet-rich plasma (PRP) has emerged as a newer therapeutic modality containing growth factors that may promote muscle regeneration and exert anti-inflammatory and analgesic effects. However, no randomized controlled trials had previously compared PRP directly to DN for masticatory MPS, leaving clinicians uncertain whether the benefits of PRP come from the injected solution itself or merely from the mechanical needle effect.

This study aimed to fill that gap by comparing these two interventions head-to-head.

The researchers conducted a randomized controlled trial with 30 patients who had clinically confirmed myofascial trigger points in the masseter muscle, diagnosed according to the 2013 Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Participants were randomly allocated in a 1:1 ratio to either the test group (PRP injection) or the control group (dry needling). The PRP group received 0.5 mL of autologous PRP solution per trigger point, prepared through a two-step centrifugation process. The DN group underwent identical needle insertion into trigger points but without any injected solution, using a back-and-forth motion three to four times.

Both groups could receive retreatment at follow-up visits if pain reduction was less than 50%. Assessments were performed at baseline and at 2-week, 1-month, 3-month, and 6-month follow-ups by an investigator blinded to group assignment. Outcomes included pain measured on a 0-10 visual analog scale (VAS), range of functional jaw movements (maximum unassisted and assisted mouth opening, protrusive movement, and lateral excursive movements), need for pain medication, patient satisfaction on a 1-5 Likert scale, and sleep quality.

Both treatments significantly reduced pain from baseline, but PRP showed superior results at most time points. The mean VAS pain score in the PRP group dropped from 5.47 ± 1.506 at baseline to 1.53 ± 1.060 at 2 weeks, 0.67 ± 0.816 at 4 weeks, 1.13 ± 2.167 at 3 months, and 0.60 ± 1.056 at 6 months. In the DN group, mean VAS decreased from 5.13 ± 1.959 at baseline to 3.07 ± 2.219 at 2 weeks, 2.00 ± 1.732 at 4 weeks, 2.00 ± 2.449 at 3 months, and 2.00 ± 1.964 at 6 months. Intergroup comparisons showed statistically significant differences favoring PRP at 2 weeks (P = .047), 4 weeks (P = .015), and 6 months (P = .019).

Notably, by 6 months, 66.66% of PRP patients were asymptomatic versus only 26.66% in the DN group, and 66.67% of PRP patients were "very satisfied" compared to 26.67% of DN patients. None of the PRP patients required reinjection, while 26.66% of DN patients needed retreatment at 2 weeks and 20% at 4 weeks. At 4 weeks, only 20% of PRP patients needed pain medication versus 53.33% of DN patients. Functional jaw movements improved in both groups but did not differ significantly between them.

No major adverse effects were reported in either group.

For patients with myofascial trigger points in the masseter muscle, a single PRP injection appears to provide faster, more complete, and longer-lasting pain relief compared to dry needling alone. The sustained benefit at 6 months without reinjection suggests that PRP's growth factors and anti-inflammatory properties may actively promote healing beyond the temporary mechanical effect of needle insertion. This could mean fewer treatment sessions and less reliance on pain medications for patients. For clinicians, PRP may be preferable when available, particularly for patients seeking durable relief from masticatory myofascial pain.

However, the study's small sample size (15 per group), lack of patient blinding, and absence of long-term follow-up beyond 6 months mean these findings should be considered preliminary. Larger, multi-center trials with longer observation periods and standardized PRP preparation protocols are needed to confirm these results and establish PRP as a standard treatment option for this common orofacial pain condition.