{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T14:05:53Z","timestamp":1778249153753,"version":"3.51.4"},"reference-count":64,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Musculoskeletal"],"published-print":{"date-parts":[[2026,3]]},"abstract":"\n Background:<\/jats:title>\n Vasovagal responses (VVR) are common transient autonomic reactions to invasive procedures such as injections or needling, characterized by bradycardia, hypotension, and transient loss of consciousness; however, their occurrence and underlying autonomic mechanisms during dry needling (DN) for myofascial pain syndrome (MPS) remain poorly understood.<\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n This study aimed to determine the frequency of VVR during DN in patients with MPS and to compare autonomic parameters\u2014heart rate variability (HRV), pupil diameter, and skin perfusion\u2014between those with and without VVR.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Prospective observational study.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n In total, 100 adults with acute cervical MPS underwent a standardized DN procedure. Outcomes included pressure pain threshold (PPT), heart rate (HR), blood pressure (BP), HRV indices [average NN interval (AVNN), standard deviation of NN intervals (SDNN), low-frequency (LF)\/high-frequency (HF) ratio], pupil diameter, and skin perfusion, assessed at baseline, 5\u2009min, and 30\u2009min post-intervention. Participants were classified post hoc as VVR positive (VVR+) or VVR negative (VVR\u2212) based on clinical signs of vasovagal reaction.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n No significant changes in skin perfusion or BP were found over time or between groups (\n p<\/jats:italic>\n \u2009>\u20090.05). Significant main effects of time and Time\u2009\u00d7\u2009Group interactions were observed for PPT (\n p<\/jats:italic>\n \u2009<\u20090.001), HR (\n p<\/jats:italic>\n \u2009<\u20090.001), AVNN (\n p<\/jats:italic>\n \u2009<\u20090.001), SDNN (\n p<\/jats:italic>\n \u2009<\u20090.001), LF\/HF ratio (\n p<\/jats:italic>\n \u2009<\u20090.001), and pupil diameter (\n p<\/jats:italic>\n \u2009<\u20090.001). Post hoc analyses revealed that only the VVR+ group showed significant increases in PPT (\n p<\/jats:italic>\n \u2009<\u20090.001), AVNN (\n p<\/jats:italic>\n \u2009<\u20090.001), SDNN (\n p<\/jats:italic>\n \u2009<\u20090.001), and pupil diameter (\n p<\/jats:italic>\n \u2009<\u20090.001), alongside decreases in HR (\n p<\/jats:italic>\n \u2009<\u20090.001) and LF\/HF ratio (\n p<\/jats:italic>\n \u2009<\u20090.001) from baseline to post-intervention. The VVR\u2212 group showed no significant changes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Patients experiencing VVR during DN demonstrated distinct autonomic modulation with parasympathetic predominance, pupil dilation, and increased pain threshold. These findings suggest individual variability in autonomic reactivity during DN and suggest the need for awareness and monitoring of susceptible patients.<\/jats:p>\n <\/jats:sec>\n \n Trial registration:<\/jats:title>\n The clinical registration number is ISRCTN16484644, date: January 28, 2025.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1759720x261422368","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T10:32:41Z","timestamp":1771842761000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Physiological correlates and predictors of vasovagal responses following dry needling in myofascial pain syndrome: a controlled observational study"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4276-4813","authenticated-orcid":false,"given":"Robert","family":"Trybulski","sequence":"first","affiliation":[{"name":"Medical Department Wojciech Korfanty, Upper Silesian Academy in Katowice, Katowice 40-659, Poland"},{"name":"Provita \u017cory Medical Center, \u017cory, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Ku\u017cd\u017ca\u0142","sequence":"additional","affiliation":[{"name":"Institute of Physiotherapy, Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzesz\u00f3w, Rzesz\u00f3w, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gracjan","family":"Olaniszyn","sequence":"additional","affiliation":[{"name":"Medical Department Wojciech Korfanty, Upper Silesian Academy in Katowice, Katowice, Poland"},{"name":"Olaniszyn Physiotherapy Centre, Racib\u00f3rz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bartosz","family":"Kapustka","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Provincial Hospital in Jastrze\u02dbbie Zdr\u00f3j, Jastrze\u02dbbie Zdr\u00f3j, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wies\u0142aw","family":"Marcol","sequence":"additional","affiliation":[{"name":"WSB University Medical College, Da\u02dbbrowa G\u00f3rnicza, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Walicka-Cupry\u015b","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzesz\u00f3w, Rzesz\u00f3w, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.21276\/apjhs.2022.9.4S.44"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2020.08.003"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006205-199504000-00004"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/10582450902820473"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/09638280310001639696"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2008.04.023"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1300\/J094v12n03_06"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.2217\/pmt.12.78"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2010.05.090296"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S154728"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e3181f18c36"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2017.06.003"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2017.7096"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13237032"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.52082\/jssm.2024.548"},{"key":"e_1_3_4_17_2","first-page":"810","article-title":"Pertinent dry needling considerations for minimizing adverse effects\u2014part 2","volume":"11","author":"Halle JS","year":"2016","unstructured":"Halle JS, Halle RJ. 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