Trigger Point Injections and dry Needling can be Effective in Treating Long COVID Syndrome-related Myalgia

A Case Report

Mengyi Zha; Kristina Chaffee; Jude Alsarraj


J Med Case Reports. 2022;16(31) 

In This Article

Abstract and Introduction


Introduction: Myofascial pain is a complex health condition that affects the majority of the general population. Myalgia has been recognized as a symptom of long COVID syndrome. The treatment for long COVID syndrome-related myalgia lacks research. Dry needling is a technique that involves the insertion of a needle into the tissue of, or overlaying, a pain point. Wet needling is the addition of an injection of an analgesic substance such as lidocaine while performing needling. Both dry and wet needling have are practiced as treatment modalities for myofascial pain. Limited literature exists to define long COVID syndrome-related myalgia and its relation to myofascial pain, or to examine the utility of needling techniques for this pain. We report a case of dry and wet needling as effective treatments for long COVID-related myofascial pain.

Case Presentation: A 59-year-old, previously healthy Hispanic male with no comorbid conditions was diagnosed with COVID-19 pneumonia. The patient suffered moderate disease without hypoxia and was never hospitalized. Three months later, the patient continued to suffer from symptoms such as exertional dyspnea, "brain fog," and myalgia. An extensive multisystem workup revealed normal cardiac, pulmonary, and end organ functions. The patient was then diagnosed with long COVID syndrome. The nature and chronicity of the patient's myalgia meet the criteria for myofascial pain. Both wet and dry needling were used to treat the patient's myofascial pain, with good short- and long-term therapeutic effects.

Conclusions: COVID-19 infection has been shown to exacerbate preexisting myofascial pain syndrome. Our case report indicates that long COVID syndrome-related myalgia is likely a form of new-onset myofascial pain. Additionally, both wet and dry needling can be utilized as an effective treatment modality for this pain syndrome, with short- and long-term benefits.


Myofascial pain (MP) is a complex health condition that affects many patients, and is thought to occur from muscle overuse, trauma, and psychological stress.[1] The loci of the pain are termed "trigger points," which are tender spots in a taut muscle band. When pressure is applied to these trigger points, it produces a pain response.[2] Although trigger points can be reliably detected on ultrasound as hypoechoic foci within the muscle,[3,4] the exact mechanism by which trigger points form remains debated.[1,5] While not interchangeable, fibromyalgia (FM) and MP syndrome have overlapping diagnostic criteria.[6]

Post-acute COVID or long COVID syndrome (LCS) has become increasingly recognized as a prevalent disease and long-term sequela of COVID-19 survivors.[7–9] Common symptoms include fatigue, dyspnea, palpitations on minimal exertion, cognitive impairment or "brain fog," sleep disturbances, digestive issues, mood disorders, headache, and myalgia.[10,11] Myalgia has been commonly associated with LCS, either in the sense of new pain or exacerbation of preexisting pain.[12–15] Interestingly, myalgia following SARS-CoV-2 infection seems to be independent of the severity of the initial infection.[8] In general, a multidisciplinary approach is recommended for the management of LCS.[9,10,16] However, effective management of this lingering myalgia remains to be explored.

Dry needling (DN) is an umbrella term to describe an array of different techniques that generally involve the insertion of a needle into the tissue of, or overlaying, a trigger point.[17] It is a relatively new, but increasingly widely used technique to treat myofascial pain.[18–20] In some studies, DN is shown to reduce stiffness and tone, improve contractile properties of certain muscles, and decrease pressure pain perception.[21,22] The pain reduction effect of DN is apparent both immediately after treatment and at an interval of 4 weeks in multiple body regions.[23–25] Wet needling (WN), or trigger point injection, is the additional injection of an analgesic substance, such as lidocaine, while performing needling. Long- and short-term efficacy varies between the two techniques.[26] However, acute pain relief tends to be greater with WN.[27–29]

Limited literature exists to define LCS-related myalgia and its relation to MP, though treatment options are urgently needed. Although DN and WN are both effective treatment modalities for MP, their utility for LCS-related myalgia have not been examined.