Objectives: To compare post-needling soreness among three different soreness reduction methods: diclofenac spray with contract-relax stretching, cold gel pack with self-stretching, and spray and stretch technique in patients after upper trapezius dry needling.

Study design: A randomized controlled trial.

Setting: Department of Rehabilitation Medicine, Phetchabun Hospital, Phetchabun Province, Thailand.

Subjects: One hundred and twenty-six participants who had a numeric rating scale (NRS) score of post-needling soreness intensity of 3 or more and who received dry needling as a treatment of myofascial pain syndrome at the upper trapezius.

Methods: Participants were allocated into three groups (42 patients per group) which received different soreness reduction methods: a cold gel pack combined with self-stretching (CP group), a diclofenac spray combined with contract-relax stretching (DCF group), and a spray and stretch technique (SS group). The primary outcome was the post-needling soreness numeric rating scale score. Secondary outcomes were muscle pain NRS and pain-free cervical range of motion (ROM).

Results: No statistically significant difference (p > 0.05) among the dependent variables, including post-needling soreness, muscle pain, and pain-free forward neck flexion, was observed among the 3 groups with the exception of pain-free lateral neck flexion which was greater in the DCF and SS group. Pairwise analyses demonstrated that the DCF and SS groups both had significantly greater post-needling soreness reduction immediately after the treatment when compared with the CP group (DCF = -1.9, SS = -1.5, CP = -0.7) and also 24 hours after dry needling (DCF = -2.6, SS = -2.1, CP = -1.3).

Conclusions: DCF spraying with contract-relax stretching can reduce post-dry needling soreness at the upper trapezius muscle at a level comparable to the spray and stretch technique. Both methods were superior to cold gel packs with self-stretching. In addition to the spray and stretch techniques, DCF spraying with

 contract-relax stretching might be the intervention of choice to effectively reduce post-dry needling soreness at the upper trape-zius muscle.