Many clinicians have noted nonspecidfic pain modulating effects of injecting NACL0.9% or sterile water or another sterile solution which is considered inactive (used in the control group).

It is hypothesized that subcutaneous and intracutaneous injections modulate pain through:

1/ Dry needling effect: the effect of the needle which penetrates the skin and or muscle tissue such a 1A/ s the bleeding effect (blood contains platelets and growth factors), 1B/ triggerpoint effect when needling myofascial trigger points, 1C/ Gate control effect, 1D Effect on neuroinflammation, TRPV1 receptors,

2/ Volume effect: expansion of the extracellular space stimulates peripheral nerve endings

3/ Placebo effect (the placebo effect of an injection is bigger than a pil, but the effect seems to lessen after repeated sessions)

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