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Gross, et al reply To the Editor: We thank Bjordal and Joensen for their thorough review of our recently published systematic review. We agree that we have overclassified the study by Stav, et al. Bjordal and Joensen's comments are consistent with our focused medicines and injections systematic review1, in which we classified the Stav trial as providing limited evidence. Bjordal and Joensen are correct that the trial reported by Esenyel, et al2 was classified as limited evidence. However, we considered these results with other evidence from our Cochrane Review1, where intramuscular injection of lidocaine was superior to placebo and to dry needling2-4. To provide a consistent presentation across our reviews we chose to highlight particular findings in the abstract. ANITA R. GROSS, BScPT, MSc, Grad Dip Manip Therapy, Associate Clinical Professor, School of Rehabilitation Sciences, McMaster University, 1400 Main Street West, Hamilton, Ontario L8N 3Z5, Canada; PAUL PELOSO, MD, MSc, FRCPC, Director, Product Benefit Risk Assessment and Management, Amgen Inc.; TED HAINES, MSc, MD, DOHS, FRCPC, Associate Professor, Program in Occupational Health and Environmental Medicine; KIEN TRIHN, MSc, MD, Dip Sports Med, Assistant Clinical Professor, School of Medicine, McMaster University. Address reprint requests to A.R. Gross. E-mail: grossa@mcmaster.ca 2. Esenyel M, Caglar N, Aldemir T. Treatment of myofascial pain. Am J Phys Med Rehabil 2000;79:48-52. [MEDLINE] 3. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point: The importance of the local twitch response. Am J Phys Med Rehabil 1994;73:256-63. [MEDLINE] 4. Kamanli A, Kaya A, Ardicoglu O, et al. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int 2005;25:604-11. [MEDLINE]
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