It is estimated that neck pain is the fourth cause of disability in the United States [1], with an annual prevalence of 37.2% [2]. The neck pain episodes that remain for 3 or more months are classified as chronic neck pain (CNP). Around 50% of the cases may experience pain one year after the onset [3].

It is well known that patients with CNP may present a lack of deep cervical flexor motor control [4], decreased pressure pain threshold (PPT) [5] and disability [6]. In addition, these symptoms are closely linked to psychological distress [[7], [8], [9]].

Currently, the clinical guidelines recommend a combination of education, exercise and electrotherapy for the treatment of CNP [10,11]. The implementation of these strategies has proven effective in diminishing both pain intensity and disability [[12], [13], [14], [15], [16]], and they constitute the established standard care protocol in the rehabilitation departments of primary care settings in Spain [17]. However, the etiology of CNP is still unclear [18] and some authors suggest that the continuous pain may be related to the presence of myofascial trigger points (MTrP) [19,20]. In fact, several systematic reviews have demonstrated the presence of MTrPs in patients with CNP [21,22].

MTrPs are hyperirritable nodules in a taut band of skeletal muscle fibers [23] and are classified as active or latent [24]. Active MTrPs can cause both local and referred spontaneous pain [25]. The local and referred pain described for different neck muscles such as the upper trapezius, levator scapulae or sternocleidomastoid muscles [20] are similar to the pain areas described by patients with CNP.

Dry needling (DN) is an invasive technique based on the introduction of a filiform needle into the MTrP [26]. The current literature suggests that DN reduces musculoskeletal pain in the upper quarter of the body [[27], [28], [29], [30]]. Previous studies performed in CNP population showed that DN provides positive effects in several outcome variables such as pain intensity, hyperalgesia, and disability among others. However, most of the studies compared DN in isolation to a conservative manual technique, a sham technique or no intervention [[31], [32], [33]]. Therefore, the aim of this randomized controlled trial was to evaluate the short-term effects of adding a DN therapy to the standard care protocol used in primary care settings of Spain compared to a sham procedure and to a standard care protocol in isolation in patients with CNP.