The VAS is an instrument for measuring perception of current pain, rated from 0 (no pain) to 10 (most severe pain ever experienced). In this study, the VAS was assessed before the first treatment as well as before and after the treatment at week 2 and week 4 and followed up in week 6. Tissue hardness and pressure pain threshold (PPT) were measured using a tissue hardness meter and algometer (OE-220, ITO/JAPAN). Tissue hardness measurement involved pushing the force sensor of the device on the skin over the trapezius muscle until the beep sound was noted and then stopping pushing and reading the recorded number giving the percentage of tissue hardness. PPT was measured using the algometer mode of the device. The 1-cm2 sensor knob was gradually pushed down on the skin over the muscle until the patient feels a little discomfort without pain. At this time, the patient was informed to push the hand-held switch with a beep sound to stop the procedure and read the recorded force for PPT. The reliability of measurement was tested at the beginning of the study and found high for tissue hardness (ICC = 0.97) and PPT (ICC = 0.92). The tissue hardness and the PPT were assessed before the first treatment as well as after the treatment at week 2 and week 4 and followed up in week 6.