In this weeks post I have given a quick rundown of the evidence relating to the use of Dry Needling as a technique falling under the ‘umbrella’ of Medical Acupuncture in the treatment of trigger points related myofascial pain.
I have not provided links to each study, however a quick Google scholar search of the author, year and subject should locate the full article’s if required.
The effectiveness and efficacy of Dry Needling
Kietrys DM (2013) in a meta analysis found that dry needling can be effective in providing pain relief. These studies noted that a “twitch” often occurs when a needle is inserted into the trigger point, and this “twitch” may be a sign that the treatment will be helpful. Effects of dry needling varied across studies and that more research needs to be done to determine whether dry needling is better for this condition than other treatment options.
Tough et al (2007) highlights problems with problem with diagnosis – most studies consider secondary myofascial pain i.e. in association with some other problem e.g. underlying OA which may negatively affect outcomes to dry needling. Studies need to be based on careful diagnosis i.e. treatment of primary myofascial pain to reveal true effectiveness of dry needling.
Knowles (2003) found Acupuncture needling combined with stretch more effective than stretch alone, as well as no treatment for trigger point related pain scores and PPT’s at 3 weeks follow up.
Ceccherelli et al (2003) found deep dry needling to be more effective than superficial needling at trigger points for shoulder pain at 3 months follow up.
Cummings et al (2001) confirms dry needling is effective for trigger points. Sham needling may be as effective as dry needling trigger points directly. Dry needling and wet needling show no difference for effectiveness. Wet needling effects are independent of substance injected, so when treating trigger points, effect may be due to needle not injected substance.
Tough, White, Cummings (2009) Dry needling and ‘sham’ were both clinically effective when treating trigger points. But methodology issues1. Were TrP sole cause of pain? 2. Small sample sizes more likely to lead to a false negative 3.Treatment interventions varied considerably limiting conclusions.
Kalichman (2010) concluded that the effectiveness of dry needling confirmed in 2 comprehensive systematic reviews and numerous studies. But efficacy beyond ‘placebo’ or ‘sham’ not well established.
Furlan et al (2005) found dry needling more effective than sham needling and no treatment for low back pain – effects were at immediate and short term follow up only.
Edwards and Knowles (2003) found superficial needling combined with stretch > stretch only or no treatment for shoulder pain after six weeks.
Naslund et al (2003) found superficial needling as effective as deep needling for idiopathic knee pain at 3 and six month follow ups. There were fewer adverse reactions with superficial needling.
Deep versus superficial needling?
Baldry (2005) has shown good empirical results with superficial needling ie 5-10mm for 30 secs, then up to 2/3 mins if no change in sensitivity.
Ceccherelli et al (2002) found superficial needling to be as effective as deep needling in lumbar myofascial pain immed after treatment but deep needling better at 3 month follow up.
Itoh et al (2004) found a trend in favour of deep needling at trigger points being more effective than standard acupuncture at acupuncture points as well as superficial dry needling for elderly patients with chronic low back pain but no statistical significance between.
Needling MTrP with paraspinal needling?
Gunn (1997) advocates deep needling at trigger points AND the relevant paraspinal (multifidus) muscles of the same spinal segment/s (as the muscle being needled). His theory proposes the release of multifidus results in decompression of the segment and regulation of neural outflow from the spinal nerves resulting in reduced sensitivity through the corresponding spinal segment/ myotome.
Ga et al (2007) found dry needling of trigger points in the upper trapezius muscle combined with paraspinal needling was more effective than dry needling at the trigger points in the UFT alone in elderly patients. Outcome measures included a reduction in continuous pain, the geriatric depression scale and improved cervical range of motion. However as the study was small (n=40) with insufficient blinding, conclusions that more research required.
I am sure I may have missed a study or two, please tweet my should you have any relevant quality studies I should include in my next review.
Have a good week.
