Dry needling for myofascial trigger point pain: what the evidence shows

Dry needling is a technique that uses thin needles to address pain in muscles and connective tissues [1]. It is often used to treat what are known as myofascial trigger points [2]. These are tender spots in muscles that can cause pain [2].

This article summarizes findings from recent research on dry needling for musculoskeletal pain. It also discusses the safety of dry needling and important considerations about practitioner qualifications.

What is Dry Needling?

Dry needling involves inserting a thin needle, without injecting any substance, into a myofascial trigger point [1]. The goal is to reduce pain and improve muscle function [1]. This technique is distinct from acupuncture, which is based on traditional Chinese medicine principles. You can learn more about how dry needling differs from acupuncture.

Dry needling is commonly used by physical therapists and other regulated health professionals to treat various types of musculoskeletal pain [1].

Research on Dry Needling Effectiveness

To understand how effective dry needling may be, researchers often conduct systematic reviews and meta-analyses. A systematic review gathers all available studies on a topic, while a meta-analysis combines the results of several studies to provide a more comprehensive picture. Two such reviews were published in 2017, examining the evidence for dry needling.

Review 1: Gattie et al. (2017)

This systematic review and meta-analysis looked at the effectiveness of dry needling performed by physical therapists for any musculoskeletal pain condition [1].

Study Design and Methods Researchers searched electronic databases for randomized controlled trials (RCTs) [1]. RCTs are studies where participants are randomly assigned to different treatment groups, which helps compare the effects of an intervention against a control or other treatments [1]. The review included studies where human subjects with musculoskeletal conditions were treated with dry needling by a physical therapist [1].

Included Studies and Quality of Evidence The initial search found 218 articles, but only 13 met the specific criteria for inclusion in the review [1]. The quality of these studies was assessed using a scale called the Physiotherapy Evidence Database (PEDro) scale, with scores ranging from 4 to 9 out of a maximum of 10, and a median score of 7 [1]. The overall quality of the evidence was described as "very low-quality to moderate-quality" [1]. This means that while some studies showed positive results, the certainty of these findings was not consistently high across all included research [1].

Findings: Immediate to Short-Term Effects (up to 12 weeks) The review found that in the period immediately following treatment up to 12 weeks later, dry needling may offer benefits: * Pain Reduction: Studies provided evidence that dry needling may decrease pain when compared to no treatment, sham needling (where needles are inserted superficially or in non-trigger point areas), or other treatments [1]. * Pressure Pain Threshold: Dry needling may also increase the pressure pain threshold, meaning the point at which pressure becomes painful [1]. This was observed when compared to control/sham or other treatments [1]. * Functional Outcomes: When compared to no treatment or sham needling, dry needling showed a statistically significant effect on functional outcomes [1]. Functional outcomes refer to a person's ability to perform daily activities. However, the review found no difference in functional outcomes when dry needling was compared to other types of physical therapy treatments [1].

Findings: Longer-Term Effects (6 to 12 months) For follow-up periods between 6 and 12 months, the results were less clear: * Dry needling was "favored for decreasing pain," but this treatment effect was "not statistically significant" [1]. This means that while there might have been a trend towards less pain, the evidence was not strong enough to confidently say it was due to dry needling [1]. * The review concluded that "evidence of long-term benefit of dry needling is currently lacking" [1].

Conclusion of the Review Gattie et al. concluded that "very low-quality to moderate-quality evidence" suggests dry needling performed by physical therapists is more effective than no treatment, sham dry needling, and other treatments for reducing pain and improving pressure pain threshold in the immediate to 12-week follow-up period [1]. For functional outcomes, "low-quality evidence" suggested superior results with dry needling compared to no treatment or sham needling, but no difference compared to other physical therapy treatments [1]. The review highlighted the lack of evidence for long-term benefits [1].

Review 2: Espejo-Antúnez et al. (2017)

This systematic review of randomized controlled trials also aimed to examine the effectiveness of dry needling in managing myofascial trigger points [2]. It also explored how specific aspects of the technique might affect its results [2].

Study Design and Methods Researchers identified relevant studies published between 2000 and 2015 by searching several major medical and physiotherapy databases [2]. They screened these studies against specific criteria to decide which ones to include [2].

Included Studies and Outcomes Measured This review included 15 studies [2]. The main outcomes measured in these studies were pain levels, range of motion (how far a joint can move), disability, depression, and quality of life [2].

Findings: Short-Term Effects The results of this review suggested that dry needling is effective in the short term for: * Pain Relief: It helped reduce pain [2]. * Increased Range of Motion: It helped improve how far a joint could move [2]. * Improved Quality of Life: It had a positive effect on participants' overall quality of life [2]. These benefits were observed when dry needling was compared to no intervention, sham treatment, or placebo [2].

Areas with Insufficient Evidence The review also found that there was "insufficient evidence" to determine dry needling's effect on: * Disability [2]. * Analgesic medication intake (how much pain medication people took) [2]. * Sleep quality [2].

Conclusion of the Review Espejo-Antúnez et al. concluded that despite "some evidence for a positive effect in the short term," more randomized clinical trials are needed [2]. They emphasized the need for studies of "high methodological quality" that use "standardized procedures for the application of dry needling" [2].

Common Limitations Noted by Reviews

Both systematic reviews highlighted several limitations in the existing research on dry needling for myofascial trigger point pain: * Small Sample Sizes: Many of the individual studies included in the reviews involved a small number of participants [1, 2]. Smaller studies can sometimes lead to less reliable results. * Heterogeneous Protocols: The ways dry needling was performed varied significantly across studies [1, 2]. Differences in needle size, depth, duration, and number of needles used can make it difficult to compare results consistently [1, 2]. * Risk of Bias: The overall quality of the evidence was often described as low or very low [1]. This suggests that there might be factors in the study designs that could influence the results, such as how participants or researchers were aware of the treatment being given [1, 2].

These limitations mean that while dry needling shows promise for short-term effects, more high-quality, standardized research is needed to fully understand its effectiveness, especially for long-term benefits [1, 2].

Safety of Dry Needling: Adverse Events

Understanding the safety profile of any treatment is important. A prospective survey conducted by Brady et al. in 2014 investigated the adverse events (AEs) associated with trigger point dry needling [3].

Study Design and Methods This study was a prospective survey, meaning data was collected as treatments were happening [3]. It involved 39 chartered physiotherapists in Ireland who had completed specific dry needling training [3]. Data was collected over a ten-month period using two forms: one for mild adverse events and one for significant adverse events [3].

Results: Incidence of Adverse Events The survey collected data from 7,629 dry needling treatments [3]. * Mild Adverse Events: A total of 1,463 mild adverse events were reported [3]. This means that mild adverse events occurred in 19.18% of treatments [3]. * Significant Adverse Events: No significant adverse events were reported in any of the 7,629 treatments [3]. Based on this, the estimated upper risk rate for significant adverse events was calculated to be less than or equal to 0.04% [3].

Types of Mild Adverse Events The survey detailed the types of mild adverse events that occurred: * Common Adverse Events: * Bruising: 7.55% of treatments [3]. * Bleeding: 4.65% of treatments [3]. * Pain during treatment: 3.01% of treatments [3]. * Pain after treatment: 2.19% of treatments [3]. * Uncommon Adverse Events: * Aggravation of symptoms: 0.88% of treatments [3]. * Drowsiness: 0.26% of treatments [3]. * Headache: 0.14% of treatments [3]. * Nausea: 0.13% of treatments [3]. * Rare Adverse Events: * Fatigue: 0.04% of treatments [3]. * Altered emotions: 0.04% of treatments [3]. * Shaking, itching, claustrophobia, and numbness: all occurred in 0.01% of treatments [3].

Conclusion of the Survey The authors concluded that while mild adverse events were very commonly reported in this study, no significant adverse events occurred [3]. For the physiotherapists surveyed, trigger point dry needling "appeared to be a safe treatment" [3].

Scope of Practice and Practitioner Qualifications

Dry needling is a technique that may be performed by different regulated health professions, depending on provincial regulations [5]. In Canada, each province has its own rules about which professionals can perform certain health services and what training is required [5].

Regulatory colleges are bodies that govern health professions in the public interest [5]. They set standards of practice, codes of ethics, and continuing education requirements for their members [5]. These standards help ensure that health professionals provide services in a competent, safe, and ethical manner [5].

For example, in Alberta, the College of Physiotherapists of Alberta [4] regulates physiotherapists. The Government of Alberta provides information about how regulated health professions and regulatory colleges function in the province [5]. It explains that no single profession has exclusive ownership of a specific skill, and different professions may provide the same health services, provided it is within their authorized scope of practice [5].

Before undergoing dry needling, it is important to: * Confirm your practitioner's training: Ask about their specific qualifications and training in dry needling. * Verify their professional registration: Check with their provincial regulatory college to ensure they are licensed and in good standing. * Ensure the practice is within their authorized scope: Confirm that performing dry needling is within the legal scope of practice for their profession in your province.

Checking with the relevant regulatory college can provide clarity on a practitioner's qualifications and the services they are authorized to provide. For example, you can find physiotherapy clinics in Edmonton and then verify their practitioners' credentials.

What this means for you

Based on current research, dry needling may offer short-term benefits for people experiencing myofascial trigger point pain. * Evidence suggests it may help reduce pain and improve pressure pain threshold in the immediate to 12-week period [1, 2]. * It may also improve range of motion and quality of life in the short term [2]. * However, the evidence for long-term benefits is currently lacking [1]. * While mild adverse events like bruising and pain are common, serious adverse events appear to be rare [3].

If you are considering dry needling for musculoskeletal pain, it is important to discuss your options with a regulated health professional. A licensed professional can assess your specific condition and help determine if dry needling is a suitable treatment option for you. They can also explain the potential benefits and risks based on your individual health needs. Always ensure that any practitioner you choose is properly trained and authorized to perform dry needling in your province.