Does Dry Needling Work for Pain? Research Reviews & Alternative Treatment

Does Dry Needling Work for Pain?

Introduction 

A significant percentage of the general population suffers from persistent pain. While pharmacological formulations provide pain relief, a lot of people seek relief from complementary and alternative medicine (CAM). Common concerns among these individuals are headache, neck pain, thoracic pain, low back pain, and other musculoskeletal pain conditions. CAM interventions include electroacupuncture, dry needling, laser acupuncture, herbal medicine, spinal manipulation, laser therapy, t’ai chi, and chiropractic. (1) This article discusses the current scientific evidence available for the effectiveness of dry needling in relieving pain and described the correct and evidence-based way of relieving pain in the context of the healing cycle. 

What is Dry Needling?

Dry needles are used in acupuncture practice. These are thin monofilament needles and do not require injectate into tendons, ligaments, subcutaneous fascia, scar tissue, and muscles. Dry needles can also be inserted proximal to the neurovascular bundles and peripheral nerves for the management of different neuromusculoskeletal pain syndromes. Dry needling is also considered a treatment of myofascial trigger points. (2)

Dry Needling – The Claims and Available Research 

The claims related to microneedling and pain relief are listed as follows. 

  1. Dry needling treats myofascial pain as it releases fascia restrictions
  2. Dry needling relieves muscle pain
  3. Dry needling decreases inflammation 
  4. Dry needling improves functional activities 

Following is a description of different research studies related to the use of dry needling for pain relief. 

Table 1 Research Reviews on Dry Needling for Pain

Study Title 

Is Dry Needling Effective for Pain 

Dry needling: A literature review with implications for clinical practice guidelines (2)

This study revealed that dry needling does not have a significant effect on the functional outcomes when it was compared with sham needling or no treatment. There is a lack of supporting evidence regarding the long-term benefits of dry needling for pain relief. 

Dry needling in subjects with muscular trigger points in the lower quarter: A systematic review (3)

In this systematic review, a total of 6 studies were reviewed. The findings of the study suggested that there are no positive effects of dry needling on the quality of life, strength, function, and range of motion. 

The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis (4)

In this study, 218 articles were included initially. After screening, only 13 articles were included in the systematic review and meta-analyses. This study involves a total of 8 meta-analyses. The study concluded that there are no differences in the functional outcomes. However, functional outcomes are different when dry needling compared to other treatments in physical therapy. There is a lack of evidence related to the long-term benefits of dry needling. 

Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: A systematic review (5)

This systematic review included a total of 3 studies. The review concluded that there is limited evidence present for supporting the effects of dry needling or injection of the myofascial trigger points that are related to the onset of plantar heel pain.

Normal Healing Cycle

The normal healing cycle comprises three stages that occur in a certain sequence and in a timely manner. These stages are called the inflammation stage, proliferation stage, and maturation stage. The description of each stage of the healing cycle is mentioned as follows. (6)

Table 2 Phases of the Normal Healing Cycle 

Inflammation Phase

Proliferation Phase

Maturation Phase 

This is the initial phase of the healing cycle. The cardinal signs of this stage of the healing cycle are loss of function, warmth, redness, pain, and swelling. The immune cells and inflammatory cells at the site of the affected area work in harmony to eliminate the injurious stimuli. This phase also involves the release of inflammatory mediators and cytokines which modulate the different mechanisms of inflammation. 

This is the second phase of the healing cycle. In this stage, new blood vessels form, collagen is deposited by the proliferating fibroblasts, re-epithelization occurs, and an extracellular matrix is produced. This stage of the healing cycle is regulated by negative feedback mechanisms which prevent excessive scar tissue formation and collagen deposition. 

This is the last phase of the healing cycle and is marked by the resolution of the healing cycle. The three key mechanisms occurring in this stage are the replacement of type III collagen with type I collagen, scar formation, and wound contraction.

Chronic Conditions and Healing Cycle 

In chronic conditions, the proliferation phase and inflammation phase of the healing cycle persists for a relatively longer duration and fail to achieve resolution, which leads to oscillation of the healing cycle between these two stages. This manifests as the formation of excess scar tissue, muscle spasm, muscle knots or trigger points, and fascia restrictions, which may lead to pain and restricted mobility. (6)

Effective Treatments for Pain Relief 

Evidence-based and effective therapeutic strategies for relieving pain are described as follows. These are broadly classified into strategies for the resolution of the inflammation stage of the healing cycle and the resolution of the proliferation stage of the healing cycle. 

  1. Adequate rest, consumption of an anti-inflammatory diet, use of a MagnaHeal device, and addressing nutrient deficiencies are important for the resolution of the inflammation stage of the healing cycle. MagnaHeal devices are of two types. MagnaHeal 1 is used for mild inflammation and MagnaHeal 2 is used for severe inflammation. An anti-inflammatory diet comprises fruits, vegetables, whole grains, legumes, and fish. AskASTR program is useful for the recognition and management of nutrient deficiencies that otherwise hinder the process of inflammation. (7, 8, 9)
  2. The release of fascia restrictions, muscle trigger points, and scar tissue is crucial to the resolution of the proliferation stage of the healing cycle. Required tools include A1, A3, and A5 tools. 

Conclusion 

A significant percentage of individuals complain of persistent pain and tend to opt for CAM interventions such as dry needling for pain relief. Although dry needling claims to relieve pain and reduce inflammation, scientific studies don’t support these claims. An effective and evidence-based strategy to counter pain is to target both inflammation and proliferation stages of the healing cycle. 

References 

  1. Zheng, Z., & Xue, C. C. (2013). Pain research in complementary and alternative medicine in Australia: a critical review. Journal of alternative and complementary medicine (New York, N.Y.)19(2), 81–91. https://doi.org/10.1089/acm.2011.0233 
  2. Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: a literature review with implications for clinical practice guidelines. Physical therapy reviews : PTR19(4), 252–265. https://doi.org/10.1179/108331913X13844245102034
  3. Morihisa, R., Eskew, J., McNamara, A., & Young, J. (2016). DRY NEEDLING IN SUBJECTS WITH MUSCULAR TRIGGER POINTS IN THE LOWER QUARTER: A SYSTEMATIC REVIEW. International journal of sports physical therapy11(1), 1–14.
  4. Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. The Journal of orthopaedic and sports physical therapy47(3), 133–149. https://doi.org/10.2519/jospt.2017.7096
  5. Cotchett, M. P., Landorf, K. B., & Munteanu, S. E. (2010). Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. Journal of foot and ankle research3, 18. https://doi.org/10.1186/1757-1146-3-18 
  6. Grubbs H, Manna B. Wound Physiology. [Updated 2022 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518964/
  7. Ross, C. L., & Harrison, B. S. (2013). Effect of pulsed electromagnetic field on inflammatory pathway markers in RAW 264.7 murine macrophages. Journal of inflammation research6, 45–51. https://doi.org/10.2147/JIR.S40269 
  8. Ricker, M. A., & Haas, W. C. (2017). Anti-Inflammatory Diet in Clinical Practice: A Review. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition32(3), 318–325. https://doi.org/10.1177/0884533617700353 
  9. Gatt A, Agarwal S, Zito PM. Anatomy, Fascia Layers. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526038/