Is dry needling Myofascial Trigger Points effective for neck & shoulder pain?

Cervical spine and shoulder pain are some of the most common pathologies treated by musculoskeletal therapists. Many patients with this type of pain will be suffering from active myofasical trigger point (MTrP) pain. These are localised hyper irritable spots within fascia that surround skeletal muscle.

Dry needling (use of acupuncture needles or hollow-core hypodermic needles for therapy of MTrPs) is a treatment that is widely used in clinical practice by physiotherapists, but how does it compare to other available treatments?

Here’s what they did

The authors searched the following 10 databases (English and Chinese) from inception to January 2014: PubMed, EBSCO, PEDro, ScienceDirect, The Cochrane Library, ClinicalKey, Wanfang Data Chinese database, China Knowledge Resource Integrated Database, Chinese Chongqing VIP Information and SpringerLink. Studies were included if they were a randomised controlled trial (RCT) that included patients with MTrPs associated with neck and shoulder pain, and used acupuncture or dry needling as an intervention. Furthermore, pain visual analogue scale or numerical rating scale had to be the outcome measure used. No language restriction was imposed during the search.

Review authors independently screened studies by inclusion/exclusion criteria, extracted data and assessed validity of the included studies using the PEDro scale. A third reviewer adjudicated when necessary.

Here’s what they found

Twenty RCT’s involving a total of 839 patients were identified and included in the 9 meta-analyses completed.

Compared with control/sham, dry needling was effective in the short term (immediately to 3 days) (SMD = -1.91; -3.10 to -0.73 95% CI; p = 0.002) and medium term (9-28 days) (SMD = -.1.07; -1.87- to -0.27 95% CI ; p = 0.009;
However, wet needling (e.g. local anaesthetic injection) was superior to dry needling in relieving MTrP pain in the medium term (SMD = 1.69; 0.40 to 2.98 95% CI; p = 0.01).
The results for ‘other therapies’ (e.g, intramuscular stimulation, botox, physiotherapy) failed to reach enough statistical power to determine a significant change in pain when compared to dry needling.
There were no statistically significant effects in the long term (2 to 6 months), however only a small number of studies looked at long term outcomes.

The authors concluded

Dry needling can be recommended for relieving MTrP in neck and shoulder in the short and medium term, but wet needling is found to be more effective than dry needling in relieving MTrP in neck and shoulders in the medium term.

Dry needling can be recommended for relieving MTrP in neck and shoulder in the short and medium term, but wet needling is found to be more effective in the medium term.

The Musculoskeletal Elf’s view

Firstly it is important to note that results should be treated with some caution as there was high heterogeneity between the trials, which is an inevitable effect when comparing trials with much clinical and methodological diversity. The authors tried to account for this in the statistical analysis.

When treating MTrP pain in the neck and/or shoulder pain, dry needling is a valid treatment option to use for short to medium term reduction in self reported pain. Wet needling is not a treatment modality used by physiotherapists and so the results for this are not directly applicable to our practice.

More research is needed to conclude about long term effects of dry needling for MTrP pain in the cervical spine and shoulders. In particular large-scale, multi-centred high quality RCTs with adequate follow up is recommended.

What do you think?

What treatment modalities do you commonly use to treat active MTrPs?
What are your experiences of using dry needling in clinical practice?

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Do you know that there is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses? This is called the Preferred Reporting Items for Systematic Reviews and Meta-Analyses or PRISMA statement and can be accessed through the website of the EQUATOR Network. The Elves use the PRISMA statement for critical appraisal of systematic reviews, although it is not a quality assessment instrument to gauge the quality of a systematic review.

Links

Liu, L., Huang, Q. M., Liu, Q. G., Ye, G., Bo, C. Z., Chen, M. J., & Li, P. 2015, ‘Effectiveness of Dry Neeedling for Myofascial Trigger Points Associated with Neck and Shoulder Pain: A Systematic Review and Meta-analysis’ Archives of physical medicine and rehabilitation, Vol. 96, no.5, pp.944-955 [Abstract]