Comparisonofdryneedlingandtriggerpointmanualtherapyinpatientswithneckandupperbackmyofascialpainsyndrome:asystematicreviewandmeta-analysis

Myofascial pain syndrome (MPS) of the neck and upper back is a common condition characterized by active trigger points—tender knots in skeletal muscle that cause local pain, referred pain, and decreased function. Risk factors include overuse and prolonged awkward postures, with the upper trapezius, levator scapulae, and infraspinatus muscles frequently affected. Two commonly used interventions for managing MPS are dry needling (DN), which involves inserting a fine needle into trigger points to elicit local twitch responses, and trigger point manual therapy (TPMT), which uses compression techniques such as ischemic compression, pressure release, and strain counter-strain. While prior research had examined each intervention separately against controls, no systematic review had directly compared DN to TPMT for reducing pain and improving function in this patient population.

This gap in knowledge created uncertainty for clinicians trying to choose between these two treatment approaches.

The researchers conducted a systematic review and meta-analysis following PRISMA guidelines, with the protocol registered on PROSPERO. They searched PubMed, PEDro, and CINAHL in June 2019 for randomized controlled trials published within the previous 10 years that compared DN to TPMT in adults with neck, shoulder, and/or upper back pain. Six RCTs with a total of 241 participants met inclusion criteria. Two independent reviewers assessed study quality using the PEDro scale and the Cochrane risk-of-bias tool.

The mean PEDro score was 6.17, with four studies rated as good quality and two as fair quality. All studies had limitations regarding blinding of participants and therapists. Data were extracted for pain outcomes (Visual Analog Scale [VAS], Numeric Rating Scale [NRS], and Pressure Pain Threshold [PPT]) and function (Neck Disability Index [NDI]) in the short to medium term (1 week to 28 days). Meta-analyses used a random-effects model to calculate standardized mean differences (Cohen's d) and 95% confidence intervals.

The meta-analysis found no statistically significant differences between DN and TPMT for any of the three primary outcomes. For VAS pain scores, the effect size was d = 0.41 (95% CI: −0.18 to 0.99, I² = 34.8%) based on three studies. For PPT, the effect size was d = 0.64 (95% CI: −0.19 to 1.47, I² = 84.8%) based on four studies, though high heterogeneity was noted. For NDI function scores, the effect size was d = −0.66 (95% CI: −1.33 to 0.02, I² = 69.5%) based on four studies.

A meta-analysis for NRS could not be performed due to limited data. While individual studies showed significant improvements from baseline to follow-up in both treatment groups, these changes were largely attributable to time effects rather than group differences. Only three individual studies reported significant between-group differences: Llamas-Ramos et al. found greater PPT improvement with DN after 2 weeks; Campa-Moran et al. found greater NDI improvement with DN after two sessions (p = 0.032); and Ziaeifar et al. found greater VAS improvement with DN after 1 week (p = 0.01). However, these isolated findings were not consistent across the broader evidence base.

This systematic review provides important evidence that both dry needling and trigger point manual therapy are effective treatments for neck and upper back myofascial pain syndrome in the short to medium term, but neither appears superior to the other. This finding gives clinicians and patients flexibility in treatment selection based on patient preference, cost, availability, and potential adverse effects. The lack of clear superiority may help resolve disagreements among practitioners who strongly favor one technique. However, the review has notable limitations: no long-term follow-up data were available, treatment protocols varied considerably in frequency and duration across studies, and three studies included passive stretching as an adjunct to DN but not TPMT, potentially confounding results.

Additionally, no included studies reported adverse events, leaving important safety questions unanswered. Future research should compare both interventions against sham treatments, clarify optimal dosing parameters, and examine effects in other body regions and over longer time periods. For now, clinicians can confidently offer either intervention as part of a comprehensive approach to myofascial pain management.