DryNeedlingintheManagementofMusculoskeletalPain

Myofascial pain is one of the most common reasons patients seek care from family physicians and other primary care providers. It can affect up to 10% of the adult population and accounts for a substantial portion of both acute and chronic pain complaints. The underlying problem involves myofascial trigger points (MTrPs)—highly localized, hyperirritable spots within tight bands of skeletal muscle. When these trigger points are pressed or stimulated, they produce two key clinical phenomena: referred pain to other areas and a local twitch response in the muscle.

Despite how common this condition is, research suggests that MTrPs frequently go undiagnosed by both physicians and physical therapists, leading patients down a path of chronic pain and disability. Studies have found that MTrPs were the primary source of pain in 30% to 85% of patients presenting with musculoskeletal pain across various clinical settings, including neurology clinics, comprehensive pain centers, dental clinics for head and neck pain, and university primary care practices. Given this substantial burden, effective treatments are essential. Numerous noninvasive approaches have been tried—including stretching, massage, laser therapy, heat, ultrasound, transcutaneous electrical nerve stimulation, and medications—but none has proven universally successful.

This sets the stage for considering dry needling, a minimally invasive technique that has gained traction worldwide.

This clinical narrative review aimed to introduce dry needling to the broader medical community, particularly family physicians and other clinicians who may be unfamiliar with the technique. The authors synthesized existing literature on different dry needling methods, their effectiveness, physiological mechanisms, and adverse effects. They examined two primary conceptual models: the myofascial trigger point model developed by Travell and Simons, which focuses on direct needling of MTrPs; and the radiculopathy model developed by Gunn, known as intramuscular stimulation (IMS), which treats segmental muscle dysfunction related to peripheral neuropathy. The authors also compared deep versus superficial needling approaches and reviewed evidence from randomized controlled trials and systematic evaluations.

They drew on epidemiologic data, physiological research, and clinical studies to build a comprehensive picture of where dry needling fits in musculoskeletal pain management.

The review found that dry needling has been evaluated in numerous randomized controlled trials and several systematic reviews, with evidence supporting its effectiveness for MTrP-related pain. Cummings and White's systematic review of 23 RCTs concluded that direct needling of MTrPs appears effective, though whether this effect extends beyond placebo remains uncertain. The most recent systematic review by Tough and colleagues included 7 RCTs and found evidence that direct MTrP needling reduced pain compared with no intervention, though results comparing direct needling to needling elsewhere in muscle were contradictory, and 4 studies failed to show superiority over nonpenetrating sham interventions. The Cochrane review of 35 RCTs found evidence of pain relief and functional improvement for chronic low back pain with acupuncture compared with no treatment or sham therapy, though effects were small and observed mainly immediately after treatment and at short-term follow-up.

One notable long-term study by Gunn and colleagues found that in 56 patients treated at a Workers' Compensation Board, the needled group was "clearly and significantly better than the control group (P < .005)."

Regarding deep versus superficial needling, the evidence suggests deep dry needling is more effective for MTrP-associated pain. Ceccherelli and colleagues found that after 3 months, deep dry needling resulted in significantly better analgesia than superficial needling in 42 patients with lumbar myofascial pain. However, Itoh and colleagues found that while deep needling to MTrPs in elderly patients with chronic low back pain produced less pain intensity and improved quality of life compared with standard acupuncture or superficial needling, the differences were not statistically significant. The authors note that superficial dry needling still shows effectiveness and may be preferable over areas with risk of significant adverse events, such as above the lungs and large blood vessels.

For paraspinal needling in addition to MTrP needling, one small study of 40 elderly patients found that those receiving additional paraspinal dry needling had more continuous subjective pain reduction, significant improvements on the geriatric depression scale, and improvements in cervical range of motion that were not seen with MTrP needling alone.

Adverse effects were found to be generally minor and uncommon. In a prospective observational study of 229,230 patients receiving acupuncture, 8.6% reported at least one adverse effect and 2.2% reported one requiring treatment. The most common were bleeding or hematoma (6.1% of patients), pain (1.7%), and vegetative symptoms (0.7%). Two pneumothorax cases occurred.

A British study found minor adverse effects in 671 per 10,000 acupuncture sessions, with 14 per 10,000 considered "significant," all resolving within 1 week except two cases.

For clinicians, this review suggests that dry needling represents a valuable addition to the toolkit for managing chronic musculoskeletal pain, particularly when myofascial trigger points are present. The technique is minimally invasive, inexpensive, relatively quick to learn (basic courses typically 21–32 hours), and carries a favorable safety profile when performed by trained providers. Deep dry needling appears to be the preferred method for most MTrPs, but clinicians should consider superficial needling in anatomically vulnerable regions. The evidence supports using dry needling as part of a comprehensive treatment approach rather than as a standalone therapy.

For patients, this means that if you have persistent muscle pain that hasn't responded to other treatments, asking your healthcare provider about dry needling may be worthwhile—especially if active trigger points are identified. The procedure involves thin acupuncture needles inserted directly into painful muscle spots, often producing immediate relief. While more research is needed, particularly on optimal techniques and long-term outcomes, current evidence suggests this is a reasonable option to discuss with your physician or physical therapist.