EfficacyofDryNeedlingandAcupunctureinPatientswithFibromyalgia:ASystematicReviewandMeta-Analysis

Fibromyalgia is a challenging chronic condition characterized by widespread pain, fatigue, sleep disturbances, depression, and reduced quality of life. It disproportionately affects middle-aged women and remains difficult to treat effectively. While pharmacological treatments exist, they often come with adverse effects and limited long-term benefits. Complementary therapies such as dry needling and acupuncture have gained attention as potential additions to multidimensional treatment approaches.

Dry needling involves inserting needles into myofascial trigger points to inactivate them and reduce pain, while acupuncture, a practice with over three millennia of history, stimulates specific points to modulate pain through central nervous system mechanisms. Despite numerous studies on acupuncture for fibromyalgia, no prior systematic review had specifically included dry needling assessment for this population. This gap in knowledge motivated researchers to conduct a comprehensive systematic review and meta-analysis evaluating both interventions.

The researchers followed PRISMA guidelines and registered their protocol in advance. They systematically searched MEDLINE, PubMed, SCOPUS, and Web of Science databases from inception through May 2022 for randomized controlled trials evaluating dry needling and/or acupuncture in adults with fibromyalgia. Studies needed to report outcomes related to pain, disability, function, or quality of life. After removing duplicates and screening titles, abstracts, and full texts, 24 studies met inclusion criteria—4 assessing dry needling and 20 assessing acupuncture.

Importantly, no study directly compared both techniques against each other.

Two independent reviewers extracted data using standardized forms and assessed methodological quality with the PEDro scale (0–10 points). The GRADE approach evaluated overall evidence quality. Statistical analyses used Review Manager software with random-effects models, calculating mean differences or standardized mean differences with 95% confidence intervals. Heterogeneity was assessed using I² statistics.

Outcomes were analyzed by follow-up period: short-term (0–3 months), mid-term (>3 to <6 months), and long-term (≥6 months).

The 25 included studies (24 in qualitative synthesis) comprised 1,809 total participants, predominantly women. PEDro scores ranged from 5 to 9 (mean 6.8), indicating generally acceptable methodological quality. Common flaws included lack of therapist blinding (22 of 25 studies), patient blinding (19 of 25), concealed allocation (10 of 25), and assessor blinding (10 of 25).

For dry needling, four studies with 312 participants showed significant short-term benefits. Meta-analysis revealed a large effect for pain reduction (MD −2.36, 95% CI −3.27 to −1.46; SMD −1.20, 95% CI −1.66 to −0.75; p = 0.003) compared to control interventions including medical treatment, taping, manual myofascial release, and TENS. Dry needling also significantly improved Fibromyalgia Impact Questionnaire scores (MD −16.03, 95% CI −28.20 to −3.86; SMD −0.75, 95% CI −1.22 to −0.28), sleep quality (SMD −0.51, 95% CI −0.81 to −0.22), and pressure pain thresholds (SMD 0.89, 95% CI 0.63 to 1.16). However, effects on depression were not significant (SMD −0.29, 95% CI −0.58 to 0.00).

For acupuncture, 20 studies with 1,497 participants showed mixed results. The overall short-term pain effect was significant (MD −1.18, 95% CI −1.91 to −0.45; SMD −0.55, 95% CI −0.89 to −0.21) but driven by substantial heterogeneity (I² = 87%). When separated from dry needling, acupuncture alone showed no significant short-term pain reduction (MD −0.70, 95% CI −1.54 to 0.14; SMD −0.30, 95% CI −0.65 to 0.06). Acupuncture showed no significant effects at mid-term or long-term follow-up for pain.

For Fibromyalgia Impact Questionnaire, acupuncture showed no significant short-term (SMD −0.26, 95% CI −0.75 to 0.22), mid-term (SMD −0.25, 95% CI −1.11 to 0.61), or long-term effects (SMD −0.44, 95% CI −0.85 to −0.02, with p = 0.04 for MD but not SMD). Sleep quality improvements were not significant at any timepoint. Depression showed a significant short-term effect in the acupuncture subgroup (SMD −0.68, 95% CI −1.31 to −0.06) but not overall.

GRADE assessment found moderate quality evidence for dry needling on pain and pressure pain thresholds, but low or very low quality for most acupuncture outcomes due to serious inconsistency (heterogeneity) and imprecision.

This systematic review provides important, though cautiously interpreted, evidence for clinicians and patients considering needle-based therapies for fibromyalgia. Dry needling appears to offer meaningful short-term improvements in pain, physical function, and quality of life, with moderate-quality evidence supporting its use. The effect sizes were clinically relevant and larger than those seen for acupuncture. However, with only four studies and limited follow-up beyond 6 weeks, these findings require replication in larger, longer trials.

Acupuncture's benefits appear more modest and less consistent. While some individual studies reported positive outcomes—particularly when combined with other treatments like dietary therapy or exercise—the pooled evidence shows significant heterogeneity and lacks robust statistical significance for most outcomes. The placebo effect appears substantial, as sham acupuncture often produced improvements, though verum acupuncture generally outperformed sham in direct comparisons.

For patients, this suggests dry needling may be a reasonable short-term option to discuss with healthcare providers, particularly if myofascial trigger points are present. Acupuncture may provide some benefit, especially as part of a multimodal approach, but expectations should be tempered. Neither technique has been directly compared to the other, so choosing between them remains speculative. Future research must address this gap with well-designed, adequately powered randomized trials that include proper blinding, concealed allocation, and longer follow-up periods.