Dry needling

[[File:VIPER Clinic, Improving lives of current and future USAF recruits 150803-F-PU339-003.jpg|thumb|left|165px|[[Tax]] dollars being wasted with dry needling in the Air Force]]
{{Altmed}}
'''Dry-needling''' or '''trigger point therapy''', also known as '''intramuscular stimulation''' is the [[alternative medicine]] practice that involves poking dry filiform needles, the same general type commonly used in [[acupuncture]] through the skin into muscular tissue in effort to treat disorders related to chronic [[pain]] and movement impairment. Dry-needling shares similarities with acupuncture in that it involves poking human beings with needles and it has very little evidence in support of its effectiveness. The "dry" aspect of dry needling means the needle contains no active drugs or medications, as it is not hollow like an injection needle. One may  suggest  dry-needling is just [[acupuncture]] under a different name, but they are genuinely distinct. Acupuncture is part of [[traditional Chinese medicine]] and only punctures the skin. Dry-needling in contrast is a modern alternative medicine invention attributed to MD {{wpl|Janet G. Travell}} {{lived|1901|1997}}, and it punctures the muscle.<ref>''Myofascial Pain and Dysfunction: Trigger Point Manual. Volume 1: The Upper Extremities'' by Janet G. Travell (1983). Williams & Wilkins. ISBN 068308366X.</ref> Because solid filiform needles are regulated as a Class II medical device by the US [[Food and Drug Administration]],<ref>[https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=880.5580 Sec. 880.5580 Acupuncture needle] ''Code of Federal Regulations Title 21''</ref> they do not require a medical license to obtain or use and are hence available to alternative medicine practitioners.

A technique similar to dry-needling exists within [[evidence-based medicine]] that instead uses a hypodermic needle with a local anesthetic. This technique was also described by Travell,<ref>''Myofascial Pain and Fibromyalgia Syndromes: A Clinical Guide to Diagnosis and Management'' by Peter E. Baldry (2001) Churchill Livingstone. ISBN 0443070032. Page 36.</ref> and is known as trigger point injection.<ref>[https://www.webmd.com/g00/pain-management/guide/trigger-point-injection Trigger Point Injection for Pain Management,] reviewed by Melinda Ratini (March 13, 2018) ''WebMD''.</ref>

==Effectiveness==
Multiple [[meta-analyses]] have been conducted referencing the effectiveness of the practice of dry needling, all with varying conclusions. The three [[meta-analyses]] of dry needling below are based on relatively small numbers of trials and subjects, and hence are not very conclusive due to these limitations.
*A meta-analysis published in 2018 looking at a total of 496 participants across 11 [[randomized controlled trial]]s concluded that trigger point dry needling was not very effective in treating upper extremity pain, and also came with adverse effects (mostly bruising, bleeding, and pain).<ref name=hall>[https://www.researchgate.net/publication/318980750_Effects_of_dry_needling_trigger_point_therapy_in_the_shoulder_region_on_patients_with_upper_extremity_pain_and_dysfunction_a_systematic_review_and_meta-analysis Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review and meta-analysis] by Michelle Louise Hall et al. (2018) ''Physiotherapy'' 104(2):167-177. doi:0.1016/j.physio.2017.08.001.</ref> The authors noted a high risk of [[bias]] in the studies used in the meta-analyses and the low quality of evidence in the studies, therefore concluding that future studies could change the assessment of the effectiveness of dry needling.<ref name=hall/>
*A 2017 meta-analysis published  examined 16 randomized control trials. It concluded that dry needling was more effective in treating lower back pain and disability compared to [[placebo]] and/or [[acupuncture]] but had similar efficacy to [[acupuncture]] with follow up trials.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6242300/ Is dry needling effective for low back pain? A systematic review and PRISMA-compliant meta-analysis] by Han-Tong Hu et al. (2017) ''Medicine''97(26): e11225. doi:10.1097/MD.0000000000011225.</ref>
*A meta-analysis published in 2013 was based on 12 studies. The authors cautiously recommended dry-needling for treating pain compared to a [[placebo]] but concluded more randomized controlled trials were needed to adequately evaluate its effectiveness.<ref>[https://www.jospt.org/doi/10.2519/jospt.2013.4668 Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis] by David M. Kietrys et al. (2013) ''Journal of Orthopaedic & Sports Physical Therapy'' 43(9):620–634. doi:10.2519/jospt.2013.4668.</ref>

==References==
{{reflist|2|80%}}

[[Category:Manipulative therapy]]

Categories: Manipulative therapy