Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta‐analysis of randomised controlled trials

Abstract

Pain from myofascial trigger points is often treated by needling, with or without injection, although evidence is inconclusive on whether this is effective. We aimed to review the current evidence on needling without injection, by conducting a systematic literature review. We searched electronic databases to identify relevant randomised controlled trials, and included studies where at least one group were treated by needling directly into the myofascial trigger points, and where the control was either no treatment, or usual care; indirect local dry needling or some form of placebo intervention. We extracted data on pain, using VAS scores as the standard. Seven studies were included. One study concluded that direct dry needling was superior to no intervention. Two studies, comparing direct dry needling to needling elsewhere in the muscle, produced contradictory results. Four studies used a placebo control and were included in a meta-analysis. Combining these studies (n=134), needling was not found to be significantly superior to placebo (standardised mean difference, 14.9 [95%CI, -5.81 to 33.99]), however marked statistical heterogeneity was present (I(2)=88%). In conclusion, there is limited evidence deriving from one study that deep needling directly into myofascial trigger points has an overall treatment effect when compared with standardised care. Whilst the result of the meta-analysis of needling compared with placebo controls does not attain statistically significant, the overall direction could be compatible with a treatment effect of dry needling on myofascial trigger point pain. However, the limited sample size and poor quality of these studies highlights and supports the need for large scale, good quality placebo controlled trials in this area.

Dry Needling in the Management of Musculoskeletal Pain

“…10,23,24 Cum-mings and White, 10 in their systematic review of 23 RCTs of needling therapies (dry needling or injections), stated that direct needling of MTrPs seems to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor refuted by the evidence from clinical trials. Any effect of these therapies is probably because of the needle or placebo rather than the injection of either saline or active drug.…”

“…Two studies provided contradictory results when comparing direct needling of MTrPs versus needling elsewhere in muscle; the evidence from another 4 studies failed to show that needling directly into an MTrP is superior to various nonpenetrating sham interventions. Tough and colleagues 24 mentioned significant methodological limitations of original studies included in the review. Firstly, although MTrPs seem to have been identified carefully in most studies, it is not clear that they were the sole cause of pain.…”

“…24 Evidence from one study suggested that direct MTrP needling was effective in reducing pain compared with no intervention. Two studies provided contradictory results when comparing direct needling of MTrPs versus needling elsewhere in muscle; the evidence from another 4 studies failed to show that needling directly into an MTrP is superior to various nonpenetrating sham interventions.…”

Short-term efficacy of joint and soft tissue injections for musculoskeletal pain: An interventional cohort study

“…A previous review of seven studies noted limited evidence of dry needling on MTP, and a meta-analysis concluded that this technique is not superior to placebo. [9] In another study, 39 elderly patients complaining of myofascial pain in the trapezius muscle were randomly divided into two groups; significant improvements in pain were observed after 4 weeks, but there was no significant difference between groups. [10] Shoulder pain of different etiologies may respond to a single IA or subacromial CS injection.…”

Effects of Kinesio Taping on Jumping Performance and Blood Lactate in Elite Male Volleyball Athletes

“…Treatments of MTrP include manual therapies [1], physical therapy modalities [25], needling therapy (including MTrP injection [26], dry needling [27][28][29], acupuncture [30][31][32], percutaneous soft tissue release [33], and subcutaneous needling [34]), or oral medicine. Eliminating any perpetuating factors and introducing adequate education and home programs to patients are also important [1,35].…”