Corticosteroid injection or dry needling for musculoskeletal pain and disability? A systematic review and GRADE evidence synthesis

Abstract

Background Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. Methods Electronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach. Results Six studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term. Conclusions There are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions. PROSPERO registration number CRD42020148650.

Efficacy of trigger point dry needling on pain and function of the hip joint: a systematic review of randomized clinical trials

“…Another myofascial trigger point DN study in knee OA 31 revealed that both the trigger point DN and standard acupuncture groups experienced significant improvements in pain and function; however, trigger point therapy may be more beneficial. Sousa Filho et al, 12 in their recent meta-analysis, examined DN versus corticosteroid injections for musculoskeletal pain and disability. Their analysis of six RCTs (384 patients) showed that corticosteroid was more effective than DN for plantar fasciitis and lateral epicondylitis in the short and midterm but less effective in the long-term.…”

“…7 –9 Trigger points commonly emerge in conditions like OA. 10 The mechanism of DN is not completely understood; however, its efficacy and effectiveness have been studied in the management of various musculoskeletal pain syndromes 9,11,12 in regions like the knee, 13,14 lower extremity, 8 plantar region, 15 low back, 16 elbow, 17 shoulder 18,19 and neck. 20 To our knowledge, only one systematic review has examined the effect of DN on hip disease.…”

Effectiveness and safety of warm needling therapy combined with electroacupuncture for patients with plantar heel pain syndrome

“…[6] A recent systematic review suggests that acupuncture can reduce PHPS pain in the short term, however, more nuanced issues, such as how practitioners choose different acupuncture in different situations, remain unclear. [7] Previous studies have reported electroacupuncture for analgesia. [8,9] Warm needling therapy is an indirect moxibustion method that can be combined with acupuncture.…”

“…[ 6 ] A recent systematic review suggests that acupuncture can reduce PHPS pain in the short term, however, more nuanced issues, such as how practitioners choose different acupuncture in different situations, remain unclear. [ 7 ]…”

“…Stimulation of acupuncture points by acupuncture has been shown to induce analgesia by releasing neuropeptides such as enkephalins, dynorphins, beta-endorphins, and endorphins [6] . A recent systematic review suggests that acupuncture can reduce PHPS pain in the short term, however, more nuanced issues, such as how practitioners choose different acupuncture in different situations, remain unclear [7] …”