Trigger point dry needling for musculoskeletal pain and disability: a systematic review of comparative effectiveness research

Background: Dry needling (DN) has been proposed to reduce pain and improve function related to myofascial trigger points (MTrPs). Several primary studies and systematic reviews have been conducted to examine the effect of DN versus placebo. However the comparative effectiveness of DN and established interventions has yet to be established. Purpose: The purpose of this systematic review was to determine whether DN was more effective than other established therapies to treat MTrPs. Data Sources: MEDLINE Complete, EBSCO, CINAHL, Sport Discus and Cochrane library databases were searched. Study Selection: Randomized controlled trials that used DN directed to MTrPs and used at least one other intervention method were included. Studies that had a placebo or sham group were excluded. Data Extraction: Of 394 records screened, 8 studies met the established criteria. The quality of each study was assessed using the PEDro scale. Data Synthesis: When DN was compared to standard therapy programs, 3 of the 4 studies found that DN was more effective in reducing pain and 1 found no difference. When DN was compared to stretching, DN reduced pain more effectively. Dry needling was not significantly more effective than high-power pain threshold ultrasound (US), laser, non steroidal anti inflammatory drugs, and percutaneous electrical nerve stimulation (PENS). Limitations: Included studies were relatively small and some lacked sound methodology. Conclusions: The results are mixed on the effectiveness of DN over standard rehab. More large scale, high quality studies are needed before definitive decisions can be made about the role of DN in physical therapy practice