Dry Needling in the Management of Musculoskeletal Pain

Dry Needling in the Management of Musculoskeletal Pain

This is an excellent comprehensive introduction and description of dry-needling

Myofascial pain is a common syndrome seen by family practitioners worldwide. It can affect up to 10% of the adult population and can account for acute and chronic pain complaints. In this clinical narrative review we have attempted to introduce dry needling, a relatively new method for the management of musculoskeletal pain, to the general medical community.

Different methods of dry needling, its effectiveness, and physiologic and adverse effects are discussed. Dry needling is a treatment modality that is minimally invasive, cheap, easy to learn with appropriate training, and carries a low risk. Its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews.

The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial trigger points. However, over areas with potential risk of significant adverse events, such as lungs and large blood vessels, we suggest using the superficial technique, which has also been shown to be effective, albeit to a lesser extent.

Myofascial pain is a common form of pain that arises from muscles or related fascia and is usually associated with myofascial trigger points (MTrP). An MTrP is a highly localized, hyperirritable spot in a palpable, taut band of skeletal muscle fibers.1When an MTrP is stimulated, 2 important clinical phenomena can be elicited: referred pain and a local twitch response.

Epidemiologic studies from the United States have shown that MTrPs were the primary source of pain in 30% to 85% of patients presenting in a primary care setting or pain clinic because of pain.2–4 MTrPs were the primary source of pain in 74% of 96 patients with musculoskeletal pain who were seen by a neurologist in a community pain medical center, 5 and in 85% of 283 patients consecutively admitted to a comprehensive pain center.2 Of 164 patients referred to a dental clinic for chronic head and neck pain, 55% were found to have active MTrPs as the cause of their pain, 3 as were 30% of those from a consecutive series of 172 patients who presented with pain at a university primary care internal medicine group practice.4

Therefore, MTrP pain constitutes a substantial burden for both individual patients and for society as a whole. Despite this, there is evidence that MTrPs that cause musculoskeletal pain often go undiagnosed by both physicians and physical therapists, which leads to chronic conditions.

Numerous noninvasive methods—such as stretching, massage, ischemic compression, laser therapy, heat, acupressure, ultrasound, transcutaneous electrical nerve stimulation, biofeedback, and pharmacological treatments—have been used to alleviate chronic myofascial pain, but no single strategy has proved to be universally successful. Another way to treat myofascial pain is by dry needling (intramuscular stimulation, Western acupuncture, medical acupuncture), which is a minimally invasive procedure in which an acupuncture needle is inserted directly into an MTrP.

Although an acupuncture needle is used, the therapy is based on the traditional reasoning of Western medicine. The sites for needle insertion are located in skeletal muscles taught in any basic anatomy course. Dry needling is easy to learn, and a basic course usually lasts 2 to 4 days. The aim of this review is to introduce dry needling, a relatively new treatment modality used by physicians and physical therapists worldwide as a part of complex treatment of chronic musculoskeletal pain, to the wide audience of family physicians, rheumatologists, orthopedic surgeons, physiatrists, pain specialists, dentists, and physical therapists.

The article goes on to elaborate on the following topics:

  1. Dry Needling Methods
  2. Effectiveness of Dry Needling in the Management of MTrPs
  3. Deep Versus Superficial Needling
  4. Needling With or Without Paraspinal Needling
  5. Adverse Effects of Dry Needling
  6. Training Information

Conclusions

Dry needling is a relatively new treatment modality used by physicians and physical therapists worldwide. It is minimally invasive, cheap, easy to learn, and carries a low risk. Its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews. Dry needling can be used as part of complex treatment for chronic musculoskeletal pain and can be applied by family physicians, rheumatologists, orthopedic surgeons, physiatrists, pain specialists, dentists, and physical therapists.

The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with MTrPs. Therefore, we suggest that it be used as the method of choice. However, above areas with potential risk of significant adverse events, such as lungs and large blood vessels, we suggest using the superficial technique, which has also been shown to be effective, albeit to a lesser extent.

 

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