Dry needling



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, and it punctures the muscle. Because solid filiform needles are regulated as a Class II medical device by the US Food and Drug Administration, 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, and is known as trigger point injection.

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 trials 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). 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.
 * 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.
 * 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.