Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis

Han-Tong Hu, Hong Gao, Rui-Jie Ma, Xiao-Feng Zhao, Hong-Fang Tian, Lu Li, Han-Tong Hu, Hong Gao, Rui-Jie Ma, Xiao-Feng Zhao, Hong-Fang Tian, Lu Li

Abstract

Background: To evaluate the efficacy and safety of dry needling (DN) for treating low back pain (LBP).

Methods: Nine databases were searched from inception to October 2017. Eligible randomized controlled trials (RCTs) involving DN for treating LBP were retrieved. Two reviewers independently screened the articles, extracted data, and evaluated the risk of bias among the included studies using the risk of bias assessment tool by Cochrane Collaboration.

Results: Sixteen RCTs were included and the risk of bias assessment of them was "high" or "unclear" for most domains. Meta-analysis results suggested that DN was more effective than acupuncture in alleviating pain intensity and functional disability at postintervention, while its efficacy on pain and disability at follow-up was only equal to acupuncture. Besides, DN was superior to sham needling for alleviating pain intensity at postintervention/follow-up and functional disability at postintervention. Additionally, qualitative review revealed that DN combined with acupuncture had more significant effect on alleviating pain intensity at postintervention and achieved higher response rate than DN alone. However, compared with other treatments (laser, physical therapy, other combined treatments, etc.), it remained uncertain whether the efficacy of DN was superior or equal because the results of included studies were mixed.

Conclusions: Compared with acupuncture and sham needling, DN is more effective for alleviating pain and disability at postintervention in LBP, while its effectiveness on pain and disability at follow-up was equal to acupuncture. Besides, it remains uncertain whether the efficacy of DN is superior to other treatments. Nevertheless, considering the overall "high" or "unclear" risk of bias of studies, all current evidence is not robust to draw a firm conclusion regarding the efficacy and safety of DN for LBP. Future RCTs with rigorous methodologies are required to confirm our findings.

Details of ethics approval: No ethical approval was required for this systematic review and meta-analysis.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of the trial selection process.
Figure 2
Figure 2
Risk of bias assessment of the included studies. (A) Risk of bias assessment for each included study (B) risk of bias summary of the included RCTs. RCT = randomized controlled trial.
Figure 3
Figure 3
Forest plot for DN compared with sham needling. (A) Pain intensity at postintervention. (B) Functional disability at postintervention. (C) Pain intensity at follow-up. (D) Functional functional disability at follow-up. DN = dry needling.
Figure 4
Figure 4
Forest plot for DN compared with acupuncture. (A) Pain intensity at postintervention. (B) Functional disability at postintervention. (C) Pain intensity at follow-up. (D) Functional disability at follow-up. (E) Response rate at postintervention. DN = dry needling.

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