Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis

Marcos J Navarro-Santana, Jorge Sanchez-Infante, César Fernández-de-Las-Peñas, Joshua A Cleland, Patricia Martín-Casas, Gustavo Plaza-Manzano, Marcos J Navarro-Santana, Jorge Sanchez-Infante, César Fernández-de-Las-Peñas, Joshua A Cleland, Patricia Martín-Casas, Gustavo Plaza-Manzano

Abstract

Our aim was to evaluate the effect of dry needling alone as compared to sham needling, no intervention, or other physical interventions applied over trigger points (TrPs) related with neck pain symptoms. Randomized controlled trials including one group receiving dry needling for TrPs associated with neck pain were identified in electronic databases. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The Cochrane risk of bias tool and the Physiotherapy Evidence Database (PEDro) score were used to assessed risk of bias (RoB) and methodological quality of the trials. The quality of evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Between-groups mean differences (MD) and standardized mean differences (SMD) were calculated (3) Twenty-eight trials were finally included. Dry needling reduced pain immediately after (MD -1.53, 95% CI -2.29 to -0.76) and at short-term (MD -2.31, 95% CI -3.64 to -0.99) when compared with sham/placebo/waiting list/other form of dry needling and, also, at short-term (MD -0.51, 95% CI -0.95 to -0.06) compared with manual therapy. No differences in comparison with other physical therapy interventions were observed. An effect on pain-related disability at the short-term was found when comparing dry needing with sham/placebo/waiting list/other form of dry needling (SMD -0.87, 95% CI -1.60 to -0.14) but not with manual therapy or other interventions. Dry needling was effective for improving pressure pain thresholds immediately after the intervention (MD 55.48 kPa, 95% CI 27.03 to 83.93). No effect on cervical range of motion of dry needling against either comparative group was found. No between-treatment effect was observed in any outcome at mid-term. Low to moderate evidence suggests that dry needling can be effective for improving pain intensity and pain-related disability in individuals with neck pain symptoms associated with TrPs at the short-term. No significant effects on pressure pain sensitivity or cervical range of motion were observed. Registration number: OSF Registry-https://doi.org/10.17605/OSF.IO/P2UWD.

Keywords: cervical spine; dry needling; meta-analysis; neck pain; systematic review.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2
Figure 2
Plot of the risk of bias of the included studies.
Figure 3
Figure 3
Mean differences (MD) comparing the immediate effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy interventions on pain intensity.
Figure 4
Figure 4
Mean differences (MD) comparing the short-term effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy. SD: standard deviation; CI: confidence interval.
Figure 5
Figure 5
Mean differences (MD) comparing the mid-term effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy. SD: standard deviation; CI: confidence interval.
Figure 6
Figure 6
Standardized mean differences (SMD) comparing the effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy interventions on pain-related disability at the (A) short- and (B) mid-terms. SD:standard deviation; CI: confidence interval.
Figure 7
Figure 7
Mean differences (MD) comparing the effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy interventions on the pressure pain thresholds (kPa) (A) immediately after and (B) at the short-term. SD: standard deviation; CI: confidence interval.
Figure 8
Figure 8
Mean differences (MD) comparing the effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy interventions on the cervical range of motion in flexion (A) immediately after and (B) at the short-term. SD: standard deviation; CI: confidence interval.
Figure 9
Figure 9
Mean differences (MD) comparing the effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy interventions on the cervical range of motion in extension (A) immediately after and (B) at the short-term. SD: standard deviation; CI: confidence interval.
Figure 10
Figure 10
Mean differences (MD) comparing the effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy interventions on the cervical range of motion in rotation (A) immediately after and (B) at the short-term. SD: standard deviation; CI: confidence interval.
Figure 11
Figure 11
Mean differences (MD) comparing the effects of dry needling alone against sham/placebo/waiting list/other forms of dry needling or manual therapy or other physical therapy interventions on the cervical range of motion in lateral-flexion (A) immediately after and (B) at the short-term. SD: standard deviation; CI: confidence interval.

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