Focus of the Report: The focus of this Health Technology Assessment is to evaluate the effectiveness and safety of dry needling (DN) compared with standard therapies to treat chronic pain of the neck or upper trapezius in adults.
Technology Description: DN (also called intramuscular stimulation or trigger point [TrP] needling) involves the use of thin needles that penetrate the skin and stimulate underlying tissues. Such tissue stimulation is thought to improve pain and movement. Although the precise mechanism is not known, the most predominant theory suggests that the localized twitch response (LTR) evoked by DN induces an analgesic effect by interrupting motor end-plate noise. Coupling the LTR with stretching is thought to help relax the actin-myosin bonds that restrict the tight bands. Most advocates of this model believe that treatment of TrPs with DN should be part of a multimodal care plan that includes other interventions, such as stretching, joint mobilizations, neuromuscular reeducation, and strengthening.
Controversy: Professional organizations for acupuncture contend that DN is a form of acupuncture that precludes the necessary educational and safety standards of the acupuncture profession. Other controversies include the safety and effectiveness of DN versus other treatments, optimal technical parameters for administration, and patient selection (i.e., which patients might benefit the most from the treatment).
Is DN effective for reducing pain, improving function, and improving quality of life among adults with mechanical neck and/or trapezius pain?
How does DN compare with standard treatments for mechanical neck and/or trapezius pain?
Is DN in patients with mechanical neck and/or trapezius pain safe?
Have definitive patient selection criteria been identified for DN for adults with mechanical neck and/or trapezius pain?
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