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No Added Benefit of Combining Dry Needling With Guideline-Based Physical Therapy When Managing Chronic Neck Pain: A Randomized Controlled Trial

PainSci » bibliography » Stieven et al 2020
Tags: treatment, muscle pain, neck, dry needling, bad news, muscle, pain problems, head/neck, spine

Seven pages on PainSci cite Stieven 2020: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Chronic Tension Headaches3. The Complete Guide to Neck Pain & Cricks4. Science versus Experience in Musculoskeletal Medicine5. Manual Therapy: What is it, and does it work?6. Reluctantly Reconsidering RESTORE7. Neck needling? Study says: nope!

Closeup photo of hands in latex gloves inserting an acupuncture needle into a pinched bunch of muscle on the shoulder.

PainSci commentary on Stieven 2020: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a rare good quality trial of dry needling of trigger points as a treatment for chronic neck pain. It had a clearly negative result, and it’s a bit of a nail-in-coffin study for dry needling, as much as any one study ever could be.

The researchers compared standard “guideline-based physio” — as garden-variety as possible — to a combination of that with dry needling in more than a hundred patients, with follow-up at 1, 3, and 6 months. It seems like a fair comparison to me, and I agree with the authors that it is effectively testing and “mimicking the clinical decision-making process seen in daily practice.” Their conclusions:

Adding dry needling to guideline-based physical therapy resulted in a small, not clinically meaningful, reduction in average neck pain intensity at one-month post-randomization, but not at 3 and 6 months in participants with chronic neck pain. Clinicians should not consider dry needling in addition to physical therapy as an approach to managing chronic neck pain.

I will keep following the evidence on needling, but after this data, I know where I am placing my bets on the long-term outcome of this controversy.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVES: To determine the added benefit of combining dry needling with a guideline-based physical therapy treatment program consisting of exercise and manual therapy on pain and disability in people with chronic neck pain.

DESIGN: Randomized controlled trial.

METHODS: Participants were randomized to receive either guideline-based physical therapy or guideline-based physical therapy plus dry needling. The primary outcomes, measured at 1 month post-randomization, were: average pain intensity (in the previous 24 hours and in the previous week) measured with a numerical pain rating scale (0-10), and disability measured with the Neck Disability Index (0-100). The secondary outcomes were pain and disability measured at 3 and 6 months, and global perceived effect, quality of sleep, pain catastrophizing, and self-efficacy measured at 1, 3 and 6 months.

RESULTS: 116 participants were recruited. At one month post-randomization, people who received dry needling plus guideline-based physical therapy had a small reduction in average pain intensity in the previous 24 hours (mean difference: 1.56 points; 95% CI 1.11 to 2.36), and average pain intensity in the previous week (mean difference: 1.49 points; 95% CI 1.02 to 2.21). There was no effect of adding dry needling to guideline-based physical therapy on disability at 1-month post-randomization (mean difference: -2.08 points; 95% CI -1.16 to 5.07). There was no effect for any of the secondary outcomes.

CONCLUSION: When combined with guideline-based physical therapy for neck pain, dry needling resulted in small improvements in pain only at 1 month post-randomization. There was no effect on disability.

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