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Mechanisms of inaction 

 •  • by Paul Ingraham
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

“Mechanisms of inaction:” Bullshit ideas about how treatments allegedly work when they probably do not work.

This phrase popped into my head while reading a paper all about the “mechanisms of action” for dry needling. (Dry needling is treating trigger points — sore spots — by piercing them with acupuncture needles.)

All modern dry needling is done with fine acupuncture needles, far smaller than the syringes Dr. Travell used. She thought acupuncture needles were too delicate!

The evidence is clear that dry needling does not work well, if at all, so any and all speculation about how it works is probably nonsense by definition. Even if it clearly did work, I’ve yet to see an explanation that would satisfy me. My strong impression is that needling is a highly speculative bizarre treatment method with clear potential for harm and no good evidence of benefit.

I’ve read many papers about dry needling over the last year, and updated the needling chapter of my trigger points book seven times since late 2017. Prior to that it was just a quick tour of the pros and cons; now it’s a deep dive, a large dose of well-substantiated debunking. The most skeptical book about trigger points is now even more skeptical!

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