Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-Analysis of Effectiveness and Safety

Background and/or Objectives: Myofascial pain syndrome (MPS) is a common source of musculoskeletal pain and is often resistant to conventional treatments such as exercise and medication. Dry needling has emerged as a promising treatment option for upper-quarter MPS. Existing systematic reviews have limitations, leaving uncertainty about its effectiveness and safety. This systematic review and meta-analysis evaluated the effectiveness and safety of dry needling for upper-quarter MPS.

Design: We searched seven databases and trial registries through June 26, 2024, for randomized trials comparing dry needling to sham or no intervention in adults (≥18 years) with upper-quarter MPS.

Setting : N/A

Participants : Adults with myofascial trigger points (MTrPs), myofascial pain syndrome (MPS), or both in the shoulder, cervical, or orofacial region and with an average pain history of at least 3 months.

Interventions: We compared dry needling to sham or no intervention in adults.

Main Outcome Measures: We conducted random-effects meta-analyses for patient-important outcomes at short-term follow-up (0 to 24 hours after end of the intervention), medium-term follow-up (7 to 21 days), and long-term follow-up (>21 days). We performed a priori subgroup analyses to explore heterogeneity and assessed the certainty of evidence using GRADE.

Results: We included 10 trials (384 participants). The frequency and duration of dry needling interventions ranged from a single session to six sessions over four weeks. Compared to sham, moderate-certainty evidence shows that dry needling probably reduces pain at short-term follow-up by 2.41 points on a 10-point Visual Analogue Scale (VAS) (95% CI −3.20 to −1.63). A greater reduction was observed at medium-term follow-up (MD −2.67, CI −3.27 to −2.07; moderate-certainty). Results were robust to worst plausible assumptions regarding pain relief in studies with missing outcome data. No data were available at long-term follow-up. Reported adverse events were mild and transient.

Conclusions: Dry needling likely reduces pain in adults with upper-quarter MPS at short- and medium-term follow-up.