Arch Phys Med Rehabil. 2025 Sep 6:S0003-9993(25)00887-1. doi: 10.1016/j.apmr.2025.08.019. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the neurophysiological effects associated with dry needling. This review evaluates the influence of dry needling on pain-related biomarkers, conditioned pain modulation, and temporal summation to clarify the potential mechanisms underlying its therapeutic effects.

DATA SOURCES: A literature search across the Physiotherapy Evidence Database (PEDro), Web of Science, PubMed, Cochrane Library, and Scopus databases until October 2024 was conducted.

STUDY SELECTION: Studies were included if they assessed the neurophysiological effects of dry needling in animal or human models. Fourteen results were included in the qualitative synthesis (n=4 in animals, n=10 in humans) and 4 in the quantitative analysis. Selection was performed independently by two reviewers.

DATA EXTRACTION: Data were extracted independently by two reviewers using a standardized form. Neurophysiological outcomes included levels of biomarkers (e.g., substance P, cortisol, interleukins, CGRP, serotonin, TNF-α), as well as measures of conditioned pain modulation and temporal summation. The methodological quality was assessed using the PEDro, Cochrane Risk of Bias-2 and Risk of Bias in Non-randomized Studies of Interventions scales.

DATA SYNTHESIS: Dry needling showed increases in miR-939, miR-25, β-endorphin, IL-2, TNF-α, iNOS, HIF-1α, COX-2, VEGF, inflammatory cells, IL-6, and AChE, while decreases were observed in MYOZ2, SP, CGRP, ACh, and AChR. The effects on neurophysiological variables related to pain processing are limited, leading to small improvements in conditioned pain modulation (SMD 0.36, 95% 0.05 to 0.67) and no apparent changes in temporal summation (SMD -0.08, 95%CI -0.44 to 0.27).

CONCLUSION: The application of dry needling can induce significant changes in pain-related biomarker levels in animal and human studies, providing insights into its underlying mechanisms of action and potential clinical effects.

PMID:40921318 | DOI:10.1016/j.apmr.2025.08.019