Do treatment parameters of dry needling influence its effect on pain? A systematic review and meta-analysis

J Man Manip Ther. 2026 Oct 16:1-15. doi: 10.1080/10669817.2026.2747616. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: No consensus exists regarding the parameters of dry needling application. Therefore, this paper aims to examine the number of sessions, muscles treated, and local twitch responses reported in dry needling literature, and to evaluate their influence on neck pain.

DESIGN: Systematic review and meta-analysis.

METHODS: Six databases (PubMed, Web of Science, Embase, Cochrane Central, Scopus, CINAHL) were searched from database inception to November 2024. Articles included were investigating the effect of dry needling on pain that compared dry needling to (1) sham dry needling, (2) manual therapy and/or exercise, or (3) investigated it as an adjunct to manual therapy and/or exercise. Due to high heterogeneity, the meta-analysis was limited to studies on neck pain.

RESULTS: Of 5,220 records identified, 71 comparisons were included in the qualitative synthesis and 23 in the quantitative synthesis. In almost 30% of studies, only 1 session was held, or only 1 trigger point was needled. The number of local twitch responses was rarely reported. Meta-regressions did not identify the number of sessions, trigger points needled, or local twitch responses elicited as moderators of dry needling effectiveness for neck pain (QM = 0.26, p = 0.968 to QM = 3.17, p = 0.205).

CONCLUSION: Considering neck pain, the current evidence does not allow a reliable dose-response relationship between DN parameters and pain outcomes to be identified. Substantial heterogeneity, incomplete reporting, and high risk of bias indicate that the findings should be interpreted cautiously and highlight the need for more research to be able to inform clinical decision-making and optimize treatment protocols.

PMID:42885938 | DOI:10.1080/10669817.2026.2747616