Pain Med. 2021 Jun 11:pnab188. doi: 10.1093/pm/pnab188. Online ahead of print.
OBJECTIVE: To examine the effects of dry needling against trigger point (TrP) injections (wet needling) applied to TrPs associated with neck pain.
METHODS: Electronic databases were searched for randomized clinical trials where dry needling was compared to TrP injections (wet needling) applied to neck muscles and collected outcomes on pain or related-disability. Secondary outcomes consisted of pressure pain thresholds, cervical mobility, and psychological factors. The Cochrane risk of bias (RoB) tool, the Physiotherapy Evidence Database (PEDro) score, and GRADE approach were used.
RESULTS: Six trials were included. TrP injection reduced pain intensity (MD -2.13, 95%CI -3.22 to -1.03) with a large effect size (SMD -1.46, 95%CI -2.27 to -0.65) as compared to dry needling. No differences between TrP injection and dry needling were found for pain-related disability (MD 0.9, 95%CI -3.09 to 4.89), pressure pain thresholds (MD 25.78kPa, 95%CI -6.43 to 57.99kPa), cervical lateral-flexion (MD 2.02° 95%CI -0.19° to 4.24°) or depression (SMD -0.22, 95%CI -0.85 to 0.41). The RoB was low, but the heterogenicity and imprecision of results downgraded the evidence level.
CONCLUSION: Low evidence suggests a superior effect of TrP injection (wet needling) for decreasing pain of cervical muscle TrPs at short-term as compared to dry needling. No significant effects on other outcomes (very low-quality evidence) were observed.
LEVEL OF EVIDENCE: Therapy, level 1a.
REGISTRATION NUMBER: OSF Registry – https://doi.org/10.17605/OSF.IO/3H6GS.