Clinical criteria for the application of dry needling in myofascial pain Syndrome: An expert consensus document and a cross-sectional study among physical therapists

Abstract

Presently, there is no clear consensus on the essential and confirmatory criteria which should govern the application of dry needling (DN) in the treatment of myofascial trigger points. The aim of this study was to generate a consensus on these criteria, via a panel discussion with DN experts which took place at the International Conference of Invasive Physical Therapy held in 2018, including the opinion of the attendees who participated in a live survey on the subject at the conference via an app. The results obtained reveal discrepancies regarding confirmatory criteria such as the elicitation of referred pain; nonetheless, consensus exists on the suitability of the application of individualized and personalized DN treatment and the combination of treatment with other intervention approaches in physical therapy, with the use of ultrasound when required to support a safer clinical practice.

The Effects of Ultrasound-guided Dry Needling on Patients With Myofascial Pain Syndrome

“…Previous studies revealed that US fails to identify the exact echogenicity changes [12]. The mechanism of action of DN in pain relief among patients with MPS remains undiscovered [9]. However, therapists can employ needles with an appropriate length to minimize the micro-trauma caused by muscle stimulation; this is due to the effectiveness of this therapeutic technique, the inadequate availability of all muscles, the risk of damage to vessels entering the muscles and the surrounding nerves, and the odds of monitoring muscles through US [10,12].…”

“…Besides, the International Conference on Invasive Physical Therapy (ICIPT) recommended using US during needling. The safety considerations, visualizing deep tissues and LTR, and recording changes and outcomes were mentioned as the main reasons for applying US [9]. However, the main purpose of US-guided DN is to guide fine needles into deep muscles [14][15][16][17][18][19][20][21][22][23][24].…”

“…DN is a frequent therapeutic technique, in which a solid, filiform, and stainless steel needle is inserted through the skin [7]. Inserting needles into the target soft tissues causes mechanical hyperstimulation and manipulation [9]. Bruises, bleeding, and soreness are the three most frequent adverse effects of DN.…”

“…LTR) of DN. Moreover, the evaluation of treatment outcomes is a major concern following DN [7][8][9][10][11]. In this regard, Baraja-Vegas et al indicated that DN may elicit intramuscular edema and alternations in the contractile properties of muscles [11].…”

“…The need for information, such as the needle penetration depth, needle insertion into the target muscle and trigger points, as well as the prevention of needle penetration into the adjacent structures (e.g. nerves) has led researchers to employ diagnostic Ultrasound (US) along with DN [7,9].…”