Research Report: Dry Needling Adds No Benefit to the Treatment of Neck Pain: A Sham- Controlled Randomized Clinical Trial with 1-Year Follow Up
Introduction:
This study looked to examine the effects of adding myofascial trigger point dry needling to evidenced-based care of individuals with non-specific mechanical neck pain. The authors defined evidenced-based care to include manual therapy interventions (STM, joint mobilization, and manipulation) and exercise-based therapy addressing neck, shoulder, and upper back musculature.
Study Design: Double-blind, sham-controlled, randomized controlled trial Methods:
The study was double-blinded and constructed in such a way as to mimic usual clinical practice. Follow up was conducted at 4-weeks, 6-months, and 1-year. Participants were recruited if they had acute, subacute, or chronic mechanical neck pain. The inclusion criteria were 18 years or older, primary complaint of neck pain, and an NDI score of 20% or greater. Participants were excluded if they presented with red flags, neurologic deficits, CNS involvement, previous surgery in the cervical or thoracic spine, and other constraints detailed in the article.
Following randomization, participants were assigned to receive either 1) dry needling, manual therapy, and exercise (needling group) or 2) sham-dry needling, manual therapy, and exercise (sham needling group). Participants received treatment on seven occasions over 4 weeks before follow up.
Treatment was directed to participants in a manner consistent with usual clinical practice, allowing for some variations in treatment technique based on examination findings. Both needling and sham-needling detailed that patients receive needling at 6-10 locations as appropriate each session. 15 minutes were allotted for needling/sham-needling, manual therapy, and exercise interventions each for a total of 45-minute sessions.
The primary outcome was NDI score. Secondary outcomes included pain (VAS) and global rating of change score (GROC). An MCID of 12 points was utilized for the NDI.
Results:
Both groups demonstrated improvement in all outcomes at all follow up points relative to baseline. At all follow up periods there was no significant difference in outcomes for primary and secondary outcomes. Additionally, all patients allocated to the sham needling group believed that they received true dry needling. Statistical analysis demonstrated that duration of pain or age at enrollment were not significant predictors of outcome.
Discussion:
The authors assert that this study provides evidence that dry needling adds no additional benefit to current evidenced based practice in the short- or long-term for mechanical neck pain.
Previous studies have demonstrated that dry needling can provide meaningful benefit in the short-term when compared to sham needling or stretching therapy alone. When dry needling has been compared to the likes of varying manual therapy interventions, results are similar to this study showing no significant difference in outcomes. The authors acknowledge that the results of this study may have been different had the compared dry needling and exercise to sham needling and exercise.
The authors further explain that the purported effects of manual therapy interventions (including dry needling) are neurophsysiological in nature (i.e. reduced pain pressure threshold, reduction in primary and secondary hyperalgesia, reduced allodynia). With this assumption, it is possible that the combination of manual therapy and needling/sham-needling “contaminates” the findings of this study as both interventions have similar effects. Despite this explanation, the authors reveal their bias asserting that “the pragmatic design of this trial suggests that dry needling should not be a part of first-line treatment for neck pain.”
The findings of this study suggest that the addition of dry needling to manual therapy and exercise provides no further benefit for non-specific mechanical neck pain. Due to the study design, however, one cannot assert that dry needling has no part in the management of mechanical neck pain. There is a mismatch between the research question that was asked and the answer the results provide.
It seems that despite promising findings regarding dry needling for musculoskeletal conditions, further research will be needed for its implementation in specific diagnoses. It may be prudent for clinicians to utilize dry needling in specific situations for which it is currently indicated (i.e. chronic pain, myofascial referred pain, cervicogenic headaches, etc.).
Clinical Applications:
This study further supports the combination of manual and exercise therapy as effective in treating mechanical neck pain. Based on this study, it may be more practical to utilize either traditional manual therapy or trigger point dry needling rather than both in the management of mechanical neck pain. This is important as it allows more time to emphasize active management strategies including exercise therapy that are known to increase patient self-efficacy and independent management.
Citation:
Gattie E, Cleland JA, Pandya J, Snodgrass S. Dry Needling Adds No Benefit to the Treatment of Neck Pain: A Sham-Controlled Randomized Clinical Trial With 1-Year Follow-up. J Orthop Sports Phys Ther. 2021 Jan;51(1):37-45. doi: 10.2519/jospt.2021.9864. PMID: 33383999.
