Within the realms of physiotherapy, osteopathy, chiropractic care, and other forms of musculoskeletal therapies, acupuncture and dry needling is commonly seen as an available service. The use of these modalities often create debate on whether they work, or whether they are just a waste of money, with some placebo effects at best. Here, we will take a deep dive into the use of needles by therapists in an effort to help pain and function, and whether or not you should consider them for your issue.

*most data compiled from the 2020 NICE (National Institute of Health and Care Excellence) Report on Acupuncture

What is Acupuncture & Dry Needling?

It is hotly debated amongst some health professionals that there are specific differences between the two treatments, some referring to dry needling as ‘Western Acupuncture’ or ‘Medical Acupuncture’. Dependent on how different therapist will explain how and why they are performing the treatment, the depth of needle penetration ranges from just touching the skin, to penetration of deeper body layers, such as bones and deep muscle tissues. The aim varies from practitioner, but the claim is usually that the needles will give some pain relief to the patient.

What is the Evidence?

Finding evidence can be very tricky, as there is always a company who is trying to sell a product and will fund research that supports their scan, piece of equipment, or treatment. Any health care professional in the UK who wants to treat their patients with the best evidenced care, will often follow the National Institute for Health and Care Excellence Guidelines, commonly referred to as NICE Guidelines. The NICE committee are in charge of collating all of the high quality research, and providing recommendations for doctors, physiotherapists, and other health care professionals, on how to best treat their patients. If health professionals are ever unsure on how treatment recommendations have changed, they will often look at the most recent NICE guidelines, and not trawl through the thousands of poor quality, often anecdotal content on social media and on a Google search, full of paid advertisements.

Do Dry Needling & Acupuncture Reduce Pain?

The NICE report on acupuncture in 2020, reported that the majority of the evidence they gathered was of ‘low quality’. In this low quality research, they found a slight difference in short term pain relief when comparing acupuncture to ‘sham acupuncture’ ie. placing needles around the painful area, but with less ‘specificity’ from the therapist. No pain benefit was seen in patients >3 months after injury. When compared to usual care (education and exercise), there was a mixture of results, with some studies showing no difference in pain reduction, while one large study of over 3,000 patients finding that in early stages, there was some benefit in pain reduction from acupuncture.

Quality of life (Chronic Pain & Disability)

Much of the research into acupuncture has been performed in the realm of chronic pain. NICE have compiled a large amount of research on mostly ‘low and moderate’ quality research. Once again, there was no significant consensus on whether acupuncture had a benefit over sham acupuncture, but overall, it can be claimed that acupuncture shows more promise for improvement in chronic pain than sham acupuncture. When compared to exercise and education alone, a large amount of the research does show that acupuncture can have a benefit for those with chronic pain >3 months.

Physical Function

All of the research compiled by the NICE Report on Acupuncture showed no clinical benefit between acupuncture and sham acupuncture (remember this is being non specific with needle placement). No evidence greater than ‘very low quality’ studies were found when comparing exercise and acupuncture and their effect on physical function, and acupuncture showed no benefit in these studies.

NICE’s Summary

The NICE committee noted that the majority of evidence was based on women with chronic neck pain or fibromyalgia. It is noted that all benefits seen in acupuncture and dry needling was most prominent in those with chronic pain, and those finding it difficult to engage in exercise.

Is Dry Needling & Acupuncture Appropriate For Me?

Acupuncture gets a bad name sometimes, and in other circles, it gets sold as the magic bullet. These treatments may have their place, but this information is intended to help you to make an informed decision on whether it is appropriate for you. If you have been struggling with chronic neck or back pain, or have a chronic pain condition such as fibromyalgia, then dry needling and acupuncture may be beneficial for you, as a part of your treatment. However, if you are an active individual with an acute injury, then this is likely both a waste of time and money, as active rehabilitation is more suited to your injury.

What are the Dangers of Acupuncture?

• Unless performed by someone who is careless or untrained, the use of needles in acupuncture is relatively safe.

• The dangers of these treatments aren’t necessarily physical. Treatments like dry needling have often been sold as a ‘series of treatments’, where you get sold 5, 10, or even 20 sessions. Particularly with people using insurance to fund their physiotherapy, health professionals have been known to ‘overtreat’, bringing you in for weekly, or even twice weekly sessions until all of your sessions have been used up. Always be wary of a healthcare professional who asks you very early on in the conversation “how many sessions will your insurance pay for?”.

• The psychological aspect of feeling dependent on such extensive treatment, instills a fragility mindset in some people, whereby they feel like they are broken, and need to be fixed.

• Financially, treatments like acupuncture aren’t cost effective compared to movement and training.

• Treatments like acupuncture don’t promote self management, meaning all dry needling teaches you is that every time you have an issue, you need to rush back to the clinic and have more treatment sessions.

• Real physiotherapy, should be based on activity modification, movement, strength training, and teaching you how to manage these things independently in the future.