Pictured: The difference between the acupunctures and dry needling.

Pictured: The difference between the acupunctures and dry needling.

War, huh, yeah
What is it good for
Absolutely nothing
Uh-huh huh
War, huh, yeah
What is it good for
Absolutely nothing
Say it again, y’all
War, huh,
What is it good for
Absolutely nothing
Listen to me
Ohhh, war, I despise
Cause it means destruction
Of innocent lives
War means tears
To thousands of mothers eyes
When their sons go to fight
And lose their lives
Ooh, war, huh
Good God, y’all
What is it good for
Absolutely nothing
Say it again
War, whoa,
What is it good for
Absolutely nothing
Listen to me
War, it ain’t nothing
But a heartbreaker
Friends only to the undertaker
Ooooh, war
It’s an enemy to all mankind
The point of war blows my mind
War has caused unrest
Within the younger generation
Induction then destruction
Who wants to die
Aaaaah, war-huh
Good God y’all
What is it good for
Absolutely nothing
Say it again
War, huh
What is it good for
Absolutely nothing
Listen to me
War, huh, yeah
What is it good for
Absolutely nothing
Come on, let me hear ya
War, it ain’t nothing but a heartbreaker
It’s got one friend
That’s the undertaker
War has shattered
Many a young man’s dreams
Made him disabled, bitter and mean
Life is much to short and precious
To spend fighting wars these days
War can’t give life
It can only take it away
Ooooh, war, huh
Ooh yeah
What is it good for
Absolutely nothing
Say it again, y’all
War, whoa,
What is it good for
Absolutely nothing
Come on, sing it
War, whoa,
Come on and shout it, y’all
What is it good for
Absolutely nothing
Come on, come on now
It ain’t nothing but a heartbreaker
Friends only to the undertaker
Peace, love and understanding
Is there no place for them today
They say we must fight to keep our freedom
But Lord knows there’s got to be a better way
Ooooooh, war, huh
Good God y’all
What is it good for
absolutely nothing
Say it again, y’all
War, huh
What is it good for
Absolutely nothing
Say it again, y’all
What is it good for
Absolutely nothing

Edwin Starr

I’m convinced. War is bad. But I have a solution. To the 54 current armed conflicts in the world: forget about it. Then no shots will be fired and no one will be injured or killed. It’s that easy. Problem identified, problem sol-ved. Go Science and Big ‘S’ Skepticism. Any complaints about my solution aren’t worth responding to.

Now that the problem of war is settled, let’s move on to dry needling.

What is dry needling?

Well there is its yin, wet needling, which is the use of hollow-bore needles to inject, well, wet things: steroids, anesthetics, etc.

Contrast to the yang that is dry needling, which in its original manifestation used small hypodermic needles placed directly into trigger points, but which now often uses thin monofilament/filiform needles (not acupuncture needles, oh no. It’s a filiform needle) placed into various soft tissues primarily to treat chronic pain such as myofascial pain syndromes and ISN’T ACUPUNCTURE NO IT ISN’T. IT MAY LOOK LIKE ACUPUNCTURE BUT REALLY IT IS NOT.

Sorry I shouted. You will see why later.

Dry needling has nothing to do with chi and meridians and acupoints and the rest of the fantastical underpinnings of traditional Chinese pseudo-medicine with its tongue and pulse diagnosis. Nor is dry needling used for every human aliment. Nope. Because it’s not acupuncture. No siree-Bob. It’s dry needling.

Although that presupposes that there is a single form of acupuncture of which dry needling is not, but as has been noted in the past there as likely as many forms of acupuncture as there are acupuncturists, so dry needling is not like the multitudinous forms of the acupunctures.

Since dry needling isn’t the acupunctures, oh no, it isn’t, how does it work?

Well, in correctly-done dry needling a needle is placed into a myofascial trigger point, causing a local twitch response (LTR aka muscle contracture) which activates endogenous opioids, which is not how acupuncture is supposed to relieve pain. Totally different mechanism.

Other mechanisms by which dry needling is alleged to work include:

…mechanical disruption of the integrity of dysfunctional endplates, alterations in the length and tension of muscle fibers and stimulation of mechanoreceptors, increased muscle blood flow and oxygenation, and endogenous opioid release affecting peripheral and central sensitization, among others.

Proposed mechanisms mind you. They really don’t know the mechanism of action. Not at all like the foundations of acupuncture where:

modern research into acupuncture, the potential therapeutic mechanisms of acupuncture have been explored and include Pavlovian conditioned reflexes, nerve segment theory, gate theory, somato-autonomic nerve reflexes and others.

Dry needling is ‘among others’ where the acupunctures is ‘and others’. Big difference. Presuming an efficacy, dry needlers keep looking for anatomical and physiologic correlates to back up their clinical practice and they do find a variety of structures and associations, although:

the lack of anatomical information about these structures constitutes a major obstacle to obtaining a complete understanding of the pathophysiology and widespread clinical treatment of MTrP.

I sense they are finding what they want to find. Not at all like the acupunctures.

Does dry needling work?

As always, it depends on who you ask and for what.

One meta-analysis suggested that:

DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3–4 weeks.

I think that is a first for a meta-analysis of a pseudo-medicine. It was actually worse than placebo.

Another suggests:

dry needling is effective in reducing pain associated with lower quarter trigger points in the short-term. However, the findings suggest that dry needling does not have a positive effect on function, quality of life, depression, range of motion, or strength.

But it is not as effective as wet needling aka lidocaine:

Dry needling can be recommended for relieving MTrP pain in neck and shoulders in the short and medium term, but wet needling is found to be more effective than dry needling in relieving MTrP pain in neck and shoulders in the medium term.

Others are more optimistic:

strong evidence for dry needling to have a positive effect on pain intensity.

Reading through the literature is not at all like the acupunctures literature: a hodgepodge of studies with a variety of methodologies with variable results.

So, it’s acupuncture then, right?

Dry needlers are adamant that dry needling is not acupuncture, although acupuncturists as just as adamant that it is and keep trying to draw dry needlers into the fold; acting the goody two shoes of looking out for patient welfare.

But really. Given the innumerable forms of acupuncture, it is safe to say that for all practical purposes dry needling is yet another form of the acupunctures and likely just as ineffective. Dry needlers have simply abandoned 2,000 years of nonsensical baggage that accompanies the acupunctures and have added a ducks breath of science and modernity to their placebo.

I suspect that dry needling is at somewhat of a disadvantage when compared to the acupunctures: acupuncturists have the whole mystique of Eastern medicine on their side to help with their theatrical placebo, although I can’t find any head-to-head comparisons.

Dry needlers just have trigger points, a concept that upon review comes across as only just a little more believable than chi and meridians. Although as best I can tell my wife sure as hell has trigger points as defined in her trapezius and she has never used the term.

But the real reason that dry needling is not the acupunctures is turf wars, since dry needling is the “number-one threat to the existence of the acupuncture profession”.
It is quite amusing to see how upset acupuncturists are, getting their medians twisted into a knot over physical therapists taking their business, and how acupuncturists want:

to protect the public’s health safety, welfare and to stop all insufficiently trained and unlicensed practitioners from unsafe acupuncture.

When from my perspective there are no sufficiently-trained acupuncturists who practice safely. Extended training in nonsense doesn’t make for better nonsense.

It is our [acupuncturists’] professional duty to change the message that a weekend seminar is comparable to the more than 700 hours of clinically supervised training obtained by the LAc.

I agree. Two days of education on pseudo-medicine is not the same as three months of education on pseudo-medicine. In this, the principles of homeopathy are probably valid; less is better.

If you are practicing the pseudo-medicine of the acupunctures, then you have to have gone through the education and training of an acupuncturist, which is 99.9% nonsense, and are subject to state licensing and oversight.

If dry needling is not acupuncture, then a PT or a DC or an ND or whoever is free of those onerous requirements and can needle without the worry of acupuncture boards and regulations.

There have been lawsuits in a variety of states to try and prevent physical therapists from offering dry needling, saying dry needling is acupuncture and beyond their scope of practice. Physical therapists beg to differ.

WWCD?

Me? I would take a PT over an acupuncturist any day. They are not trained in the nonsense of chi and meridians, with the somewhat-more-plausible trigger point as a clinical guiding principle. PTs are grounded in reality-based medicine, and I want my pseudo-medicines with a modern patina. PTs are not going to needle for fertility, blindness, schizophrenia, and more. Or so I would hope. And I suspect we will never see the equivalent of “A case of perforating injury of eyeball and traumatic cataract caused by acupuncture” from a dry needler. Or so I would hope.

But more importantly, as often as not practitioners of dry needling use gloves during their needling, which is NEVER seen in the practice of acupuncture. Give me good infection control with my pseudo-medical practice any day.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.

Loading...