To evaluate the current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with low back pain (LBP).
PubMed, Ovid, EBSCO, ScienceDirect, Web of Science, Cochrane Library, CINAHL, and China National Knowledge Infrastructure databases were searched until January 2017.
Randomized controlled trials (RCTs) that used dry needling as the main treatment and included participants diagnosed with LBP with the presence of MTrPs were included.
Two reviewers independently screened articles, scored methodologic quality, and extracted data. The primary outcomes were pain intensity and functional disability at postintervention and follow-up.
A total of 11 RCTs involving 802 patients were included in the meta-analysis. Results suggested that compared with other treatments, dry needling of MTrPs was more effective in alleviating the intensity of LBP (standardized mean difference [SMD], −1.06; 95% confidence interval [CI], −1.77 to −0.36; P=.003) and functional disability (SMD, −0.76; 95% CI, −1.46 to −0.06; P=.03); however, the significant effects of dry needling plus other treatments on pain intensity could be superior to dry needling alone for LBP at postintervention (SMD, 0.83; 95% CI, 0.55–1.11; P<.00001).
Moderate evidence showed that dry needling of MTrPs, especially if associated with other therapies, could be recommended to relieve the intensity of LBP at postintervention; however, the clinical superiority of dry needling in improving functional disability and its follow-up effects still remains unclear.
List of abbreviations:CI (confidence interval), LBP (low back pain), MD (mean difference), MTrP (myofascial trigger point), Nfs (fail-safe number), RCT (randomized controlled trial), SMD (standardized mean difference)
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- The prevalence of low back pain among former elite cross-country skiers, rowers, orienteerers, and nonathletes: a 10-year cohort study.Am J Sports Med. 2012; 40: 2610-2616
- Non-specific low back pain.Lancet. 2017; 389: 736-747
- The prevalence of low back pain: a systematic review of the literature from 1966 to 1998.J Spinal Disord. 2000; 13: 205-217
- Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002.Spine (Phila Pa 1976). 2006; 31: 2724-2727
- The prevalence of low back pain in Africa: a systematic review.BMC Musculoskelet Disord. 2007; 8: 105
- A cross sectional study between the prevalence of chronic pain and academic pressure in adolescents in China (Shanghai).BMC Musculoskelet Disord. 2015; 16: 219
- A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain.Eur Spine J. 2011; 20: 19-39
- Acupuncture and dry-needling for low back pain.Cochrane Database Syst Rev. 2005; : CD001351
- Baseline examination factors associated with clinical improvement after dry needling in individuals with low back pain.J Orthop Sports Phys Ther. 2015; 45: 604-612
- Comparison of two angles of approach for trigger point dry needling of the lumbar multifidus in human donors (cadavers).Man Ther. 2016; 26: 160-164
- The effect of dry needling on the radiating pain in subjects with discogenic low-back pain: a randomized control trial.J Res Med Sci. 2016; 21: 86
- Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2015; 96: 944-955
- Myoelectrical activity and muscle morphology in a rat model of myofascial trigger points induced by blunt trauma to the vastus medialis.Acupunct Med. 2013; 31: 65-73
- Understanding of myofascial trigger points.Chin Med J (Engl). 2014; 127: 4271-4277
- The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: study protocol of a controlled clinical trial.BMJ Open. 2013; 3: e002825
- Travell and Simons'myofascial pain and dysfunction: the trigger point manual, volume 1: upper half of body.Williams & Wilkins, Baltimore1999
- Effectiveness of trigger point dry needling for multiple body regions: a systematic review.J Man Manip Ther. 2015; 23: 276-293
- Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.Spine (Phila Pa 1976). 2013; 38: 2124-2138
- Effectiveness of acupuncture for low back pain: a systematic review.Spine (Phila Pa 1976). 2008; 33: E887-E900
- Acupuncture for acute low back pain: a systematic review.Clin J Pain. 2013; 29: 172-185
- Acupuncture for low back pain.Cochrane Database Syst Rev. 2000; : CD001351
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6: e1000097
- Cochrane handbook for systematic reviews of interventions.(Available at:)http://handbook.cochrane.org/Date: 2011Date accessed: March 2, 2017
- 2015 Updated method guideline for systematic reviews in the Cochrane Back and Neck Group.Spine (Phila Pa 1976). 2015; 40: 1660-1673
- Short-term intensive insulin therapy in type 2 diabetes mellitus: a systematic review and meta-analysis.Lancet Diabetes Endocrinol. 2013; 1: 28-34
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Publication bias in meta-analysis: confidence intervals for Rosenthal's fail-safe number.Int Sch Res Notices. 2014; 2014: 825383
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924-926
- [Study on the super laser therapy on trigger points for low back myofascial pain syndrome].([Chinese]) Guangzhou Univ Chin Med, Guangzhou2014
- [A controlled clinical trial comparing trigger point acupuncture with tender point acupuncture treatments for chronic low back pain-a pilot study on 9 elderly patients].J Jpn Soc Acupunct Moxibustio. 2006; 56 ([Japanese]): 68-75
- Effects of trigger point acupuncture on chronic low back pain in elderly patients–a sham-controlled randomised trial.Acupunct Med. 2006; 24: 5-12
- Trigger point acupuncture treatment of chronic low back pain in elderly patients—a blinded RCT.Acupunct Med. 2004; 22: 170-177
- [Effect of acupuncture treatment on chronic low back pain with leg pain in aged patients—a controlled trial about short-term effects of trigger point acupuncture].J Jpn Soc Acupunct Moxibustio. 2005; 55 ([Japanese]): 530-537
- [A research on acupuncture at trigger points treatment for chronic low back myofascial pain syndrome].([Chinese]) Guangzhou Univ Chin Med, Guangzhou2013
- [Clinical observation of needling of myofascial trigger points and acupoints for myofascial pain syndrome in the lower back].J Guangxi Univ Chin Med. 2012; 15 ([Chinese]): 17-19
- [Clinical observation of effectiveness in the treatment of lumbar disc herniation with intramuscular stimulation therapy—30 cases reports].Zhejiang J Tradit Chin Med. 2015; 50 ([Chinese]): 676
- [Clinical observation of effectiveness in the treatment of myofascial pain syndrome in the lower back with intramuscular stimulation therapy].Chin J Rural Med Pharm. 2010; 17 ([Chinese]): 44-45
- Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: a preliminary clinical trial.J Bodyw Mov Ther. 2015; 19: 464-472
- Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.Acad Emerg Med. 2003; 10: 390-392
- Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points.J Bodyw Mov Ther. 2017; 21: 48-52
- Sensitivity to change of the Roland-Morris Back Pain Questionnaire: part 1.Phys Ther. 1998; 78: 1186-1196
- Different minimally important clinical difference (MCID) scores lead to different clinical prediction rules for the Oswestry disability index for the same sample of patients.J Man Manip Ther. 2013; 21: 71-78
Published online: July 06, 2017
Supported by the National Natural Science Foundation of China (no. 81470105).
© 2017 by the American Congress of Rehabilitation Medicine