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Dry Needling Plus Physical Therapy: A Major Advance for Fibromyalgia Treatment

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By Richard Podell, MD, MPH • www.ProHealth.com • June 21, 2016


Dry Needling Plus Physical Therapy:  A Major Advance for Fibromyalgia Treatment
Reprinted with the kind permission
of Richard Podell, MD, MPH

Background

Dry needling is a technique used by specially trained physical therapists, physicians, and dentists to treat several forms of musculoskeletal pain.  Controlled studies show benefit for regional myofascial pain, temporomandibular joint dysfunction (TMD), and chronic tension headache. It typically uses an acupuncture type needle to enter into and disrupt localized spots of intense muscle spasm called trigger points. This may allow almost immediate relaxation of the involved muscle which often relieves pain. It also allows concurrent physical therapy to be done more effectively.

The needling is called “dry” because no medicines are injected. Several studies show that dry needling alone is as effective as injecting a local anesthetic or corticosteroids into the trigger point.  Three years ago, the New Jersey State Board of Physical Therapy authorized physical therapists to treat with dry needling.  Since the excellent physical therapy group I refer to added dry needling to their tool kit, their results for my Fibromyalgia patients have greatly improved.

Today I’m pleased to report on a double blind study that confirms the benefits from adding “dry needling” to standard treatments.  Researchers from the Rheumatology Services at the Specialist Clinic of Cantabria in Santander, Spain added six weekly one hour sessions of dry needling to the standard treatment of 60 Fibromyalgia patients. Another 60 patients (controls) continued with standard treatment alone.  Unlike the usual practice of inserting needles into palpable trigger points within any symptomatic muscle, the Santander group inserted their needles specifically into the site of the 18 standard Fibromyalgia tender points. These anatomical locations were defined by the American College of Rheumatology.   Clinically, we find the standard tender point sites often also contain trigger points.

Findings

After six weeks of treatment the patients treated with dry needling improved considerably more than the control patients who did not have dry needling.  Several measures of pain and fatigue status showed major benefit.  Improvement was found for each of the following: The Visual Analogue Scale for Pain (P=0.002), the Visual Analogue Scale for Fatigue (p=.02), the SF-36 health questionnaire (p=.0001), the degree of pain elicited by pressing six specified sites with a dolorimeter (pain inducing device ) (p=0.0005), the amount of pressure needed to induce pain (p=.002) and a survey of global subjective improvement (P=.00001).   (The P values indicate the probability that the advantage of dry needling was due to chance. A P value of .05 or greater is considered to be statistically significant. A P value of .01 or greater is highly significant.

No dry needling was done during the next six weeks. Then outcomes for both groups (treated and controls) was measured again. Most impressively, six weeks later—12 weeks after the study started—the advantage for the dry needling group over the controls, continued to be high.

Training

Now for the “bad” news. In the United States, although dry needling by physical therapists is authorized in about half the states, only a modest number of physical therapists, physicians or dentists have major experience with dry needling.  As with any therapeutic technique, training and experience are important.  For many Fibromyalgia patients, the simplest way to locate a trained or experienced practitioner will be contact the programs that train clinicians in this technique. They can refer you to their graduates. They also might know other experienced clinicians.

In the Northeast United States, the main training program is run by Robert Gerwin, M.D., a professor of neurology, together with Jan Dommerholt, PT, PhD, an outstanding physical therapist.  I most often refer patients seeking this technique to North Jersey Physical Therapy Associates.

Is dry needling related to acupuncture?  Except that both use a similar tool, the theory and practice of dry needling have little in common with acupuncture. They are fundamentally different.  A few acupuncturists have also trained in dry needling. Unfortunately, a guild mentality may have developed among acupuncture organizations.  In New Jersey and several other states, the acupuncture professional society is attempting to ban physical therapists from doing dry needling on the grounds that dry needling by physical therapists is the “illegal practice of acupuncture.” Good grief.

Take Home Thoughts

Dry needling done alone without concurrent physical therapy is more likely to relapse if posture problems and weak or tight muscles remain. The best results should occur if dry needling and physical therapy are done at the same time.  Contact the physical therapy association in your state (e.g. Delaware Physical Therapy Association) and ask if physical therapists are allowed to do dry needling in your state. If so and you suffer from Fibromyalgia, Headache, Temporomandibular Joint Disorder (TMD) or other chronic muscle-related problems, consider consulting a physical therapist with training and experience in this potentially useful technique.


Richard Podell, M.D., MPH, is a graduate of Harvard Medical School and the Harvard School of Public Health. He has been treating patients with ME-CFS and Fibromyalgia for more than 20 years. A clinical professor at New Jersey's Robert Wood Johnson Medical School, Dr. Podell see patients at his Summit, NJ and Somerset, NJ offices.

His website is www.DrPodell.org.



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