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Triggered Debates: Unraveling the Dry Needling Narrative

Updated: Aug 20, 2023

Dry needling, often lauded as a panacea for musculoskeletal pain, finds its foundation on the contentious concept of "trigger points." These supposed taut bands of muscle fibres, which allegedly cause referred pain, remain largely elusive, with robust scientific evidence being limited.

Furthermore, the mechanism of action for dry needling remains nebulous. Proponents argue that inserting a needle into these "trigger points" deactivates the said point. Yet, emerging evidence suggests that the therapeutic benefits of needling might have little to do with targeting these hypothetical spots. Instead, studies indicate that the insertion of needles may stimulate the release of adenosine, a naturally occurring chemical in the body. Adenosine is known for its role in improving blood flow, particularly to nerves. Thus, any relief experienced post-needling might owe more to enhanced local blood flow rather than the deactivation of a "trigger point."

The complex interplay between nerve entrapment and myofascial pain is highlighted by Hong et al.'s case report, which emphasizes the challenge of distinguishing between these conditions in patients with chronic abdominal pain. While their study leans towards nerve entrapment, the overlapping characteristics of these two phenomena, such as the presence of taut bands in nerve entrapment syndrome and nerve compression in myofascial pain syndrome, make them nearly indistinguishable in clinical settings.

While I firmly believe in the efficacy of dry needling based on numerous anecdotal accounts and some research findings, the underlying mechanisms explaining its effectiveness remain a subject of debate. The once-popular notion that the procedure targets "trigger points" is increasingly contentious, with some evidence suggesting that the benefits of needling might be due to the release of adenosine near nerve entrapments thus resolving the energy crisis and reducing irritation of nervi nervorum by local acidosis.


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References:


The elusive nature of trigger points:


- Travell, J.G., & Simons, D.G. (1983). Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins.

- Tough, E.A., White, A.R., Cummings, T.M., Richards, S.H., & Campbell, J.L. (2007). Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomized controlled trials. European Journal of Pain, 11(8), 279-288.


Adenosine and its role in pain relief:


- Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., ... & Nedergaard, M. (2010). Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience, 13(7), 883-888.

- Takano, T., Chen, X., Luo, F., Fujita, T., Ren, Z., Goldman, N., ... & Nedergaard, M. (2012). Traditional acupuncture triggers a local increase in adenosine in human subjects. The Journal of Pain, 13(12), 1215-1223.


Critiques of dry needling:


- Quintner, J.L., Bove, G.M., & Cohen, M.L.(2015). A critical evaluation of the trigger point phenomenon. Rheumatology, 54(3), 392-399.


Other:

Jeong Il Choi. Korean J Pain. 2014 Apr; 27(2): 186–188. Chicken and Egg: Peripheral Nerve Entrapment or Myofascial Trigger Point?


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