I have read discussions on social media with questions similar to this: “Why would you ever stick a needle in someone with chronic pain?” As a therapist who has spent much of my professional life to serve people with chronic pain, my first thought response is always: “Why would you not?” 

Dry needling is a powerful treatment technique that has shown robust shifts in self-reported pain in patients -including those with chronic pain – who have attended physical therapy. By inserting a needle into a muscle to facilitate normalization of physiological processes associated with pain (spasm, pH-imbalances, blood flow changes, etc.), dry needling allows a patient to move better with less pain. Several studies have shown that immediately following dry needling there are improvements in active range of motion and self-reported pain. 

In pain science, a cornerstone of treating people with pain – especially chronic pain – is to create a therapeutic alliance (TA). TA focuses on trust. This is trust in therapy, or what the clinician and the treatment provided is to the patient. How do we do build trust?  Several patient and clinician factors drive trust, but trust is powerfully strengthened by listening to patients and meeting their needs.  Just as we explain pain to our patients (pain neuroscience education), we also explain other forms of therapeutic treatments to our patients, including dry needling. This includes what dry needling is, what it does to the muscle, what the patient can expect during and after the treatment, and a proposed mechanism as to why dry needling can be beneficial for them. Meeting patient needs is the essence of placebo – the most powerful treatment to-date shown to impact a human’s pain experience. Placebo is enhancing the endogenous mechanisms of the brain and CNS, which starts with trust and TA. 

The more someone knows about their treatment and how it can help them, the less fearful and anxious they become. This alone has been shown through many studies to decrease the sensitivity of the nervous system – the current underpinning of most chronic pain states. All of this comes down to setting the stage for your treatment – in this case, dry needling. In our Pain Fellowship, we recently published 2 papers associated with dry needling and pain science for patients with chronic pain. Following needling, not only did self-reported pain decrease significantly, but improved measures used in clinical practice to measure structural shifts in the brain of people with chronic pain, such as left/right discrimination, two-point discrimination and pain drawings. Pain is complex and as we expand more pain science research, we will likely get more answers, but it all starts (and ends) with the patient. Is dry needling for everyone? No. Is pain science for everyone? No. But by building a TA we can explore and see what treatments, including dry needling, may be of benefit to our patients, including those struggling with chronic pain. In this day and age with the opioid and pain epidemic, if we cannot embrace (or be open minded) to non-pharmacological and non-surgical approaches to pain, we will never “move the needle”. 

Relevant research: 

1. Louw, C., Louw, A., Maywhort, K., Collins, B., Keatts, A., Podolak, J., Louw, H., Cox, T. (2023). “Dry Needling and Pain Drawings: An Exploratory Study.” Annals of Physiotherapy and Occupational Therapy 6(1): 1-8. 
2. O’Neill, M., et al. (2021). “A Case-Series of Dry Needling as an Immediate Sensory Integration Intervention.” J Man Manip Ther: 1-7. 
3. Fernandez-de-Las-Penas, C. and J. Nijs (2019). “Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm.” J Pain Res 12: 1899-1911.