Efficacy of Dry Needling and Acupuncture in the Treatment of Neck Pain
Berger et al. · Anesthesiology and Pain Medicine · 2021
Evidence Level
STRONGOBJECTIVE
To review the efficacy of acupuncture and dry needling in the treatment of neck pain
WHO
Patients with chronic and acute neck pain
DURATION
Variable across reviewed studies (2 weeks to 6 months)
POINTS
TE-5, LI-11, SI-15, GB-21, LI-15, abdominal points, and study-specific points
🔬 Study Design
Traditional Acupuncture
n=800
Acupuncture with traditional needles
Dry Needling
n=600
Dry needling at trigger points
Electroacupuncture
n=400
Acupuncture with electrical stimulation
Controls
n=200
Sham or waiting list
📊 Results in numbers
Pain reduction (visual analog scale)
Significant functional improvement
Dry needling efficacy at trigger points
Reduction in neck disability
Percentage highlights
📊 Outcome Comparison
Pain Intensity (VAS 0-100)
Neck Disability Index
This review shows that acupuncture and dry needling are safe and effective treatments for neck pain. Both techniques can significantly reduce pain and improve cervical function, both immediately after treatment and over the long term.
Article summary
Plain-language narrative summary
This comprehensive review examines the scientific evidence on the use of acupuncture and dry needling in the treatment of neck pain, a problem that affects up to 288 million people globally. Chronic neck pain, defined as pain that persists for more than 3-6 months, develops in 10-30% of patients with acute neck pain and is strongly associated with office work and computer use. The study analyzes multiple randomized clinical trials that investigated different treatment modalities, including traditional acupuncture, electroacupuncture, dry needling, and cupping therapy. The methodology of the reviewed studies varied from 2 weeks to 6 months of follow-up, with sample sizes between 24 and 456 participants.
The results demonstrated consistent efficacy of the interventions. Traditional acupuncture showed a mean reduction of 19.04 points on the visual analog pain scale compared to controls. Dry needling at myofascial trigger points resulted in significant improvement in 80% of cases, with change in trigger point status from active to latent or resolved. Electroacupuncture demonstrated superiority to biofeedback in the treatment of cervical myofascial pain syndrome.
Dry cupping therapy showed significant reductions in pain at rest (22.5 mm) and movement-related pain (17.8 mm). The studies also showed improvements in cervical function, range of motion, quality of life, and reduction in disability. The techniques were shown to be safe, with mild and transient adverse events including mild local pain, bruising, neck stiffness, and occasionally fatigue. The proposed mechanism of action involves nerve stimulation through the skin, leading to the release of neurotransmitters and endogenous pain modulators.
Limitations include methodological heterogeneity between studies, different treatment protocols, and the need for more direct comparative studies between different modalities. The evidence supports that these therapies should be considered as part of a multimodal approach to the treatment of neck pain, especially considering their favorable safety profile and relatively low cost.
Strengths
- 1Multiple randomized controlled trials analyzed
- 2Consistent evidence of efficacy across different modalities
- 3Favorable safety profile of the interventions
- 4Benefits maintained over the long term
- 5Well-documented multimodal approach
Limitations
- 1Methodological heterogeneity between studies
- 2Few direct comparative studies between modalities
- 3Variability in treatment protocols
- 4Risk of bias in some studies analyzed
- 5Need for more high-quality studies
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Chronic neck pain is one of the most frequent diagnoses in any physiatry and pain clinic, and this review consolidates evidence that dry needling and acupuncture have a defined place in the multimodal therapeutic arsenal. The 19.04-point reduction on the VAS with traditional acupuncture exceeds the minimal clinically important difference threshold widely accepted in the musculoskeletal pain literature. Functional improvement in 80% of cases and a 5.75-point reduction in the neck disability index translate into gains that the patient perceives in activities of daily living — cervical rotation while driving, prolonged tolerance at the computer, sleep quality. For the increasingly prevalent profile of the office worker with chronic cervical myofascial pain and limited range of motion, these modalities offer a safe intervention with a profile of mild and transient adverse events that rationally complements conventional pharmacological analgesia and structured physical rehabilitation.
▸ Notable Findings
The most substantive piece of data in this review is the 79% efficacy of dry needling at myofascial trigger points with conversion of the point from active to latent or resolved — an objective neurophysiological outcome, not just a subjective one. This is relevant because it validates the model of peripheral sensitization of the trigger point as a measurable therapeutic target. The superiority of electroacupuncture over biofeedback in cervical myofascial pain syndrome also deserves attention: it suggests that electrical stimulation added to the needle recruits descending pain modulation pathways more efficiently than techniques based solely on autonomic self-regulation. Dry cupping therapy, often ignored in formal clinical discussions, presented significant reductions in both pain at rest and movement-related pain, adding a low-cost modality to the repertoire. The maintenance of benefits over the long term — documented in studies of up to six months — is the finding that most influences decisions about when to initiate and how to structure treatment.
▸ From My Experience
In my practice in the musculoskeletal pain clinic, I have observed that patients with chronic cervical myofascial pain associated with sedentary work respond to dry needling consistently from the second or third session — which is aligned with the results of this review. I usually structure an initial cycle of six to eight weekly sessions, reassessing range of motion and VAS at the fourth session to decide whether to maintain the frequency or anticipate discharge. For cases with a more evident component of central sensitization, electroacupuncture has been my preference, combined with cervical stabilization exercise and, when necessary, low-dose duloxetine. The patient profile that responds best, in my experience, is the one with palpable active trigger points in the upper trapezius and levator scapulae, without overt radicular irradiation — in these cases, dry needling often eliminates the need for analgesic escalation. When there is cervical radiculopathy confirmed by imaging and progressive neurological deficit, I do not indicate needling as a primary intervention.
Full original article
Read the full scientific study
Anesthesiology and Pain Medicine · 2021
DOI: 10.5812/aapm.113627
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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