Comparison of dry needling with physical modalities for myofascial trigger point of patients with neck pain: A systematic review and meta-analysis

This systematic review and meta-analysis examined the comparative efficacy of dry needling versus physical modalities in the treatment of myofascial pain syndrome of the neck. The analysis included eight randomized clinical trials with 470 adult participants who had myofascial trigger points in the upper trapezius muscle. Myofascial pain syndrome is a chronic musculoskeletal condition characterized by tender, painful spots in the muscles, known as trigger points, which can cause local and referred pain. The neck is one of the most commonly affected regions, with an annual incidence of 14.6% in the general population.

Dry needling is a technique that uses thin needles inserted directly into trigger points to inactivate pathological muscle contraction, while physical modalities include treatments such as ultrasound, extracorporeal shockwave therapy, electrical stimulation, massage, and therapeutic exercise. The methodology rigorously followed PRISMA guidelines, with a comprehensive search of PubMed, EMBASE, SCOPUS, and Cochrane Library databases through September 2023. Inclusion criteria were strict: adults aged 18-70 years with neck pain induced by trigger points in the upper trapezius, studies comparing dry needling with physical modalities, and use of validated measures such as the visual analog scale (VAS), pressure pain threshold (PPT), and Neck Disability Index (NDI). Methodological quality was assessed using the Cochrane risk-of-bias tool and the GRADE system to rate the quality of evidence.

Results revealed an absence of statistically or clinically significant differences between the two therapeutic approaches. For pain intensity measured by VAS, the mean difference was only -0.13 cm (95% CI: -0.35 to 0.09), well below the minimal clinically important difference threshold of 1-2 cm. The pressure pain threshold showed a mean difference of 0.04 kgf (95% CI: -0.08 to 0.16), also insufficient for clinical relevance. Neck function, assessed by the NDI, presented a mean difference of 0.00 points (95% CI: -0.61 to 0.60), indicating absolute therapeutic equivalence.

Heterogeneity between studies was low, strengthening the reliability of the pooled results. Notably, no adverse events were reported in any of the treatments evaluated, suggesting a favorable safety profile for both approaches. The clinical implications of these findings are significant for healthcare professionals and patients. Because there are no clinically relevant differences between dry needling and physical modalities, the choice of treatment can be based on factors such as patient preference, equipment availability, cost-effectiveness, and therapist experience.

Dry needling may be advantageous in terms of operating cost and treatment time, while physical modalities may be preferable for patients with needle phobia or a preference for noninvasive treatments. However, several important limitations should be considered. The methodological quality of included studies was limited, with GRADE ratings ranging from moderate to low quality. The main limiting factor was the inability to blind participants due to the inherently different characteristics of the treatments (invasive versus noninvasive), increasing the risk of performance bias.

In addition, dry needling protocols varied substantially across studies in terms of needle depth, manipulation techniques, and number of sessions, limiting the standardization of findings. The lack of long-term follow-up data prevents conclusions about the durability of therapeutic benefits. The restricted anatomical focus on the upper trapezius limits generalizability to other body regions or patient populations. Future research should prioritize high-quality randomized clinical trials with standardized protocols, larger samples, long-term follow-up, and objective outcome measures to minimize performance bias.

Cost-effectiveness studies would also be valuable to guide health policy decisions. In conclusion, both dry needling and physical modalities demonstrate equivalent efficacy in the management of myofascial pain syndrome of the neck, allowing flexibility in therapeutic choice based on individual clinical context.