The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis

ABSTRACT

Objective: The purpose of this systematic review was to evaluate the effects of deep versus superficial dry needling or acupuncture on pain and disability for spine-related painful conditions. A secondary purpose was to account for the differences of needling location in relation to the painful area.

Methods: This PROSPERO (#CRD42018106237) registered review found 691 titles through a multi-database search. Following a comprehensive search, 12 manuscripts were included in the systematic review and 10 in the meta-analysis. Standardized mean differences (SMD) with 95% confidence intervals were calculated for pain and disability.

Results: The included studies demonstrated an unclear to high risk of bias recommending a cautious interpretation of the results. A consistent effect supporting deep needling over superficial with an SMD of 0.585 [0.335, 0.835], p < 0.001 from 10 articles for pain but a non-significant effect of 0.197 [−0.066, 0.461], p = 0.14 from 2 studies for disability. A temporal examination was similar for effects on pain with an SMD of 0.450 [0.104, 0.796] immediately, 0.711 [0.375, 1.048] short-term (1 to 11 weeks), and 0.470 [0.135, 0.805] for time-points ≥12 weeks. Regionally, there was a greater effect needling the area of pain locally (SMD = 0.754) compared to remotely (SMD = 0.501).

Discussion: Statistically significant between-group differences were observed favoring deep needling over superficial. Both superficial and deep needling resulted in clinically meaningful changes in pain scores over time. However, differences between groups may not be clinically meaningful. More high-quality trials are needed to better estimate the effect size of deep versus superficial needling while controlling for location and depth of the lesion.

Level of evidence: 1a

KEYWORDS:

• Deep
• superficial
• dry needling
• acupuncture
• pain

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

D. Griswold

D. Griswold, DPT, PhD is an Associate Professor of Physical Therapy at Youngstown State University in Youngstown, OH. He received his DPT from Youngstown State University and his PhD in Physical Therapy from Nova Southeastern University.  David has three nationally recognized manual therapy certifications with peer-reviewed publications in his line of research activity focused on orthopedic manual therapy for spinal conditions.

M. Wilhelm

M. Wilhelm, PT, DPT is an assistant professor of physical therapy at Walsh University. His research spans multiple areas within musculoskeletal practice, with focuses on the spine and lower extremity. Within related topics, he has co-authored two book chapters and numerous peer-reviewed journal publications.

M. Donaldson

M. Donaldson, PT, PhD, FAAOMPT is an Assistant Professor and Director of Curriculum for the Doctor of Physical Therapy program at Tufts University. She is an educator, clinical researcher, and practicing clinician with specific interest focused on the efficacy of manual therapy and exercise for musculoskeletal disorders.

K. Learman

K. Learman, PT, PhD is a Professor of Physical Therapy at Youngstown State University in Youngstown, Ohio. He received his BSPT at SUNY-Buffalo, his MEd in Health Education at Penn State University and his PhD in Sports Medicine at the University of Pittsburgh. In addition, Ken is a board certified specialist in orthopedic physical therapy, a certifieded orthopedic manual therapist through Maitland-Australian Physiotherapy Seminars (MAPS), and a fellow in the American Academy of Orthopedic Manual Physical Therapists.

J. Cleland

J. Cleland, PT, PHD, is a professor in the Doctor of Physical Therapy program at Franklin Pierce University. He is a clinical researcher, author, and practicing clinician who has co-authored four textbooks and has over 200 publications with specific interest focused on the efficacy of manual therapy and exercise for disorders affecting the spine and extremities.