Acupuncture and dry needling

Acupuncture and dry needling both use very thin, solid needles placed through the skin. Nothing is injected.

How they differ

• Acupuncture comes from traditional Chinese medicine. Needles go in at specific points chosen according to that tradition, often several at once, and stay in while you rest.
• Dry needling is based on Western anatomy and pain science. The needle is aimed at a trigger point, a tight, tender knot in a muscle, and is often moved in and out briefly.
• Who gives it: acupuncture is given by licensed acupuncturists and by some physicians and other clinicians trained in it. Dry needling is most often done by physical therapists, and by some physicians.
• State rules: most states license acupuncturists, and requirements vary. Whether physical therapists may offer dry needling also depends on the state.

Sometimes a mild electrical current is passed through acupuncture needles. This is called electroacupuncture. Both treatments are used for low back pain and neck pain. Most of the research is on the low back.

No one knows for sure how needling eases pain. Research, much of it in animals, suggests that needles stimulate nerves, which may prompt the brain and spinal cord to release the body’s own pain-relieving chemicals.

With dry needling, researchers think needling a trigger point may relax the tight band of muscle and calm the nerves that make it tender.

Expectations seem to matter with needle treatments. In studies, people who expected acupuncture to work tended to improve more.

Before

The practitioner will ask about your pain and your health. An acupuncturist may also look at your tongue or check your pulse, as part of traditional Chinese medicine. Tell the practitioner if you take a blood thinner, have a bleeding problem, are pregnant, or have a pacemaker or other implanted electrical device.

During

You lie or sit comfortably. The needles are very thin. Many people feel a quick prick, then a dull ache, heaviness or tingling around the needle.

In acupuncture, the needles often stay in for about 15 to 20 minutes while you rest. In dry needling, the needle is often in the muscle only briefly. A quick twitch in the muscle is common. It can feel odd, but it passes quickly.

After

Some soreness or a small bruise where the needles went in is common. Soreness after dry needling is usually temporary. A course of treatment often means weekly visits for several weeks. In one large US trial, people had 10 sessions over 7 weeks.

Finding a practitioner

For acupuncture, look for a state-licensed acupuncturist or a physician with acupuncture training. For dry needling, ask about the practitioner’s training, and ask whether a new sterile needle is used each time. The National Institutes of Health has tips on choosing a practitioner (opens in a new tab).

Medicare covers acupuncture for long-lasting low back pain, with limits on the number of visits and on who can provide it. Coverage for dry needling, and by other plans, varies.

The American College of Physicians lists acupuncture among the non-drug treatments to try first for low back pain. It rated the evidence as low quality for new pain and moderate quality for long-lasting pain. [19]

For long-lasting low back pain, a Cochrane review found acupuncture eased pain by a meaningful amount right after a course of treatment, compared with no treatment. Compared with sham (fake) acupuncture, the extra benefit was small, below what is usually considered a noticeable change. [9]

In a large US trial of 638 people with long-lasting low back pain, real acupuncture and a fake version that used a toothpick without piercing the skin helped about equally. Both helped more than usual care. This suggests that exactly where the needles go, and even whether they pierce the skin, may matter less than once thought. [3]

Across many long-lasting pain conditions, the benefits seen in trials faded only a little over a year. [11]

For neck pain, acupuncture added to other care may ease pain for a few months, but it has not clearly beaten sham acupuncture. A Canadian neck pain guideline advises against electroacupuncture for neck pain, citing evidence that it does not work. [10] [20]

Dry needling has been studied less. Small studies suggest it may ease low back or neck pain in the short term, especially when added to other physical therapy. Longer-term benefits are unclear. [5] [21] [22]

Common and short lived

• Soreness, a small bruise or a drop of blood where a needle went in. In large studies, about 1 in 10 people had some side effect during a course of acupuncture, most often at the needle site.
• With dry needling, minor effects like these were reported after about 1 in 5 to 1 in 3 treatments.

Less common

• Brief dizziness, tiredness or feeling faint.
• A short flare of your usual pain.

Rare but serious

• Serious problems are rare, about 1 in 10,000 people in large studies of acupuncture.
• Infection is rare when single-use sterile needles are used and the skin is clean.
• A needle placed too deep over the chest, upper back or shoulders can very rarely puncture a lung and cause it to collapse (pneumothorax).

Take extra care

• Blood thinners: studies of acupuncture in people taking blood thinners found significant bleeding was very rare. Dry needling goes deeper into muscle and has been studied less. Either way, tell the practitioner so they can take extra care.
• Pacemakers and other implanted heart devices: tell the practitioner before any electrical stimulation. Current passing across the chest could interfere with the device.
• Pregnancy: tell the practitioner. Some needle points and techniques are usually avoided during pregnancy.

Other downsides

• A course of treatment takes time, and costs can add up. Insurance coverage varies.
• Benefits are often modest, and pain can come back.

Get emergency care for sudden chest pain or trouble breathing after needling near the chest, upper back or shoulders, even if it starts hours later, or for new weakness or numbness after needling near the spine. Call your clinician for redness, warmth, swelling or pus where a needle went in, or a fever.