Effectiveness of ultrasound-guided dry needling in painful musculoskeletal conditions: A systematic review and meta-analysis

Abstract

Objective: To identify the treatment effects of pain and disability in US-guided DN on various painful musculoskeletal conditions.

Methods: A comprehensive literature search of six databases without language restrictions was conducted for relevant articles containing quantitative data. Randomized controlled trials (RCTs) or quasi-experimental studies involving the effectiveness of US-guided DN on pain and disability in adult patients (age >18 years) with painful musculoskeletal conditions were included. Studies that not related to US-guided DN, paediatric patients, and patients with acute, trauma, postoperative, or malignant pain were excluded. The quality and certainty of the included articles were assessed using the PEDro scale and the GRADE approach respectively.

Results: Four high-quality studies with a total of 240 patients’ data, aged 18-71 years old, were included in this meta-analysis. Results showed a significant improvement in pain with US-guided DN (p<0.001) with a standardized mean difference of 0.96 (95% CI: 0.66, 1.27; I2=31.23). On the other hand, a significant improvement in disability is seen with US-guided DN (p<0.001) with a standardized mean difference of 0.85 (95% CI: 0.61, 1.09; I2=30.89). Both outcomes had symmetric funnel plots, and the results of Egger’s test showed no significant publication bias.

Conclusion: US-guided DN is a safe and effective treatment modality for reducing pain and disability for some painful musculoskeletal conditions in the short-term. However, only limited high-quality study examined the effectiveness of USguided DN over various painful musculoskeletal conditions. Further high-quality studies that focus on the long-term treatment effects of US-guided DN on various painful musculoskeletal conditions are warranted.

Impact statement: Our systematic review suggested that ultrasound guided dry needling has short-term effects for those painful musculoskeletal conditions which led 2 out of 10 people to seek medical care annually in reducing pain and disability