International Journal of Osteopathic Medicine
Volume 12, Issue 1 , Pages 2-13 , March 2009

Therapeutic needling in osteopathic practice: An evidence-informed perspective

Received 5 November 2008 ,Revised 15 December 2008 ,Accepted 5 January 2009.

References 

  1. White A, Cummings M, Barlas P, Cardini F, Filshie J, Foster NE, et al. Defining an adequate dose of acupuncture using a neurophysiological approach – a narrative review of the literature. Acupunct Med. 2008;26:111–120
  2. Campbell A. Where to place the needles and for how long. Acupunct Med. 1999;17:113–117
  3. Ernst E. Acupuncture – a critical analysis. J Intern Med. 2006;259:125–137
  4. Ceccherelli F, Gagliardi G, Rossato M, Giron G. Variables of stimulation and placebo in acupuncture reflexotherapy. J Altern Complement Med. 2000;6:275–279
  5. Pariente J. Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. Neuroimage. 2005;25:1161–1167
  6. Johnson MI. The clinical effectiveness of acupuncture for pain relief – you can be certain of uncertainty. Acupunct Med. 2006;24:71–79
  7. Campbell A. Point specificity of acupuncture in the light of recent clinical and imaging studies. Acupunct Med. 2006;24:118–122
  8. Ma YT, Ma M, Cho ZH. Biomedical acupuncture for pain management: an integrative approach. St. Louis: Churchill Livingstone; 2005;
  9. Mann F. Reinventing acupuncture: a new concept of ancient medicine. 2nd ed.. Oxford: Butterworth-Heinmann; 2000;
  10. Dommerholt J. Dry needling in orthopaedic physical therapy practice. Orthop Pract. 2004;16:11–16
  11. Bekkering R, van Bussel R. Segmental acupuncture. In:  Filshie J,  White A editor. Medical acupuncture: a western scientific approach. Edinburgh: Churchill Livingstone; 1998;
  12. MacPherson H. Body palpation and diagnosis. J Chin Med. 1994;44:5–12
  13. Gunn CC. Acupuncture in context. In:  Filshie J,  White A editor. Medical acupuncture: a western scientific approach. Edinburgh: Churchill Livingstone; 1998;
  14. Tough EA, White AR, Richards S, Campbell J. Variability of criteria used to diagnose myofascial trigger point pain syndrome: evidence from a review of the literature. Clin J Pain. 2007;23:278–286
  15. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2009;13:3–10.
  16. Dommerholt J, Bron C, Franssen J. Myofascial trigger points: an evidence-informed review. J Manual Manip Ther. 2006;14:203–221
  17. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004;14:95–107
  18. Simons DG. Understanding effective treatments of myofascial trigger points. J Bodyw Mov Ther. 2002;6:81–88
  19. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. Int J Osteopath Med. 2006;9:120–136
  20. Huguenin LK. Myofascial trigger points: the current evidence. Phys Ther Sport. 2004;5:2–12
  21. Lewith K. The needle effect in the relief of myofascial pain. Pain. 1979;6:83–90
  22. Baldry P. Management of myofascial trigger point pain. Acupunct Med. 2002;20:2–10
  23. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82:986–992
  24. Dommerholt J, Mayoral del Moral O, Gröbli C. Trigger point dry needling. J Manual Manip Ther. 2006;14:E70–E87
  25. Hong CZ. Myofascial trigger points: pathophysiology and correlation with acupuncture points. Acupunct Med. 2000;18:41–47
  26. Baldry P. Superficial versus deep dry needling. Acupunct Med. 2002;20:78–81
  27. Myburgh C, Larsen AH, Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil. 2008;89:1169–1176
  28. Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain, in press.
  29. Quintner JL, Cohen ML. Referred pain of peripheral nerve origin: an alternative to the ‘myofascial pain construct’. Clin J Pain. 1994;10:243–251
  30. Gunn CC. The Gunn approach to the treatment of chronic pain. Edinburgh: Churchill Livingstone; 1998;
  31. Bowsher D. Mechanisms of acupuncture. In:  Filshie J,  White A editor. Medical acupuncture: a western scientific approach. Edinburgh: Churchill Livingstone; 1998;
  32. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85:355–375
  33. Carlsson C. Acupuncture mechanisms for clinically relevant long-term effects – reconsideration and a hypothesis. Acupunct Med. 2002;20:82–99
  34. Kim DH. Evolution of acupuncture for pain management. Semin Integr Med. 2004;2:135–147
  35. Watkin H. Segmental dysfunction. Acupunct Med. 1999;17:118–123
  36. Gunn CC, Milbrandt WE, Little AS, Mason KE. Dry needling of muscle points for chronic low-back pain. Spine. 1980;5:279–291
  37. Karakurum B, Karaalin O, Coskun O, Dora B, Uçler S, Inan L. The ‘dry-needle technique’: intramuscular stimulation in tension-type headache. Cephalalgia. 2001;21:813–817
  38. Ga H, Choi JH, Park CH, Yoon HJ. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. J Altern Complement Med. 2007;13:617–623
  39. Campbell A. Acupuncture in practice: beyond points and meridians. Oxford: Butterworth Heinemann; 2001;
  40. Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain. 1977;3:3–23
  41. Melzack R. Pain and the neuromatrix in the brain. J Dent Educ. 2001;65:1378–1382
  42. Craig AD. A new view of pain as a homeostatic emotion. Trends Neurosci. 2003;26:303–307
  43. Campbell A. Methods of acupuncture. In:  Filshie J,  White A editor. Medical acupuncture: a western scientific approach. Edinburgh: Churchill Livingstone; 1998;
  44. Gunn CC, Milbrandt WE. Acupuncture loci: proposal for their classification according to their relationship to know neural structures. Am J Chin Med. 1976;4:183–195
  45. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med. 2007;13:603–616
  46. Lewith GT, White PJ, Pariente J. Investigating acupuncture using brain imaging techniques: the current state of play. Evid Based Complement Alternat Med. 2005;2:315–319
  47. Napadow V, Webb M, Pearson N, Hammerschlag R. Neurobiological correlates of acupuncture. J Altern Complement Med. 2006;12:931–935
  48. Bradnam L. A proposed clinical reasoning model for Western acupuncture. NZ J Physiother. 2003;31:40–45
  49. Bradnam L. Erratum – a proposed clinical reasoning model for Western acupuncture. NZ J Physiother. 2003;31:111–112
  50. Ernst E, Pittler MH, Wider B, Boddy K. Acupuncture: its evidence-base is changing. Am J Chin Med. 2007;35:21–25
  51. Birch S. Problems with systematic reviews of acupuncture. What should we do about these?. Clin Acupunct Orient Med. 2003;4:105–108
  52. Derry CJ, Derry S, McQuay HJ, Moore RA. Systematic review of systematic reviews of acupuncture published 1996–2005. Clin Med. 2006;6:381–386
  53. Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Sing BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217–225
  54. Ernst E, Lee M. A trial design that generates only “positive” results. J Postgrad Med. 2008;54:214–216
  55. Birch S. Clinical research on acupuncture: part 2. Controlled clinical trials, an overview of their methods. J Altern Complement Med. 2004;10:481–498
  56. Birch S. A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert. J Altern Complement Med. 2006;12:303–310
  57. White AR, Filshie J, Cummings TM. Clinical trials of acupuncture: consensus recommendations for optimal treatment, sham controls and blinding. Complement Ther Med. 2001;9:237–245
  58. Lund I, Lundeberg T. Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls?. Acupunct Med. 2006;24:13–15
  59. Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain. Ann Intern Med. 2005;142:651–663
  60. Furlan AD, Van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, et al. Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the Cochrane collaboration. Spine. 2005;30:944–963
  61. Manheimer E, Linde K, Lao L, Bouter LM, Berman BM. Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med. 2007;146:868–877
  62. White A, Foster NE, Cummings M, Barlas P. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology. 2007;46:384–390
  63. Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, et al. Acupuncture for neck disorders. Spine. 2007;32:236–243
  64. Kwon YD, Pittler MH, Ernst E. Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology. 2006;45:1331–1337
  65. Ammendolia C, Furlan AD, Imamura M, Irvin E, van Tulder M. Evidence-informed management of chronic low back pain with needle acupuncture. Spine J. 2008;8:160–172
  66. Keller A, Hayden J, Bombardier C, van Tulder M. Effect sizes of non-surgical treatments of non-specific low-back pain. Eur Spine J. 2007;16:1776–1788
  67. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39:411–422
  68. Endres HG, Diener HC, Molsberger A. Role of acupuncture in the treatment of migraine. Expert Rev Neurother. 2007;7:1121–1134
  69. Davis MA, Kononowech RW, Rolin SA, Spierings EL. Acupuncture for tension-type headache: a meta-analysis of randomized, controlled trials. J Pain. 2008;9:667–677
  70. Green S, Buchbinder R, Hetrick S. Acupuncture for shoulder pain. Cochrane Database Syst Rev. 2005;2:CD005319
  71. Lundeberg T, Lund I, Näslund J. Acupuncture – self-appraisal and the reward system. Acupunct Med. 2007;25:87–99
  72. Näslund J, Näslund UB, Odenbring S, Lundeberg T. Sensory stimulation (acupuncture) for the treatment of idiopathic anterior knee pain. J Rehabil Med. 2002;34:231–238
  73. Itoh K, Katsumi Y, Kitakoji H. Trigger point acupuncture treatment of chronic low back pain in elderly patients – a blinded RCT. Acupunct Med. 2004;22:170–177
  74. Linde K, Streng A, Jürgens S, Hoppe A, Brinkhaus B, Witt C, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005;293:2118–2125
  75. Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, et al. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ. 2005;331:376–382
  76. Scharf HP, Mansmann U, Streitberger K, Witte S, Krämer J, Maier C, et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med. 2006;145:12–20
  77. Campbell A. Role of C tactile fibres in touch and emotion–clinical and research relevance to acupuncture. Acupunct Med. 2006;24:169–171
  78. Hui KK, Liu J, Marina O, Napadow V, Haselgrove C, Kwon KK, et al. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage. 2005;27:479–496
  79. Fang J, Jin Z, Wang Y, Li K, Kong J, Nixon EE, et al. The salient characteristics of the central effects of acupuncture needling: limbic–paralimbic–neocortical network modulation. Hum Brain Mapp, in press. doi:10.1002/hbm.20583.
  80. Dhond RP, Yeh C, Park K, Kettner N, Napadow V. Acupuncture modulates resting state connectivity in default and sensorimotor brain networks. Pain. 2008;136:407–418
  81. Wang SM, Kain ZN, White P. Acupuncture analgesia: I. The scientific basis. Anesth Analg. 2008;106:602–610
  82. Dhond RP, Kettner N, Napadow V. Do the neural correlates of acupuncture and placebo effects differ?. Pain. 2007;128:8–12
  83. Yoo SS, Kerr CE, Park M, Im DM, Blinder RA, Park HW, et al. Neural activities in human somatosensory cortical areas evoked by acupuncture stimulation. Complement Ther Med. 2007;15:247–254
  84. Campbell A. Acupuncture, touch, and the placebo response. Complement Ther Med. 2000;8:43–46
  85. Kaptchuk TJ, Stason WB, Davis RB, Legedza AR, Schnyer RN, Kerr CE. Sham device vs inert pill: a randomised controlled trial of two placebo treatments. BMJ. 2006;332:391–397
  86. Paterson C, Dieppe P. Characteristic and incidental (placebo) effects in complex interventions such as acupuncture. BMJ. 2005;330:1202–1205
  87. Vas J, White A. Evidence from RCTs on optimal acupuncture treatment for knee osteoarthritis–an exploratory review. Acupunct Med. 2007;25:29–35
  88. Campbell A. Acupuncture: where to place the needles and for how long. Acupunct Med. 1999;17:113–117
  89. Bovey M. Deqi. J Chin Med. 2006;81:18–29
  90. Inoue M, Kitakouji H, Ikeuchi R, Katayama K, Ochi H, Imai K, et al. Randomized controlled pilot study comparing manual acupuncture with sham acupuncture for lumbago (2nd report). J Jpn Soc Acupunct Moxibustion. 2001;51:412
  91. Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005;366:136–143
  92. Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache. 2006;46:1264–1272
  93. Ettlin T, Schuster C, Stoffel R, Brüderlin A, Kischka U. A distinct pattern of myofascial findings in patients after whiplash injury. Arch Phys Med Rehabil. 2008;89:1290–1293
  94. Shen J. Research on the neurophysiological mechanisms of acupuncture: review of selected studies and methodological issues. J Altern Complement Med. 2001;7:S121–S127
  95. Marcus P. Towards a dose of acupuncture. Acupunct Med. 1994;12:78–82
  96. Langevin HM, Churchill DL, Fox JR, Badger GJ, Garra BS, Krag MH. Biomechanical response to acupuncture needling in humans. J Appl Phys. 2001;91:2471–2478
  97. Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 2001;15:2275–2282
  98. Langevin HM, Konofagou EE, Badger GJ, Churchill DL, Fox JR, Ophir J, et al. Tissue displacements during acupuncture using ultrasound elastography techniques. Ultrasound Med Biol. 2004;30:1173–1183
  99. Abad-Alegría F, Pomarón C. About the neurobiological foundations of the De-Qi – stimulus-response relation. Am J Chin Med. 2004;32:807–814
  100. Hui KK, Nixon EE, Vangel MG, Liu J, Marina O, Napadow V, et al. Characterization of the “deqi” response in acupuncture. BMC Complement Altern Med. 2007;7:33
  101. Vincent CA, Richardson PH, Black JJ, Pither CE. The significance of needle placement site in acupuncture. J Psychosom Res. 1989;33:489–496
  102. Fang JL, Krings T, Weidemann J, Meister IG, Thron A. Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints. Neuroradiology. 2004;46:359–362
  103. Yan B, Li K, Xu J, Wang W, Li K, Liu H, et al. Acupoint-specific fMRI patterns in human brain. Neurosci Lett. 2005;383:236–240
  104. Leung AY, Kim SJ, Schulteis G, Yaksh T. The effect of acupuncture duration on analgesia and peripheral sensory thresholds. BMC Complement Altern Med. 2008;8:18
  105. Radhakrishnan R, Sluka KA. Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve stimulation induced antihyperalgesia. J Pain. 2005;6:673–680
  106. Barlas P, Ting SL, Chesterton LS, Jones PW, Sim J. Effects of intensity of electroacupuncture upon experimental pain in healthy human volunteers: a randomized, double-blind, placebo-controlled study. Pain. 2006;122:81–89
  107. Kavaris M. The neurophysiology of acupuncture: a viewpoint. Acupunct Med. 1997;15:33–42
  108. White PF, Craig WF, Vakharia AS, Ghoname E, Ahmed HE, Hamza MA. Percutaneous neuromodulation therapy: does the location of electrical stimulation effect the acute analgesic response?. Anesth Analg. 2000;91:949–954
  109. Kong J, Fufa DT, Gerber AJ, Rosman IS, Vangel MG, Gracely RH, et al. Psychophysical outcomes from a randomized pilot study of manual, electro, and sham acupuncture treatment on experimentally induced thermal pain. J Pain. 2005;6:55–64
  110. Kurosu Y. Acupuncture and moxibustion for lumbago (II) – comparative experiment of the therapeutic effectiveness of acupuncture and garlic moxibustion. J Japan Acupunct Moxibustion Assoc. 1979;28:31–34
  111. Li K, Shan B, Xu J, Liu H, Wang W, Zhi L, et al. Changes in FMRI in the human brain related to different durations of manual acupuncture needling. J Altern Complement Med. 2006;12:615–623
  112. Harris RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F, et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. J Altern Complement Med. 2005;11:663–671
  113. Price DD, Rafii A, Watkins LR, Buckingham B. A psychophysical analysis of acupuncture analgesia. Pain. 1984;19:27–42
  114. Liu T. Role of acupuncturists in acupuncture treatment. Evid Based Complement Alternat Med. 2007;4:3–6
  115. MacPherson H, Mercer SW, Scullion T, Thomas KJ. Empathy, enablement, and outcome: an exploratory study on acupuncture patients' perceptions. J Altern Complement Med. 2003;9:869–876
  116. Pincus T, Vogel S, Savage R, Newman S. Patients' satisfaction with osteopathic and GP management of low back pain in the same surgery. Complement Ther Med. 2000;8:180–186
  117. Price S, Mercer SW, MacPherson H. Practitioner empathy, patient enablement and health outcomes: a prospective study of acupuncture patients. Patient Educ Couns. 2006;63:239–245
  118. MacPherson H, Asghar A. Acupuncture needle sensations associated with DeQi: a classification based on experts' ratings. J Altern Complement Med. 2006;12:633–637
  119. Kong J, Gollub R, Huang T, Polich G, Napadow V, Hui K, et al. Acupuncture de qi, from qualitative history to quantitative measurement. J Altern Complement Med. 2007;13:1059–1070
  120. Takeda W, Wessel J. Acupuncture for the treatment of pain of osteoarthritis knees. Arthritis Care Res. 1994;7:118–122
  121. White P, Bishop F, Hardy H, Abdollahian S, White A, Park J, et al. Southampton needle sensation questionnaire: development and validation of a measure to gauge acupuncture needle sensation. J Altern Complement Med. 2008;14:373–379
  122. Linde K, Witt CM, Streng A. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain. 2007;128:264–271
  123. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes. CMAJ. 2001;165:174–179
  124. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine. 2001;26:1418–1424
  125. Bialosky JE, Bishop MD, Robinson ME, Barabas JA, George SZ. The influence of expectation on spinal manipulation induced hypoalgesia: an experimental study in normal subjects. BMC Musculoskelet Disord. 2008;9:19
  126. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001;110:481–485
  127. Ernst G, Strzyz H, Hagmeister H. Incidence of adverse effects during acupuncture therapy – a multicentre survey. Complement Ther Med. 2003;11:93–97
  128. Melchart D, Weidenhammer W, Streng A, Reitmayr S, Hoppe A, Ernst E. Prospective investigation of adverse effects of acupuncture in 97,733 patients. Arch Intern Med. 2004;164:104–105
  129. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med. 2004;22:122–133
  130. White A. Towards greater safety in acupuncture practice – a systems approach. Acupunct Med. 2004;22:34–39<http://www.acupunctureinmedicine.org.uk/showarticle.php?artid=601>Available from:
  131. White A. The safety of acupuncture – evidence from the UK. Acupunct Med. 2006;24:S53–S57
  132. Ernst E, White A. Life-threatening adverse reactions after acupuncture? A systematic review. Pain. 1997;71:123–126
  133. MacPherson H, Scullion A, Thomas KJ, Walters S. Patient reports of adverse events associated with acupuncture treatment: a prospective national survey. Qual Saf Health Care. 2004;13:349–355
  134. White A, Hayho S, Hart A, Ernst E. Adverse events following acupuncture (SAFA): prospective survey of 32,000 consultations with doctors and physiotherapists. Acupunct Med. 2001;19:84–92
  135. Peuker E, Grönemeyer D. Rare but serious complications of acupuncture: traumatic lesions. Acupunct Med. 2001;19:103–108
  136. MacPherson H, Thomas K, Walters S, Fitter M. A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists. BMJ. 2001;19:93–102
  137. Linde K, Streng A, Hoppe A, Jurgens S, Weidenhammer W, Melchart D. The programme for the evaluation of patient care with acupuncture (PEP-Ac) – a project sponsored by ten German social health insurance funds. Acupunct Med. 2006;24:S25–S32

PII: S1746-0689(09)00004-2

doi: 10.1016/j.ijosm.2009.01.003

International Journal of Osteopathic Medicine
Volume 12, Issue 1 , Pages 2-13 , March 2009