A More Controversial Application of Dry Needling

There is another kind of dry needling that is much more controversial. Unlike the dry needling used to treat acne scars, the dry needling used for pain relief is an outgrowth of acupuncture.

In acupuncture, longer, thicker needles are inserted at acupuncture points to rebalance the mystical energy known as chi to release the congested and congealed energies that cause pain. Or at least that was the original theory. No Chinese-trained doctor of Traditional Chinese Medicine believes in a literal chi. (Some American-trained doctors, oddly enough, do.) The system of acupuncture points nonetheless identifies places where needling will result in pain relief.

Dry needling takes the idea one step further and allows the doctor to place needles directly into muscles and nerve pathways that are causing pain, not just at the traditional acupuncture points. Doctors use needles that are just as long as the needles used in acupuncture, but much thinner. These needles are as thin as those used in the other application of dry needling, just 32 to 36 gauge (0.25 to 0.20 mm wide).

Dry needling for pain relief also requires sticking the needle in deeper. In dry needling for acne scars, the needle is stuck 1 to 2 mm (about 1/20 of an inch to about 1/10 of an inch) into the skin at a 45-degree angle. It’s less painful and less injurious to needle the skin at a 45-degree angle than it is just to jab the needle straight in. In dry needling for pain relief, the needle is inserted perpendicular to the skin. This hurts more. It is more likely to draw blood.

How Does Dry Needling for Pain Relief Work? How Well Does It Work?

Dry needling for pain relief, ironically, is itself painful. Inserting the needle into a muscle is sufficiently pain-inducing that the muscle can go into a spasm. In medical terms, the insertion of the needle interrupts a neurological feedback loop that perpetuates pain. There will be pain from the needle, but once that pain has subsided, the other pain does not come back. 

People who don't get relief with opiates, capsaicin creams, muscle relaxers, massage, hydrotherapy, ice packs, ultrasound, exercise, or TENS (transdermal electroneural simulation) often benefit from this form of dry needling.

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Don't Try This at Home

However, this application of dry needling is also something you don't want to try at home. Why?

• Some people experience a vasovagal response to being poked with needles. They pass out. You really don't want to pass out when you're holding a needle.
• The needles used in this form of dry needling are typically 50 to 80 mm (2 to 3 inches) long. That's long enough to damage internal organs in children, and it's long enough to reach an artery in an adult. You only want to receive this form of dry needling from someone who is well informed of human anatomy. Not everyone's internal organs are in exactly the same place. Sometimes the lungs are just 3 cm (a little over an inch) beneath the skin of the torso, even in adults. Penetrating the lungs can result in a condition known as pneumothorax.
• Inserting a dry needle into the buttocks muscles, especially in children or very thin adults, can result in permanent injury to the muscle. A wet needle, the kind used to inject a medication, does not carry the same risk.
• If you are someone who passes out when getting shots, at the very least you need to be lying down when you receive dry needling treatment.

Applied by a trained professional, either a physical therapist or a physician, dry needling sometimes relieves pain that no other treatment can. Don't be your doctor's training case, however. Always go to someone who has experience with the technique.