I wish to dispel some of the myths that are being promulgated by physical therapists who write in support of "dry needling".

A recent review by Shah et al. (2015) confirms my impression that those who place “dry needles” into the tender muscles of their patients, and otherwise poke around there, have been “flying by the seat of their pants”. There is no scientific evidence to support the claims of efficacy being made on this public forum.

Shah et al. (2015) concede: “To date, the pathogenesis and pathophysiology of MTrPs (myofascial trigger points) and their role in MPS (myofascial pain syndrome) remain unknown” and that “It remains unknown whether the nodule is an associated finding, whether it is a causal or pathogenic element in MPS, and whether or not its disappearance is essential for effective treatment.”

They also pose a number of rather embarrassing questions for researchers to answer:

1. What is the etiology and pathophysiology of MPS?
2. What is the role of the MTrP in the pathogenesis of MPS?
3. Is the resolution of the MTrP required for clinical response?
4. What is the mechanism by which the pain state begins, evolves and persists?
5. Although the presence of inflammatory and noxious biochemicals has been established, what are the levels of anti-inflammatory substances, analgesic substances, and muscle metabolites in the local biochemical milieu of muscle with and without MTrPs?
6. How does a tender nodule progress to a myofascial pain syndrome?
7. Which musculoskeletal tissues are involved, what are their properties, and how do these change with treatment?

Need I say more? 

Reference: Shah JP, Thaker N, Heimur J, et al. Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015; available at http://dx.doi.org/10.1016/j.pmrj.2015.01.024