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|Evidence for dry needling in the management of myofascial trigger points associated with low back pain: a systematic review and meta-analysis|
|Liu L, Huang Q-M, Liu Q-G, Thitham N, Li L-H, Ma Y-T, Zhao J-M|
|Archives of Physical Medicine and Rehabilitation 2018 Jan;99(1):144-152|
OBJECTIVE: To evaluate the current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with low back pain (LBP). DATA SOURCES: PubMed, Ovid, EBSCO, ScienceDirect, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health, and China National Knowledge Infrastructure databases were searched until January 2017. STUDY SELECTION: Randomized controlled trials (RCTs) that used dry needling as the main treatment and included participants diagnosed with LBP with the presence of MTrPs were included. DATA EXTRACTION: Two reviewers independently screened articles, scored methodological quality, and extracted data. The primary outcomes were pain intensity and functional disability at post-intervention and follow-up. DATA SYNTHESIS: A total of 11 RCTs involving 802 patients were included in the meta-analysis. Results suggested that compared with other treatments, dry needling of MTrPs was more effective in alleviating the intensity of LBP (standardized mean difference (SMD) -1.06, 95% confidence interval (CI) -1.77 to -0.36, p = 0.003) and functional disability (SMD -0.76, 95% CI -1.46 to -0.06, p = 0.03); however, the significant effects of dry needling plus other treatments on pain intensity could be superior to dry needling alone for LBP at post-intervention (SMD 0.83, 95% CI 0.55 to 1.11, p < 0.00001). CONCLUSIONS: Moderate evidence showed that dry needling of MTrPs, especially if associated with other therapies, could be recommended to relieve the intensity of LBP at post-intervention; however, the clinical superiority of dry needling in improving functional disability and its follow-up effects still remain unclear.