178. Dry Needling for Pain Relief: What We Think Is Happening (4 Key Mechanisms)

Welcome to this brief episode on dry needling and what current research suggests may explain its pain-relieving effects. The episode clarifies why it’s called “dry” needling (no medication injected) and emphasizes the importance of being able to explain why it may help patients. Dry needling is presented as working locally and systemically through four main mechanisms: local muscle and tissue effects, biomechanical and inflammatory biomarker changes, peripheral and spinal pain modulation, and supraspinal/autonomic pathways. We also discuss who this is appropriate for, and how to combine it with other techniques to help our patients get to their goals successfully.

00:00 Welcome to PTs Snacks
00:48 Why Dry Needling Matters
01:15 What It Is and Isn't
02:39 Four Mechanisms Overview
03:24 Local Tissue Effects
04:19 Inflammation Biomarkers
05:14 Spinal Pain Modulation
06:35 Autonomic Brain Pathways
07:16 Who Should Avoid It
07:58 Patient Education and Training
08:52 Wrap Up and Next Steps

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Transcript

Hey guys, welcome to PTs Snacks podcast. This is Kasey, your host, and if you're tuning in for the very first time, welcome. But what you need to know is that this podcast has meant for physical therapists, students, physical therapists, assistants, and students, anyone who is in that field, in that realm, who is trying to invest a little bit at a time on making themselves a better clinician or provider. Today we're gonna be talking about dry needling and what we believe is happening to offer pain relief with dry needling. But before we do that, if you've listened to the show at least three times and you feel like it's been really helpful for you, if you wouldn't mind leaving a review wherever you listen to podcasts, that would really be helpful. Or you're on YouTube, hit subscribe, et cetera. Other than that, let's go right into it. So why are we talking about dry needling? Unless you've been living. Under a rock or maybe you're in a place where you don't really offer dry needling. There's a lot of physical therapists who have been using dry needling to help their patients meet their goals, essentially. Now think about this from a perspective. If you are a patient and maybe you've never. Had it before, you've never been to physical therapy. Imagine them being like, yeah, we could try dry kneeling for you. And they're like, what is it? First of all, it's called dry needling because it's not a hollow tube. You're not injecting any medicine, hence the term dry. Or how does this differ from acupuncture? There are several differences in how it is administered, et cetera. But also being able to answer the question of why are we doing this? Why do you feel like dry kneeling would be helpful? Or if your patient may have heard of it? They've seen it done before. They wanna know what is it actually doing? We don't wanna just be like it helps increase blood flow. It is helpful to be able to at least see what the current research is saying. So that we can give our professional opinion, but also professionally understand when it may be beneficial for our patients or not. So we're gonna talk briefly in this episode, like I did on the benefits of exercise with pain relief on dry needling. So essentially we're gonna cover four main avenues in which we believe that is having an impact on the patient's. System and what that entails. Remember, this is a pretty brief episode, but I more so want this to be a launching pad of, oh, I never thought of that before. Let me do a deeper dive on my own, so sound good? Okay. So essentially on a broad spectrum, dry needling. Dry needling likely works at both a local level and a systemic level. Local meaning wherever you administer the dry needles and systemic meaning body wide with regard to a pain modulating aspect, we're not just like releasing knots here per se. There are four main key mechanisms that we're talking about. Local muscle and tissue effects is number one, biomechanical and inflammatory changes is number two. Three is peripheral and spinal pain modulation. And then number four is SuperSPIN and autonomic mechanisms. Those are the aspects that we're gonna talk about. So let's dive into number one. In terms of local muscle and tissue effects, we found that when we dry needle a quote, quote, trigger point, it actually can help to reduce abnormal electrical activity at the motor end plate. And may disrupt a taught band characteristic of myofascial trigger points, which is what we're defining here as a trigger point. It can change the local blood flow, hypoxia and inflammation around the trigger point, potentially normalizing previous ischemic irritated area. So that's why a lot of people say, oh, it increases blood flow to that area. And there has been some animal work that has been done to show improved muscle strength and function and increased antioxidant activity after dry needling, a specific area. So we know that there are local muscle and tissue effects with dry needling. Now when we're talking about number two, which is biomechanical inflammatory changes, there was a 2025 systematic review that found that dry needling actually altered multiple pain related biomarkers including increasing beta endorphin IL two IL six. TNF Alpha, nitric oxide synthase, and decreasing substance P-C-G-R-P and acetylcholine in its receptors in a muscle. So when we're hearing these shifts, essentially what it's talking about is these suggest both a pro-inflammatory, micro response that we need for tissue repair. Remember, that's a normal part. Of tissue healing is that inflammatory response, but also a antinociceptive effect that reduces pain signaling. So we're getting healing with a mixture of pain relief. Sounds like a good combination right now. Number three, we're talking about peripheral and spinal pain modulation. So needling can actually reduce peripheral noo ception from trigger points and it can dampen dorsal horn neuron activity, which decreases peripheral and central sensitization. So essentially it helps to activate inhibitory spinal mechanisms or our gait control theory. And Opioid deic. Say that five times fast. Serotonergic and noradrenergic pathways. I had to read that off of my notes. Sorry. Now I can also inhibit spinal mechanisms like in our gait control theory. So I'm gonna read these off because I always mispronounce these for whatever reason. But it specifically in our pathways, our opioid doic pathways. Serotonergic pathways and noradrenergic pathways, which helps to reduce pain transmission. So essentially the signals that are being sent to our body to say, Hey, we're having pain. We're getting less of those signals. So it can help someone imagine if they're getting less of this. Either be able to tolerate more exercise, things that help with long-term effects, or even just get through their day a little bit better. And then lastly, we have SuperSPIN and autonomic mechanisms that can help with pain relief pathways. So dry needling can actually activate the sympathetic nervous system acutely, which we can see through an increased heart rate, and raise pain pressure thresholds both locally and at distance sites showing central pain modulating effect. There have been several reviews that describe descending pain, inhibition from brainstem structures and engagement at the hypothalmic pituitary adrenal axis, and endogenous opioids and cannabinoids. We have multiple avenues in ways that dry needling can help with pain modulation. Now let's also flip this over 'cause I like to play devil's advocate too with these sorts of things. Remember that dry needling is a modality and it can be helpful in especially the right circumstances. So for instance, if your patient has a metal allergy, or maybe they're terrified of needles in general, that person may not be a good candidate for dry needling. We need to make sure that we are also using our clinical brains and not just putting on blinders of, I know this is good. This research should be combined with the person in front of you and also what you're comfortable with. So with that aspect, remember. We need to educate our patients on all what this entails. Educate them on the risks of this too, especially if you're in an area that you're dry needling that is close, let's say for instance to the lung field but also explaining. Depending on what they are coming to see you for how this can be used in conjunction for, let's say they're trying to help prepare their body to have less pain for a marathon. We also still have to include components that help their body to train for that event, not just the pain relief, feel good stuff, but also the things that create long-term tissue adaptation. So it is important to work on both. You just might need to meet your patient where they're at in terms of what they can tolerate, what their pain level is, and what they're willing to do. So that being said. Use your brain. If you have any questions, feel free to reach out at PTs x podcasts@gmail.com. I hope that this episode was helpful for you. I know it's a short one, but take deep dives. If you are not on the newsletter, be sure and check that out because I also do include short summaries and tips in there in case you're not able to listen in for the podcast. But other than that, if you guys need anything, please let me know. If there are study guides that you would like or topics in the future for future episodes, I really do listen to that and take it into account. But other than that, I hope you have a great rest of your day.