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USA Today injects a vital dose of scrutiny to story on ‘dry needling’ for pain

Rating

4 Star

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Dry needling' for pain therapy is under scrutiny

Our Review Summary

Needle and hands of physiotherapist doing a dry needling.This is a story about an alternative therapy known as “dry needling.” It involves inserting needles into the skin, similarly to acupuncture.

The story leads with an anecdote that comes dangerously close to being a promotional advertisement for an unproven alternative therapy for pain, but that’s just the hook. The story (and the headline) is more measured, sifting through what we know and what we don’t know yet about dry needling, largely through interviews with competing trade associations.

We would have liked if the story had gone a step further and delved into the actual science behind dry needling and acupuncture more deeply, and if some of the interviews with people with vested interests had been exchanged for interviews with pain management experts who don’t have a predisposition for or against the procedure. There is enough evidence on acupuncture as a therapy to have persuaded at least some states to create medical licensure programs for its practice, and the story touches at the very end on the idea that there is a training component here that needs further exploration.

[Editor’s note: The notion that the evidence on acupuncture has persuaded states to create medical licensure programs has been contested by the Society for Science-Based Medicine in this post. They argue that evidence is not a factor in state licensing of such practitioners. We have also amended our comments under the “Independent Sources” criterion below in response to their feedback.] 

For this type of story, which is trying to truth-test some of the claims being made about a buzzed about alternative therapy, we really appreciate the question and answer format. The story calls out some of the key elements, including risks and costs, that are necessary for patients to make informed decisions.

 

Why This Matters

Dry needling has become increasingly popular despite questionable evidence for the procedure.  A pertinent question, which the story attempts to address, is whether or not it is acupuncture in disguise.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story nicely calls out different questions that readers might have, including whether insurance will pay for the therapy. It answers, “Many will not. Charges for patients can range from $10 to $75 per session, says Edo Zylstra, CEO of KinetaCore, a company that offers intensive three-day weekend courses in dry needling to physical therapists.”

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

This was a tough call, since the story includes a general discussion of the benefits. But what it doesn’t do is report on any quantified benefits, such as how much pain relief people report in the studies, or for how long. It does tell us that the evidence shows the technique “may be useful” and points out other findings, such as the evidence overall shows “mixed results.”

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

We like that the story called out risks specifically, which is something we don’t see often. It says, “Needling can produce minor bleeding and some soreness, but in trained hands, and with the use of sterile needles and gloves, “it’s a very safe procedure,” Briggs says. In rare cases, deep needling can lead to a punctured lung or injuries to nerves and blood vessels, and acupuncturists fear non-specialists will be more likely to make such mistakes, Burgoon says.”

The story would have been stronger if it had quoted a source with no vested interest in discussing risks. Also, it’s worth pointing out that these risks are real whether “trained hands” do the procedure or not.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The section “What do published studies say?” includes a look at findings from a review and a meta-analysis, and lets us know the findings of these efforts are mixed.  From early in the story, there are statements about the lack of evidence supporting this therapy and the need for more research.

Does the story commit disease-mongering?

Satisfactory

There is no disease mongering in this piece.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story should be commended for its extensive sourcing. There are many sources packed into this piece and likely more sources who were interviewed and not quoted given the amount of reporting that clearly went into it.

At the same time, most of the sources have a potential conflict of interest in some way:

  • Alex Pierce is a patient who says the therapy changed her life. So she loves it.
  • Justin Elliott is vice president of government affairs for the American Physical Therapy Association, which wants its members to be able to practice dry needling.
  • Thomas Burgoon is president of the American Academy of Medical Acupuncture, which thinks that only its members should be able to practice dry needling.
  • Mark Crislip writes for Science-Based Medicine — as the story notes “a website critical of alternative medicine” — and generally is quite skeptical of alternative therapies like dry needling. [Editor’s note: Mark Crislip’s name appeared on this list due to an editing error. We do not believe that being skeptical of alternative therapies constitutes a conflict of interest.]
  • Edo Zylstra is the CEO of KinetaCore, “a company that offers intensive three-day weekend courses in dry needling to physical therapists.”

All of these potential conflicts are called out in the piece, which is commendable.

The one person who brings a fairly down-the-middle view is Matt Briggs, a physical therapist who is studying the technique to see whether it works. But our question about him is whether he also is a practitioner of the technique.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

We would have liked to have seen more exploration of alternatives — or shall we say the standard of care — for injuries like the one described in the lead, runner’s knee. We’re not given a strong idea of what the evidence says is generally the right path to choose for practitioners and patients. We know the toolkit for pain is quite shallow, but physical therapy, diet, exercise, carefully targeted medication, and, at times, surgical interventions all have long track records. We would have liked to have seen more weight given to the proven techniques along the way.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story essentially lets people know that this is something that is becoming more popular but that not very many physical therapists are trained in it yet.

Does the story establish the true novelty of the approach?

Satisfactory

The story establishes what’s new and why it’s being written about with this statement: “And there, Briggs says, is where dry needling is lacking. While some studies have shown promise, he says, “the quality of the evidence is not strong.” That’s why Briggs and his colleagues are starting a study looking at dry needling in “runner’s knee,” the condition that has plagued Pierce. Their goal, and the goal of other researchers now looking at dry needling, is to produce results rigorous enough to show whether it really works.”

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not rely on a news release.

Total Score: 8 of 10 Satisfactory

Comments (1)

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Stephen Cox, MD

July 26, 2016 at 2:15 pm

I disagree with one of your statements, “”there is enough evidence on acupuncture as a therapy to have persuaded at least some states to create medical licensure programs for its practice….” Evidence is weak for acupuncture and other faith or theatrical based alleged health practices. They have been falsely legitimized in some states due to political money and lobbies that influence medical decisions by non medical legislators.

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