This news release from an orthopedics journal relates a study finding that dry needling, which uses filament needles to stimulate trigger points in the muscles, is just as effective as cortisone injections when it comes to reducing pain and swelling caused by greater trochanteric pain syndrome (GTPS), a common hip condition.
We applaud its restrained tone but would have liked to get a sense of how much symptom improvement patients experienced during the six-week trial as well as a discussion of costs and availability of these two treatment options.
This release says the effectiveness of steroid injections “is increasingly being questioned. An equally effective treatment with fewer adverse side effects would be beneficial.” To conclude that dry needling is “not inferior” to a treatment that isn’t very effective doesn’t say much. There is no slam-dunk treatment for chronic hip pain. But if it comes with low risk and a modest cost, dry needling might be an alternative to steroids for combating chronic pain. Also, dry needling might offer an option for patients who haven’t felt relief from steroids or are precluded from taking them due to medication interactions.
As the release states, GTPS is very common and at times very painful. A safe, successful treatment that rapidly resolves pain (beyond normal natural healing) would benefit many individuals. A specific risk profile of a single cortisone injection in the soft tissues has not been determined but most researchers and practicing physicians would consider it to be minimal.
There’s no discussion of costs for either steroid injections or dry needling. According to costhelper.com, the cost of a steroid injection runs $100 to $300, not including the cost of a doctor’s office visit. Dry needling is considerably less expensive but typically requires more frequent treatments. We found one Kansas physical therapy practice that charges $25 for the first treatment and $20 for additional visits. Both may be covered by insurance.
The news release states the results “showed that cortisone injection did not provide better outcomes than dry needling for either pain or function in patients with GTPS. Both groups experienced a decrease in pain and an improved ability to move and complete daily activities.”
But there’s no information on how big the benefits were. For example, average pain scores for patients who underwent dry needling dropped from 5.4 to 2.8 on a 10-point scale, while those who received a cortisone injections saw their pain scores go from an average of 6.1 to 3.9. Weighted averages for functionality increased from 3.9 to 7.3 for those who received dry needling versus an increase from 3.4 to 6.1 for patients who had a cortisone injection.
The true benefit of either treatment is difficult to determine. This study lacked a placebo group so it’s hard to gauge how it compares with normal healing without being treated.
While no harms were reported in the study, the news release still should have mentioned typical side effects of dry needling such as temporary pain, bruising and post-treatment soreness. The release does mention the “potentially harmful effects of steroids” but doesn’t say what they are.
The concern over potential complications from steroid injection seems to be magnified while any potential harms from dry needling is ignored.
The news release describes the study’s methodology, number of patients, randomized assignment of treatment, length of treatment and other details that give readers a decent grasp of how the results were obtained. It also cautions that “while this study uses a larger sample than most, further studies are warranted. In particular, participants were only followed for six weeks; additional studies over longer time periods will be important.”
The release would have been better if it mentioned additional study limitations such as a lack of blinding and the possibility that both treatment groups experienced a placebo effect, as well as the study’s’ recommendation that dry needling be studied in conjunction with rehabilitative physical therapy over a prolonged period.
The release doesn’t engage in disease mongering. Hip dysfunction is very common, and the news release doesn’t appear to overstate that. It says GTPS “is estimated to affect 10% to 25% of the general population. This kind of hip pain has been reported to be more common in women and in patients with coexisting low back pain, osteoarthritis, Iliotibial band tenderness, and obesity.”
The news release doesn’t mention any conflicts of interest, and none were reported in the study. The release also echoes the study’s statement that funding came from Baylor Scott & White Health, which is a Dallas-based healthcare system.
The news release adequately compares dry needling with steroid injections. Still, it could have mentioned other strategies for managing chronic hip pain such as physical therapy.
There’s no discussion of what’s involved with dry needling. While steroid injections take about five minutes and are usually done in a physician’s office once every six weeks or more, dry needling is usually performed by a physical therapist and requires more frequent treatments of about 20 minutes apiece.
During this six-week study, the dry needling group received an average of 5.4 treatments while those who received cortisone injections had one shot.
Dry needling might be more convenient than steroid injections if it’s part of treatment strategy that also involves physical therapy.
The news release says this is “the first to directly compare these two treatments for the syndrome.” We found no other studies of a similar nature after a quick online search.
The language is this news release is restrained.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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