Dry Needling is an Amateur and Potentially Dangerous Form of Acupuncture

The American Society of Acupuncturists has released its position paper on the new technique practiced by physical therapists in some states, which they are calling, "Dry Needling" but is really just an attempt to co-opt and diminish acupuncture, while potentially endangering their patients. 

Here is the position paper in its entirety:

ASA Position on Dry Needling

The American Society of Acupuncturists (“ASA”) opposes the illegal and unsafe practice of acupuncture. “Dry needling” is a pseudonym for acupuncture that has been adopted by physical therapists, chiropractors, and other health providers who lack the legal ability to practice acupuncture within their scope of practice. This strategy allows these groups to skirt safety, testing, and certification standards put into place for the practice of acupuncture. Dry Needling is a style of needling treatment within the greater field of acupuncture. The practice of “acupuncture” includes any insertion of an acupuncture needle for a therapeutic purpose. Acupuncture training has always included both traditional and modern medical understandings.

Anatomically, “trigger points” and “acupuncture points” are synonymous, and acupuncture has targeted trigger points for over 2,000 years. “Dry needling” is indistinguishable from acupuncture since it uses the same FDA-regulated medical device specifically defined as an “acupuncture needle,” treats the same anatomical points, and is intended to achieve the same therapeutic purposes as acupuncture. 

The US Food and Drug Administration (FDA) defines the acupuncture needle as a Class II medical device, and has explicitly stated that the sale of acupuncture needles “must be clearly restricted to qualified practitioners of acupuncture as determined by the States.” As “dry needling” is acupuncture, it presents the same inherent risks including but not limited to perforation of the lungs and other internal organs, nerve damage, and infection. Recent reports of serious and potentially life-threatening injuries associated with “dry needling” include pneumothoraces and spinal cord injury. These and other injuries support the statement that “dry needling” presents a substantial threat to public safety when performed without adequate education, training, and independent competency examination. Adequate training and competency testing are essential to public safety.

In addition to biomedical training, licensed acupuncturists receive at least 1365 hours of acupuncture-specific training, including 705 hours of acupuncture-specific didactic material and 660 hours of supervised clinical training. Further, many states also require even physicians wishing to practice acupuncture to have substantial training. The American Academy of Medical Acupuncture (AAMA) has set the industry standard for a physician to practice entry level acupuncture at 300 hours of postdoctoral training with passage of an examination by an independent testing board. This standard presumes extensive, pre-requisite training in invasive procedures [including underlying structures, contraindications for skin puncture, clean needle technique, anticipated range of patient responses to invasive technique, etc.], the differential diagnosis of presenting conditions, clinical infection-control procedures in the context of invasive medicine, management of acute office and medical emergencies, and advanced knowledge of human physiology and evidence based medicine. The AAMA expects that physicians choosing to incorporate acupuncture into practice will pursue lifelong learning, including formal and self-directed programs.

In contrast, there are no independent, agency-accredited training programs for “dry needling,” no standardized curriculum, no means of assessing the competence of instructors in the field, and no independently administered competency examinations.

Neither physical therapy nor chiropractic entry-level training includes any meaningful preparation for the practice of invasive therapeutic modalities such as the insertion of acupuncture needles. Training in these programs is generally limited to external therapeutic modalities. In some states, however, physical therapists and others have begun inserting acupuncture needles and practicing acupuncture with 12-24 hours of classroom time and little to no hands-on training or supervision. This is being done under the name “dry needling.”

Physical therapists and chiropractors without acupuncture included in their state practice acts have, in some cases, been authorized to perform dry needling by their own regulatory boards’ non-binding guidelines or through administrative rulemaking. Such actions often occur even when the statutory practice act adopted by the state legislature lacks any legislative intent to authorize invasive procedures such as the insertion of needles.

All health care providers without acupuncture formally included in their state practice act should be prohibited from the practice of acupuncture, even when described as “dry needling,” unless their practice act is legally expanded to include the practice of acupuncture and provide the same level of clinical and classroom training required for the licensure of acupuncturists. 

Bedwetting Effectively Treated with Acupuncture

Using Acupuncture to Treat High Blood Pressure

Acupuncture has been well established as a means of lowering blood pressure and managing chronic hypertension. Now, several recent studies have added yet more evidence supporting this as an effective therapy.

 “This clinical study is the culmination of more than a decade of bench research in this area,” Dr. John Longhurst, a cardiologist and an author of the study, said in the press release. “By using Western scientific rigor to validate an ancient Eastern therapy, we feel we have integrated Chinese and Western medicine and provided a beneficial guideline for treating a disease that affects millions in the U.S.”

The latest study, published in the journal Medical Acupuncture, examined the effects of acupuncture on 65 hypertensive patients who weren’t on any hypertension meds. The participants were divided into two groups. The first group received electroacupuncture (low-intensity electrical stimulation on different needle points in the body) on their inner wrists and below their knees, and 70 percent of the participants saw a reduction in blood pressure, an improvement that lasted over a month. This group also saw a reduction of blood concentration levels of norepinephrine, a hormone and neurotransmitter that constricts blood vessels and elevates blood pressure.

Another study, from Scientific Reports, reveals one possible mechanism:

Repetitive Acupuncture Attenuates Cold-Induced Hypertension through Enkephalin in the Rostral Ventral Lateral Medulla.

Angina and Chest Pain Respond Well to Acupuncture

If you are having chest pains related to angina, acupuncture may be more effective than conventional drugs says theNational Certification Commission of Acupuncture and Oriental Medicine (NCCAOM). In a recent meta-analysis, researchers found that "acupuncture significantly increased the clinical curative effects in the relief of angina symptoms and improved the electrocardiography indicating that acupuncture therapy was superior to conventional drugs.[1]"

You can read the rest of the article here, at the National Certification Commission of Acupuncture and Oriental Medicine's website.

Post Herpetic Neuralgia, Shingles and Chinese Medicine

Any individual who has suffered through shingles (herpes zoster) can attest that the experience can be counted as among the worst that a human being can suffer. Usually shingles manifests as an agonizing, burning pain following one or more nerve paths from the spine outwards, and is accompanied by a fluid-filled rash which gradually evolves into painful scabs.

Cruelly, the visual signs of shingles may vanish after several weeks, but leaving searing nerve pain where it had been yet with little or no outward signs. This pain is termed, post-herpetic neuralgia.

While we often treat acute shingles at the Northside Holistic Center with good effect, it is even more common that people are directed to us by their physician or a peer who has been treated at the clinic for post-herpetic neuralgia. This is because living with the neuralgia is often almost intolerable and acupuncture and Chinese medicine are so effective at alleviating the problem.

Articles and Research

• A recent article compared the effectiveness of acupuncture and Chinese medicine to conventional medical care for shingles and found that the effectiveness was the same and was, ultimately, cheaper. The article, reprinted below:

Acupuncture Cost-Effective For Herpes Zoster Care - New Research

12 APRIL 2012

New research published in the Journal of Traditional Chinese Medicine finds acupuncture as effective as pharmacological drugs for the treatment of herpes zoster. The study also notes that acupuncture is more cost-effective as a treatment modality for this ailment. Herpes zoster, also known as shingles, is a viral infection that causes painful skin rashes with blisters. This is the same virus that causes chickenpox. Adults who have had chickenpox earlier in life have a 50 percent chance of contracting a herpes zoster outbreak later in life, however, herpes zoster can attack at any age.

A total of 500 patients with herpes zoster were part of this randomized clinical trial. They were divided into 5 treatment groups to compare Chinese medicine with anti-viral drug therapy. Group 1 received acupuncture and electroacupuncture. Group 2 received moxibustion. Group 3 received red-hot needle treatment. Group 4 received tapping needle technique plus cupping and group 5 received drug therapy. The researchers found no statistical difference between the treatment groups for the “curative effect.” Given the same clinical effects between the treatment groups, the researchers then compared the cost of care and concluded that acupuncture is a more cost-effective modality for the treatment of herpes zoster.

Reference:

Journal of Chinese Medicine. 1-2012. Economic Evaluation of Treating Herpes Zoster with Various Methods of Acupuncture and Moxibustion.

• An Italian study, which can read about here, found that,

...acupuncture is as effective as standard drug treatment for acute pain in patients with herpes zoster (HZ).

• A Yale School of Medicine case report, abstract viewable here, found that with a patient whose post herpetic neuralgia was unresponsive to a variety of Western medical treatments responded well to acupuncture, 

A comprehensive pain treatment regimen, consisting of a stellate ganglia block, medications, transcutaneous electrical nerve stimulation and hypnosis, was administered, but the patient did not gain any incremental pain relief.
The acupuncture service was consulted . . . after acupuncture treatment over a 2-month period, the patient's nausea disappeared. Her left facial pain continued to decline from a maximum of 10 to 0 . . .

[their] conclusions, "Acupuncture and its related techniques may be an effective adjunctive treatment for symptoms associated with post herpetic neuralgia and deserve further study."

A research project comparing several different means of using acupuncture and Chinese medicine to treat shingles (which can be read here) found that, 

Acupuncture plus encircled needling and acupuncture plus encircled needling combined with cotton-moxibustion, or with fire needle stimulation, or with tapping and cupping are effective in the treatment of herpes zoster at the acute stage, being comparable to the medication in the clinical curative effect and improvement of blisters, and better than medication in pain relief.