Effectiveness of Dry Needling for Myofascial Trigger Points: An Overview of Systematic Reviews and a Meta-Meta-Analysis

OBJECTIVE: To evaluate the effectiveness and safety of dry needling (DN) for musculoskeletal conditions associated with myofascial trigger points (MTrPs).

DESIGN: Overview of systematic reviews and meta-meta-analysis.

LITERATURE SEARCH: PubMed, CINAHL, Cochrane Library, and PEDro were searched in May 2025. Systematic reviews, with or without meta-analyses, that evaluated DN for MTrPs in musculoskeletal conditions were eligible to be included.

DATA SYNTHESIS: Methodological quality was appraised with AMSTAR-2, risk of bias with ROBIS, certainty of evidence with GRADE, and review overlap with the corrected covered area (CCA). Effect estimates were synthesized and 95% prediction intervals (PIs) calculated. Adverse events (AEs) were categorized as mild, significant, or serious.

RESULTS: Thirty-three systematic reviews were included. Methodological quality was predominantly low or critically low, risk of bias was acceptable, and CCA was 2.8%. Overall, the certainty of evidence ranged from low to very low across outcomes. For pain intensity, DN showed a short-term benefit over sham (PI −1.71 to −0.97), although long-term effects were not estimable. Compared with other active treatments, pain intensity findings were heterogeneous. An immediate PI favored DN for pain-related disability (−2.47 to −0.09), whereas short- and long-term PIs crossed the null. Only one-third of the reviews reported AEs.

CONCLUSION: DN may be more effective than sham DN for reducing pain in musculoskeletal conditions associated with MTrPs. Compared with other active treatments, DN may show an immediate benefit for pain-related disability but did not consistently outperform active treatments for pain intensity or disability across follow-up periods. Reported AEs were mild and self-limiting; serious AEs were rarely reported.