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.