SYSTEMATIC REVIEW WITH META-ANALYSIS The effect of dry needling for myofascial trigger points in the neck and shoulders: A systematic review and meta-analysis Joshua Ong, BPhty a , Leica S. Claydon, PhD, PG Cert Tert Teach, BSc (Hons) b, * a Centre for Physiotherapy Research, University of Otago, PO Box 56, Dunedin, New Zealand b Department of Allied Health and Medicine, Faculty of Health, Social Care, and Education, Anglia Ruskin University, Rivermead Campus, Bishops Hall Lane, Chelmsford CM1 1SQ, UK Received 5 September 2012; received in revised form 15 September 2013; accepted 16 October 2013 KEYWORDS Dry needling; Lidocaine; Myofascial trigger points; Randomised controlled trial Summary Background: and purpose: The aim of this systematic review with meta-analysis is to determine the effect of dry needling in the treatment of MTrPs. Methods: Searches were performed using the electronic databases AMED, EBM reviews, Em- base, and Ovid MEDLINE (all from database inception-February 2012). Study selection: Randomized controlled trials (RCTs) were included if they compared dry needling with another form of treatment or placebo and included pain intensity as an outcome. Data extraction: Two blinded reviewers independently screened the articles, scored their methodological quality and extracted data. Quality assessment: Physiotherapy Evidence Database (PEDro) quality scale and the Cochrane risk of bias tool were used. Results: Four RCTs compared dry needling to lidocaine and one RCT compared dry needling to placebo. Meta-analyses of dry needling revealed no significant difference between dry needling and lidocaine immediately after treatment standardized mean difference (SMD) 0.41 (95%CI 0.15 to 0.97), at one month (SMD 1.46; 95% CI 2.04 to 4.96) and three to six months (SMD 0.28; 95% CI 0.63 to 0.07). Discussion: Although not significant in the meta-analyses, there were interesting patterns fa- voring lidocaine immediately after treatment and dry needling at three to six months. ª 2013 Elsevier Ltd. All rights reserved. * Corresponding author. E-mail address: leica.claydon@anglia.ac.uk (L.S. Claydon). + MODEL Please cite this article in press as: Ong, J., Claydon, L.S., The effect of dry needling for myofascial trigger points in the neck and shoulders: A systematic review and meta-analysis, Journal of Bodywork & Movement Therapies (2013), http://dx.doi.org/10.1016/ j.jbmt.2013.11.009 1360-8592/$ - see front matter ª 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jbmt.2013.11.009 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/jbmt Journal of Bodywork & Movement Therapies (2013) xx,1e9