Neurophysiological and psychophysical effects of dry versus sham needling of the infraspinatus muscle in patients with chronic shoulder pain: a randomized feasibility study.

This was a small feasibility study with 21 randomized adults, not a powered efficacy trial; the authors state low statistical power and a high risk of missing a real difference. Outcome data were incomplete: pressure-pain analysis included 8 dry-needling and 11 sham participants, while excitability analysis included 7 dry-needling and 10 sham participants. The study did not measure function or long-term effects, so it says little about whether patients improve in daily life. Sham needling was not inert; it produced significant changes in excitability and sensitivity, so a null between-group result may reflect low power or similar effects rather than proof that dry needling does not work. Participants were warned that needling could cause soreness for up to 48 hours, and the authors suggest expectation effects may have influenced pressure-pain results. The excitability measure used, active motor threshold, is specific but not sensitive and cannot distinguish where changes occur along the pathway. The study was retrospectively registered. Twenty of 47 interested individuals were excluded, so the analysed sample may not represent all people with chronic shoulder pain.

Do not conclude that dry needling is clinically superior to sham needling for chronic shoulder pain. This was a small feasibility study; the between-group excitability differences were not significant, and the pressure-pain result was mainly a change in the sham group rather than a significant improvement in the dry-needling group.