Functional connectivity patterns are altered by low back pain and cause different responses to sham and real dry needling therapies: a systematic review of fMRI studies

Author: Nina F Kelly1,2,3, Cody J Mansfield2,3,4,5,6, Eric Schneider7, Josh C Moeller6,8, Jerald S Bleacher2,3, Ruchika S Prakash9, Matthew S Briggs4,5,6,10
1 Cleveland Clinic Main Campus, Crile Building Sports Medicine Rehabilitation, Cleveland, OH, USA.
2 Orthopedic Manual Physical Therapy Fellowship, Sports Medicine Rehab, Ohio State University Wexner Medical Center, Columbus, OH, USA.
3 Gahanna Sports Medicine Rehabilitation, Ohio State University Wexner Medical Center, Columbus, OH, USA.
4 Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA.
5 Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
6 School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH, USA.
7 School of Health Sciences, Mount St. Joseph University, Cincinnati, OH, USA.
8 Department of Psychology, Ohio State University 1825 Neil Avenue, Columbus, OH, USA.
9 Center for Cognitive and Behavioral Brain Imaging, Ohio State University, Columbus, OH, USA.
10 Department of Orthopedics, Ohio State University Wexner Medical Center, Columbus, OH, USA.
Conference/Journal: Physiother Theory Pract
Date published: 2022 Dec 9
Other: Special Notes: doi: 10.1080/09593985.2022.2155094. , Word Count: 214

There is a relationship between low back pain (LBP) and central nervous system dysfunction. Needling therapies (e.g. acupuncture, dry needling) are proposed to impact the nervous system, however their specific influence is unclear.

Determine how needling therapies alter functional connectivity and LBP as measured by functional magnetic resonance imaging (fMRI).

Databases were searched following PRISMA guidelines. Studies using fMRI on individuals with LBP receiving dry needling or acupuncture compared to control or sham treatments were included.

Eight studies were included, all of which used acupuncture. The quality of studies ranged from good (n = 6) to excellent (n = 2). After acupuncture, individuals with LBP demonstrated significant functional connectivity changes across several networks, notably the salience, somatomotor, default mode network (DMN) and limbic networks. A meta-analysis demonstrated evidence of no effect to potential small effect of acupuncture in reducing LBP (SMD -0.28; 95% CI: -0.70, 0.13).

Needling therapies, like acupuncture, may have a central effect on patients beyond the local tissue effects, reducing patients' pain and disability due to alterations in neural processing, including the DMN, and potentially other central nervous system effects. The meta-analysis should be interpreted with caution due to the narrow focus and confined sample used.

Keywords: Dry needling; acupuncture; functional magnetic resonance imaging; low back pain; needling therapies.

PMID: 36484262 DOI: 10.1080/09593985.2022.2155094