Do Not Use ‘Dry Needling’ after Spine Surgery.

Posted on January 9, 2024

The abstract of a case report below does not indicate if ‘dry needling’ a questionable form of acupuncture, which lead to an infection after spine surgery was provided by a physical therapist with minimal education in the state of TN, or a licensed acupuncturist (Lac) with years of education.  I thank the authors for taking the time to write this case report.

Dry needling an acupuncture technique which the authors define “as inserting acupuncture-like needles into a myofascial trigger point to reduce pain and improve motion”.  Unfortunately healthcare providers with minimal education and training in acupuncture are using ‘dry-needling’.  It is important to disclose who provided acupuncture in case reports, was it a physical therapist, a chiropractor, or another provider who obtain their dry-needling training over a weekend, or maximum 300 hours of training?  Licensed acupuncturists (L.Ac.) obtain close to 3000 hours of education.  State regulators must keep an eye on these case reports and restrict the practice of acupuncture accordingly.

Licensed acupuncturists who evaluate and treat children must obtain additional education in pediatric acupuncture.  Licensed acupuncturists who evaluate and treat patients after spine surgery also require additional education and training.  It is never necessary to insert needles near the spine to reduce pain.

Dry-needling is an aggressive form of acupuncture, which requires the use of thicker needles (larger gauge), deep insertion, and aggressive manual stimulation of the needle.  There is never an indication for this form of acupuncture after a spine surgery.

I contacted the authors; they are unaware if a physical therapist provided the ‘dry needling’ in this case reported.

Licensed acupuncturists (LAc)  typically do not advertise the practice of dry needling,  physical therapists (P.T.) typically do.  Acupuncture is regulated at the state level, and state regulators must be diligent to keep patients safe by requiring adequate education, training and licensing.

Abstract (case report is from the state of TN)

Background

“Acupuncture can be used to manage chronic pain. The most common complications related to acupuncture include pain, bruising, bleeding, or symptom exacerbation. Rarely, more serious adverse events occur, including infection, pneumothorax, septic arthritis, and peripheral nerve injury. To our knowledge, there are no reports of complications associated with acupuncture following spinal instrumentation.”

Purpose

To report a case of deep infection as a rare complication of acupuncture following posterior spinal fusion for adolescent idiopathic scoliosis.

Study Design

Case report.

Methods

Case report.

Results

“A 15-year-old female presented 21 months after spinal arthrodesis for idiopathic scoliosis with a deep spine infection. The patient had recently been receiving a variation of acupuncture (dry needling therapy) in her medial periscapular region to manage chronic back and shoulder pain. She underwent serial irrigation and debridement with implant removal. Intraoperative cultures revealed pseudomonas and aerobic diptheroids. Two weeks later, the patient developed a periscapular abscess requiring additional operative debridement; cultures from this abscess were negative. After an 8-week course of antibiotics, the patient remains infection free with normalized inflammatory markers 2 years postoperatively.”

Conclusions

“Acupuncture is sometimes pursued as part of a multimodality pain management program for back pain, but it is not without risk and can lead to infection. Deep infection from acupuncture may contaminate existing spinal instrumentation and require operative debridement, implant removal, and long-term antibiotic therapy. Accordingly, there is an increased risk for deformity progression in this scenario related to the implant removal.”

Reference: Callan AK, Bauer JM, Martus JE. Deep Spine Infection After Acupuncture in the Setting of Spinal Instrumentation. Spine Deform. 2016;4(2):156-161. doi:10.1016/j.jspd.2015.09.045

Dry Needling in Tennessee

This case report presents the dangers of inadequate education, training and lack of licensing for acupuncture.   ‘Dry Needling’ is typically used by physical therapist.  Most states do not allow physical therapist to practice dry needling due to patient safety concerns.  Physical therapist do not have adequate education to practice any form of acupuncture.  Licensed acupuncturists are required to complete 3000 hours of education, spend at least one year in clinical residency, and are required to pass a state and/or national board exam (American acupuncutrists have at least 6-8 years of education).

Tennessee allows physical therapist  and occupational therapist  to practice ‘DRY NEEDLING’

Section 1150-01-.22 – DRY NEEDLING

(1) In order to perform dry needling, a physical therapist must obtain all of the educational instruction described in paragraphs (2)(a) and (2)(b) herein. All such educational instruction must be obtained in person and may not be obtained online or through video conferencing.
(2) Mandatory Training – Before performing dry needling, a practitioner must complete educational requirements in each of the following areas:

(a) Fifty (50) hours of instruction, to include instruction in each of the four (4) areas listed herein, which are generally satisfied during the normal course of study in physical therapy school:

1. Musculoskeletal and Neuromuscular systems;
2. Anatomical basis of pain mechanisms, chronic pain, and referred pain;
3. Trigger Points;
4. Universal Precautions; and
(b) Twenty-four (24) hours of dry needling specific instruction.

1. The twenty-four (24) hours must include instruction in each of the following six (6) areas:

(i) Dry needling technique;
(ii) Dry needling indications and contraindications;
(iii) Documentation of dry needling;
(iv) Management of adverse effects;
(v) Practical psychomotor competency; and
(vi) Occupational Safety and Health Administration’s Bloodborne Pathogens Protocol.
2. Each instructional course shall specify what anatomical regions are included in the instruction and describe whether the course offers introductory or advanced instruction in dry needling.
3. Each course must be pre-approved or approved by the Board or its consultant, or the Board may delegate the approval process to recognized health-related organizations or accredited physical therapy educational institutions.
(3) A newly-licensed physical therapist shall not practice dry needling for at least one (1) year from the date of initial licensure, unless the practitioner can demonstrate compliance with paragraph (2) through his or her pre-licensure educational coursework.
(4) Any physical therapist who obtained the requisite twenty-four (24) hours of instruction as described in paragraph (2)(b) in another state or country must provide the same documentation to the Board, as described in paragraph (2)(b), that is required of a course provider. The Board or its consultant must approve the practitioner’s dry needling coursework before the therapist can practice dry needling in this state.
(5) Dry needling may only be performed by a licensed physical therapist and may not be delegated to a physical therapist assistant or support personnel.
(6) A physical therapist practicing dry needling must supply written documentation, upon request by the Board, that substantiates appropriate training as required by this rule.
(7) All physical therapy patients receiving dry needling shall be provided with information from the patient’s physical therapist that includes a definition and description of the practice of dry needling and a description of the risks, benefits, and potential side effects of dry needling.

Tenn. Comp. R. & Regs. 1150-01-.22

New rule filed March 31, 2016; effective 6/29/2016.

Authority: T.C.A. §§ 63-13-304 and 63-13-305.

Licensing Acupuncturists (L.Ac.) in the state of Tennessee 

TN does provide licensing for acupuncturists who are certified by the NCCAOM, or hold licenses from other states. The educational requirement for licensing is still at the least 3000 hours.