An “Anecdote” on Dry Needling by Dr. Justin Dunaway, DPT

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Physio Twitter is getting it’s panties in a bunch over Dry Needling. Take a chill-pill & soak in this much-needed Point Of View by Dr. Justin Dunaway. In case you aren’t already familiar with him (who isn’t??), then check out my interview with Justin here & here.

Enjoy!


 

An “Anecdote” on Dry Needling

With all this talk about RTCs, efficacy and effectiveness, and the necessity or futility of clinical experience… I’d like to share an experience, one that I feel matters more than the research, more than opinions or my clinical experience: a patient experience.  While I am very well read on the needling literature, have a strong foundation in physiology and a deep understanding of placebos, nocebos, and non-specific effects, as well as very strong opinions on all of these things…I’m going to leave them out of this discussion. I feel as we delve deeper and deeper into this rabbit hole of which research is better, who has a stronger understanding of its nuances, and the over reaching value of the research, we are forgetting about why we do it all. Each year of schooling, the piles of research, and the endless debates… aren’t about the stats or publications, and certainly are not about the paycheck. It was, is, and always should be about the patient first.  I want to share this single anecdote, keeping in mind the current debate between Dunning et al and Ridgeway/Venere et al in regards to the effectiveness and efficacy of dry needling.

This is the story of Sandy. Sandy is a person, not a statistic or a subject in a well powered RTC that wound up in a systematic review with a metanalysis showing strong evidence in support of my treatment choice, but a human in a very debilitating amount of chronic pain.  A human with loads of bias, confounding variables, and expectations.

Sandy (who is now 70 years old) was in a car accident 20 years ago, leaving her with chronic neck pain and headaches. Like many patients, she received radiographs, medical interventions, medications, shots, and legitimately good PT. As all these interventions failed and her condition worsened, she became depressed, decreased her activity due to pain, took increasing amounts of pain meds, and her condition ultimately deteriorated. She ended up having a cervical fusion (which was unsuccessful) that launched her into an even more pain and deeper depression and was prescribed methadone 3x/day. At this point, she was spending 90% of her time crying in bed, her medical team had given up on her and she on herself. Sadly, we’ve all known these patients.

When I first met Sandy, I just let her talk. A quick objective revealed neck joints and musculature that had clearly not moved in over a decade and a human feeling hopeless about her situation, just as you’d expect. After talking about treatment, she agreed to give dry needling a shot. I placed 10-15 needles in her neck, upper traps, back of her head, and a few points in her hands and applied electric to the needles for 20 min.

The next day she called to tell me that she had had her first good night’s sleep in longer than she could remember. I saw her twice a week for a few weeks and primarily performed DN. Within a month, she was going to the store, having family dinners, and playing cards with friends. Within two months, she was hiking the grand canyon with her new boyfriend pain free.  All from an intervention with no therapeutic value.

I realize this is anecdotal, Level 5 evidence, clinical experience, or whatever you want to call it. I understand that it is full of bias, confounding variables, “placebo”, “non-specific effects”, and other terms we use to discredit the things we don’t understand. But really, this is a human, a person who lost her life and then got it back through physical therapy. Sandy has regained her life because of an intervention. The choice of this specifically was guided by clinical experience, which may or may not be backed solidly in the literature. No RCTs have been written about the Sandys or the countless others with similar stories and certainly, if I practiced “Evidence Blinding Medicine,” Sandy would still be in bed, lonely and miserable.

I am not writing this to stoke the fires of the current debate on needling, what it means to be evidence based, or where clinical experience falls into the mix. I write this as a reminder that we treat humans, not statistics, and we should not forget that. We cannot be so focused on the PDF on our laptop that we forget about the human on our table.  Let the evidence guide you, but not blind you. Clinical experience, while full of bias and confounding variables, is absolutely paramount in treating the Sandys of the world. As promised, I will not cite any literature, nor will I reference any gurus or experts in the field. But I will leave you with this quote, one that we continue to get further and further from as we “advance” our knowledge, education, and research skills…one that speaks to the human element of what we do and the need for clinical experience and expertise.

“I would rather know the person who has the disease than the disease the person has.” 

–Hippocrates 460 BCE – 375 BCE

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