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Dry Needling for Fibromyalgia: Can it Help?

Dry Needling for Fibromyalgia: Can it Help?

The overall effect of Dry Needling (DN) on the human body is a decrease in sympathetic and an increase in parasympathetic tone. We do not even come close to understanding how exactly this works as of yet, but we do know the end result. The most recent literature measuring the fluctuation of the autonomic nervous system following the insertion of needles, using microneurography, indicates that it takes about 20 minutes for the nervous system to stop changing. For this reason and a few other physiologic factors, and based on clinical experience, I prefer to leave my needles in for 30 minutes if tolerable for the patient. This is an excellent topic of debate that we will get further into later. Now let's get into how dry needling can help Fibromyalgia.

Can Dry Needling help Fibromyalgia?

Fibromyalgia is a symptom of chronically elevated sympathetic tone. This results in:

  • central sensitization
  • allodynia
  • hyperalgesia
  • chemically induced pain
  • other detrimental phenomena

Counterintuitively, those with Fibromyalgia respond much better to needles than they do to constant hand pressure. With needles, they just experience the initial pain sensation, which typically resolves into a slight but tolerable discomfort, where you know the needle is there, but it is not immediately bothersome.

Will Dry Needling overstimulate and make Fibromyalgia worse?

The primary caution with FM patients, or other patients with elevated sympathetic tone, is to avoid overstimulating the sympathetics. The primary goal is to return the CNS, ANS, and other nervous systems to a more homeostatic level.

Theoretically, if the nervous systems return to homeostasis, FM is not possible. Therefore, my initial aim with these patients is to elevate the parasympathetics and decrease the sympathetics. Every patient responds differently to needles, so it is essential to monitor their response in order to provide effective treatment. These patients easily slip into vasovagal response, so it is of utmost importance to not overstimulate the sympathetics. Remember, each time a person is treated with needles, their body becomes more accustomed and tolerant to them, so be nice and ease these patients into the treatment. Going vasovagal is not dangerous for your average person, unless you pass out and hit your head, but it is an extremely uncomfortable feeling. So I avoid doing that to my patients.

Related: Click here to see my dry needling course offerings

The two most accessible and safe areas to access the parasympathetic portion of the ANS is the suboccipital / upper cervical periosteum (I like the base of C2 spinous) and the sacral periosteum between S2-S4. Remember that the ANS is primarily a controller of organ function and there is minimal access to it with the methods available to us. However, needling these two locations, especially connecting the two with low frequency stim (1-5 Hz), is extremely relaxing and effective at increasing parasympathetic tone and decreasing sympathetic tone by targeting the cranial nerves and the sacral plexus.

Related: Click here to read more about how low-frequency stimulation benefits the autonomic Nervous System.

It is important to properly incorporate specific focus on altering the nervous system, not simply inducing mechanical changes. This does also have a positive effect on the nervous system, but not as drastically as it does when you specifically focus on it. There is a technique called PTNS for urinary incontinence that uses 2 needles to target the brain areas involved in micturition via the sacral plexus. There is excellent acupuncture research showing a significant decrease of overactive electrical brain activity in the areas associated with micturition, such as the pontine micturition center (PMC) in the Pons. These studies use in-vivo imaging of the brain while the needles are inserted. The results are seriously amazing, showing over 80% success.

How to prevent overstimulating someone with Fibromyalgia

A chiropractor friend asked me the other day about treating FM patients. He relayed that he treated someone with FM for the first time with needles, and the patient was extremely sore for about 3 weeks. I asked how many needles were used and where, and he said he used about 10 into the most pathologic tissue in the patient’s most problematic body region. This is a totally reasonable treatment and would typically not cause undo soreness in a non-FM patient. However, with this individual, their sympathetics, being already turned way up, got overly stimulated and apparently stayed elevated for a few weeks following Tx. When I first started needling, I did this to a few patients as well. It’s a learning process.

Over the years, by reading literature and experimenting on myself and patients, I have found that the best way to typically treat severe FM patients is to first target the nervous system with as few needles as possible with the addition of 1-5 Hz stim to encourage homeostasis. Once the patients are not as hypersensitive and you have achieved a more homeostatic condition in their body and mind, a more mechanically oriented approach to needling may be more tolerable. Here is the overall concept to keep in mind: You want to slowly introduce the needles to the patient’s body by stimulating the parasympathetics and depressing the sympathetics of both the CNS and ANS. If done gradually, this is a relaxing and enjoyable experience.

The reason I mention using 1-5 Hz with my microcurrent unit (AWQ-104L) is that for my treatment goal—reduction of sympathetic tone, there is consistent literature confirming the effectiveness of this frequency in releasing endogenous opioids and other regulating substances that, as a whole, serve to reduce sympathetic overdrive. This conversely elevates the parasympathetics, which is awesome, and it is exactly what I’m looking to achieve. You may notice that some patients who respond strongly to DN will become extremely tired after a treatment. This is an excellent and sought-after result, clearly indicating the desired nervous system response. It’s super cool to see this.

Some of the beneficial substances released secondary to DN are beta-endorphin, CGRP, NGF, VIP and others.

I will continue this topic and other stuff in future blogs. Click here to see all of my blogs and keep up to date.

References

Filshie, J., White, A. and Cummings, M. eds., 2016. Medical Acupuncture E-Book: A Western Scientific Approach. Churchill Livingstone.

Gallego-Sendarrubias, G.M., Rodríguez-Sanz, D., Calvo-Lobo, C. and Martín, J.L., 2020. Efficacy of dry needling as an adjunct to manual therapy for patients with chronic mechanical neck pain: a randomised clinical trial. Acupuncture in Medicine, pp.acupmed-2018.

Mayor, D., 2013. An exploratory review of the electroacupuncture literature: clinical applications and endorphin mechanisms. Acupuncture in Medicine, 31(4), pp.409-415.

Sillevis, R., Van Duijn, J., Shamus, E. and Hard, M., 2019. Time effect for in-situ dry needling on the autonomic nervous system, a pilot study. Physiotherapy Theory and Practice, pp.1-9.

Liu, C., Chao, L., Li, Z., Lv, W., Jia, C., Shi, D. and Guo, S., 2018. Meta-analysis of Electro-acupuncture in Human Clinical Trials for the Treatment of Post-Stroke Urgency Urinary Incontinence and Possible Application in Canine Lower Urinary Tract Dysfunction. American Journal of Traditional Chinese Veterinary Medicine, 13(2).

Peters, K.M., MacDiarmid, S.A., Wooldridge, L.S., Leong, F.C., Shobeiri, S.A., Rovner, E.S., Siegel, S.W., Tate, S.B., Jarnagin, B.K., Rosenblatt, P.L. and Feagins, B.A., 2009. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. The Journal of urology, 182(3), pp.1055-1061.

de Wall, L.L. and Heesakkers, J.P., 2017. Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome. Research and reports in urology, 9, p.145.

Fowler, C.J. and Griffiths, D.J., 2010. A decade of functional brain imaging applied to bladder control. Neurourology and Urodynamics: Official Journal of the International Continence Society, 29(1), pp.49-55.

Rayman, G., Hassan, A. and Tooke, J.E., 1986. Blood flow in the skin of the foot related to posture in diabetes mellitus. Br Med J (Clin Res Ed), 292(6513), pp.87-90.

Hagblad, J., Lindberg, L.G., Andersson, A.K., Bergstrand, S., Lindgren, M., Ek, A.C., Folke, M. and Lindén, M., 2010. A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths. Medical & biological engineering & computing, 48(5), pp.415-422.

Albrecht, D., Isenberg, A.L., Stradford, J., Monreal, T., Sagare, A., Pachicano, M., Sweeney, M., Toga, A., Zlokovic, B., Chui, H. and Joe, E., 2020. Associations between vascular function and tau PET are associated with global cognition and amyloid. Journal of Neuroscience.

Dommerholt, J., Thorp, J.N., Hooks, T. and Mayoral, O., 2020. MYOFASCIAL PAIN AND TREATMENT: EDITORIAL A Critical Overview of the Current Myofascial Pain Literature–October 2020.