Blog 10: Specific Ethical Question

I am a pre-physical therapy student, at my internship this past summer I was introduced to a new physical therapy modality:  trigger point dry needling.  According to Kinetachore, this treatment technique "uses small filament needles to release tight muscles with the goal of permanently reducing pain and dysfunction."  The pain that this treatment is attempting to cure is pain caused by a trigger point: an irritated contraction knot found in tight bands of muscles. The needles used for dry needling are solid, and they do not cut the skin or muscle; they function by deactivating and desensitizing myofascial pain.  At first this seems like a good approach to overcome pain caused by trigger points.  However, after collaborating with other physical therapists, I found that physical therapists are not in agreement on the technique.  

One physical therapist that I recently shadowed is against trigger point dry needling because in his experience injections are more effective and provide long-lasting relief faster.

According to Progressive Physical Therapy, after a dry needling session, you will likely be sore for about 2 days, and a day or 2 of relief will follow.  A patient will likely need multiple dry needling sessions to obtain permanent relief.  This does not seem like a good approach to treat a trigger point, as a patient I would want lasting relief as soon as possible.  

The Department of Physical Medicine & Rehabilitation at the University of California Irvine did a study to compare the outcomes of patients treated with trigger point dry needling as opposed to patients treated with injections that contained 0.5% lidocaine. After receiving treatment, 100% of the patients who were dry needled experienced soreness different from their previous trigger point pain, while only 42% of patients who received lidocaine injections experienced soreness.   The author states that, "Patients treated with dry needling had postinjection soreness of significantly greater intensity and longer duration than those treated with lidocaine injection."  Through this study, it is apparent that lidocaine injections are a better option in treating trigger points than dry needling.  The two main reasons are that patients don't become as sore and that relief lasts longer.  

After observing how effective lidocaine injections can be, I began to wonder why a physical therapist would use dry needling as a technique.  The only reason I can conclude is that physical therapists aren't licensed to administer injections; they are only allowed to perform dry needling.  I don't think it's ethical for a physical therapist to perform a certain treatment if there is a better treatment option available; even if they have to give up patients.  In health care, it's all about the patients; a physical therapist should recognize which patients would better benefit from lidocaine injections and refer them to a doctor who will give the patient the injections.  Patients with trigger point pain should receive injections as a faster and more pleasant treatment. 

Sources

1)  Hong, CZ. "Lidocaine Injection versus Dry Needling to Myofascial Trigger Point. The Importance of the Local Twitch Response." Pubmed.gov. Department of Physical Medicine & Rehabilitation, University of California Irvine, Orange. Web. 24 Oct. 2011. <http://www.ncbi.nlm.nih.gov/pubmed/8043247>.

2)  "TDN Overview." Intramuscular Manual Therapy, Aka Trigger Point Dry Needling, Training Physical Therapists. Web. 24 Oct. 2011. <http://www.kinetacore.com/physical-therapy/TDN-Overview/page34.html>.

3)   "Trigger Point Dry Needling." Progressive Physical Therapy. 1 May 2011. Web. 24 Oct. 2011. <http://pptaccess.dot3tech.net/?p=35>.