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Table 1 Characteristics of the included studies

From: Corticosteroid injection or dry needling for musculoskeletal pain and disability? A systematic review and GRADE evidence synthesis

Author, Year

Condition

Funding source

CoI

Methods

Participants

Interventions

Outcomes measures and time points

Results (outcomes, responder analysis, adverse events)

GĂŒngör and GĂŒngör [31]

Lateral epicondylitis

Not funded

None

Randomized clinical trial conducted in Turkey from 2018 to 2020

Sample size (n)*

DN: 24

CSI: 24

Sex (Females)

DN: 13F

CSI: 15F

Age (mean ± SD)

DN: 46.0 ± 7.4 years

CSI: 40.9 ± 7.7 years

*This study had another intervention group, which received platelet-rich plasma (PRP) treatment (n = 24)

DN: A fine needle (23 gauge) was withdrawn and advanced throughout the long axis of the tendon about 40–50 times during 2 min to pepper the tendon. Dry needling was performed once a week for 3 weeks

CSI: A single corticosteroid injection of 40 mg methylprednisolone acetate was administered with the patient seated on a chair and the forearm placed in the neutral position and the elbow in 90Âș of flexion

Pain intensity measured by using the Visual Analogue Scale (VAS) and function assessed through Disabilities of the Shoulder, Arm, and Hand (DASH) score before treatment, 3 weeks and 3 months follow-up

Pain (VAS)

3 wk: DN 2.3 ± 0.6 versus CSI 2.3 ± 0.6 p = 0.98

3mo: DN 1.1 ± 0.5 versus CSI 0.7 ± 0.6 p = 0.01

Function (DASH)

3wk: DN 31.6 ± 6.8 versus CSI 32.0 ± 5.0 p = 0.84

3mo: DN 30.0 ± 6.7 versus CSI 26.6 ± 3.2 p = 0.01

Responder analysis:

Not reported

Adverse events:

Not reported

Rastegar et al. [27]

Plantar Fasciitis

Medical Research

Council at Isfahan University of Medical Sciences

None

Randomized clinical trial conducted in Iran from April 2013 to April 2015

Sample size (n)

DN: 32

CSI: 34

Sex (Females)

DN: 18F

CSI: 20F

Age (mean ± SD)

DN: 39.8 ± 7.9 years

CSI: 42.0 ± 10.3 years

DN: The medial aspect of heel pad through the point of maximum tenderness was dry needled for 30 s using a 0.3 mm diameter needle. The needle was withdrawn and advanced during the time

CSI: 1 ml of methylprednisolone acetate (40 mg/ml) was injected to the medial aspect of heel pad through the point of maximum tenderness using a 0.3 mm diameter needle with 3 or 2 ml syringe

Pain intensity measured by VAS before treatment, 3 weeks, 6 weeks, 3 months, 6 months and 1 year after treatment

Pain (VAS)

Short-term

3wk: DN 3.47 ± 1.32 versus CSI 0.32 ± 0.71 p < 0.001

6wk: DN 2.66 ± 1.33 versus CSI 0.21 ± 0.67 p < 0.001

Mid-term

12wk: DN 1.59 ± 1.24 versus CSI 0.56 ± 1.33 p = 0.44

Long term

6mo: DN 1.28 ± 1.46 versus CSI 1.79 ± 1.55 p = 0.65

1 yr: DN 0.69 ± 0.93 versus CSI 2.09 ± 1.58 p = 0.004

Responder analysis:

Not reported

Adverse events:

Not reported

Brennan et al. [26]

Greater trochanteric pain syndrome

Baylor Scott & White Health

None

Prospective, randomized clinical trial conducted in USA between 2013 and 2015

Sample size (n)

DN: 21

CSI: 22

Sex (Females)

DN: 19F

CSI: 18F

Age (mean ± SD)

DN: 61.3 ± 16.5 years

CSI: 70.1 ± 11.4 years

DN: Muscles assessed as contributing for patient pain was needled by a 0.3–0.5 mm diameter needle. The needle was withdrawn and advanced repeatedly while it produced an appropriate response and was tolerated by the participant. Then, the needle was left in situ for 5–7 min

CSI: A 10 ml injection mixture containing 2 mL methylprednisolone acetate (40 mg/mL), 4 mL 1% lidocaine and 4 mL 0.25% marcaine was injected in the point of maximal tenderness on the greater trochanter with an area coverage of 3-4 cm by 3–4 cm. 2 mL were injected perpendicular to the skin to the level of bony contact; then, 2 mL were injected in each of 4 quadrants around the injection side. Needle length was 1.5 inch and diameter was 21 or 22 gauge, depending on soft tissue thickness

Pain intensity measured by NPRS and function measured by PSFS before treatment, 1 week, 3 weeks and 6 weeks after treatment

Pain (NPRS)

Short term

1wk: DN 3.6 ± 2.1 versus CSI 2.6 ± 2.7

3wk: DN 4.0 ± 2.2 versus CSI 2.7 ± 2.9

6wk: DN 2.8 ± 2.4 versus CSI 3.9 ± 3.7

Disability (PSFS)Short term

1wk: DN 5.2 ± 2.2 versus CSI 6.5 ± 2.8

3wk: DN 5.7 ± 2.0 versus CSI 6.5 ± 2.8

6wk: DN 7.3 ± 2.3 versus CSI 6.1 ± 3.0

Responder analysis:

Not reported

Adverse events

DN: 0% (n = 0)

CSI: 0% (n = 0)

Uygur et al. [30]

Lateral epicondylitis

Not reported

None

Randomized clinical trial conducted in Turkey,

Sample size (n)

DN: 49

CSI: 52

Sex (Females)

–

Age (mean ± SD)

DN: 47.5 ± 7.3 years

CSI: 48.1 ± 10.3 years

DN: Fifteen 0.25 × 25 mm needles were inserted at the lateral epicondyle region. The needles were rotated 3–4 times, held in place for 10 min, and withdrawn. Dry needling was performed twice a week for 5 sessions

CSI: A single dose of corticosteroid injection containing 2 ml methylprednisolone acetate (40 mg/ml) was inserted into the lateral epicondyle region. The periosteum was pricked

90 20–30 times without withdrawing the needle and no local anesthetic was used

Patient improvement was assessed by using the Patient-rated Tennis Elbow Evaluation (PRTEE) before interventions, at 20th day and at 6 months follow-up

Patient improvement

20th day: DN 15.6 ± 7.7 versus CSI 36.0 ± 14.7 p < 0.01

6 months: DN 9.7 ± 7.6 versus CSI 19.3 ± 19.4 p < 0.01

Responder analysis: not reported

Adverse events

DN: 2% (n = 1) of participants did not tolerate pain due to intervention and was excluded from the study

CSI: 7.6% (n = 4) of participants presented skin atrophy and whitening at 6-months follow-up

Uygur et al. [28]

Plantar fasciitis

Not funded

None

Randomized clinical trial conducted in Turkey

Sample size (n)

DN: 49

CSI: 47

Sex (Females)

N(%): 63F (66%)*

Age (mean ± SD)

DN: 49.6 ± 11.7 years

CSI: 49.9 ± 12.3 years

DN: Fifteen-0.25 × 0.4 mm needles were inserted into the plantar fascia origin at the calcaneous. The needles were left in situ for 10 min and were rotated 3 to 4 times. Dry needling was performed twice a week for 5 sessions

CSI: A single dose of corticosteroid injection containing methylprednisolone acetate (2 mL Depo Medrol, 40 mg/ml) and bupivacaine (1 mL marcaine, 0.5%) was injected between the plantar fascia and the periosteum. Needle diameter was 25 gauge

Pain intensity and disability score measured by the Foot Function Index (FFI)

Before treatment, 3 weeks and 6 months after treatment

Pain (FFI Pain score)

Short term

3wk: DN 27.7 ± 9.82 versus CSI 33.6 ± 10.6

Long term

6mo: DN 29.7 ± 10.3 versus CSI 50.5 ± 12.3

Disability (FFI Disability Score)

Short term

3wk: DN − 28.3 ± 8.9 versus CSI − 28.4 ± 11.6*

Long term

6mo: DN − 28.8 ± 8.8 versus CSI − 43.1 ± 11.1*

Responder analysis:

Not reported

Adverse events

DN: 38% (n = 18) of participants presented pain at the needling site and

12% (n = 6) reported subcutaneous bleeding

CSI: 0% (n = 0)

*multiplied by − 1 to adjust the direction of the effect

Venancio et al. [29]

Myofascial pain and headache

Not reported

Not reported

Randomized clinical trial conducted in Brazil

Sample size (n)

DN: 15

CSI: 15

Sex (Females)

–

Age (mean ± SD)

–

DN: not sufficiently described

CSI: Corticosteroid injection mixture containing 0.2 mL dexamethasone (4 mg/mL) and lidocaine (0.25%)

Pain measured by the modified Symptom Severity Index (SSI)

Before treatment, 1 week, 4 weeks and 12 weeks after treatment

Pain (Modified SSI)

Short term

1wk: DN 0.34 ± 0.08 versus CSI 0.51 ± 0.20

4wk: DN 0.42 ± 0.08 versus CSI 0.43 ± 0.11

Mid term

12wk: DN 0.36 ± 0.17 versus CSI DN 0.33 ± 0.1

Responder analysis:

Not reported

Adverse events:

Not reported

  1. CoI conflict of interest, CSI corticosteroid injections, DN dry needling, NPRS numerical pain rating scale, PSFS patient specific functional scale, USA United States of America
  2. *It refers to the proportion of females in the entire sample. The study has not reported the proportion of females for each intervention group