In this November 30, 2013 photo, 17-year-old professional freeskier Torin Yater-Wallace gives the thumbs-down sign from his hospital bed at St. Anthony Summit Medical Center in Frisco, Colorado, while recovering from surgery for a pneumothorax (an accumulation of air in the space between the lung and the chest wall [pleural space], causing the lung to collapse) that he suffered after a physical therapist punctured his right lung with an acupuncture needle. (Photo: @TorinWallace)
1. Dry needling is acupuncture.
Acupuncture is the act of puncturing and stimulating an acupuncture point (a specific muscle or connective tissue site at which stimulation exerts a maximal therapeutic effect) with an acupuncture needle (a solid, stainless steel needle) to cure, mitigate, treat, or prevent disease or other conditions (1). Originating in China, acupuncture is a surgical operation (1–4) and is based on anatomy, physiology, and pathology (1,5–12).
Dry needling is acupuncture that involves puncturing and stimulating a reactive (painful) acupuncture point, more commonly known in the West as a trigger point, with an acupuncture needle to cure, mitigate, treat, or prevent disease or other conditions, especially musculoskeletal and connective tissue disorders, including musculoskeletal pain (1). The reactive (painful) acupuncture point is identiﬁed by a flinch reaction on palpation (1).
Dry needling is not new. It was first described in the first century BCE in the Yellow Emperor’s Inner Classic (黃帝內經, Huáng Dì nèi jīng), the foundational text of Chinese medicine (1).
2. Dry needling is unsafe when performed by unqualified practitioners of acupuncture, such as physical therapists.
As exposed by the National Center for Acupuncture Safety and Integrity’s (NCASI) Dry Needling Adverse Event Tracking System map, dry needling is unsafe when performed by unqualified practitioners of acupuncture, such as physical therapists.
Dry Needling Adverse Event Tracking System Map
To view some of the serious adverse events from dry needling performed by unqualified practitioners of acupuncture, such as physical therapists, click on the red-colored states in the map below. This map was last updated on June 15, 2017.
To report serious adverse events from dry needling performed by unqualified practitioners of acupuncture, such as physical therapists, use NCASI’s Dry Needling Adverse Event Reporting System form.
3. It is a violation of Federal law when unqualified practitioners of acupuncture, such as physical therapists, purchase, possess, or use an acupuncture needle (13).
An acupuncture needle is a restricted medical device under section 520(e) of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) (21 U.S.C. § 360j(e)) (14).
The sale, distribution, and use of an acupuncture needle are restricted “to prescription use” (15). In addition, the sale, distribution, and use of an acupuncture needle are further restricted “to qualified practitioners of acupuncture as determined by the States” (16). The U.S. Food and Drug Administration (FDA) has determined that these restrictions on sale, distribution, and use are necessary “to provide reasonable assurance of the safety and effectiveness of” an acupuncture needle (15).
4. It is a violation of Federal law when unqualified practitioners of acupuncture, such as physical therapists, reinsert a used acupuncture needle into a patient (17).
This practice can transmit bacterial, fungal, and viral infections.
An acupuncture needle is intended “for single use only” (i.e., for one insertion only) (15) and must be discarded immediately after use (18).
5. It is a violation of Federal law when unqualified practitioners of acupuncture, such as physical therapists, submit a claim for payment to Medicare for dry needling disguised, for example, as electrical stimulation (Current Procedural Terminology [CPT] code 97032), therapeutic exercises (CPT code 97110), neuromuscular reeducation (CPT code 97112), or manual therapy (CPT code 97140) (19).
Dry needling is acupuncture (1); Medicare does not cover acupuncture (20).
To report Medicare fraud related to dry needling, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may be eligible for a reward of up to $1,000.
Yellow Emperor’s inner classic (黃帝內經, Huáng Dì nèi jīng). China; compiled in the first century BCE.
The national encyclopaedia: a dictionary of universal knowledge. Library ed. London: William Mackenzie; 1876.
Davidson T. Chambers’s twentieth century dictionary of the English language: pronouncing, explanatory, etymological, with compound phrases, technical terms in use in the arts and sciences, colloquialisms, full appendices, and copiously illustrated. London: W. and R. Chambers; 1903.
Ban B, Ban G, Ban Z. Book of Han (漢書, Hàn shū). China; 111.
Zhu J. Drawings of Ou Xi Fan’s five viscera (歐希范五臟圖, Ōu Xī Fàn wǔ zàng tú). China; 1041–1048.
Yang J. Drawings for preserving the truth (存真圖, Cún zhēn tú). China; 1102–1106.
Kendall DE. Dao of Chinese medicine: understanding an ancient healing art. 1st ed. New York (NY): Oxford University Press; 2002.
Wang JY. Robertson JD, translator, editor. On the nature of channels. Lantern. 2010;7(3):4–14.
Schnorrenberger CC. Anatomical roots of acupuncture and Chinese medicine. Schweiz Z Ganzheitsmed. 2013;25(2):110–118.
Neal E. Introduction to Neijing classical acupuncture Part II: clinical theory. J Chin Med. 2013;(102):20–33.
Shaw V, McLennan AK. Was acupuncture developed by Han Dynasty Chinese anatomists? Anat Rec. 2016;299(5):643–659.
Centers for Medicare and Medicaid Services. Your Medicare benefits. Washington (DC): U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services; Revised 2017 Jan.