I had a physical therapist stop by my office last week and try and sell me on dry needling. I said heard all about dry needling and that I thought that like the force, it can have a strong influence on the weak minded. I said I thought dry needling sounded a lot like acupuncture and said I agreed with Colquhoun and Novella’s position that acupuncture is theatrical placebo.
She said dry needling was better because it had Western rather than Eastern justifications. I said the Western justifications I had heard thus far were different, but to me, no more convincing. She said lots of physical therapists do it, and I said critical thinking isn’t most therapists strong suit. She said she had a lot of great testimonials, I said so do I and I don’t have to stab my patients. That was the gist of the conversation, but before she left I printed off a copy of Colquhoun and Novella’s paper to take with her.
So anyway that got me thinking I ought to do some more investigating of this whole dry needling thing to see if I’m missing out on anything, and this was the first newer paper I found, which was fascinating and almost comedic with full text AND VIDEO available.
Pneumothorax complication of deep dry needling demonstration [FREE FULL TEXT]
The paper was considerably more juicy than I anticipated. I expected it to be a complication of some inexperienced dry needling practitioner performing a risky technique, or a patient rolling over their needle. However, what it was was one doctor performing a demonstration on another doctor, while teaching ‘safe’ and ‘correct’ technique. Right after the instructor “emphasized the danger of pneumothorax” and explained, at length, how to perform the movement safely to avoid such he then pushed the needle 4 centimeters into the man’s chest cavity. As promised HERE’S THE VIDEO.
All’s well that ends well, the victim later complained of chest pain and had difficulty breathing and a chest x-ray confirmed the pneumothorax with his left lung collapsed 20%. He was treated conservatively, after 2 weeks breathlessness lessened, and at 6-8 weeks he was back to normal. That’s more than you can say for another patient for which another dry needling mishap resulted in a epidural hematoma and emergency spine surgery. The authors later went on to emphasis safety techniques when performing dry needling over the thorax. Strangely abstinence of dry needling, particularly over the rib cage, was not one of their ideas. I would imagine Traditional Chinese Medicine practitioners might say acupuncture is better but they have similar horror stories, almost as if dry needling and acupuncture were in effect the same thing.
Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember Spinal Flow Yoga for you or someone you know in the future.
Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed Yoga Teacher Training at Sampoorna Yoga in Goa, India.
8 thoughts on “Dry Needling Collapses Lung, on Video”
You wrote: ” I would imagine Traditional Chinese Medicine practitioners might say acupuncture is better but they have similar horror stories, almost as if dry needling and acupuncture were in effect the same thing.”
The linked article states: “When a massage therapist tried to treat the headaches she suffered after a 2006 car crash with acupuncture…”
A massage therapist is not an acupuncturist.
That’s a good point but it sounds like pneumothorax with acupuncture in general isn’t all that uncommon.
This article (in Chinese) talks of 38 cases by itself. And then you have to ask yourself, or at least I would ask myself, what’s being cured?
I am a licensed acupuncturist and it is my opinion that dry needling or “acupuncture” performed by PTs, massage therapists, Chiropractors or MDs with a few hundred hours of training carries an increased risk of pneumorthorax and other adverse events, but this risk is still quite low if they were well trained. The problem is that they don’t have as much experience. If you are going in for surgery would you prefer the surgeon with 10 years of experience who has performed your procedure thousands of times, or the resident who watched it a few times and performed it twice before? IMO there is a similar gap in experience between a licensed acupuncturist and someone who just completed a weekend dry needling course.
In any case the research literature shows that pneumothorax is an extremely rare complication of acupuncture. A prospective observational study conducted in German and published in Complimentary Medicine Research in 2009 included a total of 229,230 patients who received an average of 10.2 ± 3 acupuncture treatments (that’s somewhere between 2 and 3 million acupuncture treatments) and only two patients experienced a pneumothorax (one needed hospital treatment, the other observation only). https://www.karger.com/Article/Abstract/209315
Another systematic review published in the British Medical Journal published in 2004 found 6 pneumothorax cases out of 109,152 patients who received 1,107,270 acupuncture treatments. They concluded “According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10,000 treatments, and 0.55 per 10,000 individual patients. The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.” http://aim.bmj.com/content/22/3/122.short
As I understand this data it means that 1 patient has a reportable adverse event for every 20,000 acupuncture patients and the most common adverse effect is a bruise. This is an extremely low rate. Just for the sake of comparison a 1996 study of nonsteroidal anti-inflammatory drugs (NSAIDs) that followed 1921 patients reported that approximately 15% of them reported an adverse GI related side effect over a 2.5 year observation period. So that means that 3,000 patients out of every 20,000 suffer side effects. 42 of the 1921 patients required hospitalization, about 2%, indicating a rate of 400 per 20,000 patients taking NSAIDs. I would argue that acupuncture is much safer than taking NSAIDs, let alone opioid painkillers.
Finally I want to briefly address the claim that acupuncture is “theatrical placebo”. Since Colquhoun and Novella’s article was published in 2013, more recent systematic reviews such as Vickers et al’s 2012 (updated in 2017) “Acupuncture for Chronic Pain”: https://www.ncbi.nlm.nih.gov/pubmed/29198932 found that “acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time.” Vickers found that acupuncture outperformed “placebo” and no treatment. Finding a true placebo for acupuncture trials has been a challenge for researchers. In my opinion “placebo acupuncture” is not an inert treatment, and therefore is not a true placebo. If it is performed at an acupuncture point is stimulates the point, even if it is a toothpick. There is mounting evidence that acupuncture is effective for a pain and wide range of other conditions (see https://www.acupuncture.org.au/resources/publications/the-acupuncture-evidence-project-a-comparative-literature-review-2017/ and https://www.evidencebasedacupuncture.org/present-research/pain-2/).
I hope that my comments are interesting for you to read. Best wishes to you, I think you have a great website, keep up the good work!
I don’t like physical therapists doing dry needling either, though I suppose for different reasons. Physical therapists, as a profession, talk a lot about providing “evidence based medicine” and here we are providing dry needling. I suppose it depends on what you define as evidence but if you ask me, acupuncture is a placebo treatment with a bogus Eastern rationale. Dry needling is much the same except with a bogus Western rationale. Safety wise I suppose I would rather have a treatment delivered by someone with more experience, as you say, but it reminds me of a Nietzsche quote where talks about men fishing in a pond without fish, thinking themselves profound and for that he would not even call them superficial. So with either, I think if you are doing a treatment that doesn’t have any “real” effects, what does it matter? Though I suppose I would rather my placebo administrator be skilled enough to not puncture my lung. I should acknowledge that I’m aware there is evidence that placebo treatments do result in a real endorphin release, so in that way you could say they are all “real” if you count that.
As for risks of pneumothorax, I’m sure they are low and I expect a fair number go unreported. I would also expect the risk to be zero if you are needling body parts other than the thorax, for example the knee or ankle, which it does not sound like your paper takes into account. I don’t have access to anything other than the abstract so if I’m wrong and you have a full PDF you can email me, I’d be happy to read it.
Much the same with your reviews on effectiveness. If you think my reading the full paper would sway my opinion please email me a PDF, otherwise those summary abstracts don’t move my opinion. Acupuncture being very “theatrical” of placebo should be (slightly) more effective at decreasing pain than placebo that is less theatrical. Such that if reviewers fail to take that into account they are going to show a false “benefit.” One of my favorite blogs was about the placebo effect and what makes it better or worse and it was fascinating. Like two placebo pills “work” better than one, brand name placebos work better than generic, needles better than pills… Such that in the placebo department acupuncture has a lot going for it, but in the grand scheme of things seems those effects (placebo or not) aren’t that great.I would also add that placebo isn’t the only thing reviewers need to be looking out for. Publisher’s bias, among others, is likely a huge factor as well.
A paper I read recently compared acupuncture to other treatments of low back pain and found they all decreased pain on average of 1 point out of 10, bringing pain from a 6/10 to a 5/10. I wouldn’t brag about that. Now Absolute Physical Therapy, or Spinal Flow Yoga, that’s different.
Hi Chad, I’m glad we can agree that acupuncture is a safe treatment.
Thanks for the links on placebo, its a fascinating topic and I enjoyed the Ted talk. I would love to give one of those some day! Publication bias is a big deal and I’ve read about how drug companies withhold negative study results to make their drugs look better. Its a big problem, I agree with you. In the case of acupuncture do you think publishing bias is a big issue?
Thanks for offering to read the studies I linked to. Honestly I’m not worried about changing your mind about acupuncture. You’re entitled to your opinion, but I still think its important to debate this topic with other healthcare practitioners. I want people who might stumble on your article to see the most recent evidence that shows that acupuncture is safe and effective so they can make up their own minds. So thanks for letting me post here and engaging with me.
Here are links to PDFs of the full articles I listed in my last post…
Vickers review from The Journal of Pain:
The Acupuncture Evidence Project (summary and full literature review):
The evidence you’re looking for is in the systematic review by Vickers et al. They reviewed 29 RCTs with a total of almost 18,000 patients and their work was published in The Journal of Pain (http://www.jpain.org/). Vickers et al control for publication bias and even after excluding outlying “RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain”. I doubt that drug companies exclude outlying RCTs that strongly favor their drug.
You say that acupuncture is a theatrical placebo but you linked American College of Physicians clinical guidelines published in the Annals of Internal Medicine. I’m a little confused… is acupuncture a theatrical placebo or is it a clinically effective treatment recommended by one of the most conservative American medical institutions as a first-line non pharmaceutical treatment for low back pain? When I look at table 1 (results for acute low back pain) it looks like Acupuncture was as effective as NSAIDs and outperformed Tylenol (Acetaminophen), systemic corticosteroids, Chiropractic spinal manipulation, and physical exercises, all of which had “no effect”. In table 2 you can see that acupuncture was more effective than most of the pharmacological interventions listed and was at least as effective as all of the non-pharm treatments surveyed (1-2 points out of 10). They also found that acupuncture outperformed OTC painkillers in several ways without the risk of harm associated with pharmacologic therapies. If acupuncture is a theatrical placebo does that mean that OTC painkillers are no better than placebo? Physical therapy is listed in the guidelines in several places and performs no better than acupuncture, how would you explain that?
Thanks for debating this with me and considering the evidence even though you have such a strong opinion about acupuncture. Spinal flow yoga looks pretty cool, is that one of your projects?
James, thank you for the papers. I’m reading through them now and I have a busy weekend so it may take a few days for me to respond. You ask good questions though, and I particularly want to address them in relation to acute and chronic low back pain. But I would like to ask you; how and why do you think acupuncture helps lessen low back pain?
James, not sure if you are still there or not, but I did read every one of those papers. Hit me back if you want to further discuss any one of them in particular. Overall my response is this. I don’t agree that acupuncture is safe, people do get their lungs punctured. However, things like that are rare so relative to many Western procedures (like surgery) acupuncture might be safer, but relative to the improvements you get afterwards, I think acupuncture is still placebo, while surgery might be awesome for you, or terrible, depending on your condition and surgeon.
As for your papers a few of the reviews were compiled by people who wanted to promote acupuncture and it shows in what they reviewed and what they concluded. Controlling for publication bias will still show false benefits if it does not adequately control for placebo, with active placebo treatments and double blinding being necessary to avoid residual bias resulting what seem to be “small” benefits of acupuncture with regards to pain. Much as would be expected.
Regarding the American College of Physicians paper, I have a little more to say about that here, but I plan to address on SpinalFlowYoga.com in detail soon. But in short (yet similar to how I responded to Tyson) I think acupuncture has only placebo benefits for low back pain, while anti-inflammatory medication has minimal benefits yet real side effects. Physical exercises can have considerable benefits, but it’s only a partial answer to back pain, and historically most researchers looking at exercise and back pain have used poor exercises that are either ineffective, or if effective were ‘mixed bags’ combined with pathological forces, so that if they made the muscles better they made the spine worse at the same time. If mixed bag exercises are compared with ineffective exercises one would draw the conclusion that no exercise works very well. I looked into it and the authors of that paper were experts in “writing review papers” with no expertise in the biomechanics of what causes low back pain whatsoever. In physical therapy they are still largely to this day teaching 1990s techniques at best. In short that’s how I explain it. The long answer, and what to do about it, I’m teaching on SpinaFlowYoga.com, which is VERY different from most yoga, which will often make your back worse too. However, is derived from the word “to yoke” so I’m yoking together all the principles for back pain, neck pain, heath and fitness and making it into something anyone can do inexpensively from home.
Simple question: If acupuncture is a placebo, why is it effectively being (repetitively) used in treating animals for all sorts of medical disorders?
Also, Cambridge University conducted a study that proved that acupuncture has a veritable physiological effect via the use of advanced MRI technology.
How do patients with macular degeneration see vast improvement to their sight in relatively short time (lasting improvement).
How do patients with debilitating pain only get relief through the use of acupuncture (most have tried everything else first, including Rx, pt/ot, and surgery).
The clinical trials you are wanting to see are lacking because the sources that usually fund said trials DON’T want to contribute to said trails as they see little to no potential profit in it (conflict of interest).
People can hide behind the guise of science, but science only defines what we know at this time based on repeating the exact same steps, which result in a similar outcome.
Acupuncture and herbal therapies are exactly in line with said structure, however, unlike “modern” medicine (acupuncture continues to evolve on a daily basis), acupuncture has thousands of years of documented trials that prove the effectiveness of the medicine.
The REAL problem is that the money making megaliths (pharma, insurance, etc) will never profit from this medicine like they do from their toxin riddled and dangerous practices. Also, the false advertising that has been programmed into every one of us, is the greatest detractor for reaching the truth. We have blind, ignorant faith in a broken/failing system that continues to prove itself unable and unwilling to meet the needs of the people. Education is key.
I do appreciate the fact that the language you use is not as inflammatory as many who attempt to discredit acupuncture and oriental medicine. I do think that we should follow the money as it concerns health in this country, starting with the food industry and how it all bleeds together, and not in a way to help the health of the individual but rather the health of the exec pockets.