Art of deception needed to prove dry needling works

Dry needling INSIDE UNISA

One of UniSA’s brightest new PhD students will look to the skills of magicians to help design better research into dry needling – a western form of acupuncture.

While dry needling is increasingly popular in the physiotherapy and allied health fields, the technique lacks solid proof of effectiveness and part of the problem is that it’s hard to test because of the difficulty in creating a convincing placebo.

PhD student Felicity Braithwaite. So how can researchers fool study participants into thinking they are having needles stuck into their skin? It’s this question that Vice Chancellor and President’s Scholarship recipient Felicity Braithwaite (pictured right) is tackling in her PhD, and finding an answer will require tapping into the art of deception.

“Dry needling involves needling and palpating tight, sore spots called myofascial trigger points to bring pain relief and promote healing,” Felicity says.

“It’s not the same as acupuncture – it uses the same needles but a different philosophy, with an emphasis on responding to clinical findings.

“At the moment, dry needling hasn’t been conclusively proven beyond placebo, which is a big problem because there are lots of people using it, including many South Australian physiotherapy clinics, and there are potential ethical concerns if the technique is not proven.

“To run strong studies we need to develop a fake dry needling technique, which we call a ‘sham’, to convince study participants that they are receiving the real thing. At the moment there is no standard sham.

“It’s a bit like a placebo in a drug trial – we need the sham to be able to conduct proper blinded studies around dry needling.

“The goal of my research is to develop sham guidelines, achieve a consensus among experts on the best sham, and then test it out.”

This is where Felicity hopes famous magicians will come into the picture to contribute valuable expertise on how to fool people.

“We’re looking to approach well-known magicians who we hope can give us a unique perspective on ways to deceive people,” Felicity says.

“It might be small visual cues, like maybe leaving a toothpick in sight on a table to fool people into thinking they’re getting the sham. It might be ways to set up the room, things to say to people, their positioning, and how to perform the fake technique.

“I actually don’t know what the magicians will offer up.

“In previous shams, researchers have focused on sensation. We think the whole simulation experience is important, from when participants enter the room to when they leave.”

Adding further challenge to Felicity’s project is a need to mimic the actual sensations of dry needling.

“The needles penetrate the skin and go deep into muscle tissue. Some people don’t feel anything, whereas others feel some sensation,” she says.

“We need to mimic these sensations, ideally without producing any physiological reaction. However, sham needling involves mimicking real needle sensations like pricking and pain which could, for example, cause opioids to be released into the blood. How can we effectively fake these sensations without getting a bodily response?

“It’s very complex, which perhaps explains why previous research approaches have been inconsistent.”

Felicity completed a Bachelor of Physiotherapy with Honours last year, during which she conducted a small dry needling study. This, she says, inspired her to continue research in the area.

She is one of this year’s Vice Chancellor and President’s Scholarship recipients, an award that recognises the top seven new domestic PhD students and contributes $10,000 towards their research.

“Almost everything I hear anecdotally about dry needling is positive, but research doesn’t reflect this yet – and this could be a consequence of inconsistent sham methods out there,” she says.

“If I can develop a consensus on the best sham technique, it can be a basis for more consistent dry needling research in the future.

“I’m still planning how to use my scholarship, but it might go towards a trip to Las Vegas to meet with magicians, a trip to China for an acupuncture philosophy perspective, conferences, or perhaps an advanced dry needling course.

“I hope this will help me gain the diversity in perspectives that will assist me to become a leader in the field.

“Any magicians out there who might be interested, please feel free to contact me.”