Acupuncture and Dry Needling
What’s the Difference?
Many patients have asked their provider this exact question. In response, we have developed a brief summary of the two treatments. Further information is available at the sources below, or through your trusted provider.
The earliest written documentation of acupuncture places its beginnings over 2000 years ago in China (1). Traditional or Classical Acupuncture (TA) is based on the stimulation of specific points on the body in order to restore balance. However, modern acupuncturists are trained in both classical theory as well as biomedical science and anatomy (2).
While commonly thought to be developed by Drs. Travell and Simon in the 1940s, modern dry needling was actually first performed using solid acupuncture needles by Karel Lewit in 1979 (2, 3, 5). Early in the 20 th century, one treatment for myofascial pain was an injection of local anesthetic or saline using a hypodermic needle. Researchers later found that inserting an empty (or “dry”) hypodermic needle into certain areas on the body was equally as effective for pain relief, hence the term “dry needling” (4). Modern dry needling uses the same solid filiform needles as acupuncture (7).
How It Works:
There are various proposed therapeutic mechanisms behind the effects of acupuncture. These include the gate control theory, increasing levels of endogenous opioids, increasing levels of adenosine, stimulating muscle relaxation, and modulating parasympathetic activity, among others (2,6). The wide variety of effects acupuncture has on the body help explain why studies have found it to be effective for over 117 conditions (6).
Dry needling is most frequently utilized to release myofascial trigger points, which are “hyperirritable spots in skeletal muscle that are associated with… taut bands” (5). Trigger points can cause muscle tension, fatigue, pain, and inflammation (5). The majority of dry needling studies available on PubMed support its use for musculoskeletal pain (2).
Owing to the wide variety of styles of acupuncture, there are many different potential methods a practitioner may utilize. One of the more common styles in the US is Traditional Acupuncture. In this system, a provider may check a patient’s tongue and pulse along with performing a detailed intake of symptoms. Needles will then be placed on various places throughout the body to restore balance to the myofascial, endocrine, cardiovascular, neurological, and meridian systems (6,8). Needles are typically retained for anywhere from 15-30 minutes. In another common style of acupuncture known as trigger point acupuncture, a needle is inserted into an active trigger point and thrust repeatedly in a method known as “sparrow pecking technique” (9). This is continued until a twitch response is achieved in the muscle, then the needle is often withdrawn. This may be followed with gua sha, or scraping, to further relax the muscle.
Zhou, Ma, and Brogan describe dry needling as follows: “needles are inserted deep into the tissues directly toward the trigger points in order to reach them. ‘Sparrow pecking’, whereby solid filiform needles are manipulated in and out of each trigger point to elicit a local twitch response, is commonly used with treatment regimens typically consisting of a course of three or more treatments, given once a week…
Dry Needling practice by PTs is typically ‘fast-in and fast-out’, often described as ‘pistoning’, and does not usually involve needle retention” (2).
The entry level degree for acupuncturists in the United States is a master’s degree or equivalent. Some practitioners may opt to continue their education and earn their doctorate. In fact, many programs are transitioning to an entry-level doctorate, meaning future acupuncturists who enter school will graduate with both their master’s and doctoral degrees. Acupuncturists must also pass three to four national board exams. In addition, licensed acupuncturists in the state of Kentucky must complete continuing education in order to maintain their license.
Per ASACU, “There are no objectively determined standards of education, curriculum, standardized national examination, or requisite knowledge, skills, and abilities (KSAs) in place for dry needling. There are no standards for clinical mentorship. In short, there is no current definition of the practice referred to as dry needling and no standardized system of demonstrating either minimal competency or safety.” Practitioners frequently begin practicing dry needling with as few as 12-27 hours of training (7).
American Medical Association Position:
In June 2016, the AMA released the following statement
The AMA adopted a policy that said physical therapists and other non-physicians practicing dry needling should – at a minimum – have standards that are similar to the ones for training, certification and continuing education that exist for acupuncture.
"Lax regulation and nonexistent standards surround this invasive practice. For patients' safety, practitioners should meet standards required for licensed acupuncturists and physicians" AMA Board Member Russell W. H. Kridel, M.D. (10)
American Medical Association CPT Code Position:
CPT codes are the numbered codes a medical provider uses to bill insurance companies. There are thousands of CPT codes, each indicating a different procedure.
In the last several years, both physical therapists and chiropractors have lobbied for a new CPT code to cover dry needling. Acupuncturists also submitted an application for a new CPT code to cover trigger point acupuncture. Current acupuncture CPT codes 97810-97814 are time based and therefore not applicable to trigger point release when a needle is inserted and then quickly removed.
In October 2018, the AMA CPT committee agreed to create new codes for “needle insertion(s) without injection(s).” These same codes are to be used for both dry needling and trigger point acupuncture, as the CPT committee equates the two procedures as one and the same. In addition, it was accepted that any needling with needle retention or e-stim applied to the needle should be billed as acupuncture under current codes 97810-97814, not as dry needling. Providers such as physical therapists and
chiropractors utilizing needle retention or electrical stimulation on needles are therefore considered by the AMA to be performing acupuncture. (11)
While the debate over acupuncture and dry needling is likely to continue for some time, the vast majority of providers simply desire that their patients are able to find wellness through whatever means necessary. We hope that this article can provide and empower patients to find the treatment and practitioner most beneficial for their particular case.
1. White, A., & Ernst, E. (2004). A brief history of acupuncture. Rheumatology,
43(5), 662-663. https://doi.org/10.1093/rheumatology/keg005
2. Zhou, K., Ma, Y., & Brogan, M.S. (2015). Dry needling versus acupuncture: The
ongoing debate. Acupuncture in Medicine, 33, 485-490.
3. Lewit, K. (1979). The needle effect in the relief of myofascial pain. Pain, 6, 83-90.
Retrieved from https://www.mvclinic.es/wp-content/uploads/
4. Paulett, J.D. (1947). Low back pain. The Lancet, 250(6469), 272-276.
5. Unverzagt, C., Berglund, K., & Thomas, J.J. (2015). Dry needling for myofascial
trigger point pain: A clinical commentary. International Journal of Sports Physical
Therapy, 10(3), 402-418. Retrieved from
6. Koppelman, M.H. (n.d.). Acupuncture: An overview of scientific evidence.
Retrieved from https://www.evidencebasedacupuncture.org/
7. American Society of Acupuncturists (n.d.) The relationship between acupuncture
and dry needling- Clarifying myths and misinformation. Retrieved from
8. Li, Q.-Q., Shi, G.-X., Xu, Q., Wang, J., Liu, C.-Z., & Wang, L.-P. (2013).
Acupuncture effect and central autonomic regulation. Evidence-based
Complementary and Alternative Medicine. Retrieved from
9. Itoh, K., Asai, S., Ohyabu, H., Imai, K., & Kitakoji, H. (2012) Effects of trigger
point acupuncture treatment on temporomandibular disorders: A preliminary
randomized clinical trial. Journal of Acupuncture and Meridian Studies, 5(2), 57-
10. American Medical Association. (2016). AMA adopts new policies on final day of
annual meeting [Press release]. Retrieved from https://www.ama-assn.org/press-center/
11. American Society of Acupuncturists (2018). Report from the American Medical
Association CPT code committee meeting. Retrieved from
Dr. Jacqui Kinzig is the founder of Sustaining Health Acupuncture in Lexington and one
of the first acupuncturists in Kentucky to earn her doctorate. She enjoys treating
patients of all ages but holds a special interest in pediatrics. When not at the office, she
can be found playing outside with her husband, their two young boys, and their pug,