The consistency of reporting adverse events associated with dry needling: a narrative review

Dry needling interventions are associated with disabling and potentially life-threatening events. Presently, undesired treatment effects are not reported consistently across the literature and as such, the degree of risk to and impact on patients cannot be clearly articulated. To systematically summarise available literature and capture trends in the reporting of undesired treatment effects occurring during and after dry needling, we searched Scopus, PubMed, Cochrane, CINAHL, Sports Medicine and Education Index and Web of Science. In total, 130 adverse events were reported synthesized into 31 general categories. Synthesis and risk categorisation identified "pneumothorax (bilateral)" as the only potentially life-threatening adverse event, while "acute spinal epidural haematoma, "dysautonomia", "nerve injury", "pneumothorax" and "pneumothorax (self-limiting)" were reported as severe. Adverse events resulting in more than mild, transient symptoms during or after dry needling are rare. However, the occurrence of pneumothorax and peripheral nerve injury remain of greatest concern as they are, at least in part, ascribable to clinician error.