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PubMed This is a summary of 20 peer-reviewed journal articles Updated

Dry Needling and Injections: What to Expect

At a Glance

Dry needling and trigger point injections may temporarily reduce pain and muscle tension in myofascial pain syndrome. Expect a deep, bruised ache for 24–72 hours, use the relief to support rehabilitation, and seek emergency care for shortness of breath or chest pain after chest-area treatment.

For many patients with Myofascial Pain Syndrome (MPS), procedures like dry needling or trigger point injections are used to help manage pain [1]. It is important to view these treatments as a temporary “window of opportunity” rather than a permanent cure [2]. While they can reduce pain and muscle tension in the short term, the taut bands often return if the procedure isn’t followed by active rehabilitation and corrective exercise [3][4].

Dry Needling vs. Trigger Point Injections

There are two main ways clinicians use needles to treat trigger points. Both techniques are proposed to physically disrupt the trigger point, but they differ in what—if anything—is put into the body [5].

  • Dry Needling: A thin, solid filament needle (like an acupuncture needle) is inserted directly into the trigger point [6]. No medication is used. The goal is often to elicit a local twitch response, an involuntary contraction that may help the muscle relax [7].
  • Trigger Point Injections (TPI): A hollow needle is used to deliver a liquid into the trigger point [5].
    • Local Anesthetics (e.g., Lidocaine): These are the most common injectates. They provide immediate, short-term numbing [5]. While they may offer a slightly better pain reduction in the first few days compared to dry needling, studies suggest this advantage often disappears after a week or two [1][5].
    • Saline (Salt Water): Some studies suggest that injecting simple sterile saline can be just as effective as using anesthetic medications after the first 24 hours [5][8].
    • Botox (Botulinum Toxin): Although popular, Botox has not been consistently proven to be better than local anesthetics or saline for most myofascial pain [9][10]. Its use for myofascial pain is often off-label, and practice varies; it can also carry medication-specific risks like temporary muscle weakness [11][12].

What to Expect: Post-Needling Soreness

The most common side effect of any needling procedure is post-needling soreness [13]. This feels like a deep, “bruised” ache in the muscle that was treated.

  • Duration: This soreness typically lasts 24 to 72 hours [14][13].
  • Intensity: You may feel more sore if the clinician made many “passes” with the needle or if you had many local twitch responses [7][14].
  • Management: Gentle stretching and heat are often recommended, but specific post-procedure advice should come from your treating clinician [2].

Safety and Serious Risks

While generally safe when performed by a trained professional, needling procedures carry specific risks that you should discuss with your provider, including your history of anticoagulants, bleeding disorders, or immunosuppression:

Risk Description Warning Signs
Pneumothorax A “collapsed lung” caused by a needle accidentally piercing the lung lining. This is a rare but serious risk when treating the neck, chest, or upper back [15][16]. Symptoms such as sudden shortness of breath, chest pain, or a dry cough can be delayed and require immediate emergency evaluation [16].
Nerve Injury If a needle strikes a nerve, it can cause temporary or, very rarely, long-term damage [17]. An “electric shock” sensation, sudden weakness, or new numbness [17].
Infection/Bleeding As with any skin puncture, there is a small risk of infection or local bruising (hematoma) [17][18]. Contact your clinician if you develop increasing redness, warmth, swelling, drainage, or fever.

To improve safety, some clinicians use ultrasound guidance [19]. While this can improve visualization in selected procedures, it does not universally eliminate the risks of pneumothorax, nerve injury, or bleeding, and adequate clinician training remains essential [19][20].

Common questions in this guide

What is the difference between dry needling and a trigger point injection?
Dry needling uses a thin, solid needle without medication. A trigger point injection uses a hollow needle to place a liquid such as lidocaine or saline into the painful muscle spot. Both approaches aim to disrupt the trigger point and reduce pain or muscle tension.
What kind of soreness is normal after dry needling or an injection?
Post-procedure soreness usually feels like a deep, bruised ache in the treated muscle and lasts about 24 to 72 hours. It can be stronger after multiple needle passes or several muscle twitches. Follow your clinician’s instructions; gentle stretching or heat may be recommended.
Will dry needling or an injection permanently fix my myofascial pain?
These procedures often provide short-term relief rather than a permanent cure. Pain and tight muscle bands may return if treatment is not followed by active rehabilitation, physical therapy, and corrective exercise. Your clinician can help use the period of relief to support movement and exercise.
Is lidocaine, saline, or Botox best for a trigger point injection?
Local anesthetics such as lidocaine may numb the area quickly, but their early advantage over dry needling often fades after a week or two. Sterile saline may work similarly after the first day, while Botox has not been consistently shown to work better and may cause temporary muscle weakness. The choice should be based on your clinician’s reasoning and your individual risks.
What serious symptoms should I watch for after needling near my chest or upper back?
Sudden shortness of breath, chest pain, or a new dry cough can signal a rare collapsed lung and require immediate emergency evaluation, even if symptoms are delayed. New numbness, sudden weakness, or an electric-shock sensation may indicate nerve irritation or injury and should be reported promptly. Increasing redness, warmth, swelling, drainage, or fever may indicate infection.
Should I tell my clinician about blood thinners before a needling procedure?
Yes. Tell your clinician about blood thinners, a bleeding disorder, or a weakened immune system before the procedure because these factors can affect safety. Your clinician can advise what precautions are appropriate.
Does ultrasound guidance make needling completely safe?
Ultrasound can help the clinician see nearby structures during selected procedures, especially near the neck, chest, or ribs. It does not eliminate the risks of a collapsed lung, nerve injury, or bleeding, so appropriate training and careful technique remain important.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Will you be using ultrasound guidance for this procedure, especially if you are working near my neck or rib cage?
  2. 2.If we are using an injection, why do you recommend a specific substance (like lidocaine or saline) over dry needling?
  3. 3.What is the plan for my physical therapy immediately following this procedure to ensure the benefits last?
  4. 4.How many 'passes' with the needle do you typically perform, and can we minimize them to reduce post-procedure soreness?
  5. 5.If I experience shortness of breath or chest pain after a chest-area injection, what is the specific protocol for emergency evaluation?

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References

References (20)
  1. 1

    Local Anesthetic Injections for the Short-Term Treatment of Head and Neck Myofascial Pain Syndrome: A Systematic Review with Meta-Analysis.

    Nouged E, Dajani J, Ku B, et al.

    Journal of oral & facial pain and headache 2019; (33(2)):183–198 doi:10.11607/ofph.2277.

    PMID: 30893405
  2. 2

    Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial.

    Cerezo-Téllez E, Torres-Lacomba M, Fuentes-Gallardo I, et al.

    Pain 2016; (157(9)):1905-1917 doi:10.1097/j.pain.0000000000000591.

    PMID: 27537209
  3. 3

    Pathophysiology and Management of Abdominal Myofascial Pain Syndrome (AMPS): A Three-Year Prospective Audit of a Management Pathway in 120 Patients.

    Niraj G

    Pain medicine (Malden, Mass.) 2018; (19(11)):2256-2266 doi:10.1093/pm/pnx343.

    PMID: 29444277
  4. 4

    Localized myofascial pain responds better than referring myofascial pain to botulinum toxin injections.

    Abboud WA, Hassin-Baer S, Joachim M, et al.

    International journal of oral and maxillofacial surgery 2017; (46(11)):1417-1423 doi:10.1016/j.ijom.2017.04.020.

    PMID: 28521968
  5. 5

    Comparison of the Effects of Physiologic Saline Interfascial and Lidocaine Trigger Point Injections in Treatment of Myofascial Pain Syndrome: A Double-Blind Randomized Controlled Trial.

    Tantanatip A, Patisumpitawong W, Lee S

    Archives of rehabilitation research and clinical translation 2021; (3(2)):100119 doi:10.1016/j.arrct.2021.100119.

    PMID: 34179755
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    Correlations between the Frankfort Plane and the Presence of Myofascial Trigger Points in Posterior Cervical Musculature: An Exploratory Study.

    Sánchez-Guilabert D, Martínez-Carrasco Á

    Journal of clinical medicine 2024; (13(12)) doi:10.3390/jcm13123614.

    PMID: 38930143
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    The local twitch response during trigger point dry needling: Is it necessary for successful outcomes?

    Perreault T, Dunning J, Butts R

    Journal of bodywork and movement therapies 2017; (21(4)):940-947 doi:10.1016/j.jbmt.2017.03.008.

    PMID: 29037652
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    Normal Saline Trigger Point Injections vs Conventional Active Drug Mix for Myofascial Pain Syndromes.

    Roldan CJ, Osuagwu U, Cardenas-Turanzas M, Huh BK

    The American journal of emergency medicine 2020; (38(2)):311-316 doi:10.1016/j.ajem.2019.158410.

    PMID: 31477359
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    Intramuscular injections of botulinum toxin for the treatment of upper back myofascial pain syndrome: A systematic review of randomized controlled trials.

    Leonardi G, Alito A, Portaro S, et al.

    European journal of pain (London, England) 2024; (28(3)):369-381 doi:10.1002/ejp.2198.

    PMID: 37950343
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    Effect of Local Anesthetic Versus Botulinum Toxin-A Injections for Myofascial Pain Disorders: A Systematic Review and Meta-Analysis.

    Ahmed S, Subramaniam S, Sidhu K, et al.

    The Clinical journal of pain 2019; (35(4)):353-367 doi:10.1097/AJP.0000000000000681.

    PMID: 30589660
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    Trigger point injection therapies for chronic myofascial neck and back pain: A systematic review.

    Debrosse M, Shergill S, Shah A, et al.

    Interventional pain medicine 2022; (1(3)):100076 doi:10.1016/j.inpm.2022.100076.

    PMID: 39238525
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    Comparison of the Efficacy of Botulinum Toxin, Local Anesthesia, and Platelet-Rich Plasma Injections in Patients With Myofascial Trigger Points in the Masseter Muscle.

    Yilmaz O, Sivrikaya EC, Taskesen F, et al.

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2021; (79(1)):88.e1-88.e9 doi:10.1016/j.joms.2020.09.013.

    PMID: 33045182
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    Post-needling soreness after myofascial trigger point dry needling: Current status and future research.

    Martín-Pintado-Zugasti A, Mayoral Del Moral O, Gerwin RD, Fernández-Carnero J

    Journal of bodywork and movement therapies 2018; (22(4)):941-946 doi:10.1016/j.jbmt.2018.01.003.

    PMID: 30368339
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    Postneedling Soreness and Tenderness After Different Dosages of Dry Needling of an Active Myofascial Trigger Point in Patients With Neck Pain: A Randomized Controlled Trial.

    Martín-Pintado-Zugasti A, Fernández-Carnero J, León-Hernández JV, et al.

    PM & R : the journal of injury, function, and rehabilitation 2018; (10(12)):1311-1320 doi:10.1016/j.pmrj.2018.05.015.

    PMID: 29857165
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    Pneumothorax after trigger point injection: A case report and review of literature.

    Ahiskalioglu EO, Alici HA, Dostbil A, et al.

    Journal of back and musculoskeletal rehabilitation 2016; (29(4)):895-897 doi:10.3233/BMR-160666.

    PMID: 26922846
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    Unnecessary Needling: A Case of Iatrogenic Pneumothorax Following Dry Needling Procedure for Chronic Myofascial Pain.

    Arora A, Arora Y, Vasireddy S

    Cureus 2024; (16(12)):e76055 doi:10.7759/cureus.76055.

    PMID: 39834995
  17. 17

    Spinal cord injury by direct damage during trigger point injection: a case report.

    Kim JB, Chang MC

    The Journal of international medical research 2021; (49(5)):3000605211012367 doi:10.1177/03000605211012367.

    PMID: 33942634
  18. 18

    Immediate Effects of Dry Needling in Patients with Myofascial Temporomandibular Disorders: A Randomized Controlled Trial.

    Durmaz N, Gözler S, Demircioğlu G, Burma K

    Healthcare (Basel, Switzerland) 2026; (14(14)) doi:10.3390/healthcare14142189.

    PMID: 42512705
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    Ultrasound-guided interventional procedures for myofascial trigger points: a systematic review.

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    Regional anesthesia and pain medicine 2021; (46(1)):73-80 doi:10.1136/rapm-2020-101898.

    PMID: 33159004
  20. 20

    Trigger Point Injection as a Rare Cause of Ischemic Stroke: A Case Report.

    Tanoğlu C, Duman İlki C, Ersoy A, Yaşar H

    The neurologist 2022; (27(4)):203-205 doi:10.1097/NRL.0000000000000373.

    PMID: 34855672

This page is for informational purposes only and does not constitute medical advice. Ask your treating clinician whether dry needling or a trigger point injection is appropriate for you, and seek emergency care for concerning symptoms after a chest-area procedure.

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