Arthur Yin Fan1,2 , Jun Xu1,3, and Yong-ming Li1,3
1. American Alliance for Professional Acupuncture Safety. Greenwich, Connecticut (06878), U.S.A.;
2. American Traditional Chinese Medicine Association. Vienna, Virginia (22182), U.S.A.;
3. American Acupuncture Association of Greater New York, New York, (10016), U.S.A
The original white paper was published in Chinese Journal of Integrative Medicine: [AAPAS White Paper on Dry Needling(I-III) Fan AY, Xu J, Li YM]
1. Fan AY, Xu J, Li YM. Evidence and expert opinions: Dry needling versus acupuncture (I) : -The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med. 2017 Jan;23(1):3-9. doi: 10.1007/s11655-016-2630-y.
2. Fan AY, Xu J, Li YM. Evidence and expert opinions: Dry needling versus acupuncture (II) : -The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med. 2017 Feb;23(2):83-90. doi: 10.1007/s11655-017-2800-6
3. Fan AY, Xu J, Li YM. Evidence and expert opinions: Dry needling versus acupuncture (III) : -The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med 2017 Mar; (3):163-165. doi: 10.1007/s11655-017-2542-x.
The white paper includes in 7 topics:
1. What Is Dry Needling? [page3]
2. Who First Used Dry Needling in the West? [page5]
3. Has Dry Needling Been Used in China? [page7]
4. Does Dry Needling Use Acupuncture Points? [page9]
5. What Is New About Dry Needling Points (Trigger Points)? [page13]
6. Is Dry Needling a Manual Therapy? [page16]
7. Summary of Dry Needling [page17]
(1) Academic perspective [page17]
(2) The Problems Dry Needling caused [page18]
(3) Our Position [page20]
Summary[AAPAS White Paper on Dry Needling(I-III) Fan AY, Xu J, Li YM]
In the last twenty years, in the United States and other Western countries, dry needling (DN) became a hot and debatable topic, not only in academic but also in legal fields. This White Paper is to provide the authoritative information of DN versus acupuncture to academic scholars, healthcare professionals, administrators, lawmakers, and the general public through providing the authoritative evidence and experts’ opinions regarding critical issues of DN versus acupuncture, and then reach consensus.
We conclude that DN is the use of dry needles alone, either solid filiform acupuncture needles or hollowcore hypodermic needles, to insert into the body for the treatment of muscle pain and related myofascial pain syndrome. DN is sometimes also known as intramuscular stimulation, TrP acupuncture, TrP DN, myofascial TrP DN, or biomedical acupuncture. In Western countries, DN is an over-simplified acupuncture using biomedical language in treating myofascial pain, a contemporary development of a
portion of Ashi point (Ah-yes point, or tender point) acupuncture from traditional Chinese acupuncture. As developed by Travell & Simons, C. Chan Gunn and Peter Baldry, et al, it seeks to redefine Acupuncture by re-translating reframing its theoretical principles in a Western manner. It reflects the effort of de-acupoint, and de-theory of Chinese medicine by some healthcare professionals and researchers. DN with filiform needles have been widely used in Chinese acupuncture practice over the past 2,000 years, and with hypodermic needles as Dr. Travell described has been used in China in acupuncture practice for at least 72 years. In Eastern countries, such as China, since 1800s or earlier, DN is a common name of acupuncture among acupuncturists and the general public, which has been used 2000 years, and its indications, is not limited to treating and preventing musculoskeletal disorders or illness including so called the myofascial pain.
Medical doctors Travell, Gunn, Baldry and others who have promoted dry needling by simply rebranding:
(1) acupuncture as dry needling and (2) acupuncture points as trigger points (dry needling points). Dry needling simply using English biomedical terms (especially using “fascia” hypothesis) in replace of their equivalent Chinese medical terms. Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy (a surgical procedure) instead of
manual therapy. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture’s local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients’ safety, dry needling practitioners
should meet standards required for licensed acupuncturists and physicians.
DN is not merely a technique but a medical therapy and a form of acupuncture practice. As a form of acupuncture, an invasive practice, it is not in the practice scope of physical therapists (PTs). DN has been “developed” simply by replacing terms and promoted by acupuncturists, medical doctors, and researchers, and it was not initiated by PTs. In order to promote DN theory and business, some commercial DN educators have recruited a large amount of non-acupuncturists, including in PTs, as students and
customers in recent years. The national organizations of PT profession, such as APTA and FSBPT, started to support the practice of DN by PTs around 2010. Currently, there are probably more PTs involving DN practice and teaching than any other specialties. In most states, licensed acupuncturists are required to attain an average of 3,000 educational hours via an accredited school or program before they apply for a license. The physician or medical acupuncturists are required to get a minimum of an
additional 300 educational hours in a board -approved acupuncture training institution and have 500 cases of clinical acupuncture treatments in order to get certified in medical acupuncture. However, a typical DN course run only 20-30 hours, and the participants may receive “DN certificate” without any examination. For patients’ safety and professional integrity, we strongly suggest that all DN practitioners and educators
should have met the basic standards required for licensed acupuncturists or physicians.
KEYWORDS dry needling, acupuncture, biomedical acupuncture, authoritative evidence, experts’ opinions, consensus
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AAPAS White Paper on Dry Needling(I-III) Fan AY, Xu J, Li YM
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