Acupuncture by Any Other Name Does Not Smell as Sweet

When I first heard the term “dry needling,” I thought: Hmmmm, perhaps this is one of those “dumb questions” professors are always saying don’t exist, but…is there such a thing as “wet needling?” Is there some sort of “waterslide acupuncture” my school failed to inform me about, and if so then why am I not practicing it?

Waterfalls in Monteverde, Costa Rica_February 2017

A waterfall in Monteverde, Costa Rica. Taken February 2017.

Alas, approximately 0% of waterslide acupuncture sounds safe, not to mention that getting a waterslide into an acupuncture clinic (or an acupuncture clinic into a waterslide) sounds questionable at best. As it turns out, “wet needling” is a thing, and it just means that the needle involved contains some sort of medicinal substance for injection. Dry needling, on the other hand, is the insertion of a solid (as opposed to hollow) needle into the skin.1 The therapeutic effect comes from the needle itself, rather than what’s inside it.

If that sounds a lot like acupuncture, that’s because it is. Dry needling is acupuncture performed by non-acupuncturists. That is the only difference.

And what a big difference it is. If I, as a licensed acupuncturist, decided one day to start performing surgery, but I called it “organ visibility therapy” (because it makes the organs more visible, duh!), I would want you to report me to the Oregon Medical Board STAT. This is essentially what some chiropractors and physical therapists have done with acupuncture/dry needling. They claim that dry needling is different because it is based on a biomedical understanding of the musculoskeletal system rather than Chinese medicine theory, but the so-called “trigger points” they use for musculoskeletal and connective tissue disorders, including pain, have been used in Chinese medicine for over 2,000 years for precisely these purposes.1

While the Oregon Court of Appeals already ruled in 2014 that dry needling is not lawful for chiropractors to perform,2 I only just last week received an email from the Oregon Association of Acupuncture and Oriental Medicine (OAAOM) stating that the Oregon Attorney General has finally ruled dry needling to be outside the scope of practice of physical therapists, as defined in ORS 688.010.1

This is a big deal, and not just for acupuncturists. Yes, we want to protect our turf, but more importantly we want to protect our patients! The letter from the attorneys representing the OAAOM to Oregon Attorney General Ellen Rosenblum requesting her to comment on the legality of dry needling by physical therapists included copious evidence about the dangers it has posed to the public due to lack of training, from pneumothorax (puncture of the pleural cavity outside the lungs) to nerve damage.1 The former is what landed U.S. Olympic free-skier Torin Yater-Wallace in the hospital after a physical therapist performed dry needling on him prior to a competition in 2013.1

Roses_July 2016 cropped

“A rose by any other name would smell as sweet.” -Juliet Capulet, in William Shakespeare’s Romeo and Juliet. Taken July 2016.

Not too long ago I had an encounter with a patient at the community acupuncture clinic where I work that illustrates, from the patient’s perspective, the problem with claiming that dry needling is different than acupuncture. At the end of my intake with new patients, I always ask if they have any questions—a bold move considering I have 10 minutes to complete the intake in this particular setting, while Chinese medicine has had a few thousand years to develop more than a little depth and complexity.

In response, the patient said something like, “Yes, actually. Do you do dry needling? I absolutely love it when my physical therapist does that.”

Not wanting her to become disenchanted with the insertion of solid filiform needles into the skin for therapeutic benefit, aka ACUPUNCTURE, I checked my tone (after all, she was the victim in this scenario) and said as calmly and informatively as I could, “I am so glad you enjoyed it! Because dry needling is basically acupuncture–without proper training or a license to practice it.”

This patient had experienced acupuncture–albeit by someone who had no acupuncture education–and didn’t even know it! What if her experience hadn’t been positive? What if she had walked away with a pneumothorax or nerve damage? I can only guess, but I’d be willing to bet that as a result she would not have let any acupuncturist come near her with a 10-foot pole–or a one-inch needle, as the case may be.

Then there was the new patient who asked me this: “What’s the medicine inside?” Her question caught me so off-guard that I had to clarify what she even meant. “You mean, inside the needle?” She nodded. “I just want to know what you’re going to put into my body.”

I don’t know how she got the idea that acupuncture needles contain medicine–I sure hope it wasn’t because she only had “dry needling” to compare it to, leading her to assume that the “medicine inside” was what made acupuncture different–but in any case, she made an excellent point: patients have the right to know what their medical practitioners are putting into their bodies, whether it’s anesthesia or insulin or a stainless steel needle. They also have the right to know what training and certification come with it: is it a stainless steel needle and a 24-hour course on “dry needling,” or a stainless steel needle and a four-year program at an accredited institution of Chinese medicine?

The moral of the story is that if you don’t want me to take out your appendix because I have never learned how to take out anyone’s appendix (and because, rightfully so, you are skeptical of this “organ visibility therapy” I say I practice even though I am a licensed acupuncturist and not a licensed organ visibility therapist), please, please, please make sure you are experiencing acupuncture via a licensed acupuncturist and no one else. Your body and mind will be very grateful.

References

  1. Tienson TW & Foran PT, on behalf of the Oregon Association of Acupuncture and Oriental Medicine. Re: “dry needling” falls outside Oregon physical therapists’ scope of practice. U.S. mail correspondence to The Honorable Ellen Rosenblum, Oregon Attorney General. 2016.
  2. Howlett B. Dry needling is acupuncture: Anatomy of a legal victory in Oregon. Acupuncture Today. 2014;15(5). http://www.acupuncturetoday.com/mpacms/at/article.php?id=32883. Accessed May 2017.