Podcast Summary: What's That Rash?

Episode: Difference between dry needling and acupuncture?

Host: ABC News
Date: November 4, 2025

Overview

This episode of "What's That Rash?" dives into one of the most commonly asked questions: what is the difference between dry needling and acupuncture? Hosts Dr. Norman Swan and his co-host discuss their personal experiences, the historical origins, similarities and differences in approach, existing evidence for effectiveness, and the underlying theories behind both techniques. The discussion is sparked by multiple listener questions and aims to untangle the confusion around these popular pain treatment methods.

Key Discussion Points & Insights

Personal Experiences with Needling

• Dr. Norman Swan shares his first acupuncture experience (00:43)
  • Recently tried during a rural doctors conference; tiny dot needles placed on acupuncture points.
  • Norman: "Almost instantly my knee pain got worse." (01:31)
  • Lost track of where the tiny needles ended up.
  • Points out the anecdotal nature: "You wouldn't judge acupuncture or dry needling based on my experience…" (01:45)
• Co-host recounts a dry needling experience (12:27, 13:42)
  • Describes muscle clenching and feeling startled during the session.
  • "The needle going in itself doesn't really hurt that much, but the whole muscle clenches up… it actually gave me such a fright… that I started crying." (13:17)

What is the Difference: Dry Needling vs Acupuncture?

Definitions & Traditions (02:39–05:40)

• Acupuncture:
  • Rooted in traditional Chinese medicine, uses meridians and balances yin/yang.
  • Diagnoses include pulse checks, and points are selected to ‘rebalance’ the body beyond just pain.
  • Norman: "If you're doing traditional acupuncture, you would do… traditional Chinese diagnosis, and…needle points along those meridians…to rebalance the body." (02:39)
• Dry Needling:
  • Emerged from Western medical traditions, focuses on myofascial trigger points (painful muscle knots).
  • "Needling aimed at what are called myofascial trigger points… you needle those trigger points to relieve them." (03:54)
  • Thought to disrupt pain by physically irritating the trigger point.
• Common Features:
  • Both involve inserting needles, causing overlap in appearance.
  • "I think I thought that dry needling was like the home brand version of acupuncture. But [...] their traditions…are more different than I expected." (05:40)
• Historical Callouts:
  • Acupuncture described in China 3,000 years ago, documented 2,000+ years ago, observed in Japan by Europeans in the 1600s. (05:52)
  • Sir William Osler tried acupuncture for back pain…using hat pins (with disastrous results). (07:18)

Origins of Dry Needling

(08:16)

• Likely arose from wet needling: injecting anesthetic into muscles.
• Observed that even just the needling, without injection, had effects.
• Norman: "The act of poking the muscle kind of was doing something whether or not there was anesthetic, saline or nothing in the needle." (08:32)

Overlap and Distinctions in Practice

(08:32–09:39)

• Some acupuncturists argue ashi acupuncture (needling sore spots/trigger points) is essentially the same as dry needling.
• Sham acupuncture in clinical trials often mimics dry needling (needling at non-meridian points).
• Trials show both acupuncture and dry needling provide pain relief, sometimes with acupuncture slightly ahead, but both seem effective for some.

Evidence, Effectiveness, and Theories

Clinical Trials & Effect Sizes (09:39–12:27)

• Clinical trial design is challenging; "pretend" needling is hard.
  • Use of magician-like distraction techniques to create placebo/sham procedures (10:15).
• Pain Mechanisms & Theories:
  • Gait control theory of pain once considered primary explanation ("acupuncture closes the gate to pain", now understood to be more complex and likely not the main factor).
  • Superficial dry needling does not seem much different from deep needling in effect based on limited trials.
• Efficacy:
  • Both systems show the most evidence for muscle pain or trigger point pain.
  • "It looks as though there's no difference between the massage and...needling process." (13:42)

Safety, Practicality, and Bottom Line Findings

• No strong evidence that provoking pain is necessary for benefit: "There's a growing shared belief that creating pain does little to reduce pain, especially chronic pain with massage. And that massage doesn't have to hurt to work." (15:53)
• Risk is low, and both treatments might be incorporated in broader pain management or physiotherapy plans.
• For trigger-point pain, needling (of either tradition) or massage/stretching can provide some (not huge) relief and might help support rehabilitation.
• Key limitations: Many variables in technique, intensity, and context; size of benefit can vary; research is not definitive. (17:19)

Notable Quotes & Memorable Moments

Personal Humor & Relatability

• "Whenever we're talking about your anecdotes, the N in N equals 1 stands for Norman." — Co-host (01:57)
• "You suck needles in your knee." — Co-host, ribbing Norman about worsening his pain (01:36)
• Co-host on surprise: "I don't think I expected this conversation to land so favorably… Maybe that's just disbelief on my behalf." (17:56)
• "So you just thought I was going to say bullshit, bullshit, bullshit." — Norman (18:05)
• Norman, tongue-in-cheek: "I've been transformed by these little dots on my knee and I'd love to find where those needles went." (18:10)

On the Trial Placebo Challenge

• "How do you pretend to stick a needle in someone without actually doing it?" — Co-host on the difficulty of sham-controlled trials (09:39)

On Pain and Treatment

• "Is the mechanism of treatment pain itself?...with massage you can get results without necessarily causing pain." — Norman (16:40)

Timestamps: Important Segments

• 00:43: Norman tries acupuncture, shares a new (ineffective) personal anecdote
• 02:39: Definitions and core differences between acupuncture and dry needling
• 05:40: Historical background on both methods
• 08:16: The origin of 'dry needling' as a concept
• 09:39: Placebo/sham trial difficulties in acupuncture research
• 10:53: Best evidence for use is muscle pain/trigger points
• 12:27: Co-host's dry needling story
• 13:42: Summary of evidence for different techniques and their comparative effectiveness
• 14:37: Guidelines and the importance of context (injury, other conditions)
• 17:19: Key evidence summary and lack of known harms
• 17:56: Co-host surprise at overall positive conclusion

Conclusion & Takeaways

• Both acupuncture and dry needling may relieve muscle pain, particularly when targeting myofascial trigger points.
• The lines between the two are historically and theoretically blurred; techniques overlap more than their traditions suggest.
• Evidence for benefit exists, but effects aren’t huge and results vary.
• There is no strong evidence that needling must be painful to be effective, and both massage and needling can help without causing pain.
• Use of these interventions should be as part of a broader management plan—especially in physiotherapy.

Final word: Neither technique is proven to cure underlying causes of pain (like muscle tears or disease), but used appropriately and safely, either may offer some relief as part of pain management.

To read more: References for clinical studies and additional reading can be found in show notes.

This summary maintains the conversational tone and key insights of the original episode while providing comprehensive coverage for listeners and non-listeners alike.