Dry needling combined with percutaneous electrical stimulation using a needle-surface configuration for musculoskeletal pain: A systematic review.

Abstract

Objective: To systematically review the evidence on percutaneous electrical stimulation delivered via a needle-surface electrode configuration for musculoskeletal pain.

Methods: PubMed and Scopus were searched, with additional screening of Google Scholar, from January 2010 to January 2026. Eligible studies included adults with musculoskeletal pain receiving percutaneous electrical stimulation delivered via a needle-surface electrode configuration. Primary outcomes were pain intensity and pain-related disability. Risk of bias was assessed with the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation criteria. Due to heterogeneity, a narrative synthesis was used to summarise the findings.

Results: Four randomised controlled trials involving 150 participants were included. All studies examined myofascial neck pain involving upper trapezius myofascial trigger points. Pain generally improved over time in both the intervention and comparator groups. Needle-surface stimulation showed selected short-term advantages over only dry needling, but superiority was not consistent across outcomes or follow-up periods. Disability improved in some trials without clear between-group differences. Certainty of evidence for pain and disability was low.

Conclusion: Percutaneous electrical stimulation delivered via a needle-surface electrode configuration may improve pain-related outcomes in myofascial neck pain, but current evidence does not show consistent superiority over active comparators. Mechanistic and biophysical studies are needed to determine whether the needle-surface configuration produces clinically meaningful differences in current distribution, tissue recruitment and neuromodulatory effects when compared with other electrical stimulation configurations.