Targeting the Nervous System with Dry Needling: Techniques and Recommendations

As therapists, we continually enhance our understanding and application of therapeutic methods through our pursuit of effective, evidence-based interventions. Dry needling techniques are recognized for their effectiveness in relieving myofascial pain, but it can also be beneficial when applied strategically to address neurological issues. For conditions such as radiculopathy, nerve impingement (including sciatica), chronic pain due to spinal segmental sensitization (SSS), or peripheral neuropathies, such as chemotherapy-induced peripheral neuropathy (CIPN), an advanced approach focused on neural modulation can lead to significant clinical improvements. This blog, based on recent research, examines the specific neurophysiological applications of dry needling techniques, including perineural electrical dry needling (PEDN) and electroacupuncture (EA), thereby translating complex scientific principles into practical therapeutic techniques.

Comprehending Neurological Pain: The Influence of Spinal Segmental Sensitization and Peripheral Neuropathies

Neuropathic pain syndromes stem from various conditions. Lumbar radiculopathy is a common condition caused by irritation or compression of a nerve root. This can lead to radiating pain, paresthesia, and muscle weakness following a dermatomal or myotomal pattern. A thorough physical examination is necessary, often supplemented by diagnostic tools such as MRI, to assess symptom severity and identify the underlying cause.1,4

Beyond specific nerve root compression, a significant portion of chronic non-specific regional musculoskeletal pain cases are linked to Spinal Segmental Sensitization (SSS). Nakazato et al. (2021) describe SSS as a persistent regional pain syndrome characterized by peripheral and central sensitization resulting from ongoing nociceptive stimulation caused by an unstable spinal segment. It affects one or more adjacent vertebral segments and their corresponding metameres. SSS represents a type of nociplastic pain marked by altered nociception without definitive evidence of tissue injury or nerve damage. Key factors contributing to SSS include spinal segment instability, nerve root irritation, and chronic nociceptive stimulation of the central nervous system.5

Peripheral neuropathies, especially Chemotherapy-Induced Peripheral Neuropathy (CIPN), pose a unique challenge. CIPN is a common side effect of neurotoxic chemotherapy drugs, especially at higher doses, and impacts many individuals. It results from neuronal injury, ion channel changes, mitochondrial dysfunction, and neuroinflammation. Symptoms often include numbness, tingling, and burning sensations in a glove-and-stocking distribution. Granger et al. (2025) highlight the rising prevalence of CIPN and the need for effective management strategies.8

Precise diagnosis, as stressed by O’Malley (2024), is essential to enable appropriate and effective treatment.1 Accurate diagnosis is especially important when addressing radiculopathy, SSS, or specific neuropathies. Conservative treatments are usually the first line of management and typically involve patient education, manual therapy, and non-steroidal anti-inflammatory drugs. However, when these initial approaches fail, dry needling offers a valuable adjunct.6 Dry needling techniques’ ability to modulate pain at the peripheral, spinal, and central nervous system levels makes it a promising intervention for disorders involving direct nervous system involvement, such as SSS or nerve injury in peripheral neuropathies.6

Dry needling techniques interact with the neurological system through various complex mechanisms:

• Peripheral Nerve Modulation
  • Gate Control Theory: DN activates large-diameter afferent nerve fibers, which can effectively “close the gate” to pain signals transmitted by smaller nociceptive fibers in the spinal cord. This quick external action helps reduce localized discomfort.2,6
  • Localized Anti-inflammatory Effects: Conditions such as nerve root compression (e.g., in sciatica), SSS, CIPN, and cervicogenic headache often involve localized inflammation and a hypoxic-ischemic environment. DN can improve blood flow and oxygen levels around inflamed nerves, helping to decrease injury and alter levels of inflammatory mediators crucial for nerve health and function.2,6
  • Neurochemical Release: Needle insertion prompts the release of local neurochemicals that can lessen peripheral nociceptor sensitivity and improve nerve function. Perineural electrical dry needling (PEDN) in chemotherapy-induced peripheral neuropathy (CIPN) has been shown to increase the release of corticosterone, calcitonin gene-related peptide (CGRP), mesenchymal stem cells, norepinephrine, and beta-endorphins. It also promotes new blood vessel growth and nerve repair.8
• Spinal Cord Modulation
  • Reduction of Central Sensitization: Extended nerve irritation, seen in radiculopathy, sciatica, SSS, and CIPN, can cause central sensitization, making the spinal cord more sensitive to pain signals. DN helps decrease this hyperexcitability by affecting ascending and descending pain pathways. Neuroimaging studies (fMRI, PET) show that needling changes activity in the brain’s pain-processing centers, leading to cortical desensitization.3
  • Activation of the Endogenous Opioid System: DN stimulates the body’s natural pain control system by releasing endogenous opioids (such as endorphins and enkephalins) and other neurochemicals, including serotonin and norepinephrine, within the spinal cord.2,6 These chemicals directly interfere with pain signals from the affected nerve root.
  • Electrical Stimulation for Better Neural Modulation: Combining electrical stimulation with dry needling (electroacupuncture or EA) enhances its neurophysiological benefits for neuropathic pain. EA can trigger local pain relief via adenosine A1 receptors and reduce pain segmentally via the gate-control theory, involving serotonin and noradrenaline in descending pain inhibition. Perreault et al. (2021) note that many needle treatments for sciatica often overlook the underlying neuropathic pain mechanisms, underscoring the need for more research into mechanism-based approaches.10 Pilot studies by
  • Moon et al. (2020) on electroacupuncture (EA) for difficult-to-treat neuropathic pain show significant pain reduction, particularly for burning, electric-shock-like pain, and hyperalgesia, highlighting EA’s potential for managing complex neuropathic symptoms.9
• Central Nervous System (CNS) Integration:
  • HPA Axis and Neuroimmune Interaction:** DN affects both the neuroimmune system and the Hypothalamic-Pituitary-Adrenal (HPA) axis, potentially triggering a systemic anti-inflammatory response through hormones like glucocorticoids and cytokines. This can help reduce nerve-related inflammation in conditions such as radiculopathy, SSS, and CIPN.3
  • Cortical Desensitization: Neuroimaging research by Cho et al. (2006) shows that acupuncture-like stimulation, which shares features with dry needling (DN), decreases activity in pain-related cortical regions including the anterior cingulate cortex (ACC) and thalamus. This indicates a widespread CNS-mediated pain relief, going beyond immediate localized effects, and significantly altering how the brain processes and perceives pain, which is especially important in SSS and chronic neuropathic pain.3

Employing dry needling techniques for neurological issues, particularly those resulting from SSS, peripheral neuropathies (such as CIPN or sciatica), or conditions like cervicogenic headache, requires meticulous attention, concentration, and diligence.

• Precise Diagnostic Foundation: An exceptionally accurate diagnosis is vital.1 O’Malley (2024) emphasizes the importance of understanding the specific nerve root or peripheral nerve involved, whether there is compression, and the exact pain distribution (dermatomal/myotomal patterns), as further detailed by Berry et al. (2019) and Nakazato et al. (2021) in the context of radiculopathy and SSS, respectively.4,5 The diagnostic criteria for SSS include persistent regional pain with metameric distribution, signs of peripheral and central sensitization, and an assessment of spinal segment instability, nerve root irritation, and peripheral nociceptive foci. Imaging studies (MRI) and electrodiagnostic tests (EMG, NCV) offer critical information for precise targeting.
• Perineural Electrical Dry Needling (PEDN) for Targeted Nerve Modulation: This innovative treatment specifically targets nerves or nearby tissues, altering their electrical activity and reducing irritation
  • Cervicogenic Headache (CH): Dunning et al. (2021) found that combining spinal manipulation with perineural electrical dry needling techniques significantly improved headache severity, frequency, and disability in CH patients, compared to spinal mobilization and exercise alone.⁷ The standard protocol involved perineural electrical dry needling targeting areas such as the occipito-cervical region, greater and lesser occipital nerves of the upper cervical spine, posterior occipital myofascial tissues, and the supraorbital and ophthalmic branches of the trigeminal nerve.⁷
  • Chemotherapy-Induced Peripheral Neuropathy (CIPN): Granger et al. (2025) reported a significant case series showing that combining PEDN with neural mobilization led to notable improvements in chronic lower-extremity neuropathic pain and function in CIPN patients.8 This highlights PEDN’s ability to reduce neural sensitivity, improve intraneural blood flow, and promote neuronal regeneration in conditions that directly affect peripheral nerves. The technique involved electrical stimulation targeting nerves, such as the tibial, sural, and plantar nerves, in affected limbs.
• Segmental Targeting for SSS: For conditions like SSS, consider needling muscles that are segmentally connected to the affected nerve root(s) and metameres. This includes paraspinal muscles near the level of spinal segment instability and root pathology, as well as muscles within the affected myotome or dermatome that may contribute to nerve compression or spasms. The goal is to inhibit continuous transmission of pain signals to the spinal cord.5
• Addressing Localized Inflammation and Edema: In nerve impingement or SSS cases, localized inflammation and microcirculatory changes can worsen symptoms. Dry Needling techniques that enhance local blood flow and decrease inflammatory mediators (as described by De Greef et al., 2025) can reduce nerve root pain and the inflammatory aspect of SSS.²
• Integration with Neuromuscular Re-education and Stabilization: Use DN alongside specific exercises to improve nerve gliding, restore segmental stability, optimize muscle activation, and enhance postural control. Dry Needling techniques help reduce pain and muscular guarding, creating an opportunity for patients to perform therapeutic exercises crucial for long-term SSS management.7-10
• Patient Education: Educate patients on how Dry Needling techniques can modify their neurological symptoms and its role within a comprehensive rehab plan. This includes explaining SSS, peripheral neuropathy, and how DN addresses these complex issues.

Dry needling techniques are an effective therapy for neurological disorders, especially those linked to nerve impingement, radiculopathy, spinal segmental sensitization, peripheral neuropathies like chemotherapy-induced peripheral neuropathy, and syndromes such as cervicogenic headache. Clinicians can significantly reduce pain, improve functionality, and promote recovery by understanding and strategically applying its complex neurophysiological principles, including peripheral nerve modulation, spinal cord integration, and central nervous system effects. The specific use of perineural electrical dry needling shows the precision and effectiveness of dry needling techniques in directly targeting neural structures for optimal results, as demonstrated in both cervicogenic headache and chemotherapy-induced peripheral neuropathy. A thorough diagnosis, based on comprehensive evaluation and, when needed, advanced diagnostic imaging, is essential for successful dry needling treatment of these complex conditions. This approach targets the root causes of neurological pain and sensitization, rather than just the symptoms. To provide advanced, science-based care, practitioners must skillfully employ these strategies to improve patient outcomes and enhance their clinical expertise. This approach aligns with the Pentamodal Method for analyzing and resolving dysfunction. For a patient handout, “Calming Your Nerves: How Dry Needling Works for Nerve Pain & Persistent Conditions” that you can use in your clinic, click here. Clinicians aspiring to excel in the treatment of neural disorders must acquire these principles through recognized, evidence-based education. To receive this industry-leading evidence-based education, visit Structure & Function Education’s® course offerings, starting with Foundations in Dry Needling for Orthopedic Rehab & Sports Performance, or visit our upcoming courses page to find an advanced course near you.

References

1. . O’Malley P. A Correct Diagnosis is of Increasing Importance. Irish Medical Journal. 2024;117(3):88.
2. 2. De Greef, Indra, Marjolein Chys, Robert D. Gerwin, Kayleigh De Meulemeester, and Barbara Cagnie. “The Neurophysiological Effects of Dry Needling: An Update of a Narrative Review.” American Journal of Physical Medicine & Rehabilitation, ahead of print, Sephttps://doi.org/10.1097/PHM.0000000000002855.
3. 3. Cho, Z. H., S. C. Hwang, E. K. Wong, et al. “Neural Substrates, Experimental Evidences and Functional Hypothesis of Acupuncture Mechanisms.” Acta Neurologica Scandinavica 113, no. 6 (2006): 370–77. https://doi.org/10.1111/j.1600-0404.2006.00600.x.
4. 4. Berry JA, Elia C, Saini HS, Miulli DE. A Review of Lumbar Radiculopathy, Diagnosis, and Treatment. Cureus. 2019;11(10):e5934. Published 2019 Oct 17. doi:10.7759/cureus.5934
5. 5. Nakazato T, Romero P, Guzzardo M. Spinal segmental sensitization as a prevalent etiology of chronic non-specific regional musculoskeletal pain: A review of its pathogenesis and diagnostic criteria. Physical Medicine and Rehabilitation Research. 2021;
6. 6: 1 6. Butts R, Dunning J, Perreault T, Mourad F, Grubb M. Peripheral and spinal mechanisms of pain and analgesia mediated by dry needling: A clinical resource guide for healthcare practitioners. International Journal of Physical Medicine and Rehabilitation. 201.
7. 7. Dunning J, Butts R, Zacharko N, et al. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. Spine J. 2021;21(2):284-295. doi:10.1016/j.spinee.2020.10.008
8. 8. Granger A, Dunning J, Young I. Perineural Electrical Dry Needling and Neural Mobilization for Chemotherapy-Induced Peripheral Neuropathy: Case Report. J Clin Med. 2025;14(7):2318. Published 2025 Mar 28. doi:10.3390/jcm14072318
9. 9. Moon JY, Lee CS, Yoo Y, Lee S, Lee SH, Lee S. Evaluation of an effectiveness and safety of the electroacupuncture in the management of intractable neuropathic pain: A prospective, open-labeled, randomized, cross-over clinical trial. Medicine (Baltimore).
10. 10. Perreault T, Fernández-de-Las-Peñas C, Cummings M, Gendron BC. Needling Interventions for Sciatica: Choosing Methods Based on Neuropathic Pain Mechanisms-A Scoping Review. J Clin Med. 2021 May 19;10(10):2189. doi: 10.3390/jcm10102189. PMID: 34069357; PMCI