Clinical use of percutaneous needle electrolysis in musculoskeletal injuries: A critical and systematic review of the literature

Objective: To review the current scientific evidence for the clinical use of percutaneous needle electrolysis (PNE) in musculoskeletal conditions. Methods: A systematic electronic search was performed in biomedical databases. Only clinical studies on human subjects using PNE on musculoskeletal pathologies were included. Methodological quality and risk of bias were assessed using the methodological index for non-randomized studies (MINORS). Treatment protocols were described, and primary outcomes (pain, injury-related function, and tissue structure) were compared against other treatment modalities or control groups in short (<1 month), mid (1-3 months) and long term (>3 months). Results: Twenty-one studies met eligibility criteria (14 comparative studies and 7 case series). Sixty-two percent were at moderate to high risk of bias. PNE was applied in a wide range of injury types (mostly tendon-related), and application protocols were heterogeneous in terms of dosage (intensity: 0.35-6mA; time: 9-90sec), frequency (from twice a week to once every 2 weeks) and treatment duration (1-10 weeks). PNE showed moderate effects on pain at short and mid-term compared to active exercise interventions alone and sham needling. There is limited evidence that PNE improves injury-related function compared to other treatment modalities and no evidence of tissue structure improvement after PNE application. Conclusion: There is paucity of high-quality clinical studies about PNE in musculoskeletal conditions and lack of consensus about treatment indications and application protocols. Although a moderate effect on pain at short and mid-term has been documented, further research is needed.