Table 6 Studies included - dry needling or acupuncture for scar treatment

Dry needling or acupuncture as a monotherapy in case report studies (n = 5 of 8 case reports included)

Hunter 2011 [15] (Unspecified)

local ACU

Not applicable

Non-specified

4 mos./8 sessions/6 mos.

0.20 mm/15 mm (Seirin, without guide tube)

Depth not specified/angle non-specified

10 needles inserted locally around the scar 1 cm apart/ „circling the dragon”/ without manipulating

The patient was aware of improvement straightaway; after eight further treatments over four months the scar was flatter and much less sensitive. After six months, the patient was free of pain or other symptoms.

Bintoro and Helianthi 2022 [22] (Indonesia)

local ACU and TCM

Not applicable

30 min

8 wks./ 12 sessions/no follow-up

0.15 mm/15 mm (Huanqiu)

Superficial needling 1-2 mm depth/ angle not specified

a. Inserted locally alongside the scar at points at local areas that had a positive VAS response

b. Manual BFA, points on the ear: Cingulate Gyrus, Thalamus, Point Zero, Shen Men, and Omega 2./ without manipulating

A combination of BFA with local-point acupuncture was effective in reducing severe pain caused by a post-laparotomy scar; pain-free, no severe side-effects.

Huang et al., 2020 [25] (China)

Fu’s subcutaneous needling

Not applicable

2 min, 2–3/week

1mo./non-specified/no follow-up

A needle for FSN (Nanjing Paifu Medical Technology Co., Ltd.; Batch No. 20,152,270,832

Subcutaneous depth not specified/at the smallest possible angle into the connective tissues beneath the scars

a. The needle tip 2 cm from the scar, needling direction parallel to the scar tissues /FSN/swaying movement for 2 min beneath scars, frequency of 100 times per minute

b. “tightened muscle (TM)”: bilateral SCM, PM, TPA, RA, DIA, ES muscles

FSN therapy has obvious effects on the treatment of muscle-related disorders and can effectively release loose subcutaneous connective tissues and dissociate tissue adhesions beneath scars.

Das and Khan 2019 [23] (India)

DN

Not applicable

1 h

Non-specified/8 sessions/ no follow-up

Non-specified

Depth not specified/angle non-specified

Multiple needles inserted in and around the scar tissue, along pain map of the patient/ without manipulating

The patient reported 50% pain relief.

Fang 2014 [24] (USA)

local ACU and distal TCM points, TCM diagnosis

The patient refused herbs.

20 min/ 2 per week at the beginning, after 3rd session 1 per week

5 wks./8 sessions/no follow-up

0.20 mm/40 mm DBC brand needles

1 cun deep/ inserted at an angle of 45^o

a. 8 needles inserted 1 cun aside from the scar margins / according to „surrounding the dragon” (Wei Ci technique) / evenly rotated forward and backward; b. TCM distal points: bilateral Hegu-LI-4, Taichong-LIV-3, and Zusanli-ST-36

ACU may have a good short-term pain-relieving effect on scar pain but long-term scar-pain-relieving effects are still unclear.

Combination of dry needling or acupuncture with other modalities during a therapeutic session in case report studies (n = 3 of 8 case reports included)

Anderson 2014 [14] (Northern Ireland)

local ACU

US, stretching exercises and splintage

20 min

3mos./7 times/no follow-up

a. 0.20 mm/40 mm (no 3)

b. 0.3 mm/50 mm (no 8) (Seirin J-Type) depending on the resistance of the scar tissue

Depth not specified/ subcutaneously into the skin at a horizontal angle under the scar

6 needles applied more directly to the scar tissue at local points that induce segmental effects /once stimulated for a few minutes

Measurable improvement in the degree of fixed flexion in the PIPJ of the patient’s little finger, improvements in the temperature, sensation and appearance of the digit.

Tuck 2015 [26] (UK)

local ACU and ACU on the BL meridians

oral morphine

30 min

a.1 session/ in scar location / treatment discontinued

b. 2 sessions in back location

a. 0.16 mm /30 mm in scar location (Seirin)

b. 0.25 mm /30 mm in back location ACU on the BL meridians (Seirin)

a. 0.5 mm/ perpendicular to the skin in scar location

b. 2 cm/ perpendicular to the skin (deep insertion) in back location

a. Local insertion close to the scar line, 1–2 inches away from scar / according to „surrounding the dragon”

b. 8 needles/ trigger point in locations: BL22 bilaterally, BL23 bilaterally, BL25 bilaterally and BL26.5 bilaterally (halfway between BL26 and BL27)/ without manipulating

a. local ACU treatment for neuropathic pain secondary to local recurrence in mastectomy scar was unsuccessful. Scar pain did not improve either immediately or within 2 weeks following one local session of acupuncture.

b. ACU treatment for low back pain was successful, releasing pain from 7/10 (VAS) to 1/10 (VAS) after two sessions.

Tuckey et al., 2022 [27] (Australia, New Zealand)

local ACU

5 min massage of scar and continued previous regimen of treatment: massage, stretching and exercise

15 min/12 sessions during 7 wks.

7wks./12 sessions/10-week follow up

Non-specified

10 mm depth under the skin/ an angle of 45° (so that 20 mm of the needle shaft was inserted)

20 needles inserted locally at 2 cm intervals (some needles also inserted inside the grafted area) / surrounding the scar / the needles were stimulated manually via bi-directional rotation to the moderate deqi (three times over the course of each session).

ACU applied locally around the scar was associated with short-term relief of symptoms and significantly reduced the patient’s subjective outcome (scar thickness, redness and pliability with a small but clinically relevant reduction in scar pain.

Combination of dry needling or acupuncture with other therapeutic modalities in Randomized Controlled Trials (n = 2)

Kotani et al., 2001 [28] (Japan)

local ACU

Patients were permitted to take diclofenac during needling treatment

24 h, 5 days per week (Mon-Fri)

4 wks. / 20 sessions/ follow-up weeks 4 and 26

0.16 mm/5 mm (Asahi Industry Co.)

Intradermal depth not specified/ horizontally inserted into each marked skin area

10 local insertion points surrounding the scar detected as painful points (trigger points) in treatment group; nonpainful points in sham group /intradermal/ without manipulating

Insertion of intradermal needles into painful points is an effective treatment for abdominal scar pain. More than 70% of participants in the treatment group showed good- to excellent outcomes, i.e., reduction in all pain parameters. Analgesia was minimal in the sham-treatment and control groups. Decrease in the pain threshold pressure correlated with decreases in continuous and lancinating pain.

Song et al., 2011 [29] (China)

Tr group- local ACU C group without ACU

US- 0.50-1.25cm²/ 5–10 min, once a day in Tr group; Mebo Scareducer Ointment + US (the same as Tr group) in C group

30 min/ One every day, 10 sessions per treatment course/ 7-day break x 4 treatment courses

4 courses / 40 sessions / no follow-up

0.30 mm/40-60 mm

Depth not specified/ inserted obliquely at an angle of 15°

Inserted along the skin at the border of the scars / surrounding the scars / needles lifted and thrust 2–3 times and retained for 30 min, and manipulated once every 10 min

ACU plus US therapy is more effective in the treatment of hypertrophic scars. The total effective rate was better in the treatment group.

Combination of dry needling or acupuncture with other therapeutic modalities in case series study (n = 1)

Lubczyńska et al. 2023 [30] (Poland)

DN

manual manipulation and massage every session cupping (4 times per whole treatment) and taping (8 times per whole treatment)

Non- specified

8wks./ two times per the entire protocol; at 9th and 13th session/no follow-up

Non-specified

Non-specified

“surrounding the dragon” / manipulation non-specified

Treatment had a significant positive effect on pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed.