Table 3.

Contraindications, Risks, and Complications of Dry Needling (DN)

Precautions and relative contraindications with use of DN	Absolute contraindications with use of DN	Common risks and potential complications of DN	Rare and serious risks/complications
Needle aversion or phobia Significant cognitive impairments or unable to give consent for treatment Inability to communicate directly or via an interpreter Local lymphedema Severe hyperalgesia and allodynia Allergy to certain metals Following surgical procedures where the joint capsule has been opened	Local skin lesions Local or systemic infections Abnormal bleeding or using anti-coagulants Compromised immune system The first trimester of pregnancy Presence of vascular disease, including varicose veins	Muscle soreness Bruising Vasovagal response Fatigue	Infection Broken needle(s) Pneumothorax

Adapted from the American Physical Therapy Association’s Description of dry needling in clinical practice: an educational resource paper (2013) and Kalichman 2010.21, 39