Dry Needling Side Effects and Safety

Urgent first

Call 911 (in the US) or your local emergency number for sudden chest pain, shortness of breath or trouble breathing, a fast heartbeat, or feeling faint after any needling treatment. A collapsed lung (pneumothorax) is a documented, rare complication. [1]

What most people may notice

Minor reactions are common. In a prospective survey of 420 physical therapists covering 20,464 treatment sessions, 36.7% of treatments were followed by a minor adverse event. The most frequent were bleeding (16%), bruising (7.7%) and pain during the needling (5.9%). [2]

A 2026 systematic review and meta-analysis of 59 studies reported minor events ranging from 0% to 48.15% per treatment, and major events as uncommon (0% to 0.43% per treatment). [3] The wide ranges reflect differences in technique, how events were counted and who was surveyed.

Serious complications

• Pneumothorax (collapsed lung). The survey above counted major events (pneumothorax, excessive bleeding, prolonged aggravation) at under 0.1%, about 1 per 1,024 treatments. [2] A narrative review of 130 reported adverse events found bilateral pneumothorax was the only potentially life-threatening category, and listed spinal epidural hematoma, dysautonomia, nerve injury and pneumothorax as severe. [4] A published case report describes a young woman who developed a pneumothorax after treatment of upper-back muscles and needed hospital care. [1]
• Nerve injury. Reported as severe in the same review, which said events beyond mild, transient symptoms are rare but pneumothorax and nerve injury remain of greatest concern. [4]
• Reporting is inconsistent. The same review said events are not reported consistently, so the true risk is hard to state. [4]

A cadaver and volunteer study notes that needling chest wall muscles has an inherent risk of puncturing sensitive structures such as the pleura (the lining around the lung). [5] This page gives no technical guidance on how needling is done.

Does training lower the risk?

The big survey found no association between the frequency of adverse events and a practitioner's level of training or years of experience. [2] A Canadian physiotherapy association statement says there is limited evidence that more rigorous training improves safety, while noting serious events are rare. [6] See dry needling training and credentials.

Who should take extra care

Tell any practitioner before treatment if you:

• take blood thinners or have a bleeding disorder, since bleeding and bruising are the most common reactions [2];
• are pregnant, have a pacemaker or other device, have lymphedema, or have a weakened immune system or skin infection (cautions drawn from acupuncture; see acupuncture side effects and precautions and the safety quick reference);

Ask how needles are handled: single-use sterile needles and a sharps container are standard in professional descriptions. [7]

Stop signs: contact a clinician

Breathing difficulty or chest pain (emergency), numbness or weakness that does not settle, increasing pain or swelling, redness, warmth or fever near the site (possible infection), or heavy bleeding.

Safety of at-home needling

Do not needle yourself or use unsupervised kits; see at-home acupuncture kits.