Do acupuncture and dry needling work for muscle pain?

Short answer

For long-lasting muscle and neck pain, yes. But the gap over fake needling was small, it was no better than other physical therapy, and it did nothing for next-day muscle soreness after exercise.

Do acupuncture and dry needling work for muscle pain?
'Needle the knot → knot releases → less pain' — does this formula hold?
Dry needling pushes a thin needle, with no drug, into a tight spot in a muscle; it looks a lot like acupuncture. We checked whether needling really lowers pain, how long the effect lasts and which kinds of pain it helps.
For long-lasting pain, acupuncture worked
The result held across more than 20,000 people
An analysis of raw data from 39 trials and 20,827 people found that for chronic musculoskeletal pain, headache, arthritis and shoulder pain, people who got acupuncture had less pain than those who got none and those who got fake acupuncture. After 1 year, about 85% of the effect remained.
But the gap over fake needling was small
Less than half the gap over no needling
In the same analysis, the size of the difference was about 0.5 against no acupuncture and about 0.2 against fake acupuncture. That means more than half of the pain relief also showed up with fake needles. The part that comes only from real needle points was small.
Dry needling also cut pain for weeks
Neck pain scores 1.5 to 2.3 points lower
An analysis of 28 neck pain trials found that pain scores with dry needling were 1.53 points lower right after treatment and 2.31 points lower 1 to 12 weeks later than with fake needling or waiting. Another analysis of 42 studies found less pain from 72 hours up to 24 weeks after treatment.
But it was not better than other treatments
No pain difference from other physical therapy
In the neck pain analysis, dry needling beat hands-on therapy by only 0.51 points at 1 to 12 weeks and was no different from other physical therapy. After 12 weeks there was no difference from the comparison treatments. An analysis of 13 trials also found no difference in function from other physical therapy.
No help for next-day soreness after exercise
Needles and fake needles were no different from nothing
60 people were given sore arm muscles with exercise, then split into acupuncture, laser acupuncture, fake needles, fake laser and no treatment. Over 72 hours, none did better than no treatment for pain or strength. An analysis of 21 studies also found needling did not restore strength in post-exercise soreness.
Bottom line: helps long-lasting pain, not workout soreness
Not a 'miracle cure' that beats other treatments
For long-lasting pain, acupuncture and dry needling lowered pain more than doing nothing, and with acupuncture about 85% of the effect remained after 1 year. But the gap over fake needling was small, and it was no better than other physical therapy. It did nothing for next-day muscle soreness after exercise.