As I write this, I am taken back to an awful day. A day filled with pain, suffering and fear. A day that I was ready to give up, to completely surrender my life in order to not feel pain anymore. There are no exact words that can fully emanate the emotional and physical trauma that was created by this event.

My concussion doctor recommended I give dry needling a try. The goal was to help release tension in the muscles of the head, neck and upper back. It would hopefully provide relief from my headaches and migraines. Usually when I talk to people about dry needling, they think it is the same as acupuncture. While they both use needles, they are completely different treatments. It is sort of confusing because some people use the two words interchangeably. I am going to briefly explain the differences and then share my experience.

Based on ancient Chinese medicine, acupuncture involves the placement of needles into points along meridian lines of the body. These lines coincide with the body’s organs. The purpose of acupuncture is to restore energy and balance in the body. Acupuncture has been practiced for over two thousand years! Based on Western medicine, dry needling is fairly new, developed in the 1980s. The needles of dry needling are inserted directly into muscles and trigger points to essentially release the tension in those areas and reduce pain. 

The training for each is very different and if I had known this is all it took for a provider to practice dry needling, I would have thought twice before going forward with this treatment.

To practice acupuncture in the US, obtaining a master’s degree and attending a Chinese medicine program or accredited acupuncture program is the minimum to become a practicing acupuncturist. There are doctorate programs for acupuncture as well. In addition to a bachelor’s degree, it takes three to four years to complete. The programs are overseen by the US Department of Education. Typically, a minimum of 250-350 supervised patient acupuncture treatments are required prior to graduation which results in hundreds of hours of training in needle technique. Following a program, the practitioner must then pass a board exam prior to becoming licensed. Continuing education is required in addition to the national board certification exam. 

To practice dry needling, a provider has to take a 27-72 hour course. Some of these hours may be online with half of those hours being hands-on experience. There is typically no training requirement for supervised patient treatments. This results in the practitioner only having a handful of hours of training in needle technique. No continuing education is required. There is no oversight or accreditation of the dry needling certification programs. There is no standardized dry needling credential.

June 12, 2019. My third dry needling appointment.

I was going back and forth on whether I should give a third appointment a try. I decided to give it one last shot, something I would come to regret. The appointment started the same as the first two. I was lathered in rubbing alcohol and the needling began. The physical therapist started by placing needles in my paraspinals (muscles that line the spine), then my upper traps and shoulders. The last areas needled were my scalene muscles, just above the clavicle in the front of the neck. Things started to feel different than previous appointments when she placed needles in my upper back.

A needle was placed just medial to my left scapula and it caused my whole body to start profusely sweating and made me feel flushed. The area felt like it was on fire. There was one needle to the left paraspinal that was so painful and seemed to be stuck. The physical therapist told me it would not go in and continued to push further. I started tearing up but attempted to tough it out. She eventually took it out because it was so painful. It then bled and she told me I could have a bruise there later. As the last needle penetrated my left scalene, I again felt flushed and experienced an indescribable pain. I was just grateful the appointment was over with. I wasn’t sure if I’d ever go back.

What soon unraveled left me no choice but to never return.

I left the appointment and about two hours later as I was sitting at home waiting to leave for my next appointment, I developed a deep, gnawing pain to my back by my left scapula. Ironically, I was waiting to head to an acupuncture appointment. I initially tried to write it off as a muscle spasm but as time went on, it rapidly started to get worse and I started to become concerned.

The back pain evolved into sharp, stabbing pain radiating through to my chest. My Mom and I got into the car to go to my acupuncture appointment. About ten minutes into the drive, I was unable to take a deep breath and at the end of inspiration there was a popping sensation in my chest. I was slumped over in half in the passenger seat trying to find a comfortable position to breathe in. 

My Mom asked me if I needed to go to the emergency department (ED). I again tried to tough it out and downplay it. I also didn’t want to cancel my acupuncture appointment and be charged a cancelation fee; this seems silly now but with all my medical bills piling up, I didn’t want that extra expense. I said to my Mom that maybe it was a muscle spasm but the pain and difficulty breathing was becoming so intense that I started to wonder if something more serious could be going on.

My chest felt like it was going to explode. That’s when it hit me that maybe I had a pneumothorax caused by one of the needles going in too far. A pneumothorax is the medical term for a collapsed lung which occurs when air leaks into the space between the chest wall and lung. The air trapped between the layers causes the lung to collapse by pushing on it. I did a quick google search and typed in, “pneumothorax and dry needling,” and there was a medical case study that sounded identical to mine, resulting in a life-threatening emergency. Even though this made it even more of a possibility now that I read this, I continued to proceed to my appointment.

I made it to my acupuncture appointment which was typically a calming experience. This was not. The standard protocol was to lie on the heated exam table, the practitioner placed the needles (in my hands, wrists, shins, feet and forehead) and then left me in the room where I stayed for 45 minutes until the session was over. I did my best to hide my pain and difficulty breathing as the acupuncturist placed the needles, still trying to convince myself this was nothing serious. I would soon regret this as things took a turn and I really needed help.

My chest pain was worsening rapidly as well as my breathing. My heart felt like it was going to beat out of my chest. Usually there was a working clock on the wall but in this room the clock was broken. I looked at it to see how much longer I had. I thought to myself, is this a sick joke? I started to wonder if I’d make it out of there.

Time seemed to stand still and I felt trapped. I couldn’t move because I had needles all over me and the practitioner was so far away that if I called out for help, he would’ve never heard me. I knew I needed to get to an ED, and to an ED fast. The 45 minutes was up which felt like an eternity, and I told my Mom we needed to book it to the ED. The car ride also felt like an eternity, and I could feel my body decompensating.

The chest pain and difficulty breathing continued to intensify until I made it to the emergency department. Once in the ED, I told the PAs and doctor, “I believe I have a pneumothorax.” The doctor initially performed a bedside chest ultrasound to see if I did indeed have a pneumothorax. This test was supposed to be more sensitive at identifying it, if there was one.

The ultrasound was normal so I felt a little crazy, that this severe pain was nothing. But I knew there had to have been something wrong; I had never felt pain like this nor had I ever experienced such breathing difficulty. At this point my heart was beating so fast, I was very tachycardic (heart rate exceeded normal resting rate) and my blood pressure was dropping very low. I then had a chest x-ray. I was in so much pain and breathing was becoming more and more difficult. 

The radiologist called the provider with the urgent chest x-ray result, confirming I had a large pneumothorax. I was given two percocet. Shortly after, I was given one dose of ketorolac (an anti-inflammatory) and three doses of fentanyl for emergent chest tube placement. Despite receiving these medications, it did not even touch the pain. I have a very high pain tolerance and this was the most painful thing I have ever endured. This is something I would never wish upon anyone.

I was kicking myself because just the day before this happened, I had said to a family member, “The good thing is this recovery can only go up from here.” It went down, and went down quickly. I wondered if I’d die; my initial feeling of fear dissipated and I felt calm about the thought of death. Maybe then, all of my pain would be gone. Something I still think about a lot to this day is a text from a friend while I was in the hospital: “Promise me you’ll hang in there.” In that moment, I made that promise and decided to keep fighting.

By the point of the chest tube placement, I was given all of these pain medications and it did not take the edge off. The skin to my left chest was anesthetized with local lidocaine. This was helpful for one thing and one thing only, that being the initial incision to the skin of my chest. After this, the doctor used forceps to break through my muscles and fascia through the ribs. This act is actually quite barbaric; there is no nice or gentle way of doing this as you have to use force to pop through the layers of the chest. 

Not only did I feel this stab through the layers of my chest, there was also an audible, tearing sound that I can’t put into words. After the forceps penetrated the chest, the doctor dilated the wound by pushing his finger through it. After this, a tube was pushed through that incision through every single layer of my chest and again, I could feel and hear the tube go through all these layers. 

There were eight people in the room besides me during this emergent procedure. These people included my Mom, my sister, two nurses, two physician assistants, a respiratory therapist and the doctor. My Mom and sister sat in chairs beside me as I silently sobbed. I squeezed my sister’s hand through the entire procedure, squeezing so hard until I cut off blood flow and left the imprints of my fingers in her hand. 

I thought I would feel instant relief when the tube was placed but this was not the case. After the tube was placed, I was still in agony. I couldn’t move or breathe without being in excruciating pain. I could not get comfortable. I had a repeat chest x-ray to ensure the tube was in the right location, causing more pain. 

It was late in the night by the time I was admitted to the hospital. I must say, I did feel I lucked out in one aspect of this experience, getting my own single hospital room. No roommate was a big win. 

Each morning, I was greeted by the radiology tech for a portable chest x-ray. They were so kind but I hated the pain associated with them. I ended up having six chest x-rays during my stay and then a CT scan of my chest. Each imaging study, I endured extreme pain to get into the proper position for it.

My hospital stay was far from pleasant or easy. I was hospitalized with the chest tube in place for five days. I experienced severe pain the entire time, sometimes going unmedicated for hours straight. Unfortunately, some of the nurses didn’t believe that I was in severe pain and ignored me despite my pain medication orders being in the system from my doctor. I had to lay in one position and could not move because if I did, I would cry out in pain. My IV line kept infiltrating which means it gets blocked or fluid and medications leak out of the vein into surrounding tissues. This left me unmedicated even further. 

When they finally did medicate me again through what was supposed to be a good IV line, it turned out to also infiltrate in which all of the medication went up into my arm, causing it to feel like it was on fire for an hour straight. I laid in bed for that hour writhing and sobbing in pain. This happened so many times that they had to request the IV team to come and place a line using an ultrasound which took a great deal of time. I wasn’t sure how much more I could handle. I started using an incentive spirometer, a device used to help expand the lungs fully in order to keep my lungs active which caused further pain.

Something that I’ve repeated in many of my posts is to be your own advocate and when you can’t be, to have someone there who can advocate for you. Thankfully, I had many people willing to advocate for me during this hospital stay when I needed it the most and wasn’t able to myself.

I had many visitors for which I am eternally grateful. I even had friends and family willing to rub lotion onto my legs because those rooms are so dry. Get yourself some friends who are willing to rub lotion onto your legs!

The best part of my hospitalization was my first shower while there, which didn’t happen until day three. I felt disgusting. My sister came to give me a shower which turned out to be absolutely hilarious. 

The shower had a small lip to keep the water in, possibly one inch in height. Because of where the chest tube was, we had to be careful not to get that area wet. I wasn’t very helpful as I stood there like a statue to avoid increasing my pain while she bathed me and washed my hair. We didn’t realize until after I was done showering that we had accidentally flooded the room.

As we stood there in the flooded room, my feet completely covered with water, we just stared at each other and cried laughing. It hurt me so much to laugh but it was welcomed. I really needed to laugh. We became a little concerned. How could we clean up all this water before a nurse came in? My sister started using plastic bags and towels to push the water back into the shower. We threw towels, scrubs, gowns, sheets and anything else we could find on the floor to soak it up. This is something we still laugh about to this day. I can’t explain how badly I needed this moment in that hospital room that day.

One of the key focuses of my brain injury recovery at that point was to minimize stress. You can imagine what kind of stress this brought to my body and my mind. The pneumothorax caused my chest to hurt so badly that I could not sit up straight, or lie on my left side or back. This specifically caused me to favor the left side of my chest which led directly to stiffness and pain along the left side of my back and chest. This also led to all of the ribs on my left side to be stuck and stiff as well as the muscles to my scapula. For months afterwards, I experienced intense, sharp pain to my left shoulder blade that radiated to my chest and down my arm in addition to shortness of breath and deconditioning. 

I could not lift my left arm to bathe or shower myself for a prolonged period of time after due to the pain this caused to my chest. In such a vulnerable place, I was and am still so grateful for the compassion and help from friends and family. Aside from the physical symptoms, the emotional toll was a lot for me and difficult to navigate to say the least.

If I had known a pneumothorax was a risk of dry needling and had known that a physical therapist could practice dry needling just after taking a one weekend or online course, I don’t think I would have gone forward with it. It’s easy for me to say this now after experiencing this outcome. While the incidence of this happening is low, it’s important to recognize that this can still happen.

I attempted to find an incidence rate of dry needling induced pneumothorax. It’s difficult to find. There are some stats shown below but long story short is, it is rare and with a qualified, trained professional this should NOT happen.

• The largest prospective study comes from Germany showing an incidence rate of 1 in 1, 300, 000 consultations
• 0 incidences of pneumothoraces in over 66,000 consultations in the UK
• 0 incidences of pneumothoraces in 65,482 consultations over a 6-year survey in Japan
• 2 incidences of pneumothoraces in 139,988 consultations in Czechoslovakia
• More research needs to be done to establish the actual incidence rate because the studies include dry needling that does not involve the thoracic region making it questionable if some of the pneumothoraces could have been spontaneous and not caused by dry needling

There is a possibility that I would have gone forward with the treatment even knowing this risk because in my head, the similar melody that “this couldn’t possibly happen to me,” would play over again, similar to my brain injury and the destruction that followed. This traumatic experience still brings me anxiety and set me back big. Again, it is something that I would never wish upon anyone. I would caution anyone considering this treatment to consider the risks.

I now have a scar to my chest which is a constant reminder of this trauma. It likes to remind me every single day as I experience pain to the site in the form of pins and needles, like someone is poking the scar over and over again with a sharp object. If the pain subsides, it itches like crazy. This is unfortunately because it didn’t heal properly and became a hypertrophic scar, leaving it raised and thick. While this is a constant reminder of the trauma inflicted by this event, it is also a reminder of my resiliency. That is something I hold onto.

Sources

McCutcheon, L., & Yelland, M. (2011). Iatrogenic pneumothorax: safety concerns when using acupuncture or dry needling in the thoracic region. Physical Therapy Reviews, 16(2), 126–132.doi:10.1179/1743288x11y.0000000012