{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T21:12:49Z","timestamp":1788556369250,"version":"build-2803163510"},"reference-count":45,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","mskscienceandpractice.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Musculoskeletal Science and Practice"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.msksp.2026.103618","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T15:38:43Z","timestamp":1783784323000},"page":"103618","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["A severity-based classification framework for dry needling unintended responses and adverse events: An expert consensus Delphi"],"prefix":"10.1016","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6530-2611","authenticated-orcid":false,"given":"Gary A.","family":"Kearns","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2573-7079","authenticated-orcid":false,"given":"Austin","family":"Sheldon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1756-696X","authenticated-orcid":false,"given":"Tiffany","family":"Barrett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4771-4732","authenticated-orcid":false,"given":"Emilio","family":"Puentedura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1037-7704","authenticated-orcid":false,"given":"Jean-Michel","family":"Brism\u00e9e","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6415-029X","authenticated-orcid":false,"given":"Jan","family":"Dommerholt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"4","key":"10.1016\/j.msksp.2026.103618_bib1","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jbmt.2020.06.023","article-title":"Impact of physical therapists' instructions on function and the perception of post-dry needling soreness in mechanical cervical pain; a randomized clinical trial","volume":"24","author":"Almaee Nejad","year":"2020","journal-title":"J. Bodyw. Mov. Ther."},{"issue":"3","key":"10.1016\/j.msksp.2026.103618_bib2","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.pmrj.2018.07.009","article-title":"Acute spinal epidural hematoma as a complication of dry needling: a case report","volume":"11","author":"Berrigan","year":"2019","journal-title":"PM&R"},{"key":"10.1016\/j.msksp.2026.103618_bib3","article-title":"Expectations of increased and decreased pain explain the effect of conditioned pain modulation in females","volume":"289","author":"Bj\u00f8rkedal","year":"2012","journal-title":"J. Pain Res."},{"issue":"1","key":"10.1016\/j.msksp.2026.103618_bib4","doi-asserted-by":"crossref","first-page":"103","DOI":"10.26603\/ijspt20200103","article-title":"Adverse events associated with therapeutic dry needling","volume":"15","author":"Boyce","year":"2020","journal-title":"Int. J. Sports Phys. Ther."},{"issue":"3","key":"10.1016\/j.msksp.2026.103618_bib5","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1179\/2042618613Y.0000000044","article-title":"Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists","volume":"22","author":"Brady","year":"2014","journal-title":"J. Man. Manip. Ther."},{"issue":"2","key":"10.1016\/j.msksp.2026.103618_bib6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"issue":"8","key":"10.1016\/j.msksp.2026.103618_bib7","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1007\/s11916-013-0348-5","article-title":"Physiologic effects of dry needling","volume":"17","author":"Cagnie","year":"2013","journal-title":"Curr. Pain Headache Rep."},{"key":"10.1016\/j.msksp.2026.103618_bib8","unstructured":"Carlesso LC, MacDermid JC, Santaguida LP. Standardization of Adverse Event Terminology and Reporting in Orthopaedic Physical Therapy: Application to the Cervical Spine. vol. 9."},{"issue":"5","key":"10.1016\/j.msksp.2026.103618_bib9","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.math.2010.02.006","article-title":"Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review","volume":"15","author":"Carlesso","year":"2010","journal-title":"Man. Ther."},{"issue":"4","key":"10.1016\/j.msksp.2026.103618_bib11","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.math.2009.12.006","article-title":"Adverse events and manual therapy: a systematic review","volume":"15","author":"Carnes","year":"2010","journal-title":"Man. Ther."},{"issue":"1","key":"10.1016\/j.msksp.2026.103618_bib10","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.math.2009.02.003","article-title":"Defining adverse events in manual therapies: a modified Delphi consensus study","volume":"15","author":"Carnes","year":"2010","journal-title":"Man. Ther."},{"issue":"6","key":"10.1016\/j.msksp.2026.103618_bib12","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1136\/acupmed-2014-010659","article-title":"Pneumothorax complication of deep dry needling demonstration","volume":"32","author":"Cummings","year":"2014","journal-title":"Acupunct. Med."},{"key":"10.1016\/j.msksp.2026.103618_bib13","unstructured":"Dalton B, Swarbrigg C, Raman V, Sheehy M, Glynn S. \u201cAcupuncture-D\u201d - bilateral pneumothoraces following dry needling. Ir. Med. J. 115(2):P546."},{"issue":"3","key":"10.1016\/j.msksp.2026.103618_bib15","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1179\/2042618615Y.0000000001","article-title":"Dry needling for the management of thoracic spine pain","volume":"23","author":"Fern\u00e1ndez-de-Las-Pe\u00f1as","year":"2015","journal-title":"J. Man. Manip. Ther."},{"key":"10.1016\/j.msksp.2026.103618_bib14","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.2147\/JPR.S154728","article-title":"Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm","volume":"12","author":"Fern\u00e1ndez-de-Las-Pe\u00f1as","year":"2019","journal-title":"J. Pain Res."},{"issue":"7","key":"10.1016\/j.msksp.2026.103618_bib17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0270671","article-title":"Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: a scoping review","volume":"17","author":"Funabashi","year":"2022","journal-title":"PLoS One"},{"issue":"11","key":"10.1016\/j.msksp.2026.103618_bib16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-050219","article-title":"Expert consensus on a standardised definition and severity classification for adverse events associated with spinal and peripheral joint manipulation and mobilisation: protocol for an international e-Delphi study","volume":"11","author":"Funabashi","year":"2021","journal-title":"BMJ Open"},{"key":"10.1016\/j.msksp.2026.103618_bib18","article-title":"A survey of American physical therapists' current practice of dry needling: practice patterns and adverse events","volume":"50","author":"Gattie","year":"2020","journal-title":"Musculoskelet Sci Pract"},{"issue":"8","key":"10.1016\/j.msksp.2026.103618_bib19","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1111\/papr.12241","article-title":"Effect of pain induction or pain reduction on conditioned pain modulation in adults: a systematic review","volume":"15","author":"Goubert","year":"2015","journal-title":"Pain Pract."},{"issue":"4","key":"10.1016\/j.msksp.2026.103618_bib20","first-page":"651","article-title":"Pertinent dry needling considerations for minimizing adverse effects - part one","volume":"11","author":"Halle","year":"2016","journal-title":"Int. J. Sports Phys. Ther."},{"issue":"5","key":"10.1016\/j.msksp.2026.103618_bib21","first-page":"810","article-title":"Pertinent dry needling considerations for minimizing adverse effects - part two","volume":"11","author":"Halle","year":"2016","journal-title":"Int. J. Sports Phys. Ther."},{"issue":"4","key":"10.1016\/j.msksp.2026.103618_bib22","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1046\/j.1365-2648.2000.t01-1-01567.x","article-title":"Research guidelines for the Delphi survey technique","volume":"32","author":"Hasson","year":"2000","journal-title":"J. Adv. Nurs."},{"issue":"4","key":"10.1016\/j.msksp.2026.103618_bib23","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00002060-199407000-00006","article-title":"Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local Twitch response","volume":"73","author":"Hong","year":"1994","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"10.1016\/j.msksp.2026.103618_bib24","first-page":"1","article-title":"Identifying which adverse events associated with dry needling should be included for informed consent: a modified e-Delphi study","author":"Ickert","year":"2023","journal-title":"Physiother. Theory Pract."},{"issue":"8","key":"10.1016\/j.msksp.2026.103618_bib25","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1177\/0269216317690685","article-title":"Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review","volume":"31","author":"J\u00fcnger","year":"2017","journal-title":"Palliat. Med."},{"issue":"2","key":"10.1016\/j.msksp.2026.103618_bib26","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/10669817.2017.1346745","article-title":"Accuracy and safety of dry needle placement in the piriformis muscle in cadavers","volume":"26","author":"Kearns","year":"2018","journal-title":"J. Man. Manip. Ther."},{"issue":"2","key":"10.1016\/j.msksp.2026.103618_bib27","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1080\/10669817.2022.2077516","article-title":"Lack of standardization in dry needling dosage and adverse event documentation limits outcome and safety reports: a scoping review of randomized clinical trials","volume":"31","author":"Kearns","year":"2023","journal-title":"J. Man. Manip. Ther."},{"issue":"3","key":"10.1016\/j.msksp.2026.103618_bib29","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0319586","article-title":"The mechanisms of manual therapy: a living review of systematic, narrative, and scoping reviews","volume":"20","author":"Keter","year":"2025","journal-title":"PLoS One"},{"key":"10.1016\/j.msksp.2026.103618_bib28","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijosm.2025.100750","article-title":"Context is complex: challenges and opportunities addressing contextual factors in manual therapy mechanisms research","volume":"55","author":"Keter","year":"2025","journal-title":"Int. J. Osteopath. Med."},{"issue":"3","key":"10.1016\/j.msksp.2026.103618_bib30","doi-asserted-by":"crossref","first-page":"145","DOI":"10.5505\/respircase.2017.58826","article-title":"A rare complication caused by dry needling method: tension pneumothorax","volume":"6","author":"Kozac\u0131","year":"2017","journal-title":"Respir Case Rep."},{"issue":"1","key":"10.1016\/j.msksp.2026.103618_bib31","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.pneurobio.2010.10.005","article-title":"The pain matrix reloaded","volume":"93","author":"Legrain","year":"2011","journal-title":"Prog Neurobiol"},{"issue":"2","key":"10.1016\/j.msksp.2026.103618_bib32","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1136\/aim.19.2.93","article-title":"A Prospective Survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists","volume":"19","author":"MacPherson","year":"2001","journal-title":"Acupunct. Med."},{"issue":"2","key":"10.1016\/j.msksp.2026.103618_bib33","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1179\/1743288X11Y.0000000012","article-title":"Iatrogenic pneumothorax: safety concerns when using acupuncture or dry needling in the thoracic region","volume":"16","author":"McCutcheon","year":"2011","journal-title":"Phys. Ther. Rev."},{"key":"10.1016\/j.msksp.2026.103618_bib34","doi-asserted-by":"crossref","unstructured":"McManus R, Cleary M. Radial nerve injury following dry needling. BMJ Case Rep. Published online January 26, 2018:bcr-2017-221302. doi:10.1136\/bcr-2017-221302.","DOI":"10.1136\/bcr-2017-221302"},{"issue":"1","key":"10.1016\/j.msksp.2026.103618_bib35","doi-asserted-by":"crossref","first-page":"59","DOI":"10.7556\/jaoa.2019.009","article-title":"Dry needling\u2013induced pneumothorax","volume":"119","author":"Patel","year":"2019","journal-title":"J. Osteopath. Med."},{"key":"10.1016\/j.msksp.2026.103618_bib36","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2025.1537242","article-title":"Contextual effects in musculoskeletal pain: are we overlooking essential factors?","volume":"16","author":"Poulter","year":"2025","journal-title":"Front. Psychol."},{"issue":"7","key":"10.1016\/j.msksp.2026.103618_bib37","article-title":"Use of Delphi in health sciences research: a narrative review","volume":"102","author":"Shang","year":"2023","journal-title":"Medicine (Baltim.)"},{"key":"10.1016\/j.msksp.2026.103618_bib38","article-title":"The person-centered hypothesis framework: advancing clinical reasoning in musculoskeletal pain management","volume":"80","author":"Shepherd","year":"2025","journal-title":"Musculoskelet Sci Pract"},{"key":"10.1016\/j.msksp.2026.103618_bib39","series-title":"Nonparametric Statistics for the Behavioral Sciences","author":"Siegel","year":"1988"},{"key":"10.1016\/j.msksp.2026.103618_bib40","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.2147\/JPR.S146485","article-title":"Rehabilitation management of low back pain \u2013 it's time to pull it all together!","volume":"10","author":"Tousignant-Laflamme","year":"2017","journal-title":"J. Pain Res."},{"issue":"1","key":"10.1016\/j.msksp.2026.103618_bib41","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1111\/jep.13190","article-title":"Operationalization of the new Pain and Disability Drivers Management model: a modified Delphi survey of multidisciplinary pain management experts","volume":"26","author":"Tousignant\u2010Laflamme","year":"2020","journal-title":"J. Eval. Clin. Pract."},{"issue":"6","key":"10.1016\/j.msksp.2026.103618_bib42","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.radcr.2018.08.019","article-title":"A case with iatrogenic pneumothorax due to deep dry needling","volume":"13","author":"Uzar","year":"2018","journal-title":"Radiol. Case Reports"},{"issue":"2","key":"10.1016\/j.msksp.2026.103618_bib43","doi-asserted-by":"crossref","DOI":"10.15344\/2455-7498\/2019\/157","article-title":"Dry needling in physical therapy practice: adverse events","volume":"5","author":"Valdes","year":"2019","journal-title":"Int J Phys Ther Rehabil"},{"issue":"8","key":"10.1016\/j.msksp.2026.103618_bib44","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/j.techfore.2012.04.013","article-title":"Consensus measurement in Delphi studies","volume":"79","year":"2012","journal-title":"Technol. Forecast. Soc. Change"},{"issue":"2","key":"10.1016\/j.msksp.2026.103618_bib45","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1136\/aim.19.2.84","article-title":"British Medical Acupuncture Society and Acupuncture Association of Chartered Physiotherapists. Survey of adverse events following acupuncture (SAFA): a prospective study of 32,000 consultations","volume":"19","author":"White","year":"2001","journal-title":"Acupunct Med J Br Med Acupunct Soc"}],"container-title":["Musculoskeletal Science and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2468781226001347?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2468781226001347?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T20:23:54Z","timestamp":1788553434000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2468781226001347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":45,"alternative-id":["S2468781226001347"],"URL":"https:\/\/doi.org\/10.1016\/j.msksp.2026.103618","relation":{},"ISSN":["2468-7812"],"issn-type":[{"value":"2468-7812","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"A severity-based classification framework for dry needling unintended responses and adverse events: An expert consensus Delphi","name":"articletitle","label":"Article Title"},{"value":"Musculoskeletal Science and Practice","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.msksp.2026.103618","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"103618"}}