 Similarly, a second review of dry needling found insufficient high-quality evidence for the use of direct dry needling for short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes.The same review reported that robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis is lacking and that high-quality studies demonstrate that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners.Three more recent reviews reached similar conclusions