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Final Program

1320 - Dry needling for spasticity management in a pediatric patient with metabolic brain injury due to opioid overdose

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST
Case Diagnosis: Opioid overdoses are increasingly more common. Metabolic brain injury can occur in the setting of substance overdose due to respiratory depression and subsequent ischemic injury. This can lead to impairment of communication, cognition, and sensorimotor function. Although commonly utilized for myofascial pain, this case describes the use of dry needling for spasticity management.

Case Description: A 17-year-old boy with history of multiple opioid overdoses was admitted after polysubstance drug overdose with prolonged period down. He required intubation due to respiratory depression. Further workup revealed severe acute renal injury and rhabdomyolysis. His course was complicated by dysautonomia requiring multiple medications, spasticity, and dystonia. Once extubated, he developed worsened spasticity despite the use of conservative management and medications.  Botulinum toxin injections were completed without notable improvement to upper extremities. Therefore, dry needling was initiated to the biceps, latissimus dorsi and pectoralis bilaterally. He demonstrated significant improvement in active/passive range of motion (degrees gained prior to starting dry needling to fifth session of dry needling). Gained range includes elbow flexion (left 28/20 degrees, right 42/22 degrees), elbow extension (left 76/70 degrees, right 150/107 degrees), shoulder external rotation (left 82/58 degrees, right 70/55 degrees), and shoulder flexion (left 88/86 degrees, right 128/74 degrees).  

Discussions: Dry needling has been proven effective for spasticity management in post-stroke patients. It has not been widely studied in pediatric populations nor in metabolic brain injuries. Given our patient’s improvement (which allowed him to be able to assist with transfers, manipulate his phone and play games), future studies would be beneficial to further evaluate the effectiveness of dry needling as a tool for spasticity management in the pediatric population.  

Conclusions: Dry needling for spasticity management in the pediatric brain injury population may have significant functional benefits.