 Controlled trials that assess DN efficacy either use 1 sham or control such as no or an inactive treatment or 2 other treatments such as lidocaine injections, non-local DN, or usual care, such as stretching and exercise for the comparison group. A blunted needle that does not penetrate the skin is a good sham treatment Streitberger and has been recommended as adequate control. As discussed elsewhere Streitberger, every needle penetration, be it at a trigger point or not, will induce physiological responses and are as such not appropriate to use as control. 