Efficacy, Safety and Mechanisms of Acupuncture and Electroacupuncture for Pain: A Narrative Review
Main Article Content
Abstract
Research into the efficacy and safety of acupuncture and electroacupuncture for the relief of various types of pain, as well as the underpinning physiological mechanisms, has been ongoing since the 1950s. Recent trends have shown a significant increase in both the quantity and quality of studies, with an increasing range of pain types being supported by high and moderate certainty evidence. The primary aim of this narrative review is to provide an overview of the most robust evidence currently available to support the efficacy of acupuncture for inflammatory, neuropathic, and visceral pain, as well as pain in different clinical contexts. This evidence synthesis brings together the results of systematic reviews, meta-analyses, umbrella or overview reviews, and evidence maps. The secondary aim of this review is to explore animal and human studies on the mechanisms of acupuncture and electroacupuncture in pain relief. Despite potential underestimation of effect sizes in existing studies, high to moderate certainty evidence supports the efficacy of acupuncture and electroacupuncture in managing a broad range of acute and chronic pain conditions, with a consistently favourable safety profile. These interventions have been shown to induce lasting neuromodulatory effects in both central and peripheral nervous systems, partly through the reversal of maladaptive neuroplasticity and sustained modulation of central and peripheral nervous system activity. Emerging evidence highlights the analgesic, antihyperalgesic, and anti-inflammatory properties of acupuncture and electroacupuncture, underscoring their potential in contemporary pain management.
Article Details
How to Cite
MCDONALD, John L.
Efficacy, Safety and Mechanisms of Acupuncture and Electroacupuncture for Pain: A Narrative Review.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6871>. Date accessed: 13 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6871.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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9. Patel M, Urits I, Kaye AD, Viswanath O. The role of acupuncture in the treatment of chronic pain. Best Pract Res Clinl Anaesthesiol. Sep 2020;34(3):603–616. doi:10.1016/j.bpa.2020.08.005
10. Lu L, Zhang Y, Ge S, et al. Evidence mapping and overview of systematic reviews of the effects of acupuncture therapies. BMJ Open. 2022;12(6):e056803. doi:10.1136/bmjopen-2021-056803
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15. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. Apr 04 2017;166(7):514–530. doi:10.7326/m16-2367
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17. Birch S. A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert. J Altern Complement Med. Apr 2006;12(3):303–10.
18. Birch S, Lee MS, Kim T-H, Alraek T. On defining acupuncture and its techniques: A commentary on the problem of sham. Integr Med Res. 2022/06/01/ 2022;11(2):100834. doi:https://doi.org/10.1016/j.imr.2022.100834
19. Zhang HN, Chen JG, Wang XY, et al. Efficacy comparison between acupuncture and other modalities in the treatment of rotator cuff diseases: meta-analysis of randomized controlled trials. Am J Transl Res. 2024;16(2):599–616. doi:10.62347/ncrj1270
20. An SJ, Shin WC, Joo S, et al. Effects of acupuncture on shoulder impingement syndrome: A systematic review and meta-analysis. Med (Baltimore). Sep 13 2024; 103(37):e39696. doi:10.1097/md.0000000000039696
21. Fang J, Shi H, Wang W, et al. Durable Effect of Acupuncture for Chronic Neck Pain: A Systematic Review and Meta-Analysis. Curr Pain Headache Rep. Sep 2024;28(9):957–969. doi:10.1007/s11916-024-01267-x
22. Lee SH, Park SY, Heo I, Hwang EH, Shin BC, Hwang MS. Efficacy of acupuncture for whiplash injury: a systematic review and meta-analysis. BMJ Open. Jan 17 2024;14(1):e077700. doi:10.1136/bmjopen-2023-077700
23. Zhao H, Wang C, Wang X, Ju J, Yan C, Shi B. Efficacy and Safety of Acupuncture in the Treatment of Radicular Cervical Spondylosis: A Systematic Review and Meta-Analysis. Comb Chem High Throughput Screen. 2024;27(19):2951–2962. doi:10.2174/0113862073265007231108050338
24. Birch S, Lee MS, Robinson N, Alraek T. The U.K. NICE 2014 Guidelines for Osteoarthritis of the Knee: Lessons Learned in a Narrative Review Addressing Inadvertent Limitations and Bias. J Altern Complement Med. Apr 2017;23(4):242–246. doi:10.1089/acm.2016.0385
25. Lee B, Kwon CY, Lee HW, et al. The effect of sham acupuncture can differ depending on the points needled in knee osteoarthritis: A systematic review and network meta-analysis. Heliyon. Feb 29 2024;10(4):e25650. doi:10.1016/j.heliyon.2024.e25650
26. Sun N, Tu JF, Lin LL, et al. Correlation between acupuncture dose and effectiveness in the treatment of knee osteoarthritis: a systematic review.Acupunct MedOct 2019;37(5):261–267. doi:10.1136/acupmed-2017-011608
27. Luo H, Jing C, Liu H. Curative Effect of Electroacupuncture and Manual Acupuncture for Knee Osteoarthritis: A Meta-Analysis. Iran J Public Health. Sep 2024;53(9):1951–1963. doi:10.18502/ijph.v53i9.16450
28. Zhu RX, Li X, Yan ZB, et al. Efficacy and safety of acupuncture with moxibustion for knee osteoarthritis: a meta-analysis of randomized controlled trials. Syst Rev. Jan 16 2025;14(1):15. doi:10.1186/s13643-025-02762-x
29. Mao JJ, Ismaila N, Bao T, et al. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology–ASCO Guideline. J Clin Oncol. 2022;40(34):3998–4024. doi:10.1200/jco.22.01357
30. Giese N, Kwon KK, Armour M. Acupuncture for endometriosis: A systematic review and meta-analysis. Integr Med Res. Dec 2023;12(4):101003. doi:10.1016/j.imr.2023.101003
31. Chen C, Li X, Lu S, Yang J, Liu Y. Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024/08/07 2024;doi:10.1007/s00404-024-07675-z
32. Bissoto JR, Silva Júnior J, Alvares GP, Santos FH, Len CA. Acupuncture for pediatric chronic pain: a systematic review. J Pediatr. Nov–Dec 2024;100(6):586–595. doi:10.1016/j.jped.2024.03.013
33. Bonemazzi I, Nosadini M, Pelizza MF, et al. Treatment of Frequent or Chronic Primary Headaches in Children and Adolescents: Focus on Acupuncture. Children (Basel). Sep 29 2023;10(10). doi:10.3390/children10101626
34. Cabano R, Al-Abdallat H, Hamamreh R, et al. Acupuncture for procedural pain in newborn infants. Cochrane Database Syst Rev. Apr 22 2025;4(4):Cd 015894. doi:10.1002/14651858.CD015894.pub2
35. Ogul T, Yildiz S. Effect of Acupressure on Procedural Pain in Children: A Systematic Review. J Perianesth Nurs. Dec 2023;38(6):930–937.e1. doi:10.1016/j.jopan.2023.01.023
36. Raffagnato A, Rossaro MP, Piretti E, et al. Acupuncture for Prevention of Primary Headaches in Children and Adolescents: A Literature Overview for the Pediatric Neurologist. Pediatr Neurol. Apr 2025;165:22–30. doi:10.1016/j.pediatrneurol.2024.12.013
37. Pan J, Jin S, Xie Q, et al. Acupuncture for Chronic Prostatitis or Chronic Pelvic Pain Syndrome: An Updated Systematic Review and Meta-Analysis. Pain Res Manag. 2023;2023:7754876. doi:10.1155/2023/7754876
38. Li WX, Wu CQ, Feng W, et al. Acupuncture for rehabilitation after total knee arthroplasty: a systematic review and network meta-analysis. Int J Surg. Jan 1 2025;111(1):1373–1385. doi:10.1097/js9.0000000000002006
39. Liu N, Liu G, Chang X, et al. Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials. Front Neurol. 2024;15:1361037. doi:10.3389/fneur.2024.1361037
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