Acupuncture for pediatric chronic pain: a systematic review

Chronic pain in childhood and adolescence represents a significant challenge for patients, families, and healthcare professionals. Defined as pain that persists or recurs for more than three months, this condition affects more than 30% of children and adolescents, causing profound impacts on quality of life, school attendance, social relationships, and family dynamics. Beyond the physical limitations, pediatric chronic pain often compromises academic progress and the development of social skills, potentially altering life trajectories in lasting ways. Current management recommends an interdisciplinary approach involving physicians, physical therapists, psychologists, and other professionals, since the mechanisms perpetuating pain are complex and involve neurological, psychological, and social aspects that are not fully understood.

The growing interest in integrative practices in pediatrics, with up to 50% of children with chronic illnesses using complementary therapies, prompted Brazilian and international researchers to conduct a systematic review on the use of acupuncture in pediatric chronic pain management. The primary aim was to analyze the available scientific evidence regarding the efficacy, safety, and impact of acupuncture and related techniques in treating chronic pain in children and adolescents. The methodology followed rigorous international standards, including searches in three major databases (MEDLINE, Scopus, and SciELO) without restrictions on publication date or language. The researchers included clinical studies with participants up to 22 years of age and assessed methodological quality using specific tools such as MMAT and STRICTA criteria for acupuncture clinical trials.

The initial search identified 2,369 articles, which after rigorous selection resulted in only five studies included in the final analysis. These studies comprised 86 participants in total and used different methodological approaches: two case series, two single-arm studies, and one randomized clinical trial. The results showed promising findings, with significant reductions in pain intensity across all studies analyzed. In the feasibility study with 31 children, 45.2% of participants reported at least a 50% reduction in current pain intensity.

The randomized clinical trial demonstrated statistically significant pain reduction in the group receiving real acupuncture compared with the control group at the four-week assessment. In addition to pain improvement, the studies documented important improvements in school attendance, participation in sports and social activities, and reduced use of analgesic medications. Notably, the adverse effects reported were minimal and transient, including only mild pain at the puncture site, dizziness, and light-headedness immediately after sessions.

For patients and families dealing with pediatric chronic pain, these findings suggest that acupuncture may represent a promising and safe complementary therapeutic option. The technique demonstrated not only the ability to reduce pain intensity but also to improve important functional aspects such as return to normal school activities and participation in social and athletic events — fundamental milestones of childhood development that are often compromised by chronic pain. For healthcare professionals, the results indicate that acupuncture may be considered as part of multiprofessional protocols for pediatric pain management, especially considering its good tolerability and low adverse-effect profile. The high acceptance rate among patients (up to 94% in the feasibility study) suggests that children and adolescents tolerate the treatment well, which is crucial for therapeutic adherence in this population.

However, it is essential to recognize the important limitations of this review. The small number of available studies, heterogeneity in the acupuncture techniques used, small sample sizes, and lack of protocol standardization significantly limit the strength of the evidence. Only one study conducted long-term follow-up, and interestingly it showed that benefits did not persist after eight weeks, suggesting that effects may be temporary. The variability in approaches — from traditional Chinese acupuncture to Japanese techniques, with or without electrical stimulation, moxibustion, or other complementary practices — makes it difficult to determine which approach is most effective.

Additionally, the lack of control groups in most studies considerably reduces the reliability of the results obtained.

In conclusion, although the findings are encouraging and suggest relevant clinical benefits of acupuncture in pediatric chronic pain management, current scientific evidence remains limited and of moderate quality. The positive results observed justify more robust future investigations, including randomized clinical trials with larger samples, standardized protocols, and long-term follow-up. Until more solid evidence is available, acupuncture may be considered as adjuvant therapy within the context of integrative care for pediatric chronic pain, always under the supervision of qualified professionals and as part of a comprehensive multidisciplinary approach.