Comparative effectiveness of different acupuncture therapies for neck pain

Neck pain is one of the most common musculoskeletal complaints, affecting between 22% and 70% of the population at some point in life. This problem not only causes significant physical discomfort but also compromises patients' quality of life, reduces productivity at work, and considerably increases healthcare costs. Cervical pain can range from mild muscle tension to a debilitating condition that interferes with daily activities. Conventional treatment generally includes medications, injections, massage, and physical therapy; however, some of these treatments have limited evidence of efficacy or may cause undesirable side effects such as cardiovascular problems, renal toxicity, or nerve injuries.

In this context, acupuncture has gained prominence as a promising therapeutic alternative and is widely used in many countries for the treatment of musculoskeletal pain.

This study aimed to compare the efficacy of different types of acupuncture in the treatment of neck pain through a systematic review and network meta-analysis. The researchers conducted a comprehensive search of nine electronic databases, looking for randomized clinical trials published through July 2021. The methodology included sophisticated statistical analyses using R software, focusing on three main outcomes: pain intensity, pain-related disability, and efficacy rate. To ensure scientific quality, the authors used rigorous tools for risk-of-bias assessment and the GRADE system to evaluate the certainty of the evidence.

Network meta-analysis is an advanced statistical technique that allows multiple treatments to be compared simultaneously, combining direct and indirect evidence to establish a ranking of the most effective treatments.

The results of this research were quite revealing. The study included 65 randomized clinical trials involving 5,266 participants, comparing nine different interventions: manual acupuncture, electroacupuncture, warm acupuncture, fire-needle acupuncture, catgut implantation at acupoints, sham acupuncture, usual care, Western medicine, and no treatment. The analyses showed that fire-needle acupuncture consistently ranked first in efficacy rankings. This method proved superior in reducing pain intensity and had the highest efficacy rates among all techniques evaluated.

Electroacupuncture, warm acupuncture, and catgut implantation also proved more effective than traditional manual acupuncture in several aspects. Particularly interesting was the finding that electroacupuncture was more effective in reducing pain-related disability when compared to manual acupuncture. All acupuncture methods tested demonstrated superiority over usual care and sham acupuncture.

For patients suffering from neck pain, these findings offer valuable information for therapeutic decision-making. Fire-needle acupuncture, although less well known in Brazil, emerges as the most promising option according to this study. This method uses needles heated to red-hot that are rapidly inserted at acupuncture points, creating an intense thermal stimulus that may accelerate the absorption of inflammatory factors and influence the central nervous system. For healthcare professionals, especially acupuncturists, the results suggest that techniques that combine electrical, thermal, or other adjuvant methods of stimulation may be more effective than manual acupuncture alone.

Electroacupuncture, which is more widely available and familiar to Brazilian professionals, presented results consistently superior to traditional acupuncture, especially in reducing functional disability. It is important to emphasize that all the acupuncture methods evaluated demonstrated an adequate safety profile, with adverse effects generally mild and transient, such as small hematomas, local discomfort, or occasional dizziness.

However, this study presents important limitations that must be considered in interpreting the results. The main limitation is the low methodological quality of the included studies, with most presenting a high risk of bias due to problems with blinding of participants and assessors, inadequate concealment of randomization, and incomplete reporting of outcomes. The certainty of the evidence was rated as "very low" by the GRADE system, which means that the results must be interpreted with caution. In addition, significant heterogeneity between studies was observed in terms of treatment protocols, acupuncture points used, and frequency and duration of sessions.

Publication bias was also identified in analyses of pain-related disability. Another limiting aspect was the scarcity of safety data, particularly for fire-needle acupuncture and catgut implantation, which ranked highly in efficacy. Most of the included studies were conducted in China, which may limit the generalizability of the results to other populations.

In conclusion, this network meta-analysis represents the first study to systematically compare different acupuncture modalities for neck pain, providing evidence that techniques such as fire-needle acupuncture, electroacupuncture, and warm acupuncture may be more effective than traditional manual acupuncture. Although the results are encouraging and suggest that fire-needle acupuncture may be the most effective option, the low quality of the available evidence prevents definitive conclusions. The researchers emphasize the urgent need for higher-quality clinical trials, with larger samples and standardized protocols, to confirm these promising findings. For patients considering acupuncture treatment for neck pain, it is advisable to discuss these options with qualified professionals who can individually evaluate the benefits and risks of each modality, considering the specific characteristics of each case and the local availability of the different types of acupuncture.