Compare the efficacy of acupuncture with drugs in the treatment of Bell's palsy: A systematic review and meta-analysis of RCTs
Zhang et al. · Medicine · 2019
Evidence Level
MODERATEOBJECTIVE
Compare the efficacy of acupuncture versus medications in the treatment of Bell's palsy
WHO
Patients with Bell's palsy (idiopathic facial palsy)
DURATION
1 to 1.5 months of follow-up
POINTS
Varied points including Fengchi, Yingxiang, Shuigou, Chengzhu
🔬 Study Design
Acupuncture
n=646
Manual acupuncture or acupuncture + moxibustion
Medications
n=612
Prednisone, vitamin B, antivirals
📊 Results in numbers
Cure rate - acupuncture
Cure rate - medications
Relative risk for cure
Total effective rate - acupuncture
Relative risk for effectiveness
Percentage highlights
📊 Outcome Comparison
Cure rate (%)
Total effective rate (%)
This study shows that acupuncture may be more effective than conventional medications for treating Bell's palsy, a condition that causes sudden weakness of the facial muscles. Patients treated with acupuncture had nearly twice the likelihood of complete recovery compared with those who used medications alone.
Article summary
Plain-language narrative summary
Bell's palsy is a neurologic condition characterized by sudden, unilateral weakness of the facial muscles caused by inflammation of the facial nerve. This systematic meta-analysis examined 11 randomized controlled trials involving 1,258 patients to compare the efficacy of acupuncture with conventional medical treatment. The study was conducted through systematic search of the PubMed, Embase, and Cochrane databases through July 2018, including only studies that directly compared acupuncture (manual or with moxibustion) versus medications (corticosteroids, B vitamins, antivirals). The methodology followed PRISMA guidelines and used Cochrane tools for risk-of-bias assessment.
The results demonstrated significant superiority of acupuncture in two main outcomes. The cure rate was 59.7% in the acupuncture group versus 32.5% in the medication group (RR = 1.77; 95% CI: 1.41-2.21), indicating that patients treated with acupuncture have a 77% greater likelihood of complete recovery. The total effective rate was 96.9% versus 83.0%, respectively (RR = 1.18; 95% CI: 1.07-1.31). Acupuncture treatments used classical points such as Fengchi, Yingxiang, Shuigou, and others, with 20-30 minute sessions.
The clinical implications suggest that acupuncture may be considered a first-line treatment for Bell's palsy, especially given its favorable safety profile and cost-effectiveness. However, the study identified important limitations including high heterogeneity between studies (I² = 67% for cure, I² = 90% for effectiveness), variable methodologic quality of the included trials, lack of adequate blinding in most studies, and insufficient reporting of adverse events. The heterogeneity may reflect differences in acupuncture techniques, operator experience, study populations, and medication comparator protocols. Despite these limitations, sensitivity analysis confirmed the robustness of the findings, and subgroup analyses showed consistency of results regardless of acupuncture method, type of comparator medication, year of publication, or sample size.
The study reinforces prior evidence on the benefits of acupuncture in Bell's palsy but emphasizes the need for future trials with greater methodologic rigor, larger samples, standardized protocols, and systematic safety assessment to establish definitive clinical guidelines.
Strengths
- 1First meta-analysis directly comparing acupuncture versus medications
- 2Robust sample of 1,258 patients from 11 RCTs
- 3Sensitivity analyses confirmed stability of results
- 4Rigorous inclusion criteria focused only on direct comparisons
Limitations
- 1High heterogeneity between studies (I² = 67-90%)
- 2Variable methodologic quality with high risk of bias
- 3Lack of systematic adverse event assessment
- 4All studies conducted in China, limiting generalizability
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Bell's palsy places the clinician before a narrow therapeutic window: treatment within the first 72 hours determines the long-term functional prognosis. This meta-analysis of 11 RCTs with 1,258 patients provides a quantitative basis for positioning acupuncture as an active component of the treatment protocol, not as an optional adjuvant. The 59.7% cure rate in the acupuncture group versus 32.5% in the medication group — with an RR of 1.77 — has direct implications for cases in which corticosteroid use is limited by decompensated diabetes, severe hypertension, or immunosuppression. In these patients, acupuncture is no longer an alternative and becomes the intervention with the strongest available support. For physiatrists working in neurologic rehabilitation, the total effective rate of 96.9% in the acupuncture group guides functional planning and expectations of facial muscle recovery communicated to the patient.
▸ Notable Findings
The finding that deserves the most attention is the magnitude of the relative risk for complete cure: an RR of 1.77 with a confidence interval of 1.41 to 2.21 is a striking effect for any intervention in peripheral neurology, and the sensitivity analysis confirmed the stability of this result regardless of the acupuncture method used, the type of comparator medication, and the sample size of the included studies. This degree of consistency across distinct subgroups suggests that the effect is not anchored to a single point protocol or to a specific population. The 96.9% total effective rate with an RR of 1.18 indicates that, in addition to producing more cures, acupuncture reduces the proportion of non-responders — a relevant finding for planning facial rehabilitation and for the decision of when to escalate to electrical stimulation or motor speech therapy.
▸ From My Experience
In my practice in the pain clinic and neurologic rehabilitation, I have been referring patients with Bell's palsy for acupuncture starting in the first week of the condition, in parallel with the standard medication protocol when no contraindication is present. The response is usually perceptible between the third and fifth sessions, with return of periorbital tone and mobility of the nasolabial fold before complete motor recovery. On average, I work with cycles of 10 to 15 sessions until functional stabilization, with reassessment using the House-Brackmann scale every five sessions. The profile that responds best in my experience is the young patient, without comorbidities, treated early — exactly the scenario in which the RCTs in this meta-analysis tend to recruit. I routinely combine low-frequency electrical stimulation at facial points and supervised motor exercises with specialized physical therapy. When there is severe retroauricular pain or established synkinesis, I prefer to proceed with dry needling of the masseter musculature before resuming direct facial stimulation.
Full original article
Read the full scientific study
Medicine · 2019
DOI: 10.1097/MD.0000000000015566
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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