Different Acupuncture Treatments for Myofascial Pain Syndrome in Neck or Shoulder: A Network Meta-Analysis Based on Randomized Controlled Trials

Myofascial pain syndrome of the neck and shoulder region has become an increasingly relevant health problem in modern society. This condition affects millions of people worldwide and is directly related to changes in our contemporary lifestyle, especially prolonged use of electronic devices and inadequate working postures. The syndrome is characterized by extremely sensitive muscle tension points, known as trigger points, which can cause intense pain and movement limitation. Studies show that among people who use smartphones for long periods, the prevalence of cervical pain can reach 89%, with myofascial syndrome being the most common form of this condition.

In addition to significant physical discomfort, this syndrome considerably impacts work productivity, with patients showing on average 23 times more workplace absences compared to the general population.

To investigate which acupuncture method would be most effective in treating this condition, Chinese researchers conducted a comprehensive study known as a network meta-analysis. This methodology allows different treatments to be compared indirectly, even when they have not been directly tested against each other in individual studies. The researchers analyzed 29 randomized controlled trials, involving 2,424 patients divided between experimental and control groups. The main objective was to determine which among 13 different acupuncture techniques would be most effective in reducing pain and improving the clinical condition of patients.

The techniques evaluated included conventional acupuncture combined with other therapies, electroacupuncture, moxibustion, acupoint injections, subcutaneous needling, and internal heat acupuncture, among other modalities.

The results revealed significant findings about the relative efficacy of the different treatments. For pain reduction, measured through the visual analog scale ranging from zero to ten points, three techniques stood out as superior: moxibustion (a technique that combines needling with heat application through herbs), internal heat acupuncture, and the combination of conventional acupuncture with moxibustion. When the researchers analyzed overall treatment efficacy, considering not only pain reduction but also functional improvement, eight techniques demonstrated results superior to conventional acupuncture alone. Among all evaluated modalities, internal heat acupuncture emerged as the technique with the best overall performance, presenting excellent results for both pain relief and overall clinical efficacy.

This innovative technique combines traditional needling with controlled heating of the needle through an electronic device, allowing heat to penetrate deeply into affected tissues.

The clinical implications of these findings are substantial for both patients and healthcare professionals. For patients, the results suggest that more sophisticated acupuncture techniques, especially those incorporating thermal elements such as internal heat acupuncture, may offer more effective pain relief compared to traditional acupuncture methods. The mechanism of action of internal heat acupuncture is particularly promising, as the controlled heat applied through the needle promotes improved local blood circulation, reduces inflammation, decreases muscle tension, and facilitates the release of myofascial trigger points. For practitioners, these data provide evidence to guide more informed clinical decisions, allowing the selection of techniques with greater probability of therapeutic success.

The research also highlights the importance of considering integrated approaches, where conventional acupuncture is combined with other modalities such as moxibustion, Chinese herbal medicine, or therapeutic massage.

However, it is important to acknowledge the significant limitations of this research. The quality of evidence from the included studies was considered relatively low, which may affect the reliability of the results. Most analyzed studies had small samples and variable methodology, with important differences in patient selection criteria, application techniques, and outcome measures. Many studies did not adequately specify their randomization methods or did not implement blinding strategies, factors that can introduce bias in the results.

Additionally, the vast majority of included studies were conducted in China, which limits the generalizability of the findings to populations of different ethnic and cultural origins. Differences in clinical practices, resource availability, and patient characteristics in different countries may influence the relative efficacy of treatments. Another important limitation is that many of the outcome indicators used are subjective, based on patients' own perceptions of their pain and functional improvement, which can be influenced by cultural factors and personal expectations.

In conclusion, although this study provides valuable evidence on the superiority of certain acupuncture techniques, especially internal heat acupuncture, for the treatment of cervical and shoulder myofascial syndrome, the results should be interpreted with caution. The methodological limitations and the predominance of Chinese studies suggest that more high-quality, multicenter research involving diverse populations is needed to confirm these findings. Patients interested in these treatment modalities should discuss available options with qualified professionals, considering their individual circumstances and the local availability of different acupuncture techniques. The field continues to evolve, and future research will likely provide more robust evidence to guide best practices in treating this common and debilitating condition.