Effect of Acupuncture on Chronic Pain with Depression: A Systematic Review

The combination of chronic pain and depression is extremely common and challenging in medical practice. Approximately 30% to 45% of patients with chronic pain present symptoms of depression, while 52% to 65% of people with depression suffer from chronic pain. This dual condition creates a vicious cycle in which pain worsens depressive symptoms, and depression intensifies pain perception. Studies show that both conditions share similar neurotransmitters and nerve pathways in the brain.

Treating this combination is particularly difficult because patients often respond poorly to conventional medications and face significant side effects. Pain medications, such as opioids, can cause dependence and even increase the risk of depression. Antidepressants, in turn, may interact with analgesics and cause adverse effects. This makes it urgent to find safer and more effective therapeutic alternatives.

This study aimed to systematically evaluate the efficacy of acupuncture in the treatment of chronic pain associated with depression. The researchers conducted a comprehensive search in six scientific databases, including PubMed, Cochrane Library, EMBASE, and other Chinese databases, looking for studies published through March 2020. Only randomized controlled trials comparing acupuncture alone or combined with other treatments versus conventional treatments without acupuncture were included. Participants were required to have a confirmed diagnosis of chronic pain and depression.

The main outcomes assessed were the Visual Analog Scale for pain, where higher scores indicate more pain, and the Hamilton Depression Rating Scale, where higher scores indicate greater severity of depression. Adverse events were also recorded to evaluate the safety of the treatments. Statistical analysis was conducted using standardized methods for systematic reviews.

The research initially identified 535 studies, of which only seven randomized controlled trials met the rigorous inclusion criteria, involving 535 patients in total. Of these, 265 participants received acupuncture alone or combined with other treatments, while 270 received only conventional treatments. All studies were conducted in China and published between 2000 and 2018. The results showed significant improvement in both pain and depression in the group that received acupuncture.

Specifically, the reduction on the pain scale was 0.68 points greater in the acupuncture group compared to the control group, while the improvement on the depression scale was even more impressive, with a reduction of 2.18 points. Additionally, patients who received acupuncture experienced fewer side effects. While the medication group had adverse events in 16% to 67% of cases, the acupuncture group had only 0% to 36% adverse effects, demonstrating greater treatment safety.

These findings have important implications for patients and health professionals. Acupuncture proved to be not only more effective than conventional treatments alone but also safer. For patients suffering from this debilitating condition—especially those who do not respond well to medications or experience severe side effects—acupuncture represents a valuable alternative. Treatment costs are also generally lower than long-term medications.

For health professionals, these results suggest that acupuncture can be integrated into the therapeutic plan as a complementary or alternative treatment. Importantly, acupuncture worked well both alone and combined with medications, offering flexibility in the therapeutic approach. The studies analyzed used different acupuncture points, but frequently included local points near the area of pain and distal points related to emotional well-being according to traditional Chinese medicine.

Despite the promising results, the study presents important limitations that should be considered. The methodological quality of most of the included studies was considered low, with only one of the seven studies receiving a high score on the quality criteria. Due to the characteristics of acupuncture, it is difficult to implement fully blinded studies, which may influence the results. Additionally, all studies were conducted in China, limiting the generalization of the results to other populations.

The different acupuncture protocols used in the studies also make it difficult to establish standardized treatment guidelines. The relatively small number of studies and participants also limits the strength of the conclusions. Therefore, although the results are encouraging, more high-quality studies with larger samples and long-term follow-up are needed to definitively confirm the efficacy of acupuncture in this specific condition and to establish more precise treatment protocols.