The use of acupuncture for addressing neurological and neuropsychiatric symptoms in patients with long COVID: a systematic review and meta-analysis

This systematic review and meta-analysis represents the first comprehensive study to investigate the efficacy of acupuncture for neurological and neuropsychiatric symptoms commonly encountered in patients with long COVID. Although the authors did not directly include patients with long COVID, the researchers analyzed studies addressing symptoms similar to those reported in this condition. The study included 110 randomized clinical trials with 8,514 participants, examining the effects of acupuncture on fatigue, depression, anxiety, cognitive impairment, headache, and insomnia. The methodology was robust, following PRISMA guidelines and including searches across eight English- and Chinese-language databases.

The results demonstrated that acupuncture was superior to medication or sham acupuncture across several validated clinical scales. For fatigue, acupuncture showed significant improvements on the Fatigue Scale compared with both medication and sham acupuncture. In the treatment of depression, there were significant benefits as measured by the Hamilton Rating Scale, although sensitivity analyses restricted to high-quality studies showed more modest results compared with fluoxetine. For cognitive impairment, acupuncture demonstrated small but statistically significant improvements on the Mini-Mental State Examination.

In the treatment of insomnia, the results were particularly promising, with consistent improvements on the Pittsburgh Sleep Quality Index compared with both medication and sham acupuncture. For headache, acupuncture was effective in reducing pain intensity, although it did not show significant benefits for episode frequency. Interestingly, no significant differences were found for anxiety. Subgroup analyses revealed that short-duration treatments (less than or equal to 4 weeks) tended to be more effective than prolonged courses, and there were no substantial differences between manual acupuncture and electroacupuncture.

With respect to safety, approximately 7.8% of patients receiving acupuncture reported adverse events, mainly local bleeding, hematoma, needle-insertion pain, and dizziness, all considered mild and with complete recovery. This rate was similar to or lower than that observed with conventional medications. Only 0.48% of patients discontinued treatment due to intolerance or adverse events. The clinical implications are significant, suggesting that acupuncture may be a valuable complementary therapeutic approach for patients with long COVID.

Proposed mechanisms include modulation of inflammation, regulation of the immune response, and normalization of nitric oxide production for improved blood flow. However, several limitations must be considered: the absence of direct studies in patients with long COVID, variability in the acupuncture protocols used, heterogeneity in assessment scales, and inconsistent methodological quality across the included studies.