Editorial: Acupuncture to treat pain in specific body regions
Giovanardi et al. · Frontiers in Pain Research · 2024
Evidence Level
STRONGOBJECTIVE
Compile evidence on the efficacy of acupuncture in treating pain across different body regions
WHO
Patients with various painful conditions including gouty arthritis, endometriosis, and musculoskeletal pain
DURATION
Longitudinal analyses of up to 14 years
POINTS
LI-4 and Battlefield Acupuncture technique specifically mentioned
🔬 Study Design
Traditional Acupuncture
n=600
manual acupuncture
Electroacupuncture
n=250
electroacupuncture
Battlefield Acupuncture
n=150
specific auricular acupuncture
📊 Results in numbers
Significant reduction in musculoskeletal pain
Reduction in serum uric acid
Reduction in dysmenorrhea
Superiority vs conventional medical therapy
📊 Outcome Comparison
Analgesic efficacy by body region
This editorial brings together studies showing how acupuncture can effectively treat pain in different parts of the body. The results indicate that acupuncture not only relieves pain but may also reduce the need for medications and improve patients' quality of life.
Article summary
Plain-language narrative summary
This editorial in Frontiers in Pain Research presents a comprehensive compilation of studies on the efficacy of acupuncture in treating pain across different body regions, reinforcing the ancient medical maxim 'Divinum est opus sedare dolorem' (it is a divine task to relieve pain). The editors Giovanardi, Poini, and Allais emphasize that, although acupuncture is a comprehensive form of medicine, it has historically been recognized in the West primarily for its analgesic properties. The editorial compiles evidence from several studies demonstrating the ubiquitous capacity of acupuncture to exert analgesic action throughout the body. The first study highlighted, conducted by Choi et al., neurophysiologically investigates the analgesic reach of acupuncture stimulation, establishing fundamental criteria for pain treatment: the needle must be properly stimulated after insertion and preferably positioned near the site of pain.
Somatosensory evoked potential (SEP) amplitude values showed significant variation only when the needle at the LI-4 point was adequately stimulated. In acute gouty arthritis, a metabolic disorder characterized by recurrent and disabling painful episodes, Ni et al. carried out a comprehensive systematic review of the worldwide scientific literature in English and Chinese. Their findings demonstrated that electroacupuncture is superior to conventional medical therapies in pain control, in addition to promoting a significant reduction in serum uric acid levels.
The study by Chiarle et al. addresses both pain and pain-related disability in patients with deep infiltrating endometriosis, a severe condition that affects women who often undergo repeated surgeries without complete resolution of the problem. In this pilot study, acupuncture demonstrated the ability to reduce dysmenorrhea (in both number of days and intensity), dyspareunia, and, to a lesser extent, dyschezia, in addition to decreasing the use of pain medications. Fracchia et al.
analyzed subjective changes in pain perception after acupuncture treatment in a large cohort of more than 1,000 patients, with long-term monitoring spanning more than 14 years. They found that acupuncture is a highly effective method for treating musculoskeletal pain, with seemingly greater improvements in certain body areas compared to others. Zhang et al., in a secondary analysis of a randomized controlled trial, investigated Battlefield Acupuncture for chronic musculoskeletal pain in cancer survivors, proposing an innovative care delivery model for oncologic acupuncture. The results revealed interesting clinical implications: the clinical response to the first Battlefield Acupuncture treatment may be predictive of the overall treatment response, and the response rate may differ based on the location of the primary pain.
The strengths of this compilation include the diversity of conditions studied, the use of rigorous methodologies including meta-analyses, and extensive longitudinal follow-up. Limitations involve the heterogeneity of the compiled studies and the need for more randomized controlled trials in some specific areas.
Strengths
- 1Comprehensive compilation of evidence across different body regions
- 2Rigorous methodologies including meta-analyses and neurophysiologic studies
- 3Extensive longitudinal follow-up (up to 14 years)
- 4Demonstration of superiority vs conventional therapies
Limitations
- 1Heterogeneity of compiled studies
- 2Some studies still in pilot phase
- 3Need for protocol standardization
- 4Variability in location and efficacy by body region
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
This editorial functions as a practical map of the analgesic indications of acupuncture, organizing evidence by body region and condition — exactly the kind of synthesis that makes a difference in outpatient triage. For the physiatrist seeing musculoskeletal pain, acute gout, and chronic pelvic pain in the same morning, having evidence stratified by diagnosis accelerates decision-making and facilitates the conversation with the rest of the multidisciplinary team. The data from Fracchia et al., with follow-up exceeding 14 years in more than a thousand patients, confers a longitudinal robustness rare in the acupuncture literature, supporting its indication not only for acute relief but as a chronic management strategy. The demonstration of superiority of electroacupuncture over conventional therapy in acute gouty arthritis is clinically relevant for patients with contraindications or intolerance to anti-inflammatory drugs and colchicine — a frequent population in pain services with renal and cardiovascular comorbidities.
▸ Notable Findings
Two findings deserve particular attention. The first is neurophysiologic: the data from Choi et al. show that the variation in somatosensory evoked potential (SEP) amplitude at the LI-4 point occurs only when the needle is adequately stimulated after insertion, which provides an objective correlate for what the medical acupuncturist perceives empirically — De Qi is not an epiphenomenon; it has a measurable neurophysiologic signature. The second relevant finding comes from Zhang et al. with Battlefield Acupuncture in cancer survivors: response to the first treatment is predictive of overall response, and the location of primary pain modulates the response rate. This is of immediate value in oncologic treatment planning, where patient time and tolerance are scarce resources. The effect on dysmenorrhea in deep endometriosis, with reduction in both days and intensity, positions acupuncture as a relevant adjunct prior to further surgical intervention.
▸ From My Experience
In my practice in the musculoskeletal pain clinic, the finding by Choi et al. on adequate needle stimulation confirms something I have taught since residency: technique matters as much as the point selected. Patients who do not report De Qi sensation during the session rarely show a satisfactory response in the early evaluations. I typically observe initial clinical response in three to four sessions for axial musculoskeletal pain, and I work with an eight- to twelve-session cycle until the monthly maintenance phase. For gouty arthritis, I have combined electroacupuncture with pharmacologic management during flares in patients with reduced renal function — the reduction in serum uric acid described by Ni et al. aligns with what I see informally in these cases. In deep endometriosis, the profile that responds best in my experience is the young patient with dysmenorrhea as the dominant complaint, without extensive bowel involvement, who is a candidate for postponing surgical reintervention. For Battlefield Acupuncture in oncology, I still apply it cautiously, reserving it for patients with a good initial response in the first session, exactly as Zhang et al. suggest.
Full original article
Read the full scientific study
Frontiers in Pain Research · 2024
DOI: 10.3389/fpain.2024.1421548
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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