Global Trends and Performances of Magnetic Resonance Imaging Studies on Acupuncture: A Bibliometric Analysis
Zhang et al. · Frontiers in Neuroscience · 2021
Evidence Level
MODERATEOBJECTIVE
To analyze global trends and research topics in magnetic resonance imaging studies on acupuncture
WHO
829 scientific articles from 21 countries published between 1994-2020
DURATION
Analysis of 26 years of research (1994-2020)
POINTS
ST-36, LR-3, LR-2, ST-44 were the most studied points in the analyzed articles
🔬 Study Design
Research articles
n=709
original MRI studies
Reviews
n=71
review articles
Other types
n=49
editorials, letters, etc.
📊 Results in numbers
Articles from China
Annual growth
Participating countries
Institutions involved
Percentage highlights
📊 Outcome Comparison
Publications by country
This study shows that scientific research on how acupuncture affects the brain is growing globally. The results indicate that acupuncture modulates important brain networks for pain, emotion, and memory, especially in chronic pain conditions.
Article summary
Plain-language narrative summary
This bibliometric study offers a comprehensive view of 26 years of magnetic resonance imaging (MRI) research on acupuncture, analyzing 829 scientific articles published between 1994 and 2020. The methodology used the CiteSpace and VOSviewer tools to map scientific collaborations, research trends, and emerging themes in the field of neuroimaging in acupuncture.
The results reveal continuous growth in publications, with China leading in the number of studies (475 articles, 57.4%), followed by the United States (228 articles, 27.5%). This distribution reflects both the cultural origin of acupuncture and the growing Western scientific interest. The analysis identified Kyung Hee University as the most productive institution (70 articles), while Massachusetts General Hospital demonstrated greater centrality in international collaborations.
The main findings highlight four central topics in current research: acupuncture, functional magnetic resonance imaging (fMRI), pain, and stimulation. The analysis of emerging keywords reveals three frontier themes: connectivity, modulation, and fMRI, indicating a methodologic evolution from isolated brain activation studies to analyses of complex neural networks.
Citation mapping identified that the most influential studies focus on the modulation of specific brain networks by acupuncture, particularly the limbic-paralimbic-neocortical network and the default mode network (DMN). These networks are intimately related to pain processing, emotional regulation, and cognitive functions, providing a neurobiological basis for the therapeutic effects of acupuncture.
The temporal analysis shows three main research directions: chronic low back pain, simulated electroacupuncture treatment, and clinical research. The most cited studies consistently demonstrate that acupuncture modulates functional connectivity between multiple brain regions, especially those involved in nociceptive processing and autonomic regulation.
The clinical implications are significant, as they provide objective evidence of the neural mechanisms of acupuncture. The findings support the efficacy of acupuncture in painful conditions through the modulation of specific brain circuits. This is particularly relevant considering the costs and limitations of conventional pharmacologic treatments for chronic pain.
Limitations include possible language and publication bias, as only English-language articles from the Web of Science database were analyzed. In addition, bibliometric analysis does not evaluate the individual methodologic quality of the included studies. Heterogeneity in acupuncture protocols and neuroimaging parameters also represents a challenge for definitive syntheses.
Strengths
- 1Comprehensive analysis of 26 years of scientific literature
- 2Robust methodology using validated bibliometric tools
- 3Global mapping of collaborations and research trends
- 4Identification of emerging themes and future directions
Limitations
- 1Possible language bias (only English-language articles)
- 2Does not evaluate individual methodologic quality of studies
- 3Limited to the Web of Science database
- 4Heterogeneity in the acupuncture protocols analyzed
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
The documentation of 26 years of neuroimaging in acupuncture—829 articles, 21 countries, 197 institutions—consolidates a body of evidence that can no longer be ignored in contemporary clinical practice. For the physician treating chronic pain, the most operational finding of this analysis is the convergence of the most cited studies around the modulation of the limbic-paralimbic-neocortical network and the default mode network, structures directly implicated in nociceptive processing and emotional regulation. This translates mechanism into indication: patients with chronic pain of marked central component, particularly those with fibromyalgia, chronic low back pain, and refractory tension headache, represent the population in whom acupuncture finds its most robust neurobiological justification. Integrating these findings into clinical reasoning allows the physician to offer acupuncture not as an empirical resource, but as an intervention with a mechanistic substrate demonstrable by an objective imaging method.
▸ Notable Findings
What stands out most in this analysis is not the volume of publications, but the qualitative trajectory it reveals: studies have evolved from simple activation-deactivation paradigms of the brain to sophisticated analyses of functional connectivity between networks. Emerging keywords such as 'connectivity' and 'modulation' signal that the field has come to view acupuncture as an intervention that reconfigures circuits, not merely as one that suppresses or excites isolated regions. The prominence of the default mode network is particularly relevant: this network, known to be dysfunctional in patients with chronic pain, consistently appears as a target of acupuncture modulation in the most influential studies of the corpus. The geographic distribution also deserves attention—China contributes 57.4% of the articles, while the United States accounts for 27.5%, and Massachusetts General Hospital emerges as the hub of greatest centrality in international collaborations, indicating that Western interest goes far beyond the folkloric.
▸ From My Experience
In my practice at the Pain Center of HC-FMUSP, what this bibliometric analysis confirms is exactly the pattern we have been observing clinically for decades: acupuncture modulates the central nervous system in a measurable way, and the patients who benefit most are precisely those with chronic pain of central sensitization, where the conventional pharmacologic arsenal frequently runs out without satisfactory resolution. I usually observe the first perceptible responses between the third and fifth sessions, with consolidation of benefit between the eighth and twelfth sessions in the maintenance protocol. I routinely combine acupuncture with motor physical therapy and, when pertinent, with central nervous system modulators such as duloxetine. The profile of patient that responds best, in my experience, is one with an anxious-depressive component associated with pain—exactly the profile in which the modulation of the limbic network documented in these neuroimaging studies makes complete physiologic sense.
Full original article
Read the full scientific study
Frontiers in Neuroscience · 2021
DOI: 10.3389/fnins.2020.620555
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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