Systematic review of clinical practice guidelines on acupuncture for chronic musculoskeletal pain

Acupuncture has become increasingly popular in the treatment of chronic musculoskeletal pain, which includes conditions such as osteoarthritis, low back, neck, and shoulder pain. These conditions represent one of the leading causes of disability worldwide, affecting millions of people and generating significant costs for healthcare systems. In the United States, for example, chronic pain costs at least 560 billion dollars annually. With the growing scientific evidence on the benefits of acupuncture, demand has also grown for clinical guidelines to advise clinicians on when and how to use this therapy.

The investigators carried out a systematic review to examine clinical guidelines on acupuncture published between 2014 and 2024. They searched for guidelines developed by specialized committees that included evidence-based recommendations for the treatment of osteoarthritis, low back, neck, and shoulder pain. The goal was to understand how different organizations around the world recommend the use of acupuncture and to evaluate the methodological quality of those guidelines. The investigators searched nine international databases and used standardized tools to evaluate both the strength of the evidence and the quality of the guidelines identified.

The study identified 17 clinical guidelines containing 35 specific recommendations on acupuncture. Shoulder pain was the most addressed condition, accounting for 40% of recommendations, followed by low back pain at 31%, osteoarthritis at 23%, and neck pain at only 6%. Traditional manual acupuncture was the most discussed type, appearing in about three-quarters of the recommendations, although other modalities such as electroacupuncture and laser acupuncture were also considered. Among the most interesting results, 60% of recommendations supported the use of acupuncture, while 23% offered no clear suggestion and 17% advised against its use, revealing significant contradictions among different guidelines.

For patients and clinicians, these results carry important implications. The finding that there is disagreement among guidelines suggests that the decision to use acupuncture should consider not only the scientific evidence but also the local context, including cultural factors, availability of qualified clinicians, and patient preferences. In countries where traditional medicine is more integrated into the healthcare system, such as China and South Korea, recommendations tend to be more favorable to acupuncture. For patients, this means that the availability and recommendation of acupuncture may vary significantly depending on where they live and which clinician they consult.

The study revealed some important limitations. Many guidelines did not provide sufficient practical detail on how to apply acupuncture, such as which points to use, how long to treat, or how many sessions are needed. In addition, 60% of the recommendations did not mention potential adverse effects. The quality of the evidence supporting the recommendations also varied considerably, with only a small percentage based on high-quality evidence.

The investigators suggest that well-developed local guidelines, which consider the specificities of each region and involve local clinicians and patients, may be more useful than attempting to apply guidelines developed in very different contexts. This work highlights the need for more high-quality acupuncture research and the development of more adequate tools to evaluate traditional medicine guidelines.