Therapeutic effects of acupuncture plus fire needle versus acupuncture alone in lateral epicondylitis: A randomized case control pilot study

This randomized controlled pilot study investigated whether combining acupuncture with fire needle therapy offers benefits superior to traditional acupuncture alone in the treatment of lateral epicondylitis, commonly known as tennis elbow. Lateral epicondylitis is a common degenerative condition affecting the wrist extensor tendons, causing significant pain and functional limitation. The study was conducted between January 2010 and January 2011 at a university hospital in Taiwan, following rigorous inclusion criteria that required persistent symptoms for at least two months. Fire needle therapy is a traditional Chinese technique that combines acupuncture with moxibustion, in which a tungsten needle is heated until incandescent and then rapidly inserted into specific painful points.

This approach aims to simultaneously stimulate acupuncture points and apply therapeutic heat directly to the affected tissue. The researchers selected well-established acupuncture points for the treatment of epicondylitis, including LI-10, LI-11, LI-12, LU-5, and Ah Shi points located in the most painful area of the lateral epicondyle. The treatment protocol consisted of 12 sessions administered twice weekly for six weeks, with assessments performed before treatment, immediately after its completion, and three months later. The results demonstrated that both groups experienced significant improvements, but with different temporal patterns.

The group that received acupuncture combined with fire needle showed faster improvements in pain reduction, with benefits evident as early as the end of treatment. Visual analog pain scale scores decreased from 3.38 to 1.43 points at rest, and grip strength improved significantly. Additionally, there were substantial improvements in functionality measured by the PRFEQ questionnaire and in quality of life assessed by the SF-36. The acupuncture-alone group, although it did not show such pronounced immediate improvements, demonstrated significant benefits at the three-month follow-up, with dramatic reductions in pain and functional improvements comparable to the combined group.

Interestingly, no statistically significant differences were observed between the groups at the three-month follow-up, suggesting that both approaches achieve similar long-term efficacy. From the perspective of traditional Chinese medicine, fire needle therapy is theoretically appropriate for lateral epicondylitis, as it aims to warm and release the body's yang qi, repelling wind, cold, and dampness from the meridians—patterns commonly associated with this condition. The needle's heat dissipates rapidly, providing focal stimulation without excessive irritation. The clinical implications of this study are important for clinicians treating patients with chronic lateral epicondylitis.

The results suggest that acupuncture, whether alone or combined with fire needle, represents an effective therapeutic option, especially for patients who have not responded adequately to conventional treatments or who seek alternatives to nonsteroidal anti-inflammatory drugs and corticosteroid injections. The combined approach may be particularly beneficial for patients who require faster symptom relief, while traditional acupuncture offers sustained benefits with a less invasive technique.