Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial
Vas et al. · Rheumatology · 2008
Evidence Level
STRONGOBJECTIVE
Evaluate the efficacy of single-point acupuncture combined with physical therapy for patients with shoulder pain
WHO
425 patients with unilateral subacromial syndrome (rotator cuff tendinitis/bursitis)
DURATION
3 weeks of treatment with 12-month follow-up
POINTS
Single point Tiaokou (ST-38) on the side ipsilateral to the lesion, tiao-shan technique
🔬 Study Design
Acupuncture + Physical Therapy
n=205
3 weekly sessions of acupuncture at ST-38 + 15 physical therapy sessions
Control + Physical Therapy
n=220
Sham TENS + 15 physical therapy sessions
📊 Results in numbers
Improvement in Constant-Murley Score (acupuncture)
Improvement in Constant-Murley Score (control)
Reduction in analgesic use (acupuncture)
Reduction in analgesic use (control)
Statistical difference between groups
Percentage highlights
📊 Outcome Comparison
Constant-Murley Score (improvement in points)
Reduction in analgesic use (%)
This study showed that adding a weekly acupuncture session to physical therapy for shoulder pain produced significant benefits. Patients who received acupuncture had greater improvement in shoulder function and pain, and required less analgesic medication, compared with those who underwent physical therapy alone.
Article summary
Plain-language narrative summary
Shoulder pain is one of the most common complaints in health care systems, affecting approximately 1.2% of patients seen in primary care clinics annually. Among the leading causes of this condition is subacromial syndrome, which encompasses rotator cuff tendinitis, subacromial bursitis, and other inflammatory disorders of the joint. This condition produces severe pain, limited motion, and loss of shoulder function, significantly impacting patients' quality of life. The problem is even more relevant when we consider that approximately 50% of work time lost to medical leave is related to muscular or skeletal injuries in the neck and shoulder region.
Conventional treatments include physical therapy, anti-inflammatory medications, and injections; however, the scientific evidence on the efficacy of these approaches was still limited at the time of this study.
This study aimed to evaluate the efficacy of acupuncture combined with physical therapy in the treatment of patients with shoulder pain. To this end, the researchers conducted a multicenter randomized controlled trial involving six rehabilitation medicine departments of the public health system in two Spanish regions. A total of 425 patients with a diagnosis of unilateral subacromial syndrome and persistent symptoms for at least three months were included. Participants were randomly divided into two groups: one received acupuncture combined with physical therapy, while the other received a placebo treatment (sham electrical stimulation) along with physical therapy.
The treatment protocol lasted three weeks, with 15 physical therapy sessions for all participants, plus three weekly sessions of acupuncture or placebo. The acupuncture technique used was simplified, employing only one specific point on the leg ipsilateral to the affected shoulder, following a traditional Chinese approach known as tiao-shan.
The results demonstrated significant benefits of acupuncture when combined with physical therapy. The group that received acupuncture showed a mean improvement of 16.6 points on the shoulder functional assessment scale, compared with 10.6 points in the control group, representing a statistically significant difference of 6 points. In addition, daytime pain intensity decreased by 2 points in the acupuncture group versus 1.1 points in the control group, with a similar reduction observed for nighttime pain. A particularly relevant finding was that 53% of patients treated with acupuncture were able to reduce their use of analgesic medications, compared with only 30% in the control group.
The safety profile was also excellent, with only 2% of patients reporting severe pain at the time of needle insertion, and no other significant adverse effects. Long-term follow-up showed that the benefits were maintained and even increased over time, persisting for up to 12 months after the end of treatment.
For patients suffering from shoulder pain, these results represent a promising and safe therapeutic alternative. The combination of acupuncture with physical therapy can accelerate recovery, reduce the need for analgesic medications, and provide lasting symptom relief. For health care professionals, the study offers robust evidence for a simple and economically viable approach using only one acupuncture point that can be easily implemented in rehabilitation services. The technique proved especially valuable for enabling significant reductions in NSAID consumption, thereby decreasing the risks of gastrointestinal side effects and other problems associated with prolonged use of these medications.
The study also suggests that acupuncture may reduce work absenteeism, representing important socioeconomic benefits.
It is important to acknowledge some limitations of this study. The inability to apply complete double-blinding in acupuncture research is a methodological challenge inherent to this type of intervention. Although the researchers took rigorous measures to maintain concealment about which treatment each patient received, participants inevitably knew whether they were receiving needles or sham electrical stimulation. In addition, the choice to use only one acupuncture point, while simplifying the protocol, may have limited the potential benefits of the technique, since approaches combining local and distal points traditionally yield superior results.
The study also focused specifically on subacromial syndrome, and the results may not apply to other causes of shoulder pain.
This work represents the largest study ever conducted on acupuncture for shoulder pain, providing solid scientific evidence that the technique, when combined with physical therapy, offers real and lasting clinical benefits. The simplicity and safety of the approach make it a viable option for implementation in different clinical contexts, especially considering the growing demand for alternatives to conventional treatments. The results suggest that acupuncture should be considered a valid adjunctive treatment for patients with subacromial syndrome, contributing to more comprehensive and effective management of this common and debilitating condition.
Strengths
- 1Large multicenter sample (425 patients)
- 2Rigorous protocol with blinded assessors
- 3Long-term 12-month follow-up
- 4Simple and safe technique
- 5Results sustained over time
Limitations
- 1Inability to use double-blinding because of the nature of acupuncture
- 2Use of only one acupuncture point may have limited results
- 3Sham TENS may not have been fully convincing
- 4Variability among practitioners in a multicenter study
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Subacromial syndrome accounts for a substantial share of visits in rehabilitation and musculoskeletal pain services, and the practical question has always been: what should be added to physical therapy to accelerate functional recovery and reduce the analgesic burden? This multicenter trial of 425 patients provides an objective answer — adding acupuncture to the physical therapy protocol produced a 6-point difference on the Constant-Murley Score, a scale with well-established clinical relevance for shoulder function, with p < 0.001 and sustained benefits at 12 months. The data on analgesic reduction are equally applicable: 53% of the acupuncture group reduced analgesic use compared with 30% in the control group, a concrete argument for patients with contraindications to NSAIDs, older adults at gastrointestinal or cardiovascular risk, and workers requiring rapid functional return. The protocol of three sessions per week for three weeks is easily absorbed by the schedule of any rehabilitation service in either the public or private system.
▸ Notable Findings
What stands out most in this study is the deliberate choice of ST-38 — Tiaokou — distal to the shoulder, with no local needling, producing greater functional gain than control with only three sessions per week. This finding challenges the reflexive logic of stacking local points and reinforces the neurophysiological model of segmental and suprasegmental modulation at a distance, with direct implications for patients in an acute phase whose shoulder cannot tolerate nearby needling. The maintenance and even expansion of benefits over 12 months after only three weeks of intervention suggests a mechanism that goes beyond transient analgesia — possibly facilitation of tendon remodeling and normalization of scapular motor control by reducing central nociceptive input. The safety profile was notable: only 2% reported severe needle pain, with no significant adverse events recorded in the case series.
▸ From My Experience
In my practice with painful shoulder, especially in subacute subacromial syndrome, I usually note an analgesic response perceptible to the patient within the first two to three sessions — consistent with what this trial demonstrates. I typically work with a protocol of eight to ten sessions for induction, reserving Tiaokou and other distal points for phases when the shoulder cannot tolerate local needling, and adding points such as LI-4 and TE-5 according to the clinical pattern. I systematically combine treatment with scapular kinesiotherapy and eccentric strengthening of the rotator cuff — in my view, acupuncture functions as a facilitator of the therapeutic window, allowing the patient to perform exercise with quality. Patients over 60 with bleeding risk from chronic NSAID use are those who benefit most from this combination in my service. Overhead workers and throwing athletes respond well when the protocol is started early, before a consolidated compensatory scapular pattern sets in.
Full original article
Read the full scientific study
Rheumatology · 2008
DOI: 10.1093/rheumatology/ken040
Access original articleThis study underpins the editorial content of the site.
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Scientific 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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