Acupuncture for musculoskeletal pain: current clinical evidence

Abstract

Musculoskeletal pain is a frequent reason for consultation in primary care and a major source of disability. Acupuncture is widely used as a non-pharmacological option, but its interpretation is complicated by methodological issues, particularly the choice of control intervention and the difficulty of blinding practitioners. This narrative review summarizes clinically relevant evidence for chronic low back pain, knee osteoarthritis, chronic neck pain and selected shoulder disorders, with emphasis on comparisons with sham acupuncture and usual care. Individual-patient meta-analysis shows that acupuncture is superior to both sham and no-acupuncture controls for chronic pain, although the specific difference versus sham is smaller than the overall difference versus usual care. More recent reviews and pragmatic trials suggest benefits in pain or function for chronic low back pain and knee osteoarthritis, while evidence for neck and shoulder pain remains more heterogeneous. Sham procedures may produce somatosensory stimulation and therefore cannot always be considered physiologically inert. Serious adverse events are uncommon when treatment is performed by appropriately trained professionals. In clinical practice, acupuncture is best considered as a possible component of multimodal care after appropriate diagnostic assessment, with realistic and measurable goals focused on pain, function and quality of life.