Acupuncture for Chronic Pain

Chronic pain affects millions worldwide, significantly impacting quality of life. Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been the subject of numerous clinical trials and randomized controlled trials (RCTs) investigating its potential efficacy in managing chronic pain. These studies aim to determine whether acupuncture offers a viable and effective treatment option for individuals suffering from this debilitating condition.

Protocols Studied in Research

[1] Electroacupuncture and auricular acupuncture for chronic musculoskeletal pain in cancer survivors. (Cited by: 56) (pmid: 33734288)

• Protocol: A randomized controlled trial (RCT) compared electroacupuncture, auricular acupuncture, and usual care in 360 cancer survivors with chronic musculoskeletal pain. Participants received 10 weekly acupuncture sessions (or offered sessions later for usual care).
• Outcome: Both electroacupuncture and auricular acupuncture significantly reduced pain compared to usual care at 12 weeks. However, auricular acupuncture was not non-inferior to electroacupuncture and had more adverse events.

[2] Needle and laser acupuncture for chronic knee pain in patients over 50. (Cited by: 101) (pmid: 25268438)

• Protocol: A Zelen-design randomized clinical trial in Australia involving 282 participants with chronic knee pain. Participants received needle, laser, sham laser, or no acupuncture for 12 weeks.
• Outcome: Neither needle nor laser acupuncture provided significant benefit over sham acupuncture for pain or function at 12 weeks or 1 year. Modest improvements were seen compared to the control group at 12 weeks only, but not sustained.

[3] Individualized acupuncture (high or low sensitivity acupoints) for chronic neck pain (CNP). (Cited by: 1) (pmid: 39222507)

• Protocol: A 24-week, multicenter randomized controlled trial in China with 716 CNP participants. Participants received 10 acupuncture sessions over 4 weeks (HSA, LSA, SA, or waiting list).
• Outcome: Individualized acupuncture (HSA and LSA) showed greater reduction in neck pain than sham acupuncture or waiting list at 24 weeks, though the improvement didn't always meet the minimum clinically important difference.

[4] Acupuncture for chronic pain (knee osteoarthritis). (Cited by: 2) (pmid: 36602299)

• Protocol: A randomized controlled neuroimaging trial with 52 patients receiving either real or sham acupuncture for 4 weeks. Baseline psychological and neurological assessments (including MRI) were performed. Blinding was employed.
• Outcome: Acupuncture was more effective than sham acupuncture for pain reduction. Positive expectation, extraversion, emotional attention, and specific brain structural and functional measures predicted acupuncture effectiveness. A machine learning model predicted treatment response with 81.48% accuracy.

[5] Electroacupuncture at different frequencies for chronic low back pain in older adults (≥65 years). (Cited by: 2) (pmid: 36988362)

• Protocol: A triple-blind, randomized controlled trial (RCT) with 125 elderly participants with chronic nonspecific low back pain, randomly assigned to 3 electroacupuncture groups (different frequencies), a manual acupuncture control group, and a placebo group. Treatment lasted 5 weeks.
• Outcome: All groups experienced pain reduction, but placebo showed the greatest improvement. Electroacupuncture was not superior to manual acupuncture or placebo. No single electroacupuncture frequency proved most effective.

[6] Depression-specific and pain-specific acupuncture for comorbid chronic pain and major depressive disorder (MDD). (Cited by: 5) (pmid: 36948325)

• Protocol: A double-blinded, randomized, crossover clinical trial with 47 patients. Patients received either depression-then-pain or pain-then-depression acupuncture treatments with a washout period. Clinical measures and cytokine levels were assessed.
• Outcome: The study found no significant difference in pain or depression relief between pain-specific and depression-specific acupuncture. Cytokine results suggest shared biological mechanisms between pain and depression.

[7] Acupuncture for Temporomandibular Disorders (TMD) (Cited by: 0) (pmid: 38710498)

• Protocol: A randomized clinical trial (RCT) assigned 60 TMD patients to either real or sham acupuncture. Participants received three weekly sessions for four weeks.
• Outcome: Acupuncture significantly reduced pain intensity and improved physical and emotional function in TMD patients compared to sham acupuncture at both 4 and 8 weeks post-treatment.

[8] Tuina therapy combined with Yijinjing exercise for nonspecific chronic neck pain. (Cited by: 18) (pmid: 36512354)

• Protocol: A 12-week randomized clinical trial (8 weeks intervention, 4 weeks follow-up) compared tuina therapy alone vs. tuina plus Yijinjing exercise in 102 participants with chronic neck pain. Both groups received 24 sessions of tuina over 8 weeks; the combined group also performed Yijinjing exercises 3 times weekly.
• Outcome: Tuina combined with Yijinjing was significantly more effective than tuina alone in reducing pain, improving neck function, and decreasing anxiety at 8 and 12 weeks.

[9] Electroacupuncture vs. sham electroacupuncture for chronic low back pain. (Cited by: 21) (pmid: 33107921)

• Protocol: A double-blind, randomized clinical trial involving 121 adults with chronic low back pain receiving 12 sessions of real or sham electroacupuncture over 6 weeks. Outcomes were measured at baseline and 2 weeks post-treatment.
• Outcome: No significant difference in pain intensity (PROMIS) between real and sham electroacupuncture. Real electroacupuncture showed significantly greater reduction in disability (RMDQ) compared to sham. Effective coping and race were associated with treatment response.

[10] Electroacupuncture of different frequencies for chronic low back pain in older adults. (Cited by: 0) (pmid: 37192255)

• Protocol: The abstract is missing, preventing a summary of the study design, participants, and intervention administration.
• Outcome: The abstract is missing, preventing a summary of the study findings.

[11] The abstract provides no information on the intervention or condition studied. (Cited by: 0) (pmid: 37302436)

• Protocol: The abstract is empty and provides no information on the study design, participants, or intervention administration.
• Outcome: The abstract is empty and provides no information on the study's findings or conclusions.

[12] Tuina (TN), physiotherapy (PT), or a combination (TP) for Chronic nonspecific low back pain (CNLBP). (Cited by: 0) (pmid: 39395482)

• Protocol: A randomized, single-blind trial with 204 CNLBP patients received 6 treatment sessions (30 minutes each) over 8 weeks. Patients were assigned to TN, PT, or TP groups. Outcomes were assessed at baseline, post-treatment (week 9), and at 20-week follow-up.
• Outcome: All three treatments (TN, PT, TP) significantly reduced pain (VAS) and improved disability (ODI) scores, with effects lasting 20 weeks. No significant differences were found between the treatment groups, suggesting all are effective for CNLBP.

[13] Acupuncture for chronic sciatica pain. (Cited by: 0) (pmid: 39089662)

• Protocol: A randomized controlled trial comparing acupuncture vs. sham acupuncture in 60 patients. Participants received 10 sessions over 4 weeks. Pain levels, disability, and brain activity (fMRI) were measured.
• Outcome: Acupuncture significantly reduced pain and disability compared to sham acupuncture. Increased brain activity in the right superior parietal lobule and postcentral gyrus correlated with improved outcomes, suggesting these regions' involvement in acupuncture's analgesic effects. Right SPL activity predicted treatment response.

[14] Dry needle acupuncture for chronic mechanical low back pain (CMLBP). (Cited by: 0) (pmid: 39081147)

• Protocol: A randomized controlled trial (RCT) compared dry needle acupuncture to muscle strengthening and stretching exercises in 30 adults (20-45 years) with CMLBP. Outcomes measured included pain, functional impairment, and lumbar range of motion (ROM).
• Outcome: Dry needle acupuncture significantly improved pain intensity, functional impairment, and lumbar ROM compared to exercise, suggesting it's a beneficial treatment for CMLBP.

[15] Invasive laser acupuncture (ILA) at 650nm and 830nm wavelengths for chronic non-specific low back pain (CNLBP). (Cited by: 4) (pmid: 35639723)

• Protocol: A randomized, placebo-controlled trial with 45 participants assigned to sham laser, 650nm ILA, or 830nm ILA groups. Participants received 10 minutes of ILA followed by 10 minutes of electroacupuncture twice weekly for four weeks.
• Outcome: 650nm ILA showed significant improvement in pain intensity and functional disability compared to the control group. 830nm ILA showed significant improvement in functional disability. No adverse events were reported.

[16] Hand-pressed pellet therapy for chronic lower back pain (CLBP) in elderly individuals. (Cited by: 0) (pmid: 38702676)

• Protocol: A randomized controlled trial (RCT) with 27 intervention and 24 placebo groups (elderly >65) receiving six weeks of hand-pressed pellet therapy targeting acupressure points related (intervention) or unrelated (placebo) to CLBP. Pain was measured using VAS, K-ODI, and a digital algometer.
• Outcome: Hand-pressed pellet therapy significantly reduced pain intensity (VAS), improved pain pressure threshold, and decreased CLBP dysfunction (K-ODI) compared to the placebo group, suggesting effectiveness in alleviating CLBP.

[17] Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). (Cited by: 0) (pmid: 38431530)

• Protocol: A secondary analysis of a randomized controlled trial involving 206 men with CP/CPPS receiving acupuncture for 32 weeks. Response was defined as a ≥6-point decrease in NIH-CPSI score.
• Outcome: Patients who were active, non-smokers, without comorbidities, and had initially severe symptoms responded better to acupuncture treatment.

[18] Fu's subcutaneous needling (FSN) for chronic non-specific low back pain (LBP). (Cited by: 0) (pmid: 39214379)

• Protocol: A randomized controlled trial comparing FSN to traditional acupuncture (TA) in 90 participants with chronic LBP. Treatment consisted of three consecutive days of either FSN or TA. Outcomes were measured before, after each treatment day, and one month later.
• Outcome: FSN demonstrated significantly greater improvements in pain intensity, fear-avoidance beliefs, trunk extensor endurance, and lumbar range of motion compared to TA, both immediately and one month post-treatment. FSN is suggested as an effective treatment for chronic LBP.

[19] Electroacupuncture and auricular acupuncture for sleep quality in cancer survivors with chronic musculoskeletal pain and sleep disturbance. (Cited by: 6) (pmid: 36989257)

• Protocol: A secondary analysis of a randomized clinical trial (PEACE) comparing electroacupuncture, auricular acupuncture, and usual care over 10 weeks in 268 cancer survivors with chronic pain and sleep problems. Sleep quality was measured using the PSQI.
• Outcome: Both electroacupuncture and auricular acupuncture resulted in significantly greater and sustained improvements in sleep quality (measured by PSQI) compared to usual care. A larger proportion of acupuncture patients experienced clinically meaningful sleep improvement.

[20] Acupuncture (4, 7, or 10 sessions) for chronic low back pain. (Cited by: 12) (pmid: 28459161)

• Protocol: A randomized controlled feasibility trial of 45 participants with chronic low back pain, comparing the effectiveness of 4, 7, and 10 acupuncture sessions added to usual care. Data collected at baseline, discharge, and 6 and 12 weeks post-randomization.
• Outcome: The study demonstrated the feasibility of a larger RCT. While most outcomes showed no significant difference between groups, the 10-session group showed superior results at 12 weeks for most secondary outcomes (except pain intensity). High participant satisfaction was reported.

[21] Trigger point acupuncture for chronic non-specific low back pain (CNLBP). (Cited by: 2) (pmid: 36760118)

• Protocol: A randomized, single-blind controlled trial with 33 participants (11 per group) comparing trigger point acupuncture, traditional acupuncture, and a waiting list control. Treatment lasted 4 weeks (3 times/week).
• Outcome: Trigger point acupuncture provided short-term pain relief and disability improvement compared to the control group. However, these benefits were not sustained at 8 weeks.

[22] Cupping and scraping therapy with medicated balm for chronic nonspecific low-back pain (CNLBP). (Cited by: 0) (pmid: 38311541)

• Protocol: A prospective, multicenter, randomized controlled trial (RCT) compared cupping and scraping therapy to diclofenac sodium and capsaicin plaster in 156 CNLBP patients over one week.
• Outcome: Cupping and scraping therapy demonstrated significantly greater short-term pain reduction and improved quality of life compared to the NSAID/capsaicin control group, with no adverse effects reported.

[23] Laser auriculotherapy combined with cupping therapy for chronic spinal pain. (Cited by: 0) (pmid: 38432806)

• Protocol: A randomized controlled trial (RCT) with 50 participants (25 experimental, 25 control) receiving either 10 sessions of combined laser auriculotherapy and cupping or no intervention. Pain intensity and threshold were measured using a numeric pain scale and dynamometer.
• Outcome: The experimental group showed significantly greater reductions in pain intensity and increased pain threshold compared to the control group, both immediately after treatment and at 15-day follow-up. The combined therapy was effective in reducing chronic spinal pain.

[24] Classical massage therapy (KMT) and acupuncture (AKU) for chronic back pain. (Cited by: 4) (pmid: 30321900)

• Protocol: A randomized controlled non-inferiority trial comparing KMT (n=66) to AKU (n=66) in patients with chronic back pain. Outcomes measured using Hannover Function Questionnaire (HFAQ) and Von Korff pain questionnaire at one-month follow-up.
• Outcome: Classical massage was not shown to be non-inferior to acupuncture in reducing pain and functional impairment at one month. The study failed to demonstrate non-inferiority within the predefined margin.

[25] Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). (Cited by: 26) (pmid: 29733836)

• Protocol: A 32-week randomized controlled trial comparing acupuncture to sham acupuncture in 68 men (18-50 years old) with CP/CPPS. Treatment lasted 8 weeks, followed by 24 weeks of follow-up.
• Outcome: Acupuncture demonstrated statistically significant and clinically meaningful improvements in NIH-CPSI total scores compared to sham acupuncture at 8, 20, and 32 weeks. Acupuncture also showed superior results for most secondary outcomes.

[26] Low-power laser auriculotherapy for chronic spinal pain. (Cited by: 0) (pmid: 35405631)

• Protocol: A randomized controlled trial with 47 participants (24 intervention, 23 control). The intervention group received 10 sessions of laser auriculotherapy over five weeks. Pain intensity, nociceptive threshold, and pain severity were assessed at baseline, post-intervention, and 15 days later.
• Outcome: Laser auriculotherapy significantly reduced pain intensity and increased nociceptive threshold in the intervention group compared to the control group. These effects persisted for 15 days post-treatment.

[27] Trigger point acupuncture (TrPAcp) combined with exercise for chronic low back pain (CLBP) in older adults. (Cited by: 3) (pmid: 35770581)

• Protocol: A randomized controlled trial (RCT) compared exercise plus TrPAcp versus exercise alone in 14 older adults (≥65 years) with CLBP for at least 3 months. Interventions lasted 3 months.
• Outcome: The combined TrPAcp and exercise group showed significantly greater pain reduction (measured by NRS) compared to the exercise-only group. One minor adverse event (heaviness) was reported in the acupuncture group.

[28] Acupuncture therapy for Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). (Cited by: 17) (pmid: 25453515)

• Protocol: A randomized controlled trial comparing real acupuncture to sham acupuncture in 12 CP/CPPS patients. Blood samples were collected before and after 20 acupuncture sessions (10 weeks). Symptom and mood questionnaires were also administered.
• Outcome: While clinical response wasn't significantly different between groups, the acupuncture group showed a statistically significant 5% increase in natural killer cell levels compared to the sham group (-13%). The study suggests a possible link between acupuncture, immune function, and CP/CPPS symptom improvement, but further research is needed.

[29] Transcutaneous electrical acupoint stimulation (TEAS) for chronic pain after mastectomy. (Cited by: 18) (pmid: 34271271)

• Protocol: A multicenter, randomized clinical trial comparing sham, single-acupoint (PC6), and combined-acupoint (PC6 & CV17) TEAS (30 min pre-anesthesia) in women undergoing radical mastectomy.
• Outcome: Combined-acupoint TEAS significantly reduced the incidence of chronic post-mastectomy pain at 6 months compared to sham and single-acupoint TEAS. It also lowered remifentanil use and postoperative nausea/vomiting.

[30] Ear acupuncture with and without dry cupping for chronic back pain. (Cited by: 2) (pmid: 35770580)

• Protocol: A randomized controlled trial comparing ear acupuncture alone (control) to ear acupuncture plus dry cupping (experimental) in 198 adults with chronic back pain. Treatment consisted of five weekly sessions over five weeks.
• Outcome: Ear acupuncture combined with dry cupping resulted in significantly better improvements in quality of life and health satisfaction compared to ear acupuncture alone, although both groups showed improvement in pain and daily activities.

[31] Minimal acupuncture treatment for chronic low back pain (CLBP). (Cited by: 7) (pmid: 35594274)

• Protocol: A secondary analysis of a randomized controlled trial. 142 CLBP patients (pain ≥4/10) received 8 acupuncture sessions over 4 weeks. Pre-treatment expectations were assessed using the Expectation for Treatment Scale (ETS).
• Outcome: Higher pre-treatment expectations correlated with greater pain reduction after four sessions, but this effect wasn't sustained after eight sessions. The effect was consistent across genders.

[32] Electronic Acupuncture Shoes (EAS) for chronic low back pain. (Cited by: 6) (pmid: 33104004)

• Protocol: A double-blinded, randomized controlled trial compared EAS plus placebo NSAIDs to sham EAS plus NSAIDs in 83 patients with chronic low back pain over 20 visits (6 weeks). Pain, range of motion, and quality of life were assessed.
• Outcome: While the EAS group showed higher treatment success rates and greater pain reduction than the NSAID group at certain visits, statistically significant differences were limited and not consistently observed across all assessments. EAS may be a viable alternative for NSAID-contraindicated patients, but further research is needed.

[33] Acupuncture for chronic discogenic sciatica. (Cited by: 20) (pmid: 31369674)

• Protocol: A randomized controlled trial compared 12 sessions of acupuncture vs. sham acupuncture over four weeks in 46 patients with chronic discogenic sciatica. Both groups received treatment at the same acupoints.
• Outcome: Acupuncture demonstrated short-term benefits in reducing leg pain compared to sham acupuncture (clinically significant difference). No significant differences were found for other outcomes. Acupuncture was deemed safe.

[34] Fateh massage, acupuncture, and physiotherapy for chronic low back pain (CLBP). (Cited by: 1) (pmid: 35770546)

• Protocol: A randomized controlled trial compared the effectiveness of Fateh massage, acupuncture, and physiotherapy on 84 CLBP patients (28 per group). Each group received 10 therapy sessions, and pain (VAS) and disability (Roland-Morris) were assessed at baseline, post-intervention, and 4 weeks later.
• Outcome: All three interventions significantly reduced pain and disability, with no significant differences observed between the groups at the end of treatment or at the 4-week follow-up. Fateh massage showed comparable efficacy to acupuncture and physiotherapy.

[35] Electroacupuncture and gabapentin for chronic neck and back pain. (Cited by: 0) (pmid: 34325532)

• Protocol: A pilot randomized controlled trial comparing true electroacupuncture, sham electroacupuncture, gabapentin, and placebo in 50 participants with chronic neck or back pain. Interventions were administered over 3 weeks (gabapentin/placebo) or 6 sessions (acupuncture).
• Outcome: No significant differences were found between groups in quantitative sensory testing, pain reduction, or functional improvement. A larger study is suggested.

[36] Bee venom acupuncture (BVA) for chronic low back pain (CLBP). (Cited by: 26) (pmid: 29112155)

• Protocol: A randomized, double-blind, sham-controlled trial with 54 patients. Participants received six sessions of BVA or sham BVA over three weeks, alongside daily loxonin. Outcomes were measured weekly and at follow-ups.
• Outcome: BVA showed significantly greater improvement in pain bothersomeness, intensity, and functional status compared to sham treatment after three weeks. Adverse events were minimal and resolved without intervention. BVA is suggested as a potential adjunct to conventional CLBP treatment.

[37] Traditional acupuncture (TA) and laser acupuncture (LA) for chronic non-specific neck pain. (Cited by: 0) (pmid: 39653805)

• Protocol: A randomized controlled trial comparing TA, LA (808 nm, 100 mW, 10 J/point), and sham LA in 84 adults with chronic neck pain (≥3 months). Participants received a single treatment session targeting specific acupuncture points.
• Outcome: Both TA and LA were significantly more effective than sham LA in immediately reducing pain intensity at rest and during movement. TA and LA showed equal effectiveness in pain reduction.

[38] Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). (Cited by: 0) (pmid: 38621728)

• Protocol: A randomized controlled trial comparing true acupuncture versus sham acupuncture in 70 CP/CPPS patients. Treatment involved 24 sessions over 8 weeks. Outcomes were measured using SF-36, VAS, NIH-CPSI, and IPSS scores.
• Outcome: Acupuncture significantly improved quality of life, reduced pain, and alleviated prostate symptoms compared to sham acupuncture, with effects lasting up to 24 weeks post-treatment. No significant adverse effects were reported.

[39] Joint mobilization and acupuncture for Chronic Neck Pain (CNP). (Cited by: 2) (pmid: 35770602)

• Protocol: A randomized controlled trial (RCT) compared joint mobilization, acupuncture, and a control group (no treatment) in 45 adults with CNP over 8 weeks (3 sessions/week). Pain (VAS) and disability (NDI) were assessed.
• Outcome: Both interventions significantly reduced pain and disability compared to the control group. Acupuncture showed significantly greater pain reduction and disability improvement than joint mobilization.

[40] Acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in drinkers. (Cited by: 0) (pmid: 39219163)

• Protocol: A randomized controlled trial (RCT) with 224 male drinkers with CP/CPPS comparing acupuncture versus sham acupuncture. Participants were assessed at multiple time points.
• Outcome: Acupuncture significantly reduced pain (NIH-CPSI) and improved global response assessment (GRA) compared to sham acupuncture, but showed no significant effect on urinary symptoms (IPSS) at any time point. Erectile function (IIEF-5) improved with acupuncture at later time points.

Research Interpretation: Summary and Conclusion

The reviewed studies on acupuncture for chronic pain employed diverse protocols, including various acupuncture techniques (electroacupuncture, laser acupuncture, manual acupuncture, auricular acupuncture), control groups (sham acupuncture, usual care, placebo, other therapies), and durations of treatment. While many studies demonstrated statistically significant pain reduction with real acupuncture compared to sham or control groups, the magnitude of benefit varied considerably across studies and specific acupuncture modalities. Some studies found no significant differences between real and sham acupuncture, highlighting the need for well-designed, adequately powered trials. Consistent findings include the importance of patient factors (e.g., expectations, comorbidities) influencing treatment response. Interestingly, several studies indicated a potential beneficial effect beyond pain relief, including improvements in sleep quality, function, and even immune markers. Overall, the evidence suggests that acupuncture may offer some benefit for chronic pain in certain patient populations and under specific treatment protocols, but further research is warranted to clarify optimal techniques, patient selection criteria, and mechanisms of action.

Publications

[1] Mao JJ; Liou KT; Baser RE; Bao T; Panageas KS; Romero SAD; Li QS; Gallagher RM; Kantoff PW (2021). Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial JAMA oncology 7 (5) :720-727.

[2] Hinman RS; McCrory P; Pirotta M; Relf I; Forbes A; Crossley KM; Williamson E; Kyriakides M; Novy K; Metcalf BR; Harris A; Reddy P; Conaghan PG; Bennell KL (2014). Acupuncture for chronic knee pain: a randomized clinical trial JAMA 312 (13) :1313-22.

[3] Zhao L; Sun M; Yin Z; Cui J; Wang R; Ji L; Geng G; Chen J; Cai D; Liu Q; Zheng H; Liang F (2024). Long-Term Effects of Individualized Acupuncture for Chronic Neck Pain : A Randomized Controlled Trial Annals of internal medicine 177 (10) :1330-1338.

[4] Wang X; Li JL; Wei XY; Shi GX; Zhang N; Tu JF; Yan CQ; Zhang YN; Hong YY; Yang JW; Wang LQ; Liu CZ (2023). Psychological and neurological predictors of acupuncture effect in patients with chronic pain: a randomized controlled neuroimaging trial Pain 164 (7) :1578-1592.

[5] Torres SF; de Macedo ACB; Sakai RY; Bressan GCS; Dos Santos MBR; Marques AP (2023). Effect of Different Frequencies of Electroacupuncture on Chronic Low Back Pain in Older Adults: A Triple-blind, Placebo-controlled, Randomized Clinical Trial Pain physician 26 (2) :161-173.

[6] Liao HY; Satyanarayanan SK; Lin YW; Su KP (2023). Clinical efficacy and immune effects of acupuncture in patients with comorbid chronic pain and major depression disorder: A double-blinded, randomized controlled crossover study Brain, behavior, and immunity 110 :339-347.

[7] Liu L; Chen Q; Lyu T; Zhao L; Miao Q; Liu Y; Nie L; Fu F; Li S; Zeng C; Zhang Y; Peng P; Wang W; Lin Y; Li B (2024). Effect of acupuncture for temporomandibular disorders: a randomized clinical trial QJM : monthly journal of the Association of Physicians 117 (9) :647-656.

[8] Cheng ZJ; Zhang SP; Gu YJ; Chen ZY; Xie FF; Guan C; Fang M; Yao F (2022). Effectiveness of Tuina Therapy Combined With Yijinjing Exercise in the Treatment of Nonspecific Chronic Neck Pain: A Randomized Clinical Trial JAMA network open 5 (12) :e2246538.

[9] Kong JT; Puetz C; Tian L; Haynes I; Lee E; Stafford RS; Manber R; Mackey S (2020). Effect of Electroacupuncture vs Sham Treatment on Change in Pain Severity Among Adults With Chronic Low Back Pain: A Randomized Clinical Trial JAMA network open 3 (10) :e2022787.

[10] Cheng Y; Yang Y; Yang L (2023). Comments on "Effect of Different Frequencies of Electroacupuncture on Chronic Low Back Pain in Older Adults: A Triple-blind, Placebo-controlled, Randomized Clinical Trial" Pain physician 26 (3) :E246-E247.

[11] Liao HY; Chang CM; Lin YW; Su KP (2023). When East meets West in clinical trial designs! Reply to "Discussion regarding the establishment of pain- and depression-specific acupoints in a randomized controlled trial with crossover design" Brain, behavior, and immunity 112 :173-174.

[12] Ma Q; Zhou X; Liang H; Guo Y; He K; Shen L; Fan Q; Yang J; Celia TIC; Bauer BA; Chen J (2024). Tuina versus physiotherapy or a combination of both for the management of chronic nonspecific low back pain: A randomized controlled trial Complementary therapies in medicine 86 :103098.

[13] Wei XY; Wang X; Shi GX; Tu JF; Yang JW; Ren MM; Liu JL; Lee CK; Zhou H; Wang ZY; Liu CZ (2024). Acupuncture Modulation of Chronic Neuropathic Pain and Its Association With Brain Functional Properties The journal of pain 25 (11) :104645.

[14] Alrawaili SM; Elshiwi AM; Sulieman A; Azab AR; Ezzat W; Abdelbasset WK; Koura GM (2024). Short-term effect of acupuncture dry needle in treatment of chronic mechanical low back pain: a randomized controlled clinical trial European review for medical and pharmacological sciences 28 (14) :3973-3981.

[15] Kim JH; Na CS; Cho MR; Park GC; Lee JS (2022). Efficacy of invasive laser acupuncture in treating chronic non-specific low back pain: A randomized controlled trial PloS one 17 (5) :e0269282.

[16] Park H; Lee H (2024). Effects of hand-press pellet on pain and daily life of elders with chronic lower back pain: randomized controlled trial BMC complementary medicine and therapies 24 (1) :182.

[17] Wang X; Zhu L; Yang M; Chen Y; Liu Z (2024). Factors related to acupuncture response in patients with chronic prostatitis/chronic pelvic pain syndrome: secondary analysis of a randomized controlled trial World journal of urology 42 (1) :112.

[18] Zhang DQ; Fu ZH; Sun J; Song YJ; Chiu PE; Chou LW (2024). Effects of Fu's subcutaneous needling on clinical efficacy and psychological cognitive characteristics in patients with chronic non-specific low back pain: A randomized controlled trial Complementary therapies in medicine 85 :103080.

[19] Yang M; Baser RE; Liou KT; Li SQ; Piulson L; Panageas KS; Mao JJ (2023). Effect of acupuncture versus usual care on sleep quality in cancer survivors with chronic pain: Secondary analysis of a randomized clinical trial Cancer 129 (13) :2084-2094.

[20] Liu L; Skinner MA; McDonough SM; Baxter GD (2017). Acupuncture for chronic low back pain: a randomized controlled feasibility trial comparing treatment session numbers Clinical rehabilitation 31 (12) :1592-1603.

[21] Liu H; Li YP; Hou MJ; Huang WJ; Chen XL; Gao Z; Jiang Z (2023). Effect of trigger point acupuncture on pain and functional activity in patients with chronic non-specific low back pain: a randomised controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 41 (3) :130-141.

[22] He JY; Tu XY; Yin ZF; Mu H; Luo MJ; Chen XY; Cai WB; Zhao X; Peng C; Fang FF; Lu C; Li B (2024). Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain: A prospective, multicenter randomized trial Journal of integrative medicine 22 (1) :39-45.

[23] Mantuani APA; Chaves ECL; Menezes FDS; Oliveira PE; Moura CC; Carvalho LC; Iunes DH; Marino LS (2024). Laser auriculotherapy associated with cupping therapy in chronic spinal pain: Randomized controlled clinical trial Journal of bodywork and movement therapies 37 :194-201.

[24] Klassen E; Wiebelitz KR; Beer AM (2019). Classical Massage and Acupuncture in Chronic Back Pain - Non-Inferiority Randomised Trial Zeitschrift fur Orthopadie und Unfallchirurgie 157 (3) :263-269.

[25] Qin Z; Zang Z; Zhou K; Wu J; Zhou J; Kwong JSW; Liu Z (2018). Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized, Sham Acupuncture Controlled Trial The Journal of urology 200 (4) :815-822.

[26] Menezes FDS; Chaves ECL; Mantuani APA; Marino LS; Alcantara MAR; Nassif MS; de Castro Moura C; Carvalho LC; Iunes DH (2022). Effects of low-power laser auriculotherapy on chronic spinal pain: Randomized clinical trial Complementary therapies in clinical practice 48 :101578.

[27] Minakawa Y; Miyazaki S; Waki H; Yoshida N; Iimura K; Itoh K (2022). Trigger Point Acupuncture and Exercise for Chronic Low Back Pain in Older Adult: a Preliminary Randomized Clinical Trial Journal of acupuncture and meridian studies 15 (2) :143-151.

[28] Lee SW; Liong ML; Yuen KH; Krieger JN (2014). Acupuncture and immune function in chronic prostatitis/chronic pelvic pain syndrome: a randomized, controlled study Complementary therapies in medicine 22 (6) :965-9.

[29] Lu Z; Wang Q; Sun X; Zhang W; Min S; Zhang J; Zhao W; Jiang J; Wang Y; Zhu Y; Zheng L; Wang Y; Guo Y; Zhang L; Wang L; Lei C; Liu T; Yang X; Zhang J; Li C; Zhang N; Dong H; Xiong L (2021). Transcutaneous electrical acupoint stimulation before surgery reduces chronic pain after mastectomy: A randomized clinical trial Journal of clinical anesthesia 74 :110453.

[30] Moura CC; Chaves ECL; Nogueira DA; Iunes DH; Azevedo C; Correa HP; Pereira GA; Silvano HM; Macieira TGR; Chianca TCM (2022). Effect of Ear Acupuncture plus Dry Cupping on Activities and Quality of Life in the Adults with Chronic Back Pain: a Randomized Trial Journal of acupuncture and meridian studies 15 (2) :130-142.

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