Acupuncture for Myofascial Pain Syndrome: A Comprehensive Meta-Analysis Review

A 2024 systematic review and meta-analysis published in Frontiers in Neurology (2024) shows that acupuncture may alleviate symptoms of myofascial pain syndrome (MPS). By analyzing data from multiple randomized controlled trials (RCTs), the study concludes that acupuncture not only reduces pain intensity but also enhances overall treatment efficacy compared to conventional therapies. These findings highlight acupuncture's potential as a valuable treatment option for individuals suffering from this common musculoskeletal pain condition.

Key Points

• Significant Pain Reduction: Acupuncture led to a notable decrease in pain intensity measured by the Visual Analog Scale (VAS).

• Improved Pain Ratings: Patients reported better outcomes on the Pain Rating Index (PRI) and Present Pain Intensity (PPI) scales.

• Higher Treatment Efficacy: Acupuncture showed superior overall effectiveness compared to control interventions, including medication and standard care.

• Safe Therapy: No serious adverse effects were reported, highlighting acupuncture's safety profile.

• Need for Standardization: The study emphasizes the importance of optimizing acupuncture protocols for maximum therapeutic benefit.

This meta-analysis synthesized data from ten RCTs involving 852 patients, offering a robust evaluation of acupuncture's effectiveness in treating MPS. The key findings suggest that acupuncture can play a significant role in pain management strategies, especially for patients seeking non-pharmacological treatment options. By demonstrating substantial improvements in pain scores and overall treatment success, the study supports the integration of acupuncture into standard care practices for MPS.

Study Overview

Background

Myofascial pain syndrome is a chronic musculoskeletal disorder characterized by pain originating from trigger points in skeletal muscles. Affecting up to 85% of patients in pain clinics, MPS is one of the most common causes of chronic pain. Traditional treatments often involve medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. However, long-term use of these medications can lead to adverse effects such as gastrointestinal issues, renal problems, and increased risk of bleeding. As a result, there's growing interest in alternative therapies like acupuncture, which offer pain relief without the associated risks of medication side effects.

Objective

The primary aim of the meta-analysis was to evaluate the effectiveness of acupuncture in treating myofascial pain syndrome compared to conventional treatments or no treatment. By systematically reviewing existing RCTs, the study sought to provide evidence-based guidance for clinicians and patients considering acupuncture as a treatment option for MPS. The researchers aimed to determine whether acupuncture could significantly reduce pain intensity and improve overall treatment efficacy.

Methodology

The researchers conducted a comprehensive search of multiple databases, including PubMed, Cochrane Library, and Chinese medical databases, up to November 22, 2023. The inclusion criteria for studies were:

• Participants: Patients diagnosed with myofascial pain syndrome.

• Interventions: Acupuncture alone or combined with other therapies.

• Comparisons: Control groups receiving standard care, medication, or no treatment.

• Outcomes: Measures including VAS, PRI, PPI, and treatment efficacy according to traditional Chinese medicine (TCM) standards.

A total of ten RCTs involving 852 patients met the inclusion criteria, with 427 patients in the acupuncture group and 425 in the control group. The quality of the studies was assessed using the Cochrane Risk of Bias Tool, ensuring a rigorous evaluation of methodological soundness. Statistical analyses were performed using mean differences for continuous outcomes and risk ratios for dichotomous outcomes.

Key Findings

Pain Reduction

The meta-analysis revealed that acupuncture significantly reduces pain intensity in patients with MPS:

• Visual Analog Scale (VAS): Patients receiving acupuncture reported a greater reduction in VAS scores compared to control groups. The mean difference was -1.29 points (95% CI: -1.65 to -0.94; P < .00001), indicating a substantial decrease in pain levels.

• Pain Rating Index (PRI): Acupuncture led to a more pronounced decrease in PRI scores, with a mean difference of -2.04 points (95% CI: -3.76 to -0.32; P = .02).

• Present Pain Intensity (PPI): Patients in the acupuncture group showed lower PPI scores, with a mean difference of -1.03 points (95% CI: -1.26 to -0.79; P < .00001).

These results demonstrate that acupuncture is effective in reducing both the subjective experience of pain and the measurable intensity of pain symptoms in patients with myofascial pain syndrome. The significant reductions across multiple pain assessment tools underscore the robustness of acupuncture's analgesic effects.

Treatment Efficacy

Beyond pain reduction, the study assessed overall treatment efficacy based on TCM diagnostic criteria:

• Significant Efficacy Rate: The acupuncture group had a 35% higher rate of significant improvement compared to the control group (Risk Ratio: 1.35; 95% CI: 1.21 to 1.51; P < .0001).

• Total Efficacy Rate: The total effectiveness of acupuncture was also higher, with a risk ratio of 1.12 (95% CI: 1.06 to 1.18; P < .0001).

These findings suggest that acupuncture not only alleviates pain but also contributes to overall clinical improvement in patients with MPS. The higher efficacy rates indicate that patients receiving acupuncture are more likely to experience significant relief and functional improvements.

Safety Profile

An important aspect of the study was the evaluation of acupuncture's safety:

• Adverse Events: None of the included studies reported serious adverse effects associated with acupuncture treatment.

• Tolerance: Patients generally tolerated acupuncture well, further supporting its suitability as a treatment option for MPS.

The lack of significant adverse events underscores acupuncture's safety and supports its use as a non-invasive therapy with minimal risks. This is particularly relevant for patients who may be concerned about the side effects of long-term medication use.

Subgroup Analyses

The researchers conducted subgroup analyses to explore the consistency of acupuncture's effectiveness across different variables:

• Intervention Types: Both acupuncture alone and acupuncture combined with massage were effective in reducing pain and improving treatment outcomes.

• Patient Age and Pain Location: The benefits of acupuncture were consistent across different age groups and for various pain sites, including the neck, shoulder, and lower back.

These analyses reinforce the robustness of the results and suggest that acupuncture can be broadly applied to diverse patient populations with MPS. The effectiveness across different subgroups indicates that acupuncture may be a versatile treatment option regardless of patient demographics or specific pain locations.

Study Strengths

The meta-analysis possesses several strengths that enhance the credibility of its findings:

• Comprehensive Scope: By including ten RCTs with a total of 852 patients, the study provides a substantial evidence base for evaluating acupuncture's effectiveness.

• Diverse Data Sources: The inclusion of studies from both Western and Chinese databases ensures a wide representation of research on acupuncture and MPS.

• Standardized Outcome Measures: The use of validated pain assessment tools like VAS, PRI, and PPI allows for consistent comparisons across studies.

• Quality Assessment: Employing the Cochrane Risk of Bias Tool helps identify potential biases and ensures a rigorous evaluation of study quality.

• Subgroup Analyses: Exploring different subgroups enhances the understanding of how various factors may influence treatment outcomes.

These strengths contribute to the reliability of the meta-analysis and support the conclusion that acupuncture is effective for treating myofascial pain syndrome. The rigorous methodology and comprehensive approach lend weight to the study's recommendations for clinical practice.

Study Weaknesses

Despite its strengths, the study has certain limitations:

• Heterogeneity Among Studies: There was significant variability in acupuncture techniques, treatment durations, and control interventions across the included studies, which may affect the comparability of results.

• Blinding Challenges: Due to the nature of acupuncture, blinding participants and practitioners is difficult, potentially introducing performance bias.

• Variability in Diagnostic Criteria: Differences in how MPS was diagnosed and the criteria used could influence the outcomes and limit generalizability.

• Limited Adverse Event Reporting: The lack of detailed reporting on adverse effects makes it challenging to fully assess the safety profile of acupuncture.

• Short-Term Focus: Most studies evaluated immediate or short-term effects without long-term follow-up, leaving uncertainty about the sustained benefits of acupuncture.

Acknowledging these weaknesses is important for interpreting the findings cautiously and highlights the need for more standardized and rigorous future research. Addressing these limitations in future studies could strengthen the evidence base and enhance the applicability of the results.

Implications for Practice

The findings of this meta-analysis have significant implications for clinicians and patients:

Effective Pain Management Alternative

Acupuncture emerges as a viable non-pharmacological treatment option for myofascial pain syndrome:

• Reduced Reliance on Medications: Acupuncture offers pain relief without the side effects associated with long-term use of NSAIDs and muscle relaxants.

• Complementary Therapy: It can be integrated into existing treatment plans alongside conventional therapies to enhance pain management and patient outcomes.

By providing an effective alternative to medications, acupuncture can help patients who are unable or unwilling to use pharmacological treatments. It also offers an additional tool for clinicians to address chronic pain more comprehensively.

Personalized Treatment Approach

• Tailored Interventions: Acupuncture allows for customization based on individual patient needs, specific trigger points, and symptom severity.

• Holistic Care: By addressing both physical and potentially psychosomatic aspects of pain, acupuncture contributes to a more comprehensive treatment strategy.

Healthcare providers should consider discussing acupuncture as a treatment option with patients suffering from MPS, especially those seeking alternatives to medication or who have not responded adequately to conventional treatments. Incorporating patient preferences and individualizing care can improve adherence and outcomes.

Future Research Recommendations

To build upon the findings of this meta-analysis, future research should focus on:

• Standardization of Acupuncture Protocols: Developing consistent treatment methodologies, including acupuncture points, techniques, and session durations, to reduce variability among studies.

• High-Quality, Large-Scale RCTs: Conducting well-designed randomized controlled trials with larger sample sizes and rigorous methodologies to confirm the effectiveness and safety of acupuncture for MPS.

• Long-Term Follow-Up Studies: Assessing the sustained effects of acupuncture over extended periods to determine the longevity of its benefits.

• Mechanistic Studies: Investigating the biological and physiological mechanisms through which acupuncture alleviates myofascial pain to enhance understanding and acceptance within the medical community.

• Adverse Event Reporting: Ensuring comprehensive documentation of any side effects to fully establish the safety profile of acupuncture.

By addressing these areas, future research can strengthen the evidence base and facilitate the integration of acupuncture into standard care for myofascial pain syndrome. Enhanced understanding and more robust data will benefit both practitioners and patients.

Conclusion

This comprehensive meta-analysis provides strong evidence that acupuncture is an effective and safe treatment for myofascial pain syndrome. Patients receiving acupuncture experienced significant reductions in pain intensity and higher overall treatment efficacy compared to control groups receiving medication or standard care. With its favorable safety profile and potential to reduce reliance on medications, acupuncture represents a valuable addition to the range of treatment options for MPS. Clinicians should consider incorporating acupuncture into multidisciplinary pain management strategies, and further research is encouraged to optimize treatment protocols and deepen understanding of its therapeutic mechanisms.

Over to you

If you liked this article, please share with friends and family who may want to learn more about acupuncture for myofascial pain syndrome.

Sources:

• Xiong J, Zhou X, Luo X, Gong X, Jiang L, Luo Q, Zhang S, Jiang C, Pu T, Liu J, Zhang J, Li B, Chi H. Acupuncture therapy on myofascial pain syndrome: a systematic review and meta-analysis. Front Neurol. 2024 May 3;15:1374542. doi: 10.3389/fneur.2024.1374542. PMID: 38765261; PMCID: PMC11100351.

Disclaimer: This web site is intended for educational and informational purposes only. Reading this website does not constitute providing medical advice or any professional services. This information should not be used for diagnosing or treating any health issue or disease. Those seeking medical advice should consult with a licensed physician. Seek the advice of a medical doctor or other qualified health professional for any medical condition. If you think you have a medical emergency, call 911 or go to the emergency room. No acupuncturist-patient relationship is created by reading this website or using the information. Morningside Acupuncture PLLC and its employees and contributors do not make any express or implied representations with respect to the information on this site or its use.

Read more from our blog