BACKGROUND: Extremity musculoskeletal pain (EMP) is a major contributor to chronic pain and disability worldwide, often involving tendinopathies, enthesopathies, and myofascial pain syndromes. Conventional treatments such as medications, injections, and physical therapy frequently provide only partial or short-term relief. Acupuncture, widely practiced in clinical settings, has been proposed as a safe and effective alternative or adjunctive therapy.
METHODS: A comprehensive search of PubMed, Embase, and the Cochrane Library identified studies published from January 2015 to June 2024. Eligible publications included randomized controlled trials (RCTs), systematic reviews, or meta-analyses involving adults with EMP and reporting pain or function as primary outcomes. Nineteen studies (10 RCTs, 9 reviews) met the inclusion criteria and were narratively synthesized.
RESULTS: For lateral epicondylitis (LE), manual acupuncture provided short-term benefit, while dry needling demonstrated superior long-term effects. Evidence for carpal tunnel syndrome (CTS) was insufficient, with mixed findings and high risk of bias. In patellofemoral pain syndrome (PFPS), trigger point dry needling showed short-to-medium term pain relief, though its added value in multimodal therapy was inconsistent. For plantar heel pain syndrome (PHPS), both electroacupuncture and dry needling produced significant improvements in pain and function, with benefits sustained beyond three months.
CONCLUSION: Acupuncture appears to be a safe, low-risk therapy for EMP, with strongest evidence for PHPS and LE, limited support for PFPS, and insufficient evidence for CTS. Clinically, acupuncture should be considered as part of comprehensive multimodal strategies, tailored to patient needs and preferences. Future research should focus on large-scale, standardized RCTs, direct comparisons between acupuncture modalities, and inclusion of regional and non-English studies to strengthen the global evidence base.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The title of this review fails to indicate that it also includes dry needling, which it must be emphasized is a technique that operates under different principles and objectives.
Physician rater
This review evaluates acupuncture's role in treating extremity musculoskeletal pain. For lateral epicondylitis, acupuncture relieves pain immediately, and dry needling shows better long-term results. Evidence for acupuncture in carpal tunnel syndrome is limited and low quality. Trigger-point dry needling provides moderate short- to medium-term relief for patellofemoral pain and enhances function, but its extra benefit with other therapies varies. For plantar fasciitis, dry needling offers long-lasting relief and better function, and electroacupuncture combined with warm needling also seems beneficial.
Physician rater
Acupuncture provides a low-risk, drug-free alternative for limb musculoskeletal pain, supplementing painkillers. It aims to lower risks like gastrointestinal, cardiovascular, and addiction issues. Effectiveness varies by individual, pain type, and response. Practitioner skill is crucial for optimal results. However, research limitations, such as variability and low quality, require cautious interpretation and more rigorous standardized trials.
, McMaster University