Comparison of the efficacy of acupoint stimulation therapy in the treatment of pain in musculoskeletal diseases: A network meta-analysis based on randomized controlled trials

BackgroundOrthopedic patients often present with significant pain symptoms, which can impact both the physical and mental well-being of patients, emerging as a significant concern. Given its safety, effectiveness, and absence of side effects, acupoint therapy is being increasingly utilized in the pain management of orthopedic patients. This study conducted a network meta-analysis to compare analgesic efficacy, safety, and effectiveness of acupuncture (AP), electroacupuncture (EA), moxibustion, and acupressure, so as to provide a reference for the clinical application of acupoint therapies in managing orthopedic pain.MethodsEight databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, and VIP, were searched for clinical randomized controlled trials (RCTs) investigating the effects of AP, EA, moxibustion, and acupressure on orthopedic pain. The quality of the included documents was evaluated using the Cochrane Risk of Bias Tool, and graphs regarding the risk of bias and network meta-analysis were drawn by Revman 5.2, Stata 18.0 and R software (v4.3.2). Intervention ranking probabilities were quantified using SUCRA values derived from a Bayesian random-effects model.Results1) For decreasing Visual Analogue Scale (VAS) scores in patients with orthopedic pain, moxibustion therapy was identified as the optimal intervention (SUCRA=94.84%); 2) For decreasing VAS scores in patients with orthopedic pain undergoing surgical intervention, AP therapy was identified as the optimal intervention (SUCRA=76.99%); 3) For decreasing VAS scores in patients with orthopedic pain not undergoing surgical intervention, moxibustion therapy was identified as the optimal intervention (SUCRA=90.26%); 4) AP therapy (SUCRA=83.73%) demonstrated the most favorable safety profile; 5) Acupressure therapy (SUCRA=77.93%) was identified as the most effective therapeutic method.ConclusionIt is recommended to select differentiated acupoint therapies tailored to the type of orthopedic pain. Specifically, post-operative patients with orthopedic pain should prioritize AP, while moxibustion is advised for non-surgical patients.