Shoulder Pain

2022 Frontiers in Medicine

Electroacupuncture may be more effective than manual acupuncture for managing frozen shoulder, with larger effect sizes in terms of pain, function, and response rate.

This review included thirteen studies involving 936 patients. The EA group exhibited improvements in FS pain, function, and response rates over the manual acupuncture (MA) group. As an adjunct treatment, EA improved FS pain compared to the control treatments. No adverse effects were reported.

EA was found to be an efficacious method for treating FS in this review. The meta-analysis showed that EA led to a greater reduction of FS pain than MA did, although with a very low certainty of evidence. In comparison to MA, EA led to a superior degree of functional improvement in FS patients, with a very low certainty of evidence. In comparison to MA, EA enhanced the response rate of FS, again with a low certainty of evidence. Compared with WM used in isolation, EA plus WM reduced FS pain with a low certainty of evidence.

Electroacupuncture for the treatment of frozen shoulder: A systematic review and meta-analysis Heo JW, Jo JH, Lee JJ, Kang H, Choi TY, Lee MS, Kim JI

2022 Perspectives on Integrative Medicine

Acupuncture is safe and may be a cost-effective treatment for shoulder pain.

There were 131 statements recommending the use of acupuncture for shoulder pain across 12 subtypes of shoulder pain. The most common statements were for non-specific ‘shoulder pain.’ There were 11 statements against the use of acupuncture for shoulder pain and three subtypes of shoulder pain. The level of evidence in studies of acupuncture treatment for shoulder pain is low, therefore, further research is needed. Recommendations for the use of acupuncture for shoulder pain are increasing but lag behind those for other pain problems such as low back pain.

Shoulder Pain and the Potential Role of Acupuncture: A Narrative Review of Clinical Practice and Treatment Guidelines Birch S, Lee MS, Kim TH, Alraek T

2021 American Journal of Translational Research

Massage combined with acupuncture can better improve the range of motion of joints and daily living ability of patients with frozen shoulder complicated with cervical spondylosis.

A total of 164 patients with frozen shoulder treated in our hospital from June 2016 to April 2019 were recruited and divided into a control group and an observation group. There were 100 cases in the observation group, all of whom were treated with massage combined with acupuncture. Another 64 cases were enrolled in the control group, all of whom were treated with acupuncture alone. The recovery of myodynamia, rating scale of the American Shoulder and Elbow Surgeons (ASES), score of American Spinal Injury Association (ASIA), ROM score, vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1), complication rate, total effective rate, and patient satisfaction were assessed.

After treatment, patients in the observation group had better recovery of myodynamia than the control group. They also had lower VAS scores, higher life function score and total ASES scores, higher ASIA scores, higher ROM scores, lower VCAM-1 and ICAM-1 expression, lower complication rate, higher total effective rate, and higher patient satisfaction.

Effects of massage and acupuncture on the range of motion and daily living ability of patients with frozen shoulder complicated with cervical spondylosis Liu M, Liu Y, Peng C, Wang H, Xu Y, Jiao S, Ding Y

2020 Evidence-Based Complementary and Alternative Medicine

Acupuncture could be safe and effective for pain reduction, restoring shoulder function, and restoring flexion range of motion for frozen shoulder patients in the short term and midterm.

In this systematic review and a meta-analysis, acupuncture had shown to be a safe treatment with a significant effect in regard to reducing pain, improving shoulder function, and flexion ROM in the short term and midterm. However, due to the small number of included studies and methodological limitations in these studies, more large-scale high-quality RCTs are warranted in order to give a robust conclusion. Future studies should compare acupuncture to other treatments and sham acupuncture. Additionally, longer follow-up time is needed for investigating the effect of acupuncture in the mid- and long term, and the duration of future FS studies follow-up should be increased to one year.

The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis Ben-Arie E, Kao PY, Lee YC, Ho WC, Chou LW, Liu HP

2019 Frontiers in Neurology

Acupuncture therapy seems effective for motor function, pain relief and activities of daily living in stroke patients with mild Shoulder-Hand Syndrome, when it is used in combination with rehabilitation.

This systematic review shows that adding acupuncture to routine rehabilitation can improve clinical outcomes (pain and motor function) for people with mild post-stroke SHS. However, the evidence was assessed as “low” by GRADE due to the methodological limitations and heterogeneity of included studies, which made our certainty in recommending acupuncture for this condition in clinical practice as “low.” Well-designed placebo-controlled RCTs with a long treatment duration and follow up, as well as standardized reporting, are needed to support acupuncture's safe and effective use in the management of post-stroke SHS.

Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis Liu, S., Zhang, C. S., Cai, Y., Guo, X., Zhang, A. L., Xue, C. C., & Lu, C

2018 Clinical Rehabilitation

Current evidence suggests that traditional manual acupuncture integrated with rehabilitation therapy is more effective in alleviating pain, improving limb movement and activities of daily living.

A total of 20 studies involving 1918 participants were included in this study. Compared to rehabilitation therapy alone, the combined therapy significantly reduced pain on the visual analogue scale and improved limb movement on the Fugl–Meyer Assessment scale and the performance of activities of daily living (ADL) on the Barthel Index scale or Modified Barthel Index scale. Of these, the visual analogue scale score changes were significantly higher favoring the combined therapy after treatment, with severe heterogeneity.

Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis Peng, L., Zhang, C., Zhou, L., Zuo, H. X., He, X. K., & Niu, Y. M. (

2018 Frontiers in Neurology

Most studies reviewed concluded that conventional and electroacupuncture could be effective for management of shoulder pain after stroke.

This review suggests that conventional acupuncture and electroacupuncture could be effective treatments for survivors with poststroke shoulder pain, with regard to reducing pain and improving upper extremity function and physical function. However, the results of this review should be interpreted with consideration of its limitations.

Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review Chau, J., Lo, S., Yu, X., Choi, K. C., Lau, A., Wu, J., Lee, V., Cheung, W., Ching, J., & Thompson, D. R.

2018 Evidence-Based Complementary and Alternative Medicine

Compared with other therapies, acupuncture at ST38 appeared to reach a better therapeutic effectiveness in improving the recovery of shoulder joint mobility.

The results of our meta-analysis revealed significant differences in acupuncture at Tiaokou (as sole treatment or in combination with shoulder acupoints) versus other therapies (acupuncture at shoulder acupoints, tuina, exercise of the affected shoulder, and oral NSAIDs) for the relief of shoulder pain. What is more, compared with other therapies, acupuncture at Tiaokou appeared to reach a better therapeutic effectiveness in improving the recovery of shoulder joint mobility.

Acupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Yang C, Lv TT, Yu TY, Wong S, Lu MQ, Li YZ

2017 The Journal of Pain

Acupuncture has a clinically relevant effect on chronic pain that persists over time. Referral for acupuncture treatment is a reasonable option for chronic pain patients.

We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to sham as well as no acupuncture control for each pain condition (all P < .001) with differences between groups close to .5 SDs compared with no acupuncture control and close to .2 SDs compared with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year.

Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.

Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis Vickers, Andrew J. et al.

2017 Pain Medicine

Our study provides evidence that acupuncture has a specific impact on frozen shoulder beyond the placebo effects that may not only be beneficial in reducing short-term pain perception, but may also have a positive long-term influence on the time course of recovery.

Primary adhesive capsulitis ("frozen shoulder") is a common disorder associated with pain and significant morbidity in humans worldwide. This first double-blinded (patient- and observer-blinded) study in patients with AC showed the efficiency of our special distal needling protocol by systematic combination of acupoints for immediate pain reduction. The study also confirmed the suitability of press tack needles and press tack placebos as an effective option for double-blind studies in acupuncture. The follow-up clinical observation with classical needle acupuncture confirmed that results obtained with the press tack placebos/press tack needles design can be transferred to classical needle acupuncture. Furthermore, conservative therapy that included acupuncture represented a superior effectiveness on the time course of recovery in AC patients compared with patients treated with conservative therapy alone in a standard clinical setting.

Immediate Pain Relief in Adhesive Capsulitis by Acupuncture—A Randomized Controlled Double-Blinded Study Schröder S, Meyer-Hamme G, Friedemann T, Kirch S, Hauck M, Plaetke R, Friedrichs S, Gulati A, Briem D

2012 The Journal of Alternative and Complementary Medicine

Acupuncture combined with exercise is effective for shoulder pain after stroke.

It was found in this review of reported RCTs that acupuncture is an effective treatment for shoulder pain after stroke. Acupuncture can be considered as an adjuvant therapy in combination with exercise for rehabilitation of the stroke patients who are suffering from shoulder pain. Further trials concerning this topic should be conducted according to the highest methodological standards for certainty.

Acupuncture for Shoulder Pain After Stroke: A Systematic Review Jung Ah Lee, Si-Woon Park, Pil Woo Hwang, Sung Min Lim, Sejeong Kook, Kyung In Choi, and Kyoung Sook Kang.