Acupuncture for Postherpetic Neuralgia: An Evidence Mapping

Objective: This study is to systematically evaluate the efficacy of acupuncture for PHN and provide a visual overview of treatment landscape. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang Database for systematic reviews (SRs) on acupuncture for PHN up to Apr 18, 2025. Studies were included if they were SRs of randomized controlled trials (RCTs) assessing traditional Chinese acupuncture interventions for PHN, and excluded if they involved non-traditional acupuncture, herpes zoster, or PHN prevention research. Two independent reviewers utilized Excel, EndNote 20, and R software for data analysis and assessed the quality of included studies using the AMSTAR2 tool. Results: Of 351 identified records, 40 SRs met inclusion criteria, encompassing 926 RCTs, 63,493 patients, 13 types of acupuncture interventions and 29 outcomes. Acupuncture interventions, particularly fire needling, CPBLC, Fu’s subcutaneous needling, plum-blossom needle, multi-acupuncture and multi-acupuncture + pharmacotherapy, showed the most robust benefits in improving effective rate, reducing visual analog scale (VAS) scores, and decreasing adverse reactions in PHN treatment. Despite most SRs reporting positive outcomes, the quality was generally low by AMSTAR2. Conclusion: Acupuncture could be a valuable adjunct to standard PHN treatment, offering benefits in overall efficacy, pain management and treatment safety. However, high-quality clinical trials and systematic reviews are needed to confirm these preliminary results and guide clinical practice. Keywords: acupuncture, evidence mapping, postherpetic neuralgia