What question did this study set out to answer?

This research aims to evaluate acupuncture's effects on brain networks involved in altered pain processing and validate its clinical effectiveness in managing chronic pain.

May 5, 2026Open Access

A meta-analysis of neuroimaging evidence for acupuncture-mediated modulation of altered central pain processing in patients with chronic pain

Key Points

This research aims to evaluate acupuncture's effects on brain networks involved in altered pain processing and validate its clinical effectiveness in managing chronic pain.
Conducted a systematic review and meta-analysis of RCTs from English and Chinese databases (2016–2025) focusing on acupuncture for chronic pain with neuroimaging.
Independently selected studies, extracted data, and assessed bias by two researchers.
Utilized RevMan 5.4 for meta-analysis, assessing heterogeneity and evidence quality via GRADE.
Acupuncture improved neuroimaging indicators in areas like the anterior cingulate cortex (ACC) and thalamus (MD = 0.30, p < 0.00001).
Clinically, it significantly reduced Visual Analogue Scale scores (MD = -2.31, p < 0.00001) and increased pain relief rate (OR = 4.30, p < 0.00001).
Efficacy was especially pronounced for osteoarticular pain, with high-quality evidence rated by GRADE.

Abstract

ObjectiveChronic pain, a major global public health burden, is primarily driven by altered central pain processing, which conventional treatments rarely target directly. This systematic review and meta-analysis synthesized RCT evidence to quantify acupuncture’s modulatory effects on brain networks associated with altered central pain processing, validate its clinical efficacy/safety, and explore brain network-clinical outcome associations.MethodsComprehensive searches of English/Chinese databases (2016–2025) identified RCTs of acupuncture for chronic pain with neuroimaging. Two researchers independently performed study selection, data extraction, and bias assessment. Meta-analysis used RevMan 5.4; heterogeneity was evaluated via I2/Q test, with correlation analysis and GRADE evidence quality assessment.ResultsSeventeen high-quality RCTs comprising 750 patients, with osteoarticular pain and migraine as main subtypes, were included. Acupuncture significantly improved neuroimaging indicators in the anterior cingulate cortex (ACC) and insula (MD = 0.27, p < 0.00001), primary somatosensory cortex (S1) and thalamus (MD = 0.30, p < 0.00001), and default mode network (DMN) (MD = 0.29, p < 0.00001). Clinically, acupuncture reduced Visual Analogue Scale (VAS) scores (MD = -2.31, p < 0.00001) and increased pain relief rate (OR = 4.30, p < 0.00001), with only mild adverse events reported. Osteoarticular pain demonstrated more pronounced efficacy. No significant publication bias was detected. The GRADE assessment rated the evidence for pain relief rate as high.ConclusionAcupuncture exerts dual effects by alleviating clinical pain - exceeding the minimal clinically important difference (MCID) for VAS - and modulating brain networks implicated in altered central pain processing. It is a safe and valuable non-pharmacological intervention, with standardized protocols and subtype-specific application recommended. However, the evidence is constrained by a limited number of studies, heterogeneity in pain subtypes and neuroimaging modalities, and short follow-up durations. Larger RCTs and multimodal neuroimaging studies are needed for further validation.Systematic review registrationRegistered in PROSPERO (CRD420261290299); URL: https://www.crd.york.ac.uk/prospero/.

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