Acupuncture combined therapy for the treatment of nape dorsal myofascial pain syndrome: meta-analysis, systematic evaluation, and GRADE evaluation

Objective This study aimed to assess the therapeutic efficacy and safety risks of acupuncture combined therapy in nape dorsal myofascial pain syndrome (MPS) management. Methods Clinical randomized controlled trials of acupuncture combined therapy for nape dorsal myofascial pain syndrome were retrieved from databases such as China National Knowledge Infrastructure (CNKI), VIP Chinese Journal Platform, Wanfang Data, SinoMed, Web of Science, PubMed, Embase, and Scopus, covering publications from respective inception dates until 26 February 2025. Methodological quality appraisal involved dual assessments: GRADEprofiler 3.6 evaluated evidence certainty, while the Cochrane risk of bias (RoB) 2.0 tool analyzed bias risk. Statistical computations encompassed meta-analysis, heterogeneity analysis, sensitivity analysis, subgroup analysis, publication bias analysis, and trim-and-fill methods performed using StataSE 15, stateMP 18, and RevMan 5.4. Results The systematic review incorporated 21 randomized controlled trials with a pooled cohort of 1,630 patients. ➀ Meta-analysis revealed that compared with control groups, acupuncture combined therapy can improve Visual Analogue Scale (VAS); score [standardized mean difference (SMD) = −1.51, 95% confidence interval (CI) (−2.12, −0.90), p < 0.00001], clinical effective rate [relative risk (RR) = 1.15, 95%CI (1.1, 1.2), p < 0.00001], Range of Motion (ROM); flexion [MD = 7.76, 95%CI (0.64, 14.88), p = 0.03], Pain Rating Index (PRI) score [MD = −0.45, 95%CI (−0.52, −0.38), p < 0.00001], and Oswestry score [MD = −0.30, 95%CI (−0.59, −0.01), p = 0.05]. ➁ Subgroup analysis indicated that acupuncture combined therapy demonstrated greater efficacy in pain reduction and cervical dysfunction improvement for patients with a mean age>35 years. ➂ Publication bias analysis identified potential bias for the VAS score and clinical effective rate, which may affect the reliability of VAS conclusions but not the clinical effective rate. Conclusion Acupuncture combined therapy demonstrates clinically significant short-term benefits for nape dorsal MPS in pain relief and clinical effective rate. Existing limited evidence shows a low incidence of adverse events, but the risk profile cannot be fully clarified due to insufficient safety reporting in the majority of studies. Future rigorously designed, high-quality studies with diverse populations are needed to verify these findings. Systematic review registration https://www.crd.york.ac.uk/prospero/ , Unique Identifier: CRD420251000444.