Review of modern approaches to the treatment of patients with musculoskeletal disorders and diseases using traditional Chinese medicine (TCM) – acupuncture
The relevance of the study is due to the substantial spread of diseases of the musculoskeletal system and the need for effective non-drug treatment methods. Its purpose was to analyse scientific data on clinical efficacy, physiological mechanisms of action, and innovative approaches to the use of acupuncture in the treatment of musculoskeletal pathologies. The study was a literature review of scientific publications of 2019-2025 using a comprehensive three-stage methodological approach, which included the analysis of published data on the clinical effectiveness of acupuncture on standardised scales and questionnaires, generalisation of research on neurophysiological mechanisms of action, and systematisation of modern innovative protocols presented in the scientific literature. An analysis of clinical studies showed that the effectiveness of acupuncture varies depending on techniques and nosological forms, with the highest level of evidence for chronic lower back pain and osteoarthritis. After a course of acupuncture (2-3 sessions per week, with a total duration of 4-8 weeks), a decrease in pain intensity on the visual-analogue scale was recorded by 2.87-4.1 points and an improvement in functional indicators by 9.5-20.3%. Based on the generalisation of the data, two theoretical models were formulated: a triune concept of therapeutic action of acupuncture, which covers physiological (reduction of pain symptoms), functional (restoration of motor activity), and psychoemotional (normalisation of psychological state) components and an integrative model of effectiveness in chronic pain, which includes short-term anaesthesia through neuromodulation, improvement of local microcirculation, and functional restoration of muscle-fascial structures. The examination of neurophysiological mechanisms demonstrated that the therapeutic effect of acupuncture is mediated by activation of the endogenous opioid system, modulation of inflammatory cytokines, and neuroplastic changes in brain networks, which is confirmed by neuroimaging methods. The study also systematised current innovations in acupuncture practice, including optimisation of treatment protocols, group forms of therapy, and telemedicine models. Integrative approaches that combined acupuncture with traditional treatments showed better results in 83% of the analysed studies compared to monocomponent interventions. The results of the study confirm the clinical effectiveness of various acupuncture techniques in diseases of the musculoskeletal system, which is justified by the complex effect on the neurophysiological mechanisms of pain modulation and proves the feasibility of including the method in standard therapeutic protocols
chronic pain; functional state; therapeutic effect; pain syndrome; integrative approach
https://doi.org/10.63341/ijmmr/1.2025.105- World Health Organization. Musculoskeletal health [Internet]. 2022 [cited 2025 February 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
- Skrypnykov PM, Skrypnikova TP, Lupatsa NA, Raskolupa NV, Ostrovska GY, Titarenko VI, et al. Oral health status of internally displaced persons. Ukrain Dent Alman. 2023;1:12–6. DOI: 10.31718/2409-0255.1.2023.02
- Rademacher A. Complementary medicine: Acupuncture. In: Maziarz RT, Slater SS, editors. Blood and marrow transplant handbook. Cham: Springer; 2021. P. 747–57. DOI: 10.1007/978-3-030-53626-8_46
- Akçalı D, Çevik C. Potential role of acupuncture. In: Özge A, Uludüz D, Karadaş Ö, Bolay H, editors. Peripheral interventional management in headache. Cham: Springer; 2019. P. 87–95. DOI: 10.1007/978-3-030-10853-3_11
- Patel P, Sabia M, Patheja J, Kapoor R, Mathias T, Murtaza T. Acupuncture and its effects on chronic pain. Coop Row Med J. 2020;2(1):84–97. DOI: 10.31986/ISSN.2578-3343_VOL2ISS1.7
- Urits I, Patel M, Putz MF, Monteferrante NR, Nguyen D, An D, et al. Acupuncture and its role in the treatment of migraine headaches. Neurol Therap. 2020;9:375–94. DOI: 10.1007/S40120-020-00216-1
- Iskandarani SE, Deng G. Acupuncture in hematologic malignancies and hematopoietic cell transplantation. Blood Rev. 2022;56:100985. DOI: 10.1016/J.BLRE.2022.100985
- Halámková J, Dymáčková R, Krákorová AD. Acupuncture from the perspective of evidence-based medicine – options of clinical use based on National Comprehensive Cancer Network (NCCN) guidelines. Klin Onk. 2022;35(2):94–9. DOI: 10.48095/CCKO202294
- Zhu J, Li J, Yang L, Liu S. Acupuncture, from the ancient to the current. Anat Rec. 2021;304(11):2365–71. DOI: 10.1002/AR.24625
- Litscher G. The human touch in acupuncture: A future with artificial intelligence? OBM Integ Com Med. 2025;10(1):003. DOI: 10.21926/OBM.ICM.2501003
- Guideline 00393. Acupuncture [Internet]. 2014 February 7 [cited 2025 February 12]. Available from: https://guidelines.moz.gov.ua/documents/3256
- Tan H, Tumilty S, Chapple C, Huang G, Baxter G. Sensitized-points acupuncture versus routine integrative acupuncture for chronic low back pain: A randomized-controlled feasibility study. J Back Musc Rehabil. 2025;38(1):101–12. DOI: 10.1177/10538127241289343
- Comachio J, Oliveira CC, Silva IFR, Magalhães MO, Marques AP. Effectiveness of manual and electrical needle stimulation in acupuncture for chronic nonspecific low back pain: A randomized controlled trial. J Acupun Merid Stud. 2020;13(3):87–93. DOI: 10.1016/J.JAMS.2020.03.064
- Dastjerdi MJ, Azadvari M, Kordafshari G, Zhao B, Adel-Mehraban M, Alipour R, et al. Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: A randomized clinical trial. Ann Med Surg. 2024;86(5):2729–38. DOI: 10.1097/MS9.0000000000001944
- Torres SF, De Macedo ACB, Sakai RY, Bressan GCS, dos Santos MBR, Marques AP. Effect of different frequencies of electroacupuncture on chronic low back pain in older adults: A triple-blind, placebo-controlled, randomized clinical trial. Pain Physic. 2023;26:161–3. DOI: 10.36076/PPJ.2023.26.161
- DeBar LL, Justice M, Avins A, Cook A, Eng CM, Herman PM, et al. Acupuncture for chronic low back pain in older adults: Design and protocol for the BackInAction pragmatic clinical trial. Contemp Clinic Trials. 2023;128:107166. DOI: 10.1016/J.CCT.2023.107166
- Li T, Wang S, Zhang S, Shen X, Song Y, Yang Z, et al. Evaluation of clinical efficacy of silver-needle warm acupuncture in treating adults with acute low back pain due to lumbosacral disc herniation: Study protocol for a randomized controlled trial. Trials. 2019;20:470. DOI: 10.1186/S13063-019-3566-2
- Lv X, Su Y, Wu C, Gu C, Li J, Wang I. Effects of time-dependent acupuncture on back muscle endurance in women with chronic nonspecific low back pain: A randomized crossover trial. J Back Muscul Rehabil.2024;38(3):434–52. DOI: 10.3233/BMR-240213
- Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block, et al. 2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2020;72(2):149–62. DOI: 10.1002/ACR.24131
- Zhu RX, Li X, Yan ZB, Chen C, Zhai W, Zhang HC, et al. Efficacy and safety of acupuncture with moxibustion for knee osteoarthritis: A meta-analysis of randomized controlled trials. System Rev. 2025;14:15. DOI: 10.1186/S13643-025-02762-X
- Li J, Yang J, Wu S, Wang MR, Zhu JM. Effects of acupuncture on rheumatoid arthritis: A systematic review and meta-analysis. Afr J Tradit Complement Altern Med. 2016;13(2):61–71. DOI: 10.4314/AJTCAM.V13I2.8
- Zhang XC, Chen H, Xu WT, Song YY, Gu YH, Ni GX. Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. J Pain Res. 2019;12:527–42. DOI: 10.2147/JPR.S186227
- Navarro-Santana MJ, Sanchez-Infante J, Fernandez-de-Las-Peñas C, Cleland JA, Martin-Casas P, Plaza-Manzano G. Effectiveness of dry needling for myofascial trigger points associated with neck pain symptoms: An updated systematic review and meta-analysis. J Clin Med. 2020;9(10):3300. DOI: 10.3390/JCM9103300
- Cavaggioni L, Gilardini L, Redaelli G, Croci M, Capodaglio P, Gobbi M, et al. Effects of a randomized home-based quality of movement protocol on function, posture and strength in outpatients with obesity. Healthcare. 2021;9(11):1451. DOI: 10.3390/HEALTHCARE9111451
- Chen YJ, Chen CT, Liu JY, Bassi GS, Yang YQ. What is the appropriate acupuncture treatment schedule for chronic pain? Review and analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2019;2019(1):5281039. DOI: 10.1155/2019/5281039
- Zou X, Yang J, Lin L, Qi L, Wang Y, Yan S, et al. Optimization and implementation of clinical trial of acupuncture: Reflection on the successful case of acupuncture for postprandial distress syndrome. Chin Acupunct Moxibus. 2021;41(11):1276–80. DOI: 10.13703/J.0255-2930.20201109-0005
- Ginnerup-Nielsen E, Christensen R, Bliddal H, Henriksen M. Effect of research participation versus usual clinical care in patients with rheumatic and musculoskeletal disorders: A prospective cohort study. RMD Open. 2023;9:e003414. DOI: 10.1136/RMDOPEN-2023-003414
- Chan SC, Engkasan JP. Does acupuncture improve pain and function in people with hip osteoarthritis? A cochrane review summary with commentary. Intern J Rheum Diseas. 2020;23(12):1741–3. DOI: 10.1111/1756-185X.13948
- Epstein AS, Liou KT, Romero SAD, Baser RE, Wong G, Xiao H, et al. Acupuncture versus massage for pain in patients living with advanced cancer: The IMPACT randomized clinical trial. AMA Netw Open. 2023;6(11):e2342482. DOI: 10.1001/JAMANETWORKOPEN.2023.42482
- Trinh K, Belski N, Zhou F, Kuhad A, Luk D, Youn E. The efficacy of acupuncture on foot and ankle for pain intensity, functional status, and general quality of life in adults: A systematic review. Med Acupunct. 2021;33(6). DOI: 10.1089/ACU.2021.0006
- Lu M, Sharmin S, Tao Y, Xia X, Yang G, Cong Y, et al. Effectiveness of acupuncture in treating patients with pain and mental health concerns: The results of the Alberta Complementary Health Integration Project. Front Neurol. 2024;15:1366685. DOI:10.3389/FNEUR.2024.1366685
- Tang CT, Sookochoff M, Rhea L, Carrier J, Prather H, Guan L. An audit of structure-based medical acupuncture by a single provider in patients with musculoskeletal pain using PROMIS scores as the outcome. Acupunct Med. 2023;41(1):48–54. DOI: 10.1177/09645284221118589
- Lyu Z, Guo Y, Gong Y, Fan W, Dou B, Li N, et al. The role of neuroglial crosstalk and synaptic plasticity-mediated central sensitization in acupuncture Analgesia. Neural Plastic. 2021;2021(1):8881557. DOI: 10.1155/2021/8881557
- Zhou M, Zhang Q, Huo M, Song H, Chang H, Cao J, et al. The mechanistic basis for the effects of electroacupuncture on neuropathic pain within the central nervous system. Biomed Pharm. 2023;161:114516. DOI: 10.1016/J.BIOPHA.2023.114516
- Hsiao IH, Liao HY, Lin YW. Optogenetic modulation of electroacupuncture analgesia in a mouse inflammatory pain model. Scient Rep. 2022;12:90167. DOI: 10.1038/S41598-022-12771-8
- Gao Y, Wang J, Han Y, Liu J. Κ-opioid receptor is involved in electroacupuncture analgesia via inhibition of spinal microglial Toll-like receptor 4 in neuropathic pain rats. Acupunct Res. 2022;47(2):95–100. DOI: 10.13702/J.1000-0607.201112
- Ding SS, Xu Y, Zhang YY, Chen JZ, Hong SH. An hypothesis for CXCL1/CXCR2 signaling regulating neutrophil-derived opioid peptides involved in acupuncture for inflammatory pain. Evid Based Complement Alternat Med. 2021;2021(1):6671195. DOI: 10.1155/2021/6671195
- Ma X, Chen W, Yang NN, Wang L, Hao XW, Tan C, et al. Potential mechanisms of acupuncture for neuropathic pain based on somatosensory system. Front Neurosci. 2022;16:940343. DOI: 10.3389/FNINS.2022.940343
- Qi M, Wang Y, Zhang Y, Feng Y, Liu B. Potential neural mechanisms of acupuncture therapy on migraine: A systematic review and activation likelihood estimation meta-analysis update. Quantit Imag Med Surg. 2025;15(2):1653–68. DOI: 10.21037/QIMS-24-916
- Saha DK, Bohsali A, Saha R, Hajjar I, Calhoun VD. Neuromark PET: A multivariate method for estimating whole brain fMRI guided intrinsic networks and connectomes from fMRI and PET data. bioRxiv. 2025. DOI: 10.1101/2024.01.10.575131
- Lv Q, Xu G, Pan Y, Liu T, Liu X, Miao L, et al. Effect of acupuncture on neuroplasticity of stroke patients with motor dysfunction: A meta-analysis of fMRI studies. Neural Plastic. 2021;2021(1):8841720. DOI: 10.1155/2021/8841720
- Madsen SS, Hvidsten S, Andersen TL. Functional FDG-PET: Measurement of task related neural activity in humans – a compartment model approach and comparison to fMRI. Diagnostics. 2023;13(19):3121. DOI: 10.3390/DIAGNOSTICS13193121
- Liu Z, Wen C, Zhang S. Stimulated oxygen transport in tissue by magnetic needle acupuncture. bioRxiv. 2021. DOI: 10.1101/2021.02.01.426016.
- Yu WL, Park JY, Park HJ, Kim SN. Changes of local microenvironment and systemic immunity after acupuncture stimulation during inflammation: A literature review of animal studies. Front Neurol. 2022;13:1086195. DOI: 10.3389/FNEUR.2022.1086195
- Perdrizet JA, Shiau DS, Xie H. The serological response in dogs inoculated with canine distemper virus vaccine at the acupuncture point governing vessel-14: A randomized controlled trial. Vaccine. 2019;37(13):1889–96. DOI: 10.1016/J.VACCINE.2018.10.076
- Fan AY. Anti-inflammatory mechanism of electroacupuncture involves the modulation of multiple systems, levels and targets and is not limited to “driving the vagus-adrenal axis”. J Integrat Med. 2023;21(4):320–3. DOI: 10.1016/J.JOIM.2023.06.001
- Hwang YC, Lee IS, Ryu Y, Lee MS, Chae Y. Exploring traditional acupuncture point selection patterns for pain control: Data mining of randomised controlled clinical trials. Acupunct Med. 2020;39(9):184–91. DOI: 10.1177/0964528420926173
- Mao JJ, Liou KT, Baser RE, Bao T, Panageas KS, Romero SAD, et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: The PEACE randomized clinical trial. JAMA Oncol. 2021;7(5):750–7. DOI: 10.1001/JAMAONCOL.2021.0310
- Bao T, Zhi WI, Baser RE, Li QS, Weitzman M, Gillespie EF, et al. Electro-acupuncture versus battle field auricular acupuncture in breast cancer survivors with chronic musculoskeletal pain: Subgroup analysis of a randomized clinical trial. Breast Cancer Res Treat. 2023;202:287–95. DOI: 10.1007/S10549-023-07072-1
- Hung YC, Lin PY, Chiu HE, Huang PY, Hu WL. The effectiveness of laser acupuncture for treatment of musculoskeletal pain: A meta-analysis of randomized controlled studies. J Pain Res. 2021;14:1707–19. DOI: 10.2147/JPR.S308876
- Pugazhendi S, Rajamani P, Daniel A, Pugazhendi K. Non-invasive complementary therapies in managing musculoskeletal pains and in preventing surgery. Intern J Therap Massag Bodyw. 2020;13(2):9–18. DOI: 10.3822/IJTMB.V13I2.493
- Dilaveri CA, Croghan IT, Mallory MJ, Dion LJ, Fischer KM, Schroeder DR, et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. J Altern Compl Med. 2020;26(7). DOI: 10.1089/ACM.2019.0479
- Ha D, Kim S, Baek Y, Won J, Nam S, Shin J, et al. Current research trends in randomized controlled trials investigating the combined effect of Korean medicine and western medicine treatment. J Acupunct Res, 37(1):13–8. DOI: 10.13045/JAR.2019.00318
- McKee MD, Nielsen A, Anderson B, Chuang E, Connolly M, Gao Q, et al. Individual vs. group delivery of acupuncture therapy for chronic musculoskeletal pain in urban primary care – a randomized trial. J Gen Intern Med. 2020;35:1227–37. DOI: 10.1007/S11606-019-05583-6
- Ribagin S, Grozeva A, Popova G. Generalized net model of telerehabilitation program for patients with socially significant diseases. In: Sotirov SS, Pencheva T, Kacprzyk J, Atanassov KT, Sotirova E, Staneva G, editors. Contemporary methods in bioinformatics and biomedicine and their applications. Cham: Springer; 2022. P. 91–9. DOI: 10.1007/978-3-030-96638-6_10
- Jiang YB, Guan L, Li Y, Shu M, Cui BC, Huang ZY. Efficacy analysis of acupuncture and rehabilitation for traumatic spinal cord injury. Medicine. 2025;104(2):e41245. DOI: 10.1097/MD.0000000000041245