A meta-analysis of neuroimaging evidence for acupuncture-mediated modulation of altered central pain processing in patients with chronic pain
Abstract
Objective: Chronic 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.
Methods: Comprehensive 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.
Results: Seventeen 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 p p p 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.
Conclusion: Acupuncture exerts dual effects by alleviating clinical pain - exceeding the minimal clinically important difference (MCID) for VAS - and modulating brain networks implicated…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 750 participants or records.
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