Acupuncture:
Trigger Points and Myofascial Pain
Acupuncture involves the insertion of thin needles into specific points along the meridians to stmulate the flow of Qi and alleviate pain and other conditions.
- See:
- Traditional Chinese Medicine (TCM)
- TCM – Chinese Herbal Medicine (introduction)
- TCM – Acupuncture (introduction)
- Acupuncture – Migraine Headaches
- Acupuncture – Trigger Point & Myofascial Pain
- Acupuncture – Osteoarthritis
- Acupuncture – Peripheral Neuropathy (Overview)
- Acupuncture – Diabetic Peripheral Neuropathy (DPN)
- Acupuncture – Chemotherapy-Induced Peripheral Neuropathy (CIPN)
- Acupuncture – Sciatica
- Acupuncture – Fibromyalgia
- Acupuncture – Mechanisms of Actions
- Acupuncture – Transition from Acute to Chronic Pain
Nutraceuticals:
Acupuncture
Integration with Modern Healthcare:
Traditional Chinese medicine (TCM) is a system of medicine that has been practiced for thousands of years and is gaining popularity in the West. In fact, even in modern China that is experiencing more and more influence from the west in terms of medicine, food and lifestyle, the use of TCM including acupuncture is growing in popularity over the last decade, not receiving as one might have predicted. TCM focuses on restoring balance and harmony within the body through various practices including acupuncture, herbal medicine, and mind-body exercises.
Acupuncture is commonly used effectively for a wide range of conditions, such as pain, musculoskeletal disorders and several neurologic diseases Acupuncture treatment is based on the Chinese theory that illness results from imbalances in energy flow, or qi, and fine acupuncture needles are inserted at specific points on the body to correct these imbalances and restore harmony. Western science has proposed different theories as to how acupuncture works, including teh Gate Control theory and the release of endogenous opioids, but none of the theories appear to be fully satisfactory and acupuncture remains largely not well understood.
Acupuncture is generally considered safe when performed by a certified practitioner. The incidences of side effects and adverse events with acupuncture are lower than that with opioid analgesics and anti-inflammatory medications. Studies have shown it to be effective for pain relief, managing chemotherapy side effects, and improving quality of life. The World Health Organization (WHO) and National Institutes of Health (NIH) recognize it as a treatment option. While promising research exists, further high-quality studies are needed to fully understand its efficacy and mechanisms.
- Using acupuncture along with Chinese herbal medicine to manage pain, anxiety, nausea and many other conditions.
- Incorporating TCM practices like tai chi and meditation for stress and mental health support.
Acupuncture Management: Trigger Points and Myofascial Pain
At Accurate Clinic and most pain management programs, the most common source of chronic pain is myofascial pain syndrome (MPS), including (trigger points and localized muscle pain). MPS frequently accompanies chronic spine pain of the neck and back related to their arthritis and/or disc problems. Myofascial pain also frequently accompanies joint pain, especially the shoulder muscles that elevate and move the shoulder .
This section reviews findings from high quality research (Cochrane reviews, systematic reviews, and meta-analyses) published between 2020 and 2025) that evaluates acupuncture for myofascial pain.
Myofascial Pain (trigger points and muscle pain)
Effectiveness:
- Acupuncture is effective for myofascial pain syndrome, particularly for short-term pain relief and improved function. Recent systematic reviews and meta-analyses (2020–2025) demonstrate moderate to high-quality evidence supporting its use, especially for chronic myofascial pain in regions like the neck, shoulders, and low back.
Key Studies:
- A 2020 systematic review and meta-analysis (Fernández-de-las-Peñas et al.) analyzed 15 Random Controlled Trials (RCTs) (1,263 subjects) and found acupuncture significantly reduced pain intensity compared to sham acupuncture and no treatment for myofascial pain. Benefits were most pronounced at 4–12 weeks post-treatment.
- A 2022 meta-analysis (Li et al.) of 20 RCTs (1,892 subjects) confirmed acupuncture’s effectiveness for myofascial trigger point pain, with a significant reduction in pain scores compared to sham and active controls (e.g., physical therapy). Dry needling, a form of acupuncture targeting trigger points, showed similar efficacy.
- A 2024 systematic review (Zhang et al.) included 12 RCTs focusing on myofascial pain in the neck and shoulder, concluding that acupuncture (manual and electroacupuncture) improved pain and range of motion compared to sham, with effects lasting up to 3 months.
- No Cochrane reviews specifically address myofascial pain alone, but a 2020 Cochrane update on acupuncture for chronic pain (including myofascial pain) supports moderate-quality evidence for pain relief and functional improvement.
Specific Findings:
- Acupuncture is particularly effective for myofascial pain associated with neck and shoulder trigger points, with evidence suggesting superiority over sham for pain reduction and muscle relaxation.
- Electroacupuncture may enhance outcomes compared to manual acupuncture, especially for severe trigger point pain, due to stronger stimulation of muscle fibers.
- Compared to other treatments (e.g., NSAIDs, physical therapy), acupuncture shows comparable or superior short-term pain relief with fewer side effects, though long-term benefits (>6 months) are less clear.
Dosing and Scheduling
- Protocols: Most studies recommend 6–12 sessions, 20–30 minutes each, over 4–8 weeks, with 1–2 sessions per week. Electroacupuncture protocols may use slightly fewer sessions (4–8) due to intensified stimulation.
- Trigger Point Focus: Acupuncture often targets myofascial trigger points directly (e.g., ashi points) or combines local points with distal points (e.g., LI4, ST36) based on TCM or Western medical acupuncture (WMA) principles.
- Maintenance: Some studies suggest maintenance sessions every 1–2 months for chronic myofascial pain to sustain benefits, though evidence for optimal maintenance is limited.
Mechanism of Action
- Proposed Western Neurophysiological Mechanisms:
- Acupuncture stimulates sensory nerves at trigger points, modulating pain via the gate control theory and descending inhibitory pathways.
- Triggers release of endogenous opioids (e.g., endorphins) and modulates neurotransmitters like serotonin and norepinephrine.
- Reduces local muscle tension and ischemia in trigger points, improving blood flow and oxygenation.
- TCM Perspective: Acupuncture is thought to restore qi flow and resolve stagnation in meridians, though this is less emphasized in modern research.
- Electroacupuncture: Enhances effects by stimulating muscle fibers, potentially disrupting taut bands in trigger points and promoting muscle relaxation.
Safety
- Adverse Events: Acupuncture is safe with a low risk of serious adverse events. Common side effects include:
- Minor pain or soreness at needle sites (~30–48% of trials).
- Bruising or bleeding (~10–20%).
- Transient dizziness or fatigue (~5–10%).
- Serious Risks: Rare (e.g., pneumothorax, infection), occurring in <0.01% of cases when performed by trained practitioners using sterile needles.
- Comparison: Acupuncture has fewer side effects than pharmacological treatments (e.g., NSAIDs, muscle relaxants) commonly used for myofascial pain.
Cost
- Range: $50–$150 per session in the U.S., depending on location, practitioner expertise, and session length.
- Insurance Coverage: Variable, with some plans covering acupuncture for chronic pain (e.g., Medicare for chronic low back pain since 2020). Coverage for myofascial pain specifically is less common, often requiring out-of-pocket payment.
- Cost-Effectiveness: Limited data, but a 2021 study suggested acupuncture may be cost-effective for chronic pain when compared to long-term NSAID use, given reduced medication-related adverse events.
Evidence Quality
- Overall Quality: Moderate to high for short-term pain relief and functional improvement in myofascial pain, based on well-conducted RCTs and meta-analyses.
- Strengths:
- Large sample sizes in recent meta-analyses (e.g., n=1,892 in Li et al., 2022).
- Consistent findings across studies for neck and shoulder myofascial pain.
- Inclusion of sham-controlled trials strengthens evidence for specific acupuncture effects.
- Limitations:
- Heterogeneity in acupuncture protocols (e.g., manual vs. electroacupuncture, point selection) reduces generalizability.
- Limited long-term follow-up (>6 months) data.
- Potential bias in some trials due to inadequate blinding or small sample sizes.
- Lack of standardization in myofascial pain diagnosis across studies (e.g., varying criteria for trigger point identification).
- Research Gaps: More studies are needed on long-term efficacy, optimal dosing, and comparisons with other non-pharmacological treatments (e.g., manual therapy).
References
- Fernández-de-las-Peñas C, et al. (2020). Effectiveness of acupuncture for myofascial pain syndrome: A systematic review and meta-analysis. J Pain Res. DOI: 10.2147/JPR.S247110.
- Li X, et al. (2022). Acupuncture for myofascial trigger point pain: A meta-analysis of randomized controlled trials. Acupunct Med. DOI: 10.1177/09645284211056332.
- Zhang Y, et al. (2024). Acupuncture for myofascial pain in the neck and shoulder: A systematic review. Complement Ther Med. DOI: 10.1016/j.ctim.2023.103012.
- Vickers AJ, et al. (2020). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. J Pain. DOI: 10.1016/j.jpain.2017.11.005.
- NCCIH: Acupuncture Effectiveness and Safety. (2020). Available at: https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know.
- PMC: Acupuncture for the relief of chronic pain: A synthesis of systematic reviews. (2020). DOI: 10.3390/medicina56010006.
- AAFP: Acupuncture for pain. (2019). Available at: https://www.aafp.org/pubs/afp/issues/2019/0715/p89.html.
This review provides robust evidence supporting acupuncture’s efficacy for myofascial pain, particularly in the short term, with moderate to high-quality evidence. However, variability in protocols and limited long-term data suggest a need for further standardization and research.
Emphasis on Education
Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.
For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.
Should you wish more information regarding any of the subjects listed – or not listed – here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.
For more information, please contact Accurate Clinic.
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