Stimulated by Li et al 2025.[1]
EA – electroacupuncture
IF – impact factor
APC – article publishing charge (cost to the authors or their institution for publishing a paper)
SEA – sham electroacupuncture
WL – waiting list
NPQ – Northwick Park neck pain questionnaire
MCID – minimal clinically important difference
SF-MPQ – short form McGill pain questionnaire
VAS – visual analogue scale
PT – pain threshold (surface electrical threshold in this case)– key to acronyms
This paper comes from Guangzhou and is published in the Journal of Pain Research (IF 2.5), which is an open access journal with a current APC of £2920 (UK figure).
It is much smaller (n=98) than the trial from Chengdu on manual acupuncture for chronic neck pain (n=716) that I highlighted last year – see Acupuncture for chronic neck pain 2024.
But now I realise that I have missed an even bigger trial of manual acupuncture in neck pain (n=896) from the same group as the current paper on EA.[2] It was published in the journal Pain (IF 5.5) in 2021. The population in this one was not described as chronic neck pain, but cervical spondylosis related neck pain, so some of this population may not have fulfilled the criteria to be considered to have chronic pain, but there is an obvious similarity. I will come back to this one.
The current study utilised 3 parallel arms – EA, SEA, and WL. The SEA was non-penetrating and used a foam device to hold the needle in place. The foam was also used in the EA group. 10 treatment sessions of 30 minutes were performed over 5 weeks followed by 12 weeks follow-up. Outcomes were measured at after 5 sessions, after 10 sessions (5 weeks), and at the 3-month follow-up. The primary outcome was the NPQ,[3] and I guess the primary endpoint was at the end of treatment (10 sessions, 5 weeks), although this is not specified in the paper. A >25% change from baseline was taken as the MCID on this measure.[4] Other outcomes included SF-MPQ, VAS, and PT.
The points used in the real EA group were SI15 (2 cun lateral to GV14) and an extra point Jingbailao (2 cun above and 1 cun lateral to GV14). These were connected to one of Jisheng Han’s simulators (HANS–200A) at a dense dispersed frequency of 2/100Hz. Intensity is not discussed, but it is likely to be to patient tolerance. The needles used were 0.30 x 25mm, which is reassuring considering that the points used could theoretically reach the lung or spinal canal – see the recent blog Post-acupuncture ACSEH.
The NPQ is a 9-item questionnaire, with item 10 added on subsequent uses. Each item is scored between 0 and 4, making a total of 36, unless the patient never drives, in which case the total is 32 and item 9 is not used. Usually, as in this case, the score is converted to a percentage. The baseline was ~24. The reduction in NPQ after 10 sessions (5 weeks) in the EA group was just over 11, which is a 47% reduction from baseline. The reduction in the SEA (sham) group was just over 5 (a 21% reduction from baseline). There was minimal change in the WL group.
At the 3-month time point, the reduction in NPQ from baseline was just over 9, which is a 40% reduction from baseline, so the effect was maintained reasonably well.
The bigger trial from this group was published in 2021, but the trial was performed from 2008 to 2009, which seems quite a delay from data collection to publication. Some delays were due to funding bodies inspecting the data analysis and presumably requesting other analyses be performed, since 2 further grants for this were received in 2018 and 2019.
The trial had 3 parallel arms, each of which had nearly 300 patients. The interventions were called optimised acupuncture, shallow acupuncture, and sham acupuncture. All three involved penetrating needling and 8 to 10 sessions were performed over 4 weeks. The optimised group received standard manual acupuncture at SI15, GV14, TE3 (in the 4th web space of the hand), plus 2 sets of cervical paraspinal points (Huatuojiaji) chosen by tenderness. That makes a total of 9 needles (0.30 x 40mm) inserted 20mm. After the needles were removed, 5mm intradermal indwelling needles were inserted in 3 or 4 of the 7 neck points (alternating each treatment) and left in until the next session.
The shallow group received the same treatment, but the needles were only inserted 3mm. The intradermal needles were used in the same way as in the optimised group. The sham group also received 3mm insertion of needles, but into so-called sham points, which were close to the real acupuncture points used in the optimised group. Vacarria hispanica seeds were used instead of intradermal needles in the sham group, which is probably a more important difference in terms of dose than the precise location of shallow needling. So, this trial performs an interesting and slightly complex dose variation.
The primary outcome was the NPQ at the end of treatment (4 weeks) and there was follow-up at 8 and 16 weeks after baseline. Unfortunately, there was a significant baseline difference between the groups in the NPQ (~40 in the optimised group vs ~36 in the other groups). Since the change score from baseline was used, this slightly favours the optimised group. All three groups had a clinically relevant mean reduction in NPQ (~53% vs ~37% vs ~29%). The improvement in all three groups was maintained over the follow-up period, and the optimised group was significantly ahead of both other groups the whole time across the majority of the outcome measures. There was a trend in favour of shallow over sham (remember both of these used superficial needling, but the sham group used seeds rather than intradermal needles) but this only reached significance in the MPQ.
References
1 Li W, Liu X, Lin J, et al. Clinical Efficacy of Electroacupuncture in the Treatment of Chronic Neck Pain: A Randomized Clinical Trial. J Pain Res. 2025;18:2909–22. doi: 10.2147/JPR.S515679
2 Chen L, Li M, Fan L, et al. Optimized acupuncture treatment (acupuncture and intradermal needling) for cervical spondylosis-related neck pain: a multicenter randomized controlled trial. Pain. 2021;162:728–39. doi: 10.1097/j.pain.0000000000002071
3 Vernon H, Mior S. The Northwick Park Neck Pain Questionnaire, devised to measure neck pain and disability. Br J Rheumatol. 1994;33:1203–4. doi: 10.1093/rheumatology/33.12.1203
4 Sim J, Jordan K, Lewis M, et al. Sensitivity to change and internal consistency of the Northwick Park Neck Pain Questionnaire and derivation of a minimal clinically important difference. Clin J Pain. 2006;22:820–6. doi: 10.1097/01.ajp.0000210937.58439.39
The BMAS Blog 
You must be logged in to post a comment.