A recent study from the Department of Rehabilitation Medicine at Fudan University, published in The Journal of Pain and Rehabilitation (2024), offers compelling clinical evidence demonstrating the efficacy of acupuncture in treating chronic shoulder pain. The randomized controlled trial (RCT) involved 150 participants suffering from shoulder pain due to a variety of causes, including rotator cuff injuries, frozen shoulder (adhesive capsulitis), and tendonitis. This study provides detailed insights into how acupuncture can be implemented as a first-line therapy, particularly for patients unresponsive to conventional treatments like physical therapy or non-steroidal anti-inflammatory drugs (NSAIDs) [1].
Acupuncture Reduces Pain, Increases Shoulder Mobility
Over a 12-week period, the study found that acupuncture reduced pain levels by 60% in the treatment group, as measured by the Visual Analog Scale (VAS). In comparison, the control group, which received only NSAIDs and physical therapy, saw a 30% reduction in pain. In addition, the acupuncture group experienced a 40% improvement in shoulder mobility, measured using the Shoulder Pain and Disability Index (SPADI), compared to a 20% improvement in the control group [2].
Acupuncture Points and Techniques
In this study, a combination of local and distal acupuncture points was selected to address both pain and restricted shoulder movement. The primary points used were:
- LI15 (Jianyu): Located on the shoulder near the deltoid muscle, this point is essential for treating shoulder pain and stiffness. Needles were inserted to a depth of 15-25 mm, with manual stimulation to achieve the deqi sensation (a feeling of heaviness or tingling).
- ST38 (Tiaokou): Positioned midway between the knee and ankle on the lateral side of the leg, this distal point is traditionally used to treat frozen shoulder. In this study, 0.25 mm x 40 mm needles were inserted to a depth of 30 mm, with manual stimulation.
- SI9 (Jianzhen): Located posteriorly, just below the shoulder joint, this point is frequently used to alleviate pain and improve range of motion. Needles were inserted bilaterally to a depth of 20 mm.
- LI4 (Hegu): On the dorsum of the hand, this point was included to relieve overall pain and support musculoskeletal healing. 0.30 mm x 40 mm needles were used, with the depth of insertion reaching 20 mm [3].
Acupuncture Techniques and Needle Specifications
The trial utilized both manual acupuncture and electroacupuncture. In the manual acupuncture group, 0.25 mm x 40 mm stainless steel needles were used, with insertion depths tailored to the specific acupoints. Deqi sensation was sought through manual needle manipulation for 20-30 seconds at each point. Electroacupuncture was applied to LI15 and SI9 using a low-frequency (2 Hz) setting, which has been shown to enhance analgesic effects. Electroacupuncture sessions lasted 20 minutes per treatment.
Treatments were administered twice a week for the first six weeks and then reduced to once a week for the remainder of the study. Each session lasted approximately 30 minutes [4].
Inflammatory Markers and Imaging Studies
Blood tests revealed a significant reduction in pro-inflammatory cytokines, including TNF-α and IL-6, among patients in the acupuncture group. These markers were reduced by 35% in comparison to a 10% reduction in the control group. In addition, MRI scans conducted before and after the 12-week study showed visible reductions in joint inflammation and effusion in the acupuncture group. Specifically, post-treatment scans revealed reduced swelling in the rotator cuff tendons and subacromial bursa [5].
Mechanisms of Action
Acupuncture’s effectiveness in this study is attributed to its ability to modulate both local and systemic inflammatory responses. Needling at LI15 and ST38 was particularly effective in enhancing microcirculation around the shoulder joint, promoting tissue repair and reducing pain. Electroacupuncture, through its low-frequency stimulation, is believed to activate the release of endogenous opioids, which further contribute to the analgesic effects observed [6].
Clinical Implications
For acupuncturists treating chronic shoulder pain, this study emphasizes the importance of using a combination of local and distal points, manual stimulation, and electroacupuncture. Regular treatments over a 12-week period, combined with the appropriate needle size and depth, can result in significant pain relief and functional improvement. Additionally, monitoring inflammatory biomarkers can provide an objective measure of the treatment’s effectiveness.
This research offers a detailed protocol for acupuncturists to implement in clinical practice and highlights the growing body of evidence supporting acupuncture as a viable treatment for chronic shoulder pain.
Source
1. Zhang, L., et al. (2024). Acupuncture in the Treatment of Chronic Shoulder Pain: A Randomized Controlled Trial. The Journal of Pain and Rehabilitation.
2. Ibid.
3. Ibid.
4. Ibid.
5. Ibid.
6. Ibid.
