A recent international multicenter randomized controlled trial (RCT) has provided strong evidence supporting the efficacy of acupuncture in the treatment of lateral epicondylitis, commonly known as tennis elbow. The study found that acupuncture significantly improved arm function and reduced pain intensity compared to sham laser treatment. These results present an evidence-based approach for licensed acupuncturists seeking to optimize clinical outcomes in patients with chronic lateral elbow pain [1].
The RCT was conducted across four centers in Australia, China, Hong Kong, and Italy, enrolling 96 participants diagnosed with unilateral chronic lateral epicondylitis persisting for at least three months. Participants were randomized into two groups: a treatment group receiving manual acupuncture and a control group undergoing sham laser acupuncture. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, assessed three weeks after treatment. Secondary outcomes included Visual Analog Scale (VAS) scores for pain at rest, during motion, and during exertion [1].
Licensed acupuncturists with extensive clinical experience performed the acupuncture treatments according to a standardized protocol. Sterile, single-use stainless steel needles measuring 0.25 mm in diameter and 40 mm in length were used. The selected acupoints were:
- LI10 (Shousanli)
- LI11 (Quchi)
Needles were inserted perpendicularly to a depth sufficient to elicit the deqi sensation, characterized by soreness, distension, or radiating warmth. Manual stimulation techniques, including lifting, thrusting, and rotating, were applied to achieve and maintain deqi. Each session lasted 30 minutes, and treatments were administered twice weekly for three weeks, totaling six sessions [1].
The control group received sham laser acupuncture, designed to replicate the procedural aspects of acupuncture without actual therapeutic stimulation. A deactivated laser device was applied to the same acupoints (LI10 and LI11) without skin penetration or electrical stimulation. This approach ensured blinding and controlled for placebo effects [1].
At the three-week post-treatment follow-up, patients in the acupuncture group exhibited a median DASH score reduction of 11.7 points, indicating significant improvement in arm function, compared to a 7.5-point reduction in the control group. This difference was statistically significant (p = 0.015), with an estimated effect size of 0.47 [1].
Additionally, the acupuncture group demonstrated significantly greater reductions in VAS scores for pain at rest and during motion compared to the control group. These improvements highlight the analgesic and functional benefits of acupuncture for chronic lateral epicondylitis. No severe adverse events were reported, confirming the safety of acupuncture in this patient population [1].
Although the study primarily focused on clinical outcomes, acupuncture’s efficacy may be explained by its physiological effects, including:
- Neurotransmitter Modulation: Acupuncture has been shown to stimulate the release of β-endorphins and enkephalins, which act on opioid receptors to reduce pain perception [1].
- Anti-Inflammatory Effects: Needling at LI10 and LI11 may modulate pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), which are associated with chronic tendon inflammation [1].
- Local Blood Flow Regulation: Acupuncture may enhance microcirculation and oxygenation in the lateral epicondyle region, promoting tissue repair and reducing ischemic pain [1].
Further studies incorporating biochemical markers and neuroimaging could help elucidate these mechanisms in greater detail. The findings of this RCT provide strong evidence for integrating acupuncture into clinical treatment protocols for lateral epicondylitis. The observed improvements in pain reduction and functional recovery underscore acupuncture’s role as a non-pharmacological alternative to conventional treatments such as corticosteroid injections or physical therapy [1].
This rigorously designed study substantiates acupuncture’s efficacy in treating chronic lateral epicondylitis, providing an effective and safe alternative for pain management. The detailed acupuncture protocol presented in this article serves as a practical guide for practitioners seeking to apply evidence-based acupuncture techniques in clinical practice. As the demand for non-invasive treatment options grows, acupuncture continues to emerge as a viable and scientifically supported modality for musculoskeletal pain management [1].
Reference:
[1] PubMed. “Acupuncture for Chronic Lateral Epicondylitis: A Multicenter Randomized Controlled Trial.” National Library of Medicine, April 2024.
