Effect of Electroacupuncture on Postherpetic Neuralgia

 

1. Lu Chen, MD^1,2; Qianyan Liu, PhD^1,3; Lixia Pei, MD¹
2. et al
   
   Key Points

   Question  Does a 4-week course of electroacupuncture reduce pain intensity in adults with postherpetic neuralgia compared with sham electroacupuncture?

   Findings  In this multicenter randomized clinical trial of 448 patients with postherpetic neuralgia, electroacupuncture reduced pain scores more than sham electroacupuncture at 4 weeks. Electroacupuncture also increased responder rates (≥30% reduction in pain scores), with benefits persisting at 1 month.

   Meaning  Despite a modest mean pain score reduction, this 4-week course of electroacupuncture significantly improved responder rates; these findings suggest that electroacupuncture may have a role in multimodal management of postherpetic neuralgia.

   Abstract

   IMPORTANCE  Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.

   OBJECTIVE  To determine whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluate its safety in patients with PHN.

   Design, Setting, and Participants  This multicenter, randomized, sham-controlled clinical trial took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial.

   INTERVENTION  Twenty sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up.

   MAIN OUTCOMES AND MEASURES  The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.

   RESULTS  Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (−1.52) than the sham electroacupuncture group (−0.99) with an adjusted mean difference of −0.53 (95% CI, −0.61 to −0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.

   CONCLUSIONS AND RELEVANCE  Among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.

   TRIAL REGISTRATION  ClinicalTrials.gov Identifier: NCT04560361.
   https://jamanetwork.com/journals/jamaneurology/fullarticle/2849572