Efficacy of ultrasound-guided pharmacopuncture: A systematic review and meta-analysis

Pharmacopuncture, used for the treatment and management of musculoskeletal diseases, improves pain and functional outcomes. This study aimed to examine the practice trends, clinical effectiveness, and safety of ultrasound-guided pharmacopuncture for various conditions.

All clinical studies across 11 databases on ultrasound-guided pharmacopuncture published before January 2024 were included, regardless of disease type and study design. Meta-analyses were conducted according to the Cochrane systematic review protocol using RevMan 5.4. The Grading of Recommendations, Assessment, Development, and Evaluation method was used for evidence-level rating.

From 16 studies with ultrasound-guided pharmacopuncture, 9 randomized clinical trials, 4 chart reviews, and 3 case studies were included. A total of 685 patients from 9 randomized clinical studies were included in the meta-analysis. For all diseases, the percentage of patients showing improvement in pain reduction in the ultrasound-guided pharmacopuncture group was higher than that in the unguided pharmacopuncture (risk ratio [RR]: 1.17; 95% confidence interval [CI]: 1.08-1.26) and usual care groups (RR: 1.23; 95% CI: 1.07-1.41). Subgroup analyses for lumbar disease revealed that the percentage of patients showing improvement was higher in the ultrasound-guided pharmacopuncture group than that in the unguided group (RR: 1.27; 95% CI: 1.13-1.44).

Ultrasound-guided pharmacopuncture is clinically effective for pain reduction and improvement of functional outcomes. Furthermore, the intervention groups reported fewer adverse events. For lumbar spine conditions, significant differences in pain reduction and improvement in functional disability outcomes were confirmed 1 week and 1 month after treatment, respectively. To verify the clinical effectiveness of ultrasound-guided pharmacopuncture with high levels of evidence, more high-quality and large-scale randomized controlled trials are needed.