Systematic review of clinical practice guidelines on acupuncture for chronic musculoskeletal pain

Acupuncture is increasingly utilised in primary care to manage chronic musculoskeletal pain, supported by a growing body of evidence. This rising adoption has driven demand for clinical practice guidelines (CPGs). We summarised the characteristics of recent acupuncture CPGs for osteoarthritis, low back pain, neck pain, and shoulder pain, and critically appraised their methodological quality.

We searched nine databases to identify acupuncture CPGs published from January 2014 to November 2024. Eligible CPGs were required to be developed by guideline committees and to include evidence-informed recommendations linked to clearly defined levels of evidence. Two independent reviewers extracted CPG characteristics and assessed methodological quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.

Of the 1,999 records screened, 17 CPGs were included, encompassing 35 recommendations. Shoulder pain was the most addressed condition (n = 14), followed by low back pain (n = 11), osteoarthritis (n = 8), and neck pain (n = 2). Various types of acupuncture were considered, with manual acupuncture featuring in most (n = 26) recommendations. Overall, 60% of the recommendations supported the use of acupuncture, comprising 5.7% strong recommendations and 54.3% weak or conditional recommendations. In contrast, 22.9% of recommendations offered no explicit guidance, while 17.1% advised against its use. Methodological assessment classified 10 CPGs as high quality, while seven were of moderate quality.

Contradictions exist among the included CPGs regarding whether acupuncture should be recommended for routine practice, potentially reflecting differences in clinical and cultural contexts. Local CPGs should be developed using rigorous methodology, ensuring the involvement of local stakeholders. An AGREE II extension should be developed for the methodological quality assessment of acupuncture CPGs.