Efficacy of Acupuncture Combined with the Three-Step Analgesic Protocol in Treating Pain in Liver Cancer Pain: A...

Approximately 60-80% of patients with advanced liver cancer experience pain, significantly impairing quality of life. While the three-step analgesic regimen has limitations, acupuncture has gained attention for cancer pain management, though evidence for its combined use remains inconsistent. This Bayesian network meta-analysis evaluated the clinical value of acupuncture combined with the three-step regimen.

Randomized controlled trials on acupuncture combined with three-step analgesia for liver cancer pain were searched in Chinese and English databases up to August 2025. Bayesian network meta-analysis was performed using R software.

Twenty-seven studies involving 2220 patients were included, covering six acupuncture modalities: Chinese herbal acupoint application, acupoint injection, acupuncture and moxibustion, acupuncture alone, heat-sensitive moxibustion, and floating acupuncture. For pain relief efficacy, SUCRA rankings were: acupuncture plus moxibustion combined with three-step therapy (0.96) > acupuncture plus herbal application combined with three-step therapy (0.65) > floating acupuncture plus herbal application combined with three-step therapy (0.64). For pain intensity (NRS), rankings were: herbal acupoint application combined with three-step therapy (0.72) > floating acupuncture plus herbal application combined with three-step therapy (0.70) > acupuncture combined with three-step therapy (0.63). For adverse events, rankings were: herbal acupoint application combined with three-step therapy (0.80) > acupuncture combined with three-step therapy (0.74) > heat-sensitive moxibustion combined with three-step therapy (0.72). CINeMA assessment indicated generally low evidence quality.

Current evidence suggests that herbal acupoint application and acupuncture combined with moxibustion may enhance the three-step analgesic regimen for liver cancer pain, but conclusions are limited by low evidence quality and require further high-quality trials for validation.