Acupuncture for Neuropathic Pain: Mechanisms, Clinical Efficacy and Future Perspectives

Neuropathic pain is a prevalent, intolerable disease that poses significant clinical challenges due to the limited efficacy and adverse effects of conventional pharmacotherapy. Acupuncture is widely recognized for its efficacy in neuropathic pain management. This review aims to provide a comprehensive overview of the current understanding, clinical evidence, challenges, and future potential of acupuncture, and to thus highlight its role within an integrated, multidisciplinary approach to managing neuropathic pain. Despite its popularity, the mechanisms by which acupuncture exerts these effects are not fully understood. Its possible mechanisms of action are complicated, involving the modulation of endogenous opioids and neurotransmitters, activation of descending pain-inhibitory pathways, suppression of neuroinflammation, and induction of beneficial neuroplasticity. Clinical evidence from systematic reviews supports its efficacy, in particular for diabetic peripheral neuropathy, chemotherapy-induced peripheral neuropathy, and central post-stroke pain, and shows significant promise for various neuropathic pain disorders. However, the quality of primary studies is variable. Within a multidisciplinary basis, acupuncture offers a promising, safe, and mechanistically supported adjunct for managing complex neuropathic pain.