Acupuncture and Moxibustion for Neck Pain: A Clinical Practice Guideline

Neck pain (NP) is a leading cause of disability worldwide. Pharmacological treatments often provide limited benefits and may be associated with adverse effects, highlighting the need for effective non-pharmacological options.

To develop evidence-based recommendations on the effectiveness, safety, and clinical implementation of acupuncture and/or moxibustion for adults with NP.

This guideline was developed in accordance with the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for acupuncture and the BMJ Rapid Recommendations process. Recommendations were informed by a systematic review of 88 randomized controlled trials (RCTs) involving 10,172 participants. Evidence certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and recommendations were formulated through an evidence-to-decision framework and multidisciplinary consensus.

The guideline proposed five recommendations: (1) acupuncture and/or moxibustion is suggested rather than no such treatment (weak recommendation, moderate-certainty); (2) acupuncture and/or moxibustion may be considered for patients with moderate-to-severe pain or prolonged symptoms (weak recommendation, low-certainty); (3) adding acupuncture and/or moxibustion to usual care is suggested rather than usual care alone (weak recommendation, low-certainty); (4) an initial 3-4-week course, using 5-10 acupoints/session and 3-5 sessions/week, may serve as a reference regimen (weak recommendation, low-certainty); and (5) electroacupuncture may be preferentially considered for pain relief and functional improvement, whereas manual acupuncture, warm needling, and moxibustion may be alternatives (weak recommendation, low-certainty). Adverse events were generally mild and self-limiting.

Acupuncture and/or moxibustion may be reasonable and safe non-pharmacological options for adults with NP. Clinical use should be guided by shared decision-making that considers symptom severity, disease duration, treatment goals, patient preferences, accessibility, and practitioner expertise.