Acupuncture Therapy for Extremity Musculoskeletal Pain: A Clinically Focused Evidence Synthesis with Therapeutic Implications.

Background: Extremity musculoskeletal pain (EMP) is a major contributor to chronic pain and disability worldwide, often involving tendinopathies, enthesopathies, and myofascial pain syndromes. Conventional treatments such as medications, injections, and physical therapy frequently provide only partial or short-term relief. Acupuncture, widely practiced in clinical settings, has been proposed as a safe and effective alternative or adjunctive therapy. Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library identified studies published from January 2015 to June 2024. Eligible publications included randomized controlled trials (RCTs), systematic reviews, or meta-analyses involving adults with EMP and reporting pain or function as primary outcomes. Nineteen studies (10 RCTs, 9 reviews) met the inclusion criteria and were narratively synthesized. Results: For lateral epicondylitis (LE), manual acupuncture provided short-term benefit, while dry needling demonstrated superior long-term effects. Evidence for carpal tunnel syndrome (CTS) was insufficient, with mixed findings and high risk of bias. In patellofemoral pain syndrome (PFPS), trigger point dry needling showed short-to-medium term pain relief, though its added value in multimodal therapy was inconsistent. For plantar heel pain syndrome (PHPS), both electroacupuncture and dry needling produced significant improvements in pain and function, with benefits sustained beyond three months. Conclusion: Acupuncture appears to be a safe, low-risk therapy for EMP, with strongest evidence for PHPS and LE, limited support for PFPS, and insufficient evidence for CTS. Clinically, acupuncture should be considered as part of comprehensive multimodal strategies, tailored to patient needs and preferences. Future research should focus on large-scale, standardized RCTs, direct comparisons between acupuncture modalities, and inclusion of regional and non-English studies to strengthen the global evidence base.