Is acupuncture effective for treating shoulder pain?

Acupuncture for Shoulder Pain

Acupuncture combined with standard therapeutic exercise may be considered as a safe and effective adjuvant treatment for shoulder pain, particularly in hemiplegic shoulder pain after stroke, though evidence for general shoulder pain remains limited and inconclusive.

Evidence Quality and Context

The effectiveness of acupuncture for shoulder pain varies significantly based on the underlying cause and study methodology:

For Hemiplegic Shoulder Pain (Post-Stroke)

• Acupuncture combined with standard therapeutic exercise appears beneficial for hemiplegic shoulder pain, based on a systematic review identifying 7 RCTs all showing positive effects, though concrete conclusions were limited by the small number of trials 1.

• A more recent meta-analysis demonstrated that electroacupuncture reduced pain by 1.9 points on a 0-10 scale and auricular acupuncture reduced pain by 1.6 points compared to usual care, with treatment effects remaining durable at 6 months 1.

• The American Heart Association/American Stroke Association guidelines suggest acupuncture may be a safe and effective adjuvant specifically for hemiplegic shoulder pain when combined with proper positioning, range of motion maintenance, and motor retraining 1.

For General Musculoskeletal Shoulder Pain

• Evidence for acupuncture in general shoulder pain (rotator cuff disease, adhesive capsulitis) is insufficient to make a definitive recommendation 2.

• A Cochrane review found that acupuncture showed short-term benefit in improving the Constant-Murley Score at 4 weeks (improvement of 17.3 points), but by 4 months the difference was no longer clinically significant (only 3.53 points improvement) 2.

• One small RCT showed acupuncture produced clinically significant improvements in chronic shoulder pain (mean SPADI score improvement of -20.3 to -20.4 points versus -6.5 for sham), with no difference between individualized and standardized acupuncture approaches 3.

For Osteoarthritis-Related Shoulder Pain

The evidence is particularly weak for osteoarthritis:

• The American Academy of Orthopaedic Surgeons concluded they are unable to make a recommendation for or against acupuncture for knee osteoarthritis due to conflicting evidence 1.

• Meta-analysis revealed that apparent effects of acupuncture depend heavily on study design—effects were not statistically significant in studies that verified patients were properly blinded, suggesting placebo effects may account for observed benefits 1.

Clinical Application Algorithm

Step 1: Identify the underlying cause of shoulder pain

• If hemiplegic shoulder pain post-stroke → Consider acupuncture as adjuvant to standard rehabilitation 1
• If chronic rotator cuff disease or adhesive capsulitis → Acupuncture may provide short-term benefit (4 weeks) but effects diminish by 4 months 2
• If osteoarthritis-related → Evidence is inconclusive; prioritize proven treatments first 1

Step 2: Implement acupuncture appropriately if chosen

• Use standardized acupuncture points rather than individualized approaches, as there appears to be no difference in efficacy and standardization facilitates treatment 3
• Combine with standard therapeutic exercise and rehabilitation, not as monotherapy 1
• Plan for 12 treatments over 6 weeks for chronic shoulder pain based on trial protocols 3
• Consider electroacupuncture or auricular acupuncture for post-stroke shoulder pain 1

Step 3: Set realistic expectations

• Expect modest pain reduction (1.6-1.9 points on 0-10 scale) in post-stroke patients 1
• Benefits may be primarily short-term (4 weeks) for general shoulder pain 2
• Monitor for minimal adverse events, though ear pain may occur with auricular acupuncture 1

Critical Pitfalls to Avoid

• Do not use acupuncture as monotherapy—it should be combined with proper positioning, range of motion exercises, and motor retraining for hemiplegic shoulder pain 1.

• Avoid overhead pulley exercises in stroke patients with shoulder pain, as these can worsen symptoms 1, 4, 5.

• Do not assume acupuncture effects are specific rather than placebo—the highest quality blinded trials show minimal to no effect, particularly for osteoarthritis 1.

• Recognize that acupuncture evidence is strongest for post-stroke hemiplegic shoulder pain and weakest for osteoarthritis-related shoulder pain 1.

Alternative Evidence-Based Approaches

For cancer-related chronic musculoskeletal pain, the Society for Integrative Oncology-ASCO guidelines recommend acupuncture with low-quality evidence but note it may reduce pain with minimal toxicities 1.

For general shoulder pain management, prioritize NSAIDs, physical therapy with progressive range of motion, and consider corticosteroid injections or suprascapular nerve blocks before or alongside acupuncture 4, 5.