Effect of electrical acupoint stimulation and electroacupuncture on pain and function in knee osteoarthritis: A systematic review and meta-analysis with hypotheses for analgesic rehabilitation of osteoporotic fractures

Abstract

Objectives: In this review, we evaluate the effects of electroacupuncture (EA) and transcutaneous electrical nerve stimulation (TENS) on pain and function in knee osteoarthritis (KOA) and discuss whether this evidence can inform analgesic rehabilitation research in osteoporotic fractures.

Materials and methods: PubMed, Embase, Cochrane CENTRAL, Web of Science, and CNKI were searched from inception to January 2025 for randomized-controlled trials in KOA. Trials comparing EA or TENS with sham procedures, manual acupuncture, no-treatment controls, or pharmacological therapy were included. Continuous pain, function, and WOMAC-related outcomes were synthesized as standardized mean differences (SMDs) using Hedges' g, whereas categorical responder or effective-rate outcomes were analyzed separately as risk ratios (RRs). For multi-arm trials sharing the same intervention or comparator group, the shared group was split across relevant comparisons to preserve statistical independence.

Results: Eight studies contributed 10 continuous comparisons and one categorical responder comparison. After correction for shared groups in multi-arm trials, electrical acupoint stimulation showed a significant benefit for continuous pain and functionrelated outcomes (SMD = 0.45, 95% confidence interval [CI]: 0.31-0.58; p < 0.0001), with no statistical heterogeneity (I² = 0.0%). The 95% prediction interval was 0.29 to 0.61. Pain outcomes showed a pooled SMD of 0.53 (95% CI: 0.35-0.71), and function-related continuous outcomes showed a pooled SMD of 0.34 (95% CI: 0.13-0.55). The categorical responder comparison was not merged with the SMD model and favored EA (RR = 1.32, 95% CI: 1.07-1.63). Sensitivity analysis excluding studies had high risk in key bias domains remained significant (SMD = 0.44, 95% CI: 0.28-0.59).

Conclusion: Electrical acupoint stimulation, particularly EA, significantly improves pain and function in KOA. These findings support its role in KOA management and provide preliminary translational support for future electroacupuncture-based analgesic rehabilitation studies in osteoporotic fractures.

Citation: Bai ZX, Xia R. Effect of electrical acupoint stimulation and electroacupuncture on pain and function in knee osteoarthritis: A systematic review and meta-analysis with hypotheses for analgesic rehabilitation of osteoporotic fractures. Jt Dis Relat Surg 2027;38(x):1-14. doi: 10.52312/jdrs.2027.2936.