Effect of Electroacupuncture on Postherpetic Neuralgia: A Randomized Clinical Trial
Electroacupuncture increased meaningful pain improvement, but average pain reduction was modest.
*Randomized sham-controlled trial; Level 2 (OCEBM).
Citation
Chen L, Liu Q, Pei L, et al. Effect of Electroacupuncture on Postherpetic Neuralgia: A Randomized Clinical Trial. JAMA Neurology. 2026;83(7):667-676. doi:10.1001/jamaneurol.2026.1443
Background
Postherpetic neuralgia can cause long-lasting nerve pain after shingles, and current drug options often provide incomplete relief or cause side effects. This trial tested whether electroacupuncture adds meaningful pain relief beyond a credible sham procedure.
Patients
448 adults aged 45 to 75 years in China with postherpetic neuralgia and moderate to severe pain. Key exclusions included recent prohibited pain treatments, multiple pain medicines without washout, severe uncontrolled illness, other major pain conditions, or prior nerve procedures for this condition.
Intervention
Twenty electroacupuncture sessions over 4 weeks.
Control
Sham electroacupuncture with blunt needles and no active electrical stimulation.
Outcome
Primary outcome: change in pain on the 11-point Numeric Rating Scale (0 to 10), and response defined as at least 30% pain reduction.
Follow-up Period
4 weeks of treatment plus 4 weeks after treatment.
Results
| Outcome | Electroacupuncture vs sham | Clinical meaning |
|---|---|---|
| Pain score change at 4 weeks (primary) | 0.53 points greater reduction | Below the 1.5-point minimally important difference |
| At least 30% pain reduction at 4 weeks (primary responder outcome) | 46.68% vs 24.28%; risk difference 22.40% | Number needed to treat: 5 |
| At least 30% pain reduction at 8 weeks | Risk difference 21.65% | Number needed to treat: 5 |
| Rescue pain medicine use | 6.67% vs 13.90% | Number needed to treat to avoid rescue use: 14 |
Results were analyzed by intention to treat. The control was sham treatment, not standard medication care.
Limitations
The average pain-score benefit was statistically significant but smaller than the accepted minimally important difference. Follow-up was short, all participants were Chinese, and sham treatment may still have produced placebo or physical effects.
Funding
Chinese governmental and academic grants; no conflicts reported.
Clinical Application
Consider electroacupuncture as an adjunct for selected patients seeking non-drug options, while explaining that average pain improvement is modest.
Discussion
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In this multicenter sham-controlled randomized clinical trial, electroacupuncture improved PHN pain more than sham at 4 weeks (NRS adjusted mean difference −0.53; responders 46.68% vs 24.28%); is this statistically significant but modest effect clinically valid and applicable enough to change practice? In this randomized trial, 46.68% of patients receiving electroacupuncture and 24.28% receiving sham electroacupuncture achieved at least a 30% pain reduction. Which statement best describes the adjusted risk difference of 22.40% reported by the authors?