Effect of acupuncture at ST36 and SP6 on pain management in osteoarthritis: A systematic review of randomized controlled trials and meta-analysis

Context: Osteoarthritis is a prevalent joint disorder that significantly impairs mobility and quality of life, particularly among older adults. Acupuncture, especially at the ST36 and SP6 acupoints, has been increasingly utilized for symptom relief due to its minimal side effects, although the strength of evidence regarding its specific effectiveness remains uncertain. Aims: To evaluate the current evidence from randomized controlled trials on the clinical outcomes of acupuncture targeting the ST36 and/or SP6 acupoints in adults with osteoarthritis. Methods: The review was registered in PROSPERO (CRD420251035560). Randomized controlled trials published in the past ten years were identified, screened independently, and assessed for bias using the RoB 2 tool. Meta-analysis was performed for pain (VAS) and functional (WOMAC) outcomes after treatment, while other data were narratively synthesized. Results: Eight trials involving 465 participants aged 38-75 years were included. The pooled analysis of post-intervention VAS scores from three studies showed no significant difference between acupuncture and controls (SMD = 1.35; 95% CI: -0.38 to 3.08; p = 0.13; I² = 96%). Similarly, WOMAC scores from four studies indicated a non-significant pooled effect (SMD = -0.76; 95% CI: -2.09 to 0.56; p = 0.26; |2 = 95%). Despite heterogeneity, individual studies reported clinically relevant improvements in pain and function, favoring acupuncture. Adverse events were rarely reported, indicating a favorable safety profile. Conclusions: Acupuncture at ST36 and SP6 shows potential benefits for pain and function in osteoarthritis with good tolerability. Although pooled effects were not statistically significant, consistent positive trends warrant further standardized, high-quality trials.