{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:30:43Z","timestamp":1792593043119,"version":"4.5.0"},"reference-count":147,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to evaluate the efficacy and safety of various acupuncture treatments in conjunction with multimodal analgesia (MA) for managing postoperative pain and improving knee function in patients undergoing total knee arthroplasty (TKA), based on the findings from clinical research indicating the potential benefits of acupuncture-related therapies in this context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched Web of Science, PubMed, SCI-hub, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) to collect randomized controlled trials of acupuncture-related therapies for post-TKA pain. After independent screening and data extraction, the quality of the included literature was evaluated. The potential for bias in the studies incorporated in the analysis was assessed according to the guidelines outlined in the Cochrane Handbook 5.1. Network meta-analysis (NMA) was conducted using RevMan 5.4 and Stata 16.0 software, with primary outcome measures including visual analog scale (VAS), pain pressure threshold (PPT), hospital for special surgery knee score (HSS), and knee joint range of motion (ROM). Furthermore, the interventions were ranked based on the SUCRA value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We conducted an analysis of 41 qualifying studies encompassing 3,003 patients, examining the efficacy of four acupuncture therapies (acupuncture ACU, electroacupuncture EA, transcutaneous electrical acupoint stimulation TEAS, and auricular acupoint therapy AAT) in conjunction with multimodal analgesia (MA) and MA alone. The VAS results showed no significant difference in efficacy among the five interventions for VAS-3 score. However, TEAS+MA (SMD: 0.67; 95%CI: 0.01, 1.32) was more effective than MA alone for VAS-7 score. There was no significant difference in PPT score among the three interventions. ACU\u2009+\u2009MA (SMD: 6.45; 95%CI: 3.30, 9.60), EA\u2009+\u2009MA (SMD: 4.89; 95%CI: 1.46, 8.32), and TEAS+MA (SMD: 5.31; 95%CI: 0.85, 9.78) were found to be more effective than MA alone for HSS score. For ROM score, ACU\u2009+\u2009MA was more efficacious than EA\u2009+\u2009MA, TEAS+MA, and AAT\u2009+\u2009MA, MA. Regarding the incidence of postoperative adverse reactions, nausea and vomiting were more prevalent after using only MA. Additionally, the incidence of postoperative dizziness and drowsiness following ACU\u2009+\u2009MA (OR\u2009=\u20094.98; 95%CI: 1.01, 24.42) was observed to be higher compared to that after AAT\u2009+\u2009MA intervention. Similarly, the occurrence of dizziness and drowsiness after MA was found to be significantly higher compared to the following interventions: TEAS+MA (OR\u2009=\u20090.36; 95%CI: 0.18, 0.70) and AAT\u2009+\u2009MA (OR\u2009=\u20090.20; 95%CI: 0.08, 0.50). The SUCRA ranking indicated that ACU\u2009+\u2009MA, EA\u2009+\u2009MA, TEAS+MA, and AAT\u2009+\u2009MA displayed superior SUCRA scores for each outcome index, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For the clinical treatment of post-TKA pain, acupuncture-related therapies can be selected as a complementary and alternative therapy. EA\u2009+\u2009MA and TEAS+MA demonstrate superior efficacy in alleviating postoperative pain among TKA patients. ACU\u2009+\u2009MA is the optimal choice for promoting postoperative knee joint function recovery in TKA patients. AAT\u2009+\u2009MA is recommended for preventing postoperative adverse reactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/<\/jats:ext-link>\n                      , identifier (CRD42023492859).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2024.1361037","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T11:34:34Z","timestamp":1710761674000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"15","author":[{"given":"Ningning","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaihong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingxue","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongbin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianzhu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaozong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"ref1","first-page":"5","article-title":"Epidemiological survey of rheumatoid arthritis among rural minority residents aged 20-79 years in Qiannan Prefecture, Guizhou Province","volume":"47","author":"Yebin","year":"2020","journal-title":"Mod Preven Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"817716","DOI":"10.3389\/fpsyt.2022.817716","article-title":"The impact of psychological health on patient recovery after arthroplasty front","volume":"13","author":"Zhang","year":"2022","journal-title":"Psychiatry"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/s0885-3924(02)00465-7","article-title":"International Association for the Study of Pain: update on WHO-IASP activities","volume":"24","author":"Breivik","year":"2002","journal-title":"J Pain Symptom Manag"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1097\/j.pain.0000000000000874","article-title":"Pharmacoepidemiologic analyses of opioid use among OEF\/OIF\/OND veterans","volume":"158","author":"Hudson","year":"2017","journal-title":"Pain"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2776","DOI":"10.1007\/s00167-021-06657-x","article-title":"Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial","volume":"30","author":"Eymir","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"127","DOI":"10.4103\/0259-1162.134474","article-title":"Fast-track surgery: toward comprehensive peri-operative care","volume":"8","author":"Nanavati","year":"2014","journal-title":"Anesth Essays Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1249\/MSS.0000000000001207","article-title":"Sedentary behavior, cadence, and physical activity outcomes after knee arthroplasty","volume":"49","author":"Webber","year":"2017","journal-title":"Med Sci Sports Exerc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s40798-024-00678-9","article-title":"Wearable devices to improve physical activity and reduce sedentary behaviour: an umbrella review","volume":"10","author":"Longhini","year":"2024","journal-title":"Sports Med Open"},{"key":"ref9","volume-title":"Global action plan on physical activity 2018\u20132030: more active people for a healthier world","year":"2018"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.cjca.2014.12.008","article-title":"Obesity and coronary artery disease: evaluation and treatment","volume":"31","author":"Garcia-Labb\u00e9","year":"2015","journal-title":"Can J Cardiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1016\/j.arth.2015.03.016","article-title":"Does Total knee arthroplasty affect physical activity levels? 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