Is Electroacupuncture Better Than Regular Acupuncture for Frozen Shoulder?

Key points in 30 seconds

1. There's research showing electroacupuncture did better than regular acupuncture for pain in frozen shoulder.
2. It's an analysis of 13 studies with 936 people, and the difference isn't large.
3. There's also a Korean pharmacopuncture study, but it's a report of three patients, so the evidence is weak.
4. Frozen shoulder needs different things at different stages. We figure out the stage first.
5. If you lost strength after an injury, it may be a different problem, so imaging comes first.

References

Heo I, et al. Effectiveness of electroacupuncture for frozen shoulder: a systematic review
and meta-analysis. Front Med. 2022;9:928823. DOI 10.3389/fmed.2022.928823

Kim MH, Jeon SH. Three cases of combined Hominis Placenta pharmacopuncture and Chuna treatment for patients with frozen shoulder [in Korean].
J Korean Med. 2023;44(1):117-127. DOI 10.13048/jkm.23011

What we often hear

• "I can't lift my arm above my shoulder."
• "I'm getting acupuncture, but I don't know when it'll get better."
• "I heard electroacupuncture works better. Is that true?"

Is electroacupuncture better than regular acupuncture for frozen shoulder?

An analysis of 13 randomized studies with 936 people found that electroacupuncture gave better results for pain. However, the size of the difference isn't large, and the methods differed from study to study.

With frozen shoulder, the pain is hard, but not being able to raise your arm is even more limiting. It gets in the way of everyday movements like washing your hair or getting dressed. That's why pain and movement need to be looked at together.

What kind of study is it?

It pooled and analyzed 13 randomized studies with 936 frozen shoulder patients. It compared electroacupuncture with regular acupuncture and other treatments.

Electroacupuncture adds a mild electrical stimulus to the needles. The results showed electroacupuncture did better for pain, and the share of people who responded to treatment was slightly higher. No side effects were reported.

Study	Design	Participants	Main results	Level of evidence
Heo 2022
Front Med 9:928823
DOI 10.3389/fmed.2022.928823	Meta-analysis
13 randomized studies	936 people
Frozen shoulder (adhesive capsulitis)	Pain: electroacupuncture vs regular acupuncture
MD −1.11 (95% CI −1.61~−0.61)
Response rate RR 1.16 (1.07–1.25)	Moderate
Kim 2023
J Korean Med 44(1):117-127
DOI 10.13048/jkm.23011	Case report	3 people	After combined pharmacopuncture and Chuna,
less pain and improved range for raising the arm out to the side and rotating it outward	Low
Only 3 people, so it can't be generalized

What are the limits of this evidence?

Whether a pain score about 1 point lower is a difference you'd notice in daily life needs to be looked at separately. A difference in numbers and a difference you feel aren't the same.

A few more points. First, the 13 pooled studies each used different strengths and durations of electrical stimulation and different numbers of sessions. This data can't tell us which settings work best. Second, the Korean study in the second row of the table is a report of three patients. It's the weakest kind of evidence, and we included it only to let you know that this approach has been tried in Korea.

Third, frozen shoulder has a stretch where it gets better on its own over time. We'll be honest that it's hard to separate whether improvement came from treatment or from the stage it was in.

So what do you do in the clinic?

We start by seeing what stage you're in. The stage when pain is severe and the stage when stiffness is the main problem call for different things. Starting exercises without knowing the stage can actually make it hurt more.

In the painful stage, lowering pain comes first; in the stiff stage, increasing range of motion is the focus. If your shoulder suddenly won't lift, or you lost strength after an injury, it could be a different problem such as a rotator cuff tear, so we recommend imaging first.

We look first at what stage you're in, rather than which kind of acupuncture is better. What we use in the painful stage and the stiff stage is different.

If pain at night keeps you from rolling over, come see us. That nighttime pain is the first thing we work on. Recovery starts with sleep.

How fast things improve differs from person to person, depending on how stiff the shoulder is and what stage it's in.