Acupoint stimulation for pain management in patients after transcatheter arterial chemoembolization: A systematic review and meta-analysis

To systematically evaluate the clinical efficacy of acupoint stimulation for managing post-transcatheter arterial chemoembolization (TACE) pain and to provide a reliable evidence-based foundation for its clinical application in post-TACE pain management. Clinical randomized controlled trials evaluating acupoint stimulation for post-TACE pain were retrieved from the Chinese National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Chinese Science and Technology Journal Database, China Biology Medicine disc, PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov, covering all records from database inception to July 28, 2025. Articles were screened and data were extracted according to predefined inclusion and exclusion criteria. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Assessment Tool. Statistical analyses were conducted using Review Manager 5.4.1 and Stata 15.0. The certainty of evidence for each outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. This study was registered on PROSPERO (CRD420251108966). A total of 17 studies involving 1525 patients with liver cancer who experienced acute postoperative pain following TACE were included. Meta-analysis results demonstrated that acupoint stimulation significantly reduced pain intensity scores (Numerical rating scale: mean difference [MD] = −0.83, 95 % confidence interval [CI] [−0.96, −0.71], P < 0.00001; Visual analog scale: MD = −1.15, 95 % CI [−1.67, −0.63], P < 0.0001), increased the complete pain remission rate (Risk ratio [RR] = 1.74, 95 % CI [1.35, 2.23], P < 0.0001), shortened the onset time of analgesia (MD = −25.39 min, 95 % CI [−27.53, −23.26], P < 0.00001), prolonged the duration of analgesia (MD = 3.03 h, 95 % CI [0.40, 5.66], P = 0.02), and reduced the need for rescue analgesics (RR = 0.43, 95 % CI [0.28, 0.64], P < 0.0001). Furthermore, acupoint stimulation improved liver function indicators (Alanine aminotransferase: MD = −5.27 U/L, 95 % CI [−6.90, −3.63], P < 0.00001; Aspartate aminotransferase: MD = −6.76 U/L, 95 % CI [−8.39, −5.12], P < 0.00001), lowered plasma substance P levels (MD = −18.28 ng/L, 95 % CI [−30.97, −5.60], P = 0.005), and enhanced patient satisfaction (RR = 1.33, 95 % CI [1.05, 1.69], P = 0.02). Regarding safety, acupoint stimulation significantly reduced the risk of adverse events compared with blank controls (RR = 0.24, 95 % CI [0.10, 0.56], P = 0.001). However, no statistically significant differences in the risk of adverse events were observed when acupoint stimulation was combined with analgesics (RR = 0.91, 95 % CI [0.39, 2.13], P = 0.82) or compared directly to analgesics alone (RR = 0.79, 95 % CI [0.04, 14.95], P = 0.87). Acupoint stimulation demonstrates favorable effects in alleviating pain following TACE. However, the relatively low methodological quality of the included studies limits the strength of the conclusions. Additional high-quality studies are needed to provide more robust evidence to guide clinical practice.