The Role of Acupuncture in Postoperative Pain: A Literature Review

ABSTRACT Postoperative pain remains a significant clinical challenge and is associated with increased morbidity, delayed mobilization, prolonged hospital stay, and a higher risk of chronic post-surgical pain. Although pharmacological analgesia, particularly opioids and non-steroidal anti-inflammatory drugs, remains the cornerstone of postoperative pain management, their use is frequently limited by adverse effects such as nausea, vomiting, sedation, respiratory depression, gastrointestinal complications, and the potential for dependence. These limitations have encouraged the integration of non-pharmacological modalities, including acupuncture, into multimodal analgesia strategies. This literature-based review evaluates the role of acupuncture in the management of postoperative pain across various surgical procedures, including orthopedic, abdominal, gynecologic, thyroid, and minimally invasive surgeries. Evidence from randomized controlled trials and systematic reviews demonstrates that different acupuncture modalities—manual acupuncture, electroacupuncture, transcutaneous electrical acupoint stimulation (TEAS), auricular acupuncture including Battlefield Acupuncture, laser acupuncture, and wrist-ankle acupuncture—are associated with significant reductions in pain intensity scores measured by Visual Analog Scale (VAS) or Numeric Rating Scale (NRS) within the first 24–72 hours after surgery. Several studies also report decreased cumulative opioid consumption and a lower incidence of opioid-related adverse events, particularly postoperative nausea and vomiting. From a neurophysiological perspective, acupuncture exerts analgesic effects through activation of endogenous opioid peptides such as β-endorphin, enkephalin, and dynorphin; modulation of descending inhibitory pathways involving serotoninergic and noradrenergic systems; inhibition of nociceptive transmission at the dorsal horn of the spinal cord; and regulation of autonomic balance via vagal pathways. Additionally, acupuncture demonstrates anti-inflammatory effects by reducing pro-inflammatory cytokines, including TNF-α and IL-1β, while increasing anti-inflammatory mediators. Overall, current evidence supports acupuncture as a safe and effective complementary therapy in postoperative pain management. Its integration into multimodal analgesia protocols may enhance analgesic efficacy, reduce opioid requirements, and improve postoperative recovery outcomes. Keywords: Acupuncture, Pain, Post-Operative Pain, Multimodal Analgesia.