Since the 1970s, acupotomy, a minimally?invasive therapeutic technique originating from China, has been widely adopted for managing chronic musculoskeletal pain and has yielded promising clinical outcomes in real-world practice. Despite its growing popularity, several critical challenges have emerged during its clinical implementation, including inappropriate selection of clinical indications, substandard technical performance, and inconsistent, heterogeneous treatment regimens across different practitioners and medical centres. Such practice-related limitations may contribute to unstable therapeutic effects, preventable treatment-related incidents, and avoidable peri-procedural complications, which consequently hinder the safe, standardised promotion and widespread popularisation of acupotomy therapy. To address these gaps and standardise the clinical application of acupotomy for chronic musculoskeletal pain, this expert consensus was initiated at the formal invitation of the Editorial Board of the Chinese Journal of Painology. A multidisciplinary panel of leading national specialists in pain medicine was convened to develop this document. The expert group systematically searched and appraised available evidence-based literature published both domestically and internationally, and integrated high-level research findings with extensive, long-term front-line clinical experience. After thorough discussion, the panel summarised core recommendations covering the fundamental principles, standard operating procedures, indications, contraindications and key safety precautions for acupotomy intervention in chronic musculoskeletal pain. Following multiple rounds of group discussion, peer review and iterative revision, the final version of this expert consensus was reached.
| Published in | International Journal of Pain Research (Volume 2, Issue 3) |
| DOI | 10.11648/j.ijpr.20260203.22 |
| Page(s) | 201-216 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2026. Published by Science Publishing Group |
Needle-knife, Acupotomy, Chronic Musculoskeletal Pain, Expert Consensus
Disorder Categories | Evidence Quality Grade | Recommendation Strength |
|---|---|---|
1. Spinal-derived Pain | ||
(1) Cervicogenic headache [8, 9] | B | 1 |
(2) Cervical spondylosis [10, 11] | A | 1 |
(3) Lumbar disc herniation [12-17] | B | 1 |
(4) Spinal stenosis [18-21] | B | 2 |
(5) Vertebral compression fracture [22 ] | B | 2 |
(6) Facet joint disorder syndrome [23 ] | A | 1 |
(7) Ankylosing spondylitis [24, 25] | B | 2 |
(8) Third lumbar transverse process syndrome [26, 27] | A | 1 |
2. Osteoarthritis and Joint Pain | ||
(1) Joint Pain | ||
① Knee joint pain [28 -37] | A | 1 |
② Shoulder pain [38 -43] | A | 1 |
③ Hip joint pain (including femoral head necrosis) [44] | B | 2 |
(2) Rheumatoid arthritis [45, 46] | C | 3 |
(3) Gouty arthritis [47, 48] | B | 2 |
(4) Sacroiliitis [49, 50] | B | 2 |
3. Soft Tissue Lesions | ||
(1) Bursal lesions [51, 52] | A | 1 |
(2) Myofascial trigger points [53-55] | A | 1 |
(3) Tendinopathy / Enthesitis [57-59] | A | 1 |
(4) Tenosynovitis [60-65] | A | 1 |
4. Nerve Entrapment Pain | ||
(1) Nerve root entrapment [66-68] | B | 1 |
(2) Piriformis syndrome [69, 70] | B | 2 |
(3) Peripheral nerve entrapment [71, 72] | A | 1 |
(4) Spinal nerve posterior branch syndrome [73, 74] | B | 1 |
Instrument / Modality | Structural Characteristics | Advantages | Disadvantages | Main Indications |
|---|---|---|---|---|
Micro / Ultra-micro Acupotomy [75-77] | Small blade (approx. 0.5 mm), slender shaft. | It enables sufficient release of muscles, fascia, and other soft tissues. It features simple operation, superior safety, and higher patient acceptance. | Slender and soft shaft, weak transverse peeling capability. | Similar to traditional acupotomy. |
Injection Acupotomy [10, 78] | Hollow canal in the center of the shaft, with a flat or concave blade edge. | It integrates two therapeutic approaches -release of closed adhesive scar tissue and drug injection, enabling acupotomy manipulation and drug administration to be performed simultaneously. | Hollow shaft, insufficient force during transverse release dissection. | Pathologies requiring anti-inflammatory and analgesic injections following target adhesiolysis, such as scapulohumeral periarthritis, knee osteoarthritis, cervical disc herniation, lumbar disc herniation, etc. |
Specially Shaped Acupotomy [79, 80] | Different shapes designed according to specific regional anatomical characteristics, such as sickle shape, curved hook shape, concave blade shape, etc. | It enables highly targeted intervention for specific diseases. For example, the sickle-shaped acupotomy has obvious advantages in treating stenosing tenosynovitis of hand flexor tendons. | While designed for specific diseases, acupotomy has limited general applicability. | Mainly suitable for stenosing tenosynovitis and peripheral nerve entrapment syndromes. |
Acupotome Endoscope (Needle-knife Endoscope) [81, 82] | Dedicated acupotome endoscope equipment, including endoscopic imaging system, irrigation system, shaving and debridement systems, endoscopic surgical instruments, and meridian-sinew acupotomes, etc. | Operative procedures are performed under direct visualization inside the joint cavity or tissues via the endoscope. It simplifies procedures, minimizes wounds, offers a broad treatment range, and causes only minor adverse reactions. | Similar to arthroscopy, it requires specialized instruments and equipment. | Mainly suitable for scapulohumeral periarthritis, knee osteoarthritis, ankle osteoarthritis, gouty tophi, and other diseases requiring intra-articular interventions. |
Combined Therapy Model | Evidence Quality Grade | Recommendation Strength |
|---|---|---|
Acupotomy + Nerve Block [67, 83] | A | 1 |
Acupotomy + Ozone Injection [84, 85] | B | 2 |
Acupotomy + Biological Therapy (PRP / Stem Cells) [86-88] | B | 2 |
Acupotomy + Acupuncture [66, 89] | B | 2 |
Acupotomy + Physical Therapy [90, 91] | B | 1 |
Disorder Categories | Treatment Points | Image Guidance | Operation Key Points |
|---|---|---|---|
1. Spinal-derived Pain | |||
(1) Cervicogenic headache [8, 9] | Spinous processes, facet joints, and posterior tubercles of the transverse processes of the upper cervical vertebrae; tenderness points of the head and neck muscles, and their occipital attachments. | X-ray or ultrasound-guided. | Keep the blade aligned parallel to the longitudinal axis of the spine. Advance the needle-knife to the osseous surface, perform 3 longitudinal peels, then 3 transverse swings. Withdraw the needle-knife once a loosening sensation is achieved. |
(2) Cervical spondylosis [10, 11] | Paravertebral facet joints, joint capsules, and posterior tubercles of the transverse processes of the affected segments; tender sites of the scapular region or cervical palpable taut bands and positive nodules; ligamentum flavum, lateral recesses, nerve root exits, and the brachial plexus pathway. | X-ray, ultrasound, or CT-guided. | Keep the blade aligned parallel to the longitudinal axis of the spine. Advance the needle-knife to the osseous surface, perform 3 longitudinal peels, then 3 transverse swings. Withdraw the needle-knife once a loosening sensation is achieved. For affected nerve roots, directly or indirectly, contact and stimulate the nerve root or ganglion to induce a neural stress response and elicit a protective avoidance reflex. |
(3) Lumbar disc herniation [12 -17] | Transverse processes, paravertebral facet joints, joint capsules, spinous processes, ligamentum flavum, and lateral recesses of the affected segments. | X-ray, ultrasound, or CT-guided. | The nerve stimulation targets for lumbar lesions are usually accessed and stimulated via the lateral recess or nerve root exit zone; other manipulations are consistent with those applied for cervical spondylosis. |
(4) Spinal stenosis [18 -21] | Facet joints, joint capsules, ligamentum flavum, and lateral recesses of the affected segments. | X-ray, ultrasound, or CT-guided. | Keep the blade aligned parallel to the longitudinal axis of the spine. Advance the needle-knife to the osseous surface of the facet joints, lateral recesses, or ligamentum flavum; perform longitudinal peeling and transverse swinging, withdrawing upon a loosening sensation. |
(5) Vertebral compression fracture [22] | Interspinous spaces above and below the fractured vertebra, facet joints, costotransverse joints, local soft tissue spaces, and local tenderness sites. | X-ray, ultrasound, or CT-guided. | Keep the blade aligned parallel to the longitudinal axis of the spine. Advance the needle-knife to the surface of facet joints, interspinous spaces, or local tenderness points; perform longitudinal peeling and transverse swinging, withdrawing upon a loosening sensation. |
(6) Facet joint disorder syndrome [23] | Perform on the facet joint capsules and surrounding soft tissues of the responsible segment. | X-ray, ultrasound, or CT-guided. | Shovel-cut the facet joint capsule and surrounding soft tissues of the responsible segments. Keep the blade aligned parallel to the longitudinal axis of the spine. Insert the needle-knife vertically to reach the osseous surface, then adjust the blade direction parallel to the joint facet plane. Execute 2–3 shoveling cuts to release the joint capsule and surrounding soft tissues, withdrawing upon a loosening sensation. |
(7) Ankylosing spondylitis [24, 25] | Sacroiliac joint cavity, surrounding tendon attachments, and tenderness points. | X-ray, ultrasound, or CT-guided. | At the osseous surface and surrounding tenderness points of the joint, perform 2–3 longitudinal peels, followed by 2–3 transverse peels, withdrawing upon a loosening sensation. |
(8) Third lumbar transverse process syndrome [26, 27] | Quadratus lumborum, intertransverse muscles, and fascia attached to the transverse process. | X-ray, ultrasound, or CT-guided. | Keep the blade aligned parallel to the longitudinal axis of the spine. Rapidly insert the needle-knife to reach the osseous surface of the L3 transverse process tip. Closely along the anterior and posterior bone margins of the transverse process tip, perform 2–3 longitudinal peels and 2–3 transverse peels. Withdraw the needle-knife when a loosening sensation is felt or the patient reports soreness or distension. |
2. Osteoarthritis and Joint Pain | |||
(1) Joint Pain | Treatment points are mainly identified by manual palpation of tender points, fibrous bands, indurated nodules, and high-tension areas, in combination with pathomorphological findings on X-ray and musculoskeletal ultrasound. | Ultrasound-guided. | For affected ligament or tendon: Perform 2–3 longitudinal peels, followed by 2–3 transverse peels. Then rotate the blade line by 90°and conduct another 2–3 cross-peels (cross-cutting), withdrawing upon a loosening sensation. For affected joint cavity: Insert the needle body vertically through the skin to access the joint cavity directly. Perform 1–2 dredging manipulations, and withdraw upon a loosening sensation. |
① Knee joint pain [28-37] | The anserine bursa of the knee joint , medial and lateral patellar retinacula, quadriceps tendon, patellar ligament, suprapatellar bursa, as well as the tibial and fibular collateral ligaments. | Ultrasound-guided. | |
② Shoulder pain [38-43] | Coracoid process of the scapula, the greater and lesser tubercles of the humerus, the intertubercular groove, the subacromial bursa, and attachments of periarticular soft tissues in the quadrangular space exhibiting contracture, scar, and adhesion tenderness. | Ultrasound-guided. | |
③ Hip joint pain (including femoral head necrosis) [44 ] | Femoral greater trochanter, gluteus medius, adductor group, iliotibial band, and tensor fasciae latae, groin, entrapment point of the superior cluneal nerve , hamstring origin, hip joint capsule release, and femoral head decompression drilling. | X-ray or ultrasound-guided. | |
(2) Rheumatoid arthritis [45, 46] | Joint cavity, surrounding ligaments, and tendon tenderness points of affected joints. | X-ray or ultrasound-guided. | |
(3) Gouty arthritis [47, 48] | Joint cavity, surrounding ligaments, and tendon tenderness points of affected joints. Note: Acupotome endoscope (needle-knife endoscope) offers superior efficacy over simple acupotomy. | Ultrasound-guided. | |
(4) Sacroiliitis [49, 50] | Sacroiliac joint cavity, surrounding ligaments, and tendon attachment tenderness points. | X-ray, ultrasound, or CT-guided. | At the osseous surface and surrounding areas, perform 2–3 longitudinal peels and 2–3 transverse peels, withdrawing upon a loosening sensation under the needle. |
3. Soft Tissue Lesions | |||
(1) Bursal lesions [51, 52] | Suprapatellar bursa, anserine bursa, subacromial bursa, subcoracoid bursa, ischial bursa, etc. | Ultrasound-guided. | Insert the needle along the course of muscle or tendon. When reaching the bursa and tendon site, perform 2–3 longitudinal dredgings and transverse peels. |
(2) Myofascial trigger points [53-55] | Palpate the local taut band to locate localized painful indurated nodules at the center of the affected muscle belly, musculotendinous junctions, and at muscle-bone insertions. | Ultrasound-guided. | Align the blade parallel to the myofascial direction. Insert the needle vertically through the skin at the tender point. Upon reaching the target, perform longitudinal cuts and swings, then tilt the shaft at 90° to the myofascial direction, execute 3 transverse peels, and withdraw upon a loosening sensation under the needle. |
(3) Tendinopathy / Enthesitis [57-59] | Tender points at tendon insertions or calcified tendon lesions; Tender points characterized by positive pressure pain, palpable indurated masses, and fibrous bands or nodules. | Ultrasound-guided. | At the osseous surface of the tender point, perform 2–3 longitudinal peels and 2–3 transverse peels, withdrawing upon a loosening sensation. For calcified lesions, target the calcification under ultrasound guidance, insert the needle-knife parallel to the tendon fibers to break up the calcium deposits, and withdraw the needle-knife after confirming the disappearance or dispersion of the hyperechoic mass under real-time ultrasound. |
(4) Tenosynovitis [60-65] | Affected tendons, tendon sheaths, osteofibrous sheaths, and pulley sites. | Ultrasound-guided. | Perform 2–3 longitudinal peels along the affected tendon, tendon sheath, osteofibrous canal, and pulley, withdrawing upon a loosening sensation. |
4. Nerve Entrapment Pain | |||
(1) Nerve root entrapment [66 -68] | Spinal spinous processes, trigger points between intertransverse regions; ligamentum flavum, intervertebral canal internal orifice ligaments, intervertebral canal external orifice surrounding ligaments, and soft tissues; affected vertebral facet joints. | X-ray, ultrasound, or CT-guided. | For the internal orifice of the nerve root via the interlaminar space: Advance the needle-knife tightly close to the bony surface of the medial margin of the facet joint to release the ligamentum flavum and the soft tissue at the internal ostium of the extradural intervertebral canal. For the external orifice of the intervertebral canal: Perform 2–3 cuts along the osseous margin at the upper-middle 1/3 of the affected external intervertebral orifice; pay close attention to patient-reported paresthesia. |
(2) Piriformis syndrome [69, 70] | insertion and muscle belly indurations and fibrous bands located at the piriformis origin. | Ultrasound-guided. | For Piriformis: Align parallel to the piriformis, perform local transverse cuts 3–5 times, and swing the needle shaft at the mid-to-lower portion of the muscle belly, withdrawing upon a loosening sensation. Adjust the position and direction of the needle-knife to gently contact and stimulate the sciatic nerve trunk and its sheath for 5–8 times, until radiation soreness, distension, pain, muscle twitching, numbness, or electric-shock sensation occurs in the lower limb. For origin, insertion, and tender points: Insert the needle vertically to the osseous surface, perform 3–5 longitudinal peels and transverse swings, and withdraw upon a loosening sensation. |
(3) Peripheral nerve entrapment [71, 72] | Nerve entrapment points and tender points. | Ultrasound-guided. | Keep the blade line parallel to the long axis of the nerve surrounding the entrapment point. Perform 3–5 longitudinal peels and transverse swings, withdrawing upon a loosening sensation. |
(4) Spinal nerve posterior branch syndrome [73, 74] | The intersection of the transverse process root and the facet joint along the path of the affected posterior nerve branch. | X-ray, ultrasound, or CT-guided. | Keep the blade aligned parallel to the longitudinal axis of the spine. Slowly advance the needle to the transverse process root and the bone surface of the facet joint. Perform 3–4 shoveling cuts close to the bone surface, withdrawing the needle-knife when a loosening sensation is felt or the patient reports soreness or distension. |
Level / Strength | Classification | Operational Definition and Description |
|---|---|---|
Quality of Evidence | ||
High Quality (A) | High confidence | Highly confident that the estimated clinical effect is close to the true therapeutic effect. |
Moderate Quality (B) | Moderate confidence | Moderately confident in the estimated effect: the estimate is likely close to the true value, but there is a possibility that it is substantially different. |
Low Quality (C) | Low confidence | Limited confidence in the estimated effect: the clinical estimate may be substantially different from the true therapeutic value. |
Very Low Quality (D) | Very low confidence | Little to no confidence in the estimated effect: the clinical estimate is highly likely to differ substantially from the true value. |
Strength of Recommendation | ||
Strong Recommendation (1) | Strong recommendation | Most patients would select the recommended strategy under this scenario, with only a small minority declining; most clinicians should adopt this intervention, supported by over 70% of the consensus expert panel. |
Weak Recommendation (2) | Weak recommendation | Most patients would choose the recommended strategy, but many would not; clinicians should actively search for evidence summaries to prepare for collaborative discussions reflecting patient values and preferences; supported by 50%–70% of the consensus expert panel. |
No Clear Recommendation (3) | Neutral recommendation | Benefits and harms are closely balanced; the target population is not clearly defined; evidence is insufficient to formulate a recommendation; supported by less than 50% of the consensus expert panel. |
CMP | Chronic Musculoskeletal Pain |
CNKI | China National Knowledge Infrastructure |
ICD-11 | International Classification of Diseases, 11th Revision |
CPMSP | Chronic Primary Musculoskeletal Pain |
CSMSP | Chronic Secondary Musculoskeletal Pain |
GRADE | Grading of Recommendations Assessment, Development, and Evaluation |
| [1] | El-Tallawy SN, Nalamasu R, Salem GI, Christo PJ. Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain. Pain Ther. 2021; 10(1): 181-209. |
| [2] | Raja SN, Carr DB, Cohen M, Vader K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN. 2020; 161(9): 1976-1982. |
| [3] | Zhu HZ, Liu BZ. Acupotomy Clinical Diagnosis and Treatment. 2nd ed. Beijing, People’s Medical Publishing House; 2009, 23-301. |
| [4] | Pang JG. Foundations and Clinical Practice of Acupotomy Medicine - Bone and Joint Diseases. 2019: 892. |
| [5] | Zhu HZ. Principles of Acupotomy Medicine. Beijing, People’s Medical Publishing House; 2002, 1-56. |
| [6] | Zhang TM, Liu JM, Wang RL. Expert lecture series VI: Etiological and pathological theory of chronic visceral diseases. China Medical Herald, 2017, 14(21): 151-154. |
| [7] | Wu XP, Peng L, Zhou P, editors. Clinical Diagnosis, Treatment and Operational Standards of Acupotomy Medicine. 2021. p. 315. |
| [8] | Wang LX, Ma JY, Zhu LX, et al. Effectiveness and safety of ultrasound-guided C2-3 facet joint block combined with acupotomy release at posterior atlantoaxial joint for cervicogenic headache. Imaging Research and Medical Application, 2019, 3(18): 126-127. |
| [9] | Wang KP, Fan KY, Zhou XH, et al. Clinical observation of acupotomy combined with warm needle acupuncture for cervicogenic headache based on meridian-sinew theory. Journal of Guangxi University of Chinese Medicine, 2024, 27(5): 16-19. |
| [10] | Pu J, Cao W, Chen Y, et al. Ultrasound-guided injection acupotomy as a minimally invasive intervention therapy for cervical spondylotic radiculopathy: a randomized control trial. Ann Med, 2023, 55(1): 2233556. |
| [11] | Liu F, Zhou F, Zhao M, et al. Acupotomy therapy for chronic nonspecific neck pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med, 2017, 2017: 6197308. |
| [12] | Song X, Zhang CR, Zuo XT, et al. Different acupotomy insertion points for lumbar disc herniation: a randomized controlled study. Zhongguo Zhen Jiu, 2022, 42(1): 35-40. |
| [13] | Kim HJ, Jeon JH, Kim YI, et al. Clinical effect of acupotomy combined with Korean medicine: a case series of a herniated intervertebral disc. J Acupunct Meridian Stud, 2016, 9(1): 31-41. |
| [14] | Jiang L, Zhang B, Yu H, et al. Analysis on adverse event in acupotomy therapy based on literature research. Zhongguo Zhen Jiu, 2018, 38(9): 1007-1012. |
| [15] | Lee J, Lee S, Suh H, et al. Effectiveness of acupotomy combined with epidural steroid injection for lumbosacral radiculopathy: a randomized controlled pragmatic pilot study. Medicina (Kaunas), 2024, 60(1): 175. |
| [16] | Sun XC, Zhang SM, Liu SJ. Acupotomy Combined with Celecoxib and Zhenggu Shenjin Capsules for Lumbar Disc Herniation: a propensity score-matched retrospective cohort study. J Pain Res, 2026, 19: 594368. |
| [17] | Liang Y, Chen L, Cui Y, et al. Ultrasound-guided acupotomy for trigger finger: a systematic review and meta-analysis. J Orthop Surg Res, 2023, 18(1): 678. |
| [18] | Kwon CY, Yoon SH, Lee B, et al. Acupotomy for the treatment of lumbar spinal stenosis: a protocol for a systematic review and meta-analysis. Medicine, 2019, 98(3): e14160. |
| [19] | Lee JH, Lee HJ, Woo SH, et al. Effectiveness and safety of acupotomy on lumbar spinal stenosis: a pragmatic, pilot, randomized controlled trial. J Pain Res, 2023, 16: 659-668. |
| [20] | Kim, JH, Han, CH, Lee, T al. Effectiveness and safety of combining pharmacopuncture therapy and acupotomy for treating patients with degenerative lumbar spinal stenosis: A pragmatic, assessor-blinded, randomized, controlled trial. Integr Med Res. 2026, 15(1): 101204. |
| [21] | Chen Y, Song H, Chen M, et al. The role of acupotomy in treatment of patients with lumbar spinal stenosis: a protocol for a randomized study. Medicine, 2020, 99(31): e21444. |
| [22] | Wang ZG, He ZL, Peng SY. Clinical efficacy of ultrasound-guided ultra-micro needle knife combined with PVP in elderly patients with OVCF: a retrospective study. Am J Transl Res. 2025, 17(12): 9905-9915. |
| [23] | Lu D, Xu WX, Ding WG, et al. Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis. Chin J Orthop Trauma, 2013, 26(3): 221-225. |
| [24] | Gao YQ, Zhu H, Zhang H, et al. Needle knife diagnosis and treatment for ankylosing spondylitis at middle and advanced stage based on the theory of meridian tendons. Zhongguo Zhen Jiu, 2025, 45(4): 387-391. |
| [25] | You Y, Cai M, Lin J, et al. Efficacy of needle-knife combined with etanercept treatment regarding disease activity and hip joint function in ankylosing spondylitis patients with hip joint involvement: a randomized controlled study. Medicine, 2020, 99(19): e20019. |
| [26] | Wang YZ, Dong FH, Zhong HG, et al. Randomized control clinical study on third lumbar transverse process syndrome treated by knife needle. Zhongguo Gu Shang, 2009, 22(6): 438-441. |
| [27] | Guo C, Dong F, Li S, et al. Effects of acupotomy lysis on local soft tissue tension in patients with the third lumbar vertebrae transverse process syndrome. Zhongguo Zhen Jiu, 2012, 32(7): 617-620. |
| [28] | Acupotomy Medicine Branch of Chinese Association of Chinese Medicine, Xiu ZB, Chen CX, et al. Clinical diagnosis and treatment guideline for acupotomy in knee osteoarthritis. Journal of Rehabilitation, 2023, 33(3): 193-201. |
| [29] | Lee C, Luo W, Tam K, et al. Comparison of the effects of acupotomy and acupuncture on knee osteoarthritis: a systematic review and meta-analysis. Complement Ther Clin Pract, 2023, 50: 101712. |
| [30] | Fang T, Li Q, Zhou F, et al. Effect and safety of acupotomy in treatment of knee osteoarthritis: a systematic review and meta-analysis. J Tradit Chin Med, 2020, 40(3): 355-364. |
| [31] | Wu Q, Wu Z, Lu Z. Efficacy of acupotomy combined with sodium hyaluronate versus sodium hyaluronate alone in the treatment of knee osteoarthritis: a meta-analysis. Medicine, 2023, 102(37): e34930. |
| [32] | Sun J, Zhao Y, Zhu R, et al. Acupotomy therapy for knee osteoarthritis pain: systematic review and meta-analysis. Evid Based Complement Alternat Med, 2020, 2020: 2168283. |
| [33] | Qu B, Wu X, Liu H, et al. Meta-analysis and systematic review of acupotomy combined with puncture and moxibustion in the treatment of knee osteoarthritis. Ann Palliat Med, 2021, 10(6): 6637-6649. |
| [34] | Zhu J, Zheng Z, Liu Y, et al. The effects of small-needle-knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized-controlled study. Clin Rehabil, 2020, 34(12): 1497-1505. |
| [35] | Liu MR, Li L, He ZW. Therapeutic effect of ultrafine acupotomy at anti-Ashi points for knee osteoarthritis. Zhongguo Zhen Jiu, 2012, 32(7): 621-624. |
| [36] | Ding Y, Wang Y, Shi X, et al. Effect of ultrasound-guided acupotomy vs electro-acupuncture on knee osteoarthritis: a randomized controlled study. J Tradit Chin Med, 2016, 36(4): 450-455. |
| [37] | Lin S, Lai C, Wang J, et al. Efficacy of ultrasound-guided acupotomy for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Medicine, 2023, 102(2): e32663. |
| [38] | Zhai PF, Zhao YG. Clinical efficacy of acupotomy combined with release manipulation for periarthritis of shoulder. Clinical Research and Practice, 2022, 7(22): 133-135. |
| [39] | Wan Q, Wang L, Yang LF, et al. Clinical effect of ultrasound-guided hydro-acupotomy release of coracohumeral ligament for frozen shoulder in elderly patients. Chinese Journal of Gerontology, 2022, 42(18): 4462-4465. |
| [40] | Chae H, Chu H, Lee J, et al. Effectiveness and safety of acupotomy treatment on shoulder pain: 25 multicenter retrospective study. J Pain Res, 2023, 16: 1367-1380. |
| [41] | You J, Yang F, Liu N, et al. Acupotomy therapy for shoulder adhesive capsulitis: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med, 2019, 2019: 2010816. |
| [42] | Xu H, Zhang Y, Wang C, et al. Ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of frozen shoulder. J Back Musculoskelet Rehabil, 2022, 35(5): 1153-1160. |
| [43] | Guo S, Liu D, Yang Y, et al. Clinical efficacy of small needle knife therapy on stage I-II frozen shoulder. J Vis Exp, 2023, (201): e65904. |
| [44] | Wang Z, Zhou X, Xie L, et al. Acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages: a clinical randomized controlled trial. Zhongguo Zhen Jiu, 2016, 36(10): 1031-1035. |
| [45] | Ning YF, Tian XM, Lei HT. Related mechanisms and clinical research progress of acupotomy for rheumatoid arthritis. Clinical Journal of Chinese Medicine, 2023, 35(11): 2256-2260. |
| [46] | Wang JY, Yan Y, Xia CM, et al. Efficacy analysis of manual release combined with acupotomy release for hip joint dysfunction caused by rheumatoid arthritis. Chinese Journal of Bone and Joint Injury, 2022, 37(10): 1055-1058. |
| [47] | Gao YQ, Tian XM, Wang HD, et al. Discussion on acupotomy for refractory gout based on meridian-sinew theory. Rheumatism and Arthritis, 2023, 12(12): 47-50, 61. |
| [48] | Zhang GH, Wang JJ, Yang L, et al. Efficacy of Qingre Tongbi decoction combined with minimally invasive acupotomy arthroscopy for knee gouty arthritis and its effects on serum cyclooxygenase-2 and nitric oxide. Hebei Journal of Traditional Chinese Medicine, 2023, 45(11): 1837-1840. |
| [49] | Liu LG, Tian MN, Kui Y. Clinical observation of small needle-knife therapy combined with manipulation for postpartum sacroiliac joint subluxation. Journal of Guangzhou University of Chinese Medicine, 2023, 40(7): 1712-1717. |
| [50] | Hou XJ, Zhou ZY, Li WL, et al. Clinical efficacy of J-type acupotomy combined with sinomenine for sacroiliitis. Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine, 2024, 24(11): 6-9, 23. |
| [51] | Cheng HJ, Liao LH, Chen SJ, et al. Efficacy of high-frequency ultrasound-guided small needle-knife combined with drug injection for subacromial bursitis. Chinese Journal of Physical Medicine and Rehabilitation, 2016, 38(8): 591-593. |
| [52] | Zhu T, Xiao LZ, Jiang W, et al. Ultrasound-guided drug injection combined with acupotomy for pes anserine bursitis. Chinese Journal of Pain Medicine, 2018, 24(8): 615-618. |
| [53] | Wang ZQ, Li Y. Research progress of traditional Chinese medicine on trigger points for myofascial pain syndrome. J Emerg Tradit Chin Med, 2020, 29(12): 2245-2249. |
| [54] | Tang ZY, Zhang HK, Wu Mq, Zhang Sd.Ultrasound-guided acupotomy release in the treatment of refractory low back pain: A case report. Medicine. 2025, 104(42): e45046. |
| [55] | Yu XJ, Chen XY, Zhu ZL, et al. Clinical therapeutic effects of trigger point acupuncture for chronic lumbar myofascial pain syndrome. Chinese Journal of Pain Medicine, 2017, 23(3): 194-199. |
| [56] | Liu LQ, Wang AC. Ultrasound-guided suprascapular nerve block combined with acupotomy for calcific tendinitis of rotator cuff: a report of 42 cases. Chinese Journal of Traditional Medical Traumatology & Orthopedics, 2020, 28(7): 50-52, 56. |
| [57] | Ge L, Liu X, Zhang R, et al. Comparison between acupotomy and corticosteroid injection for patients diagnosed with different classifications of tennis elbow: a randomized control trial. J Orthop Surg Res, 2022, 17(1): 433. |
| [58] | Xu L, Luo YX, Zhou CJ, et al. A standardized acupotomy protocol for the treatment of tenosynovitis of hand flexor tendons in human patients. J Vis Exp, 2026, 231. |
| [59] | Feng C, Yao J, Xie Y, et al. Small needle-knife versus extracorporeal shock wave therapy for the treatment of plantar fasciitis: a systematic review and meta-analysis. Heliyon, 2024, 10(1): e24229. |
| [60] | Zhu T, Jiang W, Wang K, et al. Ultrasound-guided drug injection combined with acupotomy for stenosing tenosynovitis of radial styloid process. Chinese Journal of Interventional Imaging and Therapy, 2018, 15(8): 465-468. |
| [61] | Jiang L, Liu H, Li H, et al. Ultrasound-guided needle-knife for De Quervain's disease: a protocol for systematic review and meta-analysis. Medicine, 2021, 100(14): e24877. |
| [62] | Pan M, Sheng S, Fan Z, et al. Ultrasound-guided percutaneous release of A1 pulley by using a needle knife: a prospective study of 41 cases. Front Pharmacol, 2019, 10: 267. |
| [63] | Li D, Wang X, Fang T, et al. Acupotomy in the treatment of tenosynovitis of hand flexor tendons: a systematic review and meta-analysis. Medicine, 2022, 101(45): e31504. |
| [64] | Zhang WB, Yao DW, Wu WX. Efficacy of ultrasound-guided small needle-knife for stenosing tenosynovitis of flexor tendons. Zhongguo Zhen Jiu, 2019, 39(8): 867-870. |
| [65] | Lan X, Xiao L, Chen B, et al. A comparison of the outcomes of open trigger release versus ultrasound-guided modified small needle-knife percutaneous release for treatment of trigger digits. J Hand Surg Asian Pac Vol, 2023, 28(1): 69-74. |
| [66] | Li AL, Wang XW, Wang JR, et al. Clinical observation of acupotomy combined with warm needle acupuncture for cervical spondylotic radiculopathy with qi stagnation and blood stasis syndrome. Zhen Ci Yan Jiu, 2022, 47(10): 914-917, 926. |
| [67] | Wang BJ, Gao CY, Jin ZF, et al. Ultrasound-guided acupotomy combined with transforaminal nerve root block for lumbar disc herniation: a report of 40 cases. Zhongguo Zhen Jiu, 2020, 40(12): 1297-1298. |
| [68] | Wang ZB, He H, Luo ZC, et al. Efficacy of acupotomy combined with Mulligan maneuver for cervical spondylotic radiculopathy. The Journal of Cervicodynia and Lumbodynia, 2023, 44(1): 126-127. |
| [69] | Song SF, Wang XY, Su JG. Effect of ultrasound-guided acupotomy nerve stimulation combined with sinomenine injection for piriformis syndrome. Henan Medical Research, 2024, 33(10): 1790-1793. |
| [70] | Miao TT, Ping JJ, Yang J, et al. Acupoint injection combined with small needle-knife for piriformis syndrome. Jilin Journal of Traditional Chinese Medicine, 2024, 44(3): 351-355. |
| [71] | Ni CF. Clinical observation of ultrafine acupotomy for superior cluneal nerve entrapment syndrome. Chinese Journal of Acupuncture and Moxibustion (Electronic Edition), 2018, 7(2): 45-48. |
| [72] | Zhou Q, Shen Y, Jia Y, et al. Clinical anatomical study on the treatment of carpal tunnel syndrome with classic acupotomy. Zhongguo Gu Shang, 2020, 33(8): 745-749. |
| [73] | Song JC, Ye ML. Clinical observation of DSA-guided acupotomy for lumbar dorsal ramus syndrome. Guangming J Chin Med, 2021, 36(14): 2401-2403. |
| [74] | Xu YZ, Su M, Feng PJ, et al. Application of ultrasound-guided selective nerve branch block in lumbar dorsal ramus syndrome. Zhongguo Gu Shang, 2021, 34(4): 341-346. |
| [75] | Bai HX, Ma DP, Pan XF. Review on improvement and development of small needle-knife instruments. Xinjiang Journal of Traditional Chinese Medicine, 2022, 40(4): 132-134. |
| [76] | Luo JC, Wang LD, Xu WB, et al. Micro-acupotomy for cervical vertigo and its effect on vertebral artery hemodynamics. Zhongguo Zhen Jiu, 2022, 42(8): 844-848. |
| [77] | Wang LZ, Guo ZP, Wang SZ, et al. Research progress on clinical application of ultrafine acupotomy therapy. Journal of Hebei North University (Natural Science Edition), 2021, 37(10): 60-63. |
| [78] | Yan ZJ, Sun HL, Zhao LF, et al. Comparison of efficacy among hydro-acupotomy, small needle-knife, and intra-articular sodium hyaluronate injection for knee osteoarthritis. The Journal of Practical Medicine, 2023, 39(5): 591-596. |
| [79] | Jin JM, Zhang NJ, Wang JZ, et al. Efficacy of ultrasound-guided hook-knife for adult trigger finger. Chin Mod Dr, 2022, 60(17): 55-57, 72. |
| [80] | Li RQ, Zhang GP, Li YJ, et al. Comparative study of minimally invasive treatment with self-made sickle-shaped small needle-knife versus open surgery for stenosing tenosynovitis of flexor tendons. Chin Gen Pract, 2013, 16(36): 3611-3613. |
| [81] | Ding XJ, Cheng MZ, Zhang YJ, et al. Research progress on clinical application of minimally invasive acupotomy arthroscopy for joint diseases. Rheumatism and Arthritis, 2023, 12(4): 67-70. |
| [82] | Ge C, Zhang Y, Cheng SD, et al. Medium and long-term efficacy of acupotomy arthroscopy combined with manual release for severe frozen shoulder and its effects on serum inflammatory factors. Chinese Journal of Traditional Medical Traumatology and Orthopedics, 2023, 31(2): 35-39, 43. |
| [83] | Rao Y, Hou F, Huang H, et al. The combined treatment of entrapped infrapatellar branch of the saphenous nerve after ACL reconstruction: ultrasound-guided perineural injection and acupotomy. J Back Musculoskelet Rehabil, 2022, 35(3): 479-483. |
| [84] | Chen FY, Zhou X, Wu BQ. Clinical efficacy of radiofrequency acupotomy combined with ozone injection for knee osteoarthritis. The Journal of Practical Medicine, 2022, 38(3): 335-339. |
| [85] | Mu HZ, Zhang QJ, Dong ZB, et al. Comparison of two imaging-guided plasma needle-knife combined with ozone for lumbar disc herniation. Orthopedic Journal of China, 2021, 29(13): 1226-1228. |
| [86] | An X, Wang T, Zhang W, et al. Chondroprotective effects of combination therapy of acupotomy and human adipose mesenchymal stem cells in knee osteoarthritis rabbits via the GSK3beta-Cyclin D1-CDK4/CDK6 signaling pathway. Aging Dis, 2020, 11(5): 1116-1132. |
| [87] | Ji GF, Chen WX. Clinical application of ultrasound-guided acupotomy combined with platelet-rich plasma in the treatment of carpal tunnel syndrome. Front Surg, 2025, 12: 1629781. |
| [88] | Wang Y, Yang A, Dai S. Efficacy evaluation of acupotomy combined with platelet-rich plasma in the treatment of early and middle osteoarthritis. Am J Clin Exp Immunol, 2021, 10(2): 48-55. |
| [89] | Wu J, Huang YJ, Xiong P, et al. Effect of small needle-knife combined with acupuncture, massage, and traction for cervical spondylotic radiculopathy. Chin. Mod. Med., 2024, 31(24): 27-30, 34. |
| [90] | Fang WF. Clinical observation of small needle-knife closed release combined with Chinese herbal fumigation for ankylosing spondylitis. J. Pract. Tradit. Chin. Med., 2023, 39(1): 119-121. |
| [91] | Koonen L, Van A, Smulders K, et al. Added value of ultrasound-guided percutaneous needle tenotomy over hydrodissection and physiotherapy in chronic lateral elbow tendinopathy: a pilot randomized controlled trial. J Ultrason, 2023, 23(95): e358-e364. |
| [92] | Balshem H, Helfand M, Schunemann H, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4): 401-406. |
| [93] | Guyatt G, Oxman A, Akl E, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394. |
| [94] | Jaeschke R, Guyatt G, Dellinger P, et al. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ, 2008, 337: a744. |
APA Style
Cai, Z., Chen, J., Chen, J., Cheng, Z., Fan, X., et al. (2026). Chinese Painology Expert Consensus on Acupotomy for the Treatment of Chronic Musculoskeletal Pain (2026 Edition). International Journal of Pain Research, 2(3), 201-216. https://doi.org/10.11648/j.ijpr.20260203.22
ACS Style
Cai, Z.; Chen, J.; Chen, J.; Cheng, Z.; Fan, X., et al. Chinese Painology Expert Consensus on Acupotomy for the Treatment of Chronic Musculoskeletal Pain (2026 Edition). . 2026, 2(3), 201-216. doi: 10.11648/j.ijpr.20260203.22
AMA Style
Cai Z, Chen J, Chen J, Cheng Z, Fan X, et al. Chinese Painology Expert Consensus on Acupotomy for the Treatment of Chronic Musculoskeletal Pain (2026 Edition). . 2026;2(3):201-216. doi: 10.11648/j.ijpr.20260203.22
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijpr.20260203.22,
author = {Zhenhua Cai and Jianping Chen and Jinsheng Chen and Zhixiang Cheng and Xiaochong Fan and Liwei Han and Ruilin He and Shuiqing Li and Xiang Liao and Fuqing Lin and Guangzhao Liu and Liu Jinfeng and Rongguo Liu and Liu Shanshan and Ke Ma and Chao Meng and Wen Shen and Zhongxing Shi and Tao Song and Tao Sun and Gaojian Tao and Dequan Wang and Likui Wang and Dasheng Wu and Zhaohui Xie and Xuexue Zhang and Yongjun Zheng and Huacheng Zhou},
title = {Chinese Painology Expert Consensus on Acupotomy for the Treatment of Chronic Musculoskeletal Pain (2026 Edition)},
journal = {International Journal of Pain Research},
volume = {2},
number = {3},
pages = {201-216},
doi = {10.11648/j.ijpr.20260203.22},
url = {https://doi.org/10.11648/j.ijpr.20260203.22},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijpr.20260203.22},
abstract = {Since the 1970s, acupotomy, a minimally?invasive therapeutic technique originating from China, has been widely adopted for managing chronic musculoskeletal pain and has yielded promising clinical outcomes in real-world practice. Despite its growing popularity, several critical challenges have emerged during its clinical implementation, including inappropriate selection of clinical indications, substandard technical performance, and inconsistent, heterogeneous treatment regimens across different practitioners and medical centres. Such practice-related limitations may contribute to unstable therapeutic effects, preventable treatment-related incidents, and avoidable peri-procedural complications, which consequently hinder the safe, standardised promotion and widespread popularisation of acupotomy therapy. To address these gaps and standardise the clinical application of acupotomy for chronic musculoskeletal pain, this expert consensus was initiated at the formal invitation of the Editorial Board of the Chinese Journal of Painology. A multidisciplinary panel of leading national specialists in pain medicine was convened to develop this document. The expert group systematically searched and appraised available evidence-based literature published both domestically and internationally, and integrated high-level research findings with extensive, long-term front-line clinical experience. After thorough discussion, the panel summarised core recommendations covering the fundamental principles, standard operating procedures, indications, contraindications and key safety precautions for acupotomy intervention in chronic musculoskeletal pain. Following multiple rounds of group discussion, peer review and iterative revision, the final version of this expert consensus was reached.},
year = {2026}
}
TY - JOUR T1 - Chinese Painology Expert Consensus on Acupotomy for the Treatment of Chronic Musculoskeletal Pain (2026 Edition) AU - Zhenhua Cai AU - Jianping Chen AU - Jinsheng Chen AU - Zhixiang Cheng AU - Xiaochong Fan AU - Liwei Han AU - Ruilin He AU - Shuiqing Li AU - Xiang Liao AU - Fuqing Lin AU - Guangzhao Liu AU - Liu Jinfeng AU - Rongguo Liu AU - Liu Shanshan AU - Ke Ma AU - Chao Meng AU - Wen Shen AU - Zhongxing Shi AU - Tao Song AU - Tao Sun AU - Gaojian Tao AU - Dequan Wang AU - Likui Wang AU - Dasheng Wu AU - Zhaohui Xie AU - Xuexue Zhang AU - Yongjun Zheng AU - Huacheng Zhou Y1 - 2026/09/30 PY - 2026 N1 - https://doi.org/10.11648/j.ijpr.20260203.22 DO - 10.11648/j.ijpr.20260203.22 T2 - International Journal of Pain Research JF - International Journal of Pain Research JO - International Journal of Pain Research SP - 201 EP - 216 PB - Science Publishing Group SN - 3070-1562 UR - https://doi.org/10.11648/j.ijpr.20260203.22 AB - Since the 1970s, acupotomy, a minimally?invasive therapeutic technique originating from China, has been widely adopted for managing chronic musculoskeletal pain and has yielded promising clinical outcomes in real-world practice. Despite its growing popularity, several critical challenges have emerged during its clinical implementation, including inappropriate selection of clinical indications, substandard technical performance, and inconsistent, heterogeneous treatment regimens across different practitioners and medical centres. Such practice-related limitations may contribute to unstable therapeutic effects, preventable treatment-related incidents, and avoidable peri-procedural complications, which consequently hinder the safe, standardised promotion and widespread popularisation of acupotomy therapy. To address these gaps and standardise the clinical application of acupotomy for chronic musculoskeletal pain, this expert consensus was initiated at the formal invitation of the Editorial Board of the Chinese Journal of Painology. A multidisciplinary panel of leading national specialists in pain medicine was convened to develop this document. The expert group systematically searched and appraised available evidence-based literature published both domestically and internationally, and integrated high-level research findings with extensive, long-term front-line clinical experience. After thorough discussion, the panel summarised core recommendations covering the fundamental principles, standard operating procedures, indications, contraindications and key safety precautions for acupotomy intervention in chronic musculoskeletal pain. Following multiple rounds of group discussion, peer review and iterative revision, the final version of this expert consensus was reached. VL - 2 IS - 3 ER -
Department of Painology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
Biography: Zhenhua Cai, female, born in October 1983, PhD, Associate Chief Physician, Department of Painology, The Second Affiliated Hospital of Harbin Medical University; Area of expertise: treatment of chronic musculoskeletal pain; Research focus: mechanisms of chronic pain.
Department of Painology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
Biography: Zhixiang Cheng, male, born in July 1972, PhD, Chief Physician, Master's Supervisor, Department of Painology, The Second Affiliated Hospital of Nanjing Medical University; Area of expertise: diagnosis and treatment of chronic pain; Research focus: clinical application of extracorporeal shockwave therapy, platelet-rich plasma, and digital therapy in chronic pain management.
Department of Painology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Biography: Huacheng Zhou, male, born in November 1977, Post-graduate/PhD, Professor, Doctoral Supervisor, Department of Painology, First Affiliated Hospital of Chongqing Medical University; Area of expertise: diagnosis and treatment of chronic spinal-derived pain, neuralgia, and cancer pain; Research focus: mechanisms and treatment of intervertebral disc degeneration and neuropathic pain.
Information