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Electroacupuncture analgesia: An updated review

#,1
Eng Fang Ying, Chen Yi Hung* ,2,3

1 International Master Program in Acupuncture, China Medical University, Taichung 404333,
Taiwan
2 School of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
3 Department of Acupuncture, China Medical University Hospital, Taichung 404333, Taiwan
* E-mail: engfangying@gmail.com, yihungchen@mail.cmu.edu.tw

Abstract
Pain management remains a critical challenge in modern medicine, particularly with the
limitations and risks associated with opioid-based therapies. Electroacupuncture (EA), a
modern adaptation of traditional acupuncture, presents promising opioid-dependent and opioid-
independent analgesic mechanisms.This literature review elucidates the multimodal
mechanisms underlying electroacupuncture (EA) analgesia mechanisms through an integrative
analysis of four core systems: (1) central glial modulation; (2) endogenous opioid activation (3)
orexin-endocannabinoid crosstalk; and (4) TRPM8 cold-receptor activation that synergizes
with both opioid and endocannabinoid pathways while inhibiting pain-transmitting neurons.
Clinical and preclinical evidence suggests that EA offers a safer and more effective alternative
to single-target analgesics, particularly in complex conditions involving CNS injury,
neuroinflammation, chronic pain, and pain hypersensitivity. The review highlights a critical
knowledge gap concerning how these glial transformations integrate with endogenous
systems—such as opioid, orexin, and cannabinoid signalling—to coordinate EA-induced
analgesia. Future research should aim to clarify glial–endogenous pathway cross-talk and
optimize acupoint-specific stimulation protocols for clinical translation.

Keywords: Electroacupuncture; Analgesia; Pain; Glial cells; Microglia; Astrocytes