“Where energy flows, pain settles” – an ancient East Asian wisdom that surprisingly aligns well with high-performance medicine today. Those who seek peak performance need pain-free movement, a clear mind, and swift recovery. Acupuncture, once relegated to a purely traditional method, is currently being redefined by modern evidence: from osteoarthritis to the postoperative phase – when properly integrated, it can measurably improve pain management and reduce medication use. This article illustrates how to utilize the technique effectively and what innovations are currently gaining momentum.

Acupuncture is a stimulation therapy that uses fine needles to stimulate defined points on the skin to modulate the neuroimmune balance. Electroacupuncture EAAcupuncture with weak electrical impulses through the needles enhances this stimulation and can more precisely activate pain-relieving networks in the nervous system. Warm-Needling WANeedle acupuncture plus heat and moxibustion MoxaThermal stimulus through smoldering mugwort apply thermal stimuli. Importantly for everyday life: Acupuncture is not a substitute for movement, nutrition, and targeted rehabilitation, but rather a component of a multimodal plan. The best application follows the principle of “combining rather than replacing” – so acupuncture plus active therapy, rather than a monolithic needle focus.

In knee osteoarthritis, acupuncture reduces pain and improves function – in studies, it has proven more effective than sham treatment; electroacupuncture even performed better than a common medication option, reducing pain intensity and functional limitations more significantly ^[1]. In animal experiments, acupuncture at “sensitized” points shows anti-inflammatory effects, inhibits nociception, and improves microcirculation – a plausible mechanism behind clinical improvements ^[2]. In the postoperative setting, acupuncture can reduce pain, medication requirements, as well as nausea and vomiting; patients and nursing staff consider it helpful and practical in the recovery room, with high acceptance and minimal side effects ^{[3] [4]}. An innovative checkpoint-based point selection achieved significant pain relief within minutes and increased pain thresholds after abdominal surgeries – regardless of the type of surgery ^[5]. Electroacupuncture also exhibits anti-inflammatory signatures: it raises the pain threshold, reduces pro-inflammatory cytokines, and modulates NLRP3 signaling pathways – a potential route to long-term reductions in analgesic use ^[6].

A large, multicenter, randomized comparison for knee osteoarthritis showed: several acupuncture techniques were clearly superior to sham treatment; electroacupuncture reduced pain and functional loss even more than a common pharmacotherapy – indicating that electrical stimulation can enhance analgesic output ^[1]. Preclinically, a carefully standardized model supports that acupuncture at sensitized points dampens inflammation, slows down nociception, and improves local perfusion – mechanisms that plausibly account for functional gains ^[2].

In the perioperative context, the evidence is consolidating: A systematic review of ERAS programs found that acupuncture or acupuncture stimulation resulted in less pain, lower analgesic consumption, and decreased nausea/vomiting; side effects were rare ^[4]. Clinically, a PACU case-control analysis showed high patient satisfaction and good integration into processes directly after surgery ^[3], while a pilot study with “checkpoint” personalization demonstrated ultra-rapid effects on pain and pain thresholds ^[5].

A bibliometric analysis of electroacupuncture identifies a clear trend: growing research focuses on mechanisms, RCTs, and perioperative applications; fMRI-based studies are gaining importance ^[7]. A systematic fMRI review confirms modulated brain networks for pain, emotional regulation, and cognition across various disease states – neurobiological plausibility for the clinical effects ^[8]. Additionally, preclinical meta-analyses suggest that NLRP3 inflammasome inhibition may be part of the analgesic effect ^[6]. Together, these data demonstrate: Acupuncture is not an isolated magic bullet but an evidence-based enhancer in integrated pain pathways – particularly effective when combined with active measures.

- For knee osteoarthritis: Plan 2-3 sessions per week over 4 weeks and prefer electroacupuncture, as it often improves pain and function more than standard medication in studies ^[1]. If available, examine sensitized acupuncture points (pressure pain, temperature) to enhance effectiveness ^[2]. Combine with strength training, mobility, and weight management.
- Postoperative phase (ERAS): Integrate acupuncture early into the recovery room or within the first 24-48 hours to reduce pain, analgesic needs, as well as nausea/vomiting; commonly used points are ST36 (Zusanli) and PC6 (Neiguan) ^{[4] [3]}. Use personalized “checkpoint” protocols, if available, for quick effects ^[5].
- Expand electroacupuncture: Use EA selectively for chronic pain syndromes and inflammatory pain states. Goal: Increase pain threshold, reduce pro-inflammatory cytokines, and dampen NLRP3 activity – with the potential to reduce analgesics (under medical supervision) ^[6]. Monitor trends and protocols from current mechanism and fMRI studies for more precise point selection ^{[7] [8]}.
- Multimodal instead of monoculture: Avoid a one-sided dependence on needles. Combine acupuncture with movement (e.g., targeted stretching) or mindfulness-based methods like Qigong; pilot data suggest additive improvements ^[9].
- Build competence: Promote training for physicians, physiotherapists, and nursing professionals to integrate acupuncture into interdisciplinary pain pathways – from pain clinics to palliative and long-COVID care. Focus on programs with a translational focus and clinical certification ^[10].

Acupuncture is evolving from a traditional craft into a smart component of modern, data-driven pain therapy. In the coming years, more precise protocols are expected through fMRI, biomarkers, and personalized point selection – especially in osteoarthritis and perioperative applications. Those who integrate today will learn faster tomorrow: The future belongs to multimodal, measurable, and patient-centered setups.