Comparison of clinical efficacy of different acupuncture methods in the treatment of fibromyalgia: a network meta-analysis based on randomized controlled trials.

BACKGROUND: Fibromyalgia is a complex chronic pain syndrome for which current pharmacological treatments have limitations. Acupuncture, as a complementary therapy, has shown potential, but the efficacy differences among various acupuncture methods remain unclear. METHODS: A network meta-analysis was conducted by systematically searching commonly used databases up to December 28, 2025, to identify relevant randomized controlled trials evaluating different acupuncture approaches for fibromyalgia. The primary outcome measure was visual analog scale (VAS), with total effective rate (TER) as a secondary exploratory indicator. RESULTS: A total of 26 studies involving 2,037 patients were included. Pairwise meta-analysis showed that acupuncture combined with cupping and medication was superior to medication alone in improving VAS [WMD = -3.81, 95% CI (-6.04, -1.58)] and HAMD scores [WMD = -4.90, 95% CI (-6.15, -3.65)]. Regarding pain improvement (VAS score), a widely recognized core outcome measure internationally, electroacupuncture had the highest SUCRA value (0.99), indicating the highest probability of ranking first within this network meta-analysis. However, it should be noted that this ranking is based on limited evidence (only one small-sample study), resulting in very low certainty of evidence, and thus should be interpreted cautiously. For overall effective rate (TER, a composite endpoint commonly used in Chinese acupuncture trials), floating needle combined with cupping had the highest SUCRA value (0.74). Meta-regression suggested a positive correlation between acupuncture efficacy and treatment duration. CINeMA assessment of evidence quality indicated that the overall quality of evidence ranged from low to very low. CONCLUSION: Based on current low-quality evidence, the findings of this study should be regarded as exploratory. The SUCRA reflects probabilistic ranking rather than absolute clinical superiority, and these results require further validation in higher-quality studies.