A network meta-analysis of the performance of acupoint stimulation therapy in improving fatigue, neurological function, and activities of daily living in patients with multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a chronic autoimmune disease with a high disability rate, primarily characterized by inflammatory demyelination of the central nervous system. As a complementary and alternative therapy, acupoint stimulation exhibits potential in alleviating the symptoms of MS. However, the relative efficacy of different therapies remains unclear. This study sought to systematically compare the effects of various acupoint stimulation therapies on neurological function, fatigue, and activities of daily living in MS patients through a network meta-analysis (NMA).

METHODS: Eight databases were systematically searched for relevant publications from their inception to August 3, 2025. Randomized controlled trials (RCTs) comparing different acupoint stimulation therapies (e.g., acupuncture, electroacupuncture, moxibustion, acupressure, acupoint injection) for treating MS were incorporated. A Bayesian NMA was implemented to comprehensively compare the impacts of various interventions on Expanded Disability Status Scale (EDSS) scores, Fatigue Severity Scale (FSS) scores, the Barthel index (BI), and response rates. The surface under the cumulative ranking curve (SUCRA) values were utilized to evaluate the relative ranking of each regimen.

RESULTS: Finally, 23 RCTs involving 1,384 patients and 8 acupoint stimulation interventions were incorporated. The results suggested that electroacupuncture combined with acupoint injection demonstrated the greatest effectiveness in improving neurological function (EDSS) (mean difference [MD] = -2.9, 95% CrI: -3.4 to -2.3). Acupressure therapy performed the best in relieving fatigue (FSS) (standardized mean difference [SMD] = -1.3, 95% CrI: -1.6 to -1.0). Electroacupuncture combined with acupoint injection demonstrated the best efficacy in improving the activities of daily living (BI) (MD = 18, 95% CrI: 8.8 to 28).

CONCLUSION: The application of acupoint stimulation therapy in combination with standard pharmacotherapy has demonstrated potential value in relieving fatigue, improving neurological function, and enhancing quality of life in patients with MS. However, due to methodological limitations of the included studies and clinical heterogeneity among interventions, the findings of this study should be considered exploratory evidence and are insufficient to support definitive clinical recommendations. This study aimed to provide a basis for hypotheses and a reference for intervention prioritization for future research. Therefore, the conclusions should be interpreted with caution.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=51124476, PROSPERO CRD420251124476.