---
title: "Spinal cord injury"
url: "https://acuiq.com/wiki/evidence/spinal-cord-injury"
updated: 2026-10-10
last_verified: 2026-10-10
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-10"
reading_minutes: 11
sources: 22
---

# Spinal cord injury

_What Cochrane's reviews of pain and bowel care, later reviews of motor recovery, bladder function and neuropathic pain, the small sham- and active-controlled trials, and the CanPain SCI, PVA and NICE guidelines report on acupuncture after spinal cord injury._

A spinal cord injury (SCI) damages the nerve pathways that carry movement, sensation and control of the bladder and bowel below the level of the injury. Trials in this field grade an injury on the American Spinal Injury Association (ASIA) impairment scale, from A, a complete injury, to E, normal function, and report strength as the ASIA motor score. They report independence in daily life on the Functional Independence Measure (FIM) or the modified Barthel index (MBI). Most trials below add acupuncture or electroacupuncture, a current passed through the needles ([Electroacupuncture](/wiki/techniques/electroacupuncture) covers the method), to rehabilitation and compare the result with rehabilitation alone.

## Cochrane reviews

Cochrane has no review of acupuncture for spinal cord injury. Its [2014 review of non-drug treatments for chronic pain after SCI](https://doi.org/10.1002/14651858.CD009177.pub2), by Boldt and colleagues, included 16 trials with 616 participants, 2 of them of acupuncture. None of the 16 was judged at low risk of bias, and the authors reported that the trials of acupuncture, like those of five other treatments, provided no evidence that it reduces chronic pain. Its search ran in March 2011, and Cochrane has published no later version. The [2017 Cochrane review of acupuncture for neuropathic pain](https://doi.org/10.1002/14651858.CD012057.pub2) by Ju and colleagues included 6 studies with 462 participants, all with peripheral neuropathic pain, so none concerned pain arising from the spinal cord.

For the bowel, the [2024 Cochrane review](https://doi.org/10.1002/14651858.CD002115.pub6) of conservative, physical and surgical treatments for faecal incontinence and constipation in central neurological disease, by Todd and colleagues, included 25 studies with 1,598 participants. The interventions it lists range from nursing protocols and probiotics to massage, standing, electrical stimulation and transanal irrigation; acupuncture is not among them.

## Reviews of motor and neurological recovery

A standardised mean difference (SMD) states an effect in units of the spread between patients, so that trials using different scales can be pooled. GRADE is the scale reviewers use to rate certainty, from high to very low.

| Review | Trials | Comparison | Main finding |
| --- | --- | --- | --- |
| [Heo and colleagues 2013](https://doi.org/10.1155/2013/364216), Pusan National University | 16; 8 on function, 6 on the bladder, 2 on pain | Acupuncture added to conventional treatment, against that treatment alone; sham in 1 | Better ASIA motor and FIM scores; the 2 pain trials conflicted |
| [Ma and colleagues 2015](https://doi.org/10.1089/neu.2014.3866), bias-adjusted, searched to August 2014 | 12 | Randomised trials only | Neurological recovery RR 1.28 (95% CI 1.12 to 1.50); motor score 6.86 points higher (0.41 to 13.31) |
| [Xiong and colleagues 2019](https://doi.org/10.1155/2019/2371084), network meta-analysis | 22, with 1,644 people | Acupuncture at different body regions, with exercise, against exercise alone | Higher ASIA motor scores with electroacupuncture and exercise than with exercise alone |
| [Tan and colleagues 2022](https://doi.org/10.1155/2022/8040555), electroacupuncture, searched to September 2020 | 10, with 712 people | In 8, electroacupuncture with rehabilitation against rehabilitation alone | ASIA motor score SMD 0.96 (0.75 to 1.18; 5 trials); FIM 13.46 points higher (3 trials); moderate certainty for motor function and daily living, low for sensation |

Of the 16 trials in Heo’s review, 12 were from mainland China, 2 from Taiwan and 2 from the United States; the authors called for sham-controlled trials for each condition. Ma’s review, from Zhejiang Chinese Medical University and the University of Queensland, found larger effects in trials of fewer than 30 people and in acute injury, judged the studies generally of poor quality, and found publication bias favouring positive studies, so the authors wrote that the benefit was by no means definitive. Xiong’s review, from West China Hospital at Sichuan University, ranked electroacupuncture at the head and back, and at the back and front of the trunk, highest. Tan’s review, from Guangzhou University of Chinese Medicine and Sun Yat-sen University, reported that most of its trials were published in Chinese and that most only used the word “random” without describing a randomisation. Five of its trials used Governor Vessel points, and one needled Huatuojiaji points (EX-B2 in the WHO notation) on both sides of the injured segment with [`GV14`](/points/GV14) (Dazhui) and [`GV04`](/points/GV04) (Mingmen).

## A trial in acute injury

Wong and colleagues at Chang Gung Memorial Hospital in Taiwan [reported a trial in 2003](https://doi.org/10.1097/00002060-200301000-00004) that randomised 100 people with acute traumatic injuries graded ASIA A or B to rehabilitation alone or rehabilitation with electrical stimulation through adhesive surface electrodes at [`SI03`](/points/SI03) (Houxi) and [`BL62`](/points/BL62) (Shenmai), plus ear acupuncture, starting in the emergency room or soon after surgery. The authors reported that sensory, motor and FIM scores in the acupuncture group improved from admission to discharge and to 1 year, and that a greater share of that group moved up an ASIA grade. There was no sham, and the stimulation at the two body points used skin electrodes rather than needles.

## Bladder

A [2016 review](https://doi.org/10.1155/2016/9245186) by Wang and colleagues at Guang’anmen Hospital in Beijing found 3 trials with 334 people with chronic urinary retention after SCI. Against rehabilitation training alone, the trials that added acupuncture reported 109 mL less urine left in the bladder after voiding (95% CI 62 to 157); against sterile intermittent catheterisation alone, they reported a higher response rate (RR 1.23). The authors drew no definitive conclusion for want of high-quality trials. A [2021 network meta-analysis](https://doi.org/10.3389/fneur.2021.723424) by He and colleagues pooled 26 trials with 1,652 people, ranked electroacupuncture with moxibustion first for retention, and detected publication bias. For incontinence, a [2025 review](https://doi.org/10.3389/fneur.2025.1573090) by Zhang and colleagues found 15 trials with 1,394 people, all published and conducted in China, comparing electroacupuncture with or without rehabilitation against rehabilitation alone or with sham. Incontinence episodes fell by 1.42 a day (95% CI 0.96 to 1.88) and residual urine by 20 mL, both at low certainty; across outcomes certainty ranged from low to moderate, and none of the trials had a registered protocol.

Two trials stand out from that pool. Cheng and colleagues [reported in 1998](https://doi.org/10.1038/sj.sc.3100689) on 80 patients given an intermittent catheterisation programme, half also given electroacupuncture at [`CV03`](/points/CV03) (Zhongji), [`CV04`](/points/CV04) (Guanyuan) and both [`BL32`](/points/BL32) (Ciliao). Among the 60 who reached balanced voiding, those with upper motor neuron lesions got there in 57 days with electroacupuncture against 85 without; complete injuries with marked detrusor-sphincter dyssynergia, where bladder and sphincter contract against each other, or with a bladder that did not contract at all, were not affected. Gu and colleagues ran a [three-arm trial in 2015](https://pubmed.ncbi.nlm.nih.gov/26770641/) with 107 patients with urinary retention: clean intermittent catheterisation alone, with electroacupuncture, or with sham acupuncture. The catheterisation-only and sham arms did not differ at 1 month, and more patients reached bladder balance with electroacupuncture than in either. [Urinary retention](/wiki/evidence/urinary-retention) reports the trials in retention from other causes.

## Bowel

No randomised trial of acupuncture for neurogenic bowel dysfunction after SCI turned up in this search. A [2026 single-centre study](https://doi.org/10.3389/fmed.2026.1866886) by Liao and colleagues let 106 patients choose between anorectal biofeedback alone and biofeedback with electroacupuncture at the sacral Baliao points. At 6 weeks the neurogenic bowel dysfunction score fell 5.2 points with the combination and 2.9 with biofeedback alone, an adjusted difference of 2.1 points. The authors wrote that the design does not establish an effect specific to electroacupuncture and that randomised trials with attention-matched controls are needed.

## Neuropathic and shoulder pain

A [2022 review](https://doi.org/10.1155/2022/6297484) by He and colleagues at Zhejiang Chinese Medical University found 6 trials with 286 people, 5 from China and 1 from the United States, each adding acupuncture to conventional therapy. Pain severity was lower (SMD −1.40, 95% CI −2.23 to −0.57), publication bias was observed, and the authors concluded that a role for acupuncture remains to be determined. One included trial needled [`GV20`](/points/GV20) (Baihui), [`LI04`](/points/LI04) (Hegu) and tender points.

The trials with an active or sham control are small. At the Karolinska Institutet in Stockholm, Norrbrink and Lundeberg [assigned 30 people](https://doi.org/10.1136/aim.2010.003269) with neuropathic pain after SCI to acupuncture or massage twice a week for 6 weeks; 8 of 15 given acupuncture and 9 given massage reported improvement at the end, and 6 and 1 at 2 months. At the Kessler rehabilitation centre in New Jersey, Dyson-Hudson and colleagues [randomised 17 wheelchair users](https://doi.org/10.1016/j.apmr.2007.06.014) with chronic shoulder pain to acupuncture or shallow needling away from acupuncture points; pain fell 66% and 43%, a difference the trial could not distinguish from chance. Estores and colleagues [randomised 24 people](https://doi.org/10.1080/10790268.2016.1141489) with below-level neuropathic pain to 8 weekly sessions of Battlefield Acupuncture, a ten-needle ear protocol, or a waiting list. Pain fell 2.92 points against 1.13 on a 0 to 10 scale (P = 0.065), with pain at baseline higher in the acupuncture group. [Reading an acupuncture trial](/wiki/research/reading-an-acupuncture-trial) explains why a waiting list and a sham answer different questions.

## What guidelines say

The [CanPain SCI 2021 update](https://doi.org/10.1038/s41393-021-00744-z), the Canadian guideline for neuropathic pain after SCI, published in Spinal Cord in 2022 and replacing the 2016 treatment recommendations, lists acupuncture among treatments requiring further research. Its working group cited the lack of a standardised protocol and the waiting-list control in the Battlefield trial; 56% voted to recommend acupuncture, short of the 75% the guideline requires.

The Consortium for Spinal Cord Medicine’s [Evaluation and Management of Pain After Spinal Cord Injury](https://pva.org/wp-content/uploads/2021/09/CPG_Pain_digital_FINAL.pdf), published by Paralyzed Veterans of America (PVA) in 2026 from evidence available in 2025, makes a conditional recommendation (5B.4) that additional non-drug options can be considered after careful discussion of their limited evidence. It lists acupuncture among therapies with limited evidence of positive effect, on the strength of 1 low-quality randomised trial of fewer than 50 people. The Consortium’s [bladder management guideline](https://pva.org/wp-content/uploads/2021/09/cpgbladdermanageme_1ac7b4.pdf) of August 2006, still on PVA’s guideline list, names acupuncture only among the interventions its evidence tables recorded and makes no recommendation about it.

NICE’s [CG148](https://www.nice.org.uk/guidance/cg148) on urinary incontinence in neurological disease, published on 8 August 2012 and last updated on 2 October 2023, does not mention acupuncture. For people with spinal cord disease and overactive bladder symptoms it recommends antimuscarinic drugs, then botulinum toxin injections into the bladder wall when those fail or are not tolerated.

## What the reviews could not settle

The reviews could not separate the needling from the extra treatment time around it, because almost every pooled trial added acupuncture to rehabilitation and compared it with rehabilitation alone. They could not say whether the effects hold in larger trials: Ma found the largest effects in trials of fewer than 30 people and in acute injury, and three of the reviews detected publication bias. Nor could they draw on trials from more than a few settings, since the pooled trials come mostly from China. For pain, Cochrane’s review has not been updated since 2014, and the one sham-controlled pain trial in these reviews enrolled 17 people. For the bowel there are no randomised trials to pool.

AcuiQ’s [spinal cord injury](/symptoms/spinal-cord-injury) page lists the protocols individual studies prescribed, each with its citation, and [Stroke recovery](/wiki/evidence/stroke-recovery) reports the corresponding evidence after stroke.

### Sources

1. Boldt I, Eriks-Hoogland I, Brinkhof MW, et al., Non-pharmacological interventions for chronic pain in people with spinal cord injury, Cochrane Database of Systematic Reviews 2014 — https://doi.org/10.1002/14651858.CD009177.pub2
2. Ju ZY, Wang K, Cui HS, et al., Acupuncture for neuropathic pain in adults, Cochrane Database of Systematic Reviews 2017 — https://doi.org/10.1002/14651858.CD012057.pub2
3. Todd CL, Johnson EE, Stewart F, et al., Conservative, physical and surgical interventions for managing faecal incontinence and constipation in adults with central neurological diseases, Cochrane Database of Systematic Reviews 2024 — https://doi.org/10.1002/14651858.CD002115.pub6
4. Heo I, Shin BC, Kim YD, et al., Acupuncture for spinal cord injury and its complications: a systematic review and meta-analysis of randomized controlled trials, Evidence-Based Complementary and Alternative Medicine 2013 — https://doi.org/10.1155/2013/364216
5. Ma R, Liu X, Clark J, Williams GM, Doi SA, The impact of acupuncture on neurological recovery in spinal cord injury: a systematic review and meta-analysis, Journal of Neurotrauma 2015 — https://doi.org/10.1089/neu.2014.3866
6. Xiong F, Fu C, Zhang Q, et al., The effect of different acupuncture therapies on neurological recovery in spinal cord injury: a systematic review and network meta-analysis of randomized controlled trials, Evidence-Based Complementary and Alternative Medicine 2019 — https://doi.org/10.1155/2019/2371084
7. Tan J, Meng F, Zhang B, et al., Electroacupuncture for spinal cord injury: a systematic review and meta-analysis of randomised controlled trials, Evidence-Based Complementary and Alternative Medicine 2022 — https://doi.org/10.1155/2022/8040555
8. Wong AM, Leong CP, Su TY, et al., Clinical trial of acupuncture for patients with spinal cord injuries, American Journal of Physical Medicine and Rehabilitation 2003 — https://doi.org/10.1097/00002060-200301000-00004
9. Wang J, Zhai Y, Wu J, et al., Acupuncture for chronic urinary retention due to spinal cord injury: a systematic review, Evidence-Based Complementary and Alternative Medicine 2016 — https://doi.org/10.1155/2016/9245186
10. He K, Li X, Qiu B, Jin L, Ma R, Comparative efficacy of acupuncture-related techniques for urinary retention after a spinal cord injury: a Bayesian network meta-analysis, Frontiers in Neurology 2021 — https://doi.org/10.3389/fneur.2021.723424
11. Zhang PY, Xu CL, Ye GX, Meng L, Wang F, Clinical efficacy of electroacupuncture for urinary incontinence following spinal cord injury: a meta-analysis and trial sequential analysis, Frontiers in Neurology 2025 — https://doi.org/10.3389/fneur.2025.1573090
12. Cheng PT, Wong MK, Chang PL, A therapeutic trial of acupuncture in neurogenic bladder of spinal cord injured patients: a preliminary report, Spinal Cord 1998 — https://doi.org/10.1038/sj.sc.3100689
13. Gu XD, Wang J, Yu P, et al., Effects of electroacupuncture combined with clean intermittent catheterization on urinary retention after spinal cord injury: a single blind randomized controlled clinical trial, International Journal of Clinical and Experimental Medicine 2015 — https://pubmed.ncbi.nlm.nih.gov/26770641/
14. Liao M, Huang X, Mo D, Electroacupuncture at Baliao points added to anorectal biofeedback for spinal cord injury-related neurogenic bowel dysfunction: a single-center prospective preference-allocated comparative study, Frontiers in Medicine 2026 — https://doi.org/10.3389/fmed.2026.1866886
15. He K, Hu R, Huang Y, et al., Effects of acupuncture on neuropathic pain induced by spinal cord injury: a systematic review and meta-analysis, Evidence-Based Complementary and Alternative Medicine 2022 — https://doi.org/10.1155/2022/6297484
16. Norrbrink C, Lundeberg T, Acupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory study, Acupuncture in Medicine 2011 — https://doi.org/10.1136/aim.2010.003269
17. Dyson-Hudson TA, Kadar P, LaFountaine M, et al., Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial, Archives of Physical Medicine and Rehabilitation 2007 — https://doi.org/10.1016/j.apmr.2007.06.014
18. Estores I, Chen K, Jackson B, Lao L, Gorman PH, Auricular acupuncture for spinal cord injury related neuropathic pain: a pilot controlled clinical trial, Journal of Spinal Cord Medicine 2017 — https://doi.org/10.1080/10790268.2016.1141489
19. Loh E, Mirkowski M, Agudelo AR, et al., The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord injury: 2021 update, Spinal Cord 2022 — https://doi.org/10.1038/s41393-021-00744-z
20. Consortium for Spinal Cord Medicine, Evaluation and Management of Pain After Spinal Cord Injury: clinical practice guideline, Paralyzed Veterans of America 2026 — https://pva.org/wp-content/uploads/2021/09/CPG_Pain_digital_FINAL.pdf
21. Consortium for Spinal Cord Medicine, Bladder Management for Adults with Spinal Cord Injury: a clinical practice guideline for health-care providers, Paralyzed Veterans of America 2006 — https://pva.org/wp-content/uploads/2021/09/cpgbladdermanageme_1ac7b4.pdf
22. National Institute for Health and Care Excellence, Urinary incontinence in neurological disease: assessment and management (CG148), published 8 August 2012, last updated 2 October 2023 — https://www.nice.org.uk/guidance/cg148