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Bee venom acupuncture for musculoskeletal pain conditions: an updated systematic review and meta-analysis

BMC Complementary Medicine and Therapies volume 25, Article number: 161 (2025) Cite this article

Abstract

An updated systematic review of randomized controlled trials (RCTs) was conducted to evaluate the clinical evidence for the use of BVA for musculoskeletal pain. We searched 13 electronic databases up to December 2024 with no language restrictions. Since 2008, nine RCTs have been additionally identified, so a total of 20 trials were included in our updated review. In a meta-analysis of 2 RCTs, pain was significantly reduced with BVA compared to sham injection of normal saline (10-cm visual analog scale [VAS]; mean difference [MD]: -16.93; 95% confidence interval [CI] = -26.35 to -7.51, P = 0.0004, n = 85; heterogeneity: I2 = 0%). The meta-analysis of 5 RCTs comparing BVA plus acupuncture to saline injection plus acupuncture showed significant improvements in the 10-cm VAS (MD: -1.24; 95% CI = -1.63 to -0.85, P < 0.00001, n = 152; heterogeneity: I2 = 16%). No severe side effects such as anaphylaxis were observed in any of the eight trials. BVA appeared to improve musculoskeletal pain conditions compared to sham injections. However, the meta-analysis included only a limited number of RCTs with small sample sizes, and there was considerable clinical heterogeneity in terms of pain types, dosage, and concentration of BVA, which restricts the ability to draw definitive conclusions.

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Background

Musculoskeletal pain is defined as acute or chronic pain associated with musculoskeletal disorders, and is a common medical and socioeconomic problem worldwide [1]. Musculoskeletal pain has a major impact on quality of life and causes sleep disturbance, fatigue, depressed mood, activity limitations, and participation restrictions [2, 3]. It is estimated that 47% of the general population experiences musculoskeletal pain, of which approximately 39–45% have long-lasting problems requiring medical consultation [4]. As the population continues to increase, the impact of musculoskeletal disorders on society is also increasing [5]. It is a major public health problem that incurs significant costs to the health system and disability insurance [6].

Non-pharmacological treatments should initially be selected for patients with musculoskeletal pain, including home exercises and multidisciplinary rehabilitation protocols [4]. In patients with chronic musculoskeletal pain who are unresponsive to non-pharmacological therapy, pharmacological treatment with non-steroidal anti-inflammatory drugs (NSAIDs) should be considered as first-line therapy, with or without adjuvant therapy [7]. NSAIDs and opioids (where appropriate) also offer short-term benefits for musculoskeletal pain; however, the potential for adverse effects (e.g., gastrointestinal bleeding and opioid-induced hyperalgesia) requires careful consideration [8].

Bee venom (BV) is an animal toxin that contains several active compounds, such as enzymes, peptides, non-peptide components, and biologically active amines [9]. BV acupuncture (BVA) involves the injection of purified and diluted BV into acupuncture points [10] to achieve the pharmacological effects of acupuncture analgesia [11]. Experimental studies have suggested that BVA is effective in improving pain and symptoms of arthritis [12,13,14,15]. Clinical research has reported various pain conditions, arthritis, and Parkinson’s disease [9, 16–17].

In a previous systematic review [18], 11 randomized controlled trials (RCTs) on BVA for musculoskeletal pain were reviewed in 2008. We found that BVA was statistically effective compared with the control group for pain conditions of the neck, lower back, ankle sprain, post-stroke shoulder, rheumatoid arthritis, herniated lumbar disc, and osteoarthritis, but not for wrist pain. However, this systematic review was conducted more than a decade ago, and only five of the included RCTs compared BVA with sham injection (normal saline). Therefore, the conclusions suggested positive effects on musculoskeletal pain; however, the evidence was not strong enough.

As more rigorous RCTs [19,20,21,22] have been recently conducted, and a large number of RCTs (20 compared with 11 in 2008) have been published, an updated systematic review is strongly needed. Therefore, we conducted an updated systematic review to summarize the existing results of RCTs to evaluate the clinical evidence on the effectiveness and safety of BVA in patients with musculoskeletal pain conditions, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (See Additional File 1 for PRISMA Checklist) [23]. An additional objective was to present BVA as an evidence-based treatment option for patients experiencing pain.

Materials and methods

Protocol and registration

Our systematic review protocol was registered in an international prospective register of systematic reviews under the registration number PROSPERO 2021 (https://www.crd.york.ac.uk/prospero/CRD42021250689).

Data sources and searches

We searched the following electronic databases up to December 2024: PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDRO), CINAHL, Korean medical databases (ScienceON, Korean Traditional Knowledge Portal, KoreaMed, OASIS, RISS, and the National Library of Korea), and Chinese databases (China Knowledge Resource Integrated Database (CNKI) and Wangfang data). There were no language-based limitations in the papers selected for our review.

The search terms used were (bee venom OR bee toxin OR apitherapy OR bee venom therapy OR bee venom acupuncture) AND (musculoskeletal pain OR wrist pain OR shoulder pain OR back pain OR lumbar pain OR spine pain OR neck pain OR cervical pain OR hip pain OR knee pain OR temporomandibular pain OR ankle pain OR elbow pain OR heel pain OR myofascial pain OR arthritis OR osteoarthritis OR rheumatoid arthritis OR fibromyalgia OR spondylitis) AND (randomized controlled trial OR randomized clinical trial) (See Additional File 2 for the search terms used in each database).

Study selection

Types of studies

All RCTs that evaluated the efficacy and safety of BVA for musculoskeletal pain were included. We excluded non-randomized trials among clinical studies (e.g., case reports, case series, and case-controlled trials), animal in vivo and in vitro experimental studies, surveys, and reviews. RCTs were included if BVA was compared with sham/placebo or active controls, with or without any concomitant treatment (equally adjunct to both groups).

Types of participants

All adult participants (≥ 18 years) of either sex with musculoskeletal pain conditions were included in this systematic review.

Types of interventions

BVA, which involves the injection of purified, diluted BV into acupoints at various dosages, was regarded as the target intervention. Wild bee sting therapy, regarded as a folk medicine, was excluded because BV was not purified and no dosage could be defined. RCTs were included if they were randomized studies on BVA as an intervention for sole treatment or as an adjunct to other treatments.

Types of comparisons

We compared BVA with any control intervention. RCTs of the control group were included if the intervention involved BVA with other treatment(s), and the control group also received the same concomitant treatment(s).

Types of outcome measures

The primary outcomes considered were any type of pain measure (e.g., numeric rating scale [NRS], numeric pain intensity scale, and visual analog scale [VAS]). As secondary outcomes, we examined functionality measures for musculoskeletal diseases (e.g., Oswestry Disability Index [ODI] for low back pain, neck pain questionnaire [NPQ], Western Ontario and McMaster Universities Arthritis Index [WOMAC] for knee pain), quality of life, and adverse events (AEs).

Data extraction

Two authors (SJ and JKP) independently reviewed and screened the titles and abstracts of the relevant studies based on predefined criteria. Two independent reviewers (SJ and JKP) collected the following data from the included studies: author information; condition and sample size of the participants; interventions (BV dosages, concentrations, acupoints, and concomitant treatments); treatment sessions; outcome measures; main results; and AEs. Missing information was collected by contacting the corresponding authors of each study. Any disagreements were resolved by discussion with all authors until a consensus was reached.

Assessment of risk of bias (ROB)

Two authors (S.-H.S and J.-K.P) independently evaluated the risk of bias (ROB) using the Cochrane Handbook version 5.1.0 [24], which includes random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other sources of bias. The quality of each RCT was categorized as low (L), unclear (U), or high (H). Any differences of opinion were resolved through discussion or consultation with B.-C.S.

Data analysis

We extracted the baseline and primary endpoint values, and the mean differences of interventions and controls were evaluated using weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) for continuous outcomes and risk ratio (RR) with 95% CIs for dichotomous variables [25].

Review Manager (RevMan) software (version 5.4, Windows; The Nordic Cochrane Center, Copenhagen, Denmark) was used to calculate the meta-analysis statistics. The estimated differences in treatment effects were calculated using a random-effects model. I2 statistics and Cochran’s Q test were used to assess heterogeneity. Subgroup analysis based on differences in interventions, controls, and dosages was performed, and sensitivity analysis was performed according to the low versus high ROB of the included studies. Publication bias was tested using funnel plot asymmetry and/or the Egger’s test [24, 25].

Results

Study selection and description

The search yielded 90 relevant studies. After screening titles and abstracts, 40 studies were excluded. Out of the remaining 50 studies, a total of 20 RCTs (English databases: n = 8, Korean databases: n = 12) were included in our review [19,20,21,22, 26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]. Figure 1 shows a flowchart of the study selection process. Details of the included 20 RCTs are summarized in Table 1.

Fig. 1
figure 1

Flowchart of the RCT selection process. BVA: Bee Venom Acupuncture; RCTs: Randomized Controlled Trials

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Table 1 Characteristics of the included studies
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Participants

A total of 1,399 patients with musculoskeletal pain were included in this review. The BVA and control groups comprised 817 and 582 participants, respectively. Ten conditions were assessed: neck pain [28, 37], shoulder pain with adhesive capsulitis [19, 20], pain after post stroke [21, 30, 33, 38, 39], back pain with herniated lumbar disc [34, 35], low back pain [22, 29, 40], acute ankle sprain [36, 41], wrist sprain [31], knee osteoarthritis [27, 32] and rheumatoid arthritis [26].

Interventions

Seven trials compared BVA with sham injections such as normal saline [19,20,21,22, 26], histamine injection [27], NSAIDs [28], or BVA plus NSAIDs [28]. Another RCT compared BVA plus NSAIDs to normal saline injections plus NSAIDs [29]. Three of the included RCTs compared BVA with acupuncture [30,31,32], and the other four trials compared BVA plus acupuncture with acupuncture treatment alone [33,34,35,36]. Five RCTs compared BVA plus acupuncture with normal saline injection plus acupuncture [37,38,39,40,41]. Details of the BVA interventions are presented in Table 1.

BVA concentration and dosage

Each concentration of BVA ranged from 1,000:1 to 20,000:1, and three studies [29, 33, 39] did not mention the concentration of BVA. Each amount of BVA of one treatment session ranged from 0.03 mL to 9.6 mL. The BVA concentrations and dosages according to the participants’ conditions are summarized in Table 2.

Table 2 Concentration and dosage of BVA according to participant’s conditions
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Outcomes

The pain reduction was greater in BVA groups than in the various control groups in all but four [20, 30, 33, 36] of the 20 included RCTs.

BVA versus sham injection of normal saline/or histamine

All RCTs comparing BVA with sham injection of normal saline [19,20,21,22, 26] reported that BVA treatment significantly alleviates shoulder pain with adhesive capsulitis [19, 20], pain after post-stroke [21], chronic low back pain [22], and pain with rheumatoid arthritis [26] compared to sham injection treatment. An RCT on knee pain with osteoarthritis [27] reported that BVA reduced pain more significantly than a sham injection (histamine injection). A meta-analysis of two RCTs [21, 26] suggested an effect in favor of BVA (100-mm VAS; MD: -16.93; 95% CI = -26.35 to -7.51, P = 0.0004, n = 85; heterogeneity: I2 = 0%; Fig. 2a). Two trials of shoulder pain with adhesive capsulitis [19, 20] reported positive effects of BVA on pain reduction (10-cm VAS; MD: -1.24; 95% CI = -2.05 to -0.44, P = 0.002, n = 83; heterogeneity: I2 = 0%; Fig. 2b). In two RCTs [19, 20], the BVA group showed significantly better effects on the Shoulder Pain and Disability Index (SPADI) than the sham injection (normal saline) group (MD: -11.48; 95% CI = -17.88 to -5.08, P = 0.0004, n = 83; heterogeneity: I2 = 0%; Fig. 2c).

Fig. 2
figure 2

Meta-analysis of BVA versus Saline Injection (Normal Saline). AT: Acupuncture; BVA: Bee Venom Acupuncture; SI(NS): Saline Injection (Normal Saline); SPADI: Shoulder Pain and Disability Index; VAS: Visual Analog Scale. (a) BVA Versus Saline Injection (Normal Saline): 100-mm VAS. (b) BVA Versus Sham Injection (Normal Saline) for Shoulder Pain with Adhesive Capsulitis: 10-cm VAS. (c) BVA Versus Sham Injection (Normal Saline): SPADI

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BVA versus NSAIDs versus BVA plus NSAIDs

In one study [28], treatment with BVA showed significant effectiveness in improving neck pain compared to NSAIDs alone (P < 0.05) and BVA plus NSAIDs (P < 0.05).

BVA plus NSAIDs versus sham injection (normal saline) plus NSAIDs

An RCT by Seo et al. [29] evaluated the effects of BVA and NSAIDs in patients with chronic low back pain. BVA plus NSAIDs had significant effects on the VAS (AID treatmP < 0.05), ODI (P < 0.05), and EQ-5D (P < 0.05).

BVA versus acupuncture

Two RCTs reported that pain from wrist sprains [31] and osteoarthritis [32] were significantly improved in the BVA group compared to the acupuncture group. Another study [30] that compared BVA treatment with acupuncture treatment for shoulder pain after stroke showed no significant differences between the groups. The results of the meta-analysis [31, 32] showed that pain reduction on the 10-cm VAS was not significantly different between the groups (MD: -0.08; 95% CI = -1.25 to -1.10, P = 0.90, n = 83; heterogeneity: I2 = 91%; Fig. 3a).

Fig. 3
figure 3

Meta-analysis of BVA and BVA plus AT in VAS. AT: Acupuncture; BVA: Bee Venom Acupuncture; VAS: Visual Analog Scale. (a) BVA Versus Acupuncture: 10-cm VAS. (b) BVA Plus Acupuncture Versus Acupuncture: 10-cm VAS

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BVA plus acupuncture versus acupuncture

Four RCTs compared BVA combined with acupuncture with acupuncture alone [33,34,35,36]. Regarding back pain with a herniated lumbar disc, two trials [34, 35] reported significant effectiveness of treatment with BVA plus acupuncture compared to acupuncture alone. Two studies reported that BVA plus acupuncture treatment showed no significant effects on pain condition of shoulder pain after post-stroke [33] or acute ankle sprain [36] compared with the acupuncture control group. The meta-analysis suggested an effect in favor of BVA plus acupuncture in 10-cm VAS (MD: -2.18; 95% CI = -3.00 to -1.36, P < 0.00001, n = 47; heterogeneity: I2 = 17%; Fig. 3b).

BVA plus acupuncture versus sham injection (normal saline) plus acupuncture

Five double-blind RCTs [37,38,39,40,41] reported that BVA plus acupuncture significantly alleviated neck pain [37], shoulder pain after post stroke [38, 39], lower back pain [40], and pain with acute ankle sprain [41] compared to normal saline injection plus acupuncture. Meta-analysis of these five trials [37,38,39,40,41] showed significant differences in the 10-cm VAS (MD: -1.24; 95% CI = -1.63 to -0.85, P < 0.00001, n = 152; heterogeneity: I2 = 16%; Fig. 4a). In two RCTs [38, 39], the BVA plus acupuncture group showed significantly better Fugl-Meyer Motor Assessment (FMMA) results than the sham injection (normal saline) plus acupuncture group (MD: 3.24; 95% CI = -2.21, 8.68, P = 0.24, n = 86; heterogeneity: I2 = 0%; Fig. 4b).

Fig. 4
figure 4

Meta-analysis of BVA plus AT versus Saline Injection (Normal Saline) plus AT. AT: Acupuncture; BVA: Bee Venom Acupuncture; FMMA: Fugl-Meyer Motor Assessment. (a) BVA Plus AT Versus Sham Injection (Normal Saline) Plus AT: 10-cm VAS. (b) BVA Plus AT Versus Sham Injection (Normal Saline) Plus AT: FMMA

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Assessment for ROB

The details of the ROB for each RCT are summarized in Fig. 5. Regarding random sequence generation, 13 RCTs [19, 21, 22, 28, 29, 31, 33, 36,37,38,39,40,41] reported an appropriate randomization procedure, whereas the other seven trials [20, 26, 27, 31, 32, 34, 35] did not clearly mention random sequence generation. In the allocation concealment segment, four studies [21, 22, 28, 29] had a low ROB, whereas the other trials [19, 20, 26, 27, 30,31,32,33,34,35,36,37,38,39,40,41] did not clearly describe allocation concealment. In terms of blinding, 10 trials [20, 22, 27,28,29, 37,38,39,40,41] were double (practitioner-participant) blinded, 4 trials [21, 32, 33, 36] had a high ROB for blinding of personnel, and six studies [19, 26, 30, 31, 34, 35] did not mention blinding of participants and personnel. Six RCTs reported assessor blinding [19, 22, 28, 29, 38, 39]; however, other clinical studies [20, 21, 26, 27, 30,31,32,33,34,35,36,37, 40, 41] did not report any details. In four RCTs [30,31,32, 35], there were no missing data, and 11 trials [19, 21, 22, 28, 29, 33, 34, 37,38,39, 41] had similar numbers of dropouts, and the dropout rate did not exceed 20% for follow-up. Four RCTs had a high risk of attrition bias due to a dropout rate > 20% [26, 27, 36, 40], and one study [20] did not clearly describe the reason for dropout between groups. Five RCTs [19, 21, 22, 28, 29] registered their protocol, whereas the other trials [20, 26, 27, 30,31,32,33,34,35,36,37,38,39,40,41] did not provide information about published or registered study protocols.

Fig. 5
figure 5

Summary risk of bias assessment

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Adverse events

Adverse events were reported in eight RCTs (40% of 20 RCTs) [22, 27,28,29, 37, 38, 40, 41]. Another 12 RCTs [19,20,21, 26, 30,31,32,33,34,35,36, 39] did not report any adverse events. Symptoms of BVA include pruritus, skin flares (skin rashs), skin hypersensitivity, itching, burning sensation, and pain at the injection site. Two RCTs [22, 29] reported adverse effects of physical symptoms, including edema, headache, generalized myalgia, and dizziness. No severe side effects such as anaphylaxis were observed in any of the 8 trials.

Discussion

A previous study [18] reviewed 11 papers published until 2008 on the use of BVA for musculoskeletal pain. Our review provides evidence that BVA has been effective in treating various musculoskeletal pains published since 2008: shoulder pain with adhesive capsulitis [19, 20], post-stroke pain [21, 33, 39], chronic low back pain [22, 29], knee pain with osteoarthritis [27], and neck pain [28]. In addition, high-quality studies [22, 28, 29] have been conducted, suggesting that the level of research on BVA for musculoskeletal pains has grown both qualitatively and quantitatively.

One RCT [28] showed that BVA had a statistically significant pain reduction effect compared to NSAIDs and mild side effects (e.g., itching and redness at injection sites in two cases) observed in comparison to NSAIDs (e.g., skin urticaria, abdominal pain, nausea, and low back pain in one case). In a study by Seo et al. [29], combined treatment with BVA and NSAIDs showed significant effects on pain improvement compared to a sham injection of normal saline plus NSAIDs. These two studies [28, 29] suggest that BVA treatment alone or in combination with NSAIDs could be recommended as a treatment option for pain conditions. In addition, the quality levels of the two studies [28, 29] were high, supporting the reliability of the research results. However, the total number of RCTs and comparative studies in the analysis and their sample sizes were too small to determine the effectiveness of the treatment approach. Further trials with larger sample sizes are warranted.A meta-analysis of four trials [19,20,21, 26] on musculoskeletal pain (e.g., shoulder pain with adhesive capsulitis, pain after central post stroke, and pain from rheumatoid arthritis) showed a significant effect of BVA treatment compared with sham injection (normal saline). A meta-analysis of BVA plus acupuncture in the treatment of musculoskeletal pain (e.g., neck pain, shoulder pain after post-stroke, low back pain, and pain with acute ankle sprain) was conducted in five RCTs [37,38,39,40,41] and showed that the experimental group had significantly reduced pain compared to the sham injection (normal saline) plus acupuncture group. These studies used saline injections as placebo controls, which are generally used in modern clinical research to accurately measure the effectiveness of the experimental group [42]. However, the overall quality of the nine trials was low, and only one study was performed with a blinding procedure for participants, practitioners, and evaluators. Therefore, high-quality research on the use of BVA in musculoskeletal pain management is necessary.

Most included RCTs (95%, n = 19) were conducted in South Korea. BV is extracted from the venom pouch of worker bees (Apis mellifera ligustica), processed, refined, and freeze-dried into a powder in a clean room [9]. BV powder is purified and diluted in distilled water at a specific concentration [9, 43], and then filled, sealed, sterilized, and packaged as pharmacopuncture injections for clinical use [9, 43]. In Korea, a type of pharmacopuncture was produced in a facility controlled by the Ministry of Health and Welfare under the accreditation system of an external herbal medicine facility in 2018 [44]. As such, BV is prepared under government management at the same level as injections and is used to treat musculoskeletal pain in traditional Korean medicine (TKM) institutions (Fig. 6). According to national statistics, 22.4% of patients who visit TKM institutions receive pharmacopuncture (e.g., BVA, snake venom, and toad venom) [45]. In addition, pharmacopuncture is covered by insurance, which means that the government recognizes its safety and effectiveness [46].

Fig. 6
figure 6

BVA form and injection. BV: Bee venom; BVA: Bee Venom Acupuncture. (a) BV vial and BVA, (b) BVA injected into human body

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Most of the trials included in this study showed low or unclear ROBs for the quality assessment items. Unclear ROBs were mostly present in the domains of allocation concealment, outcome assessment blinding, and selective reporting. In most pharmacopuncture interventions, it is difficult to blind the procedures; therefore, the risk of performance bias is high. In some studies [26, 27, 36, 37], the dropout rate was high, the risk of attrition bias was high owing to the differences between groups, and a high dropout rate due to AEs of BV was reported. The methodological weaknesses of the included RCTs reduced the reliability of their results. In the future, a larger number of high-quality studies will be conducted by referring to the research methods of the three high-quality trials [24, 28, 29] conducted after 2012.

Eight RCTs [22, 27,28,29, 37, 38, 40, 41] reported adverse events, including injection site symptoms (pruritus, skin flare, skin hypersensitivity, itching, burning sensation, and pain) and physical symptoms (edema, headache, generalized myalgia, and dizziness). None of the included studies identified severe side effects such as anaphylactic shock. Adverse events occurred in 16.7% of patients treated with BVA and disappeared within 24 hours without additional treatment [47]. Because BV is a natural toxin, risk management of serious side effects is essential for its clinical use. Bee-sting therapy uses live bee stings in the human body, and serious adverse events such as systemic allergic reactions and anaphylaxis may occur [48]. In contrast, BVA is applied to the body by diluting purified BV to a certain concentration.

This study has several limitations. First, there is a concern about the possibility of publication bias, as most of the studies in this review were conducted in Korea. If studies conducted in a particular country exhibit positive results, they should be interpreted with caution [49]. Secondly, the pain types, dosages, and concentrations of BVA were too varied to draw definitive conclusions. Nevertheless, the number of RCTs increased to 20 compared with a previous study [18] that analyzed 11 trials, showing a tendency to grow quantitatively and qualitatively. Progress has been made in the methodology of the study, and deficiencies at the current research level, such as the sample size and registration of research plans, need to be addressed in future research. Thirdly, the average sample size across the 20 trials was 69.9 patients, with a range from 20 to 538 patients, reflecting considerable variability. Clinical studies with small sample sizes are often associated with reduced statistical power, which underscores the need for caution in interpreting the results. Finally, the fact that only 8 out of 20 RCTs (40%) reported adverse events made it difficult to assess the safety of BVA in the treatment of musculoskeletal pain. Future BVA RCTs should include detailed reporting of adverse events, specifying symptoms and cases. In fact, it is difficult to completely confirm the safety of these BVA treatments without a prospective cohort study. Therefore, it is expected that further research will be conducted to validate safety issues related to BVA by collecting and analyzing real-world data from clinical practice.

Conclusions

The results of our systematic review and meta-analysis suggest BVA seems to have certain effects in the treatment of various musculoskeletal pain conditions. Based on our updated review, the quality of RCTs on BVA for musculoskeletal pain has improved both qualitatively and quantitatively. However, small sample size, moderate risk of bias, clinical heterogeneity (the types of pain, BVA dosage and concentration) of the included RCTs prevents firm conclusions. In the future, standardization of BVA interventions and high-quality trials with homogenous pain conditions and larger sample size are warranted.

Data availability

Data is provided within the manuscript.

Abbreviations

EQ-5D:

EuroQol-5 Dimension

T&CAM:

Traditional, complementary and alternative medicine

KHP:

Korea Health Panel

QOL:

Quality of life

HRQOL:

Health-related quality-of-life

KIHASA:

Korea Institute for Health and Social Affairs

OR:

Odds ratio

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Funding

This study received no external funding.

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Authors and Affiliations

  1. Department of Policy Development, National Institute of Korean Medicine Development, Seoul, 04554, South Korea

    Soo-Hyun Sung

  2. Department of Preventive Medicine, College of Korean Medicine, Daegu Haany University, 1 Haanydaero, Gyeongsan-si, Gyeongsangbuk-do, 38610, South Korea

    Soobin Jang

  3. College of Korean Medicine, Dongshin University, Naju, 58245, South Korea

    Gihyun Lee

  4. Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, South Korea

    Jang-Kyung Park

  5. College of Korean Medicine, Kyung Hee University, Seoul, 02447, South Korea

    Sungjoo Lee

  6. Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, South Korea

    Byung-Cheul Shin

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Contributions

SHS and BCS conceived and designed the study. SJ and JKP performed the data collection, data analysis and interpretation of data. SHS, SL and JKP drafted manuscript. GL and BCS conducted a critical review of the manuscript. SHS and BCS finalized the manuscript.

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Correspondence to Byung-Cheul Shin.

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Sung, SH., Jang, S., Lee, G. et al. Bee venom acupuncture for musculoskeletal pain conditions: an updated systematic review and meta-analysis. BMC Complement Med Ther 25, 161 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12906-025-04891-1

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BMC Complementary Medicine and Therapies

ISSN: 2662-7671

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