Objectives : This study aimed to quantitatively evaluate the efficacy of acupuncture as a treatment for painful diabetic peripheral neuropathy (PDPN) by comparing it with conventional pharmacotherapies through a network meta-analysis. Methods : A comprehensive literature search was conducted in databases including PubMed, Cochrane Library, Google Scholar, and RISS. Randomized controlled trials (RCTs) comparing acupuncture with pregabalin, duloxetine, or methylcobalamin for PDPN were included. The primary outcomes analyzed were visual analogue scale (VAS) scores and effective rates (defined as ≥50% pain reduction). Data were synthesized using network meta-analysis with R software (netmeta package), applying mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and heterogeneity was evaluated using I² and τ² statistics. Results : Fourteen RCTs were included. Acupuncture showed significantly greater pain reduction than methylcobalamin in terms of VAS scores (MD: -1.267, 95% CI: -1.756 to -0.779) and effective rates (OR: 3.113, 95% CI: 2.014 to 4.811). Duloxetine also demonstrated significant pain relief compared to methylcobalamin (MD: -0.823, 95% CI: -1.642 to -0.004). P-score ranking analysis indicated that acupuncture was the most effective intervention. Conclusion : Acupuncture demonstrated significant efficacy in reducing pain in patients with PDPN, showing comparable or superior analgesic effects to conventional pharmacotherapies. Therefore, acupuncture may be considered a clinically valuable, non-pharmacological option for the management of PDPN.
