3.1.3. Electro-Acupuncture, Fire Needling, or Warm Needling vs. Acupuncture

The level of evidence and recommendations were derived based on seven RCTs [22,52–57] that observed the effect of additional thermal or electrical stimulation in acupuncture for LHIVD in terms of pain, function, and overall symptom improvement.

As a result of the meta-analysis, the addition of thermal stimulation or electrical stimulation during acupuncture was effective in improving the overall symptoms (RR: 1.16, 95% CI: 1.09–1.23, *p* < 0.001), pain (MD, −0.58, 95% CI: −0.76–−0.39, *p* < 0.001), and function (ODI: MD, −0.71, 95% CI: −1.29–−0.13, *p* < 0.05) compared to acupuncture monotherapy.

In conclusion, the addition of thermal stimulation or electrical stimulation during acupuncture is recommended for improving the overall symptoms of LHIVD (A/High).

3.1.4. Deep-Insertion Acupuncture vs. Superficial-Insertion Acupuncture

The level of evidence and recommendations were derived based on eight RCTs [58–65] that observed the effect of the difference in the depth of insertion with respect to the pain and overall symptom improvement in acupuncture for LHIVD.

The meta-analysis showed that deep-insertion acupuncture was more effective in improving the overall symptoms (RR: 1.31, 95% CI: 1.23–1.39, *p* < 0.001) than superficialinsertion acupuncture. However, the level of evidence was evaluated to be one level lower due to inconsistency owing to the high heterogeneity (I2 = 88%) observed between studies. There was no significant difference in pain improvement (MD, −1.66, 95% CI: −3.97–0.65, *p* = 0.16).

In conclusion, deep-insertion acupuncture should be considered for improving the overall symptoms of LHIVD (B/Moderate).
