Effectiveness and safety of acupuncture therapies for intractable hiccups: a systematic review and network meta-analysis

BACKGROUND: Intractable hiccups (IH) have diverse causes, including central lesions (e.g., stroke, intracranial injury) and peripheral triggers (e.g., gastrointestinal disease, tumors, chemotherapy, cirrhosis, surgery). IH significantly impairs quality of life, delays recovery, and increases the risk of complications. Acupuncture is frequently used as a complementary or alternative therapy for IH in China, but no prior study has systematically compared different acupuncture modalities within a unified framework. OBJECTIVE: To assess the comparative effectiveness and safety of multiple acupuncture therapies for treating IH via network meta-analysis. METHODS: RCTs on acupuncture for IH published from January 2015 to January 2025 were retrieved from eight databases and four clinical trial registries. Study quality was assessed via the Cochrane risk of bias tool. Meta-analysis was performed with Stata software. RESULTS: The 41 included studies were all conducted in China and published in Chinese and no studies or data from other countries. The studies covered a total of 3,060 patients with IH and 15 types of acupuncture-related intervention measures. Manual acupuncture combined with acupoint injection showed the highest efficacy in improving both total effective rate and quality of life. Electroacupuncture combined with conventional medicine was most effective in reducing hiccup symptoms. Among monotherapies, auricular acupressure achieved the greatest improvement in total effective rate. All acupuncture therapies demonstrated acceptable safety, with no serious adverse events reported. CONCLUSION: Acupuncture appears effective and safe for treating IH in China. Combination therapies outperformed monotherapies, with manual acupuncture plus acupoint injection showing the greatest efficacy and acceptable safety. Electroacupuncture with conventional medication was most effective for symptom relief. However, limitations of linguistic and geographical scope, potential favorable bias and uneven methodological quality warrant further high-quality international studies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier: CRD42025638314.