Understanding the core journals in a specific field helps researchers align their work with publication trends, thereby identifying prevailing research hotspots and directions. Moreover, knowledge of journal rankings provides valuable guidance for manuscript submission.

According to Bradford’s Law, the distribution of journal publication in a given field follows a 1:n:n² ratio among core, related, and peripheral journals. Applying this model, core journals were defined as those publishing more than 30 articles. Based on this threshold, there are 4 core journals, 20 related journals, and 99 peripheral journals in this field. Table 1 presents the identified core journals.

As shown in Table 1, the Journal of Ethnopharmacology ranks first in terms of the number of publications, total citations, and average citations. It is classified in the Q1 quartile, reflecting its high impact in the field. The second-ranking journal, Frontiers in Pharmacology, also falls within the Q1 quartile. Both journals emphasize pharmacological research, highlighting that investigations into the mechanisms of CHM in chronic pain management occupy a central role in this research domain.

Co-citation analysis of journals is a powerful bibliometric method for identifying interconnected academic disciplines, visualizing scholarly communication networks, and informing comprehensive literature reviews. Table 2 lists the top 10 co-cited journals, and Figure 3 provides a visual representation of co-citation relationships.

Among the most frequently co-cited journals, the Journal of Ethnopharmacology again ranks highest, underscoring the foundational role of pharmacological mechanism studies in this area. The second most co-cited journal is Evidence-Based Complementary and Alternative Medicine, reflecting the growing scholarly interest in CHM as a complementary therapy for chronic pain. The third-ranking journal, Annals of the Rheumatic Diseases, suggests that the application of CHM in the management of rheumatic disease-related chronic pain constitutes an important subfield and research hotspot.

Bibliometric keyword analysis is essential for mapping the developmental trajectory of a research field, identifying current research hotspots, and forecasting future trends. High-frequency keywords serve as a critical foundation for this process, offering insight into the core themes of the literature.

According to Price’s Law (25), the minimum frequency (m) for a keyword to be considered high-frequency is calculated as:

Where n_max represents the occurrence of the most frequent keyword. In this study, the highest-frequency keyword appeared 128 times, yielding a minimum threshold of approximately 8.47. To ensure strong relevance, the minimum frequency for inclusion as a high-frequency keyword was set at 9. Based on this criterion, a keyword co-occurrence map was generated (Figure 5).

The top 10 high-frequency keywords are presented in Table 5. The four most frequently occurring keywords are: rheumatoid arthritis (172), traditional Chinese medicine (128), neuropathic pain (75), and inflammation (59).

These findings indicate that current research hotspots primarily center on the application of CHM for managing inflammatory conditions, rheumatoid arthritis, and neuropathic chronic pain.

As illustrated in Figure 5, the keyword co-occurrence network reveals tight interconnections between various clusters. This indicates a high degree of thematic integration across different research topics related to CHM for chronic pain, reflecting a cohesive and interrelated body of work.

Keyword burst analysis helps identify shifts in research focus over time and highlights emerging areas of interest. As shown in Figure 6, the term “traditional Chinese medicine” exhibits the strongest burst intensity (5.97), which aligns with its central role in the field.

Recent burst keywords include “network pharmacology” and “molecular docking,” both of which are expected to remain influential. These terms reflect the growing trend of applying modern technological tools to the study of CHM for chronic pain, such as for new drug development, efficacy evaluation, and mechanistic exploration. These technologies are likely to become key research frontiers shortly.

An analysis of keyword bursts also reveals a phased evolution in the field: (1) Early stage (2011–2017): Focused on theoretical groundwork, with keywords such as “gene expression” and “extract” indicating foundational research and initial exploration; (2) Mid-stage (2018–2020): Marked by standardization efforts, characterized by keywords like “criteria,” “model,” and “protocol,” reflecting the development of methodological norms; (3) Recent stage (2021–2024): Represents a phase of review and methodological innovation, featuring both retrospective analysis (“systematic review”) and the adoption of advanced tools (“network pharmacology,” “molecular docking”). This progression suggests a maturing field that is evolving from basic conceptual studies to the application of sophisticated computational and pharmacological methodologies.

The term “randomized controlled trial” (RCT) ranks highest in both frequency and centrality, appearing at the core of the co-occurrence map and showing close association with multiple topics. This indicates a growing emphasis in the field on high-quality, evidence-based clinical trial designs, exemplified by RCTs. These findings align with the burst term analysis from the Web of Science Core Collection, further supporting the view that rigorous, modern clinical trial designs are becoming a cornerstone of research in CHM for chronic pain. This transition represents a necessary step for the field to engage with international standards.

However, current clinical trial designs in this area still face notable limitations. A review of the literature reveals that most CHM clinical studies remain single-center and small in scale. Methodologically, they often lack the rigorous design and detailed reporting found in studies of comparable Western medical management. To meet international standards of evidence-based medicine, future research must consider adopting methodological frameworks from modern medicine, including larger sample sizes, multi-center designs, and objective, multifaceted outcome assessments. For example, the inclusion of validated pain rating scales is recommended. Additionally, due to the complex composition of many CHM formulations, long-term safety and follow-up must be emphasized. Real-world studies, as opposed to strictly controlled RCTs, may offer greater practical relevance for CHM due to its broad application and individualized nature. Consequently, complementing RCTs with large-scale, multi-center real-world research is likely to become an important trend.

The keywords “osteoarthritis” and “migraine” reinforce findings from reference burst analysis based on Web of Science Core Collection data. These two conditions represent primary foci for the clinical application of CHM in chronic pain management. Both diseases are prevalent and impose significant economic burdens, making them high-priority conditions in primary care settings (43, 44). This underscores the significant potential of CHM in managing chronic pain within primary care.

Interestingly, “cancer pain”—a concept with longstanding relevance in CHM—appears in a more peripheral position in both the PubMed clinical trial data and the co-occurrence analysis from the Web of Science database. However, in the analysis of highly cited literature (26), cancer pain-related articles have received notable academic attention. This suggests that while CHM research on cancer pain is robust at the basic science level, its clinical translation remains underdeveloped. The historical use of CHM in managing cancer pain, coupled with its dual focus on symptom relief and root-cause management, suggests great clinical potential (45–47). Accelerating the transition from basic research to clinical application in this area is expected to become a major focus of future research.

The keyword co-occurrence map reveals strong connections between “flunarizine,” “randomized controlled trial,” and “Zhengtian Capsule.” This indicates ongoing efforts to integrate traditional Chinese and modern medical approaches, to identify synergistic management strategies that offer patients more effective and personalized options (48).

Similarly, in clinical research on chronic pain, the combination of CHM and modern pharmaceuticals is being explored to provide more comprehensive care. For example, studies have shown that Nimodipine combined with Yufeng Ningxin tablets results in a significantly higher cure rate for migraine (49).

These findings support the hypothesis that future clinical research on CHM for chronic pain will increasingly focus on integrated therapeutic models, blending traditional and modern management. Areas of potential include CHM-assisted reduction in analgesic dosage, mitigating drug dependence and tolerance, lowering adverse effects, and improving overall management outcomes and quality of life.

An analysis of key CHM reveals that Tripterygium wilfordii Hook.f, Sophora flavescens Aiton, Conioselinum anthriscoides “Chuanxiong,” and Paeonia lactiflora Pall are currently among the most prominent and widely studied herbs in this domain.

Tripterygium wilfordii Hook.f is widely used for chronic pain associated with immune-inflammatory conditions due to its potent immunosuppressive and anti-inflammatory properties (50–53). Studies have shown that four active monomeric compounds isolated from Tripterygium wilfordii Hook.f (triptolide, celastrol, demethylzeylasteral, and wilforgine) exhibit analgesic effects in experimental models. One of the key analgesic targets is believed to be the Nav1.7 sodium channel protein. Among these compounds, triptolide demonstrates significant efficacy in relieving both neuropathic and inflammatory pain, even at relatively low doses (53). In addition to its analgesic properties, triptolide has demonstrated marked anti-inflammatory, immunosuppressive, and anticancer activities (54). Therefore, it may offer effective therapeutic potential for chronic pain commonly associated with clinical conditions such as rheumatoid arthritis and cancer (55, 56). These findings suggest that triptolide and related compounds warrant consideration in drug screening and future research on chronic pain management.

Sophora flavescens Aiton has demonstrated the ability to alleviate both inflammatory and peripheral neuropathic pain (57). Mechanistic studies suggest that oxymatrine, a key bioactive compound in Sophora flavescens Aiton, inhibits oxidative stress and inflammation by suppressing the phosphorylation of p38 and Nuclear Factor Kappa-B p65 pathway proteins in mice (58). Additionally, Sophora flavescens Aiton (commonly known as Kushen) has a long-standing history of both internal and topical use in TCM. The external application of Sophora flavescens Aiton has already been documented in classical texts, such as the Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun), and remains a common practice in contemporary clinical settings (59, 60). The analgesic effect of topical Kushen for persistent pain may be attributed to oxymatrine’s ability to regulate inflammation, chemokine activity, and immune mediators, as well as to inhibit mRNA expression of Transient Receptor Potential Ankyrin 1 and Transient Receptor Potential Vanilloid ion channels (61). In cancer pain management, a Kushen-based Chinese medicine formulation, Fufang Kushen Injection, has been shown not only to relieve cancer-associated pain but also to inhibit tumor growth directly (62–64). The primary mechanism involves inhibition of Transient Receptor Potential Vanilloid-mediated, capsaicin-induced Extracellular Signal-Regulated Kinase phosphorylation and a reduction in tumor-induced proinflammatory cytokine production (62). It is important to note that cancer-related chronic pain can arise from nearly all types of cancer therapies, including surgery, radiation, hormone therapy, and chemotherapy (65). In recent years, the use of neoadjuvant therapies (such as preoperative chemotherapy or radiotherapy) has increased, which has led to a higher incidence of treatment-related chronic pain (65, 66). Much of this pain is localized to soft tissues, muscles, or joints (65). Notably, topical administration has been demonstrated to alleviate cancer-related chronic pain (67) effectively. Given the dual modality of Sophora flavescens Aiton (as both an oral and topical agent) and its potential to both relieve cancer pain and exert antitumor effects, it may serve as a promising adjunctive therapy. The external application of Sophora flavescens Aiton-based formulations or extracts to manage cancer-related chronic pain (including pain directly caused by cancer and that resulting from chemotherapy or radiotherapy) represents a potentially valuable frontier for future research. Currently, however, this area remains underexplored.

Conioselinum anthriscoides “Chuanxiong” is regarded in TCM as a key herb for treating headaches and is well known for its blood-activating and stasis-resolving properties (68). Clinically, it has been used for a long time in the treatment of various headache disorders (69). The significant anti-migraine effects of total alkaloids from Conioselinum anthriscoides Chuanxiong have been confirmed through their ability to increase levels of 5-hydroxytryptamine and its metabolite 5-hydroxyindoleacetic acid (70). Another major component, ligustrazine, has been shown to target dopamine D2 receptors, thereby reducing reactive oxygen species production and abnormal nociception in migraine rat models. These mechanisms suggest its potential in the effective management of chronic migraine (71).

Paeonia lactiflora Pall is believed to relieve inflammatory pain and regulate nervous system function through the anti-inflammatory and neuroprotective effects of paeoniflorin, thereby reducing nociceptive transmission and effectively relieving peripheral neuropathic pain and associated inflammatory pain in conditions such as diabetic foot (72). The analgesic mechanisms of paeoniflorin are thought to involve the activation of adenosine A1 receptors, as well as the potential modulation of several other pathways, including suppressors of cytokine signaling, the endogenous opioid receptor system, and anti-neuroinflammatory effects (73). However, current research into these latter three pathways remains in the exploratory stage, and further studies are required to establish their definitive roles in pain modulation and analgesia.

A shared pharmacological feature of these herbs is their anti-inflammatory activity, which underlies their analgesic effects. This underscores the anti-inflammatory mechanism of CHM as a central research focus and an emerging trend in the management of chronic pain. As such, these herbs have become focal points in current research and provide valuable reference points for developing clinically relevant therapies in chronic pain management.

Recent reference bursts, the progress of clinical trials, authors with high publication counts, and keyword co-occurrence analyses indicate a growing scholarly interest in the application of CHM for managing chronic pain associated with arthritis. This trend suggests that research in this area will likely continue to expand in the coming years. Among the most prominent diseases under investigation are inflammatory arthritic conditions, particularly rheumatoid arthritis and osteoarthritis. As rheumatoid arthritis and osteoarthritis are the most common, both of which are the most prevalent types of arthritis (74, 75). In TCM, these conditions correspond to the category of “bone bi syndrome” (76, 77).

Osteoarthritis is a chronic degenerative joint disease primarily affecting older adults. It often results in joint damage and chronic pain and can lead to disability in severe cases (78). The associated chronic pain significantly impairs patients’ ability to perform daily activities and is considered one of the leading causes of chronic pain (79). Chronic pain caused by osteoarthritis has drawn increasing attention from researchers in recent years (80, 81). Particularly as rising obesity rates and population aging contribute to an increased prevalence of the condition (82). Currently, modern Western medicine lacks highly effective and specific therapeutic interventions for osteoarthritis (83). In contrast, CHM has demonstrated evidence-based efficacy in managing osteoarthritis-related chronic pain (84). Specifically, active compounds in CHM have been shown to attenuate inflammation mediated by key cytokines, such as interleukin and tumor necrosis factor, both of which are critical in the pathogenesis of osteoarthritis-associated pain (13, 85). Indeed, pro-inflammatory mediators are widely recognized as primary drivers of pain in osteoarthritis (86, 87). A real-world clinical study on knee osteoarthritis demonstrated that integrative treatment combining CHM with Western medicine significantly outperformed conventional treatment alone in managing chronic pain (88). This finding highlights the potential of integrative approaches as a promising direction for future research. According to TCM theory, pain is often associated with stagnation or obstruction of qi and blood. Therefore, herbal formulations aimed at promoting blood circulation and resolving blood stasis have demonstrated significant efficacy in alleviating certain types of pain. These effects have been substantiated in clinical studies on knee osteoarthritis (89), offering valuable guidance for chronic pain management in clinical practice.

Rheumatoid arthritis is a chronic, systemic autoimmune disease that primarily affects the synovial joints, often resulting in functional limitations and chronic pain (31). The global prevalence of rheumatoid arthritis is estimated to be approximately 0.24% (90). For patients with rheumatoid arthritis, pain remains the symptom they most hope to alleviate (91). However, there is still a lack of safe, effective, and relatively low-burden pharmacological options for pain management in this population (31). CHM has demonstrated potential in managing chronic pain associated with rheumatoid arthritis, primarily through the modulation of inflammatory mediators and inhibition of oxidative stress responses (92, 93). Notably, CHM may play a key role by preventing the nuclear translocation of Nuclear Factor Kappa-B, a mechanism that has been identified as critical in recent studies (94, 95). Nuclear Factor Kappa-B emerged as a high-frequency keyword in our bibliometric analysis, highlighting its significance as a research hotspot in studies of chronic pain. On the other hand, central sensitization is also recognized as an important factor in rheumatoid arthritis -related pain (96). This implies that even when inflammation is well controlled, some patients with rheumatoid arthritis may continue to experience inadequate pain relief (97). Acupuncture has demonstrated substantial evidence for its efficacy and underlying mechanisms in modulating central sensitization and, consequently, in supporting pain management (98–101). By contrast, similar research on CHM in this context remains limited. Therefore, the regulation of Nuclear Factor Kappa-B by CHM is currently a focal point in the management of chronic pain in rheumatoid arthritis. Future research frontiers may include the investigation of central sensitization mechanisms in pain management and the synergistic effects of combined CHM and acupuncture therapies.

Moreover, the high co-citation ranking of top-tier journals like Annals of the Rheumatic Diseases and The Lancet is particularly noteworthy. It signifies that CHM research is actively aligning with mainstream medical standards, citing landmark articles on diseases such as rheumatoid arthritis and osteoarthritis to establish scientific rigor and clinical relevance. This trend underscores a critical shift toward conducting more rigorous, comparative clinical trials and integrating CHM into evidence-based frameworks, which is essential for its future inclusion in international clinical guidelines.

Notably, the recent emergence of keywords such as network pharmacology and molecular docking indicates that contemporary research in this field is increasingly integrating modern computational and systems biology approaches. These methodologies represent a shift toward more precise, mechanism-based investigations and signal a growing emphasis on exploring the molecular underpinnings of CHM management for chronic pain.

Beyond the current use of network pharmacology and molecular docking, the broader role of Artificial Intelligence (AI) offers profound inspiration for the field. Although it is not clustered as a core keyword, as far as we conclude, the importance of AI or large language models merits attention. This trend is exemplified by the selection of the 2024 Nobel Prize in Chemistry, where AlphaFold, an AI-driven tool, was recognized as a groundbreaking advancement and a research frontier in the life sciences (102). At present, AI has been utilized in various aspects of CHM research, including drug design, clinical decision support, data analysis, and disease characteristic identification and prediction (103–107). For example, AI can revolutionize CHM research by mining vast quantities of traditional and modern data to generate novel hypotheses, enabling highly personalized treatments through precise “pattern differentiation,” and modernizing clinical trials by identifying optimal patient subgroups (108).

This deeper integration of AI signifies a paradigm shift, advancing CHM from a traditional practice to a data-driven, precision-focused medical science.

An analysis of institutional publication volumes reveals that eight of the top 10 publishing institutions are located in China’s economically developed coastal regions. In contrast, institutions in the central and western regions are relatively underrepresented, both in publication output and in collaborative research networks. Coastal institutions exhibit a clear advantage in both dimensions, demonstrating a pronounced “top-heavy” pattern in scholarly productivity.

Moreover, the concentration of CHM research in coastal regions may reflect disparities in research infrastructure, policy support, funding availability, and healthcare resources. For instance, the economically developed eastern coastal areas have significant advantages over the less-developed western regions in terms of TCM education, talent subsidies, and the availability of related medical positions, resulting in a greater aggregation of TCM professionals in these eastern coastal areas (109). In the field of CHM for chronic pain, this manifests as most affiliated institutions being concentrated in the developed eastern coastal regions. Also, due to the region-specific nature of TCM practices, research findings from coastal regions may not be universally applicable, particularly for guiding CHM-based pain management strategies in inland or under-resourced areas (110). So, there is a need to provide more support in the field of CHM for chronic pain in the central and western regions.

Compared to acupuncture and massage, which are increasingly recognized in the global management of chronic pain, CHM remains controversial in many parts of the world. One key reason lies in its deep historical roots in specific regions and the inherent complexity of its formulations (111). Consequently, the findings are likely to be more generalizable to countries such as Japan and South Korea, which share a longstanding tradition of CHM usage (112–115).

In these regions, both clinical application and academic research on CHM, particularly compound formulas, are active and well-established. Research in these areas often focuses on evaluating clinical efficacy and integrating approaches that combine Chinese and Western medicine (116–119). In this sense, the identification of key CHMs and the emphasis on real-world clinical validation can offer valuable insights to researchers in these countries. This focus may represent a current research hotspot and frontier in the study of CHM for chronic pain.

In recent years, interest in complementary and alternative medicine related to CHM has gradually increased in Western countries. For example, in France and Germany, nearly 50% of adults have tried some form of complementary or alternative medical treatment within a year (120). However, for Western countries where CHM lacks historical or cultural grounding, generalizability may be more limited. In these regions, researchers and clinical doctors tend to approach CHM more cautiously. Due to cultural differences and the relative lack of relevant research, studies in Western countries often emphasize purified components, single-compound analyses, the investigation of CHM toxicity and side effects, and mechanisms of action, areas that are more closely aligned with mainstream biomedical paradigms (111, 120, 121). Therefore, comprehensive research and mechanistic studies on CHM will be crucial for achieving greater recognition in the West and are likely to become future hotspots and frontiers in CHM research in these countries.