The growing interest in the development of complementary and alternative ways to treat mind and body seems to be demonstrated by the increase in public demand in the United States in the last two decades. Acupuncture and other traditional Oriental medicine therapies are gaining popularity at a rapid rate
The NCCAOM consulted with subject matter experts and researchers to identify the most common pain conditions in the US, and collect several studies supporting the effectiveness of acupuncture for each of those conditions. The team scoured documents from the Centers for Disease Control and Prevention (CDC) as well as the Agency for Healthcare Research and Quality (AHRQ) and individual papers to come up with the 14 pain conditions listed in our online resource. A number of Diplomates were also informally surveyed for the common musculoskeletal issues they commonly treat.
Over 175 studies were initially chosen including those evaluating mechanisms of action, safety, and cost effectiveness. They were pared down based on publication date, where those published in the past 5 years were given higher priority as well as randomized controlled trials (RCTs), and those studying larger populations. The final list of 52 papers was then cleared through the NCCAOM Executive Committee and Board of Commissioners. Due to copyright restrictions, we can only provide access to the abstracts of the pain studies.
Murakami et al. Ear Acupuncture for Immediate Pain Relief – A Systematic Review and Meta-Analysis of Randomized Controlled Trials (2017)
Summary: Ten studies met the authors’ inclusion criteria with six demonstrating auricular acupuncture to be superior to its comparator (e.g. standard care) although the mean difference was small; three showed no difference, and one showed inconsistent results. The authors concluded that, “Ear acupuncture may be a promising modality to be used for pain reduction within 48 hours, with a low side effect profile.”
Macpherson, et al. The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain (2017)
Summary: The study aimed to determine the trajectory of pain scores over time using data from 29 high quality randomized controlled trials including 17,922 patients. The chronic pain conditions included low back, neck and shoulder pain, knee osteoarthritis, and headache/migraine. Acupuncture versus control resulted in 90% of the benefit still holding one year after end of treatment. In acupuncture vs. sham control, the sham group improvement diminished by 50% over 12 months whereas the acupuncture group showed no significant reduction. Patients can therefore be reassured that acupuncture treatment effects persist for chronic pain.
Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis Vickers, Andrew J. et al. The Journal of Pain, 2017 Nov 30. pii: S1526-5900(17)30780-0. doi: 10.1016/j.jpain.2017.11.005.
Summary: Researchers performed a meta-analysis of raw data from 39 randomized controlled trials including 20,827 patients suffering from non-specific musculoskeletal pain, osteoarthritis, chronic headache or shoulder pain. Acupuncture was superior to both sham and no acupuncture control groups for each pain condition and found clear evidence that the effects of acupuncture persist over time with only a small decrease of approximately 15% over a year.
Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clin Proc. 2016 Sep;91(9):1292-306.
Summary: This paper evaluates supplements such as glucosamine & chondroitin, MSM, and SAMe as well as tai chi, yoga, acupuncture, manipulation, massage therapy, meditation and other relaxation techniques in the management of chronic pain (back pain, fibromyalgia, osteoarthritis, neck pain and severe headaches/migraines). Acupuncture was found to offer clinically significant improvement in all pain categories, however, a few randomized controlled trials didn’t demonstrate superiority of acupuncture treatment over sham control. (Complete paper is open access at www.ncbi.nlm.nih.gov/pmc/articles/PMC5032142/)
Zheng Z, Guo RJ, Helme RD, Muir A, Da Costa C, Xue CC. The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: a pilot randomized controlled clinical trial. European journal of pain (London, England). 2008;12(5):671-6.
Summary: This small trial involving 35 patients randomly assigned to receive real electroacupuncture (EA) or sham EA twice a week for 6 weeks before entering a 12-week follow up. Pain scales, opioid like medication consumption and their side effects were recorded daily. Participants also completed a number of standardized questionnaires such as the SF-36 at the intervals out to the 20th week. Reductions in opioid like medications were reduced by 39% in the real EA group and 25% in the sham EA group. The authors concluded that, “Real electroacupuncture demonstrates promising short-term reduction of opioid like medication for participants with chronic non-malignant pain, but such effect needs to be confirmed by trials with adequate sample sizes.”
Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013 Nov 15;38(24):2124-38.
Summary: Thirty-two studies were included in the systematic review and 25 studies presented relevant data for the meta-analysis. Acupuncture was found to have a clinically meaningful reduction in levels of self-reported pain when compared to sham, improved function, (both with no care as a control and compared to usual care). When acupuncture was compared with medications (NSAIDS, muscle relaxants and analgesics), there were statistically significant differences, however none that would be noticed clinically. Acupuncture worked equally well compared to transcutaneous electrical nerve stimulation.
Thomas, K J et al. “Randomised Controlled Trial of a Short Course of Traditional Acupuncture Compared with Usual Care for Persistent Non-Specific Low Back Pain.” BMJ : British Medical Journal 333.7569 (2006): 623. PMC.
Summary: Researchers evaluated 10 individualized acupuncture treatments for 160 patients or usual care only for 81 patients. The primary outcome measure was pain scale measured at 12 and 24 months as well as reported use of analgesics, Oswestry pain disability index, safety, and patient satisfaction. Weak evidence was found of an effect of acupuncture on persistent non-specific back pain at 12 months, but stronger evidence of a small benefit at 24 months.
Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med. 2006 Feb 27;166(4):450- 7. doi: 10.1001/archinte.166.4.450. PMID: 16505266. 178.
Summary: A total of 298 patients suffering from chronic low back pain were randomized into acupuncture, superficial needling of sham points, or a waiting list (control group). The patients received 12 treatments over an 8-week period, and were required to fill out a questionnaire at baseline, 8, 26 and 52 weeks including a pain scale. The patients who received acupuncture improved significantly over the sham and waitlist groups at the 8-week mark, however, at the 26th and 52nd week mark there was no significant difference between the pain reduction from the real vs. sham acupuncture groups.
Wu, Jun-Yi et al. “Acupuncture Therapy in the Management of the Clinical Outcomes for Temporomandibular Disorders: A PRISMA-Compliant Meta-Analysis.” Ed. Priscila Lie Tobouti. Medicine 96.9 (2017): e6064. PMC. Web. 2 Jan. 2018.
Summary: Nine studies met the authors’ inclusion criteria involving 231 patients applying various sham controls (sham acupuncture, sham laser, etc.) with pain scale being the main outcome. The authors asserted that acupuncture is effective at reducing pain in patients suffering from Temporomandibular disorders, especially those with myofascial pain symptoms.
Fernandes AC, Duarte Mour DM, Da Silva LG, De Almeida EO, Barbosa GA. Acupuncture in Temporomandibular Disorder Myofascial Pain Treatment: A Systematic Review. 2017 Summer;31(3):225-232. doi: 10.11607/ofph.1719.
Summary: A total of four randomized clinical trials were included in this review, and although the studies featured small sample sizes and short-term follow-up periods, acupuncture treatment results were similar to those TMD patients treated with occlusal splints and were significantly superior to those obtained from sham acupuncture groups. The authors state that, “acupuncture treatment appears to relieve the signs and symptoms of pain in myofascial TMD, however more RCTs with larger sample sizes are needed to verify the initial findings.”
Ferreira, L.A., de Oliveira, R.G., Guimarães, J.P. et al. Laser acupuncture in patients with temporomandibular dysfunction: a randomized controlled trial. Lasers Med Sci (2013) 28: 1549.
Summary: The study was looking at the analgesic efficacy of infrared low-power GaAIAs diode laser applied to acupuncture points. Forty female patients were randomized into two groups: one that received laser acupuncture in addition to reversible occlusal splint therapy, and a control group who received placebo laser. Both approaches were applied weekly for a 3-month period. The measurements showed a significantly faster and lower pain intensity values in the real laser group with a higher proportion of patients with remission of symptoms.
La Touche R, Goddard G, De-la-Hoz JL, et al. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain. 2010 Jul-Aug;26(6):541–550.
Summary: A total of 8 RCTs were selected and 4 met the criteria demonstrating positive results such as reducing pain, improving masticatory function and increasing maximum interinsisal opening. The results of the meta-analysis suggest that acupuncture is a reasonable treatment for producing short-term analgesic effects in patients with painful TMD symptoms. The researchers believe there was substantial bias in the studies they included in their analysis, and suggested that further RCTs with solid methodologies be conducted.
Ural F, Öztürk T, Bölük H, and Akkuş S. Ultrasonographic Evaluation of Acupuncture Effect on Common Extensor Tendon Thickness in Patients with Lateral Epicondylitis: A Randomized Controlled Study. The Journal of Alternative and Complementary Medicine. October 2017, 23(10): 819-822.
Summary: Researchers randomly assigned 41 patients into acupuncture and control groups. Conventional treatment (rest, NSAIDS, bracing, stretching/exercise) were applied to both groups. Pain scale and the Duruoz Hand Index (DHI) for functioning of the affected limb, pressure pain threshold, and common extensor tendon (CET) thickness were assessed before and after treatment for both groups. Ten treatments roughly 2 or 3 times a week for 4 weeks were provided to the patients. Both pain and DHI scores in both groups decreased, however the pressure pain threshold and CET thickness only demonstrated improvement in the acupuncture group. (This is significant in that physicians would be impressed with structural changes due to acupuncture treatment…) The points used were an ashi point, SJ 5, Lu 5, LI 10, LI 11, and LI 4.
Gadau M, Yeung WF, Liu H, Zaslawski C, Tan YS, Wang FC, et al. Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials. BMC complementary and alternative medicine. 2014;14:136.
Summary: Researchers evaluated 19 randomized controlled trials that compared acupuncture and/or moxibustion with sham acupuncture or another form of acupuncture or conventional treatment. They considered most of the studies to be of low quality, but demonstrated that acupuncture or moxibustion was superior or equal to conventional treatment such as local anesthetic injection, local steroid injection, NSAIDS, or ultrasound. The studies showed that acupuncture plus moxibustion were superior to acupuncture alone.
Chang W, Lai P, Tsou Y. Analgesic effect of manual acupuncture and laser acupuncture for lateral epicondylalgia: a systematic review and meta-analysis. Am J Chin Med. 2014;42(6):1301-14. doi: 10.1142/S0192415X14500815.
Summary: Researchers found 9 randomized controlled trials where 6 of them examined manual acupuncture and the remaining studied laser acupuncture. The results showed that acupuncture was effective for short-term relief, however, its long-term analgesic effect is unremarkable. Manual acupuncture, however, produced a more marked effect than laser acupuncture in the included studies.
Trinh K, Phillips S, Ho E, Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review, Rheumatology, Volume 43, Issue 9, 1 September 2004, Pages 1085–1090
Summary: This review found 6 high quality studies that met the inclusion criteria, all of which suggested that acupuncture was effective in the short-term relief of lateral epicondyle pain. Five out of six of the studies indicated that acupuncture was more effective compared to the control treatment. The authors concluded that, “There is strong evidence suggesting that acupuncture is effective in the short-term relief of lateral epicondyle pain.”
Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, et al. Acupuncture and other Physical Treatments for the Relief of Pain Due to Osteoarthritis of the Knee: Network Meta-analysis. Osteoarthritis and Cartilage / OARS, Osteoarthritis Research Society. 2013;21(9):1290-8.
Summary: Out of 156 eligible studies, 114 trials (involving 9,709 patients) provided data suitable for analysis. End of treatment results showed that eight interventions: interferential therapy, acupuncture, TENS, pulsed electrical stimulation, balneotherapy, aerobic exercise, sham acupuncture and muscle strengthening exercise produced a statistically significant reduction in pain compared with standard care. Based on a summary of the current available research, the meta-analysis results indicate that acupuncture can be considered one of the more effective physical treatments for alleviated osteoarthritis knee pain in the short term.
Jubb RW, Tukmachi ES, Jones PW, Dempsey E, Waterhouse L, Brailsford S. A blinded randomised trial of acupuncture (manual and electroacupuncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee. Acupunct Med. 2008;26(2):69-78
Summary: A total of 68 patients were randomized into two groups of 34, one receiving real acupuncture and one non-penetrating placebo needle (sham). The acupuncture group had greater improvement in pain scale and the pain reduction continued a month after the treatment ceased compared to baseline. The release of plasma beta-endorphin did not change for either intervention.
Liu, T. and Liu, C. (2006), Acupuncture for treating osteoarthritis of the knee and the hip. Arthritis & Rheumatism, 54: 3375–3377. doi:10.1002/art.22155
Witt C, Brinkhaus B, Jena S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomized trial. Lancet. 2005;366(9480):136-43.
Summary: Three hundred patients with chronic osteoarthritis of the knee were randomized into acupuncture treatment (150), minimal acupuncture (superficial needling at acupoints)(76), or a waiting list control (74). The patients completed standardized questionnaires at baseline, 8 weeks, 26 weeks and 52 weeks. After 8 weeks of treatment, pain and joint function were improved more with acupuncture than minimal or no acupuncture in patients suffering with knee osteoarthritis.
Seo SY, Lee KB, et al. Effectiveness of Acupuncture and Electroacupuncture for Chronic Neck Pain: A Systematic Review and Meta-Analysis The American Journal of Chinese Medicine 2017 45:08, 1573-1595
Summary: The authors searched nine databases for studies involving acupuncture and electroacupuncture for the treatment of chronic neck pain. Outcomes included pain intensity, disability, quality of life, and adverse effects. Sixteen RCTs were selected and significant pain relief was observed when the sole electroactupuncture group was compared to control or when electroacupuncture was added into the active control group, however the results were evaluated to have low level of evidence. The authors recommend better designed large-scale studies for the future.
Ho LF, Lin ZX, Leung AWN, et al. Efficacy of abdominal acupuncture for neck pain: A randomized controlled trial. Baak JPA, ed. PLoS ONE. 2017;12(7):e0181360. doi:10.1371/journal.pone.0181360.
Summary: A total of 154 patients with neck pain were randomly assigned to receive 6 treatments of abdominal acupuncture or non-penetrating sham abdominal acupuncture. Primary outcome measures included neck pain disability scores, secondary outcomes included neck pain intensity and health-related quality of life measures assessed at baseline, two and 6 weeks from baseline. Patients in the abdominal acupuncture group received additional follow up evaluations at 14 weeks from baseline. Patients who received the real abdominal acupuncture exhibited greater improvement (both in pain and quality of life measures) than those who received sham at both 2 and 6 weeks, and there was an even more significant improvement over sham at the 14-week mark.
Trinh K, Graham N, Irnich D, Cameron ID, Forget M. Acupuncture for neck disorders. Cochrane Database Syst Rev. 2016(5):Cd004870.
Summary: This meta-analysis included 27 studies covering both chronic and acute neck pain, whiplash associated disorders, myofascial & mechanical neck pain, and those with radicular signs. For mechanical neck pain, acupuncture was beneficial at immediate-term compared to sham for pain intensity, at short term compared with sham for disability and at short term follow up compared with wait list control for pain intensity and neck disability improvement. These studies found acupuncture treatments to be safe and cost-effective.
He D, Høstmark AT, Veiersted KB, et al Effect of intensive acupuncture on pain-related social and psychological variables for women with chronic neck and shoulder pain – an RCT with six month and three year follow up Acupuncture in Medicine 2005;23:52-61.
Summary: Twenty-four women suffering from chronic neck and shoulder pain were randomly assigned to acupuncture or sham control group. Ten treatments were administered over a three to four week period, and questionnaires for social and psychological variables were completed during the treatment period and six and three years after the treatment was completed. Not only was the pain reduced in the acupuncture group compared to the controls, but there were significant differences in the quality of sleep, anxiety, depression and life satisfaction at the end of the treatment. At six -months and three years, the acupuncture group showed further improvements in most variables compared with the control group.
Cao, Huijuan et al. “Acupoint Stimulation for Fibromyalgia: A Systematic Review of Randomized Controlled Trials.” Evidence-based Complementary and Alternative Medicine : eCAM 2013 (2013): 362831. PMC. Web. 2 Jan. 2018.
Summary: The authors found 16 RCTs with 1081 participants that met their inclusion criteria, and only two trials were evaluated as having a low risk of bias. With that said, acupuncture alone or combined with cupping therapy was superior to conventional medications on reducing pain scores and/or number of tender points. However, acupuncture didn’t fare any better than sham acupuncture on pain reduction.
Stival, RS, Cavalheiro, PR, Stasiak, CE, Galdino, DT, Hoekstra, BE, Schafranski, MD. Acupuncture in fibromyalgia: a randomized, controlled study addressing the immediate pain response [in Portuguese]. Rev Bras Reumatol. 2014;54:431–436.
Summary: This randomized controlled, double-blind study included 36 patients with fibromyalgia where 21 were selected for acupuncture treatment and 15 underwent sham acupuncture. The real acupuncture group had the greatest improvement in subjective pain scale.
Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013(5):Cd007070.
Summary: This meta-analysis evaluated outcomes of randomized controlled trials including pain, physical function, fatigue, sleep, total well-being and stiffness. Nine trials including 395 participants met the inclusion criteria. Three studies used electroacupuncture (EA) with the remainder using manual acupuncture. Low quality evidence from one study (with 13 participants) showed EA improved symptoms at one month following treatment, including pain, well-being, stiffness and fatigue. There was no difference in sleep quality. Moderate quality evidence from six studies (286 participants) indicated that acupuncture (EA or MA) was no better than sham acupuncture except for less stiffness at one month. Low quality evidence from a study with 38 participants showed a short-term benefit of acupuncture over antidepressants for pain relief. Four studies reported no difference between acupuncture and control or other treatments described at a six to seven month follow-up. The authors conclude that electroacupuncture is superior to manual acupuncture for pain, stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up.
Martin, DP, Sletten, CD, Williams, BA, Berger, IH. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clin Proc. 2006;81:749–757
Summary: This study randomly selected 25 patients for the acupuncture group and 25 in the control group (receiving simulated acupuncture). Total fibromyalgia symptoms (as measured by the Fibromyalgia Impact Questionnaire) significantly improved in both groups during the study period. Fatigue and anxiety were the two most significantly improved symptoms measured during the follow up period, but activity and physical function levels remained unchanged. The authors concluded that, “acupuncture significantly improved symptoms of fibromyalgia.”
Tedesco D, Gori D, Desai KR, Asch S, Carroll IR, Curtin C, McDonald KM, Fantini MP, Hernandez-Boussard T. Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg. 2017;152(10):e172872. doi:10.1001/jamasurg.2017.2872
Summary: The intent of this study was to perform a meta-analysis of RCTs evaluating nonpharmacological approaches to postoperative pain management after a total knee arthroplasty. Out of 5509 studies, 39 RCTs met inclusion criteria involving 2391 patients total. The most commonly performed interventions were continuous passive motion, preoperative exercise, cryotherapy, electrotherapy and acupuncture. The results showed that acupuncture delayed opioid use from an average of 20.8 minutes to 71.5 minutes to the first patient-controlled analgesia. There was low quality evidence that acupuncture improved pain. The authors concluded that, “electrotherapy and acupuncture after a total knee arthroplasty were associated with reduced and delayed opioid consumption.”
Liu XL, Tan JY, Molassiotis A, Suen LK, Shi Y. Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-based complementary and alternative medicine : eCAM.2015;2015:657809.
Crespin DJ, Griffin KH, Johnson JR, Miller C, Finch MD, Rivard RL, et al. Acupuncture provides short-term pain relief for patients in a total joint replacement program. Pain medicine (Malden, Mass). 2015;16(6):1195-203.
Summary: Acupuncture was offered to total hip and knee replacement patients at no additional charge at Abbott Northwestern Hospital in Minneapolis MN. The retrospective study evaluated 2,500 admissions between 2010 and 2012. Average short-term pain reduction was 45% from the mean pre-pain score. Forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture. The authors concluded that, “Acupuncture may be a viable adjunct to pharmacological approaches for pain management after a total knee or hip replacement.
Chen CC, Yang CC, Hu CC, Shih HN, Chang YH, Hsieh PH. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial. Regional anesthesia and pain medicine. 2015;40(1):31-6.
Summary: Sixty patients were randomly assigned to receiving true acupuncture (auricular, scalp and/or knee) or sham auricular acupuncture (AA). All procedures were conducted under general anesthesia and the AA needles were retained for 72 hours. Postoperative pain was managed with IV fentanyl using a patient-controlled pump. The total amount of fentanyl, time to the first analgesic request, pain intensity and analgesia related adverse effects were recorded. The 30 patients in the true acupuncture group faired better in all measures, including incidence of analgesia-related nausea and vomiting.
Ji M, Wang X, Chen M, Shen Y, Zhang X, Yang J. The Efficacy of Acupuncture for the Treatment of Sciatica: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM. 2015;2015:192808.
Summary: Researchers found 12 studies involving 1842 patients that met their inclusion criteria. Results showed that acupuncture was more effective than conventional western medicine in outcomes of effectiveness, pain intensity and pain threshold.
Liu H, Li H, Xu M, Chung KF, Zhang SP. A systematic review on acupuncture for trigeminal neuralgia. Alternative therapies in health and medicine. 2010;16(6):30-5.
Summary: Researchers found 12 studies with 506 patients treated with acupuncture and 414 treated with carbamazepine (CBZ) as a control group. All were considered low quality studies, and only four trials reported that acupuncture was superior to CBZ, and the remaining eight showed no difference between the treatment and control groups.
Abuaisha, B. B.; Costanzi, J. B.; Boulton, A. J. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: A long-term study. Diabetes Res. Clin. Pract. 39(2):115–121; 1998.
Summary: Forty-six diabetic patients suffering from painful peripheral neuropathy received up to 6 treatments over a 10-week period. Forty-four patients completed the study with 77% showing significant improvement in their symptoms, however only 21% had complete resolution of symptoms. A follow-up period of 18-52 weeks demonstrated that 67% of the patients were able to reduce or completely eliminate their medications. There were no significant changes in the peripheral neurological examination scores, vibration perception threshold (VPT) or HbA1c during the course of the treatment. The authors concluded that, “…acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative.”
Naderinabi B, Saberi A, Hashemi M, et al. Acupuncture and botulinum toxin A injection in the treatment of chronic migraine: A randomized controlled study. Caspian Journal of Internal Medicine. 2017;8(3):196-204. doi:10.22088/cjim.8.3.196.
Summary: One hundred fifty patients were randomized into three groups: (A) Acupuncture, (B) Botox and (C) controls taking migraine medication. All patients were evaluated at baseline, one, two and three months after treatment using a visual analogue score and other parameters. During the 3-month study, pain severity diminished in all three groups, with the greatest reduction in group (A). The frequency, absence from work, and need for medication decreased in all three groups, with fewer side effects in group (A). The authors concluded that, “Acupuncture, botulinum toxin-A injection and pharmacological treatment have beneficial effects on chronic migraine; however, acupuncture showed more effectiveness and fewer complications.
Coeytaux, R. R. and Befus, D. (2016), Role of Acupuncture in the Treatment or Prevention of Migraine, Tension-Type Headache, or Chronic Headache Disorders. Headache: The Journal of Head and Face Pain, 56: 1238–1240. doi:10.1111/head.12857
Summary: Researchers evaluated systematic reviews and meta-analyses of acupuncture in the treatment of headaches and migraines. For migraine, 22 studies were chosen representing 4985 patients. These meta-analyses demonstrated that acupuncture was associated with statistically significant improvement in both headache frequency and response when compared with routine care only and with prophylactic drug treatment at 2 months. Acupuncture was associated with better response and lower headache frequency at 3-4 months and 5-6 months compared with usual care, but not compared with drug treatment at those time points. For tension-type headaches, 12 trials met their inclusion criteria representing 2349 patients. Meta-analyses demonstrated that acupuncture was statistically significantly superior to both routine care and sham acupuncture for both “response” and reduction in the number of headache days at 2 months, 3-4 months, and 5-6 months after randomization. For chronic headache, Vickers et al. analyzed the raw, patient-level data from 29 RCTs and found that the effect size associated with acupuncture was statistically significantly larger than the effect size associated with sham acupuncture. The final conclusion of the authors is that, “Those studies provide ample evidence that acupuncture is effective as an adjunct to usual care in the management or prevention of common headache disorders…”
Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. The Cochrane database of systematic reviews. 2016;(6):CD001218. doi:10.1002/14651858.CD001218.pub3.
Summary: This paper is an update to a Cochrane review from 2009. The researchers included RCTs at least 8 weeks in duration that compared an acupuncture intervention with no acupuncture control, sham acupuncture, or prophylactic drug in patients with episodic migraine. Twenty-two trials included 4985 patients total, and those who compared acupuncture with no acupuncture, acupuncture was associated with a moderate reduction of headache frequency, where 41% of the participants had their migraine frequency cut in half (compared to 17% reduction in those without treatment). Both after treatment (12 trials, 1646 participants) and at follow-up (10 trials, 1534 participants), acupuncture was associated with a small but statistically significant frequency reduction over sham. After three months headache frequency at least halved in 57% of participants receiving acupuncture and 46% receiving prophylactic drugs and after six months in 59% and 54%, respectively. The authors concluded that, “The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches.”
Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: randomized controlled trial. BMJ. 2005 Aug 13;331(7513):376-82.
Summary: A total of 270 patients participated in a randomized controlled trial receiving 12 acupuncture treatments over 8 weeks. The main outcome measure was the difference in number of days with headache between the four weeks before intervention and 9-12 weeks after treatment, as recorded by patients in headache diaries. The number of days with headache decreased by 7.2 days in the acupuncture group vs. 1.5 days in the wait list group, and 6.6 days in the minimal acupuncture group. Almost half of those in the acupuncture group had a 50% reduction in number of days with headache. The authors concluded that, “Acupuncture was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache.”
Xu T, Hui L, Juan YL, Min SG, Hua WT. Effects of moxibustion or acupoint therapy for the treatment of primary dysmenorrhea: a meta-analysis. Alternative therapies in health and medicine. 2014;20(4):33-42.
Summary: The study compared the effectiveness of moxibustion, sandwiched moxibustion, acupuncture, and eye of floating needle techniques on primary dysmenorrhea evaluating the total effective rate, symptom score and variation of peripheral blood prostaglandin F2 α (PGF2 α). A total of 20 RCTs involving 2134 participants met the inclusion criteria. All of the interventions were better than control methods, and the combination of acupuncture with moxibustion was obviously better than control interventions as well.
Chung YC, Chen HH, Yeh ML. Acupoint stimulation intervention for people with primary dysmenorrhea: Systematic review and meta-analysis of randomized trials. Complementary therapies in medicine. 2012;20(5):353-63.
Summary: Thirty RCTs met inclusion criteria with 25 providing data for meta-analysis (involving 3,109 participants with an average age of 19 years old). The main outcomes were cure rate, total effective rate, pain intensity, menstrual pain, plasma PGF(2α)/PGE(2) ratio and adverse events. The results demonstrated that both acupuncture and acupressure, moxibustion and acupoint herbal patches had significant effects compared to medication or non-acupoint stimulation in terms of pain relief, pain intensity, and total effective rate. The acupressure stimulation, moxibustion and/or herbal patches applied to acupoints was more effective compared with acupuncture. Four studies reported minor adverse events such as bleeding at the needle site, hematoma and needle-site pain.
Smith CA, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea. The Cochrane database of systematic reviews. 2011(1):Cd007854.
Summary: Ten trials met inclusion criteria including 944 participants. Six were studying acupuncture and four evaluated acupressure. There was an improvement in pain relief from acupuncture compared with placebo control and medication, and in one trial, acupuncture improved quality of life compared with usual care. There was an improvement in pain relief and menstrual symptoms from acupressure compared with placebo control. The authors’ conclusion was that, “Acupuncture may reduce period pain, however there is a need for further well-designed randomized controlled trials.”
Cho SH, Hwang EW. Acupuncture for primary dysmenorrhoea: a systematic review. BJOG : an international journal of obstetrics and gynaecology. 2010;117(5):509-21.
Summary: A total of 27 RCTs were reviewed, however, only nine of the 27 clearly described their methods of randomization. Acupuncture was associated with a significant reduction in pain compared with medication or herbal medicine. Three trials reported reduced pain, however, two RCTs did not find a significant difference between acupuncture and sham acupuncture.
Ural FG, Öztürk GT. The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study. Evidence-based Complementary and Alternative Medicine : eCAM. 2017;2017:7420648. doi:10.1155/2017/7420648.
Summary: The trial consisted of 27 female patients (and 45 wrists) randomly divided into two groups (acupuncture and control). All patients used a night wrist splint. Pain scale, Duruoz hand index, quick disabilities of the arm, shoulder and hand questionnaire scores, electrophysiologic measurements and median nerve cross sectional areas (CSA) were recorded before and after treatment in both groups. All indices were improved in both groups, however, the median nerve CSA in the acupuncture group was significantly reduced compared to the control group. The authors’ conclusion was that, “After acupuncture therapy, the patients with CTS might have both clinical and morphological improvement.”
Hadianfard M, Bazrafshan E, Jahani N, Momeninejad H. Efficacies of Acupuncture and Anti-inflammatory Treatment for Carpal Tunnel Syndrome Journal of Acupuncture and Meridian Studies , Volume 8 , Issue 5 , 229 – 235
Summary: Fifty patients with mild to moderate Carpal Tunnel Syndrome (CTS) were randomized into two groups, both receiving night wrist splints for a month, and the acupuncture group was given 8 treatments over a 4 week period. A control group was given 400 mg of ibuprofen three times a day for 10 days. A month later, significant improvements were found in both groups. Acupuncture improved all measures compared to ibuprofen, except distal motor latency, and the authors suggest that acupuncture may be an effective treatment for CTS.
Khosrawi S, Moghtaderi A, Haghighat S. Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences. 2012;17(1):1-7.
Summary: A total of 64 patients were randomly assigned to either a control group where night splinting, vitamins B1 and B6, and sham acupuncture for four weeks were administered, or intervention group that underwent acupuncture twice a week for four weeks. The acupuncture group had a significantly improved global symptom score and nerve conduction velocity compared with the control group in 4 weeks. Other parameters didn’t show any statistically significant difference after acupuncture treatments. The authors’ concluded that, “…acupuncture can improve the overall subjective symptoms of carpal tunnel syndrome and could be adopted in comprehensive care programs…”
Yang, C.P., Hsieh, C.L., Wang, N.H., Li, T.C., Hwang, K.L., Yu, S.C., Chang, M.H. Acupuncture in patients with carpal tunnel syndrome: A randomized controlled trial. Clin J Pain. 2009;25:327–333.
Summary: A total of 77 patients were randomly assigned to either a steroid group (prednisolone) and acupuncture group receiving 8 treatments over a four-week period. Both groups improved at weeks two and four with no statistical significance except the acupuncture group experienced a greater decrease in distal motor latency and nocturnal latency at week four. The authors’ concluded that, “Short-term acupuncture treatment is as effective as short-term low-dose prednisolone for mild-to-moderate CTS. For those who do have an intolerance or contraindication for oral steroid or for those who do not opt for early surgery, acupuncture treatment provides an alternative choice.”
Zhang H, Sun J, Wang C, et al. Randomised controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain Acupuncture in Medicine 2016;34:164-170.
Summary: A total of 80 patients were randomly assigned to receive manual contralateral acupuncture for 4 weeks or be assigned to a waiting list while receiving conventional orthopedic therapy. Pain scale, mobility of the shoulder and quality of life measures were evaluated before the interventions and at 2, 4, 8 and 16 weeks. All measures improved as well as social functioning and mental health components of the SF-36 (quality of life questionnaire). No significant adverse effects were noted.
Itoh K, Saito S, Sahara S, Naitoh Y, Imai K, Kitakoji H. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study. J Acupunct Meridian Stud. 2014 Apr;7(2):59-64. doi: 10.1016/j.jams.2013.02.002. Epub 2013 Feb 24.
Summary: A total of 18 patients between the ages of 42 and 65 years with non-radiating shoulder pain for at least 6 months and normal neurological findings were randomized into two groups, each receiving 5 treatments of either trigger point acupuncture or sham acupuncture. Outcome measures were pain scale and shoulder function. After treatment, the acupuncture group’s pain reduced significantly in addition to a significant increase in shoulder function compared with sham. The authors’ concluded that, “Compared with sham acupuncture therapy, trigger point acupuncture appears to be more effective for chronic shoulder pain.”
Molsberger AF, Schneider T, Gotthardt H, Drabik A. German randomized acupuncture trial for chronic shoulder pain (GRASP) – a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Pain2010;151:146-54.
Summary: A total of 424 patients were randomly assigned to receive Chinese acupuncture, sham acupuncture, or conventional conservative orthopedic treatment. The two acupuncture groups received 15 treatments over 6 weeks. Pain scale was the major outcome measure at the end of treatment and 3 months later. The verum acupuncture group improved significantly over the sham and conventional orthopedic treatments. Descriptive statistics demonstrated a greater improvement of shoulder mobility (specifically abduction and arm above the head test) for the verum group versus the control group immediately after treatment and after 3 months.
Guerra de Hoyos JA, Andrés Martín MC, et al. Randomised trial of long-term effect of acupuncture for shoulder pain. 2004 Dec;112(3):289-98.
Summary: Participants between the ages of 25 to 83 years were randomly assigned to electroacupuncture or placebo acupuncture groups, receiving two treatments over 8 weeks and were able to take diclofenac if needed for intense pain. Outcome measures included pain intensity, range of motion, functional ability, quality of life, NSAID consumption, credibility and global satisfaction. Assessments were performed before, during and three and six months after treatment. At the six-month follow up, the acupuncture group showed a significantly greater improvement in pain intensity and improvement in every secondary outcome measure compared with the control group. The authors’ concluded that, “Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissue lesions) in a primary care setting.”
He XF, Xu Hb. Observation on the therapeutic effect of acupuncture at Yanglingquan (GB34) on sprain of external ankle joint. Zhongguo Zhen Jiu. 2006 Aug;26(8):569-70.
Summary: A total of 79 participants were semi-randomly assigned to either an acupuncture group, receiving verum needling at Yanglingquan (GB34) and electromagnetic therapy at local acupoints, or control group receiving just electromagnetic therapy. The cured rate was almost double that of the control group (67.4% vs. 36.4%).
To systematically review the literature on the effectiveness of ear acupuncture (EA) for immediate pain relief.
AMED, CINAHL, Cochrane Reviews, Embase, PsycINFO, PubMed, Scopus Web of Science, from inception through March 2015.
English publications, randomized controlled trials on human subjects involving EA as a treatment for pain, with outcomes recorded within 48 hours.
DATA EXTRACTION AND DESIGN:
Two authors independently assessed trial eligibility, quality, results, and side effects, and extracted data; a third author checked final data. Effect size (d), mean difference (MD), and 95% confidence interval (CI) were calculated. The Physiotherapy Evidence Database (PEDro) scoring system was used to assess study quality. Meta-analysis was performed for two primary outcomes measures-pain intensity score and analgesic requirements.
Ten studies met inclusion criteria. Quality per PEDro scores: four excellent, four good, two fair. Based on their primary outcome measures, six studies showed EA being superior to its comparator, three showed no difference to comparators (which in all cases were analgesics), and one study showed significant pain decrease at the first time point and no significant decrease at the second. Meta-analysis was completed for the three studies that evaluated pain intensity as a primary outcome measure, and EA was superior to comparator (MD = -0.96, 95% CI = -1.82- -0.11), but the MD was small. Meta-analysis was completed for the six studies that evaluated analgesic requirements, and EA was superior (MD = -1.08, 95% CI = -1.78- -0.38]), again with a small MD. Six studies reported side effects; all were minor and transient.
Ear acupuncture may be a promising modality to be used for pain reduction within 48 hours, with a low side effect profile. Rigorous research is needed to establish definitive evidence of a clinically significant difference from controls or from other pain treatments.
There is uncertainty regarding how long the effects of acupuncture treatment persist after a course of treatment. We aimed to determine the trajectory of pain scores over time after acupuncture, using a large individual patient data set from high-quality randomized trials of acupuncture for chronic pain. The available individual patient data set included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck, and shoulder), osteoarthritis of the knee, and headache/migraine. We used meta-analytic techniques to determine the trajectory of posttreatment pain scores. Data on longer term follow-up were available for 20 trials, including 6376 patients. In trials comparing acupuncture to no acupuncture control (wait-list, usual care, etc), effect sizes diminished by a nonsignificant 0.011 SD per 3 months (95% confidence interval: -0.014 to 0.037, P = 0.4) after treatment ended. The central estimate suggests that approximately 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, we observed a reduction in effect size of 0.025 SD per 3 months (95% confidence interval: 0.000-0.050, P = 0.050), suggesting approximately a 50% diminution at 12 months. The effects of a course of acupuncture treatment for patients with chronic pain do not seem to decrease importantly over 12 months. Patients can generally be reassured that treatment effects persist. Studies of the cost-effectiveness of acupuncture should take our findings into account when considering the time horizon of acupuncture effects. Further research should measure longer term outcomes of acupuncture.
Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for four chronic pain conditions. We searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001) with differences between groups close to 0.5 standard deviations (SD) for comparison with no acupuncture control and close to 0.2 SDs in comparison with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at one year. In secondary analyses, we found no obvious association between trial outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were associated with the type of control group, with smaller effects sizes for sham controlled trials that used a penetrating needle for sham, and for trials that had high intensity of intervention in the control arm.We conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. While factors in addition to the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain following acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominately by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.
Acupuncture is effective for the treatment of chronic musculosketal, headache and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.
Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches-acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga-as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines.
Opioid-like medications (OLM) are commonly used by patients with various types of chronic pain, but their long-term benefit is questionable. Electroacupuncture (EA) has been previously shown beneficial in reducing post-operative acute OLM consumption. In this pilot randomized controlled trial, the effect of EA on OLM usage and associated side effects in chronic pain patients was evaluated. After a two-week baseline assessment, participants using OLM for their non-malignant chronic pain were randomly assigned to receive either real EA (REA, n=17) or sham EA (SEA, n=18) treatment twice weekly for 6 weeks before entering a 12-week follow-up. Pain, OLM consumption and their side effects were recorded daily. Participants also completed the McGill Pain Questionnaire (MPQ), SF-36 and Beck Depression Inventory (BDI) at baseline, and at the 5th, 8th, 12th, 16th and 20th week. Nine participants withdrew during the treatment period with another three during the follow-up period. Intention to treat analysis was applied. At the end of treatment period, reductions of OLM consumption in REA and SEA were 39% and 25%, respectively (p=0.056), but this effect did not last more than 8 weeks after treatment. There was no difference between the two groups with respect to reduction of side effects and pain and the improvement of depression and quality of life. In conclusion, REA demonstrates promising short-term reduction of OLM for participants with chronic non-malignant pain, but such effect needs to be confirmed by trials with adequate sample sizes.
A systematic review and meta-analysis of randomized controlled trials (RCTs).
To evaluate the totality of evidence in relation to the effectiveness of acupuncture for nonspecific chronic low back pain(NSCLBP).
SUMMARY OF BACKGROUND DATA:
Acupuncture has become a popular alternative for treating clinical symptoms of NSCLBP. A number of RCTs have examined the effectiveness of acupuncture in the treatment of NSCLBP.
A systematic literature search was completed without date or language restrictions up to May 2012. Studies included in the review were RCTs that examined all forms of acupuncture that adhered to the Traditional Acupuncture Theory for treating NSCLBP. Outcome measures included impairment, activity limitation, and participation restriction. The methodological quality of the studies was examined using the Cochrane risk of bias tool.
Thirty-two studies were included in the systematic review, of which 25 studies presented relevant data for the meta-analysis. Acupuncture had a clinically meaningful reduction in levels of self-reported pain (mean difference =-16.76 [95% confidence interval, -33.33 to -0.19], P = 0.05, I = 90%) when compared with sham, and improved function (standard mean difference =-0.94 [95% confidence interval, -1.41 to -0.47], P < 0.00, I = 78%) when compared with no treatment immediately postintervention. Levels of function also clinically improved when acupuncture in addition to usual care, or electroacupuncture was compared with usual care alone. When acupuncture was compared with medications (NSAIDs, muscle relaxants, and analgesics) and usual care, there were statistically significant differences between the control and the intervention groups but these differences were too small to be of any clinical significance. There was no evidence in support of acupuncture over transcutaneous electrical nerve stimulation.
This systematic review demonstrates that acupuncture may have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies.
To determine whether a short course of traditional acupuncture improves longer term outcomes for patients with persistent non-specific low back pain in primary care.
Pragmatic, open, randomised controlled trial.
Three private acupuncture clinics and 18 general practices in York, England.
241 adults aged 18-65 with non-specific low back pain of 4-52 weeks’ duration.
10 individualised acupuncture treatments from one of six qualified acupuncturists (160 patients) or usual care only (81 patients).
MAIN OUTCOME MEASURES:
The primary outcome was SF-36 bodily pain, measured at 12 and 24 months. Other outcomes included reported use of analgesics, scores on the Oswestry pain disability index, safety, and patient satisfaction.
39 general practitioners referred 289 patients of whom 241 were randomised. At 12 months average SF-36 pain scores increased by 33.2 to 64.0 in the acupuncture group and by 27.9 to 58.3 in the control group. Adjusting for baseline score and for any clustering by acupuncturist, the estimated intervention effect was 5.6 points (95% confidence interval -0.2 to 11.4) at 12 months (n = 213) and 8.0 points (2.8 to 13.2) at 24 months (n = 182). The magnitude of the difference between the groups was about 10%-15% of the final pain score in the control group. Functional disability was not improved. No serious or life threatening events were reported.
Weak evidence was found of an effect of acupuncture on persistent non-specific low back pain at 12 months, but stronger evidence of a small benefit at 24 months. Referral to a qualified traditional acupuncturist for a short course of treatment seems safe and acceptable to patients with low back pain.
Acupuncture is widely used by patients with low back pain, although its effectiveness is unclear. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with chronic low back pain.
Patients were randomized to treatment with acupuncture, minimal acupuncture (superficial needling at nonacupuncture points), or a waiting list control. Acupuncture and minimal acupuncture were administered by specialized acupuncture physicians in 30 outpatient centers, and consisted of 12 sessions per patient over 8 weeks. Patients completed standardized questionnaires at baseline and at 8, 26, and 52 weeks after randomization. The primary outcome variable was the change in low back pain intensity from baseline to the end of week 8, as determined on a visual analog scale (range, 0-100 mm).
A total of 298 patients (67.8% female; mean +/- SD age, 59 +/- 9 years) were included. Between baseline and week 8, painintensity decreased by a mean +/- SD of 28.7 +/- 30.3 mm in the acupuncture group, 23.6 +/- 31.0 mm in the minimal acupuncture group, and 6.9 +/- 22.0 mm in the waiting list group. The difference for the acupuncture vs minimal acupuncture group was 5.1 mm (95% confidence interval, -3.7 to 13.9 mm; P = .26), and the difference for the acupuncture vs waiting list group was 21.7 mm (95% confidence interval, 13.9-30.0 mm; P<.001). Also, at 26 (P=.96) and 52 (P=.61) weeks, pain did not differ significantly between the acupuncture and the minimal acupuncture groups.
Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain, whereas there were no significant differences between acupuncture and minimal acupuncture.
The purpose of this study was to evaluate conventional acupuncture therapy in the management of clinical outcomes for temporomandibular disorders (TMD) in adults.
The electronic databases PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trails.gov were searched for reports published until March 31, 2016.
Nine eligible studies from 8 publications involving 231 patients were included in the meta-analysis. A comparison of the main outcome of visual analog scale (VAS) values of pain between the acupuncture group and control group showed a significant decrease (MD = -0.98, 95% CI [-1.62, -0.34], I=54%, P = 0.003) in the VAS following acupuncture treatment. However, subgroup analysis according to the type of sham control group indicated that there were significant differences in the results when sham acupuncture was used as the control group (MD = -1.54, 95% CI [-2.63, -0.45], I=58%, P = 0.006) as well as when sham laser treatment was used as the control group (MD = -1.29, 95% CI [-2.32, -0.27], I = 0%, P = 0.01). However, there was no significant difference when the splint treatment group was used as the control group (MD = -0.09, 95% CI [-0.69, 0.50], I = 0%, P = 0.76). Subgroup analyses of VAS for pain by the classification of diseases indicated that the myogenous TMD subgroup demonstrated a significant difference (MD = -1.49, 95% CI [-2.45, -0.53], I = 47%, P = 0.002), and TMD showed no statistically significant difference (MD = -0.42, 95% CI [-1.14, 0.30], I = 46%, P = 0.25). Subgroup analysis according to whether the subgroup penetrated the skin showed that nonpenetrating sham acupuncture as the control group showed a significant difference (MD = -1.56, 95% CI [-2.70, -0.41], I = 58%, P = 0.008) compared with the conventional acupuncture as the treatment modality, while penetrating sham acupuncture as the control group showed no significant difference (MD = -1.29, 95% CI [-3.40, 0.82], I = not applicable, P = 0.23). No publication bias was observed considering the symmetry of the funnel plots.
Our results indicate that conventional acupuncture therapy is effective in reducing the degree of pain in patients with TMD, especially those with myofascial pain symptoms.
A prospective, double-blind, randomized, and placebo-controlled trial was conducted in patients with chronic temporomandibular disorder (TMD) to check the analgesic efficacy of infrared low-power GaAlAs diode laser applied to acupuncture points. Forty female subjects, ranging in age from 20 to 40 years, with diagnoses of chronic myofascial pain and arthralgia were randomly allocated to two groups: an experimental group (EG) who received the laser acupuncture as adjunct to reversible occlusal splint therapy and a control group (CG) who received a placebo laser associated with occlusal splint therapy. Both approaches were applied once a week for 3 months. Laser acupuncture was defined by the following parameters: 50-mW continuous radiation for 90 s to acupoints ST6, SI19, GB20, GB43, LI4, LR3, NT3, and EX-HN3; defining 4.5-J energy; 1250-W/cm(2) density point; and 112.5-J/cm(2) total density. The outcome measurements included a symptom evolution assessment carried out by checking spontaneous and palpation pain intensity, which was indicated on a visual analog scale (VAS). All evaluations were made by an assessor who was blind to the treatment. The symptom reduction was significant in both groups (EG: VAS = 0, n = 20; CG: VAS between 2 and 4, n = 18). The measurements showed significantly faster and lower pain intensity values in the EG (p ≤ 0.002), where there was a higher proportion of patients with remission of symptoms related to the action of laser acupuncture. For patients in whom conservative treatment was adopted, the laser acupuncture is a secure, noninvasive, and effective treatment modality because it improves the chronic pain associated with TMD and has no side effects.
Acupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP). A comprehensive systematic reviewof randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupunctureand moxibustion in the treatment of LEP.
Revised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included.
All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustioncombined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncturealone.
Moderate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP.
To explore the effect of acupuncture on common extensor tendon (CET) thickness in patients with lateral epicondylitis (LE). Additionally, to identify whether clinical and ultrasonographic changes showed any correlation.
Forty-one patients were randomly assigned to acupuncture and control groups. Conventional treatment (rest, NSAİİ, bracing, exercise) methods for LE were applied to all patients. In addition to this, the acupuncture treatment was applied to the acupuncture group. The visual analog scale (VAS) for pain, the Duruoz Hand Index (DHI) for functioning of the affected limb, the pressure pain threshold, and CET thickness (via ultrasound imaging) were assessed before and end of the treatment in both groups.
The VAS and DHI scores in both groups decreased. The pressure pain threshold and CET thickness only demonstrated improvement in the acupuncture group.
These findings show that the CET thickness was reduced after 10 sessions of acupuncture treatment in LE patients.
The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs).
By using electronic databases, the goal was to search and evaluate all the randomized controlled trials (RCTs) in which acupuncture was used in the management of pain attributed to these clinical entities. For the meta-analysis, an adequate description of the results’ statistical data was required along with a comparison of the treatment with a control group using a placebo or sham. Two independent reviewers evaluated the quality of the studies using the Jadad scale.
A total of 8 RCTs were selected, and the quality of only 4 was considered acceptable. These 4 studies showed positive results such as reducing pain, improving masticatory function, and increasing maximum interincisal opening. By combining the studies (n=96) and analyzing the results, it was concluded that acupuncture is more effective than placebo in reducing pain intensity in TMD (standardized mean difference 0.83; 95% confidence interval, 0.41-1.25; P=0.00012).
The results of this meta-analysis suggest that acupuncture is a reasonable adjunctive treatment for producing a short-term analgesic effect in patients with painful TMD symptoms. Although the results described are positive, the relevance of these results was limited by the fact that substantial bias was present. These findings must be confirmed by future RCTs that improve the methodologic deficiencies of the studies evaluated in this meta-analysis.
To carry out a systematic review of clinical trials published up to 2015 to determine the effectiveness of acupuncture in treating myofascial pain in temporomandibular disorder (TMD) patients.
The databases used were the Cochrane Library, PubMed, Scopus, and Web of Science; the dates of the articles surveyed ranged from 1990 to May 2015. The inclusion criteria were: (1) publications in English, Portuguese, or Spanish; (2) controlled clinical trials; (3) patients with TMD of muscular origin; and (4) studies that used acupuncture or laser acupuncture only for treatment. Reference lists of the included articles were hand searched.
A total of four randomized clinical trials using acupuncture (traditional, trigger point, and laser) for TMD treatment met the eligibility criteria and were included. Although the studies featured small sample sizes and short-term follow-up periods, acupuncture yielded results similar to those observed in groups treated with occlusal splints and were significantly superior than those obtained from placebo acupuncture-treated groups.
Despite the weak scientific evidence supporting its efficacy, acupuncture treatment appears to relieve the signs and symptoms of pain in myofascial TMD. More controlled and randomized clinical trials with larger sample sizes are needed in this field of research to verify these initial findings.
Lasers Med Sci. 2013 Nov;28(6):1549-58. doi: 10.1007/s10103-013-1273-x. Epub 2013 Feb 5.
Lateral epicondylalgia is a common orthopedic disorder. In traditional Chinese medicine, acupuncture is often used for treating lateralepicondylalgia. Laser acupuncture, compared with manual acupuncture, has more advantages because it is painless, aseptic and safe. However, the analgesic effect of manual acupuncture and laser acupuncture on lateral epicondylalgia has rarely been explored. We conducted a systematic review and meta-analysis to compare the analgesic effect of laser acupuncture and manual acupuncture for the treatment of lateral epicondylalgia. We investigated studies published in the Medline, PubMed, and CINAHL databases from January 1980 to December 2013. This review included 9 randomized articles. Six of them examined manual acupuncture and the others focused on laseracupuncture. We analyzed the meta-analysis results regarding the analgesic effect of the treatment, and observed substantial differences in 4 articles related to manual acupuncture. Manual acupuncture is effective in short-term pain relief for the treatment of lateral epicondylalgia; however, its long-term analgesic effect is unremarkable. A suitable acupuncture point and depth can be used to treat lateral epicondylalgia. Manual acupuncture applied on lateral epicondylalgia produced stronger evidence of an analgesic effect than did laser acupuncture, and further study on the analgesic effect of laser acupuncture is required.
Lateral epicondyle pain is a common complaint in North America. In the past 10 yr acupuncture has become increasingly recognized as an alternative treatment for pain, including epicondyle pain. This review evaluates the effectiveness of acupuncture as a treatment for lateral epicondylitis using the appropriate analysis.
Online bibliographic database searches in any language from Medline, PsychINFO, CINAHL, Healthstar, PMID, CAM, EMBASE, Cochrane Database of Systematic Review (3rd quarter 2003), articles listed in reference lists of key articles and the author’s personal files were performed. Randomized and quasi-randomized controlled trials examining the effects of acupuncture on lateral epicondyle pain were selected. From the six studies that met inclusion criteria, the first author, year of publication, population studied, dropout rate, treatment plan, assessment scale and outcome measures were extracted. Study quality was determined by using the Jadad scale, in which all studies were rated as high quality. A best evidence synthesis approach was used to analyse the data presented in the six studies.
All the studies suggested that acupuncture was effective in the short-term relief of lateral epicondyle pain. Five of six studies indicated that acupuncture treatment was more effective compared to a control treatment.
There is strong evidence suggesting that acupuncture is effective in the short-term relief of lateral epicondyle pain.
To compare the effectiveness of acupuncture with other relevant physical treatments for alleviating pain due to kneeosteoarthritis.
Systematic review with network meta-analysis, to allow comparison of treatments within a coherent framework. Comprehensive searches were undertaken up to January 2013 to identify randomised controlled trials in patients with osteoarthritis of the knee, which reported pain.
Of 156 eligible studies, 114 trials (covering 22 treatments and 9,709 patients) provided data suitable for analysis. Most trials studied short-term effects and many were classed as being of poor quality with high risk of bias, commonly associated with lack of blinding (which was sometimes impossible to achieve). End of treatment results showed that eight interventions: interferential therapy, acupuncture, TENS, pulsed electrical stimulation, balneotherapy, aerobic exercise, sham acupuncture, and muscle-strengthening exercise produced a statistically significant reduction in pain when compared with standard care. In a sensitivity analysis of satisfactory and good quality studies, most studies were of acupuncture (11 trials) or muscle-strengthening exercise (9 trials); both interventions were statistically significantly better than standard care, with acupuncture being statistically significantly better than muscle-strengthening exercise (standardised mean difference: 0.49, 95% credible interval 0.00-0.98).
As a summary of the current available research, the network meta-analysis results indicate that acupuncture can be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term. However, much of theevidence in this area of research is of poor quality, meaning there is uncertainty about the efficacy of many physical treatments.
To compare the effect of acupuncture (manual and electroacupuncture) with that of a non-penetrating sham (‘placebo’ needle) in patients with osteoarthritic knee pain and disability who are blind to the treatment allocation.
Acupuncture naïve patients with symptomatic and radiological evidence of osteoarthritis of the knee were randomly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed ‘placebo’ needle system. Acupuncture points for pain and stiffness were selected according to acupuncture theory for treating Bi syndrome. Both manual and electrical stimulation were used. Response was assessed using the WOMAC index for osteoarthritis of the knee, self reported pain scale, the EuroQol score and plasma beta-endorphin. The effectiveness of blinding was assessed.
There were 34 patients in each group. The primary end point was the change in WOMAC pain score after the course of treatment. Comparison between the two treatment groups found a significantly greater improvement with acupuncture (mean difference 60, 95% CI 5 to 116, P= 0.035) than with sham. Within the acupuncture group there was a significant improvement in pain (baseline 294, mean change 95, 95% CI 60 to 130, P<0.001) which was not seen by those who had sham acupuncture (baseline 261, mean change 35, 95% CI -10 to 80, P=0.12). Similar effects within group, but not between groups, were seen with the secondary end points of WOMAC stiffness, WOMAC function, and self reported pain. One month after treatment the between group pain difference had been lost (mean difference 46; 95% CI -9 to 100, P=0.10) although the acupuncture group was still benefiting compared to baseline (mean difference 59; 95% CI 16 to 102, P=0.009). The EuroQol score, a generic measure of health related quality of life, was not altered by the treatments. A minority of patients correctly guessed their treatment group (41% in the acupuncture group and 44% in the control group). Plasma beta-endorphin levels were not affected by either treatment.
Acupuncture gives symptomatic improvement for patients with osteoarthritis of the knee, and is significantly superior to non-penetrating sham acupuncture. The study did not confirm earlier reports of release of plasma beta-endorphin during acupuncture.
Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee.
Patients with chronic osteoarthritis of the knee (Kellgren grade < or =2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat.
294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26.9 (SE 1.4) in the acupuncture group, 35.8 (1.9) in the minimal acupuncture group, and 49.6 (2.0) in the waiting list group (treatment difference acupuncture vs minimal acupuncture-8.8, [95% CI -13.5 to -4.2], p=0.0002; acupuncture vs waiting list -22.7 [-27.5 to -17.9], p<0.0001). After 52 weeks the difference between theacupuncture and minimal acupuncture groups was no longer significant (p=0.08).
After 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.
The aim of this systematic review was to assess evidence from randomized controlled trials (RCTs) on the effectiveness and safety of acupuncture and electroacupuncture in patients with chronic neck pain. We searched nine databases including Chinese, Japanese and Korean databases through 30 July 2016. The participants were adults with chronic neck pain and were treated with acupuncture or electroacupuncture. Eligible trials were those with intervention groups receiving acupuncture and electroacupuncture with or without active control, and control groups receiving other conventional treatments such as physical therapy or medication. Outcomes included pain intensity, disability, quality of life (QoL) and adverse effects. For statistical pooling, the standardized mean difference (SMD) and its 95% confidence interval (CI) were calculated using a fixed-effects model. Sixteen RCTs were selected. The comparison of the sole acupuncture group and the active control group did not come out with a significant difference in pain (SMD 0.24, 95% CI [Formula: see text]0.27-0.75), disability (SMD 0.51, 95% CI [Formula: see text]0.01-1.02), or QoL (SMD [Formula: see text]0.37, 95% CI [Formula: see text]1.09-0.35), showing a similar effectiveness of acupuncture with active control. When acupuncture was added into the control group, the acupuncture add-on group showed significantly higher relief of pain in studies with unclear allocation concealment (SMD [Formula: see text]1.78, 95% CI [Formula: see text]2.08-[Formula: see text]1.48), but did not show significant relief of pain in studies with good allocation concealment (SMD [Formula: see text]0.07, 95% CI [Formula: see text]0.26-0.12). Significant relief of pain was observed when the sole electroacupuncture group was compared to the control group or electroacupuncture was added onto the active control group, but a lot of the results were evaluated to have low level of evidence, making it difficult to draw clear conclusions. In the result reporting adverse effects, no serious outcome of adverse event was confirmed. Acupuncture and conventional medicine for chronic neck pain have similar effectiveness on pain and disability when compared solely between the two of them. When acupuncture was added onto conventional treatment it relieved pain better, and electroacupuncture relieved pain even more. It is difficult to draw conclusion because the included studies have a high risk of bias and imprecision. Therefore better designed large-scale studies are needed in the future.
This study aims to provide evidence regarding the clinical efficacy of abdominal acupuncture for neck pain.
This randomized, patient and assessor-blind, sham-controlled trial was conducted at a Chinese medicine center in Hong Kong between November 2014 and March 2016. A total of 154 eligible participants (age range, 18-65 years) with neck pain were randomly assigned to receive abdominal (n = 77) or non-penetrating sham abdominal (sham group; n = 77) acupuncture. Each participant was administered treatment over six sessions by Registered Chinese Medicine Practitioners, in accordance with a standardized protocol. The primary outcome was mean improvement in neck pain disability scores evaluated by the Northwick Park Neck Pain Questionnaire (NPQ). Secondary outcomes included intensity of neck pain and health-related quality-of-life measures. The outcomes were assessed at baseline and at 2 and 6 weeks from baseline. Patients in the abdominal acupuncture group received additional follow-up evaluation at 14 weeks from baseline. Outcomes were evaluated by intention-to-treat analysis.
All participants provided informed consent for treatment and follow-up evaluation. Patients who received abdominal acupunctureexhibited greater improvement in NPQ scores than those who received sham treatment at both 2 and 6 weeks from baseline (intergroup mean differences, -5.75; 95% confidence interval [CI], -9.48 to -2.03; P = 0.008 and -8.65; 95% CI, -12.13 to -5.16; P < 0.001, respectively). The improvement in NPQ scores in the abdominal acupuncture group was even more significant at 14 weeks from baseline. Patients in the abdominal acupuncture group also exhibited significantly greater improvements in intensity of neck pain and a few quality-of-life measures than those in the sham abdominal acupuncture group, without any serious adverse events.
These findings suggest that abdominal acupuncture is an effective alternative treatment for neck pain.
Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic.
To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.
We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs).
DATA COLLECTION AND ANALYSIS:
Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group ‘Risk of bias’ tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models.
Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I(2) = 20%). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.Acupunctureappears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncturetreatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence.
Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.
This study examines whether intensive acupuncture treatment can improve several social and psychological variables for women with chronic pain in the neck and shoulders, and whether possible effects are long-lasting. The effects on pain have been reported elsewhere.
Twenty-four female office workers (47 +/- 9 years old, mean +/- SD) who had had neck and shoulder pain for 12 +/- 9 years, were randomly assigned to a test group or a control group. Acupuncture was applied 10 times during three to four weeks either at presumed acupuncture points for pain (test group) or at sham points (control group). In addition, acupressure was given to patients between treatments, at either real or sham points. Questionnaires for social and psychological variables were completed before each treatment, just after the course, and six months and three years later.
The pain-related activity impairment at work was significantly less in the test group than the controls by the end of treatment (P < 0.04). Also there were significant differences between the groups for quality of sleep, anxiety, depression and satisfaction with life (P < 0.05). At six months and three years follow ups the acupuncture group showed further improvements in most variables and was again significantly different from the control group.
Intensive acupuncture treatment may improve activity at work and several relevant social and psychological variables for women with chronic pain in the neck and shoulders. The effect may last for at least three years.
Acupoint stimulation is popular for treatment of fibromyalgia though there is lack of comprehensive evaluation of current clinical evidence for its effect and safety.
To systematically review the beneficial effects and safety of acupoint stimulation for fibromyalgia.
We searched six electronic databases for randomized trials on acupoint stimulation for treatment of fibromyalgia. Two authors extracted data and assessed the trial quality independently. RevMan 5.2 software was used for data analyses with effect estimate presented as (standard) mean difference and a 95% confidence interval. We defined minimum, medium, and large SMD effect sizes as 0.3, 0.5, and 0.75.
16 RCTs with 1081 participants were involved in this review. Only two trials were evaluated as low risk of bias. Meta-analysis showed that acupuncture alone or combined with cupping therapy was superior to conventional medications on reducing pain scores and/or the number of tender points. However, acupuncture showed no better than sham acupuncture on pain reduction. There was no serious adverse event reported to be related to acupoint stimulation.
Acupoint stimulation appears to be effective in treating fibromyalgia compared with medications. However, further large, rigorously designed trials are warranted due to insufficient methodological rigor in the included trials.
To evaluate the efficacy of acupuncture in the treatment of fibromyalgia, considering the immediate response of the visual analogue pain scale (VAS) as its primary outcome.
Randomized, controlled, double-blind study including 36 patients with fibromyalgia (ACR 1990) selected from the outpatient rheumatology clinic, Santa Casa de Misericórdia, Ponta Grossa, PR. Twenty-one patients underwent an acupuncture session, under the principles of the traditional Chinese medicine, and 15 patients underwent a placebo procedure (sham acupuncture). For pain assessment, the subjects completed a Visual Analogue Scale (VAS) before and immediately after the proposed procedure. The mean change in VAS was compared among groups.
The variation between the final and initial VAS values was -4.36±3.23 (P=0.0001) in the treatment group and -1.70±1.55 in the control group (P=0.06). The difference in terms of amplitude of variation of VAS (initial – final VAS) among groups favored the actual procedure (P=0.005). The effect size (ES) for the treatment group was d=1.7, which is considered a large effect. Although small, the statistical power of the sample for these results was very relevant (94.8%).
Acupuncture has proven effective in the immediate pain reduction in patients with fibromyalgia, with a quite significant effect size.
One in five fibromyalgia sufferers use acupuncture treatment within two years of diagnosis.
To examine the benefits and safety of acupuncture treatment for fibromyalgia.
We searched CENTRAL, PubMed, EMBASE, CINAHL, National Research Register, HSR Project and Current Contents, as well as the Chinese databases VIP and Wangfang to January 2012 with no language restrictions.
Randomised and quasi-randomised studies evaluating any type of invasive acupuncture for fibromyalgia diagnosed according to the American College of Rheumatology (ACR) criteria, and reporting any main outcome: pain, physical function, fatigue, sleep, total well-being, stiffness and adverse events.
DATA COLLECTION AND ANALYSIS:
Two author pairs selected trials, extracted data and assessed risk of bias. Treatment effects were reported as standardised mean differences (SMD) and 95% confidence intervals (CI) for continuous outcomes using different measurement tools (pain, physical function, fatigue, sleep, total well-being and stiffness) and risk ratio (RR) and 95% CI for dichotomous outcomes (adverse events). We pooled data using the random-effects model.
Nine trials (395 participants) were included. All studies except one were at low risk of selection bias; five were at risk of selective reporting bias (favouring either treatment group); two were subject to attrition bias (favouring acupuncture); three were subject to performance bias (favouring acupuncture) and one to detection bias (favouring acupuncture). Three studies utilised electro-acupuncture (EA) with the remainder using manual acupuncture (MA) without electrical stimulation. All studies used ‘formula acupuncture’ except for one, which used trigger points.Low quality evidence from one study (13 participants) showed EA improved symptoms with no adverse events at one month following treatment. Mean pain in the non-treatment control group was 70 points on a 100 point scale; EA reduced pain by a mean of 22 points (95% confidence interval (CI) 4 to 41), or 22% absolute improvement. Control group global well-being was 66.5 points on a 100 point scale; EA improved well-being by a mean of 15 points (95% CI 5 to 26 points). Control group stiffness was 4.8 points on a 0 to 10 point; EA reduced stiffness by a mean of 0.9 points (95% CI 0.1 to 2 points; absolute reduction 9%, 95% CI 4% to 16%). Fatigue was 4.5 points (10 point scale) without treatment; EA reduced fatigue by a mean of 1 point (95% CI 0.22 to 2 points), absolute reduction 11% (2% to 20%). There was no difference in sleep quality (MD 0.4 points, 95% CI -1 to 0.21 points, 10 point scale), and physical function was not reported.Moderate quality evidence from six studies (286 participants) indicated that acupuncture (EA or MA) was no better than sham acupuncture, except for less stiffness at one month. Subgroup analysis of two studies (104 participants) indicated benefits of EA. Mean pain was 70 points on 0 to 100 point scale with sham treatment; EA reduced pain by 13% (5% to 22%); (SMD -0.63, 95% CI -1.02 to -0.23). Global well-being was 5.2 points on a 10 point scale with sham treatment; EA improved well-being: SMD 0.65, 95% CI 0.26 to 1.05; absolute improvement 11% (4% to 17%). EA improved sleep, from 3 points on a 0 to 10 point scale in the sham group: SMD 0.40 (95% CI 0.01 to 0.79); absolute improvement 8% (0.2% to 16%). Low-quality evidence from one study suggested that MA group resulted in poorer physical function: mean function in the sham group was 28 points (100 point scale); treatment worsened function by a mean of 6 points (95% CI -10.9 to -0.7). Low-quality evidence from three trials (289 participants) suggested no difference in adverse events between real (9%) and sham acupuncture (35%); RR 0.44 (95% CI 0.12 to 1.63).Moderate quality evidence from one study (58 participants) found that compared with standard therapy alone (antidepressants and exercise), adjunct acupuncture therapy reduced pain at one month after treatment: mean pain was 8 points on a 0 to 10 point scale in the standard therapy group; treatment reduced pain by 3 points (95% CI -3.9 to -2.1), an absolute reduction of 30% (21% to 39%). Two people treated with acupuncture reported adverse events; there were none in the control group (RR 3.57; 95% CI 0.18 to 71.21). Global well-being, sleep, fatigue and stiffness were not reported. Physical function data were not usable.Low quality evidence from one study (38 participants) showed a short-term benefit of acupuncture over antidepressants in pain relief: mean pain was 29 points (0 to 100 point scale) in the antidepressant group; acupuncture reduced pain by 17 points (95% CI -24.1 to -10.5). Other outcomes or adverse events were not reported.Moderate-quality evidence from one study (41 participants) indicated that deep needling with or without deqi did not differ in pain, fatigue, function or adverse events. Other outcomes were not reported.Four studies reported no differences between acupuncture and control or other treatments described at six to seven months follow-up.No serious adverse events were reported, but there were insufficient adverse events to be certain of the risks.
There is low to moderate-level evidence that compared with no treatment and standard therapy, acupunctureimproves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. MA probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using EA alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted.
To test the hypothesis that acupuncture improves symptoms of fibromyalgia.
PATIENTS AND METHODS:
We conducted a prospective, partially blinded, controlled, randomized clinical trial of patients receiving true acupuncture compared with a control group of patients who received simulated acupuncture. All patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture. We measured symptoms with the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory at baseline, immediately after treatment, and at 1 month and 7 months after treatment. The trial was conducted from May 28, 2002, to August 18, 2003.
Fifty patients participated in the study: 25 in the acupuncture group and 25 in the control group. Total fibromyalgia symptoms, as measured by the FIQ, were significantly improved in the acupuncture group compared with the control group during the study period (P = .01). The largest difference in mean FIQ total scores was observed at 1 month (42.2 vs 34.8 in the control and acupuncture groups, respectively; P = .007). Fatigue and anxiety were the most significantly improved symptoms during the follow-up period. However, activity and physical function levels did not change. Acupuncture was well tolerated, with minimal adverse effects.
This study paradigm allows for controlled and blinded clinical trials of acupuncture. We found that acupuncture significantly improved symptoms of fibromyalgia. Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety.
There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions.
To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty.
Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Web of Science (ISI database), Physiotherapy Evidence (PEDRO) database, and ClinicalTrials.gov for the period between January 1946 and April 2016.
Randomized clinical trials comparing nonpharmacological interventions with other interventions in combination with standard care were included.
DATA EXTRACTION AND SYNTHESIS:
Two reviewers independently extracted the data from selected articles using a standardized form and assessed the risk of bias. A random-effects model was used for the analyses.
MAIN OUTCOMES AND MEASURES:
Postoperative pain and consumption of opioids and analgesics.
Of 5509 studies, 39 randomized clinical trials were included in the meta-analysis (2391 patients). The most commonly performed interventions included continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. Moderate-certainty evidence showed that electrotherapy reduced the use of opioids (mean difference, -3.50; 95% CI, -5.90 to -1.10 morphine equivalents in milligrams per kilogram per 48 hours; P = .004; I2 = 17%) and that acupuncture delayed opioid use (mean difference, 46.17; 95% CI, 20.84 to 71.50 minutes to the first patient-controlled analgesia; P < .001; I2 = 19%). There was low-certainty evidence that acupuncture improved pain(mean difference, -1.14; 95% CI, -1.90 to -0.38 on a visual analog scale at 2 days; P = .003; I2 = 0%). Very low-certainty evidence showed that cryotherapy was associated with a reduction in opioid consumption (mean difference, -0.13; 95% CI, -0.26 to -0.01 morphine equivalents in milligrams per kilogram per 48 hours; P = .03; I2 = 86%) and in pain improvement (mean difference, -0.51; 95% CI, -1.00 to -0.02 on the visual analog scale; P < .05; I2 = 62%). Low-certainty or very low-certainty evidence showed that continuous passive motion and preoperative exercise had no pain improvement and reduction in opioid consumption: for continuous passive motion, the mean differences were -0.05 (95% CI, -0.35 to 0.25) on the visual analog scale (P = .74; I2 = 52%) and 6.58 (95% CI, -6.33 to 19.49) opioid consumption at 1 and 2 weeks (P = .32, I2 = 87%), and for preoperative exercise, the mean difference was -0.14 (95% CI, -1.11 to 0.84) on the Western Ontario and McMaster Universities Arthritis Index Scale (P = .78, I2 = 65%).
CONCLUSIONS AND RELEVANCE:
In this meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.
The purpose of this study was to evaluate the effectiveness of Acupuncture-point stimulation (APS) in postoperative pain control compared with sham/placebo acupuncture or standard treatments (usual care or no treatment). Only randomized controlled trials (RCTs) were included. Meta-analysis results indicated that APS interventions improved VAS scores significantly and also reduced total morphine consumption. No serious APS-related adverse effects (AEs) were reported. There is Level I evidence for the effectiveness of body points plaster therapy and Level II evidence for body points electroacupuncture (EA), body points acupressure, body points APS for abdominal surgery patients, auricular points seed embedding, manual auricular acupuncture, and auricular EA. We obtained Level III evidence for body points APS in patients who underwent cardiac surgery and cesarean section and for auricular-point stimulation in patients who underwent abdominal surgery. There is insufficient evidence to conclude that APS is an effective postoperative pain therapy in surgical patients, although the evidence does support the conclusion that APS can reduce analgesic requirements without AEs. The best level of evidence was not adequate in most subgroups. Some limitations of this study may have affected the results, possibly leading to an overestimation of APS effects.
Given the risks of opioid medications, nonpharmacological strategies should be considered for total joint replacement patients. We investigated acupuncture as an adjunct therapy for postsurgical pain management in a total joint replacement program by examining which total hip and knee replacement patients elected to receive acupuncture and the effect of acupuncture on short-term pain.
A total joint replacement program using fast-track physiotherapy offered elective postsurgical acupuncture to all patients, at no additional cost, as an adjunct therapy to opioids for pain management.
The Joint Replacement Center at Abbott Northwestern Hospital, a 630-bed teaching and specialty hospital in Minneapolis, Minnesota from 2010 to 2012.
Our sample included 2,500 admissions of total hip (THR) and total knee replacement (TKR) patients.
Self-reported pain was assessed before and after acupuncture using a 0-10 scale and categorized as none/mild (0-4) and moderate/severe pain (5-10).
Seventy-five percent of admissions included acupuncture. Women (Odds Ratio: 1.48, 95% Confidence Interval (CI): 1.22, 1.81) had higher odds of receiving acupuncture compared to men, and nonwhite patients (Odds Ratio: 0.55, 95% CI: 0.39, 0.78) had lower odds of receiving acupuncture compared to white patients. Average short-term pain reduction was 1.91 points (95% CI: 1.83, 1.99), a 45% reduction from the mean prepain score. Forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture.
Acupuncture may be a viable adjunct to pharmacological approaches for pain management after THR or TKR.
The effectiveness of acupuncture in relieving acute postoperative pain is still controversial. This patient-evaluator blinded and sham auricular acupuncture (AA)-controlled study tested whether acupuncture is effective in controlling acute postoperative pain after total knee arthroplasty.
Patients were randomly assigned to receive true acupuncture (knee, scalp, and AA) or sham AA. All procedures were conducted under general anesthesia, and the AA needles were retained in situ for 3 days. Postoperative pain was managed with intravenous fentanyl using a patient-controlled analgesia pump. The amount of postoperative fentanyl required, the time to the first fentanyl request, pain intensity on a 100-mm visual analog scale, incidence of analgesia-related adverse effects, and success of patients’ blinding were recorded.
This study comprised 60 patients (30 in the study group and 30 in the control group). The fentanyl requirement via patient-controlled analgesia in the study group was lower [mean (SD), 620.7 (258.2) vs 868.6 (319.3) μg; P = 0.002). The time to first request for fentanyl was longer in the study group. Pain intensity on a 100-mm visual analog scale was lower in the study group in the first 24 hours afterthe operation. The incidence of analgesia-related adverse effects of nausea and vomiting was lower in the study group. The success of blinding was not significantly different between the 2 groups (P = 0.731).
The data obtained from this clinical trial demonstrate the potential advantages of using acupuncture for postoperative pain control after total knee arthroplasty.
Sciatica is one of the most frequently reported complaints; it affects quality of life and reduces social and economic efficacy. Clinical studies on the efficacy of acupuncture therapy in sciatica are increasing, while systematic reviews assessing the efficacy of acupuncture therapy are still lacking.
This study aims to assess the effectiveness of acupuncture therapy for sciatica.
Comprehensive searches of 8 databases were conducted up until April 2015. Outcomes included effectiveness (proportion of patients who improved totally or partly in clinical symptoms), pain intensity, and pain threshold. Effect sizes were presented as risk ratio (RR) and mean difference (MD). Pooled effect sizes were calculated by fixed effects or random effects model.
A total of 12 studies (involving 1842 participants) were included. Results showed that acupuncture was more effective than conventional Western medicine (CWM) in outcomes effectiveness (RR 1.21, 95% CI: 1.16-1.25), pain intensity (MD -1.25, 95% CI: -1.63 to -0.86), and pain threshold (MD: 1.08, 95% CI: 0.98-1.17). Subgroup and sensitivity analysis found that the results did not change in different treatment method and drug categories substantially. The reported adverse effects were acceptable.
Acupuncture may be effective in treating the pain associated with sciatica.
Trigeminal neuralgia (TN) is a commonly seen pain condition with limited treatments available, and acupuncture is widely used for pain conditions, including TN.
To review the efficacy of acupuncture treatment for TN.
English and Chinese databases were searched extensively to identify randomized controlled studies of acupuncture treatment for TN. Selected studies were assessed for methodological quality. Odds ratios (OR) between treatment and control groups were used to assess efficacy.
Twelve studies met the inclusion criteria with 506 people in the acupuncture arm and 414 people in the control arm, in which carbamazepine (CBZ) was used as the control treatment. They were all low-quality studies, hence precluding meta-analysis. Only four trials reported that acupuncture was superior to CBZ, and the remaining eight studies showed no difference between the treatment and control groups. Adverse effects of acupuncture, which were reported in three studies, were mild.
The evidence reviewed previously suggests that acupuncture is of similar efficacy as CBZ but with fewer adverse effects in treatment of TN. However, the evidence is weak because of low methodological quality of the reviewed studies. Further studies with improved methodologies are recommended to support the use of acupuncture for TN.
Forty-six diabetic patients with chronic painful peripheral neuropathy were treated with acupuncture analgesia to determine its efficacy and long-term effectiveness. Twenty-nine (63%) patients were already on standard medical treatment for painful neuropathy. Patients initially received up to six courses of classical acupuncture analgesia over a period of 10 weeks, using traditional Chinese Medicine acupuncturepoints. Forty-four patients completed the study with 34 (77%) showing significant improvement in their primary and/or secondary symptoms (P < 0.01). These patients were followed up for a period of 18-52 weeks with 67% were able to stop or reduce their medications significantly. During the follow-up period only eight (24%) patients required further acupuncture treatment. Although 34 (77%) patients noted significant improvement in their symptoms, only seven (21%) noted that their symptoms cleared completely. All the patients but one finished the full course of acupuncture treatment without reported or observed side effects. There were no significant changes either in the peripheralneurological examination scores, VPT or in HbA1c during the course of treatment. These data suggest that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative.
Migraine is a common type of headache. Sometimes adequate pain relief is not achieved by conventional treatments. Acupuncture and botulinum toxin-A injection are known as non-pharmacological interventions for this purpose. The aim of this research was to compare the effect of acupuncture with botulinum toxin-A injection and pharmacological treatment in controlling chronic migraine.
This clinical trial was conducted on patients with chronic migraine in the North of Iran during 2014-2015. Eligible patients were randomly allocated to groups receiving acupuncture (A) or botulinum toxin A (B) and controls (C) by designed quadripartite blocks. All patients were evaluated at baseline, one, two and three months after treatment using visual analogue scale (VAS) score and other parameters. The analysis of data was performed in SPSS software Version 19.
One hundred fifty patients (48 males and 102 females) completed this study. During the 3- month study, the pain severity significantly diminished in three groups (P=0.0001), with greater reduction in group A (P=0.0001). The number of days per month with migraine, absence from work and the need for medication significantly decreased in three groups at 3 times of evaluation (p<0.05) with fewer side effects in group A (P=0.021).
Acupuncture, botulinum toxin-A injection and pharmacological treatment have beneficial effects on chronic migraine; however, acupuncture showed more effectiveness and fewer complications.
To summarize the current evidence that evaluates the effectiveness of acupuncture for the treatment or prevention of migraine, tension-type headache, and chronic headache disorders.
Findings from selected systematic reviews and meta-analyses are summarized.
Recently published systematic reviews and meta-analyses demonstrate that acupuncture is associated with improved clinical outcomes compared to routine care only, medical management, and sham acupuncture 2 months after randomization. The evidence in support of acupuncture’s comparative effectiveness at longer follow-up periods is mixed. Cost effectiveness analyses conducted in the United Kingdom and Germany suggest that acupuncture is a cost-effective treatment option in those countries. There are few or no cost-effectiveness studies of acupuncture in the United States.
This brief review of the current, published evidence does not include a discussion of potential risks or adverse events associated with acupuncture. There is also the question of the extent to which placebo effects might contribute to acupuncture’s clinical effectiveness. From a purely comparative effectiveness perspective, however, the evidence from clinical trials and meta-analyses makes a compelling case in support of a potentially important role for acupuncture as part of a treatment plan for patients with migraine, tension-type headache, and several different types of chronic headache disorders.
Acupuncture is often used for migraine prevention but its effectiveness is still controversial. We present an update of our Cochrane review from 2009.
To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than sham (placebo) acupuncture; and c) as effective as prophylactic treatment with drugs in reducing headache frequency in adults with episodic migraine.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL: 2016, issue 1); MEDLINE (via Ovid, 2008 to January 2016); Ovid EMBASE (2008 to January 2016); and Ovid AMED (1985 to January 2016). We checked PubMed for recent publications to April 2016. We searched the World Health Organization (WHO) Clinical Trials Registry Platform to February 2016 for ongoing and unpublished trials.
We included randomized trials at least eight weeks in duration that compared an acupuncture intervention with a no-acupuncture control (no prophylactic treatment or routine care only), a sham-acupuncture intervention, or prophylactic drug in participants with episodic migraine.
DATA COLLECTION AND ANALYSIS:
Two reviewers checked eligibility; extracted information on participants, interventions, methods and results, and assessed risk of bias and quality of the acupuncture intervention. The primary outcome was migraine frequency (preferably migraine days, attacks or headache days if migraine days not measured/reported) after treatment and at follow-up. The secondary outcome was response (at least 50% frequency reduction). Safety outcomes were number of participants dropping out due to adverse effects and number of participants reporting at least one adverse effect. We calculated pooled effect size estimates using a fixed-effect model. We assessed the evidence using GRADE and created ‘Summary of findings’ tables.
Twenty-two trials including 4985 participants in total (median 71, range 30 to 1715) met our updated selection criteria. We excluded five previously included trials from this update because they included people who had had migraine for less than 12 months, and included five new trials. Five trials had a no-acupuncture control group (either treatment of attacks only or non-regulated routine care), 15 a sham-acupuncture control group, and five a comparator group receiving prophylactic drug treatment. In comparisons with no-acupuncture control groups and groups receiving prophylactic drug treatment, there was risk of performance and detection bias as blinding was not possible. Overall the quality of the evidence was moderate. Comparison with no acupuncture, Acupuncture was associated with a moderate reduction of headache frequency over no acupuncture after treatment (four trials, 2199 participants; standardised mean difference (SMD) -0.56; 95% CI -0.65 to -0.48); findings were statistically heterogeneous (I² = 57%; moderate quality evidence). After treatment headache frequency at least halved in 41% of participants receiving acupuncture and 17% receiving no acupuncture (pooled risk ratio (RR) 2.40; 95% CI 2.08 to 2.76; 4 studies, 2519 participants) with a corresponding number needed to treat for an additional beneficial outcome (NNTB) of 4 (95% CI 3 to 6); there was no indication of statistical heterogeneity (I² = 7%; moderate quality evidence). The only trial with post-treatment follow-up found a small but significant benefit 12 months after randomisation (RR 2.16; 95% CI 1.35 to 3.45; NNT 7; 95% 4 to 25; 377 participants, low quality evidence). Comparison with sham acupunctureBoth after treatment (12 trials, 1646 participants) and at follow-up (10 trials, 1534 participants), acupuncture was associated with a small but statistically significant frequency reduction over sham (moderate quality evidence). The SMD was -0.18 (95% CI -0.28 to -0.08; I² = 47%) after treatment and -0.19 (95% CI -0.30 to -0.09; I² = 59%) at follow-up. After treatment headache frequency at least halved in 50% of participants receiving true acupuncture and 41% receiving sham acupuncture (pooled RR 1.23, 95% CI 1.11 to 1.36; I² = 48%; 14 trials, 1825 participants) and at follow-up in 53% and 42%, respectively (pooled RR 1.25, 95% CI 1.13 to 1.39; I² = 61%; 11 trials, 1683 participants; moderate quality evidence). The corresponding NNTBs are 11 (95% CI 7.00 to 20.00) and 10 (95% CI 6.00 to 18.00), respectively. The number of participants dropping out due to adverse effects (odds ratio (OR) 2.84; 95% CI 0.43 to 18.71; 7 trials, 931 participants; low quality evidence) and the number of participants reporting adverse effects (OR 1.15; 95% CI 0.85 to 1.56; 4 trials, 1414 participants; moderate quality evidence) did not differ significantly between acupunctureand sham groups. Comparison with prophylactic drug treatmentAcupuncture reduced migraine frequency significantly more than drug prophylaxis after treatment ( SMD -0.25; 95% CI -0.39 to -0.10; 3 trials, 739 participants), but the significance was not maintained at follow-up (SMD -0.13; 95% CI -0.28 to 0.01; 3 trials, 744 participants; moderate quality evidence). After three months headache frequency at least halved in 57% of participants receiving acupuncture and 46% receiving prophylactic drugs (pooled RR 1.24; 95% CI 1.08 to 1.44) and after six months in 59% and 54%, respectively (pooled RR 1.11; 95% CI 0.97 to 1.26; moderate quality evidence). Findings were consistent among trials with I² being 0% in all analyses. Trial participants receiving acupuncture were less likely to drop out due to adverse effects (OR 0.27; 95% CI 0.08 to 0.86; 4 trials, 451 participants) and to report adverse effects (OR 0.25; 95% CI 0.10 to 0.62; 5 trials 931 participants) than participants receiving prophylactic drugs (moderate quality evidence).
The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.
CONTEX: Primary dysmenorrhea (PD) is a common gynecological syndrome that is characterized by cramping in the lower abdomen during menstruation, particularly during puberty. Treatment for PD includes a variety of pharmacological, nonpharmacological, and surgical options. Although studies supporting use of traditional Chinese medicine (TCM) have helped in the proliferation of its comprehensive therapy, their results do not determine with certainty whether moxibustion and acupoint therapy are better for the treatment of PD than nonacupuncture-related therapy.
The study intended to compare the effectiveness of moxibustion and acupoint therapy- such as sandwiched moxibustion, moxibustion, acupuncture, eye of floating needle, and acupoint application-with other therapeutic methods for the treatment of PD.
Six electronic databases-PubMed, Web of Science, the Chinese Biomedical Literature Database (CBM), the Chinese Journal Full-text Database (CNKI), the Chinese Science and Technology Journal Full-text Database (VIP), and Chinese Wanfang Data-were searched electronically, from inception to December, 2012, to find randomized, controlled trials (RCTs). Relevant references in articles used in the current study were searched manually. Literature was screened, data were extracted, and the methodological quality of the included studies was assessed. Then, meta-analyses were performed.
All of processes of this study were conducted at Tianjin University of Traditional Chinese Medicine and School of Nursing at Tianjin Medical University.
The research team divided the selected RCTs into 2 groups based on the type of PD that the participants had: (1) the undifferentiated type group (UTG) and (2) the cold-damp stagnation type group (CDSTG).
The research team measured total effective rate, symptom score, and variation of peripheral blood prostaglandin F2α (PGF2α).
A total of 20 RCTs, involving 2134 participants, were included in the current study. Results of the metaanalysis showed that (1) the total efficacy for the 2 studied interventions was better, with a statistically significant difference from that of the control methods: degrees of freedom (df) = 14, relative risk (RR) = 1.19, 95% confidence interval (95% CI) = (1.14 – 1.24), P < .000 for the UTG, and df = 4, RR = 1.15, 95% CI (1.02 – 1.29), P = .03 for the CDSTG; (2) the studied interventions were better than the control methods, with statistically significant differences, in relieving the severity of symptoms of PD: df = 3, mean difference (MD) = 3.20, 95% CI (2.36 – 4.04), P < .000 for the UTG and df = 1, MD = 2.09, 95% CI (0.16 – 4.02), P = .03 for the CDSTG; and (3) no statistical difference existed between the intervention and control methods groups in the reduction of the level of peripheral blood PGF2α: df = 2, standardized mean difference (SMD) = 0.13, 95% CI (-0.13 – 0.39), P = .32.
Moxibustion and acupoint therapy can relieve pain effectively for individuals with PD, and these treatments have advantages in overall efficiency. Because of limitations on the quantity and quality of the included studies and the lack of a large, multicenter study, the research team’s conclusion has yet to be substantiated.
Primary dysmenorrhea is a common gynecologic complain in women of reproductive age. Acupoint stimulation therapies might be an effective intervention for primary dysmenorrhea.
The aim of this study was to determine the effectiveness of acupoint stimulation for primary dysmenorrhea.
All searches in the Cochrane Library, MEDLINE, PubMed, CINAHL Plus with Full Text, and CEPS databases (inception to March 2011).
Randomized controlled trials (RCTs) included were comparing acupoint stimulation with non-acupoint-related stimulation or medication.
Data were abstracted independently by two authors onto standardized forms, and disagreements were resolved by discussion.
Thirty RCTs met the selection criteria, and 25 reported sufficient data for pooling. The main outcomes assessed were cure rate, total effective rate, pain intensity, menstrual pain, plasma PGF(2α)/PGE(2) ratio, and adverse events. According to the type of outcome, the strength of a relationship between two dichotomous variables was described by odds ratios and 95% confidence intervals, and continuous variables were expressed as mean±standard deviation. Fixed-effects models were used to perform meta-analysis.
Twenty-five RCTs with a total of over 3000 participants were included for the meta-analysis. Acupoint stimulation when compared with non-acupoint-related stimulation or medication had significant effects. Moderator analysis further confirmed that invasive and noninvasive acupoint stimulation was effective separately, with the latter being more effective. The most common adverse events were hemorrhage and hematoma.
Papers written in language other than English or Chinese were not included.
CONCLUSIONS AND IMPLICATION:
This finding indicates that acupoint stimulation, especially non-invasive acupoint stimulation, could have good short term effects on pain of primary dysmenorrhea. Inference in some studies was somewhat restricted due to low methodological rigor. We suggest well-designed, methodologically rigorous, large trial, evaluating both short and long-term effects on pain and other outcomes in comparison with the available standard treatments.
The effectiveness of acupuncture in primary dysmenorrhoea is not fully understood.
To assess the effectiveness of acupuncture for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs).
Nineteen electronic databases, including English, Korean, Japanese and Chinese databases, were systematically searched for RCTs investigating acupuncture for primary dysmenorrhoea up to July 2008 with no language restrictions.
All RCTs that evaluated the effects of acupuncture compared with controls were included. Studies that assessed the effect of moxibustion or body acupressure were excluded.
DATA COLLECTION AND ANALYSIS:
The study abstraction and quality assessment of all studies were undertaken following the detailed descriptions of these categories as described in the Cochrane Handbook for Systematic Reviews of Interventions.
Twenty-seven RCTs were systematically reviewed. Only nine of the 27 trials clearly described their methods of randomisation and none of the trials stated the methods of allocation concealment. Compared with pharmacological treatment or herbal medicine, acupuncture was associated with a significant reduction in pain. Three studies reported reduced pain within groups from baseline; however, two RCTs did not find a significant difference between acupuncture and sham acupuncture.
The review found promising evidence in the form of RCTs for the use of acupuncture in the treatment of primary dysmenorrhoea compared with pharmacological treatment or herbal medicine. However, the results were limited by methodological flaws. The evidence for the effectiveness of acupuncture for the treatment of primary dysmenorrhoea is not convincing compared with sham acupuncture. Further rigorous nonpenetrating placebo-controlled RCTs are warranted.
The aim of this study was to explore the acupuncture effect on the cross-sectional area (CSA) of the median nerve at the wrist in patients with carpal tunnel syndrome (CTS) and, additionally, to identify whether clinical, electrophysiological, and ultrasonographic changes show any association.
Forty-five limbs of 27 female patients were randomly divided into two groups (acupuncture and control). All patients used night wrist splint. The patients in the acupuncture group received additional acupuncture therapy. Visual analog scale (VAS), Duruöz Hand Index (DHI), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, electrophysiologic measurements, and median nerve CSAs were noted before and after the treatment in both groups.
VAS, DHI, Quick DASH scores, and electrophysiological measurements were improved in both groups. The median nerve CSA significantly decreased in the acupuncture group, whereas there was no change in the control group.
After acupuncture therapy, the patients with CTS might have both clinical and morphological improvement.
This study compared the efficacies of acupuncture and anti-inflammatory treatment in patients with carpal tunnel syndrome (CTS). Fifty patients with mild to moderate CTS were randomly divided into two groups. Both groups received night wrist splints as the standard conservative treatment for 1 month. The acupuncture group also received eight sessions of acupuncture therapy (twice a week for 4 weeks). The control group received 400 mg of ibuprofen three times a day for 10 days. The visual analog scale (VAS) score, the score on the Boston Carpal Tunnel Questionnaire for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT), and the electrodiagnostic findings were evaluated at baseline and 1 month after treatment. At the final follow up, significant improvements were found in both groups (p < 0.05). Statistically significant improvements were observed in the VAS score, the score on the global BCTQ FUNCT and SYMPT, and the electrodiagnostic findings, but not in the distal motor latency (DML), in the acupuncture group (p < 0.05). Our findings indicate that acupuncture affected the score on the global BCTQ FUNCT and SYMPT, the VAS score, and the electrodiagnostic findings, except the DML, more than ibuprofen did and that acupuncture might be an effective treatment for CTS.
Carpal tunnel syndrome (CTS) is the most preva lent form of peripheral neuropathy. The efficacy of acupuncture in management of mild to moderate CTS has been investigated in limited studies with controversial results. The aim of this study was to assess the short-term effects of acupuncture in treatment of mild to moderate carpal tunnel syndrome.
In a randomized controlled trial study, participants were randomly assigned to either control group which night splinting, vitamin B1, B6 and sham acupuncture for four weeks were administered, or intervention group that underwent acupuncture in 8 sessions over 4 weeks and night splinting. The clinical symptoms using global symptom score (GSS) and electrophysiological parameters were assessed at baseline and four weeks after the intervention.
Of 72 patients met the inclusion criteria, 64 patients actually completed the 4 week intervention and were evaluated for the outcome. There was a statistically significant difference in GSS between two arms of treatment after the intervention (p < 0.001) Using repeated measure ANOVA, the GSS in acupuncture group was significantly different after 4 weeks (p <0.001). Among electrophysiological parameters, nerve conduction velocity (NCV) was significantly different between two groups after 4 weeks (p = 0.02). Other parameters showed no statistically significant difference after intervention (p > 0.05).
Our findings indicated that the acupuncture can improve the overall subjective symptoms of carpal tunnel syndrome and could be adopted in comprehensive care programs of these patients.
To investigate the efficacy of acupuncture compared with steroid treatment in patients with mild-to-moderate carpal tunnel syndrome (CTS) as measured by objective changes in nerve conduction studies (NCS) and subjective symptoms assessment in a randomized, controlled study.
A total of 77 consecutive and prospective CTS patients confirmed by NCS were enrolled in the study. Those who had fixed sensory complaint over the median nerve and thenar muscle atrophy were excluded. The CTS patients were randomly divided into 2 treatment arms: (1) 2 weeks of prednisolone 20 mg daily followed by 2 weeks of prednisolone 10 mg daily (n = 39), and (2) acupunctureadministered in 8 sessions over 4 weeks (n = 38). A validated standard questionnaire as a subjective measurement was used to rate the 5 major symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (very severe). The total score in each of the 5 categories was termed the global symptom score (GSS). Patients completed standard questionnaires at baseline and 2 and 4 weeks later. The changes in GSS were analyzed to evaluate the statistical significance. NCS were performed at baseline and repeated at the end of the study to assess improvement. All main analyses used intent-to-treat.
A total of 77 patients who fulfilled the criteria for mild-to-moderate CTS were recruited in the study. There were 38 in the acupuncture group and 39 in the steroid group. The evaluation of GSS showed that there was a high percentage of improvement in both groups at weeks 2 and 4 (P < 0.01), though statistical significance was not demonstrated between the 2 groups (P = 0.15). Of the 5 main symptoms scores (pain, numbness, paresthesia, weakness/clumsiness, nocturnal awakening), only 1, nocturnal awakening, showed a significant decrease in acupuncture compared with the steroid group at week 4 (P = 0.03). Patients with acupuncture treatment had a significant decrease in distal motor latency compared with the steroid group at week 4 (P = 0.012). Acupuncture was well tolerated with minimal adverse effects.
Short-term acupuncture treatment is as effective as short-term low-dose prednisolone for mild-to-moderate CTS. For those who do have an intolerance or contraindication for oral steroid or for those who do not opt for early surgery, acupuncture treatment provides an alternative choice.
To explore the effects of contralateral manual acupuncture (MA) on patients with chronic shoulder pain.
Eighty patients with chronic shoulder pain were randomly allocated to receive contralateral MA (n=38) for 4 weeks or to remain on a waiting list while receiving conventional orthopaedic therapy (n=42). Visual analogue scale (VAS) scores were taken as the primary outcome measure and used for a priori power calculation. Secondary outcome measures for the assessment of shoulder mobility and quality of life included the Jobe test, the Constant-Murley (CM) score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the 36 item Short Form Health Survey (SF-36).
Intention-to-treat (ITT) analysis demonstrated significant pain relief with contralateral acupuncture, with mean differences in VAS scores compared to the waiting list group of -19.4 (-28.0 to -10.8) at 2 weeks, -40.4 (-49.0 to -31.8) at 4 weeks, -41.1 (-49.7 to -32.5) at 8 weeks, and -40.9 (-49.5 to -32.3) at 16 weeks. CM and DASH scores were also improved at all time points (p<0.01). Shoulder mobility, physical functioning, social functioning and mental health components of the SF-36 were also improved by contralateral acupuncture at 8 weeks. No significant adverse effects were observed.
These results demonstrate beneficial effects of contralateral acupuncture in the treatment of chronic shoulder pain, both in terms of pain and function. Future research is required to compare directly the effects of local and contralateral acupuncture and to quantify the specific and non-specific effects.
There is evidence for the efficacy of acupuncture treatment for chronic shoulder pain, but it remains unclear which acupuncture modes are most effective. We compared the effect of trigger point acupuncture (TrP), with that of sham (SH) acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. The participants were 18 patients (15 women, 3 men; aged 42-65 years) with nonradiating shoulder pain for at least 6 months and normal neurological findings. The participants were randomized into two groups, each receiving five treatment sessions. The TrP group received treatment at trigger points for the muscle, while the other group received SH acupuncture treatment on the same muscle. Outcome measures were pain intensity (visual analogue scale, VAS) and shoulder function (Constant-Murley Score: CMS). After treatment, pain intensity between pretreatment and 5 weeks after TrP decreased significantly (p<0.001). Shoulder function also increased significantly between pretreatment and 5 weeks after TrP (p<0.001). A comparison using the area under the outcome curves demonstrated a significant difference between groups (p=0.024). Compared with SH acupuncture therapy, TrP therapy appears more effective for chronic shoulder pain.
The German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) comprised 424 outpatients with chronic shoulder pain (CSP) > or =6 weeks and an average pain score of VAS > or =50 mm, who were randomly assigned to receive Chinese acupuncture (verum), sham acupuncture (sham) or conventional conservative orthopaedic treatment (COT). The patients were blinded to the type of acupuncture and treated by 31 office-based orthopaedists trained in acupuncture; all received 15 treatments over 6 weeks. The 50% responder rate for painwas measured on a VAS 3 months after the end of treatment (primary endpoint) and directly after the end of the treatment (secondary endpoint).
In the ITT (n=424) analysis, percentages of responders for the primary endpoint were verum 65% (95% CI 56-74%) (n=100), sham 24% (95% CI 9-39%) (n=32), and COT 37% (95% CI 24-50%) (n=50); secondary endpoint: verum 68% (95% CI 58-77%) (n=92), sham 40% (95% CI 27-53%) (n=53), and COT 28% (95% CI 14-42%) (n=38). The results are significant for verum over sham and verum over COT (p<0.01) for both the primary and secondary endpoints. The PPP analysis of the primary (n=308) and secondary endpoints (n=360) yields similar responder results for verum over sham and verum over COT (p<0.01). Descriptive statistics showed greater improvement of shoulder mobility (abduction and arm-above-head test) for the verum group versus the control group immediately after treatment and after 3 months. The trial indicates that Chinese acupuncture is an effective alternative to conventional orthopaedic treatment for CSP.
The objective of the study is to compare the efficacy of electro-acupuncture with placebo-acupuncture for the treatment of shoulder pain. This study comprised of a prospective, randomized, placebo controlled trial, with independent evaluator set in a Public primary care clinic in Spain. The participants are patients aged from 25 to 83 years with shoulder pain. Patients were randomly allocated to two treatments over eight weeks, with electro-acupuncture or skin non-penetrating placebo-acupuncture, both able to take diclofenac if needed for intense pain. Primary outcome measure was the difference between groups in pain intensity (visual analogue scale-VAS). Secondary outcomes were differences between groups in pain intensity measured by Lattinen index, in range of motion (goniometer), functional ability (SPADI), quality of life (COOP-WONCA charts), NSAIDS intake, credibility (Borkoveck and Nau scale) and global satisfaction (10 points analogue scale). Assessments were performed before, during and three and six months after treatment. At six month follow-up after treatment the acupuncture group showed a significantly greater improvement in pain intensity compared with the control group [VAS mean difference 2.0 (95% CI 1.2-2.9)]. The acupuncture group had consistently better results in every secondary outcome measure than the control group. Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissues lesions) in a primary care setting.
To observe the increasing effect of Yanglingquan (GB 34) on sprain of external ankle joint.
Seventy-nine cases of sprain of external ankle joint were semi-randomly divided into a treatment group (n = 46) and a control group (n = 33). The treatment group were treated with acupuncture at Yanglingquan (GB 34) and electro-magnetic therapy at local acupoints, and the control group with electro-magnetic therapy.
The cured rate and the total effective rate were 67.4% and 91.3% in the treatment group, and 36.4% and 69.7% in the control group, respectively, with a significant difference between the two groups (P<0.01, P<0.05).
Acupuncture at Yanglingquan (GB 34) has a better therapeutic effect on sprain of the external ankle joint.
Acupunct Med. 2016 Jun;34(3):164-70. doi: 10.1136/acupmed-2015-010947. Epub 2016 Jan 21.