Acupuncture Pain Management Research

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/)

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 26^th and 52^nd 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.

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.