Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis.
This the authors of this meta-analysis find, after studying data received for a total of 20,827 patients from 39 trials, that: “Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects.”
J Pain. 2017 Dec 2. pii: S1526-5900(17)30780-0. doi: 10.1016/j.jpain.2017.11.005. [Epub ahead of print]
Vickers AJ1, Vertosick EA2, Lewith G3, MacPherson H4, Foster NE5, Sherman KJ6, Irnich D7, Witt CM8, Linde K9; Acupuncture Trialists’ Collaboration.
URL for abstract of the foregoing paper: https://www.ncbi.nlm.nih.gov/pubmed/29198932 (accessed 1/3/18)
Acupuncture for pain divided into conditions for which there is strong evidence and conditions for which there is moderate evidence that acupuncture is effective in stopping or reducing pain:
The Acupuncture Evidence Project found strong evidence (reviews with consistent statistically significant positive effects and where authors have recommended the intervention. The quality of evidence is rated as moderate or high quality to support the efficacy of acupuncture in the following pain-related conditions:
High-quality evidence that acupucnture helps the pain from:
- Chronic low back pain,
- headache (tension and chronic),
- knee osteoarthritis,
- migraine prophylaxis
- post-operative pain.
The same project found moderate evidence (reviews reporting all individual randomised controlled trials (RCTs) or pooled effects across RCTs as positive, but the reviewers deeming the evidence insufficient to draw firm conclusions. The quality of evidence is rated as moderate or high quality to support the efficacy of acupuncture in the following pain-related conditions:
Moderate or high-quality evidence that acupuncture helps the pain from:
- Acute low back pain
- back or pelvic pain during pregnancy
- cancer pain
- labour pain
- lateral elbow pain
- neck pain
- plantar heel pain
- post-stroke shoulder pain
- prostatitis pain
- chronic pelvic pain syndrome
- shoulder impingement syndrome (early stage, with exercise)
- shoulder pain
- temporomandibular pain
McDonald J, Janz S. The Acupuncture Evidence Project: A Comparative Literature Review (Revised edition). Brisbane: Australian Acupuncture and Chinese Medicine Association Ltd; 2017. http://www.acupuncture.org.au.
Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis.
“Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.”
PLoS One. 2017 Oct 27;12(10):e0186616. doi: 10.1371/journal.pone.0186616. eCollection 2017.
Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S.
BACKGROUND: Endometriosis is a multifactorial, oestrogen-dependent, inflammatory, gynaecological condition that can result in long-lasting visceral pelvic pain and infertility. Acupuncture could be an effective treatment for endometriosis and may relieve pain. Our aim in the present study was to determine the effectiveness of acupuncture as a treatment for endometriosis-related pain.
METHODS: In December 2016, six databases were searched for randomised controlled trials that determined the effectiveness of acupuncture in the treatment of endometriosis-related pain. Ultimately, 10 studies involving 589 patients were included. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. All analyses were performed using comprehensive meta-analysis statistical software.
RESULTS: Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level-measured on a 0-10-point scale) between the acupuncture and control groups was 1.36 (95% confidence intervals [CI] = 1.01-1.72, P<0.0001). Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups (MD = 5.9, 95% CI = 1.56-10.25, P = 0.008). Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups (odds ratio = 2.07; 95% CI = 1.24-3.44, P = 0.005).
Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.
Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand
“Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting.”
(also saved as pdf in website materials)
Elizabeth Soliday, Debra Betts
DOI: https://doi.org/10.1016/j.jams.2017.11.005 |
- Observational studies of acupuncture outcomes and descriptions of specific acupuncture approaches for treating pregnancy conditions are needed to strengthen the existing evidence base to guide professionals who use acupuncture in their practice.
- Our observational study results from women’s reports after acupuncture treatment for lumbopelvic pain in pregnancy indicated clinically meaningful pain reduction following treatment.
- Treatment was based on published guidelines for acupuncture in pregnancy and was effective despite excluding so-called “forbidden points” that have been used in clinical trials.
Introduction: Clinic-based acupuncturists, midwives, and physiotherapists have reported using acupuncture to treat lumbopelvic pain in pregnancy, a common condition that may affect functioning and quality of life. To contribute to the emerging evidence on treatment outcomes, we collected patient-reported pain reduction data from women treated during pregnancy in a no-pay, hospital-based acupuncture service in New Zealand.
Methods: Observational study of patient-reported symptom reduction.The main outcome measure was the MYMOP (Measure Your Medical Outcome Profile), a brief, validated self-report instrument. Open-ended questions on treatment experiences and adverse events were included.
Results: Of the 81 women on whom we had complete treatment data, the majority (N = 72, 89%) reported clinically meaningful symptom reduction. Patient-reported adverse events were infrequent and mild.
Discussion: Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting. We discuss this study’s unique contributions in providing guidance for clinicians who practice acupuncture in pregnancy, including midwives, physiotherapists, and physicians.
Acupuncture for the prevention of tension-type headache
“The available results suggest that acupuncture is effective for treating frequent episodic or chronic tension-type headaches …”
Authors: Klaus Linde, Gianni Allais, Benno Brinkhaus, Yutong Fei, Michael Mehring, Byung-Cheul Shin, Andrew Vickers, Adrian R White
Editorial Group: Cochrane Pain, Palliative and Supportive Care Group
First published: 19 April 2016
Background: Acupuncture is often used for prevention of tension-type headache but its effectiveness is still controversial. This is an update of our Cochrane review originally published in Issue 1, 2009 of The Cochrane Library.
Objectives: 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 other interventions in reducing headache frequency in adults with episodic or chronic tension-type headache.
Search methods: We searched CENTRAL, MEDLINE, EMBASE and AMED to 19 January 2016. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform to 10 February 2016 for ongoing and unpublished trials.
Selection criteria: We included randomised trials with a post-randomisation observation period of at least eight weeks, which compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another prophylactic intervention in adults with episodic or chronic tension-type headache.
Data collection and analysis: Two review authors checked eligibility; extracted information on participants, interventions, methods and results; and assessed study risk of bias and the quality of the acupuncture intervention. The main efficacy outcome measure was response (at least 50% reduction of headache frequency) after completion of treatment (three to four months after randomisation). To assess safety/acceptability we extracted the number of participants dropping out due to adverse effects and the number of participants reporting adverse effects. We assessed the quality of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
Main results: Twelve trials (11 included in the previous version and one newly identified) with 2349 participants (median 56, range 10 to 1265) met the inclusion criteria.
Acupuncture was compared with routine care or treatment of acute headaches only in two large trials (1265 and 207 participants), but they had quite different baseline headache frequency and management in the control groups. Neither trial was blinded but trial quality was otherwise high (low risk of bias). While effect size estimates of the two trials differed considerably, the proportion of participants experiencing at least 50% reduction of headache frequency was much higher in groups receiving acupuncture than in control groups (moderate quality evidence; trial 1: 302/629 (48%) versus 121/636 (19%); risk ratio (RR) 2.5; 95% confidence interval (CI) 2.1 to 3.0; trial 2: 60/132 (45%) versus 3/75 (4%); RR 11; 95% CI 3.7 to 35). Long-term effects (beyond four months) were not investigated.
Acupuncture was compared with sham acupuncture in seven trials of moderate to high quality (low risk of bias); five large studies provided data for one or more meta-analyses. Among participants receiving acupuncture, 205 of 391 (51%) had at least 50% reduction of headache frequency compared to 133 of 312 (43%) in the sham group after treatment (RR 1.3; 95% CI 1.09 to 1.5; four trials; moderate quality evidence). Results six months after randomisation were similar. Withdrawals were low: 1 of 420 participants receiving acupuncture dropped out due to adverse effects and 0 of 343 receiving sham (six trials; low quality evidence). Three trials reported the number of participants reporting adverse effects: 29 of 174 (17%) with acupuncture versus 12 of 103 with sham (12%; odds ratio (OR) 1.3; 95% CI 0.60 to 2.7; low quality evidence).
Acupuncture was compared with physiotherapy, massage or exercise in four trials of low to moderate quality (high risk of bias); study findings were inadequately reported. No trial found a significant superiority of acupuncture and for some outcomes the results slightly favoured the comparison therapy. None of these trials reported the number of participants dropping out due to adverse effects or the number of participants reporting adverse effects.
Overall, the quality of the evidence assessed using GRADE was moderate or low, downgraded mainly due to a lack of blinding and variable effect sizes.
The available results suggest that acupuncture is effective for treating frequent episodic or chronic tension-type headaches, but further trials – particularly comparing acupuncture with other treatment options – are needed.
Acupuncture relieves TMD pain
Acupuncture appears to relieve myofascial pain in temporomandibular disorder (TMD) report the Portuguese authors of a systematic review. A total of four randomised trials using acupuncture for TMD treatment were included. Results for acupuncture were observed to be similar to those for treatment with occlusal splints and significantly superior to those for placebo acupuncture.
Acupuncture in Temporomandibular Disorder Myofascial Pain Treatment: A Systematic Review. J Oral Facial Pain Headache. 2017 Summer;31(3):225-232.
Electro-Acupuncture is Beneficial for Knee Osteoarthritis: The Evidence from Meta-Analysis of Randomized Controlled Trials.
“Meta-analysis indicated that EA was more effective than pharmacological treatment and manual acupuncture, with 91.4 per cent of patients seeing significant benefits from EA in comparison with 79 per cent from pharmacological treatments and 82.7 per cent from manual acupuncture. EA also demonstrated significant advantages in reducing pain intensity and improving physical function.”
Am J Chin Med. 2017;45(5):965-985.
Electro-acupuncture can significantly alleviate pain and improve physical function in knee osteoarthritis (KOA) patients, with a low risk of adverse reactions. Chinese authors compiled evidence from 11 randomised controlled trials with 695 participants in their systematic review. Meta-analysis indicated that EA was more effective than pharmacological treatment and manual acupuncture, with 91.4 per cent of patients seeing significant benefits from EA in comparison with 79 per cent from pharmacological treatments and 82.7 per cent from manual acupuncture. EA also demonstrated significant advantages in reducing pain intensity and improving physical function, with no serious adverse events reported in any of the EA groups (the percentage of adverse events reported for other treatments was between 3.3 and 13.3 per cent). The main acupuncture points used were Xiyan MN-LE-16, Xuehai SP-10, Liangqiu ST-34 and Zusanli ST-36. In addition, the results implied that EA should be performed for at least four weeks, for 20–30 minutes per session.
Acupuncture has long-lasting effects on period pain
Investigators from Australia and New Zealand report that acupuncture treatment can reduce menstrual pain intensity, and that its effects can still be felt one year later. A randomised controlled trial was performed with 74 women randomly assigned to one of four treatment arms: low frequency manual acupuncture (LF-MA), high frequency manual acupuncture (HF-MA), low frequency electro-acupuncture (LF-EA) and high frequency electro-acupuncture (HF-EA). A clinical manual-based protocol was used to allow individualised treatment, with a maximum of seven points used per treatment and a total of 12 treatments performed over three menstrual cycles, either once per week (LF groups) or three times per week (HF groups), in the week prior to menstruation. All groups also received a treatment in the first 48 hours of their period. Acupuncture was found to reduce menstrual pain intensity and duration after three months of treatment, and this was sustained for up to one year after the start of the research. The mode of stimulation or frequency of treatment was not found to be significant, although the authors suggest that this may be due to a lack of statistical power. During the treatment period and nine month follow-up all groups showed statistically significant reductions in peak and average menstrual pain compared to baseline, but there were no differences between groups. Health-related quality of life increased significantly in six domains in groups with a high frequency of treatment compared to only two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups. HF-MA was most effective in reducing secondary menstrual symptoms compared to both-EA groups.
The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial. PLoS One. 2017 Jul 12;12(7):e0180177.
Moxibustion as effective as drugs for period pain
A Chinese study suggests that moxibustion may be as effective as drugs for alleviating menstrual pain. In a pragmatic randomised trial, 152 participants received either moxibustion or ibuprofen over a three month period. Moxibustion was carried out at Guanyuan REN-4, Shenque REN-8 and Sanyinjiao SP-6, once a day for seven days leading up to the beginning of the period for three menstrual cycles. The results showed that menstrual pain intensity in both the experimental and control groups was significantly reduced after treatment. Pain reduction was not significantly different between the two groups. Three months after the end of treatment, the effectiveness of moxibustion was sustained and superior to the effect of the drug. Serum levels of pain mediators, including prostaglandins, were found to have significantly improved after treatment in both groups.
Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial. PLoS One. 2017 Feb 7;12(2):e0170952.
Acupuncture may help with vulvodynia
A small study carried out by investigators in the USA has found that acupuncture appears to reduce pain and dyspareunia, while increasing sexual function, for women with vulvodynia (a chronic pain syndrome affecting the vulvar area without an identifiable cause). Thirty-six women with vulvodynia were randomly assigned either to an acupuncture group or a wait-list control group. Subjects assigned to the acupuncture group received acupuncture twice a week for five weeks. Reports of vulvar pain and dyspareunia were significantly reduced, while changes in scores on the Female Sexual Function Index suggested significant improvement in sexual function, in those receiving acupuncture compared with those who did not. However, acupuncture did not significantly increase sexual desire, sexual arousal, lubrication, ability to orgasm or sexual satisfaction in women with vulvodynia.
Acupuncture for the treatment of vulvodynia: a randomized wait-list controlled pilot study. J Sex Med. 2015 Apr;12(4):1019-27.