Randomized Controlled Trials of Acupuncture for Neck Pain: Systematic Review and Meta-Analysis
ABSTRACT The objectives of this study were to assess the effectiveness and efficacy of acupuncture in the treatment of neck pain.
The following computerized databases were searched from their inception to January 2008: MEDLINE (PubMed), ALT HEALTH WATCH (EBSCO), CINAHL, and Cochrane Central.
Systematic review and meta-analysis were conducted on randomized controlled trials of acupuncture for neck pain. Two (2) reviewers independently extracted data concerning study characteristics, methods, and outcomes, as well as performed quality assessment based on the adapted criteria of Jadad.
Fourteen (14) studies were included in this review. Meta-analysis was performed only in the absence of statistically significant heterogeneity among studies that were selected for testing a specific clinical hypothesis. While only a single meta-analysis was done in previous reviews, this review performed nine meta-analyses addressing different clinical issues. Seven out of nine meta-analyses yielded positive results. In particular, the meta-analysis based on the primary outcome of short-term pain reduction found that acupuncture was more effective than the control in the treatment of neck pain, with a pooled standardized mean difference (SMD) of -0.45 (95% confidence interval [CI], -0.69 to -0.22). Moreover, the meta-analysis with a pooled SMD of -0.53 (95% CI, -0.94 to -0.11) showed that acupuncture was significantly more effective than sham acupuncture for pain relief. However, there was limited evidence based on the qualitative analysis of the trial data to support the above conclusions. We provided a detailed analysis on the issue of heterogeneity of the studies involved in meta-analysis and examined the consistencies and inconsistencies among the present review and two other reviews conducted previously.
The quantitative meta-analysis conducted in this review confirmed the short-term effectiveness and efficacy of acupuncture in the treatment of neck pain. Further studies that address the long-term efficacy of acupuncture for neck pain are warranted.
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ABSTRACT: Chronic post-traumatic headache (PTH) is one of the most common complaints after mild traumatic brain injury, yet evidence to date is insufficient to direct conventional treatment of headaches with this etiology. Therefore, the current guidelines recommend a symptomatic approach for the three patterns of PTHs: migraine-like, tension-like, and mixed symptomatology. To improve response rates and minimize the potential for polypharmacy, adverse effects, and risk of dependency, effective nonpharmacologic options should be employed to support faster and safer patient rehabilitation. Current evidence shows that acupuncture is at least as effective as drug therapy for migraine prophylaxis and neurovascular and tension-type headaches. Because of its safety, cost-effectiveness, and long-lasting benefits, adjunctive acupuncture should be offered to patients with chronic PTHs and may be a valuable primary treatment alternative for those with contraindications to pharmacotherapy. Future head-to-head, adequately powered, well-controlled randomized clinical trials are needed to investigate acupuncture efficacy for PTHs. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.Military medicine 02/2015; 180(2):132-6. DOI:10.7205/MILMED-D-14-00195 · 0.77 Impact Factor
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ABSTRACT: Objectives This trial aimed to evaluate the short-term effectiveness of acupuncture plus stretching to reduce pain and improve range of motion in patients afflicted by cervical myofascial pain syndrome. Design Randomized, double-blind, placebo-controlled crossover study. Intervention Nineteen patients (11 females, 8 males, 33 ± 14 years) with myofascial neck pain in randomized order received the following treatments with one week washout between: acupuncture, acupuncture plus stretching, placebo laser acupuncture. Main outcome measures Mechanical pain threshold (MPT, measured with a pressure algometer) represented the primary outcome. Secondary outcomes were motion-related pain (Visual Analogue Scale, VAS) and cervical range of motion (ROM, recorded by means of an ultrasonic 3D movement analysis system). Outcomes were assessed immediately prior as well as 5, 15 and 30 minutes post treatment. Friedman tests with post hoc bonferroni-holm correction were applied to compare differences between treatments. Results Both acupuncture as well as acupuncture plus stretching increased MPT by 5 respectively 11 percent post treatment. However, only acupuncture in combination with stretching was superior to placebo (p < 0.05). There were no significant differences between interventions at 15 and 30 minutes post treatment. VAS did not differ between treatments at any measurement. Five minutes after application of acupuncture plus stretching, ROM was significantly increased in the frontal and the transversal plane compared to placebo (p < 0.05). Conclusions The combination of acupuncture and stretching could represent a suitable treatment option to improve cervical movement behavior and reduce trigger point pain in the short-term. However, additional studies further discriminating the placebo effects are still warranted.Complementary Therapies in Medicine 09/2014; 22(5):835-841. DOI:10.1016/j.ctim.2014.09.001 · 2.22 Impact Factor
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ABSTRACT: Neck pain (NP) and low back pain (LBP) are common symptoms bothering people in daily life. Traditional Chinese medicine (TCM) has been used to treat various symptoms and diseases in China and has been demonstrated to be effective. The objective of the present study was to review and analyze the existing data about pain and disability in TCM treatments for NP and LBP. Studies were identified by a comprehensive search of databases, such as MEDLINE, EMBASE, and Cochrane Library, up to September 1, 2013. A meta-analysis was performed to evaluate the efficacy and safety of TCM in managing NP and LBP. Seventy five randomized controlled trials (n = 11077) were included. Almost all of the studies investigated individuals experiencing chronic NP (CNP) or chronic LBP (CLBP). We found moderate evidence that acupuncture was more effective than sham-acupuncture in reducing pain immediately post-treatment for CNP (visual analogue scale (VAS) 10 cm, mean difference (MD) = -0.58 (-0.94, -0.22), 95% confidence interval, p = 0.01), CLBP (standardized mean difference = -0.47 (-0.77, -0.17), p = 0.003), and acute LBP (VAS 10 cm, MD = -0.99 (-1.24, -0.73), p< 0.001). Cupping could be more effective than waitlist in VAS (100 mm) (MD = -19.10 (-27.61, -10.58), p < 0. 001) for CNP or medications (e.g. NSAID) for CLBP (MD = -5.4 (-8.9, -0.19), p = 0.003). No serious or life-threatening adverse effects were found. Acupuncture, acupressure, and cupping could be efficacious in treating the pain and disability associated with CNP or CLBP in the immediate term. Gua sha, tai chi, qigong, and Chinese manipulation showed fair effects, but we were unable to draw any definite conclusions, and further research is still needed. The efficacy of tuina and moxibustion is unknown because no direct evidence was obtained. These TCM modalities are relatively safe.PLoS ONE 02/2015; 10(2):e0117146. DOI:10.1371/journal.pone.0117146 · 3.53 Impact Factor