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: The aim of this systematic review was to determine the effectiveness of acupuncture for the treatment of whiplash associated disorder (WAD). Twenty databases were searched from their inceptions to Oct. 2013. Randomised clinical trials (RCTs) of acupuncture (AT), electroacupuncture (EA), or dry needling (DN) for the treatment of WAD were considered eligible. The risk of bias was assessed using the Cochrane tool. Six RCTs met the inclusion criteria. Most of the included RCTs have serious methodological flaws. Four of the RCTs showed effectiveness of AT, AT in addition to usual care (UC), AT in addition to herbal medicine (HM) or EA was more effective than relaxation, sham EA, sham EA in addition to HM or UC for conditioned pain modulation (CPM) and alleviating pain. In one RCT, DN in addition to physiotherapy (PT) had no effect compared to sham-DN in addition to PT for the reduction of pain. None of the RCTs showed that AT/EA/DN was more effective than various types of control groups in reducing disability/function. One RCT did not report between-group comparisons of any outcome measures. The evidence for the effectiveness of AT/EA/DN for the treatment of WAD is limited. Therefore, more research in this area is warranted.Evidence-based Complementary and Alternative Medicine 01/2014; 2014:870271. · 1.72 Impact Factor
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ABSTRACT: Background Therapeutic evidence of effectiveness for acupuncture is largely confined to pain, but is compromised by poor study quality, limited methodologies and selective reporting. Objectives To assess how the evidence of effectiveness for acupuncture for pain has developed over time, and to inform future research decisions. Methods PubMed was searched for meta-analyses and systematic reviews of acupuncture for pain. No time limits were imposed. ResultsTwenty-two meta-analyses and systematic reviews of acupuncture for pain were identified. There was one report of positive evidence for acupuncture vs. placebo from 1990–2004, and six from 2005–2012. An apparent clustering of positive evidence in recent years could be explained by the emergence of better trial methodologies, although a placebo effect still cannot be dismissed. Treatment effects appear to be small. Conclusions As recent studies show small effect sizes, acupuncture may have a specific but clinically unimportant effect; alternatively, the small benefits seen may have resulted from a residual placebo effect. A better understanding of the effect of acupuncture may be achieved through deeper analysis of existing studies, rather than the conduct of new randomised controlled trials.Focus on Alternative and Complementary Therapies. 06/2013; 18(2).
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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. · 2.09 Impact Factor