Acupuncture for pain relief in patients with rheumatoid arthritis: A systematic review

Tufts University, Бостон, Georgia, United States
Arthritis & Rheumatology (Impact Factor: 7.76). 09/2008; 59(9):1249-56. DOI: 10.1002/art.24009
Source: PubMed


To systematically review the efficacy of acupuncture on pain relief in patients with rheumatoid arthritis (RA).
We performed a comprehensive search of 12 western and Chinese databases and reference lists through March 2008. We included randomized controlled trials with pain as an end point, measured by tender joint count (TJC) or a pain scale. We also reviewed the effect of acupuncture on morning stiffness, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level. Study quality was assessed by Jadad score. Differences between treatment groups were pooled as mean or median change (P value).
Eight studies met eligibility criteria with a total of 536 subjects. There were 4 placebo-controlled trials and 4 active-controlled trials. Average study duration was 11 weeks. Mean +/- SD acupuncture points and sessions were 11 +/- 8 and 42 +/- 62, respectively. Average duration of needle insertion was 24 minutes. Six studies reported a decrease in pain for acupuncture versus controls; the mean or median changes of acupuncture-decreased TJC pain ranged from 1.5 to 6.5. In addition, 4 studies reported a significant reduction in morning stiffness (mean change -29 minutes), but the difference was nonsignificant versus controls. With regard to inflammatory markers, 5 studies observed a reduction in ESR (mean change -3.9 mm/hour) and 3 observed a CRP level reduction (mean change -2.9 mg/dl); only 1 study showed a significant difference for both ESR and CRP.
Despite some favorable results in active-controlled trials, conflicting evidence exists in placebo-controlled trials concerning the efficacy of acupuncture for RA. Rigorous and well-controlled randomized trials are warranted.

Download full-text


Available from: Paola de Pablo, Jul 03, 2014
  • Source
    • "Twenty-five reviews [67-91], involving 162 RCT and controlled clinical trials (CCT) and one review of reviews with 12,675 patients total, assessed acupuncture efficacy in treating a range of chronic pain conditions (as defined in Table 1) including low back pain, neck pain, osteoarthritis, knee pain, temporomandibular disorders, carpel tunnel syndrome, rheumatoid arthritis, and trigeminal neuralgia. The majority of the results reported were either inconclusive/mixed [72-74,76-80,88-91] or positive [67-71,75,85-87] with only four reviews [81-84] reporting negative acupuncture effectiveness. We characterize acupuncture as ‘promising for pain but with no conclusions able to be drawn’ at this point because, although all the reviews were high quality, most of the reviews reported mixed results. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Co-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology. Methods PubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed. Results Of the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety. Conclusions Based on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components.
    Full-text · Article · Oct 2012 · Systematic Reviews
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The conventional reinforcement learning approaches have difficulties in handling the policy alternation of the opponents because it may cause dynamic changes of state transition probabilities of which stability is necessary for the learning to converge. A multiple learning module approach would provide one solution for this problem. If we can assign multiple learning modules to different situations in which each of the module can regard the state transition probabilities as consistent, then the system would provide reasonable performance. This paper presents a method of multi-module reinforcement learning in a multi-agent environment, by which the learning agent can adapt its behaviors to the situations as results of the other agent's behaviors. We show a preliminary result of a simple soccer situation.
    Preview · Conference Paper · Feb 2002
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A precision guidance law is presented for three dimensional intercepts against a moving target. We consider a measurement model representative of an optical sensor and optical flow calculations, the use of optical flow for guidance and navigation having been inspired by recent research into insect navigation. The guidance law is based on a circular navigation guidance, extended to three dimensions and adapted to this measurement model.
    Full-text · Conference Paper · Jan 2004
Show more