ArticlePDF AvailableLiterature Review

The Immediate Analgesic Effect of Acupuncture for Pain: A Systematic Review and Meta-Analysis

Authors:

Abstract and Figures

Although acupuncture is gaining popularity for the treatment of nonspecific pain, the immediate analgesic effect of acupuncture has never been reviewed. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on disease-related pain to critically evaluate the immediate effect of acupuncture for pain relief. The PubMed and Cochrane Central Register of Controlled Trials databases as well as three Chinese databases including the China National Knowledge Infrastructure (CNKI), Wanfang, and VIP platforms were searched through November 2016. The outcome was the extent of pain relief from baseline within 30 min of the first acupuncture treatment. We evaluated all RCTs comparing acupuncture with other interventions for disease-related pain. Real acupuncture showed statistically significantly greater pain relief effect compared to sham acupuncture (SMD, −0.56; 95% confidence interval [CI], −1.00 to −0.12; 9 RCTs) and analgesic injection (SMD, −1.33; 95% CI, −1.94 to −0.72; 3 RCTs). No serious adverse events were documented. Acupuncture was associated with a greater immediate pain relief effect compared to sham acupuncture and analgesic injections. Further RCTs with stricter design and methodologies are warranted to evaluate the immediate pain relief effect of acupuncture for more disease-related pain.
This content is subject to copyright. Terms and conditions apply.
Review Article
The Immediate Analgesic Effect of Acupuncture for Pain:
A Systematic Review and Meta-Analysis
Anfeng Xiang, Ke Cheng, Xueyong Shen, Ping Xu, and Sheng Liu
Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Correspondence should be addressed to Sheng Liu; lskingcn@hotmail.com
Received 12 April 2017; Accepted 14 August 2017; Published 25 October 2017
Academic Editor: Shu-Ming Wang
Copyright ©  Anfeng Xiang et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Although acupuncture is gaining popularity for the treatment of nonspecic pain, the immediate analgesic eect of acupuncture
has never been reviewed. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on disease-
related pain to critically evaluate the immediate eect of acupuncture for pain relief. e PubMed and Cochrane Central Register
of Controlled Trials databases as well as three Chinese databases including the China National Knowledge Infrastructure (CNKI),
Wanfang, and VIP platforms were searched through November . e outcome was the extent of pain relief from baseline within
 min of the rst acupuncture treatment. We evaluated all RCTs comparing acupuncture with other interventions for disease-
related pain. Real acupuncture showed statistically signicantly greater pain relief eect compared to sham acupuncture (SMD,
.; % condence interval [CI], . to .;  RCTs) and analgesic injection (SMD, .; % CI, . to .;  RCTs).
No serious adverse events were documented. Acupuncture was associated with a greater immediate pain relief eect compared to
sham acupuncture and analgesic injections. Further RCTs with stricter design and methodologies are warranted to evaluate the
immediate pain relief eect of acupuncture for more disease-related pain.
1. Introduction
Pain is a major health problem with serious social and eco-
nomic consequences. e annual cost of pain management in
the USA in  was – billion, which was a conserva-
tive estimate because it excluded the cost of management of
pain aecting institutionalized individuals []. Conventional
medical treatments are only moderately eective, and they
oen cause adverse side eects. A majority of people suering
pain in the USA and Europe have reported inadequate pain
control,andone-thirdworryaboutaddictiontopainmedica-
tions [, ]. Pain conditions appear to have a greater negative
impact on the factors aecting the quality of life, such as work
performance,sleep,andmood,comparedwithotherhealth
problems [, ]. Given the increasing life expectancy and
the aging population, appropriate management of pain and
reduction of disability are likely to assume greater impor-
tance.
Acupuncture, which is a mainstay in the healthcare prac-
tices of traditional Chinese medicine, is commonly used
for the treatment of pain. ere is substantial evidence for
acupuncture being eective in the treatment of acute [–]
and chronic pain []. To date, over  systematic reviews have
been conducted to assess the role of acupuncture and related
therapies in the relief of pain. However, the results of these
systematic reviews are far from unanimous. e majority of
the reviews reported positive results for pain relief in low back
pain and osteoarthritis by acupuncture [–]. Two recent
systematic reviews [, ] examined the ecacy of acupunc-
ture in the relief of cancer-related pain, and both reported
positive results. e systematic review and meta-analysis by
Lu et al. suggested that acupuncture was useful in decreasing
postoperativepain[].However,theecacyofacupuncture
as a treatment of pain in other pain conditions such as neu-
ropathic pain [] or bromyalgia [] remains inconclusive.
Ernst et al. conducted a review of reviews [] and concluded
that acupuncture is not eective in reducing pain.
Various factors, such as acupuncture manipulation [,
], acupuncture sensation [], acupoint prescription [],
pathological status [], and types of pain [], can aect the
assessmentofthetherapeuticeectofacupuncture.edura-
tion of acupuncture stimulation and acupuncture paradigm
Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2017, Article ID 3837194, 13 pages
https://doi.org/10.1155/2017/3837194
Evidence-Based Complementary and Alternative Medicine
as well as the assessment of analgesic eect following acu-
puncture treatment in dierent clinical trials have been
varied, and these time-dependent factors might be a crucial
determinant in evaluating the analgesic eect of acupuncture.
e eects of acupuncture can be classied as either the
immediate eects (immediately aer the end of the rst treat-
ment) or the cumulative eects of multiple acupuncture treat-
ments [, ]. To date, most clinical trials and systematic
reviews have focused on the cumulative analgesic eects. In
fact, immediate analgesic eect could have clinical signi-
cance in determining the ultimate ecacy of acupuncture in
pain management because of the following factors. () Psy-
chological components such as conditioning and expectation
may play important roles in acupuncture-induced analgesia.
Patients who receive little benet or no immediate analgesic
eect following the rst treatment might expect to be less
likely to gain benet from the subsequent treatment. () For
many patients with acute postoperative pain and labor pain,
the reported analgesic eect of acupuncture usually reects
the immediate eect. () e results of some fMRI studies
have suggested that the immediate and cumulative acupunc-
ture-induced analgesic eect elicit dierent temporal neural
responses in a wide range of brain networks [, ], suggest-
ing there is specic underlying mechanisms for the immedi-
ate analgesic eect of acupuncture.
To date, there is no published systematic review or meta-
analysis of the immediate analgesic eect of acupuncture.
erefore, we conducted a systematic review and meta-anal-
ysis to evaluate the immediate eect of acupuncture for vari-
ous disease-related pain in order to summarize the available
evidence, evaluate the quality of that evidence, and oer
suggestions for future research and treatment. is PRISMA-
compliant (Table S; see Table S in the Supplementary Mate-
rial available online at https://doi.org/.//)
systematic review was conducted with the following aims:
() to compare the immediate analgesic eect and safety of
acupuncture in the treatment of disease-related pain with
those of sham acupuncture and other active treatments; ()
to identify specic factors associated with positive results; and
() to identify areas for future treatment and research.
2. Materials and Methods
2.1. Search Strategy. Inthepresentstudy,weappliedthe
review methods advocated by the updated Cochrane Hand-
book for Systematic Reviews of Interventions []. e pro-
tocol of this systematic review has been registered in PROS-
PERO (http://www.crd.york.ac.uk/PROSPERO/DisplayPDF
.php? ID=CRD). We searched through the fol-
lowing databases to retrieve records from the earliest publi-
cations to those published till November , : PubMed/
MEDLINE, the Cochrane Central Register of Controlled Tri-
als, and three Chinese databases including the China National
Knowledge Infrastructure (CNKI), Wanfang, and VIP plat-
forms. Acupuncture-related terms including acupuncture,
electroacupuncture, and needle and pain-related terms
including pain, ache, and analgesia were used as the key
search terms in the English databases. e following key
terms were used in the Chinese digital databases: zhenjiu,
zhenci, dianzhen, zhen, and tong (which translate into acu-
puncture, needle-acupuncture, electroacupuncture, needle,
and pain, resp.). Our search was restricted to trials pub-
lished in English and Chinese. e reference lists of all
of the retrieved trials and reviews were screened; relevant
conference proceedings and abstracts as well as on-going
and unpublished studies were also manually searched. Two
reviewers independently evaluated each of the reports for
eligibility. Disagreements were resolved by discussion.
2.2. Inclusion Criteria. Studies that met the following criteria
were included in the present review: () randomized con-
trolled clinical trials; () trials comparing acupuncture with
sham acupuncture, no treatment, or eective western medi-
cations (e.g., anesthetics or analgesics); () studies including
participants suering from nonspecic pain; that is, there
were no restrictions on the type, cause, or duration of pain;
and () studies measuring self-reported pain relief using
scales such as the visual analogue scale (VAS), numeric rating
scale (NRS), or verbal rating scale (VRS). e outcome for
this review was pain relief immediately following the rst
treatment (i.e., less than or equal to  min aer the end of
treatment) from the baseline level.
2.3. Exclusion Criteria. We exclude RCTs comparing dif-
ferent types of acupuncture among each other, or those
using transcutaneous electrical nerve stimulation (TENS) as
a treatment, or those of perioperative pain management, or
those using pressure/palpation pain as the unique outcome.
2.4. Data Collection and Analysis. Two authors (AX and KC)
independently extracted the study characteristics and out-
come data from the included studies. Disagreements between
the authors were resolved by discussion, and in case of
continued disagreement, a third reviewer (SL) was consulted.
Since the outcome for our review was the improvement in
pain immediately aer the end of the rst treatment, in case
of RCTs reporting the outcomes at multiple time points aer
treatment, we used the data at the time point closest to the end
of the treatment. In cases where only the nal and baseline
scores were available, we calculated the mean change of the
scorebysubtractingthemeannalvaluefromthemeanbase-
line value and computed the change-from-baseline standard
deviation using a correlation coecient []. In cases where
only the condence intervals (CIs) were available, we com-
puted the CIs for the mean values to calculate the standard
deviations []. In cases where the values were only available
in gures, we used a ruler to measure the value of the pain
outcomes. We combined the results of groups in which the
real acupuncture was adopted [] to create a single pairwise
comparison according to the Cochrane Handbook for Sys-
tematic Reviews of Interventions [].
2.5. Assessment of Risk of Bias in the Included Studies. For
each of the included studies, we assessed the risk of bias using
the Cochrane Collaborations risk of bias tool [], which
evaluates seven factors that might increase the risk of over-
or underestimating an intervention eect.
Evidence-Based Complementary and Alternative Medicine
In the assessment of the blinding of the participants and
assessors, we assigned sham-controlled trials a judgment of
“unclear” unless we were certain that the sham control was
convincing enough in fully blinding the participants to the
treatment being evaluated. We considered sham-controlled
trials as having a low risk of bias for blinding if the RCT either
(i) evaluated the credibility of the sham treatment and found
it to be indistinguishable from true acupuncture or (ii) used
a penetrating sham needle or a previously validated sham
needle (e.g., the Streitberger needle []). Two of the authors
(KC and AX) independently judged the risk of bias for each
domain. Any disagreement was resolved by discussion.
2.6. Assessment of Adequacy of Acupuncture. Tw o acupu n c-
turists (SL and XS) with a combined clinical experience of
nearly  years in treating the pain syndrome with acupunc-
ture, and who had previously worked on RCTs of acupunc-
ture, assessed the adequacy of the acupuncture administered
in the trials. Four aspects of each acupuncture intervention
were assessed for adequacy: the choice of acupuncture points,
needling technique, duration of treatment, and experience
oftheacupuncturist[].etotalnumberofsessionsand
treatment frequency were not taken into account in the
assessment since, according to the denition of the immedi-
ate eect described above, only the rst treatment mattered
in the present study. e likelihood of the sham intervention
having physiological activity was also assessed by means of
an open-ended question. e acupuncturist assessors were
provided with only those parts of the publications that
described the acupuncture and sham procedures so that their
assessments could remain uninuenced by the results of the
trials. To test the success of blinding of the assessors to the
study publication and results, we asked the assessors to guess
the identity of each study being assessed. e acupuncturists
assessed the adequacies independently and achieved consen-
sus by discussion.
2.7. Data Synthesis and Statistical Analysis. We o n l y p ool e d
the data from the trials that used similar controls (e.g., sham
acupuncture, no treatment, or drug injection treatment). For
thepooleddata,thesummaryteststatisticswerecalculated
with the RevMan soware, version . [], using the random
eects model to account for the expected heterogeneity. We
evaluated the heterogeneity using the 𝐼2statistic [], which
indicates the proportion of variability across the trials not
explained by chance alone []. e statistical heterogeneity
was assessed using the 𝐼2statistic; an 𝐼2statistic value
of % or more was considered as indicating substantial
heterogeneity. All continuous data reported for all of the
studies were represented in forest plots. We did not carry out
meta-analysis when there were less than two studies in a com-
parison according to the denition of meta-analysis [].
We analyzed the penetrating and nonpenetrating sham
acupuncture-controlled trials separately; however, in cases
where there were no large or signicant dierences in the
pooled eect between these two subgroups of trials, we
pooled the data of all such trials available.
Two of the authors (AX and KC) independently graded
the overall quality of the evidence for each outcome using
the Grading of Recommendations Assessment, Development
and Evaluation (GRADE) classication [].
2.8. Measures of Treatment Eect. e major outcomes of the
review were the standardized mean dierences (SMDs) in the
pain outcomes between acupuncture and each of the control
groups.WeusedtheSMDsastheprincipalmeasureofeect
size because although the RCTs had assessed the same out-
comes, they had performed the measurements using dierent
scales (e.g., VAS and NRS).
2.9. Subgroup Analysis. We p er f o r m ed th e s u b g roup anal y s i s
of two clinical characteristics that might inuence the imme-
diate analgesic eect of acupuncture on pain: () the type
of sham, penetrating or nonpenetrating; () the duration of
pain, acute ( months) or chronic (>months)[].Weper-
formed statistical tests for interaction only if each subgroup
includedmorethanonestudy.Wecalculatedthe𝑃values,
pooled estimates, and 𝐼2values of each of the two relevant
subgroups for the subgroup comparisons of both character-
istics.
2.10. Sensitivity Analysis. Considering that clinical pain
included in present study was induced by various diseases, we
also conducted the sensitivity analysis using the leave-one-
out approach. e study by Zhang et al. [] was excluded for
further meta-analysis.
3. Results
3.1. Search Results. Figure  outlines the procedure of search
and screening throughout the review. e initial electronic
database search identied  potential studies of interest.
Aer screening these citations by their titles and abstracts, we
considered  potentially eligible articles for inclusion and
retrieved the corresponding full articles. Of the  studies,
wereexcludedbecauseoftheuseofothertypesofacu-
puncture as controls, improper denition of the immediate
eect, inaccurate protocols, or the quasi-random method of
allocating patients to each group alternately, leaving  eligible
RCTs [–]. Tables  and  describe the trial characteristics
and the acupuncture and control interventions.
3.2. Characteristics of the Included Studies. We nally evalu-
atedatotalofstudiesincludingatotalof,participants
with a mean age of  years (range, – years). For all of
theeligibleRCTs,theparticipantswererequiredtohavebeen
diagnosed with disease-related pain for eligibility. Of the 
RCTs,  investigated LBP [, , , ], and the remaining
 investigated neck pain [], neck and shoulder pain [],
carpal tunnel syndrome (CTS) [], knee osteoarthritis [],
bromyalgia [], dysmenorrhea [], sore throat [], renal
colic [], and migraine []. e RCTs included in this
review used either the VAS or NRS to measure pain outcomes.
While  RCTs [, , , –] used acupoints based
on the traditional Chinese medicine theory of meridians
andcollaterals,[,,,]usedtenderpointsnear
the most painful areas, and  [] used points based on
Evidence-Based Complementary and Alternative Medicine
T : Characteristics of randomized controlled trials.
Study, year Country Disease 𝑁(M/F) Mean age
(year)
Acupuncture
(points; duration time) Control
Time point aer
treatment for
assessment
Pain
assessment
Chen and Li []
() China Renal colic  (/) . (.) EA (KI, GB, BL, RN,
tender points;  minutes)
Intramuscular
Fortanodyn injection  min VAS
Inoue et al. []
() Japan Low back pain  (/) . (.) MA (one most painful
point;  seconds) Nonpenetrating SA Immediately VAS
Inoue et al. []
() Japan Low back pain  (/) . (.) MA ( two to ve tender
points;seconds)
Local dibucaine
injection Immediately VAS
Liu et al. []
() China Dysmenorrhea  (/) . (.) EA (SP;  minutes) (1) EA at unrelated point
(2)EAatSP immediately VAS
Lu et al. []
() China Knee OA  (unclear) . (.) EA (GB, SP, SP, ST,
ST;  minutes) Sham EA at SPs Immediately VAS
Mejuto V´
azquez et al. []
() Spain Neck pain  (/) . (.) DN (MTrPs; –
seconds) No treatment  min NRS
Maeda et al. []
() USA CTS  (/) . (.) EA (PC, TW or SP, LI;
more than  minutes) Nonpenetrating SA Immediately VAS
Nabeta and Kawakita []
() Japan Neck and shoulder pain  (/) . (.) MA (two to twelve tender
points;  minutes) Nonpenetrating SA Immediately VAS
Shin et al. []
() Korea Low back pain  (/) . (.)
Motion style acupuncture
(DU, LR, LI; 
minutes)
Local diclofenac sodium
injection  min NRS
Stival et al. []
() Brazil Fibromyalgia  (/) . (.) MA (PC, HT, SP, LI,
LR, ST;  minutes) Penetrating at SPs Immediately VAS
Su et al. []
() China Low back pain  (/) . (.) MA (two ankle points; 
minutes) Nonpenetrating SA Immediately VAS
Yang e t a l . [ ]
() China Sore throat  (/) . (.)
MA (LI; removing the
needle aer eliciting the
sensation)
Penetrating at SP  min VAS
Zhang et al. []
() China Migraine  (/) . (.) EA (GB, SJ, GB, GB;
 minutes) Penetrating at SPs Immediately NRS
Notes.Mean (standard deviation); CTS: carpal tunnel syndrome; DN: dry needling; EA: electroacupuncture; F: female; M: male; MA: manual acupuncture; 𝑁: number; SA: sham acupuncture; SP: sham acupoint.
Evidence-Based Complementary and Alternative Medicine
T:Riskofbiassummary.
Study, year Sequence
generation
Allocation
concealment
Participants and assessor
blinding
Treatment provider
blinding
Incomplete outcome
data addressed
Free of selective
reporting others
Chen and Li []
() Low Unclear [b]High[c]High Low Low Low
Inoue et al. []
() Low Low Low High Low Low Low
Inoue et al. []
() Low Unclear[b]High[c]High Low Low Low
Liu et al. []
() Low Low Low High Low Low Low
Lu et al. []
() Unclear[a]Uncle ar[b]Low High Low Low Low
Mejuto-V´
azquez et al. []
() Low Low High[d]High Low Low Low
Maeda et al. []
() Unclear[a]Uncle ar[b]Unclear[e]High Low Low High[f]
Nabeta and Kawakita []
() Low Unclear[b]Low High Low Low Low
Shin et al. []
() Low Low High[c]High Low Low Low
Stival et al. []
() Low Uncle ar[b]Low High Low Low Low
Su et al. []
() Low Low Low High Low Low Low
Yang e t a l . [ ]
() Low Low Low High Low Low Low
Zhang et al. []
() Low Low Low High Low Low Low
[a]Lu et al.  and Maeda et al.  RCT claimed to have randomly assigned participants but did not describe the methods in detail; [b]Chen and Li , Inoue et al. , Maeda et al. , Lu et al. , Nabeta
and Kawakita , and Stival et al.  did not mention allocation concealment; [c]Chen and Li , Inoue et al. , and Shin et al.  compared acupuncture versus analgesia injection, and the participants,
who were also the outcome assessors, could not be blinded; [d]Mejuto-V´
azquez et al.  compared acupuncture versus no treatment, and the participants, who were also the outcome assessors, could not be
blinded; [e]Maeda et al.  RCT used nonpenetrating sham acupuncture as control but did not evaluate the credibility of the sham; [f]forMaedaetal.RCT,thebaselinewasnotcomparableinthetwogroups.
Evidence-Based Complementary and Alternative Medicine
921 English records identied
through PubMed and Cochrane
1679 Chinese records identied
through Chinese databases
2586 records aer removing
duplicates
2586 records screened
2484 records unrelated to
acupuncture and immediate
analgesia from reading the
abstracts were excluded
102 full-text articles
assessed for eligibility
13 studies eligible for inclusion
13 studies included in qualitative and
quantitative synthesis (meta-analysis)
102 full-text articles were excluded with
reasons:
Controlled with other types of
acupuncture, sham laser, acupressure
(n=75)
Evaluated multiple treatments (n=6)
Blood-letting therapy (n=2)
TENS (n=3)
Protocol (n=2)
Quasi-RCT (n=1)
F : Flow diagram showing the number of studies included and excluded from the systematic review.
another acupuncture theory (i.e., the wrist-ankle acupunc-
ture method). Electroacupuncture was administered in 
RCTs[,,,,]andmanualacupuncturein
RCTs [, , , –]. Of the  RCTs that had used sham
acupuncture as a control,  had used nonpenetrating sham
[, , , ] and  had used penetrating sham [, , ,
, ]. Of the  RCTs that had used analgesic injection as a
control,  [, ] had administered intramuscular analgesic
injections and  [] had administered a local anesthetic
injection. One of the included RCTs [] compared the eects
of acupuncture at distal and local points and sham acupunc-
ture; we, therefore, combined the results of the two real acu-
puncture groups to create a single pairwise comparison.
3.3. Acupuncture Adequacy. e acupoints and needling
techniques were judged as being adequate in all of the
includedtrials.Allofthetrialsincludedinthisreviewwere
judged to be adequate in terms of the treatment duration,
except for those by Maeda et al. [] and Yang et al. []. In
the RCT by Maeda et al., only the fMRI scan time ( min and
 s) was known []. In the trial by Yang et al., the needle had
been inserted and removed quickly []. Neither of the trials
had reported the exact treatment durations, while the rest of
thetrialsincludedinthisreviewhad.Whiletheacupunc-
turists in  of the trials [–, –] were judged as having
adequate experience, we were unclear about the experience of
the acupuncturists in the remaining  trials [, , ] owing
to that fact that there is no description of the experience of
acupuncturists in these studies. e assessors of acupuncture
adequacy in this review were successfully blinded to all
included publications and were unable to distinguish the
origins of the results included.
3.4. Risk of Bias in the Included Studies. Of the  trials
included in this review,  [–, –, , ] were assessed
as having a low risk of bias upon sequence generation, while
the risks of bias of the remaining  trials [, ] were
assessed as being unclear (Table , Figures S and S). e
RCTs by Lu et al. and Maeda et al. claimed to have randomly
assigned the participants but did not describe their methods
in detail [, ]. Nearly half (/) of the included trials did
notmentionallocationconcealment[,,,,,]
Evidence-Based Complementary and Alternative Medicine
Std. mean dierenceStd. mean dierence
1.1.2 Penetrating sham
Liu et al. 2014 (dysmenorrhea) −26.8 16.72 167 −22.4 17.85 167 13.5% −0.25 [−0.47, −0.04]
Lu et al. 2010 (knee osteoarthritis) −1.1 0.53 10 −0.565 0.4 10 8.4% −1.09 [−2.05, −0.14]
Stival et al. 2014 (bromyalgia) −4.36 3.23 21 −1.7 1.55 15 10.3% −0.97 [−1.68, −0.27]
Yang et al. 2012 (sore throat) −3.1 1.73 36 −1.35 1.74 38 11.9% −1.00 [−1.48, −0.51]
Zhang et al. 2015 (migraine) −1.84 0.63 55 −2.7 1.57 55 12.6% 0.71 [0.33, 1.10]
Subtotal (95% CI) 289 285 56.7% −0.46 [−1.11, 0.18]
Total (95% CI) 391 367 100.0% −0.56 [−1.00, −0.12]
−15
Study or subgroup
1.1.1 Nonpenetrating sham
Inoue et al. 2006 (low back pain) 9 15 9 16 9.8% −1.08 [−1.84, −0.32]
Maeda et al. 2013 (carpal tunnel syndrome) −1.2 1.82 40 −0.5 1.4 19 11.4% −0.41 [−0.96, 0.14]
Nabeta and Kawakita 2002 (neck and shoulder pain) −11 24.74 17 −7.3 26.02 17 10.5% −0.14 [−0.82, 0.53]
Su et al. 2010 (low back pain) −18.53 10.3 30 −6.7 9.3 30 11.4% −1.19 [−1.74, −0.64]
Subtotal (95% CI) 102 82 43.3% −0.70 [−1.21, −0.20]
−5
Verum acupuncture Sham acupuncture
Mean SD Total Mean SD Total We i gh t IV, random, 95% CIIV, random, 95% CI
Heteroge neity: 2= 0.16;2= 7.72,>@ = 3 (P = 0.05); I2=61%
Test for overall eect: Z = 2.74 (P = 0.006)
Heteroge neity: 2= 0.45;2= 40.09,>@ = 4 (P < 0.00001 ); I2= 90%
Test for overall eect: Z = 1.4 1 (P = 0.16)
Heteroge neity: 2= 0.36;2=54.99,>@ = 8 (P < 0.00001); I2=85%
Test for overall eect: Z = 2.5 0 (P = 0.01)
Test for subgroup dierences: 2= 0.34,>@ = 1 (P = 0.56), I2=0%
−1−2
Favors verum acupuncture
120
Favors sham acupuncture
F : Acupuncture versus sham acupuncture: pain. % CI, condence interval; Std., standardized.
and were, therefore, assessed as having unclear risk of bias
in this dimension. e remaining  trials were assessed as
having a low risk of bias on allocation concealment. In one
of the  sham-controlled trials [], we were not certain
whether the sham was distinguishable from true acupuncture
by the participants because this trial used nonpenetrating
sham acupuncture as a control, and the credibility of the sham
had not been mentioned or evaluated in previous literature.
e remaining  sham-controlled RCTs [, , , , –
] had either used penetrating sham acupuncture or eval-
uated/mentioned nonpenetrating sham acupuncture in their
study and were therefore assessed as having a low risk of bias
on participant/assessor blinding. All of the included trials
were regarded as having a low risk of incomplete outcome
data (attrition bias) and selective reporting (reporting bias)
becauseallofthepatientshadcompletedthersttreatment
session as well as the posttreatment assessment, and there had
been no withdrawals.
3.5. Eects of Interventions
3.5.1. Acupuncture versus Sham Acupuncture. Real acupunc-
ture showed a greater immediate pain relief eect compared
to sham acupuncture (SMD, .; % CI, . to .;
 RCTs, Figure ). ere was a substantial heterogeneity of
results in these trials (𝐼2=85%).eresultsoftheGRADE
analysis indicated that the overall quality of evidence for this
outcome was moderate as a consequence of uncertain risk
of selection bias because of the nonavailability of detailed
descriptions of sequence generation and allocation conceal-
ment ( RCTs) and unclear risk of performance bias because
of uncertain blinding ( RCT).
3.5.2. Acupuncture versus Analgesic Injection. e results of
the comparative ecacy studies revealed that acupuncture
was associated with statistically signicantly greater imme-
diate pain relief compared to analgesic injection with non-
steroidal anti-inammatory drugs (NSAIDs) or local anes-
thetic (SMD, .; % CI, . to .;RCTs;Figure).
ere was a substantial heterogeneity of results in these trials
(𝐼2=60%).eresultsoftheGRADEanalysisindicatedthat
the quality of evidence for this outcome was low as a con-
sequence of a high risk of performance and detection bias
because of inadequate data and the lack of blinding.
3.5.3. Acupuncture versus No Treatment. Acupuncture was
associated with statistically signicantly greater immediate
pain relief than no treatment (SMD, .; % CI, . to
.;  RCT). e results of the GRADE analysis indicated
that the quality of evidence for this outcome was low as a
consequence of a high risk of performance and detection bias
because of inadequate data and the lack of blinding.
3.6. Subgroup Analysis. ere was no statistically signicant
dierence in the eect estimates between the two substrata for
either of the clinical characteristics, that is, the type of sham
(𝑃 = 0.56,Figure)andthedurationofpain(𝑃 = 0.92,
Figure ). e results did show that true acupuncture was
statisticallysignicantlymoreeectivethannonpenetrating
sham acupuncture (SMD, .; % CI, . to .; 
RCTs; 𝐼2=61%); however, the pooled result was not sta-
tistically signicant when compared with that of penetrating
sham acupuncture (SMD, .; % CI, . to .;  RCTs;
𝐼2=90%). For the duration of pain, the results showed that
real acupuncture was statistically signicantly more eective
than sham acupuncture for chronic pain (SMD, .; %
CI, . to .;  RCTs; 𝐼2=50%);however,thepooled
result was not statistically signicant for acute pain (SMD,
.; % CI, . to .;  RCTs; 𝐼2=95%).
Evidence-Based Complementary and Alternative Medicine
Chen and Li 2012 (renal conic)
Inoue et al. 2009 (low back pain)
Shin et al. 2013 (low back pain)
1.82−3.43 −1.92
−43.1 27
−3.83 2.05
26
13 −15.3
29 −0.71
1.26
20.4
1.06
25 37.3%
13 27.3%
29 35.4%
Std. mean dierence
−0.95 [−1.53, −0.37]
−1.13 [−1.96, −0.29]
−1.89 [−2.51, −1.26]
Std. mean dierence
Total (95% CI) 68 67 100.0% −1.33 [−1.94, −0.72]
Study or subgroup Mean SD Total Mean SD Total Weight IV, random, 95% CI IV, random, 95% CI
Acupuncture Analgesic injection
Favors analgesic injection
Heterog eneity: 2= 0.17;2= 4.94,>@ = 2 (P = 0.08); I2=60%
Test for overall eect: Z = 4.26 (P < 0.0001 )1012−2
Favors acupuncture
F : Acupuncture versus analgesic injection: pain. % CI, condence interval; Std., standardized.
Verum acupuncture Sham acupuncture Std. mean dierence Std. mean dierence
Mean SD Total Mean SD Total IV, random, 95% CI
2.1.1 Acute pain
−18.53 10.3 30 −6.7 9.3 30 11.4% −1.19 [−1.74, −0.64]
Yang et al. 2012 (sore throat) −3.1 1.73 36 −1.35 1.74 38 11.9% −1.00 [−1.48, −0.51]
Zhang et al. 2015 (migraine) −1.84 0.63 55 −2.7 1.57 55 12.6% 0.71 [0.33, 1.10]
Subtotal (95% CI) 121 123 36.0% −0.48 [−1.76, 0.80]
IV, random, 95% CI
2.1.2 Chronic pain
Inoue et al. 2006 (low back pain) −15 9 15 −5 9 16 9.8% −1.08 [−1.84, −0.32]
Liu et al. 2014 (dysmenorrhea) −26.8 16.72 167 −22.4 17.85 167 13.5% −0.25 [−0.47, −0.04]
−1.1 0.53 10 −0.565 0.4 10 8.4% −1.09 [−2.05, −0.14]
Maeda et al. 2013 (carpal tunnel syndrome) −1.2 1.82 40 −0.5 1.4 19 11.4% −0.41 [−0.96, 0.14]
Nabeta and Kawakita 2002 (neck and shoulder pain) −11 24.74 17 −7.3 26.02 17 10.5% −0.14 [−0.82, 0.53]
Stival et al. 2014 (bromyalgia) −4.36 3.23 21 −1.7 1.55 15 10.3% −0.97 [−1.68, −0.27]
Subtotal (95% CI) 270 244 64.0% −0.54 [−0.88, −0.21]
Total (95% CI) 391 367 100.0% −0.56 [−1.00, −0.12]
Favors sham acupuncture
Heteroge neity: 2= 1.21;2= 44.24,>@ = 2 (P < 0.00001 ); I2=95%
Test for overall eect: Z = 0.7 4 (P = 0.46)
Heteroge neity: 2= 0.08;2= 9.95,>@ = 5 (P = 0.08); I2=50%
Test for overall eect: Z = 3.22 (P = 0.001 )
Heteroge neity: 2= 0.36;2=54.99,>@ = 8 (P < 0.00001); I2=85%
Test for overall eect: Z = 2.5 0 (P = 0.01)
Test for subgroup dierences: 2= 0.01,>@ = 1 (P = 0.92), I2=0%
Su et al. 2010 (low back pain)
Lu et al. 2010 (knee osteoarthritis)
Wei g htStudy or subgroup
−1 0 1 2−2
Favors verum acupuncture
F : Subgroup analysis with the duration of pain (acute versus chronic) for sham-controlled trials. % CI, condence interval; Std.,
standardized.
3.7. Sensitivity Analysis. As shown in Table , heterogeneity
of sham-controlled meta results decreased (𝐼2=68%) when
the study by Zhang et al. [] was excluded. Real acupuncture
consistently showed a greater immediate pain relief eect
compared to sham acupuncture and drug injection by exclud-
ing Zhang et al.s study (SMD, .; % CI, . to .;
 RCTs, Figure ) or each of the other included ones. Aer
excluding the study by Zhang et al., subgroup meta-analysis
showed that real acupuncture was better than penetrating
sham in terms of the ecacy of pain relief (SMD, .; %
CI, . to .;  RCTs, 𝐼2= 75.8%, Figure ), and acu-
puncture was more eective than the sham acupuncture in
reducingacutepain(SMD,.; % CI, . to .; 
RCTs, 𝐼2=0%, Figure ). e heterogeneity of present study
seemstobemainlyfromtheZhangetal.sstudy.
3.8. Safety of Acupuncture. A total of  trials had included
descriptions of adverse events associated with acupuncture
[,,,,,].Sevenofthesetrialsreported
no adverse events following acupuncture treatment; only Liu
et al. [] reported a small hematoma in one of the patients in
their acupuncture group and a small hematoma and needling
pain experienced, respectively, in one patient in their pene-
trating sham acupuncture group. No serious adverse events
were reported in any of the trials.
4. Discussion
is is the rst systematic review and meta-analysis of RCTs
on the immediate eects of acupuncture for the treatment of
disease-related pain. We included a total of  studies in our
review. e results showed statistically signicant dierences
between the ecacy of real acupuncture and those of sham
controlsforalltypesofpainincludedinthisreview.e
SMDs between real acupuncture and control sham acupunc-
ture were lower than those between real acupuncture and a
no-acupuncture control. In addition, acupuncture appeared
to be more eective than analgesic injection (at intragluteal
site with analgesic or local inltration with anesthetic) in
reducing pain. e meta-analytic eect sizes were not sim-
ilar across pain conditions. ere was no evidence of any
signicant harm caused by acupuncture in any of the RCTs.
However, it should be stressed that this lack of evidence is
based on the results of a few small trials with a high risk of
Evidence-Based Complementary and Alternative Medicine
T : Sensitivity analysis of included studies.
Study, year Statistics with study removed
Dierence in means Lower limit Upper limit 𝑍-value 𝑃value 𝐼2
Acupuncture versus sham acupuncture
Inoue et al.  −0.5 −0.97 −0.04 . . %
Maeda et al.  −0.58 −1.08 −0.09 . . %
Nabeta and Kawakita  −0.61 −1.10 −0.13 . . %
Su et al.  −0.47 −0.93 −0.02 . . %
Liu et al.  −0.62 −1.20 −0.04 . . %
Lu et al.  −0.51 −0.97 −0.05 . . %
Stival et al.  −0.51 −0.98 −0.04 . . %
Yang e t a l .  −0.50 −0.97 −0.03 . . %
Zhang et al.  −0.72 −1.06 −0.38 . <. %
Acupuncture versus analgesic injection
Chen and Li  −1.56 −2.30 −0.82 . <. %
Inoue et al.  −1.41 −2.33 −0.49 . . %
Shin et al.  −1.00 −1.48 −0.53 . <. %
1.1.1 Nonpenetrating sham
Inoue et al. 2006 (low back pain) −15 9 15 −5 9 16 10.1%
Maeda et al. 2013 (carpal tunnel syndrome) −1.2 1.82 40 −0.5 1.4 19 13.3%
Nabeta and Kawakita 2002 (neck and shoulder pain) −11 24.74 17 −7.3 26.02 17 11.3%
Su et al. 2010 (low back pain) −18.53 10.3 30 −6.7 9.3 30 13.3%
Subtotal (95% CI) 102 82 48.0%
1.1.2 Penetrating sham
Liu et al. 2014 (dysmenorrhea) −26.8 16.72 167 −22.4 17.85 167 18.9% −0.25 [−0.47, −0.04]
Lu et al. 2010 (knee osteoarthritis) −1.1 0.53 10 −0.565 0.4 10 7.8% −1.09 [−2.05, −0.14]
Stival et al. 2014 (bromyalgia) −4.36 3.23 21 −1.7 1.55 15 10.9% −0.97 [−1.68, −0.27]
Yang et al. 2012 (sore throat) −3.1 1.73 36 −1.35 1.74 38 14.4% −1.00 [−1.48, −0.51]
Subtotal (95% CI) 234 230 52.0% −0.75 [−1.27, −0.23]
Std. mean dierence Std. mean dierence
Total (95% CI) 336 312 100.0% −0.72 [−1.06, −0.38]
Verum acupuncture Sham acupuncture
Study or subgroup Mean SD Total Mean SD Total Weight IV, random, 95% CI IV, random, 95% CI
−1.08 [−1.84, −0.32]
−0.41 [−0.96, 0.14]
−0.14 [−0.82, 0.53]
−1.19 [−1.74, −0.64]
−0.70 [−1.21, −0.20]
Favors verum acupuncture
Heteroge neity: 2= 0.16;2= 7.72,>@ = 3 (P = 0.05); I2=61%
Test for overall eect: Z = 2.74 (P = 0.006)
Heteroge neity: 2= 0.19;2= 11.96,>@ = 3 (P = 0.008 );I2=75%
Test for overall eect: Z = 2.84 (P = 0.005 )
Heteroge neity: 2= 0.15;2= 21.70,>@ = 7 (P = 0.003); I2= 68%
Test for overall eect: Z = 4.17 (P < 0.0001 )
Test for subgroup dierences: 2= 0.02,>@ = 1 (P = 0.89), I2=0%
−1 0 1 2−2
Favors sham acupuncture
F : Subgroup analysis with the type of sham (nonpenetrating versus penetrating) for sham-controlled trials (excluding study by Zhang
et al. []). % CI, condence interval; Std., standardized.
bias. erefore, a careful interpretation is warranted before
arriving at a positive conclusion.
Compared with the assessment of the cumulative eects
of acupuncture, the determination of the immediate eects
could be relatively easy; that is, it is not necessary to consider
the treatment endpoint or follow-up duration. Acupuncture
alsohasaverylowdrop-outrate.Forthesystematicreview
and meta-analysis of the ecacy of acupuncture, various
factors could aect the outcomes in the evaluation of the
cumulative eects of acupuncture, including the total number
of treatment sessions, treatment period, and variation in the
end points, such as those of pain and function measurements
at dierent times. Because of the exclusion or minimization of
thesevariablefactors,theevaluationoftheimmediateeect
may closely reect the actual analgesic eects of acupuncture
stimulation.
Primary analgesic agents, such as morphine, can be used
for the management of both acute and chronic pain. e peak
eect of morphine is at around  min when administered
intravenously and at  min when administered orally, while
the duration of its eect is between  and h [, ]. e
results of our systematic review and meta-analysis indicate
that acupuncture shows an immediate analgesic eect as the
treatment of chronic pain. In general, the duration of onset of
theeectofacupunctureismin[,].edurationof
the analgesic eect following a single session of acupuncture
is about  days, although this duration is not consistent [].
erefore, the immediate eect of acupuncture may have
 Evidence-Based Complementary and Alternative Medicine
2.1.1 Acute pain
Su et al. 2010 (low back pain) −18.53 10.3 30 −6.7 9.3 30 13.3% −1.19 [−1.74, −0.64]
Yang et al. 2012 (sore throat) −3.1 1.73 36 −1.35 1.74 38 14.4% −1.00 [−1.48, −0.51]
Subtotal (95% CI) 66 68 27.7% −1.08 [−1.45, −0.72]
2.1.2 Chronic pain
Inoue et al. 2006 (low back pain) −15 9 15 −5 9 16 10.1% −1.08 [−1.84, −0.32]
Liu et al. 2014 (dysmenorrhea) −26.8 16.72 167 −22.4 17.85 167 18.9% −0.25 [−0.47, −0.04]
Lu et al. 2010 (knee osteoarthritis) −1.1 0.53 10 −0.565 0.4 10 7.8% −1.09 [−2.05, −0.14]
Maeda et al. 2013 (carpal tunnel syndrome) −1.2 1.82 40 −0.5 1.4 19 13.3% −0.41 [−0.96, 0.14]
Nabeta and Kawakita 2002 (neck and shoulder pain) −11 24.74 17 −7.3 26.02 17 11.3% −0.14 [−0.82, 0.53]
Stival et al. 2014 (bromyalgia) −4.36 3.23 21 −1.7 1.55 15 10.9% −0.97 [−1.68, −0.27]
Subtotal (95% CI) 270 244 72.3% −0.54 [−0.88, −0.21]
Total (95% CI) 336 312 100.0% −0.72 [−1.06, −0.38]
Std. mean dierence Std. mean dierenceVerum acupuncture Sham acupuncture
Study or subgroup Mean SD Total Mean SD Total Weight IV, random, 95% CI IV, random, 95% CI
Favors sham acupuncture
Heteroge neity: 2= 0.00;2= 0.26,>@ = 1 (P = 0.61); I2=0%
Test for overall eect: Z = 5.82 (P < 0.00001 )
Heteroge neity: 2= 0.08;2= 9.95,>@ = 5 (P = 0.08); I2=50%
Test for overall eect: Z = 3.22 (P = 0.001 )
Heteroge neity: 2= 0.15;2= 21.70,>@ = 7 (P = 0.003); I2=68%
Test for overall eect: Z = 4.17 (P < 0.0001 )
Test for subgroup dierences: 2= 4.57,>@ = 1 (P = 0.03), I2= 78.1%
−1 0 1 2−2
Favors verum acupuncture
F : Subgroup analysis with the duration of pain (acute versus chronic) for sham-controlled trials (excluding study by Zhang et al. []).
% CI, condence interval; Std., standardized.
clinical signicance as an alternation for analgesic medication
or as a reasonable method for pain treatment. Moreover, the
success of acupuncture as a treatment of pain is oen gauged
by the number of clients retained in pain management or
treatment facilities. e apparent benets of the immediate
analgesic eect of acupuncture may entice patients to receive
long-term acupuncture treatment willingly or open to other
forms of acupuncture options. erefore, the immediate suc-
cess of acupuncture treatment should not be overestimated.
In present study, we did not nd a greater immediate pain
relief eect of acupuncture for acute pain compared with the
sham acupuncture (𝑃 = 0.46). However, our sensitivity anal-
ysis showed that real acupuncture was more eective than
the sham acupuncture in reducing acute pain immediately,
if excluding the study by Zhang et al. []. is might be
explained by some variable factors, such as the types of sham
acupuncture, control procedures, and outcome measures.
Further rigorous studies with standardized methodologies
are required to test the ecacy of acupuncture for the
treatment of acute pain.
e design of a control group is a continuing challenge for
clinical trials of acupuncture. Many clinical trials were unable
to detect statistically signicant dierences in the treatment
ecacies between their acupuncture treatment and control
groups in terms of any of the outcome measurements [–
]; the authors of these trials concluded that acupuncture
was no more eective than any sham interventions, for exam-
ple, skin-touch sham (nonpenetrating) and skin-penetration
sham in reducing pain. Based on the results of this systemic
review and meta-analysis study, we found real acupuncture
treatment has statistically signicantly greater immediate
pain relief than nonpenetrating sham acupuncture (SMD,
.; % CI, . to .;RCTs),butnottheseof
penetrating sham acupuncture (SMD, .; % CI, .
to .;  RCTs). Interestingly, when we excluded the study
by Zhang et al. [], we found real acupuncture was more
eective than the sham acupuncture in relieving pain imme-
diately aer acupuncture treatment, which indicates some
sham acupuncture treatment is not inactive.
Our systematic review and meta-analysis study focuses
on the immediate analgesic eect of acupuncture. is raises
some interesting questions. e rst question is whether the
immediately analgesic eect following the rst acupuncture
treatment can be used as a predictor for the success of sub-
sequent or long-term acupuncture treatment. Most clinical
trials focused on analgesic eects aer multiple acupuncture
treatment. Few studies assessed analgesic eects aer both
immediate posttreatment and multiple acupuncture treat-
ments. erefore, further studies must be performed to clar-
ify this issue. e second question is whether the immediate
acupuncture analgesic eect and cumulative analgesic eects
following repeated acupuncture treatments share common
mechanisms. us far, there is no clear documentation in
regard to the underlying mechanisms of these two analgesic
eects. Based on the available data published, needle inser-
tion of the local acupuncture points triggers the release of
adenosine and changes of broblast organization at the loose
connective tissue layer [–]. e cumulative analgesic
eects following repeated acupuncture treatments on the
brain dier from the immediate analgesic eect aer one acu-
puncture treatment. e immediate analgesic eect of acu-
puncture was a result of an extensive brain activation at
selective pain-related regions []. However, the cumulative
analgesic eects of acupuncture indicated bimodal habitua-
tion—a positive brain response appeared at the beginning of
acupuncture stimulation, which then declined and became
negative towards the nal stages []. From neurohormonal
prospective, a single acupuncture treatment can facilitate
the release of opioid peptides []. Repeated administration
of electroacupuncture leads to the development of opioid
Evidence-Based Complementary and Alternative Medicine 
tolerance [, ]. erefore, although acupuncture has
both immediate and cumulative analgesic eects following
repeated treatments, underlying mechanisms may be dier-
ent.
Our systematic review and meta-analysis study has sev-
eral limitations. Only English and Chinese literatures were
reviewed in present study and potential data from studies
published in other languages might exist and were ignored,
which decreased the credibility of the results in present study
to some extent. We included RCTs evaluating various types
of pain, including chronic neck pain, LBP, and knee pain.
In fact, accumulated work has shown that acupuncture is
benecial in treatment of various pain syndromes. e eects
of acupuncture on nonspecic pain may share the similar
underlying mechanisms. In traditional Chinese medicine,
disease-related pain results from stagnation of energy “Qi”
owwithinmeridians.Painistreatedlocallyordistally
via acupuncture points further along the meridian, drawing
energy away from the pain. Recently, the neurophysiology of
acupuncture has been investigated extensively. Local anesthe-
sia at the needle-insertion sites completely blocks the imme-
diate analgesic eect of acupuncture, indicating that these
eects are dependent on intact neural conduction. e imme-
diate analgesic eect on various types of pain may be involved
in the nociceptive pathway, including descending noradren-
ergic and serotonergic pathways []. In our meta-analysis, a
high level of heterogeneity may be resulted from the baseline
values, the acupuncture manipulation, acupuncture points
selected, and the duration and frequency of treatment. Our
review has a number of strengths. First, our search for
relevant studies was extensive. Key Chinese databases were
explored in addition to the English databases. Second, we
assessed the dierences in the immediate analgesic eect of
acupuncture between real acupuncture and dierent types of
controls. ird, the review only evaluated RCTs, which have
study designs appropriate for the determination of the eects
of intervention.
In conclusion, this review facilitates a better understand-
ing of acupuncture stimulation and its immediate analgesic
eect for disease-related pain. e results of our systematic
review and meta-analysis suggest that evidence of the imme-
diate analgesic eect of acupuncture is encouraging, but not
convincing. Nevertheless, our review has yielded interesting
andinnovativendingsandprovidedimpetustofurther
investigations. Further rigorous, high-quality, randomized
controlled trials comparing acupuncture with nontreatment
and sham acupuncture without skin penetration are required
to evaluate the immediate analgesic eect of acupuncture.
Conflicts of Interest
eauthorshavenoconictsofinteresttodeclare.
Authors’ Contributions
AnfengXiangandKeChengcontributedequallytothiswork.
Acknowledgments
e authors thank Dr. Lixing Lao at the School of Chinese
Medicine,UniversityofHongKong,Dr.BingZhuatChina
Academy of Chinese Medical Sciences, and Dr. Yih-Ing Hser
at the University of California, Los Angeles, for helpful
comments on the manuscript. is work was funded by the
National Basic Research Program of China ( Program:
CB) and the National Natural Science Foundation
of China (NSFC: ).
References
[] RelievingPaininAmerica:ABlueprintforTransformingPre-
vention, Care, Education, and Research, National Academies
Press, Washington, D.C., USA, , Institute of Medicine (US)
Committee on Advancing Pain Research, Care, and Education,
Institute of Medicine.
[]H.Breivik,B.Collett,V.Ventafridda,R.Cohen,andD.Gal-
lacher, “Survey of chronic pain in Europe: prevalence, impact
on daily life, and treatment,” EuropeanJournalofPain,vol.,
no. , pp. –, .
[] Q.Shi,G.Langer,J.Cohen,andC.S.Cleeland,“PeopleinPain:
How Do ey Seek Relief?” Journal of Pain,vol.,no.,pp.
–, .
[] A. Narayana, N. Katz, A. C. Shillington et al., “National
Breakthrough Pain Study: Prevalence, characteristics, and asso-
ciations withhealth outcomes,Pain,vol.,no.,pp.,
.
[]B.Sivertsen,T.Lallukka,K.J.Petrie,O.A.Steingrimsdottir,
A. Stubhaug, and C. S. Nielsen, “Sleep and pain sensitivity in
adults,Pain,vol.,no.,pp.,.
[] L. Jones, M. Othman, T. Dowswell et al., “Pain management for
women in labour: an overview of systematic reviews,Cochrane
Database of Systematic Reviews, no. , Article ID CD,
.
[] H. Lee, J.-H. Lee, T.-Y. Choi, M. S. Lee, and B.-C. Shin, “Acu-
puncture for acute low back pain: a systematic review,Clinical
Journal of Pain,vol.,no.,pp.,.
[] C. A. Smith, X. Zhu, and L. He, “Acupuncture for primary dys-
menorrhea,e Cochrane Database of Systematic Review,vol.
, no. , Article ID D, p. CD, .
[] A. J. Vickers, A. M. Cronin, A. C. Maschino et al., “Acupunc-
ture for chronic pain: individual patient data meta-analysis,
Archives of Internal Medicine,vol.,no.,pp.,
.
[] L. Casimiro, L. Barnsley, L. Brosseau et al., “Acupuncture and
electroacupuncture for the treatment of rheumatoid arthritis,
e Cochrane Database of Systematic Review,vol.,no.,p.
CD, .
[] Y. D. Kwon, M. H. Pittler, and E. Ernst, “Acupuncture for peri-
pheral joint osteoarthritis: a systematic review and meta-
analysis,” Rheumatology,vol.,no.,pp.,.
[] E. Manheimer, A. White, B. Berman, K. Forys, and E. Ernst,
“Meta-analysis: acupuncture for low back pain,Annals of
Internal Medicine,vol.,no.,pp.,.
[] H. Y. Chiu, Y. J. Hsieh, and P. S. Tsai, “Systematic review and
meta-analysis of acupuncture to reduce cancer-related pain,
European Journal of Cancer Care,vol.,no.,ArticleID
e, .
[] C. H. Y. Lau, X. Wu, and V. C. H. Chung, “Acupuncture
and Related erapies for Symptom Management in Palliative
Cancer Care: systematic Review and Meta-Analysis,Medicine
(Baltimore),vol.,no.,ArticleIDee,p.e,.
 Evidence-Based Complementary and Alternative Medicine
[]Z.Lu,H.Dong,Q.Wang,andL.Xiong,“Perioperativeacu-
puncture modulation: More than anaesthesia,British Journal
of Anaesthesia,vol.,no.,pp.,.
[] M. H. Pittler and E. Ernst, “Complementary therapies for
neuropathic and neuralgic pain: Systematic review,Clinical
Journal of Pain,vol.,no.,pp.,.
[] J. Langhorst, P. Klose, F. Musial, D. Irnich, and W. H¨
auser,
“Ecacy of acupuncture in bromyalgia syndrome: a system-
atic review with a meta-analysis of controlled clinical trials,
Rheumatology,vol.,no.,pp.,.
[] E. Ernst, M. S. Lee, and T.-Y. Choi, “Acupuncture: does it
alleviate pain and are there serious risks? A review of reviews,”
Pain,vol.,no.,pp.,.
[] J. S. Han, “Acupuncture: neuropeptide release produced by
electrical stimulation of dierent frequencies,Tre nds in Neu-
rosciences,vol.,no.,pp.,.
[] F. Beissner and C. Henke, “Methodological problems in fMRI
studies on acupuncture: a critical review with special emphasis
on visual and auditory cortex activations,Evidence-Based
Complementary and Alternative Medicine, vol. , Article ID
,  pages, .
[] S. Liu, W. Zhou, X. Ruan et al., “Activation of the hypothalamus
characterizes the response to acupuncture stimulation in heroin
addicts,Neuroscience Letters,vol.,no.,pp.,.
[] A. Margolin, S. K. Avants, and H. D. Kleber, “Investigating
alternative medicine therapies in randomized controlled trials,
Journal of the American Medical Association, vol. , no. , pp.
–, .
[] K. J. Sherman, D. C. Cherkin, D. M. Eisenberg, J. Erro, A. Hrbek,
and R. A. Deyo, “e practice of acupuncture: Who are the
providers and what do they do?” Annals of Family Medicine,vol.
, no. , pp. –, .
[] H. MacPherson and R. Hammerschlag, “Acupuncture and the
Emerging Evidence Base: Contrived Controversy and Rational
Debate,JAMS Journal of Acupuncture and Meridian Studies,
vol.,no.,pp.,.
[] S.A.P.Calamita,D.A.Biasotto-Gonzalez,N.C.DeMeloetal.,
“Evaluation of the immediate eect of acupuncture on pain,
cervical range of motion and electromyographic activity of the
upper trapezius muscle in patients with nonspecic neck pain:
Study protocol for a randomized controlled trial,Tr i als ,vol.,
no.,articleno.,.
[]A.O.Freire,G.C.M.Sugai,S.M.Togeiro,L.E.Mello,
and S. Tuk, “Immediate eect of acupuncture on the sleep
pattern of patients with obstructive sleep apnoea,Acupuncture
in Medicine,vol.,no.,pp.,.
[] S. Shukla, A. Torossian, J.-R. Duann, and A. Leung, “e anal-
gesic eect of electroac upuncture on acute thermal p ain percep-
tion—a central neural correlate study with fMRI,Molecular
Pain,vol.,article,.
[] C. Li, J. Yang, K. Park et al., “Prolonged repeated acupuncture
stimulation induces habituation eects in pain-related brain
areas: an fMRI study,PLoS ONE,vol.,no.,ArticleIDe,
.
[] C. Lefebvre, E. Manheimer, and J. Glanville, “Chapter : Search-
ing for studies,” in Cochrane Handbook for Systematic Reviews of
Interventions,J.P.T.HigginsandS.Green,Eds.,eCochrane
Collaboration, .
[] M. Chen and S. Li, “Clinical observation of the ecacy on renal
colic treated with electroacupuncture at the Xi-cle points of
kidney and bladder meridians as well as the relevant Front-mu
points,World Journal of Acupuncture—Moxibustion,vol.,
no.,pp.,.
[] M. Inoue, H. Kitakoji, N. Ishizaki et al., “Relief of low back
pain immediately aer acupuncture treatment: a randomised,
placebo controlled trial,Acupuncture in Medicine,vol.,no.
, pp. –, .
[] M. Inoue, T. Hojo, M. Nakajima, H. Kitakoji, and M. Itoi, “Com-
parison of the eectiveness of acupuncture treatment and
local anaesthetic injection for low back pain: A randomised
controlled clinical trial,Acupuncture in Medicine,vol.,no.
, pp. –, .
[] C.-Z. Liu, J.-P. Xie, L.-P. Wang et al., “A randomized controlled
trial of single point acupuncture in primary dysmenorrhea,
Pain Medicine (United States),vol.,no.,pp.,.
[] T.W.Lu,I.P.Wei,Y.H.Liuetal.,“Immediateeectsofacu-
puncture on gait patterns in patients with knee osteoarthritis,
Chinese Medical Journal,vol.,no.,pp.,.
[] M. J. Mejuto-V´
azquez, J. Salom-Moreno, R. Ortega-Santiago, S.
Truyols-Dom´
ınguez, and C. Fern´
andez-De-Las-pe˜
nas, “Short-
Term changes in neck pain, widespread pressure pain sensitiv-
ity, and cervical range of motion aer the application of trigger
point dry needling in patients with acute mechanical neck pain:
a randomized clinical trial,JournalofOrthopaedicandSports
Physical erapy,vol.,no.,pp.,.
[] Y. Maeda, N. Kettner, J. Lee et al., “Acupuncture-evoked res-
ponse in somatosensory and prefrontal cortices predicts imme-
diate pain reduction in carpal tunnel syndrome,Evidence-
Based Complementary and Alternative Medicine,vol.,
Article ID ,  pages, .
[] T. Nabeta and K. Kawakita, “Relief of chronic neck and
shoulder pain by manual acupuncture to tender points - A
sham-controlled randomized trial,Complementary erapies
in Medicine,vol.,no.,pp.,.
[] J.-S. Shin, I.-H. Ha, J. Lee et al., “Eects of motion style acupunc-
ture treatment in acute low back pain patients with severe
disability: a multicenter, randomized, controlled, comparative
eectiveness trial,Pain,vol.,no.,pp.,.
[] R. S. M. Stival, P. R. Cavalheiro, C. E. S. Stasiak, D. T. Galdino,
B. E. Hoekstra, and M. D. Schafranski, “Acupuncture in bro-
myalgia: a randomized, controlled study addressing the imme-
diate pain response,Revista Brasileira de Reumatologia,vol.,
no. , pp. –, .
[]J.-T.Su,Q.-H.Zhou,R.Li,J.Zhang,W.-H.Li,andQ.Wang,
“Immediate analgesic eect of wrist-ankle acupuncture for
acute lumbago: a randomized controlled trial,Chinese Acu-
puncture & Moxibustion,vol.,no.,pp.,.
[] S.-H. Yang, P.-C. Xie, and X.-L. Qin, “An instant pain-relief
eect of balance acupuncture for relieving sore throat in acute
pharyngitis patients,Acupuncture Research,vol.,no.,pp.
–, .
[]H.Zhang,Y.Hu,J.Wu,andH.Zheng,“Timelinesslawon
the immediate analgesia on acute migraine treated with elec-
troacupuncture at shaoyang meridian points,Chinese acupunc-
ture & moxibustion,vol.,no.,pp.,.
[] J. P. T. Higgi ns, J. J. Deeks, and D. G. Altman, “Chapter :
Special topics in statistics,” in Cochrane Handbook for Systematic
Reviews of Inter ventions,J.P.T.HigginsandS.Green,Eds.,e
Cochrane Collaboration, , Version ...
[] J. P. T. Higgins and J. J. Deeks, “Chapter : Selecting stud-
ies and collecting data,” in Cochrane Handbook for System-
atic Reviews of Interventions,J.P.T.HigginsandS.Green,
Evidence-Based Complementary and Alternative Medicine 
Eds., e Cochrane Collaboration, , Version .., http://
handbook--.cochrane.org/.
[] J. P. T. Higgins, D. G. Altman, and J. A. C. Sterne, “Chapter
: Assessing risk of bias in included studies,” in Cochrane
HandbookforSystematicReviewsofInterventions,J.P.T.Higgins
and S. Green, Eds., e Cochrane Collaboration, , Version
...
[] K. Streitberger and J. Kleinhenz, “Introducing a placebo needle
into acupuncture research,e Lancet,vol.,no.,pp.
-, .
[] E. Manheimer, L. S. Wieland, K. Cheng et al., “Acupuncture for
irritable bowel syndrome: systematic review and meta-analysis,
American Journal of Gastroenterology,vol.,no.,pp.
, .
[] Review Manager, “e Nordic Cochrane Centre,” computer
program, Version ., e Cochrane Collaboration, Copen-
hagen, Denmark, .
[] J. P. T. Higgins, S. G. ompson, J. J. Deeks, and D. G. Altman,
“Measuring inconsistency in meta-analyses,British Medical
Journal,vol.,no.,pp.,.
[] J. J. Deeks, J. P. T. Higgins, and D. G. Altman, “Chapter :
Analysing data and undertaking meta-analyses,” in Cochrane
HandbookforSystematicReviewsofInterventions,J.P.T.Higgins
and S. Green, Eds., e Cochrane Collaboration, , Version
...
[] H. J. Sch¨
unemann, A. D. Oxman, and G. E. Vist, “Chapter
: Interpreting results and drawing conclusions,” in Cochrane
HandbookforSystematicReviewsofInterventions,J.P.T.Higgins
and S. Green, Eds., e Cochrane Collaboration, , Version
...
[] T. Jonsson, C. B. Christensen, H. Jordening, and C. Frølund,
“e bioavailability of rectally administered morphine Pharma-
cology and Toxicology,Pharmacology & Toxicology,vol.,no.
, pp. –, .
[] M. J. Brennan, “e eect of opioid therapy on endocrine
function,American Journal of Medicine, vol. , no. , pp. S–
S, .
[] Beijing College of Traditional Chinese Medicine, Shanghai Col-
lege of Traditional Chinese Medicine, Nanjing College of Tradi-
tional Chinese Medicine, and e Acupuncture Institute of
the Academy of Traditional Chinese Medicine, “Essentials of
Chinese aBeijing,” , Beijing, People’s Republic of China,
Foreign Language Press; Beijing, People’s Republic of China,
.
[] L. Liu, Q.-M. Huang, Q.-G. Liu et al., “Eectiveness of dry
needling for myofascial trigger points associated with neck and
shoulderpain:asystematicreviewandmeta-analysis,Archives
of Physical Medicine and Rehabilitation,vol.,no.,pp.
, .
[] D. C. Cherkin, K. J. Sherman, A. L. Avins et al., “A randomized
trial comparing acupuncture, simulated acupuncture, and usual
care for chronic low back pain,Archives of Internal Medicine,
vol. , no. , pp. –, .
[] M.V.Madsen,P.C.Gøtzsche,andA.Hr
´
objartsson, “Acupunc-
ture treatment for pain: systematic review of randomised
clinical trials with acupuncture, placebo acupuncture, and no
acupuncture groups,British Medical Journal,vol.,no.,
pp. –, .
[] M. E. Suarez-Almazor, C. Looney, and Y. Liu, “A randomized
controlled trial of acupuncture for asteoarthritis of the knee:
eects of patient-provider communication,Arthritis Care and
Res (Hoboken),vol.,no.,pp.,.
[] H. M. Langevin, “Evidence of connective tissue involvement
in acupuncture,e FASEB Journal: Ocial Journal of the
Federation of American Societies for Experimental Biology,vol.
, no. , pp. –, .
[] N. Goldman, M. Chen, T. Fujita et al., “Adenosine A receptors
mediate local anti-nociceptive eects of acupuncture,Nature
Neuroscience, vol. , no. , pp. –, .
[] M.Sandberg,T.Lundeberg,L.Lindberg,andB.Gerdle,“Eects
of acupuncture on skin and muscle blood ow in healthy
subjects,European Journal of Applied Physiology,vol.,no.
-,pp.,.
[] R. P. Dhond, N. Kettner, and V. Napadow, “Neuroimaging
acupuncture eects in the human brain,Journal of Alternative
and Complementary Medicine,v
ol.,no.,pp.,.
[] H. Ji-Sheng, L. Si-Jia, and T. Jian, “Tolerance to electroacupunc-
ture and its cross tolerance to morphine,Neuropharmacology,
vol. , no. , pp. –, .
[] P. Chandran and K. A. Sluka, “Development of opioid toler-
ance with repeated transcutaneous electrical nerve stimulation
administration,Pain,vol.,no.-,pp.,.
[] Z.-Q. Zhao, “Neural mechanism underlying acupuncture anal-
gesia,Progress in Neurobiology, vol. , no. , pp. –, .

Supplementary resource (1)

... Functional modulation also occurs in symptomatic regions of the viscera, such as peristalsis [5]. Acupuncture (AC) has become an increasingly popular strategy for treating acute and chronic pain [6]. However, the process of selecting acupoints for specific patterns of complaints is essential for the success of AC treatment [7][8][9][10] and enhances efficacy [11][12][13]. ...
... Before AC, the mean VAS score for all patients was 5.3 ± 1.6 [3][4][5][6][7][8][9][10], indicating moderate to severe pain. Patients who underwent RYGB had a similar pain level as those who underwent VSG (5.2 ± 1.6 vs. 5.6 ± 1.5, p = 0.3345). ...
Article
Full-text available
Background It remains challenging in clinical practice to perform optimal pain management following bariatric surgeries. Acupuncture (AC) is an effective method of postoperative pain management, but its clinical efficacy depends on the rationale used to select AC points. Methods We developed a method to identify individual patterns of pain and a corresponding set of acupoints (corrAC) based on the relative pressure sensitivity of six abdominal visceral pressure points, i.e., the gastrointestinal (GI) checkpoints (G1–G6). Patients with moderate to severe pain were included and received a single AC treatment following surgery. The visual analog scale (VAS) score, pain threshold, and skin temperature were assessed before AC and at 5 min, 1 h, and 24 h following AC. AC was performed with 1-mm-deep permanent needles. Results From April 2021 to March 2022, 72 patients were included in the analysis. Fifty-nine patients received corrAC, whereas 13 received a noncorresponding AC (nonAC) as an internal control. Patients receiving corrAC showed a significant reduction (74%) in pain at 5 min after treatment (p < 0.0001) and a significant increase (37%) in the pain threshold (p < 0.0001). In this group, a significant increase in skin temperature above G1, G3, G4, and G5 was observed. Patients receiving nonAC showed neither significant pain reduction nor significant changes in pain threshold. The skin above G3 and G4 did not reveal temperature changes. Conclusion Checkpoint AC may be an effective tool in postoperative pain therapy after bariatric surgery. Vegetative functional involvement might be associated with pain relief. Graphical Abstract
... Future research is warranted for the assessment of ANF efficacy against a sham intervention (similar to what has been studied for acupuncture) 26) in a randomized controlled trial (RCT), with double-blind assessment and a longitudinal design. This would allow for a follow-up of the duration of treatment effects, and of any adverse event. ...
Article
Full-text available
Purpose] Non-invasive and drug-free interventions for pain are being developed. One of them is ANF (which stands for “Amino Neuro Frequency”) Therapy®, which consists in the application of carbonized metal devices on a patient’s skin. We aimed to: 1) test perceived changes in pain intensity after ANF application, 2) record frequency and severity of side effects, 3) assess clinician and patient satisfaction, 4) explore effects on swelling and range of motion (ROM). [Participants and Methods] In this real-world multisite observational study, N=113 physical therapists in 45 countries, applied ANF to N=1,054 patients (Mage=45.2, 56.2% female) with pain complaints. Demographic data, pain intensity (NRS-11), effects of ANF on swelling and ROM, clinician and patient satisfaction and side effects were collected. [Results] Main pain locations were: low back (14.9%), knee (12.4%), neck (10%), and shoulder (9.6%). Pre-treatment pain intensity was high (Mean=7.6, SD=1.9). It significantly decreased post-treatment (Mean=3.1, SD=2.0), t(1053)=7.25, with a large effect size (Cohen’s d=2.2). Swelling decreased and ROM increased. Average satisfaction with ANF was 92/100. Patients often experienced mild side effects (42.3%): dry mouth, headache and fatigue. [Conclusion] Results show large effect sizes, high satisfaction, and mild and short-term side effects. This is very promising but should be interpreted with caution considering the study limitations.
... In recent years, acupuncture effects have been classified as either immediate (evaluations assessed after the end of the first session) or cumulative effects of multiple acupuncture sessions (96). Currently, most animal models, clinical trials, and systematic reviews have focused on the analgesic effects of cumulative acupuncture in acute and chronic pain conditions (97,98). ...
Article
Full-text available
Pain within the trigeminal system, particularly dental pain, is poorly understood. This study aimed to determine whether single or multiple dental pulp injuries induce persistent pain, its association with trigeminal central nociceptive pathways and whether electroacupuncture (EA) provides prolonged analgesic and neuroprotective effects in a persistent dental pain model. Models of single dental pulp injury (SDPI) and multiple dental pulp injuries (MDPI) were used to induce trigeminal neuropathic pain. The signs of dental pain-related behavior were assessed using the mechanical head withdrawal threshold (HWT). Immunofluorescence and western blot protocols were used to monitor astrocyte activation, changes in apoptosis-related proteins, and GABAergic interneuron plasticity. SDPI mice exhibited an initial marked decrease in HWT from days one to 14, followed by progressive recovery from days 21 to 42. From days 49 to 70, the HWT increased and returned to the control values. In contrast, MDPI mice showed a persistent decrease in HWT from days one to 70. MDPI increased glial fibrillary acidic protein (GFAP) and decreased glutamine synthetase (GS) and glutamate transporter-1 (GLT1) expression in the Vi/Vc transition zone of the brainstem on day 70, whereas no changes in astrocytic markers were observed on day 70 after SDPI. Increased expression of cleaved cysteine-aspartic protease-3 (cleaved caspase-3) and Bcl-2-associated X protein (Bax), along with decreased B-cell lymphoma/leukemia 2 (Bcl-2), were observed at day 70 after MDPI but not after SDPI. The downregulation of glutamic acid decarboxylase (GAD65) expression was observed on day 70 only after MDPI. The effects of MDPI-induced lower HWT from days one to 70 were attenuated by 12 sessions of EA treatment (days one to 21 after MDPI). Changes in astrocytic GFAP, GS, and GLT-1, along with cleaved caspase-3, Bax, Bcl-2, and GAD65 expression observed 70 days after MDPI, were reversed by EA treatment. The results suggest that persistent dental pain in mice was induced by MDPI but not by SDPI. This effect was associated with trigeminal GABAergic interneuron plasticity along with morphological and functional changes in astrocytes. EA exerts prolonged analgesic and neuroprotective effects that might be associated with the modulation of neuron-glia crosstalk mechanisms.
... Acupuncture (AC) has become an increasingly popular modality for the treatment of acute and chronic pain [12]. Additionally, acupuncture significantly improved gastrointestinal function and reduced postoperative hospitalization [13]. ...
Article
Full-text available
Background Optimal pain management is one of the core elements of Enhanced Recovery After Surgery (ERAS®) protocols and remains a challenge. Acupuncture (AC) is an effective treatment for various pain conditions. Systematic and personalized allocation of acupoints may be decisive for efficacy. Methods Based on the predominant pressure sensitivity of six gastrointestinal (GI) checkpoints (G1-G6), we devised a method to detect personalized patterns of pain and a corresponding set of acupoints. We performed a single AC treatment with semi-permanent needles and assessed the visual analogue scale (VAS) score, pain threshold based on pressure algometry (PA), and temperature changes on abdominal skin areas before and 5 min after AC. Results Between April and June 2021, thirty-eight patients were prospectively included in this pilot study. The mean reduction in subjective pain sensation as assessed by VAS was 86%, paralleled by an augmentation of the pain threshold as measured by PA by 64%. A small but significant increase in the skin temperature was observed above the abdominal surface. These effects were independent of the type of surgery. Conclusion Checkpoint acupuncture may be a complementary tool for postoperative pain management. Further investigations are needed to explore this analgesic effect.
... Furthermore, poor postoperative pain management could facilitate the development of chronic pain and opioid dependence [9], leading to increased morbidity and impaired quality of life [10,11]. Acupuncture (AC) has become an increasingly popular modality for the treatment of acute and chronic pain [12]. Additionally, acupuncture signi cantly improved gastrointestinal function and reduced postoperative hospitalization [13]. ...
Preprint
Full-text available
Background Optimal pain management is one of the core elements of Enhanced Recovery After Surgery (ERAS®) protocols and remains a challenge. Acupuncture (AC) is an effective treatment for various pain conditions. Systematic and personalized allocation of acupoints may be decisive for efficacy. Methods Based on the predominant pressure sensitivity of six gastrointestinal (GI) checkpoints (G1-G6), we devised a method to detect personalized patterns of pain and a corresponding set of acupoints. We performed a single AC treatment with semi-permanent needles and assessed the visual analogue scale (VAS) score, pain threshold based on pressure algometry (PA) and temperature changes on abdominal skin areas before and 5 min after AC. Results Between April and June 2021, thirty-eight patients were prospectively included in this pilot study. The mean reduction in subjective pain sensation as assessed by VAS was 86%, paralleled by an augmentation of the pain threshold as measured by PA by 64%. A small but significant increase in the skin temperature was observed above the abdominal surface. These effects were independent of the type of surgery. Conclusion Checkpoint acupuncture may be a complementary tool for postoperative pain management. Further investigations are needed to explore this analgesic effect.
... Acupuncture is a Chinese medical practice It leverages the life energy of the body's flow, known as De Qi energy. De Qi energy is believed to recover the body when a needle enters the skin, with or without needle manipulation on specific points of the body, which can stimulate the sense of pain, numbness, and tingly [31,32]. In a study using the RCT method, Dietzel et al. (2021) examined the impact of acupuncture on diabetic neuropathy pain and concluded that it may be both beneficial and safe for those with the condition [13]. ...
Conference Paper
Full-text available
Background: Pharmacological treatment of neuropathic pain has various side effects, while complementary therapies have minimal risk of side effects. Aim: To explore more deeply the types of complementary therapies that can be used to treat painful diabetic neuropathy. Methods: Articles were searched using Science Direct, Pubmed, Google Scholar, and EBSCO to find articles according to inclusion and exclusion criteria. Articles that meet the criteria set by the author are then analyzed, determined by the level of evidence extracted, and then synthesized. Results: Complementary therapies that can reduce neuropathic pain in diabetic patients are electrical stimulation, Low-Intensity Laser Therapy (LILT), Repetitive Magnetic Stimulation, Acceptance and Commitment Therapy (ACT), Aromatherapy Massage, Exercise Training, Acupuncture, and China Herbal Medicine. Conclusion: Among these interventions, Acupuncture and electrical stimulation were the most widely used interventions to reduce neuropathic pain in diabetic patients. Complementary therapies can reduce neuropathic pain in people with diabetes. It is hoped that future research using the RCT method with many samples can be generalized.
Preprint
Background Pain is a common, debilitating, and poorly understood complication of sickle cell disease (SCD). The need for clinical pain management of SCD is largely unmet and relies on opioids as the main therapeutic option, which leads to a decreased quality of life (QoL). According to the literature, acupuncture has shown certain therapeutic effects for pain management in SCD. However, these clinical studies lack the guidance of Traditional Chinese Medicine (TCM) Syndrome Differentiation principles for treatment. Aim To characterize differences in clinical presentation amongst TCM-diagnosed syndromes in SCD patients. Method 52 patients with SCD and 28 age- and sex-matched healthy controls (HCs) were enrolled in an ongoing trial of acupuncture. Each participant completed a series of questionnaires on pain, physical function, fatigue, sleep, anxiety, depression, and QoL and underwent cold- and pressure-based quantitative sensory testing at baseline. Data on prescription opioid use over the 12 months prior to study enrollment was used to calculate mean daily morphine milligram equivalents (MME). Differences among the three TCM syndromes were analyzed by one-way ANOVA followed by Tukey post hoc testing. Two-sample t-tests were used to compare SCD and HC groups. Results TCM diagnosis criteria classified SCD patients into one of three TCM syndromes: a) Equal; b) Deficiency; and c) Stagnation. The Stagnation group exhibited higher pain interference, physical dysfunction, nociplastic pain, fatigue, anxiety, depression, MME consumption, and lower sleep quality and QoL compared to the Equal group. Few differences were observed between HCs and the Equal SCD group across outcomes. Deficiency and Stagnation groups were differentiated with observed- and patient-reported clinical manifestations. Conclusion These findings suggest that TCM-diagnosed syndromes in SCD can be differentially characterized using validated objective and patient-reported outcomes. Because characteristics of pain and co-morbidities in each SCD patient are unique, targeting specific TCM “syndromes” may facilitate treatment effectiveness with a syndrome-based personalized treatment plan that conforms to TCM principles. These findings lay the foundation for the development of tailored acupuncture interventions based on TCM syndromes for managing pain in SCD. Larger samples are required to further refine and validate TCM diagnostic criteria for SCD.
Chapter
Patients who undergo head and neck cancer surgeries are faced with cosmetic, physiologic, and pain challenges, and adequate perioperative pain management is integral to patient care and quality of life. Further, inadequately controlled acute postsurgical pain puts patients at risk for chronic postsurgical pain and other sequelae including risk of chronic opioid use and substantial healthcare costs. Clinicians should utilize multimodal analgesia, defined as various therapies to mitigate pain in which these therapies act differently, and consider routes of medication administration as oral options are not always appropriate for these patients. Ensuring adequate analgesia decreases hospital length of stay, minimizes cardiac and pulmonary complications, and mitigates deconditioning, all of which decrease healthcare costs. Pain management plans tailored to each patient’s comorbidities and procedures along with clinicians’ thoughtful ability to maximize resources available at an institution allow for successful patient care and optimal outcomes.
Article
Objetivo: Identificar evidências científicas que discorram sobre o efeito da acupuntura no trabalho de parto. Métodos: Trata-se de um estudo de revisão integrativa da literatura realizado nas bases de dados da LILACS, MEDLINE, CINAHL, Scopus e Web of Science, em setembro de 2022. A seleção de estudos e a extração dos dados foram feitas por dois revisores independentes. Inicialmente a busca retornou 48 produções, onde após aplicação dos critérios de inclusão e exclusão, cinco foram selecionadas para compor a amostra desta revisão. A classificação do nível de evidência se baseou nos níveis propostos por Melnyk e Fineout-Overholt. Resultados: Entre os efeitos identificados, destacam-se: alívio da dor, redução de complicações obstétricas, redução no número de cesarianas, menor duração no tempo de trabalho de parto e menos sangramento pós-parto. Considerações finais: A acupuntura é um método que apresenta efeitos benéficos quando utilizada no trabalho de parto. O profissional de saúde precisa conhecer a técnica para aplicá-la e orientá-la de forma adequada à mulher, garantindo uma assistência mais humanizada e que proporcione a saúde materno-fetal.
Book
Full-text available
The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review. The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions. This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet. Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
Article
Full-text available
Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care. The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited. Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n = 175, pooled weighted mean difference: −0.76, 95% confidence interval: −0.14 to −0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n = 111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36–1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild. Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting future RCTs in these areas.
Book
Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority. © 2011 by the National Academy of Sciences. All rights reserved.
Article
Background: Low back pain limits activity and is the second most frequent reason for physicians visits. Previous research shows widespread use of acupuncture for low back pain. Purpose: To assess acupuncture's effectiveness for treating low back pain. Data Sources: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues. Study Selection: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain. Data Extraction: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed. Data Synthesis: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies. Limitations: The quantity and quality of the included trials varied. Conclusions: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.
Article
We conducted a systematic review and meta-analysis to evaluate the effects of acupuncture on malignancy-related, chemotherapy (CT)- or radiation therapy (RT)-induced, surgery-induced, and hormone therapy (HT)-induced pain. Randomised controlled trials (RCTs) examining the effects of acupuncture on cancer-related pain were reached from the EMBASE, PubMed, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Airiti library, Taiwan Electrical Periodical Service, Wanfang Data (a Chinese database) and China Knowledge Resource Integrated Database from inception through June 2014. Heterogeneity, moderator analysis, publication bias and risk of bias associated with the included studies were examined. A total of 29 RCTs yielding 36 effect sizes were included. The overall effect of acupuncture on cancer-related pain was −0.45 [95% confidence interval (CI) = −0.63 to −0.26]. The subanalysis indicated that acupuncture relieved malignancy-related and surgery-induced pain [effect size (g) = −0.71, and −0.40; 95% CI = −0.94 to −0.48, and −0.69 to −0.10] but not CT- or RT-induced and HT-induced pain (g = −0.05, and −0.64, 95% CI = −0.33 to 0.24, and −1.55 to 0.27). Acupuncture is effective in relieving cancer-related pain, particularly malignancy-related and surgery-induced pain. Our findings suggest that acupuncture can be adopted as part of a multimodal approach for reducing cancer-related pain.
Article
This review examined the currently available evidence supporting the use of acupuncture to treat primary dysmenorrhoea. To determine the efficacy and safety of acupuncture in the treatment of primary dysmenorrhoea when compared with a placebo, no treatment, or conventional medical treatment (for example oral contraceptives and non-steroidal anti-inflammatory medication (NSAIDs)). The following databases were searched (from inception until March 2010): the Cochrane Menstrual Disorders and Subfertillity Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), PubMed, CINAHL, PsycINFO, Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), VIP database, Dissertation Abstracts International, BIOSIS, AMED (The Allied and Complementary Medicine Database), Acubriefs, and Acubase. Inclusion criteria included all published and unpublished randomised controlled trials comparing acupuncture with placebo control, usual care, and pharmacological treatment. The following modes of treatment were included: acupuncture, electro-acupuncture, and acupressure. Participants were women of reproductive age with primary dysmenorrhoea during the majority of the menstrual cycles or for three consecutive menstrual cycles, and moderate to severe symptoms. Meta-analyses were performed using odds ratios (OR) for dichotomous outcomes and mean differences or standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI). Primary outcomes were pain relief and improved menstrual symptoms, measured by self-rating scales. Other outcomes included use of analgesics, quality of life, and absence from school or work. Ten trials were included in the review with data reporting on 944 participants. Six trials reported on acupuncture (n = 673) and four trials (n = 271) reported on acupressure. There was an improvement in pain relief from acupuncture compared with a placebo control (OR 9.5, 95% CI 21.17 to 51.8), NSAIDs (SMD -0.70, 95% CI -1.08 to -0.32) and Chinese herbs (SMD -1.34, 95% CI -1.74 to -0.95). In two trials acupuncture reduced menstrual symptoms (for example nausea, back pain) compared with medication (OR 3.25, 95% CI 1.53 to 6.86); in one trial acupuncture reduced menstrual symptoms compared with Chinese herbs (OR 7.0, 95% CI 2.22, 22.06); and in one trial acupuncture improved quality of life compared with usual care.There was an improvement in pain relief from acupressure compared with a placebo control (SMD -0.99, 95% CI -1.48 to -0.49), and in one trial acupressure reduced menstrual symptoms compared with a placebo control (SMD -0.58, 95% CI -1.06 to -0.10). The risk of bias was low in 50% of trials. Acupuncture may reduce period pain, however there is a need for further well-designed randomised controlled trials.