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

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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.
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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: ).
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Supplementary resource (1)

... Significant research has focused on acupuncture in the treatment of pain. An SRM of immediate analgesic effects (13 randomized controlled trials [RCTs], n ¼ 1,077) found that acupuncture was associated with greater immediate pain relief 30 minutes or less after the end of a single treatment than the pain relief reported with sham or analgesic injections [30]. A large individual patient data meta-analysis (39 trials) of 20,827 patients with chronic pain found acupuncture to be significantly better than sham treatment or usual care, with 85% retention of treatment benefit 1 year following a course of care [31,32]. ...
... To be clear, the severity of pain is a predictor of response to acupuncture in chronic pain-i.e., the worse the pain, the better the response [33]. The immediate analgesia from a single acupuncture treatment provides better pain relief than does sham or analgesic injection, making acupuncture especially beneficial for acute pain, with opioid-sparing potential in hospital settings [30]. The largest hospital accreditation organization in the United States, The Joint Commission, has revised its pain mandate, which was originally introduced in 2000. ...
Article
Full-text available
Background A crisis in pain management persists as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis, and the evidence-base for nonpharmacologic strategies. Over 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. Objective This paper updates the evidence-base of acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses: post-surgical/peri-operative pain with opioid sparing, acute non-surgical/trauma pain including acute pain in the emergency department (ED). Methods To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials for ‘acupuncture’ and ‘acupuncture therapy’ and ‘acute pain’, ‘surgery’, ‘peri-operative’, ‘trauma’, ‘emergency department’, ‘urgent care’, ‘review(s)’, ‘systematic review’, ‘meta-analysis’ with additional manual review of titles, links, and reference lists. Results There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit (ICU). There are additional studies of acupuncture in acute pain settings. Conclusion The majority of reviews find acupuncture therapy to be an efficacious strategy for acute pain with potential to avoid and/or reduce opioid reliance. Future multi-center trials are needed to clarify the dosage and generalizability of acupuncture for acute pain in the ED. With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care.
... Acupuncture has been gaining popularity for the treatment of pain arising from various causes, particularly including low back pain. Xiang et al. [9] conducted a systematic review and meta-analysis, reporting that acupuncture was associated with greater immediate pain relief than was sham acupuncture or analgesic injections. The authors, however, stated that more studies with rigorous design and methodologies were needed to confirm the findings. ...
Article
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Background Wound pain after surgery for lumbar spine disease may interfere with patients’ recovery. Acupuncture is commonly used for pain management, but its efficacy for postoperative pain control is unclear. This study aimed to evaluate the effectiveness of acupuncture for adjuvant pain control after surgery for degenerative lumbar spine disease. Methods We retrospectively reviewed the records of consecutive patients who received surgery for degenerative lumbar spine disease at our institution from 2013 to 2014. Surgical procedures included open laminectomy, discectomy, and trans-pedicle screw instrumentation with posterior-lateral fusion. Patients were grouped by pain control methods, including routine analgesia, patient-controlled analgesia (PCA), and acupuncture. The routine analgesia group received oral acetaminophen/non-steroidal anti-inflammatory drugs with meperidine as needed for immediate pain control. The PCA group received a basal dose of morphine and subsequent user-demand doses. The acupuncture group received acupuncture every other day after surgery. Results Ninety-six patients were included, of whom 37 received acupuncture, 27 received PCA, and 32 received routine analgesics for pain control. Visual analog scale (VAS) pain scores in all 3 groups decreased significantly, and to the same degree, from the first postoperative day to the second day. No significant differences were found in VAS scores over the next 6 postoperative days; however, the scores of patients treated with PCA were slightly but still significantly higher ( p = 0.026) on postoperative day 4 than scores of patients treated with acupuncture and traditional analgesia, a difference likely due to PCA being discontinued on postoperative day 3. No major complications were noted in the acupuncture group, but 2 patients dropped out because of fear of needle insertion. Conclusions Acupuncture may be as effective as traditional analgesia and PCA for adjuvant pain control after surgery for degenerative lumbar spine disease.
... Studies in recent years have shown that the acupuncture treatment of acute renal colic caused by urinary calculi has rapid pain relief [12,13], reliable curative effect, and no toxic side effects, but the sample sizes of these trials were small, and their conclusions were seen as overly positive. At present, over 80 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 [14], and there is no systematic evaluation of the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults. e purpose of this study is to systematically evaluate the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults and to provide more evidence for clinical application. ...
Article
Full-text available
Background: Acute renal colic caused by urinary calculi has a considerable impact on the quality of life. Pain relief is the primary goal in the management of patients with acute renal colic caused by urinary calculi. At present, there is no systematic evaluation of the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults. Objective: To evaluate the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults. Methods: Databases of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Medical, VIP Database for Chinese Technical Periodicals (VIP), and China Biomedical Literature (SinoMed) were searched for literature and other randomized controlled registration platforms. We searched to identify the relevant randomized controlled trials from the establishment of the database to February 9, 2022. Only randomized controlled trials (RCTs) of manual acupuncture as the therapy for acute renal colic caused by urinary calculi in adults were included, whether or not the blind method is used. The patients were adults diagnosed with urinary calculi and renal colic. The control group was treated with commonly used analgesics and antispasmodics. The experimental group was treated with acupuncture as a monotherapy or as an adjuvant therapy (manual acupuncture combined with analgesics and antispasmodics). Two review authors independently assessed titles and abstracts for relevance and extracted data on study design, participants, interventions, and outcomes from potentially relevant articles. Cochrane risk bias assessment tool was used to evaluate the quality of the included study, and RevMan5.4 software was used for meta-analysis. Our primary outcomes were response rate and time duration before pain remission. Secondary outcomes were the time of complete pain relief, pain variation, need for rescue analgesia, and adverse events. Results: Out of 1123 records identified, 15 were found to be of relevance to this study, and 1210 participants were included in the meta-analysis. The meta-analysis of the results shows that, in terms of response rate, compared with the control group, acupuncture as a monotherapy seems to have a slight advantage (RR = 1.10 (95% CI: 1.03, 1.18), I 2 = 28%, P=0.004), while acupuncture as an adjuvant therapy has no advantage (RR = 1.06 (95% CI: 0.95, 1.20), I 2 = 77%, P=0.30). In terms of duration before pain relief, acupuncture as a monotherapy had an advantage over the control group (MD = -10.28(95% CI: -14.40, -6.17), I 2 = 93%, P < 0.00001). Acupuncture as a monotherapy was similar to positive medication in terms of complete pain relief (MD = -7.13 (95% CI: -20.19, 5.94), I 2 = 95%, P=0.28). Pain variation: VAS scores at 10 min, acupuncture as a monotherapy (MD = -2.47 (95% CI: -3.40, -1.53), I 2 = 84%, P < 0.00001) or as an adjuvant therapy (MD = -3.38 (95% CI: -4.33, -2.43), I 2 = 60%, P < 0.00001) was better than the control group. VAS scores at 30 min, compared with the control group, there was no difference between acupuncture as a monotherapy (MD = -0.27 (95% CI: -1.43, 0.88), I 2 = 88%, P=0.64) and acupuncture as an adjuvant therapy (MD = -1.17 (95% CI: -3.15, 0.81), I 2 = 96%, P=0.25). VAS scores at 60 min, compared with the control group, there was no difference in the acupuncture as a monotherapy (MD = 0.58 (95% CI: -0.28, 1.45), I 2 = 77%, P=0.19), while acupuncture as an adjuvant therapy was better (MD = -1.22 (95% CI: -1.93, -0.51), I 2 = 72%, P=0.0007). VAS scores at 120 min, there was no difference in acupuncture as a monotherapy compared to the control group (MD = -0.24 (95% CI:-1.22, 0.75), I 2 = 0, P=0.64). One study reported on rescue analgesia. Fewer adverse events occurred in the experimental group compared to the control group. Conclusion: In the course of manual acupuncture treatment of acute renal colic caused by urinary calculi in adults, available evidence suggests that manual acupuncture is as effective as positive treatment drugs, either as a monotherapy or as an adjunctive therapy, with the advantage of acupuncture being its rapid onset of action. However, the number of existing clinical studies is small, and the quality of evidence is generally low, so it is recommended to use it with caution. In order to further verify the above conclusions, more high-quality clinical RCTs need to be carried out. Trial Registration. The present review protocol was registered with the International Prospective Register of Systematic Reviews (CRD42019134900).
... Acupuncture can provide immediate and long-lasting pain relief in many pain syndromes, including visceral cancer pain, although the evidence of its effect on malignant neuropathic pain remains limited [2][3][4]. A characteristic of neuropathic pain in malignant myelopathies is the shooting breakthrough pain radiating along the segmental nerves into the periphery of the body. ...
Article
Full-text available
Introduction Acupuncture is a promising treatment for visceral cancer pain, but to date, evidence for immediate effects on neuropathic pain is limited. Case presentation This report presents a case of immediate pain relief by single-needle acupuncture on opioid-refractory neuropathic breakthrough pain in a 78-year-old female breast cancer patient with cervical bone metastases. Acupuncture was applied at a single point neuroanatomically correlating to the pain affected spinal segment. Discussion Immediately after acupuncture, the patient reported a complete pain relief lasting for one day. In the following days, neuropathic breakthrough pain was better manageable with reduced dosages of opioids. Acupuncture is possibly effective in providing immediate and safe pain relief in neuropathic cancer pain through neuromodulating effects on the spinal and central nervous level. Randomized controlled studies with individualized acupuncture point protocols are needed to establish efficacy and safety.
... Chronic pain, often defined as pain lasting longer than 3e6 months, or beyond the time of normal tissue healing, 1 is widely acknowledged to be associated with enormous social and economic costs. 2 In the USA, for example, an estimated 100 million adults in 2008 were affected by chronic pain, including joint pain or arthritis, and the annual cost of treating and managing chronic pain in the USA was as much as $635 billion in 2010 dollars, exceeding the yearly combined costs of cancer, heart disease, and diabetes. 3 Moreover, chronic pain is associated with impaired physical and mental functioning and reduced quality of life and is a leading cause of disability. ...
Article
Full-text available
Background and aim We have previously reported that histamine H1 receptor antagonists facilitate electroacupuncture (EA) analgesia in experimental animals. In this pilot study, we sought to determine whether the histamine H1 receptor antagonist dexchlorpheniramine (DCPA) facilitates EA analgesia in healthy human subjects. Experimental procedure Forty healthy subjects aged 20–30 years were randomly allocated to 1 of 4 groups: (1) sham EA at acupoints Zusanli (ST36) and Yanglingquan (GB34) (sham EA; n = 10); (2) EA at ST36 and GB34 (n = 10); (3) EA at ST36 and GB34 plus low-dose DCPA (2 mg, n = 10); (4) EA at ST36 and GB34 plus high-dose DCPA (4 mg, n = 10). Before and after acupuncture treatment, pain thresholds were determined by transcutaneous electrical stimuli on the glabrous skin of the left upper arm. Results After the acupuncture session, subjects in the EA plus high-dose DCPA group had a significantly higher pain threshold elevation compared with the other 3 study groups. The change from baseline in pain threshold in the EA plus high-dose DCPA group was significantly greater than the change in pain threshold with EA only, indicating that DCPA 4 mg facilitated EA analgesia. Conclusion The results suggest that combining H1 receptor antagonist treatment with EA appears to relieve pain to a greater extent compared with EA alone. This study is registered with ClinicalTrials.gov (https://clinicaltrials.gov/), number NCT03805035 (https://clinicaltrials.gov/ct2/show/NCT03805035).
... However, the conclusion regarding the efficacy of acupuncture treatment for brain diseases should be drawn after high-quality RCTs (Timpel & Harst, 2020;Ventz et al., 2021). In addition, in the clinical study, we should also consider the characteristics of influencing factors , such as manipulation, sensation, acupoint prescription, pathological status, and types of pain (Xiang et al., 2017) during acupuncture. ...
Article
Full-text available
The brain is probably the most complex organ in the human body. It has been the hot spot and direction of brain science research all over the world to deeply study the pathogenesis of various kinds of brain diseases and find effective treatment methods. Acupuncture is a nonpharmacological therapy of traditional Chinese medicine originating from ancient clinical practice. The research on the treatment of brain diseases by acupuncture has been constantly enriched and updated with the promotion of interdisciplinary research. In order to account for the current achievements in the field of acupuncture for brain diseases, this article reviews it in terms of conception, application, and exploration. Based on the literature review, we found that in the past decades, acupuncture has received widespread attention worldwide and many literatures have reported the clinical efficacy and underlying mechanisms of acupuncture in the treatment of brain diseases. Presently, the conception, application, and exploration of acupuncture in the treatment of brain diseases have evolved from empirical medicine to evidence‐based medicine and precision medicine, and are experiencing a deeper understanding of the information about acupuncture regulating the brain function based on interdisciplinary research. 脑是人体最为复杂的器官,深入研究各类脑病的发病机制并寻找有效的治疗方法,已成为世界各国脑科学研究的热点和方向。针刺作为一种起源于古代临床实践的中医非药物疗法,其在学科交叉影响下关于脑病的研究不断被丰富和更新。为反映近年来针刺治疗脑病的研究进展,本文试从理念、应用和探索三方面对该领域进行综述。基于文献回顾,我们发现,在过去的几十年中,针刺治疗脑病受到世界范围内的广泛关注,大量文献报道了针刺治疗脑病的临床疗效及关于这些疗效的潜在机制。目前,针刺治疗脑病的理念、应用和探索已从经验医学跨越到向循证医学和精准医学的演变,并正在经历着基于跨学科研究对针刺调节脑功能信息的更深层次理解。
... There was no significant difference between the acupressure and electrical stimulation groups before and immediately after intervention, but the labor pain 30 and 60 min after intervention was significantly lower in the acupuncture-like electrical stimulation group (Pour, Kaviani, and Razeghi, 2012). It seems that these results are related to immediate analgesic effects of acupuncture points (Xiang et al., 2017). ...
Article
Background: Labor pain is one of the most severe pains experienced by a woman during her life. Interferential current (IFC) is a type of transcutaneous electrical stimulation that can reduce pain, especially deep ones. Objective: This randomized controlled clinical trial (RCT) aimed to study the effects of quadripolar IFC on pain and the duration of the active phase of labor in primiparous women. Method: In this RCT, 60 primiparous women were randomized into two groups of IFC and sham IFC. The IFC group received IFC in two periods. The sham group received sham IFC. Primary outcomes were labor pain in different times of active phase and duration of active phase, and secondary outcomes were delivery satisfaction; the number of infants transferred to neonatal intensive care units (NICUs), fetal heart rate (FHR) disorders, Apgar score, partograph variables, and adverse side effects were recorded. Result: Between-group changes showed a significant decrease in labor pain during the active phase in the IFC group compared to the sham IFC group (mean difference (MD) = -0.95; 95% confidence interval (95% CI) = -1.35 to -0.55; P < .001). The mean of active phase duration was significantly shorter in the IFC group than in the sham IFC group (MD = -38.25; 95% CI = -62.84 to -13.67; P = .003). Conclusion: This study showed the effectiveness of interferential electrical stimulation during labor to reduce pain and duration of the active phase, which can be valuable in improving the quality of care and encouraging natural childbirth.
... 6,7 Prolonged clinical practice proved acupuncture compound analgesia therapy in OPU has the advantages of safety, high efficiency, fast recovery, and few side effects. 8,9 Although previous systematic review 10 demonstrated no evidence supporting acupuncture to be more optimal for pain relief during OPU than PCA with CSA, the updated Cochrane review supported acupuncture is appropriate to adjuvant analgesia OPU process. Various analgesic combinations are the current trend in OPU and are hotspots of peer attention. ...
Article
Objective: To obtain evidence-based conclusions about the effect of acupuncture on pain relief in women undergoing oocyte retrieval, the results of randomized controlled trials (RCTs) that met the criteria were assessed on the Pain Assessment Scale and pregnancy indicators. Search Methods: References were retrieved in MEDLINE, EMBASE, CNKI database, CBM database, VIP database, and Wanfang database from inception to June 26, 2021. Unpublished ongoing trials were searched in the Clinical Trials Registries. This review included RCTs that investigated the acupuncture analgesic effects during oocyte retrieval in women undergoing in vitro fertilization. Results: Fourteen RCTs (2503 women in total) with six types of comparisons were finally included. The quality of concluding evidence was generally low or very low. Performance bias and outcome assessment bias was the main risk of bias of the included studies. Acupuncture combined with conscious sedation and analgesia (CSA) was associated with less intraoperative (SMD=−1.03; 95% CI: −1.71 to −0.36) and postoperative (SMD = −1.11; 95% CI: −1.51 to −0.71) pain compared to receive CSA alone in oocyte retrieval. Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) was more effective than using NSAIDs alone for postoperative analgesia (MD = −1.76; 95% CI: −2.08 to −1.44). Conclusion: Acupuncture complex analgesic therapy is more effective than utilizing CSA or NSAIDs alone. Furthermore, there is no significant consensus on whether there is an analgesic effect of applying acupuncture alone during oocyte retrievals, which needs further research. The overall results should be interpreted with caution due to the high risk of bias/ low-GRADE scores among these studies. Protocol and Registration: PROSPERO registration number: CRD42020170095.
Article
Background As a traditional Chinese therapy, acupuncture is proposed worldwide as a treatment for pain and other health problems, but the findings of acupuncture analgesia have been inconsistent due to its variable modalities of therapeutic intervention. Objective This study aims to evaluate the existing animal studies for evidence of acupuncture and its association of glia with reduction in pain conditions. Methods Literature searches were performed in four English and Chinese-language databases (Web of Science, PubMed, EMBASE and CNKI) on the 8th of October 2021. Included studies reported the pain outcome (e.g., paw withdrawal latency/paw withdrawal threshold) and glia outcome (e.g., glial marker GFPA, IBA1 and OX42) in pain-induced animals during acupuncture treatment. Results 52 studies of preclinical studies were included in the meta-analysis. Single acupuncture treatment in rodents had analgesic effect, which was more effective in inflammatory pain than neuropathic pain in the early phase of treatment. The analgesic efficacy became more curative after repeated acupuncture. Furthermore, acupuncture treatment could effectively inhibit the activity of astrocytes and microglia in both inflammatory pain and neuropathic pain in a time-course pattern. Conclusions Acupuncture treatment improves analgesic effect in rodent pain conditions under the possible mechanism of glial inhibition. Therefore, these results provide an opportunity to evaluate the effectiveness of acupuncture analgesia and neuroinflammation in animal models to research further neurobiological mechanisms and to inform the design of future clinical trials.
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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.
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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.
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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.