Acupuncture and electro‐acupuncture for people diagnosed with subacromial pain syndrome: A multicentre randomized trial

Abstract

Background:Musculoskeletal disorders have been identified globally as the second most common healthcare problem for 'years lived with disability', and of these shoulder conditions are amongst the most common, frequently associated with substantial pain and morbidity. Exercise and acupuncture are often provided as initial treatments for musculoskeletal shoulder conditions but their clinical effectiveness is uncertain. This study compared group exercise with group exercise plus either acupuncture or electro-acupuncture in patients with subacromial pain syndrome. Methods:Two hundred and twenty-seven participants were recruited to a three-arm parallel-group randomized clinical trial. The primary outcome measure was the Oxford Shoulder Score. Follow-up was post treatment, and at 6 and 12 months. Between-group differences (two comparisons: the exercise group versus each of the acupuncture groups) were analysed at 6 months. A similar comparison across all follow-up time points was also conducted. Data were analysed on intentionto-treat principles with imputation of missing values. Results:Treatment groups were similar at baseline, and all treatment groups demonstrated an improvement over time. Between-group estimates at 6 months were, however, small and nonsignificant, for both of the comparisons. The analyses across all follow-up time points yielded similar conclusions. There was a high rate of missing values (22% for the Oxford Shoulder Score). A sensitivity analysis using complete data gave similar conclusions to the analysis with missing values imputed. Conclusions:In the current investigation, neither acupuncture nor electro-acupuncture were found to be more beneficial than exercise alone in the treatment of subacromial pain syndrome. These findings may support clinicians with treatment planning. Significance:Shoulder pain is common and associated with substantial morbidity. Acupuncture is a popular treatment for shoulder pain. The findings suggest that acupuncture and electro-acupuncture offer no additional benefit over exercise in the treatment of shoulder pain of musculoskeletal origin.3

Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial

“…5,17,73 Nevertheless, a recent multicenter randomized clinical trial 53 (n = 227) found that the addition of acupuncture or electroacupuncture was no more effective than exercise alone in the treatment of individuals with SAPS. However, in contrast to the current study, Lewis et al 53 included patients with full-thickness and/or massive irreparable rotator cuff tears, and therefore used a much broader and nonspecific definition of SAPS than other trials 2,7,31,32,47,63,68 and diagnostic guidelines. 14 Prior trials on dry needling for shoulder pain investigated intramuscular trigger point dry needling and needle pistoning techniques, resulting in inconsistent outcomes for meaningful changes in pain and disability.…”

“…Additionally, placement of up to 6 needles in the upper thoracic paraspinal, periscapular, and glenohumeral regions was optional and based on the findings from passive motion testing, the presence of localized myofascial trigger points, and/ or the presence of stiffness or pain during palpatory examination. Details regarding needle size, insertion site, angulation, depth, anatomical target, manipulation, 15,42,48,63,89 and electrical stimulation parameters 29,31,47,52,53,63,64 are summarized in APPENDIX A.…”

“…69 Interferential current therapy is an effective supplemental intervention for treating acute and chronic musculoskeletal pain, 12,27 and, when used in addition to exercise in patients with SAPS, IFC seems to have a positive effect on the mental component of quality of life. 84 Needling therapies (trigger point dry needling 2,68 and acupuncture/electroacupuncture 31,42,47,53,63 ) have inconsistent effects on pain and disability when compared with conventional orthopaedic therapy, placebo acupuncture, or subacromial corticosteroid injections in patients with shoulder pain.…”

Effects of Adding Interferential Therapy Electro-Massage to Usual Care after Surgery in Subacromial Pain Syndrome: A Randomized Clinical Trial

“…The PPAS is a valid, reliable, and simple-to-handle tool to assess the subjects’ apprehension to receive electrical stimulation therapy [37]. The exclusion criteria were as follows: Any contraindication to the use of IFT (Table 1) [38,39]; previous cervical spine or shoulder surgery; a history of neurological or mental illnesses; diagnosed central or peripheral nervous system diseases [23]; concomitant fracture in the neck/shoulder; altered sensitivity to tactile stimuli or loss of sensation in the neck/shoulder or upper extremity [6]; concomitant radiological diagnosis of osteoarthritis of the glenohumeral or acromioclavicular joints; fibromyalgia or rheumatoid arthritis [23]; having received injections of corticoids or hyaluronic acid following surgery; symptoms of frozen shoulder [40]; impaired cognition or communication; and being involved in an on-going medico-legal dispute.…”

“…Among shoulder complaints, subacromial pain syndrome (SAPS) is the most common disorder that result in loss of function, increased pain sensitivity [3], and impaired quality of life, accounting for up to 70% of consultations in primary care [4]. SAPS is characterized by persistent pain around the acromion, which usually worsens during or after lifting the upper extremity [5], and embraces clinical diagnosis such as subacromial impingement and rotator cuff tears [6]. The clinical course of SAPS remains unclear, and previous evidence suggests that 50% of adults with chronic SAPS may only recover after 10 to 18 months of initial onset [7].…”