Acupuncture for Chronic Pain

Abstract

Background Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain. Methods We conducted a systematic review to identify randomized trials of acupuncture for chronic pain where allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible trials, with a total of 17,922 patients analyzed. Results In the primary analysis including all eligible trials, acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001). After exclusion of an outlying set of trials that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores 0.23 (95% C.I. 0.13, 0.33), 0.16 (95% C.I. 0.07, 0.25) and 0.15 (95% C.I. 0.07, 0.24) standard deviations lower than sham controls for back and neck pain, osteoarthritis, and chronic headache respectively; the effect sizes in comparison to no acupuncture controls were 0.55 (95% C.I. 0.51, 0.58), 0.57 (95% C.I. 0.50, 0.64) and 0.42 (95% C.I. 0.37, 0.46). These results were robust to a variety of sensitivity analyses, including those related to publication bias. Conclusions Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

Warm needle acupuncture vs. needle acupuncture for osteoarthritis of the knee: A pilot study protocol

“…Consequently recent systematic reviews provide more reliable evidence when compared to reviews that were carried out in the late 1990s [1][2][3][4]. The current evidence indicates that acupuncture provides clinically relevant benefits when compared to usual care/ waiting list/ other physical interventions [4,5].…”

“…The acupuncture interventions were designed by an experienced TCM practitioner/ lecturer (Appleyard) and are based on standard texts used in the West and in China [18][19][20]; treatment protocols used in trials that have been included in systematic reviews [3,4]; treatment protocols that have been used in trials investigating warm needle acupuncture for osteoarthritis of the knee published in Chinese.…”

“…The effects of acupuncture for chronic pain have also been shown to be superior to the socalled sham/placebo/ minimal acupuncture procedures -this difference is statistically significant [4]. Interpretation of the results, however, remains controversial which has led to the identification of paradoxes within acupuncture research [6].…”

“…The procedure will be referred to here as 'needle acupuncture'. Systematic reviews of acupuncture for osteoarthritis of the knee have concluded that acupuncture provides clinical benefits [3,4,13]. The clinical trials that form the evidence base of acupuncture for osteoarthritis of the knee did not use moxibustion as part of their acupuncture protocols [3,4].…”

Effectiveness of Serious Gaming During Multidisciplinary Rehabilitation for Patients with Complex Chronic Pain or Fatigue: A Natural Quasi-experiment (Preprint)

“…With small to medium sized effects, many patients will not benefit as intended [28]. The current state of evidence, provides little support as to identify those circumstances in which patients with CP or FSS will likely have the best experiences and outcomes from which (computer-based) bio-psychosocial or alternative treatments, and why [16,18,66,67]. In this regard, present findings point towards potential positive effects when (mindfulness-based) serious gaming is presented later on in a rehabilitation process to patients with chronic back pain and comorbid psychosocial problems.…”