Acupuncture for neuropathic pain: A meta-analysis of randomized control trials

Abstract

BackgroundNeuropathic pain (NP) is expected to increase due to the high risk of global population aging. Acupuncture has a definite clinical effect on NP. Therefore, a systematic review and meta-analysis were conducted to evaluate the effect on pain intensity and safety of acupuncture in patients with NP.MethodsAn encompassing search of specific authoritative databases in English, from their inception to 2022, was performed. The databases were as follows: Scopus, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, and Daily. All the randomized controlled trials regarding the acupuncture treatment of NP will be included. Methodological quality assessment of the included trials was assessed based on the risk of bias from the Cochrane handbook. A meta-analysis was performed for the main outcomes. In addition, sensitivity analysis, subgroup analysis, and funnel plot were also carried out.ResultsA total of 16 studies with 1,021 patients with NP were evaluated in a systematic review. According to the results of the overall meta-analysis in eight RCTs with 338 participants, the acupuncture group was better than the control group in improving changes in pain intensity (SMD −0.59, 95% CI: −0.95 to −0.23, P = 0.001). In subgroup analysis, five trials indicated that acupuncture was more effective in improving changes in pain intensity than sham acupuncture (SMD −0.54, 95% CI: −0.95 to −0.13, P = 0.01), two trials evaluated the effect on changes in pain intensity in the comparison of acupuncture and conventional treatments, no significant difference existed (SMD −0.61, 95% CI: −1.83 to 0.61, P = 0.33), and one trial compared acupuncture with blank control evaluating the effect of changes in pain intensity with a significant difference. Eleven studies mentioned the safety conditions and acupuncture-induced AEs were mild and reversible. Both the sensitivity analysis and funnel plot analysis showed that the meta-analysis was stable and irreversible without publication bias. The GRADE was rated as “very low.”ConclusionThe acupuncture group had higher effectiveness than sham intervention or blank control for changes in pain intensity, but there is no significant difference between acupuncture and conventional treatments in treating NP. The acupuncture-induced adverse events were mild and reversible. However, the interpretation of our results should be performed cautiously due to the low methodological quality of selected publications.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306461.

A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET

“…Moderate level evidence suggests favorable utilization of acupuncture as an optional treatment for PDN. [117][118][119][120] Numerous prospective clinical studies and RCTs suggest a positive effect with relatively low adverse event rates. 119,[121][122][123][124][125] A singleblinded, placebo-controlled RCT compared acupuncture to sham acupuncture demonstrated low-moderate treatment effect without appreciable side effects, meanwhile another RCT found that pain was improved at week 12 of follow-up but efficacy waned by week 18 when acupuncture was compared to standard of care.…”

Acupuncture for radicular pain: a review of analgesic mechanism

“…Research, including a meta-analysis, has shown that acupuncture, along with massage, provides superior outcomes compared to traction therapy and traditional Chinese medicine in the context of lumbar disk herniation treatment ( Mo et al, 2019 ). Feng et al (2023) reported that acupuncture was more effective in reducing pain intensity compared to sham interventions or no treatment, and adverse events related to acupuncture were mild and reversible. Furthermore, clinical evidence suggests that acupuncture delivers better short-term relief of leg pain in patients suffering from chronic discogenic sciatica than sham acupuncture ( Huang et al, 2019 ).…”