Acupuncture for Posttraumatic Stress Disorder: A Systematic Review of Randomized Controlled Trials and Prospective Clinical Trials

Abstract

To evaluate the current evidence for effectiveness of acupuncture for posttraumatic stress disorder (PTSD) in the form of a systematic review, a systematic literature search was conducted in 23 electronic databases. Grey literature was also searched. The key search terms were “acupuncture” and “PTSD.” No language restrictions were imposed. We included all randomized or prospective clinical trials that evaluated acupuncture and its variants against a waitlist, sham acupuncture, conventional therapy control for PTSD, or without control. Four randomized controlled trials (RCTs) and 2 uncontrolled clinical trials (UCTs) out of 136 articles in total were systematically reviewed. One high-quality RCT reported that acupuncture was superior to waitlist control and therapeutic effects of acupuncture and cognitive-behavioral therapy (CBT) were similar based on the effect sizes. One RCT showed no statistical difference between acupuncture and selective serotonin reuptake inhibitors (SSRIs). One RCT reported a favorable effect of acupoint stimulation plus CBT against CBT alone. A meta-analysis of acupuncture plus moxibustion versus SSRI favored acupuncture plus moxibustion in three outcomes. This systematic review and meta-analysis suggest that the evidence of effectiveness of acupuncture for PTSD is encouraging but not cogent. Further qualified trials are needed to confirm whether acupuncture is effective for PTSD.

Needle Acupuncture for Posttraumatic Stress Disorder (PTSD): A Systematic Review

“…The results of this review are comparable to the conclusion of the one previous systematic review on acupuncture for PTSD (Kim, Heo, et al, 2013). As with our review, this previous review concluded that evidence in support of acupuncture for PTSD is encouraging yet not cogent due to the small number of RCTs and participants providing data for meta-analyses.…”

“…A previous systematic review on acupuncture for PTSD concluded that, while encouraging, the evidence of effectiveness of acupuncture for PTSD was incomplete and required further high-quality RCTs (Kim, Heo, et al, 2013). However, this previous review was conducted prior to several recent RCTs on acupuncture for PTSD, included acupressure interventions in addition to needle acupuncture interventions, and did not examine possible moderators of the intervention.…”

“…• (Lua and Talib, 2012;Lin, Chan, and Chen, 2012;Cho and Whang, 2009;Kim, Schiff, et al, 2006;Mills et al, 2005;Liu et al, 2009;Gates, Smith, and Foxcroft, 2006;Jordan, 2006), and a previous review on acupuncture for PTSD conducted before several recent trials on acupuncture for PTSD were published (Kim, Heo, et al, 2013). Search strings included terms related to PTSD (e.g., "PTSD," "post-traumatic stress") and needle acupuncture (e.g., "acupuncture," "acupuncture therapy").…”

Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis

“…Comparison to other reviews A previous systematic review on the topic concluded that evidence in support of acupuncture for PTSD is encouraging yet not cogent due to the small number of studies providing data for their meta-analyses and limitations due to the methodological quality of included trials (Kim et al, 2013). The results of this review are compatible with this previous systematic review, though we are less encouraged by the current evidence base.…”

“…Several established psychological and pharmacological approaches for PTSD are supported by evidence from systematic reviews (Amos, Stein, & Ipser, 2014;Bisson, Roberts, Andrew, Cooper, & Lewis, 2013;Stein, Ipser, & Seedat, 2006). The most recent systematic review specifically on acupuncture for PTSD is four years old and was therefore conducted prior to several recent randomized controlled trials (RCTs) on acupuncture for PTSD (Kim et al, 2013). The review authors concluded that the evidence of effectiveness of acupuncture for PTSD is encouraging, yet they included uncontrolled clinical trials that provide less valid estimates of clinical effects, did not consider several important clinical outcomes such as depressive symptoms, quality of life, and sleep quality (Hollifield, 2011), did not analyze outcomes at different time points, and did not involve formal assessments of the quality of the body of evidence to indicate the degree of confidence in the accuracy of estimates of clinical effects.…”