Efficacy and underlying mechanisms of acupuncture therapy for PTSD: evidence from animal and clinical studies

Abstract

As a major public health problem, posttraumatic stress disorder (PTSD) has a substantial impact on individuals and society. The total excess economic burden of PTSD in the US is estimated to be more than $232.2 billion a year. Acupuncture is widely used in patients with PTSD, and an increasing number of studies have been undertaken to assess the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. However, there has not yet been a review that simultaneously elucidates the therapeutic efficacy and biological mechanisms of acupuncture. We wished to examine the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. We conducted this review in three sections as follows: a meta-analysis, an acupoint analysis, and mechanism research. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database, China Biology Medicine Database (CBM), Chinese Science and Technology Journals Database (VIP), and other databases were searched from 1 January 2012 to 27 November 2022. Based on the included studies, we first determined whether acupuncture is more effective than psychological treatment or pharmacological treatment for treating and improving the quality of life of individuals with PTSD by meta-analysis. Second, the most commonly used acupoints and parameters of acupuncture were summarized based on animal and clinical studies. Third, we attempt to summarize the current mechanisms of acupuncture in the treatment of PTSD. Finally, 56 acupoint analyses, eight meta-analyses, and 33 mechanistic studies were included. Acupuncture outperformed pharmacotherapy treatment in improving symptom scores by CAPS, HAMA, HAMD, PCL-C, and SCL-90 somatization for PTSD and outperformed psychotherapy treatment in improving symptom scores by CAPS PCL-C and HAMD, according to the meta-analysis. GV20 was the most frequently used acupuncture point in clinical studies and animal studies, with a 78.6% application rate. Acupuncture may be effective in treating PTSD by regulating the structure and components of several brain areas, regulating the neuroendocrine system, and involving signaling pathways. In conclusion, this finding indicates that acupuncture has promising potential for treating PTSD.

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“…These data extend previous work and are more definitive because of adequate power, the use of blind assessment using the CAPS-5, the combined clinical and biological effects, and the evaluation of protocol adherence. A recent systematic review by Tang and colleagues reports clinical effects of verum acupuncture for PTSD that are larger than those with psychotherapy or pharmacotherapy and mechanistic studies that demonstrate effect on systems known to be disrupted in PTSD. These authors also note that effectiveness may be strengthened by relatively high retention rates .…”

“…A recent systematic review by Tang and colleagues reports clinical effects of verum acupuncture for PTSD that are larger than those with psychotherapy or pharmacotherapy and mechanistic studies that demonstrate effect on systems known to be disrupted in PTSD. These authors also note that effectiveness may be strengthened by relatively high retention rates . Our study demonstrated either higher tolerability, satisfaction, or both compared to approximately 50% treatment retention in some trauma-focused psychotherapy clinical trials .…”

“…This led to broader adoption of and more research about acupuncture for PTSD, which has generally shown efficacy with persisting methodological limitations . The potential value of acupuncture lies in its effects in multiple interacting body systems that are core to known PTSD physiology …”

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“…This tends to occur when C&A providers achieve better outcomes at lower costs and with fewer pharmacologic side effects—a benefit that cannot be understated given the opioid crisis. For these reasons, Medicare covers acupuncture for lower back pain, and the Veteran's Administration covers acupuncture for use in PTSD (Tang et al 2023). In such cases, C&A may be a viable substitute, which should improve health outcomes and spark competition on these therapies.…”