Author: Vickers AJ1, Vertosick EA2, Lewith G3, MacPherson H4, Foster NE5, Sherman KJ6, Irnich D7, Witt CM8, Linde K, Acupuncture Trialists' Collaboration
Affiliation: <sup>1</sup>Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: vickersa@mskcc.org.
<sup>2</sup>Memorial Sloan Kettering Cancer Center, New York, NY.
<sup>3</sup>University of Southampton, Southampton, UK.
<sup>4</sup>University of York, York, UK.
<sup>5</sup>Keele University, Newcastle-under-Lyme, UK.
<sup>6</sup>Group Health Research Institute, Seattle, WA.
<sup>7</sup>Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.
<sup>8</sup>University of Zurich and University Hospital Zurich, Zurich, Switzerland; Charite-Universitätsmedizin, Berlin, Germany; University of Maryland School of Medicine, Baltimore, Maryland.
<sup>9</sup>Technical University Munich, Germany.
Conference/Journal: J Pain.
Date published: 2017 Nov 30
Other:
Pages: S1526-5900(17)30780-0 , Special Notes: doi: 10.1016/j.jpain.2017.11.005. [Epub ahead of print] , Word Count: 409
Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for four chronic pain conditions.We searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001) with differences between groups close to 0.5 standard deviations (SD) for comparison with no acupuncture control and close to 0.2 SDs in comparison with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at one year. In secondary analyses, we found no obvious association between trial outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were associated with the type of control group, with smaller effects sizes for sham controlled trials that used a penetrating needle for sham, and for trials that had high intensity of intervention in the control arm.We conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. While factors in addition to the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain following acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominately by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.
PERSPECTIVE: Acupuncture is effective for the treatment of chronic musculosketal, headache and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.
Copyright © 2017. Published by Elsevier Inc.
KEYWORDS: Acupuncture; back pain; chronic pain; meta-analysis; migraine; neck pain; osteoarthritis; shoulder pain; tension-type headaches
PMID: 29198932 DOI: 10.1016/j.jpain.2017.11.005