Systematic reviews of clinical RCTs of acupuncture for chronic pain
| Reference | Indication | Comparisons | Studies | Features | Results | Conclusion |
|---|---|---|---|---|---|---|
| Key: Features (reading left to right): 1 = comprehensive search, 2 = explicit inclusion criteria, 3 = formal quality assessment, 4 = summary of each single studies result, 5 = meta-analysis; y = yes, p = partly, n = no. RCT = randomised controlled trials, CCT = non-randomised controlled trials, CS = cohort studies, UCS = uncontrolled studies; OR = odds ratio, RR = rate ratio. | ||||||
| Chronic pain | ||||||
| Ezzo 200026 | Chronic pain | Sham, placebo, no treatment, standard | 51 RCT | y / y / y / y / n | Positive results in 21 RCTs, negative in 3, and neutral in 27. Better studies more often negative or neutral | Limited evidence that acupuncture is more effective than no treatment, inconclusive evidence regarding placebo, sham and standard care |
| Patel 198927 | Chronic pain | Sham, no treatment, standard | 14 RCT | n / y / n / y / y | Overall patients receiving acupuncture were 18% (p<0.01) more likely to experience improvement | Available evidence positive but definitive conclusions difficult due to various potential sources of bias |
| ter Riet 199028 | Chronic pain | Sham, no treatment, standard, other acupuncture | 51 CCT | y / y / y / y / n | RCTs small and of low quality. 24 with positive and 27 with negative results. Better studies more often negative | The efficacy of acupuncture in the treatment of chronic pain remains doubtful |
| Back & neck pain | ||||||
| van Tulder 200129 | Low back pain | Sham, other, no treatment | 11 RCT | y / y / y / y / n | Conflicting evidence for acupuncture v. no treatment. Acupuncture not more effective than trigger point injection or transcutaneous electrical nerve stimulation. Acupuncture not more effective than placebo or sham acupuncture in most trials. Methodological quality judged as low | Acupuncture not recommended as regular treatment for low back pain. High quality trials needed |
| Smith 200030 | Back & neck pain | Inactive (sham, other, no treatment) | 13 RCT | y / y / y / y / n | 5 studies positive, 8 studies negative; better studies reported more often negative results | No convincing evidence for the analgesic efficacy of acupuncture for back and neck pain |
| White 199931 | Neck pain | Sham, other, no treatment | 14 RCT | y / y / y / y / n | 7 studies positive, 7 negative. Of the 8 better studies 5 negative, 3 positive | No convincing evidence for the effectiveness of acupuncture for neck pain |
| van Tulder 199932 | Low back pain | Sham, other, no treatment | 11 RCT | y / y / y / y / n | Conclusions of primary authors positive in 8 studies, by reviewers for 2 studies. Methodological quality judged as low | Acupuncture not recommended as regular treatment for low back pain. High quality RCTs needed |
| Ernst 1998 33 | Back pain | Sham, other, no treatment | 12 RCT | y / y / y / y / y | OR for improvement compared with all control interventions 2.30 (95%CI 1.28-4.13), with sham 1.37 (0.84-2.25). Majority of studies good quality | Acupuncture superior to various control interventions although insufficient evidence whether superior to sham |
| Longworth 199734 | Sciatica | Unclear | 1 RCT, 6 CCT, 31 UCS | n / p / n / y / n | Most studies of poor quality; a large number of patients seem to have benefited | There may be a role for acupuncture treatment of lumbar disk protrusions and sciatica |
| ter Riet 198935 | Neck and back pain | Unclear | 16 RCT, 6 CCT | y / p / y / n / n | Study design was generally poor. Results only discussed for a few better quality studies | Due to the low methodological quality no definitive conclusions can be drawn |
| Headache | ||||||
| Linde 200136 | Idiopathic headaches | Sham, other, no treatment | 26RCT | y / y / y / y / n | Majority of 16 sham controlled trials with at least a trend in favour of acupuncture. Trials vs. other treatments contradictory | Existing evidence suggests the value of acupuncture for the treatment of headache. However, quality and amount of evidence not fully convincing |
| Melchart 199937 | Recurrent headaches | Sham, other, no treatment | 22 RCT | y / y / y / y / y | Majority of 14 sham controlled RCTs with at least a trend in favour of acupuncture. RCTs vs. other treatments contradictory | Existing evidence suggests that acupuncture has a role in headache treatment. However, quality and amount of evidence not fully convincing |
| ter Riet 198939 | Tension type headache | Sham, other treatment | 7 RCT, 1 CCT | y / p / y / n / n | Small study size and methodological problems make the available RCTs uninterpretable | No definitive conclusions on the effectiveness of acupuncture for headache can be drawn |
| ter Riet 198938 | Facial pain | Sham | 2 RCT | y / p / y / y / n | Methodological quality poor | No definitive conclusions possible |
| Rheumatic diseases | ||||||
| Ezzo 200140 | Knee osteoarthritis | Sham, other, no treatment | 7 RTC | y / y / y / n / n | Strong evidence that acupuncture is more effective than sham acupuncture for pain. Limited evidence that acupuncture better than usual treatment; insufficient evidence v. other treatments. | Evidence suggests that acupuncture may play a role in the treatment of knee osteoarthritis, particularly for the treatment of pain. |
| Berman 199941 | Fibromyalgia | Sham, other treatments | 3 RCT, 4 CS | y / y / y / y / n | Acupuncture more effective than sham for symptoms and global ratings | Limited amount of evidence positive. Further research needed |
| Ernst 199742 | Osteoarthritis | Sham, other, no treatment | 7 RCT, 4 RCT /CCT, 2 RCT | y / p / n / y / n | Both sham and true acupuncture improve symptoms but better RCTs suggest no difference between the two | The notion that acupuncture is superior to sham-needling is not supported by data from controlled clinical RCTs |
| Lautenschläger 199743 | Inflammatory rheumatoid disease | Sham, no treatment, different acupuncture | 2 RCT, 7 CCT, 9 CS | n / p / n / y / n | RCTs contradictory, quality often low | Acupuncture cannot be recommended for rheumatoid arthritis, spondarthropathy, lupus eryth., scleroderma |
| ter Riet 198944 | Rheumatoid arthritis | Sham | 1 RCT, 2CCT | y / p / y / n / n | Only 1 RCT summarised; this found positive effects on pain but not on inflammation | No definitive conclusions possible |