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Background. Acute renal colic caused by urinary calculi has a considerable impact on the quality of life. Pain relief is the primary goal in the management of patients with acute renal colic caused by urinary calculi. At present, there is no systematic evaluation of the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults. Objective. To evaluate the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults. Methods. Databases of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Medical, VIP Database for Chinese Technical Periodicals (VIP), and China Biomedical Literature (SinoMed) were searched for literature and other randomized controlled registration platforms. We searched to identify the relevant randomized controlled trials from the establishment of the database to February 9, 2022. Only randomized controlled trials (RCTs) of manual acupuncture as the therapy for acute renal colic caused by urinary calculi in adults were included, whether or not the blind method is used. The patients were adults diagnosed with urinary calculi and renal colic. The control group was treated with commonly used analgesics and antispasmodics. The experimental group was treated with acupuncture as a monotherapy or as an adjuvant therapy (manual acupuncture combined with analgesics and antispasmodics). Two review authors independently assessed titles and abstracts for relevance and extracted data on study design, participants, interventions, and outcomes from potentially relevant articles. Cochrane risk bias assessment tool was used to evaluate the quality of the included study, and RevMan5.4 software was used for meta-analysis. Our primary outcomes were response rate and time duration before pain remission. Secondary outcomes were the time of complete pain relief, pain variation, need for rescue analgesia, and adverse events. Results. Out of 1123 records identified, 15 were found to be of relevance to this study, and 1210 participants were included in the meta-analysis. The meta-analysis of the results shows that, in terms of response rate, compared with the control group, acupuncture as a monotherapy seems to have a slight advantage (RR = 1.10 (95% CI: 1.03, 1.18), I2 = 28%, P = 0.004 ), while acupuncture as an adjuvant therapy has no advantage (RR = 1.06 (95% CI: 0.95, 1.20), I2 = 77%, P = 0.30 ). In terms of duration before pain relief, acupuncture as a monotherapy had an advantage over the control group (MD = −10.28(95% CI: −14.40, −6.17), I2 = 93%, P < 0.00001 ). Acupuncture as a monotherapy was similar to positive medication in terms of complete pain relief (MD = −7.13 (95% CI: −20.19, 5.94), I2 = 95%, P = 0.28 ). Pain variation: VAS scores at 10 min, acupuncture as a monotherapy (MD = −2.47 (95% CI: −3.40, −1.53), I2 = 84%, P < 0.00001 ) or as an adjuvant therapy (MD = −3.38 (95% CI: −4.33, −2.43), I2 = 60%, P < 0.00001 ) was better than the control group. VAS scores at 30 min, compared with the control group, there was no difference between acupuncture as a monotherapy (MD = −0.27 (95% CI: −1.43, 0.88), I2 = 88%, P = 0.64 ) and acupuncture as an adjuvant therapy (MD = −1.17 (95% CI: −3.15, 0.81), I2 = 96%, P = 0.25 ). VAS scores at 60 min, compared with the control group, there was no difference in the acupuncture as a monotherapy (MD = 0.58 (95% CI: −0.28, 1.45), I2 = 77%, P = 0.19 ), while acupuncture as an adjuvant therapy was better (MD = −1.22 (95% CI: −1.93, −0.51), I2 = 72%, P = 0.0007 ). VAS scores at 120 min, there was no difference in acupuncture as a monotherapy compared to the control group (MD = −0.24 (95% CI:−1.22, 0.75), I2 = 0, P = 0.64 ). One study reported on rescue analgesia. Fewer adverse events occurred in the experimental group compared to the control group. Conclusion. In the course of manual acupuncture treatment of acute renal colic caused by urinary calculi in adults, available evidence suggests that manual acupuncture is as effective as positive treatment drugs, either as a monotherapy or as an adjunctive therapy, with the advantage of acupuncture being its rapid onset of action. However, the number of existing clinical studies is small, and the quality of evidence is generally low, so it is recommended to use it with caution. In order to further verify the above conclusions, more high-quality clinical RCTs need to be carried out. Trial Registration. The present review protocol was registered with the International Prospective Register of Systematic Reviews (CRD42019134900).

IMPORTANCE Renal colic is described as one of the worst types of pain, and effective analgesia in the shortest possible time is of paramount importance.OBJECTIVES To examine whether acupuncture, as an adjunctive therapy to analgesics, could accelerate pain relief in patients with acute renal colic. DESIGN, SETTING, AND PARTICIPANTSThis single-center, sham-controlled, randomized clinical trial was conducted in an emergency department in China between March 2020 and September 2020. Participants with acute renal colic (visual analog scale [VAS] score Ն4) due to urolithiasis were recruited. Data were analyzed from October 2020 to January 2022. INTERVENTIONS After diagnosis and randomization, all patients received 50 mg/2 mL of diclofenac sodium intramuscular injection immediately followed by 30-minute acupuncture or sham acupuncture. MAIN OUTCOMES AND MEASURESThe primary outcome was the response rate at 10 minutes after needle manipulation, which was defined as the proportion of participants whose VAS score decreased by at least 50% from baseline. Secondary outcomes included response rates at 0, 5, 15, 20, 30, 45, and 60 minutes, rescue analgesia, and adverse events.RESULTS A total of 115 participants were screened and 80 participants (66 men [82.5%]; mean [SD] age, 45.8 [13.8] years) were enrolled, consisting of 40 per group. The response rates at 10 minutes were 77.5% (31 of 40) and 10.0% (4 of 40) in the acupuncture and sham acupuncture groups, respectively. The between-group differences were 67.5% (95% CI, 51.5% to 83.4%; P < .001). The response rates of acupuncture were also significantly higher than sham acupuncture at 0, 5, 15, 20 and 30 minutes, whereas no significant difference was detected at 45 and 60 minutes. However, there was no difference between the 2 groups in rescue analgesia rate (difference 2.5%; 95% CI −8.8% to 13.2%; P > .99). No adverse events occurred during the trial. CONCLUSIONS AND RELEVANCEThese findings suggest that acupuncture plus intramuscular injection of diclofenac is safe and provides fast and substantial pain relief for patients with renal colic compared with sham acupuncture in the emergency setting. However, no difference in rescue analgesia was found, possibly because of the ceiling effect caused by subsequent but robust analgesia of diclofenac. Acupuncture can be considered an optional adjunctive therapy in relieving acute renal colic.