A Randomized, Controlled Trial of Acupuncture for Chronic Daily Headache

Coeytaux, Remy R; Kaufman, Jay S.; Kaptchuk, Ted J.; Chen, Wunian; Miller, William C.; Callahan, Leigh F.; Mann, J. Douglas

doi:10.1111/j.1526-4610.2005.00235.x

Cited by 78 publications

(63 citation statements)

References 31 publications

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“…The largest of these, which compared 132 verum patients with 63 sham controls [29], reported smaller overall decreases in headache days per month with no statistically significant differences between groups (41% verum vs. 37% sham, p=0.58 compared to 62% verum vs. 50% sham, p<0.001). The results of the other large randomised trial for chronic headache cannot be directly compared with ours as headache days was not an endpoint; nonetheless, a statistically significant difference was reported between patients randomised to acupuncture plus specialist headache care compared to those receiving specialist headache care alone [23]. The results of the trials appear somewhat discordant: it is for future meta-analysts to determine the extent differences between the trials are greater than what would be expected by chance, indicating genuine heterogeneity in treatments or patients.…”

Section: Discussionmentioning

confidence: 86%

Acupuncture for Tension-Type Headache: a Multicentre, Sham-Controlled, Patient and Observer-Blinded, Randomised Trial

Endres

Böwing²,

Diener

et al. 2008

Deutsche Zeitschrift für Akupunktur

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Acupuncture treatment is frequently sought for tension-type headache (TTH), but there is conflicting evidence as to its effectiveness. This randomised, controlled, multicentre, patient-and observerblinded trial was carried out in 122 outpatient practices in Germany on 409 patients with TTH, defined as ≥10 headache days per month of which ≤1 included migraine symptoms. Interventions were verum acupuncture according to the practice of traditional Chinese medicine or sham acupuncture consisting of superficial needling at nonacupuncture points. Acupuncture was administered by physicians with specialist acupuncture training. Ten 30-min sessions were given over a six-week period, with additional sessions available for partial response. Response was defined as >50% reduction in headache days/month at six months and no use of excluded concomitant medication or other therapies. In the intent-to-treat analysis (all 409 patients), 33% of verum patients and 27% of sham controls (p ( =0.18) were classed as responders. Verum was superior to sham for most secondary endpoints, including headache days (1.8 fewer; 95% CI 0.6, 3.0; p=0.004) and the International Headache Society response criterion (66% vs. 55% response, risk difference 12%, 95% CI: 2%-

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Section: Discussionmentioning

confidence: 86%

Acupuncture for Tension-Type Headache: a Multicentre, Sham-Controlled, Patient and Observer-Blinded, Randomised Trial

Endres

Böwing²,

Diener

et al. 2008

Deutsche Zeitschrift für Akupunktur

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“…15,21 Clinical effects of each of these two therapies alone have been widely studied. The effects of acupuncture on alleviating symptoms and improving QoL are supported in some studies [22][23][24][25] ; however, negative results have also been reported in the literature. 26,27 Studies that included RR as part of the study intervention reported beneficial effects of the intervention on enhancing immune function, reducing psychologic distress, and improving QoL among patients with HIV/AIDS.…”

Section: Introductionmentioning

confidence: 90%

The Combined Effect of Relaxation Response and Acupuncture on Quality of Life in Patients with HIV: A Pilot Study

Chang

Boehmer

Zhao

et al. 2007

The Journal of Alternative and Complementary Medicine

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Objectives-Treatment advances have transformed human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) into a chronic manageable disease; quality of life (QoL) has become an important health outcome. Some studies have shown the individual effects of acupuncture and the relaxation response (RR) in improving QoL of patients with HIV/AIDS. In light of the presumed shared features of acupuncture and the RR, we conducted a pilot study to examine the effects of adding the RR to usual acupuncture treatment on improving the QoL of HIV/AIDS patients. Design-Two-arm double-blind randomized controlled trial.Settings/location and subjects-We enrolled 119 patients with HIV/AIDS (mean age 46 years, 85% male) who had at least 1 of the highly prevalent HIV-related symptoms and who were receiving acupuncture treatment in an acupuncture clinic in Boston, MA.Intervention-We randomized patients into intervention (N = 58) and control (N = 61) groups. All participants received individualized acupuncture treatments prescribed by their acupuncturists. While receiving acupuncture treatment, the intervention group wore earphones to listen to tapes with instructions to elicit the RR followed by soft music that was routinely played in the clinic; the control group listened only to soft music. Results-At the 12-week follow-up, the intervention group showed significant improvements in emotional (p = 0.0002), spiritual/peace (p = 0.02), physical (p = 0.003) and mental health (p = 0.0003) QoL from baseline. Results of mixed effects regression models indicated linear trends of improvement over time in these dimensions of QoL for the intervention group (p < 0.02). In the control group, the only significant improvement was observed in the emotional QoL (p < 0.01).

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“…There was also little impact of including summary data from RCTs for which raw data were not obtained (two RCTs) 128,129 or which were published recently (four RCTs), [124][125][126][127] either for the primary analysis or the analysis with the outlying RCTs by Vas et al [120][121][122] excluded (data not shown).…”

Section: Figurementioning

confidence: 99%

Acupuncture for chronic pain and depression in primary care: a programme of research

MacPherson

Vickers

Bland

et al. 2017

Programme Grants Appl Res

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BackgroundThere has been an increase in the utilisation of acupuncture in recent years, yet the evidence base is insufficiently well established to be certain about its clinical effectiveness and cost-effectiveness. Addressing the questions related to the evidence base will reduce uncertainty and help policy- and decision-makers with regard to whether or not wider access is appropriate and provides value for money.AimOur aim was to establish the most reliable evidence on the clinical effectiveness and cost-effectiveness of acupuncture for chronic pain by drawing on relevant evidence, including recent high-quality trials, and to develop fresh evidence on acupuncture for depression. To extend the evidence base we synthesised the results of published trials using robust systematic review methodology and conducted a randomised controlled trial (RCT) of acupuncture for depression.Methods and resultsWe synthesised the evidence from high-quality trials of acupuncture for chronic pain, consisting of musculoskeletal pain related to the neck and low back, osteoarthritis of the knee, and headache and migraine, involving nearly 18,000 patients. In an individual patient data (IPD) pairwise meta-analysis, acupuncture was significantly better than both sham acupuncture (p < 0.001) and usual care (p < 0.001) for all conditions. Using network meta-analyses, we compared acupuncture with other physical therapies for osteoarthritis of the knee. In both an analysis of all available evidence and an analysis of a subset of better-quality trials, using aggregate-level data, we found acupuncture to be one of the more effective therapies. We developed new Bayesian methods for analysing multiple individual patient-level data sets to evaluate heterogeneous continuous outcomes. An accompanying cost-effectiveness analysis found transcutaneous electrical nerve stimulation (TENS) to be cost-effective for osteoarthritis at a threshold of £20,000 per quality-adjusted life-year when all trials were synthesised. When the analysis was restricted to trials of higher quality with adequate allocation concealment, acupuncture was cost-effective. In a RCT of acupuncture or counselling compared with usual care for depression, in which half the patients were also experiencing comorbid pain, we found acupuncture and counselling to be clinically effective and acupuncture to be cost-effective. For patients in whom acupuncture is inappropriate or unavailable, counselling is cost-effective.ConclusionWe have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.Trial registrationCurrent Controlled Trials ISRCTN63787732.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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A Randomized, Controlled Trial of Acupuncture for Chronic Daily Headache

Cited by 78 publications

References 31 publications

Acupuncture for Tension-Type Headache: a Multicentre, Sham-Controlled, Patient and Observer-Blinded, Randomised Trial

Acupuncture for Tension-Type Headache: a Multicentre, Sham-Controlled, Patient and Observer-Blinded, Randomised Trial

The Combined Effect of Relaxation Response and Acupuncture on Quality of Life in Patients with HIV: A Pilot Study

Acupuncture for chronic pain and depression in primary care: a programme of research

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