Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews

Abstract

Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.

Acupuncture Combined with Three-Step Analgesic Drug Therapy for Treatment of Cancer Pain: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

“…Evidence-Based Complementary and Alternative Medicine nausea and vomiting than analgesic drug treatment alone. Acupuncture treatment for cancer pain is considered to have sufficient evidence to determine its effectiveness [37]; these results are encouraging and support further research on acupuncture treatment for cancer.…”

Is acupuncture effective for knee osteoarthritis? A protocol for a systematic review and meta-analysis

“…One review presented 'the challenge of adequacy of dose' recently. 33 Our group built a scoring Open access instrument to calculate the dose of acupuncture from four parameters. 53 Based on the sum of the scores, we defined three doses of acupuncture treatment: high dosage, medium dosage and low dosage.…”

“…32 In 2019, however, a review suggested that acupuncture provided relief of pain associated with KOA. 33 Most meta-analyses mainly focused on chronic pain and peripheral joint OA and were not specific to KOA. 16 17 34-37 Although there were some systematic reviews conducted to establish the association of acupuncture with KOA, few drew a definitive conclusion.…”

Systematic review and meta-analysis: the effectiveness and safety of acupuncture in the treatment of herpes zoster

“…There is some evidence that acupuncture may be beneficial in the treatment of neurological pain (12). Additionally, acupuncture is known to be a safe treatment with few adverse reactions (13). The curative effect of acupuncture in the treatment of this disease is certain.…”