Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review

Abstract

BackgroundPoststroke shoulder pain limits stroke survivors’ physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain.MethodsFourteen English and Chinese databases were searched for data from January 2009 to August 2017. The review included adult participants with a clinical diagnosis of ischemic or hemorrhagic stroke who had developed shoulder pain and had undergone conventional acupuncture, electroacupuncture, fire needle acupuncture, or warm needle acupuncture. The participants in the comparison group received the usual stroke care only.ResultsTwenty-nine randomized controlled trials were included. Most studies were assessed as having a substantial risk of bias. Moreover, due to the high heterogeneity of the acupuncture therapies examined, pooling the results in a meta-analysis was not appropriate. A narrative summary of the results is thus presented. The review showed that conventional acupuncture can be associated with benefits in reducing pain and edema and improving upper extremity function and physical function. The effects of conventional acupuncture on improving shoulder range of motion (ROM) are in doubt because this outcome was only examined in two trials. Electroacupuncture might be effective in reducing shoulder pain and improving upper extremity function, and conclusions on the effects of electroacupuncture on edema, shoulder ROM, and physical function cannot be drawn due to the limited number of eligible trials. The evidence to support the use of fire needle or warm needle acupuncture in stroke survivors with shoulder pain is also inconclusive due to the limited number of studies.ConclusionAlthough most studies reviewed concluded that conventional and electroacupuncture could be effective for management of shoulder pain after stroke, the very high potential for bias should be considered. Further work in this area is needed that employs standardized acupuncture treatment modalities, endpoint assessments, and blinding of treatments.

<p>Interventions for Post-Stroke Shoulder Pain: An Overview of Systematic Reviews</p>

“…29 Three of the reviews examined more than one intervention; only data for the interventions that were included in this overview (based on recency and quality on a per intervention basis) were extracted. [30][31][32] Characteristics of the Included Reviews Table 1 summarizes the characteristics of the included reviews. Ten of the included interventions examined nonpharmacological interventions 26,28,[30][31][32][33] and one examined a pharmacological intervention.…”

Decreased risk of pneumonia in stroke patients receiving acupuncture: A nationwide matched-pair retrospective cohort study

“…Most patients’ pain has moderate or severe effects on their daily lives and remains untreated or becomes treatment-resistant [ 30 ]. However, we have no related data to show the effects of acupuncture on post-stroke pain and it needs further researches [ 31 ]. Finally, stroke survivors commonly experience varying degrees of mood disorders including depression and anxiety [ 32 , 33 ].…”

Therapeutic effect of Fu's subcutaneous needling for hemiplegic shoulder pain among stroke survivors

“…Many trials had explored the effect and safety of acupuncture for treating HSP, [11–15] and a recent systematic review also concluded that conventional and electroacupuncture could be effective for management of HSP after stroke; however, very high potential for bias should be considered. [16] Fu's subcutaneous needling (FSN) is a new acupuncture therapy, which mainly acts in the subcutaneous layer, like superficial acupuncture documented in “Huangdi Neijing” and developed from Ashi point therapy and wrist-ankle acupuncture therapy. [17] Evidence has indicated that FSN could rapidly relieve the pain and obviously improve the spasm of soft tissues in treating the soft tissues injuries in clinical practice.…”