The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews

Abstract

BackgroundCo-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology.MethodsPubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed.ResultsOf the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety.ConclusionsBased on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components.

The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel

“…A review of studies on acupuncture for the treatment of symptoms that are frequently comorbid with PTSD in active duty military returning from combat, reported promising results for acupuncture in reducing the severity of headaches, anxiety, fatigue, sleep disturbances, depression and chronic pain [52]. Acupuncture may be a practical and effective treatment of PTSD in emergency room settings [53].…”

Consumer Information and Treatment Resources for Posttraumatic Stress Disorder

“…Few publications examined these latter methods; two reviews of acupuncture treatment for PTSD concluded that the evidence base is not strong enough to offer rigorous recommendations. 29,30 With respect to potential consumer-targeted information in the review literature, of special note is the work of Bajor and colleagues (2011), 31 which presented a PTSD update from the Harvard South Shore Program's Psychopharmacology Algorithm Project (http://psychopharm.mobi)-work that aims at developing algorithms for pharmacological treatment options. It should be noted that this algorithm for PTSD was located only via an extensive literature search, not via a consumer-inspired Internet review.…”

Integrative Medicine and the Trauma Spectrum Response

“…Samueli Institute has performed a comprehensive systematic review of acupuncture for the full spectrum of the wrTSR. 80 Complementary and IM approaches are often of a different nature than symptom-based treatments for isolated manifestations of the wrTSR. These practices can result in healing and recovery of the entire spectrum of symptoms and dysfunction of wrTSR simultaneously.…”