Highlights
- •Acupuncture has a clinically relevant effect on chronic pain that persists over time.
- •The effect of acupuncture cannot be explained only by placebo effects.
- •Factors in addition to the specific effects of needling are important contributors.
- •Referral for acupuncture treatment is a reasonable option for chronic pain patients.
Abstract
Despite wide use in clinical practice, acupuncture remains a controversial treatment
for chronic pain. Our objective was to update an individual patient data meta-analysis
to determine the effect size of acupuncture for 4 chronic pain conditions. We searched
MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published
up until December 31, 2015. We included randomized trials of acupuncture needling
versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal
pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included
if allocation concealment was unambiguously determined to be adequate. Raw data were
obtained from study authors and entered into an individual patient data meta-analysis.
The main outcome measures were pain and function. An additional 13 trials were identified,
with data received for a total of 20,827 patients from 39 trials. Acupuncture was
superior to sham as well as no acupuncture control for each pain condition (all P < .001) with differences between groups close to .5 SDs compared with no acupuncture
control and close to .2 SDs compared with sham. We also found clear evidence that
the effects of acupuncture persist over time with only a small decrease, approximately
15%, in treatment effect at 1 year. In secondary analyses, we found no obvious association
between trial outcome and characteristics of acupuncture treatment, but effect sizes
of acupuncture were associated with the type of control group, with smaller effects
sizes for sham controlled trials that used a penetrating needle for sham, and for
trials that had high intensity of intervention in the control arm. We conclude that
acupuncture is effective for the treatment of chronic pain, with treatment effects
persisting over time. Although factors in addition to the specific effects of needling
at correct acupuncture point locations are important contributors to the treatment
effect, decreases in pain after acupuncture cannot be explained solely in terms of
placebo effects. Variations in the effect size of acupuncture in different trials
are driven predominantly by differences in treatments received by the control group
rather than by differences in the characteristics of acupuncture treatment.
Perspective
Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and
osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot
be explained solely in terms of placebo effects. Referral for a course of acupuncture
treatment is a reasonable option for a patient with chronic pain.
Key words
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Article info
Publication history
Published online: November 30, 2017
Footnotes
The Acupuncture Trialists' Collaboration is funded by an R21 (AT004189I and an R01 (AT006794) from the National Center for Complementary and Alternative Medicine at the National Institutes of Health to Dr. Vickers) and by a grant from the Samueli Institute. Dr. MacPherson's work on this project was funded in part by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10186). Prof. Foster, an NIHR Senior Investigator, was supported through an NIHR Research Professorship (RP-011-015). The views expressed in this publication are those of the author(s) and not necessarily those of the National Center for Complementary and Alternative Medicine, National Health Service (NHS), NIHR, or the Department of Health in England. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the report.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2017 by the American Pain Society
