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Acupuncture for chronic pain: an individual patient data meta-analysis of randomized trials

Acupuncture for chronic pain: an individual patient data meta-analysis of randomized trials
Acupuncture for chronic pain: an individual patient data meta-analysis of randomized trials
Background Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.

Methods We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.

Results In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.

Conclusions Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

0003-9926
E1-E10
Vickers, Andrew J.
e39cb4e7-1e87-47c3-a19e-c643ae9c884e
Cronin, Angel M.
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Maschino, Alexandra C.
0110c8e5-202a-4903-b0a1-d12dfea3cdf7
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
MacPherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Foster, Nadine E.
2ca79c15-6ada-4b99-982c-f8abee19e628
Sherman, Karen J.
deb97429-5af6-4328-bede-ca755bf5f1da
Witt, Claudia M.
698f841b-08d3-4179-9aca-78968fbb35ed
Linde, Klaus
72a255e6-2da6-4fd6-b9d9-452fba23de4d
Vickers, Andrew J.
e39cb4e7-1e87-47c3-a19e-c643ae9c884e
Cronin, Angel M.
0f581bb0-a980-460d-839d-6300af97a5a2
Maschino, Alexandra C.
0110c8e5-202a-4903-b0a1-d12dfea3cdf7
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
MacPherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Foster, Nadine E.
2ca79c15-6ada-4b99-982c-f8abee19e628
Sherman, Karen J.
deb97429-5af6-4328-bede-ca755bf5f1da
Witt, Claudia M.
698f841b-08d3-4179-9aca-78968fbb35ed
Linde, Klaus
72a255e6-2da6-4fd6-b9d9-452fba23de4d

Vickers, Andrew J., Cronin, Angel M., Maschino, Alexandra C., Lewith, George, MacPherson, Hugh, Foster, Nadine E., Sherman, Karen J., Witt, Claudia M. and Linde, Klaus (2012) Acupuncture for chronic pain: an individual patient data meta-analysis of randomized trials. Archives of Internal Medicine, E1-E10. (doi:10.1001/archinternmed.2012.3654). (PMID:2965186)

Record type: Article

Abstract

Background Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.

Methods We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.

Results In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.

Conclusions Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

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More information

e-pub ahead of print date: 10 September 2012
Published date: September 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 342868
URI: http://eprints.soton.ac.uk/id/eprint/342868
ISSN: 0003-9926
PURE UUID: 5b40e420-0b30-4f58-8cdf-a74c625c8452

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Date deposited: 17 Sep 2012 13:07
Last modified: 14 Mar 2024 11:56

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Contributors

Author: Andrew J. Vickers
Author: Angel M. Cronin
Author: Alexandra C. Maschino
Author: George Lewith
Author: Hugh MacPherson
Author: Nadine E. Foster
Author: Karen J. Sherman
Author: Claudia M. Witt
Author: Klaus Linde

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