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

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).


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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.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1001/archinternmed.2012.3654
ISSNs: 0003-9926 (print)
Organisations: Primary Care & Population Sciences
ePrint ID: 342868
Date :
Date Event
10 September 2012e-pub ahead of print
September 2012Published
Date Deposited: 17 Sep 2012 13:07
Last Modified: 17 Apr 2017 16:38
Further Information:Google Scholar

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