Identifying patients with chronic pain who respond to acupuncture: results from an individual patient data meta-analysis
Identifying patients with chronic pain who respond to acupuncture: results from an individual patient data meta-analysis
Background: in a recent individual patient data meta-analysis, acupuncture was found to be superior to sham and non-sham controls in patients with chronic pain. It has been suggested that a subgroup of patients has an exceptional response to acupuncture. We hypothesized the presence of exceptional acupuncture responders would lead to a different distribution of pain scores in acupuncture versus control groups, with the former being skewed to the right.
Methods: this individual patient data meta-analysis included 39 high-quality randomized trials of acupuncture for chronic headache, migraine, osteoarthritis, low back pain, neck pain and shoulder pain published before December 2015 (n = 20,827). In all, 25 involved sham acupuncture controls (n = 7097) and 25 non-acupuncture controls (n = 16,041). We analyzed the distribution of change scores and calculated the difference in the skewness statistic—which assesses asymmetry in the data distribution—between acupuncture and either sham or non-acupuncture control groups. We then entered the difference in skewness along with standard error into a meta-analysis.
Findings: control groups were more right-skewed than acupuncture groups, although this difference was very small. The difference in skew was 0.124 for non-acupuncture-controlled trials (p = 0.047) and 0.141 for sham-controlled trials (p = 0.029). In a pre-specified sensitivity analysis excluding three trials with outlying results known a priori, the difference in skew between acupuncture and sham was no longer statistically significant (p = 0.2). Conclusion: We did not find evidence to support the notion that there are exceptional acupuncture responders. The challenge remains to identify features of chronic pain patients that can be used to distinguish those that have a good response to acupuncture treatment.
acupuncture, pain research, individual patient data meta-analysis, chronic pain, exceptional responder
83-90
Foster, Nadine E.
2ca79c15-6ada-4b99-982c-f8abee19e628
Vertosick, Emily A.
23aa8973-57dd-4370-9032-ddf647f79f59
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Linde, Klaus
72a255e6-2da6-4fd6-b9d9-452fba23de4d
MacPherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Sherman, Karen J.
deb97429-5af6-4328-bede-ca755bf5f1da
Witt, Claudia M.
698f841b-08d3-4179-9aca-78968fbb35ed
Vickers, Andrew J.
e39cb4e7-1e87-47c3-a19e-c643ae9c884e
on behalf of the Acupuncture Trialists' Collaboration
1 April 2021
Foster, Nadine E.
2ca79c15-6ada-4b99-982c-f8abee19e628
Vertosick, Emily A.
23aa8973-57dd-4370-9032-ddf647f79f59
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Linde, Klaus
72a255e6-2da6-4fd6-b9d9-452fba23de4d
MacPherson, Hugh
6485cd22-1dc3-4600-9e00-d3187e981663
Sherman, Karen J.
deb97429-5af6-4328-bede-ca755bf5f1da
Witt, Claudia M.
698f841b-08d3-4179-9aca-78968fbb35ed
Vickers, Andrew J.
e39cb4e7-1e87-47c3-a19e-c643ae9c884e
Foster, Nadine E., Vertosick, Emily A., Lewith, George, Linde, Klaus, MacPherson, Hugh, Sherman, Karen J., Witt, Claudia M. and Vickers, Andrew J.
,
on behalf of the Acupuncture Trialists' Collaboration
(2021)
Identifying patients with chronic pain who respond to acupuncture: results from an individual patient data meta-analysis.
Acupuncture in Medicine, 39 (2), .
(doi:10.1177/0964528420920303).
Abstract
Background: in a recent individual patient data meta-analysis, acupuncture was found to be superior to sham and non-sham controls in patients with chronic pain. It has been suggested that a subgroup of patients has an exceptional response to acupuncture. We hypothesized the presence of exceptional acupuncture responders would lead to a different distribution of pain scores in acupuncture versus control groups, with the former being skewed to the right.
Methods: this individual patient data meta-analysis included 39 high-quality randomized trials of acupuncture for chronic headache, migraine, osteoarthritis, low back pain, neck pain and shoulder pain published before December 2015 (n = 20,827). In all, 25 involved sham acupuncture controls (n = 7097) and 25 non-acupuncture controls (n = 16,041). We analyzed the distribution of change scores and calculated the difference in the skewness statistic—which assesses asymmetry in the data distribution—between acupuncture and either sham or non-acupuncture control groups. We then entered the difference in skewness along with standard error into a meta-analysis.
Findings: control groups were more right-skewed than acupuncture groups, although this difference was very small. The difference in skew was 0.124 for non-acupuncture-controlled trials (p = 0.047) and 0.141 for sham-controlled trials (p = 0.029). In a pre-specified sensitivity analysis excluding three trials with outlying results known a priori, the difference in skew between acupuncture and sham was no longer statistically significant (p = 0.2). Conclusion: We did not find evidence to support the notion that there are exceptional acupuncture responders. The challenge remains to identify features of chronic pain patients that can be used to distinguish those that have a good response to acupuncture treatment.
This record has no associated files available for download.
More information
Accepted/In Press date: 19 March 2020
e-pub ahead of print date: 22 June 2020
Published date: 1 April 2021
Additional Information:
*George Lewith is deceased
Funding Information:
This is a study from the Acupuncture Trialists? Collaboration, which includes physicians, clinical trialists, biostatisticians, practicing acupuncturists, and others. The collaborators within the Acupuncture Trialists? Collaboration are listed in our primary publications. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Acupuncture Trialists? Collaboration was funded by an R21 (AT004189 from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) to Dr Vickers) and by a grant from the Samueli Institute. Time from Prof. Foster, an NIHR Senior Investigator, was funded by the National Institute for Health Research (NIHR) under its Research Professorship award (RP-PG-011-015). The views expressed in this publication are those of the author(s) and not necessarily those of the NCCAM, 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 manuscript.
Publisher Copyright:
© The Author(s) 2020.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords:
acupuncture, pain research, individual patient data meta-analysis, chronic pain, exceptional responder
Identifiers
Local EPrints ID: 450510
URI: http://eprints.soton.ac.uk/id/eprint/450510
ISSN: 0964-5284
PURE UUID: e1ce07d2-d4ec-465b-93d8-bee80d97751d
Catalogue record
Date deposited: 02 Aug 2021 16:30
Last modified: 17 Mar 2024 14:02
Export record
Altmetrics
Contributors
Author:
Nadine E. Foster
Author:
Emily A. Vertosick
Author:
George Lewith
Author:
Klaus Linde
Author:
Hugh MacPherson
Author:
Karen J. Sherman
Author:
Claudia M. Witt
Author:
Andrew J. Vickers
Corporate Author: on behalf of the Acupuncture Trialists' Collaboration
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics